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05/18/2023
RESPONSES/COMMENTS
RE: Unequal Treatment of Ex-Patriot DPMs by ABPM
From: Jeff Carnett, DPM
There are many of us American trained DPMs working overseas who are not eligible to be board certified by either board as we did one or two-year residencies, but not three-year programs. So, how shocking to see that ABPM will certify those with bachelor degrees in podiatry from the UK, SA, Australia, Malta, and New Zealand who did not take the MCAT, have no basic medical sciences in their courses, and no residencies. These degrees are right from high school.
Doesn't that discredit anyone with the ABPM certification in the U.S.? So, we expatriate DPMs need to take a bachelor podiatry degree so we can get certified, but we can't get certified with a CPME-approved DPM degree and residency? I’m trying to understand how that helps the profession. While overseas, our work is often highly surgical, but alas that doesn't count.
Jeff Carnett, DPM. Auckland, New Zealand
Other messages in this thread:
07/11/2024
RESPONSES/COMMENTS (SCOPE OF PRACTICE)
From: Elliot Udell, DPM
The question of whether podiatrists should be allowed to treat any systemic condition that affects the foot is not clear cut. On one hand, would anyone question our right to prescribe antibiotics even though they are either orally or intravenously administered? On the other hand, if a patient presents with neuropathy caused by complicated diabetes, should a podiatrist be allowed to manage the patient's diabetes? What if the neuropathy is caused by a spinal lesion, would we be expected or allowed to operate on the patient's back?
The answer lies in the complexity of the systemic condition and the training to manage it. It takes an internist or endocrinologist many years to master the management of diabetes. I would not allow that same internist or endocrinologist to operate on my back. To sum it up, it’s not the practitioner's title which should govern whether he or she should be allowed to treat a systemic condition with pedal manifestations, but the training to treat such a condition.
Elliot Udell, DPM, Hicksville, NY
07/11/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE VA)
From: Joseph T. Hogan, DPM
Congratulations to Bradley Hart, DPM on his appointment to U of Washington Medical School Faculty. Brad was an outstanding resident during his residency program in Binghamton, NY. Our profession is better due to Brad's presence.
Joseph T. Hogan, DPM, Binghamton, NY
07/11/2024
RESPONSES/COMMENTS (INTERNET SECURITY) - PART 1B
From: Michael Brody, DPM
Even though secure and convenient, biometric password authentication requires and stores sensitive and unique information about individuals, like fingerprints and facial features. The risk of identity theft and fraud might significantly increase if this data falls into the wrong hands.
Biometric data is 'static'; it does not change. Once you use biometric data for login, that data is stored in your computer so that your computer can recognize you. If your computer is hacked, hackers now have your biometric data which can be utilized to break into your accounts. Here are some links to events of breaches of biometric data:
which appropriately points out breaches, the biggest disadvantages of biometrics, because biometric data can't be changed. So, if your password is hacked, you can change your password. If your security key is hacked, you can get a new security key. You cannot change your biometric data so once a hacker has it, they always have it. That is why I am not a fan of using biometric data for security purposes.
Michael Brody, DPM, Commack, NY
07/11/2024
RESPONSES/COMMENTS (INTERNET SECURITY) - PART 1A
From: Steve Pribut, DPM
Practice software requires an individual sign-in. And multiple users can use the same computer - and then sign in to the practice management software as distinct individuals on different days. Some Software allows remote access with multi-factor verification.
While the formula verification described by Dr. Brody works, there are others who feel a completely unique password for each site, and the use of a secure password remembering program is closer to ideal. I've used both methods.
When an employee leaves the practice, their password and access can be easily removed by an administrator.
Steve Pribut, DPM, Washington, DC
07/10/2024
RESPONSES/COMMENTS (SCOPE OF PRACTICE)
RE: Podiatrists Treating Systemic Conditions Affecting the Foot
From: Daniel Chaskin, DPM
In different states, podiatrists are licensed to carry out physical exams that involve ordering tests and other examinations alongside foot care treatments. The APMA and local podiatry groups should advocate for the licensing of podiatrists to manage all systemic conditions linked to any foot condition. The podiatric medical colleges offer a solid base of studies to support this argument. I recall that NYSPMA offered classes in anatomy, neuroanatomy, biochemistry, histology, pathology, internal medicine, and emergency medicine, etc.
If nurse practitioners have the authority to treat the whole body, podiatrists should also have the authority to treat any systemic condition that causes foot symptoms. If nurse practitioners do not remove a patient's shoes or socks during an examination and a podiatrist does, that podiatrist should be the one authorized to treat systemic conditions related to foot symptoms, since the feet are likely to be examined during every follow-up appointment. Patients are protected because a podiatrist’s code of conduct includes not independently treating conditions they lack current competence to treat.
Daniel Chaskin, DPM, Ridgewood, NY
07/10/2024
RESPONSES/COMMENTS (PODIATRISTS IN THE VA)
RE: Congratulations to Bradley Hart, DPM
From: Jeffrey M. Robbins, DPM
Congratulations to Bradley Hart, DPM, who was selected in May 2024 as the Deputy Chief of Surgery at the Boise VAMC. Dr. Hart has also been appointed as a Clinical Instructor, University of Washington School of Medicine, Department of Orthopedics and Sports Medicine.
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Dr. Bradley Hart |
He works closely with the UW residents and other faculty teaching the residents, lecturing during grand rounds and other noon conferences. Earlier this year, he was invited to lecture for their Hindson Winter Conference.
Jeffrey M. Robbins, DPM, National Podiatric Medical Director
07/10/2024
RESPONSES/COMMENTS (INTERNET SECURITY)
From: Joel Lang, DPM
What happens if more than one person uses the same computer?
In my office, many assistants were cross-trained and the computer had multiple users on different days.
Joel Lang, DPM (retired), Cheverly, MD
07/10/2024
RESPONSES/COMMENTS (BOARD CERTIFICATION)
RE: Confusion About Board Certification
From: H. David Gottlieb, DPM
I don't understand the mischaracterization of the concept of one podiatry board for the podiatric profession. If enacted, this would only mean that ALL podiatrists would have the chance to be board certified. Those of us who are certified by APBM or ABFAS would then have TWO, not one, certification.
One podiatry board should not eliminate the desire to specialize if one wants. Nor should it eliminate the desire to seek certification in that specialty if one wants. Podiatrists should be able to be board certified podiatrists.
H. David Gottlieb, DPM, Baltimore, MD
07/09/2024
RESPONSES/COMMENTS (INTERNET)
From: Martin R. Taubman, DPM, MBA
Consider Gnu Cash. It's free and has been around for many years. It loads onto your computer, is very powerful, and will easily suit your needs.
Martin R. Taubman, DPM, MBA, San Diego, CA
07/09/2024
RESPONSES/COMMENTS (INTERNET SECURITY)
From: David Secord, DPM
I'm surprised that Dr. Brody didn't mention the most secure way of having secure passwords: don't use them. If you use a desktop computer, a USB-based biometric reader can easily be found on Ebay. Every laptop I've owned for about a decade has had a biometric reader, but if yours doesn't, you can always pick one up.
My understanding is that the requirement to change and log password changes is eliminated if you are using a fingerprint to sign in. My newest laptop has the biometric reader built into the power button. As you are powering up, my fingerprint is read at the same time and lets me know that it has been read successfully (or not) as the Windows splash screen displays. Very convenient.
David Secord, DPM, McAllen, TX
07/09/2024
RESPONSES/COMMENTS (CPME)
From: Lee C. Rogers, DPM
CPME has proposed sweeping changes to the rules for certifying boards. In fact, much of the document for certifying boards is new. Guess what's not in there? One Board for Podiatric Medicine and Surgery. This document actually does the opposite; it's creating even more separation between "podiatric medicine" and "podiatric surgery". The fact is that a vast majority of the profession supports One Board and, in March, the APMA House of Delegates even passed a resolution expressing their support for One Board and created a task force. In the new rules, CPME incredibly violates the APMA Bylaws and takes away APMA's authority to determine which specialties we should have in the profession. The new rules also ban the ABPM from issuing Certificates of Added Qualification (CAQs).
ABPM has been testing and issuing CAQs for years in Amputation Prevention and Wound Care, Podiatric Sports Medicine, and Podiatric Surgery. CPME has never before taken any official action against the ABPM for CAQs, and to the contrary, they have granted the Board continuing recognition every year since we offered CAQs. In reality, CPME never had the authority to govern CAQs, so the rules were rewritten to give them this authority.
Lee C. Rogers, DPM, Immediate Past President, ABPM
07/08/2024
RESPONSES/COMMENTS (PHYSICIAN FRAUD)
From: Paul Kesselman, DPM
As the story states: Amniotic Wound Grafts - Charges were filed in the District of Arizona against four individuals who allegedly filed $900 million in false and fraudulent claims to Medicare for amniotic wound grafts used on Medicare patients. As alleged, the defendants targeted elderly Medicare patients, many of whom were terminally ill. The defendants caused medically unnecessary and expensive amniotic grafts to be applied to these vulnerable patients’ wounds indiscriminately, without coordination with the patients’ treating physicians and without proper treatment for infection to superficial wounds that did not need this treatment, and in sizes that far exceeded the size of the wound.
In just 16 months, Medicare paid two defendants more than $600 million as a result of their fraud scheme, paying on average more than a million dollars per patient for these unnecessary grafts. These two defendants owned wound care companies in Arizona and received more than $330 million in illegal kickbacks in exchange for purchasing the grafts billed to Medicare. In connection with the charges, the government seized over $70 million, including four luxury vehicles, gold, jewelry, and cash.
The story does not identify either of the individuals nor their specialty. No matter who has participated in this fraud and/or abuse, it provides the very reasons why CMS has decided to clamp down hard on the use of CTP. This investigation is not going to help the case which APMA and other medical associations are right now wrangling with CMS.
Paul Kesselman, DPM, Oceanside, NY
07/08/2024
RESPONSES/COMMENTS (INTERNET SECURITY)
From: Michael Brody, DPM
As part of the July 4 activities, a hacking group known as ObamaCare posted 9,948,575,739 unencrypted passwords to the Internet in a file titled rockyou2024. This list of passwords comes from a combination of old and new data breaches.
Data breaches are now seeming like an almost daily event with more and more passwords being ‘broken’ on a regular basis. What does this mean for you in terms of protecting the Protected Health Information (PHI) you are responsible for as well as protecting your private data? You always want to follow good password security policy which includes:
Change your passwords on a regular basis – at least once a year for ALL of your...
Editor's note: Dr. Brody's extended-length letter can be read here.
07/08/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 B
From: Kathleen Neuhoff, DPM
Well written Dr. Santi!
I have paid APMA dues since I was a new graduate opening a brand new practice “from scratch”. Money was tight at that time but I have always recognized the importance of supporting the only group that truly represents ALL podiatrists.
Kathleen Neuhoff, DPM, South Bend, IN
07/08/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 A
From: Kathleen Neuhoff, DPM
I agree with Dr. Chaskin’s comments about podiatrists being gatekeepers. In addition to his comments, I suggest that if we have already ordered appropriate tests and have results, it can expedite a referral appointment. For example, if I have a neurological patient with EMG/NCV results indicating progressive axonal degeneration in only one leg, I can generally get that patient into a neurologist within a week, especially if I send him to the neurologist who interpreted the report. Without those results, it may take months to get an appointment.
Another example, I have a patient with a non-painful “lump” in his leg. My fine needle aspirate indicated a hemangiosarcoma. I was able to get him in to an oncologist within a week. Without those results, I suspect it would have taken weeks or months. Also, in our area, we have a shortage of physicians, so many patients have only a PA for their primary care provider. Although PAs are an important part of our healthcare team, they certainly do not have the depth of training which is necessary to become an MD, DO, or DPM. As podiatrists, we are in a much stronger position to serve as gatekeepers than a PA is, and we have an obligation to accept that responsibility.
Kathleen Neuhoff, DPM, South Bend, IN
07/05/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Name Withheld (FL)
Name Withheld, I commend you for the way you will be handling a difficult situation. This was an honest mistake on your part, and you are trying to remedy the situation. The most important advice I would give you is to contact a medical consultant to guide you along this process. Hopefully, you are with a malpractice company that provides you with legal defense. If so, they will talk you through the process of reporting these errors to insurance companies. Several years ago, I had a circumstance where I misinterpreted the regulation of taking x-rays in my office. I thought the rules stated that as long as the practicing podiatrist is in the office the assistant can take an x-ray without being certified. I unfortunately found out this wasn’t the case.
Although we did not take many x-rays in our office, enough were taken through the years that would have put me in a difficult situation had that not been reported. I did have legal defense through PICA and they put me in contact with a healthcare consultant. It turned out to be an expensive mistake. Working with the healthcare consultant, they contacted Medicare to explain my circumstance. Medicare appreciated our transparency, but still asked for a refund of $10,000 dollars. This amount was based on three years' worth of billing. Obviously, this was not a slap on the wrist, but if they would have discovered this error themselves via a whistle blower or disgruntled employee, they could have gone back, I believe, seven years or more if fraud was suspected.
You are doing the right thing by reporting this unfortunate situation but you must go about it the right way.
Name Withheld (FL)
07/05/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A
From: Alan Bass, DPM
This is very troublesome to hear. This is why it is so important to review your collections report, as well as your accounts receivables monthly with your billing company. At this time, I suggest the following steps be taken:
1. Contact your malpractice carrier and alert them to this and ask if your policy with them contains administrative defense coverage (ADC) and if it will cover any audits that may arise from this. Hearing that this was for skin substitute claims leads me to believe that these were for Medicare recipients and that can be very problematic.
2. Contact the billing company and alert them to their inappropriate billing practices. You should ask them to return any monies to you that they were paid on the inappropriate claims, since the monies reimbursed by the insurance carrier should be refunded to them.
3. Contact the insurance companies for these claims and inform them that you are aware that you were reimbursed inappropriately for certain claims and discuss reimbursing them for the inaccurate claims.
4. Contact your accountant regarding any tax implications this may have.
5. Consider switching your billing company. I would review the last several months of billing to see if this happened previously.
Disclosure: I am the owner of my own podiatric-specific billing company.
Alan Bass, DPM, JARALL Medical Management Consulting
07/04/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 C
From: Robert Kornfeld, DPM
Dr. Santi, when I quit accepting insurance 24 years ago, the reimbursement fees, which I thought were terrible and getting worse, are now about 75% lower than when I went to a direct-pay model. This does not support your argument that APMA has done so much to put money back in the pockets of podiatrists. In fact, over the past 24 years, private practice has become a dying model because of the untenable expenses imposed on doctors by the sheer fact that without seeing a high volume of patients every day, no one can survive in the insurance-dependency model. Larger offices, larger staffs, more supplies, etc. eat away at the profitability of a private practice. Stress and burnout have replaced professional satisfaction.
So young podiatrists look for employment, where they are controlled by a private equity corporation and have productivity demands, lack of job security, nasty bosses, and no autonomy at all. I'm not sure that this is something to take pride in.
Robert Kornfeld, DPM, NY, NY
07/04/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 B
From: Andrew Levy, DPM
Once again, Dr. Jacob‘s voice is a concise, cogent, and well thought out response. He is correct, we have made inroads with a continued battle that all of us have known throughout our professional careers. His important take-away is to continue to do what we do well, ethically and properly. That will stand us well individually and as a profession.
Andrew Levy, DPM, Retired, Jupiter, FL
07/04/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 A
From: Daniel Chaskin, DPM
I have a difference of opinion than Allen Jacobs, DPM
1. Podiatric medicine mandates knowledge beyond the foot. Podiatrists who specialize in podiatric medicine act as gatekeepers similar to internists so long as physical evaluations are in conjunction with the provision of podiatric treatment. Both an internist and podiatrist can treat a foot condition, find the underlying cause of this foot condition and make a referral to the correct specialist to treat the underlying systemic cause.
2. The way medicine is practiced today is not in the best interest of patients. Podiatrists should have knowledge beyond their own...
Editor's note: Dr. Chaskin's extended-length letter can be read here.
07/03/2024
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Wenjay Sung, DPM, Joel Feder, DPM
Congrats on the name change and new logo, but what color blind agency came up with this color by committee scheme? It’s like if old podiatrists asked AI “what colors do young people like?” but vomit green and puke yellow were already taken. But congrats on the name change.
Wenjay Sung, DPM, Arcadia, CA
I agree with Dr. Steinberg's Congratulation on the change of the "Illinois Podiatric Medical Association" to the "ILAPPS". But why is the logo missing the "Winged Foot" on the caduceus? And in keeping with modern medicine, it should really be "The Staff of Aesculapius with a Foot".
Joel Feder, DPM (Retired), Sarasota, FL
07/03/2024
RESPONSES/COMMENTS (INTERNET)
From: Robert Scott Steinberg, DPM, Marco A Vargas, DPM
DJR of Tampa, FL has been my website designer for fifteen years.
Robert Scott Steinberg, DPM, Schaunburg, IL
I have tried 3 different website developers and have not been impressed. The last one I used, Patient Pop, was a complete disaster. I found a company called Carewise who developed my site and also manages it. They are extremely affordable and do a great job keeping me relevant in my market.
Marco A Vargas, DPM, Sugarland, TX
07/03/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1C
From: Jon Purdy, DPM
This topic once again spurs the question of degree change, or should I say augmentation. Going through the rigors of years of training, dedication, and the ever rising expense of getting a DPM degree, does make one wonder why we are swimming upstream.
My father was a podiatrist. He was not as well trained as I, nor did he have the privileges today’s podiatrists enjoy. He also had a fraction of the debt we face, minimal insurance interference, and did not have to deal with EHR or the myriad of other government regulatory and overhead expenses current podiatrists deal with. He was able to treat his patients well and enjoyed an income probably far better than most of today’s podiatrists, and did so seeing less patients. In short, his return on investment was far greater than today’s podiatrist.
So while we pat ourselves on the back for having achieved more inclusion, we are not reaping the benefits of our...
Editor's note: Dr. Purdy's extended-length letter can be read here.
07/03/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Allen Jacobs, DPM
Quite some years ago, I served as the scientific chairman, assisted by Ray Esper, DPM for the APMA scientific meeting for three years (Disney, California, Las Vegas, and Boston). At that time, the scientific meeting was held concurrently with the House of Delegates. At the Las Vegas meeting, I had invited a number of nationally respected medical school faculty members to lecture. I was rather upset at the fact that it seemed to me that the House of Delegates was receiving priority over my needs for the academic faculty. Although I did not voice my concern, I was indeed upset about this.
James Ganley was one of the individuals I had invited to speak. With his usual insight, he sensed that I was upset. He asked me to take a walk with him through the exhibit hall. He asked me, “Allen, you any good at politics?” I told Dr. Ganley absolutely not. I have an inability to negotiate if I feel someone is wrong and willfully misrepresenting facts or willfully distorting facts. Dr. Ganley looked at me and said "neither am I." He then said, “you know, neither one of us is good at politics. But we do need politicians. We need them to move the profession forward and...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
07/03/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Lawrence A. Santi, DPM
Dr. Steinberg asks what our APMA has done to put money back in members’ pockets. In addition to defending our members’ reputations from scurrilous attacks that could have a legitimate impact on their patient volume, our APMA is the leading organization protecting members from fee cuts, onerous payer policies, and more, all of which affect your bottom line.
Following advocacy by our APMA and others to change office and other outpatient E&M level selection methodology and advocacy to increase payment associated with those services, in 2022, podiatrists submitted approximately 530,000 more Level 4 and 5 office and other outpatient E/M services than in 2018, resulting in approximately $76.8 million more paid to podiatric...
Editor's note: Dr. Santi's extended-length letter can be read here.
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