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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:
06/15/2026
RESPONSES/COMMENTS (DME]
RE: WISeR Model Days May be Numbered
From: Paul Kesselman, DPM
Rumblings are growing in Washington that threaten any further funding of the WISeR program. For those unfamiliar, the WISeR program was set up as a pilot program to perform prior authorization (P/A) is a few states for a few medical policies. For podiatrists, WISeR has since earlier this year been conducting P/A for cellular tissue products (CTP) primarily in New Jersey, Ohio, Oklahoma, and Texas.
The U.S. House Appropriations Committee has moved forward with an amendment blocking further funding during a June 9 vote on their 2027 spending bill. Under the provisions of this proposal, none of the funds could be allocated to WISeR or any similar...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
06/15/2026
RESPONSES/COMMENTS (DIABETIC FOOT EXAMS)
From: Lawrence Rubin, DPM
Dr. Hardiman, thanks for bringing up this incredibly important topic. Your sensed frustration is completely understandable, given how crucial the diabetic foot exam is for preventing severe lower extremity complications.
I actually have some direct updates on this. Through regular communications via the Lower Extremity Amputation Prevention (LEAP) Alliance, I have been in personal contact with current NCQA administrators. They shared the exact present published status of where things stand regarding the integration of the diabetic foot exam. To the best of my knowledge Here is the substance of the HEDIS status information points as they have been published to date by...
Editor's note: Dr. Rubin's extended-length letter appears here.
06/15/2026
RESPONSES/COMMENTS (CME)
From: Chris Seuferling, DPM
Two words: PRESENT Podiatry. I have been using them for years. Well worth the fee when you weigh out the alternative methods of obtaining CME. Tons of lectures. You can select your topic. I’ve been diving deep into diabetic wound care. I listen to them on the way to and from work and before I know it I’ve met my state’s requirements. Alan Sherman (co-owner) is great too!
Disclosure: I am not affiliated nor receive any proceeds from PRESENT Podiatry.
Chris Seuferling, DPM, Portland, OR
06/12/2026
RESPONSES/COMMENTS (CODING & BILLING Q&As FROM CODINGHELPLINE.COM) - PART 1B
From: Steven Finer, DPM
When I read the question about the refusal to pay $28 I am sad. Here is the way a dental practice handles their billing. My wife needed oral surgery. When making the appointment, the receptionist informed us the fee would be $700. We have dental insurance, so we were told to bring $189.The balance was paid within 3 days electronically. Smooth as a baby’s derrière.
Steven Finer, DPM, Philadelphia, PA
06/12/2026
RESPONSES/COMMENTS (CODING & BILLING Q&As FROM CODINGHELPLINE.COM) - PART 1A
From: Howard R. Fox, DPM
I have successfully sued Magnacare in small claims court when they refused to send me a check, but rather an image of a merchant's account card. Since I don't take credit cards, I had no way of depositing their "payment." I sued them for my entire regular fee, not their allowable amount. Their lawyer called me promptly after they were served and mailed me a check the next day (and paid the full amount).
It happened again 10 years later as a secondary payer to Medicare. I called the lawyer (who still worked there), and he fixed the problem and marked my account "paper check only" and I haven't had a problem with them since. Requiring two patients' claims before they will process it is ridiculous and probably violates CMS rules. Suing them will preserve your relationship with the patient and likely be more successful. You'll find it very gratifying.
Howard R. Fox, DPM, Staten Island, NY
06/10/2026
RESPONSES/COMMENTS (INSURANCE COMPANY FRAUD)
RE: Reports on More Fraud by Contractors
From: Paul Kesselman, DPM
Two recent reports continue to illustrate the significant amount of fraud and abuse at the level of contractors, NOT physicians or suppliers. The first is the State of Massachusetts is suing UHC over alleged $100M in fraudulent Medicaid payments. Having read the summary of the complaint, it appears that for over the last decade, UHC has been involved in data mining and billing CMS for higher levels of care than were actually provided. The full story can be found here.
The second is a report from the OIG entitled: “CMS Potentially Overpaid Medicare Advantage Organizations $462 Million Based on Certain Unsupported Acute Stroke Diagnosis Codes”. The OIG Found the following:
• For all 97 sampled enrollees,...
Editor's note: Dr. Kesselman's extended-length letter appears here.
06/09/2026
RESPONSES/COMMENTS (THE ROAD TO PARITY)
RE: Maintenance of Certification (MOC) Through the National Board of Physicians and Surgeons (NBPAS)
From: Rod Tomczak, DPM, MD, EdD
MDs and DOs have another method for maintenance of certification or recertification that caught my attention. Someone sent me the article and addresses for five additional articles that explain the complete process through the National Board of Physicians and Surgeons (nbpas.org). In a nutshell, this board requires initial certification after completing an ACGME residency, an active license, and at least 50 hours of continuing medical education over a two-year period. This ACGME requirement would definitely tell us why APMA and Patrick DeHeer, DPM have tabled the offer by ACGME to visit some podiatry residency programs. The only thing podiatry would need to fulfil the stipulations set up by NBPAS for recertification is the initial certification of residency programs by ACGME. But remember, NBPAS is a maintenance of certification program for now, but things change.
One of the roads APMA and ABFAS uses to seek parity is testing podiatrists to death. Test results for first time RRA certification test takers are not released by ABFAS but...
Editor's note: Dr. Tomczak's extended-length letter appears here.
06/09/2026
RESPONSES/COMMENTS (STATE PODIATRY NEWS)
From: Erwin J. Juda, DPM, Gene Sherwood, DPM
Congratulations to John Boyle, DPM chosen as Vice President of the State Medical Board of Ohio. There is no one more deserving than him to fulfill that position. I first met John as a 4th year student during an externship at Lindell Hospital in St. Louis, Mo. back in 1981. He is an ethical and responsible decision-maker, rendering him an excellent choice to uphold the necessary standards of care issues that he will face.
Erwin J. Juda, DPM, RPh, Wilmington, DE
Congratulations to Dr. John Boyle on becoming Vice President of the State Medical Board of Ohio. He was a classmate of mine at OCPM 1982. I'm glad to see his accomplishment.
Gene Sherwood, DPM (retired)
06/09/2026
RESPONSES/COMMENTS (AI)
From: Daniel Chaskin, DPM
Running Large Language Models (LLMs) locally through Ollama or LM Studio have become the gold standard approach for independent clinics, hospitals, and medical software developers building clinical charting and billing tools.
Because medical data is governed by strict privacy laws like HIPAA, sending patient data to a third-party cloud API (like OpenAI or Anthropic) introduces significant legal, security, and compliance liabilities. Running models locally via Ollama or LM Studio completely eliminates this risk by processing patient notes entirely on-premise, with zero data leaving the clinic's local network.
Daniel Chaskin, DPM, North Bellmore, NY
Editor’s comment: PM News does not provide legal advice. Using the free or plus versions of ChatGPT does not ensure HIPAA compliance because it does not allow for Business Associate Agreements (BAA). The Enterprise and Developer Tools (ChatGPT Enterprise/API) version does allow for BAAs.
06/08/2026
RESPONSES/COMMENTS (AI)
RE: Using ChatGPT with EMR
From: Brian Kiel, DPM
I use Epic EMR. I dictate my findings into ChatGPT. It arranges an excellent SOAP note and I copy and paste into the Epic chart. It is never exposed other than onto my screen. As it prints, I read, review, and make corrections. I can get a really good chart note in about 90 seconds or less and HIPAA compliance is not an issue.
Brian Kiel, DPM, Memphis, TN
06/04/2026
RESPONSES/COMMENTS (AI)
RE: Evaluating Trusted Locally Controlled AI Systems
From: Daniel Chaskin, DPM
The deployment of artificial intelligence within clinical settings should ensure data privacy and clinical accuracy. Emerging open-source platforms—such as LM Studio and Ollama—now enable individual podiatrists to deploy localized, private Large Language Models (LLMs) directly on secure hardware. This architecture allows practitioners to enter evidence-based reference materials into a local database. The LLM can then be queried exclusively against this trusted dataset, minimizing the risk of "hallucinations" while maintaining strict confidentiality.
I believe that the American Podiatric Medical Association should consider actively developing and distributing verified, standardized datasets optimized for members to securely upload into secure LLM systems.
Daniel Chaskin, DPM, North Bellmore, NY
06/01/2026
RESPONSES/COMMENTS (MEDICARE)
From: Paul Kesselman, DPM
In the current issue of Becker’s Spine Review, there is a story which echoes the comments made over the past few days regarding physician payment. Several comments really relate to those comments made previously. First is that the MIPS program drives up the costs to medical providers who annually spend 53 hours on MIP-related tasks with compliance costing physicians almost $13,000 per year.
My question is: How does MIPS or HEDIS or any similar program actually improve patient care? Where are the peer review studies to prove it or are these programs simply a measure by which to punish physicians and reimburse less? How many specialty physicians actually measure weight and height, other than those caring for those issues and simply rely on patients to provide that information? Does your Ortho, GI, dermatologist...
Editor's note: Dr. Kesselman's extended-length letter appears here.
05/29/2026
RESPONSES/COMMENTS (DME)
RE: $15 Billion Dollar DME Fraud
From: Paul Kesselman, DPM
Becker’s ASC Review recently posted that the DOJ has settled a fraud case against 8 physicians involved in DME fraud, to the tune of $1.5B. One of the physicians was an OB-GYN who signed numerous prescriptions for DME items for Medicare beneficiaries who were not her patients. She agreed to pay Medicare back $507,000 to resolve False Claim Act allegations. She and another physician who agreed to pay back about $62,000 were the low folks on the totem pole. There was one individual who was captured after being a fugitive who was sentenced to 150 months in prison for leading and organizing a $61.5M healthcare fraud scheme. This involved orthotic braces, foot baths, and genetic testing for patients who did not need any of these DMEPOS.
The list goes on and on. I again ask Medicare why DME fraud is so rampant in the Medicare Fee for Service world, yet you don’t hear much of it going on in the private sector or Medicare Part C plans. The reason is simple. There are much...
Editor's note: Dr. Kesselman's extended-length letter appears here.
05/27/2026
RESPONSES/COMMENTS (PODIATRISTS AND AI)
RE: When Will AI Replace Podiatrists?
From: Dieter Fellner, DPM
Out of curiosity (and perhaps mild professional self-preservation), I recently asked ChatGPT how long it thought it would be before AI and robotics replace podiatrists and surgeons. The response was interesting. AI will likely become extraordinarily powerful in diagnostics, pattern recognition, documentation, workflow optimization, and decision support over the next 10–20 years. No great surprise there.
But when it comes to hands-on procedural medicine? The estimate became much longer. AI pointed out something that is often overlooked by Silicon Valley enthusiasts: medicine is not merely information processing. Even the mundane task of trimming toenails is, in reality, an extraordinarily complex physical interaction. What appears to the casual observer as, “clip nail” actually involves continuous subconscious processing of...
Editor's note: Dr. Fellner's extended-length letter appears here.
05/27/2026
RESPONSES/COMMENTS (HEALTHCARE NEWS)
From: Elliot Udell, DPM
For many years, we have employed the use of dermatoscopes in our practice, and yes it can make a life or death difference for patients. Several years ago, a patient came into my office for care of mycotic toe nails. He asked me to look at a black lesion on his belly. I was quick to let him know that it is totally out of scope for me. He replied that he just came from his dermatologist who looked at it with his naked eyes and said it was nothing. After prodding, I looked at the lesion with my dermatoscope and noted that it had asymmetric borders and different colors, and, as some experts would say, "It was an ugly lesion." I sent him back to his dermatologist immediately with my findings. Three months later, the patient returned to my office and gave me a big hug. The dermatologist did a biopsy and it was indeed a melanoma. The dermatologist told him that his podiatrist saved his life.
To buy a dermatoscope, do a search on Amazon and you will find dermatoscopes ranging from low to high prices. To learn the cardinal signs of how to determine if a lesion is a melanoma or a non-malignant nevus, I highly recommend attending lectures on the topic given by Dr. Steve McClain from McClain labs, and/or read some of the literature on the Internet. You can also attend seminars given by Ashvin Margoob, MD, a world authority on dermatoscopy. The Academy of Continuing Podiatric Medical Education often has Dr. Margoob and Dr. McClain lecture, online, on this very topic.
Elliot Udell, DPM, Hicksville, NY
05/26/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS) - PART 1B
From: Vince Marino, DPM
The comment posed by Dr. Kesselman and especially the follow-up by Dr. Ribotsky are spot on. Today’s practitioner should not only read these articles but REALLY UNDERSTAND what is being said and the economics behind it. Medical practice in general is, after all, a business. Without understanding the economics and points discussed by Drs. Kesselman and Ribotsky, today’s young practitioners will have a very difficult time succeeding in the business of podiatric medicine.
Vince Marino, DPM (Retired), Novato, CA
05/26/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS) - PART 1A
From: Paul Kesselman, DPM
I received this post from a non-physician. He apparently has his pulse on the insurance market, which provides more on the story, not from the public but from the private part of the insurance market. I urge everyone to read this.
Would you actually be shocked (as he was) that the insurance companies actually hid some of their profits using some accounting scheme and that their profits are much larger than they reported? Would you be shocked that the private insurance segment does not want Medicare for all and is doing what they can behind the scenes to stall this? None of those are surprises.
Paul Kesselman, DPM, Oceanside, NY
05/22/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS)
RE: Salary Raises for Physicians
From: Paul Kesselman, DPM
Here in the Northeast, the largest commuter railroad strike ended after 3.5 days. Union workers prior to the strike were paid a median wage of over $140K. With overtime, one train engineer is hauling in a salary of more than $350,000. These figures do not include other benefits, including shift differential, health and disability insurance, and vacation pay. With their new contract they are expected to gain an average of increase of approximately 4% compared to a few years ago from when their previous contract expired. The raises will continue for the next several more years.
Similarly, many LIRR non-union executives have salaries well over $300K. The same is true for our utility executives with hundreds exceeding $500,000 and some deferring payments of well over $185,000 until they retire. Note that many of the union laborers have no college degree and...
Editor's note: Dr. Kesselman's extended-length letter appear here.
05/22/2026
RESPONSES/COMMENTS (INTERNATIONAL PODIATRY IN THE NEWS)
From: Gary S Smith, DPM, Keith Gurnick, DPM
When I first opened practice in a small town in 1991, I discovered that a podiatrist had been here for 25 years before they found out he didn't have a license and he left. Apparently, everybody loved him and thought he was great. His secretary took over his business and went door to door practicing podiatry. She would even call me "her colleague". She "practiced" for several years and there wasn't anything I could do because her husband was the local judge.
I really don't see this as much different than what goes on in rural areas today. There is a local "cardiology center" where you can make an appointment to see the "cardiologist "and he is just a PA. There is no doctor, period. No doctor ever comes to or is affiliated with that clinic. There is a dermatologist clinic that is the same way. Only a PA on staff. There is no doctor and no doctor ever comes to that dermatology clinic though they tell you when you make an appointment you will see a dermatologist.
Gary S Smith, DPM, Bradford, PA
It sounds like she should apply for a job at the Good Feet Store.
Keith Gurnick, DPM, Los Angeles, CA
05/21/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Ken Meisler, DPM
I was glad to see this topic because my practice uses bone stimulators quite a bit. We do use bone stimulators for non-unions but predominantly use them for delayed unions. In addition, we also use them for some fresh fractures. Insurance companies have different periods of time when a delayed union fracture will qualify so that the bone stimulator will be paid for. It may depend on the amount of healing that has occurred by that period.
Bone stimulators can also be approved for fresh fractures and will be paid for by the insurance company in some cases. For example, a Jones fracture where the patient is not a surgical candidate, the bone stimulator may be approved to avoid prolonged non-weight-bearing and possible non-union. Another example is a displaced metatarsal neck fracture that is borderline between needing surgery or not. Healing faster can avoid further displacement and significant mal union. They can also be used for surgery patients if there are concerns about possible delayed fusion.
Finally, I have found patients who develop a fracture this time of year and are very upset they might have to avoid golf or tennis for 2-3 months will consider paying out-of-pocket for a bone stimulator to speed healing. Many of those patients are willing to pay for the bone stimulator themselves to be able to get back to sports a few weeks earlier. Most importantly, I find them very effective.
Ken Meisler, DPM, NY, NY
05/21/2026
RESPONSES/COMMENTS (INTERNATIONAL PODIATRISTS IN THE NEWS)
From: Richard H. Mann, DPM
I would like to extend my heartfelt congratulations to Jeffrey A. Ross, DPM, MD, on his induction as a Fellow of the Royal College of Physicians and Surgeons of Glasgow (FRCPSG). This internationally recognized honor is a reflection of Dr. Ross's decades of outstanding clinical excellence, leadership, and dedication to advancing our profession. We should all be proud to call him a colleague and celebrate this well-deserved distinction.
Richard H. Mann, DPM, Boca Raton, FL
05/20/2026
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Lawrence Rubin, DPM
It is truly unfortunate that so many podiatrists remain unaware of the significant benefits of time-based billing, a missed opportunity that hinders both professional recognition and patient outcomes. By failing to leverage these codes, specialists overlook a vital mechanism for documenting the exhaustive coordination required to collaborate with primary physicians and the intensive counseling necessary for managing chronic conditions like diabetic peripheral neuropathy (DPN) and peripheral rrtery disease (PAD). This gap in knowledge not only undervalues the podiatrist’s complex role in the multidisciplinary care team but also limits the dedicated time spent educating patients on limb-salvage and long-term health.
Lawrence Rubin, DPM, Las Vegas, NV
05/20/2026
RESPONSES/COMMENTS (AI)
RE: More AI Uses and Features
From: George Jacobson, DPM
I don't think the profession is using these new AI technologies in their everyday practice. I have been using AI to evaluate all of my personal market holdings and strategies. I can now monitor CEFs and ETFs for destructive NAV patterns with updated tax estimates. It tracks the amount of room for ROTH conversions without pushing into a higher tax bracket while also tracking the ceiling to receive the maximum additional >65-year old's additional tax deductions.
George Jacobson, DPM, Hollywood, FL
05/18/2026
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW- PART 1B
From: Paul Kesselman, DPM
Having previously spent a few decades applying CTP to many patients, it is a shame what has transpired over the past six years since I retired from practice. We have no doubt killed a golden goose. But gold is not referred to in a monetary fashion for the graft reimbursement, per se, but for what it was worth to the millions of patients whose limbs and wounds were salvaged. The UT case is only one, https://podiatrym.com/go.cfm?n=16088
There is so much blame to go around for this massive problem. Let’s start with the HCPCS common work group, which...
Editor's note: Dr. Kesselman's extended-length letter appears here
05/18/2026
RESPONSES/COMMENTS (PODIATRISTS AND THE LAW) - PART 1B
From: Brian Kashan, DPM
Once again, podiatrists/physicians are being used as the pawn in the chess game of medical supply and pharmaceutical companies. This is nothing new, but the stakes are getting higher with the increased costs of drugs and products. What is not new, are these companies refusing to take on any risk, and make the lion's share of profit. Without us, they have no business, but they refuse to partner with us when it comes to risk.
Years ago, when skin substitutes became available, I asked the rep (from a well known and large company) to share the cost risk with me. The product was a thousand dollars or so, and the application of it paid about...
Editor's note: Dr. Kashan's extended-length letter appears here.
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