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06/05/2023
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Advice for Expatriates Returning to U.S.
From: Paul Taylor, DPM
For a podiatrist who leaves the country and is unable to practice upon return, there is another consideration. Since I retired in Maryland, I maintain an inactive license for $50 a year. If I elect to return to practice, all I need to do is make up all missed continuing education credits. I don't intend to return to practice, but if I need to, it's nice to know I can. I don't know if this is available in all states.
Paul Taylor, DPM, Silver Spring, MD
Other messages in this thread:
09/02/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: H. David Gottlieb, DPM
Reviewing this current topic, I have started and deleted several multi-paragraph replies. The topic is addressed by most, if not all self-help and self-improvement lectures, books, and tapes/CDs/podcasts. And the answer is always this: The only person who defines who/what you are is you.
H. David Gottlieb, DPM, Baltimore, MD
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Brian Wm. Zale, DPM
I was sued some 25 years ago by an attorney who I believe just hated podiatrists. PICA was my medical liability company at that time. The patient had bilateral bunionectomies by another podiatrist previous to seeing me. She also had some plastic surgery on her right ankle for a brown recluse spider bite that looked horrible. Needless to say, she was unhappy with the bunionectomies I performed and I was sued along with my assistant surgeon and the resident on the case. She sued me for all the normal things of lack of informed consent, chronic pain, inability to have sex, unable to work, loss of future income, etc.
They had an economics guru expert from University of Houston to figure out her future loss of income. Their expert witness was a "Board certified foot and ankle orthopedic surgeon" from San Antonio who hated podiatrists. My expert was a board certified podiatrist from...
Editor's note: Dr. Zale's extended-length letter can be read here.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ken Hatch, DPM, Herb Schmirer, DPM
I did get a notice via my state association. I first joined APMA in 1976. I am now a life member. When I tried to vote, it kicked out my password and number. When I called APMA, I was told that LIFE membership did not include voting rights. WE old guys saw the best and worst of podiatric medicine over many years. I guess the current leadership does not need input from our experience.
Ken Hatch, DPM, Annapolis. MD
I join the growing list of APMA life members whose vote is not important to the APMA. If my opinion is not good enough for the APMA, my money will not be either.
Herb Schmirer, DPM (Retired), Port Washington, NY
Editor's note: This topic is now closed.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Bret Ribotsky, DPM, Lawrence A. Santi, DPM
I’m eagerly awaiting APMA’s response to this issue before I send my check. Please choose wisely.
Bret Ribotsky, DPM, Fort Lauderdale,, FL
APMA values every member and their input, and we apologize to any life member who may feel disenfranchised by the current referendum. As background, eligibility to vote in a referendum is codified in the APMA Bylaws for each member category—the APMA Board of Trustees and staff cannot simply choose to allow life members to vote. The Bylaws, Procedures, and Rules Committee reviewed the privileges afforded each member category as part of its comprehensive review of APMA’s governance documents and included the current privileges that were adopted by the 2019 House of Delegates. Life members are not the only category of members who are ineligible to vote. For more information on eligibility, check out our FAQs about the referendum at www.apma.org/referendum.
The philosophy of the committee has been that members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum. So, life members, who are retired from practice, would not be affected by language designed to support scope of practice modernization.
I have heard your concerns, and the Bylaws, Procedures, and Rules Committee will consider the feedback we have received from life members at its fall meeting. To be clear, changing the bylaws would require action by the APMA House of Delegates, so any changes will take time. I thank you in advance for your patience and understanding.
Lawrence A. Santi, DPM, President, APMA
Editor's note: This topic is now closed.
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Steven J Berlin, DPM, Carl Solomon, DPM
I read that several retired podiatrists have felt slighted by not being able or being denied the opportunity to voice their opinions on current events affecting the profession. That certainly needs to change. I suggest a column of current situations affecting this great profession. We need a special column in the newsletter drafted by senior editors and/or Journal to encourage the opinions of us older podiatrists
Steven J Berlin, DPM
I acknowledge, but don't agree with the philosophy that life members are ineligible to vote because "... members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum."
That makes about as much sense as not allowing voting rights to members who are employed by a hospital or other institution, because they may not be affected by certain issues that would have a greater impact on private practice docs. Some issues affect everybody and some issues do not affect everybody. We cannot permit our membership to be fragmented like that.
Carl Solomon, DPM, Life Member, APMA
Editor's note: This topic is now closed.
08/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Ira Cohen, DPM
I join Rod, Larry, and Name Withheld in deciding not to pay the voluntary contribution after 39 years of practice and 4 years of Life Membership. I learned so much from senior DPMs like Sy Lane, Howard Marshall, and a long list of veteran podiatrists.
As California podiatrists, we fought for years to obtain ankle privileges (I believe 2nd in the nation) establishing a path for many states to follow. For APMA to take our contribution and not allow us to vote indicates they have no regard for our decades of experience in medicine and politics.
Ira Cohen, DPM, Boca Raton, FL
08/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Steven E Tager, DPM
I too am a life member of APMA. I also did not get solicited for my opinion on the APMA definition of podiatry. I will withhold my contribution this year.
Recalling something about "taxation without representation" comes to mind and who knows more about "history can teach us a lot" than those who lived it?
Steven E Tager, DPM, (Retired), Scottsdale, AZ
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
I am an APMA Life Member. I love APMA and its decisions most of the time, but not always. Not only can we not vote, but in the past, I have found that suggestions for specific positive actions that would benefit podiatry and our contribution to public health have been disregarded without explanation. One would think that new ideas and opportunities would be welcomed and respected and not treated with indifference.
Lawrence Rubin, DPM, Las Vegas, NV
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: APMA Member
I am a life member of APMA who was solicited for a $150 voluntary contribution. I did not get solicited for my opinion on the APMA definition of podiatry. I think I'll withhold my contribution this year just like the Life Member in the August 27, 2024 PM News. That's only two of us withholding and it won't make much difference in the APMA budget, but perhaps other Life Members who have not sent their contribution might follow suit and join us. What our action does do is alert the younger members of APMA what the future holds in store for them. Perhaps APMA could count 3 out of 5 Life Members in determining our input.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
RE: Who Decides Who is a Physician? (Rod Tomczak, DPM, MD, EdD)
From: Paul Kesselman, DPM
This is a very interesting topic considering that on this very day 47 years ago, I attended my first classes at what was then referred to as the Illinois College of Podiatric Medicine (ICPM) and which is now part of the Rosalind Franklin University (RFU). Almost fifty years later, ICPM has been incorporated into the "mainstream" medical educational system. For those who are unaware, RFU hosts the Chicago Medical School, Scholl College of Podiatric Medicine, School of Nursing, Pharmacy, and several other programs in the medical field.
During my undergraduate podiatry rotations, whether at the VA or Naval Hospitals, there was no distinction for medical (MD) vs. podiatry (DPM) vs. DO students. We all were treated in the same tough manner. Not once during those rotations did I ever hear, "Oh, you are a podiatry student; we don't expect you to ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Eric J. Lullove, DPM
There are numerous multilayer compression systems on the market for management and treatment of venous leg ulcers. They are not “replacements” of an Unna boot. They are specific for a different diagnosis code set. Multilayer compression systems should be billed with the I87.xxx series ICD-10s. The CPT code for those systems is 29581. The code is not a substitute for making a multi-layer compression from your supplies — this code was designed specifically for the compression system kits that are manufactured by 3M, Urgo, Milliken, Hartmann, et al.
You must document the need for edema control, CEAP or VCSS clinical documentation for a VLU or venous hypertension (or hyper congestion) as well as the failure of conservative therapy of elevation and stockings. You also should as a caveat have a recent ABI dated from the initial onset of the venous event or ulcer and any other additional vascular studies (venography, for example). As always, it’s about documentation, documentation, documentation, especially with wound care services.
Eric J. Lullove, DPM, Coconut Creek, FL
08/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Lawrence Rubin, DPM
"Medicare and private insurance cannot always identify an MD's or DO's specialty and their use of billing codes as easily as they can with a DPM after their name." - Reingold
In response to Dr. Reingold's post that suggests Medicare may not know what provider specialist such as DPM, MD, etc., is billing the claim, and that knowing this might alter a payment coverage, this is not the case. A Medicare/Medicaid Provider Number (MPN) on the claim verifies that a provider has been Medicare certified and establishes the type of care the specialist provider can perform. This identifier is a six-digit number. In addition, other than there being a few exceptions, Medicare considers podiatrists as physicians providing what it determines and publishes to be medically necessary for all specialties and is within the scope of our license.
Lawrence Rubin, DPM, Las Vegas, NV
08/27/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: APMA Wants My Money, Not My Vote
From: APMA Member
APMA excludes Life members from voting, then asks for money. I feel quite disappointed that the recent referendum about the new definition for podiatric physician that APMA is seeking approval for has excluded life members from voting. Who better than people who have longitudinal knowledge and experience to be able to shed insight into this process?
And then the same week, I receive a lifetime member contribution form with APMA asking for $150 from me. I have always paid this contribution amount to APMA, but this year I’m refraining from doing so because obviously if my vote doesn’t count, neither does my money.
APMA Member (Verified)
08/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jack Reingold, DPM
I graduated from CCPM in 1979 and retired in 2023, practicing in San Diego, CA the whole time. Luckily, there were hospitals in the area that let me have surgical privileges when I started. Within 15 years, all the hospitals in my area granted podiatrists virtually full surgical privileges (including ankle) and admitting privileges. Managed care arrived and discovered that podiatrists delivered excellent, cost-effective care and began hiring them in great numbers. Kaiser Permanente Medical Group went from none to currently 21!
Hospitalists started calling us and begging us to take patients. Nobody seemed to care about our degrees, caring only if we could take care of their patients (and perhaps off their hands). The hospitals wanted us to take positions on many...
Editor's note: Dr. Reingold's extended-length letter can be read here.
08/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatrists Should be Doing Their Compliance Due Diligence
From: Lawrence Rubin, DPM
Due diligence refers to the reasonable steps that should be taken by a person or business entity in order to satisfy legal requirements. This diligence should include complying with the Medicare Office of the Inspector General (OIG) strong recommendation to have a provider and staff written compliance plan that is implemented and kept up-to-date.
There is no better way to avoid unintentional coding and documentation errors from resulting in an audit that can lead to potentially devastating punitive actions. This is because the OIG is on record for saying: Having a provider and staff (including outsourced billing staff) compliance program can be a mitigating factor in the decision of whether or not we (OIG) effect punitive action.
If you are a solo or small group practice owner or manager and are interested in knowing more about Medicare compliance matters, discuss this with your healthcare attorney or a qualified compliance consultant.
Lawrence Rubin, DPM, Las Vegas, NV
08/24/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Name Withheld
Early this morning, I had just finished my coffee and reading the latest PM News. Once again, we, as podiatrists, were discussing the DPM vs. MD/DO parity issue and whether or not we are physicians. As usual, many in our profession believe we are on par with the MD/DO group and should be treated as such by all, and the other side believes we should remain as we are, our own profession.
I have to admit that there had been many times in my now 35 plus year career as a podiatrist that I have wished that I had gone the MD or DO route so I could be a “real doctor, a physician” but that had not been my path. I was daydreaming about what it would be like to be that “real doctor” and contemplating a second cup of coffee but my cell phone rang. It was a hospitalist standing in the ED at the local community hospital asking me to...
Editor's note: Name Withheld's extended-length letter can be read here.
08/20/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: The Language of Podiatry
From: Lawrence Rubin, DPM
I rarely look into my storage boxes, but I did dust this item off when I found it sticking out of a box. I opened this notebook containing my first healthcare entrepreneurial venture. In 1978, with the help of Dr. Phil Brachman and a few other supportive faculty members of the Illinois College of Podiatric Medicine (now the Scholl College of Podiatric Medicine), I recorded and we published The Language of Podiatry tape cassettes and printed manual for podiatric assistants.
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The Language of Podiatry |
It made only a little money for me and the college, but it was very well received by many podiatric assistants. I'm wondering if any of my peers who might have bought this for their assistants is reading this post and remember it?
Lawrence Rubin, DPM, Las Vegas, NV
08/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Steven Finer, DPM
After reading Dr. Tomczak’s post, I reviewed the various boards in Pennsylvania. The Podiatry Board is the only medical one that requires two physicians, save one other. Physical therapists, require one. I have not researched the history of these board hand holdings. Somewhere in our past, podiatrists needed a lot of guidance, lest they stumble and do something idiotic. It seems that chiropractors, optometrists, and dentists do not need any help.
Steven Finer, DPM, Philadelphia, PA
08/19/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM
The Merriam Webster Dictionary defines physician as follows: "a healthcare professional (such as a dermatologist, internist, pediatrician, or urologist) who has earned a medical degree, is clinically experienced, and is licensed to practice medicine as usually distinguished from surgery..."
What’s interesting is that two dictionaries distinguish "being a physician" from being a surgeon. In England, if a doctor specializes in surgery, he or she is no longer called doctor, but Mr. or Ms.
But who really defines who is a physician? It’s the patient! Many years ago, I needed to do an emergency incision and drainage on a patient who had a badly infected toe. He would not let me touch him until his chiropractor gave him clearance. He did not clear him and the patient eventually wound up in the hospital on IV antibiotics. In this case, who would that patient define as being his physician, I the podiatrist, his chiropractor, or the doctors who took care of him in the hospital?
Elliot Udell, DPM, Hicksville, NY
08/17/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Who Decides Who is a Physician?
From: Rod Tomczak, DPM, MD, EdD
So, are we or are we not physicians and who decides the answer? Does someone in an ivory tower get to ratify our decisions and are there legal repercussions if we answer in the affirmative? But another group asserts we made the wrong choice. Is there some knight in the background counselling us to, “Choose wisely!”
Chiropractors call themselves chiropractic physicians in several states, perhaps over 30. It seems ludicrous to think there are chiropractic physicians and not podiatric physicians, but yet here we are, and it is happening. How can this be? I think the problem begins with which medical board holds sway over a certain discipline. Every state has a chiropractic board that more or less governs chiropractors within the framework of the state law. Where ambiguities exist, the state legislature and attorney general turn to the...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Joel Lang, DPM
My heartiest congratulations to Dr. Michael and his "soon-to-be-doctor" daughter for not accepting the status quo. Nothing ever changes until someone decides to change it. Sometimes it only takes a small voice speaking into a receptive ear. If she were my daughter, I could not have been prouder. Jonathan, give her a hug from all of us.
Joel Lang, DPM (Retired) Cheverly, MD
08/15/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From Paul Kesselman, DPM
Orthotics are custom fabricated, custom fitted, off-the-shelf, etc. Some companies advertise their wares as being able to cure everything and custom fabricated. While not every consumer can sniff out the snake oil salesman as medical providers, it is our job to report those who violate the law! Each state has different board regulations on who can dispense orthotics. If a company is marketing custom fabricated or custom fitted orthotics to the consumer, there are often state laws limiting this activity.
One can identify the 20 or so states which strictly regulate who can provide orthotic devices. By visiting the NPE West contractor at NSC, one can search under tools bar for a particular state's licensure database for all sorts of DME. Here you can find your state's licensure requirements for dispensing all types of orthotic devices. If you find that you practice in a state requiring a licensure and should the orthotic manufacturer be marketing directly to the consumer, this may be a reportable violation of the state’s laws and must be reported. There may be different regulations between custom fit, off-the-shelf and custom fabricated orthotics. So one needs to be careful to check all three benefit categories (OR1 =Custom Fabricated, OR2=Custom Fitted; OR3=Off-the-Shelf).
It is important to note that while this information is available on a Medicare contractor's website, the NPE contractor is using your state's board information and this is updated on a fairly regular basis. Thus, it is both fairly reliable and accurate.
Paul Kesselman, DPM, Oceanside, NY
08/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jonathan Michael, DPM
I appreciate all the comments sent regarding my initial post. Here is an update to the situation: My daughter decided to have a meeting with the dean who happened to be fairly new to the school and went to a medical school with a podiatry program. She was very empathetic to the situation and told my daughter that the reason she was told "no" initially by the staff below her is that the rule was set from before she was dean at the school.
She encouraged my daughter to write a letter to the committee laying out reasons why podiatrists are physicians and surgeons. Following the detailed letter by my daughter, we got the news this morning that her wish was approved by the committee and I will (hopefully) coat my daughter at the end of the month at her medical school.
Jonathan Michael, DPM, Bayonne, NJ
08/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: False Advertising about Orthotics? (Vincent Gramuglia, DPM)
From Elliot Udell, DPM
Dr. Gramuglia brings up two issues. One is whether a non-medical professional can prescribe orthotics. The other is whether a provider, professional or non-professional, can promote their product as being a panacea for all sorts of non-pedal ailments.
Anyone can legally sell foot orthotics. We are all aware of the Dr. Scholls machines in Walmarts, and orthotics sold on the internet via Amazon as well as in all sporting goods stores.
Whether a vendor can make a claim that his or her orthotics can cure herniated discs, scoliosis, or other systemic ailments is a legal matter and most states have district attorneys who investigate fraudulent claims made by any vendor selling any sort of product. Perhaps Dr. Gramuglia should call his local DA's office and report the matter.
Elliot Udell, DPM, Hicksville, NY
08/13/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Vincent Gramuglia, DPM
I am happy that Dr. Rubin brought up this false advertising regarding orthotics. If you ever listen to The PGA station with Michael Breed in the morning on Sirius radio you will have heard the Pine Valley orthotic commercial. I cannot express more emphatically how this ad ruins my day. Owner and “Inventor” Stu Sachowitz even features Michael Breed, who is usually a very measured and thoughtful broadcaster/golf instructor, on the Pine Valley bandwagon. These $99 over-the-counter inserts have the magical power to cure everything from plantar fasciitis to scoliosis and herniated discs. And by the way, they will Instantly cut your handicap In half. Stu says that if he can’t help you, he will gladly refund your $99.
He doesn’t care what size your feet are, whether they are flexible or rigid, pes planus, cavus, vertical talus, club foot... his “orthotics will correct the problem and make you a better golfer!” I don’t understand how companies like this are able to get away with these claims. Is this practicing medicine without a license? Did anyone in Pine Valley wonder if the lower extremity pain could be due to peripheral vascular disease or if the back pain was due to a spinal deformity or neoplasm? These miraculous claims are made without any evidence-based reasoning and are an insult to those of us who base our treatments on a sound history and physical and a knowledge of podiatric biomechanics. I’m sure that if a licensed healthcare provider made such claims, they might at minimum receive a phone call from their state society, or even visit from their medical board.
Vincent Gramuglia, DPM, Bronx, NY
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