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10/03/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: It’s Time to Unionize
From: Jeffrey Kass, DPM
This is a post I saw on “X” (formerly Twitter). This is the guy medicine needs to be run by. In the past year I saw two unions get 40 percent raises for their members. Now, the Longshoreman’s union that controls the East Coast ports is on strike. I guarantee you they will get what they want. Then, I think of podiatry. I am being paid less for CPT codes then when I started in 1996. Cost of goods has gone up exponentially.
Doctors need to create unions. If a tradesman is allowed to “cripple” the country, then doctors have rights to be heard and given fair wages too.
Jeffrey Kass, DPM, Forest Hills, NY
Other messages in this thread:
10/15/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Mark Hinkes, DPM
I concur with the suggestion of Dr. Rubin concerning the development of a policy statement that advocates for an annual comprehensive diabetes amputation prevention foot examination for at-risk patients.
India has recognized the value of screening patients with diabetes to prevent DFUs and amputations by mobilizing nearly 19,000 medical professionals in over 100 government hospitals, an effort called Paadham Paadhukappom Thittam (Project to Protect the Feet).
Screening programs are much more cost-effective than treating a DFU or an amputation, so it just makes sense to promote this conservative approach of educating the public on the value of an annual foot screening exam.
Mark Hinkes, DPM, Nashville, TN
10/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Scott Steinberg, DPM
I do not have a problem with "paid for biased speakers for drugs, surgical techniques, and wound care products." I highly doubt any of my colleagues are fooled into using a product or device after a lecture paid for by a corporation. I can read the research for myself and make my own decisions. I want to know the cost to the patient or the hospital. And, of course, is it demonstrably better?
Considering our CME requirements and the fact that some meetings are held in the downtown areas of expensive cities, I'll accept that at least the cost of registering for a conference is reduced thanks to sponsorships. I will maintain an open mind to new things. Seasoned physicians are not easily swayed.
Robert Scott Steinberg, DPM, Schaumburg, IL
10/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: APMA Should Promote Annual Comprehensive Diabetes Prevention Foot Examination for At-risk Patients
From: Lawrence Rubin, DPM
The American Medical Association (AMA) states its policy position on aspects of medical care it believes should be promoted to the public. An example is the information it provides about having regularly scheduled female mammography examinations (see link).
As one of the most senior APMA life members, I suggest APMA develop and promote a policy statement that is posted on the Internet that advocates for an annual comprehensive diabetes amputation prevention foot examination for at-risk patients. When the policy statement is published online, the concerned public could easily promote this information to family, friends, and others through group and individual sharing in LinkedIn and other social media, as well as through APMA-generated national news releases.
Lawrence Rubin, DPM, Las Vegas, NV
10/12/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Are Some CME Programs Just Infomercials?
From: Allen M. Jacobs, DPM
I received a recent notice from a CPME-approved CME provider with reference to an upcoming free CME event awarding 1 CECH. Three speakers are scheduled to discuss a product/technique. The program is sponsored by a corporation. The sponsoring of such programs by corporations and the awarding of free CME (CECH) has become commonplace in our profession. The common thread running through all of these programs is a discussion which includes obvious bias as the speakers are generally consultants or otherwise financial beneficiaries of the product or corporation, the CME providers receive money to present the discussion, and ultimately the discussion results in a positive view of the product or technique presented. These programs are simply infomercials.
In addition to the ease with which these programs may be presented virtually, our profession and CPME/APMA have allowed this misuse of the...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
10/10/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: OIG Report on Remote Patient Monitoring
From: Paul Kessleman, DPM
It was interesting to have read this report from the OIG which is full of misleading facts and information. For one, they suggest a significant increase in the expenditures for Remote Physiologic monitoring over a two-year period of time. Which years did they pick to compare? Not the previous two years, but the year prior to and the initial year after institution of the RPM codes. The starting point has to be 0 (or almost 0) and the end point for the first year, one would hope would be more than 0. So an exponential increase? Where are the examples of abuse here?
As for patients not receiving all three CPT codes each month? That would be incorrect on the face of it and abusive. The only month patients are entitled to be billed for all 3 codes, would be...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/09/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: William DeFeo, DPM
After reading all the comments about unionizing, I feel compelled to add my two cents. Physicians have sold their souls to big business and it was just a matter of time for all of this to come to fruition. Corporate medicine has made countless millions of dollars on the backs of physicians. I saw the recent survey that stated that podiatrists make about $79 an hour. An HVAC specialist makes $145 an hour as a high school graduate and does much better than most podiatrists. To put a shingle out today requires 11 years of higher education and personal moral and legal responsibility. It's hard to put a price on that.
If you decide to put your own shingle out, you have the responsibility of being a businessman. There is, of course, kudos for taking care of people’s healthcare. But the sad reality is that for the amount of sweat and tears required, it’s starting to get ridiculous. The doctor suffers, and in the long run, so does the patient. I remember the old days; I retired after 45 years of practice and I don’t think we’ll ever see them again. I wish there was a solution that I could suggest, but I don’t think there is one.
William DeFeo, DPM, Allentown, PA
10/07/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Ivar E. Roth, DPM, MPH
As everyone knows, the reimbursement dollars go down, yet the longshoremen will get a 60% increase over 6 years. Something is wrong here. Doctors deserve to be compensated well but when you take the insurance money like cocaine you get addicted. This year, I decided to give myself a 10% increase on all my fees. As a concierge direct pay podiatrist, I can do what I feel is fair and necessary. Guess what? NO one left my practice with a 10% fee increase.
Patients know that the cost of living has increased with inflation, and they understand when you raise your fees. I encourage everyone to go to the direct pay model. Also, as a member of the APMA, I have suggested that they form a pay committee so that members can share information about our success.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
10/05/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Kornfeld, DPM
I think it is an absolute travesty that as the years went on, podiatrists have been paid less and less. I agree with Dr. Kass that something must be done. However, it is my opinion that a union will have only limited success because insurance companies will still retain the power of payment. After all, they collect the premium dollars. They don't want to share that money with doctors. You can go on strike, but you will be limited to the power of negotiation and the amount of money that insurance will be willing to let go of.
There is a movement (finally) in medicine back to private practice/direct-pay models. I am friendly with many MDs and DOs who are leading the charge away from...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
10/05/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Irv Luftig, DPM
Although it may be a good thought to unionize physicians, podiatrists, dentists, etc., it's a really bad idea. It was a tactic used by various medical groups a few times up in Canada and each time ended quickly as a miserable failure. There was absolutely zero support from the general public. There was palpable outrage from the public. Simply put, doctors (MDs, DOs, DPMs, DDS’) are perceived as wealthy because "we all make hundreds of thousands of dollars."
The public doesn't care about overhead, salaries, etc. Most people make $50,000 or less, maybe a bit more. You will be viewed as greedy, wealthy, uncaring, and if you withhold services in a strike, then watch out for the swift reaction from politicians and the public. Politicians will make mince meat out of you and the public will hate you. It won't be pretty and you will potentially be losing your patients' trust for years.
Irv Luftig, DPM (retired), Toronto, Ontario, Canada
09/30/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Bret M. Ribotsky, DPM
It’s time to really look at the APMA budget and see where money can be re-allocated. Currently, $290K is spent on advertising, and $457K on pensions of employees - True Marketing/Advertising has never been more reasonable - Social Media, DPM influencers, etc. should be tried.
So here’s a few ideas for APMA to consider re-allocating money and I’d love others to make suggestions:
1) APMA - exit the seminar business, and leave it to others; this, will leave significant money available. Currently $750 thousand was spent last year.
2) Limit travel of board members to regional/state meetings and use telecommunication to allow more members to get involved. $1.2 million was spent on travel last year.
Bret M. Ribotsky, DPM, Fort Lauderdale, FL
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Kornfeld, DPM
I thoroughly enjoyed reading Dr. Tomczak's post about how exciting it is to have a new APMA administration that finally understands what is happening and is going to do something about it. Well, I am a 1980 graduate of NYCPM. If you do the math, I graduated 44 years ago. And during all 4 1/2 decades that I have been a podiatrist, APMA has been "working" on making things better for us. Sometimes, they work "hard" at making things better. Yet, in all these years, not only has it not gotten better, it has gotten so much worse.
I won't go into details about my personal issue with my own NYSPMA which I quit many years ago, but what I will say is if anyone out there wants to make things better, you need to stop counting on APMA and do it yourself. When I realized that nothing was changing for the better, I decided to do it myself. And to be honest, my efforts to improve my professional experience all paid off without dues to an organization that is always working hard for us but never seems to accomplish what they promise.
I'm sure I'll catch some backlash for this, but my career is nearly over and I don't care what they have to say about me and my opinions. Of course, what I have already heard is if I'm not a dues-paying member, then I'm part of the problem. Nah. My career was amazing in spite of, not thanks to, APMA.
Robert Kornfeld, DPM, NY, NY
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jon Purdy, DPM
Regarding the post from Dr. Tomczak, I did find that very amusing. I don’t intend to do a back and forth on this, but suffice it to say, I never put someone’s name in print without their permission. I’m sure that person would have been fine with it had I asked.
All associations post-covid have struggled, which necessitated change. As treasurer of the American Academy of Podiatric Practice Management, there has been change required of our own organization. We welcome constructive criticism, as it helps us improve and grow. It’s no different for the APMA. Time will tell, but I like the vibe they are currently putting out, and its leaders seem to be in tune with positive change.
Jon Purdy, DPM, New Iberia, LA
09/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1A
From: Lawrence Rubin, DPM
Dr. Purdy has posted that he would love to see a national APMA public relations campaign in the future if it is possible. So would I and many others. And it is possible. One means is teaming up with collaborating partners to develop robust campaigns that present podiatrists as the nation's preferred foot and ankle specialists. For example, I am happy to report the potential for a collaborative national public health improvement campaign of APMA members teamed up with Lions Clubs International (LCI) members.
The Lower Extremity Amputation Prevention (LEAP) Alliance, a 501(c)3 non-profit charity, has informed APMA that it has developed a collaborative diabetes limb saving program with LCI administrators and local Lions Clubs members. There are about 1.4 million members worldwide, and Lions members support community- based programs that enhance prevention, control, and management of diabetes and its complications - two of which complications are diabetic peripheral neuropathy (DPN) and peripheral artery disease (PAD).
There are potential donor funds and LCI granting programs that potentially can help defray costs. (See grant information: LCIF Empowering Service: Diabetes) What's more, LCI leader members have expressed interest in advancing collaborative efforts with APMA to provide the Lions Hunt for Diabetic Peripheral Neuropathy (DPN) and Peripheral Artery Disease (PAD) Free Foot Screening Program. APMA is successfully putting podiatry in the limelight through collaborative efforts with the American Diabetes Association (ADA). We shall see if an APMA-LCI team up can also be worked out.
Lawrence Rubin, DPM, Las Vegas, NV
09/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Rod Tomczak, DPM, MD, EdD
I wonder if Jon’s letter was written tongue in cheek. If accurate, Jon’s report about a recent encounter with a secret agent from APMA who assured Jon there are changes a comin’ at APMA headquarters gives cause for celebration. That’s tongue in cheek. If what Jon was told is indeed true, and why should we doubt anything out of the mouth of an unnamed secret APMA leader, then I am grateful that the spirit of Deep Throat is alive and well in Washington, DC. One difference between the original Deep Throat and the APMA Deep Throat is that the current mole is wearing old Rohadur orthotics posted to the casts to throw off younger potential trackers.
But there is a disparity between these new APMA promises and those made in the waning moments of the Nixon administration. Deep Throat’s assertions proved to be true. Both the current APMA Deep Throat and the Watergate Deep Throat were accurate when they presently advised Purdy and in...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/25/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Jon Purdy, DPM
I would like to submit an update to my previous post. After speaking to one of APMA's leaders, I am happy to learn of recent developments. They have been making some significant cuts in expenditures and have plans to do more. The new leadership has voiced an understanding of where things are and where they need to go, which is exciting.
I think we would all love to see a national campaign in the future if that’s possible.
Jon Purdy, DPM, New Iberia, LA
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: “Why I Chose an NP for My Care” National Commercial
From: Jon Purdy, DPM
If there’s a will there’s a way. The end result is more applications to podiatry school and increased income for practicing podiatrists, both of which result in increased income for the APMA. The APMA, like most large regulatory associations, has expenses that can be reined in. Large expenses for committee meetings can be reduced as well as many of the bloated salaries and lavish meeting expenses for the anointed. Even so, it would be a struggle to fund a national TV campaign. That is why many partner with other symbiotic associations and companies.
Jon Purdy, DPM, New Iberia, LA
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Kathleen Neuhoff, DPM
I have always found it interesting that when gabapentin was only available as Neurontin, insurance companies would not pay for it because it was off-label use. Then Lyrica came on with it on-label used for diabetic neuropathy, but at a high cost. So, the insurance companies would decline Lyrica until the patient had tried and failed gabapentin, which was still off-label.
We all know that cost is never considered an adequate reason for choosing a drug, so when my patients would decline Lyrica, I had them sign a consent form advising them that we were using gabapentin in an off-label manner, and that they had declined my recommendation for Lyrica.
I do the same thing when I am using something off-label for surgeries. For example, I use cryoablation for most of my neuromas with very good success, but I have the patient sign a form telling them that the instrument I’m using was not designed for neuromas. Many of my colleagues thought I was a bit paranoid, but maybe I was not!
Kathleen Neuhoff, DPM, South Bend, IN
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Justin Sussner, DPM
But how often do all of us get a fax or email or phone call that "ABCD" antifungal cream needs pre-approval, all for what may be a $20 generic. Isn't it the insurance companies' fault for not requiring the big ticket items to be pre-authorized first? This doesn't make sense to me. Maybe they just don't trust DPMs, and let the MDs do whatever they want.
Justin Sussner, DPM, Suffern, NY
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ron Werter, DPM
What I don’t understand (and maybe the lawyers among us could explain) is how does the insurance company have the legal right to charge the doctor for writing a prescription. The doctor has no financial stake in the prescription; the patient and the pharmacy are the ones who have financial benefit. Is there something in an insurance company contract that says they can do that?
Ron Werter, DPM, NY, NY
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3B
From: Lawrence Rubin, DPM
Dr. Udell has posted that expecting the APMA to invest millions of dollars into national advertisements is a great idea but in reality it boils down to a pipe dream. I agree with Dr. Udell. We cannot expect APMA to invest millions of dollars into national advertisements. But, although it may require a modest increase in the costs of special human and outsourced resources, it would not cost APMA anything even close to millions of dollars to expand its efforts to put podiatry in the public limelight by employing "guerilla marketing" tactics (Getting great marketing results with minimal expense through advertising creativity).
This creative guerilla marketing could include launching an easily promoted Internet newsroom especially for news and feature reporters and healthcare media copywriters. It can have interesting news releases and feature stories that highlight why podiatrists are best educated and equipped to improve the lives of our footsore public. There could also be collaborations with nonprofit health groups in order to to create and distribute social media PSA print and videos (Public Service Announcements at no charge by the publisher) that present podiatrists as the nation's preferred foot care physicians. These PSAs are not prohibitively expensive to generate and can be easily emailed to literally thousands of national media. And, we could also include these PSAs on our individual websites.
In addition to this, there could be an inexpensive complex hub website that could provide information for the public and even lead potential patients directly to podiatry practices. APMA is without doubt doing a good job with its allocated marketing financial resources. We just have to find ways to modestly but significantly increase those financial resources in order to better reach our goals.
Lawrence Rubin, DPM, Las Vegas, NV
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Robert Scott Steinberg, DPM)
Dr. Udell's comment underscores our problem—old thinking. Who said anything about a million-dollar ad campaign? I suggested using much of the costs put aside for the HOD on an advertising campaign. And if states only sent the president and president-elect to the much smaller HOD, states would have money to advertise, as well.
Robert Scott Steinberg, DPM, Schaumburg, IL
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From Elliot Udell, DPM
Thank you, Dr. Kesselman for making us aware of this new way in which insurance companies may finally put an end to the practice of medicine.
On one hand, I understand where they are coming from. Drugs like Ozembic are high ticket items and if insurance companies were forced to pay out thousands of dollars for every patient who refuses to try diet and exercise and would rather take injections, they would either go belly up or would have to raise everyone's premiums through the roof.
On the other hand, if I had to pay back for every script I have written for gabapentin or cortisporin otic solution, bankruptcy would definitely be in my future.
Elliot Udell, DPM, Hicksville, NY
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Back to the Future
From: Steven Finer, DPM
Upon reading the new issue of Podiatry Management, I counted ten ads for various creams and lotions pertaining to skin, nails, and pain relief. There were other ads for orthotics and podiatry-related machines. I have a 1962 Journal of the American Podiatry Association. It contains three ads for prescription internal medications. Also there were various ads for skin, nails, and orthotics. I know the various surgical magazines feature countless ads for surgical instruments and devices.
Must we now read internal medicine journals and use the Internet to review the latest medical news. I know everything is segregated in medicine, but this 62 year old journal was ahead of its time.
Steven Finer, DPM, Philadelphia, PA
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
Along with others in this thread, I am also an APMA Life Member who has no vote and is grateful to Barry Block for giving us an invaluable platform to voice our opinions. Relevant to this thread, back in 2012, I was very active in several APMA activities and worked together with other podiatrists throughout the nation and APMA assigned program personnel in providing the, "Knock Your Socks Off" public information campaign. APMA launched this public service program to educate the public about amputation prevention and other foot healthcare matters, to create awareness of the broad scope of our podiatric practices, and to show the public that we are the preferred providers of footcare.
Although the program was magnificent in structure and content, it depended upon APMA members in all states and communities working closely together in conforming to a program implementation plan. I was assigned the State of Nevada, and was pleased to report that the program did raise community awareness wherever the local volunteer DPMs were willing to participate in the program. Unfortunately, too few podiatrists nationwide were willing to get involved personally or assign their staff members to provide the program elements. For this reason, the program had to be discontinued.
When the Knock Your Socks Off Program was discontinued, I and a small group of Las Vegas APMA members who were providing the APMA Knock Your Socks Off program elements joined together in 2010 in order to help to create the non-profit Lower Extremity Amputation Prevention (LEAP) Alliance. LEAP creates community-based lower extremity amputation prevention programs in collaboration with local healthcare and community services entities.
Lawrence Rubin, DPM, Las Vegas, NV
09/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: David Secord, DPM
My experience was somewhat the opposite, in that an anchor for one of the local television stations happened into my office for a nail procedure, worried that it would keep her from wearing stylish (I would go with inappropriate, but there you go) dress shoes as part of her work and that everyone she knew assured her that the experience would be akin to a slow trip through hell. She was amazed that she didn’t feel the injection stick (ethyl chloride) and didn’t feel the injection (1% lidocaine with epi, 0.5% Marcaine plain, 8.4% sodium bicarbonate to buffer the injectable back to physiologic pH) and didn’t have any pain after the procedure (no tourniquet needed due to the use of epi in the block). She recommended that the anchor at another station in Corpus Christi see me, as she had the same problem and staved off the procedure for the same reasons. She had the same positive experience.
The two of them began a discussion with me about my practice and I mentioned that...
Editor's note: Dr. Secord's extended-length letter can be read here.
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