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10/16/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Ron Freireich, DPM
If APMA promotes an Annual Comprehensive Diabetes Prevention Foot Examination, I hope they also promote that the exam is not covered by insurance, unless things have changed since this issue was also brought up in a post on PM News back on 07/09/2021.
It should be a covered exam just like an annual eye exam for at-risk patients, which would save limbs and lives not to mention save money for insurance companies. First things first. Get insurance companies to cover the exam, promote it, and then we'll be more than happy to perform them.
Ron Freireich, DPM, Cleveland, OH
Other messages in this thread:
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) PART 2
From: Michael J. Schneider, DPM
I would like to add my congratulations to SuEllen and David on their retirement. I had used their products throughout my career. When I retired and began volunteering at the Denver Rescue Mission, SuEllen and David donated Gordon Labs products for my patients. Good Luck on your retirement!
Michael J. Schneider, DPM, Denver, CO
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Paul Kesselman, DPM
I stand by my partner Alan Bass, DPM, whose opinion is absolutely correct. Each patient encounter should have at a minimum an appropriate history and physical with components of lower extremity systems including but not limited to dermatology and must also include neurovascular and a MSK examination. Any changes in patient history or PE should be well documented and incorporated into the note.
But the change in history is not what will get you paid for a separate E/M nor is documenting a change in the physical examination. It is that last part, the management, what exactly did you do? If all you did was document a change in history, nope. If all you did was document a change in the PE, again, no dice. You must document all 3 issues, ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Lawrence Rubin, DPM
A recent post in PM News pertaining to insurance reimbursement compliance said, "Any abnormal findings on the LEAP Vitals Exam, i.e. dry and xerotic skin (L85.3) caused by sudomotor dysfunction, is a significant risk to a patient with diabetes. It therefore warrants a care plan." To prevent confusion of business names, this is not a stated opinion of the 501(c)3 not-for-profit LEAP Alliance.
Lawrence Rubin, DPM, Las Vegas, NV
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
09/23/2024
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 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
09/13/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Alex Dellinger, DPM, Brian Zale, DPM
I, too, used Cantharone and Cantharone Plus for years. After it became impossible to get, I took an empty bottle of the Plus across my parking lot to Cornerstone Pharmacy who compounded a perfect replacement. I have been using this version successfully for about a year and a half.
Alex Dellinger, DPM, Little Rock, AR
There is no need for an alternative. I get my Cantharone and Cantharone Plus from Canada shipped to me. Here is the lab. Dormer Laboratories, Inc., Toronto, ON
Brian Zale, DPM, Rosenberg, TX
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jerry Peterson, DPM
No, you are not missing something. He should be able to assist ANY physician on ANY surgery. In Oregon, a podiatric physician can assist in general surgical procedures, Ortho, Neuro procedures, etc. They are not required to have the privileges to be able to assist. Good luck moving forward.
Jerry Peterson, DPM, West Lynn, OR
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.
08/28/2024
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
07/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Steven Kravitz, DPM
I fail to understand why there is so much attention to podiatrists or at least some podiatrists trying to expand scope of practice beyond that of our specialty area - the foot and ankle. The concept of the serving as gatekeeper brings many questions, and I agree with Dr. Rodney Tomczak. The DPM degree has served me well and the podiatrists I know. My colleagues (many in wound care) have benefitted from their education and ability to practice medicine within the scope of DPM degree they earned. That degree points to the general public and more importantly to other medical providers that we are indeed specialists in the foot and ankle pathology. We have developed very good reputations generally; we as a group provide excellent service to patients. At the end of the day, it is the patient that matters.
Becoming gatekeepers necessitates overseeing treatment of medical conditions out of our scope of...
Editor's note: Dr. Kravitz's extended-length letter can be read here
06/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Elliot Udell, DPM
Kudos to Dr. Ribotsky for suggesting that there be some way of tracking podiatrists diagnosed with some form of cancer. As a cancer patient in remission, this issue is very close to me.
The medical community is grappling with another issue. Patients with breast and colon cancer are now presenting at very young ages. One patient of mine had his first colonoscopy at age forty and discovered that he had stage four colon cancer. Another young woman in her thirties is undergoing treatment for breast cancer. Are these caused by unidentified carcinogens or are people discovering these conditions earlier in life because of testing and awareness?
Elliot Udell, DPM, Hicksville, NY
05/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3A
From: Elliot Udell, DPM
Concierge practices are not always direct-pay practices. My doctor flipped his practice into a concierge practice. The deal is you pay an annual fee for the honor of being a patient but have to pay or have your insurance pay for each visit. The annual fee may be 2K a year. If the doctor has 1,000 patients in the practice, the doctor makes $200,000 a year before turning the key in his door. The rest is gravy.
I visited an eye center for a cataract procedure. They let me know that my insurance would cover the procedure, but the laser they use to open the capsule would cost me 2K out-of-pocket.
Elliot Udell, DPM, Hicksville, NY
05/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Kornfeld, DPM
Since this thread is still going, I would like to bring up a really important point that Dr. Meisler glossed over. Patients coming from these concierge practices were willing to pay directly when they came and were "surprised that they did not have to pay at the time of their visit." That should tell you something about the value they are experiencing in a direct-pay practice. That's number one.
Number 2, I agree with Dr. Meisler that eliminating poor payors will always make room for more value in the practice. However, it is important to note that as long as you continue to accept insurance, you will always be fighting an uphill battle. You will need to see a high volume of patients which means a large office, large staff, and high expenses. You will still have to navigate the slippery slope of...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
04/12/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Greg Caringi, DPM
Salus University, the former Pennsylvania College of Optometry, now has a certified Orthotics & Prosthetics program. Has our profession completely abandoned a science and a skill that distinguished us from other health providers?
Greg Caringi, DPM, North Wales, PA
04/11/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Sarah B Clark, MS
I have been using Freshbooks for nearly 5 years and have been very pleased with it. They have an extension for check writing that integrates seamlessly, as well as payroll options. There are a variety of plan levels depending on needs and budget. It is web-based and there is an app for your phone as well, and all updates are done without extra fees.
Sarah B Clark, MS, Charlotte, NC
03/13/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Michael A Uro, DPM
Thank you Dr. Tomczak for the gracious compliment. The feeling is mutual. Once again, I agree with your assessment of our profession. While I do not possess your eloquence in the written word, I will in my own humble way attempt to further express my feelings. Your assumption as to why I would not recommend podiatry to a college student is correct. I do not like the direction in which the profession is going.
Not everyone who enters medical school wants to be a surgeon. Not all have the abilities to become a surgeon. Does this make them any less of a physician? Of course not. Our patients need and deserve the experience of all the specialties and subspecialties. It takes many spokes to...
Editor's note: Dr. Uro's extended-length can be read here.
03/12/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Lawrence Oloff, DPM
Let me start off by saying I am happy with my chosen profession. I have read the posts over the years about the profession and its frustrations. As a side note, I wish such discussions did not surface on public forums as I fear that this likely has had a negative impact on student recruitment, but I guess that is the way of the world in an era of social media. Why we should be happy with our chosen profession is a complex discussion and probably needs two parts. Here is Part 1.
What I find interesting is that people think that these claims of unhappiness, discord, frustration, the haves and have nots is unique to podiatry. I can assure you it is not. I have had many podiatry lives: Dean of a podiatry school, practice in an orthopedic group who managed professional sports teams, large institutional medicine, and as the first podiatrist in the orthopedic department at Stanford with an...
Editor's note: Dr. Oloff's extended-length letter can be read here.
03/07/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Allen Jacobs, DPM
Waiting for Godot? Vladimir and Estragon waited and waited. As you know full well Dr. Tomzack, Godot never arrives. The play was an offering of the theatre of the absurd. Is this the arena in which we as a profession now function? Yes there are “haves and have nots”. The Joshua tree you refer to (actually a plant and not a tree) has branches which include rather complex surgical interventions performed by some podiatrists. Charcot joint reconstructions, deformity corrections with external fixation, distal leg and ankle trauma management are a long way from the DSC days you fondly recall.
Our first responsibility is to protect the public and assure that those providing advanced care with significant responsibilities possess adequate training and experience. To a large extent, DPMs are entrusted with the authority to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/29/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: David Secord, DPM
One aspect of the current surfeit of schools of podiatric medicine we should consider is how an average applicant pool being diluted by so many schools weakens the whole. I can only speak of Temple, as I am good friends with someone who instructs there and reveals that the number of applicants and the number of admitted students is too low to sustain a tuition-driven institution.
I understand that at some point Temple University dropped the hammer and let the school of podiatry know that it has to start being a neutral entity and not be financially subsidized to keep it afloat. I know of no established time frame, but if Temple may be contemplating the long-term fate of the Philadelphia school (my alma mater) I can only imagine that...
Editor's note: Dr. Secord's extended-length letter can be read here.
02/14/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Dominic Bianco
Public knowledge and educating the public is really part of the answer. The other part is the patient has to feel confident and comfortable with their choice when seeking medical attention.
Retailers are now selling custom-made orthotics utilizing shippable impression kits. These start at $200. Originally, they were only available through podiatrists who were selling to their patients custom orthotics for $200 back in the 1980s. Now it seems these products are widespread, not just in custom orthotics but for all kinds of podiatry products.
Podiatrists, on average, are seeing 10-20 patients per day. Overseeing their practice and growing it takes a lot of...
Editor's note: Dominic Bianco's extended-length letter can be read here.
01/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Ann Ganley
May I thank PM News for printing the letter “The Legacy of James Ganley, DPM” by Allen Jacobs, DPM. It was brought to my attention by a former resident and the podiatrist wife of our grandson. Since my husband, Jim, died of myelogenous leukemia at the age of 62 on Oct 4, 1992, our family is pleased that he is being remembered after all these years.
Allen Jacobs, DPM wrote for the purpose of improving the daily practice of podiatrists today with his thoughts and insight. He highlighted many of Jim’s areas of expertise. He was the ultimate diagnostician. Also, Dr. Jacobs’ reference to William Osler (which I had to look up) was quite a compliment. Thank you for that statement.
Jim was quite a storyteller. Our family enjoys retelling his stories and those of our own to remember him at the family dinner table. Thank you to Dr. Jacobs and the other doctors who contributed with their reflections as well.
Ann Ganley
01/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Gian Steinhauser, DPM
I’ve used Stryker Smart Toe implants for over a decade and had no issue with them with MRI in the past. Stryker Smart Toe implants are made of memometal nitinol, an alloy made approximately of 50% nickel and 50% titanium. Nitinol, a nickel-titanium alloy, is generally considered safe for magnetic resonance imaging (MRI). Nitinol is non-ferromagnetic, meaning it doesn't dislodge during an MRI and only heats slightly. It's considered safe for MRI. The metal typically will show a bit of image flare around the implant site on MRI imaging, so as long as you’re not interested in seeing tissue directly adjacent to the implant, it should be fine.
Gian Steinhauser, DPM, Houston, TX
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