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10/21/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Doran Edwards, MD
In response to the ongoing discussions about Comprehensive Diabetic Foot Exams (CDFE) not being reimbursable, I wanted to provide a different viewpoint. A CDFE certainly might be reimbursable, IF a new diagnosis, or a change in medical condition is found during the exam.
Objective, reproducible, real-time physiological measurements of foot health are provided by the innovative Arche LEAP Vitals+ Program. When a podiatrist follows the comprehensive Arche LEAP Vitals+ protocol, documents the objective abnormal findings, and creates a care plan for management, it is my expert opinion, the encounter satisfies the medical necessity requirements for billing an evaluation and management service, either alone, or in conjunction with at-risk foot care services performed on the same day, using a -25 modifier.
Doran Edwards, MD, Former DME MAC/PDAC Medical Director
Other messages in this thread:
11/04/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: eRX Phone Apps
From: Brent Rubin, DPM
There are several free eRX phone apps. These enable you to prescribe electronically without requiring you to have an EMR system. These allow you to prescribe directly on your phone and you don’t have to call the pharmacy.
I use the app called Prescriber on my iPhone, but you can also use iprescribe on any android phone.
Brent Rubin, DPM, Lakewood Ranch, FL
10/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Paul Kesselman, DPM
I have to partially disagree with Dr. Tomczak. There is no question that the MD degree may get doors open that another doctorate degree may not. I also know at least 2 MDs who either decided not to pursue residency programs or who quit their surgical residency in midstream to pursue other areas of interest, such as medical IT, etc. This area is growing by the day as physicians with clinical experience and those in medical school see how difficult clinical practice is.
However I know many DPMs who, for one reason or another, pursued work outside the clinical arena in the pharmaceutical industry, orthopedic equipment or orthotics and prosthetics industries, and some even the teaching profession, at one level or another. Other DPMs are working for insurance companies as investigators, others as...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Howard Bonenberger, DPM
Everything is related to the perceived value brought to the table. In their minds, a degree which is universally recognized by the public, VC firms, or other businesses, the MD (DO) can author research on the entire body. The DPM has limited scope which can be covered by orthopedic research, at least in their minds.
Perhaps submit research that is blind as to the authors' names and degrees. It would not be for actual publication but to have it read by someone who is curious. If of high enough quality and the publication inquired, then it would be revealed that the author(s) were DPMs. I may be way off base, I'd appreciate thoughts on this idea.
Howard Bonenberger, DPM (Retired), Nashua, NH
10/30/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: David Laurino, DPM
Dr. Khoury, I'd be happy to share my experiences. Like Dr. Vargas, I co-own a virtual assistant company which offers virtual front and back office support specifically tailored to the needs of medical practices. Our VAs, primarily based in the Philippines, are college-educated, and many are nurses or have advanced educational backgrounds, which brings an added layer of understanding to medical administrative tasks.
We've found that by leveraging virtual assistants, our clients experience a reduction in both overhead and turnover, which can ease the workload on remaining staff significantly. Our VAs are trained in handling phone calls, scheduling, insurance verification, prescribing, and prior authorizations. Additionally, they become a stable extension of your team, helping to reduce the disruption that often accompanies staff changes.
David Laurino, DPM, Chandler/Gilbert, AZ
10/29/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: No DPMs Need Apply
From: Rod Tomczak, DPM, MD, EdD
I recently received a notice on Linkedin from a young lady who gave up a lucrative career with a pharmaceutical company to attend medical school in Curacao. The notice simply stated there was a change in her status. I remember asking her in the interview why she wanted to give up her position to pursue an MD degree from the Caribbean. She said there was a glass ceiling for folks in the medical business industry who were not doing the bench research and did not possess an MD degree.
I followed up the other day on Linkedin and saw she is presently teaching at Columbia University in New York City. When I talked with her, she told me she got a great offer to teach, not in Columbia’s College of Physicians and Surgeons but in the business sector, at least partly because of her MD degree, so she took it. She mentioned there was even a ‘go to’ site for MDs who did not want to practice medicine, and this website even advertised jobs. I was curious about what she said, and I...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
10/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Marco A Vargas, DPM
It seems that after the pandemic, it has been very difficult to find and retain staff. Salaries have increased dramatically and there is a significant amount of staff turnover which creates disruption and is very costly for the practice. Therefore, after limited success with two virtual assistant companies for my own practice, I decided to start my own podiatry-specific virtual assistant company based in Medellin, Colombia.
We specialize in training podiatry virtual assistants in-office duties such as answering phones, appointment scheduling, insurance verification, and prior authorizations among other tasks. We also provide in-room translation services for Spanish speaking patients. All virtual assistants are bilingual, college graduates with podiatry experience, and cost less than half of what an on-site employee does and with less turnover.
Marco A Vargas, DPM, Sugar Land, TX
10/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Source for Cantharone
From: Paul Betschart, DPM
I was surprised to see on the Dormer Laboratories' website in bold red that Cantharone and Cantharone Plus are not permitted for sale or use in the United States. It is a shame as they make a quality product that is very effective for treating plantar warts. People may be scrambling to find alternatives as their supplies dwindle. Practitioners should contact their preferred compounding pharmacy to see if they can have a compound made with the same ingredients.
I have gotten compounds with the same exact ingredients as Cantharone Plus from Bayview Compunding Pharmacy in Warwick, RI in the past when Cantharone plus was in short supply. It costs a little more per mL than Cantharone but the effectiveness was similar to the original formula.
Disclosure: I have no financial interest in Bayview Compunding Pharmacy
Paul Betschart, DPM, Danbury, CT
10/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Kathleen Neuhoff, DPM
When I was in veterinary school, I remember my instructors telling us that the difference between a trade and a profession was research, I believe this to be true. We have some amazing researchers in podiatry but they are rare. The value of contributing research should be part of the mindset of us all and as Dr. Secord pointed out, it is not.
Kathleen Neuhoff, DPM, South Bend, IN
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
10/24/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Shawna Shapero
Like Dr. Arnold Signer, I am saddened to see the recent announcement of the closure of Gordon Laboratories yet happy for SuEllen and Dave on their decision to retire. In their 60 years of service to the podiatric medical community, Gordon Labs has generously given back to the profession in ways too numerous to be mentioned in one place. Thank you for setting the standard for everyone involved on the commercial side; truly the end of an era.
Congratulations on your retirement, SuEllen and Dave. Gordon Labs will be missed.
Shawna Shapero, VP Corporate Relations, Bako Diagnostics
10/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Paul Kesselman, DPM
I must admit that those promoting this are either a mentor and friend of the last twenty years (Doran Edwards, MD) or Lawrence Rubin, DPM, a longtime mentor, friend and former teacher of mine at ICPM in the late '70s and '80s. So it pains me to have to offer some criticism of each of their posts. And I will have attempted to speak with or have already spoken with both of them prior to this post being printed.
For one, Dr. Edwards and I have worked together numerous times to improve the therapeutic shoe bill, met with DME MAC medical directors and CMS to improve the accessibility to beneficiaries by removing some of the...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Doran Edwards, MD
I appreciate Dr. Bass's post and his enthusiasm for the Arche LEAP Vitals exam for patients with diabetes. There is one point of clarification that needs to be provided. Dr. Bass wrote, “if a provider has a diabetic patient (chronic illness) who may have exacerbation or progression, and this patient may need a prescription based upon the findings of the LEAP tests, the patient will then meet the requirements for an E/M service.”
The quick and efficient LEAP Vitals tests are all about skin integrity in this high risk population. We understand that “chronic illness” as well as “chronic illness with exacerbation” helps determine, in part, the level associated with the E/M service through medical decision-making (i.e. 99212 versus 99213). By no means does the patient need to exhibit exacerbation or progression of their diabetes to qualify for the LEAP Vitals tests, nor the ability to meet the medical necessity associated with an E/M billing. A prescription is also not required.
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, either an initial care plan or a change to a previous care plan that’s not working well. This change in medical condition alone provides the medical necessity for an evaluation and management service through the counseling of the patient on their risks associated with dry skin, and changing their treatment, even if only an over-the-counter skin care recommendation.
Doran Edwards, MD, Former DME MAC and PDAC Medical Director
10/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: David Secord, DPM
Although it pains me to say so, I agree with Dr. Tomczak on the issue of research. In 2013, I practiced in Riyadh, Saudi Arabia, at the King Abdulaziz Medical City, Central Region hospital. At that time, the Chief of the Section, Dr. Abdulaziz al Gannass, was doing Charcot reconstructions (as indicated) as ankle fusions, either with or without talectomy. Instead of using an intermedullary rod, he repurposed the Synthes VA-LCP Condylar Plate (normally used to fixate femoral fractures) to connect the tibia to the calcaneus. The butterfly shape of the condylar plate worked amazingly well at the calcaneus and after removing the distal fibula, laying the plate at the lateral aspect of the tibia to the calcaneus made for a robust structure, as it is a locking screw and plate system with variable angle abilities. The majority of the patients walked on it post-op (although informed that they were to be non-weight-bearing) and none of these patient failed to fuse.
In the case of a talectomy, allograft bone stock was used to...
Editor's note: Dr. Secord's extended-length letter can be read here.
10/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Rubin, DPM
In a recent post, Dr. Freireich said, "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."
Actually, there has been some progress in gaining covered podiatric Medicare diabetes amputation prevention examination coverage. Although we have not yet succeeded in gaining coverage for a comprehensive diabetic foot examination (CDFE) to screen for many potentially hazardous lower extremity problems, podiatrists can now be well reimbursed when providing...
Editor's note: Dr. Rubin's extended-length letter can be read here.
10/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Alan Bass, DPM, CPC
As a certified professional coder and someone who has reviewed the Arche LEAP Vitals+ Program, I agree with Dr. Edwards’ assessment. The program provides the user with real-time physiologic findings. Following the guidelines for an E&M visit provided by the AMA, if a provider has a diabetic patient (chronic illness) who may have exacerbation or progression and this patient may need a prescription based on the findings when performing the tests within the program, the patient will meet the requirements for an E&M.
Disclaimer: I have no financial relationship with Arche Healthcare.
Alan Bass, DPM, CPC, Manalapan, NJ
10/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Physician or Allied Healthcare Provider?
From: Rod Tomczak, DPM, MD, EdD
We are convinced that we are physicians. Unfortunately, the rest of the world has not universally been persuaded to classify us as such. It’s not so much what the 40,000 or so of us call ourselves, but what does the rest of the world call us? Why is there a reluctance to move us from the allied healthcare provider column into the big boys’ physician column? I always look at economics as a reason for most social problems, then move to self-esteem issues before considering what may be the truth. One horrible truth is that there is nothing we do that other physicians or healthcare providers can’t do.
I was on the admissions committees at both Des Moines University College of Podiatry and the Ohio State University College of Medicine. Yes, there are vast differences. That is not to say that students at the podiatry colleges could not...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
10/19/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: George A. Cioe
For the past 16 years, I have had the immense pleasure of knowing SuEllen and David Dercher. Our conversations at podiatric conventions have always been a highlight for me, filled with stimulating discussions on topics ranging from the FDA to parenting. I appreciate every moment spent with them. SuEllen and David embody integrity, hard work, experience, and knowledge, all delivered with a wonderful sense of humor and humility. They truly are a class act.
As they embark on this new chapter, I will miss our conversations greatly. I hope David finds time to enjoy fishing, and I wish SuEllen all the joy of being a grandmother. May their retirement be filled with health and happiness beyond their wildest dreams.
George A. Cioe, The Tetra Corporation
10/17/2024
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Gordon Laboratories -The End of an Institution
From: Arnold Signer, DPM
In reading PM News, I saw the notification that, after 60 years, Gordon Laboratories is being closed down by its owners SuEllen Derscher and her husband David. Reading their message, I was both saddened and happy. It has been a rarity to attend a podiatry meeting and not see Gordon Laboratories in a prime location in the exhibit hall. Having been involved in meeting planning in Florida, I learned early on which companies knew how to attract doctors to their booths and those companies that had no idea how to do so. SuEllen has been one of the finest marketers of her company. Even if you were not her customer, you could always stop at the Gordon Laboratories booth to trade the latest jokes with her.
It has been a privilege to know SuEllen and David for these many years and I wish them all the best wishes on their retirement.
Arnold Signer, DPM, Maitland, FL
10/16/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Jay Seidel, DPM
I have been ordering online from Olympia Pharmacy. They have a great product at a great price with next day delivery. If I remember correctly, the first time I needed to call to set up an account, but after that I was able to order online through my account portal.
Jay Seidel, DPM, Deerfield, Beach, FL
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
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
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