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03/17/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Bruce Kaczander, DPM
Congrats to my fellow ICPM ‘81 classmate, Paul Kesselman, on a well-earned and deserved honor. Hopefully, Paul, you realize that you have directly or indirectly helped every colleague throughout the country. How many other Hall of Famers can make that claim! Your Motown friend is proud of you.
Bruce Kaczander, DPM (retired)
Other messages in this thread:
03/21/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Steven Finer, DPM
Yesterday, I received the March 2025 issue of Podiatry Management. A most important statistic in PM's Annual Survey Report showed the 1997 gross income as $268,000. Fast forward... it was the same for 2023. Adjustments for inflation should make it $453,000 dollars. A new car then was $19,000, a house $143,000. What do you pay for office rent in 2025, supplies, and salaries? In 1997, my office rent was $800. My secretary was paid $10 an hour. If you make $100 a week and bread is 25 cents, then all is well.
Steven Finer, DPM, Philadelphia, PA
03/18/2025
RESPONSES/COMMENTS (PM ARTICLES)
From: Steven Kravitz, DPM
Congratulations to my friend Paul Kesselman. Paul is a quiet, non-assuming professional who doesn't brag about his accomplishments. He simply continues his passion of informing podiatrists of the many different aspects and the changing environment that constantly occurs with billing - coding and related aspects.
As pointed out nicely in the post by Bruce Kaczander, DPM, Dr. Kesselman has undoubtedly helped countless numbers of podiatrists across the country for many years in this important aspect of medical practice. He has, in my opinion, been under-recognized for his contribution to our field. The readers of PM magazine got it right in giving him this award for the Hall of Fame. Well deserved. Expect to see more to come. With gratitude and a strong congratulations.
Steven Kravitz, DPM Winston-Salem NC area
11/19/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Keith L. Gurnick, DPM
Keith L. Gurnick, DPM, Los Angeles, CA
11/14/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Jeffrey Trantalis, DPM
I find a meeting on biomechanics is critical in the importance of caring for people, not only for the lower extremities. but even the lower back. The commercialization of store-bought orthotics is doing a disservice to the American public. Not only are the American people ignorant of the benefits of biomechanics, so is the medical community in general. After all, surgery is the main impetus for many of the surgical professions, not conservative care that might help many of these people.
Years ago, I had the opportunity to work for a back surgeon. What I learned in this short time was that people with hip or back pain were born with a limb-length difference (with or without a pelvic rotation), or it was acquired as we got older. I did not have the opportunity to perform studies showing these benefits. Nobody in academia was interested. Besides, surgeons are trained to perform surgery and their livelihood would be affected. We as podiatrists are trained in surgery as well as providing non-surgical treatments. I saw the benefits of our training while working at the University of Washington Sports Medicine Clinic and practicing in Florida among the elderly.
Jeffrey Trantalis, DPM, Retired, Delray Beach, FL
11/13/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Keith l. Gurnick, DPM
An accurate definition of the word "custom" (as an adjective) is something made to unique specifications, especially something one of a kind. Its synonym is "custom-made". A definition of "custom-made" is something made for a specific or a particular person or individual. A definition of a "specific or particular person" is of or relating to a single or specific person, rather than to others or all. There are numerous definitions of the word "orthotic".
Here are examples of some of them: An orthotic is an orthopedic appliance designed to straighten or support a body part. Another is a device or brace to control, correct, or compensate for a bone deformity. Still another I found is a shoe insert designed to improve posture, improve function, and prevent injury. I am certain our readers can find...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
10/05/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Jon Purdy, DPM
This is yet another joke by Medicare on the unsuspecting. I believe it was 2021 when they changed the rules on the L1951 and probably some others. I’ve been burned by RAC for having dispensed these on patients such as those with CMT drop foot. I did my peer-to-peer to find out this new “rule” had been added buried deep in the layers of determinations and edits.
Pre-fabricated is just that, and by definition should not need “customization.” Yet a brace that fits perfectly as is, is no longer adequate if it is not “adjusted” in some fashion. It’s just getting ridiculous out here. But that’s the game. Change it up even if it makes no sense, they’ll miss it, and we can get them until they figure it out. Doctors and patients suffer because of it.
Jon Purdy, DPM, New Iberia, LA
10/03/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Paul Kesselman, DPM
There are several additional points one should understand when it comes to RAC and TPE. You are not being targeted; it is the code which is being audited and you have been the "lucky" one selected from a batch of several thousand claims.
Second and most important: A colleague from another healthcare profession and I recently commiserated on our experiences with unjustifiable denials as a result of RAC audits. We have both concluded that these judgments are stacked against the provider because the financial health of the RAC agency is wholly dependent on...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/14/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Lawrence Kosova, DPM
Dr. Davis, there is a saying in AI, "AI won't replace doctors but doctors that don't use AI will be replaced." Being one of the podiatrists interviewed for the article, I wanted to comment. AI is really being used for most of us for increased efficiency and improvement, not replacement. If anyone will be replaced, the radiologists might be lessened in numbers.
The technology for breast cancer diagnosis and other cancers is really something, and using AI as an assistant for improved diagnosis is key. I am having an upcoming colonoscopy and the doctor is one of the leading specialist in this field is using AI as an adjunct. With AI, she has an increased finding of adenoma rate of 25% that might of been missed before this technology. Now all residents/fellows are being trained with...
Editor's note: Dr. Kosova's extended-length letter can be read here.
09/11/2024
RESPONSES/COMMENTS (PM ARTICLES)
From: Elliot Udell, DPM, Bruce Pinker, DPM
Dr, Davis may be concerned that computer technology may phase out some aspects of medicine. It is doubtful that it will affect podiatry. Until they invent a computer with two sets of four fingers and two thumbs, we will always be needed.
Elliot Udell, DPM, Hicksville, NY
Earlier this year, I completed a course for Artificial Intelligence in Healthcare through the Massachusetts Institute of Technology (MIT). Artificial Intelligence (AI) has several benefits, as well as drawbacks. Overall, it can facilitate processes, and these systems will likely improve in the future.
Currently, some operating rooms utilize AI systems to assist with scheduling to improve efficiency, and there is a report that ChatGPT helped to diagnose a neurological patient who had seen several doctors and finally received the proper treatment thanks to the assistance of AI. Also, there are AI systems that can help improve patient compliance in following a doctor’s orders in terms of taking medications properly, as prescribed. However, AI cannot function on its own - AI results must be reviewed and monitored to ensure accuracy.
Bruce Pinker, DPM, White Plains, NY
09/10/2024
RESPONSES/COMMENTS (PM ARTICLES) - PART 1
From: Ali Davis, DPM
I just wanted to make a comment about the AI article recently written. I have explored AI in my practice but a big concern is the reason this is free or cheap to us is because they are planning to phase us out- we are feeding the computers the data and knowledge to phase us out- it is allowing computers to collect data and eventually a company will use this to charge patients money to diagnose and treat themselves- not good for our profession. I personally do not plan to use this technology as it is helping to phase out physicians. It is not good for our profession.
Ali Davis, DPM, Overland Park, KS
09/10/2024
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Paul Kesselman, DPM
The article cited in a recent PM News edition requires some updating. Since it was written and published, CMS has made a change with respect to the process of prior authorization of bone stimulators. Due to some technical issues with various generations of this technology, CMS last week announced that they were halting the prior authorization process on bone stimulators. When enforcement of this process takes place, CMS promises to make another announcement.
Paul Kesselman, DPM, Oceanside, NY
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) -PART 1
From: James Koon, DPM
I closed my practice 8 years ago to join a multi-specialty clinic. I got one records request in the 7 years I had to keep the records. One. I called the requestor and was released from it as my contribution was nominal. I simply kept my server. My vendor, MacPractice, assured me that IF I ever needed a chart, they would be able to pull it off my server no matter how many software updates transpired. For a fee. I never needed it.
We did have some residual paper charts that I rented a storage space for and pared them yearly. I paid to have them shredded. I also sold my x-rays for the silver recovery. Both were an expensive and laborious endeavor. In retrospect, I should’ve just had a big bonfire and partied with friends.
Closing a practice takes longer than you think and costs more than you think. Bills come out of thin air for months. Banking costs, vendor contract terminations, x-ray equipment decommissioning costs, files, legal notifications, etc. I don’t envy anyone doing it. I love being an employed physician.
James Koon, DPM, Winter Haven, FL
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2A
From: Robert Kornfeld, DPM
Dr. Kesselman makes a powerful point. But it isn’t limited to DPMs as to under-valuing services. I am friends with many MDs and the ones who still accept insurance suffer the same issue. The system has conditioned patients to not want to pay for anything so doctors feel their services have no value. I used to share an office with a cosmetic dermatologist and a plastic surgeon. They collected enormous amounts of money every day from their patients, and my patients often refused to pay co-pays and deductibles.
I went to a direct-pay model almost 24 years ago. I decide what my services are worth. I set my own fees. Every patient pays my full fee at the time of the visit. My accounts receivable has been $0 all these years. And I have made almost double the net income on 8-10 patients daily than I made on 50 insurance patients daily. Honestly, it’s a choice. I do not work hard. My days are pleasant and stress free. No one has to be exploited and abused by insurance companies.
Robert Kornfeld, DPM, NY, NY
12/14/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2B
From: Robert D Teitelbaum, DPM
David Secord's posting recently about "allopathic" medicine and how DPMs are allopathic doctors was a great lesson in the real meaning and the corruption of common words that we use to describe our professional status. I would also like to bring up three words that have held us back professionally and consistently for 40 years and I have not seen them much talked about. Those three words are Routine Foot Care.
My thesis is this:
1.There is no complaint about foot pain that is routine. A patient who realizes that her bent second toe has a painful corn on the first joint that hurts in all shoes is in distress. They need someone to counsel them on the choices they may face and the treatments that are relevant. The patient wants our experience, knowledge, and ability to communicate. They want a plan of action--in other words they want...
Editor's note: Dr. Teitelbaum's extended-length letter can be read here
12/13/2023
RESPONSES/COMMENTS (PM ARTICLES) -PART 1
From Ron Werter DPM
Dr. Kobak has written an in-depth article in PM Magazine about closing a practice. There is one item I have a question about: preserving the charts. When we all had paper charts, we could put them in boxes and take them home or have a company store them for 7 years Now, most of us have an EHR which is administered by a vendor. What is the best way of retaining those charts? Are there known problems with asking the vendor to copy all the data and allow it to be accessible if you no longer have their program.
Ron Werter, DPM, NY, NY
12/13/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Paul Kesselman, DPM, Mark Spier, DPM
The whole point of my last letter was to point out that we, as individuals, are partly if not totally responsible for setting our own self-worth. If we don't, who will? If we podiatrists, as Dr. Secord states, are allopathic physicians, then it’s time we start acting like ones.
Can you find me an MD or DO who will work for the kind of dollars DPMs line up and stab each other in the back to sign up for? And that is the crux of the problem. We think if we sign up for less, then we can become invaluable to the patient and carrier. In fact, that’s exactly the opposite of what happens. The carrier realizes we are so dependent on them, we become so desperate to retain their lifeline, that they pay us less and less. So who’s really responsible for this? Each of us!
Paul Kesselman, DPM, Oceanside, NY
I’m asking if the antipathetic allusion to allopathy is an anonymously announced alliterative allegory? Or is it not necessarily nuanced enough to notice now?
Mark Spier, DPM, Reisterstown, MD
12/12/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: David Secord, DPM
"Much of what we have been talking about for the last four decades is the attempt to be treated as equals to our allopathic and osteopathic colleagues," says Dr. Paul Kesselman.
I like to comment on people in our profession referring to MD and DO medicine as allopathic and osteopathic and then putting ‘podiatric medicine’ in a separate category, as if podiatric medicine wasn’t allopathic medicine. The poll in question does this same thing. There are a certain finite number of medical theories out there, including allopathic, osteopathic, homeopathic, chiropractic, native American Indian pan-theistic naturopathy, witch doctors, Eastern Indian Ayurvedic medicine, and a few others. Allopathic medicine has as its basis the idea of pathology from disease state: bacteria, virus, prion, spirochete, genetic dyscrasia, etc.
Unless I missed something critical in medical school, that’s the disease model we in podiatry follow as well. As such, podiatric medicine IS allopathic medicine. Podiatry is often stated as wishing to contribute with "allopathic" providers in the area, as if WE were not allopathic physicians. One of the myopic tendencies in our profession is to separate ourselves in like manner from allopathy, which makes no sense to me. Podiatry follows the allopathic theory of medicine. We ARE allopathic physicians and referring to ourselves as podiatric physicians with similarities to allopathic physicians (as if allopathy means "MD", which it obviously does not) shows either ignorance of what the term means or is a strange form of self-denigration I don't understand.
David Secord, DPM, McAllen, TX
12/05/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: Mark Ross, DPM
Dr. Rothenberg said, “Diabetic is a label and should be avoided. Compliance is authoritative and stigmatizing." To an old-timer getting ready to be put out to pasture, my response is, “The truth shall set you free.”
We accept great responsibility when treating diabetics, particularly those with infections, ulcerations, osteomyelitis, and gangrene. Compliance always affects outcomes. Failure is not an option, but can happen and when it does, the onus is on us.
The most important thing a doctor can tell their patient is the absolute truth. And patients know when the doctor is lying. Give the patients credit. When the patient is told they’re going to lose their toe which could very well lead to loss of limb, which could lead to death within five years, they are not dwelling on your choice of words. They are looking to the doctor to save them. And that is our job.
Mark Ross, DPM, Yardley, PA
12/04/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: Janet McCormick, MS
I agree with Dr. Maleski that Medicare and insurance patients should not have services in a podiatry practice by an MNT. If a patient is in treatment, they are only within the scope of care for RFC by the podiatrist, period, and a podiatrist that is billing insurance and Medicare for services performed by an MNT is billing improperly and fraudulently. This is stated many times in the MNT program and graduates are instructed in this clearly. Sadly, some podiatrists bypass this when the client gets to the counter and bill the care anyhow to insurance or Medicare. I experienced this myself in a podiatry practice once and had to insist on paying for the RFC I had that day!
Since 1995, the patients who are eligible to have their RFC billed to insurance and Medicare have reduced in percentage dramatically due to a ruling by Medicare and have become...
Editor's note: Ms. McCormick's extended-length letter can be read here
12/01/2023
RESPONSES/COMMENTS (PM ARTICLES)
RE: Addition by Subtraction (Janet McCormick, MS)
From: Richard M. Maleski, DPM, RPh
In the past, I have opined in this space on the need for DPMs to use extenders for nail care. As I stated before, back in 2008, I inquired about this with our state society (PPMA). I was told that it was not within our license for a DPM to supervise nail care. For a DPM to bill for nail care services, the DPM MUST perform the service personally; the use of an extender would be insurance fraud.
Our PPMA representative even told me of a DPM who, at that time, was being taken to court for insurance, i.e. Medicare fraud, because he used a nail technician under his supervision and billed Medicare for nail debridement. My question to Ms. McCormick is how can we even discuss the merits of using such ancillary personnel if it is illegal, at least in Pennsylvania, to use nail care extenders? Or has the law changed that allows for this practice?
Richard M. Maleski, DPM, RPh, Pittsburgh, PA
11/30/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 1
From: Paul Kesselman DPM
As an update on the very interesting issue of RPM and wearable technology, CMS recently had a call-in, a four hour meeting entitled Digital Technology and Diabetes. A very limited number of speakers spoke on a variety of topics, but mostly the NIH and inventors spoke about CGM (continuous glucose monitors). Some mention was made of wearable technology by some individuals from the NIH, CMS, and CDC.
Fortunately, APMA had registered me to speak at this meeting. The NIH speakers provided some time to discuss wearable technology but this was not limited to only socks and mats but also included potential use of "smart" orthotics and prosthetic devices as well as "smart" dressings. There was universal interest by these scientists who asked many questions on the impact wearables could have for reducing the significant costs our society bears in treating DM. It will be interesting to see where CMS takes this over the next few years.
Having podiatry invited to be part of the discussion with these preeminent scientists was certainly a big win and definitely shows we as a profession are part of this equation!
Paul Kesselman, DPM, Oceanside, NY
11/30/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 2
From: Gary Rothenberg, DPM
I would like to applaud Luke Hunter and Amanda Miller for their recent article posted from Podiatry Management. As a podiatrist who has a career dedicated to prevention of lower extremity complications among people with diabetes, any opportunity to share thoughts on the significant relationship between mental health and diabetes outcomes is welcome. However, I ask that we take this article to the next level and realize that language and words matter.
A lot of work has been done in the diabetes education space around the importance of appropriate and acceptable language in treating patients with diabetes. By the title of the article and even though people with diabetes are a significant part of podiatric practices, our field is slow to catch on to the significance of the words we use. "Diabetic" is a label and should be avoided when referring to people with diabetes. "Compliance" is authoritative and stigmatizing. There are excellent references that can help us all communicate in a more sensitive and effective way, especially important for our patients with diabetes and concomitant mental health issues. Robin Sharma said, ‘‘Words can inspire. And words can destroy. Choose yours well."
Lewis DM. Language Matters in Diabetes and in Diabetes Science and Research. J Diabetes Sci Technol. 2022 Jul;16(4):1057-1058.
Speight J, et al. Our language matters: improving communication with and about people with diabetes. Diabetes Res Clin Pract. 2021; 173.
Dickinson J, et al. The use of language in diabetes care and education. Diabetes Care, 2017; 40(12): 1790-1799.
Gary Rothenberg, DPM, Ann Arbor, MI
11/30/2023
RESPONSES/COMMENTS (PM ARTICLES) - PART 3
From: Janet McCormick, MS
I agree with most of Dr. Roth's comments concerning extenders. Medical nail technicians (MNT) do leave for many reasons, as do other extenders in offices - few of us in business have the same staff as five years ago. To counter this, I provide podiatrists ways to keep them, such as suggesting an Educational Agreement and proper pay, and more. If they continue to leave, then I always make a suggestion toward an evaluation of staff management practices. I also suggest a friendly exit to all when and if it happens, that a well nurtured referral system can be very profitable on both sides between an MNT and a podiatry practice. Wise podiatrists who build this referral system see new clients from this collaboration on a continual basis.
Over the years, I have made comments comparing the dental scenario with dental hygienists, and podiatrists with extenders, and have mentioned that many years ago, dentists saw the handwriting on the...
Editor's note: Ms. McCormick's extended-length letter can be read here.
11/27/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: Ivar E. Roth, DPM, MPH
I read Ms. McCormick's explanation of why we should have a nail extender work in our office. I would say be careful. I have been a proponent of extenders and have coined the term podiacurist which is a mani/pedicurist doing routine care in a podiatrist's office. The major problem with this has been that once these individuals have been trained by you, they get emboldened and then will leave you and start a routine foot care practice down the street. They will be in direct competition with you and usually take some of your patient load with them.
If Ms. McCormick, who I believe owns a training program for these individuals, had the ability to mandate that they must work under a podiatrist or lose their certification, that would go a long way. In reality, a program through a podiatry school could make this a real legitimate profession and would ensure that the certificate had value and protected the podiatrists.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
11/24/2023
RESPONSES/COMMENTS (PM ARTICLES)
From: Janet McCormick, MS
Dr. Hultman’s article, “Addition by Subtraction” is very interesting in that dentists began to ‘add by subtraction’ in their practices 6 decades ago: they embraced the training of dental hygienists to perform lower-level care they did not care to do: cleaning and x-rays. They eliminated these tasks almost completely from their practice rooms by delegating them to these trained professionals. Podiatrists should consider the same tactics in their practices.
As a former dental hygienist, I wonder why more podiatrists do not hire certified medical nail technicians to perform routine foot care. These nail technicians are advanced trained (and licensed) to perform the tasks of routine foot care in their services and can relieve the podiatrist of them to practice ‘real’ podiatry. While many podiatrists are doing so and enjoying the benefits of their decision, more continue to hold back.
These advanced trained nail technicians are special people who care about providing safe care within their scope of practice for persons who are chronically ill and/or elderly and have taken special training to do so safely. They wish to work directly for a podiatrist or to have a referral podiatrist to refer their aesthetic clients to who may need their care. Those of you who may need some support in this lower-level care in your office might give this some thought. Try delegating these tasks to a certified medical nail technician as dentists did to a registered dental hygienist. Most of you who do will never go back to performing those tasks except on those who specifically need you.
Janet McCormick, MS, Nailcare Academy, Naples, FL
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