Query: CMS Changes
Two years ago, we were told that the global surgery days were to be eliminated. I have not heard any mention of whether this was implemented. Also, does anyone know the status on the exemption limits to the CMS quality assurance program? They currently are $30,000 with up to 100 patients and the proposed change was to $90,000 for up to 200 patients. The latter proposed change was reported here on PM News. This is a very important change for solo small practices. The impact from an elimination of the global surgery days will affect all practices.
George Jacobson, DPM, Hollywood, FL
Query: Pacific Medical for Digital X-Ray System
My office is in the market to purchase a DR x-ray system. I have recently been in touch with Pacific Medical who uses Metron software. I'm not familiar with this company but they do have very good pricing. Does anyone have any experience with this company, and could you inform me as to how happy you are with the DR digital x-ray system?
Peter Riznyk, DPM, Orchard Park, NY
Query: Hospital Call Schedule
The hospital I currently go to is planning on starting a non-paid call schedule. I'm trying to negotiate a paid call schedule because, in my opinion, non-paid is ridiculous. Why should all other specialties get paid while podiatry doesn't? Does anyone else experience this, and do you have any tips to negotiate?
Mike Zuri, DPM, Tampa FL
Query: Non-Allergenic Support Hose
Does anyone know of any support hose that are non-allergenic? My patient has tried several brands with no luck.
Robert Fridrich, DPM, NY, NY
Query: Shoe for Parkinson's Disease
I have a very close friend who has had Parkinson's disease for over twenty years. He is in his early 60s and has been doing relatively well. He does shuffle while walking and sometimes stumbles and trips. His shoes are mostly rubber composite designer footwear. I am researching shoes with less grabbing soles.
I know the SAS line would be good but I would like some other suggestions, especially if there are any designer shoes that would have a more forgiving sole for this type of gait. A leather sole is not an option due to insufficient padding. Any input would be greatly appreciated.
Query: Beneficial Insurance
I just received a very good quote from Beneficial Insurance for my malpractice insurance policy which is coming up for renewal. I have not heard anything, negative or positive about this insurer. I'm wondering if any of my colleagues have had any experience with them?
Deardre Nadel, DPM, Bronx, NY
Query: Options After Residency
I am beginning my third year of residency starting July 1st. I feel very excited and eager to begin my last year of training, however I have a lot of anxiety of the future. I feel completely lost as to when, where, and how I should be looking for a job and any other necessary things to do in order to prepare for the next steps. I am planning to apply for my state license in the state where I hope to work, but other than that, I'm not sure what else to do? I'm writing to see if there is any advice that can be offered. Also, I would like to thank PM News for the job postings. They are very convenient. Are there additional sources?
Query: Hiring a Registered Dietitian (RD)
In an effort to provide complete care to their patients, many hospitals in the area have begun offering diabetic counseling and meal planning sessions with registered dietitians (RD). I was considering hiring a registered dietitian and providing those services (and billing for them) in the office. This will help ensure that patients follow through with the referral, and it would also generate additional income for the practice. Has anyone else set up a similar arrangement? Are there any reasons why this shouldn't work? Would our scope prevent this arrangement or preclude billing for their services, even though the RD is practicing under his/her own license?
Jay Seidel, DPM Baltimore, MD
Query: Endoscopic Plantar Fasciotomy Blade/System
I’m looking to find a reasonably priced endoscopic plantar fasciotomy blade/system? Any help would be much appreciated.
Kyle J. Kinmon, DPM, Boca Raton, FL
Query: Life Coach to Help Rehab Patients
Would you refer patients to a life coach? What would be your thoughts and concerns about such a service? Would it help our patients who require additional reinforcement and support to meet their rehabilitation goals?
A. James Fisher, DPM, Crescent City, CA
Query: Kinesiology Tape?
What is everyone's preferred kinesiology tape to use? Which do you feel gives the best support, is waterproof, and causes minimal skin reaction?
Chad Friedman, DPM, West Chester, PA
We are considering installing a VOIP system in our offices. There seems to be a bunch of companies out there. Can anyone recommend a company? What are your experiences with them?
Nicole Kaiser, DPM, Delran, NJ
Query: Source for ClearNail Pro+
Can ClearNail Pro+ topical anti-fungal be purchased for resale to patients, or is this product discontinued?
Allan Freiberg, DPM, Metairie, LA
Editor's note: The product has not been discontinued. It is available OTC on Amazon for about $40 for a 10ml bottle.
Query: Microscope for KOH Preps
If any colleagues are performing KOH preps in their offices, what type of microscope are you using? I just want to be sure that a $300 scope from Amazon will do the trick.
David Kahan, DPM, Sacramento, CA
Query: Source for Cantharone
Can anyone provide information on a vendor who distributes Cantharone to California? I have been finding it more and more difficult to access. For the treatment of warts, I use a number of different modalities including Cryoprobe, Candida injections, 5-FU, laser, S.A., Adapalene, and duct tape, but have found that Cantharone is still one of the most effective treatments.
Charles Baik, DPM, Tustin, CA
Query: Interstate Licensing
I just read an article in Univadis reporting that interstate medical licensing is now available in 18 states that participate in the Interstate Medical Licensure Compact. There are elegibility requirements and fees (varied by state), and background checks are required. Seven more states and DC have legislation pending to join the compact. There was no mention of the MD vs. DO degree. Does such a movement exist within our podiatric medical specialty to broaden our licensing structure?
Neil H Hecht, DPM, Tarzana, CA
Query: Insurance Eligibility Checking
We try to check insurance eligibility and our participation in our patient’s health insurance program before they arrive at our office. At times, this is done when the appointment is made. Some time can be saved by using a service on line such as Availity, a corporation founded by Humana and BC/BS, for data on deductibles and co-pays. However, details of specific CPT code coverage, i.e., Orthotics L3000, can only be completed via a long and arduous phone call to the patient’s health insurance company. Any suggestions on how to make this process more efficient? Is there a better service for finding this information?
Jerry Cosentino, DPM, Tampa, FL
Query: Non-Staining Disinfectant for Instruments
What soaking solutions are being used for treatment room instruments? We are using Cetylcide-II, but it is staining instruments really badly.
Nick Costidakis, DPM, Lafayette, IN
Query: Missed First Appointments
I have a problem with patients missing their first appointments and wonder if it is acceptable to run a credit card to hold this first appointment so that it isn't missed without notice. Would this be an acceptable practice? Is there anyone else doing this? Are there any other ways to keep the new patient missed appointment from happening?
All my patients sign a waiver which allows me to bill them for their missed appointments, once they are an established patient, and this works well to keep the missed rate down.
Frank J. DiPalma, DPM, Athens, GA
Query: Source for 4% Dehydrated ETOH?
Can anyone give me the name of a company that supplies 4% dehydrated ETOH?
Andrew Carver, DPM, Washington, DC
QUERIES (NON-CLINICAL) - PART 1
From: Brian Kiel, DPM, Deb Lund-Tlumak
Tincture of Benzoin works well. Apply and let it dry for a moment until tacky.
Brian Kiel, DPM, Memphis, TN
Mastisol is an adhesive adherent. It comes in a single application vial with an applicator tip. It also comes in bottles. This has been used for some time in the OR for Steristrips, etc.
Deb Lund-Tlumak, Clinical Practice Manager, Edmonds, WA
Query: Non-Aerosol Tape Adherent
Does anyone know of a non-aerosol tape adherent?
Michael Forman, DPM, Cleveland, OH
Query: Formula for Value of a Practice
I am interested in hearing what is the typical "ballpark" criteria used to determine a practice's sale price. Is it last year's gross revenue, 50% of last year’s gross revenue, or something completely different? I realize every practice and every situation is different, but I am really just interested in a basic guideline to follow. Also, if a practice is financed by the seller, what is the typical time frame for repayment of payoff, 3 yrs, 5 yrs, longer, shorter? Any insight would be greatly appreciated.
Editor's comment: There was a time before managed care when podiatry practices were quite similar and could be valued by formula. In recent decades, because of the complexity and variations in practices, no formula can accurately value a practice. Three practices can have the same gross income, but widely different net incomes. The key is not what the practice earns but what the purchasing podiatrist can expect to earn. Today, an increasing number of DPMs are choosing to join a practice rather than buy one, thus the ultimate answer is that a practice is worth what a buyer is willing to pay for it. Like everything else, seller financing is negotiable.
Query: Recommendations for Billing Company
After 15 years, I am looking for a new billing company as the current one that has generally done a good job in reviewing my accounts receivable, has added price increases both in terms of percentages charged as well as new ancillary fees.
Can anyone provide me with any contacts and names of billing companies, preferably located in the Northeast (NY/NJ/PA area) with whom you have had a good relationship with, and with whom you are satisfied with both the quality of their work and the fees that are charged for their services?
Bill Lipkin, DPM, Hoboken, NJ
Query: Do patients judge us by what kind of car we drive?
From; Elliot Udell, DPM
My mechanic "read me the riot act" yesterday. I had the oil changed and he let me know that at the next state inspection my car would need upwards of 3,000 dollars in repairs in order to pass inspection. He said based on the car's age, if he owned it, he would chuck it and lease a new car. He is probably on target. What I need to assess is whether I as a doctor in private practice need to invest a lot of extra money in an upscale car in order to impress patients. My inclination is to buy or lease a Toyota, Hyundai, or Honda but do patients in the year 2017 judge us by what kind of cars we drive? I would appreciate some feedback on this.
Elliot Udell, DPM, Hicksville, NY