Podiatry Management Online


Podiatry Management Online
Podiatry Management Online



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Query: Digital X-ray Equipment


What suggestions do you have about buying or leasing the best digital x-ray equipment? We are a two-doctor office looking to get the entire digital x-ray package. What do you currently use? What do you dislike or like about it? If you could buy something today, what would you get? Would you lease or buy? Is there any other advice about setting everything up? Space is not an issue.


Mike Anderson, DPM, Salt Lake City, UT

Other messages in this thread:



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



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.


Name Withheld


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



Query: Erchonia Lunula Laser


Does anybody have feedback on the new Erchonia Lunula cold laser out of Ireland that treats onychomycosis? All feedback is appreciated. 


Joel Greenwald, DPM, Natanya, Israel



Query: CME Record-Keeping Course


I am looking for a record-keeping CME course. Could anyone recommend one?


Yelena Voronova, DPM, Brooklyn, NY



Query: Nerve Biopsy on a Diabetic?


For the third time in the last two years, I have been pulled aside by an MD inquiring as to why podiatrists would do a nerve biopsy on a diabetic. Each time, the same local DPM has done an in-office punch biopsy, it resulted in a cellulitis. I find it very difficult to justify this procedure as medically necessary. I can’t help but wonder if my colleagues would continue to perform this procedure if the insurance reimbursements were not so good. I would like to hear other viewpoints from the PM News readers.


John M. Hurchik, DPM, Andover, MA



Query: Internet Marketing


I am considering advertising on the Internet and I'm wondering if anyone can give me any advice. I am thinking about web enhancement as well as specific marketing on Google and Facebook, etc. Which of these has been successful in enhancing your practice?  


Brent Rubin, DPM,  Lakewood Ranch, FL 



Query: Online Podiatry Store Alternative


With closing up shop, has anyone found any other similar service to use? I didn't get a ton of use (out of the site), but I think it provides a nice service on my website.


Joe Gonzalez, DPM, East Lansing, MI



RE: Recommendation for a Healthcare Attorney


After being in solo private practice for 19 years, I have been offered a position with a local orthopedic group. I would be coming in as an employee. Although I see many advantages in being part of a larger group, I want to make sure I am making all of the right decisions. I am looking for some recommendations for a healthcare attorney or consultant who has guided many DPMs through this exact process.  


Name Withheld 



Query: Encrypted email Vender


Could someone recommend a vendor to provide encrypted email services? 


Gary Hoberman, DPM, Chicago, IL



Query: Digital X-Rays and EMR


I just upgraded to digital x-rays and had a question for the old pros. The system will store the images on my computer, but there is also an easy way to upload them to my EMR (Practice Fusion) as a static image. Is there any advantage or disadvantage to adding them to the EMR? If stored locally, I can manipulate the images - measure angles, change contrast / sharpness. For the EMR - you can't,  so should I forget about uploading them to the EMR?


Al Musella, DPM, Hewlett, NY



Query: Pharmacogenetics Testing


During a pre-operative work-up for a bunionectomy, I gave patient orders for blood work and x-rays. The patient asked, “Aren’t you going to do a DNA test?” Apparently, other doctors in my area are doing DNA testing for “pharmacogenetics.” Is this becoming a popular thing? Is this something you order? And, if you do order it, what do you do with the results that you wouldn’t normally do without doing the test in the first place? t’m just wondering if I am missing the boat here.


Dave Williams, DPM, El Paso, TX



Query: Recommendations for Credit Card Processing Companies


I get advertisements all the time from credit card processing companies and never know if info in their flyers are accurate. I have had two systems and both said one price and amount; then it turns into a lot more depending on the type of credit card being used. What credit card processing systems do you recommend?


Robert Fridrich, DPM, Green Valley, AZ



Query: Starting a Practice from Scratch


I am interested in starting a new office from scratch. I previously had two offices in Massachusetts in the '90s but sold them. There wasn't technology like today, so I am a bit lost and I'm looking for some guidance as to what equipment I need to run a practice in 2017.  


Wayne McCullough, DPM, Frankfort, IL



Query:  The Global Foot and Ankle Congress 2017


I've been receiving notices about a new conference group hosting a meeting in China called The Global Foot and Ankle Congress 2017. The meeting is supported by the Asia-Pacific Society for Foot and Ankle Surgery, Chinese Orthopaedic Foot & Ankle Society.  


They say that they held a meeting in Cleveland, OH last year with over 300 attendees from 27 countries. That's a big meeting. It's too big of a meeting not to have gotten some attention on online groups but I don't recall hearing about them. I wouldn't mind spending the money to visit China, but I don't want to find out that there is no meeting upon arrival. Has anyone heard of this group and/or gone to the Cleveland meeting last year? 


H. David Gottlieb, DPM, Baltimore, MD



Query: OTC Insert with Built-in Morton's Extension


Can anyone recommend an OTC insert that has a Morton's extension built in?  


Brian W. Fullem, DPM, Clearwater, FL



Query: Master Surgeon


I have recently noted that one of the podiatrists in the greater Sacramento metropolitan area now advertises being a “Master Surgeon”, a title given by a subtalar joint arthroereisis implant company. What do others think of the title “Master Surgeon”? If given the title of “Master Surgeon” by a podiatric surgical implant company, would you use it and advertise it?


Kevin A. Kirby, DPM, Sacramento, CA



Query: Funding for Fellowships


I am a third year resident and looking into fellowships. I noticed two types - one approved by CPME and the other by ACFAS. After some research, I found that CPME is accredited by the Department of Education and Council for Higher Education Accreditation (CHEA). I did not see a higher authority that accredits ACFAS's ability to approve fellowships. The two questions I have are 1) is there a higher authority that ACFAS uses? 2) Are the fellowships approved by ACFAS allowed to be reimbursed by CMS under the graduate medical education formula if sponsored by an institution, or are they self-funded ?


Response by ACFAS: 


ACFAS Recognized Fellowships are not “accredited,” per se, although a few programs do have both CPME accreditation and ACFAS-approved status. 


The ACFAS Recognized Fellowship Initiative ensures its “approved” surgical programs meet or exceed a list of specific criteria. Once they are approved, ACFAS provides these programs support and visibility. Most of our approved programs are self-funded; some have hospital funding. Fellows of these recognized programs benefit from lower dues rates and recognition of program completion. We currently have 37 recognized or conditionally approved programs, plus three pending applications.  


When ACFAS started this initiative in 2010, there were 10 programs, so we believe ACFAS’s criteria and support of fellowships has greatly enhanced this career path for residents. More importantly, fellowships aid in the specialty’s push for full professional equality. For more information and a list of all programs, click here.


J.C. (Chris) Mahaffey, MS, ACFAS Executive Director



Query: Intra-Office Communications System


I would like to know what systems my colleagues are using in their clinics to optimize intra-office communication between doctor and staff to optimize patient flow. A few examples of "periodic" intra-staff communication/patient flow problems: 

1) I'm not sure which exam room to go to next, 

2) An assistant tells me to see the patient in Room 1, then another assistant comes in that room to tell me I was supposed to see the patient in Room 2 first, 

3) An assistant comes in the exam room to let me know that we're getting behind or someone's been waiting a while, or I go into a room to tell an assistant that we're getting behind, 

4) I am looking for or calling out down the hall for an assistant to help me with a patient, 

5) I have to go into an exam room while the assistant is working with a patient to tell the assistant what they need to do for another patient (or an assistant coming into a room to tell me what another patient needs).  


In my Internet search, I came across BlueNote Lights software system. Does anyone have experience with this program or any other other intra-office communications software system to recommend...or any other ideas to get things consistently running smoothly?  


Tom Silver, DPM, Minneapolis, MN



Query: Source for Dermal Filler


I am looking for a resource to order Juvederm or an equivalent product for subQ. I contacted the company (Galderma/McKesson) that distributes the product and they said it can ONLY be sold to an MD or DO. No DPMs.  Can anyone suggest other resources or options?


David Weiss, DPM, Richmond VA
Euro International