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RE: NYSPMA Efforts to Ensure the Future Viability Of Podiatry

From: Paul Liswood, DPM 


There is often discussion on PM News regarding the future viability of podiatry. The New York State Podiatric Medical Association (NYSPMA) has taken an aggressive and proactive approach to strengthen podiatry and ensure our members will have opportunities and succeed in new healthcare realities. NYSPMA retained Navigant, a nationally recognized healthcare consulting firm to investigate the New York State health goals and prevention agenda, and find ways for podiatry to show value in helping the state achieve its health objectives. Navigant then preformed an extensive data analysis on commercially available claims data to support podiatry’s value in improving outcomes, reducing hospitalizations, and lowering healthcare costs in the treatment of diabetics, obese patients, as well as preventing falls and reducing opioid use when patients are under our care.  


NYSPMA will be using this information in its dealing with legislators, department of health regulators, insurance medical directors, health systems, advocacy groups and the public to help pass legislation, propose healthcare policies favorable to podiatry and our patients, and increase the demand and appreciation for the services we provide. Podiatry needs to be recognized as essential care providers and important members of the healthcare team who improve public health, prevent complications and hospitalizations, and lower healthcare costs. We will be sharing more about this important initiative with our members at our clinical conference in Manhattan next week.


Paul Liswood, DPM, President Elect, NYSPMA

Other messages in this thread:



RE: Inexpensive Podiatry Chair Restoration

From: Michael Lawrence, DPM


Over three years ago, I got a great deal on an SUV.  The only problem was the two front seats were broken down due to some extremely large previous owners. So they had to be replaced and the ones I got were used in great shape from the same year, make, and model. They should have matched colorwise but for some reason did not. I researched my options and came up with a product made by Colorbond car seat paint for leather and vinyl, and with just a little effort, refinished those seats myself, matching perfectly. The vehicle is driven daily and the seats still look great, three years later. Two seats for less than 80 bucks.


When I was in practice and my chairs were getting worn and outdated, how nice it would have been to know of such an option. I spent a lot to have them re-upholstered, losing them to service for days on end. With this product, you could literally prep and apply in an evening and they'd be ready for use the next day!   


Michael Lawrence, DPM, Chattanooga, TN



From: Pete Harvey, DPM


Our staff uses a free virtual a time clock called Redcort Software. I then enter the hours in That software calculates the amount of the check and payroll tax. My staff prefers a paper check (which are the only paper checks I write) but the amount can be deposited into their account electronically after set-up. The data is then sent to my CPA. She then sends all notices to the employee including year-end tax withheld, etc.


She also manages all quarterly reports. Taxes due are paid electronically through managepayroll. Her fee is $40 per quarter. You must have a CPA who is familiar with managepayroll. I asked the company and they sent a list of ten CPAs in my area who use their service.


Pete Harvey, DPM, Wichita Falls, TX



From: Paul Baumgarten, DPM


I highly recommend It is free and you keep track of all employees. They clock in on any computer and clock out. It also has a GPS feature so that if someone tries to cheat you, i.e. clocking in at home or something, you can tell. 


Paul Baumgarten, DPM, East Glenville, NY



RE: Noridian Medicare's Portal for Checking Patient Eligibility or Deductible

From: David L. Kahan, DPM


Just a head’s up to those that utilize the Noridian Medicare portal for checking patient eligibility or deductible status. The site will NO LONGER show you the deductible status of those patients who are considered “special needs”, i.e. Medicare and Medicaid (SNP). In the past, you may have held claims until deductibles had been met so you did not have to eat the deductibles. Now you will have to just guess or ask the patients when they come in whether they have been to the doctor and estimate the deductible remaining. 


David L. Kahan, DPM, Sacramento, CA



From: Jeffrey Kass, DPM


The discussion on demonstrating podiatry's value within the healthcare system does sound imperative for the long-term survival of the profession. I am curious on how exactly this is done and what statistics are being used. There does not seem to be any standard protocols from the profession for treating patients. For example: Dr. Liswood brought up the role of podiatry and diabetes. There are some who opine the gold standard for diabetic ulcerations is total contact casting, yet statistics reveal the majority of podiatrists don't use them. 


Dr. Liswood brought up the role of podiatry and fall prevention. Most podiatry articles on fall prevention bring up the Moore Balance brace. Yet, one of our podiatric icons, Dr. Ritchie, has written that there is no evidence these braces do anything to prevent falls. What stats are we using?


I think some focus should be on evidence-based medicine, and using universal protocols based on evidence would help demonstrate our true value.


Jeffrey Kass, DPM, Forest Hills, NY



RE: Difficulty Getting Local Anesthetics (Sam Bell, DPM)

From: Nick Turner, Joshua Kaye, DPM


While many local anesthetics specifically with epinephrine are out of stock nationwide, DocShop Pro - a podiatry distributor serving offices nationwide - has various sizes and types of Marcaine, Carbocaine, and lidocaine/Xylocaine (including Xylocaine 1% with EPI) available and in stock.


Nick Turner, Managing Director - DocShop Pro 


As many of you probably know, currently you cannot purchase lidocaine with epinephrine due to a so-called shortage of the product. Plain lidocaine is readily available from all suppliers.  One can also readily purchase 1 cc vials of epinephrine in a concentration of 1 mg / cc, which is available from local pharmacies, hospital pharmacies, and your usual medical suppliers. If you would like the usual 1% or 2% lidocaine with 1:100,000 epinephrine, simply draw up the 1 cc of 1 mg/cc of epinephrine into a 1 cc syringe, and inject 0.5 cc into the common 50 ml vial of lidocaine plain, and you will have your usual mixture of lidocaine with epinephrine.


So this "so-called" shortage really begs the question of why couldn’t the drug companies produce the usual lidocaine with epinephrine when the components are readily available? Does this have any similarity to the shortage of colchicine and the subsequent current increase of its price by about 2,000%, or the current enormous price increase of Atenalol?


Joshua Kaye, DPM, Los Angeles, CA



From: William D. Spielfogel, DPM, Vito J. Rizzo, DPM


This is an excellent initiative by NYSPMA and it is great that the Board of Trustees is being proactive in its advocacy for podiatry. They are an example of an organization advocating for its membership and trying to get a seat at the table.


William D. Spielfogel, DPM, NY, NY 


In our rapidly changing healthcare delivery paradigm, it is imperative that there be opportunities to help define what a particular category of healthcare provider can offer to contribute to the problems facing our population. Policymakers need to be educated on the facts as they relate to outcome statistics and verified cost factors. Many of these policy considerations are determined in a federal or centralized system. Podiatry’s first advocate should be the APMA. As experience has demonstrated, podiatry seems to be not permitted “a seat at the table”, and this profession is often caught needing to try to fix policy shortcomings after the fact. This has proven to be bad policy. 


I applaud the effort of the NYSPMA, which has been the leading advocate for progressive healthcare policy specifically as it relates to podiatry and to the communities we serve. NYSPMA led the charge, resulting in the Thompson Reuters Study which demonstrated the value of podiatry in the care of lower extremity manifestation of diabetes. NYSPMA has been trying for years to have care measurements developed specifically for podiatry, which could then force payers to better consider podiatry as a key partner in many healthcare scenarios. This effort in population health is the next phase of what has been a multi-year and ongoing effort to demonstrate the need for podiatry’s inclusion in a myriad of ongoing and pressing healthcare issues. The opioid crisis, fall risk, and the ever present concern with the ever rising costs of managing the effects of diabetes are areas where it has once again been shown that with podiatry on the team better outcomes and lower costs result. 


I encourage APMA, and all of its individual components, to carefully consider and then support the work of NYSPMA as a national effort. In the big picture, it will help podiatrists and their patients throughout the nation, and not just in New York.


Vito J. Rizzo, DPM, Bay Shore, NY



From: Brian Kiel, DPM, Paul Busman DPM, RN


There is a national shortage. I was told that much of this was made in Puerto Rico and because of the hurricane damage there is none being made. I can't be absolutely sure of this as the reason but I do know it is a national problem.


Brian Kiel, DPM, Memphis, TN


I have a somewhat cynical theory about that. The drug companies make up a "shortage" of common but essential items (I once saw a shortage of 3L bags of saline!), let providers stew a while without it, then manage to meet the "shortage" and return the product to the market. Providers are so happy to get it back that they don't gripe about the fact that the manufacturers have raised the price significantly. This probably isn't true, but these days nothing surprises me. 


Paul Busman DPM, RN, Frederick MD



RE: Historical Perspective on Podiatry

From: Bruce Lebowitz, DPM


Since retiring, I have become a docent at a Johns Hopkins museum. As such, I have learned a great deal of history. When I entered classes at MJ Lewi Podiatry school, I learned that in 1912 organized medicine had ignored the foot. Dr. Lewi helped create the school in order to fill the gap. I’ve now learned more about the state of medical care in the late 19th and early 20th centuries.


Johns Hopkins University and medical school were founded at the end of the 19th century as a result of Mr. Hopkins' will which allotted some 71/2 million dollars toward that end. Nevertheless, the U.S. economy took a fall at the same time, making it impossible to get the school off the ground. As it turned out, the Hopkins board found a donor willing to shell out the extra millions. Mrs. Garrett, a wealthy philanthropist, donated the funds with a couple of strings attached. One, women would have to be admitted every year. Second, there would have to be students accepted who had achieved academically in college.


She did this because she well knew the state of medical care in this country was awful. She knew too that there were American medical schools graduating doctors who could not read or write. So, podiatry began out of need around the same time as academic medicine did. How’s that for parity? 


Bruce Lebowitz, DPM, Baltimore, MD



RE: The Passing of Ivan Abrahamson, DPM

I had the pleasure and privilege, back in the mid to late '70s and beyond, to participate and work with Ivan and the Queens County Podiatry Society. We even co-authored a published article on minimal incison removal of a dorsal talar exostosis. Dr. Abrahamson was always a gentleman. He was a kind and caring man who was a credit to the profession of podiatry. He will be missed.

Larry Kobak, DPM, JD



RE: Doctors, Action is Needed Today

From: Richard B. Willner, DPM


There was a time not so long ago when doctors could have disputes with hospitals and simply move on. Nowadays, the hospital uses a fraudulent peer review to destroy the doctor’s career. The reason for this is to control the healthcare dollar and to diminish the bond of trust between physicians and patients and sell the snake oil of falsified hospital quality ratings to the public. 


The parties who have become the defacto credentialing authorities of physicians are corporate lawyers whose firms represent banking, insurance, cigarette companies, asbestos manufacturers, and other gross offenders of health and well being of ordinary people in the pursuit of profit. These law firms comprise the roster of...


Editor's note: Dr. Willner's extended-length letter can be read here



From: Brian Kiel, DPM


First of all, if one is to publicly praise and justify the actions of Joseph McCarthy, why are you ashamed to let us know who you are. He was publicly disgraced and proven to be a liar and was the precursor to the same political hate game we are seeing today. This "withheld" person is looking for ghosts under every bed and is obviously a proponent of the extreme right wing political persuasion. I disagree with his basic premise, but he has every right to espouse it, just don't do it behind a curtain. What are you ashamed of if not your views?


Brian Kiel, DPM, Memphis, TN



From: Mike Kempski


I work on the insurance side of medical malpractice and have twenty five years of experience. In the early years of the Data Bank, the doctors had great concerns about entries against them. The concern was so intense that the carriers responded by changing their policy language as it relates to the settlement of claims. The change was the policies stated they won’t settle a claim without your consent to do so. However, I don’t think there was much reason to be worried. There’s very limited access to the Data Bank. For example, the general public (your patients) can’t access it. Medical malpractice insurance carriers can’t. Hospitals can. But they’re always very reluctant to revoke privileges. How has it hurt physicians?


Mike Kempski, Plymouth Meeting, PA



RE: The HIPAA Audit

From: Richard B. Willner, DPM


One of the by-products of the passage of the HITECH ACT as part of The American Recovery and Reinvestment Act (ARRA) was the mandatory HIPAA Audit with mandatory fines. The passage of these laws were delayed to give time to understand the Regs and to come into compliance. It was not until April 2010 that the Office of Civil Rights (OCR) at the U.S. Dept. of HHS awarded two contracts to Booz Allen Hamilton, Inc. The first contract was for audit consulting support to OCR to help train the auditors. The second contract was to help OCR develop training seminars for state atty generals on HIPAA rules and regs. 


The HITECH Act is a subsection of the HIPAA of '96. HITECH Security Act part 2 strengthens many of the rules and regs of HIPAA and can be thought of making it stronger, especially for...


Editor's note: Dr. Willner's extended-length letter can be read here. 



From: Name Withheld


Dr. Willner has worked very hard over the years to point out the Kafkaesque nature of the NPDB (as has the Semmelweis Society International). The only issue I take issue with would be his comparison of the NPDB to the work of Senator Joseph McCarthy. Once the Verona letters were in hand and translated/decoded, every, single individual named by McCarthy was not only identified as a Soviet plant, but had their Soviet handler identified as well. No such vindication is forthcoming for the NPDB. According to the GAO reports of 1990, 1993, and 2000, approximately 40% of the information in the NPDB is incorrect. I doubt that the percentage has improved over time. We are used to the inefficiencies of Federal Agencies, but name me another organization which could have as much as a 40% failure rate and still exist…and on the taxpayer dime?


It is very much the case that reports can and very often are arbitrary, simply punitive, and serve no purpose in the furtherance of “protecting the community”. A nice read on this would include:  B. Abbott Goldberg, The Peer Review Privilege: A Law in Search of a Valid Policy, 10 AM. J.L. & MED. 151, 154 (1984). I believe—from my own experience of the process and the lack of recourse once reported by an organization who made up the charges in retaliation for reporting a negligent homicide at their facility—that the NPDB is as malignant an organization as the EPA or the Bureau of Land Management and should be abolished. Every once in a while, a doctor prevails, but the Poliner cases out there are very rare.


Name Withheld



RE: The National Practitioner Data Bank (NPDB)

From: Richard B Willner, DPM


The National Practitioner Data Bank (NPDB) is a 20-year experiment created by an act of Congress along with the Health Care Quality Improvement Act of 1986 (HCQIA). The experiment has failed. It is time to abolish this agency. The NPDB is a blacklist reminiscent of the McCarthy blacklist of the 50s. Instead of targeting the Red Menace, or Communists, the target of this blacklist of the White Menace: "Bad Doctors." 


The problem is that too many good doctors' names are submitted to this list. And it is disturbingly easy to do. The perception is, if a doctor is included on this list, they must be a bad doctor; otherwise, why are they on the list? The consequences of a listing are dire. As a result of a listing in this "databank", many...


Editor's note: Dr. Willner's extended-length letter can be read here.



RE: Best Way to Study for 10-Year Forefoot Boards

From: Patrick (Pat) Caputo, DPM


I have recertified for foot surgery two times. If you study for foot surgery, you should do fine. Antibiotics, medicine and surgical principles are the same for foot surgery as they are for reconstructive rearfoot/ankle (RRA) surgery.


Patrick (Pat) Caputo, DPM, Holmdel, NJ



RE: Medical Symbol Misunderstanding 

From: Rick Harris III, DPM


Why do we still see the caduceus linked with medical associations instead of the Rod of Asclepius? The confusion seems to stem from the appearance of the caduceus on the chevrons of Army hospital stewards as early as 1856. A misinterpretation led to the caduceus being adopted by the United States Army Medical Department in 1902. It would gain such popularity that it even briefly served as the symbol for the AMA, but would subsequently be replaced by the Rod of Asclepius. 


Many believe the caduceus to be inappropriate as it is associated with the Greek god Hermes, who was patron of commerce as well as thieves, liars, and gamblers. Being as that, it is interesting to see its continued usage. There have been a number of recent articles in the medical literature that have highlighted the inappropriateness of the caduceus as a symbol of medicine and have sought to restore the Rod of Asclepius to its rightful place. For historical context, look no further than the first paragraph of the original Hippocratic Oath, “I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea, and by all the gods and goddesses as my witness, that, according to my ability and judgment, I will keep this Oath and this contract."


It will be interesting to see if there is a continued shift by academic and health institutions to the single serpent entwined rod wielded by the Greek god of healing and medicine, Asclepius.


Rick Harris III, DPM, Jacksonville, FL



RE: Regulation for Power over Physicians and Surgeons

From: Michael M. Rosenblatt, DPM,


The abuse of physicians is clearly a byproduct of progressive liberal rule of the United States. Ostensibly, it is "couched" in regulation to raise the standard of care and "limit" damage by "incompetent or dangerous physicians." The regulations and their promulgators always say this is for the public good. It has nothing to do with the public good or protection. It is entirely regulation for POWER over doctors and professionals. It creates "boards of review" who are not qualified in most cases and also exposes physicians to "Star Chamber" procedures and accusations with absolutely no civil rights. 


Make no mistake: Regulation is for power. It has no intent or purpose otherwise. It also creates boards and employment for non-professional people and expands government into every aspect of our personal and professional lives. Physicians must be careful for whom they vote. Bigger government means lack of rights without improvement in opportunities. Marxism is a byproduct of big government. This country has been on a rolling slope toward cultural and professional Marxism with Democrats in control. 


The "members" of these various committees are fools if they believe they are on the "right side." It is only a short step, under accusation of another person who wishes to take away your rights, your profession, and your be ON the other side and become a target yourself. 


Michael M. Rosenblatt, DPM, Henderson, NV  



From: Jack Ressler, DPM


We've been using Square in a satellite office for several years. The rates are very competitive and they email you a confirmation of payment within a few minutes of the transaction. You can access reports quickly on-line with relatively easy navigation.


Jack Ressler, DPM, Delray Beach, FL



RE: Best Way to Study for 10-Year Forefoot Boards

From: Mark L Miller, DPM


I just recertified last year for the second (and last) time—the Goldfarb Board Review Course was all I needed. I took the class over a weekend and then took the test the next week. Everything was fresh in my head and the test was not bad at all. As one of the instructors in the course said, "the recertification test is testing what you do every day."


Mark L Miller, DPM, McLean, VA



RE: Pass-through Income Tax Changes as They Apply to Podiatrists

From: Richard Rettig, DPM


The Tax Cuts and Jobs Act of 2017 (H.R.1) was passed by Congress and signed into law December 22, 2017 by President Trump. What does that mean to us as physicians, and how can it benefit us? First of all, there are some changes to the dollar amounts of tax brackets that will change things in a minor way, one way or another. They lowered the brackets percentages, but also changed the size of each bracket in what seems at first glance to be a non-adventitious way. 


Secondly, there are major changes in allowed itemized deductions for SALT (state and local taxes, including real estate taxes) that will harm many...


Editor's note: Dr. Rettig's extended-length letter can be read here.



RE: Due Process Rights and Peer Review

From: Richard B. Willner, DPM


Medical peer review is the process by which a committee of physicians investigates the medical care rendered by a colleague in order to determine whether accepted standards of care have been met. The professional or personal conduct of a physician may also be investigated. If the  committee finds that the physician departed from accepted standards, it may recommend limiting or terminating the physician’s privileges at that institution. If the physician’s privileges are restricted for more than 30 days, federal law requires the peer review committee to report that fact to the National Practitioner Data Bank. 


There is no federal statute that requires peer review committees to observe due process, which the Supreme Court has defined as...


Editor's note: Dr. Willner's extended-length letter can be read here.  



RE: Rules of Evidence and Professional Practice

From: W. David Herbert DPM, JD


Anyone who is interested in determining who can do what to whom in a medical sense should review the appropriate licensing acts of all medical type providers in states like Montana, Alaska, and Minnesota. I also recommend that they review the scope of practice of naturopaths in states where they are licensed. Not too long ago, I was contacted by several state legislatures about the issue of nurse anesthetists obtaining hospital privileges on hospitals that only employed anesthesiologists. The unlimited scope of practice of nurse anesthetists was not the issue. Only the politics involving who was granted hospital privileges in the larger hospitals was the issue. In states where they are allowed to practice independently, many nurse anesthetists have larger incomes than many primary care physicians.


In a medical malpractice case in some states, nurses can testify against physicians and vice versa depending on the issue. In a lawsuit involving medical providers, it will be your malpractice carrier that will determine whether you are covered or not. How it is in Florida is not how it is everywhere when it comes to the practice of anything that might be related to medicine.


W. David Herbert DPM, JD, Billings, MT 



From: Steven Kravitz, DPM


Dr. Markinson makes some very salient points that podiatrists should consider. There is no turning back the clock; physician extenders are here to stay. But the good news is that there has been a change in podiatry recognition of this aspect of delivery care over the past 3 to 4 years. Assessment of the membership of a well-established physician (MD and DPM) only wound healing association provides interesting data on a dramatic shift with podiatric perspective on NPs and PAs. 


Four to five years ago, there was much more concern about competition with these practitioners and therefore a conflict of interest. But over the past two to three years, more and more podiatrists are working with...


Editor's note: Dr. Kravitz's extended-length letter can be read here
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