Spacer
PMbanA7-513.jpg
Spacer
AMIFASBannerCU418
Spacer
INGBannerE215
Podiatry Management Online


Facebook

Podiatry Management Online
Podiatry Management Online


PracticeEHRWebBannerGY218

Search

 
Search Results Details
Back To List Of Search Results

01/11/2018    

RESPONSES/COMMENTS (NON-CLINICAL)


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:


04/23/2018    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Dennis Shavelson, DPM


 


Greg Sands, OP, & Ortho-Rite have been the sole fabrication subcontractor for FootHelpers Lab for decades. He accepts the cost and high maintenance standards needed to produce foot centering orthotics. That enables me to offer an alternative to subtalar joint neutral cast devices where needed. During the recent shutdown, I made the mistake of sending casts to two other labs that assured me they could produce RestorThotics to my standards. The 75%+ return rate that ensued proved more destructive than if I had shut down and waited for Greg to rebuild.


 


My devices dispense by conforming to two tests. They must “integrate” to optimal casting position and they must activate the 1st ray rockers when underfoot. The replacement devices were too wide, too long, under-vaulted, and poorly posted. LLD lifts were not applied professionally and many made 1st ray activation worse, not better.


 


Although some patients and clients accepted the makeshift devices without complaint, I have re-dispensed more than half of the back-up devices with an Ortho-Rite product in order to re-establish my reputation. I have stated many times that Greg is the best production administrator of a custom foot orthotic lab. This was a pricey way to find out. I'm so glad to have you back.


 


Dennis Shavelson, DPM, NY, NY

04/21/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Bret Ribotsky, DPM


 


I have used Tsheets for years with a few service employees. It geotags them, and lets you track them while on the job. It runs via their smart phones and works directly with Quickbooks payroll.  


 


Bret Ribotsky, DPM, Boca Raton, FL

04/21/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: John S. Steinberg, DPM


 


We apologize for what your friend experienced. However, it is unfair to turn this misinformation into an accusation that Georgetown is somehow discriminatory towards podiatric surgery. I am the co-director of the Center for Wound Healing at MedStar Georgetown University Hospital. Our team is composed of podiatric surgeons, plastic surgeons, vascular surgeons, nurse practitioners, and numerous other specialists.


 


MedStar Health is a system of over 36,000 employees with 10 hospitals, so I cannot speak for every circumstance, but I can tell you that podiatric surgery is well established here and is not in a discriminatory status. I believe it would be best for you and me to speak directly about what happened rather than have this debate on PM News. Please contact me at 202.444.3059 and I would be happy to reach out to your friend to provide assistance.


 


John S. Steinberg, DPM, Washington, DC

04/19/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B


RE: The Importance of Examining Legs 


From: Robert D. Phillips, DPM


 


I would like to commend the thoughtful letters written by Dr. Forman (4/14/18), Dr. Silver (4/18/18), and Dr. Jacobs (4/16/18). All bring to the fore the important facts that diabetes not only has a negative effect on all the systems in the foot, but that decrease in the utilization of the foot also accelerates the impact of the disease on the other body systems. 


 


Certainly, the main goal of any podiatrist treating the diabetic patient is to increase the activity level of the patient. Many years ago, I heard Dr. Root talk about no longer thinking of geriatric foot care as trimming calluses and nails and moisturizing the skin. Instead he stated that...


 


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

04/19/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3


RE: Podiatrists Disparaged by Georgetown Staff


From: Lloyd Eisenberg, DPM


 


Recently, a close friend fell and was sent by ambulance to the hospital. After having her leg wounds dressed by the ED staff, she was told to make an appointment with the hospital's wound staff. She was given a list of names. She selected a name from the list and called to schedule an appointment for evaluation and treatment. She was told by the receptionist that the doctors on the wound management staff were all podiatrists and she should seek treatment at another hospital in the Washington metro area where the wound management docs were physicians. This type of discrimination is not tolerable and should be queried by the podiatry department at this large teaching hospital.


 


Lloyd Eisenberg, DPM, Chevy Chase, MD 

04/19/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Bill Beaton, DPM


 


I would like to comment on Dr. Richard Simmons' post in regard to "non-medically licensed" personnel performing routine foot care and that procedure is billed as if the DPM personally performed the procedure. In Florida, it is against the Florida Podiatry Practice Act for anyone not licensed to perform any procedure that falls under the definition of the Practice of Podiatry.


 


Florida Statutes 461.003(5) states that "Practice of podiatric medicine" means the diagnosis or medical, surgical, palliative, and mechanical treeatment of ailments of the human foot and leg. The surgical treatment of ailments of the human foot and leg shall be limited to that part below the anterior tibial tubercle.


 


In my opinion, anyone other than a licensed podiatrist providing palliative foot care or a podiatrist that is supervising a non-medically licensed person is in violation of the Florida Podiatry Statutes and subject to penalties under Statute 461.012(2)(d).


 


Bill Beaton, DPM, Saint Petersburg, FL

04/19/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: An Open Letter from Greg Sands of Ortho-Rite to His Customers


From: Greg Sands


 


Within a few short months, and after a catastrophic fire that completely blindsided me, Ortho-Rite is up and running. It’s good to be back! I am not sure how the fire started. What we do know is that the paper storage is where it started. Paper storage is a ticking time bomb. How it started will remain an unsolved mystery. 


 


The first thing I want to do is thank my customers for their loyalty and support. I know that the fire has disrupted practices and hurt patients nationwide. I was overwhelmed and shocked, but I focused all my energy to rise above the ashes and rebuild. The building bureaucracies of this new town kept us from operating sooner. To circumvent the red tape, we worked a night shift to get things going. We have cleared the hurdles and we are now producing. Three months of anguish and stress have finally come to an end. I will do anything I can to make whole anybody who was adversely affected.


 


It was tough getting restarted after going for so many years. For the rest of my time in this industry, Ortho-Rite will be committed to make it up to all of you who were compromised. I am truly sorry for what happened. I want to maintain and exceed the level of product and service that you were used to. My entire team remains intact and eager to take care of everybody as usual. 


 


Greg Sands, Owner of Ortho-Rite

04/18/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Thomas Silver, DPM


 



I have tons of patients sent to me for "routine care" from large managed care clinics in my area. I often hear from these patients that they were seen by the podiatrists in their clinic and told by them, "I'm a surgeon. I don't trim toenails or calluses!" and that they often don't even look at their feet. They refer them out to the few clinics in my area (population >1 million) that do "routine care". 


 


In most all cases, I do a full lower extremity exam for these "routine care" patients. Many of the elderly have had knee or hip replacements, so I routinely measure for leg-length discrepancies, excessive pronation, collapsing or collapsed medial column, and I have them stand and walk. As a result, we fit...


 


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


04/18/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Richard A. Simmons, DPM


 


Dr. Forman wrote: “I received notification from Medicare that 33% of my visits submitted included an E/M charge. I was told it was above the average.” To me, there are two issues here: 1) do you really want to go toe-to-toe with Medicare defending your E&Ms and 2) I am surprised that 33% is above average. I know that some doctors will challenge Medicare personally and spend a lot of time and effort defending their claims. If your office is equipped to handle this, then go for it. The 33% number seems low and may be something that APMA could look into. 


 


That said, there may be a lot of practices where “non-medically licensed” personnel are trimming toenails, corns, and calluses, and these offices may simply have a high turnover of procedures without examinations. On a side note, if a PA (physican assistant) or NP (registered nurse practitioner) submits a bill to Medicare, it is paid at a lower fee profile than if submitted by an MD, DO, or DPM; however, when “non-medically licensed” personnel perform routine foot care, that procedure is billed as if the DPM personally performed the procedure. Even though Dr. Forman may be practicing good medicine, it appears that the numbers may simply be against him.


 


Richard A. Simmons, DPM, Rockledge, FL

04/17/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Simon Young, DPM


 


I agree with Dr. Jacobs. The one word he used that must be analyzed is “normal”. Insurance companies rate you in relation to your peers. If let’s say, 90% only do C & C, then anyone who does more and deviates from the norm and bills for it falls out of “NORMAL”. The more standard deviations away from normal, the more ABNORMAL your practice is and they don’t question and evaluate why a practitioner is more observant and caring, but instead can consider it fraudulent. 


 


We as a profession “old” or “new” must change NORMAL. No one will admonish you for raising  a patient's pants legs and looking for abnormalities for referrals, if needed. This will save lives and hopefully garner respect. It’s sad we don’t look at legs routinely, no matter what the state laws. It’s preposterous to think we only did it for whirlpool treatments!


 


Simon Young, DPM, NY, NY

04/17/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Lawrence J. Kansky, DPM, JD


 


As a criminal defense attorney, I have been involved in many felony theft cases such as the one written about by Name Withheld (MA) podiatrist. First, you did not make a mistake in agreeing with the district attorney to dismiss your employee's criminal charges in exchange for full restitution of the stolen $13,000  (In Pennsylvania this is called a "586" which is the PA Criminal Code Rule number that allows for Court dismissal upon satisfaction or agreement of the parties). If your employee became a convicted felon, you would likely have had no chance of getting your stolen money back, because in our judicial system, convicted felons lose just about everything.


 


In my PA cases, when a criminal defendant breaches the restitution part of their agreement, the victim usually contacts the district attorney, the criminal charges are immediately re-instated, and a warrant is issued for the defendant's arrest. The case then starts all over again, and the defendant cannot claim a due process right violation for lack of a speedy trial. Your state, (MA) is likely very similar to PA, so contact your district attorney as soon as possible.


 


You are not out of luck just yet, because many times after a defendant is re-arrested, the restitution money magically appears and the victim is quickly paid. Good people sometimes make bad mistakes for a variety of reasons, so I commend you for giving your employee at least a chance for a better life.


 


Lawrence J. Kansky, DPM, JD, Kingston, PA

04/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Anyone Can be a Victim of Employee Theft


From: Name Withheld (MA)


 


I just spent a lovely morning in court having to deal with an employee who stole nearly $13,000 from me over a period of four years, beginning in 2008. The original court date was April 9, 2014. At that time, the thief was given the opportunity to pay restitution during a period of probation, or go to jail. I agreed with the district attorney to allow her to pay restitution and not have a criminal record or any jail time. Was this a mistake? This morning, I appeared before the judge asking why, after four years, full restitution has still not been made. According to the original agreement, full restitution should’ve been paid at the end of one year. 


 


Believe it or not, all of us are at risk for this above scenario. I never thought I would be. It happens more often than you think. Please, please consider that you could be a victim yourself. There are many ways to prevent what happened to me. Please take the steps necessary and don’t let this happen to you. 


 


Name Withheld (MA)

04/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3B



From: Allen Jacobs, DPM


 



Dr. Forman raises the issue of a concurrent E/M code with nail and/or callus care. In the case of the diabetic patient, the question Dr. Forman brings to the table is rather straightforward. What is your job as a podiatric physician? Your “job” is to improve quality of life, and reduce the risk of limb loss. This requires the identification of risk factors and the initiation of appropriate interventions. Subsequently, the effectiveness and safety of such therapies and appropriate adjustments must be conducted. 


 


That requires evaluation and treatment of dermatologic, neurologic, arterial, venous, musculoskeletal, rheumatic pathologies, gait and fall risk evaluation, and assessment of footwear. In my humble opinion, the problem is not that Dr. Forman’s 33% concurrent E/M use is above the norm. The problem is...


 


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


04/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART #A



From: Elliot Udell, DPM


 


Dr. Forman asks an important question. Should podiatrists be held responsible for examining a person’s legs? The answer should be divided into two parts. What is legally mandated and what is morally necessary.


 


From the legal aspect, if one practices in a state where the scope of practice goes up to the knee, whether it is only soft tissue or soft tissue and bone, it would seem that those podiatrists would be legally obligated to examine a person’s legs when doing a podiatric examination and it would appear that if he or she missed a melanoma or some other malignancy, the doctor would be held responsible. In states where the scope is limited to ankle and/or distal to it, then it becomes a moral issue. In years gone by, when all podiatrists used hydrotherapy as part of their practices, all podiatrists were forced to look at a patient's legs because patients had to raise their clothing above the knee so as to not get it wet. This forced all podiatrists to do at least a cursory exam of the entire lower extremity.


 


Elliot Udell, DPM, Hicksville, NY

04/16/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Kudos to Amerx Healthcare


From: Ted Mihok, DPM


 


I would like to thank the Amerx Healthcare Corporation for contributing wound care products to our Lions and Rotarian's Joint Service Project in Mexicali, Mexico on April 4 and 5. They have been a partner for over ten years and their generosity is greatly appreciated. The service project has been going on for over 42 years and consists of both medical care and construction in and around Mexicali, MX.  


 


Ted Mihok, DPM, Alameda, CA

04/14/2018    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: The Importance of Examining Legs


From: Michael Forman, DPM


 


Recently, some of my colleagues have been contacted by "Medicare" for the inappropriate use of E/M codes during a routine foot care or an at- risk foot care visit. I received notification from Medicare that 33% of my visits submitted included an E/M charge. I was told it was above the average. I hope I am not thought of as a criminal or law breaker. I would rather be thought of as a doctor who cares for - and takes care of his patients. As all of us are aware, our profession has changed a great deal. We are responsible for our patients' well-being and should be curious as to their general medical health and in particular their lower extremities. 


 


If we are only interested in clipping someone’s toenails and trimming a callus and whisking 30-40 people or more a day through our office while ignoring important signs that are presented to us, we are doing a disservice. I recently heard Dr. Jeff Lehrman lecture at a meeting. He suggested that we roll up our patients’ pant legs and...


 


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

04/13/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Thomas Graziano, DPM, MD


 


With all due respect to Dr. Lipkin, the decision to drop out of the insurance networks is not a "knee jerk" reaction as he implied. And as he said, "thinking with your head, and not your heart", is exactly why he and others should drop out. If anyone in solo practice thinks they are going to negotiate better fees with any of these insurance companies, they suffer from delusional personality disorder. It's not going to happen. If you think its all right to devalue your services on one hand to get thrown some crumbs for another service, then continue to practice that way. 


 


But if you're looking for real solutions, put your big boy pants on and stop putting up with it. I remember some time ago the late Neal Frankel, DPM met with our division in NJ and told us something that stuck with me. He said the CEO of one of the larger insurance companies told him and I quote, "why should we pay podiatrists more when we know they'll work for less."  That statement continues to resonate, and its one of the reasons I'm out-of-network today. I only wish I had done it sooner.


 


Thomas Graziano, DPM, MD, Clifton, NJ

04/13/2018    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Tim Patrick


 


We wanted to respond to a post in the March 22, 2018 edition of PM News by Dr. Craig Breslauer, where a Cartiva Facebook page was referenced. Cartiva, Inc. does not have a corporate presence on any social media forum, including Facebook. We have never asked or endorsed a podiatric or orthopedic surgeon or employee to participate on our behalf as a moderator on any social media site. 


 


We receive thousands of contacts each year from patients suffering with painful osteoarthritis of the great toe, inquiring if a Cartiva synthetic cartilage implant could be an option for them. We refer these patients to foot and ankle surgeons nearest to them who have been trained on Cartiva, without regard to specialty. Our belief is that a well-trained foot and ankle surgeon is just that, without regard to professional title.


 


Thank you for the opportunity to clear up any confusion about our ongoing support of the podiatric community.


 


Tim Patrick, President and CEO, Cartiva, Inc.

04/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Dennis Shavelson, DPM


 


I have been using Synergy Global Group for my billing for four years now with excellent rapport and results. Last year, I became a consultant to the group, where I am especially helpful partnering with their clients practicing out-of-network or hybrid (in and out-of-network). The best way I can explain SGG to podiatry is that they are a 10% billing company that charges 4%. In addition, they handle but do not take a % on claims that are not insurance bound. Amit Bose, the CEO of SGG has built a platform that caters to small private practitioners as well as multi-location and grouped practices.  


 


They have dedicated staff chasing open claims, and their monthly statements and analytics are sophisticated yet understandable. SGG has allowed me to manage my receivables with less energy and frustration and greater profit. I work with their podiatry accounts regarding coding and charting (especially biomechanics and uncovered services), and assist in maximizing OTC sales in practice.   


                                               


Disclosure: I am a consultant to Synergy Global Group.


 


Dennis Shavelson, DPM, NY, NY

04/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Jeffrey Kass, DPM


 


I am not sure if all the negative comments about Costco orthotics are well guided. I, like most of my colleagues, watch shark tank - and I say kudos to the people who came up with the idea. It's rather ingenious, and from a business point of view, I think they will make money. I think it's ludicrous to point to the inferiority of the product without having seen it or tried it. That is sheer jealousy. Some of my colleagues have been known to have their secretaries cast patients, yet no one is up in arms over that. I'm not sure that I can even agree who the experts are or if there are any when, as Dr. Shavelson points out, there are no studies proving anything. 


 


The more important question is - should the profession have been able to deem orthotics prescription products to be prescribed only by doctors, and did the profession let us down in that regard? What exactly is the Costco process? When the operator is quizzing the patron on what ails, can this be construed as a medical exam that the operator should not be doing? 


 


Jeffrey Kass, DPM, Forest Hills, NY

04/12/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Brian Kiel, DPM


 


I, just like many podiatrists, see patients who have been treated by Costco and urgent care facilities. I, like Dr. Jacobs, will not deal with devices that others have made. I explain that it is a useless device and I cannot and will not take responsibility for them. On the other hand, if someone comes into my office with a boot and a fracture, or an improperly treated condition of the foot, I don't feel that we can or should refuse them. If another facility screwed it up in the first place, then they probably won't get it any better the second. It is our responsibility to do everything we can to help that patient. Of course, proper charting regarding the prior care is critical, but we have an ethical responsibility to care for those patients.


 


Brian Kiel, DPM, Memphis, TN

04/11/2018    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Costco Selling Custom Orthotics


From; Robert Scott Steinberg, DPM, Jack Ressler, DPM


 


As a Costco member, I can tell you that Costco is going to hear from me. If fellow colleagues feel like I do, write and call Costco. I encourage those interested to go to Costco and directly observe the sell. Stealth recording might be a good idea. 


 


Robert Scott Steinberg, DPM, Schaumburg, IL


 


I am not calling out fellow podiatrists on this, especially since we are the best trained and have the most expertise to evaluate and dispense custom orthotics to our patients, but we also must realize not all of our patients have the financial means to spend stratospheric fees that some podiatrists charge. This is especially true when our orthotic lab fees are in the $100 range. I dispense my share of custom orthotics but sell just as many or more pre-fabs with excellent results. I am not familiar with the Costco product but it would be very interesting to see a poll on percentage of patient/customer satisfaction and relief when comparing Costco’s product to the customs dispensed by podiatrists.


 


Jack Ressler, DPM, Delray Beach, FL.

04/09/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Dennis Shavelson, DPM


 



I reviewed the RESA website. They have a homogeneous proprietary plan using software, an algorithm, a technician, and a scanning method developed by a cyclist + engineers to create what they value as a $199 product. Remember the Soles 3-D printed orthotics that DPMs were dispensing that is now out of business having lost $30 million. 


 


I welcome the competition from Costco that will help educate the foot and postural suffering public towards the need for customized orthotic props. My insult comes from Costco stating that the DPM product is worth $300 when mine are...


 


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


04/09/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Allen Jacobs, DPM


 


I wanted to share some thoughts with regard to the issue of what to do when individuals present to an office with orthotics made at Costco, the Good Feet Store, or similar non-podiatric facilities. 


 


Simply stated, you have completed undergraduate and post-graduate training, including training in biomechanics and kinesiology. Your decision as to the nature and type of orthotics to be utilized, and the specific corrections to be utilized in those orthotics, are unique and individualized based upon an examination of that patient and a determination of multi-variant factors resulting in...


 


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

04/06/2018    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Doug Richie, DPM


 


Nine years ago, I posted a blog documenting my experience with a patient who had purchased "custom" foot orthotics from Costco.


 


To my surprise, this blog posting became the most popular blog entry ever posted on the Podiatry Today website, primarily due to the readership of the general public. Today, over 116,000 people have read the post. The comments on this blog are also interesting, but my own message is still valid today. Commercial entities who provide low cost, ineffective foot orthoses will only increase awareness and motivate the general public to seek quality foot care interventions provided by qualified podiatric physicians.   


 


Doug Richie, DPM, Seal Beach, CA
KovenBanner?216