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02/02/2018    

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



From: Jack Ressler, DPM


 


I am very interested to find out the amount of time that passed between when the podiatrist passed away and when the practice was put on the market. I'm sure the deceased podiatrist had an excellent relationship with his patients that probably could not be duplicated by the revolving door of podiatrists who pitched in to help in this unfortunate situation. It led to a perfect storm for that other podiatrist. Although grief and shock by the family of the sudden death of their loved one probably prevented the practice from being put up for sale earlier, that delay cost them a very marketable practice. 


 


The other podiatrist who opened was very fortunate/underhanded to be able to take advantage of a unique and sad scenario that rarely occurs. I do not believe Dr. Name Withheld’s conclusion about a practice not having inherent value. A thriving modern up-to-date practice should have a good marketable value, especially if the seller takes the time and markets it properly. I worked very hard in my practice for many years and was able to sell it. I took the time to market it properly and got a nice return for my hard work.


 


Jack Ressler, DPM, Delray Beach, FL

Other messages in this thread:


02/05/2018    

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



From: John V. Guiliana, DPM, MS


 


I wholeheartedly agree with Dr. Kashan and Dr. Ressler. It saddens me when I hear physicians state that "their practice has no value and they will someday just close the doors". Surprisingly, I hear this quite a bit.


 


A practice is a living and breathing entity. It needs to be continuously nourished and maintained. Marketing, continuous quality control, investment in technologies, optimizing processes, etc. all create inherent value throughout the years. In the end, the fair market value can be computed through various techniques which often revolve around net earnings and an applicable capitalization rate. Leave that to the experts. But there are buyers out there, so please take good care of your practice and it will certainly provide you with post-retirement income. 


 


John V. Guiliana, DPM, MS, Little Egg Harbor, NJ

12/27/2017    

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



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

12/04/2017    

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



From: Neil H Hecht, DPM


 



I have read the recent posts regarding the ABFAS Board Exam pass/fail rates. I looked up the American Board of Orthopedic Surgery statistics in an attempt to compare. Although the MD/DO residency in orthopedics is 5 years, their scope is the whole body, and therefore it seems to me that 3 years of post-doctoral foot and ankle residency training would be appropriately rigorous and adequate for our DPM graduates.


 


The American Board of Orthopaedic Surgery posts these statistics on their website:


 


2013       86%        pass       593/689 candidates passed


2014       93%        pass       713/770 passed


2015       95%        pass       707/747 passed


2016       96%        pass       700/729 passed


2017       93%        pass       689/743 passed


 


Statistics can be difficult to interpret, but certainly more than 90% of our 3-year residency-trained post-doctoral DPM candidates should be able to pass “our” certification examination. If not, either we have poor candidates for foot doctors or something is wrong with the test. I would like to believe that the test needs to be closely re-evaluated and rewritten in order to better reflect the trained doctors who seek to become boarded.


 


Neil H Hecht, DPM, Tarzana, CA


12/01/2017    

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


RE: ABFAS Board Exam Pass Rate is Disparaging (Joseph Borreggine, DPM)


From: Matthew Williams, DPM


 


The American Board of Foot and Ankle Surgery’s (ABFAS) mission is to protect and improve the health and welfare of the public by the advancement of the art and science of podiatric surgery. As surgeons, we want the best outcomes for our patients, and ABFAS will continue to strive to fulfill our mission to certify high quality surgical candidates for the betterment of the profession. 


 


The trending of Part I spring exam results for first time takers shows the impact of the three-year surgical residencies. 


 













ABFAS Part 1 Pass Rates 



 


Although there is a drop in the pass rate for...


 


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

11/08/2017    

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



From: Larry Kobak, DPM, JD


 


This email is in response to Dr. Udell's inquiry if you can sue a patient or social media site that posts an untrue review. The answer is sometimes. If the review merely expresses an opinion, that is protected constitutionally. In NY, if the patient goes further and states something that reflects on the podiatrist's ability, such as "(s)he is a butcher", or inaccurately, such as (s)he lost his/her license last year, that is actionable. I have successfully sued the patient for libel in such cases. Please be warned that there is a statute of limitations in such cases. In NY, it is only one year from the time the review was first published.


 


Larry Kobak, DPM, JD, Senior Counsel, Frier Levitt

10/30/2017    

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



From: Lee C. Rogers, DPM, Ed Davis, DPM


 



The Internet has made education available to everyone with a connection, without unnecessary time and travel expense. I encourage our state boards of podiatry to modernize their CME requirements to take advantage of these advancements in technology and the renaissance that will be the future of learning.


 


Lee C. Rogers, DPM, Los Angeles, CA


 


Dr. Sherman is right concerning the issue of certain states restricting online CME. One can go to a "brick and mortar" CME seminar but no one can ensure that attention to the subject matter presented occurs nor that the attendee is even awake. Online CME generally requires that attendees read the material presented and answer questions to ensure learning.


 


Ed Davis, DPM, San Antonio, TX


10/28/2017    

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


RE: Why Do Some State Boards of Podiatry Still Limit Online CME? (Alan Sherman, DPM)



From: Larry Aronberg, DPM



I completely agree with Dr. Sherman. When I go to a bottoms-in-the-chairs seminar, people wander in and out, tune out the lecture, etc. You just have to sign in and sign out for credit. With online, there is a test you have to pass. You have to learn the material to get the credits. When you also consider travel, lodging, and time away from your practice when attending a seminar, online seems even more logical. I love the hands-on courses at seminars, but would much prefer most of my credits online with just an occasional trip for a distant seminar.


 


Larry Aronberg, DPM, Lake Worth, FL

09/20/2017    

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



From: Bryan C. Markinson, DPM


 


My friend Dr. Robert Hatcher is absolutely dead on about "working smarter, not harder." There is no question that we should all strive for life balance and more efficiency in our practices. But "working smarter, not harder" is predominantly an empty sentiment....but only us old timers get it. I teach students, residents, and young colleagues on a regular basis. One of my most common points is "the days of 9-5 are long gone." If you want to coach little league and catch every ballet recital, and go to "mommy and me", you may need to settle for a three bedroom house instead of a 5 bedroom house. If you don't get what I am saying, advice on office efficiency and life balance is wasted on you.


 


Bryan C. Markinson, DPM, NY, NY

07/15/2017    

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



From: Martin G. Miller, DPM


 


I went to the website that Dr. Kesselman referenced in his response, and after putting in my NPI, it correctly identified me and my specialty (podiatry), but it only said revalidation: TBD. I assume this means "To Be Determined". I guess I have to keep checking back to see if any date actually shows up. It would be far more helpful if the actual date was given.  


 


Martin G. Miller, DPM, Freeport, NY

06/12/2017    

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


RE: Enough Already with Time-Consuming Chart Requests (David P. Luongo, DPM)


From: Matthew B. Richins, DPM, Cynthia Ferrelli, DPM


 



When we get a request, my office manager charges a fee for our supplies and her time to the companies, to be paid in advance. Most pay. Others ask to send a representative out to make the copies. We tell them to bring their own paper, printer, and ink - and they do!



 


Matthew B. Richins, DPM, Joplin, MO

04/18/2017    

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



From: Lynn Homisak


 


I believe you are asking ‘should you bill a new patient you haven’t even seen yet?’ and ‘should you collect their credit card information prior to their appointment?' Instead of applying a Band-aid on an obvious problem and sending a negative message to patients before you even meet them, why not try to determine the reason WHY new patient cancellations are such an issue for you? 


 


Yes, new patients must occasionally cancel an appointment. It happens. It is not typical, however, to have a new patient cancellation "problem"; unless of course, new patients are scheduled so far out that...


 


Editor's note: Lynn Homisak's extended-length letter can be read here

04/17/2017    

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



From: Paul Kesselman, DPM 


 


There is no simple solution to this and there are multiple factors here. On one hand, asking for a credit card deposit on the phone does set a bad tone, but with high deductibles and co-payments and tight schedules, last minute cancellations are also unfair to other patients who otherwise would have been able to obtain care sooner. 


 


I agree that calling the patient the day before to confirm is far better than collecting a credit card "deposit" on the potential new patient. However, the reality is that tight schedules and last minute (24 hours is last minute) cancellations are unfair to...


 


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

04/15/2017    

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



From: Ivar Roth, DPM, MPH


 



Missed first appointments were a continuing source of irritation in my practice. We now take a credit card from all first time patients and bill a nominal amount to make sure the card is real. This amount is deducted from their visit if they come in. We send a confirmation email immediately after they call with a copy of our policy so there is NO miscommunication.  


 


This has worked well for us. Those who refuse to give us a credit card do not get an appointment. This is a real simple solution. We only charge $75 if they fail to show up or give notice. This policy is really to keep the new patient mindful that our time is valuable when they book an appointment.


 


Ivar Roth, DPM, MPH, Newport Beach, CA


04/06/2017    

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



From: Elliot Udell, DPM


 


Dr. Secord shines a light on the fact that the exorbitant price of brand name medications charged by pharmaceutical companies to U.S. citizens could not be totally justified by the cost of research. Much of this research, as Dr. Secord points out, is done at institutions funded by taxpayers.


 


Even if we want to give an inch to big pharm's argument that research expenses are at the heart of why Americans pay so much more than "Canadians" for pharmaceuticals, it by no means explains how drug companies have cornered generics and raised the prices to astronomical levels. All of us are aware of how big pharm was able to exploit a legal loophole and start charging over ten dollars a pill for Colchicine when as a generic it sold for pennies for a tablet.


 


Econazole cream which is a generic antifungal, used to cost less than two dollars for an 85 gram tube. Somehow, the pharmaceutical firms were able to corner that market and raise the price to over $250 dollars for the same product. The ingredients in the EpiPen for which the company charges over $650 dollars (which we all have in our emergency crash carts) are available for less than $2 dollars. The bottom line is that the American citizens deserve close government scrutiny of what is going on and laws to protect its interests.


 


Elliot Udell, DPM, Hicksville, NY 

01/28/2017    

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



From: David E. Samuel, DPM


 


Several years ago, better vitamin therapy was introduced by a few companies that started showing better efficacy for diminishing neuropathic pain. You purchase the vitamins and resell them to your patients. You make a little on the vitamins and many times, patients feel better and are happy. 


 


Good clinical studies on it and biopsy, I'm sure, played a roll in determining what the vitamins ultimately did to warrant a trial with them. We have used these vitamins and some have seemed to give some moderate improvement and some have also not been helpful. It just depends on...


 


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

01/23/2017    

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



From: Jeff Kittay, DPM


 


Hooray! Finally the Boards will be accountable to SOMEONE. The high-handed attitude that many state boards have exhibited against the members of our profession may at last be at an end. More than twenty years ago, I was the victim of such board abuse which cost me two years of aggravation and nearly $5,000 in legal expenses before the board rescinded their accusations of professional misconduct (I had had the nerve to suggest in a malpractice case against another DPM that he had indeed violated the standard of care, an opinion with which I stand).  


 


I was advised at the time by my attorneys that the board members had “governmental immunity” and could say or do whatever they pleased without fear of retribution and that I could not pursue them to recover my costs. Perhaps the removal of such immunity by the SCOTUS will put the Boards on notice that their actions can indeed have consequences and that they must be more careful when making accusations or levying punishments. Those board members that feel that they must resign in protest to being held responsible for their decisions should feel free to do so and will not be missed by the profession.


 


Jeff Kittay, DPM (retired), San Rafael Norte, Costa Rica

01/23/2017    

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



From: Michael Forman, DPM,  Joseph Borreggine, DPM


 



Thank you Dr. Evans for warning us about the North Carolina Dental Board v. Federal Trade Commission decision. I was under the impression, obviously false, that you could not be sued for stating your opinion. Perhaps this decision can be used to punish "hired gun" experts who testify whichever way they get paid.


 


Michael Forman, DPM, Cleveland, OH


 


This has been an issue for many years. Click here.


 


Joseph Borreggine, DPM, Charleston, IL 


01/18/2017    

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



From: Paul Kesselman, DPM


 


I am saddened to hear of the heartache that Greg and the whole Ortho-Rite team are going through, especially during this holiday season. I wish them well in the hard work ahead to get their company back up and running again. I hope to see other companies (especially those located in the metro NY area) lend a hand to assist Ortho-Rite during the rebuilding process. This could include providing lending space to Ortho-Rite to continue to function so as to assure their job security of their dedicated employees. 


 


I will keep a watchful eye on the progress of their rebuilding and hope to see them even stronger than before. 


 


Paul Kesselman, DPM, Woodside, NY

12/27/2016    

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



From: Steven N. Solomon, DPM, JD, Raymond F Posa, MBA


 


With the latest Yahoo breach, encrypting your email is a great idea. As a medical practitioner though, you need to make sure that the people you're communicating with are using the same email system as you are. You also need to make sure that you have a BAA signed with the email provider so as to be HIPAA-compliant. You may find it easier to use a patient portal for your communications as it forces the people communicating with you to do so securely. 


 


Steven N. Solomon, DPM, JD, NY, NY 


 


I recommend Zix Corp (zixcorp.com) to all of my HIPAA clients. It is fairly inexpensive and works seamlessly through Outlook. Also, along similar lines, if you need to encrypt your text messages, check out Tiger Text (tigertext.com)


 


Disclosure: I have no financial relationship to either company. I just have years of experience with them and they are solid reputable companies that offer outstanding service.


 


Raymond F Posa, MBA, Farmingdale, NJ 

12/27/2016    

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



From: David Cutler, DPM


 


For those of you who prefer evaluating newer surgical procedures with a bit more published research behind them, look at the European orthopedic literature on MIS bunionectomy. Most of these procedures are variations on the same technique, namely a through-and-through metatarsal neck osteotomy with aggressive lateral translation of the capital fragment along with a unique stabilization of the capital fragment using a 2mm K-wire as shown here. 


 













Post-op X-ray of SERI Bunionectomy



 


There are several of these published studies dating back to the early 1990s, but the most expansive is by Giannini, et al. in International Orthopedics, September 2013 entitled "A Minimally Invasive Technique for the Surgical Treatment of Hallux Valgus; Simple, Effective, Rapid, Inexpensive (SERI)" (PMID 23820757) with 1,000 cases. At first glance, this technique seems prone to non-union, though in this study, none were reported. Dorsal malunion was observed though only in 8 cases.


 


I’ve been doing open bunionectomy techniques since I started practice in 1988, though with robust studies on MIS such as these, I’ve started doing the SERI technique over the past several months. It is trickier to perform than you might expect, though patients do experience very little post-op pain and minimal swelling compared to open techniques, and they do appreciate the smaller scar.


 


David Cutler, DPM, Bellingham, WA

11/03/2016    

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



From: Gary S Smith, DPM, Tip Sullivan, DPM


 


Unilateral edema in the absence of obvious pathologies is almost always caused by a DVT or a bulging disc in the lower back.


 


Gary S Smith, DPM, Bradford, PA


 


This sounds typical for early RSD -- now known as CRPS. The first line treatment is aggressive PT. You may want to get a second opinion if you have not seen much of this.


 


Tip Sullivan, DPM, Jackson, MS

10/27/2016    

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



From: Hal Ornstein, DPM


 


Every physician has experienced the situation where they need something from their back office assistant and they are not available. This situation happens numerous times each day in most practices and leads to us walking to finding the assistant or the infamous call down the hall to find them. Now there is a low-cost, low-tech way to solve this problem and ultimately enhance the efficiency of your practice. 


 


The concept makes use of inexpensive walkie talkies which are worn by the doctor and various members of your staff. The walkie talkies are worn on the belt or scrub suit with an ear bud and a microphone hanging at the level of the collar for the assistants and a microphone for the doctor. When you need anything from a staff member or have something you want heard in the back office, you simply...


 


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

10/14/2016    

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


RE: ADA Section 1557


From: Raymond F Posa, MBA


 


To address Dr. Borreggine's and Dr. Rees' concerns regarding ADA Section 1557, the final rule has the same provisions as the HIPAA privacy rule, in that you must exercise a degree of reasonableness. The exact wording is: “Requiring covered entities to take reasonable steps to provide meaningful access to individuals with limited English proficiency. Covered entities are also encouraged to develop language access plans.” 


 


No where does it prohibit a family member from interpreting for a patient. So, especially in a small practice, having all sorts of interpreting skills in-house would be unreasonable. If your practice has a large percent of non-English speaking patients of one particular language, then it would behoove the practice to have a staff member who can translate. I see it all the time in practices that have many Spanish-speaking patients, or Russian or Hindi ones; they have staff who can speak their language.


 


So your language access plan can be as simple as: "In the event that we cannot communicate with a patient in their native language, we will rely upon an individual who accompanies the patient in their care, or in the case where that is not feasible, we will make use of telephone/Internet translating service XYZ." In most cases, this will be an infrequent occurrence. Also the offense occurs only if the patient files a complaint, so the key is to try to accommodate the patient in a way that the patient is most comfortable with - again with reasonableness and dignity.


 


Raymond F Posa, MBA, Farmingdale, NJ

10/12/2016    

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



From: Richard Rees, DPM


 


I am interested in how many doctors' offices are going to be compliant to HHS' new rule on interpretation requirements for each office on October 16th. For small offices such as mine, this could be a financial death sentence.


 


Richard Rees, DPM, Bellaire, TX

09/24/2016    

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



From: Philbert Kuo, DPM


 


I'm not sure about post-op shoes but there are CAM walker boots that accommodate up to that size. Brands include Bledsoe and Donjoy.


 


Philbert Kuo, DPM, Chesapeake, VA
Biofreeze