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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)

Other messages in this thread:



RE: Pillars of Our Profession

From: Richard M. Hofacker, DPM


A few weeks ago at the KSUCPM awards banquet, Dr. Richard Ransom took this "classic" picture of a couple of our distinguished colleagues. You might say, they are the "Arnold Palmers" of podiatry. 


Seated are Dr. and Mrs. Alan Spencer.  Standing is Dr. Ray Suppan, Sr.


Just about everyone in this profession has been taught, consulted, or helped in some way by Drs. Spencer and Suppan. Podiatry owes a great deal to these fine pillars of our profession.


Richard M. Hofacker, DPM, Akron, OH  



RE: Pedicure Drill for Podiatry

From: Robert D Teitelbaum, DPM


For several years, I have been using an incredibly inexpensive ($3.00 or less) pedicurist drill in each of my treatment rooms and in my ALF/NH bag. I found them just by searching for "Pedicure Drills" on my laptop and getting multiple ebay sites with these drills that use 2 AA batteries. First, you discard all the multiple heads that are supplied. Then, you can use dental (that's right--dental) burrs from Henry Schein's Dental division - which is older and much larger than the podiatry section. I had my dentist order S.S. White stainless steel burrs that come in a ten pack and are 1.5 mm in diameter. They are not expensive. These burrs fit right into this drill by a friction lock--as do the accessories that come with it.  


Why this little drill is better than a 120 volt rheostat-driven one is exactly because it is not that powerful. When you have nail borders that cannot be curetted easily or painlessly, it is precisely the instrument to use. You can de-bulk a hypertrophied border to the point that you can then do an angled cut to give your patients relief. These burrs are very sharp and effective, so the constant, moderate speed helps to keep you in control. Along with this find, I discovered many smaller 120 volt drills that each of our suppliers offer, but at major price reductions. This confirms the old idea that "if it used by a 'doctor', we can double the price."


Robert D Teitelbaum, DPM, Naples, FL



RE: Drug Pricing Insanity  

From: Robert D. Teitelbaum DPM


I was interested in prescribing Ertaczo cream for my patients, as it seems to be effective for dermatophytic and candidial organisms. When I searched for it on Google, I was taken aback by the amazing prices. For a 60 gram tube, the average price was $830. Even in real estate, they deal in "comparables" for recently sold homes. How many of you out there prescribe antifungal cream in this range? I was told some years ago by a pharmacy tech here at my CVS store in Naples that, "Medicine is a racket." How true, how true.  By the way, my practice does not support that point of view. And this example can only enhance one's suspicion, of "Big pharma."


Robert D Teitelbaum DPM, Naples FL



From: Vito Rizzo, DPM


As a healthcare professional and now having the distinct advantage of serving in the U.S Congress, Brad Wenstrup should be leading the charge in reforming healthcare and advocating to put medical professionals back in charge. He should take no contributions from insurance companies that have a record of putting profits before patients and should be focused on eliminating the channeling of healthcare dollars into any other purpose than patient care. He should never stand behind or support policies that undermine the protection of the sick and less fortunate. Being a representative can be easy if certain principled actions are followed.


Vito Rizzo, DPM, Bay Shore, NY



From: Dan Michaels, DPM, MS


With all doctors on a salary and all employed by the government, you would also have several very bad consequences. As in England, doctors would have their day job with the government and have their private practice that is all cash on the side. If someone needed surgery, there would be a 6-month or more wait with the government practice and their private cash practice would be able to deal with the surgery immediately.


This would create a tiered healthcare system that would favor the wealthy. There would be a lot more conservative care and much more web surfing by the employed physicians just doing the minimum to get by, and of course the really smart people would leave the field. This single payer system fails everywhere it is implemented. Socialism fails always (e.g. Venezuela). We have the best healthcare in the world.


Dan Michaels, DPM, MS, Frederick, Hagerstown, MD



From: Jon Purdy, DPM


I couldn’t sit idle after reading Dr. Kass’ comment promoting universal healthcare with salaried positions. There are reasons monopolism in a free market society is not tolerated in the private sector; the reasons being stifling of ingenuity, lack of price competition, and the elimination of free choice to name a few. To promote it in the public sector is the antithesis of what drives this country’s greatness.


Imagine for a minute, a doctor who has no incentive to keep a patient a satisfied returning customer, or to direct staff to provide a welcoming environment. There may be minimum outcomes to obtain, but anything difficult or time-consuming could be written off as a loss. Certainly, one could “hope” all doctors practice to their fullest ability, but that is not reality and an unfortunate consequence of human nature in the absence of incentive.


When the government controls the livelihood of individuals and their freedom of pursuit, especially after going through training 99% of humanity is unable or unwilling to do, it will no doubt create a catastrophic physician shortage. If a singular controlling entity wishes to eliminate podiatry, it could do so next week. Take a moment and imagine yourself as a patient in that environment with a serious condition. I certainly can’t. There is corruption in all walks of life including the government or any other controlling body. I am not willing to sell my freedom of individual pursuit because of the actions of others.


Jon Purdy, DPM, New Iberia, LA



From: Justin Sussner, DPM


Another problem that we see in our office is many of the ER and urgent care foot pathology patients are seen by a lower level practitioner who has no idea or training regarding what they are looking at. And they almost never consult with the MD who is supposed to be supervising them. 


This is not meant to be a jab against PAs or NPs, I know quite a few who work for my PCP and my dermatologist, but they have been properly trained and supervised. 


Justin Sussner, DPM, Suffern, NY



RE: Podiatrists vs. MDs as Foot Specialists 

From: Jeffrey Bean, DPM


An emergency physician called me today for guidance on a patient with a foot injury. The doctor told me, “It looks like the patient has a fracture of the first "METACARPAL" that might also involve the "HELIX of the SESSAMO". Should I be concerned about a Lisfranc injury?” I had the physician repeat this several times, and was told the same thing repeatedly. I felt it was futile to begin by teaching this MD kindergarten anatomy (leg bone connected to the foot bone). 


I told him to apply a fracture boot and send the patient to me or any other podiatrist for appropriate treatment. No wonder I see so many patients with disabling neglected foot and ankle injuries. Most were seen by multiple physicians who...


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



From: Paul Kesselman, DPM 


This is an extremely complex matter fraught with many mine fields. While the suggestions which have been made might sound appealing, they may not be the best path for you to take. In fact, I’m concerned they may not be the correct way to go at all. I suggest you find an attorney very experienced in anti-kickback statutes and Stark. While the latter may be more familiar to most and possibly only affects your business and Medicare, the former may be less familiar yet applies across the board to all patients, Medicare, other third-party payments, and even self-paying ones.


The mere appearance that your salary is somehow tied to the number of your DME referrals and volume of DME your group provides to patients may constitute incentives that some experts may feel is problematic. The best and only advice I can offer is to spend the time and no doubt some money on a healthcare attorney who can safely navigate you through some very complex regulations.


Paul Kesselman. DPM, Woodside, NY



From: Ron Werter DPM


Dr. Hofacker's comments remind me of something that a new patient's daughter related to me recently. A 92 year old gentleman brought in by his daughter came to me because they were outraged with the billing of the previous doctor. She received 2 checks from Anthem Insurance for the one visit of the previous podiatrist of her father totaling $1,550. She told me that she had taken her father to the other podiatrist for the past 6 years for nails and corns. On the last visit to this other podiatrist, when dad was called into the room as usual, she remained in the waiting room. He returned to her after his treatment 15 minutes later and said there's a different doctor. She found that peculiar since there was no notice that the other doctor had left or retired.


The father has an insurance plan that pays both in and out-of-network; out-of-net is 60/40. When she called the doctor’s office about the received checks, she was told to...


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



From: Name Withheld


Welcome to the world of wRVUs! I’ve been working in this model for the last 5 years. Long story short, my hospital has no interest whatsoever in doing DME. Early on, I tried to explain to a C-Suite member that in my previous group I had collected over 90k in DME. They still balked at any DME. That said, I am compensated well for my time. My production (wRVUs) is at the 50th percentile, as is my compensation (based on MGMA benchmarks). So, at the end of the day, I’m a highly compensated employee who does what my employer wants me to do (see patients and fill my OR block).   


Name Withheld



From: Stacy A. Resnick, DPM, Hyim Baronofsky, DPM


Along with my RVU-based pay, I receive 55% of what was collected on custom molded orthotics, Arizona and Richie braces, and diabetic shoes. I do not receive compensation for CAMwalkers, ankle braces, or any other DME products.


Stacy A. Resnick, DPM, Bethlehem, PA


I work for a multi-specialty group and I am paid based on RVU production. When I informed my employer that if a patient has fascitiis and is following up for orthotic casting/scanning at times, I cannot even bill an E&M code. Thus, the visit has no compensation value for me. When I explained to them the only alternative would be to send out all orthotics, DME, etc., they quickly assigned an RVU value for both the casting and orthotic codes so they would not lose that revenue stream.


This problem is not exclusive to podiatry and DME. Groups often assign RVU values for medical services that lack them. Our dermatologist has several services that are cash payment and the group has assigned them RVU values as well.


Hyim Baronofsky, DPM, Mount Prospect, IL



RE: It's Time to Clean Up Our Act 

From: Joseph Borreggine, DPM


Having previously been on the Illinois Podiatry Licensing board for the last 5 years and serving as its chair for three of those years, I had the opportunity to review a number of cases that were initially brought to the board as patient complaints. I could only opine that these patient complaints were driven by possible perceived high fees for medical services with outcomes that did not solve the patient’s problem. Therefore, with the basis of this type of complaint, not much could be done. But, many cases with similar complaints were more frequent than one would think. 


The reason that nothing could be done was due to the inability to “restrict someone’s trade.” Hence, it did not allow me or the board to make any judgment against these podiatrists. So, the complainants were usually just left without any...


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



From: Elliot Udell, DPM


Dr Kass is correct. When it comes to anatomic locations of ulcerations, the determination of what is and what is not in scope for a podiatrist in NYS is absurd. I would love to see how insurance companies would handle a case of an ulceration that was half in scope and half out, and if the podiatrist would treat half of the ulcer and a "dermatolgist" would treat the upper half of the same ulcer.


That being said, there is a greater area of scope of practice that our state society should not ignore. Last year, we saw a miserable flu season with many deaths as a result. If pharmacists can give flu shots, why not podiatrists who give injections all day long? Since we treat geriatric patients, this would make sense from a public health perspective.


Elliot Udell, DPM, Hicksville, NY



RE: Relaxing Scope of Practice Restrictions

From: Jeffrey Kass, DPM


Medpage Today reported this week that Health and Human Services Secretary Alex Azar said that states should consider relaxing scope of practice restrictions as this impedes healthcare competition, raises healthcare costs for patients, and deprives them of choices. I could not agree more. There are some states where the scope of practice is absurd, New York being one of them. 


In a personal communication with the NY State Podiatry Board, I asked if I were treating a leg ulcer contiguous with a foot ulcer and the leg ulcer healed, could I continue to treat the leg ulcer? The response was (paraphrased) ”if I was treating it before, common sense would dictate I could continue to treat it.” I responded with a follow-up. Wouldn't common sense also dictate, if I can treat a leg ulcer with the healed foot ulcer, I could treat the leg ulcer without the foot ulcer ever existing? The Board has yet to issue a response. 


With the comments made by Alex Azar, every state with ludicrous scope issues should capitalize on these comments, agree with them, and invoke change. If not now, when?


Jeffrey Kass, DPM, Forest Hills, NY



RE: 20 Years with Sammy

From: Christopher A. Orlando, DPM


August 8, 2018 marked 20 years with Sammy. On 8/8/98, Ken himself came to my office to install Sammy. At the time, it was DOS-based! It was the best business decision I ever made. Ken Katz and company have exceeded my expectations and have kept up with all the insane insurance changes and demands. Thanks to Ken and his excellent support staff.


Christopher A. Orlando, DPM, Hartsdale, NY 



RE: Medicare Unmasked Revisited

From: Joseph Borreggine, DPM


The website: came out in 2013 in the Wall Street Journal and shows how doctors and other providers compare with peers in their state and nationwide. This information, I believe, is accurate since it came from CMS; most importantly it is public information. I do not think there is any further data beyond 2015 since CMS now has a "" site which is much harder to navigate to find the same data. I tried. 


I recommend that my colleagues investigate the WSJ site and see their own data and consider how they compare to their associates in their own community with respect to how much they were paid by Medicare from 2012-2015. You may be surprised to see...


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



From: Darryl Burns, DPM


They can be found at:


Darryl Burns, DPM, Salinas, CA 



From: David E Gurvis, DPM


I respectfully disagree with Dr. Al Musella. My most frequent code for a new patient is CPT 99203. I also frequently use 99201 and 99203. On occasion, if the time has been spent in counseling - 99204. I have a similar distribution on established patient visits... 99212 and 99213, for the most part.


When appropriate, I do a complete LE neurological, muscle strength and testing, ROM, integument and nails, along with musculoskeletal. I read and document that I have read and gone over with the patient the family history, social history, and ROS. At times, a patient who has waited too long to come in presents with 4 or 5 complaints, and each requires an...


Editor's Note: Dr. Gurvis' extended-length letter can be read here.



From: Al Musella, DPM


Take a look at the proposed rules before making comments. They specifically ask about something that is not addressed in the APMA letter. They specifically say on page 345: "We are soliciting public comment on what that total time would be for payment of the proposed new podiatry G-codes. The typical times for these proposed codes are 22 minutes for an established patient and 28 minutes for a new patient, and we could use these times."


I think that is reasonable. They predict that the changes will result in a net loss of 2% of our...


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



From: Andrew Shapiro, DPM


Dr. Kass appropriately recognizes Dr. Dennis Frisch and the APMA for their efforts, but he should also thank the more than 12,000 united APMA members who have invested in their national and component organizations. Without  the advocacy and work of the APMA and its state and division components, there would be no voice to defend and support the podiatric profession. ATTENTION NON-MEMBERS: It's time you stop relying on others to save your profession. Step up and join now, and be a part of the solution, not the problem!


Andrew Shapiro, DPM, Valley Stream, NY



From: Eric J. Lullove, DPM 


I don’t want to sound like a broken record in this post. I cannot stress how important this issue is to all of us. Basically, whether you pay for APMA dues or not, this is as of right now, the most important battle we as DPMs are ever going to fight. I have seen the direct result of how advocacy and involvement at the public policy level works for the day-to-day practicing podiatric physician.


It is this very time that EVERY DPM in this country access the APMA e-Advocacy website and send your customized letter to your members of Congress as well as CMS Administrator Seema Verma to immediately close the...


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



From: Jeffrey C Kass, DPM


I would like to applaud Dr. Frisch and the APMA for allowing not only members, but non-members and anyone who wants to be part of the letter writing campaign to say "no" to the proposed CMS changes to their reimbursement policy.


I know that on a divisional level here in NY, I used to complain that only members of the association were able to partake in letter campaigns to state senators and assembly persons.


So, I thank APMA for recognizing the importance of everyone fighting for the cause. I sent in my letter tonight through APMA.ORG and I invite all members or non-members, all active or retired podiatrists, all students and residents to do the same. It literally takes no more than one minute to fill in your info, click send, and might just be the most important minute of the year.


Jeffrey C Kass, DPM, Forest Hills, NY



From:  Dennis R. Frisch, DPM


Dr. Kass asks if there is a course of action to ensure the profession is not short-changed when it comes to the changes to E/M codes included in the proposed rule for the Medicare Physician Fee Schedule. In short, yes: Visit the APMA eAdvocacy site today to send a pre-populated, customizable message to CMS. Physicians must send a comment by September 10 to be on the record on this critical issue.


APMA has actively communicated with members since the release of the proposed rule and is asking every member, state component, and affiliate to take part in this profession-wide call to action. We encourage non-members to...


Editor's Note: Dr. Frisch's extended-length letter can be read here.  



From: David S. Wolf, DPM


"The times, they are a changin." The old mantra was "if you did it and didn't document it, you didn't do it; and if you documented it and didn't do it, you did it."


Now with the new CMS proposition, the mantra is the converse... you don't have to document it (copy and pasting bullets to satisfy the coders) and you get paid. Go figure.


David S. Wolf, DPM, Retired, Houston, TX

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