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12/24/2007
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE Part 1
RE: ACFAS Drops APMA Membership As Renewal Requirement
From: Multiple Respondents Dr. Ambroziak wrote about problems with the Michigan Podiatric Medical Association and APMA membership. It is a fact that in order to be in APMA, one also has to be a member of their respective state association. This has caused some problems. Occasionally, some local actions by state associations have caused anger and resentment. This causes the individual member to want to drop out of APMA. Podiatrists need to separate their anger with their local people from APMA. Your state officers, being mostly volunteers, may have their "defects." But they will eventually leave their positions. Instead of being angry with your local podiatry Association for wrongs committed against you or the profession, VOLUNTEER yourself. Get active in your state association and MAKE the changes you want. But please stay in APMA. Believe me, they have your best interests at heart, and accomplish things that are impossible for individual doctors to do for themselves. Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net Kudos to the ACFAS for finally removing the requirement of APMA membership. We are now in parity with allopathic medicine in this regard. The ACFAS is truly the academic arm of our profession and it’s about time its link to the political arm (APMA) has been severed with regard to this membership requirement. The powers that be in ACFAS have listened and acted responsibly on behalf of their membership. Thomas Graziano, DPM, Clifton, NJ, TGrazi6236@aol.com As a former board member of ACFAS, APMA House of Delegates member, and past president of ABPOPPM, I have been involved with organizational issues /disagreements with all of the parties -BUT - we always were able to work things out for the good of ALL DPM's. I remember several years ago where ACFAS asked its membership a similar question that now has resulted in a policy change. My simple question to ACFAS Board of Directors is - Did you poll the membership on this policy change? A bylaws change requires a membership vote? An old saying- "be careful what you wish for, you may not get what you want ".. is appropriate in this issue. No matter what transpires, I plan to keep both memberships and hope that this ACFAS policy change will not last. I, along with others, would be glad to help work through this matter that will result in all of us benefiting. Joe Agostinelli, DPM, Niceville, FL, jmpa21@cox.net
Other messages in this thread:
01/03/2009
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Exit Strategy (Name Withheld)
From: Michael M. Rosenblatt, DPM, Mike Crosby Name withheld is 60 y/o with a successful solo practice. He/she wants to retire in 5-10 years. The practice does not support more than one person. But that can be changed by selling the practice “over time” to a personable, well-qualified, surgically-boarded young doctor. The new doctor will be younger and work harder. But that will only happen if the young doctor sees REAL financial advantage to the arrangement, including job security. You may also have excellent PM skills to teach your new partner.
You should look into the only “hybrid” practice purchase/associateship arrangement marketed by Medical Mavin, Ltd. MM’s hybrid makes it possible for doctors to buy-in without a bank loan, a real advantage during these tough-money times.
There are disadvantages to staying in “too” long. If you work shorter hours, you will only pay your MP insurance and put your estate into danger. There are a lot of practices for sale now, so you have tough competition. As more boomers seek retirement, it may get worse for sellers. Credit is so tight now that financing is almost impossible. This may improve slightly over time. The situation definitely favors an “installment” purchase.
My best advice: If you are looking to retire in 5 years, hire an associate and create a practice purchase/installment contract over 5-8 years. Cut back and let the associate have REAL access to your patients. Be willing to take less practice income during that time. Prepare to leave “earlier” than you originally intended. If you don’t plan ahead, odds are you will end up walking away with no buyer.
Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net Editor’s note: Mr. Cosby’s extended-length note appears at:
http://www.podiatrym.com/letters2.cfm?id=23874&start=1
11/15/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Merging Existing Practices (Name Withheld)
From: Michael Forman, DPM, Marc Platt, DPM Name Withheld wanted to know of a system where the busier podiatrist would not be unfairly compensated. I have always been of the opinion that, "You eat what you kill." That is, each DPM receives the same percentage of profit that he produces. As an example, if three docs are together and run on a 60% overhead, and the total practice does $1,000,000 with a 40% net; there is $400,000 to split. If Dr A produces 60% of the gross, Dr. B 30%. and Dr. C 10%, they are compensated at that rate.
Doc / Gross percent receives pays to overhead
Dr A $600,000 60% 60% of the net ($240,000) 600,000 - 240,000 = $360,000
Dr. B $300,000 30% 30% of the net ($120,000) 300,000 - 120,000 = $180.000
Dr. C $100,000 10% 10% of the net ($40,000) 100,000 - 40,000 = $60,000
If Dr. C, who may be the new associate, is unhappy with his share, the answer is "work harder, smarter, and make more money."
Each doctor is then paying his share of the overhead. That is, Dr. A is getting 60% of the net, and he is using 60% of the office resources, but he is also paying 60% of the overhead, which he should (he uses more Band-Aids, DME supplies, etc. I also suggest that each doctor pay his own malpractice premium and their health insurance through their own corporation. If one of the partners gets tagged by a large settlement and his/her premium goes up, the other partners do not have to share in this increase in costs. You are going to have to discuss this with your financial people and your attorneys. The solo practitioner is soon going to be archaic. Merge together and lower your overhead.
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com Editor's Note: Dr. Platt's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=23107&start=1
09/11/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Patient Cell Phone Policy (Dale Shrum, DPM)
From: Multiple Respondents Although we have a sign posted, “Please turn your cell phones off,” patients still use them in the treatment rooms. What are the policies/responses by my colleagues when;
1. Cell phone rings while taking a history or performing treatment? a. patient answers and begins a conversation: I’ve only had this happen once. The patient waved me off so she could have her conversation. I left the exam room, told the staff to send the patient home and block them from the computer. I thought about sending her a bill, but ultimately decided against it. b. patient answers and says, “ I’m at the doctor’s office. I will call you back.” This happens all the time; it doesn’t bother me at all. Eric Edelman DPM Syracuse, NY, ericedelman@gmail.com We also have notices posted that request that patients turn off cell phones in the office waiting rooms and treatment rooms. If a cell phone rings while the patient is in the office, a simple "please turn your phone off" works well. Michael J. Schneider, DPM, Avon-Frisco, CO, MJS10Vail@aol.com While patients wait for me I'm OK with short calls. Signs are in each room, asking patients to silence their phone's ring (or whatever the heck rap tune they uploaded).
A while ago a patient was in the exam room talking on her cell phone and despite my opening the exam room door a few times she kept yapping away. Looking in her chart, I noted her cell phone number. I went to my office phone, called her and asked if she wanted to reschedule her appointment. She got the message and ended her call. When I came into the room, her face was red but we both had a good laugh.
Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com
06/27/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: DVD on Procedures (Stephen Hartman, B.Sc.)
From: Multiple Respondents "Surgery of the Foot and Ankle" edited by Coughlin has a very good accompanying DVD of surgical procedures. This book has many references to DPMs. Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com 'The Art of Surgery' videos are well done and good reference material which I used as a resident. Visit OAMercado.com for a listing of available DVD's.
Christopher Formanek, DPM, Baton Rouge, LA, cformaneaux@bellsouth.net The ACFAS has a Surgical Procedure Series that individual procedures which can be purchased at acfasdistancelearning.com/SurgicalProcedureSeries_2007/ Philip Wrotslavsky, La Jolla, CA, drphilipw@msn.com
06/26/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Pedorthists Vs. Podiatrists (John Mishasek, C Ped.)
From: Paul Kesselman, DPM Editor’s note: Dr. Kesselman’s extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=20378&start=1
06/25/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Helping Flood Victims (Bob Warkala, DPM) We would also like to know how we can help the podiatrists affected by the flooding in the Midwest. Let us know...we can all send a box of gloves, a sleeve of gauze, extra instruments, etc. Please let us know.
Pam Hoffman, DPM, Katonah, NY, katonahpodiatry@yahoo.com
06/24/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Non-Diabetic Orthopedic Shoes (Joan E. Schiller, DPM)
From: Robert Gaynor, DPM A couple of the podiatric shoe companies sell lines of shoes that are name-brand but also Medicare-approved for diabetics. The New Balance line represents a tremendous opportunity to sell your patients a quality walking, running, or cross-trainer shoe. You can offer the New Balance line when you dispense a pair of orthotics to a patient. This adds to your bottom line and at the same time provides a good service. Several companies offer the New Balance line, including Dia-Foot and Safe Step. Robert Gaynor, DPM, President, Dia-Foot, Nailcutter@aol.com
06/23/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: High Quality Korex or Rubber Butter Orthotic
From: Steve Gersh DPM, Carl Ganio, DPM Schuster and Richard Lab in New York fabricates quality Korex and rubber butter orthotics. I've used them over the years and have had only positive experiences with the company. (718)-358-8607.
Steve Gersh DPM, Pasadena, MD, dslsg@verizon.net If the device came from New York, it may have come from Schuster & Richard. With a picture, tracing, and impression, they should be able to help you. I do not have any affiliation. I make my own leather devices and would be happy to help if they cannot. I learned to work leather from Dr. Schuster.
Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net
06/21/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Multi-Function Digital Scanner (John Moglia, DPM)
From: Ira Weiner, DPM, Zac Childress There are multiple devices on the market from extremely high end laser devices to rather inexpensive inkjet devices. We have a totally paperless office and use EMR which includes all scanned patient forms as well as digitized x-rays on the EMR program, which is a web-based program.
We have three of these devices in the office but only one of them is hooked up to the fax and it is an inkjet device. We have 3 Brother MFC devices which are available in most office supply stores for less than $150. They scan rather quickly and high-yield ink cartridges run less than $15 if you use the refill programs many office supply stores have. Depending on the fax volume, they will last from 2-3 weeks.
One caution, is that if you are using a Windows Vista program, make sure the device is compatible. If not you will have to buy a program from nuance.com known as paper port 11 to scan and stack your files to PDF format which runs about $200. XP is not a problem. At $150 each, they are basically throwaways, although I have been using one of mine for over 2 years with no problem.
Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com There are many Multi-function scanner, printer, copier and fax units that are in the $125-350 range. If you are going to be doing a high number of scans daily or weekly, you and your staff will probably find these units to be highly inefficient due to the speed of scanning and the fact that they only scan one side of a document at a time. For high-speed scanning, we use a Fujitsu 5120C that scans 25 pages per minute (or 50 images per minute in duplex mode to capture both sides), has an automatic document feeder that can handle 50 sheets at a time and will also handle an insurance card with raised lettering. We also use this model because our EMR requires the scanner to be TWAIN compliant. It is around $850. If you are not scanning into an EMR, look at the Fujitsu ScanSnap S500, which goes for around $450-475. It is a little slower and is not TWAIN-compliant, but is a good unit for high-speed scanning.
I have no affiliation with Fujitsu
Zac Childress, Oxford, MI, zac@godarwintech.com
06/13/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: MTBC Billing (Juliet Burk, DPM)
From: Multiple Respondents I've been using MTBC Billing service for almost a year now. Their fee is lowest among all the billing companies I have researched. The service provided is good. They collect balances from patients. I like the EMR/Scheduler, the web-based claims follow-up, and how they compile financial reports. The only slow part was in the beginning when I needed to inform them with a lot of information about my practice and have them incorporate the superbill/encounter forms that I am using. Once they get used to the way the office does billing, everything runs pretty smoothly. Helene Nguyen, DPM, Elizabeth, NJ, drhelene@gmail.com This company is not too reliable. I’m currently with them and am thinking about leaving them. They outsource to Pakistan, so good luck once you sign up with them in trying to speak with the same person all the time. Their turnover rate for employees is very high and each biller does not know what they are doing. The only advantage is that they are 4%, but one loses more than that in the account receivables. Arnold Horowitz, DPM, East Brunswick, NJ, ahorowitz71@yahoo.com I have used MTBC for the past year. It is the first outside billing service that I have used so I have no basis for comparison. The set-up is easy as you only have to purchase a high speed scanner. There is a built-in scheduler and all patient data in your computer will be picked up. You don't need to pay yearly software renewals. Of course, there is a learning curve and oversight is necessary. Their 4% fee is one of the lowest. Larry Cohen, DPM, Clinton, NJ, larrydpm2002@yahoo.com
06/09/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Kudos For Practice Management Tip of the Day
From: Bret Ribotsky, DPM What a wonderful complete metamorphous and rebirth that has been going on within PM News over the past few weeks. Dr. Block reintroduced the 1st pillar of what he started years ago with bringing to the forefront the "M" in PM News. Since Podiatry Management started many years ago, it has grown to so much more. I feel that the daily email is the circulation that keeps all of us alive with information. Seeing the management tip of the day is a refreshing highlight that has become addicting. Dr. Block, "YOU ROCK !" Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@doctorbret.com
06/03/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Dealing With a Claim of Racism (Name Withheld)
From: Peter Smith, DPM I believe that you should always contact a colleague if a patient is bad-mouthing them, or worse claiming mistreatment. We all know how patients can hear and believe what they want, regardless of what we tell them. We need to watch each others' backs, and hope that they would do the same for us!
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu
06/02/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Dealing With a Claim of Racism (Name Withheld)
From: Clarence M. Stewart, DPM You should call your colleague because actually you don't know if what she is telling is the truth. I have found out that believing what a patient tells you is the truth, can get you into major trouble. Also, how do you know that she is not exhibiting racism, or envious of an African-American physician? Clarence M. Stewart, DPM, Raleigh, NC, IIICMS@aol.com
05/31/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Daniel Joseph McCarthy, Jr., D.P.M., Ph.D
From: Joe Agostinelli, DPM, Bryan C. Markinson, DPM
My first encounter with Dr McCarthy was as an applicant to PCPM when he was on my interview committee. The next time I saw him was as a student in his embryology and gross anatomy lectures. He was an amazing person in many ways. During the 1990's, we ran several Air Force CME Meetings that Jay Wenig and I attended and Dan was always the first to offer a lecture to give or workshop to run for us--at no cost. Once you were a student of Dan's and later a colleague, he always had a smile, a hello, and a funny story to tell. Although his illnesses took their toll, Dan was always at the meetings spending time with his former students, now colleagues, and always happy to see the people he trained. His scholarly achievements are awesome to behold but I will remember the times after lectures and at breaks in meetings with Dan holding court and making people laugh! He was truly one of a kind. Joe Agostinelli, DPM, Niceville, FL My first experience with Dr. McCarthy was in 1977, when interviewing for admission to what was known then as the Pennsylvania College of Podiatric Medicine. I had only completed three years of pharmacy school at the time, but had amassed over 100 credits. Dr. McCarthy grilled me (in a very professional way) mercilessly about why I thought that before I actually got an undergraduate degree, I would be able to handle the rigors of podiatric medical school. I responded by saying that if they gave me an interview, perhaps that may be the reason. It went all downhill from there, and PCPM was the only school that rejected me. I never forgot that interview. Fast forward 7 years later, and I get a call from Dr. McCarthy who somehow found out that as a junior faculty member at NYCPM, I had developed an interest in podiatric dermatology. He anointed me the NYCPM faculty representative of the American Society of Podiatric Dermatology, and from then on we had a wonderful professional relationship, speaking often on the phone and glad to see each other at the annual ASPD meeting, which he had been unable to attend for the last few years. About 5 years ago, I got up the courage to remind him of our very first meeting in 1977, of which he had no recollection, probably having forgot about it three minutes into the next interview. He feigned a reaction of shock, and stated, “That was a mistake among many that I have made in my life.” I viewed that statement as a vote of confidence from a brilliant man, and one which defined his humility, and respect for his colleagues. Rest in peace, Dan. Bryan C. Markinson, DPM, NY, NY
05/30/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Dox Podiatry (Josh Prero, DPM)
From: Brian Doerr, DPM
. I have been using DOX podiatry for 2 years now and I'm very satisfied with the program. It is extremely easy to use and to navigate. The biggest negative that I can say is that the front-office component still needs some work. The best part of the program is that they know it's not perfect and they are constantly upgrading the program.
Brian Doerr, DPM, Ft Myers , FL, DocDoerr@aol.com
05/28/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Conflicts of Interest
From: Irv Kanat, DPM The 2007 House of Delegates of APMA adopted Resolution Number 11, which had been submitted by no less than 29 state societies. The subject was “ETHICS PRESENTATIONS.” The Resolution outlined the importance of increasing the amount of information and direction that appropriately and ideally should be provided to members of the profession at every opportunity. The Resolution stated, in part - ”RESOLVED that the Annual Scientific Meeting of APMA, officially designated regions of APMA, component societies and their divisions, APMA affiliated and related organizations, and other podiatric educational seminars, be encouraged to include at least one (1) continuing medical education (CME) credit annually on the subject of “Ethics in the Delivery of Health Care Services,” based on the APMA Code of Ethics.”
Further, APMA is directed to report annually to the House of Delegates the results of a National Annual Survey of the presentations that are provided as a result of this Resolution. As a result, APMA continues to gather those statistics and report its findings every year, as it did in 2008. Hopefully, those entrusted with the development of podiatry meetings all across the country will be reminded of the importance of this concept,and will assure that this most timely and important suggestion is taken into consideration during all future meeting planning sessions. Irv Kanat, DPM, West Bloomfield, MI, ikanat@maxai.com
05/27/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Conflicts of Interest (Richard Boone, Esq.)
From: Barry Mullen, DPM, Michael M. Rosenblatt, DPM Mr. Boone has raised several excellent medical ethics points ...and yes, to my knowledge, healthcare providers don't receive formal medical ethics education during their professional training. With respect to healthcare provision, when a physician "owns" a vested interest in any product or service being delivered, the following questions need to be answered in the affirmative in order to avoid conflict of interest issues and their associated medical ethics violation(s). Is the product or service: 1) medically necessary? 2) medically appropriate? 3) in the best health care interests of the patient? If one can answer yes to ALL 3 questions, then I see no conflict of interest when a physician financially gains from a legal "self-referral" to a vested service/product he/she "owns." That's a win-win scenario for patient and healthcare provider. Since we aren't "not for profit" professional entities, that is the ultimate objective any healthcare provider strives for in the provision of professional care.
Conflict(s) of interest occurs when ANY of the 3 questions cannot be answered in the affirmative. When this occurs, then by default, service over-utilization occurs. The resultant physician financial reward then serves as the ends to a means which violates medical ethics and cannot be justified or condoned on any level.
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com Richard Boone, JD, a frequent contributor to PM and defender of podiatrists suggests that it is "improper to refer your patient to a surgical center in which you retain a financial interest." Doctors own and operate surgical centers more or less "naturally" because they have the abilities, skills and resources to own and operate them. Rather than seeing this as an "ethical" problem, I see it as a matter of honest disclosure. It makes ethical sense for a doctor to disclose that you have a financial interest in the surgical center, and as a part of this disclosure, make the choice available to the patient for a different venue, if that is their choice. Then, leave it up to the patient. It is also within ethical boundaries, to outline advantages and disadvantages for each choice, for your patient. A number of businesses exercise what is called "vertical integration." It is not considered "unethical" for oil companies to own their own fields, production and distribution facilities, as long as they don't engage in "price fixing" with other companies. I must admit that I tire of Government and other respondents constantly limiting the ability of physicians to survive financially and pay their bills. The cost of podiatric education is enormous. Podiatrists and all physicians are under enormous pressures and stultifying regulations that other businesses and professions don't have to face. Ethics count. Inform your patient and leave it up to them. Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net
05/26/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: MD/DPM Debate Video
From: Leonard A. Levy, DPM, MPH, Amram Dahukey, DPM This Sunday the first DPM to complete our accelerated American Osteopathic Association approved program will be graduating from NSU-COM. This DO degree program is designed for those DPMs who wish to obtain added value to their current podiatric medical practice rather than for those who intend to engage in another field not related to podiatric medicine. Leonard A. Levy, DPM, MPH, Nova Southeastern University College of Osteopathic Medicine, Levyleon@nova.edu I watched the debate on the webcast and was delighted to see that Dr. Block is in the forefront of change to MD degree. I believe that the reason we see no change is because if we do so, there may not be a need for APMA but for specialty organizations. There is always the claim that we are different and need to keep our identity. I do not agree with it, rather that we distinguish ourselves with our practice. Dr. Block mentioned parity over all areas of the world and I wholly agree. If I had an MD degree, I would have no problem with practicing or consulting in my hometown Jerusalem. Amram Dahukey, DPM, Tucson, AZ, drd@premiersurgeons.com Editor’s comment: Regardless of degree (and podiatry has had many) there will always be a need for APMA. It is likely that eventually APMA could become a component of AMA or AOA, much as other medical sub-specialty organizations have. To view the debate video click here.
05/23/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Conflicts of Interest
From: Multiple Respondents The University of Texas Southwestern Medical Center in Dallas no longer allows any commercially sponsored CME speakers. Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com
I am not writing to completely disagree with Dr. Goldstein, but to give a different perspective. Sure, larger markets and seminars may be expected to have the nationally known experts rounded up to speak on their topic and typically they are paid their reasonable/customary fee. That's how the business is. I'm telling you it can be different and work well in a smaller market or event and still result in a quality educational seminar, without the need to fly in most of these speakers and go to great expenses, whether it's the seminar budget or some company's dime.
Dr. Goldstein says he "would be hard-pressed to find enough speakers to fill up an entire day's worth of lectures without them receiving some form oo remuneration by a manufacturer or a drug company." The Midwest Podiatry Academy (of the OPMA), put on the Quickie Seminar last October, which is a one-day, 7.5 credit CME seminar, whose faculty of 20 speakers included 7 podiatry residents from three area programs, 4 MDs and 1 PT. Our final budget for the entire seminar was under $7,000 and only three faculty members required honorariums (2 MDs, 1 DPM). This year's Quickie Seminar is no different so far, with only 1 MD and 1 DPM requiring sponsorship/honorarium of some kind.
As for disclosure of sponsorship at the Quickie Seminar, all faculty are required to sign disclosure statements. Further, their sponsorships are identified in the seminar program and as the host for the program, I personally disclose their sponsorship during their introduction right before they speak to the audience. I think this is the standard.
Marc S. Greenberg, DPM, Dayton, OH, tripperdpm@yahoo.com It seems that some people are now apologizing for the disarray we face regarding seminars, speakers, honorariums, journals, the research world and our CME process. If our speakers are paid for their comments, their honesty is jeopardized. If a study is funded by a company with a self-interest, the entire study is worthy of scrutiny, if not worthless. Many reports indicate that drug companies simply bury the negative studies and only report the positive ones. Academic medical centers are beginning to deny drug company representatives and device manufacturers access to their physicians and their research departments. A proposal has surfaced from the AMA to stop accepting corporate contributions to their scientific meetings. Most meetings in podiatry, as in many professions, are almost totally funded by corporate donations. If that money were to disappear, our seminar costs would skyrocket. As participants in this process, we become not only victims, but the guilty participants.
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com
05/20/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Conflicts of Interest
From: Lloyd S. Smith, DPM I find comments made by all sorts of professionals that do not identify their conflicts unethical and dishonest. Whether the conflict is an honorarium for a lecture, a stipend for a consulting arrangement or a research grant for a particular study is immaterial. The world of medicine has been very guilty of allowing this type of conflict without challenging the individuals involved. That era has ended and the notoriety of many guilty providers has been revealed in major publications in the scientific and lay press.
I encourage those people who chose to post on this list serve to "spill the beans" so we all know what is influencing your comments. I encourage the editor of this list serve to demand no less.
Lloyd S. Smith, DPM, Newton, MA lloydpod@yahoo.com Editor’s Note: PM News Guidelines require those posting notes to disclose any potential conflict of interest. This guideline is in accordance with the APMA Code of Ethics.
05/19/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Billing Programs (Mark Williams, DPM)
From: William Tronvig, DPM I use e-clinical works and have been very happy-they do have a quarterly fee, though. The electronic remittance application is amazing. The "Explanation of Benefits", which can be several pages long (having many transactions) on it can be electronically transmitted to the program and the payments posted against the charges. The payment is deposited (Electronic Funds Transfer) about the same time. My "biller" will look over the postings by the program and verify their accuracy. It now takes her 15-20 minutes to gather the file for sending out (the claims) in the evening and 30 to 40 minutes to do a 15 -20 page Medicare EOB. This is much faster than our previous system.
William Tronvig, DPM, Aberdeen, WA, Harbor_Foot_and_Ankle_CLinic@msn.com
05/17/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Billing Programs (Mark Williams, DPM)
From: Robert K Hall, DPM We began billing programs in 1992, starting with DR software (DOS based/default/non-HIPAA), then Medisoft, then an outside billing service. For the past 3 yrs, we have used CollarorateMD (formerly ClaimGear). It is an Internet-based mainframe (read: no data loss due to crashes). It offers a flat start-up fee, depending on the features you want, gives daily updates on payor issues & a flat fee (not PER claim). Other options include auto-posting, Insurance verification, paper claim filing, etc. You can print multiple reports & access the program from ANY computer by logging on & entering password (Changed monthly, per HIPAA mandate). They offer free updates with no periodic upgrade fees or charge for support. This seems good to me. Robert K Hall, DPM, Ft Lauderdale, FL, robertkhalldpm@bellsouth.net
05/14/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
Re: Competitive Bidding Phone-In PowerPoint
From: Paul Kesselman, DPM Woodside NY For those registered for the competitive bidding phone-in, or for those wishing to review the presentation who could not participate in the phone-in, you may download the PowerPoint registration by clicking here. Paul Kesselman DPM, Woodside, NY, pkesselman@pol.net
05/13/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Medical Crocs (Elliot Udell, DPM)
From: Multiple Respondents
Our office started selling Rx Crocs about one-and-a-half years ago. We placed them on a shoe tree in the waiting area and for the first couple of months we dispensed about three to five pairs per day. Sales have slowed down now, likely because everyone who would buy the shoes have already purchased theirs, or people have finally looked down at their feet and said to themselves, "Hey...these things look stupid!" Regardless, we only dispense a few pairs per week at this point. Nat Chotechuang, DPM, Bend, OR, natchot@hotmail.com I have been selling Crocs Rx for over a year with good success. It is not a big money maker but once you get past the original cost of inventory they do sell themselves in most cases. I also recommend them for my diabetics as an alternative to going barefoot in their homes. I will caution you, however, that state regulations will require you to get a retail sales tax ID number and you will have to file and pay sales tax on these items. It takes a few months to get that set up and Crocs will not send your 1st order until you have that tax number. Also, they are not 100% honest in the claim "only available" through doctors’ offices, as they sell them on their own website to the public and I have seen them for sale in the FootSmart catalogue. I just keep my prices lower and the consumer saves on shipping fees.
Kathy Riffe, DPM, Trenton, TN, kriffedpm@gibsoncountypodiatry.com Editor’s notes: An extended-length letter by Dr. Ornstein appears at: http://www.podiatrym.com/letters2.cfm?id=19497&start=1 An extended-length letter by Dr. Macy appears at: http://www.podiatrym.com/letters2.cfm?id=19492&start=1
05/12/2008
RESPONSES / COMMENTS (NON-CLINICAL) ACTIVE PART 1
RE: Total Contact Casting with Wound Care
From: Eric Jaakola DPM, Rober Wunderlich, DPM My office used 1030 total contact casts last year without a reimbursement denial. We use them for post-Apligraf aplication as well as post-operative treatment such as partial amputations and Charcot surgeries. We apply them on a weekly basis or sometimes twice weekly, if need be, without reimbursement issues. For more specific coding questions you could contact MedEfficiency who produces a Total Contact Casting Kit. They can address issues on a state-by-state basis.
Eric Jaakola DPM, Denver, CO, ejaakola@yahoo.com If you apply a total contact cast (CPT 29445) on the same date of service as a debridement or other procedure, they will bundle the cast in with that other procedure (i.e., you won't get paid for the cast). However, you can apply the cast any time thereafter (including the next day, if you want) and you will be paid for the cast application and materials. My experience has been that casting is separately reimbursable within ANY global period (whether it be for offloading an ulcer, immobilizing a fracture, or for immobilizing an osteotomy), and the only modifiers I use are either -RT or -LT. P.S. - Don't forget to bill for your casting supplies! (Q4037 for plaster and/or Q4038 for fiberglass) Rober Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com
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