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11/21/2008
RESPONSES / COMMENTS (NON-CLINICAL) CLOSED PART 3
RE: ASPS, APMA’s New Surgical Affiliate
From: Barry Mullen, DPM, Juliet Burk, DPM Kudos to Dr.'s Kanat and Kashan. They've both hit the nail on the head regarding this issue and I agree 100% w/ their sentiment. I'm confident I'm one of many former ACFAS fellows who saw right through the smoke and mirrors ACFAS' leadership attempted, resigned following this fiasco. APMA is THE organization that represents ALL podiatrists and fights in the trenches on a daily basis for the betterment of our profession. Somewhere along the way, ACFAS' leadership forgot what their organization's mission statement is and also forgot that they were elected to lead their membership, not dictate to it. Let's hope that the new ASPS fully espouses and endorses APMA's mission statement and acts as the surgical affiliate for its parent organization in a responsive and responsible way...something ACFAS has long since abandoned.
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com The idea that a surgical affiliate, be it ASPS or ACFAS, can adequately represent the podiatric profession really only highlights a critical shift in podiatric medicine—the devaluation of the primary care podiatrist. I believe that we have fundamentally weakened the profession in the last decade with multiple states requiring surgical residencies in order to even get a license. No wonder the pedorthists and physical therapists are making such gains into our market share. Will a podiatrist who practices primarily biomechanics have a place left to hang a shingle in a few years? There is so much good we can do in our profession in the PREVENTION of surgery that in many ways economically improves our practices. I practice in Oklahoma, a state where if I were to apply today, I would be unable to even be licensed to practice. But interestingly, I am well-regarded by my patients and community, and much less likely to harm a patient than a podiatrist who practices surgery. YET, I would be denied a license today because of licensure laws designed to protect patients from inadequate care. And I am limited in where I can practice if I ever decided to move. Where is the logic in that? State by state, and dare I say nationally, we are choosing to disenfranchise podiatrists who choose not to do surgery. It would be akin to MD’s outlawing primary care providers. Will this nonsense ever stop? We won’t flourish as a profession until we can decide who we are, and we are not all surgeons. Juliet Burk, DPM, Muskogee, OK, juliet-burk@cherokee.org
Editor's note: Having presented a representation of opinions on this issue, we are temporarily closing this topic. We will reopen this topic when more details about ASPS become available.
Other messages in this thread:
05/05/2009
RESPONSES / COMMENTS (NON-CLINICAL) CLOSED PART 3
RE: Gifts to Patients for Patient Referrals (Brian Homer, DPM)
From: Michael A. Janning, DPM When I was still in practice, my habit was to send a thank-you note, personally signed by me, for the referral of Mr. or Mrs. So-and-So. If the referring patient had referred more than one new patient, I would also send a single carnation or rose as a thank you. I do not know how there could be any objection to this practice. Michael A. Janning, DPM (Ret.), South Euclid, OH, drmikej1008@sbcglobal.net
12/03/2008
RESPONSES / COMMENTS (NON-CLINICAL) CLOSED PART 3
RE: Inheriting Employees (Name Withheld)
From: Eric Hart, DPM I agree strongly with name withheld, who noted his frustrations as an employee. What one must remember is that each physician holds a degree and each physician is ultimately responsible for his/her own actions and patients. Let’s face it, many of the experienced podiatrists in any community have something to learn from podiatrists just out of residency. No one would argue that the young practitioner has far more to learn regarding practice management and some of the pitfalls of different treatment plans, but this is best done in a positive manner as one colleague to another. If you want to make all of the medical decisions for every patient to come through the door, then you should have become an MD/DO and hired a physician's assistant. Associates are not your PA’s and if you treat them that way, you are undermining their degree and in turn yours. I applaud all of the employers who use employee meetings to discuss treatments, billing, etc in a group setting and are willing to hear why or why not one approach is better than another. For the employers that force their employees to do things their way—and often this includes questionable billing practices, I hope you can see that there is a better way. Eric Hart, DPM, Salt Lake City, UT, ericandalix@yahoo.com
11/24/2008
RESPONSES / COMMENTS (NON-CLINICAL) CLOSED PART 3
RE: NY Podiatrist Overbilled State: Audit
From: MultBryan C. Markinson, DPM, Brian Kashan, DPM This is only the tip of the iceberg. About six months ago, state auditors uncovered a group of Long Island surgical centers that routinely forgave deductibles and co-payments for out-of-network cases, because much of the time, as everyone knows, out-of-network reimbursement is much higher even with forgiving these charges. It was only a matter of time before they started looking into physicians doing the same thing. The reason it is only the Empire plan at the moment is because this is a state-funded insurance program, directly paid for by taxpayers. Everyone knows that the success of practicing out-of-network for most podiatrists involves forgiving of these charges in large measure. The fraud aspect is that the charges you bill for are not actual, but a fantasy when you do not balance bill the patients. State law is not very clear on the mandate for billing deductibles and co-payments, but federal law is. However, the attorney general's big bite can be under the heading of unfair business practice, which forgiving these charges really is. It is therefore only a matter of time before private insurers begin to do what the state has done. The "out-of-network" gravy train is therefore over...unless practitioners really start collecting a fee that the patient is aware of and consents to before the procedure is done. Bryan C. Markinson, DPM, New York, NY, Bryan.Markinson@mountsinai.org When patients ask me why they have to pay when they come to my office when their friends go down the street to another doctor and "never have to pay," I answer them as follows.
"I am not sure what services your friends are being provided. Nor do I know their medical history or conditions. However, these laws apply to everyone. I am not going to prison so you don't have to pay to have your toenails cut, and if you want to have your services here, you will need to pay." I try to say this almost jokingly and not demeaning.
Then, if I get similar comments about the same doctor,I call the doctor and ask him directly, "What criteria are you using for your patients for covered and non-covered footcare?" Frequently, the doctor is billing correctly and the patient was in error. If that is not the case, at least the doctor knows that word is getting out about what he is doing and he will be more diligent.
Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net
09/22/2008
RESPONSES / COMMENTS (NON-CLINICAL) CLOSED PART 3
RE: Chiropractors and Orthotics (Bob Kornfeld, DPM)
From: Jason Kraus The foot orthotic genie has long been out of the bottle, and like most genies, can't be put back in. There are probably more devices prescribed and dispensed outside of the podiatric profession than there are in your offices. The reasons for this are varied, but chief among them was the lack of intellectual and scientific commitment to the science of podiatric biomechanics, the lack of a comprehensive approach to patient assessment and the willingness to trade innovation and high technical standards for low orthotic prices. In the majority of offices that I visit, DPM,s are not even asking their patients to stand up and/or walk as part of their evaluation. It's hard to claim a leadership position in the evaluation and treatment of mechanically caused (or influenced) lower extremity conditions when shortcuts are taken and a comprehensive and coherent biomechanical assessment is not performed. The best way to gain or regain a competitive advantage over other disciplines is to use all the knowledge that you have,or should have, and to provide patients with a level of care and expertise unmatched by other practitioners. Free markets always reward excellence.
Jason Kraus, Jkraus65@gmail.com Editor's note: This topic is closed
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