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12/06/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Elliot Udell, DPM


 


Many of us have been led to believe that when the new scope of practice laws in New York State take effect, it will not just affect bone surgery of the ankle, but the treatment of soft tissue problem in the adjacent areas.


 


I, for one, have no intention, at this stage of my practice, to study for or to become certified to perform ankle surgery, however I don't see why the new law would require colleagues like me to complete a residency in ankle surgery in order to treat a verruca which happens to be above the lateral malleolus.


 


Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Other messages in this thread:


04/16/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A



From: Raymond F Posa, MBA


 


This doctor's story is disturbing, and while we don’t want to distrust our employees, in the medical field with the sensitive nature of the data we have, we need to have protocols in place to prevent such occurrences. They should be articulated in your HIPAA security manual.


 


When an employee is going to leave your practice, the protocol should be to pay them two weeks’ severance and immediately lock down all of their user accounts as soon as they give notice. I have experienced another situation where the employee leaving the practice took lists of all of the practice's patients so as to use them at another practice. That final two weeks tend to be very unproductive weeks on behalf of the outgoing employee, and leaves the practice vulnerable to all sorts of mischief and possible damage.


 


On a second point, the doctor mentioned that the employee deleted all of the mail from the Gmail. For the record, Gmail and Yahoo and any other free email accounts are NEVER to be used for the communication of ePHI. Only domain email accounts which are encrypted may be used. Also, had this doctor used domain e-mail, even if the employee had deleted the mail and emptied the trash folder, you would still be able to go onto the e-mail server and get your e-mails.


 


Raymond F. Posa, MBA, Farmingdale, NJ, Rposa@themantagroup.com

04/16/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B



From: Pete Harvey, DPM, Jack Kay, PhD


 


Isn’t your info backed up on a cloud or hard drive? The emails should be there even if they were deleted by Google. If it is not backed up, then start TODAY! A forensic Information technologist might be able to recover the data if your own IT team can't.


 


Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com


 


I am not an attorney; I do not dispense legal advice. But allow me to offer the following — In Massachusetts, to cite only one example, there is something called the Massachusetts Wage Act, which subjects an employer and its entire board of directors to three times the amount of wages withheld. I doubt very much that the Massachusetts judges who administer this court would care a whit as to the rationale for withholding such wages; as a group, they tend to be employer-hostile. All podiatrists should seek legal counsel before embarking on a risky course of action such as this.


 


Jack Kay, PhD, Woodmere, NY, Jack@nomirmedical.com

03/14/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



 


I just took the course provided by the FPMA; however, the deadline for taking it with them was March 1st. The Barry University College of Podiatric Medicine did not offer it this year as a home study.


 


Don R Blum, DPM, JD, Dallas, TX, donrblum@sbcglobal.net

03/01/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Olga Luepschen, DPM


 


This discussion brings up an interesting point. What percentage of our colleagues carry $250,000/750,000 vs 1 million/3 million coverage? I was under the impression that $250,000/750,000 coverage was adequate.


 


Olga Luepschen, DPM, Sebring, FL, Feetdoctor10@hotmail.com


 


Editor's Comment: This will be the topic of next week's PM News Quick Poll question. As previously stated, we believe that $250,000/750,000 coverage is inadequate.

02/27/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL))



From: Joseph Borreggine, DPM


 


Here's a follow-up to the matter regarding BC/BS wanting their money back for a surgical procedure they deemed an "investigational or experimental procedure." I was under the impression after my conversation during a requested peer-to-peer interview with the DPM who initially reviewed the case that my claim should have "no problem being paid" if I just resubmitted a "corrected or addendum" operative report as to why a metallic implant had to be used during a joint salvage arthroplasty of the 1st MPJ utilizing CPT codes 28111 and 28126. 


 


I did just as he requested and the union insurance plan with BC/BS as its TPA stated that all claims paid past, present and future will not be paid and...


 


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

02/14/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B



From: Paul Kesselman, DPM


 


According to the Provider Outreach and Education Department for DME MAC A, they are adding a feature on their website which should address some of the questions raised by Dr. Schaffer.


 


DME MAC A is adding a "physicians only" portal to its website. This will list the documentation requirements for physicians for various DME products. Echoing the posting by David Mullens, DPM, Esq, the DME MAC cannot list requirements which are contrary to Stark or other CMS requirements.


 


Check your DME MAC website within the next 3-4 weeks for this information.


 


Paul Kesselman, DPM, Woodside, NY, drkesselmandpm1@hotmail.com

02/13/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B



From: Paul Kesselman, DPM


 


My classmate and colleague asks several questions which are actually quite more complicated than they appear. First off, the issue of Stark and signing off on a podiatric diagnosis are two separate issues, which apparently he/she is confusing as are other MDs/DOs and DPMs. 


 


The Stark issue is one that I would defer to an attorney to provide a formal legal response. In lieu of that, I have personally spoken with several healthcare attorneys who are well-versed in Stark and I can provide you with a brief explanation. In most cases, as long you are...


 


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

01/03/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Steven J. Kaniadakis, DPM


 


My post related to the Banyan® crash cart. We kept it under our surgical suite back table. We also had Armstrong's Medintech® flooring. This is a type of non-conductive flooring. Electrical-type currents  from an AED or electro-cautery require grounding (plates, floors, etc). This is especially true when oxygen is flowing. 


 


Steven J. Kaniadakis, DPM , Saint Petersburg, FL, stevenkdpm@yahoo.com

01/02/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Jim Fisher, DPM


 


911 is your first line of defense, yes. In addition, I bought a HealthFirst mobile crashcart complete with O2 and defibrillator. It is made for the dental profession and is amazingly organized, light, and easy to move. I take it with me to my satellite office. It saved the life of an accident victim I came across on our rural roads two days after I received it. It has everything a crashcart would need and is very cost-effective.


 


The defibrillator is amazing as well: easy to use, and it tells you what to do, even if that is to do nothing. The 15 minutes I spent with the accompanying DVDs for the crashcart and the defibrillator were well worth it, and it gave me just a tiny bit more peace of mind.


 


Jim Fisher, DPM, Crescent City, CA, quantumscimus@gmail.com

01/01/2014    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Carl Ganio, DPM


 


Right out of residency, I trained in advanced cardiac life support. We started out in the office with all the meds, etc. However, as meds and certifications expired, I began to rethink the risk. You should understand that having those meds exposes you to a higher level of scrutiny and expectations beyond our scope of practice. If you feel comfortable, up-to-date, and capable, I admire you. However, understand that perhaps oxygen and an EpiPen are enough. Call 911.


 


Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

12/31/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Steven J. Kaniadakis, DPM


 


I bought a Banyan® crash cart from a plastic surgeon. I also had an oxygen tank. However, even the MD related that he would "call 911". However, for medical-legal reasons, he related that having a crash cart is useful medically-legally. I thought it was wise practice advice and was lucky enough never to require either. 


 


DPMs performing surgery should have the supplies, equipment, instrumentation, and the people available as sources and resources. An AED is now affordable for most practices, and you should be at least willing, ready, and able to use one.


 


Steven J. Kaniadakis, DPM, Saint Petersburg, FL stevenkdpm@yahoo.com

12/30/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Elliot Udell, DPM


 


Dr Bergman is correct. We as podiatrists should not be managing anaphylaxis or a myocardial infarction on our own. I imagine that most physicians, no matter what branch of medicine  they practice,  would call 911 if a patient was suffering with a life-threatening emergency in an office setting.


 


Anaphylaxis is one of the conditions that does not afford the physician the luxury of placing a call to dial 911 and waiting for help to arrive. Emergency treatment has to be started immediately, or the patient might not live to greet the ambulance. An allergist gave me a copy of the emergency instructions that he and his staff use in case one of their patients develops anaphylaxis in their office. I have this sheet hanging in my office along with easy access to appropriate medications. If anyone is interested, I would be happy to forward you a copy of this page of instructions along with the list of appropriate medications you should have on hand.


 


Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

12/12/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Jeffrey Kass, DPM


 


Dr. Kruper brings up a valid point in terms of pathology - that a podiatrist is more likely to see non-bony surgical issues than bony surgical problems. I think full allopathic scope is a pipe dream here in New York. It seems the atmosphere is to take baby steps. Considering we have the oldest podiatry school, one would think our scope would be advanced compared to that of the other states. 


 


I am trying very hard to understand why it is possible to pass a scope bill to allow 3-year trained RRA certified podiatrists to perform bony ankle surgery and skin and soft tissue to the knee, while the rest of NY podiatrists are deemed incompetent to treat the non-surgical problems (skin and soft tissue) above the ankle. This law seems very "egosurgical-centric".


 


The surgical trained person gets to perform surgery and non-surgical care, while everyone else is left out. ABPM, where are you? Can you hear me now? Any dues-paying member in the NYSPMA or ABPM should voice their concerns to the societies they pay dues to. The assumption seems to be if you don't call them, you don't oppose what is taking place.


 


Jeffrey Kass, DPM, Forest Hills, NY,  jeffckass@aol.com

12/11/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Paul Kruper, DPM


 


The last time I treated a patient who needed bone surgery of the ankle was... The last time I treated a patient who needed primary care for diabetes, arthritis, or dermatopathology was today, 6 times. New York podiatrists would be far better off professionally and financially to have a full allopathic scope, which would give unlimited potential to expand patient load and employment opportunities. Chasing ankle cases is egocentric and does nothing to fill up the empty spaces in the appointment book.


 


Paul Kruper DPM, Kingsburg, CA, prkruper@yahoo.com

12/07/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)- PART 1



From: Michael L. Brody, DPM 


 


EHR requirements are that a patient have access to a limited data set. This includes: active problems, active medications, active medication allergies, vital signs, test results, and a number of other items that can be put into a list.


 


The patient chart notes is just one of the items that is NOT included in the information that the patient must be able to view online. So, the online requirement is not the complete medical record. When a patient requests a copy of the records, it is the complete record they are requesting.


 


If the patient requests a copy of the records, you will need to follow the same policies and procedures you currently have in place.


 


Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com

12/07/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 2



From: Jeffrey Kass, DPM


 


Dr. Udell brings up one of many SERIOUS problems with this new scope bill. 


 


1) Not many of the practicing podiatrists even know what the new law is. 


2) The law as written will increase scope for less than 1% of the current practicing podiatrists. 


3) There is absolutely no alternate pathway for one to achieve an increased scope without going back and completing a 3-year residency that is rearfoot and...


 


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

12/05/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 2



From: Steven J. Kaniadakis, DPM


 


Dr. Daniel Chaskin's post is very enthusiastic. This would bring parity among our profession. Also, I think this pathway will demonstrate a type of unity strength as a profession. I still believe that there will not be enough podiatrists and other physicians and surgeons, with Obamacare to treat every American in the United States. If our profession does not make moves to accommodate, then others will take up the slack from a backlog of patients. We need more schools and post-graduate programs, which should include program pathways akin to the ones mentioned by this post. Dr. Chaskin is the type of podiatrist whom I was initially inspired by before I attended podiatry school.


 


Steven J. Kaniadakis, DPM, St. Petersburg, FL, stevenkdpm@yahoo.com

12/05/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A



From: Philip J. Shapiro, DPM


 


Your malpractice carrier can give you overall guidance as to what you should have, but the general concept is ABC: Airway, Breathing, and Cardiac. Prior to an emergency response team arriving at your office from a 911 call, you should be able to respond quickly and efficiently to anaphylaxis, seizures, cardiac arrest (crash cart plus your documented proficiency in ALS), diabetic reactions, hyper- and hypotensive crises, and other medical emergencies that can, and periodically do, arise in podiatric clinical settings. Equally as important, your entire staff should know what their role is during an emergency.  


 


When purchasing a crash cart, be certain that you have a system to check on the expiration dates of the medications as well as periodic monitoring of the oxygen tank level. Emergency equipment should be easily accessible, and all staff members should know where it is and bring it to you – never leave a patient unattended in an emergency. Possession of a crash cart alone is insufficient; the training and the system that you have in place to use that crash cart effectively is what makes the difference.


 


Philip J. Shapiro, DPM, Ormond Beach, FL, pjsdpm@yahoo.com

12/04/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Daniel Chaskin, DPM


 


"There should be some form of alternate pathway for everyone! The fact is that there isn't, and that there won't be is shameful. An alternative path could exist " - Kass


 


Regarding the above, I believe an alternative pathway should exist in every state. Such equivalency criteria can consist of a certain number of years in practice in a sister state for all those who do not meet the residency and or board certification requirements for a basic podiatry license. I feel the first step should be to have every state accept a certain number of years in successful practice as a podiatrist as meeting any residency equivalency criteria in every state.


 


Furthermore, if an unmatched podiatrist is able to become licensed and currently competent as a podiatrist, he/she should be enabled to move from state to state without restriction due to residency criteria.


 


Daniel Chaskin, DPM, Ridgewood, NY, podiatrist12@gmail.com

12/03/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A



From: Ira Baum, DPM


 


With respect for Dr. Vito, if you drill down his clear, yet complex combination of solutions, I think the issue becomes transparent. The problem is the convoluted certification classification system of the ABPS. The classification system appears to have its origin from podiatrists confronting obstacles to perform surgeries that they were trained to perform, in bona fide podiatric surgical residency programs. 


 


The podiatrists were unfairly scrutinized primarily by orthopedic surgeons and subsequently... 


 


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

11/30/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Jeffrey Kass, DPM


 


Ira Baum, DPM asks a great question, but you don't have to go back to the 1970s. There could be podiatrists from a few years ago who will not be able to increase their scope. The law is flawed. We are being told to drink the Kool-Aid, that this is what is needed to improve the profession. This will enable the profession to move forward. The truth is, it is exclusionary. 


 


There should be some form of alternate pathway for everyone! The fact is that there isn't, and that there won't be is shameful. I am happy for all those who will have the opportunity to have this increased scope. And for all those who want me to believe that I will have someone to sell my practice to when I retire because of this change in scope - get real. 


 


And for all those who want to tell me I should take in an associate with these skills - get real. That is the weakest defense for this exclusionary restrictive scope law. The marines know how to take care of their brethren - they leave none behind.


 


Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

11/23/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A



From: Eric M. Hart, DPM 


 


I have been in practice for a little over four years. I practice in a different region of the country, but my answer would be the same if I were practicing in California where I attended school or in Utah where I completed my residency training. Without a doubt, we should all be making referrals for problems outside of our scope of practice. That's why people make referrals to us. They are sending care to us that is outside of their general practice in most cases. 


 


Making referrals has led to better relationships with my physician peers, and most importantly to better overall healthcare for my patients. We treat "people with feet and ankles" not "feet and ankles with people" so I feel a responsibility to refer, document, and follow through with any health complaint that my patient may have. When I make a referral, I remind the patient that it is their responsibility to check with their insurance provider regarding any requirement that the referral come from their assigned primary care provider and to determine who is within their network.


 


Eric M. Hart, DPM Bismarck, ND, erichartdpm@gmail.com

11/23/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B



From: Philip J. Shapiro, DPM


 


With regard to Dr. Udell’s question about documentation on referrals for outside of the scope of podiatry practice, the answer is yes. Any time that a medical professional makes a referral, regardless of the reason, that needs to be noted in the progress notes. The underlying issue of liability is that the patient asked you based on your professional status and knowledge; it was not a casual inquiry of general public conversation. 


 


You are to some degree liable for the referral. If you know the practitioner to be unprofessional or impaired or controversial, that referral could come back to haunt you if your patient experiences an adverse outcome linkable to the referral. Again, the patient asked you for referral advice based on your professional status. If you are unsure whom to refer to, advise your patient to communicate with his/her primary care physician or to obtain a referral from the local hospital – and even then, document that into your progress notes.


 


Philip J. Shapiro, DPM, Ormond Beach, FL, pjsdpm@yahoo.com

11/22/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL)



From: Stephen Musser, DPM, Barry Mullen, DPM


 


When referring a patient on to a  physician of a different specialty, I give them more than one name (I believe 3 is the norm). I also tell them to go back/call their family physician for additional names/referrals if there is a specific doctor they work with, and to keep them in the same health system for continuity of care and coordination. Yes, I would document this in the patient record and have the patient keep me updated at a follow-up encounter.


 


Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com 


 


I will qualify my statement by stating I am not a healthcare attorney. I opine one is not responsible for the treatment outcome another surgeon achieves. I also believe that we are indemnified against any negligence that might be alleged against another healthcare provider. Additionally, it's a patient's right, and OPTION to either follow your recommendation, or not. In good consciousness, if you feel a given medical/surgical issue is best served by referring to a specialist, then do so. Scope of practice doesn't seem relevant. 


 


If the issue were misdiagnosed and the patient was incorrect in what condition they thought they had, it is likely that specialist would refer to the appropriate one after evaluating the patient. Document the patient's request in the subjective portion of your SOAP note, and your recommendation/referral in the treatment plan. I just made a similar referral yesterday for a friend of mine who asked for help dealing with the EXACT same pathology.


 


Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com 

11/20/2013    

RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1A



From: Richard Rettig, DPM


 


Jim Scales, DPM may certainly be correct that in his state, the BC/BS plan will put the word 'pathway' on the ID cards of those buying exchange ACA insurance. I am not clear how that is important. I agree that it is very important that some doctors will not be selected as providers for these plans. I suspect that BC/BS did not choose randomly, but established participation based on the hospital-based affiliations of those doctors. 


 


I think that this could be derived by two separate items that Dr. Scales mentions:  1. not one podiatrist in his area is on the plan. 2.  the two hospitals that his daughter uses - I presume they are the hospitals in the area - are not on the plan. Insurance companies have always established networks of participating hospitals and affiliated doctors based on contracts they negotiate with the hospitals, including employer-sponsored plans, and they will be doing this more and more, regardless of ACA. That is called the free market, a tenet of conservatism. I am not clear if the protesting doctors are against "Obamacare" or upset because they are not allowed to participate!


 


Richard Rettig, DPM, Philadelphia, PA, rettigdpm@gmail.com