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11/06/2018    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: ABPS Maintenance of Certification Lifetime


From: Michael McCormick, DPM


 


$900 to take a self-assessment exam. What a joke! It’s absolutely ridiculous to waste any of our remaining days on this Earth going to an ultra-secure testing facility, by appointment, with multiple forms of identification, to take a self-assessment test, which no-one but no-one cares if you pass or fail, will likely never be evaluated by anyone, just to be able to state "Board Certified” on your letterhead and keep your hospital privileges.


 


I get it if passing or failing is important and the data is needed for educational purposes, but for a self-assessment? How about we join the 21st century and do it online for free? We already pay enough for annual dues. Just my two bits. I'm happy this is my last time having to perform this stupid exercise.


 


Michael McCormick, DPM, Venice, FL

Other messages in this thread:


04/24/2019    

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



From: James DeWitt, DPM


 



I have been prescribing balance AFOs for patients at risk for falls since 2011 and have found them to be an important and effective component of my comprehensive fall prevention program. I conduct a fall risk assessment with any patient who has admitted to falls/unsteadiness or whom my staff and I observed demonstrating a balance deficit as they ambulate about the office.


 


I refer you to the randomized controlled trial by Bijan Najafi, et al. from November 2018 published in Gerontology entitled "Effectiveness of Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses on Balance, Fear of Falling, and Physical Activity in Older Adults: A Randomized Controlled Trial". I feel that podiatry has a tremendous opportunity and is very well positioned to make a difference in this rapidly developing medical issue. I would be happy to answer any questions you may have.


 


James DeWitt, DPM, Wyoming, MI


04/24/2019    

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



From Paul Kesselman. DPM


 


From a purely utilization standpoint, those who dispense bilateral AFOs on the same date of service, stand out on the right end of the bell curve. Now mind you, being on the right side of the bell curve or being an "outlier" is not necessarily a bad thing. But if you are going to be a "pioneer", be prepared for lots of potential negative push back from carriers, simply because you are not in step with your peers. And by your peers, I mean all providers of AFOs, not just podiatrists. Currently, the data simply is not in line with bilateral dispensing of AFOs.


 


As for the time period mentioned by Dr. Shavelson, I believe he was referring to the Same or Similar issue, which somewhat precludes a new AFO within a 5 year (not 3-5 as mentioned in his LTE) period. While the Same or Similar period can be overcome through appealing to your DMEMAC and meeting the requirements stipulated in the LCD (new diagnosis, change in anatomy, physiology, etc.), it's no slam dunk to a successful appeal. If your appeal fails, you may... 


 


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

04/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Dennis Shavelson, DPM


 


There is a new fall prevention system on the marketplace that has many benefits over the standard heavy and cumbersome AFOs that fit inside the shoe with a foot plate, and needs to be accommodated with oversized shoes. The system combines the use of an external ankle foot orthotic (E-AFO) that exists outside instead of inside the shoe coupled with a restorative custom foot orthotic (RCFO) cast in optimal functional position.


 


The lightweight E-AFOs and RCFOs offer increased forefoot, midfoot, rearfoot, and ankle stability, symmetry, support, and balance, while reducing sway and perturbation in stance and when moving about. In addition, the ankle position can be free to move or bolted tight in any position on the sagittal plane, as needed. Two obvious drawbacks are that RCFOs are not covered by Medicare and E-AFO are not covered for three-five years if an AFO has already been dispensed under Medicare.                                                                                                                    


Disclosure: I am a consultant for and national distributor of an E-AFO manufacturer.


 


Dennis Shavelson, DPM, NY, NY 

04/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A



From: Spencer F. Dubov, DPM    


 


In response and support of Michael Schneider’s recommendation apparently to retirees to retain their licenses as long as possible, I am in total agreement since no one knows what the future may bring. But one of the nicest features of New York licensure is you never lose it and simply by paying the current fees and taking the required CME credits, the license is completely restored. I wonder what other states offer this “way back”.


 


Spencer F. Dubov, DPM, (Retired) Naples, FL

04/23/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B



From: Paul M Taylor, DPM


 



Maryland offers an inactive status license. For $50 a year, if I ever decide to resume practice, I would need to update all my CMEs. If I did not renew my license at all, if I needed to go back into practice, I would need to re-apply, including taking the national boards. Although I do not intend to resume practice, paying the $50 a year is a nice insurance policy in case my situation changes.


 


Paul M Taylor, DPM, Silver Spring, MD


04/18/2019    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Spencer F. Dubov, DPM, Steven J. Kaniadakis, DPM


 


In answer to the query from John Scholl, DPM, I found Magic Jack as a reliable VoIP alternative. It plugs directly into your router, allows transfer of your telephone number or will give you a new one if requested, costs about $3 per month which is included in the purchase price ($45 approx.) for the first year, and provides unlimited calls throughout the U.S. and Canada. In lieu of your personal answering service or device, it will intercept incoming calls with your personal message and record callers messages. It has worked flawlessly for me for the past 4 years. 


 


Spencer F. Dubov, DPM, Naples, FL


 


Although, VoIP has its place in the markets, and in other communications, I think that it is not the place for healthcare. It sounds like your expectations will not be any better than what you are experiencing in your post. In fact, VoIP will be rattled at times with digitized words or the issue breaking up. You will be dependent upon Internet traffic just like any Internet service. Therefore, at peak times, I am thinking that you will experience breaking up issues as well as dropped calls.


 


Steven J. Kaniadakis, DPM, St. Petersburg, FL

04/16/2019    

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



From: Elliot Udell, DPM


 


At the expense of insulting friends and colleagues who have a vested interest in balance braces, allow me to give my personal experiences with them. When these products first became available, I attended many sponsored lectures on them and it was exciting. Having lost a grandparent as a result of a fall, I wanted to do anything and everything to help my patients prevent unnecessary falls, so I dispensed many pairs of balance braces to patients. My findings were that the patients who used them did well and reported back greater stability and less falls.


 


The problem is that the devices are bulky, often hard for an elderly patient to put them on, and most of the patients stopped using them. Some were open and honest about it. Others said they were using them but when they came into my office for some "mysterious" reasons they never had them on. Yes, I truly believe they have value but the rate of compliance in my patient population was not there. I am, however, open to revisiting the issue of balance braces if they can be rendered more comfortable so that my patients will use them.  


 


Elliot Udell, DPM, Hicksville, NY

04/16/2019    

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



From: Nicholas A. Ciotola, DPM 



 


We tried this for a short period since it dovetailed well with our MIPS reporting. I found them to be poorly tolerated. The AFOs are cumbersome and don't fit easily into patients' shoes. This is extremely problematic in a deconditioned patient. I did have one patient with a reducible equinovarus deformity who found the AFO helpful, but the feedback was lukewarm to unfavorable. You will need to spend time responding to patients' complaints and returning the AFOs to the lab for adjustments. If you really want to help your fall risk patients, a PT referral can go a long way. Establish a relationship with a home nursing agency to set up home PT if needed. Your patients will return to you with a spring in their step.


 


Nicholas A. Ciotola, DPM, Methuen, MA


04/15/2019    

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



From: W. David Herbert, DPM, JD


 



It was the first day or two that I spent at OCPM in the fall of 1972 that our dean Abe Rubin, DPM told us why real doctors (i.e.. MDs) did not consider podiatrists real doctors. He stated they said this because podiatrists did not deliver any babies during their training. Dr. Rubin stated that beginning with our class, that would all change!


 


I remember spending 6 weeks in an externship at an osteopathic hospital in Texas in the fall of 1975. While there, every Wednesday I observed podiatric surgery. For 24 hours a day, one of us was on call for assisting on obstetric deliveries. I remember assisting on 27 deliveries while I was there. I am not sure this experience made me feel more like a real doctor when I graduated. I do know that it convinced me that I would not have become an obstetrician even if I was able to!


 


W. David Herbert, DPM, JD, Billings, MT


04/15/2019    

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



From: Dieter J Fellner, DPM


 



As a 57-year-old podiatrist (Class 1987, UK, England) who also graduated from the American system of podiatry education in 2016, I have a little insight. I concur 100% with Dr. Markinson. Podiatric and medical education are similar: on paper. Podiatry school attempts to cram in topics in a few hours of 'teaching' that will receive three months of studious attention in medical school. This disparity, among others, is ever more evident when the hapless podiatry resident is thrown into the e.g. vascular service, in residency, charged with the duty to keep the patients safe and attempt to match the effort of the medical resident. A plea to the movers and shakers of podiatry education: wake up and smell the coffee. That's just an absurdity.



 


I will also agree that if podiatry were ever to follow the model of the osteopath, in the quest for 'parity', podiatry will wither away. I, for one, am quite happy with what I know, and what I can do. Had I wanted to work as an MD, I would have gone to medical school, not podiatry school.


 


Dieter J Fellner, DPM, NY, NY

04/13/2019    

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


RE: Using the DPM Degree Outside of Podiatry 


From: Bryan C. Markinson, DPM


 


I have stayed away from this discussion (but Alan Sherman drew me in) because I feel the hard facts as I see them regarding podiatric medical/medical/DO equivalency are also going to be hard truths.


 


First of all, the notion that a gynecology course and psychiatry course evens up the score is an outrageous fantasy. It does so only on paper. The milieu, structure, oversight, support, etc. in a medical school is different than...


 


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

04/13/2019    

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


RE: Using the DPM Degree Outside of Podiatry 


From: Ty Hussain, DPM


 


I have to commend all these great physicians and their inputs as to basically answer our question of who we are and where our profession is headed. I would love to be on a panel at any of our national or regional meetings as this topic and anything relevant to it will draw crowds by the thousands.


 


After reading much of what has been stated, the need for DPMs to be equal or this so called parity to our MD colleagues will only begin with us having the initials MD behind our names. That being said, discussion has now led us to...


 


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

04/12/2019    

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


RE: Using DPM Degree Outside of Podiatry 


From: David S. Wolf, DPM, Robert Scott Steinberg, DPM


 


With only a 45% pass rate for the ABFAS Certification test, maybe the USMLE will be easier? Maybe that is one of the reasons that younger DPMs are looking outside of their DPM degrees for more realistic opportunities. The ABFAS needs to make their requirements to even sit for the exam more seamless as well as make the exam more relevant and less esoteric (I was board certified with ABFAS).


 


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


 


What should we do to the podiatry colleges that refuse to add Ob/Gyn, Peds, and Psych? Does your alma mater offer these courses? Are you a member of the alumni association? If so, would you contact them and let them know you expect them to offer a modern and complete education? 


 


Robert Scott Steinberg, DPM, Schaumburg, IL

04/12/2019    

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


RE: Using DPM Degree Outside of Podiatry 


From: Robert Kornfeld, DPM


 


In the almost 39 years since I graduated from NYCPM, it is my assertion that very little has changed in the world of parity with MDs and DOs. I will also say that very little has changed in podiatric medical education in terms of teaching our students cause and effect. We still focus on attacking symptoms and when we fail, we turn to surgery. The reality is that if every podiatrist understood the reasons why patients presented to his/her office with a problem, we would be light years ahead in our transition to parity. 


 


Here is an example: I lectured to a group of podiatric residents. I asked them what could be the underlying cause of...


 


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

04/12/2019    

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


RE: Using DPM Degree Outside of Podiatry 


From: Joe Agostinelli, DPM


 


I have been following this discussion closely and would like to present comments from experiences in my 23 year USAF active duty military career and then 14 years in private practice as a DPM in a large orthopedic surgery/sports medicine group. Ultimately, it is not the "degree" that allows other than podiatry utilization, but the "person." 


 


While in the military, I found that when it came to additional duties such as - ACLS instructor and affiliate faculty, trauma management lectures, executive committees of medical staff, chief of surgical services (including orthopedics), etc., my actual degree did NOT matter! It was the...


 


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

04/10/2019    

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



From: Alan Sherman, DPM


 


Former podiatry school and Nova Southeastern osteopathic school Dean Leonard Levy is one of my heroes in podiatry and our finest futurist in podiatry. Barry Block, Bryan Markinson, Harvey Lemont, Tracey Vlahovic, Brad Bakotic, myself, Leonard Levy, and others have all grown beyond clinical podiatry to establish consultancies or full-fledged businesses outside of clinical podiatry. I’m all for our podiatry students and residents who feel up to it to take the USMLE. I bet a subset of our residents can pass this test if we add Ob/Gyn, Peds, and Psych to our curriculum.  Any prediction on what percentage will pass?


 


Alan Sherman, DPM, Boca Raton, FL

04/10/2019    

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



From:  Paul Kesselman, DPM


 



Over the last 35 years, I have seen many DPMs who left the profession and did quite well with the DPM degree as part of their resume. Several have gone into teaching at the HS or university level and have excelled, receiving numerous awards, grants for research, etc. 


 


Others may have started in the "cellar" of pharmaceutical sales and go onto become national directors, national physician education liaisons, far surpassing the average incomes of most MD/DO/DPMs. These gifted individuals no doubt would have excelled at anything they chose to do, but the fact was their DPM degree and educational background did get them in that first door which...


 


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


04/10/2019    

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



From: Simon Young, DPM


 



Bottom line... we have a limited license. MD/DO/NP/PA all seem to be able to treat the whole body (give or take). We can't even give a flu vaccine in NYS. My local pharmacist can. Others can be hired in hospitals and by insurance companies. Unless there is a special niche, or someone wants specialized opinions, we don't fit the majority of needs. Unless we are able to increase our scope of medical (not surgical)  practice, we are stuck. 


 


Simon Young, DPM, NY, NY


04/09/2019    

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



From: Allen Jacobs, DPM


 


Several years ago, podiatric students from California took the USMLE examination. In point of fact, the podiatry students performed horribly in the examination. The results of this testing was to test the current status of general medical education in the podiatry schools. I suspect that medical students would fail the podiatry national boards.


 


If the objective of podiatry school is to prepare students to pass the USMLE examination, a restructuring of the current state of education within the podiatric colleges would be required. This would involve more than simply adding coursework in three areas. Clerkships and rotations would also have to change. Students and residents would have to...


 


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

04/09/2019    

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



From: Ira Baum, DPM


 


Dr. Solokoff made a reasonable assessment when he suggested reducing the hours spent on podiatric surgery and biomechanics and including hours in pediatrics, Ob-Gyn, and psychiatry that would enable a podiatrist to sit for the USMLE and COMPLEX examinations. That would enable those podiatrists seeking an MD/DO degree the ability to take those exams and receive those degrees. Then the adverse forces outside podiatry would be mitigated.


 


Ira Baum, DPM, Naples, FL

04/09/2019    

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



From: Leonard A. Levy, DPM, MPH


 



As we all know, preparation for podiatric medical practice today includes undergraduate podiatric medical education and, as part of a continuum, 3 years of residency training. Not too many years ago, the DPM completed podiatric medical school and perhaps a year of residency. As a result, education and training took just four years, and perhaps for a relatively small core of graduates, another year of training. Today, much more general medicine and surgery is a standard part of podiatric medical school which is significantly increased in the three years of residency that follows. 


 


But in spite of our greatly expanded education and training and the fact that there is virtually no difference in how we practice when compared to specialists in medicine such as ENTs, ophthalmologists, dermatologists, the recognition we receive is still considerably less. This lack of recognition often...


 


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


04/08/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Kudos to Amerx Health Care


From: Ted Mihok, DPM


 


We recently had a joint venture of Lions and Rotarians in Mexicali, Mexico. We had a clinic and work party on March 29-30. Amerx donated wound care products to help the uninsured population of Mexicali. I had the opportunity to spend some time with the assistant director of the General Hospital of Mexicali who was very grateful to Amerx for their kind donation. The dressings will be used in their wound care clinic and hospital. Special kudos to Jennifer Creel at Amerx for making this another blessed year.


 


Ted Mihok, DPM, Oak Harbor, WA

04/08/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Tilden H Sokoloff, DPM, MD


 


Kudos David Secord, DPM, you are so right on. You did go to medical school as did your classmate that you wrote about. You obtained a DPM and your colleague a DPM, MD. I too am a card-carrying AMA member and can agree with your conclusion 100%.


 


Let’s take your premise a step further. Today many medical schools (I am using that term as a collective for MD/DO education) are in a 3-year mode and based on PBL, problem-based learning. No more irrelevant 2 year basic science and two year clinical science. In fact, each problem teaches the anatomy, physiology, biochemistry, physiology as well as the clinical aspects of the presenting problem. This is the way your brain works when you approach a patient...


 


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

04/08/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Name Withheld


 


I am in full agreement and totally on board with asking for monetary compensation for chart recovery, copying, and preparation. I have been bombarded myself. You mentioned that your success rate is roughly 25% in getting paid $25 per chart. And I understood that you do NOT send any charts until payment has been made to you, which means 75% of requests are left unanswered. Have there been any negative or regrettable outcomes from any of the Medicare Advantage plans thus far? Correct me if I am wrong, but, as a participating podiatrist in many plans, we all signed and agreed to abide by the companies medical records requests or perhaps lose our participation status in that plan.


 


I pose this question to ALL who read this query. What are the ramifications of not answering these chart requests? Are there any legal, participation, or monetary penalties? 


 


Name Withheld 1

04/06/2019    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Medicare Advantage Plan Audits


 


It is that time of year again that a lot of podiatrists are receiving requests for charts from Medicare Advantage and other plans. As if we are not burdened enough with paperwork and jumping through hoops for insurance payments, these insurances are asking for patient charts for audits as required by Medicare. Companies such as Arro health, Inovalon, Ciox, are contracted by the insurance companies. They request doctors’ charts and gather information that can actually increase their fees from the contractors. They contact our offices via telephone or fax with their requests. The number of charts can range from a few to many. They are relentless in their efforts that borderlines on harassment.  


 


My solution to this big inconvenience is to fax them an invoice for $25 per chart. My invoice itemizes the charge as chart recovery, copying, and preparation. I will not send a chart without payment. I then put these requests in a file and send them if payment is received. I will not copy any patient charts until payment is sent. I have taken this inconvenience and turned it into a win/win situation. Most of the time, they do not pay (70%-80%), but when they do, I get paid for my time. You are entitled to get paid for this service, and you should!


 


Name Withheld
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