Query: Sterilization of Nail Nippers
If I am understanding the APMA Weekly Focus dated June 11 correctly, it suggests that we perform steam sterilization of nippers after each use. I have always used cold sterilization between patients with steam sterilization at the end of each day or after I accidentally cut a patient. It made it clear that this was a suggestion and not a standard of care. I wonder what my colleagues are doing.
Matthew B. Richins, DPM, Joplin, MO
Query: Opening a Cash-only, Non-surgical Foot Clinic
Four other retired DPMs and I are interested in opening a cash-only, non-surgical foot clinic (no insurance precerts/deductibles/co-payments) in a disadvantaged area of our urban community. Any advice would be appreciated.
Query: Source for Formaldehyde Products
I have been using Lazerformalyde and/or 10% Formadon for years for verruca plantaris. None of the pharmacies in my area have access to 10% formaldehyde or Lazerformalyde. Are there any other sources for this? Would there be any issue with me purchasing 10% buffered formaldehyde and dispensing it from my office?
Ira R. Cohen, DPM, Downey, CA
Query: CPR Certification for Staff
I am considering CPR certification for my entire staff. Do most private podiatry offices certify their staff? Are the podiatrists certified?
Olga Luepschen, DPM, Sebring, FL
Query: Are the Meet the Masters Podcasts Still Available?
I am a 2nd year student at CSPM. Recently, I noticed the Meet The Masters (Podiatric Success) website was down and I was unable to go back to listen to the old podcasts from other DPMs. I have listened to most of the episodes and it has allowed me to learn so much about the profession and how much progress has been made within the field.
In fact, one episode about the California's Physician and Surgeon Task Force is what convinced me to enroll in podiatry school and stay in California. It was also one of reasons which motivated me to run for the CPMA Student Representative position and be involved with the profession early on. My classmates have also benefitted from this podcast and has helped us realize the different paths that are available in this field and the work that needs to be done to help this field grow, such as student recruitment. Please advise.
Andrew Hu, CPMA Representative, Class of 2021
Response: From 2009-2017, I had the incredible opportunity to interview and host town hall discussions with over 500 of the most incredible DPMs in the world. Due to needed security Web issues, my IT partners took down the website and the audio downloading ability last month without my notice. I’m happy to report all 420 episodes are now available as a PodCast through Apple Podcast. I expect this to remain available for a few months, so for now, please consider downloading the series. There is zero cost as this is offered as a service to our great profession.
Bret Ribotsky, DPM, Boca Raton, FL
Query: Reason to Maintain License?
Is there any reason to maintain a license to practice if a podiatrist has sold his/her practice and: A) is not going to make enough money in side practice activities (assisted living patients, locum tenens, etc.) to pay for the license and malpractice, or B) is not planning on using the license even for activities like volunteer work. I have talked to 3 different podiatrists that are inactive in any type of practice who are maintaining their license and getting required CME "just in case". What is the consensus among other soon to be, or already retired podiatrists?
Query: Switching to VOIP
We use cable for our phone service provider which is bundled with Internet. Our office has had problems for about a year with dropped calls, both incoming and outgoing. All of these problems appear to be along the phone lines that the buildings share and are not internal phone line problems. I am thinking of making a switch to VOIP. Does anyone have experiences to share with this type of service?
John Scholl, DPM, Lady Lake, FL
Query: Ordering Lyme Disease Tests
The CDC has now confirmed that in the most recent available statistics, Pennsylvania, New Jersey, and New York rank the highest in the number of confirmed cases of Lyme disease. Based on this, it is probably advisable for podiatrists practicing in the above states to order a Lyme disease test when evaluating patients who present with joint pain and swelling.
Elliot Udell, DPM, Hicksville, NY
Query: Quality Metrics
I am part of a medium size multi-specialty group practice. As part of our ongoing commitment to quality improvement, all specialties are tasked with identifying, measuring, and meeting quality metrics. Examples include percentage of patients with BP below 140/90 or glycohemoglobin below 7 for primary care, or cholesterol screening for pediatric patients, etc. I am requesting suggestions for quality metrics for podiatry from my colleagues.
Nicholas Sol, DPM, Colorado Springs, CO
Query: EBM for Orthotics Coverage
I have been working with a local insurance company on getting custom molded orthotics covered as a benefit. They would like me to submit evidence-based research in support of using them for inflammatory conditions as well as preventing breakdown of pre-ulcerative calluses. They have submitted this request to me:
"We request that you send literature that covers all research, not just the literature that promotes a certain stance. We do not consider information such as promotional materials, product dossiers, review articles, and white papers. Since our medical policy is developed around evidence-based medicine, it is best to submit research articles from peer-reviewed, randomized controlled trials."
Has anyone ever successfully argued this position? Any information/insight about what articles are most supportive or demonstrate the effectiveness of custom molded orthotics would be appreciated. I am not trying to re-invent the wheel here and have spent considerable time on Pub Med looking for such articles.
Richard Silverstein, DPM, Havre de Grace, MD
Query: Pay Structure for New Associate
I am a solo podiatrist of 21 years. I have been blessed with a very busy and growing practice. I am currently building a new office large enough to accommodate two doctors. My question is in regard to how to pay the new associate. I know there are so many variables to consider so even just some general rules or formulas would be appreciated. For the sake of argument, let us assume this is a fresh 3-year trained resident graduating from their program and I would be paying their malpractice, CME, health insurance, and any other "normal" benefits.
What range of base salary is considered normal for a smaller southern city of a population around 100,000 people? For example would a $100K base salary based of a 40% split based off gross collections be a good starting point? (In this example, the new associate would have to collect $250K to break even, and then would keep 40% of the gross collections above $250K.) I am open for all suggestions. I would like to pay associates fairly, yet incentivize them to produce.
Query: Using a DPM Degree Outside of Podiatry
What else can I do with a “DPM” degree besides practice clinical medicine? Where else is the DPM recognized outside of our community? I have a bachelors degree in biology and then I went to podiatry school right out of undergrad. I’m feeling that practicing and seeing patients is perhaps not for me—at least full time. One of my true passions is to teach. I’m interested in seeking teaching opportunities at some of my local colleges and universities. Anyone else care to share their experience?
Editor's comment: You only go through life once, so you should always pursue your passion. Many academic institutions from high school level (NYC Public Schools, for example) on accept the DPM as post-graduate training.
Query: Creating a Facebook Page
I have had a website for several years, but I am considering creating a presence on Facebook. I would like to know if my colleagues who have Facebook pages have any tips or suggestions on setting up a practice Facebook page. Does it consume a lot of time adding content regularly? Has it proved to be a significant source of new patients (compared to print or other advertising)?
Mark Aldrich, DPM, Antigo, WI
Query: Source for Carbocaine
Can any reader direct me to a supply source for carbocaine 2% Plain 50ml bottle? All my supply sources say it is on backorder of unknown time.
Pete Harvey, DPM, Wichita Falls, TX
Query: Custom Shoes for Patients with Gout
I have a very unique diabetic patient who has the most severe case of tophaceous gout I have ever seen. The patient's hands are affected as well, so the use of laces is out. My question is: Are there any other custom shoe makers that can make a shoe for a really, really deformed foot in constant danger of ulceration, especially around the tophi?
A. James Fischer, DPM, Eureka, CA
Query: User-Friendly Billing Software
I am looking for billing software that can submit electronic claims to insurance companies, track accounts receivable, and print monthly statements for patients that need to be billed. It needs to be able to receive electronic EOBs and, if possible, have a function to check insurance benefits. I prefer to have software I can purchase and install on an office computer as opposed to a cloud-based platform. I am not interested in an EMR package. Does such a program exist that is reasonably priced?
Judd Davis, DPM, Colorado Springs, CO
Query: SMB Podiatry Services Billing
Can anyone give either positive or negative feedback as to their experience with SMB Podiatry Services Billing out of the Kansas City, MO area? I’m considering signing on to their company in the very near future.
Allan Freiberg, DPM, Metairie, LA
Query: Podiatry-Specific Insurance Billing and Collection Services
I would like to get recommendations from the profession on podiatry-specific insurance billing and collection services, specifically the pro and cons. Also I’d like to know what percentage of procedure codes are being rejected and has this gone up in the past few years?
Allan Freiberg, DPM, Metairie, LA
Query: Axolotl Biologics
I have to assume that many of you have clicked on the PM News advertisement for Regenerative Treatment. The company is based out of Arizona. Have any of you had any experience with the injectable form of this product including results, using with or without PRP, with or without ultrasound guidance, patient interest, etc.? This is a very intriguing time for all of us and a modality such as this, if successful, could change the way we treat many injuries, acute and mostly chronic. I curiously await your feedback.
David Kahan, DPM, Sacramento, CA
Query: Yearly Diabetic Foot Exams
I've been in solo practice just under 6 years, and I was hoping for some clarity on the issue of yearly diabetic foot exams for people with diabetes but no concurrent foot issues. I have heard back and forth from different voices in the podiatry world giving conflicting opinions. What is the answer?
I have read Dr. Jacobs recent post about the 2019 ADA guidelines but would still appreciate further advice and direction as it relates to scheduling diabetic patients on a yearly basis with no foot complaints/problems; they just have diabetes.
Jeff Merrill, DPM, Klamath Falls, OR
Query: How to Check Patients’ Deductible Status
Is there a free or inexpensive way to check patient deductibles before services rendered (especially Medicare and Horizon)?
John Moglia, DPM, Berkeley Hts, NJ
Query: Wound Care Clinics
I'm looking for advice regarding out-patient wound care clinics, specifically: type of procedures performed; which types of products/biologics make the most sense to have on hand; the most common modalities utilized; and protocol recommendations.
S. Jeffrey Siegel, DPM, Bradenton, FL