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01/13/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Elliot Udell, DPM, Vladimir Gertsik, DPM


 


There are some less expensive programs you can buy to e-prescribe. One is Veradigm.com. It’s part of Allscripts. They have plans that range from 9 to 18 dollars a month. There are other programs as well. Check them all out. 


 


Elliot Udell, DPM, Hicksville, NY


 


For those who are near retirement, you can ask your state for exemption. Go to their website and try to find it.


 


Vladimir Gertsik, DPM, NY, NY

Other messages in this thread:


09/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Jane E. Graebner, DPM


 



One solution I have initiated in my office is creating a position called New Patient Coordinator. One of my 70+ year old employees whose only job prior to COVID-19 was visiting referral physician offices wanted to only work from home. Her duty is to call every new patient (or new problem which is someone who has been to our practice before but not recently and has a new foot/ankle problem) who are booked for one hour in our practice (1/2 hour with staff member and 1/2 hour with provider). She covers things like:


1) COVID-19 questions


2) Office location


3) Insurance coverage (to make sure we are in-network)


4) Referral source


5) Name they would like to be called


6) How they are completing their paperwork (i.e. portal, mailed, printed from website)


7) Confirming they are really a new patient (i.e. never been treated in our practice prior to this)


 


She even calls NPs after their first visit (within a week) and asks if they understand their treatment plan, etc. which gives us feedback about how we are doing. So far, this experiment has been good. Although the no show rate has not been lowered (which was my primary goal), the use of our portal has increased to 50% and the number of NPs who show up at time of appointment without any paperwork filled out has diminished as well, which helps keep us on schedule. You might want to try this for your practice.  


 


Jane E. Graebner, DPM, Delaware, OH


09/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Keith L. Gurnick, DPM


 


Some, but not all patients have little respect for doctors and your time and office space commitment to them. If you force patients to give you an upfront "scheduling" deposit on their credit card and then they do not show up, too many of them will send in a dispute to their credit card company who will almost always side in favor of the patient and refund the money you took as a deposit. Credit card companies almost always side with the cardholder. That is just the way it works, and it just isn't worth the time or trouble to do what you are suggesting.


 


If you want to charge for "no shows", then you should do it the old fashion way. Simply post your policy in your office reception room, and also include it with your new patient intake paper work and also any mailings to patients. Inform your patients in advance on the phone when they schedule, and enforce your policy by sending a reasonable bill for the "no shows" or late cancellations, and enforce your policy by collecting the money.


 


Keith L. Gurnick, DPM, Los Angeles, CA

09/29/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: George Jacobson, DPM


 


We have had this discussion before, but now with volunarily seeing fewer patients per hour, the "No Show" new patients make it harder to recover from this financial disaster. After being closed for 4.5 months due to the lockdown and then open-heart surgery, I began seeing patients 3 weeks ago. We have many 80 to 100-year-old at high risk patients who stayed shut in since March. We referred others and new patients to colleagues. 


 


It's like starting over again, 37 years later, but we have a small base of patients versus zero. I don't recall patients being so rude as to not show up for appointments or not calling if they...


 


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

09/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Proposed Outpatient Prospective Payment System


From: Joseph Borreggine, DPM


 


The new proposed Outpatient Prospective Payment System (OPPS) rule is out. It looks like CMS is pushing ahead with its changes in how to document and determine E&M levels (No more H+P component, Medical decision-making DM, and time only) as well as significantly increasing reimbursement for office based E&Ms. Due to budget neutrality though, this increase is offset by an across the board decrease in the conversion factor of about 11%. This is going to result in a significant decrease in fees for many procedures which will include the routine foot care codes that are used quite frequently by podiatrists. If this proposed fee scheduled is approved, then the financial impact will be catastrophic. 


 


It is my understanding that the APMA is planning to make a comment to CMS on behalf of the profession. However, they will be just one comment that will provide a global statement with respect to the negative financial consequences it will have on the profession. Moreover, every podiatrist needs to consider leaving a comment on this proposed CMS fee schedule change. 


 


The more comments that are provided from this profession to CMS on this issue, the greater the chance that CMS may reverse their decision. Here is the link to do soPlease don't neglect this. Share it with friends and colleagues. These cuts could impact every specialty. It's not just our payments that would be jeopardized. The care received by our friends and families would also be at risk.


 


Joseph Borreggine, DPM, Port Charlotte, FL

09/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Cigna Policy on NY Regulatory Restrictions on Balance Billing For PPE


From: Steve Abraham, DPM


 


From Cigna: “Effective August 5, 2020, the State of New York implemented a mandate that healthcare entities, such as Cigna, are required to notify participating providers that they should not charge our customers any fees for protective personal equipment (PPE) that exceed that customer’s normal financial responsibility.


 


Accordingly, if such fees are charged, Cigna is obligated to recoup those fees on behalf of the customer. If you have charged a Cigna customer for any PPE-related fees, we request that you immediately reimburse that customer for any funds that exceed their normal financial responsibility.


 


If a customer notifies Cigna of balance billing for PPE by a participating provider, a complaint will be filed on behalf of the customer and a Cigna representative will contact the treating office to seek reimbursement.”


 


Steve Abraham, DPM, NY, NY

09/25/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Marty Wendelken, DPM


 


You will on rare occasions find an insurance company that will require some certification/accreditation. In NJ, there is one such insurance company that requires it for everyone. For that company, I assisted a DPM in becoming accredited through the AIUM (American Institute of Ultrasound in Medicine). There, of course, is a cost to that charged by the AIUM, but it really was not a difficult process.  After that was completed, there was no problem. 


 


Disclosure: I teach and train DPMs on MSK ultrasound for 2020 Imaging. 


 


Marty Wendelken, DPM, Elmwood Park, NJ

09/24/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



rom Ron Werter DPM


 


Dr. Moglia asked about the certification process for us as podiatrists to get certified for insurance companies such as Oxford and Cigna which require a certification. A few years ago, I checked about this and I found it is possible, but you first need to take a general course in sonography which covers the entire body. The course cost about $1,000 and then take the certification exam which also then cost about $1,000 at that time.


 


Since the other insurance companies at that time were paying about $35 for a CPT 76882 and $75 for a CPT 76881, I didn't think it was worth either the time or money to get paid from the few insurance companies that required the extra step. If I have a patient with insurance that I know does not pay, I tell them such, explain my reasons for needing the test, and charge them a reasonable, (both for me and the patient) fee. If they don't want to do that, I will refer them to the local radiologist and have them return another day for a follow-up appointment.


 


Ron Werter, DPM, NY, NY

09/17/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Alan Bass, DPM


 


Conferences such as the New York Clinical Conference and the APMA National Meeting offer one day sessions on some of the hot topics on billing and coding. In addition to those, the American Academy of Podiatric Practice Management (AAPPM) has meetings throughout the year that have tracks on billing and coding.


 


Disclosure: I am a Board Member of AAPPM.


 


Alan Bass, DPM, Manalapan, NJ

09/16/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Jim Rief


 


Gill Podiatry Supply Company has both manual and automatic processor solutions in stock. 


 


Jim Rief, Gill Podiatry – Sales

09/11/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Richard A. Simmons, DPM, Daniel D. Michaels, DPM, MS


 


I did not think anyone was still using instrument trays. I have 20 sets of routine care instruments that are autoclaved sometimes twice daily as needed. On rare occasions, instruments are flash-sterilized in the autoclave. When the lid on this closes, the instrument with contaminated debris goes back into a solution. I doubt anyone would put glutaraldehyde into one of these (OSHA), but I can not think of anything that could sterilize an instrument between patient changes in a treatment room. That might be why you are having a difficult time finding a replacement.


 


Richard A. Simmons, DPM,  Rockledge, FL


 


Dr. Weiss, I have a 12-step program to help you get over your addiction to these trays! Perhaps it is time to upgrade your practice by sterilizing all of your instruments. I have done this since starting my practice in 2004 with everything we use. It is safer for me, my staff, and patients. Given our current pandemic situation, it is most likely the right direction to go. It is either sterile, or not sterile!


 


Daniel D. Michaels, DPM, MS, Frederick and Hagerstown, MD

09/10/2020    

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



From: Ben Cullen, DPM


 


I respectfully disagree with Dr. Gurnick. Not only is a mini-tightrope exceedingly difficult for an MPJ, if the underlying boney deformity is not addressed, it will do nothing for the long-term outcome. The 2nd and 3rd metatarsals are both elongated and medially angulated in this patient, causing the lateral deviation of the toes. Correctional osteotomies of the second/third metatarsal are necessary. This can be done distally with a translational Weil.


 


Although the metatarsal head may end up appearing laterally angulated to achieve the correction necessary, the digit will maintain it's position in the transverse position, and weight-bearing may be initiated sooner than with a proximal osteotomy.


 


Ben Cullen, DPM, San Diego, CA

09/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Susan K. Claffey


 


The American Association of Colleges of Podiatric Medicine (AACPM) operates the Central Application Service for Podiatric Residencies (CASPR) application and matching process. In a nutshell, here is how it works.


 


Podiatric medical applicants and programs register to participate in the CASPR residency application and matching program. Applicants apply to residency programs, and programs evaluate their applicants. Programs grant selected applicants an interview. After all evaluations and interviews are complete, each applicant submits a list of desired programs in numerical order of preference (first choice, second choice, etc.)—rank order list. Similarly, each program also submits to CASPR a rank order list of desired applicants.


 


No direct offers of residencies are made by programs. The CASPR match process takes the rank order lists submitted by applicants and programs and applies a fair and unbiased algorithm to place applicants into residency positions. The algorithm ensures that both applicants and programs receive the best placements possible.


 


Susan K. Claffey, Director, Office of Graduate Services, AACPM

09/08/2020    

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



From: Richard A. Simmons, DPM


 



Dr. Ricketti asks why more podiatrists are not using the Phenol EZ Swabs for P&As. I rarely do P&As anymore since my practice consists primarily of terminal hospice patients. Initially, it looks like the EZ Swabs are expensive; however, here’s another twist. Over the past few years, when I attended risk management lectures, the attorneys who have spoken tell us about the need for everything in the office to have an expiration date on it and to remove everything from the office whose expiration date has come and gone. If I remember the lecture correctly, once any bottle is opened, it immediately has an expiration date of 30-days.


 


If OSHA shows up at your office at 8 a.m., by law, they have to be allowed access. Attorneys are now representing physicians facing tens of thousands of dollars of fines for unmarked/non-dated products (injectables, creams, lotions, etc.) that are commonly used. So, if you have a disgruntled employee who you recently fired, they can get money by being a whistle-blower. The last lecture I heard about this was put on by the Academy of Continuing Podiatric Medical Education, August 29, 2019.


 


Richard A. Simmons, DPM, Rockledge, FL


09/08/2020    

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



From: Jay Kerner, DPM, Judd Davis, DPM


 


Thank you, Dr. Ricketti, for your phenol EZ Swabs. I’ve been using them for years and haven’t looked back.


 


Jay Kerner, DPM, Rockville Centre, NY


 


I contacted the manufacturer of our phenol years ago to find out how long it lasts since there was no expiration on the bottle. We were told that phenol really does not degrade if stored properly in a dark cabinet. I can confirm that it is effective for years as I've had several patients return for other foot issues after undergoing matrixectomies with it, and had no evidence of regrowth. I caution that if you buy it through a local compounding pharmacy, it may not have the same longevity though. I previously used some sodium hydroxide from a local pharmacy that was effective for no more than one month after it was made up, so I switched back to phenol.


 


Judd Davis, DPM, Colorado Springs, CO

09/08/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jack Ressler, DPM


 


For many years, we’ve been purging x-ray film in our office, and we found less and less companies even wanting old x-ray film, let alone paying you for the silver content. The fact that a certified company would come out to our office and take the film for free and legally dispose of it was more valuable than rarely finding a company that would pay you for the silver content.


 


Jack Ressler,  DPM, Delray Beach, FL

09/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Steven R Kravitz, DPM


 


There's no doubt that the virtual Zoom-type meetings have replaced relatively well the previous live presentations that were standard prior to the COVID-19. Going forward it's my suspicion, as a meeting planner as well as a lecturer, that some form of virtual continuing education will continue after the COVID-19 crisis. There are definite advantages to these venues as pointed out in the article by Dr. Udell.


 


However, I also strongly suspect that live conferences will return. There's a difference when watching a theatrical performance that's recorded live even when... 


 


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

09/07/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: Source for Phenol? (Jane E. Graebner, DPM)


From: Mark Stempler, DPM, Jim Ricketti, DPM


 


I recently bought a large bottle of phenol only to find out that it is not considered medical grade. I then ordered a large bottle from Schein Medical.


 


Mark Stempler, DPM, Staten Island, NY


 


Why is anyone not using my Phenol EZ Swabs for P&As? A bottle of phenol does not last, and the cost versus the ease of Pheno EZ Swabs are a no-brainer.


 


Disclosure: I am the inventor of the Swabs


 


Jim Ricketti, DPM, Hamilton Sq, NJ

09/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Robert Scott Steinberg, DPM


 


Dr. Rosenblatt changed the subject a bit, to one about his impression that the lack of in-person interaction is having a negative effect on our health. I feel that is an exaggeration. I have been using the Internet for social networking since 1999. In 2005, I began using video conferencing for my Internet international Rotary Club meetings. We had members from Madagascar, Italy, Germany, Portugal, Sweden, UK, and the U.S. Quickly, it took on the feel of in-person meetings.


 


Since March, much of my life has been via Zoom. Hospital MEC and credentials meetings are via Zoom. They have proved far more efficient. My Rotary Club is also using Zoom. We have guests join us from all over the world, and it feels normal. I love to go to meetings, but I am not going to be able to do that safely. I choose to make the most of new opportunities. My point: it's about one's attitude. Make the most of what you have. We are physicians. We can think rationally about the situation in which we find ourselves.


 


Robert Scott Steinberg, DPM, Schaumburg, IL

09/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Richard D Wolff, DPM, Keith L. Gurnick, DPM


 


Sun Pure Botanicals has 90% liquefied phenol 4 oz. for $34.57. I have no affiliation with this company.


 


Richard D Wolff, DPM, Oregon, OH


 


I purchased a 500 cc. bottle from Sigma-Aldrich Co. of St. Louis one month ago. It arrived very well packaged, well insulated in a box, and inside a protected metal can. I did some research and got lucky. I found their website and ordered off of it paying with a credit card. The price seemed really good to me. 


 


P9346-500ML Estimated to ship on 09/30/20   500 mL  $92.70


P9346-100ML Available to ship on 09/02/20 -  100 mL   $39.30


 


Keith L. Gurnick, DPM, Los Angeles, CA

09/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Robert S. Schwartz, CPed


 


To accomplish your goal, consider adding a lateral flare and buttress to his/her footwear. High-tops work best. Lateral stability is hard to achieve even in an Arizona AFO unless there is extra lateral support. Elevate for equinus conditions. And don't forget about rocker-soles for limited sagittal plane motion. Shoe inserts play a big role, as well.


 


Robert S. Schwartz, CPed, NY, NY

09/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 3



From: Michael L. Brody, DPM


 



CME Online has partnered with a number of organizations to provide online seminars. Those organizations include The International Foot and Ankle Federation, The New York College of Podiatric Medicine, Dermfoot, The Ohio, Missouri, Minnesota, Kansas, Colorado, Tennessee, Iowa, Nebraska, Georgia, and California Podiatric Medical Associations, and ACLES, as well as broadcasting our own events. Some of these events are one hour weekday evening events, others are half-day events on weekend mornings, and others are multi-day events. We have had events with starting times that align with Eastern, Central, Mountain, and Pacific time zones.


 


There have been events that should align with most podiatrists' time needs. In addition, the events for California, Missouri, and NYCPM were recorded and...


 


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


09/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Michael M. Rosenblatt, DPM


 


The COVID-19 crisis has unmasked a serious threat to our business travel world and has raised the question: “Is there more to life than bandwidth?” We recently "attended" a Zoom Bar Mitzvah of a son of a family member and the reception kept blinking on and off. The sound was poor and we could often not hear the participants. Some reception was very good, but you could never predict it.


 


I know there will be some who say that they use Zoom all the time and that it is excellent. Perhaps. But even if it is good, it begs the question: “Is fellowship and human interaction doomed to... 


 


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

09/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Pete Harvey, DPM, Howard R. Fox, DPM, Carla Ross


 


I have always had my local pharmacy mix fresh 88% phenol which I replace every 2 months. The solution should always be almost clear and not yellowish.


 


Pete Harvey, DPM, Wichita Falls, TX 


 


Fisher Scientific has 99% phenol crystals in bottles of 100g or 500g. You’ll need to fax them your state license and a letter on your letterhead of your intended use. It ships by freight (corrosive).


 


Howard R. Fox, DPM, Staten Island, NY


 


Phenol can be ordered directly from Medisca:


 


MFG Item # Item Description Pack Quantity Price


38779193805 PHENOL LIQUID USP (LIQUEFIED) BO 100 $12.35


38779193808 PHENOL LIQUID USP (LIQUEFIED) BO 495 $34.40


 


Carla Ross, Talar Medical

09/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Rahn A. Ravenell, DPM


 


The Podiatry Institute is offering hybrid conferences, virtual conferences, and virtual short courses. The virtual conferences are on Saturday mornings starting at 10am EST so as to not have West Coast colleagues waking up too early. These offer 5 hours of CECH each and are held monthly, with the next being on September 19th (the first occurred in August). On demand courses are being worked on, but have not been fully set up yet.


 


Disclosure: I am Immediate Past Chairman, Podiatry Institute BOD


 


Rahn A. Ravenell, DPM, Charleston, SC

09/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Elliot Udell, DPM


 


Not having to travel for seminars and not having to rent space for seminar conference space, paints a rosy picture of all of us paying less for our continuing education seminars. Having just attended and lectured at a virtual seminar, I can vouch that as a participant, I was able to hear the speakers better than had I been to an in person seminar. I was also more comfortable sitting in the chair I am now sitting at than some moldy chair in some far away hotel. 


 


There is, however, another side to this issue. We are all linked in our economy, and hotels - even resort hotels - are dependent upon convention business to survive. If  post-COVID-19 conventions find that Zoom or "Go To Meetings" seminars make more sense than live seminars, we can expect many resorts to go under in the years to come. 


 


Elliot Udell, DPM, Hicksville, NY
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