In 1995, when healthcare was transitioning to HMOs and capitation as forms of reimbursement, I was asked to speak on process re-engineering at a seminar sponsored by ConnectiCare, a relatively new HMO based in Connecticut. Prior to my lecture, I attended a presentation delivered by ConnectiCare’s Senior Vice President. As a way of pointing out the direction that healthcare was taking at the time, he opened his presentation with the following story about duck hunting:
Six doctors go duck hunting. When they spot a flock of ducks flying overhead, the internist steps up to take the first shot. Watching the ducks flying overhead, he states, “I can’t shoot at the ducks without first running a battery of tests to see if they are healthy.”
Enhanced by Podiatric Care
IMPROVED QUALITY OF LIFE an Outcome
By Jon A. Hultman, DPM, MBA, CVA
The radiologist then steps up to take his turn. Following the ducks with his rifle, he too fails to take a shot. When asked by the others why he wasn’t yet taking a shot, his reply was, “I need several views of the duck from multiple angles before I am comfortable taking a shot.”
The psychiatrist then steps forward without picking up his rifle, stating “We know it’s a duck, but I’m not certain if the duck knows it’s a duck. I would need to psychoanalyze the duck to be certain the duck knows it’s a duck before I can take a shot.”
As the surgeon steps up, he immediately fires his rifle. When the duck hits the ground, he turns to the pathologist and asks, “Can you take your microscope over to where the duck hit the ground and let me know if it’s a duck?”
The pathologist confirms that it was a duck
Finally, it’s the family doctor’s turn. He steps up and aims his rifle towards the ducks. He continues to follow them with his rifle until they fade from sight. Turning to the other doctors, he says, “You know, when you follow these things long enough, they just go away.”
It does not require a financial genius to understand that delaying treatment until medical problems “just go away“ is the least costly way to run healthcare, but this approach does not meet the quality standards which healthcare systems strive to achieve. When
on page 5
The Premier Provider of Podiatric Diagnostics Services
Onychomycosis
Both PAS and PCR based identification of pathogens provide precise diagnosis, optimizing patient outcomes.
Onychomycosis
Both PAS and PCR based identification of pathogens provide precise diagnosis, optimizing patient outcomes.
Wound Care
Podiatric Pathology
Histopathologic and histochemical examination of nail, skin, tissue, bone, and cytology.
Podiatric Pathology
Histopathologic and histochemical examination of nail, skin, tissue, bone and cytology.
Results within 24–48 hours. 3-5x more sensitive than culture. One of the largest organism & resistance gene panels available, providing clinicians a much broader spectrum of antibiotic choices.
Wound Care
ENFD Testing
ENFD testing is a valuable diagnostic tool for identifying the presence and severity of small fiber neuropathy which helps doctors provide optimal treatment solutions.
Results within 24-48 hours. 3-5x more sensitive than culture. One of the largest organism & resistance gene panels available, providing clinicians a much broader spectrum of antibiotic choices.
the goal of a healthcare system is to create not only lower costs, but also higher quality, everyone recognizes that prevention is the superior approach.
The costliest challenges in healthcare today are the many complications resulting from the large number of chronic conditions – conditions that practitioners strive to forestall or prevent. This is where podiatry has so much to offer – both in outcomes that lead to a higher quality of life for the patient as well as cost savings. Third Party Payers are familiar with the cost savings resulting from the prevention of diabetic ulcers as a result of podiatric care. They also recognize the value of timely treating existing ulcers prior to their progression to infection which often results in amputated limbs. Payers, however, are far less aware of another significant outcome of podiatric care – the improvement in their patients’ ability to walk which leads to a subsequent increase in their quality of life. This one lifestyle change to increased walking lessens many of the complications related to chronic diseases. Successfully achieving this one change in patient behavior will lead to decreases in total costs which the healthcare system is seeking.
In 2008, Rober Sallis, MD, touted the benefits of walking to California podiatric leaders at a session of CPMA’s Western Foot and Ankle Conference. At the time, he was president of the American College of Sports Medicine. Sallis was also the founder of Exercise is Medicine (EIM). This was a program launched in 2007 that encouraged doctors to write prescriptions for exercise. He felt that of all forms of exercise, walking was perhaps the best for everyone, especially as people aged. What got my attention was his
presentation of irrefutable evidence demonstrating that walking at a moderate pace for at least thirty minutes, five times a week, prevents both the primary causes and secondary complications stemming from conditions such as diabetes mellitus, cancer (breast and colon), hypertension, depression, osteoporosis, dementia, stroke, and cardiovascular disease. While many of these conditions are related to obesity, Dr. Sallis emphasized that for long-term health, it is better to be overweight and active than to be thin and sedentary. Podiatrists are uniquely positioned to help patients achieve Sallis’ goal of becoming and remaining active. In 2015, EIM expanded this evidence-based list of chronic diseases which are positively impacted by prescribing exercise as therapy. This expanded list of twenty-six conditions includes: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis), metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes), cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis), musculoskeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis), and cancer. Lessening the impact of these diseases increases the quality of life for these patients. Significantly, as long ago as 2008, Dr. Sallis determined that this 30 minutes of walking, five days a week, prevented the slow decline in functional capacity that often leads to nursing home admission – what not many feel to be the highest quality of life.
continued on page 7 ▶
A
Complete MIS Instrumentation System for Guided Trajectory and Fixation
MIS Trajectory Guide
Targeted precision for dialed-in K-wire placement
Beveled FT Screws
Increased cannulation allows for larger guidewires and reduced cortical skiving 3.5 mm 4.0 mm
Shifting Device
Use with the trajectory guide or alone to shift and maintain rotational correction
MIS Parallel Guide
Ergonomically designed for simple, accurate placement of secondary K-wires or complete construct
Clearly, when DPMs treat patients to resolve their foot and ankle pain or to correct deformities and enable them to wear shoes comfortably, they also increase those patients’ ability to walk and thereby improve their quality of life. What practitioners must recognize is that not everyone comes for podiatric treatment because they want to increase the amount that they walk. Likewise, patients who smoke and schedule appointments for medical concerns are not necessarily seeking reasons to quit smoking; however, it is their physician’s responsibility to educate these patients as to the potential future health problems caused by their smoking. In the same way, DPMs need to reinforce their patient’s knowledge of the negative impact of inactivity on their chronic conditions. It is also imperative that they educate them regarding the many health benefits of walking. Podiatric practitioners are in the ideal position to do this and to treat conditions that are keeping their patients from walking.
When DPMs are able to show evidence that one outcome of a podiatric visit is a patient who is motivated and able to increase his/her walking, they will be able to demonstrate the major cost savings associated with the list of chronic conditions that are lessened, or cured, by walking. Such evidence would clearly demonstrate the value of a podiatric visit and should increase the level of compensation
for podiatric treatment. Evidence-based outcomes can be supported by documenting the amount that each patient walks during his/her initial visit and then following up by having the patient record this information daily going forward. The doctor would need to discuss the benefits of walking and document any increase in the patients’ walking at each follow-up visit. DPMs who are able to present this type of evidence when negotiating third party contracts will be demonstrating that they offer higher quality visits. This will be a compelling approach for negotiating higher paying contracts –especially for larger groups because their potential for cost savings is magnified by the group’s size.
It is difficult to quantify the potential cost savings that could result from increased walking, but this number is substantial. It does not take a giant leap of faith to see how walking would have a positive impact on lessening obesity and its myriad of complications. In 2018, the CDC estimated that 42.4% of adults aged 20 and older are obese. In 2020, the U.S. adult population was 258.3 million. If 42.4% of this population were obese, this would equate to approximately 109,519,200 obese adults. The Milken Institute shows that the annual cost and economic impact of obesity in the United States exceeds $1.4 trillion. Many of the 26 chronic diseases listed by Exercise is Medicine are complications
continued on page 9 ▶
stemming from obesity, including diabetes type II and most of the cardiovascular diseases. If 18,000 DPMs could reduce this obese population by 10%, each DPM would potentially save the healthcare system close to $8 million. Similarly, if 30 minutes of walking, five days per week, can prevent a decline in functional capacity as people age, treatment that leads to increased walking would dramatically reduce the number of people requiring care in nursing homes. In 2022, there were 1.16 million seniors living in nursing homes at an approximate annual cost for each of $100,000. This puts the total cost of nursing home care at $116 billion. According to the Kaiser Family Foundation, Medicaid covers six in ten nursing home residents. Again, podiatric care could put a significant dent in these costs – something that should provide a compelling argument as to why podiatric services should no longer be an optional benefit under Medicaid. I will not try to quantify the potential cost savings for each disease on the list, but almost everywhere you look, there are
opportunities to demonstrate the unique monetary as well as lifestyle value of the services that DPMs provide. There is value in improving patients’ quality of life rather than just striving to maintain the status quo. This is what maintaining the ability to walk can provide. At the same time that the complications of chronic diseases are alleviated, substantial cost savings are generated for the healthcare industry. When DPMs perform surgery, provide biomechanic care, or deliver any form of medical care, fee-for-service reimburses them for that service. If they additionally are able to show that their medical group employs protocols that clearly lead to their patients increasing the amount they walk, those groups should be able to negotiate a higher level of payment for their visits. Given that every payer claims to prefer to pay doctors for performance, documentation of such positive patient results would demonstrate “performance,” making this type of “walking data” a good place to begin reimbursement negotiations.
D N'T DELAY!
BakoDx’s Web Space PCR Test can rapidly establish a diagnosis and help guide definitive therapy.
Web Space PCR Test
Addressing Poor Employee Performance: A PROACTIVE APPROACH
By Tina Del Buono, PMAC, XT
Ihave addressed this problem a few times before, but it seems that this is a problem that continuously presents itself. Every workplace experiences fluctuations in employee performance.
We all have days when we’re not at our best, but when underperformance becomes the norm rather than the exception, it can significantly impact the entire practice. For podiatric physicians and practice managers, addressing poor performance promptly is crucial—not only for maintaining efficiency but also for fostering a productive and engaged team.
The Impact of Poor Performance on The Team and Ultimately The Practice
Our practices thrive on teamwork. Each role, from front desk assistants to medical assistants and billing staff, is essential to providing excellent patient care. When one employee consistently underperforms, it affects not only their own responsibilities but also disrupts workflow, increases stress on co-workers, and can ultimately diminish patient satisfaction.
This might manifest as an assistant failing to properly
set up exam rooms, a front office team member not verifying insurance accurately, or a biller making repeated coding errors that lead to claim denials. Left unaddressed, these performance issues can result in delays, rework, and financial losses.
Even more concerning is the message that tolerating underperformance sends to the rest of the team. When standards slip for one employee, others may feel frustrated, leading to disengagement or resentment. Employees who consistently go above and beyond may question why they should continue putting in extra effort when others are not held accountable.
Why Practice Leaders Hesitate to Address Performance Issues
Many Physician business owners and their managers struggle with confronting poor performance. The hesitation often stems from one or more of the following:
• Avoiding Conflict: No one enjoys difficult conversations, and addressing performance issues can feel confrontational.
continued on page 13
ALL In 4 Podiatry
The California Podiatric Political Action Committee (CalPPAC) is the only CA PAC dedicated solely to the protection and support of California’s podiatric physicians, their patients and medical specialty. Help CalPPAC continue its critical role by donating TODAY. Simply scan the QR Code to the right; or go to calppac.square.site , or send your check (made payable to CalPPAC) to 7311 Greenhaven Drive, Ste. 208, Sacramento, CA 95831
Thank You!
• Time Constraints: Busy practices often lack the time to monitor employees closely and provide ongoing feedback.
• Hope That It Will Improve: Some managers prefer to ‘wait and see’ if the employee corrects the behavior on their own.
• Concerns About Employee Retention: In a tight labor market, managers may worry that addressing performance issues will push an employee to leave, making staffing shortages worse.
However, ignoring the issue hoping it will go away rarely leads to improvement, I know this from experience. Instead, it creates an environment where inconsistent work becomes acceptable, undermining the efficiency and reputation of the practice. Management stress and frustration can lead to multiple other undesired issues for the practice.
A Proactive Approach to Handling Poor Performance
To prevent underperformance from becoming a recurring issue, physician leaders, practice owners and managers should adopt a structured approach to addressing it. Here are five key instructional points to
develop your office policy and protocols in handling poor performance.
1. Address the Issue Early and Directly
The best time to address performance concerns is as soon as they arise. A simple, non-accusatory conversation can help uncover potential underlying causes. For example:
“I’ve noticed that you’ve been struggling with staying on top of patient benefit checks recently. Is everything okay?”
This approach opens the door for discussion. The employee may reveal that they are overwhelmed, struggling with a new system, or facing personal challenges. By identifying the root cause early, you can work together to find solutions before the issue escalates.
2. Be Specific and Objective
Avoid vague feedback such as “You need to do better.” Instead, provide concrete examples:
• “Over the past two weeks, I’ve noticed three instances where insurance verification wasn’t completed before patient check-in, causing delays.”
continued on page 14 ▶
• “Charting errors have increased recently, leading to confusion for the provider and billing team.”
• “You’ve been arriving late multiple times this month, which affects our ability to start the day smoothly.”
Specific feedback helps employees understand what needs improvement and prevents defensiveness.
3. Set Clear Expectations and Offer Support
After addressing the issue, clarify expectations moving forward:
“Moving forward, we need to ensure that all new patient paperwork is completed before their appointment time. Let’s set a plan to help you stay on top of this.”
If the employee needs additional training or resources, offer them. In many cases, poor performance is due to a lack of clear instruction rather than lack of effort.
If needed, provide written guidelines, checklists, or mentorship to reinforce expectations.
4. Follow Up and Provide Constructive Feedback
One conversation is not enough. Schedule a follow-up discussion to assess progress. If the issue persists, document the steps taken and escalate as necessary. Some employees may need additional coaching, while others may require a formal performance improvement plan.
5. Be Consistent in Holding All Employees Accountable
Consistency is key. Employees should see that performance standards apply to everyone, regardless of their tenure or role. If one employee is held accountable while others are not, it can create tension and lower morale.
Creating a High-Performance Culture in Your Practice
Beyond addressing individual performance issues, podiatric practices should foster a culture where high standards are expected and supported. This can be achieved through:
• Regular Performance Reviews: Conducting periodic check-ins allows for ongoing feedback rather than waiting for problems to escalate.
• Clear Job Descriptions and Policies: Employees should understand their responsibilities and the consequences of not meeting expectations.
• Recognition and Positive Reinforcement: Acknowledging employees who consistently perform well boosts morale and encourages others to follow suit.
• Encouraging Open Communication: Create an environment where employees feel comfortable discussing challenges before, they affect performance.
Consistency is Key
Addressing poor performance in a timely, structured, and fair manner is essential for maintaining a smooth-running podiatric practice. By setting clear expectations, offering support, and maintaining accountability, physicians and managers can ensure that their teams remain engaged, efficient, and committed to delivering excellent patient care. A proactive approach benefits not only individual employees but also the entire practice, leading to better outcomes for both staff and patients.
Tina Del Buono, PMAC, CPC Director Top Practices Virtual Practice Management Institute Consultant and Performance Coach
Tina Del Buono is a Practice Management Performance Coach, Consultant and Mentor for physicians and her fellow office managers/administrators and their staff. She has been a practice manager for over 25 years. Tina is the author of a National Indie Award Winning Book, “Truth from the Trenches” The Complete Guide to Creating A High-Performing, Inspired Medical Team.
Tina@Toppractices.com
4D ADVANCED BUNION CORRECTION RIGHT SOLUTIONS, FOR THE RIGHT REASONS.
Anatomical Design
Minimally invasive anatomical plate minimizes soft tissue disruption and allows for small 1-2cm medial incision.
Two Distal Screws
Allows for maximum stability of the capital fragment.
Compression Factor
Lag Screw compresses distal and proximal segments to promote faster bone healing.
Targeted Proximal Anchor Screw
Maximizes proximal stability to reduce torsion and pistoning.
Our proprietary arch allows surgeons to derotate and hold the sesamoids in their anatomically correct position under the Crista.
By turning the blue dial clockwise a surgeon is able to reduce the intermetatarsal (IM) angle.
The green screw allows a surgeon to adjust the planter/dorsal flexion of the first ray.
The gold dial allows a surgeon to compress or to distract the TMT joint.
REMINDER: DON’T FORGET TO CLAIM YOUR SHARE OF THE BCBS PROVIDER ANTITRUST SETTLEMENT
In 2024, a settlement was reached in a longrunning class action lawsuit against Blue Cross Blue Shield (BCBS) brought by physicians, hospitals, large health systems, and provider organizations. The lawsuit alleged a range of antitrust violations by BCBS, including price fixing and allocating markets using exclusive service areas.
Under the settlement agreement, Blue Cross and Blue Shield plans have agreed to implement changes that will benefit physicians and other providers by increasing transparency, efficiency, and accountability in claims processing, including the process of BlueCard claims. Economists have valued the injunctive relief at more than $17.3 billion.
If you or your business provided health care services, equipment or supplies to Blues Plan enrollees, including Anthem Blue Cross, Blue Shield of California or out-of-state Blue Card patients, anytime from July 24, 2008, to October 4, 2024, you may be eligible to submit a claim for your share of the $2.8 billion provider settlement. The settlement is the largest antitrust settlement in the history of the U.S. healthcare sector. The claims period is now open and will run until July 29, 2025. For more information, go to Blue Cross Blue Shield Provider Settlement FAQ at
https://www.bcbsprovidersettlement.com/Home/ Index
CMS GRANTS AUTOMATIC MIPS
EXCEPTION FOR CLINICIANS IMPACTED
BY CA WILDFIRES
CMS has recently announced that an automatic MIPS exception will be applied to MIPS-eligible
clinicians in designated counties of California in response to recent wildfires. These automatic exceptions will apply to both the 2024 and 2025 performance periods. MIPS-eligible clinicians in these areas will automatically receive a neutral payment adjustment for the 2026 and 2027 MIPS payment years unless they submit data on two or more performance categories for either/both performance years.
View the list of affected counties at www.fema.gov/ disaster/4856/designated-areas
MIPS Exemption Application Page https://qpp.cms.gov/mips/exception-applications Clinicians with questions can contact the Medicare Quality Payment Program at (866) 288-8292 or QPP@cms.hhs.gov
MEDICARE: JW/JZ MODIFIER DENIALSRESOLVED 03/18/25
Provider/Supplier Type(s) Impacted: All Reason Codes: Not applicable. Claim Coding Impact: Not applicable.
Description of Issue: Noridian is aware of a claims processing issue involving incorrect denials on procedure codes billed with the JW or JZ modifier. The incorrect denials were processed between February 20-February 26. The issue has been resolved, and impacted claims will be adjusted.
Noridian Action Required: The system update was completed on February 26 to correct the editing causing incorrect denials. Noridian will conduct a mass adjustment for claims denied in error.
Provider/Supplier Action Required: No action is required at this time.
Proposed Resolution/Solution: The system update was completed on February 26 to adjust the editing
causing the incorrect denials. Noridian will conduct a mass adjustment for claims denied in error.
03/14/25 - Noridian initiated mass adjustments on 03/11/25.
Date Reported: 02/28/25 | Date Resolved: 03/18/25
EEOC ISSUES DEI GUIDANCE
On March 19, 2025, the Equal Employment Opportunity Commission (EEOC) issued two technical assistance documents intended to educate the public about unlawful discrimination related to diversity, equity and inclusion (DEI) in the workplace — “What You Should Know About DEIRelated Discrimination at Work ” and “What to Do If You Experience Discrimination Related to DEI at Work.” These guidance documents follow President Donald Trump’s executive orders issued earlier this year, regarding DEI initiatives in the federal government and private sector.
These orders didn’t change Title VII of the Civil Rights Act or any other existing federal law, yet employers were left with some uncertainty regarding what constitutes “illegal” DEI.
Now, the EEOC’s new technical assistance documents shed some light on the subject, addressing, among other things:
• The scope of Title VII;
• What employees can do if they believe they experienced DEI-related discrimination at work; and
• Most importantly, when a DEI initiative may be unlawful under Title VII.
According to the EEOC, an employer’s DEI initiative, policy, program or practice may be unlawful if it involves an employer taking an employment action motivated — in whole or in part — by race, sex or another protected characteristic. This includes decisions such as hiring, firing,
promotions and demotions, fringe benefits, access to training, mentoring, sponsorship, workplace networks, internships, interview selection and work assignments.
Title VII also prohibits employers from “limiting, segregating, or classifying employees or applicants based on race, sex, or other protected characteristics in a way that affects their status or deprives them of employment opportunities,” according to the EEOC guidance. In the DEI context, “unlawful segregation can include limiting membership in workplace groups, such as Employee Resource Groups, Business Resource Groups, or other employee affinity groups, to certain protected groups.”
Additionally, separating workers into groups based on race, sex or another protected characteristic when administering DEI or any trainings, workplace programming or other privileges of employment, even if the separate groups receive the same programming content or amount of employer resources, may violate Title VII.
Furthermore, the EEOC clarified that employers can’t justify making employment decisions based on protected characteristics in the interest of diversity or equity as Title VII doesn’t contain any such exception.
The EEOC’s guidance isn’t news to employers — Title VII has long prohibited the types of programs and decisions described above. Nevertheless, the guidance did clear up some uncertainty created by the initial executive orders and provides some helpful examples. Employers with DEI initiatives should review the EEOC’s guidance and consult with legal counsel to ensure their programs comply with the law.
James W. Ward, J.D., Employment Law Subject Matter Expert/Legal Writer and Editor, CalChamber/
The California Division of Workers’ Compensation (DWC) recently updated its Official Medical Fee Schedule for Physician Services/Non-Physician Practitioner Services to conform to relevant 2025 changes in the Medicare payment system. The update is effective for dates of service on or after February 1, 2025.
The new fee schedule includes the following adjustments:
• Updated relative value units
• Updated CPT coding
• Updated conversion factors
• Updated National Correct Coding Initiative Edits
• Updated Table A – anesthesia conversion factors adjusted for Geographic Practice Cost Index localities
• Updated telehealth list
For more information, see the detailed explanation of the changes from DWC.
Questions can be directed to DWC at DWCFeeSchedule@dir.ca.gov.The order and related documents can be found on the DWC OMFS physician fee schedule webpage.
DMHC DIRECTS PLANS TO PROVIDE FLEXIBILITIES FOR PROVIDERS DISPLACED
BY SOCAL WILDFIRES
DMHC is requiring health plans to implement additional flexibilities for providers who were displaced by the devastating Southern California wildfires.
On March 19, 2025, the California Department of Managed Health Care (DMHC) issued an All Plan Letter (APL 25-005) directing its regulated health plans to provide specific flexibilities to providers who were displaced by the devastating wildfires in Los Angeles and Ventura counties earlier this year. The guidance requires plans to:
• Extend the duration of existing prior authorizations by 180 calendar days so providers can focus on providing care to enrollees rather than having to re-request prior authorization for previously authorized services.
• Extend the minimum timeframes for contracted and non-contracted providers to submit claims to at least 365 days from the date of service.
• If a plan believes it overpaid a provider, extend the minimum time for the provider to dispute the overpayment from 30 working days to 180 calendar days.
• For a period of at least 6 months from the date of the guidance, allow displaced providers to deliver care from appropriate alternative settings, such as mobile clinics or temporary locations.
• Create a public-facing wildfire resource webpage for providers to easily access information without needing to first log into the health plan’s provider portal.
While DMHC had previously issued an All Plan Letter (APL 25-001) directing health plans to ensure that patients have access to medically necessary care and prescription drugs, it only “encouraged” them to implement additional administrative flexibilities, such as relaxing requirements around prior authorization and extending claims filing deadlines.
The California Podiatric Medical Association (CPMA) had joined other stakeholders in urging DMHC to take additional steps to ensure that physician practices affected by the Southern California Wildfires can continue to deliver patient care without undue administrative obstacles or financial strain.
This latest APL requires plans to implement these flexibilities, and provide documentation to DMHC by April 21, 2025, showing that they are in compliance.
EDD: NEW REGS WILL REQUIRE DISABILITY INSURANCE CERTIFICATIONS TO BE FILED ELECTRONICALLY
Following recent changes to Title 22 of the California Code of Regulations (Section 2706-
4), medical providers will be required to file California State Disability Insurance (SDI) medical certifications electronically. The California Employment Development Department (EDD) has indicated that it is in the process of incorporating this new change into its systems. Until that process is complete, physicians should continue to submit SDI documents as usual.
CPMA will provide an update once the EDD systems have been updated. EDD will also publish regular updates on its website and through its newsletters, social media, and other outreach efforts.
For more information on the provider's role in certifying SDI claims, please visit edd.ca.gov/ disability.
CONSISTENT TREATMENT, DOCUMENTATION KEY TO REDUCING RETALIATION RISKS
An employee complained about workplace conditions but had ongoing performance issues before and after the complaint. Can I still discipline the employee despite the complaint?
Yes, you can discipline the employee for legitimate business reasons, such as poor performance, if doing so is unrelated to their making a complaint. You should take steps, however, to ensure your actions are fair and consistent, and don’t appear retaliatory.
• Avoid Retaliation
Retaliation occurs when an employer takes adverse employment action against an employee for exercising their rights under the law — otherwise known as a protected activity.
Protected activities include actions like reporting discrimination, harassment, wage issues or unsafe working
conditions. On the other hand, general complaints about workload or personal disagreements don’t typically qualify.
Accordingly, if your employee’s complaint was a protected activity, the risk of a disciplinary action being seen as retaliation is high.
To complicate matters, in California, as of January 1, 2024, any adverse action taken against an employee within 90 days of the employee’s protected activity is presumed to be retaliatory.
In other words, state law assumes that your disciplinary action taken after the employee complained is unlawful unless proven otherwise. You can overcome this presumption by demonstrating a legitimate, nonretaliatory reason for the action.
Therefore, although discipline is allowed within the 90-day window, your action requires careful consideration. A clear and consistent process, supported by detailed documentation, can help overcome the presumption of retaliation, which otherwise could result in costly litigation. Although avoiding retaliation is key, it is just as important to handle disciplinary actions consistently.
•
Consistency Is Critical
Apply your disciplinary policies consistently to all employees, regardless of whether they’ve made a complaint.
Following a consistent process may help you overcome any presumption of retaliation as well as complaints of disparate treatment from other employees.
One way to assess your motives is to ask yourself how you would treat other employees having
similar performance problems but who haven’t engaged in a protected activity. If you would issue a warning or start a performance improvement plan (PIP), do the same here. Treating an employee differently because of their complaint could be considered retaliation.
If other employees with similar performance issues have faced similar consequences, documented proof of consistent treatment can demonstrate further that your decision is based on performance, not the employee’s complaint.
• Documentation Is Key
If you haven’t already, start documenting every instance of an employee’s poor performance. Ideally, you want documentation showing that performance problems existed before the complaint. This establishes a clear record that disciplinary actions are due to ongoing issues, not the complaint itself.
Many employers overlook the importance of documenting performance issues from the start and end up documenting issues only after an employee complains. This can create the appearance of retaliation, as the timing of the documentation coming immediately after the complaint may seem suspicious.
To avoid bad timing, document issues as they arise to demonstrate that your actions are based on legitimate business reasons, not the employee’s protected activity.
If the employee’s performance issues continue after their complaint, continue to document those issues. Be specific about dates, instances and any efforts to help the employee improve.
Well-documented records can help show that you’re handling the situation fairly and consistently. Also consider whether any additional support, such as coaching or mentoring, might help the employee improve. Showing a genuine effort to help the employee succeed reinforces that any disciplinary action is based on performance rather than their complaint.
By being consistent, documenting thoroughly, and following a clear process, you can address performance issues while minimizing the risk of retaliation claims.
Vanessa M. Greene, J.D., Employment Law Subject Matter Expert, CalChamber/ March 13, 2025
REMINDER’ LICENSE RENEWAL FEES DEFERRED FOR LICENSEES IMPACTED BY SOCAL WILD FIRES
On January 29, 2025, Governor Gavin Newsom issued an executive order that postpones for one year renewal fees for Department of Consumer Affairs (DCA) licenses – which includes the Medical Board of California – that expire between January 1, 2025, and June 30, 2025, and whose residential or business address is within the impacted zip codes.
Upon renewal, eligible licenses will automatically renew with no payment due, with this year’s renewal fees automatically postponed to 2026. DCA has already identified expiring licenses with an address on file within the identified zip codes. For these licenses, the renewal system will automatically reflect that $0 is owed at the time of renewal. If you believe you are eligible to postpone payment of your renewal fees but are showing a balance due at renewal, contact the Podiatric Medical Board of California at pmbc@dca.ca.gov
The DCA Disaster Help Center is also available to help fire survivor licensees with other DCA-related questions at (800) 799-8314 or CAFires@dca. ca.gov
For more information, including answers to common questions, click here.
CPMA CO-SPONSORS BILLS WITH CMA FOR MORE ROBUST PRIOR AUTHORIZATION AND APPEALS REVIEW REFORMS
The California Podiatric Medical Association and the California Medical Association are Taking a Stand by Co-Sponsoring Legislation to Protect Patients in Calling for More Robust Prior Authorization and Appeals Review Reforms!
• AB 510 (Addis) requires health care plans to review appeals or grievances related to the denial, delay, or modification of services based on medical necessity by a provider specialized in the related field. These reviews must be completed within two business days or sooner if the enrollee's health is at risk. If the timeframes are not met, the request is deemed approved.
• AB 539 (Schiavo) is a crucial step toward ensuring the continuity of patient care. It mandates that prior authorizations granted by health care service plans or insurers remain valid for a minimum of one year from approval. This legislation addresses the current Knox-Keene Health Care Service Plan Act regulations and includes penalties for willful violations, thus enforcing compliance and potentially improving patient care continuity.
MAKING SENSE OF MINIMUM WAGE REQUIREMENTS
With different federal, state, local and industry-specific minimum wage requirements, how do I know if I am properly paying my California employees?
The first step to compliance is determining which minimum wage applies to your employees.
When it comes to your California employees, you won’t have to worry about the federal minimum wage — that’s because at $7.25
per hour, it’s substantially less than California’s required minimum wage.
When state and federal law differ, you must follow the law that is more protective of employees. The California state minimum wage is higher, so that is the rate that you must pay employees in California.
• California Minimum Wage
California’s minimum wage applies to all nonexempt (or hourly) employees in the state — unless, as discussed below, they are covered by a local ordinance or industry-specific minimum wage. California’s minimum wage is currently $16.50 per hour as of January 1, 2025.
• Industry-Specific
You also should confirm whether either of California’s industry-specific minimum wages apply to your employees. Currently, there are separate minimum wage requirements for certain fast food and health care workers.
The minimum wage for fast food workers is currently $20 per hour, and the minimum wage for health care workers varies from $18 to $23 depending on the type of health care facility in which they work. Does not apply to physicians’ groups (a medical practice or medical partnership) with less than 25 physicians.
If your employees are covered by either of these laws, they must be paid the higher, industryspecific minimum wage — not the state minimum wage.
• Local Ordinances
It’s important also to determine whether your employees work in cities or counties that have local minimum wage ordinances. The ordinances generally apply based on where your employees are working, not where your business is located. So, pay close attention to employees who are working away from your facilities, such as from their home or at client sites.
Once you have confirmed which minimum wage applies to your employees, ensure that employees currently are being paid at least that wage and then increase their pay as needed whenever the minimum wage increases.
Lastly, don’t forget about your exempt employees. The salary test for the executive, administrative, and professional exemptions is based on the California minimum wage and thus increases when the
minimum wage increases. The salary threshold in California is two times the state minimum wage. For 2025 this Is $16.50 per hour X is $16.50 per hour X 2,080 hours (the number of hours in a year for a full-time employee) X 2 = $68,640.
Simply paying an employee a salary does not make them exempt, nor does it change any requirements for compliance with wage and hour laws.
• Discretion and Independent Judgment
Most California employees who are classified as exempt customarily and regularly exercise discretion and independent judgment in their jobs. Discretion and independent judgment involve comparing and evaluating possible courses of action and making a decision after considering various possibilities.
Erika Barbara, Senior Employment Law Counsel, CalChamber/ February 26, 2025
Employers should consult with legal counsel regarding issues of compensation and other Human Resources issues. CPMA members with questions regarding employment and human resource issues please contact CPMA at (800) 794-8988 x4
Get YOUR Medical Assistant Trained to Take X-rays in YOUR Practice at a Fraction of the Cost with The California Podiatric Medical Association’s ONLINE, ON-DEMAND RADIOLOGY TRAINING PROGRAM ARE YOU COMPLIANT?
Medical Assistants (MAs/PMAs) MUST hold a valid California limited X-ray technician license IF they position the patient and or take x-rays in a medical practice. CPMA’s Limited License Radiology Training Program: For
Is Approved by the State of California Is Online, On-Demand and in YOUR Office Saves Time & Money Prepares Students to Sit for the State Exam
BETTER TOGETHER!
EXPERIENCING THE POWER OF MEMBERSHIP IS A WIN-WIN WITH CPMA'S BETTER TOGETHER - MEMBER GET A MEMBER!
This is your chance to be part of something bigger, to make a difference, and to reap the rewards of helping to grow your professional community.
CPMA’s current Experience the Power of Membership campaign is now a WIN-WIN for both current and future members! With BETTER TOGETHER, eligible new/reinstating members receive a 50% discount off their first year’s Association dues, and current members will receive $100 off their CPMA membership dues for each eligible new/ reinstating member that they successfully recruit during their next membership renewal period.
The California Podiatric Medical Association (CPMA) is the ONLY organization dedicated SOLELY to Advancing, Promoting, and Protecting California's doctors of podiatric medicine (DPMs), their patients, practices, and profession.
CPMA membership is more than just a membership; it's a strategic investment in your professional success. It's a partnership dedicated to supporting YOU, YOUR patients, YOUR practice, and YOUR practice rights in the face of continuing
challenges. These include ongoing threats to scope of practice and self-governance, increasing regulatory burdens, reductions in reimbursement rates, and fighting discriminatory policies and practices that negatively impact DPMs, their patients, practices, and medical specialties.
Furthermore, CPMA members gain access to comprehensive support, from help with hospital privileging and credentialing to assistance with billing and coding, legal help, regulatory compliance, free and reduced-cost educational programs, member discounts, and advocacy to safeguard practice rights, and to enable California’s Doctors of Podiatric Medicine to practice medicine to the fullest extent of their extensive and rigorous medical education and training. If CPMA Doesn't Do it, Who Will?
For more information, contact CPMA Membership services at memership@calpma.org
WE ARE STRONGER TOGETHER!
PRESIDENT
2024/2025 CPMA BOARD OF DIRECTORS
Phong H. Le, DPM Sacramento, CA 95828
PRESIDENT-ELECT
Arman A. Kirakosian, DPM San Francisco, CA 94121
IMMEDIATE PAST PRESIDENT
Diane Koshimune Guadron, DPM San Jose, CA 95119
SECRETARY-TREASURER
Heather R. McGuire, DPM Ventura, CA 93003
DIRECTORS
Yaseer Parupia, DPM Sacramento, CA 95825
David A. Pougatsch, DPM Beverly Hills, CA 90210
Thomas Rambacher, DPM Mission Viejo, CA 92692
Douglas M. Taylor, DPM Walnut Creek, CA 94596
Ebonie E. Vincent, DPM Long Beach, CA 90813
PARLIAMENTARIAN
Stephen C. Wan, DPM Rossmoor, CA 90720
EXECUTIVE DIRECTOR
Jon A. Hultman, DPM, MBA, CVA Sacramento, CA 95831
GENERAL COUNSEL
C. Keith Greer, Esq. San Diego, CA 92128
LEGISLATIVE COUNSEL
Ryan Spencer, MBA Sacramento, CA 95814
STUDENT REPRESENTATIVES
Carolyn Truong CPM @ SMU
Isaiah Claudio CPM @ WesternU
2024/2025 CPMA SOCIETY PRESIDENTS
ALAMEDA/CONTRA COSTA
Renee Woo, DPM San Leandro, CA 994578 (510) 614-5633
CENTRAL COAST
Frank Sturh, DPM Ventura, CA 93003 (805) 643-8572
CENTRAL VALLEY
Jack A. Harvey, DPM Manteca, CA 95336 (209) 823-2700
COACHELLA VALLEY
Kenneth K. Phillips, Jr., DPM Palm Desert, CA 92260 (760) 773-3338
INLAND
Jan Tepper, DPM Upland, CA 91786 (909) 920-0884
LOS ANGELES COUNTY
David A. Pougatsch, DPM Beverly Hills, CA 90210 (310) 919-4179
MID-STATE
Brandon J. Hawkins, DPM Bakersfield, CA (661) 832-1667
Cherrelle L. Nguyen, DPM Visalia, CA (559) 960-3426
NORTHERN CALIFORNIA KAISER
Christy King, DPM Oakland, CA 94611 (510) 813-3831
ORANGE COUNTY
Kyle Hehe, DPM Aliso Viejo, CA 92656 (949) 272-0007
REDWOOD EMPIRE
Rachel A. Hoyal, DPM Santa Rosa, CA 95404 (707) 546-2107
SACRAMENTO VALLEY
Christopher Galli, DPM Rocklin, CA 95677 (916) 961-3434
SAN DIEGO
Stephen Kriger, DPM Chula Vista, CA 91910 (619) 427-3481
SAN FRANCISCO/SAN MATEO
Bill Metaxas, DPM Burlingame, CA 94010 (650) 342-2420
SANTA CLARA VALLEY
Misha Tavaf, DPM Los Gatos, CA 95032 (408) 358-6234
SOUTHERN CALIFORNIA KAISER
Suzette Lee, DPM Los Angeles, CA 90066 (323) 857-4034
The California Podiatric Physician is the official publication of the California Podiatric Medical Association. CPMA and the California Podiatric Physician assume no responsibility for the statements, opinions and/ or treatments appearing in the articles under an authors’ name. For editorial or business information and advertising, contact California Podiatric Medical Association, 7311 Greenhaven Drive, Suite 208 Sacramento, CA 95831; Telephone, (916) 448-0248; Facsimile; (916) 448-0258; E-mail; cpma@calpma.org.
.smith-nephew.com
WELCOME BACK TO 100%
In-Person Meetings and Exhibits!
General Sessions offering 26 CECH for DPMs –get more for your money!
On-Demand Fluoroscopy course adding 4
fluoroscopy/radiology CECH included for all DPMs
Engaging Exhibit Hall with even more vendors to visit over 3 days, including hands-on Innovations Hub booths and Mobile Labs
Risk Management program for your PICA discount
2-Day program for Medical Assistants covering front and back office – 1 day administrative, 1 day of clinical hands-on training!
Brand new mobile app for an enhanced experienceno attendee login required!
