California Podiatric Physician April/May/June 2013

California Podiatric Physician The

a p r i l | m ay | j u n e | 2013

western foot and ankle conference

june 20 – 23, 2013 disneyland hotel & convention center anaheim, california

THE

PRESIDENT’S MESSAGE

“A project well begun is half done.”

Aristole as i write this, my last president’s message to you, i realize you will read it at very nearly the end of my term.

2013

i contemplate the past year and necessarily evaluate whether our Cpma BOD, and i personally, have met our goals as stated last june.

registration

visit TheWestern.org for more information and to register online

brochure

2430 K Street • Suite 200 • Sacramento, CA 95816 • (800) 794-8988

SEE PAGE 7 FoR THE WESTERN 2013 REGISTRATIoN DETAIlS!

There is a wonderful old story that is told about a stone mason working alongside his young son on the foundation of notre Dame Cathedral. as we know, notre Dame took generations to build. The man is assiduous and happy in his work as he places each stone with loving care, all to the puzzlement of his son. The son asks, “How can you work so diligently and happily on this cathedral that you will never see completed? That you will never enter or enjoy?”

See PRESIDENT’S MESSAGE on Page 65

lEAN INTo lEARNING AND FuN AT THE 2013 WESTERN FooT AND ANklE CoNFERENCE Just as the specialty of podiatric medicine evolves, so does The Western Foot and Ankle Conference as one of the largest podiatric medical conferences in the country, The Western is a premier program, which provides countless opportunities to stay engaged and to be inspired. See the most-upto-date clinical and technological advancements in surgery, medicine and management. learn the latest must knows to keep your practice compliant. Stroll the vibrant exhibition hall featuring more than 150 companies showingcasing the latest in modern medical technology, products and services, which will allow attendees to stay ahead of the curve. Come stimulate your mind with a myriad of CeCH opportunities covering all aspects of podiatric medical practice from regulatory requirements to innovative instructional courses, dynamic lectures and cutting-edge hands-on workshops. renew old friendships and make new ones. and take the family to “The Happiest place on earth”, Disneyland, where perennial favorites will be joined by exciting new rides, shows and exhibits including the new Iron Man Tech Exhibit by Stark Industries.

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Unplug and Reboot

- In This Issue -

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California Radiological Update 2.0 Neil MaNsdorf, dPM

24

It’s Déjá Vu All Over Again

JoN HultMaN, dPM, MBa

35

Workplace Humor

tiNa del BouNo, PMaC

46

Annual Health Policy Report

fraNkliN kase, dPM

67

CURRENT LEGAL ISSUES C. keitH Greer, esq.

Have you seen our bells and whistles?

Keeping in touch with PICA is easier than ever.

Information is only useful when it relates to you. That is why PICA’s information is custom-tailored to podiatrists.

• Online account management • Webinars and online lectures • Customizable sample forms available on our website • E-communications delivered to your inbox • Podiatry-focused information from PICA available 24/7

Contact us today to get a medical professional liability insurance quote or find us online to learn more.

www.picagroup.com • (800) 251-5727

PICA is proud to be exclusively endorsed by the California Podiatric Medical Association.

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i a t i o n i am looking fo rward to seeing you at the 2013 (The Western), Western Foot june 20-23 at th and Ankle Con e Disneyland H ference otel in anaheim The Western Sc ience and educ , California. at ion Committee featuring a wid e array of the m has planned an ost up-to-date outstanding pro techniques and surgery, medicin gram trends to enhan e an d managemen ce your skills an t topics, in particular, i w d services. ould like to rem ind Cpma mem program: The Ju bers of the PICA ry’s Out – The A risk managemen natomy of a Po 22*. if you are a diatric Malpract t piCa policyhold ic e Trial on Saturd er and a Cpma mem discount on yo ay ur piCa policy p , june b er , you can receiv remium at your well as receivin e up to a 15 per next renewal b g 1.5 Ce contact cent y attending this hours. if you hav cent discount b p ro g ra e m al y attending anot ready received as piCa’s standard her program or members can re 10 per by purchasing a ceive an additio home study co nal 5 per cent (fo piCa program at urse, Cpma r a total of 15 p this year’s Weste er ce rn n . t) b y at tending the piCa’s enhance d discount prog ram is available endorsement ag to Cpma memb reement with th ers through its e California pod addition to offer exclusive ia tric medical ass ing the discoun ociation (Cpma t to policyholder significantly to ). in s, piCa’s generou our association s sponsorship co . This source of its activities and non-dues incom ntributes programs like Th e helps suppor e Western – the west of the mis t Cpma and largest podiatric sissippi – and on program and ex e of the nation’s management p hibition premier podiatr rograms. ic surgery, med icine and The 2013 Weste rn will feature 2 5 PLUS CE con hours for both tact hours, includ doctors and assi st ing X-ray Cme co ants; vital inform hands-on surgic ntact ation on billing, al workshops; in coding and com novative instruct lectures; a dynam p lie io nce, n al courses; excitin ic 3-day assistan ts’ program cove g cutting-edge well as a world-c ring both the fr lass exhibit hall ont and back offi featuring the la medicine and m ce, as test tools and te anagement. chnologies in m odern Western confere nce goers will en resort hotels, as joy substantially well as significa reduced room rates at Disneyla nt savings on p California Adve ar nd k p nture theme par asses to both D isneyland and ks .! i look forward to Disney’s seeing you ther e!

Thank you,

2430 K Street

Suite 200

Sacramento

California

95816

fon 916/448.0 248 800/794.8988 fax 916/448.02 58

web www.ca polpm diatri a.osts rg.org

Karen Wrubel, D pm president

*PICA Program attendees MUST register to atte in with the PICA nd the Western representative general meeting s onsite during , AND MUST si the PICA progra gn m to receive th e extra discount .

a p r i l | m ay | j u n e | 2013

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uNPluG, uNWIND, RElAx AND REbooT WITH FAMIly, With three distinct hotels, each with its own unique sparkling pool; the dynamic, vibrant entertainment district Downtown Disney that connects the hotels via a lively promenade to both Disney theme parks – California adventure and Disneyland, the Disneyland resort is a true destination location.

Western conference attendees will enjoy deep discounts off the resort’s hotels room rates, as well as substantial savings on tickets to Disney’s California adventure and Disneyland theme parks.

So, come on and lean into learning, fun, and savings during the 2013 Western foot and ankle Conference at the Disneyland resort june 20-23.

Meet your favorite Disney Princess

Sit back and relax on the Monorail

Rockin’ Princess Tiana

Disneyland Hotel Pool

Character Dining

Practically perfect Mary Poppins & bert 4|

The Jazz kitchen

Mandera Spa C p m a | C a l i f O r n i a p O D i aT r i C m e D i C a l a S S O C i aT i O n

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FRIENDS AND FuN AT THE DISNEylAND RESoRT

Mickey and the Gang

Rainforest Cafe

Disney Nightlife

Strolling in Downtown Disney

Private Cabana by the Pool

lego Store Romantic Dinners a p r i l | m ay | j u n e | 2013

Visit The leGO® Store at the Downtown Disney - it’s the second largest lego Store in the country. | 5

western foot and ankle conference

june 20 – 23, 2013 disneyland hotel & convention center anaheim, california

2013 visit TheWestern.org for more information and to register online

registration

brochure

2430 K Street • Suite 200 • Sacramento, CA 95816 • (800) 794-8988

to attend the MUST-SEE C.E. meeting of the year,

The Western!

Join us this year at the award winning Western Foot and Ankle Conference, your premier meeting for continuing education and exhibition. The Western is esteemed in the podiatric medical community as a leading, national level event for foot and ankle specialists from all over the United States and abroad.

Besides being ranked among the three largest meetings of its kind in the country, The Western boasts some of the most esteemed faculty and hottest topics at a price which can’t be beat. It has become not only an annual tradition for members of the podiatric community to come together, but also the ideal place for doctors and medical staff from all areas of expertise to earn continuing medical education contact hours, including radiology CEs, for their license requirements while gaining a top notch education. As always, The Western’s educational program will help all attendees meet their educational needs. Office staff and medical assistants will learn how to run the office and care for patients when they attend the Assistants’ Program (see page 12 for more information on the Assistants’ Program).

The Western welcomes an esteemed faculty who will no doubt provide the latest and greatest tips and techniques on hot topics including, but not limited to, biomechanics, sports medicine, wound care, pain management, and changes in healthcare. A myriad of workshops from hands-on labs to give attendees experience while learning new and important techniques to practice management and the latest updates in billing and coding from the experts on the subject offer even more learning opportunities.

The Western’s enticing exhibit hall will provide you with the chance to not only see the latest in medical and surgical advancements and a host of other products to aid in the success of your practice and patient care, but also take a nice break between lectures and workshops. The Western provides free refreshments to attendees, including healthy snacks to keep you on your toes the duration of the meeting.

western sponsors diamond Bako Integrated Physician Solutions Wright Medical Technology, Inc.

gold DermaTran Health Solutions, LLC Formula 3 Shire Regenerative Medicine, Inc.

silver Anacor Pharmaceuticals, Inc. Arthrex, Inc.

bronze Amerx Arthrosurface Bard Peripheral Vascular KCI Matrix Biosurgical ProLab Orthotics, USA Stryker Orthopaedics Vilex

The 2013 Western Foot and Ankle Conference will be hosted by the newly renovated 4 Diamond Disneyland Hotel & Convention Center in Anaheim, California. Boasting brand new pools, updated guest amenities and entertaining dining facilities, the revamped venue will provide even more areas for catching up with colleagues and friends before and after the meeting.

Come see what makes The Western the most successful program and exhibition west of the Mississippi. Explore the opportunities and join your colleagues at this incomparable event at a superb destination. Register today!

copper Bioventus, LLC Solana Surgical, LLC

Sincerely,

program Jonathan M. Labovitz, DPM Chair, Western Foot and Ankle Conference

Shannon M. Rush, DPM Chair, CPMA Science and Education Committee

Performance Materials Podiatry Insurance Company of America Smith & Nephew Wound Management

table of contents General Information............................7 Theme Park Tickets ............................7 Meeting at a Glance ...........................8 Continuing Education .........................9 82 |

Invited Faculty ..............................10-11 Scientific Objectives ......................... 12 Doctors’ General Sessions.......13-14 Doctors’ Workshops ......................... 15

2013 2013 Western Western Foot Foot and and Ankle Ankle Conference Conference Registration Registration Brochure Brochure

Assistants’ Program ....................16-17 Doctor Registration Form ............... 18 Assistant Registration Form ........... 19

general information

TICKE TS

theme park tickets

Reservation cut-off date: May 22, 2013

Disneyland® and Disney’s California Adventure™ TICKE parks offer fun for you and your family. Purchasing tickets through The Western will save you valuable time and money. Tickets for theme park admittance are available in advance from the Disney ticket website or by phone for attendees. These discounted tickets are valid beginning Friday, June 14, 2013 through Thursday, June 27, 2013.

TS

hotel information

The 2013 Western Foot and Ankle Conference will once again be hosted by the Disneyland Resort in sunny Anaheim, California! A block of rooms is reserved for attendees of The Western. These rooms will be available at the special rates listed until May 22, 2013 ONLY if available, so reserve your room at this popular resort early! Be sure to mention The Western to get these great rates:

Online: http://tinyurl.com/2013Western (Ends June 16, 2013 at 9 pm PST) Phone: (714) 520-5005 (Monday through Friday, 8 am - 5 pm PST)

Disneyland® Hotel: $189 single or double

Some tickets will also be available for purchase on-site at The Western while supplies last.

Disney’s Grand Californian® Hotel and Spa: $253 single or double

ticket prices Adult tickets are for those ages 10 and up. Child tickets are for ages 3 to 9 years. Children under 3 are admitted free of charge.

Online: http://tinyurl.com/2013Western Phone: (714) 520-5005

adult child

Disneyland Resort Hotel and Convention Center 1150 W. Magic Way • Anaheim, CA 92802

$79 $73

1 Day Theme Park Ticket. A one-day admission to either Disneyland® Park or Disney’s California Adventure® Park. Not a Park Hopper.

Disneyland® Resort Park Hopper Ticket.

Admission is valid for either Disneyland® Park or Disney’s California Adventure™ Park.

Guests may visit both parks on the same day. These tickets are valid for the appropriate number of visits within a 14 consecutiveday period.

refreshments The Western provides attendees with complimentary morning and afternoon coffee, tea, and refreshments to keep them on their toes throughout the meeting. Enjoy whole grain muffins, whole wheat croissants, fresh fruit, granola and energy bars, mixed nuts, yogurt, and more.

Concession lunch will be available in the Exhibit Hall during all lunch breaks.

all guests $76

spouse & guest registration Badges for spouses and guests of the 2013 Western attendees are complimentary and may be acquired at the registration desk.

Admittance to the exhibit hall requires a badge. Due to liability issues, such as the possibility of injury from surgical equipment, The Western strongly discourages attendees from bringing anyone under the age of 16 into the exhibit hall. Children must be accompanied by an adult. Strollers are not permitted in the exhibit hall.

# of days

adult

child

1 day

$111

$105

2 day

$174

$161

3 day

$200

$185

4 day

$225

$205

5 day

$240

$220

Twilight Ticket. Admission is valid for either Disneyland® Park or Disney’s California Adventure™ Park after 4:00 p.m., or four hours before park closing, whichever is earlier. Not a Park Hopper.

tickets will be sold at the ticket counter in the center lobby: wednesday, june 19

9 am - 4 pm

thursday, june 20

9 am - 4 pm

friday, june 21

9 am - 4 pm

saturday, june 22

9 am - 4 pm

2013 Western Foot and Ankle Conference Registration Brochure

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meeting at a glance wednesday, june 19 9 am – 5 pm California Podiatric Medical Association House of Delegates

4 – 6 pm Podiatric Medical Assistants’ Workshop: Office Managers

thursday, june 20

4 – 6 pm Podiatric Medical Assistants’ Workshop: Padding and Strapping

6:30 am – 6 pm Conference Registration 8 am – 6 pm General Sessions

6 – 7:30 pm California School of Podiatric Medicine Alumni Reunion Reception

8 am – 5 pm Podiatric Medical Assistants’ Workshop: Radiology Review Course

6 – 7:30 pm Western University Reception

9:30 am – 4 pm Exhibit Hall Open 1:30 – 5 pm Workshop: Surgical Management of Osteoarthritis 4 – 5 pm California Podiatric Medical Association Past Presidents Meeting 5 – 7 pm Workshop: Billing & Coding

friday, june 21 6:30 am – 6 pm Conference Registration 7:30 am – 6 pm General Sessions 8 am – 3:15 pm Podiatric Medical Assistants’ Program 8:30 am – 12 pm Workshop: New Approaches to Foot and Ankle Trauma 9:30 am – 4 pm Exhibit Hall Open 1:30 – 5 pm Workshop: The Diabetic Foot 1:30 – 5 pm Workshop: Practice Management as Healthcare Evolves

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6 – 9 pm American Board of Podiatric Medicine Reception

saturday, june 22 6 am – 6 pm Conference Registration 7 am – 6 pm General Sessions 8 am – 3:15 pm Podiatric Medical Assistants’ Program 9:30 am – 4 pm Exhibit Hall Open 10 am – 12 pm Workshop: Innovative Forefoot Surgical Techniques 1 – 4 pm Workshop: Ankle Arthroscopy 4 – 6 pm Podiatric Medical Assistants’ Workshop: Anatomy 4 – 6 pm Podiatric Medical Assistants’ Workshop: Billing, Coding, and Collecting

sunday, june 23 8 am – 12 pm General Sessions

2013 Western Foot and Ankle Conference Registration Brochure

continuing education credits podiatric physicians California Podiatric Medical Association is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine. Attendees of The Western Foot and Ankle Conference may earn up to 26 Continuing Education Contact Hours (CECH).

radiology

Doctors of Podiatric Medicine will be able to attain a maximum of 10 Radiology Continuing Education Contact Hours to meet California Radiology Continuing Education requirements.

The radiology continuing education lectures are included in the Doctors’ General Sessions.

important

Badges are barcoded with your registration information and must be scanned twice daily at designated times for credit.

In accordance with the Council on Podiatric Medical Education (CPME), The Western is required to monitor educational session attendance for continuing education (CE) verification.

Attendees will be sent transcripts reflecting only the number of Continuing Education Contact Hours earned by scanning for general sessions and/or attending workshops. To receive the maximum number of CECH, DPMs must have their badges scanned at each of the listed scanning times. Continuing education verification transcripts will be sent to meeting attendees by August 31, 2013. Each registrant is responsible for reporting attendance to all appropriate licensing boards and agencies requiring continuing education.

Retain the original transcript sent to you. Electronic copies may be obtained by emailing a request to jsteed@calpma.org. A ten dollar ($10) fee will be charged for replacement hard copies faxed or mailed.

CECH scanning schedule To receive your Continuing Education Contact Hours (CECH), you must scan your badge during each of the noted scanning times for verification purposes.

CPMA is providing up to 26 CECH during the 2013 Western Foot and Ankle Conference.

Following are the scanning schedule, locations, and CECH available:

thursday, june 20

saturday, june 22

friday, june 21

sunday, june 23

12 - 1:30 pm Exhibit Hall Booth 1125 3.25 CECH (.75 Radiology CECH) 2:30 - 4 pm Exhibit Hall Booth 1125 3.75 CECH (2.33 Radiology CECH) 12 - 1:30 pm Exhibit Hall Booth 1125 3.75 CECH (.75 Radiology CECH) 2:30 - 4 pm Exhibit Hall Booth 1125 3.75 CECH (3.5 Radiology CECH)

12 - 1:30 pm Exhibit Hall Booth 1125 4.25 CECH (1.75 Radiology CECH) 2:30 - 4 pm Exhibit Hall Booth 1125 3.75 CECH (0 Radiology CECH) 9:45 am - 12:30 pm Central Lobby Registration Desk 3.5 CECH (.92 Radiology CECH)

podiatric medical assistants radiology

Podiatric Medical Assistants may earn a total of 14.75 Radiology Continuing Education Contact Hours (CECH) to meet California Radiology Continuing Education requirements by attending lectures, courses, and workshops shown to provide radiology credits. Assistants must sign in to get credits. Transcripts reflecting radiology credits earned will be sent by August 31, 2013.

To attain CECH, assistants may attend the following:

Certified Podiatric Assistants and Certified Medical Assistants will be able to obtain up to 21.5 Continuing Education Contact Hours (CECH) for their ASPMA and CMA Certifications. Please sign in with the Assistants’ Program Director to obtain these credits.

8 am - 3:15 pm Assistants’ Program 5 CE CECH for Certified Assistants (1.75 Radiology CECH) 4 - 6 pm Office Managers (Additional registration fee) 2 CECH for Certified Assistants

thursday, june 20

8 am - 5 pm Pre-Conference Radiology Review Course (Additional registration fee) 7.5 CE CECH for Certified Assistants (7.5 Radiology CECH)

friday, june 21

4 - 6 pm Padding and Strapping (Additional registration fee) 2 CECH for Certified Assistants (2 Radiology CECH)

saturday, june 22

8 am – 3:15 pm Assistants’ Program 5 CE CECH for Certified Assistants (1.5 Radiology CECH) 4 - 6 pm Anatomy (Additional registration fee) 2 CECH for Certified Assistants (2 Radiology CECH) 4 - 6 pm Billing, Coding, and Collecting (Additional registration fee) 2 CECH for Certified Assistants

2013 Western Foot and Ankle Conference Registration Brochure

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invited faculty Bradley W. Bakotic, DPM, DO Alpharetta, GA Dermatopathologist and Principal Partner, Bako Integrated Physician Solutions Diplomate, Dermatopathology, American Board of Dermatology and American Board of Pathology Diplomate, Anatomic and Clinical Pathology, American Board of Pathology Fellow, College of American Pathologists, American Association of Podiatric Practice Management, American Professional Wound Care Association Advisory Board, International Foot & Ankle Foundation for Education and Research Faculty, Barry University School of Podiatric Medicine, New York College of Podiatric Medicine Edward Barnes, II, MD, FACP Rancho Cucamonga, CA Vice Chair, Department of Internal Medicine; and Chief, Division of Nephrology and Hypertension; College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA Ronald J. Belczyk, DPM Van Nuys, CA Associate, ACFAS Fellowship Director, Surgical Limb Salvage, Valley Presbyterian Hospital Consultant Physician, Amputation Prevention Center, Valley Presbyterian Hospital Adjunct Clinical Faculty, Western University of Health Sciences, Pomona, CA

Robert A. Christman, DPM, EdM Pomona, CA ABPM, ACFAOM Professor, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA Stan Conte, PT, DPT, ATC San Francisco, CA Vice President and Director of Medical Services, Los Angeles Dodgers Mary E. Crawford, DPM Everett, WA ABPS, ACFAS Past President, American College of Foot and Ankle Surgeons Director, Board of Medical Advisors, International Foot and Ankle Foundation Consultant, BioMedical Enterprises, Inc. (BME) Private Practice, Everett, WA Alla Danilkovitch, PhD Columbia, MD Osiris Therapeutics, Inc. Tina C. Del Buono, PMAC, XT Santa Rosa, CA ASPMA Member, American Academy of Podiatric Practice Management Past President, American Society of Podiatric Medical Assistants Chair, Western Assistants Educational Program Santa Rosa Foot & Ankle Associates

Nicholas Bolognini, DPM Sunnyvale, CA ABPS, ACFAP, ACFAS Palo Alto Medical Foundation

G. Dock Dockery, DPM Everett, WA ABPS, ACFAOM, ACFAP, ACFAS, ASPD Chairman and Director of Scientific Affairs, International Foot & Ankle Foundation, Edmonds, WA

David J. Caldarella, DPM LaCrosse, WI ABPS, ACFAS Faculty, Podiatry Institute Department of Podiatric Medicine & Surgery, Gundersen Lutheran Medical Center The Florida Center for Foot and Ankle Disorders, PA

Lawrence A. Ford, DPM Berkeley, CA ABPS, ACFAS Program Director, Kaiser San Francisco Bay Area Foot & Ankle Residency, Department of Orthopedics & Podiatric Surgery, Kaiser Permanente, Oakland, CA Attending Staff, The Permanente Medical Group, Oakland, CA

Marty Chalfin, CPed Lake Mary, FL Dr. Comfort

Kris Frank Rancho Cordova, CA Regional Director, State Government Affairs, Aetna

Thomas J. Chang, DPM Santa Rosa, CA ABPS, ACFAS Redwood Orthopedic Surgery Associates 12 6 |

Daniel C. Fulmer, DPM Tucson, AZ ABPS

2013 2013 Western Western Foot Foot and and Ankle Ankle Conference Conference Registration Registration Brochure Brochure

Mahmoud A. Ghannoum, PhD, EMBA Cleveland, OH Harry Goldsmith, DPM Cerritos, CA ABPS, ACFAS, ACFAOM Member, AAPC CEO, LOJON, LLC and Codingline.com Co-Chairman, Nomenclature and Coding Committee C. Keith Greer, JD San Diego, CA Partner, Greer & Associates Law Firm Rob Gussenhoven, PharmD Rome, GA Chief Science Officer, DermaTran Health Solutions Graham A. Hamilton, DPM Deer Valley, CA ACFAS AO Faculty Annual Scientific Committee Member, American College of Foot and Ankle Surgeons John D. Hollander, DPM Santa Rosa, CA ABPS, ASPS, ACFAS Santa Rosa Foot & Ankle Associates Mary Hudson-McKinney, PT, MS, DPT, NCS Yorba Linda, CA Assistant Professor, Department of Physical Therapy, Western University of Health Sciences, College of Allied Health Professions, Pomona, CA Physical Therapist and Neuro Clinical Specialist, Sea Crest Home Care Physical Therapy Jon A. Hultman, DPM, MBA Los Angeles, CA ABPS, ACFAS Executive Director, California Podiatric Medical Association Senior Consultant, Integrated Physician Systems Former practice: University Podiatry Group, UCLA Medical Center, Los Angeles, CA Lawrence Z. Huppin, DPM Seattle, WA ABPM Assistant Clinical Professor, Western University College of Podiatric Medicine, Pomona, CA Medical Director, ProLab Orthotics Private Practice, Seattle, WA

Franklin Kase, DPM Burbank, CA AAPSM Burbank Podiatry Associates Group Kevin A. Kirby, DPM Sacramento, CA AAPSM, ABPM, ACFAOM, ACFAS Adjunct Associate Professor, Department of Applied Biomechanics, California School of Podiatric Medicine Member, Editorial Advisory Board, Journal of American Podiatric Medical Association Private Practice, Sacramento, CA Diane M. Koshimune, DPM, MS Pasadena, CA AAWP, ABPS, ACFAS Assistant Professor, Department of Podiatric Medicine, Surgery & Biomechanics, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA Pomona Valley Hospital Medical Center Chino Valley Medical Center Riverside County Regional Medical Center Jonathan M. Labovitz, DPM Torrance, CA ABPS, ACFAS Associate Professor and Department Chair, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA Chair, Western Foot and Ankle Conference Member, Los Angeles Community Leadership Board, American Diabetes Association Adam S. Landsman, DPM, PhD Brookline, MA ABPS, ACFAS Assistant Professor of Surgery, Harvard Medical School, Boston, MA Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Cambridge, MA Robert K. Lee, DPM Calabasas, CA ABPS, ACFAS Assistant Clinical Professor, UCLA School of Medicine University Podiatry Group

glossary of credentials: AAPSM: Fellow, American Academy of Podiatric Sports Medicine ABPM: Diplomat, American Board of Podiatric Medicine ABPS: Diplomat, American Board of Podiatric Surgery ACFAOM: Fellow, American College of Foot and Ankle Orthopedics and Medicine ACFAP: Member, American College of Foot and Ankle Pediatrics

John “Jack” Lynch, JD Chicago, IL Attorney, Private Practice Jonathan E. Moore, DPM, MS Somerset, KY AAPPM, ABPM, APWCA Past Board Member, American Academy of Podiatric Practice Management Speaker Bureaus, Amerx and Arizona AFO Managing Partner, Cumberland Foot and Ankle Centers of Kentucky Director, Cumberland Foot Health Solutions, Corbin Medical Associates Fellowship Director, Central Kentucky Diabetes Management Fellowship Trustee and Fellow, American Academy of Podiatric Practice Management Adjunct Faculty, Ohio College of Podiatric Medicine Bijan Najafi, PhD Tucson, AZ College of Medicine, University of Arizona Megan Nguyen, PharmD Pomona, CA Associate Professor, Western University of Health Sciences College of Pharmacy, Pomona, CA Infectious Diseases Pharmacist, HarborUCLA Medical Center, Torrance, CA and St. Mary’s Medical Center, Long Beach, CA Lawrence M. Oloff, DPM Redwood City, CA AAPPM, ABPS, ASPS Sports Orthopedic and Rehabilitation (SOAR) Surgery Group Medical Staff, San Francisco Giants Medical Staff, Santa Clara University Athletics Clinical Professor, Midwestern University, Glendale, AZ Jeffrey C. Page, DPM Glendale, AZ ABPS, ACFAOM, APMWA, ASPD, ASPM Arizona Podiatric Medicine Program, Midwestern University, Glendale, AZ Anthony Poggio, DPM, MS Alameda, CA AAPSM, ABPM, ABPS, ASPS Medicare Committee Chair and CAC Representative, CPMA ACFAS: Fellow, American College of Foot and Ankle Surgeons AENS: Member, Association of Extremity Nerve Surgeons APWCA: Diplomat, American Professional Wound Care Association ASPD: Fellow, American Society of Podiatric Dermatology ASPMA: American Society of Podiatric Medical Assistants

Alexander M. Reyzelman, DPM Castro Valley, CA ABPS, ACFAS Eden Podiatry Group Chair and Assistant Professor, Department of Medicine, Samuel Merritt University, Oakland, CA Douglas H. Richie, DPM Seal Beach, CA AAPSM, ACFAS Adjunct Associate Clinical Professor, Department of Applied Biomechanics, California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA Alamitos Seal Beach Podiatry Group Lee C. Rogers, DPM Sherman Oaks, CA ABPM Director, Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA Shannon M. Rush, DPM Mountain View, CA ABPS. ACFAS Palo Alto Medical Foundation Fellowship Director, Silicon Valley Foot and Ankle Fellowship Sub Chief, El Camino Hospital Ross E. Taubman, DPM Olney, MD ABPS, ACFAS, ASPS President and Chief Medical Officer, Podiatry Insurance Company of America Nicholas W. Todd, DPM San Francisco, CA Associate, American College of Foot and Ankle Surgeons Palo Alto Medical Foundation Dan Totaro, MA, LMFT Upland, CA Jesus C. Vazquez, PMAC Santa Rosa, CA Director of Communications, ASPMA Santa Rosa Foot & Ankle Associates Glenn M. Weinraub, DPM San Francisco, CA ACFAS Clinical Assistant Professor, Midwestern University, Glendale, AZ TPMG, Department of Orthopaedic Surgery Past President, American College of Foot and Ankle Surgeons

2013 2013 Western Western Foot Foot and and Ankle Ankle Conference Conference Registration Registration Brochure Brochure

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scientific objectives By attending the General Sessions, Doctors of Podiatric Medicine will be able to accomplish the following medical education objectives: the bill olson biomechanics track: balance & gait disorders

Evaluate and diagnose disorders of balance and gait.

This will include important clinical tests and evaluations to treat foot and ankle pathology. Evaluate mechanical dysfunction of the foot as well as neuromuscular disorders, which impact gait.

Evaluate common problems with foot orthoses. This session is based on the most current literature and research presented by experts in their respective field.

fall risk

Identify and discuss the potential fall risk patient.

Make recommendations for proper screening and treatment methods for the patient at risk.

sports medicine

Evaluate, manage, and treat the athlete and sports related pathology as it relates to the foot and ankle.

Use and application of advanced healing technologies including platelet rich plasma and bone marrow aspirate. Sports related injuries of the ankle, ligamentous repair, cartilage injuries and repair, and impingement syndromes. Arthroscopic techniques will be presented to address individual clinical scenarios. Specific techniques related to diagnosis and management will be detailed. Surgical indications will be details as well as pitfalls and problem solving. Imaging techniques will be reviewed as they relate to management of specific injuries.

managing the chronically ill patient

Recognize medical conditions, which have a direct influence on the treatment of Foot and Ankle pathology.

Systemic conditions such peripheral arterial disease, renal disease, diabetes mellitus, and cardiac disease and how they impact treatment of the foot and ankle. Instruction will include clinical evaluation, management, and appropriate referral.

The impact certain chronic medications have on healing and complications will be presented and discussed.

managing surgical complications

Treatment and management of surgical foot and ankle pathology and complications. The panel of experts will discuss and debate controversial issues in failed and reconstructive bunion surgery. Didactic knowledge on revision flatfoot surgery, ankle arthroscopy and foot trauma will be detailed. Decision making and surgical algorithms will be discussed. Several surgical interventions will be discussed including the proper indications and surgical execution. Pitfalls and problem solving will be discussed. Imaging techniques will be discussed to manage various clinical scenarios.

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affordable care act symposium

Provide an update on the main changes that will occur in 2014. Discuss the role of the podiatric physician and how these changes will impact various practice models. Update on the Health Benefits Exchange.

the jury’s out – the anatomy of a podiatric malpractice trial

Appreciate the risks of failure to timely diagnose melanoma and the significance of biopsy in making an appropriate diagnosis. Understand the importance of implementing office systems to allow for timely patient followup. Have knowledge of what occurs in a podiatric malpractice trial. Understand the importance of proper documentation to plan and coordinate the patient’s medical care and to defend allegations of medical malpractice.

the pediatric patient

Recognize evaluate and treat the specific pediatric conditions, which impact the foot and ankle.

Congenital disorders including clubfoot, tarsal coalition, and dysfunctional flatfoot will be discussed. Clinical and diagnostic tools will be presented to evaluate and manage these conditions.

Surgical indications will be detailed as well as surgical algorithms and techniques. Consideration for the autistic patient will be discussed including implications on care for the foot and ankle Surgeon. Radiographic and advanced imaging techniques will be discussed.

management of the chronic pain patient

Understand the various clinical scenarios involving the patient with chronic pain. Review and understand chronic pain and the pathophysiology of pain. Specific considerations regarding the peripheral nervous system and chronic pain, including targeted pain management techniques. Discuss topical pain management techniques and how these can be incorporated into peripheral pain management.

the real evidence in onychomycosis therapy

Review and understand pathogens, which cause diseases of the nail. A detailed review of systemic and topical medications used to treat onychomycosis. Current evidence will be presented to substantiate the current recommendations for care. Laser technology for onychomycosis including evidence for the use of laser technology for onychomycosis.

evidence based wound care

Understand and critically evaluate the most current wound care technologies. Compare and contrast advanced wound care technologies and various clinical indications.

Evaluate stem cell therapy indications for management of the chronic foot wound. Use and indications of negative pressure wound therapy. Considerations to limb salvage and limb sparing surgery will be highlighted.

2013 Western Foot and Ankle Conference Registration Brochure

doctors’ general sessions thursday, june 20

friday, june 21

8 – 10 am The Bill Olson Biomechanics Track: Balance & Gait Disorders 2 CECH (.33 Radiology CECH)

7:30 am – 12 pm Managing the Chronically Ill Patient 3.75 CECH (.75 Radiology CECH)

(Supported in part by educational grants from Performance Materials, ProLab and Orthotics, USA.)

• Adjusting Orthoses: Simple Solution to Prevent Complaints • Biomechanical Rationale behind the Most Important Clinical Tests for the Podiatrist • Clinical Pearls in Treating Mechanical Dysfunction of the Foot • How Foot Pathology Affects Postural Control* • Identifying and Screening for Fall Risk • Q&A

• Peripheral Arterial Disease in the Dialysis Patient* • Pearls to Managing the ESRD Patient • Expectations in the Brittle Diabetic • Providing the Expected Quality for the Diabetic Patient • Managing Cardiac Patients • Managing Resistant Community Acquired Infections • Factors Affecting Bone and Wound Healing* • Perioperative Recommendations for the Rheumatoid Patient on DMARDS • Q&A

10:45 am – 12 pm Fall Risk 1.25 CECH (.42 Radiology CECH)

1:30 – 6 pm Managing Surgical Complications 3.75 CECH (3.5 Radiology CECH)

• Diagnostics and the Changing Technology • Round Table: Stabilizing the High Risk Patient • Q&A

• Just Because You Can Doesn’t Mean You Should* • The Lateral Release: Point and Counter Point* • Revising Failed First MPJ Fusion* • Salvage of the Dysfunctional Forefoot* • Revising the Failed Flatfoot* • Locking Plates: Do They Prevent Complications?* • Avoiding Common Complications in Ankle Fractures* • Revising the Neglected Calcaneal Fracture* • Surgical Misadventures* • Q&A

1:30 – 6 pm Sports Medicine 3.75 CECH (2.33 Radiology CECH) • Insights into Dealing with Athletes • Roundtable: The Three Best Pearls in Sports Medicine • PRP: What Can We Learn from the Orthopedic Literature?* • The Role of Bone Marrow Aspirate in Osseous Healing* • Late Repair of Syndesmotic Instability* • Arthroscopic Treatment of OCLT* • The Complexities of Posterior Ankle Pain* • Q&A

introducing Western eHandouts The 2013 Western will feature free virtual handouts for attendees. When speakers upload their presentations, notes, slides, etc. the files will be available for Western attendees to download for effortless access any time - much better than a stack of paper handouts waiting to be lost when the meeting is over. Simply find all available files right at your fingertips, saving time and trees.

Create a login and save files easily. After you register for The Western, you will receive an email containing a link to create your eHandouts login. Follow the link in the email to create your account, or go to thewestern.org/program/ehandouts and follow the prompts to reset your password.

Once logged into the eHandouts page at TheWestern.org, browse and save files you want to your computer.

It really IS easy being green. *Denotes lecture which provides radiology continuing education contact hours (CECH).

2013 Western Foot and Ankle Conference Registration Brochure

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doctors’ general sessions saturday, june 22

sunday, june 23

7 – 8 am Affordable Care Act Symposium 1 CECH (0 Radiology CECH)

8 am – 12 pm Evidence Based Wound Care 3.5 CECH (.92 Radiology CECH)

8 – 9:30 am The Jury’s Out - The Anatomy of a Podiatric Malpractice Trial (PICA Presentation) 1.5 CECH (0 Radiology CECH)

• Advanced Therapies: Are They Really Useful?

• The New Biologics: The Role of Mesenchymal Stem Cells • Negative Pressure Wound Therapy: The Evidence Is Mounting • Appropriate Management, Documentation, and Outcomes Assessment in the ACA • The Approach to Osteomyelitis: Imaging or Clinical?* • Considering Other Causes for Non-Healing Ulcers • Complicated Case Panel* • Q&A

(Supported by an educational grant from Podiatry Insurance Company of America.)

Doctors of Podiatric Medicine must register for The Western to attend this lecture. PICA policyholders who attend this lecture can earn a 10% discount on their insurance renewal premium.

CPMA members earn an additional 5%.

10:15 am – 12 pm The Pediatric Patient 1.75 CECH (1.75 Radiology CECH) • Clubfoot Update: Ponsetti Technique and Clinical Pearls* • Arthroereisis for the Pediatric Pes Plano Valgus Foot* • Evaluation and Management of Common Pediatric Fractures* • Coalitions, Evaluation and Management* • Minimal Invasive Gastroc Recession in the Pediatric Patient* 1:30 – 3:15 pm Management of the Chronic Pain Patient 1.75 CECH (0 Radiology CECH) • Pathophysiology of Chronic Pain: What’s Involved?

• Medical Management of Chronic Foot and Ankle Pain: The Current Standard • The Role of the Peripheral Nervous System in Pain Management • Topical Approach to Anagelsia: Does It Work?

• Q&A 4 – 6 pm The Real Evidence in Onychomycosis Therapy 2 CECH (0 Radiology CECH)

(Supported in part by educational grants from Anacor Pharmaceuticals, Inc. and DermaTran Health Solutions, LLC.)

• Back to the Basics • Current Treatments for Onychomycosis • The Evidence for Topical Treatments • Show Me the Laser • Q&A

*Denotes lecture which provides radiology continuing education contact hours (CECH).

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2013 Western Foot and Ankle Conference Registration Brochure

doctors’ workshops thursday, june 20

friday, june 21

1:30 – 5 pm Surgical Management of Osteoarthritis (Cadaver) 3.5 CECH

8:30 am – 12 pm New Approaches to Foot and Ankle Trauma (Cadaver) 3.5 CECH

(Supported in part by educational grants from Arthrosurface, Stryker Orthopaedics, and Vilex.)

Limited to 24 participants

(Supported in part by an educational grant from Wright Medical Technology, Inc.)

Limited to 24 participants

This workshop provides hands-on training to enhance the practitioner’s skills in the evaluation and management of osteoarthritis in the foot and ankle. Through a variety of procedures the podiatric physician will gain a better appreciation for surgically managing this potentially complex joint pathology.

5 – 7 pm Billing and Coding 0 CECH Limited to 75 participants

This cadaver workshop provides participants the training in new and well established techniques in fracture management using different types of internal fixation.

1:30 – 5 pm The Diabetic Foot (Pigs’ Feet) 3.5 CECH

(Supported in part by an educational grant from Bako Pathology Services.)

Limited to 24 participants

This workshop provides the participants with an update in the billing and coding issues facing them in 2013 and a look into the ICD-10 changes. In addition, participants will be exposed to some of the latest techniques in contracts and appeals.

This workshop provides hands-on training in the evaluation of the underlying pathology leading to complications such as peripheral neuropathy and peripheral arterial disease.

Additionally, the participant will learn innovative techniques to manage these patients should complications arise.

1:30 – 5 pm Practice Management as Healthcare Evolves (Supported in part by an educational grant from Amerx..)

3.5 CECH Limited to 75 participants Based on the transformation of healthcare, this workshop will help practices remain aligned with the changes in preparation for the implementation of many Affordable Care Act measures in 2014 by focusing on patient outcomes, patient satisfaction and cost.

saturday, june 22 10 am – 12 pm Innovative Forefoot Surgical Techniques (Cadaver) 2 CECH (Supported in part by an educational grant from Arthrex, Inc.)

Limited to 20 participants This cadaver based hands-on workshop is designed to educate participants in new techniques to repair challenging forefoot pathology.

1 – 4 pm Ankle Arthroscopy (Cadaver) 3 CECH Limited to 16 participants Contemporary arthroscopic techniques to address intra-articular pathology of the ankle and subtalar joint.

2013 Western Foot and Ankle Conference Registration Brochure

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assistants’ program The Whole Office Learns at The Western The Assistants’ Program at the Western Foot and Ankle Conference has something for every member of your staff. Office managers, podiatric medical assistants, front office and back, will have an enjoyable time learning from an educated and skilled faculty who will lecture on various topics from ICD-10 and risk management to treating patients and trauma. Take a look at what the two-day program of general sessions has to offer; then consider extending the experience by taking one or more of the specialized workshops created to suit the individual needs of each staff member.

Got Radiology?

The 2013 Western will provide podiatric medical assistants 14.75 Radiology Continuing Education Contact Hours (CECH) to meet California Radiology Continuing Education requirements. For assistants needing all possible Radiology CECH, follow this schedule: Thursday:

Pre-conference Radiology Review Course

Friday:

Assistants’ Program (General Sessions) Padding and Strapping workshop

Saturday:

Assistants’ Program (General Sessions) Anatomy workshop

Certified?

Certified Podiatric Assistants and Certified Medical Assistants will be able to get up to 21.5 Continuing Education Contact Hours (CECH) for ASPMA and CMA Certifications. If you are certified and need all possible CECH, make this your agenda: Thursday:

Pre-conference Radiology Review Course

Friday:

Assistants’ Program (General Sessions) Either workshop

Saturday:

Assistants’ Program (General Sessions) Either workshop

Office Manager?

There are many topics covered in the general sessions as well as a workshop just for you. Consider this your itinerary: Thursday:

Pre-conference Radiology Review Course

Friday:

Assistants’ Program (General Sessions) Office Managers workshop

Saturday:

Assistants’ Program (General Sessions) Billing, Coding, and Collecting workshop

Whether new to podiatry or well-seasoned, The Western will supply cutting edge information to improve knowledge and skills for everyone in your office.

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2013 Western Foot and Ankle Conference Registration Brochure

assistants’ general sessions friday, june 21

saturday, june 22

8 am – 3:15 pm 5 CECH for Certified Assistants (1.75 Radiology CECH)

8 am – 3:15 pm 5 CECH for Certified Assistants (1.5 Radiology CECH)

• Making a Difference - Office Atmosphere • Weekend Warrior* • Marketing Online • ICD-10 the Future of Billing • AFOs and Braces* • Facts & Treatments for Onychomycosis • Anger Management • Common Billing Errors and How to Correct Them

• Podiatric Dermatology • Bunions and Hammertoes, Causes and Corrections* • Diabetic Wounds and Osteomyelitis* • Diabetic Shoe Documentation – Dr. Comfort • Meaningful Use and Quality Measures Communicating with the Elderly Patient • Podiatric Trauma* • Turning around Your Accounts Receivables • Risk Management-Protect Yourself; Protect Your Office

assistants’ workshops thursday, june 20

saturday, june 22

8 am – 5 pm Pre-Conference Workshop Radiology Review Course* 7.5 CECH for Certified Assistants (7.5 Radiology CECH) Limited to 75 participants

4 – 6 pm Anatomy (Cadaver)* 2 CECH for Certified Assistants (2 Radiology CECH) Limited to 16 participants This is a fantastic opportunity for assistants to work with doctors in dissecting the human foot and studying the anatomy and the function of the foot. From toes to tendons this course reviews it all, and is a hands-on workshop that you will never forget.

Attendees must be registered for the Assistants’ Program.

This course will be a review on various topics from radiology protection and set-up to trauma.

4 – 6 pm Billing, Coding, and Collecting 2 CECH for Certified Assistants Limited to 75 participants

friday, june 21 4 – 6 pm Office Managers 2 CECH for Certified Assistants Limited to 75 participants Topics to be covered include: • Handling and Heading Off an Office Crisis • Employee Empowerment and Accountability • Hiring the Right Person for the Job and What Happens When You Don’t Downloads will be available for all topics discussed. If you have any questions that you would like to submit prior to the workshop to be discussed please email them to tinapmac@msn. com with “Question Office Manager Workshop” in the subject line. All questions need to be submitted by June 1, 2013.

This workshop is designed for assistants who need to learn more in each of these important areas which keep practice doors open. Dr. Poggio will be covering the basics of billing, where to get the information you need to bill correctly, along with what you need to do when a claim is denied (understanding denials and what the insurance company wants from you). You may submit billing questions or problems that you would like to discuss prior to the workshop by sending them to tinapmac@msn.com by June 1, 2013.

4 – 6 pm Padding and Strapping* 2 CECH for Certified Assistants (2 Radiology CECH) Limited to 24 participants From Lodi strapping to off-loading pre-ulcerative lesions, learn the how’s and why’s of padding and strapping. There will be hands-on demonstration and participation for all attendees.

Learn new skills to help out in the office. This is a fun course to bring an office mate to so you can practice on each other.

*Denotes lecture or workshop which provides radiology continuing education contact hours.

2013 Western Foot and Ankle Conference Registration Brochure

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doctor of podiatric medicine registration form 2013 western foot and ankle conference June 20 – 23, 2013

Disneyland Hotel and Convention Center • Anaheim, CA

2013

early bird discount ends march 24

NOTE: Full contact information provided here will be bar-coded on your badge and available to exhibitors. If you do not wish to disclose this information, do not have exhibitors scan your badge.

registrant information

Please complete one form per registrant. All communication regarding The Western coming from CPMA or exhibitors who purchase or capture registrant data onsite will be sent to the contact information given below.

Last Name

First Name

Informal Name for Badge if Preferred

Mailing Address City/State/Zip or Province/Country/Postal Code Daytime Phone

Email - Required for eHandouts (see page 13)

Fax

  Please check here if you have a disability and may require special accommodations and CPMA will contact you. meeting registration General Sessions if received on or between May 6 & June 12

CPMA Member

APMA Member

Life Member

Federal Services Member

NonMember

Resident Name of Program:

L

L

L

L

L

L

L$149 L $79 L

L$219 L$149 L

L$149 L $79 L

L$149 L $79 L

L $289 L $299 L

L L L

L $79 L

L$149 L

L $79 L

L $79 L

L $299 L

L L

L

L

L

L

L

L

L$299

L$399

L$299

L$299

L $499

$299

$499

$125

$299

$729

$75

Student Name of School:

L

$75

workshops Surgical Management of OA Billing & Coding New Approaches to Foot & Ankle Trauma The Diabetic Foot Practice Management as Healthcare Evolves Innovative Forefoot Surgical Techniques Ankle Arthroscopy

$149

$89

$149

$219

$149

$159

$89

$219

$149

$149

$289

$89

$229

$149

$289

L

$149 $79 $149 $79 $89 $149 $299

L L L

$149 $79 $149

L L

$79 $89

L

$149

L

$299

TOTAL

payment information  Check enclosed payable to The Western

 Visa / Master Card / Discover  American Express

___________________________________________________________________________________________________________ Credit Card Number

Exp. Date (mm/yy)

CVV Code

___________________________________________________________________________________________________________ Cardholder’s Name

Cardholder’s Signature

Date

___________________________________________________________________________________________________________ Credit Card Billing Address if Different from Above Mailing Address

mail fax

The Western 2430 K Street Suite 200 Sacramento, CA 95816 (916) 448-0258

online TheWestern.org 20 |

Registration confirmations and CECH transcripts will be sent by email or mail.

Cancellation Policy: Cancellations received on or between Monday, May 6 and Sunday, May 19, 2013 will receive a refund minus a $35 administration fee. No refunds will be issued on or after Monday, May 20, 2013. Refunds are not granted to no-shows.

Additional Notes: Space in workshops is limited. Registration policy is first come, first served. Payment must be received to secure registration.

On-site registration will incur a $50 administration fee. Returned checks may incur service charges. If written confirmation is not received, please call CPMA at (800) 794-8988 to confirm registration.

2013 Western Foot and Ankle Conference Registration Brochure

podiatric medical assistant registration form 2013 western foot and ankle conference June 20 – 23, 2013

Disneyland Hotel and Convention Center • Anaheim, CA

2013

early bird discount ends march 24

NOTE: Full contact information provided here will be bar-coded on your badge and available to exhibitors. If you do not wish to disclose this information, do not have exhibitors scan your badge.

registrant information

Please complete one form per registrant. All communication regarding The Western coming from CPMA or exhibitors who purchase or capture registrant data onsite will be sent to the contact information given below.

Last Name

First Name

Employer/Doctor’s Name

Mailing Address City/State/Zip or Province/Country/Postal Code Daytime Phone

Email - Required for eHandouts (see page 13)

Fax

  Please check here if you have a disability and may require special accommodations and CPMA will contact you.

meeting registration

CPMA Member’s Assistant

General Sessions if received on or between May 6 & June 12

L

APMA Member’s Assistant

L

$179

$229

Non-Member’s Assistant

L

$279

workshops L L L L L

Pre-Conference Radiology Course Office Managers Padding and Strapping Anatomy Billing, Coding, and Collecting

L L L L L

$79 $49 $49 $59 $49

$129 $59 $59 $69 $59

L L L L L

$229 $79 $69 $89 $79

TOTAL

payment information  Check enclosed payable to The Western

 Visa / Master Card / Discover  American Express

___________________________________________________________________________________________________________ Credit Card Number

Exp. Date (mm/yy)

CVV Code

___________________________________________________________________________________________________________ Cardholder’s Name

Cardholder’s Signature

Date

___________________________________________________________________________________________________________ Credit Card Billing Address if Different from Above Mailing Address

mail fax

The Western 2430 K Street Suite 200 Sacramento, CA 95816 (916) 448-0258

online TheWestern.org

Registration confirmations and CECH transcripts will be sent by email or mail.

Cancellation Policy: Cancellations received on or between Monday, May 6 and Sunday, May 19, 2013 will receive a refund minus a $35 administration fee. No refunds will be issued on or after Monday, May 20, 2013. Refunds are not granted to no-shows.

Additional Notes: Space in workshops is limited. Registration policy is first come, first served. Pre-registration ends Wednesday, June 12, 2013.

Payment must be received to secure registration. On-site registration will incur a $50 administration fee. Returned checks may incur service charges. If written confirmation is not received, please call CPMA at (800) 794-8988 to confirm registration.

2013 Western Foot and Ankle Conference Registration Brochure

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Vilex Answers, Again!

The Vilex Plate System: Answers for Surgeons—Results for Their Patients.

Vilex has developed an all-encompassing plate system for the hand and foot. During a procedure, this plate system will offer the surgeon optimal proficiency in mending a patient’s bones and joints.

Practical applications include: > 1st MPJ Fusion > Lateral or Medial Column Fusion > Metatarsal Base Fracture Repair 1-5 > Capital Osteotomy > Medial Malleolus Repair

Vilex Plate System Kit

> Cotton Flat Foot > Calcaneal Fracture/Osteotomy > Opening and Closing (Dwyer) Osteotomy > Metatarsal, Phalangeal and Fibular Fractures

This system is presented in a single surgical tray with a varied number of pre-bent and bendable shapes that anticipate the requirements of most plate applications for hand or foot surgery.

Many shapes are offered with locking screws, while others are available in a non-locking version.

The accompanying screws are also available both cannulated and solid, locking and non-locking.

All trays consist of plate benders, centering tools,depth gauges, and much more.

Vilex P470, Plate Bender

Contact us today and let Vilex be the answer to your next surgical need.

Vilex 1st MPJ Reamers

Vilex RFP 18, Locking Plate

Visit vilex.com to see all the exciting products we offer.

Plates

Screws

Rails

TOV

Open Base Wedge Plate

111 Moffitt Street McMinnville, TN 37110 USA Phone: 800-521-5002 Fax: 866-606-4911 E-mail: info@vilex.com www.vilex.com facebook.com/vilexinc ©2012 Vilex, Inc. All rights reserved.

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CAlIFoRNIA RADIoloGy uPDATE 2.0 Dear Cpma members: CPMA has received a number of calls regarding the Radiology Update article that appeared in the 2013 Jan/Feb/March issue of The California Podiatric Physician. We have printed it here again for quick reference. First these regulations are in effect and being enforced. With regard to inspections, please remember that a licensed inspector from the Radiological Health Branch can drop in at anytime and without notice. As to fines, not being in compliance at the time of inspection will depend upon the inspector, who might issue what is essentially a “fix-it-ticket”, which would give a practice 45 days to become compliant. HOWERVER, the inspector has the authority to cite a practice onsite not only for not being compliant with the new regulations, but for any and all aspects of a practice’s radiology protocol that are not in compliance.

CPMA members can find materials to help them meet the new regulatory requirements in the Compliance Center on the Association’s website at CalPMA.org.

Some of you may recall in last year’s report, i made mention about anticipated changes to Title 17 that would have a substantial effect on offices still using analog x-ray film processing equipment.

These changes are both a financial and time consuming burden. effective january 1, 2013, the regulations are being enforced and some offices are already feeling the sting by not implementing the quality control measures required under the new Title 17 update.

To be more specific, the “medical and Dental Quality assurance regulations” require medical offices to perform quality assurance procedures to ensure proper functioning of x-ray film and chemical processors. The purpose is to reduce the risk of retakes and ensuring best possible x-ray quality. The goal, of course, is to reduce patient radiation exposure. it is important to note that these quality assurance regulations do not apply to digital x-rays.

So what are the direct effects on you? you will need to purchase both a sensitometer and densitometer as well as sensitometric strips. new equipment at a discount seems to be running around $1600. you may be lucky in finding some used equipment from offices that are a p r i l | m ay | j u n e | 2013

closing or on eBay. next, each morning after your x-ray film processor has warmed up and prior to processing patient films, you or your staff is required to expose film or a sensitometric strip in the sensitometer and develop the film. The processed film is then read using the densitometer and the result recorded in a log book. it is recommended that you date and keep the strips for proof of your quality assurance performance. This will be requested by the radiologic Health Branch, not if, but when they field inspect your office. every three months you are also expected to test the residual fixer level retained on your films. Staff may perform this test if you purchase the chemical test kit. if you have a service that comes to your office regularly to replenish your x-ray chemicals and clean your processor, you may be able to contract with them to perform this test during their routine maintenance. at some point, you may wish to consider moving to a digital x-ray system and eliminate all of the maintenance, cost and testing required for the analog systems.

Below is a copy of the Title 17 regulation.

These new policies must be incorporated into your current X-ray policies and procedures manual:

§ 30308.1. QuAlITy ASSuRANCE FoR RADIoGRAPHIC INSTAllATIoNS (oTHER THAN MAMMoGRAPHy, DENTAl, AND VETERINARy MEDICINE) (a) each user subject to this article, as specified in section 30305(a)(1), who develops clinical radiographs for diagnostic purposes with automatic film processors for other than mammographic, dental, or veterinary use, shall assure all of the following: (1) each processor used to develop clinical radiographs is adjusted and maintained to meet the manufacturer’s processing specifications for the highest speed radiographic film used clinically.

(2) measurements are performed each day before clinical radiographs are processed, so as to determine that the processor is operating within the following limits: (a) The base-plus-fog density is within plus 0.05 of the operating level

established with the highest speed radiographic film used clinically; (B) The mid-density is within plus or minus 0.15 of the operating level established with the highest speed radiographic film used clinically; and (C) The density-difference is within plus or minus 0.15 of the operating level established with the highest speed radiographic film used clinically.

(3) Tests are performed at intervals not to exceed three months to determine that the residual fixer level retained in clinical radiographic films is not more than 5.0 micrograms per square centimeter.

(4) Tests are performed at intervals not to exceed six months to determine that the optical density attributable to darkroom fog is not more than 0.05 when the highest speed of each type radiographic film used clinically, which has a middensity of no less than 1.20 optical density, is exposed on the counter top for one minute under typical darkroom conditions with the safelight on.

(5) for any test result falling outside the criteria specified in this section, the problem is identified and corrective action is taken before clinical radiographs are processed.

(6) records of the tests specified in this section, including the problems detected, corrective actions taken, and the effectiveness of those corrective actions, are maintained for at least one year from the date the test was performed.

Neil M aNsdorf, dPM Chair, r adiologiCal TaskforCe | 23

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IT’S Deja Vu All oVER AGAIN a few weeks ago, i began to write an article for the California podiatric physician outlining strategies that members should be considering as they formulate their plans for addressing the future of healthcare. as i got into the article, the maxim “it’s déjá vu all over again” came to mind. researching, i found an “old” article that i authored for apma news in 1998 – one focused on the type of changes i believed doctors should be making to adapt to the challenges they would be facing in the new millennium. after reviewing this fifteen year old article – except for a few changes in the “alphabet soup” of names given to various healthcare delivery models of the time – i realized that the advice i would give today’s Dpms planning for the future remains the same. Those who followed this path have done well over the past decade and are well-positioned for the future. a great deal which makes this advice even more compelling today has been learned since 1998; fortunately, there is still time to make changes, but i don’t think any practitioner should wait another fifteen years.

PhysiCiaN Model 2000 (aPMa News,1998) The better we understand the future trends that will be affecting our practices, the

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easier it will be to recognize changes that we need to make in order to thrive in that environment. The goal of strategic planning is to seek answers to the questions: Where are we now? Where are we going? and How do we get there? The new millennium creates an ideal excuse for us to examine the future of the practice of medicine and to attempt an answer to those three questions for our individual practices.

Where are we now? finding where we are now is much like performing a medical exam. a patient arrives with symptoms. The doctor assesses the symptoms, conducts an examination, and makes a diagnosis. We understand that the best way to eliminate the symptoms is to make a correct diagnosis before we structure the “cure” for the underlying causative disease. Similarly, when determining the best way to “cure” a practice, we first need to assess the “symptoms” of both the external market and our practices, make a diagnosis, and then design the treatment plan.

The symptoms practicing physicians are experiencing include: loss of “control,” declining revenues, increasing overheads, decreasing time available to spend with

each patient, longer hours, poor cash flow, declining collection ratios, growing accounts receivables, longer patient waits, high staff turnover, insufficient funds to afford an associate, and difficulty on staying current with tasks such as dictation, referral letters, and returning patient calls.

These symptoms are exaggerated as patient and paper volumes increase; yet, the primary “curative” strategy employed by the majority of physicians is to continue increasing patient volume at ever-more discounted fees. it is easy to see why past attempts at “fixing” the healthcare system have failed. each failure could easily have been predicted in advance because past models have addressed the symptoms rather than the causes of problems related to cost and quality. understanding the needs of the market and the reasons for past failures is essential to developing a practice strategy that can effectively address the future. i strongly believe the environment of tomorrow will be essentially the same as the one we face today. What could be easier? it doesn’t matter whether we are reimbursed as salaried employees, through discounted fee-for-service/point-of-service plans, or through capitation. it doesn’t matter whether HmOs disappear or new entities surface to replace them. What is certain is that current managed care models are not meeting the market needs, and they will eventually have to change. all we need to do is focus on what is driving this market and determine what will be best for doctors, patients, and payers alike.

The conditions that created the need for managed care have not changed; in fact, every study projects they will continue to worsen. in order to be worth pursuing, any plan we implement must fully address the needs of the market. We must recognize that we face the same economic market issues that all industries face – pricecompetition and well-informed consumers demanding better service and seeking greater value. To remain in business, every industry has had to face these same issues and develop a plan for addressing them.

Competition will ultimately reward those who “figure out” how to effectively do this and punish those who don’t.

C p m a | C a l i f O r n i a p O D i aT r i C m e D i C a l a S S O C i aT i O n

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Why are patients unhappy with their HmOs? Doctors would like to attribute their discontent to quality of care; however, the typical complaints are not about quality of care. patients love their doctors and feel they are getting good care – at least, when they are able to get it. The American Medical News’ September 27, 1999, headline reads, “pOS patients are happier, HmO patients are not.” This article quoted a national survey which revealed that, “HmO plan members are happy with their doctors but increasingly dissatisfied with pharmacy benefits and customer service.” patients consistently complain about the quality of service – such as access to care, delays in getting care, and long waiting times at the time of care. Consider also the cover story for the October 7, 1999, issue of USA Today entitled “rethinking managed Care.”

The article stated, “it’s delays in getting care, denial of specific treatments, and paperwork that has americans asking for change.” neither the traditional feefor-service nor the HmO practice model has solved problems related to quality of service. One reason for this is that poor service has never been seriously addressed. physicians ignored the complaints when they were paid at higher rates; yet, they cite today’s lower rates when explaining why they are unable to provide superior service. a 1994 article published in Physician Manager listed patients’ top four concerns as: 1) physician listening and explaining skills, 2) amount of time spent at office visits, 3) amount of time required to get an appointment, and 4) efficiency and courtesy of non-medical staff. every subsequent study i have seen basically duplicates these same results. Quality of care does not make the “top four” because patients feel they receive quality care. rather than addressing patients’ concerns, managed care added several new ones to the list – such as a lack of choice of physicians and barriers faced when attempting to access specialists. planning strategy for the next millennium must solve these service issues. importantly, addressing them will create a long-term strategic advantage. any strategy able to address these patient concerns will “win” – especially when it can be shown that the “cure” for these patient concerns is a p r i l | m ay | j u n e | 2013

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the same one that will cure the entire list of physician practice “symptoms.”

Where are we going? answering this question is as simple as knowing what our customers want and figuring out how to deliver it in a price competitive environment, while still making a profit. reducing waiting times in order to meet our customers’ need for better service correlates with meeting our own need to reduce overhead and increase revenue. Both are accomplished through the implementation of an efficient infrastructure. “fixing” our old infrastructures to support better strategies should be our highest priority. The best strategy for practice growth is to focus on the needs of both the doctor and the patients. a recent article in the October 28, 1999, issue of The Wall Street Journal entitled “a CeO Tussles With a jam in Xerox machine” presented an example that illustrates the relationship between operational efficiency and long-term strategic issues.

The article stated, “a rapid consolidation of billing centers has left Xerox sales people spending as much as 40% of their time getting orders right and answering billing questions. That distraction has allowed rival, Canon inc., to gain market share and contributed to Xerox’s 11% profit drop and flat revenue in the third quarter.” Doctors and staff of medical practices that i have analyzed consistently spend at least 40% of their available productive time performing similar “wasted activities.” This not only lowers profitability and patient satisfaction, but reduces a practice’s ability to compete and grow into the future. experts all agree that the fragmented physician industry needs to consolidate if there is ever to be hope of creating economies of scale, eliminating redundancies and waste, reducing treatment variation, improving service quality, and delivering seamless care; however, attempts at accomplishing these things on a large scale have been as unsuccessful as Xerox’s attempts to consolidate its billing centers. While everyone has a pet theory to explain these failures, each one ultimately traces back to two basic causes − efficiency principles have not been employed correctly, and

physicians have not been involved. ppmCs, pHOs, ipas, and others thought they could bring management expertise and business discipline to medical practices and run those practices better and more efficiently than the doctors could; doctors were totally removed from the process.

This strategy didn’t work, and nothing will work until doctors are included in the process and work together to accomplish heathcare goals.

Doctors and staff are located at the points of care and service, and for this reason, it is necessary that they be an integral part of the “cure.” They currently function at these locations without benefit of the relevant tools, information, and expertise needed to create efficiencies (the majority of which must be applied at points of service). Since all clinical and financial data is generated at the points of care and services, and all clinical and business information needs to be accessible at these points where transactions occur, a relevant infrastructure that can “connect” points of care and service and make the management of practices from afar possible must be in place. also, a relevant infrastructure must include physician involvement. Some transactions need to be processed at decentralized locations while others are better centralized. in previous models, attempts were made to centralize all functions. This is the least efficient way to manage practices and reduces the ability to add value at the practice level. poorly designed infrastructures exaggerate inefficiencies for the following reasons: practice management and medical records softwares are not fully integrated, relevant information is not located at the points of care, points of service and care are not connected or integrated, larger scale does not necessarily increase economies, See DEJA voUS on Page 27

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appropriate data is not centralized, care is not managed at multiple locations, followup “falls through the cracks,” treatment variations are not reduced, outcomes are not measured, and practices are not managed effectively. managers simply have not been at the point of service where major efficiencies can be created. placing managers at these locations would simply be too costly. This has left managers to focus on financial matters rather than on operational problems. This is what created the symptoms that put larger practices and networks on the critical list.

The best clues as to the direction we should be going are coming from big employers who pay much of the medical costs and who originally pushed for managed care. a recent example cited in the October 27, 1999, issue of The Wall Street Journal under the headline, “your Health insurance for 2000: The Squeeze is on.” The article stated that, “after five years of stable prices, many managed care plans are raising rates abruptly in what they say is a response to feverish demand. When HmOs are being slammed by doctors, patients, Hollywood, and Congress, they can always count on support from the business community. But behind closed doors, that relationship is starting to fray.” laurel pickering, executive director of the new york Business Group on Health, stated, “employers are frustrated because managed care doesn’t seem to be working.” emma Hoo, senior manager for the pacific Business Group on Health, stated, “We’ve looked for efficiencies, but we’ve yet to see any.”

Big business’s discontent with managed care began several years ago. The best clue for doctors to take note of (as to strategic direction) came last year when a large business healthcare purchasing group in minnesota that had “tried everything” concluded that, “There will be no significant reform of managed care until the doctors get far more control over medicine and the economics of their practices.” i absolutely agree with this statement, but how do doctors get control when they are fragmented, working independently, “unconnected,” and often don’t trust one another? it should be easy for doctors to determine “where we should be going” when patients and payers keep a p r i l | m ay | j u n e | 2013

telling us what they need. Since business is about meeting the needs of customers and making a profit, doctors need to do both in order to succeed. This should provide the road map for answering the final strategic question.

How do we get there?

We know that our best strategy is to address and cure the causes of symptoms that patients, payers, HmOs, and doctors are suffering. To sum up patients’ needs: they want access and shorter waits. payers want competitive rates with less price inflation.

HmOs want predictable outcomes with less variation amongst doctors who treat the exact same condition, and doctors want less aggravation, greater autonomy to make decisions, and higher profit margins. meeting these needs and eliminating the wide array of symptoms each group suffers all require the same cure – the introduction of new infrastructures that will support dramatically more efficient and effective practice models. The technology and efficiency tools needed to accomplish this are currently available. The primary constraint to implementing change is doctors themselves; yet, there is no logical scenario that can address all needs without doctors taking charge and leading the way. unfortunately, the physician practice industry is fragmented, consisting mostly of individual doctors and small groups working independently – doctors who lack the necessary trust to work together. The benefits of collaboration are so compelling that, hopefully, doctors will refocus their strategy and seize the opportunity to create better models capable of addressing all symptoms.

Since no attempt to “force” collaboration from the top down has worked, it is clear that cooperation will have to start from the ground up with physicians working together. practices can be seen as links in a chain. By making each individual link stronger, the entire “collaborative chain” will be stronger.

This means that doctors can start today by focusing on their own practice needs. By making their own practices more efficient they will simultaneously be focusing on patient needs. This will increase profit margins for them and create shorter waits for patients. The next step is to consider merging two or more efficient practices. This

could be a merger under one roof or the merger of business operations of practices in multiple locations. This will further reduce costs by eliminating redundancies and will also reduce oversupply. Once multiple, efficient practices are working together as an integrated group practice, the challenge of treatment variation can be tackled through the employment of electronic medical records which are fully integrated with business management software. These practices can share the cost of a full time manager, will be able to manage care better, and will be capable of tracking outcomes and other important data through the use of proven treatment guidelines.

The potential opportunity in the practice of medicine is significant. With the use of mergers and well designed, fully integrated, digital infrastructures (ones that are connected to all points of service), profit margins could be 50 to 100% greater (without increasing volume).

These collaborative practices will have the capability of managing care and providing consistent outcomes regardless of practice location. They will also be able to coordinate care with other specialists who have developed similar models. an efficient infrastructure and a high level of patient satisfaction will provide a strategic advantage, accelerating any a group’s visibility and growth. This will be assisted by a technology and marketing budget more likely to be available to larger groups –with use of the internet being capable of leveraging this opportunity even further. practicing in an efficient group model will provide doctors with better hours and enable them to stay caught up with “paperwork” as it is created. many doctors (of all specialties) are in the various stages of making their practices stronger. These doctors will soon be ready to look for nearby merger and collaboration opportunities with distant practices. everything is in place for physicians to take back control of healthcare. They just need to recognize the opportunity of working with like-minded peers to “cure” problems. i suggest that the new millennium serve as the catalyst for every physician to evaluate his/her long-term strategy and determine if a change in direction is warranted and what that change should be. | 27

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A boARD WITH HEART Too Many DPM heroes To MenTion What would you do if you were hired and found out the Board was corrupt?”

So i was asked in December 1989. responding as a public administrator, i soon found the only questionable individuals were those making the accusations.

They had instigated legislative Hearings in 1988 alleging Bpm “selective enforcement.” aside from the one member resigning under a cloud in early 1990 (it was he who asked that question), the State Board of podiatric medicine members and staff were honorable and courageous.

They resembled Carl Sandburg’s advice: “be brave and truthful, keep your poetry and integrity.”

This tradition was set by those serving earlier, as Board members and consultants. Bpm’s solvency was guaranteed by an $800-renewal fee kicking in january 1, 1990. The residency requirement and oral clinical exam had accelerated your becoming a respected medical specialty. Bpm had dedicated corps of examiners and experts.

Still, to a person, the Board members felt in crisis. under ranting attacks at every meeting, they called in State police to maintain order December 8, 1989. By the second meeting in 1990 the three amigos causing the commotion stopped attending. One is now in prison.

By that time, we also settled a Superior Court pm case the aG had made a people’s action (with Bpm still footing the bill), embracing the risks of a jury trial for greater “client control.” The settlement won Bpm $420,000 in cost recovery, but being civil rather than administrative it brought injunctions, not discipline. enforcement had been erratic. Staff put out a four-page, no-cando apologia beginning, “There is a podiatrist in my community who is hurting people. Why don’t you do something?”

Cpma Board members asked the same thing when i first met them.

Bpm staff adopted a new mantra – “no Cover-ups. no Special Deals. no Selective enforcement.” We reviewed and refuted every allegation. We resolved to go by the book, with no-nonsense enforcement, reminding anyone expecting anything less that we were a State agency.

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JiM raThlesberger, MPa

later, Senator presley served two terms as Bpm president upon his legislative retirement.

We designed the “medical Board enforcement matrix report” that more than one mBC deputy director tried to kill. it brought unwanted scrutiny (“poking us in the eye!”) showing where cases were in the system and how long they had been there. “nobody supports this,” the deputy executive director spit in my face, “except you and your wife!”

He was referencing my colleague at the Hearing aid Dispensers examining Committee, not imagining Board members could possibly support it as well. a chief deputy director of DCa commented, “Board members believe what their executive officers tell them.”

The Department and a public interest group urged backing off— suggesting it was counterproductive. The Bpm Board members wouldn’t have it, and the matrix is now a management staple. professional staff used it to clean up the mBC data base so the chiefs now have accurate data for management and reporting. previously, the jumble of numbers was seen as a refuge. accountability was perceived as a threat, not a tool for building credibility. “This is our data!” one exec said. To one legislative request, they submitted a moving box full of unintelligible computer printouts. “They want data. We’ll give it to them!” returning to California after 20 years in Washington, DC and new york, i was taken aback by the professional discrimination as well as the management mindset of the medical Board at that time. a Hispanic member of our Board pulled me aside after one incident saying, “jim, you are going to learn in this job what it is like being a person of color.”

But soon Bpm was no longer seen as “podiatrists protecting podiatrists,” and podiatrists were being viewed as physicians. jim “Walk your Talk” Conran, a case study as DCa Director, said in 1992, “This is a model Board . . . setting examples i wish other boards would follow.”

One was national leadership strengthening Dpm training programs. This began in the early 1990s when the law restricting Dpm postgraduate training to two years jeopardized those going into third-year rotations, more and more common.

We instituted a 24-hour rule for reviewing consumer complaints, rather than letting them sit for months.

With support from the Department and senior staff of the Senate Business and professions Committee, the Governor signed the Board’s bill extending the two years to four, over bitter opposition.

We changed the management culture, and sought the same at the medical Board, and even our Department of Consumer affairs (DCa).

The deal involved an mBC review of podiatric training programs that one senior physician privately allowed later was expected to result in shutting them down. rather, the Nelson-Medio Report

We were the first State agency to support the presley bills beginning with SB 2375 of 1990 to reform physician discipline. a p r i l | m ay | j u n e | 2013

See BoARD WITH HEART on Page 31

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(Bpm insisted on a joint study co-authored by franklin medio, phD with Tom nelson, mD) recommended further strengthening, and transitioning to health science teaching centers.

“We asked you to do an objective study! Why are these results so rosy?” sputtered one red-faced medical Board member.

Taking the report to heart, buoyed with hope, Bpm initiated the California liaison Committee and uC access Committees. ClC continued under Cpma’s leadership working with the schools, organized medicine and the leaders of our tax-supported, State health science teaching centers.

We are seeing results today, and Cpma is working for more. nationally, not just in California, the residencies are now threeyear minimum and include all the nelson-medio recommended components.

Back at the medical Board, with allegations of shredding its complaint backlog, and 60 Minutes sinking his predecessor, executive Director Dixon arnett, a close associate of Governor Wilson, was perhaps the best ever at mBC and the leader we were looking for. He rejected circling the wagons, and being defensive, reactive, passive, protected by the clout of medicine, taking the hits for the status quo and path of least resistance, knowing little would happen anyway except more bad press, erosion of credibility, and loss of public confidence.

We had outreached as supportively with the prior exec as we did with arnett. But as “the family” dug in its heels, and Bpm stayed with outsiders seeking change, we were labeled disloyal. Dixon was told, “Don’t trust jim.”

We looked to the Code of Ethics adopted by Congress in 1958, “put loyalty to the highest moral principles above loyalty to persons, party, or department.” and we presented awards to some of the exemplary rank and file—people like now-retired investigators ron Olson, Ted maurino, and joan jerzak, naming a few of many.

Dixon said, “The Bpm does not follow but, in fact, leads.”

He argued against the grain that licensing boards are not mD or Dpm organizations, but State agencies. We are chiefly accountable, he said, not to the professions, but to the public through its elected representatives. He saw public agencies acting properly in a fishbowl of scrutiny, not hunkered down keeping a lid on things.

and the recommendations made by Bpm during the sunset review process continue this trend and are worthy of serious consideration,” said the joint legislative Sunset review Committee in 1998.

Bpm became the first and still only doctor-licensing board in the country to implement a Continuing Competence program. We became the first and still only one in California to write primary source verification into our statute. We became the first and only to implement the Department’s public disclosure standards, over bureaucratic resistance.

Throughout, almost without exception, the Bpm Board members led and stood firm. neither depositions and 25 law suits in one case, nor an investigational cover-up in another, checked by the Sacramento Bee somehow getting the story, nothing, ever unsteadied the decks.

The Board stewarded Bpm, to which so many have contributed, the institution being larger than all of us as individuals.

With Cpma’s landmark aB 932 (Koretz) of 2004, Bpm became the first and still only doctor-licensing board in California requiring two years of post-graduate training for licensure, reflecting the longheld view of medical educators that one is insufficient. paul Koretz served on Bpm between his time in the legislature and the la City Council. a magnet for leaders, Bpm was also led in turn by anne Kronenberg, portrayed in the movie Milk. aB 932 carried another Bpm provision from the federation of podiatric medical Boards’ Model Law. it authorizes Dpms, as part of your scope, to function outside of that scope as assistant surgeons.

This recognized the need of physicians and facilities for collegial collaboration for the benefit of efficient, quality patient care, and the fact that Dpms are like other medical specialists regardless of degree. recently, SB 1236 of 2012, increasing the cap on Dpm postgraduate training from four years to eight, rather than sunsetting it altogether as approved by the Business & professions Committees in both houses, was another compromise en route.

We compromised on legislation to move forward, but our principles are intact for fighting another day.

Staying on the high road, we will keep our poetry and integrity.

aiding arnett, Conran had the Governor appoint Bpm president Karen mcelliott out of San Diego to the medical Board. Though some protested “she is not a physician!,” Karen became an mBC insider, the only person ever to serve as president of both boards. a strong period in the mBC’s history lasted throughout her and Dixon’s tenure and that of another thoughtful public member-Bruce Hasenkamp of San francisco.

“Bpm is operating efficiently and is carrying out its mandate for public protection effectively. . . . Bpm is a consumer protection leader among the Department’s occupational licensing boards, a p r i l | m ay | j u n e | 2013

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CPMA SToRMS THE CAPITolS – WA The California podiatric medical association is proactive on both the state and national levels educating legislators about the critical role podiatric physicians play in healthcare delivery; the importance of patient access to treatment and care by podiatric physicians in order to save both lives and limbs, and the recognition of doctors of podiatric medicine as physicians and surgeons based on their education and training.

CPMA Executive Director Jon Hultman, DPM, MBA (r) with Assemblyman Richard Pan (c) and CPMA Legislative Counsel Barry Broad, Esq (l) at the State Capitol

CPMA Immediate Past President William Tarran, DPM (r ) with CSPM Student Kevin Grenier, CPMA President-Elect Carolyn McAloon, DPM and her son Andrew visiting legislators during APMA’s Legislative Leadership Conference

Ami Sheth, DPM, Secretary-Treasurer and Rebecca Moellmer, DPM, Director at the Capitol Building in Washington DC, during APMA’s Legislative Leadership Conference.

Rebecca Moellmer, DPM and Western University College of Podiatric Medicine student Byron Peck-Collier 32 |

At APMA Leadership Conference Western University College of Podiatric Medicine students Byron Peck-Collier (l) and Travis Weber C p m a | C a l i f O r n i a p O D i aT r i C m e D i C a l a S S O C i aT i O n

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S HINGToN, DC AND SACRAMENTo

CPMA Past President Michael Cornelison, DPM (l) and Vice President Thomas Elardo, DPM, outside the Capitol Building.

Jon Hultman, DPM, MBA; Assemblyman Steve Fox and Lee Rogers, DPM

William Tarran, DPM; Congresswoman Jackie Speier and Kevin Grenier a p r i l | m ay | j u n e | 2013

Byron Peck-Collier, Travis Weber, Congressman Mark Takano, Ami Sheth, DPM and Rebecca Moller, DPM

California State Senator Fran Pavley and Lee Rogers, DPM

Thomas Elardo, DPM; Senator Barbara Boxer, and Michael Cornelison, DPM

Rebecca Mollemer, DPM; Byron Peck-Collier, Travis Weber and Ami Sheth, DPM | 33

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2012/2013 BoarD oF DireCTors PresiDenT Karen l. Wrubel, Dpm Hawthorne, Ca 90205 p: (310) 675-0900 drkw@cox.net

DireCTors john a. Chisholm, Dpm Chula Vista, Ca. 91910 p: (619) 427-3481 dr_triguy@yahoo.com

PresiDenT-eleCT Carolyn e. mcaloon, Dpm Castro Valley, Ca 94546 p: (510) 581-1484 drmcaloon@bayareafootcare.com

Devon Glazer, Dpm newport Beach, Ca 92660 p: (949) 272-0007 drdev01@yahoo.com

ViCe PresiDenT Thomas j. elardo, Dpm los Gatos, Ca 95032 p: (408) 358-6234 painfulfeet1@gmail.com iMMeDiaTe PasT PresiDenT William Tarran, Dpm Daly City, Ca 94015 p: (650) 757-3338 wtarran@sbcglobal.net seCreTary-Treasurer ami a. Sheth, Dpm los Gatos, Ca 95032 p: (408) 358-6234 amishethdpm@gmail.com

rebecca a. moellmer, Dpm San Bernardino, Ca 92404 p: (909) 886-3668 rebeccamoellmer@hotmail.com Thomas j. Tanaka, Dpm Ontario, Ca 91761 p: (909) 724-5052 drtanaka@doctor.com jonathan j. uy, Dpm Hercules, Ca 94547 p: (510) 724-4674 flipdpm@sbcglobal.net sTuDenT rePresenTaTiVes nathan Hansen (CSpm) p: 510-909-2264 nathan.hansen@samuelmerritt.edu

exeCuTiVe DireCTor jon a. Hultman, Dpm 2430 K St Ste 200 Sacramento, Ca 95816 p: (916) 448-0248 (800) 794-8988 f: (916) 448-0258 Cpma fax jhultman@calpma.org General Counsel C. Keith Greer, esq.

San Diego, Ca 92128 p: (858) 613-6677 greerkeith@aol.com GoVernMenTal rePresenTaTiVe Barry Broad, esq.

Sacramento, Ca 95814 p: (916) 442-5999 broad@bglaw.org ParliaMenTarian/ reCorDinG seCreTary roderick farley, Dpm/ albuquerque, nm 87122 drrodfarley@gmail.com/ rodnedrafarley@aol.com

Binoy Sheth (Western u) p: (832) 483-9278 bsheth@westernu.edu

2012/2013 CoMPonenT soCieTy PresiDenTs MonTerey Bay area Bobby yee, Dpm monterey, Ca 93940 p: (831) 646-8242 yeedoc@comcast.net

san FranCisCo/san MaTeo David Tran, Dpm San francisco, Ca 94127 p: (415) 681-2022 DTran@samuelmerritt.edu

CenTral Valley Clifford endo, Dpm modesto, Ca 95355 p: (209) 544-6088 endoc@sutterhealth.org

norThern CaliFornia Kaiser Thomas DaSilva, Dpm Walnut Creek, Ca 94596 p: (925) 295-7099 thomasdasilva@hotmail.com

san luis oBisPo/sanTa BarBara David Sterling, Dpm Santa maria, Ca 93455 p: (805) 928-5645 sterlingfamily4@gmail.com

CoaChella Valley Harvey Danciger, Dpm palm Desert, Ca 92260 p: (760) 568-0108 docofeet@hotmail.com

oranGe CounTy Gregory eirich, Dpm Tustin, Ca 92780 p: (714) 669-1780 eirichdpm@sbcglobal.net

sanTa Clara Valley adam Howard, Dpm Cupertino, Ca 95014 p: (408) 446-5811 footdoc4u@gmail.com

inlanD jeffrey Bruening, Dpm pomona, Ca 91766 p: (909) 622-4501 brueningdpm@yahoo.com

reDWooD eMPire paul Weiner, Dpm Vallejo, Ca 94590 p: (707) 643-3687 mdweiner@scrserv.com

shasTa reGion Gordon Shumate, Dpm redding, Ca 96001 p: (530) 246-4800 g.shumate.dpm@frontiernet.net

los anGeles CounTy Vladmir Zeetser, Dpm encino, Ca 91316 p: (818) 907-6100 drzeetser@gmail.com

saCraMenTo Valley mark Warford, Dpm fair Oaks, Ca 95628 p: (916) 548-0218 markwarforddpm@att.net

souThern CaliFornia hMo anthony Cannizzaro, Dpm pasadena, Ca 91188 doctoracann@aol.com

MiD-sTaTe richard motos, Dpm Visalia, Ca 93291 p: (559) 734-1171 moetoes@hotmail.com

san DieGo/iMPerial Kenneth Charp, Dpm Carlsbad, Ca 92007 p: (760) 931-9353 zfootdr@roadrunner.com

alaMeDa/ConTra CosTa CounTy Timothy Dutra, Dpm 450 30th Street p: (510) 869-6511 x7564 tdutra@samuelmerritt.edu

VenTura CounTy Heather mcGuire, Dpm Ventura, Ca 93003 p: (805) 648-2016 drhmcguire@me.com

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’s name. For editorial or business information and advertising, contact California Podiatric Medical Association, 2430 K Street, Suite 200, Sacramento, California 95816; telephone, (916) 448-0248; facsimile; (916) 448-0258; e-mail; calpma.org.

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WoRkPlACE oR HEAlTHy The other day as i was taking a patient’s copayment she said to me, “you guys sure do seem to have a lot of fun here.” i replied, “Since we all need to work and we are here more than we are at home, this has to be a place where we can have fun and enjoy each other and what we do; otherwise why would we want to be here?” it wasn’t too many years ago when if the office staff was heard laughing that the treatment room door would open and they would hear the words, “if there is that much laughter going on out there, then work must not be.” This was and still is a common thought among employers, supervisors, and managers, but the contrary is true. research at California State university long Beach showed that people who have fun at work are more creative, more productive, work better with others, and call in sick less often - not bad benefits for a little bit of humor.

Creating a culture in the workplace where levity is part of the makeup is a topic of great study at this time. findings show that when people who work together laugh, their relationships grow closer. for laughter to occur there has to be an understanding that is built on a relationship between the sender and the receiver. We all know what it is like when you say something funny to someone and the other person does not laugh; there was not a connection with that person and with what you were trying to transmit. it is the emotional connection, the shared meaning between the sender and receiver, that is the key. There is an intimacy in humor when you laugh with someone; it is a bond that says, “i understand what you are saying. i get it”. adrian Gostick in his book The Levity Effect states that humor scholar William Hampes noted in two influential studies that close interpersonal relationships are forged and strengthened through humor. in addition to reducing stress, humor promotes feelings of comfort, and as a by-product, humor increases empathy. Hampes found that individuals who laugh more

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HuMoR: HAzARDouS ? tend to have more positive, productive relationships. He also demonstrated a correlation between humor and trust: two dynamics of relationships we are all trying to foster at work and at home. not only are levity and laughter important in our workplace to help cultivate our relationships with co-workers and patients, but it is also very good for our health. lee Berk, DrpH, mpH from loma linda university School of medicine (Google him for more info) has done research on laughter and its effects on our health. Dr. Berk’s research on laughter began in the late 1970’s. His studies on exercise showed that it not only boosted the immune system, it also decreased stress hormones in the body. He thought laughter might have similar effects. This led him to begin studies with Dr. Stanly Tan (loma linda university of medicine) and Dr. William fry (Stanford university). The outcome of these studies

proved that laughter increases the immune system’s activity by doing the following: • natural killer cells increase in number and activity.

• more T cells are activated than normal.

• The antibody immunoglobulin a increases.

• Gamma interferon increases. This cytokine tells different components of the immune system to turn on.

• immunoglobulin G (the immunoglobulin produced in the greatest quantity) and Complement 3 (which helps antibodies pierce dysfunctional or infected cells) increase both during laughter and the next day.

• in general, stress hormones which actually constrict blood vessels and suppress immune activity decrease in the body as a result of laughter.

What great benefits from just a good belly laugh! We all know that when we are having fun, enjoying what we do and who we are doing it with that we naturally feel good. Humor causes us to be less on edge and increases our ability to handle encounters better.

Over the past several years as we began to lighten up in our office we have noticed how much more our patients enjoy coming to see us, not that they did not like the care they had been receiving before. The difference is that they really enjoy coming to see us now; they have fun while they are here with us.

We really go all out for the holidays, decorating the office, dressing up for Halloween and birthday themed parties, and having patient raffles. We also create our own fun themes for no reason like pink flamingo days or under the Sea week. Our patients love what we do. many times they just stop by to say hello and see what the theme of the month is, or they bring the grandkids in for a look at the office after they have had an appointment because of the fun theme. When our office is just normally decorated, patients will ask what’s up and want to know what we are going to be doing next. This makes us all feel good about what we do, and we have fun doing it for our patients and ourselves.

Bringing levity to our office has changed our culture, the staff/doctor team is closer, our work ethic is excellent, the practice has grown with patient referrals, and on monday mornings you will hear “i am glad to be here” from each one of us - and we truly are. Try a little levity in the office - your patients and staff will enjoy the lightness and laughter it will bring. i will leave you with one of my personal mottos: “life is too short not to have fun at work,” and it’s healthy, too.

a p r i l | m ay | j u n e | 2013

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MEMbERSHIP HAS ITS bENEFITS CPMA is the only organization that lobbies on behalf of the podiatric profession in California’s capitol. in addition to realizing the accomplishments that only strong organization and representation can achieve, there are a number of immediate and tangible benefits only members of Cpma, apma, and the iBT union can access and receive.

not a Member? Join now!

With convenient payment plans and a simple application process, CPMa makes it easy to join. apply online today at www.calpma.org/membership or complete the form below.

CPMa membership gives you access to the following: • Significant discounts for educational • Regional support through State and Local conferences and courses, including activities The Western, which provides 25 CMEs • Convenient automatic monthly payment including units to meet California Radiology option requirements • Online Radiologic Manual, required by the • Discount on malpractice insurance premiums State of California • E-subscription to the DPMemo, CPMA’s • California Resident-to-Practitioner “how to” monthly email newsletter plus eAlerts as handbook - coming soon news you need to know arises • Discounts on wireless service • Free subscription to the California Podiatric • Car rental, travel, and entertainment Physician and JAPMA discounts • Free and discounted legal advice and • Vacation tours savings to destinations across support the globe • Representation to CMS and insurance carriers • Theme park discounts via 20+ committees • Loan and mortgage programs • Webinars with CMEs available 24/7 • Health program savings – save on vision and • Access to tools for managing and marketing dental care and more your practice online • Plus many more discounts and opportunities • Networking and knowledge-sharing for your professional and personal benefit! opportunities with other DPMs

APPlICATIoN FoR MEMbERSHIP First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M .I . . . . . . . . . . . . Professional licensure Podiatric Medical Licenses Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Year . . . . . . . . . . . State . . . . . . . . . Number . . . . . . . . . . . . . . .

Year . . . . . . . . . . . State . . . . . . . . . Number . . . . . . . . . . . . . . .

Previous Last Name (if changed due to marriage, divorce, etc .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Year . . . . . . . . . . . State . . . . . . . . . Number . . . . . . . . . . . . . . .

Birth Date . . . . / . . . . / . . . . Sex:  Male  Female Have you ever had a license to practice podiatric medicine suspended or Practice Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Owner  Employee revoked in any state?

Home Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Home Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Home Fax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 yes  no If yes, please explain on a separate sheet .

Are you currently, or have you ever been, on probation suspension, or Principal Office/Residency Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . investigation by any licensure authority, state or federal agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  yes  no Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If yes, please explain on a separate sheet .

E-Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Professional Medical Practice Secondary Office/Residency Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Original Start of Practice Date (Mandatory) . . . / . . . / . . .

Please submit a copy of ALL state licenses with this application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Podiatric Medical Education

Podiatric Medical Degree  yes  no E-Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Podiatric Medical College . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . unless you are in a residency program, please forward your completed application directly to the Year of Graduation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

California podiatric medical association at 2430 K Street, Suite 200, Sacramento, Ca 95816, or fax to (916) 448-0258. if you are applying for resident membership, please forward your application directly to apma at 9312 Old Georgetown road, Bethesda, mD 20814.

FoR MoRE INFoRMATIoN oN MEMbERSHIP, PlEASE CoNTACT THE CAlIFoRNIA PoDIATRIC MEDICAl ASSoCIATIoN AT (800) 794-8988 oR JSTEED@CAlPMA.oRG. a p r i l | m ay | j u n e | 2013 | 37

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SPRING ClEANING: WHAT To kEEP AND WHAT To ToSS

RETENTIoN oF TAx RECoRDS it’s that time of year that businesses and individuals start to clean and want to toss old unnecessary documents. There are a few items to consider as you start your spring cleanup. records may have to be produced if the irS (or a state or local taxing authority) was to audit your return or seek to assess a tax. in addition, lenders or other parties may require that you produce copies of your tax returns as a condition to lending money, approving a purchase, or in doing other business with you.

Keep returns indefinitely and the supporting records for six years. Generally, except in cases of fraud or substantial understatements of income, the irS can only assess tax within three years of that year’s filing. (for the state of California, this is four years). for example, if your 2012 individual income tax return is filed by april 15, 2013, the irS will have until april 15, 2016 to assess a tax deficiency against you. if you file your return late, the irS generally will have three years from the date you filed to assess a deficiency.

However, the three-year rule isn’t ironclad. The assessment period is extended to six years if more than 25% of gross income is omitted from a return. in addition, the irS can assess tax at any time (even beyond three or six years) if no return was filed for a tax year.

Keeping a copy of the return will help to refute this claim.

While it’s impossible to be sure that the irS won’t assess tax at some point, retaining tax returns indefinitely and important records for six years after filing should, as a practical matter, be adequate.

The backup to the returns, including all bank statements, general ledgers, checks and supporting documents, can generally be destroyed after six years.

Records relating to property may have to be kept longer. The tax consequences of a transaction that occurs this year, such as a sale of property, may depend on events that happened years ago.

The period for which you should retain records must be measured from the year in which the tax consequences actually occur.

When new property takes the basis of old property, such as in a like-kind section 1031 exchange or trade-in, records relating to the old property should be kept until six years after the sale of the new property is reported. for example, suppose you bought a car for business use in 1999 and you traded it in on a new car for business use in 2002. if you sell that car in 2013, your basis in the car will determine whether you have a tax gain or loss on the sale, and your basis in the car is determined, at least in part, by your basis in the car you traded in for it in 2002. accordingly, records relating to your old car should be kept until 2020 (six years after your 2013 return is filed in 2014).

Similar considerations apply to other property that is likely to be bought and sold—for example, stock in a business corporation or in a mutual fund, bonds or other debt securities, etc. in particular, remember that if you reinvest dividends to buy additional shares of stock, each reinvestment is a separate stock purchase. The records of each reinvestment should be kept for at least six years after the return is filed for the year in which the stock is sold.

Because the calculation of the casualty and theft loss deduction is determined in part by your basis in the damaged or stolen property, you’ll need to have records to support that basis, until six years after you file the return claiming the loss deduction.

Loss or destruction of records. To safeguard your records against loss from theft, fire or other disaster, you should consider keeping your most important records in a safe deposit box or other safe place outside your business or home. in addition, consider keeping copies of the most important records in a single, easily accessible location so that you can grab them if you have to leave your business or home in an emergency.

Scan and backup. Consider scanning all records over two years old and retaining them electronically at an offsite location or in a cloud based solution. This saves on space and protects the records from loss or destruction. make sure that the scanned documents are complete and make multiple electronic backups of the scanned documents to ensure they are accessible when needed.

darla a. ColsoN, CPa, MsT, shareholder gilberT assoCiaTes, i NC., CPas aNd advisors gilberT fiNaNCial serviCes, llC 38 |

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oN youR ToES HElPIng EnsuRE lIfE- AnD lIMb- sAVIng ACCEss TO PODIATRIC PHysICIAns (HEllPP) ACT Dear California podiatric physicians, On Thursday, april 25, 2013 u.S. representatives lee Terry (r-ne) and Diana DeGette (D-CO) introduced the Helping Ensure life- and limb- saving Access to Podiatric Physicians (HEllPP) Act (H.R. 1761). a Senate companion bill is expected to be introduced in the next couple of weeks. as you know, this legislation is of critical importance to podiatric medicine because it would finally bring parity for our profession under the medicaid program by recognizing Dpms as “physicians.”

This year’s bill also adds a new medicare section, to improve coordination of care in medicare’s therapeutic shoe program for diabetic patients. and the legislation contains for the first time an actual budget offset, which would strengthen medicaid program integrity by closing a long-standing tax loophole allowing tax-delinquent medicaid providers to still receive full medicaid reimbursements. please take a few minutes today to visitapma’s e-advocacy page (link available on Cpma homepage under issues and advocacy), and send a pre-written message to your elected lawmakers asking that they cosponsor the Hellpp act (H.r. 1761).

Thank you for taking this time to benefit our specialty.

Karen Wrubel, Dpm president CMS ISSUES TEMPoRARy DELAy oF IMPLEMENTATIoN oF oRDERINg AND REFERRINg DENIAL EDITS Due to technical issues, the Centers for medicare and medicaid Services (CmS) has temporarily delayed implementation of the ordering and referring denial edits originally planned for may 1. a new implementation date has not yet been announced.

Despite the delay, the California podiatric medical association is urging members who refer or order services for medicare beneficiaries to enroll with medicare now and not to wait. When the edits are turned on, claims will be denied if the ordering/referring physician does not have an enrollment record.

CmS began notifying ordering/referring physicians of the need to enroll in medicare in October 2009. enrollments can be completed via the online provider enrollment, Chain, and Ownership System (peCOS) or by completing a paper enrollment application (applicable CmS-855).

Doctors can confirm whether a referring or ordering provider is enrolled by downloading a report of all eligible practitioners who have current enrollment records from the CmS website. The report is updated weekly. (sourCe: CMaNeT 3/25/2013) IN MAJoR REvERSAL, CMS HAS BEgUN CoNDUCTINg PER-PAyMENT AUDITS BEFoRE RELEASINg 2013 EHR INCENTIvE PRogRAM BoNUSES The Centers for medicare and medicaid Services (CmS) is performing pre-payment audits —in addition to the post-payment meaningful use audits that started last summer—before mailing out some bonus checks. CmS says the audits affect a random sampling of 5% to 10% of incentive applications. according to CmS, the pre-payment audits began with attestations submitted during and after january 2013, in addition to pre-payment edit checks already built in to the eHr incentive programs’ systems. The audits may target suspicious data, says CmS, and providers selected for audits will have to provide data to back their attestation or validate their submitted data before CmS will release their bonus payment. providers selected for audits will receive a letter from CmS’ contracted Cpa firm, figliozzi & Co. an initial review will follow, using data provided to CmS in a response to the audit notice from the provider. On-site reviews may follow in some cases and could include a demonstration of the provider’s eHr system. any providers who are found to be ineligible for their bonus may initiate an appeals process, CmS says. a p r i l | m ay | j u n e | 2013

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oN YoUR ToES fram Page 39

according to CmS, providers should retain back-up documents that support their previously submitted meaningful use data for 6 years. any back-up document is fair game for figliozzi to request. in addition, providers should be prepared to capture dated screenshots — copies of what appears on a computer screen — that document, for example, a test exchange of patient data with another clinician or any other software function that figliozzi wants to verify. after an initial review of the submitted documents, figliozzi may request additional information and even visit a doctor’s office or hospital to see a demonstration of its eHr system, according to CmS. if figliozzi determines that a healthcare provider did not meet CmS meaningful use requirements after all, CmS will stop payment of the bonus. furthermore, CmS may take legal action against providers that fraudulently attempted to collect the money. any providers who are found to be ineligible for their bonus may initiate an appeals process, according to CmS. (sourCe: roberT lowes, MedsCaPe, aPril 8, 2013/raChel ZiMliCh, MediCal eCoNoMiC, MarCh 27, 2013) ANTHEM BLUE CRoSS To PAy PRovIDERS FoR UNDERPAyMENTS anthem Blue Cross agreed to a $3 million settlement for underpayment of interest on late claims to providers.

The California Department of managed Health Care announced a $3 million settlement withanthem Blue Cross over underpayment of interest on late claims to providers.

The agreement, which includes penalties, relates to services provided between july 1, 2007 and april 30, 2011. approximately 5000 providers will be receiving payment as part of the settlement, with 85 percent of them receiving less than $100, according to anthem. The company estimates the total pay-out at $3.2 million. anthem must make payments, with appropriate penalties and interest, within 120 days. The company also is required to make changes in its claims payment and provider dispute processes, including improved training and auditing procedures to ensure claims are paid appropriately. (sourCe: saCraMeNTo busiNess JourNal 4/24/13) DUALS DEMoNSTRATIoN gETS gREEN LIgHT FRoM FEDS Department of Health Care Services (DHCS) and CmS have signed a “memorandum of understanding” ((mOu) that serves as the framework for moving forward with the demonstration project, which aims to redesign care for medicare/medi-Cal dual eligibles.

The centerpiece of the project is requiring dual eligibles to enroll into medi-Cal managed care plans.

The project, previously known as the “Coordinated Care initiative,” will now be called Cal mediConnect. The eight counties in the demonstration project are alameda, los angeles, Orange, riverside, a p r i l | m ay | j u n e | 2013

San Bernardino, San Diego, San mateo and Santa Clara.

Cpma joined with a number of other stakeholders to express concern over the projects large size, rapid time line set for implantation, overall complexity and its potentially detrimental impact on the frail medi-medi population, which suffers from multiple chronic conditions and for whom such a transition could be very difficult. as a result a number of changes were made The state originally wanted to include 800,000 people in the demonstration project. That number has been cut back to 450,000 Californians eligible for Cal mediConnect. in los angeles County, where 275,000 of those eligibles live, the agreement sets a maximum cap of 200,000 people who can be enrolled in the demonstration project.

The agreement also delays the planned launch to October 2013.

State officials had hoped to start in September. it also excludes the state’s request for a six-month lock-in period for enrollees.

The California podiatric medical association (Cpma) is analyzing the mOu. Cpma has created a Duals resource Center on the association’s website that is designed to help keep members abreast of developments in the demonstration project and to provide resources for patients, who are permitted to opt-out of the project for their medicare services.

(CaPiTol desk; CaliforNia healThliNe 3/28/13) SEqUESTRATIoN CUTS CASTS LoNg SHADoW ovER REIMBURSEMENT RATES as noted in the january/february/march 2013 issue of The California Podiatric Physician providers will not only be hit with a 2% reduction in medicare reimbursement rates, but that the 2 per cent reduction would also be applied to medicare eHr incentive payments for reporting periods ending on or after april 1, 2013 (if the last day of the reporting period occurs before april 1, 2013, those incentive payments will not be subject to the reduction.) medicaid (medi-Cal) is exempt from the sequestration cuts. additionally, Cpma has recently learned that aetna, anthem Blue Cross, Health net and united Healthcare are passing on the 2 per cent sequestration cuts to physician payments for medicare advantage patients.

PALMETTo’S CoNTRACT CHALLENgE FAILS IN CoURT The u.S. Court of federal Claims has tossed out a suit brought by palmetto GBa llC and CGS administrators llC who lost a $373 million medicare administrative contract, following the u.S. Government accountability Office (GaO) rejection of their bid protest of the award to noridian administrative Services llC. The court dismissed the case brought by the two contractors, which protested the u.S. Department of Health and Human Services’ decision to choose noridian to provide administrative services for medicare part a and medicare part B fee-for-service benefit claims for jurisdiction 1, which includes California.

See oN YoUR ToES on Page 56

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CPMA,

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IT PAyS To bE A CPMA MEMbER Discounts on registration for The Western – The largest podiatric medicine, management and exhibition West of the mississippi up to 15% off your annual piCa professional liability insurance Cpma dues are tax deductible Cost of being listed on the state (Cpma) and national (apma) Find-a-Podiatrist websites – included in membership (not available to non-members) Cost of mini-practice website hosted by Cpma – included in membership (not available to non-members) Cost of peace-of-mind in having Cpma’s professional team there for support when a payor is engaging in discriminatory or improper reimbursement practices, scope of practice rights are being denied, or when there’s the unexpected knock at the office door…

PRICELESS!

WHo WIll Do IT? Once upon a time there were four podiatric physicians named everybody, Somebody, anybody and nobody. They were involved in an important California podiatric medicine campaign. everybody was asked to contribute. everybody was sure Somebody would do it. anybody could have done it, but nobody did. Somebody got angry because it was everybody ’s job. everybody realized that anybody could do it, but nobody realized that everybody would do it. So, everybody blamed Somebody, when nobody did what anybody could have done.

To help ensure that the job does get done, please send your contribution today to CalppaC, a non-profit, non-politically-aligned organization run for California’s doctors of podiatric medicine for the betterment of California’s doctors of podiatric medicine.

Checks should be made to: CalppaC 2430 K Street, Suite 200 Sacramento, Ca, 95816 To use your ViSa, masterCard or amex call (800) 794-8988.

Help CalPPAC in its ongoing efforts to help yoU! a p r i l | m ay | j u n e | 2013

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Prescribed byy D Dermatologists ermatologists and Podiatrists1

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References: 1. IMS Health, NPA June 2012.

NAFTIN is a registered trademark of Merz Pharmaceuticals LLC. Š 2012 Merz Pharmaceuticals LLC.

All rights reserved

10/12

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WHAT HAS CPMA EVER DoNE FoR ME?

for over 100 years, the California podiatric medical association (Cpma) has blazed the way for virtually every step of progress made by California’s podiatric medical profession – moving it from a peripheral medical skill to mainstream medicine and enhanced standing in California healthcare system. Here are just a few of Cpma’s hard fought victories on your behalf:

• The right for a podiatric physician acting within his or her scope of licensure to prescribe orthotic or prosthetic devices covered by the patients health plan

• The right to perform independent h & Ps

• JCaho recognition of podiatric physicians as qualified members of hospital staff

• The right to perform amputations • The ability to assist an MD or Do in surgery outside scope of practice • The right for podiatric physicians to perform surgery within scope of practice • The right for limited license podiatric x-ray technicians to take digital x-rays

• The right to prescribe prescription medications • The right to administer local anesthetics

• The right to perform, read and interpret x-rays • The Veterans administration inclusion of podiatry in the division of medicine and surgery.

• establishment of podiatric residency programs

• The availability of state funds for podiatric medical students • Clarification of language guaranteeing DPMs’ right to surgically treat ankles • surgery center privileges for DPMs • The right to form MD/DPM partnerships • The right to supervise Pas within the scope of licensure • The right for DPMs to expand the names they may use for their practices for nearly 100 years, Cpma has been the difference between success and failure, literally the life or death of California’s podiatric medical profession. join Cpma and help us in our ongoing efforts to help you! Call (800) 794-8988.

NoW, ASK yoURSELF HoNESTLy, WHERE WoULD yoU BE WITHoUT THE EFFoRTS AND ADvANCEMENTS MADE By CPMA? a p r i l | m ay | j u n e | 2013

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ANNuAl HEAlTH PolICy REPoRT Thank you for the opportunity to allow me to continue as Chair of the Health policy Committee for the California podiatric medical association. We have had some specific issues developing with regard to individual insurance companies, but more importantly, we have large changes that have occurred in the workers’ compensation arena in California and are continuing to experience changes in the landscape of general healthcare in our state and throughout the country. i would like to thank and express my appreciation to matthew Garofoulis, Dpm, president of the american podiatric medical association for appointing me to the Health policy Committee of the american podiatric medical association. previously i was a member of the Health Systems Committee of the american podiatric medical association and now begin my new responsibility as a Committee member in Health policy for the american podiatric medical association at our first meeting on may 3, 2013. i am very much looking forward to that meeting.

with which podiatric physicians use the -25 modifier. as it clearly expected, podiatric physicians, because we are a procedure intensive specialty, have a greater and more frequent utilization of the -25 modifier in our billing than our colleagues in most other specialties. equiclaim is seriously investigating podiatric physicians’ claims and has already given feedback to many of our colleagues that we are “well above the norm” in comparison to other medical specialists with regard to the use of the -25 modifier. equiclaim has threatened that they will review claims of podiatrists that over utilize the -25 modifier without demonstrating proper substantiation in their medical records. it is therefore important for the podiatric physician to document and substantiate the reason why they are using a -25 modifier when billing an office procedure that requires a separately identifiable and significant evaluation and management service at the same time. The medical record is what will either “make or break you” in such an investigation.

now i will highlight some specific issues that we are dealing with concerning individual insurance companies. i will then discuss workers’ compensation issues, general healthcare reform issues, and include in the report some recommendations for effective dealing with insurance companies and maintaining a healthy practice.

i have discussed this issue at length with our legal counsel, Keith Greer, esquire, and we are preparing a rebuttal letter to anthem Blue Cross regarding the fact that it is expected that podiatric physicians, especially those who have a very diversified practice and perform many office-based procedures, would tend to bill the -25 modifier with greater frequency. What i would recommend to all our colleagues who do use a -25 modifier with great frequency, is to justify in your medical record the appropriateness of such usage of the -25 modifier.

ANTHEM bluE CRoSS oF CAlIFoRNIA: One of the most challenging issues we have had with regard to anthem Blue Cross of California is their policy of reviewing podiatric physicians’ usage of the -25 modifier in billing. The -25 modifier when used with an evaluation and management service code, allows the podiatric physician to bill that evaluation and management service code at the same time as he is performing a procedure. The provision is that that evaluation and management service is medically necessary and is separately identifiable and follows the rules of rules of evaluation and management service as seen in the CpT coding book. anthem Blue Cross has hired a company called equiclaim to review the frequency 46 |

One of the other issues we have been dealing with anthem Blue Cross is their extremely low payment for functional foot orthotic devices, l-3000. in southern California, anthem Blue Cross allows approximately $138 per l-3000 orthotic.

The next lowest paying insurance company for the l-3000 code is Cigna and aetna, each of which allows approximately $211 for the l-3000 orthotic code. i have indicated this to anthem Blue Cross and they are in the process of reviewing their fee schedule for foot orthotics and have

informed me that they are seriously looking to increase fees for the l 300 in the near future. We continue to maintain dialogue with anthem Blue Cross regarding this and hopefully we will actually soon see an increase in the fee associated with the l-3000 foot orthotic device. also, with regard to anthem Blue Cross, it is recommended that when using biosynthetic grafting materials, the podiatric physician reviews the anthem Blue Cross website to determine which biosynthetic grafts will be paid for treating various foot ulcerations and which grafts will be denied. an example of this is the written policy that anthem Blue Cross considers any biosynthetic graft material, other than apligraf and Dermagraft, to be investigational and experimental for the treatment of a non-healing diabetic foot ulcer. Therefore, any other biosynthetic graft material which is used for treatment of an ulcer will be denied by anthem Blue Cross.

The only way a podiatric physician would be able to ascertain this policy would be to review the policy which is found on the anthem Blue Cross website. The other way a podiatric physician would be paid for this graft would be to get preauthorization from the insurance plan. bluE SHIElD oF CAlIFoRNIA; many of the previous issues that we have had regarding Blue Shield have been adequately rectified. unfortunately, there are still instances where Blue Shield has sent to patients eOBs (explanation of benefits) with denial of certain services containing the explanation that “providers of this classification are not to be reimbursed for these services.” i have indicated to Blue Shield that they should completely eliminate such language from their explanation of benefits as it is extremely confusing to patients. an example of an eOB where this disrespectful language was used by Blue Shield was for services performed by a podiatric physician which involved manipulation of the calcaneal cuboid joint for the diagnosis and condition of cuboid peroneal syndrome.

This is clearly a case where proper utilization of manipulation is not only indicated, but is warranted and manytimes

C p m a | C a l i f O r n i a p O D i aT r i C m e D i C a l a S S O C i aT i O n

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reduces the pain associated with that syndrome. We have indicated to Blue Shield of California that this language on an explanation of benefits is inappropriate and the treatment rendered is appropriate for the condition being treated by the podiatric physician, and is well within the podiatric physician’s scope of practice.. This issue has been discussed with the medical Director at Blue Shield and is presently being rectified and the podiatric physician is being properly paid.

The primary issue is that there should never be language on an explanation of benefits to a Blue Shield consumer stating that “providers of this classification are not to be reimbursed for this service”, which indicates that the podiatrist is acting outside of their scope of practice. i have explained this to Blue Shield that this is not acceptable and should be immediately discontinued. as indicated in our discussion with anthem Blue Cross regarding biosynthetic grafts, we have had a different issue with Blue Shield of California regarding podiatric physicians using various biosynthetic grafts. Blue Shield of California has again written on some patient’s explanation of benefits the inappropriate language that “providers of this classification are not to be reimbursed for these services.” We have again discussed with Blue Shield of California that this is inappropriate language and should never be utilized on an explanation of benefits. Hopefully this general language will no longer be utilized. fortunately, we are seeing much less frequency with regard to instances of the above mentioned when compared to the language found in explanation of benefits in previous years. i have explained to the medical Directors at Blue Shield of California that even a small instance of explanation of benefits containing this inappropriate language is unacceptable and will not be tolerated. i think Blue Shield of California is finally getting the message.

CIGNA AND AETNA: Cigna and aetna, in many cases, do not pay for foot orthotic devices for the treatment of plantar fasciitis or posterior a p r i l | m ay | j u n e | 2013

tibial tendonitis. it is therefore imperative that a podiatric physician receives prior authorization from the insurer to determine whether or not the patient has benefits for these services. if you do not receive such prior authorization, and do not collect appropriate fees from the patient for the foot orthotic devices up front, you would certainly be chasing after the patient after the patient has already received the foot orthotics. Therefore, we highly recommend that you determine preemptively whether or not the patient does indeed have coverage for such devices and proceed accordingly.

HuMANA: i have enjoyed a very productive relationship with the previous Chief medical Officer at Humana, Tom james, m.D. unfortunately, Dr. james has left his position as Chief medical Officer and this has been filled phillip painter, m.D. unfortunately, i have not yet had the opportunity to speak to Dr. painter, but have left him several messages and will continue to do so. Dr. james worked with me and his Committee to make standards of credentialing uniform for podiatric physicians and mD and DO physicians. prior to that change in Humana’s policy, podiatric physicians were credentialed in a manner completely different from mDs and DOs. now all physicians re similarly credentialed.

The major problem with Humana is the fact that Humana has a separate fee schedule for foot and ankle services rendered to patients by podiatric physicians which is less than that paid to mDs and DOs for the same services. i was working with Dr. james, prior to his leaving Humana, on changing that policy, especially in view of the fact that apma passed and now has sought to enforce the resolution that i wrote in 2003, stating that there should not be any separate podiatry fee schedules in any health insurance plan. i hope to continue discussion with Dr. painter regarding rectifying this policy of Humana so that it conforms to standardization of payment to mDs, DOs and Dpms. Stay tuned for further information.

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MulTIPlAN: multiplan is a company that has been purchasing many health plans in California, particularly in the workers’ compensation market. multiplan does not consider Dpms physicians as are mDs and DOs. Therefore, by their own admission, they consider Dpms “mid-level providers similar to that of a nurse practitioner, an optometrist, and a psychologist.” They pay podiatric physicians for the same foot and ankle services rendered by mDs and DOs at 85% of the mD and DO fee. This may be especially problematic in both the private sector market and in the workers’ compensation market. it is extremely important to review all of your health plan contracts and determine what the fee schedule is and whether or not you are being paid a fair payment for the services that you render and whether or not you are being discriminated against with regard to the payment you are receiving. fortunately, in California, we have eliminated most insurance plan discrimination policies. multiplan, however, is the one organization that perpetually insists on discriminating against podiatric physicians with regard to the fees that they allow for podiatric physicians. as indicated above, they pay podiatric physicians at a substantially lower fee schedule than they allow to mDs and DOs for the same services.

WoRkERS’ CoMPENSATIoN: in january of 2013, a new law SB-863, was passed by the California State legislature.

This law changed certain provisions of workers’ compensation in California. a few of the salient points of that law are the following: See HEALTH PoLICY REPoRT on Page 49

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HEALTH PoLICY REPoRT from page 47

1. a podiatric physician or any other physician needs to be part of a medical provider network (mpn) in order to treat the injured worker. it is important to understand that in workers’ compensation, podiatric physicians are considered the same as any other mD or DO physician. Therefore, i will use the generic term physician rather than utilizing podiatric physician in my further discussion about the workers’ compensation laws in California, as the provisions of the law applies equally to mDs, DOs and Dpms.

2. in order to request treatment for various occupationally-related injuries, you must demonstrate good quality evidence utilizing the medical treatment utilization schedule (mTuS), aCOem guidelines (american College of Occupational and environmental medicine), or ODG guidelines (Official Disability Guidelines). as some of you may know, i have been reappointed to the medical evidence evaluation advisory Committee of the Department of Workers’ Compensation in California. my charge will eventually be to rewrite the aCOem and ODG guidelines to conform to updated standardized evidence for proper evaluation and treatment of occupational disorders to the foot and ankle. i will be calling on some of our academic and scientific organizations to provide research, randomized controlled blinded studies, and general expert consensus with regard to proper evaluation and treatment for various pedal and ankle conditions. it is very exciting that podiatric physicians will be writing these new guidelines and directives for proper evaluation and treatment of occupational injuries to the foot and ankle. Stay tuned for further information regarding this.

3. it is now a requirement that a physician has to pay $150 to activate a lien filed against an employer for services rendered in the treatment of an injured worker. This eliminates the idea of outside people being able to buy liens and then force settlement on the employer. unfortunately, this a p r i l | m ay | j u n e | 2013

will have an adverse dramatic impact on all physicians as review companies and insurers will be able to down-code many of the services rendered to the injured worker. The insurance company and review company know that it will be cost-ineffective to fight these downcoded claims especially if you have to pay $150 to file the claim and know that you will get substantially less dollar value return. This is a very unfortunate provision for physicians.

4. you also need to pay $100 to activate an old lien, otherwise that old lien may be expunged.

5. There are no more Qualified medical evaluations (Qme) for utilization review.

The Qme process can only be used now for medical issues, permanent and Stationary status, aOe/COe ((causation) and need for permanent work restrictions and/or impairment.

6. There is now an independent medical reviewer for utilization review disputes. unfortunately, these disputes will now only be based on medical records and not an independent examination. This is also very unfortunate as an injured worker may have received foot orthotic devices which are totally ineffective, but the medical record would indicate that the patient did receive foot orthotic devices. unless a trained podiatric physician can see how a foot orthotic device fits the foot and determines whether or not the device is performing the functions for which it is intended, it is almost impossible to determine that such a foot orthotic devices has been efficacious. i think this is a very negative provision of this new law and unfortunately, i do not think that it will lead to a positive outcome with regard to utilization review results.

7. in 2014, the official medical fee schedule becomes 120% of medicare rBrVS. This is also not good for physicians because if medicare undergoes a substantial reduction in its valuation of fees, the workers’ compensation official medical fee schedule now will be based on that decreased fee. it is planned as of right now, that if the sustained growth

rate (SGr) is not fixed by january 2014, then the medicare fee schedules to physicians will decrease between 25% and 30%. if this occurs, and if the workers’ compensation fee schedule becomes tied to medicare, the physician treating the injured worker will then be subjected to a 25% to 30% discount from the official medical fee schedule. let’s hope that the SGr is fixed and/or medicare fees are not decreased. in my opinion, these two fee schedules should be independent of each other.

HEAlTH INSuRANCE REFoRM: With regard to the patient protection act of 2010 or aCa, there are many specific provisions that will affect podiatric physicians. We will discuss these in much greater detail at a workshop we will be involved in at the Western podiatric medical Congress. i urge many of our colleagues and medical assistants to sign up for what should be an extremely informative program. However, in this section i will discuss in generality, some of the changes that will occur and are occurring with regard to the changing healthcare landscape.

1. We are moving from an iCD-9 to an iCD-10 diagnosis base. This means that we are going from what is now approximately 14,000 codes in medicine to 70,000 codes in medicine. fortunately, many of these codes are not applicable to podiatric physicians, but a substantial amount of them are. it is imperative that anybody who plans on practicing after October 1, 2014 immediately, if not sooner, look into getting on an electronic medical records system. This is because it will be extremely difficult to properly bill for services rendered to patients utilizing the iCD-10 diagnosis code base if you do not have an electronic medical record, as the electronic medical record builds the iCD-10 diagnosis code.

2. The implementation and progressive usage of the accountable Care Organization, aCO. Out of the aCa came a shared savings program See HEALTH PoLICY REPoRT on Page 51

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HEALTH PoLICY REPoRT from page 49

which emphasizes quality care at reasonable cost. The good news for podiatric physicians is that through the good work of apma and the aCO Task force, of which i was a member, and implemented by apma, podiatric physicians are included in all aspects of the aCO organization except for founding member status. podiatric physicians can be included the shared savings and/or shared losses, they can be included in governance of the organization and in leadership of the organization. The aCO has not yet been determined to create great savings as patients within the aCO are free to go to any physician they wish, thereby making control of healthcare costs less than certain. The good news for podiatric physicians is that they can be included in many aCOs whereas primary care physicians can only be included in one aCO. Stay tuned to determine whether or not what the outcome of aCO participation is.

3. Anti-Discrimination Provision: One of the great benefits to come out of the aCa is the fact that no health plan can discriminate against any provider who is acting within his scope of practice. unfortunately however, it does not preclude a health plan from paying a provider with a different licensure in a disparate manner. an example of this is multiplan. While multiplan has to allow access of its patients to podiatric physicians, unfortunately they may still be allowed to pay podiatric physicians at a rate differential, significantly less than that paid to mDs or DOs. This has not been fully determined.

One of the very positive outcomes to come out of the aCa is the fact that whereas eriSa plans had previously been allowed to put a limitation of benefit on podiatric services, they can no longer do this. That means that an eriSa plan can no longer have a $500 or $1,000 annual, or in some cases, lifetime podiatric medical benefit. Therefore, a patient in an eriSa program can access a podiatric physician for foot and ankle services in a manner similar to the way they would access a foot orthopedist for similar services. This is a major benefit for podiatric physician. a p r i l | m ay | j u n e | 2013

4. Physician Acting as Patient representative. another benefit of the aCa is the fact that the doctor can now act as a patient representative and agent for the patient. That means, that if a patient assigns representation of themselves to a doctor and makes the doctor his or her agent, the insurance company must send payment directly to the doctor, whether or not the doctor is a contracted member of that particular health plan. in practical terms, this means that Blue Shield of California, for example, which previously would send the non-contracted provider’s payment directly to a patient, can no longer do so, provided that the patient not only assigns their benefits to the doctor, but tells the doctor to act as their agent and representative. This is a substantial difference in the way health insurance plans will have to now pay doctors, even if the doctor is not contracted with the insurance plan.

The last issue regarding the aCa that i am going to discuss is the formation of health insurance exchanges (Hiep).

The purpose of Hiep is to ensure that all patients in California and in other states have insurance coverage and the number of non-covered patients is significantly minimized. in the Hiep, there are certain specific essential benefits that are included.

These benefits include ambulatory patient services and prevention and wellness services which are the two primary benefits that affect podiatric physicians.

Other benefits that affect all physicians are: emergency room services, maternity services, prescription drugs, mental health, pediatric services, laboratory services, rehabilitation services and hospital services.

What is very important to understand about these exchanges, is that our Cpma members and mDs and DOs alike are receiving contracts, for example, from Blue Cross and Blue Shield which, in preparation for participation in these exchanges, are offering doctors significantly lower fees in order to participate in these exchanges. an example of this is when Blue Shield sent contracts to many of our colleagues, the contract indicated that if the doctor accepted Blue Shield contract as is, then they would accepting either 90% of Blue Shield’s fee schedule, 80% of Blue Shield’s

fee schedule or 70% of Blue Shield’s fee schedule. What is important to understand in these fee schedule changes is that a provider cannot “balance bill” a member of the exchange. Therefore, the provider is accepting either 90%, 80% or 70% of Blue Shield’s fee schedule which it is important to note, is less than the current medicare fee schedule. in conclusion, it is extremely important to review your contracts and determine whether or not it makes sense to participate in such insurance plans offering such contracts. i cannot emphasize enough how important it is to review all those contracts. remember, above all, that yOu DO nOT maKe up lOSS On VOlume. if one is not capable of understanding a contract, which has a great deal of legalease contained within it and is not easily understandable, it is recommended that the podiatric physician seek legal counsel. as a disclosure, my wife is a very prominent healthcare attorney in southern California who specialized in health contracts and healthcare transactions. i think the workshops that are going to take place at the Western podiatric medical meeting are going to be extremely important this year, especially with regard to coding and billing, the appealing of claims and general changes in the healthcare landscape that will effect podiatric physicians. i recommend that Cpma members sign themselves and/or their medical assisting staff for participation in these workshops as i feel the information garnered from them will be invaluable and help them maintain a healthy practice in our changing healthcare world.

Once again, it has been a pleasure to serve as your Chair of the Health policy Committee and the Workers’ Compensation Committee for the California podiatric medical association. We are here to serve our members and appreciate input and information about discriminatory policies that may affect our Cpma members. We will always do our best to either resolve issues or give advice to Cpma members on how they may effectively resolve any such issues.

Thank you members of Cpma for your confidence. | 51

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No DoG DAyS oF SuMMER AT CPMA Summer typically means reduced work schedules, vacation and relaxation - not at Cpma.

Despite often sweltering triple digit temperatures in Sacramento, Cpma’s headquarters continues to operate during its normal hours in order to assist members on a myriad of issues ranging from problems with third-party payers, regulatory issues, licensing, providing continuing medical education, and legislative advocacy.

We are here to serve our members.

Contact information: 2430 K Street, Suite 200, • Sacramento, California 95816 Phone: (916) 448-0248 or (800) 794-8988 • Fax: (916) 448-0258 • E-mail: cpma@calpma.org • Website: www.calpma.org

LESSONS FROM GEESE 1. as each bird flaps its wings, it creates lift for the bird following it. By flying in a Vee formation, the whole flock extends its flying range 71% greater than if each bird flew alone.

(Moral: People who share a common direction and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another.)

The migration of geese is an awesome sight, as they fly south in the Fall and north in the spring of each year. The remarkable thing in their interdependence in flight, and the following observations are the result of years of study.

2. Whenever a goose falls out of formation, it suddenly feels the extra drag of ‘going it alone’ and it quickly gets back into the formation to take advantage of the lifting power of the bird immediately in front.

(Moral: if the rest of us had as much sense as a goose, we would stay in formation with those headed where we want to go.)

3. When the head goose at the tip of the Vee gets tired, it rotates back into formation and another goose takes over the lead in the point position.

a p r i l | m ay | j u n e | 2013

(Moral: it pays to take turns doing the hard tasks and sharing leadership. People, as with geese, are interdependent with each other.)

4. The geese in formation honk from behind to encourage those up front to keep up their speed.

(Moral: We need to be sure our ‘honking’ from behind is encouraging, not something less helpful.)

5. When a goose gets sick or wounded or shot down, two geese drop out of formation to follow him down, to help and protect him/her. They stay with him/her until he/she is either able to fly again, or dies. They launch out on their own with another formation or catch up with the flock.

(Moral: if we would have as much sense as the geese, we would stand by each other.)

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CAlIFoRNIA SCHool oF PoDIATRIC MEDICINE CSPM WHITE CoAT CEREMoNy On march 8, 2013 the California School of podiatric medicine (CSpm) at Samuel merritt university (Smu) held its seventeenth annual White Coat Ceremony for the class of 2016. With over two hundred family members, friends and other guests in the audience, forty-two first year podiatric medical students were presented their first white clinic coat by faculty members from the departments of applied biomechanics, medicine, podiatric surgery and preclinical sciences. in 1996 CSpm was motivated to establish the White Coat Ceremony as a starting place to encourage the student doctors to cease the negative competition with each other, promote the importance of humanism in podiatric medicine, and to inspire the concept of teamwork in medicine. The White Coat Ceremony also signifies the transition from a basic science oriented, classroom setting to the clinical arena of patient-centered learning. ronald D. jensen, Dpm, past president of the american podiatric medical association and a member of the CSpm alumni & associates along with Daniel C. fulmer, Dpm, who is an executive Committee member of the alumni & associates, each delivered keynote addresses. at the conclusion of the program, the students took an Oath of Commitment.

ElEctronic HEaltH rEcords Manual logon to www.poggiodpm.com to preview and download this valuable asset to ease the transition to your ehr system.

This manual is only available as a download.

Considering converting to an electronic Health records system in your office? Confused? Heard other horror stories?

There are links to CmS and other websites to get more information and clarification.

meaningful use? This critical process is explained so that you can meet all the requirements and collect your inCenTiVe mOney!!!!.

This manual has all the information you will need located in one convenient location. Transitioning to an eHr process is outlined in a step-by-step, easy to follow along fashion.

a p r i l | m ay | j u n e | 2013

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oN YoUR ToES fram Page 41

jurisdiction 1 will now be jurisdiction e and administered noridian administrative Services llC, which is also California’s medicare contract administrator for durable medical equipment (Dme).

CmS and noridian will now move forward with implementation of the new contract and expects the process to complete by mid-September 2013. The California podiatric medical association has and will continue to work closely with both CmS and noridian to ensure a smooth transition. Cpma will also be monitoring the transition closely and will provide members with additional information as it becomes available. (sourCe: law360 4/22/13) DoCToRS MUST ACT NoW To AvoID THE 2% E-PRESCRIBINg PENALTy IN 2014 are you e-prescribing yet? if not, nOW is the time to start!

To avoid a 2 per cent penalty on all medicare part B claims in 2014, doctors must by june 30, 2013, report e-prescribing activity using measure code G8553 with at least 10 fee schedule services between january 1 and june 30, 2013. This is true even for doctors who are already reporting through an electronic health record (eHr) system. Please note: There is no incentive payment for e-prescribing in 2014. june 30 is also the deadline to apply for an e-prescribing exemption for 2014, if you fall into one of the following hardship exemption categories:

BILL To BLoCK MEDI-CAL CUTS CLEARS CoMMITTEE oN UNANIMoUS voTE following a strong show of support from a broad coalition of stakeholders consisting of healthcare professional organizations (including the California podiatric medical association), labor groups, insurance providers, pharmacies and California hospitals, a measure to block the state’s planned medi-Cal cuts has taken its first step towards becoming law.

SB 640, authored by state Senator ricardo lara (D-los angeles) passed out of the Senate Committee on Health with an 8-0 vote.

The bill, if approved, would repeal the 10 per cent cut to medi-Cal, a reimbursement rate that was approved by the legislature as part of the 2011 budget process.

To date, the cuts have yet to implemented, due to a pending lawsuit. last year, the court denied the cuts, but the state appealed the ruling and an appeals court recently ruled that the cuts could move forward. The state plans to assess the cuts both retroactively to june 2011 and moving forward.

SB 640, if approved, would prevent both scenarios from occurring. (sourCe: CMaNeT 4/25/2013) EDD MIgRATES ALL DISABILITy CLAIMS To NEW oNLINE PRoCESS

• The doctor is unable to electronically prescribe due to local, state or federal law or regulation;

a reminder, that on march 1, the employment Development Department (eDD) stopped using its old claim process and implemented a new electronic claim filing system for State Disability insurance (SDi) called SDi Online.

• The doctor has or will prescribe fewer than 100 prescriptions for all patients during a 6-month reporting period (january 1 through june 30, 2013)

The new system allows claimants, physicians and employers to electronically submit disability insurance (Di) and paid family leave (pfl) claims.

• The doctor practices in a rural area without sufficient high-speed internet access

Providers should also be aware that filing a paper claim is still an option, but effective March 1, 2013, only the new oCR forms will be accepted (DE 2501, Rev. 78[4-12]).

• The eligible provider practices in an area without sufficient available pharmacies for electronic prescribing Cpma strongly recommends that members submit more than 10 claims during the reporting period to ensure the minimum threshold is met. exemptions must be requested through the Quality net portal. members can find a link to the site on the homepage of the Cpma website under Dates Doctors mustin miss in 2013. providers may also avoid the penalty if they have demonstrated meaningful use of a certified eHr between january 1, 2012, and june 30, 2013, or have registered to participate in the eHr incentive program.

Cpma urges members planning to apply for an exemption to do so nOW! The site is often overloaded on the last day to apply and there are frequent glitches. additionally, members have reported problems with trying to log on using maCs.

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for more information about SDi Online, or to order SDi OCr claim forms, visit www.edd.ca.gov/disability or call (855) 342-3645, which is a dedicated line for medical providers and employers.

PRovIDERS WHo REFER, oRDER oR PRESCRIBE FoR MEDICAL BENEFICIARIES MUST ENRoLL WITH DHCS The Department of Health Care Services (DHCS) made changes in january to its medi-Cal provider enrollment requirements as a result of the patient protection and affordable Care act (aCa). One of the changes now requires all providers who order, refer or prescribe (including but not limited to physicians, nps, and pas) be enrolled in the medi-Cal program. previously, providers needed to enroll only if they wished to furnish (and bill for) covered services for medi-Cal beneficiaries. if an ordering and/or referring provider (Orp) is not enrolled in medi-Cal, the “filling providers” (for example, the pharmacy that is filling the patient’s prescription or the specialist you are referring a patient to for treatment) will not be paid. as a result, patients may C p m a | C a l i f O r n i a p O D i aT r i C m e D i C a l a S S O C i aT i O n

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not receive needed items or services if the “filling providers” refuse to accept orders or referrals from providers who are not enrolled in medi-Cal. although the new requirement took effect january 1, 2013, DHCS established a grace period to allow more providers to enroll before claims are denied. The grace period could end at any time and Orp providers are encouraged to complete the enrollment process as soon as possible.

Orp providers are providers who enroll for the sole purpose of ordering, referring or prescribing to covered beneficiaries and who do not directly submit claims for their services. please note that this type of enrollment does not allow the medi-Cal program to reimburse the Orp- only provider for services provided directly to medi-Cal beneficiaries. providers who are already enrolled in medicare or medi-Cal under their individual (type 1) national provider identifier (npi) number do not also have to enroll as Orp providers.

The providers that may be affected by this change include individual physicians or physicians employed by physician groups, federally qualified health centers, rural health clinics, critical access hospitals, the Department of Veterans affairs, Department of Defense TriCare program and the public Health Service. for more information, or to enroll as an Orp provider, visit the DHCS website. The Orp enrollment form is “DHCS 6129.” for questions regarding enrollment as an Orp provider, please contact the DHCS provider enrollment Division atpedcorr@dhcs.ca.gov or (916) 323-1945. (sourCe: CMaNeT 3/25/13) BLUE SHIELD FoLLoWS BLUE CRoSS’S LEAD REqUIRINg PRovIDERS To NoTIFy PATIENTS BEFoRE REFERRINg oUT-oF-NETWoRK effective, may 15, doctors will be required to notify patients in writing using a form provided by the payor when referring a patient to an out-of-network provider. The policy does not apply to emergencies.

This change comes on the heels of a similar change recently implemented by anthem Blue Cross.

While existing language in Blue Shield provider contracts had placed limitations on referrals to out of network providers for patients with HmOs, epOs and/or medicare advantage plans, those limitations did not apply to patients with ppOs. That will change effective may 15. according to Blue Shield, the completed form must be filed in the patient’s medical record and be made available to Blue Shield within five business days if requested. The notice does not provide details on how Blue Shield intends to enforce this provision.

Doctors with concerns are encouraged to contact the Blue Shield provider liaison unit at (800) 258-3091.

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BILL WoULD STRIP MEDICAL BoARD oF PoWER To INvESTIgATE PHySICIANS lawmakers are considering a bill (SB 304) that would eliminate the medical Board of California’s authority to investigate physician misconduct.

The board has been criticized for failing to discipline physicians accused of harming patients, particularly doctors suspected of overprescribing addictive pain medications. according to a December 2012 Los Angeles Times investigation, at least 30 patients in Southern California died of prescription drug overdoses or related causes while their physicians were being investigated by the medical board. physicians were reprimanded or placed on probation in 80% of the 190 cases of overprescribing filed by the board since 2005.

However, physicians in most of those cases were permitted to continue writing prescriptions with few or no restrictions according to the bill -- by Sen. Curren price (D-los angeles) and assembly member richard Gordon (D-menlo park) -- the California attorney general would handle investigations of physician misconduct. The medical Board would handle physician licensing. (sourCe: CaliforNia healThliNe 4/26/13) oIg ISSUE SPECIAL FRAUD ALERT REgARDINg PHySICIANoWNED ENTITIES The inspector general for the Health and Human Services Department, has issued an unusual “special fraud alert” regarding physician-owned distributorships, or pODs. The companies sell medical devices that the doctor owners then use in surgical procedures on their own patients.

The alert noted that doctor-owned businesses that act as middlemen between medical device makers and hospitals are “inherently suspect” and some of their practices may violate u.S. anti-kickback laws, according to a government inspector general. (sourCe: blooMberg News 3/26/13) CMS PRoPoSES $10 MILLIoN BoUNTy FoR MEDICARE FRAUD The Centers for medicare & medicaid Services (CmS) has proposed increasing its reward for reporting medicare fraud from a maximum $1000 to nearly $10 million in a bold move to encourage more seniors to tip off the government about fraudulent healthcare providers and suppliers.

The Obama administration has stepped up efforts to prosecute medicare and medicaid chicanery ranging from fictitious office visits to power wheelchairs for the able-bodied, and its campaign recovered a record $4.2 billion in fiscal 2012 as a result. However, only a tiny fraction of that amount represents fraudulent activity reported by tipsters through medicare’s incentive reward program (irp).

See oN YoUR ToES on Page 58

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oN YoUR ToES fram Page 57

CmS believes irp could receive more leads on fraud — and garner far more in criminal fines, civil settlements, forfeitures, and other actions — if the bounty were higher. right now, CmS offers a reward equal to 10% of fraud collections, but not to exceed $1000, to anyone who passes on information that leads to the recovery of ill-gotten medicare payments. under proposed regulations the reward would be 15% of the recovered amount up to $66 million, for a maximum reward of $9.9 million. in the proposed rule, CmS noted that the new bounty formula is modeled roughly after one used by the internal revenue Service (irS) to reward individuals who report tax fraud. Between 2007 and 2012, the irS paid out $193 million in rewards for almost $1.6 billion in recoveries. (sourCe: MedsCaPe 4/25/013) ANALySIS oF PHASE 1 oF oRDERINg/REFERRINg EDITS FoR JURISDICTIoN PART B phase 1 of the ordering/referring edits began on October 5, 2009, with informational messaging (remark codes n264 and n265) on the remittance advice (ra) to alert the billing provider that the identification of the ordering/referring provider is missing, incomplete or invalid, or that the ordering/referring provider is not eligible to order or refer. The informational message on an adjustment claim that did not pass the edits indicated the claim/ service lacked information that was needed for adjudication. effective may 1, 2013, the Centers for medicare & medicaid Services (CmS) will turn on the phase 2 denial edits. This means that medicare will deny claims for services or supplies that require an ordering/referring provider to be identified and that provider is not identified, is not in medicare’s enrollment records, or is not of a specialty type that may order/refer the service/item being billed. palmetto GBa has completed an analysis of claims submitted by jurisdiction 1 part B providers and suppliers which we processed from january 1, 2013, through march 28, 2013. The following chart provides the monthly percentage of claims submitted that received the informational message.

JURISDICTIoN 1

JANUARy 2013

FEBRUARy 2013

MARCH 2013

northern California

1.45%

1.67%

1.79%

Southern California

1.91%

2.05%

1.99%

Hawaii & islands & nevada

1.37%

1.57%

1.52%

providers are encouraged to review the CmS’ ‘Ordering & referring file’ to ensure that the physicians and non-physician practitioners from whom you accept orders and/or referrals have current medicare enrollment records, and are of a type/specialty that is eligible to order or refer in the medicare program. The Ordering & referring file will be made available periodically that will 58 |

replace the posted file; at any given time, only one file (the most recent) will be available. please ensure you are correctly spelling the Ordering/referring provider’s name.

Helpful Ordering/referring Tips: • The name and the national provider number (npi0 you enter for the Ordering/referring provider must belong to a physician or non-physician practitioner and not to an organization, such as a group practice that employs the physician or non-physician practitioner who generated the order or referral • please ensure you are correctly spelling the Ordering/referring provider’s name. Do not use ‘nicknames’ on the claim, as their use could cause the claim to fail the edits • Do not enter a credential (e.g., ‘Dr.’) in a name field • if you have a claim denied due to the Ordering/referring provider edits, you must file an appeal. an adjustment cannot be submitted. more information may be found in medicare learning matters® number Se1305 (pDf, 163 KB) located on the CmS website. (sourCe: ToNy Poggio, dPM) FIRST qUARTER RESULTS oF WIDESPREAD PREPAyMENT REvIEW oF CLAIMS FoR ANKLE-FooT/KNEE-ANKLE-FooT oRTHoSIS (HCPCS L4360, L1970 AND L1960) Current review results The jurisdiction D Dme maC medical review Department is conducting a widespread complex review of HCpCS codes l4360, l1970 and l1960. The first quarter edit effectiveness results from December 2012 through march 2013 are as follows: The l4360 review involved 564 claims of which 474 were denied.

This resulted in an overall error rate of 84%.

The l1970 review involved 63 claims of which 53 were denied.

This resulted in an overall error rate of 86%.

The l1960 review involved 109 claims of which 87 were denied.

This resulted in an overall error rate of 80%. primary documentation errors that resulted in denial of claims 23% of l4360 claims received a denial as no proof of delivery submitted.

• 7% of l1970 claims received a denial as no proof of delivery submitted. no proof of delivery submitted. proof of delivery (pOD) is a Supplier Standard and DmepOS suppliers are required to maintain pOD documentation in their files. for medical review purposes, pOD serves to assist in determining correct coding and billing information for claims submitted for medicare reimbursement. regardless of the method of delivery, the contractor must be able to determine from delivery documentation that the supplier properly coded the item(s) submitted for medicare reimbursement and that the item(s) are intended for, and received by, a specific medicare beneficiary.

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• 22% of l4360 claims received a denial as no detailed written order or dispensing order received. no detailed written order or dispensing order received. all items billed to medicare require a prescription. an order for each new or full replacement item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. equipment and supplies may be delivered upon receipt of a dispensing order except for those items that require a written order prior to delivery. a dispensing order may be verbal or written. The supplier must keep a record of the dispensing order on file. it must contain: • Description of the item • Beneficiary’s name • prescribing physician’s name • Date of the order and the start date, if the start date is different from the date of the order •physician signature (if a written order) or supplier signature (if verbal order) for items that are provided based on a dispensing order, the supplier must obtain a detailed written order before submitting a claim. Detailed written order (DWO) is required before billing.

Someone other than the ordering physician may produce the DWO. However, the ordering physician must review the content and sign and date the document. it must contain: • Beneficiary’s name • physician’s name • Date of the order and start date, if start date different than date of order •Detailed description of the item(s) •physician signature and signature date • 25% of l1970 claims received a denial as the treating physician’s records don’t provide detailed documentation to support medical necessity of custom rather than prefab orthosis.

22% of l1960 claims received a denial as the treating physician’s records don’t provide detailed documentation to support medical necessity of custom rather than prefab orthosis.

The treating physician’s records don’t provide detailed documentation to support medical necessity of custom rather than prefab orthosis. for custom-fabricated orthoses, there must be detailed documentation in the treating physician’s records to support the medical necessity of custom-fabricated rather than a prefab orthosis. This information will be corroborated by the functional evaluation in the orthotist or prosthetist’s records. This information must be available upon request.

• 22% of l1970 claims received a denial as criteria 1,2,3,4 Or 5 not met.

• 21% of l1960 claims received a denial as criteria 1,2,3,4 Or 5 not met.

Criteria 1,2,3,4 Or 5 not met. a p r i l | m ay | j u n e | 2013

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afO’s and KafO’s that are custom-fabricated are covered for ambulatory beneficiaries when the basic coverage criteria and one of the following criteria are met: 1. The beneficiary could not be fit with a prefabricated afO; or, 2. The condition necessitating the orthosis is expected to be permanent or of longstanding duration (more than 6 months); or, 3. There is a need to control the knee, ankle or foot in more than one plane; or, 4. The beneficiary has a documented neurological, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injury; or, 5.The beneficiary has a healing fracture which lacks anatomical integrity or anthropometric proportions. if a custom-fabricated orthosis is provided but basic coverage criteria and the additional criteria 1-5 for a custom-fabricated orthosis are not met, the custom-fabricated orthosis will be denied as not reasonable and necessary.

• 19% of l4360 claims received a denial as documentation insufficient to support basic coverage criteria.

• 17% of l1960 claims received a denial as documentation insufficient to support basic coverage criteria.

• 13% of l1970 claims received a denial as documentation insufficient to support basic coverage criteria.

Documentation insufficient to support basic coverage criteria. ankle-foot orthoses (afO) described by codes l1900, l1902-l1990, l2106-l2116, l4350, l4360, l4386 and l4631 are covered for ambulatory beneficiaries with weakness or deformity of the foot and ankle, who require stabilization for medical reasons, and have the potential to benefit functionally.

Going forward Based on high error rate, noridian administration Services will continue with the prepayment Widespread review. education resources it is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the anklefoot/ankle-Knee-foot local Coverage Determination (lCD) l142 and policy article a19800.

Suppliers can also review specific policy resources for anklefoot/ankle-Knee-foot on the naS website at https://www. noridianmedicare.com/dme/train/index.html#tools. There, you will find, information related to faQs, and a presentation used during Web-based workshops. noridian administrative Services’ provides educational offerings by scheduling for supplier workshops, training opportunities, and presentations. educational training and events are located at https://www.noridianmedicare.com/dme/train/. information about probe/error validation reviews may be found in CmS publication 100-8, program integrity manual (pim), Chapter 3 located at: http://www.cms.gov/manuals/downloads/pim83c03.pdf (sourCe: ToNy Poggio, dPM) | 59

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WESTERN FOOT AND ANKLE CONFERENCE

youR PlACE FoR INFoRMATIoN

Save the Date!

June 19-22, 2014 Visit www.TheWestern.org

The 2013 CPMA House of Delegates Convenes

Wednesday, June 19 Disneyland Hotel Anaheim, CA

Doctors’ Billing service We SPeCIaLIZe in Podiatry Billing over 18 years experience! low % commission rates SPECIAl: 1st month free*

Our Services Include:

• Billing & Collections • Daily Billing • paper & electronic • Complete insurance follow-up • extensive collection • posting all charges & payments • aging & financial reports • patient statements mailed daily and monthly • lighting fast turnaround

Don’t Skip a Beat!

For more information call 1.866.324.7003 *new clients only

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CPMA Members Get More For Their Money: Get your $avings on!

•

save 15% on aT&T wireless services and products

•

save up to 30% off Dell computers

•

save up to 25% off alamo, avis, hertz, national, Budget and enterprise rental cars

•

save on theme parks, sporting events and movie tickets

•

save on vacation travel, flowers, books and More!

For details visit the Member Benefits page at CalPMA.org a p r i l | m ay | j u n e | 2013

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CONTRIBUTION TO THE PHYSICIAN AND SURGEON JOINT TASK FORCE Foundation for Foot and Ankle Education 2430 K Street, Suite 200 Sacramento, CA 95816 (800) 794-8988/(916) 448-0258 www.calpma.org Foundation Tax ID # 94-3174315

Contributor Name: Amount: $_________________________ ($25 minimum for credit card contributions) Phone: ___________________________ Email:

Payment Method:

 Check (enclosed)

 Visa/MasterCard/Discover

 American Express

Please make checks out to Foundation for Foot and Ankle Education with “P&S Task Force” in the memo field.

Credit Card #: Ex. Date (mm/yy): ______________ CVV Code: ______________ Signature: Billing Address: City, State Zip:

On behalf of the profession, thank you for your support.

FAX: (916) 448-0258 MAIL: CPMA - 2430 K Street, Suite 200 Sacramento, CA 95816 PHONE: (800) 794-8988 (credit card contributions only) EMAIL: acarrick@calpma.org 62 |

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CPMA, youR PRoFESSIoNAl lIFEGuARD FoR oVER 100 yEARS! joining The California podiatric medical association (Cpma) is like hiring a powerful professional staff to watch out for regulatory, legal and legislative actions that would negatively impact your ability to practice medicine – for pennies a day. your Cpma membership allows you to focus on your patients while Cpma looks out for you.

2430 K Street, Suite 200 Sacramento, Ca 95816 916-448-0248 • 800-794-8988 fax 916-448-0258

CPMA

cpma@calpma.org • www.calpma.org

STAPlES WElCoMES CPMA MEMbERS! Staples welcomes CPMA Members!

Access to StaplesLink.com is now available as a benefit of the California Podiatric Medical Association.

You can order is supplies access to Stapleslink.com now available as a benefit electronically for delivery and have immediate of the California Podiatric Medical Association. access to over 30,000 products all with you can order supplies electronically for delivery and negotiated discounts ranging from 2 – 80%.

have immediate access to over 30,000 products all with negotiated

Register with Staples as a member now at: discounts ranging from 2–80%. http://linkregistration.stapleslink.com/c/s? register with staples as a member now on the Bember Benefits RegFormId=631185

page at CalPMa.org.

Find Us on Facebook Like our Page: www.facebook.com/calpma Join or group (CPMA Members only): www.facebook.com/groups/calpma a p r i l | m ay | j u n e | 2013

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CPMA HIGHlIGHTS ToDAy’S PoDIATRISTS ACTIVE bEyoND FooT AND ANklE CARE Podiatric Physicians Contributing to the Healthcare System beyond Traditional Settings hyperspectral imaging equipment to evaluate hemoglobin decay. By studying amputated limbs, her partnership with the CSi of los angeles County hopes to enable investigators to have a more accurate picture when solving crimes.

“I believe that actively collaborating with others allows us to achieve [past] perceived boundaries in our profession.” as well as practicing as a clinician, she hopes to inspire the next generation of physicians through teaching and mentorship.

The California podiatric medical association (Cpma) is encouraged by its outstanding membership and takes pride in the contributions they have made to the quality of life for the people of California.

Today’s podiatric physicians participate in all aspects of the healthcare delivery system. using their various talents and skills, podiatrists have made significant contributions to society beyond foot and ankle surgery.

Lee C. Rogers, DPM, has been co-medical director of the worldrenowned amputation prevention Center in Van nuys, Ca, for several years while also practicing as a full time physician. He has a role as an administrator that calls for him to act as a referee to intervene in issues involving scope or referrals and sometimes just conflicting personalities. even after being elected by his peers for administrative duties, Dr. rogers continued to donate his time to pursue patient care and staff satisfaction to higher levels. He states, “We’re all administrators in some capacity, running our practices, departments, or households… You have to find your niche inside the larger

“I’ve been very lucky, but as my father always told me, ‘the harder you work, the luckier you get.” Barry Scurran, DPM, has an accomplishment list longer than most physicians. for the last two, he has been the Chief Compliance Officer and physician-in-Chief at Kaiser permanente Group for the last 8 years. prior to that, he had served on various committees and chief positions for 25+ years while maintaining a busy practice at Kp. as an executive, Dr. Scurran has been instrumental in the decisions to manage and train other physician leaders. “Building a strong executive team is not degree specific but skill specific. By being an excellent clinician, you gain the trust of others who then have confidence in you to elect you as their leader or manager.” as a nationally recognized clinical researcher and physician, Aksone Nouvong, DPM, has been actively managing interdisciplinary research projects at the Olive View/uCla medical center. Dr. nouvong recently collaborated and developed a “time of death” study with the Crime Scene investigation Department of los angeles County that uses specialized 64 |

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PRESIDENT’S MESSAGE from page 1

The old stone mason smiled and told his son, “But i can see it. i enter it every day, and with each stone i place, because i am taking part in something that is greater than myself, and the results of my labor will remain long after i am gone” i am sure we all feel to some extent that we are laboring in obscurity and to no real purpose at times. But each day, we do accomplish a little. So it is true with our professional lives as well. each day another stone is placed. We change one mind, make a friend from an adversary, attend a meeting with far reaching positive results; and wait for that confluence of preparation and opportunity where luck is always found.

12 months ago as of when you are reading this, i advised you to expect the following: 1. We will move steadily forward with our Physician and Surgeon initiative. This has been true. This year we have completed the 2 school site visits and held the initial and follow up joint task force meetings whose findings and next steps will be presented at the 2013 HOD. The task force proceeds at pace.

2. We will continue our cooperative relationship with CMA as well as other entities to share information and to intervene on legislative and regulatory issues that affect us all. This past year we have worked closely with Cma, laCma, COa, and OpSC on legislative, regulatory and national issues. This collaboration has been at all levels: executive Directors, legislative advocates and Board members. We continue to forge new relationships with entities with which we share common cause.

3. We will break new ground with APMA to bring to California the resources that only our large national organization can develop. We will continue to make California’s voice heard at the national level. We have been well heard and supported by the apma BOT. We have also strengthened our relationship with aCfaS on a national and state level. These will both be of great benefit to our physician and Surgeon initiative.

4. With the newly revamped CPMA website, we have the capability to add new resources for members. On the www.Calpma.org members only site, you will find a legal resource Center with tools for all aspects of practice including employment and partnership contracts, appeal letters to payors, consent forms and more. you will also find a Duals resource Center and Covered California resource Center with information you need on these newest implementations of health care reform.

5. We will regularly meet regionally with groups of IPA administrators to demonstrate the value of podiatric medicine. an ongoing project to educate those managed care plans that do not contract with Dpms will continue. We count on you to name any others which you would like to be on our list. This will help pave the way for those of you who choose to contract with ipa and managed care medical groups.

6. We will continue to support and augment the plan initiated by LACPMS to ensure that any plan which may be implemented for the duals conversion is modified to be a p r i l | m ay | j u n e | 2013

the best possible for DPMs, and for all physicians. We have continued to work with laCpmS and support their coalition with laCma. The demonstration project, newly named Cal medi-Connect , has been modified significantly in the past year, with great opportunity still available. We also will continue to develop resources for members when further details of the project (currently slated to begin 10/1/13) become available.

7. our new Public Relations Committee will launch a professional ad campaign including articles, PSAs and use social media as well as other instruments to increase public awareness of podiatric medicine, and to actively direct patients to your offices. The pr Committee has gained new energy. We have published articles in the Teamster newsletters, continued pr campaigns through the website, engaged health reporters at prominent publications, sent timely press releases and advanced our social media campaign.

8. one of the watchwords of my administration is communication. As such you will hear from me monthly via email on current issues and events. i hope you have found my personal communications as well the information we have sent through the monthly Dpmemo helpful and timely. The Dpmemos are also posted on the www.Calpma.org site for your reference.

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

-Aristotle We didn’t arrive at this point without many stones being placed by generations of our predecessors, and we are forever grateful to them.But this past year provided a beautiful opportunity to take advantage of an already rich history of cooperation between Board members, consultants, component presidents, advisors, legislators, and of course members. it is true that so many people continue to contribute to this effort. We honor them with our continued diligence, commitment and dedication. your president is merely the figurehead who can communicate to you the combined work and work product of so many officers, consultants, members and staff. for me to evaluate this past year, the questions that must be answered are: Did we better the professional lives of our members? are they better able to help the patients they serve? are they more prepared for that change that always comes? i look into my heart of hearts and the answer is an unequivocal: yes.

Generations will follow us, and i hope will be grateful for the stones we laid. i do have a vision of the finished product. i see more than those before me; not as much as those who will follow. i know that we have reached this point together for a reason. We are poised for great success. i am grateful for my turn at the wheel, and i am the better for it.

Thank you all for this great opportunity. | 65

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INTRoDuCING CPMA’S REVAMPED lEGAl RESouRCE CENTER as promised by Cpma president Karen Wrubel, D.p.m., the legal resource Center on the Cpma website has undergone major changes. in addition to our new layout, additional instructive articles, contracts, sample forms and sample letters have been added to an already robust list of helpful materials.

EMPLoyMENT MATTERS We now have sample employment agreements and independent contractor agreements for both medical and non-medical staff. all of the important employment terms and conditions are already included in our sample employment agreements. We also have an employee handbook and progressive corrective action plan documentation (for employee discipline).

retroactive exclusion from the plan and late claims. These forms have proven to be successful and time saving for many members. if you are a Cpma member, be sure to browse our new legal resource Center and enjoy all of the articles, forms and letters that will help all aspects of your practice. if there are any issue statements or forms that are not yet on the site, please let us know at 1-800-fOOTlaW. We will do our best to address your concerns and expand the site so other members can also benefit.

LAW LIBRARy for the past sixteen years i have been writing articles addressing the myriad legal issues faced by members on a daily basis, from how to fight repayment demands and insurance denials to the procedures for authorizing medical assistants to provide adjunct physician services.

We have now consolidated articles from recently published issues of The California podiatric physician, and will be updating our online database as new issues are addressed.

CoRPoRATE FoRMS many members have their own corporations. However, if proper procedures and protocols aren’t followed, such as documenting the annual meeting of shareholders, the protections and benefits provided by a corporate structure can be lost. The forms necessary to fulfill these requirements can be found in the legal resource Center.

PRACTICE SALES/PARTNERSHIP AgREEMENTS Selling your practice or brining on a new partner are timeconsuming processes rife with legal land mines. The legal resource Center now has all of the contracts that you need to paper the deal, including a sample practice purchase agreement, purchase money security agreement, employment agreement and assumption of lease contracts, just to name a few. With these forms, and a little of our help, several members over the past year have sold their practices the right way, without incurring any legal fees. oFFICE FoRMS The legal resource Center also has an extensive list of sample office forms that medical offices use in their daily practice, including, among others, a sample surgical consent form, patient orthotic services forms, medical assistant certification forms and letters discharging patients.

These forms are particularly helpful to new practitioners, who can avoid reinventing the wheel.

APPEALS To INSURANCE CoMPANIES One of the most used sections of the legal resource Center is our payor Denials Section. We have several form letters designed to appeal a variety of repayment demands, including: lack of medical necessity,

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CuRRENT lEGAl ISSuES EHR IN The Centers for medicare and medicaid Services (CmS) has started auditing random recipients of eHr incentive payments through the contracted auditing company, figliozzi and Company, Cpas, p.C. (figliozzi). The purposes of the audit are to confirm that the provider accurately attested and submitted Clinical Quality measures (CQms) and to verify the accuracy of the incentive payment. CQms are tools that help medicare measure and track the quality of healthcare services provided by eligible professionals. if medicare determines that the eHr incentive payment was made in error, it will then seek to recoup any unsupported or improper incentive payments that were previously paid to the provider. at this time, we have provided the auditors with all the requested information and documentation for the members we are monitoring, and are awaiting the auditors’ findings. We will update you regarding the results and our further recommendations in future issues.

WoUND CARE AUDIT ALERT We have handled a number of palmetto medicare audits this year involving wound care where repayment demands were based on the an incorrect lCD. Specifically, the auditors are improperly utilizing lCD 31973, which although it covers “Surgical Debridement of Wounds,” it is listed in palmetto’s website under 01101, maC - part a, which only applies to facilities or Hospitals. The correct lCD for part B providers is lCD 28308, which also covers “Treatment of ulcers and Symptomatic Hyperkeratoses,” but is listed under palmetto’s 01192, maC - part B lCD Codes for physicians and non-physician practitioner Services. although these two lCDs are similar in most aspects, they vary regarding the type of description needed for the tissue that was removed. Whereas lCD 31973 requires identification of “the amount of tissue that was surgically removed” and “the character of the wound before and after debridement,” lCD 28308 only requires identification of the specific “Depth/level” of debridement performed (instead of the specific amount of tissue removed). We believe that lCD 28308 should apply to treatment rendered by podiatric physicians. However, our contentions have been rejected in the first level of appeal. We will update you once we have a ruling on the second level of appeal.

CARRIER AUDITS TARgETINg 25 MoDIFIER anthem Blue Cross has implemented a new automated claims review program that changes the way it evaluates global periods, as defined by CmS in the medicare physician fee Schedule, and how multiple claims for a single date of service are reviewed. The new edits include a “modifier to procedure validation” edit that has resulted in a large number of members receiving notices from equiClaim, the company anthem has contracted with to review the use of e/m codes with modifier -25. according to the notices, the -25 modifier is used in approximately 43% of the billings by in-network Dpms on the same date of service as a non-diagnostic procedure. members who used -25 in a “considerably higher” percentage of claims were advised that they are being monitored and that continued use in excess of the expected distribution may result in demands for supporting documentation and recovery of associated overpayments. We are currently monitoring cases where records have been requested, and will update you once we have the audit results.

Our preliminary survey revealed that many members are actually underutilizing the -25 modifier, which results in the average use percentage being undervalued. in light of the anthem Blue Cross audit, and a similar audit by aetna, we suggest that all members carefully scrutinize their utilization of the -25 modifier. Those of you that are underutilizing the -25 modifier should scrutinize your billing and charting protocols to determine whether you are being underpaid in circumstances where the records reflect: (1) a complaint or problem that stands alone as a billable service; (2) performance and documentation of the key components of an e/m service for the complaint or problem; and (3) either a different diagnosis for a significant portion of the visit or extra work above and beyond the usual preoperative and postoperative work associated with the procedure. Those of you that are substantially higher than the norm should scrutinize your records to confirm that they comply with the stated criteria.

WE ENCoURAgE MEMBERS WHo HAvE ANy qUESTIoNS REgARDINg THESE, oR oTHER, LEgAL ISSUES, To CALL THE CPMA LEgAL HoTLINE AT 1-800-FooTLAW.

News you NEED to know delivered to your in box each month. Don’t miss it!

Be sure CPMA has your correct email on file. a p r i l | m ay | j u n e | 2013

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The Law Offices of

Greer & Associates

Proudly serving the legal needs of Podiatric Physicians since 1993 We know how much you rely on us. So while you are taking care of your patients, we are taking care of you. We would like to thank CPMA Member Bob Alavynejad, D.P.M. for his professorial assistance at our recent cadaver lab. At right, Dr. Alavy shows Nurse-Paralegal Theresa Drobina and Attorney Ken Wilson how to access mid-foot joints.

At left, Attorney Keith Greer exposes a neuroma with Nurse-Paralegal Drobina assisting and Senior Paralegal Bryan Loven,Paralegal Rachel Darby and Attorneys Jon Berger and Ken Wilson observing.

Reputations are earned through commitment, experience and results. Over the last twenty years we have proudly represented Podiatric Physicians in more than 1,000 malpractice claims, hundreds of Medicare, Medi-Cal and private insurance audits and more Board of Podiatric Medicine matters than any firm in the state. Aren’t we the type of team you want in your corner during challenging times?

Available exclusively through

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DHCS ANNouNCES NEW DElAy IN IMPlEMENTATIoN oF DuAl- ElIGIblE PRoJECT as The California Podiatric Physician was about to go to press the California Department of Health Care Services (DHCS) announced that it would delay the implementation of the state’s “pilot project” to redesign healthcare for medicare/medi-Cal dual eligibles. The program, now called Cal mediConnect, is expected to begin no earlier than january 2014. most recently, implementation had been scheduled for October 2013.

The California podiatric medical association (Cpma) along with the California medical association (Cma) and other stakeholders has continuously urged DHCS to withdraw the overly-ambitious project proposal in order to take more time to develop a scaled-down project that gives seniors and the healthcare professionals that provide care for this fragile population, information and feedback mechanisms to assure continuity of care and improved care coordination.

“Never doubt that a small group of people who care can change the world. In fact, it is the only thing that ever has.” Margaret Mead Karen Wrubel, Dpm president

MEMbER GET A CoRPoRATE MEMbER AND $$$ Cpma is kicking off its 2013 Corporate member drive with the Member get a Corporate Member Campaign, where any Cpma member who signs up a new presidential level Cpma Corporate member will receive a $100 Visa Gift Card, or for signing up an executive level Corporate member a $25 Visa Gift card. The campaign will run from april 1 to june 15, 2013. members can download a Corporate member benefits list/application from the Cpma website calpma.org/corporatemembers or contact Cpma at (800) 794-8988 to have a Corporate member brochure faxed to you.

Cpma Corporate members are companies that go the extra mile to support yOu! funds received through this program enable Cpma to offer enhanced services to its members while also providing public information and education to the general population on

podiatric medicine and the important role podiatric physicians play in healthcare delivery. Cpma’s Corporate member program also allows companies to learn about the activities of Cpma and work with the association to support the podiatric medical profession, physicians, and patients.

CPMA gratefully acknowledges the companies in our Corporate Member program and their commitment to excellence in the podiatric medical community. Please visit their websites to learn more about their products, services, and efforts to promote quality foot health.

Remember to Support Those That go the Extra Mile to Support yoU!

SuPPoRT THoSE THAT Go THE ExTRA MIlE To SuPPoRT you! a p r i l | m ay | j u n e | 2013

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Experience Magic!

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Thrilling news rides, exciting attractions, dazzling shows and special events await the 2013 Western Attendees at Disneyland and Disney’s California Adventure.

Jedi Academy Where younglings learn to defend the galaxy from the Darkside

Take a heart-pounding thrill ride on Tower of Terror

World of Color

Mark Twain Riverboat

The nighttime water spectacular weaves water, color, fire and light into a kaleidoscope of fantasy and imagination. more than 1,000 jets of water form incredible shapes in time to the music as Disney characters come to life on a shimmering veil of mist .

Cruise back in time on an authentic steampowered paddlewheel riverboat. The 19thcentury riverboats that carried people and cargo up and down the mighty mississippi.

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Aladdin live night skies come alive with the nightly display of Disney’s dazzlingly fireworks

Continues to thrill audiences at Disney’s California adventure’s spectacular Hyperion Theater.

Fantasmic!

Dumbo

fantasmic! a nighttime extravaganza featuring music, pyrotechnics, water screens , lasers and much more!

you’ll believe an elephant can fly on this family favorite, which captures the magic of Disney’s Dumbo the elephant

Pirates of the Caribbean

buzz lightyear Astro blasters Help save the galaxy when Buzz lightyear recruits you as a Space ranger to thwart the evil emporer Zurg! Spin, twist and turn as you shoot lasers at Zurg’s bad robots to keep them from carrying out his evil plan to steal the batteries from good toys everywhere. a p r i l | m ay | j u n e | 2013

Paradise Pier

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Cars land

The Matterhorn

Ca-Chow!

luigi’s Flying Tires Soarin’ over California fly away on a gentle breeze of music and inspiration! Soarin’ Over California is an exhilarating simulated hang-glider flight over California’s famous natural and manmade wonders.

best friends Mater and lightening McQueen

king Triton’s Whimsical Carousel 72 |

Jumping Jelly Fish C p m a | C a l i f O r n i a p O D i aT r i C m e D i C a l a S S O C i aT i O n

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Innoventions is the site of the new iron man Tech exhibit by Stark industries

Suit up at the Iron Man Tech Exhibit

Tea Cups

It’s a Small World everyone’s favorite! Try to spot your favorite Disney characters!

Finding Nemo Submarine Voyage

Grizzly Peak Rapids a p r i l | m ay | j u n e | 2013

Dive into the Tomorrowland lagoon and discover the world of finding nemo! as your whimsical australian submarine sinks into the vibrant waters, explore the undersea curiosities and follow marlin as he searches for nemo through the perils that dwell in the ocean deeps. | 73

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