California Podiatric Physician July/Aug/Sept 2014

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J u ly | Au g u s t | S e pt e m b e r | 2014

PRESIDENT ELardo’s I na u g u ral A ddress

Delegates, Board of Directors, Past Presidents, and Honored guests present here today, I am deeply and truly honored to have your support as I assume the Presidency of the California Podiatric Medical Association.

I’m here today because of the people who have inspired me… but I’m also here because of all the people whom I have inspired along the way - for you are the ones who have had the faith and confidence to put me here in this leadership role.

For the next 12 months I will guide this organization with my heart and soul, keeping in mind the well-being of every Podiatric Physician in this state. As we navigate the treacherous waters of a changing healthcare system, there is no doubt that the leadership that sits before you today will work tirelessly to guide this organization forward and steer clear of troubled waters.

We have an outstanding crew, well assembled, and well planned, but this did not happen by accident.

It was the work our past leaders who saw in us things we did not see in ourselves, for great leaders are identified early in their careers. They are people with innovative ideas that possess the ability to execute a strategy and accomplish a goal. Characteristics such as honesty and humor, confidence and commitment, positivity and creativity permeate each and every one of us to some degree. Our ability to inspire others is our greatest asset. Our ability to work together is our See Presidential address on Page 5

Western Attendees Get a Leg-up on the Latest Trends in Modern Podiatric Medicine and Management More than 1,100 conference goers packed the Disneyland Convention Center for the June 19-21 event that featured more than 25 CECH in instructional courses, lectures and workshops.

The Western’s world class exhibit hall was abuzz with activity as over 160 companies displayed and demonstrated the latest tools, techniques and technologies in medicine and management.

The 2014 Western Foot and Ankle Conference gave attendees a chance to see and hear the latest trends in the profession.

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“This was one of the best Westerns so far,” said newly elected CPMA President Thomas J. Elardo, DPM. “I think attendees left feeling energized

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about podiatry, and taking what they learned back to their practices. The Western provides a great opportunity for doctors to empower their team and infuse new energy into their practices.”

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Elardo Elected CPMA President A member of CPMA since 1997, Dr. Elardo has served in a number of leadership roles, including President-Elect, Vice President and Secretary/Treasurer of the California Podiatric Medical Association. Before being elected to the CPMA Board of Directors, Dr. Elardo previously served as President of the Santa Clara Valley Podiatric Medical Society for two separate terms in 2001-2003 and again in 2005-2006.

A native of New Jersey, Dr. Elardo, after finishing his high school career as State Gymnastics Champion, earned an Athletic Scholarship to compete in Gymnastics at San Jose State University.

During his tenure at SJSU, he competed as a Division I Gymnast earning multiple awards including the prestigious Clair Jennet award for Outstanding Scholar Athlete. He received his Bachelors of Science Degree in Systems Physiology, with a minor in chemistry.

Podiatric physician and surgeon Thomas J. Elardo, DPM was installed as the 94th president of the California Podiatric Medical Association (CPMA) during the organization’s annual House of Delegates held in Anaheim, CA in June.

Addressing the group of more than 100 podiatric physicians, residents, podiatric medical students and others, Dr. Elardo challenged his colleagues to be proactive participants in the tremendous changes coming in healthcare rather than sitting back and reacting to changes by default.

“We owe it to our patients, the public and to our profession to be leaders in healthcare reform – to develop a brighter future that we help create,” he said to the crowd.

Dr. Elardo received his postgraduate medical training at the California College of Podiatric Medicine (CCPM) in San Francisco, where he earned his Doctor of Podiatric Medicine (DPM) Degree in 1996. He went on to complete his surgical residency at the Veterans Hospital in Palo Alto and Stanford Health Services.

Board certified by the American Board of Podiatric Surgery (ABPS) and a Fellow of the American College of Foot and Ankle Surgeons, Dr. Elardo is currently in private practice in Los Gatos, California. He serves on the Credentials Board for Columbia Good Samaritan Hospital and works closely with the surgical residents at the Veterans Hospital in Palo Alto, teaching advanced surgical skills.

Dr. Elardo resides in the Almaden area of San Jose with his wife and their three daughters. He enjoys playing softball, skiing, hiking, paddle boarding and when he can find time in his busy schedule, vacationing in Maui, Hawaii.

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After a day of inspired learning, Conference goers had the opportunity to relax and unwind with family and friends at the Disneyland Resort where they could soak up the warm California sunshine at one of the Resort’s three playful pools; stroll the dynamic, shopping, entertainment and dining Downtown Disney district. Or, head over to one of the resort’s two theme parks – Disneyland and Disney’s California Adventure - to try the newest rides, revisit old favorites, take in a show or watch a passing parade.

The California School of Podiatric Medicine (CSPM) at Samuel Merritt University/California College of Podiatric Medicine (CCPM) celebrated a century of podiatric medical education and training with a Centennial Gala, reuniting old friends and colleagues who shared an evening of fond memories, fine food and fun as they danced the night away.

Plans are well underway for an even bigger and better 2015 Western Foot and Ankle Conference, June 25-28 at the Disneyland Hotel and Convention Center in Anaheim, CA. The 2015 Western will be your E-Ticket to the most up-to-date clinical and technological advancements in medicine, numerous stimulating C.E opportunities, extensive exhibits, networking and fun at one of the nation’s premier podiatric medical conferences at the destination location Disneyland Resort.

So, come for the meeting, stay for the fun and join in what is sure to be a dazzling salute to 60 years of magic at The Happiest Place on Earth as Disneyland celebrates its Diamond Jubilee!

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Presidential address from Page 1

greatest blessing, for working together is how we get things done.

We are a family, The CPMA family, and I am proud to be part of this family with you.

Nothing worth doing is completed in our life time. Nothing true or beautiful or good makes complete sense in any immediate context of history. Nothing we do, however virtuous, can be accomplished alone.

Three years ago CPMA celebrated an anniversary. 100 years of serving the Podiatric Physicians of this state - truly a milestone for any organization. When we think of the progress we have made in that time period, we have everything to be proud of. How did we do it? We did it with dedicated individuals who knew that Podiatric Medicine was a necessary and integral part of the healthcare system.

I was fortunate enough to share in the readings of some letters from members to our President Rod Farley in 1976. I came across a letter from CPMA Past President Russell Bliss, DPM (1953) who stated that most of Podiatric Medicine’s problems had all been resolved but 2: • The need for removal of the limitation of Amputation; and • The need for legal interpretation of Podiatrist as meaning “Physician and Surgeon” with the license limiting practice to the care of the feet and the tendon of the leg governing of the functions of the foot.

He went on to say that if these two items could be accomplished, then we would have our parity. Most of you know that Assembly Bill 932 helped clarify our amputation privileges, admission history and physicals, and ability to assist outside our scope over 10 years ago.

However, the second part of his recommendations was going to take a bit longer to accomplish, and the answer to the question of true parity has been a hot topic of discussion and debate. What exactly does this mean?

It is not simply calling oneself a Physician or advertising as one.

It is the art and practice of medicine in its full scope, enabling the DPM to practice as a Physician and Surgeon specializing in Podiatric Medicine and Surgery, equivalent to any other medical specialist.

Podiatric Medicine needed a longer term strategy to accomplish this goal. We needed to continue to build the trust of our medical colleagues by developing strong relationships with key people who could see that we were not merely asking for something we did not deserve. The process we are choosing will someday be the roadmap for other groups of health professionals looking to advance their profession.

Well, my friends, I am here today to tell you we are close to accomplishing one of the most important goals this profession has ever seen. I believe Dr. Bliss would be pleased to know that we continue to work diligently on his final point to Dr. Farley over 38 years ago.

The visionary planning of this Board and its components set into action the Physicians and Surgeon Joint Task Force to answer this final question.

We are over 2 years into this process and have made significant gains toward accomplishing our goal. While there have been many challenges along the way, Drs. Wan and Cornelison have taken a J u ly | Au g u s t | S e p t e m b e r | 2014

“never give up” strategy. Any roadblocks we have encountered have been overcome by changes in strategy. California continues to pave the way for a new tomorrow.

I am proud to say this initiative has been supported 100% by volunteer donations from members and corporations that believe in our cause. Please continue to support this initiative and encourage your colleagues to do the same.

Presiding over an association such as CPMA requires amazing coordination. Every President relies heavily on the work of strong committees, an outstanding Executive Director and staff ,and his or her Board colleagues in order to accomplish the goals of the organization. This year will be no different. As medicine changes, adaptation is essential. I am committed along with the team that sits here before you to help guide you through those changes.

I will highlight some of this past year’s accomplishments: Governmental Affairs and CalPPAC Our Governmental Affairs Committee has fallen upon good fortune this past year with the addition of our new legislative advocate Jodi Hicks. She has been an amazing asset to our team in such a short time. President McAloon was steadfast in her decision to support legislation to end the Medi-Cal standoff that has kept Podiatric Medicine on the sidelines for the past 5 years.

The efforts of the Governmental Affairs Committee and the PAC under the leadership of Drs. Tom Tanaka and Derick Ball have been targeting key legislators throughout the year. Scott Wilk and Jimmy Gomez were present at the Legislative Leadership Conference earlier this year showing their support. From this relationship evolved CPMA’s Medi-Cal Bill AB 1868, which passed the California State Assembly floor on May 7th with a resounding 66-0 vote and will now head to the Senate. This bill authored by Democrat Jimmy Gomez of Los Angeles would reinstate full foot and ankle care by all Podiatrists in the Medi-Cal system. Its time has come. Let us finish this task so that the patients that need our services the most may have the necessary access to the quality podiatric healthcare we provide.

Our Political Action Committee has had a remarkable year of fundraising with the continued success of the One Voice events in Los Angeles and Santa Clara. We look forward to the continuation of our fundraising efforts with expansion of these types of events throughout the state.

Communications Our Communications Committee has seen successes not experienced before at a time when we need it the most. Under the guide of our very own Dr. Wenjay Sung, this committee has performed flawlessly throughout the year by promoting Podiatric Medicine and the Association to the public with multiple advertising campaigns that strive to promote foot health. Raising awareness of what we do and how we can be successful in our communities is essential for tying us into the healthcare system.

The ability of our specialty to communicate has never been more important. The current threat to MICRA this year will require every member and nonmember to participate in this battle. Our Communications Committee will be essential in getting the word out. I’m looking forward to greater success this year.

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Presidential address from Page 5

Member Services and Student Recruitment Our Member Services and Student Recruitment Committee lead by Dr. Diane Koshimune has been hard at work evaluating strategies to maintain current members and recruit new ones.

Demonstrating value as an organization has always been a challenge, but I believe the value CPMA offers to its members is exceptional and growing. I see a greater collaboration between this committee and our communications committee as we attempt to reach out to our member and non-member population, educating them on the importance of MICRA and how its presence is critical for maintaining a stable healthcare system here in California. Our past chair of this committee, Dr. Rebecca Moellmer, has established a student scholarship program showing the importance of student involvement at the local and state levels.

Science and Education and Western Foot and Ankle Conference When we talk about the value that we offer to members, one cannot help but look to the success of the Western Foot and Ankle Conference. Our Scientific Chair Shannon Rush and Western Chair Jonathan Labovitz continue to perform above and beyond the level of ordinary men. Each year, this conference outperforms the previous year, making it one of the top podiatric educational conferences in the country. Something we can all be extremely proud of.

Corporate Relations Over the past year I have watched a spark ignite in Dr. Adam Howard, the incoming Chair to the Corporate Relations Committee.

I couldn’t have found a more qualified individual to take over this committee. Dr. Howard is extremely comfortable and effective at initiating and following through with corporate contacts and fostering lasting relationships.

The job of the Corporate Relations Committee is to demonstrate the value of this organization. I task each and every one of you to show your support and gratitude to the vendors as you pass through the exhibit hall this week. The corporations that attend the Western Foot and Ankle Conference are critical to our past, present, and future success. The monies raised by the Corporate Membership program allow this Board to follow through with our strategic plan.

MICRA and Healthcare Leadership Academy Earlier this year CPMA executive leadership was invited to attend the Healthcare Leadership Academy in San Diego for the first time.

This was truly a product of the relationship our Executive Director Jon Hultman has nurtured with CMA Executive Director Dustin Corcoran. Our invitation as Physician attendees solidifies CMA’s support in our organization as partners in healthcare delivery. This conference allowed us to attend CMA’s training on MICRA, which as you know, has qualified as a ballot initiative earlier this year.

MICRA (the Medical Injury Compensation Reform Act) threatens the foundation of healthcare in the state of California. As you all know and have heard here today, this will be a major focus this year for CPMA and the coalition. Our fundraising efforts have topped our expectations thanks to all of you. We will continue our grassroots efforts until we defeat this ballot measure.

DUAL Eligibles and Medi-Cal We continue to monitor the changes that are forced upon us and the ever so vigilant efforts and watchful eye of our very own J u ly | Au g u s t | S e p t e m b e r | 2014

Dr. Karen Wrubel will continue to monitor the changes in the Dual Eligibles in California. I am looking forward to her continued service to this association through her liaison to the board, Dr. John Chisholm, who has his finger on the pulse on the Medi-Cal issues.

What Can I Offer You As a Leader?

1. Integrity - I will be consistent in my actions and do the best for this organization.

2. Hard Work – I’ll sleep with one eye open so you don’t have to.

3. Determination - I don’t like or accept failure; it is not an option.

4. Perseverance - If I fail, I will find another way.

What You Can Expect As the Year Progresses 1. A valiant effort to defeat MICRA; 2. The continued coalition building with our medical colleagues CMA, COA, OPSC and other entities that share the same values and beliefs as CPMA; 3. Continued public education and awareness of Podiatric Medicine; 4. Advancement of our Physician and Surgeon initiative; 5. New avenues for raising non-dues income and expanding our corporate relations; and 6. Expanding the financial and legal educational opportunities for our members.

Thank you to my family standing in the back of the room for always being there for me. And a special recognition to my daughter Tara who put together the video you saw here today.

It has been your support throughout this journey that allows me to rise every morning, give it the 110% that the day deserves and getting up to do it all over again the next day.

I’d like to thank all of my Board, my Parliamentarian, and my Executive Director. You guys are the base of my pyramid, and I am grateful to have you here.

I’d like to thank my business partner Richard Meltzer who is not here today for providing me with an opportunity over 17 years ago to work in a great community and allow me to become all that I have.

I’d like to thank Dr. Sheth, my partner in crime, my sounding board, my spellchecker and overall voice of reason. Most of you don’t know that Dr. Sheth and I work in the same office, and it will be the first time in the history of CPMA that there will be two Presidents back-to-back from the same office, truly a unique situation.

Andy Rooney once said, “Everyone wants to live on top of the mountain, but all the happiness and growth occurs while you’re climbing it.”

I am enjoying this climb, and the climb is not over yet. I look forward to the challenges that lie ahead this year, and I am blessed to have the support of this Association. I know that I will do my part to leave the Association better than I found it, and I ask that you all do the same and join me to make it better.

Thank you!

Thomas Elardo, DPM President, California Podiatric Medical Association | 7

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Congratulations

2014 Awards

President’s Award Paul R. Phinney, MD

Meritorious Service Jonathan J. Uy, DPM

Executive Director Award Thomas J. Elardo, DPM

Humanitarian Award Michael A. Zapf, DPM

Society President of the Year Adam S. Howard, DPM

Step-Up Award Wenjay Sung, DPM

Distinguished Service Bruce R. Lawrence, DPM

Podiatric Physician of the Year Karen L. Wrubel, DPM

CalPPAC Awards

Champion for Podiatric Medicine Jim Rathlesberger, MPA

GOLD – Orange County SILVER – LA County Bronze – San Diego

Society with Highest Number of Members Contributing Santa Clara Valley Podiatric Medical Society

Honorable Mention Alameda/Contra Costa Podiatric Medical Society San Diego/Imperial Podiatric Medical Society

Corporate Citizen of the Year DermaTran

Communication Awards

Society with Highest Total Contribution Los Angeles County Podiatric Medical Society

Society with Highest Contribution per Member Santa Clara Valley Podiatric Medical Society

Legacy Award Melvin R. Barton, DPM David D. Mullens, DPM Randall J. Sarte, DPM

Service Above Self Carolyn E. McAloon, DPM

Come for the 2015 Western, Stay for the Magic of Disneyland’s Diamond Celebration

2014 Western Sponsors Platinum DermaTran Health Solutions Stryker Orthopaedics

Diamond Wright Medical Technology, Inc.

Gold The Tetra Corporation

Silver Arthrex, Inc. Integra LifeSciences Volcano Corporation

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Bronze Bako Integrated Physician Solutions Merz Pharmaceuticals Smith and Nephew TEI Medical, Inc.

Copper Solana Surgical, LLC

Program Podiatric Insurance Company of America (PICA)

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Howard and Zeetser Elected to CPMA Board of Directors Adam S. Howard, DPM (Hayward, California) was elected as a Director-at-Large to the Board of Directors of the California Podiatric Medical Association (CPMA) during the organization’s Annual House of Delegates, which took place in Anaheim this past June.

In addition to being elected to the CPMA Board of Directors, Dr. Howard was also named the Association’s 2014 Society President of the Year for his outstanding leadership of the Santa Clara Valley Podiatric Medical Society.

A native of Maine, Dr. Howard earned his Bachelor of Science degree in Health Sciences with honors from Linfield College in Oregon. He received his Doctorate of Podiatric Medicine degree at the William M. Scholl College of Podiatric Medicine in Illinois. There he also received his second Bachelor of Science degree, this one in Biology. He was also the recipient of the Scholl Distinguished Scholar Award.

Dr. Howard completed his three-year surgical residency at the Department of Veterans Affairs in Palo Alto. A private practitioner in Cupertino, California, Dr. Howard resides in Hayward, California with his wife and young son.

Vladimir Zeetser, DPM (Torrance, California) was elected as a Directorat-Large to the California Podiatric Medical Association’s (CPMA) Board of Directors during the Association’s Annual House of Delegates in June.

A Past President of the Los Angeles County Podiatric Medical Society, for which he was named CPMA’s 2013 Society President of the Year, Dr. Zeetser is a graduate of the University of California, Los Angeles (UCLA), where he received his Bachelor of Science Degree in Biology. He received his degree of Doctor of Podiatric Medicine (DPM) from the California College of Podiatric Medicine (CCPM) in San Francisco, where he graduated with highest honors. Dr. Zeetser went on to complete a two-year surgical program at Northridge Hospital Medical Center.

A certified podiatric physician and surgeon, Dr. Zeetser practices in Encino and currently maintains hospital privileges at Northridge Hospital Medical Center and Providence Holy Cross Medical Center. He holds active membership in the American College of Foot and Ankle Surgeons (ACFAS), the American Board of Podiatric Surgery (ABPS) and the American Professional Wound Care Association (APWCA).

In 2011 Dr. Zeetser was recognized as one of America’s Top Podiatrists. He resides with his wife and two children in Torrance, California.

at the bpm Manzi Appointed to BPM Gov. Jerry Brown has appointed CPMA member Dr. Judith Manzi of Santa Cruz to the California Board of Podiatric Medicine (BPM).

Dr. Judith Manzi has been senior physician at Kaiser Permanente Santa Clara Medical Center since 2001, where she was a staff physician from 1998 to 2001. She was a podiatric physician in private practice at the Sunnyvale Foot and Ankle Center from 1984 to 1998 and chairman of the Ohio College of Podiatric Medicine Department of Surgery from 1982 to 1984.

Dr. Manzi earned her Doctor of Podiatric Medicine degree from Temple University.

(KION www.kionrightnow.com 9/3/2014)

BPM Has New Executive Officer Jason S. Campbell has been appointed as the Executive Officer of the Board of Podiatric Medicine (BPM), following the retirement of J u ly | Au g u s t | S e p t e m b e r | 2014

James Rathlesberger, who served as the Board’s Executive Officer for 25 years.

Campbell previously served as Customer Communications Manager for the Los Angeles County Metropolitan Transportation Authority (Metro) since 2013. He has held various positions with the agency since 2010, including serving as Acting Principal Hearing Officer for Metro’s Transit Court, and as Senior Ethics Officer responsible for enforcing provisions of the California Political Reform Act of 1974 and overseeing the operations of conflicts of interest, ethics and lobby registration program functions. Prior to Metro, Campbell served as a Compliance Officer with the City of Los Angeles in the Office of Finance.

Before beginning his career in public service, Campbell served as an attorney in private practice from 2006 to 2008, where he specialized in immigration law and was responsible for managing complex litigation and investigations. Before entering private practice, Campbell clerked for the Honorable Andrew S. Hanen of the United States District Court for the Southern District of Texas and the Los Angeles County District Attorney’s Office.

Campbell earned a Juris Doctor degree from the University of Maine School of Law and a Bachelor of Arts from the University of California, Los Angeles. He is admitted to the state and federal courts of New Jersey and with the Ninth Circuit Court of Appeals. | 11

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November is Diabetes Awareness Month

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Strategic Planning The CPMA Board of Directors is preparing for its annual strategic planning retreat which will be under the leadership of CPMA president, Tom Elardo, DPM. Looking back over the past ten years, we can see that CPMA strategic planning retreats have generated a positive momentum – both financially and strategically. They have also helped us to build a disproportionate amount of influence for our “small” association – in California and nationally.

While both not-for-profit and for-profit businesses hold annual strategic planning retreats, this is a tool employed by few medical practices. Given the number of challenges faced by today’s practitioners and the high level of uncertainty regarding future changes in healthcare delivery and payment, regular strategic planning retreats should be at the top of every DPM’s “to do” list for his/her practice. With this recommendation in mind, I have selected two short sections from my book The Medical Practitioners Survival Handbook (pp 223 - 227) that are relevant to the topic of strategic planning and should help motivate our members to consider establishing their own retreats for this purpose. An upcoming CPMA seminar which would also be helpful for any practitioner looking to position his/her practice for the future is the Essentials of Practice – scheduled for Saturday, November 1, at CSPM. This seminar has been designed to present various practice models to podiatric physicians who are looking for effective ways to address the future. Additional topics that will be covered are designed to help guide practitioners in adapting to the changes that are expected to come about as well as those that have already been implemented.

Use Retreats to Plan Big Changes One truism that I have found throughout my career is that there is not always a correlation between the amount of work required to reach a goal and the size of the achievement. It seems intuitive that spending more time and exerting a greater effort when planning changes would assure bigger and better results; yet, some of our most significant achievements are accomplished in less time and with less effort than smaller ones. This is not to say that changes happen automatically; to achieve significant goals, we must have a well thought out master plan. It is a shame that we often miss big opportunities and accomplishments because we are bogged down in the day-to-day small things, the struggles of “getting through” the typical busy day. Obviously, we have to deal with the day-to-day “busyness” of our practices, but we should make sure that we also take time out to tackle the big goals.

more than one hundred calls, while the higher paid salesperson has made only three. The statistic relevant to the boss, however, is that the “underpaid” salesperson has made one sale whereas the “overpaid” one has made three. In this case, the “underpaid” employee is confusing effort with accomplishment. This argument of “I am working harder and, therefore, should be paid more” is heard frequently in every business and is usually accompanied by numerous excuses for poor outcomes rather than attempts to discover why actual accomplishments have been few.

The primary reason that we miss opportunities or don’t accomplish as much as we could is that we seldom have a “plan” for reaching our goals. Days pass quickly in a busy practice, and most decisions are directed at “putting out fires” and “getting through the day.”

Frequently, much of our work is even incomplete at the end of the day, necessitating that we catch up at a later time. It is impossible to set long-term goals and develop the strategy for achieving them in this type of environment. One solution to this dilemma is to get out of the routine office environment and devote a few days to contemplating “the big issues.”

Many businesses set aside one weekend a year for a strategic planning retreat. Few medical practitioners, however, take this type of “time out.” In spite of concerns regarding the added cost of a retreat, or the fact that you will be “giving up a weekend,” this is a strategy worth adopting. A retreat is not the same as an office meeting – even when the meeting is off site. A retreat requires advance planning, and its significance is elevated when it is established as a priority, without overly skimping on cost. Sometimes it makes sense for attendance to be “doctors only” – with the intent of setting this time aside for the purpose of establishing goals and priorities. At other times (such as prior to implementing a project which will require major change and full commitment from both doctors and staff ), attendance should include the entire staff, along with the doctors.

The retreat environment is conducive to generating ideas, setting goals, and solidifying relationships amongst those who will ultimately be charged with prioritizing and implementing the plan that will be developed. Participants can relax, take time to envision the type of practice they would like to have, and set a plan for achieving this goal. It is best to set the bar high because this forces participants to

I think most of us recognize that there is a significant difference between being busy and being productive. I remember watching a basketball game in which one of the announcers kept pointing to the effort that one player was putting forth. Even though this player had not scored a point, or retrieved a rebound, he did appear to be putting out a major effort. Bill Walton, the co-announcer, was less impressed with this player’s effort, remarking, “Don’t confuse effort with accomplishment.”

A business example that parallels this is that of the sales person who complains to his boss that he is underpaid, supporting his request for a raise with the explanation that he puts in more time and effort than his colleague in the adjacent cubicle who is much higher paid. He shows his boss phone logs, pointing out how he has made 14 |

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think out of the box and actually achieve “bigger” accomplishments.

For example, if your goal were to grow profit by 10%, there would be a number of “easy” ways to achieve this; however, if the goal were to increase profit by 100%, you would have to be more creative, and this is best done in an atmosphere where no one is distracted by daily routine and everyone is encouraged to “think outside the box” – with no initial ideas being considered too radical. Even if you “fail” and reach only 20% of your 100% goal, the end accomplishes twice as much as “succeeding” at the 10% goal. Once goals have been discussed and established at the retreat, a successful implementation is more likely upon return to the practice. This is because team members who have come together at the retreat have already “bought into” the plan; they themselves have been instrumental in setting the goals and will be the ones charged with their implementation.

practice. Make this a high priority; pick a date when most everyone can attend; seek ideas for a location, and make it an event that everyone will look forward to. During the months leading up to the event, everyone will begin to think of ideas or issues s/he would like to discuss at the retreat. It is O.K. to list these and have a structured agenda, but leave a majority of the time open for “brainstorming sessions” at which everyone has a blank page in front of him/her with no preconceived point of view. If time is regularly set aside for this type of activity, you will find that your practice’s accomplishments will be “bigger and better” each year.

The first formal retreat held by the partners of my former practice was established with the purpose of setting goals for a major “recomputerization” of our office being contemplated for later in the year. The location we chose was a beach resort in California. In spite of the fact that the retreat included time for relaxing on the beach and social dinners in the evening, we emerged at the end of the weekend with clear written goals for our project and a formal plan of implementation. Instead of simply setting the typical goals for computerization (such as “becoming paperless”), we were able to set a number of broader ones designed to achieve specific results – including employment of this new system for improving quality (both service quality and quality of care) and increasing profitability (through both cost reduction and improved collections). If we had not held the retreat, we would have spent the same amount of money on technology and expended the same amount of time and energy installing and implementing it, but we simply would have achieved a “paperless practice” – with little improvement in either quality or profit.

Following office meetings, or successful retreats, multiple ideas are put forth, creating a long list that needs to be reduced to a manageable size. The challenge lies in deciding where to focus first. When facing this type of decision, it is helpful to be familiar with the “80:20 business rule,” a concept that was initially derived by Vilfredo Pareto, an Italian economist born in 1906, who described the unequal distribution of wealth in his country in which 20% of the population was shown to hold 80% of the wealth. This finding was applied to business in the 1930s, when Joseph Juran, one of the early gurus focused on quality, determined that 20% of the defects in manufacturing caused 80% of its problems. As has been verified by multiple researchers, this 80:20 relationship is universal and holds true for most types of business decisions we face.

One recommendation I make is that you “think big” during a strategic planning retreat; this is the time to be outrageous and think the impossible – the key to achieving big accomplishments.

One thing that helps prepare participants for a retreat is reading motivational books prior to the event. These will not give you a specific plan, but they will help to “adjust” doctor and staff attitudes prior to the retreat so that the plan that is ultimately adopted will deliver bigger results. A book that I recommend is The Magic of Thinking Big, one that I had forgotten about until I came across it recently while “reorganizing” my office. My copy was quite worn, but as I thumbed through its pages, I realized this was the one “positive thinking” book that I had chosen to keep because it had helped me to overcome the tendency to focus on all the reasons why something might not work or to look for excuses as to why something had not worked in the past. This book was copyrighted in 1959; the version I owned was reprinted in 1973, and the price had I paid for it was $1.50! I am sure it has gone through a number of revisions since then, but you or your staff should find this (or a similar book) an inspiring read prior to a retreat.

At your next office meeting, suggest the idea of scheduling a retreat for the purpose of addressing the long-term goals of your J u ly | Au g u s t | S e p t e m b e r | 2014

Separate the Vital Few from the Trivial Many

Examples of this 80:20 rule found in a medical practice include the likelihood that: 1) 20% of your staff cause 80% of your problems, 2) 20% of your staff provide 80% of your production, 3) 80% of your revenue is generated during 20% of your office hours, 4) 80% of your revenue comes from 20% of your patient visits, 5) 80% of your revenue comes from 20% of your CPT codes, and 6) 80% of your costs are generated by 20% of your expense categories. A slight variation on this theme is detected when implementing a large project. In most cases, a combination of the first 10% and last 10% of a project consume 80% of the project’s total time. You may have experienced this if you have been involved in a home remodeling project. This is the reason that many construction companies run out of money when finishing the last 10% of a project.

Obviously, if you plan to focus on finding ways to increase productivity in your practice, you will first want to identify the 20% of patient visits, CPT codes, productive staff, and key hours that account for 80% of your revenue. This is certainly not an exhaustive list; there are many other factors impacting productivity that have been discussed throughout this book (The Medical Practitioners Survival Handbook). The key point is that, in today’s computerized medical practices, doctors face information overload. The amount of data generated by computers can be overwhelming, making it difficult to know where to focus attention. Understanding this Pareto concept and knowing that 80% of this data is basically “trivial” should give you confidence to narrow your focus to the 20% of “vital few” data that most significantly impact your practice. | 15

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excellence!

The 2014 Distinguished Service Award was presented to Bruce R. Lawrence, DPM (center) by CPMA Director John A. Chisholm, DPM (r) and APMA President Frank Spinosa, DPM

CPMA Secretary/Treasurer Rebecca A. Moellmer, DPM presented the 2014 Step-Up Award to Wenjay Sung, DPM

CPMA Vice President Ami A. Sheth, DPM (r) presented the 2014 Podiatric Physician of the Year Award to Karen L. Wrubel, DPM J u ly | Au g u s t | S e p t e m b e r | 2014

CPMA President Carolyn E. McAloon, DPM presented the 2014 President’s Award to California Medical Association Immediate Past President Paul R. Phinney, MD

James W. Stavosky, DPM (l) was the recipient of CSPM Alumni & Associates’ Heather Barton, JD Award, which was presented by Eric R. Hubbard, DPM and Daniel C. Fulmer, DPM

Timothy A. Dutra, DPM (l) was presented CSPM Alumni & Associates’ 2014 Gary P. Bianchi, DPM Award by Eric R. Hubbad, DPM (center) and Daniel C. Fulmer, DPM | 19

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excellence!

The 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.

J u ly | Au g u s t | S e p t e m b e r | 2014

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We’re looking forward to the Western Foot and Ankle Conference!

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Patient:

Phone: DOB (Age) / Sex: Collect Date: Received Date:

Doe, John Z 770-634-6616 3/19/1985 (28) / M 3/27/2013 3/28/2013

Ref Physician:

JANE DOE, DPM 111 YOUR ADDRESS HERE ST ATLANTA, GA 30309 877-376-7284/

Copy To:

PODIATRIC PATHOLOGY REPORT DIAGNOSIS:

SKIN, RIGHT ANTERIOR LOWER LEG, PUNCH BIOPSIES (two): - SPONGIOTIC DERMATITIS, SUBACUTE, MOST CHARACTERISTIC OF NUMMULAR (eczematous) DERMATITIS. - A PERIODIC ACID SCHIFF REACTION FAILS TO DEMONSTRATE FUNGAL ELEMENTS. COMMENT: These histopathologic features may be seen in association with conditions as disparate as acute allergic contact dermatitis, early-evolving nummular (eczematous) dermatitis, and Id reaction.

In light of the constellation of both clinical and histopathologic features in this case; one potential therapeutic course for this patient could include the application of a low potency (class 6-7) topical corticosteroid. The therapeutic value of such steroids may be augmented by concomitant use of topical urea.

CLINICAL INFORMATION: Dermatitis. Rule out tinea corporis. Lower leg.

GROSS DESCRIPTION: Received in formalin fixative are two 2-mm punch biopsy specimens which are submitted en toto for processing in 2 cassettes.

MICROSCOPIC DESCRIPTION: Sections demonstrate a superficial perivascular infiltrate comprised of lymphocytes. There is diffuse spongiosis and an admixed compact and basket-woven stratum corneum with intracorneal serum. Scattered intradermal eosinophils are seen. A PAS stain fails to demonstrate fungal organisms.

Final Diagnosis performed by Bradley W. Bakotic DPM,DO. Electronically signed 3/28/2013

Hydrocortisone 1%

Correlating Office Dispensed Therapeutics

CPT Codes:88305 ICD9 Codes: 692.9

Bradley W. Bakotic, DPM, DO

Joseph “Jody” Hackel, MD Medical Director

Wayne L. Bakotic, DO

Superior Reporting with Therapeutic Recommendations

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Successful Collection Protocols for Your Practice Collections can be a daunting task. Unless you have one or two dedicated staff members whose only job is follow the account receivables, this task has a way of getting put on the back burner causing collectable money to slip away.

notification? Some insurance carriers send electronic denials and others send a written letter in the mail.

Insurance companies are changing their payment protocols, and many will only allow a 60 or 90-day appeal process for denied claims. In a busy office with no real set time apart for collection work this deadline will pass very quickly and the opportunity to fight for your payment can be lost.

Find out from your carriers what the correct appeals process is for their company. Who are your provider relation contacts and what are their phone and fax numbers? This will save time in the future when you need to contact them. How long does it take for a previously denied claim to be reviewed?

Collections should be the responsibility of every person in the office. The front office person needs to collect every copayment and balance as patients come in the door. The back office assistants should be responsible that payment is made for any product or equipment that is dispensed during the patient’s appointment, not allowing for items to walk out the door.

Setting up a good collection system for your office includes several important policies and processes.

Establishing Policies Unless you have a great collection protocol in place, this is where you need to begin. Walking through the whole process and writing the steps it takes to get your claims paid takes some time, but in the long run you will be more successful.

Insurance Company Protocols Contact your large insurance carriers and ask them how long it takes to process your claims if they are clean. If a claim is denied, how will you be notified, and what is the time frame for

Usually when claims are submitted electronically there is a report available from your clearing house which lets you know if the claims you sent have been received by the insurance company. If you know the insurance company’s turn-around time for payment is 14 days, you can contact them if payment is not made on a claim within that time frame.

Calling the insurance company at 2-3 weeks from submission time to see if they received a claim will allow you to re-submit the claim much quicker instead of waiting 30-45 days and then following up. Remember it is the early bird that gets the worm.

With the technology we have today it is very easy to see if a claim is in process or not. Taking advantage of this can make a tremendous difference in collecting the monies that are due to you.

Patient Contracts Insurance benefits must be verified on patients with commercial insurance. Again, this is much easier now as many companies have the information regarding limitations, deductibles and durable medical equipment information online that can be accessed and printed in a few minutes. Giving the patient a copy of their benefits shows them that you are on the ball, and know what their insurance coverage is and what they will owe.

Having contracts with your patients for orthotics or other durable medical equipment will help them to understand that you have contacted their insurance, have checked their benefits, and have a reference number for the call. Patients will sign this contract and also be given a copy so if there are any issues that come up after items are dispensed and billed they will have the information to help you fight for their claim.

Patients must also know if any item is not a covered benefit and what the cost will be to them. Let them make the decision if they can afford it or not. If they can, have a contract that spells out the costs, non-coverage and any expectations. If a patient is given all of the information and it is explained to them why it is not covered and they sign acknowledging such, you are protecting your relationship with your patient. Remember, no one likes unexpected surprises, especially when it comes to paying out money.

See SUCCESSFUL on Page 25

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SUCCESSFUL from Page 23

Establishing Staff Collection Protocols Attitude: Always assume the patient expects to pay. Do not be afraid to let your new patients know what is expected from them prior to their first visit with you. Make sure that all new patients receive your financial policy and are clear of the office policies that you have regarding copayments, deductibles and over-the-counter products.

Let patients know that you take credit cards. The staff member’s voice should reveal that their doctor is their best choice and your fees are in line with those of other physicians in your area. Any staff member answering the phone needs to be confident and able to have clear communication with patients regarding their insurance plan and responsibility. This is important to your professional relationship with your patients.

Eye contact: The look in the staff member’s eyes while collecting for services rendered should reveal that they genuinely expect that the fees for services should be paid for. Staff members need to remain friendly and professional when collecting payments. Their eye contact, facial expressions and tone of voice should set the tone for a positive collection experience.

Resourcefulness: The staff member’s ability to answer any questions the patient may have about their bill is very important.

There needs to be prior protocols set up as to payment plans and parameters so that staff members can conduct business without interrupting the doctor for approval. All staff members need to be able to understand an explanation of benefits and why a patient owes money so that this information can be easily explained to the patient. No one feels comfortable paying someone for something that they do not understand completely.

Follow-up: Follow-up is very important in effective collecting of patient accounts. A good collector tracks promises made and has appropriate timelines for follow-up. Patient and insurance companies both know that weak follow-up or follow-through allow for payments not being made to the provider.

Appropriate timelines and follow-through are not only necessary, but are a must and need to be monitored. A lack in this area is a loss in the bottom line of revenue to the practice.

Preparation: Staff members need to be prepared when collecting.

Make sure that all information is reviewed and all documentation is in hand when making calls either to patients or insurance companies.

They need to know what money is due to the physician and why.

Be prepared to fax claims, information or statements immediately.

Have a clear understanding of all of the facts of the claim.

Practice People Skills: Effective collectors must have good people skills in order to get good responses from patients and insurance companies. Remember, with insurance companies, if the person on the other end of the phone does not like the way he/she has been treated your claims could go to the bottom of the pile or worse to the shredder.

Timing: Have your collections protocol for patients clearly spelled out. Patients need to have a copy of your financial policy. Send your statements in a timely manner and have your phone calls to patients who have balances done on time.

If your policy is that the balance is to be paid in full at 90 days and there has not been any attempt by the patient to pay, do not hesitate to send the account to collections. Your policy must state that this will be done and under what conditions.

The patient has had time to contact the office and let you know of their situation and make arrangements for paying their account in full.

If no contact has been made and a reasonable attempt has occurred then sending them to a collection agency is a good choice for the following reasons: • It removes your office from being the “bad guy” making the collection calls.

• Collection agencies have knowledge of the laws of collections in your state of which you might not be aware.

• Collection agencies can commit more time to collecting your money, since that is all they do.

• Using a collection agency frees up your staff to focus on what they do best: serving your patients.

• By adding to your financial statement, “if your account goes to collections 35% of your balance will be added to what is owed to cover collection costs” it will cost you nothing for the collection agency if they successfully get the patient to pay.

• You do not pay the collection agency if they do not pay. You do not pay employees for wasted time in trying to collect.

• Your patients will know that you are serious about your business.

Financial policies are important and need to be reviewed with each patient.

It is important to have every staff member trained and committed to effective protocols in collecting payments for the practice. All staff members must realize that their paycheck comes from the revenue that is collected from patient visits. Making collections a team effort will benefit everyone in the office.

Find Us on Facebook Like our Page: www.facebook.com/calpma Join or Group (CPMA Members Only): www.facebook.com/groups/calpma

J u ly | Au g u s t | S e p t e m b e r | 2014

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2014 house of

DELEGATES A Gathering of Leaders

Carolyn E. McAloon, DPM, President

Immediate Past President Karen L. Wrubel, DPM is welcomed into the ranks of CPMA Past Presidents

Neil B. Mansdorf, DPM, Chair, House Credentials Committee

Douglas M. Taylor, DPM, Delegate, Alameda/Contra Costa Society

Thomas J. Tanaka, DPM, Director

(l to r) CPMA Past Presidents Daniel L. Altchuler, DPM; Lyman H. Wilson, DPM with R. Daniel Davis, DPM, Vice President, American Podiatric Medical Association 26 |

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Past President Franklin Kase, DPM, Delegate, Chair, Health Policy Committee

CPMA Past Presidents and LA delegates Eric R. Hubbard, DPM (l) and Franklin Kase, DPM casting their votes

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HOD Leadership Lunch

President-Elect Thomas J. Elardo, DPM

David D. Mullens, DPM

President Carolyn E. McAloon, DPM (r) presents Immediate Past President Karen L. Wrubel, DPM with the Past President’s Pin J u ly | Au g u s t | S e p t e m b e r | 2014

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Past President Ernest J. Hook, DPM (l) with Western Workshop Director Roman Paulus

Delegate Harvey R. Danciger, DPM and member of the House Elections Committee collects delegates’ ballots

Credentials Committee (l to r) David D.Q. Tran, DPM; Diane B. Branks, DPM and Committee Chair Neil B. Mansdorf, DPM

Bako Representatives Aaron McKenzie (l) and Mandi McGill (center) with CPMA Past Presidents Daniel L. Altchuler, DPM and Stephen C. Wan, DPM

Bruce R. Lawrence, DPM

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Lawrence R. Harkless, DPM, Dean, College of Podiatric Medicine at Western University; David D. Mullens, DPM and Sharon Diaz, PhD, President, Samuel Merritt University

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Mary Basso (l) with Nedra Farley, House Recording Secretary

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President Carolyn E. McAloon, DPM; Executive Director Jon A. Hultman, DPM, MBA, CVA and Parliamentarian Roderick D. Farley, DPM, JD

Lester L. Jones, DPM, Executive Associate Dean, College of Podiatric Medicine at Western University and Rebecca A. Moellmer, DPM, Secretary/Treasurer

Ramero Espinosa, Omeria/AgeWell Compounding Pharmacy (l); Past Presidents Daniel L. Althculer, DPM and Ernest J. Hook, DPM

2014-2015 CPMA Board of Directors (l to r) Carolyn E.McAloon, DPM, Immediate Past President; Devon N. Glazer, DPM, Secretary/Treasurer; Rebecca A. Moellmer, DPM, Vice President; John A. Chisholm, DPM, Director; Roderick D. Farley, DPM, JD, Parliamentarian; Thomas J. Elardo, DPM, President; Jon A. Hultman, DPM, MBA, CVA; Ami A. Sheth, DPM, President-Elect; Adam S. Howard, DPM, Director; Mark A. Warford, DPM, Director; Vladimir Zeetser, DPM, Director; Thomas J. Tanaka, DPM, Director J u ly | Au g u s t | S e p t e m b e r | 2014

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CPMA Past Presidents Stephen C. Wan, DPM, (l) and Michal J. Cornelison, DPM (r) with APMA Past President and PICA President Ross E. Taubman, DPM

Kristina M. Dixon, MBA, President, Board of Podiatric Medicine

C. Keith Greer, Esq., CPMA Legal Counsel

Ross E. Taubman, DPM, President, PICA 30 |

Delegates (l to r) Cheryl Strich, DPM; Katrina DiPasque, DPM and Holly Spohn-Gross, DPM

Karen L. Wrubel, DPM, Immediate Past President

Diligent Delegates

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CPMA Director Jonathan J. Uy, DPM (facing) embraces President- Elect Thomas J. Elardo, DPM after receiving Meritorious Service Award

DermaTran Representative Richard Eno (l) and CPMA Director Mark A. Warford, DPM

CPMA Past Presidents Eric R. Hubbard, DPM (l) and Oliver S. Foster, DPM (r) with LA Delegate Jack Morgan, DPM

CPMA Thanks

DermaTran H E A LT H S O L U T I O N S

& TM

President - Elect Thomas J. Elardo, DPM

J u ly | Au g u s t | S e p t e m b e r | 2014

for their outstanding support of the 2014 HOD Leadership Luncheon | 31

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Jodi Hicks, CPMA Legislative Counsel

Doing the Association’s business

Jon N. Venson, DPM, Dean, California School of Podiatric Medicine (CSPM) at Samuel Merritt University

Lester L. Jones, DPM (l) and Mark Benard, DPM

R. Daniel Davis, DPM, Vice President, American Podiatric Medical Association 32 |

Ami A. Sheth, DPM, Vice President

Devon N. Glazer, DPM, Director

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Past Presidents R. Eric Hubbard, DPM and Franklin Kase, DPM during salute to the flag

HOD leadership lunch presentation

Directors Mark A. Warford, DPM and Jonathan J. Uy, DPM sharing phone pics J u ly | Au g u s t | S e p t e m b e r | 2014

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Carolyn E. McAloon, DPM, President

Frank Spinosa, DPM, President, American Podiatric Medical Association

LA Delegates (l to r) Leslie G. Levy, DPM; Lawrence A. Rubin, DPM; Joseph M. Hughes, DPM; Eric R. Hubbard, DPM and Franklin Kase, DPM | 33

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Dustin Corcoran, MBA, Executive Officer, California Medical Association

Lawrence L. Harkless, DPM, Dean, College of Podiatric Medicine at Western University

President-Elect Thomas J. Elardo, DPM and Past President Daniel L. Altchuler, DPM 34 |

Delegates deliberating

Delegates checking out the selection of goodies available

(l to r) Stephen C. Wan, DPM; Neil B. Mansdorf, DPM with newly appointed Board of Podiatric Medicine Executive Officer Jason Campbell, JD and Board of Podiatric Medicine President Kristina M. Dixon, MBA C PM A | C a l ifo r nia Podiat r ic M e dica l A s s ociat ion

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Past President Oliver S. Foster, DPM and Jan David Tepper, DPM, Delegate

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(l to r) CPMA Past Presidents Michael J. Cornelison, DPM and Stephen C. Wan, DPM

Delegates (l to r) Richard Koenigsberg, DPM; Randall J. Sarte, DPM and Jan David Tepper, DPM

Taking a break, delegates Naleen Prasad, DPM and Timothy Dutra, DPM

CPMA Past President and APMA Trustee Jeffrey R. DeSantis, DPM Bako Representatives Aaron McKenzie and Mandi McGill J u ly | Au g u s t | S e p t e m b e r | 2014

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Immediate Past President Karen L. Wrubel, DPM with Past President and Executive Director Jon A. Hultman, DPM, MBA, CVA

Alameda/Contra Costa Delegates Naleen Prasad, DPM and Timothy G. Dutra, DPM

President- Elect Thomas J. Elardo, DPM

Delegate David Tran, DPM and Irma Walker-Adame, MS, Associate Dean, Administrative Affairs, CSPM at Samuel Merritt University 36 |

President Carolyn E. McAloon, DPM with Bruce R. Lawrence, DPM and John A. Chisholm, DPM, Director

Nedra Farley and Franklin Kase, DPM

(l to r) Gabriel J. Halperin, DPM; Holly Spohn-Gross, DPM; Jack Morgan, DPM and Dustin Corcoran, MBA, Executive Officer, California Medical Association C PM A | C a l ifo r nia Podiat r ic M e dica l A s s ociat ion

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Aaron Meltzer, DPM; Richard Koenigsberg, DPM and Steven Subotnick, DPM

President-Elect Elardo photo-bombing Secretary/Treasurer Rebecca Moellmer, DPM and Vice President Ami Sheth, DPM

Past President Michael J. Cornelison, DPM and President-Elect Thomas J. Elardo, DPM

Jack A. Reingold, DPM (l) and CMA Immediate Past President Paul R. Phinney, MD

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The California Podiatric Medical Association wishes to thank‌

DermaTran H E A LT H S O L U T I O N S

MULTI-ACTIVE TOPICAL DRUG DELIVERY EXPERTS (AgeWell Compounding Pharmacy)

for their generous support of the 2014 CPMA House of Delegates 38 |

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2014-2015 CPMA Board of Direc tors

Thomas J. Elardo, DPM, President

Ami A. Sheth, DPM, President-Elect

Rebecca A. Moellmer, DPM, Vice President

Carolyn E. McAloon, DPM , Immediate Past President

Devon N. Glazer, DPM, Secretary-Treasurer

John A. Chisholm, DPM, Director

Adam S. Howard, DPM, Director

Thomas J. Tanaka, DPM, Director

Mark A. Warford, DPM, Director

Vladimir Zeetser, DPM, Director

Roderick Farley, DPM, JD, Parliamentarian

Jon A. Hultman, DPM, MBA, CVA, Executive Director

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Essentials of Practice Management Saturday, November 1, 2014 • 8 am - 4:30 pm California School of Podiatric Medicine at Samuel Merritt University Health Education Center 400 Hawthorne Avenue • Oakland, California 94609

Program Moderator: Harry Goldsmith, DPM

Welcome and “State of the State” Co-sponsored by: California Podiatric Medical Association California School of Podiatric Medicine at Samuel Merritt University

Proceeds to go toward student scholarships

Thomas J. Elardo, DPM President, California Podiatric Medical Association

Reimbursement Update ICD-10 Update Harry Goldsmith, DPM

Medicare Update Anthony Poggio, DPM, MS Thinking of a Cash Practice?

Harry Goldsmith, DPM Jon Hultman, DPM, MBA, CVA Tales from the Dark Side: How to Lose a Medicare Audit C. Keith Greer, JD How to Handle Audits David D. Mullens, DPM, JD Panel Discussion Harry Goldsmith, DPM; C. Keith Greer, JD; Anthony Poggio, DPM, MS; and David D. Mullens, DPM, JD

Pearls: Practice Transitions 2015

Intro: Global Trends in Healthcare & Your Practice Harley Schultz, MD, MBA

ASSISTANTS’ BREAKOUT SESSION ICD-10 2015 Reality: Q&A Harry Goldsmith, DPM Improving Your Practice and Efficiency by Simplifying Tina Del Buono, PMAC, XT How to Set Goals and Achieve Them Rem Jackson

Multi-Specialty Group Opportunities Ronald D. Jensen, DPM Podiatric Group Opportunities: To Be or Not To Be? (Now That’s a Great Question) Jon Hultman, DPM, MBA, CVA Orthopedic Group Opportunities Thomas J. Chang, DPM Roundtable Discussion: Future Shock – Where Medical Practice is Going and Your Options Harley, Schultz, MD, MBA; Jon Hultman, DPM, MBA, CVA; Thomas J. Chang, DPM; and Ronald D. Jensen, DPM Effective Practice Marketing: An “Essential” to Your Success in the Complex and Difficult Environment We Are Facing Rem Jackson Introduction by Tina Del Buono, PMAC, XT

WINE AND CHEESE NETWORKING RECEPTION

Essentials of Practice Management Saturday, November 1, 2014 • 8 am - 4:30 pm California School of Podiatric Medicine at Samuel Merritt University Health Education Center 400 Hawthorne Avenue • Oakland, California 94609 Co-sponsored by: California Podiatric Medical Association California School of Podiatric Medicine at Samuel Merritt University

Register Now! Essentials of Practice Management, a one-day seminar for doctors of podiatric medicine and medical assistants. Specialists will present topics of interest to podiatric physicians, office managers, staff, and technicians to help you enhance, build, and earn from your practice.

Bring your questions and get answers from the experts!

Plus, visit exhibits and a stay for a complimentary wine and cheese reception after the meeting for more time with the speakers and exhibitors.

Proceeds to go toward student scholarships Hotel Info

A block of rooms is reserved for exhibitors and attendees of Essentials of Practice Management. These rooms will be available at the special rate or $109 Single or Double until September 29, 2014. Please refer to the group code “EPM” when making a reservation.

Homewood Suites by Hilton Oakland Waterfront 1103 Embarcadero Oakland, CA 94606 (510) 663-2700

Registration All communication regarding Essentials of Practice Management coming from CPMA or exhibitors who purchase registrant data will be sent to the contact information given below. CPMA Member pricing is for CPMA members and podiatric medical assistants or office managers working for CPMA members.

Non-Member pricing is for all other registrants.

Regular Late 8/30-10/3 10/4-10/24 __________________________________________ m CPMA Member $199 $229 Last Name First Name m Non-Member $399 $429 ________________________________________________________________________________ Name of Company/Office ________________________________________________________________________________ Mailing Address ________________________________________________________________________________ City, State Zip ________________________________________________________________________________ Daytime Phone Email Additional office staff Discount of $50 applies to each additional staff member from the same office if registering at the same time. __________________________________________ (Subtract $50 from rate above) Last Name First Name

$______________

__________________________________________ (Subtract $50 from rate above) Last Name First Name

$______________

__________________________________________ (Subtract $50 from rate above) Last Name First Name

$______________

Payment m Check enclosed payable to CPMA

$______________

Total: m Visa / Master Card / Discover m American Express

_______________________________________________________________________________ Credit Card Number Exp. Date (mm/yy) Security Code _______________________________________________________________________________ Cardholder’s Name Cardholder’s Signature Date _______________________________________________________________________________ Credit Card Billing Address if Different from above Mailing Address

Mail CPMA, 2430 K Street Suite 200, Sacramento, CA 95816 Fax (916) 448-0258 Email jsteed@calpma.org Cancellation Policy All registration cancellations must be supplied in writing by mail, fax, or email (jsteed@calpma.org) and received by Friday, October 3, 2014 to receive a full refund. No refunds will be issued on or after Friday, October 3, 2014. Refunds are not granted to no-shows.

Additional Notes Registration policy is first come, first served. Late fee begins Saturday, October 4, 2014. Pre-registration ends Friday, October 24,2014. Payment must be received to secure registration. No onsite registration will be available. Returned checks may incur service charges. If written confirmation is not received, please call CPMA at (800) 794-8988 to confirm registration.

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2014 HOUSE SETS GOALS AND SELECTS LEADERSHIP FOR COMING YEAR

Well over100 leaders of California’s podiatric medical profession gathered at the Disneyland Hotel in Anaheim this past June for the California Podiatric Medical Association’s (CPMA) Annual House of Delegates (HOD) where they discussed and debated a myriad of medical practice, public health and CPMA governance issues.

Delegates and alternates representing CPMA’s eighteen (18) local component societies (stretching from the Oregon to Mexican borders) received in-depth briefing on legislative affairs including MICRA; CPMA’s Joint Physician and Surgeon Taskforce; important healthcare policy issues impacting podiatric physicians and their patients; regulatory issues; podiatric medical education, and legal matters.

Elections The delegates were also tasked with choosing the Association’s Board of Directors for the coming year. The 2014-2015 Board of Directors as voted by the 2014 CPMA House of Delegates are as follows: Thomas J. Elardo, DPM (Los Gatos) was elected President; Ami A. Sheth, DPM (Los Gatos) was elected President-Elect; Rebecca A. Moellmer, DPM (Pomona) was elected Vice President, and Devon N. Glazer, DPM (Mission Viejo) was elected Secretary/Treasurer. John A. Chisholm, DPM (Chula Vista) was re-elected as Director-at-Large for another two year term. And, CPMA added two new Directors-atLarge: Adam S. Howard, DPM (Cupertino) and Vladimir Zeetser, DPM (Encino).

The 2014 House also selected the delegation that would represent California at the 2015 American Podiatric Medical Association (APMA) House of Delegates next spring in Washington, D. C. J u ly | Au g u s t | S e p t e m b e r | 2014

Jon A. Hultman, DPM, MBA, CVA was re-elected to the four-year delegate position joining CPMA’s three other four-year delegates Eric R. Hubbard, DPM; Franklin Kase, DPM; and Stephen C. Wan, DPM. Those elected as one-year delegates and alternates to the 2015 APMA House of Delegates are: Michael J. Cornelison, DPM; Ronald D. Jensen, DPM; Carolyn E. McAloon, DPM; Rebecca A. Moellmer, DPM; Ami A. Sheth, DPM; and Karen L. Wrubel, DPM. The three elected Alternates are Derick A. Ball, DPM; Devon N. Glazer, DPM and Neil B. Mansdorf, DPM

Awards During the meeting, the House honored a number of members of the podiatric medical community for their efforts to promote and advance the specialty of podiatric medicine. Bruce R. Lawrence, DPM received the 2014 Distinguished Service Award. Jonathan J. Uy, DPM received the Association’s Meritorious Service Award. Adam S. Howard, DPM was named 2014 Society President of the Year.

Michael A. Zapf received the 2014 Humanitarian of the Year Award.

Wenjay Sung, DPM was awarded the 2014 Set Up Award. Thomas J. Elardo, DPM was the recipient of the 2014 Executive Director Award.

California Medical Association (CMA) Immediate Past President Raul R. Phinney, MD was the recipient of the 2014 President’s Award. Randall J. Sarte, DPM; David D. Mullen, DPM and Melvin R. Barton, DPM received CPMA’s Legacy Award. Karen L. Wrubel, DPM was named 2014 Podiatric Physician of the Year. And, retired Board of Podiatric Medicine Executive Officer Jim Rathlesberger, MPA received the 2014 Champion for Podiatric Medicine Award. | 43

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OUT &

ABOUT Thomas Tanaka, DPM, Director and Past President Karen Wrubel, DPM

CPMA Past President and Executive Director Jon Hultman, DPM, MBA, CVA with (l to r) Mary Basso; Shelly Jensen; Robin Wright, DPM and Past President Noreen Oswell, DPM

Past Presidents Oliver (Ollie) Foster, DPM; Eric Hubbard, DPM, and Roderick Farley, DPM

Proactive Students 44 |

Goofing around with Goofy

Patti Hultman with daughter Amiee Levi and grandson Eli C PM A | C a l ifo r nia Podiat r ic M e dica l A s s ociat ion

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At The 2014 Western Smile for the camera

Thomas Elardo, DPM, President and spouse Mai

Nightlights at the Disneyland Hotel J u ly | Au g u s t | S e p t e m b e r | 2014

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out & about

Sharon Diaz, PhD, President, Samuel Merritt University; Past President Tracy Basso, DPM; Patti Hultman

Holly Spohn-Gross, DPM and Director Vladimir Zeetser, DPM

Executive Director Jon Hultman, DPM, MBA, CVA and Steven Subotnick, DPM

APMA Vice President R. Daniel Davis, DPM and CPMA President Thomas Elardo, DPM

Past President Michael Cornelison, DPM with spouse Nancy 46 |

CPMA Presiden-Elect Ami Sheth, DPM and Vice President Rebecca Moellmer, DPM

Past Presidents Oliver Foster, DPM and Noreen Oswell, DPM

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Lots of Smiles

at the

2014 Western J u ly | Au g u s t | S e p t e m b e r | 2014

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out & about

The Elardo First Family

Samuel Merritt University President Sharon Diaz, PhD; CPMA Executive Director Jon Hultman, DPM, MBA, CAV and spouce Patti Hultman

Director Adam Howard, DPM and President Thomas Elardo, DPM

Nedra Farley, Past President and Parliamentarian Roderick Farley, DPM, JD; Diane Branks, DPM 48 |

Past Presidents Eric Hubbard, DPM and Ernest Hook, DPM

Past Presidents Michael Cornelison, DPM; Karen Wrubel, DPM; William Tarran, DPM C PM A | C a l ifo r nia Podiat r ic M e dica l A s s ociat ion

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Jonathan Uy, DPM and Bill Metaxas, DPM

Past Presidents Oliver Foster, DPM; Lyman Wilson, DPM; Eric Hubbard, DPM

Past President Daniel Altchluer, DPM and spouse Eileen Haworth, DC

Western registration was brisk

Bako Rep. Mandi McGill with Past President Stephen Wan, DPM

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Yummy! | 49

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out & about

Disneyland Hotel Pool

Vice President Rebecca Moellmer, DPM; Past President Karen Wrubel, DPM; Immediate Past President Carolyn McAloon, DPM; President-Elect Ami Sheth, DPM

Past President Frank Kase, DPM (center) with Patti Hultman (l) and Millie Hubbard

Frank Kase, DPM and Staci Laboritz, JD 50 |

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Selfie with Goofy

Say cheese

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Happy to be here

David Tran, DPM and Jonathan Uy, DPM

CSPM Centennial Gala

Past President Ernest Hook, DPM all smiles

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Celebrated a Proud Past while Looking Toward a Bright Future | 51

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out & about - CSPM

CPMA Immediate Past President Carolyn McAloon, DPM; Samuel Merritt University President Sharon Diaz, PhD; CPMA Executive Director Jon Hultman, DPM, MBA, CVA

Badley Bakotic, DPM (far right) and the Bako team were out in force

CPMA Past Presidents Ronald Jensen, DPM; Carolyn McAloon, DPM and Franklin Kase, DPM (far right) with APMA President Frank Spinosa, DPM and his spouse Robin Wright, DPM 52 |

Gala Emcees Eric Hubbard, DPM and Daniel Fulmer, DPM

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Centennial Gala

Lester Jones, DPM and Oliver Foster, DPM

Steven Sutobnick, DPM; James LaRosa, DPM; Mark Wolpa, DPM

Having a great time

Thomas Tanaka, DPM and spouse Diane

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out & about - CSPM

Daniel Fulmer, DPM

Melvin Barton, DPM; Nedra Farley and Roderick Farley, DPM, JD

The Adames

The future looks bright

Sharon Diaz, PhD, President Samuel Merritt University toasts to 100 years of excellence in podiatric medical education and training 54 |

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Centennial Gala

Catching up with old friends and making new ones

Watch the birdie

John Chisholm, DPM; Rebecca Moellmer, DPM; Devon Glazer, DPM

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Ami Sheth, DPM; Carolyn McAloon, DPM; Rebecca Moellmer, DPM

Patti and Jon Hultman, DPM, MBA, CVA | 55

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2015 CPMA House of Delegates will convene

Wednesday, June 24, 2015 Disneyland Hotel Anaheim, CA

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2014/2015 board of directors President Thomas J. Elardo, DPM Los Gatos, CA 95032 P: (408) 358-6234

Directors John A. Chisholm, DPM Chula Vista, CA. 91910 P: (619) 427-3481

President-Elect Ami A. Sheth, DPM Los Gatos, CA 95032 P: (408) 358-6234

Adam S. Howard, DPM Cupertino, CA95014 P: (408) 446-5811

Vice President Rebecca A. Moellmer, DPM Pomona, CA 91766 P: (909) 469-8413 Immediate Past President Carolyn E. McAloon, DPM Castro Valley, CA 94546 P: (510) 581-1484 Secretary-Treasurer Devon N. Glazer, DPM Mission Viego, CA 92691 P: (949) 272-0007

Thomas J. Tanaka, DPM Ontario, CA 91761 P: (909) 724-5052 Mark A. Warford, DPM Fair Oaks, CA 91316 P: (916) 548-0218 Vladimir Zeetser, DPM Encino, CA 95628 P: (818) 907-6100 Student Representatives Luke Hultman (CSPM) Dayna Chang (Western U)

Executive Director Jon A. Hultman, DPM 2430 K St Ste 200 Sacramento, CA 95816 P: (916) 448-0248 (800) 794-8988 jhultman@calpma.org jonhultman@gmail.com General Counsel C. Keith Greer, Esq. San Diego, CA 92128 Governmental Representative Jodi Hicks Sacramento, CA 95814 Parliamentarian/ Recording Secretary Roderick Farley, DPM,JD/ Nedra L. Farley

2014/2015 COMPONENT SOCIETY PRESIDENTs ALAMEDA/ CONTRA COSTA COUNTY Michael Grimes, DPM Pinole, CA 94564 P: (510) 724-1530

June 25-28, 2015 J u ly | Au g u s t | S e p t e m b e r | 2014

MONTEREY BAY AREA Bobby Yee, DPM Monterey, CA 93940 P: (831) 646-8242

CENTRAL VALLEY John Abordo, DPM Merced, CA 95341 P: (209) 383-7441

NORTHERN CALIFORNIA KAISER Thomas DaSilva, DPM Walnut Creek, CA 94596 P: (925) 295-7099

COACHELLA VALLEY Harvey Danciger, DPM Palm Desert, CA 92260 P: (760) 568-0108

ORANGE COUNTY Thomas Rambacher, DPM Mission Viejo, CA 92692 P: (949) 916-0077

INLAND Diane Koshimune, DPM Pomona, CA 91766 P: (909) 706-3778

REDWOOD EMPIRE Paul Weiner, DPM Vallejo, CA 94590 P: (707) 643-3687

LOS ANGELES COUNTY Gabriel Halperin DPM Los Angeles, CA 90063 P: (323) 264-6157

SACRAMENTO VALLEY Daniel Lee, DPM Sacramento, CA P: (916) 688-2030

MID-STATE Richard Motos, DPM Visalia, CA 93291 P: (559) 734-1171

SAN DIEGO/IMPERIAL Nicholas DeSantis, DPM San Diego, CA 92101 P: (619) 239-3286

SAN FRANCISCO/ SAN MATEO Bill Metaxas, DPM San Francisco, CA 94108 P: (415) 433-3668 SAN LUIS OBISPO/ SANTA BARBARA David Sterling, DPM Santa Maria, CA 93455 P: (805) 928-5645 SANTA CLARA VALLEY Mehryar Amirkiai, DPM Sunnyvale, CA 94087 P: (408) 245-3230 Gordon Shumate, DPM Redding, CA 96001 P: (530) 246-4800 SOUTHERN CALIFORNIA HMO Diane Branks, DPM VENTURA COUNTY Heather McGuire, DPM Ventura, CA 93003 P: (805) 648-2016

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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On your toes DHCS to Utilize Administrative Measures to Reimburse Medi-Cal Services Provided by Podiatric Physicians CPMA’s assertive, positive advocacy and education has resulted in an about face by the Department of Health Care Services DHCS, which has announced that it would make administrative changes to its policy to allow podiatric services to be covered by Medi-Cal in emergency room settings, including outpatient and inpatient.

Additionally, DHCS stated that a hospital receiving DRG reimbursement does not prevent a podiatrist (or physician) from direct billing Medi-Cal for services provided in hospital settings, whether outpatient or inpatient. They also noted that hospitals may have restrictions on privileges; however, this is outside of DHCS’ purview.

“The Department’s willingness to fix this most egregious problem (podiatric physicians being required to provide services and not being reimbursed for those services) is a BIG win for our members,” said CPMA President Thomas Elardo, DPM. “DHCS has acknowledged that the Optional Benefits Exclusion (OBE) section of the Medi-Cal Provider Manual is outdated and has caused confusion. To this end, DHCS will be revising this section and other applicable areas within the Medi-Cal Provider Manual that may be outdated.” As part of this effort, DHCS will share its proposed revisions with CPMA to help ensure appropriate provider feedback is obtained and incorporated prior to publishing updates to the Medi-Cal Provider Manual. Furthermore, CPMA has requested follow-up discussions to review how podiatric providers may bill retroactively for services provided. Members will be kept abreast of CPMA’s discussions with DHCS, the implementation of changes, and retroactive reimbursement for services rendered.

Providers Can Now Request Continuity of Care Under New DHCS Rules for Duals Demonstration Project After CPMA, and other healthcare provider organizations, strongly voiced serious concerns about the need for continuity of care for the vulnerable duals (Medi-Medi) patients involved in the state’s Duals Demonstration Project, the California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state’s dual eligible beneficiaries to managed care plans.

Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network providers without interruption.

The new continuity of care rules allow beneficiaries who meet certain criteria to keep their current providers for up to six months for Medicare services and up to 12 months for Medi-Cal services. Patients must demonstrate they’ve seen the out-of-network physician at least once in the previous 12 months for primary care and twice in the previous 12 months for specialists.

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Providers can request continuity of care The new rules will now allow providers to request continuity of care for their patients under the duals demonstration project.

Previously, only the patient could initiate such a request. This new rule will help beneficiaries who have difficulty navigating the health care system so they can maintain their provider for up to 12 months.

Continuity of care can be requested via telephone Under the new rules, continuity of care requests can be made via telephone and plans will be prohibited from requiring beneficiaries to submit a request through a paper form.

Plans must process request within 3 days Under the new rules continuity of care requests must be processed within three days if there is a risk of harm to the beneficiary. Urgent requests will be processed within 15 days and all other requests are to be processed within 30 days.

Retroactive continuity of care Under these new rules, providers or the beneficiary can now request continuity of care after delivering the service – ensuring payment for treatment. To qualify, the request must be received within 20 business days of the first service following the beneficiaries’ enrollment in Cal MediConnect. Once a beneficiary is approved for continuity of care, providers must work with the health plans to ensure compliance with the plan’s utilization and management policies.

These changes in continuity of care do not apply to providers of DME, transportation or ancillary services.

DHCS is expected to release a Dual Plan Letter within the next few weeks with direction on the new continuity of care rules for the Cal MediConnect population with an effective date.

CPMA is pleased with the efforts DHCS has made to strengthen the physician-patient relationship and will continue to work with the department in ensuring adequate access to care.

New Standardized Prior Authorization Form for Prescription Medications Becomes Effective October 1 CPMA backed bill SB 866 that streamlines and standardizes the prior authorization process for prescription drugs will take effect October 1. The new law requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications.

Additionally, if a health plan or insurer fails to use or accept the prior authorization form, or fails to make a determination within two business days, the prior authorization request is deemed approved. Currently, plans have five business days in which to make a determination, while practices are often forced to sort through hundreds of different prior authorization forms to locate the one needed.

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authorization is required, prescribing physicians must submit (and plans and insurers must accept) the new standardized two-page form. Please note the two-page form only applies to medication prior authorization requests; it does not apply to requests for authorization of procedures.

The Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) jointly developed the standardized authorization form and implementing regulations with stakeholder input. The two agencies, however, will be enforcing the regulations on different timetables.

The regulation for DMHC-regulated products, which includes all HMOs, their contracting medical groups/IPAs, and most Blue Cross and Blue Shield PPOs, becomes effective January 1, 2015. However, the regulation for DOI-regulated products, including all other PPOs and the Blue Cross and Blue Shield Life & Health products, becomes effective on October 1, 2014.

The lack of synchronicity in the effective dates has the potential to cause confusion for practices, particularly those who treat patients with Anthem Blue Cross PPO or Blue Shield of California PPO products, as it can be difficult to determine whether the patient has a DOI regulated product, a DMHC regulated product or a product that is regulated out-of-state (i.e., Blue Card product).

However, in an effort to avoid confusion for practices, some plans/insurers are implementing the new form across most, if not all, of their product lines on October 1. There are exceptions, however, so practices are encouraged to review the payor notices and to call payors with any specific questions they may have.

CPMA Members can find links to the payor notices that were available at the time of publication on the September 2014 page of the On Your Toes section on of the CPMA website – CALPMA.org The form can be found can also be found on the same page, and can be submitted via paper, electronic transmission, fax, web portal or another mutually agreeable method.

DHCS Revises Cal MediConnect Duals ‘Choice Forms’ After unrelenting advocacy from the California Podiatric Medical Association (CPMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MedConnect duals demonstration project and remain in traditional Medicare fee for service.

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The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion of the state’s dual eligible beneficiaries transition to managed care plans.

The project will impact approximately 450,000 duals in eight counties - Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.

The previous Choice Forms did not make it clear how a patient could opt-in or out of the program and DHCS was criticized for its lack of transparency in the documents. CPMA was very vocal in requesting DHCS change the forms to clearly state the patient’s options. The state hopes the new forms provide clarity and make it easier for patients to make the choice between opting into the Cal MediConnect program or opting out of it. The Spanish language forms were also revised.

The updated forms are found in the Duals Resources Center on the CPMA website and

should be included in new Plan Choice books for newly enrolled members.

The plan Choice Form is located in the middle of the Plan Choice Book.

DHCS will also soon be finalizing a physicians’ toolkit to help doctors and their patients understand the project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups. The toolkit can also be found in the Duals Resources Center on the CPMA website – CALPMA.org

Virtual Credit Cards Dear CPMA Members: The Association has received several calls recently regarding insurance companies using virtual credit cards for reimbursement.

In recent years, health plans have shifted from paper checks to electronic methods of physician payment. As part of this movement, many health plans have started paying physicians through payer-issued virtual credit cards (VCCs).

When paying via VCCs, health plans send credit card payment information and instructions to physicians, who process the payments using standard credit card technology.

Cost to Doctors - Although a valid electronic alternative to paper checks, the use of VCCs for payment cane come at a See on your toes on Page 61

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significant cost to physicians. As with traditional credit card payments, VCC payments are subject to interchange and transaction fees. The interchange fees can run as high as 5% for these corporate “card not present” transactions. Physicians are often unaware of these high fees when accepting VCC payments.

Unlike traditional credit card payments received from patients, the physician processing fees for VCCs do not come with corresponding benefits. Patient credit cards ensure physician payment by shifting the patient debt collection responsibilities to credit card companies, thereby eliminating the potential bad debt risk for physicians. VCCs do not offer risk reduction for physicians, but nevertheless carry increased processing charges.

Health Plan Financial Incentives - While physicians receiving VCCs must pay additional processing costs in order to receive payments, health plans often receive cash-back incentives from credit card companies for such transactions. Credit card companies may offer health plans up to 1.75% rebates for paying provider claims with VCCs. Recommendations • Enroll in Health Insurance Portability and Accountability Act (HIPAA)-standard Automated Clearinghouse (ACH) Electronic Funds Transfer (EFT) • Be aware of payment terms when contracting with health plans • Educate practice staff on credit card processing EFT - Similar to direct deposit offered by many employers, ACH EFT is a funds transfer tool in which payer-to-provider payment is processed over the ACH Network, a payment system implemented by NACHA - The Electronic Payments Association. Unlike percentage-based interchange fees associated with VCCs, ACH EFT payments are subject only to a single transaction fee (approximately $0.34) regardless of payment amount. As of January 1, 2014, all health plans are required to use ACH EFT to pay physicians that request and register for this payment method. Physicians looking to enroll in EFT payments should contact their health plans.

Contract Payment Terms - Although HIPAA requires health plans to make ACH EFT available upon request, health plans may seek to require other payment methods, such as VCC, within their contracts with physicians in order to avoid using ACH EFT. Physicians should be cognizant of any restrictions in payment methods when contracting with health plans and avoid signing contracts with inflexible payment terms.

Practice Staff Education - While patient and health plan payments differ in many ways, they are often processed by the same practice staff. If a practice chooses not to accept health plan VCCs, physicians should ensure that practice staff can differentiate between patient and health plan credit card payments in order to prevent undesired authorization of health plan VCC payment.

Noridian Incorrectly Denied Tens of Thousands of E&M Services Claims Dear CPMA Members: You may have been getting recent denials for E/M services with the denial code CO-151. Last fall during the transition from Palmetto to Nordian CMS (Centers for Medicare and Medicaid Services) experienced editing glitches with the new patient E&M codes that resulted in claims being inappropriately denied. The problems began in October of 2013 and were thought to have been corrected in early February 2014. CPMA, however, has learned that the same claims continued to be incorrectly paid through July 15, 2014.

In January, Noridian, California’s Medicare contractor began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, in the process of implementing the corrections, Noridian inadvertently subjected established patient E&M codes to incorrect editing, resulting in incorrect denial of codes 99211- 99215.

Noridian has corrected the editing for both the new patient codes and the established patient codes, and claims received by Noridian on and after July 16, 2014, should be processing correctly.

Noridian is now beginning the process of mass adjustments to the incorrectly denied claims. Due to the large number of claims involved (tens of thousands dating back to October of 2013), this process could take several months to complete.

Doctors do not need to do anything to have their claims adjusted and they should NOT resubmit the claims. The claims will be automatically adjusted.

Tony Poggio, DPM Chair, Medicare Committee

Hydrocodone Schedule Switch; Things to Know If you prescribe hydrocodone combination products, prescribing these medications to the patients who need them to alleviate pain just became more complicated. A new rule from the Drug Enforcement Administration (DEA) taking effect Oct. 6 reclassifies these drugs as Schedule II controlled substances, prohibiting refills and establishing other restrictions that will require major changes to prescribing practices.

Here are the six key points you need to know so you can take appropriate action: 1. Refills aren’t allowed for prescriptions that are written beginning Oct. 6. Be prepared to issue new hard-copy or electronic prescriptions for patients. Note that eScripts can only be used if state law permits and the prescriber is certified to ePrescribe Schedule II substances. Pharmacies also must be certified to accept eScripts for controlled substances.

(Source: AMA “The effect of health plan virtual credit card payments on physicians practices”) See on your toes on Page 79

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spotlight on

education

Hands-on

Franklin Kase, DPM, FACFAS

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Diane M. Koshimune, DPM, MS

Edward G. Blahous, Jr., DPM

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Eager attendees

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Jesus C. Vasquez, PMAC and Tina Del Bouno, PMAC, XT

So many choices

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Q & A Session

Standing room only

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Robert M. Joseph, DPM, PhD

Learning can be fun

Alexander M. Reyzelman, DPM

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Acquiring new skills

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Jesus C. Vasquez, PMAC; Daniel C. Fulmer, DPM; Tina Del Bouno, PMAC, XT

Lectures

Kevin A. Kirby, DPM

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Workshops

Doreen Pon, PharmD, BCOP, BCPS

Ross E. Taubman, DPM

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education

Western Workshop Team (l to r): Matthew Doyle, 3rd year student CSPM; Roman Paulus, Workshop Director; Deepal Dalal, 2nd year student CSPM; Neil Mansdorf, DPM, Assistant Workshop Director

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Naohiro Shibuya, DPM, MS

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Wrubel Named Podiatric Physician of the Year The California Podiatric Medical Association (CPMA) bestowed its highest honor “Podiatric Physician of the Year” on Karen L. Wrubel, DPM at its 2014 House of Delegates, and in doing so, made her the first female recipient of the honor.

Dr. Wrubel has a distinguished record of service and leadership in the podiatric medical profession. She has served on and chaired numerous committees and boards, including the CPMA Board of Directors, serving as Association president from 2012-2013, and as President of the Board of Podiatric Medicine (BPM) from 2009-2011.

Born in Detroit, Michigan, Dr. Wrubel attended the University of Michigan, Ann Arbor, Michigan, from which she graduated with a Bachelor of Science (BS) in zoology. She received her medical training and earned her Doctor of Podiatric Medicine (DPM) degree at the William M. Scholl College of Podiatric Medicine in Chicago, Illinois.

Board Certified in foot and ankle surgery by the American Board of Podiatric Surgery (ABPS), Dr. Wrubel is also a Fellow of the American College of Foot and Ankle Surgeons (ACFAS). She is in private practice and partnership with her spouse Derick Ball, DPM in Hawthorne, California.

DPMemo and CPMA Alerts, are you getting AND reading yours?

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Privileging Parity: In my experience, hospitals generally don’t want to break the law. Unfortunately, they often do because they simply don’t understand that what they are doing is illegal. Case in point, privileging. It is illegal for hospitals to deny Podiatric Surgeons access to all foot and ankle privileges. It is also illegal for hospitals to have privileging criteria and procedures that require Podiatric Physicians to do anything different from what is required for M.D.s or D.O.s applying for the same privileges.

Specifically, California Health and Safety Code §1316(a), provides in pertinent part: “The rules of a health facility shall include provisions for use of the facility by, and staff privileges for, duly licensed podiatrists within the scope of their respective licensure.” We are currently working with a member to resolve a situation where a hospital does not allow D.P.M.s to perform ankle replacement surgery, despite the fact that such surgery is clearly within the scope of practice for a D.P.M. and the member has substantial experience and proven competence with performing such procedures. I anticipate that properly educating the hospital regarding the law will result in a favorable resolution of this little misunderstanding.

In addition to allowing Podiatric Physicians the opportunity to practice within the full scope of their licensure, hospitals must create and apply credentialing criteria or protocols in a manner that does “not discriminate on the basis of whether the staff member holds an M.D., D.O., or D.P.M. degree, within the scope of their respective licensure.” (California Health and Safety Code §1316(a)). “Discrimination” is defined as the failure to treat all persons equally where no reasonable distinction can be found between those favored and those not favored. Thus, the criteria for obtaining foot and ankle privileges must be substantially similar between M.D.s, D.O.s and D.P.M.s.

Section 1316(a) further provides that: “With regard to the practice of podiatry in health facilities throughout this state, medical staff status shall include and provide for the right to pursue and practice full clinical and surgical privileges for holders of M.D., D.O., and D.P.M. degrees within the scope of their respective licensure. Such rights and privileges shall be limited or restricted only upon the basis of an individual practitioner’s demonstrated competence. Such competence shall be determined by health facility rules, regulations, and procedures which are necessary and are applied in good faith, equally and in a nondiscriminatory manner, to all practitioners regardless of whether they hold an M.D., D.O., or D.P.M. degree. . .”

The clear intent of these laws is to ensure that hospitals treat all physicians equally when it comes to accessing surgical privileges, regardless of the type of medical degree they hold.

Hospitals that require Podiatric Physicians to submit more cases, undergo more proctoring, of require proctoring of specific

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It’s the Law procedures while letting M.D.s obtain privileging for aggregate blocks of procedures by undergoing proctoring for only a few procedures within that block of privileges, are committing the exact type of discrimination that these laws were enacted to eliminate. In other words, when hospitals’ actions constitute disparate treatment without a rational basis, they constitute illegal acts of discrimination.

It should also be noted that any differences between the board certifications available to Orthopedic Surgeons versus those available to Podiatric Surgeons is not a valid basis for disparate privileging criteria since it now violates federal law to require a specific board certification as a prerequisite for hospital privileges. Specifically, hospitals must comply with the standards set forth in Medicare’s Conditions of Participation (“COPs”), which establish minimum health and safety standards, and also set forth credentialing guidelines designed to restrict hospitals from unfairly denying properly licensed healthcare providers access to Medicare beneficiaries. Specifically, 42 CFR 482.12(a) states, in relevant part, that in determining the criteria for staff privileges, the governing body must: (6) Ensure the criteria for selection are individual character, competence, training, experience, and judgment; and (7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.”

The policy of basing a doctor’s staff privileges on individual character, competence, training, experience and judgment, as codified in the Medicare Conditions of Participation, has also been established in state courts. In the case of Armstrong v.

Board of Directors, 553 S.W.2d 77 (Tenn. App. 1977), the Court found that a hospital acted “illegally, arbitrarily and beyond its jurisdiction” when it adopted a bylaw which required certification, or eligibility for certification, by the American Board of Surgery as a prerequisite to granting surgical privileges to physicians who apply for such privileges. The Armstrong Court reasoned that: “[A] requirement of certification by any particular society as a mandatory prerequisite for the right of a duly licensed physician to practice his profession in a public hospital is illegal, arbitrary, capricious and beyond the jurisdiction of the governing body of the hospital. The governing body of a public hospital may accept a certification of a certain board or society and, based upon that certification alone, grant

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a physician specified hospital privileges. But, in the absence of the acceptable certification the governing body of the hospital, acting in a quasi-judicial capacity, must determine from evidence presented to it whether the applying physician is competent to perform the surgical procedures requested by him.”

Several other state courts addressing this issue, including California, have issued similar rulings. See Cameron v. New Hanover Memorial Hospital, 293 S.E.2d 901 (N.C. Court of Appeals 1982); Wyatt v Tahoe Forest Hospital, 174 Cal.App.2d 709 (1959) (physician cannot be deprived of the privilege to practice medicine in a public hospital by rules, regulations or acts of its governing authorities which are unreasonable, arbitrary, capricious or discriminatory. Rather, staff membership should be based on competency, character and professional ethics).

Thus, there is no valid basis to discriminate, in any fashion, between M.D.s, D.O.s or D.P.M.s seeking a particular surgical privilege. Rather, their individual character and competence must be analyzed in a nondiscriminatory manner that is applied equally to all applicants, regardless of the type or medical degree they hold.

Please rest assured that the CPMA takes discriminatory actions against Podiatric Surgeons very seriously, and although we prefer to resolve such matters amicably through proper education, we will, and have on prior occasions, sought redress through the court where illegal discriminatory practices were not stopped.

If you feel you are dealing with discriminatory credentialing practices, please contact CPMA at 800-794-8988.

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with Dynamic Displays, Demonstrations, HAnds-on instruction, Networking, Shopping, Games, Food and Fun the 2014 Western Exhibit Hall was the PLACE TO BE!

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The new law also imposes certain posting and recordkeeping requirements on covered employers. In particular, employers must display a poster in their workplaces explaining the new sick leave accrual requirements. Employers also must inform new employees in writing of their sick leave accrual rights. In addition, employers must provide written notice of the amount of sick time accrued after each pay period to all employees, either through the employee’s itemized wage statement or in a separate document.

(SFgate.com 9/14/2014)

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2. Prescriptions issued before Oct. 6 won’t necessarily qualify for refills; plan to issue new ones. Although the DEA rule allows refills of prescriptions issued before Oct. 6 until April 8, 2015, other factors could prevent patients from getting those refills.

Restrictions on Hydrocordone on the September 2014 page of the On Your Toes section.

Several states have published notices that they will treat hydrocodone combination product prescriptions issued before Oct. 6 in the same way they will handle prescriptions issued after the rule’s implementation date. In addition, any state laws that are more stringent than the DEA rule will govern refills. Meanwhile, some pharmacy quality and safety processes may not allow refills for prescriptions issued before Oct. 6, and some health insurers will not pay for those refills.

CPMA’s bill AB 1868, authored by Assembly Member Jimmy Gomez (D-51), to fully reinstate adult fee-for-service podiatric services was stalled in the Senate Appropriations Committee.

3. Prescriptions can’t be called in or faxed. Make sure to plan ahead for any patients who may need refills. The new rule prohibits pharmacies from filling prescriptions delivered over the phone or via fax, so you’ll need to issue written scripts.

The only exception to this rule is emergency treatment, which would allow physicians to call in a limited quantity of the medication to cover the emergency period only. Pharmacies are required to report prescribers to the DEA if they make such a request and do not give the pharmacy a written prescription within seven days.

4. Allied health professionals might not be able to write prescriptions for these drugs going forward. Check California’s restrictions around Schedule II substances to confirm whether any non-doctor members of your team who have prescriptive authority will be able to continue issuing prescriptions for hydrocodone combination products. You may need to modify your collaborative practice agreements accordingly.

5. Multiple prescriptions may be issued at one time under certain circumstances. The new rule does allow a patient to receive prescriptions that would total a 90-day supply, if the prescriber has determined it is appropriate to see the patient only once every 90 days. Each prescription must include written instructions that specify the earliest date it may be filled.

6. Patients should be notified of the new requirements and processes. Make sure your patients understand that their new prescriptions will not be refilled and are aware of the procedures they will need to follow going forward.

In addition to sound medical judgment and established medical standards, make sure to base your practice’s policy on issuing multiple prescriptions on relevant federal and state laws.

CPMA is concerned about the potential unintended consequences of reclassifying hydrocodone combination products. Eliminating phoned-in prescriptions and refills could make it difficult for some patients to get the pain relief they need, especially patients in nursing homes and those with persistent pain and disabilities.

CPMA members can find additional information on the new rules regarding HCCP prescribing as well as a patient information letter on the CPMA website CalPMA.ORG. See New Tighter

Senate Sideline AB 1868

(Source: AMA Wire 9/15/2014)

Strong advocacy and education of the legislature by CPMA created tremendous momentum for AB 1868. It moved through the Assembly’s policy and fiscal committees and received a 66 to 0 vote in favor of passage by the full Assembly before going to the Senate. The measure continued to receive strong legislative support in the Upper House, making it out of the Senate Health Committee on an 8 to 0 vote.

As AB 1868 was moving through the Legislative process, reinstatement of podiatry services in Medi-cal was also on the Legislative Budget Committee Agenda. The Senate budget proposal included reinstatement of all optional services cut in the 2009 budget and was an item of discussion in the Legislature’s Budget Conference Committee. Provider and consumer advocates lobbied for reinstatement of the recession-era cuts, including a repeal of the 10 percent reduction in Medi-Cal provider rates. At the Governor’s request, despite intense lobbying by a large coalition of stakeholders, the 2014 budget was signed leaving cuts in the Medicaid program in place.

As a consequence, once the final budget was passed, legislative proposals that included a budget appropriation were sidelined in the Legislature. “We pushed back hard”, said CPMA President Thomas J. Elardo, DPM, “but any measure that was not included in the final budget proposal was DOA on the Governor’s desk”.

“Though disappointed, we also know that CPMA’s voice was heard. CPMA’s strong advocacy to reinstate podiatry services through sponsorship of AB 1868 and the budget process led to DCHS reinstating coverage for podiatry services in emergency room and hospital settings. This is the largest reinstatement of podiatry since services were originally cut in 2009. This is a HUGE victory for CPMA, but it is not enough. CPMA plans to try again next year for the full restoration of fee-for-service adult podiatric Medi-Cal services in the budget.”

APMA, CMS Meet to Seek Regulatory Relief on Therapeutic Shoes Documentation APMA met with representatives from CMS’ Office of Financial Management and Center for Clinical Standards and Quality to discuss our members’ concerns with the burdensome documentation and adverse patient outcomes associated with the current rules for prescribing therapeutic shoes in the Therapeutic Shoes for Persons with Diabetes (TSD) program.

APMA was seeking regulatory relief, additional guidance from CMS to the DME MACs, or technical assistance CMS could provide with the legislative language in the Helping Ensure Life- and LimbSee on your toes on Page 87

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2014 western sponsors

PICA: Lisa Johnson; CPMA President Thomas J. Elardo, DPM; PICA President Ross Taubman, DPM; CPMA Executive Director Jon A. Hultman, DPM, MBA, CVA; Western Chair Jonathan M. Labovitz, DPM

THANK YOU!

Arthrex: Matt Dullaghan; Thomas Elardo, DPM; Jamie Bradshaw; Roman Ledman; Kelly Lingle; Donnie Carter; Jonathan Labovitz, DPM (2nd row): Jon Hultman, DPM, MBA, CVA; Sean Vendenboss; Tom Parisi; Anthony Orozco 80 |

Valeant: Thomas Elardo, DPM; Kat Kaczka; Christina Vannarath; Janessa Murphy; Scott Keeter; Jon Hultman, DPM, MBA, CVA; Jonathan Labovitz, DPM; (back row) Jon Rodda

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2014 western sponsors

DermaTran: Western Chair Jonathan M. Labovitz, DPM; CPMA Executive Director Jon A. Hultman, DPM; MBA, CVA; Steve Caudle; Polly Yu; Rick Eno; CPMA President Thomas J. Elardo, DPM

THANK YOU!

Smith & Nephew: Jonathan Labovitz, DPM; Thomas Elardo, DPM; Luke Trageser; Robert Han; Dustin Campbell (back); David Vosicher; Jon Hultman, DPM, MBA, CVA

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Volcano: Jonathan Labovitz, DPM; David Goodman; Thomas Elardo, DPM; Michelle Bayne; Jon Hultman, DPM, MBA, CVA

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Wright: CPMA Executive Director Jon A. Hultman, DPM, MBA, CVA; CPMA President Thomas J. Elardo, DPM; Brianne Tabor; Thomas Kevin McGuire; Western Chair Jonathan Labovitz, DPM

THANK YOU! Hvala Danke Köszönettel Grazie Diky Tesekkürler Bedankt Merci Aksante Gracias 82 |

Merz: Jon Hultman, DPM, MBA, CVA; Thomas Elardo, DPM; Michael Zuppe; Angela Bullard; Alex Paz; Jonathan Labovitz, DPM

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Stryker: CPMA President Thomas J. Elardo, DPM; Sage Siverhus; Josh Sewell; Chris Bird; Erik Reginald; CPMA Executive Director Jon A. Hultman, DPM, MBA, CVA; Western Chair Jonathan Labovitz, DPM; (2nd row) Eric Nofsinger; Mitch Foley; Marcus Mason; Jared Griffin

THANK YOU!

Integra: David Garcia; Jonathan Labovitz, DPM; Ryan Hewitt; Jon Hultman, DPM, MBA, CVA; Jeremy Steiding; Thomas Elardo, DPM; Lindsay Williams; Sunny Yi; Rob Gipson; Manny Duran; Debra Holtham (front) J u ly | Au g u s t | S e p t e m b e r | 2014

TEI: Jonathan Labovitz, DPM; Jason Sternberg; Jon Hultman, DPM, MBA, CVA; Thomas Elardo, DPM; Dan McKee

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The Tetra Corporation: Steve Martelli; Travis Rath; Brian Penrose; CPMA President Thomas Elardo, DPM; George Cioe; CPMA Executive Director Jon A. Hultman, DPM, MBA, CVA; Western Chair Jonathan M. Labovitz, DPM

BAKO: Jon Hultman, DPM, MBA, CVA; Thomas Elardo, DPM; Justin Marcello; Mandi McGill; Aaron McKenzie; Jeneal Wiskercher; Elizabeth Watt; Jonathan Labovitz, DPM 84 |

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CLASSIFIEDS Practice for Sale

Looking to Hire Podiatrists

Premier Southern California Podiatry practice for sale. The practice consists of a main office, which contains Medicare Certified2 OR Surgical Center used exclusively for foot and ankle surgery. A portable fluoroscopy unit is within the ASC. A satellite office is within 30 minutes. All aspects of Podiatry are treated with a full mix of patients. Only private, PPO and Medicare insurance are taken. A new 2010 electronic billing system is included. Please email drjohns5462@yahoo.com or call 954-612-7144 for details.

For new company: Platinum Podiatry Great company, with patients already lined up! No need to market yourself!

We are currently located throughout California from Southern, to Central, to Northern and will eventually be one of the biggest nursing home podiatrist company’s in the nation!

- flexible hours/ make your own schedule - part-time and full time available

Associate Wanted Seeking associate leading to purchase of practice. Busy office with all types of in-office and out-of-office facilities including private nursing and retirement facilities. 20% medicine; 50% c&c; 30% orthotics. Excellent terms. Email CV to

Requirements:

- graduated from Certified Podiatry school and residency performed - driver’s license, car registration and insurance

Podiatry Practice for Sale

Briefly, we arrange all scheduling, documentation, consents, billing, and collections. This allows our practitioners to concentrate on delivering

East Bay Area, Ca. (Oakland, Hayward).

excellent and dignified clinical care.

Office, nursing homes, and private salaried positions available.

If you’re interested in an Independent Contract Podiatrist position please contact Shelley Cable at (310) 600-1720 or SCable@PlatinumPod.com

sandiegopodiatry@gmail.com

To inquire contact ellwenger@comcast.net

Podiatry Practice for Sale

Thank you and looking forward to hearing from you!

Bay Area Berkeley, California. Established 34 yo practice. Able to get buyer into HMO plans. Priced based on value of equipment, instruments and goodwill. Never a malpractice issue. Good referral base. To inquire, contact footguy123@aol.com

Part-time Podiatry Associate (Inland Empire)

Podiatrist Wanted Established medical group, in Beverly Hills, CA, looking for an experienced podiatrist. This position entails making rounds at hospitals, skilled nursing facilities and scheduled office appointments. Must be comfortable with all aspects of podiatric care, have great bedside manner and will be doing no less than the hiring partners. Full-time position with competitive salary.

Send CV to administrator@footnankledoc.com

Seeking Part-time Podiatry Associate to service skilled nursing and assisted living facilities in the Inland Empire, specifically San Bernardino and Riverside Counties. Staff and supplies will be provided. Independent contractor.

Must have: - Valid state license - Valid malpractice insurance - Valid DEA license - Reliable transportation Please send resume with contact information in response.

Rock Solid Practice 15 minutes from San Francisco. Grossing 300K and growing.

All private, no HMOs. All sports/surgery. Turnkey opportunity.

Call 510-214-8283

Thank you for your interest, Dr. Pete Carrasco Jr. Carrasco Podiatry Corp. pcarrasco@pete-melissa.com

Central CA Practice For Sale I will stay for transition. Price and terms negotiable. Serious Inquiries only call/txt 209-617-0241 or email sbaileydpm@aol.com J u ly | Au g u s t | S e p t e m b e r | 2014

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Give to CalPPAC, the only PAC that supports YOU!

Send your contribution today to 2430 K Street, Suite 200, Sacramento Ca, 95816 To use your VISA, MasterCard or American Express call 800-794-8988 or go online to CalPPAC.org

You’ve Got Mail CPMA is increasingly utilizing Email and the Association’s website (CalPMA. org) to get important information to members in a rapid, efficient and costeffective manner.

To make sure that CPMA has your correct email please go to CalPMA.org and log-in. Once you are logged in, click on Physicians’ Desk and then on Member Directory. Put in your name and view your contact information. If the Association does not have your email, or if it or any of your information is incorrect call 800-794-8988 or email jsteed@calpma.org.

Members are also encouraged to check the CPMA website regularly.

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Saving Access to Podiatric Physicians (HELLPP) Act to address the inconsistency between interpretation of statutory policy and the documentation requirements related to the TSD program, which are inconsistent across DME MACs. APMA and CMS were able to reach consensus that:

For more information about the audit and what to expect from the contractor, see the HMS Medicaid RAC website - www.medicaid-rac. com/. Providers can also contact HMS Provider Services at info@hms. com or (855) 699-6290.

• there is a problem with this program, particularly in the area of documentation; and • the problem largely exists at the interface between suppliers (in our case, physician suppliers—DPMs, MDs, and DOs) and certifying MDs and DOs. APMA and CMS discussed possible CMS sub-regulatory actions and additional DME MAC guidance, but no consensus solution was agreed upon at the meeting. APMA will supply CMS with more information it has requested, and we will continue a dialogue with CMS on this issue.

Mandatory SSN Now Required for Medi-Cal Provider Applicants

In addition, this meeting established evidence and commentary for us to provide to our congressional contacts regarding the difficulty in establishing regulatory solutions for our TSD documentation efforts through CMS, and the DME MACs. APMA will continue its legislative efforts to address this problem.

CPMA/APMA will keep you informed of any resulting developments. For more DME-related information, visit the DME section of APMA.org. For our federal advocacy efforts, visit the Federal Advocacy section.

(APMA September 15, 2014)

Medi-Cal Audits Slated to Begin in September The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California.

The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states.

DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery Audit Contractor (RAC) for the State of California. HMS will perform desk and field audits for selected fee-forservice Medi-Cal claims paid within the last three years to determine if claims were paid correctly. HMS will contact providers whose claims have been selected for review. After the initial contact, providers may receive letters from HMS requesting medical records for further review. These letters, which should specify HMS’ preliminary results will be coming out no earlier than October.

DHCS is urging all providers to comply with requests for medical records from HMS. If you fail to submit the requested records, it will be considered a valid overpayment and you will be required to refund the claim payment amount to DHCS. Your cooperation will help ensure that the audit results are accurate and that California retains its much-needed federal matching monies for the Medi-Cal program.

(CMAnet 9/16/2014)

In accordance with the Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising the Medi-Cal Ordering/Referring/Prescribing Provider Application/Agreement/Disclosure Statement For Physician and NonPhysician Practitioners(DHCS 6219), the Medi-Cal Rendering Provide Application/Disclosure Statement/Agreement For Physician/Allied/ Dental Providers (DHCS 6216) and the Medi-Cal Disclosure Statement (DHCS 6207). These revisions are necessary for implementation of the Final Rule published by CMS on February 2, 2011, in Volume 76, Number 22 of the Federal Register (Title 42 Code of Federal Regulations [CFR], Parts 405,424, 447 et al.) and specifically for compliance with 42 CFR, Section 455.104(b), which mandates disclosure of Social Security Numbers (SSNs) These revisions are also necessary for compliance with 42 CFR , Section 455.436, which mandates that the State Medicaid Agency perform routine checks of Federal databases. The revised forms and SSN requirement will be effective for all Medi-Cal provider applications received on or after July 7, 2014.

Beginning July 7, 2014, Medi-Cal provider applicants, as described below, are required to complete and submit the following revised forms: Qualified individual providers who are requesting enrollment for the sole purpose of ordering, referring or prescribing goods and/ or services for Medi-Cal patients must use the Medi-Cal Ordering/ Referring/Prescribing Provider Application/Agreement/Disclosure Statement For Physician and Non-Physician Practitioners (DHCS 6219) that has a printed revision date of July 2014 and are required to provide the individual provider’s SSN Individual providers who are rendering healthcare services as members of a provider group or groups must use the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement For Physician/Allied/Dental Providers (DHCS 6216) that has a printed revision date of July 2014 and are required to provide the individual provider’s SSN All other provider applicants must use the Medi-Cal Disclosure Statement (DHCS 6207) that has a printed revision date of July 2014 and are required to provide the provider’s SSN . Please note that the Medi-Cal Disclosure Statement (DHCS 6207) is one of three required forms needed for a complete application package. The specific forms to be submitted are determined by provider type The REVISED applications can be found on the Medi-Cal websitewww.medi-cal.ca.gov/ See on your toes on Page 90

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DermaTran H E A LT H S O L U T I O N S

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thank you for your support

DermaTran H E A LT H S O L U T I O N S

WRIGHT

PICA

MERZ

Omiera (AgeWell)

CSPM

FORMULA 3 (Tetra Corp)

BLAINE LABS J u ly | Au g u s t | S e p t e m b e r | 2014

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DEA Classifies Tramadol as A Schedule IV Controlled Substance On July 2, 2014, the Drug Enforcement Administration (DEA) published its Final Rule placing Tramadol into Schedule IV of the Controlled Substances Act (CSA), effective August 18, 2014.

Tramadol is a synthetic opioid analgesic used in the treatment of pain, and brand names for the substance include Ultram®, Ultram ER®, Ultracet®, and ConZip®.

Tramadol initially was approved for marketing in 1995, but the drug was not scheduled under the CSA at that time. DEA’s rescheduling of tramadol comes at a time of growing concerns relating to abuse and misuse of opioid analgesics.

The final rule imposes the regulatory controls and administrative, civil and criminal sanctions applicable to schedule IV controlled substances on persons who handle (manufacture, distribute, dispense, import, export, engage in research, conduct instructional activities with, or possess) or propose to handle tramadol.

Doctors should be aware of the following: • The change becomes effective on Monday, August 18, 2014.

After that, all regulatory requirements applicable to schedule IV controlled substances will apply to tramadol. This includes specific rules relating to storage, record-keeping, inventory, disposal and prescribing.

Every DEA registrant who possesses any quantity of tramadol on August 18 must take an • Inventory of all stocks of tramadol on hand.

• In order to prescribe tramadol on or after August 18, 2014, prescribers will have to be registered with the DEA to prescribe Schedule IV substances.

Any unfilled prescriptions/refills for tramadol after August 18 will have to follow Controlled Substances Act rules governing Schedule IV substances, and some patients may need new prescriptions.

(Source: CMAnet.org 7/15/2014)

LCD Threatens Podiatrists’ Ability to Prescribe PCDs Durable Medical Equipment Medicare Administrative Contractors just released a final local coverage determination (LCD) for pneumatic compression devices (PCDs). This LCD would prevent podiatric physicians from prescribing PCDs. (LCDs establish which services are covered as Medicare benefits. Providers look to LCDs for information about how to submit claims to ensure reimbursement.)

This determination is unacceptable to CPMA/APMA and will be challenged aggressively. CPMA/APMA successfully rebutted this threat to podiatrists’ ability to prescribe PCDs in 2011, providing comments and testimony.

According to the LCD: Prescriptions for PCDs (E0650-E0652, E0675, E0676) are limited to Physicians (MD, DO) and physician extenders (NP, PA, & CNS) to the extent allowed by their applicable state scope-of-practice or other license requirements.

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Podiatrists (DPMs) and other providers are excluded because applicable state scope-of-practice or other license requirements limit management of systemic conditions.

Treatment of peripheral artery disease, lymphedema, chronic venous insufficiency with ulceration and complications related to the treatment of these conditions by use of PCDs, require consideration of diagnoses and management of systemic conditions that fall outside of these license limitations.

(APMA September 15, 2014)

HIPAA Audits to Resume Soon; Make Sure Your Practice is Compliant If you haven’t conducted a privacy and security risk assessment recently, now’s the time to do so. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) plans to implement random Health Insurance Portability and Accountability Act (HIPAA) audits to monitor compliance, beginning as soon as later this summer.

Building on a HIPAA auditing program piloted in 2012, the agency expects to launch random HIPAA audits focused on ferretting out major threats to patient health information confidentiality and network security.

Failure to comply with HIPAA’s privacy, security and breach notification requirements likely will result in financial penalties that could be significant. Recent OCR data shows that 60 percent of security breaches come from theft and loss of technology containing protected health information. However, issues related to hospital and practice staff using their own mobile devices and unsecure Wi-Fi networks are on the rise.

Your practice should take these three steps to protect against a breach in security and the loss of patient information: • Educate your staff about the importance complying with HIPAA requirements • Ensure all electronic patient information is encrypted when in transit and at rest • Perform a privacy and security risk assessment for all health care information technology, not just your electronic health records CPMA offers a number of free resources to help members’ comply with the HIPAA requirements, including a HIPAA privacy and security toolkit These resources and additional information are available on the Compliance Center on the CPMA website - CALPMA.org

Therapeutic Shoes (HCPCS A5500) Quarterly Results of Service Specific Prepayment Review The Jurisdiction D DME MAC Medical Review Department is conducting a service specific review of HCPCS code A5500. The quarterly edit effectiveness results from March 2014 through June 2014 are as follows: The A5500 review involved 2219 claims, of which 1865 were denied. Based on dollars, this resulted in an overall potential improper payment rate of 84%.

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Top Denial Reasons • Documentation of foot abnormalities by certifying physician not met *No documentation was received in response to Additional Documentation Request (ADR) letter *Documentation of diabetes management by certifying physician not met *Documentation of in-person visit prior to selection of items not met Going Forward Based on the results of this review, Noridian will continue with the Prepayment Service Specific Review.

Educational Resources It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Therapeutic Shoes Local Coverage Determination (LCD) and Policy Article.

Suppliers can also review specific policy resources for Therapeutic Shoes on the Noridian website – NoridianMedicare.com. There, you will find information related to proper documentation requirements including a physician letter, documentation checklists, FAQs, and a presentation used during web-based workshops.

Suppliers can also review a specific policy Documentation Checklist for Therapeutic Shoes on the Noridian website.

Noridian provides educational offerings by scheduling supplier workshops, training opportunities, and presentations.

Information about probe/error validation reviews may be found in CMS Publication 100-8, Program Integrity Manual This link takes you to an external website. (PIM), Chapter 3.

Policy Education Documentation of foot abnormalities by certifying physician not met.

There must be documentation to support that the certifying physician has documented in the patient’s medical record one or more of the following conditions: *Previous amputation of the other foot, or part of either foot, or *History of previous foot ulceration of either foot, or *History of pre-ulcerative calluses of either foot, or *Peripheral neuropathy with evidence of callus formation of either foot, or *Foot deformity of either foot, or *Poor circulation in either foot.

In order to meet criterion 2, the certifying physician must either: *Personally document one or more of criteria a - f in the medical record of an in-person visit within 6 months prior to delivery of the shoes/inserts and prior to or on the same day as signing the certification statement; or *Obtain, initial/sign, date (prior to or on the same day as signing the certification statement), and indicate agreement with information from the medical records of an inperson visit with a podiatrist, other M.D. or D.O., physician assistant, nurse practitioner, or clinical nurse specialist that is within 6 months prior to delivery of the shoes/inserts, and that documents one of more of criteria above.

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Note: The certification statement is not sufficient to meet the requirement for documentation in the medical record.

No documentation was received in response to Additional Documentation Request letter.

Suppliers are in violation of Supplier Standard #28 when, upon request, they fail to provide requested documentation to a Medicare contractor. Medicare regulations (42 C.F.R §424.516[f ]) stipulate that a supplier is required to maintain documentation for seven years from the date of service and, upon the request of CMS or a Medicare contractor, provide access to that documentation. Therefore, the consequences of failure to provide records may not only be a claim denial but also referral to the National Supplier Clearinghouse (NSC).

Please also remember, the documentation must be submitted to our office within 45 days from the date on the ADR letter. Failure to provide the requested documentation within 45 days may result in a partial or complete denial of the claim. Submission information can be found on the ADR letters or under the claims section on our website.

Documentation of diabetes management by certifying physician not met.

There must be documentation to support that the certifying physician has certified that indications (1) and (2) are met and that he/she is treating the patient under a comprehensive plan of care for his/her diabetes and that the patient needs diabetic shoes. For claims with dates of service on or after 1/1/2011, the certifying physician must: *Have an in-person visit with the patient during which diabetes management is addressed within 6 months prior to delivery of the shoes/inserts; and *Sign the certification statement (refer to the Documentation Requirements section of the related Local Coverage Determination) on or after the date of the in-person visit and within 3 months prior to delivery of the shoes/inserts.

Note: Per Policy Article A37076 the Certifying Physician is defined as a doctor of medicine (M.D.) or a doctor of osteopathy (D.O.) who is responsible for diagnosing and treating the patient’s diabetic systemic condition through a comprehensive plan of care. The certifying physician may not be a podiatrist, physician assistant, nurse practitioner, or clinical nurse specialist.

Documentation of in-person visit prior to selection of items not met.

There must be documentation from the supplier to support an in-person visit prior to selection of the item billed. Prior to selecting the specific items that will be provided the supplier must conduct and document an in-person evaluation of the patient. The in-person evaluation of the patient by the supplier at the time of selecting the items that will be provided must include at least the following: • An examination of the patient’s feet with a description of the abnormalities that will need to be accommodated by the shoes/ inserts/modifications.

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• For all shoes, taking measurements of the patient’s feet.

For custom molded shoes (A5501) and inserts (A5513), taking impressions, making casts, or obtaining CAD-CAM images of the patient’s feet that will be used in creating positive models of the feet.

(Source: Noridian 9/9/2014 post via Tony Poggio, DPM)

FDA warns doctors of danger from fake drugs Health care providers ordering meds should view ‘too good to be true’ offers with suspicion, agency says.

The number of ‘rogue’ wholesale distributors selling fake or unapproved prescription drugs is growing, so doctors need to be vigilant when purchasing medicines, the U.S. Food and Drug Administration warned in a September 23 news release.

In a statement, the agency said the problem is so widespread that it has launched a program to educate doctors and other health care providers and administrators about proper drug purchasing procedures. The program aims to protect patients from taking potentially harmful counterfeit drugs.

The “Know Your Source” program urges health care professionals to only buy prescription drugs from wholesale drug distributors licensed in their states. Doing so will reduce the risk of giving unsafe or ineffective drugs to patients.

The FDA cautioned doctors to avoid offers that sound too good to be true, and to question aggressive marketing tactics and major discounts on prescription drugs suggesting that the medicines may be stolen, fake, substandard or unapproved.

The agency urged doctors to verify that they are only receiving FDA-approved products. Unapproved drugs may contain unknown or harmful ingredients, or may not have been made, transported or stored under proper conditions, the agency said.

One FDA flyer lists clues for spotting drugs that are not FDAapproved, including: • The label is not in English • The packaging looks slightly different from the FDA-approved product • The product name differs from the name of the FDA-approved drug • The dosing recommendations are unfamiliar • Safety information or warnings are missing • The dosage form or administration is different More information

overall cost of health insurance, but now hundreds of thousands of consumers could owe back some of that money next April.

If you are one of the millions of Americans getting tax credits to help pay health-insurance premiums under the Affordable Care Act, you might want to do some tax planning now or you might be in for an unwelcome surprise, especially if you’re expecting a tax refund.

It’s estimated that more than 7 million people bought insurance through the healthcare marketplace. Based on their estimated income for 2014, a large number of enrollees receive financial help with the monthly payment by taking advantage of a premium subsidy provided by the ACA. But what happens if this is the year you finally got that raise, worked more overtime than anticipated or your spouse got a higher paying job? What might seem like a windfall can suddenly come back to bite you at tax time.

When you file that 2014 tax return next year, the Internal Revenue Service will compare your actual income for the year with the amount you estimated when applying for exchange-based health insurance under the health insurance law.

A large majority receiving health-insurance tax credits are unaware that they are required to promptly report to the exchange any adjustment to their income to avoid getting too much or too little of a tax credit. Simply put, if you received too big a subsidy for health care in 2014 based on your income, you have to pay it back next year.

Docking tax refunds is the first way the IRS will seek repayment.

If you have any questions about the tax credits as it relates to your tax return, see a tax professional, go to HealthCare.gov and IRS.gov/aca, and California’s health exchange Covered California at coveredca.com to update your account.

Whatever you do, don’t wait. Report any changes that could affect your coverage.

What should you report? A move, an increase or decrease in income, a marriage or divorce, the birth or adoption of a child, whether you started a job that offers health insurance and whether you gained or lost eligibility for other health care coverage.

While this might mean higher premiums, it will avoid financial surprises come tax time. Since so many consumers count on their tax refund, it would be highly prudent to avoid the repercussion of an unexpected tax burden.

(Source: Yahoo News 9/17/2014))

CEDI Trading Partner Recertification Process for 2014

Tax Refunds Could Be Hit Hard by ACA

If you are a physician supplier and submit electronic claims, you may be required to re-certify your user status with NGS Common Electronic Data Interchange (CEDI). NGS CEDI requires all CEDI Trading Partners to re-certify their user access on an annual basis.

The 2014 CEDI Recertification Form is located on the CEDI Web site http://www.ngscedi.com under CEDI Recertification Form 2014.

A significant benefit of the Affordable Care Act (ACA) is the opportunity to receive money-saving tax credits up front to cut the

The owner of the Trading Partner ID is responsible for recertification. Suppliers using billing services or clearinghouses

Here’s where you can learn more about the Know Your Source Program www.fda.gov/Drugs/ResourcesForYou/HealthProfessionals/ ucm389121.htmprogram.

(Source: U.S. Food and Drug Administration, news release, Sept. 23, 2014)

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who do not have their own Trading Partner ID are not required to complete the recertification form.

Recertification began on July 1 and will conclude on December 31.

CEDI offers an online tool to check the status of your CEDI Trading Partner Recertification Form for 2014. To access the tool, select Recertification Status Check Tool on the CEDI Web site www.ngscedi.com under Self-Service Tools.

Contact your billing service or clearinghouse if you are unsure whether you are required to complete the recertification form.

For questions regarding the recertification process, contact the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com or 866-311-9184.

For more information about physician supplier issues, visit the DME section of APMA.org.

CMS DME Supplier Revalidation Fee Dear CPMA Members:

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and should be printed for their records. CMS strongly recommends doctors mail a copy of the receipt to their Medicare contractor along with the Certification Statement for the enrollment application. CMS will notify the Medicare contractor that the application fee has been paid.

CPMA strongly recommends mailing any enrollment supporting documents or paper applications using a method that provides proof that the information was sent and received (i.e. return receipt).

Once an Internet-based PECOS application is submitted, be sure to print, sign, date, and mail the certification statement along with all required supporting documentation. In order for the Medicare Contractor to process the revalidation, the original signature and documentation must be received within 15 days of internet submission.

Please review the following Medicare Learning Network (MLN) Matters for more details,

The Association has received a number of inquiries from Members regarding CMS’ revalidation fee for DMEPOS suppliers.

www.cms.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNMattersArticles/downloads/SE1126.pdf

In accordance with the Patient Protection and Affordable Care Act, Section 6401, all new and existing providers must be reevaluated under the new screening guidelines n Section 6028 by no later than March 23, 2015. Medicare requires all enrolled providers & suppliers to revalidate enrollment information every five years (reference 42 CFR 424.57(e)). To ensure compliance with these requirements, existing regulations at 42 CFR 424.515(d) provide that CMS is permitted to conduct off-cycle revalidations for certain program integrity purposes.

California Enacts New Law Mandating Paid Sick Leave for Employees

Doctors should not submit an enrollment application to their Medicare contractor solely for the purposes of revalidation until they have received a letter asking them to do so. Once a physician receives a request from their Medicare contactor to revalidate their information, they are required to respond within 60 days otherwise they risk deactivation of their billing privileges.

To be covered under the new law, an employer needs to have at minimum only one employee who works 30 or more days in California within a year from the commencement of their employment. The law will apply to all such employees who meet that threshold (including part time and temporary employees), except for: (1) those employees who are covered by a collective bargaining agreement that provides for paid leave, among other requirements; (2) certain construction industry employees covered by a collective bargaining agreement, even if the agreement does not provide for paid leave; (3) in home supportive service providers; and (4) airline flight deck and cabin crew employees, as long as they otherwise accrue paid time off of at least one hour per every 30 hours worked.

Provider/suppliers can submit their revalidation application in two different ways, 1) Internet-based PECOS https://pecos.cms.hhs.gov/pecos/login.do and 2) submit the appropriate and current CMS-855 Medicare Enrollment application from the CMS web site- www.cms.gov/Medicare/Medicare.html, see provider enrollment and recertification.

While most doctors are exempt from enrollment application fee, doctors who are enrolled as a durable medical equipment (DME) supplier will be subject to a fee. The fee for 2014 is $542.00. When revalidating, doctor suppliers must pay their enrollment fee online https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do Fees may be submitted by electronic check, debit, or credit card.

Revalidations are processed only when fees have cleared. Once a doctor completes the form and submits payment as directed, a confirmation screen will display indicating that payment was successfully made. This confirmation screen is a physician’s receipt J u ly | Au g u s t | S e p t e m b e r | 2014

On September 10, 2014, California Governor Jerry Brown signed into law the Healthy Workplaces, Healthy Families Act of 2014. As a result, most employers in California will be required to provide up to 24 hours (3 days) of paid sick leave to their employees beginning July 1, 2015. The following are some of the key requirements of the Act. Who Is Covered

Exempt employees are also covered. For purposes of calculating sick leave accrual, the law presumes that exempt employees work 40 hours per week, unless the employee’s normal workweek is less than 40 hours (in which case the lesser amount will be used).

An employee may use sick leave for the treatment of a health condition or for preventative care related to the employee or an employee’s family member (which includes a child, parent, spouse or registered domestic partner, grandparent, grandchild, or sibling).

Such sick leave also can be used after the employee was a victim of domestic violence, sexual assault, or stalking. | 93

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California Podiatric Medical Association 2430 K Street Sacramento, CA 95816

Western Foot and Ankle Conference June 25 – 28, 2015 Disneyland Hotel & Convention Center Anaheim, California

register early to take advantage of the

Early Bird Discount Ends March 29th

Get More for Your Money: • Economically conscious registration rates • 25 CE contact hours • 10 radiology CE contact hours • Dynamic lecture tracks • Distinguished faculty • Innovative instructional courses • Hands-on surgical workshops • ICD-10 Updates • PICA presentation • 3-day educational seminar for podiatric medical assistants including radiology credits • 3 days of exhibits • Exceptional room rates at the Disneyland Hotel and Grand Californian Hotel & Spa • Significant savings on Disneyland & California Adventure Park Passes • Optimal location near shopping, dining, entertainment and more!

visit www.thewestern.org for more information.

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