The OHFAMA Journal | Vol. 66 | Issue 2 | Spring 2004

VOL 66 • NO.2 • SPRING 2024

The Ohio APMA Delegation represented our state at the APMA House of Delegates, which took place March 16-17 in Washington, D.C.

THE OHFAMA JOURNAL | SPRING 2024 | 1

President’s Column: Expect the Unexpected

Thom Arnold, DPM

Let me open by thanking you for reading this article. Membership numbers are on the way up. Contributions to our PAC are improving.

We are anticipating a great turnout for the in-person portion of the Annual Seminar. Please be an engaged member at some level.

Obviously, it is impossible to foresee or predict unexpected situations.

You must, however, anticipate them. It will not necessarily be the situation that defines you. It will likely be your response. There are various situations in one’s life where this may apply.

Something may happen that involves a child of yours. This could be an injury or a poor choice. How will you react to the situation? Better question, will you react or will you take action? In these situations, the child is looking to you for leadership, strength, and focus. You must show no fear and take charge of the situation. Your reaction will not only steer the resolution but impact your child’s response to future situations.

An unexpected incident may occur in surgery.

A bone may break when placing hardware.

Something may not line up as anticipated.

What will your immediate response be? Will you allow your frustration to be externalized? One Orthopedic attending I had as a resident provided wisdom in situations like this. He advised us to stop and step away from the field. Go to the back of the room or review an x-ray. Use this opportunity to take a breath and refocus your effort. I find this approach effective in many aspects of life.

I’m sure many times office staff, patients, or even colleagues may create unexpected or uncomfortable situations. How will you handle this? I challenge you to not just react. Pause, process the facts, remove emotion, and be positive. I leave you with this: Many times, it is not what you say, but what you do not say, that may have the most lasting impact on a situation.

OHFAMA Calendar

Table of Contents

May 16-17, 2024 108th Annual Scientific Seminar Columbus Hilton at Easton

Page 2....................................................................President’s Column

August 1, 2024 Budget and Finance Meeting OHFAMA Headquarters August 1, 2024 Board of Trustees Meeting OHFAMA Headquarters August 8-9, 2024 GXMO - Didactic Course Virtual August 10, 2024 GXMO - Clinical Course Virtual September 21, 2024 Holy Toledo Seminar Brandywine Country Club, Maumee October 10, 2024 Budget and Finance Meeting OHFAMA Headquarters October 10, 2024 Board of Trustees Meeting OHFAMA Headquarters

Page 2......................................................OHFAMA Calendar of Events Page 3...................................................... Executive Director’s Column Page 4-6.....................................................Membership News & Notes Page 7......................................................... APMA House of Delegates Page 10.........................................................................Advocacy News Page 11-13...............................................Coding & Compliance Corner Page 14-15...........................................................Continuing Education Page 15........................... Annual Scientific Seminar Program Schedule Page 16.................................. Kent State College of Podiatric Medicine Page 18..................................................Thank You to Our Contributors Page 19........................................................................... Classified Ads

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Executive Director’s Column: A Fond Farewell

Mike Mathy, CAE

Serving as your executive director is a tremendous honor. It’s been an absolute joy to work with our dedicated volunteer leaders, loyal members, and talented staff to preserve, protect, and promote podiatry in Ohio.

That’s why it’s so difficult to share some personal news with you.

After nearly four years in my role, I notified the Board of Trustees in late March that I will be departing OHFAMA at the conclusion of the Annual Seminar in May. I can promise you this decision did not come lightly. I am leaving a position I absolutely adore. I’ve been lucky enough to work in partnership with an incredibly supportive, committed, and highfunctioning Board of Trustees. I’ve been constantly inspired by our brilliant staff who constantly strive for excellence – and have a lot of fun along the way.

But, as they say, all good things must come to an end.

And I would be remiss if I didn’t specifically thank Luci Ridolfo for her steadfast dedication to this association. Luci’s been a trusted colleague and friend during my time at OHFAMA. Together, we’ve celebrated professional wins and been there for each other when times got tough.

What more can you ask for in a co-worker?

As my time at OHFAMA quickly winds down, I encourage everyone to continue to support your association. Podiatry is a small profession and, as I’ve seen firsthand, the more you give, the more you’ll get in return – both personally and professionally.

Thank you for the opportunity to serve as your executive director. It’s truly been an honor. Rest assured, wherever my career takes me, I’ll be a podiatry advocate for life.

While I’ve made the decision to accept an advancement opportunity in my association management career, I want all of you to know my cup is overflowing with gratitude, nostalgia, and optimism.

Thank you to the Board of Trustees, Budget and Finance Committee Members, Foundation Board of Directors, CAC and PIAC representatives, and Academy leaders for giving so much of your time and talents. Your passion is infectious and your dedication to advancing your profession is inspiring.

Thank you to everyone who supported OPPAC, contacted their legislators, and answered one of my many questions on the podiatric scope of practice, payment policies, and the general healthcare landscape. Your support and expertise were the fuel that powered our successful legislative and regulatory advocacy efforts.

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MEMBERSHIP

NEWS&NOTES

Dr. Marc Greenberg, Dr. Kelly Whaley to Receive OHFAMA Service Award The OHFAMA Service Award will be presented to Marc Greenberg, DPM, and Kelly Whaley, DPM, May 17 at the 108th Annual Ohio Foot & Ankle Scientific Seminar.

The Service Award is given to deserving recipients who have demonstrated commitment to fulfilling the mission of OHFAMA by devotion to the association through dedicated leadership and volunteerism at the academy and state level.

This is an award based on service to organized podiatry in Ohio and may include the organization’s political action committee, OPPAC. Although community and professionalism are quality attributes, this award is based exclusively on service to OHFAMA as a valued leader and/or volunteer.

OHFAMA Executive Director Mike Mathy sat down with Dr. Greenberg and Dr. Whaley to get their reaction to earning the Service Award.

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Dr. Greenberg

What does receiving the Service Award mean to you?

I am honored. I thought of those who had been given the Service Award before me and the thought of being in their company is very much an honor.

For me, earning this award is a validation from my peers that all my work for this profession at the local, state, and national levels is worthy of recognition. It’s a tremendous acknowledgement of the work that I have done and encouragement for me to continue to work on projects for the profession, our Association, and members and the public.

Looking back, what are some of your favorite memories of your service to the association?

There are many times with so many good memories and I’m not sure there’s any that are way above and beyond as favorites. I will say that each time I have had the opportunity to step up in higher leadership, such as the OHFAMA President in 2013 and as the Chair of the Ohio Delegation to the APMA House of Delegates these last three years, it has been more special as I embrace and cherish those leadership roles.

Also, each time I have taken on a larger task that affected the future of our governance it has meant a little more. The biggest example was when I was Chair of the OHFAMA HOD Assessment Committee (OHAC) and our research led to the recommendation of the transition from the OHFAMA HOD to the Annual Business Meeting model. As the Chair of the Bylaws Committee, I was one of the members who worked on those changes, and others, that we still have in place today. Research that has affected change in Association management, function, purpose have been rewarding to watch unfold.

Dr. David Hintz administers the oath of office to the new president, Marc Greenberg, DPM, at the 2012 OHFAMA House of Delegates.

Who inspired or encouraged you to get involved in the Midwest Academy and OHFAMA? At the Midwest Academy, it was John Stevenson who got me involved initially. Funny story made short, he saw my potential to contribute, and I later found out I was elected to the position of Vice President when I got the minutes of the meeting in the mail.

Why should members get involved with their Academy and OHFAMA? There are so many reasons on so many levels. We are a small profession, so only by sticking together can we accomplish goals like protecting our scope of practice, addressing our parity issues, educating the public about who we are and what we do, having effective student recruitment campaigns, and raising money in our PAC to support state legislators who support our profession.

There are educational benefits at the Academy and state levels with quality CME programs that are free or with significant member discounts.

Academy and OHFAMA meetings are great places for members, particularly young members, to make meaningful connections with

other members and gather valuable practice management pearls to assist with practice development and sometimes discover job opportunities.

The Academy level is usually where we are searching for new leadership for the Academy and state levels. All those things and more for the price of 97% tax deductible dues makes it well worth membership. I think my involvement has been highly instrumental for my career development as well. I’ve been very active in leadership and participation in meetings at the Academy and OHFAMA levels, as well as seminars for both, that have helped develop me into a more confident, informed person and advocate for the profession. I have benefitted from events outside of the podiatry bubble due to my status and knowledge gained from my past experiences with OHFAMA. On top of all of that, there is a social component to it all, with camaraderie at meetings, seminars, Board meetings, and other volunteer opportunities. The best way to survive in today’s medical practice climate is to stick together and stay involved. I would advise anyone who wants to know more or get involved to reach out and talk to somebody like me who is currently involved at the next level so they can learn how their Academy and OHFAMA can help them, or how they can help their Academy and OHFAMA.

Dr. Whaley

What was your reaction when you learned you’re receiving the OHFAMA Service Award?

I’m humbled and grateful. It is hard to believe how fast 25 years of practice flies by. Winning the Service Award puts a smile on my face. The last several years of volunteering with my academy and OHFAMA feels so easy and natural, especially as a private, solo practitioner.

If you’re not involved with your professional association, it’s easy to get lost in the intricacies of running a practice and it’s nice to have my colleagues to bounce ideas, share complicated cases, and compare practice stories. Special thanks to Joy Rowland, DPM, who nominated me. I appreciate your confidence in my Dr. Kelly Whaley addresses members at leadership! the 2020 OHFAMA House of Delegates.

What are the benefits of volunteering to serve the association?

I thoroughly enjoyed my years of service as a Northeast Academy officer. Not only did I expand my practice knowledge, but I also made some lifelong friends. It’s been great getting to know my colleagues at meetings and on Academy-supported seminar trips. The same holds true in my later years, as I served at the state level and have colleagues in every corner of the state I call a friend.

The OHFAMA Board of Trustees and staff is a fantastic group of individuals who respect and value our profession and each other, which, in turn, keeps our meetings productive and efficient.

Who inspired or encouraged you to get involved in the Northeast Academy and OHFAMA? My true friend, Mark Gould, DPM, has always cheered me on in my professional and personal life. I learned early on that membership has its advantages and it’s easier to call on your professional friends when you have them on speed dial. As a side note, it is a true honor to receive the service award next to one of my favorites, Marc Greenberg, DPM. THE OHFAMA JOURNAL | SPRING 2024 | 5

Niehaus Earns Mideast Academy Lifetime Achievement Award

Dr. Les Niehaus was presented with the Mideastern Academy of the Ohio Foot & Ankle Medical Association’s Lifetime Achievement Award on March 27.

Dr. Niehaus is a 1980 graduate of Ohio College of Podiatric Medicine, completed his surgical residency in Youngstown, and practiced for 43 years in Alliance.

Dr. Niehaus trained under Drs. Dooley, Landers, Ransom and Suppan. He began the Alliance Community Hospital Podiatric Surgical Residency program in 1996. Dr. Niehaus, who recently retired, has been a voice for podiatry students and residents for many years.

Mideastern Academy Holds 24th Annual Stewart Surloff Memorial Seminar 36 attendees and 11 exhibitors participated in the 24th Annual Stewart Surloff Memorial Seminar on April 10 at the Hilton Akron Fairlawn.

The seminar was coordinated by Dr. Rich Hofacker, featured an outstanding program developed by Dr. Les Niehaus, and offered attendees up to 8 Category 1 CME Hours.

Sponsored by the Mideastern Academy, the seminar is held annually in honor of Stewart Surloff, DPM, a Mideastern Academy leader who passed away from cancer in 2001. A portion of the proceeds from the event supports Stewart’s Caring Place, a center named in Dr. Surloff’s honor that offers counseling and support to those impacted by cancer.

He informed students about prerequisite classes, what the training and education process was like, and what personal and professional choices helped him get to where he is today.

The goal of the Career Showcase program was to build community, social network, showcase the amazing career opportunities in and around the local community, and highlight some unique careers that Jackson graduates have entered.

North Central Academy Holds No-Nonsense Seminar The 38th Annual No-Nonsense Seminar was held March 8-10. The virtual seminar, sponsored by the North Central Academy, drew over 350 attendees, and provided up to 25 AMA PRA Category 1 Credits.

This event discussed different surgical techniques of the foot and ankle, explained the biomechanics of the lower extremity, delved into limb salvage and endocrinology care as well as identified wound care options of the lower extremity.

Proceeds will benefit student scholarships for Kent State University College of Podiatric Medicine and support Academy networking events.

The North Central Academy will hold the 39th Annual No-Nonsense Seminar virtually in March 2025. Registration will open late in 2024 or early in 2025.

Northeast Academy Holds Travel Seminar The 2024 Northeast Academy Travel Seminar was held February 29 - March 7 at Royalton Punta Cana Resort in the Dominican Republic.

The seminar, organized by Dr. Brian Weiss, featured six hours of continuing education and a wealth of networking opportunities for members.

Ohio Foot and Ankle Medical Foundation Announces Board Appointments Richard Schilling, DPM, and Nick Butler, DPM, were appointed to a three-year term on the Ohio Foot and Ankle Medical Foundation Board of Trustees on April 8.

Dr. Schilling is an OHFAMA past president who chairs the Wound Care Seminar and cochairs the Assistant’s Program at the Annual Scientific Seminar.

Drs. Joe Favazzo, Colleen DeBarr, Kelly Whaley, and Joy Rowland gather for a photo at Royalton Punta Cana Resort.

Dr. Butler is an Assistant Professor in the Division of Clinical Sciences at Kent State University College of Podiatric Medicine. He is an award-winning educator who represented Ohio at the 2022-23 APMA Emerging Leaders Program, a program designed to support an exclusive group of young physicians with a vested interest in future leadership opportunities.

Sayner Participates in Career Showcase Russ Sayner, DPM, FACFAS presented at the Career Showcase for Jackson High School junior and senior students on January 11.

Dr. Sayner volunteered to be part of an in-person discussion panel and educated students about the career of podiatric medicine and surgery.

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Drs. Joe Favazzo, Colleen DeBarr, Kelly Whaley, and Joy Rowland gather for a photo at Royalton Punta Cana Resort.

APMA HOUSE OF DELEGATES Delegates from across the country gathered March 16-17 for the 2024 APMA House of Delegates in Washington, D.C. The assembled leaders discussed, debated, and voted upon issues ranging from unification of certifying boards to supervision of physician extenders.

“The House of Delegates, which represents all members of APMA, made enormous strides in carrying out APMA’s mission to defend podiatric physicians,” said APMA President Lawrence A. Santi, DPM. Below are highlights of the meeting compiled by Ohio Chief Delegate Marc Greenberg, DPM: Policy Proposition 2-24: Single Certifying Board in Podiatric Medicine and Surgery The House of Delegates passed a policy calling for the unification of the two currently recognized certifying boards into a single administrative entity resulting in a single unified certifying board in podiatric medicine and surgery.

Policy Proposition 4-24: Establishment of Re-eligibility Pathways for Board Certification in Podiatric Medicine and Surgery There are podiatric physicians who for a multitude of reasons were unable to achieve board certification by a Council on Podiatric Medical Education (CPME)-recognized board and currently do not have access to these boards. These include the length of their training program, type of training program, and other circumstances.

APMA Delegates discussed the difficulties in obtaining hospital and surgical privileges without board certification and supported a policy advocating for a podiatric board certification re-eligibility pathway.

Policy Proposition 5-24: Preventative Foot Examinations/Care While there are ample patient populations with at-risk conditions of the feet, including diabetes and PVD, there is declining participation of podiatrists, particularly younger podiatrists, who provide preventative foot exams. Declining reimbursement rates, coupled with increasing competition from non-DPM providers, are also challenges.

This policy supports the concept of a comprehensive lower extremity exam for patients at risk for amputations and falls including people with diabetes or peripheral arterial disease (PAD) with risk stratification to guide at risk foot care visits. The policy also calls for modifying public and private insurer policies to reimburse for yearly comprehensive lower extremity exams in these patient populations and reimbursement for regular visits based on risk stratification.

Ohio APMA Delegation Chief Delegate • Marc Greenberg, DPM Delegates • Sarah Abshier, DPM • Karen Kellogg, DPM, MBA • Stacey Koss, DPM • Thomas McCabe, DPM • Kelly Whaley, DPM

Alternate Delegates • Thomas Arnold, DPM • Richard Kunig, DPM Staff • Mike Mathy, CAE • Luci Ridolfo, CAE

This policy, which was supported by the APMA Board of Trustees, is an extension of an issue that was extensively discussed at the 2023 House of Delegates and Summit on Board Certification. The author, speaking for the American Board of Podiatric Medicine (ABPM), publicly stated that ABPM would pause the issuance of Certificate of Added Qualification (CAQ) in Podiatric Medicine certificates while all parties involved worked on a single certifying board pathway.

Budgetary Action Item 3-24, which also was adopted, establishes a task force to work with a broad group of stakeholders to explore pathways for the unification of the recognized certifying boards.

This is a significant first step in working toward the goal of a single certifying board for podiatry and was a major sticking point in 2023 between ABPM and the American Board of Foot and Ankle Surgery.

Budgetary Action Item 2-24: Referendum on Definition of Podiatric Medicine and Surgery APMA membership last approved a referendum for the definition of podiatric medicine in 1991. Since then, there have been significant changes to the education and training of podiatric physicians and surgeons including the adoption of a standardized, hospital-based, three-year post-graduate residency training program.

The APMA House of Delegates authorized a referendum to be presented to the membership that would more accurately define podiatric medicine and surgery as “Podiatric medicine and surgery is the specialty that addresses the diagnosis and treatment of pathologies and conditions of the leg, with special emphasis in the diagnosis and treatment of the foot, ankle, and their governing and related structures of the leg by any and all means. Osseous surgical treatment is limited to that part of the leg at or distal to the tibial tubercle.”

A Note from Chief Delegate Marc Greenberg, DPM I would like to conclude this report with the recognition of the members listed in this report. These delegation members were elected by OHFAMA members and charged with representing Ohio in the affairs of the APMA House of Delegates. They gave many hours of their time with multiple meetings before and after the HOD as well as time in Washington D.C. This was time away from their families as well as sacrificing revenue as they needed to be away from their offices to represent Ohio and their profession. All members of the delegation acted professionally and with purpose in carrying out our business and you, the members of the Ohio Foot and Ankle Medical Association, should be proud of our representation and accomplishments. It has been my honor to serve again as the Chief Delegate and to represent Ohio podiatrists alongside them.

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ADVOCACY

NEWS

Legislative Committee Advances Podiatry Rules The Joint Committee on Agency Rule Review (JCARR) on April 15 advanced two important administrative rules relating to the podiatry scope of practice as part of a multi-step rule review process.

JCARR, a legislative committee composed of members of the Ohio House of Representatives and the Ohio Senate, agreed with the State Medical Board of Ohio (SMBO) that no changes should be made to longstanding rules that define foot and outline requirements for podiatrists to perform surgery on the ankle joint.

The rules, which were unanimously approved by SMBO in November, cleared the Common Sense Initiative (CSI) in January before advancing to JCARR. After JCARR jurisdiction ends, SMBO can renew the rules for another five years.

Podiatry Scope of Practice SMBO, using rulemaking authority granted to it by the Ohio General Assembly, created Rule 4731-20-01, OAC, which defines “foot” as follows: “Foot,” as used in section 4731.51 of ORC, means the terminal appendage of the lower extremity, and includes the ankle joint which consists of the tibial plafond, its posterolateral border (posterior malleolus), the medial malleolus, distal fibula (lateral malleolus) and the talus.

The Board further promulgated Rule 4731-20-02, OAC, to formally empower podiatrists to perform surgery on the ankle joint provided they hold privileges from a college of podiatric medicine, hospital, or ambulatory surgical center and can demonstrate adequate education, training, and experience needed to conform to minimal standards of care of similar practitioners.

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Both Rule 4731-20-01, OAC, and Rule 4731-20-02, OAC, have been in place since 1997.

Support Your Profession, Support OPPAC OHFAMA’s legislative success relies on member contributions to the Ohio Podiatric Political Action Committee (OPPAC).

Please join your colleagues today and make a personal donation to OPPAC today. Your generous contribution will help us preserve, protect, and advance podiatry in Ohio.

Visit OHFAMA.org and click on Donate to OPPAC on the top of the homepage.

Mideast Academy Karen Kellogg, DPM Richard Kunig, DPM Lee Sayner, DPM Midwest Academy Marc Greenberg, DPM John Stevenson, DPM Northeast Academy Michael LeCastre, DPM Debra Thornton, DPM Kelly Whaley, DPM

Northwest Academy Thomas McCabe, DPM Southern Academy Amy Masowick, DPM Kim Seaver, DPM Additional Contributors Dan Leite

CODING & COMPLIANCE

CORNER

CMS Releases Non-Coverage Policy for Amniotic Injectables

LCD Highlights Plantar Fasciitis Studies Three industry-sponsored studies investigating the effects of amniotic and placental-derived products on plantar fasciitis were detailed in the LCD.

The Centers for Medicare and Medicaid Services (CMS) released a Local Coverage Determination (LCD) outlining noncoverage of amniotic and placental-derived product injections and applications for musculoskeletal indications.

One study found a modest clinically significant benefit for pain reduction and functional improvement in the intervention group compared to placebo at the primary endpoint (three months follow-up). The certainty of these results was rated as moderate, with further concern about generalizability to the Medicare population.

The detailed LCD notes “there is insufficient evidence-based literature to support coverage of amniotic and placental-derived products injected or applied, both non-operatively and intra-operatively in the treatment of musculoskeletal conditions or pain related to such.” This guidance does not include discussion on burns, wounds, or ophthalmic conditions.

What are Amniotic and Placental-derived Products?

Amniotic and placental-derived products are obtained from the placenta of donors, usually, immediately post caesarean-section at full term, and screened for transmittable diseases. These products are made up of varying combinations of amniotic membrane, amniotic fluid, chorionic membrane, umbilical cord, umbilical cord blood, and what is known as Wharton’s jelly.

These biological products are being investigated for a multitude of indications, including but not limited to musculoskeletal conditions involving joint pain and back pain, chronic pain in general, dental conditions, alopecia, wounds, and burns. These products are aimed at decreasing pain and increasing function by treating musculoskeletal conditions to heal injury and trauma, slow down degenerative conditions, and effectuate regeneration of tissues.

None of the other studies reported significant differences between groups for measures of pain-related outcomes, nor did they assess function.

The alleged shortcomings of the studies led CMS to conclude there is insufficient evidence to support the use of amniotic and placental-derived injections for plantar fasciitis.

The LCD noted similar issues with other studies focusing on the spine, upper extremities, and lower extremity osteoarthritis: Due to the lack of randomized controlled trials, poor study designs, small sample sizes, lack of comparators, lack of long-term efficacy and safety data, and high risk of bias in the current body of literature, CMS found there is insufficient evidence to demonstrate efficacy of any amniotic and placentalderived product in the treatment of specific musculoskeletal conditions, whether injected or applied intra-operatively. There is lack of knowledge of intermediate or long-term safety data derived from human clinical trials.

Therefore, the CMS issued its non-coverage policy noting that the Medicare Reasonable and Necessary requirements have not been met.

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New Code Available for Podiatrists Treating Complex Chronic Conditions G2211 is an add-on code that signifies longitudinal care that went into effect January 1, 2024. CMS created code G2211 to better account for the resource costs associated with visit complexity inherent to primary care and other longitudinal care.

It is a HCPCS add-on code that reflects the time, intensity, and practice expense resources involved when physicians provide office/outpatient visits that build longitudinal relationships with patients and address the majority of a patient’s health care needs with consistency and continuity over longer periods of time.

G2211 may be reported with new and established patient office/outpatient evaluation and management (E/M) services. It should not be utilized when your relationship with the patient is of a discrete, routine, or time-limited nature. It also should not be associated with an office visit if there is a modifier 25 appended or a procedure performed on the same date of service.

A podiatric appropriate example would be long term management of Charcot arthropathy. After initial phases of care there is longitudinal complex management and ongoing care via offloading, gait changes, and management of other downstream consequences of the resultant deformity.

Ask OHFAMA Responses to Member Questions on Coding, Compliance, and Scope of Practice Issues Question: Can podiatrists hire and oversee Advanced Practice Registered Nurses (APRNs) in Ohio?

Answer: Yes, nurse practitioners in Ohio who provide direct patient care are required to work in collaboration – or be supervised – by one or more DPMs, MDs, or DOs. Before we dive deeper into this question, let’s first define APRNs: There are four types of Advanced Practice Registered Nurses (APRNs) that are legally recognized in Ohio: Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), and Clinical Nurse Specialist (CNS).

Collaboration All CNPs, CNMs, and CNSs in Ohio who provide direct patient care are required to work in collaboration with one or more DPMs, MDs, or DOs. Nurse practitioners, in collaboration with one or more physicians or podiatrists, may provide preventive and primary care services, provide services for acute illnesses, and evaluate and promote patient wellness within the nurse’s specialty, consistent with the nurse’s education and certification, and in accordance with rules adopted by the nursing board.

Collaboration means that a physician has entered into a Standard Care Arrangement with the CNP, CNM, or CNS and is continuously available to communicate with the CNP, CNM, or CNS either in person or by electronic communication in accordance with section 4723.01(L) of the Ohio Revised Code. The collaborating physician is not required to be on site where the CNP, CNM, or CNS is practicing. However, a back-up plan is required in case of emergencies or planned absences.

When a certified nurse practitioner is collaborating with a podiatrist, the nurse’s scope of practice is limited to the procedures that the podiatrist has the authority under section 4731.51 of the Revised Code to perform.

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an APRN who prescribes, the physician shall not collaborate at the same time with more than five nurses (known as the 5:1 ratio) in the prescribing component of their practice, according to section 4723.431(A)(1) of the Ohio Revised Code.

Mandatory collaboration between APRNs and physicians sometimes requires Ohio APRNs, especially those who are self-employed, to contract with DPMs, MDs, and DOs for their ongoing consultation services.

Supervision Alternatively, CRNAs work in supervision with DPMs, MDs, DOs, and dentists. Supervision means that the CRNA is under the direction of a DPM, MD, DO, or dentist when providing direct patient care.

The supervising DPM, MD, DO, or dentist must be actively engaged in direct clinical practice in Ohio and practicing in a specialty that is the same as, or similar to, the CRNA’s nursing specialty, according to section 4723.43(B) of the Ohio Revised Code.

Prescribing Security: Why Healthcare Practices and Providers Should Take Note of Recent Ransomware Attack By: Dan Zinsmaster, Dinsmore & Shohl At any hour, your practice is vulnerable to cybercriminals aiming to cripple your operations.

The repercussions are vast, from productivity loss to compromising sensitive information, which erodes trust with patients and staff alike. The financial toll and reputational harm can be severe and lasting. Whether facing a widespread assault or a precise strike, these attacks are escalating in frequency, sophistication and financial impact.

On February 21, 2024, Change Healthcare, a healthcare technology company under Optum and owned by UnitedHealth Group, disclosed enterprise-wide connectivity issues and service application interruptions, attributing them to the ALPHV/Blackcat ransomware as a service threat actor. This incident affected tools used for healthcare payment and revenue cycle management across various healthcare provider customers in the United States.

Consequences of this incident include disruptions in pharmacy and health system operations nationwide, prompting the American Hospital Association (AHA) to advise healthcare organizations potentially affected to disconnect from Change Healthcare applications until the situation resolves. To mitigate the impact, over 90% of U.S. pharmacies have implemented modified electronic claims processing methods, while the remaining have resorted to offline processing systems. This, according to UnitedHealth Group.

In the event of compromised patient data, affected organizations may face legal obligations under HIPAA and state breach notification laws, leading to regulatory scrutiny or privacy-related lawsuits. The incident is part of a broader trend, with the FBI identifying over 1,000 global victims of ALPHV Blackcat ransomware and data extortion, with healthcare being a primary target.

A report from Health-ISAC suggests potential exploitation of certain ConnectWise ScreenConnect vulnerabilities may be behind the attack, with predictions of more organizations falling victim due to the exploit’s simplicity. Impacted Change Healthcare customers are advised to communicate with payors for payment workarounds, monitor official updates, follow AHA advisories and review recommendations from various entities including Health-ISAC, CISA, HFMA and HHS.

Additional steps for impacted practices and companies include the following: • Develop security-related queries for Change Healthcare to ensure security prior to reconnection to any impacted networks.

• Review all current HIPAA compliance programs including policies and any risk analysis.

• Notify insurers of potential business interruptions and security incidents, and evaluate your current cyber risk coverage.

• Review and update cybersecurity programs, policies and procedures including privacy policies and incident response plans.

• Review your current contracts for data or privacy provisions with contracted vendors. While vendors have their own privacy policies and practices, practices that utilize their services may be held accountable for third party breaches. Reviewing vendors’ contracts and adding key provisions that ensure the vendor is abiding by their regulatory duties helps you stay informed and could create a cause of action in the case of non-performance.

It is important to effectively manage complications by addressing the patient’s condition and the potential for complications before they occur. And recognizing complications when they do occur so you can appropriately respond to complications is also critical.

Reduce Risk by Taking a Complete Patient History One of the first steps in risk reduction is to obtain and document an appropriate history and physical exam prior to the initiation of treatment.

Does the patient have other conditions that need to be co-managed with other specialists? Does the patient have risk factors for a potential complication? Is a patient’s hypertension or diabetes under control? Do not just take the patient’s word that all is well. Consider obtaining copies of the patient’s lab work and other physician’s patient records.

Obtain and document the patient’s social history. The patient’s social history is also extremely important in ascertaining potential risks and determining the best course of treatment for that patient. Does the patient smoke? Is the patient able to comply with instructions? For example, does the patient have adequate support at home? Can the patient afford to be off work for an extended period? Is the patient responsible for caring for small children or aging parents?

It is important to document both normal and abnormal physical exam findings. If abnormal findings are present, document your rationale for your decision to refer or not refer for further evaluation. Collaborating with vascular, cardiology, infectious disease, endocrinology, and other specialists can help reduce the risk of complications and achieve better outcomes for your patients.

• Review business associate agreements to ensure that your vendors are responsible for any costs you may incur for their breach, like patient notification, credit monitoring and fines.

• Review internal policies, as organizations often fail to ensure the promises and assertions made in the public facing policies posted on their website are actual practices of the organization.

• Connect with data privacy counsel/advisors to proactively navigate through the complexities of data privacy law and provide the best course of action to avoid data breaches and regulatory fines for noncompliance.

These measures aim to navigate the aftermath of the incident and prevent similar occurrences in the future.

Complications Resulting in Amputation – Reducing the Risk for You and Your Patients By: Luke Cicchinelli, DPM, PICA As you could probably surmise, amputations are a leading factor in malpractice suits against podiatrists. So, how do you reduce the risk that a complication will result in amputation? And if amputation is necessary, how can you reduce the risk of a lawsuit being filed?

In many instances, patients that end up with an amputation have multiple co-morbidities such as diabetes and vascular disease which lead to nonhealing or infected wounds. There could be a post-operative surgical complication, injury, or other factor that leads to amputation. Regardless of the cause, amputation significantly impacts the patient’s quality of life.

Education and Expectation-Setting with the Patient (and Their Family) Patient (and family) education is key in reducing the risk of complications leading to amputations. Explain the patient’s condition, treatment options, and risk factors. Explain why you are referring the patient for further testing. Explain the importance of following instructions and what may happen if instructions are not followed. Make sure the patient has realistic expectations regarding treatment and the outcome of treatment.

Documentation of all patient education and instructions in the patient’s record is a valuable risk reduction tool in the event a lawsuit is filed. You may have properly informed and instructed your patient, but if it is not documented, it is your word against the patient’s word that they were not informed. If you are performing surgery, document your medical justification for surgery, procedure options and your rationale for selection and obtain the patient’s written informed consent.

Pay Attention When Complications Arise and Act Fast Recognize a complication when it first arises. Is a wound not healing as expected? Does the patient have a loss of vascularity? Is an infection not responding to antibiotics? Promptly document the abnormal findings and inform the patient.

Document your rationale for addressing the complication. Assess and document the patient’s compliance with instructions. Documentation of the patient’s non-compliance is another valuable risk reduction tool in the event of litigation. If the patient is non-compliant, try to work with the patient (and family) to address the reasons for non-compliance.

Inform the patient of the risks of non-compliance, including the risk of amputation. Promptly refer the patient to an appropriate specialist for further workup if appropriate.

Should a patient eventually undergo an amputation, documentation of your assessments, rationale for treatment decisions, patient education, and prompt response to complications is key in reducing the likelihood a lawsuit will be filed or will greatly aid in your defense should a lawsuit be filed.

PICA is proud to be a corporate sponsor of Ohio Foot & Ankle Medical Association as a preferred provider of medical malpractice insurance for podiatrists. Please visit picagroup.com to learn more about the benefits of being a PICA policyholder or to request a free, no-obligation quote!

THE OHFAMA JOURNAL | SPRING 2024 | 13

CONTINUING

MEDICAL EDUCATION Register Today: The 108th Annual Foot and Ankle Scientific Seminar May 16 – 17, 2024 17 Hours In-Person CE Make plans today to attend Ohio’s pre-eminent podiatric educational seminar – the 108th Annual Foot and Ankle Scientific Seminar – on May 16-17 at the Columbus Hilton at Easton This year’s event will cover a broad variety of education including diabetic management, updates on current technology, malpractice, coding, artificial intelligence, pain management, and much more.

There will also be a one- or two-day Assistant’s program that will include important information and refreshers for medical assistants, coding tracks, OSHA, and HIPPA compliance.

This is simply one event you won’t want to miss. Come to the Hilton for food, fun, and camaraderie. Bring your office shopping list to receive fabulous exhibit hall discounts from over 80 exhibitors! Door prizes abound along with an exceptional experience that only OHFAMA and OFAMF can provide. We hope to see you there!

14 | THE OHFAMA JOURNAL | SPRING 2024

108th Annual Ohio Foot and Ankle Scientific Seminar - May 16 – 17, 2024 Attendees will Receive Up to 18 CE Contact Hours Register at www.ohfama.org PHYSICIANS SEMINAR SCHEDULE Thursday, May 16, 2024 7:30 - 9:30 AM Diabetic Patient Management 9:30 - 10:00 AM Break 10:00 - 11:30 AM MIS Possibilities and Forefoot Surgery 11:30 AM - 1:00 PM Lunch and Learn - Choose from 3 Presentations 1:00 - 3:00 PM Scientific Paper and Poster Competitions:

Presentations from Podiatric Physician Residents 3:00 - 3:30 PM Break – Service Award Presentation 3:30 - 5:30 PM Looking Forward: Cutting Edge Technologies,

Recent Trends, and How to Protect Yourself

in a Changing World 5:30 - 6:30 PM Welcome Reception – Hosted by KSUCPM

Friday, May 17, 2024 7:30 - 9:00 AM Stuff Happens: How to Make the Most of Bad Outcomes

and Complications 7:30 - 9:30 AM Breakout Session: APMA Presents - 2024 Coding

and Documentation 9:00 - 10:00 AM Break - based on session attending 9:30 - 11:30 AM Difficult Patients, Conditions, and Decisions:

How to Optimize Their Management 10:00 - 11:30 AM Breakout Session: APMA Presents - 2024 Coding

and Documentation Continued 11:30 AM - 1:00 PM Exhibitor’s Marketplace Luncheon 1:00 - 2:30 PM Ankle Arthritis, TAR, Sports Injury and Recovery 1:00 - 2:00 PM Breakout Session:

1:00 - 1:30 PM - Artificial Intelligence in Lower

Extremity Dermatology

1:30 - 2:00 PM - Podiatric Misdiagnoses Resulting

in Malignancies 1:00 - 2:30 PM Breakout Session: MIPS 2024 Update 2:30 - 3:00 PM Break 3:00 - 4:45 PM Evolution of Practice: Nothing Stays the Same 3:00 - 4:00 PM Breakout Session: The HIPAA

Right of Access Rule 4:45 - 5:30 PM O Doctor, Where Art Thou?

5:30 - 6:30 PM

Closing Reception - Hosted by The Podiatry Foundation

ASSISTANT’S PROGRAM

Assistants may register for Thursday and/or Friday

Thursday, May 16, 2024 7:30 - 8:00 AM

Registration

8:00 - 8:45 AM

Foot and Ankle Anatomy, Conditions and Commonly Performed Procedures

8:45 - 9:30 AM

Navigating Confidentiality Implications with Patients and Third Parties

9:30 - 10:00 AM

Break

10:00 - 11:00 AM Interactive Hands-On Workshop 11:00 - 11:30 AM Chief Complaint and HPI Registration Forms 11:30 AM - 12:30 PM Lunch (on your own) 12:30 - 1:00 PM

Dermatology: What Not to Miss

1:00 - 1:30 PM

Coding Basics: What Every Medical Assistant Should Know

1:30 - 2:00 PM

Office Communication: Why It Matters

2:00 - 3:00 PM

Podiatry Jeopardy

3:00 - 3:30 PM

Break

3:30 - 4:00 PM

Burnout: Prevention, Recognition and Management

4:00 - 4:20 PM

Pearls from the Attendees’ Offices

4:20 - 5:00 PM

Expert Panel Discussion

5:00 - 6:00 PM

Staff Appreciation Reception

Friday, May 17, 2024 7:00 - 7:30 AM

Registration

7:30 - 9:30 AM

APMA Presents – Coding and Documentation

9:30 - 10:00 AM

Break

10:00 - 11:30 AM APMA Presents – Coding and Documentation

Continued 11:30 AM - 1:00 PM Exhibitor Marketplace Luncheon – Easton Ballroom 1:00 - 2:30 PM

MIPS 2024 Update

2:30 - 3:00 PM

Break

3:00 - 4:00 PM

The HIPAA Right of Access Rule

4:00 - 4:45 PM

Break

4:45 - 5:30 PM

O Doctor, Where Art Thou?

2024 Faculty: Sarah Abshier, DPM – Seminar Chair; Lawrence DiDomenico, DPM – Seminar Chair; Christopher Hyer, DPM – Seminar Chair; Robert Mendicino, DPM – Seminar Chair; Joshua Banks, DPT; Samantha Bark, DPM; Robert Brandao, DPM; Robert Brarens, DPM; Michael Brody, DPM; Patrick Burns, DPM; Doug Chalker, RT(R)(RC); Luke Cicchinelli, DPM; David DeLuccia, LPO; Jaqueline Donovan, DPM; Mike Dujela, DPM; Melissa Galli, DPM; Marc Greenberg, DPM; Peter Highlander, DPM; Mark Hofbauer, DPM; Karen Kellogg, DPM, MBA; Mike King, DPM; June Baker Laird, Esq; Scot Malay, DPM; Krishna Mannava, MD; Suhail Masadeh, DPM; Amy Masowick, DPM; Gladstone McDowell, MD; Mark Mendeszoon, DPM; Alan Ng, DPM; Andrew Pavelescu, DPM; Rolland Ramdass, DPM; Matthew Reiner, DPM; Marcus Richardson, DPM; William Scherer, DPM;; Richard Schilling, DPM; Jeffrey Strakowski, MD; Rebecca Sundling, DPM, MPH; Katie Swanstrom, DPM; Randall Thomas, DPM; Elizabeth Wakefield, DPM; Congressman Brad Wenstrup, DPM; Dan Zinsmaster, Esq.

THE OHFAMA JOURNAL | SPRING 2024 | 15

KENT STATE COLLEGE OF PODIATRIC MEDICINE Remembering Dr. Allan Spencer

The Kent State University College of Podiatric Medicine (KSUCPM) community is deeply saddened by the passing of its long celebrated and adored alumni, former faculty and hall of fame member, Allan M. Spencer, DPM. Born November 17, 1930, Dr. Spencer passed away on Sunday, March 17, 2024, at the age of 93.

After graduating valedictorian from the Ohio College of Chiropody’s class of 1958, Dr. Spencer began his teaching career at the College and Cleveland Foot Clinic from 1958-1997. A much admired and respected professor and clinician who taught orthopedics, biomechanic s, and spor t s medicine, he was elected Teacher of the Year by the student body.

For nearly 40 years, he remained dedicated to his alma mater, rising to the ranks of Clinical Supervisor and Chairmen of the Department of Orthopedics, and gifting the college over $20,000 in proceeds from one of his numerous publications, “Practical Podiatric Orthopedic Procedures”.

It is no surprise that Dr. Spencer was respected on an international scale, taking his time and talents abroad as a visiting professor at Saltford University in Manchester, England in 1979. As his career came to an end, Dr. Spencer was the recipient of the Honorary Degree of “Doctor of Humane

Letters” from OCPM in 1998, and later was honored with the college’s highest honors, an induction into the KSUCPM Hall of Fame in 2008.

Dr. Spencer made great strides in his many years practicing and teaching podiatric medicine and leaves behind a great legacy. We give our sincerest condolences to Dr. Spencer’s loved ones.

KSUCPM Student Wins APMWA Student Writing Competition Lekha Mutyala, a 3rd year student at the Kent State University College (KSUCPM) has been named the winner of the 38th Annual American Podiatric Medical Writers Association (APMWA) Student Writing Competition. Her paper was entitled, “Advancements in Technology and Innovative Approaches in Diabetic Foot Ulcer Management,” She will receive a $1,000 honorarium from a special endowment by Dr. and Mrs. Steven Berlin to the APMA Educational Foundation.

KSUCPM Dean Allan Boike, DPM (left) and OHFAMA Eastern Academy Trustee Bruce Blank (right) met with Youngstown State University President Bill Johnson in March to discuss student recruitment opportunities.

DRS. CENTRAL BILLING, LLC VOL 66 • NO.2 • SPRING 2024

w w w . d r s b i l l i n g i n c . c o m

The Ohio APMA Delegation represented our state at the APMA House of Delegates, which took place March 16-17 in Washington, D.C.

The OHFAMA Journal is published four times per year. The advertising deadline is mid-month preceding publication. Portions may be used with permission of the publisher.

President: Thom Arnold, DPM Published By: Mike Mathy, CAE, Executive Director mmathy@ohfama.org Advertising: Luci Ridolfo, CAE, Assistant Executive Director lridolfo@ohfama.org Contact Information: 1960 Bethel Rd., Ste. 140 | Columbus, Ohio 43220 Phone: 614.457.6269 | Fax: 614.457.3375 www.ohfama.org Editorial Disclaimer:

The OHFAMA Journal is provided to Association members and Industry Affiliates of the profession as a part of our communications to inform/ update our members on podiatric issues and events. The contents of OHFAMA Journal are intended for general information purposes only and should not be read as specific legal, financial, or business advice regarding specific issues or factual events. We urge you to consult your legal, financial, and professional advisors with any specific questions you may have.

The information published herein has been prepared for educational and informational purposes only.

This information is not intended as legal, podiatry or practice management advice or an opinion on same. Circumstances change from day-to-day and one situation may differ from the next; the authors and publisher cannot assume responsibility for any actions taken based on the information contained herein. This information is not a substitute for expert advice specific to your situation.

More specifically, legal or regulatory advice must be tailored to the specific circumstances of each case, and laws are constantly changing. Nothing provided herein should be used as a substitute for the advice of competent counsel. Federal law requires that the authors and publisher let you know that nothing published herein is intended or written to be used, and cannot be used for the purpose of avoiding any penalties under the law.

The publication of the information herein is not intended to create, and receipt does not constitute a professional or contractual relationship between the author and the publisher and you. While the publisher tries to provide accurate and helpful information, they do not make any claims, promises or guarantees about the accuracy, completeness, helpfulness or adequacy of the information contained herein. No warranties are made for the information published to be accurate and no other warranties express or implied are made. The information here is presented “as is.”

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THANK YOU TO OUR 2023 OPPAC CONTRIBUTORS: Please consider financial support of our state legislative efforts by contributing to the Ohio Podiatric Political Action Committee (OPPAC).

OHFAMA’s legislative success relies on member contributions to our political action committee — the Ohio Podiatric Political Action Committee (OPPAC).

Please consider making a personal donation to OPPAC today.

Your generous OPPAC contribution will help preserve, protect, and advance podiatry in Ohio!

Central Academy

Sarah Abshier, DPM Roberto Brandao, DPM Andrew Brown, DPM Anthony Cozzolino, DPM Abigail Elliott, DPM Timothy Holmes, DPM Anastasia Koss, DPM Lynette Mehl, DPM Amanda Quisno, DPM Adam Thomas, DPM Jennifer Trinidad, DPM Eastern Academy Mitchell Dalvin, DPM

Mideast Academy Thomas Arnold, DPM Karen Kellogg, DPM Richard Kunig, DPM Leslie Niehaus, DPM Kenneth Nixon, DPM Lee Sayner, DPM Rodney Scott, DPM

18 | THE OHFAMA JOURNAL | SPRING 2024

Midwest Academy Darrell Ballinger, DPM Marc Greenberg, DPM Elizabeth Nicely, DPM Gerald Perelman, DPM John Stevenson, DPM Erica Suprenant, DPM Charles Trimble, DPM

North Central Academy Christopher Bohach, DPM Martin Lesnak, DPM Elizabeth Wakefield, DPM Brian Zimmerman, DPM

Northeast Academy Robert Bair, DPM Colleen DeBarr, DPM Michael LeCastre, DPM Joy Rowland, DPM Debra Thornton, DPM Howard Waxman, DPM Kelly Whaley, DPM

It’s easy. Go to OHFAMA.org and click on Donate to OPPAC on the top of the homepage.

Northwest Academy Charles Marlowe, DPM Thomas McCabe, DPM Pamela Sheridan, DPM

Southern Academy

Brian Ash, DPM Ruth Ann Cooper, DPM Matthew Hamilton, DPM Tatyana Hamilton, DPM Amy Masowick, DPM

Additional Contributors Michael Brody, DPM Dan Leite Mike Mathy, CAE Luci Ridolfo, CAE

*Include your name today!

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Interested in purchasing an Ad? Are you seeking employment or looking to hire? Do you have a practice or equipment for sale? Do you have office space available?

Post your advertisement in The OHFAMA Journal and on the OHFAMA website to reach over 600 practicing podiatry physicians and surgeons in Ohio.

Rates start at just $10/month for website advertisements and $10/issue of The OHFAMA Journal.

Please contact Luci Ridolfo with any quesions at (614) 457-6269 or lridolfo@ohfama.org.

THE OHFAMA JOURNAL | WINTER 2024 | 5

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