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TECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014EMENT HOW TO USE SMARTPHONE ROADMAP 2015ICD-10AncillaryServicesThe Most InfluentialPublication for the PodiatricICD-10ProfessionTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014 ROADMAP 2015MANAGEMENT HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014MANAGEMENT ROADMAP 2015OW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014 ROADMAP 2015 HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014 ROADMAP 2015ACOsComplianceROAD MAP2015HIPAAComplianceROUND TABLE /ROADMAP 2015 /PODIATRY MANAGEMENTMANAGEMENT HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014PODIATRY ROADMAP 2015ROAD MAPROAD MAPROAD MAPAncillaryServicesnlineviewsPODIATRY MANAGEMENTMANAGEMENT HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014PODIATRY ROADMAP 2015MeaningfulACOsAncillaryUseJanuary D-10PodMcoverJan15:CoverA/M09 12/15/14 4:44PM Page 1EncroachmentJanuary 2015The Most Influential Publication for the Podiatric lsHIPAAAncillaryMeaningfulObamacare ComplianceTheMost Influential Publication for the Podiatric ProfesServicesPatientUseACOsmacare15/14 4:44 PM Page rA/M09 12/15/14 4:44 PM Page cesJanuary2015The Most Influential Publicationfor the Podiatric Profession MalpracticeGrMeaningfulPatientICDUse PQRS MeaningfulEBM PracticeOnlineNewUse 2015JanuaryAncillaryPublication for the Podiatric croachmentServicesPQRSBY MARC HASPEL,ICD-10 DPMEBMMalpracticeGroupParityHIPAAPublication for the Podiatric ProfessionJanuary 2015TheMost InfluentialEncroachmentPracticeComplianceNewDPMs will thriveby meeting today’sspecial challenges2015TheFutureofPodiatry20152015ROAD MAPROAD MAP20152015ACOsDPMs will thriveby meeting today’sDPMswill thriveOurexpertsdiscussthe outlookfor the profession.specialchallengesDPMs will thrive bymeeting today’sby meeting today’s special challengesspecial challengesMeaningfulTechnologiesMalpracticeDPMs will thriveGroupUseHIPAAPracticeDELIVER PROMPTLYNewGroup PERIODICALSComplianceMeaningfulby meetingtoday’sICD-10Encroachment iesthriveDELIVER TOPracticeUseNew Ancillary lengesPQRS Services by meeting today’sEBMOnlineICD-10ReviewsParityspecial challengesEBMMalpracticeROAD MAP2015T20152015PERIODICALS DELIVER PROMPTLYDELIVER NewPQRSEncroachmentwww.podiatrym.comPERIODICALS DELIVER NewPatienttimes for podiatricmedicine—asinstructor in theDepartmentEBMof DermatologicTechnologiesOnlinePERIODICALS DELIVERPROMPTLYForensic PodiatryPortalswell DELIVERas for TOall medicine,for ReceivablesthatSurgery. He Parityis Meaningfula clinical consultantto BakoAlso Inside:ReviewsIVER PROMPTLYMalpracticeUseRediscoveringmatter—is beyond dispute. Today, AlsoPodiatricPathology Laboratories.Inside:EBMOnline ReceivablesR TOForensicPodiatryPQRSCompoundingReviews podiatricParityhitphysicians are beingAndrew Schneider,DPMPharmaciesis in privateParityROAD MAPDPMs MAPwill thriveROADby meeting today’sROAD M2015Jon Hultman,DPMAlso Inside:AlsForensic PodiatryForensic PRediscoveringCompounding PharmaciesRediscTherapeutic Shoe UpdateDPMs will thrCompounding Phaby Therapeuticmeeting Shoetodspecial challenBryan Markinson,NewTechnologiesDPMForensic Podiatrywww.podiatrym.comRediscoveringfrom all directionswith a specialveritable alphabetpractice in .Heisafellowand memberOnlineDPMswillthriveUsePERIODICALS DELIVER PROMPTLYCompoundingReviewsto ICD-10,www.podiatrym.comHIPAA,and DELIVERMU—andall arede- PharmaciesReceivablesof the Board Therapeuticof Trustees ICALS DELIVER cvices topublic. Moreover,podiatric physiInside:DELIVERTOtheManagement(AAPPM),a fellowof the y’sFAOMForensiccians PQRSalso find their bypracticesbeing encroachedand APWCA, and a memberof theRediscoveringPodiatryupon by otherhealth professionalsseekEBM mastermindOnline alliedspecialTop Practicesgroup.He DELIVER ing to expand theirwww.podiatrym.comown patient bases and serinternationallyontopicsrelatedtopracticeDELIVER ent, marketing, wound care, andTechnologiesMalpracticeGroupwww.podiatrym.comin this matter involves placing blame on podi- Therapeuticbiomechanicsandis an adjunct faculty memShoeUpdateAndrew Schneider,PracticeNewatry itself).berofKentStateUniversityCollege of OMPTLYthis turbulent climate, podiatric LIVER TO is well equippedatricmedicinenot only forJarrod Shapiro, AlsoDPM Inside:is an assistantproEBMOnlinesurvival,holdingReviews but the ability to thrive. By Parityfessor at WesternUniversityCollegeofPoForensic Podiatryon to the basic tenets of practice necessarydiatric Medicine in Pomona, California andRediscoveringto satisfy a growing and demanding patienthas been in activeclinical and surgical pracOMPTLYReceivables safeguarding and continuingAlsoCompoundingpopulation,to Inside:tice for eight years.PharmaciesHe is the author of PM’swww.podiatrym.comembrace services vulnerable to the ePerfect”column.PERIODICALS DELIVER PROMPTLYForensic parElliotUdell,DPMisadiplomateof theAlsoInside:DELIVER TOity with allopathic medicine, podiatricRediscoveringpracAmerican Board of Podiatric Medicine. He isForensicPodiatryCompoundingPharmaciestitioners can be well assuredthat the futurea fellowand currentpresident of the AmerJarrod Shapiro,omremains strong for their ic Medicine and aTherapeutic Shoe UpdateDPMJoining this roundtable to discuss these Compoundingfellow of thePharmaciesAmerican Society of Podiatricand other issues regarding the future of po- Therapeuticwww.podiatrym.comDermatology.Shoe Updatediatric medicine:Jon Hultman, DPM is Executive DirectorPM: How do you see podiatricof the California Podiatric Medical Association,practice changing because of thepractice management and valuation consultantpotential impact—positive or negafor Vitera Healthcare Solutions, and author oftive—of the Affordable Care Act?The Medical Practitioner’s Survival Handbook(available at www.mbagurus.com).Hultman: In spite of all the iterationsBryan Markinson, DPM is chief of pocreated in healthcare’s attempt to reform andElliot Udell,diatric Medicine and surgery at the Leni andfix healthcare, none have actually been sucDPMPeter W. May Department of Orthopediccessful at fixing the cost, quality, and accessSurgery at the Mount Sinai School of MediContinued on page 82EncroachmentQwww.podiatrym.comJANUARY 2015 PODIATRY MANAGEMENT81Parity
Future (from page 81)problems that plague the system.One can assume that this most recentattempt won’t be the last. While weexpect that the ACA will increasedemand because more people will beShapiro: I don’t think anyonetruly knows what will happen as aresult of the ACA. Time will tell. Bylooking at current trends, though,one could anticipate significantchanges to podiatric practice. Manyof the changes (increased paperworkRegardless of the ACA—or whatever future iterations of healthcare reformlie ahead—the good thing is that there will bea growing demand for the foot and ankle servicesprovided by podiatric physicians.—Hultman82covered by insurance, the continuallowering of reimbursement as theprimary method for addressing costs,along with the growing complexity involved in billing and fulfillingcompliance requirements, make theachievement of cost savings, quality improvement, and quicker accessever more difficult to attain.Regardless of the ACA—or whatever future iterations of healthcarereform lie ahead—the good thingis that there will be a growing demand for the foot and ankle services provided by podiatric physicians. Unless one has a conciergeor niche type practice, my recommendation is that one build a practice model capable of thriving in anenvironment that demands qualityand quick access—even when challenged by low fees, high volume,and ever increasing complexity. Themost effective model for addressing this type of environment is anefficient, integrated group model,one consisting of multiple doctorsat multiple locations. A group’s costgoal is to spread a greater volumeof patients and services over stablefixed costs, and its quality goals areto offer same-day availability, utilize evidence-based medicine, andinclude doctors with different skillsets and training within the group,so that patients with any type offoot or ankle problem will be ableto access a doctor within the groupwho is qualified to treat the patient’s specific condition.Y MANAGEMENTMANAGEMENT HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014 ROADMAP 2015ROUND TABLEfor compliance, ACOs, and increasedgovernmental regulation) will placeincreased pressure on solo practitioners and smaller groups. Physicians will be increasingly pushedinto larger organizations to absorbthe administrative paperwork. Thismay mean the end of solo providers,which would be a great shame. Onthe positive side, a larger number ofpatients with health insurance meansa greater potential patient load forproviders.Schneider: The Affordable CareAct has already caused some changesto occur in podiatry, along with seICD-10OnlineReviewsis easy to fall behind with the newadministrative and documentationburdens, which can lead to potentialfines PQRSif offices are audited.As employers, the ACA affectsGroupPractice towhether a practice is mandatedprovide health insuranceEBM and theParityscope of the policy. This will affectthe financial burden on average podiAlso Inside:atry practices. ERIODICALS DELIVER PROMPTLYDELIVER TOForensic PodiatryRediscoveringCompounding PharmaciesTherapeutic Shoe UpdateUdell: The concept of enablingeveryone in the country to havehealthcare insurance is a very goodidea. The way it has been implemented, however, is creating problemsfor both patients and physicians.One area that is affecting all of us isthat patients often choose inexpensive plans and these patients cometo the doctor thinking they are fullyinsured only to find that they havea large substantial annual deductibleand/or considerably large co-payment for each visit. In my practice,we have provoked the anger of somepatients when we sent them bills forservices which they were told werecovered by their insurance companies but were applied toward theirdeductibles. Other patients have become angry when we asked themto pay their co-payments and couldnot comprehend that unless we collected this money all their insuranceplans would be paying us are minuteamounts for the visits. I believe thatwww.podiatrym.comWe have provoked the anger of some patientswhen we sent them bills for services which they weretold were covered by their insurance companies butwere applied toward their deductibles.—Udellmedical specialties. There are somepositive elements, such as a widerpool of insured patients seeking carefrom our offices.Some of the negatives are increased administrative burden topractices. The ACA is a tremendouslydetailed document and most podiatrists will rely on the APMA andother organizations, such as AAPPM,to decipher and educate on the necessary steps to take. That said, itJANUARY 2015 PODIATRY MANAGEMENTthe concept of affordable healthcareis a good one, but the system stillneeds a great deal of tweaking without more political meddling.Markinson: The AffordableCare Act’s most visible effect, in myopinion, will result in more peoplebeing insured. Yet, the greatest majority of covered individuals will bethose who have transferred out ofContinued on page 84www.podiatrym.com
Y MANAGEMENTMANAGEMENT HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014 ROADMAP 2015ROUND TABLEFuture (from page 82)or lost traditional coverage and havebecome Medicaid-eligible, or thosewho have elected very poor-payingplan options that also have high deductibles and co-payments. I actuallythink that this is a golden opportunity for podiatrists to take a stanceagainst the insurance company abuseof doctors and reject poor reimbursements. Unfortunately, so many of ourcolleagues are stuck believing that“patients won’t pay.” In my experience, the 20% of the patient population that will be willing to pay clearlyoutweighs the 80% who insist on thedoctor being on the plan. I certainlyhave not lost money by ending participation in poor-paying plans.84QPM: Other recent developments in healthcare—mostvisibly PQRS, MeaningfulUse, and ICD-10—will likely necessitate DPMs making changes in their practices. Whatsort of adaptations do you foresee?Schneider: Considering that thethree developments that are citedinvolve the government effectivelyusing physicians for data collection,there is every reason to think thatmore optional incentives leading topunitive payment adjustments willcome. Each past development, aswell as any in the future, will requirea significant change in one’s officeworkflow.It is for this reason that one’soffice workflow should be well-documented, staff well-trained and, mostimportantly, the office needs to beadaptable to future changes. Nowmore than ever it is vital that everyoffice have a manual documentingevery office function and operation.It is also essential to have a treatment protocols manual. The manualsshould be available to the entire staffin printed and electronic form.Having such a manual will ensure that the entire staff, including doctors, front and back office,schedulers, billers, etc., are able toaccess the correct way to performa task or approach a patient, in thepractice. When the team is in thehabit of referring to such a manual,any changes to workflow that become necessary with future healthcare changes can be incorporatedinto the systems and protocols. Thiswill help to minimize the disruptionto workflow and allow the office tomaximize efficiency.Hultman: These are but a few ofthe new things being heaped upondoctors, who are already overloaded dealing with the complexities ofbilling and maintaining compliance.It is becoming far too difficult andtime-consuming for small practicesto stay on top of all the old things,much less the new ones. This is justone more reason to consider mergingpractices or becoming employed by agroup.Since the primary goal of PQRSand meaningful use is improvementin quality, a group should ulUseICD-10OnlineReviewspatients’ outcomes. This will assurepayers that care within the groupis consistent, regardless of locationPQRSor thespecific doctor treating thepatient. Such a protocol also makesGroupPracticeit possible for doctors to recognizewhen a change in a specificEBMguidelineParityimproves outcomes, enabling continuous improvement in ODICALS DELIVER PROMPTLYDELIVER TOReceivablesAlso Inside:Forensic PodiatryShapiro: PQRS and meaningfulRediscoveringCompounding Pharmaciesuse will mandate electronicmedicalTherapeutic Shoe Updaterecords, which is added pressure especially for the solo provider whohas yet to switch over. Granted, thisis a small number of providers, butthese initiatives also increase the administrative costs of providing care.This will be a headache for providers, since they require extra documentation and, in some cases, extraface time with patients. Providers,however, should maintain a posi-www.podiatrym.comThe meaningful use and PQRS and the 44,000 dollarincentive for implementation of EMR,as well as threat of penalties for not implementing,have been a proven boondoggle for which podiatryfell for hook, line, and sinker.—MarkinsonSteve Covey’s advice as found in hisbook The 7 Habits of Highly Effective People, this being, “Begin withthe end in mind.” The “end”, in thiscase, is quality, and the reduction ofvariation is the definition of qualityin every industry. Quality is worthmore to patients and payers, andhaving the ability to measure it iswhat should eventually enable payfor quality reimbursement methods.Healthcare is currently faced witha major hurdle to the achievement ofclinical quality, and this is the hugevariation in treatment of patientswho present with the same problem; this is something that we needto change. A patient with heel paincould go to ten different doctors withthe exact same symptoms and get tendifferent treatment recommendations.All doctors in a group should be utilizing one set of treatment guidelines,and they should be measuring theirJANUARY 2015 PODIATRY MANAGEMENTtive outlook and understand that theextra information gathered is intended to improve patient care. Savvyphysicians may also find opportunities to increase their billing levelsdue to a more comprehensive patient visit. By adding much of thisinformation to patient intake forms,physicians can remain in compliance,while not increasing their in-roomtimes.Udell: The central pathway tomeaningful use is via electronichealth records used to document patients’ cases. Actually, we have beenusing EHR in our office for manyyears. The programs we have usedhave created clean, legible notes. Theproblem is that the government hasforced doctors to use government-approved programs, and all of theseprograms are cumbersome, someContinued on page 86www.podiatrym.com
Y MANAGEMENTMANAGEMENT HOW TO USE SMARTPHONETECHNOLOGYTO DOCUMENT YOUR NURSING HOME CARE JANUARYAUGUST 20152014 ROADMAP 2015ROUND TABLEFuture (from page 84)times very expensive and create agreat deal of extra time-consumingwork on the part of physicians. Thistime could have been better spentcaring for patients. Because thesegovernment-approved-and-supervised programs are so cumbersome,it is ironic that very often informationabout patient care happens not tobe clearly visible to multiple doctorsin a clinic or hospital setting. A recent article in the New York Timesimplied that these cumbersome EHRsystems might have been the reasonwhy the medical staff at a Dallas hospital sent home a patient sufferingwith Ebola, causing that man to dieand risk spreading the disease.86Markinson: The meaningfuluse and PQRS and the 44,000 dollar incentive for implementation ofEMR, as well as threat of penaltiesfor not implementing, have been aproven boondoggle for which podiatry fell for hook, line, and sinker.It has already come to fruition, forsome, that the incentive paymentsare quite lower than the true cost ofimplementation and ongoing supportrequired.Equally confounding to me is thethreat of relative
Surgery. He is a clinical consultant to Bako Podiatric Pathology Laboratories. Andrew Schneider, DPM. is in private . practice in Houston, Texas at Tanglewood Foot Specialists. He is a fellow and member of the Board of Trustees and secretary of the American Academy of P
