APMA News - January 2012 - (Page 26)

T i CAC-PIAC: The Only Constant in Health Care is Change expanded anti-fraud provisions from CMS. Dr. Agrawal discussed the latest happenings at CPI, covering a range of activities from honest mistakes to outright fraud, and touched on three recent fraud cases involving podiatrists. Among other initiatives, CPI is beta-testing a provider screening lab, which aims to reduce time for the enrollment process. “It’s very exciting to hear from someone who still practices medicine but also works in the insurance world, such as Dr. Agrawal,” said Dr. King. Henry Desmarais, MD, MPA, addressed health-care reform and what comes next, with a particular focus on podiatric medicine. Dr. Desmarais, former acting administrator for HCFA and an ongoing consultant to APMA, understands the pressures podiatrists face, and he discussed the Accountable he Annual Joint National Podiatric Carrier Advisory Committee (CAC) and Private Insurance Advisory Committee (PIAC) Representatives’ Meeting is a perfect example of the flexibility APMA has demonstrated in dealing with an evolving health-care landscape throughout its 100-year history. Consider that when APMA (then the National Association of Chiropodists) was founded in 1912, there was no Medicare and very little to no private insurance available to our members’ patients—the policies available would visory Co Ad m have been for accident or disability. Prim er vate insurance began to take off in the • • 1920s with the Blues plans and accel& erated in the 1940s when businesses, seeking to circumvent wartime wage su controls, decided to compete for labor ra y nce or Advis by offering health insurance. Medicare was established in 1965 as the culmination of President Lyndon Johnson’s “Great Society.” Now, in 2012, these payer systems are the primary mechanism of payment for our members. To provide for information exchange between carriers and physicians, HCFA (now CMS) ordered formation in 1992 of Carrier Advisory Committees (CAC) made up of physician representatives, and in response to APMA’s efforts, CMS included podiatric medicine shortly thereafter. Sensing the need for a similar outlet for private insurance, APMA established its Private Insurance Advisory Committee. As evidenced by the passage of the Affordable Care Act (ACA) in 2010, health care continues to change rapidly, and APMA and its members must continue to adapt. The CAC-PIAC meeting is no different, as it continues to focus on the rapid changes in health care and technology, the need to stay informed, and the need for representatives to be effective advocates for the profession. First established in 2001, the CAC-PIAC meeting allows representatives to gain the most pertinent and current public and private payer information available in order to share it in their home states. The 11th CAC-PIAC meeting took place November 5–6, 2011 at the Wardman Park Marriott in Washington, DC. The meeting focused on the latest communication trends and the two-way flow of information between states and APMA. In keeping with this theme, representatives were given pins to identify themselves at their regional meetings and were provided with a highlights document to share with their states. The meeting kicked off with a word from APMA President Michael J. King, DPM, who reminded the representatives of the critical role they play in the flow of information. Perhaps no individual could better address the volatility of the current state of health care than keynote speaker Shantanu Agrawal, MD, chief medical officer, Center for Program Integrity (CPI) at CMS, who provided an overview of Medicare policies affecting podiatrists and explained how health-care reform has greatly CAC PIAC it rr te Ca e mit C om 26 APMA News January 2012 Privat tee First established in 2001, the CACPIAC meeting allows representatives to gain the most pertinent and current public and private payer information available in order to share it in their home states. Care Organization (ACO) final rule published in the November 2, 2011 Federal Register. It’s important, he emphasized, for podiatrists to understand how to participate most effectively in an ACO, if they choose to do so. Dr. Desmarais explained that the final rule adopts two tracks: track one, in which there are shared savings all three years, and track two, in which there are shared savings and losses all three years. Also of note, Dr. Desmarais said that waivers of federal laws apply broadly to ACO participants. As health care evolves, so too do the models available. Dr. Desmarais also discussed the Essential Benefits Package, which will be a key component of the care available to many Americans under the ACA. APMA and our state components already have participated in listening sessions sponsored by the Department of Health and Human Services (HHS), and APMA is in contact with key members of HHS Secretary Kathleen Sebelius’ staff to discuss the importance of podiatrists’ inclusion in this program. The association will keep members informed on the progress of discussions. Julie Taitsmand, MD, JD, chief medical officer for the Office of Inspector General (OIG), advised attendees about fraud prevention and enforcement, noting five principles of an effective health-care integrity strategy: 1. Scrutinize Provider Enrollment—Scrutinize who may participate in Medicare. 2. Ensure Payment—Ensure reasonable payment methodologies. A new CMS rule allows for prepayment review for “shady” billings. e In

Table of Contents for the Digital Edition of APMA News - January 2012

APMA News - January 2012
President’s Message
Contents
APMA Celebrates its Centennial
APMA by the Decade: 1912–1921
Updated List of Seal Holders
Paving the Path to Parity: A Look Back at 2011 State Advocacy Initiatives
2011 Podiatric Practice Survey: How Do Your Benefits Compare?
CAC-PIAC: The Only Constant in Health Care is Change
Reimbursement
Federal Advocacy Forum
APMAPAC Chair Report
IT Consultant
Can They Really Do That?
Website Wisdom
Technofile
Young Voices
Small Business 101
CPME Update
APMA All Stars
Awards Nominations
In Short
Worthy of Note
Resolutions Submissions
Affiliates Corner
List of Affiliated Organizations
Insurance Advisor
New Members
Death Notices
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions

APMA News - January 2012