American Podiatric Medical Association. 82nd Regular Sessions, House of Delegates. March 24, 25, and 26, 2002, Washington, DC

Abstract

R. Douglas Sowell, DPM, presided as president of the Association for the full sessions of the American Podiatric Medical Association (APMA) House of Delegates on March 24, 25, and 26, 2002. William F. Munsey, DPM, presided as speaker. Roderick D. Farley, DPM, served as protocol officer. Werner Strupp, JD, served as parliamentarian. Glenn B. Gastwirth, DPM, served as secretary. Eric R. Hubbard, DPM, served as installing officer. Official recordings of the APMA 2002 House of Delegates were transcribed by Mr. Ray Heer. Richard B. Viehe, DPM, assumed the office of president of the Association at the adjournment of the House of Delegates on Tuesday, March 26, 2002.

The following list consists of delegates (d) and alternates (a) whose names were submitted to the Secretary’s office by the state component societies and who were certified by the Credentials Committee in Washington, DC:

• ALABAMA (1)
  Tommy W. Garnett (d)* (* Chief Delegate)
  Robson F. Araujo (a)
• ALASKA (1)
  No delegates or alternates present.
• ARIZONA (2)
  Stephen M. Geller (d)
  Ralph B. Rabin (d)*
  Paul J. Selander (a)
• ARKANSAS (1)
  H.F. “Bunny” Brown, III (d)*
  Martha A. Jackson (a)
• CALIFORNIA (9)
  Jeffrey R. DeSantis (d)
  Oliver S. Foster (d)
  Daniel C. Fulmer (d)
  Harry Goldsmith (d)
  Eric R. Hubbard (d)
  Jon A. Hultman (d)
  Franklin Kase (d)
  Scott A. Tafuri (d)*
  Lawrence I. Rubin (a)
  Barry L. Scurran (a)
  Lyman H. Wilson (a)
• COLORADO (2)
  William F. Hineser (d)*
  Gordon P. Rheaume (d)
• CONNECTICUT (3)
  R. Daniel Davis (d)*
  Brian P. Deschamps (d)
  Anthony R. Iorio (d)
  Harvey D. Lederman (a)
• DELAWARE (1)
  David H. Haley (d)*
  Linda L. Lawton (a)
• DISTRICT OF COLUMBIA (1)
  Arnold S. Ravick (d)*
  Stephen M. Pribut (a)
• FEDERAL SERVICES (2)
  Joseph R. Agostinelli (d)*
  Gregg K. Young (d)
  Andrew B. Paglia (a)
  Jeffrey M. Robbins (a)
• FLORIDA (8)
  William J. Beaton (d)
  Thomas P. Broner (d)*
  Edward A. Fazekas (d)
  Robert Frimmel (d)
  Dennis R. Frisch (d)
  Barney A. Greenberg (d)
  Stephen M. Meritt (d)
  Joseph L. Sindone (d)
  Joseph H. Strickland (a)
  Timothy H. Tillo (a)
  Sheldon Willens (a)
  Cary M. Zinkin (a)
• GEORGIA (3)
  Wesley L. Daniel (d)*
  Kile W. Kinney (d)
  Barbara S. Schlefman (d)
  Allen Lazerson (a)
  Mickey D. Stapp (a)
• HAWAII (1)
  Tyler A. Chihara (d)*
• IDAHO (1)
  Kert W. Howard (d)*
• ILLINOIS (6)
  Terence B. Albright (d)
  Carl J. Cortese (d)
  Matthew G. Garoufalis (d)*
  John F. Grady (d)
  Donald W. Hugar (d)
  Michael J. Wessels (d)
  Gregory T. Amarantos (a)
  Michael A. Buck (a)
  Kirk M. Contento (a)
  Joel A. Feder (a)
  Jondelle B. Jenkins (a)
• INDIANA (3)
  Ranford K. Hall (d)
  James L. Lewis (d)
  Patricia A. Moore (d)*
  Richard L. Isaacson (a)
  William K. Oliver, III (a)
• IOWA (2)
  Charles E. Keenan, Jr. (d)
  Michael W. Ward (d)*
• KANSAS (1)
  Barry E. Wesselowski (d)*
  Richard L. Bradbury (a)
• KENTUCKY (2)
  Peter J. Doll (d)
  Paul E. Tipton (d)*
• LOUISIANA (1)
  James Noriega (d)*
  Rita Rae Fontenot (a)
• MAINE (1)
  Brad G. Samojla (d)*
• MARYLAND (3)
  James R. Christina (d)
  Marc D. Lenet (d)
  Michael L. Michetti (d)*
  Todd A. Harrison (a)
  Andrew L. Liss (a)
• MASSACHUSETTS (3)
  Richard S. Eisner (d)
  John E. George (d)*
  Leonard F. Pinto, Jr. (d)
• MICHIGAN (5)
  Marc A. Borovoy (d)
  Craig M. Gastwirth (d)
  Irvin O. Kanat (d)*
  Randy K. Kaplan (d)
  Shay N. Rosenfeld (d)
  Marie Delewsky (a)
  Kevan R. Kreitman (a)
• MINNESOTA (2)
  Michael Joyce (d)
  Roy R. Moeller (d)*
• MISSISSIPPI (1)
  Andrea Leigh White (d)*
• MISSOURI (2)
  William G. Gerlach (d)*
• MONTANA (1)
  Loren L. Rogers (d)*
• NEBRASKA (1)
  Robert J. Hilkemann (d)*
  Charles M. Halverson (a)
• NEVADA (1)
  James A. Fausett (d)*
  Mark D. Rawson (a)
• NEW HAMPSHIRE (1)
  Stanley A. Gorgol (d)*
  James H. Dolan (a)
• NEW JERSEY (6)
  Harvey S. Karpo (d)
  Rosario J. LaBarbera (d)
  Warren B. Mangel (d)
  George M. Nassoor (d)
  Robert J. Warkala (d)
  Robert L. Zeevalk (d)*
  Bruce J. Frankel (a)
  Nancy Kaplan-Warman (a)
  Kenneth F. Malkin (a)
  Po Raval (a)
• NEW MEXICO (1)
  John R. Panek (d)*
  Janet Simon (a)
• NEW YORK (13)
  Scott Altman (d)
  Richard A. Altwerger (d)
  Edward A. Buro (d)
  Donald S. Feldman (d)*
  Les J. Glubo (d)
  Bruce J. McLaughlin (d)
  Raymond J. Mollica (d)
  Robin C. Ross (d)
  Lawrence A. Santi (d)
  Mark M. Schilansky (d)
  Frank A. Spinosa (d)
  Bruce E. Waxman (d)
  Michael L. Wodka (d)
  Barry H. Block (a)
  David V. Chazan (a)
  Robert Rampino (a)
  Vito J. Rizzo (a)
• NORTH CAROLINA (2)
  Carroll D. Kratzer (d)*
  Phillip E. Ward (d)
  Kevin S. Molan (a)
  Silvia Virbulis (a)
• NORTH DAKOTA (1)
  Brian Gayle (d)*
  OHIO (6)
  Bruce G. Blank (d)
  Karen A. Glandon (d)
  Paul Lieberman (d)*
  Patrick J. Nunan (d)
  Kevin Schroeder (d)
  Howard Waxman (d)
  Thomas V. Melillo (a)
  Peter A. Wiggin (a)
• OKLAHOMA (1)
  Carol F. LaRose (d)*
  James E. Webb, Jr. (a)
• OREGON (1)
  Richard W. Peffley (d)*
• PENNSYLVANIA (7)
  Steven A. Conner (d)
  Mallory L. Eisenman (d)*
  Edwin S. Hart, III (d)
  Eric E. Leonheart (d)
  John A. Mattiacci (d)
  Stephen A. Monaco (d)
  Mark E. Pinker (d)
  Stanley Boc (a)
  Craig G. Kriza (a)
• PUERTO RICO (1)
  Jose Mattei-Diaz (d)*
• RHODE ISLAND (1)
  Brian W. Cornell (d)*
  Robert W. Gibbons (a)
• SOUTH CAROLINA (1)
  Edwin L. Blitch, IV (d)*
• SOUTH DAKOTA (1)
  Scott Shindler (d)*
• TENNESSEE (2)
  Steven K. Chase (d)
  Ira Kraus (d)*
  Gary W. Cockrell (a)
• TEXAS (5)
  Joseph Caporusso (d)
  Bradford W. Glass (d)
  S.F. Charles Hartley (d)
  Paul Kinberg (d)
  Lawrence S. MacTavish (d)*
  K. Kyle Ballew (a)
  Robert A. Boudreau (a)
  Karen E. Brooks (a)
  Lawrence B. Harkless (a)
  Jay D. Lifshen (a)
• UTAH (1)
  Mark Rogers (d)*
  Brian Richman (a)
• VERMONT (1)
  Denis Lamontagne (d)*
• VIRGINIA (3)
  Mark D. Dollard (d)
  Seth A. Rubenstein (d)*
  Eugene B. Feinberg (a)
• WASHINGTON (2)
  Donald G. Hovancsek (d)*
  Timothy E. Messmer (d)
  Kevin Morris (a)
  Scott A. Schroeder (a)
• WEST VIRGINIA (1)
  Leonard Simmons (d)*
• WISCONSIN (2)
  Robert M. Sage (d)
  Michael B. Thompson (d)*
• WYOMING (1)
  No delegates or alternates present.
• APMSA (1)
  Jennifer Purvis (d)*
  Barron Elleby (a)
  Jennifer Suess (a)

ELECTIONS

APMA Officers

J.D. Ferritto, Jr., DPM, President Elect

Lloyd S. Smith, DPM, Vice President

Harold B. Glickman, DPM, Treasurer

APMA Board of Trustees

Joseph Caporusso, DPM

Elected to a three-year term

Christian A. Robertozzi, DPM

Reelected to a three-year term

Speaker of the House

William F. Munsey, DPM

Reelected to a one-year term

Joint Committee on the Recognition of Specialty Boards

APMA House of Delegates Representative:

Eric E. Leonheart, DPM

Elected to a two-year term

Fund for Podiatric Medical Education Board of Trustees

Robert J. Hilkemann, DPM

Reelected to a three-year term

REVISION OF THE CONSTITUTION AND BYLAWS

The proposed Bylaws were adopted unanimously.

The proposed Policies and Administrative Procedures were adopted as amended.

2002 RESOLUTIONS ADOPTED

RESOLUTION NO. 1-02: DSC – JOEL A. FEDER, DPM

WHEREAS, Joel A. Feder, DPM, has been a tireless leader in the podiatric medical community for more than 30 years;

WHEREAS, Dr. Feder served with distinction as president of the Illinois Podiatric Medical Association from 1976 to 1977;

WHEREAS, Dr. Feder was a dedicated member of the Illinois Podiatric Medical Association Board of Directors from 1970 through 2000;

WHEREAS, Dr. Feder has been published numerous times in both the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery;

WHEREAS, Dr. Feder served with enthusiasm as president of the Illinois Foot Health Foundation from 1970 to 1974;

WHEREAS, Dr. Feder has served as Clinical Professor of the University of Chicago Hospitals from 1993 to the present;

WHEREAS, Dr. Feder served with commitment and dedication as Director of the Legislative Interest Committee of Illinois Podiatrists from 1977 to 1994;

WHEREAS, Dr. Feder showed his devotion to podiatric medicine by becoming a founding member of the Foot Health Foundation of America;

WHEREAS, Dr. Feder’s contributions to the profession of podiatric medicine are of positive and lasting significance; and

WHEREAS, Dr. Feder was an Illinois delegate to the American Podiatric Medical Association House of Delegates and served as chair of the House of Delegates Credentials Committee from 1978 through 2000;

RESOLVED, That this Association’s highest honor, the Distinguished Service Citation, be awarded to Joel A. Feder, DPM.

RESOLUTION NO. 2-02: DSC – EDWARD R. NIEUWENHUIS, SR., DPM

WHEREAS, Edward R. Nieuwenhuis, Sr., DPM, has served the profession of podiatric medicine with dedication and enthusiasm for over 35 years;

WHEREAS, Dr. Nieuwenhuis was a member of the New Jersey Podiatric Medical Society Board of Trustees from 1967 to 1985, serving as vice president from 1970 to 1971 and as president from 1971 to 1972;

WHEREAS, Dr. Nieuwenhuis faithfully served as a member of the New Jersey Podiatric Medical Society House of Delegates from 1972 through 1994;

WHEREAS, Dr. Nieuwenhuis was an active member of the American Podiatric Medical Association (APMA) Committee on Professional Information and Scientific Publications from 1984 to 1993;

WHEREAS, Dr. Nieuwenhuis served this Association with tireless energy as a member of its House of Delegates from 1972 through 1994;

WHEREAS, Dr. Nieuwenhuis further served on the APMA Resolutions Committee from 1983 to 1994 and as chair for four years;

WHEREAS, Dr. Nieuwenhuis was awarded the prestigious New Jersey Podiatric Medical Society Distinguished Service Award in recognition of such dedication to the podiatric medical community;

WHEREAS, Dr. Nieuwenhuis has shown his commitment to the future of podiatric medicine by personally championing the cause of student recruitment; and

WHEREAS, Dr. Nieuwenhuis served with great distinction as Speaker of the APMA House of Delegates from 1994 through 1999;

RESOLVED, That this Association’s highest honor, the Distinguished Service Citation, be awarded to Edward R. Nieuwenhuis, Sr., DPM.

RESOLUTION NO. 3-02: RESOLUTIONS-POLICY REVIEW

WHEREAS, Resolution 43-94 mandated that the American Podiatric Medical Association (APMA) publish an APMA Policy Manual of Resolutions and establish a review process for retaining or discarding resolutions of this House of Delegates after 10 years;

WHEREAS, Resolution 15-96 provided that the following types of recurring resolutions need not be included in the compilation of APMA policy:

admission of umbrella organizations, components, affiliated, and related; assignments; awards; budget actions; bylaws recommendations; contents of documents; dues; membership status; committees and work groups; operations; personnel actions; procedures; recognition; report approvals; statements regarding specific legislation no longer being considered; and statements of thanks and gratitude;

WHEREAS, Resolution 25-97 requires that all resolutions pertaining to dues assessments shall be retained;

WHEREAS, The 2002 House of Delegates Speaker appointed the 2002 Resolutions Policy Review Committee and charged the committee with both reviewing 1991 and 1992 resolutions approved by the House of Delegates and determining which 1991 and 1992 resolutions should be retained as policy of the Association; and

WHEREAS, The 2002 Resolutions Policy Review Committee has completed its assignment and has submitted the Resolutions Policy Review Committee Analysis and Report with recommendations to the 2002 House of Delegates for review and approval;

RESOLVED, That all awards or citations granted in 1991 and 1992 be retained permanently;

RESOLVED, That the 2002 House of Delegates affirms as continuing policy of this Association the following resolutions: 23-91, 25-91, 28-91, 29-91, 31-91, 15-92, 16-92, 17-92, 18-92, 25-92, 26-92, 27-92, 28-92, 30-92, 31-92, 38-92, 42-92, and 50-92; and

RESOLVED, That all other 1991 and 1992 resolutions not listed to be retained be hereby sunset for reasons of being either outdated, not containing policy statements, no longer necessary, no longer appropriate, no longer timely, duplicated by other resolutions or actions, or no longer in the best interest of the APMA.

RESOLUTION NO. 5-02: ALTERNATIVE PATHWAYS FOR BOARD CERTIFICATION

WHEREAS, Many American Podiatric Medical Association (APMA) members do not have the opportunity to participate in the American Board of Podiatric Surgery (ABPS) and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) board-certification process;

WHEREAS, Five years ago, 18 companies controlled 80% of the private health insurance market;

WHEREAS, As a result of rapid consolidation of the private insurance market in the United States, five national health insurance companies now control almost 80% of the private health insurance market; and

WHEREAS, These private health insurance companies are increasingly requiring specialty medical board certification as a means of limiting doctors on their managed-care panels;

RESOLVED, That the APMA House of Delegates request that the ABPS and the ABPOPPM offer alternative pathways that would allow doctors to participate in the board-certification process.

RESOLUTION NO. 7-02: REQUIRED MEMBERSHIP FOR APMA SCIENTIFIC SPEAKERS

WHEREAS, Without dues-paying members there would be no American Podiatric Medical Association (APMA);

RESOLVED, That the APMA continue to require all seminar presenters who hold the degree of DPM and who are speaking at an APMA program to be members of the APMA; and

RESOLVED, That this resolution in its entirety be shared with all other podiatric continuing medical education (CME) programs across the country and that these programs also be encouraged to make membership in the APMA and the state component society a requirement for presenting.

RESOLUTION NO. 8-02: APMA RECOGNITION OF MICHIGAN PEER REVIEW ORGANIZATION

WHEREAS, The Michigan Peer Review Organization (MPRO) has adopted the Centers for Medicare and Medicaid Services (CMS) national priority position for statewide projects of diabetes management by supporting a pilot project that would encourage diabetic foot examinations by primary-care physicians in an effort to lessen the risk of lower-extremity amputations;

WHEREAS, This Diabetic Foot Exam Initiative was developed through collaboration with the Michigan Podiatric Medical Association, the American Podiatric Medical Association (APMA), the MPRO, and the CMS;

WHEREAS, This innovative project has enlisted volunteer podiatrists who are members of the APMA and who have completed a training program to provide academic detailing to primary-care physician offices demonstrating the components of a basic foot exam as well as delivering a kit of information for the physicians’ use;

WHEREAS, MPRO staff members, including Kristy I. Wietholter, RN, MHA, Barbara L. Allen, RN, MSN, Janet E. Garza, RN, BSN, Gerriann Finnegan, BA, MSA, Diane McCagg, MSN, RN, Marjorie Hovis, RN, BSN, MBA, and especially Paola Valsania, MD, have made outstanding contributions and expended great effort to ensure the success of the project; and

WHEREAS, This collaboration has spawned other collaborative activities including involvement in health screenings and other presentations to the public;

RESOLVED, That the APMA recognize the special achievement of the MPRO and its staff in identifying the need for podiatric intervention in the diabetic population; and

RESOLVED, That the APMA express its gratitude for the efforts of the MPRO in developing and implementing this important project.

RESOLUTION NO. 10-02: EQUAL PAY FOR EQUAL WORK

WHEREAS, There are other physician (MD and DO) providers of foot and ankle care in the United States besides podiatric physicians;

WHEREAS, Reimbursement fee schedules vary from one insurer to another;

WHEREAS, Substantial information indicates that managed-care/insurance contracts often discriminate against podiatric physicians by offering lower payment for evaluation and management (E&M) services as well as other medical and surgical procedure codes than that offered to MDs and DOs for the same E&M services or other procedure codes;

WHEREAS, The education and training of podiatric physicians is commensurate with that of other physician providers of foot and ankle services;

WHEREAS, The cost of providing foot and ankle services is similar for all physician providers;

WHEREAS, Podiatric physicians are held to the same standards of care as other physician providers of foot and ankle services; and

WHEREAS, The Physician Payment Review Commission (PPRC) stated in its 1991 Annual Report to Congress, “Podiatrists . . . should be paid under the Medicare fee schedule using the same relative values and conversion factors as applied to doctors of medicine and osteopathy”;

RESOLVED, That the American Podiatric Medical Association (APMA) reaffirm the Association’s policy established by resolutions 12-86, 55-94, and 18-97 that reimbursement to podiatric physicians for E&M services and other medical and surgical procedures should be equal to that of other physicians providing the same care;

RESOLVED, That the APMA continue to monitor and act on any attempts to alter the equal pay for equal service provision for participating physicians in the Medicare program;

RESOLVED, That the APMA will continue to seek a federally legislated solution mandating equal pay for equal service in ERISA plans;

RESOLVED, That the APMA will continue to seek a change in Title XIX defining podiatrists as physicians in the Medicaid program;

RESOLVED, That the APMA will continue to utilize its organized labor resources to seek equal pay for equal work for APMA members;

RESOLVED, That the APMA will continue to assist state associations and societies with legislative and regulatory changes that mandate equal pay for equal service in state-regulated insurance programs;

RESOLVED, That the APMA will continue to work diligently to obtain legislative authority for special pay for Veterans Affairs, Military, Public Health, and Indian Health Service podiatrists equivalent to that afforded MDs and DOs; and

RESOLVED, That the APMA will continue to report progress on these issues through the APMA NEWS, the APMA Alert, the APMA Daily eNews, and annual reports to the House of Delegates.

RESOLUTION NO. 11-02: CODE OF ETHICS

WHEREAS, Resolution 5-99 called for the American Podiatric Medical Association (APMA) Board of Trustees to reexamine the APMA Code of Ethics for possible revision;

WHEREAS, Resolution 5-99 called for the Board of Trustees to report its findings and possible suggestions for changes to the Code of Ethics to reflect changing health-care issues;

WHEREAS, The Board of Trustees appointed a task force to revise the Code of Ethics; and

WHEREAS, The Code of Ethics Task Force submitted to the Board of Trustees a draft of the revised Code of Ethics that was subsequently approved by the Board;

RESOLVED, That the revised Code of Ethics be adopted.

RESOLUTION NO. 13-02: PILOT RECRUITMENT PROGRAM

WHEREAS, The American Podiatric Medical Association (APMA) and the American College of Foot and Ankle Surgeons (ACFAS) entered into an agreement on August 9, 2000, calling for the creation of a Blue Ribbon Task Force (Task Force) to “. . . be appointed by the presidents of the respective organizations to objectively consider all methods to increase membership in the APMA, ACFAS, and the component societies, as well as any other issues of importance to the respective organizations”;

WHEREAS, A Task Force was created and has worked diligently toward the development of a mutually agreed upon Pilot Recruitment Program; and

WHEREAS, The agreement further called for the Task Force to report to the 2002 APMA House of Delegates;

RESOLVED, That the House of Delegates approve the Pilot Recruitment Program proposed by the Task Force; and

RESOLVED, That this pilot program be extended by mutual consent to other affiliated organizations.

ACFAS/APMA Pilot Recruitment Program

The elements for the implementation of this Pilot Recruitment Program will consist of the following:

• Both associations will support the other organization’s proposal to amend its bylaws to permit the implementation of such a program.
• The ACFAS will support that portion of the proposed APMA Bylaws requiring members of an affiliated organization (except international members) to be members in good standing of the APMA.
• The target group of potential members will be those American Board of Podiatric Surgery (ABPS) board-certified or board-qualified DPMs who have never been members of either the state or national organization as of January 1, 2001.
• The program will commence in 2002, and will be structured to permit members to join at any time during its duration, in one of the two following ways:
  • A fluid, five-year rolling program which would enable eligible candidates to join at any time during a five-year period (2002–2006) at the first year’s dues level, and pay the agreed-upon escalated dues for the succeeding four years.
  OR
  • A static five-year program (2002–2006) which would enable eligible candidates to join at any time at the dues level agreed upon for the year that they would be applying for membership, eg, if they join in 2004, they pay the third-year level dues.
• The ACFAS will contact the component societies in advance of the recruitment mailings with a listing of the candidates in their respective states for their review and approval.
• The target group will only receive recruitment materials about this special program after these materials have been jointly approved by the ACFAS, the APMA, and the respective component societies.
• The ACFAS and the APMA will work together to jointly promote the endorsement and acceptance of this pilot program by their respective members and the APMA House of Delegates.
• The ACFAS and the APMA will uniformly collect data from the individuals of the target group who have joined as a result of this pilot program to assess its impact on membership retention, and this will be done on an equally shared cost basis.
• The dues for participating in this program will be equally split between the ACFAS, the APMA, and the component society. After a maximum of five years in the pilot program, members will be required to pay the full dues for each organization in order to maintain their membership in good standing.
• The collection of total annual dues for this pilot membership program will be the responsibility of the component societies. The component societies will be required to remit to the APMA, on a monthly basis, those portions of the dues collected belonging to the ACFAS and the APMA.
• The dues for this pilot program will be structured as indicated below and will be considered an integral part of this proposal.
• The APMA will remit that portion of the dues belonging to the ACFAS within 30 days from the time the APMA receives the dues payments from the components.
• The ACFAS agrees to cease any activities relating to the elimination of the Bylaws dual membership requirement during the term of this pilot program.
• The APMA agrees to “keep on the table” for further discussion other issues that have been previously identified as being relevant to this joint, cooperative program, eg, an ACFAS seat in the APMA House of Delegates.
• The Blue Ribbon Task Force will remain in place as currently constituted to develop measurements of success for this pilot program, and to consider other pertinent issues that may arise from time to time during the duration of the program.
• The results of this pilot program will be reported annually to the APMA House of Delegates.

RESOLUTION NO. 15-02: INCREASED PODIATRIC RESEARCH FOR DIABETES-RELATED FOOT CARE

WHEREAS, On October 17, 2001, the Centers for Medicare and Medicaid Services (CMS) released a national coverage decision, Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS);

WHEREAS, In its discussion of the decision, the CMS cited existing studies and revealed that a review of the literature would be performed within two years;

WHEREAS, The CMS encourages the professional community to conduct high-quality studies to evaluate the effectiveness of scheduled foot care for patients with diabetic peripheral neuropathy with LOPS;

WHEREAS, The CMS stated that a clear demonstration of the benefit from foot care may allow the CMS to consider extending the coverage to a broader subpopulation of patients with diabetes and earlier signs of sensory neuropathy;

WHEREAS, The podiatric community should be the source of this data; and

WHEREAS, The Podiatric Research Advisory Committee (PRAC) has the ability to encourage such research, in terms of both expertise and funding;

RESOLVED, That the APMA strongly recommends that the PRAC and all other potential funding sources and all centers of podiatric research, including the podiatric medical colleges, make studies of this type their highest priority.

RESOLUTION NO. 16-02: RECOGNITION OF THE NEW YORK COLLEGE OF PODIATRIC MEDICINE

WHEREAS, The New York College of Podiatric Medicine and its administration, faculty, students, and podiatrists who volunteered for duty were called to assist in the rescue efforts at “Ground Zero” after the “Attack on America” and on the World Trade Center in New York City on September 11, 2001;

WHEREAS, At a time of medical necessity, podiatry was recognized as an equal partner and specialist and immediately called to participate in this national emergency; and

WHEREAS, Without hesitation, supplies, physical presence, expertise, and moral support were made available to the rescue attempts;

RESOLVED, That the New York College of Podiatric Medicine and its administration, faculty, students, and podiatrists who volunteered for duty receive special recognition for the role they played in response to the “Attack on America,” and in particular on the World Trade Center in New York City.

RESOLUTION NO. 17-02: RETENTION OF DUES ADJUSTMENT

WHEREAS, The 1999 House of Delegates adopted Resolution 20-99, which increased the dues for a full active member by $50 for the fiscal year beginning June 1, 2000, and by an additional $50 for the fiscal year beginning June 1, 2001;

WHEREAS, In keeping with Resolution 20-99, the dues for membership categories other than full active were proportionately adjusted to reflect the increase;

WHEREAS, In keeping with Resolution 20-99, the dues increase beginning June 1, 2000, was directed or allocated for three (3) and only three (3) areas or committees of the American Podiatric Medical Association (APMA): 1) Health Policy Committee, 2) Health Systems Committee, and 3) information technology (with the proviso that the information technology budget directly relate to communication with and between APMA members);

WHEREAS, In keeping with Resolution 20-99, the dues increase allocation did not affect the existing APMA budget allocations to the Health Policy Committee, Health Systems Committee, and information technology, and that these committees and areas within the APMA were not diminished in their existing budgets with the understanding that the dues increase allocation will supplement those existing budgets;

WHEREAS, In keeping with Resolution 20-99, any unspent monies from the dues increase allocations were directed to a strategic reserve for each of the three (3) committees and areas noted above, and the strategic reserve was carried over to the following fiscal year(s) and allocated directly to the same committees and areas for which it was first derived;

WHEREAS, The Board of Trustees has successfully utilized the dues increase to significantly and positively affect the work of the Health Policy Committee, Health Systems Committee, and information technology;

WHEREAS, The Board of Trustees and staff have demonstrated that the Association can conduct its business in a substantially more cost-efficient and accountable manner as evidenced by an almost $800,000 surplus in FY 2001–2002; and

WHEREAS, It is the intent of the Board of Trustees to continue to build on its accomplishments in each area of the Association, including the work of the Health Policy Committee, Health Systems Committee, and information technology;

WHEREAS, The House of Delegates received the Annual Report of 2001 that specifically identifies the major accomplishments of the Association;

WHEREAS, It is the intent of the Board of Trustees to recommend to the 2003 House of Delegates that the dues level of FY 2002–2003 be retained indefinitely; and

WHEREAS, It is the further intent of the Board of Trustees to recommend that the restrictions placed on the use of the dues increase in 1999 be removed so that those funds may be used for all appropriate Association programs and activities; and

WHEREAS, The FY 2002–2003 budget reflects funds dedicated to priority programs that did not exist in 1999;

RESOLVED, That the 2002 House of Delegates recognize within this resolution the intent of the Board of Trustees of retaining the dues level of FY 2002–2003; and

RESOLVED, That the restrictions placed on the dues increase passed by the APMA House of Delegates in 1999 be removed.

RESOLUTION NO. 18-02: MODIFICATION OF THE ALTERNATE PATHWAY TO CERTIFICATION WITH ABPOPPM

WHEREAS, The Council on Podiatric Medical Education through its Joint Committee on the Recognition of Specialty Boards (JCRSB) has modified its position to allow individuals in the alternate pathway who had achieved board-qualified status with the certifying boards to be allowed their retake options beyond year 2000 (the year in which the alternate pathway to certification ended);

WHEREAS, The American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) considers alternate pathway individuals who still had active case documents on file beyond the year 2000 but had not achieved board-qualified status by 2000 to be legitimately “in the pipeline”; and

WHEREAS, There are 33 individuals in the system that fall in this category;

RESOLVED, That it is recommended that those individuals regarded by ABPOPPM as being “in the pipeline” by way of having active case documents be entitled to continue their efforts toward board certification beyond the year 2000 as long as their currently approved case documents have not expired.

(NOTE: All of these individuals would have two years added to the “life” of their case documents to cover years 2001 and 2002 when they were not allowed to test with ABPOPPM.)

RESOLUTION NO. 19-02: MEDICARE CO-PAYMENTS

WHEREAS, A number of insurance companies, when participating as secondary payers, have steadfastly refused to reimburse contracted health-care providers Medicare’s approved 20% co-payment and deductible because they state that their plans’ provider fees are less than Medicare’s fee schedule allowance and advised their insureds that they are not liable for these amounts;

WHEREAS, When managed-care companies do not pay the 20% co-payment and deductible, it appears that beneficiaries are paying for secondary insurance without receiving any tangible benefit;

WHEREAS, It is a violation of Medicare regulations for the contracted health-care provider to fail to attempt to collect Medicare’s approved 20% co-payment and deductible from either the patient or the secondary payer; and

WHEREAS, The Health Systems and Health Policy Committees of the American Podiatric Medical Association (APMA) and their consultants have been evaluating possible remedies in instances when secondary payers refuse to pay the Medicare deductible and 20% co-payment;

RESOLVED, That the APMA, through the appropriate committees and within their existing budgets, continue to seek a remedy for this problem including forming coalitions with the American Medical Association, the American Osteopathic Association, and other medical organizations whose members might also be adversely affected in instances when secondary payers refuse to pay the Medicare deductible and 20% co-payment;

RESOLVED, That the APMA, through the appropriate committees and within their existing budgets, continue to pursue remedies for this problem through active discussions with other appropriate parties such as the Centers for Medicare and Medicaid Services, the American Association of Health Plans, the Health Insurance Association of America, and the American Association of Retired Persons; and

RESOLVED, That the APMA report back to the membership, through appropriate information channels, on progress to resolve this problem.

RESOLUTION NO. 20-02: CCI EDITS

WHEREAS, Health-care providers, in order to properly code services for Medicare, must utilize the National Correct Coding Initiative (CCI) edits; and

WHEREAS, The CCI edits, developed and licensed by Medicare contractors, represent an ongoing cost to each medical practice;

RESOLVED, That the American Podiatric Medical Association contact both the American Medical Association and the American Osteopathic Association in an attempt to work collaboratively to eliminate the CCI licensing fees for providers.

RESOLUTION NO. 21-02: OPT-OUT OF MEDICARE

WHEREAS, Medical doctors (MDs) and osteopaths (DOs) have, by law, the option to “opt-out” of Medicare, that is, to treat Medicare patients without the application of Medicare reimbursement;

WHEREAS, These professionals may, by law, enter into contracts with their patients; and

WHEREAS, By an error of omission, podiatric physicians (DPMs) were left out of these statutes;

RESOLVED, That the American Podiatric Medical Association House of Delegates direct its lobbyists to continue to work with Congress to allow DPMs to enter into private contracts with their Medicare patients.

RESOLUTION NO. 22-02: RESIDENCY TRAINING EXPECTATIONS

WHEREAS, In 1995 the American Podiatric Medical Association (APMA) House of Delegates adopted Resolution 58-95 recommending to the Council on Podiatric Medical Education (CPME)–recognized certifying boards that a minimum requirement of two (2) years of graduate medical education (GME) be required for board eligibility or qualification;

WHEREAS, The CPME-recognized certifying boards have complied with Resolution 58-95, and have established two (2) years of residency training as a minimum requirement for board qualification and therefore certification;

WHEREAS, The APMA House of Delegates adopted corresponding Resolution 59-95 to develop standards, policies, and procedures to ensure that there is a sufficient number of two-year residency programs available for all podiatric medical graduates by the year 2000;

WHEREAS, The APMA has worked closely with the CPME, the Council of Teaching Hospitals (COTH), and the colleges of podiatric medicine to achieve a sufficient number of two-year residency positions;

WHEREAS, The Liaison Committee on Podiatric Medical Education and Practice (LCPMEP) has recently discussed a three-year comprehensive program of residency training for board eligibility and qualification leading to certification as a means to enhance the education of podiatric medical college graduates;

WHEREAS, The current rewrite of CPME Document 320 describes multiple new models of podiatric residency training, and an examination of the requirements of each reveals that both podiatric medicine and surgery competencies are present in every model;

WHEREAS, The American Podiatric Medical Students’ Association (APMSA) represents all students of podiatric medicine and therefore the future of the profession;

WHEREAS, The consensus among students’ elected representatives in the APMSA continues to reflect students’ desire to obtain postgraduate residency training in both podiatric medicine and surgery;

WHEREAS, The Educational Enhancement Project (EEP) Blueprint for the Future was unanimously accepted by the APMA House of Delegates, and the very first residency training recommendation of that document is for every program to result in qualification for certification in both CPME-recognized specialty boards;

WHEREAS, Specialized training in more complex areas of podiatric surgery and/or medicine requiring additional years has been and likely will remain desirable to some but not all graduates of podiatric medical colleges;

WHEREAS, The 1999 APMA House of Delegates established its desire for a single certifying board, and standardization of podiatric residency programs’ minimum length and benchmark comprehensive medical and surgical competencies would provide the first meaningful framework for the realization of a single certifying board;

WHEREAS, The certifying boards are recognized only through the authority of the CPME by the Joint Committee on the Recognition of Specialty Boards (JCRSB); and

WHEREAS, The CPME’s published definition of itself includes that its authority is derived from the APMA House of Delegates;

RESOLVED, That the APMA House of Delegates and Board of Trustees reaffirm Resolution 58-95, requiring a minimum of two (2) years of GME for board eligibility or qualification;

RESOLVED, That the APMA House of Delegates and Board of Trustees reaffirm Resolution 59-95 that the APMA, CPME, COTH, and the colleges of podiatric medicine reaffirm their commitment to ensure that there is a sufficient number of two-year residency positions available for all graduates from this date forth;

RESOLVED, That the APMA House of Delegates highly recommends that CPME Document 320 reflect recognition of a comprehensive two-year training model as the standard for all graduates, with competency benchmarks in both podiatric medicine and surgery as defined by the profession, including the profession’s considered opinion of the current CPME Document 320 rewrite;

RESOLVED, That the profession recognize and endorse extended training opportunities beyond the required two years of comprehensive residency training, such as fellowships in advanced or complex podiatric surgery or medicine for those who desire it; and

RESOLVED, That the APMA House of Delegates highly recommends that the CPME issue a written report of progress on the above objectives at least sixty (60) days prior to the meeting of the 2003 APMA House of Delegates.

EMERGENCY RESOLUTION NO. 23-02: THE APPROPRIATE USAGE OF MODIFIER –25

WHEREAS, Modifiers were developed as an integral part of Current Procedural Terminology (CPT) to “. . . indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code” (CPT 2002, page xi);

WHEREAS, Modifier –25 was developed to describe significant separately identifiable evaluation and management (E&M) service by the same physician on the same day of a procedure or other service;

WHEREAS, Many private insurance companies routinely deny the payment of claims for an initial E&M service with a minor procedure when both are performed on the same day;

WHEREAS, Many private insurance companies are not acknowledging the use of modifier –25 when appended to an initial E&M service when billed with a minor procedure on the same day;

WHEREAS, This problem is not unique to podiatric physicians or the practice of podiatric medicine; and

WHEREAS, The American Podiatric Medical Association (APMA) has initiated a coalition of other medical specialty societies to work collectively to get insurers to change their policies;

RESOLVED, That standard of care for any medical practice requires that the doctor perform an appropriate history and physical examination prior to performing a procedure;

RESOLVED, That the APMA requests that each state component society collect data from its members about which insurance companies are not paying for initial E&M services with procedures when modifier –25 is used;

RESOLVED, That this data be provided to the APMA’s Health Systems Committee for analysis so that the respective insurance companies not following the accepted CPT definition for the use of modifier –25 and initial E&M visits can be identified;

RESOLVED, That the Health Systems Committee make all reasonable efforts, within its current approved budget allocation, to inform these companies of their inappropriate policies and attempt to alter these policies; and

RESOLVED, That the APMA, through its contacts at CPT, Relative Value Update Committee (RUC), and elsewhere, continue to encourage other medical specialty societies, including but not limited to the American Medical Association, to unite in an effort to further these aims.

EMERGENCY RESOLUTION NO. 24-02: APPOINTMENT OF APMA EXECUTIVE DIRECTOR

WHEREAS, Contractual arrangements satisfactory to the American Podiatric Medical Association (APMA) Board of Trustees and Glenn B. Gastwirth, DPM, have been completed for the period of April 1, 2002, through May 31, 2007; and

WHEREAS, The Bylaws of the Association call for the approval of the House of Delegates for this appointment;

RESOLVED, That the reappointment of Glenn B. Gastwirth, DPM, as Executive Director of the APMA for the period of April 1, 2002, through May 31, 2007, be approved.

EMERGENCY RESOLUTION NO. 25-02: ASO/PVD

WHEREAS, Medicare Carrier Manual (MCM) section 4120 prohibits doctors of podiatric medicine (DPMs) from independently diagnosing arteriosclerosis obliterans/peripheral vascular disease (ASO/PVD) as a complicating condition and requires that claims submitted for routine-type foot-care services performed by a podiatrist also include the name of the MD or DO who diagnosed the complicating condition;

WHEREAS, By virtue of education, training, and experience a DPM is qualified to independently diagnose ASO/PVD;

WHEREAS, Individual state scope of practice laws may permit a DPM to independently diagnose ASO/PVD;

WHEREAS, A significant amount of time and effort has been invested, both locally and nationally, in seeking a change to existing Medicare policy;

WHEREAS, The Centers for Medicare and Medicaid Services (CMS) has indicated that a study from the General Accounting Office (GAO) is necessary to demonstrate to the agency that a change in policy would be in the best interest of the Medicare program and the beneficiaries it serves, and recognizing that such a study is initiated at the request of a Member of Congress;

WHEREAS, A recent survey performed by the American Podiatric Medical Association (APMA) of component presidents, executive directors, and Carrier Advisory Committee (CAC) representatives appears to demonstrate support for the APMA to pursue a change in Medicare policy; and

WHEREAS, The APMA had identified that there is a risk involved with pursuing a national change in Medicare policy related to ASO/PVD and that existing local policies may be adversely affected as a result of such action;

RESOLVED, That the APMA proceed, through its legislative contacts, to identify a Member of Congress to request that the GAO initiate an appropriate ASO/PVD study; and

RESOLVED, That the APMA work cooperatively with the CMS in revising MCM section 4120 for non-asterisked (*) conditions to read: “The name of the MD, DO, or DPM who diagnosed the complicating condition.”

EMERGENCY RESOLUTION NO. 27-02: IMPLEMENTATION OF NEW RESIDENCY REQUIREMENTS

WHEREAS, The Educational Enhancement Project (EEP) has made recommendations for changes in the structure of approved podiatric residency programs;

WHEREAS, The Council on Podiatric Medical Education (CPME) is charged with implementation of changes to the standards of CPME 320; and

WHEREAS, Residency programs will require significant time and resources to fall into alignment with the new standards;

RESOLVED, That the CPME be encouraged to publish the changes in CPME 320 and a schedule for implementation in a timely fashion to prevent any undue burden on preexisting programs.

EMERGENCY RESOLUTION NO. 28-02: ANTI-DISCRIMINATION LITIGATION ON BEHALF OF PODIATRIC PHYSICIANS AND PATIENTS

WHEREAS, Recent information brought to the attention of the American Podiatric Medical Association (APMA) indicates that some insurance carriers and managed-care companies are currently engaged in fee discrimination against podiatric physicians and patients;

WHEREAS, The services of a podiatric physician have the same or greater value to patients afflicted with foot and ankle problems as those of any other medical professional;

WHEREAS, To create a tiered fee schedule based solely on degree is an unacceptable policy;

WHEREAS, Reimbursement for services of a podiatrist should be equal to reimbursement to other medical professionals;

WHEREAS, The podiatric profession has in the past pursued and will continue to pursue anti-discrimination legislation and regulation with the passage of Resolution 10-02: Equal Pay for Equal Work;

WHEREAS, The equal pay for equal work resolution does not address advocacy through the use of litigation;

WHEREAS, All three branches of government—judicial, legislative, and executive—should be utilized in realizing these objectives;

WHEREAS, The APMA Board of Trustees should obtain proposals from leading law firms to consider the filing of legal action to remedy the above-mentioned discrimination; and

WHEREAS, This resolution does not require the APMA Board of Trustees to file a lawsuit, but is designed to determine the feasibility of litigation to carry out the aforementioned purposes;

RESOLVED, That the APMA Board of Trustees take appropriate action through the Health Systems Committee to obtain proposals from leading law firms to consider the feasibility of litigation, including a possible class action suit, to remedy the discriminatory actions by insurance companies and managed-care companies related to equal pay for equal work described in this resolution; and

RESOLVED, That the use of APMA reserves not to exceed $1,500,000 is hereby authorized to finance such litigation.

RESOLUTIONS SUMMARY

Adopted: 1–3, 5, 7, 8, 10, 11, 13, 15–25, 27, 28

Defeated: 6

Withdrawn: 9, 12, 14, 26, 29

Postponed Indefinitely: 4

REPORT OF AWARDS

Distinguished Service Citation for Members

Joel A. Feder, DPM

Edward R. Nieuwenhuis, Sr., DPM

Humanitarian Award

Baja Project for Crippled Children

Presidential Award

Frank Vinicor, MD, MPH

Executive Director Award

James Brown

Fund for Podiatric Medical Education: Corporate Citizen of the Year

Spenco Corporation

Fund for Podiatric Medical Education: Podiatric Physician of the Year

Ronald S. Lepow, DPM

APMSA Kennison Award

Jeffrey Robbins, DPM

OTHER ACTIONS OF THE HOUSE OF DELEGATES

• The following guest speakers addressed the House:
  • Jose Roofthooft, President, Federation Internationale des Podologues et Podiatres
  • Richard Corlin, MD, President, American Medical Association
  • Peter Graham, BSc, MChS, DPodM, SRCh, Chair, The Society of Chiropodists and Podiatrists
  • Anthony Minissale, DO, President Elect, American Osteopathic Association
• The following oral reports were presented to the House:
  • Introduction of House Team Appointments, William F. Munsey, DPM, Speaker
  • Necrology Report, Glenn B. Gastwirth, DPM, Executive Director
  • Credentials Committee Report, Stanley A. Gorgol, DPM, Chair
  • House Rules Presentation, William F. Munsey, DPM, Speaker
  • State of the Association Address, R. Douglas Sowell, DPM, President
  • Executive Director’s Report, Glenn B. Gastwirth, DPM, Executive Director
  • Surgical Care of the Lower Extremity Report, Ross E. Taubman, DPM
  • Committee on Constitution and Bylaws Report, Irvin O. Kanat, DPM, Chair
  • Recruitment Report, Christian A. Robertozzi, DPM
  • Resolutions Committee Report, R. Daniel Davis, DPM, Chair
  • Council on Podiatric Medical Education, Kathleen M. Pyatak-Hugar, DPM, Chair
  • Podiatry Political Action Committee/E-Advocacy Report, Thomas S. Godfryd, DPM, Chair
  • Board of Inquiry Reports, Irvin O. Kanat, DPM, Chair
  • APMA/ACFAS Blue Ribbon Panel Report, R. Douglas Sowell, DPM, President
  • American Podiatric Medical Students’ Association Report, Student Doctor Jennifer Purvis, President
  • Inaugural Address, Richard B. Viehe, DPM, President Elect
  • Fund for Podiatric Medical Education Report, Steven M. Berlin, DPM, President
  • President’s Farewell Remarks, R. Douglas Sowell, DPM, President
• The following were approved, adopted, or endorsed by the House:
  • Rules of the 2002 House of Delegates
  • Detailed Order of Business of the 2002 House of Delegates
  • 2000 Abstract of Proceedings
  • 2002–2003 APMA Budget
  • Board of Inquiry Reports
• The following appointments were made by the House:
  • The APMA Board of Trustees was appointed as the 2002 House of Delegates Minutes Approval Committee by William F. Munsey, DPM, Speaker
• The following acknowledgments were made by the House:
  • Sergeants-at-Arms
  • Past Presidents of the APMA
  • First-time delegates and alternates
  • Hilary DeLyon, BA, MPhil, Chief Executive, The Society of Chiropodists and Podiatrists