With the respect to the four topics, please consider the following:

Continuing to Advance MFAS’s Legislative Agenda

The MFAS Legislative Committee continues to work on the association’s legislative priorities. Having defeated legislation to prohibit the use of the term “surgeon” and efforts to move the state podiatry board under the thumb of the state medical board, MFAS has also made significant progress in advancing the filed matters to create an amputation prevention task force and increasing continuing education hours. First time filings each; these bills sit before the respective Ways and Means Committees (House & Senate), having received favorable reports from the Joint Committee on Public Health. Always at the forefront, MFAS continues to advocate for passage of the updated podiatric practice act or its inclusion in a larger, omnibus bill. Earlier announcements that the House and Senate would be considering omnibus health care bills never materialized, but MFAS Legislative Committee continues to eye other potential vehicles. Be prepared to act when you receive a “call to action” later this month.

Senate Passage of Primary Care Reform; House Action Remains Incomplete.

For its part, the Massachusetts Senate scaled back its hopes for a comprehensive health care bill and, instead, recently passed Senate Bill 3141, An Act Relative to Primary Care for You. The bill attempts to address long wait times for primary care appointments, workforce shortages, administrative burden, and the overuse of higher-cost care when patients cannot access basic preventive services. In doing so, the bill would require hospitals, health care entities, and commercial insurers to increase the share of total health care spending dedicated to primary care, with a goal of reaching 15% of overall health care spending over time; recent primary care spending has been reported at approximately 6.7% of total commercial health care spending. The bill would also give the Health Policy Commission oversight and enforcement authority, including the ability to require performance-improvement plans and impose penalties for noncompliance. It further supports community health centers by requiring commercial insurers to reimburse them at no less than the applicable MassHealth rate for the same services, and it seeks to expand the primary care workforce by reestablishing a Medicaid graduate medical education program to leverage federal matching funds for primary care residency and fellowship training. In addition, the bill moves primary care payment away from a strictly fee-for-service model by promoting prospective, value-based payments, with the stated goal of reducing administrative burden, improving access, and shifting the health care system toward earlier, lower-cost, relationship-based care. While time is running short, the Massachusetts House of Representatives is expected to counter with legislation addressing the continued role of pharmacy benefit managers (PBMs) and limited primary care reforms. To view the Senate’s primary care bill, please visit: https://malegislature.gov/Bills/194/S3141.

“Prior Authorization” Regulations Finalized

The Massachusetts Division of Insurance (DOI) has finalized its prior authorization regulations, which took effect on June 5, with implementation to occur in phases. DOI has indicated that additional guidance will be provided through educational sessions during June, and carriers will be required to submit implementation plans by September. The final regulations prohibit prior authorization for certain categories of care, including primary care and rehabilitative therapies such as occupational, physical, and speech therapy. The final rule also expands beyond the proposed version by adding targeted protections for certain medications used to treat serious and persistent mental illness, as well as post-diagnosis cancer-related imaging used for staging and treatment monitoring, excluding PET scans. The regulations also strengthen continuity-of-care protections by requiring prior authorization approvals for chronic conditions to remain in effect for the duration of a stable course of treatment, unless there is a change in medication, provider, or treatment plan. At the same time, the final rule narrows the chronic-condition prior authorization prohibition by limiting it to specific medications for diabetes, asthma, and cardiovascular conditions, rather than applying more broadly. Finally, the regulations create a process through which carriers may seek DOI-approved exceptions when utilization patterns support the need for additional management. A copy of the regulations may be found at: https://www.mass.gov/doc/211-cmr-5200-managed-care-consumer-protections-and-accreditation-of-carriers/download. (Note: “prior authorization” is referred to as “prospective review” in the regulations.).

DPH’s Newly Proposed Medical Debt Reporting Prohibitions

MFAS is closely monitoring proposed Massachusetts Department of Public Health (DPH) regulations regarding the reporting of medical debt. DPH’s draft regulation, proposed as 105 CMR 95.00, would apply to health care facilities and health care providers licensed by the Department and would prohibit providers and facilities from reporting any portion of medical debt to a consumer reporting agency. The draft also requires contracts executed on or after January 15, 2027, between debt collectors and providers or facilities to include a provision prohibiting such reporting. Existing contracts extending beyond April 15, 2027, would need to be terminated or amended by that date. Failure to comply would be deemed a violation of Chapter 93A, and DPH could refer alleged violations to the Attorney General.

MFAS has been engaged on this issue because the proposed regulation expressly includes podiatrists within the definition of “health care provider.” DPH has approached licensing boards regarding the regulation, and while the DPH had received approval from its multiple licensing boards, including the Board of Registration in Medicine and the Board of Registration in Podiatry, which raised issues concerning the proposed regulations impacts on small practices. MFAS has been in communication with DPH staff to better understand the Department’s process, timing, and intended implementation of the regulation. MFAS recognizes the policy goal of protecting patients from the long-term financial harm associated with medical debt reporting. At the same time, any final regulation must be implemented clearly and fairly for providers, including small and independent podiatric practices. MFAS will continue to monitor and participate in the rulemaking process, which should include a series of public hearings in July.  A copy of the proposed regulations may be found at: https://www.mass.gov/info-details/medical-debt-reporting-requirements-for-health-care-providers-licensed-by-boards-within-the-department-of-public-health.

In short, there is no shortage of work for the MFAS Legislative Committee. To that end, a shout-out to this Committee of dedicated podiatrists – who not only participate in the legislative and regulatory process – but attend fundraisers and other events on a regular basis. Led by Dr. Tyler Silverman, they volunteer their time with the sole interest of advancing the profession to benefit both podiatrists and their patients throughout the state.

As always, MFAS members are encouraged to stay engaged, respond to calls to action, and contact the MFAS Legislative Committee or Executive Director Libby Maynard with questions, concerns, or interest in participating in ongoing advocacy efforts.

As we move further into this new term for the Massachusetts Foot & Ankle Society, I want to thank you for the trust you have placed in me to serve as your President. I am excited about the opportunities ahead and look forward to connecting with members across the Commonwealth while continuing to grow and strengthen our Society.

One of my primary goals this year is engagement. I want every member, from seasoned practitioners to new attendings and early-career physicians, to feel that their voice is heard and represented. Our Society is strongest when we remain connected, openly share ideas, and work together to address the challenges and opportunities facing our profession.

Advocacy will continue to be a central focus. Whether the issues involve scope of practice, reimbursement disparities, insurance denials, legislative initiatives, or the evolving landscape of hospital-based and private practice, the Society remains committed to representing the interests of Massachusetts foot and ankle surgeons. Your experiences and perspectives are invaluable, and I encourage you to share them as we work together to advance our profession.

Education remains equally vital to our mission. We are committed to creating innovative opportunities for learning through hands-on workshops, collaborative educational programs, and continued enhancements to our annual Region One Conference. Our goal is to deliver fresh, engaging content that reflects the latest advances in foot and ankle surgery while fostering meaningful discussion and professional growth.

Over the coming months, I also plan to visit multiple regions throughout Massachusetts to meet with members in person. I will be planning our first Town Hall this upcoming September, with the location and date to be determined, and this will be the first of quarterly we will hold throughout the year. These gatherings will provide an opportunity to discuss local concerns, exchange ideas, strengthen professional relationships, and keep you informed about the ongoing work of the Society. I hope many of you will take the opportunity to join these conversations.

The future of the Massachusetts Foot & Ankle Society depends on the collective passion, expertise, and dedication of its members. Together, we have an incredible opportunity to elevate our profession, advocate for our patients, and shape the future of foot and ankle care throughout our state.

Thank you for your continued support, your commitment to excellence, and the privilege of serving as your President. I look forward to working alongside each of you in the year ahead.

Sincerely,

David A. Sipala, DPM, FACFAS
President, Massachusetts Foot & Ankle Society

Many healthcare organizations focus on securing computers, servers, and electronic health record systems. However, one often-overlooked device may also contain sensitive information: your office copier.   This device, if not properly secured, can be the cause of a large HIPAA breach for your practice.

Today's multifunction copiers do much more than make copies. They can print, scan, fax, email, and store documents electronically. Depending on the model, a copier may contain a hard disk drive (HDD) or solid-state drive (SSD) that retains copies of documents processed by the device.

Not All Copiers Store Data

A common misconception is that every copier contains a hard drive. In reality, some smaller devices use only temporary memory (RAM), which is cleared when the machine is powered off. Larger multifunction devices, however, often contain permanent storage that can retain information even after documents have been printed or scanned.

Because healthcare organizations routinely handle protected health information (PHI), it is important to know whether your copier stores data.

How to Find Out

You can determine whether your copier stores information by:

• Reviewing the manufacturer's specifications
• Looking for features such as document storage, secure print queues, or scan-to-folder functionality
• Checking the device's administrative settings
• Contacting the copier vendor or service provider

If you're unsure, it is safest to assume the device stores data until confirmed otherwise.

Why It Matters

If a copier contains a hard drive or other permanent storage, patient information may remain on the device long after a document has been processed. This can create security and compliance risks if the copier is:

• Connected to a network without proper safeguards
• Accessed by unauthorized users
• Returned at the end of a lease
• Sold, donated, or disposed of without removing stored data

Security Best Practices

Healthcare organizations can reduce risk by:

• Enabling password or badge-based authentication
• Using secure or "pull" printing so documents are released only when the user is present
• Changing default administrator passwords
• Limiting access to authorized personnel
• Including copiers in cybersecurity and HIPAA risk assessments
• Using encryption and secure overwrite features when available

When replacing or returning a copier, ensure that any stored data is securely erased or destroyed before the device leaves your control.

More Than a HIPAA Issue

While HIPAA requires healthcare organizations to protect patient information, other regulations may also apply. The Federal Trade Commission (FTC) can take enforcement action against organizations that fail to implement reasonable safeguards for sensitive information.

A copier that stores patient, employee, or consumer information should be treated like any other information system in your organization.

Takeaway

Copiers are no longer simple office equipment. Many function as network-connected computers that may store sensitive information. Taking a few minutes to determine whether your copier contains permanent storage—and ensuring appropriate security controls are in place—can help protect patient privacy, reduce compliance risks, and strengthen your organization's overall cybersecurity posture.

This risk is not new and even as early as 2010 CBS news ran a piece on copiers being a security risk.  Don't let what happened in this video happen to you.  Watch the CBS Video on You Tube

Good evening everyone,

It is truly an honor to stand before you today—surrounded by mentors, colleagues, fellow foot and ankle physicians and surgeons, educators, leaders, and friends. We are a relatively small community within the broader medical profession, but our impact is anything but small. Our voice is meaningful, and our work is essential to the health, mobility, and overall well-being of patients across the Commonwealth.

As a proud foot and ankle surgeon, I am deeply passionate about what we contribute to medicine. To now have the privilege of serving as President of the Massachusetts Foot and Ankle Society is something I do not take lightly. I am committed to advocating for each and every one of you—colleagues who share not only a profession, but a genuine dedication to improving patient care. I promise to lead with intention, to listen to every voice, and to ensure that our society continues to represent all its members.

Our profession has made tremendous strides—in training, in education, in research, and in legislative advocacy. The evolution of our field has been remarkable, and it reflects the commitment and excellence of those in this room, but also by the many individuals who came before us and helped pave the way for where we stand today. But while we should be proud of how far we’ve come, we must also recognize that there is still more ahead of us. There is more to achieve, more to strengthen, and more opportunities to elevate our profession—and I intend to ensure we remain on that trajectory.

Looking ahead, one of my goals is to make our society more present and more accessible. I plan to establish quarterly town halls across Massachusetts, creating opportunities for members to engage directly with leadership. These will be open forums—spaces where concerns can be voiced, ideas can be shared, and meaningful dialogue can occur face-to-face. Every member should feel heard, represented, and connected to this society. By fostering that sense of inclusion and engagement, we can continue to strengthen our organization and inspire future growth in membership and involvement. Because when our foundation is strong, there is truly nothing that can keep us from taking the next step forward—together.

Education, academics, and the continued support of our residents and residency programs will remain paramount to the vision and mission of this board. We are committed to creating meaningful opportunities for growth through scholarships, educational and economic resources, board preparation support, mentorship, and professional development initiatives that invest in the future of our profession. Most importantly, we must continue to cultivate and retain the next generation of foot and ankle surgeons here in Massachusetts, training exceptional physicians within our Commonwealth and inspiring them to build their careers, practices, and leadership right here at home.

In today’s digital age, our presence extends far beyond in-person interaction. Strengthening our online visibility is not simply about keeping up—it is about remaining relevant, unified, and proactive. We will continue to grow our voice through social media and enhance our digital platforms, including a much-needed modernization of our website. This will improve access to leadership, educational resources, and tools that support your practice, your training, and your professional growth. 

Beyond visibility to our current, and hopefully additional future members, we must also strengthen our visibility to the public we serve. It is our responsibility to continue educating patients, legislators, healthcare systems, and our communities on the true depth and scope of foot and ankle medicine and reconstructive surgery. For too long, outdated perceptions have failed us, falling short to accurately reflect the advanced training, surgical expertise, innovation, and comprehensive care that our profession provides every single day. Through continued grassroots advocacy, public engagement, and a unified professional presence, we can reshape that narrative and elevate our collective voice. We will continue to make meaningful strides toward expanded scope, greater professional autonomy, fair and equitable reimbursement, and the recognition our profession deserves, and quite honestly, has rightfully earned alongside all medical professionals and surgical specialists.

In addition to all these initiatives, we will always remain steadfast in our legislative efforts. Advocacy is critical to the advancement of our profession, and we will continue pushing forward to ensure our scope of practice reflects the training, expertise, and value we provide. I am equally committed to exploring innovative and strategic ways to amplify our voice—ensuring we are heard clearly across every corner of this state. The future of our profession is not something we wait for—it is something we actively shape.

This year, we celebrate a remarkable milestone—our 120th anniversary. One hundred and twenty years of dedication, progress, and service. It is both humbling and inspiring to step into this role at such a significant moment in our history. As we reflect on the legacy built before us, we also look ahead—to the next 120 years—filled with continued growth, innovation, and excellence.

As we begin this next 120 years, I challenge all of us to continue pushing boundaries, lifting one another, and advancing our profession with pride and purpose.
Let’s stand together, move forward together, and leave a lasting footprint on the future of medicine in Massachusetts.

Thank you for your trust, your support, and the work you do every day. It is an honor to serve you.

On May 14, 2026, APMA held its first quarterly Contractor Advisory Committee (CAC) and Private Insurance Advisory Committee (PIAC) meeting of 2026. The virtual meeting brought together CAC and PIAC representatives, subject matter experts, and APMA staff to discuss emerging payer trends, Medicare developments, prior authorization concerns, and ongoing advocacy efforts affecting podiatric physicians nationwide.

The discussion focused heavily on evolving payer behavior, artificial intelligence in utilization management, Medicare contractor engagement, skin substitute reimbursement issues, and operational challenges affecting podiatric practices. Chair Jodie Sengstock, DPM, opened the meeting at 8:02 PM ET, outlining the recent committee structure changes and CAC and PIAC role expectations.

Payer Advocacy

Payer Advocacy, Modifier Issues, and AI Concerns

• APMA staff provided updates regarding ongoing discussions with private payers, including Aetna and UnitedHealthcare. Topics included prior authorization modernization, modifier denials, peer-to-peer review access, skin substitute policies, and the growing use of automation and artificial intelligence in utilization management processes.
• APMA also highlighted newly enhanced modifier 25 educational resources, including practical documentation examples designed to help providers better support significant and separately identifiable E/M services billed on the same day as procedures. The discussion included a recent advocacy success in Michigan, where BCBS Michigan paused a reimbursement policy affecting appropriately reported modifier 25 claims following advocacy efforts from the Michigan Podiatric Medical Association and broader physician community.
• Additional updates included APMA’s ongoing re-engagement with CMS and NCCI regarding modifier 59 guidance that improperly bundles callus paring and toenail debridement services in certain clinical scenarios.
• Dr. Sengstock also reviewed APMA’s recently released position statement, “Podiatric Physician Involvement in the Development of Emerging AI Laws and Regulations.”

  Discussion and Next Steps

• Representatives shared growing concerns regarding AI-driven provider service systems, automated denials, and broader utilization management trends affecting patient access and administrative burden.
• Next Step: CAC/PIAC Representatives collect real-world examples and denial data to support future advocacy and policy discussions.
• Next Step: CAC/PIAC representatives will explore reengaging with local Blue plans about holding annual meetings to educate them about podiatry.
• Next Steps: Payer advocacy will explore banding together with other specialties and provider types, and representatives should work with their state leadership to help identify opportunities.
• Representatives discussed National Committee for Quality Assurance’s (NCQA) growing influence in coverage and credentialing discussions and emphasized that, while NCQA itself does not directly regulate payers, partnering with organizations like NCQA and collecting real-world denial data and patient access stories may help strengthen advocacy efforts related to AI, prior authorization, and utilization management practices.
• Members should continue to surface these issues with APMA and their CAC and PIAC representatives.

Medicare Updates

Medicare, LCD, and Skin Substitute Updates

• APMA staff provided updates on ongoing engagement with CMS and the CAC Engagement Coalition related to Medicare Administrative Contractor (MAC) Local Coverage Determination (LCD) processes. Discussion focused on improving transparency, strengthening specialty representation during evidentiary review meetings, and addressing operational concerns surrounding LCD development and implementation.
• APMA additionally highlighted emerging Congressional interest in MAC and LCD reform legislation, including H.R. 8500, the “Timely Access to Coverage Decisions Act of 2026,” which would streamline and standardize portions of the LCD process.
• Skin substitute reimbursement and WISeR implementation concerns remained a significant topic of discussion. APMA continues collaborating with the Alliance of Wound Care Stakeholders and monitoring reports of denials and non-payment, particularly within the Palmetto jurisdiction.

  Therapeutic Shoes for Patients with Diabetes

• Coding and Payment Policy Committee Chair Steve Merckx, DPM, reviewed APMA’s advocacy efforts related to the Medicare Therapeutic Shoes for Patients with Diabetes (TSD) benefit, including recent CMS clarification that cosigned notes are not required for diabetic shoe coverage when documentation standards are otherwise met (because there are two alternative compliance pathways).
• Additionally, APMA’s newly introduced Diabetes Foot Health Access and Modernization Act seeks to modernize outdated Medicare documentation requirements and reduce unnecessary administrative burdens affecting patient access to preventive diabetic foot care.

  Discussion and Next Steps

• Representatives discussed emerging concerns involving requests from payers to include supplier invoices in documentation associated with skin substitute claims, as well as broader reimbursement delays and claim processing concerns. Representatives reported that most members who had been encountering payment delays and denials (including ones in the Palmetto region) have started receiving payment.
• Next Steps: APMA staff will investigate appropriateness/legality of requiring supplier invoices as a part of the documentation necessary for payment.
• Members experiencing reimbursement, prior authorization, denial, or operational issues related to skin substitutes should share examples and information with APMA, their state component society, or their CAC/PIAC representative to help inform ongoing advocacy and outreach efforts.

DME Trends

• Paul Kesselman, DPM, concluded the meeting with several Durable Medical Equipment (DME) updates, including supplier enrollment and revalidation concerns, pre-payment audit activity, orthotics documentation requirements, and operational changes involving National Provider Enrollment contractors.
• Dr. Kesselman reminded providers that DME supplier enrollment and revalidation requirements continue to become more complex, with failures potentially resulting in costly appeals, billing interruptions, or revocations. He encouraged practices to keep licensure, insurance, and enrollment information updated and promptly report practice location changes, including suite number changes.

  Discussion and Next Steps

• Representatives also discussed increasing prior authorization and pre-payment review scrutiny involving orthotics and therapeutic shoes, including growing documentation expectations related to medical necessity modifications performed at the time of delivery.

  Closing

• Dr. Sengstock thanked members for attending and encouraged them to register for the National Annual Scientific Meeting in August.
• Dr. Sengstock reminded representatives of the next virtual meeting scheduled for August 20, at 8:00 p.m. ET, and the annual in-person meeting scheduled to take place in Herndon, Virginia, on November 13, 2026.

ADJOURNMENT

Committee Members Present

Jodie Sengstock, DPM, CAC Chair
David Alper, DPM
Mitchell Barber, DPM
Mark Block, DPM
Jim Bray, DPM
Leslie Campbell, DPM
Jeffrey Crowhurst, DPM
Alex Dellinger, DPM
Mark Dollard, DPM
Jeffrey Falcone, DPM
Michael Fein, DPM
David Freedman, DPM
Howard Gale, DPM
Brent Harwood, DPM
Paul Kesselman, DPM
Ira Kraus, DPM
Len La Russa, DPM
Steve Merckx, DPM
Mark Miller, DPM
Robb Mothershed, DPM
Andrew Pavelescu, DPM
Jeffrey Petty, DPM
David Pougatsch, DPM
Thomas Rambacher, DPM
Dominic Roda, DPM
Selin Ruggieri, DPM
Janet Simon, DPM
Daniel Smith, DPM
Keyoka Smith, DPM
Shashank Srivastava, DPM
Andrew Torigian, DPM
Susan Walsh, DPM
Anna Weber, DPM

Staff Present

Gail Reese, JD
Sabah Bhatnagar, MPAP
Dyane Tower, DPM  

Artificial intelligence is rapidly entering everyday workflows—from documentation support and patient messaging to clinical decision support and triage tools. While these technologies can improve efficiency in private practice settings, a recent Pennsylvania lawsuit highlights an important and emerging risk: AI systems that appear to “act like clinicians” may be crossing into the unlicensed practice of medicine.

The Commonwealth of Pennsylvania has filed suit against Character Technologies Inc., the company behind Character.AI, after an AI chatbot allegedly presented itself as a licensed psychiatrist and provided responses that resembled clinical evaluation and treatment recommendations.

This case carries direct implications for private practices who are increasingly adopting AI tools in clinical and administrative workflows.

What Happened

According to the complaint, a Pennsylvania Department of State investigator interacted with a chatbot posing as a psychiatrist on the Character.AI platform.

The chatbot allegedly:

• Identified itself as a “Doctor of psychiatry”
• Suggested possible mental health conditions based on symptoms
• Conducted clinical-style “assessments”
• Claimed medical training and psychiatric experience
• Asserted licensure in Pennsylvania and other jurisdictions
• Generated a fabricated medical license number

The state confirmed the license number was invalid and argues the behavior may constitute
misleading representation of licensed medical practice.

Why Regulators Are Taking Action

Pennsylvania has asked the court to stop AI systems from presenting themselves as licensed clinicians or engaging in behavior that could be interpreted as practicing medicine under false credentials.

The state is also advancing broader oversight measures, including:

• Reporting mechanisms for suspected AI-driven unlicensed medical activity
• An AI task force focused on “companion” and conversational technologies
• Proposed safeguards such as age verification, self-harm escalation protocols, and clear AI disclosure requirements

The direction from regulators is increasingly clear: when AI behaves like a clinician, it may be regulated like one.

Official Statement from Pennsylvania Leadership

Pennsylvania Governor Josh Shapiro emphasized the public safety concern behind the action:

“Pennsylvanians deserve to know who — or what — they are interacting with online, especially when it comes to their health,” Pennsylvania Governor Josh Shapiro said in a statement announcing the lawsuit filed on Tuesday in state court. “We will not allow companies to deploy AI tools that mislead people into believing they are receiving advice from a licensed medical professional.”

Why This Matters for Private Practices

Even though this case targets a technology company, the downstream effects are directly relevant to medical practices.

Patients are already using AI before visits

Many patients now arrive with AI-generated explanations for:

• Heel pain and plantar fasciitis
• Neuropathy symptoms
• Nail and skin conditions
• Surgical “recommendations” they found online

These outputs can sound authoritative even when inaccurate or incomplete.

AI can mimic clinical reasoning

Modern chatbots often present:

• Structured “diagnoses”
• Confident treatment suggestions
• Medical-sounding language that resembles clinician guidance

This increases the risk that patients confuse AI content with real medical advice from their doctor.

AI is already entering practice workflows

Private practices are increasingly using AI for:

• Charting and note generation
• Patient messaging drafts
• Prior authorization support
• Intake summarization

Without proper controls, these tools can blur the line between administrative assistance and clinical interpretation.

What You Should Do Now

To reduce risk and maintain compliance boundaries, practices should ensure AI systems cannot impersonate clinicians or appear to provide independent medical judgment.

1. Require strict non-clinician AI configuration
Ensure all AI tools are explicitly set to:

• State they are not licensed healthcare providers
• Avoid titles like “doctor,” “physician,” or “clinician”
• Never imply licensure or specialty certification

2. Lock down prompts and system behavior
For any configurable AI tools:

• Use fixed system-level instructions that prohibit identity claims
• Restrict user ability to modify core safety rules
• Perform periodic audits of AI behavior and outputs

3. Eliminate “roleplay” or clinical persona modes

• Disable “act as a doctor” or similar functions
• Prevent simulation of provider–patient conversations
• Block outputs framed as independent clinical decision-making

4. Add clear patient-facing disclosures
Any AI interacting with patients should clearly state:

• “This system is not a licensed healthcare provider”
• “This information is for general informational purposes only”
• Instructions on when to contact the practice directly

5. Require clinician oversight for clinical content
To reduce risk of misinterpretation:

• Use AI for drafting only, not final clinical communication
• Route patient-facing medical messaging through provider review
• Flag any diagnostic or treatment language for approval

6. Restrict diagnostic and treatment recommendations
AI systems should not independently:

• Diagnose foot or ankle conditions
• Recommend procedures or surgery
• Provide medication or dosing guidance
• Make triage determinations

7. Monitor for false authority claims
Systems should be configured to detect and prevent:

• Claims of being a doctor
• Fabricated license numbers
• Assertions of clinical authority or credentials

8. Train staff on AI-generated misinformation
Front office and clinical teams should be prepared to:

• Identify AI-influenced patient beliefs
• Correct misinformation without dismissing concerns
• Escalate potential safety or compliance issues

9. Align AI use with HIPAA and state medical practice laws
Before deploying AI tools, practices should:

• Confirm HIPAA compliance of vendors
• Review risks under “unlicensed practice of medicine” statutes
• Document safeguards against impersonation
• Establish internal AI governance policies

Broader Regulatory Climate

This Pennsylvania enforcement action reflects a broader shift in how regulators view AI systems that mimic professional identity.

Expanding litigation risk

AI companion platforms have already faced lawsuits related to mental health safety concerns and vulnerable users, increasing scrutiny of how conversational systems behave in emotionally or medically sensitive contexts.

Federal attention increasing

Proposed federal legislation, including the CHATBOT Act, would prohibit AI systems from implying they hold professional licenses in regulated fields such as healthcare and law. If enacted, it would create a national standard restricting AI impersonation of clinicians.

Together, these developments indicate that AI systems simulating professional identity are moving into a defined legal risk category—not an emerging gray area.

The Bigger Picture for Practices

For private practices, the key issue is not just whether AI is useful, but whether it creates confusion about who is providing medical guidance.

The primary risks include:

• Patients arriving with AI-generated misdiagnoses of foot and ankle conditions
• Misunderstanding AI outputs as clinical advice from your practice
• Workflow tools unintentionally producing patient-facing content that sounds like medical judgment

Bottom Line

This Pennsylvania lawsuit signals a clear direction from regulators: AI systems that imitate clinicians—even conversationally—are increasingly viewed as a compliance risk.

The priority is not only adopting AI safely, but ensuring that any system used in the practice is explicitly and technically incapable of:

• Presenting itself as a licensed provider
• Offering independent clinical judgment
• Blurring the line between administrative support and medical decision-making
  
  

This article was submitted by Michael L. Brody, DPM, CEO of TLD Systems

Of note the Massachusetts Division of Insurance (DOI) recently proposed regulations to reform the system of prior authorizations. The regulations stem from Governor Maura Healey’s announcement in early January that the DOI was moving forward with regulatory updates aimed at modernizing and streamlining prior authorization requirements for health insurance claims. The initiative, which is intended to reduce administrative complexity and eliminate delays that can impede timely access to care, has long been sought by patients, providers and medical establishments of all sizes, whether hospital, community health center or an independent provider office.

When the DOI unveiled updates to the regulations 211 CMR 52.00 in late February, various groups advocating for an update were left asking whether enough was done to change the prior authorization paradigm. The proposed updates to 211 CMR 52.00 represent a restructuring of sorts to how prior authorization—referred to in the regulation as “prospective review”—is applied across Massachusetts health plans. Under the proposal, insurance carriers would be prohibited from imposing prospective review on a wide range of in-network services, including primary care, preventive services, a limited panel of chronic diseases (asthma, two of the most prevalent heart conditions and diabetes-related care, devices, and medications), maternity care, behavioral health services, and common therapies like physical, occupational, and speech therapy. However, emergency services and many urgent or post-acute services are also excluded.

Of concern, advocates for reining in prior authorizations have noted the proposed regulations seem too limited in their application (i.e. the chronic disease definition is very limited) and try to ban prior authorizations for procedures most insurers do not require today. Further, while the regulations propose more distinct patient protections around continuity of care, there is concern the regulations envision a system where chronic diseases or conditions follow a predictable schedule. Approved authorizations must remain valid for at least 90 days or through the end of the benefit year, and importantly, must be honored when a patient transitions between health plans—provided the service remains covered and the provider is in-network. The newly proposed regulations also protect patients who are stable on a treatment regimen by requiring continued coverage if that treatment is later removed from a plan’s formulary or made subject to new restrictions. Again, it has been noted that the 90-day authorization / end of coverage period is more reflective of a calendar year style of thinking than the reality a chronic disease or condition presents.

Finally, the regulations would also attempt to introduce a series of more uniform administrative processes. For urgent cases where delays could substantially impact a patient’s health, carriers must issue a determination within 24 hours of receiving all necessary information. (Note: the key being “upon receipt of all necessary information”, which is still determined, ostensibly, by the insurer). The proposed regulation establishes mechanisms to monitor utilization trends and preserve limited flexibility for carriers under defined circumstances. If a carrier can demonstrate a significant increase in risk-adjusted utilization for certain services over time, it may petition the DOI to temporarily reinstate targeted prior authorization requirements. For its purposes, the DOI will be required to conduct periodic reviews—at least every three years—assessing the financial, clinical, and equity impacts of eliminating or maintaining prospective review requirements.

The proposed regulations will likely face some sort of amendments before their final promulgation. The MFAS Legislative Committee, which keeps in contact with other stakeholder organizations, will continue to monitor and report on the same.  To review the proposed regulations, please visit: https://www.mass.gov/doc/proposed-regulation-211-cmr-5200/download.

Stay tuned for the additional updates in future newsletters and on social media on MFAS legislative and regulatory work! As we head into Spring, we continue to be very active advancing MFAS’ legislative agenda - the podiatric practice act (Senate Bill 1542), / (House Bill 2407); the amputation prevention task force, (HB2433) / (SB1508); and updates to the podiatry statute’s continuing education language (House Bill 247 / Senate Bill 2470) – as the legislative session heads towards its July 31^st deadline for formal sessions. As there are always a host of legislative and regulatory initiatives to get involved in, please let any member of the MFAS Legislative Committee or Libby Maynard, Executive Director, know of your interest in participating in an area of interest.

I hope this message finds you well as we move into a busy and productive spring for the Massachusetts Foot and Ankle Society.

On March 10th, our Board of Trustees gathered for a productive meeting at Seasons 52. It was a great opportunity for the board to connect in person, review ongoing initiatives, and continue our work advancing the profession and supporting our members across the Commonwealth. These meetings are always valuable for aligning our goals and ensuring that our society remains active, responsive, and forward-thinking.

Just a few days later, March 13–15, our delegation represented Massachusetts exceptionally well at the APMA House of Delegates Meeting. The engagement and advocacy demonstrated by our Massachusetts representatives continues to highlight the strength and leadership of our state within the national podiatric community. Their efforts ensure that the voice of Massachusetts podiatrists remains strong in shaping the future of our profession.

Looking ahead, I encourage everyone to join us for one of our favorite annual traditions—the Gavel Dinner. This year’s event will take place on May 12th at The Westin Waltham Boston. It’s always a wonderful evening to reconnect with colleagues, celebrate our accomplishments, and enjoy time together outside of the clinical setting. If you’d like to catch up with friends and colleagues and have a great night out, please be sure to register at: www.massfootandankle.org/event/gavel2026

We also have another excellent educational opportunity coming up. Our next MFAS webinar will be held on Tuesday, May 19th at 6:00 PM. The presentation, “Evaluation and Non-Surgical Management of Foot and Ankle Musculoskeletal Conditions in Athletes,” will be delivered by Adam Tenforde, MD. This promises to be an informative session focused on practical strategies for managing athletic injuries and musculoskeletal conditions in the foot and ankle.

Please also save the date for the 2026 APMA Region One Conference, which will be held October 23–24, 2026, at The Westin Waltham Boston—we look forward to another outstanding meeting.

Thank you all for your continued support and involvement in the Massachusetts Foot and Ankle Society. I look forward to seeing many of you at our upcoming events.

Warm regards,

Anthony Tickner, DPM
President, Massachusetts Foot and Ankle Society

The 2025-2026 landscape demonstrates that data breaches are no longer just administrative headaches; they are clinical emergencies.

1. Clinical Continuity & Patient Safety Risks

When systems like) go offline, the risk is measured in patient outcomes, not just data points. For a physician, a breach often results in:

• Loss of Vital History: Lack of access to allergies, active medications, and recent imaging can lead to preventable medical errors or the administration of contraindicated drugs.
• "Blind" Diagnostics: Without the EMR, doctors may be forced to reorder labs or scans, delaying critical intervention windows (e.g., in stroke or cardiac protocols).
• Diversion Fatigue: Ransomware often forces hospital diversions, which increases "boarding" times in neighboring ERs and delays specialized care.

2. The "February 16, 2026" HIPAA Deadline

Today is a critical compliance date. The 42 CFR Part 2 alignment with HIPAA has reached its enforcement deadline.

• What you must do today: Doctors must ensure their Notice of Privacy Practices (NPP) has been updated to include specific language regarding Substance Use Disorder (SUD) records.
• Key Requirement: The new NPP must explicitly state that SUD records cannot be used in legal proceedings against a patient without specific written consent or a court order.
• Liability Note: Even if you aren't a dedicated SUD program, if you receive these records for care coordination, your NPP must reflect these protections.

3. Liability & The "Wall of Shame"

Doctors often underestimate the reputational damage of an OCR investigation.

• The "Wall of Shame": The OCR’s public breach portal is a searchable database. For smaller practices, a breach appearing here can lead to a 4-5% drop in patient visits within the first year as trust is eroded.
• Insider Threats: 2025 saw a rise in "curiosity" breaches—staff accessing high-profile patient files. Physicians can be held liable for "Failure to Supervise" if staff aren't properly trained or if access logs aren't regularly audited.

4. Actionable Checklist for Physicians

Is your organization compliant with the new HIPAA February 16, 2026 deadline regarding Notice of Privacy Practices (NPP)?  TLD Systems is presenting a free webinar on the NEW SUD requirements Wednesday March 18 at 8:00 pm Eastern Time.  To register for this free non CME webinar visit https://attendee.gotowebinar.com/rt/1337001095261746518 

This article was submitted by Michael L. Brody, DPM   CEO of TLD Systems

Nationwide Moratorium on Certain Medical Supply Company Enrollments

One of the key measures is a nationwide six-month moratorium on new Medicare enrollments and certain ownership changes for specific categories of medical supply providers.

The policy, which took effect February 25, 2026, applies to seven categories of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers, primarily businesses whose primary role is distributing medical equipment or supplies.

Link to full article:
https://www.tldsystems.com/cms-announces-new-measures-strengthen-medicare-and-medicaid-fraud-prevention

Members are encouraged to review the DEA’s official scam alert for more information and guidance:
https://www.dea.gov/scam-alert

Please share this information with colleagues in case others receive similar calls.

Data breaches in healthcare continue to increase in frequency and severity, and they are increasingly followed by class action lawsuits against medical practices and healthcare systems. These lawsuits represent a significant financial and operational risk for covered entities and business associates alike.

A publicly available website, ClaimDepot.com, tracks class action lawsuits and settlements across industries, including healthcare. As of January 17, 2026, healthcare-related data breach settlements listed on the site include¹:

• Des Moines Orthopaedic Surgeons – Data Breach Settlement
• Inova Health – $3.15 million MyChart Privacy Class Action Settlement
• U.S. Dermatology Partners – Data Breach Class Action Settlement
• American Addiction Centers – $2.75 million Class Action Settlement
• Hospital Sisters Health System – $7.6 million Data Breach Settlement

Reviewing these cases highlights an important reality for medical practices and healthcare systems: settlement amounts can reach millions of dollars, and these figures typically do not include legal fees, forensic investigations, breach notification costs, credit monitoring services, regulatory response efforts, or operational disruption.

Legal Exposure Following a Healthcare Data Breach

A data breach is not only a regulatory compliance issue but also a significant legal and financial event. In addition to breach containment and remediation, organizations must comply with the HIPAA Breach Notification Rule² and respond to any investigations initiated by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR).

Patients generally do not have a private right of action under HIPAA itself³. However, this does not eliminate litigation risk. Patients commonly bring lawsuits under alternative legal theories, including:

• State privacy and data protection laws
• Negligence
• Consumer protection statutes

As a result, class action lawsuits following healthcare data breaches are typically not based on HIPAA, but rather on state statutory and common-law claims, which vary by jurisdiction and often allow for monetary damages.

HIPAA Security Risk Analysis: A Regulatory Requirement

Under the HIPAA Security Rule, covered entities and business associates are required to conduct an **accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information (ePHI)**⁴:

• 45 CFR § 164.308(a)(1)(ii)(A) – Risk Analysis
• 45 CFR § 164.308(a)(1)(ii)(B) – Risk Management

HHS OCR guidance emphasizes that a HIPAA Security Risk Analysis (SRA):

• Must be documented
• Must be organization-specific
• Is an ongoing process, not a one-time exercise⁵

OCR explicitly states:

“The risk analysis process should be ongoing. In order for risk analysis to remain effective, it should be reviewed periodically and updated as needed.”⁵

Completing a risk analysis and implementing a corresponding risk management (mitigation) plan can significantly reduce the likelihood and impact of a breach. However, it is important to recognize that breaches can still occur even in organizations that have performed a Security Risk Analysis.

Third-Party and Business Associate Risk

Healthcare organizations remain legally exposed even when a breach originates outside their direct control. Breaches frequently involve:

• Business Associates
• Patient portals
• Web tracking or analytics tools
• Cloud-based or third-party software platforms

For example, Inova Health faced class action litigation related to privacy issues involving MyChart, a third-party patient portal application¹. This illustrates the importance of vendor risk management, Business Associate Agreements (BAAs), and ongoing oversight.

OCR guidance makes clear that covered entities are responsible for ensuring that their Business Associates appropriately safeguard ePHI and comply with the HIPAA Security Rule⁶.

Cyber Liability Insurance as a Risk Management Tool

In addition to regulatory compliance efforts, healthcare organizations should strongly consider cyber liability insurance as part of a comprehensive risk management strategy. Such policies may help offset costs associated with:

• Forensic investigations
• Legal defense and settlements
• Breach notification and credit monitoring
• Regulatory fines and penalties (where insurable)
• Business interruption

Cyber insurance should be viewed as a supplement to—not a substitute for—HIPAA compliance.

Maintaining an Ongoing Risk Management Program

HHS OCR guidance states that a Security Risk Analysis should be reviewed and updated at least annually, and whenever there are material changes that affect an organization’s risk profile⁵, including:

• Implementation of new hardware or software
• Adoption of new EHR or patient engagement platforms
• Changes in clinical workflows or data storage
• Emerging cybersecurity threats, such as ransomware

About TLD Systems

TLD Systems has assisted many healthcare organizations, including hundreds of small ambulatory practices, with HIPAA Security Risk Analyses and compliance support. Our approach emphasizes practical risk identification, regulatory alignment, and realistic mitigation strategies tailored to clinical environments.

For more information or to contact TLD Systems:

• Website: https://www.tldsystems.com
• Email: info@tldsystems.com
• Phone: (631) 403-6687

Michael L. Brody, DPM
CEO, TLD Systems

References

1. ClaimDepot. Healthcare Data Breach Class Action Settlements. ClaimDepot.com.
2. HHS. HIPAA Breach Notification Rule, 45 CFR §§ 164.400–414.
3. HHS OCR. Enforcement Rule and HIPAA Overview – No Private Right of Action.
4. HHS. HIPAA Security Rule, 45 CFR § 164.308(a)(1).
5. HHS OCR. Guidance on Risk Analysis Requirements under the HIPAA Security Rule.
6. HHS OCR. Business Associate Contracts and Responsibilities under HIPAA.

The 2025-2026 landscape demonstrates that data breaches are no longer just administrative headaches; they are clinical emergencies.

1. Clinical Continuity & Patient Safety Risks

When systems like) go offline, the risk is measured in patient outcomes, not just data points. For a physician, a breach often results in:

• Loss of Vital History: Lack of access to allergies, active medications, and recent imaging can lead to preventable medical errors or the administration of contraindicated drugs.

• "Blind" Diagnostics: Without the EMR, doctors may be forced to reorder labs or scans, delaying critical intervention windows (e.g., in stroke or cardiac protocols).

• Diversion Fatigue: Ransomware often forces hospital diversions, which increases "boarding" times in neighboring ERs and delays specialized care. 

2. The "February 16, 2026" HIPAA Deadline

Today is a critical compliance date. The 42 CFR Part 2 alignment with HIPAA has reached its enforcement deadline.

• What you must do today: Doctors must ensure their Notice of Privacy Practices (NPP) has been updated to include specific language regarding Substance Use Disorder (SUD) records.
  
  
• Key Requirement: The new NPP must explicitly state that SUD records cannot be used in legal proceedings against a patient without specific written consent or a court order.
  
  
• Liability Note: Even if you aren't a dedicated SUD program, if you receive these records for care coordination, your NPP must reflect these protections.

3. Liability & The "Wall of Shame"

Doctors often underestimate the reputational damage of an OCR investigation.

• The "Wall of Shame": The OCR’s public breach portal is a searchable database. For smaller practices, a breach appearing here can lead to a 4-5% drop in patient visits within the first year as trust is eroded.

• Insider Threats: 2025 saw a rise in "curiosity" breaches—staff accessing high-profile patient files. Physicians can be held liable for "Failure to Supervise" if staff aren't properly trained or if access logs aren't regularly audited.

4. Actionable Checklist for Physicians

Is your organization compliant with the new HIPAA February 16, 2026 deadline regarding Notice of Privacy Practices (NPP)?  TLD Systems is presenting a free webinar on the NEW SUD requirements, Wednesday March 18 at 8:00 pm Eastern Time.  To register for this free non CME webinar visit: https://attendee.gotowebinar.com/rt/1337001095261746518

This article was submitted by:
Michael L. Brody, DPM  
CEO of TLD Systems

Cyberattacks targeting health care organizations are on the rise. According to OCR Director Melanie Fontes Rainer, securing electronic protected health information (ePHI) is more important than ever. Organizations that fail to address known vulnerabilities put patient data—and their reputation—at risk.

Why Phishing Is a Big Threat

Phishing is one of the easiest ways cybercriminals gain access to health care systems. It happens when attackers send emails or messages that look legitimate, tricking recipients into:

• Sharing passwords or sensitive information
• Clicking malicious links
• Opening harmful attachments

Even a single click can compromise your entire system.

Spotting Phishing Attempts

Health care professionals should watch for:

• Unexpected messages asking for urgent action
• Emails requesting passwords or account verification
• Sender addresses that are unfamiliar or slightly off
• Spelling or grammar mistakes
• Unexpected links or attachments

Red flags often appear in messages about billing, password resets, or patient records.

Your Role in Protecting ePHI

Every team member is a line of defense. Staff should:

• Avoid clicking suspicious links or attachments
• Verify unusual requests through trusted channels
• Report suspected phishing emails to IT or security teams

Training and awareness are just as important as technology.

Tech Tools That Help

Even the best-trained staff need strong technical safeguards. Key tools include:

• Email filters and spam protection – block phishing messages before they reach inboxes
• Multi-factor authentication (MFA) – adds a second layer of login security
• Regular software updates & security patches – close vulnerabilities before attackers exploit them
• Endpoint protection, intrusion detection, and data loss prevention – monitor activity and prevent unauthorized access

Simulated phishing tests and periodic risk assessments can help staff recognize real threats and improve your defenses.

Real-World Consequences

Phishing attacks can be costly—financially and legally. For example:

• Solara Medical Supplies, a Durable Medical Equipment company, paid $3 million after attackers accessed 8 employee email accounts via phishing
• The attack exposed ePHI for 114,007 individuals
• OCR investigated the incident, highlighting the need for both staff training and robust technology

Protect Your Practice with TLD Systems

TLD Systems is here to help health care organizations stay ahead of cyber threats. Visit Booth 414 at the FPMA SAM Meeting for assistance implementing a HIPAA Security Plan.

Take home a Phishing Prevention Checklist for Health Care Organizations—a practical resource to help your practice avoid becoming the next victim.

Contact TLD Systems at:

https://www.tldsystems.com

info@tldsytems.com

(631) 403 6687

Or visit us at the FPMA SAM conference booth 414 to pick up the Phishing Prevention Checklist for Health Care Organizations

Final Local Coverage Determinations (LCDs) for Certain Skin Substitutes Withdrawn

https://www.cms.gov/newsroom/fact-sheets/upcoming-update-final-local-coverage-determinations-lcds-certain-skin-substitutes

As we close out 2025, I want to extend my sincere appreciation to every member of the Massachusetts Foot and Ankle Society for your commitment to our profession, your patients, and each other. This has been a year defined by collaboration, progress, and a renewed sense of purpose within our specialty.

MFAS entered 2025 with a clear mission: to strengthen the voice of podiatry in Massachusetts and ensure that our training, expertise, and clinical capabilities are recognized at the full extent of their value. I’m proud to say that we have taken meaningful steps toward that goal, particularly in advancing our scope-of-practice efforts to include the ankle.

Your engagement has made this possible. Whether you attended a meeting, spoke to a legislator, contributed data, offered testimony, or simply stayed informed and supportive, you played a role in moving our profession forward. The unity we have shown this year has been one of our greatest strengths.

We also made strides in education and professional development. Our conferences and CME events were among our most successful to date, offering members access to cutting-edge clinical updates, surgical pearls, and meaningful networking. The energy and engagement at these gatherings made it clear that MFAS is not just an organization—it is a community.

Looking ahead to 2026, we will continue building on this momentum. Our priorities are clear:

• Achieve equitable scope of practice that reflects modern podiatric training and enables comprehensive ankle care.
• Strengthen our advocacy presence on Beacon Hill.
• Expand educational offerings and member engagement opportunities.
• Support the next generation of podiatric physicians through mentorship and leadership development.

As president, it has been a privilege to serve an organization filled with such talented, dedicated, and passionate clinicians. I am grateful for your trust and partnership throughout this year. Together, we are shaping a stronger future for podiatry in Massachusetts—one that truly reflects the full breadth of our profession.

Thank you for all you do for your patients, your communities, and the continued evolution of our specialty. I wish you and your families a healthy, joyful, and prosperous new year.

Warm regards,

Anthony Tickner, DPM
President, Massachusetts Foot and Ankle Society

Among those issues we are working to advance, the Joint Committee on Public Health, as reported in the last update, advanced the Senate version of the podiatric practice act (Senate Bill 1542), sponsored by Senator Cindy Friedman, in September. The MFAS Legislative Committee is happy to report, however, that the Senate bill was then further advanced by the Joint Committee on Health Care Financing, chaired by Senator Friedman, to the Senate Committee on Ways and Means since that time. Further still, since our last update, the Joint Committee on Public Health advanced the House version (House Bill 2407) of the podiatric practice act, filed by Representative Paul Donato. The House measure was then advanced by the House Committee on Steering, Policy and Scheduling to the House Committee on 3^rd Reading. The progress of both bills is already further than that achieved last session. Many thanks to our shareholder partners of the American Podiatric Medical Association; National Medical Association; American Public Health Association, Foot & Ankle Section; numerous individual vascular and orthopedic surgeons, as well as the Alliance for Wound Care Stakeholders, among others.

With respect to another MFAS priority bill, the amputation prevention task force, it was great to see that this first-time filing, sponsored by Representative Jessica Giannino in the House and Senator Sal DiDomenico in the Senate, received favorable reports from the Joint Committee on Public Health. (The House version (HB2433) received a favorable in September; the Senate version (SB1508) received a favorable report in November.). Both matters have been referred to the respective Ways and Means Committee for further review. We are working closely with the American Diabetes Association (ADA) to build a stakeholder coalition to keep this initiative moving forward.

Finally, MFAS’s third priority piece to update the licensing statute’s continuing education language (House Bill 247 / Senate Bill 2470), filed by Representative Mike Kushmerek and Senator John Keenan, respectively, received favorable reports from the Joint Committee on Public Health. This represents a trifecta for MFAS from the Joint Committee on Public Health; many thanks are extended to the Committee Chairs, Representative Marjorie Decker and Senator Bill Driscoll, as well as their hardworking staffs.

Unfortunately, every session seems to involve legislation that, in some manner or another, would harm the podiatry profession in Massachusetts. This session is no different. As MFAS has in the past, it continues to protect the profession from legislative initiatives that would adversely impact the practice of podiatry. This session, the MFAS Legislative Committee is happy to report that initiatives that would have prevented podiatrists from using the term “surgeon” and moving the Massachusetts Board of Registration for Podiatry under the Massachusetts Board of Registration in Medicine have now been put into a study order by the Joint Committee on Public Health. The defeat of these bills, which would have set back the practice of podiatry in Massachusetts, is another reason MFAS remains active on Beacon Hill.

Stay tuned for the additional updates in future newsletters and on social media on MFAS legislative and regulatory work! As always, there are a host of initiatives to get involved in, please let any member of the know of your interest in participating in an area of interest to you. In the meantime, may the end of the year provide MFAS members throughout the Commonwealth the opportunity to spend time with family and friends. We have made a lot of progress on initiatives of importance in 2025, but more work remains in the upcoming year.

It is with great honor, humility, and enthusiasm that I continue the role of President of the Massachusetts Foot and Ankle Society. This organization has a long tradition of excellence, professionalism, and advocacy on behalf of our patients and our profession. To be entrusted with this leadership role at such a dynamic and transformative moment in healthcare is a privilege that I do not take lightly.

Our field of foot and ankle medicine and surgery continues to grow in sophistication and complexity. Advances in reconstructive techniques, wound healing, biomechanics, diagnostic imaging, and evidence-based care have placed us at the forefront of lower extremity healthcare. Yet, as our profession has advanced, our scope of practice in Massachusetts has not always kept pace with our training, our competencies, or the needs of our patients. One of my highest priorities during my tenure as President was to surround myself with great people to do great things! To continue the Society’s longstanding efforts to expand the scope of practice to fully include the ankle. This is not only an issue of professional fairness; it is a matter of public health. Patients deserve seamless, comprehensive care from highly trained specialists who understand the full spectrum of foot and ankle pathology. Achieving this goal will require advocacy, persistence, and a unified voice, and I am confident that, together, we will rise to the challenge. You’d also be surprised with the number of our orthopedic colleagues who are becoming more amenable to these changes. 

Another key focus for the coming year is education and engagement. Our Society’s strength has always been its members—diverse, highly skilled professionals who are committed to lifelong learning and to advancing the art and science of our specialty. We will continue to expand opportunities for continuing education, research, and collaboration, with special attention to our younger colleagues and residents. Poster sessions, research presentations, and the complications conference at the Region One meeting will serve as vital platforms for learning and mentorship, ensuring that the next generation of leaders is well-prepared to carry our profession forward.

I also wish to acknowledge and thank our dedicated Board of Trustees, whose collective expertise, guidance, and hard work sustain our Society. Their contributions, both seen and unseen, make our successes possible. 

A particular note of gratitude is owed to Dr. Tyler Silverman for his leadership in developing and executing the 2024 webinar series, which has significantly broadened our educational outreach and reaffirmed our commitment to accessible learning for all members. Dr. Silverman is one of the first people to ‘jump’ on an opportunity to advance our organization as soon as an idea is brought up. 

I’d also like to give kudos to David Sipala, our MFAS President-Elect. Dr. Sipala is not only a talented foot and ankle surgeon and residency director, he also goes above and beyond to get the job done in anything he does. We are lucky to have him and he’s well equipped for the next chapter in his MFAS tenure! 

Lastly, I’d like to acknowledge Dr. Frank Campo for his involvement over the many years. Dr. Campo is not only the Region One president but he’s a great guy. 

Thank you to our legal counsel and our management company, our awesome board and our sponsors and members! It truly is a group effort. We appreciate all you do! 

As we look to the future, I believe the Massachusetts Foot and Ankle Society is uniquely positioned to advocate for our patients, to elevate the standard of care, and to strengthen the visibility and influence of our profession. I invite each of you to join me in this important work. Whether through participation in our meetings, engagement with our committees, mentoring a resident, or reaching out to legislators and stakeholders, your contributions matter. 

Thank you for your trust, your commitment, and your dedication to excellence. It is an honor to serve as your President, and I look forward to working alongside each of you in the year ahead. Please don’t forget to register for the APMA Region One Meeting 10/24-10/25 in Waltham, MA. Please email Karen Murphy to get the link or go to massfootandankle.org 

With deepest respect and gratitude,

Anthony Tickner, DPM
President, Massachusetts Foot and Ankle Society

In mid-September, MFAS worked with the American Podiatric Medical Association (APMA) as the APMA’s Advocacy Summit was held in Boston on Thursday, September 18^th and Friday September 19^th. Working to complement the APMA’s work in securing a slate of strong speakers, MFAS secured a variety of legislative and state policy speakers for the two-day event that brought podiatric policy minds from across the country together to discuss advocacy goals and objectives. Representative Tackey Chan, House Chair of the Joint Committee on Consumer Protection and Professional Licensure, and Dr. Tyler Silverman kicked off the first panel by looking at specific issues – whether related to licensure compacts or professional board oversight by agencies. Former House Ways and Means Chair Jeff Sanchez and Dr. David Sipala, using the Commonwealth’s Health Equity Compact, which has made incredible strides in bringing people together to address disparities in the provision of health care services, as. model, discussed how engaging stakeholders consistently and in partnership can make a significant difference in addressing problems plaguing our health care system.

Using Massachusetts as an example, Doug Howgate, President of the Massachusetts Taxpayers Foundation (MTF) and Alex Sheff, Federal Director of Health Care for All, Massachusetts (HCFAMA), led by two-time moderator Dr. Silverman, kicked off Friday’s MFAS panel on the impact federal actions will have on state Medicaid budgets. It quickly became apparent that MFAS, as well as other state podiatry associations, will need to be active in their engagement with state Medicaid programs in the coming months and years. To that end, it was a great moment to have Senate Assistant Majority Leader Sal DiDomenico participate on a panel and share his thoughts on how to create lasting legislative champions and the best strategies for engaging with staff and electeds. (Note: MFAS Legislative Committee members Dr. David Alper and Dr. Susan Walsh did yeoman’s work speaking about amputation prevention and modifier-25 legislation as panelists!). Many thanks to all the speakers, but a special shout to Representative Chan, Mr. Howgate, Mr. Sheff and Senator DiDomenico and his aide, Yoshki Wurtz, for taking the time to participate in this informative two-day summit.

Inside the State House, MFAS continues to push for the passage of its three priority bills – the podiatric practice act, the amputation prevention task force and an amendment to the continuing education requirements. To that end, we have seen some early progress on a couple of these matters. The Joint Committee on Public Health has advanced the Senate version of the podiatric practice act (Senate Bill 1542), sponsored by Senator Cindy Friedman, while it continues to look at the House version (House Bill 2407) of the same filed by Representative Paul Donato. With respect to the amputation prevention task force, it was great to see this first-time filing, sponsored by Representative Jessica Giannino, have the House version (House Bill 2433) of the bill get a favorable from the Joint Committee on Public Health. The Senate version (Senate Bill 1508), sponsored by Senator DiDomenico, is still under consideration by the Committee. Finally, no action has yet to be taken on either of the MFAS initiatives to amend the licensing statute’s continuing education language (House Bill 247 / Senate Bill 2470), which were filed by Representative Mike Kushmerek and Senator John Keenan, respectively.

Additionally, the MFAS Legislative Committee, which has expanded its outreach and support for other initiatives impacting the profession, specifically, and health care providers, generally, has recently submitted written testimony in support of the modifier-25 legislation, House Bill 4338, An Act to Reduce Inequities in Access to Medical Procedures, which is now before the Joint Committee on Health Care Financing. The legislation, of which MFAS joined with over ten other medical specialties in submitting testimony earlier in the session, was released with a favorable report by the Joint Committee on Financial Services. Along the lines of supporting matters that impact all health care providers, MFAS recently submitted written testimony in support of Senate Bill 1718, An Act Requiring Health Care Employers to Develop Plans for Preventing Workplace Violence. The legislation, which is currently before the Senate Committee on Ways and Means, will institute a series of measures to make workplaces safer for practitioners and staff when confronted by violent patients.

Stay tuned for the additional updates in future newsletters and on social media! The MFAS Legislative Committee continues to build partnerships with other health care professional organizations as we broaden the scope of our work. As always, there are a host of initiatives to get involved in, please let any member of the MFAS Legislative Committee know of your interest in participating in an area of interest to you.

A Statement from APMA President Brook Bisbee, DPM

David Thordarson, MD, president of the American Orthopaedic Foot and Ankle Society (AOFAS) recently published an editorial to the members of the American Academy of Orthopaedic Surgeons (AAOS) titled "Protecting musculoskeletal care: Perspective of the president of the American Orthopaedic Foot and Ankle Society." In this article, Dr. Thordarson exhorts his colleagues to engage with hospital credentialing committees as well as lawmakers and health-care leaders about the differences between orthopaedic and podiatric training "to prevent scope creep."

Dr. Thordarson's article is riddled with misleading messages, exaggerations, and outright falsehoods. He references decades-old studies to support his argument. In an era in which science itself is under attack, physicians must hold themselves to an even higher standard for truth and accuracy.

APMA addresses individual inaccuracies in "Protecting musculoskeletal care" below. On behalf of our member podiatric physicians and surgeons, APMA demands that AAOS and AOFAS rescind this deceptive article.

Podiatry's Proven Value

Dr. Thordarson notes that a 2024 analysis showed that orthopedic surgeons provide foot and ankle care with lower costs and fewer complications. The cost differences noted in the study Dr. Thordarson quoted were marginal, and the research had methodological flaws that impact the author's findings, as detailed in a letter to the editor published in May in Foot and Ankle International.

Regardless of cost, value in health care is defined by outcomes and patient safety. A nationwide Pearl Diver analysis of 130,982 older adults with ankle osteoarthritis found that patients undergoing total ankle arthroplasty (TAA) were 51-percent less likely to fall over an 11-plus year follow-up than those managed non-surgically. This finding reinforces that ankle surgery, such as that performed by podiatrists, improves long-term health and reduces downstream costs.

Another Pearl Diver study covering 2010–2023 demonstrated that TAA outcomes did not differ by surgeon specialty: The risk of revision, 90-day readmission, infection, and venous thromboembolism did not differ between podiatric and orthopedic surgeons. TAA survivorship is not associated with surgeon specialty; thus, care provided by podiatrists is just as safe and effective as TAA performed by other surgeons.

The current evidence is clear—podiatric surgeons deliver care that is safe and effective.

Specialized Training = Unmatched Expertise

Dr. Thordarson diminishes podiatric training for its concentration on the foot and ankle. Podiatrists, just like other physicians and surgeons, undergo three years of mandatory, hospital-based residency training, with optional fellowships for further specialization. Podiatric education also, by necessity, covers systemic health care. In fact, podiatric medical students often learn alongside MD and DO students.

Podiatric residency training is uniquely focused on the foot and ankle compared to the broader training orthopedic surgeons receive. This concentrated training produces experts from day one, with foot and ankle surgical case volumes often exceeding those of non–fellowship-trained orthopedists.

The latest outcomes research proves that this training translates into clinical equivalence between DPMs and MDs and DOs, and, in certain areas such as limb preservation, superiority for DPMs.

It is no wonder, then, that so many orthopedic practices employ podiatric surgeons to manage foot and ankle cases, or that the federal government recognizes podiatrists as physicians. Podiatrists manage patients and develop strong patient-centered relationships with our vascular surgery, internal medicine, endocrinology, rheumatology, and orthopedic colleagues.

Scope Modernization Reflects Trust, Not Turf

State legislatures modernize podiatric scope of practice because of decades of demonstrated safety and quality care. These expansions improve patient access in communities underserved by fellowship-trained orthopedists.

Recent evidence confirms no increase in complications when podiatrists perform certain ankle procedures, directly rebutting claims that scope expansion endangers patients.

Legislatures and hospitals modernize scope of practice laws and privileges for podiatrists consistent with the advancements in podiatrists' education and training: four years of medical education, national boards, three years of residency, and lifelong CME. Podiatrists' education and training mirrors the rigor of MD and DO training.

It is problematic to suggest that not only legislators but also hospital medical staff would advance scope of practice laws or hospital privileges without sound evidence of patient safety and quality outcomes.

Dr. Thordarson reverts to scare tactics, suggesting that podiatric scope may soon include the knee or hip. As noted by Dr. Thordarson, in a few limited states, podiatrists can treat the hands, but contrary to his assertion, podiatrists are not authorized to perform invasive surgical treatments of the hand. Treatment of the hand is limited to superficial lesions, such as warts.

Residency Growth = Access for Patients

Dr. Thordarson bemoans the fact that podiatry residency training positions are uncapped by CMS. While orthopedic residency slots are capped, podiatric residencies are not—allowing the profession to meet urgent workforce needs. With nearly 40 million Americans projected to have diabetes by 2030, the demand for limb salvage and reconstructive surgery will rise sharply.

Each year, millions of older people—those 65 and older—fall, making podiatrists vital resources to assess fall risk and implement life-saving measures to protect patients from falls.

Podiatric residency expansion ensures patient access to surgical care in both urban and rural settings. More podiatric residents mean more innovation, scholarship, and patient care capacity—critical for addressing the national physician shortage.

Collaboration Over Competition

Patients benefit most when specialties work together, not compete. Podiatrists bring unmatched expertise in diabetic limb salvage, biomechanics, minimally invasive surgery, and reconstructive foot and ankle care.

Orthopedists bring broad musculoskeletal training.

Together, we can partner on CME, collaborate on high-quality research, and develop co-management and referral pathways that elevate musculoskeletal care for all patients.

Conclusion: Standing Proud as Podiatric Physicians

The latest evidence confirms what patients and payers already know: Podiatrists deliver safe, effective, cost-saving care.

Our outcomes in total ankle arthroplasty are equivalent across specialties. Our surgeries and services reduce long-term risks such as falls in older adults. Our residency growth ensures that patients will not be left behind in a time of national physician shortages.

APMA stands firmly behind the care our members provide: Podiatry is not just protecting musculoskeletal care—it is advancing it.

References

1. Fleischer A, Albright R, Jetty I, Tower D, Hook J, Weil L Jr. How Does Total Ankle Arthroplasty Affect Fall Risk?: A Nationwide Database Study of 130,982 Older Adults with Ankle Osteoarthritis. J Foot Ankle Surg. 2025; Epub ahead of print. PMID: 40588119 .
2. Fleischer AE, Albright RH, Patel K, Santiago H, Hook J, Tower D, Weil L Jr. Risk of revision and other complications in total ankle arthroplasty do not differ by surgeon specialty: Analysis of the Pearl Diver healthcare claims database from 2010 to 2023. J Foot Ankle Surg. 2025; Epub ahead of print. PMID: 40639434 .
3. Chan JJ, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Vulcano E. Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty. J Bone Joint Surg Am. 2019;101(2):127-135. PMID: 30653042 .
4. Reeves CL. American College of Foot and Ankle Surgeons Commentary on Surgeon Type and Outcomes After Inpatient Ankle Arthrodesis and Total Ankle Arthroplasty: Chan et al, J Bone Joint Surg 2019;101:127-135. J Foot Ankle Surg. 2019 Sep;58(5):1051. doi: 10.1053/j.jfas.2019.07.006 . PMID: 31474394.
5. Nixon D, Ko H, Martin B. Impact of Surgeon Type on Total Ankle Arthroplasty Readmission, Complication, and Infection Rates. Foot Ankle Orthop. 2024;9(2):2473011424S00075. PMCID: PMC11015809 .
6. Albright R, DeHeer P, Tower D. Letter Regarding: A Retrospective Cohort Analysis Comparing the Costs of Ankle Fracture Fixation in Orthopaedics and Podiatry in a U.S. Medicare Limited Data Set. Foot & Ankle International. 2025;46(5):571-572. doi: 10.1177/10711007251330603 .
7. Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg. 2020 Apr;37(2):327-369. doi: 10.1016/j.cpm.2019.12.005 . Epub 2020 Jan 30. PMID: 32146988.
8. Sadra S, Fleischer A, Klein E, Grewal GS, Knight J, Weil LS Sr, Weil L Jr, Najafi B. Hallux valgus surgery may produce early improvements in balance control: results of a cross-sectional pilot study. J Am Podiatr Med Assoc. 2013 Nov-Dec;103(6):489-97. doi: 10.7547/1030489. PMID: 24297985 ; PMCID: PMC4815263.
9. Yalla SV, Crews RT, Fleischer AE, Grewal G, Ortiz J, Najafi B. An immediate effect of custom-made ankle foot orthoses on postural stability in older adults. Clin Biomech (Bristol). 2014 Dec;29(10):1081-8. doi: 10.1016/j.clinbiomech.2014.10.007 . Epub 2014 Oct 30. PMID: 25467809.

Dear Colleague,

APMA has just launched a major compensation survey, and we want to be sure you saw it. We strongly encourage our physician members to complete the survey, and our executive members to share it widely with their members. The more responses we collect, the more accurate and comprehensive the data will be.

This information is critical to our advocacy efforts by:

• Showing policymakers the real story on on-call pay and work RVUs

• Equipping younger members with tools to negotiate strong contracts

• Providing a complete picture of compensation and benefits across the profession

The survey takes only about five minutes. Physicians, once you’ve completed it, please share it with your colleagues so we can capture as many voices as possible.

Thank you for your continued commitment to our committees and for helping advance this important data collection effort.

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would increase quality care for Medicare recipients while significantly reducing unnecessary spending. The calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) proposed rule would advance primary care management through new quality measures, reduce waste and unnecessary use of skin substitutes, and introduce a new payment model focused on improving care for chronic disease management.

Medicare spending on skin substitutes has had unprecedented growth, rising from $256 million in 2019 to over $10 billion in 2024, according to Medicare Part B claims data. This dramatic spending increase is largely attributed to abusive pricing practices in the sector, including the use of products with limited evidence of clinical value. In one notable case, the CMS Fraud Defense Operations Center stopped more than $1 million in improper payments for skin substitutes to a medical group practice. The practice was submitting Medicare claims for wound care services allegedly performed by the owner, a psychiatrist.

CMS currently treats skin substitutes as biologicals for the purposes of Medicare payment, which can reach as high as $2,000 per square inch. CMS is proposing to pay for skin substitutes as incident-to supplies, a change expected to reduce spending on these products by nearly 90%. These proposed savings would not come at the expense of patient access or quality of care. If finalized, this will save billions for Medicare and taxpayers and incentivize the use of products with the most clinical evidence of success. 

CMS calls a measure topped-out when:

• Median performance rate is 95% or higher, and
• Variation between high and low performers is minimal (often defined by CMS statistical testing).

Why CMS Flags Them

If nearly everyone scores near 100%, the measure stops being useful for distinguishing quality among clinicians.
For example, if 99% of clinicians meet the standard for a measure, it’s not an effective differentiator for incentives.

Scoring Impact

• Alternative (flat) benchmarks are applied — so even perfect performance may not earn the full 10 points in
  the Quality category.
• Instead, scores might be capped — e.g., perfect reporting on a topped-out measure could give only 7 points.
• Once a measure is topped-out for 3 consecutive years, CMS may remove it from the MIPS inventory unless
  it’s clinically critical or tied to another policy requirement.

An important part of MIPS is selecting the measures that fit best for your practice.  Among the considerations
when selecting measures is ‘Are they topped out?’. Keeping up to date with the Topped Out list an be very helpful when
selecting your measures, or even when evaluating an EHR system to see if they support measures that are best for
your practice.

Here are the 19 quality measures that CMS is proposing to designate as “topped-out” for the 2026 performance year
under the Physician Fee Schedule (PFS). These will receive flat, alternative benchmarks due to limited measure choice
and high performance ceilings in certain specialty sets and MVPs.

The following are the Quality IDs and descriptive titles:

1. Quality ID 141: Primary Open-Angle Glaucoma — Reduction of IOP by 20% OR Documentation of a Plan of Care
2. Quality ID 143: Oncology: Medical and Radiation – Pain Intensity Quantified (eCQM/MIPS CQM)
3. Quality ID 144: Oncology: Medical and Radiation – Plan of Care for Pain (MIPS CQM)
4. Quality ID 249: Barrett's Esophagus (Medicare Part B Claims/MIPS CQM)
5. Quality ID 250: Radical Prostatectomy Pathology Reporting (Medicare Part B Claims/MIPS CQM)
6. Quality ID 320: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients (Medicare Part B Claims)
7. Quality ID 350: Total Knee or Hip Replacement: Shared Decision-Making: Trial of Conservative (Non-surgical)
   Therapy (MIPS CQM)
8. Quality ID 351: Total Knee or Hip Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation (MIPS CQM)
9. Quality ID 360: Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High-Dose Radiation Imaging
   Studies: CT and Cardiac Nuclear Medicine Studies (MIPS CQM)
10. Quality ID 364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for
    Incidentally Detected Pulmonary Nodules According to Recommended Guidelines (MIPS CQM)
11. Quality ID 395: Lung Cancer Reporting (Biopsy/Cytology Specimens) (Medicare Part B Claims/MIPS CQM)
12. Quality ID 396: Lung Cancer Reporting (Resection Specimens) (MIPS CQM)
13. Quality ID 397: Melanoma Reporting (Medicare Part B Claims/MIPS CQM)
14. Quality ID 405: Appropriate Follow-Up Imaging for Incidental Abdominal Lesions (MIPS CQM)
15. Quality ID 406: Appropriate Follow-Up Imaging for Incidental Thyroid Nodules in Patients (Medicare Part B
    Claims/MIPS CQM)
16. Quality ID 430: Prevention of Post-Operative Nausea and Vomiting (PONV) — Combination Therapy (MIPS CQM)
17. Quality ID 440: Skin Cancer: Biopsy Reporting Time — Pathologist to Clinician (MIPS CQM)
18. Quality ID 463: Prevention of Post-Operative Vomiting (POV) — Combination Therapy (Pediatrics) (MIPS CQM)
19. Quality ID 477: Multimodal Pain Management (MIPS CQM)

These measures will use the topped-out benchmark approach in scoring to avoid skewed incentives from measures
that have reached high performance plateaus

The currently “Topped Out Measures”  that are subject to a 7 point cap include:

Please find attached a letter from Bureau of Health Professions Licensure Director James Lavery informing you of a new partnership that the Department of Public Health has entered into with The Fenway Institute at Fenway Health to further improve the visibility, availability, and applicability of educational resources and trainings to improve care for the LGBTQIA+ community. 

If you have any questions about this initiative, please feel free to contact the Bureau of Health Professions Licensure at bhpl-policy@mass.gov.  

Kind regards, 

Department of Public Health
Bureau of Health Professions Licensure
250 Washington St., 1^st Floor 
Boston, MA  02108 

APMA is pleased to report that Optum has reversed its decision to reclassify podiatrists. APMA thanks Optum for recognizing that podiatrists are independently licensed physicians who undergo specialized education and training and reaffirming the vital role podiatrist play in advancing clinical outcomes and caring for their patients.

When news first broke of Optum's proposed reclassification, APMA, state component societies, and members sprang into action. APMA is proud to lead this collective advocacy effort and thanks state components, societies, members, and other stakeholders for their strong and relentless advocacy on behalf of the entire profession and patients.

As APMA champions our members on Capitol Hill, we need your support more than ever! Join us in making your voice heard and stepping up for the profession. The Senate recently released their version of the Budget Reconciliation Bill and aims to pass it by the July 4th holiday. Use APMA eAdvocacy to tell your elected officials to support podiatry’s priorities, including Medicare physician payment reform, patient access through Medicaid, small health-care practice tax concerns, and student loan relief.

CONTACT YOUR SENATORS