Guest guest Posted December 5, 2004 Report Share Posted December 5, 2004 This is a forwarded message from Harvey Kaltsas to David Molony. Thanks for posting. ------------------- Dear Dave, Richard Freiberg apparently doesn't understand that you're trying to do the best you can with the coding situation. What you don't understand is that Richard is a tactical and stategic genius and that AAOM and the other State acupunctture organizations should be following his lead and advice on these matters, because he does see the situation very clearly and he has the brass balls and legal savvy to challenge the medical/governmental power structures to win on this and other issues important to our profession. To make it simple for everyone else who might join this e-mail conversation, let's give the ball to Richard Freiberg on this issue, let him quarterback the team. Meanwhile, Kanaya is moving forward, and in about 16 months I will have some real momney to put back into our profession's lobbying efforts. Keep up your good work Dave. Harv *Acupuncturist proves it doesn't take a developer to dream* > > By MICHAEL POLLICK from the Front page of last Sunday's Sarasota Herald Tribune > SARASOTA -- Meet the most leveraged man in Southwest Florida. > > His mortgage broker, Robert H. Rogers, with his client standing right > there listening, bluntly points out that acupuncturist Harvey Kaltsas > is a guy who makes $80,000, maybe $100,000 a year, has no history as a > developer, but has now received a bank's commitment for a $24 million > condominium construction loan. > > " It's true, " said Kaltsas, smiling calmly, as if the thought were in > some way amusing. " I'm more leveraged than anybody in America right now. " > > The 57-year-old owner of his own acupuncture clinic isn't building > just any condo. > > From the creation of its name, " Kanaya, " to its rooftop gardens, the > building is feng shui-inspired and designed to promote the well-being > of its inhabitants. > > It was no easy journey getting to where he is now, with big-time > builder W.G. Mills poised to start sinking the pilings for $40 million > worth of construction, including Kaltsas' own future dwelling, the > ninth-floor southwest corner unit. > > Part of Kaltsas' success is good timing. > > The once seedy Orange Avenue property where he moved his acupuncture > practice in 1992 has blossomed into a real estate hot zone, with > beat-up four-plexes going for three-quarters of a million bucks. > > Later, with his condo project growing in mind, he had to borrow money > from friends and relatives to buy enough adjacent land to build > straight up. Then he had a tough time finding a lender. > > " There were times I was just about ready to say to hell with it, " > Kaltsas recalled. > > Not any more. > > On Tuesday, in the hallway of his Oriental medicine clinic on Morris > Street, he attached a paper gold star to a poster-size drawing of the > building. > > He had just received a 20 percent down payment on a 10th-floor unit > listed at upwards of $1 million. It was the 27th sale for the > project's 35 residential units. > > Now, instead of listening to the polite rejections of bankers, Kaltsas > is busy listening to buy-out offers. > > But, as he has from the beginning, the acupuncturist-turned-developer > insists on maintaining control of his beloved Kanaya. > > " I'm not going to become a mega-mega developer, but if I can inspire > them, that's what I'd really like to do, " he said. > > *Feng shui* > > The words " feng " and " shui " are Chinese for wind and water. > > Like the Oriental medicine Kaltsas practices, feng shui is an art > developed over thousands of years of civilization. > In this case, the art is the proper placement of objects. You are > engaging in a feng shui exercise when you move a plant in your living > room to somewhere that makes you feel happier. > > Now imagine making an entire apartment building that follows hundreds > of subtle guidelines. > > Layer on top of that a building in which nearly every New Age health > concern has been addressed, from electromagnetic radiation to > filtering the air-conditioning air. > > You're starting to get the idea of Kanaya. > > A year and a half from now, Sally and Roger Betts will have moved into > Kanaya from Punta Gorda, where they have owned a home for the past 12 > years. > > They will drive into the building from Orange Avenue and take a > private elevator to their apartment, the center unit of three on the > fifth floor. > > They won't see the shielded electrical course that makes its vertical > run near the east end of the apartment, keeping electromagnetic > radiation as far away as possible from their master bedroom, which is > near the west or bay side of the apartment. > > When the weather is right, opening the doors onto two large balconies, > facing east and west, will send breezes through their home. When it's > too hot or too humid for that, their apartment will be refreshed by a > high-efficiency air-conditioning system that brings in 15 percent > fresh air as part of its mix after it has run it through a heavy-duty > set of filters. > > An ultraviolet lamp inside the air conditioner will make sure that no > mold grows on the cooling coils. > > In keeping with feng shui design principles, exposed wall corners will > be rounded, not sharp. > > In the kitchen, the sink and stove, representing fire and water, will > be arranged so they are not directly opposite each other. > > " The stove is a fire element. The sink is water. What does the water > do to the fire? It puts it out. So two conflicting elements in a room > causes arguments. It can cause illness, " said Katrine Karley, founder > of Sarasota's Absolute Harmony Feng Shui Inc. and a consultant to > Kanaya from its very inception. > > Karley even named it. > > Kaltsas was going to call it something like " Ringling Court Tower. " > Karley said forget it, and began a feng shui process to make up the name. > > " It cost $3,000 just to come up with the name, " Kaltsas said. " I know > it sounds flaky, but it's worth it. The name is really important. " > > Inside, Kaltsas has gone to extremes (measured in the > * *Page 3) > . . . hundreds of thousands of dollars) to make the dwellings quiet, > with each one insulated from the sound of the others. > > The techniques include an engineered wallboard called QuietRock and > cast iron drain pipes instead of PVC pipes. The drain pipes alone cost > an extra $50,000. > > " That is not much money, " Kaltsas says, repeating a constant refrain. > " Otherwise, you are listening to people flush their toilets all day > long. Think of it. It is like a waterfall, 150 feet tall. " > > Kanaya has much more to offer than solid plumbing. > > For example, architect Don Lawson and Karley turned the rooftop into a > community living space, with herb gardens, kitchens and shady vistas. > > " Immediately I knew this was the right place for us, " said Sally > Betts, a student of what she calls energy medicine, meaning the > treatment of the inner body through energy. > > *A path of his own > * > Kaltsas' father, a Boston-based Greek immigrant and entrepreneur, > wanted his son to become a lawyer, but he lasted exactly six weeks at > Boston University School of Law before dropping out. > > The younger Kaltsas took up macrobiotics, studied Oriental medicine, > and started his own commune on a 155-acre farm he bought with his own > money in Saskatchewan, Canada. > > He apprenticed in acupuncture with a Chinese doctor in Boston and had > practices in Tucson, Ariz., and in the Northeast before settling down > in Sarasota in the early 1980s. > > His sister had already been living on Siesta Key for seven years when > Florida liberalized its laws for the practice of acupuncture in 1981. > > " She had always urged me to come down, " Kaltsas said. " When I found > out I could actually practice acupuncture without an M.D. supervising, > it was a no-brainer. " > > It wasn't until 12 years later, in 1993, that Kaltsas began indulging > his taste for commercial property ownership. > > He bought the old house on Orange that year because it was the > cheapest place near downtown. > > But the check writing didn't start in earnest until December 2001. > > At that point, Kaltsas had a half-acre along Orange that had cost him > roughly $500,000, and he began hiring experts to determine what he > could build on it. > > He soon realized that to combine parking with a large building, it > would help if he had a bigger site, say three-quarters of an acre. > > In April 2003, he took the big gulp, paying more for a couple of lots > behind his property -- land with no commercial frontage -- > than he paid for what should have been the most expensive property, > the land along Orange. > > Kaltsas borrowed money from his sister and business partner Cynthia > Kaltsas, then paid $765,000 for 1622 Laurel Ave. and 520 Rawls Ave. > > So there he was with enough land to do something big, and some > drawings for a building, but he had a tough time finding a banker who > would listen. > > " Basically they were saying 'Look, you don't have any experience. > You're not a builder. Your personal financial statement doesn't > support a $24 million loan, so you would have to take on a partner who > will co-sign with you,' " Kaltsas said. > > Then somebody told him he could borrow money from an insurance > company. He got involved in a yearlong process with one of them, but > when push came to shove, they raised the bar to an unrealistic level, > asking him to show $12 million in cash to get the $24 million. > > " He has had to go so far out on a limb, that was my biggest fear with > Harvey, was his health, " said Kaltsas' friend, fellow acupuncturist > Thomas McCormack. > > He and Kaltsas are the same age, 57. > > " Day after day, you have to get up and know that everything you own is > at risk. It is extremely stressful. So I'm always looking at Harvey's > tongue. In Chinese medicine, that is one of the ways we determine > somebody's health. " > > So how does it look? > > " Harvey is holding up very well, " McCormack said. " He can > compartmentalize, which most people can't. " > > Saving grace > > During what has been a prolonged period of seeking construction > financing, what saved Kanaya was that the value of the property not > only continued to rise, but accelerated quickly in value. > > As property values downtown and in the residential area " West of the > Trail " skyrocketed throughout the '90s, Orange Avenue became less > seedy in the eyes of home buyers and investors. > > From 2001 to 2003, what is now the Kanaya property rose in value by > about $1 million. > > In April 2003, when Kaltsas received an entitlement to build from City > Hall, the appraised value soared to $3.4 million. > > " That is insane; it's insane, but it's true, " said Kaltsas, his voice > climbing an octave, as it does when he gets exuberant. > > It was in January that Robert H. Rogers, founder of First Nationwide > Mortgage, found Kaltsas. > > Rogers had worked for a couple of big lenders before dropping out, > then opening his own firm. He knows how to talk the talk. > > Kaltsas " had been. n working with another company that was really just > stringing him along. As he is going along, he is still spending money, > money he doesn't have, " Rogers recalled. > > " He was primed for a development to go up, but everybody knew he > didn't have any money. Developers were circling around him. He was > still going to walk away with money, but he was primed for getting his > butt beat. " > > At this point, Kaltsas owed fees in the hundreds of thousands to his > architectural firm and his law firm, Lawson Group and Icard Merrill. > > " To Don Lawson's credit, he carried this project. Icard Merrill too. > They all carried the project without payment. Bottom line, everybody > knew there was value in the real estate and value in the project. " > > For his part, Lawson didn't have to bother with Kaltsas or Kanaya. He > has designed such monumental projects as Sarasota Bay Club and is a > lead designer in the Ringling Museum expansion. > > He just got hooked on Kaltsas' concept for Kanaya. > > " We thought, this could be an example that others could really look at > and benefit from, " Lawson said. " We just thought, 'We are going to > make this work, whatever it takes.' " > > Meanwhile, Rogers did 47 presentations just to get a bridge loan of > $2.5 million in the spring. With that as breathing room, he convinced > Orion Bank to commit to the $24 million construction loan that is > about to be issued. > > " It was a job, " he said. " The problem was, everybody who had the > horsepower to make the investment, they wanted to buy the project. " > > On the poster-sized rendering of the building with all the apartment > numbers written in, Kaltsas points to the one he plans to live in, No. > 1203. > > It would be priced at $1,585,000 if it were for sale. > > " You know, I couldn't afford to live in this building unless I were > building it. I would have to work 17 years as an acupuncturist and put > every cent into it, and that's without eating. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2004 Report Share Posted December 5, 2004 Laura As to reimbursements it is NOT a violation of RICO to tell you the meaning and purpose of the facts and figures that have been negotiated and put into place on all of our behalf. Those numbers are related to how you might be reimbursed and has little to do with what you might charge for your services. These are guidelines PUT into place by the profession's largest competitor. Amazing don't you think? Arrogant is more like it. Richard In a message dated 12/5/2004 12:12:30 PM Eastern Standard Time, acuman1 writes: David Wells' replies: Dear Laura, I only used the example of 20 patients a day in the article I wrote to acupuncturists such as yourself on the email list of AAOM. No indication of a normal daily work load was given to the AMA's Relative Unit Committee. The information that led to the work value of the codes was derived from a survey of acupuncturists across the country. We never asked how many they see in a day. We only asked what steps they took and how many minutes was required for each step to perform a standardized treatment. I was not one of the acupuncturists surveyed, nor was anyone on the committee. In regards to your question about a range of reimbursement, neither I nor the association can even suggest a range of numbers. Any hint of guidance in this regard is considered " collusion " and is punishable under the federal Racketeering and Corrupt Organizations Act (RICO). Sorry. That's why I gave a suggestion as to how you might arrive at a fair market price on your own. David Wells and Dear Dave Molony, I don't know what Richard is referring to and cannot comment on the accuracy of the statement regarding Florida or New Mexico (presumably their work comp systems). All I know is the Medicare conversion factor, which is 37.8925. This equates to a paltry $22.74 for the initial 15 minutes of acupuncture. However, the Medicare fee schedule is considerably below market. I addressed the issue of " what to charge and what will they pay me? " in my article. Personally, I do not base my charges on what someone other than the patient is willing to pay. Regards, David Wells So there you have it. If you are going to do a medicare only practice using only acupuncture and not doing an examination deep enough to qualify for E & M coding or a second acupuncture 15 minutes (such as a second side), you have to treat a lot of patients, similar to my clinical training in China, where I was in a room of 8 tables and rotated thru them with a nurse staying ahead of me taking needles out. Needless to say, I don't have that style of practice today, but some may want to. Let's face it. When a government is involved (nationalized healthcare?), people get less personalized care. Now, is this something we should not have done? If we didn't participate, it would have been worse yet. As I said earlier, I am still a BIG proponent of the ABC codes, as is the AAOM, I assume (I am writing this personally and not as a rep of AAOM, so I cannot pretend to provide their take on this). Use the ABC codes every time you send insurance billing out, and use CPT as a backup, but learn how to use it too your best ability by taking a course on coding and working with your state and national organization to bring your scope up to par so that you can bill for items other than acupuncture alone, if you use those things, you should bill for them. For instance, cupping is vasopnumatics. I suspect that there will be organizations providing educational programs on coding for acupuncture coming out of the woodwork soon. David Molony 101 Bridge Street Catasauqua, PA 18032 Phone (610)264-2755 Fax (610) 264-7292 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2004 Report Share Posted December 5, 2004 Laura As you can see there are many ways to twist the information. The most information you have will enable you to SEE the truth and the inevitable. We all should know by now that Medicare still doesn't pay for acupuncture nor do they reimburse acupuncturists for any kind of treatment or visits. Thats WHY AOMNC is moving forward with the Federal Acupuncture Bill which this year closed out legislative session with 63 co-sponsors with no help from any other state or national AP/OM organizations. Next year will be even more and soon we will get the Bill heard in the appropriate committees. Dave Molony posts a response from the AAOMs David Wells... " All I know is the Medicare conversion factor, which is 37.8925. This equates to a paltry $22.74 for the initial 15 minutes of acupuncture. However, the Medicare fee schedule is considerably below market. " This is only part of the truth. What is not said is 'HOW goes Medicare GOES the rest of the reimbursement marketplace'. Medicare rates most USED as a guideline. You wait and see the denials and short payments that start after 1/1/05. And if you inquire deep enough you will be told.....'medicare only pays $22.74 so therefore.......' Richard In a message dated 12/5/2004 12:12:30 PM Eastern Standard Time, acuman1 writes: David Wells' replies: Dear Laura, I only used the example of 20 patients a day in the article I wrote to acupuncturists such as yourself on the email list of AAOM. No indication of a normal daily work load was given to the AMA's Relative Unit Committee. The information that led to the work value of the codes was derived from a survey of acupuncturists across the country. We never asked how many they see in a day. We only asked what steps they took and how many minutes was required for each step to perform a standardized treatment. I was not one of the acupuncturists surveyed, nor was anyone on the committee. In regards to your question about a range of reimbursement, neither I nor the association can even suggest a range of numbers. Any hint of guidance in this regard is considered " collusion " and is punishable under the federal Racketeering and Corrupt Organizations Act (RICO). Sorry. That's why I gave a suggestion as to how you might arrive at a fair market price on your own. David Wells and Dear Dave Molony, I don't know what Richard is referring to and cannot comment on the accuracy of the statement regarding Florida or New Mexico (presumably their work comp systems). All I know is the Medicare conversion factor, which is 37.8925. This equates to a paltry $22.74 for the initial 15 minutes of acupuncture. However, the Medicare fee schedule is considerably below market. I addressed the issue of " what to charge and what will they pay me? " in my article. Personally, I do not base my charges on what someone other than the patient is willing to pay. Regards, David Wells So there you have it. If you are going to do a medicare only practice using only acupuncture and not doing an examination deep enough to qualify for E & M coding or a second acupuncture 15 minutes (such as a second side), you have to treat a lot of patients, similar to my clinical training in China, where I was in a room of 8 tables and rotated thru them with a nurse staying ahead of me taking needles out. Needless to say, I don't have that style of practice today, but some may want to. Let's face it. When a government is involved (nationalized healthcare?), people get less personalized care. Now, is this something we should not have done? If we didn't participate, it would have been worse yet. As I said earlier, I am still a BIG proponent of the ABC codes, as is the AAOM, I assume (I am writing this personally and not as a rep of AAOM, so I cannot pretend to provide their take on this). Use the ABC codes every time you send insurance billing out, and use CPT as a backup, but learn how to use it too your best ability by taking a course on coding and working with your state and national organization to bring your scope up to par so that you can bill for items other than acupuncture alone, if you use those things, you should bill for them. For instance, cupping is vasopnumatics. I suspect that there will be organizations providing educational programs on coding for acupuncture coming out of the woodwork soon. David Molony Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 goes Medicare GOES the rest of the reimbursement marketplace' >>>>That is very true and why i have been warning against Medicare inclusion. If acup is going to become part of medicare $15 acup treatments will become the norm for all insurance's and soon after privet practice. Quote Link to comment Share on other sites More sharing options...
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