News From ACFAS

The victory of Massachusetts Republican Scott Brown over Democrat Martha Coakley in the race to fill the remaining two years of Sen. Ted Kennedy’s term has thrown a major wrench into the Democrats' efforts to pass health system reform. While Democrats will still hold the largest majority in the Senate in decades, losing the “60th vote” means that after Brown is sworn in, Republican Senators can now kill the final bill through a filibuster. The options for Democrats include:

1. Fast-tracking the reconciliation process so that votes are complete before Brown is sworn in.
2. Finding a Republican who will cross over party lines (Olympia Snowe’s name is mentioned).
3. The House passing the Senate bill as is, which means that the bill can pass the Senate with a simple majority.

Otherwise, health system reform may, in fact, be dead for 2010.

Register online for the ACFAS 2010 Annual Scientific Conference in Las Vegas, February 23–26. This premier educational event offers over 50 sessions and workshops where you can earn more than 30 continuing education contact hours.

Some timely discounts can help you save money on the trip:

• January 21 — reserve your room at host hotel Mandalay Bay by January 21 to receive the special ACFAS rate of only $189.
• February 1 — register online by February 1 to save 10 percent over on-site conference registration.

Don’t delay — make your conference plans today!

ACFAS' monthly, online Scientific Literature Reviews help you stay up-to-date with research published in journals you might not usually read. January’s concise summaries of 11 articles come from a variety of publications, including the Journal of Plastic, Reconstructive & Aesthetic Surgery, the Journal of Vascular Surgery, Lancet and Bone.

The reviews have been prepared for you by podiatric residents at the Botsford Hospital, Kaiser North Bay Consortium, and St. John Hospital and Medical Center. Check out current research quickly and easily with Scientific Literature Reviews.


Now is the time to determine whether you will participate in Medicare's PQRI and/or E-Prescribing initiatives in 2010. Practices that are in a strong position to participate stand to earn bonuses of up to 4 percent of their Medicare Part B payments in 2010. Practices not yet fully equipped to participate should nonetheless be taking steps in that direction, because E-Prescribing will be mandatory by 2015. Medicare is also likely to institute some type of mandatory quality reporting in the future.

Visit acfas.org/Medicare for the information you and your staff need on this important issue.

Foot and Ankle Surgery

Ankles Gain as Candidates for Joint Replacement

Approximately 4,400 patients are expected to undergo surgery to replace arthritic or injured ankles with artificial joints made of metal alloys and lightweight plastic this year, and demand is expected to increase as the Baby Boomer generation ages. Each year, approximately 2 million Americans visit the doctor for ankle pain from arthritis or fracture, and an estimated 50,000 people a year experience end-stage ankle arthritis. “For an ankle replacement you have to be a little more picky in who you select,” says Dr. Craig S. Radnay, an associate at the Insall Scott Kelly Institute for Orthopedics and Sports Medicine in New York who has performed more than 100 ankle replacements.



Does the Anteromedial or Anterolateral Approach Alter the Rate of Joint Puncture in Injection of the Ankle?

Injection or aspiration of the ankle may be performed through either an anteromedial or an anterolateral approach for diagnostic or therapeutic reasons. To compare the two procedures, two orthopaedic surgical trainees each injected methylene blue dye into 18 of 38 ankles through an anterolateral approach and into 20 of the ankles through an anteromedial. An arthrotomy was then performed to confirm the placement of the dye within the joint. Of the anteromedial injections 31 of 40 were successful, as were 31 of 36 anterolateral injections. Observed was a trend towards greater accuracy with the anterolateral approach, but the difference was not statistically significant.



Effect of Selective Sensory Denervation on Fracture-Healing

The impact of selective sensory denervation on fracture-healing was the focus of a study performed by researchers at the Wake Forest University School of Medicine's Department of Orthopedic Surgery. Fifty-one rats underwent a procedure involving unilateral placement of an intramedullary rod followed by generation of a standardized femoral fracture, and sensory denervation was performed on one group of rats via a localized capsaicin injection. At three days following the fracture, the sensory-denervated animals had substantially less collagen-I upregulation than the sensory-intact group, and significantly less collagen-II upregulation at a week after the fracture. A significantly larger cross-sectional area and less density were observed in the fracture callus in the sensory-denervated group. The researchers' conclusion is that the healing of fractures is adversely affected by sensory denervation.



New Arthritis Drug Actemra Approved

The FDA has approved Actemra for moderate to severe rheumatoid arthritis for patients not responding to TNF inhibitors. Actemra, given by once-monthly hour-long infusions, is the first IL-6 inhibitor for arthritis. Actemra cannot be given in combination with TNF inhibitors or other biologic treatments for arthritis, but it can be used in combination with disease-modifying drugs such as methotrexate.

Practice Management

More Vendors Offer Stimulus Guarantee

Electronic health record (EHR) vendors are aggressively marketing to physicians in hope that the EHR incentive payments available through the 2009 stimulus package will bring them new business. Ingenix, a subsidiary of United Healthcare, is the latest vendor to offer interest free bridge financing and a guarantee that the software will comply with meaningful use requirements. GE, Allscripts, athenaHealth and others are offering similar financing deals. Allscripts requires no payment for the first six months and will waive up to 12 months of support fees if the practice’s EHR does not qualify under meaningful use.



Four Ways Practices Can Conduct Effective, Cost-Efficient Outreach

There are a number of effective and cost-efficient patient outreach and business development strategies, starting with giving healthcare-related presentations to local groups. Organizations that may welcome a physician presenter include local employers, schools, crowds at local fairs and block parties, church groups and service clubs. Another option is to write health-related articles for local newspapers and magazines, blogs and Web sites, and health and fitness publications. A third outreach approach is to actually sponsor local events.. Cultivating a great patient experience also is beneficial for practices, as satisfied patients are the best messenger and the key to effective outreach.



Truncated Information Mandated for Patient Receipts

The Federal Trade Commission says it's time for medical practices and other healthcare entities to check their credit and debit card receipts to make sure they're in compliance with a law that's been in effect for all businesses since December 1, 2006. The federal Fair and Accurate Credit Transaction Act (FACTA) mandates that the receipts must shorten the account information to include no more than the last five digits of the card number and delete the card's expiration date in a bid to reduce fraud.

Health Policy and Reimbursement

California Limits HMO Wait times

The California Department of Managed Health Care has issued new regulations that require physicians participating in HMOs to see patients within a certain number of days. The regulations require a 10-day maximum wait time for primary care and 15-day wait for specialists. Urgent care that does not require prior authorization must be provided within 10 days.



Coalition Releases Doc-pay Reform Principles

The American Board of Internal Medicine Foundation Forum, which includes representatives from provider organizations, employers, health plans and AARP, has issued a paper on Physician Pay Reform Principles based on a consensus reached at an August 2009 meeting. The report notes that the current system results in “unsustainable healthcare spending, rewards volume over value, does not distinguish quality of care and does not support care coordination.” The principles recommended include using evidence to guide clinical decisions, recognizing the contributions of both primary care and specialist physicians, using valid performance measures, and paying for team-based care.

Technology and Device Trends

Delivering Stem Cells Improves Major Bone Repair

New research reinforces the potential value of stem cells in repairing major injuries involving the loss of bone structure. The study shows that delivering stem cells on a polymer scaffold to treat large areas of missing bone leads to improved bone formation and better mechanical properties compared to treatment with the scaffold alone, offering a potential alternative to bone grafting operations. The research was published in the early edition of the journal Proceedings of the National Academy of Sciences on January 11, 2010.



Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial

Researchers report that an increasingly-used treatment method for chronic Achilles tendinopathy that includes injection of platelet-rich plasma into the tendon does not appear to result in greater improvement in pain or activity compared to placebo. An estimated 30 percent to 50 percent of all sports-related injuries are Achilles tendon disorders, according to the researchers. Approximately 25 percent to 45 percent of patients eventually require surgery following ineffective conservative treatment. “There is a clear need for improved conservative therapy,” say the researchers.



Using Nanotechnology to Boost the Lifespan of Medical Implants

University of Connecticut Department of Chemical Materials and Biomolecular Engineering professor Leon Shaw is working on developing new materials for the next generation of medical implants. Shaw's work largely focuses on developing a titanium/hydroxyapatite orthopedic implant designed to improve implant longevity and reduce the need for revision surgery, ultimately reducing long-term health care costs and patient stress. Shaw's research has focused on developing a new family of functionally graded, porous implant materials with a hierarchy of engineered microstructures.



Abstract News © Copyright 2010 INFORMATION, INC.

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