News From ACFAS

A fix to the scheduled Medicare physician fee schedule is in jeopardy with the stall in health system reform. It may be too early to declare the death of health system reform, but advocates for physicians are concerned that the toxic atmosphere in Washington right now will make it difficult for Congress to pass a fix to the scheduled 22 percent cut in Medicare payments. The cut was delayed through February 28 as part of the defense bill, but without further action, it will go into effect March 1. Hopes for a permanent fix are fading because of the $300 billion price tag.

The earthquake devastation of Haiti has brought out the best in all Americans, including ACFAS members. Offers to assist or donate have poured into the ACFAS office. ACFAS suggests the following organizations and resources. For details and requirements, visit each organization’s web site.

• Donation Opportunities
• Soles for Souls
• Hospital Albert Schweitzer
• American Red Cross
• Volunteer Opportunities
• Project HOPE
• U.S. Department of Health and Human Services National
  Disaster Medical System
• Centers for International Disaster Information
• Partners in Health

ACFAS thanks its colleagues at the Society for Critical Care Medicine for their assistance in coordinating many of these resources in the healthcare community.

Value speaks volumes … and now, more than ever, ACFAS members are finding tremendous value in the College:

• Membership numbers ended 2009 at an all-time high — more than 6,100!
• Registration for the Annual Scientific Conference, February 22–26, is on track to break the all-time attendance record set in 2006! And pre-conference surgical workshops are sold out.

It’s not too late to register for the conference — you can register online now. Or, on-site registration will open at 1:00 p.m. on Monday, February 22, at the Mandalay Bay Conference Center. For details, visit acfas.org/lasvegas.


Adam M. Budny, DPM, AACFAS, has been appointed the ACFAS representative to the Joint Commission Ambulatory Care Professional and Technical Advisory Committee (ACPTAC) for 2010.

ACPTAC’s role is to make recommendations to the Joint Commission on new or revised standards, and provide input into changes in the field that may affect standards. In 2009, ACPTAC provided feedback on a proposed modification to the Universal Protocol relating to presenting wrong-site surgery errors, and the Joint Commission made changes based on that feedback.

Dr. Budny practices in Altoona, Pa., and is also a member of the ACFAS Professional Relations Committee.

Foot and Ankle Surgery

Preoperative MRI Misses Many Ankle Instability-Related Lesions

Researchers led by Patrick J. O'Neill, MD, have determined that a substantial number of chronic ankle instability-associated lesions may not be spotted by preoperative magnetic resonance imaging (MRI), and surgeons may be more skilled than radiologists at recognizing these lesions on preoperative images. O'Neill and his research team compared the preoperative MRI reports of community radiologists and the attending foot and ankle surgeons to the intraoperative findings of 133 consecutive patients on whom 135 lateral ankle ligament reconstruction procedures for chronic ankle instability were performed. The researchers uncovered 72 related lesions, including 38 chondral injuries, 18 brevis tears, 7 loose bodies, and 9 additional pathologies; comparison of the preoperative MRI reports revealed that the radiologist missed half of the associated lesions found intraoperatively and the attending surgeon missed one-third. O'Neill concluded that many of the lesions might not have been seen on MRI owing to a potentially high number of superficial lesions that lack bony edema, as well as the innate challenges in visualizing peroneal tears. O'Neill presented his findings at the 25th Annual Summer Meeting of the American Orthopedic Foot and Ankle Society.



Ultrasound-Guided Sciatic Nerve Block in the Popliteal Fossa Using a Lateral Approach: Onset Time Comparing Separate Tibial and Common Peroneal Nerve

A group of researchers tested their theory that blocking the tibial and common peroneal nerves individually using ultrasound distal to sciatic bifurcation would speed up the time it took to complete the block versus a block proximal to the bifurcation. They performed a sciatic nerve block either proximal or distal to the point of bifurcation on 76 patients undergoing foot or ankle surgery, and ultrasound was employed to direct needle adjustments to achieve circumferential spread. Patients in the tibial-peroneal nerve group completed blocks in a significantly faster time than those in the sciatic group. This supports the conclusion that blocking the tibial and common peroneal nerves in the popliteal fossa individually facilitates a faster onset than a prebifurcation sciatic block.

Practice Management

Are You Sharing Too Much Online?

Doctors are increasingly writing blogs about their work, but experts warn that they should keep their remarks general and not delve into the specifics of their patients’ cases if they want to avoid violating privacy laws. Most doctors are so careful to avoid violating HIPAA that they would never think of using a patient’s name, but even if the name is not included it is possible the patient’s identity can be guessed from the specifics of the case. Doctors who blog at Better Health, a medical blogger community, must follow its Healthcare Blogger Code of Ethics, and all blogs are peer-reviewed before being approved for publication. Before publishing anything to a blog, doctors should first re-read the post to make sure there are no identifying details or any remarks that might disturb patients. If the writer must cite patient cases, it is best to blend and fictionalize them so that they become unrecognizable.



Performance Reviews Important, Even in Small Practices

The new year is a good time to take stock of how your practice is functioning. Make sure you have an effective performance review system in place that rewards high performers, provides helpful feedback on areas for improvement and creates a record in the event a personnel action, such as probation or termination, is required. While performance reviews are typically on an annual basis, it is also common for new employees to be evaluated at 60- or 90-day intervals. To manage legal risk, practices should develop an evaluation form and process that is used for all employees. Many employers develop forms that the employee populates with specific goals and measures that will be evaluated. This ensures that both employee and supervisor have the same expectations.



Have a Strategy to ICD-10 Codes

Another major technology change is on its way in the not-too-distant-future, and practices need to start preparing, By October 1, 2013, all stakeholders in the health system must have completed the transition from ICD-9-CM to ICD-10. This has major implications for practice management software and HIT strategies. For example, ICD-9 assigns between three and five digits to a diagnosis, whereas ICD-10 is three to seven and is alpha-numeric. If a practice uses software that can accommodate only five digits and accepts only alpha characters, this will require significant changes. The ICD-10 will enable much greater specificity in reporting symptoms and diagnosis, but the result is a much more voluminous code set. The index alone is 1,322 pages. The United States is the last of the major developed countries to transition to ICD-10, so while the transition is an added hassle and possible expense, it will bring the U.S. in sync with the rest of the world in terms of research and public health reporting. To learn more about the ICD-10 transition, visit the CMS web site at cms.hhs.gov/icd10.

Health Policy and Reimbursement

If Bill Fails, A Quandary for Insurers

Though share prices of health insurers jumped initially at the prospect of healthcare reform failing, observers note that health insurers may be worse off over the long haul than they would be under the House or Senate bill. Both bills mandate purchase of insurance, which would bring as many as 30 million new customers into the market, some of whom would be eligible for government help with premiums. If health system reform fails, insurers will continue to face a shrinking market for their product. Insurers have lost market share during the recession because of job loss and the lack of affordability of their product for many Americans. Observers note that insurers will still be under intense pressure from employers and shareholders to control costs, and an obvious target will be hospital and physician fees.



MedPAC Recommends 0.6% Rate Increase for ASCs in 2011

MedPAC is recommending that lawmakers raise Medicare payment rates for ambulatory surgery center (ASC) services by 0.6 percent in 2011 and require ASCs to begin reporting cost and quality data to the Centers for Medicare and Medicaid Services. MedPAC also advises Congress to raise rates for hospitals' acute inpatient and outpatient prospective payment systems according to the projected rise in the hospital market basket index. Those changes, recommended for 2011, should be "concurrent with implementation of a quality incentive payment program" for hospitals, MedPAC says.

Technology and Device Trends

Methodist Research Program First of Its Kind for Orthopedics

A new research program at The Methodist Hospital in Houston is the first in the United States dedicated solely to advancing nanotechnology in orthopedics. Researchers in the lab, in conjunction with colleagues at the Texas Medical Center, will be looking at various ways nanotechnology can improve the treatment of musculoskeletal disease. "In the future, we hope to give an injection into the vein and, with sophisticated mapping, send it directly to specific musculoskeletal tissues, said Dr. Bradley Weiner of Methodist. “We are exploring many avenues of intervention such as the delivery of proteins to help bone formation when doing fusions and ways of delivering anti-inflammatory drugs and pain medications to help decrease musculoskeletal pain.”



Modeling the Interaction of Ankle-Foot Orthosis and Foot by Finite Element Methods to Design an Optimized Sole in Steppage Gait

In this study, a finite element model of human gait with ankle-foot orthosis (AFO) based on kinematics data in steppage was proposed to optimize the role of AFO through minimizing stress in the patients' sole. The required kinetics data for the model were captured through a force plate and then analyzed by software. In the proposed three-dimensional finite element model, the transmitted tension in soft tissue and bones during gait were calculated. By changing the thickness and materials of different layers of sole in AFO, the tension variations have were assessed, and the effect of orthosis on tension generated in bones and muscles were dynamically and continuously modeled. The researchers found that tension reduction in the sole can improve the effect of AFO during abnormal gait, concluding that it is possible to design each orthosis sole based on the kinetics data of each patient.



Running Shoes May Cause Damage to Knees, Hips and Ankles, New Study Suggests

While running has been proven to have cardiovascular and other health benefits, it also places increased stress on the joints of the leg. A study published in the December 2009 issue of PM&R: The Journal of Injury, Function and Rehabilitation, compared the effects of knee, hip, and ankle joint motions of running barefoot as opposed to running in modern running shoes, and found that running shoes exert more stress on these joints than running barefoot, or even walking in high-heeled shoes. An average 54 percent increase in the hip internal rotation torque, a 36 percent increase in knee flexion torque, and a 38 percent increase in knee varus torque were measured when running in running shoes compared to running barefoot. The findings confirm that while the typical construction of modern running shoes provides good support and protection for the foot itself, it increases the stress on each of the three lower extremity joints, most likely due to an elevated heel and increased material under the medial arch.



Abstract News © Copyright 2010 INFORMATION, INC.

---

You have received this newsletter as a service of the American College of Foot and Ankle Surgeons. To change your email address, please click here. If you wish to unsubscribe click here.