News From ACFAS

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Online registration for the 2014 Annual Scientific Conference closes on February 13. For convenience, complete your registration online today but no worries if you aren’t able – on-site registration will be available in Orlando at the conference starting on February 26.

Looking to get the most of out of your conference experience? Several pre-conference workshops are still available for online registration by February 13. Visit acfas.org/Orlando to download the conference brochure containing course descriptions and times or to make your registration. If you’re asking yourself what is ICD-10, then you've come to the right place! ICD-10 is coming, and with it comes unprecedented changes to coding, documentation and reimbursement. Don’t be caught off guard-- join Marcy C. Blitch, RHIA, CCS & ICD-10 Certified Trainer for a one-hour webinar on Transitioning Your Practice to ICD-10 on February 12, 2014 at 7:30pm CT.

While nearly all healthcare providers are aware of the October 1, 2014 deadline, most are unprepared for the transition to ICD-10. This new coding system is radically different from the version currently in use, so it’s important to start preparing for and implementing the massive changes to the existing coding system.

Registration for the webinar is $65 for ACFAS members and their staff, and $100 for non-members and non-members’ staff. To register, visit acfas.org/practicemanagement. Two of ACFAS’ Regional Divisions recently held elections to fill open officer positions. Division 5: Florida held a call for nominees to fill their open Treasurer/Secretary position and Alan MacGill, DPM, FACFAS, will fill this position. Division 12: Tri-State (Del, NJ and Penn) needed to fill the Director of Education position, and Jarrett Cain, DPM, FACFAS was elected by the Division 12 Membership.

These new officers’ terms will commence at the 2014 Annual Scientific Conference in Orlando. If you are interested in learning more about your ACFAS Division and having a voice in their activities for the rest of 2014, please make plans to attend their annual membership meetings at the conference. Each Division meets in a reserved section of the Exhibit Hall during the lunch hour. All ACFAS Members who attend their Division meeting will be placed in a raffle to win one of two Apple iPad minis.

Many thanks to all local officer candidates for their interest in becoming involved in their ACFAS Division and to all of the ACFAS Division Members who took a moment to vote in their local election. And, congratulations to Drs. MacGill and Cain!

Foot and Ankle Surgery

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Proximal interphalangeal (PIP) joint realignment using an intramedullary implant is an effective method for treating lesser toes deformities, a new study has found. A total of 156 toes in 117 patients were implanted with the implants during the study. After one year, 83.8 percent of joints were fused on X-rays. Reoperation was not necessary in patients who experienced incomplete joint fusion and had a stable joint and no pain. American Orthopaedic Foot and Ankle Society lesser metatarsophalangeal-interphalangeal scale (AOFAS-LMIS) scores, meanwhile, improved from 40.4 before the operation to 85.5 a year afterward. Patients were less likely to report experiencing pain a year after the operation, and nearly all of the patients reported being satisfied with the outcome of the procedure. However, complications were reported intraoperatively in 1.3 percent of patients and postoperatively in 3.2 percent. One patient also required revision surgery. Finally, mallet toe deformity was seen in 2 percent of patients after one year.


A recent study compared the effectiveness of tenocutaneous suture and conventional Kessler suture techniques in treating patients with an acute closed rupture of the Achilles tendon. The 33 patients who participated in the study were treated with one of the techniques and were followed up with after an average of three years. The excellent rate as measured by the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 98 percent in the tenocutaneous suture group and 91 percent in the Kessler suture group. The difference in the excellent rates seen in the two groups was significant. The study concluded that the tenocutaneous suture technique has a number of advantages over the conventional incision method and should be widely adopted in clinical applications.


A multicenter study by Canadian orthopaedic surgeons has found that patient-reported clinical outcomes are similar following total ankle replacement and ankle arthrodesis when the two procedures are used to treat end-stage ankle arthritis. The study consisted of a review of 321 ankles, 232 of which underwent ankle replacement while the remainder underwent arthrodesis, at an average follow up of 5.5 ± 1.2 years. Patients in both groups experienced improvements in their pre- and post-operative Ankle Osteoarthritis Scale (AOS) total, pain, and disability scores. Both groups also displayed improvements in Short Form-36 (SF-36) physical component summary scores after the operations. Differences between the AOS and SF-36 scores seen in the total ankle replacement and arthrodesis groups at follow up were minimal after taking into account baseline characteristics and the surgeon who performed the procedure.

Practice Management

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Doctors' practices should look for a number of signs that could be an indication that they are not ready for the upcoming transition to ICD-10. For example, a practice is not prepared if it has not spent any money on getting ready for the transition. Although some practices may have decided to wait and purchase the final version of the ICD-10 book once it is released, practices should buy the draft version as soon as possible so they can educate key employees about the shift to the new codes. Another potential red flag that a practice may not be ready for ICD-10 is the continued use of paper encounter forms. Practices that are still using paper encounter forms will need to adopt a new system, since the use of these forms--which can involve circling the most commonly-used codes and writing in codes that are not on the forms--has resulted in many unspecified codes. The overuse of unspecified diagnosis codes can also be an indication that a practice is not prepared for ICD-10. Practices that use a large number of unspecified diagnosis codes should begin using specific ICD-9 codes immediately so that the shift to the more detailed and descriptive ICD-10 system is not so jarring.


Physicians' practices that want to remain independent instead of selling to hospitals and larger groups may want to consider collaborating with other private practices. Doing so allows the practices to increase their negotiating power and efficiencies, allows them to share resources, and creates greater economies of scale. There are three tips that doctors' practices may want to take into consideration before collaborating with other independent practices. For instance, doctors should find other physicians nearby who are of like mind and may be open to collaborating. These physicians should meet with one another to discuss possible opportunities for collaboration, as well as issues such as how the practices could work together to benefit patients and themselves and the areas that need investment. Doctors should also discuss the desired level of integration, making sure not to run afoul of the Federal Trade Commission's policies on anti-competitive practices and anti-trust statutes. Integrated practices may be subject to review to determine that their integration is legal and is not contributing to an increase in healthcare costs. Finally, practices should examine the different types of integrated business models--such as accountable care organizations (ACOs), physician/practice associations (IPAs), and management services organizations (MSOs)--to see which is the best fit for them.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) and several other federal agencies have issued a rule that will allow consumers in 39 states and their designees to receive lab test results directly from medical labs. The new rule calls for labs to provide patients with copies of test results within 30 days of a request. Labs covered by the Health Insurance Portability and Accountability Act (HIPAA) will have 180 days from the time the rule takes effect--which will occur 60 days after it is published in the Federal Register--to comply. Patients in the 39 states affected by the rule previously could only receive or view lab test results through their physician or another authorized healthcare provider, or by their provider's leave. Federal officials decided to adopt the new rule partly in response to calls from patient advocates and healthcare organizations to allow patients to play a more active role in making healthcare decisions, as well as their desire to promote the use of electronic health records. Developers of personal health records systems will be one type of patient designee that will be allowed to receive patient lab results.


Healthcare providers say they remain opposed to the Centers for Medicare and Medicaid Services' (CMS) "two-midnights" rule, despite the agency's recent decision to delay implementation until Oct. 1. One reason why hospitals say they are opposed to the rule, which calls on CMS auditors to assume that Medicare hospital stays are generally not legitimate if patients are not in the hospital for two nights, because they will now reimbursed for short inpatient procedures under the lower Medicare outpatient rates. CMS has also opted to reduce standard payment rates to hospitals by 0.2 percent to help offset the higher costs that will result from the expected higher rate of conversion of observation care into more expensive inpatient care. In fact, CMS says hospitals will benefit from the policy because it will allow them to receive full inpatient rates for hospital says that would have been considered outpatient in the past, so long as adequate physician notes are included with claims. The American Medical Association, meanwhile, says it is opposed to the two-midnights rule because it could force physicians to fill out more documentation while simultaneously increasing out-of-pocket expenses for patients. Those who are opposed to the rule could take advantage in the delay by pushing for negotiations, legislation, or litigation to block its implementation altogether.


Congressional staff members are examining a number of proposals that would pay for reforms of the Medicare physician payment system. One of the ideas under consideration is a requirement for drug manufacturers to pay a minimum rebate on drugs covered by Medicare Part D for low-income beneficiaries. That proposal would reportedly generate $123 billion in savings over 10 years. $262 billion in revenues could be generated over 10 years by limiting the tax exclusion for employer-sponsored insurance. Meanwhile, lawmakers and congressional aides on three committees are working to combine a number of similar proposals for overhauling the Medicare physician payment system.


The Centers for Medicare and Medicaid Services (CMS) reported Jan. 30 that Medicare accountable care organizations (ACOs) saved $275 million in their first year of operation while simultaneously delivering high-quality care. CMS said that 54 of the 114 Medicare Share Savings Program ACOs that began operating in 2012 achieved lower expenditures than expected during their first year of operation. Twenty-nine of those 54 ACOs achieved shared savings totaling more than $126 million. These ACOs also achieved a total of $128 million in net savings for Medicare trust funds, CMS said. The 23 Pioneer ACOs, meanwhile, saved the Medicare program $147 million in their first year. Finally, CMS said that the Physician Group Practice Demonstration initiatives--which provide doctors' practices with incentive payments for providing high-quality coordinated care that achieves Medicare savings--was successful in saving the program money over the course of five years. Seventy percent of physician group practices earned a total of $108 million in shared savings payments for improving cost efficiency and the quality of the care they provided during the programs.


The National Association of Chain Drug Stores (NACDS) has asked the Centers for Medicare & Medicaid Services (CMS) to make medication adherence and appropriate medication use part of its Quality Rating System for Qualified Health Plans (QHPs). Such a move would mean that information about the success healthcare plans have had in improving medication adherence would be provided to consumers when they purchase coverage. NACDS said that there is evidence that improving medication adherence, including the use of medication therapy management (MTM), can help improve health outcomes and reduce healthcare costs. In addition, providing consumers with information about the success of health insurance plans' medication adherence improvement efforts will provide consumers with "meaningful" protections "regarding affordable, quality healthcare, and meaningful, reliable and actionable rating information, NACDS said.


According to a study published in Medical Care, healthcare providers' biggest challenges associated with Meaningful Use attestation for electronic health records (EHRs) were clinical summary measurement, the required security risk analysis and the reporting of patient smoking status. The study, which collected data from 55 regional extension centers in 2012, found that the prevalent issues for providers were engagement and administrative issues. Other issues reported by providers included vendor selection, delays in implementation and installation and practice work flow adoption. The authors of the study said, "New challenges emerge as providers progress toward [Meaningful Use], creating opportunities to preempt large-scale issues with timely interventions. These interventions must take into account organizational and cultural dynamics, increasing the need to identify multiple, often setting-specific, solutions. If identified quickly and a timely response is provided, problems may be halted before becoming widespread or impeding progress."

Medicine, Drugs and Devices

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The Food and Drug Administration (FDA) and hospital pharmacists say there is a serious shortage of intravenous (IV) saline bags used in surgical units and patient rooms in hospitals across the country. Several factors have been blamed for the shortage, including the severity of the flu season, which caused a spike in demand for IV fluids over the past month. Planned factory shutdowns at saline IV bag suppliers during the holidays have also resulted in production problems. The shortage has resulted in the price of saline IV bags spiking to levels that are five to six times higher than normal, says Hallmark Health System Assistant Director of Pharmacy Michelle Corrado. However, Geisinger Health System Director of Clinical Pharmacy Programs Dean Parry says the shortage has been alleviated somewhat. One step that Geisinger Health System's hospitals have taken to cope with the shortage is to dilute some medications with different, non-saline solutions. The FDA, meanwhile, is working with the manufacturers of saline IV bags to increase supplies and is also considering asking foreign suppliers to export their products to the U.S.


Carnegie Mellon University (CMU) robotics researchers have developed an active orthotic device using soft plastics and composite materials, instead of a rigid exoskeleton. The robotic device can achieve natural motions in a person's ankle by combining the soft materials with pneumatic artificial muscles (PAMs), lightweight sensors, and advanced control software. The same technique could be used to create rehabilitative devices for other body joints or even to create soft exoskeltons that increase the strength of the wearer, according to CMU professor Yong-Lae Park. The robotic device can also be used to help people with neuromuscular disorders of the foot and ankle associated with cerebral palsy, amyotrophic lateral sclerosis, multiple sclerosis, or stroke. The soft orthotic device enabled the researchers to mimic the biological structure of the lower leg. The device has artificial tendons attached to four PAMs, which correspond to three muscles in the foreleg and one in the back that control ankle motion. Park says additional work will be necessary to improve the wearability of the device.