News From ACFAS

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Online registration for the Annual Scientific Conference in San Antonio March 1-4, is still open.

Don't delay! Complete your registration today to be among your peers at the foot and ankle conference of the year, deep in the heart of Texas!

To register, follow the web link below. Don't miss your opportunity to participate in ACFAS' new research initiative on subtalar joint endoprosthesis for flexible flatfoot.

Applications are being accepted for investigative sites in this multicenter retrospective study examining the determinants of favorable and unfavorable outcomes in adults and children. Subjects and sites will be compensated for their time.

For more information or to fill out an application, visit the web link below.

Legal Briefs

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The Ninth Circuit Court ruled that Good Samaritan Hospital was permitted to suspend privileges for physician Richard Fox in 1999 on the basis of the federal Health Care Quality Improvement Act (HCQIA), and barred Fox's lawsuit from disputing the suspension. Fox's privileges were suspended because he refused to comply with a newly enacted hospital rule requiring a doctor's designated backups to hold the same set of privileges as the doctor, and Fox's 2004 lawsuit alleged that the hospital in actuality suspended his privileges as retaliation for his earlier criticism of patient care at the facility and to institute a monopoly on the provision of pediatric intensive care services. The court determined that a hospital has a right to HCQIA immunity for any "professional review action" taken according to the doctor's competence or professional comportment, provided the hospital afforded the physician sufficient procedural protections. The court found that the hospital's action fell within these bounds because Fox's professional conduct motivated the privilege suspension decision; "a doctor's failure to comply with a rule of the hospital where he practices unquestionably implicates his professional conduct, whether or not he agrees with the rule," the court wrote.

Foot and Ankle Surgery

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A study was performed to assess functional management of ankle sprains by characterizing physical activity (PA) in the first week following injury and comparing results with a non-injured control group. Participants with an acute ankle sprain were randomly assigned to a standard or exercise group, with both groups advised to apply ice and compression and walk within the limits of pain. The exercise sample followed additional therapeutic exercises, while PA was measured with an activPAL accelerometer worn for a week after the sprain. The standard group exhibited substantially less activity than the exercise and healthy control groups. The standard group managed 1.2 plus or minus 0.4 hours of daily activity, and 5,621 plus or minus 2,294 steps per day. In comparison, the exercise group did 1.7 plus or minus 0.7 hours of activity per day, and 7,886 plus or minus 3,075 steps, while the control group was active 1.7 plus or minus 0.4 hours per day and walked 8,844 plus or minus 2,185 steps per day. The standard and exercise groups also spent less time engaged in moderate and high-intensity activity than the control group.


Survival of the Agility Total ankle arthroplasty (TAA), the general reoperation rate, and function in patients who retained their implant were determined through a retrospective review of 64 patients who had 65 TAAs between June 1999 and May 2001. Nine patients had passed away, and data was available for 41 of the remaining 55 patients. The minimum followup was 0.5 years. Revisions were required for 16 of the 41 patients, and the median time to revision surgery was four years, with six of the revisions taking place within 12 months of the TAA. Twelve of the 25 patients who retained their implants needed secondary surgery for an overall reoperation rate of 28 of 41 at an average of eight years followup. The median VAS pain score, the average Foot and Ankle Ability Measure (FAAM) sports subscale score, and the average FAAM activities of daily living subscale score were 4, 33, and 57, respectively.


Researchers evaluated whether power Doppler ultrasonography (PDU) is a suitable method to identify a predisposition to midportion Achilles tendinopathy (MPT) in yet asymptomatic runners. At 23 major running events, 634 asymptomatic long-distance runners were tested for Achilles tendon thickness, vascularization, and structural abnormalities using a high-resolution PDU device. All subjects were contacted six and 12 months later and asked about any new symptoms. The highest odds ratio (OR) for manifestation of MPT within one year was found for intratendinous blood flow (neovascularization, OR = 6.9, P < 0.001). An increased risk was also identified for subjects with a positive history of Achilles tendon complaints (OR = 3.8, P < 0.001). A third relevant parameter, just above the level of significance, was a spindle-shaped thickening of the tendon on PDU (Wald ?2 = 3.42).

Practice Management

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Practices that implement electronic health record systems (EHRs) with an integrated practice management module could encounter problems when an outside company handles billing and collections, particularly if the billing company's system does not support the new EHR. These problems generally can be avoided if practices reach out proactively to their billing companies early on. Experts say practices should not retain their old practice management system solely because the billing company does not support the new one, as practices will benefit from increased efficiency and net collections by switching to an integrated system. They should look for a new billing company if their current one will not bill on the new system.

Practices also should not transition to the new system overnight, but instead select a "go live" date and ensure all new charges are entered into the new system at that time. However, they should keep the old system operational for a few months while old receivables are processed. The new features of the integrated system should reduce billing fees, so practices should be sure to negotiate better rates with their billing company. Those that purchase an EHR directly from their billing company should ensure that they have full access to their practice data. Finally, practices should ensure that their billing companies can perform certain advanced functions, like transmitting payer acceptance confirmations directly to the practice management system to improve claims tracking. Some practices might want to consider moving billing in-house.


The latest survey numbers from the American Hospital Association point to a 34 percent increase in physicians employed by hospitals between 2000 and 2010, while the American Medical Association and the American Osteopathic Association report a mere 17 percent increase in the number of allopathic and osteopathic doctors in patient care and other healthcare roles. Among the factors boosting hospitals' incentives for hiring more physicians is the passage of healthcare reforms two years ago favoring the formation of accountable care organizations, the provision of bonuses for more efficient, higher-quality care, and the establishment of bundled payments that hospitals and physicians share for inpatient care. Many physicians also are migrating to hospitals to relieve themselves of various burdens associated with independent practice, including long hours, at-risk revenue streams, and government pressures to adopt costly electronic health record systems.

Health Policy and Reimbursement

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House and Senate Democrats Feb. 7 rejected a proposal by House Republicans that would fund nearly half the cost of a payroll tax cut bill that includes an increase in Medicare reimbursement for physicians at the fourth meeting of the House/Senate conference committee on H.R. 3630. Senate Majority Leader Harry Reid (D-Nev.) says if the conference committee has not reached an agreement by early next week, Democrats will put forward their own plan. The panel's next meeting has not been scheduled.


The mandated Jan. 1 conversion to a new set of electronic claims transaction standards is not going smoothly for office-based physicians, disrupting medical groups' cash flow and creating hassles, according to the head of the Medical Group Management Association (MGMA)-American College of Medical Practice Executives. In a letter to Health and Human Services Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney outlined eight steps HHS needs to take to fix problems that began arising even before the Jan. 1, 2012 deadline HHS set for national compliance with federally mandated use of the ASC X12 Version 5010 standards.

One of Turney's recommendations is to push that enforcement delay even further back, to June 30. Turney also called on Sebelius to "permit all covered entities to submit and accept Version 4010 claims until at least June 30." In a third recommendation, Turney advised HHS to "closely monitor" industry readiness up to that extended deadline and take what steps are necessary even then "to ensure that transactions continue to flow and that physicians are paid."

Medicine, Drugs and Devices

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As many as one in seven hospitalized patients experience some form of error in care, and about one-third of these mistakes are related to drugs. When doctors enter prescriptions on a computer instead of with pen and paper, hospitals can see error rates fall by up to 60 percent. A team of researchers, reporting their findings in PLoS Medicine, tracked medication errors in two Australian hospitals before and after the installation of electronic prescription systems. Incomplete or unclear prescriptions had numbered in the hundreds before the systems were installed, but fell to single digits at both hospitals after the electronic prescription systems. The new system not only removed the problem of illegible prescription writing, but limited other miscalculations and oversights by including data about each patient and rules for proper dosing, allergies, and drug interactions. The software provided hints and warnings that helped guide doctors' decisions. Although software design accounted for 35 percent of the remaining errors, most mistakes were minor, and could be prevented once the program was updated and improved.


Some doctors are taking action to suppress negative online reviews by patients on Internet rating sites, despite the fact that just 16 percent of adults said they use the Internet to search for reviews of physicians while even fewer post such reviews, according to a Pew Research Center survey. Another poll by the Altarum Institute found that while 60 percent of respondents conducted rigorous research while shopping for a car, less than one-third committed much time to vetting a doctor. Doctors attempting to squelch reviews often cite agreements patients sign that prohibit them from publishing critiques, and although consumer proponents say such agreements would not stand up in court, they are worried that such strategies will discourage consumers and inhibit the open exchange of information on consumer review sites.


Researchers tested the hypothesis that overall patient surgical results would exhibit improvement by forming the Tennessee Surgical Quality Collaborative using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes information. The study involved the collection of all NSQIP data from January to December 2009 and January to December 2010, and comparing data on 20 categories of postoperative complications and 30-day mortality between periods. Complication comparisons and hospital costs related to complications were calculated per 10,000 procedures, while statistical analysis was executed by Z-test. The first period encompassed 14,205 total surgical cases and the second period 14,901 cases. Significant improvements were seen between periods in superficial surgical site infections, on ventilator longer than 48 hours, graft/prosthesis/flap failure, acute renal failure, and wound disruption. Higher mortality was seen in the second period, but no statistical difference was observed. Net costs avoided between these periods were estimated at approximately $2.2 million per 10,000 general and vascular surgery cases.