News From ACFAS

---

The Obama administration recently released its budget trimming the deficit by $1.1 trillion over 10 years. For Medicare physicians, it plans to pay for two years of reimbursements at current levels with $62 billion in specific health care savings. According to the administration, without the change Medicare payments to doctors would be cut by 30 percent.

ACFAS members can learn more about boosting their own budgets with government incentive programs at the pre-conference workshop, “Managing Your Practice: Reimbursements, Records and Rationale for Getting Value,” on March 8, 2011, in Fort Lauderdale, Fla. Workshop topics include:

• ePrescribing (eRx) incentive — You can still qualify for 1 percent of your total Medicare annual payments, an average of $1,000 per ACFAS member. You must voluntarily e-prescribe at least 10 times in the first six months of 2011, or you will lose 1 percent of your total 2012 annual Medicare payments, with potentially greater penalties in 2013.
• Physician Quality Reporting System (PQRS) — Incentives will add an additional 2 percent cash bonus to your annual Medicare payments for reporting quality measures, more than $2,000 on average.

Bring an electronic health record system (EHR) into your practice with informed decision-making and less stress when you work with Welch Allyn’s EHR Prep-Select. This latest ACFAS BenefitsPartner guides foot and ankle surgeons and their practices through the complex EHR preparation and selection process with a mix of:

• Expert consulting
• An easy-to-follow 10-step project plan
• An intuitive, web-based EHR vendor selection tool

Working with EHR Prep-Select will help ACFAS members achieve “meaningful use” and qualify for federal incentive money offered to those up and running in 2011. For more information, visit Welch Allyn's online portal for ACFAS members.
In just a few minutes you can enhance your knowledge with the latest research from journals you may not regularly read. Podiatric residents have prepared concise reviews from a variety of journals, including:

Mechanical Stability of the Subtalar Joint After Lateral Ligament Sectioning and Ankle Brace Application: A Biomechanical Experimental Study, from the American Journal of Sports Medicine.
Reviewed by Rotem Ben-Ad, DPM, Cambridge Health Alliance.

Unilateral Subtalar Coalition: Contralateral Sustentaculum Tali Morphology, from Radiology.
Reviewed by Diane M. Castro, DPM, Cambridge Health Alliance.

Read these reviews and many more in ACFAS' Scientific Literature Reviews.

Foot and Ankle Surgery

---

Researchers reported long-term results of modified Brostrom procedures (MBP) without calcaneofibular ligament (CFL) reconstruction. Thirty patients with chronic ankle instability who were treated using the MBP without CFL reconstruction from March 1997 to June 1999 were evaluated retrospectively. The mean followup period was 10.6 years. Mean AOFAS score was 91 and the mean VAS at final followup was 87. According to the Hamilton classification, 12 achieved an excellent result, 16 a good result, and two a fair result. Mean anterior translation values at final followup were 6.9 and 6.1 mm on ipsilateral and contralateral sides. Mean talar tilt angles were 3.0 and 2.5 degrees for ipsilateral and contralateral sides. Twenty-eight of the 30 patients were restored to pre-injury activity levels.



Researchers evaluated the surgical results of modified tension band wiring using two cortical screws for the treatment of fifth metatarsal stress fractures. Forty-two patients—all elite athletes—with Torg’s type I and II fifth metatarsal stress fractures treated using the modified tension band wiring technique from 2005 to 2008 were evaluated retrospectively. The mean length of follow-up was 26 ± 16 months. All patients were able to return to their previous levels of sporting activity. The mean time to union was 75 ± 25 days. However, during follow-up, there were four delayed unions, one nonunion, and four refractures. The researchers concluded that the modified tension band wiring technique is a good alternative method for the surgical treatment of Torg’s type I and II fifth metatarsal stress fractures.



To treat acute progressive diabetic foot infection while minimizing the risk of the infection spreading following guillotine amputation, surgeons developed a procedure that consists of tibiotalar disarticulation and vertical incisions performed throughout the lower leg to remove the septic foot and drain the compartments. During the interval period, appropriate antibiotherapy and wound care are applied. After the interval period, definitive transtibial amputation is performed in the second stage. Fifty-nine percent of the 62 transtibial amputations performed were healed completely. Failure developed in three cases which required opening of the amputation stump. In one patient, revision amputation at a higher transtibial level was done. Infection and necrosis reached to the knee joint in the other two patients; transfemoral amputation became the only treatment option for these cases.

Practice Management

---

Benchmarking can improve a practice's health and help it avoid unnecessary problems in the long term. Statistics can be tracked at daily, monthly, quarterly, or annual frequencies. Sources that can be used to find appropriate benchmarking data with which to compare one's practice include national, regional, and/or specialty reports; Medical Economics' annual Continuing Survey; and the Medical Group Management Association and the National Society of Certified Healthcare Business Consultants (NSCHBC) report. A baseline for one's practice can be acquired by obtaining national or regional statistics and applying adjustments, and once normalized, the same type of adjustments can be reapplied on a year to year basis.



CMS is implementing protocols in May that will allow eligible professionals (EPs) to designate a third party, such as a practice administrator, to register and attest for them as part of the EHR meaningful use incentive program . Until CMS implements the new policy, however, EPs should register themselves separately for the Medicare and Medicaid EHR Incentive Programs. EPs may qualify for either $44,000 under the Medicare EHR program or up to $63,750 under the Medicaid EHR incentive program.

Health Policy and Reimbursement

---

Retroactive provisions in the Patient Protection and Affordable Care Act and technical corrections to the 2010 Medicare physician fee schedule have resulted in overpayments and underpayments on many Medicare fee-for-service claims during the first five months of 2010. To address this, CMS has announced that it would begin reprocessing some of them over the next few weeks. According to CMS, claims that were underpaid will not be automatically reprocessed at higher rates. Providers should not resubmit these claims. Instead, they should request a manual reopening and adjustment of the claims from the Medicare contractor. Contractors will also send requests for repayment of overpayments to providers. CMS will waive beneficiary cost-sharing and claim adjustment time limits for claims affected by these changes. Instructions can be found here.



Legislation introduced in the House would mandate that medical care providers be transparent about their training and qualifications in a effort to mitigate patient confusion and deter fraud. Under the Healthcare Truth and Transparency Act, anyone advertising medical services would be required to state in the ad the license that authorizes them to furnish those services, while the practice of providing deceptive or misleading information that causes patients to believe practitioners have training or qualifications that they do not would be outlawed. Even stricter model legislation drafted by the American Medical Association would require practitioners to identify their license type in ads, wear a photo ID badge when seeing patients, and post their type of license in their offices. Meanwhile, four states—California, Arizona, Pennsylvania, and Illinois—have approved laws calling for health care professionals to provide clarity about their qualifications. Physician groups in other states intend to pass similar legislation this year.



A measure sponsored by Rep. Phil Roe (R-Tenn.) would eliminate the Medicare Independent Payment Advisory Board (IPAB). If left unchanged, the panel is instructed, under the healthcare reform law, to help extend the solvency of Medicare when it begins its work on Jan. 15, 2014. IPAB was created aimed to improve Medicare quality and cut costs when the program's per capita growth rate exceeds a specified target. Its members will be appointed by President Obama and face Senate confirmation.

Medicine, Drugs and Devices

---

The FDA's Innovation Pathway is a new effort to expedite the commercialization of "pioneering" medical devices. The initial test will be a brain-controlled upper-extremity prosthesis developed by the Defense Advanced Research Projects Agency. The FDA says a device would have to reflect "truly pioneering technologies with the potential of revolutionizing patient care or healthcare delivery" in order to be considered for approval via the Innovation Pathway. Applicants would receive a memo with a proposed development road map from the FDA's Center for Devices and Radiological Health (CDRH), and the device might be eligible for a "flexible" clinical trial protocol. Currently under development within CDRH is a new oversight entity, the Center Science Council, that would review the devices. The FDA could carry out premarket product reviews in the Innovation Pathway within 150 days; also, whereas device makers typically contact the FDA when they are near the end of the development process, they would work with FDA reviewers early in the process under the Innovation Pathway.



Emergency department physicians are often harried by interruptions, which raises the risk of them committing medical errors, according to a study by University of Indiana researchers published in the Annals of Internal Medicine. The researchers determined that most ED doctors' activities are spent on indirect patient care, with such care lasting an average of 64 minutes in academic settings and 55 minutes in community hospitals. The number of interruptions the physicians endured was as many as 19 per two-hour period for community hospital doctors, with an average of six, and 32 for academic environments, with an average of 12. The researchers suggest that EMR systems produce virtual patient records accessible to multiple nurses and consultants for review and data entry simultaneously, allowing asynchronous information transmission and interaction without interruptions.



The FDA has approved the first applications that doctors can use to view medical images and make diagnoses using an iPhone or iPad. The new app allows doctors to view images from diagnostic tests such as CT scans, MRIs, and PET scans. The FDA says that the app is not intended to replace full work stations but is rather intended for use when there is no access to a workstation. Images taken in a hospital or doctor's office are compressed and transferred over a secure network to portable wireless devices using the app, allowing physicians to measure distance on the image and image intensity values and display measurement lines, annotations, and regions of interest.



Accidental damage to thin or buried nerves during surgery can have severe consequences, from chronic pain to permanent paralysis. Researchers have found a remedy: injectable fluorescent peptides that cause hard-to-see peripheral nerves to glow, alerting surgeons to their location even before the nerves are encountered. The researchers injected a systemic, fluorescently labeled peptide into mice. The peptide preferentially binds to peripheral nerve tissue, creating a distinct contrast (up to tenfold) from adjacent non-nerve tissues. The effect occurs within two hours and lasts for six to eight hours, with no observable effect upon the activity of the fluorescent nerves or behavior of the animals. The researchers are continuing to refine their probes in animal models in preparation for eventual human clinical trials.