News From ACFAS

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If you attended the ACFAS 2011 Annual Scientific Conference in Fort Lauderdale, you can now find handouts from the sessions at your fingertips on the ACFAS website. Simply log in with your member or attendee number to get even more from your participation in this premier educational event.

Handouts are available exclusively to attendees of ACFAS 2011. Download them any time on the conference web page.
In its March 2011 report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended a 1.0% update for outpatient hospital and physician payments, and a 0.5% update for ambulatory surgery centers. MedPAC, which reports to Congress annually, also said there should be no payment update in FY 2012 for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities or home health providers.

A fact sheet on the report can be downloaded here (29 KB PDF).
The Centers for Medicare & Medicaid Services will hold conference calls early next month on registering to participate in the Medicare and Medicaid electronic health record (EHR) incentive programs. The April 1 call will help physicians review topics such as eligibility for Medicare incentive payments and switching between Medicare and Medicaid EHR programs. Call registration will end the day before each call or when space is filled. For more information, visit the CMS site on EHR incentive programs.

ACFAS has an exclusive resource to help you and your practice partners select the right EHR solution in its latest BenefitsPartner, Welch Allyn. Find details on their program, EHR Prep-Select, at their members-only online portal.

Foot and Ankle Surgery

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A single surgeon randomized prospective study was conducted to evaluate the efficacy of an automated tourniquet system modified to set tourniquet pressure based on measurement of limb occlusion pressure (LOP) on 244 patients undergoing foot and ankle surgery. One hundred twelve patients were randomly assigned to the automated pressure study group while 132 were assigned to the control group. The primary outcome measure was tourniquet pressure used for either group, and secondary measures included the time to set the pressure and the number of patients failing LOP measurement. The tourniquet pressure was substantially lower in the study group versus the control group, while time to measure the LOP was 20 plus or minus six seconds; the quality of the surgical field was assessed to be better in the study group based on all three evaluation methods. It was determined that LOP measurement was a workable way of setting tourniquet pressures for limb surgery, and the automated pressure averages were lower than those routinely employed by most surgeons for thigh tourniquets.



Researchers assessed six ankles of five patients who underwent hindfoot endoscopy for intraosseous cysts localized to the posterior portion of talus. The median preoperative AOFAS score was 69 points, and all patients exhibited flexor hallucis longus tendinitis in clinical and radiologic evaluations; five affected ankles had large os trigoni. Graft union was verified with computed tomography in all patients, and the median postoperative AOFAS score improved to 90 points. The researchers concluded that hindfoot endoscopy can be utilized for the treatment of posteriorly localized intraosseous talar cysts, and benefits of this technique include reduced morbidity and expedited postoperative hospitalization time. Hindfoot endoscopy is thus a safe and effectual method for treating cystic lesions and is appealing for experienced arthroscopic surgeons.



A prospective study of 22 consecutive patients with Sanders type II, AO-OTA 83-C2 intra-articular calcaneal fractures who underwent dual-modality imaging guided percutaneous fracture fixation with a minimum follow-up of two years was undertaken to assess the effectiveness of subtalar arthroscopy and intraoperative fluoroscopy in percutaneous fixation of such injuries. The maximum accepted postreduction step-off was 1 mm, and fractures were fixed definitively with four to eight percutaneous cancellous screws. The study determined that subtalar arthroscopy enhances intraoperative fluoroscopy in anatomic reduction of the posterior calcaneal facet of the subtalar joint and is most effective for Sanders type II, AO-OTA 83-C2 fractures. The percutaneous strategy further evades complications with soft tissue affiliated with open reduction, but the procedure has a steep learning curve, and the migration to open reduction must be considered when percutaneous reduction fails.

Practice Management

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As health care providers adopt electronic medical records (EMRs), many are turning to cloud computing instead of in-house servers. Smaller practices of three to four physicians can save valuable office space by using cloud computing and take advantage of an operating expense model rather than a capital expense model. This enables a practice to start converting to an EMR with less money spent up front. Furthermore, cloud computing lets small practices leverage services and applications they otherwise would not be able to afford.



The Accreditation Council for Graduate Medical Education (ACGME) approved new rules that will limit first-year medical residents to 16-hour shifts, effective July 1, 2011. The majority of 464 residency program directors surveyed in July 2010 felt the new rules would compromise residents’ care to their hospital patients, negatively affect their ability to train medical students, and would not have any effect on resident fatigue, according to a study published in the March issue of the Mayo Clinic Proceedings.

Health Policy and Reimbursement

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When one of the largest physician groups in Nashville, Tenn., wanted to offer MRI scans in-house, it had to obtain approval of the state agency that governs whether new hospitals, medical equipment, and health services can be added to a community. Heritage Medical Associates PC Chief Executive Mark Grasela estimates that his group spent at least $35,000 in legal costs and application fees to secure approval for its MRI project. Grasela is now leading a coalition of 25 medical practices with a total of 1,100 doctors around the state hoping to pass a bill in the state legislature to remove medical equipment and services from the state's certificate of need requirements. Doctors supporting the effort say people willing to accept financial risks should be allowed to proceed with medical projects without regulatory hurdles. A major argument against making it easier for people to obtain new equipment is that it could result in more unnecessary procedures being performed.



The right of Medicaid healthcare providers to sue over payment cuts is the focus of not only a recently accepted Supreme Court case but also of coming HHS regulations, according to Sen. Chuck Grassley (R-Iowa). An amicus brief filed by several federal agencies in a Medicaid provider case accepted for review by the Supreme Court promised “a rulemaking proceeding over the next year that will result in an authoritative interpretation of” the relevant federal law. If the ruling allows providers to challenge states’ Medicaid reimbursement rates, then the guidance might propose different reimbursement rates, a statement from Grassley theorized.

Medicine, Drugs and Devices

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Current treatment of sports-related injuries includes nonsteroidal anti-inflammatory drugs (NSAIDs) that often lead to upper gastrointestinal side effects, and researchers evaluated the effectiveness and safety of the diclofenac epolamine topical patch (DETP), a topical NSAID to treat acute minor sprains and strains. The study involved the participation of 134 adult patients with acute, sprain-related ankle pain occurring less than 48 hours before entering the study, who received daily treatment of either the DETP or a placebo topical patch for a week. Pain associated with the ankle injury was greatly reduced in patients treated with the DETP compared to placebo patients, starting four hours after the first application, and the DETP was well tolerated while its safety was comparable to that of the placebo. The results of the study generally indicate that DETP is an effective analgesic for local treatment of pain in mild acute ankle sprain.



Researchers have found using a computer-based electronic order set helped facilitate timely discontinuation of postoperative antibacterials. In 2005, CMS and CDC released a report that showed only 41 percent of prophylactic antibacterials were correctly stopped within 24 hours of completed surgery. The researchers conducted an analysis over an eight-month period, implementing a computerized provider order entry (CPOE) system designed to stop the administration of prophylactic antibacterials. Results showed CPOE significantly improved timely discontinuation of antibacterials from 38.8 percent of surgeries to 55.7 percent in the intervention hospital.



A longitudinal study of elite rugby players that focused on functional overload injuries of patellar and Achilles tendons in a five-year ultrasound survey concluded that elite athletes are susceptible to patellar and Achilles tendonitis and progressive damage even after intense exercise is halted. The study compared data from elite athletes with that from a cohort of healthy nonathlete volunteers, matched for age and gender, to highlight any morphostructural disparities possibly related to functional overload. Fifty-two athletes underwent to ultrasound of their patellar and Achilles tendons in 2005, including 26 professional rugby players and 26 controls; patellar measurements were collected at rest and recorded on longitudinal scans at the proximal third, mean third, and distal third. Comparison between tendon thickness, focal hypoechoic areas, and calcifications in players and controls was made between 2005 and 2010. The researchers found that the incidence of degenerative hypoechoic areas in asymptomatic rugby players had increased at five-year follow-up, even though most of them had ceased their intense activity. They recommend that rugby players undergo evaluations of their tendons with ultrasonography even if they are asymptomatic. The research was presented at the European Congress of Radiology 2011.