News From ACFAS

---

ACFAS submitted comments to the Federal Trade Commission (FTC) supporting their work in promoting competition in the healthcare market. The FTC’s call for comments followed a two-day worshop on this topic in March that ACFAS attended.

In the College’s comments, ACFAS President Thomas S. Roukis, DPM, PhD, FACFAS said, “Our members encounter roadblock after roadblock in their ability to treat patients. Why? Because the MD community continually conspires to restrain trade by attempting to prevent podiatric foot and ankle surgeons and other licensed professionals from providing patient care.”

The comments cited a Physicians Foundation 2012 white paper that outlined “a pattern of anti-competitive behavior by the MD medical community,” and the American Medical Association’s 2007 scope analysis of podiatry as “riddled with inaccurate data that’s still being used against our members on MD practice websites and when ACFAS members seek hospital privileging.”

In conclusion, Roukis said, “An independent watchdog is sorely needed to protect the consumer and promote competition, and in this case, ensure patient access to licensed healthcare professionals. ACFAS wholeheartedly encourages the FTC to continue - and increase - its work in this arena, while rejecting MD-led opposition of the Commission’s work by Members of Congress.” Watch your mailbox for the latest edition of ACFAS Update to see a complete wrap up of all the education, networking, honors and fun had by over 1300 attendees at ACFAS 2014 in Orlando!

Can't wait for the hard copy? Get a sneak peek at the issue at acfas.org.

Foot and Ankle Surgery

---

A new study has found that endoscopic-assisted Achilles tendon reconstruction using free hamstring tendon autograft is an effective way to treat chronic ruptures of the Achilles tendon. The study found that the 15 patients who underwent the procedure experienced statistically significant improvements in their American Orthopaedic Foot & Ankle Society (AOFAS) scores for the hindfoot, which rose from an average of 32.6 before the operation to 90.8 two years after. In addition, the study found that patients were able to return to all daily activities--with the exception of athletic activities--after an average of 12.6 weeks. Finally, isokinetic strength testing of the calf muscle showed that there was no significant difference between the involved and uninvolved plantar flexors and dorsiflexors in terms of peak torque, average power, and total work two years after the operation.


A recent study examined the effectiveness of using combined standard posterior and anterior ankle arthroplasty in the same surgical session to treat patients with combined anterior and posterior ankle pathologies. Nineteen patients with both types of ankle pathologies, all of whom had undergone at least six months of unsuccessful conservative managements, were included in the study. The posterior procedure was performed first while patients were in the prone position, and the anterior procedure was performed next while patients were turned onto the supine position. The study found that the procedure produced initial results that were encouraging. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score, for example, rose from 70.2 +/- 15.2 points before the operation to 93.0 +/- 5.4 points at the one-year follow-up point--an increase that was seen as significant. More than 84 percent of patients were able to return to their pre-injury activity levels. Finally, the study found that none of the patients experienced persistent neurological deficits or infections.

Practice Management

---

The release of Medicare payment data could increase the risk of doctors being falsely accused of engaging in fraudulent billing practices, writes attorney Ike Devji, JD. Devji notes that this is true because the media is sensationalizing the news stories it is publishing or airing about the payment data by implying or even accusing doctors who bill Medicare for large sums of money of committing fraud. However, physicians can take several steps to protect themselves from such accusations as well as any other potential problems that may arise as a result of the publication of the Medicare payment data. For instance, Devji says that doctors should have their billing and coding practices reviewed by a third party so that any innocent mistakes can be reported and corrected proactively. Physicians practices should also make sure that their employees have the necessary billing certifications and that their drug treatment and compliance policies are up to date, Devji says. Finally, Devji recommends that practices purchase insurance in order to absorb any financial costs associated with false claims of fraud, innocent mistakes or other types of problems with Medicare billing.


A recent survey of 385 providers who were in the market for a new electronic health record (EHR) system in the first quarter found that roughly 40 percent of these providers were looking to replace their existing EHR. That figure is up 30 percent since the first quarter of 2013. Survey respondents had a variety of reasons for wanting to replace their current EHR, including difficulty using the system, a desire to upgrade to a more recent EHR, as well as a need to integrate their EHR with other systems.


MedData Group has released the results of a survey in which 532 doctors were asked about their use of mobile apps as part of their clinical work. The survey found that more than three-quarters of respondents used mobile apps. The most popular types of apps were medication interaction checkers, which were used by 48 percent of respondents. Diagnosis support apps were the second most popular apps, as they were used by 27 percent of doctors. Electronic health record viewer apps, which were used by 19 percent of survey participants, rounded out the top three.

Health Policy and Reimbursement

---

The findings of a new study published in the journal JAMA Internal Medicine highlights one of the challenges Medicare accountable care organizations (ACOs) face on holding down health spending: the ability of patients to see any doctor or visit any hospital they want, regardless of whether they are in the accountable care network or not. Researchers from Harvard University analyzed the Medicare bills for beneficiaries who were included in 145 ACOs during the two-year period prior to the beginning of the program, and found that 67 percent of visits by those patients were to specialists who were not members of the ACOs. A third of the beneficiaries were not in the same ACO both years, the study found. Economist Paul Ginsburg says the findings show that ACOs are limited in terms of what they can do to encourage beneficiaries to seek treatment from doctors and hospitals who belong to ACOs. Patients have few incentives for staying within an ACO when seeking care, Ginsburg says. A number of proposals have been made to address this issue, including one supported by the American Hospital Association that would allow senior citizens to volunteer or enroll in ACOs. However, some say that could encourage ACOs to try to keep their costs down by recruiting seniors who have minimal need for expensive healthcare services.


The Food and Drug Administration (FDA) announced April 22 that it is proposing a way to streamline the process of approving medical devices that are the only potential treatment options for some patients. Under the new Expedited Access Premarket Approval Application program, the FDA will focus on interacting with medical devicemakers earlier and more frequently in the approval process to bring certain devices to the market more quickly. The only devices which will be eligible for the program are those that feature new technologies offering substantial benefits for patients compared to products that are already on the market. The introduction of the expedited device approval program comes as the FDA has faced criticism over the inefficiency and slowness of the existing approval process--problems that critics say have delayed patients' access to new devices that could be useful in treating their conditions. Meanwhile, the FDA has also published proposed guidance on when data can be gathered after a device is approved and what actions the agency can take if devicemakers fail to collect post-market data or meet other approval conditions. The FDA is currently accepting comments on both proposals.


The Congressional Budget Office (CBO) and statisticians hired by insurers say that future increases in insurance premiums will be lower than previously thought. Statisticians are expecting insurance premiums to rise by an average of roughly 7 percent next year, which is below the double-digit increase that some had been expecting. Before the Affordable Care Act was enacted, premiums rose by an average of 7 to 10 percent annually. However, one statistician says that the rate of increase will vary in different locations across the country. Improvements in the healthcare system may be responsible for at least some of the slowdown in the increase in insurance premiums. CBO, meanwhile, recently announced that insurance premiums will be roughly 15 percent lower than what it had projected in the fall of 2009. The agency said it altered its projects in part because both the federal government and the private health sector are facing lower projected healthcare costs. However, Dave Axene of the Society of Actuaries says that insurance premiums are likely to increase more after 2017, once reinsurance and risk corridors are eliminated. Insurers may opt to spread out such increases over 2016 and 2017 in order to minimize the impact on their customers, Axene says.

Medicine, Drugs and Devices

---

A review of seven randomized clinical trials (RCTs) involving the use of hyperbaric oxygen therapy (HBOT) in treating patients with diabetic foot ulcers has found that there is some evidence that the technique is effective at improving the healing of such ulcers in patients with concomitant ischaemia. Two of the trials that were reviewed found that patients with ischaemic ulcers who underwent HBOT had increased rates of complete healing at the one year follow-up point, though the procedure did not seem to have an effect on the need for amputations. However, a separate trial found that ischaemic ulcer patients who were treated with HBOT did have significantly lower rates of major amputations. Trials that involved patients with non-ischaemic ulcers, meanwhile, found that HBOT brought about no change in wound healing or amputation rates. RCTs that included patients with unknown types of ulcers found that HBOT had a positive impact on amputation rates but that it had no effect on the need for other types of interventions. Researchers warned that further studies need to be performed before HBOT is used in routine clinical practice.


A new study has found that dry needling of myofascial trigger points is an effective technique for managing plantar heel pain. The study involved 84 patients who had plantar heel pain for at least one month. These patients were treated with either real trigger point dry needling or a sham version of the procedure for six weeks. After following patients for 12 weeks, the researchers determined that real dry needling was better than sham dry needling at reducing pain, as measured by the Visual Analog Scale (VAS) and the pain subscale of the Foot Health Status Questionnaire (FHSQ). However, the between group difference in pain was lower than the minimal important difference. Nevertheless, researchers concluded that dry needling brought about statistically significant improvements in plantar heel pain. However, patients who underwent real dry needling experienced significantly more minor transitory adverse events than their counterparts in the sham dry needling group.