News From ACFAS

---

Starting tomorrow, May 24, watch for one of two important ACFAS surveys in your email inbox; the sender will be “ACFAS President.”

Fifty percent of ACFAS members will receive the Practice Economics Survey on May 24, and 50 percent will receive the Member Opinion Survey next week. The survey you receive will be determined by random sample.

Once you receive your email, click on the link to take you to the confidential survey website. Your responses will be anonymous and only reported in the aggregate by a third-party survey consultant. Results will be posted on acfas.org in August 2012.

Once you complete your survey, you’ll be entered into a drawing for one of four new iPads or your registration fee for ACFAS 2013 in Las Vegas – your choice!
ACFAS is pleased to report that the Centers for Medicare and Medicaid Services (CMS) recently announced the final rule that will amend the hospital Conditions of Participation (CoP) to allow DPMs to serve as president of a hospital medical staff in states where it is not otherwise excluded by law. The final rule will take effect around July 16, 2012.

The College first raised this issue with the CMS back in 2009 and continued to actively advocate for change after several ACFAS members who were already serving in medical staff president roles became aware of this outdated rule and were forced to step down from their positions at their respected hospitals.

“This is a monumental move in the fight for equality for DPMs in the hospital setting,” said Michelle Butterworth, DPM, FACFAS, ACFAS President. “The outdated rule did not take into account how DPMs have evolved into their current stature with advanced education and training to serve in these roles.”

Watch This Week @ ACFAS and ACFAS Update for further news on the ruling.
Attention: Physicians and Office Staff Members

Space is still available in tonight's complimentary webinar on growing your practice's online presence.

Does getting new patients from the Internet or social media seem confusing? Don't know where to begin on developing a successful Internet marketing strategy? Join ACFAS and Officite for the complimentary one-hour webinar Grow Your Practice with an Online Presence tonight, May 23, 8-9pm CDST and learn how you can easily launch and manage a complete Internet strategy for your practice.

Experts from Officite will walk you through:

• How a Typical Patient Searches for a Podiatrist on Google and Other Major Search Engines
• The Important Elements You Need to Build a Successful Website and Marketing Strategy Including:
  • Website Design
  • Search Engine Marketing
  • Reputation Management
  • Social Media
  • Mobile Marketing

To register, visit officite.com/company/webinars. After you register, you will receive a confirmation email containing further details about joining the program.

Foot and Ankle Surgery

---

Noncalcium images reconstructed from dual-energy (DE) CT exams could help rule out distinct bone marrow lesions in the ankle, researchers wrote in the May 8 online edition of Radiology. MR is the standard for detecting such lesions, but it is not routine for patients presenting with ankle trauma, and single-energy CT does not permit bone marrow evaluation. With DE CT, calcium can be subtracted from the images. Researchers at University Hospital Zurich in Switzerland hypothesized that reconstruction of the noncalcium images could allow for the detection of traumatic bone marrow lesions in the ankle joint. The study involved 30 patients with acute ankle trauma who underwent dual-source DE CT and MR imaging within one day of the injury. Independent readers evaluated images for traumatic bone marrow lesions. Results suggest that DE CT with reconstruction of noncalcium images can help diagnose traumatic bone marrow lesions with high sensitivity and excellent negative predictive value when readers follow strict image interpretation criteria. However, sensitivity and negative predictive value fell with the inclusion of subtle lesions in the analysis. Specificity and positive predictive value of DE CT were poor, regardless of interpretation criteria. The research team shared several potential indications for the use of noncalcium DE CT, including early detection of traumatic bone marrow lesions and exclusion of such lesions and obviation of MR. Future studies must prove these potential indications.


Research was performed to assess the extensile posterior approach to the ankle with detachment of the Achilles tendon for resection of extensive tumors involving the posterior ankle, with a focus on six patients, five of whom were diagnosed with pigmented villonodular synovitis and one with chondroblastoma. All patients were observed to be free from tumors at an average follow-up of six years, as well as capable of unlimited walking without support. No complications with Achilles incompetence were recorded. The average Musculoskeletal Tumor Society score was 97 plus or minus 4.2 percent, and the average Achilles Tendon Total Rupture Score was 95 plus or minus 5.7. One patient with screwed suture anchors had backing out of two anchors along with deep infection, requiring surgical debridement and anchor removal. One other patient experienced a post-traumatic small wound dehiscence which was responsive to local wound care.


Researchers assessed the clinical effectiveness of surgical treatment for displaced intra-articular calcaneal fractures in comparison to nonsurgical treatment through a systematic search of four databases to identify randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that compared the two treatments between 1980 and 2011. The modified Jadad scale was used to evaluate trial quality, while effective data was pooled for meta-analysis. Ten studies—six RCTs and four CCTs—with a total of 891 participants were screened, and results demonstrated the superiority of surgical treatment over nonsurgical treatment in terms of better Bohler angle recovery, more stable calcaneal height, and width. In addition, fewer surgically treated patients required bigger shoe size and more were capable of resuming pre-injury work than the nonsurgical patients. The researchers observed no significant difference between the two techniques regarding the incidence of residual pain, but operative management corresponded with a higher risk of complications.

Practice Management

---

Physicians' offices and clinics can take several steps to avoid or deal with poor reviews on physician-rating sites. Physicians should keep their focus only on the items that directly relate to them, rather than negative reviews about issues such as parking availability. Doctors should allow survey results to show them what additional steps may be necessary. They should pay attention to negative ratings on issues such as clearly explaining things to patients and including patients in decision-making, and then ask themselves what they can do differently. This may include asking more open-ended questions that show concern.

Physicians should also set an "agenda" at the beginning of a patient visit by asking patients up front if they have additional concerns, which can help the doctor budget time correctly and avoid unpleasant surprises toward the end of the visit. Those who want to improve their online presence can easily maintain a LinkedIn or a Google profile with little regular upkeep. These sites tend to appear higher in a Web search of a physician's name compared to independent ratings sites. A blog or a practice website is more time-consuming, but will also help.

Physicians should also encourage patient reviews. On independent sites, many doctors can respond to negative reviews, but they should stay empathetic and professional if they do so. Unfair reviews may be removed from a site, but it is not recommended that a physician sue for defamation.


When recognizing the efforts of a medical staff, the least expensive rewards often have the greatest impact. Although employee compensation must stay competitive, it is also vital to praise staff for putting patients first. When establishing effective employee recognition programs, practices should first decide their objectives, such as increased patient safety or fewer billing errors, and tailor their rewards accordingly.

These goals should pass the "SMART" test: Specific, Measurable, Achievable, Results-oriented, and Time-bound. Management should attempt to quantify their current position in relation to these goals. This may involve patient and employee surveys, which can be informal and can verify the practice's culture. Leadership in the organization should also find opportunities for process improvement, such as faster check-in, same-day call backs, and efficient scheduling. Then, practice leadership should explain to the staff what behavior is desired and how it can help the individual and the practice. If patients wait too long for their appointment time, staff may be instructed to apologize, explain the reason for the delay, and offer assistance in making the wait more comfortable.

Managers must also model the desired behavior themselves. Public recognition should be used for staff members who set a good example; if this cannot be done immediately, it should be as soon as possible, such as the next staff meeting. As with the practice goals, this praise should be specific. A simple “Good job” may be nice to hear, but may not tell the employee exactly what they did right. Patients may be asked for the names of staff who provided outstanding service. Practices may also use award walls to acknowledge employees and even the physicians, or send handwritten notes to staff members.

Because not every employee interacts directly with patients, a reward system should not be connected exclusively to customer service, but should include workers in the billing department and the assistants who clean the exam rooms. Practice managers should take the time for informal interactions with staff, asking them what worked and what did not, and if they have all the tools they need. Management may want to begin a "Bright Ideas" campaign to encourage staff to suggest cost-saving measures and process-improvement ideas.


By choosing the right event or venue, such as a summer festival, business expo, or health fair, medical practices can widen their community exposure and attract new patients. Medical marketing experts stress approaching such a challenge creatively, and considering how to engage attendees and establish realistic expectations about what benefits will be gained. The first step when considering such events is to ascertain whether the practice will reach its intended market.

To interest potential patients at such events, the practice should offer standard brochures but use creative methods to spread information. Offering a minor, noninvasive medical assessment to attendees may draw passers-by. Ethics experts recommend that doctors follow up with patients in the event an on-site assessment uncovers abnormalities. Offering water bowls for dogs, free snacks or a bottle of water, or freebies such as magnets and other items sporting the practice's name and contact details are additional strategies practices can use to attract people. Once people are in the practice's booth, the practice should obtain their contact information so it can follow up with a phone call or note.

Health Policy and Reimbursement

---

The American Medical Association (AMA) is once again calling for a postponement of the adoption of the ICD-10 diagnostic and procedural codes, with AMA executive vice president James Madara stating in a letter to Centers for Medicare and Medicaid Services acting administrator Marilyn Tavenner that doctors need the delay because they are "overwhelmed with the simultaneous implementation of multiple health IT programs." He requested a two-year extension to Oct. 1, 2015, with the proviso that "if stakeholders cannot reach consensus for this matter during this two-year period, then the move to ICD-10 should be postponed indefinitely." The letter comes within the public comment period on a proposed rule from the Department of Health and Human Services to extend the national ICD-10 compliance deadline by one year to Oct. 1, 2014.


The MGMA-ACMPE, formerly the Medical Group Management Association, is seeking a six-month extension of the deadline for submitting hardship exemptions to avoid penalties associated with federal e-prescribing requirements. The deadline needs to be extended from June 30, 2012, to Dec. 31 to give practices time to assess their success in reporting so far this year and avoid the imposition of penalties in 2013, association President and CEO Susan Turney wrote in a letter to CMS Acting Administrator Marilyn Tavenner. The group also wants CMS to deem as compliant with the e-prescribing requirement all physicians who meet the separate electronic health-record system incentive program's meaningful-use requirements, which include e-prescribing and reporting clinical quality measures.

Medicine, Drugs and Devices

---

A growing number of hospitals are turning to companies to help them understand the massive amounts of data they are collecting. Companies like Microsoft, SAS Institute, IBM, and Oracle are using data-mining technologies to help hospitals detect patterns and improve medical care. The analytics industry generated more than $30 billion in 2011, according to the research firm IDC, and is projected to generate $33.6 billion in 2012. Data-mining has already resulted in some significant improvements in patient care.

New York-Presbyterian Hospital, for example, has reduced the rate of potentially fatal blood clotting by scanning for risk factors like cancer, smoking, and the amount of time patients were bed-bound. Last year, Seton Healthcare Family, a hospital system in central Texas, started using data-mining software to search through transcribed doctors' notes and other "unstructured data" like medical imaging numbers to find ways of lowering readmission rates for congestive heart failure patients.


More than a third of the nation’s prescriptions now are electronic, according to the latest count from Surescripts, the largest network for paperless prescribing. At the end of 2011, 36 percent of all prescriptions were electronic. That’s up from 22 percent of prescriptions that were paperless a year earlier.


Federal Communications Commission (FCC) Chairman Julius Genachowski said the United States will become the first country in the world to dedicate a portion of the wireless communications spectrum to Medical Body Area Networks (MBANs) for use by medical providers for wireless medical monitoring devices. The FCC has scheduled at its May 24 meeting discussion of proposed rule-making that will dedicate a part of the wireless spectrum to MBANs. If the measure is approved, and Genechowski said he believed it would be, “it will make the U.S. the first country in the world that will dedicate spectrum for MBAN technology in hospitals and doctors office.”