News From ACFAS

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Don’t take a chance on Lady Luck — come to ACFAS’ “Practice Made Perfect” practice management/coding seminar in Las Vegas, Oct. 14–15, 2011. Sign up for a free coding consultant at the seminar with Douglas G. Stoker, DPM, FACFAS, by contacting kristin.hellquist@acfas.org.

Remember, members of the College can e-mail coding questions to Dr. Stoker any time at coding@acfas.org. In its effort to make it easier for residents and other potential Fellows to find information about high-quality foot and ankle fellowships, the ACFAS Fellowship Committee has added another program to the growing list of Recognized Fellowships on the ACFAS website. This program has met the minimal criteria set by ACFAS to assure adequate post-graduate training is occurring in the program:

• American Foundation of Lower Extremity Surgery and Research, Alamogordo, N.M.
  Fellowship Director: J. Joseph Anderson, DPM, FACFAS

For details on the Recognized Fellowship initiative, including a complete listing of ACFAS Recognized Fellowship Programs, ACFAS planned support for programs, and the criteria and application for recognition, visit the ACFAS website. “Complex Foot & Ankle Applications of Circular External Fixators,” Oct. 28–30, 2011, in Scottsdale, Ariz., is a comprehensive experience encompassing external fixation techniques specifically for the foot and ankle surgeon. Spend three days at the external fixation course that combines discussion, case presentations, lecture and hands-on instruction in foot and ankle procedures using monolateral and ring fixation techniques, and will reinforce the concepts of pathology correction and frame construction.

Visit the ACFAS website today for the full brochure and online registration. ACFAS e-Learning’s latest free podcast, “Physiologic Changes in the Foot during Pregnancy Utilizing a Computerized Mapping System,” is a concise presentation of a recent research study. Conducted at Wayne State University in Detroit, this study builds on earlier research and uses computerized gait analysis to determine causes of foot and back pain in pregnant women.

“It’s remarkable how little research has been done in this area,” says presenter Lawrence S. Brown, DPM, FACFAS, “given the universal symptoms of low-back and foot pain reported by pregnant women.”

Visit any time to learn more on this and the entire library of foot and ankle health topics at ACFAS e-Learning.

Foot and Ankle Surgery

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In the treatment of chronic ankle instability, most non-anatomical reconstructions use the peroneus brevis tendon. This, however, sacrifices the natural ankle stabilizing properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of patients treated with a hemi-Castaing procedure, which uses only half the peroneus brevis tendon. A retrospective cohort study of patients who underwent hemi-Castaing ligamentoplasty for chronic lateral ankle instability between 1993 and 2010 with a minimum of 12 months follow-up was carried out for the purpose of assessing the functional outcome of the procedure. Patients were given a questionnaire consisting of five validated outcome measures—Olerud-Molander Ankle Score (OMAS), Karlsson Ankle Functional Score (KAFS), Tegner Activity Level Score, visual analog scale on pain (VAS), and the Short Form 36 (SF-36). The questionnaire on functional outcome was completed by 20 patients, and the OMAS demonstrated good to excellent results in 80 percent and the KAFS in 65 percent. The Tegner Score improved from surgery but did not attain pre-injury levels, the VAS on pain was 1 of 10, and the SF-36 reverted to normal in comparison with the average population.


Researchers set out to provide evidence of responsiveness for the foot and ankle ability measures (FAAM) over a six-month period in individuals with diabetes mellitus. The two most recent FAAM scores of 155 diabetic patients treated for foot/ankle pathology were analyzed. Based on physical component summary (PCS) scores of the SF-36, subjects were categorized as improved (>7-point positive change), worsened (>7-point negative change), or unchanged (<7-point change). ANOVA curve analysis demonstrated a significant difference between groups (P=0.001). An increase in FAAM score of 9 points represented the minimal clinically important difference (MCID) with 0.64 sensitivity and 0.78 specificity. A decrease in FAAM score of 2 points represented a MCID with 0.65 sensitivity and 0.61 specificity.


Researchers studied how the Taylor spatial frame is employed to correct severe foot deformities in conjunction with double osteotomy, with eight severe deformities treated. A double Taylor spatial frame reconstruction was mounted to the limb. All patients had a midtarsal osteotomy and an additional inverse dome-shaped calcaneus osteotomy. Mean follow-up was 576.5 days. The final functional outcome according was good in seven cases, fair in none, and poor in one. Early complications included pin-tract infection, temporary hypoesthesia, and temporary shortening of the tendon of the M. flexor digitorum. At follow-up there was no deformity recurrence.

Practice Management

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As many as 209,000 physicians and other healthcare providers may already be in line for a 1 percent payment reduction in 2012 for not writing electronic prescriptions. The Centers for Medicare and Medicaid Services is examining claims from the first half of 2011 to determine who will be penalized starting next year. The 2008 Medicare Improvements for Patients and Providers Act established a Medicare e-prescription program that pays incentives to doctors who write at least 10 percent of their prescriptions electronically, with certain exceptions. The bonuses are 2 percent of eligible Medicare Part B charges in 2009-2010, 1 percent in 2011-2012, and 0.5 percent in 2013. Failing to write e-prescriptions carriers a 1 percent penalty in 2012, 1.5 percent in 2013, and 2 percent in 2014.


Adoption of electronic health records (EHRs) and participation in the meaningful use incentive program are being hindered by the high costs of EHR systems, physician practice size, and a lack of technical resources. Single practitioners and small practices are having difficulty finding lenders willing to give them an unsecured loans, and practices that try to finance EHR systems with vendors have no leverage to negotiate terms due to their limited market share. Congress is being urged to provide sufficient financial resources to enable solo practitioners to establish health IT, and to consider delaying the penalties for those who do not becoming meaningful users until such a time that a functional integrated EHR system is widely available.


Legal experts say a Michigan court ruling over disclosing patient names places tighter restrictions on what information physicians can release during legal proceedings and could lead to a rise in lawsuits against health care professionals over patient-privacy violations. The case stems from a 2009 lawsuit filed by Howell, Mich.-based podiatrist Isidore Steiner, DPM, of Family Foot Center against podiatrist Marc Bonanni, DPM, alleging that Bonanni "stole" patients in violation of an employee agreement. During discovery, the center requested that Bonanni disclose the names, addresses and telephone numbers of all patients treated at his new practice since he left the center. The center filed a motion asking the court to force Bonanni to produce the information. It said the Health Insurance Portability and Accountability Act (HIPAA) should be applied to the case; HIPAA allows certain patient disclosures during legal proceedings. But Bonanni argued that Michigan's patient privacy law, which prevents such disclosures, should be applied. A trial court ruled in favor of Bonanni. The decision was appealed. The appellate court ruled that the plaintiffs were not entitled to the patient information because Michigan law preempts HIPAA and that HIPAA applies only if there is not a more stringent state law related to patient privacy.


The Health IT Policy Committee has endorsed the delay of stage 2 for one year until 2014. As a result, providers will have three years through 2013 in which to verify that they have met stage 1 meaningful use requirements. The delay is designed to avoid any chaos that could result from the publication of the final rule for stage 2 requirements just several months before the provider reporting period would begin. The timing revision will only affect those providers who have attested to stage 1 in 2011.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services (CMS) is proposing to allow organizations that meet certain qualifications to have access to patient-protected Medicare claims data from Parts A, B and D. The Medicare information would be combined with private-sector claims data to identify physicians and hospitals that provide the highest quality care at the most cost-effective rates. To prevent mistakes, the proposed rule requires that any reports generated from the Medicare data be shared confidentially with providers and suppliers before being released to the public. Publicly released reports would contain only aggregated information.


Reps. Jackie Speier (D-Calif.) and Jared Polis (D-Colo.) are calling for support from their colleagues regarding upcoming legislation on healthcare pricing transparency. The lawmakers said in a letter that patients lack the information they need to “shop for” the best prices on procedures such as blood tests, colonoscopies and mammograms. The two lawmakers will soon introduce the Transparency in All Health Care Pricing Act of 2011 and have asked their House colleagues to endorse legislation by becoming original co-sponsors. “Our bill requires that all healthcare providers—including hospitals, physicians, nurses, pharmacies and dentists—furnish patients with price disclosures at or before the time they receive a healthcare product service or treatment,” the two wrote.


Starting July 1, Medicaid will halt its reimbursement to states of any sums spent for providing medical aid for provider-preventable events. Previous rules specified reduced payments for hospital-acquired conditions such as foreign object retained after surgery and surgical site infection following orthopedic procedures. Until this rule, states had flexibility to pay for these complications. However, only 29 states developed nonpayment policies for these conditions. The new rule closes the gap.

Medicine, Drugs and Devices

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Five U.S. senators have asked the Inspector General of the Department of Health and Human Services to open an investigation into physician-owned distributorships. The senators' request was accompanied by the release of a Senate Finance Committee report compiled by the office of Sen. Orrin Hatch of Utah, the top Republican on the committee, on the proliferation of such entities in spine and orthopedic surgery. By creating "financial incentives for physician investors to use those devices that give them the greatest financial return," they may violate an anti-kickback statute and other federal fraud and abuse laws, the report says.


A new animal study has determined that stem cell therapy enhanced with the insulin-like growth factor-I (IGF-I) hormone can help repair nonhealing bone fractures. University of North Carolina at Chapel Hill professor Anna Spagnoli, MD, and colleagues analyzed the impact of engineering the mesenchymal stem cells of mice to express IGF-I and transplanting them into mice that cannot heal bones and had tibial fractures. The treated mice's fractures healed better than did the control mice either left untreated or treated solely with stem cells, and the researchers discovered that the IGF-I-enriched stem cells became bone cells and helped the cells in the broken bones mend the break; Spagnoli reports that in comparison to controls left to heal on their own, the treated animals had more bone bridging the fracture gap, and that the new bone was several times stronger. The study was presented at the Endocrine Society's 93rd Annual Meeting


U.S. Sen. Sherrod Brown (D-Ohio) is calling for a probe of URL Pharma's recent 12,400 percent price-hike on Colcrys, its exclusive oral colchicine medicine to treat gout, accusing the company of price gouging. The drug that used to cost 4 cents per pill when 21 different drug companies were manufacturing oral colchicines, now costs $5 per pill once URL Pharma won FDA approval for the exclusive rights to produce and sell Colcrys. The increase raises the cost of a standard maintenance dose to $10 a day or higher to treat gout flare-ups. Brown estimates URL Pharma will earn nearly $11 billion per year with the price hike, though the company argues the figure to be grossly exaggerated. The hike will strain the budgets of 3 million gout sufferers, many who are senior citizens on fixed incomes.