News From ACFAS

Sources in Washington say the Senate is close to passing a bill that would postpone the 21 percent Medicare reimbursement cut to doctors for one year. The Centers for Medicare and Medicaid Services has given Congress additional time by using administrative authority to delay processing claims at a reduced rate until June 18. Many in Congress are still wary of the bill’s price tag, and none of the proposed solutions addresses a permanent fix to the reimbursement formula.

Visit "Articles in Press" at the Journal of Foot & Ankle Surgery's online home page, where new articles are available as soon as their proofs have been approved — even before they're assigned to an issue.

It's quick and easy:

• Go to acfas.org/jfas.
• Click on “Read current and past issues online” (member login required).
• When you reach the JFAS home page, click on “Articles in Press” in the left-hand menu.

Check out what's new, including original research, case reports, and tips, quips and pearls.


ACFAS’ Scientific Literature Reviews offer you the chance to quickly catch up on articles from journals you may not usually read. Current research is abstracted especially for the interests of foot and ankle surgeons by podiatric residents. New abstracts for June include:

Anterior Tarsectomy Long-term Results in Adult Pes Cavus, from Orthopaedics and Traumatology: Surgery and Research.
Reviewed by Stanitia Davis, DPM, Central Alabama Veterans Healthcare Systems.

Fine Needle Aspiration for Clinical Triage of Extremity Soft Tissue Masses, from Clinical Orthopaedics and Related Research.
Reviewed by Kurt Glesne, DPM, Florida Hospital East Orlando.

Read these reviews and many more on the ACFAS website.

Foot and Ankle Surgery

Study: Lax Infection Control At Surgery Centers

A new federal study suggests that many same-day surgery centers have major problems with controlling infection. Failing to wash hands, wear gloves, and clean blood glucose meters were some of the major problems. Clinics reused devices intended for single use, or used single-dose medicine vials on multiple patients. The findings, published in the Journal of the American Medical Association, suggests that insufficient infection practices may plague the country's 5,000-plus outpatient centers. "These are basic fundamentals of infection control, things like cleaning your hands, cleaning surfaces in patient care areas," says the study's lead author Dr. Melissa Schaefer of the Centers for Disease Control and Prevention. "It's all surprising and somewhat disappointing." U.S. Health and Human Services Secretary Kathleen Sebelius says her department is expanding its hospital infection control plan to include ambulatory surgical centers and dialysis centers. The study found that 67 percent of centers had at least one lapse in infection control, and 57 percent were cited for deficiencies. The study did not examine whether any of the lapses actually led to infections in patients. Some of the centers examined in the study had not been inspected for 12 years. State agencies have the primary responsibility for ensuring centers comply with federal standards. States are now required to use a new audit tool to inspect centers participating in Medicare. Dr. David Shapiro of the Ambulatory Surgery Center Association, a trade group, says the study will cause centers to redouble their efforts to improve patient care, as any incident is one too many.



Ultrasonographic Phases in Gap Healing Following Ponseti-type Achilles Tenotomy

The Ponseti technique is well established in the management of clubfoot deformity, and an Achilles tenotomy is frequently performed to facilitate dorsiflexion of the foot. This study describes the ultrasonographic phases of healing of the tendon gap created by the Achilles tenotomy and how the healing varies. A prospective ultrasonographic study of gap healing following a Ponseti-type tenotomy in 27 tendons in 26 patients with idiopathic congenital clubfoot was performed. Serial ultrasound examinations (both static and dynamic) were performed at three, six, and 12 weeks after the tenotomy. The end point of healing was defined as the observation of tendon homogeneity across the gap zone on ultrasound, with the divided tendon ends being indistinct. Three phases of healing were apparent on ultrasound assessment at three, six, and 12 weeks after the tenotomy. The transition to normal structure was demonstrated by ultrasonography only at 12 weeks in 13 of 21 tendons. The researchers concluded that while there is evidence of continuity of the Achilles tendon by three weeks after tenotomy, healing is not typically complete until at least 12 weeks. The time needed for the tendon to completely heal should be taken into consideration before a revision Achilles tenotomy is planned.

Practice Management

Doctors Tack on Fees for Patients

An increasing number of doctors are boosting revenue by asking patients to pay new fees for services not covered by insurance. The extra payments include no-show fees of $30-$50 for missed appointments; varying charges for filling out health forms for school, work or athletic teams; and annual administrative fees of $35-$120 or more to simply be a patient in some practices. While these doctors are still in the minority, more are joining them because they say the need the fees to offset the rising costs of practicing medicine.

"It's not unlike the airlines," said William Jessee, president of the Medical Group Management Association, which generally advises against extra fees that may anger patients or run afoul of insurance contracts. "They've gone from all-inclusive to a la carte."



How to Find Any Attorney Who's Right for You—and Your Practice

There are various issues that physicians may have to contend with when managing their medical practice, and practice management experts recommend cultivating relationships with specialized legal professionals to help navigate these issues. Health Law Center President Neil B. Caesar says that "it's very important to view [the attorney] as a business adviser—perhaps one who filters advice through a legal prism—but an adviser nonetheless." Consultant Michael D. Brown stresses the value of looking for an attorney who is solely focused on healthcare law. Among the resources that healthcare providers can use to find healthcare attorneys are referrals from colleagues, the Internet, speaker lists, bar associations and specialty associations, state attorney's offices, and county and state medical societies. Caesar notes that specific types of issues call for specific specialists. Furthermore, the degree of legal service the practice owner may require may vary according to the size of the practice.



MGMA Physician Placement Report: 65 Percent of Established Physicians Placed in Hospital-Owned Practices

The Medical Group Management Association's (MGMA's) physician placement report finds that in 2010 hospital-owned practices were the site of placement of 65 percent of established physicians and nearly 50 percent of physicians hired out of residency or fellowship. Primary care and specialty care physicians in hospital-owned practices were offered higher first-year guaranteed compensation than in not hospital-owned practices, which is a reversal of historical trends. MGMA's data also indicates that first-year guaranteed compensation has fallen by 2.1 percent since 2006 for specialists in single specialty practices, while primary care first-year guaranteed compensation has risen by 17.4 percent in the same period. "Physicians are looking to sustain income to pay office overhead and have a paycheck to take home, and those with large Medicare populations are more likely to want to move to hospital-employed positions," observes MGMA survey advisory committee member Brenda Lewis.

Health Policy and Reimbursement

Cobra Health Coverage Payment Aid Appears Likely to End

Unless lawmakers approve an extension retroactively, people who lose their jobs on or after June 1 no longer will receive government financial help to cover 65 percent of their premium costs for Cobra health coverage. The House stripped a provision that would have extended the Cobra payment subsidy out of a recent jobs bill . That bill now heads to the Senate. If lawmakers choose not to extend the Cobra subsidy, the only people who could claim those subsidies for 15 months are those who were laid off between September 2008 and May 31, 2010.



Doctors and Hospitals Say Goals on Computerized Records Are Unrealistic

The eligibility criteria for hospitals to receive government funding to adopt electronic medical records systems is so strict that very few physicians or hospitals can meet them, including leaders like Kaiser Permanente or Intermountain Healthcare who already use fairly sophisticated technology. The government’s approach has “unrealistic expectations” and “unachievable timelines,” according to Dr. Thomas H. Lee of Partners HealthCare. Doctors and hospital executives have met with officials at the White House to convey this message, stressing that it could actually have the unintended effect of discouraging hospitals from even attempting a conversion. A letter to the administration from 27 senators and 245 House members echoed this concern. Jonathan D. Blum of the Centers for Medicare and Medicaid Services said the government is taking the concerns of the medical community into advisement, but still wants to “push them to elevate their performance.”



Reform Repayment Rules Change Game for Providers, N.Y. Medicaid IG Says

A healthcare reform provision requiring mandatory reporting and repayment of overpayments to the Medicare and Medicaid programs are game changers for providers, according to the New York Medicaid inspector general. “The obligation had been on the government to determine if there were monies owed,” said New York IG James Sheehan at the June 7 Fifth National Medicaid Congress. “The burden for providing accurate claims now goes on the provider. It's a pretty significant increase in the power of the government and the responsibilities of providers.”

Under the Patient Protection and Affordable Care Act, providers have 60 days from identifying an overpayment to report and repay the overpayment. Providers must also include a reason for the overpayment. Any overpayments that are retained after the 60-day period constitute false claims and are violations of the False Claims Act.

The provision went into effect March 23.



State Aid to Medicaid Drops 2.7 Percent; Fed Spending Jumps 17 Percent

State funding for Medicaid fell an estimated 2.7 percent in fiscal 2010 as federal spending climbed 17.2 percent, according to the most recent poll by the National Association of State Budget Officers and National Governors Association. The survey suggests a sharp reversal of this trend, which stems from $87 billion in federal Medicaid relief for states under the 2009 economic stimulus bill, in fiscal 2011 as the funds are depleted. Governors' budget recommendations forecast a 7 percent increase in state Medicaid spending in 2011 as federal funds decline 1.7 percent, while Medicaid enrollment is anticipated to expand 5.4 percent in the coming year following an estimated 8.3 percent in 2010 and 6 percent growth in 2009. Thirty-two states slashed payments to Medicaid providers or intended to do so this year, while another 28 made similar proposals for fiscal 2011. Fifteen states proposed or implemented a freeze on payments in 2010, as did governors' 2011 budget recommendations for 20 states.

Technology and Device Trends

Platelet-rich Plasma Shows Effectiveness in the Treatment of Severe Achilles Tendinosis

Autologous platelet-rich plasma (PRP) can provide short-term patient satisfaction after its use in the treatment of severe Achilles tendinosis, according to research presented at EFORT Congress 2010 in Madrid. Researchers injected 4 cc of PRP into 27 patients who had failed an average 8 months of nonoperative management for severe Achilles tendinosis. Pretreatment American Orthopaedics Foot and Ankle Society scores averaged 34. After treatment, the patient’s average AOFAS scores improved to 84 at 1 month, 87 at 2 months, 88 at 3 months, and 92 at 6 months.



Post-Op Patients Tap Internet for Meds Monitoring

Patients recovering from congestive heart failure at Nyack Hospital in Nyack, N.Y., are being offered a telemonitoring system to help with medication compliance. The data collected from the system generates an e-diary of patient adherence to the prescribed drug regimen, allowing clinicians and physicians to monitor compliance at the patient or study group level. The eMedonline telemonitoring system is being tested at the hospital. Patients can opt into the program when they are released. They are provided their medication in smart-labeled packaging that includes a radio frequency identification tag, a wireless tag reader, and a cell phone. The reader turns the phone into a medication scanner. A mobile app on the phone schedules the medication and calls patients, providing prompts and a synthesized voice that tells them which medication to take and what it's for. The tag reader lets patients know they have the right bottle, and the phone transmits their responses to a database and to medical and clinical staff. Missed doses generate alerts to the medical team.



Abstract News © Copyright 2010 INFORMATION, INC.

---

You have received this newsletter as a service of the American College of Foot and Ankle Surgeons. To change your email address, please click here. If you wish to unsubscribe click here.