News From ACFAS

The House is not agreeing to pass the Senate's recent bill to help avert a Medicare physician payment cut. Insiders cite Speaker Pelosi's desire to have the Senate pass a larger version of the bill including provisions for the unemployed. Pressure mounts from AARP and physician groups, as well as the ticking time until Congress' July 4 recess, to get this legislation signed into law.

New York SB 2992A was passed by the Senate yesterday, expanding the definition of the practice of podiatry to include conditions of the ankle and all soft tissue structures of the leg below the knee anatomically affecting the foot and ankle. The new legislation also:

• Establishes that podiatrists licensed prior to the effective date of this act need to be certified to operate on the ankle
• Provides for the conducting of office-based surgery by podiatrists
• Directs the N.Y. Department of Health to study the feasibility of a podiatrist profiling program
• Will authorize the calling of a physician as an expert witness in a podiatric medical malpractice cause of action.

Questions? E-mail ACFAS Director of Health Policy, Practice Advocacy and Research Kristin Hellquist.

Apply for support for your research proposal with the 2010 ACFAS Clinical and Scientific Research Grant. Fellows and Associate Members can receive up to $20,000 for research in the podiatric surgical arena that will have an impact on issues of interest to members of the College.

For more information and to download an application, visit the ACFAS website. The deadline for proposal submission is October 15, 2010.

Do you have a professional profile on LinkedIn? Advertise your membership in the College by linking your profile to the brand-new LinkedIn group, “American College of Foot and Ankle Surgeons (ACFAS).” It’s easy to do; just go to the group’s LinkedIn page and click on the button “Join Group.”

You’ve worked hard to get to this point in your career — take advantage of another opportunity to advertise yourself as a member of ACFAS!

Catch up on research in journals you may not usually read with ACFAS’ Scientific Literature Reviews. Article abstracts are prepared for the interests of foot and ankle surgeons by podiatric residents. New abstracts include:

Plantar Pressures in Patients with and without Lateral Foot Pain after Lateral Column Lengthening, from the Journal of Bone and Joint Surgery (American).
Reviewed by Shanta L. Griffin, DPM, Central Alabama Veterans Healthcare System.

Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults, from the New England Journal of Medicine.
Reviewed by Catherine Hudson, DPM, Central Alabama Veterans Healthcare System.

Read these reviews and many more on the ACFAS website.

Foot and Ankle Surgery

Early Operative Intervention in Fractured Ankle Patients Key for Optimum Outcomes, Lower Costs

Early operative intervention, performed even before swelling begins, for patients with ankle fractures would result in significantly improved patient outcomes and financial savings, according to a study presented at EFORT Congress 2010 in Madrid. The study's goal was to examine the relationship between delays in surgical intervention with ankle fractures, length of hospital stay, and postoperative complications. The researchers performed a retrospective study of patients treated for ankle fractures between January and December 2008. They reported that out of 117 patients, 28 had their surgery delayed beyond 24 hours. The mean inpatient stay for the patients was 3.79 days, but the patients who had surgery delayed had a mean stay of 8.57 days.

Swelling was the cause of a postponed operation in 57 percent of the cases in the delayed group, while other causes include a lack of theatre time and a lack of fitness for surgery. "The ideal path is to either send the patient home for 5 to 7 days and operate on them when the swelling has come down – we can do that as a 1-day surgery – or to get them into surgery as soon as possible," said lead researcher Mohamed Qaffaf. "By doing that, we are preventing the high costs of the patient’s stay in the hospital and also reducing their risk of infection."



Study Suggests Larger Wounds Heal Quicker After Bypass Than Endovascular Surgery

Researchers have found that wound healing after lower extremity bypass (LEB) or endovascular revascularization (EV) demonstrated a more complete and faster rate of healing for larger wounds of more than 2 cm. The study reviewed the records of 142 LEB patients and 148 EV patients between January 2004 and December 2008. When comparing EV to LEB, there was no difference in average initial wound size (EV 14.1mm, LEB 14.6mm) and there was equivalent healing between the two groups, with 76 percent of wounds healed after LEB and 41 percent after EV. However, there was a difference in the healing rate for larger wounds, with complete healing in 70 percent of LEB patients and 27 percent of EV patients.

The EV procedures included 20 balloon angioplasties, 82 stent deployments, 30 atherectomies, and 10 cryoplasties. Lesions treated in the lower extremity were found in the superficial femoral arteries (30 percent), and popliteal (19 percent) and tibial (51 percent) arteries with 2.8 lesions treated per patient. The LEB patients included 98 vein grafts and 44 using polytetrafluoroethylene (PTFE) with a distal vein patch. Target arteries included 14 below knee popliteal, 46 anterior tibial, 41 posterior tibial, and 41 peroneal.

The findings were presented at the 64th Vascular Annual Meeting presented by the Society for Vascular Surgery on June 10 in Boston.



One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia

Congenital brachymetatarsia can be corrected surgically by callus distraction or one-stage lengthening using bone graft. Researchers examined whether one-stage metatarsal lengthening using metatarsal homologous bone graft could improve forefoot function, lead to metatarsal healing, restore metatarsal parabola, and improve cosmetic appearance.They retrospectively reviewed 29 patients (41 feet) in whom they lengthened 50 metatarsals. Surgery consisted of a transverse proximal osteotomy of the metatarsal shaft and interposition of a metatarsal homologous bone graft (average, 13 mm long) fixed with an intramedullary Kirschner wire. Bone union was achieved in all cases. The mean preoperative American Orthopaedic Foot and Ankle Society score was 37 points (range, 28-53 points) and the mean postoperative score was 88 points (range, 74-96 points), with an average improvement of 51 points.

Practice Management

1 in 5 Medical Claims Processed Inaccurately, AMA says

One in 5 medical claims is processed inaccurately by the nation's seven largest health insurers, slowing payments to physicians and causing confusion for consumers, according to a report released at the AMA's annual meeting in Chicago. The report said making claims processing 100 percent accurate would save the healthcare system $15 billion, largely by making healthcare more efficient and reducing administrative costs.



Affordable Care Act Provides Expanded Tax Benefit to Health Professionals Working in Underserved Areas

The IRS has announced that under the Affordable Care Act, healthcare professionals who received student loan relief under state programs that reward those who work in underserved communities may qualify for refunds on their 2009 federal income tax returns as well as an annual tax cut going forward. Prior to the new law, only amounts received under the National Health Service Corps Loan Repayment Program or certain state loan repayment programs eligible for funding under the Public Health Service Act qualified for a tax exclusion.

The Affordable Care Act expands this tax exclusion to include any state loan repayment or loan forgiveness programs intended to increase the availability of healthcare services in underserved areas or health professional shortage areas and makes this exclusion retroactive to the 2009 tax year. Health care professionals participating in these programs who have reported income from repaid or forgiven loan amounts on their 2009 returns may be due refunds.



Staffing: How Will New Technologies Affect Your Need For Personnel?

Electronic health record (EHR) systems have been heralded as a way to reduce paperwork and mistakes in the medical industry, but there is still no consensus on whether these technologies will also result in lower staffing needs and costs. Some industry experts say new technology will reduce staffing needs. "Because you are relying more on technology and automation, it gives you a fair chance of making some reductions in the human resources of the practice," says Gray Tuttle Jr., president of the National Society of Certified Healthcare Business Consultants. Tuttle says that the cost of new EHR technology can even be offset by staffing savings.

However, other industry observers say EHR technology will increase the need for staffing and could take a heavy toll on physician and staff time, particularly during implementation. "Implementing EHR data entry slows many physicians by 25 percent or more," says Keith C. Borglum, appraiser and broker with Professional Management & Marketing in Santa Rosa, California. He believes one solution could be to have a scribe that does the data entry while a physician works with a patient, and another could be to implement online patient pre-registration.

Health Policy and Reimbursement

Federal Agencies Will Establish A 'Do Not Pay List' to Prevent Fraud

The White House has ordered federal agencies to establish a national "do not pay list" to prevent the government from paying benefits, contracts, grants, and loans to ineligible people or organizations as part of efforts to cut government waste and fraud. The administration has also announced plans for CMS to use an online fraud-detection program developed by federal watchdogs who are tracking the economic stimulus program. CMS made $65 billion in erroneous payments in fiscal 2009, and officials expect the tool will help the agency keep closer tabs on medical providers by conducting deeper background checks.



HHS Details $250M Investment in Primary Care Workforce

The Department of Health and Human Services has announced the allocation of $250 million to bolster the U.S. primary care workforce. The funding represents the first allocation from the $500 million Prevention and Public Health fund for fiscal 2010, created by the Affordable Care Act. Half of the fund—$250 million—will attempt to boost the number of primary care providers by creating additional primary care residency slots, supporting physician assistant training in primary care, encouraging students to pursue full-time nursing careers, establishing new nurse practitioner-led clinics, and encouraging states to address health professional workforce needs.



Medical Liability Insurers Look at Tort Alternatives

Medical liability insurers attending the recent Physician Insurers Association of America annual meeting indicated that the healthcare reform law provides some of the tools necessary to reform the medical liability system. The law provides $50 million in incentive payments to states that test alternatives to damage caps and other traditional tort reform strategies. Four of the alternatives under consideration include health courts, early offers, apology programs and medical review panels to reduce claims and expenses, improve efficiency and improve fairness for physicians and patients.



Medicaid Funds May Not Come Through, Leaving States in a Lurch

If increased federal support for Medicaid is not extended, states will have to fill budget holes next year that state lawmakers had not anticipated. In Florida, for example, extra Medicaid funding worth $1 billion is in jeopardy, while the congressional impasse threatens to punch a $130 million hole in Kansas' budget, just weeks after state legislators raised taxes to keep it balanced.

States are also concerned about plans to expand Medicaid as part of the health overhaul. The Medicaid expansion will cost Ohio taxpayers $1.45 billion from 2014 through 2019, according to projections released by the state.

Technology and Device Trends

A Method to Calculate the Center of the Ankle Joint: A Comparison With the Vicon Plug-in-Gait Model

The conventional way to calculate the ankle joint center in gait analysis is using the Vicon Plug-in-Gait model. The present study proposes a new model, which calculates the joint center from two markers positioned over the medial and lateral malleoli. In order to compare the proposed model with Plug-in-Gait model, gait data were captured using a motion capture system. The ankle joint centers were calculated by the two models. The researchers found that the two ankle joint centers produced by two models were significantly different. The distances between two ankle joint centers were approximately 16.8 mm, and the differences in the posterior-anterior, medial-lateral and inferior-superior directions were approximately 6.3 mm, 7.7 mm, and 8.2 mm, respectively. Further error analysis highlighted that the probability of producing errors in two-marker-model is lower than that in Plug-in-Gait model.



Medical Radiation Is a Growing Concern

Americans get the most medical radiation in the world, with the average dose having grown sixfold over the last couple of decades. The United States accounts for half of the most advanced procedures that use radiation. CT scans have soared in use over the past decade, often replacing ultrasound and MRI, tests that don't require radiation. The proliferation in use has drawn concerns.

A study by Columbia University researchers, published in 2007, estimated that in a few decades, as many as 2 percent of all cancers in the United States might be due to radiation from CT scans given now. Because previous studies suggest that a third of all tests are unnecessary, the researchers concluded that 20 million adults and more than 1 million children are being put needlessly at risk.

Dr. Fred Mettler, radiology chief in the New Mexico Veterans Administration healthcare system, urges patients to challenge "big ticket'' tests like CT scans that deliver a lot of radiation to the chest and abdomen—places where cancer is likely to develop. "You shouldn't get too excited about feet and knee X-rays,'' he adds.



Postoperative MR Imaging of the Foot and Ankle: Tendon Repair, Ligament Repair, and Morton's Neuroma Resection

Researchers describe the postoperative magnetic resonance (MR) findings relating to surgery after tendon repair, ligament repair, and Morton's neuroma resection. The normal postoperative tendon is typically thickened, showing signal changes that are most pronounced three to six months after surgery. Two years after tendon suture, the signal intensity should be low on T2-weighted images. The focus of the postoperative MR imaging after ankle repair is to detect the normal condition after the various surgical procedures (e.g., Broström, Watson-Jones, Evans, or Chrisman-Snook). The repaired ligament has to be visible, low signal intense on T2-weighted MR images, and the shape should be homogeneous. Twenty-six percent of Morton's neuroma recurrences are seen in asymptomatic individuals after Morton's neuroma resection. Postoperatively, intermetatarsal bursitis MR abnormalities are more commonly encountered in symptomatic intermetatarsal spaces than in asymptomatic intermetatarsal spaces.



Abstract News © Copyright 2010 INFORMATION, INC.

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