News From ACFAS

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The ACFAS Regional Divisions will continue to support first-year podiatric surgical residents by providing complimentary first-year membership in the College. This offer gives new residents:

• Dues waived for one year — a direct value of $114
• Member pricing on conferences, products and services
• Access to the College’s top-notch educational offerings
• Connection to a community of your peers, the best and brightest foot and ankle surgeons in the country
• A subscription to the prestigious Journal of Foot and Ankle Surgery

Residents who join now will get an additional three months of membership, through September 2012. Applications are available at the ACFAS website.

Once again, congratulations to the Class of 2011. The ACFAS Regional Divisions look forward to welcoming you to the College.
Members of the College can receive up to $20,000 for their research through the 2011 ACFAS Clinical and Scientific Research Grant. Research should have a direct or indirect impact on issues of interest to ACFAS members. Projects capable of obtaining EBM Levels of Evidence 1, 2 or 3 will be given preference, but beginning this year, cadaveric, animal or bench-top studies will also be considered.

The ACFAS Research Committee is also encouraging use of a scoring scale, including the ACFAS Scoring Scale, which was recently validated by a volunteer ACFAS task force. Find the Scoring Scale, the Validation, an application and more information at acfas.org/grant.

Application deadline is Sept. 1, 2011.
Join us for a free webinar on July 26 to get relief from your concern and confusion as you face difficult decisions on an electronic health record (EHR) system. ACFAS and its BenefitsPartner Welch Allyn will review a proven program to help you manage the complex EHR preparation and selection process.

Title: “Taking Your EHR Selection Process from Confusion to Confidence”
Date: Tuesday, July 26, 2011
Time: 9:00–10:00 p.m. EDT

Please note a time change from 9am to 9pm.

This webinar will examine five key elements of a successful EHR selection project, and end with review of a successful EHR selection case study.

Visit the ACFAS website for more information and to register now for this valuable free presentation!
Senators Schumer (D-NY) and Grassley (R-IA) introduced S 1309, to recognize the services of podiatrists as physician services in the Social Security Act’s Title XIX/Medicaid statute, and would specifically identify podiatrists as physicians. The law currently requires that physician services be covered by state Medicaid programs, but states may currently opt to cover "podiatry services" or not.

Legal Briefs

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A physician's reliance on an oral statement that directly contradicted the clear terms of his written employment contract was unreasonable as a matter of law, the U.S. Court of Appeals for the Eastern District of Louisiana has ruled in granting summary judgment for the physician's former employer on his detrimental reliance claim. In Caplan v. Ochsner Clinic, the court went on to deny summary judgment for either party on the employer's counterclaim alleging that Dr. W. Ryckman Caplan deliberately misrepresented his malpractice claims history, that the Ochsner Clinic LLC detrimentally relied on the misrepresentation, and that the misrepresentation constituted a fraud that vitiated the employment contract. Caplan was an obstetrician/gynecologist. Ochsner solicited him to move his practice to its clinic. During negotiations, Ochsner allegedly guaranteed the physician five years of employment. Caplan's written agreement guaranteed only one year, however, with automatic one-year renewals subject to a provision that allowed either party to terminate the contract with 90 days' notice. Ochsner terminated Caplan's contract effective upon the expiration of his guaranteed first year of employment. Caplan sued, alleging detrimental reliance.

Foot and Ankle Surgery

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A multi-center retrospective study was performed to assess the effective use of botulinum toxin in the management of striated or hitchhiker's toe. The study involved the participation of four consultants and two trainees representing five separate neurological rehabilitation services, and full data was available from the 29 completed proformas. The subjects were 15 women between 20 and 78 years old. Stroke was the primary diagnosis in 18 subjects, while four exhibited bilateral involvement and 16 exhibited either an associated foot drop or equino varus deformity. Dysport was employed in 15 patients with an average dose of 170 units per injection, and Botox was used in the other 14 with an average dose of 65 units. The treatment was effective in 24 subjects, or 83 percent. All patients to whom Dysport was administered responded to treatment, while five subjects or 35 percent treated with Botox failed to respond. The majority of the non-respondents appeared to receive insufficient doses of Botox, while surgical management was successful in three out of the five non-respondent cases.


Researchers evaluated the long-term outcome of 83 Sanders type 4 comminuted intra-articular fractures of the calcaneum in 64 patients who underwent non-operative treatment between 1999 and 2005. Each fracture was treated by closed reduction and immobilisation in a long leg cast. Patients were reviewed every three months in the first year, and every six months thereafter. At each visit, the involved ankles were assessed by the AOFAS criteria. At a mean follow-up of 51 months, the mean AOFAS score was 72. Osteoarthritis was scored radiologically using Graves' classification and was evident in the subtalar joints of 75 ankles (90%), of which 20 were grade 0 or 1, 39 grade 2, and 24 grade 3. The researchers concluded that a non-operative approach to treating these fractures may be simpler, less expensive, easier to administer with fewer complications, and may be better tolerated than surgery, by many patients.


Researchers identified the incidence of post-operative symptomatic deep-vein thrombosis (DVT), as well as the risk factors for and location of DVT, in 665 patients (701 ankles) who underwent primary total ankle replacement. All patients received low-molecular-weight heparin prophylaxis. A total of 26 patients (3.9%) had a symptomatic DVT. Most thrombi (84.6%) were localized distally in the operated limb. Using a logistic multiple regression model, the researchers identified obesity, a previous venous thromboembolic event and the absence of full post-operative weight-bearing as independent risk factors for developing a symptomatic DVT. The incidence of symptomatic DVT after total ankle replacement and use of low-molecular-weight heparin is comparable with that in patients undergoing total knee or hip replacement.

Practice Management

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Physicians are unnecessarily losing time and money due claims-processing errors made by health insurers, according to AMA’s 2011 National Health Insurer Report Card. The findings show that physician’s practices are diverting nearly 14 percent of gross revenue annually to ensure accurate payments for their services. The AMA estimates errors in health insurer claims-processing cost the healthcare industry some $17 billion in unnecessary administrative costs per year. The average claims-processing error rate for commercial insurers was found to be nearly 20 percent, 2 percent higher than the previous year. The eight insurers surveyed in the report had an average claims-processing accuracy rate of 80 percent, down 2 percent since last year. UnitedHealthcare was the only insurer to see improvements, with an accuracy rating of 90 percent, while Anthem Blue Cross Blue Shield scored lowest with 61 percent accuracy.


When it comes to data recovery from computers or other equipment used to store health data following a disaster such as flooding, fire, or tornado, smaller healthcare organizations such as neighborhood clinics and physician offices can be hit just as hard, if not harder, than hospitals. A new fund set up by the charitable arm of the American Health Information Management Association, the AHIMA Foundation, aims to help association members return to work to help their organizations recover that data after a disaster. The AHIMA Foundation's Health Information Relief Operation Fund will give cash grants to health information professionals who need help after a natural or man-made disaster. To ensure data restoration is performed in a way that's compliant with privacy laws, AHIMA says contracts should ensure the data restoration company takes measures not to use or disclose recovered information and uses safeguards to prevent the use or disclosure of the information. The contract should also detail which methods will be used to recover the data and how long it will take to return the information and/or equipment. A termination clause that goes into effect if the business partner violates any material term of the contract should be included.


Many medical practices nationwide are victimized by their own employees, according to a recent report by the Medical Group Management Association. According to the report, nearly 83 percent of respondents were affiliated with a medical practice that had been a victim of employee theft or embezzlement. Dr. Donald Elton, a pulmonary and critical care physician and author of "How to Steal from a Medical Practice," says, "The people most likely to steal are the people you are least likely to suspect: The ones that are the long-time, loyal employees." He says such people typically do not like taking time off, tend to work extra hours, usually arrive early and stay late, and appear to be hard workers who do many different types of tasks. To curb employee theft, Elton installed software on the computers in his practice that track mouse clicks and screens visited by employees. He also limits access to the mail that comes to the practice and has taught himself billing.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services (CMS) has announced that it plans to allow eligible professionals to attest in 2012 that they used their electronic health records (EHRs) to collect data on clinical quality measures as part of the CMS criteria for "Meaningful Use" of EHRs. The 2010 Meaningful Use regulations required attestation only in 2011, after which providers would be required to report the quality data through uploads from their EHRs to a CMS-designed Web portal. Under CMS' new proposed rule on changes in physician reimbursement, CMS explained that it would allow attestation in 2012 because it is not ready to accept data online. CMS also announced the creation of a new pilot program, called the Physicians Quality Reporting System-Medicare EHR Incentive Pilot, to lay the foundation for the online submission of quality data from EHRs. Providers who participate in the pilot, instead of attest, can either submit data through their software vendor, if CMS allows the vendor to reformat data and submit it, or submit the data directly from their EHR, if it is approved by CMS. However, CMS will not release its list of approved vendors until the summer of 2012.


A survey by AMN Healthcare shows that physician alignment is the primary obstacle to accountable care organizations (ACOs). The survey of 882 facility administrators and physicians found that 58 percent of their organizations were in the process of forming ACOs or are considering them while 42 percent would not do so. Of those forming ACOs 42 percent said physician alignment was the biggest challenge they faced, followed by lack of capital at 38 percent, lack of integrated IT systems at 31 percent, and lack of evidence-based treatment protocol data at 25 percent. Of those who said they were not forming ACOs, 40 percent said that physician alignment was their primary reason for not doing so, followed by lack of capital (31 percent), lack of integrated IT systems (26 percent), and lack of evidence-based treatment protocol data (23 percent).

Medicine, Drugs and Devices

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In an effort to prevent wrong-site surgeries, the Joint Commission tamed up with several hospitals to determine exactly where and how these mistakes take place. The Commission says it now has a tool that can help hospitals discover the flaws in their processes that can result in wrong-site surgeries. The Targeted Solutions Tool uses Robust Process Improvement methods to help hospitals and surgical centers follow some simple sets of instructions using an electronic application that is available through every organization's secure electronic connection with the Joint Commission. The tool measures each organization's risk at the time of scheduling, in pre-op, and in the operating room. Recommended checkpoints serve to eliminate adverse events are being tested at eight hospitals, and are expected to be added to the tool later this summer. The commission will then pilot test these checkpoints to prove their effectiveness in different types and sizes of hospitals as well as ambulatory surgery centers and other care settings.


Brain-computer interfaces have enabled patients to execute basic thought-controlled tasks in the lab, and current designs for monitoring the electrical firings of single motor cortex neurons constitute electrode arrays implanted in the brain, linked to a computer that decodes recorded neural signals to move a cursor on the screen, or even a robotic limb. Over the next few years, paralysis patients will attempt to learn how to manipulate virtual hands or robotic appendages to reach push, grasp, or eat, and researchers hope to train users to carry out movements of increasing complexity as trials progress. Some brain-computer interfaces attempt to capture electrical signals using grids of electrodes on the surface of the dura mater, rather than implanting electrodes within the brain itself. The electrode grids can pick up the signals of neuron groups, and these neural assembles have synchronized activity that generates local field potentials, broadcasting what the brain is doing. The assemblies can adjust themselves to signal for particular movements through training.


Reports of potentially misleading pharmaceutical advertisements tripled from the previous year after the U.S. Food and Drug Administration launched its Bad Ad Program, which encourages health professionals to submit information on reputed deceitful advertising. Prior to the May 2010 rollout of the program, the FDA received an average of 104 yearly reports regarding misleading promotions by drug firms; that number has jumped in the last year to 328, with 188 of those reports coming from physicians and other health professionals, according to a June FDA report. Although anyone reporting to the Bad Ad Program can do so anonymously, the FDA's report indicated that only 4 percent of reports were anonymous, while a lack of familiarity with the program among health professionals is rampant.


Researchers report the short- to mid-term results of a prospective study evaluating dual intramuscular and intra-arterial autologous bone-marrow mononuclear cell (BM-MNC) implantation for the treatment of patients with severe peripheral arterial occlusive disease (PAD) in whom amputation was considered the only viable treatment option are presented. Ankle-brachial indices (ABIs), rest pain, and ulcer healing were assessed at 3 months. Success was defined as improvement in ABI measurements; absence of rest pain; absence of ulcers; and absence of major limb amputations. Twenty patients (21 limbs) were enrolled. Three-month follow-up evaluation accounting included 18 patients (19 limbs). Four (22.2%) major and 2 (11.1%) minor amputations were performed within 3 months postoperatively. With 17 (94.4%) of 18 limbs demonstrating at least one criterion for success and major amputation avoided in 14 (77.8%) of 18 limbs at the 3-month evaluation, the BM-MNC implantation technique was found to be an effective limb salvage strategy for patients with severe PAD.