News From ACFAS

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

Find the answers you need to select the appropriate electronic health record system for your practice. Register today to participate in this free webinar, presented by ACFAS and its BenefitsPartner Welch Allyn. This fall the popular “1st MTPJ A-Z Workshop and Seminar” series returns to a city near you! Each program begins on Friday evening with the presentation “Bunion Complications and Failures,” followed by shared case studies. On Saturday, succinct lectures lead into comprehensive hands-on workshops.

ACFAS and Regional Divisions 1, 8, and 12 have teamed to bring this program to three new locations:

• Manhattan Beach Marriott, Manhattan Beach, Calif., Sept. 9–10
• Boston Marriott Burlington, Burlington, Mass., Oct. 21–22
• Best Western Lehigh Valley Hotel and Conference Center, Bethlehem, Pa., Dec. 2–3

Visit the ACFAS website for a full brochure and convenient online registration.
If you want to reduce recovery time for sports injuries and confidently return your athletic patients to their game, then you belong in this course! Attend the ACFAS Sports Medicine Surgical Skills Course, Oct. 1–2, at the Orthopaedic Learning Center in Rosemont, Ill., to learn nuanced approaches for the athletic patient.

Through concise lectures, ample lab time and group discussion, this course will provide the latest treatment options for the most common and most difficult sports-related injuries. Visit the ACFAS website today for complete information.

Foot and Ankle Surgery

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Researchers examined whether augmenting the Achilles tendon with extracellular matrix xenograft results in reduced repair site gapping and increased peak failure load in a cadaveric model with simulated physiologic loads. Ten matched pairs of fresh-frozen human lower extremities amputated just below the knee were obtained and each Achilles tendon was sharply tenotomized. One specimen from each pair underwent Achilles repair using a 4-strand Krackow technique with extracellular matrix xenograft augmentation, while the other underwent suture repair alone. Both tendons were then subjected to 1,000 sinusoidal tensile loading cycles to 86 N, during which repair site gapping was monitored, followed by distraction to failure. The study results show that significantly less gapping was observed in the augmented tendon group at all time points after the 10th load cycle. The ultimate failure load for the augmented group was 821 N, with a range of 613-1021 N, while the suture-only group was 392 N, with a range of 322-481 N. The clinical relevance of the research is that tendon repair augmentation may allow for more aggressive early rehabilitation, particularly in cases involving chronic rupture or poor tendon quality.


Researchers investigated the effect of different adjunctive treatments following botulinum toxin type A. The single-blind, randomized trial examined 69 chronic hemiplegic adult patients with spastic equinus foot. Following a botulinum toxin type A injection at the plantar flexors, patients were randomly assigned to three groups and treated either with taping, casting, or stretching for one week, with stretching and gait training the following week. The study measured subjects using the Modified Ashworth Scale at plantar flexors, passive range of motion at the ankle, six-minute walking test, 10-meter walking test, Functional Ambulation Categories, and ankle dorsiflexor strength both before and after the treatment. Only the taping and casting groups showed significant improvements in Modified Ashworth Scale, six-minute walking test, 10-meter walking test and passive range of motion. While the results were maintained for the casting group, only six-minute walking text and Modified Ashworth Scale were still significantly improved in the taping group after 90 days. Ankle dorsiflexor strength and Functional Ambulation Categories did not change in any of the groups. After 90 days, the casting group performed better than the taping and stretching groups on the Modified Ashworth Scale and passive range of motion, and better than the stretching group at the six-minute walking test.


A study was performed to assess the long-term clinical and radiographic results of the Osteochondral Autograft Transfer System (OATS) for the talus and compare the outcomes of patients who have had prior surgical interventions with patients for whom OATS is the primary surgical treatment. Twenty-six talus OATS procedures in 25 patients were analyzed with a mean follow-up of 84 months, while nine patients had OATS as a second surgical intervention. The patients completed the AOFAS and Tegner scores plus the visual analog scale (VAS) preoperatively and at follow-up. Magnetic resonance imaging examinations were conducted on a 1.5-T whole-body magnet that assessed transplant congruency, adjacent surface of the talus, the corresponding distal tibia, and joint effusion. The researchers found significant increases for the AOFAS score (50 to 78 points, P < .01) and the Tegner score (3.1 to 3.7, P < .05) and a significant decrease for the VAS (7.8 to 1.5, P < .01) from preoperative to postoperative. Patients with normal integration or minor incongruity of the transplant on magnetic resonance imaging (81%) had significantly better AOFAS scores (P = .03). Other magnetic resonance imaging criteria did not predict clinical results. Patients for whom OATS represented a second procedure had significantly worse clinical AOFAS and Tegner scores plus a higher VAS.

Practice Management

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Some physicians have been anonymously blogging and Tweeting about their frustrations with the medical industry. The results of these social media posts can be funny, provocative, and revealing, but some see them as a failure in physician professionalism. An analysis of physician tweets, published in the Journal of the American Medical Association (AMA), show that an estimated 3 percent of physician Tweets contain "unprofessional content." AMA's ethics policy on social media does not explicitly advise against posting online anonymously, but warns, "Physicians must recognize that actions online and content posted ... can undermine public trust in the medical profession."


Medical schools have traditionally done little to screen applicants who show poor people skills, but that is changing. At Virginia Tech Carilion, for example, administrators have decided against relying solely on grades, test scores and hour-long interviews to determine who got in. Instead, the school invites candidates to nine brief interviews that forces candidates to show they have the social skills to navigate a healthcare system in which good communication has become critical. The new process has enormous consequences not only for the lives of the applicants but, its backers hope, also for the entire healthcare system. It is called the multiple mini interview, and its use is spreading. At least eight medical schools in the United States and 13 in Canada are using it.


The Department of Health and Human Services has released an interim rule requiring insurers to employ uniform transmission formats and standardized forms when they seek information or provide claims and coverage information to physicians. Citing a study published in Health Affairs in 2010, HHS says the new regulations would save the healthcare system approximately $12 billion by reducing phone calls between doctors and health plans, lowering postage and paperwork costs, creating fewer claims denials for physicians, and automating healthcare administrative processes.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call entitled "ICD-10 Implementation Strategies for Physicians" on Aug. 3, 2011, 1–3 p.m. ET as part of ongoing efforts to prepare the physician community for the upcoming transition to the ICD-10 code set scheduled to take effect Oct. 1, 2013. Participants must register for this call by Aug. 2 or before available space has been filled. More information can be found here.


The U.S. Department of Health and Human Services (HHS) has published proposed rules outlining the requirements a state must meet to launch a health insurance exchange (HIX). The exchanges are expected to deliver coverage to approximately 11.5 million people in 2014, while HIX enrollment by individuals and small businesses will expand to 27.6 million by 2021, according to a March 2011 report from the Congressional Budget Office. The Affordable Care Act mandates that states establish HIX by January 2013 and that they be operational by January 2014.


During a congressional hearing, lawmakers in both parties expressed concerns about the Independent Payment Advisory Board (IPAB), comprised of 15 non-elected officials who will have the responsibility of recommending ways to reduce Medicare costs. Rep. Phil Roe (R-Tenn.), a physician, and Sen. John Cornyn (R-Texas)—both of whom have introduced legislation to repeal the IPAB—testified with Reps. Allyson Schwartz (D-Pa.) and George Miller (D-Calif.) before the House Energy and Commerce Subcommittee on Health. “First, I am concerned that the only tool in the IPAB toolbox will be cutting payments to providers, and we are already seeing how government price controls are restricting access to care,” said Cornyn, who added that 42 percent of physicians in Texas are considering leaving the Medicare program entirely because of reimbursement issues. Schwartz, one of eight Democratic co-sponsors on Roe's bill, said her decision to support repealing the IPAB reflects her “confidence in the many cost-containment measures” in the healthcare reform law.


Expanding Medicaid to low-income uninsured adults increases their use of inpatient, outpatient and preventive care, raises their reported health status and reduces unpaid medical bills, according to a study published by the National Bureau of Economic Research. The study found the expansion of Medicaid coverage to low-income adults in Oregon increased their likelihood of using outpatient care by 35 percent, using prescription drugs by 15 percent, and being admitted to the hospital by 30 percent, but did not seem to affect emergency department use. In 2014, the Patient Protection and Affordable Care Act will expand Medicaid to cover additional low-income adults.

Medicine, Drugs and Devices

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A Food and Drug Administration advisory panel will meet Sept. 9 to discuss the long-term safety of drugs used to treat osteoporosis. The panel will discuss bisphosphonates, which have been associated with a rare type of thigh fracture and osteonecrosis of the jaw, or jawbone death, when they are used over a long period. The FDA last year strengthened warning labels on the drugs and said doctors should periodically evaluate the need for continued bisphosphonate therapy for patients who have been on the drugs for longer than five years.


Thirty mice were on board the final mission of the space shuttle Atlantis, to help determine if a new drug can prevent bone loss associated with space flight. The drug is a bone-building sclerostin antibody being developed by Amgen in collaboration with UCB. Because zero gravity in space flight causes bone loss, the space shuttle flight offers an important opportunity to study how the new drug could be used in patients losing bone mass due to immobilization or disuse conditions such as stroke, cerebral palsy, muscular dystrophy, and spinal cord injury. Scientists will compare the bone mineral density of the 15 mice aboard the shuttle that received the sclerostin antibody with the 15 mice on board that received a placebo, and with 30 Earth-bound mice that also received either the drug or the placebo.


Small firms are offering orthopedic devices to hospitals at greatly reduced prices by dispensing with costly sales tactics, such as sending representatives into operating rooms to advise surgeons. Traditional heavyweights like Johnson & Johnson and Zimmer Holdings Inc. still dominate the $37 billion global orthopedics market, and small discount suppliers have been operating on the margins for a while. But hospitals' growing focus on controlling costs is drawing new interest and potentially boosting opportunities for cheaper products. "The market forces are moving in our direction," said John Marotta, chief executive of Emerge Medical, a private device-maker that launched last year and aims to offer savings of at least 40 percent. Emerge Medical's products, such as screws, plates, and drill bits used to fix broken bones, are geared toward a trauma market, and Orthopedic Network News reports that trauma kits with an array of components can cost thousands of dollars. Market forces in the devices sector, such as more aggressive hospital bargaining and decelerated growth for leading products, have raised expectations that device firms also will have to slash selling costs. Companies offering less expensive products see room to eliminate the full-court sales promotion, at least for products used in simple procedures.