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July 27, 2011

News From ACFAS


Register Now for ICD-10 Implementation Strategies for Physicians
On Wednesday, Aug. 3, at 1–3 p.m. ET, subject matter experts from the Centers for Medicare & Medicaid Services will hold a national provider call on how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding. Specific agenda items include: ICD-10 overview; lab NCDs conversion process from ICD-9-CM to 1CD-10-CM; home health conversion; OASIS and procedure code reporting; update on claims spanning the implementation date; national ICD-10 implementation issues.

Registration closes Tuesday, Aug. 2, at 1 p.m. ET or when filled, so please register early.

Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare fee-for-service (FFS) providers should listen in to this informative session.
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Take the ExFix Workshop for In-Depth Technique
“Complex Foot & Ankle Applications of Circular External Fixators,” Oct. 28–30, 2011, in Scottsdale, Ariz., is a comprehensive experience in external fixation techniques for the foot and ankle surgeon. This three-day course 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 a full brochure and online registration.
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Great Minds Share Alike
Research is essential to the medical profession. If you’re involved in a study, submit your manuscript or poster to be considered for presentation at the ACFAS 2012 Annual Scientific Conference, March 1–4, in San Antonio, Texas.

Don’t wait — the deadline for research manuscripts is only a few days away!Find applications and more details at the ACFAS website.
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Foot and Ankle Surgery


Neuromuscular Activity of the Peroneal Muscle After Foot Orthoses Therapy in Runners
A study was conducted to analyze neuromuscular activity of the musculus peroneus longus in runners with overuse injury symptoms treated with foot orthoses, focusing on 99 subjects randomized in a control group (CO) and an orthoses group (OR) who were studied on a treadmill prior to and following an eight-week foot orthoses intervention. Activity of the peroneal muscle was measured and quantified in the time domain (initial onset of activation (Tini), time of maximal activity (Tmax), total time of activation (Ttot)) and amplitude domain (amplitude in preactivation (Apre), weight acceptance (Awa), push-off (Apo)). There was no initial divergence in peroneal activity in the time domain between CO and OR, and no effect was seen following therapy (Tini: CO = -0.88 ± 0.09, OR = -0.88 ± 0.08 / Tmax: CO = 0.14 ± 0.06, OR = 0.15 ± 0.06 / Ttot: CO = 0.40 ± 0.09, OR = 0.41 ± 0.09; P > 0.05). Muscle activity was higher in OR after intervention in preactivation (CO = 0.97 ± 0.32, 95 percent confidence interval = 0.90-1.05; OR = 1.18 ± 0.43, 95 percent confidence interval = 1.08-1.28; P = 0.003). No group or intervention effect was observed during stance (Awa: CO = 2.33 ± 0.66, OR = 2.33 ± 0.74 / Apo: CO = 0.80 ± 0.41, OR = 0.88 ± 0.40; P > 0.05).

From the article of the same title
Medicine and Science in Sports and Exercise (08/11) Vol. 43, No. 8, P. 1500 Baur, Heiner; Hirschmuller, Anja; Muller, Steffen; et al.
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Spatial Orientation of the Subtalar Joint Axis Is Different in Subjects With and Without Achilles Tendon Disorders
The asymmetric mechanical load distribution within the Achilles tendon during locomotion is often cited as a major risk factor for Achilles tendon disorders, and it is theorized that the spatial orientation of the subtalar joint axis (STA) may influence the Achilles tendon loading, possibly leading to overload injuries. Research was conducted to test the hypothesis that a significant difference between the orientation of the STA in subjects with and without Achilles tendon pathologies exists, and 614 STAs uncovered in 307 long-distance runners with and without Achilles tendon disorders were included. Achilles tendon disorders were categorized as any Achilles tendon-related pain during or following running, existing for more than 14 days in the past. Motion analysis of the foot was executed using an ultrasonic pulse-echo-based measurement system, and the orientation of the STA was expressed by two angles. The average inclination angle was 42 plus or minus 16 degrees and the average deviation angle was 11 plus or minus 23 degrees. A substantial difference was observed between the mean deviation angle measured in subjects with Achilles tendon pathologies (18±23°) and those without (10±23°).

From the article of the same title
British Journal of Sports Medicine (07/01/11) Reule, Claudia A.; Alt, Wilfried W.; Lohrer, Heinz; et al.
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The Plantar Gap: Another Prognostic Factor for Fifth Metatarsal Stress Fracture
Researchers observed variable results even in the same Torg type classification, in cases with fifth metatarsal stress fracture, and they tested the hypothesis that the plantar gap correlates with the time for bone union and complications, and might be employed for a prognostic factor. The study involved the assessment of 75 cases with a fifth metatarsal stress fracture treated with modified tension band wiring from January 2003 to December 2008, and the elite-level athlete patients included 71 male and two female patients with an average of 19.8 years of age at the time of surgery. The average time for bone union for each Torg type was 71.05 plus or minus 21.77 days for type I, 104.48 plus or minus 54.62 days for type II, and 122.92 plus or minus 51.75 days for type III. A significant difference in the time for bone union was observed among the three Torg types. The average time for bone union in group A, with a plantar gap of less than 1 mm, was 71.21 plus or minus 29.95 days, and it was 126.4 plus or minus 51.99 days for group B, with a plantar gap greater than or equal to 1 mm. Furthermore, a positive correlation of the time for bone union with the degree of plantar gap was seen. In cases with Torg type II classification, there was a substantial difference in the time for bone union between groups A and B, while a strong correspondence between the time for bone union and the degree of plantar gap was exhibited. Eight cases of nonunion in Torg type II, and one case in Torg III, were reported. In reference to the plantar gap, there was a single case of nonunion in group A, and eight cases in group B.

From the article of the same title
American Journal of Sports Medicine (07/14/11) Lee, Kyung Tai; Park, Young Uk; Young, Ki Won; et al.
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Practice Management


Changing Reimbursement Models, Meaningful Use Are Top Medical Practice Concerns: MGMA
The top daily challenge for medical practice managers this year is "preparing for reimbursement models that place a greater share of financial risk on the practice," according to a Medical Group Management Association (MGMA) survey of 1,190 respondents. Participating in the Centers for Medicare and Medicaid Services' electronic health record (EHR) meaningful use incentive program is the second biggest daily challenge for respondents, followed by rising operational costs, selecting and deploying a new EHR system, and implementing and/or optimizing an accountable care organization. "The pressure to adopt technology and the morass our members face in determining the best systems for their practices and then complying with the various government programs to receive incentives and avoid penalties are proving to be of particular concern," said MGMA CEO William Jessee in a news release.

From the article of the same title
Modern Physician (06/11) Robeznieks, Andis
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HHS Releases Regulation Mandating New HIPAA Operating Rules
The Department of Health and Human Services (HHS) has issued the initial administrative simplification regulations required by the Affordable Care Act. This interim final rule, outlining operating rules for the HIPAA electronic insurance eligibility verification and claim status transactions, is the first in a series of regulations that are expected to reduce inefficient business processes by standardizing and improving electronic healthcare transactions. This interim final rule requires compliance by providers, health plans and healthcare clearinghouses by Jan. 1, 2013.

From the article of the same title
MGMA.com (07/25/11)
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Selling Your Practice
It is no simple task to sell a medical practice, and experts recommend that a physician start planning such a sale at least two years in advance. Measuring the value of the practice's assets, finding the optimal buyer, and placing a price tag on goodwill are some key factors to be mindful of during this time. The sale of the practice can be split into three main asset categories—hard assets, accounts receivable (A/R), and goodwill. Once the value of the practice's assets is determined, the next step involves finding the best purchaser, and the three primary buyers are other physicians, hospitals, and corporate medical entities. Of these categories, other physicians, specifically the selling physician's junior partners or another physician within one's specialty looking to move into one's geographic area, may make the best buyers.

From the article of the same title
Modern Medicine (07/10/11) Galloway, Amy J.
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Health Policy and Reimbursement


Budget Plan Fixes SGR, Cuts Billions from Healthcare
A proposal from the "Gang of Six" to increase the debt ceiling would cut over $200 billion from healthcare programs and repeal the sustainable growth rate (SGR) formula for physician reimbursement under Medicare. The plan would cut $3.7 billion from the national budget over the next decade, and calls for more efficient healthcare spending to strengthen Medicare and Medicaid, while simultaneously maintaining the basic structure of these programs. Repealing the SGR would put the Finance Committee in charge of finding a permanent solution to the payment formula that regularly calls for cuts in reimbursements that doctors receive for treating medical patients. The SGR calls for a 30 percent reduction in Medicare reimbursement starting Jan. 1, 2012, when current legislation blocking the cut expires.

From the article of the same title
MedPage Today (07/20/11) Walker, Emily P.
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IOM Urges Changes in Pain Management
A report from the Institute of Medicine finds that healthcare providers should customize pain treatment to each patient's experience and promote self-management of chronic pain. According to the researchers, the Department of Health and Human Services should devise a plan that raises awareness of pain and its consequences, and improves pain evaluation and management in the delivery of care and the funding of federal government programs. In the meantime, primary care doctors ought to collaborate with pain specialists in cases where the pain is persistent for patients, while public and private insurers could provide incentives to support the delivery of coordinated, evidence-based, interdisciplinary pain evaluation and treatment for those who live with complex pain.

From the article of the same title
Modern Healthcare (06/29/11) Zigmond, Jessica
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Release of Bundled-Payment Rules to Quicken
Regulators will speed up the issuance of rules deploying bundled payments for Medicare providers under the Patient Protection and Affordable Care Act, according to Centers for Medicare and Medicaid Services official Richard Gilfillan. He says such rules will be issued before their 2013 deadline, and he expects them to initially concentrate on the acute- and post-acute-care segments because private-sector efforts have already succeeded in those areas. Proponents of bundled payments for episodes of care have promoted their potential to lower the growth in healthcare costs, which are significantly higher among patients requiring care for multiple chronic ailments than among acute- and post-acute-care patients. It is probable that providers will prefer bundled payments over the accountable care organizations proposed earlier this year because they will permit providers to boost profitability for specific patients even as overall spending is more restricted, Gilfillan says.

From the article of the same title
Modern Healthcare (07/18/11) Daly, Rich
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Medicine, Drugs and Devices


FDA Defines Its Authority Over Mobile Medical Apps
The FDA has released draft guidelines indicating that out of the thousands of mobile medical apps currently available the agency will only look to oversee a small subset of apps, specifically those that physicians would most likely use to diagnose or monitor a patient's medical condition. This subset could include how a currently regulated medical device, like ultrasound equipment, performs, as well as apps capable of transforming smartphones and tablets into regulated medical devices. Apps that allow physicians to view medical images on a smartphone would also fall under the proposed guidelines. Mobile apps that would not fall under the guidelines would include those that allow a physician to view a medical video, or those capable of automating general office operations.

From the article of the same title
HealthLeaders Media (07/20/11) Tocknell, Margaret Dick
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Implant Chip Will Improve Care
Lee Berger, an orthopedic surgeon in New Jersey, has developed a chip that can be implanted in prosthetics to relay medical information about the patient. Berger developed the chip following numerous experiences with patients who did not remember the information needed to obtain proper follow-up care. The wireless chip can be embedded in the prosthetic, and contains information on the patient, the implant, and the procedure, ensuring the patient will never lose the necessary information for follow-up care. It has not yet been approved by the FDA, but Berger hopes it will be within a year.

From the article of the same title
Bergen Record (NJ) (07/19/11) Lopez, William
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One in 10 Computer-Generated Prescriptions Contains an Error: Study
A study published in the Journal of the American Medical Informatics Association reports that computer-generated prescriptions are as likely to contain errors as handwritten prescriptions. In the study, researchers reviewed 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain to identify and classify medication errors, potential adverse drug events, and the rate of prescribing errors by prescription type and system type. The researchers found at least one error in 11.7 percent of the computer-generated prescriptions reviewed. The most common error was omitted information, accounting for 60.7 percent of faulty prescriptions.

From the article of the same title
Modern Healthcare (06/30/11) Conn, Joseph
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