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July 31, 2013
Have you seen the all-new ACFAS.org yet?

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News From ACFAS


ACFAS Research Grant Applications Due September 16
Wouldn’t it be great to have some extra cash to help improve patient outcomes and further the field of foot and ankle surgery? Up to $40,000 in grant money will be awarded and allocated to highly qualified members who are able to fully demonstrate their desire and capability to do just that. Apply for the 2013 ACFAS Clinical and Scientific Research Grant by September 16, 2013 – applications and instructions are available at acfas.org.

The goal of this program is to encourage members to implement evidence-based medicine in order to advance their clinical practice and to help better serve patients. The research must be clinical or laboratory-based, with clearly defined research goals meeting all the criteria for grant submission. Information on the criteria and other details regarding the grant application can be found on acfas.org, under the "Research and Publications" tab when you click on "Research Resources" in the main pull-down menu. Remember, all applications are due by September 16, 2013, so apply now!
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Stay Social: Final Day of ACFAS' Facebook "Group"
Today marks the last day ACFAS' Facebook Group will be active. Stay connected to ACFAS and the podiatric arena by "Liking" ACFAS' new Facebook Page. Remember, anyone liking the new Page will be entered into the drawing for a $100 Amex gift card, which will be announced in the August 7 edition of This Week@ACFAS.

Join Spencer Niemann, DPM, FACFAS, of Chandler, AZ, in making the switch -- his efforts won him the second $50 Amex gift card from ACFAS just for "Liking" ACFAS on Facebook. You could be the $100 grand prize winner--you have until Midnight tonight, July 31, to make the switch to be entered into the drawing. Don't forget to also share the new ACFAS Facebook Page with your Colleagues.
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August 31 Application Deadline Nearing for ACFAS Recognized Fellowships
Your fellowship program could be among the latest to be officially recognized by ACFAS! The College is accepting applications through August 31, 2013, the date chosen by the Fellowship Committee, in an effort to streamline internal processes. This will allow for a better focus on program support, visibility and high standards of the programs currently recognized by ACFAS.

If you are a fellowship program director and would like your program to be considered for official recognition by the College, contact ACFAS Director of Membership Michelle Brozell for the application, then be sure to send it in to ACFAS Headquarters by August 31. Program interviews between committee representatives and the program director will be scheduled and held during the month of September. For information, please visit acfas.org/fellowshipinitiative.
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Foot and Ankle Surgery


The Role of Arthroscopy in the Treatment of Functional Instability of the Ankle
A recent study has concluded that ankle arthroscopy has a role to play in treating functional instability (FI) of the ankle following trauma, particularly when conservative measures have not been successful. Researchers came to that conclusion by examining 72 patients who had undergone ankle arthroscopy after suffering an ankle sprain with FI. The patients did not display signs of mechanical instability or soft tissue impingement. All of the patients had used up all their options for conservative therapy. Fifty-two of the patients showed signs of improvement after a minimum of six months follow-up. Sixty-seven of the patients had significant amounts of scar tissue needing debridement, typically in the antero-lateral corner.

From the article of the same title
Foot and Ankle Surgery (07/17/13) Kerr, Hui-Ling; Bayley, Edward ; Jackson, Rosalyn; et al.
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Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus
A recent study has found that the proximal oblique sliding closing wedge osteotomy (POSCWO) technique is an effective and reliable method for treating moderate to severe incongruent hallux valgus deformity. The study examined 144 patients (187 feet) who were operated on between May 2005 and June 2010. Patients were at a median age of 60 years, and they were included in the study only if they had no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility.

Eighty-seven percent of the participants reported being satisfied with the POSCWO technique. Mean hallux valgus angles dropped from 35.6 degrees before the procedure to 12.3 degrees after a median follow-up period of 35 months. The mean preoperative intermetatarsal angle (IM) was 15.3 degrees, while the mean postoperative IM angle was 4.8 degrees. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score, meanwhile, increased from 53 points before the operation to 89 points afterward. However, revision surgeries were required in 12 feet that displayed a recurrence of the incongruent hallux valgus deformity.

From the article of the same title
Foot & Ankle International (07/13) Wagner, E. ; Ortiz, C. ; Gould, J.S.; et al.
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Practice Management


Portals Give Patients a Handy Window to Their Health Information
Patient portals are slowly evolving into a concept known as a "health information exchange (HIE) of One," in which patients are given control over their healthcare data so that it can be shared wherever and with whomever they wish. This concept offers a number of benefits to physicians and patients alike. Giving patients control over their own data empowers them. Doctors, meanwhile, are able to receive vital information about their patients at the point of care. Patient-controlled portals also allow doctors to eliminate some of the hoops that they have to jump through to obtain patient information--including obtaining patient consent, since consent is implied when using these portals. However, experts say that an HIE of One should only be seen as a tool to enhance the exchange of information between doctors and their patients, not as a replacement for that type of communication. This is because patients may not tell their doctors about information they believe is unimportant, even though it may be, or about information they feel is private. As a result, doctors still need to be proactive about getting the information they need from several different sources.

From the article of the same title
American Medical News (07/22/13) Dolan, Pamela Lewis
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Doctors Who Skip Social Media Risk Alienating Patients
A report released last month by the digital consulting firm HP Social Media Solutions concluded that doctors need to have at least a basic presence in the realm of social media in order to communicate with their patients and to prevent negative reviews written by patients from damaging their reputation. The report noted that doctors who fail to use social media may be completely unaware of these negative reviews, and that having a social media presence can allow doctors to quickly respond to any online complaints. The report also noted that doctors can use social media to correct any erroneous medical information that might be posted online.

Experts say that as part of a basic social media presence, doctors should at least monitor what patients are saying about them. But experts also say that physicians should consider opening a Twitter account to send out short messages that include updates about their practices as well as general health information. Doctors may want to consider opening an account on the professional social networking site LinkedIn as well, experts say. Experts also point out that doctors should be sure to open social networking accounts in their names so that others can not impersonate them.

From the article of the same title
American Medical News (07/22/13) Ter Maat, Sue
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Health Policy and Reimbursement


CMS Issues Temporary Moratoria on New Providers in Certain Areas
The Centers for Medicare & Medicaid Services announced July 26 that it was placing a temporary freeze on Medicare provider and supplier enrollments in some areas of the country with high rates of fraud. The temporary moratoria on enrollments applies to new home health agencies in the Miami and Chicago areas. New ambulance providers and suppliers in the Houston area are also affected. CMS does not believe that the moratoria will have a negative impact on patient care.

From the article of the same title
BNA's Health Care Daily Report (07/26/13)
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Congress Faces Busy Healthcare Agenda in Week Before August Recess Begins
Congress will hold a number of committee hearings and votes on healthcare issues this week as lawmakers prepare to leave for their five-week August recess. Among the hearings is a session that will be held on July 31 by the House Energy and Commerce Committee to markup legislation that would replace the physician reimbursement formula used by Medicare with a new payment system based on quality performance measures. The metrics that will be used to measure the performance of doctors have yet to be decided on. Meanwhile, the Senate Finance Committee will hold an informal meeting on July 31 in which it will discuss physician reimbursements in Medicare. The committee has yet to write legislation dealing with that issue.

Back over in the House, other lawmakers are focusing on the implementation of the Affordable Care Act (ACA)--including how to prevent it from being implemented. The House Ways and Means Committee will hold a hearing on Aug. 1 in which several officials, including at least one from the Centers for Medicare and Medicaid Services, will testify on the progress that is being made in implementing ACA. The House has also scheduled a vote for this week on legislation that would prohibit the Treasury Department or any designee of the Treasury Secretary--including the IRS--from implementing any part of the healthcare reform law.

From the article of the same title
Bloomberg BNA (07/30/13) Lindeman, Ralph
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HHS OIG Finds Unallowable Claims Paid by Medicare Contractor for Prosthetics
The Department of Health and Human Services' inspector general released a report on July 19 that said the Medicare contractor CGS Administrators paid roughly $6 million in unallowable clams for lower limb prosthetics to durable medical equipment suppliers in 2010 and 2011. The report noted that the Nashville-based company did not verify that claims for lower limb prosthetics met the requirements of the applicable local coverage determination (LCD). The report also said that $5.1 million of the $6 million in claims that were identified as being unallowable were missing a functional level modifier or had one that was incorrect. $709,340 was paid for claims with unallowable quantities of socket inserts, the report said, while $183,527 was paid for claims with unallowable combinations of prosthetic components. CGS Administrators has said that it agrees with the report's findings and that it would recoup the $6 million overpayment. The company also said that it would take steps to ensure that similar overpayments do not occur in the future, including using the report's findings in its "supplier educational activities."

From the article of the same title
Bloomberg BNA (07/25/13) Ballard, Andrew M.
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Bill Aims to Reshape Medical Pricing
Democratic and Republican lawmakers have drafted legislation that would reshape the way the country pays doctors, responding to criticism that the current method of valuing medical procedures inaccurately prices payments. Medicare and most private insurers use this pricing system, which depends on assessments made by the American Medical Association. The group assigns values to thousands of medical services during confidential annual meetings. However, some of those values are based on exaggerated assumptions for how long a procedure takes -- which helps unnecessarily increase the doctors' fees for those services, according to a Washington Post investigation. The proposed bill would require Medicare officials to collect data such as how much time doctors spend performing procedures and would reduce the doctor payment for overvalued services.

From the article of the same title
Washington Post (07/23/13) Whoriskey, Peter
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MGMA Urges ICD-10 End-to-End Testing
The Medical Group Management Association (MGMA) has urged the Medicare program to reverse a decision not to conduct ICD-10 end-to-end testing with external trading partners. Failing to carry out ICD-10 testing could result in a "catastrophic" backlog of Medicare claims following the October 2014 implementation deadline, MGMA President and CEO Susan Turney wrote in a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius. Physicians could also face cash flow disruption, and Medicare patients could experience reduced access to care if testing isn't performed, Turney wrote.

From the article of the same title
Becker's Hospital Review (07/23/13) Adamopoulos, Helen
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Promoting Health Insurance Exchange, with No Help From State
Private organizations in Texas are working to promote the health insurance marketplace that is scheduled to open in October, while opposition to the Affordable Care Act from Gov. Rick Perry and others has meant that the state largely failed to inform uninsured residents about the exchange. Among those organizations are the Texas Organizing Project and Enroll America, which are canvassing and organizing community meetings where people can get more information about the health insurance exchange in Texas. But such groups face a number of challenges in getting eligible residents signed up, including the fact that many such residents live in remote areas where they are difficult to reach. Many aspects of the exchange also remain unknown, which has also made it difficult to promote the exchange to uninsured Texans.

From the article of the same title
New York Times (07/19/13) Luthra, Shefali
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CMS Posts Apps for Tracking Payments
The Centers for Medicare and Medicaid Services (CMS) on July 18 introduced two new mobile applications that will help hospitals, drug and medical device manufacturers and other healthcare businesses track payments and other value transfers that they will be required to report under the Physician Payments Sunshine Act. CMS said that it introduced the apps because it wanted to provide healthcare businesses covered by the Sunshine Act with a "user-friendly" tool that will help them comply with the law when the collecting and tracking requirements take effect on Aug. 1. However, the apps cannot be used to send data directly to CMS or its contractors because they are not designed to interact with CMS' systems. CMS has also said that it will not verify that data stored in the apps is accurate, nor will it protect that data from security threats.

Under the Sunshine Act, drug and device manufacturers will be required to report payments and/or other transfers they make to doctors and teaching hospitals, while group purchasing organizations (GPOs) will be required to report payments or value transfers made to doctor owners or investors if they hold ownership/investment interest. Finally, manufacturers and GPOs will be required to report investment interest and/or ownership held by doctors or members of their immediate family.

From the article of the same title
Government Health IT (07/18/13) McCann, Erin
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Medicine, Drugs and Devices


Low-Frequency Ultrasound Debridement in Patients with Diabetic Foot Ulcers and Osteomyelitis
A recent randomized clinical trial performed in Iran examined the effectiveness of low-frequency ultrasound (LFU) debridement in chronic wound healing in diabetic foot ulcers in osteomyelitis patients. The trial involved 40 diabetics, all of whom had a grade-three ulcer (Wagner Classification) and an ankle brachial index equal to or between 0.6 and 1.2. One group of patients received ultrasound-assisted wound therapy (UAW) in conjunction with standard wound care, while the control group received only standard wound care. After following both groups of patients for six months, researchers found that the complete healing rate in the UAW group was five percentage points higher than it was in the control group. The mean wound size reduction percentage was significantly higher in the UAW group than in the control group at two and three months, though not at six months. As a result, researchers concluded that LFU debridement along with standard wound care will accelerate the healing of grade-three diabetic foot ulcers only at the beginning of treatment.

From the article of the same title
Wounds (07/11/13) Amini, Sareh ; ShojaeeFard, Abolfazl; Annabestani, Zohreh; et al.
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Meta-Analysis of High-Energy Extracorporeal Shock Wave Therapy in Recalcitrant Plantar Fasciitis
A recent meta-analysis compared the effectiveness and feasibility of high-energy extracorporeal shock wave therapy (HESWT) with that of a placebo in treating recalcitrant plantar fasciitis. Researchers ultimately selected five placebo-controlled and double-blinded clinical trials, all of which were determined to be of good quality with little heterogeneity. Researchers used a fixed-effects model or a random model depending on heterogeneity and estimated the odds radio (OR) and 95 percent confidence interval. The pooled OR from the trials was estimated to be 2.25 (95 percent CI, 1.66-3.06; p <0.00001) at 12 weeks following active treatment. The study concluded that HESWT was more effective than the placebo in treating recalcitrant plantar fasciitis. Researchers recommended using HESWT as a remedial measure following the failure of traditional conservative treatment but before surgery.

From the article of the same title
Swiss Medical Weekly (07/07/13) Zhiyun, L.; Tao, J. ; Zengwu, S.
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