News From ACFAS

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While you’re gaining knowledge and refining skills at the ACFAS 2012 Annual Scientific Conference, March 1-4, take some time to explore the charms of host city San Antonio. Blending diverse cultures in a lively urban environment with a small-town feel, San Antonio has a multitude of attractions within easy walking distance of the conference’s convention center and attached luxury hotel.

Enjoy great food from a variety of world cuisines; live music; the beauty and history of the River Walk and the Mission Trail; and a thriving artists’ colony in this town that houses many major art museums and galleries. If you have time to extend your stay, you can play golf on one of several popular courses, or explore the neighboring hill country for wine tasting, hiking, biking, or horseback riding.

Add to your skill set in the camaraderie of your peers and relax in the attractions of the heart of Texas. The complete program will be coming soon on the ACFAS website. Two 3-year director terms on the ACFAS Board of Directors are now open for nomination. ACFAS Fellows who meet criteria for election are encouraged to submit a nomination application by Sept. 20. For complete details on the recommended criteria for candidates and the nomination application, visit acfas.org/nominations, or contact Executive Director Chris Mahaffey. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Michael S. Lee, DPM, FACFAS.

The Nominating Committee will announce recommended candidates to the membership by Nov. 3. Candidate information and ballots will be e-mailed to all voting members no later than Dec. 18, and electronic voting will end Jan. 17, 2012. New officers and directors will take office during the ACFAS 2012 Annual Scientific Conference on March 1-4, 2012, in San Antonio, Texas. ACFAS e-Learning offers you a valuable online library of foot and ankle health topics in video, podcast and DVD. Tune in whenever you are ready for these latest no-cost podcasts:

• DVT Prophylaxis — “This is a hot topic,” begins moderator Scott Jorgensen, DPM, FACFAS. “Foot and ankle surgery is usually deemed low-risk, but that can vary with each patient’s individual history. The silent nature of DVT makes it a very unique complication with fatal potential, which is why I think prevention is so very important.” Listen in as surgeon panelists discuss ways of preventing fatal pulmonary embolism and other possible serious complications.
• Coding Changes for 2011 — ACFAS coding consultant Douglas G. Stoker, DPM, FACFAS, addresses 2011 coding changes that directly affect billing for podiatric treatment services in this concise recording. Members of the College may also send their own coding questions to Dr. Stoker at coding@acfas.org.

Check back often for new additions to the knowledge at ACFAS e-Learning!

Futurescan™

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Healthcare, especially healthcare financing, is changing day by day. To help provide some basic education on current trends in the U.S. healthcare industry, ACFAS is sharing abstracted articles from the American Hospital Association's publication, Futurescan™ 2011: Healthcare Trends and Implications 2011–2016, in this special eight-week section.

The delivery of healthcare will change amid the convergence of existing market trends and recently approved healthcare reforms. Market trends include an aging populace, a changing insurance market, more provider accountability, a concentration on value, and a movement to outpatient care. Reforms include new payment models, greater market regulation, and the ascendance of primary care. For hospitals, this implies a move away from voluntary staff and toward committed physician partners, which may not necessarily entail employment.

Physicians, meanwhile, will need capital to adopt new technologies to drive higher performance and quality levels. With the advent of these trends, it behooves hospitals to meet with major payers and employers to determine key efforts to enhance the value of community healthcare; engage the board of directors in dialogue about serving populations across the care continuum; assess the hospital's readiness to be an accountable care organization (ACO); commence construction of an ACO framework and function by developing the capacity to do clinical integration or accept bundled payments, with the sharing of rewards with doctors for better quality and cost-effectiveness; and set up or broaden opportunities for physician leadership training.

Foot and Ankle Surgery

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Researchers investigated the contribution of nerve mobilization exercises to the conservative treatment of tarsal tunnel syndrome. Twenty-eight patients were randomly allocated into two groups. The control group was composed of 14 patients who were treated conservatively with a program consisting of physiotherapy and supportive inserts, whereas 14 patients in the study group were given nerve mobilization exercises in addition to the same treatment. After 6 weeks, there was a significant improvement in range of motion, muscle strength, and pain in both groups. Significant improvement in two-point discrimination, light touch sensation and Tinel's sign was detected only in the study group.


Researchers evaluated the clinical and functional of outcome of minimally-invasive technique for resection of calcaneo-navicular coalition (CNC) and interposition of synthetic graft. The study involved 9 patients (12 feet) with symptomatic CNC. Percutaneous resection of the CNC was done using a motorized bone burr through a small incision in the sinus tarsi under image intensifier control. After complete resection a synthetic graft of Teflon or Dacron measuring 15mm×30mm was interposed to prevent re-union of the bone bar. There was statistically significant improvement in the mean total AOFAS score from 47.89 preoperatively to 90.22 at the two-year followup (P<0.05). The mean time to return to full daily activity was 7.44 weeks.


A cohort of 224 patients were followed for a minimum of 10 months to determine the effectiveness of segmental wedge resection of involved ingrown margin (Winograd method) on chronic ingrown toenails.

Recurrence was observed in 22 patients, and revision surgery was carried out in 16 patients. Disease stage, infection, involved margin, previous procedure, followup time and age did not show any statistical association with recurrence.

Practice Management

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Approximately 750,000 physicians in the Medicare program will soon be asked to revalidate their individual enrollment records during a massive anti-fraud effort required by the healthcare reform law. The Centers for Medicare & Medicaid Services hopes to weed out the people who should not have billing privileges. CMS gradually will send revalidation requests by mail to more than 1.4 million health professionals -- more than half of whom are doctors -- between now and March 23, 2013, the agency has announced. Physicians who have enrolled since March 25, 2011, will not be required to revalidate, since their applications were scrutinized under new screening criteria. Those receiving a request would have 60 days to recertify their enrollment information.


A study in the August issue of the journal Archives of Surgery found that training can help surgical residents enhance the quality of information they communicate to patients about a specific condition, but more general communication skills are not improved. The study concentrated on 44 University of Connecticut School of Medicine general surgery residents participating in an interactive program that featured learning principles of patient communication, role-playing, and hearing a surgeon's experience as a physician, patient, and patient's spouse. Study authors said the improvement of general communication skills would likely call for sustained coaching with repeated practice rather than a one-time session.

Health Policy and Reimbursement

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In a study published in the journal Health Affairs, researchers asked hundreds of physicians and administrators in private practices in the United States and Canada how much time they spent each day with insurers and third-party payers, collecting information for claims that were denied or incorrectly paid, resolving questions about insurance coverage for prescriptions or diagnostic tests, and completing the forms required by each insurance company. The study showed that American doctors spent on average over $80,000 per year coping with multiple health plans -- approximately four times as much as doctors in Canada, where healthcare is administered mainly by the government. Doctor offices in the United States spent as many as 21 hours per week with payers, almost 10 times as much as Canadian offices.


The Centers for Medicare & Medicaid Services' final rule on changes to the federal e-prescribing incentive program for 2011 includes additional hardship exemptions and more time for providers to obtain such exemptions. Under the final rule, there are additional significant-hardship exemption categories to help providers avoid the Medicare payment cuts they would face beginning in 2012 for not meeting e-prescribing targets. The new exemptions apply to providers participating in the Medicare or Medicaid EHR incentive programs that adopt certified EHR technology. Also, the deadline for requesting significant-hardship exemptions will be extended to Nov. 1, 2011.

Medicine, Drugs and Devices

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Stanford researchers have developed a method for reconnecting severed blood vessels that is potentially safer, quicker, and easier than the traditional stitching technique by using an adhesive that does away with sutures. The method takes advantage of the unique "thermoreversible" properties of a Poloxamer 407 gel, which was modified for experimentation. The experiment involved the liquid gel being injected into the broken vessels and then solidifying under a warm halogen light. The outside of the vessels were glued together with Dermabond, and then the light was extinguished. The cooling temperature allowed the glue to set, and the poloaxamer dissolved and was flushed out into the bloodstream. Animal tests demonstrated that the method was five times faster than the suture technique and resulted in less inflammation and scarring after two years, according to a study published online Aug. 28 in the journal Nature Medicine.


Gout drug colchicine interacts dangerously with many commonly prescribed pharmaceuticals, such as antibiotics, anti-hypertensive drugs, anti-fungals, immunosuppresants and protease inhibitors, according to a study published in the August issue of Arthritis & Rheumatism. A series of drug-drug interaction studies was performed to assess the concomitant treatment of colchicine with known inhibitors of cytochrome P450 3A4 (CYP3A4)/P-glycoprotein: cyclosporine, ketoconazole, ritonavir, clarithromycin, azithromycin, verapamil ER (extended release), and diltiazem ER. . The researchers recommended that colchicine doses be reduced by a third to two-thirds for the treatment of acute gout and 50 percent to 75 percent for prophylaxis, when used as concomitant therapy with each of the drugs studied with the exception of azithromycyin where no dose adjustments were necessary.


Researchers cultured material taken from different sites of white coats or uniforms worn by clinicians, and found that of 238 samples collected, exactly half were positive for some pathogen. Physicians' garb contained the same number of pathogens as did nurses' attire. Many of the samples revealed the presence of multi-drug resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA). The researchers stressed that their research did not examine whether healthcare workers' contaminated clothing increased germ transmission to patients. However, they made several recommendations based on the data. "Wearing a clean uniform daily, providing adequate laundering, improving hand hygiene practices, and using plastic aprons when performing tasks that may involve splashing or contact with body fluids likely will decrease the bacterial load on uniforms," they wrote. The study was published in the September issue of the American Journal of Infection Control.