News From ACFAS

---

Register now - the website for the Annual Scientific Conference February 11-14, 2013 is now live! Visit acfas.org/lasvegas to view sessions and speakers. Make the best of your time in Vegas and attend one of the pre-conference workshops on February 10.

Check out our great hotel rates at Mandalay Bay – only $139 per night!

The full program will be hitting your mailbox in the next few weeks, so watch for it. In the meantime, visit acfas.org/lasvegas 24/7 and register today so you can cross it off your “To Do” list. Your practice can utilize the free patient newsletter FootNotes, provided by ACFAS and reviewed by your peers. Access the fall edition at acfas.org/footnotes or by clicking on the web link below (login is required).

Market your practice by putting your logo and contact information in the space provided on the back page so readers know who to go to in case of a foot or ankle injury.

The articles featured in this edition are:

• Parents: Know How to Buy the Right Shoes for Your Child’s Feet
• Assist Your Diabetic Loved One this Autumn
• Enjoy the Fall Colors and Keep Your Feet Safe

Visit acfas.org to listen to our most recently released podcast, titled The Business of Medicine, moderated by Douglas Stoker, DPM, and featuring panelists David Nilasena, CMS Regional Director; Barry Scurran, DPM and Marcy Blitch, DPM.

Learn about the changing business of medicine, including how to handle changes with ACOs, ICD-10, EHRs and how to assess and manage data which is essential for defining quality outcomes, patient satisfaction, costs and directing the future of how physicians deliver care.

"I want to encourage the members of the college to get out there and be proactive on all these issues. It is truly important not only to the quality of care you deliver, but to the future of our practice." - Barry Scurran, DPM

Foot and Ankle Surgery

---

Researchers compared the ultimate load to failure and stiffness of the traditional Broström technique using only a suture repair compared with a suture anchor repair of the anterior talofibular ligament (ATFL) for secondary repair of chronic lateral ankle instability. Twenty-four fresh-frozen cadaveric ankles were randomly divided into four groups of six specimens. One group was an intact control group, and the other groups consisted of the traditional Broström and two suture anchor modifications (suture anchors in talus or fibula) of the Broström procedure. In load-to-failure testing, ultimate failure loads of the Broström (68.2 ± 27.8 N; P = .013), suture anchor fibula (79.2 ± 34.3 N; P = .037) and suture anchor talus (75.3 ± 45.6 N; P = .027) repairs were significantly lower than that of the intact (160.9 ± 72.2 N) ATFL group. Stiffness of the Broström (6.0 ± 2.5 N/mm; P = .02), suture anchor fibula (6.8 N/mm ± 2.7; P = .05) and suture anchor talus (6.6 N/mm ± 4.0; P = .04) repairs were significantly lower than that of the intact (12.4 N/mm ± 4.1 N/mm) ATFL group.


A new technique for treating Freiberg disease involving microfracture of the metatarsal head and reattachment of the cartilage flap was assessed, using a sample of 11 patients with an average postoperative follow-up period of 49 months. Average visual analog pain score at rest and on mobilizing was 2.1 and 3.1, respectively, at six months. All 11 patients reported satisfactory results and a return to acceptable activity levels, and no cases of severe restriction of movement or fixed deformity of the toe were reported. The method was determined to not cause shortening or other anatomic abnormalities.


Researchers explored the relationship between clinically observed pathologies of foot and ankle joints and leg tendons and the corresponding gait kinematics as they relate to rheumatoid arthritis (RA). The gait of 25 subjects with varying stages of RA disease was recorded and foot and ankle kinematics were assessed. Magnetic resonance imaging was performed on each subject: first metatarsal-phalange (MTP I), midfoot and hindfoot synovitis and erosion scores and leg tendon involvement were determined. Results showed that maximum MTP I dorsiflexion at pre-swing was related to reduced MTP I passive motion, MTP I synovitis and erosion, midfoot synovitis and erosion and hindfoot erosion. Midfoot pronation range of motion during single-stance was related to subtalar alignment and Achilles tendon involvement. Hindfoot eversion range of motion during single-stance was related to subtalar alignment and peroneus longus tendon involvement. Involvement of the tibialis posterior tendon could not be identified as an independent factor influencing foot or ankle kinematics.

Practice Management

---

Although online marketing approaches are important for medical practices, experts also suggest complementary strategies that employ more tangible marketing materials, and that are simple and less expensive as well. Signs posted in the waiting room indicating that the practice is open to new patients through referrals and recommendations may convince new patients to pass the word on to friends, family and co-workers. Experts recommend against handwritten signage and urge professionally produced plastic or metal signs. Another suggestion involves marketing a tchotchke or similar item that is appropriate for the practice and that patients would like to use. Examples include refrigerator magnets, calendars, pens and silicone wristbands. Not only may these items remind current patients about the practice, but they also might draw other potential patients.

Another marketing strategy is holding an office open house that shows existing patients they are appreciated and introduces the office to potential clients. The open house may include an educational element, such as a presentation by a physician, or a chance for patients to confer casually with a physician to discuss philosophy of care. Meanwhile, community organizations' frequent search for public speakers offers physicians opportunities to talk about their fields of expertise, which can subsequently boost the practice's appeal to established patients and attract new ones. Marketing experts recommend speaking to audiences who reflect the type of clientele the practice is seeking.

Sending a letter or calling established patients to remind them to return to the practice is another marketing effort that can yield dividends. Experts say these initiatives should align with a plan that includes both virtual as well as physical world strategies, and all messages should be consistent and appropriate to the practice.


An effective, modern practice website is now expected to be more interactive, with features such as online video, rather than only a few pages full of simple information. Although adding online video can sound intimidating, there are simple ways to use it in promotional strategies. The practice also does not need to create the video content itself. The person in charge of building the practice's website could begin to include video by looking at videos on YouTube that are relevant to the practice. This might take as little as 15 minutes each week.

A new YouTube account may be created for this specific purpose, since this allows the user to mark videos as favorites, add them to specific play and subscribe to other accounts to see their new videos as soon as they are available. A practice's website can embed these videos on the relevant practice pages. Further YouTube research is helpful for when the practice wants to begin creating and adding its own videos, as this can help determine what topics to focus on. When searching for such inspiration, it is helpful to think like a patient and consider what one of the practice's patients might type into a YouTube search if they wanted relevant, correct information. It is not difficult to tell the useful, popular videos from the irrelevant or spa videos.

Practices should also take note of what makes the videos themselves interesting, as well as what keywords are popular in video descriptions, comments and titles. Other things to consider include: whether the videos are produced by individual doctors, how long these videos usually are and what the style is like. Those in charge of adding video to the website should consider gaps in content or quality. Aside from noting which videos have poor quality or information, the practice should make a note of "content holes" among popular videos where some topics may not be well covered. New videos created by the practice can help fill in some of these holes. For example, YouTube videos about gallbladder surgery are often not produced by a surgeon, but by companies that produce and sell patient-education videos. While these may try to impress doctors, they do not necessarily have accurate, up-to-date or understandable information.


Practices are increasingly offering patient Web portals to support self-service and save time for staff and patients. The portals let patients communicate with their physicians, set up appointments, order drug refills, register insurance information, access medical records and get lab results around the clock. Some portal applications exist as standalone websites that sell their services to providers, while others are integrated into the practice's existing website, and still others are added on to an existing electronic health record (EHR) system. The majority of patient portals require the practice to have an EHR or patient management system.

Portals can help practices get paid faster, and also help them collect from self-pay patients for deductibles and copays. Athenahealth Vice President of Integration David Hardy says a key reason patients prefer the portals is the ability to receive their lab results in a timely manner. Kristin Lau with Desert Ridge Family Physicians of Phoenix, Ariz., reports that medication refills and lab results are managed with greater efficiency though a portal, noting that the portal's direct connection to the electronic medical record allows the system to pull up their medications so patients can choose the ones to be refilled.

Practices with portals concur that the technique changes the physician-patient interaction dynamic, permitting faster and improved care while often discouraging unnecessary office visits and emergency room visits. A key ingredient in a successful portal is a secure email system, while Gartner's Thomas Handler notes that practices with their portals tied to an EHR system enjoy the most success. He says the clinical data within the portal is identical to the data in the EHR. Pediatrician Jeff Drasnin says his practice's portal helps practices keep closer tabs on lab results and tests, offering greater tracking accuracy than paper.

Practices are mandated by the Affordable Care Act to provide a clinical summary of each visit to at least half of their patients within three business days, and practices must supply 50 percent of their patients with electronic copies of the health information, including lab results and medication lists. Standard clinical summaries can be produced by the top EHR systems.

Health Policy and Reimbursement

---

The Agency for Healthcare Research and Quality (AHRQ) has asked the Office of Management and Budget to allow it to design and test a system that would aggregate information from patients about healthcare safety events. The system will be known as the Consumer Reporting System for Patient Safety, and funding for the development of a prototype has already been provided. AHRQ wrote in its Federal Register filing that such a system is necessary because current reporting systems are not set up to allow patients and their families to submit reports about healthcare safety events, and because such reports could include important information that healthcare providers do not provide. Many healthcare safety events are not reported by healthcare providers.


The 9th U.S. Circuit Court of Appeals has ruled on a lawsuit brought by Palomar Medical Center in Escondido, Calif., against the Department of Health and Human Services, which challenged auditors' reopening of a Medicare claim 20 months after a first payment was made. The court ruled that health professionals cannot bring a legal challenge against auditors' decisions to revisit Medicare claims that are over a year old on the grounds that federal rules do not allow them to do so, according to California Medical Association legal counsel Long X. So, the ruling is detrimental to physicians because it means that they will be unable to challenge the reasoning behind audits of Medicare claims that are more than a year old.


The Centers for Medicare & Medicaid Services' (CMS) proposed rule to establish the Medicare physician fee schedule for 2013 prompted over 2,900 comments from various stakeholders. CMS says the fee calculation revisions would boost payments to family physicians by 7 percent while payments for other primary care physicians would increase by 3 percent to 5 percent, but comments took issue with the complex calculations required to arrive at the payment hike. Additional provisions of the rule include updated payments for Medicare Part B drugs, addition of Medicare-covered services that can be supplied through telehealth and provision of additional payments for care coordination. Comments mainly concentrated on the areas of care coordination, misvalued codes, multiple procedure payment reductions, Medicare telehealth services and the physician value-based payment modifier.

Medicine, Drugs and Devices

---

The U.S. Food and Drug Administration (FDA) intends to improve its post-market surveillance system for medical devices, partly by setting up a unique device identification (UDI) system, which is one of four initiatives proposed by the agency's Center for Devices and Radiological Health. The FDA recommends establishing a UDI system capable of integration with electronic medical records, promoting the development of national and international registries for certain devices, modernizing negative-event reporting and analysis and devising new techniques for evidence generation, synthesis and appraisal.


The Federal Communications Commission (FCC) has issued a final rule to distribute wireless spectrum for medical body area networks (MBANs). The FCC earlier announced support for the development of MBAN technology, which involves a type of wireless medical device to limit the number of wires that keep a patient to a hospital bed. The FCC voted unanimously for allocating spectrum for body area networks. “This platform will enhance patient safety, care and comfort by reducing the need to physically connect sensors to essential monitoring equipment by cables and wires,” the FCC said in the Sept. 11 filing. MBAN will use a wireless sensor on a patient’s body to gather physiological data and transmit it to a nearby “hub,” and from there to a monitoring system.


Researchers at the Hospital for Special Surgery (HSS) have received a $100,000 grant from the National Football League (NFL) Charities toward research into the use of platelet-rich plasma (PRP) and stem cells as treatments for tendon injury and degeneration. PRP has long been used in various sports injuries, but evidence of its efficacy is lacking. The research could lead to an effective therapeutic strategy for tendinopathy that would allow NFL players to play more quickly after an injury. The grant money will go toward research on how degenerated tendons respond to PRP and bone marrow-derived stem cells and if these two treatments could be combined. One research goal is to examine the structural and mechanical properties of the treated tendon tissue and test its response to PRP and stem cells.