News From ACFAS

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Take advantage of the “Early Bird” rate and register now. You have less than two weeks until December 17 -- when the rate expires. By registering early, you’ll have some extra change in your pocket in February for the Annual Scientific Conference in Las Vegas! Visit acfas.org/vegas to register today or for more information. The always popular and increasingly insightful arthroscopy courses have been scheduled for 2013! These interactive, two-day, hands-on courses led by skilled ACFAS arthroscopy surgeons will take place at the state-of-the-art Orthopaedic Learning Center in Rosemont, IL on the following dates in 2013:

• March 2-3
• June 14-15
• August 3-4
• December 14-15

Keep watching This Week @ACFAS and acfas.org for further information and to find out when you can register! The new year brings resolutions for patients to finally fix that bunion, hammertoe, heel pain, etc. Give your patients the information they need to proceed with treating the foot and ankle issues they may face by purchasing the Patient Education CD Series and the Perioperative CD Series. Your practice will get the latest in patient-centered, all-inclusive information compiled for ACFAS members’ use in the office.

Each CD set includes printable handouts that you can provide to your patients before and after surgery to ease their worries. If your patient is non-surgical, there’s information for him or her as well! Also, each printout is fully customizable to suit the marketing needs of your practice, and it’s backed with the ACFAS logo, so your patients can rest assured that they are being treated by a quality foot and ankle surgeon.

Visit the acfas.org/marketing to check out all the topics the CDs have to offer or to order your series today.

Legal Briefs

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Common law duty requires that chiropractors disclose inherent risks to their patients, the Texas Supreme Court has ruled in Felton v. Lovett. A reasonable healthcare provider must disclose the risks that would influence a reasonable patient in deciding whether to undergo treatment but not those that would be unduly disturbing to an unreasonable patient,” the court said, reversing an intermediate appellate court ruling that reversed a jury verdict for a chiropractor's patient.



A doctor fired from a medical group for leaving signed, blank prescription forms with his assistant when he went on vacation was not entitled to reimbursement for accrued unused vacation under either his employment contract or an employee handbook, a state high court has ruled in Henick v. Fast-Track Anesthesia Associates of West Virginia. The key takeaway from the decision is that where an individual employment contract was silent as to doctor's right to reimbursement for accrued, unused vacation, the terms of employee handbook, which allowed reimbursement only to employees who resigned with notice, applied.

Foot and Ankle Surgery

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A study was conducted to understand national variation in delay of emergency procedures in patients with open tibial fracture at the hospital level, as well as compare length of stay (LOS) and cost in patients cared for at the best and worst performing hospitals for delay. The 2003-2009 Nationwide Inpatient Sample was retroactively analyzed, with adult patients with primary diagnosis of open tibial fracture chosen for inclusion. The final sample encompassed 7,029 patients from 332 hospitals, and adjusted analyses showed that patients treated at hospitals in the fourth or worst quartile for delay were calculated to have 12 percent higher cost versus patients treated at hospitals in the first quartile. Furthermore, LOS of patients treated at hospitals in the fourth quartile was estimated to be 11 percent longer compared to patients treated at hospitals in the first quartile.


A study was held to review the researchers' experience with the treatment of stress positive (+) supination and external pattern injuries using shared decision-making with patients. The study involved treatment of 114 patients with stress (+) supination and external rotation type fibula fractures over a period of nine years. X-rays were reviewed, and the medial clear space (MCS) quantified on the presentation, stress and final united radiographs. The option for surgical or nonsurgical treatment was made by the patient and surgeon following discussion of both approaches' risks and benefits. Medial widening and talar subluxation on abduction/external rotation stress after fibular fixation were used to diagnose syndesmotic instability for the operative cases. Fifty-four of the 114 cases were treated in a cast, while 60 were treated operatively. Twenty-seven of the operative cases showed syndesmotic instability on radiographic examination. The MCS on stress examination was statistically different, with more widening observed for operatively treated patients. No subluxation was detected on weight bearing x-rays for any healing patients.


Congenital vertical talus (CVT) is a deformity that can be either idiopathic or non-idiopathic. Researchers analyzed the talar axis–first metatarsal base angle (TAMBA) values of idiopathic and non-idiopathic CVT cases that had been treated with the Dobbs method. The investigators compared TAMBA measurements of CVT successfully treated with the Dobbs method to TAMBA values of CVT unsuccessfully treated with a minimally invasive approach. Of 20 CVT, 14 were successfully treated with the Dobbs method. Five of those 14 feet were non-idiopathic and nine were idiopathic. The feet that did not have complete correction after the Dobbs protocol were associated with arthrogryposis or caudal regression syndrome. Results indicated that the success of the Dobbs method in treating CVT depends on the flexibility in the talonavicular complex. The TAMBA value and the TAMBA neutral minus TAMBA plantarflexion both express the flexibility in the talonavicular joint and may predict the success of a minimally invasive treatment. For the few cases in which the success of the Dobbs method is limited, the feet are associated with a TAMBA greater than 120 degrees in neutral position and a TAMBA difference smaller than 25 degrees.

Practice Management

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Physicians could reap significant cost savings in 2013 by following a number of strategies when they file their 2012 tax returns. These tips could be particularly beneficial in the event Congress fails to take action to block several impending tax hikes. A new law slated to go into effect next year stipulates that married physicians who file their tax return jointly will pay an extra 0.9 percent if their wages, self-employment income or other compensation tops $250,000, on top of the regular 1.45 percent Medicare tax. The payroll tax limit for single filers is $200,000. It thus pays for physicians to put more money into their retirement fund.

Meanwhile, physicians could have to pay an additional 3.8 percent Medicare surtax next year if their modified adjusted gross income surpasses $200,000 for individuals and $250,000 for couples. Those who expect considerable taxable gains next year should boost their 2013 contributions to qualified tax-deferred retirement plans, such as a 401(k) or SEP IRA, to reduce their adjusted gross income and help minimize or avoid the surtax.

The expiration of the Bush-era tax cuts at the end of year means that tax rates on earned income will jump at least three percentage points, and as much as 4.6 for those in the highest income bracket. It might therefore be sensible to take certain taxable payments this year rather than waiting until next year, such as bonuses, honorariums for sitting on advisory boards or income from the goodwill value of one's practice or cashing in stock options.

Making business-related equipment investments also can be advantageous. A physician can write off the full amount of any 2012 purchases up to $139,000, which can cut his or her 2012 tax bill significantly. The IRS' definition of "equipment" applies to commercially sold computer software, which may encourage physicians to add an electronic medical records system or upgrade an existing one. Furthermore, these tax breaks are added to any applicable government-funded incentives.


The American Medical Association and other groups have devised guidance for medical practices developing disaster preparedness and response plans. No matter what plan practices develop, they should retain three core elements: security of the practice's data, a contingency plan for creating records after a disaster strikes and identification of possible backup power and Internet sources. The first component ensures that patient records and other data is backed up at an off-site location so it can be retrieved once the practice resumes online operations following a disaster. It is recommended that practices with locally hosted electronic health record systems have an off-site data backup plan. The optimal solution is a cloud-based vendor that eases the copying of patient data to the cloud's off-site servers. The best location to store the backup data is a site far from the practice so as to avoid the wipeout of both the practice and the data center by the same disaster.

The second guidance point is to establish a contingency plan for every possible disaster category the practice may face. A phone tree should be created with not only with each staff member's number, but also with a list of their service providers. The contingency plan's next step is detailing how the practice will temporarily switch back to paper records and how records will be transferred when patients are referred to different care facilities.

The third guidance point is to find and secure possible backup power and Internet sources. Preparations can include prior acquisition of a backup generator that can be hooked up to natural gas lines. There also are last-minute precautions to take if the practice has the luxury of time and fair warning, such as removing all electronic equipment from the floor in the event of flooding, while one final data backup should be performed before the last person departs the office. If time is short, the practice can save several years' worth of data if staff unplug the servers and take them with them.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services (CMS) has chosen the first three participants in its Medicare data sharing for performance measurement program, which focuses on increasing consumer access to healthcare quality and cost information. The three groups are the Health Improvement Collaborative of Greater Cincinnati, the Kansas City Quality Improvement Consortium and the Oregon Health Care Quality Corporation. The data sharing program, established under the healthcare reform law, provides Medicare claims data to certified groups that can then use it to help create reports on provider performance.


The U.S. Supreme Court has ordered the U.S. Court of Appeals for the Fourth Circuit to reconsider Lynchburg, VA-based Liberty University's challenge to the federal healthcare law in light of the high court's decision to uphold the law. The university says the law violates its religious freedoms, and it is specifically challenging provisions that require most people to carry health insurance or pay a penalty and require many employers to provide health coverage to workers. Experts say the appeals court will decide on issues it chose not to rule on previously and address issues not addressed by the high court.


A newly issued study published online by the Archives of Internal Medicine shows that Medicare spent more on primary care and specialty physicians in the year following a 2010 policy change that discontinued more expensive consultation payments, but hiked pay for office visits. The higher rate of office visit pay accounted for roughly 66 percent of the approximately 6.5 percent increase in spending that year after the policy change, while an increase in the reported complexity of patients constituted the remainder of the growth. The study examined data for 2.2 million individuals with Medicare supplemental insurance from a large employer between 2007 and 2010. Only persons with diabetes or heart disease diagnoses or prescriptions were included. Fifty-eight percent of the spending expansion was received by primary care physicians, while specialists received the remaining 42 percent. Although the researchers say the study outcome suggests that the policy's budget neutrality goal was not realized in the first year, "it did appear to narrow the gap in Medicare payments for office encounters between" primary care physicians and specialists. The study found no change in the volume of patient visits and concluded that "any pressure to increase volume may have been directed to other, perhaps more profitable, services."


A study tracking physician income growth over a 25-year period found that physician pay has failed to keep pace with that of other health professionals. The results of the report, published in the Journal of the American Medical Association, indicated that adjusted physician earnings rose just 9.6 percent between 1987-1990 and 2006-2010, versus 44 percent for pharmacists. Furthermore, from 1996-2000 and 2006-2010, physician earnings shrank 1.6 percent, while pharmacist earnings increased 34.4 percent. In the period of 1987-1990 physicians earned $143,963 on average, compared to $157,751 during 2006-2010. Possible factors underlying the growth rate disparity include the expansion of managed care, Medicaid payment reductions, "sluggish" Medicare reimbursement increases and bargaining by insurance firms. Still, the study observed that physician earnings continue to top those of other professions.

Medicine, Drugs and Devices

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A study by researchers at the University of Basel in Switzerland has found that potassium citrate can help increase areal and volumetric bone mineral density (BMD) in elderly men and women who do not have osteoporosis. The study, published in the Journal of Clinical Endocrinology and Metabolism, examined 201 non-osteoporotic men and women who were given 60 mEq of potassium citrate or a placebo each day, in addition to calcium and vitamin D. Patients who were given potassium citrate experienced an average 1.7 percent increase in BMD at the lumbar spine after two years, as well as a 1.3 percent and a 2 percent increase in trabecular density in the non-dominant tibia and radius, respectively. Researchers said that the findings are sufficient evidence that potassium citrate can help strengthen bones when given as a nutritional supplement.


A new report from the Office of Inspector General for the Department of Health and Human Services (HHS) concluded that the conversion to electronic medical records is susceptible to fraud and abuse because of Medicare officials' failure to develop adequate protections to ensure the accuracy of the information being provided by hospitals and physicians about their electronic records systems. The investigators determined that Medicare "faces obstacles" in administrating the electronic records incentive program "that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements." Medicare anticipates spending some $7 billion over five years to induce physicians and hospitals to adopt electronic records.


Patient use of web-based electronic health record system portals is linked to increased use of clinical services, including higher rates of office visits and telephone calls to providers, according to a study published in the Nov. 21 issue of the Journal of the American Medical Association. The study looked at healthcare services by nearly 89,000 patients enrolled for at least 24 months with the integrated delivery network from March 2005 through June 2010. These patients were divided into two equal groups: those who were users of the organization's My Health Management patient online access system and those who were not. Researchers found "a significant increase in the per-member rates of office visits (0.7 per member per year) and telephone encounters (0.3 per member per year) for portal users compared with non-users.