News From ACFAS

Candidate profiles and ballots for the 2011 ACFAS Board of Directors election were mailed to ACFAS voting members on Dec. 20. Ballots must be returned to the ACFAS office by mail or fax no later than 5 p.m. CST on Jan. 24, 2011.

Three Fellows were recommended by the Nominating Committee for two three-year terms. Voting members may vote for one or two candidates:

• Darryl M. Haycock, DPM, FACFAS
• Laurence G. Rubin, DPM, FACFAS
• John S. Steinberg, DPM, FACFAS

Voting members are Fellow, Associate, Life and Emeritus members. More information on nominations and elections is available on the ACFAS website.

Help decide the future of your College! Return your ballot by Jan. 24.


President Obama has signed the “Red Flag Program Clarification Act of 2010” that exempts most physician offices, among other occupations, from the Federal Trade Commission’s (FTC) Red Flags Rule. The Red Flags Rule is intended to prevent individual identity theft via patient credit card information. The enforcement date is Dec. 31, 2010.

Several professional associations had filed lawsuits seeking to prevent enforcement to their professions, including the American Medical Association, saying the definition of a “creditor” was too broad and would cover small businesses that pose little threat of identity theft.

Some medical creditors are still covered under the Act, such as plastic and Lasik surgery facilities that accept payments over time, and are required to establish programs to protect patients from medical identity theft. The FTC website provides additional clarification on who is and who isn’t covered under the Act.

ACFAS members who wish to qualify for Electronic Healthcare Records (EHR) incentive payments under the American Recovery and Reinvestment Act of 2009 should ensure they select an EHR firm that has been tested and certified by the federal Office of the National Coordinator for Health Information Technology. For more information, visit the Health IT website.

Of the 130 EHR firms tested thus far, only five have been approved for incentive payments:

• ICSA Labs, Mechanicsburg, Pa.
  Date of authorization: Dec. 10, 2010.
  Scope of authorization: Complete EHR and EHR modules.
• SLI Global Solutions, Denver, Colo.
  Date of authorization: Dec. 10, 2010.
  Scope of authorization: Complete EHR and EHR modules.
• Certification Commission for Health Information Technology (CCHIT), Chicago, Ill.
  Date of authorization: Sep. 3, 2010.
  Scope of authorization: Complete EHR and EHR modules.
• Drummond Group, Inc. (DGI), Austin, Texas.
  Date of authorization: Sep. 3, 2010.
  Scope of authorization: Complete EHR and EHR modules.
• InfoGard Laboratories, Inc., San Luis Obispo, Calif.
  Date of authorization: Sep. 24, 2010.
  Scope of authorization: Complete EHR and EHR modules.

The January 2011 issue of the Journal of Foot & Ankle Surgery (JFAS) is now online, featuring two new audio add-ons: conversations between the editor, D. Scot Malay, DPM, MSCE, FACFAS, and authors John M. Schuberth, DPM, of “Total Ankle Replacement in the Varus Ankle,” and Christopher Bibbo, DO, DPM, FACFAS, of “Lower Extremity Manifestations & Treatment of Heparin Induced Thrombocytopenia Syndromes: A Cohort Study.”

You can hear them discuss some of the more complex points of their research in these quick and timely recordings. More interviews are planned for each issue in 2011. Enjoy free member access to all the online features and the finest foot and ankle research by logging in at acfas.org/jfas.

Look for new features in the print journal as well! “A Look Back” will feature noteworthy articles from past years of JFAS. “Perspectives on Anatomy, Medicine, and Surgery” will present prose and poetry related to foot and ankle surgery. And case studies, online-only in 2010, return to the print edition for 2011. Watch for it in your mailbox soon.

The ACFAS headquarters office in Chicago will be closed several days in observance of the coming holidays:

• Friday, Dec. 24
• Monday, Dec. 27
• Friday, Dec. 31

Have safe and very happy holidays!

Foot and Ankle Surgery

Augmented Repair of Acute Tendo Achilles Ruptures With Gastrosoleus Turn Down Flap

Researchers present the results of primary repair of acute tendo Achilles (TA) rupture augmented with the gastrosoleus turn down flap technique. Seventy-eight consecutive patients with a complete acute rupture of the Achilles tendon operated between 1993 and 2004 were included in study. The researchers performed a modification of the Lindholm technique in which the primary Kessler suture repair of the tendon was augmented by a turn-down ~3 cm x 10 cm gastrosoleus aponeurosis flap. In all cases, a short-leg circular walking cast was applied at 90º of the ankle dorsiflexion for three weeks and all the patients were encouraged to full weightbearing ambulation immediately. After removal of the cast, isometric and isokinetic ankle exercises were performed for three weeks. Modified Rupp Score was used to evaluate the subjective satisfaction.

All of the patients returned to daily activity and 54 (69 percent) of them returned to previous sport activity. The tendon repair failed in two patients, who were reoperated with an allograft. Three patients developed infection and one of them required dιbridement. One developed deep venous thrombosis and two permanent sural nerve injuries were encountered. One of the patients had a severe skin necrosis, which was treated with rotation flap. The mean Rupp score was 29.



Effect of Percutaneous Transluminal Angioplasty on Tissue Oxygenation in Ischemic Diabetic Feet

Percutaneous transluminal angioplasty (PTA) has been performed as an alternative to bypass surgery for improving tissue oxygenation in ischemic diabetic feet because the former is less invasive than the latter. Researchers evaluated the effect of PTA on tissue oxygenation in ischemic diabetic feet. The study included 29 ischemic diabetic feet, as determined by a transcutaneous oxygen pressure (TcPO2)<30 mmHg. The PTA was carried out in 29 limbs. The PTA procedure was considered successful, acceptable, and failed when residual stenosis was 30 percent, between 30-50 percent, and >50 percent, respectively. For evaluation of tissue oxygenation, the foot TcPO2 was measured before PTA and weekly for six weeks after PTA.

Immediately after PTA, 26 feet were evaluated as being successful and the remaining three as acceptable. Before PTA, the average foot TcPO2 was 12.7±8.9 mmHg. The TcPO2 values were increased to 43.6±24.1, 51.0±22.6, 58.3±23.0, 61.3±24.2, 59.0±22.2, and 53.8±21.0 mmHg one, two, three, four, five, and six weeks after PTA, respectively.

The researchers concluded that PTA procedure significantly increases tissue oxygenation in ischemic diabetic feet. The maximal level of tissue oxygenation was measured on the fourth week following PTA.



Simultaneous Bilateral Versus Unilateral Total Ankle Replacement: A Patient-Based Comparison of Pain Relief, Quality of Life and Functional Outcome

Researchers compared the outcome of bilateral sequential total ankle replacement (TAR) with that of unilateral TAR. They reviewed 23 patients who had undergone sequential bilateral TAR under a single anaesthetic and 46 matched patients with a unilateral TAR. Follow-up was carried out at four months, one year, and two years.

After four months, patients with simultaneous bilateral TAR reported a significantly higher mean pain score than those with a unilateral TAR. The mean AOFAS hindfoot score and short-form 36 physical component summary score were better in the unilateral group. However, this difference disappeared at the one-and two-year follow-ups.

The researchers concluded that bilateral sequential TAR under one anaesthetic can be offered to patients with bilateral severe ankle osteoarthritis. However, they should be informed of the long recovery period.

Practice Management

CMS Releases New Crosswalk Information for ICD-10 Codeset

CMS has released the ICD-10 crosswalk codeset for 2011, intended to help the transition from ICD-9 to ICD-10 by the Oct. 1, 2013, deadline. The crosswalk allows providers to translate a code from ICD-9 into ICD-10, whenever possible. However, due to the increased amount of codes in ICD-10, a full translation is not possible.

Changes incorporated into the 2011 crosswalk update included increasing the specificity of the codeset translations. For example, one change involved the diagnosis code for abnormality of gait. The 2010 crosswalk translated the ICD-9 code into three ICD-10 codes. A comment said that was not specific enough, so the 2011 crosswalk linked the ICD-9 code to four ICD-10 codes.



Claim Deadline Looms

CMS is reminding physicians that all claims for services furnished on or after Jan. 1, 2010, must be submitted no later than one calendar year (12 months) from the date of service. If submitted after the one year deadline, Medicare will deny services for untimely filings. To ensure compliance with the deadline, practices should:

1) Run a missing charge report and submit all services if the system shows a missing charge for Medicare patients or patients covered by other carriers.

2) Conduct an internal audit of all surgical services performed in the office, ER, ASC or hospital and reconcile to ensure all surgical services are submitted.

3) If missing charges are found, review internal processes to improve charge capture in 2011.



Health Coaching: Good for Your Patients and Your Practice

Physicians and medical practices have only started using health coaches more recently, primarily because many physicians have not been aware of the concept, says Patrick T. Buckley, president and CEO of PB Healthcare Business Solutions, a consulting firm that specializes in medical practice management and marketing. Health coaches bring many benefits to both patients and a practice by:

* helping patients navigate an increasingly complex healthcare system
* helping patients prepare for their medical visits, such as preparing questions and reviewing progress since the last visit with the patient and the medical team;
* answering questions regarding medical instructions and processes;
* confirming that information is correct in the medical chart;
* following up with the patient after a visit to your practice;
* strengthening patient satisfaction;
* motivating patients to change behaviors and to self-manage their health toward meeting mutually agreed-on goals.




Physician RAC Vulnerabilities Detailed in CMS Release

CMS has released the fourth in a series of MLN Matters articles, providing education on two high-risk vulnerabilities for physician claims. According to CMS, these claims were denied because the demonstration RACs determined that either a duplicate claim was billed and paid or the physician reported an incorrect number. "Physician offices need to be proactively self-auditing their billing process and actively monitoring the RAC websites for medically unlikely edits (MUEs)," says Elizabeth Lamkin, president of Dalzell Consulting Group of Hilton Head, S.C. "Issues involving MUEs are oftentimes clerical errors though, so this is an issue that can be avoided with comprehensive review."

Health Policy and Reimbursement

Doctors Seeking $200M Owed by Medicare

Physicians are asking the Medicare agency to explain how it will distribute $200 million in overdue reimbursements following “a highly disruptive year" for physician payments. Healthcare reform enacted this year called on the Centers for Medicare and Medicaid Services (CMS) to reimburse doctors retroactively to Jan. 1, 2010, on several provisions, including extending the floor for a Medicare payment scale used to determine relative costs of practicing medicine in specific locations. The Medicare and Medicaid Extenders Act of 2010, which provided a one-year delay in a scheduled cut to Medicare physician rates, included $200 million to process the payment increases, the letter said.



Online Medical Records System Planned for N.Y.

The New York State Department of Health and a public-private partnership called New York eHealth Collaborative have announced plans to spend $129 million in state and federal money to create a statewide network for electronic medical records. The partners envision the network as a public utility that will allow medical providers anywhere in the state to view, with patient consent, a list of patient medications, allergies, and recent X-rays or other tests that could help guide care. The e-records network would be the largest in the country. It is scheduled to be completed by 2014.



The Little-Known Decision-Makers for Medicare Physicians Fees

For a particular service, referred to as Z by Uwe E. Reinhardt, an economics professor at Princeton, Medicare pays a fee calculated with this formula: FeeZ = (Work RVUZ x Work GPCI + PE RVUZ x PE GPCI + PLI RVUZ x PLI GPCI) x CV. FeeZ is the dollar amount of the fee paid for the service, Work RVUZ represents the relative value units for the physicians’ work going into the production of service Z, PEZ is the relative value units of the physician’s practice expenses allocated to service Z, and PLIZ denotes the relative value units for the professional liability insurance premium allocated to service Z.

Reinhardt explains that Medicare requires changes in the RVUs to be budget neutral overall, effectively forcing a zero-sum game on the RUC, the group of 29 physicians drawn from a variety of medical specialties that advises CMS on recalibrations of the relative value scale underlying the Medicare fee schedule. This means that when the RUC recommends raising the RVU for some services, the RVUs of other services must be decreased.

Medicine, Drugs and Devices

The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults

Researchers analyzed data on Medicare beneficiaries from two states who were new initiators of opioid therapy for nonmalignant pain, including codeine phosphate, hydrocodone bitartrate, oxycodone hydrochloride, propoxyphene hydrochloride, and tramadol hydrochloride. The researchers matched 6,275 subjects in each of the 5 opioid groups.

The risk of cardiovascular events was similar across opioid groups 30 days after the start of opioid therapy, but it was elevated for codeine after 180 days. Compared with hydrocodone, after 30 days of opioid exposure the risk of fracture was significantly reduced for tramadol and propoxyphene users. The risk of gastrointestinal safety events did not differ across opioid groups. All-cause mortality was elevated after 30 days for oxycodone and codeine users compared with hydrocodone users.



Tibiotalocalcaneal Arthrodesis With a Curved, Interlocking, Intramedullary Nail

Tibiotalocalcaneal fusion with a straight rod has a risk of damaging the lateral plantar neurovascular structures and may interfere with maintaining normal heel valgus position. Researchers report the results of a prospective study of tibiotalocalcaneal (TTC) arthrodesis with a short, anatomically curved interlocking, intramedullary nail. Forty-five arthrodesis in 42 patients, performed between January 2003 and October 2008, were prospectively followed. The mean followup was 48 months.

Union rate was 89 percent (40/45) for all patients. Eighty-two percent (37/45) reported improvement in pain and 73 percent (33/45) had improved foot function. Satisfactory hindfoot alignment was achieved in 84 percent (38/45). Postoperatively, there was a mean improvement in the AOFAS score of 37.

Complications included a below knee amputation for persistent deep infection, five nonunions, and three delayed unions. Four nails, six proximal, and six distal locking screws were removed for various causes. Other complications included two perioperative fractures, four superficial wound infections, and one case of lateral plantar nerve irritation.

The researchers concluded that with a short, anatomically curved intramedullary nail, a high rate of tibiotalocalcaneal fusion with minimal plantar neurovascular complications can be achieved. A short, curved intramedullary nail, with its more lateral entry point, helped maintain hindfoot alignment.




EHR Adoption Crosses 50 Percent Threshold

The National Ambulatory Medical Care Survey conducted by CDC and the National Center for Health Statistics found that 51 percent of physicians reported using complete or partial EMR/EHR systems in 2010, versus 48 percent last year. About 25 percent reported having systems that met the criteria of a basic system, up from 22 percent last year, and 10 percent reported having systems that met the criteria of a fully functional system, up from 7 percent last year.



Abstract News © Copyright 2010 INFORMATION, INC.

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