January 4, 2012

News From ACFAS

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AMA Objects to DPMs as Medical Staff Leaders Under Guise of ‘Patient Safety’
ACFAS has read the comments that the American Medical Association (AMA) submitted to CMS’ proposed rule changes for the hospital conditions of participation (CoPs) for Medicare, and as expected, they dispute CMS’ recommendation to allow podiatrists to hold leadership positions within the medical staff of any hospital.

AMA erroneously notes it is their understanding that this proposal was prompted by a situation where a podiatrist at a podiatric hospital was unable to hold a leadership position at that hospital. CMS' proposed revision goes beyond this scenario, however, by allowing a podiatrist to hold a leadership position at any hospital.

ACFAS and its members understand that this was not the case and that many qualified foot and ankle surgeons were denied or lost their medical staff leadership position to outdated and unfounded CoPs. AMA went on to tell CMS, “We are concerned about the precedent that this proposal sets. Practitioners who are not medical doctors or doctors of osteopathy should not be authorized by the CoPs to hold leadership positions on the medical staffs of all hospitals. We are particularly troubled by a practice taking place in many hospitals whereby a “Chief Medical Officer,” someone hired by the hospital who is not a physician, is appointed to serve in a leadership position that would otherwise be held by a member of the medical staff. We think that CMS' proposal, if broadened, could result in more of this activity, and ask that CMS consider carefully the intended result of this proposal.”

They end their comments with, “If CMS does intend to modify these requirements, particularly those related to supervision, such modifications would be significant changes in policy and would clearly require prior notice and comment. We would likely have serious objections to such changes, and ask that CMS carefully evaluate the effect of their objectives in this arena on patient health and safety.”

The full comment letter can be accessed at the link below.
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Foot and Ankle Surgery

Achilles Tendinopathy Has an Aberrant Strain Response to Eccentric Exercise
A study assessed the sonographic traits and acute anteroposterior (AP) strain response of healthy, asymptomatic, and symptomatic Achilles tendons to an eccentric exercise regime. It involved 11 adult males with unilateral midportion Achilles tendinopathy and 9 control adult males without tendinopathy. Sagittal sonograms were obtained immediately prior to, immediately after and 24 hours after a common eccentric rehabilitation exercise 40 mm proximal to the calcaneal insertion. Both the asymptomatic and symptomatic tendons were thicker and hypoechoic at baseline than the controls, while all tendon thickness decreased immediately following eccentric exercise. Symptomatic tendon showed lower AP strain response to eccentric exercise than both the asymptomatic and control tendons. No difference between AP strains was observed in the control and asymptomatic tendons. Pre-exercise thickness was restored 24 hours after the exercise in all tendons.

From the article of the same title
Medicine and Science in Sports and Exercise (01/12) Vol. 44, No. 1, P. 12 Grigg, Nicole L.; Wearing, Scott C.; Smeathers, James E.
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Negative Percutaneous Bone Biopsy for Suspicion of Osteomyelitis of the Foot in Patients with Diabetes
Researchers investigated occurrence of new osteomyelitis at the biopsied site in diabetic patients. The study enrolled 41 patients who initially had negative biopsy result despite clinical and radiographical suspicion of osteomyelitis. On follow-up at a mean of 41.2 months post-bone biopsy, 16 (39.0 percent) patients had complete wound healing. Of the other 25 patients, 15 had a new bone biopsy performed. Six of those 15 patients yielded positive culture results. Among the 10 patients who neither healed nor underwent bone biopsy, six showed a stable biopsied site in serial radiographs. Osteomyelitis at the initial biopsy site was newly diagnosed during follow-up in six (14.6 percent) patients and suspected in four (9.7 percent) additional patients.

From "Outcome of Patients With Diabetes With Negative Percutaneous Bone Biopsy Performed for Suspicion of Osteomyelitis of the Foot"
Diabetic Medicine (01/01/2012) Vol. 29, No. 1, P. 56 Senneville, E.; Gaworowska, D.; Topolinski, H.; et al.
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Simple Calcaneal Bone Cysts: A Pilot Study Comparing Open Versus Endoscopic Curettage and Grafting
Researchers analyzed the outcome of open (Group 1) versus endoscopic curettage and bone grafting (Group 2) for the treatment of simple calcaneal bone cysts. A total of 26 patients were divided into two equal groups. The mean follow-up was 28.7 months. There were no statistically significant differences in age, cyst size and the follow-up periods in the two groups. The operating time and mean length of hospital stay of Group 2 was significantly shorter than Group 1 (p < 0.001). The time to heal, success rate, radiological healing were similar between the two groups.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (12/01/11) Vol. 93-B, No. 12, P. 1626 Yildirim, C.; Akmaz, I.; Sahin, O.; et al.
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Practice Management

AMA Report Highlights Cost of Malpractice Claims
A physician's average cost for defending a malpractice claim was more than $47,000 and the average payout was almost $332,000 in 2010, according to a report from the American Medical Association. The report also stated that in 2010, 63.7 percent of all closed claims were either dropped, withdrawn or dismissed,but still cost almost $27,000 to defend and accounted for more than one-third of total defense expenses for the year.

Another AMA report analyzed malpractice insurance premiums from 2004-2011 that appeared in annual rate surveys published by the Medical Liability Monitor. The report highlights how rates continue to climb.

From the article of the same title
Modern Healthcare (12/25/11) Robeznieks, Andis
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Healthcare E-Transaction Change Needs More Time
Some medical practices have stated that they plan to revert to paper records because they are not ready to implement electronic insurance claim standards, according to the Medical Group Management Association (MGMA). TMGMA is asking the Centers for Medicare and Medicaid Services (CMS) to double its grace period to six months, pointing to new data that shows that few physician practices are ready for the change. A survey by the MGMA shows that only 13.9 percent of the organizations members have completed their preparations for electronic insurance claims. Less than a third of respondents say they have upgraded their practice management systems to produce 5010-compliant transactions and have completed internal testing. Almost 25 percent of MGMA's respondents were planning on switching to paper claims so they can continue to get paid after the deadline.

In October, the MGMA joined several other organizations urging CMS to develop a contingency plan for the numerous providers that will not be ready to submit 5010 transactions by the first of the year. The CMS responded to public concerns by saying that it will not enforce the rule until the end of March. Without an extension, even private insurers would not legally be able to pay claims in the old 4010A1 format starting January 1, potentially freezing cash flow for providers nationwide.

From the article of the same title
InformationWeek (12/27/11) Versel, Neil
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Seven Land Mines of Hospital Employment Contracts
It is to physicians' advantage to carefully scrutinize hospital employment contracts so that they might avoid hidden pitfalls. One such pitfall is the job description, which, if vaguely worded, can conceal contractual obligations for doctors to perform tasks they never planned to perform, working hours they did not intend. Other traps include excessively restrictive covenants; poorly drafted contract clauses governing outside activities that could entail doctors giving royalties earned from such activities to the hospital; payment recoupment clauses; medical liability tail coverage; generic language stating that a physician will supply call coverage based on the hospital board's requirements, rather than splitting the coverage equally among the doctors; and contract termination stipulations.

From the article of the same title
American Medical News (12/19/11) Elliott, Victoria Stagg
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Health Policy and Reimbursement

CMS Details Recovery Auditor Prepayment Review Demo
The Centers for Medicare & Medicaid Services (CMS) in November announced that it will launch a number of demonstration programs that are set to begin in January 2012, one of which is its recovery auditor prepayment review initiative. On December 21, CMS held a special open door forum to further discuss the program. The operational details that CMS clarified during the call include:

* Limits on prepayment reviews won't exceed current post-payment additional documentation request limits.
* Providers may appeal the denial and have the same appeal rights as with other denials. Appeal time frames start on the date of the denial as indicated in the remittance advice.
* Medical records provided on appeal will be remanded to the recovery auditor for review. (This only applies to claims that were denied as a result of nonreceipt of medical records).
* Claims will be off-limits from future post-payment reviews from Medicare administrative contractors and recovery auditors.

From the article of the same title
HealthLeaders Media (12/29/11)
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HHS Plans Database on EHR Incentive Program Participants
The Department of Health and Human Services plans to create a national database that will contain information about office-based healthcare providers participating in federally funded electronic health record system incentive payment programs. Goals of the proposed new system are to create a tool to evaluate those incentive programs and to check up on the work of a national system of regional health information technology extension centers.

From the article of the same title
Modern Healthcare (12/22/11) Conn, Joseph
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Medicine, Drugs and Devices

NIH Establishes National Center for Advancing Translational Sciences
With congressional and presidential approval of a fiscal year 2012 spending bill, the National Institutes of Health (NIH) has established the National Center for Advancing Translational Sciences (NCATS) to retool the process of converting scientific discoveries into new pharmaceuticals, diagnostics, and devices. "The entire [scientific] community must work together to forge a new paradigm, and NCATS aims to catalyze this effort," said NIH director Francis Collins. NCATS will lead projects such as a joint venture between NIH, U.S. Food and Drug Administration, and the Defense Advanced Research Projects Agency to develop state-of-the-art chip technology that will enable researchers to screen for safe, effective drugs with much greater speed and efficiency than current techniques.

From the article of the same title
Healthcare IT News (12/27/11) Manos, Diana
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New Federal Fee on Health Insurers Will Help Pay for Head-to-Head Tests of Medical Treatments
Beginning in 2012, the government will charge a new fee to Americans' health insurance plans to cover research to determine which drugs, medical procedures, tests, and treatments are most effective. The fee will be $1 per covered person in its first year, rising to $2 in the next year and thereafter climbing with inflation. The research will be performed by the congressionally-founded Patient-Centered Outcome Research Institute, but Heritage Foundation policy analyst Kathryn Nix maintains that "the more concerning thing is not the institute itself, but how the findings will be used in other areas. Will they be used to make coverage determinations?" Institute director Joe Selby says decisions will be made by patients and doctors, and not the institute. He says his organization hopes to see two key results stemming from patient involvement in research. "One is that we will start asking questions in a more practical fashion, so the results would speak more consistently to questions that patients want to know the answers to," Selby notes. "And two is that ... trust will rise."

From the article of the same title
Associated Press (12/28/11)
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Pharma-Doctor Gift Ban Generated Lots of Talk, No Final Action in 2011
Despite strong signals that Massachusetts Gov. Deval Patrick and the state legislature would support peeling back parts of a three-year-old ban on gifts from pharmaceutical companies to doctors in the state, no action was taken in 2011. But efforts to dismantle components of the ban are poised to reemerge in 2012 and received the fresh backing of a panel of lawmakers last week, potentially teeing up the issue for consideration during debate on a major healthcare system overhaul eyed for next year.

From the article of the same title
Boston Herald (12/28/11) Cheney, Kyle
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