News From ACFAS

Congress is still in recess, but work on reconciling the House and Senate Health Reform bills has started behind closed doors. It appears that Democrats have decided to negotiate informally rather than form a conference committee. Washington insiders call this process “ping pong” as the two chambers pass proposed changes in language back and forth. Democrats think that involving Republicans in the reconciliation process is unproductive, given their unanimous opposition. The Democrats believe that including Republicans in the process is simply giving them the opportunity to obstruct through procedural maneuvers. The strategy is being criticized by some as undermining transparency.

Start your New Year with the latest ACFAS e-Learning podcast, “When Not to Operate.”

Whether to surgically intervene on a patient is a complex question whose answer depends on many different factors. Moderator Kris DiNucci, DPM, leads a discussion with three experienced surgeons that explores:

• considerations for particular patient groups, such as pediatrics, diabetes and those with preexisting mental or physical impairments.
• factors in the assessment of risk management, such as patient behavior and likelihood of improvement or harm from surgery.
• special circumstances, such as trauma or limb salvage.

Visit ACFAS e-Learning anytime to access this thought-provoking discussion on the decision to operate—or not.


Promote your practice with free, customizable news releases from ACFAS. You can send them to local newspapers, radio stations, hospital PR departments, or to other community organizations for their newsletters.

“Enjoy Pregnancy without Foot Pain,” the latest ACFAS news release, provides advice on ways to avoid or alleviate the foot and ankle complaints that commonly afflict pregnant women.

You can put yourself in the news with this same story using a pre-formatted Fill-In-The-Blanks Press Release from acfas.org. Download the form and jump-start your practice marketing efforts.

If you haven't already voted, please fax in your ballot for the ACFAS Board of Directors election. They must be submitted to the ACFAS office no later than 5 p.m. CST on January 12. You can vote for one or two of the three candidates recommended by the Nominating Committee:

• Richard Derner, DPM, FACFAS
• Sean Grambart, DPM, FACFAS
• Roya Mirmiran, DPM, FACFAS

Help decide the future of your College—return your ballot by January 12!

Foot and Ankle Surgery

Medial Approaches to Osteochondral Lesion of the Talus Without Medial Malleolar Osteotomy

The purpose of this study was to determine the area of the talus that can be reached through combined anterior and posterior arthrotomy without medial malleolar osteotomy. Cadaver foot-ankle specimens were examined using posteromedial approach and anteromedial approach. From the posteromedial talus, the researchers found they could access 33 percent of the talus’ AP length and 30 percent of its medial to lateral length through a posteromedial approach. From the anteromedial arthrotomy, 50 percent of the AP length and 31 percent of the medial to lateral length could be reached, leaving approximately 20 percent that is not accessible. If the osteochondral lesion is within the accessible area through either a posteromedial or anteromedial approach as viewed on MRI/CT, it can be safely reached without a medial malleolar osteotomy, the researchers concluded.



Results of Joint-preserving Procedures by a Modified Mann Method for Big Toe Deformities in Rheumatoid Patients Undergoing Forefoot Surgeries

Researchers aimed to evaluate joint-preserving procedures by a modified Mann method for rheumatoid forefoot deformities and their functional outcomes in the mid-term. Eleven feet in seven patients underwent forefoot surgery using a modified Mann method for the big toe, combined with offset osteotomy or resection arthroplasty of the lesser toes. The researchers concluded that for restraint of rheumatoid forefoot deformities, the procedure was satisfactory for improving the foot function and preserving metatarsophalangeal joint mobility.



Smoking Ups Men's Rheumatoid Arthritis Risk Most

Smoking is a leading risk factor for rheumatoid arthritis (RA) in men, new analysis of 16 studies confirms. Men who tested positive for rheumatoid factor (RF), a self-attacking antibody found in about 80 percent of RA patients, were at even higher risk if they smoked. The research was published in the January 2010 edition of the Annals of the Rheumatic Diseases.



Senate Health Reform Bill Preserves Essential Diagnostic Services for Osteoporosis

The passage of healthcare reform in Congress will help older Americans more easily access quality osteoporosis diagnosis, prevention, and treatment services. The Senate health reform bill features a provision on restoring Medicare reimbursement for dial energy X-ray absorptiometry (DXA), the leading diagnostic tool for the early detection and management of osteoporosis. Medicare cuts for DXA tests have jeopardized patient access to this important preventive healthcare service, and without congressional action many doctors would have to discontinue providing DXA services in their offices as reimbursement is currently far lower than the cost of the test. The inclusion of DXA in the healthcare reform bill is an example of a renewed focus on prevention. Numerous studies have shown that increased DXA testing and treatment result in a significant drop in fractures and related healthcare costs.

Practice Management

Readiness, Records and Risk: Preparing Your Practice for 2010

Creating a medical practice budget is an important part of managing a successful practice, and now is the time to finalize a budget for 2010. Creating a formal budget encourages physicians and practice managers to evaluate their needs and think about some of the initiatives they want tackle in the upcoming year. As the economy shows signs of recovery, now is a good time to revisit some of the projects that were dropped when the economy started to collapse. In planning the upcoming year for a practice, remember the three Rs: readiness (for a public health emergency), (electronic health) records, and (minimizing liability) risk.



The Virtual Visit May Expand Access for Doctors

UnitedHealth Group's OptumHealth division has developed NowClinic, a service that links patients and physicians using video chat, which advocates see as a less costly way to supply routine medical care. "NowClinic gives you the ability to have that gut feel if something is wrong, in tone or facial expression or body language, that you have when you walk in the door with a patient," says Texas family physician Christopher Crow. NowClinic has been initially deployed in Texas, but OptumHealth is planning a national rollout on a state-by-state basis. Any patient in Texas who pays a $45 fee can use NowClinic by visiting NowClinic.com, regardless of whether they are insured.



IBM To Offer Financing Deals for Products by Four Health IT Vendors

IBM Global Financing has announced a new initiative to offer financing for electronic health system products sold by four health IT firms: Healthcare Management Systems, Lavender and Wyatt Systems, SCC Soft Computer; and Siemens Healthcare. The program is designed to encourage more healthcare providers to invest in electronic health systems. It will offer interest rates as low as 3 percent to providers with high credit ratings.

Health Policy and Reimbursement

Medicare Stops Coding for Consults: What to Do Now?

The announcement that Medicare will no longer pay for consultation codes has left many doctors worried about their income and how to handle the new system. The change will significantly affect specialists who rely on the payment differentials, 20 percent to 30 percent, between visit and consult codes. In an effort to offset the elimination of consult payments, the Centers for Medicare and Medicaid Services (CMS) will increase the work relative value units (RVUs) for new and established office visits by about 6 percent and work RVUs for initial hospital and facility visits by approximately 0.3 percent to reflect the elimination of the facility consultation codes.



Medicare Plans Bonus to Promote Digital Records

On December 30, CMS unveiled a proposal to offer bonus payments to hospitals and physicians that shift from paper to electronic medical records (EMRs). To qualify for the bonus payments, hospitals and physicians must employ EMRs for 80 percent of their “medical instructions,’’ to check for possible drug interactions and to print out medical histories for patients. Additionally, 10 percent of orders must be handled by hospitals electronically. This proposal is distinct from the incentive plan for adoption of electronic health records (EHRs). EHRs must be interoperable with other external systems, which is not the case for EMRs. The proposal, which will not be finalized until spring, will be up for public comment for 60 days.



Fate of Missouri's Liability Cap Before State Supreme Court

A legal challenge to Missouri's noneconomic damage cap could undo the state's stabilizing medical liability climate, warn state physicians. The Missouri Supreme Court is set to hear a constitutional challenge to the $350,000 award limit in medical liability cases. Physicians credit liability reform with lowering insurance premiums and lawsuit filings and helping doctors remain practicing in the state. A recent report by state insurance regulators showed that in 2008 1,215 new liability claims were filed in 2008, the lowest number since 1999. Another 3,017 claims remained open, the lowest number in the three decades the state has tracked the data.

Technology and Device Trends

Better Function, Few Complications Seen with Minimally Invasive TAR Technique

Early results indicate that a minimally invasive total ankle replacement procedure may provide good functional outcomes and a low complication rate in patients with severe ankle arthritis, report researchers from Germany. A short median approach with a 5-cm to 6-cm skin incision was used for the procedure, said Dan-Henrik Boack, MD, during his presentation at the American Orthopaedic Foot and Ankle Society annual summer meeting. The anterior tibial tendon was left complete in the tendon sheet. Boack performed the procedures without subperiosteal bone preparation and explored the ankle with a moving window technique, percutaneously fixing the aiming cutting device under fluoroscopic control and resecting the dorsal portion of bones using a bit-by-bit technique.



Robotic Ankle Only Steps Away From Daily Use

Researchers at Arizona State University are developing a technology called Spring Ankle with Regenerative Kinetics, nicknamed SPARK, a spring-loaded robotic ankle developed in conjunction with the Military Amputee Research Program at Walter Reed Army Medical Center. The technology uses lightweight energy-storing springs to provide a flex that traditional devices do not provide. Amputees use 20 to 30 percent more energy than able-bodied people just to walk. SPARKy's technology relies on a "robotic tendon" that stretches with each step to generate energy stored in a small motor in the ankle.



Abstract News © Copyright 2010 INFORMATION, INC.

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