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January 8, 2014

News From ACFAS


Did You Vote?
The election of Directors for the ACFAS Board of Directors closes next Tuesday, January 14. Your vote is important to advance our profession and surgical specialty. If you haven’t voted, please take a few minutes today to select members of your Board of Directors who will help lead the College over the next three years. If you have questions accessing the ballot site, please contact our independent election firm at johnarbitell@intelliscan.com.

A reminder email to anyone who did not yet vote was sent on Monday, December 23 from acfas.ballot@intelliscaninc.net with the subject line: ACFAS Board of Directors Election. We Need Your Vote! The small percent of members without an email address were sent voting instructions by US Mail in mid-December.
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Register Now: ICD-10 Webinar
Are you and your staff ready to transition to ICD-10? The deadline for implementation for ICD-10 is October 2014, and with its unprecedented changes to coding, documentation and reimbursement, there's a lot of new information to learn. To educate members and help them prepare for the transition, ACFAS is presenting the one-hour webinar Transitioning Your Practice to ICD-10 on February 12, 2014 at 7:30pm.

Join Marcy C. Blitch, RHIA, CCS and ICD-10 Certified Trainer as she walks listeners through the new, radically different coding system and helps them start to prepare for the implementation into their practice. Registration is $65 for ACFAS members and their staff, and $100 for non-members and non-members’ staff. To register, visit acfas.org/practicemanagement.
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New Associate Member iPad Winner
Congratulations to Jessica L. Kwan, DPM, AACFAS, of Calgary, Alberta, Canada! Of all the new ACFAS Associate Members, she is the lucky winner of a new Apple iPad Air. The ACFAS Membership Committee sponsored this contest to celebrate residents who have recently passed the ABPS Board Qualifying exam and upgraded their membership to “Associate Member” with ACFAS.

Again, congratulations, Dr. Kwan, and welcome to you and all of our new Associate Members to ACFAS.
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Foot and Ankle Surgery


Single-Stage Correction for Clubfoot Associated with Myelomeningocele in Older Children: Early Results
A recent longitudinal study examined the outcomes of a new single-staged surgical procedure in children with clubfoot deformity associated with myelomeningocele. Thirty-four children with a minimum of four-year follow-up, who underwent Achilles tenotomy, plantar fasciotomy and closing dorsolateral wedge osteotomy, were evaluated. The postoperative follow-up, as well as the preoperative and intraoperative evaluations, included detailed morphological, functional, and radiographic scoring according to International Clubfoot Study Group guidelines. At the final-follow up, researchers noted excellent results in four of the 42 feet, while 30 feet displayed good results. Results were fair in five feet and poor in three others. Researchers also observed that good healing had taken place in the 16 feet with preoperative ulcers at the pressure area and in the eight feet with preoperative osteomyelitis of underlying bones. These findings led researchers to conclude that the new surgical procedure is effective at managing clubfoot associated with myelomeningocele.

From the article of the same title
Current Orthopaedic Practice (02/01/14) Vol. 25, P. 64 Shingade, Viraj Uttamrao; Shingade, Rashmi Viraj; Ughade, Suresh Narayanrao
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Comparative Study of Posteromedial Release and Complete Subtalar Release in Resistant/Recurrent Congenital Talipes Equinovarus Foot
Surgeons who performed a study to compare posteromedial release and complete subtalar release in treating children with congenital talipes equinovarus foot observed no differences in the results produced by the two soft-tissue surgical procedures. The study involved 27 children and a total of 44 feet with congenital talipes equinovarus, half of which were treated with posteromedial release and the other half treated with complete subtalar release. Surgical outcomes were assessed using the clinical, radiographic, and functional parameters included in a modified version of Magone's scoring system at follow-up, which was performed at an average of 64 months. Surgeons achieved more than 80 percent excellent and good results using either technique. The study concluded that soft-tissue release is a good option for treating young children with congenital talipes equinovarus foot who do not respond to conservative treatment.

From the article of the same title
Current Orthopaedic Practice (02/01/14) Vol. 25, No. 1, P. 43 Gupta, Sumit ; Kanojia, Rajesh Kumar; Lohia, Lalit
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Calcanectomy: Avoiding Major Amputation in the Presence of Calcaneal Osteomyelitis—A Case Series
A recent retrospective study of diabetic and non-diabetic patients who underwent calcanectomy to treat calcaneal osteomyelitis found that there are a number of benefits associated with using this procedure. Five of the seven diabetics who were included in the review healed at an average of 64 days, compared to an average of 19 days in the three non-diabetic patients who were included. The average length of hospital stay was 49.3±39.4 days in the diabetic patients and 14±16.8 days in the non-diabetic group. The study also found that two patients in the diabetic group needed to undergo a transtibial amputation. In the non-diabetic group, all patients were still alive more than three years after undergoing calcanectomy. Microbiological analysis of bone believed to be osteomyelitic typically isolated more than four organisms. Researchers concluded that calcanectomy is useful in saving limbs and reducing morbidity rates in patients with calcaneal osteomyelitis.

From the article of the same title
The Foot (12/01/13) Walsh, Tom P.; Yates, Ben J.
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Practice Management


Avoiding Inappropriate Staff Conversations at Your Medical Practice
The recent changes in the Health Insurance Portability and Accountability Act (HIPAA) and the sensitivity people have to certain topics of conversation have made it more important than ever for doctors' practices to update their workplace conversation topics policies. Such policies should focus on several topics that could possibly come up in conversation among practice employees. Perhaps the most important topic that should be addressed in a policy on workplace conversations is patient cases. The policy should state that practice members should discuss patient cases in a professional manner and never use specific identifiable information inappropriately. Workplace conversation policies should also state that staff members should not discuss their personal lives, since conversations on these topics can sometimes come close to being construed as sexual harassment. A third topic of conversation that should be addressed in a practice's policy is politics. Employees who express controversial political opinions in the office may give patients the impression that the doctor likely thinks the same way. Such an assumption may cause patients, who tend to want to be around like-minded people, to find another doctor.

From the article of the same title
Physicians Practice (12/28/13) Cloud-Moulds, P.j.
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Health Policy and Reimbursement


President Obama Signs Budget Deal, Including Temporary Relief for Physicians
President Obama on Dec. 26 signed a budget measure that blocked the Jan. 1 implementation of the 23.7 percent cut in Medicare physician reimbursement rates until the end of March. The move will give lawmakers additional time to come up with a long-term solution to the problem. The budget agreement also extends Medicare provider payment cuts that were part of sequestration for another two years. Avalere Health CEO Dan Mendelson said the two-year extension of the cuts means that hospitals should expect to see small, single-digit reductions in their pay in the next several years. Meanwhile, the Senate Finance Committee has approved Medicare physician pay legislation that would permanently repeal the Medicare sustainable growth rate (SGR) formula but states that physicians will not be guaranteed pay increases for 10 years. The House Ways and Means Committee approved a similar bill on Dec. 12, though its legislation calls for a 0.5 percent annual increase in physician payments in each of the first three years of the reimbursement program that will replace SGR.

From the article of the same title
Bureau of National Affairs (12/27/13)
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Performance Scores for Dual-Eligibles Can Drag Down Medicare Advantage Ratings, Study Says
A new study by the research firm Inovalon has found that the presence of dual-eligible patients in Medicare Advantage plans lowers the ratings for those plans, which are used to determine if they are eligible for bonuses. Researchers examined 10 of the 50 health plan performance variables the federal government uses to determine ratings for Medicare Advantage plans, and found that plans performed significantly worse on nine of the metrics with dual-eligible beneficiaries than with other enrollees. For example, the study found that dual-eligibles--many of whom are impoverished and suffer from a number of serious medical conditions--are less likely to be screened for certain health problems and are also more likely to be readmitted to hospitals within 30 days after treatment, which in turn results in lower ratings for Medicare Advantage plans. The findings are important because plans that do no receive adequate ratings are ineligible for bonuses, meaning they may someday find themselves without the funds needed to serve dual-eligibles, said Inovalon Chief Innovation Officer Dan Rizzo. He added that the financial incentive to increase ratings could result in insurers no longer offering Medicare Advantage plans in some locations. The study concluded that the rating system, which currently does not take into account the proportion of dual-eligibles enrolled in a plan, needs to be changed to ensure the performance of plans that serve different populations are evaluated fairly.

From the article of the same title
Modern Healthcare (01/02/14) Demko, Paul
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Medicare Pricing Drives High Healthcare Costs
Several recent studies have found that the prices Medicare sets for healthcare procedures and services have a significant effect on the cost of healthcare for Americans not enrolled in the government healthcare program. In one such study, researchers at the University of California at San Diego analyzed millions of claims in order to identify a possible relationship between changes in the amount of money Medicare paid for a procedure or service and subsequent changes in the amount private insurers paid. The study found that private insurers tended to follow Medicare's pricing scheme, even when the program paid more than what was necessary for certain procedures and services. Another study by an economist at the University of British Columbia found that a $1 change in the amount Medicare pays for a procedure or service results in a $1.30 change in what private insurers pay. Researchers theorize that Medicare has a significant effect on the prices private insurers pay for procedures and services because the money the program pays out comprises more than one-fifth of the amount spent on personal healthcare, and because private insurers save money by following Medicare's price-setting decisions. But because those decisions are sometimes erroneous, private insurers may be spending more than what is necessary on healthcare procedures and services.

From the article of the same title
Washington Post (12/31/13) Whoriskey, Peter; Keating, Dan
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Health-Insurance Sign-Ups on U.S. Exchange Top 1.1 Million in Initial Enrollment Period
The Obama administration announced Dec. 29 that over 1.1 million people have signed up for health insurance through Healthcare.gov during the initial enrollment period. More than 975,000 of those individuals enrolled this month alone, which Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner said was partly due to the fixes that have been made to Healthcare.gov since the site's troubled launch. But CMS did not release any demographic information about the consumers who have signed up for health insurance coverage, leaving insurers to wonder whether their risk pools are balanced between younger, healthier consumers and their older, sicker counterparts. Insurers need such a balance in order to avoid having to raise premiums. Meanwhile, the state-run exchanges have signed up roughly 850,000 people since enrollment began on Nov. 1, bringing the total number of people who have enrolled in health insurance coverage under the Affordable Care Act to nearly 2 million. That is well short of the 3.3 million people the Department of Health and Human Services had hoped would sign up by the end of the year, though experts say that the surge in enrollments in December means that the administration could meet its goal of signing up 7 million consumers by March 31.

From the article of the same title
Washington Post (12/30/13) Eilperin, Juliet; Kliff, Sarah
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CMS Announces Payment Adjustments for Unsuccessful eRx Prescribers
The Centers for Medicare and Medicaid Services (CMS) has released information about how it plans to adjust payments for healthcare providers who failed to successfully participate in the Electronic Prescriptions Incentive Program (eRX) in either 2012 or 2013. According to CMS, providers who did not successfully participate in eRX in either of those years will receive a 2 percent cut to payments they are entitled to under the Medicare Part B physician fee schedule (PFS) for covered professional services in calendar year 2014. In addition, CMS said it plans to apply payment adjustments to healthcare providers that did not successfully demonstrate meaningful use under the Medicare Electronic Health Record (EHR) Incentive Program beginning Jan. 1, 2015. Those adjustments will be determined by the reporting period in a prior year. Healthcare providers who receive an eRX adjustment in 2014 and who also fail to demonstrate meaningful use will be subject to a 2 percent EHR payment adjustment in 2015. Those who did not demonstrate meaningful use and also did not receive an eRX adjustment will receive an EHR payment adjustment of 1 percent in 2015. CMS says that providers may be able to avoid the EHR payment adjustment by demonstrating meaningful use before 2015 or by receiving a hardship exemption.

From the article of the same title
EHR Intelligence (12/13/2013) Freeman, Nicole
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Predictive Factors of Hospital Length of Stay in Patients with Operatively Treated Ankle Fractures
American Society of Anesthesiologists (ASA) physical status score is a strong predictor of postoperative length of stay (LOS) in ankle fracture patients treated with operative fixation, a new study has found. Researchers retrospectively identified 622 ankle fracture patients who were treated with various methods of fixation and developed univariate and multivariate models to determine predictors of patient LOS. A linear regression analysis found that there was a statistically significant relationship between ASA status and LOS, while a multiple regression analysis found that a 1-U increase in ASA classification resulted in an average increase in LOS of 3.42 days. Assuming an average per-day inpatient cost of $4,503, a one unit increase in ASA status results in a $15,490 increase in costs, the study found. Researchers noted that they believe it is important for orthopaedic surgeons to have a strong understanding of the factors that affect LOS in patients who undergo operative fixation of ankle fractures in order negotiate appropriate reimbursement. This is particularly important as reimbursement plans evolve with the potential for bundled payments, researchers said.

From the article of the same title
Journal of Orthopaedics and Traumatology (12/01/13) McDonald, Matthew R.; Sathiyakumar, Vasanth; Apfeld, Jordan C.; et al.
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Medicine, Drugs and Devices


The Risk of Gastrointestinal Perforations in Patients with Rheumatoid Arthritis Treated with Anti-TNF Therapy
There is no statistically significant association between anti-tumor necrosis factor (anti-TNF) therapy used to treat rheumatoid arthritis (RA) and the risk of gastrointestinal perforation (GIP), a new study has found. Researchers who performed the study used Cox regression modelling to compare the incidence of GIPs in 11,881 RA patients treated with anti-TNF therapy and the rate of GIPs in 3,393 RA patients treated with non-biological disease-modifying antirheumatic drugs (nbDMARDs). Researchers calculated hazard ratios (HRs) with confidence intervals (CIs) and made adjustments for current steroid use and other possible confounders. Five GIPs were observed in the nbDMARD patients and 37 were seen in the anti-TNF group. Anti-TNF was associated with an HR of 1.6 for all GIPs, 2.7 for lower GIPs, and 0.9 for upper GIPs after adjustment. Researchers found that the most important predictor of GIP was current steroid usage with an adjusted HR of 2.9, though this risk was seen only in lower GIPs.

From the article of the same title
Annals of the Rheumatic Diseases (01/01/2014) Zavada, Jakub; Lunt, Mark; Davies, Rebecca; et al.
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Researchers Find Genetic Clues for Arthritis
A recent genetic study has produced a discovery that could someday lead to a drug that cures rheumatoid arthritis (RA), researchers say. During the study of 30,000 patients, researchers compared the DNA of those with RA and found 42 single nucleotide polymorphisms (SNPs) in their DNA that increase the risk of the disease. The study, which was published in the journal Nature, concluded that drugs could someday be developed to correct these SNPs, which are faulty areas of DNA. Researchers say their theory is validated by the fact that an existing RA drug is effective at treating symptoms caused by a particular SNP, even though it was not developed to correct the problems in the DNA of RA patients. Some experts disagree with the assertion that targeting SNPs associated with RA is an effective approach to treating or preventing the disease.

From the article of the same title
Health Central (12/26/13)
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