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This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

This Week's Healthcare Reform Update

The January 19 special election to fill the remaining term of the late Sen. Ted Kennedy, D-Mass., may have a significant impact on the Democrats' health system reform reconciliation strategy. Although Democrat Martha Coakley still has a 50-41 percent lead against Republican Scott Brown in the polls, that lead has shrunk significantly. Mr. Brown opposes both the House and Senate bills. If he wins, the Democrats would lose their filibuster-proof 60-seat majority. Observers speculate that if this happens, House Democrats are likely to pass the Senate bill with no changes. This would mean that the final bill could pass the Senate with a simple 51 vote majority.
ACFAS Urges CPME to Retain the “S” in PM&SR

ACFAS has written to the Council on Podiatric Medical Education (CPME) on its proposed revisions to CPME Documents 320 and 330 on residencies. “We believe dropping the word 'surgical' [from the PM&SR terminology] is taking a step backward in our profession’s never-ending quest for equivalency of training and professional parity,” says ACFAS President Mary E. Crawford, DPM, FACFAS.

“This word was added only a few years ago; what unintended consequence does its removal signal to the healthcare profession?” continues Crawford. “Podiatric residency directors need every possible tool to maintain the full scope of foot and ankle reconstructive surgery and trauma at teaching institutions. If we don’t proclaim and highlight our surgical training to the healthcare profession, who will?”

The ACFAS Board of Directors will discuss other CPME revisions at its February 22 meeting and may send additional comments at that time. The deadline for public comment is April 1.
Board of Directors Election Results

In balloting that concluded on January 12, ACFAS members elected two new members to the Board of Directors:
  • Richard Derner, DPM, FACFAS, of Lake Ridge, Va., for a three-year term
  • Sean Grambart, DPM, FACFAS, of Champaign, Ill., for a three-year term
The Divisions Presidents Council has selected Kimberly Eickmeier, DPM, FACFAS, to serve as council chair for 2010–2012. This position also serves as an ex-officio member of the Board of Directors.

In February, these new members will join the continuing members of the 2010–11 board.
Renew Your Membership Now — and Avoid a Late Fee

Planning to renew your ACFAS membership for 2010, but haven't done it yet? Renew by January 20 and avoid a $50 late fee. Dues can be paid online at the ACFAS web site, or by calling 773-693-9300 during normal business hours.

Start the year off right by continuing your relationship with the professional organization comprised of the best and brightest foot and ankle surgeons — ACFAS.

Foot and Ankle Surgery

FDA Issues Four Wound Care Precautions

The FDA has issued a Medwatch Safety Alert that warns hospitals and long-term care facilities to be on the lookout for serious complications and risk of death resulting from use of negative pressure wound therapy (NPWT) systems that can cause fatal bleeding and infections. The alert was issued after the FDA received reports of six deaths and 77 injuries associated with NPWT systems over the past two years related to extensive bleeding involving vascular grafts, sternal and groin wounds, anti-coagulant therapy, and the removal of dressings. More information can be found at

From the article of the same title
HealthLeaders Media (01/08/10) Clark, Cheryl

Reconstruction After Wide Resection of the Entire Distal Fibula in Malignant Bone Tumors

Researchers presented a series of patients with resection of the entire distal fibula in the case of sarcoma or metastasis and described a new method to restore ankle stability with a tibiotalocalcaneal arthrodesis using a retrograde hindfoot nail in contrast to tibiotalar arthrodesis with screws. The crucial benefits of an arthrodesis with a retrograde nail are a stable arthrodesis, intramedullary stabilization of the tibia and avoidance of extrinsic material in the wound area. The researchers concluded that an arthrodesis with a retrograde nail is a good alternative for reconstruction after a wide distal fibula resection.

From the article of the same title
International Orthopaedics (12/29/09) Dieckmann, Ralf; Ahrens, Helmut; Streitburger, Arne; et al.

Risk of Venous Thromboembolism Greater, Lasts Longer, Than Thought

Researchers report online in the British Medical Journal that the post-surgical risk of venous thromboembolism (VTE) is greater and lasts longer than previously considered, according to a study of middle-aged women. The researchers found that women were nearly 70 times more likely to be admitted to the hospital with VTE during the first six weeks following an inpatient operation and close to 10 times more likely after a day case operation. This connection is critical since preventive treatment for thrombosis is not typically employed in day surgery patients. The researchers imply that one in 140 middle-aged women in Britain will be admitted with VTE in the 12 weeks after any inpatient operation, one in 45 after hip- or knee-replacement surgery, and one in 85 following cancer surgery. Vascular surgeon Alexander T. Cohen says that the researchers' findings "should lower the threshold for using prolonged prophylaxis in lots of patients with respect to thrombosis."

From the article of the same title
Medscape (12/28/09) Nghiem, Hien T.

Practice Management

How to Get $20 Billion for Using Electronic Medical Records

HIT was a major focus of health care news this past week as the Centers for Medicare & Medicaid Services released a 556-page proposed rule that sets forth what physicians and other providers must do to show “meaningful use” of an electronic health record (EHR) in order to qualify for up to $44,000 in incentive payments. The rule requires, among other things, that providers file prescriptions and submit insurance claims through the EHR, give patients electronic access to health information, record vital lab signs and tests electronically, and use EHR to record at least some physician and nurse orders. The rule backed off significantly on the “interoperability” requirement which focuses on using the EHR to communicate with external systems, such as other hospitals and health insurers. The rule requires that by 2011, the provider must have performed “at least one test” of the EHR system's ability to “electronically exchange information.”

Provider groups will be weighing in on the proposed rule. There is significant concern about the applicability of the rules to small practices, because providers will be penalized for not adopting EHR beginning in 2015. There is already evidence that many hospitals are behind schedule in their efforts to qualify for the incentive, and hospitals have exponentially greater resources than small practices.

From the article of the same title
Wall Street Journal (12/30/09) Goldstein, Jacob

Physicians Must Adapt, Evolve in 2010

Health Leader’s managing editor Elyas Bahkairi predicts that 2010 will be a year of major adaptation for physicians. He suggests several steps for physicians to position themselves optimally for change, including: 1) forming closer relationships with hospitals, as the government shifts to bundled payments and integrated systems models; 2) embracing technology, including EHRs and social media; 3) reevaluating all finances and contracts; and 4) educating and listening to patients.

From the article of the same title
Health Leaders Magazine Online (12/09) Bakhtiari, Elyas

How to Get Credit When Banks Don't Want to Lend

The credit crunch has affected physician practices, even though they still remain more attractive to lenders than many other small businesses. Physicians seeking credit must be prepared to provide significantly more documentation than in the past to demonstrate the financial health of the practice, including how they are handling cash flow. Lenders also may require physicians to personally guarantee the loan. Experts encourage physicians to establish a personal and ongoing relationship with a banker in the community. While there are benefits to maintaining a long-term banking relationship, physicians should also be willing to walk if their banks will not accommodate the need for working capital.

From the article of the same title
American Medical News (01/11/10) Stagg-Elliott, Victoria

Health Policy and Reimbursement

Health Spending Rises in 2008, but at Slower Rate

Health spending grew in 2008 at the slowest pace in 48 years, according a report by the Department of Health and Human Services. Health spending topped $2.3 trillion in 2008, a 4.4 percent increase from 2007, compared to the 6 percent of 2007 and an average increase of 7 percent a year in the decade from 1998 to 2008. The decrease is largely attributed to the recession and is not an indication of a long-term trend, says the report.

From the article of the same title
New York Times (01/04/10) Pear, Robert

Will Bundling Include Doctors? Medicare Looking for Alternative Payment Plans

Congress is mulling bundled payment, a new approach for paying doctors and hospitals under Medicare in which physician and hospital payments are lumped together in a single "global" payment for a procedure or episode of care instead of payment based on individual services and procedures. Physicians are concerned that global payments to hospitals would give hospitals too much leverage over physicians' payment, that bundled pay would create an incentive to withhold necessary care to maximize profits, and that an emphasis on acute care episodes would leave primary care doctors in the lurch. Some experts say that bundling needs to include post-acute, chronic, or primary care in order to restrain the growth of health care spending and to encourage care coordination.

From the article of the same title
American Medical News (01/04/10) Aston, Geri

Technology and Device Trends

Total Ankle Replacement by the Ankle Evolution System: Medium-term Outcome

Researchers present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. They found that the medium-term results of the ankle evolution system ankle replacement are satisfactory with high patient satisfaction, but that the rate of osteolysis is of some concern. The long-term benefit of this procedure has yet to be determined.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (01/01/10) Vol. 92, No. 1, P. 61; Morgan, S. S.; Brooke, B.; Harris, N. J.

Body's Own Veins Provide Superior Material for Aortic Grafts

A vascular surgical technique developed by researchers at the University of Texas Southwestern Medical Center is designed to replace infected aortic grafts with the body’s own veins. The technique has proven more durable and less prone to new infection than similar procedures using synthetic and cadaver grafts. Called the neo-aortoiliac system, the procedure involves removing the infected graft and replacing it with sections of femoral-popliteal veins harvested from the patient’s thighs rather than another synthetic graft or vessels harvested from human cadavers.

From the article of the same title
Newswise (12/30/09)

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January 13, 2010