News From ACFAS

Foot and Ankle Surgery

Increasing Number Avoid Transfusions
Las Vegas Review-Journal (01/11/09) Wells, Annette

Valley Hospital Medical Center in southern Nevada is one of 125 facilities nationwide that practice transfusion medicine. The program is favored by Jehovah's Witnesses, who view blood as sacred and prohibit blood transfusions but is appropriate "for any patient wanting to avoid blood transfusions," says Jerry Montgomery, coordinator of the hospital's Transfusion-Free Medicine and Surgery initiative. He says the hospital approach involves using medicines to boost patients' red blood cell count prior to surgery, taking steps to minimize unnecessary blood loss, and recycling blood via technology. Valley has invested in several Continuous AutoTransfusion Systems, or cell savers, that gather blood at the surgery site for recycling. Medical experts say the trend is being driven by patients who are worried about the rising costs of blood, potentially contracting diseases like HIV or hepatitis, and declining numbers of blood donors. They also want to avoid the complications of receiving the wrong blood during a transfusion. A study published in the New England Journal of Medicine found that heart-surgery patients receiving blood transfusions fared worse if the blood was stored for more than 14 days, compared to patients who received transfusions of fresher blood. An example is given in the article of 65-year-old Dorothy Phillips, who needed surgery on her foot and hip following a car accident. Because Phillips needed two operations, doctors decided to start with the one that would result in less blood loss, the foot surgery. After that surgery, Phillips was given drugs to replenish her red blood cell count prior to her hip replacement. The Joint Commission is currently mulling ways to create performance measurements to prevent anemia among hospital patients who need surgery, says Jonathan Waters, medical director of the University of Pittsburgh's blood management program and president of the Society for the Advancement of Blood Management.


Marker for Heart Attack Risk Also May Predict Bone Infection in Diabetes
University of Arizona (01/06/09) Gellerman, Jo Marie

University of Arizona researchers say a test to identify artery inflammation can be used to enhance the detection of bone infection. The test for C-reactive protein, a marker for heart attack risk, can be combined with a clinical assessment of wounds to check for osteomyelitis, a serious bone infection, the researchers say. The combination of tests is believed to be more effective than using either one separately. This experimental approach may help healthcare professionals "target limb-sparing antibiotics and surgery to the place where they might be most needed," says David G. Armstrong, DPM, FACFAS, professor of surgery and director of the university's Southern Arizona Limb Salvage Alliance. The Centers for Disease Control estimates that upwards of 60 percent of non-traumatic lower limb amputations occur in people with diabetes.

Practice Management

New Outpatient Center Cuts Health-Care Hassle
Columbus Dispatch (OH) (01/05/09) Pramik, Mike

Billed as a "hospital without beds," the new Westerville Medical Campus recently opened by OhioHealth will put a number of different medical specialties and services in one place to make things easier for patients. For example, the Orthopedic Foot & Ankle Center, one of the offices set to open in the coming months, could service the same patients with ankle problems who receive X-rays or MRIs, undergo surgery, and receive rehabilitation at other offices on the three-building campus. "On occasion, we have to send patients elsewhere to get services. We really don't have to do that now. It can all be done within this building," says Terrence Philbin, DO, a partner in the foot and ankle center. Philbin notes that primary care doctors, orthopedic surgeons, podiatrists, physical therapy, wound care, and surgery are all available on site. The designers of the new campus paid attention to small touches, such as having some patient changing rooms with lockers that open from the inside of the room and from the hallway, and replacing a "front desk" with kiosks where patients register then follow marked pathways on the floor to their destinations. Free parking, a free child-care center, a Tim Hortons Cafe, and assistance with buying or renting equipment and scheduling home-care services are among the other amenities.


Toledo Area Physicians Say Good-bye to Prescription Pads
Toledo Blade (OH) (01/04/09) McKinnon, Julie M.

Physicians in the Toledo, Ohio, region are following the national trend of medical practitioners who are electronically transmitting their patients' prescription orders right to pharmacies. Beginning in January, Medicare has been rewarding physicians who are regularly utilizing e-prescription software with bonus payments, part of a federal initiative that will climax in 2012 when payments could be stopped to those who have not switched. Around 10 percent of American physicians employ e-prescription software, which helps increase patient safety by doing away with physicians' illegible handwriting and the possibility of error at the pharmacy. Qualified e-prescribing physicians will receive a 2 percent incentive payment in 2009 and 2010 from Medicare, and then get a 1 percent payment in 2011 and 2012, and a half-percent payment in 2013. Physicians not successfully e-prescribing by 2012 could be at risk of a 1 percent penalty, a 1.5 percent penalty in 2013, and 2 percent penalty in 2014, the U.S. Department of Health and Human Services notes. Maumee, Ohio, family physician Dr. Shalini Singh now electronically sends medications she prescribes to pharmacies. She claims the system has helped eliminate the sticky notes that were put in patient files containing notes that could be rewritten with mistakes. "That not only helps with time efficiency, but the error of recording and rerecording is taken away," she says.

Health Policy and Reimbursement

Aetna to Pay $20 Million to Settle Health Care Rates Dispute
Bloomberg (01/16/09)

Aetna, the third largest U.S. health insurer, has reached a $20 million agreement to settle an investigation of reimbursement rates for out-of-network doctors by New York Attorney General Andrew Cuomo's office. The announcement comes on the heels of a similar settlement reached with the largest health insurer in the United States, UnitedHealth, which has agreed to pay $50 million to a nonprofit group to create a new database for determining charges for doctors' services. This database would allow consumers to view reimbursement rates for out-of-network services. In an earlier probe, New York focused on UnitedHealth division Ingenix, which runs databases used by insurers to determine "reasonable and customary" charges for services. Insurers give providers' billing information to Ingenix, and the state found that out-of-network doctors frequently get paid less from insurers than they charge, meaning patients end up having to pay a larger portion of the bills than anticipated. Cuomo had also subpoenaed Aetna and CIGNA. The $20 million Aetna is paying will supplement UnitedHealth's payment to fund the nonprofit database that will replace the Ingenix database. Separately, UnitedHealth has agreed to pay $350 million to settle a class-action suit brought by physician groups that claimed payments to doctors for out-of-network services have been manipulated for the past 15 years.


Diagnosis Codes Multiply in 'Nightmare' for Providers
Bloomberg (01/14/09) Marcus, Aliza; Goldstein, Avram

The number of codes for medical billing is set to increase from 17,000 to more than 155,000 as part of efforts to bring the United States in line with the health coding widely used internationally that allows providers to define diseases and treatments more narrowly. In keeping with efforts to promote electronic record-keeping to boost healthcare efficiency while reducing costs, ICD-10, as the new system is called, will end up doing the opposite for hospitals and physicians seeking reimbursement, at least in the short-run, say experts. "It has the potential to be a nightmare," says Rick Jung, chief operating officer of Medsphere Systems, a healthcare information technology company in Carlsbad, California. "If you’re going to roll out all these new codes, you have to have humans who understand what they mean and how to match them with the procedure codes to get the claim correct." A study by consulting firm Hay Group estimates that it would cost up to $8.3 billion to carry out the requirements of the new system.


Stimulus Includes Help for Doctors
Associated Press (01/14/09) Freking, Kevin

Many doctors are reluctant to migrate from a paper-based records system to a digital one, which can cost $30,000 to $40,000. Approximately one in five physicians are currently using electronic record keeping. President Bush advocated the digitization of health records five years ago, but did not provide the money to make feasible. During his election campaign, President-elect Barack Obama pledged to invest $50 billion towards electronic medical records. His economic stimulus package is predicted to have two years' worth of funding, or roughly $20 billion. The money would go to doctors and hospitals via grants and higher reimbursement rates for those who serve Medicare patients. Doctors who opt not to migrate to electronic records might see reduced reimbursements from government subsidized health care programs.


Medicare Seeks to Ban Some Penalties for Picking Brand-Name Drugs
Wall Street Journal (01/11/09) P. A3; Zhang, Jane; Fuhrmans, Vanessa

The Bush administration has recommended prohibiting a practice that allows private insurers to charge Medicare recipients steep penalties if they select brand-name medications over less expensive generics. Under reference-based pricing, the penalty for choosing a brand-name medication frequently equals the price difference between the medication and the generic version, as well as a co-payment. In certain situations, that forces patients to pay the full cost of the brand-name prescription. In comparison, buyers of brand-name medications when there is no generic equal are only charged a co-payment. Although the Centers for Medicare and Medicaid Services (CMS) had backed the pricing mechanism as a means to control prices since the drug benefit was begun in 2006, the agency recently reversed itself, proposing to prohibit such pricing for the 2010 drug plans. It stated that the complex formulas made it "very difficult to accurately convey the extent of expected out-of-pocket spending" for prescription medications. The ban is part of CMS' requirements for prescription-medication plans that insurers will provide for 2010. Excellus Blue Cross Blue Shield, which offers drug plans in upstate New York, stated the practice has saved both the firm and Medicare recipients money because it is frequently more effective than other tools in getting patients to recognize that a less expensive generic alternative exists, which keeps their co-payments and out-of-pocket expenses down.

Technology and Device Trends

A New Advance: Artificial Ankles
Orlando Sentinel (FL) (01/06/09) Neergaard, Lauran

A new generation of artificial ankles is giving foot and ankle specialists new hope of reducing the pain and improving the function of people with ankle problems, something that earlier generations of ankle prostheses in the 1970s and 1990s were less successful at doing. "These third-generation prostheses really mimic a natural ankle, which is really what makes them different," says ankle specialist Steven L. Haddad, MD, of the Illinois Bone and Joint Institute, who is also an orthopedic-surgery professor at Northwestern University. The Journal of the American Academy of Orthopedic Surgeons warned in its September issue that there is little research so far to indicate the durability of the newer prostheses, and not many hospitals have much practice in implanting them. Replacing the ankle with an artificial prosthesis has been a difficult job because the ankle joint is smaller than the hip and knee but must absorb more force, said Dr. Keith Wapner, MD, of the University of Pennsylvania at a recent meeting of the American Academy of Orthopedic Surgeons. In 2005, the Food and Drug Administration (FDA) began approving some of the new generation of designs, though all of the ones approved so far have been two-piece designs, where one piece is a stem on the lower leg bone and the other piece is connected to the top of the foot with thin plastic on the side to serve as cartilage. Some designs in use in Europe have three pieces, with the plastic cushion free-floating, and the FDA is considering whether to allow this approach here amid discussion over whether this is a better or worse design.


Abstract News © Copyright 2009 INFORMATION, INC.

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