January 23, 2013

News From ACFAS

ACFAS 2013 Online Registration Closes Tomorrow
Tomorrow, January 24, online registration closes for the ACFAS 2013 Annual Scientific Conference. After January 24, you may register on-site in Las Vegas. Several workshops are still available, and if you feel like coming a day early, consider the Practice Management Pre-Conference course on February 10. Attendance is heading to an all-time high! Visit to download the conference brochure containing course descriptions and times.
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Still Need a Place To Rest Your Head at ACFAS 2013?
ACFAS hotel rooms are still available at our incredible rates for those who are registering for the ACFAS 2013 Annual Scientific Conference. Book your hotel room online with OnPeak at to get the best rate. You can also phone toll-free at 800-950-5542. Hotel rates at Mandalay Bay are only $95 per night, and THE Hotel at Mandalay Bay – only $125 per night! If you plan on attending but have not yet booked your hotel room, be sure to do so by February 1.
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Watch Your Inbox for Your Mobile Conference App Code
Why? Because the ACFAS 2013 app is personalized to you! The mobile conference app allows you to keep track of your personal schedule, a listing of all attendees, and it will connect you with other attendees at your discretion. All you need to do is enter your unique code and email address when you select the “Contacts” icon on the mobile app. Attendees who registered before January 8 will get their unique “My Schedule” code today (January 23) via email, and those who registered after January 8 will receive their code via email next week.

If you plan on attending the ACFAS 2013 Annual Scientific Conference in Las Vegas, your best bet will be to download the mobile app that puts the entire conference in the palm of your hands. If you haven’t yet downloaded this amazing app, you can at any time by visiting and via iTunes. You can also visit on your mobile device to download it.
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Foot and Ankle Surgery

Achilles Tendon Lengthening: Friend or Foe in the Diabetic Foot?
The recurrent ulceration rate in a patient group who underwent soft-tissue repair of diabetic forefoot or midfoot wounds with concomitant Achilles tendon-lengthening surgery was compared to the rate of a second patient group without surgical lengthening. The study involved a review of all diabetic patients with plantar forefoot or midfoot ulceration who underwent soft-tissue reconstruction during two different periods, from 1983 to 1991 or from 1996 to 2004. The "early group" consisted of 179 wounds in 149 patients who were treated with wound closure surgery alone. The "later group" involved 145 wounds in 138 patients who underwent similar wound closure procedures with the addition of Achilles tendon-lengthening surgery.

A quarter of early group patients and 2 percent of later group patients developed recurrent ulceration requiring additional surgery, resulting in 94 percent relative risk reduction. Both groups had similar risk factors and demographic data. Furthermore, 12 percent in the early group and 4 percent in the later group developed transfer lesions.

From the article of the same title
Plastic and Reconstructive Surgery (01/01/13) Vol. 131, No. 1, P. 37e Colen, Lawrence B.; Kim, Claudia J.; Grant, William P.; et al.
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Practice Management

Checklists May Save Lives During Surgical Crises
Researchers report that the presence of checklists in the operating room for rare life-threatening situations that surgeons might not have recent practice handling improves overall surgical outcomes. The researchers ran a series of simulated operating room crises and found that operative teams -- consisting of anesthesia staff, operating room nurses, surgical technologists, and surgeon stand-ins -- missed only 6 percent of potentially life-saving care processes when they had a checklist available versus the 23 percent of steps missed when there were no checklists. Some 97 percent of the study participants said they would want those operative checklists used by their surgeons if they were a patient. The study was published online Jan. 17 in the New England Journal of Medicine.

From the article of the same title
Medscape (01/16/13) Osterweil, Neil
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Cloud-Based EHRs Create Medical Privacy Risks
Some physicians feel laws governing cloud-based storage of patients' information are not clear enough to be properly followed, making such information storage a risky choice for medical institutions looking to streamline their record keeping. Deborah Peel, chair of Austin, Texas-based privacy watchdog and advocacy group Patient Privacy Rights, recently sent a letter to the U.S. Department of Health and Human Services' Office for Civil Rights asking it to help physicians better understand and prepare for potential vulnerabilities in cloud systems that could expose a medical practice to Health Insurance Portability and Accountability Act (HIPPA) violations. Peel would like to see the office offer guidance on secure infrastructure, security standards, privacy of protected health information and business associate agreement requirements and standardization. Medical institutions can minimize risk by making sure the contract they have with the cloud storage provider points out when and how a practice can get access to data and how the access is achieved, how security of the data is assured, where and how often data backups are stored and how they are accessed, how frequently the cloud service is upgraded, how much downtime can be expected and what laws and rules pertain to the data if it is stored in an offshore location.

From the article of the same title
American Medical News (01/14/13) Dolan, Pamela L.
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Physician Employment: Build a Contract That Suits You
Renewing a contract is a perfect time to negotiate new and more favorable terms because of the increased bargaining power a doctor has once they have established themselves in a health system. Physicians should keep in mind their contract renewal date and make sure to act upon changing the terms of their contract before this date comes.

Some contracts contain evergreen renewal clauses that automatically renew the contract if no action is taken. Before going into negotiations about the contract, physicians should make sure to gather the data they need to support any increases in compensation they are seeking, including data on how they compare to quality metrics set by the industry. Because the composition of physician pay is becoming increasingly convoluted, physicians should make sure they know the steps to take to get to a desired salary amount, taking into account the amount of overall salary dependent on incentive pay and the amount dependent on volume.

During contract negotiations, physicians should make sure their administrative costs are taken into account when their pay is considered. This could include costs accrued from spending time teaching, giving expert testimony or public speaking. During contract renewal time, it's also a good point to bring up retirement and other personal matters like childcare. Those looking to retire in the near term might ask to have their hours incrementally reduced, while those with children might ask to reduce both their hours and on-call schedule. Even if an employer does not go for a physician's proposed changes, the information gleaned from the process could be useful in contract negotiations with a different employer.

From the article of the same title
American Medical News (01/14/13) Elliott, Victoria S.
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The Importance of Engaging Your Medical Practice Staff
In a time of recession it is important for all organizations to maximize the effectiveness of their staff, and there are a number of simple ways medical practices in particular get the most out of their employees. Louis Pennow, financial and operations officer for Boise, Idaho ophthalmology practice Hollingshead Eye Center, says that the practice has turned to better individual engagement between management and the staff, paired with greater recognition of employee's work, to help foster a happy, productive and engaged workforce. The company offers employees the day off on their birthdays and makes a gift every year of gift cards to favorite stores or restaurants to each employee on the anniversary of their hiring. The practice has also chosen to do away with annual review periods for raises in favor of merit-based raises that can be offered by supervisors when the feel they are warranted. Such incremental, individualized and non-regimented acts of recognition by employers can have all sorts of benefits, especially when paired with setting measurable goals for both the employee and the practice as a whole.

Practice managers can also provide opportunities for career development such as training, certification and even, if possible, reimbursement for continuing education. These methods not only increase the abilities of your employees, making them more efficient and productive, but help to motivate them and foster a respectful team spirit that benefits the whole practice. While workforce development can be expensive, it doesn't have to be. There are solutions that work for almost any budget.

Finally, one of the easiest ways to improve your workforce is simply by communicating with them on their own terms. There are any number of factors that can lead an employee's work to suffer, for instance anxiety about job security during rough financial times. Many employees, especially at smaller practices, worry about the possibility of mergers or acquisitions making them redundant. To allay these and other worries among staff, practices should communicate quickly and clearly any and all information that has the potential to impact their jobs.

From the article of the same title
Physicians Practice (01/02/13) Schwartz, Shelly K.
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Health Policy and Reimbursement

E-Prescribing Growth to Pop as Penalties Approach
A study released by Black Book Market Research has found that the use of e-prescribing systems is on the rise and that it will continue to increase in the coming years. Nearly two-thirds of doctors used e-prescribing systems last year, Black Book said, up from just 6 percent in 2007. The report noted that even more doctors will begin using e-prescribing systems in order to earn incentives and avoid penalties levied by the federal government and commercial health insurance companies, and to achieve meaningful use. However, the report also identified several obstacles to the greater adoption of e-prescribing systems, including a lack of funding and connectivity problems at independent pharmacies.

From the article of the same title
InformationWeek (01/14/13) McNickle, Michelle
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Inaccurate Quality Reports Could Skew EHR Incentives: Study
A study published in the Annals of Internal Medicine found wide variance in electronically reported clinical quality measures that could hamper the federal government's electronic health-record (EHR) incentive program, and cause denial of intended incentives to the highest quality providers. Participants in the Center for Medicare and Medicaid Services' EHR incentive program will be required to report quality data via EHRs starting next year, and the majority of quality-reporting efforts depend on administrative billing data criticized for a lack of clinical relevance, or manual record review. Researchers analyzed 2008 data from over 1,100 patients receiving treatment at a federally qualified health center, and uncovered major gaps in sensitivity from one electronic measure to another. The researchers advised greater use of structured fields in EHRs as a way to improve accuracy, as well as better measures designed especially for electronic reporting.

From the article of the same title
Modern Physician (01/15/13) McKinney, Maureen
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New York City Ties Doctors' Income to Quality of Care
Complaints from patients at New York City’s public hospitals and other measures of their care—like how long before they are discharged and how they fare afterward—will be reflected in doctors’ paychecks under a plan being negotiated by physicians and their hospitals. Under the proposal, Health and Hospitals Corporation, which runs the city’s 11 public hospitals and is the country’s largest public health system, would make doctors’ raises dependent on their performance on quality measures. The details are being negotiated with the doctors’ union, but both sides expect to reach an agreement that incorporates the idea.

From the article of the same title
New York Times (01/12/13) Hartocollis, Anemona
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Medicine, Drugs and Devices

Bone Regeneration with BMP-2 Delivered From Keratose Scaffolds
Researchers have found that the biomaterial keratose could be capable of indirectly enhancing bone regeneration when combined with BMP-2 and fabricated into a scaffold. The researchers implanted a keratose/BMP-2 scaffold into a critical-size rat femoral defect and found that it showed bridging as soon as four weeks and induced trabecular morphology similar to what is seen in a remodeling hard fracture callus at 16 weeks. Researchers also found that the regenerated tissue had greater volume and mineral content than normal cortical bone, though it had less density and ultimate shear stress values. Finally, the study found that regeneration was similar to an Infuse control, though a correlation was seen between BMP-2 release and keratose degradation that was not observed in Infuse's collagen carrier system.

From the article of the same title
Biomaterials (02/01/2013) De Guzman, R.C. ; Saul, J.M.; Ellenburg, M.D.
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Osteoporosis Regulation by Salubrinal through eIF2a Mediated Differentiation of Osteoclast and Osteoblast
Researchers have found that salubrinal could be used to develop an osteoporosis drug. The study found that salubrinal treatment to co-cultured bone marrow macrophage (BMM) and MC3T3-E1 cells was able to reduce osteoclast differentiation. The study also found that salubrinal was able to raise bone mineral density (BMD) and other osteoporosis factors in mice model treated with RANKL. Finally, researchers found that the ability of salubrinal to modulate ATF-4 and NFATc1 expressions through eIF2a phosphorylation means that it could be a promising form of treatment for osteoporosis.

From the article of the same title
Cellular Signaling (02/01/2013) Vol. 25, No. 2, P. 552 He, L.; Lee, J.; Jang, J.H.; et al.
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Web-Based QoL Tool Beneficial in Juvenile Idiopathic Arthritis
Children with arthritis who use a Web-based application to monitor health-related quality of life (HRQoL) have more discussions with their physician about psychosocial issues, and their physicians are more satisfied with the care provided during consultations, according to a study published online Jan. 6 in Pediatrics. The study involved 176 children with juvenile idiopathic arthritis who completed Web-based questionnaires to assess HRQoL and generate an electronic patient-reported outcome (ePRO) profile, which was provided to their physician. The ePROfile was not discussed during the consultation during the control period but was provided and discussed during the intervention period.

The researchers found that using the ePROfile significantly increased the discussion of psychosocial issues and significantly increased the satisfaction of the physician with the care provided during the office visit. Use of the ePROfile had no effect on referrals to a psychologist or parental satisfaction. In 80 to 100 percent of the consultations, parents and physicians rated the ePROfile as positive.

From the article of the same title
DoctorsLounge (01/07/13)
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