January 30, 2013

News From ACFAS

On-Site Registration Available for ACFAS 2013
If you missed the registration deadline for the Annual Scientific Conference in Las Vegas, don’t fret. You can still register on-site in Las Vegas at the registration desk in Islander D beginning at 1pm on Sunday, February 10. Still need to make your hotel reservations or change them? Visit for more information or phone toll-free at 800-950-5542 through February 8.
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See the Conference Program Flip Book Online Now
You can see the entire on-site Annual Scientific Conference 2013 Final Program now at in an easy "flip book" format, including the full descriptions of 300 posters, manuscripts, programs, and much more.
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Follow the Conference via Facebook and Twitter
Be a part of the action at the 2013 Annual Scientific Conference even if you aren’t able to be in Las Vegas through ACFAS’ Twitter and Facebook feeds! Follow #ACFAS2013 on Twitter or like our American College of Foot and Ankle Surgeons page on Facebook and watch your news feed for all the buzz, Vegas style!
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Legal Briefs

Owner of Texas Durable Medical Equipment Companies Convicted in Fraud Scheme
A Texas federal judge has convicted High Marion Willet, the owner of two Texas-based durable medical equipment companies, on multiple healthcare fraud charges. Willet was found guilty on seven counts of the June 2012 second superseding indictment, one count of conspiracy to commit healthcare fraud and six counts of healthcare fraud stemming from a durable medical equipment (DME) fraud steam. Evidence at trial showed that between 2006 and 2010, Willet and his wife co-owned and operated JS&H Orthopedic Supply LLC and Texas Orthotic and Prosthetic Systems Inc., which claimed to provide orthotics and other DME to beneficiaries of Medicare and private insurance benefit programs including Aetna, Blue Cross Blue Shield and CIGNA. Evidence presented in court proved both of those companies intentionally submitted claims to Medicare and other insurers for products that were materially different from and more expensive than the products that were actually provided. Willet faces a maximum potential penalty of 10 years in prison and a $250,000 fine on each count. Since March 2007, the Medicare Fraud Strike Force, supervised by the Justice Department's Criminal Division, have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion.

From the article of the same title
U.S. Department of Justice (01/18/13)
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Foot and Ankle Surgery

Diabetes-Related Amputations Can Be Cut in Half
A study that will be presented at the International Conference on Prosthetics and Orthotics in Hyderabad, India, next month has found that shoe inserts, foot care, regular checkups and other simple measures can reduce the number of amputations in diabetics by more than 50 percent. Researchers at the University of Gothenburg's Sahlgrenska Academy came to that conclusion after examining 114 Swedish diabetics who were at risk of developing foot ulcers after having diabetes for an average of 12 years. Only 0.9 percent of participants who wore one of three types of shoe inserts had developed new foot ulcers after a year, compared to 3-8 percent of diabetics who did not wear the inserts.

From the article of the same title (01/18/2013)
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Lower Leg Neuromuscular Changes Following Fibular Reposition Taping in Individuals with Chronic Ankle Instability
Researchers determined the effects of fibular reposition taping (FRT) on soleus and peroneus longus h-reflex amplitude in patients with chronic ankle instability. Twelve patients with chronic ankle instability participated in two testing sessions. The researchers measured peak h-reflex and M-wave of the soleus and peroneus longus and v-wave of the soleus only. Measurements were recorded before and after the application of FRT or a sham tape intervention. Sessions were separated by a week and counterbalanced; h-reflex and v-wave were normalized to M-wave at each time point.

Significant increase in h/M ratio was observed in the soleus following FRT compared to baseline, but not after the sham intervention. No difference in peroneus longus h/M ratio or soleus v/M ratio was observed in any session.

From the article of the same title
Manual Therapy (01/09/13) Chou, Esther ; Kim, Kyung-Min ; Baker, Andrew G.; et al.
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Use of the iPhone for Radiographic Evaluation of Hallux Valgus
Researchers compared the measurements made using a smartphone accelerometer and computerized measurements as a reference in a series of 32 hallux valgus patients. Two observers used an iPhone to measure the hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) of anteroposterior foot radiographs in 32 patients with symptomatic hallux valgus on a computer screen. Digital angular measurements on the computer were set as the reference standard for analysis and comparison.

The variability of all measurements was similar for the iPhone and the computer-assisted techniques. The concordance between iPhone and computer-assisted angular measurements was excellent for the HVA, IMA and DMAA. The maximum mean difference between the two techniques was 1.25±1.02° for HVA, 0.92±0.92° for IMA and 1.10±0.82° for DMAA. The interobserver reliability was excellent for HVA, IMA and DMAA. The maximum mean difference between observers was 1.31±0.89° for HVA, 0.90±0.92° for IMA and 0.78±0.87° for DMAA. The intraobserver reliability was excellent for HVA, IMA and DMAA.

From the article of the same title
Skeletal Radiology (02/13) Vol. 42, No. 2, P. 269 Ege, Tolga ; Kose, Ozkan ; Koca, Kenan; et al.
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Practice Management

3 Ways Doctors Can Protect against Social Media Fraud
Social media identity fraud is becoming an increasing concern among physicians, and frequently the issue is someone posing not as the physician but as a patient for the purpose of spreading misinformation. Gartner estimates that about 15 percent of social media reviews will be bogus by 2014. No one has polled physicians to determine how many have been victimized by social media fraudsters, but a Grant Thornton survey found that 58 percent of 141 corporate executives said their firms did not train anyone to identify and report social media fraud. Social media experts say this makes a proactive approach vital to optimizing and protecting a physician’s social media and Internet identities, and they offer a number of tips in this regard.

One recommendation is aggressive monitoring and management of physicians' digital footprint, which consists of their profile and the other professional data that is accessible via the Internet and through social media. This includes physicians managing their own Web sites, guaranteeing that the information posted on physician review and information sites is accurate and requesting that patients post positive feedback and reviews to diffuse information throughout the network. Physicians should additionally carry out regular electronic self-audits through Google searches and by establishing Google alerts with their name and practice to track social media and online dialogue.

Another tip is for physicians not to feel obligated to respond to someone with an indeterminate identity. Knowing who is following them on Twitter, for instance, is only pertinent if the physician is in some sort of committed engagement, according to one expert. If a physician cannot use common tools such as Google to ascertain the identity behind a tweet or a review, it is possible that the tweeter or reviewer is actually a bot or someone with a malevolent purpose, experts say.

A third tip is to use available privacy tools. Social media sites can be vulnerable to potential scammers if precautions are not implemented to ensure that personal information is safeguarded as much as possible through privacy settings. Facebook, Twitter and Google’s Gmail have generally solid privacy protection, says one expert. He says physicians should be aware of ensuring that they adjust privacy settings to maximize privacy.

From the article of the same title
American Medical News (01/21/13) Cash, Sheryl
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How Group Purchasing Can Boost Practice Revenue
Physician practices do not typically devote much time to purchasing and inventory management, but some focus on these things can pay off with reduced costs big enough to affect the bottom line, according to Dena Kitchens, senior director of physician services with Provista, a consulting company based in Irving, Texas. One of the first options to consider is buying supplies and equipment through a group purchasing organization (GPO), which can give a practice more buying power than going it alone. "A GPO can offer you significant savings in the supply chain when it comes to med-surg, pharmacy or anything else that a physician's office purchases," Kitchens explains. Sometimes a distributor will direct the practice's med-surg purchases through a GPO to provide a better price, but then the practice is not taking advantage of other potential savings from the GPO.

Those potential benefits include purchasing capital equipment such as exam room tables, waiting room furniture and office furniture and even medical equipment such as imaging machines and ultrasounds. Many physician practices do not realize they are eligible to participate in a GPO, adds Marty Heath, FACHE, director of product marketing at Provista. Practices will sometimes join together to make group purchases of specific items such as vaccines, but Heath says they would be better off joining a typical GPO. Savings can be as high as 15 percent when using a GPO, and special promotions often offer savings of 50 percent to 70 percent off the retail price of capital purchases such as furniture. In addition, GPOs sometimes offer pharmaceutical savings of 15 percent or more. To get involved with a GPO, a physician practice can send a request for proposal to several GPOs. An alternative is to invite the organizations to visit a practice and evaluate how they might save the practice money. A good GPO will prescreen and vet vendors, which lowers the risk of working with substandard companies. GPOs also can offer savings to practice employees.

From the article of the same title
HealthLeaders Media (01/17/13) Freeman, Greg
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Is Concierge Medicine Finally Ready for Takeoff?
Physicians might finally be ready for a transition to direct pay or concierge medicine, in which they will no longer have to accept low Medicare and Medicaid reimbursements or negotiate with private payers, according to a recent poll by Merritt Hawkins for the Physicians Foundation. The survey determined that 6.8 percent of more than 13,500 physicians would "embrace" direct pay or concierge medicine within the next three years. That includes almost 10 percent of practice owners, 7.7 percent of primary care physicians and 6.4 percent of specialists. "We keep kicking [the Medicare Sustainable Growth Rate funding formula] down the road and the docs' confidence becomes less and less that those chickens will come home to roost," notes Merritt Hawkins President Mark E. Smith.

Access issues could be raised by the spread of the direct pay practice model, says American Academy of Family Physicians President-Elect Reid B. Blackwelder. "It depends again on how the physicians chose to provide that care," he says. "It doesn't mean that it is a good or bad thing. As individuals choose to practice medicine in a certain way and patients choose to find that care, we just want to make sure that all patients have access to the right care from the right person at the right time." Blackwelder harbors skepticism that significant numbers of primary care physicians will move to direct pay practices, and is not sure that concierge medicine will take off amidst economic uncertainty. On the other hand, Smith believes changes in the healthcare payer market will draw physicians into direct pay practices. "You can take a private practice and convert it to a concierge practice and make life greatly better for the physician," he says. "They will become much more prosperous and reduce their business responsibilities by 90 percent and their employer responsibility by 75 percent."

From the article of the same title
HealthLeaders Media (01/18/13) Commins, John
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Health Policy and Reimbursement

Groups Urge Feds to Issue Physician Payments Final Rule
A lack of progress on a final rule outlining full disclosure procedures for medical device manufacturers and pharmaceutical companies is engendering frustration among groups and coalitions representing physicians, labor unions and distributors, and the AFL-CIO and 18 other groups sent a letter to the Office of Management and Budget asking for a swift issuance of a final rule. "There is a significant consequence for healthcare system costs associated with the ongoing delay in implementation because of the practice by some physicians of over-prescribing certain drugs or by prescribing otherwise medically unnecessary and expensive treatments," they wrote.

Under the Physician Payment Sunshine Act, makers of medical devices and prescription drugs covered by Medicare and Medicaid will be required to report all grants, consulting fees and travel reimbursements they provide to physicians and teaching hospitals. The proposed rule stipulated that companies would be fined $150,000 for not disclosing any gifts or payments totaling more than $10, while information on those payments would be posted on a public Web site. Some healthcare officials say the protracted delay in releasing a final rule could be the result of the federal government being swamped with implementing multiple provisions of the Affordable Care Act.

From the article of the same title
HealthLeaders Media (01/23/13) Desjardins, Doug
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New Session of Congress Brings More Anti-Reform Legislation
Republican lawmakers in the 113th Congress have proposed repealing the Patient Protection and Affordable Care Act's Independent Payment Advisory Board (IPAB), which would be tasked with suggesting ways to cut Medicare spending's per capita growth rate if it grows at a rate of gross domestic product per capita plus 1 percent. IPAB's recommendations from the board would become law unless Congress takes action to achieve the same level of savings through other means. The repeal legislation has bipartisan support, with Rep. Allyson Schwartz (D-Pa.) saying the board could potentially choke both innovation and collaboration among healthcare providers. The proposal also has the support of the American Medical Association (AMA), and AMA President Jeremy Lazarus notes that "patients and physicians are still struggling with the frequent threat of drastic cuts from the broken SGR Medicare physician payment formula. IPAB would be another arbitrary system that relies solely on payment cuts.”

From the article of the same title
Modern Healthcare (01/23/13) Zigmond, Jessica
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New HIPAA Rules Released
The U.S. Department of Health and Human Services has released stronger rules and protections governing patient privacy. The rules enhance the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which governs health records and patient information. HHS is expanding the government's scope over healthcare providers, health plans and other entities that process health insurance claims to include their contractors and subcontractors -- "business associates" -- with whom they share protected health information. The new rules also increase penalties for noncompliance to a maximum of $1.5 million per violation and strengthen the Health Information Technology for Economic and Clinical Health (HITECH) breach notification requirements by making clear when breaches must be reported to HHS. Additionally, the new rules allow that, when a patient is required by a provider to request records or documents in writing, the request may be made electronically. Starting March 26, covered entities and their business associates will have 180 days to comply with the new rules.

From "Quick Parse: 4 Parts to HIPAA Final Rule on Privacy and Security"
Government Health IT (01/17/13) Sullivan, Tom
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Medicine, Drugs and Devices

New Glue Developed to Treat Complex Bone Fractures
Researchers at Sweden's Royal Institute of Technology have developed a new glue that is better at treating complicated bone fractures than existing methods. Researchers say that the glue eliminates the need to use metal pins and screws, which in turn makes surgeries to repair bone fractures faster, safer and simpler. The glue also eliminates the need to use general anesthesia, which means operations can be swifter and safer. Researchers are examining toxicology reports to ensure that the glue is not toxic, and plan to begin animal trials if the reports show that the substance is safe.

From the article of the same title
EuroNews (01/17/13)
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Physician EHRs Emerge as Hot Advertising Venue for Drugs
Opportunities for marketers to deliver point-of-care advertising customized to prescribers and their patients are opening up through the greater use of cloud-based health information technology systems. “From an advertiser perspective, the functionality of [electronic health records (EHRs)] and [electronic medical records (EMRs)] is potentially a gold mine in that you are able to reach physicians during point of care and in a targeted capacity as well,” notes comScore's Jonathon Padron. A comScore report determined that physicians have the most interaction with online EHRs in terms of total time spent using the systems versus time spent on other online activities. Padron says EHR data can be an effective marketing tool because it enables marketers to target messages in a more granular way to the specific physician.

Another contributing factor has been changes in pharmaceutical ad strategy stemming from bans on free drug samples and other regulations. The University of Pittsburgh Graduate School of Public Health's Julie Donohue says the relatively low cost of placing ads in EHRs could yield a significant return on investment. Practice Fusion Vice President of Sales Zach Gursky says the past 18 months have seen market awareness of EHR-placed ads grow from a low level to a point where over 85 percent of the major pharmaceutical companies are running ads with Practice Fusion. Gursky points to a clear “value exchange” when it comes to selling physicians on the idea of receiving ads at the point of care. “What the physician has to do in return for getting this really valuable software for free is give permission for us to deliver ads,” he notes. However, Gursky says physicians are finding value in the ads, because they are tailored to them and their patients.

From the article of the same title
American Medical News (01/21/13) Dolan, Pamela Lewis
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