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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

As Congress regroups, there were some interesting developments relating to health reform.
  • President Obama’s proposed 2010 budget includes assumptions of $23 billion in savings from health system reform.
  • The Senate has exempted funds to fix the Medicare “sustained growth rate” physician payment system from “pay as you go” budget rules. This could open the way for a five-year payment fix. Congress must act by February 28 to prevent a 21 percent cut from going into effect March 1.
  • States are now actively pursuing their own healthcare reform efforts. The California Senate has once again approved a single-payer proposal, and single-payer efforts are alive in Missouri as well. Other states are looking at ways to expand coverage through already strained Medicare programs.

Remembering Gary Jolly

Gary P. Jolly, DPM, FACFAS, 61, died January 31, 2010, after battling cancer for the past two years. Jolly served as ACFAS president in 2004-05. He will be remembered as a visionary leader who often challenged the status quo and constantly urged raising the bar in the education and training of foot and ankle surgeons, from medical school through the end of one’s career. A memorial service will be held Saturday, February 6, at St. Matthew’s Church, 224 Lovely Street, Avon CT 06001, at 11:30 a.m. In lieu of flowers, the family has requested that donations in Jolly’s name be made to the ACFAS Legacy Fund for podiatric surgery education and research initiatives.
New Podcast: Surgical Management of the Athlete

“Why is this unique subset of patient so challenging?” asks moderator Richard T. Bouché, DPM, FACFAS. “Three reasons come to mind,” he continues, “they are serious about their health problems, they are motivated to get healthy, and they are frustrated and depressed when they cannot exercise or perform.”

Bouché and a group of foot and ankle surgeons specializing in the comprehensive management of athletes discuss how you define an athlete, and how their health and treatment needs differ from those of ordinarily active or sedentary patients. And, as the panelists concur, you never know when your patient may become an athlete.

Hear more about treatment approaches for the athletic patient at

Raise Your Professional Profile, the official ACFAS consumer web site, provides valuable tools for foot and ankle patients. One of the most important is the “Find an ACFAS Physician” search, which helps them easily locate an ACFAS member in their area.

Make sure current and prospective patients get the information they need about your practice by completing your online professional profile — now with space for up to three locations! It takes only a few minutes at

Foot and Ankle Surgery

Ankle Peak Systolic Velocity: New Parameter to Predict Nonhealing in Diabetic Foot Lesions

Researchers sought to determine whether ankle peak systolic velocity (APSV) can predict nonhealing in diabetic foot lesions. One hundred consecutive limbs were included in the study. Forty-three limbs with diabetic foot lesions reached the end point of adequate healing or complete healing, whereas 57 limbs had nonhealing lesions. The APSV was significantly higher in limbs with healed or healing lesions compared with limbs with nonhealed lesions.

From the article of the same title
Medscape (01/27/10) Bishara, Rashad A.; Taha, Wassila; Akladious, Ihab; et al.

Opiate Painkillers Raise Fracture Risk

A new study by the Group Health Research Institute in Seattle, published in the Journal of General Internal Medicine, reports that older adults taking powerful prescription painkillers know as opioids are at a higher risk for bone fractures, particularly when taking moderately high doses. The drugs are known to be highly effective against pain in the short term, but their long term effectiveness is less clear. Researchers found that among more than 2,300 older adults with chronic pain, the risk of suffering a bone fracture was high in patients using an opioid for prolonged periods.

From the article of the same title
Reuters (01/25/10) Norton, Amy

The Use of Weightbearing Radiographs to Assess the Stability of Supination-External Rotation Fractures of the Ankle

Researchers recently investigated the use of weightbearing radiographs to distinguish stable and unstable isolated lateral malleolar fractures. The study found that 90 percent of patients were found to have stable fractures and were treated non-operatively. The researchers concluded that the use of weightbearing radiographs is an easy, pain-free, safe, and reliable method to exclude the need for operative treatment.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (01/10) Weber, Martin; Burmeister, Helge; Flueckiger, Gerhard; et al.

Practice Management

Will the iPad Revolutionize Healthcare?

HealthLeaders Media asked several healthcare leaders to weigh in on the Apple iPad, based on what is currently known. Generally, the respondents are taking a “wait and see” attitude. Dr. John Halmanka, MD, chief information officer at Harvard Medical School, said that the “iPad comes closer to my requirements than other devices on the market.” But he noted that it does not have a camera for clinical photography and video conferencing. He wonders how tolerant the iPad is of being dropped on a hospital floor. Tom Cehring, CEO of San Diego County Medical Society, is less impressed. He thinks the key for usefulness will be whether “people write cool apps” for it and whether it can transmit information in a HIPAA-compliant manner.

From the article of the same title
HealthLeaders Media (01/29/10) Clark, Cheryl

Doctors Speak Out About Red Flags Rule

Four large medical associations have joined together to make another plea to the Federal Trade Commission that healthcare professionals should not be subject to the Red Flags Rule, scheduled to go into effect June 1, 2010. The American Medical Association, American Dental Association, American Osteopathic Association and American Veterinary Medical Association argue that a recent federal appeals court ruling exempting lawyers from the Red Flags Rule provides a compelling reason to re-evaluate applicability to their members.

From the article of the same title
HealthLeaders Media (01/29/10) Clark, Cheryl
Resources for Regulatory Compliance

Although enforcement of the “Red Flags” Rule is under debate, ACFAS members should proceed on the assumption that they must have a plan in place to spot the warning signs (red flags) of identify theft by June 1, 2010. ACFAS provides free resources on compliance to members at the ACFAS web site.

Phishing Schemes Are Becoming Sneakier in Targeting Doctors

Cunning phishers are using "spearphishing" tactics to fool physicians into giving them sensitive information by sending them e-mails that purport to be from parties that they routinely do business with. Identity theft consultant Robert Siciliano says there are a number of warning signs that an e-mail may be from a phisher. One such telltale is an e-mail that comes from a company with which the doctor has no business; another is an e-mail address or URL that does not quite jibe with the apparent source. Siciliano advises physicians not to click on a link sent through an e-mail, but rather bookmark commonly visited sites, and use that link whenever they get an e-mail requesting that they click through. Calling to confirm the source named in the e-mail is a good idea, according to Jorge Rey with Kaufman, Rossin & Co.; he also cautions against downloading files sent via e-mail no matter what the extension.

From the article of the same title
American Medical News (01/25/10) Dolan, Pamela Lewis

Health Policy and Reimbursement

Insurer Steps Up Fight to Control Health Care Cost

Continuum Health Partners, a consortium of five New York hospitals, including the major teaching hospitals Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center, is going to battle with UnitedHealthcare over their new contract terms. The new contract includes a provision that requires hospitals to notify the insurance company within 24 hours after a patient's admission, or reimbursement will be reduced by half. UnitedHealthcare says the proposed rule is intended to improve quality of care and lower costs by allowing insurance case managers to become involved immediately. The hospitals argue that cutting reimbursements in half is too extreme for a penalty on a clerical error, and that the revenue drain would ultimately hurt patients. Hospitals around the country are upset about the new provision. In Tennessee, hospitals successfully lobbied the legislature to pass a law stating that the penalty would not apply on weekends or federal holidays.

From the article of the same title
New York Times (11/24/10) Hartocollis, Anemona

N.Y. Governor Pushes to Ban Drug-Industry Gifts to Docs

New York Gov. Paterson’s proposed 2010 New York budget includes provisions to restrict ties between doctors and drug companies. Paterson’s proposal would allow drug company representatives to bring lunch to doctors’ offices, for example, though it would ban taking doctors or their staff out to a restaurant. Other gifts—including floral arrangements, artwork, compact discs, and tickets to a sporting event—would also be prohibited under the proposal, which also regulates consulting relationships between doctors and drug companies. Doctors and other healthcare professionals could be fined $5,000 to $10,000 per violation.

From the article of the same title
Wall Street Journal (01/25/10)

Study: Higher Co-Pays Mean More Trips to the Hospital

A new study published in the New England Journal of Medicine found that bigger co-payments for primary-care and specialty doctor visits were tied to more in-patient hospital time for elderly patients, especially those with heart disease, diabetes and other chronic conditions. The implication is that people who avoided the doctor’s office to save money ended up in the hospital because their problems weren’t detected or treated in their early stages.

From the article of the same title
Wall Street Journal (01/27/10)

Value-Based Insurance Plans Can Boost Health at No Added Cost

A new study from University of Michigan, Harvard, and other researchers indicates that value-based insurance design (VBID) programs can break even financially or possibly save money. A VBID program lowers patient co-payments for highly effective medications, and the researchers analyzed data from a large company that deployed a VBID program in 2005; co-payment rates were reduced for workers using five classes of drugs used to treat common chronic conditions, including diabetes, heart disease, and hypertension. Patients using the specified drugs were offered a 50 percent co-payment reduction at minimum. The researchers believe that the extra employer spending on prescription drugs is more than compensated for by lower use of other services that become necessary when patients do not take needed drugs. Patient non-compliance fell by about 10 percent in four of the five drug classes.

From the article of the same title
Newswise (01/21/10)

Technology and Device Trends

Aging of Blood Stem Cells May Be Reversible

Researchers have discovered a way to make old stem cells in the blood act like young stem cells, a discovery that could lead to blood-based treatments for age-related health problems. By taking certain factors from the blood of young mice and putting them in old mice, researchers were able to make old stem cells take on the characteristics of younger stem cells. The change in the older stem cells is driven by signals from another type of cell nearby in the bone, the researchers explained. The study findings are published in the January 27 issue of the journal Nature.

From the article of the same title
HealthDay (01/27/10)

FDA Recalls More Than 2 Million Needles Used in Port Implants

Millions of needles used in ports implanted under the skin of chronically ill patients are being voluntarily recalled by the FDA. More than 2 million Huber needles, manufactured by Nipro Medical and distributed by Exelint International, are affected. Huber needles are used to draw blood or to inject medicine, other nutritional solutions, or blood products. They are used with ports placed under the skin.
The FDA has determined that 60 to 70 percent of Exelint's needles "cored," or cut slivers of silicone, when inserted into ports, raising the possibility of the silicone slivers entering the veins, damaging the port itself, or harming the surrounding tissue.

From the article of the same title
Reuters (01/26/10) Young, Saundra

FDA Schedules Public Meeting on Premarket Clearance Process for Medical Devices

The FDA has scheduled a public meeting on Feb. 18, 2010, to discuss the premarket notification, or 510 (k) process, used to review and approve certain medical devices. The meeting is designed to support the efforts of the FDA's internal working group, which was recently convened to assess the quality and consistency of the agency's administration of and decision-making in the 510 (k) program. At the meeting, the FDA is expected to present a brief overview of the challenges the agency has faced, including issues related to predicate devices, new technologies and scientific evidence, practices the FDA has adopted in response to a high volume of submissions, and postmarket surveillance.

From the article of the same title (01/22/10)

New Medical Device to Salvage Joint Cartilage Awaits FDA Approval

Awaiting FDA approval is a new surgical probe from NuOrtho Surgical that will be employed to save joint cartilage tissue during orthopedic repair procedures. "The goal of our new surgical probe is to allow the surgeon to preserve the healthy articular cartilage tissue while repairing and contouring the damaged area—using lower temperatures and lower levels of radiofrequency energy—all with the benefit of avoiding necrosis, the killing of healthy tissue," says NuOrtho CEO Jeffrey W. Morrill. The Ceruleau probe is designed for one-time use while executing a chondroplasty procedure.

From "Medical Device Creators Expand Financing, Await FDA Approval"
South Coast Today (MA) (01/17/10) Othote, Linda

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February 3, 2010