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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

Action is underway in Congress to prevent physician reimbursement cuts looming under Medicare's sustainable growth rate (SGR) formula. Last week the House approved legislation that would provide $82 billion to partially fund physician payments and to revamp the SGR formula. The legislation does not, however, address how to fully fund reimbursement, or try to repeal or replace the SGR. These measures have drawn criticism from physician organizations that feel they don’t go far enough to address the problem.

President Obama recently reaffirmed his commitment to the stalled healthcare reform legislation, and has called for a televised, bipartisan healthcare summit on February 25 to re-engage Republicans in the process. It remains unclear, however, whether the Republicans will participate, and if they do, whether any meaningful negotiation will ensue.
Hands-On Opportunities at the Conference

After a busy day at the 2010 ACFAS Annual Scientific Conference, gain some in-depth knowledge in a more relaxed setting. Enjoy interactive demonstrations of new products and technology in non-CME workshops provided by some of the College’s corporate sponsors.

    Wednesday, February 24
    • Extremity Medical—New Concepts in Intramedullary Fixation of the Midfoot and MTP. Tradewinds D, 6:15 p.m.
    • DePuy Orthopaedics—Innovative Locked Plating Techniques in Reconstructive Surgery. Tradewinds E & F, 6:30 p.m.
    • Osteotech, Inc.—Introduction of New Grafting Techniques: Midfoot & Hindfoot Case Review. Tradewinds C, 6:30 p.m.
    Thursday, February 25
    • GraMedica Breakfast—Critical Look at Diagnosing and Stabilizing Flexible Flat Feet. Tradewinds E & F, 6:30 a.m.

ACFAS Study Now on

The College’s first multi-center research project is now posted at This web site, a service of the National Institutes of Health, lists more than 84,000 trials in progress and receives over 50 million page views per month. All clinical trials sponsored by the U.S. government or organizations must be listed on this site.

The purpose of ACFAS' study is to examine long-term outcomes for the surgical treatment of end-stage degeneration in the first metatarsophalangeal joint. It is being supervised by Paul J. Kim, DPM, FACFAS, chair of the ACFAS Research/EBM Committee. Read a full synopsis online at

Up-to-the-Minute Research from JFAS

JFAS "Articles in Press" offer you the most current references and the latest developments in the profession. New articles are available as soon as their proofs have been approved — even before they're assigned to an issue.

For quick and easy access:
  • Go to
  • Click on “Read JFAS Online” (member login required)
  • When you reach the JFAS home page, click on “Articles in Press” in the menu on the left
Check out what's new, including original research, case reports, and tips, quips and pearls.

Foot and Ankle Surgery

Ponseti Method of Clubfoot Correction Leads to Lower Surgical Rates and Less Revision Surgery

Researchers compared two common treatment options for clubfoot: the Ponseti method and surgical treatment. Fifty-five patients with 86 clubfeet were treated as part of the study. Forty patients’ feet were treated with the Ponseti method. Forty-six were treated with surgery and casting. The average number of casts per patient was six in the Ponseti group and 13 in the surgical group. The researchers found that 15 feet in the Ponseti group had a recurrence requiring some surgery—4 of these feet had a major recurrence and 11 had a minor recurrence—while 14 feet in the surgical group required revision surgery. Only one foot in the Ponseti group required revision surgery. The study is published in the February 2010 issue of The Journal of Bone and Joint Surgery.

From the article of the same title
Newswise (02/02/10)

Risk of Deep Vein Thrombosis Following a Single Negative Whole-Leg Compression Ultrasound

A group of researchers performed a study to ascertain the risk of venous thromboembolism following the withholding of anticoagulation in patients with suspected lower-extremity deep vein thrombosis (DVT) following a single negative whole-leg result derived from compression ultrasound (CUS). They identified seven studies for the analysis that encompassed 4,731 patients. Analysis showed that 34 patients died from venous thromboembolism or suspected venous thromboembolism. Of that group, 11 patients had distal DVT, seven had proximal DVT, seven had nonfatal pulmonary emboli, and nine patients' deaths may have been related to venous thromboembolism. The use of a model revealed that the combined venous thromboembolism event rate at three months was 0.57 percent. "In summary, withholding anticoagulation following a single negative whole-leg CUS result was associated with a low risk for venous thromboembolism during three-month follow-up in patients with suspected DVT," the researchers concluded. "Using a single negative whole-leg CUS result as the sole diagnostic modality in patients with high pretest probability of DVT requires further study."

From the article of the same title
Journal of the American Medical Association (02/03/10) Vol. 303, No. 5, P. 438; Johnson, Stacy A.; Stevens, Scott M.; Woller, Scott C.; et al.

The Versatility of Propeller Flaps for Lower Limb Reconstruction in Patients with Peripheral Arterial Obstructive Disease: Initial Experience

Researchers explored the feasibility of propeller flaps for soft tissue reconstruction in patients with peripheral arterial obstructive disease (PAOD). Patients with necrosis of several foot units were diagnosed with stage IV PAOD and diabetes mellitus. The patients underwent revascularization, followed by soft tissue reconstruction using propeller flaps. A total of 6 flaps were performed, with dimensions ranging from 4-by-seven centimeters to 8-by-31 centimeters. Perforator origin was the peroneal, five flaps, or the tibial posterior artery, one flap. The operations lasted an average of 190 minutes. Overall patency was 83.3 percent, one case was complicated by total flap loss followed by below-knee amputation, and one case developed partial necrosis, requiring a skin graft. All flaps developed mild postoperative edema that resolved spontaneously. Propeller flaps proved to be useful tools for soft tissue reconstruction in patients with PAOD because of low operative morbidity, the simple technique and fast learning curve, and low complication rate.

From the article of the same title (02/01/10) Jiga, L. P.; Barac, S.; Taranu, G.; et al.

Up-regulation of Cytokines and Chemokines Predates the Onset of Rheumatoid Arthritis

It has been verified by researchers from the University Hospital in Umea, Sweden, that rheumatoid arthritis (RA) can be predicted with a blood test that detects cytokines, which are present and functionally active in the synovial tissue once the ailment has developed. The study involved the analysis of blood samples from 400 patients. The researchers determined that patients who developed RA differed from control subjects in the manifestation of TH1cell-, TH2cell-, and Treg cell-related cytokines. "We observed a clear relationship between cytokines related not only to Th1, Th2 and Treg cells but also to Th17 and the presence of anti-CCP antibodies, thereby supporting the concept that the immune system was already stimulated and disease was developing toward RA," said lead researcher Solbritt Rantapaa-Dahlqvist.

From the article of the same title
Arthritis & Rheumatism (02/01/10) Vol. 62, No. 2, P. 383; Kokkonen, Heidi; Soderstrom, Ingegerd; Rocklov, Joacim; et al.

Practice Management

How to Run a Cash-Only Practice and Thrive

A cash-only medical practice can be a profitable business for physicians, as exemplified by Brian Forrest, MD, whose North Carolina practice is a cash cow. Forrest maintains low expenses by forgoing insurance administration duties and negotiating low fees for lab work. He also furnished his office with items purchased from a hospital surplus, while a price list is posted in the waiting room. Much of Forrest's success is attributed to positive word-of-mouth from patients, complemented by advertising. "The major thing that's made this work is keeping the overhead very low," says Forrest. "In my opinion, what's gone wrong with medicine is, we've assumed the burden of overhead that the insurance companies should have themselves."

From the article of the same title
Medical Economics (01/22/10) Lewis Jr., Morgan

Physicians Work Less When Medical Liability Risk Increases, Study Says

Doctors work less when their risk of malpractice litigation is higher, according to a new study published in the Journal of Law and Economics. On average, doctors end up working 1.7 hours less per week when their expected medical liability risk increases by just 10 percent, according to the study. The researchers calculated that physicians working 1.7 hours less per week is the equivalent to one in 35 physicians leaving the workforce entirely.

From the article of the same title
HealthLeaders Media (02/01/10) Cantlupe, Joe

Sharing Your Space: Things to Consider When Looking for an Office Mate

When it comes to finding office mates, there are a number of things physicians should consider, such as how well potential candidates will complement their practices. Experts say physicians considering subleasing their space should first study the original lease agreement to see if this is permitted, and then determine the structure of the subtenant agreement; details to be worked out in this step include whether the subtenant will have access to a specific space 24/7. Consider whether there is enough waiting room space for additional patients that the new professional may bring in. Once such questions have been answered, physicians can look for potential office mates via professional networking or advertising in local medical society newsletters. Once a connection has been made, both parties should check references and inquire about professional reputations.

From the article of the same title
American Medical News (02/01/10) Elliott, Victoria Stagg

Health Policy and Reimbursement

Public Health Tab to Hit Milestone

For the first time ever, federal and state programs next year will account for more than half of all U.S. healthcare spending, according to estimates by the Centers for Medicare and Medicaid Services (CMS). CMS estimates that the proportion will rise to 50.4 percent by 2011 as the weak economy sends more people into Medicaid and slows growth of private insurance. Public funds accounted for 47 percent of the $2.34 trillion of national health spending in 2008. CMS predicts enrollment in Medicaid will rise 5.6 percent this year.

From the article of the same title
Wall Street Journal (02/04/10)

Community Health Centers Can Fill Care Gaps

Community health centers can help fill gaps in the U.S. healthcare system for relatively little money, say researchers in a report published in the journal Health Affairs. A $500,000 increase in funding for U.S. centers would provide treatment for an extra 540 uninsured patients, according to the study. Obama's proposed 2011 budget adds $290 million to expand a network of federally funded health centers. There were 1,200 such centers in 2007.

From the article of the same title
Reuters (02/02/10)

Little Progress Seen Against Health Insurance Fraud

The federal government began a new crackdown on Medicare fraud more than two years ago, but the number of people committing fraud against health insurers remains essentially unchanged. Medicare loses about $60 billion a year in fraud, and lawmakers had hoped to use the savings generated by anti-fraud measures to help pay for healthcare legislation and a government-run healthcare plan. According to the Justice Department, federal prosecutors charged 803 people with defrauding medical insurers in the fiscal year that ended in September, nearly all of them involved in fraud against Medicare. The number of people charged is an increase of about 2 percent since "strike forces" were first deployed against fraud in 2007.

From the article of the same title
USA Today (01/28/10) Heath, Brad

Technology and Device Trends

Immune Treatment Helps Chronic Pain Patients: Study

Treating the immune system can dramatically ease the suffering of people with chronic pain from an injured limb or following an amputation, report researchers. According to a study appearing in the Annals of Internal Medicine, a dose of a blood product called intravenous immunoglobin (IVIG) significantly reduced pain in almost half of patients with Complex Regional Pain Syndrome (CPRS). The researchers said they were trying to develop ways to allow patients to administer IVIG treatment in their own homes.

From the article of the same title
Reuters (02/01/10)

New Ways to Calculate the Risks of Surgery

Surgery risk calculators, used by heart surgeons for several years, are now being developed for other surgical specialties. The American College of Surgeons recently introduced calculators for surgery of the colon and pancreas, and is designing similar tools for 18 other procedures. The calculators use data from more than 1 million patient records gathered as part of the group's National Surgical Quality Improvement Program.

From the article of the same title
Wall Street Journal (02/02/10) Landro, Laura

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February 10, 2010