February 15, 2012

News From ACFAS

CMS May Delay ICD-10 Implementation Schedule
Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced it will consider postponing implementation of its new disease coding system, the International Classification of Diseases, 10th Revision (ICD-10) coding system.

CMS still believes ICD-10 is a good idea, and certainly will lead to better prevention of fraud and abuse, but is sympathetic to physician concerns surrounding implementation. ICD-10 is to be used for classifying healthcare diagnoses and procedures and all Health Insurance Portability and Accountability Act (HIPAA) covered transactions, including outpatient and inpatient claims, have to comply with ICD-codes by Oct. 1, 2013.

ACFAS will keep members apprised of any updates regarding the situation. If you have and questions or concerns, please contact
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Medicare Rate Agreement Reached
Today Congress reached a tentative agreement on a payroll tax holiday bill that averts a 27.4 percent cut in Medicare physician payment rates and extends current rates until the end of 2012.

The deal also extends certain Medicare programs—such as ambulance add-on payments and outpatient hospital hold-harmless payments—but requires that the CMS, Government Accountability Office and Medicare Payment Advisory Commission report to Congress on the effectiveness of those programs. Two Medicare programs—Section 508 hospitals and special pathology payments—would be phased-out as well while providing time for providers to adapt. The deal would also call for extending and reforming the therapy cap exception process by requiring greater accountability.

Meanwhile, about $11.6 billion in cuts to the Patient Protection and Affordable Care Act—including more than $4 billion in Medicaid spending reductions—would pay for more than half of the Medicare spending in the deal. The non-Affordable Care Act health savings total $9.6 billion and include reductions to Medicare bad debt and clinical laboratory payments.
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Need Ways to Perfect Your Practice?
Whether you're looking for the inside scoop on the latest trends in podiatric surgical coding and CPT policy or you're new in practice or ready to retire and need help planning for your future, make plans to attend one of ACFAS' 2012 "Perfecting Your Practice" practice management programs.

Featuring all-new curriculum for 2012, "Perfecting Your Practice" offers attendees the most-up-to-date information available to help you get the most of of your practice. Register today for one of the following sessions by clicking the web link below:

February 29, 2012
Special One-Day Pre-conference "Perfecting Your Practice" Program at the Annual Scientific Conference in San Antonio

June 1-2
Two-Day "Perfecting Your Practice" Program
Portland, Oregon

October 12-13
Two-Day "Perfecting Your Practice" Program
Arlington, Virginia
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ACFAS Recognizes New Fellowship Program
The ACFAS Fellowship Committee recently met and officially recognized one more new Foot and Ankle Surgical Fellowship Program:

Sarasota Orthopedic Associates Foot & Ankle Fellowship
Sarasota, FL
Fellowship Director: James Cottom, DPM, FACFAS

ACFAS recommends and supports the continuation of foot and ankle surgical education after residency in the form of a specialized fellowship. Programs meeting minimal requirements are officially recognized by the College, which will in turn provide support for these programs.

For a complete listing of programs, support by ACFAS and minimal requirements, please visit the ACFAS Fellowship Initiatives web link below.
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Foot and Ankle Surgery

Effects of Joint Manipulation on Ankle Range of Motion and Functional Outcomes in Individuals With Chronic Ankle Instability
A study was carried out to ascertain whether proximal or distal tibiofibular joint manipulation would change ankle dorsiflexion range of motion and functional outcomes over a three-week period in individuals with chronic ankle instability, using 43 participants assigned at random to proximal tibiofibular joint manipulation, distal tibiofibular joint manipulation, or a control group. Included as outcome measures were ankle dorsiflexion range of motion, the single-limb stance on foam component of the Balance Error Scoring System, the step-down test, and the Foot and Ankle Ability Measure sports subscale. No significant change in dorsiflexion between groups was observed over time, while a substantial increase in dorsiflexion was seen at each postintervention time interval. The Balance Error Scoring System foam, step-down test, and Foot and Ankle Ability Measure sports subscale scores did not reveal any differences either.

From the article of the same title
Journal of Orthopaedic and Sports Physical Therapy (02/12) Vol. 42, No. 2, P. 125 Beazell, James R.; Grindstaff, Terry L.; Sauer, Lindsay D.; et al.
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Sciatic Lateral Popliteal Block With Clonidine Alone or Clonidine Plus 0.2 Percent Ropivcaine
Researchers assessed the sole use of clonidine or clonidine in combination with 0.2 percent ropivacaine in 66 children to determine effective analgesia following mild to moderate painful foot surgery, after combined sciatic lateral popliteal block (SLPB) plus femoral block. Patients were randomized into three groups to receive placebo, clonidine, and clonidine plus ropivacaine. Kaplan-Meier and the log-rank test were employed to analyze time to first analgesic request in the groups. Clonidine administered alone in the SLPB shows promise by maintaining intraoperatively the hemodynamic parameters arterial systolic and diastolic pressure, heart rate to the lower normal values so that no patient required nalbuphine under 0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for an average time of six hours. Furthermore, clonidine received as an adjuvant augments ropivacaine's analgesic effect for the first postoperative day. In addition, the parents of children in the clonidine and clonidine plus ropivacaine groups were satisfied with perioperative management of their children, with satisfaction scores of 9.74 plus or minus 0.45 and 9.73 plus or minus 0.70, respectively. All parents whose children were in the control group needed rescue nalbuphine in the recovery room, and postoperatively, along with high incidence of postoperative nausea and vomiting, and children's parents expressed a low satisfaction score.

From the article of the same title
BMC Anesthesiology (02/12) Vol. 12, No. 2, P. 1471 Petroheilou, Kalliopi; Livanios, Stavros; Zavras, Nikolaos; et al.
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Tendon Structure's Lack of Relation to Clinical Outcome After Eccentric Exercises in Chronic Midportion Achilles Tendinopathy
Research was performed to measure structural tendon changes and evaluate clinical change in tendinopathy patients, using a sample of 23 subjects with chronic midportion Achilles tendinopathy. The patients carried out a 16-week home-based eccentric exercise regimen, and symptom severity was characterized by the validated Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Ultrasonographic tissue characterization was executed to quantify tendon structure via measurement of the proportion of four echo types, with echo types I and II representing more or less organized tendon bundles, and echo types III and IV representing disintegrated tendon structure. The average percentage of echo types I and II changed by 0.3 percent after 24 weeks, while the average VISA-A score rose by 11.3 points. There was no correlation between a higher VISA-A score and a higher percentage of echo types I and II, and the baseline percentage of echo types I and II did not correspond with a higher VISA-A score.

From the article of the same title
Journal of Sport Rehabilitation (02/01/12) Vol. 21, No. 1, P. 34 de Vos, Robert J.; Heijboer, Marinus P.; Weinans, Harrie; et al.
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Practice Management

Don't Give Up on Dead Claims
Richard J. Quadrino, a founding partner at the law firm of Quadrino Schwartz, says that while denials can hurt a practice's revenue stream, practices often give up on receiving payments too soon. Many "dead" claims may be payable if the law is properly applied. "Providers often have a lot of denials that they've written off, figuring that they don't have value," says Quadrino. "Especially with smaller providers, we sometimes see a whole group of claims that were only partially paid and should have been fully paid. These providers have a lot more leverage than they realize." The strength of a provider's position comes from the Employee Retirement Income Security Act (ERISA) of 1974, which requires that an ERISA retirement plan be reimbursed for medical care provided to a beneficiary. This means payers if fail to meet deadlines under federal regulations, providers have the opportunity to obtain full payment.

Quadrino cites an example in which the payer does not respond within the required 30 days, instead waiting until 60 days have passed to say the care was not medically necessary or that more information is needed. "At that point, there are some very good arguments that their rights are waived completely and the claim just has to be paid," he says. "But 99 out of 100 providers don't realize that the lateness even matters, and instead they start trying to jump through all the hoops that the insurers want them to go through. They don't realize that they actually have leverage to get the claims paid." If the claim response is late, the provider is not even obligated to provide more information when requested, Quadrino says. However, he recommends the provider be polite when refusing a request for more information and just indicate to them that the claim is payable. Eventually, these requests will occasionally need to be made by the provider's lawyer.

From the article of the same title
HealthLeaders Media (02/03/12) Freeman, Greg
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Report Decries Lack of Price Transparency
Hospitals may end up paying more for some implantable medical devices due to physician influence on hospital purchasing, says a Feb. 3 report from the Government Accountability Office (GAO). The office analyzed the prices that 31 hospitals paid for cardiac devices, discovering a "substantial variation" among prices paid. The analysts noted that physicians with strong device preferences could limit a hospital's ability to receive volume discounts. "The lack of price transparency for the [implantable medical devices] we examined makes it difficult to know whether hospitals are achieving the best device prices," the GAO report said. Hospitals usually accommodate physicians' device preferences, and without the data to compare the costs of certain devices, facilities cannot inform physicians on how their preferences impact pricing. Analyzing Medicare expenditures from 2004 to 2009, the GAO found that outpatient expenditures for implantable device procedures rose 24.1 percent annually, from $1.0 billion in 2004 to $2.9 billion in 2009.

From the article of the same title
Modern Healthcare (02/03/12) Lee, Jaimy
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5010 Deadline Extended, but Threat Remains, Says AMA
The Centers for Medicare and Medicaid Services' Office of E-Health Standards and Services (OESS) has extended the deadline for physician practices and payers to comply with new 5010 HIPAA transaction standards by 90 days, but leading professional organizations say the extension is insufficient. OESS said it is delaying compliance enforcement so that more physician practices have the opportunity to implement the new ICD-10 billing coding standard without incurring penalties. In the meantime, OESS will continue to accept complaints associated with compliance with Version 5010, National Council for Prescription Drug Programs (NCPDP) D.0, and NCPDP 3.0 transaction standards during the 90-day period starting Jan. 1, 2012. Both the Medical Group Management Association and the American Medical Association say the government must organize a comprehensive contingency plan allowing health plans to adjudicate claims that may not have all the required data content, or otherwise put a halt to the transition.

From the article of the same title
HealthLeaders Media (02/06/12) Freeman, Greg
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HHS Warns of Fraud Liability in Reassigned Medicare Numbers
Doctors permitting healthcare firms to use their Medicare provider numbers can be held liable for any bogus bills the firms submit on their behalf, according to a warning from the Department of Health and Human Services' inspector general's office. The advisory was spurred by eight settlements where doctors were charged with violating the Civil Monetary Penalties Law after reassigning their Medicare provider numbers to firms in return for obtaining medical directorships with the companies. The office is advising physicians to use "heightened security" to guarantee that the entities receiving their payments are authentic providers or suppliers of healthcare products and services.

From the article of the same title
Modern Physician (02/08/12) Carlson, Joe
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Health Policy and Reimbursement

Arkansas Court Rejects Expert Witness Provision in Medical Liability Cases
The Supreme Court of Arkansas has ruled that expert witnesses in medical liability lawsuits no longer need to practice in the same specialty as defendant doctors, striking down a key provision of the state's tort reform law. The ruling is a setback for physicians who have had most reform measures enacted in the 2003 law overturned by the courts. The Supreme Court ruled that the same-specialty rule is unconstitutional because it violates the separation-of-powers doctrine, and that the authority to decide who may testify and under what conditions is a procedural matter within the province of the courts.

From the article of the same title
American Medical News (02/06/12) Gallegos, Alicia
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Billions Wasted on Defensive Medicine: Study
Orthopaedic surgeons in the United States waste $2.1 billion annually in ordering unnecessary tests and diagnostic procedures to defend against potential malpractice accusations, according to a study by researchers at Vanderbilt University Medical Center in Nashville. Researchers polled 2,000 orthopaedic surgeons picked randomly from a list provided by the American Academy of Orthopaedic Surgeons, and 96 percent answered that they practiced defensive medicine. Twenty-four percent of all imaging studies, lab tests, consultations and hospital admissions for the respondents were ordered or conducted for defensive reasons, according to the researchers. Using AMA billing codes for reference, the researchers calculated that an orthopaedic surgeon spends about $8,495 monthly on defensive medicine—approximately a quarter of their total practice costs. That's $101,820 annually per surgeon. The results were published in February's issue of the American Journal of Orthopedics.

From the article of the same title
Modern Physician (02/09/12) Selvam, Ashok
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Medicine, Drugs and Devices

Targeted Solutions Tool for Wrong Site Surgery Debuts
The Targeted Solutions Tool (TST) has been released by the Joint Commission Center for Transforming Healthcare to help guide healthcare organizations through a step-by-step process to identify, measure and reduce risks in key processes that can contribute to a wrong site surgery. The tool helps organizations evaluate risks across their surgical system, including scheduling, pre-operative and operating room areas. Because wrong site surgery incidents are rare, TST helps an organization monitor its surgical cases for weaknesses that might result in a wrong site surgery.

From the article of the same title
Joint Commission Online (02/04/12)
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Advice for the Ill, and Points for the Doctors
Palo Alto startup HealthTap has brought a game-like model to the provision of medical advice and the building of public reputations by doctors. Users post questions and doctors post brief answers at the HealthTap website, and rather than earning money, physicians earn points and advance to higher levels if their advice is deemed helpful. Participation can help doctors wishing to attract new patients obtain greater visibility, and HealthTap reports that it has signed up over 9,000 doctors and is adding 100 daily. "In academic or big hospitals, a physician's reputation is known only to fellow physicians," says HealthTap CEO Ron Gutman. "At HealthTap, professional reputation is transparent to patients as well as to peers."

From the article of the same title
New York Times (02/04/12) Stross, Randall
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Early Study Suggests Nanodiamonds Safe for Implants
Nanodiamonds designed to toughen artificial joints could prevent inflammation caused by metal joints shedding debris into the body, researchers wrote in the journal Acta Biomaterialia. Scientists at the University of Alabama at Birmingham are studying the use of nanodiamond coatings on joints made of metal alloys. Debris particles from metal joints are absorbed by scavenging immune cells called macrophages, which can cause inflammation that turns on bone-eating cells near implants. The resulting bone loss may increase the likelihood that implants will break loose and require a second surgery. Although the grinding force within joints can cause even nanodiamonds to shed some debris, nanodiamonds shed fewer, smaller particles. The study authors suggest that the macrophages that engulf nanodiamonds release fewer inflammatory chemicals than those encountering metal and polymer particles. Study results suggest that nanodiamonds are nontoxic in living cells. Next, the researchers will determine where nanodiamond particles go in the body and the safety of this resulting buildup.

From the article of the same title
Science Daily (02/05/2012)
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