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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

Senate Majority Leader Harry Reid’s (D-Nev.) new, pared-down Senate jobs bill was stripped of an extension of the temporary Medicare payment cut fix which expires February 28. This extension had been criticized by the American Medical Association, which called instead for a permanent fix to the current payment formula.

Also cut was an amendment to the American Recovery and Reinvestment Act of 2009 (ARRA) that would have made “hospital-based physicians” who practice in “inpatient or outpatient” settings eligible for federal electronic health record (EHR) subsidies. The act currently excludes these providers under the assumption that they can use their hospital’s EHRs and don’t need funding for their own.

These and other healthcare provisions could be addressed in separate "extenders bills" that the Senate may take up following the President's Day recess.

This week the White House released nearly $1 billion in ARRA funds to help thousands of hospitals and primary-care physicians adopt health information technology, and to train people in healthcare and information technology careers.

Meanwhile, as Democrats and Republicans prepare for President Obama’s February 25 healthcare summit, Democratic leaders in both chambers are trying to resolve differences between House and Senate-passed healthcare bills. There are also hints from the White House that the president will release his own healthcare bill on the Internet prior to the summit. Republican leaders have called for scrapping the current bills and starting over.
Come As You Are

Just discovered you can attend the ACFAS Annual Scientific Conference? Join a record crowd of ACFAS members at this premier educational event, where you can earn more than 30 continuing education contact hours!

On-site registration will be open Monday, February 22, through Thursday, February 25. For full details, visit
Recent Research at Your Fingertips

Make the most of your spare time by catching up on the latest research with Scientific Literature Reviews, a monthly feature on the ACFAS web site. In just a few minutes you can read abstracts of research from journals you may not regularly see.

For February, residents from Englewood Hospital and Kaiser Foundation Hospital have prepared abstracts tailored to the needs of podiatric surgeons from the European Journal of Pediatric Surgery, American Journal of Orthopedics, Journal of Bone & Joint Surgery (American), and Annals of Vascular Surgery.

Browse new entries or the entire archive anytime at Scientific Literature Reviews.

Foot and Ankle Surgery

FDA Approves Biologic for Dupuytren's Contracture

The FDA has officially approved collagenase clostridium histolyticum (Xiaflex) for the treatment of Dupuytren's contracture. However, the agency recommends that the drug only be administered by a healthcare professional experienced with injections of the hand, because tendon ruptures may occur. Xiaflex is a biologic drug made from the protein product of a living organism. It works by breaking down the excessive buildup of collagen in the hand.

From "FDA Approves Xiaflex for Debilitating Hand Condition" (02/02/10)

Microfracture for Chondral Defects of the Talus: Maintenance of Early Results at Midterm Follow-up

A group of researchers ascertained whether the early improvement in symptoms and function following microfracture in the management of articular cartilage defects of the talus is sustained at midterm follow-up, while variables influencing outcome and postoperative magnetic resonance imaging (MRI) were additionally assessed. MRI was utilized to evaluate cartilage repair tissue based on factors that include degree of defect repair and filling of the defect, integration to border zone, repair tissue surface, repair tissue structure, and subchondral bone alterations. No deterioration was indicated through comparison of the Hannover Scoring System for the ankle and the Visual Analog Scale for pain and function. It is the researchers' conclusion that microfracture arthroplasty triggers the mending of localized articular cartilage defects of the talus, maintaining the encouraging early outcome at midterm follow-up.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (02/04/10) Becher, Christoph; Driessen, Arne; Hess, Thomas; et al.

Osteo-periosteal-cutaneous Flaps of the Medial Femoral Condyle: A Valuable Modification for Selected Clinical Situations

Transplantation of vascularized soft tissue in addition to bone graft is desired in instances of bony nonunions with weak skin coverage, and a group of researchers report on the employment of an osteocutaneous flap from the medial femoral condyle. Four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects between 2004 and 2009. The first three cases exhibited primary healing, with bony union accomplished between 32 and 170 days. No flap loss or surgery-related complications at the donor site were recorded. The researchers conclude that the transfer of free combined vascularized corticoperiosteal-cutaneous flaps appears to be ideal for postradiation-induced fractures or chronic nonunions with small odds of spontaneous healing and a concomitant small skin defect.

From the article of the same title
Journal of Reconstructive Microsurgery (02/09/10) Pelzer, Michael; Reichenberger, Matthias; Germann, Gunter

Practice Management

FCC to Promote Mobile Health Apps in Broadband Plan

The Federal Communications Commission (FCC) wants to promote the use of wireless devices and applications in healthcare as part of a national broadband plan the agency expects to release next month, according to Dr. Mohit Kaushal, digital healthcare director of the FCC’s Omnibus Broadband Initiative. As part of the new program, the agency will analyze health IT applications that run on broadband, including electronic health records, videoconferencing tools, and remote monitoring systems.

From the article of the same title
Government Health IT (02/05/10) Mosquera, Mary

Preparing for Reform’s New Patients

The healthcare reform effort in Congress will enable many more Americans to receive health insurance, and the healthcare industry must be ready to receive those patients. Each version of the legislation aims to expand health coverage to at least 31 million more Americans, making now the time to examine practice operations and prepare for the opportunities and challenges. For example, many newly insured patients may be unfamiliar with the system, and may make appointments but may not know about copay and deductible requirements. Practices should publish their copay and deductible billing policies for new patients, and patients should counseled on payment when first visiting a practice. Practices may also need to examine their patient volume, schedule, staffing requirements, and several other areas to prepare for changes made by the reform movement.

From the article of the same title
Physicians Practice (02/10) Michael, Sara

Requests For Medical Data Are Questioned

Connecticut's largest physician organization is looking for answers after several doctors received faxed requests for patients' medical information from UnitedHealthcare subsidiary Ingenix. The insurer sent faxed requests to physicians, asking for data dating back to Jan. 1, 2008. Medical society executive vice president Matthew Katz says while it is not uncommon for insurers to ask to review patients' charts, doctors generally do not receive requests by fax, and will not fax such sensitive information to third parties. UnitedHealthcare spokesman Daryl Richard says Ingenix sent faxes because a survey of Connecticut doctors showed that fax is the preferred form of communication, and that the chart reviews are intended to improve the accuracy of diagnosis-related data.

From the article of the same title
Hartford Courant (CT) (02/09/10) Sturdevant, Matthew

Health Policy and Reimbursement

Insurer Delays Rate Increase in California

Anthem Blue Cross of California has agreed to postpone a plan to increase rates for some California residents who buy insurance on their own after reaching a deal with state regulators. Anthem's planned rate increase, which the state estimates would affect about 700,000 customers, averages 25 percent and would be as high as 39 percent for some. Anthem agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the company's plan filing, including data on the medical costs it expects to incur. The planned increase has come under heavy criticism from federal officials and lawmakers.

From the article of the same title
Associated Press (02/14/10)

Study Shows How Medicare Rewards MDs for Overuse

A new study published in the journal Cancer shows that Medicare's move in 2005 to pay doctors to do bladder cancer surgery in their offices rather than in hospitals dramatically raised the number of procedures and overall health costs. The CMS based its decision to pay doctors extra to do the procedure in their offices because, in theory, it would cost less than doing it in a hospital, but after the decision, the number of procedures spiked. The study shows how in some cases Medicare gives doctors incentives to provide too much care, the researchers said.

From the article of the same title
Reuters (02/08/10) Steenhuysen, Julie

Study: Health Costs Higher Where Hospital Competition Is Lower

A study published in the American Journal of Managed Care reports that spending by private insurers is generally higher when the hospital market is less competitive. The study compared geographic patterns of Medicare spending, using the Dartmouth Atlas data, with spending by big employers that cover their works, and found that the two do not correlate, but not because insurers, acting for the big employers, are better than Medicare at saying no to paying for unneeded care, because utilization patterns were relatively parallel. Rather, the researchers suggest that when a small market has only one or a few hospital systems, employers spend more than they do in large cities where there is more competition, which generally does not impact government health payers. There are some other reasons why payments from private insurers and Medicare would not match, most obviously because the over-65 population has different medical needs than younger people.

From the article of the same title
Wall Street Journal (02/08/10) Mathews, Anna Wilde

Technology and Device Trends

Anesthetic Approach Stops Pain Without Affecting Motor Function

Researchers at Children's Hospital Boston have discovered an anesthetic technique that promises to numb patients' pain without impairing motor function. The unexpected finding, revealed online in the Early Edition of The Proceedings of the National Academy of Sciences, was made during an unrelated study on the use of surfactants to prolong the effects of anesthetics. Three different surfactants, a kind of chemical permeability enhancer that allows drugs to spread more easily throughout a tissue, were tested in conjunction with the anesthetics QX-314 and QX-222 on rats. The researchers were able to block sensation in the rats' sciatic nerves for seven hours or more, depending on which surfactant was used. At the same time, the rats suffered little or no impairment in their motor function.

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

Daily Pill Helped Cure Osteoporosis in Mice, Rats

A once-a-day pill helped completely rebuild bone in rodents with severe osteoporosis, a finding that could lead to a new class of drugs to treat the disease in humans, researchers reported in the journal Nature Medicine. The team used a compound that blocks the production of serotonin produced in the gut in mice and rats with a severe form of osteoporosis and found they completely recovered their bone density. The team is now working to develop this type of treatment for human patients.

From the article of the same title
Reuters (02/08/10) Steenhuysen, Julie

FDA Issues Guidance for Device Trials

The FDA has issued guidance on the use of Bayesian statistical methods in the design and analysis of medical device clinical trials that potentially could result in less costly and more efficient patient studies. The method applies an algorithm that makes it possible for companies to combine data collected in prior studies with data collected in a current trial, which could provide "sufficient justification for smaller or shorter clinical studies."

From the article of the same title (02/05/10)

Insulin Study Could Lead to New Dosage Devices

A novel computer algorithm may be bringing scientists closer to the development of new devices for supplying insulin to individuals with diabetes. A new study published in The Lancet found that an algorithm that analyzed children's glucose levels and recommended frequent adjustments to insulin doses was better at preventing hypoglycemia than a standard diabetes management system. With the standard system, used by about 3 million people nationwide with type 1 diabetes, a continuous glucose monitor operates separately from a preprogrammed insulin pump. U.S. and European researchers are attempting to develop an automated system for type 1 diabetes that would wirelessly connect an external glucose monitor with an insulin delivery device. These devices would continually monitor glucose levels by using algorithms like the one involved in The Lancet study, and calibrate insulin dosages to be dispensed in real time.

From the article of the same title
New York Times (02/04/10) Singer, Natasha

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February 17, 2010