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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

You Can Show Up and Sign Up at the Annual Scientific Conference

Two weeks from today, 1,100 DPMs plus hundreds of exhibitors and guests will be arriving in Washington, D.C. for the ACFAS Annual Scientific Conference.

If you're not yet registered, on-site registration will be open at the Gaylord National Resort and Conference Center from 1 to 5 p.m. on Wednesday, March 4 and starting at 6:30 a.m. on Thursday, March 5.

The Opening General Session begins at 8:30 a.m. Thursday. Newsweek's political commentator Howard Fineman and songster-satirists The Capitol Steps will get you revved up for the conference's bounty of educational sessions, hands-on workshops, networking and fellowship. It's a great way to kick off the week.
ACFAS Partners with Homeless Coalition to Collect Socks in DC

Homeless people often don't remove their shoes and socks when they spend the night in shelters or on the street. Many have had their possessions stolen, and they can't take that risk.

You can only imagine what this does to their feet, which don't get to air out.

Here's how you can help: Bring one or more pairs of new socks to the ACFAS Annual Scientific Conference "Socks for the Homeless" campaign. ACFAS is partnering with the National Coalition for the Homeless, which will distribute the socks at Washington, D.C.-area soup kitchens and a homeless shelter. This project is sponsored by DOX Podiatry.
Understanding CMS Remittance Advice

Physicians receive “remittance advice” from Medicare carriers which notifies them about Medicare’s claims processing decisions, such as payments, adjustments and denials. These decisions can greatly impact physicians’ practices. To assist physicians and other health care providers in understanding and interpreting these notices, the Centers for Medicare and Medicaid Services (CMS) has just released a new edition of Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers and Billers. This guide is available for download from the CMS website. Click on the link below.

Foot and Ankle Surgery

Arthroscopically Detected Intra-Articular Lesions Associated With Acute Ankle Fractures

When ankle fractures are surgically realigned, their success may be diminished by occult intra-articular injuries. The aim of the researchers in this study was to examine if the severity of an acute ankle fracture is linked to a higher number of arthroscopically detected intra-articular chondral lesions. The researchers conducted a retrospective review of medical charts on 283 ankle fractures that involved routine ankle arthroscopy inclusive of open reduction and internal fixation. Of the 283 patients, 44 females and 40 males adhered to the researchers' inclusion criteria. Chondral lesions were found in 61 patients, or 73 percent. The study indicated that the number of intra-articular chondral lesions associated with the more severe ankle fracture patterns, such as pronation-external rotation and supination-external rotation type-IV fractures, was greater than the number associated with the less severe ankle fracture patterns.

From the article of the same title
Journal of Bone and Joint Surgery (02/01/2009) Vol. 91, No. 2, P. 333; Leontaritis, Nikoletta; Hinojosa, Lauren; Panchbhavi, Vinod K.

C-arm Fluoroscopes Carry Radiation Exposure Risk

New research appearing in the February issue of Journal of Bone & Joint Surgery outlines the risk posed to surgeons and patients when large-c-arm and mini-c-arm fluoroscopy are used to examine patients. University of Rochester Medical Center researcher Brian D. Giordano, MD, and colleagues have concluded that orthopedic surgeons should be mindful of exposure to radiation when using a fluoroscope to image body parts larger than the hand or wrist or when the extremity is closer to the X-ray source. They based their findings on a study of radiation exposure using a cadaver ankle specimen, which was suspended from an adjustable platform and scanned with a standard mini-c-arm fluoroscope. "Exposure of the patient and surgeon to radiation depends on the tissue density and the shape of the imaged extremity. Elevated exposure levels can be expected when larger body parts are imaged or when the extremity is positioned closer to the x-ray source. When it is possible to satisfactorily image an extremity with use of the mini-c-arm, it should be chosen over its larger counterpart," the researchers wrote.

From the article of the same title
Modern Medicine (02/09/09)

Diabetes Rates Continue to Climb

Researchers from the National Institutes of Health and the Centers for Disease Control and Prevention (CDC) have found that almost 13 percent of U.S. adults 20 years of age and older have diabetes, compared to an 8 percent estimate the CDC made last June. According to the researchers, about 40 percent of people with diabetes have not been diagnosed. Almost one-third of people over age 65 have diabetes, researchers found, and another 30 percent of adults have prediabetes. The study involved data from the 2005-2006 National Health and Nutrition Examination Survey, which used both a fasting glucose test and the more sensitive oral glucose tolerance test (OGTT). Lead author Catherine Cowie, director of the Diabetes Epidemiology program at the National Institute of Diabetes and Digestive and Kidney Diseases, said that diabetes prevalence has traditionally been estimated based only on fasting glucose test results, but not from OGTT. The report appears in the February issue of Diabetes Care.

From the article of the same title
American Medical News (02/10/09) Landers, Susan J.

Practice Management

Riding the Revenue Cycle: Coping With Seasonal Fluctuations

Quarterly changes in revenue require medical offices to switch their routines. By implementing different processes, doctors can stabilize these changes. During the first quarter, experts believe that practices should see more patients who carry insurance without deductibles, such as HMOs. Start the collection year off by focusing on the front end, says Ilene Gilbert, regional vice president of ambulatory services for Provena Medical Group in Joliet, Ill. "Make sure the office pre-certifies patients, and doesn't wait until the patient is there. Collect any money up front that you can, because the odds of collecting drop dramatically after the patient is gone." It is also vital that physicians are coding correctly and that the staff is properly trained in revenue collection, says Cheryl Carr, national director of operations for Bill Dunbar and Associates in Indianapolis. "If a code has changed and the office didn't make appropriate changes to reflect that, it will lose revenue."

The second quarter should be reserved for analyzing patient balances and resolving any issues with insurance companies. "You need to have one person dedicated to doing this follow-up, without doing any billing," says Allen DeKaye, president and CEO of DeKaye Consulting Inc. in Oceanside, N.Y. "Some doctors would rather outsource this. It's up to the practice, but you must make sure you hold the insurers accountable." This is also the time for physicians and staff to consider a vacation as caseloads start to slow.

The third quarter is typically the slowest, and offices can increase revenue by getting acquainted with residents in the area. Physicians can check the charts of chronic care patients to see who hasn't been seen as often as they should be, says Gilbert. "Let them know you would like to get them in for a visit and set a date." Connections with students and the elderly can be obtained by performing annual school physicals and visiting nursing homes.

Various money management plans for the next year should be considered in the fourth quarter. Bill Dunbar, of Indianapolis-based practice revenue consultant Bill Dunbar and Associates says a practice needs to have its payment system in place by the end of the year to make sure insurers do not add other discounts. DeKaye recommends going after accounts receivable in November and December: "If you take a more proactive approach in the fourth quarter, you will do better in the first quarter."

From the article of the same title
American Medical News (02/09/09) Caffarini, Karen

Physicians, Patients Connect on the Web

E-mail visits, also called eVisits, are enabling doctors and patients to stay in touch online. They allow doctors to answer quick questions and avoid unnecessary office visits. Patients can set up electronic accounts for their medical records and access other services. "I'm totally sold on how useful it is," says Dr. Barbara Saul, a family medicine doctor at the Troy, Mich., center of the Henry Ford Health System. There are some questions about insurance reimbursement, as insurers have been studying whether the idea helps save money and improve health. Blue Care Network and Aetna pay $30 for eVisits to primary care doctors, while Priority Health is planning to start paying for them in April. "Initial feedback from doctors and patients has been 100 percent positive. It's very convenient and easy to use," says Matt Walsh, associate vice president of purchase initiatives at the Health Alliance Plan. Additionally, there have been increases in measurements of good patient care.

From the article of the same title
Detroit Free Press (MI) (02/08/09) Anstett, Patricia

Debate Over Digitizing

Some consumer groups are concerned about President Barack Obama's proposal to computerize medical records within five years. According to these groups, computerized medical records could be misused and there could be more medical identity theft if safeguards are not put in place. In fact, security breaches of electronic medical records could be far worse than the recent incidents that have resulted in the release of thousands of patients' personal information because data will be more easily disseminated when it is computerized, says Pam Dixon of the World Privacy Forum, a research group that focuses on privacy issues. Other groups, meanwhile, are urging the government not to make efforts to protect the privacy of patients so onerous that they will slow down the efficiency of the nation's healthcare system. "We believe that there's got to be an appropriate balance between protecting privacy and allowing safe, high-quality care to be delivered," says Tina Grande of the Healthcare Leadership Council, which represents healthcare corporations.

From the article of the same title
Wall Street Journal (02/07/09) Mincer, Jilian

Health Policy and Reimbursement

Medicare Advisory Agency to Back 1.1 Percent Physician Pay Raise for 2010

The Medicare Payment Advisory Commission will recommend to lawmakers that physicians receive a 1.1 percent pay increase in 2010 rather than the approximate 21 percent cut that is currently slated. The recommendation will appear in the annual March report to Congress. The commission is a congressional agency that counsels lawmakers on how they should set Medicare rates. While lawmakers do not always follow the commission's advice, its suggestions are often use as a starting point for debate. The commission is also recommending that Congress boost Medicare payments to primary care doctors by establishing a special claims modifier that would produce higher rates for evaluation and management services for those physicians than for physicians not considered to be in primary care.

From the article of the same title
American Medical News (02/09/09) Silva, Chris

Cigna Web Tool Tells Cost of Care Upfront

Cigna Corp. plans to introduce an online tool called Cigna Cost of Care Estimator in April. The Cost of Care Estimator will tell Cigna insurance carriers the amount they will pay out-of-pocket for procedures before they visit a doctor. The software includes data on deductibles, co-payments, and other money that can be used toward the payment of medical expenses when determining the cost of various procedures. The Cost of Care Estimator also assists health-care professionals by increasing the odds that patients will pay for services. The number of payments should increase since patients will know up front how much they will be paying. According to Dr. Jeffrey Kang, Cigna's chief medical officer, "Every other service industry provides estimates of cost prior to service; for the first time, we are systematically trying to do this for health care." Cigna conducted a trial of the program with more than 250 doctors from hospitals, clinics, and private practices. According to Jim Nastri, vice president of product development at Cigna, the software is correct "within 10% of the cost of those services 90% of the time." The Cost of Care Estimator was developed in large part because employers, who handle health insurance for 180 million Americans, are moving a larger portion of healthcare costs to workers. This has caused an increase in out-of-pocket medical payments for individuals and a need for more information about medical expenses.

From the article of the same title
Wall Street Journal (02/10/09) Knight, Victoria E.

When Attorneys General Attack

State attorneys general are increasingly turning their attention to the healthcare field, as reflected by New York Attorney General Andrew Cuomo's new Health Care Industry Task Force and by the Memorial Hermann Healthcare System's settlement of an antitrust case in Texas. "When you become attorney general, you don’t realize how much of the work is involved in the provision of healthcare to people," says Illinois Attorney General Lisa Madigan, who has also done much work in the area. Michigan Attorney General Mike Cox has called on lawmakers to resist Blue Cross and Blue Shield of Michigan's efforts to reduce his office's rate-setting oversight. The Illinois Hospital Association actually sought Madigan's office's help in drafting legislation to compete with other pending legislation intended to cap hospitals' charges to uninsured patients. Madigan's other healthcare efforts have included a settlement with 14 Chicago-area MRI centers in a whistle-blower lawsuit and an antitrust suit against two large physician practices in Champaign and Urbana. These cases often end in settlements as the defendants seek to avoid lengthy and costly litigation.

From the article of the same title
Modern Healthcare (02/02/09) Blesch, Gregg

Federal Appeals Court Clarifies When Doctor Conduct Is Reportable

A federal appeals court panel has issued the first clarification on what constitutes an investigation under the Health Care Quality Improvement Act (HCQIA), which could provide physicians with better guidance in disciplinary and reporting actions. Generally, federal law requires hospitals to report physicians to the National Practitioner Data Bank if they surrender privileges during an investigation or are reprimanded for conduct issues. The 1st Circuit panel decision said that an investigation is considered ongoing until the hospital's decision-making process is completed and the medical executive committee either formally closes the probe or takes a final corrective action. "Congress did not intend to construct an easily accessible escape hatch that would permit beleaguered physicians to elude the reach of the HCQIA's reporting requirement," said the decision, issued Jan. 14 in a case involving a physician who was investigated after a nurse alleged that the physician threatened her. Following the nurse's complaint, the doctor's privileges were suspended by the medical executive committee during an investigation by another committee; after the findings of the investigation were reported to the executive committee, the executive committee proposed restoring the doctor's privileges if he agreed to some conditions. The doctor voluntarily resigned instead, and the hospital reported him to the data bank, believing he had resigned while under investigation. The doctor argued that the process was over when the executive staff received the findings of the investigation, but the secretary of the Department of Health and Human Services had concluded that the doctor resigned prior to a formal resolution of the query. The appeals court's decision affirmed the secretary's interpretation.

From the article of the same title
American Medical News (02/09/09) Sorrel, Amy Lynn

Technology and Device Trends

Interpositional Arthroplasty of the Calcaneocuboid Joint Using a Regenerative Tissue Matrix to Treat Recurrent Nonunion

A patient who had had three unsuccessful attempts at calcaneocuboid joint arthrodesis was finally treated successfully with interpositional arthroplasty of the joint. The patient was a 49-year-old woman with longstanding rheumatoid arthritis, and after triple hindfoot arthrodesis, the talonavicular joint and the talocalcaneal joints achieved successful arthrodesis but the calcaneocuboid joint did not unite. Additional failures were experienced with revision arthrodesis of the joint and another attempt at percutaneous grafting; in each case, there were postoperative complications due to nonweight bearing restrictions, medication changes, and medical comorbidities. Rather than undergoing a fourth attempt at arthrodesis, she was treated with interpositional arthroplasty using a regenerative tissue matrix, with allograft dermal matrix used as interpositional material at the calcaneocuboid joint. A year after the operation, the patient says she experiences only mild hindfoot discomfort that does not interfere with daily activity.

From the article of the same title
Ortho Supersite (02/01/2009) Kim, David H.; Berkowitz, Mark; Pino, Edward

Autologous Chondrocyte Implantation of the Ankle: A 2- to 5-year Follow-up

It is difficult to treat full-thickness talar cartilage defects if previous surgery proved unsuccessful. In this study, 11 patients (six women and five men with a mean age of 33 years) underwent autologous chondrocyte implantation of the talus after previous failed surgical management. There were 9 medial and 2 lateral lesions that had an average size of 21 mm x 13 mm. Five patients underwent autologous chondrocyte implantation of the talus alone, and six had it with a "sandwich procedure." Ten patients underwent a second-look arthroscopy with screw removal. After a mean follow-up of 38 months, three patients were classified as excellent, six as good, and two as fair. The researchers concluded that autologous chondrocyte implantation of the talus yields significant functional improvement. However, additional studies are needed to ascertain long-term structural and biomechanical properties of the repair tissue, they said.

From the article of the same title
American Journal of Sports Medicine (02/01/09) Vol. 37, No. 1, P. 274; Nam, Ellis Kevin; Ferkel, Richard D.; Applegate, Gregory R.

Henry Ford Posts Live Surgical Blog

Henry Ford Hospital is using the Twitter micro-blogging service to allow the public to observe live surgical operations. On Feb. 9, surgeons posted real-time updates of a robot-assisted surgery on a 60-year-old kidney cancer patient. Hospital officials hope that the posting of live updates will give patients, medical students and physicians better exposure to Henry Ford's new surgical procedures and technology. "With the way medicine is going, patients are looking for more information about procedures going on," says Dr. Rajesh Laungani, the hospital's chief resident of urology. "This kind of lets them know our world, what we go through in the OR and what kind of new technology we're using." The hospital also is hoping to use the latest round of blogging to better promote the use of multi-limbed surgical robots that aid doctors with making minuscule incisions that some medical experts say are more precise and less complicated that more traditional surgical techniques. Affixed to the robots' arms are miniaturized instruments that help Twitter users follow the surgeon's journey within the patient's body. Henry Ford also has used other online media to better connect with patients and the medical community, posting YouTube videos and podcasts that provide medical advice or guidance for nutrition and exercise.

From the article of the same title
Detroit News (02/10/09) Rogers, Christina

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February 18, 2009