February 22, 2012

News From ACFAS

On-site Registration Available for ACFAS 2012
Missed the registration deadline for the Annual Scientific Conference in San Antonio? Don't fret--registrations will be accepted on site at the registration desk in the convention center beginning at 1 pm on Wednesday, February 29, 2012.

Still need to make your hotel reservations or change them? Visit the web link below for more information or phone (800) 950-5542.
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ACFAS 2012 in the Palm of Your Hands
Now Available for download – the 2012 ACFAS Annual Scientific Conference Mobile App! Go digital this year with the app that puts ACFAS 2012 at your fingertips. Conference going will never be the same!

Simply download the conference app to your iPhone, iPad, Droid or Blackberry and you’ll instantly be able to:

  • Keep track of your pre-selected sessions
  • Review all the conference happenings
  • Find your way around with convenient maps
  • Find the vendors you don’t want to miss
  • Read the latest conference happenings in the Twitter feed
  • Receive the latest conference alerts

Download your app today through one of three ways:
  • Search your phone's App Store for ACFAS 2012 and install
  • On your mobile phone web browser, type Your phone will automatically detect and download the app you need!
  • Visit on your mobile device for a link to download the app

Once you've downloaded your app, you can populate it with your personal schedule and contact information by entering a unique code provided by ACFAS. If you registered by February 15, you should have received an email and a fax providing you with your code. Simply enter it into your Contact button on the app. If you registered after February 15, you will receive your code at the meeting to sync your app then.

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Follow the Latest News from San Antonio
Whether you're a part of the action deep in the heart of Texas at ACFAS' Annual Scientific Conference 2012 in San Antonio or you're in your office, stay abreast of the latest happenings at the conference on Twitter at #ACFAS2012.

The Twitter feed is also accessible through the ACFAS 2012 Mobile App.

Get connected and join in the conversation!

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View the Final Conference Program Online
Looking for ACFAS 2012 conference details? The final program for the Annual Scientific Conference in San Antonio is now available for viewing or downloading at the web link below.

Inside you'll find the conference schedule, 100 poster descriptions, the Class of 2011 Fellows, Fellows in 2011, descriptions of all our scientific exhibits and much more!
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Foot and Ankle Surgery

Factors Influencing Functional Outcomes After Distal Tibia Shaft Fractures
A study was held to determine whether tibial nails would be associated with more knee pain and that plates would correspond with pain from implant prominence in subjects with extra-articular distal tibia shaft fractures, using 104 patients randomized to treatment with a reamed intramedullary nail or standard large fragment medial plate. The subjects' ability to work was assessed after a minimum of 12 months, with a mean of 22 months. The average Musculoskeletal Function Assessment (MFA) score was 27.5, and average total Foot Function Index (FFI) score was 0.26. Ninety-five percent of 64 patients working at the time of injury had returned to work, while 31 percent had altered their work duties due to injury; three patients could not find employment, and none reported joblessness secondary to the fracture. Forty percent of the patients cited persistent ankle pain, and 31 percent reported pain in the knee after nailing, compared to 32 percent and 22 percent, respectively after plating. Twenty-seven percent of patients with nails and 15 percent of those with plates had both knee and ankle pain, and rates of implant removal were similar after nails compared to plates. None of the patients, apart from one with knee pain when kneeling, reported changing their activity because of persistent knee or ankle pain, although these pains occurred more frequently among the unemployed. Unemployed patients requested implant removal more often and continued to report pain following removal. Both MFA and FFI scores worsened in the presence of knee or ankle pain, and in patients who remained unemployed. All four patients with work-related injuries had gone back to work but had worse FFI scores.

From the article of the same title
Journal of Orthopaedic Trauma (03/12) Vol. 26, No. 3, P. 178 Vallier, Heather A; Cureton, Beth Ann; Patterson, Brendan; et al.
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Functional Treatment After Surgical Repair for Acute Lateral Ligament Disruption of the Ankle in Athletes
Researchers tested the hypothesis that functional treatment for acute lateral ligament disruption of the ankle following primary surgical repair can decrease the failure rate in comparison with functional treatment alone. The study involved 132 patients and 132 feet, with 78 treated solely with functional treatment (group F) and the remaining 54 treated with functional treatment after primary surgical repair (group RF). The average Japanese Society for Surgery of the Foot Ankle-Hindfoot scale (JSSF) score at two years after injury were 95.6 plus or minus 5 points in group F and 97.5 plus or minus 2.6 points in group RF. The differences of the talar tilt angles versus the contralateral side and displacement of the talus on stress radiography at two years after injury were 1.1 degrees plus or minus 1.5 degrees and 3.6 mm plus or minus 1.6 mm in group F, and 0.8 degrees plus or minus 0.9 degrees and 3.2 mm plus or minus 0.8 mm in group RF, respectively. Eight cases in group F exhibited fair to poor results, with JSSF scores below 80 points and instability at two years after injury. Nine cases in group RF showed dorsum foot pain along the superficial peroneal nerve, which resolved within a month. The time elapsed between the injury and the patient's return to full athletic activity without any external supports was 16 weeks plus or minus 5.6 weeks in group F and 10.1 weeks plus or minus 1.8 weeks in group RF.

From the article of the same title
American Journal of Sports Medicine (02/01/12) Vol. 40, No. 2, P. 447 Takao, Masato; Miyamoto, Wataru; Matsui, Kentaro; et al.
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Osteochondral Lesion of the Talus: Could Age Be an Indication for Arthroscopic Treatment?
Research was conducted to determine if age has any association with poor surgical outcome on arthroscopic talar osteochondral lesion repair. The researchers studied a sample of 173 ankles that underwent arthroscopic marrow stimulation treatment between 2001 and 2008, and were stratified into six age groups. Age's impact on clinical outcome was determined via bivariate and multivariate analyses. No significant differences among the six age groups in the preoperative and postoperative visual analog scale for pain or the AOFAS score were observed. The older group exhibited a significant increase in the duration of symptoms and a significant decrease in the incidence of trauma, while a poor clinical outcome was independently projected by both the size of the osteochondral defect and the number of associated intra-articular lesions.

From the article of the same title
American Journal of Sports Medicine (02/01/12) Vol. 40, No. 2, P. 419 Choi, Woo Jin; Kim, Bom Soo; Lee, Jin Woo
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Practice Management

Bundling Ain't What It Used to Be – But It's Probably in Your Future
In the context of healthcare reimbursement, the term "bundle" relates to reimbursing providers who form some type of alliance to reduce costs and hopefully improve outcomes for specific procedures or episodes of care. Numerous federal government and private payer initiatives may enable providers to share in savings from lower costs and hopefully improved quality, and providers have an opportunity to share in risk if costs exceed reimbursement and/or specific quality metrics are not met. One of the big questions that needs to be addressed is how do you compensate physicians and align their interests and performance with the overall objectives of bundling? To begin, it is safe to assume that a complete change from fee-for-service reimbursement to bundling will not happen overnight, which means current compensation plans will run for some time while incorporating additional components to address different payment methodologies. There are several primary goals and objectives of a physician compensation plan that must be addressed if a bundling component is to be incorporated. These goals and objectives could include recruiting and retaining physicians, ensuring that entities are fiscally responsible, ensuring that entities are compliant with regulations, promoting productivity, providing quality incentives, controlling expenses, and managing resources wisely.

From the article of the same title (02/14/12) Milburn, Jeffrey B.
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Keeping Patients Happy Hurts Outcomes as Costs Rise
Although patient satisfaction is higher when doctors give them what they want, this is not necessarily best for their treatment, a study suggests. Researchers looked at data from a study that surveyed more than 50,000 people nationally from 2000 to 2007, finding that healthy outcomes do not always correlate with satisfaction. Patients who were the most satisfied spent more on care and medicine but they were also 26 percent more likely to die, according to a report published Feb. 14 in the Archives of Internal Medicine. Study authors pointed out that patient satisfaction is being used more often to measure quality of care, but because doctors are paid for each service they provide, they are not encouraged to consider whether a service is necessary. Doctors that want to make patients more satisfied may not address challenging topics, such as substance abuse or the risks of medically unnecessary tests.

From the article of the same title
Bloomberg BusinessWeek (02/14/12) Frier, Sarah
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Medicare Offers Free Webinar With CEU
The next Understanding Medicare webinar will be held on March 6 and 7, 2012. It is designed for people who are new to Medicare, and for people wanting a refresher, will provide current, accurate, consistent information on Medicare, including hospital (Part A) coverage, medical (Part B) coverage, Medicare Advantage plans (Part C), and prescription drug (Part D) coverage. The Centers for Medicare & Medicaid Services (CMS) is authorized by the International Association for Continuing Education and Training (IACET) to offer 0.4 Continuing Education Units (CEU) for this program. In order to receive CEU credit participants must:

• Complete the pre-assessment
• Attend all four hours of the training
• Complete the course registration and evaluation
• Complete the post-test with an aggregate score of at least 70%.

Please visit the National Medicare Training Program Web-based Training page for accreditation statements, author biographies, and disclosure information. CEU credit for this course expires December 15, 2013. To register click

From the article of the same title
Centers for Medicare & Medicaid Services (02/22/12)
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Strike a Balance as a Boss
The key to success for many small physician practices is finding, managing, and holding on to a collegial, cooperative, and efficient office staff, and it is essential for doctors to strike a balance between friendliness and professionalism, mainly by establishing boundaries. Those boundaries are defined by the physician as he or she wishes, and internist Alieta Eck notes that her office generally recruits people known by the staff. "We look for people who are diligent, have proven character, are friendly and people-oriented," she says, and the office's doctors treat them they way they themselves would want to be treated. Otolaryngologist Cindy Daly especially values self-reliance and resilience, and she says she asks prospective employees situational questions to winnow out applicants who will not work well with her.

From the article of the same title
American Medical News (02/13/12) Kelly, Caitlin
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Health Policy and Reimbursement

AMA Backs HHS' ICD-10 Delay
The American Medical Association (AMA) said it supports an HHS decision to move back its Oct. 1, 2013 deadline for implementing the ICD-10 diagnosis and procedure codes. A new compliance date will be announced during a formal rulemaking process. Health and Human Services Secretary Kathleen Sebelius announced the move in a news release issued a day after acting Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner said that the CMS "would re-examine the time frame."

"The American Medical Association appreciates Secretary Sebelius' swift response to address the AMA's serious concerns with ICD-10 implementation," Peter Carmel, president of the AMA, said. "The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance. Burdens on physician practices need to be reduced—not created—as the nation's healthcare system undertakes significant payment and delivery reforms."

From the article of the same title
Modern Healthcare (02/16/12) Robeznieks, Andis
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Medicare Physician Payment Rule Factors in GPCI
As a result of intense lobbying by the California Medical Association (CMA), the final 2012 Medicare physician payment rule from CMS includes an adjusted fee schedule for the Geographic Practice Cost Index (GPCI) that some industry leaders say is a great deal more fair to many physicians. CMS adjusted the fee schedule so that a larger percentage of the payments are adjusted for geographic differences in practice costs, preventing large cuts in 2012 and helping California physicians in future years. There are other major changes in the fee schedule, including some related to E-prescribing, the Physician Quality Reporting System, value modifiers, and multiple procedure cuts.

From the article of the same title
HealthLeaders Media (02/10/12)
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New Overpayment Rules Proposed
Federal regulators have proposed new rules requiring healthcare providers to return any overpayments within 60 days of their discovery, and Department of Health and Human Services Secretary Kathleen Sebelius says the rules are designed to reduce overpayments without resorting to civil or criminal investigations. The proposal has courted controversy with some healthcare legal experts because it could potentially invoke provisions of the False Claims Act if healthcare providers knowingly withhold funds past 60 days. The rule says the clock would start ticking on the 60-day mandate when a person or organization possesses "actual knowledge" of an overpayment, or when the person acts in deliberate ignorance of the facts or with reckless disregard to them. Under the rule, organizations would not be required to find "proof of specific intent to defraud" in order to determine an overpayment and refund the money.

From the article of the same title
Modern Healthcare (02/14/12) Carlson, Joe
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Proposed Physician Sunshine Rule Comments Key Takeaway
Associations representing drug and medical device manufacturers are urging the Centers for Medicare & Medicaid Services (CMS) to delay final implementation of a “sunshine” provision requiring reporting of payments to doctors by at least 180 days following publication of a final rule, according to comment letters. Matthew Bennett, senior vice president at Pharmaceutical Research and Manufacturers of America (PhRMA), said “at least a 180-day preparation period following publication of the final rule would be appropriate in order for companies to fully operationalize preparations such as updates to (or establishment of) company systems, hiring new personnel, and training of personnel,” according to a Feb. 17 statement supporting the PhRMA comment letter to CMS.

From the article of the same title
BNA Health Care Policy Report (02/22/12) Swann, James
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UnitedHealth Will Tie Doctors’ Payments to Quality of Care
UnitedHealth Group expects to save twice as much as it would spend on incentive payments under a plan that will pay doctors based on the quality of their care. Most of the savings will result from improved patient health. The program may cover as much as 70 percent of the insurer’s commercial members by 2015, from less than 2 percent now, the company said. The nationwide expansion of the program follows similar efforts by the U.S. government and rival insurers to trim medical costs by shifting away from paying based on the amount of services provided. Optum, UnitedHealth’s services business, will be able to sell software, data and consulting to providers making the changes. Hospitals and doctors will see their costs fall through the program, UnitedHealth said.

From the article of the same title
Bloomberg (02/13/12) Frier, Sarah; Armstrong, Drew
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Medicine, Drugs and Devices

Big Rise in Artificial Feet Costs
Medicare's bill for artificial feet rose nearly 60 percent in recent years, although foot and leg amputations due to diabetes continued a dramatic decline. Medicare paid $94 million for artificial feet in 2010, according to research conducted for the Associated Press. That was nearly $35 million more than in 2005, even though in 2010, Medicare covered about 1,900 fewer such prostheses. The spending spike highlights basic questions about affordability, technology and appropriate care that confront Medicare.

A report last year by the Health and Human Services inspector general found widespread questionable billing for lower-limb prostheses, a category that includes artificial feet. In 2009, Medicare inappropriately paid $43 million for lower-limb prostheses that did not meet certain basic standards for accurate claims, investigators said. They found an additional $61 million in questionable billing in cases where it wasn't clear that the Medicare beneficiary had seen the referring doctor in the previous five years, raising questions about whether the prosthesis was medically necessary. Medicare has started covering a computer-controlled ankle/foot that costs $15,000

The HHS inspector general's report recommended that Medicare revise a scale of functional activity levels that clinicians use to help determine what kind of artificial limb is appropriate for a particular patient, based on that individual's lifestyle. It said definitions of the patient's potential for rehabilitation should be clarified.

From the article of the same title
Associated Press (02/15/12) Alonso-Zaldivar, Ricardo
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Dartmouth Atlas Project Moves Beyond Medicare Data
The Dartmouth Atlas Project has found geographic variations in the volume and cost of U.S. healthcare, with most of the project's work based on Medicare claims data. This year, the Dartmouth Institute for Health Policy & Clinical Practice will begin two new projects to examine whether the same variations exist for patients with private health insurance and patients under age 65. In one study, researchers will use data from Blue Health Intelligence (BHI) to examine orthopaedic procedures, particularly joint arthroplasty and knee arthroscopy. Dartmouth researchers requested that BHI examine commercial insurance claims data to see whether it would match findings in the Medicare population. The number of orthopaedic joint procedures has grown rapidly, with geographic variations in volume. "Understanding that variation is one of the key foundations before you can even start to address the appropriateness of care," BHI Chief Informatics Executive Andrea Marks said. These orthopaedic procedures are expected to become increasingly common among the middle-aged as well as the elderly. Researchers expect to report results for both projects in 18 months to two years. The Atlas Project previously found variations in Medicare spending that could not be explained by regional differences in cost and income or by severity of illness.

From the article of the same title
American Medical News (02/14/12) Berry, Emily
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Opportunity to Participate in American Society of Bone & Mineral Research Meeting
The American Society for Bone and Mineral Research (ASBMR) is hosting a topical meeting on bone and skeletal muscle interactions July 17 - 18, 2012. This 'state of the science' topical meeting, to be held in Kansas City, Missouri, will draw together leading muscle and bone researchers to exchange ideas, develop new collaborations and accelerate the emerging scientific discoveries in the area of muscle and bone interactions. Click here to the notice soliciting abstracts, which are due by Wednesday, February 29. To contact ASBMR for further information, please call (202) 367-1161 or email

From the article of the same title
American Society of Bone & Mineral Research (02/21/12)
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