News From ACFAS

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Soon, Section 1921 of the Social Security Act will expand reporting to the National Practitioner Data Bank by requiring each state to report disciplinary licensure actions taken against all licensed healthcare practitioners and organizations. It also requires states to report any negative action or finding that a peer review organization, private accreditation entity, or a state has concluded against a healthcare practitioner or organization.
The Centers for Medicare and Medicaid Services announced Feb. 21 on their Open Door Forum for Physicians that Medicare claims that were “kicked out” will be automatically reprocessed, and urged providers NOT to resubmit claims. CMS went on to state that all normal under- and overpayment processes are in place. All refunds due providers will be aggregated with regularly scheduled payments. For additional information, visit the CMS’ Medicare information website.
The American Society for Bone and Mineral Research (ASBMR) will hold a “Forum on Aging and Skeletal Health” on March 21-22, 2011, at the Natcher Conference Center, National Institutes of Health, Bethesda, Md. This meeting is designed to bring together those studying the aging process with those active in areas of bone health to increase understanding of issues surrounding age-related bone loss and fractures.

The U.S. Bone and Joint Decade/Initiative, a co-sponsor of this meeting, encourages your participation as a podiatric foot and ankle surgeon. For the official program and to register, visit the ASBMR website.

Foot and Ankle Surgery

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Research was performed to determine if arthroscopic matrix-associated chondrocyte implantation (MACI) is a safe procedure for the treatment of osteochondral lesions in the ankle with generally good clinical and magnetic resonance imaging (MRI) results. Eighteen patients with osteochondral lesions in the ankle underwent MACI between February 2006 and May 2008, and the clinical results up to three years after MACI were compared to preoperative data for 14 cases and the MRI data for all 19 lesions. A substantial improvement in all clinical scores was observed, with 64 percent rated as excellent and good and 36 percent rated as fair and poor, according to the AOFAS Hindfoot score. Results corresponded with patent age and symptom duration, but not with lesion size; 16 patients reported regular sports activities prior to symptom onset, and 13 of them resumed sports following the MACI.



A clinical study of ankle arthropathy in 34 mild/moderate hemophilia A patients was performed, and 16 patients had ankle pain, which was rated as moderate to severe in nine patients and tied to limitation of physical activities in 13 patients. Seventeen of 33 patients examined via radiology were positive for ankle arthropathy, and 16 also were positive according to the physical score. The presence and severity of ankle arthropathy was more frequent in patients with a one-stage factor VIII level of less than or equal to 11 IU/dl. A significant correspondence between the presence of ankle arthropathy and a history of bleeding into the ankle joint during childhood was uncovered.



Suturing of the ruptured stumps of the extensor hallucis longus (EHL) tendon to the extensor hallucis brevis (EHB) tendon in cerebral palsied adolescents provides a great toe extension without the need for tendon graft from an adjacent or a remote site, report researchers. Twelve patients (12 feet) with spastic cerebral palsy had trauma in the form of direct hitting of the great toe to a hard object, together with indirect foot twist outwardly. MRI revealed rupture of the EHL tendon in the forefoot zone with a wide gap between the stumps in all cases. The two stumps of the ruptured tendon were impossible to suture by the classic tendon repair techniques. No graft was taken, but the two stumps were sutured to the extensor hallucis brevis EHB tendon. Clinical evaluation using the AOFAS Hallux Metatarsophalangeal–Interphalangeal Scale revealed that nine feet (75 percent) were classified as excellent and three feet (25 percent) were classified as good. Neither fair nor poor cases were recorded. No complications were reported.

Practice Management

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Medical practices that were on sounder financial footing and designated as "better performers" were more likely than those that were not doing as well to say they paid close attention to patient flow through the office, according to a recently released survey by the Medical Group Management Association. Experts say patient flow is something almost all practices should consider, and improving patient flow varies among practices. The first step is to obtain buy-in from staff that this challenge is worth meeting, with practice advisers suggesting an appeal to staffers' desire to leave the office on time and supply higher-quality care. The next step is to evaluate the movement of patients through a practice, and practices may wish to try timing patients as they move through the office. Patient scheduling can impact patient flow, and experts recommend paying attention to verbal communication with a patient. Experts do not recommend addressing all problems at once, as gradual change typically works better and staff buy-in will likely grow as results become apparent.



X-rays, magnetic resonance imaging (MRI) scans, and other imaging tests are often carried out so that doctors can protect themselves from litigation, according to a review of 2,068 orthopedic patients in Pennsylvania by Children's Hospital of Philadelphia. The review found that more than one-third of the imaging costs were ordered for "defensive" purposes, researchers revealed at the annual meeting of the American Academy of Orthopaedic Surgeons. Lead study author John Flynn said medical malpractice lawsuits frequently rely on allegations that the physician should have ordered more tests, and noted in a news release that "such a claim may be the driving force of so much of the defensive test ordering." Flynn observed that even longtime doctors were likely to order tests as a protective measure against lawsuits. A 2005 study of over 800 doctors in the Journal of the American Medical Association learned that nearly 93 percent said they practiced defensive medicine, and Flynn said it is time for the United States to measure how much of yearly healthcare costs are "wasted" on defensive medicine.



Researchers outline the characteristics of 260 self-identified physicians who use Twitter, with a specific emphasis on professionalism. Three percent of the tweets were identified as unprofessional, with 0.7 percent representing potential privacy violations, 0.6 percent containing profanity, 0.3 percent featuring sexually explicit material, and 0.1 percent including discriminatory statements. Twenty-five of the 27 users responsible for the potential privacy violations were identifiable by full listed name on the Twitter profile, profile photo, or full listed name on a linked site; 1 percent of the tweets were categorized as "other unprofessional," including 12 potential conflicts of interest and 10 statements about medical therapies that contradicted existing medical knowledge or guidelines. The researchers note that self-identified physicians on Twitter share medical information with the public, with unprofessional conduct and ethical breaches observed but rare. The presence of potential patient privacy violations and conflicts of interest was of especial concern, leading to the conclusion that accountability for health professionals may be required to maximize the interaction with social media's possible societal and professional benefits.

Health Policy and Reimbursement

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CMS has published a proposed rule to prohibit Medicaid agencies from using federal funds to pay for medical care resulting from healthcare-acquired conditions. The rule also proposes to authorize states to identify other "provider-preventable conditions," which is a new category CMS intends to create, for which Medicaid payment would be prohibited. Medicare presently lists 27 healthcare-acquired conditions for which it will not reimburse providers. The conditions fall into 10 categories: foreign object retained after surgery, air embolism, blood incompatibility, Stage III and IV pressure ulcers, falls and trauma, manifestations of poor glycemic control, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection, and deep vein thrombosis/pulmonary embolism. The proposed rule can be found here.



President Obama's fiscal 2012 budget proposal has won plaudits from physicians and criticism from hospitals. The president's plan to shift some $50 billion in Medicare and Medicaid payments away from states, insurers, and drug companies over the next decade and invest it into improving physician reimbursements was welcomed by the American Medical Association (AMA). "The president's budget includes a renewed commitment to permanently fix the broken Medicare physician payment system, which the AMA strongly supports," said AMA President Cecil B. Wilson. The budget also contains funding to delay cuts scheduled to occur Jan. 1, 2012, for another two years. Meanwhile, American Hospital Association President Rich Umbdenstock stressed that his organization was "deeply disappointed" with Obama's call for roughly $18 billion in Medicaid cuts over the next 10 years, as well as with the termination of funding for the children's graduate medical education program at a time when a bigger physician workforce is greatly needed.



Although President Barack Obama embraced medical malpractice reform during his State of the Union address, some U.S. House Republicans are concerned that curbing malpractice awards could undermine states' rights. For those seeking medical malpractice tort reforms, the battle could be harder than expected. Legislation being debated by the House Judiciary Committee would impose $250,000 limits on noneconomic damages in medical malpractice cases, but two Republicans already have objected to the measure because they did not want the federal government to override state constitutions barring limits on malpractice awards in state courts. About 28 states already have limits on noneconomic or economic damages.

Medicine, Drugs and Devices

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IBM engineers and Eliot Siegel, vice chairman of the University of Maryland School of Medicine's department of diagnostic radiology, envision IBM's Watson supercomputer working hand-in-hand with doctors and medical specialists. Siegel says he expects Watson to radically enhance patient care through its ability to respond to questions with answers rather than data. Within a year, the system is expected to digest electronic medical records, abstract them for the physician, and cite any causes for concern, highlighting any abnormalities and potential drug interactions. Siegel also is hoping that Watson will have the capability to take patient and treatment data from hundreds, perhaps thousands, of hospitals and organize it into a coherent whole. "It'll have an encyclopedic knowledge and suggest diagnostic and therapeutic possibilities based on databases much larger than one physician can possibly hold in his head," Siegel says. IBM researcher Jennifer Chu-Carroll thinks that sooner or later Watson will possess the speech-recognition capability to listen to patients talk about their symptoms in an exam room while it files through their medical histories, functioning as a physician's assistant.



Surgical sponges embedded with a radio-frequency (RF) chip were spotted 100 percent of the time, an accuracy rate that far exceeds traditional counting or use of radiographs during surgery, according to study published in the February issue of the American Journal of Surgery. The blind medical trial involved the placement of 840 sponges, 619 of which contained the RF chip and 221 of which did not, in nontransparent bags. The bags were attached to 210 participants' torsos and in each of the four abdominal quadrants. Participants were asked to lie on an exam table while doctors waved a special RF wand over them. As the wand passed the area of the participant's torso with the sponge, the device relayed a sound with 100 percent accuracy signaling the presence of a tagged sponge.



A new study published in the Archives of Internal Medicine focused on 113 devices the FDA recalled between 2005 and 2009 for posing serious health risks, and found that 71 percent of the products had undergone an accelerated approval process that excluded clinical testing, while 19 percent were subjected to more rigorous review. This was on account of the majority of the devices being designated as similar to another product already on the market, and the analysis concludes that the FDA is permitting too many medical devices to be sold using the less stringent approval process.