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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

On Monday, President Obama released his outline for provisions he would like to retain in a healthcare reform bill. While many note the president’s proposal is similar to the healthcare reform bill passed in the Senate in late 2009, it does not address several key issues, including the 21 percent cut in Medicare physician reimbursement scheduled to go into effect at the end of February.

Both Democrats and Republicans continue preparations for tomorrow’s bipartisan healthcare summit.
Vogler Honored at Vegas Conference

Harold W. Vogler, DPM, FACFAS, is the 2010 recipient of the ACFAS Distinguished Service Award. This award is presented annually by the ACFAS Board of Directors to recognize long-term, behind-the-scenes volunteerism to the profession and the College. Vogler was selected for over 20 years of leadership in the cause of professional parity and unfettered hospital privileges for podiatric surgeons.

As early as 1990 Vogler was pushing for changes to the Joint Commission and CMS procedures to allow DPMs to conduct histories and physicals in hospitals. As chair of the ACFAS Professional Relations Committee, Vogler’s goal was achieved within the Joint Commission in 2000, which led to similar changes by CMS in 2006.

“Dr. Vogler has been our profession’s leading advocate for parity and privileging, bar none,” says ACFAS President Mary E. Crawford, DPM, FACFAS. “Quite frankly, this honor is long overdue. We are all beneficiaries of Harold’s vision and determination.”

The award will be presented to Vogler in a ceremony today at the ACFAS Annual Scientific Conference in Las Vegas. A listing of past recipients is available on the ACFAS web site.
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Foot and Ankle Surgery

Diabetes Drug Raises Bone Fracture Risk in Older Women

A study at Henry Ford Hospital has found that women with type 2 diabetes who take thiazolidinedione (TZD) for one year are 50 percent more likely to experience a bone fracture. Women older than 65 years of age are at the greatest risk of a fracture from TZD use. "Older women are already at a higher risk of osteoporosis and osteoporosis-related fractures, which might explain why they appeared to be the most affected by TZDs," says study senior author Dr. L. Keoki Williams of the Center for Health Services Research and Department of Internal Medicine at Henry Ford Hospital. The study appears in The Journal of Clinical Endocrinology & Metabolism.

From the article of the same title
Daily News & Analysis (India) (02/11/2010)

In Vitro Measurement of Intraarticular Pressure in the Ankle Joint

Although ankle joint affections and injuries are common issues in sports traumatology and in the daily routine of arthroscopic surgeons, little knowledge about intraarticular loads exists. Researchers ascertained pressures on the ankle in a dynamic model on eight cadavers, applying forces to foot tendons over the stance phase under vertical loading. They observed a characteristic course of loading in the tibiotalar joint with a quick increase upon heel contact, increasing gradually to achieve a maximum after 70 percent of the stance phase, during the push-off phase. The researchers pinpointed the major torque in the ankle joint anterolaterally and demonstrated a dynamic loading curve of the joint, which explains phenomena such as the appearance of osteophytes on the anterior tibia in the case of ankle osteoarthritis and the relatively infrequent occurrence of posterior tibial edge fragments in the case of trimalleolar ankle fracture. Additionally, the medial side of the talus is less loaded versus the lateral side, which seems pertinent to the treatment of osteochondrosis dissecans.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (02/02/10) Suckel, Andreas; Muller, Otto; Wachter, Nikolaus; et al.

Novel Approach to Repair of Acute Achilles Tendon Rupture

A group of researchers conducted a study to determine if a new approach to the repair of Achilles tendon rupture allows early rehabilitation without any postoperative immobilization or orthosis. The procedure involved the application of a side-locking loop technique of the researchers' own design for the core suture, employing braided polyblend suture thread, with peripheral cross-stitches added. Twenty consecutive patients with acute subcutaneous Achilles tendon rupture received the procedure, and they began active and passive ankle mobilization from the next day, partial weightbearing walking from one week, full-load walking from four weeks, and double-legged heel raises from six weeks after surgery. The researchers found that the new Achilles tendon repair method facilitates early mobilization exercise without expensive specialized orthosis or immobilization, permitting an early return to normal life and sports activities.

From the article of the same title
American Journal of Sports Medicine (02/01/10) Vol. 38, No. 2, P. 287; Yotsumoto, Tadahiko; Miyamoto, Wataru; Uchio, Yuji

Postoperative Infection Rates in Foot and Ankle Surgery: A Comparison of Patients With and Without Diabetes Mellitus

Patients with diabetes have an increased risk of severe postoperative infection compared to those without diabetes, according to a retrospective review of 1,000 patients' charts. All of the patients had orthopedic foot and ankle surgery, and there was a 4.8 percent infection rate overall. Although only 19 percent of the patient population had diabetes, they made up 52 percent of all infections that occurred. Compared to patients without diabetes, those with diabetes were five times more likely to have a severe infection that required hospitalization. After excluding patients with neuropathy, however, there was no significant association between diabetes and infection. Diabetes complications also increased the risk of an infection, the researchers noted.

From the article of the same title
Journal of Bone and Joint Surgery (02/01/2010) Vol. 92, No. 2, P. 287; Wukich, Dane K.; Lowery, Nicholas J.; McMillen, Ryan L.; et al.

Practice Management

Docs Wrestle Cultural, Language Barriers: Survey

Almost half of physicians in 2008 reported minor communications problems associated with language or cultural differences, although only 5 percent of physicians surveyed considered this a major problem, according to a survey by the Center for Studying Health System Change (HSC). This survey, "Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities," also found that 7 percent of physicians routinely use information technology to keep track of their patients' preferred languages, and 40 percent have training related to minority health issues. A little more than 50 percent said that their practices offer some kind of interpreter services. These findings were taken from data in the HSC’s 2008 Health Tracking Physician Survey, with responses from more than 4,700 physicians.

From the article of the same title
Modern Healthcare (02/10/10) Lubell, Jennifer

How to Choose the 'Right' Electronic Medical Record System

Physician practices need to be careful when selecting an electronic medical record system to avoid mistakes. Among the factors that must be considered is the human/computer interface, which includes how the system handles claims and the look of the medical record on the computer screen in terms of color, space, placement, size, shape, and form. A monotonous design that hides information can be dangerous, says Joseph Cramer, MD, a pediatrician based in Murray, Utah, who recommends systems that force clinicians to ask and answer questions and says that practices should avoid systems that require numerous clicks to locate information.

From the article of the same title
Modern Medicine (02/05/10) Cramer, Joseph G.

Kiosks: Self-Serve Patient Satisfaction

Kiosks are a common part of our lives, often being found in airports, banks, hotels, and similar places, but they are now starting to be used in doctors' offices. A recent healthcare consumer study showed that kiosks may help consumers obtain better convenience and control, and that 37 percent of consumers surveyed were "extremely" or "very" interested in using a self-service kiosk to help them check in for medical appointments more quickly. Additionally, more than 43 percent of respondents said that they have chosen one medical provider over another because that provider offered self-service. Self-service kiosks can provide consumer information and front/back office functionality by interfacing with registration, schedule, and financial systems. Some organizations have managed to cut patient wait time in half using self-service kiosks.

From the article of the same title
Advance for Health Information Executives (02/10) Gaffney, Kathleen

Health Policy and Reimbursement

Emergency Doctors Back Bill Redefining Malpractice

Emergency physicians in Tennessee are backing a bill designed to protect them, on-call specialists, and hospitals from "unreasonable lawsuits" when they're rendering emergency care. Under the bill, filed last month, the definition of medical malpractice would be changed from "negligence" to "gross negligence," which would raise the bar for mistakes that could trigger a lawsuit. Proponents say the current definition makes it too easy to sue emergency physicians, who are required by federal law to treat all emergency department patients regardless of their abilities to pay, resulting in millions of dollars in extra healthcare costs from doctors practicing "defensive medicine."

From the article of the same title
Tennessean (TN) (02/17/10)

Individual Insurance Rates Soar in 4 States

Consumers in at least four states who buy their own health insurance are facing premium increases of at least 15 percent, and their counterparts in other states could see the same thing. Anthem Blue Cross, a subsidiary of WellPoint Inc. has notified some of its 800,000 individual policyholders in California that it plans to raise rates by up to 39 percent, while the Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent. One unidentified Kansas insurer wanted to raise most individual rates 20 percent to 30 percent but was persuaded by state insurance officials to reduce the increases to 10 percent to 20 percent, and in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year.

From the article of the same title
Associated Press (10/12/10) Johnson, Linda A.

L.A. County Slashes Doctors' Reimbursement Rate

Emergency room doctors and on-call specialists treating poor, uninsured patients at private hospitals in Los Angeles County are set to experience a sharp cut in reimbursement rates. L.A. County reimburses doctors 27 percent of estimated fees for patients' first three days of care at private hospitals under the Physician Services for Indigents Program. Supervisors voted unanimously Tuesday to reduce the rate to 18 percent as of July 1, after reducing the rate from 29 percent in January 2009. The rate cut could lead private hospitals to close emergency rooms and send more patients to crowded county hospitals.

From the article of the same title
Los Angeles Times (02/17/10) Hennessy-Fiske, Molly; Lin II, Ron-Gong

Technology and Device Trends

FDA Gives Hospitals More Time to Transition from Steris SS1

The FDA has extended the deadline to 18 months for hospitals to transition away from using the Steris System 1 processor, used to disinfect medical devices disinfect medical devices in many hospital operating rooms and ambulatory surgery centers. Using the FDA's original December 2009 announcement of the six-month timeframe, the new extension would bring the deadline to August 2011. In an initial safety notice first published in December, the FDA said Steris modified the SS1 and that the agency hasn't approved the modifications yet and that despite discussions with Steris, the agency is not satisfied with the company's response to concerns about providing hospitals with adequate replacements to the SS1. The processor was the only product of its kind for many years, but in recent memory, several alternatives have come on the market.

From the article of the same title
HealthLeaders Media (02/16/10) Wallask, Scott

FDA Memo Hints at Curbs to Approval Process for Medical Devices

An internal FDA memo intimates that the agency may tighten or remove several routes for the rapid approval of medical devices amid worries of industry overuse. According to the memos, officials question the growing use of private firms that are hired by device manufacturers to pre-review products; if the third party passes the device, then the FDA may approve it without much further consideration. The document says the "real value to industry may be that this is perceived as a way to 'sneak things in.'" The FDA initiated a review of device approvals following Wall Street Journal stories about the Menaflex knee implant, which was approved in late 2008 using the fast-track 510(k) process despite the objections of more than six FDA scientists and managers.

From the article of the same title
Wall Street Journal (02/17/10) Mundy, Alicia; Favole, Jared A.

Miniature Ultrasound Device Could Revolutionize Pain Relief

A miniature ultrasound device created by a Cornell biomedical engineering graduate student could one day introduce a whole new level of home therapy for arthritis and other painful ailments The device slips into a pocket and sends ultrasound waves deep into muscles via a coin-sized polystyrene pad that converts electrical energy into ultrasound. Work is underway to prepare the first clinical trial of the device. The study will focus on osteoarthritis patients to determine whether the devices can significantly reduce joint pain. The research is funded by the National Science Foundation.

From the article of the same title
Newswise (02/17/10)

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February 24, 2010