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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

Discover how to make the most of your member benefits at the ACFAS booth

Did you know you can give ACFAS' free patient newsletter to your patients? Sign up confidentially to find a new job or employee? Get CME credit for participating in convenient, 24/7 eLearning sessions?

Come to the ACFAS booth at the Annual Scientific Conference in Washington, D.C. for a whirlwind tour of the great things ACFAS offers to help you and your practice. They include practice marketing tools, patient education materials, the Surgical Techniques Series online and more.

While you're packing to travel to Washington, please remember to bring one or more pairs of socks to donate to the homeless. ACFAS is partnering in this charitable effort with sponsor DOX Podiatry and The National Coalition for the Homeless. By providing socks, we can show our concern for the foot health of the homeless in our host city.
New Guideline Published in Current Issue of JFAS

A new ACFAS Clinical Practice Guideline (CPG) has been published in the March/April issue of the Journal of Foot & Ankle Surgery (JFAS). The journal is on its way to you in the mail, but you can read the CPG and other articles in this issue now by using the Web link below.

The CPG, “Diagnosis and Treatment of Forefoot Disorders,” appears in five parts: Digital Deformities, Central Metatarsalgia, Morton’s Intermetatarsal Neuroma, Tailor’s Bunion, and Trauma.

Copies of JFAS will also be available during Annual Scientific Conference at the publisher’s booth #603 in the exhibit hall.

Learn leading-edge diabetic skills at July 9-11 summer summit in California's wine country

Bring an eager mind and a discerning palate to the Diabetic Surgery Seminar and Workshop, which will be held July 9-11 at the Hyatt Vineyard Creek in Santa Rosa, Calif.

New diabetes research and techniques mean caring for patients is ever-changing. This seminar will bring you up-to-date on the latest so you can give your patients the fruits of new approaches. It will deliver carefully-considered information on topics such as Surgical Principles, Flap Surgery, Ulceration, Equinus, Charcot, Osteomyelitis and Amputation. Didactic sessions will take place from 7 a.m. to 1 p.m. and an optional wet lab will be offered Friday afternoon.

Friday evening's "Wine & Wisdom" participants will discuss controversial and challenging cases in a relaxed setting. Allow time to enjoy Santa Rosa's attractions, which include biking, hiking the bluffs of Bodega Bay, kayaking on the Russian River, 200 wineries, lovely golf courses and hot-air ballooning.
Watch for registration details on and in "This Week@ACFAS."
Update has a fresh, new look! Check it out when it arrives in your mailbox

Find out three ways changing your staff's habits can save you money. Learn which new CME courses are debuting this year. And read about the progress ACFAS made last year on defending podiatric surgeons' scope of practice.

It's all in the new issue of "Update," which has been redesigned and is coming to you in a more compact, easy-to-handle format. It has new colors and a fresh look, it's easier to navigate, and it will publish more frequently. As a bonus, it is environmentally friendly. It uses vegetable-based inks and recycled-content paper. Give it a read when it arrives in your mailbox this week.

Foot and Ankle Surgery

Takeda Wins U.S. Approval for First New Gout Drug in 40 Years

Leading Asian drugmaker Takeda Pharmaceutical has won approval from the U.S. Food and Drug Administration (FDA) to sell its febuxostat medication for gout, the first new gout treatment approved since 1966. The drug for controlling excess uric acid in the blood, which can build up in joints or soft tissues, will be marketed under the name Uloric. "This approval is a significant milestone for Takeda," Alan MacKenzie, president of Takeda Pharmaceuticals North America, Inc., said in a statement. "We are pleased to offer a new treatment option to the more than five million Americans who have hyperuricemia associated with gout." Takeda tested the drug against generic allopurinol, the most common prescription for cutting down on uric acid in the blood; doctors have been discouraged from using the highest doses of allopurinol because of concern about the possibility that it can cause rashes or fatal skin reaction.

From the article of the same title
Bloomberg (02/14/09) Matsuyama, Kanoko; Larkin, Catherine

Cell Injections Accelerate Fracture Healing, According to Recent Study

Research recently published in BMC Musculoskeletal Disorders indicates that the healing of long bone fractures can be sped up through the injection of osteoblast cells cultured from the patient's bone marrow. The study involved the participation of 64 patients with long bone fractures, 31 of whom were given the cell injection treatment while the rest were left to heal normally. "The cultured osteoblast injection group showed fracture healing acceleration of statistical significance, and there were no specific patient complications when using this treatment," stated corresponding study author Seok-Jung Kim, MD, from the Catholic University College of Medicine in Seoul. The injections' effectiveness was assessed using modified callus formation scores. "We believe that an osteoblast transplant that achieves bone union may be a successful alternative to autologous bone transplant," said Kim. "In addition, if such osteoblast transplants could be used for all fracture patients, not only an early return to their daily routine but also the prevention of complications following surgery, such as delayed union and nonunion, could also be anticipated."

From the article of the same title
Ortho Supersite (02/01/2009) Press, Robert

New Guidelines Help Doctors Diagnose Elusive Nerve Problem Called Neuropathy

A group of 19 physicians has put together the first evidence-based guidelines for diagnosing distal symmetric polyneuropathy, which were published in a recent edition of the journal Neurology. Distal symmetric polyneuropathy is the most common type of peripheral neuropathy, affecting more than 20 million people in the United States. The guidelines aim to help physicians accurately diagnose distal symmetric polyneuropathy when it is the cause of foot problems in patients, rather than diagnosing other conditions and attempting to treat them only to find that the foot problems persist. It is important to be able to diagnose it early, so that people who are pre-diabetic can use exercise and diet to manage their weight to reduce their risk of becoming diabetic. Physicians should be aware of problematic symptoms, which include not only pain or burning sensations in the feet but also numbness.

From the article of the same title
Rochester Democrat & Chronicle (NY) (02/18/09) Swingle, Chris

Could Carbon Dioxide Replace Antibiotics in Surgery?

Mikael Persson and Jan van der Linden from the Karolinska Institute in Sweden have won the journal Medical Hypotheses' 2008 David Horrobin prize for medical theory for their article "Intraoperative CO2 insufflation can decrease the risk of surgical site infection." The article suggests that continuously flooding a wound with carbon dioxide gas during surgery could suffocate germs and prevent airborne bacteria from reaching the wound. It would also maintain warm and moisture in the wound, which could cut down on tissue damage and accelerate healing. "I chose this because the hypothesis revolves around a very unusual approach to an extremely common and important clinical problem and the authors seem to have gone someway to defining the route to which it could be tested by appropriate clinical trial," says prize judge Sir David Weatherall, Emeritus Regius Professor of Medicine at the University of Oxford.

From the article of the same title
Science Daily (02/12/09)

Practice Management

Tax Breaks for You in the Federal Bailout

The Emergency Economic Stabilization Act of 2008 (EESA) that was signed into law this past fall provides members of the health care industry with a variety of tax breaks, since most doctors are considered small business owners. Individuals with higher incomes will now face the effects of the alternative minimum tax, since the IRS increased the amount of money workers need to make in order to face deductions. A larger number of middle-class citizens are also now affected since Congress did not include inflation when calculating the exemptions. The law also decreases the cost recovery time to 15 years for people who have made upgrades to their leased properties. This assists physicians that are improving their practices. In addition to tax breaks for property improvements, the law extended tax credits to medical practices that become more environmentally aware. Medical facilities in lower-income areas could benefit from the New Markets Tax Credit, which provides tax incentives for people that invest in those practices. Finally, if medical personnel become more innovative by purchasing plug-in electric-drive cars, they can see a tax credit up to $7,500.

From the article of the same title
Medical Economics (02/05/09) Battersby, Mark E.

Reviewer of Dining Helps Rate Doctors

Nina Zagat, the co-founder of Zagat survey guides, is entering a new market by pairing up with insurance company WellPoint to review doctors. By entering the healthcare sector, Zagat is helping to develop a completely different product. Zagat guides typically focus on restaurants, golf courses, hotels, spas, movies, and nightlife activities. The Zagat guide for doctors follows the same format as its predecessors. WellPoint carriers can go online and express opinions of their doctors and rate them in various categories. Ms. Zagat says that the reviews are supposed to assist with choosing a doctor, but they are not meant to be the only determining factor. Many physicians are opposed to the survey system. Dr. William Handelman, president of the Connecticut State Medical Society, says, "It is curious that they would go to a company that had no experience in health care to try to find out how good a doctor is. It is certainly very subjective." Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, echoed the disapproval, stating, "There is no correlation between a doctor being an inept danger to the patient and his popularity."

From the article of the same title
New York Times (02/16/09) P. B8; Freudenheim, Milt

Court Sides With Doctors on Privacy of Medicare Claims, Reverses 2007 Ruling

The U.S. Court of Appeals for the D.C. Circuit ruled on Jan. 30 that a consumer group does not have the right to receive and publicize Medicare physician claims data because it would violate doctors' right to privacy. The ruling overturns a 2007 decision by the U.S. District Court for the District of Columbia that favored Checkbook/Center for the Study of Services' (CSS') demand for selected data from all Medicare claims submitted in 2004 by physicians in Illinois, Maryland, Virginia, Washington and the District of Columbia. The federal appeals court concluded that the requested Medicare claims data is exempt from disclosure under the Freedom of Information Act. The data Checkbook/CSS was after included the diagnosis, type of procedure, place of service and the Medicare ID number of the doctor who carried out the service. The court determined that an individual could use the Checkbook/CSS resource to estimate the total annual Medicare payments made to a specific doctor, since related physician personal information is all publicly available online, as are the Medicare fees a physician gets for performing a specific procedure. The American Medical Association (AMA) declared that the latest ruling was a "major victory" for preserving physician privacy and for protecting patients who otherwise could have received faulty data. "We are in favor of patients having information that's evidence-based and statistically balanced, but the problem with the request by Consumers' Checkbook is that it's raw billing data, which could be misleading to society," said speaker of the AMA House of Delegates Jeremy A. Lazarus, MD. "Unless it's tied to quality measures and an adequate patient size, then it could be damaging."

From the article of the same title
American Medical News (02/16/09) Silva, Chris

Health Policy and Reimbursement

Cigna to Stop Using Flawed Insurance Database

Cigna will stop using a database operated by Ingenix, a unite of the UnitedHealth Group, to calculate reimbursement rates for patients seeing doctors outside of their insurance networks, the latest victory in New York Attorney General Andrew Cuomo's fight against insurers' alleged intentional underpayment for out-of-network services. Cigna will also contribute $10 million to a new independent payment database, though a class-action lawsuit against it has not been settled, making it unclear whether the insurer will reimburse customers who overpaid for past services. Cuomo also announced intentions to sue Excellus Health Plan of Rochester, N.Y., for allegedly defrauding consumers by manipulating rates. Meanwhile, Cuomo has announced that an agreement with WellPoint has been reached, calling for the insurer to contribute $10 million toward the creation of the independent database.

From the article of the same title
Associated Press (02/18/09)

U.S. to Compare Medical Treatments

As part of the economic stimulus bill, the federal government will for the first time be given substantial funding for comparing the effectiveness of various treatments for specific illnesses. Researchers will receive $1.1 billion to compare drugs, medical devices, surgeries, and other treatment methods, and a council of up to 15 federal employees will coordinate the research and advise the president and Congress on spending. This is prompted by increasing concerns that doctors have little solid evidence of the value of treatments, and supporters hope it will allow for saving money in the long term by discouraging expensive treatments that are not effective. Economists and health policy experts have been discussing the merits of such research for close to a decade, and similar bodies already exist in other countries such as the United Kingdom and France. The idea has sparked great concern among pharmaceutical and medical device lobbyists, who are worried that insurers or the government will use the information to deny coverage for more expensive treatments; Republican lawmakers and conservative commentators have similarly complained that it would allow for federal intrusion in a person's health care. However, the idea has been backed by consumer groups, labor unions, large employers, and pharmacy benefit managers, who say it will give doctors and patients more information and help save lives.

From the article of the same title
New York Times (02/15/09) Pear, Robert

Online Health Data in Remission

The U.S. Congress's economic stimulus package allocates $19 billion for the computerization of U.S. health care records, an initiative that has been held back by issues that include cost, liability, an absence of universal protocols for collecting data, and rules defining how, with whom and under what conditions the data can be shared. Doctors and their practices stand to receive $44,000 to $64,000, and hospitals as much as $11 million, as incentives to computerize their medical records. Providers who treat Medicare and Medicaid patients and have not computerized their systems within five years could be stripped of funding, which could be a major impetus since the federal government spends in excess of $600 billion annually on 80 million Americans through Medicare, Medicaid and other programs. Vendors say many doctors' offices and smaller hospital systems have abstained from adopting available systems due to cost and uncertainty whether the one they choose ultimately would adhere to federal standards. The anticipated demand for workers with technology skills who can help deploy medical record systems and then train doctors and health-care workers to use them will require training programs. Ritu Agarwal with the University of Maryland's Robert H. Smith School of Business says launching such programs is "not an easy thing to do."

From the article of the same title
Washington Post (02/16/09) P. D1; Huslin, Anita

Technology and Device Trends

Below-knee Cast Endorsed for Severe Ankle Sprains

Investigators at England's University of Warwick say a below-knee cast or air-cell brace speeds up the healing of severe ankle sprains compared to a Bledsoe boot or tubular compression bandage. According to their report in the Feb. 14 issue of The Lancet, lead researcher Sarah Lamb, D.Phil., and colleagues found that the 10-day below-knee cast and the Aircast saw a 8 percent to 9 percent improvement in 90-day recovery quality compared to a tubular compression bandage, while the Bledsoe boot's improvement was not significantly different from that of the tubular compression bandage. "Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts." In addition, they wrote, "Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device. Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment." The researchers' multicenter, randomized clinical trial involved 584 patients who had suffered a severe ankle sprain that was treated in emergency departments.

From the article of the same title
MedPage Today (02/12/09) Bankhead, Charles

Promising Preliminary Results Seen With Ankle Distraction for Post-Traumatic OA

Ankle distraction could improve pain relief and function in young and active patients with endstage post-traumatic ankle osteoarthritis (OA), according to emerging research from the University of Iowa. An ongoing prospective study involves the assessment of 40 patients with Stage IV post-traumatic OA who were randomized to receive either three months of ankle distraction alone or three months of ankle distraction with intermittent motion. "I would say about three-fourths of the patients have benefited from the distraction procedure," said University of Iowa researcher Annunziato Amendola, MD. A comparison of preoperative and 24-month postoperative average Ankle Osteoarthritis Scale subscale scores indicates a 25-point reduction in pain and a 30-point decrease in disability. Amendola said pin tract infection was the most commonplace complication, and it was usually treated with local wound care and antibiotics. He reported that the degree of distraction used for the study was based on research conducted by investigators from Utrecht University, noting that "a lot of these parameters—about how much should you distract, how long should you distract, should you use motion or no motion—are not fully determined about what is optimal." Distraction is not recommended for older patients with poor bone stock or misalignment, said Amendola.

From the article of the same title
Orthopedics Today (02/09) Brockenbrough, Gina

Research by D.A. Porter and Colleagues in Foot and Ankle Research Provides New Insights

Research led by David A. Porter, MD, appearing in Foot & Ankle International compared the use of 5.5-mm cannulated screw fixation for fifth metatarsal stress fractures in athletes to use of a 4.5-mm screw. Twenty athletes were treated with a 5.5-mm cannulated screw. After the operation, this cohort wore a removable walking boot, applied cold compression, initiated immediate range of motion, and used crutches for 1 week. Average radiographic healing was 96.7 percent and all fractures healed clinically. Athletes returned to sports in an average of 9.3 weeks, with three re-injuries treated with 2 weeks in a walking boot. No patients required screw removal or experienced pain at the hardware site, except the three who were reinjured. No differences were found when compared to an earlier study of use of a 4.5-mm screw, except there were no re-fractures in the 4.5-mm study, though there were three bent screws. The researchers concluded that surgical fixation for the fracture type studied was effective but were not able to determine the optimal surgical procedure. "We were unable to demonstrate significant improvement over the 4.5-mm screw and thus cannot conclude that a larger screw is more effective."

From the article of the same title
Medical Imaging Week (02/21/09) P. 193

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February 25, 2009