February 27, 2013

News From ACFAS

New Conflict of Interest Complaint Process Launched
ACFAS has historically been the most stringent monitor of conflicts of interest in both its governance and its clinical programs and publications of any podiatric organization. Its efforts were significantly increased early this year with the adoption of a complaint form and enforcement process. The new policies were rolled out at the 2013 Annual Scientific Conference in February to all volunteers, speakers and attendees.

In 2012 the College’s attendee evaluation forms started asking if any commercial bias occurred during the program. Some instances were reported, but no formal process was in place to formally document, adjudicate, and discipline those who violated College policies, especially in the area of product promotion. Now, a new Conflict of Interest Complaint Form is available at, along with details on how complaints will be reviewed and adjudicated.

“Not only is this the right thing to do, it is increasingly expected by your peers, patients, government, and the public,” said ACFAS Executive Director Chris Mahaffey, CAE, FASAE. “We invite all podiatric organizations and educators to adopt similar procedures. If the profession doesn’t self-regulate, the Department of Justice and Congress has shown they will do it for us,” said Mahaffey.
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Register for the 2013 Surgical Skills Courses
The College’s highly acclaimed, hands-on surgical skills course schedule and catalogue for 2013 are now live at Register today and be a part of the learning experience, which includes hands-on cadaveric labs, insightful case presentations and panel discussions throughout each course. Visit the website to download the catalogue and register for the program best suited to your schedule. Act fast because these courses fill up sooner than you think!
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Winners from ACFAS 2013 Exhibit Hall
If you attended the ACFAS 2013 Annual Scientific Conference in Vegas, chances are you gained some knowledge, lost some money and made some new acquaintances. If you are one of the names listed below, you are also a lucky winner of an awesome prize -- congratulations to everyone listed! Check out some photos of our 2013 Exhibit Hall prize winners on the ACFAS Facebook Page. Remember to “Like” it while you’re there!
  • Huoi Lam, DPM – Kindle Fire
  • Anne Massey, DPM – iPad 4 (32GB)
  • Najwa Javed, DPM, AACFAS – iPod Touch (32GB)
  • Shevonne K. Wells, DPM – $200 Gift Certificate
  • Joudy-Ann Dinnall, DPM – $100 Gift Certificate
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Congratulations to iPad Winner, Dr. Michael Stempel
Michael Stempel, DPM, FACFAS, from Washington DC won a 64 GB Apple iPad simply by attending his ACFAS Division 11 “Mid-Atlantic” Membership Meeting in conjunction with the ACFAS Annual Scientific Conference (ASC) in Las Vegas, Nevada. Congratulations, Dr. Stempel!

For all ACFAS members who attended the conference and sat in on their Division’s Membership Meetings, thanks for taking part in the ACFAS Division Presidents Council’s iPad raffle. Please watch your email to learn about your ACFAS Division’s activities happening soon, or you can visit the Division webpages for more information.
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Foot and Ankle Surgery

Diabetic Foot Disease: Impact of Ulcer Location on Ulcer Healing
Researchers looked at how the location of a heel ulcer can affect its healing in diabetic patients. In a study of 1,000 patients, the researchers found that median time to healing for toe ulcers was 147 days, for midfoot ulcers was 188 days, for heel ulcers was 237 days, for plantar ulcers was 172 days and for non-plantar ulcers was 155 days. The researchers used multivariate Cox regression analysis and found that the hazard ratio for ulcer healing for midfoot and heel ulcers compared to toe ulcers was 0.77 and 0.62, respectively. The hazard ratio for ulcer healing for plantar versus non-plantar ulcers was one. Factors that significantly influenced healing were duration of diabetes, ulcer duration, presence of heart failure and presence of peripheral arterial disease.

From the article of the same title
Diabetes & Metabolism Research and Reviews (02/01/2013) Pickwell, Kristy M.; Siersma, Volkert D.; Kars, Marleen; et al.
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Minimally Invasive Distal Linear Metatarsal Osteotomy for Correction of Hallux Valgus
Researchers recently looked at the effectiveness of minimally invasive distal linear metatarsal osteotomy (DLMO) using a radiographic mapping system. The researchers performed DLMO in 30 patients, for a total of 36 feet in all, who had reducible symptomatic hallux valgus. Researchers reviewed radiographs of first ray construct, hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle and other radiographic profiles prior to the operation and as part of a follow-up, and they assessed the clinical trial data based on the AOFAS score. All 36 feet in the study had predominantly moderate hallux valgus, with preoperative AOFAS score of 70.2 plus or minus 11.3 and postoperative score of 95 plus or minus 6.4. The radiographic mapping system showed postoperative improvements of first ray construct deformity, and significant reductions in all angular feet measurements were achieved, correlating with the AOFAS score. The researchers concluded DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate severity.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (03/13) Vol. 133, No. 3, P. 321 Angthong, Chayanin; Yoshimura, Ichiro; Kanazawa, Kazuki; et al.
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What is the Best Clinical Test for Achilles Tendinopathy?
Researchers looked at the diagnostic accuracy of clinical tests used to determine chronic mid-body Achilles tendinopathy. The researchers examined 21 study participants, some of whom had Achilles tendinopathy and the rest of whom did not. Each participant underwent an ultrasound scan followed immediately by 10 clinical tests to determine the accuracy and reproducibility of each test. The researchers found that the location of pain and pain on palpation of the tendon were the most reliable and accurate tests. Pain on palpation of the tendon had a sensitivity of 84 percent and specificity of 73 percent. Subjective reporting of the pain two to six centimeters above the insertion into the calcaneum had a sensitivity of 78 percent and a specificity of 77 percent.

From the article of the same title
Foot and Ankle Surgery (02/14/13) Hutchinson, Anne-Marie; Evans, Rhode; Bodger, Owen; et al.
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Practice Management

Real-Estate Management for Physician Practices
Managing debt, liability and loss with your real estate—including real estate outside of your practice—can be tricky and stressful. When dealing with debt, you should first make sure you understand the limits and extents of any personal guarantees you sign. Any leases, indemnity agreements or other legal documents should be drafted by a lawyer or reviewed by an experienced real estate lawyer before you use them. You should also seek out an accounting professional to make sure you get the most of out your yearly tax refunds. By using energy studies and cost segregation studies, you can reduce your overall long term costs and save more money as a result. When analyzing a property, you should avoid lease audits offered by some real estate lawyers and accounting firms, as these are often inaccurate and misleading.

As a property owner, you are responsible for the health, welfare and safety of patients visiting your practice and those who might be renting out properties you own. You should have specific written policies in place that dictate the proper use of a property and any penalties associated with violating that proper use. Insurance guarding against accidents or other incidents that occur on your property is a good start to achieving protection, but it is only one step. You should consult with your legal counsel to see what other steps can be taken, such as implementing a personal asset protection plan that designates how to manage the risks associated with your assets. While loss follows closely with liability, you should still be sure to insure yourself separately against it and against property damage.

When choosing an insurer, make sure they are a large, top-rated national insurer that you can sue for bad faith practices if they fail to pay out legitimate claims under your policy. As the owner or manager of a property, you need to make sure you have coverage for general liability and professional malpractice, as well as directors' and officers' insurance if you are personally responsible for major decision-making. Insurance should be pursued before an event occurs, as insurance after the fact is considerably more pricey and less likely to work.

From the article of the same title
Physicians Practice (02/05/13) Devji, Ike
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Tool Lets Physicians Compare What Insurers Are Paying
The amount of money insurers are paying can be compared between companies through use of a total relative value unit (RVU) analysis. The more common use of RVUs is for quantification of practice productivity, but using them to compare insurers is deemed important because they are the only way to evaluate contracts that typically state a payment based on a percentage of Medicare, but use different base years or conversion factors depending on the plan. The data can be managed by most spreadsheet software programs.

The first step involves identifying the 20 to 30 most frequently billed CPT codes as the focus of the analysis. The total RVU number, which adds in the work, practice expense and malpractice sums for each of these codes, should be determined by accessing the American Medical Association’s coding website or other databases. The information also may be compiled from some practice management systems. The next step is identifying the payers doing the most business with the practice, and smaller payers may not warrant the time the process takes. Following this is a count of the sum of money paid by an insurer for a specific CPT code over a one-month period. The total should be divided by the sum of RVUs carried out by a practice when performing a particular service. Analysis should not include services that have not been fully adjudicated, but it should include denied services, which is important because denials can reduce the average and signal difficulties with the payer.

The resulting numbers should be compared with each other and with benchmarks available from practice consultants. Trellis Healthcare's InfoDive estimates that the benchmark collection per RVU for all payers across the country is $41.98, but this can vary from $30.28 for Medicaid to $45.55 for the average commercial payer, depending on the locale. The information can be an element of contract negotiations, but practice management consultants note that it may contribute to decisions of whether to keep working with a particular insurer. Experts advise considering these numbers along with factors such as the burden of dealing with a specific company. The analysis also can be used in capitation scenarios. The payments should be divided by the number of RVUs supplied during a set period to ascertain the amount of money received per unit. Practices should apportion their own RVU numbers for services that have not been assigned one.

From the article of the same title
American Medical News (02/11/13) Elliott, Victoria Stagg
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Health Policy and Reimbursement

Doctors, Lawyers Support Oregon Medical Errors Bill
Doctors and trial lawyers both support an Oregon bill to create a new mediation process for patients injured by medical mistakes, which could reduce medical liability claims. Under the measure, injured patients would be able to confidentially discuss the medical error, a possible settlement with the hospital or clinic where the error occurred, and could possibly receive the aid of a professional mediator. Proponents hope the measure will encourage frank discussion, as participation would be voluntary, but the discussions would not be admissible in court should a lawsuit be filed.

From the article of the same title
Associated Press (02/17/13) Cooper, Jonathan J.
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HHS Issues Final Rule for Essential Health Benefits
The Department of Health and Human Services (HHS) has released a final rule for health benefits requiring coverage by 2014 by individual and small group plans that were enacted since passage of the Affordable Care Act (ACA) on March 23, 2010. The final rule implements an ACA mandate that the plans cover essential health benefits (EHBs) for 10 categories of care, including basic services such as hospitalization and emergency care, along with mental health and maternity care. The plans also must cover at least 60 percent of the actuarial value of covered medical services. The final rule can be accessed here.

From the article of the same title
BNA's Health Care Daily Report (02/20/13) Hansard, Sara
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NCQA Issues First ACO Accreditations
The National Committee of Quality Assurance (NCQA) announced its first six physician-hospital networks that are accredited as accountable care organizations (ACOs). NCQA determines the quality of each ACO based on 65 elements. In order to qualify, organizations must measure and report quality metrics, have adequate specialists and primary care providers available and provide various forms of care. NCQA officials say many facilities have begun labeling themselves as an ACO without set standards, which led to the need for an accreditation process.

From the article of the same title
HealthLeaders Media (02/19/13) Clark, Cheryl
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Medicine, Drugs and Devices

Surveyors Temporarily Stop Scoring One Requirement of SSI NPSG.07.05.01, EP 5
Joint Commission organizations will no longer be cited on a specific requirement in element of performance (EP) 5 of the National Patient Safety Goal on surgical site infection (SSI) prevention, NPSG.07.05.01. The statute previously required measurement of surgical site infection rates for the first year following procedures involving implantable devices. Organizations will still be required to measure surgical site infection rates for the first 30 days following procedures that do not involve inserting implantable devices. The change was made following revisions by the Centers for Disease Control and Prevention (CDC) to its long-standing requirement for organizations to conduct SSI surveillance for one year after a device is surgically implanted in a patient. The CDC no longer requires one-year surveillance for all procedures in which devices/materials have been implanted during a surgery. Instead, surveillance is now required for 90 days after certain National Healthcare Safety Network (NHSN) operative procedures.

From the article of the same title
Joint Commission Online (02/20/13)
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The Effect of Foot Orthoses on Balance, Foot Pain and Disability in Elderly Women with Osteoporosis: A Randomized Clinical Trial
The impact of insoles with medial arch support and metatarsal pad on balance, foot pain and disability in elderly women with osteoporosis was measured through a randomized clinical trial. Ninety-four elderly women with osteoporosis being treated at the Rheumatology Division of UNICAMP were randomly assigned to an intervention group (IG) with foot orthoses or to a control group (CG) without orthoses. The Berg Balance Scale, the Timed Up and Go test, the Manchester Foot Pain and Disability Index and a numeric pain scale were evaluated at baseline and after four weeks. A comparison of baseline values between the IG and the CG was executed through application of the chi-squared test, Fisher’s exact test and Mann-Whitney test. Longitudinal measures were compared via repeated measures of analysis of variance followed by Tukey’s test for multiple comparisons and the contrast profile test. The Spearman coefficient was employed for numeric variable relationship analysis. The IG and the CG exhibited similarity at baseline, while only IG patients showed improvements in balance, foot pain and disability.

From the article of the same title
Rheumatology (03/01/13) Vol. 52, No. 3, P. 515 Barbosa, Cecilia de Morais; Bertolo, Manoel Barros; Neto, Joao Francisco Marques; et al.
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The Effectiveness of Extracorporeal Shock Wave Therapy on Chronic Achilles Tendinopathy
A systematic review was performed to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in treatment of insertional and noninsertional Achilles tendinopathies. A search of articles from the Cochrane Controlled Trials Register, MEDLINE, CINAHL, EMBASE and SPORTDiscus was conducted, and studies merited inclusion if they were prospective clinical trials examining the effectiveness of ESWT for insertional or noninsertional Achilles tendinopathies. Four of the included studies were randomized controlled trials, while two were pre-post study designs. Not blinding the clinician and participants were among the included common methodological deficiencies. Evidence was consistent from four reviewed studies on the effectiveness of ESWT in the management of patients with chronic Achilles tendinopathies at a minimum three months' follow-up.

From the article of the same title
Foot & Ankle International (01/13) Vol. 34, No. 1, P. 33 Al-Abbad, Hani; Simon, Joel Varghese
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