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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

The U.S. Senate has voted 78-19 to delay a 21 percent cut in Medicare reimbursement to physicians for 30 days. Sen. Jim Bunning, R-Ky., agreed to a vote Tuesday night after blocking the measure since last week.

This measure is retroactive to March 1, when the pay cut went into effect, and is intended to give Congress time to adjust the sustainable growth rate (SGR) formula, which links Part B Medicare reimbursement to the gross domestic product. Physician groups have repeatedly called for a permanent fix to what most see as a deeply flawed formula for reimbursement.

With no major bipartisan agreement resulting from last week’s healthcare summit, President Obama is expected to present a refinement of his compromise health reform bill this afternoon. Reform watchers predict the bill will incorporate some GOP proposals in an attempt to win over Republicans and gain the votes of undecided Democrats. Democrats may try to enact some version of health system reform under the rules of reconciliation, which would allow Senate passage by a simple majority and avoid a filibuster by Republicans.
New Online Audio and Video Education

The class will start when you are ready at ACFAS e-Learning! Refine your skills anytime with information from this valuable online library. The newest additions are:
    Podcast: Lis Franc Pathology
      Surgeons discuss approaches for evaluation and intervention with Lis Franc injuries, including how to diagnose subtle injuries; whether to pursue conservative care or to operate; and choices in surgical technique, types of fixation, and post-operative care.
    Scientific Session: Musculoskeletal Tumors
      An exploration on video of the challenges involving soft tissue tumors and bone tumors of the lower extremity, including case presentation and discussion with an emphasis on differential diagnosis.
Visit ACFAS e-Learning to download podcasts, view scientific session videos and browse all the educational offerings.
Record Numbers Swell Scientific Conference

More than 1,500 foot and ankle surgeons, residents and students thronged to Las Vegas to gain the latest podiatric medical knowledge at ACFAS’ 68th Annual Scientific Conference, February 22–25, 2010. While enjoying the Vegas vitality, attendees were able to:
  • Learn about the most recent research and new discoveries for the practice of foot and ankle surgery through manuscript sessions, scientific posters, panels and workshops.
  • Discover the latest e-Learning podcasts and videos, practice marketing tools, and patient education information available to members on the ACFAS web sites.
  • View new advances in medical devices, supplies and services from the industries that support podiatric medicine.
  • Contribute to Socks for the Homeless, a drive sponsored by the ACFAS Consumer Education Committee and Dox Podiatry, benefiting The Shade Tree, a Las Vegas shelter for homeless and abused women, children and their pets.
Don't miss the most valuable clinical program in the profession! Make your plans now to join us March 9–13, 2011, for the ACFAS Annual Scientific Conference at the Broward County/Fort Lauderdale Convention Center, Florida.

Foot and Ankle Surgery

Combined Rotation Scarf and Akin Osteotomies for Hallux Valgus: A Patient Focused 9 Year Follow Up of 50 Patients

A recent study extended the follow up period for surrogate measures like x-ray angles, which are commonly reported at only a year post operatively, to a minimum of eight years, with the intention of address specific patient concerns with hallux valgus surgery. The extended follow up also enabled a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies. From 1996 to 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. A follow up with 50 patients enabled the review of 73 procedures, with an average follow up of over nine years. In 86 percent of participants there were no footwear restrictions post-operatively. A great majority, 96 percent, were better after surgery, and 88 percent were satisfied with their post-operative result. The study concluded that, when combined, the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that results in good long-term correction with a low incidence of recurrence, footwear restriction, or metatarsalgia.

From the article of the same title
Journal of Foot and Ankle Research (02/15/2010) Kilmartin, Tim E.; O'Kane, Claire

Lasofoxifene Helps Reduce Risk of Bone Fractures

Low doses of the medication lasofoxifene can reduce the risk of vertebral and non-vertebral fractures in postmenopausal women with osteoporosis, according to a study published in the New England Journal of Medicine. Lasofoxifene, a non-steroidal selective estrogen receptor modulator, had previously been shown to decrease bone loss and bone weakening in postmenopausal women, but its wider benefits had not been studied. In the latest study, patients who took lasofoxifene experienced fewer vertebral fractures than the placebo group—a 58 percent reduction in the patients taking 0.5mg a day and 31 percent reduction for those taking 0.25mg a day—and non-vertebral fractures (24 percent and 10 percent, respectively). Those taking lasofoxifene also experienced increases in bone density compared to the placebo group.

From the article of the same title
Newswise (02/23/10)

Radiologists Describe Sonographic Appearances Associated With Os Peroneum Pain

A recent study has found that the causes of lateral ankle pain with a co-existent os peroneum are multifactorial and may not be directly related to the presence of an os peroneum. For this reason, researchers find that ultrasound can be of value in separating out the specific etiology for pain. It may also provide a method for problem solving by the performance of targeted diagnostic or therapeutic injections in the lateral ankle. These recommendations were based on researchers' search of an ultrasound database using the keyword "os peroneum". A total of 47 patients referred for sonographic evaluation of lateral foot and/or ankle pain who had an os peroneum identified during the sonographic evaluation were found. Radiographs were available for correlation in 28 patients. All patients had tendinosis of the peroneus longus, while 18 patients were referred specifically for targeted injection of the lateral ankle.

From "Sonographic Evaluation and Sonographic-Guided Therapeutic Options of Lateral Ankle Pain"
HSS Journal (02/10) Sofka, Carolyn M.; Adler, Ronald S.; Saboeiro, Gregory R.; et al.

Treatment Outcome of Enchondroma by Simple Curettage Without Augmentation

Researchers have conducted a study exploring simple curettage for enchondroma without augmentation, which is known to lead to spontaneous bone consolidation at the curettage site, a potential standard treatment. In the study, 38 patients with enchondroma were treated with simple curettage without augmentation, and a historical group of patients with enchondroma were treated with hydroxyapatite reconstruction. Bone formation was confirmed in all cases, with an average of 6.5 weeks and a range of three to 20 weeks, and there were no surgery-related complications. Tumor size, represented by two-dimensional measurements, was significantly correlated with the bone formation period. Polycystic lesions required a prolonged postoperative bone formation period, compared to monocystic lesions. The bone formation period did not was not significantly different between the two patient groups. The researchers conclude that simple curettage without augmentation is a safe, promising method for the treatment of small enchondromas in the hand and foot.

From the article of the same title
Journal of Orthopaedic Science (01/01/10) Vol. 14, No. 1, Morii, Takeshi; Mochizuki, Kazuo; Tajima, Takashi; et al.

Practice Management

Beyond Informed Consent to Include Risk

Communicating information about risk to patients is one of the most important skills a doctor can learn. However, even with the best efforts there is still a chance that a patient will misunderstand the risk or dismiss those conversations. To improve risk communication, determine if you are explaining risk in absolute or relative terms. For example, if a new drug reduces the odds of dying from cancer from 20 in 1,000 people to 10 in 1,000, that risk goes from 2 percent to 1 percent in absolute terms. A relative risk express of the same information would be that the risk of death from cancer has decreased by 50 percent. While the relative figure may be technically accurate, it makes the decrease in risk seem far more impressive than it is in reality. Expressing risk in absolute terms to patients gives the most complete picture, though doctors must also take into consideration a patient's emotional state and their education level. Committing to providing patients with the most balanced and accurate information will strengthen trust between doctor and patient, and using absolute terms is a perfect way to demonstrate that commitment. If you are unsure whether a patient fully understands the level of risk, ask the patient specific questions, like the possible side effects of a medication or procedure, or have them repeat back specific instructions or risks.

From the article of the same title
Medical Economics (02/19/10) Saylor, Benjamin P.

ID Theft Rule Decision Offers Doctors a Way Out

On Dec. 1, 2009, the U.S. District Court for the District of Columbia blocked the Federal Trade Commission (FTC) from applying the red flags rules to attorneys, which has prompted the American Medical Association (AMA) to petition the FTC for a similar exemption for health care professionals. The red flags rules require health professionals to implement a formal identity theft prevention program or face penalties, and it sparked concerns from organized medicine that it would place an unnecessarily onerous burden on physician practices and hike health care costs. "The [American Bar Association] decision should force some kind of pointed discussion between the FTC and the provider community," and it would provide health professionals with a stable foundation to bring similar action, according to Lucy C. Hodder with Rath Young Pignatelli. Among the organizations that joined the AMA's petition for an exemption for health professionals was the American Osteopathic Association, the American Dental Association, and the American Veterinary Medical Association.

From the article of the same title
American Medical News (02/15/10) Sorrel, Amy Lynn

Physician Workweek Declined by 4 Hours During Past Decade

The work hours of U.S. physicians fell from 55 to 51 between 1996 and 2008, according to a study published in the February 24 issue of the Journal of the American Medical Association. The study's goal was to assess physician work hours and their relationship to declining fees. In tandem with the decline in hours, physician fees fell by 25 percent, after adjustment for inflation, between 1995 and 2006. The exact relationship between reduced fees and fewer hours remains unclear, however. "When fees decrease, a physician earns less for working an additional hour, all else equal, and may have less incentive to work long hours," the authors write. "However, the evidence on the relationship between fees and work hours is mixed, with some studies finding that lower fees encourage physicians to work more hours to achieve a target income." According to the researchers, physicians have attempted to make up for the loss in income in a myriad of ways: by decreasing time spent in activities other than patient care, offering more ancillary services and increasing their ownership in such services, or spending less time with each patient.

From the article of the same title
Medscape (02/23/10) Larson, Nancy Fowler

Health Policy and Reimbursement

Anthem Blue Cross Plans to Go Ahead With Rate Hikes in California

Executives from Anthem Blue Cross said they expected that planned rate increases would go forward. Appearing before the state Assembly's health committee, the officials said that they believed rate increases for individual health insurance policies, delayed until May 1 while being reviewed by the Department of Insurance, would survive scrutiny.

From the article of the same title
Los Angeles Times (02/24/10) Helfand, Duke

Doctor Training Aided by Drug Industry Cash

More than 50 percent of U.S. medical residency programs to train doctors in internal medicine accepted financial support from the drug industry even though 75 percent of the programs' directors said accepting the aid was “not desirable,” according to a study published in the online version of The Archives of Internal Medicine. The survey, conducted in 2006 and 2007, found that drug companies paid for educational materials like pocket guides in 83 percent of the programs that accepted support, meals in 90 percent, office supplies in 68 percent, and drug samples in 57 percent.

From the article of the same title
New York Times (02/22/10) Wilson, Duff

House Votes to Revoke Health Insurers' U.S. Antitrust Exemption

The U.S. House voted 406-to-19 in favor of legislation to eliminate health insurers' exemption from federal antitrust laws. During debate, U.S. Rep. Louise Slaughter (D-N.Y.) said, "This will enable the Justice Department to begin aggressively enforcing the laws that protect the consumers against the cartel of health insurers who wield outsize influence in the healthcare industry." Despite recent reports from the Congressional Budget Office and Congressional Research Service that indicate little reason to believe that the measure will reduce health insurance premiums, the White House issued a statement in support of the measure's ability to do just that. The larger healthcare reform measure remains stalled in Congress.

From the article of the same title
Bloomberg (02/24/10) Woellert, Lorraine

States Look Beyond Washington on Health

Some states, frustrated by halted federal efforts to overhaul the U.S. healthcare system, are introducing their own changes at the state level. Utah, for example, is working on its a 10-year healthcare overhaul plan. Utah's House of Representatives this month approved a measure that would require the governor and legislature to sign off on any changes in the healthcare system mandated by federal legislation. In Pennsylvania, officials are pushing to provide around-the-clock, non-emergency care for patients who might otherwise seek out emergency rooms to treat minor ailments occurring outside of doctors' office hours.

From the article of the same title
Wall Street Journal (02/22/10) Thiruvengadam, Meena

Technology and Device Trends

Artificial Foot Recycles Energy for Easier Walking

An artificial foot that recycles energy typically wasted in between steps could make it easier for amputees to walk. Compared with conventional prosthetic feet, the new prototype device significantly cuts the energy spent per step. A paper about the device is published in the Feb. 17 edition of the journal PLoS ONE.

From the article of the same title
Medical News Today (02/17/10)

FDA Creates Partnership to Boost Regulatory Science

The Food and Drug Administration and the National Institutes of Health have announced a plan to help the FDA make quicker decisions about the safety and effectiveness of new products and procedures. The new partnership will promote the development of testing and other tools that FDA regulators need in order to assess drugs and other products coming from fields such as genomics, nanotechnology, and stem cell therapy.

From the article of the same title
Los Angeles Times (02/25/10) Zajac, Andrew

New Material Mimics Bone to Create Better Biomedical Implants

Researchers at North Carolina State University have developed a "metal foam" with a similar elasticity to bone that could lead to a new generation of biomedical implants that avoid bone rejection. The metal foam is lighter than solid aluminum and can be made of 100 percent steel or a combination of steel and aluminum. The researchers report that in addition to the extraordinary high-energy absorption capability and light weight of the foam, its "modulus of elasticity" is very similar to that of bone. The rough surface of the foam also fosters bone growth into the implant, boosting the strength of the implant.

From the article of the same title
ScienceDaily (02/16/10)

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March 3, 2010