News From ACFAS

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Alan R. Catanzariti, DPM, FACFAS, is the 2011 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. Catanzariti was selected for his career-long work in residency training and in ACFAS education programs. He will continue to work for the expansion of knowledge as the 2011-12 chair of the College’s CPG Management Council.

“Dr. Catanzariti brings an exceptional track record of achievement to his leadership of the council,” says ACFAS President Michael S. Lee, DPM, FACFAS. “I'm very pleased he is once again lending his expertise to the College's educational pursuits.”

The award will be presented to Catanzariti in a ceremony tomorrow at the ACFAS 2011 Annual Scientific Conference in Fort Lauderdale. A listing of past recipients is available on the ACFAS website.
Couldn’t make it to ACFAS 2011 in Fort Lauderdale? Start warming up now to “Rock & Roll Your Practice” at the ACFAS Practice Management/Coding Workshop in Cleveland, Ohio, May 13–14, 2011. The workshop features two days of information geared toward new trends in medical practice, including:

• Medicare reimbursement incentives
• New hospital-employment models
• Marketing tips for social media
• Financial best practices & strategic business planning

Learn new skills or refresh your expertise with seasoned and respected educators in profitable practice strategies. Look for more information soon on the ACFAS website.
Reach out to your patients and community with the newly improved FootNotes patient newsletter. ACFAS’ free, customizable newsletter has been completely redesigned with a bright new layout and color photos complementing each article. This valued member benefit is still available for download quarterly on acfas.org and will continue to feature timely articles to help you communicate with your current patients and attract new ones!

The Spring 2011 issue will inform your patients about:

• Travel Tips to Prevent Deep Vein Thrombosis
• Springing into Sports without Spraining Your Ankle
• Tips to Not Ignore Big Toe Pain

Get it today at acfas.org/marketing.

Foot and Ankle Surgery

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Researchers evaluated the outcome of patients with Weber B-type (Lauge–Hansen SE) fractures with and without repair of the anterior inferior tibiofibular ligament (AITFL). A total of 288 patients with Lauge–Hansen SE4 ankle fractures were evaulated. In group 1 (n=165), the AITFL was explored and the ruptured ligament sutured or the avulsion fracture fixed at the original insertion. In group 2 (n=123), a similar operative method was used, but the AITFL was not explored. The postoperative medial tibiotalar clear space (TTCS) and congruence of the tibiotalar joint were measured and analyzed. The clinical outcome was measured using the Olerud–Molander (OM) scoring system with a minimum follow-up of two years for both groups. No significant difference was found between these two treatment protocols using the postoperative TTCS, talar tilt, or OM functional score.



Researchers investigated whether fresh osteochondral allograft transplantation of talar osteochondral defects improves function. Twelve patients with a minimum followup of two years were tracked. Mean total AOFAS scores (61 ± 9 to 79 ± 6), pain subscores (17 ± 8 versus 26 ± 5), and function subscores (34 ± 3 versus 42 ± 4) improved from preoperatively to last followup. At last followup, three of the 12 grafts had radiolucencies, four had edema, one failed to incorporate, and none had subsidence.



The sinus tarsi approach to open reduction and internal fixation in the surgical treatment of displaced intra-articular calcaneal fractures was evaluated. A literature search in the electronic databases of the Cochrane Library and Pubmed Medline was conducted to identify studies in which the sinus tarsi approach or a modified sinus tarsi approach was utilized for the treatment of displaced intra-articular calcaneal fractures. A total of eight case series reporting on 256 patients with 271 calcaneal fractures were identified. Overall good to excellent outcome was reached in 75 percent of all patients. An average complication rate of minor wound complications of 4.1 percent was reported and major wound complications in 0.7 percent. The need for a secondary subtalar arthrodesis occurred at an average rate of 4.3 percent. The average Coleman methodology score was 56.8.

Practice Management

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A 2006 Department of Education study pointed to worryingly low levels of health literacy among Americans, with 36 percent of adults possessing only basic or below-basic skills for dealing with health material. Beginning this year, the Joint Commission is requiring hospitals to use plain-language materials to "communicate in a manner that meets the patient's oral and written communication needs" in supplying care. Javed Butler with Emory University Hospital in Atlanta cites the language doctors usually use as a hindrance to improving health literacy. Agency for Healthcare Research and Quality analyst Cindy Brach says some physicians have complained that their schedules are too busy to add a concentration on health literacy, but she says there are simple measures that can be incorporated into the patient visit. These include a "teach back" technique in which doctors ask patients to repeat in their own words what they have just been told.



To avoid being sued for malpractice, doctors need to know the correct way of telling patients about recommended treatments. State laws on informed consent require doctors to disclose the risks, benefits, and alternatives of any proposed treatment or procedure. A consent form should be used if the proposed treatment has material risks. If the risks are listed, it should be worded in a way that is not all-inclusive, such as "Among the risks discussed are..." or "The risks include, but are not limited to, the following..." During the consent conversation, sufficient time should be given to adequately discuss both serious risks and side effects.



Physician practices are increasingly adopting touchscreen tablets, kiosks, or patient portals that automate the check-in process and speed up wait times, reduce errors, and cut labor costs. Successful check-in technology solutions allow patients to update personal medical information and find out their copays and physician practices to streamline billing and claims processes by automatically verifying insurance eligibility and benefits. However, implementation comes with caveats, including issues related to integration of the check-in software with practice management software. Small practices, also, may not see the benefits due to the expenses involved in implementation.

Health Policy and Reimbursement

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Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) are pushing legislation to overturn a 1979 court injunction that prevents public access to the Medicare claims database, considered one of the best tools for identifying fraud and abuse in the healthcare program. The injunction stems from a lawsuit filed by the Florida Medical Association and the American Medical Association (AMA) in response to an effort by the Carter administration to publish a list of the annual Medicare reimbursements to all doctors. AMA argues that opening up the database would be a violation of doctors' privacy and could lead to some of them leaving the program.



The U.S. House of Representatives has voted to repeal a provision in the healthcare reform law requiring businesses to file a tax form for every vendor with which they have transactions worth $600 or more. Last month, the Senate repealed this provision in a Federal Aviation Administration reauthorization bill in a vote of 87-8. At issue is how to pay for repealing the provision, which would cost about $22 billion. The House bill aims to do this by recouping overpayments of taxpayer-funded health insurance exchange subsidies. If the Senate passes this House bill and makes changes to it, there could be a conference committee to resolve differences between the chambers.



CMS's three-day payment window rule has perplexed providers nationwide since it was adopted in 1990, so much so that Congress stepped in and enacted a clarification in the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. Kimberly Hoy, director of Medicare and Compliance at HCPro, Inc., breaks down the government's payment rule in a white paper she recently authored. The white paper will enable readers to identify recent changes to the rule, understand to which related entities the rule applies when a patient is admitted, define services subject to bundling or separately billable under the new guidance, describe how to implement recent billing and coding guidelines for proper reimbursement, and identify prohibited audit activities under the new law. The white paper can be accessed here.

Medicine, Drugs and Devices

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The federal government this year is embarking on a grand experiment in the government-driven adoption of technology, its goal being to improve healthcare and to reduce its long-term expense by moving the doctors and hospitals from ink and paper into the computer age through a shift to digital patient records. The long-range vision is that computerized patient data will lead to a “learning health system,” where data across populations of patients can be analyzed to find what treatments are most effective or to get early warnings on dangerous drug interactions. But the road to such a system promises to be long, experts warn. A major obstacle is that so many doctors, especially in small practices, are wary of technology they see as needlessly hard to use and time-consuming. “Doctors don’t want to become clerks,” says Dr. Isaac Kohane, a health technology specialist at the Harvard Medical School.



Regeneron Pharmaceuticals said its drug Arcalyst was effective in reducing gout flares in patients that are beginning to use a standard therapy for the inflammatory condition. The company said the treatment showed success in two studies, one that focused on effectiveness in preventing gout flares and another, larger trial that concentrated on the drug's safety. Regeneron plans to file a marketing application in mid-2011 with the FDA. When anti-inflammatory medicines do not help in preventing attacks of gout, physicians often use allopurinol, which blocks uric acid production, as a preventive measure. The initial use of allopurinol, however, can actually cause the disease to flare up as uric acid crystals are broken up. The data on Arcalyst show that it helped reduce this initial increase of attacks.



Doctors no longer have to print out medical records to carry with them as they go from patient to patient at the Orthopedic Foot and Ankle Center in Columbus, Ohio. Instead, they use iPads to look at patient records, consult with colleagues and explain procedures to patients. “Our office sees about 400 patients a week, and for each we were printing out five or six pieces of paper a day,” said Dr. Thomas Lee, who figures the Columbus practice now saves about seven trees a year thanks to the new technology.