Banner
March 12, 2014

News From ACFAS


2014 Annual Conference CME Now Online
If you attended the 2014 Annual Scientific Conference, you can now check your CME credits quickly and conveniently online. View and print your conference certificate of attendance and CME hours by selecting "Access Conference CME" on the homepage of acfas.org to log on.

Be sure to verify your CME credits promptly, as after June 30, 2014, no changes can be made online.

For directions on how to view your transcripts and CME credit online, be sure to check your email or fax machine for instructions sent from ACFAS. If you have questions regarding your online CME records, contact the Education Department at 800-421-2237.
Share Facebook  LinkedIn  Twitter  | Web Link
See the Latest Posters from ACFAS 2014 Electronically
The Scientific Format Poster learning experience from ACFAS' Annual Scientific Conference has been expanded to include an interactive poster display of the award winners online at acfas.org. This enriched experience allows more people the opportunity to view and learn from the valuable research after the conference.

To view the award-winning research from ACFAS 2014, visit acfas.org/orlando.
Share Facebook  LinkedIn  Twitter  | Web Link

Foot and Ankle Surgery


Long-Term Results of Comprehensive Clubfoot Release Versus the Ponseti Method: Which Is Better?
Researchers compared focused physical and radiographic examinations, gait analysis, and quality-of-life measures at long-term follow-up between groups of adult patients with clubfoot treated either with the Ponseti method or a comprehensive surgical release via a Cincinnati incision. These two groups were then compared with a non-clubfoot control group. The study focused on 42 adults with isolated clubfoot and 48 healthy controls. Twenty-four adults with clubfoot were treated surgically, while 18 were treated with Ponseti method. Both groups receiving treatment experienced diminished strength and motion versus the control subjects on physical examination measures, but the Ponseti group exhibited significantly greater ankle plantar flexion ROM, greater ankle plantar flexor and evertor strength, and less incidence of osteoarthritis in the ankle and foot compared with the surgical group. During gait the surgical group demonstrated reduced peak ankle plantar flexion and reduced sagittal plane hindfoot and forefoot ROM during the preswing phase in comparison with with the Ponseti group. The surgical group showed the lowest overall ankle power generation during push off versus the control subjects. Outcome tools indicated higher pain levels in the surgical group compared with the Ponseti group and lower scores for physical function and quality-of-life for both clubfoot groups compared with age-range matched control subjects.

From the article of the same title
Clinical Orthopaedics and Related Research (04/01/14) Vol. 472, No. 4, P. 1281 Smith, Peter A.; Kuo, Ken N.; Graf, Adam N.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Displaced Intra-articular Fractures of the Great Toe in Children: Intervene with Caution
A new study has found that doctors should exercise caution when treating children with displaced intra-articular fractures of the great toe, due to the difficulties involved in managing such fractures. The study involved 10 children who were roughly 12 and a half years old on average, all of whom underwent surgery to correct an intra-articular fracture of the proximal phalanx of the great toe. There were seven intra-articular fractures of the proximal phalanx base, four of which occurred in the setting of an open physis. Average fracture displacement was 4.4mm. Open reduction needed to be performed in nine cases, while K-wire fixation was used an equal number of times. After an average follow-up period of 50.5 months, nine patients had returned to full activity without limitation though six patients had suffered significant complications. Two of the patients who experienced complications underwent revision open reduction internal fixation. There was one case each of refracture, post-traumatic arthritis requiring interphalangeal joint fusion, asymptomatic fibrous nonunion with avascular necrosis of the fragment, and K-wire migration that required early surgical removal.

From the article of the same title
Journal of Pediatric Orthopaedics (03/01/14) Vol. 34, No. 2, P. 144 Kramer, Dennis E.; Mahan, Susan T.; Hresko, Michael Timothy
Share Facebook  LinkedIn  Twitter  | Web Link

Distally Based Perforator Flaps for Reconstruction of Post-Traumatic Defects of the Lower Leg and Foot: A Review of the Anatomy and Clinical Outcomes
A recent review of 24 clinical reports analyzed the failure rates in a sample of 640 patients whose post-traumatic foot and lower-leg defects were treated with distally-based perforator flaps. The patients in the sample were treated with either sural flap reconstructions, saphenous flaps, supramalleolar flaps, and propeller flaps. Failure rates ranged from a low of 0 percent in patients who underwent supramalleolar flap reconstructions to a high of 6 percent in those treated with saphenous flaps. But the review noted that the differences in the failure rates of the four types of flaps were not statistically significant at the 95 percent confidence level. Researchers also attempted to compare the outcomes seen in patients who underwent these procedures, though they noted that interpreting the outcome comparisons in the study sample should be done cautiously due to methodological flaws. For example, most of the studies that were reviewed failed to adequately define risk variables and outcome indicators. However, the study concluded that fasciocutaneous perforator flaps seem to have a high survival rate. In addition, the use of these flaps is feasible in post-traumatic reconstructions, particularly those that are performed in low-resource settings.

From the article of the same title
Injury (03/01/14) Vol. 45, No. 3, P. 469 Tajsic, N.; Winkel, R.; Husum, H.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management


Patient Portal Messaging, Tele-Visits Do Not Affect In-Person Physician Visit Frequency, Say Mayo Researchers
Communicating with patients through patient portals or through telemedicine does not have a significant impact on the number of patients' in-person physician visits. Researchers at the Mayo Clinic in Rochester, Minn., conducted a retrospective study of 2,357 primary care patients who used both secure messaging and e-visits through an online patient portal during the study period, and analyzed each patient's in-person visit frequency before and after the introduction of patient portal. Results showed there was no significant change in the frequency of in-person visits before and after the introduction of the patient portal. Patients who used the portal most frequently had the highest number of in-person visits, both before and after the introduction of the portal, suggesting the online interactions have a limited effect on the frequency of in-person visits.

From the article of the same title
Becker's Hospital Review (03/04/14) Gregg, Helen
Share Facebook  LinkedIn  Twitter  | Web Link

RVUs: A Valuable Tool for Aiding Practice Management
Relative value units (RVUs) are very helpful in the management of practice finances, as they can be utilized for determining compensation in a practice with multiple physicians, informing decisions to accept a buyout offer from a hospital system, and many more applications. RVUs are a component of Medicare's system for deciding how much it will reimburse physicians for each of the services and procedures covered under its Physician Fee Schedule, and which are assigned current procedural terminology code numbers. Three elements influence the dollar amount for each service: physician’s work, practice expenses and malpractice insurance. An RVU is assigned to each of these three elements, and each is multiplied by the Geographic Practice Cost Index to account for variations in living and business costs across the U.S. The elements are then summed up, with the resulting amount multiplied by the conversion factor to arrive at the reimbursement dollar figure. RVUs are determined as part of the Resource-based Relative Value Scale, whose values are regularly reviewed by the Relative Value Scale Update Committee. The portion of the Medicare fee schedule a commercial insurer will pay is frequently a function of the supply of, and demand for, the type of service a practice delivers. Consultant Frank Cohen says RVUs can help practices compare how well payers reimburse for the same service or procedure. He also advises his clients to quantify their providers’ productivity-per RVU relative to one another. The use of RVUs for determining physician compensation in multi-physician practices usually follows one of two pathways: straight productivity, in which the practice multiplies the number of work RVUs the clinician generates by its own conversion factor to arrive at a compensation number; and paying each physician a salary plus a bonus linked to the number of work RVUs generated over a base figure.

From the article of the same title
Medical Economics (02/25/14) Bendix, Jeffrey
Share Facebook  LinkedIn  Twitter  | Web Link

Lawsuits Against Physicians Not Limited to Medical Care
Doctors can be sued for medical malpractice for far more reasons than providing inadequate care to their patients. For example, an anesthesiologist in California and his entire medical group are being sued by a woman who claims the anesthesiologist put stickers on her face in the shape of a mustache and gang tears during surgery and photographed her. The woman claims she was forced to leave her job at the hospital where the surgery was performed, which is also being sued, because of the incident. The plaintiff claims she is owed damages as a result of the violation of her privacy and emotional stress, among other things. Meanwhile, a doctor in Cook County, Ill., as well as the Feinberg School of Medicine and Northwestern Memorial Hospital, are being sued for $1.5 million in damages by a woman who was taken to the hospital while extremely drunk and was allegedly photographed by the attending emergency room physician. The photos, which showed the woman crying and passed out, were posted on social media and were not deleted by the attending physician at the request of the hospital. The woman claims the incident cost her the chance to someday work for a Fortune 500 company. These incidents underscore the need for doctors, as well as all medical personnel, to follow appropriate policies, best practices, and insurance and legal structures when dealing with patients.

From the article of the same title
Physicians Practice (03/04/14) Devji, Ike
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Free Registration

Health Policy and Reimbursement


CMS Adds Quality Scores to Physician Compare Website
The Centers for Medicare and Medicaid Services (CMS) has added physician quality measures for diabetes and heart disease treatments to Physician Compare, the website designed to help patients select providers. The website, was launched in 2010 as a requirement of the Affordable Care Act. This year, quality measures will be reported for 66 group practices that participated in the Physician Quality Reporting System Group Practice Reporting Option, and 141 accountable care organizations that participated in the Medicare Shared Savings Program. The quality ratings are displayed using a five-star scale. Currently, information for individual providers includes their name, education, and contact information. However, CMS plans to expand upon that information. Eventually, the website will also include publicly-reported patient experience data.

From the article of the same title
Medical Economics (03/05/14) Ritchie, Alison
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

House GOP's Effort to Repeal SGR Takes Aim at ACA's Individual Mandate
The U.S. House is expected to vote soon on legislation backed by Republicans that would repeal Medicare's Sustainable Growth Rate (SGR) formula but would also either repeal or delay the Affordable Care Act's individual mandate. The repeal or delay of the individual mandate is intended to help offset the cost of permanently repealing SGR. However, a one-year delay of the mandate would save only about $9 billion over 10 years, which is far short of the $138 billion it would cost over 10 years to repeal SGR. It remains unclear whether the House Republicans who support the measure plan to move forward with a temporary delay or an end to the individual mandate. Neither course of action is likely to be approved in the Democratic-controlled Senate. Congress is facing a deadline of March 31 for finding a way to pay for the repeal of SGR or adopt another temporary fix. Such a temporary fix is looking increasingly more likely, observers say, though the Centers for Medicare and Medicaid Services could also opt to hold payments to providers for about two weeks after March 31 to give lawmakers more time address SGR.

From the article of the same title
Modern Healthcare (03/08/14) Zigmond, Jessica
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Medicare Officials Back Away From Changes to Prescription Drug Plan
The Centers for Medicare and Medicaid Services (CMS) announced March 10 that it will not move forward with several planned changes to Medicare Part D that had been proposed in a draft regulation issued earlier this year. The proposal called for eliminating anti-depressants and immune system suppressant drugs from Medicare's list of protected drug categories beginning in 2015. CMS wanted to remove those drugs from protected status in order to help Medicare Part D negotiate better discounts with drugmakers. The proposal also called for insurers to be allowed to offer only one basic prescription drug plan and one enhanced plan in the same service area in order to help beneficiaries more easily understand the differences between the plans. But both proposals proved controversial, with patient groups and lawmakers in both parties saying that the move to end protected status for anti-depressants and drugs that suppress the immune system would make it more difficult for patients to obtain the drugs they need. Critics said the second proposal would limit the choices senior citizens have for Medicare Part D coverage. CMS says it may move forward with some or all of the proposals at a later time, albeit after eliciting further input from stakeholders. But the agency does plan to move ahead with other aspects of the proposal, including those that call for the release of Medicare Part D data that would not identify beneficiaries and the reduction of fraud.

From the article of the same title
Kaiser Health News (03/10/14) Carey, Mary Agnes
Share Facebook  LinkedIn  Twitter  | Web Link

Bundled Payments Give Surgeons a Powerful New Incentive to Reduce Costs
Hundreds of hospitals across the country are participating in bundled-payment arrangements offered by Medicare and a number of private payers in order to improve the quality of the healthcare they provide and to maximize profits from surgeries and other forms of care. Such arrangements establish a set price for an episode of care that includes the cost of any implant or device used, as well as the surgeon's costs and fees and the cost of the facility and anesthesiologist. Since hospitals and doctors split any profit they make from bundled-payment arrangements, they generally do a better job of working together to keep the costs of care down. This can include asking implant and device makers to give them the best prices for their products, as well as efforts to reduce readmissions, unnecessary imaging and lab tests, and average length of stay. However, there are a number of obstacles to the success of bundled-payment arrangements, including a general unawareness on the part of doctors about how much devices actually cost. In addition, doctors often develop preferences for certain devices or device manufacturers that can be hard to break, particularly because devicemakers spend millions of dollars a year to ensure that physicians use their products.

From the article of the same title
Modern Healthcare (03/01/14) Lee, Jaimy
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Free Registration

Lilly, Pfizer and Merck Slash Doctor Payments, But J&J and Forest Shell Out More
Several drug companies are making their first reports about how much they are paying doctors to speak on behalf of their products, as part of the requirements laid out in the Physician Payments Sunshine Act, which is now taking effect. Among them is Johnson & Johnson, which says that its speaking fees for doctors fell by 17 percent in 2012. Eli Lilly says that the payments it made to doctors dropped by 55 percent in 2012, while Merck reported a 28 percent decline. Drug companies may increase their payments to doctors as part of an effort to promote new drugs, while others may slash such payments when they do not have new medicines, new clinical data, or new indications to promote.

From the article of the same title
Fierce Pharma (03/04/2014) Staton, Tracy
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices


CDC: Antibiotic Overuse Can be Lethal
The Centers for Disease Control and Prevention (CDC) recently analyzed doctors' prescribing practices at 506 hospitals in 2010 and 2011, as well as the prescriptions written for 11,282 patients during that time frame, and found that antibiotics are being overused at the nation's hospitals. The study, which was released March 4, found that roughly 36 percent of patients were prescribed the antibiotic vancomycin for too long a period of time or without first undergoing testing. In addition, the study found that in over 20 percent of cases in which intravenous vancomycin was administered, the patient did not have methicillin-resistant Staphylococcus aureus (MRSA), an infection that is commonly treated with the antibiotic. The overprescription of antibiotics is a concern because it is fueling the development of deadly superbugs that are resistant to antibiotics. The CDC's Arjun Srinivasan says the overuse of vancomycin is particularly troublesome because alternatives for treating MRSA infections are expensive. Srinivasan says that hospitals can cut back on their use of antibiotics in part by ensuring that patients who are suspected of having MRSA are indeed infected. If it turns out that patients do not have MRSA, Srinivasan says, the use of vancomycin should be stopped.

From the article of the same title
Wall Street Journal (03/04/14) McKay, Betsy; Bauerlein, Valerie
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Hospitals Adapting Amid Continued Drug Shortages
A new survey by the group purchasing organization Premier has found that the steps hospitals have taken to deal with drug shortages have helped mitigate the effects these shortages have on their patients. Premier surveyed 124 "pharmacy experts" in December and January and found that 35 percent said they did not experience a drug shortage that could have delayed or cancelled patient care--a figure that is twice as high as it was in 2010. The survey also found that the number of respondents who reported experiencing six or more drug shortages that resulted in the delay or cancellation of care has fallen 46 percent since 2010. Meanwhile, the number of respondents who reported experiencing six or more drug type shortages regardless of their impact on patients fell by 26 percent during the same period of time. Premier Chief Operating Officer Mike Alkire says the number of drug shortages has fallen in part because healthcare providers have taken steps such as backing up inventories of drugs, adjusting par levels for vitally important categories of drugs, and implemented restrictions or rationing for drugs that are in short supply. These and other steps have made hospitals and other healthcare providers better able to handle severe supply chain disruptions, Alkire says.

From the article of the same title
HealthLeaders Media (03/04/14) Commins, John
Share Facebook  LinkedIn  Twitter  | Web Link

Selective Estrogen Receptor Modulators (SERMs): New Alternatives for Osteoarthritis?
Several studies have shown that the use of selective estrogen receptor modulators (SERMs) are effective in treating osteoarthritis (OA). Post-menopausal women with osteoporotic OA may especially benefit from SERMs, which may have a direct effect on joint cartilage as well as indirect effects on subchondral bone, synovium, muscle, tendons, and ligaments. However, more research into the use of SERMs as a treatment for OA is needed.

From the article of the same title
Maturitas (02/21/2014) Lugo, L.; Villavilla, A.; Largo, R.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link





Copyright © 2014 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe click here.

Abstract News © Copyright 2014 INFORMATION, INC.
Powered by Information, Inc.