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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

Last week the U.S. Senate approved the House’s $140 billion tax extenders bill, which would delay the scheduled cut in Medicare physician reimbursements until October 1, 2010, and delay until December 31 the $1,860 hard cap on outpatient physical or occupational therapy services. House Ways and Means Chairman Sander Levin, D-Mich., said his committee may need to examine the Senate’s amendments to the bill, which could result in a further-amended bill bouncing back to the Senate.

Leaders in the House are working feverishly to garner enough votes to pass a healthcare reform bill ahead of the start of their Easter break. On Monday afternoon, the House Budget Committee approved a draft reconciliation bill that will be used to make changes to the Senate-approved healthcare reform bill.

There is speculation that Democrats may use either the reconciliation bill— which would allow them to pass the Senate healthcare reform bill pursuant to reconciliation instructions in the House bill—or "deem and pass," a process that would let the Senate bill go through the House without members actually voting on it. House Speaker Nancy Pelosi, D-Calif., said Tuesday she has not made a decision on which way the House may opt to vote on reform legislation.
Wake Up Your Research Interests

Get a jolt of recent research with Scientific Literature Reviews on the ACFAS web site. Every month, podiatric residents prepare abstracts relevant to the interests of foot and ankle surgeons from a variety of medical journals.

This month, studies include osteochondral lesions of the talus, surgical safety with infants, and post-operative pain management, taken from The American Journal of Sports Medicine, Journal of Vascular Surgery, Journal of Pediatric Orthopaedics and Acta Anaesthesiologica Scandinavica.

Residents from Massachusetts General Hospital in Boston and Cedars-Sinai Medical Center in Los Angeles have summarized them so you can quickly determine their significance for your interests. Access these abstracts online, any time.
50 Foot & Ankle Topics on CD-ROM

The ACFAS Consumer Education Committee announces the release of the second edition of its highly-regarded patient education series.

Reflecting two years' work by 19 ACFAS member volunteers, a medical writer, and a medical illustrator, the 50 topics on the 5-CD set provide easy-to-understand explanations and illustrations in both English and Spanish, specifically for use by the foot and ankle surgeon.

View the full list of topics and learn how you can obtain the 2010 edition of ACFAS Patient Education on CD-ROM.

Foot and Ankle Surgery

In-Hospital Complications and Mortality Following Major Lower Extremity Amputations in a Series of Predominantly Diabetic Patients

Researchers performed a study to analyze the results of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the goal of determining whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. They retrospectively analyzed 283 MLEAs executed between Jan. 1, 1998, and Dec. 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria; 221 of the patients were diabetic while the remainder were not. Seventy-five years of age, postoperative cardiac complications, and postoperative respiratory complications were categorized as significant risk factors, while no statistically significant risk factors were associated with the presence of systemic and wound-related complications. Postoperative cardiological complications, postoperative respiratory complications, and first episode of amputation were significant risk factors of mortality in patients with diabetes, while no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients were recorded.

From the article of the same title
International Journal of Lower Extremity Wounds (03/01/10) Vol. 9, No. 1, P. 16; Aragon-Sanchez, Javier; Hernandez-Herrero, Maria J.; Lazaro-Martinez, Jose L.; et al.

Limb Salvage for Soft-tissue Sarcomas of the Foot and Ankle

Researchers evaluated the oncological and functional outcome of 27 patients who had limb salvage for a soft-tissue sarcoma of the foot or ankle between 1992 and 2007. There were 18 tumors located in the foot and nine around the ankle. Synovial sarcoma was the most frequent histological diagnosis. Excision was performed in all cases, with 16 patients requiring plastic surgical reconstruction with 13 free and three local flaps. Adjuvant treatment was undertaken in 20 patients, 18 with radiotherapy and two by chemotherapy. Limb salvage was successful in 26 of the 27 patients. The researchers concluded that limb salvage can achieve good oncological and functional results with additional treatment.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (03/01/10) Vol. 92, No. 3, P. 424; Jones, Robert; Hunt, Agnes

Open Versus Endoscopic Excision of a Symptomatic Os Trigonum: A Comparative Study of 41 Cases

A recent study aimed to compare the clinical results of a consecutive series of cases of excision of a symptomatic os trigonum performed with an open versus hindfoot endoscopic technique. Between 1994 and 2007, 43 patients underwent a symptomatic os trigonum excision, and submitted a subjective satisfaction questionnaire and a visual analog scale score for pain, and the American Orthopaedic Foot & Ankle Society ankle and hindfoot score and the time needed to return to previous sports levels were determined in 41 patients. Patients who underwent endoscopic excision had a significantly shorter mean time to return to previous sports levels, though there was no difference in postoperative visual analog scale score, American Orthopaedic Foot & Ankle Society score, subjective satisfaction rating, or rating of sensory nerve between the two patient groups.

From the article of the same title
Arthroscopy (03/01/10) Vol. 26, No. 3, P. 384; Guo, Qin Wei; Hu, Yue Lin; Jiao, Chen; et al.

Practice Management

Physicians Worried Proposed Meaningful Use Will Decrease Productivity

According to the Medical Group Management Association (MGMA), the majority of physicians believe that changes may be necessary to meet more than two dozen "meaningful use" criteria proposed in a Medicare electronic health record incentive rule, which could result in decreased provider productivity. In response to a MGMA questionnaire, some physicians expressed confusion over the proposed rule and the rule's potential impact, while others said the program is unworkable. The primary concern is the meaningful use provision. Many physicians have expressed concern that the goals for implementing 25 meaningful use criteria cannot be accomplished, and some providers believe that the administration's plan is too rushed.

From the article of the same title
HealthLeaders Media (03/08/10) Cantlupe, Joe

Study: File-Sharing Tools Could Put Personal Health Data at Risk

Physicians who use file-sharing software on their computers could inadvertently be exposing sensitive patient information, according to a recent study published in the Journal of the American Medical Informatics Association. For the study, researchers from the Children's Hospital of Eastern Ontario in Ottawa, Canada, used popular file-sharing software to analyze the IP addresses of millions of computers in the United States and Canada. The researchers found that personal health and financial information could be accessed through a simple search in 2 percent of Canadian files and 5 percent of U.S. files. Some of the information that researchers found included a medical authorization form that contained patient insurance information and other data; another medical authorization form that included a patient's Social Security number, medical history and current medications; and numerous files that contained personal banking information such as credit card numbers, passwords and PINs.

From the article of the same title
iHealthBeat (03/05/10)

The Legal 40 Percent Return on Investment When Buying a Practice

Certified healthcare business consultant Keith Borglum writes that physicians can reap tremendous financial rewards in both a good and bad economy by buying outstanding physician practices and running them themselves or staffing them with employed doctors and midlevel providers. He says the present decade is an excellent time to invest in practices, given the friendliness of the Democratic administration to healthcare. In addition, baby boomers are requiring more care for the next two decades, demand for physicians has surpassed supply for many specialties in most of the country, and many boomer-physicians are approaching retirement. This means that many excellent practices are selling for less than their appraised value or are going unsold and just closing up because they cannot find buyers. Borglum writes that it is not uncommon to see rates of return of 20 percent to 35 percent for pretax earnings after owner's compensation for professional practices not subject to Medicare or insurance company reimbursement or clinical malpractice; thus, private medical practice ownership should yield a return to ownership that is 40 percent or higher.

From the article of the same title
Modern Medicine (03/05/10) Borglum, Keith

Health Policy and Reimbursement

Sebelius Calls on Health Insurers to Post Rate Hikes

Health insurers should post information about rising premiums for certain customers on their company Web sites to justify rising costs, said U.S. Health Secretary Kathleen Sebelius in a letter to several insurers on Monday. Sebelius called on the companies to make public details about their estimated costs, enrollment changes, and other details. "Post on your Web sites the justification for any individual or small group rate increases you have implemented or proposed in 2010, and continue to post such a justification in connection with any future increases," she wrote.

From "Health Insurer Rises Should Be Public: Health Sec"
Reuters (03/08/10) Heavey, Susan

Health Plans Extend Their Market Dominance

Members of Congress and state legislatures have been questioning why health insurance executives are allowing their companies to increase individual insurance rates so drastically across the country. A study from the American Medical Association on health insurance markets reports that the reason is simply because they can. The AMA's study finds that 99 percent of 313 metropolitan areas would be considered to have "highly concentrated" insurance markets under guidelines used by the U.S. Department of Justice and the Federal Trade Commission. A single insurer held 70 percent or more of the health plan market share in 24 of 43 states measured, up from 18 in 42 in the previous year's study. Previous AMA studies have noted that insurer market dominance has allowed health plans to force physicians into take-it-or-leave-it contracts, but now the market dominance has allowed plans to give patients take-it-or-leave-it pricing.

From the article of the same title
American Medical News (03/08/10) Berry, Emily

Obama Says Curbing Waste, Abuse Will Help Fund Healthcare Plan

The White House is focusing on reducing waste and fraud in the Medicare program as part of efforts to reform the U.S. healthcare system. As part of the initiative, President Obama has signed an order authorizing government agencies to use private auditors to uncover fraudulent claims and payment errors, a step the White House says may save $2 billion over three years.

From the article of the same title
Bloomberg (03/11/10) Runningen, Roger; Jensen, Kristin

Technology and Device Trends

Electromagnetic Pulses Provide Pain Relief for Osteoarthritis, Study Suggests

Henry Ford Hospital researchers report that electromagnetic pulses significantly decrease pain and inflammation associated with osteoarthritis of the knee. In the double-blind, randomized placebo-controlled study, patients used a portable battery-operated device that emits a low-intensity pulsating electromagnetic frequency, and reported more than 40 percent pain relief on the first day. The electromagnetic signals decrease calcium in cartilage cells, which results in a series of chemical events that can lead to reduced inflammation.

From the article of the same title
ScienceDaily (03/08/10)

Intraoperative Adjunctive Stem Cell Treatment in Patients with Critical Limb Ischemia Using a Novel Point-of-Care Device

Researchers tested whether adjunctive intraoperative stem cell treatment in patients with critical limb ischemia (CLI) can be performed safely in combination with bypass surgery and/or interventional treatment. The end point of the study was the safety and integrity of a novel point-of-care system used in patients with CLI. The researchers included only patients with CLI and tissue loss according to Rutherford categories 4-6 and used the Harvest Bone Marrow Aspirate Concentrate System, which consists of an automated, microprocessor-controlled dedicated centrifuge with decanting capability and the accessory BMAC Pack for processing a patient's bone marrow aspirate (BMA). Eight consecutive patients were treated according to the study protocol. Stem cells were always injected during the final revascularization attempt. One minor amputation and two major amputations were required. In five of eight patients there was a discrete increase in the ankle-brachial index post-stem cell treatment. The researchers concluded that the buffy coat preparation using a point-of-care system is a simple and fast method to enrich stem cells from BMAs. This automated system gives high recovery rates and good reproducibility.

From the article of the same title
Annals of Vascular Surgery (04/01/10) Vol. 24, No. 3, P. 367; Kolvenbach, R.; Kreissig, C.; Cagiannos, C.; et al.

Mind-controlled Prosthetics Without Brain Surgery

The concept of thought-controlled prosthetics that do not involve invasive brain surgery has been brought a step closer to realization with a University of Maryland, College Park research team's success in using electrodes attached to the scalp to "read" three-dimensional hand movements. The researchers employed electroencephalography (EEG) to measure the brain activity of volunteers as they moved their hands in three dimensions, while also recording the movement read by motion sensors placed on the subjects' hands. The two sets of readings were then correlated to generate a mathematical model that converts one into the other. The model was used in subsequent tests to enable the researchers to use the EEG readings to precisely monitor the speed and position of each volunteer's hand in three dimensions. Team leader Trent Bradberry theorizes that EEG could potentially be used to control other prosthetic devices.

From "Simple Scalp Electrodes Follow Hand's Twists and Turns"
New Scientist (03/12/10) Vol. 205, No. 2750, P. 15; Pearson, Aria

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March 17, 2010