March 27, 2013

ACFAS: Podiatric CME Needs Reform; Proposes Changes to Accreditation Standards

In submitting comments this week on proposed revisions to CPME’s CME accreditation standards, ACFAS stated, “We believe podiatric CME standards should be equivalent or more stringent than allopathic CME requirements if podiatry is serious about professional parity. We are also calling for significantly greater oversight of CME providers. Such steps are sorely needed. This arena needs a ‘sheriff’ with vastly more authority – and the will to use it.” (More)
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News From ACFAS

Spring FootNotes Available for Download
Take advantage of FootNotes, our free and customizable patient newsletter, to start a conversation with your patients and community. The latest edition is now available for download at or at the web link below (member login required). Be sure to include your prectice's contact information in the space provided.

Topics for spring 2013 include:
  • Pediatric Flatfoot – Cause for Alarm?
  • Smoking and Bone Healing – 5 Surgical Risks Smokers Take
  • How to Prevent Deep Vein Thrombosis: Tips for Travelers
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ACFAS Wants to Stay in Touch!
Have you recently changed your address, email, phone or fax number? Does your practice have a website? Do you want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other ACFAS mailings? Make sure ACFAS has all your correct information by updating your contact information at (member login required).

Did you also know, your business contact information can be listed in the College’s online membership directory so your colleagues can find you, and you can also be listed in the “Find an ACFAS Physician” public search tool on ACFAS’ consumer website,, by simply completing your professional profile on the website? Complete your profile with website, hours, and up to three locations, scroll down to “ACFAS Website Listing” and check “Yes” for “Consumer Physician Search” and “Members-Only Directory.” Don't forget to click on the Submit button at the bottom!

Keep yourself available to your peers, potential patients and the College! Update your profile today.
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Foot and Ankle Surgery

Efficacy of Thrust and Non-Thrust Manipulation and Exercise with or Without Addition of Myofascial Therapy for the Management of Ankle Sprain
A randomized clinical trial was held to compare the impact of thrust and non-thrust manipulation and exercises with and without myofascial therapy for the treatment of acute post inversion ankle sprain. Fifty patients were randomly grouped within two cohorts, including a comparison cohort who received a thrust and non-thrust manipulation and exercise intervention, and an experimental cohort who received the same protocol and myofascial treatment. The primary results were ankle pain at rest and functional ability, and ankle mobility and pressure pain threshold (PPT) over the ankle were evaluated by a clinician blinded to the treatment apportionment. Outcomes of interest were captured at baseline, immediately after the treatment period and at a one-month follow-up. The Group x Time interaction served as the primary analysis. The 2x3 mixed model ANOVA exposed significant Group x Time interactions for ankle pain and functional score with the patients receiving both non-thrust and thrust manipulation and myofascial intervention experiencing greater improvement in pain and in function than those receiving the non-thrust and thrust manipulation intervention alone. The researchers also noted significant Group x Time interactions for ankle mobility and PPTs, with those in the experimental group experiencing greater increases in ankle mobility and PPTs. Between-groups effect sizes were large for all results.

From the article of the same title
Journal of Orthopaedic and Sports Physical Therapy (03/13) Truyols-Dominguez, Sebastian; Salom-Moreno, Jaime; Abian-Vicent, Javier; et al.
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Temporary Kirschner Wire Transfixation Versus Strapping Dressing after Second MTP Joint Realignment Surgery
A study was performed to compare a temporary Kirschner wire fixation
(tKW) with a postoperative strapping dressing (SD) after realignment surgery of second metatarsophalageal (MTP) instability in conjunction with correction of claw toe deformity, through postoperative examination of 54 consecutive patients with 62 procedures at 10 years. The tKW group resulted in significantly fewer recurrence, while no statistical difference was detected in AOFAS and pain VAS.

From the article of the same title
Foot & Ankle International (03/13) Holinka, Johannes; Schuh, Reinhard; Hofstaetter, Jochen G.; et al.
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Practice Management

Claiming Your Space on Medical Internet Rating Sites
Medical Internet rating websites sometimes offer minimal and frequently outdated information. Claiming your "space" involves identifying yourself as the practice listed on online rating sites, and it is critical to begin the process of correcting potentially outdated information. Once a space has been claimed, many directories and rating sites permit practices to add details to their listing. This can improve the search ranking and bring the practice's website to the forefront. Following such steps helps practices guarantee that the accuracy of the information listed on the sites is correct and lets them respond in case a negative review is posted. Google employs data from these various rating sites to improve its search results.

Google has continued stressing local webpages in its search results, which practices can use as a significant marketing tool. Google Places is a core tool for bringing results to the local market. Google Places gathers information from across the web to create business profiles for search-firm websites, creating directories broken down by professional categories. The tool also depends on business owners to confirm and develop their own Google Places profile. It allows practices to claim their space, correct inaccuracies, update or add more addresses and supply a detailed description of their practice and its service mix. Practices can present their business data in the best light with professional assistance.

Once a practice claims its space, a web-savvy staff member can be made responsible for keeping it current, provided management lets the staff member know when updates are required. It is recommended that practices check in on their ratings from time to time, as they can offer a critical gauge of their patients' opinions on the services they receive, and the practice's general patient experience.

From the article of the same title
Physicians Practice (03/12/13) Capko, Judy
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Doctors Willing to Go Only So Far on Patient EHR Access
A new survey by Accenture has found that while a majority of American physicians are willing or even interested in allowing patients greater access to their electronic healthcare records, most want such access to be limited. The Accenture survey polled some 3,700 physicians from around the world about EHR access, 500 of them were from the U.S. Of those 500, 82 percent said they wanted patients actively participating in updating and maintaining their EHR, with 49 percent saying this was crucial to providing better patient care. However, most felt there should be some limits, with only 35 percent saying patients should have full access to their EHR. The specific reasons that 65 percent felt there should be limits on EHR were not entirely clear, though it appeared that physicians' willingness to provide EHR access declined with the complexity of the information patients were being allowed to access. Almost all doctors said allowing patients to update demographic information, family medical history, and history of allergic episodes would be permissible, but only 53 percent said patients should have access that would allow them to update some or all of their lab results.

From the article of the same title
American Medical News (03/18/13) Cook, Bob
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Ways to Market a Medical Practice After ACA Takes Hold
Strategic marketing remains essential for medical practices following enactment of the Affordable Care Act (ACA), especially as they seek to differentiate themselves from the competition. Strategic marketing can enable a practice to establish its clinic and physicians as go-to experts in the field, as well as accentuate their personal interests or areas of expertise. Furthermore, strategic marketing allows practices to attract the kinds of patients they want, particularly through targeted, ongoing marketing of certain employers or insurance plans. Announcing new physicians and unique services also can be applied to the marketing push. The practice should establish and maintain a brand to distinguish it from other practices, while cultivating relationships with other physicians will prove critical given the ACA's emphasis on physician referrals. Practices also should build a better patient experience by providing a hospitable environment, modern equipment and good customer service. Moreover, the practice should determine its primary patients, and identify the reasons they patronize the practice as well as how it can attract new patients. Finally, the practice should recognize deficiencies and shortcomings and strive to improve upon them, using tools such as surveys.

From the article of the same title
American Medical News (03/18/13) Caffarini, Karen
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Health Policy and Reimbursement

CMS Starts Conducting EHR Incentive Program Pre-Payment Audits
The Centers for Medicare and Medicaid Services (CMS) will send out letters informing a random segment of providers that their Medicare billing activities will be audited in an effort to ensure that meaningful use payments are going to the right people for the right reasons. After widespread concern about questionable billing practices among providers vying for government funds and accusations that CMS has not been doing enough to combat fraud, the agency has strengthened its efforts to keep an eye on meaningful use participants. Providers who have already received their incentive payments for January will not be audited, but those who are missing a check should look in their mailboxes for a letter from Figliozzi & Co., the firm contracted by CMS to conduct its pre-payment investigations. More than 2,000 post-payment audits are currently underway, some targeted due to flagged data and others entirely random. During these sweeps, CMS has found that some eligible providers cannot provide the documentation to support their attestation, prompting the agency to release additional guidance in the coming months. Audits by Figliozzi may include an on-site visit and a demonstration of the provider’s EHR system. If the provider is found ineligible after a review, the payment will be recouped. Providers who wish to appeal may do so, and the process will be handled by the provider’s home state.

From the article of the same title
EHR Intelligence (03/15/2013) Bresnick, Jennifer
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FDA Will Not Regulate Consumers' Mobile Devices, Official Tells Panel
The U.S. Food and Drug Administration (FDA) has no plans to regulate consumer smartphones and tablet computers as medical devices, an agency official told the House Energy and Commerce Oversight and Investigations Subcommittee March 21. Neither would the FDA consider mobile platform manufacturers or medical apps distributors—such as the iTunes App store or the Android market—to be medical device manufacturers, FDA's Office of Device Evaluation Director Christy Foreman said during an Energy and Commerce subcommittee hearings on oversight of the mobile medical applications industry. Foreman's testimony sought to address concerns that heavy-handed FDA regulation of mobile health apps would make the software and the consumer devices on which many of them are used subject to oversight and the medical device excise tax, which was created by the health care reform law.

From the article of the same title
BNA Health Care Policy Report (03/22/13) Plank, Kendra Casey
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NCQA Launching Patient-Centered Specialty-Practice Recognition Program
The National Committee for Quality Assurance has launched a patient-centered specialty-practice recognition program modeled after its patient-centered medical home program. The new program will recognize specialty practices that meet standards for care coordination and management. The recognition program will consist of six standards, including tracking and coordinating of referrals, providing access and communicating with patients, planning and managing care, and measuring and improving performance. More information can be found here.

From the article of the same title
Modern Physician (03/21/13) McKinney, Maureen
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Senate OKs Budget Plan That Includes $275 Billion in Healthcare Cuts
The U.S. Senate has approved a Democratic $3.7 trillion budget for next year that embraces nearly $1 trillion in tax increases over the coming decade but shelters domestic programs targeted for cuts by House Republicans. The plan includes $275 billion in unspecified healthcare cuts over the next 10 years.

From the article of the same title
Associated Press (03/23/13) Daly, Rich
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Medicine, Drugs and Devices

Anti-Fibrosis Effect of BMP-7 Peptide Functionalization on Cobalt Chromium Alloy
Researchers examined the effectiveness of using bone morphogenic protein-7 (BMP-7) in preventing the development of fibrous capsules on the surface of cobalt chromium (CoCr) alloy orthopaedic prosthetic implants following implantation. The researchers covalently bonded BMP-7 to a CoCr alloy and examined the gene and protein expression of several fibrosis markers to examine BMP-7's effectiveness at preventing the formation of fibrous capsules. The study found that the BMP-7 treated alloy showed a significant reduction of fibrosis markers expression after one week of incubation, compared to control CoCr substrates not treated with BMP-7. The researchers say their findings could lead to improved CoCr implants used in orthopaedic surgeries.

From the article of the same title
Journal of Orthopaedic Research (03/01/13) Tan, Hark Chuan ; Poh, Chye Khoon; Cai, Yanli; et al.
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Newly Identified Human Cells Might One Day Heal Damaged Tissue and Organs, Researchers Say
Researchers say they have made an unexpected finding that could lead to the development of a new technique for healing damaged bones and other tissues. In a study published in the Proceedings of the National Academy of Sciences, the researchers describe their finding of a new type of cell found in human breast tissue called endogenous pluripotent somatic (ePS) cells can be placed in mice or a Petri dish and used to make bone and other types of cells. ePS cells have an advantage over induced pluripotent stem (iPS) cells—which can also be used to create different types of cells— because they are more genetically stable and are less likely to form cancerous tumors when introduced into the human body.

From the article of the same title
Contra Costa Times (CA) (03/05/13) Kleffman, Sandy
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Patients with Diabetes Don't Wear Custom Footwear Enough
Adherence rates for wearing custom-made footwear are inadequate for patients with diabetes with a recently healed plantar foot ulcer, according to a new study. Researchers assessed footwear use over seven days with a shoe-worn, temperature-based monitor in 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer and custom-made footwear. An ankle-worn activity monitor simultaneously measured daily step count, and adherence was evaluated based on the percentage of steps for which prescription footwear was worn. The researchers found that mean adherence was 71 percent, with 61 percent adherence at home and 87 percent adherence away from home. The mean adherence at home was 28 percent for 35 patients with low adherence. Factors which were significantly correlated with adherence included lower body mass index, more severe foot deformity and more appealing footwear. The study was published online in Diabetes Care.

From the article of the same title
Renal and Urology News (03/13/13)
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