March 30, 2011

News From ACFAS

Free CMS Webinar on Version 5010

ACFAS members have less than a year to get ready for Medicare’s Version 5010 transaction set change on Jan. 1, 2012. On April 4–8, 2011, the Centers for Medicare and Medicaid Services will sponsor a second set of free webinars focusing on testing. All providers should plan to test soon if they expect to meet the deadline.

These educational sessions will offer practical information and lessons learned on:
  • Testing for Large and Small Practices and Facilities
  • How to Test with Medicare Fee-for-Service
  • Testing with Commercial Payers and Clearinghouses
For more information and to register, visit the GetReady5010 website.
Got the Coding Blues?

Beginning April 1, Douglas Stoker, DPM, FACFAS, will offer one-on-one coding advice to ACFAS members as our official coding and billing consultant. Dr. Stoker is a renowned podiatric coding expert who is a fellow of the American College of Podiatric Medical Review, diplomate of the American Board of Quality Assurance and Utilization Review Physicians, and a past chairman of the APMA Coding Committee. Most recently he served on the ACFAS Board of Directors and has taught coding and billing at the College's practice management seminars for more than 20 years.

Send your coding questions to Dr. Stoker at, or contact Kristin Hellquist Cunningham, ACFAS Director of Health Policy, Practice Management & Research at
ACFAS in Dialogue with CMS

The Centers for Medicare and Medicaid Services (CMS) has informed ACFAS that they are comprehensively reviewing and revising their hospital Conditions of Participation regulations. CMS noted that their concerns and priorities reflect “many of ACFAS’ and other organizations’ concerns” on issues related to parity on the medical staff, and they will be seeking ACFAS' support as they move forward developing regulations surrounding “improving care and protecting patients while better reflecting current hospital practices.”
White Paper Reviewer Needed

Do you teach or practice in an academic health center? If so, please contact Kristin Hellquist Cunningham at to help review a white paper on a related topic.

Foot and Ankle Surgery

A Modified Ponseti Method for the Treatment of Idiopathic Clubfoot: A Preliminary Report

To assess whether a modified Ponseti technique for treatment of idiopathic clubfoot was effective, a study involving 46 patients with 72 idiopathic clubfeet was conducted; 26 patients with 40 clubfeet received the Ponseti treatment twice weekly, while 20 patients with 32 clubfeet were treated once a week. In the twice weekly group, all aspects of the deformity with the exception of the equinus were corrected in 20.61 days, while the duration of treatment in the regular, once weekly group was 35.35 days. No differences between the groups in the average number of casts were observed. The study determined that the modified Ponseti method with the treatment program twice a week is safe and effective, and substantially shrinks the treatment's timeframe.

From the article of the same title
Journal of Pediatric Orthopaedics (05/01/11) Vol. 31, No. 3, P. 317 Xu, Rui Jiang

Correction of Crossover Deformity of Second Toe by Combined Plantar Plate Tenodesis and Extensor Digitorum Brevis Transfer

Research was conducted to examine the effectiveness and safety of the combined plantar plate tenodesis and extensor digitorum brevis (EDB) transfer in correction of claw toe deformity through a study of 11 patients who underwent such treatment between 2007 and 2008. No patients exhibited further crossover toe deformity, and two patients exhibited mild residual claw toe deformity. The lateral metatarsophalangeal angle in preoperative weight-bearing radiograph averaged 53 degrees plus or minus 5 degrees, while the postoperative lateral metatarsophalangeal angle averaged 23 degrees plus or minus 6 degrees; the dorsoplantar metatarsophalangeal angle in preoperative weight-bearing radiograph averaged -9 degrees plus or minus 4 degrees, and the postoperative dorsoplantar metatarsophalangeal angle averaged 2 degrees plus or minus 4 degrees. The conclusion of the study is that combined plantar plate tenodesis and EDB is an effective procedure for repairing crossover second toe deformity, and it can be carried out through small incisions with minimal soft tissue dissection.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (03/11) Lui, Tun Hing

Endoscopic Surgery for Young Athletes With Symptomatic Unicameral Bone Cyst of the Calcaneus

Researchers tested a hypothesis that endoscopic curettage and percutaneous injection of bone substitute is an effective treatment for young athletes with asymptomatic calcaneal bone cyst, focusing on 13 out of 16 patients who underwent the procedure. Average ankle-hindfoot scale score improved from preoperative 78.7 plus or minus 4.7 points to postoperative 98 plus or minus 4.2 points, while postsurgical pain and functional scores showed significant improvement. No recurrence or pathologic refracture was observed in radiologic assessment at most recent follow-up, and in all cases the injected calcium phosphate cement was retained. All patients could resume their initial levels of sports activities with eight weeks after surgery.

From the article of the same title
American Journal of Sports Medicine (03/01/11) Vol. 39, No. 3, P. 575 Innami, Ken; Takao, Masato; Miyamoto, Wataru; et al.

Treatment of Peroneal Tendon Dislocation and Coexisting Medial and Lateral Ligamentous Laxity in the Ankle Joint

A study of 42 patients with peroneal tendon dislocation and coexisting ligamentous laxity in the ankle joint who were treated between 2005 and 2007 determined that combined therapy for both conditions following arthroscopy yields good clinical outcomes and high levels of patient satisfaction. Anchor technique and flap repair was utilized to reconstruct the superior extensor retinaculum, while anchor reconstruction was employed to address preexisting ligamentous laxity with regard to the extensor inferior retinaculum. Arthroscopy was performed on all patients prior to surgery. Clinical results demonstrated a significant boost in the AOFAS-Hindfoot Score as a frequently used but not confirmed outcome measure, as well as a substantial reduction in the Visual Analogue Scale and in the internal and external rotation, after three months. The clinical outcome was validated at the 6-, 12-, and 24-month measuring points and there was no recurrence of dislocation of the peroneal tendon within the 24-month follow-up.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (03/16/11) Ziai, Pejman; Sabeti-Aschraf, Manuel; Fehske, Kai; et al.

Practice Management

AMA: Office Docs Support $1.4 Trillion in Economic Activity

The nearly 639,000 office-based doctors in the United States support 6.2 jobs and $2.2 million in economic activity each on average, which translated into a collective economic impact of 4 million jobs and $1.4 trillion in 2009, according to a new study from the American Medical Association's Advocacy Resource Center. The report found that the average office-based doctor supported $1.3 million in salaries and benefits, which totaled $833 billion across the country; revenue and earnings produced by an individual physician office contributed an average of almost $100,000 in yearly state and local taxes, amounting to $401 million two years ago.

From the article of the same title
Modern Physician (03/11) Robeznieks, Andis
Web Link - May Require Free Registration

Streamline Your Electronic Health Records Investment

Rosemarie Nelson, a healthcare consultant with the Medical Group Management Association, offers recommendations designed to improve the potential for successful electronic health record adoption while increasing operational efficiency regardless of future technology adoption:

* Standardize forms
* Standardize chart styles
* Stop printing paper schedules
* Save documents printed from the Web as electronic files
* Stop using paper message forms, and standardize electronic phone message tasks across all support staff
* Investigate hiring an information technology support firm
* Implement electronic signoff on transcription, whether it is outsourced or performed in-office
* Maintain electronic folders with transcribed notes, and provide physician access to them to reduce chart pulls
* Identify the paper logs or notebooks the practice uses for tracking things
* Investigate electronic faxing
* E-prescribe
* Make medication and follow-up orders consistent
* Build a patient portal on your practice's website

From the article of the same title
Modern Medicine (03/10/11) Nelson, Rosemarie

The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices

Researchers assessed the cost of implementing an electronic health record system in 26 primary care practices in a physician network in north Texas, taking into account hardware and software costs as well as the time and effort invested in implementation. For an average five-physician practice, the researchers found that implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year. They also estimated that the implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that “end users”—physicians, other clinical staff, and nonclinical staff—needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters.

From the article of the same title
Health Affairs (Winter 2011) Vol. 30, No. 3, P. 481 Fleming, Neil S.; Culler, Steven D.; McCorkle, Russell; et al.

Health Policy and Reimbursement

Washington State Healthcare Panel Drawing National Attention

Washington State's Health Technology Assessment committee has authority under state law to determine which medical devices and procedures the state will cover for Medicaid patients, injured workers and state employees, a total of about 750,000 people. While all states, private insurers and the federal Medicare program decide what will be covered, Washington's program is attracting national attention, partially because it is open to the public. The transparency of the committee creates a stage for exploring the complexities of applying evidence-based medicine, which is increasingly being used as a way to control health care costs. The program is also attracting attention because it explicitly considers the cost of treatments when making decisions. That element has made the program a target of criticism for opponents of the new federal health care legislation. A major complaint is that the committee lacks experts in many of the fields being studied.

From "A Panel Decides Washington State’s Health Care Costs"
New York Times (03/21/11) Pollack, Andrew

Institute of Medicine Issues Reports on Standards for Clinical Practice, Systematic Reviews

The Institute of Medicine has issued two reports to provide an objective and consistent framework for clinical practice guidelines and standardize systematic reviews of comparative effectiveness. The studies were requested by Congress and sponsored by the Department of Health and Human Services. In "Clinical Practice Guidelines We Can Trust," IOM describes eight standards: establishing transparency, management of conflict of interest, guideline development group composition, clinical practice guideline-systematic review intersection, establishing evidence foundations for and rating strength of recommendations, articulation of recommendations, external review, and updating. In "Finding What Works in Health Care: Standards for Systematic Reviews," IOM lists 21 standards that are broken into four sections: initiating systematic reviews, finding and assessing individual studies, synthesizing the body of evidence, and reporting systematic reviews.

From the article of the same title
Becker's ASC Review (03/11) Rodak, Sabrina

PHA Backs Repeal of Ban on Physician-Owned Hospitals

Physician Hospitals of America (PHA) is lobbying Congress to repeal a section of the Patient Protection and Affordable Care Act (PPACA) that curtails new construction or expansion of physician-owned hospitals. HR 1159, introduced by Rep. Doc Hastings (R-Wash.) and HR 1186, introduced by Rep. Sam Johnson (R-Texas), would both repeal Section 6001 of PPACA, which prohibits future physician investment in hospitals, caps existing physician investments, and restricts existing physician-owned hospitals from expanding. PHA President Michael Russell said the ban on physician-owned hospitals reduces access to care even as the act brings more than 30 million new patients into the public health system.

From the article of the same title
HealthLeaders Media (03/23/11) Commins, John

States Rush to Settle Medicaid Bills

Special federal assistance for Medicaid that was part of the extended stimulus package expires July 1, 2011, causing states to rush to clear a backlog of medical bills at the bargain rates. The extended federal stimulus law gave states an extra $80 billion for Medicaid in 2009 and 2010, by reducing the states’ contribution from 40 percent to 28 percent. The rate will increase slightly April 1 and increase to 40 percent on July 1. To beat the deadline, states are streamlining bill-paying processes. California, expecting to save $143 million through the program, has suspended the usual one-week auditor’s hold on checks. Illinois will triple their normal quarterly payments to $650 by April 1 to avoid the rate increase. New York anticipates saving $66 million by speeding up their payments. North Carolina is asking providers to submit their bills as quickly as possible.

From the article of the same title
USA Today (03/21/11) Cauchon, Dennis

Medicine, Drugs and Devices

Outcomes of Suture Button Repair of the Distal Tibiofibular Syndesmosis

Researchers reviewed the clinical and radiographic results of 24 patients with acute injuries to the distal tibiofibular syndesmosis who were treated with suture button fixation. Average followup was 20 months. The average AOFAS score was 94 points. Syndesmotic parameters returned to normal after surgery and remained normal throughout the followup period. One in four patients required removal of the suture endobutton device due to local irritation or lack of motion. Osteolysis of the bone and subsidence of the device into the bone was observed in four patients. Three patients developed heterotopic ossification within the syndesmotic ligament—one mild, one moderate, and one who had a nearly complete syndesmotic fusion.

From the article of the same title
Foot & Ankle International (03/11) Vol. 32, No. 3, DeGroot, Henry; Al-Omari, Ali A.; El Ghazaly, Sherif Ahmed
Web Link - May Require Paid Subscription

Video Games in the OR? Doctors Say New Technology Makes Surgery More Efficient

Doctors in Toronto are using Xbox Kinect to gain hands-free access to medical images during surgical procedures. The device allows doctors to use hand gestures to zoom in and out or freeze images without having to leave the operating table. Otherwise, doctors have to use nearby computers to view images, requiring re-sterilization procedures before returning to the operating table, a process that can take up to 20 minutes. The use of the Xbox saves time, and keeps the doctor’s attention focused on the surgery. While some surgeons have assistants consult the images and report back to them, having the surgeons view the images directly allows them to be more precise.

From the article of the same title
Winnipeg Free Press (Canada) (03/17/11) Loriggio, Paola

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