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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

Congress Breaks without Pay Cut Fix

Congress began its two-week Easter recess on March 26 without addressing the looming 21 percent cut in Medicare physician reimbursements. The House and Senate did not vote on bills to delay the cut, so the current pay fix will expire as scheduled on April 1.

The Centers for Medicare and Medicaid Services announced that it is instructing its contractors to hold the payment of claims submitted for services delivered after April 1 for 10 business days, in anticipation of swift action when representatives return on April 12. A cloture vote to extend the pay fix to May 1 is scheduled for that day in the Senate.

J. James Rohack, MD, president of the American Medical Association, on Friday called the delay “unconscionable,” stating that “Congress' failure to act on permanent repeal of the broken Medicare physician payment formula has put access to healthcare for seniors and military families in jeopardy.”
Hone Your Skills with Continuing Education

Maximize your reimbursements and add to your surgical and decision-making skills with 2010 education from ACFAS. Get expert instruction and advice in:
    Coding and Practice Management Seminars
  • Chicago, May 14–15
  • San Francisco, October 1–2
    • CPT changes; coding and documentation skills; account management; employee relations; using the Internet to build your practice
    Surgical Skills Courses
  • Trauma of the Foot and Ankle, Denver, Colo., October 16-17
  • Tendon Repair, Dallas, Texas, November 5 or 6
  • Foot and Ankle Arthroscopy, Rosemont, Ill., December 11-12
    • Clinical assessment and indications; current trends; problems, complications and risks; advanced and restorative techniques
Visit the ACFAS web site for online registration and more details. Some courses are already sold out, so sign up soon for your best opportunities!

Research Abstracts at Your Convenience

Whenever you want recent research, ACFAS’ Scientific Literature Reviews are ready online. Nineteen new podiatry-relevant abstracts await your attention, from journals you may not usually read such as:
  • Plastic and Reconstructive Surgery
  • The Journal of Trauma
  • Diabetes Care
  • Chest
  • World Journal of Gastroenterology
These reviews have been prepared for you by podiatric residents at the Botsford Hospital and Detroit Medical Center. Check in every month to browse new additions or the entire archive at Scientific Literature Reviews.

Foot and Ankle Surgery

Evaluation of Feasibility of Ankle Pressure and Foot Oxymetry Values for the Detection of Critical Limb Ischemia in Diabetic Patients

A group of researchers assessed the feasibility of ankle pressure and foot oxymetry values for the diagnosis of critical limb ischemia (CLI) in patients with diabetes, studying 261 diabetic patients who were admitted on account of rest pain and/or foot ulcer in one limb. The researchers measured ankle pressure (AP) and transcutaneous oxygen tension (TcPO2), and performed digital subtraction arteriography. They determined that measurement of TcPO2 is crucial for detection of CLI in diabetic patients exhibiting rest pain or foot ulcer, not only when AP is unmeasurable but also when TcPO2 is equal to or more than 70 mm Hg.

From the article of the same title
Vascular and Endovascular Surgery (04/10) Vol. 44, No. 3, P. 184; Ezio, Faglia; Giacomo, Clerici; Maurizio, Caminiti; et al.

Value of a Modified Clinical Signs and Symptoms of Infection Checklist for Leg Ulcer Management

Researchers analyzed the validity of a modified Clinical Signs and Symptoms Checklist to measure infection in patients with a leg ulcer. Data from patients undergoing a randomized controlled trial evaluating larval therapy was analyzed using factor analysis to find the underlying checklist structure. Linear regression analysis determined if checklist items, patient characteristics, and subjective judgment of infection could predict bacterial load. The study found several checklist items were redundant when implemented in the sample, there was no clear structure to the checklist, and there was only one underlying theme, which had a low internal consistency. Predictions of bacterial count were possible using the theme, some checklist items, and ankle circumference, but not using clinicians' subjective judgment on its own. The researchers conclude that the modified Clinical Signs and Symptoms Checklist does not represent a valid tool to measure infection in leg ulcers. Some checklists items may predict bacterial load and may be better than just subjective judgment alone.

From the article of the same title
British Journal of Surgery (03/22/10) Dennis, L. A.; Dumville, J. C.; Cullum, N.; et al.

Levobupivacaine 0.5% Provides Longer Analgesia After Sciatic Nerve Block Using the Labat Approach Than the Same Dose of Ropivacaine

Researchers hypothesized that the pure S-enantiomer of bupivacaine provides longer-lasting analgesia than ropivacaine for posterior sciatic nerve block (Labat approach) in foot and ankle surgery. They compared the analgesic characteristics of 20 mL levobupivacaine versus 20 mL ropivacaine 0.5% and assessed the onset, duration, and success of the block, and the need for rescue analgesia and technical or neurologic complications over 24 hours. They found that the onset of sensory block and the success rate were similar in levobupivacaine and ropivacaine groups (onset, 15 minutes [5-40 minutes] vs 15 minutes [5-60 minutes], respectively; success rate, 90% vs 92.5%), but that the average time for the first request of pain medication provided by 20 mL levobupivacaine 0.5% was significantly longer than with ropivacaine (1605 minutes [575-2400 minutes] vs 1035 minutes [590-1500 minutes], P < 0.001) and the need for postoperative rescue analgesia was higher in the ropivacaine group (37 of 40 [92.5%] vs 30 of 40 [75%], P < 0.034).

From the article of the same title
Anesthesia and Analgesia (03/19/10) Fournier, R.; Faust, A.; Chassot, O.; et al.

Practice Management

Make Your Office Accessible to All

Physician practices are required under Title III of the Americans with Disabilities Act to accommodate people with various physical impairments and implement accessibility, or face a narrowed scope of business or possible legal action. The U.S. Justice Department advises that public accommodations operators consult with disabled individuals and their proponents to ascertain what type of assistive measures are necessary to guarantee access. Margaret A. Nosek with Baylor College of Medicine's Center for Research on Women with Disabilities says that all doctors should institute procedures involving one or more designated staffers on how to aid patients with mobile handicaps without hurting the patients or themselves; she recommends that physicians set up disability awareness sessions for their personnel. In addition, accommodations should be made for impaired family members of non-disabled patients if they are participating in the patient's care. Physicians are disallowed from charging patients or their insurance carriers for auxiliary aids or other services intended to make their offices accessible to disabled people.

From the article of the same title
Modern Medicine (03/19/10) Weiss, Gail Garfinkel

Health Policy and Reimbursement

Funds Double for Health Clinics

Federally funded health clinics will play a larger role under the recently enacted healthcare measure, which expands Medicaid and other insurance coverage and sharply increases funding for the clinics. The number of clinics in the United States nearly doubled under the Bush administration, and the healthcare measure signed by President Obama Tuesday boosts funding by $10 billion over five years for the clinics, while an additional $2.5 billion is included in a package of changes to the bill.

From the article of the same title
Wall Street Journal (03/25/10) Favole, Jared A.

Healthcare Suits by States Unlikely to Succeed, Scholars Say

Scholars are predicting the likely failure of lawsuits by 14 U.S. states to ban the enforcement of health care legislation signed by President Obama, arguing that they cannot prevail against the broad constitutional powers granted to Congress. The states claim the law is unconstitutional and would unlawfully impose a fiscal burden on their cash-depleted budgets with an expansion of state-run Medicaid.

From the article of the same title
Bloomberg (03/24/10) McQuillen, William; Harris, Andrew

Ruling Strikes Down Georgia's Cap on Malpractice Awards

The Georgia legislature cannot cap the amount of money that juries award to medical malpractice victims, according to a March 22 ruling by the state Supreme Court. The decision overturned a 2005 state statute limiting jury awards at $350,000 for victims' pain and suffering; it was the court's contention that the cap unsuitably eliminated a jury's basic role to decide the damages in a civil case. Victims' rights groups and plaintiffs' lawyers lauded the ruling, while doctors and Republican lawmakers who championed the 2005 law castigated it. The National Conference of State Legislatures says that 30 states, Puerto Rico, and the Virgin Islands impose caps on jury awards in malpractice cases, but courts in Illinois, New Hampshire, Oregon, Washington, and Wisconsin have rescinded such caps since the late 1980s. Still, University of Georgia law professor Thomas A. Eaton says that "there's not necessarily a national trend."

From the article of the same title
New York Times (03/22/10) Brown, Robbie

Physician Cost-Profiling Methods May Be Flawed

About 25 percent of 13,788 physicians studied would be misclassified under the cost-ranking system that many insurers use, according to findings by the RAND Corp. Investigators examined data from Massachusetts insurance claims in 2004 and 2005 and analyzed the costs of treating common illnesses, such as diabetes and heart attacks. The study authors assigned each episode of care to a doctor and developed a cost profile for each doctor based on all similar episodes of care. Investigators then evaluated the reliability of physician cost scores, accounting for factors such as the number and types of patients the physicians treated. The results indicate that the reliability of cost-profiling scores was unacceptably low for physicians in most specialty groups. Only about 40 percent of physicians in 28 specialty groups had cost-profile scores that were at least 70 percent reliable, while fewer than 10 percent of those doctors had cost profiles that were at least 90 percent reliable.

From the article of the same title
Business Insurance (03/18/10) Wojcik, Joanne

Technology and Device Trends

FDA Wrestles With Undoing Decision

The Food and Drug Administration's (FDA) reassessment of ReGen Biologics' Menaflex knee-repair device is raising issues over how far the agency's authority extends. The device was cleared in December 2008 by the head of the FDA's device division over the repeated objections of FDA scientists and managers. A reevaluation was prompted by revelations in a 2009 Wall Street journal article that outside pressure from Congress and ReGen lobbyists had been applied in the approval process. ReGen has questioned the legality of the reevaluation, and some agency officials say that uncertainty over the FDA's powers to re-open cleared cases could result in greater agency investigation into medical device applications so as to evade another controversy such as the Menaflex approval. Industry lobbyist Jeffery Gibbs warns that if the FDA could rescind clearances for approved devices, it could promote confusion in the industry and create immense difficulties for doctors who have used the products for patients.

From the article of the same title
Wall Street Journal (03/22/10) P. B1; Mundy, Alicia

Potential for New Treatment for Peripheral Arterial Disease

Bone marrow stem cells suspended in X-ray-visible microbubbles dramatically improve the body's ability to build new blood vessels in the upper leg, providing a potential treatment for those with peripheral arterial disease, according to research presented at the Society of Interventional Radiology's Annual Scientific Meeting. The researchers used a technique that encloses stem cells derived from bone marrow in an alginate capsule or microbubble made from seaweed to create factors to build new vessels. Tested in a rabbit model, the bubble prevents the body's immune system from reaching and attacking the transplanted cells.

From the article of the same title
Ivanhoe (03/22/10)

Heat Treatment Found Effective for Plantar Warts

A targeted heat treatment appears to alleviate plantar warts, researchers from China have found. The researchers used a patented infrared heat-producing device, which heats warts to 111 degrees Fahrenheit (44 degrees Centigrade) without touching patients' skin. The approach cured plantar wart infections in nearly 54 percent of those treated and reduced wart-related walking pain in 80 percent of the patients who initially had such pain.

From the article of the same title
Reuters (03/19/10) Hendry, Joene

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March 31, 2010