April 4, 2012

News From ACFAS

Annual Conference CME Now Online
If you attended the 2012 Annual Scientific Conference, you can now check your CME credits quickly and conveniently online. View and print your conference attendance and CME hours at or from a link on the home page.

Be sure to check them promptly, as after May 30, 2012, 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 did not receive it, or if you have questions on the online CME records, contact the Education Department at 800-421-2237.
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Attention Researchers!
Do you have an idea that would contribute to advancing the science of foot and ankle surgery? ACFAS is awarding up to $20,000 to a principal investigator and team through the 2012 Clinical and Scientific Research Grant. For an application and more information, visit Application deadline is Sept. 1, 2012.
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ACFAS Call for Manuscripts 2013
If you are involved in a study that would be beneficial to the profession, the Annual Conference Program Committee invites you to submit your manuscript for consideration of presentation at the Annual Scientific Conference Monday, February 11-Thursday, February 14, 2013 in Las Vegas.

The deadline for manuscript submission is August 15, 2012. Winners of the ACFAS Manuscript Awards of Excellence divide $10,000 in prize money from a generous grant given to ACFAS by the Podiatry Foundation of Pittsburgh. To submit your manuscript or for more information, visit

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Foot and Ankle Surgery

Autologous Stem Cell Therapy in the Treatment of Limb Ischaemia Induced Chronic Tissue Ulcers of Diabetic Foot Patients
Assessing the safety, feasibility, and effectiveness of transplantation of bone marrow-derived stem cells regarding improvement in microcirculation and lowering of amputation rate was the purpose of a study involving diabetic foot patients with critical limb ischaemia. Twenty-four of 30 patients included in the trial were randomized to receive either bone marrow mononuclear cells (BMCs) or tissue repair cells (TRCs). Twenty-two patients entered treatment in total, while one patient in the TRC group and two in the BMC group did not show wound healing during followup. One patient in each treatment group passed away before reaching the end of the study, one after having achieved wound healing in the BMC group, the other one without having achieved wound healing in the TRC group. Eighteen patients exhibited wound healing after 45 weeks. The total number of applicated cells was 3.8 times lower in the TRC group, but TRC patients were given significantly higher amounts of CD90+ cells. Improvement in microvascularisation was identified in some, but not all patients by angiography, while TcPO2 improved substantially compared with baseline in both therapy groups.

From the article of the same title
International Journal of Clinical Practice (04/01/12) Vol. 66, No. 4, P. 384 Kirana, S.; Stratmann, B.; Prante, C.; et al.
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Scarf Osteotomy in the Management of Symptomatic Adolescent Hallux Valgus
A study was performed to evaluate the management of symptomatic adolescent hallux valgus via scarf osteotomy, using a cohort of 29 patients, or 39 feet, with an average followup of 38.6 months. At final followup, the average AOFAS score was 94.2, and 93 percent of all patients were either satisfied or very satisfied with their final results. One patient has been listed for revision surgery following symptomatic recurrence at three years followup. The preoperative hallux valgus angle, inter-metatarsal angle, and distal metatarsal articular angle were 34.8 degrees, 15.9 degrees, and 16.0 degrees, respectively. Respective postoperative values were 16.3 degrees, 8.8 degrees, and 9.2 degrees, and Pearson's r coefficient values indicated good inter-rater reliability of measurement.

From the article of the same title
Journal of Children's Orthopaedics (03/17/12) Farrar, N.G.; Duncan, N.; Ahmed, N.; et al.
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Treatment of Talocalcaneal Coalitions
The results of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft over a 13-year period were reviewed. The procedure was administered to 93 feet by six surgeons, and patient's outcome was evaluated at the last follow-up using the AOFAS Hindfoot scale. Postoperative computed tomography (CT) scans were available for 20 feet. Forty-nine feet had follow-up of at least one year and had a score acquired via the AOFAS Hindfoot scale. At an average of 42.6 months of follow-up, the average score was 90/100. The postoperative CT scans showed a single recurrence that was corrected with repeat excision. An additional patient was reoperated for failure to remove the coalition completely. Eleven patients underwent subsequent surgery to fix foot alignment, and none of the patients excluded because of short follow-up had repeat surgery or recurrence.

From the article of the same title
Journal of Pediatric Orthopaedics (05/01/12) Vol. 32, No. 3, P. 301 Gantsoudes, George D.; Roocroft, Joanna H.; Mubarak, Scott J.
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Practice Management

Guidance on Troubleshooting Claims Submissions for Version 5010
Recently, some providers have experienced issues with Version 5010 claims processing or payment. The Centers for Medicare & Medicaid Services has created a fact sheet that provides guidance to help providers troubleshoot some of the difficulties they are experiencing. The fact sheet contains information on:

* How to handle claims that have failed edits during the delivery process
* What providers can do if they have difficulty receiving information from clearinghouses and/or billing vendors
* Links to each of the Medicare-Administrative Contractor websites, which include lists of their top 10 edits for Version 5010 claims
* Additional reasons why some providers may receive claims rejections

The fact sheet can be found here.

From the article of the same title
Centers for Medicare & Medicaid Services (03/30/12)
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More Doctors Work Part Time, Flexible Schedules
A survey by Cejka Search, a physician search firm based in St. Louis, and the American Medical Group Assn. found that in 2011, 22 percent of male physicians and 44 percent of female physicians worked less than full time, up from 7 percent and 29 percent, respectively, in 2005. Two of the fastest-growing physician demographics -- men near the end of their careers and women at the beginning or middle -- are the most likely to demand part-time or flexible work schedules, according to experts in physician recruitment. The first place physicians looking to work part-time search is large, physician-owned practices. Physician search firms said the increasing demand for part-time work is pressuring smaller groups to offer similar options. According to the survey, 75 percent of groups in 2011 offered a four-day workweek, and 30 percent allowed job-sharing. Experts advise that physicians looking for less than full-time work be up-front with potential employers about what they want and why they want it, because flexibility is possible. Still, some specialties may find it more difficult than others to set up a part-time or flexible arrangement.

From the article of the same title
American Medical News (03/26/12) Elliott, Victoria Stagg
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Should Physician Practices Ask Potential Hires for Facebook Login Info?
Many, if not most, medical practices have some kind of social-media policy that guides employees on what they can or cannot say about their employer on the World Wide Web. While most practices also do some kind of Web-based research on employee candidates before hiring them, a growing number of employers are actually going so far as to ask potential hires to share social networking log-in and password information. Some companies and government agencies are going beyond merely glancing at a person’s social networking profiles and instead asking to log in as the user to have a look around. The issue raises several questions. In today’s era of social media use, to what extent should a practice monitor its employees’ actions? Should potential employees’ social media accounts be screened? Or should a practice just stick to handing out a social media policy?

“Asking anyone for any password for any account is entirely inappropriate,” physician Russell Faust, a Practice Notes blogger and healthcare consultant, says. “As a potential employee, if asked for any of my passwords, I might be persuaded to provide my Facebook password if the requester provides the login for their bank account in exchange.” However, Faust said he feels that “any public information, whether in print, or online, is fair game for a potential employer to screen.”

Practice Notes blogger C. Noel Henley agreed that asking for potential employees’ login information is inappropriate. “If our office manager suggested we start doing this, I'd be very wary,” Henley said. Henley did, however, say it is reasonable for a medical practice to create a policy outlining what it expects from employee discussions on social media. Faust said such a policy should be mandatory. “Every employer should have a clear social media policy that clarifies expectations, and specifies boundaries and possible consequences for disregarding those rules,” he said.

From the article of the same title
Physicians Practice (03/26/12) Torrieri, Marisa
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Should Surgeons Postpone Procedures for Heavy Drinkers?
Surgeons could reduce the length of time in the hospital and ICU and the likelihood of a repeat operation by postponing procedures for patients who consume large amounts of alcohol to give patients time to stop, according to a study published in the Journal of the American College of Surgeons. The study of 5,171 male patients of Veterans Affairs suggests that patients who drink four or more glasses of alcohol a day have significantly higher post-surgical complication rates than patients who do not drink at all. However, getting heavy drinkers to stop for only 30 days substantially reduces that risk.

From the article of the same title
HealthLeaders Media (MA) (03/23/12) Clark, Cheryl
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Health Policy and Reimbursement

Doc Associations Warn CMS About Coming ‘Storm' of Overlapping Regulations
The American Medical Association (AMA) joined with other physician specialty groups to urge the CMS to consider the “imminent storm” of overlapping regulations going into effect next year. In a letter to acting Administrator Marilyn Tavenner, the groups expressed concern that the timeline for transitioning to ICD-10 overlaps with other program deadlines, such as e-prescribing, electronic health records and the physician quality reporting system. The letter also highlighted that the changes are coming to pass as physicians face a roughly 30 percent cut in Medicare payments. “The combination of these financial burdens could prevent physicians from making the investments needed to transition to new models of care delivery and improve the value and quality of care in the Medicare system,” AMA President-elect Jeremy Lazarus said in the statement.

From the article of the same title
Modern Healthcare (03/29/12) Kutscher, Beth
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Getting a Doctor's Appointment Tougher on Medicaid
According to a new study from the University of Colorado, Americans on Medicaid have a harder time getting a prompt doctor's appointment, which may help explain why some end up going to the ER. The problem is likely to grow, researchers say, as more people go on Medicaid as part of national healthcare reform; and simply expanding coverage may not be enough to improve access to primary care. The study found that of more than 230,000 Americans surveyed over a decade, Medicaid recipients had more problems getting an appointment with a doctor. Just over 16 percent reported at least one "barrier," such as having to wait too long for an appointment or even being unable to get someone on the phone at the doctor's office, compared with 9 percent of survey respondents who had private insurance.

From the article of the same title
Reuters (03/27/12) Norton, Amy
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MedPAC Calls for Pay Parity Between Hospital, Doctor Office Visits
A Medicare Payment Advisory Commission (MedPAC) proposal recently sent to Congress would reduce payments for patient office visits provided in hospital outpatient departments. The recommendation would lower hospital pay for primary care services to the same rates as those paid for the same care when provided in physician offices. The commission says its proposal could save Medicare about $1 billion a year. MedPAC has seen a rise in office visits provided to patient in hospital outpatient departments as more hospitals acquire physician practices. The commission now wants Medicare to start paying the same rates for office visits in both settings. For example, a mid-level office visit in a hospital outpatient department pays $124.40, but the same visit in a physician's office pays $68.97, 44.6 percent less, according to MedPAC. The commission urged Congress to enact legislation to phase in the payment parity provisions over three years.

From the article of the same title
American Medical News (03/26/12) Fiegl, Charles
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Medicine, Drugs and Devices

EHR Adoption Rates Jump for Solo Practices
An ongoing study by SK&A shows that, for the first time, ever, medical practices with only one or two physicians are adopting electronic health records (EHRs) faster than practices of any other size. The study found that adoption rates for single-doctor offices rose from 30.8 percent to 36.9 percent. The Health Information Technology for Economic and Clinical Health Act, part of the 2009 stimulus package, allows practices to earn up to $44,000 per physician over five years from Medicare, or nearly $64,000 over six years, if they demonstrate meaningful use of EHRs. Large practice EHR adoption has slowed partially because it is nearing a ceiling, but adoption still grew from 75.5 percent to 77.2 percent in 2011.

From the article of the same title
American Medical News (03/26/12) Dolan, Pamela Lewis
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New FDA Guidance on Considerations Used in Device Approval
The U.S. Food and Drug Administration has published a first-of-its-kind guidance for medical device manufacturers, detailing how the benefits and risks of certain medical devices are weighed during premarket reviews. The newly released guidance outlines the systematic approach FDA device reviewers take when making benefit-risk determinations, and provides manufacturers with an explanation on the principal factors the FDA considers during premarket approval applications, the regulatory pathway for high-risk devices, and the regulatory pathway available for novel, low- to moderate-risk devices. The guidance can be found here.

From the article of the same title
U.S. Food and Drug Administration (03/27/2012) Bolek, Michelle
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Pharma Scales Back Drug Samples to Physician Offices
Pharmaceutical companies have reduced their sales rep force by about 30 percent from five years ago, and the number of drug samples to doctors' offices has also declined. Drugmakers' spending on samples given to physician offices has gone down by 25 percent since 2007, according to Cegedim Strategic Data (CSD). In 2007, drugmakers spent nearly $8.4 billion on samples, but by 2011, that figure fell to about $6.3 billion. The number of detailer visits that included samples fell by 35 percent between 2007 and 2011. Some doctors have noticed this trend, finding themselves short of many drugs they formerly had in excess. Nearly 25 percent of doctors, meanwhile, refuse to see drug reps, and about half will only see reps by appointment, according to SK&A, a division of CSD. Almost a quarter of surveyed physicians refuse to take samples.

From the article of the same title
American Medical News (03/26/12) O'Reilly, Kevin B.
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