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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

Check Your Conference CME Online

If you attended the 2010 Annual Scientific Conference, you can now check your CME credits quickly and conveniently online on the ACFAS web site!

Please view your transcripts and check your CME credit promptly, as you will have only 45 days to make any changes in the records. After May 15, 2010, no changes can be made online.

If you have questions about the online CME records, please contact the ACFAS Education Department at 800-421-2237.
New Podcast on Diabetic Care

Podcasts from ACFAS e-Learning are a handy, free resource for knowledge of foot and ankle health issues.

The latest addition, “Wound Care vs. Diabetic Surgery,” is a comprehensive discussion on the complexities of care for diabetic foot ulcers. Three surgeons and educators explore the pros and cons of debridement, negative pressure wound therapy, dressings, skin grafts, bioengineered tissue and a variety of surgical interventions.

Tune in whenever you are ready to get the new podcast or browse the entire library at ACFAS e-Learning.

ACFAS Comments on CPME Residency Standards

This past winter the Council on Podiatric Medical Education (CPME) proposed revisions to podiatric residencies and sought comment from the residency community of interest. At its February meeting, the ACFAS Board of Directors approved the following recommendations to CPME on the proposed changes.
  • Terminology — ACFAS strongly recommended that the word “surgical” be retained from the current PM&S terminology for residencies, in the interest of equivalency of training and professional parity.
  • Institutional Standards Item 3.9 (g) — ACFAS recommends that the proposed new clause, “membership in the American Podiatric Medical Association,” be deleted as a program requirement, noting that: “Neither the American Council of Graduate Medical Education nor the American Osteopathic Association’s Postdoctoral Training Document mentions professional memberships in their standards. CPME must be autonomous, independent, and impartial in its relationships with all professional societies or external organizations.”
  • Program Standards Item 5.2 — The board suggested CPME reconsider the feasibility of requiring that future program directors be certified by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine.
  • Appendix A, Item A – Patient Care Activity Requirements — ACFAS also noted proposed changes to the required case activities for residents, recommending that that the number of required clinic encounters be maintained, and that the minimum requirement for medical histories and physical examinations be increased.
For more information on ACFAS’ comments, look for the full article in the April issue of Update, available now on the ACFAS web site.

Foot and Ankle Surgery

Shoes: A Treatment for Osteoarthritis in the Knees?

According to a study by Rush University Medical Center, certain kinds of footwear are better than others at alleviating the load on the knee joints when walking, which could be a critical factor in the treatment of osteoarthritis. "Our study demonstrated that flat, flexible footwear significantly reduces the load on the knee joints compared with supportive, stable shoes with less flexible soles," says lead study author and Rush rheumatologist Najia Shakoor. The study involved the analysis of 31 patients with osteoarthritis symptoms in the Rush Motion Analysis Lab while they walked barefoot and with four common shoe types—flip-flops, Dansko clogs, Brooks Addiction stability shoes, and Puma H-Street shoes. The researchers found the load on the knee joints to be significantly higher with the clogs and the stability shoes, compared to walking barefoot or with the flat walking shoes or the flip-flops. "The results in our study demonstrate that the reduction in load achieved with different footwear, from 11 to 15 percent, is certainly comparable to reduction in load with braces and shoe inserts," Shakoor observes.

From the article of the same title
ScienceDaily (03/25/10)

Subtalar Versus Triple Arthrodesis After Intra-Articular Calcaneal Fractures

Depending on initial treatment, between 2 percent and 30 percent of patients with a displaced intra-articular calcaneal fracture will need a secondary arthrodesis. A recent study aimed to determine the effect of subtalar verses triple arthrodesis on functional outcome. A total of 33 patients with 37 secondary arthrodeses (17 subtalar and 20 triple) were asked to complete questionnaires regarding disease-specific functional outcomes, including the Maryland Foot Score, quality of life, and overall satisfaction with the treatment. The Maryland Foot Score was similar following subtalar and triple arthrodesis, and there was no statistically significant difference found in quality of life. Smoking was found to be statistically associated with a non-union. The study's findings suggest that there is no significant difference in functional outcome between an in situ subtalar or a triple arthrodesis as a salvage technique for symptomatic arthrosis following an intra-articular calcaneal fracture.

From the article of the same title
Strategies in Trauma and Limb Reconstruction (03/23/2010) Schepers, Tim; Keiboom, Brenda C.T.; Bessems, Gert H.J.M.; et al.

Practice Management

Here's Where Doctors Often Neglect to Bill for Services Rendered

Healthcare consultants say many physicians take a surprisingly lackadaisical approach to how they bill for charges such as hospital consultations, test readings, and procedures performed outside the office. Physicians must develop a method for gathering and recording charge information that takes place outside the office. The medium for reporting is not as important as the consistency of it. Furthermore, someone in the office should debrief a physician regularly and formally to ensure the billing clerk is receiving data on a daily basis.

From the article of the same title
Medscape (03/12/10) Denning, Jeffrey J.

How Facebook Fan Pages Can Connect With Patients

Physician practices can use Facebook fan pages to attract new patients or create interpersonal relationships that can keep existing patients from changing doctors. Before creating a fan page, practices must determine the goal of the page, who will have posting privileges, and who will act as a moderator and respond to comments. Some practices do not let fans post due to concerns about inappropriate comments from disgruntled patients, but unlike other online spaces, experts say Facebook fan pages allow practices to manage the message. Among other things, practices with Facebook pages use the social media site to post videos about new procedures and treatments, talk with patients outside the treatment room—without providing medical advice or recommendations—and feature personal stories from patients who wish to share. To promote the practice's Facebook page, the link should be posted on the practice's Web site and on physicians' business cards. Experts say practices should not pay too much attention to the number of fans, as success is determined by the level of interaction and user satisfaction.

From the article of the same title
American Medical News (IL) (03/15/10) Dolan, Pamela Lewis

Lawyer Repellent

Doctors, particularly surgeons, are no strangers to malpractice lawsuits. A major reason for many lawsuits are unrealistic patient expectations. Medical Group Management Association Health Care Consulting Group principal Kenneth Hertz says managing a patient's expectations is fundamental to protecting yourself from a lawsuit. However, expectations can vary from patient to patient. Tom Cox, president and managing member of risk insurance management firm Bluewater Solutions, says doctors should strive to eliminate the possibly of any surprises by explaining all possible outcomes to patients and families. Fully communicating risks may take multiple visits, as medical information can be complicated and hard to hear.

From the article of the same title
Physicians Practice (03/10) Michael, Sara

Health Policy and Reimbursement

27 Senators Tell CMS to Relax, Postpone Meaningful Use Rules

A bipartisan coalition of 27 U.S. senators has sent a letter to the Centers for Medicare & Medicaid Services (CMS), urging it to push back the quality reporting requirement for electronic health records (EHRs), arguing that few medical facilities can currently meet all of the EHR goals or mandates needed to receive federal incentives payments. "We urge you to consider a longer transition that recognizes a practical, incremental approach to EHR adoption that rewards the efforts already underway in America's hospitals," wrote the coalition. The senators also raised objections to what they describe as the "inappropriate exclusion of most physicians working in outpatient centers" from eligibility for EHR stimulus incentives on account of their clinics or offices being located in facilities owned by the hospital system. Another worry of the coalition is that critical access hospitals are currently excluded from qualifying for incentive payments even if they take up meaningful use systems that are eligible, which "is contrary to the statute and inappropriate," according to the senators' letter.

From the article of the same title
HealthLeaders Media (MA) (03/30/10) Clark, Cheryl

Pfizer Gives Details on Payments to Doctors

Pfizer has disclosed that it made about $20 million in payments to doctors and other medical professionals for consulting and speaking on its behalf in the second half of 2009, while academic medical centers and other research groups received $15.3 million for clinical trials. Pfizer's Kristen E. Neese said most of the disclosures were mandated by an integrity agreement that Pfizer entered into in August to resolve a federal probe into the unlawful promotion of drugs for off-label applications. She noted that Pfizer's disclosures included components not mandated by the integrity agreement, such as payments to academic centers and to nurse practitioners and physician assistants. Under the terms of the Physician Payment Sunshine Act, drug and medical device firms will be obligated to report doctor payments of more than $10 starting in 2012, with the first disclosure available in 2013.

From the article of the same title
New York Times (03/31/10) Wilson, Duff

Surgeons Say Medicare Payments Cuts Would Limit Access to Care

A national survey of 13,834 physicians performed by the Surgical Coalition found that surgeons and anesthesiologists are planning to opt out of Medicare or make practice changes that will make care less accessible to Medicare patients if a proposed 22 percent cut in physician payments is pushed through. A breakdown of the survey response by specialty determined that just 28 percent of ophthalmologists, 27 percent of orthopedists, 35 percent of anesthesiologists, and 26 percent of otolaryngologists would continue to participate in Medicare following a 22 percent rate cut. Three-quarters of the 31 percent of physicians who said they would maintain Medicare participation said they intended to amend their practice if the rate cut were enacted. Such anticipated changes include restricting appointments with Medicare patients, no longer providing certain services, staff cuts, or suspending new equipment purchases. The Surgical Coalition concluded that "timely access to surgical care will be jeopardized if Medicare payments continue to decline."

From the article of the same title
Outpatient Surgery (03/01/10) Tsikitas, Irene

Technology and Device Trends

A Prospective Randomized Controlled Study With Intermittent Mechanical Compression of the Calf in Patients With Claudication

A group of researchers ran a randomized controlled single blind study to test the feasibility of using a new portable mechanical compression device for the treatment of claudication as a convenient, more affordable option for patients that results in solid compliance and better clinical outcomes. The device applied intermittent non-pneumatic mechanical compression (IMC) to the calf, and the study involved 14 patients who received active IMC and 16 control patients who continued with medical treatment alone. The study analyzed changes in exercise tolerance using Initial Claudiacation Distance and Absolute Claudiaction Distance along with ankle-brachial index at rest and post-exercise (ABI-pe). The researchers reached the conclusion that three-month application of IMC on the calf boosted claudication distances and supported objective improvements in ABI-pe.

From the article of the same title
Journal of Vascular Surgery (04/01/10) Vol. 51, No. 4, P. 857; de Haro, Joaquin; Acin, Franscisco; Florez, Aurora; et al.

Finding a Potential New Target for Treating Rheumatoid Arthritis

Researchers at New York University Langone Medical Center have developed a unique rheumatoid arthritis therapy that augments the activity of immune cells that protect against excessive inflammation through the administration of an investigational drug. Researchers at NYU and elsewhere have determined over the past several years that regulatory T cells keep inflammation in check by compensating for the tendency of conventional T cells to become overactive, and the Langone scientists discovered that the protein kinase C theta enzyme is only partially activated in regulatory T cells. The researchers started testing protein kinase C theta inhibitors, including a compound that had been in development by Boehringer Ingelheim. The compound raised the normal activity of regulatory T cells by about 500 percent, and the researchers ascertained that specifically blocking the activity of the kinase enzyme enhanced the regulatory T cell's natural tendency to keep it out of the communication channels, therefore elevating the cells' anti-inflammation activity.

From the article of the same title
Newswise (03/24/10)

Molecule That Keeps Skeletal Stem Cells "Young" Could Treat Osteoporosis, Fractures

Scientists have found how to control a key molecular player to keep stem cells in a sort of extended infancy, which could pave the way for new methods to fight arthritis, osteoporosis, and even bone fractures. Researchers led by Dr. Matthew J. Hilton of the University of Rochester Medical Center were able to increase the number and delay the development of stem cells that create bones, cartilage, muscle and fat. They showed that a molecule called Notch, which is well known for the influence it wields on stem cells that form the blood and the nervous system, is a key factor in the development of mesenchymal stem cells. In animal tests, the team showed that Notch prevents stem cells from maturing. The study has been published online in the journal Development.

From the article of the same title
Daily News & Analysis (India) (03/31/2010)

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April 7, 2010