April 11, 2012

News From ACFAS

New eLearning Opportunities
Take advantage of the latest free educational offerings from ACFAS and earn CPME without leaving your office!

New for the month of April:
  • Heel Pain Clinical Session-- Hear a comprehensive approach to surgical and non-surgical treatment options for heel pain from presenters Laurence Rubin, DPM, Michelle Butterworth, DPM and Richard Bouch, DPM.
  • Podcast on Complicated Patient Relationships (moderated by George Liu, DPM, with panelists Sam Mendicino, DPM, John Steinberg, DPM, and Sean Wilson, DPM) is an insightful discussion of the evolutional doctor/patient relationship and helps listeners gain intuition on what to do in even the most complicated of cases.
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ACFAS Regional Divisions Seek Volunteer Leaders
Ever think about getting involved in ACFAS as a volunteer, but not sure how to go about it? New to volunteering, and want to get a taste of it by offering support to doctors, residents and students in your part of the country? Now’s your chance!

ACFAS’s Regional Divisions offer the opportunity to connect with other members through state and local seminars, meetings and labs. Regional Divisions also offer scholarships and grants to students and residents. A portion of each member’s dues is allocated for Division activities.

Two Divisions are currently seeking volunteers to fill their executive officer slates: Division 2 “Northwest/Canada” (encompassing AK, ID, MT, OR, WA, WY and Canada) and Division 13 “Ohio Valley” (including the states of IN, KY, OH and WV). If you reside in one of these Divisions and are interested in getting involved and running for office, please contact Michelle Brozell, Director of Membership, with questions or to provide your CV.
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Correct Coding is Critical
Attend ACFAS' Practice Management/Coding Workshop on June 1-2 in Portland and help perfect your practice!

Sign up today for the two-day workshop, which includes one evening roundtable event, Contract Consternation or Coding and Practice Professionals Interactive Session, and get the inside scoop on the latest trends in podiatric surgical coding and CPT policy.

For more information or to register, visit For additional questions, contact ACFAS at (800) 421-2237.
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Foot and Ankle Surgery

Associations of Plasma VWF and 5-HIAA With Blood Flow in Lower Leg Arteries
A study was performed to assess associations of circulating levels of proinflammatory molecules and endothelial factors with blood flow in lower-leg arteries in diabetic Japanese patients with normal ankle-brachial index (ABI). The researchers enrolled 123 type 2 diabetic patients with normal ABI and 30 age-matched nondiabetic patients consecutively admitted to the hospital. Flow volume and resistive index at the popliteal artery were assessed via gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. An automatic device was employed to quantify ABI and brachial-ankle pulse-wave velocity (baPWV) for evaluation of arterial stiffness. Plasma soluble intercellular adhesion molecule-1 (sICAM-1) and monocyte chemoattractant protein-1 (MCP-1) concentrations, serum high-sensitivity C-reactive protein (hsCRP) levels, plasma von Willebrand factor ristocetin cofactor activity (VWF), and plasma vasoconstrictor serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) concentrations were quantified. BaPWM, resistive index, sICAM-1, MCP-1, log hsCRP, VWF, and 5-HIAA were higher in diabetic patients than in non-diabetic patients, while the blood flow was lower. A negative correlation was established between blood flow in diabetic patients and VWF or 5-HIAA, but not between blood flow and sICAM-1, MCP-1, and log hsCRP. It was assessed through multivariate analysis that the significant independent determinants of blood flow were hypertension, use of renin–angiotensin system inhibitors, VWF, and 5-HIAA in diabetic patients.

From "Associations of Plasma von Willebrand Factor Ristocetin Cofactor Actvity and 5-hydroxyindole Acetic Acid Concentrations With Blood Flow in Lower..."
Journal of Diabetes and its Complications (03/29/2012) Murase, Hiroshi; Suzuki, Eiji; Tajima, Yoshitaka; et al.
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Validity and Interobserver Agreement of Lower Extremity Local Tissue Water Measurements in Healthy Women Using Tissue Dielectric Constant
The measurement of the tissue dielectric constant (TDC) may become a key tool in clinical assessment of chronic lower extremity swelling in women, but several factors are known to influence TDC measurements, and there is little comparative data on healthy lower extremities. A cohort of 34 healthy female volunteers was studied, and age, body-mass index (BMI), moisturizer use, and hair removal were registered. Three blinded investigators measured TDC in a randomized sequence on clearly marked locations on the foot, ankle, and lower leg; effective measuring depth was 2.5 mm. The average TDC was 37.8 plus or minus 5.5 on the foot, 29 plus or minus 3.1 on the ankle, and 30.5 plus or minus 3.9 on the lower leg. TDC was highly reliant on measuring site but did not vary substantially between investigators. Age, BMI, hair removal, and moisturizer had no significant influence on the lower leg TDC. Intraclass correlation coefficients were 0.77 for the foot, 0.94 for the ankle, and 0.94 for the lower leg.

From the article of the same title
Clinical Physiology and Functional Imaging (03/21/12) Jensen, Mads R.; Birkballe, Susanne; Norregaard, Susan; et al.
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A Cohort-Controlled Trial of the Addition of Customized Foot Orthotics to Standard Care in Fibromyalgia
A study to test the effectiveness of customized foot orthotics for treating fibromyalgia was held, involving a cohort of 67 consecutive patients with chronic, widespread pain. A control group of patients were prescribed a spinal exercise therapy program and analgesics, while a second group of 35 patients received the same therapy, with the addition of customized foot orthotics. All patients completed the Revised Fibromyalgia Impact Questionnaire (FIQR) at the start of the study and at eight weeks follow-up, and the number of subjects using any type of prescription analgesic or other medication for chronic pain at baseline and at eight weeks was recorded as well. Thirty control group subjects and 33 orthotics group subjects completed the study, and all subjects completed the baseline and eight-week FIQR. The two groups had a close correspondence in terms of age, medication use, pain duration, and baseline FIQR scores. At eight weeks, the orthotics group had a greater reduction in the FIQR score than the cohort control group, with a reduction of 9.9 plus or minus 5.9 for the orthotics group versus 4.3 plus or minus 4.4 for the control group. This was primarily on account of changes in the "function" domain of the FIQR.

From the article of the same title
Clinical Rheumatology (03/20/12) Ferrari, Robert
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Practice Management

7 Tips for Marketing a Physician Practice to Patients
Physicians are looking for new ways to connect with patients and social media outlets like Twitter and Google Places have become a staple for many physician practices. John Lynn, founder of the Healthcare Scene blog network and co-founder of Influential Networks, provides some advice for physicians on how to market their practices to patients. First, develop a social media plan and focus on one or two social media platforms, and remember that social media is a long-term effort with the goal of connecting to patients. "Be your authentic self as you participate in social media," says Lynn. "Doing so is the best way to market your practice."

Learn which social media systems your target audience frequent and start participating as fully as possible. Be careful to draw boundaries and know what is acceptable and unacceptable communication so patients know your limits and expectations. "Start by giving more than you take and you'll end up receiving more than you give," says Lynn. Be sure to list your practice on Google Places, as it is a free way to give your web presence a boost in local Google Search results, and encourage patients to post reviews on Yelp and other review sites.

Starting a blog is a great way to drive traffic to your website and help potential patients learn more about your practice. "Can you provide information that will help patients before they even see you in person? All of these can help a patient understand more about your practice and why they should visit your practice instead of your competitor down the street," says Lynn. Be willing to try multiple social media options. Try multiple venues to see what works for you. "Certainly be thoughtful in your approach, but people are surprisingly forgiving if you're trying something new and make a mistake," says Lynn. "That's all part of the learning process and will help you to become a master of marketing your practice."

If the idea of a social media presence seems too daunting, consider bringing in a partner who is more comfortable with this kind of marketing, but be sure to set clear guidelines and understand what results are expected from the partnership. Lastly, Lynn says to remember that successful social media campaigns will not necessarily mean more patients. "Things like followers on Twitter, email subscriptions or likes on Facebook can be even more valuable long term than one patient through the door today."

From the article of the same title
Healthcare Finance News (04/03/12) McNickle, Michelle
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The Joint Commission Enterprise Launches HAI Portal
The Joint Commission enterprise, in collaboration with the Joint Commission Center for Transforming Healthcare, Joint Commission Resources, and Joint Commission International, rolled out a healthcare-associated infections (HAI) electronic portal on April 2 designed to provide an abundance of HAI resources. The purpose of the HAI Portal is to deliver an integrated kiosk of resources, both those that are free and those that are available for purchase, in a single organized area accessible via any Joint Commission-related websites. The portal can be found here.

From the article of the same title
Joint Commission Online (04/02/12) Zhani, Elizabeth Eaken
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Health Policy and Reimbursement

HHS Proposes Delaying ICD-10 Deadline to Oct. 1, 2014
A proposed rule from the Department of Health and Human Services (HHS) delays by 12 months the compliance deadline for conversion to the International Classification of Diseases 10th Revision of diagnostic and procedural codes (ICD-10) to Oct. 1, 2014, and the postponement was indicated by HHS Secretary Kathleen Sebelius in February. HHS also announced the issuance of a proposed rule pursuant to a Health Insurance Portability and Accountability Act mandate that all health insurance plans be numerically tagged with a unique health plan identifier, which could save providers and plans as much as $4.6 billion over 10 years. "The new healthcare law is cutting red tape, making our healthcare system more efficient and saving money," Sebelius said. "These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients."

From the article of the same title
Modern Healthcare (04/09/12) Conn, Joseph
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CMS Extends Deadline to Appeal EHR Incentive Eligibility
Physicians and other eligible professionals still wanting to appeal their eligibility determinations for the 2011 Medicare electronic health record (EHR) incentive payment program will have an extra month to file those appeals, the Centers for Medicare & Medicaid Services has announced. The new deadline is April 30. The eligibility period for Stage 1 of the program, in which providers needed to attest to having met 90 consecutive days of meaningful use of an EHR, began Jan. 1, 2011, and ended December 31, 2011. Appeals allow providers an opportunity to show they have met all the requirements for the incentive payment program under the American Recovery and Reinvestment Act of 2009. Guidance on the appeals process can be found here.

From the article of the same title
Modern Healthcare (04/03/12) Conn, Joseph
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CMS Clarifies Patient Notification Requirements
Ambulatory surgical centers (ASCs) are allowed to provide patients with federally mandated information on the day of surgery as long as they provide it before surgery begins, according to a letter from the Centers for Medicare and Medicaid Services to its state survey agency directors. The letter confirms a recent regulatory revision that lets ASCs perform surgeries on the same day they are scheduled. While the revision took effect on Dec. 23, 2011, state surveyors were not formally notified until last week. As a result, some still enforced the previous standard, that patients must receive a notification of rights, of the physician's financial interests in the center, and of the center's advance directive policies, at least 1 day before the day of surgery.

From the article of the same title
Outpatient Surgery (04/03/12) Bernard, David
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Doctor Panels Recommend Fewer Tests for Patients
A coalition of nine medical specialty boards recommended on April 4 that physicians perform 45 common tests and procedures less frequently, and advise patients to question these services if they are offered. The groups announced the Choosing Widely educational initiative, directed at both doctors and patients, under the aegis of the American Board of Internal Medicine and in collaboration with Consumer Reports. These recommendations represent an atypically honest admission by doctors that many profitable procedures are executed needlessly and may harm patients. "Any information that can help inform medical decisions is good—the concern is when the information starts to be used not just to inform decisions, but by payers to limit decisions that a patient can make," says Heritage Foundation analyst Kathryn Nix. "With health care reform, changes in Medicare and the advent of accountable care organizations, there has been a strong push for using this information to limit patients' ability to make decisions themselves." Disputing this assertion is American Board of Internal Medicine Foundation CEO Christine K. Cassel, who says the United States can cover the cost of all Americans' healthcare needs, provided care is appropriate.

From the article of the same title
New York Times (04/04/12) Rabin, Roni Caryn
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Medicine, Drugs and Devices

Electronic Health Records Mean Fewer Tests
Doctors' access to patients' electronic medical records means fewer orders for lab tests, but this efficiency may presently be restricted to state-of-the-art records exchanges, according to a new study based on the experience of Brigham and Women's Hospital and Massachusetts General Hospital, which form the nonprofit Partners HealthCare. Twelve years ago the hospitals set up a health information exchange to access each others' electronic medical records, and study author Alexander Turchin says that "the number of lab tests went down after the introduction if there were recent lab tests available." Turchin and colleagues analyzed 117,606 people who were outpatients at one of the hospitals between Jan. 1, 1999, and Dec. 31, 2004. Of that number, 346 had recent tests done at the other hospital, and 44 patients had them administrated prior to the exchange rollout. As for those who did not have recent test results available, 21,968 were at one of the hospitals before the exchange.

Turchin says the number of lab tests ordered for each patient before the exchange in 1999 was about seven, which slipped to about four in 2004. For patients without prior tests, the amount climbed slightly to about six tests per patient from about five. In comparison to the modest increase for patients without tests, the number of tests ordered for those with previous results plunged by 49 percent after the establishment of the exchange. The number of tests ordered fell by roughly 53 percent after accounting for confounders.

However, findings published in the journal Health Affairs earlier this month suggested office-based doctors with electronic access to imaging and lab results do not reduce the number of tests ordered—in fact, they may increase it. Turchin says imaging results may be more vulnerable to reordering by doctors, since the pictures need to be interpreted by a human. "People may think my radiologists are better than the radiologists next door. So they may repeat the tests," he notes. The doctors may additionally misunderstand the results and want to consult with the radiologist. The next stage for Turchin's team is to study potential savings from ordering less tests.

From the article of the same title
Reuters (03/29/12) Seaman, Andrew M.
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In Age of Gadgets, Doctors Try to Keep Human Touch
With the United States migrating to paperless medicine, doctors must contend with the challenge of tapping the potential of computers, smartphones, and iPads in the exam room without eroding the human connection with their patients. Georgetown University, Stanford University, and other medical institutions are creating a growing number of programs to train new doctors in this new paradigm. The Georgetown initiative involves using actors as patients to identify problems ahead of time, while this summer Stanford medical students will bring a school-issued iPad along as they commence their bedside training. "The promise of these devices to augment the delivery of clinical care is tremendous," says Stanford's Clarence Braddock, who employs a secure application on his iPad to pull up patient charts if he is called after hours.

Middle-aged physicians may be less comfortable using the technology and take longer with it, while younger clinicians who grew up texting while multitasking may not be aware how intrusive patients might find the gadgets. "If the screen is turned away from the patient, they don't know if you're looking at their electronic health record or playing solitaire or looking up stocks," observes Glen Stream with the American Academy of Family Physicians. Stream takes pains to show patients what he is doing, especially when viewing images on the screen can help them better comprehend a health condition.

Meanwhile, Georgetown doctor Vincent WinklerPrins restricts screen time in front of his own patients by typing notes into their charts after they leave. Actors conferred at Georgetown recently, each to portray an older diabetic seeking care for the first time since a spouse's passing. WinklerPrins watched on a monitor outside the room as medical students carried out a 15-minute office visit. They utilized computerized records while giving each actor test results, establishing a treatment plan, and submitting an electronic prescription to the pharmacy. The actor-patients offered valuable feedback afterward, and the students perceived the importance of the technology but at the same time noted how easy it is to get distracted. WinklerPrins says that hopefully the systems will become less cumbersome. "We don't lose, in the meantime, the focus on the patient," he notes.

From the article of the same title
USA Today (03/29/12) Neergaard, Lauran
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