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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

New Temporary Pay Fix Considered in Senate

Senate Democrats, joined by a few Republicans, broke a Republican filibuster on Monday to clear the way for legislation to extend a temporary stay on the Medicare physician pay cut and continue COBRA subsidies and unemployment benefits.

The extension to either May 1 or June 1, depending on current motions in the chamber, would be retroactive to April 1, when the current extension expired. The legislation must pass by April 15 to avoid reduced payments being issued to physicians.

Healthcare provider groups are relieved to see progress on the extension, which has encountered opposition twice in the past two months from Republicans concerned about covering the cost. However, many point out that this is still just another temporary extension, and say they will continue to press for a permanent fix to the Medicare reimbursement formula.
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Total Ankle Replacement Position Statement is Adopted by Board

Total ankle replacement can be a safe and effective treatment option for end-stage ankle arthritis in certain patients, according to a new position statement adopted by the ACFAS Board of Directors.

The position statement summarizes the results of research into the advantages and limitations of both ankle fusion and total ankle replacement, and concludes that the safety profiles of the two procedures are comparable.

Studies have shown total ankle replacement surgery improves patient function, reduces pain and promotes improved quality of life. A surgeon experienced in total ankle surgery can determine whether a patient is a sound candidate through careful history and physical evaluation.

The entire position statement is available on the ACFAS web site.

Foot and Ankle Surgery

Combination of Modified Broström Procedure With Ankle Arthroscopy for Chronic Ankle Instability Accompanied by Intra-articular Symptoms

Researchers evaluated the effectiveness of the modified Broström procedure combined with ankle arthroscopy for chronic ankle instability (CAI) accompanied by intra-articular symptoms. They identified 85 consecutive patients with CAI (87 ankles), all with intra-articular symptoms. Ankle arthroscopic surgery was performed initially to manage any intra-articular lesions, followed by the modified Broström procedure, including shortening of the anterior talofibular ligament and/or calcaneofibular ligament, as well as extensor retinaculum augmentation. Intra-articular lesions were found in 79 ankles (90.8%), including 75 with synovitis and soft-tissue impingement, 33 with chondral injuries, 23 with anterior tibial osteophytes, 7 with loose bodies, and 6 with distal tibiofibular syndesmosis injuries. The mean AOFAS score improved from 46.6 ± 8.1 preoperatively to 86.5 ± 7.6 postoperatively (P < .05) after a mean of 29 months. Mean postoperative AOFAS scores were significantly higher in patients without chondral lesions than in those with chondral lesions (89.76 ± 5.88 and 81.35 ± 7.18, respectively; P < .05). Improvements in AOFAS scores after surgery were significantly greater in patients without chondral lesions than in those with chondral lesions (42.28 ± 9.04 and 36.06 ± 11.85, respectively; P < .05).

From the article of the same title
Arthroscopy (04/01/10) Vol. 26, No. 4, P. 524; Hua, Yinghui; Chen, Shiyi; Li, Yunxia; et al.

Maintenance of Hardware After Early Postoperative Infection Following Fracture Internal Fixation

Determining the prevalence of osseous union with maintenance of hardware following the development of postoperative infection within six weeks after internal fixation of a fracture was the purpose of this study. The analysis involved 121 patients in whom 123 postoperative wound infections with positive intraoperative cultures had developed within six weeks following internal fixation of acute fractures. Eighty-six patients (eighty-seven fractures; 71%) had fracture union with operative débridement, retention of hardware, and culture-specific antibiotic treatment and suppression. Statistically significant predictors of treatment failure were open fracture and the presence of an intramedullary nail. The researchers concluded that operative débridement, antibiotic suppression, and hardware retention can successfully treat deep infection after internal fracture fixation until fracture union transpires.

From the article of the same title
Journal of Bone and Joint Surgery (American) (04/01/10) Vol. 92, No. 4, P. 823; Berkes, Marschall; Obremskey, William T.; Scannell, Brian; et al.

Practice Management

Doctors with Ownership in Surgery Center Operate More Often

Doctors invested in an outpatient surgery center perform twice as many surgeries on average as doctors with no such financial stake, according to a new study from the University of Michigan Health System. "Through what some have labeled the ‘triple dip,’ physician owners of surgery centers not only collect a professional fee for the services provided, but also share in their facility’s profits and the increased value of their investment. This creates a potential conflict of interest,” says study author John Hollingsworth. The study appears in the April issue of Health Affairs.

From the article of the same title
Newswise (04/06/10)

Health Reform Mandates Disclosure of Industry Gifts

Nearly any kind of payment of $10 or more from a drugmaker, device maker, or other medical industry firm to a doctor will be published on a searchable Web site starting Sept. 30, 2013. The "sunshine" provisions of the health system overhaul President Obama signed into law in March also apply to teaching hospitals and are aimed at curbing industry's influence on medical decision-making.

From the article of the same title
American Medical News (IL) (04/05/10) O'Reilly, Kevin B.

Medicare Enrollment: Staying in the Game Even When the Rules Change

Physician practices were once guaranteed indefinite access to Medicare dollars once they were given initial approval. Now, they must revalidate every five years, at which time they are required to complete a full enrollment application. Additionally, offices are given certain time frames during which they must update their data whenever specific changes occur. Neglecting to keep enrollment information current may lead to a rescission of billing privileges, levying of overpayment penalties, or exposure to fraudulent claims liability. Physicians have three enrollment forms they must use: 855B for physician practices, diagnostic testing facilities, and other offices; 855I for individual doctors and nonphysician providers; and 855R for those who are reallocating benefits to another facility. Physician practice applications must be accompanied by an array of additional documents—a completed CMS-588 electronic funds transfer form, requisite reassignment forms, etc.—within one month of submission.

From the article of the same title
Family Practice Management (04/10) Shay, Daniel F.

Health Policy and Reimbursement

Health Insurers Sue to Raise Rates

Several health insurers have filed a suit against Massachusetts seeking to reverse a decision by the state's insurance commissioner to block premium increases. The proposed rate hikes would have taken effect April 1 for plans covering thousands of small businesses and individuals. Insurers wanted to raise base rates an average of 8 percent to 32 percent.

From the article of the same title
Boston Globe (04/06/10) Weisman, Robert

Insurer Fights Maine Regulator on Premiums

State insurance regulators are closely monitoring a court case in Maine, where Anthem Blue Cross and Blue Shield is fighting Maine Insurance Superintendent Mila Kofman's rejection of a proposed 18.5 percent increase in rates on individual health insurance policies that it claims would have allowed it to turn a profit. Kofman instead approved a 10.9 percent increase, which the insurer claims will result in losses. Anthem claims that Maine law requiring insurers to accept all applications for individual health policies has driven up expenses, but Kofman points out that claims have risen in states without broad coverage rules. "It's about medical costs and how effective or not effective companies have been in tackling the cost of medical care," she says.

From the article of the same title
Wall Street Journal (04/02/10) Mathews, Anna Wilde; Johnson, Avery

Texas Doctors Seeking Support to Replace Medicare Reimbursement Formula

Physicians in Texas have launched a campaign to collect 1 million signatures from patients and sympathizers in support of scrapping the federal government's Medicare reimbursement formula. Under the current payment structure, doctors are facing a 21 percent cut in Medicare reimbursements. While Congress is expected to step in to prevent the cuts, the doctors say they are tired of temporary fixes year after year.

From the article of the same title
Dallas Morning News (TX) (04/06/10) Roberson, Jason

Technology and Device Trends

Calcaneal Osteotomy Preoperative Planning System With 3D Full-Sized Computer-Assisted Technology

Researchers developed a CT-based computer-assisted pre-operative planning and simulating system for the calcaneal osteotomy by integrating different software’s function. The system uses the full-scaled 3D reverse engineering technique in designing and developing preoperative planning modules for the calcaneal osteotomy surgery. The system presents a real-sized three-dimensional image of the calcaneus, and provides detailed interior measurements of the calcaneus from various cutting planes.

From the article of the same title
Journal of Medical Systems (03/29/10) Chou, Yi-Jiun; Sun, Shuh-Ping; Liu, Hsin-Hua

Paralysed Limbs Revived by Hacking Into Nerves

Various experiments are underway to restore movement to paralyzed limbs by connecting artificial electrical networks to natural ones. One such technique controls ankle movement for people suffering from footdrop; the method involves placing four electrodes around a nerve within a cylindrical cuff, injecting current into the nerve while also reading signals sent back by the foot in order to communicate the pressure it senses. That data is used by a control unit implanted in the patient's thigh to time its signal to flex the ankle in a manner that facilitates a normal gait. Another method under development is the flat interface nerve electrode, a solution in which a flat cuff forces nerve fiber bundles closer to the electrodes for a better connection.

From the article of the same title
New Scientist (04/03/10) Vol. 206, No. 2754, P. 16; Campbell, MacGregor

Shock Wave Therapy Compared with Intramedullary Screw Fixation for Nonunion of Proximal Fifth Metatarsal Metaphyseal-Diaphyseal Fractures

The current "gold standard" for treatment of chronic fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal is intramedullary screw fixation. Researchers in this study evaluated the safety and efficacy of shock wave therapy as a treatment of these nonunions. Twenty-three patients with a fracture nonunion in the metaphyseal-diaphyseal region of the fifth metatarsal received high-energy shock wave therapy (2000 to 4000 shocks; energy flux density per pulse, 0.35 mJ/mm2), and 20 other patients with the same type of fracture nonunion were treated with intramedullary screw fixation. Twenty of the 23 nonunions in the shock wave group and 18 of the 20 nonunions in the screw fixation group were healed at three months after treatment. One of the three nonunions that had not healed by three months in the shock wave group was healed by six months. There was one complication in the shock wave group (post-treatment petechiae) and eleven complications in the screw-fixation group (one refracture, one case of cellulitis, and nine cases of symptomatic hardware).

From the article of the same title
Journal of Bone and Joint Surgery (American) (04/01/10) Vol. 92, No. 4, P. 846

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April 14, 2010