April 17, 2013

News From ACFAS

3 Clinical e-Sessions New This April: CME Credit Available
ACFAS has built a reputation for excellence in scientific education, and for good reason. We have unparalleled speakers for presentation topics of all sorts. Below are three new Clinical e-Sessions that came straight from the mouths of some of our most highly regarded presenters. Click on the links to be directed to each e-session:These online presentations are available to members and non-members at no cost. Continuing education contact hours are available to ACFAS members.
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Calling All Manuscripts for ACFAS 2014
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, which will take place Thursday, February 27 to Sunday, March 2, 2014 in Orlando, Florida.

Manuscripts may be submitted beginning May 1, 2013, and the deadline is August 15, 2013. 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

Indications and Limitations of Osteochrondral Autologous Transplantation in Osteochondritis Dissecans of the Talus
A study was held to further define various factors which might influence the clinical results in patients treated with osteochondral autologous transplantation (OAT) from the ipsilateral femoral lateral condyle in osteochondritis dissecans of the talus. The clinical OAT outcome of 32 OAT patients was assessed using the AOFAS Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS) and Hospital for Special Surgery (HSS) Patella score. This was followed by analysis of the statistical correlation between clinical outcome and various variables such as age, pre-existing osteoarthritis or lesion size. The average AOFAS score was 86, while median ankle pain on VAS was 2 and median HSS Patella score was 95. Advanced age was affiliated with a significantly lower HSS Patella score. None of the other factors, including obesity, pre-existing osteoarthritis, lesion size, necessity of malleolar osteotomy, localization of the lesion and number of previous surgeries, influenced the clinical outcome negatively.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (04/01/13) Woelfle, Julia V.; Reichel, H.; Nelitz, M.
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Intense Pulsed Light Treatment of Chronic Mid-Body Achilles Tendinopathy
A randomized controlled trial was held to ascertain whether active intense pulsed light (IPL) would effectively treat patients with chronic mid-body Achilles tendinopathy. Forty-seven patients were randomly assigned to three weekly therapeutic or placebo IPL treatments, and the primary outcome measure was the Victorian Institute of Sport Assessment-Achilles score. Secondary outcomes were a visual analog scale for pain and the Lower Extremity Functional Scale. Outcomes were recorded at baseline, six weeks and 12 weeks post-treatment, as were ultrasound assessment of the thickness of the tendon and neovascularization. No significant difference was observed between the groups for any of the outcome scores or ultrasound measurements by 12 weeks, demonstrating no measurable benefit from treatment with IPL in Achilles tendinopathy patients.

From the article of the same title
Bone & Joint Journal (04/13) Vol. 95-B, No. 4, P. 504 Hutchison, A.M.; Pallister, I.; Evans, R.M.; et al.
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Isolated Anterior Talofibular Ligament Brostrom Repair for Chronic Lateral Ankle Instability
A study was performed to characterize the safety and long-term effectiveness of combined anterior talofibular Brostrom repair and ankle arthroscopy in the treatment of chronic lateral instability and intra-articular lesions in 42 athletes. Thirty-eight patients were reviewed at an average of 8.7 years post-surgery, and four were lost to follow-up. Patients were significantly improved for ankle laxity, AOFAS scores and Kaikkonen scales at the last follow-up. The average AOFAS score rose from 51 to 90, while the average Kaikkonen score improved from 45 to 90. Preoperatively-set outcome criteria indicated eight failures by the AOFAS score and nine by the Kaikkonen scale. Twenty-two patients practiced sport at the preinjury level, six had shifted to lower levels but were still active in less intense sports and 10 had shunned active sport participation although they still were physically active. Occurrence of new ankle instability episodes made six of these patients feel unsafe. Eight of the 27 patients who had no evidence of degenerative changes before the procedure had radiographic signs of degenerative changes of the ankle. Four of the 11 patients with preexisting grade I changes remained unchanged, and seven had progressed to grade II. No correlation was observed between osteoarthritis and status of sport activity.

From the article of the same title
American Journal of Sports Medicine (04/01/13) Vol. 41, No. 4, P. 858 Maffulli, Nicola; Del Buono, Angelo; Maffulli, Gayle D.; et al.
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Practice Management

Boosting Employee Satisfaction in Your Medical Practice
Employee satisfaction is key to the success of medical offices, where the entire customer/patient experience is person to person. Happy employees are essential not only to long-term retention of the employee but also to their quality of work, which includes how they treat each other and patients. Symptoms of employee dissatisfaction include tardiness/absenteeism, low company morale, poor work quality, disobedience and increased patient complaints, issues and/or conflicts.

Utilizing an anonymous employee satisfaction poll is a good way to diagnose a suspected problem. Be sure to include questions about suspected concerns by asking specific questions such as, “do you feel you have the technology available to do your job well?” If you don’t have any suspected concerns, start with a general survey and look for areas where they give elaborate concerns or compliments.

Another option is to have employee meetings to review problems. Employees are generally more comfortable speaking up among the people they work closely with. The manager can ask questions during a meeting and have the staff give live responses. Be sure to inform them that as long as they deliver their concerns or compliments in a respectful way, and as long as it is constructive, they will not be penalized.

After these steps are taken, it is time to get at the root of the disatisfaction. Oftentimes employee dissatisfaction is remedied by:

• Increased recognition: Develop a recognition program, such as an “employee of the month” or “employee of the week” program with some sort of plaque or certificate, maybe an up-close parking space or a gift card to a favorite coffee shop.

• Re-evaluating job duties: Ensure that each employee is challenged but not overwhelmed, even if it means re-evaluating what a particular job titles’ matching job duties are.

• Develop skills: No matter how big or small your staff, make sure your employees are receiving training in their job duty areas.

• A positive work environment: Make sure the leadership positions in your clinic are demonstrating a genuine positivity.

• Encourage social connections: Have a group lunch picnic or a Friday afternoon happy hour or other team-building activities to encourage social connections in your clinic. People who feel they belong to group or a team are more satisfied and more productive.

From the article of the same title
Physicians Practice (04/04/13) Mclaughlin, Audrey
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Don't Let Loan Debt Strangle Your Practice
Culling loan and lease debt is a critical component of keeping a practice afloat. Practices often spend too much time stressing about revenue and not paying enough attention to equipment leases, lines of credit and loans that could be bleeding them dry. Focusing on these money drains can help a practice save the cash it has already earned rather than throwing it away in interest payments.

One way to manage these debts is to seek out a loan to consolidate the amount owed overall into a single sum, a single interest rate and a single payment. Practices are urged to seek out lenders that specialize in the medical community when looking for a consolidation loan, as these lenders underwrite differently than small business lenders do. Managers should also consider incorporating real estate into their practice so that when they sell their business they will have real estate attached to the deal in addition to their patient base. This real estate will sweeten the deal and make the practice more attractive to buyers.

From the article of the same title
Health Leaders Media (04/03/2013) Freeman, Greg
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Tips on How to Maintain Physician Compensation Levels
Given the rapid developments in today's healthcare landscape, it can be difficult to anticipate the best way to do business. The future is not as clear as many would hope, but practice managers must keep their eyes and mind open. How a practice plans for and reacts to changes occurring in the industry will help set the direction for the future. A major issue continues to be maintaining physician compensation levels, especially given the general economic climate. There are a few items to consider when attempting to accomplish this.

The first is to ensure a rigorous business discipline. It is imperative that a practice adheres to a rigorous business discipline that involves planning, budgeting, assessing and monitoring goals and objectives on a regular basis and tweaking processes as necessary. The next item is to manage the revenue cycle. Many practices believe their revenue cycle is effective and efficient, but assessments can often prove otherwise. There is an opportunity for improvement in virtually every practice. Key areas include the registration process, verification of benefits, pre-authorization and point-of-service collections, coding and documentation processes and billing and collections.

Another set of considerations is education, investigation and innovation. Managers should take advantage of the top opportunities to keep informed. There are webinars, publications, on-site educational programs and other resources that can provide valuable information for a practice. Investigate these opportunities or consider joining an organization that can provide these resources, such as MGMA-ACMPE. Innovation is more critical than ever. Everything is changing, and a practice's ability to be nimble and innovate in this environment may help position it for success. Practices must determine whether it makes sense to implement new technology or employ a new service line, and such advancement challenges should be looked at as opportunities rather than problems. Finally, practices must be realistic. Expectations should be set based on past indicators, current conditions and future realistic projections. It is not possible to maintain physician compensation levels without setting clear and manageable expectations and working hard to see and care for patients.

From the article of the same title
Modern Physician (04/01/13) Hertz, Kenneth
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Health Policy and Reimbursement

CMS Launches 'Sunshine' Website
The Centers for Medicare & Medicaid Services (CMS) has launched a website for the National Physician Payment Transparency Program. The site will serve as a public source for collected data on payments made to physicians by drug and device manufacturers. Collection of data for the site will begin in August 2013, and information will be posted by September 2014. Physicians are not required to report any information on payments or register with the program. However, doctors are recommended to become familiar with the information being reported, register with CMS to receive updates on the program, review information submitted to CMS, keep records on payments or transfers that have to be submitted and work with manufacturers to ensure information is correct.

From the article of the same title
BNA Health Care Policy Report (04/01/13)
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White House 'Doc Fix' Language Mirrors House Proposal, Raising Hopes for Action
The White House has included language in its fiscal year 2014 budget proposal that reflects similar language used by House Republicans on a new physician payment system. The languages used is similar on topics such as allowing for a period of stable payments while new payment models are developed and implemented and linking payments to the delivery of quality care. The House Energy and Commerce and Ways and Means committees have released the second draft of new physician payment plan and hope to have legislation on the House floor by August. The similarities have raised hopes that a new system can gain momentum to approval this year. Republicans have also expressed concern that the cost of a new system and the Affordable Care Act could derail passage of a bill. However, the President Obama's budget indicated that the White House is committed to reforming the physician payment system. Officials warn that working out the details of the bill will be the most difficult part of the process, but expressed hope that legislators are moving in the right direction.

From the article of the same title
BNA's Health Care Daily Report (04/01/13)
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Obama Proposes $5.6B in Medicare Payment Cuts for FY 2014
President Obama has sent Congress his budget for fiscal 2014, which proposes $5.6 billion in Medicare payment cuts. Much of those savings, $3.1 billion, would come from adopting a Medicaid drug rebate program for people eligible for both Medicare and Medicaid that would require drug manufacturers to provide refunds to Medicaid programs. The budget also calls for roughly $400 billion in total federal healthcare savings over the next 10 years, much of which would come from a variety of drug cuts. The budget has been criticized by Sen. Orrin Hatch (R-Utah) for not doing enough to address Medicare's fundamental problems and for threatening the healthcare of seniors.

From the article of the same title
Modern Healthcare (04/10/13) Daly, Rich ; Zigmond, Jessica
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Proposed Rules Would Extend EHR Safe Harbor
The Centers for Medicare and Medicaid Services and the Department of Health and Human Services' (HHS) inspector general's office have proposed a pair of complementary rules to extend 2006 waivers that eased federal Stark and anti-kickback laws to encourage the use of electronic health-record (EHR) systems. The Dec. 31, 2013, sunset provisions of the original rules would be lengthened to Dec. 31, 2016, and the proposed rules also would jettison an e-prescribing mandate as well as revise language on what types of EHRs are eligible for the waivers. The original rules said qualification for the waivers hinged on whether the EHR systems being offered were interoperable, as determined by the system's certification within the previous 12 months by a certification body “recognized” by the HHS secretary. The updates contain amendments in the deeming language for interoperability, mandating that a certification body must be “authorized by” HHS' Office of the National Coordinator for Health Information Technology. A two-year regulatory interval also replaces the 12-month interval. The proposals suggest limiting the waivers to cover only hospitals, group practices, prescription drug plan sponsors and Medicare Advantage plans.

From the article of the same title
Modern Healthcare (04/09/13) Conn, Joseph
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Court Upholds Same-Specialty Expert Witness Requirement
Arizona's high court ruled in March that a statute requiring experts in medical liability lawsuits to share the same specialty as the treating physician does not break state or federal laws that ensure people the right to go to court. Under the law, a testifying expert must spend the bulk of his or her professional time practicing or teaching in the specialty in the year prior to the incident on which they are testifying transpired. The justices wrote that they construed “specialty” to refer “to a limited area of medicine in which a physician is or may become board certified.” The court also proclaimed that the purpose of the law would be defeated if subspecialties are not accounted for when deciding who is qualified to testify.

From the article of the same title
American Medical News (04/03/13) Henry, Tanya Albert
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Medicine, Drugs and Devices

3D-Printing of Bones Directly from X-Ray CT Scans Demonstrated by Freshman Student
A recent demonstration by University of Notre Dame researchers underscores how easy and inexpensive it has become to use to produce bones from a 3D printer. During the demonstration, which was also discussed in an article published in the Journal of Visualized Experiments, researchers showed how they used X-ray computer tomographic data sets from a live rat and the preserved skull of a rabbit to produce anatomical 3D models. These models were then used to create bones with the help of a 3D printer. This technique is not new, but its use by students shows how inexpensive and easy to use the software and 3D printers used to create new bone have become.

From the article of the same title
Science World Report (04/04/13) Hoffman, Mark
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EphB4 Enhances the Process of Endochondral Ossification and Inhibits Remodeling During Bone Fracture Repair
Researchers have performed a study that examined the role the tyrosine kinase receptor EphB4 plays in the bone repair process after a traumatic injury. Researchers performed femoral fractures with internal fixation in transgenic mice that overexpress EphB4 under the collagen type 1 promoter (Col1-EphB4) and examined the bone repair process for as long as 12 weeks after the fracture. They found that the bones of Col1-EphB4 were stiffer and stronger than those of wild-type mice following a fracture. These and other findings suggest that EphB4 promotes endochondral ossification while simultaneously limiting osteoclast development during callus formation, and that EphB4 could be a novel drug target for treating fractured bones.

From the article of the same title
Journal of Bone and Mineral Research (04/13) Vol. 28, No. 4 Arthur, Agnieszka; Panagopoulos, Romana A.; Cooper, Lachlan; et al.
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Nanokicking Stem Cells to Open for New Generation of Orthopaedics
Researchers at the University of Glasgow in Scotland have developed a new technique for growing bone. The technique involves vibrating, or "nanokicking," mesenchymal stem cells (MSC) in the lab roughly five to 30 nanometers in distance 1,000 times per second, causing the stem cells to differentiate into bone. Researchers say their technique is less expensive and easier to use than other methods for growing bones. They hope that their technique will eventually be used in whole bones in order to treat spinal traumas, osteoporosis, stress fractures and other orthopaedic conditions.

From the article of the same title
Medical Xpress (04/05/13)
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