April 20, 2011

News From ACFAS

What CME Should ACFAS Provide?

Keep your eyes open tomorrow for an e-mail from ACFAS President Glenn M. Weinraub, inviting you to take an important 10-minute survey on your educational needs.

When you receive the e-mail, just click on the link to take the survey. It takes only a few minutes and is completely confidential. An independent CME research firm will report only the aggregate results, not individual responses.

And, if you complete the survey by Friday, April 29, you’ll be entered in a drawing to win one of three $100 American Express gift cards.

ACFAS looks to YOU to learn how to improve our educational programming. Thank you for your participation!
HHS Issues Report on ASCs

The U.S. Department of Health and Human Services has released a report to Congress that contains a plan to implement a value-based purchasing (VBP) program under Medicare for ambulatory surgery centers. Quality measures that would be considered under the program include: patient falls and burns; hospital transfers and admissions; wrong site, side, patient and implant surgeries; prophylactic antibiotic administration; surgical site hair removal; surgical site infection; medication administration and reconciliation; and venous thromboembolism measures.

Facilities that report and show high levels of quality on those measures would be rewarded with higher payments under the VBP program. The report can be downloaded here (600 KB PDF).
Rock and Roll Your Practice

There’s still time to register for ACFAS’ Practice Management/Coding Workshop, May 14–15, in Cleveland. And members of the College can take advantage of a unique, value-added benefit: a private consultation with ACFAS coding and billing expert Douglas G. Stoker, DPM, FACFAS. For a brochure and to register visit the ACFAS website. For more information on scheduling a coding consultation at the course, e-mail
Check Your Conference CME Online

If you attended the 2011 Annual Scientific Conference, you can now view and print your conference attendance and CME hours quickly and conveniently on the ACFAS website!

Please check your records promptly; after May 15, 2011, no changes can be made online. For questions on the online CME records, contact the ACFAS Education Department at 800-421-2237.

Handouts Online Too!
Find handouts from the scientific conference sessions at your fingertips. Just log in at handouts web page with your member or attendee number to download them and get even more from your participation in this premier educational event.
Stay Sharp with Recent Research

Make the most of your spare time by catching up on current research at ACFAS’ Scientific Literature Reviews, a monthly feature on the ACFAS website. In just a few minutes you can read abstracts prepared by podiatric residents from journals you may not regularly see. The latest edition includes:

Plantar Fascia-Specific Stretching Versus Radial Shock-Wave Therapy as Initial Treatment of Plantar Fasciopathy, from the Journal of Bone and Joint Surgery (American).
Reviewed by Saadia Whatley, DPM, Central Alabama Veterans Hospital.

Foot Orthoses in the Prevention of Injury in Military Training, from the American Journal of Sports Medicine.
Reviewed by Michael Brondon, DPM, Central Alabama Veterans Hospital.

Browse new entries or the entire archive any time at Scientific Literature Reviews.

Foot and Ankle Surgery

Consistency Between Emergency Department and Orthopedic Physicians in the Diagnosis and Treatment of Distal Fibular Salter Harris I Fractures

Research was conducted to ascertain diagnostic and management divergences between emergency physicians (EPs) and orthopedic physicians (OPs) for patients suffering from distal fibular physis pain without radiographic fracture. Out of a cohort of 1,343 patients, 247 satisfied criteria. EP diagnosis included 80 percent with a Salter Harris (SH) I fracture, 2 percent with a sprain, 10 percent with some other fracture, and 8 percent with some other injury; OP diagnosis included 55 percent with an SH I fracture, 19 percent with a sprain, 23 percent with some other fracture, and 3 percent with some other injury. It was determined that EPs had a greater likelihood of diagnosing SH I fracture, but few fractures were missed despite this trend. The majority of patients needed ongoing immobilization by OPs irrespective of final diagnosis.

From the article of the same title
Pediatric Emergency Care (04/11) Vol. 27, No. 4, P. 301 Zomorrodi, Arezoo; Bennett, Jonathan Eric; Attia, Magdy William; et al.

Outcomes Following Midfoot Arthrodesis for Primary Arthritis

Evaluating the functional outcomes following midfoot arthrodesis for primary midfoot arthritis was the goal of research that studied 95 patients who underwent the procedure. Union was achieved in 96 out of 104 feet, with one delayed union and eight nonunions. Major complications included three deep infections and one chronic regional pain syndrome, while reoperations were necessary in 11 feet in addition to 26 symptomatic hardware removals. A substantial improvement in the talo-first metatarsal angle and medial cuneiform height was observed in radiographs. The researchers concluded that primary or degenerative midfoot arthritis with refractory symptoms was treated with midfoot arthrodesis with good outcomes and a low occurrence of nonunion.

From the article of the same title
Foot & Ankle International (04/11) Vol. 32, No. 4, Nemec, Scott A.; Habbu, Rohan A.; Anderson, John G.; et al.

Role of Intraoperative Varus Stress Test for Lateral Soft Tissue Release During Chevron Bunion Procedure

A study was executed to assess the clinical results of distal chevron osteotomy conducted in conjunction with selective lateral soft tissue release through retrospective analysis of 48 feet in 43 patients classified as having mild to moderate hallux valgus between August 2005 and November 2007. Distal chevron osteotomy without lateral soft tissue release was carried out in 26 cases when passive correction of the hallux valgus deformity was possible, and osteotomy with lateral soft tissue release was performed in 22 cases when passive correction was impossible. In the group that underwent osteotomy without lateral soft tissue release, the average correction of the hallux valgus angle (HVA) was 12.8 degrees, the average correction of the first and second intermetatarsal angle (IMA) was 4.7 degrees, and the AOFAS score improved an average of 29.2 points at the last follow-up; in the group that had osteotomy performed with lateral soft tissue release, average correction of HVA was 19.1 degrees, the average correction of IMA was 7 degrees, and the AOFAS score improved an average of 31.8 points at the last follow-up.

From the article of the same title
Foot & Ankle International (04/11) Vol. 32, No. 4, Kim, Hyong-Nyun; Suh, Dong-Hyun; Pil-Sung

Practice Management

Obama Signs Law Repealing Business Tax Reporting Mandate

President Obama has signed a bill repealing the 1099 tax-compliance mandate in last year’s healthcare law. The repealed provision would have required businesses to report to the IRA any transactions totaling at least $600 in a year paid for goods and services, effective 2012. To cover the cost of the forgone revenue, the measure includes provisions that will curtail health insurance tax credits in the healthcare law.

From the article of the same title
Bloomberg (04/14/11) Rubin, Richard

Surgeon Group Builds Online Collaboration for Rural Docs

The establishment of an online community designed to effect online collaboration between surgeons in rural areas is the goal of a partnership between the American College of Surgeons (ACS) and Within3, a maker of secure online healthcare community networking platforms. The site was partly designed by a rural-surgeon advisory group that aims to promote rural surgeon collaboration on cases and care and expand physicians' "collective knowledge through shared resources, the latest news, information on advanced procedures and ongoing online educational opportunities," said an ACS news release. The online community's rollout will take place at the Rural Surgery Symposium and Workshop scheduled for May 5-8 at ACS' Chicago headquarters and at the Northwestern University Center for Simulation Technology and Immersive Learning.

From the article of the same title
Modern Healthcare (04/13/11) Robeznieks, Andis
Web Link - May Require Free Registration

Health Policy and Reimbursement

AMA Shares Physician Complaints About Burdensome CMS Regulations

President Obama earlier in the year issued an executive order calling on all government agencies to complete an analysis of rules that may be ineffective, insufficient, or excessively burdensome. The American Medical Association (AMA) has sent a letter to the Centers for Medicare & Medicaid Services outlining the federal regulations physicians find most burdensome, based on survey of physicians with more than 2,000 responses. The letter can be found here.

From the article of the same title
Becker's Hospital Review (04/14/11) Oh, Jaimie

Economists: Voucher Program Shifts Costs to Patients, Providers

Some 200 healthcare economists are calling on federal lawmakers to reject a premium support model for Medicare and instead back "vigorous implementation" of the 2010 health reform law. The 193 economists signed a letter to House Speaker Rep. John Boehner (R-Ohio) and House Minority Leader Rep. Nancy Pelosi (D-Calif.), among others, that cited two broad approaches to Medicare spending, with the "right" strategy included in the Patient Protection and Affordable Care Act. The fiscal 2012 budget proposed by House Republicans would convert the Medicare program into a premium-support system that would provide patients with a list of health plans from which to choose, with the Medicare program subsidizing the plan. The economists' letter says the term "premium support" incorrectly labels a voucher program, which will pass costs on to consumers. The economists express concern that current proposals would tie payments to growth in the Consumer Price Index (CPI) adjust for population growth.

From the article of the same title
Modern Healthcare (04/12/11) Zigmond, Jessica
Web Link - May Require Free Registration

Obama Deficit Reduction Plan Prompts Call for Repeal of IPAB

President Obama has proposed to strengthen the Independent Payment Advisory Board (IPAB), provide it with additional enforcement measures, and give it additional tools to improve the quality of care such as promoting value-based benefit designs. But several physicians groups have voiced their desire to see IPAB repealed. IPAB was created by the healthcare reform law and has the power to analyze the drivers of Medicare cost growth and then recommend to lawmakers policies to reduce that growth. Congress must either vote on IPAB's recommendations or enact policies that achieve equivalent savings.

From the article of the same title
HealthLeaders Media (04/15/11) Tocknell, Margaret Dick

Medicine, Drugs and Devices

MedPAC Takes Aim at Imaging Overuse

For the first time in its history, Medicare would mandate prior authorization before clinicians treating beneficiaries could employ medical imaging devices if it followed the Medicare Payment Advisory Commission's (MedPAC) recent recommendation. The panel voted in favor of recommending that the Centers for Medicare and Medicaid Services start requiring prior approval for "practitioners who order substantially more advanced diagnostic imaging services than their peers." MedPAC member Scott Armstrong cites "overwhelming" research data indicating a significant overuse of imaging equipment, including a finding that 10 percent of providers order half of all imaging studies. The commission additionally recommended that Medicare reduce payments for successive imaging studies carried out in the same session. MedPAC also called for a redesign of Medicare's quality improvement organization initiative so that it would halt funding advisory groups in all 50 states and instead issue direct grants to providers with the shared objective of improving care quality.

From the article of the same title
Modern Healthcare (04/07/11) Daly, Rich
Web Link - May Require Free Registration

Lawmakers Propose Palm Reading Measure to Curb Medicaid Fraud in New York

A bill introduced by state lawmakers in New York would require medical providers to use biometric palm readers to help curb Medicaid fraud. The proposal calls for the palms of Medicaid patients to be scanned when they access services in hospitals, medical clinics, and pharmacies. Encoded biometric data on a patient’s palm will be imbedded in the Medicaid card for verification. The cards will be able to store a log of doctor and pharmacy visits for each service billed to the Medicaid program. Other states are considering similar measures. The Georgia State Senate has approved a bill to implement Medicaid ID cards with biometric technology, while Texas has run a pilot program using fingerprinting.

From "Medicaid Fraud Bill Asks Scan Device"
Albany Times Union (NY) (04/07/11) Lee, Stephanie

Study Indicates Possible Treatment for Heterotopic Ossification

Researchers may have discovered a potentially effective treatment for heterotopic ossification (HO) through an animal study detailed online in Nature Medicine. The study indicates that HO can be prevented through use of a drug that interrupts a signaling-nuclear protein pathway signaling. The researchers analyzed the use of nuclear retinoic acid receptor-γ agonists in mice genetically engineered to model HO, and ran a comparison to controls; the agonists selectively target a regulatory pathway during cartilage formation that is an crucial step in HO development. The agonists prevented the occurrence of HO in experimental mice, while the mice in the untreated control group developed HO-like masses.

From the article of the same title
Ortho Supersite (04/14/11)

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