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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

Physician Pay Cut Freeze Extended

On Friday, April 16, President Obama signed a bill to delay the 21 percent Medicare physicians reimbursement cut and extend COBRA subsidies until June 1. The Centers for Medicare and Medicaid Services has instructed Medicare contractors to begin processing claims filed since the last deferral expired on April 1, which had been held up by CMS in anticipation of the new legislation.

Another bill already passed by both chambers of Congress would extend the pay cut freeze and COBRA subsidies to December 31, if Democrats and Republicans can agree on budget offsets. As yet there is no word on efforts to reform the current Medicare reimbursement formula.
Optimize Practice Performance at ACFAS Seminars

Come to Chicago May 14–15, 2010, and position your practice for success with the knowledge you’ll gain at the ACFAS Coding and Practice Management Seminar.

You’ll get return on your investment with understanding of CPT changes for 2010, refreshed E & M coding and correct coding for prompt reimbursement.

Walk away with what you need to know so your practice will thrive! To find out more and to register, visit the ACFAS web site or call 800-421-2237.
Delineation of Privileges Guidelines Undergoing Rewrite

One of the most frequently requested ACFAS documents is the Delineation of Privileges Guidelines. Along with the College’s Credentialing and Privileging position statement, it has aided countless members in their hospital staff privileging efforts since it was first written in the early 1990s. Twelve privileges-related documents are now available on the ACFAS web site.

The credentialing and privileging statement was revised in December 2009. The companion delineation guidelines have been temporarily removed from the website and are being completely rewritten by a special task force. The revised guidelines should be posted by early August 2010.

Questions? Contact ACFAS at 773-693-9300 or

Foot and Ankle Surgery

Arthrodesis of the Ankle and Subtalar Joints in Patients With Haemophilic Arthropathy

Researchers evaluated the outcome of surgery in haemophilic arthropathy of the ankle and subtalar joints, using internal fixation. From 1983 to 2006, 20 fusions were performed in 13 patients with advanced haemophilic arthropathy of the ankle and subtalar joints. There were 11 ankle fusions, one isolated subtalar fusion and eight combined ankle and subtalar fusions. Three of the latter had a subtalar fusion at a second operation. In the majority of the cases, the ankle fusion was achieved by two crossing screws. For the subtalar fusion, either staples were used or the tibiotalar screws were extended to the calcaneus. Arthrodesis of the ankle was successful in all but one patient, in whose case the procedure was revised and eventually his condition was progressed to fusion. There was also one case of painless non-union of the subtalar joint which was not revised. There was no recurrent bleeding, and no deep infection. The researchers concluded that arthrodesis with cross screw fixation is an effective method for fusion of the ankle and subtalar joints in patients with haemophilia.

From the article of the same title
Haemophilia (04/12/10) Tsailas, P. G.; Wiedel, J. D.

Significant Improvements Seen Using Intra-articular Injections of Hyaluronic Acid for Ankle OA

Researchers have found that patients with arthritic ankles that were treated nonoperatively with consecutive intra-articular injections of hyaluronic acid experienced symptomatic relief which sometimes lasted for several months. The researchers studied the effects of hyaluronic acid injections in 16 patients aged 31 to 79 years old who had symptomatic ankle osteoarthritis (OA). Each ankle received a 25 mg intra-articular injection of sodium hyaluronate once a week for 5 weeks. Thirteen of 15 patients who completed the study showed improvement, including a 20% improvement in ankle range of motion. Patients also experienced a statistically significant reduction in their pain according to changes in their Visual Analog Scale and ankle-hindfoot scores. At seven months post-treatment, the efficacy of the injections did not decrease. Of the two patients whose global assessment did not improve from the injections, one did not complete the follow-up due to concurrent back surgery.

From the article of the same title
Ortho Supersite (04/07/10)

The Reliability and Variation of Measurements of the Os Calcis Angles in Children

Researchers evaluated the reliability and variation of measurements of the os calcis angles in children. The databases of the Picture Archiving and Communication Systems of two hospitals were searched and all children who had a lateral radiograph of the ankle during their attendance at the emergency department were identified. In 227 radiographs, Bohler's and Gissane's angles were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. For Bohler's angle the overall inter-observer reliability, the intraclass correlation coefficient was 0.90 and the intra-observer reliability 0.95, giving excellent agreement. For Gissane's angle, inter- and intra-observer reliability was only fair or poor across most age groups. Further analysis of the Bohler's angle showed a significant variation in the mean angle with age. Researchers concluded that contrary to published opinion, the angle is not uniformly lower than that of adults but varies with age, peaking towards the end of the first decade before attaining adult values.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (04/01/10) Vol. 92, No. 4, P. 571; Clint, S. A.; Morris, T. P.; Shaw, O. M.; et al.

Practice Management

4 Ways to Improve Staff Retention

After going to the trouble of finding and training new staff, keeping good staff members is critical to efficiency and patient satisfaction. However, turnover is notoriously high in medical practices. Fortunately, there are ways to keep staff happy and in the practice. First, provide training and growth opportunities. Second, keep lines of communication open. Third, examine your benefits package and see if you can offer extra time off, flexible hours, free parking, or other perks like gym memberships. And fourth, incorporate some fun into work.

From the article of the same title
Physicians Practice (04/10) Beckel, Abigail; Lukeninch, Erica

Free EMRs: Too Good to Be True?

Open-source electronic medical records (EMRs) from providers such as Practice Fusion offer a number of advantages, such as their low cost. However, Steven E. Waldren, MD, with the American Academy of Family Physicians' Center for Health IT says that physicians should not enroll before carefully reading license and privacy agreements to see what services the EMR vendor is supplying. He categorizes open-source EMR products as either community or professional products, with the former typically provided by a small group or practice that developed an EMR and opted to offer it as an open-source product, and the latter backed by a company. Waldren says that the practice will be on its own in terms of implementing and maintaining the EMR system if the community product lacks a service component, while in the professional model the company would likely be required to handle certification, installation, and training. Physician practices face various challenges from an EMR product standpoint, such as ascertaining where application support will be acquired; what information technology resources will be needed to manage the installation and keep the network operational; how the product will be certified for meaningful use; and whether the product fulfills requirements from a usability and workflow standpoint.

From the article of the same title
HealthLeaders Media (04/13/10) Vaughan, Carrie

Health Policy and Reimbursement

CMS Bans Aetna From Enrolling New Medicare Beneficiaries

CMS has issued an immediate sanction notice to Aetna barring the insurer from marketing to and enrolling new beneficiaries after it "continued to improperly administer the Medicare drug benefit in the plan's national standalone prescription drug plan and its 25 Medicare Advantage prescription drug contracts," according to CMS. The sanction takes effect April 21 and will remain in place until Aetna "demonstrates to CMS that it has corrected its deficiencies and they are not likely to recur."

From the article of the same title
HealthLeaders Media (04/09/10) Masterson, Les

Private Insurer Wants States to Hire Them for Medicaid Help

UnitedHealth Group Inc. plans to issue managed care strategies that "it says will help cash-strapped states solve budget problems and doctor shortages that hobble the government health-care programs for the poor." AmeriChoice, the company's Medicaid managed-care unit, is one of several in the country now vying to get it the expansion of Medicaid by looking to win contract bids from states to help run their public health programs.

UnitedHealth's strategy is to show states how much money the Minnesota-based insurer could help save them in running their programs. "The company says $93 billion could be saved by adopting coordinated-care techniques to cut down on drug interactions and keep patients out of the emergency room. It finds $140 billion in savings by better coordinating long-term care and moving elderly patients from nursing homes and into home-based care. Another $133 billion could come from updating Medicaid's technology and infrastructure to reduce administrative expenses." But financial experts say Medicaid contracts might not be enough to save the business from ensuing troubles caused by health reform. "Although the company has some diverse businesses – including a health information technology business that brought in over $2 billion in 2009 – the bulk of its $87 billion in sales comes from selling risk-based health plans that are likely to be less profitable under the overhaul."

From "Insurer Sets Out Medicaid Coping Strategies for States"
Wall Street Journal (04/15/10) Johnson, Avery

Judge Blocks Insurers on Rates

A Superior Court judge in Massachusetts has denied a request that would have let six health insurers go forward with double-digit rate hikes for tens of thousands of small businesses and individuals in the state, setting up a protracted battle that could become a test of government’s role in controlling healthcare costs. The judge rejected the companies’ contention that the insurance market would be thrust into chaos if they could not quickly institute the higher rates. Insurers are pursuing appeals within the state Division of Insurance, which if turned down could send the case back to court later this spring.

From the article of the same title
Boston Globe (04/13/10) Weisman, Robert

Troubling Increase in Serious Hospital Infections

The Health and Human Services (HHS) department's 2009 quality report to Congress found little progress eliminating hospital-acquired infections. HHS called for immediate action to address these decade-long serious deficiencies in healthcare delivery.

The HHS report noted that more than 98,000 people a year die from medical errors, notably preventable infections and medication errors. Medicare payments to hospitals in the future will be reduced for preventable readmissions and for certain infections that can usually be staved off with good nursing care, stated the report.

Ten years ago the Institute of Medicine began to raise the visibility of and work to eradicate these types of preventable medical errors. Hospitals themselves, along with the Joint Commission, have made reductions of nosocomial or hospital-acquired infections through infection control programs and committees. Yet today’s released results are significantly less than experts have hoped for, according to HHS’ latest data.

From the article of the same title
Associated Press (04/14/10)

Technology and Device Trends

Avatar II: The Hospital

Second Life—a free 3D virtual world where users can socialize, connect, and create virtual characters using free voice and text chat—has been tapped by healthcare organizations as a tool for medical training and building skills in handling situations where quick decision-making is required. Virtual training usually is less expensive than full-dress drills with hired actors. Virtual patients can be programmed to exhibit symptoms and response to treatment.

From the article of the same title
Wall Street Journal (04/13/10) P. R8; Simon, Stephanie

New Pathway Involved in Rheumatoid Arthritis Identified

A new pathway involved in inhibiting inflammation that does not work properly in people with inflammatory arthritis has been discovered by researchers at the Hospital for Special Surgery, and the discovery could lead to new therapies in the future. Before the study, researchers were aware that immunoreceptor tyrosine-based activation motif (ITAM)-coupled receptors played a role in regulating inflammation, but they did not know how the ITAM pathways actually deactivated inflammatory signaling. The researchers set out to explore what signaling pathways might be induced by the triggering of ITAM-associated receptors in studies using white blood cells similar to those that cause disease. They learned that activation of the ITAM receptor triggered a pathway known as DAP12-Syk-Pyk2-p38-MSK that relied on calcium signaling and suppressed pro-inflammatory cytokine production.

From the article of the same title
Newswise (04/12/10)

FDA OKs Drug to Treat Small Varicose Veins

The U.S. Food and Drug Administration has approved Asclera injections for the treatment of small types of varicose veins. "Varicose veins are a common condition," said Dr. Norman Stockbridge, director of the FDA's Division of Cardiovascular and Renal Products. "Asclera (polidocanol) is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance." Factors such as genetics, age, sex, pregnancy, obesity and prolonged periods of standing may increase the risk for varicose veins. Asclera is approved to close spider veins and reticular veins. Asclera acts by damaging the cell lining of blood vessels, causing the blood vessel to close, to eventually be replaced by other types of tissue.

From the article of the same title
United Press International (03/31/10)

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April 21, 2010