April 24, 2013

News From ACFAS

Register Today for Surgical Skills Courses - Availability Limited
Register today for the Total Ankle Arthroplasty Surgical Skills Course, October 3-5, 2013, in Henderson, Nevada, where ACFAS offers the remarkable opportunity for you to earn 16 continuing education contact hours by learning to perform the implantation of three FDA-approved ankle replacement systems – all over one weekend. Your skilled and experienced faculty will discuss their surgical decision-making processes throughout these lessons and will also offer proven, valuable tips to help you improve outcomes.

Information about tuition, accommodations, daily schedule and more can be found by downloading the course catalog (pages 5-6). This course does not have an online registration option, so be sure to Download the Registration Application and fax it to 800-382-8270. Hurry if you’re interested, as this course has very limited availability.
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Are You Social? Join Your Peers on Our Facebook Page
ACFAS will soon be closing down our Facebook "Group" and directing all Facebook activity to our Facebook "Page." Take a quick moment to visit the page and "Like" it so that you can share your success stories, comment on other foot and ankle surgeons' endeavors, post pictures and more! Visit and click “Like” so you can be an active member of this online community.

Have a question, article or comment that you want to share with the foot and ankle surgical community? Post it on the ACFAS Facebook Page. “Like” the ACFAS Facebook Page today so you can participate in the interactive discussions, read posts, add or comment on pictures, etc., and share useful information with your own network of colleagues.
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Foot and Ankle Surgery

The Impact of Metabolic Control and QTc Prolongation on All-Cause Mortality in Patients with Type 2 Diabetes and Foot Ulcers
Assessing the impact of different HbA1c levels and heart-rate-corrected QT (QTc) prolongation on all-cause mortality in a high-risk population of patients with type 2 diabetes mellitus and foot ulcers was the purpose of a study involving 214 subjects. The patients were grouped based on HbA1c level, and baseline traits, including use of potential hypoglycaemic drugs, were similar between groups. During the the eight-year follow-up period 151 patients passed away and a strong association between HbA1c < 7.5 percent and increased mortality was observed. The highest mortality was witnessed in patients with a combination of HbA1c < 7.5 percent and QTc prolongation, with an eight-year mortality of 92.1 percent versus 48.8 percent in those with HbA1c < 7.5 percent but without QTc prolongation.

From the article of the same title
Diabetologia (05/01/13) Vol. 56, No. 5, P. 1140 Fagher, K.; Londahl, M.
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The Scandinavian Total Ankle Replacement: Long-Term, 11 to 15-Year, Survivorship Analysis of the Prosthesis in 72 Consecutive Patients
A study was held to determine the long-term survivorship and clinical and radiographic outcomes of 72 patients treated with the Scandinavian Total Ankle Replacement (STAR) from February 1996 to March 2000. A total of 77 ankles underwent total ankle replacement using the STAR prosthesis with a single coating of hydroxyapatite. Two patients were lost to follow-up, and 12 patients with 13 ankle replacements died. The average duration of follow-up for the patients without revision was 12.4 years, and 62 of the 77 ankles were available for final follow-up. Twenty-nine of the 77 ankles experienced a revision of at least one of the metallic components, and the likelihood of implant survival was 70.7 percent at 10 years and 45.6 percent at 14 years. Aseptic loosening, subsidence of the talar component and progressive cyst formation were the chief reasons for revision. Polyethylene insert fractures were seen in 11 ankles.

From the article of the same title
Journal of Bone and Joint Surgery (04/17/2013) Vol. 95, No. 8, P. 711 Brunner, Samuel; Barg, Alexej; Knupp, Markus; et al.
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Treatment of Osteochondral Lesions of the Talus with Particulated Juvenile Cartilage
A study was held to collect clinical results of pain and function in retrospectively and prospectively enrolled patients treated with particulated juvenile cartilage for symptomatic osteochondral lesions in the ankle. Outcomes and incidence of reoperations in standard clinic patients were collected, and the analysis includes final follow-up to date for 23 patients (24 ankles). Average outcome scores at final follow-up were AOFAS Ankle-Hindfoot Scale 85 ± 18 with 18 ankles exhibiting good to excellent scores, Short-Form 12 Health Survey (SF12) physical composite score 46 ± 10, SF12 mental health composite score 55 ± 7.1, Foot and Ankle Ability Measure (FAAM) activities of daily living 82 ± 14, FAAM Sports 63 ± 27 and 100-mm visual analog scale for pain 24 ± 25. Results data divided by lesion size showed 92 percent good to excellent outcomes in lesions 10 mm or larger and those smaller than 15 mm. To date, one partial graft delamination has been disclosed at 16 months.

From the article of the same title
Foot & Ankle International (04/13) Coetzee, J. Chris; Giza, Eric; Schon, Lew C.; et al.
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Practice Management

Fee Data Puts Brakes on Docs' Test Orders: Study
Johns Hopkins University School of Medicine researchers report in the online edition of JAMA Internal Medicine that physicians who are aware of the cost of lab tests could exercise more restraint in ordering such tests, and lead to a decrease of inappropriately ordered diagnostic tests. The study involved the tracking of physicians and others who ordered a selected group of 61 lab tests through Johns Hopkins Hospital's computerized order entry system over six months in late 2008 and early 2009 and then again over another six months in late 2009 and early 2010. None of the tests had their costs displayed with them in the first study period. The control group in the second study period continued to go "priceless" when ordering, while a second group had their Medicare allowable fee available when ordering. Almost 1.2 million tests were ordered. The researchers discovered that in the test group, when prices were not displayed, the providers ordered 3.7 tests per patient day, but later, when the prices were linked, the number of tests per patient day dropped nearly 8.6 percent to 3.4. Tests in the control group climbed 5.1 percent. Meanwhile, for the test group with prices, the cost per patient day declined 9.6 percent to $3.79, and charges per patient day in the control group rose 2.9 percent or 52 cents.

From the article of the same title
Modern Healthcare (04/15/13) Conn, Joseph
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How Mailing Lists Can Help Reach Prospective Patients
Practices that desire to expand their patient database can do so by purchasing a mailing list. Once they have obtained the list they can use it to send prospective patients an introduction or to promote an open house or a special offer. The success of a practice's campaign depends on the steps it takes leading up to the mail's delivery. The first step in a campaign is to locate a mailing list vendor with a solid reputation. The practice should begin by contacting printers in its area and see if they rent their lists out or if they have knowledge of someone in the area that does. Practices can alternatively employ an online printer or mailing list service, but they should be mindful that if the service seems too inexpensive to be true, it likely is.

The second step is to target the audience by focusing on homes within the general area that people will be coming from to visit the practice's office. The practice area also should be kept in mind when it comes to targeting. When purchasing lists, the practice can generally narrow it down to things such as zip code, gender and income.

The practice should then refine its message to grab the reader's interest, which may require the hiring of a copywriter. Return on investment (ROI) also needs to be tracked. When new patients contact the office, the practice should inquire how they heard about it. A solid ROI for direct mail campaigns is about a 1 percent to 2 percent response rate.

A final tip is to consider acquiring email lists. Some practices are resistant to the idea because people hate getting spam. Practices considering this step should make sure they can still target according to demographics so they only email their target audience.

From the article of the same title
Physicians Practice (04/06/13) Woo-Ming, Michael
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How Practices Can Avoid Employee Vendor Scams
Physician practices need to be aware of and take steps to prevent fraud and embezzlement scams that dishonest employees use to steal money. Such scams include setting up a phony vendor account and reactivating an old vendor account. Experts say the stolen money is rarely recovered in its entirety, even if the employee is prosecuted. Among the measures recommended to prevent such schemes is for practices to look for odd behavior in the employee, although the most obvious sign is a dearth of take-home pay despite a rigorous job ethic and a steady stream of revenue.

Guaranteeing the legitimacy of a vendor requires practices to set policies and procedures that include documenting and confirming the company's name, physical address, phone and email address, W-9/taxpayer information number and vendor type. The practice needs to check with the Better Business Bureau to ascertain the vendor's presence in its database, verify that the company is not listed on the federal government's excluded party list and Google its name to determine if there is any negative public information on the vendor.

Furthermore, physicians ought to create special controls for one-time-use companies, high-dollar amounts or recurring payments; review vendor payments and canceled checks every month to ensure the vendor matches the person who deposited the check; confirm that employee and vendor contact information does not contain matching data such as street address; complete a yearly vendor master file audit; and check the signature's validity. Also recommended is reviewing the vendor list at least annually and inactivating duplicate vendors, limiting employees' rights for adding vendors and changing vendor addresses, ensuring correct spelling of vendor names and never using acronyms unless the vendor's name is an acronym.

Practices also should seek vendors with an exceptional increase in activity with the practice, and experts note that embezzlers have a tendency to round out the dollar amount billed and simplify the invoice process, numbering them 1, 2, 3, etc., for example. Attaining familiarity with people who provide the services for which practices are paying, such as carpet cleaners, is vital for spotting warning signs such as a lack of presence or shoddy work performance.

From the article of the same title
American Medical News (04/15/13) Caffarini, Karen
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Health Policy and Reimbursement

CMS Announces Listening Session on Billing and Coding with EHRs
A “listening session” on billing and coding with electronic health records (EHRs) will be co-hosted May 3 by the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology. Among the topics discussed will be the impact of EHRs on clinical care, healthcare provider efficiency, and opportunities and challenges created by coding. For more information and to register for the event, click here.

From the article of the same title
AHA News (04/12/13)
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Doctors Win First Safe Harbor Against ACA Use in Liability Suits
Physician leaders are hoping other states will adopt legislation approved in Georgia that shields physicians from civil liability for breaching federal health system reform mandates. It has been a persistent concern of medical associations that federal quality-of-care and payment reform measures, such as those directed by the Affordable Care Act, could be used to launch negligence accusations against individual physicians. The Georgia law, based on American Medical Association (AMA) model legislation, proscribes the use of such health reform metrics as evidence in liability cases. The law dictates that payer guidelines and quality criteria under federal law shall not set up a legal foundation for negligence or a standard of care for the purposes of determining medical liability. The Georgia bill's passage coincides with the reintroduction in Congress of an AMA-supported federal version of the legislation banning health system reform provisions from being construed to establish a standard or duty of care owed by a health professional to a patient in any liability case. Patrice A. Harris on the AMA Board of Trustees lauds the Georgia law, saying federal reform statutes and regulations are designed to improve access to high-quality and efficient healthcare, not to justify payouts through lawsuits against physicians.

From the article of the same title
American Medical News (04/15/13) Gallegos, Alicia
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For Doctors, Fewer Perks and Free Lunches
Two of the largest drug makers, Pfizer and GlaxoSmithKline, are cutting back on the amount of money they spend on dinners and other events where doctors are paid to give presentations about drugs and diseases. Both of these companies reduced payments to doctors by double-digit percentages last year and also laid off pharmaceutical sales representatives, resulting in fewer sales calls at doctors' offices and fewer free lunches provided by the drug makers. Some of these cuts are the result of drug makers losing patent protection for popular drugs. But such cutbacks are not taking place at all drug companies, since some--including several of Johnson & Johnson's pharmaceutical divisions--actually increased payments to doctors last year.

From the article of the same title
Wall Street Journal (04/12/13) Loftus, Peter
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Medicine, Drugs and Devices

1,25-Dihydroxyvitamin D Linked to Poorer Bone Health in Men
The Journal of Clinical Endocrinology & Metabolism has published a study that examined the relationship between serum 1,25-dihydroxyvitamin D and bone health in men. Participants in the study were men aged 40 to 79 who underwent quantitative ultrasound of the heel, had their height and weight measured and answered questions about their lifestyles. The researchers found that serum 1,25-dihydroxyvitamin D is associated with a higher bone turnover and poorer bone health in middle-aged and older men.

From the article of the same title
Endocrine Today (04/05/13) Vanderschueren, D.
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Doctors May Soon Be Able to Print Bodies to Study
Notre Dame researchers are utilizing three-dimensional (3D) printing technology to produce educational models of skeletal and soft tissue systems for the purpose of studying anatomical details. At the start of the project, the researchers took 3D body scans of rats, uploaded the data to a computer, translated it into a 3D printer ready file and then extruded a complex plastic model of skeletal or soft tissue data. The researchers say the models are much more complex than traditional plastic injection molding, and they can print models of soft tissue systems that nest within the skeletal frame. It also is considerably less expensive than procuring high-quality anatomical models. The researchers running the project visualize a day when surgeons print out patient-specific models before complicated operations to get a better sense of a person's unique anatomical details.

From the article of the same title
FastCoExist (04/17/13) Stone, Zak
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