May 1, 2013

News From ACFAS

Fellowship Committee Announces New Program
The North Jersey Reconstructive Foot and Ankle Fellowship, under the direction of Michael Subik, DPM, FACFAS, in Lyndhurst, NJ, is the newest fellowship program to be considered by the ACFAS Fellowship Committee for Recognition by the College.

The committee determined that this program has met minimal requirements established by an analysis of the program's educational processes and support structures, which ensures adequate post-graduate-level training is occurring in the fellowship. As this will be the first year that a Fellow will matriculate through the program, it has been granted “Conditional Status” by the College, and will be considered for full Recognition by ACFAS after completion of the first year.

If you would like your fellowship program to be considered for the College’s recognized list of programs, please request an application by contacting the Director of Membership Michelle Brozell.
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Members Have Access to JFAS Articles Online Before They're Published
Visit the Journal of Foot & Ankle Surgery's online home page at and click “Read Current and Past Issues Online,” then "Articles in Press" to get a leg up on the latest research in your profession. New articles are available as soon as their proofs have been approved — even before they're assigned to an issue.

Enjoy tomorrow’s news today, including original research, case reports, tips, quips and pearls. It's quick and easy with your free member access!
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Foot and Ankle Surgery

Body Weight and the Medial Longitudinal Foot Arch: High-Arched Foot, a Hidden Problem?
A study was held to ascertain prevalence of hollow or high-arched and flat foot among primary school children in Krakow, Poland, and to assess the relationship between the type of medial longitudinal arch and body weight. Determination of prevalence of underweight, overweight and obesity was made via International Obesity Task Force (IOTF) cut-offs with respect to age and gender. A cohort of 1,115 children between three and 13 years old was analyzed, and high-arched foot was diagnosed in most of the children across all age groups, irrespective of gender. A clear increase in the number of children with high-arched foot was seen between seven- and eight-year-olds, and the condition was more common among underweight children regardless of gender. In the obese group, the largest differences were attributed to gender, with high-arched foot most frequently observed among boys. Flat foot was more common among boys than among girls, across all gender and obesity level groups.

From the article of the same title
European Journal of Pediatrics (05/13) Vol. 172, No. 5, P. 683 Wozniacka, R.; Bac, A.; Matusik, S.; et al.
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Correction and Recurrence of Ankle Valgus in Skeletally Immature Patients with Multiple Hereditary Exostoses
A study reviewed the results of distal tibial medial hemiepiphysiodesis (DTMH) in treatment of ankle valgus with and without multiple hereditary exostoses (MHE). 58 ankles in 41 patients, with minimum follow-up of one year were enrolled. Average patient age was 10 years, and the most common diagnosis was MHE. The rate of tibiotalar angle correction was 0.37 ± 0.28 degrees/month in MHE ankles and 0.51 ± 0.42 degrees/month in non-MHE ankles. Following epiphysiodesis hardware extraction, the rate of recurrence was faster and more total recurrent valgus deformity was seen in the MHE group.

From the article of the same title
Foot & Ankle International (04/13) Driscoll, Matthew; Linton, Judith; Sullivan, Elroy; et al.
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Noninvasive Arterial Studies Including TcPO2 Measurements with the Limbs Elevated or Dependent to Predict Healing After Partial Foot Amputation
A study was performed to determine a cut-off point for optimal healing in partial foot amputations. It also assessed altering a position of a lower limb during transcutaneous oxygen pressure (TcPO2) measurement is valuable. The study involved 307 patients who underwent partial foot amputation and had the noninvasive arterial studies in the perioperative period. It was ascertained that TcPO2 value of 38 mmHg was a good cut-off value predicting healing versus failure. The optimal cut-off point was for the most part unaffected by patient characteristics. The addition of measurement in a elevated position enhanced prediction in those with TcPO2 values lower than 38 mmHg.

From the article of the same title
American Journal of Physical Medicine & Rehabilitation (05/13) Vol. 92, No. 5, P. 385 Andrews, Karen L.; Dib, Mansour Y.; Shives, Thomas C.; et al.
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Practice Management

Feds Aim to Audit 5 Percent of Participants in EHR Program
About 5 percent of participants in the federally funded electronic health-record (EHR) incentive payment program should anticipate audits for compliance with meaningful use and other program criteria, according to Robert Anthony with the Centers for Medicare and Medicaid Services' (CMS) HIT Initiatives Group. He reports that pre-payment and post-payment audits will be ascribed approximately equal amounts of federal scrutiny going forward. Several providers have been referred for possible fraud enforcement investigations. Anthony says the majority of the reviews will be desk audits performed by the CMS' audit contractor, with information shared electronically. A frequent problem area cited by auditors so far has been noncompliance with the mandate that providers complete a data security risk assessment, which also is required under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. “We're certainly seeing some instances where people haven't done them or people just aren't sure what they're supposed to be doing,” Anthony points out. “There are not additional requirements here beyond HIPAA." However, Anthony says "they need to have something in their risk analysis that is specific to their EHR. It doesn't have to be all about the EHR. It needs to be stated and indicated that it's about your practice.”

From the article of the same title
Modern Healthcare (04/22/13) Conn, Joseph
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HHS Unveils Standards for Languages, Cultures
The Department of Health and Human Services (HHS) has released updated standards on providing cultural and language-appropriate healthcare services. The Culturally and Linguistically Appropriate Services (CLAS) standards are intended to provide a universal framework for effective healthcare regardless of race, ethic, sexual orientation or language factors. The 15 standards, first developed in 2000, direct healthcare organizations in the adoption of services and policies that respect cultural and language differences.

From the article of the same title
The Hill (04/24/13) Hattem, Julian
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Patient Email Satisfaction Starts with Managed Expectations
The migration of patient-physician communication to Web-based messaging systems means patients have the ability to contact their physicians at any time, creating an issue for physicians concerning whether they should assign call duty to the practice's electronic mail system. Mayo Clinic researchers discovered a disparity between family physicians' response rates to patient queries on weekdays and weekends. In a study in the April-June issue of Quality Management in Health Care, the researchers examined 323 messages randomly chosen from 7,322 gathered for the study. They found that almost all messages sent Monday through Friday were opened within 12 hours, but 87.1 percent of messages were not opened in at least 36 hours on the weekend.

Although no evidence exists that there are adverse consequences or outcomes associated with longer delays, researchers wish to study further whether a standard for how responses should be sent should be implemented and how delays in response times impact patient satisfaction and healthcare decision-making. Some specialists say managing patient satisfaction dovetails with managing patient expectations, while others say the timeliness of a physician's response may be determined by the design of the messaging system they are using or the manner in which the practice handles messages.

A pair of patient satisfaction surveys by Montefiore Medical Center found very high patient satisfaction rates even though many messages were not answered for two days. When patients enroll in the secure messaging service, they consent to terms of use that include an expectation that messages could take as long as two business days to be answered.

Meanwhile, an answering service handles calls made to a physician practice after business hours, and the Mayo Clinic study suggested rerouting electronic messages to a call center as a possible solution. This would require the person answering the message to have access to key patient information so that the message is passed to the right person. Feedback also would be mandated so that the primary care physician will know how the situation was managed. Offering patients a choice to send the message to an on-call person or a primary care physician with an understanding that there will be a delay in response is another solution.

From the article of the same title
American Medical News (04/22/13) Dolan, Pamela Lewis
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Patient Satisfaction May Not Be a Good Indicator of Surgical Quality, Study Finds
While experiences like a clean hospital room or a communication-oriented doctor may seem like positive indicators of a hospital's quality, a new study finds these opinions are not barometers of whether the hospital's surgical care is any good. The study, led by researchers at the Johns Hopkins University medical and public health schools, explored patient satisfaction and surgical quality measures at 31 hospitals in 10 states. Satisfaction was determined by the results of standard Medicare surveys given to patients, and quality was judged by how consistently surgeons and nurses followed recommended standards of care. The researchers found little relationship between a hospital's patient satisfaction scores and most quality ratings. "At present, little evidence supports its ability to predict the quality of surgical care," says Heather Lyu, Dr. Martin Makary and other researchers who wrote in the journal JAMA Surgery. Makary says that while patient satisfaction scores are an important component of hospital evaluations, they are receiving too much attention because they are one of the few quality measures available to the public. "It’s going to mislead patients because they’re going to think the hospital with the best lobby and the best parking and customer service is going to have the best heart surgery," says Makary. Previous studies of the relationship between patient views and the quality of care have also found they are not necessarily correlated, but they are seen as useful by Medicare. Patient assessments account for 30 percent of bonuses and penalties given to hospitals in the first year of Medicare's "value-based purchasing" program, created by the federal health law.

From the article of the same title
Kitsap Sun (04/17/13) Rau, Jordan
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Health Policy and Reimbursement

OIG Looks at Intent, Not Just Safe Harbors, in Determining Anti-Kickback Law Violations
Following changes to the Affordable Care Act (ACA), doctors should be more careful to ensure they aren't breaking an anti-kickback statute when accepting meals and trips from vendors. According to the ACA amendment, no specific knowledge of the anti-kickback law is required for the government to prove intent for an anti-kickback violation. Robert Brown, a senior compliance specialist at the University of Washington Medical Center, warned that prosecutors will have an easier time making convictions and the common vendor perk of free meals could become problematic. Even dinner or travel given as compensation for consultations or speaking arrangements can violate the law. However, there are safe harbor exceptions to the anti-kickback law, but there are still risks of breaking rules under a safe harbor. Other experts note that coupons on websites like Groupon and Living Social for medical or dental services could violate kickback laws in certain states. There are also concerns that prepaid services through the online coupon sites could lead to unnecessary procedures by doctors.

From the article of the same title
BNA Health Care Policy Report (04/25/13) Topor, Eric
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Physician Practices Must Report PQRS Data This Year to Avoid 2015 Penalty
According to the Center for Medicaid & Medicare Services (CMS), physicians who don't report quality data this year through the government's Physician Quality Reporting System (PQRS) program will docked 1.5 percent of their Medicare reimbursements in 2015. The program has four reporting options to choose from: claims based, registry-based, qualified electronic health record (EHR) or group practice reporting. Beginning on Oct. 15, 2013, CMS will review claims from individuals and groups to determine if providers meet PQRS requirements. Doctors should note if they choose claims-based reporting they will not qualify for bonus payments, but may avoid penalties. Doctors do not need to sign up for PQRS, but only need to meet CMS' guidelines for reporting during a particular reporting period to qualify. Participants can choose from one of two reporting periods: 12 months (January 1, 2013, to December 31, 2013) or 6 months (July 1, 2013, to December 31, 2013). PQRS was created with the intention of gathering information that can lead to improved patient care through a number of measures that evaluate the quality of care a patient receives. A study by the American College of Radiology estimated that physicians can lose up to $1.3 billion a year by not participating or failing to meet compliance.

From the article of the same title
Medical Economics (04/22/13)
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Medicine, Drugs and Devices

The Effect of PTH(1–34) on Fracture Healing During Different Loading Conditions
Researchers have found that parathyroid hormone (PTH) (1-34) can promote both fracture healing and intact bone formation during conditions of reduced mechanical loading. Researchers examined 25-week-old ovariectomized rats with midshaft fractures of the right tibia. They found that administering PTH(1-34) increased the ultimate force to fracture by 63 percent in control animals, which were given saline injections in the muscles of the fractured leg to cause muscle paralysis. The unloaded rats, which received Botulinum Toxin A-injections in the same area, experienced similar increases. The study also found that PTH(1-34) helped stimulate the formation of bone in both normally loaded and unloaded intact bone. In addition, researchers found that PTH(1-34) significantly increased mineral density in bone callus and bone mineral content.

From the article of the same title
Journal of Bone and Mineral Research (04/13) Ellegaard, Maria; Kringelbach, Tina; Syberg, Susanne; et al.
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Zoledronic Acid Acutely Increases Sclerostin Serum Levels in Women with Postmenopausal Osteoporosis
Researchers evaluated sclerostin serum levels after zoledronic acid administration and correlate variations with bone turnover markers. Forty women with postmenopausal osteoporosis were enrolled in this study and randomized into 2 groups to receive zoledronic acid (5 mg) or placebo. Sclerostin serum levels increased by day 2, reached a peak at day 7 (3-fold baseline, P < .001) and then decreased at day 30 and returned near to baseline after 360 days in the zoledronic acid group. Both C-telopeptide of type 1 collagen (CTX) and bone-specific alkaline phosphatase (BSAP) were reduced, and a significant negative correlation was observed between the percentage changes of sclerostin and the variation in BSAP and CTX at all time points in the zoledronic acid group (P < .05). No changes were observed in the placebo group.

From the article of the same title
Journal of Clinical Endocrinology & Metabolism (04/13) Catalano, Antonino ; Morabito, Nancy ; Basile, Giorgio
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