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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

FTC Delays of Enforcement of Red Flags Rule

The Federal Trade Commission (FTC) announced on April 30 that it will delay enforcement of the “Red Flags Rule” (Rule) until August 1, 2009, to give creditors and financial institutions more time to develop and implement written identity theft prevention programs. The FTC also said it will soon release a template written program to help entities that have a low risk of identity theft, such as businesses that know their customers personally, comply with the Rule. When the template is released, ACFAS will provide members with an analysis and tips for complying with the rules.

How a Phone Call From Sweden Made History

Harold Vogler, DPM, remembers when a nurse called him out of surgery to take a phone call from a surgeon in Sweden. The enthusiastic doctor informed Vogler that everyone at Malmo Hospital at Lund University was all fired up about Vogler's techniques in foot and ankle surgery, and insisted Vogler move to Sweden to start teaching the techniques.

After a talk with his incredulous wife, Vogler packed up the family and moved to Sweden. Surgeons there are still performing "Vogler surgery."

Listen to Vogler tell these and other tales, which reflect the advances in foot and ankle surgery in the 1980s, in the ACFAS May podcast. He's joined by surgeons who have known and worked with him: John Stienstra, DPM, Christopher Lamy, DPM, Sam Mendicino, DPM and moderator Laurence Rubin, DPM.

Realize Profits, Even In This Economy

Today’s economy has made it more important than ever to increase revenues and reduce expenses. And that’s what you and your staff will learn when you attend the ACFAS Coding and Practice Management Seminar Friday and Saturday, May 15-16 in Charleston, SC.

You’ll hear it all… management…physician quality reporting incentives (PQRI)…E-prescribing and marketing…from leading specialists in the field. Walk away with what you need to know so your practice won’t just survive, it’ll thrive!

Find out more and register.

Foot and Ankle Surgery

Intermediate-term Results of the Ludloff Osteotomy in One Hundred and Eleven Feet

Ninety-nine patients comprising 111 feet, with an average age of 56 years, were treated for moderate-to-severe hallux valgus deformity via a modified Ludloff proximal first metatarsal osteotomy and a distal soft-tissue procedure at two institutions. The American Orthopedic Foot and Ankle Society score and weight-bearing radiographs of the foot were evaluated preoperatively and after an average follow-up interim of 34 months. Clinical and radiographic outcome also was compared between patients of 60 years or less and those older than 60 years. The average American Orthopedic Foot and Ankle Society score rose from 53 points preoperatively to 88 points at the time of the latest follow-up, while the mean score for patients who were 60 or less was substantially higher than that for patients who were older than 60. The mean hallux valgus angle declined significantly from 35 degrees preoperatively to 9 degrees at the time of the most recent follow-up, and the average intermetatarsal angle fell from 17 degrees to 8 degrees. The researchers write that as far as they know the current report represents the largest group of patients undergoing a modified Ludloff osteotomy for the correction of hallux valgus deformity that has been disclosed in the literature. "Our intermediate-term results demonstrate that the procedure achieves significant correction of moderate-to-severe hallux valgus deformity, significant reduction in forefoot pain, and significant improvement in functional outcome," the researchers note. "Patients with an age of sixty years or less appear to have a more favorable outcome."

From the article of the same title
Journal of Bone and Joint Surgery (03/01/2009) Vol. 91, No. 3, P. 531; Trnka, H.-J.; Hofstaetter, S.G.; Hofstaetter, J.G.; et al.

Foot Drop Due to Lumbar Degenerative Conditions

Researchers from the Department of Orthopaedic Surgery at the Gunma University Graduate School of Medicine in Maebashi, Gunma, Japan, have analyzed the mechanism and prognostic factors of foot drop caused by lumbar degenerative conditions. In a retrospective review of the charts of 28 patients with foot drop due to a herniated nucleus pulposus (HNP) or lumbar spinal stenosis (LSS), the researchers analyzed the mechanism of foot drop and whether the duration before the operation, preoperative tibialis anterior and extensor hallucis longus strength, age, gender, and diabetes mellitus were prognostic factors for postoperative tibialis anterior recovery. The compression of double roots and a sequestrated fragment were observed respectively in nine and 13 of 16 patients with HNP. Multiple levels including the L4–5 segment were decompressed in eight of 12 patients with LSS. Analysis did not reveal a prognostic factor in surgically treated HNP, but significant links with prognosis were observed with respect to preoperative tibialis anterior and extensor hallucis longus strength in those suffering with LSS. The postoperative muscle recovery in patients with HNP was much higher than in patients with LSS. The researchers concluded that double root compression was the most common condition associated with foot drop due to HNP and that the diagnosis and preoperative tibialis anterior and extensor hallucis longus strength in LSS were factors that influenced recovery following surgery.

From the article of the same title
Journal of Neurosurgery: Spine (03/01/09) Iizuka, Yoichi; Iizuka, Haku; Tsutsumi, Satoshi

New Tendinopathy Study Findings Recently Were Published by Researchers at Thomas Jefferson University

A study by Thomas Jefferson University researchers published in Foot & Ankle International analyzed the clinical outcomes of surgical reconstruction using an FHL tendon autograft transfer through single incision on 40 patients with chronic Achilles tendinosis at an average of 27 months following surgery. "At the time of final followup, ankle strength and active range of motion (AROM) were evaluated using Biodex isokinetic dynamometry," wrote the researchers. "Additionally, patients were assessed with AOFAS Ankle Hindfoot scores, pain on a Visual Analog Scale (VAS) and their self-reported level of satisfaction (Very Good, Good, Fair, Poor). We found no loss of plantarflexion strength or plantarflexion power in the operated ankles; an average of 4-degree loss of AROM was found. The study population scored an average of 96/100 for the total AOFAS-AH score post-repair. The average VAS decreased from 7.5 pre-op to 0.3 post-op." Ninety-five percent of the patients rated their outcome as good or very good, while two deemed their outcome to be fair. "For individuals with chronic insertional Achilles tendinosis, operative repair using an FHL tendon with the single-incision technique achieved a high percentage of satisfactory results its well as excellent functional and clinical outcomes including significant pain reduction," concluded the researchers.

From the article of the same title
Medical Device Law Weekly (04/26/09) P. 553

FDA Allows New Remedy for Arthritis

The Food and Drug Administration (FDA) has approved an injectable medication from Johnson & Johnson that fights rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, three types of arthritis brought about by immune-system disorders. The new medication, Simponi, follows on the success of Remicade, a drug that had worldwide sales of more than $5 billion last year. As with Remicade, the marketing of Simponi will be split between Johnson & Johnson and Schering-Plough, which markets Remicade outside the United States. Simponi is injected once a month—less often than other drugmakers' tumor necrosis factor blockers, such as Enbrel and Humira—and is designed to be used alongside immunosuppressant drugs.

From the article of the same title
New York Times (04/24/09)

Practice Management

Institute of Medicine Calls for Doctors to Stop Taking Gifts From Drug Makers

In a new report, "Conflicts of Interest In Medical Research, Education and Practice," the Institute of Medicine (IOM) weighed in on the issue of potential conflicts of interest between medical researchers who receive gifts from pharmaceutical and medical device companies, noting that recent disclosures of conflicts have undermined public trust in medical research. The study noted that a 2007 survey found that over 75% of physicians accepted free samples, free food and free or subsidized "medical refresher courses" from these industries, and over 25% were paid for giving marketing lectures and enrolling patients in clinical trials. The IOM made a number of specific recommendations, including recommending that "academic medical centers, professional societies, patient advocacy groups, and medical journals establish conflict of interest policies that require disclosure and management of both individual and institutional financial ties to industry." It also recommended that Congress establish a national reporting system by which companies would publicly disclose all payments and gifts to physicians. Senator Charles E. Grassley (R-Iowa) and Rep. Herb Kohl (D-Wis.) are co-sponsoring legislation that would require such disclosure.

From the article of the same title
New York Times (04/29/09) Harris, Gardiner

An Affordable Fix for Modernizing Medical Records

The federal government has offered both a carrot and stick approach for hospitals and medical providers to migrate to electronic medical records systems, but the issue of funding remains a challenge and continues to hamper widespread adoption. The Veterans Administration uses open source software that powers its EMR system. It has the potential to spur the adoption of EMR by hospitals and physicians at lower-than-commercial rates. Midland Memorial Hospital in Texas had adopted the system and reports lower incidences of medication errors and patient deaths as well as a reduction in infection rates. However, PricewaterhouseCoopers consultant Dan Garrett notes that the VA software has not been commercially proven on a wide scale. Senator John D. Rockefeller recently introduced a bill urging the federal government to establish an open source electronic health-records solution and offer it at little or no cost to small rural providers and safety-net hospitals.

From the article of the same title
Wall Street Journal (04/30/09) P. A11; Landro, Laura

Forced Out of Retirement: Getting Back Into Practice Not Always Easy

With the recent financial implosion scything through their investments, many retired doctors are facing returning to the workforce, which has become increasingly challenging. "There are plenty of openings in almost every specialty, but especially primary care," says Phil Miller, spokesman for Merritt Hawkins & Associates, a national physician search and consulting firm. "Older doctors can help alleviate shortages in this area and some patients, especially elderly ones, prefer an older physician." Doctors who have been out of practice for prolonged periods may need to become relicensed, bone up on medical education they missed, and possibly even join a reentry program. Such programs can cost applicants $5,500 to $30,000 in some states. Experts recommend that retired doctors have a clear idea of what they want to do and what they can do before rejoining the job market, and they suggest getting in touch with agencies that can help them find local work in their field. Fran Lavalette, president of Healthcare Facilitators, a physician practice management and consulting firm in Ocoee, Fla., says another possibility is to develop a relationship with another doctor to fill in when he or she takes time off, or share a job with another older physician. Retired doctors also need to prepare themselves for possible ageism, with Miller noting that "the older you are, the less the chance of getting a job within the community you want. You can't discriminate based on age, but many hospital-owned and large group practices want a long-term solution, which older doctors can't or won't always give."

From the article of the same title
American Medical News (04/20/09) Caffarini, Karen

Health Policy and Reimbursement

Two Senators Offer Bipartisan Healthcare Proposal

U.S. Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) have tabled a proposal that would pay more to hospitals and doctors who meet federal quality standards and penalize those who do not. "We need to make significant improvements to our healthcare delivery system. And we need to do it in a fiscally responsible way," Grassley said. The proposal, which could form the foundation for the Obama administration's plan for Medicare and private healthcare reform, reflects a consensus among experts and officials that the current system, under which doctors' pay is based largely on the number of services offered, has led to huge waste and corrupted healthcare in the United States. The senators' proposal calls for pay incentives to encourage primary-care physicians to manage a Medicare patient's dealings with multiple providers. The amount private insurers receive from the federal government for offering Medicare coverage to seniors would be linked to quality. "They are keeping the ball rolling here on health reform, which is very, very important," says Charles N. Kahn III, head of the Federation of American Hospitals. "There are some very good suggestions. ... There are other things that will be challenging."

From the article of the same title
Los Angeles Times (04/29/09) Levey, Noam N.

AG Ends Probe Into Blue Cross Blue Shield of Texas Physician Rating Program

The Texas Attorney General's office announced the end of an investigation of Blue Cross Blue Shield of Texas's physician rating program as well as the resolution of a probe into the insurer's handling of out-of-network referrals. The attorney general's office reached a deal under which Blue Cross will stop ranking physicians using claims data, although Blue Cross Blue Shield of Texas President Darren Rodgers says the insurer still uses them to gauge a physician's compliance with some accepted procedures. Regarding physician referrals to out-of-network physicians, Rodgers said, "We changed the language to more clearly state that we believe physicians have the right to discuss all available treatment options." Investigators say the insurer had threatened to terminate physicians solely for referring patients to out-of-network specialists. Health insurers in Texas generally have systems to designate the highest-rated doctors, but doctors argue that simple numbers are not enough to get a full picture of their practice and that insurers are simply looking at bills submitted to them without talking to doctors about the cases. Doctors also say they can get downgraded due to a clerical error by an insurer or due to patients' noncompliance with orders.

From the article of the same title
Dallas Morning News (TX) (04/11/09) Roberson, Jason

Insurer Wants Boost for Primary Care at Imaging's Expense

During a congressional hearing on healthcare reform held by the U.S. Senate Finance Committee, the Blue Cross Blue Shield Association suggested increasing payments to primary care physicians by cutting payments for imaging services. "Escalating costs are the main reason people are unable to obtain health insurance, and rising healthcare costs must be addressed through delivery system reforms that increase quality and enhance value," said Blue Cross Blue Shield's Allan Korn at an April 21 roundtable discussion held by the committee. Such reforms involve switching Medicare from a fee-for-service design to a fee-for-performance model. Korn said that boosting payments to primary care physicians while fortifying the primary care workforce is crucial to building momentum for reforms. "Paying for this could be done primarily by reducing payments for imaging services to providers who rely heavily on costly imaging machines," he noted.

From the article of the same title
Diagnostic Imaging (04/24/09) Abella, H.A.

Technology and Device Trends

Blood Vessels Made From Patients' Cells

Blood vessels for kidney patients have been cultured from their own cells for use with dialysis machines in a development that could have repercussions for the treatment of circulatory problems in the legs. The regularity of dialysis treatment means that patients often run out of healthy vessels and must be hooked up via artificial ones that can become infected or inflamed. Doctors extracted skin samples from patients, and cells of those samples were grown under laboratory conditions to help them produce proteins such as elastin and collagen that were converted into sheets of tissue that were subsequently rolled into blood vessels. The vessels were completed after six to nine months and implanted into patients' upper arms. Cytograft Tissue Engineering's Todd McAllister and colleagues implanted the blood vessels into 10 kidney disease patients in Poland and Argentina from 2004 and 2007; the vessels failed in three patients while two were eliminated due to withdrawal from the study or death. The vessels lasted for at least six to 20 months in the five remaining patients, and the subjects needed fewer interventions to maintain the vessels than those on regular dialysis. Scientists reported on the new blood vessels in the medical journal Lancet. McAllister says he and colleagues intend to test similar devices in patients with heart and leg ailments. "It's basically a piece of plumbing to bypass blockages," he says.

From the article of the same title
Associated Press (04/24/09) Cheng, Maria

Ultrasound to Go

Washington University in St. Louis computer engineers have developed an ultrasound device that can be plugged directly into a smartphone's USB port. The device enables smartphones to capture images and display them directly on the phone's screen. The phone also can be used to send the images to other users. Washington University researchers William Richard and David Zar created the smartphone device from an ultrasound probe they previously developed that can plug into a laptop's USB port. The researchers transferred all of the necessary computing power to the probe and decreased its power consumption to only half a watt. The image the device creates is smaller and of a lower quality than the laptop version, but the researchers believe that it is more than sufficient for many medical applications. The researchers say it could be used in remote rural communities and developing nations, as well as for emergency imaging of patients en route to a hospital. They also say it could be used for battlefield medicine and for home use by patients with chronic illnesses. Zar plans to have open source software available this summer.

From the article of the same title
Technology Review (04/23/09) Gravitz, Lauren

Swansea University to Develop Diabetes Breath Test

Researchers at Swansea University in Wales are working to develop a breath test to diagnose patients with diabetes at risk of serious complications, such as heart disease. In the future, the researchers said the test could be used to diagnose diabetes itself by identifying compounds in a person's breath associated with the condition. The test would search for biomarkers of oxidative stress, an effect of diabetes and possible cause of damages such as cardiovascular complications and retinopathy.

From the article of the same title
WalesOnline (04/09/2009) Brindley, Madeleine

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May 6, 2009