May 8, 2013

News From ACFAS

Scientific Literature Reviews: A Quick Way to Catch Up on the Latest Studies
Just released -- May Scientific Literature Reviews (SLRs) at! Here's a sneak peek at some of the new articles that were reviewed to satisfy your educational curiosity this May:When reading over our array of May SLRs, you’ll find summarized varieties of published articles including clinical studies, case reports, methodology and technical reports, clinical "pearls," literature reviews and more; so even if you’re short on time, you can still be up-to-date on the latest scientific findings related to the field of foot and ankle surgery.

A new collection of SLRs is published monthly by podiatric residents, so you know that what you read will be relevant to your day-to-day work. Be sure to view the full listings at
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Information Your Patients Will Value
Did you know that in addition to, ACFAS also has a patient-centered educational website? It’s true! and its corresponding Facebook Page are updated frequently with all the latest information on foot and ankle injuries, relevant articles and press releases. also boasts an interactive foot guide so patients can easily discover which foot or ankle ailments they may need to see you about, as well as a built-in “Find a Physician” column so they know where to schedule their appointment.

Check it out for yourself, and encourage your patients to visit the website.
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Foot and Ankle Surgery

Impact of Autologous Blood Injections in Treatment of Mid-Portion Achilles Tendinopathy: Double Blind Randomized Control Trial
Research was conducted to evaluate the efficacy of two peritendinous autologous blood injections in addition to a standardized eccentric calf strengthening program in improving pain and function in patients with mid-portion Achilles tendinopathy, using a sample of 53 adults with symptoms of unilateral mid-portion Achilles tendinopathy for at least three months. All subjects underwent two unguided peritendinous injections one month apart with a standardized protocol. The treatment group had three milliliters of their own whole blood injected while the control group had no substance injected. Subjects in both groups performed a standardized and monitored 12-week eccentric calf training program, with follow-up at one, two, three and six months. Twenty-six participants were randomly assigned to the treatment group and 27 to the control group. Fifty subjects completed the six-month study, with 25 in each group. Clear and clinically worthwhile improvements in the Victorian Institute of Sport Assessment-Achilles score were apparent at six months in both the treatment and control groups. The treatment's impact was insignificant overall, and the 95 percent confidence intervals at all points precluded clinically meaningful benefit or harm. No significant difference between groups in secondary outcomes or in the levels of compliance with the eccentric calf strengthening program was observed, and no negative events were reported.

From the article of the same title
BMJ (04/18/13) Bell, Kevin J.; Fulcher, Mark L.; Rowlands, David S.; et al.
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The Operative Correction of Symptomatic Flat Foot Deformities in Children
A retrospective review of children with symptomatic flat feet that were surgically corrected was carried out to evaluate the results and characterize the relationship between the static alignment and the dynamic loading of the foot. Seventeen pediatric patients and 21 feet were assessed prior to and following correction of soft-tissue contractures and lateral column lengthening, using standardized radiological and pedobarographic methods for which normative data was available. Static segmental alignment of the foot and mediolateral dimension foot loading showed improvement while fore-aft foot loading was exacerbated following surgery. Only four significant associations were discovered between radiological measures of static segmental alignment and dynamic loading of the foot. A common postoperative finding was weakness of the plantar flexors of the ankle.

From the article of the same title
Bone & Joint Journal (05/13) Vol. 95-B, No. 5, P. 706 Westberry, D.E.; Davids, J.R.; Anderson, J.P.; et al.
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Tibiotalocalcaneal Fusion Using the Hindfoot Anthrodesis Nail
A multicenter study was held to evaluate clinical experience with the hindfoot arthrodesis nail (HAN) in the treatment of patients with severe ankle and foot abnormalities via tibiotalocalcaneal fusion. Seven participating European and North American clinics enlisted 38 patients who underwent ankle/subtalar arthrodesis using retrograde nailing with the HAN. The superficial wound infection rate was 2.4 percent, and no deep soft tissue or bone infections were reported. An 84 percent overall union rate was observed, while low pain levels with an average numeric rating scale of 2.2 were reported at the time of follow-up. The American Academy of Orthopaedic Surgeons' Foot and Ankle Outcomes score was 38, while the respective average Short Form-36 physical and mental health component scores were 41.2 and 52.5. All 13 patients unable to work before the procedure were able to fully resume work.

From the article of the same title
Foot & Ankle International (04/13) Rammelt, Stefan; Pyrc, Jaroslaw; Agren, Per-Henrik; et al.
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Practice Management

Medical System Largely Unprepared for Privacy Breaches
A lack of security measures to prevent privacy breaches or to ameliorate the impact of such intrusions is endemic across many healthcare organizations, according to a report from the Ponemon Institute. The study determined that although organizations clearly understand the risks and the potential consequences of a breach, many have failed to take appropriate protective action. Ninety-four percent of the polled organizations suffered a breach in the past two years, with the Ponemon Institute reporting that 875,000 healthcare records were compromised through breaches in the first quarter of 2013.

Thirty-nine percent of surveyed organizations said they lacked a response plan even after experiencing a breach, while those with a plan may be missing essential components. Just 19 percent of organizations possess tools for ascertaining the nature and cause of a breach. Meanwhile, Verizon's annual Data Breach Investigations Report cited a dearth of safeguards as a key reason healthcare organizations are so vulnerable to breaches. The hackers are not seeking health data, but rather financial information embedded within the practices' records.

Every practice needs to have an incident response plan in place, although consultant Rick Kam says many small practices have no knowledge of what such a plan is. Fundamentally, the plan should include steps for determining the breach's cause and scope, identifying and reaching out to those impacted by the breach as well as the U.S. Department of Health and Human Services' (HHS) Office for Civil Rights, mechanisms for working with those affected and plans for responding to inquiries. The Ponemon poll learned that most organizations do not provide clear communication and alerts to those affected by the breach.

Experian Data Breach Resolution Vice President Michael Bruemmer says the person overseeing the incident response plan should be authorized to make decisions on his or her own, rather than waiting for clearance every time a decision is required. Part of the incident response plan should feature federally mandated notification to those affected by the breach and HHS' Office for Civil Rights when more than 500 patients are affected. Bruemmer also says organizations must put themselves in the position of those being breached when crafting an incident response plan so that steps to mitigate reputational damage can be determined.

From the article of the same title
American Medical News (04/29/13) Dolan, Pamela Lewis
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Steps to Controlling Staff Costs
Support staff costs are the biggest expense of running a medical practice following provider compensation, and since work generally increases to accommodate the time available, excess staffing costs can come from workers being added during periods of high load, or when transitioning to open-access scheduling. Meanwhile, understaffing may lower costs in the short term, but it typically heightens the emotional costs of physician stress and staff grumbling about overwork, and it can reduce the practice's efficiency to the point where costs climb as a percentage of collections.

To determine the practice's appropriate staffing balance, the first thing to do is set up a staffing budget. The initial step in this process is to study benchmark data for practices that are similar to yours. The two optimal sources of staffing data are the National Society of Certified Healthcare Business Consultants (NSCHBC) Statistics Report for small and solo practices, and the Medical Group Management Association Costs Survey for large and multispeciality practices. The NSCHBC says the average staffing for solo and small primary care practices is three to four full-time equivalent support staff per physician, presuming no nonphysician providers or ancillary services and approximately 20 to 25 patient office visits per day. The budget for this level of staffing usually is in the range of 20 percent to 24 percent of gross collections.

The next step involves adjusting the benchmarks you find for staff count and costs to account for any specific conditions related to your practice, such as staff productivity, payer mix, capitation payments, use of quality measures and local wage levels. Also key is weighing staffers' skill level, and tailoring the benchmarks to suit your circumstances will provide a custom benchmark that can be used to assess staff costs and can be updated annually to compare with the national surveys. Once this is done, the practice leaders should discuss their findings with staff members and solicit their input for staying within budget, then review the data on a monthly basis. It is recommended that you and your staffers read "The One Minute Manager" by Kenneth Blanchard and Spencer Johnson.

From the article of the same title
Medical Economics (04/25/13)
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Texting Patients Securely at Your Medical Practice
When doctors communicate medical information to their patients via text, the same safeguards must be placed upon it as are placed upon email communications, as per federal regulations. The safeguards are meant to keep critical medical information out of the hands of hackers or other third parties who might use it for illicit purposes. Sending a text without taking the proper precautions could amount to a U.S. Health Insurance Portability and Accountability Act (HIPAA) violation for the clinician.

If healthcare providers want to text patients, they should get patients to sign an agreement that this is an appropriate method of communication. Secure text messages can be achieved through using mobile messaging platforms like TigerText, which offers the ability to deliver texts to secure corporate emails instead of mobile devices, a good option for clinicians who are reluctant to give out their personal phone information.

From the article of the same title
Physicians Practice (04/30/13) Torrieri, Marisa
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Health Policy and Reimbursement

Bill Would Prohibit HHS from Mandating ICD-10 Transition
U.S. Rep. Ted Poe (R-Texas) has introduced a bill that would prohibit the U.S. Department of Health and Human Services (HHS) from forcing healthcare providers to switch to ICD-10 code sets. Switching from the current ICD-9 code set to ICD-10 will require health providers and insurers trade out about 14,000 codes for about 69,000 codes. The deadline for the code switch is Oct. 1, 2014, but in December 2012 the American Medical Association, in cooperation with 42 state medical associations and 40 medical specialty groups, sent a letter to the U.S. Centers for Medicare and Medicaid Services urging them to stop ICD-10 implementation and instead find an "appropriate replacement" for ICD-9.

Poe has previously called the ICD-10 mandate "red tape" and "bureaucracy," and he had mentioned implementing the new code system will cost about $80,000 for individual doctors and about $250,000 for practices with five to 10 doctors. Poe's legislation was introduced into the House Energy and Commerce and Ways and Means committees, and it will need to pass votes in both of those committees before advancing to the House floor.

From the article of the same title
iHealthBeat (04/30/13)
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CMS Seeks 1.4 Percent Payment Hike for SNFs
The Centers for Medicare & Medicaid Services (CMS) has proposed a 1.4 percent hike in Medicare payments to skilled-nursing facilities for fiscal 2014, which the agency says would increase payments to providers by an estimated $500 million from 2013 payment levels. The regulation proposes to rebase and revise the skilled-nursing facility marketbasket index in 2013. The marketbasket currently reflects data from fiscal 2004, and CMS has suggested using data from 2010.

From the article of the same title
Modern Healthcare (05/01/13) Zigmond, Jessica
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Integrated Care, Payment Reform Could Save $300 Billion in a Decade: Brookings Report
A bipartisan report from the Brookings Institution found the federal government could save $300 billion in healthcare costs over the next 10 years by integrating care and moving to a risk-based payment system. One of the changes the report recommends is to make Medicare into a "Medicare comprehensive-care" system where providers receive payment depending on quality of care and patient outcomes. This, coupled with a recommended per-capita spending growth limit, would save the government $120 billion from 2019 to 2023, the report said. For Medicaid, the report suggested "person-focused" reform that would emphasize more coordinated care and low-cost growth that would save about $100 billion over a decade.

From the article of the same title
Modern Healthcare (04/29/13) Block, Jonathan
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Medicine, Drugs and Devices

Bone Drugs Help Preserve Joint Implants
Researchers from the University of Oxford presented a study at the British Society for Rheumatology's annual meeting that found that bisphosphonates can help reduce the need for repeat total joint replacement surgeries. The retrospective study examined data on 40,000 Danish patients over 40 who received joint implants, 1,950 of whom had used bisphosphonates for six months or longer. These patients were matched with 10,755 total joint replacement patients who did not take bisphosphonates. The study found that the use of bisphosphonates helped reduce the need for repeat joint replacement surgeries by 40 percent.

From the article of the same title
MedPage Today (04/25/13) Walsh, Nancy
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DNA Damage Drives Accelerated Bone Aging via an NF- KB–Dependent Mechanism
Researchers sought to determine how DNA damage leads to accelerated bone aging in mice. They examined progeroid excision repair cross complementary group 1–xeroderma pigmentosum group F (ERCC1-XPF)–deficient mice, including Ercc1-null (Ercc1-/-) and hypomorphic (Ercc1-/-) mice, and found that ERCC1 deficiency leads to DNA damage and several other problems. These problems in turn lead to increased secretion of inflammatory cytokines known to drive osteoclastogenesis, including the receptor activator of NF-KB ligand (RANKL). Researchers found that using an I-KB kinase (IKK) inhibitor to suppress NF-KB signaling reversed cellular senescence and senescence-associated secretory phenotype (SASP) in Ercc1-/- bone marrow stromal cells (BMSCs). They concluded that the NF-KB pathway is a novel therapeutic target for treating bone disease that occurs with age.

From the article of the same title
Journal of Bone and Mineral Research (05/13) Chen, Qian; Liu, Kai; Robinson, Andria R.; et al.
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