May 9, 2012

News From ACFAS

Watch for ACFAS Survey by E-mail…and Win a New iPad3 or ASC Registration
Within the next few weeks, ACFAS will be conducting two crucial surveys--but you will receive just one. By random sample, half of ACFAS members will receive the Member Success and Challenges Survey and half will receive the Practice Economics and Insights Survey. Each survey will take only 15 minutes to complete.

You will receive the survey via e-mail in the next few days. Watch your inbox (or spam file) for an email from "Michelle Butterworth, DPM” or "ACFAS President." The link will take you to a confidential survey website. Your responses will be anonymous and only reported in the aggregate by a third-party survey consultant.

Respond by June 22 to be eligible for a drawing for one of four new iPad or your registration fee for ACFAS 2013 in Las Vegas on February 11-14.
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Get the Latest JFAS Research Today
Stay a step ahead by visiting "Articles in Press" at the Journal of Foot & Ankle Surgery's online home page. New articles are available as soon as their proofs have been approved — even before they're assigned to an issue.

It's quick and easy with your free member access:
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  • When you reach the JFAS home page, click on “Articles in Press” in the left menu.
Check out tomorrow’s news today, including original research, case reports, and tips, quips and pearls.
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Foot and Ankle Surgery

Biomechanical Comparison of Four Methods of Repair of the Achilles Tendon
Researchers tested four types of surgical repair for load to failure and distraction in a bovine model of Achilles tendon repair. A total of 20 fresh bovine Achilles tendons were divided transversely 4 cm proximal to the calcaneal insertion and randomly repaired using the Dresden technique, a Krackow suture, a triple-strand Dresden technique or a modified oblique Dresden technique, all using a Fiberwire suture. Each tendon was loaded to failure. The force applied when a 5 mm gap was formed, peak load to failure, and mechanism of failure were recorded. The resistance to distraction was significantly greater for the triple technique (mean 246.1 N to initial gapping) than for the Dresden (mean 180 N; p = 0.012) and the Krackow repairs (mean 101 N; p < 0.001). Peak load to failure was significantly greater for the triple-strand repair (mean 675 N) than for the Dresden (mean 327.8 N; p < 0.001), Krackow (mean 223.6 N; p < 0.001) and oblique repairs (mean 437.2 N; p < 0.001). Failure of the tendon was the mechanism of failure for all specimens except for the tendons sutured using the Krackow technique, where the failure occurred at the knot. The triple-strand technique significantly increased the tensile strength (p = 0.0001) and gap resistance (p = 0.01) of bovine tendon repairs, the researchers said, and might have advantages in human application for accelerated post-operative rehabilitation.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (05/01/12) Vol. 94-B, No. 5, P. 663 Ortiz, C.; Wagner, E. ; Mocoçain, P.; et al.
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Forefoot Running Improves Pain and Disability Associated With Chronic Exertional Compartment Syndrome
Researchers tested their hypothesis that for sufferers of chronic exertional compartment syndrome (CECS), adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition. Ten patients with CECS indicated for surgical release were prospectively enrolled in the study. After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery.

From the article of the same title
American Journal of Sports Medicine (05/01/12) Vol. 40, No. 5, P. 1060 Diebal, Angela R.; Gregory, Robert ; Alitz, Curtis; et al.
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Treatment of Traumatic Subtalar Arthritis With Interpositional Arthroplasty With Tensor Fascia Lata or Fat
Researchers evaluated the results of interpositional arthroplasty with tensor fascia lata or fat as a treatment for traumatic subtalar joint arthritis after a fracture of the calcaneus. Twenty-two patients with traumatic subtalar joint arthritis were enrolled in this study. Tensor fascia lata was implanted for 7 patients who previously underwent surgery by open ORIf using a lateral approach. Fat was implanted for 15 patients who were previously managed with conservative care or percutaneous reduction and fixation. All the patients were followed up for more than one year.

The AOFAS Ankle-Hindfoot score changed from 60.95 to 80.23 (p < 0.05). Visual Analogue Scale pain score decreased from 6.6 to 3.8 (p < 0.05). The results of the circle draw test were excellent in eight patients, good in 11, and fair in three without any poor outcomes. The subjective satisfaction of the patients was excellent in 16 patients, good in four, and poor in two. In two patients with poor satisfaction, symptoms and mobility showed no improvement postoperatively.

From the article of the same title
European Journal of Orthopaedic Surgery and Traumatology (04/12) Kim, Gab-Lae; Park, Jae-Yong; Hyun, Yun-Sook
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Practice Management

3 Steps to EHR Training to New Staff Members
New staff members of physician practices must be trained in electronic health record (EHR) systems, and there are three key stages to be followed. The first stage involves learning basic system aspects, with Raquel Garcia de Acosta at Morris Sussex Family Practice in Lake Hopatcong, N.J., stressing that the first few days must emphasize what tasks are and are not facilitated by the EHR. The second step entails a new employee following someone else for at least a day so they can get a feel for how the EHR fits into the workflow of the practice, and then the trainer should follow the new employee to look for potential difficulties that may require correction. For the third stage, Garcia de Acosta thinks most new physicians should be prepared to go it alone on the EHR system after seven days of training, while being sufficiently supported by organizations.

From the article of the same title
American Medical News (04/30/12) Dolan, Pamela Lewis
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8 Social Media Tips for Physicians
Physicians looking to get started on social media sites in order to interact with patients and colleagues, would be wise to observe these tips:

1. Develop a social media policy. The American Medical Association offers a set of guidelines.

2. Be clear that the thoughts and views expressed are yours and not the hospital's or group practice's.

3. Stay professional. A good rule to follow is that the same conversations you can have in public, you can have online. Something that you would not do in ­public—such as using unflattering language or discussing personal patient information—shouldn't be done online either.

4. Determine what level of personal information you want to share.

5. Start small. Physicians who are interested in social media should start with Twitter, suggests Mayo Clinic's Farris K. Timimi. "There is utility in claiming your Twitter username—names are not recycled—and it should be suitable across multiple platforms, so I'd use the same name across LinkedIn and Facebook, and then decide whom you want to engage with and engage."

6. All content doesn't have to be created and posted on the same day. A lot of content is still relevant months later, so bring it back up, says Dana Lewis, interactive ­marketing specialist for Swedish Medical Center. "If you do anything like live stream videos, definitely package your efforts and show them off because they are still great resources after they happen."

7. Be cautious of how you use Facebook. "A practice or department can have a Facebook page, but if a physician has one, they should be cautious about friending patients," says Timimi, explaining that there are always tags that occur that extend beyond the physicians themselves.

8. Putting a "like me on Facebook" or "follow me on Twitter" icon on a Web page is not social media, Timimi says. "If your goal is truly engaging consumers to improve healthcare and achieve brand recognition for your institution, there has to be more conversation than that."

From the article of the same title
HealthLeaders Media (05/03/12) Vaughan, Carrie
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Realize the Tax Benefits of Owning Your Office
Physicians occasionally decide that it makes better investment sense for them to own their office facilities than to rent them. However, purchasing physicians often overlook the passive loss limitations of Internal Revenue Code Section 469. Fortunately, there are strategies for overcoming the passive loss limitations and enjoying the hoped-for tax benefits of purchasing facilities. Real estate usually is purchased and owned by an entity that is separate from the entity through which the physician operates his or her medical practice, which insulates liabilities associated with owning and operating the real estate.

From the article of the same title
Modern Medicine (04/10/12) Frooman, Matthew; Smith, Stanley M.
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Health Policy and Reimbursement

90-Day Demo Period for Stage 2 Urged
The Center for Medicare and Medicaid Services is being urged by a coalition of chief information officers and other health information technology professionals to deploy a 90-day demonstration period in the first 12 months in which providers will attest to having fulfilled Stage 2 electronic health-record (EHR) system meaningful-use requirements. The recommendation emulates the 90-day period implemented for the first year of Stage 1 of the federal government's EHR incentive program. "Through our experiences with Stage 1, we found that although EHR products were able to automatically produce CQM reports, the data was inaccurate and largely incomparable across different providers," says the College of Healthcare Information Management Executives.

From the article of the same title
Modern Healthcare (05/01/12) Conn, Joseph
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Massachusetts Payment-Reform Bill Would Overhaul How Healthcare Providers Are Paid
Massachusetts is expected in the coming months to adopt legislation to revamp how doctors, hospitals, and other healthcare providers are paid, and include numerous incentives for hospitals to take global payments, or a flat fee for all care provided to a specific person or group of people. State businesses have thus far demonstrated adaptability to such payment revisions, with some moving in that direction on their own; for example, four years ago Blue Cross Blue Shield of Massachusetts launched the Alternative Quality Contract, an effort to pay physicians and hospitals for the quality of care they provide by having a medical group accept a global budget to cover all healthcare services for a set of patients. The state legislation is expected to have a hard cap on state healthcare spending, which will likely be tied to growth in the gross state product.

From the article of the same title
Washington Post (04/30/12) Kliff, Sarah
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Physicians Fight 'Unworkable' Medicare Overpayment Rule
About 110 physician organizations led by the American Medical Association (AMA) are against a proposed Medicare requirement that practices retain a decade of records to identify possible overpayments. The groups object to overlapping regulations, are demanding rule clarifications, and seek an appeals process to dispute excessive payment determinations, while AMA chair-elect Steven J. Stack advises that the look-back period be reduced to three years "to remain consistent with other initiatives." Medical Society of the State of New York president Paul A. Hamlin wrote in a letter that his group would only back the 10-year retrospective period if its goal was "to put the fear of the federal government into those who knowingly and willfully with malice of intent act to defraud" the Medicare program—but the consequences of innocent errors by doctors and practice administrators must not also be encompassed by rules targeting willful perpetrators of fraud and abuse.

From the article of the same title
American Medical News (04/30/12) Fiegl, Charles
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Medicine, Drugs and Devices

KLAS: ICD-10 Concerns Push Providers to Consider CAC Solutions
According to a new report from healthcare technology data provider KLAS, concerns about readiness to meet the ICD-10 deadline are driving nearly half of providers to purchase an inpatient computer-assisted coding (CAC) solution within the next two years. The report found that many providers believe implementing a CAC solution can make up for some of the lost productivity and reimbursement that will result from transitioning to ICD-10. Providers are concerned their staff will not be ready in time. Provider confidence that computer-assisted coding technology will ultimately create greater efficiency, productivity, and ICD-10 readiness is high, according to the report's author. As such, many providers are looking to pull the trigger on a CAC purchase decision soon.

From the article of the same title
Health System CIO (04/23/2012) Gamble, Kate
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Mobile Health Apps Prompt Questions About Privacy
Mobile applications are being developed to help doctors deliver bedside care to patients or remotely monitor chronic conditions, but are somewhat limited by concerns about their ability to protect patient safety and privacy. Later this year, the Food and Drug Administration will probably finalize its first-ever guidance on mobile health apps, so that it has at least some degree of oversight of mobile products that supplant or complement other medical devices. The companies devising such apps also must deal with critics concerned with whether patient privacy can be shielded as more of their personal information becomes Internet-accessible.

From the article of the same title
Washington Post (04/29/12) Overly, Steven
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