May 15, 2013

News From ACFAS

Register for the July Practice Management Seminar in Chicago
Don’t miss your chance to brush up on the latest changes on how to best manage your practice and beyond – attend the ACFAS 2013 Practice Management Seminar, July 19-20 in Chicago at the Millennium Knickerbocker Hotel. Invite your office staff to join you as our first-class speaker panel discusses the essential concepts and skills required to manage today's medical practice. Attendees will be exclusively privy to our speakers’ analyses of these topics:
  • Coding for Evaluation and Management, Surgical Procedures and Use of Modifiers
  • Electronic Health Records and Meaningful Use Attestation
  • HIPAA Omnibus Final Rule Requirements
  • Transitioning to ICD-10
  • Providing and Getting Reimbursed for Durable Medical Equipment
  • Measuring Practice Success
The seminar brochure and registration form are available at Register today! Availability is limited.
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Now Accepting All Manuscripts for 2014
If you are involved in a study that would be beneficial to the profession, the ACFAS Annual Conference Program Committee invites you to submit your manuscript for consideration of presentation at the Annual Scientific Conference Thursday, February 27 to Sunday, March 2, 2014, in Orlando, Florida.

The deadline for submission is August 15, 2013. Winners of the ACFAS Manuscript Awards of Excellence divide $10,000 in prize money from a generous grant given to ACFAS by the Podiatry Foundation of Pittsburgh. To submit your manuscript or for more information, visit and click "Submit Manuscript," or click on the Web link below.
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Foot and Ankle Surgery

Autologous Blood Injections for Chronic Plantar Fasciitis—a Pilot Case-Series Study Shows Promising Results
A prospective case series pilot was performed to determine patient outcomes following ultrasound-guided autologous blood injections (ABI) for the treatment of chronic plantar fasciitis symptoms. The study concentrated on 35 consecutive patients who received ultrasound-guided ABI for plantar fasciitis symptoms in a National Health Service Sports Medicine Clinic in Leicester, Britain. Patients had an average follow-up of six months and with a maximum of more than 800 days. The visual analogue scale (VAS) for pain and the seven-part patient satisfaction outcome scale were included in the outcome measures. An average VAS reduction of more than 85 percent following ABI was observed for all enrolled patients, rising to almost 90 percent in patients with at least two months follow-up data. At the most recent follow-up appointment 53 percent of all patients were free of pain following ABI, climbing to 71 percent of patients with at least two months of follow-up data.

From the article of the same title
International Musculoskeletal Medicine (Spring 2013) Vol. 35, No. 1, P. 3 Wheeler, Patrick
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Effect of Achilles Tenotomy on Congenital Clubfoot-Associated Calf-Muscle Atrophy: An Ultrasonographic Study
An ultrasonographic study was performed to explore whether Achilles tenotomy has an adverse impact on clubfoot-associated calf-muscle atrophy, with a focus on 36 patients treated with the Ponseti method who underwent Achilles tenotomy. Unilateral cases were assessed to compare the severity of atrophy and its changes over time between affected and unaffected sides. Tenotomy was performed at an average age of 10.2 weeks after birth, and the transverse and anteroposterior diameters of the calf muscles on the unaffected and affected sides were measured ultrasonographically by two examiners. The average observation period was 27 months, and measurements were carried out within six months after tenotomy, between seven and 17 months after tenotomy and at the final evaluation. Tendon healing and gliding were accomplished in all cases. Significant differences were observed between the diameters of the unaffected and affected sides at all measurement points. The diameters of calf muscles on both sides increased substantially over time, while the patterns of change in diameter were similar on both sides.

From the article of the same title
Journal of Orthopaedic Science (05/01/13) Niki, Hisateru; Nakajima, Hiroshi; Hirano, Takaaki; et al.
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Tibiotalocalcaneal Arthrodesis with Bulk Femoral Head Allograft for Salvage of Large Defects in the Ankle
A study was held to examine the outcomes of tibiotalocalcaneal (TTC) arthrodesis using bulk femoral head allograft in the treatment of large segmental bony defects in the ankle. TTC with bulk femoral allograft was administered to 32 patients, and those who exhibited radiographic union were contacted for SF-12 clinical scoring and repeat radiographs. Patients with asymptomatic nonunions also were contacted for SF-12 scoring alone. Half of the patients healed their fusion. Diabetes mellitus was determined to be the sole predictive factor of outcome, and all nine patients with diabetes developed a nonunion. Nineteen percent of the patients in this series required a below-knee amputation.

From the article of the same title
Foot & Ankle International (05/13) Jeng, Clifford L.; Campbell, John T.; Tang, Edward Y.; et al.
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Practice Management

HHS to Providers: Check Lists of Excluded Medicare Personnel
The U.S. Department of Health and Human Services (HHS) has published new guidelines recommending that healthcare providers check their staff rosters against a list of personnel excluded from providing even indirect care to Medicare patients once per month. The requirement is applicable to temporary nurses and physicians who work under contract from staffing firms. Companies in violation of the exclusion rules can have their Medicare payments revoked, in addition to fines of $10,000 per claim, if anyone involved in the care was excluded. As of April, the exclusions list was composed of 51,588 people as well as 2,812 pharmacies, labs, ambulance companies, durable-medical equipment suppliers, medical clinics and other healthcare firms. HHS' new advisory bulletin says hospitals and physician practices are responsible for ensuring that all temporary personnel are not excluded. Still, a hospital can “reduce or eliminate” potential penalties if it can demonstrate that the agency providing the temporary workers agreed in contract to do the background screenings, according to a footnote in the rules. Even then, hospitals must make sure the staffing agency is fulfilling its function, for instance by requesting proof that the checks were carried out each month.

From the article of the same title
Modern Healthcare (05/08/13) Carlson, Joe
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If Patients Are No-Shows, Doctors Should Ask Why
Practices should make an effort to find out why patients cancel appointments or fail to show up at all, as the information could have a valuable bearing on the patient and the practice itself. The first step in the process is tracking cancellations, either via automated technology or with office staff, and then have an office manager or other administrator call each patient on that list to ascertain the reason. Specific rather than general reasons for the cancellation should be asked for. The office staffer should not have to make more than three or four calls daily, and administrators need to let the office manager know this is important and that they want to be kept abreast of results.

Patients forgetting appointments is a key reason for missed visits, and calling them gives the practice a chance to reschedule. For appointments made far in advance, the office should call or text a reminder to the patient as the date approaches. A nurse practitioner or physician can talk to the patient over the phone to discuss the problem. Some patients miss appointments because they lack the money for a co-pay or they have a balance due. A practice could waive the co-pay, although it should not do this on a routine basis. Setting up credit arrangements with the patient is another option.

Some patients intentionally skip appointments because of some aspect of the practice they do not like. Other patients skip appointments because they failed to do something physicians asked them to do at their last visit, such as fill a prescription or take a test, and do not want to admit it to the physician. Calling patients can winnow out those who are lost causes and the ones that the practice should keep.

From the article of the same title
American Medical News (05/06/13) Caffarini, Karen
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Health Policy and Reimbursement

AMA Raises Reimbursement Concerns over EHR Workarounds
American Medical Association (AMA) Chair Steven Stack contends that documenting a full clinical encounter in an electronic health record (EHR) can be extremely onerous, and he describes three time-saving methods physicians have turned to, each with the potential for abuse leading to denial of Centers for Medicare and Medicaid Services payments. Stack notes that the methods—cut-and-paste, templates and macros—can be logical and advantageous for static information, but the first method becomes abusive when physicians reproduce information created by themselves or others, either without attribution or without attention to its accuracy. Stack also says clinicians are still obligated to review their own documentation to ensure the accuracy of information. Documentation templates, meanwhile, promote a homogeneity of information that could encourage plagiarism, according to Stack. He says the AMA is calling on the Office of National Coordinator to address EHR usability issues raised by physicians, and to take swift action to add usability criteria to the EHR certification process.

From the article of the same title
HealthLeaders Media (05/07/13) Mace, Scott
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CMS Releases Online Hospital Pricing Data
Health and Human Services Secretary Kathleen Sebelius has announced a three-part initiative to give consumers information on what hospitals charge. New data from the Centers for Medicare & Medicaid Services (CMS) shows there is significant variation across the country and even within communities in what hospitals charge for common inpatient services. The data, posted on the CMS website, includes information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays. CMS says the data provided include hospital-specific charges for the more than 3,000 hospitals that receive Medicare Inpatients Prospective Payment Systems payments for the top 100 most frequently billed discharges paid under Medicare. Health and Human Services also announced it made about $87 million available to states to enhance their rate review programs and further healthcare pricing transparency.

From the article of the same title
BNA's Health Care Daily Report (05/08/13)
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CMS to Hold National Provider Call for EHR Incentive Programs
The Centers for Medicare and Medicaid Services will hold a national provider call for eligible professionals participating in stage 1 of the Medicare and Medicaid Electronic Health Record Incentive Programs. This will be the first of several national provider calls on the incentive programs. The six sessions will educate eligible providers on several subjects, including earning incentive payments, clinical quality measures, hardship exemptions and payment adjustments.

The session will take place on May 30. To register, click here.

From the article of the same title
Becker's Hospital Review (05/06/13) Vaidya, Anuja
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Medicine, Drugs and Devices

Clinical Outcomes of Mesenchymal Stem Cell Injection with Arthroscopic Treatment in Older Patients with Osteochondral Lesions of the Talus
The clinical results of mesenchymal stem cell (MSC) injection and arthroscopic marrow stimulation treatment were compared with those of arthroscopic marrow stimulation treatment alone for the treatment of osteochondral lesions of the talus (OLTs) in older patients. Among 107 patients with OLTs treated arthroscopically, only 65 patients more than 50 years old were included in the study. Thirty-five patients (37 ankles) were treated with arthroscopic marrow stimulation treatment alone in group A, while 30 patients (31 ankles) were treated with MSC injection and arthroscopic marrow stimulation treatment in group B. Clinical outcomes were assessed according to the visual analog scale (VAS) for pain, the AOFAS Ankle-Hindfoot Scale and the Roles and Maudsley score. Outcomes in activity levels were determined via the Tegner activity scale. The mean VAS score and the mean AOFAS score in each group showed significant improvement, while significant differences in mean VAS and AOFAS scores between the groups were observed at final follow-up. The Roles and Maudsley score demonstrated significantly greater improvement in group B than in group A following surgery, and the Tegner activity scale score was significantly improved in group B but not in group A. Large lesion size and the presence of subchondral cysts were significant predictors of unsatisfactory clinical results in group A, but these correlations were not seen in group B.

From the article of the same title
American Journal of Sports Medicine (05/01/13) Vol. 41, No. 5, P. 1090 Kim, Yong Sang; Park, Eui Hyun; Kim, Yong Chan; et al.
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Lab-Made Bone Replacement Moves Closer
Researchers at the New York Stem Cell Foundation have developed a technique for growing human bone. The technique, described in the journal Proceedings of the National Academy of Sciences, involves reprogramming human skin cells into embryonic-like stem cells that are placed on a scaffold and treated with a bioreactor. The embryonic-like stem cells grow into pieces of bone. Researchers were able to successfully integrate one into the body of a mouse. The researchers plan to make other pieces of bone with blood vessels to see if the technique can be used to treat injuries in animals. If they are successful, tests on humans could begin within several years.

From the article of the same title
Wall Street Journal (05/07/13) Naik, Gautam
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Minimally Invasive Reconstruction of Chronic ATR Using the Ipsilateral Free Semitendinosus Tendon Graft and Interference Screw Fixation
A study was held to test the hypothesis that minimally invasive reconstruction of the Achilles tendon, with a gap lesion larger than six centimeters, using the ipsilateral free semitendinosus tendon graft will improve overall function with a low incidence of complications in patients with chronic Achilles tendon ruptures. Twenty-eight consecutive patients were enrolled, and the Achilles tendon Total Rupture Score (ATRS), maximum calf circumference and isometric plantarflexion strength before surgery and at the last follow-up were assessed. The median follow-up after the operation was 31.4 months. The overall surgical outcome was excellent/good in 26 patients, and the ATRS rose from 42 to 86. The maximum calf circumference and isometric plantarflexion strength in the operated leg were significantly improved post-surgery, but their values remained substantially lower than those of the opposite side. All patients could walk on tiptoes and resumed their preinjury working occupation, and no infections were recorded.

From the article of the same title
American Journal of Sports Medicine (05/01/13) Vol. 41, No. 5, P. 1100 Maffulli, Nicola; Loppini, Mattia; Longo, Umile Giuseppe; et al.
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