May 18, 2011

News From ACFAS

Find Answers for Your Practice Issues

If you’re looking for answers to practice issues, including which electronic health records vendor to use, register now for ACFAS’ “Practice Made Perfect” practice management/coding seminar in Las Vegas, Oct. 14–15, 2011. And take advantage of ACFAS member pricing on Welch Allyn’s EHR Prep-Select consulting tools to help you make the best choice for your electronic health record needs. Representatives for EHR Prep-Select will also be on hand in Las Vegas to assist you in person.

The College is still seeking a pilot practice for EHR Prep-Select. If you are interested, contact Kristin Hellquist Cunningham at or 773-444-1322.
New Trauma DVDs Offer Quality CME

Preview the procedures in “Surgical Techniques e-Learning: Trauma” at ACFAS e-Learning today. Finding authoritative information on foot and ankle trauma just got easier! Faculty on this new video include:
  • Donald E. Buddecke, Jr., DPM, FACFAS
  • George S. Gumann, Jr., DPM, FACFAS
  • Mark A. Hardy, DPM, FACFAS
  • Michael S. Lee, DPM, FACFAS
  • Alan Ng, DPM, FACFAS
This collection is available on DVD-ROM or by download directly to your desktop. Continuing education credit is available with the purchase of the complete set. Visit ACFAS e-Learning any time to browse the entire library of free and purchasable education resources in podcast, video and DVD.
Recent Research at Your Fingertips

ACFAS' Scientific Literature Reviews Monthly helps you stay up-to-date with research in journals you might not usually read. Podiatric residents have prepared abstracts of podiatry-relevant research such as:

Effect of Posterior Malleolus Fracture on Outcome After Unstable Ankle Fracture, from the Journal of Trauma, Injury, Infection, and Critical Care.
Reviewed by Aaron Bellew, DPM, New York Hospital Queens.

Percutaneous Internal Fixation of Proximal Fifth Metatarsal Jones Fractures (Zones II and III) with Charlotte Carolina Screw and Bone Marrow Aspirate Concentration, from the American Journal of Sports Medicine.
Reviewed by Raffaella Buffolino, DPM, New York Hospital Queens.

Browse new entries or the entire archive at Scientific Literature Reviews Monthly.

Foot and Ankle Surgery

Major Functional Deficits Persist Two Years After Acute Achilles Tendon Rupture

Researchers evaluated the long-term results after an acute Achilles tendon rupture in patients treated surgically or non-surgically, focusing on whether any improvements occurred between the one- and two-year evaluation. Eighty-one patients were included in this study, 42 of whom were treated surgically and 39 non-surgically; otherwise the treatment was identical for the two groups. Significant functional deficits on the injured side compared with the contralateral side were found two years after Achilles tendon rupture, regardless of treatment. Only minor improvements occurred between the one- and two-year evaluations. The physical activity level remained significantly reduced as compared with prior to injury, but the Achilles tendon Total Rupture Score mean was relatively high in both groups (89 and 90).

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (04/30/11) Olsson, Nicklas; Nilsson-Helander, Katarina; Karlsson, Jón; et al.

Salvage of Failed Total Ankle Arthroplasty With Fusion Using Structural Allograft and Internal Fixation

Researchers performed a study on the conversion of failed total ankle arthroplasty (TAA) to fusion through a retrospective review of 24 ankles evenly divided between those converted to isolated ankle fusions and those converted to tibiotalocalcaneal fusions. All isolated ankle fusions in the first group were stabilized with anterior plate and screws, and structural bone graft was used in all but two fusions; all tibiotalocalcaneal fusions in the second group were fixed using either anterior plate and screws, intramedullary nail, or a combination nail:plate construct, with all receiving structured allografts. The researchers concluded that structural bone graft and internal fixation can be used to successfully convert failed TAA to fusion, with the primary risk being nonunion of the subtalar joint when tibiotalocalcaneal fusion is necessary.

From the article of the same title
Foot & Ankle International (05/11) Vol. 32, No. 5,

Ultrasound Aids Early Diagnosis of Juvenile Inflammatory Arthritis

Pediatric rheumatologists currently depend on physical examination to diagnose juvenile inflammatory arthritis (JIA), but a study presented at the American Roentgen Ray Society's annual meeting suggests that ultrasound presents greater sensitivity than physical examination. Researchers compared the results of ultrasound of the knees and ankles of patients with known JIA with observations from physical examinations. The study entailed 84 joints in 19 children with active disease, and ultrasound was performed on three planes for the knees and one plane for the ankle. Sixty-five of the joints exhibited concordance for both sonography and physical examination, and five of the joints that were active on ultrasound and inactive on physical examination progressed to clinically evident disease on follow-up, one was lost to follow-up, and eight only exhibited mild increased vascularity on ultrasound; four of the joints that were inactive on ultrasound and active on physical examination had subtalar involvement and one had no explanation.

From the article of the same title
Medscape (05/05/11) Pullen, Lara C.
Web Link - May Require Free Registration

Practice Management

Beware Physician Compare: Medicare Site Inaccurate, Say Wronged Practices

Medicare's Physician Compare website is riddled with inaccuracies such as name misspellings and locality errors, and doctors warn that unless these mistakes are corrected, expanding the website to include quality scores by 2013 might not produce a resource that engenders trust among patients. "The lack of effective and timely assistance we have received in response to our questions, as well as the lack of coordination among the entities supposedly involved in the Physician Compare website, is maddening," notes Midlands Orthopaedics CEO AnnMargaret McCraw. She considers physicians with errors under their names or who are omitted from the site to be at a disadvantage because potential patients might be unable to connect with them.

From the article of the same title
American Medical News (05/09/11) Fiegl, Charles

E-Prescribing Not Meeting Expectations

Office-based medical practices are increasingly adopting electronic prescribing, but there are currently two significant shortcomings in e-prescribing technology that are slowing adoption, and preventing physicians from achieving many of the promised safety and cost-saving benefits, according to the Center for Studying Health System Change (HSC). In many cases, it is difficult to import prescription data, such as medication history and insurance information, into patient records, and data is not always useful enough for patients to use during typical office visits. HSC says about a third of practices said their e-prescribing systems do not offer the ability to view patient medication history from a third party when writing electronic prescriptions. Additionally, 38 percent of practices had that ability, but physicians chose not to use it because information was not easily accessible, they did not see much value in it, or the technology was too difficult to use.

From the article of the same title
InformationWeek (05/06/11) Versel, Neil

Healthcare Equipment Acquisition in an Improving Economy

The economic rebound is encouraging the acquisition of healthcare equipment by organizations, and the current market environment finds equipment financing as integral and available as ever. A major concentration will be on obtaining healthcare IT systems necessary to achieve meaningful use thanks to the currently available stimulus funds, coupled with potential penalties for non-compliance looming in 2015. Although credit conditions have not reverted to pre-recession levels, the situation has definitely improved compared to 12 or 18 months ago; hospitals and doctors with solid credit histories can generally anticipate a competitive environment.

From the article of the same title
HealthLeaders Media (05/09/11) Sutton, William G.

Health Policy and Reimbursement

CHIME Raises Concerns on ACO Data Sharing

The success of new healthcare delivery models could be impeded by the ability of patients in accountable care organizations (ACOs) to limit access to their personal health information, warned the College of Healthcare Information Management Executives (CHIME). "If beneficiary claims data are withheld, the ACO's ability to improve individual beneficiary health, as well as achieve the desired shared savings, could be compromised," CHIME noted in a letter to Centers for Medicare and Medicaid Services (CMS) administrator Donald Berwick, MD. CHIME notified CMS that patients wishing to opt out of sharing claims data should be mandated to consult with a primary care physician not tied to an ACO, or that healthcare costs for these patients should not be counted against an ACO under shared savings payments; CHIME also balked at a requirement that half of an ACO's primary care physicians satisfy all meaningful use standards for electronic health records by the start of the second year of the ACO's contract with CMS.

From the article of the same title
HealthLeaders Media (05/11/11) Commins, John

Medical Liability Bill Approved by House Committee

A measure designed to reduce medical liability costs for medical providers partly through a cap on noneconomic damages has been approved by the House Energy and Commerce Committee following the House Judiciary Committee's approval in February. A $250,000 cap on noneconomic damage awards is the bill's primary provision, and the measure also would establish a three-year statute of limitations for medical malpractice claims, with certain exceptions; joint-and-several liability also would be replaced with a rule constraining defendants' liability to the percentage of the final award that equaled their share of responsibility for the injury. Republicans promoted the bill as necessary to control rapidly ballooning healthcare costs.

From the article of the same title
Modern Healthcare (05/12/11) Daly, Rich
Web Link - May Require Paid Subscription

States Eye Public Access to More Doctor Disciplinary Records

An ongoing call for transparency in the medical professional has resulted in medical boards across the country releasing more information online about physicians' professional and disciplinary history. However, the information available, both to consumers looking for information and families investigating a specific physician or complaint, can vary greatly, and states are hearing from consumers that not enough information is available or easily accessed. At least five states recently passed or are considering legislation to create more transparency, particularly regarding physician disciplinary records and procedures to enable the release of more information, make information easier for consumer access, and provide faster responses on requests for information.

From the article of the same title
American Medical News (05/09/11) Krupa, Carolyne

Medicine, Drugs and Devices

3-D Printers May Someday Allow Labs to Create Replacement Human Organs

Labs may be able to manufacture replacement human organs through printing technology that stacks up layers of organic material to make three-dimensional (3D) configurations. 3D bioprinting is in an early phase, but researchers have successfully printed skin and vertebral disks and implanted them within living bodies. Scientists say the largest technical hurdle is not producing the organ itself, but reproducing its internal network of blood vessels, which supplies it with oxygen and nutrients. Many tissue engineers think the optimal solution for now is to print only an organ's biggest connector vessels and give those vessels' cells time, space, and the best environment in which to generate the rest themselves.

From the article of the same title
Washington Post (05/09/11) Berkowitz, Bonnie

Effects of Kinesio Tape Compared With Nonelastic Sports Tape and the Untaped Ankle During a Sudden Inversion Perturbation in Male Athletes

A controlled laboratory study was conducted on 51 male premier-league athletes to test two adhesive tape conditions—ankle taped with nonelastic white sports tape and ankle taped with Kinesio Tape—versus a no-tape condition on muscle activity of the fibularis longus during a sudden inversion perturbation. The test demonstrated significantly greater average muscle activity when ankles were taped with nonelastic tape compared to no tape, while Kinesio Tape yielded no significant impact on average or maximum muscle activity compared to the untaped condition. The researchers concluded that nonelastic sports tape may augment dynamic muscle support of the ankle.

From the article of the same title
Journal of Orthopaedic & Sports Physical Therapy (05/01/2011) Vol. 41, No. 5, P. 328 Briem, Kristin; Eythorsdottir, Hrefna; Magnusdottir, Ragheidur G.; et al.

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