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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

Missed it at the ASC? View This Scientific Session Online

“My Most Challenging Cases,” a six-part series of presentations recorded at the Annual Scientific Conference, can now be viewed online at ACFAS e-Learning.

Take advantage of this exceptional opportunity, as your colleagues discuss cases that didn’t go as planned…hard decisions that had to be made…and steps that were taken.

The videos may be viewed by anyone on your staff; ACFAS members can receive CE credit by completing a post-test.

While you’re there, take a look at all that ACFAS e-Learning has to offer: 26 podcasts, nine clinical and practice management sessions, and the three-volume surgical procedure series. Visit frequently – new titles are added monthly.

Health System Reform Update

The health system reform debate is heating up, with both the House and Senate preparing to unveil proposed legislation in early June. Adding to the sense of urgency is the Medicare Trustees' report that the Medicare trust will run out of money by 2017, two years earlier than previously predicted.

In a key development, a "public health plan" to compete with private health insurers was intensely debated at a Senate Finance Committee hearing. Proponents believe it is essential to increasing competition in the insurance market and expanding coverage of the uninsured. Opponents fear it is a first step toward "socialized medicine."

In addition, "comparative effectiveness" (CE) research is expected to play an important role in legislative strategies to control cost. CE, which compares the effectiveness (outcome and cost) of different treatments for the same condition, is aimed at reducing wide geographic variations in practice patterns. Ultimately, under CE, financial incentives would be introduced for using more "effective" treatments. Influential voices in the Obama cabinet, including Budget Director Peter Orzag, strongly support CE. Skeptics wonder how it will differ from failed "managed care" strategies.

Foot and Ankle Surgery

Peroneal Activation Deficits in Persons With Functional Ankle Instability

In a study involving 21 patients with unilateral functional ankle instability (FAI) and an equal number of uninjured, matched controls, researchers concluded that arthrogenic muscle inhibition (AMI) is present in the peroneal musculature of persons with FAI but is not tied to dynamic muscle activation as measured by peroneal electromyography (EMG) amplitude. Reversing AMI may not help protect the ankle from further episodes of instability, but dynamic muscle activation ought to be restored to maximize ankle stabilization. Dynamic peroneal activity is hindered in functionally unstable ankles, which may play a role in recurrent joint instability and may make the ankle susceptible to injurious loads.

From the article of the same title
American Journal of Sports Medicine (05/01/09) Vol. 37, No. 5, P. 982; Palmieri-Smith, Riann M.; Hopkins, J. Ty; Brown, Tyler N.

Preparation, Release Profiles, and Antibacterial Properties of Vancomycin-loaded Poly(D,L-lactic) Titanium Alloy Plates

Implant-associated infections are the chief risk facing orthopedic and traumatology departments in open fractures. For this study, poly(D,L)-lactic acid (PDLLA) coatings carrying vancomycin were prepared on the surface of titanium alloy plate substrates for internal fixation of fractures using solvent-casting technology. The in vitro inhibition of Staphylococcus (S) aureus showed that the plates had an inhibitory effect on S aureus, and the antibacterial activity was maintained for at least 15 days. These findings may have important clinical significance for preventing acute infection after the fracture of internally implanted fixation plates.

From the article of the same title
Ortho Supersite (05/01/2009) Tang, LiangHua; Zhao, ChangHong; Xiong, Yan

Marked Loss of Sympathetic Nerve Fibers in Chronic Charcot Foot of Diabetic Origin Compared to Ankle Joint Osteoarthritis

The pathogenesis of Charcot foot is based on three disputed factors: (1) loss of neurotrophic influence, (2) microtraumatic lesions, and (3) neurovascular disturbances. However, no results of quantitative nerve density studies of sympathetic and sensory substance P-positive (SP+) nerve fibers are available.

This study analyzed the density of sympathetic and SP+ nerve fibers in three distinct areas of the tarsus in 15 patients with ankle osteoarthritis (OA) and 15 patients with diabetic Charcot foot. Findings pointed to the neurovascular theory in the late chronic phase of Charcot foot, which probably depends on the inflammatory upregulation of nerve repellent factors.

From the article of the same title
Journal of Orthopaedic Research (06/01/09) Vol. 27, No. 6, P. 736; Koeck, Franz-Xaver; Bobrik, Verena; Fassold, Alexander

Open Minimally Invasive Achilles Tendon Repair With Early Rehabilitation

There is no consensus among orthopedic surgeons regarding surgical technique and postoperative rehabilitation for the treatment of acute Achilles tendon rupture. This study evaluated the mid-term functional outcome results of 25 patients who had undergone open minimally invasive repair of fresh Achilles tendon ruptures followed by early rehabilitation based on early range of motion exercises. Results showed that the program provides satisfactory results with early return to previous functional status with low complication rates.

From the article of the same title
Injury (06/01/09) Vol. 40, No. 6, P. 669; Ozkaya, Ufuk; Parmaksizoglu, Atilla Sancar; Kabukcuoglu, Yavuz

Practice Management

Report Says Federal Government's Stimulus Funding Won't Cover EHR Costs

A PricewaterhouseCoopers Health Research Institute study found that stimulus funds apportioned for electronic health records (EHR) are not sufficient to fully cover the cost of implementation. Physician practices can receive up to $44,000 in federal payments between 2011 and 2015 to adopt EHRs. However, the report estimates that a three-doctor practice could pay as much as $296,000 for a complete EHR package. The government is offering a carrot and a stick to encourage EHR adoption: starting in 2017, the government will lower Medicare payments to physicians who have not implemented EHRs by one percent per year for as many as five years.

From the article of the same title
AAFP News Now (05/13/09) Porter, Sheri

Two Studies Assess Cost of Doc-office Paperwork

Two new studies posted on the Health Affairs Web site estimated how much medical practices must spend preparing and submitting health insurance claims. In one study, researchers calculated that the annual cost of performing billing-related tasks comes to $85,276 per physician. The authors observed that billing systems that ensure coding compliance can help reduce claims denials and result in more timely payment. In addition, standardization of benefit plans "appears to offer great potential" to lower costs.

From the article of the same title
Modern Healthcare (05/14/09) Robeznieks, Andis

Outsourcing Your Billing

Outsourcing to a billing company can help a busy physician practice reduce staffing needs and improve coding and billing compliance. When considering a billing company, physicians should ask:
  • how long the company has been in business,
  • how many certified coders are on staff,
  • how many medical practices in your specialty use the company,
  • what volume of claims the company processes, and
  • what are the technical capabilities of the company, including protocols for identifying coding errors and appealing incorrect claims payment.

From the article of the same title
Physicians Practice (05/09) Zupko, Karen

How to Set Your Fee Schedule: Experts Advise Updating It Every 3 to 12 Months

Practice management consultants urge doctors to develop a defensible fee schedule based on a careful analysis by CPT code of the cost of providing services. This protects a practice from agreeing to a discount, whether with a health insurer or self-pay patient, that is too deep to provide for any margin.

From the article of the same title
American Medical News (05/04/09) Berry, Emily

Health Policy and Reimbursement

Obama Plan May Give Doctors Leverage to Press for Liability Protection

The Obama administration's focus on reducing rising healthcare costs by cutting wasteful medical procedures could open the door to medical tort reform. "If we can have additional liability protection in the courtroom against not doing something that we feel doesn't need to be done, then we can achieve even more bending of the curve," says J. James Rohack, a Temple cardiologist who is president-elect of the American Medical Association.

In Texas, malpractice insurance premiums for doctors have dropped by more than 30 percent since 2003, when voters approved a law capping noneconomic damages in malpractice suits at $250,000. Rohack says caps could be part of a solution to rising costs, as could special health courts to deal with complex medical injury disputes. Any reform efforts should also grant doctors some protection if they can show they followed medical practice guidelines published by specialized medical societies.

From the article of the same title
Dallas Morning News (TX) (05/12/09) Michaels, Dave

Evidence Based Medicine Often Delayed

The average time for medical research to be practically applied is 17 years, according to Dr. Laura A. Petersen and Dr. Aanand D. Naik of the Baylor College of Medicine in Houston. The federal government is injecting $1.1 billion into comparative-effectiveness research, and the doctors argued that there ought to be investment in putting research into practice more expediently.

"We need to pay as much attention as to how the evidence is put into practice as to the evidence itself," says Petersen. "How do you get evidence into practice? ... We expect doctors and healthcare providers to know what is the right thing and then to put it into action. We know that is not happening."

From the article of the same title
United Press International (05/11/09)

Technology and Device Trends

Surgeon Breaks New Ground With Joint Grafts

Denise Mandi, DPM, section chief of foot and ankle surgery and chairman of the department of surgery at Broadlawns Medical Center in Des Moines, Iowa, in April used a new hyaline cartilage graft to give patients a better option for repairing damage to joints in what the doctor called a first for podiatrists. Hyaline cartilage occurs only in a joint and is more slippery and stronger than other types of cartilage. In the past, foot and ankle surgeons were not able to replace hyaline cartilage with hyaline cartilage, since as a general rule, hyaline cartilage in adults does not regenerate, making fibrocartilage, which is not as strong, the next best option. Mandi has used the procedure in two cases so far, both ankles, and hopes to start expanding to other joints in the foot.

From the article of the same title
Des Moines Register (IA) (05/13/09) Villanueva-Whitman, Estela

These Shoes Are Made for Talking ... to Your Phone

Scottsdale, Ariz.-based eSoles, a maker of custom insoles for athletic shoes, has developed prototype insoles with pressure sensors that relay data wirelessly to a user's cellphone, informing the wearer how much pressure he or she is applying in 11 different zones of each sole. The system has already been tested to analyze the technique of the U.S. Olympic BMX team, helping members figure out how to apply maximum power to the bicycle pedals out of the gate. Company founder Glen Hinshaw envisions medical uses for the insoles, including warning diabetes patients who have lost feeling in their feet that they risk injury from too much pressure.

From the article of the same title
Associated Press (05/13/09) Svensson, Peter

President's FY 2010 Budget for FDA Substantially Increases Investment in Medical Product Safety

The U.S. Food and Drug Administration (FDA) is requesting a budget of $3.2 billion as part of the President's budget for fiscal year 2010, a 19 percent increase over the current FDA fiscal year budget.

Of this funding, $166.4 million would be put towards the FDA's new Safer Medical Products initiative, which is designed to improve the safety of medical devices as well as other medical products for human and animal use.

According to the FDA, the initiative will allow the agency to strengthen the safety and security of the supply chain for medical products.

From "President's FY 2010 Budget for FDA Invests Substantially in Food and Medical Product Safety" (05/07/09)

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May 20, 2009