May 22, 2013

News From ACFAS

ACFAS Update Arrives in Your Mailbox Soon
Watch your mailbox for the May/June issue of ACFAS Update, which includes the latest details on the 2014 Annual Scientific Conference in Orlando, a story on a HIPAA violator that may be lurking in your office, information on how to apply for the 2014 Clinical and Scientific Research Grant, and the latest President’s Perspective article “104 Left Without a Job,” by ACFAS President Jordan Grossman, DPM, FACFAS, which expresses concern and insight to the residency shortage crisis and what can be done in order to find a plausible solution.
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Your Credit Union Offers Small-Business Loans
HealthCare Associates Credit Union (HACU), an ACFAS Benefits Partner, is able and eager to make loans to practices (small businesses) within their field of membership. Since the Recession, though, regulators have required specific verification and documentation from business owners. HACU recommends these tips to help your practice demonstrate its strength and expertise:
  • Start with an updated business plan and financial statements.
  • Outline how you’ll use the loan.
  • Highlight your ability and willingness to repay the loan.
If you’re able to illustrate that you know your business, that the loan will further growth, and that you’ll be able to repay, you’re likely to qualify for a small-business loan. Contact Norma Cantrell at HealthCare Associates Credit Union today at 630-276-5730 for all your small-business needs.
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New Podcast: Patient Oriented Research
You’ve read the Scientific Literature Reviews, the Journal of Foot and Ankle Surgery and other journals, and you may have even written your own research articles, but are you positive you’re looking for all the right information when reading or writing these articles? Listen to the latest ACFAS e-Learning Podcast, Patient Oriented Research, moderated by D. Scot Malay, DPM, FACFAS, and gain insight for making the most of the research that helps define your profession.

Some questions posed in this podcast are:
  • How does a clinician formulate a clinical research question?
  • What is the importance of relationships and collaboration among peers?
  • Why should there be a stronger need for prospective planning in addition to finishing up with retrospective review? Can you recognize the difference in retro- vs. prospective research and how they may influence the data and one’s interpretation of it?
  • How do you define evidence-based medicine?
  • Clinical significance, statistical significance, inferential significance and power (P-value) – how are these distinguished and what is the importance of knowing the differences between these for the reader?
The panelists also emphasize the need for simplifying research terminology so all those who conduct the research and all those who read and study the research are on the same page, they stress the need for clinicians to recognize self-bias, as well as the bias that can be found in other clinicians’ research. To listen to the full podcast (40 minutes), visit and click play.
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Foot and Ankle Surgery

Lowering the Pivot Point of Sural Neurofasciocutaneous Flaps to Reconstruct Deep Electrical Burn Wounds in the Distal Foot
A study was performed where the researchers used sural neurofasciocutaneous flaps with a lowered pivot point for reconstructing distal foot wounds caused by electrical burns. An ultrasound flow detector and Doppler flow imaging were utilized to detect the diameter, the perforating point and the blood flow of the lateral retromalleolar perforator. The study included 12 patients with a perforator diameter greater than 0.6 mm and a peak systolic flow more than 0.15 m/s. The pivot point of sural neurofasciocutaneous flaps was reduced to zero to three centimeters above the tip of the lateral malleolus and the size of the flaps ranged from six centimeters by 5 centimeters to 12 cm × 18 cm. Eleven of the 12 flaps survived completely, while one flap developed necrosis about one centimeter at the far point but was managed successfully via daily dressing. The researchers showed that lowering the pivot point of sural neurofasciocutaneous flaps is feasible for reconstruction of distal foot injury with the benefits of reliable blood supply and easy operation.

From the article of the same title
Burns (06/01/13) Vol. 39, No. 4, P. 808 Li, Yong; Xu, Jin; Zhang, Xiang-zhou
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Outcome of Ischemic Foot Ulcer in Diabetic Patients Who Had No Invasive Vascular Intervention
A study was held to identify factors associated with ulcer healing in diabetic patients with severe peripheral arterial disease who were unavailable for revascularization. The study included 602 diabetic patients with a foot ulcer, half of which healed either primarily or with a minor amputation. Seventeen percent of patients healed after major amputation and one third died without healing. Regression analysis showed that rest pain, impaired renal function, ischemic heart disease, cerebral vascular disease, extent of tissue destruction and ankle pressure greater than 50 mmHg impacted the outcome of the ulcers.

From the article of the same title
European Journal of Vascular and Endovascular Surgery (05/03/13) Elgzyri, T.; Larsson, J.; Thorne, J.; et al.
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Practice Management

Access to EHR Notes Lauded by Patients, Providers
OpenNotes, a trial electronic health records system used for 12 months at several medical centers, was so widely praised that patients were given access to the notes after the trial. In the 2010 trial, 105 primary care physicians used the system to give about 20,000 patients access to the clinical notes stored electronically; the patients were emailed when the notes were ready. Physician concerns of increased workflow and negative effects on their patients failed to materialize.

From the article of the same title
HealthLeaders Media (05/14/13) Mace, Scott
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Many Medical Practices Not ADA Accessible Despite Incentives
Many physician practices are not actually accessible for disabled patients, more than 20 years after the signing of the Americans with Disabilities Act (ADA). A recent survey reported in the Annals of Internal Medicine found that 22 percent of medical and surgical subspecialty practices said they could not accommodate patients in wheelchairs, mostly because they could not transfer them to an exam table. The study's lead author says a lack of awareness, liability issues, and time and cost concerns appear to be the chief reasons some medical practices are out of compliance with the ADA. Experts say practices must be fully accessible to people in wheelchairs to avoid fines from the U.S. Justice Department.

Meanwhile, consultants say mandating that the office fulfill ADA requirements could be a long-term money-saving measure. Physicians have to account for the additional time it takes to handle disabled patients in a nonaccessible setting, especially if that results in delays in seeing other patients or scheduling longer appointments for patients with mobility impairment. Although the cost of equipment such as adjustable-height exam tables is often cited as a reason practices do not provide full accessibility to disabled patients, the elimination of architectural and transportation barriers can qualify practices for a tax credit equal to 50 percent of the eligible access expenditures in a year, up to $5,000 a year, and a maximum tax deduction of $15,000 annually.

University of Texas Health Science Center Professor Lex Frieden says practices concerned about liability and workers’ compensation can employ a mechanical lift to transfer the patient to the exam table, which is a relatively inexpensive option. He also says small practices should creatively accommodate patients in wheelchairs, such as entering into a cooperative pact with large clinics or university clinics so their patients can access more expensive testing equipment and imaging devices. Sharing equipment with other small practices is another option.

From the article of the same title
American Medical News (05/13/13) Caffarini, Karen
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New HIPAA Rules: Make Sure You Are in Compliance Because Your Liability Has Increased
Healthcare providers have a Sept. 23 deadline to implement internal policies and procedures for complying with significant revisions to the Health Insurance Portability and Accountability Act (HIPAA). The new HIPAA rules carry penalties ranging from $100 to $1.5 million depending on the violation. For primary care and other physicians in private practice, compliance entails conducting and documenting a risk analysis, defined by the U.S. Department of Health and Human Services as “an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity and availability” of electronic protected health information (PHI) in your practice.

Compliance also will mean reviewing the practice’s policies and procedures for when PHI is lost or stolen or otherwise improperly disclosed, and ensuring your staff members are trained in them; guaranteeing that the electronic PHI your practice holds is encrypted so that it cannot be accessed if it is lost or stolen; modifying the practice’s electronic health record system so that you can flag data a patient does not want shared with an insurance company; being able to send patients their health information in an electronic format; reviewing your contracts with any vendors with access to your practice’s PHI; and updating your practice’s notice of privacy practices.

Additional provisions of the new HIPAA omnibus rule include restrictions on selling PHI or using it for marketing and fundraising purposes without acquiring the patient’s consent and easing some of the restrictions on sharing PHI with family members or other caregivers of deceased patients. However, disclosure is only allowed to the extent that the PHI is pertinent to the role the family member or caregiver played in the decedent’s treatment. Furthermore, release is disallowed in cases in which the individual expressly stated before death that he or she did not want the PHI disclosed.

In addition, the omnibus rule lets physicians in states with compulsory vaccination laws to release a child’s immunization records to schools without obtaining the parents' formal authorization. Physicians now can do so with only a verbal agreement, as long as they document that they received permission. Finally, the rule bans health plans from using or disclosing genetic information for insurance underwriting purposes.

From the article of the same title
Medical Economics (05/10/13) Bendix, Jeffrey
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Health Policy and Reimbursement

CBO Projects Less Growth in Healthcare Spending
Congressional Budget Office (CBO) analysts have sharply lowered their projections for the next decade's outlays on Medicare, Medicaid and covering the uninsured under the healthcare reform law, citing the society-wide slowdown in healthcare spending. The changes helped lower the CBO's overall projections for the government deficit by $618 billion through 2023 compared with estimates offered just three months ago.

From the article of the same title
Modern Healthcare (05/15/13)
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Doc Pay Reform Remains a "Top Priority"
Physician advocates see signs of progress in the Senate Finance Committee's recent hearing, its first in six years on replacing Medicare's physician payment system. Sen. Max Baucus (D-Mont.) last convened a hearing to replace Medicare's sustainable growth-rate formula on March 1, 2007. That hearing was followed by the contentious battle over the passage of the Patient Protection and Affordable Care Act, but the Senate panel again started ramping up its focus on the issue last year with a series of roundtables featuring physician advocates, former CMS administrators and policy experts. The discussions were followed by a May 10 letter from Baucus and Sen. Orrin Hatch (R-Utah), ranking member of the Finance Committee, to physician advocates seeking suggestions on a replacement Medicare payment system. “This year, physician payment reform and SGR repeal remain a top priority for the committee,” the senators wrote. “Both of us are committed to seeking a permanent solution that will address the SGR and Medicare physician payment reform.”

From the article of the same title
Modern Healthcare (05/13/13) Daly, Rich
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HHS Launches $1B Healthcare Innovation Effort
The U.S. Department of Health and Human Services has announced a new initiative to bring down healthcare costs and improve care delivery through $1 billion in grants and evaluations. The second round of Healthcare Innovation Awards will target new areas for improvement, including care for special needs populations. The awards are also meant to reduce costs for Medicare and Medicaid patients in outpatient hospital settings, test new care and financial models for specific provider groups and ensure care delivery accounts for preventive and population health. Federal health officials emphasized that the grants will help spur innovation in both the public and private sectors.

From the article of the same title
The Hill (05/15/13) Viebeck, Elise
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House Vote on HR. 45 to Fully Repeal Affordable Care Act
The House of Representatives recently voted 2290195 to pass the Patients' Rights Repeal Act (H.R. 45) which would repeal the Affordable Care Act. The House has approved legislation to partially or fully repeal the healthcare reform law a total of 37 times, and like with the other efforts the most recent bill is unlikely to advance in the Senate.

From the article of the same title
BNA Snapshot (05/01/2013) Weixel, Nathaniel
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Senate Confirms Tavenner as Medicare/Medicaid Chief
The U.S. Senate has confirmed Marilyn Tavenner, a former nurse and hospital company executive, as the first full-fledged administrator for the Centers for Medicare and Medicaid Services (CMS) since 2006. Tavenner has served as acting CMS administrator since late 2010. Her formal elevation comes at a time of mounting pressure on CMS as it acts to implement Obama's Patient Protection and Affordable Care Act by January 1. Medicare and Medicaid are also on the firing line for potential deficit reduction.

From the article of the same title
Reuters (05/15/13) Morgan, David
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Medicine, Drugs and Devices

17ß-Estradiol Positively Modulates Growth Hormone Signaling Through the Reduction of SOCS2 Negative Feedback in Human Osteoblasts
Researchers examined the effects of 17ß-estradiol (E2) on GH signaling pathways in primary culture of human osteoblasts (hOBs). They exposed hOBs to E2 for an hour before administering growth hormone (GH), and found that doing so significantly increased phosphorylated STAT5 and brought about larger increases in osteopontin, bone-sialoprotein and IGF II mRNA expression than GH alone. The study also found that using E2 to silence the suppressor of cytokine signaling-2 (SOCS2) gene prevented E2 positive effect on GH induced P-STAT5 and on GH induced bone-sialoprotein and osteopontin mRNA expression. These and other findings led researchers to conclude that E2 can improve GH intracellular signaling in hOBs, and that it plays an important role in reducing the SOCS2 mediated feedback loop.

From the article of the same title
The Bone Journal (07/01/2013) Vol. 55, No. 1, P. 84 Bolamperti, Simona; Mrak, Emanuela ; Moro, GianLuigi; et al.
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U.S. Approves a Drug to Treat Childhood Arthritis
Novartis' juvenile arthritis drug Ilaris has been approved by the Food and Drug Administration. The injectable drug, which is administered subcutaneously on a monthly basis, is intended to treat a serious form of childhood arthritis by inhibiting the production of interleukin-1 beta. The FDA's decision means that Ilaris is the only approved treatment for this severe form of juvenile arthritis that is given as a monthly subcutaneous injection.

From "U.S. Approves Novartis Drug Ilaris to Treat Childhood Arthritis"
Reuters (05/10/13)
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