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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

Medicare Contractors to Hold Physician Fee Schedule Claims

No charm the third time around for physicians, as the House voted on Friday 245 to 171 to approve of a 19-month plan to stall the 21 percent reduction starting June 1, but the Senate will not be able to act until it returns from its Memorial Day recess on June 7. Under the "doc fix" approved by the House, physicians would see an increase in payment rates of 2.2 percent for the remainder of 2010 and a 1 percent increase in 2011. Rates would return to present law after 2011.

This is the third deadline missed by Congress this year; the others were March 1 and April 1. In previous years, Congress had voted to delay the cuts annually. Physician organizations have not reacted well to Congress’ inaction, and the American Academy of Family Physicians issued a statement regarding their perception of Congress' inability to make more permanent changes in the sustainable growth rate reimbursement formula.

The Centers for Medicare & Medicaid Services has instructed its contractors to hold claims containing services paid under the Medicare physician fee schedule for the first 10 business days of June. CMS says the 10-day hold should have little impact on provider cash flow because electronic claims are not paid until at least 14 calendar days after receipt.
Considering Cavus Foot

“Most patients with this condition do not necessarily require surgery,” says podcast moderator Robert W. Mendicino, DPM, FACFAS, “but when they do, it’s a major reconstruction. The educational process, and post-operative protection, are equally as important as the surgical skill.”

You can explore approaches to this complex topic with ACFAS’ latest free podcast. Listen in as fellow foot and ankle surgeons consider aspects of care for cavus foot, including assessment of severity, success of past corrections and treatment, prognoses, patient goals, and more.

Tune in whenever you are ready to hear the new podcast or browse the entire library at ACFAS e-Learning.
One-Click Research Reviews

Just one click on one link in this message will take you right to a research abstract you can read in less than a minute. Take them in between patients or during any downtime.

Human Amniotic Fluid Stem Cells Culture Onto Titanium Screws: A New
Perspective for Bone Engineering
, from the Journal of Biological Regulators & Homeostatic Agents.
Reviewed by Josh Rhodenizer, DPM, St. John Hospital.

Complications When Using Threaded K-wire Fixation for Displaced
Intra-articular Calcaneal Fractures
, from Injury.
Reviewed by Christopher Schmitt, DPM, St. John Hospital.

Return to Training and Playing After Posterior Ankle Arthroscopy for
Posterior Impingement in Elite Professional Soccer
, from the American Journal of Sports Medicine.
Reviewed by Alex Scholl, DPM, St. John Hospital.

Visit ACFAS’ Scientific Literature Reviews any time for a wealth of current research, abstracted especially for the interests of foot and ankle surgeons by podiatric residents.

Foot and Ankle Surgery

Anteromedial Impingement in the Ankle Joint: Outcomes Following Arthroscopy

Arthroscopic resection for anteromedial impingement of the ankle provides excellent functional outcomes and allows athletes an expedited return to sport at previous levels of competition, according to the results of a single-surgeon case series. Researchers reported the results of 41 patients undergoing arthroscopic resection for anteromedial impingement. Thirty-four patients were competing at some level of athletic sport. All patients were assessed pre- and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and SF-36v2 outcome scores. Thirty-eight patients reported being satisfied with the procedure, and 33 patients returned to their prior level of sporting activity. Average AOFAS scores improved from 62.83 points preoperatively to 91.17 points postoperatively. Average SF-36v2 scores improved from 61.54 points preoperatively to 92.21 points postoperatively.

From the article of the same title
American Journal of Sports Medicine (05/17/10) Murawski, Christopher D.; Kennedy, John G.

Practice Management

Experts Worry: Government Loans to Doctors Could Raise Health Costs

Federal records show that some 5,000 healthcare providers have secured over $2.5 billion in government-backed loans under the economic stimulus package. However, some experts are concerned that these loans could cause an elevation in health costs, hiking insurance premiums and costs to taxpayers of the immense Medicaid and Medicare programs for the indigent, disabled, and elderly. "We know that a lot of health-care resources are devoted to unnecessary and wasteful services," says Elliott Fisher, director of the Center for Health Policy Research at the Dartmouth Medical School. He helms the Dartmouth Atlas of Health Care, which has performed studies showing that regions with more hospitals, specialists, or diagnostic services tend to have higher per-capita health costs. Interviews with loan recipients indicate that many have used the loans to modernize or expand their services. Some healthcare providers took out the loans to help them contend with cutbacks in government reimbursements. For instance, Oklahoma radiologist Patrick Lester, who owns a chain of diagnostic imaging facilities, obtained a $2 million loan from the Small Business Administration. He says he is hoping the money will help maintain the solvency of one center that is struggling because of Medicare payment cuts.

From the article of the same title
Kaiser Health News (05/26/10) Galewitz, Phil

FTC Delays Red Flags Rule, Again

The Federal Trade Commission (FTC) has delayed enforcement of its red flags rule requiring banks and creditors to have written plans in place to prevent, identify, and mitigate identity theft. The delay pushes back compliance to Dec. 31 from June 1 while Congress considers legislation that would exempt physician, attorney and accounting offices with fewer than 20 employees from having to comply. A bill with such exemptions passed the House last October, and a similar measure was introduced in the Senate in May by John Thune (R-S.D.) and Mark Begich (D-Alaska). The FTC had classified healthcare practices as creditors because patients normally do not pay in full for healthcare services at the time they are delivered.

From the article of the same title
Modern Healthcare (05/28/10)

Using Web to Curb Waiting Room Times

A new Web-based tool seeks to reduce the time spent by patients in the waiting room before seeing their doctor. The application, called MedWaitTime, allows patients to check before their appointment whether their doctor is running late. Patients can access the site,, up to two hours ahead of their appointment. If the doctor is running late, patients can be instructed to arrive later than their scheduled appointment. They can also enter their cellphone number into the system for alerts through text messaging.

Launched with 10 Chicago-area doctors last week, the tool is the brainchild of Vishal Mehta, an orthopedic surgeon who felt guilty about routinely running behind and making his patients sit in the waiting room for up to an hour or more. "Patients will say they ran every yellow light on the way there [to the office], then they sat and waited," said Dr. Mehta. "Medicine is now a service industry and we have to keep our patients happy."

From the article of the same title
Wall Street Journal (05/25/10) Wang, Shirley S.
Web Link - May Require Paid Subscription | Return to Headlines

Health Policy and Reimbursement

Feds Ask Va. Health Reform Lawsuit Be Dismissed

The White House is asking a federal judge in Virginia to dismiss the state's lawsuit challenging the constitutionality of the new healthcare reform measure. Health and Human Services Secretary Kathleen Sebelius argued that Congress acted well within its authority and claims Virginia lacks jurisdiction to sue. State Attorney General Ken filed suit within hours after lawmakers passed the health reform bill in March, alleging that by requiring residents to buy health coverage or pay a fee, Congress exceeded its authority under the 10th Amendment. Sebelius said that the new law is well within the scope of the Commerce Clause of the Constitution.

From the article of the same title
Associated Press (05/24/10) Lewis, Bob

Govt Warns Health Insurance Industry on Mergers

In a blunt warning to the health insurance industry, the White House said it will not hesitate to block mergers that threaten to stifle competition. Justice Department antitrust chief Christine Varney told a joint meeting of the American Bar Association and the American Health Lawyers Association that strict enforcement of anti-monopoly laws is vital to the success of the new healthcare law, particularly in efforts to control rising premiums. The antitrust division "is committed to vigorously, but responsibly, scrutinizing mergers in the healthcare industry that appear to present a competitive concern," said Varney. "If we determine that our initial concerns were well-founded, we will not hesitate to block the merger or to require the settlement concessions necessary to protect consumers."

From the article of the same title
Associated Press (05/25/10) Alonso-Zaldivar, Ricardo

Out-of-Pocket Costs Put Arthritis Drugs Out of Reach for Some

People with rheumatoid arthritis whose health insurance requires them to pay a higher share of the cost are less likely to use effective but expensive biotech drugs than those with coverage that is more generous, according to a new study in Health Services Research. The researchers analyzed health insurance data for 35 large private employers during 2000 to 2005 to determine which of 8,557 patients newly diagnosed with rheumatoid arthritis began to use the three most commonly prescribed biotech drugs—etanercept, adalimumab, and infliximab—and which of the 2,066 patients who used these drugs then stayed on them. They found that patients who paid more for these drugs were less likely to start taking them and were less likely to continue taking them once started.

From the article of the same title
Newswise (05/21/10)

Technology and Device Trends

Correlation of Fetal MRI With US Effective in Evaluating Clubfoot

Researchers sought to correlate fetal MRI with ultrasound (US) in the assessment of clubfoot and to identify the MRI features most characteristic of clubfoot. The presence of fetal clubfoot was prospectively evaluated in mothers referred for MRI for a fetus with myelomeningocele. Two radiologists blind to the US results independently reviewed the MRI for the presence of clubfoot. MRI results were compared with US results obtained the same day and birth outcomes. The results showed that of 20 patients enrolled, there were 13 fetuses with clubfoot. Interobserver agreement for the presence of clubfoot was 100 percent. The sensitivity of the MRI exam was 100 percent, and the specificity 85.2 percent. A dedicated sagittal imaging plane through the ankle region allowed the most confident diagnosis. Medial deviation of the foot relative to the leg was seen in all 13 fetuses with clubfoot.

From "Fetal MRI of Clubfoot Associated With Myelomeningocele"
Pediatric Radiology (05/19/2010) Servaes, Sabah; Hernandez, Andrea; Gonzalez, Leonardo; et al.

High-Strain Tendons Repair Less Frequently

Researchers have found that tendons in high-stress and strain areas, like the Achilles tendon, actually repair themselves less frequently than low-stress tendons. The researchers examined protein turnover in the tendons of horses of various ages and found that the high-strain superficial digital flexor tendon repairs much less frequently than the low-strain common digital extensor tendon. The researchers used an approach called amino acid racemization to measure protein age in the horse tendons. As to why the body would seemingly put its more important tendons at greater risk, the researchers suggest that it may be a trade off—too much repair may compromise the strength and stiffness of tendons that are used heavily, so the body tries to preserve their structural integrity at the expense of increased injury risk later in life. The study is published in the May 21 issue of the Journal of Biological Chemistry.

From the article of the same title
ScienceDaily (05/27/10)

New Smart Pill to Track Adherence

A new "smart pill" has been developed by researchers at the University of Florida to allows doctors to better monitor whether patients are taking their prescribed medications. The standard-size pill capsule includes a microchip and digestible antenna that transmits information once swallowed. Once the pill is swallowed, the microchip uses the antenna to send a message to an electronic device carried by the patient, which relays the signal to a cell phone or laptop to inform physicians or family members that the patient has taken the medication. The University of Florida has created a company that aims to bring the new capsule to the market.

From the article of the same title
E-Health Insider (05/17/10)

Nanotech Breath Sensor Can Tell If Someone Has Diabetes or Not

Swiss researchers have developed a nanotechnology-based sensor that may be able to detect type 1 diabetes by analyzing a patient's breath. The sensor could have future use in emergency rooms, for example, to determine if a patient has developed the potentially dangerous condition of diabetic ketoacidosis. Although everyone has some acetone in their breath, patients with type 1 diabetes release unusually high levels of acetone when they exhale, and even more in the case of diabetic ketoacidosis. The researchers, who report their findings in Analytical Chemistry, constructed a sensitive acetone detector by directly depositing a thin film of semiconducting, mixed ceramic nanoparticles between a set of gold electrodes. When struck by a puff of acetone-filled air, the device acts like an electrical resistor and experiences a drop in resistance, allowing more electricity to pass between the electrodes. Thus, the resistance will drop if a person with type 1 diabetes breathes on the sensor, but the breath of a healthy person will not strongly affect it. The new sensor can detect acetone in extremely moist air, at 20 parts per billion.

From the article of the same title
DNA (India) (05/21/10)

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June 2, 2010