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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

Don’t Forget! Survey Deadlines are June 8

Last week ACFAS members received an e-mail link to either the Member Success and Challenges Survey or the Practice Economics and Insights Survey. Your participation is important: Data obtained from these surveys will make ACFAS better equipped to serve you and your practice in the future.

Four new iPhones (or similar equipment) will be raffled off to participants, so don’t delay…responses must be received by Monday, June 8. Questions? Contact ACFAS Membership Director Michelle Brozell at or 773-693-9300 x1312.

"Red Flags" Rule: FTC Tips for Health Care Providers

As promised, the FTC has provided additional information to health care providers to help them comply with the “Red Flags” rule that goes into effect August 1, 2009.

You can read the FTC article on the ACFAS Web site at the web link below.

ACFAS Weighs In on LCD for Debridement Services

ACFAS recently weighed in on a draft Medicare Administrator Contractor (MAC) -Part B Local Coverage Determination (LCD) on debridement services. The draft LCD was issued by First Coast Service Options (FCSO), the MAC for Florida, Puerto Rico and the Virgin Islands. In a letter to FCSO, ACFAS President Mary Crawford, DPM, expressed concerns that the LCD includes unnecessary documentation requirements and several incorrect or overly-broad clinical statements. For a copy of the letter, contact Health Policy Manager Adriann Gerardi at
Podcasts: Expand Your Orbit

Starting this month, a new series of ACFAS e-Learning podcasts will be rolled out, with a mix of dialogues on a variety of topics: clinical, practice management and research.

The June podcast, “Open Fracture Management” is a controversial topic. These are not elective surgeries; physicians are responding to an emergency, and in some cases a "dirty" wound.

Moderator Mark Hardy, DPM asks tough questions, and Drs. Jordan Grossman, Graham Hamilton and George Gumann are colleagues with singular approaches to dealing with an open fracture. Use the Web link below to access this interesting discussion on infection and the variety of treatment options these experts would use.

Foot and Ankle Surgery

Chronic Venous Insufficiency and Varicose Veins

Researchers developed a protocol for evaluating and treating the case of a 52-year-old woman who presented with an ulcer measuring 5 centimeters in diameter on her ankle that has persisted for a year. The patient has no history of diabetes or smoking. Diagnosing the patient as suffering from advanced chronic venous disease, the researchers conclude that duplex ultrasonographic examination can clarify whether the pathologic process is confined to the superficial system or reflects a multisystem disease. They recommend intensive compression to heal the ulcer, the administration of pentoxifylline, and use of high-pressure socks for the long-term. Ablation of the saphenous vein should also be considered to reduce the risk of recurrence.

From the article of the same title
New England Journal of Medicine (05/28/09) Vol. 360, No. 22, P. 2319; Raju, Seshadri; Neglen, Peter

Study: Stockings for Stroke Patients Don't Work

A study of more than 2,500 stroke patients has found that special stockings commonly given to stroke patients to prevent blood clots do not work. In the study, about half of the patients got standard care in addition to the stockings, while the other half just got standard care. About 10 percent of patients in both groups developed blood clots. Additionally, approximately 5 percent of the group wearing stockings reported side effects like skin problems and blisters, compared to 1 percent in the group not given the stockings. The study was published in the Lancet medical journal and presented at the recent European Stroke Conference in Stockholm.

From the article of the same title
Associated Press (05/27/09) Cheng, Maria

High Blood Fats Tied to [Diabetes-Related] Nerve Loss

Patients with elevated levels of triglyceride fats are at greater risk of developing neuropathy, which affects about 60 percent of the 23 million people who have diabetes in the United States. A study of 427 patients with diabetes and neuropathy showed that those patients with elevated levels of triglycerides were significantly more likely to see their nerve fiber loss worsen within one year. Based on their findings, the researchers suggest that doctors of patients with diabetes need to monitor blood fat levels as well as blood sugar, as elevated serum triglyceride levels were more accurate than other measures at predicting neuropathy. The study was published online and will be in the July print issue of the journal Diabetes.

From the article of the same title
HealthDay (05/21/09)

Practice Management

Insurers Ranked on Payment Records

Watertown, Mass.-based Athenahealth, a company that helps doctors handle billing and records electronically, has released The 2009 PayerView Rankings in collaboration with the Physicians Practice management journal. The rankings—which evaluated 172 national, regional, and government payers of health claims in 40 states—showed that insurers paid physicians an average 5.3 percent faster and denied an average of 9 percent fewer medical claims in 2008 than in 2007. It also showed that national health insurers took an average of 33 days to pay physicians and denied an average of 7.1 percent of claims.

From the article of the same title
Boston Globe (05/28/09) Weisman, Robert

Doctor Pushes Back Against Insurer Scrutiny

Bradley Carpentier, a physician in Monterey, California, who specializes in pain management, has formed a political action committee—Stop Practicing Medicine—to target the practice of insurers hiring doctors to review their peers' decisions, even though the insurer-hired doctors had never seen or talked to the patient whose care they are reviewing. The practice can lead to delayed or denied claims.

A recent survey of 389 California doctors conducted by a Seattle research firm for the California Medical Association found 84 percent felt pressured to change the way they treat a patient because of a restriction from an insurance company. Eighty-six percent admitted selecting a treatment they might not otherwise have chosen because of the pressure.

From the article of the same title
San Francisco Chronicle (05/25/09) P. B1; Colliver, Victoria

Health Policy and Reimbursement

Healthcare Groups Urge Replacement of SGR

As President Obama ramps up his health reform campaign, physicians are working to make sure that fixing the flawed Medicare payment system is not put on the back burner. Under the “sustainable growth rate” formula, which is based on growth of the economy relative to services provided, physicians continue to face the possibility of annual decreases in Medicare payments. Each year Congress enacts a temporary last-minute “fix.” In 2010, physicians stand to see decreases a high as 21 percent without a fix. Sixty medical organizations, led by the AMA and Medical Group Management Association, send a joint recommendation to Congress, the White House and MedPAC asking that the SGR be replaced by a new payment system. If SGR cannot be repealed this year, the groups have asked for a five-year transitional approach that would link payment to the Medicare Economic Index.

From the article of the same title
Modern Healthcare (05/29/09) Lubell, Jennifer

Massachusetts, Model for Universal Health Care, Sees Ups and Downs in Policy

Massachusetts continued to see an increase in the share of residents who reported having a steady source of health care last year, the state's second year of near-universal coverage, a new study has found. However, the study also found that after seeing initial gains in affordability, a growing number of residents reported that they could not afford needed treatments, and many reported a shortage of primary care physicians in the state.

From the article of the same title
New York Times (05/28/09) P. A19

Study Says Uninsured Are Costly for All

A new report released by advocacy group Families USA shows that the average U.S. family with health insurance pays an extra $1,000 a year in premiums to pay for healthcare for the uninsured. The average individual with private coverage pays an extra $370 a year because of the cost-shifting, which occurs when someone without medical insurance gets care and then does not pay.

From the article of the same title
Associated Press (05/28/09) Werner, Erica

Technology and Device Trends

FDA OKs New Total Ankle Replacement System

The U.S. Food and Drug Administration (FDA) has approved a total ankle replacement system for arthritic or deformed ankles that may preserve some range of motion. The Scandinavian Total Ankle Replacement System is a mobile-bearing device, which relies on bearings that move across a surface of polyethylene. The system is an alternative to fusion surgery and may allow for greater rotation and movement in the joint, according to the FDA.

From the article of the same title
United Press International (05/27/09)

New Rules on Stem Cells Threaten Current Research

Researchers are concerned that strict new ethics criteria that the National Institutes of Health (NIH) has proposed for human embryonic stem cell research could stand in the way of what many believe is one of the most promising fields of medical research. Advocates of stem cell research say that most of the work currently underway passes close ethical scrutiny but that the procedures varied and usually did not match the details specified in the guidelines proposed by NIH.

From the article of the same title
Washington Post (05/25/09) Stein, Rob

New Hope for MS Patients

A new device can alleviate a common symptom associated with multiple sclerosis, foot drop. The device, about the size of an iPod, is strapped on and instantly sends a signal to the leg, telling the foot to lower or raise.

From the article of the same title
ABC13 (Houston) (05/27/09) Lawson, Melanie

Revealing the Secrets of Human Gait

Yifang Fan and colleagues from Jinan University in China have discovered an independent measure of gait, which they call the vertical gait reaction force, that measures the amount by which a person's center of gravity raises during two complete steps. The force is symmetrical with regard to left and right foot, a finding the researchers attribute to the principle of least action (meaning the body does no more than it has to in the process of walking) in a healthy gait. In adults suffering from an ankle injury or arthritis, the pattern of force is not symmetrical. Thus, measurement of the force can allow for a quick diagnosis and could point to the type of rehabilitation that may be needed to treat the condition.

From the article of the same title
MIT Technology Review (05/25/09)

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June 3, 2009