June 4, 2014

News From ACFAS

Got Manuscripts?
If you are involved in research you feel would be beneficial to the profession, ACFAS invites you to submit your manuscript for presentation consideration at the 2015 Annual Scientific Conference in Phoenix.

All manuscripts are due by August 15, 2014 and must be in scientific format. Winners of the ACFAS Manuscript Awards of Excellence divide $10,000 in prize money from a generous grant donated by the Podiatry Foundation of Pittsburgh. For complete instructions or to submit a manuscript, please visit
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Have You Listened to ACFAS Lately?
ACFAS offers exceptional educational content in many forms, including podcasts. Members and non-members alike can listen to indepth conversations with various viewpoints and diverse approaches to a very specific aspect of foot and ankle surgery, best-practices for treatment, and debates on the hottest topics—all conveniently available for download or to listen on demand on your iPad/iPhone or computer—24-7.

Updated monthly, the podcast library is available online at Check out the full library and the last few months’ topics, which include:
  • Diabetic Wound Care
  • Melanoma
  • Surgical Risk Factors
  • Management of Non-Unions
You can also find many other ACFAS educational opportunities, both online and in person, at
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Foot and Ankle Surgery

Lateral Ankle Ligament Reconstruction Using the Anterior Half of the Peroneus Longus Tendon
A group of orthopaedic surgeons in South Korea has found that chronic lateral instability patients who have attenuated or deficient ligamentous tissue can be successfully treated with lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon. The 34 patients who participated in the study were evaluated before the operation and again at a median of 21 months post-operatively. Surgeons observed significant improvements in the Karlsson–Peterson ankle score, which rose from 58.2 +/- 10.9 points before surgery to 83.9 +/- 7.0 points at final follow up. Mechanical stability was also achieved in patients who were treated with the novel procedure, the study found. The average talar tilt angle improved from 15.7 degrees +/- 3.5 degrees pre-operatively to 4.6 degrees +/- 1.7 degrees at the last follow up--an improvement that was seen as being significant. Average talar translation improved significantly as well, going from 7.3 +/- 2.6 mm before surgery to 4.1 +/- 1.7 mm at final follow up. Finally, the majority of patients reported being satisfied or very satisfied with the results of the procedure.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (05/01/14) Kim, Hyong Nyun; Jeon, June Young; Dong, Quanyu; et al.
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Neuropathy and Poorly Controlled Diabetes Increase the Rate of Surgical Site Infection After Foot and Ankle Surgery
Diabetics with at least one complication from the disease and non-diabetics with neuropathy are at a higher risk for surgical site infection following foot and ankle surgery. The study of 2,060 patients, including diabetics with and without complications and non-diabetics with and without neuropathy, found that diabetics who suffered from complications were at a higher risk of surgical site infection by a factor of 3.72 compared to diabetics without complications. The risk of surgical site infection was higher in patients with complicated diabetes by a factor of 7.25 compared to non-diabetics without neuropathy, the study found. In addition, non-diabetics with neuropathy had a risk of surgical site infection that was higher by a factor of 4.72 compared to non-diabetics without neuropathy. Poor long-term glycemic control was also found to be associated with an increased risk of surgical site infection.

From the article of the same title
Journal of Bone and Joint Surgery (American) (05/21/14) Vol. 96, No. 10, P. 832 Wukich, Dane K.; Crim, Brandon E.; Frykberg, Robert G.; et al.
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Practice Management

Five Ways Doctors Can Better Prepare for, Survive Malpractice Lawsuits
The process of preparing for a medical malpractice suit begins when a doctors' practice chooses a malpractice insurer, writes Jeffrey D. Brunken, the president and chairman of the insurance provider The MGIS Companies. Brunken notes that practices should be sure to select an experienced malpractice insurer that will provide them with a representative who can answer all their questions and help them understand what will happen from the time a suit is filed until a ruling is handed down. Practices should also be sure to ask malpractice insurers which law firms they use to defend their clients from malpractice cases before they sign up for coverage, Brunken says, since it is important that these firms be experienced and reputable. The lawyer who is appointed to handle the case should also have experience with malpractice claims, Brunken says. Brunken adds that practices should work with their insurers to prevent possible malpractice claims by informing them about problems that could be an indication that a suit is imminent, including patients who have expressed dissatisfaction. A practice's front-office staffers are instrumental in helping doctors remain aware of potential problems that could serve as warning signs for a malpractice suit, Brunken says. Finally, Brunken notes that practices are sued should try to learn from the experience and take steps to prevent additional suits, including implementing risk management tools with the help of their insurer.

From the article of the same title
Physicians Practice (05/25/14) Brunken, Jeffrey D.
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Four Considerations for Practices Attempting to Recruit New Physicians
It is important for doctors' practices to hire physicians who will fit in with the practice's culture instead of hiring someone who does not fit in simply to fill an open position, writes Nick Weeks, a managing partner at the healthcare consultancy Creative Healthcare Solutions (CHS). Weeks notes that the process of hiring the right candidate begins with doctors and their staff members working together to develop a clear understanding of what the practice's culture is like. These discussions should focus on the aspects of the practice's culture that are positive as well as those that are negative, so that any issues can be dealt with. Having a clear understanding of what the practice's culture is like is important, Weeks says, so that the hiring manager can identify candidates who are likely to value such a culture. Weeks adds that practices should be sure not to compromise and hire someone who does not fit in with their culture in order to relieve any pressure caused by a staffing shortage, since physicians who are a poor fit with the practice's culture may become angry and take it out on patients and other staff members. Avoiding hiring the wrong physician also saves the practice the time, money, and effort involved in having to conduct another search. However, new practices may need to take a risk on a physician who may not be a perfect fit, Weeks says, since their cultures have yet to fully develop.

From the article of the same title
Physicians Practice (05/27/14) Weeks, Nick
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Tips for How Physicians Can Make Smart Insurance Decisions
Physicians should seek out advice from a financial planner when purchasing insurance, as having a poorly-fitting policy can cost an excessive amount of money or lead to serious consequences in the event of a disaster or other crisis, writes financial planner Steven Podnos. Financial planners can help physicians find a trusted agent to sell them property and casualty insurance and other types of coverage, Podnos says. Having a good agent, Podnos says, can help physicians obtain a policy that provides the best coverage at the best cost. However, Podnos says that doctors should be aware that some agents sell policies offered by just one insurance company and may not be able to offer a competing policy that might be better. As a result, physicians may want to work with agents who can offer them policies from several different carriers, Podnos says. Podnos adds that once an agent is selected and a policy is purchased, physicians should ask their agent to rebid their policies to different companies every couple of years. Doing so can result in significant cost savings, Podnos notes. Finally, Podnos says that physicians should choose property and casualty insurance companies that are capable of paying claims in the event their practices are impacted by a natural disaster.

From the article of the same title
Physicians Practice (05/26/14) Podnos, Steven
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Health Policy and Reimbursement

CMS Delays July End-to-End ICD-10 Testing to 2015
The end-to-end ICD-10 testing that was scheduled to be held from July 21 to July 25 has been pushed back by the Centers for Medicare and Medicaid Services (CMS) until sometime next year. A select group of providers, as well as Medicare Administrative Contractors and the Common Electronic Data Interchange (CEDI) contractor, had been scheduled to participate in the test. The delay is likely to come as a disappointment to the American Medical Association and other physicians' groups that have long been calling for end-to-end testing so that providers can identify any operational issues and correct them to avoid disruptions in cash flow when ICD-10 goes live on Oct. 1, 2015.

From the article of the same title
Medical Economics (05/23/14) Marbury, Donna
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Court Deals Setback to Hospital 340B Drug Discounts
A federal court judge in Washington, D.C., on May 23 ruled in favor of several drug companies that filed a lawsuit that sought to limit the use of the 340B drug discount program, saying that participating rural and cancer hospitals are not eligible for discounts on orphan drugs that are used off-label. A rule released by the Department of Health and Human Services, which administers the program, said that providers did not have to pay the full price of orphan drugs when they were used off-label for conditions that are more common than the ones they are intended to treat. The ruling means that drugmakers could stop offering discounts for orphan drugs to the affected hospitals. If that comes to pass, it could create a major financial burden for these facilities and their patients, says the Safety Net Hospitals for Pharmaceutical Access (SNHPA). The ruling comes ahead of the release of new rules from the federal government that could also impose new limitations on the 340B program. A pharmaceutical industry group is asking federal officials to force participants to use the discounts for the benefit of only low-income and uninsured patients, though participating hospitals say that the savings allow them to provide better care to all patients.

From the article of the same title
Modern Healthcare (05/24/14)
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Hospitals Sue HHS Over Sluggish RAC Appeals
The American Hospital Association (AHA) joined three hospital-care providers in filing suit against the Department of Health and Human Services (HHS) to force it to shorten the amount of time it takes to appeal rejected Medicare claims. The federal suit calls for HHS to rule on Medicare payment appeals within 90 days as required by law, rather than the 16 months it currently takes on average. AHA Assistant General Counsel Lawrence Hughes says that the delays in the appeals process are creating substantial financial hardships for hospitals. The appeals process is taking longer to resolve because there have been a growing number of appeals following the implementation of the recovery audit contractor (RAC) post-payment review program. Nearly 36,000 Medicare payment appeals were made before the program began in 2009, a number which rose to 384,651 by 2011.

From the article of the same title
Modern Healthcare (05/23/14) Carlson, Joe
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Medicare Improperly Paid $7B for Incorrectly Coded Evaluation and Management Services
Improperly coded and insufficiently documented evaluation and management (E/M) services claims were a significant problem in 2010 that cost Medicare billions of dollars, a new report from the Department of Health and Human Services (HHS) has found. The report noted that 61 percent of the E/M services claims filed in 2010 were either improperly coded or were not submitted with adequate supporting documentation, though Medicare paid these claims to the tune of $6.7 billion. Most of the improperly coded claims were coded either for a level that was higher or lower than appropriate, the report found, with only 2 percent having other coding errors. The report also noted that most of the documentation problems were the result of a failure to submit sufficient documentation, while a small number of claims--7 percent--had no documentation at all. Of the 61 percent of E/M services claims that were problematic, 7 percent were improperly coded or had problems with documentation. The Centers for Medicare and Medicaid Services (CMS) responded to the report by saying that it agreed with HHS' recommendation to train doctors on how to properly code and document E/M services claims, but that it disagreed with the recommendation to review claims filed by high-coding physicians. Such reviews have been performed before and resulted in a negative return on investment, CMS said.

From the article of the same title
Bloomberg BNA (05/29/14) Swann, James
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Medicine, Drugs and Devices

Application of Ultrasound in the Assessment of Plantar Fascia in Patients with Plantar Fasciitis: A Systematic Review
A recent study examined the usefulness of ultrasound in assessing and treating patients with plantar fasciitis (PFS). Researchers reviewed 34 studies published in a variety of sources from 2000-2012, 16 of which involved using ultrasound to examine the effect different types of treatment had on plantar fascia thickness in PFS patients. Twelve other studies used ultrasound to compare plantar fascia thickness in patients with PFS and those who did not have the condition, while six studies examined the use of ultrasound in guiding treatment in patients with PFS. The review found that ultrasound is a reliable tool for assessing plantar fascia thickness, monitoring the effects of different treatments for PFS, and guiding therapeutic interventions in patients with the condition.

From the article of the same title
Ultrasound in Medicine and Biology (05/14) Mohseni-Bandpei, Mohammad Ali; Nakhaee, Masoomeh; Mousavi, Mohammad Ebrahim; et al.
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Safety of Infusing Rituximab at a More Rapid Rate in Patients with Rheumatoid Arthritis: Results From the RATE-RA Study
Rituximab can be safely infused in rheumatoid arthritis patients in two hours during the second and subsequent infusions of the treatment, a new study has found. The patients who participated in the study, all of whom had an inadequate response to anti-tumor necrosis factor (TNF) and were either rituximab-naive or experienced, received their first infusion of rituximab over the standard period of 4.25 hours. The three subsequent infusions were administered over two hours, rather than the current standard of 3.25 hours. The study's primary endpoint was the incidence of infusion-related reactions (IRRs) associated with the second infusion of rituximab, which was performed at day 15 of the treatment. The study found that the incidence of IRRs associated with the second infusion was 6.5 percent, compared to a weighted historical incidence rate of 8.1 percent when the second infusion was performed over the standard 3.25 hours. The incidence of IRRs associated with the third and fourth infusions was also lower compared to the weighted historical incidence rates for those infusions when they were performed over the standard amount of time. None of the IRRs seen in the study were serious.

From the article of the same title
BMC Musculoskeletal Disorders (05/24/14) Pritchard, Charles H.; Greenwald, Maria W. ; Kremer, Joel M.; et al.
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