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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

Fix For Docs Saga Continues

Senate Finance Committee Chairman Max Baucus, D-Mont., introduced yesterday a substitute amendment to the American Jobs and Closing Tax Loopholes Act (H.R. 4213) that would extend the temporary increase in Medicaid's Federal Medical Assistance Percentage through June 2011. Like the version of the bill approved by the House last month, the amendment includes provisions that would delay a 21 percent Medicare payment cut for physicians that took effect June 1 and reduce Medicare payments to hospitals by about $4 billion. That is, both versions of the bill give physicians a 2.2 percent rate increase for the rest of this year and an additional 1 percent increase in 2011, and change Medicare's "72 Hour Rule" to prevent hospitals from submitting separate Medicare reimbursement claims for inpatient and outpatient therapeutic care provided within three days of a hospital admission. As you might imagine, this has providers happy, while hospitals are feeling glum about the provision.
Give Your Feedback on Joint Commission Standards

ACFAS members can get involved with rewriting Joint Commission standards. The commission asks that respondents quantify the value of the standard, keeping in mind whether it:
  • Has a strong evidence base
  • Has a strong relationship to patient outcomes and clinical care
  • Supports a healthcare organization’s achievement of patient safety and quality of care
  • Has benefits that outweigh the costs
  • Supports a healthcare priority that has an impact on quality and safety.
To comment on standards by accreditation program, visit the commission’s website.

Promote Your Practice With FOOTNOTES

Summertime brings warm weather and fun outdoor activities. Use the change of season to remind your patients of foot health and safety with the Summer 2010 edition of FOOTNOTES, ACFAS' free patient newsletter.

Download and personalize a copy to give to your patients, add to the next entry on your blog or distribute at the next community health event. The newsletter is available in both English and Spanish on the ACFAS website.

Foot and Ankle Surgery

Human Ankle Cartilage Deformation After Different In Vivo Impact Conditions

Researchers sought to determine ankle cartilage deformation after in vivo loading and to determine any difference in volume change between four weight-bearing exercises. The four exercises represented increasing impact as well as dynamic and static loading. Based on MRI, 3D reconstructions of talar cartilage were generated to determine 3D volumes before and after four exercises in 13 healthy subjects. Mean talar deformation was 8.3 percent after bilateral knee bends, 7.7 percent after unilateral knee bends, 14.6 percent after unilateral static stance, and 12.5 percent after drop jumps. Statistical analysis revealed deformation to be significantly higher after unilateral static stance than after unilateral knee bends.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (05/20/10) Van Ginckel, Ans; Almqvist, Fredrik; Verstraete, Koenraad; et al.

New Surgery Provides Relief for People with Foot Drop

Surgeons at The Methodist Hospital in Houston have developed a new procedure to treat foot drop. “We take the gracilis muscle from the inside of the leg, connect its blood vessels to the blood vessels in the leg and then attach its nerve to the peroneal nerve, which supplies movement and sensation to the lower leg, foot and toes,” said Dr. Michael Klebuc, a plastic surgeon with The Methodist Hospital Institute for Reconstructive Surgery in Houston. “If all goes well, in about six months, the peroneal nerve fibers will grow into the transplanted muscle and people will be able to lift their foot up and walk without a brace.” The procedure is best suited for young, active people under age 50 with no atherosclerotic disease.

From the article of the same title
Newswise (06/01/10)

TcpO2 Measurement for the Risk of Non-healing and Amputation in Diabetic Foot Ulcer Patients With Non-palpable Pedal Pulses

Researchers evaluated whether transcutaneous tissue oxygen tension (tcpO2) measurement, when assessed in daily routine, can be used to predict the risk of non-healing and amputation in diabetic foot ulcer patients with non-palpable pedal pulses. Patients were divided into three subgroups according to their initial tcpO2-readings (tcpO2 <20 mmHg, tcpO2 20-40 mmHg, tcpO2 >40 mmHg). Patients with clinical signs of soft tissue infection at the initial presentation were excluded. One hundred forty-one patients were enrolled. Wounds associated with a tcpO2 reading <20 mmHg demonstrated a significantly decreased probability of healing compared with those associated with a tcpO2 >40 mmHg. The overall amputation rate increased with decreasing tcpO2, although there was no significant difference for major amputations. The researchers concluded that routine assessment of tcpO2 is suitable as a clinical screening tool for estimating the risk of non-healing in diabetic foot ulcer patients without palpable pedal pulses, but its predictive value for the risk of amputation remains unclear.

From the article of the same title
Medical Science Monitor (06/01/10) Vol. 16, No. 6, P. CR273; Ladurner, R.; Küper, M.; Königsrainer, I; et al.

Practice Management

CMS to Host ICD-10 Conference Call

The Centers for Medicare & Medicaid Services will host a national provider conference call on "ICD-10 Implementation in a 5010 Environment" on June 15, from noon to 2 p.m. EST. The conference call will be geared toward medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service providers. The toll-free teleconference will include a question and answer session that will give call participants an opportunity to ask questions of CMS subject matter experts.

From the article of the same title
Advance (05/25/10)

Know the Best Practices for Verbal Credentialing Verifications at Ambulatory Care Centers

The Joint Commission does not outline requirements for verbal or phone verifications at ambulatory care centers. However, accepted practice is to document verbal or phone verification by including the information verified, name and title of the person supplying the information, date of the verification, and the name or initials of the person obtaining the information.

From the article of the same title
HCPro (05/26/10)

Health Policy and Reimbursement

CMS Clarifies Physician Supervision Requirements for Hospital Outpatients

The Centers for Medicare & Medicaid Services has issued a transmittal clarifying its policies requiring physician supervision of diagnostic and therapeutic services provided to hospital outpatients. According to the transmittal, “physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives who operate within the scope of practice under state law may order and perform diagnostic tests” outlined in the Medicare manual and previous guidance. However, they “are not permitted to function as supervisory ‘physicians' for the purposes of other hospital staff performing diagnostic tests.”

According to CMS, covered diagnostic services to outpatients include the services of nurses, psychologists, and technicians; drugs and biologicals necessary for diagnostic study; and the use of supplies and equipment. When a hospital sends hospital personnel and hospital equipment to a patient's home to furnish a diagnostic service, Medicare covers the service as if the patient had received the service in the hospital outpatient department.

From the article of the same title
BNA Health Care Policy Report (06/02/10) Weixel, Nathaniel

Justice Department Declares War on Doctors

A proposed settlement in United States v. Idaho Orthopaedic Society would resolve claims alleging a group of Idaho orthopedists conspired to violate the Sherman Act in refusing to treat workers' compensation patients and in refusing to contract with a health insurer, according to the Department of Justice. DOJ announced that it had reached a settlement, subject to public comment and court approval, that would resolve a complaint filed the same day against the Idaho Orthopaedic Society, an orthopedic practice group, and five orthopedists. The complaint charges two separate conspiracies to boycott state and private payers between 2006 and 2008 that allegedly caused an increase in healthcare costs and denied care to injured workers.

The settlement requires the defendants to refrain from agreeing with any of their competitors on fees or contract terms and prohibits them from “collectively denying medical care to patients, refusing to deal with any payer, or threatening to terminate contracts with any payer,” DOJ said. DOJ alleged in the complaint that in one group boycott conspiracy, the defendants, through a series of meetings and communications, agreed not to treat most patients covered by workers' compensation insurance in order to force the Idaho Industrial Commission (IIC) to increase the rates they were paid for treating injured workers.

DOJ noted that IIC sets the fee schedule for orthopedists and other health care providers who treat patients covered by workers' compensation insurance in the state. DOJ said the boycott “resulted in a shortage of orthopedists willing to treat workers' compensation patients, causing higher rates for orthopedic services.”

From the article of the same title
Christian Science Monitor (05/31/10)

Medtronic Begins Disclosing Payments to Physicians

Medical-device company Medtronic has begun voluntarily posting annual physician payments exceeding $5,000 on its Web site. The new healthcare reform law mandates such disclosure by 2013. The disclosure includes information about the type of relationship—training and education, research and development, advisory services, or royalties—as well as the dollar amounts. Medtronic will not release aggregate dollar amounts with future updates to the disclosure database, because the "purpose of the site is not to provide that aggregate data, it's for patients to learn about the types of relationships their physicians have," says Steven Cragle, spokesman for Medtronic. Medtronic has received special attention and criticism in recent years. In 2008, Sens. Charles Grassley (R-IA) and Herb Kohl (D-WI) sent letters to Medtronic asking the company to provide details about its payments to physicians for consulting services following allegations that the company had paid kickbacks to surgeons to boost implant sales. Two years before, Medtronic reached a $40 million settlement with the U.S. Department of Justice but denied any wrongdoing.

From the article of the same title
HealthLeaders Media (06/01/10) Bakhtiari, Elyas

Health Centers With Hospital Affiliations Report Fewer Problems Accessing Specialists

Community health centers that are affiliated with hospitals have less trouble providing their patients with off-site specialty care than their unaffiliated counterparts, but all centers face some barriers accessing services for patients, according to a report released by the Commonwealth Fund. The report, based on a survey of 795 federal qualified health centers, said 80 percent of health centers with a hospital affiliation found it somewhat difficult or very difficult to obtain off-site specialist care for their uninsured patients, compared with 91 percent of the health centers without hospital affiliations.

The finding of fewer difficulties for affiliated health centers holds true for Medicare and Medicaid patients as well. For Medicare patients, 46 percent of affiliated health centers reported difficulty obtaining off-site specialist care while 60 percent of unaffiliated centers did. For Medicaid patients, 69 percent of affiliated health centers reported difficulty obtaining off-site specialist care while 79 percent of unaffiliated center did.

In 2010, health centers are expected to serve 20 million patients, and the need for services is likely to increase as the health reform law is implemented, according to the report, which can be accessed here.

From "National Survey of Community Health Centers Finds Those Closely Affiliated With Hospitals Report Fewer Problems Obtaining Specialty Care for Patients"
Commonwealth Fund (05/27/10)

U.S. Supreme Court to Consider Tax Rule on Medical Residents

The U.S. Supreme Court has agreed to hear a challenge by medical colleges and teaching hospitals of a Treasury Department regulation requiring payment of Social Security taxes on behalf of medical residents. Under a 2005 Treasury Department rule, medical residents and other "full-time employees" do not qualify for the general student exemption from Social Security taxes. The Social Security tax represents 12.4 percent of wages. Half of the tax is paid by the employer and half by the employee. The government argues that the Treasury regulation offers a "bright-line test" of 40 or more hours worked for an employee to be considered full time. Medical residents, who work anywhere from 50 to 90 hours a week, meet that test, the government argues.

The St. Louis-based 8th U.S. Circuit Court of Appeals sided with the IRS in a ruling last June. In their petition to the Supreme Court, the Mayo Clinic and University of Minnesota noted four other federal appellate courts have sided with hospitals against the government on the issue. That leaves medical residents in the 8th Circuit—covering Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota—subject to taxes that their peers elsewhere in the United States do not have to pay.

Oral arguments in the case are likely to take place in the fall.

From the article of the same title
Dow Jones Newswires (06/01/10) Vaughan, Martin
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Technology and Device Trends

Amgen Drug Approved to Fight Osteoporosis

The U.S. Food and Drug Administration has approved the sale of Amgen’s osteoporosis drug Prolia to help prevent fractures in postmenopausal women. The drug, known chemically as denosumab, has also received European approval. Prolia, which is given by injection once every six months, works to decrease the destruction of bone and increase bone mass and strength by inhibiting proteins that activate bone-destroying cells.

From the article of the same title
New York Times (06/01/10)

CMS Nixes Coverage of Collagen Meniscus Implant

The Centers for Medicare & Medicaid Services will not cover the use of the collagen meniscus implant to treat injuries in Medicare beneficiaries, according to a final decision memo dated May 25. CMS issued a national noncoverage determination, concluding that the collagen meniscus implant does not improve health outcomes in the Medicare population. CMS said it determined that the collagen meniscus implant “is not reasonable and necessary” for the treatment of a meniscal injury or tear.

From the article of the same title
MedPage Today (06/02/10)

Sugary Band-Aid May Help Heal Post-Operative Tissue

A report from plastic surgeons at New York-Presbyterian Hospital/Weill Cornell Medical Center and biomedical engineers at Cornell University indicates that sunless tanning spray contains a compound that may aid in the healing of post-operative tissue. A gel comprised of polyethylene glycol (MPEG) and a polycarbonate of dihydroxyacetone (DHA) may help to seal surgical wounds, and the material could potentially be used in all different reconstructive surgeries to prevent seroma formation. The adhesive characteristics of DHA enable sunless tanner to stick to the skin without being wiped off, and the substance is biodegradable as well as water soluble.

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

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June 9, 2010