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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

Rapidly Review Recent Research

In just a few minutes you can stay abreast of research from journals that you might not regularly read. ACFAS Scientific Literature Reviews, a monthly feature on, presents four new reviews this month:

• a retrospective study of Agility Total Ankle arthroplasty
• marrow mesenchymal cell use in wound therapy
• ACE inhibitors and CRPS
• effectiveness of prefabricated vs. custom foam orthotics

These reviews, written by residents at the Greater Los Angeles VA/UCLA-Olive View Medical Center, may be accessed using the web link, below.

JCAHO “Universal Protocol” Update

ACFAS is a member of the JCAHO Professional and Technical Advisory Committee on Ambulatory Health Care. In this capacity, we recently participated in a conversation with JCAHO about the draft Universal Protocol (UP) designed to prevent wrong site/person procedure errors. The JCAHO has actively sought stakeholder input to assure that the UP is “effective and achievable” and plans to make further modifications based on these comments before the final UP is released. ACFAS will disseminate the UP when it becomes final.
Reimbursement Problems? Let Us Know!

If Medicare or private insurer reimbursement practices or policies are interfering with your ability to provide optimal care for your patients, ACFAS wants to know. Please direct your concerns to Helen Jameson, JD, Director of Health Policy, Practice Advocacy, and Research at

Foot and Ankle Surgery

Below-knee Bare Nitinol Stent Placement in High-risk Patients With Critical Limb Ischaemia and Unlimited Supragenicular Inflow as Treatment of Choice

Researchers in Münster, Germany, evaluated the effectiveness of nitinol stent placement in long infrapopliteal lesions in patients with critical limb ischaemia. They concluded that the mid-term outcome demonstrates that infrapopliteal stent placement is a reliable treatment option in patients with critical limb ischaemia. In patients at high risk for crural bypass, with no flow-limiting supragenicular lesions, below-knee stent-supported angioplasty should be considered as a first treatment option.

From the article of the same title
European Journal of Vascular and Endovascular Surgery (06/01/09) Vol. 37, No. 6, P. 688; Donas, K.P.; Schwindt, A.; Schönefeld, T.

Immediate Continuous Passive Motion After Internal Fixation of an Ankle Fracture

Surgical treatment is usually mandatory in displaced bimalleolar and trimalleolar fractures. Researchers have evaluated the effect of immediate postoperative continuous passive motion in the management of displaced bimalleolar and trimalleolar fractures treated surgically. They conclude that continuous passive motion started immediately after surgery seems is an effective method for allowing complete and quick recovery of the range of motion of the ankle and for reducing the risk of early degenerative joint disease. But immediate passive ankle motion can be applied only after adequate reduction and stable internal fixation.

From the article of the same title
Journal of Orthopaedics and Traumatology (06/01/09) Vol. 10, No. 2, P. 63; Farsetti, Pasquale; Caterini, Roberto; Potenza, Vito

Oblique Supramalleolar Opening Wedge Osteotomy Without Fibular Osteotomy for Varus Deformity of the Ankle

Supramalleolar opening wedge osteotomy of the distal tibia with concurrent fibular osteotomy is often used to prevent progression to osteoarthrosis in varus deformed ankle joints. Researchers developed a new oblique supramalleolar opening wedge osteotomy without fibular osteotomy to minimize the adverse effects of mortise distortion and lateral ankle joint impingement and to improve the stability of the osteotomy site due to the presence of an intact fibula.

From the article of the same title
Foot & Ankle International (06/09) Vol. 30, No. 6, Lee, Keun-Bae; Cho, Yong-Jin

Peripheral Arterial Disease and Diabetes: A Clinical Update

Revascularization is vital to wound healing when a nonhealing wound is complicated by peripheral arterial disease. Revascularization can be accomplished through traditional bypass surgery or less invasive endovascular interventions, such as angioplasty and stenting. These alternative techniques of revascularization offer the advantages of quicker recovery and lower morbidity, though durability may be compromised.

From the article of the same title
International Journal of Lower Extremity Wounds (06/01/09) Vol. 8, No. 2, P. 75; Dinh, Thanh; Scovell, Sherry; Veves, Aristidis

Practice Management

Electronic Patient Records Will Force Consolidation in Healthcare

Participants of a "war game" held recently to assess the impact of the comprehensive implementation of electronic health records being pushed by the White House on the U.S. healthcare system came to the conclusion that hundreds of thousands of doctors in small practices would be forced to join larger groups in part because of the expense and complexity of adopting computerized health records. The exercise was attended by students from four prominent U.S. graduate business schools.

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

Some Doctors Help With Bills as Well as Ills

The recession is resulting in physicians seeing more patients who have lost their insurance or whose income has fallen so dramatically that they are having trouble meeting their co-pays and deductibles. The Medical Group Management Association reports that many more patients are canceling appointments and preventive care visits. Physicians are dealing with this in a number of ways. In some cases they are cutting their fees for these patients, and others are allowing patients to use a payment plan. Others are taking a different tack and using bill collectors more aggressively.

From the article of the same title
Washington Post (06/02/09) Boodman, Sandra G.

The Doctor Will See You Now Online

Virtual medicine is being piloted in Boston and elsewhere in the United States to help ease healthcare costs and relieve the burden that scheduling can represent. Web cameras, instant messaging, and other technologies hold promise for boosting the efficiency of the U.S. healthcare system.

Pioneering virtual medicine is Hawaii, where Blue Cross Blue Shield in January launched its Online Healthcare Marketplace, allowing enrolled patients to log in, type in their medical request at any time, and instantly see a menu of specialists who are available at that moment for a virtual visit. Patients have an option of a videoconferenced session with a specialist, a phone consultation, or instant e-mail communications for the price of $10 for a 10-minute visit. The system also provides patient and physician with simultaneous and instant access to a summarized version of patients' medical records.

From the article of the same title
Boston Globe (06/01/09) Lazar, Kay

Vt. Bans Industry Gifts, Tightens Reporting Rules

Vermont physicians will no longer be allowed to receive free lunches and most other gifts from drugmakers, device makers, and biotech firms beginning July 1 under a new state law that may be the most sweeping effort to date to target the influence of industry marketing on physicians. The law also requires that the companies publicly disclose any payments made to physicians. Reports are to be included on a Web site searchable by doctor name.

From the article of the same title
American Medical News (06/01/09) O'Reilly, Kevin B.

Doctors Turn to Social Networking Sites to Promote Services

Doctors and hospitals are using social networking sites to attract or educate patients, draw donors, gain recognition, and recruit or retain top talent. More than 250 hospitals now use YouTube, Facebook, Twitter, or blogs, according to Ed Bennett, Web strategy director for the University of Maryland Medical System.

From "Webcast Your Brain Surgery? Hospitals See Marketing Tool"
New York Times (05/24/09) Belluck, Pam

Health Policy and Reimbursement

Obama Outlines Healthcare Plan for All

In a letter to lawmakers leading the U.S. healthcare reform debate, President Obama provided some details of his vision, including a commitment to cut an additional $200 billion to $300 billion over 10 years from the Medicare and Medicaid programs. The president also said that he endorses a new health insurance exchange that would allow Americans to shop for different plans and compare prices and signaled a willingness to accept a requirement for every American to buy health insurance as long as the plan includes a "hardship waiver" to exempt low-income people from having to pay.

From the article of the same title
Associated Press (06/03/09) Werner, Erica

Obama May Let MedPAC Set Physician Pay Rates

President Obama’s letter to Senators included a suggestion for what would be a dramatic change in the way physician payment rates are set. The President indicated that he would be open to giving the Medicare Payment Advisory Commission (MedPAC), the authority to set physician rates. MedPAC currently functions as an advisory council to Congress which sets provider reimbursement. Supporters of this change think that an independent, executive branch rate-setting entity would be able to create payment rates “away from the influence of special interests.” There is currently a bill in the Senate that would amend the Social Security Act to make this happen.

From the article of the same title
MedPage Today (06/03/09) Walker, Emily P.

The FDA Has Approved Ankle Replacements, So Why Don't All Insurance Plans Cover Them?

Loyola University Health System orthopedic surgeon Dr. Michael Pinzur notes in a FootForum commentary in Foot & Ankle International that despite the fact that the first total ankle-replacement system for patients with severe ankle arthritis was approved by the U.S. Food and Drug Administration about a decade ago, many health insurance companies still refuse to cover the procedure. The insurers base their decision on a "meta-analysis" that concluded an ankle replacement was not a preferred treatment option. The meta-analysis compiled data from previous studies and was sponsored by insurance companies and based on studies published in 2002 or earlier.

From the article of the same title (06/04/09)

Feds Target Radiology Imaging Payment Cuts

Efforts to cut healthcare costs in the United States have taken aim at physician radiology services whose annual cost to Medicare more than doubled to $14 billion between 2000 and 2006. A report in March from the Medicare Payment Advisory Commission (MedPAC) said, "The rapid volume growth of costly imaging services may be driven, at least in part, by prices that are too high."

The Senate Finance Committee and others at the federal level are looking at two main ways to cut costs: prior authorization, particularly for advanced imaging, and restructuring of the payment formula to lower the value of equipment in the payment equation so provider reimbursement would be much lower.

From the article of the same title
Health Leaders Magazine Online (05/09) Clark, Cheryl

Turning Up the HEAT to Stop Medicare and Medicaid Fraud

The U.S. Department of Health and Human Services and Department of Justice are stepping up the fight against fraud. At a joint press conference, HHD Secretary Kathleen Sebelius and Attorney General Eric Holder announced the creation of a joint Health Care Fraud Prevention and Enforcement Team that will expand efforts, including creating new “strike forces” targeting specific metropolitan areas and using technology to rapidly assess electronic evidence.

From the article of the same title
Centers for Medicare & Medicaid Services (05/30/09)

Technology and Device Trends

FDA Group to Help Agency Become More Transparent to Public

The U.S. Food and Drug Administration (FDA) is creating an internal task force to determine how it can become more open and transparent about its decisions in response to criticism that decisions are made without the input of stakeholders. All options are on the table, say FDA officials, including the release of information about clinical trials, which could be a sticking point with the device industry.

From the article of the same title
Dow Jones Newswires (06/02/09) Favole, Jared A.

Medicare Begins Supplier Education for the Competitive Bidding Program for Certain Medical Equipment and Supplies

CMS has announced the next steps in the implementation of the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), including the general timeline for opening the bid window in the fall. The program is designed to cut costs for Medicare and beneficiaries who use DMEPOS.

From the article of the same title
Centers for Medicare & Medicaid Services (05/29/09)

Radiographic Measurements in Patients With Hallux Valgus Before and After Proximal Crescentic Osteotomy

Researchers conducted a study of the reliability of radiographic measurements that are made prior to and following a proximal crescentic osteotomy of the first metatarsal in order to explore the intraobserver and interobserver reliability of different techniques to measure the angles. The researchers report that a method whereby the longitudinal axis of the first metatarsal was defined using a line linking the centers of the first metatarsal head and the proximal articular surface of the first metatarsal produced the highest intraobserver and interobserver correlation coefficients for the preoperative hallux valgus and intermetatarsal angles and the postoperative hallux valgus angle. They recommend this technique for assessing radiographs before and after a proximal crescentic osteotomy performed for the treatment of hallux valgus.

From the article of the same title
Journal of Bone and Joint Surgery (06/01/2009) Vol. 91, No. 6, P. 1369; Shima, Hiroaki; Okuda, Ryuzo; Yasuda, Toshito; et al.

U.S. Company Finds 'Safer' Way to Make Stem-like Cells

Researchers at Harvard University and Massachusetts-based Advanced Cell Technology have announced the development of a new method to make stem-like cells from a patient's ordinary skin cells. The technique involves soaking cells in human proteins that turn back the clock biologically, making the cells behave like embryonic stem cells.

From the article of the same title
Reuters (05/28/09) Fox, Maggie

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June 10, 2009