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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

Health System Reform Round-Up

Here are the highlights from a very busy week in Washington, compiled by the ACFAS Department of Health Policy.

The Senate Health Education, Labor and Pensions Committee filed a 615 page health system reform bill, which is being called the “Kennedy-Dodd” bill. The proposed legislation includes the so-called “public option” as well as an individual mandate to purchase health insurance.

The Senate Finance Committee plans to vote a bill out of committee as early as June 23. There is speculation that while the bill that emerges from the committee will have much in common with the Kennedy-Dodd bill, it may include an insurance “co-op” option owned and operated by members in place of the “public plans.”

The issue of paying for health system reform looms large. The Congressional Budget Office has put an initial price tag of $1 trillion over 10 years on the Kennedy-Dodd bill. Congressional leaders are considering a broad-based consumption tax (like a value-added tax) or a series of smaller taxes (e.g., sugared soft drinks). President Obama has called for cutting Medicare spending dramatically over the next 10 years, including reduced payments to hospitals.

New Yorker Article Takes Center Stage in Health Care Reform Debate

An article in the June 1, 2009, New Yorker magazine is generating huge buzz in Washington among elected leaders and health policy experts. In "Cost Conundrum: What a Texas Town Can Tell Us About Health," Atul Gawande, MD, spent time with providers and other stakeholders in McAllen, Texas, which has the highest Medicare costs on the country but does not have better health outcomes. The article has become Exhibit 1 in the health care debate in Washington, with President Obama mentioning it in his speech to the AMA.

Read the article online using the web link, below.
2010 Poster and Manuscript Competition Now Open

Become a part of the ACFAS Annual Scientific Conference when you share your research through manuscript presentations or poster exhibits. You'll be making a valuable contribution to the content of the Conference and the profession.

Use the web link below to submit your research online by the following deadlines:
Manuscript deadline: August 3, 2009
Poster deadline: October 1, 2009
Register Now for July 9-11 Diabetic Seminar

When it comes to successful outcomes with your diabetic patients, there's no room for error. Saving the ulcerated, infected or collapsed diabetic limb is the foot and ankle surgeon's greatest challenge.

The Diabetic Foot and Ankle Seminar, with optional skills wet lab, is just three weeks away. You can still register online for the few remaining seats at this outstanding program.

Join the faculty as they lend their expertise to every aspect of this course, from the small-group discussions, to the lectures and problem-solving exercises. Discuss your challenges with other top foot and ankle surgeons at the Wine and Wisdom Reception on Friday evening.

Use the web link below to register online for this July 9-11 event, to be held at the Hyatt Vineyard Creek Hotel in Santa Rosa, California.

Foot and Ankle Surgery

Percutaneous Reduction and External Fixation Reliable for Heel Fractures

Percutaneous reduction and external fixation has shown to be a reliable technique to obtain a stable reduction of intra-articular, displaced calcaneal fractures, say researchers from Italy. Their study assessed 54 fractures in 52 consecutive patients at an average age of 48.6 years who underwent treatment with heel mini-fixator for Sander's type II, III, and IV os calcis fractures. Nearly 91 percent of the patients rated their ankles good or excellent in the Maryland Foot Score, while radiographic assessment found the average Böhler’s angle went from 6.98 preoperatively to 21.94 postoperatively. CT scans showed excellent results in 44.4 percent of cases and good results in 46.3 percent of cases.

From the article of the same title
Ortho Supersite (06/01/2009) Beadling, Lee

Pre-op Briefings Make for Safer, More Efficient Surgery

Research conducted at the Mayo Clinic in Rochester, Minn., shows that clinical mistakes and medical supply waste can be reduced when clinical teams meet before cases to discuss potential disruptions to surgery. Researchers note that pre-op briefings lasting between one and eight minutes dropped incidences of miscommunication by 53 percent. The study was published in the June 2009 issue of the Journal of the American College of Surgeons.

From the article of the same title
Outpatient Surgery (06/01/09) Cook, Daniel

Study Ties Diabetes Drugs to Fractures

Two diabetes drugs—Avandia, made by GlaxoSmithKline, and Actos, made by Takeda Pharmaceutical—may increase a patient's risk of bone fractures by 43 percent, studies suggest. Medco Health Solutions and the University of Texas Health Sciences Center in San Antonio performed the review of these thiazolidinedione (TZD) drugs over the course of 18 months. The researchers compared the drug and medical data of 69,000 patients with diabetes, who were taking either of the two drugs, with 75,000 similar patients who were taking older diabetes drugs.

The researchers said that the TZD drugs reduced bone density after only a short time by apparently hindering osteoblast activity, the mechanism that builds the body's bones. Most of the problems involved hands, wrists, legs, and ankles, with few hip and spine fractures. The researchers also noted that women using either of the two drugs are two times as likely to have fractures than men. The findings were presented at the recent American Diabetes Association conference.

From the article of the same title
Wall Street Journal (06/08/09) P. B2; Mundy, Alicia; Favole, Jared A.

Fracture Risk Doubled After Obesity Surgery

The increase in bone turnover after bariatric surgery significantly increases the risk of fractures in the feet and other body parts, according to a study presented at The Endocrine Society's annual meeting in Washington, D.C. Researchers from the Mayo Clinic in Rochester, Minn., compared the fracture rate in 97 patients (average age of 44 years) who underwent bariatric surgery to the rate expected in peers in the general population. The risk of first fracture at the foot increased almost fourfold.

From the article of the same title
Reuters (06/10/09) Rauscher, Megan

Practice Management

Pew Survey: Health Consumers Find More Help on Web

The latest survey of health consumers' use of the Internet by the Pew Research Center continues to show that a large majority of Internet users (81%) seeks online health information. The survey found that 60 percent of users consult blog comments for health information as well as online hospital and doctor reviews. Sixty percent also said that they knew someone who had been helped by following health information on the Internet.

From the article of the same title
Wall Street Journal (06/11/09) Landro, Laura

Doctors Balk at Medicaid Program

Many physicians are no longer treating or accepting new patients insured by Medicaid. In Michigan, for example, a 4 percent across-the-board decrease in Medicaid payments to doctors announced recently could mean a further decline in physician participation, thereby limiting access. Doctors say the state-set reimbursement rates are already too low, in some cases covering just a third of actual costs of patient visits. Many physicians who are continuing to treat Medicaid patients are doing so out of a sense of duty.

From the article of the same title
Associated Press (06/07/09) Rogers, Christina

Looking for Dr. Right

More than 40 Web sites allow patients to rate their doctors based on personal experiences, and there are dozens of online communities where members from the same city or town regularly discuss their physicians. Angie's List, a respected source for rating home improvement contractors since 1995, added healthcare providers last year and now a quarter of the 40,000 reports it receives from members every month are about medical providers.

Some sites do not verify input., for example, does not verify that the poster is actually a patient of the doctor they're rating. Angie's List, on the other hand, requires posters to identify themselves and also identifies them to the doctor they're reporting on.

From the article of the same title
Boston Globe (06/08/09) Kowalcyzk, Liz

One-Third of Doctors Do Not Accept Credit Cards

Credit cards are not accepted as a form of payment by 33 percent of U.S. physician offices, says SK&A Information Services' Physician Office Credit-Card Acceptance Survey. Last year, the number stood at 28 percent.

From "One-Third of Physician Offices Do Not Accept Credit Cards"
Marketwire (06/09/09)

Health Policy and Reimbursement

Existing Databases Make Tracking Comparative Effectiveness Research Difficult

ACFAS has reported previously that the federal stimulus package provides funding for “competitive effectiveness research.” The Federal Coordinating Council for Comparative Effectiveness Research is charged with getting public input on data collection approaches to guide Congress and the White House in funding initiatives. At recent “listening sessions,” the 15-member council heard from a number of providers who pointed out that existing data basis can make it difficult to track competitive effectiveness and reminded the panel that competitive effectiveness research must be able to account for individual patient differences, risks, and preferences.

From the article of the same title
Health Leaders Magazine Online (06/09) Simmons, Janice

New Law Allows Out-of-network Doctors to Be Paid Directly by Insurance Companies

A new Florida law addresses head-on providers' complaints about health insurers refusing to accept an “assignment of benefit” from patients who see out-of-network physicians. As a strategy to pressure providers to stay “in network,” many health insurers pay patients directly for services provided by an out-of-network physician. This forces the physician to bill the patient, and in tough economic times the money may have already been spent. The new Florida law requires health insurers to accept a patient’s assignment of benefits and pay the physician directly.

From the article of the same title
Florida Times-Union (06/11/09) Larrabee, Brandon

Technology and Device Trends

Force in the Achilles Tendon During Walking With Ankle Foot Orthosis

Researchers hypothesized that Achilles tendon load decreases with increased restriction of dorsiflexion in ankle-foot orthoses and is associated with decreased triceps surae activity. Analyzing eight subjects, they concluded that weightbearing in ankle-foot orthoses when dorsiflexion is restricted beyond neutral could result in increased forces in the Achilles tendon compared with barefoot walking, despite reduced electromyography activity in the triceps surae and decreased rate of force development. Thus, if patients bear full weight in an ankle-foot orthoses locked at 20 degrees plantar flexion without heel support, the maximum force in the tendon may exceed that encountered during barefoot walking.

From the article of the same title
American Journal of Sports Medicine (06/01/09) Vol. 37, No. 6, P. 1200; Fröberg, Åsa; Komi, Paavo; Ishikawa, Masaki

House Bill Would Create Artificial Joints Registry

U.S. Democratic Reps. Bill Pascrell Jr. of New Jersey and Lloyd Doggett of Texas have introduced a measure to create a national database of patients who received artificial hips and knees. The measure would establish a government-backed registry to track patients' results over time and help detect inferior devices and ineffective or unnecessary surgical practices. Patient registries in areas like orthopedics are expected to play an important role in comparative effectiveness reviews that could help identify which medical procedures and products work best. Makers of artificial joints support the idea of such a registry, but prefer to create one outside of government, asserting it would be more effective than the legislative proposal.

From the article of the same title
New York Times (06/11/09) Meier, Barry

Israelis Develop Nanotech Relief From Pain of Osteoarthritis

Researchers at the Technion-Israel Institute of Technology and the Hebrew University of Jerusalem are proposing the use of injections of tiny globules of fat using nanotechnology to treat osteoarthritis. The researchers aim to help osteoarthritis patients avoid surgery by injecting globules of phospholipids into stricken joints. Currently, hyaluronic acid is sometimes used to improve lubrication of joints as an alternative to surgery. In lab testing using large and small pieces of bone and cartilage facing each other, the pace of erosion decreased by 40 percent when the globules were added to hyaluronic acid compared to hyaluronic acid alone. The findings were published recently in the scientific journal Wear.

From the article of the same title
Jerusalem Post (06/09/09) Siegel-Itzkovich, Judy

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June 17, 2009