June 24, 2011

News From ACFAS

Power Failure at ACFAS Headquarters
This week's issue of This Week @ ACFAS was delayed due to a major power outage that interrupted telephone, e-mail and computer service at the College's Chicago headquarters.

While our phones are now working, our e-mail system is still experiencing problems. We don't know exactly when e-mail will be functional again but are working diligently to get access restored. If you need to contact any staff member at ACFAS, please call us at 773-693-9300.

Thank you for your patience, and we apologize for any inconvenience.
ACFAS Attends AMA Meeting; SOPP Update
Although there was no mention of foot and ankle surgeons in public comments or debate at the recent American Medical Association meeting in Chicago, the AMA’s Scope of Practice Partnership (SOPP) work continues its advocacy efforts behind the scenes. Funded by an SOPP grant, “Know Your Doctor” communication wheels, known as volvelles, continue to be given to state legislators and regulators throughout the country. The volvelles state that podiatrists have a four year graduate-level education (MDs, 4 years and 90 credit hours), 2-3 years of residency/fellowship training (MDs, 3–7 years) and are required to have only 40 weeks of total care hours (MDs, 12,000–16,000).

SOPP touted victories in Utah, Montana, New Mexico, Mississippi, Colorado and Iowa to limit psychologists and chiropractors from prescribing; affirm collaborative agreements and halt fluoroscopy supervision for advanced practice nurses; and limit expansion by naturopaths to conduct physical exams and order labs. Additionally, AMA reported that 10 states introduced the AMA model Truth in Advertising legislation requiring healthcare providers to disclose their type and title of their license in any advertisement of their services.
Calling All Researchers!
The 2011 ACFAS Clinical and Scientific Research Grant application is now online. Research should have a direct or indirect impact on issues of interest to ACFAS members. Projects capable of obtaining EBM Levels of Evidence 1, 2 or 3 will be given preference, but beginning this year, cadaveric, animal or bench-top studies will also be considered.

The ACFAS Research Committee is also encouraging use of a scoring scale, including the ACFAS Scoring Scale, which was recently fully validated by a volunteer ACFAS task force. Find the Scoring Scale, its Validation, the application and more information at

Application deadline is Sept. 1, 2011.
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Sports Medicine Surgical Skills — For All Levels of Sport
If you want to reduce recovery time for sports injuries and confidently return your athletic patients to their game, then you belong in this course! Attend the ACFAS Sports Medicine Surgical Skills Course, Oct. 1-2, at the Orthopaedic Learning Center in Rosemont, Ill., to learn nuanced approaches to treat the athletic patient.

Through concise lectures, ample lab time and group discussion, this course will provide the latest treatment options for the most common and most difficult sports-related injuries. Visit the ACFAS website today for a complete brochure and online registration.
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Congratulations Class of 2011! 1st Year of Membership is On Us
The ACFAS Regional Divisions will continue to support first-year podiatric surgical residents by providing complimentary first-year membership in the College. This offer provides the benefits of membership with dues waived for one year. This is a direct value of $114, plus additional savings through member pricing on conferences, products and services.

Access to the College’s top-notch offerings will kick-start careers with a strong educational base, and provide residents with a connection to a community of their peers – the best and brightest foot and ankle surgeons in the country. They will have access to the College’s premiere website, and a subscription to the prestigious Journal of Foot and Ankle Surgery (JFAS) — a must-have to increase their knowledge of the latest surgical techniques and research.

Applications are available through the ACFAS website; joining now will provide an additional three months of membership, through September 2012 — and put JFAS in your mailbox that much sooner!

Once again, congratulations to the Class of 2011. The ACFAS Regional Divisions look forward to welcoming you to the College.
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Foot and Ankle Surgery

Navicular Excision and Cuboid Closing Wedge for Severe Cavovarus Foot Deformities: A Salvage Procedure
Researchers detailed a new method to correct severe stiff cavus feet via navicular excision and cuboid dorsal closing wedge osteotomy through a retrospective review of 16 feet treated in 11 pediatric patients. The procedure is executed at the apex of the deformity, thus enabling maximum correction to be acquired through wedge resection. The etiology of the deformity was as follows: multiply operated congenital clubfoot (5 feet), arthrogryposis (6 feet), and neurological deficits (5 feet). At a mean follow-up of 4.9 years, all had a plantigrade foot.

From the article of the same title
Journal of Pediatric Orthopaedics (08/01/11) Vol. 31, No. 5, P. 551 Mubarak, Scott J.; Dimeglio, Alain
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Measuring the Accuracy of Different Ways to Identify the 'At-Risk' Foot in Routine Clinical Practice
Identifying which individual risk factors best forecast foot ulceration in routine clinical practice and whether an integrated clinical tool is an improved screening tool for future foot ulceration was the goal of research involving 3,719 patients. Overall, 851 (22.9%) had insensitivity to monofilaments, in 629 (17.2%) both pulses were absent and 184 (4.9%) had a prior ulcer. The strongest predictors of foot ulceration were prior ulcer, insulin treatment, absent monofilaments, structural abnormality and proteinuria and retinopathy. The sensitivity of predicting foot ulceration was 52% for prior ulcer, 61% for absent monofilaments, 75% for `high risk' on an integrated risk score and 91% for high and moderate risk combined. The corresponding specificities were 99%, 81%, 89% and 61%. Positive likelihood ratio was 52 for prior ulcer and 6.8 for foot risk, with negative likelihood ratios of 0.48 and 0.15, respectively.

From the article of the same title
Diabetic Medicine (06/01/2011) Vol. 28, No. 6, P. 747 Leese, G.P.; Cochrane, L.; Mackie, A.D.R.; et al.
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First Ray Resection Anthroplasty Versus Arthrodesis in the Treatment of the Rheumatoid Foot
In a retrospective study 53 patients with rheumatoid arthritis were investigated with a minimum followup of 2 years after corrective forefoot surgery. The patients were divided into two groups, one of which underwent arthrodesis of the first metatarsophalangeal joint while the other was treated with a first ray resection arthroplasty; both groups underwent resection arthroplasty at the lesser metatarsal heads. The results of 58 feet were studied, and although patient satisfaction was lower in the arthrodesis group than the resection arthroplasty group, the arthrodesis patients exhibited better functional results and demonstrated a push-off from the hallux; no significant radiographic disparity was revealed in the mean hallux valgus angles. Peak pressures were substantially higher in the lateral midfoot and the hallux following arthrodesis versus the resection arthroplasty group.

From the article of the same title
Foot & Ankle International (06/11) Vol. 32, No. 6,
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Practice Management

Test Your Version 5010 Implementation Efforts!
The Version 5010 compliance deadline of January 1, 2012, is nearly six months away! All HIPAA-covered entities should be preparing for this transition, which includes conducting external testing with all trading partners (providers, clearinghouses, and vendors) to ensure timely compliance.

To assist with testing, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Medicare Fee-for-Service (FFS) Program, is holding two National 5010 Testing Days. The testing days will serve as an opportunity for trading partners to further test compliance efforts with the added benefit of live help desk support, and direct and immediate access to Medicare Administrative Contractors (MACs).

The first National Version 5010 Testing Day was June 15, 2011. The other testing day is scheduled for August 24, 2011. We hope all trading partners will participate so that they can have a timely and smooth transition to Version 5010!

These testing days will help facilitate a better understanding of MAC testing protocols and the transition to Version 5010; they are not meant to prohibit trading partners from further compliance testing. All trading partners are encouraged to begin working with their MACS to test transactions as soon as possible.

Keep Up to Date on Version 5010 and ICD-10.
Please visit for the latest news and resources to help you prepare!

From the article of the same title
Home Health Insight (06/15/11)
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Upgrading E-Prescribing System Can Bump Up Error Risk
A report in the Journal of General Internal Medicine suggests that converting to a new or upgraded e-prescribing system may create patient safety risks during the transition period. Many practices and hospitals are upgrading or switching their e-prescribing systems to comply with meaningful use incentive requirements. Some of the safety risks emerge in the first few weeks after implementation, the study found. The most common errors were those caused by improper abbreviations, which fell from 24 percent in the first year to 6 percent in the following year. The number of non-abbreviation errors, including those related to directions, frequency, and dosage mistakes, were found to increase in the first 12 weeks of implementation of the new system. Study co-author Dr. Rainu Kaushal said problems arise because "each electronic system has its nuances and learning how to utilize it and optimize the physician-computer interaction takes time." She says one-on-one training is ideal when deploying a new system, but regardless of the form of training, it should be compulsory for everyone. Shelly Spiro, director of the Pharmacy e-Health Information Technology Collaborative, recommends that physicians working with vendors to ensure that e-prescribing systems contain functions and standards that help curb errors, such as "structured and codified sig" and RxNorm.

From the article of the same title
American Medical News (06/13/11) Dolan, Pamela Lewis
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Weathering the Storm: Preparing Your Practice for Emergencies
Preparing for an emergency should be a priority for medical practices. One of the most important things a practice should do is setting up a plan and policy that is frequently practiced. They should also establish authority by naming a decision maker who is responsible for delegating tasks and determining whether to close the practice or operate it on a modified schedule. If the practice is closed, designated personnel should follow directions for contacting patients and staff, which could include posting closure information on the practice's Web site and social media channels. Practices should also contact their equipment, supply, and infrastructure vendors and contractors to discuss if they can rapidly replace vital equipment and supplies in case of an emergency. It is also advisable to carefully read contracts and insurance policies to see what costs are covered during emergencies. Furthermore, practices need to have an off-site back-up system for electronic patient records that is not connected to the main network, so patient records remain accessible in the event of a power outage. Finally, practices should devote one day every few months to run emergency drills, examine and update their weather emergency policy, and delegate staff responsibilities.

From the article of the same title (06/01/11) Hyden, Madeline
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Consider Captive Insurance Plan to Protect Your Practice
Captive insurance plans insure the risks of medical practices and offer lower premium costs, more availability, and more insurance coverage, allowing practices to stay competitive, lower expenses, and possibly save taxes. The plan collects premiums and pays claims commonly handled by insurance companies, while allowing practices to structure the type and amount of risk they will retain and insure risks that are either uninsurable or too costly to insure. The group can decide what their premiums will be and manage the funds to maximize yield or to structure maturities to meet cash flow needs. The group determines the amount of the premiums based on their actual experience, rather than that of a pool of insured’s.

From the article of the same title
Modern Medicine (05/25/11) Battersby, Mark E.
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Health Policy and Reimbursement

National Library of Medicine Launches MedlinePlus Connect
The National Library of Medicine, the world's largest medical library and a component of the National Institutes of Health (NIH), has formally launched MedlinePlus Connect. This free service allows health organizations and health information technology (HIT) providers to link patient portals and electronic health record (EHR) systems to, a trusted source of authoritative, up-to-date health information for patients, families and health care providers.

From the article of the same title
HHS News Release (06/20/11)
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Panel: Medicare Should Give Prior Approval for Imaging Tests
Physicians who order many diagnostic imaging tests should be required to get prior approval if they want to get paid under Medicare, the Medicare Payment Advisory Commission (MedPAC) has recommended as part of a semi-annual report to Congress. The commission recommended cutting back on payments and subjecting providers who order the most imaging tests to a dual process. They would have to submit data on the tests they order, which would then be compared to clinical guidelines (prior notification). If the tests were ordered inappropriately, federal regulators or contractors would have to approve future tests (prior authorization).

From the article of the same title
The Hill (06/15/11) Pecquet, Julian
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To Curb Malpractice Costs, Judges Jump in Early
In New York State Supreme Court, Justice Douglas McKeon often sits with attorneys before medical malpractice cases go to trial to hash out settlements in judge-directed negotiations. Cases are assigned early on in the process to a judge with medical issues training who then holds frequent settlement conferences over several months, rather than the years it would take a trial to hammer out a settlement. Moreover, a nurse with legal training is assigned to help the judge. The Obama Administration has considered the approach as a way for states to curb liability expenses tied to increases in healthcare costs across the United States. In New York, officials say that the negotiation method has helped bypass years of court battles and reduced legal costs while at the same time providing injured patients with adequate compensation. With a $3 million federal grant, the program is set to expand to courts in Brooklyn, Manhattan, and Buffalo from courts in the Bronx. "We would hope that other states across the country would look at this as a model they might want to replicate," said James B. Battles, the official overseeing the grant at the federal Agency for Healthcare Research and Quality.

From the article of the same title
New York Times (06/13/11) Glaberson, William
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Medicine, Drugs and Devices

FDA Concerned About Drug Shortages
The FDA has asked for advance warning from drug makers of production shortages for medications,
particularly regarding "medically necessary" drugs, to ease the impact of ongoing drug shortages on consumers. According to the FDA, medical shortages are occurring with rapidly increasing frequency, even after a record high in 2010. The number of drug shortages has tripled over the last six years, up from 61 product shortages in 2005 to 178 in 2010, according to the FDA, not including shortages of vaccines, immune globulin products, other biologics, or products made from blood, tissue or other biological sources. The majority of the problems involve sterile injectables. Shortages have also occurred with prescription drugs taken orally. The FDA wants people to let them know if patients think their drug supply is limited. Doctors may be able to refer other drugs if there is a shortage, and the FDA can work with drug makers to get them to increase production if they know about a shortage ahead of time.

From the article of the same title
Baltimore Sun (06/13/11) Walker, Andrea
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Pfizer Touts First U.S. 'Virtual' Clinical Study
Pfizer is engaged in the first U.S. clinical study where patients participate by using mobile phones and the Internet rather than by going to hospitals repeatedly. The objective of the Research on Electronic Monitoring of OAB Treatment Experience (REMOTE) pilot study, which will test the safety and effectiveness of Pfizer's Detrol LA drug for overactive bladder, is to see whether "virtual" clinical studies can generate the same results as traditional ones; its success could mean that patients all over the country could participate in many future studies, permitting underrepresented groups to get involved, expediting data collection, and probably lowering costs and participant drop-out rates. The project was approved by the Food and Drug Administration, which has an initiative to enhance the quality and efficiency of patient studies. Some 600 patients in 10 states will enroll in the REMOTE study online, and then receive medication in the mail; the participants will then submit information online to one of the study investigators, noting when they take medication, how often they urinate, and details on symptoms and side effects.

From the article of the same title
Associated Press (06/09/11) Johnson, Linda A.
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Efficacy of Paracetamol Versus Diclofenac for Grade II Ankle Sprains
Researchers evaluated the effect of diclofenac,a nonsteroidal anti-inflammatory drug, versus paracetamol in the reduction of pain and acute edema of severe ankle sprains. Ninety patients with Grade II acute ankle sprains were randomized into two groups. Group A (45 patients) received for the first 10 days diclofenac 75 mg orally twice per day, while Group B (45 patients) received paracetamol 500 mg orally three times per day for the same period. The patients had no significant differences concerning their baseline values (p > 0.05). The ankle joint edema was decreased in both groups (p < 0.001) but there was more edema in group A than in group B at the third post-traumatic day with both measurement methods (p = 0.028/0.025). By the tenth post-traumatic day no difference was found. Pain decreased in both groups at the third day and at the tenth day (p < 0.001).

From the article of the same title
Foot & Ankle International (06/11) Lyrtzis, Christos; Natsis, Konstantinos ; Papadopoulos, Christos
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