News From ACFAS

ACFAS leaders and members alike were disappointed that the Texas Supreme Court chose not to hear an appeal from the Texas Podiatric Medical Association on its lawsuit with the Texas Orthopedic and Medical Associations involving the legal authority of the Texas State Board of Podiatric Medical Examiners to interpret the laws regulating the podiatric medical profession. Current rules illuminate the practice of podiatry to include the treatment of ailments and injuries of the foot and ankle. The Texas Board of Podiatric Medicine will be filing for a rehearing to reconsider its ruling, and ACFAS supports that initiative.

In the short term, physicians have avoided a 21 percent cut in CMS reimbursement and gained a 2.2 percent reimbursement increase for their services through November 30. But what happens next?

CMS could decide to begin anew and base future targets on actual current spending levels with modifications. Or, Congress could end the sustained growth rate system and either freeze future rates or let them rise with inflation. Or, Congress could continue with the current pattern of repeated short-term fixes because, experts say, it seems it will never get around to fixing the actual system.

Other options for longer-term solutions include setting spending targets by services, geography, by specific providers or groups of providers — or constraining high-cost areas by attempting to change physician behavior. Some favor increased primary and preventive payments, while clamping down on imaging services. One thing is certain; the “fix” has yet to come.

The July/August issue of the Journal of Foot & Ankle Surgery will be mailed next week, but ACFAS members can use their free access to read all of it today, including 10 new case reports that are available exclusively online.

Don't wait to read the original research, literature reviews, tips, quips and pearls, and online-only case reports. Log on at the ACFAS website and follow the links in the right menu for seamless access to full text of the new issue of JFAS.

The ACFAS Regional Divisions support first-year podiatric surgical residents by providing complimentary first-year membership in the College. This is a direct value of $112, plus additional savings through member pricing on conferences, products and services. Residents’ membership year begins on October 1.

“The Division Presidents’ Council is excited to be able to offer this to new residents. We believe that supporting our young residents is not only of benefit to them, but to our profession as a whole,” says council Chair Kimberly Eickmeier, DPM, FACFAS. “Access to the College will help start their careers with a strong educational base, and provide a connection to a community of their peers — the best and brightest foot and ankle surgeons in the country.”

New residents can take advantage of this offer by downloading an application from the ACFAS website.

Get quick reads on recent research with ACFAS’ Scientific Literature Reviews. Podiatric residents have prepared concise reviews of articles from journals you may not commonly read. Current abstracts include:

Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial, from the Journal of American Medical Association.
Reviewed by Joshua P. Daly, DPM, Florida Hospital East Orlando.

Long-term Glucose Control and Risk of Perioperative Complications, from the American Journal of Surgery.
Reviewed by Adam J. Peaden, DPM, Florida Hospital East Orlando.

Read these reviews and many more on the ACFAS website.

Foot and Ankle Surgery

Comparison of Modified Das De Procedure With Du Vries Procedure for Traumatic Peroneal Tendon Dislocation

Researchers investigate the clinical outcomes of a modified Das De procedure (MD) and compared the clinical outcomes to those of the Du Vries procedure (DV) that was performed in their hospital until 1996. From 1996 to 2007, 19 patients were treated by MD and from 1988 to 1996, 15 patients were treated by DV. A mean preoperative Ankle-Hindfoot Scale was 78.4 points (range: 65–84) in the MD group and 77.2 points (range: 67–87) in the DV group. A mean postoperative Ankle-Hindfoot Scale was 93.4 points in the MD group and 89.4 points in the DV group. Two patients in the DV group suffered postoperative peroneal tendon redislocation, while in the MD group, there was no postoperative peroneal tendon redislocation or complication related to skin incision. In athletes, 80.0% in the MD group and 54.5% in the DV group were able to return to their previous sports. The mean duration to return to sports was 2.9 months in the MD group and 3.9 months in the DV group.



Double Calcaneal Osteotomy and Percutaneous Tenoplasty for Adequate Arch Restoration in Adult Flexible Flat Foot

Treatment of adult acquired flexible flat foot deformity can be problematic. Triple arthrodesis for structural correction has been the standard of care, thus sacrificing hind foot motion. Researchers assessed the value of double calcaneal osteotomies in improving structural alignment while maintaining hind foot motion, which may further protect the function of adjacent motion segments. Double calcaneal osteotomies (Evans osteotomy and posterior calcaneal displacement osteotomy) were performed on 17 feet of 14 patients. Postoperative follow-up showed significant improvement in clinical foot and ankle scores.

Practice Management

CMS Releases MLN Matters Special Edition Article for Providers Affected by MAC Implementations

CMS has released MLN Matters Special Edition Article #SE1017 to assist providers that will be affected by Medicare Administrative Contractor (MAC) implementations. More details can be found here.



CMS Update Indicates High Provider Success Rate for Appealing Denials

A recently-released report from CMS indicates that providers have been winning more appeals since the last update. The new report contains statistics through March 9, 2010, and shows that the number of appeals claims dropped significantly from the 118,051 reported in January to the 76,073 in the new data. This came as a result of claims no longer being counted individually at each level of appeal, but rather being counted only once if appealed to any level.



New Rx for Young Doctors: Shorter Work Day

Patients will be told when they're being treated by rookie doctors, and those doctors would get shorter shifts and better supervision under a proposal from the Accreditation Council for Graduate Medical Education. Under the proposal, interns would be more closely supervised by experienced doctors and the maximum length of their work shifts would be cut from 24 hours to 16 hours. Maximum work shifts would remain 24 hours for residents in their second year and beyond. Maximum work weeks would remain at 80 hours for all hospital residents. All residents and their supervisors would also be required to explain their roles to patients and explain that supervisors are ultimately in charge of their care.



What Physicians Want

Community Care Physicians in Latham, N.Y., is a physician-owned group practice that offers the benefits of hospital employment in the primary form of staff job satisfaction, particularly patient interaction, according to founder and CEO Shirish Parikh, MD. His challenge is to offer physicians maximum flexibility, and this aligns with patients' wants. All Community Care doctors have the opportunity to become shareholders; each physician is employed, but at the conclusion of his or her second year, he or she can be nominated by shareholders to become a shareholder, after which he or she can choose to stay employed or purchase shares. Parikh and Community Care's chief operating officer seek various ways for expanding the practices' footprint. They want the practice to be accessible to patients for nearly everything that does not require an inpatient stay, which begins with being the patient's information repository. To facilitate this, access to physicians is available by phone, electronically, or through traditional visits.

Health Policy and Reimbursement

CMS Launches EHR Incentive Website

The Centers for Medicare & Medicaid Services (CMS) has unveiled a website to provide healthcare professionals with information about electronic health record (EHR) incentive programs. By overseeing a certified EHR system, the site asserts, providers will realize benefits beyond monetary incentives, like fewer errors, wider availability of records and data, reminders and alerts, and medical decision support. The incentive payment programs will be rolled out beginning in 2011.

The Office of the National Coordinator for Health Information Technology (ONC) recently issued a final rule to establish a temporary certification program for EHR technology. The final rule has been posted to the CMS site, along with an overview of the incentive programs, the criteria for eligibility for individual providers and hospitals, information on certification bodies, and an outline on meaningful use requirements. The site also has information for states that voluntarily offer the Medicaid EHR incentive program to their Medicaid-eligible professionals.



Debate Over Industry Role in Educating Doctors

The debate over the medical industry's role in doctors' postgraduate education is heating up. In the latest salvo, the University of Michigan Medical School has decided to no longer accept any money from drug and device makers to pay for coursework doctors need to renew their medical licenses. The debate has ignited public skirmishes as doctor groups have clashed over proposals for new limitations on industry involvement in continuing medical education courses. For instance, the accrediting body for postgraduate medical education recently announced that it would no longer grant credit to doctors for attending medical meetings that feature industry employees presenting product research.



Doctors Limit New Medicare Patients

Recent surveys by national and state medical societies have found that more physicians are limiting Medicare patients, partly because lawmakers failed to find a permanent solution that will prevent a 21 percent cut in payments. A survey by the American Academy of Family Physicians found that 13 percent of respondents did not participate in Medicare last year, up from 8 percent in 2008 and 6 percent in 2004. According to the American Osteopathic Association, 15 percent of its members do not participate in Medicare and 19 percent do not accept new Medicare patients. The American Medical Association reports that 17 percent of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice.

Technology and Device Trends

A Data Gold Mine

Hospitals are using EMR data to conduct clinical research, improve quality, and inform business decisions. At Montefiore Medical Center in Bronx, N.Y., for example, a researcher wanted to analyze whether a new clinical research tool the system had developed could duplicate the results of studies of the antibiotic gatifloxacin. The analyst performed the query on his lunch break using a software program that taps into more than a decade's worth of EMR data. The program interprets de-identified data for entire patient populations and can be used to gauge the effectiveness of patient safety measures, identify and track public health threats, and provide data for professional articles and published studies. It can also measure the impact of Medicare regulations on rehabilitation patients, quantify the reduction in radiation exposure for emergency department patients, and track the care and progress of diabetes patients over time.



Robotic Device Gives Stroke Survivors a Leg Up

The NewYork-Presbyterian Hospital/Columbia University Medical Center is using a new bionic leg to help stroke survivors who have difficulty walking, potentially allowing them to move on their own. Motors and a computer within the device provide the assistance and resistance patients need to enable their stroke-weakened leg to work in concert with their unaffected leg during therapy. While patients wear the device, therapists teach them movements like getting up from a chair and walking and climbing stairs with both legs. As patients progress, therapists progressively "dial back" support provided by the device, until the patients are able to walk safely without it.



Total Ankle Replacement Compatible with Ligament Function Produces Mobility, Good Clinical Scores, and Low Complication Rates

Researchers developed a three-part ankle replacement to achieve compatibility with the natural ligaments by allowing fibers on the medial and lateral sides to remain isometric during passive motion. Unlike all current prostheses, the new design uses nonanatomically shaped components on the tibia and talus and a fully conforming interposed meniscal bearing. The researchers reviewed 51 patients in whom 51 prostheses were implanted in a seven-center trial from July 2003 to July 2006. The mean preoperative AOFAS score of 38.5 increased to 76.9, 79.1, 76.4, and 79.0 at 12, 24, 36, and 48 months, respectively. The researchers observed a correlation between meniscal bearing movement on the tibial component and range of flexion at the replaced ankle. They concluded that the new prosthesis can provide short-term restoration of ankle mobility, a good clinical score, and low complication and failure rates, but that longer followup with a larger number of patients is required.



Abstract News © Copyright 2010 INFORMATION, INC.

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