News From ACFAS

If you’re having trouble keeping up with the numerous health care reform proposals that have been put forth in Congress, ACFAS recommends you check out the regularly-updated side-by-side comparisons available on the Kaiser Family Foundation web site. KFF, a highly regarded non-partisan source of facts on health policy, provides an interactive tool for comparing selected proposals and topics.

ACFAS members may access this useful resource using the web link, below.

Are you ready to integrate evidence-based medicine into your practice? You’ll learn a practical approach to applying EBM knowledge to guide your clinical decisions with the latest in the Scientific Sessions series on ACFAS e-Learning.

“EBM Principles in Clinical Scenarios,” which may be viewed at no cost, was originally presented at an ACFAS Annual Scientific Conference. Moderator Chris Lamy, DPM and his panel of experts focus on frequently asked questions in a case-based approach.

ACFAS members can earn continuing education credit by completing and submitting the online post-test at the conclusion of the session. View the session anytime, 24/7, using the web link, below.


A grant of up to $20,000 is available to ACFAS Fellow and Associate members for research within the podiatric surgical arena that will have a direct or indirect impact on issues of interest to members of the College.

Proposals meeting evidence-based medicine levels of evidence 1, 2 or 3 will be considered for the grant.

The deadline for proposal submission is October 15, 2009. Applications may be submitted online using the web link, below.

Make the most of downtime…whether you’re waiting for the OR to open up or suffering through a flight delay…by staying abreast of the latest research with Scientific Literature Reviews, a monthly feature on ACFAS.org. In just a few minutes you can read abstracts of research from journals you may not regularly see.

Residents at the Miami VA Medical Center have prepared six new reviews this month, on topics such as

• Five-year Functional Analysis of Ankle Fracture Fixation
• Osteoporosis in Men
• Deep Vein Thrombosis After Achilles Tendon Rupture
• Eccentric Loading vs Shock Wave for Achilles Tendinopathy

These reviews, as well as archives of previous issues, may be accessed via the web link, below.

Foot and Ankle Surgery

Grice Arthrodesis in the Treatment of Valgus Feet in Children With Myelomeningocele

Surgeons from Oslo, Norway, sought to evaluate long-term patient satisfaction and clinical effects in ambulating children with lumbosacral myelomeningocele after a Grice arthrodesis of a valgus unstable foot is performed in this 12.8-year follow-up study. The study was based on modified Grice–Green extraarticular subtalar arthrodesis performed by the study authors on one standing and 22 walking patients with lumbosacral myelomeningocele and valgus instability between 1985 and1999. The researchers concluded that the patients participating in this study benefited from having had Grice arthrodeses performed on their valgus unstable feet, which reulsted in "good long-term correctional effect on valgus deformity after Grice arthrodesis, as the talo-calcaneal and talo-first-metatarsal angles improved significantly." Mostof the patients were content with the surgery, and none "claimed that any residual deformity was the cause for reduced ability to ambulate."



Vascularized Bone Transfer for Severe Injury Around the Ankle

Vascularized bone transfer has the potential to span bone defects, eradicate infection, and provide soft tissue coverage all in one stage for severe injuries around the ankle. Researchers evaluated some of the various options available for managing severe injuries in relations to vascularized bone grafts, focusing on surgical timing, potential donor sites, outcomes, and possible complications. The fibula was found to be the best choice for transfer, producing the best results and the least donor site morbidity and offering the best chance for salvage of a functional limb.

Practice Management

Cleveland Clinic Pushes Into Future

The Cleveland Clinic has taken a patient-centric approach to healthcare reform, and in the process greatly reduced costs. The clinic, consistently rated as one of the best in the country, has been cited by President Obama as an example of how healthcare should be and can be delivered. One of the things that distinguishes the clinic is its physician pay structure. Doctors are paid a fixed salary. This reduces costs by eliminating incentives to perform more procedures and has also brought surgeons and nonsurgeons together in trying to find the best way to prevent costly procedures.



Patients to Get a Look at Physicians' Notes

One of the most intense areas of debate in efforts to computerize medical records is whether patients should be allowed to see their doctors’ notes online. These notes are typically not readily available to patients because hospitals and doctors’ groups fear that the patients will misunderstand medical jargon, take offense at observations, or worry unnecessarily about a precautionary test.

Beth Israel Deaconess Medical Center in Boston, however, is set to launch a project called "open notes," in which about 100 doctors at the hospital and two other sites will allow 25,000 to 35,000 patients to read their notes for a year as part of their online medical record. The project aims to determine whether access to the notes can improve care by giving patients more knowledge about their treatment and about their doctors’ instructions.



Ready for Medicare's Audit Police?

The Medicare Recovery Audit Contractor (RAC) pilot program, in place since 2005, identified $992.7 million in overpayments through 2008. The pilot, considered a success by the Centers for Medicare & Medicaid Services (CMS), is over, and the permanent version is now being rolled out. Though most audits to date have focused on large targets like hospitals, auditors are expected to turn their attention to practices in the near future. To prepare for a possible audit, physicians should perform self-audits, especially regarding documentation of medical necessity and coding practices. Forty percent of the dollars recovered by RACs in the pilot phase related to medical necessity, and another 35 percent were for incorrect coding.



Small Practices Lack Resources for Quality Upgrades

Small practices provide nearly three quarters of all ambulatory care in the United States, yet many of them lack the resources to improve the quality of care, implement electronic health records and serve an increasingly diverse population, according to the report Supporting Small Practices: Lessons for Health Reform released by the National Committee for Quality Assurance (NCQA). In the report, NCQA notes that small practices are more than willing to adapt but need help. The report provides specific examples of potential assistance, including developing templates for organizing medical information, sharing services or staff to support interpreter needs, and learning collaboratives to hear from other practices, stakeholders and local, state and national policy makers.

Health Policy and Reimbursement

Reform Seen as More Important Than Ever

Sixty-one percent of Americans believe healthcare reform is more important than ever given the economic situation, according to a June health tracking poll from the Kaiser Family Foundation. Sixty percent say the nation’s healthcare system could be reformed without spending more money to do so. Fifty-five percent of respondents reported that they or another member of their household have put off some medical care over the past 12 months because of costs, and 70 percent supported the idea of insurance exchanges as a way to help people purchase insurance on their own.



Secretary Sebelius Releases New Report: Hidden Costs of Health Care

A new report released by the U.S. Department of Health and Human Services documents the impact of deductibles, co-payments, and out-of-pocket expenses associated with employer-based healthcare coverage. The report notes that a person with employer-based coverage paid an average of $1,522 on healthcare (not including premiums) in 2006, compared with $1,260 in 2001. When factoring in higher premiums, out-of-pocket costs rose from an average of $2,827 in 2001 to $3,744 in 2006. The report also found that employer-sponsored health insurance premiums nearly doubled since 2000, a rate three times faster than wages, with the average premium for a family plan purchased through an employer reaching $12,680 in 2008.



Senator: Use of Faulty Insurance Data 'Pervasive'

Congressional investigators report that two-thirds of the U.S. health insurance industry used the Ingenix database that overcharged patients for seeing doctors outside their insurance network. UnitedHealth Group, the parent of Ingenix, agreed in January to pay $350 million to settle allegations by New York Attorney General Andrew Cuomo that it deliberately kept rates low to underpay doctors, boosting expenses for patients. An investigation by Sen. John Rockefeller (D-W.Va.) shows that nearly 20 regional and national insurers used Ingenix data. About a dozen insurers have already reached settlements with Cuomo and have agreed to contribute funds to develop a new, independent database to determine “usual and customary” rates.



Senator Introduces Legislation to Increase MedPAC's Power Over Physician Reimbursement

Sen. John Rockefeller (D-W.Va.) has introduced legislation that would establish the Medicare Payment and Access Commission (MedPAC) as an independent executive body. Currently, MedPAC is a legislative entity that makes recommendations to Congress regarding Medicare payment policies, but it has no power to implement those recommendations and Congress often disregards its advice. As an executive body, MedPAC would have independent authority to establish payment policies. In turn, Congress would increase its oversight of the commission and commissioners would have to be confirmed by the Senate.

Technology and Device Trends

A Pneumatically Powered Knee-ankle-foot Orthosis (KAFO) With Myoelectric Activation and Inhibition

Researchers tested the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO) powered by artificial pneumatic muscles during human walking. For the study, three healthy males were fitted with KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. The researchers concluded that the proportional myoelectric control with flexor inhibition allows for a more normal gait than direct proportional myoelectric control. Current KAFO design provides knee torques smaller than the ankle torques due to the trade-off in torque and range of motion that occurs with artificial pneumatic muscles. Future designs should incorporate cams, gears, or different actuators to transmit greater torque to the knee.



Botox Helps Australian Stroke Victim to Walk Again

Botox injections have helped a stroke victim in Australia regain his ability to walk after 20 years of paralysis. The patient had been unable to walk because the stroke had left his muscles in permanent spasm due to signals coming from the brain. Botox stopped the spasms, allowing the patient to stretch out the affected leg muscles for the first time in decades and strengthen other muscles needed for walking.



No Benefits Reported After Using Platelet Concentrate With Achilles Tendon Ruptures

Researchers are exploring alternatives like platelet concentrate and stem cells for treating ruptured Achilles tendons, but results of a randomized study led by Thorsten Schepull, MD, of Linköping University, Sweden, found that the addition of platelet concentrate provided no added healing benefit in these cases. Prior to surgery, researchers obtained a unit of blood from each patient to produce about 20 milliliters of platelet concentrate per patient. Sixteen patients received the autologous platelet concentrate prior to wound closure and 14 patients did not. Tantalum beads were implanted on either side of the rupture in all patients to help determine how the tendon was healing mechanically.



Tougher Medical Device Oversight Urged

A recent hearing of a House Energy and Commerce Committee subcommittee raised concerns over the ability of current FDA procedures to ensure the safety of medical devices. Committee chair Rep. Frank Pallone (D-N.J.) said that the committee was attempting to determine if medical device safety could be improved by legislative action or increased FDA oversight.

Marcia Cross, healthcare director for the Government Accountability Office, testified at the hearing that various shortcomings "raise concerns" about the FDA's pre-approval device reviews and postmarket surveillance processes "that are necessary for ensuring the safety and effectiveness of medical devices." Dr. William Maisel, head of the Medical Devices Safety Institute, testified that recent recalls of some medical devices raised questions about the efficacy of the FDA's ability to identify device safety issues.

Although no FDA officials testified at the hearing, FDA Commissioner Margaret Hamburg recently announced that she plans to closely investigate the FDA's use of abbreviated approval processes for medical devices and determine if more thorough reviews are necessary.



Abstract News © Copyright 2009 INFORMATION, INC.

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