News From ACFAS

• Congress is still on its July 4th recess and will return July 12. During this time the White House has said it will make a recess appointment to install Donald Berwick, MD, as head of the Centers for Medicare and Medicaid Services.
• USA Today reports that more employers and insurers are offering financial incentives to encourage workers to consider “domestic medical travel,” which focuses on facilities with high-quality care and lower prices inside the U.S. Employers are reporting cost reductions between 20 and 40 percent — more than enough to cover the travel expenses. This trend is likely to increase since it saves money by negotiating a single rate, including fees for surgeons, anesthesiologists, and all medical care until the patient is discharged.

The class will start when you are ready at ACFAS e-Learning! Refine your skills any time with free information from this valuable online library. The newest additions are:

• Podcast: Gearing Up for Residency
  • Tune in for tips on facing the challenges of going into residency.
• Scientific Session Video: Dysfunctional Forefoot
  • Foot and ankle surgeons address a variety of conditions, including multiple and stump neuromas, toe deformities, hallux varus, and damage from prior surgeries.

Visit ACFAS e-Learning to download podcasts, view scientific session videos and browse all the educational offerings.


Just in time for your summer getaway, the Council of Science Editors (CSE) offers a reading list that will take your mind in new, relaxing directions. Give your brain cells a rest; stop by your local library or bookstore and pick up one or two of the interesting titles from the CSE's "Summer Reading Roundup," from the May/June 2010 issue of Science Editor.

Catch up on research in journals you may not usually read with ACFAS’ Scientific Literature Reviews. Podiatric residents prepare article abstracts specifically for the interests of foot and ankle surgeons. Current abstracts include:

Continuous Peripheral Nerve Blocks for Postoperative Analgesia in Children: Feasibility and Side Effects in a Cohort Study of 339 Catheters, from the Canadian Journal of Anesthesia.
Reviewed by Michael R Brewer, DPM, Maricopa Medical Center.

Osteochondral Lesions of the Talus Treated With Fresh Talar Allografts, from Foot and Ankle International.
Reviewed by Vu Thai Nguyen, DPM, Maricopa Medical Center.

Read these reviews and many more on the ACFAS website.

Foot and Ankle Surgery

Decongestive Physiotherapy Helps Patients with Painful Leg Swelling

A combination treatment called complete decongestive physiotherapy can help patients with painful swelling in the legs caused by chronic venous insufficiency (CVI). The treatment improves symptoms, walking ability, and quality of life, according to a study in Topics in Geriatric Rehabilitation. Complete, or complex, decongestive physiotherapy (CDP) can significantly reduce leg swelling and pain in patients with CVI, according to the study. Researchers evaluated the effects of CDP in 62 older adults, with an average age of 65 years, with CVI. CVI causes poor blood flow in the veins of the leg, causing fluid buildup and resulting in painful swelling that can make if difficult to walk or perform other activities. Patients were treated with CDP, which combines manual lymph drainage, or massage to promote drainage, skin care to moisturize and treat other skin conditions caused by poor circulation, the application of compression bandages to prevent fluid reaccumulation, and simple leg exercises to improve blood flow and leg motion. CDP treatment dramatically reduced leg swelling, decreasing fluid building in the affected leg by the equivalent of nearly half a liter on average. Pain was also decreased, from an average score of 67 to 18 on a 100-point scale. Patients also had improved walking ability, less pain when walking, and an improved ability to perform daily activities. The researchers believe that including exercise was key to improving walking ability.



Hereditary Hemochromatosis as a Risk Factor for Joint Replacement Surgery

To determine the rate of joint replacement surgery in patients with hemochromatosis, researchers performed a cross-sectional cohort study of a total of 199 individuals with hereditary hemochromatosis, assessing the prevalence of joint replacement surgery in hip, knee, and ankle joints because of secondary osteoarthritis. A total of 32 of 199 individuals with hemochromatosis received joint replacement surgery with a total number of 52 joints replaced. Compared with expected rates in healthy individuals, patients with hemochromatosis had a significantly higher risk for joint replacement surgery (odds ratio 9.0; confidence interval, 4.6-17.4). Joint replacement also occurred significantly earlier in life in patients with hemochromatosis. Moreover, patients with hemochromatosis were more likely to require multiple joint replacements. The researchers concluded that hemochromatosis is a risk factor for joint replacement surgery because of severe secondary osteoarthritis.



Plyometrics Better Than Resistive Exercises for Improving Functional Performance After Lateral Ankle Sprain

Researchers reported on the effects of plyometric training on muscle strength and function following lateral ankle sprains. Plyometrics have been strongly recommended for the late-stage rehabilitation of many lower limb injuries, but until now there has been no research on its effects on muscle strength and function when treating lateral ankle sprains. The researchers compared the effectiveness of plyometric training and resistive exercises in a study that included 22 athletes, between 20 and 35 years old, with grade I or II unilateral inversion ankle sprains. Patients were randomly assigned to either 6 weeks of plyometric training or resistive exercises. Before and after training, researchers assessed isokinetic peak torque/body weight for invertors and evertors at 30 and 120, along with functional tests. Plyometric and resistive training improved isokinetic evertor and invertor peak torques and functional performance, and no significant differences between groups for peak torque/body weight for invertors and evertors was found at either speed. However, the plyometric training group showed significantly higher functional test scores than the resistive group.

Practice Management

Costs, Managing Finances Top List of Challenges for Practice Managers: MGMA

Rising operating costs, managing finances, and selecting a new EHR system are the top three challenges facing group practice managers, according to a survey of 1,798 individuals by the Medical Group Management Association (MGMA). “It is not surprising that ‘maintaining finances with the uncertainty of Medicare reimbursement rates' jumped to the No. 2 spot this year due to the continued congressional irresponsibility in not permanently addressing the flawed sustainable growth rate formula,” said MGMA President and CEO William Jessee. Medicare reimbursement uncertainty ranked No. 5 in the survey the previous two years.



New Study Finds 91% of Physicians Practice Defensive Medicine

The fear of being sued for medical malpractice is pervasive, leading 91percent of physicians across all specialty lines to practice defensive medicine, according to a new study finds by researchers from Mount Sinai School of Medicine in New York City. The study also found that the same percentage of physicians believe that tort reform measures to provide better protections against unwarranted malpractice suits are needed before any significant decrease in the ordering of unnecessary medical tests can be achieved. The researchers surveyed 2,416 physicians from a variety of practice and specialty backgrounds in a survey conducted between June 25, 2009, and October 31, 2009. Their findings were published in the June 28 issue of the Archives of Internal Medicine.



See You in 6 Months. And Your Insurer Is OK With the Bill.

In the near future, conversations between a doctor's office and a patient's insurer could start before the patient has even finished getting dressed in the exam room. For example, a claim is submitted by the doctor's software system, and the doctor's office could receive payment commitment from an insurance company almost instantly, just as credit card companies confirm payment in retail. Such instant payment has been discussed in the healthcare industry long enough to be given an official name, "real-time claims adjudication." However, adoption of such systems has been slow.

The American Medical Association recently released a report stating that for the seven major insurers studied, the median number of days for a response to claims submitted electronically by doctors ranged from 5 to 13 days. Mark Reiger, chief executive of NHXS, a software provider specializing in services to physicians, says there is no good reason for the delay. Major insurers, which handle more than a million claims a day, have to handle all claims the same day they are received, or they risk being overwhelmed in a single day. However, once claims are priced, or the amount to be paid is determined, they are turned over to a department that handles the insurer's payments. The payment department is not slowed for any technical reason, but may have business reasons to delay payment.

Insurers are required to make payment on the 15th day, and data from NHXS shows that insurers almost always pay on the 14th day, no sooner or later. However some insurers have been pushing for the adoption of real-time claims adjudication. Harvard economics professor David Cutler says he believes real-time claims adjudication can help cut in half the $250 billion to $300 billion he estimates is spent on administrative health care costs each year within five years.

Health Policy and Reimbursement

CMS Says It Will Hold Off Rejecting Claims Made by Providers Not in Agency Database

CMS has announced that it will delay implementation of a plan to automatically reject claims submitted by providers who are not in an agency database. In an interim final rule published in May (84 HCDR, 5/4/10), CMS required that physicians who order/refer for covered Part B services revalidate their enrollment through an online system by July 6. The rule stemmed from healthcare reform requirements and applied to orders, referrals, and certifications made on or after July 1.



CMS To Combine Quality Reporting Programs

Physicians who report quality measures to CMS under the Physician Quality Reporting Initiative (PQRI) using EHRs will soon be able to combine data with physicians who demonstrate "meaningful use" of those records under the HITECH Act. Meaningful use measures that physicians could use for PQRI reporting through electronic health records include blood pressure measurement for hypertension, body mass index screening, and prevention care follow up. The deadline for combining the two programs is Jan. 1, 2012, under the new healthcare reform law.



Joint Commission Makes Minor Revisions to National Patient Safety Goals

The Joint Commission has announced revisions to four elements of performance (EP) included in its National Patient Safety Goals (NPSG). The revisions were announced in the June 23 Joint Commission Online. They include changes to NPSG.03.05.01, EP 6: Related to anticoagulant therapy-required lab-tests; NPSG.07.04.01, EP 11: Related to central line-associated bloodstream infections, specifically antiseptics for skin preparation; NPSG.07.05.01, EP 7: Related to surgical site infections, specifically administration of antimicrobial agents for prophylaxis; and NPSG.07.05.01, EP 8: Also related to surgical site infections, specifically methods for hair removal.

Technology and Device Trends

Chromosomal Abnormality Found for Inherited Clubfoot

Genetic screening has led researchers to what they believe is the most common cause of inherited clubfoot yet discovered. By performing a routine genetic screening used to evaluate children for neurodevelopmental disorders on 66 patients with an inherited form of clubfoot, the researchers found abnormalities in a region of chromosome 17 in four patients. Three of the patients had small recurrent DNA duplications, and one had a small recurrent DNA deletion on chromosome 17. The results will be published in the July 9 issue of the American Journal of Human Genetics.



Pioneering Vet Gives Cat New Prosthetic Feet

A cat that had its back feet severed by a combine harvester has been given two prosthetic limbs in a pioneering operation by a veterinarian in the United Kingdom. The new feet are custom-made implants that "peg" the ankle to the foot. They are bioengineered to mimic the way deer antler bone grows through the skin.

The prosthetic pegs, called intraosseous transcutaneous amputation prosthetics (Itaps), were developed by a team from University College London (UCL) led by Professor Gordon Blunn, who is head of UCL's Centre for Biomedical Engineering. Blunn says the idea was initially developed for patients with amputations who have a stump socket.

The Itap technology is being tested in humans and has already been used to create a prosthetic for a woman who lost her arm in the July 2005 London bombings.



Progress Made on Artificial Pancreas for Diabetic Patients

Scientists are making advancements on an artificial pancreas for children and adults with type 1 diabetes, and they announced new technology at the 70th Scientific Sessions of the American Diabetes Association this past weekend. There are three components to the artificial pancreas: a continuous glucose monitor, an insulin pump, and a computer program that can help the two devices communicate to automate the process. The monitor and pump are already available, as illustrated in a study published by The Lancet, and can help control blood glucose levels during sleep to reduce the chance of hypoglycemia in children with type 1 diabetes. The latest presentation explained that the system provided similar benefits for 12 adults, ages 18 to 65 years, who ate a large meal and drank a glass of white wine before bed. With this technology, participants were within their target blood glucose range 70 percent of the time, compared to only 47 percent when they did not use the technology.



Abstract News © Copyright 2010 INFORMATION, INC.

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