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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

July/August JFAS: Filled with “Must-Reads” for the Foot and Ankle Surgeon

Beyond the original research and case reports readers will find in the July/August issue of the Journal of Foot & Ankle Surgery, new and interesting features include:

• A JFAS Instructional Course presenting a detailed illustrated technique guide for the “Cotton osteotomy”

• A review of the etiology and pathophysiology of benign bone tumor development in the foot and ankle

• The first in what will be a series of articles addressing ethical issues in foot and ankle surgery, “Limb Salvage versus Amputation in the Setting of an Amended Calcaneal Bone Biopsy Report.”

The July/August JFAS is in the mail, but ACFAS members can read it now using the web link, below.

New “Red Flags” Rule Tools Now Online

With the August 1 red flags rule compliance deadline looming, ACFAS has additional tools available online via the web link, below.
July Podcast: How to Conduct Research

“The purpose of conducting research is not only to add to the body of knowledge, but to challenge established dogma,” says Research Committee Chairman Paul Kim, DPM, in the latest ACFAS e-Learning podcast. “Ultimately this leads to better patient outcomes.”

But, as a clinician, how do you go about conducting research? The July podcast, with suggestions from top researchers in the field of foot and ankle surgery, answers many of the questions faced by those who would like to conduct research but just don’t know where to start.

Tune in to “How to Conduct Research: An Introduction,” using the web link, below.

Connect with Your Patients: Send the Summer FOOTNOTES Newsletter

Stay top of mind with your patients when you send them the new summer edition of the FOOTNOTES patient newsletter. This issue educates them about skateboarding injuries, warns them of the hazards of going barefoot, and reminds them to include their feet when applying sun screen.

FOOTNOTES is free to all ACFAS members, and is available in English and Spanish. Use the web link, below, to download it today.

Foot and Ankle Surgery

Complement Activation and Plasma Levels of C4b-binding Protein in Critical Limb Ischemia Patients

Researchers from Sweden and Norway sought to determine whether levels of complement activation and C4b-binding protein (C4BP) are predictive for the severity of critical limb ischemia (CLI), and, if so, whether their measurement might be of clinical advantage. The study involved 259 consecutive patients with CLI admitted to a secondary referral center for vascular diseases. The researchers concluded that increased complement activation and C4BP plasma levels are related to the degree of tissue necrosis and disease severity of critical limb ischemia, and that this knowledge, in combination with correlations to other biomarkers, is useful for understanding the pathophysiology of the disease.

From the article of the same title
Journal of Vascular Surgery (07/01/09) Martin, Myriam; Gottsäter, Anders; Nilssonk, Peter M.

FDA Panel Makes Recommendations to Reduce the Risk of Liver Damage Associated With Acetaminophen

An FDA advisory panel has voted to recommend that the agency ban acetaminophen/oxycodone (Percocet) and acetaminophen/hydrocodone (Vicodin) because of the risk of liver damage. The panel noted that many patients who take Percocet and Vicodin often develop tolerance after taking the drugs for an extended length of time, but the acetaminophen present in both drugs has been known to cause liver damage. To reduce accidents from overdosing on acetaminophen, the committee also voted to recommend that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter (OTC) medications, to 325 mg from 500 mg. Additionally, the committee voted against limiting the number of pills allowed in each bottle, which panel members said could hurt rural and poorer patients. However, most panel members agreed that consumers needed to be better educated about the risks of popular medications.

From "Panel Recommends Ban on Two Popular Painkillers"
New York Times (07/01/09) Harris, Gardiner

The Relationship Between the Deep Fibular Nerve and the Dorsalis Pedis Artery and Its Surgical Importance

The aim of this study was to demonstrate the relationship between the deep fibular nerve and the dorsalis pedis artery to provide useful knowledge for foot and ankle surgeons during the surgical release of the nerve. The dissection of 30 cadaver lower limbs was undertaken to describe the relationship. Four distinct relationships of the deep fibular nerve to the dorsalis pedis artery were determined: The dorsalis pedis artery was medial to the deep fibular nerve in the tunnel and medial to the medial terminal branch distal to the tunnel on the dorsum of the foot; the artery was medial to the deep fibular nerve in the tunnel and lateral to the medial terminal branch distal to the tunnel on the dorsum of the foot; the deep fibular nerve and the artery crossed over each other at multiple levels; and no medial terminal branch of the deep fibular nerve was observed.

From the article of the same title
Indian Journal of Plastic Surgery (06/29/09) Chitra, R.

Practice Management

Medicare Plans to Cut Specialists' Payments

The Obama administration has unveiled plans to cut Medicare payments for imaging services and specialists . Under the proposal, the savings would be used to increase payments to primary care physicians, thereby closing the gap between Medicare payments to specialists and payments to primary care doctors. The White House is seeking to boost interest in primary care a number of ways. For example, approximately $500 million in stimulus funds were allotted to train more primary care doctors and repay the student loans of primary care doctors who work in underserved areas.

From the article of the same title
Wall Street Journal (07/02/09) Zhang, Jane

The Doctor Will Text You Now

Thirty-nine percent of doctors said they have communicated with patients online in 2009, up from just 16 percent five years ago, according to a survey by health information firm Manhattan Research, a unit of Decision Resources Inc. The increase is largely attributable to the fact that more health insurers are paying doctors for treating patients online, though typically at a lower fee scale than for traditional in-office appointments. Among companies that now cover digital visits are Aetna, Cigna, and Blue Cross Blue Shield plans in Florida, Hawaii, and North Carolina. WellPoint and Humana are piloting payments for online care in parts of the country and may expand coverage.

From the article of the same title
Wall Street Journal (06/30/09) Mathews, Anna Wilde

Two States Restrict Firms' Gifts to Doctors

Laws taking effect July 1 in Massachusetts and Vermont ban pharmaceutical companies and medical device makers from giving doctors gifts such as resort trips or even coffee mugs. Offering free meals is now banned under the Vermont law and greatly curtailed in Massachusetts. Lawmakers in Oregon, Texas, Connecticut, Colorado, Illinois and Maryland have been debating whether to impose similar bans or to require public disclosure of such gifts.

From the article of the same title
Wall Street Journal (07/01/09) P. A3; Armstrong, David

Doctor Builds Web Care System

Brooklyn, N.Y.-based physician Jay Parkinson, called "The Doctor of the Future" by Fast Company magazine, is the founder of Hello Health, a national franchise of clinics that allow patients and doctors to communicate via email, text messages, or videochat. Hello Health does not accept insurance. Patients pay $100 for quick in-person or online visits and $200 for more extensive visits. They also pay a $35 monthly membership fee that covers simple questions via email. The three-doctor demonstration Hello Health clinic that was opened in Brooklyn has 400 regular patients.

From the article of the same title
Boston Globe (06/21/09) Wangsness, Lisa

Health Policy and Reimbursement

Walmart Endorses Employer Mandate

Wal-Mart has voiced its support for requiring employers to provide health insurance to workers. The support of Wal-Mart could give momentum to one of the most-contentious aspects of legislation taking shape in Congress to reform U.S. healthcare, a proposal mandating that employers provide insurance for workers or help pay for it. Lobbyists for large corporations, including the U.S. Chamber of Commerce, oppose the proposal, arguing that it would prompt companies to cut jobs and wages and possibly drive them out of business. Support for a federal employer mandate comes with conditions, Wal-Mart says, including its being a part of larger efforts to rein in healthcare costs, exemptions for some small firms, and pegging it to a moderately priced benefits package similar to the coverage Wal-Mart already offers most of its workers.

From the article of the same title
Washington Post (07/01/09) Connolly, Ceci

Stimulus Money Boosts Health Clinics Serving Poor

The stimulus package allocates $2.5 billion for free and low-cost health clinics, with approximately $500 million already being spent. The funding will allow these clinics to keep their doors open as the number of uninsured patients grows. Approximately 64 million people use rural health clinics, a number that will likely rise as more people lose their jobs and health insurance.

From the article of the same title
Associated Press (06/29/09) Wyatt, Kristen

CMS Releases Outpatient, ASC Payment Rule

Hospital outpatient departments will see a 1.9 percent increase in their Medicare payments in 2010 under a proposed CMS rule. The proposal also expands the number of surgical procedures Medicare would cover when performed in ambulatory surgical centers (ASCs). Total payments to ASCs are estimated to be $3.4 billion in 2010.

From the article of the same title
Modern Healthcare (07/01/09) Lubell, Jennifer

'Frequent Fliers' Add Billions to Hospital Bills

"Frequent fliers," patients who leave the hospital only to return days or weeks later, are a major challenge for hospitals and doctors as well as policymakers trying to control healthcare costs. The elderly and those suffering from chronic diseases account for three quarters of healthcare spending, and their experiences of being readmitted multiple times highlight some of the deficiencies in a fragmented, poorly coordinated health system focused on acute care.

As potential solutions, policymakers have proposed the bundling of payments to hospitals, doctors and perhaps nursing homes or rehabilitation centers to cover hospitalization and those first critical weeks after discharge. Another proposal is to have Medicare penalize hospitals with high readmission rates for eight common chronic diseases. Also being investigated are ways of paying primary care doctors more to help patients manage their chronic diseases and avoid repeated trips to the hospital.

From the article of the same title
Washington Post (06/30/09) Kenen, Joanne

Technology and Device Trends

47,000 Elderly Hurt in Walker, Cane Mishaps Each Year

CDC reports that more than 47,000 elderly Americans are treated at hospital emergency departments for injuries from falls that involve walkers and canes each year. The research found that people 65 and older were seven times more likely to be injured in a walker-related fall than in a cane-related fall, and that women sustained 78 percent of walker-related injuries and 66 percent of cane-related injuries.

"Walking aids are very important in helping many older adults maintain their mobility. However, it's important to make sure people use these devices safely," says study lead author Judy Stevens. "Walkers are often used by frail and vulnerable older adults; people for whom falls, if they occur, can have very serious health consequences." To prevent falls among people who use walkers or canes, professionals should spend more time with clients to fit walking aids and educate them about the safe use of walkers and canes.

From the article of the same title
HealthDay (06/29/09)

Determination of Consistent Patterns of Range of Motion in the Ankle Joint With a Computed Tomography Stress-test

Measuring the range of motion of the ankle joint can assist in accurately diagnosing ankle laxity. A computed tomography-based stress-test (3D CT stress-test) was used to determine the three-dimensional position and orientation of tibial, calcaneal, and talar bones in this study by researchers from the University of Amsterdam, whose goal was to establish a quantitative database of the normal ranges of motion of the talocrural and subtalar joints. Comparison of the ranges of motion of pathologic ankle joints with healthy subjects showed an increased inversion and axial rotation in the talocrural joint instead of in the suspected subtalar joint. The researchers thus concluded that the proposed diagnostic technique and the acquired database of helical parameters of ankle joint ranges of motion are suitable to apply in clinical cases.

From the article of the same title
Clinical Biomechanics (07/09) Vol. 24, No. 6, P. 517; Tuijthof, Gabriëlle Josephine Maria; Zengerink, Maartje; Beimers, Lijkele

In Muscle Stem Cells, Age Matters

Genes important for forming muscle cells in embryos and newborns are not normally active in adult stem cells, report Christoph Lepper and colleagues at the Carnegie Institution in Baltimore in the journal Nature. The findings could impact the way researchers think about stem cell transplants for muscular dystrophy and muscle injuries. Researchers hoping to use muscle stem cells in stem cell transplant therapies cannot now assume that the genes that control early muscle development serve the same purpose in repairing adult muscle, say the researchers.

From the article of the same title
Reuters (06/25/09) Steenhuysen, Julie

Updated AdvaMed Code of Ethics for Medical Device Industry Goes Into Effect

A revised code of ethics regarding conduct between the medical device industry and health care professionals issued by the Advanced Medical Technology Association (AdvaMed) went into effect on July 1. The revamped Code of Ethics on Interactions with Health Care Professionals establishes new guidelines related to royalty provisions and evaluation and demonstration products and clearly prohibits device companies from providing recreation or entertainment to healthcare professionals.

From the article of the same title
Orthopedics Today (07/09) Brockenbrough, Gina

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July 8, 2009