July 9, 2014

News From ACFAS

ACFAS Podcast Helps Navigate Changes to ABFAS Certification
In July's featured ACFAS podcast, “Preparing for Change: How to Get ABFAS Certified,” Christopher Lotufo, DPM, FACFAS, speaks with Mindy Benton, DPM, FACFAS, about changes to ABFAS’ (Formerly known as ABPS) board certification process. Benton, who also chairs ABFAS’ Board Certification Content Committee, explains how components in Parts 1 and 2 of the exam have been realigned since 2008 and also highlights the importance of logging surgical procedures and providing documentation for all patients.

Listen to this podcast and a library of others at “
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ACFAS Manuscript Submission Deadline is August 15
Manuscripts for presentation consideration at ACFAS 2015 are due no later than August 15, 2014 to be eligible for review by the manuscript judges.

Don't miss the opportunity to share your research with your peers. To submit your manuscript, visit Be sure to also carefully read the 2015 Call for Manuscripts and Instructions for Authors Submitting a Manuscript before sending a submission.

ACFAS Manuscript Awards of Excellence winners will divide $10,000 in prize money from a generous grant the College received from the Podiatry Foundation of Pittsburgh.
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Foot and Ankle Surgery

Supramalleolar Osteotomy with Bone Marrow Stimulation for Varus Ankle Osteoarthritis
A recent study examined the possible association between outcomes seen in varus ankle osteoarthritis patients treated with supramalleolar osteotomy (SMO) and cartilage regeneration as evaluated by second-look arthroscopy. No research has evaluated cartilage regeneration in the ankle's medial compartment following SMO. This latest study evaluated 31 ankles following arthroscopic marrow stimulation with SMO. All of the ankles subsequently underwent second-look arthroscopy. The study found a significant association between cartilage regeneration, which was evaluated using International Cartilage Repair Society (ICRS) grade during the second-look arthroscopy, and the clinical outcomes seen in patients who underwent SMO. These outcomes included significant improvements in the mean standard deviation visual analog scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society (AOFAS) scores at the time the second-look arthroscopy was performed compared to the scores seen before patients were treated with SMO. A significant association was also seen between ICRS grade and the development of degenerative arthritis of the ankle at final follow-up. This finding prompted orthopaedic surgeons to recommend that arthroscopic marrow stimulation be considered with SMO to ensure cartilage is regenerated to appropriate levels.

From the article of the same title
American Journal of Sports Medicine (07/01/14) Kim, Yong Sang ; Park, Eui Hyun ; Koh, Yong Gon; et al.
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Patient-Reported Outcomes, Function, and Gait Mechanics After Fixed and Mobile-Bearing Total Ankle Replacement
A recent study examined changes in ankle kinetics and kinematics in end-stage ankle arthritis patients who received either a fixed-bearing or mobile bearing implant during total ankle replacement, a procedure that is becoming increasingly popular as a treatment for end-stage ankle arthritis. Larger increases in the peak plantar flexion moment and the Short Form-36 (SF-36) total score were seen across time in the 41 patients who received fixed-bearing implants compared to the 49 patients who received mobile-bearing implants. Patients in the fixed-bearing group also displayed significantly larger increases independent of time in the weight-acceptance and propulsion ground reaction forces compared to fixed-bearing implant patients. However, patients who received mobile-bearing implants displayed greater improvements in visual analog scale (VAS) pain scores than did their counterparts in the fixed-bearing implant group. Patients in the mobile-bearing implant group also completed the Sit-to-Stand test significantly faster than those who received fixed-bearing implants. Both groups displayed significant improvements in walking speed, functional test results, spatiotemporal variables, patient-reported outcomes, and vertical ground reaction forces. All changes observed during the study suggest that patients in both groups experienced improved or maintenance of function after undergoing total ankle replacement.

From the article of the same title
Journal of Bone and Joint Surgery (06/18/2014) Vol. 96, No. 12, P. 987 Queen, Robin M.; Sparling, Tawnee L.; Butler, Robert J.; et al.
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Practice Management

Cash-Only Looks Good to Doctors
Anecdotal evidence suggests that the number of physicians' practices that have dropped out of the managed care system and have started accepting only cash is on the rise. A report issued by the Center for Studying Health System Change in 2008 estimated that 12.4 percent of physicians' practices have stopped accepting insurance. A growing number of these practices are run by specialists, says Free Market Health Group President Daniel Goldberg. Goldberg says there are a number of reasons why specialists and other physicians are moving to a cash-only system, including lower reimbursements, problems associated with billing and collections, and a desire to capture business from patients who are inclined to travel abroad for lower-cost surgery. Experts say that practices that are considering accepting only cash need to follow a number of rules to ensure their success, including having a strong knowledge of the market they work in and identifying the patient population that is most likely to want their services. Physicians' practices should also offer prices and quality of care that are similar to that of other practices in their area to remain competitive. In addition, practices should also be aware of the potential drawbacks associated with a cash-only approach, including the possible loss of privileges at hospitals that require doctors to accept Medicare or Medicaid.

From the article of the same title
Healthcare Finance News (06/30/14) Worth, Tammy
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Success with Health IT Requires Buy-in, Not Just Budget
IT projects at healthcare organizations require executive buy-in and organizational support to be successful, writes Marion K. Jenkins, PhD, FHIMSS, of the University of Denver's healthcare IT program. Jenkins cites several studies that discuss reasons why IT projects failed to support his position that executive and organizational buy-in are necessary for IT projects to succeed. He adds that executive and organizational buy-in is often lacking in healthcare IT projects, and that the lack of such buy-in may have caused IT project failures that may have in turn made physicians and others in the healthcare industry hesitant to undertake IT projects. Jenkins says that physicians and practice executives who have doubts about the benefits of electronic health record (EHR) systems and other forms of healthcare IT should not move forward with these projects, as their skepticism can turn into a self-fulfilling prophesy that can contribute to the project's failure. However, healthcare organizations should move forward with IT projects when there is proper buy-in at all levels, proper user requirements that are matched with a good IT product, and proper budgeting, planning, and implementation for the project. When all of these factors are in place, Jenkins writes, healthcare IT can help improve patient outcomes and overall health while simultaneously driving down costs.

From the article of the same title
Physicians Practice (06/27/14) Jenkins, Marion K.
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Health Policy and Reimbursement

CMS Releases Proposed 2015 Medicare Physician Fee Schedule
The Centers for Medicare and Medicaid Services' (CMS) proposed Medicare physician fee schedule for 2015 addresses a number of issues, including the estimated 20.9 percent cut to Medicare payment rates that will take place unless Congress acts before March 1. The cut is the result of the sustainable growth rate formula and the expiration of the Protecting Access to Medicare Act next March. Another issue addressed in the proposed fee schedule is the continued implementation of the value-based payment modifier (VBPM). The rule states that CMS plans to implement VBPM by applying the 2017 modifier to practitioners who work alone and all physicians and non-physician eligible professionals (EPs) working in groups of two or more. VBPM's limit for payment risk, meanwhile, will rise from 2 percent in 2016 to 4 percent the following year under the proposed rule. The rule also includes guidelines for avoiding penalties under the Physician Quality Reporting System (PQRS) for 2017, which will be based on how well doctors perform next year. In addition, the rule will increase the amount of information about doctors and doctors' practices on the Physician Compare website, including information about how well doctors meet quality measures. The rule is expected to be finalized by Nov. 1.

From the article of the same title (07/03/14)
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Providers Blast CMS on Two-Midnight Rule
Comments submitted to the Centers for Medicare and Medicaid Services (CMS) about the controversial Medicare two-midnights rule were largely negative. One theme seen in several of the comments submitted to the agency was the need to allow physicians to determine whether inpatient or outpatient settings are appropriate for their patients--a prerogative that CMS is usurping through the two-midnights rule, critics say. One of those critics is the Michigan Health and Hospital Association, which said in its comments that decisions about the appropriate setting of care for patients is best made by doctors after considering factors such as patient medical histories and current medical needs, rather than estimates about how long patients will need to stay in the hospital. The organization added that when physicians determine that a patient meets guidelines to be admitted as a hospital inpatient, any care provided to the patient should be covered and paid for by Medicare Part A. Other organizations, including the American Hospital Association (AHA), called for alternatives to the two-midnights rule. AHA said CMS should adopt a short stay payment (SSP) policy that more fairly reimburse hospitals for short hospital stays.

From the article of the same title
Health Leaders Media (07/01/2014) Cheney, Christopher
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Stakeholders Concerned About ICD-10 Implementation, Survey Finds
A significant number of healthcare organizations are expressing concern about the potential negative ramifications associated with the transition to ICD-10, according to a survey by the American Health Information Management Association. About 45 percent of healthcare organizations that took part in the survey said they were concerned about problems that may occur when integrating ICD-10 codes into their accounting and billing systems. In addition, another 38 percent of respondents said they believed that the adoption of ICD-10 would cause their revenue to decline. However, 14 percent predicted that the move to the new coding system would have no impact on revenue whatsoever. Respondents also said they believed that the move to ICD-10 would make the process of adjudicating reimbursements and documenting patient encounters more difficult while also improving their ability to perform research and improving the accuracy of claims.

From the article of the same title
iHealthBeat (06/27/14)
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CMS Developing ICD-10 National Timeline to Help Stakeholders
In an effort to help stakeholders prepare for the expected new Oct. 1, 2015 ICD-10 implementation deadline, the Centers for Medicare and Medicaid Services (CMS) plans to issue a national timeline. "Part of our effort to align industry and regain that momentum is bringing everyone to the table to develop a national ICD-10 timeline," said Denesecia Green, acting director of the Administrative Simplification Group at CMS, in a June 26 eHealth Initiative webcast. She added, "We have about 90 partners that we're lining up now to commit to when they are going to test. We're going to make that publicly available for the groups that are willing to do that." CMS discovered that when some clearinghouses and other vendors were prepared to test for ICD-10, some small providers were not. Green said the timeline will "lay out which payers are going to test and when their testing timeframes are, so groups can prepare to test with them as appropriate."

From the article of the same title
Health Data Management (06/14) Slabodkin, Greg
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Medicine, Drugs and Devices

Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial
A recent study sought to build on the body evidence supporting the use of dry needling of myofascial trigger points as a treatment for plantar heel pain. The study involved 84 patients who had experienced plantar heel pain for at least a month, all of whom were randomized to receive real or sham trigger point dry needling once a week for six weeks. After treatment ended, statistically significant reductions in plantar heel pain were seen in patients treated with real trigger point dry needling compared to those in the sham group. However, 32 percent of patients in the real trigger point dry needling group experienced minor transitory adverse events, compared to less than 1 percent of those given the sham treatment. The study cautioned that the effectiveness of trigger point dry needling in reducing plantar heel pain should be weighed against the frequency of minor transitory adverse events in patients treated with this type of therapy.

From the article of the same title
Physical Therapy (07/14) Vol. 94, No. 7 Cotchett, Matthew P.; Munteanu, Shannon E.; Landorf, Karl B.
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Medial Malleolar Screw Versus Tension-Band Plate Hemiepiphysiodesis for Ankle Valgus in the Skeletally Immature
A new study compared the effectiveness of guided growth with temporary medial malleolar transphyseal screw (MMS) hemiepiphysiodesis to tension-band plate (TBP) hemiepiphysiodesis in treating pediatric ankle valgus deformity, a topic that had not been researched until now. The orthopaedic surgeons who performed the study examined 35 ankles treated with MMS and 25 that were treated with TBP. The surgeons found that the average tibiotalar angles in the MMS group improved from 77.1 degrees before surgery to 87.8 degrees over 25.2 months, while the average tibiotalar angles in the TBP group also improved from 81.3 degrees before treatment to 87.6 degrees over 20 months. Tibiotalar angle correction in both groups was determined to be good. The differences in the average rate of correction in the two groups was not statistically significant. Surgeons also found that there were six hardware-related surgical complications in ankles treated with MMS and one such complication in the TBP group. The rates of symptomatic hardware complaints were 5.7 percent and 0 percent in the MMS and TBP groups, respectively, both of which were considered to be low. While TBP has been cited as a potentially better alternative to MMS, this study found that both procedures can successfully correct pediatric ankle valgus deformity, though TBP appears to do so while causing fewer hardware-related complaints among patients.

From the article of the same title
Journal of Pediatric Orthopaedics (06/01/14) Vol. 34, No. 4, P. 441 Driscoll, Matthew D.; Linton, Judith ; Sullivan, Elroy; et al.
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Efficacy of Zoledronic Acid Treatment in Paget Disease of Bone
Zoledronic acid should be used as a first-line treatment for patients with Paget disease of bone, as it helps patients achieve and maintain remission, a new study has found. Researchers came to that conclusion after retrospectively reviewing the remission and relapse statuses of 12 Paget disease of bone patients who were treated with zoledronic acid. All of these patients achieved remission after treatment, and remission was maintained at both the 12 month and 18 month points. The use of zoledronic acid also brought about statistically significant changes in pre-treatment levels of alkaline phosphates, deoxypyridinoline, and osteocalcin compared to post-treatment levels.

From the article of the same title
Osteoporosis International (06/14) Baykan, E.K.; Saygili, L. F.; Erdogan, M.; et al.
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