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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

HHS Releases “Meaningful Use” Rules

The U.S. government yesterday released two final “meaningful use” rules defining the standards doctors and hospitals must meet to receive American Recovery and Reinvestment Act (ARRA) funds to subsidize implementation of electronic health records (EHR). Initial responses to the 863-page document are mixed, with the American Medical Association withholding judgment, while the American Hospital Association says the requirements, although less stringent than an earlier draft, may still be difficult for many hospitals to meet.

The ARRA payments are scheduled to begin in May of next year. Healthcare providers who do not implement EHR will see Medicare payments reduced by 1 percent in 2015 and 3 percent in following years. The subsidies and penalties are meant to encourage the many hospitals and doctors’ offices that still do not have EHR to adopt them, for better coordination of patient care.
Find CME in Your Backyard

“1st MTPJ A-Z Workshop and Seminar” will bring ACFAS’ top-rated continuing education to surgeons’ doorsteps. You’ll have the chance to advance your surgical skills and knowledge through these convenient, contemporary, hands-on courses.

ACFAS has teamed with four of its Regional Divisions to offer programs in Minneapolis, Minn., Portland, Ore., and Charleston, S.C., this September and October. Complete information and online registration are now available on the ACFAS website.
Free News Releases: Stress Fractures; Flatfoot

“Common Runners’ Injury: Stress Fractures of the Foot” and “Don’t Ignore Flat Feet” are the latest ACFAS news releases. Fact-filled and concise, these releases inform the public about the symptoms, hazards and treatments for these conditions.

You can put yourself in the news with these same stories using a free, pre-formatted Fill-In-The-Blanks Press Release available only to ACFAS members. Download them today and jump-start your practice marketing efforts by sending the news to local newspapers, radio stations, hospital PR departments or community service organizations, or by posting to your website or blog.
Short Takes on Research for Busy Surgeons

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:

Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults, from the Journal of Bone Joint Surgery (American).
Reviewed by Richard J Rand, III, DPM, Maricopa Medical Center.

Read this and many more reviews on the ACFAS website.

Foot and Ankle Surgery

Comparison of Closed Intramedullary Nailing With Percutaneous Plating in the Treatment of Distal Metaphyseal Fractures of the Tibia

Researchers compared the outcome of closed intramedullary nailing with minimally invasive plate osteosynthesis using a percutaneous locked compression plate in patients with a type-43A distal metaphyseal fractures of the tibia. A total of 85 patients were randomised to operative stabilisation either by a closed intramedullary nail (44) or by minimally invasive osteosynthesis with a compression plate (41). The researchers found no significant difference in the pre-operative variables or in the time to union in the two groups, but the mean radiation time and operating time were significantly longer in the locked compression plate group. After one year, all the fractures had united. Patients who had intramedullary nailing had a higher mean pain score, but better function, alignment and total American Orthopaedic Foot and Ankle surgery scores, although the differences were not statistically significant. Three (6.8 percent) patients in the intramedullary nailing group and six (14.6 percent) in the locked compression plate group showed delayed wound healing, and 37 (84.1 percent) in the former group and 38 (92.7 percent) in the latter group expressed a wish to have the implant removed.

From "A Prospective, Randomised Trial Comparing Closed Intramedullary Nailing With Percutaneous Plating in the Treatment of Distal Metaphyseal Fractures..."
Journal of Bone and Joint Surgery - British Volume (07/01/10) Vol. 92, No. 7, P. 984; Guo, J. J.; Tang, N.; Yang, H. L.; et al.

In Vivo Tissue Engineering Over Wounds With Exposed Bone and Tendon: Autologous Dermal Grafting and Vacuum-Assisted Closure

Flap coverage is ideal for wounds exposing bone and tendon, but technically less demanding and speedier options might be considered for small shallow wounds and for wounds with adjacent tissue loss precluding local flaps. Researchers assessed the use of autologous dermal grafting—in combination with vacuum-assisted closure (VAC)—for such wounds. Five small- to medium-sized wounds exposing bone, joint, and/or tendon were each covered using an autologous meshed dermal graft followed by VAC application to induce granulation. Closure was completed at two weeks by split-thickness skin grafting over the granulating dermis graft. Complete and stable wound healing was achieved in all cases within four weeks of dermal grafting over exposed bone with excellent outcome at one year in terms of donor site healing and return to function. All healed wounds had a nearly flush profile with no bulkiness in the foot and toe region.

From the article of the same title
Annals of Plastic Surgery (07/01/10) Vol. 65, No. 1, P. 70; Kang, G. C.; Por, Y. C.; Tan, B. K.

Limb Reconstruction Using Circular Frames in Children and Adolescents With Spina Bifida

Researchers reported the outcome of 28 patients with spina bifida who between 1989 and 2006 underwent 43 lower extremity deformity corrections using the Ilizarov technique. The indications were a flexion deformity of the knee in 13 limbs, tibial rotational deformity in 11, and foot deformity in 19. There were 12 problems (27.9 percent), five obstacles (11.6 percent), and 13 complications (30.2 percent) in the 43 procedures. Further operations were needed in seven patients. Three knees had significant recurrence of deformity. Two tibiae required further surgery for recurrence. All feet were plantigrade and braceable.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (07/01/10) Kelley, S. P.; Bache, C. E.; Graham, H.K.

Practice Management

Automated Phone Trees: How to Create Phone Efficiencies Without Driving Your Patients Nuts

Like with many technologies, automated phone systems aim to strike a balance between saving money and increasing convenience for patients. When considering automated systems for a medical practice, try to approach them from the perspective of a patient. First, keep in mind the objective of the system. Do you want to be able to route calls to specific staff, simply send prescription refill requests to a voicemail box, or enable patients to call in to cancel an appointment or pay a bill over the telephone without taking up staff time?

Also, consider your patient base. Are most patients accustomed to dealing with automated systems, or will they be angered if they call and are not being greeted by a real person? Keep in mind any problems that may arise. For example, if prescription refills are sent to a voicemail box, and a staff member is out sick or the office is unusually busy, that mailbox can quickly fill up, requiring more time to sort through the voicemails than just answering the phone would have taken. Hire a professional with experience setting up automated systems, and discuss your goals and concerns. If patients begin to complain about being unable to reach a person or accomplish their objectives, review your system.

From the article of the same title
Physicians Practice (06/10) McCallister, Jonathan

Protecting Yourself From Identity Theft

Jay Foley of the nonprofit Identity Theft Resource Center offers several suggestions to physicians to secure their personal, financial, and business information. Practices should have a secure system to protect medical provider numbers, and those with IT departments should hire a smaller group to monitor IT staff. Physicians who do work at home should purchase a cross-cut shredder to prevent thieves from using information in discarded documents, and they should encrypt financial files, prohibit their children from playing games on computers containing patient data to avoid viruses, and separate personal financial information from practice-related and other data with a second hard drive. They also should create passwords with at least eight characters and a combination of numbers and symbols. Paige Schaffer of the identity theft protection company Europ Assistance USA adds, "The key thing to keep in mind about blending medical information you might have with your own personal data is to not have active Internet service while working with sensitive data. Avoid logging on to the Internet while conducting any work-related business."

From the article of the same title
Physicians Practice (07/10) Stewart, Janet Kidd

Some Doctors Join Facebook, Twitter; Others Wary

Some physicians are venturing into social media such as Twitter and Facebook in an effort to both educate their patients and market their medical practices to potential customers. However, many doctors are reluctant to do so out of concerns about time and patient privacy. One hindrance to greater use of social media is a lack of guidance on doctors' incorporation of social media into their practice. The American Medical Association's Council on Ethical and Judicial Affairs recently passed a resolution to "study the issue of physicians' use of social networking, as exemplified on sites such as Facebook and Twitter" and report to the association's House of Delegates at its November meeting. Physicians also have little financial incentive to reach out to patients online, since they are typically paid only for talking to patients in the examining room.

From the article of the same title
USA Today (07/08/10) Rubin, Rita
Web Link - May Require Free Registration | Return to Headlines

Taking Medical Jargon Out of Doctors' Visits

About nine of every 10 adults have trouble following routine medical advice, mostly because they do not understand it, according to the Centers for Disease Control and Prevention. Two-thirds of state Medicaid agencies are calling for health material to be rewritten at a reading level between fourth and sixth grades. Poor health literacy can drive up healthcare costs and worsen patient outcomes. One study linked health illiteracy and poor health outcomes in a study of 14,000 diabetes patients. More than 50 percent of the patients reported problems learning about their conditions, and 40 percent needed help understanding the medical materials. These patients who struggled were 30 percent to 40 percent more likely to experience hypoglycemia than those with adequate understanding. Some insurers are responding to the problem with a software program that replaces challenging medical terms with more plain-language alternatives.

From the article of the same title
Wall Street Journal (07/06/10) Landro, Laura

Health Policy and Reimbursement

AMA Finds Lobbying Power Eroding; Payment Rates Vary

The American Medical Association is finding itself "with fewer friends on Capitol Hill and more critics questioning its lobbying savvy," according to an article in Politico. This comes at a time when the group is more dependent than ever on having allies in Congress, thanks to the growing number of Medicare patients. AMA's most prominent lobbying failure has been its inability to repeal the formula governing payments for these patients.

Meanwhile, physicians working in the same geographic area and performing the same tasks often are paid at different rates, according to a study presented at the AcademyHealth annual research meeting June 29 in Boston. Some physicians may be in locations that are particularly of interest to health plans, or they may be in larger groups and more able to negotiate effectively, said Laurence Baker, lead study author. "But it does have an element of randomness to it." Researchers analyzed 2006 data from Thomson Reuters MarketScan to confirm the existence and extent of payment variation. The database includes information on 12.2 million claims.

From the article of the same title
Kaiser Health News (07/12/10)

CY 2011 Outpatient, ASC Proposed Rules Released

CMS has released a proposed rule updating Medicare payment rates for hospital outpatient and ambulatory surgery center services in calendar year 2011. The proposed rule includes a 2.15 percent inflation update in Medicare payment rates for services paid under the outpatient PPS in 2011. The rule will appear in the August 3 Federal Register, with comments accepted for 60 days.

CMS also released two related documents, one with corrections to the CY 2010 outpatient and ambulatory surgery center services payments and the other containing the final payment rates and addenda for the CY 2010 Medicare hospital outpatient and ASC payment system. The rule will appear in the August 3 Federal Register, with comments accepted for 60 days.

From the article of the same title

HHS Proposes Changes to HIPAA Privacy Rule

HHS has proposed a new federal healthcare information privacy rule to amend HIPAA. The proposed rule would give patients the right to restrict certain disclosures and ban the sale of patient data without patient consent. Specifically, the proposal would expand individuals' rights to access their information; restrict certain disclosures of protected health information to health plans; extend the applicability of certain of the HIPAA privacy and security rule requirements to the business associates of covered entities; establish new limitations on the use and disclosure of protected health information for marketing and fundraising purposes; and strengthen and expand OCR's ability to enforce HIPAA's privacy and security provisions. A 60-day public comment period on the proposal opens July 14.

From the article of the same title
Modern Healthcare (07/08/10) Conn, Joseph

Technology and Device Trends

Frozen Blood a Source of Stem Cells, Study Finds

Researchers report in the journal Cell Stem Cell that stem cell-like cells can be generated from frozen blood, which is easier to extract and store than skin cells. They used cells from blood to create induced pluripotent stem (iPS) cells, which closely resemble human embryonic stem cells but are fashioned from ordinary tissue. IPS cells are produced through the activation of three or four genes that distinguish embryonic stem cells, and Rudolf Jaenisch of the Whitehead Institute for Biomedical Research in Massachusetts says that being able to employ blood will open opportunities for researchers who wish to use iPS cells to study the development of diseases. "There are enormous resources—blood banks with samples from patients that may hold the only viable cells from patients who may not be alive any more, or from the early stage of their diseases," he notes. "Using this method, we can now resurrect those cells as induced pluripotent stem cells. If the patient had a neurodegenerative disease, you can use the iPS cells to study that disease."

From the article of the same title
Reuters (07/01/10) Fox, Maggie

In a World of Throwaways, Making a Dent in Medical Waste

Buried among the several billion pounds of discarded medical items generated each year are unused disposable devices and recyclable supplies and equipment that, along with the pressure to cut costs, are helping fuel momentum for greener medical practices. About 30 percent of a hospital's scrap material comes from the operating room. A commentary in the March edition of Academic Medicine urged more medical centers to "go green" by recycling disposable single-use devices. Several reprocessing firms clean, repackage, and resterilize certain disposables and sell them back to medical suppliers and hospitals at significantly less cost than new equipment. The commentary's authors say patients are not harmed by the use of recycled devices—a view shared by a 2008 U.S. Government Accountability Office study. Since 2000, the Food and Drug Administration has taken action to require that reprocessing companies satisfy the same strict regulations for their products that original equipment manufacturers do. Experts note that more than 50 percent of U.S. hospitals currently send at least some of their single-use products to reprocessors. One reprocessor, Ascent Healthcare Solutions, calculates that its 1,800 hospital clients diverted 2,650 tons of discarded items from landfills last year via reprocessing. Some experts say the overarching goal should be to return to the previous practice of using permanently reusable gear, while another strategy is to cut the use of disposables by streamlining packaged surgical kits to eliminate never-used devices.

From the article of the same title
New York Times (07/06/10) P. D1; Chen, Ingfei

USPSTF Urges Bone-Density Test for More Women

The U.S. Preventive Services Task Force (USPSTF) has issued new draft guidelines that recommend routine screening for osteoporosis in all younger postmenopausal women who have at least the same chance of a bone break as an older woman. The group also evaluated whether men should undergo screening for osteoporosis, but concluded there wasn't enough evidence to recommend for or against the screening. The draft guidelines widen the task force's 2002 advice, when it first said that all women over 65, plus those between the ages of 60 and 64 at higher risk for fractures, should get a bone density test. The task force now says all younger postmenopausal women should get checked if their risk of a broken bone is the same or greater than the average 65-year-old woman. Factors that can increase risk include low weight, certain drugs, smoking, heavy alcohol use and family history of hip fracture. The task force used a Web-based risk calculator called FRAX—— that estimates one's odds of a fracture within 10 years. It shows women as young as 50 may meet the threshold for a bone test depending on their risk factors, the panel said.

From "Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement (Draft)"
Department of Health and Human Services (07/06/10)

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July 14, 2010