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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

Medicare’s E-Prescribing Initiative: Prepare for the Future

Medicare’s E-Prescribing initiative offers a potential 2% bonus for physicians in 2010. While participation in the program is not mandatory, beginning in 2012 a penalty will be assessed for non-participation. Lean more about the program in a recently-released ACFAS article available at the web link below.
Publicize Your Practice…Free!

In a tight economy, you’ve got to cut expenses. Local advertising is pricey...but ACFAS has a no-cost alternative: free news releases you can customize with your name and practice information. Send them to local newspapers, radio stations, hospital PR departments…even to social and religious organizations for their newsletters.

It’s summer… kids are out of school… and skateboarders are everywhere. Make sure they come to you when their jumps and tricks result in foot and ankle injuries.

Download the newest release, Surgeon Warns: Skateboarding Tough on Feet, Ankles, and jump-start your practice marketing efforts. It’s a no-cost no-brainer!

Conference Manuscript Competition Deadline is Near

Submit your manuscript by August 3, 2009 for your research to be considered for presentation at the 2010 ACFAS Annual Scientific Conference. Winners of the ACFAS Awards of Excellence will divide $10,000 in prize money provided through a generous grant from the Podiatry Foundation of Pittsburgh.

Manuscript abstracts will be presented orally and winners will be announced at the Conference, to be held February 22-26, 2010 at the Mandalay Bay Hotel & Casino in Las Vegas, NV.

Use the web link, below, for detailed information and to submit your manuscript online. Don’t delay—submit your manuscript today!

Foot and Ankle Surgery

Cartilage Transplantation Techniques for Talar Cartilage Lesions

Ankle repair techniques have improved as a result of the adaptation of knee repair techniques, such as autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation, according to research by Matthew E. Mitchell, MD, of Casper Orthopedic Associates in Wyoming and colleagues. The researchers found that favorable ankle repair techniques include debridement with curettage and debridement with drilling, but that these salvage techniques have proven controversial. They also found that favorable results have been obtained from efforts to salvage failed debridement, including osteochondral allografts and autografts from the knee, but that these have been associated with concerns about knee donor site morbidity, the use of malleolar osteotomy, and incomplete restoration of the talar articular surface. The researchers discuss the promise of adapting knee techniques, such as autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation.

From the article of the same title
Journal of the American Academy of Orthopaedic Surgeons (07/01/09) Mitchell, Matthew E.; Giza, Eric; Sullivan, Martin R.

First Metatarsophalangeal Joint Arthrodesis and Revision Arthrodesis

Arthrodesis of the first metatarsophalangeal improves the load-bearing capabilities of the forefoot and assist in medial arch stability. It is the mainstay of treatment for patients with severe arthritic deformity of the great toe joint because it addresses the importance first ray weight-bearing has on the rest of the foot. Fusion can also be effective as a primary procedure in the treatment of hallux valgus in some individuals. Researchers from the United States found that rather than causing detrimental effects to the function of the foot, first metatarsophalangeal arthrodesis can improve faulty mechanics secondary to a dysfunctional joint.

From the article of the same title
Clinics in Podiatric Medicine and Surgery (07/09) Vol. 26, No. 3, P. 459; Hamilton, Graham A.; Ford, Lawrence A.; Patel, Sandeep

Hormone Eases Kid's Post-Surgery Distress

A study by U.S. anesthesiologists finds that children endured less post-surgery distress with the oral application of the hormone melatonin prior to surgery. Up to 20 percent of children undergoing surgery experience extreme anxiety or emergence delirium when they revive from anesthesia. The study, which was published in the journal Anesthesiology, focused on a sample of 148 children aged between 2 and 8 who were scheduled to undergo outpatient surgery. The patients were randomly assigned to be administered melatonin or the regular pre-surgery drug midazolam, and researchers gauged anxiety levels and the occurrence of emergence delirium.

From the article of the same title
United Press International (07/07/09)

Practice Management

Cutting Healthcare Costs by Putting Doctors on a Budget

A pilot physician payment model called Prometheus has caught the eye of the Obama administration and will be used by self-insured employers covering 80,000 workers in Rockford, Ill., beginning in 2010. Prometheus, funded by a $6 million grant from the Robert Wood Johnson Foundation, bases compensation for hospitals and doctors on “episodes of care" rather than on the specific treatment a patient receives. The Prometheus model is an open-source program that is gaining interest from insurers and employer coalitions in Minnesota, Pennsylvania, and elsewhere.

From the article of the same title
Time (07/06/09) Pickert, Kate

Health Co-op Offers Model for Overhaul

A clinic near Seattle run by Group Health Cooperative of Puget Sound could serve as a national model for healthcare reform. Group Health, one of the few remaining health insurance cooperatives in the United States, recently adopted electronic medical records and a collaborative model of primary care. Group Health doctors are paid a salary, can earn bonuses of up to 20 percent for high-quality work, and are rewarded for consulting by telephone and e-mail. Patients are assigned a team of primary care practitioners. Coverage decisions are based on Group Health’s own research into the effectiveness of certain treatments.

From the article of the same title
New York Times (07/07/09) P. A1; Sack, Kevin

About 45,000 Docs Qualify for Medicaid HIT Funding

The health information technology (HIT) funding in this years’ stimulus package includes additional funding for physicians who treat a large volume of Medicaid and poor patients. These physicians are eligible for up to $63,750 in funding for electronic health records (EHR), compared to 43,500 for other physicians. A study by the George Washington Medical Center found that about 45,000 physicians meet the requirement of a 30 percent Medicaid patient volume or practice at a federally qualified health clinic and see a 30 percent volume of “poor” patients. The Medicaid EHR program is different from the general program in that the money is available up front.

From the article of the same title
HealthLeaders Media (07/08/09) Commins, John

Health Policy and Reimbursement

Hospitals Reach Deal With Administration

The American Hospital Association and two other major hospital associations have reached an agreement in principle with the Obama administration that it’s members would accept reductions in Medicare and Medicaid of $155 billion over 10 years, but the reductions would take place only if health system reform actually results in expansion of coverage. The cuts would come primarily from limits in the annual increase in hospital payments. In exchange, the administration agreed in principle that a health system reform package would include strict limits on physician self-referral to physician-owned hospitals and no reductions in funding for academic medical centers.

From the article of the same title
Washington Post (07/07/09) Connolly, Ceci; Shear, Michael D.

Doctor's Settle for $44.5 Million

Doctors in Cincinnati have reached a final settlement in a six-year lawsuit against the four largest health plans operating in the area. The lawsuits alleged that Humana Health Plan of Ohio, Aetna, Anthem Health Plans of Kentucky and United Healthcare of Ohio conspired to fix physician reimbursement in Cincinnati below that of similar cities in the state. United was the last of the insurers to settle, agreeing last week to pay area doctors a total $44.5 million in increased reimbursements from 2008-2012. In total, the four plans agreed to an additional $386 million in reimbursement.

From the article of the same title
Cincinnati Enquirer (07/09/09) Perry, Kimball

Mass. Health Overhaul Offers Lessons for US program

Critics of a so-called public option for health system reform have raised concerns that employers will drop coverage for their employees, pushing those workers into the government plan. Some House Democrats propose stiff financial penalties for businesses that don’t either provide health insurance or contribute to their employee premiums. But the experience of Massachusetts suggests those concerns may be overblown. The state's 2006 health system reform law allows businesses that choose not to cover their employees to pay a minimal fee but does not include major penalties. However, employee dumping has not been a problem. In fact, since passing the law, 150,000 additional residents have become privately insured through their employers.

From the article of the same title
Boston Globe (07/10/09) Wangsness, Lisa

Technology and Device Trends

Experiment Seeks to Head Off Type 1 Diabetes

Researchers at Children's Hospital of Pittsburgh are conducting first-step experiments to test a vaccine-like therapy for type 1 diabetes. Some scientists hope to control type 1 diabetes by controlling the rogue immune cells that cause it, preserving enough insulin-producing cells that patients would need less insulin. Treatment possibilities include a vaccine developed from patients' own blood, or an experimental drug that attacks the faulty T cells that attack the pancreas. Another treatment involves blocking the dendritic cells that direct T cells to the pancreas, an idea currently under testing in 15 adults with type 1 diabetes.

From the article of the same title
USA Today (07/04/09)

FDA Warns of Retained Tissue in Arthroscopic Shavers

The FDA has warned that certain arthroscopic shavers used in orthopedic surgery have been found to retain pieces of tissue even after being cleaned according to the manufacturers’ instructions, raising concerns that the retained tissue in the shavers could compromise the sterilization process and pose a risk to public health. The FDA is urging surgical facilities using these devices to ensure that all personnel responsible for device cleaning and sterilization are aware of and comply with all steps in the manufacturer’s instructions for thoroughly cleaning these devices prior to sterilization; to consider inspecting the inside of the devices following cleaning to ensure that they have been cleared of any tissue or fluids, suggesting the use of a 3mm video scope to inspect the channels of the shaver handpiece; and if discovering retained tissue, to file a voluntary report with the FDA's MedWatch reporting system.

From the article of the same title
Outpatient Surgery (07/07/09) Tsikitas, Irene

Final Rules Broaden Pool for Stem Cell Research

The NIH has issued final guidelines on which embryonic stem cell lines will be eligible for government funding, expanding the pool of stem cells that can be used for research. To qualify for funding going forward, researchers will have to demonstrate that embryonic stem cells used in research were obtained from fertility clinic embryos that otherwise would have been discarded and must demonstrate the informed consent of the parents or mother. However, stem cells developed earlier will not require such precise documentation, a departure from draft guidelines issued by NIH in April.

From the article of the same title
Forbes (07/06/09)

Japanese Research Team Develops Nanometers-thick Surgical Band-Aid

In Japan, a multi-institute team of researchers has developed the thinnest-ever bandage for surgical use. The bandage, whose thickness varies between 30 nanometers to 1,500 nanometers, is made from chitosan and alginate sodium. Chitosan comes from the chitin in crab shells, while alginate sodium derives from kelp slime. Researchers from Waseda University, the National Defense Medical College, and other organizations found that as the thickness decreased below 200 nanometers, the adhesion became stronger. Only one side of the bandage has the adhesive so that it can be applied to tissues around wounds. The sheet eventually breaks down after the wound is healed. In an experiment, researchers placed two-inch square, 75-nanometer thick sheets onto wounds measuring 6 millimeters in diameters on dogs' lungs. The sheet was able to withstand the pressure of breathing and performed as well as traditional adhesives, which often cause complications.

From the article of the same title
Mainichi Daily News (Japan) (07/07/09)

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July 15, 2009