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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

Health System Reform Roundup

It’s been another week of intense activity in DC on the health reform front as the August recess looms. The main event was the introduction of the House Democrats’ Tri-Committee Healthcare reform bill which includes health insurance exchanges and a public option. It also requires employers to “play or pay,” requires individuals to obtain coverage, requires reforms of the insurance markets to guarantee coverage, and requires development of a standard benefit package.

In major reversal, the American Medical Association endorsed the House bill. This is likely because the bill would provide a permanent “fix” to the flawed Medicare physician payment formula, which threatens to reduce physician Medicare payment by up to 21% in 2010. The proposal would give physicians a slight payment increase over the next 10 years at a cost of $245 billion. The plan would be paid for in part by implementing a surtax on families earning over $350,000 per year.

Republicans oppose the plan across-the-board. A small group of more conservative Democrats (so-called “Blue Dogs”) are cautioning against a rush to pass legislation based on an artificial deadline.
iPhone Winners for Survey Participation Announced

Four lucky ACFAS members have been randomly drawn to receive a new 3GS iPhone (or comparable technology) for participating in either the Member Success and Challenges Survey or the Practice Economics and Insights Survey conducted in May-June. Each survey received a 25 percent response rate, which is quite high for comparable surveys that took an average 30 minutes to complete.

The winners are: Lisa G. Kornely, DPM, Germantown, WI; Marnell P. Moore, DPM, Cresskill, NJ; Joel L. Nichols, DPM, Troy, NY; and Amanda K. Westfall, DPM, Bend, OR.

Thank you to all ACFAS members who participated in these surveys! More details about the surveys will appear soon in the ACFAS Update newsletter.

Foot and Ankle Surgery

Balance Training May Help Prevent Ankle Sprains

Researchers from the Netherlands say that athletes who have suffered an ankle sprain can significantly cut their chances of spraining their ankle again by doing balance exercises. Willem van Mechelen from VU Medical Center in Amsterdam and colleagues report that an unsupervised, in-home 8-week training program made up of a series of exercises to improve balance and motor coordination skills is effective in preventing re-injury. The study is published in the July 10 online issue of the British Medical Journal.

From the article of the same title
Reuters (07/13/09)

Donor-site Morbidity After Osteochondral Autologous Transplantation for Lesions of the Talus

Autologous osteochondral transplantation is accepted as one of the major treatment options for cartilage defects of the talus but requires the harvesting of a donor graft from a normal knee. Researchers from Germany sought to determine the potentially detrimental effect of graft harvest on knee function in this study of 200 patients who had transplantation of an autologous osteochondral graft obtained from an asymptomatic knee for the treatment of an osteochondral defect of the talus. The researchers concluded that donor-site morbidity of a knee from which a graft has been harvested can potentially lead to functional impairment. The researchers urged surgeons performing osteochondral transplantations and harvesting autografts from the knee to be aware of the potentially negative effect of a higher body mass index on clinical outcomes after surgery.

From the article of the same title
Journal of Bone and Joint Surgery (07/01/2009) Vol. 91, No. 7, P. 1683; Paul, J.; Sagstetter, A.; Kriner, M.

Posterior Subtalar Dislocation

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. In treatment of an 80-year-old patient, the authors of this article note that post-reduction immobilization in a nonweight-bearing cast is required for subtalar dislocation but that the period of immobilization has been a subject of controversy. The physicians recommend 3 weeks of immobilization followed by physical therapy to restore hindfoot range of motion, considering that prolonged casting can cause loss of function and subtalar joint arthrosis. They note that no recurrent subtalar dislocation has been described in the literature to date, suggesting that residual subtalar joint laxity does not represent a risk for future recurrent subtalar dislocation.

From the article of the same title
Orthopedics (07/09) Camarda, Lawrence; Martorana, Umberto; D'Arienzo, Michele

Study Questions Popular Practice in Bypass Surgery

A new study led by scientists from Duke Clinical Research Institute concludes that the most commonly used method for extracting leg veins for grafts in coronary bypass surgery was more dangerous than the traditional method, resulting in more deaths among patients. Over the past 10 years or so, bypass surgeons have shifted from a traditional vein-extraction technique to a "minimally invasive" method, known as endoscopic harvesting, that weaves a thin tube through a small incision in the leg. Driven by faster recovery times and fewer wound complications, the endoscopic technique largely displaced open-leg harvesting, in which doctors cut the leg from ankle to groin to remove the vein. The minimally invasive method is now used in at least 70 percent of bypasses, according to the study authors. The research can be found in the July 16, 2009, issue of The New England Journal of Medicine

From the article of the same title
Wall Street Journal (07/16/09) Shishkin, Philip

Practice Management

Administration Facing Tough Sell to Doctors on Health IT

Dr. David Blumenthal is the Obama administration's point person on HIT, and he recently acknowledged that it is challenging to convince physicians that the HIT incentive program passed as part of the 2009 Stimulus Package is good for them. He acknowledges that even with the potential incentive payments, physicians will have to spend a lot of money on HIT implementation and that the return on investment to the practice is not clear. However, observers note that if physicians cannot show “meaningful use” of electronic health records by 2015, they will receive a penalty in the form of reduced Medicare and Medicaid reimbursement.

From the article of the same title
Kaiser Health News (07/17/09) Weaver, Christopher

Electronic Health Records: A Texas Model

Cook Children’s Health Care System of Fort Worth, Texas, plans to install Web-based electronic health records (EHR) and data integration technology at its 60 offices and clinics throughout Texas. The healthcare provider is also offering personal health records, controlled by the families of its patients. The EHRs are being supplied by AthenaHealth, while the data integration software and personal health records will come from Microsoft.

In a further innovation, Cook Children’s is planning a prototype “Innovation Clinic”—a small physician office, with two or three doctors. The 2,000 to 3,000 patients seen at the clinics will be from Medicaid families, and reimbursement will be a set annual payment for each patient rather than the standard fee-for-service. Small practices are the biggest challenge for electronic health-record adoption, since they cannot afford full-time technical helpers, and Cook Children's hopes it can curb costs through use of the new technology.

From the article of the same title
New York Times (07/13/09) Lohr, Steve

Health Policy and Reimbursement

Massachusetts Takes a Step Back From Health Care for All

ACFAS has reported a number of stories about the Massachusetts “Commonwealth Care” universal coverage program, which is often touted as a model for health system reform on a national level. However, the new state budget eliminates coverage for 30,000 legal immigrants. Even though the program has reduced the number of uninsured residents to 2.6%, the state is facing a significant budget deficit, with tax revenues down $2.7 billion for the fiscal year ending June 30 and still dropping.

From the article of the same title
New York Times (07/15/09) Goodnough, Abby

Health Insurance Policies Are Being Sold in Storefronts

Blue Cross Blue Shield of Florida, which already has one storefront operation in the state, is rolling out a major expansion of its retail offerings as a means of reaching individuals not covered under employer plans. Blue Cross and other health insurers are targeting this growing demographic. Blue Cross has seen an increase of 15 percent in individual policy requests over the past eight months, while Aetna says sales increased by 22 percent during the first half of the year.

From the article of the same title
Miami Herald (07/17/09) Dorschner, John

Target May Be Next to Back Government-Mandated Healthcare

Target could join Wal-Mart in supporting efforts by the White House to require all large companies to provide healthcare benefits to their employees. The nation's second-largest retail discounter behind Wal-Mart supports the program "in concept," but would have to see the final language of any legislation before formally backing it, says Target spokeswoman Kay Rubbelke. The employer healthcare mandate is seen by the retail industry in particular as overly burdensome, given the industry's reliance on low-paid employees and high turnover rate. The National Retail Federation, of which Wal-Mart and Target are not members, is strongly lobbying against mandated coverage.

From the article of the same title
Dow Jones Newswires (07/15/09) Talley, Karen

Technology and Device Trends

Gadofosveset-enhanced MR Angiography of the Pedal Arteries in Patients With Diabetes Mellitus and Comparison With Selective Intraarterial DSA

The purpose of this study by researchers at Johannes Gutenberg University in Mainz, Germany, was to compare gadofosveset-enhanced magnetic resonance angiography (MRA) of the pedal vasculature with selective intraarterial digital subtraction angiography (DSA). Eighteen patients with peripheral arterial occlusive disease (PAOD) and type II diabetes were prospectively examined. MR imaging consisted of dynamic and of high-resolution steady-state imaging, and selective DSA was performed within five days and served as standard of reference. Image analysis was done by two observers.

No differences between MRA and DSA regarding overall image quality were observed. First-pass MRA detected significantly more patent vessel segments than did DSA, and there was interobserver agreement that MRA was very good with respect to the detection of patent vessel segments and the assessment of hemodynamically relevant stenoses. Steady-state imaging depicted significantly more patent metatarsal arteries than did dynamic imaging, and delineated inflammatory complications, including osteomyelitis, soft-tissue abscesses, and fistulas related to the diabetic foot.

From the article of the same title
European Radiology (07/09/09) Röhrl, Boris; Kunz, Rainer Peter; Oberholzer, Katja

Medical Use for Waste Television Screens

Scientists at the University of York in the United Kingdom say waste material from discarded televisions could be recycled and used in medicine. They have devised a technique where recovered material is heated in water in a microwave and washed in ethanol to produce so-called "expanded PVA (polyvinyl-alcohol)." One of the material's key properties is that it does not provoke a response from the human immune system, making it suitable for use in biomedicine. Researchers say the substance is suitable for use in tissue scaffolds in the human body as well as in pills and dressings that deliver drugs to particular organs. The research is being conducted by five academics at the university's Department of Chemistry and has been published in the journal Green Chemistry.

From the article of the same title
University of York (07/09)

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July 22, 2009