July 22, 2015 | | JFAS | Contact Us

News From ACFAS

Another Nondiscrimination Victory for Non-MD Providers
Rhode Island’s governor signed legislation that ensures non-MDs will not be discriminated against by insurance plans or carriers. The following is the provision in Rhode Island House Bill 5046, now law:

“A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that provider's license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, or a health insurance issuer, from establishing varying reimbursement rates based on quality or performance measures."
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Keep Austin Weird During ACFAS 2016
They say everything’s bigger in Texas, but did you know only Austin claims fame to the biggest urban bat population, the biggest state capitol building and the biggest live music scene in world? Austin is also home to the Cathedral of Junk, Casa Neverlandia, the Museum of Natural & Artificial Ephemerata and other attractions you won’t find anyplace else.

Do your part to keep Austin big, weird and original by arriving a few days early to ACFAS 2016 or staying a few days afterward. Make the most of your conference experience by taking in everything this one-of-a-kind city has to offer.

Keep checking for the latest updates on ACFAS 2016 and get ready to enjoy the sights and sounds found nowhere but Austin!
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New Fall Seminar Dissects EBM
Register now for ACFAS’ new advanced seminar, Taking a Scalpel to the Evidence, and learn why evidence-based medicine (EBM) is the key to cutting-edge patient care.

Set for November 6–7, 2015 in Atlanta, this seminar’s one-of-kind, bottom-to-top approach will show you how to balance clinical expertise, available evidence and patient perspective when making surgical decisions.

Expert faculty will share clear-cut strategies for cases where insufficient evidence exists or patient preferences conflict, all while illustrating how EBM applies specifically to foot and ankle surgery.

Seminar includes breakfast and lunch both days plus 14 continuing education contact hours. Space is limited; visit to reserve your spot for a new take on the link between EBM and superior patient care.
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Foot and Ankle Surgery

Anatomic Reconstruction with a Semitendinosus Allograft for Chronic Lateral Ankle Instability
Most patients with chronic lateral ankle instability (CLAI) achieve successful outcomes with the modified Broström procedure, but some experience undesirable outcomes. Those patients have the option of anatomic reconstruction of the lateral ankle ligaments using a semitendinosus allograft to augment the modified Broström procedure. A retrospective review of a single surgeon's experience attempted to report the results of this process. Of 38 patients, 31 returned for final follow-up. All patients reported satisfaction scores and completed the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AHS) and a visual analog scale (VAS) for pain. After follow-up, 100 percent of patients reported being satisfied with the procedure. AHS values significantly improved, and VAS pain scores significantly decreased. Researchers concluded that these results indicated anatomic lateral ankle ligament reconstruction with a semitendinosus allograft is a viable alternative for the treatment of CLAI.

From the article of the same title
The American Journal of Sports Medicine (07/15) Dierckman, Brian D.; Ferkel, Richard D.
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Enhanced Precision of Ankle Torque Measure with an Open-Unit Dynamometer Mounted with a 3D Force-Torque Sensor
Strength parameters for ankle joint muscles are typically measured with isokinetic or isolated ankle dynamometers, but these devices often present significant limitations because they only account for force in one dimension (1D). A new study sought to determine the contribution of body position to ankle plantar-flexion torque and to assess the use of 1D and 3D torque sensors. Patients were fitted with a custom-designed Booted, Open-Unit, Three dimension, Transportable Ergometer (B.O.T.T.E.) and were observed in two conditions: (1) when the participant was restrained within the unit and (2) when the participant's position was independent of the ankle dynamometer. Ten males participated in the study. The plantar-flexion maximal resultant torque was significantly higher in the locked-unit compared with open-unit configuration. This was due to the addition of forces from the body being constrained within the testing device. A 1D compared with 3D torque sensor significantly underestimated the proper capacity of plantar-flexion torque production. The researchers concluded that any assessment of plantar-flexion torque should be performed with an open-unit dynamometer mounted with a 3D sensor that is exclusive of accessory muscles but inclusive of all ankle joint movements.

From the article of the same title
European Journal of Applied Physiology (07/15) Toumi, A.; Leteneur, S.; Gillet, C.; et al.
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Repair of Acute Superficial Deltoid Complex Avulsion During Ankle Fracture Fixation in National Football League Players
A recent descriptive case series analyzed the preliminary outcomes of acute superficial deltoid complex avulsion repair during ankle fracture fixation in a cohort of National Football League (NFL) players. The cases of 14 NFL players who underwent ankle fracture fixation with open deltoid complex repair were reviewed. Return to play was defined as the ability to successfully participate in at least one full regular season NFL game postsurgery. After follow-up at six months, all NFL players were able to return to running and cutting effectively, and no significant differences existed in playing experience before surgery versus after surgery. Return to play was 86 percent for all players, and no complications or clinical evidence of pain or instability were found. Researchers concluded that NFL players who suffer superficial deltoid complex avulsion during high-energy ankle fractures may benefit greatly from primary open repair.

From the article of the same title
Foot & Ankle International (07/15) Hsu, Andrew R.; Lareau, Craig R.; Anderson, Robert B.
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Practice Management

Hiring Right for Your Medical Practice
Hiring the right people for your medical practice is not easy, but you can take steps to ensure you only hire the best. It is important to focus on the front end of the hiring process. The time you spend on the front end will save time later and improve the likelihood of a successful hire. When interviewing a candidate, go deeper than the description of duties. Work from the bottom up instead of the top down; this will accurately describe the realities of the job and will allow both parties to avoid a bad decision. Another lesser-known strategy is to utilize the results of job reviews by current employees. At a preliminary exit interview, ask what has and has not been working well, what needs to be improved, whether or not the job was enjoyable and any other information that may seem important. The purpose is to gather information to make your practice a more appealing place when interviewing new candidates and to learn something that will reveal the best of the best while talking to potential hires. Finally, determine the personality you want to hire. Do you want an introvert or an extrovert? Will one fit the practice better than the other? The key is knowing what you want and learning about the candidates. Doing that will bring in the best talent.

From the article of the same title
Physicians Practice (07/08/15) Stryker, Carol
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ICD-10's Financial Impact Before and After Oct. 1
Oct. 1 is fast approaching. Between now and then, every medical practice will have expenses related to the ICD-10 transition. These include coding manuals, training and more. A survey from the Professional Association of Healthcare Office Management says these could cost a small practice between $2,000 and $3,000 per provider. In anticipation of these costs, practices should consider setting aside cash reserves or applying for a line of credit to help stem revenue reductions after the deadline. No matter how prepared you are, it is not guaranteed how the process will play out with your payers. Some experts are predicting a 30 percent or greater reduction in revenue for the first three to six months. After the deadline, expect to see a delay in getting paid. The process will be slow for both the payers and your staff. You will likely see a spike in denials as well, and the Workgroup for Electronic Data Interchange estimates that denials could increase by as much as 200 percent. To prepare for all of these issues, clear whatever current bills you can off the books and focus more attention on ICD-10 after the deadline. Have a billing system in place that provides alerts when denials and rejections come in. If prepared for correctly, ICD-10 has the potential to get you paid what you are owed quickly and efficiently.

From the article of the same title
Medical Economics (07/13/15) Cavanaugh, Michelle
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Ten Apps Physicians Should Start Using Now
Technology can be a powerful professional tool, and many mobile apps have been designed specifically with workplace tasks in mind. Healthcare professionals listed their top 10 picks for apps beneficial to the healthcare industry:
  1. Evernote: A productivity app that allows users to store any type of information and access it through any device or on the Internet.
  2. TigerText: A reliable and effective tool for communicating time-sensitive patient information on the go.
  3. UpToDate: Contains medical knowledge that allows practitioners to answer questions quickly. It is a very popular app and costs $499 per year per person.
  4. Paper by FiftyThree: A minimalist note-taking app with no lines and plenty of space for both words and visuals. It is fully cloud compatible.
  5. Epocrates: Another popular medical app that contains information related to prescription drugs. It can be used to evaluate alternative medications and access lab guides, as well as review countless medications.
  6. Instapaper: Cross-platform app that allows users to save articles to read for later, even when they are offline.
  7. Dragon Dictation: Users can use their voice to create emails, text messages and memos in the office or on the go.
  8. Doximity: A social network for doctors with a purported 40 percent of U.S. physicians as members.
  9. Google Apps: Google has numerous apps that can help physicians, including Google Docs (for documents) and Google Sheets (for spreadsheets). It also has a fully integrated calendar feature.
  10. Mayo Clinic: Provides access to an online health community. Patients can connect with and learn from other patients experiencing similar issues.
From the article of the same title
Physicians Practice (07/09/15) Haugen, JoAnna
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Health Policy and Reimbursement

AHRQ to Fund Clinical Decision Support Learning Network
The Agency for Healthcare Research and Quality (AHRQ) will launch an initiative aimed to disseminate and implement patient-centered outcomes research (PCOR) findings through clinical decision support (CDS) at the point of care. The PCOR CDS Learning Network will be created to conduct CDS projects and develop new CDS. AHRQ has a history in CDS, funding the Clinical Decision Support Consortium, which has worked to make CDS knowledge more easily sharable for the past five years. The new initiative will expand on that goal, developing tools to make CDS become more sharable and publicly available. "The field of CDS, as an area of scientific research, is evolving rapidly," AHRQ wrote in its funding opportunity announcement. “The PCOR CDS Learning Network will be an agile partner that can identify the issues most important to the field, can bring together the most forward-thinking researchers and implementers and can return those recommendations to the field with the highest chances of uptake."

From the article of the same title
Healthcare Informatics (07/13/15) Raths, David
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New ICD-10 Legislation Calls for Coding Flexibility
The U.S. House of Representatives has introduced another bill with the goal of instituting a relief period following the Oct. 1 deadline for transition to ICD-10. The bill calls for dual coding for six months after the deadline. Known as the Code-FLEX Act, it requires the U.S. Department of Health and Human Services to report to Congress 90 days after implementation to review the impacts the codes are having on all parties. The Centers for Medicare and Medicaid Services (CMS) have also announced a plan to help providers, saying that they will not deny or audit physician or other practitioner claims solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.

From the article of the same title
Healthcare Informatics (07/14/15) Leventhal, Rajiv
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The Pros and Cons of Certificate of Need Repeal
Certificate of Need (CON) laws prohibit providers from entering new markets or expanding their organizations without the approval of state regulators. Now, a move is underway in at least two states to repeal these laws. Thirty-six states and the District of Columbia currently have CON laws. Advocates claim the law protects patient access to services and that a repeal would lead to healthcare businesses taking advantage of deregulation and entering communities with the goal of making a profit instead of benefiting a constituency. Opponents of the law point to the lack of beds in some states, leading to unsatisfactory overnight treatment. Michael W. Thompson, chair and president of the Thomas Jefferson Institute for Public Policy, wants the law to be repealed because "in reality, this law artificially creates monopolies for healthcare services, stifles competition and prevents communities from receiving vital medical services." Virginia and South Carolina are pushing for the law to be struck down.

From the article of the same title
Fierce HealthFinance (07/13/15) Budryk, Zack
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Medicine, Drugs and Devices

FDA Proposes New Criteria for Surgical Gowns
Confusion over the definition of "gowns" has left some manufacturers wondering whether they must submit a 501(k) application for their products. The U.S. Food and Drug Administration recently set guidelines that specify parameters that determine whether a particular type of surgical gown should be classified as a Class II medical device and thus require premarket notification. Over the years, according to the draft, "a number of terms have been used to refer to gowns intended for use in healthcare settings including, but not limited to, surgical gowns, isolation gowns, surgical isolation gowns, nonsurgical gowns, procedural gowns and operating room gowns." The draft also breaks down information necessary for manufacturers who want to submit a 501(k) application. Class I gowns, "labeled as a gown other than a surgical gown (e.g., isolation gown)” or "are for only minimal or low barrier protection," are exempt from the premarket notification requirement.

From the article of the same title
Infection Control Today (07/10/15)
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Modern Doctors' House Calls: Skype Chat and Fast Diagnosis
Instant messaging and video calls have changed the way people around the world communicate, and the same forces that have pushed this transformation are now forcing health systems and insurers to rush to offer video consultations for routine ailments. While many believe that telemedicine and mobile diagnosis are inevitable in the digital age, those from the traditional corners of the medical world do not see a bright future. Medicare, for example, believes that expanding coverage for telemedicine services would increase costs instead of reducing them. Some doctors argue that a digital visit could never replace a physical visit and that the potential for misdiagnosis is great. States are split on the issue; some, like Texas, are trying to slow the growth of virtual medicine while others, like Pennsylvania, have hospitals that offer video follow-up visits with internists, urologists and ear, nose and throat specialists. Telemedicine services are cheaper to operate than brick-and-mortar offices, and prescriptions can often be written and ready to pick up within minutes. Large insurers like UnitedHealthcare are now covering virtual visits that cost less than $50.

From the article of the same title
New York Times (07/11/15) Goodnough, Abby
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Open Proximal and Distal Fractures of Tibia Treated with Naseer Awais External Fixator with T-Clamp
A recent study was conducted to compare the outcomes of open proximal and distal fractures of tibia using the Naseer Awais External Fixator with T-clamp. Thirty patients were divided evenly into two groups. Group A had distal fractures, and group B had proximal fractures. Mean fracture union time in group A was 11–23 weeks; in group B, it was 19–28 weeks. Joint stiffness occurred in fewer than ten percent of patients. Researchers determined that Naseer Awais External Fixator with T-Clamp was a safe technique and promoted union with few complications, although it was slightly more efficient in treating distal fractures than proximal fractures.

From the article of the same title
Journal of Pakistan Medical Association (07/15) Makhdoom, Asadullah; Laghari, Muhammad Ayoub; Ali, Syed Muhammad; et al.
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This Week @ ACFAS
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Mark A. Birmingham, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of "This Week" are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS, and does not imply endorsement of any view, product or service by ACFAS.

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