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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

As Congress heads towards the August recess, health system reform remains very much up in the air. On Tuesday, the New York Times characterized the battle as “paralyzed” while Washington waits for the centrist Senate Finance Committee to hash out its bill. The latest word is that the Committee will not include a public option or employer mandate, putting it at odds with the House Democrats’ plan.

With 2010 a mid-term election year, the stakes are high: President Obama is adamant that legislation must be passed by the end of 2009. Members of Congress will undoubtedly be engaging with their constituents on this topic during the recess.

Meanwhile, a group of Governors has expressed concern over any reform plan that would put more burden on already-stressed state budgets through, for example, an expansion in Medicaid eligibility. While California’s budget woes have been prominent in the news, many states have already had to cut services to balance FY 2009 budgets. In addition, reported that 12 states are already facing budget gaps totaling $24 billion in their recently-approved FY 2010 budgets.

The Kaiser Family Foundation has created a helpful side by side comparison of the various health reform proposals, available at the web link below.
President's Perspective: The Future of CME

In the most recent issue of the ACFAS Update newsletter, President Mary E. Crawford, DPM, FACFAS writes:

"What’s happening to continuing medical education (CME) across the country and worldwide? Clearly, CME is changing dramatically in terms of who provides it, what it entails and how it’s delivered. The future of CME will greatly affect ACFAS members, natural lifelong learners who have achieved Board certification. With state licensing boards steadily increasing our CME requirements, we should all be aware of the global forces having an impact on how we continually enhance our skills."

Use the web link below to read the full story.
Easy Online Updates for Your Contact Information

ACFAS uses your contact information in a number of ways. Mailings, including the Update newsletter and Journal of Foot & Ankle Surgery, go to your “preferred address” (office or home). The e-newsletter goes to your email address. And your information is included in the searchable online member directories.

Do we have your correct information in our database? Find out by using the web link below to access your profile. Make your changes online today to assure you receive all the ACFAS member benefits to which you’re entitled.
FTC Delays Red Flags Enforcement to November 1

The FTC announced today that it is delaying enforcement of the new “red flag” rules to November 1. Enforcement was scheduled to begin August 1. This is a much-needed extension for physician practices. Tools to help physician practices comply with the rules are available on the ACFAS web site via the web link, below.

ACFAS is In the News…and You Can Be, Too!

A news release urging consumers to examine their feet, and to see a foot and ankle surgeon when abnormal moles or freckles are present, was distributed by the ACFAS PR department yesterday. Within hours, the story had been picked up by over 100 internet news outlets, with print pickup to follow.

You can put yourself in the news with this same story by using the pre-formatted ACFAS customizable news release, and distributing it to your local news outlets. Download the fill-in-the-blanks release today using the web link below.

Foot and Ankle Surgery

Many Lesions Associated With Ankle Instability Missed on Preoperative MRI

Recent research indicates that preoperative MRI may miss a substantial number of associated lesions intraoperatively in patients with chronic ankle instability. In a retrospective chart review, Patrick J. O’Neill, MD, and his colleagues compared the preoperative MRI reports of a community radiologist and the attending foot and ankle surgeon to the intraoperative findings of 133 consecutive patients who underwent lateral ankle ligament reconstruction procedures for chronic ankle instability. The researchers found that the radiologist missed 50 percent of the associated lesions found intraoperatively and the attending surgeon missed 33 percent. O’Neill said that many of the lesions may have been missed on MRI due to a potentially high number of superficial lesions that lack bony edema and the inherent challenges in visualizing peroneal tears. The research was presented at the 5th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society held in Vancouver, British Columbia, Canada, July 15-18, 2009.

From the article of the same title
Ortho Supersite (07/21/2009) Brockenbrough, Gina

Superficial Blood Clots May Be Warning Sign

About 25 percent of patients who have superficial blood clots on their legs may be at risk for deep vein thrombosis, according to researchers from Austria. Barbara Binder of the Medical University of Graz and colleagues studied 46 patients with superficial vein clots from November 2006 and June 2007. Deep vein thrombosis was found in 24 percent of patients, even though most had no other symptoms. Deep vein thrombosis occurred most often with superficial clots in the lower leg and in 73 percent of cases, it occurred in the same leg as the superficial clot. The study can be found in the Archives of Dermatology.

From the article of the same title
Reuters (07/20/09)

Practice Management

Doctor's Orders

The proliferation of Web sites that allow patients to “review” physicians has led some practices to require patients to sign broad agreements that prohibit online postings or commentary in any media outlet "without prior written consent." Though many experts say such agreements are unenforceable, a growing number of doctors view them as an appropriate response to sites that not only ask detailed questions about their punctuality, availability, communication skills, office staff and effectiveness of treatment but also allow scathing comments that may be untrue.

From the article of the same title
Washington Post (07/21/09) Boodman, Sandra G.

Is a Cash-Only or Direct-Pay Medical Practice for You?

The American Academy of Family Physicians says 500 to 1,000 family medical practices nationwide are run on a cash-only basis. Many physicians opting for a cash-only model are looking to save money as insurance reimbursement rates decline. They find that eliminating insurance billing reduces staffing needs. Some of these physicians join networks such as SimpleCare, which requires members to charge "no-hassle, discounted" prices based on the length of the appointment. While fees vary, they average about $50 for a minimal visit of five minutes to $300 for a 60-minute extended visit. Other practices are adopting the cash-only, direct-pay model on their own.

From the article of the same title
U.S. News & World Report (07/17/09) Payne, January W.

Saying `Sorry' Pays Off for U. of Michigan Doctors

The estimated $5.8 billion annual cost of malpractice claims nationwide has been highlighted during the debate on healthcare reform. The University of Michigan Health System is trying to reduce such costs by admitting mistakes up front and offering compensation to patients. According to recent study by the hospital, malpractice claims against the health system decreased from 121 in 2001 to 61 in 2006, while the backlog of open claims went from 262 in 2001 to 106 in 2006 and 83 in 2007.

From the article of the same title
Associated Press (07/20/09)

Health Policy and Reimbursement

Survey: Company Healthcare Costs to Rise 9 Percent in 2010

A new report by PricewaterhouseCooper’s Health Research Institute estimates that medical costs to employer will rise by 9 percent next year, slightly lower than the previous year. However, healthcare inflation for employers is significantly higher than overall inflation and increases in wages. In fact, insurance premiums have risen at four times the rate of wages over the past five years.

From the article of the same title
BusinessWeek (06/18/09) Arnst, Catherine

AMA Ranks Payers' Claims Processes, Which Are Often a 'Murky Mess'

The American Medical Association has released its latest rankings of seven large health plans and Medicare in promptness and accuracy for paying claims. The survey found a wide variation in practices among the payers, with each using a different set of rules, timelines, and confusing and inconsistent processes. AMA is calling for a simplification of the claims process, noting that physicians now spend a total of three weeks a year, sometimes as much as 35 minutes a day, trying to figure out what codes to use and what insurance plans will cover, at a cost of $200 billion a year. "Physicians are now bogged down in paperwork," requiring they divert as much as 14 percent of their gross revenue to assure accurate payments, says William Dolan, MD, a member of the AMA board of trustees.

From the article of the same title
HealthLeaders Media (07/22/09) Clark, Cheryl

HASC Describes How Billions Wasted on Administration of Healthcare

On a related note, the Healthcare Administrative Simplification Coalition (HASC), a public/private partnership of organizations committed to reducing the administrative costs and complexity of healthcare, has released a new report which estimates that reducing administrative costs by just 10 percent could save as much as $500 billion over 10 years. HASC says that as much as a 25 percent of U.S. healthcare spending goes to administrative functions and that much of administrative activity is duplicative. Standardization could help reduce costs and as such the organization is recommending that stakeholders voluntarily adopt a coordinated nationwide approach to conducting key administrative processes including credentialing and eligibility determinations.

From the article of the same title
Healthcare Administrative Simplification Coalition (07/20/09)

Technology and Device Trends

Students Embed Stem Cells in Sutures to Enhance Healing

Johns Hopkins biomedical engineering students have demonstrated a practical way to embed a patient's adult stem cells in the surgical thread that doctors use to repair serious orthopedic injuries as part of efforts to improve healing and reduce the likelihood of re-injury without changing the surgical procedure itself. The students believe the technology has great promise for the treatment of debilitating tendon, ligament and muscle injuries, and have begun testing on animals. As envisioned, a doctor would withdraw bone marrow containing stem cells from a patient's hip while the patient was under anesthesia, and the stem cells would be embedded in the suture through a quick and easily performed proprietary process. The surgeon would then stitch together a ruptured Achilles tendon, for example, in a conventional manner. Foot and ankle surgeon Lew Schon, an assistant professor of orthopedic surgery in the Johns Hopkins School of Medicine, is one of the inventors of the technology.

From the article of the same title
ScienceDaily (07/20/09)

Researchers to Implant Pig Cells in Diabetics

New Zealand-based biotech company Living Cell Technologies has begun a trial of an experimental treatment for diabetes that involves the implantation of cells from newborn pigs into human volunteers. The cells produce pig insulin, which is very similar to human insulin and has the same effect of lowering blood sugar. The company hopes that implantation of the cells can delay the effects of Type 1 diabetes, including blindness, premature coronary illness, and limb amputation caused by poor blood circulation.

From the article of the same title
Associated Press (07/23/09) Lilley, Ray

Nerve Blocks Placed With Ultrasound Guidance Yield 99 Percent Success Rate

Using ultrasound guidance for the placement of sciatic nerve block injections at the popliteal fossa is effective, according to the results of a study presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society held in Vancouver, British Columbia, July 15-18, 2009. Kenneth J. Hunt, MD, and colleagues prospectively studied 200 consecutive patients undergoing various foot and ankle procedures who received a single or continuous sciatic nerve block injection at the popliteal fossa placed using ultrasound guidance. Only one failure was reported, and no needle paresthesia, neurologic deficits, vessel punctures, or intravascular injections were reported.

From the article of the same title
Ortho Supersite (07/17/2009) Brockenbrough, Gina

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July 29, 2009