News From ACFAS

Early this week, the Texas State Board of Podiatric Medical Examiners (TSBPME) met and affirmed that podiatrists in Texas should be able to continue to treat the foot and ankle, despite the state Supreme Court’s denial of the Texas Podiatric Medical Association’s (TPMA) appeal of the Court's earlier ruling on the TSBPME definition of podiatric scope of practice. TPMA spokespeople did note there was reason for possible concern about wound care and other procedures above the ankle which podiatrists currently hold hospital privileges to perform.

Podcasts from ACFAS e-Learning are a convenient, no-cost resource for knowledge in foot and ankle health.

The latest addition, “Arthroscopy of the Foot and Ankle: Use and Abuse,” is a comprehensive discussion of the ins and outs and controversies regarding arthroscopy. Three surgeons share their experience on questions such as equipment, adjunct diagnostics, how long the procedure should last and for what conditions it can be successfully utilized.

Tune in whenever you are ready to get the new podcast or browse the entire library at ACFAS e-Learning.

The U.S. Bone and Joint Decade (USBJD), in which the College is a member, has a public education program in partnership with a number of healthcare professionals and other organizations called “Fit to a T.” This program is offered in response to the surgeon general’s first-ever report in 2004 on bone health and osteoporosis.

USBDJ has developed a one-hour program, aimed at the general public, focusing on bone health, osteoporosis, how to avoid fragility fractures and provide consumers with the information they need to make informed decisions on bone health. Educational sessions are being conducted at community public libraries, clinics, health fairs, civic groups, schools and other venues.

For more information on how to hold a session, e-mail usbjd@usbjd.org, call 847-384-4008 or visit fit2t.org.

Foot and Ankle Surgery

Treatment of Achilles Tendinopathy With Platelet-Rich Plasma

Non-insertional Achilles tendinopathy commonly impedes the functioning of active persons. Researchers sought to evaluate the effectiveness of non-insertional Achilles tendinopathy treatment with autologous platelet-rich plasma (PRP). Autologous PRP was injected into the affected Achilles tendon of 14 prospectively selected patients (15 Achilles tendons). Before PRP administration, all patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale for the hind foot, and the Victorian Institute of Sport Assessment - Achilles (VISA-A) scale. Identical physical and imaging evaluations were performed at six weeks, and at three, six, and 18 months after injection. During follow up, a significant improvement was observed in the clinical and imaging results. The AOFAS scale improved from a baseline median of 55 points to 96 points at 18 months, while the VISA-A scale improved from a baseline of 24 to 96.



Toe the Line: Doctors Fight Cosmetic Foot Surgery

Some orthopedic surgeons and podiatrists are fighting a new trend: cosmetic foot surgery designed to make footwear more comfortable. The doctors are mainly concerned about what can go wrong, including infections and problems with anesthesia that are possible with any surgery. The risk-versus-benefit calculus has created rifts between physicians who argue that surgery should only be done to alleviate pain and deformities, and those who say that making women more comfortable in their shoes can prevent pain and deformity from happening.

Practice Management

5 Ways to Cut Overhead Without Layoffs

Physicians can lower their practice overhead without cutting staff positions by following a number of strategies, such as purchasing bulk office and medical supplies, and buying only what is necessary rather than automatically restocking overfilled inventories. Another strategy is to review facility costs and/or rent out extra space. Establishing a policy that all overtime must be sanctioned by a supervisor also can help reduce overhead. A fourth strategy is to comparison shop contracts for such services as phone and Internet, copier maintenance, and accounting and bookkeeping in an effort to get the best rates. Finally, cutting staff work hours can save money, and the reduction in paychecks can be less onerous to employees if more flexible scheduling is offered.



Best IT Practices for Small Medical Practices

Small and midsize medical practices often are hesitant to implement information technology (IT) solutions due to concerns about the lack of in-house expertise or the time and money to devote to such projects. There are many things smaller practices can do to benefit from IT, and in most cases, a server solution that can accommodate upgrades and add-ons offers the appropriate infrastructure. Upgrading their infrastructure with a server solution or implementing electronic medical records can make it easy for practices to go paperless, which also helps them meet HIPAA and other government mandates for the secure use and storage of patient information.

Practices should consider solutions with other security features, including automatic tracking capabilities and automatic updates. Additionally, they could boost productivity and improve care through mobile applications that allow physicians to look at lab results, read e-mail and text messages, and share information in real-time. Those that implement virtual communications tools can eliminate travel costs for staff meetings and training sessions, as well as allow physicians to consult with patients from remote locations. Finally, practices that offer remote access to files make it possible for physicians to see more patients during the day and complete documents at home in the evening.



Are You Using Checklists?

Checklists in the operating room can serve as effective tools to guard against memory lapse and to promote attention while also improving team performance, complying with standards of care, and protecting patient safety. Checklists can minimize risk and improve performance, especially in environments where many routine functions have been consolidated into a complex system. The simple checklist ensures that the most important steps are not forgotten.

A study on the impact of using a 19-item surgical safety checklist shows statistically significant reductions in all measured events. The Safe Surgery Saves Lives program selected eight global locations with more than 3,700 patients for the baseline and nearly 4,000 patients after introduction of the checklist. The occurrence of any complication was reduced from 11 percent at baseline to 7 percent after checklist implementation, deaths dropped from 1.5 percent to 0.8 percent; surgical-site infections declined from 6.2 percent to 3.4 percent; and unplanned returns to the operating room fell from 2.4 percent to 1.8 percent.

Health Policy and Reimbursement

2009 Medical Group Data Finds Continued Financial Losses in Most Regions

According to findings in the American Medical Group Association's 2010 Medical Group Compensation and Financial Survey, most specialties saw modest increases in compensation last year, but many provider organizations continue to operate at a significant loss. The survey found that 76 percent of the specialties experienced increases in compensation in 2009, with the overall average increase around 3.8 percent.

The section of the survey that examines financial operations, however, found that medical groups were still faced with losses overall. In 2009, organizations in the Eastern and Western regions operated at break even. Organizations in the Southern region operated at a loss (-1,034 per physician). Groups in the Northern region experienced significant losses (-9,943 per physician).



Americans Cut Back on Visits to Doctor

Insurers, lab-testing companies, hospitals and doctor-billing firms say that patient visits, drug prescriptions, and procedures were down in the second quarter compared to the same quarter in 2009. The drop is raising speculation on whether patients are reluctant to seek medical attention because they are being forced to pick up a greater share of the costs. Continued weak demand could eventually put downward pressure on spiraling healthcare costs and could also force insurers to lower premiums.



CMS Unveils Imaging Decision-Support Initiative

The U.S. Centers for Medicare and Medicaid Services (CMS) has announced a $10 million project to evaluate decision-support systems for ordering diagnostic imaging studies. The Medicare Imaging Demonstration initiative is intended to allow the CMS to determine if the use of decision-support systems can promote the ordering of diagnostic imaging procedures only when they are clinically appropriate, reducing unnecessary radiation exposure and imaging expenditures, and improving patient care quality. CMS is providing up to $10 million for the two-year project, which is expected to start January 1, 2011.

The project will assess the efficacy of decision-support systems used by physician practices on the appropriate use of medical imaging services ordered for Medicare fee-for-service patients. The decision-support systems used will provide immediate automatic feedback to the ordering physician based on current medical specialty guidelines on the appropriateness of the diagnostic imaging procedures to resolve clinical questions about patients. CMS is looking for participation from 2,500 to 3,500 physicians from 500 to 600 physician practices of various sizes, specialties, and geographic locations.



Move to Restrict Pain Killers Puts Onus on Doctors

The government of Washington State is working on regulations meant to prevent doctors from prescribing higher doses of powerful pain killers for patients to whom they provide no benefit, and medical professionals elsewhere are closely watching this development. The increasing use of long-acting pain killers such as OxyContin, fentanyl, and methadone has been a critical factor in a national outbreak of overdose deaths mainly attributed to drug abuse, according to experts in pain treatment and drug abuse prevention. On July 23 an advisory panel to the U.S. Food and Drug Administration rejected an agency proposal to better regulate drugs such as OxyContin as not strong enough because it did not mandate special training for doctors who prescribe such medications.

Three years ago Washington state adopted voluntary narcotics use guidelines, but a 2009 statewide poll showed that many doctors were not following them and about 50 percent were unaware of them. At the behest of the Washington Legislature, a committee of doctors, nurses, regulators, and others are compiling a series of medical practices that prescribers would be legally expected to follow when treating patients with long-term pain from causes other than cancer. The committee is expected to require that doctors refer patients to a pain specialist for review when their daily medication increases to a specified dosage level and they do not exhibit improvement. The specialist can then ascertain whether to continue the drug, cut the dose, or employ alternative therapies.

Washington officials say that doctors who elect to disregard the new rules could face sanctions from state licensing boards, including potentially having their right to practice revoked. Drug manufacturers and patient groups have said that new limitations would unreasonably penalize pain sufferers who rely on the drugs.



New Healthcare Model Rewards Doctors for Efficiency

Horizon Blue Cross Blue Shield of New Jersey is launching a new company intended to slow increases in healthcare costs by paying doctors for the quality of their care. The company, Horizon Healthcare Innovations, will roll out a series of pilot programs with family-practice doctors, cancer specialists, orthopedists, and a pharmaceutical company this year. Next year, 30 additional projects are planned. After tweaking these smaller demonstrations, the new company will expand to absorb the majority of Horizon's 3.8 million members.

Under the new structure, participants' compensation will be based on how well they manage patients with chronic illnesses such as diabetes and asthma and how consistently they help others get timely screenings and preventive care. The program will use high-tech tools like smart phones to help patients.

Technology and Device Trends

FCC, FDA Unveil Partnership to Promote Wireless Medical Technology

The Federal Communications Commission (FCC) and the Food and Drug Administration (FDA) have announced a partnership, to promote wireless medical technology, a field they say will cut medical costs and improve care. Calling the partnership “unprecedented,” FCC Chairman Julius Genachowski said that “all Americans stand to benefit from wireless-enabled health solutions.” The FCC’s National Broadband Plan, released in March, called on the government to streamline processes to promote wireless medical technology. The partnership comes on the heels of the FCC’s move in July to create a $400 million fund for broadband infrastructure projects at medical facilities.

Potential uses for wireless health technology include pumps that deliver insulin to diabetes patients, remote monitoring systems that measure the level of glucose in a patient’s body, and sensors that send text messages to a doctor if a patient’s state changes.




Rabbits Grow Their Own Joint Replacements in Study

Rabbits implanted with artificial bones made out of polycaprolactone and hydroxyapatite re-grew their own joints, complete with cartilage, researchers reported in the Lancet journal. The researchers replicated a rabbit's leg joint using a laser to calibrate the structure. They infused this porous bone scaffold with transforming growth factor beta-3. Ten rabbits fitted with the new joint were hopping around within three to four weeks. Only a few of the 10 rabbits fitted with an unenriched scaffold could move normally, and three rabbits whose joint was surgically damaged and not repaired limped permanently

The researchers said that such a joint should last longer and work more naturally than a metal joint. The technique could benefit patients with advanced arthritis.



Abstract News © Copyright 2010 INFORMATION, INC.

---

You have received this newsletter as a service of the American College of Foot and Ankle Surgeons. To change your email address, please click here. If you wish to unsubscribe click here.