To view this online go to:
BlackBerry users please scroll down for story text.


This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

ACFAS Greets APMA Meeting Attendees

The College’s many trusted and respected programs were on display last week at the APMA national meeting in Toronto. “We’re here to continue our ongoing contributions to and support of the podiatric profession,” said ACFAS Board member Jordan P. Grossman, DPM, who personally greeted exhibit visitors. “We couldn’t be more pleased with the inquiries and feedback we’re receiving from both Board certified and non-certified podiatrists.”

The most frequently viewed or requested programs were the College’s online CME programs, DVDs, patient education materials, and complimentary copies of the Journal and Clinical Practice Guidelines. Grossman reported that supplies of publications were exhausted half-way through the conference.

ACFAS also exhibited at the Western and Midwest Podiatric Conferences in 2009 with equally positive and inquisitive visitors. “The College will continue its support of these conferences to meet with members and non-members alike,” said ACFAS President Mary E. Crawford, DPM.

Submit a Case for “Curbside Consult” at Annual Conference

Do you have an interesting case that proved to be a diagnostic dilemma or presented a management problem? “Curbside Consult,” an innovative session debuting at the 2010 Annual Scientific Conference, provides an opportunity for you to have your problem addressed by a panel of experts in an informal setting.

The Conference will be held February 23-26 in Las Vegas. Submit your case now, using the form available at the web link below.

Health System Reform Roundup

In the week running up to the August recess, the House Energy and Commerce Committee approved the House “Tri-committee” bill, which means that there will be a floor debate when the House returns after Labor Day.

The House bill includes a “public option,” but under pressure from “Blue Dog” conservative Democrats, the public option was altered to make it more similar to private health insurance. Under the revised legislation, payment to providers participating in the public plan will not be tied to Medicare payment rates.

The Senate Finance Committee stalled in its efforts, and now has a goal of voting a bill out of committee by September 15. The Senate bill includes a health care cooperative in place of a public option.

Meanwhile, a coalition of primary care providers, including the American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association, has launched a “Heal Health Care Now” campaign urging passage of meaningful health care reform that will provide universal coverage. The groups support a public plan but have not taken a position on specific legislation.
Quality Information for Your Patients

The College’s consumer web site,, contains a wealth of patient education information developed by your ACFAS peers, provided in both English and Spanish. The number of visitors to the site continues to grow, with July seeing the highest number ever…268,647 unique visitors! is a valuable resource to ACFAS members. If your patients have internet access, you can direct them to specific topics on the site. You can also link your practice web site to any or all of the site’s patient education topics.

Seeing is believing! Use the web link below to take a test drive of the site today.

Short on Time? Quickly Read the Latest Research

You can stay abreast of the latest research in a minimum of time with the ACFAS online Scientific Literature Review (SLR). The August edition features 13 reviews prepared by residents at the OCPM-UHHS Richmond Medical Center. You’ll see podiatry-relevant research from journals you don’t usually read, such as:
• Journal of Diabetes Complications
• The American Journal of Roentgenology
• The Journal of Trauma Injury, Infection, and Critical Care
• Annals of Internal Medicine.

Access SLR 24/7, using the web link below.

Foot and Ankle Surgery

Impaired Lymphatic Function Recovered After Great Saphenous Vein Stripping in Patients With Varicose Vein

This study investigated the effect of surgical treatment on lower limb lymph flow in patients with varicose veins. Thirty-nine patients with varicose veins in the lower limb were investigated with air-plethysmography and indocyanine green (ICG) fluorescence lymphography before surgical treatment and six months later. The researchers concluded that varicose veins could affect lymphatic function and delay lymphatic flow in the lower limbs and that derangement of lymph flow may correlate with the severity of clinical venous disease and/or the magnitude of venous reflux, which could be reversible with surgical treatment of venous incompetence.

From the article of the same title
Journal of Vascular Surgery (07/27/09) Suzuki, Minoru; Unno, Naoki; Yamamoto, Naoto; et al.

Tibial Angioplasty for Limb Salvage in High-Risk Patients and Cost Analysis

This study examined the efficacy and cost of tibial angioplasty in patients with critical limb ischemia (CLI) at high operative risk utilizing a retrospective analysis of all consecutive patients who underwent tibial angioplasty with critical ischemia. The researchers concluded that tibial angioplasty has acceptable rates of limb salvage in patients with CLI considered to be at high risk for surgery, despite high recurrence rates. "The presence of diabetes or ESRD did not reduce the rate of success in this series, although ESRD seemed to predict recurrence. The procedure has low morbidity and mortality with lower cost and LOS compared with open revascularization. Aggressive angioplasty should be an option to patients who otherwise would face primary amputation," they wrote.

From the article of the same title
Annals of Vascular Surgery (07/24/09) Werneck, Christiane C.F.; Lindsay, Thomas F.

New Anesthesia May Be Safer for Critically Ill

Early testing suggests that a new chemically altered version of an existing general anesthesia may avoid two common side effects that are particularly dangerous for elderly or critically ill patients. In preclinical studies done on rats, researchers added a molecule to the chemical structure of etomidate that causes it to break down naturally. Most general anesthesia produce a drop in blood pressure-sometimes very suddenly-requiring careful monitoring by anesthesia providers. A slowdown in adrenal gland activity typically can last for days, meanwhile, but MOC-etomidate lessens this effect. The study is published in the August issue of Anesthesiology.

From the article of the same title
Atlanta Journal-Constitution (07/23/09)

Practice Management

Red Flags Deadline Delayed

As ACFAS reported last week, the Federal Trade Commission (FTC) has pushed back enforcement of the anti-fraud "Red Flags" Rule another three months to Nov. 1. The rules require any business that accepts credit as payment (including physician practices to have in place identify theft prevention, detection, and response systems. To access ACFAS tools for Red Flags compliance, click on the link below.

From "FTC Announces Expanded Business Education Campaign on 'Red Flags' Rule"
Federal Trade Commission (07/29/09)

Patient Portion of Fees Often a Mystery

A recent survey of nearly 1,300 physician practices, medical billers, and billing offices by healthcare communications network NaviNet revealed that 49 percent were unable to estimate the amount due at the time of care, except for the co-pay. Thirty-one percent of respondents said they billed patients but only got a portion of money due, 57 percent said they get "most" of their money, and only 12 percent said "we sent patients bills, and they pay them." While some practices have tried to increase patient pay rates through real-time claims adjudication or cost estimation tools, implementation has been slow because many physicians lack the necessary systems to support such solutions and health insurers have been slow to test them.

From the article of the same title
American Medical News (07/27/09) Elliott, Victoria Stagg

Can Pen and Paper Help Make Electronic Medical Records Better?

A recent study found that using old-fashioned pen and paper for certain purposes can make electronic medical records even more useful to healthcare providers and patient. The study identified, recently published in the International Journal of Medical Informatics, Identified 125 instances of beneficial paper use and organized them into 11 categories.. The most common reasons for using paper workarounds were efficiency and ease of use, followed by paper's capabilities as a memory aid and its ability to alert others to new or important information. For example, the study identified a beneficial use of paper: issuing of pink index cards to newly arrived patients at a clinic who have high blood pressure. The information was entered into patients' electronic medical records, but the pink cards allowed physicians to quickly identify a patient's blood pressure status.

From the article of the same title
IUPUI News Center (07/20/09) Aisen, Cindy Fox

Best Ways to Deal With No-Shows

Physician practices have seen patient volume fall 5 percent to 20 percent as the weak economy prompts patients to delay preventive care and elective procedures or miss follow-up appointments. Practices can take several steps to improve no-show rates. A survey of 11,000 scheduled patient visits by the University of Missouri indicates that patients were more likely to keep their appointments when schedulers inquired about the most convenient time for the patient - based on transportation, child care and work responsibilities – and scheduled accordingly. Reminder calls and e-mails also reduced the number of shows. The researchers suggested that practices create a “priority wait list” in Excel which makes it quick and easy to contact a patient to fill an unexpectedly open slot.

From the article of the same title
Medscape (07/14/09) Woodcock, Elizabeth

Health Policy and Reimbursement

EDs Can't Sustain Care in Current Economic Environment

A recent study by the US Agency for Healthcare Research and Quality (AHRQ) raises concerns about the sustainability of emergency care. The report found that while 425 hospital emergency departments (EDs) closed between 1993 and 2003, the number of visits increased by 23% and noted that EDs are “overcrowded, overburdened and underfunded.” . Forty-one percent of ED visits were billed to Medicare and Medicaid and 18% were uninsured. The report noted that only 6.8% of the visits by the uninsured resulted in an admission, indicating that the uninsured are relying on the ED for basic health care.

From the article of the same title
Health Leaders Magazine Online (08/09)

Recovery Act to Fund 12 State Efforts to Improve Care in Ambulatory Surgical Centers

CMS announced late last week that 12 states will be receiving funding from the American Recovery and Reinvestment Act of 2009 (the Stimulus Package) to survey more than 125 ambulatory surgical centers in the next several months to determine whether the facilities are in compliance with Medicare health and safety standards. Because more and more surgery is being performed in outpatient settings, and hospital-acquired infections (HAIs) are on the rise, the goal of the project is to see whether procedures are in place to minimize the possibility of HAI in an ASC setting.

From the article of the same title
CMS Press Release (07/30/09)

Technology and Device Trends

Better Function Seen in Total Ankle Replacement vs. Ankle Fusion at 2 Years

Researchers have found better function with total ankle replacement (TAR) compared to ankle fusion in a 2-year prospective controlled trial using an uncemented, mobile-bearing total ankle device. The multicenter research was part of an FDA investigational device exemption study to determine the safety and efficacy of the Scandinavian Total Ankle Replacement (STAR) prosthesis for patients with end-stage ankle arthritis. The researchers found a 58.5 percent overall efficacy success rate for the pivotal TAR group, compared to 14.9 percent for the fusion group. A 76.1 percent success rate was recorded for the continued-access TAR patients.

From the article of the same title
Ortho Supersite (07/22/2009) Brockenbrough, Gina

Initial Outcomes of 3-dimensional Imaging-based Computer-assisted Retrograde Drilling of Talar Osteochondral Lesions

The use of computer-assisted guided retrograde drilling of Berndt and Harty stage 1 and stage 2 osteochondral lesions of the talus has been described as a new technique with promising results for revascularization Researchers from Germany and the United States sought to establish whether the greater precision of computer-assisted drilling results in satisfactory clinical outcomes. They concluded that a retrograde approach does not breach the overlying intact talar cartilage and that 3-dimensional computer navigated drilling showed promising results.

From the article of the same title
American Journal of Sports Medicine (07/01/09) Vol. 37, No. 7, P. 1351; Geerling, Jens; Zech, Stefan; Kendoff, Daniel; et al.

Abstract News © Copyright 2009 INFORMATION, INC.
Powered by 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.
August 5, 2009