News From ACFAS

• On Thursday, August 12, from 2:00 to 3:30 p.m. EDT, the Centers for Medicare & Medicaid Services (CMS) is hosting a conference call on incentive programs for electronic health records (EHR). Click here to register no later than 1:30 p.m. EDT, August 12.

  The call will outline specifics such as who is eligible to participate, the size of the incentives, participation and payment milestones, and how to report on "meaningful use" measures.

• On Tuesday, August 17, from 3 p.m. to 4:30 p.m. EDT, CMS’ Provider Communications Group is holding a conference call for eligible providers on its 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx). Click here to register no later than 3 p.m. EDT, August 16.

  For those unable to attend, a transcript and MP3 file will be available shortly after the call ends. You can find them, and more information, at www.cms.gov/pqri.

Research is essential to the medical profession. If you’re involved in a study, share your findings with the most brilliant minds in foot and ankle surgery — your fellow ACFAS members.

Submit your manuscript or poster to be considered for presentation at the ACFAS Annual Scientific Conference, March 9–12, 2011, in Fort Lauderdale, Fla. Don’t wait, because the deadline for research manuscripts is only a few days away!

• Manuscript submission deadline: August 15, 2010
• Poster submission deadline: October 1, 2010

Visit the ACFAS website for applications and more details.

ACFAS is looking for members who have practice management expertise for potential speaking and podcast opportunities. If you’re interested, please fill out the faculty application available on the ACFAS website.

Questions? Contact Kristin Hellquist, ACFAS director of health policy, practice advocacy and research.

You may not have time to read all the research you’d like to, but in just a few minutes you can enhance your knowledge with ACFAS’ Scientific Literature Reviews. Podiatric residents have prepared article abstracts tailored to the interests of foot and ankle surgeons. The latest include:

Heritability of Chronic Venous Disease, from Human Genetics.
Reviewed by Jennifer Bell, DPM, OCPM/UHHS Richmond Medical Center.

A Method of External Fixation to Offload and Protect the Foot Following Reconstruction in High-Risk Patients: The SALSAstand, from Eplasty.
Reviewed by Betty Carreira, DPM, Roxborough Memorial Hospital.

Read this and many more reviews on the ACFAS website.

Foot and Ankle Surgery

Pain Management After Elective Hallux Valgus Surgery: A Prospective Randomized Double-Blind Study Comparing Etoricoxib and Tramadol

For patients with moderate pain after foot surgery, the cyclo-oxygenase 2 (COX-2) inhibitor drug etoricoxib provides better pain relief with fewer side effects than the opioid drug tramadol, concludes a new study. The study also helps to alleviate concerns that COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs may interfere with bone healing after surgery.

The researchers compared the two pain-relieving drugs in 100 women undergoing surgery for hallux valgus. Although both drugs were effective in controlling pain in the week after surgery, pain scores were significantly lower in the etoricoxib group. Patients in the etoricoxib group had lower maximum pain scores throughout the week after surgery. They also had better pain relief on the second and third days after surgery, when pain scores were highest. Additionally, computed tomography scans performed 12 weeks after surgery showed there was no difference in bone healing between the etoricoxib and tramadol groups.



Percutaneous Reduction and Fixation of Displaced Intra-Articular Calcaneus Fracture

Researchers conducted a study to evaluate the initial results of percutaneously reducing and fixing calcaneus fractures, in comparison to a control group that was openly reduced and internally fixed via an extensile lateral approach. The researchers chose 120 patients with 125 intra-articular calcaneus fractures as a consecutive series with treatment method randomized by surgeon and time of presentation. Patients treated with open reduction and internal fixation had an extended lateral approach and fractures were fixed with plates and screws, while patients treated with percutaneous reduction were administered small incisions with indirect fragment manipulation, and the reduction accomplished was secured solely with screws. There was no significant difference in average loss of reduction at healing between the two groups. The study results imply that percutaneously reducing and fixing calcaneus fractures minimizes complications and achieves and maintains extra-articular reductions, in comparison to both open reduction and standard extensile open reduction and internal fixation.



The Relationship Between the Body Mass Index (BMI) and Foot Posture in Elderly People

Researchers evaluated the postural characteristics of the feet of older people and their relationship with BMI. They evaluated 227 older women and 172 older men with respect to the BMI, the arch index (AI) and the foot posture index (FPI). Obese women were found to present mean values for the AI significantly greater than those of the normal and overweight women. The means for some of the criteria of the FPI were significantly higher in the obese men. There was a positive correlation between the BMI and the AI and some of the FPI criteria. The researchers concluded that obese women presented flatter feet while obese men presented more pronated feet, indicating a relationship between high BMI values and postural characteristics of feet.

Practice Management

Medical Homes for Medicaid: The North Carolina Model

Most new Medicaid enrollees in North Carolina are placed in enhanced medical homes, and an organization of 14 nonprofit, doctor-directed regional care networks identify local resources and customize quality improvement goals to local Medicaid patients' requirements. Patient needs dictate the kinds of care provided by Community Care of North Carolina, and Elizabeth C. Tilson, MD, medical director of Community Care of Wake and Johnston Counties, says that the networks can adjust to local patient populations better than a typical Medicaid health plan.

The Community Care model was structured according to feedback from doctors, which resulted in the development of nonprofit care networks to manage selected areas' Medicaid subscribers. Each network is a virtual integrated health system with a medical management panel of local physicians who develop best practices, a medical director, and a clinical pharmacist, among others. Care managers follow up with patients and recognize special patient needs, while the state provided doctors with financial incentives to treat Community Care patients by boosting Medicaid pay to near Medicare rates and starting to pay a care coordination fee of $2.50 per member per month.

More physician observers are beginning to realize that the Community Care model yields solid results, and the need for localized care will grow as approximately 16 million people gain Medicaid coverage under a national eligibility expansion starting in 2014.



Physicians: Get Over Your Fear of Electronic Messaging

Many physicians are concerned that e-mail communications with patients would take up too much of their time and expose them to liability. But a study—published in the July issue of the journal Health Affairs—of 35,423 people with diabetes, hypertension, or both, showed that the use of secure patient-physician e-mail messaging was associated with a statistically significant improvement in effectiveness of care during a two-month period. Physicians participating in the study said they were not overwhelmed by a large number of e-mails. On average, exchanges contained just slightly more than one patient message and one physician message, and 63 percent required clinical assessments or decisions, while 24 percent required clinical action such as ordering a lab test, showing that patients were not frivolous in their e-mails. E-mailing also cut down on unnecessary outpatient visits, thus improving the efficiency of care.



Rating Your Doctor

Health insurance plans and independent groups are increasingly making physician information available online to help patients make informed choices, but experts caution that most doctor-rating systems are still rudimentary, and a performance rating may not reliably reflect a doctor's abilities. The systems are typically based on two factors: cost and quality. Data measuring the quality of care—whether a diabetic gets regular blood-sugar tests or foot exams, for example—are not as easy to translate to the level of individual doctors, but cost is, so cost tends to be the bigger factor.

Health Policy and Reimbursement

Health IT Proficiency a Priority for Medical Board

The American Board of Medical Specialties (ABMS) announced that it will incorporate tools to promote the meaningful use of health information technology (IT) into its maintenance-of-certification program. ABMS said it would foster the development of new measurement tools or enhance existing programs to promote the meaningful use of health IT. Its three primary-care member boards—the American Board of Family Medicine, the American Board of Internal Medicine and the American Board of Pediatrics—will in the meantime develop initial products to encourage IT use.



Judge Allows Va. Healthcare Lawsuit to Move Ahead

A federal judge has refused to dismiss a Virginia lawsuit challenging the nation's new healthcare law, indicating the law represents a novel extension of Congress' constitutional authority that should be tested in court. U.S. District Judge Henry E. Hudson rejected arguments from Obama administration lawyers that Virginia has no standing to sue over the law and would have no chance of ultimately prevailing. Virginia's suit argues that Congress overstepped its constitutional authority with a provision mandating that Americans buy health insurance by 2014 or pay a fine.



Canadian Doctors Call for Major Healthcare Overhaul

The Canadian Medical Association has released a report saying that Canada's health system needs to be changed to allow universal access to prescription drugs and improved outpatient services. The report warns that the current system is insufficient to meet the needs of Canada's aging population, despite the fact Canada is one of the highest spenders of healthcare compared to other industrialized countries with universal health care. Many patients without employer health plans in Canada have large out-of-pocket expenses for prescription drugs and hospitals are increasingly focusing only on patients who are acutely ill, according to the report, which recommends using pay-for-performance funding to reward quality of care and a greater reliance on e-prescribing.

Technology and Device Trends

FDA Moves Toward Tighter Medical Device Oversight

The Food and Drug Administration (FDA) has released recommendations designed to improve oversight of the device industry. Under this proposal, makers of devices such as X-ray machines, drug pumps, and pacemakers would be required to submit more safety information for federal approval. The FDA's medical devices division has received increasing criticism from public health advocates and lawmakers in the past year regarding the agency's approval process. In 2009, the head of the device division resigned after scientists alleged that they had been pressured to approve certain products, and earlier that year, congressional investigators said the FDA should ensure that more devices are reviewed through its most stringent process.

The approval overhaul largely involves the FDA's 510(k) system, used for 35 years to grant faster approval to devices considered similar to those already on the market, including hip replacements and drug pumps. This faster system is popular among manufacturers because it is cheaper than the more rigorous review process used for newer devices. Critics say, however, that an increasing number of high-risk devices are passing through the 510(k) system without receiving thorough testing.



High-Tech 'Band-Aids' Call Doctors

The so-called smart Band-Aid, a new generation of wireless medical sensors mounted on adhesive strips, can call a doctor and transmit any kind of physiological information when it detects a problem. This kind of technology could help save money and a lot of lives. The technology builds on more than a decade of refining the practice of "remote monitoring," or when health care providers give patients easy-to-use home diagnostic equipment that connects to a network.



Robot Pills

Pill-sized robotic capsules are under development for screening, diagnostic, and therapeutic procedures. Making such capsules more reliable for gastrointestinal screening, for example, requires the addition of actuators that provide a means of propulsion or tissue manipulation, while two-way high-speed wireless data transmission of images and instructions is needed to operate the capsule's moving parts. Controlling the movement of capsular devices within the body usually involves either directing movement with onboard actuators or by magnetic fields generated outside the patient's body. In addition, imaging sensors, power supply, and other required tools must be fitted into a device small enough for the patient to swallow comfortably. A third solution is a hybrid approach that combines both internal and external locomotion methods. One research group has developed a hybrid capsule with four motor-driven extendable legs, which is guided forward by an external magnetic field. The capsule deploys its legs when it reaches a segment of intestine whose walls have collapsed, so that it can lift the surrounding tissue and move through the opening. Robots that configure themselves inside the body using magnets are being developed to expand the range of tasks that robot capsules can carry out, including surgery.



Abstract News © Copyright 2010 INFORMATION, INC.

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