News From ACFAS

The American College of Foot and Ankle Surgeons (ACFAS) has joined the American College of Surgeons by writing to President Obama about his recent comments on the appropriateness and cost of surgical procedures, particularly the cost of a foot amputation - a procedure ACFAS members know well.

At a town hall meeting on August 11, the President said, “Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.) So changing reimbursement rates will help.”

In the College's letter to the President, ACFAS President Mary E. Crawford, DPM, FACFAS said, “We agree with you that preventive and conservative care is always preferred to surgery, not only for the patient’s well-being, but to save medical costs. Unfortunately your comments painted an inaccurate picture to consumers that the surgeon is being paid up to $50,000, when, in fact, Medicare pays between $740 and $1,140 for a leg amputation, and foot amputations can often pay even less via Medicare.

"As you know, the vast majority of medical costs are not for the physician or surgeon, but for hospitals, supplies, and follow-up care. Since insurance companies pay close to Medicare’s reimbursement rates, the federal government is already the de facto single-determiner in what physicians and surgeons are paid – and the rates you believe should be changed have, in fact, already been cut or fallen far behind inflation every year for the past decade."



Check out this new publication that walks physicians through the facts about the electronic health records "incentive payments" included as part of the 2009 Stimulus package.

Download this valuable document via the web link below.

Learn recession-survival skills at the Coding and Practice Management Seminar, September 25-26 in Chicago. With outstanding faculty, this comprehensive program will provide important coding, operations and marketing tools to optimize reimbursement and reduce overhead. Register online using the web link below or phone 800-421-2237.

The August issue of the Update member newsletter will soon be arriving in your mailbox, but you can read it online now.

Read Annual Scientific Conference Chairman Sean Grambart's "Perspective" piece, "How Do We Develop the Annual Conference Program?" See the results of the recent ACFAS member surveys. And learn about implementing the Medicare Therapeutic Shoe Program for your practice.

Use the web link below to read the latest issue of Update now.

Foot and Ankle Surgery

Safer Anesthesia Comes From Battlefield

To lessen pain for up to five days after ankle surgery, anesthesiologist Dean Giacobbe uses a pump and plastic tube to deliver anesthesia. The approach is "Kind of like novocaine, when a dentist would inject your mouth, but you're injecting into the peripheral nerves in the body and numbing certain areas of the body," he explains. He adds that physicians "Just dial in a rate of how much we want to go in per hour." Giacobbe, a former Navy doctor, says the technique has been used for soldiers with limb injuries in Iraq. The peripheral pain block technique is now used at Chesapeake Medical Center in Virginia. Patients say they do not experience the side effects of morphine and recover more quickly, and can move their limbs with less pain. There are currently very few published studies on peripheral pain blocking. Potential risks may include infection and nerve damage. Doctors say the risk is reduced when ultrasound machines because the tubing can be injected with more precision.



Repair of Chronic Rupture of the Achilles Tendon Using 2 Intratendinous Flaps From the Proximal Gastrocnemius-Soleus Complex

Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible. Eleven patients with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two intratendinous distally based flaps fashioned from the proximal gastrocnemiussoleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump. The patients were followed up for a period of 6 to 9 years.

At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system. The researchers conducting the study concluded this technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.



Trephine Arthrodesis of Subtalar Joints: Operative Technique and Clinical Effect

Researchers at the Third People's Hospital of Jinan, China, reviewed the operative technique of trephine arthrodesis of subtalar joints and evaluate its clinical effect. They performed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. No severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The patients experienced improvements in pain, function, cosmesis, and shoe-wearing. Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Postoperative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1 percent. There was an increase in arthritic scores for 5 ankles, 4 talonavicular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolateral approach, which required revision arthrodesis. The researchers concluded that isolated subtalar arthrodesis with trephine method is an effective procedure for painful malalignment of hindfoot.

Practice Management

The Best New Software for Your PDA

E-mail and voicemail are excellent and convenient means of dealing with standard administrative tasks, and with the proper precautions they can even be used to notify patients of test results and to disseminate clinical recommendations. However, voicemail and e-mail messages can also be misdirected, snared by spam filters, or accessed by unintended recipients, and stray messages can result in HIPAA violations. By taking a few key precautions early, medical professionals can be confident that their electronic communication is also fully compliant.

Risk managers recommend that if medical professionals plan to communicate with patients via voicemail or e-mail, they should first notify patients of their intent and get written approval. Let patients know that e-mail correspondence will become part of their medical record. Also, advise patients not to use a work e-mail address, because employers have a right to access computer systems they're paying for.

All email messages must be conveyed in a manner that reflects that the doctor understands that this is a professional interaction. Proofread and spell-check all e-mails before clicking "send." As much as possible, avoid abbreviations, and encourage patients to do the same, to reduce the likelihood of misunderstandings. Risk managers advise against imparting bad news, changes in treatment plan, and other sensitive clinical information via e-mail.



Controlling Costs

Physician practices should examine their vendor and supplier fees in order to control costs. The Internet makes it relatively easy to shop around for such things as lower health insurance premiums, bundled phone and Internet service, and accounting costs. Professional trade associations are good resources to use when trying to find any purchasing cooperatives available that offer group discounts on office and medical supplies. Physicians should not be shy about letting vendors and suppliers know there is a lot of competition out there now in order to get the best price.

Health Policy and Reimbursement

Ad Campaign Counterattacks Against Overhaul's Critics

Americans for Stable Quality Care, a coalition of drug companies, doctors, and a major labor union, all backing a health overhaul, has developed a $12 million television advertising campaign that targets 12 states. Most of these groups, especially the drug companies, worked against President Bill Clinton's proposed overhaul in 1993-94. They are generally allied now in advocating change, although they differ in some of the particulars. The new commercials followed the opening of a 20-state, multimillion-dollar network television campaign by the United States Chamber of Commerce to try to derail support for a government-run health insurance option.



One Health Reform Bill Would Boost State Authority Over Medicare Advantage

Medicare Advantage will be a hot topic in the U.S. House after the August recess, particularly U.S. Rep. Kathy Castor's (D-Fla.) amendment to a healthcare reform bill that would return regulatory authority over Medicare Advantage marketing to states. Officials of the National Association of Insurance Commissioners (NAIC) have cited what they call "egregious failures" in federal consumer protection with regard to the Medicare Advantage program. NAIC outlined its concerns in a letter delivered to the U.S. House Energy and Commerce, Ways and Means, and Education and Labor committees in July.



Litigation Screening Panels on Trial: Are They Working?

Prelitigation review panels are touted by some as a way to temper medical liability costs by weeding out frivolous claims and encouraging early settlement of valid cases. However, the concept has faced resistance from critics who say it unnecessarily and unfairly drags out the legal process. The actuarial and consulting firm Pinnacle Actuarial Resources Inc. conducted a study which found that states with screening panels generally had better overall medical liability insurance rates - 20 percent below the national average - and lower claims costs than states without such laws. States with stronger panel laws also showed a higher percentage of cases that closed without any payout and quicker settlement times.

Technology and Device Trends

Take Two Digital Pills and Call Me in the Morning

Several California firms are seeking to raise quality and lower costs of healthcare through the development of wireless technology. Proteus Biomedical is currently testing a miniature chip that can be implanted in normal pills and safely digested as it sends information to a wireless device worn on the skin. Doctors could use such information to gather vital signs, confirm whether a patient is taking the medication, and observe a drug's impact. Triage Wireless has developed a wireless, wearable device that measures vital signs in hospital rooms, including blood pressure. PiiX, a Band-Aid-style sensor by Corventis, can measure respiration, fluid status, and physical movements. Chip makers are working to make these devices more innovative and efficient while lowering the cost. Without reimbursements from Medicare or private insurance, doctors and hospitals are unlikely to invest in such new technology, despite cost savings in the long run. One study by West Wireless Health Institute suggests that remote monitoring could save $10.1 billion for Americans suffering congestive heart failure, $6.1 billion for those with diabetes, and $4.9 billion for people with chronic obstructive pulmonary disease.



The Hospital of the Future

Robots that glide through hospital halls represent just one example of the future of patient care. According to industry analyst Datamonitor, spending on telemedicine, which now entails everything from remotely monitoring patients to analyzing medical images from afar and someday could even include long-distance surgery, will reach $2.4 billion this year and nearly triple to $6.1 billion by 2012. "By 2015, home will be the hub of care," predicts Naomi Fried, vice president of the innovation and advanced technology group at Kaiser Permanente's Sidney R. Garfield Health Care Innovation Center in San Leandro, Calif. Robots are increasingly making their mark in the operating room, too. Robotic surgery in which the surgeon manipulates computer controls rather than a scalpel is now used for heart and prostate cancer surgery, gynecologic procedures, and bariatric surgery, among others. With the help of a tiny camera inserted through an incision "port," a surgeon can see the surgical field onscreen as he sits at a console in the operating room, from which he guides the robot's instruments, also inserted through ports.



Abstract News © Copyright 2009 INFORMATION, INC.

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