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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

New Credentialing and Delineation of Privileges Statement Released

The American College of Foot and Ankle Surgeons has issued a new version of its position statements on “Credentialing of Podiatric Foot and Ankle Surgeons” and “Guidelines for Surgical Delineation of Privileges,” combined into one document.

ACFAS first issued these documents in the early 1990s, and they remain the most frequently used resource in the College’s arsenal of materials to assist board-qualified or certified podiatric surgeons in securing unfettered hospital medical staff privileges. The new document and all other ACFAS credentialing and privileging materials are available on the ACFAS website.

Members serving on the special task force that wrote the new document were Harold W. Vogler, DPM, FACFAS; Jeffrey C. Christensen, DPM, FACFAS; John J. Stienstra, DPM, FACFAS; and Jerome K. Steck, DPM, FACFAS.
CME Coming to Minneapolis, Portland, Charleston

This fall, “1st MTPJ A-Z Workshop and Seminar” will bring ACFAS’ top-rated continuing education to a city near you. You’ll have the chance to advance your surgical skills and knowledge through this convenient, contemporary, hands-on course.

ACFAS has teamed with Regional Divisions 2, 5, 6, and 14 to offer this program at three locations and dates:
  • Minneapolis, Minn., Sept. 24–25
  • Portland, Ore., Oct. 8–9
  • Charleston, S.C., Oct. 22–23
Find complete information and online registration on the ACFAS website.

Wake Up Your Research Interests

Get a jolt of recent research with ACFAS’ Scientific Literature Reviews. Every month, podiatric residents prepare abstracts relevant to the interests of foot and ankle surgeons from medical journals you may not usually read. The latest include:

MRI of Injuries to the First Interosseous Cuneometatarsal (Lisfranc) Ligament, from Skeletal Radiology.
Reviewed by Jahangir Habib, DPM, OCPM/UHHS Richmond Medical Center.

Modified Brostrom Technique Using Knotless Suture Anchors, from Techniques in Foot & Ankle Surgery.
Reviewed by Susan Orabovic, DPM, OCPM/UHHS Richmond Medical Center.

Access these reviews and more any time on the ACFAS website.

Foot and Ankle Surgery

Comparison of MRI and Arthroscopy After Autologous Chondrocyte Implantation in Patients With Osteochondral Lesion of the Talus

Researchers investigated the correlation of follow-up magnetic resonance imaging (MRI) vs. arthroscopic findings to the clinical outcome of surgically repaired osteochondral lesion of the talus with autologous chondrocyte implantation. One year postoperatively, a follow-up MRI and a second-look arthroscopy was performed on 21 consecutive patients. While the arthroscopic findings showed better correlation than MRI with the clinical outcome, measured with the modified MOCART scoring system, it did not reach any statistical significance. The researchers thus concluded that a second-look arthroscopy is not necessary, and that MRI is still a useful method to evaluate the repaired talar cartilage after an autologous chondrocyte implantation.

From the article of the same title
Orthopedics (08/10) Lee, Kyung Tai; Choi, Yun Sun; Lee, Young Koo; et al.

Outcomes After Scarf Osteotomy for Treatment of Adult Hallux Valgus Deformity

Researchers assessed the results of a treatment to correct hallux valgus deformity via scarf osteotomy with respect to AOFAS scores, patient satisfaction, radiographic results, and complications. Twenty-nine patients who underwent a unilateral scarf osteotomy combined with distal soft tissue realignment were evaluated over an 18-month period. Average AOFAS scores improved from 61.5 to 90.3, while 94 percent of patients were satisfied with the surgery at final followup. The hallux valgus angle improved from 34.6 degrees to 14.9 degrees and the intermetatarsal angle improved from 15.8 degrees to 7.2 degrees postoperatively. The results suggest that scarf osteotomy improves AOFAS scores and effectively corrects hallux valgus deformities while also minimizing the need for an Akin osteotomy and avoiding associated complications described in the literature.

From the article of the same title
Clinical Orthopaedics and Related Research (08/01/10) Adam, Stephanie P.; Choung, Steven C.; Gu, Yang; et al.

Team Approach to Foot Care Lowers Risk of Amputation in Diabetes

People with diabetic foot problems can lower their risk of leg amputation by relying on coordinated care that includes a podiatrist, according to a study published online in the journal Health Services Research. The study examined six years of Medicare claims data on nearly 190,000 diabetic patients with foot problems. The study included about 118,000 patients diagnosed as stage one, about 32,000 in stage two, 31,000 in stage three, and 55,000 in stage four (some participants experienced more than one stage). The researchers found that people who saw both a podiatrist and a medical doctor specializing in care of diabetic feet during the year before diagnosis were much less likely to need amputation eventually.

From "Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly"
Health Services Research (08/10) Sloan, Frank A.; Feinglos, Mark N.; Grossman, Daniel S.
Web Link - May Require Paid Subscription | Return to Headlines

Practice Management

AMA Reports 95 Medical Liability Claims Filed for Every 100 Physicians

According to an AMA report recently released, among physicians surveyed, there was an average of 95 medical liability claims filed for every 100 physicians, almost one per physician. The report states that nearly 61 percent of physicians age 55 and older have been sued, but wide variation in the impact of liability claims between specialties exists, as the number of claims per 100 physicians was more than five times greater for general surgeons and obstetricians/gynecologists than it was for pediatricians and psychiatrists. The AMA stated that the number of medical liability claims is not an indication of the frequency of medical error, as the physician prevails in 90 percent of the cases that go to trial. However, the average defense costs per claim range from $22,000 among claims that are dropped or dismissed to more than $100,000 for cases that go to trial.

From the article of the same title
Healthcare Finance News (08/04/10) Ledue, Chelsey

Disclosing Errors, Offering Compensation May Keep Physicians Out of Court

The University of Michigan Health System (UMHS) has seen its rate of malpractice litigation and total liability costs drop dramatically nine years after it began disclosing medical errors to patients and offering to compensate them, according to a study published in the Annals of Internal Medicine. UMHS began implementing its program, in which it admitted fault and offered compensation when an internal inquiry revealed medical error, in 2001. At first, UMHS applied the policy to all new and pending malpractice claims, but it now relies on its own employees in addition to patients and their attorneys to identify cases of patient injury.

The authors of the study acknowledge two caveats, however, to concluding that the policy can be expanded systemwide. First, malpractice claims against Michigan physicians statewide were declining when UMHS was implementing its policy. The state had passed several tort reform measures in 1994, including a cap on noneconomic damages, which may have contributed to the trend. Second, a disclosure-and-offer program may achieve less results in healthcare organizations that operate differently than UMHS. The Michigan health system employs its physicians, pays for their malpractice coverage, and accepts responsibility for claims on a system-wide basis. As a result, individual UMHS physicians are rarely reported to the National Practitioner Data Bank.

From the article of the same title
Medscape (08/16/10)
Web Link - May Require Free Registration | Return to Headlines

Health Policy and Reimbursement

Are Bigger Health-Care Networks Better or Just Creating a Monopoly?

The Carilion Clinic owns the two hospitals in Roanoke, Va., and six others in the region, employs 550 doctors, and has triggered a contentious local debate with national repercussions: is organizational domination a new healthcare industry model or a conspicuous attempt to control the market? Carilion says its standard is envisioned by the new federal healthcare law: a network that boosts efficiency by bringing together more physicians and hospitals, integrating costs from the doctor's office to the operating room. But critics call these networks monopolies, which they claim will further drive up healthcare costs. The chasm between these two viewpoints is at the core of whether the law successfully controls costs.

From the article of the same title
Washington Post (08/16/10) P. A3; MacGillis, Alec

Doctorate in Nursing Causes Confusion, Resentment

Nursing schools want the doctor of nursing practice degree to be the entry-level degree for advanced-practice nurses by 2015. Enrollment in those programs nationally jumped from 70 in 2002 to more than 5,000 last year. As nonphysicians with doctorates proliferate, the potential for confusion has grown. To address the issue, the American Medical Association has introduced "truth in advertising" legislation that requires health professionals, including physicians, to wear badges that clearly spell out their credentials. Similar laws have passed in Oklahoma, Arizona, Florida, and Illinois and are under consideration in California and Pennsylvania.

From the article of the same title
Philadelphia Inquirer (08/17/10) Burling, Stacey

Employees Will Pay More in 2011 for Healthcare

Employees may have to pay more for their healthcare expenses as large businesses make changes to their employee healthcare plans in order to comply with the healthcare reform law, according to a new report by the National Business Group on Health (NBGH). The group surveyed 72 large employers representing about 3.7 million employees and asked about medical claims costs for 2010 and projected claims costs for 2011. The findings showed that about 63 percent of businesses plan to make employees pay a higher percentage of their premium costs in 2011 and that 46 percent will increase out-of-pocket maximums, while 44 percent will increase in-network deductibles. As a result of those higher costs, providers may see patients start asking more questions about the necessity of some procedures, said NBGH President Helen Darling.

From the article of the same title
MedPage Today (08/19/10) Walker, Emily P.

States Get Funds to Boost Oversight of Health Insurance Premiums

The White House has released $1 million grants to state insurance regulators to help increase oversight of rising health insurance premiums, a key step in implementing the new healthcare law. The grants went to all but five states and will enable many to expand public access to information about rate hikes and to hire experts to review what insurers want to charge. More than a dozen states also plan to seek additional authority to block insurance premium increases they deem unjustified, according to the U.S. Department of Health and Human Services.

From the article of the same title
Los Angeles Times (08/17/10) Levey, Noam N.

Technology and Device Trends

Bear Bones: A Blueprint for Preventing Osteoporosis

Seth Donahue, an associate professor of biomedical engineering at Michigan Technological University, is studying why bears' bones emerge as strong as ever after hibernation. He has found that hibernating black bears produce parathyroid hormone that may maintain bone formation while they sleep through the winter. The research could lead to a model for preventing osteoporosis caused by disuse in people.

From the article of the same title
Newswise (08/13/10)

Scientist Discovers Stem Cell 'Partnership' That Could Advance Regenerative Medicine

Researchers have discovered a unique "partnership" between two types of bone marrow stem cells that could lead to advances in regenerative medicine. Their study has revealed that hematopoietic stem cells, which produce all blood cells in the human body, pair up in the bone marrow with mesenchymal stem cells, which give rise to bone, cartilage, fat, and other tissues. The study was published in the August 12 issue of Nature.

From the article of the same title
Newswise (08/17/10)

Titanium Coating With Protein 'Flower Bouquet' Nanoclusters Strengthens Implant Attachment

Researchers have developed a coating technique that could strengthen the connection between titanium joint-replacement implants and a patients' own bone and allow implants to last longer. The stronger connection works by manipulating signals the body's own cells use to encourage growth. Implants coated with "flower bouquet" clusters of an engineered protein that mimics the body's own cell-adhesion material fibronectin made 50 percent more contact with the surrounding bone than implants coated with protein pairs or individual strands. The cluster-coated implants were fixed in place more than twice as securely as plugs made from bare titanium.

From the article of the same title (08/18/10)

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August 25, 2010