September 5, 2012

News From ACFAS

Perfecting Your Practice – New Seminar and Podcast
“Efficiency in the office is paramount.” – Jerome Noll, DPM, FACFAS

With all the changes occurring in today’s medical environment, how are you going to keep up? Register for the Practice Management/Coding Workshop from October 12-13, or listen to a recently-released ACFAS Podcast, titled "Perfecting Your Practice."

In both the seminar and the podcast, you will have the opportunity to learn efficient and dynamically effective strategies for coping with the current changes in healthcare today, including the implementation of EHR/EMR, new coding requirements, contracting issues, reimbursement, and more. Hear tips and advice from certified professionals who have dealt with their fair share of helping practices achieve success. Also, during the Perfecting Your Practice: Practice Management/Coding Workshop, participate in one or both of the roundtable sessions offered as part of your two-day workshop registration. Note: registration includes one roundtable event.

Sign up for this eye-opening event today! Can’t make it? Listen to the Perfecting Your Practice podcast at your convenience.
Share Facebook  LinkedIn  Twitter  | Web Link
Follow ACFAS on Twitter
Use your social voice to connect with ACFAS.

We're tweeting to alert you to the latest news in professional development, education, health policy and more from your College and around the nation. Follow the feed at

For news you can use to educate your patients, send them to the College’s consumer news at — or retweet timely topics yourself.

Don’t miss out; join the conversation today!
Share Facebook  LinkedIn  Twitter 
Membership Has its Benefits: Group Purchasing with Henry Schein Foot & Ankle
Did you know as an ACFAS Member, you have preferred access to purchasing power with Henry Schein Medical: Foot & Ankle, an industry leader in medical supply distribution with a specialized foot and ankle division? Take advantage of this partnership to maximize your savings on exclusive products, such as: the Alma Laser, Sensilase PAD IQ and other prescription, medical/surgical and equipment needs for your office.

For more information, please visit or contact a consultant at 800-323-5110 or
Share Facebook  LinkedIn  Twitter  | Web Link

Foot and Ankle Surgery

Cosmetic Results of Wedge Resection of Nail Matrix (Winograd Technique) in the Treatment of Ingrown Toenail
Researchers conducted a retrospective study to assess the cosmetic results of wedge resection of the nail matrix (Winograd technique) in the treatment of ingrown toenail. The study retrospectively reviewed medical charts of 68 patients with 75 ingrown toenails who underwent surgical correction with the Winograd technique. Recurrence was evident in nine patients (13.2 percent), with a mean recurrence time of 6.7 months. All recurrences involved the lateral border of the toenail. Cosmetic ratings were statistically lower in female patients. The reasons for poor and acceptable cosmetic results were proximal-incision scar and narrowing of the nail plate.

From the article of the same title
Foot & Ankle Specialist (08/12) Vol. 05, No. 4 Kose, Ozkan ; Guler, Ferhat; Gurcan, Serkan; et al.
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Hypermobility of the First Metatarsal Bone in Patients with Rheumatoid Arthritis Treated by Lapidus Procedure
Data of patients with rheumatoid arthritis who underwent Lapidus procedure were evaluated, with focus on the role first metatarsal bone instability played in a patient cohort. One hundred twenty-five rheumatoid arthritis patients were included in the study group. The signs of the Lapidus operation were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray. Assessment of data of 143 Lapidus procedures performed between 2004 and 2010 was conducted. Symptoms and indication of the first metatarsal bone instability were determined in 92 feet in the group, while the AOFAS score was 48.6 prior to and 87.6 six months following foot reconstruction. Seven feet exhibited nonunion of the medial cuneometatarsal joint arthrodesis on X-rays.

From the article of the same title
BMC Musculoskeletal Disorders (08/20/12) Vol. 13, No. 148 Popelka, Stanislav; Hromadka, Rastislav; Vavrik, Pavel; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management

Choosing Disability, Medical Liability Insurance for Your Practice
In light of the economic crisis, it is important to apply the “buyer beware” philosophy to decisions about selecting an insurance carrier for a medical practice, especially for disability and medical liability. Many physicians and office managers view insurance purchases as commodities, forgetting that they are purchasing an insurer’s ability to pay claims throughout the duration of your practice and beyond. There are sharp contrasts between disability and medical malpractice claims, but they both present long-term risks, and insurer financial strength is crucial in such instances. When comparing “apples to apples” features, the insurance company’s financial strength can become the deciding factor.

There are three recommendations to better prepare practices for adequately vetting your carrier. First, they should check and evaluate the carriers' ratings. Practices may use A.M. Best Company ratings, which are recognized as an industry benchmark. A company should have a secure rating of "A" through "A++" in the three main types of "Best" ratings that address financial stability. These are Best’s financial strength rating, an independent opinion of an insurer’s financial strength and ability to meet its ongoing insurance policy and contract obligations; Best’s issuer credit ratings, an independent opinion of an issuer/entity’s ability to meet its ongoing senior financial obligations; and Best’s debt rating, an independent opinion of an issuer’s ability to meet its ongoing financial obligations to security holders when due. Carriers rated below "A" may not have the long-term financial "staying power" to meet policyholder obligations in the face of economic downturns or difficult insurance-market cycles, whereas an "A+" rating is far more likely to indicate long-term financial stability.

Ratings are an indication of not only a carriers’ future ability to honor its promises to policyholders but may also signal hidden issues that may be emerging due to short-term decision making in a long-term market. Second, practices should review the company’s history, even with a quick online search, looking for low profitability, acceptance of Troubled Asset Relief Program (TARP) money, major management shake-ups, shareholder complaints, and profitability plans from top management. Finally, practices may investigate the strength of the policy group. Ratings, company history and policy group strength are key indicators to an insurer’s financial stability, and including these three precautionary steps in an evaluation process is a worthy investment and can ensure a harmonious future scenario for a practice.

From the article of the same title
Physicians Practice (08/26/12) Brunken, Jeffrey D.
Share Facebook  LinkedIn  Twitter  | Web Link

Managing Lab Tests when Patients View Results Online
Loyola University Health System Director of Primary Care Keith Veselik determined that allowing patients to access their diagnostic test results via online portals did not lead to much change, except in terms of workflow and patient engagement. He says patients are more informed as a result of that access, although how quickly and from where patients get their test results varies across states. Quest Diagnostics Chief Medical Officer John Cohen says 14 states require that results go directly to physicians or that physicians give clearance before results are provided to patients. All physicians must prepare for the likelihood that patient access to information is only going to expand over time, according to Beth Israel Deaconess Medical Center internist Tom Delbanco.

From the article of the same title
American Medical News (08/27/12) Dolan, Pamela Lewis
Share Facebook  LinkedIn  Twitter  | Web Link

Small Practices May Be Least Able to Take New Medicaid Patients
A new survey from the National Center for Health Statistics has found that small practices have lower than average acceptance rates of Medicaid patients. While 96 percent of all doctors surveyed continue to accept new patients, 31 percent are unwilling to take on new Medicaid patients and 17 percent do not want new Medicare patients, while 18 percent said they were not accepting new privately insured patients. But small practices were 23.5 percentage points less likely to accept new Medicaid patients than those practices with more than 10 doctors.

From the article of the same title
American Medical News (08/20/12) Lubell, Jennifer
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement

Lawmaker Wants CBO to Review Legislation on Doc-Pay, IPAB
U.S. Rep. Phil Roe (R-Tenn.) has requested that the Congressional Budget Office conduct an analysis of any legislative fix to avert a 27 percent cut in Medicare physician payment rates slated for January, with a specific determination of whether freezing current rates would add to reductions that the Independent Payment Advisory Board (IPAB) is mandated to start enacting in 2015. "If Congress acts to stop cuts to Medicare physician payments, these cuts could come back to life through the unaccountable IPAB—thereby threatening seniors' access to medical care," Roe warns. The first five years of pay cuts are generally limited to physicians, which would create the potential for their being reimbursed now via a Medicare pay freeze, in exchange for cuts in several years. But although the 2010 healthcare revamp included an assumption that Congress would not permit Medicare to slash physician fees and restricted the IPAB's cutting authority to growth beyond a continuation of the existing rates, it was unclear whether the small inflation-related rate increases physicians' advocacy groups have pushed for as part of a Medicare patch widely expected to receive congressional approval before year's end also would clear the board's cost scrutiny.

From the article of the same title
Modern Healthcare (08/28/12) Daly, Rich
Share Facebook  LinkedIn  Twitter  | Web Link

Same Doctor Visit, Double the Cost
Hospital systems are hiking healthcare fees following their purchase of physician practices. As doctors are absorbed into hospital systems, they can receive payment for services at the systems' rates, which are usually more generous than what insurers pay independent physicians; furthermore, some services that doctors previously carried out at independent systems may start to be billed as hospital outpatient procedures, which can sometimes raise costs more than twofold. Likely accompanying this trend is a rise in Medicare spending as well, since the program pays more for certain services performed in a hospital facility, according to the Medicare Payment Advisory Commission. The commission estimates that the number of specialty physicians employed at hospitals has more than quadrupled since 2000, and the structural change is being partly impelled by shrinking reimbursements for physicians, especially in certain specialties. Hospitals say greater compensation is needed in some cases because it costs more to run outpatient clinics, which must satisfy strict regulatory mandates and often treat patients without insurance. Hospitals and health plans say they are striving to produce new payment methods that reward efficiency, such as incentives for increasing primary care service and lowering patient readmissions, as they attempt to migrate from the fee-for-service system that has created the physician-pay arbitrage.

From the article of the same title
Wall Street Journal (08/27/12) Mathews, Anna Wilde
Share Facebook  LinkedIn  Twitter  | Web Link

Some Hospital Networks Also Become Insurers
About 20 percent of U.S. hospital networks now market an insurance product, including MedStar Health, which serves the Washington-Baltimore region. Another 20 percent of systems are considering it, according to a 2011 survey of 100 hospital leaders by the research firm Advisory Board Co. Health systems that become insurers will no longer generate revenue from hospitalizations, and so must devote more resources to preventive care. While supporters say that consumers would gain streamlined care and possibly lower costs, there are those who worry that they could end up with fewer choices and limited access to outside experts and new treatments. The main driver of this change is the transition from fee-for-service payment schemes to one that pays providers a lump sum per person per year. Unlike previous attempts at managed care, electronic medical records and health databases can now help guide appropriate treatment. Experts say that transitioning to the insurance business can be risky for hospitals, which must change the way they operate and how they take care of patients. To become licensed as an insurer, a health system must also have millions of dollars in capital reserves and provide regulators with proof that it can deliver required benefits.

From the article of the same title
Washington Post (08/25/12) Rabin, Roni Caryn
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices

Efficacy and Safety of Diclofenac Diethylamine 2.32 Percent Gel in Acute Ankle Sprain
A study was held to test the safety and effectiveness of topical diclofenac diethylamine (DDEA) 2.32 percent gel for acute ankle sprain, using a sample of patients randomly assigned to receive the treatment twice daily (bid), three times daily (tid) or to receive a placebo. Efficacy and local tolerability were assessed over a period of eight days ± one day. By the fifth day, the reduction in pain on movement (POM) with DDEA bid and tid was nearly twice that with placebo. In patients with severe baseline POM, the average change in POM from baseline to the fifth day with DDEA bid or tid was 30 mm to 40 mm greater than that with placebo, which was twice the difference in patients with mild to moderate baseline POM. Over 70 percent of all DDEA patients experienced roughly 50 percent reduction in POM between the first and fifth days compared to 21 percent of placebo patients. By the eighth day, ankle swelling in patients treated with DDEA was two-thirds less than in those treated with the placebo, which had still not reached the level of ankle joint function observed with DDEA on the fifth day. At the fifth day, treatment satisfaction was good to excellent in nearly 90 percent of DDEA patients but only good or very good in 23 percent of placebo patients.

From the article of the same title
Medicine and Science in Sports and Exercise (09/12) Vol. 44, No. 9, P. 1629 Predel, Hans-Georg; Hamelsky, Sandra; Gold, Morris; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

FDA Approves Wider Use for J&J Nucynta ER Pain Drug
The U.S. Food and Drug Administration (FDA) has approved the wider use of an opioid for pain associated with diabetic peripheral neuropathy, which affects up to 8 million Americans. Some studies estimate that nearly half of all people with diabetes have some form of peripheral neuropathy, which can cause stinging or burning sensations, pain, numbness or weakness in the hands and feet, and is a major cause of amputations. Two other drugs are approved for pain related to the condition, but this is the first approved opioid.

From the article of the same title
Reuters (08/29/12) Yukhananov, Anna
Share Facebook  LinkedIn  Twitter  | Web Link

Osteoporosis Clue Found in Stem Cell Signalling Protein
Scientists could gain a new understanding of osteoporosis by learning how a signaling protein influences whether bone marrow stem cells become bone or fat, according to a new study published online in The Journal of Clinical Investigation on Aug. 13. Researchers examined the role of vascular endothelial growth factor (VEGF), a signaling protein that plays a role in the development of blood vessels vital to early bone growth and skeletal maintenance. Knock out mice lacing VEGF gene showed reduced bone and fat in their bone marrow. The team confirmed their results with additional experiments, and now want to learn more about VEGF signaling and identify targets for drugs.

From the article of the same title
Medical News Today (08/24/12) Paddock, Catharine
Share Facebook  LinkedIn  Twitter  | Web Link

Copyright © 2012 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe click here.

Abstract News © Copyright 2012 INFORMATION, INC.
Powered by Information, Inc.