September 14, 2011

News From ACFAS

Promote Your Practice with Free Fall FootNotes
Reach out to your patients and community with ACFAS’ FootNotes patient newsletter! You can download this free, customizable newsletter to include in your billings, add to your blog or distribute at your next community health event.

The Fall 2011 issue will inform your patients about yard cleanup safety, preventing children’s sports injuries, and taking control of diabetic foot care. Get it today at
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Gain New Insights on Economic Recovery
ACFAS’ “Practice Made Perfect” practice management/coding workshop can help your practice maximize its earning potential. Come to Las Vegas, Oct. 14–15, 2011, to get insights from respected experts including Douglas G. Stoker, DPM, FACFAS, and Lynn Homisak.

Members of the College can sign up for a free coding consult at the workshop with Dr. Stoker by contacting — and can e-mail coding questions to Dr. Stoker any time at

Space is filling quickly, so register now!
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Board Nominations Due Sept. 20
Two 3-year director terms are open for nomination for the ACFAS Board of Directors. If you’re an ACFAS Fellow who meets the criteria for election, help guide the future of your College and your profession by submitting your nomination application by Sept. 20.

For complete details on the recommended criteria for candidates and the nomination application, visit, or contact Executive Director Chris Mahaffey. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Michael S. Lee, DPM, FACFAS.

The Nominating Committee will announce recommended candidates to the membership by Nov. 3. Candidate information and ballots will be e-mailed to all voting members no later than Dec. 18, and electronic voting will end Jan. 17, 2012. New officers and directors will take office during the ACFAS 2012 Annual Scientific Conference on March 1-4, 2012, in San Antonio, Texas.
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Free Educational Resources for ACFAS Members
The American Hospital Association has introduced the Physician Leadership Forum as a way for physicians and hospitals to advance excellence in patient care; collaborate around issues of quality and safety; and have access to leadership development opportunities and educational seminars. Two complimentary webinars coming soon are:
  • Sept. 20 Health Information Technology: What Physicians Need to Know
    2:30–4:00 p.m. EDT
  • Oct. 26 Patient Driven Leadership
    3:00–4:30 p.m. EDT
For more information visit the forum’s home page.
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Healthcare, especially healthcare financing, is changing day by day. To help provide some basic education on current trends in the U.S. healthcare industry, ACFAS is sharing abstracted articles from the American Hospital Association's publication, Futurescan™ 2011: Healthcare Trends and Implications 2011–2016, in this special eight-week section.

Primary Care: Filling the Primary Care Supply Gap
Demand for primary care will dramatically increase starting in 2014, when health insurance exchanges begin operating and expanded eligibility for Medicaid is enacted under the new healthcare reform law. There will continue to be a primary care supply gap that training additional doctors will not be able to fill. As a result of the changing economics of primary care, unaffiliated providers may find themselves in increasing difficulty because of unfavorable contracts, but surprising new opportunities also may present themselves. In addition, there will be a shift to more accountability, accompanied by a move to greater clinical and financial integration.

As a consequence of these trends, hospital and health system leaders should proactively grow new primary care models, while primary care differentiation will result from superior service in the areas of convenience, care management, and cost-consciousness. Rural and underserved regions will continue to struggle, but there also are opportunities in those areas. Hospital and other healthcare institution leaders should not just consider creative alliances with primary care providers in care delivery, but also should engage medical and other health professional schools in education, training, and leadership cultivation.

From the article of the same title
Futurescan™ 2011: Healthcare Trends and Implications 2011-2016 (09/01/11) Dzau, Victor J.; Cho, Alex H.
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Foot and Ankle Surgery

A Systematic Review of Outcome and Failure Rate of Uncemented Scandinavian Total Ankle Replacement
Researchers conducted a systematic review on the intermediate to long-term outcome of Scandinavian total ankle replacement (STAR). Sixteen primary studies with 2,088 implants were identified. The mean AOFAS score was 77.8 points, and the mean Kofoed ankle score was 76.4 points. The pooled mean five-year survival rate of STAR was 85.9 percent, and the pooled mean 10-year survival rate was 71.1 percent. Pooled failure rate was 11.1 percent, with a mean follow-up time of 52 months; 41 percent failed within one year of initial operation. The first three reasons associated with implant failure were aseptic loosening (5.2 percent), malalignment (1.7 percent), and deep infection (1.0 percent).

From the article of the same title
International Orthopaedics (09/01/11) Zhao, Hongmou ; Yang, Yunfeng ; Yu, Guangrong; et al.
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Autologous Osteochondral Transplantation of the Talus Partially Restores Contact Mechanics of the Ankle Joint
Researchers characterized the regional and local contact mechanics after autologous osteochondral transplantation of the talus. Ten fresh-frozen cadaveric lower limb specimens were used for the study. An osteochondral defect was created at the centromedial aspect of the talar dome and an autologous osteochondral graft from the ipsilateral knee was subsequently transplanted to the defect site.

The creation of an osteochondral defect caused a significant decrease in force, mean pressure, and peak pressure on the medial region of the talus (P = .037). Implanting an osteochondral graft restored the force, mean pressure, and peak pressure on the medial region of the talus to intact levels (P = .05). The anterior portion of the graft carried less force, while mean and peak pressures were decreased relative to intact (P = .05). The mean difference in graft height relative to the surrounding host cartilage for the overall population was -0.2 ± 0.3 mm (range, -1.00 to 0.40 mm). No correlation was found between height and pressure when the graft was sunken, flush, or proud.

From the article of the same title
American Journal of Sports Medicine (08/25/11) Fansa, A. M.; Murawski, C. D.; Imhauser, C. W.
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Comparative Study of the Weil Osteotomy With and Without Fixation
Researchers compared the results of the Weil osteotomy with and without fixation. A retrospective study of 92 patients (97 feet) who underwent treatment for metatarsalgia between 1999 and 2005 was undertaken. One hundred and six osteotomies were fixed using a screw, while no fixation was used in 92. The mean follow-up was 51.2 and 46.6 months, respectively. All the patients were evaluated following the AOFAS LMIS scale, obtaining a mean score of 69.8 and 75.3 in each group (P=0.11).

From the article of the same title
Foot and Ankle Surgery (09/01/11) García-Fernández, D.; Gil-Garay, E.; Lora-Pablos, D.
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Practice Management

EHRs Beat Paper in Head-to-Head Competition
Researchers tracked quality measures and outcomes for more than 27,000 Cleveland-area adults with diabetes, and found that patients who were treated at practices using EHRs enjoyed substantially better outcomes than patient's who were treated by physicians using paper records. The researchers looked at four national quality standards for care, and found that nearly 51 percent of patients in EHR practices received care that met all four of the standards, compared to just 7 percent at paper-based practices. After accounting for patient differences, EHR practices had annual improvements in care that were 10 percent better than paper-based practices, along with 4 percent greater annual improvements in outcomes. The study was published in the Sept. 1 issue of the New England Journal of Medicine.

From the article of the same title
HealthLeaders Media (09/06/11) Shaw, Gienna
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MGMA, AAFP Urge Changes on Doc Fee Schedule
The Medical Group Management Association (MGMA) and the American Academy of Family Physicians (AAFP) argue for the revision of the Centers for Medicare and Medicaid Services' (CMS) proposed Medicare Part B Physician Fee Schedule for 2012 in order to relieve practices of IT-related administrative hardships and adjust the valuation of primary-care services.

MGMA contends that if, for instance, doctors meet electronic health record (EHR) system meaningful-use requirements and qualify for EHR subsidies via the CMS' IT incentive programs, they should be automatically eligible for bonuses under the Physician Quality Reporting System program and be excused from penalties related to electronic prescribing. MGMA also requested CMS to reconsider its decision not to offer an appeals process for doctors and practices that CMS determined had not satisfied the e-prescribing criteria or qualified for hardship exemptions.

Meanwhile, AAFP board chairwoman Lori Heim wrote in a letter that CMS should set up a more timely review of "misvalued services," hold vendors accountable for successful data submission, and impose payment for phone calls, online medical assessment and team conferences.

From the article of the same title
Modern Healthcare (09/02/11) Robeznieks, Andis
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Medical Practices Work on Ways to Serve Patients and Bottom Line
Doctors have to learn about the business aspects of running a private practice on the job. “Overhead continues to go up, but your ability to raise prices is very limited,” said J. Fred Ralston Jr., past president of the American College of Physicians. Given fixed Medicare payments and nonnegotiable managed care contracts, it is difficult to raise revenue. Physicians, thus, must look at containing costs. They can become cost-efficient by controlling human resource expenses, spreading out fixed costs as much as possible, exploiting information technology and carefully tracking business metrics.

From the article of the same title
New York Times (09/08/11) Lewis, Katherine Reynolds
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Health Policy and Reimbursement

Appeals Court Tosses Healthcare Lawsuits
The 4th Circuit Court of Appeals has dismissed two lawsuits over the healthcare reform law, making it all the more certain that the Supreme Court will be asked to weigh in on the matter. A three-judge panel ruled that Virginia Attorney General Ken Cuccinelli does not have a legal right to sue over the healthcare law’s requirement that most people buy insurance. The court also dismissed a suit filed by Liberty University and several individuals, which claimed that Congress was illegally using taxes to enforce the individual mandate.

From the article of the same title
The Hill (09/09/11) Baker, Sam
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Medicaid Transparency Push Riles State Officials
Patient advocates and medical providers are facing off against state officials over a federal push for greater transparency in how states run their Medicaid programs. The transparency effort comes as states are looking for more flexibility in how they manage Medicaid programs as a way to deal with historic budget problems. A major concern for states has been Centers for Medicare & Medicaid Services' effort to require states to document the potential impact of proposed cuts to payment rates for doctors and hospitals. Federal law requires Medicaid beneficiaries to have good access to medical care, and advocates say that proposed cuts by states would violate the law because many providers would quit the program.

From the article of the same title
The Hill (09/05/11) Pecquet, Julian
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Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries
Higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, are the main drivers of higher U.S. healthcare spending relative to other nations, particularly in orthopedics, according to a new study. Researchers compared physicians’ fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. They also compared physicians’ incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries’ national spending on physician services. Public and private payers paid much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid in the other countries. Orthopedic physicians also earned higher incomes ($442,450 on average, compared to $186,582 for primary care physicians) than their foreign counterparts.

From the article of the same title
Health Affairs (Summer 2011) Vol. 30, No. 9, P. 1647 Laugesen, Miriam J.; Glied, Sherry A.
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Medicine, Drugs and Devices

The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players
Researchers sought to determine if lace-up ankle braces reduce the incidence and severity of acute first-time and recurrent ankle injuries sustained by high school basketball players. A total of 1,460 basketball players were randomly assigned to a braced or control group. The braced group players wore lace-up ankle braces. The rate of acute ankle injury (per 1000 exposures) was 0.47 in the braced group and 1.41 in the control group (Cox hazard ratio [HR] 0.32). The median severity of acute ankle injuries was similar (P = .23) in the braced (6 days) and control group (7 days). For players with a previous ankle injury, the incidence of acute ankle injury was 0.83 in the braced group and 1.79 in the control group (Cox HR 0.39). For players who did not report a previous ankle injury, the incidence of acute ankle injury was 0.40 in the braced group and 1.35 in the control group (Cox HR 0.30).

From the article of the same title
American Journal of Sports Medicine (09/01/11) Vol. 39, No. 9, P. 1840 McGuine, Timothy A. ; Brooks, Alison ; Hetzel, Scott
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The High-Performing Surgical Program
Surgical services are under increasing pressure to be as clinically and operationally efficient as possible. St. Francis Hospital, Methodist Hospital System, The Mount Sinai Medical Center, and Bassett Healthcare share insights and lessons learned from their efforts:

* Build whole-team focus on shared outcomes
* Create a culture of safety in all surgical services
* Balance patient experience with cost & clinical efficiency
* Assemble surgical teams with the most efficient mix of skills
* Identify high-growth specialty and sub-specialty services
* Implement clinical and information technology planning strategies to improve throughput and patient experience

The full report on their experience can be accessed here.

From the article of the same title
HealthLeaders Media (09/13/11)
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