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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

Health Care Reform Update

Congress is back in session, and Sen. Max Baucus (D-MT), chair of the Senate Finance Committee, introduced his much-anticipated bill with no Republican support, after working for six months for a bipartisan approach. The Committee will start hearings next week.

The “Baucus bill” and the House Tri-Committee bill are the key bills in play right now. Both bills include a health insurance exchange where individuals and small businesses can purchase insurance, a mandate on individuals to purchase insurance, increased insurance regulation, and an expansion of Medicaid. The House bill includes the controversial “public option” as one of the choices in a health insurance exchange.

There are still major concerns about cost and the impact on the deficit, as well as the impact of Medicaid expansion on state budgets. Other recent developments of note:
  • President Obama has expressed support for “automatic spending cuts” so that “not one cent” would add to the federal deficit. He has also indicated support for pilot medical malpractice reforms in states.
  • Sen. Olympia J. Snowe (R-ME) proposed the idea of a public option “trigger.” Under this approach, a public option would be created in states where the health insurance exchanges didn’t result in certain coverage and cost thresholds.
For detailed, objective information on the various proposals, visit the Kaiser Family Foundation web site at the link below.
Bonus Podcast this Month

Tune in to ACFAS e-Learning to listen to a mid-month “bonus” podcast, “Evolution: From Resident to Clinician.” A panel of young members shares first-hand experiences with the challenges they encountered moving from resident to practicing physician.

Access the podcast and the full library of e-Learning offerings using the web link below.

Present Your Research in an ASC Poster

If you want to share your research with others in the profession, don’t miss the opportunity to display a poster at the ACFAS Annual Scientific Conference, February 22-26, 2010 in Las Vegas.

Electronic submission of poster abstracts is required; the deadline for submission is October 1, 2009. For guidelines and instructions, follow the web link below.

Foot and Ankle Surgery

Osteochondral Lesions of the Talus: Retrograde Drilling With High-Field-Strength MR Guidance

Researchers performed and assessed a MR-assisted navigation method for minimally invasive retrograde drilling of talar osteochondral lesions. They found that a single imaging plane is sufficient for navigation during intervention. To accomplish this objective, a passive MRI navigation device was used to evaluate 16 cadaveric ankle joints. Use of interactive MR-assisted navigation in combination with a passive aiming device allowed precise and rapid retrograde drilling of talar osteochondral lesions.

From the article of the same title
Radiology (09/01/09) Vol. 252, No. 3, P. 857; Seebauer, Christian J.; Bail, Hermann J.; Wichlas, Florian; et al.

The Diabetic Foot Clinic: Not a Significant Source for Acquisition of Methicillin-Resistant Staphylococcus Aureus

Although diabetes foot clinics have been reported as a source of acquiring methicillin-resistant Staphylococcus aureus (MRSA), a 10-year trends analysis shows that such clinics are not common settings for contracting the drug-resistant organism. Researchers conducted a review of patients infected or colonized with MRSA from a tertiary care hospital diabetes foot clinic, involving all new MRSA cases from the clinic, hospital, and province. Trends showed that the low-potential, clinic-attributable incidence, and total clinic incidence were comparable with regional and hospital MRSA rates.

From the article of the same title
American Journal of Infection Control (09/01/2009) Vol. 37, No. 7, P. 587; Lagace-Wiens, Philippe R. S.; Ormiston, Debbie; Nicolle, Lindsay E.; et al.

Reinjury After Acute Lateral Ankle Sprains in Elite Track and Field Athletes

Lateral ankle sprains can lead to persistent disability in athletes. Researchers studied the effect of a lateral ankle sprain on reinjury occurrence in the same region. They found that athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a reinjury, and that low-grade acute lateral ankle sprains result in a higher risk of reinjury than high-grade acute lateral ankle sprains.

From the article of the same title
American Journal of Sports Medicine (09/01/09) Vol. 37, No. 9, P. 1755; Malliaropoulos, Nikolaos ; Ntessalen, Maria; Papacostas, Emmanuel

Diabetic Foot Team Lowers Rate of Major Amputations

Ten years after a diabetic foot team was installed in a local hospital, the town of Trondheim, Norway, has seen its rate of diabetic foot amputations decline by 41 percent. The team consisted of an orthopaedic surgeon, nurse, podiatrist, prosthetist, and orthotist, and focused on preventative care and early treatment. “The decrease reflects the improved quality of the prevention and treatment of diabetic foot ulcers and a general improvement in public health,” said Eivind Witsø, MD, presenting his findings at the 10th EFFORT Congress.

From the article of the same title
Orthopedics Today (09/09) Brockenbrough, Gina

Practice Management

How Much Should You Pay Staff?

Determining a fair salary for staff is tricky, and a good point to begin with is the average salary for given positions in the region where the practice is located. Salaries tend to be higher in urban areas than in suburbs and rural locations, but rural practices can be forced to maintain wages higher than they might prefer because the pool of qualified applicants is usually thinner. Asking candidates their salary expectation is important, as is evaluating the special skills the candidate brings to the practice. The practice should also create a benchmark for its current staff salaries.

From the article of the same title
Physicians Practice (08/09) Rowden-Racette, Kellie

Rapid Rise in COBRA Enrollment Creates Billing Hassles

The rise in unemployment has created another administrative hassle for physician practices. Under COBRA of 1986, laid-off employees are entitled to continue their group coverage for 18 months, but they must pay the entire premium. However, there can be gaps in coverage for several reasons. First, the employee has 60 days to elect COBRA coverage. Second, the employer has 30 days to notify the health plan of the layoff, then the plan has 14 days to inform the employee of his/her right to elect coverage. Practice managers advise practices to establish a procedure for COBRA such as requiring patients to pay cash until COBRA coverage has been verified.

From the article of the same title
American Medical News (09/14/09) Berry, Emily

Dell Unveils Electronic Medical Records Product

Dell has released technology to digitize medical records for physicians working with hospitals. The product was developed for hospitals that want a system compatible with those of their affiliated physicians and can be configured to the needs of each hospital and the affiliated doctors' practices. Two hospitals, Tufts Medical Center and Memorial Hermann, have already adopted the technology and say that it has enabled them to retain more practices.

From the article of the same title
Dow Jones Newswires (09/10/09) Solsman, Joan E.

Health Policy and Reimbursement

Doctors Offer Senators Their Opinion on Health Care Reform

More than 11,000 doctors from around the United States who connected on the medical Web site Sermo signed a petition outlining several issues they think are critical parts of health reform. The petition was delivered to the 100 Senate offices on Sept. 8. Among the issues highlighted in the petition was the need for tort reform, transparent billing, insurance reform, and changing the payment systems to encourage preventive medicine.

From the article of the same title
Fox News (09/08/09) Angle, Jim

Arizona to Cut KidsCare Parents Program in Effort to Reduce Budget Deficit

As part of efforts to remedy a $3 billion budget shortfall, the Arizona legislature cut the budget for the agency that runs the state CHIP program. As a result, the agency had to make the difficult decision to drop all 10,000 working parents from the state’s KidsCare Parents health insurance program as of September 30. The state will also be reducing provider reimbursement rates under the KidsCare program.

From the article of the same title
Arizona Republic (09/08/09) Newton, Casey

Know When the Stark Law Applies to You

The Stark law does not cover all fraud and abuse violations, but only instances involving a specific set of health services and Medicare patients. Stark is applicable only to financial relationships between doctors—and their individual family members—and the entities to which they refer their Medicare patients. Determining whether the Stark statute will come up in any scenario requires physicians to ask three questions: Whether their patients are using Medicare; whether the services are deemed designated health services determined by CPT code; and whether the doctor has a financial relationship with the entity to which he or she refers. A doctor does not have a problem with the Stark law as long as the answer to any of these questions is "no."

From the article of the same title
Medical Economics (09/04/09) Gosfield, Alice G.

Technology and Device Trends

Bacteria Can Help to Build Bone Implants

Researchers at the U.K.'s University of Birmingham believe that stronger bone implants could be fashioned from Serratia bacteria that produce hydroxyapatite (HA). They demonstrated that the bacterial cells adhered tightly to surfaces such as titanium alloy, polypropylene, porous glass, and polyurethane foam by creating a biofilm layer impregnated with biopolymers. The material is dried and heated to kill the bacteria, and the researchers estimated that the dried biofilm had 20 times the adhesion force of the fresh biofilm. Coating the adhesive with HA and slightly roughening the surface increased the bioglue's effectiveness even more. Implant materials are currently manufactured by spraying on HA, which lacks good mechanical strength and only reaches visible areas. Lead researcher Lynne Macaskie says bacterial HA offers better properties than chemically induced HA because the HA nanocrystals made by the bacteria are of much smaller size than chemically produced HA crystals.

From the article of the same title
Times of India (09/07/09)

SPECT-CT Imaging in Degenerative Joint Disease of the Foot and Ankle

A group of researchers report in the September issue of the British edition of the Journal of Bone and Joint Surgery that the combination of single photon-emission computed tomography (SPECT) and computed tomography (CT) can help radiologists and orthopedic surgeons identify multiple arthritic joints in the feet and ankles and localize degenerative joint disease. The researchers assessed 20 consecutive patients with pain of uncertain origin in the foot and ankle by radiography and SPECT-CT, as well as by separate bone scanning and CT. The researchers discovered outstanding mean intraobserver reliability for SPECT-CT that was substantially higher than that for combined CT and bone scanning. Interobserver agreement also was significantly higher for SPECT-CT, particularly in the evaluation of the naviculocuneiform and tarsometatarsal joints.

From the article of the same title
Journal of Bone and Joint Surgery (09/01/2009) Vol. 91B, No. 9, P. 1191; Pagenstert, G.I.; Barg, A.; Leumann, A.G.; et al.

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September 16, 2009