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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

Don't Miss These Pending Deadlines!

Free CMS Education Call on Medicare FFS

On Wednesday, Sept. 29, from 2:00 to 3:30 p.m. EDT, the Centers for Medicare and Medicaid Services (CMS) is hosting a conference call on Medicare Fee-For-Service (FFS) implementation of HIPAA Version 5010 and D.0 transaction standards.

The call will focus on the TA1, 999 and 277CA transactions, review specific FFS changes and give general information to help the audience prepare for the transition. A Q&A session will follow. The presentation will also be available on the CMS website within 24 hours of the call.

Click here to register for the call no later than 2:00 p.m. EDT, Tuesday, Sept. 28.
Your Volunteer Surgical Expertise Requested

The Department of Health and Human Services (HHS) has launched a new program to help register volunteer emergency health professionals. The Emergency System for Advance Registration of Volunteer Health Professionals, run by HHS' Office of the Assistant Secretary for Preparedness and Response, aims to verify the identity, licenses and credentials of volunteer health professionals so they may be utilized at appropriate emergencies.

Interested individuals can visit the agency website to pre-register online and get information about individual state volunteer programs.
Find Quality Education in Three Cities This Fall

“1st MTPJ A-Z Workshop and Seminar” will bring ACFAS’ top-rated continuing education to surgeons’ doorsteps. You’ll have the chance to advance your surgical skills and knowledge through these convenient, contemporary, hands-on courses.

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
For more information and to register, visit the ACFAS website.
Short Takes on Research for Busy Surgeons

Get quick reads on recent research with ACFAS’ Scientific Literature Reviews. Podiatric residents have prepared concise reviews of articles from journals you may not commonly read. Current abstracts include:

Reconstruction of the First and Second Metatarsals with Free Vascularised Double-barrelled Fibular Graft after Resection of a Chondrosarcoma, from the Journal of Plastic, Reconstructive and Aesthetic Surgery.
Reviewed by Alissa Duncan, DPM, OCPM/UHHS Richmond Medical Center.

Hyperbaric Oxygen Therapy Facilitates Healing of Chronic Foot Ulcers in Patients with Diabetes, from Diabetes Care.
Reviewed by Sarah Elder, DPM, Beth Israel Deaconess Medical Center.

Read these abstracts and many more at Scientific Literature Reviews.

Foot and Ankle Surgery

First Metatarsophalangeal Arthrodesis Using a Dorsal Plate and a Compression Screw

Researchers studied 46 consecutive cases of first metatarsophalangeal (MTP) joint fusion executed between April 2006 and April 2008 using dorsal plates and compression screws, and examined the outcome in terms of fusion rate, patient satisfaction, and complication rates, with the median follow-up period being 23 months. Nearly 100 percent of the cases fused without incident by four months, with the average time to fusion being 3.1 months. One non-union remained asymptomatic after metal extraction was recorded, and no hardware failure was observed. The researchers conclude that arthrodesis of the first MTP joint with spherical reamers and a low-profile contoured dorsal titanium plate and compression screw is very successful, with outstanding patient satisfaction and functional outcomes. They favor the use of specially designed plates over improvised plates as bending leads to poor control over dorsiflexion and may increase the occurrence of plate failure.

From the article of the same title
Foot & Ankle International (09/10) Vol. 31, No. 9, Kumar, Sujit; Pradhan, Rajib; Rosenfeld, Peter S.
Web Link - May Require Paid Subscription | Return to Headlines

Hyperspectral Imaging in Diabetic Foot Wound Care

Up to 25 percent of diabetes patients will be affected by a diabetic foot ulcer at some point in their lives. Hyperspectral imaging between 450 nm and 700 nm may be used for assessing the risk of diabetic foot ulcer development and predict the likelihood of noninvasive healing. In this study, researchers describe two methods used to analyze the in-vivo hyperspectral measurements. The first method, based on the modified Beer-Lambert law, produces a map of oxyhemoglobin and deoxyhemoglobin concentrations in the foot's dermis. The second method, based on a two-layer optical model of skin, can obtain oxyhemoglobin and deoxyhemoglobin concentrations but also epidermal thickness and melanin concentration with skin scattering properties. This second method can detect changes in the foot and help identify and understand ulceration.

From the article of the same title
Journal of Diabetes Science and Technology (09/01/2010) Vol. 4, No. 5, P. 1099 Yudovsky, Dmitry; Nouvong, Aksone; Pilon, Laurent
Web Link - May Require Paid Subscription | Return to Headlines

The Use of Tricortical Autograft Versus Allograft in Lateral Column

Researchers evaluated differences with regard to union rates and complications when comparing the use of iliac tricortical autograft versus iliac tricortical allograft supplemented with platelet rich plasma (PRP) in adult acquired flatfoot lateral column lengthening procedures. The charts and radiographs of 49 patients (51 feet) were evaluated. Twenty total procedures were performed using iliac tricortical autograft and 31 procedures were performed using iliac tricortical allograft with PRP. Successful union was achieved in 14 of 20 (70 percent) autograft procedures and 29 of 31 (94 percent) allograft procedures. Thirteen of 20 (65 percent) of the autograft group and 11 of 31 (35 percent) of the allograft group had a documented complication other than nonunion. Average length of hospital stay for patients who had procedures using autograft was 3.6 days and those who had allograft was 2.5 days. The average charge for those receiving allograft with PRP, including hospital stay, was roughly $2,500 more than those receiving an autograft procedure.

From the article of the same title
Foot & Ankle International (09/10) Grier, Kathleen M.; Walling, Arthur K.
Web Link - May Require Paid Subscription | Return to Headlines

Practice Management

An Educational Intervention for Contextualizing Patient Care and Medical Students' Abilities to Probe for Contextual Issues in Simulated Patients

Doctors can be taught to listen better to individual circumstances that may affect patient care, according to researchers, who conducted a previous study that showed doctors are not good at picking up clues to details in their patients’ personal lives that may affect their treatment, what the researchers call "context." The current study was designed to see if doctors could be taught to think about context when examining patients.

Fourth-year medical students from the University of Illinois at Chicago College of Medicine were divided into two groups. One group attended four short workshops training them to recognize and respond to contextual clues during patient examinations, while the second group did not. The two groups were compared by having them see four standardized patients—actors who are trained to portray patients the same way every time. The students acted as doctors to these patients, making a diagnosis and developing a treatment plan.

In the control group, students correctly treated the contextually complicated patients about 25 percent of the time. In the group that attended the workshops, students correctly identified and appropriately treated the contextually complicated patient two thirds of the time. All students did equally well at treating other kinds of patients.

From the article of the same title
Journal of the American Medical Association (09/15/10) Schwartz, Alan ; Weiner, Saul J. ; Harris, Ilene B.; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Associations Between Physician Characteristics and Quality of Care

Publicly available information about board certification, education, and malpractice claims appear to provide consumers with little information about the quality of care individual physicians provide, report researchers. Some health plans use physician report cards and tiered physician networks to steer their members toward physicians who provide high-quality care. However, most patients do not have access to physician quality measures, the researchers note.

The researchers used claims data from 1.13 million adults from 2004 to 2005 to calculate overall performance scores on 124 quality measures for each of 10,408 Massachusetts physicians. They then obtained information about the same physicians from the Massachusetts Board of Registration in Medicine. The average overall performance score for the physicians was 62.5 percent. Of the publicly available individual physician characteristics, three were associated with higher overall performance— female sex, board certification and graduation from a domestic medical school—though the differences were small in magnitude. No significant association between malpractice claims and performance was found.

From the article of the same title
Archives of Internal Medicine (09/13/10) Vol. 170, No. 16, P. 1442 Reid, Rachel O.; Friedberg, Mark W.; Adams, John L.; et al.

Consumer Reports Is Rating Surgical Groups

Consumer Reports has published ratings of 221 surgical groups that perform heart bypass surgery from 42 states online and will print them in its October issue. The groups receive one, two or three stars, for below average, average or above average, respectively. The scores were based on complication and survival rates, whether the groups used the best surgical technique and whether patients were being sent home with certain medicines that research has shown to be beneficial after this type of surgery. Groups are rated, not individual doctors. For now, the information is available only to people who subscribe to Consumer Reports online or buy the magazine, but within a few months, the ratings should be posted and freely available to the public at the website of the Society of Thoracic Surgeons.

An article published online by The New England Journal of Medicine said this effort to make the comparative data public was “a watershed event in health care accountability.” It predicts that physicians in other surgical specialties, such as orthopedics or vascular surgery, may be expected to follow suit. "And this event will fuel the debate regarding the risks and benefits of public reporting, including the question of whether it assists patients in discriminating among sites of care."

From the article of the same title
New York Times (09/07/10) Grady, Denise

Health Policy and Reimbursement

Health System Reform May Help Doctors' Offices to Offer Coverage

Two recently published studies suggest that newly implemented health insurance tax credits and soon-to-be-created exchanges will make it easier for small businesses such as physicians' offices to offer employees health insurance and make it less onerous to keep doing so. Approximately 16.6 million people work for small businesses that are eligible for health insurance tax credits, according to as study released Sept. 2 by the Commonwealth Fund. Of this number, 3.4 million work in businesses that are projected to take advantage of the health insurance tax credit by 2013. Companies that employ fewer than 25 full-time equivalents with average salaries of less than $50,000 and that pay at least half of individual coverage costs can take a tax credit of up to 35 percent of their share of the premiums paid since the beginning of the year. The credit increases to 50 percent in 2014. A physician-owner's salary is not worked into these calculations, but the wages of physician employees are.

Another study by RAND Corp., published in The New England Journal of Medicine on Sept. 1, used a simulation model to determine the impact of the insurance exchanges that will be available for small firms within the next year to access health insurance for employees. The researchers predict that the number of workers offered coverage will increase from 115.1 million, or 84.6 percent of all workers, to 128.7 million, or 94.6 percent. The authors suggest that this will be driven by more small businesses being able to offer coverage.

From the article of the same title
American Medical News (09/13/10) Elliott, Victoria Stagg

Joint Commission to Expand Accrediting Process to Include Home Options in 2011

The Joint Commission will expand the process of accrediting ambulatory healthcare organizations to those who are interested in electing a primary care home option beginning July 1, 2011, according to Joint Commission Ambulatory Health Care Accreditation Program Executive Director Michael Kulczycki. Standards for the initiative, designed to combine improvements in quality of care and patient safety achieved through accreditation, with increased reimbursement from third-party payers when additional requirements of a primary care home are met, will be posted for a field review in November 2010, with pilot testing expected to begin in early 2011.

From the article of the same title
BNA Health Care Policy Report (09/16/10)

Judge Sets December 16 Hearing on Healthcare Suit

U.S. District Judge Roger Vinson of Florida said he would hear arguments on December 16 on a lawsuit filed by 20 states seeking to block implementation of the healthcare overhaul bill. Vinson is weighing a motion by the Justice Department to dismiss the lawsuit, which was originally filed in March by mostly Republican state attorneys general. He said he would formally rule on the dismissal motion by October 14 but gave strong indications that the case would not be dismissed. Vinson said he would likely reject "at least one" of the government's motions for dismissal of the case but he did not elaborate. The lawsuit claims the reform measure violates state government rights in the U.S. Constitution and will force massive new spending on hard-pressed state governments.

From the article of the same title
Reuters (09/14/10) Peltier, Michael

Technology and Device Trends

A Technology Sets Inventors Free to Dream

Bespoke Innovations of San Francisco is using advances in 3-D printing to create personalized prosthetic limb casings. Scott Summit, a co-founder of Bespoke, and his partner Kenneth B. Trauner, an orthopedic surgeon, are set to open a studio this fall where they will sell the limb coverings and experiment with printing entire customized limbs that could cost a tenth of comparable artificial limbs made using traditional methods. “I wanted to create a leg that had a level of humanity,” said Summit. “It’s unfortunate that people have had a product that’s such a major part of their lives that was so underdesigned.”

From the article of the same title
New York Times (09/14/10) Vance, Ashlee

Savient's Big Gamble Pays Off With Approval of Gout Drug

The decade-long gamble Savient Pharmaceuticals placed on a drug that showed potential to treat patients crippled by severe, chronic gout has paid off with the drug's approval. The drug, which will be marketed under the name Krystexxa, is the culmination of many years of effort, according to company president Paul Hamelin. Savient spent 11 years pushing Krystexxa through development, selling off other products to generate more cash for research. The drug, made from a biologically engineered uricase enzyme, works by normalizing levels of uric acid and treats the tophi that can form in a patient’s joints. The approval of the drug, and the prospect that Savient could be acquired by a large pharmaceutical company, caused shares to rise 36 percent following the approval announcement. Analysts predict that the drug could reach $600 million a year in sales. Several companies could be interested in acquiring Savient, including Johnson & Johnson, Bristol Myers, Novartis, and Amgen, a California-based biotech giant. Novartis, which is developing a drug to treat gout flares, bouts of severe and disabling pain, appears to be the most likely to purchase Savient, possibly to pair Krystexxa up with its own medication.

From the article of the same title
The Star-Ledger (NJ) (09/16/2010) Todd, Susan

Surgeons Routinely Fail to Disclose Financial Ties

Twenty-five out of 32 highly paid consultants to medical device companies in 2007, or their publishers, failed to reveal the financial connections in journal articles the following year, according to a study published on the website of The Archives of Internal Medicine. The study compared major payments to consultants by orthopedic device companies with financial disclosures the consultants later made in medical journal articles. It focused on 32 medical doctors and doctoral researchers who were each paid at least $1 million in 2007 and published one or more journal articles the next year.

From the article of the same title
Milwaukee Journal Sentinel (09/13/10) Fauber, John

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September 22, 2010