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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

This Week's Health Care Reform Update

The Senate Finance Committee began the process of “marking up” Sen. Max Baucus’s (D-MT) health reform bill yesterday (September 22). The proposed legislation received a cool reception from both sides of the aisle last week. Sen. Baucus has already indicated he will make changes, including adding more federal subsidies to help lower-income Americans purchase insurance—which is mandatory under the bill—and he will also include language that specifically states the bill will not include a public option (a nod to Republicans).

Unlike the HB 3200, the Tri-Committee House bill, the Baucus bill does not provide a permanent fix to the flawed Medicare sustainable growth rate payment formula for physicians. Instead, it includes another one-year temporary fix, after which physicians would once again face potential cuts in Medicare payment. HB 3200 also includes a provision that would define podiatrists as physicians for purposes of Medicaid payment. The Senate bill does not include such a provision.
October Research Deadlines

October 1, 2009 Showcase your current research in the 2010 Annual Scientific Conference Poster Exhibit! Applications and abstracts are due by 11:59 p.m.

October 15, 2009 Apply for support for your research proposal with a 2009 Clinical and Scientific Research Grant. Applications are due by 11:59 p.m.

Applications and information are available at

Update Special Report

A special edition of Update, the ACFAS member print newsletter, is now on its way to you. ACFAS has completed two in-depth surveys of members that you'll want to read about in this special report, along with:
  • A sneak peek at the new ACFAS web site
  • Q&A with ACFAS President Mary Crawford, DPM, FACFAS
  • A glimpse of ACFAS' strategic course for the future
Look for your copy in the US mail, arriving soon!
Register Now: Complex Reconstruction Surgical Skills

Choose either November 14 or 15, 2009, to attend the one-day Complex Reconstruction Surgical Skills Course in Las Vegas, Nevada. Extensive lab time in this fast-paced course will allow you to choose from an array of first ray, rearfoot, and tendon techniques that go beyond the basics.

Space is limited, so reserve your seat by registering now!
ACFAS is In the News…and You Can Be, Too!

"Heel Pain in Youth Athletes: A Warning Sign," the latest ACFAS news release, alerts parents to the potential damage that can be caused when youth athletes ignore the symptoms of heel injury. The release was distributed by the ACFAS PR department yesterday. Within hours, the story had been picked up by more than 200 internet news outlets, with print pickup to follow.

You can put yourself in the news with this same story by using the pre-formatted ACFAS customizable news release, and distributing it to your local news outlets. Download a Fill-In-The-Blanks Press Release today.

Foot and Ankle Surgery

Better Clinical Outcomes Seen in Patients Who Had Intraoperative Pedography

Results from a level I study have demonstrated that in nearly 50 percent of cases, surgeons modified their corrections in foot and ankle arthrodeses after using intraoperative pedography during the same procedure. The study also found that patients who underwent intraoperative pedography had significantly better clinical outcomes at 2-year follow-up than those who did not.

From the article of the same title
Orthopedics Today (10/09) Brockenbrough, Gina

Below-the-knee Revascularization. Advanced Techniques.

This review summarizes new developments in revascularization and advanced techniques to treat lesions below the knee. Below-the-knee lesions are becoming more common due to the increasing prevalence of diabetes and end-stage renal failure. Excellent acute technical success rates above 90 percent, a low frequency of complications, and high limb salvage rate of about 95 percent, even in patients with long segment and diffuse disease, seem to justify a more widespread use of endovascular therapy in tibial arteries, write the researchers.

From the article of the same title
Journal of Cardiovascular Surgery (10/01/09) Vol. 50, No. 5, P. 627; Schwarzwälder, U.; Zeller, T.

Heat-shock Protein 70 Gene Polymorphism Is Associated With the Severity of Diabetic Foot Ulcer and the Outcome of Surgical Treatment

Foot ulcer is a significant cause of morbidity in diabetics. Genetic make-up can determine inflammatory and healing responses. Researchers hypothesized that specific polymorphisms of the heat-shock protein 70 gene could predispose to the severity of diabetic foot ulceration. They concluded that HSPA1B genotype was associated with the severity of diabetic foot ulceration, need for amputation, and duration of hospitalization in patients.

From the article of the same title
British Journal of Surgery (09/03/09) Mir, K. A.; Pugazhendhi, S.; Paul, M. J.

Practice Management

Managing Referral Relationships

Practice management consultants urge physicians to keep track of the number of patients referrals they get from specific providers and to take action if they start seeing a decline. While many doctors would rather invest energy in treating patients, it is important to devote time to networking with current and potential referral sources and staff. This can range from a simple, low-key lunch with a referring physician to holding a seminar on a clinical issue that is relevant to your referral sources.

From the article of the same title
Physicians Practice (09/09) Michael, Sara

CMS Issues Final Rule Limiting Recoupment of Provider and Supplier Overpayments

CMS has issued a final rule that allows providers to avoid recoupment of funds received from Medicare if they file a timely appeal of the recoupment decision. The first-level appeal must be filed within 41 days of the recoupment order. The rule does not apply to providers under Medicare payment suspension.

From the article of the same title
AHLA Weekly Digest (09/18/09)

Rx for Money Woes: Doctors Quit Medicine

A survey of 12,000 primary care physicians conducted last October by Merritt Hawkins and the Physicians' Foundation revealed that 10.1 percent of respondents planned to seek a job outside of healthcare in the next one to three years. One reason for this dropout rate is the insurance reimbursement challenges physicians are facing while struggling with increasing overhead, including administrative costs and medical malpractice premiums.

From the article of the same title
CNNMoney (09/14/09)

Health Policy and Reimbursement

Many Employers to Raise Cost of Health Benefits, Survey Finds

With employee health insurance premiums expected to increase 5 percent for 2010, an annual survey released by Kaiser Family Foundation and the Health Research and Educational Trust shows that 40 percent of employers surveyed said they are likely to increase the amount their workers pay out of pocket for doctor visits next year, while nearly as many will likely raise annual deductibles and the amount workers pay for prescription drugs. Nine percent said they plan to tighten eligibility for health benefits and 8 percent said they plan to drop coverage entirely.

From the article of the same title
Washington Post (09/16/09) Hilzenrath, David S.

Maryland Reins In Hospital Costs by Setting Rates

Maryland’s unique approach to hospital payment is receiving attention in the health reform debate. In Maryland, an independent agency has been setting rates for all patients, including Medicare beneficiaries, at the state's acute-care hospitals since 1977. The system has helped bring state hospital costs below the national average. It requires the hospitals to turn over data covering everything from a patient's diagnosis, demographic information, and treatments to billing information, all of which are made public. In exchange, the state subsidizes the cost of treating the uninsured while giving the hospital a predictable budget and financial stability.

From the article of the same title
Wall Street Journal (09/14/09) Zhang, Jane

Medicare to Fund 'Medical Home' Model

Medicare will help fund state pilot "medical home" projects that use primary-care doctors and teams of coordinators to manage patient care and reduce costs. Under the medical home concept, physicians are paid more for coordinating care for their patients with the goal of avoiding hospital trips and expensive treatments. The government will begin soliciting applications for funding this fall. States that want to get the extra funding from Medicare will have to show that all payers in the state (including Medicaid) are on board as well as half of primary care physicians. They also must show how the program intends to reduce cost and improve care.

From the article of the same title
Wall Street Journal (09/16/09) Zhang, Jane

Technology and Device Trends

Recall of Certain ConMed Surgical Tool Accessories

The FDA has issued a recall of surgical tool products made by ConMed because of a switch problem that could cause one of the universal hand tools for orthopedic surgical attachments, such as surgical saws and drills, to turn on by itself or continue running after the trigger is shut off. The class 1 recall affects certain models of the Pro5 and Pro6 Power Pro Handpieces line, as well as their cables.

From the article of the same title
Medscape (09/11/09)

Initial Experience With Visualizing Foot Tendons by Dual-Energy Computed Tomography

Researchers at Shandong University in China conducted a study to evaluate the feasibility of visualizing foot tendons by dual-energy computed tomography (CT). They concluded that dual-energy CT has great value as a technique for visualizing the tendons and is capable of clearly depicting both anatomical structures and pathologic alterations.

From "Initial Experience With Visualizing Hand and Foot Tendons by Dual-Energy Computed Tomography"
Clinical Imaging (10/09) Vol. 33, No. 5, P. 384; Deng, Kai; Sun, Cong; Liu, Cheng; et al.

Abu Dhabi Gives U.S. Hospital $150 Million

The government of Abu Dhabi has pledged $150 million to the Children’s National Medical Center in Washington, D.C., to develop tools and processes to reduce the pain children experience before, during and after surgery. The hospital will use the funding to establish the Sheikh Zayed Institute for Pediatric Surgical Innovation, which in addition to seeking ways to ease the pain of the surgical experience will attempt to harness a child’s immune system to diminish the need for surgery, to use bioengineering to increase the precision of surgery, and to use genetic analysis to tailor treatment for children.

From the article of the same title
New York Times (09/15/09) Strom, Stephanie

Pressure Characteristics at the Stump/Socket Interface in Transtibial Amputees Using an Adaptive Prosthetic Foot

The technological advances that have been made in developing highly functional prostheses are promising for active patients, but data on whether the devices cause an increase in biomechanical load along with possibly negative consequences for pressure conditions in the socket are scarce. Researchers monitored the socket pressure at specific locations of the stump when using a microprocessor-controlled adaptive prosthetic ankle under different walking conditions. They found that pressure at the stump depends on the knee moments involved in each walking condition and that adapting the prosthetic ankle angle is a valuable means of modifying joint kinetics and thereby the pressure distribution at the stump. Large inter-individual differences in local pressures, however, underline the importance of individual socket fitting.

From the article of the same title
Clinical Biomechanics (09/09) Wolf, Sebastian I.; Alimusaj, Merkur; Fradet, Laetitia; et al.

Total Ankle Replacement in Moderate to Severe Varus Deformity of the Ankle

Researchers evaluated the clinical outcome of total ankle replacement (TAR) performed in patients with moderate to severe varus deformity. They found that the clinical outcome of TAR performed in ankles with pre-operative varus alignment = 10° is comparable with that of neutrally aligned ankles when appropriate additional procedures to correct the deformity are carried out concurrently with TAR.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (09/01/09) Vol. 91-B, No. 9, P. 1183; Kim, B.S.; Choi, W.J.; Kim, Y.S.

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September 23, 2009