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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 Healthcare Reform Update

The Senate Finance Committee began hearings on its proposed healthcare reform legislation this week. Five Democrats on the panel joined with Republicans in defeating two amendments that would have added a “public option” to the healthcare purchasing exchange included in the bill. This was not a surprise, and a number of Senate Democrats are committed to introducing a “public option” amendment on the floor of the Senate. Meanwhile, the House is working on merging its three reform bills this week, and the merged bill undoubtedly will include a “public option.”

The other big controversy this week is proposed payment cuts to health plans under the Medicare Advantage program. Well before the health reform debate, during the Bush administration, the Centers for Medicare & Medicaid Services (CMS) expressed concern that the government was paying health plans more under the Medicare Advantage program than under traditional Medicare. The current House and Senate bills seek to cut those payments. Last week Humana, Inc., the largest Medicare Advantage provider, was told by CMS to cease and desist sending letters to seniors urging them to oppose the cuts because the cuts would result in fewer benefits. A number of Republican senators criticized CMS for what they viewed as muzzling free speech.
Readers Give JFAS a Thumbs-Up

The Journal of Foot & Ankle Surgery (JFAS) is read by 98 percent of its subscribers, according to a recent readership study conducted by healthcare market research firm Franklin Communications. Attesting to the value of its content, 94 percent of recipients either save or share their copies of JFAS.

A subscription to JFAS is one of the member benefits rated most highly in the 2009 ACFAS membership survey. Print issues arrive in member mailboxes six times per year, and members can read the full version online.

Missing a back issue? All issues from 1995 to the present are available online. Just click on "Previous Issues" in the left navigation bar on the journal web site.

Submit a Case for “Curbside Consult” at Annual Conference

Do you have an interesting case that proved to be a diagnostic dilemma or presented a management problem? “Curbside Consult,” an innovative session debuting at the 2010 Annual Scientific Conference, gives you the chance to have your problem addressed by a panel of experts in an informal setting.

The conference will take place February 23–26, 2010, in Las Vegas. Deadline for submissions is November 18, 2009. Visit the conference web page to submit your case now!
Got Downtime? Get Research!

Make the most of your downtime by catching up on the latest research with Scientific Literature Reviews, a monthly collection of research summaries. The October edition features these topics, reviewed by residents at the VA-Southern Arizona Health Care System:
  • Negative Pressure Wound Therapy for Soft Tissue Injuries Around the Foot and Ankle
  • Botulinum Toxin for Diabetic Neuropathic Pain: A Randomized Double-Blind Crossover Trial
  • Diabetic Patients’ Medications Underuse, Illness Outcomes, and Beliefs about Antihyperglycemic and Antihypertensive Treatments
Read these and previous summaries anytime!

Foot and Ankle Surgery

Efficacy and Safety of Fresh Fibroblast Allografts in the Treatment of Diabetic Foot Ulcers

Various types of allogenic skin substitutes composed of cryopreserved keratinocytes, fibroblasts, or both have been used for treatments of diabetic foot ulcers, but the effects have generally not been dramatic because cryopreservation impairs cell activities. Researchers in this study evaluated the use of non-cryopreserved fresh human fibroblast allografts in treating diabetic foot ulcers. They concluded that the use of fresh human fibroblast allografts was a safe and effective treatment for diabetic foot ulcers.

From the article of the same title
Dermatologic Surgery (09/01/09) Vol. 35, No. 9, P. 1342; Han, S. K.; Kim, H. S.; Kim, W. K.

High Union Rates and Function Scores at Midterm Followup With Ankle Arthrodesis Using a Four Screw Technique

When evaluating the role of ankle arthrodesis in the treatment of severe ankle arthritis, postoperative infection, nonunion, and the development of arthritis at the adjacent joints are major issues when considering treatment alternatives. This study evaluated the rate of complications, the functional outcome, and compensatory range of motion at the midtarsal joint at medium-term followup after ankle arthrodesis with four cancellous screws. Ankle arthrodesis with screws were found to provide high rates of union, reliable pain relief, and favorable functional medium-term results.

From the article of the same title
Clinical Orthopaedics and Related Research (09/10/09) Zwipp, H.; Rammelt, S.; Endres, T.; et al.

Preoperative Footbaths Reduce Bacterial Colonization of the Foot

Researchers in this study sought to determine whether preoperative chlorhexidine bathing decreased the number of bacteria on the forefoot prior to foot and ankle surgery. They concluded that chlorhexidine provides better reduction in skin flora than a placebo, recommending the use of a chlorhexidine footbath in addition to standard surgical preparatory agent before foot and ankle surgery.

From the article of the same title
Foot & Ankle International (09/09) Vol. 30, No. 9, Ng, A. B.; Adeyemo, F. O.; Samarji, R.

Practice Management

IT Vendors Say EHRs Will Meet Unknown Guidelines

One of the great catch-22s of the electronic health records (EHRs) stimulus funds is that in order to qualify for the funds, providers must show “meaningful use” of a “qualified” EHR, but those terms have not yet been defined by the government. However, many of the big players in the market such as GE Healthcare, NextGen and Athenahealth are offering guarantees that their products will meet the standards required to qualified for the $44,000 in payments incentives. The companies deny that this strategy is designed to boost sales, but observers believe that some providers are delaying purchases until there is more clarity.

From the article of the same title
Modern Healthcare (09/28/09) Robeznieks, Andis

Are Med-Student Tweets Breaching Patient Privacy?

A new survey of medical school deans reveals that medical students' unprofessional conduct on social networking sites and blogs is common, with some reporting that students have breached patient confidentiality in some of their postings. This has been occurring despite the fact that students understand patient-confidentiality laws and have been instructed in the ethical standards of their chosen profession. At UCLA, which conducted the survey, a task force has been created to establish guidelines that students can adhere to when deciding what, and what not, to post.

From the article of the same title
Time (09/23/09) Park, Alice

Don't Let EMRs Cut Into Your Doctor-Patient Time

Doctors must make a serious effort to ensure that their face time with patients is not overtaken by information technology, note experts and physicians with technology experience. Lyle Berkowitz, MD, with the Northwestern Memorial Physicians Group in Chicago says that patients can be made to feel more at ease if the doctor tells them upfront that he or she might not always be making eye contact with them because they must refer to a computer. Timothy Fiorillo, DO, at the Perkiomen Family Practice in Pennsylvania says he usually lets the patient talk to him for up to two minutes while he listens and maintains eye contact, before typing anything. Experts say that physicians should practice scrolling through the most commonly used screens so they can learn to navigate the system quicker and have more time for direct engagement with patients. Berkowitz advises doctors who deploy an EMR system to reorganize the exam room or change the order in which an exam is carried out.

From the article of the same title
American Medical News (09/21/09) Dolan, Pamela Lewis

Health Policy and Reimbursement

Challenges to Medical Liability Caps Go before Georgia, Maryland High Courts

Two states laws that set caps on noneconomic (punitive) damages in medical malpractice cases are being challenged in the states’ highest courts. In Georgia, a lower court ruled in February that the state’s $350,000 cap was unconstitutional. In Maryland, a lower court ruled that the cap applied only to cases that went to arbitration. Because arbitration is rarely used for malpractice cases in that state, this seriously limits the effectiveness of the cap. A number of physician groups have filed friend of the court briefs in support of the caps.

From the article of the same title
American Medical News (09/28/09) Sorrel, Amy Lynn

California Medical Malpractice Law in Spotlight

California's experience with malpractice reform could provide lessons for efforts to establish a national policy. The state's Medical Injury Compensation Reform Act, or MICRA, passed by the state Legislature in 1975, caps the amount of damages for "pain and suffering" at $250,000 but not the amount plaintiffs can seek for other damages, such as medical costs and lost wages. It also does not cap punitive damages. For physicians, the law has helped to keep insurance costs in check, prevented unreasonably high jury verdicts from sympathetic juries, and kept them from leaving the state.

From the article of the same title
San Francisco Chronicle (09/21/09) P. A1; Colliver, Victoria

Use of Federal Health Clinics Soars

The 1,200 federally-qualified health centers (FQHC) around the country are a critical component in the nation’s healthcare safety net for the uninsured poor. The 2009 federal stimulus package included $2 billion more in financing for the centers The recession has resulted in a dramatic spike in the demand for their services which are provided on a sliding scale. According to the National Association of Community Health Centers, the centers will see more than 20 million patients in 2009, and many have long waiting lists for appointments. Many new patients are newly unemployed from middle-class jobs. The centers only provide basic services, so patients are still on their own if they need surgery, MRIs or other specialized procedures.

From the article of the same title
Wall Street Journal (09/28/09) P. A4; Favole, Jared A.

Technology and Device Trends

Math Used as a Tool to Heal Toughest of Wounds

Researchers at Ohio State University have developed a mathematical model of an ischemic wound designed to reduce the need for guesswork and animal testing traditionally required as researchers pursue prevention, diagnosis, and treatment of the symptom. The model simulates both non-ischemic wounds and ischemic wounds and produced results that generally match pre-clinical expectations: that a normal wound will close in about 13 days, and that 20 days after the development of an ischemic wound, only 25 percent of the wound will be healed. It also demonstrated that normal wounds have higher concentrations of proteins and cells expected to be present during the healing process, while ischemic wounds lack oxygen and remain in a prolonged inflammatory phase that delays or prevents wound closure. The research was published in the online early edition of the Proceedings of the National Academy of Sciences.

From the article of the same title
Newswise (09/21/09)

Stem Cell Study Raises Hope for Bone Repair Pastes

Research at the University of Maryland Dental School could lead to the development of strong, moldable, and injectable pastes to regenerate needed bone tissue to repair broken bones, fractures, genetic defects, and combat bone wounds. The researchers have demonstrated that human stem cells seeded in a tissue engineering scaffolding exhibited "excellent attachment and osteogenic differentiation." The research could lead to an injectable paste that would fill any shape of cavity from bone defects, breaks, or wounds by regenerating needed bone tissue.

From the article of the same title
University of Maryland, Baltimore News Release (09/22/09)

U.S. FDA Seeks Outside Review of Device Approvals

The Institute of Medicine will assess an FDA program that gives fast-track approval to certain medical devices. The FDA has been criticized for using the accelerated approval process for more products than Congress originally intended, leading to problems with devices after they are sold. Expedited reviews of devices demonstrated to be similar to already-approved products allow manufacturers to get products to market more quickly and with less expense. More than 50 percent of the devices given expedited approval actually used new technology or were intended for a new type of use, the Government Accountability Office found in a report released in January.

From the article of the same title
Reuters (09/23/09) Heavey, Susan

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September 30, 2009