News From ACFAS

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The latest free podcast in the College’s online library is “Practical Aspects of Arthroscopy.” Listen in as experienced surgeons discuss when and with what kinds of patients they would employ this minimally invasive approach to ankle pathology.

The class will start whenever you are ready at ACFAS e-Learning. Visit any time for reliable information on foot and ankle conditions, medical practice, podiatric education and more in podcast, video and DVD. What: National Provider Call on Physician Quality Reporting System & Electronic Prescribing Incentive Program sponsored by the Centers for Medicare & Medicaid Services. Agenda includes an overview of the Medicare Electronic Prescribing Incentive Program Feedback Reports and question & answer session.

When: Tuesday, Oct. 18, 1:30–3:00 p.m. ET

How to register: Information will be available soon via listserv announcement and at CMS’ sponsored-call website.

Who should attend: Eligible professionals, medical coders, physician office staff, provider billing staff, health records staff, vendors and all other interested Medicare fee-for-service healthcare professionals.

The presentation will available for download at least one day before the call at the CMS website. ACFAS is looking for members who understand current credentialing or privileging issues in facilities to serve as mentors to members facing credentialing and privileging challenges. Must be board certified and have experience on a medical staff or related committee, board of podiatry or other related experience. If interested in applying, please contact Kristin Hellquist at kristin.hellquist@acfas.org. An Ohio appeals court has affirmed the decision of the trial court that a hospital can deny staff privileges to a podiatrist who is not board certified by the American Board of Podiatric Surgery (ABPS). On Dec. 21, 2005, Grady Memorial Hospital granted James E. Blaine, DPM, clinical privileges, which he exercised until June 30, 2007. The hospital’s bylaws stipulate that each practitioner must achieve board certification by a “recognized certification board” within five years of residency completion. Dr. Blaine failed the written portion of the ABPS multiple times, but passed an alternative board exam not included in the list of “recognized boards.”

Blaine sued the hospital stating that the bylaws did not require certification through ABPS, and that any such requirement would violate the hospital's non-discrimination policy. The appeals court upheld the lower court's decision that the hospital was within its rights to deny privileges to podiatrists who did not achieve ABPS certification within the prescribed period of time.
Source: James E. Blaine, D.P.M. v. OhioHealth Corporation, et al.

Futurescan™

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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.

Digital wireless technologies will radically transform medical care in the coming decade. To begin with, every hospitalized patient's vital signs will be continuously monitored by noninvasive wireless sensors in the form of adhesive strips or wrist transceivers. Quality of care also will be facilitated by wireless devices, such as pills tagged with sensors and drug-impregnated skin patches that can be wirelessly activated to administer a precise dose at a specific time for any patient.

The takeup of wireless technology in the outpatient practice of medicine has already commenced. The implant of a microelectrode mechanical sensor into the pulmonary artery has been shown to significantly reduce rehospitalizations in a randomized trial, suggesting that a marked benefit can be realized by having more precise evaluation of the patient's hemodynamic status to direct the appropriate use of diuretics. Ultrasound also is undergoing a revolution thanks to innovations such as the Vscan, a pocket, miniature, high-resolution ultrasound imaging device that can be used for echocardiography or ultrasound of the abdomen or fetus.

Virtual office visits also show potential, and the Myca Health platform set up by Jay Parkinson in New York City enables video visits and instant messaging as well as traditional face-to-face visits. Hospital leaders should consider implementing wireless real-time in-hospital monitoring systems; fortify IT support so doctors can follow patients' vital signs on their smartphones while maintaining data security; seek technologies that enhance care or reduce costs; and prepare for e-visits.

Foot and Ankle Surgery

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Researchers evaluated the functional and radiographic outcomes of a novel surgical technique devised to treat chronic lateral ankle instability. The technique involves direct repair of the anterior talofibular ligament and anatomic reconstructions of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using a free semitendinosus tendon allograft and interference screws. A retrospective study of the records of 27 patients (28 ankles) with chronic lateral ankle instability treated from 2007 to 2009 was performed. Results were measured at a median of 19 (12–26) months postoperatively.

Median VAS pain score decreased from 6 to 2 (P < 0.05), and median AOFAS score improved from 63 to 91 (P < 0.05). Median Karlsson–Peterson score improved from 55 to 80 (P < 0.05), whereas talar tilt decreased from 17.8° to 6.7° and the mean anterior drawer test decreased from 10.0 mm to 4.5 mm (P < 0.05). Eighty-eight percent (21/24) were satisfied with surgery. No complications were encountered.


Researchers evaluated the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI). Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task.

During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase (P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion (P = .049), a lower peak eversion (P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04).

The results led the researchers to suggest that sports training or rehabilitation programs differentiate between the pre-landing and post-landing phases of sports maneuvers and educate athletes to land with an appropriate ankle position and muscle recruitment.


A retrospective review of patients who underwent triple arthrodesis (TA) with lateral column lengthening (LCL) through the calcaneocuboid joint for rigid planovalgus foot deformity was performed. Twenty-nine surgeries were identified with solid fusions occurring in 27 patients by 12 weeks postoperatively. Two patients with cerebral palsy had persistent hindfoot valgus. At an average follow-up of 32 months after surgery, correction of the talo-first metatarsal angle in the anterior-posterior and lateral planes, calcaneal pitch, and talo-horizontal angles were statistically significant. There were 25 good clinical results with minimal or no pain with activity (86.2 percent) and four poor or fair results with moderate or severe pain (13.8 percent). There were 26 radiographic successes (89.7 percent) and three radiographic failures (10.3 percent). Cerebral palsy was associated with a higher rate of radiographic failures (P=0.01). There were 15 total complications in 11 feet (37.9 percent).

Practice Management

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A revised recovery audit contractor (RAC) statement of work issued by the Centers for Medicare & Medicaid Services (CMS) on September 12 contains amendments and clarifications and new additions that will impact providers in various ways. Michael Taylor, MD, with Executive Health Resources says that areas of potential interest include the RACs' treatment of the discussion period. "When the discussion period first rolled out ... it could be done in a verbal format, but now, it is clear that discussion period has to be in a written format," he notes. "If the provider is pursuing discussion, and an appeal is filed during that time period, the RAC is charged—at that point—with ending the discussion period. So providers are going to have to make the choice of going right into the appeals process or using the discussion period first, because providers could find it fruitless to do this at the same time because of the new policy."

This revision will require providers to take a more targeted approach. Taylor says that if a provider seeks to appeal early in the process to prevent recoupment, managing timelines becomes vital. Depending on the timeliness of correspondence with the RACs, providers may choose not to use the discussion period because it may retard their process and it could jeopardize their ability to file that first level appeal in time to prevent recoupment.


A study in the September issue of the Journal of American College of Surgeons indicates that hiring more part-time surgeons may help alleviate the country's surgeon shortage by 2030. Noting that people with a balanced lifestyle have a lower rate of burnout, lead study author Bhagwan Satiani, MD, and colleagues analyzed what would happen if 25 percent, 50 percent, or 75 percent of potential retiring surgeons worked part time for an additional decade; depending on the scenario, that would translate to between 4,125 and 12,375 more part-time surgeons by 2030. Research demonstrates that more physicians are employed part time, and that some surgical specialties are seeing fewer surgeons. The study authors said that employment models should address flexible work schedules and other changes to get surgeons interested in part-time employment; such schedules may be especially appealing to older men considering retirement and young women taking time off to raise a family.


Hospitals looking to reach out to patients, expand market share, and increase awareness about their services are increasingly using physician videos, which can double as a way to engage physicians. "Research has shown that physicians who have a video gain more Web traffic," says Pam Marecki, assistant vice president of communications at Bayhealth Medical Center. Bayhealth started making a video series called "A Bit of Advice" at the same time it was finishing video biographies about the hospital's physicians to create a more interactive and engaging website. Marecki says physicians who had video links on their Web pages had three to four times more traffic.

Similarly, Tufts Medical Center set out to increase awareness and stand out in a very competitive market, so it created videos to allow potential patients to "meet" its physicians. Tufts also created TuftsMedicalCenter.tv, a website that features the expertise of its physicians through videos and features health channels with information on specific diseases and services.

Health Policy and Reimbursement

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A Medicare pilot project slated to begin in summer 2012 will pay primary care practices in select areas an additional $20 a month per patient for increasing their availability to patients and otherwise personalizing care. The Comprehensive Primary Care Initiative announced by Centers for Medicare and Medicaid Services is designed to give primary care doctors an incentive for doing things that are thought to improve patient health, but for which they are not financially compensated. The pilot project will commence in five to seven healthcare markets and likely will involve 75 practices. To be eligible for the bonus payments, a primary care practice has to be available around the clock to provide medical care and health information; help patients with serious or chronic ailments follow a personalized care plan; furnish preventive care; engage patients and families in their own care; and cooperate with other doctors to provide coordinated care.


In a New England Journal of Medicine perspective piece marking the first anniversary of the Patient-Centered Outcomes Research Institute (PCORI), the organization's co-chairs say it is "poised to lead a national movement that meaningfully involves patients and incorporates their voices in producing trusted, evidenced-based information, promoting better decisions and ultimately better health for all." Established by the Patient Protection and Affordable Care Act to conduct comparative clinical effectiveness research, PCORI announced $26 million in grants for pilot projects to advance outcomes research. It expects to award 40 grants of up to $250,000 per year for two years. Letters of intent for grants are due by Nov. 1. The funding announcement can be found on PCORI's Web site.


Outpatient surgery centers in California would face additional scrutiny under a bill pending before Gov. Jerry Brown. Both houses of the state Legislature have approved a bill that would reshape laws governing clinics. Under current law, clinics that lose private accreditation because of safety violations can apply to different accrediting firms for approval to operate. The proposed law would prohibit that. The state medical board would also be required to document on its website whenever a surgery center has its accreditation revoked or suspended or the center is placed on probation.

Medicine, Drugs and Devices

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A bipartisan group of lawmakers has introduced a bill that would provide Medicare enrollees with smartcards to improve access to healthcare, and potentially save an estimated $30 billion a year in fraud and waste. The Medicare Common Access Card Act of 2011 would create a two-stage process for the smartcard program, with the first stage consisting of a number of pilot programs to embed microchips in Medicare identification cards, and the second expanding those programs nationwide. Healthcare providers would be issued with cards with biometric security features, and both providers and patients would have to insert their cards into a reader at the point of care to confirm that services were rendered.


Researchers attempted to improve the percutaneous tenorraphy method for treating acute Achilles tendon ruptures using non-invasive, intra-operative ultrasonographic exploration. A group of 21 patients was ultrasound-controlled during the operation, while a second group of 12 patients underwent the operation without control. Average follow-up in the first group was 12 months and 24.5 months in the second group. Neither general complication, iterative rupture, nor sural nerve injury were observed in the ultrasonography group, and patients in this group returned to work earlier. No significant difference was observed between skin necrosis, return to sport, plantar flexion strength, and calf muscle atrophy. Patients in the first group also considered the procedure's economic impact to be lower.