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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

The Policies of Practicing Podiatry

While the 2010 ACFAS practice management seminars are over, best practices for management and reimbursement stewardship should not be forgotten. From simple tips such as Googling your name to see what others are saying about you, to ways to hire the best staff, to recommendations for proper coding and billing to maximize your revenue, ACFAS practice management seminars and information resources can provide you with a treasure trove of up-to-the-minute information.

Today's tip is to check out the Centers for Medicare and Medicaid Services Quarterly Provider Update, for regular doses of information to help your practice stay healthy.
New Podcast: Metatarsal Fractures

The latest free podcast at ACFAS e-Learning is an open discussion of various fractures of first, central and fifth metatarsals. Surgeon panelists share their opinions on and treatment approaches for differing patient characteristics and severity of injury, ranging from general principles to analysis of an actual case history.

“I think we can agree,” says moderator Donald E. Buddecke, DPM, FACFAS, “that while some of these fractures have been debated over and over, others may well need more study and discussion.”

Tune in to learn from peers in practice! Check out the new podcast and the full library of ACFAS e-Learning offerings today.
ACFAS Announces First Recognized Fellowship Programs

The ACFAS Fellowship Committee has announced the first group of surgical podiatric fellowship programs officially recognized by the College under its Recognized Fellowships Initiative.

This initiative is a part of efforts to foster post-graduate-level training for DPMs by providing support to programs that have met certain minimal requirements. More information on these requirements and the recognized programs can be found on the ACFAS website.

If you are a fellowship program director and would like your program to be considered for the College’s recognized list of programs, please request an application by contacting ACFAS Director of Membership Michelle Brozell.
Recent Research at Your Fingertips

Catch up on current research in just a few clicks with ACFAS’ Scientific Literature Reviews. You’ll find a wealth of abstracts written especially for foot and ankle surgeons by podiatric residents. The latest links include:

One-step Bone Marrow-derived Cell Transplantation in Talar Osteochondral Lesions, from Clinical Orthopaedics and Related Research.
Reviewed by Brant L. McCartan, DPM, MBA, MS, Beth Israel Deaconess Medical Center.

Comparative Functional Analysis of Two Different Achilles Tendon Surgical Repairs, from Foot & Ankle international.
Reviewed by Japheth Ogamba Mongare, DPM, OCPM/UHHS Richmond Medical Center.

Cartilage Lesions and the Development of Osteoarthritis After Internal Fixation of Ankle Fractures, from the Journal of Bone and Joint Surgery (American).
Reviewed by Carissa Sharpe, DPM, OCPM/UHHS Richmond Medical Center.

Browse new entries or the entire archive any time at Scientific Literature Reviews.

Foot and Ankle Surgery

A Clinical Study for Evaluation of Results of Closed Interlocking Nailing of Fractures of the Shaft of the Tibia

Researchers analyzed the role of closed interlocking nailing of fractures of the shaft of the tibia in 25 cases. There were 18 closed and 7 open fractures and most of the fractures were either oblique or transverse, while the remaining were either comminuted, spiral, or segmental. Reamed closed interlocking nailing was done in most cases under image intensifier. Partial weight bearing was started within the first two weeks in 84 percent of patients after surgery and full weight bearing was started at six weeks. Fractures united in 100 percent of cases, with time of union ranging from 11 weeks to 28 weeks, with the average 14 weeks in 24 cases. Excellent results were found in 18 (72 percent) cases, while 4 (16 percent) case results were good.

From the article of the same title
Internet Journal of Orthopedic Surgery (09/23/10) Gupta, Rakesh Kumar; Motten, Tarsem; Kalsotra, Nipun; et al.

Long-term Results of the Posteromedial Release in the Treatment of Idiopathic Clubfoot

A study was held to present the long-term consequences of the posteromedial release (PMR) in congenital clubfoot treatment of one treating surgeon. The research involved a study population of 38 patients with 58 clubfeet who had an a la carte PMR carried out by one experienced pediatric orthopedic surgeon before the age of 2 years, with an average follow-up of 16 years. In 53 feet, the average rating was 80.6 points, going by the grading system of Laaveg and Ponseti; there were 15 excellent, 17 good, 13 fair, and eight poor results. The bulk of the patients exhibited limitation of foot function with a substantial loss of dorsiflexion and a significant decrease of pronation-suppination, while the grade of osteoarthritis was consistently higher in the clubfeet than in the controlateral normal feet. The results led the researchers to conclude that PMR will lead to stiff and partly nonfunctional feet after a follow-up of 16 years.

From the article of the same title
Journal of Pediatric Orthopaedics (11/01/10) Vol. 30, No. 7, P. 700 van Gelder, Janke H.; van Ruiten, Alward G.P.; Visser, Jan D.; et al.

Practice Management

Delivering Bad News One of Medicine's Great Difficulties

The tragic shooting of Dr. David B. Cohen at Johns Hopkins Hospital left questions in many doctors minds of the best way to give patients and families bad news. Patients and their families could already be under a great deal of stress stemming from their medical condition, so when a doctor has to give them bad news, Dr. Mark Duncan, a veteran cancer surgeon at Johns Hopkins Bayview Medical Center, says that one should sit down with the patient/family and extend empathetic touches to their hand or shoulder and then try to answer any questions that might come up.

Dr. Bill Thomas, a professor at the University of Maryland, Baltimore County's Erickson School of Aging, believes that it is important to gauge every situation as different when making life-and-death decisions and it is also important to get family input which can steer the approach. Most doctors can agree that calm, clear communication is the best approach, but some believe that the lack of communication is caused by the fear of malpractice suits.

Johns Hopkins now has a program that has medical students learning the best ways to communicate with patients, in which they participate in role-playing with actors that are called "standardized patients." If there is a relationship built up over time between a doctor, patient, and/or their family, things can go much smoother when it comes to giving the bad news of a death or an undesirable outcome. If there is no existing relationship between doctor and family, sometimes it is helpful to have another doctor or nurse in attendance when the bad news is given, to reduce the risk of a conflict.

From the article of the same title
Baltimore Sun (09/20/10) Walker, Childs; Calvert, Scott

Data Risk Management: A Critical Part of Your Practice

As physician practices collect, store, and share patient data online, liability issues have become complex. Data protection must be in place from the moment patients access the practice's website. Physicians must understand that professional liability insurance does not cover Internet exposures or loss of data due to lost or stolen computers, hacking, employee misuse, negligent release of data, or improper disposal of paper documents or computer equipment. Thus, they would be wise to purchase a breach response liability policy that defends them against financial loss, penalties, and defense costs if patient data is compromised. They should ensure that lawsuits associated with malicious activity tied to the data breach are covered by the policy.

From the article of the same title (09/14/10) Grant, Nick

Healthcare Staffing Guidelines Focus on Diversity

The Joint Commission plans to clarify and refocus its patient-centered communication standards in January in response to changing demographics and the need for healthcare providers to understand that each patient has unique expectations and perspectives with regard to their health. Trinity Health President and CEO Joseph Swedish, a member of The Joint Commission committee that created the standards, says hospitals will need a plan to assess the demographic needs of their community and ensure that training, education, recruitment and clinical services take these needs into consideration. He says the demands on staff and the number of new employees needed will vary, and he emphasizes that hospitals will not be required to have an on-site staff interpreter for every language spoken by patients. Swedish says hospitals would be wise to hire workers and qualified interpreters who speak a certain language if they find that 10 percent of their patient demographic speaks that language.

From "Healthcare Staffing Guidelines Spotlight Diversity"
HealthLeaders Media (09/13/10) Commins, John

Health Policy and Reimbursement

Blue Cross and Blue Shield Pilot Program Aims to Cut Healthcare Costs

Blue Cross and Blue Shield of Nebraska has launched a six-month experiment to see if healthcare costs will fall and people will get healthier if doctors have access to better patient information. The program will rely heavily, at least initially, on an Internet program created by MDdatacor that turns disparate medical records into tailored patient checklists. It will start with about 1,200 diabetic patients in nine Nebraska cities and will be expanded rapidly if the experiment proves a success.

From the article of the same title
Lincoln Journal Star (NE) (09/29/10)

Grants Awarded for State Health Insurance Exchanges

The White House has awarded 49 grants to states and the District of Columbia to plan for new health insurance exchanges designed to help Americans shop for health plans beginning in 2014. These state-based exchanges, a vital component of the healthcare reform bill, are to become the central web-based marketplace for consumers who do not get health benefits from their employers.

Approximately 24 million Americans are expected to shop for coverage on the exchanges by 2019. Starting in 2014, most Americans will also be required by the law to get insurance, either through their jobs or on their own.

Massachusetts and Utah already have exchanges, which they created before the federal healthcare law passed in March. Most states, however, are just beginning to work on setting up their exchanges.

From the article of the same title
Los Angeles Times (09/30/10) Levey, Noam N.

Medicaid Cut for Podiatry in AZ

Health benefits for adults enrolled in Arizona's Medicaid program are being significantly scaled back. Coverage will be cut for basic health services, including podiatry. Additionally, the state will cut benefits for medical equipment, including computer-controlled lower limbs and joints.

From "Health Benefits Cut for Adults With Medicaid"
Arizona Republic (AZ) (09/26/10) Alltucker, Ken

Mass. Recasting Health Payments

Massachusetts Governor Deval Patrick is reviving the state’s plan to change how doctors and hospitals are paid, aiming to hand lawmakers in the state a specific proposal by Jan. 1. A small group of state officials and healthcare executives was convened in September to draft a first-in-the-nation blueprint for replacing the current fee-for-service model with a new payment system that would essentially put providers on a budget for each patient’s care.

The system, called global payments, would require doctors, hospitals, and other providers to form groups called accountable care organizations that would split the payments and better coordinate patient care. These groups generally would get a flat per-patient fee, along with incentives for high-quality care, hopefully eliminating the incentive for unnecessary tests and procedures, and encouraging greater focus on preventing serious health problems from developing in the first place.

A number of contentious issues still have to be ironed out, however, such as how much power state regulators will have over the prices paid to providers, the rules for forming accountable care organizations, and whether healthcare providers will have seats on the board that eventually will oversee the potential dismantling of the current system.

From the article of the same title
Boston Globe (09/27/10) Kowalczyk, Liz

Technology and Device Trends

Outcome of Limb Lengthening in Fibular Hemimelia and a Functional Foot

The decision to recommend either reconstructive or ablative surgery to the parents of children with fibular hemimelia is difficult and debatable in the orthopaedic literature. Researchers reported on their experience with the treatment of eight children (eight limbs) with fibular hemimelia with limb lengthening using Ilizarov or Taylor spatial frames. All of these children had type 1 or 2a fibular hemimelia (Achterman and Kalamchi). The researchers used the number of rays present in the foot as a guide to decide on the treatment option. Children with more than three rays at the time of presentation were considered for limb reconstruction using Taylor spatial or Ilizarov frames. All patients were ambulatory and mobile with acceptable leg lengths and limb alignment at the time of last follow-up, and all expressed satisfaction with their outcomes. However, knee stiffness was a significant problem in the majority of the patients following lengthening.

From the article of the same title
Journal of Children's Orthopaedics (09/23/10) Changulani, M.; Ali, F.; Mulgrew, E.; et al.

Court Lets Stem Cell Funds Flow for Now

A federal appeals court has ruled to allow the Obama administration to continue to fund embryonic stem cell research, for the time being. The three-judge panel claimed that the administration did meet the legal standards for a stay of injunction against a previous ruling that halted funding. The stay will remain in place until the appeals court has made a final ruling following an investigation into the legality of the funding.

From the article of the same title
Wall Street Journal (09/29/10) Kendall, Brent

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October 6, 2010