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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

View the New, your trusted and respected online resource, is now completely redesigned!

Experience an infinitely more powerful way to communicate for foot and ankle physicians, students, patients and individuals in the healthcare community and media.

Revamped navigation gives you all the content you enjoyed in the past—now clearly presented, easier to locate and access, including:
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Best of all, this is just the beginning. In the coming months, we’ll continue adding content and features to offer more to ACFAS members. Stay tuned!
This Week's Healthcare Reform Update

On Friday, the Senate Finance Committee ended its hearing on the proposed “America’s Healthy Future Act of 2009,” but the scheduled vote for Tuesday, October 6, was postponed pending a new cost estimate from the Congressional Budget Office.

The Committee has amended the bill to reduce penalties on individuals for failing to purchase health insurance, and also excluded 2 million individuals from the requirement based on income. Some stakeholders believe that this waters down the individual mandate so much that the bill will result in too many people still uninsured. Discussions continue on how to finance the proposal. A proposed tax on “Cadillac” plans gained momentum initially, but has been the subject of sharp criticism.

Once the bill is voted out of the Committee, it will be subject to debate and amendment on the Senate floor. Ultimately, it must be reconciled with the Senate HEALTH Committee bill, which includes a public option. Things have been quiet on the House side the past week as members work to reconcile competing bills.
New Podcast: When to Walk

“When to Walk,” the latest ACFAS podcast, is a lively exploration of weight-bearing and other perioperative aspects. Surgeons with a broad range of experience discuss diverse approaches to patient care.

“These individualized approaches are worth hearing,” says moderator Donald E. Buddecke, DPM. “You’ll gain a broad perspective on how surgeons take care of their patients post-operatively.”

Tune in to learn from peers in practice! Check out the podcast and the full library of ACFAS e-Learning offerings today.
Promote Your Practice with FOOTNOTES

The Fall 2009 issue of the ACFAS patient newsletter is now available for your use in practice marketing. Hundreds of ACFAS members use FOOTNOTES to stay in touch with patients and reach out to new ones. This colorful, informative publication is free to members, and available in both English and Spanish versions.

New uses members are finding for FOOTNOTES include posting the newsletter on practice web sites and adapting the articles for blogs. Patients appreciate being able to pick up a copy in your reception area, and the newsletter is a low-cost addition to billing statements.

Download the Fall issue of FOOTNOTES.

Foot and Ankle Surgery

Foot Pain: Is Current or Past Shoewear a Factor?

A new study shows that people who make poor shoe choices early in life by wearing unsupportive footwear like high heels, sandals and slippers are much more likely to suffer from foot pain in later years. Researchers examined the effects of footwear choices early in life on foot pain later in life in a group of 3,378 adults. They found that 19 percent of men and 29 percent of women had generalized foot pain on most days, and that women who wore good shoes in the past were 67 percent less likely to report hindfoot pain than those who wore average shoes. Good shoes were defined as low-risk shoes such as athletic and casual sneakers, while average shoes were defined as mid-risk shoes, like hard- or rubber-soled shoes, special shoes, and work boots. Examples of bad footwear include high-heel shoes and sandals. The researchers found no link between foot pain and shoe choice among men, largely because less than 2 percent wore bad shoes.

From the article of the same title
Arthritis Care & Research (10/15/09) Vol. 61, No. 10, P. 1352; Dufour, Alyssa B.; Broe, Kerry E.; Nguyen, Uyen-Sa D. T.; et al.

Postoperative Outcomes and Reliability of 'Sensation-sparing' Sural Nerve Biopsy

Sural nerve biopsy is a valuable tool for the diagnosis of neuropathic disorders, but concerns of persisting pain and numbness resulting from traditional whole sural nerve biopsy have led to interfascicular dissection techniques with inconsistent benefits over whole nerve biopsy. Researchers in this study describe a technique of atraumatic anterior fascicular sural nerve biopsy designed to preserve calcaneal sensation while maintaining diagnostic benefit without requiring significant interfascicular dissection. The researchers concluded that atraumatic anterior fascicular sural nerve biopsy preserved essential lateral heel sensation in patients with neuropathic disorders while providing diagnostic utility.

From the article of the same title
Muscle & Nerve (10/01/09) Vol. 40, No. 4, P. 603; Campbell, Chris A.; Turza, Kristin C.; Morgan, Raymond F.

Managing Surgery Complications Key to Curbing Mortality Rates, Study Suggests

A study published in the Oct. 1 edition of the New England Journal of Medicine shows that death rates varied widely from hospital to hospital—from 3.5 to 6.9 percent—but that complication rates did not vary significantly. The study of 84,730 people who underwent inpatient surgery at 186 hospitals from 2005 to 2007 suggests that how a hospital responds to complications may be even more important than the frequency of complications.

From the article of the same title
Modern Healthcare (09/30/09) DerGurahian, Jean

Surgical Quality Program Cuts Complications, Patient Deaths

Nearly 120 hospitals participating in a surgical quality program between 2006 and 2007 cut their complication rates by an average of 11 percent and slashed mortality rates by 18 percent, according to a study in the September Annals of Surgery. The American College of Surgeons' National Surgical Quality Improvement Program, modeled after a successful program developed in the 1990s in the Veterans Health Administration, helps hospitals collect and analyze clinical, risk-adjusted outcomes data so surgeons can spot potential problems. More than 250 hospitals have signed up for the project.

From the article of the same title
American Medical News (09/28/09) O'Reilly, Kevin B.

Endoscopic Gastrocnemius Recession for Treating Equinus in Pediatric Patients

Researchers detail an alternative procedure to endoscopic gastrocnemius recessions in neurologically healthy pediatric and adolescent patients whose gastrocnemius equinus could not be corrected nonoperatively. Twenty-three patients who underwent 40 procedures for equinus deformity or osteoarthritis were prospectively followed, and pre- and postoperative ankle dorsiflexion were quantified. The minimum followup for study inclusion was 12 months, and dorsiflexion range of motion exhibited improvement for every patient. There were no indications of postoperative diminished nerve sensation in any patient. The researchers conclude that the procedure can be employed to correct gastrocnemius equinus in otherwise healthy children who have derived no benefits from earlier nonsurgical treatment.

From the article of the same title
Clinical Orthopaedics and Related Research (09/18/09) Grady, John F.; Kelly, Carolyn

Practice Management

MGMA 2009 Cost Survey Reports Show Decline in Medical Revenue

MGMA reports its annual practice revenue survey found that multispecialty group practice revenue declined by 1.9 percent in 2009. The report notes that while the percentage isn’t high, it is the first time in several years that there has been a decline. The reasons for the revenue decline included drop in patient volume—almost 10 percent decline in procedures and 11 percent decline in patient visits—and an increase of 13 percent in bad debt from fee-for-service charges. This highlights the need for practices to focus on collecting co-pays and deductibles from patients at the time of service.

From the article of the same title (10/05/09) Ziehler, Kristina

Offering Financial Assistance to Newly Uninsured Patients

Physicians may offer discounts to uninsured patients according to financial need, as long as they take a systematic approach and document the need in accordance with established policy. This policy should include confirming the patient's income, expenses and available assets. Practices should appoint someone to review the information, verify current income, and ascertain whether a full write-off, percentage discount or payment plan is suitable. When developing their financial hardship discount program or other initiatives designed to help those who need medical care, physicians should make sure to review their practice's financial reports to determine how many patients lack insurance and the amount of charges already written off to charity or bad debt, and then consider whether systematically supplying such discounts is practical from a financial standpoint. Physicians also should be prepared to help their patients comprehend COBRA benefits and guide them to other options, including free and low-cost health services in their area.

From the article of the same title
Family Practice Management (10/09) Vol. 16, No. 5, P. 26; Hughes, Cindy

How Electronic Medical Records Affect Staffing

Adoption of electronic medical records (EMR) impacts physician practice staffing in different ways. Most practices require some additional staffing during and for at least a few months few months after implementation. After implementation, the variables depend on a number of factors including the goals of EMR, the type of EMR system purchased and the adaptability of individual employees to the change. For example, a multi-site practice with 165 employees reduced the staff by about 12 after EMR implementation due to efficiency gains. Small practices typically will not reduce staff but staff responsibilities may change to increase efficiency. Smaller practices often select EMRs maintained through application service providers to avoid hiring additional IT staff. Observers caution practices against adopting EMR with a primary purpose of reducing staffing.

From the article of the same title
American Medical News (10/05/09) Dolan, Pamela Lewis

Health Policy and Reimbursement

Work Begins on National E-Health Record Network

Less than 10 percent of U.S. health care providers are using electronic medical records (EMRs), according to studies. Some developers visualize a "network of networks" that would be similar to the model the banking industry employs for customers to access accounts from ATMs throughout the country. One of the issues standing in the way of implementation of such a network is interoperability, a requirement for facilities to receive some of the more than $17 billion in stimulus funding being offered to encourage adoption of EMRs. For an integrated system to work, developers have to agree on how their hundreds of programs present information and connect with each other. Currently, there are hundreds of programs sold by scores of developers approved by the Certification Commission for Health Information Technology, a nonprofit group that evaluates whether medical record software complies with federal and industry mandates.

From the article of the same title
Associated Press (09/30/09) Twiddy, David

Blue Cross of Illinois Pushing Medical Homes

Blue Cross of Illinois, the state's largest insurer, has unveiled a pilot “medical homes” program with two Chicago-area multi-specialty physician groups. Under the medical home model, primary care physicians are reimbursed more for coordinating care with specialists. The groups participating in the pilot were required to have an EMR system, offer 24/7 access to physicians, and adhere to quality measures. Medicare is also piloting a medical homes project. If the concept takes off, it could have a dramatic impact on referral patterns.

From the article of the same title
Chicago Tribune (10/01/09) Japsen, Bruce

Without U.S. Healthcare Plan, States Could Pay More

A new report from the Robert Wood Johnson Foundation concludes that if U.S. healthcare reforms are not approved by Congress, states will spend more on their programs for the indigent. The foundation study finds that the number of people without health insurance could increase by over 30 percent in more than 25 states within 10 years, and those without insurance are most likely to turn to state-administrated public programs. The Senate Finance Committee is working on a strategy to ensure access to affordable healthcare for all Americans, but governors and state legislatures are worried that the plan will let more people enroll in Medicaid, which means states will have to spend more. The foundation estimates that under the current system every state could see its spending on Medicaid and CHIP climb by more than three-quarters in a decade, while half could see their costs more than double.

From the article of the same title
Reuters (09/30/09) Lambert, Lisa

Technology and Device Trends

Platelet-Rich Plasma: Does It Work?

According to a study appearing in the October issue of the Journal of the American Academy of Orthopaedic Surgeons, early outcomes of platelet-rich plasma (PRP) treatment for orthopaedic-related sports medicine conditions appear promising, but more research is needed. PRP treatments have been used for the past 20 years to improve wound healing and bone grafting procedures by plastic and maxillofacial surgeons, but only recently has the technology been adopted by orthopaedic surgeons and sports medicine specialists. PRP has been used to treat Achilles tendonitis and other common conditions suffered by athletes.

From the article of the same title
Newswise (09/30/09)

Researchers Report Good First Results Using Blood Stem Cells, Hyaluronic Acid to Regenerate Cartilage

Researchers from the Kuala Lumpur Sports Medicine Centre and the University Putra Malaysia have reported the first evidence of hyaline cartilage regeneration using intra-articular injections of autologous peripheral blood stem cells in combination with hyaluronic acid. The clinical trial tracked 10 patients with full-thickness chondral defects treated with arthroscopic multiple subchondral drillings.

From the article of the same title
Ortho Supersite (09/18/2009) Trace, Robert

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October 7, 2009