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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

CMS Forum on Value-based Purchasing

As Congress once again begins to debate the Sustainable Growth Rate formula for physician reimbursement, the Centers for Medicare and Medicaid Services is holding a special Open Door Forum conference call of interest for ACFAS members. The subject of discussion is the report to Congress for implementing a value-based purchasing program for ambulatory surgery centers (ASCs).

The call will take place Oct. 14 from 3:30 p.m. to 5 p.m. ET. Comments are sought from ASCs, hospitals, physicians, physician associations, consumer groups, and all others interested in the development of the plan for implementation. Call in to 800-837-1935, conference ID 13795147. For more information, visit CMS’ Open Door Forum site.
ACFAS Joins the Coalition for Patients' Rights

ACFAS has joined the Coalition for Patients’ Rights® (CPR), a group of 36 various organizations of licensed healthcare professionals who provide safe, effective and affordable healthcare services to millions of patients each year.

CPR’s primary objective is to counter the AMA Scope of Practice Partnership (SOPP) initiative. SOPP’s unstated but obvious goal is economic protection of MD “turf,” not patient access to licensed health practitioners. Podiatry was the first target of the SOPP. While AMA “withdrew” the SOPP document on podiatry, its significantly flawed text is still being used to discriminate against DPMs. CPR’s goal is to ensure Americans’ growing need for healthcare is met by access to quality healthcare providers of their choice.

Look for future reports on CPR’s work and the College’s involvement in This Week@ACFAS and Update newsletter.
Visit the New Update Home Page

Update, the ACFAS print member newsletter, has a new, revised home page to serve your needs. Visit it today for links to more information on featured articles, programs and services.

Be sure to check back every issue to get the most out of your newsletter!

Short Takes on Research for Busy Surgeons

ACFAS’ Scientific Literature Reviews allow you to quickly catch up on articles from journals you may not usually read. Current research is abstracted for the interests of foot and ankle surgeons by podiatric residents. New abstracts for October include:

Treatment of Displaced Proximal Fifth Metatarsal Fractures Using a New One-step Fixation Technique, from the Journal of Trauma.
Reviewed by Stacie D. Anderson, DPM, OCPM/UHHS Richmond Medical Center.

High Levels of Foot Ulceration and Amputation Risk in a Multiracial Cohort of Diabetic Patients on Dialysis Therapy, from Diabetes Care.
Reviewed by Amy Barko, DPM, OCPM/UHHS Richmond Medical Center.

Read these reviews and many more on the ACFAS website.

Foot and Ankle Surgery

Anteromedial Impingement in the Ankle Joint: Outcomes Following Arthroscopy

Arthroscopic debridement is a well-accepted method of removing osseous and/or soft tissue impingement from the ankle joint. In this study, researchers report the outcomes following arthroscopic resection of anteromedial impingement. Arthroscopic surgery for anteromedial impingement was performed on 43 patients between January 2005 and July 2007; 41 patients were included in the present study. The mean follow-up time was 34.41 months (range, 24-52 months). Thirty-eight patients (93 percent) were satisfied with the procedure. The AOFAS scores improved from 62.83 points preoperatively to 91.17 points postoperatively. The SF-36v2 scores improved from 61.54 points preoperatively to 92.21 points postoperatively. All but 1 patient returned to their prior level of sporting activity. Three patients (7 percent) reported a complication.

From the article of the same title
American Journal of Sports Medicine (10/01/10) Vol. 38, No. 10, P. 2017 Murawski, Christopher D.; Kennedy, John G.
Web Link - May Require Paid Subscription | Return to Headlines

Augmented Low Dye Taping Changes Muscle Activation Patterns and Plantar Pressure During Treadmill Running

Researchers examined changes in muscle activity and plantar pressure while running with augmented low Dye (ALD) taping. ALD taping has been shown to reduce foot pronation by increasing arch height before and after exercise and by decreasing rear foot motion. It has also been shown to cause an increase in lateral midfoot plantar pressure. So far, no studies have examined the effect that ALD taping has on both muscle activity and plantar pressure while running. In the study, 13 healthy recreational runners completed a 6-minute run on a treadmill with 3 different kinds of taping, ALD, control tape, and no tape, applied in random order. Peak and average EMG signal amplitude, onset time, and burst duration were calculated for the vastus medialis, vastus lateralis, and the gluteus medius, and in-shoe plantar pressures were recorded. The study showed that ALD taping significantly alters muscle activity and plantar pressure during treadmill running by delaying the onset of the EMG signal of the gluteus medius, vastus medialis, and vastus lateralis, and by increasing lateral midfoot plantar pressure. The researchers conclude that ALD taping significantly alters plantar pressure and muscle activation during treadmill running. These findings give insight into the neuromuscular effect of a taping procedure that is used commonly in a clinical setting.

From the article of the same title
Journal of Orthopaedic & Sports Physical Therapy (10/01/2010) Vol. 40, No. 10, Kelly, Luke A.; Racinais, Sebastien; Tanner, Craig M.; et al.

Hypovitaminosis D in Patients Scheduled to Undergo Orthopaedic Surgery

Researchers report that a large percentage of patients undergoing orthopedic surgery have a vitamin D deficiency prior to surgery. For their study, the researchers conducted a retrospective chart review of 723 patients who were scheduled for orthopedic surgery between January 2007 and March 2008. They examined the vitamin D levels, which had been measured in all patients before their surgery, and found that 43 percent had insufficient vitamin D and 40 percent had deficient levels.

The highest levels of deficiency were seen in patients in the trauma service, where 66 percent of patients had insufficient levels and 52 percent had deficient levels. Of the patients undergoing foot and ankle surgery, 34 percent had inadequate levels and of patients undergoing hand surgery, 40 percent had insufficient levels.

The researchers conclude that given the importance of vitamin D in musculoskeletal health, such low levels may negatively impact patient outcomes.

From the article of the same title
Journal of Bone and Joint Surgery (American) (10/06/10) Bogunovic, Ljiljana ; Kim, Abraham D. ; Beamer, Brandon S.; et al.

Practice Management

CMS Unveils Billing, Coding Guidance

CMS and the Medicare Learning Network have released the Medicare Quarterly Provider Compliance Newsletter, the first in a series of publications intended to offer providers guidance on avoiding common Medicare billing and general errors. The quarterly newsletter will focus on top issues identified through various sources in each edition. The newsletter can be accessed here.

From the article of the same title
HealthLeaders Media (10/11/10) Carroll, James

ONC Launches Certified Product List Website

The Office of the National Coordinator (ONC) for Health Information Technology has launched a website where providers can find products that have been certified for meaningful use. The list provides a comprehensive listing of complete EHRs and EHR modules that have been tested and certified under the temporary certification program. More information and the list can be accessed here.

From the article of the same title
Healthcare IT News (10/07/10) Manos, Diana

Some Physicians Prefer the Autonomy, Reduced Load of Independent Practices

Some physicians are moving away from the trends of multiplex doctor practices and hospital-owned physician groups, preferring the autonomy and reduced patient load that independent practices offer. Without the outside pressure of seeing large numbers of patients in order to satisfy revenue objectives, independent physicians can take as much time as they want with patients. Independent doctors also often share the habit of adopting technology, in some instances establishing their own electronic medical record systems to save on paperwork.

However, in a 2008 study, the American Medical Association pointed to a "significant" migration away from small physician practices toward group practices and hospital employment. The group projected that the trend could ramp up "primarily because of the greater leverage they can exert in negotiating private payment."

From the article of the same title
Pittsburgh Post-Gazette (PA) (10/03/10) Twedt, Steve

Health Policy and Reimbursement

Foes of Health Care Law Lose Key Court Ruling

A federal judge has upheld the authority of the federal government to require everyone to have health insurance. The ruling came in a lawsuit filed in Michigan by a Christian legal group and four people who claimed lawmakers exceeded their power under the Constitution's commerce clause. The judge ruled that the mandate to get insurance by 2014 and the financial penalty for skipping coverage are legal, saying that lawmakers were trying to lower the overall cost of insurance by requiring participation.

"Without the minimum coverage provision, there would be an incentive for some individuals to wait to purchase health insurance until they needed care, knowing that insurance would be available at all times," the judge said. "As a result, the most costly individuals would be in the insurance system and the least costly would be outside it. In turn, this would aggravate current problems with cost-shifting and lead to even higher premiums."

From the article of the same title
Associated Press (10/07/10) White, Ed

Joint Commission Revised Medical Staff Standards Take Effect March 2011

The revised Medical Staff standard MS.01.01.01, formerly known as MS.1.20, goes into effect on March 31, 2011, for hospitals and critical access hospitals. Information about revised standard MS.01.01.01, including FAQs, can be found here.

From the article of the same title
Joint Commission Online (10/06/10)

New Website Shows Prices for Individual Health Coverage

The U.S. Department of Health and Human Services (HHS) will begin posting pricing information for more than 4,000 individual and family health insurance plans offered by more than 200 insurers on The information will be updated on a monthly basis, according to HHS Chief Technology Officer Todd Park. The new consumer tool will allow users to receive personalized results from available plans, including monthly premium estimates, maximum out-of-pocket costs, deductibles, major types of covered services, the percentage of plan participants denied in the last three months, and the percentage of plan participants charged more than the base price. The data will be supplied by insurers as required under the healthcare reform law, and firms must certify the accuracy of the data, according to Park. Insurers are concerned about the denial percentage data because it includes not only denials, but also incomplete applications and applicants directed to different policies. The tool also is expected to help consumers identify government programs they are eligible for, including Medicaid and new high-risk insurance pools.

From the article of the same title
USA Today (DC) (10/01/10) Young, Alison

Patient-Centered Outcomes Research Gets $473M

HHS has announced the release of $473 million in funding for patient-centered outcomes research. The funding will support comparative effectiveness research in many areas, including health care interventions in real world settings, advanced use of the research findings by diverse populations, development of effective patient registries, and training and career development for the next generation of researchers. The money comes from $1.1 billion in patient-centered outcomes research grants authorized under the American Recovery and Reinvestment Act of 2009.

From the article of the same title
HealthLeaders Media (10/04/10) Clark, Cheryl

Technology and Device Trends

Embolic Capture Angioplasty

Researchers say that a new device could spur a "paradigm shift" in the treatment of peripheral artery disease in the legs. The Proteus made by Angioslide is a balloon angioplasty device designed to suck up dangerous fragments of plaque using negative pressure caused by the balloon's deflation within the artery.

In a typical balloon angioplasty, the inflation of the balloon can dislodge loose plaque particles that could block blood flow and lead to serious complications. Up to now some physicians have used a filter to prevent the escape of debris, but this procedure is hard to deploy and could lead to arterial damage. Clinical trials of the FDA-approved device had a success rate of 97 percent to 99 percent and consistently outperformed filter devices.

From the article of the same title
Endovascular Today (09/01/10) Dieter, Robert S. ; Nanjndappa, Aravinda

Hope for Better Osteoporosis Drug After HU Scientists’ Find

A research team at the Hebrew University (HU) of Jerusalem has discovered a connection between bone density and fatty acids, leading them to start development of a drug that they hope will more effectively treat, and possibly even prevent, osteoporosis. Working on lab mice, the researchers found that acyl amides play a major role in controlling bone density. The researchers then analyzed the substances' precise chemical composition, created synthetic versions of them, and examined their effect on bone cell cultures.

The study found that one of the compounds in the group of synthetic materials, oleoyl serine, increased bone density in both healthy mice and mice with osteoporosis, and that osteoporotic mice lacked oleoyl serine in their bones. The researchers say the findings can serve as a foundation for new drugs that could prevent bone loss and increase bone formation and possibly reverse bone loss in osteoporosis patients.

From the article of the same title
Jerusalem Post (10/05/10) Siegel-Itzkovich, Judy

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October 13, 2010