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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

Health system reform took a major step forward when the Senate Finance Committee approved the centrist Baucus bill. Now all House and Senate committees of jurisdiction have voted out proposed legislation, and after the reconciliation process, bills will be presented on each chamber floor for what will certainly be a contentious debate and vote.

An issue that has not received a lot of discussion in the press is the implementation of health system reform, which under all the proposals will take place over an extended period. The non-partisan Kaiser Family Foundation has created a helpful implementation timeline chart, based on the Senate Finance Committee bill, which can be viewed at their website.
Build Your Skills in Complex Reconstruction

Choose either November 14 or 15, 2009, to attend the one-day Complex Reconstruction Surgical Skills Course in Las Vegas, Nevada.

In this fast-paced course you will choose from an array of first ray, rearfoot, and tendon techniques, and benefit from extensive lab time, knowledgeable, friendly faculty, and case study presentations.

Limited space is still available, so register today!
Connect with Local ACFAS Members

Have you wondered how you can engage with colleagues in your area, who are dealing with the same issues you are every day? You can easily find out on the new ACFAS Regional Divisions web pages! Now fully redesigned and more accessible, the improved web pages make it easy for you to:
  • Locate your Regional Division on the clickable map
  • Learn about past and future activities going on in your part of the country
  • Find out about your Division’s goals for the rest of 2009
  • Connect with your Division officers
Take advantage of the opportunity to network with other members through local seminars, meetings and labs. Visit the new Division web pages to get involved, and support your profession at the grassroots level.
Rediscover, your online information resource, is receiving rave reviews for its new look and ease of use.

Scott Nelson, DPM, writes: “Web site looks great! I am impressed. Very professional and easy browsing.”

“The site looks fantastic,” agrees Zackery Gangwer, AzPOD Class of 2011. “It is up-to-date and very user friendly.”

Discover what has your colleagues talking, and rediscover the powerful knowledge that’s at your fingertips on

Foot and Ankle Surgery

Diabetes, Vascular Disease Increase Amputation Risk After ORIF for Ankle Fracture

A study of 57,000 patients in the California discharge database who had a lateral malleolar, bimalleolar or trimalleolar ankle fracture treated surgically from 1999 to 2005 has found that diabetes mellitus and peripheral vascular disease put patients operated on for ankle fracture at an increased risk of wound infections, revisions and amputations. The study, presented at the American Academy of Orthopaedic Surgeons annual meeting, revealed an odds ratio of 27.63 for below the knee amputation in patients with complicated diabetes and odds ratios for wound infections and revision of open reduction internal fixation (ORIF) surgery in diabetic patients of 3.85 and 5.09, respectively.

From the article of the same title
Orthopaedics Today (10/09) Rapp, Susan M.

The Management of Charcot Joint Disease Affecting the Ankle and Foot by Arthrodesis Controlled by an Ilizarov Frame: Early Results

Researchers relate their experience with 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar, and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks. Patients were able to resume wearing regular shoes after a mean of 26.5 weeks.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (10/01/09) Vol. 91-B, No. 10, P. 1322; El-Gafary, K. A. M.; Mostafa, K. M.; Al-adly, W. Y.

Practice Management

Smart-Phone Makers Call the Doctor

With doctors treating more patients and hospitals facing pressure to be more efficient, companies like Apple (iPhone) and Research In Motion (RIM; Blackberry) see an opportunity to promote their devices. Stanford Hospital & Clinics in Palo Alto, Calif., recently started a trial with Apple and Epic Systems Corp., a provider of healthcare information systems, to test software that will let medical staff access patient charts on Apple's iPhone. Stanford is studying ways to use the devices to reduce the risk of errors. The University of Pittsburgh Medical Center meanwhile has distributed RIM's BlackBerry to nurses and doctors at one of its emergency rooms and surgical floors as a means of replacing pagers for communications. The hospital plans to add medical applications to the devices.

From the article of the same title
Wall Street Journal (10/07/09) Sheth, Niraj; Kane, Yukari I.

Bending the Cost Curve Could Also Reduce Physicians' Headaches

Eight health insurers and five physician organizations in Ohio are starting a pilot project aimed at reducing administrative hassles. The health insurers will create a single web portal for electronic transactions where physicians will be able to find eligibility and benefit information as well as real-time claims information for all eight insurers. This will save time on the front end and also reduce claims denials. The insurers include Aetna, Anthem, CIGNA, Humana and United, among others, and they provide coverage to 91 percent of commercially-insured Ohioans.

From the article of the same title
HealthLeaders Media (10/07/09) Masterson, Les

Call Sharing for Small Group Docs

Some physicians in solo and small group practices have found a solution to the after-hours emergency call by forming a call coverage group with other physicians. Consultant Judy Bee suggests several steps. First, find call partners with privileges at the same hospital and ideally the same specialty. The optimal number of call partners is five so that each physician has a daily rotation Monday through Friday and a separate schedule for weekends. The scheduling needs to be simple and centralized, and there are software programs to help manage call-sharing.

From the article of the same title
Physicians Practice (10/09) Lowes, Robert

Study: 54 Percent of Companies Ban Facebook, Twitter at Work

Fifty-four percent of U.S. companies have banned workers from using social networking sites while on the job, according to a survey of 1,400 CIOs commissioned by IT staffing firm Robert Half Technology. The study also found that 19 percent of companies allow social networking use only for business purposes, while 16 percent allow limited personal use and 10 percent allow full access during work hours.

From the article of the same title
Computerworld (10/06/09) Gaudin, Sharon

Health Policy and Reimbursement

One State's Solution May Not Be a Model for the Nation

Utah is the only state other than Massachusetts to develop its own insurance exchange, and its version is distinctly different from its counterpart as well as any proposal pending in Congress. Aimed initially at small businesses, the exchange offers a way for companies to pay a fixed amount toward their employees’ medical coverage rather than purchasing the coverage directly for the employees. The workers then can select from various plans on the exchange. If they cost more than the employer’s contribution, the employee pays the difference. Since it was started in mid-August, the exchange has drawn about 230 small businesses, representing about 2,300 employees, who can choose from more than five dozen policies from three insurers.

From the article of the same title
New York Times (10/06/09) Abelson, Reed

OIG Plans to Review Medicare, Medicaid Auditing Programs

CMS is boosting its Medicare and Medicaid auditing activities, which has also gained the attention of the U.S. Office of Inspector General (OIG). OIG next year plans to review the progress of many Medicare and Medicaid auditing programs, as well as CMS' oversight of several of the programs, according to its 2010 Work Plan. OIG will review Medicaid Integrity Program efforts "to determine whether states proactively manage overall program risks at the state agency, payment contractor, and provider levels" as well as how states prioritize actions to prevent improper payments; how providers and/or payment areas are identified for an audit; and whether improper payments are collected and properly reported to CMS.

From the article of the same title
HealthLeaders Media (10/07/09) Kraynak, Andrea

Technology and Device Trends

Fixing Bones With Dissolvable Glass

Metallic glass material that can be used to make dissolvable screws, pins or plates could facilitate the healing of fractured and broken bones. Materials scientists led by Jörg Löffler at ETH Zurich in Switzerland have designed a metallic glass that dissolves harmlessly in the body. The idea is to make small supporting objects from this material, such as pins or nails, that would disappear over time.

From the article of the same title (10/01/09)

Intraoperative 3-D Imaging Beneficial During ORIF of Calcaneal Fractures

Use of intraoperative 3-D imaging during open reduction and internal fixation of calcaneal fractures allows surgeons to immediately assess and correct the surgical reduction and implant positioning, according to a study presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. In a study of 32 calcaneal fractures, surgeons treated five of the fractures with closed reduction and 27 fractures with open reduction and internal fixation (ORIF). After placing the implant and judging the reduction using conventional C-arms, the surgeons used intraoperative 3-D imaging to assess their initial operative plan.

From the article of the same title
Orthopedics Today (10/09)

One Small Step for Neurons, One Giant Leap for Nerve Cell Repair

Repairing damaged nerve cells is still a major challenge for modern medicine, but a new study by researchers at McGill University and the Montreal Neurological Institute and Hospital has made significant progress towards a new technique for neuronal repair. The study is the first to show that nerve cells will grow and make meaningful, functional contacts, called synapses, with an artificial component. In this study, the artificial substance is plastic beads coated with a substance that encourages adhesion and attracts nerve cells.

From the article of the same title
McGill University Health Centre (10/07/2009)

U.S. Has No Good System to Track Medical Implants

The U.S. system for recalling those medical devices that can be implanted in the body has recently faced heightened criticism from some experts. Currently, medical device manufacturers have no centralized system for tracking products throughout their life span, which means that manufacturers and regulators have no easy way of determining where the recalled devices are or which patients have already been implanted with them. This difficulty has become an increasing concern as the number of implanted devices rises, along with the number of recalls.

From the article of the same title
Associated Press (10/06/09) Caruso, David B.

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October 14, 2009