October 17, 2012

News From ACFAS

Early Bird Gets the Worm: ACFAS 2013
Get a head start on the Annual Scientific Conference 2013 by taking advantage of the stellar preconference educational opportunities available on Sunday, February 10. Choose from an expanded line up of programs, including:
  • Perfecting Your Practice: Coding, Physicians’ Employment Models, and Contracts
  • Diabetic Deformity: Master Techniques in Reconstruction (Cadaveric)
  • Juvenile/Adolescent Flatfoot Reconstruction (Cadaveric)
  • Advanced Tendon Repair and Fixation (Cadaveric)
Each program earns continuing medical education contact hours and has a small additional fee. Be sure to view the preconference workshops (pdf) to help you choose which course to attend. And, don't forget to register early; each workshop has limited space and you don’t want to miss out on these great educational offerings!
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Catch the Latest ACFAS-Officite Free Webinar November 1
Attend the newest webinar titled “Enhancing Your Online Visibility to Secure More Referrals—And New Patients,” provided by ACFAS and its benefits partner Officite. Participate in this free webinar and learn how to think and search like a potential patient. After attending this webinar, you will know how to effectively market to new patients, improve your search engine optimization (SEO), and benefit from online advertising.

Space is limited, so reserve your webinar seat now by visiting
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Save Time with Scientific Literature Reviews
Do you feel like there’s not enough time in a day to read all the latest news in the world of surgical science? You're not alone. Check out our Scientific Literature Reviews at to find summarized varieties of published articles including clinical studies, case reports, methodology and technical reports, clinical "pearls," literature reviews and more. A new batch is published monthly on the website by podiatric residents, so you know that what you read will be relevant to your day-to-day work. Here's a sneak peek at some of what October has to offer. Be sure to view the full listings at
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Our Loyal, 40-Year Members
ACFAS recognizes and thanks its long-term members of 40 years or more for their loyalty and dedication with a Life Membership to the College. The ACFAS Board of Directors would like to honor this year’s recipients:
  • Edward L. Chairman, DPM, FACFAS
  • Nicholas G. Camarinos, DPM, FACFAS
  • Guido A. LaPorta, DPM, FACFAS
  • L. Bruce Ford, DPM, AACFAS
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Foot and Ankle Surgery

Anti-Inflammatory Cytokine Profile in Early Human Tendon Repair
A study was held to evaluate inflammation and the presence and relative levels of cytokines, which may play a role in the regulation of early human Achilles tendon healing. Surgery was performed on nine patients with acute Achilles tendon rupture, who were then immobilized following the operation. Microdialysis of the peritendinous interstitial compartment was carried out in the healing and intact contralateral Achilles tendons two weeks post-surgery. Measurement of tumor necrosis factor (TNF)-a, interferon (IFN)-Y, interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70 and IL-17A was performed using a cytometric bead array, and prostaglandin (PG) E2 levels were quantified by enzyme immunoassay. None of the patients exhibited detectable PGE2 levels. Pro-inflammatory cytokines were below detection levels or showed no variance between injured and control tendons. IL-6, IL-8 and IL-10 concentrations in the healing Achilles tendon were elevated 13-fold, 28-fold and 3.7-fold, respectively.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (09/14/12) Ackermann, P.W.; Domeij-Arverud, E.; Leclerc, P.; et al.
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Percutaneous CT-Guided Radio-Frequency Ablation of Osteoid Osteoma of the Foot and Ankle
A study was held to evaluate the effectiveness of percutaneous computed tomography (CT)-guided radio-frequency ablation (RFA) for patients with osteoid osteoma of the foot and ankle, using a cohort of 29 subjects. Clinical success of the procedure, assessed at a minimum follow-up of one year, was characterized as complete or partial pain relief after RFA. Pain and clinical results were scored preoperatively and at follow-up with a visual analogue scale (VAS) and with the AOFAS score. Twenty-six patients achieved clinical success, and following RFA, average VAS and AOFAS scores improved from 8 ± 1 to 2 ± 1 and from 60.7 ± 12.7 to 89.6 ± 7.1, respectively. Two patients experienced partial pain relief and received a second successful ablation. Local recurrences were observed in three patients, who underwent conventional excision through open surgery. There were no early or late complications detected after RFA.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (09/12) Daniilidis, Kiriakos; Martinelli, N.; Gosheger, G.; et al.
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Primary Osseous Tumors of the Hindfoot: Why the Delay in Diagnosis and Should We Be Concerned?
Determining the reasons for frequent delays in the diagnosis of osseous tumors of the hindfoot was the purpose of a study focusing on the presentation of the hindfoot, whether there is variance in the spectrum of disease between talus and calcaneus and how patients were treated. The study involved a retrospective review of the medical notes and imaging for all patients with 34 calcaneal and 23 talar tumors recorded in the Scottish Bone Tumor Registry. Demographics, presentation, investigation, histology, management, recurrence and mortality were recorded. It was determined that hindfoot tumors present with pain and often swelling around the calcaneus or talus and are most often misdiagnosed as soft tissue injury. Calcaneal lesions had a greater probability of malignancy than talar lesions, with 13 of 34 calcaneal lesions proving to be malignant compared to three of 23 talar tumors.

From the article of the same title
Clinical Orthopaedics and Related Research (09/25/12) Young, Peter S.; Bell, Stuart W.; MacDuff, Elaine M.; et al.
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Practice Management

How to Keep A/R out of the ER
Medical specialists increasingly find themselves working overtime to sustain basic financial health in the modern economy. In both developing and cultivating their practices, specialists often find themselves trailing the hospital with which they are affiliated or with which they have a contract. Specialists are starting to see the value of outreach programs and other initiatives applied by hospitals, which can produce substantial revenue for their institutions as well as make greater use of laboratory clinical instruments. Specialists are envisioning similar advantages when this model is applied to their business development efforts and their practices' basic business operations, such as accounts receivable.

There are specific, demonstrable ways to optimize systems and processes, beginning with smart Revenue Cycle Management (RCM). The linchpin of effective RCM is access to financial management capabilities that offer complete visibility into revenue and billing systems, from essential business metrics to account and payer details. Specialists must rely on systems that help quantify and manage accounts receivable in detail while also letting decision-makers see the big picture. Financial reports that specify profitability by individual payer, referring physician and/or modality are critical tools when negotiating new contracts with payers and clients or when ascertaining which areas in which to invest.

RCM branches out to managing via measurement, or setting up and tracking revenue objectives connected to specific, detailed financial metrics. It demands billing timeliness and precision, covers the automation of decision-making and entails comprehending the root causes of denials. However, marketing also plays a vital role in drawing and retaining accounts that convert into revenue. It begins with the generation of crucial tools that might include, at the very least, a capabilities brochure, sample case reports, a functioning website and a biography or dossier sheet about the practice. The creation of effective marketing materials, along with the strategic guidance that can help practitioners determine their core strengths and offerings, is an art in itself. Other instruments and strategies, such as direct mail, trade show attendance and an active social media presence, should complement and strengthen an engaging practice website. However, the practice partners themselves constitute the most vital marketing assets for specialists, as each partner's personal network remains the optimal source of new client wins.

From the article of the same title
MediaPost (NY) (10/05/12) Angress, Dan; Taylor, Bill
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How to Sell Staff on Change, Big and Small
With practices, change is an often unpleasant inevitability that nevertheless has to be met and properly managed to best serve staff and patients, even though doing so is rarely easy. Acknowledging and properly managing the discomfort and resistance to change among staff by using two-way communication is the key to successfully navigating both major and minor change. Communication with staff is required during every stage of a change.

The first step is to be upfront with staff and communicate to them what the change will involve, how it will affect them and their work, how it will affect patients and their care, what the change will require of them, why the change is going to take place and what it will accomplish. Conveying all this information requires leaders to be fully aware of the above information and have a strategy for communicating it to staff. Once staff better understand the change, they should be allowed to voice their concerns and contribute to the change process, both because they may suggest useful change strategies not yet thought of and because staff are less likely to resent or resist change if they feel like their concerns about that change have been heard and, if possible, acted upon.

This does not mean you are expected to make change a democratic process or that you should attempt to bring all of the staff to a consensus. Hearing out staff, even if their concerns or suggestions are not going to be acted on goes a long way to helping them accept change. This can mean continuing to communicate with staff even after a change has taken place, because resistance and resentment can linger long after a change has been implemented. Explaining to staff the effects that a change has had on the practice is just another opportunity to win their support and goodwill, which can be applied to make the next change easier than the last.

From the article of the same title
American Medical News (10/08/12) Elliott, Victoria Stagg
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Two Ways to Establish a Manual Inventory Control System
Many offices experience supply shortages that require last-minute ordering at premium prices on account of the absence of an inventory control system. For most practices, a digital-scanner control system may be unaffordable or insupportable due to insufficient volume. There are, however, several simple, easy-to-use manual systems that allow one person to control inventory while still letting anyone in the office use supplies when needed without first having to check with someone else. One system functions by first determining the buying cycle for each item according to usage and storage space. Most offices should order supplies on a weekly or monthly basis, and the presence of a subsystem for exam rooms and work stations means the cycle will apply to restocking those areas from the supply room. The next step in this model is to ascertain the amount of each item usually employed during each buying cycle. The practice should initially purchase enough of each item to last two buying cycles, and establish two bundles of each item, enough to last one cycle. Each bundle should be wrapped up or placed in a separate receptacle, and a reusable tag labeled with the item name, supplier, last price paid per unit, buying cycle, order amount and bundle item count should be affixed to each bundle.

In the supply room should be prominently hung an envelope marked "Reorder envelope. Put tags here," and when supplies are needed, any staffer can access a bundle, take off the tag and deposit it in the reorder envelope. One full and one partial bundle should remain for the item accessed. An inventory control clerk should be assigned to process tags and order new supplies based on the buying cycle, and when supplies arrive, only the clerk should open the delivery, compare the delivery invoice with the original order to verify accuracy and stock the items. The items are then re-bundled and labeled with used tags to complete the ordering cycle, and the new item bundle is placed behind the remaining bundle.

The second system involves development of a descriptive index, or an alphabetical listing of the practice's supplies that also functions as a cross-index of inventory control cards. The cards track costs and order lead time, as well as gather supplier information. Every time an order is placed, the date and amount are listed. As supplies come in, the person opening the package takes note of the amount received and the unit price information from the packing slip or invoice on the card. This method shows a good record of order quantities, pricing and shipping lead time. Records of the maximum quantities on hand can establish a standard for the central supply person. The ordering description may feature a catalog number, serial number or other helpful information for the supplier.

From the article of the same title
Modern Medicine (09/25/12)
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Health Policy and Reimbursement

AHRQ Wants to Develop Rating System for EHR's Patient Education Components
Developing a health information rating system (HIRS) for measuring the success of electronic health systems (EHRs) in patient education is a goal of the Agency for Healthcare Research and Quality (AHRQ), which is asking the Office of Management and Budget to clear a request for research and planning for such a system. The agency wrote that EHRs can link "patients to helpful resources on treatment and self-management," as well as "facilitate clinicians' use of patient health education materials in the clinical encounter." AHRQ officials noted, however, that EHR health education content is seldom drafted for the average consumer. The proposed project would devise a "valid and reliable" HIRS, produce a library of patient education content, review EHRs' potential patient education capabilities and reach out to vendors and providers. Developing a HIRS is the current concentration of AHRQ, with the agency creating a draft HIRS and testing it on a set of six patient education resources for asthma and another set of six education resources for colonoscopies, scoring them for accessibility and actionability. Some were rated by AHRQ researchers as helpful and some were not; AHRQ said the next objective is to run consumer tests.

From the article of the same title
Government Health IT (10/05/12) Brino, Anthony
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HIMSS G7 Offers Plan for ICD-10 Implementation
Healthcare Information and Management Systems Society (HIMSS) G7, a multi-stakeholder group charged with identifying strategies to improve the nation's healthcare financial network, has released a plan of action for supporting the implementation of the ICD-10 coding set by the Oct. 1, 2014, deadline. In an advisory report, the group outlined a number of solutions it said would assist the transition, including targeted education efforts aimed at independent physician group practices and increased vendor readiness. Also, the report pressed for the creation of an ICD-10 pilot program whose purpose “would be to test alternative implementation approaches, producing metrics around implementation impacts, resource needs, costs and outcomes, while identifying critical test cases and scenarios.” Finally, HIMSS G7 said, healthcare associations need to ramp up their member-support capabilities and ensure they are delivering a consistent message.

From the article of the same title
Modern Healthcare (10/09/12) McKinney, Maureen
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Let Geographic Doc-Pay Cuts Proceed, Say MedPAC Staffers
In draft recommendations, the staff of Congress' primary Medicare advisory body recommended allowing long-frozen geographically based payment cuts for physicians to go into effect. The Medicare Payment Advisory Commission (MedPAC) has yet to vote on the recommendation, which would be applied to the program's system for supplementing or cutting physician payments based on a comparison of costs in the area in which they practice to a national average. A legislative freeze on the cuts side of that equation is scheduled to expire Dec. 31. MedPAC's report on the geographic adjustments is not due to Congress until June 2013, but they have initiated discussion of the topic early because of the looming expiration of the freeze in cuts. The staff recommendation did not specify when the cuts should begin. The staff also concluded that the halt in physician pay cuts has not improved the quality of care Medicare beneficiaries receive or moved Medicare toward more integrated care delivery. Additionally, the staff acknowledged that the geographic-based adjustment system is not the ideal way to improve patient access but recommended the full system go into effect, in lieu of more-effective alternatives.

From the article of the same title
Modern Healthcare (10/07/12) Daly, Rich
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Medicine, Drugs and Devices

Medicare Inappropriately Paid $14 Million To Orthotics, Prosthetics Suppliers in 2010
In 2010, the Centers for Medicare & Medicaid Services (CMS) inappropriately paid $14 million in Medicare claims to prosthetics and custom-fabricated orthotics suppliers who did not provide documentation that the products were delivered to beneficiaries, according to a report from the Department of Health and Human Services Office of Inspector General (OIG). The report said the claims “were either missing all documentation of delivery, or lacked a beneficiary signature on the provided documentation.” OIG also determined that CMS has not issued regulations covering a mandated ban on payments for prosthetics and custom-fabricated orthotics that are not “furnished by a qualified practitioner and fabricated by a qualified practitioner or a qualified supplier at a facility that meets criteria determined by the Secretary.”

From the article of the same title
BNA Health Care Policy Report (10/15/12) Swann, James
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Obama Signs Bill Amending FDA User-Fee Law
President Obama has signed legislation that will amend the U.S. Food and Drug Administration's user-fee law to ensure that a new program intended to improve approval times for generic drugs can begin. The FDA User Fee Correction Act, which was passed by the House and Senate last month before Congress adjourned, addresses the industry's concern that the government's temporary funding measure would delay implementation of the program.

From the article of the same title
Modern Healthcare (10/06/12) Lee, Jaimy
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Physician Groups Warming Up to HIEs
Two recent surveys show that physicians may be buying into the value of joining health information exchanges (HIEs). Last week, Doctors Helping Doctors Transform Healthcare, a non-profit group focused on using technology to improve healthcare quality, issued a report on how and when physicians say they want to use electronic health information. The survey shows that the barriers to using and exchanging health information electronically are no longer rooted in maintaining the status quo. The fear of change that often accompanies shifts from manual systems to digital processes seems nearly gone. Instead, physicians now say the challenges lie in the limitations of technology.

This is noteworthy considering that in 2010 less than half of physician groups were using EMRs, according to the fourth annual Ambulatory Electronic Health Record (EMR) & Practice Management study. That number is now at 69 percent. The survey also shows 56 percent of hospital-owned physician groups say they plan to join a state, hospital or regional HIE.

From the article of the same title
HealthLeaders Media (10/08/12) Fellows, Jacqueline
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