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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

PQRI and Electronic Prescribing Update

ACFAS participated in a CMS Open Door Forum yesterday to discuss the Physician Quality Reporting Initiative (PQRI) payments and E-prescribing initiatives the government is spearheading to promote quality and best practices in physician offices.

The good news is that PQRI incentive payments are coming for those who participated successfully in 2009. Processing by carriers and Medicare Administrative Contractors (MACs) has begun and Oct. 25 is the target distribution date, ending Nov. 12, 2010.

These payments, earned by individual participating physicians and eligible professionals, are paid as a lump sum to the Taxpayer Identification Number under which the claims were submitted, so each practice must decide on distribution of the monies. 2009 PQRI incentive payments use the four-digit code PQ09.

The 2009 feedback reports will be on QualityNet's PQRI portal starting mid-November. Physicians can also request individual feedback reports from carriers/MACs using the instructions on this form (92KB PDF).
CMS Releases FFS Survey Results

The Centers for Medicare & Medicaid Services has released results of the 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS).

A random sample of over 33,000 providers was selected to participate in this year’s survey. Providers were asked to rate their satisfaction with services provided by the Fee-for-Service (FFS) contractors. The ratings reflect the percentage of provider satisfaction on a new, fully labeled, 5-point scale.

More than 69 percent of respondents said they were satisfied or very satisfied with their contractor’s overall performance, while approximately 13 percent indicated they were dissatisfied or very dissatisfied. The full report is available on the CMS website.
Three States Update Podiatric Requirements

A final rule of the Pennsylvania State Board of Podiatry increases biennial continuing education (CE) requirements from 30 to 50 hours and limits the number of CE hours that may be obtained via the Internet or articles in professional journals to 10 hours.

The rule also clarifies that CE will not be awarded for courses or programs in office management or marketing, and that the licensee is responsible for ensuring that CE hours have been approved before participating in a course or program. This new rule became effective Oct. 9.

As had been anticipated in earlier reports by ACFAS, the Texas State Board of Podiatric Medical Examiners amended regulations under 22 TAC 375.1 to remove the definition of “foot,” which is addressed in other provisions. The rule became effective Oct. 14. This is in response to a lawsuit that struck the board’s definition of foot.

Washington state proposes adopting regulations under a new Section WAC 246-922-650 to establish standards for the administration of sedation and anesthesia in the offices of podiatric physicians. The rule also addresses training and equipment requirements for podiatric physicians to perform office-based surgery. The changes revise definitions of “minimal sedation” and “office-based surgery,” address exemptions and facility accreditation and certification, delete competency provisions, and separate surgical and monitoring functions and emergency care and transfer protocols. A hearing is scheduled for Oct. 27.
Rise to the Challenges of Residency

ACFAS e-Learning, your online education resource, has a second free podcast this month, “Challenges of Residency.”

Listen in as foot and ankle surgeons active in podiatric education have a frank discussion of the issues — and opportunities — that both residents and educators face in today’s three-year medical and surgical residency programs. They confront the continual struggle to find the right balance: between integration and specialization, between goals and resources, and between the expectations of different generations.

Along the way there may be a lot of hard work, but as moderator Samuel S. Mendicino, DPM, FACFAS, sums up, “It’s great to see the seeds you plant grow and develop.”

Stop by whenever you are ready to get the new podcast or browse the entire library at ACFAS e-Learning.
Keep Current on Recent Research

You may not have time to read all the research you’d like to, but in just a few minutes you can catch up with ACFAS’ Scientific Literature Reviews. These reviews have been prepared for active foot and ankle surgeons by podiatric residents. Some of the latest are:

Tibial Nerve Decompression in Patients with Tarsal Tunnel Syndrome: Pressures in the Tarsal, Medial Plantar, and Lateral Plantar Tunnels, from Plastic and Reconstructive Surgery.
Reviewed by Stacie Buck, DPM, OCPM/UHHS Richmond Medical Center.

Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy? from the Journal of the American Medical Association.
Reviewed by Chuck Hoehn, DPM, OCPM/UHHS Richmond Medical Center.

Find a variety of abstracts to feed your interests at Scientific Literature Reviews.

Foot and Ankle Surgery

Inframalleolar Bypass Grafts for Limb Salvage

Researchers analyzed 122 inframalleolar bypasses performed between January 1991 and June 2005 in 116 patients. Ninety-seven percent of patients were treated for critical ischaemia. The indication for the use of podalic arteries was a lack of tibial arteries with run-off to the foot. The dorsalis pedis was predominantly used for distal anastomoses (62.3 percent) and the greater saphenous vein (84.4 percent) as the conduit. The cumulative patency was 58.2 percent at three years and 53.4 percent at five years. The best results were achieved with the devalvulated greater saphenous veins. Limb salvage was 70.0 percent at three years and 50.4 percent at five years, with preserved deambulation rates of 57.3 percent and 47.1 percent, respectively. There were 36 major and 45 minor amputations. At three years, the survival rate was 50.2 percent and the surgical mortality 13 percent. Female sex was associated with worse results for cumulative patency and limb salvage.

From the article of the same title
European Journal of Vascular and Endovascular Surgery (10/04/10) Neto, F. C. Brochado ; Cury, M. V. M ; Costa, V. S.

Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2007–2009

Nearly 50 million Americans have doctor-diagnosed arthritis, and 21 million people say the disease limits their physical activities, the CDC reports in a new study. The agency says arthritis is increasing, that it’s especially common among people who are obese, and that unless Americans learn to control their weight, the prevalence of the disease will increase further. Arthritis represents a major public health problem in the United States “that can be addressed, at least in part, by implementing proven obesity prevention strategies and increasing availability of effective physical activity programs and self-management education courses in local communities,” the study authors write.

From the article of the same title
Morbidity and Mortality Weekly Report (10/08/10) Vol. 59, No. 39, P. 1261 Stobbe, Mike

The Effect of Creatinine Clearance on the Short-term Outcome of Neuropathic Diabetic Foot Ulcers

Reduced creatinine clearance is related to an increased risk for diabetic foot ulcer development. Wound healing has been reported to be worse in diabetic patients with impaired kidney functions than general diabetic population. Researchers sought to investigate the effect of creatinine clearance on the short-term outcome of neuropathic diabetic foot ulcers. Data from 147 neuropathic diabetic foot ulcer episodes were included in the study. Diabetic nephropathy was investigated by 24 hour urinary albumin excretion and serum creatinine levels. Creatinine clearance was calculated according to Cockcroft–Gault formula. Foot ulcers were followed up for 6 months to determine the outcome. Follow-ups revealed that neuropathic diabetic ulcers healed worse in patients with decreased creatinine clearance than in those who had normal creatinine clearance. Amputation rates were also found to be higher.

From the article of the same title
Primary Care Diabetes (10/01/10) Vol. 4, No. 3, P. 181 Akinci, Baris ; Yesil, Sena ; Bayraktar, Firat; et al.

Practice Management

Medical Malpractice Costs Expected to Rise: Report

According to Aon Risk Solutions' "Hospital Professional Liability and Physician Liability Benchmark Analysis" report, medical malpractice liability costs in 2010 and 2011 are expected to rise for hospitals and physicians due to increases in claim severity and claim frequency. Erik Johnson, healthcare practice leader for Aon Risk Solutions' actuarial and analytics practice and author of the report's analysis, says, "The uncertainties of healthcare reform and difficult economic times represent significant sources of risk for many hospital systems. While many hospitals have grown accustomed to declining professional liability costs, the underlying claim frequency and severity cost drivers have entered a period of growth. Whether commercially insured or self-insured, hospitals and physicians should prepare for increases to their professional liability costs in the coming years."

From the article of the same title
Business Insurance (10/12/10) Casale, Jeff

Physicians Slow to E-mail Routinely With Patients

Less than 7 percent of office-based physicians routinely communicated with patients via e-mail in 2008, according to a study by the Center for Studying Health System Change. About 33 percent of office-based physicians said that IT was available in their practice for e-mailing patients about clinical issues, but less than 20 percent of that segment disclosed using e-mail routinely with patients. The adoption of e-mail as a vehicle for patient communication was more likely among physicians in practices with access to electronic medical records (EMRs) and those working in health maintenance organizations or in medical school; yet little more than half of the highest e-mail users said they routinely e-mail patients.

The study found that the adoption and employment of e-mail to communicate with patients has been impeded by concerns among physicians about liability, with the authors writing that "federal policy efforts currently under way to support delivery system reforms may help spur physician adoption and use of e-mail communication with patients indirectly." CMS and the Office of the National Coordinator for Health IT's incentives for deploying meaningful use of EMRs have no specific connection to electronic communication with patients, but the report's authors write that "growth in EMR use as a result of the incentives may at least indirectly encourage e-mail adoption and use to the extent electronic messaging tools are integrated or used in conjunction with EMRs."

From the article of the same title
Health Imaging & IT (10/10/10)

State Sets Up First Electronic Medical Data Exchanges

Maryland health officials have announced the opening of the first links in the statewide health information exchange that grants medical professionals immediate computerized access to patients' medical records. The system connects doctors, hospitals, medical laboratories, and pharmacies, and proponents are hopeful that it will help reduce medical errors, especially during emergencies. The first connections are among Montgomery County-based medical facilities, but rapid expansion is expected with 48 hospitals having enrolled in the system.

From the article of the same title
Baltimore Sun (10/13/10) Walker, Andrea

Health Policy and Reimbursement

Insurers Denied Coverage to 1 in 7

The four largest U.S. for-profit health insurers on average denied policies to one out of every seven applicants based on their prior medical history, according to a congressional investigation. The study covered 2007 to 2009 for Aetna, Humana, UnitedHealth Group, and WellPoint. In total, the carriers denied coverage to more than 651,000 people due to pre-existing medical conditions over the three-year period. Under a provision of the healthcare overhaul bill that takes effect in 2014, insurers will no longer be able to deny coverage because of a pre-existing health condition.

From the article of the same title
Wall Street Journal (10/15/10) Adamy, Janet
Web Link - May Require Paid Subscription | Return to Headlines

Judge Lets 20 States' Challenge of Healthcare Law Move Forward

A federal judge has ruled that a lawsuit brought by 20 states challenging the federal healthcare overhaul law can move forward. The ruling is limited to the plaintiffs' standing to mount the case, as opposed to its merits, which will be discussed at a summary judgment hearing scheduled for Dec. 16. While dismissing most of the states' other complaints, the judge ruled that they can contest whether the law's "individual mandate" requiring virtually all Americans to buy health insurance exceeds Congress' constitutional authority to regulate commerce and make laws "necessary and proper" for carrying out its powers.

From the article of the same title
Washington Post (10/15/10) Aizenman, N.C.

Office for Civil Rights Expects Final HIPAA Regs to Be Released by Early 2011

The Department of Health and Human Services Office for Civil Rights (OCR) hopes to release a final rule amending the Health Insurance Portability and Accountability Act privacy (HIPAA) rules by early 2011, according to Adam Greene, OCR senior health information technology and privacy specialist. OCR is now reviewing comments received on the proposed rule, which largely calls for modifications of the HIPAA rules as called for in the Health Information Technology for Economic and Clinical Health (HITECH) Act. The primary function of the proposed rule is to extend requirements for protecting the privacy and security of patients' protected health information to business associates of health care entities already covered by HIPAA.

From the article of the same title
BNA Health Care Policy Report (10/12/10) Cutler, Joyce

Technology and Device Trends

Feds to Build 'Data Warehouse' of Health Claims

The U.S. Office of Personnel Management plans to create a national "health claims data warehouse." The database will be stocked with personally identifiable healthcare data as well as a host of healthcare information such as diagnoses and treatments, providers involved, and charges. The data will be gathered via daily regular feeds from health insurers that cover current federal employees and retirees, military personnel, postal workers, and their families. It also will include data from participants in the national pre-existing-conditions insurance program and the multistate option plan created under the Patient Protection and Affordable Care Act.

From the article of the same title
Modern Healthcare (10/08/10) Conn, Joseph

Ultrasound Speeds Up Bone Healing

Researchers compared the healing response of tibial delayed unions between subjects treated with low-intensity pulsed ultrasound (LIPUS) and subjects treated with a sham device. Adult patients who had sustained a tibial shaft fracture that subsequently showed inadequate progress toward healing were enrolled and randomized to receive either LIPUS or an identical nonoperative sham device. The daily treatment duration was 20 minutes for a period of 16 weeks. Subjects randomly assigned to active treatment had the ultrasound pressure wave signal set at 1.5 MHz frequency, 1 kHz repetition rate, 200 us pulse duration, and 30 mW/cm2 spatial intensity. Progress toward healing was estimated from changes in bone mineral density (BMD) and gap area as determined from computed tomography scans. Based on log-transformed data, mean improvement in BMD was 1.34 times greater for LIPUS-treated subjects compared to sham. A mean reduction in bone gap area also favored LIPUS treatment.

From "Improved Healing Response in Delayed Unions of the Tibia With Low-Intensity Pulsed Ultrasound"
BMC Musculoskeletal Disorders (10/08/10) Schofer, Markus D.; Block, Jon E.; Aigner, Julia; et al.

Morton's Extension Carbon Footplate Orthotic Found to Benefit Patients With Hallux Rigidus

Patients suffering hallux rigidus showed improvement in pain and function by wearing a relatively inexpensive and simple over-the-counter shoe insert, according to research presented at the 2010 American Orthopaedic Foot and Ankle Society Annual Meeting. The researchers found that using a Morton’s extension, a rigid carbon foot orthotic that extends to the distal tip of the hallux, resulted in reducing hallux rigidus pain as well as modified the plantar loading patterns resulting in improved load distribution. For the 30-patient study, subjects with a mean age of 54 years self-reported pain and functional outcomes prior to therapy and at 6 weeks. Data were assessed with the Foot Functional Index – Revised (FFI-R). Intervention with the Morton’s insert achieved an overall 22 percent improvement in total FFI-R scores.

From the article of the same title
Orthopedics Today (10/10) Frey, Carol C.

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October 20, 2010