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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: The Flawed Physician Payment Formula

Medicare physician payments took center stage in Washington this week as some Democrats sought to fast-track free-standing legislation — separate from the health system reform bills — to fix the problematic Medicare physician payment formula. While this effort has quickly lost momentum, it is important for physicians to understand this complex issue.

The current “sustainable growth rate” (SGR) formula to set annual physician payment updates under Medicare is agreed by all to be flawed because it ties physician payment to overall Medicare expenditures, which has resulted in negative payment updates since 2000. Each year, Congress scrambles to find a temporary fix to the negative update, but has resisted a permanent fix that would scrap the SGR, because of the steep price tag — estimated to be about $237 billion over 10 years. Without a temporary fix, Medicare physician payments would decline up to 12 percent beginning January 1, 2010.

The good news for physicians is that each of the comprehensive health reform bills currently at play in Congress include at minimum, a temporary fix for 2010 (Senate Finance Committee bill). The House bill would create a permanent fix. The events of this week make it clear that regardless of the ultimate outcome of a comprehensive health reform bill, Congress is committed to taking action to stop the payment decrease for 2010.

ACFAS strongly supports a permanent fix to the SGR formula to ensure that physicians are paid fairly for the services and procedures they provide to Medicare beneficiaries.
Podcast Special: Financial Statement Basics

Get a mid-month learning bonus with the latest ACFAS podcast, “Financial Statement Basics.”

“As a doctor, you know how to diagnose and treat the medical conditions you see on a daily basis,” says podcast host Brian S. Harley, DPM. “So, why wouldn’t you want to have the same understanding of how each patient and each treatment will actually impact your finances?”

Learn easy-to-follow steps to monitor the profitability of your practice in this informative discussion. Visit ACFAS e-Learning today for the new podcast and a full library of online education.
ACFAS Wants to Stay in Contact with You

Have you recently changed your work or home address, phone or fax number, or e-mail address? Does your practice have a web site? Do you want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other ACFAS mailings? We want to stay in touch with you!

The College lists your contact information on the online membership directory to allow other members to find you, and also in the “physician search” feature on the consumer web site,

To keep yourself available to your peers, potential patients, and the College, please take a moment to download the update form and provide your current contact information.
Candidates Recommended for Board of Directors

After reviewing in-depth applications, conducting personal interviews and thoughtfully considering the qualities of applicants to serve on the ACFAS Board of Directors, the Nominating Committee has recommended three Fellows as candidates for the 2010 board election:
  • Richard Derner, DPM, FACFAS
  • Sean T. Grambart, DPM, FACFAS
  • Roya Mirmiran, DPM, FACFAS
Two 3-year terms will be filled in the election. Voters have the option of casting one or two votes on their ballot. Regular member classes eligible to vote are: Fellows, Associates, Emeritus (formerly Senior) and Life Members. Candidate information and ballots will be mailed to these member classes by December 10, 2009, with ballots due by January 10, 2010. Click here for more information about the election process.

Questions regarding the Nominating Committee’s selection process may be directed to Committee Chair John M. Giurini, DPM, at Questions about the election process may be directed to Executive Director Chris Mahaffey, CAE, at

Other members of the Nominating Committee included Tzvi Bar-David, DPM, Edwin L. Blitch, DPM, Mary E. Crawford, DPM, Michelle D. Detweiler, DPM, Robert J. Duggan, DPM, and Randal L. Wraalstad, DPM.
Get Ready for FTC Red Flag Rules

The new “red flag” rules go into effect November 1, 2009. Get the information you need to prepare for this change on the ACFAS web site.

ACFAS is committed to providing you with the tools you need to practice successfully in a changing environment. Visit the newly revised Practice Management and Marketing web pages for up-to-date information on this and a variety of issues, including coding and billing, managing staff, marketing your practice and more.

Discover what’s inside, your online professional resource!

Foot and Ankle Surgery

Antegrade Flow and Peripheral Resistance Determine the Level of Endogenous Arteriogenesis in Patients with Superficial Femoral Artery Occlusion

Occlusion in a limb artery leads to impaired blood supply and ischaemia. Collateral artery growth (arteriogenesis) is one of the most effective natural response mechanisms to compensate this pathologic situation. In this study, researchers analyzed whether clinically important features, like poor run-off, have an impact on compensatory vessel growth. They found that ankle-brachial index, grade of symptoms, and daily walking capacity could be used to predict collateral density and that a good antegrade flow and peripheral runoff have a significant effect on collateral density, implying an impact on the activation of arteriogenesis.

From the article of the same title
European Journal of Clinical Investigation (10/06/09) Vajanto, P. Korpisalo; Karjalainen, J.; Hakala, T.; et al.

Diagnostic Performance of FDG-PET, MRI, and Plain Film Radiography (PFR) for the Diagnosis of Osteomyelitis in the Diabetic Foot

Researchers in this study assessed the diagnostic performance of [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) to diagnose osteomyelitis in the diabetic foot and compared it with that of magnetic resonance imaging (MRI) and plain film radiography (PFR). They found that FDG-PET is a highly specific imaging modality for the diagnosis of osteomyelitis in diabetic foot and should therefore be considered to be a useful complimentary imaging modality with MRI. When MRI is contraindicated, the high sensitivity and specificity of FDG-PET justifies its use after a negative or inconclusive PFR to aid an accurate diagnosis.

From the article of the same title
Molecular Imaging and Biology (10/09/09) Nawaz, Asad; Torigian, Drew A.; Siegelman, Evan S.; et al.

Outcome of Arterial Reconstruction and Free-Flap Coverage in Diabetic Foot Ulcers: Long-Term Results

Major amputation for advanced soft tissue loss with bone and tendon exposure can be prevented in diabetes patients with a combined arterial reconstruction and free-flap transfer. Researchers in this study reviewed the 15-year outcome and evaluated the feasibility to save diabetic feet by means of this strategy. They found that combined arterial reconstruction and free tissue transfer provides an excellent long-term result with regard to amputation-free survival and limb salvage, concluding that the procedure should be considered in diabetes patients with extensive soft tissue deficits before amputation is performed.

From the article of the same title
World Journal of Surgery (10/13/09) Randon, C.; Vermassen, F.; Jacobs, B; et al.

Practice Management

Trick Out Your Practice Web Site

Practice consultants are encouraging their physician-clients to maximize the impact of practice web sites by ensuring they are dynamic and interesting. State-of-the-art web sites typically include online scheduling, bill-paying and patient education. Practices are creating their own short videos on topics important to their patients. Also, by embedding so-called “widgets” from other sites, such as the Centers for Disease Control public health widgets, you can provide patients easy access to patient information.

From the article of the same title
Physicians Practice (10/09) Lowes, Robert
Visit for Foot Health Facts, the ACFAS consumer web site, gives member surgeons and their patients access to the most reliable Internet source of information on foot and ankle conditions and surgery. You can link your practice’s web site to one or all of the foot and ankle conditions in the online directory. Be sure to watch future issues of This Week @ ACFAS for the launch of, the all-new consumer web site — coming soon!

H1N1 Flu: For Physicians

The American Association of Medical Society Executives has provided a list of resources available to physicians regarding the H1N1 virus. General information and specialty-specific resources as well as examples of medical society H1N1 pages can be found. Also provided is a link to CDC guidance.

From the article of the same title
American Association of Medical Society Executives (10/15/09)

How to Say No to Patients

Economic and other factors are compelling more physicians to say "no" to patients. To minimize physician-patient conflict, it is important that practices approach the situation in a caring and mutually cooperative way. This involves establishing policies and explaining those policies in a clear fashion to patients. Potential reasons for refusing to see a patient include failure to keep appointments, failure to pay copays or bills, or non-coverage by Medicare. Problems typically begin when physicians assume a defensive or aggressive stance, and assume that a patient will never pay or wants to be repaired by the doctor while taking no responsibility for his or her health.

From the article of the same title
Physicians Practice (10/09) Moore, Pamela

Telemedicine May Help Rural Trauma Surgeons Avoid Medical Errors and Unnecessary Patient Transfers

Telemedicine can help healthcare providers in rural areas stabilize and treat trauma victims when long distances or inclement weather prevents immediate transfer to an accredited trauma center, according to the results of a telemedicine program in Maine. The analysis of 59 telemedicine consultations showed fewer medical errors and near elimination of unnecessary transport compared with telephone consultations. The telemedicine system was used by Eastern Maine Medical Center to provide consultation to 11 satellite centers in northern and central Maine, covering an area approximately the size of Vermont, New Hampshire and Massachusetts combined. The system, called TeleTrauma, uses high-resolution video with synchronized audio via an Internet connection.

From the article of the same title
Newswise (10/06/09)

Health Policy and Reimbursement

Michigan: Doctor Tax May Stall in Senate

Michigan physicians are facing a catch-22 as the state Senate tries to avert massive Medicaid cuts to providers. The economically embattled state must close a $2.8 billion budget deficit by October 31, and the Democratic-controlled House has already passed a 3 percent physician tax. Under the Medicaid program, each additional dollar the state raised in revenue would be matched by the federal government with $2.72, so the 3 percent tax would generate a total of $825 million. Advocates of the tax are not optimistic that it will pass in the Republican-controlled Senate.

From the article of the same title
Crain's Detroit Business (10/18/09) Green, Jay

Mandating Cultural Competency: Should Physicians Be Required to Take Courses?

In the wake of proven racial and ethnic disparities in healthcare delivery, a number of states are considering requiring physicians to take CME courses on culturally competent patient care. California and New Jersey are the only states that currently require such CME. However, at least nine states are currently considering similar mandates: Arizona, Colorado, Florida, Georgia, Kentucky, New Mexico, New York, Ohio and Washington.

From the article of the same title
American Medical News (10/19/09)

Report: Limiting Medical Lawsuits Could Save $41B

Limits on medical malpractice lawsuits would lead doctors to order up fewer unneeded tests and save taxpayers billions more than previously thought, according to analysis by the Congressional Budget Office. The analysis estimates that government healthcare programs could save $41 billion over ten years if limits on jury awards for pain and suffering and other similar curbs are implemented nationwide.

From the article of the same title
Associated Press (10/09/09) Alonso-Zaldivar, Ricardo

Technology and Device Trends

Higher Nonunion Rates Found Using Locked Plate Constructs for Hallux MTP Fusion

A study presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society indicates a trend toward higher nonunion rates in patients with hallux metatarsophalangeal (MTP) arthrodesis who were treated with locking plates compared to nonlocking constructs and shows higher nonunion rates overall for patients with rheumatoid arthritis. The study compared the outcomes of 73 patients who underwent hallux MTP arthrodesis with a low-profile, precontoured, doral titanium locked plate to 107 patients who underwent the same procedure with a nonlocked, precontoured, dorsal stainless steel plate. The locked plate constructs used 2.7-mm screws while the nonlocked constructs used 2.7- and 3.2-mm screws.

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

Researchers Take Another Stem Cell Step

Dr. Kevin Eggan of the Harvard Stem Cell Institute and colleagues say they have found an easier way to change plain cells into induced pluripotent stem (iPS) cells, which have the power to change into any cell type in the body. The most reliable method of making iPS cells requires using viruses to carry transformative genes into the cells, which could result in contamination of the resulting batch of cells. Eggan's team has found a chemical that replaces two of the four transformative genes.

From the article of the same title
Reuters (10/08/09)

The Efficacy of the Floor-Reaction Ankle-Foot Orthosis in Children with Cerebral Palsy

The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. In this study, researchers evaluated the efficacy of this orthosis to identify clinical parameters that may compromise its function. They found that the orthosis is effective in restricting sagittal plane ankle motion during the stance phase of gait in patients with cerebral palsy. As a result, improvements in knee extension and the sagittal plane knee extensor moment in stance phase are achieved. However, knee and hip flexion contractures of ≥15° were found to limit the efficacy of the orthosis in controlling knee extension in midstance.

From the article of the same title
Journal of Bone and Joint Surgery (American) (10/01/09) Vol. 91, No. 10, P. 2440; Rogozinski, Benjamin M.; Davids, Jon R.; Davis, Roy B.

Treatment of Nonhealing Diabetic Foot Ulcers With a Platelet-Derived Growth Factor Gene-activated Matrix (GAM501)

Researchers in this study report on the results from a Phase 1/2 study of a replication-defective adenovirus encoding human platelet-derived growth factor (PDGF)-B formulated in a bovine collagen (Ad-5PDGF-B; 2.6% collagen; GAM501) gel for nonhealing neuropathic diabetic foot ulcers. The primary objectives of the study were to evaluate the safety, maximum-tolerated dose and preliminary biological activity of GAM501. They found that GAM501 did not appear to have any toxicity at doses that showed biological activity, concluding that GAM501 holds promise as a potentially effective treatment for nonhealing diabetic foot ulcers.

From the article of the same title
Wound Repair and Regeneration (10/12/09) Mulder, Gerit; Tallis, Arthur J.; Marshall, V. Tracy; et al.

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October 21, 2009