October 24, 2012

News From ACFAS

Last Chance to Submit Your Video - Deadline Oct. 31
ACFAS Members: Help us put a spotlight on the face of foot and ankle surgery! Send us a video of yourself answering these questions to be featured at the Opening General Session of the ACFAS 2013 Annual Scientific Conference, February 11-14, in Las Vegas. Be sure to check out the web link below for more information:
  • Why do you love being a foot and ankle surgeon?
  • What attracted you to this profession?
  • Whose lives have you changed and how?
  • Who had the greatest impact on your career?
  • What is your vision for your professional future?
Don’t miss your opportunity to share your story - submit your video by October 31 to ensure your story is heard!
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Beware of “Hotel Poachers” for ACFAS 2013 Las Vegas
It has come to our attention that Exhibitors Housing Services (EHS) is falsely representing itself as the official housing partner for the 2013 ACFAS Annual Scientific Conference in Las Vegas by calling and soliciting ACFAS attendees and exhibitors. If you receive a call from them, DO NOT give your credit card information or cash deposits. ACFAS' true official housing partner is OnPeak, LLC.

Have no fear, though; you can safely make your ACFAS 2013 hotel reservation by visiting and selecting “Make Hotel Reservation." We have sent a cease and desist letter to EHS. If you have any questions, please call ACFAS headquarters at 800.421.2237.
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Thank You - We Reached 1,000 Twitter Followers!
Two weeks ago, we asked you to spread the word about ACFAS' patient-based Twitter account, @FootHealthFacts so we could surpass our goal of 1,000 followers. Because of your help, we are now at 1,025 and growing! Thanks for telling your patients, family, friends and office staff about this useful tool that posts the latest news and facts about foot and ankle health.

We encourage you to keep spreading the word about @FootHealthFacts so we can keep everyone updated on what’s happening in the world of foot and ankle health and continue to share the great work you do for your patients!

To follow, visit and click “follow.”
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New ACFAS-Recognized Fellowship Program
The ACFAS Fellowship Committee recently approved the West Houston Medical Center Fellowship in Reconstructive Foot and Ankle Surgery for official ACFAS Fellowship Recognition. This Fellowship meets and exceeds the minimal requirements for recognition by ACFAS, thus the Fellowship Committee has agreed to grant this program “Recognized Status” with the College.

The program, located in Houston, Texas, is under the direction of Samuel S. Mendicino, DPM, FACFAS. For more information on the fellowship, visit

ACFAS highly recommends taking on a specialized fellowship for the continuation of foot and ankle surgical education after residency. If you are considering a fellowship, visit our Fellowship Initiative page to review a complete listing of programs and minimal requirements.
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Free Webinar: Secure More Referrals through the Web
Learn how to think and search the Web like a potential patient by attending the latest ACFAS webinar titled Enhancing Your Online Visibility to Secure More Referrals—And New Patients, provided through Officite. Take advantage of this valuable program to become an effective marketer to potential patients and find out how to benefit from online advertising by improving your search engine optimization (SEO).

Join us on November 1 at 8 p.m. CST to take advantage of this member benefit. Space is limited, so reserve your webinar seat now by visiting
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Foot and Ankle Surgery

Antimicrobial Photodynamic Therapy in Bacterially Colonized, Chronic Leg Ulcers and Diabetic Foot Ulcers
Determining if photodynamic therapy in bacterially colonized chronic leg ulcers and chronic diabetic foot ulcers can reduce bacterial load and potentially accelerate wound healing was the purpose of a study where 16 patients with chronic leg ulcers and 16 patients with diabetic foot ulcers participated in a blinded, randomized, placebo-controlled, single treatment, Phase IIa trial. Every patient had ulcer duration greater than six months, bacterially colonized with more than 10^4 cfu/ml. Following quantitative assessment of pre-treatment bacterial load via swabbing, cationic photosensitiser 3,7-Bis(di-n-butylamino) phenothiazin-5-ium bromide or placebo was applied topically to wounds for 15 minutes, followed immediately by 50 J/square cm of red light and the wound once more sampled for quantitative microbiology. Wound area was quantified for up to three months post-treatment. Therapy was well tolerated with no disclosures of pain or other safety issues. Compared to placebo, patients on active treatment exhibited a reduction in bacterial load immediately following treatment. After three months, half of actively treated chronic leg ulcer patients showed complete healing, versus 12.5 percent of placebo patients.

From the article of the same title
British Journal of Dermatology (10/15/12) Morely S.; Griffiths, J.; Philips, G.; et al.
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FS-3D-FISP for the Diagnosis of Ankle Impingement Syndrome and the Evaluation of Clinical Outcomes of Arthroscopic Surgery
A study was held to evaluate the diagnostic value of three types of magnetic resonance imaging (MRI) sequences—FSE-T2WI, FSE-PDWI and FS-3D-FISP—and to note the clinical results of arthroscopic surgery for ankle joint impingement syndrome. Ankle joint impingement syndrome was verified by the three MRI modalities in 23 patients with arthroscopically demonstrated ankle impingement. Arthroscopic surgery was performed on all 23 patients and the ankle joint function was assessed before, one week after and six months following the procedure. The patients were followed-up for 12 to 64 months. No significant difference in ankle function score between preoperatively and one week postoperatively was observed, but 86.96 percent of patients received overall excellent or good scores six months after the surgery, significantly higher than prior to the surgery. The FS-3D-FISP MRI showed good consistency with arthroscopic examination and exhibited greater sensitivity and specificity for the diagnosis of ankle impingement than FSE-T2WI and FSE-PDWI.

From the article of the same title
European Journal of Orthopaedic Surgery and Traumatology (09/12) Zhang, Shuijun; Zhao, Chen; Xia, Bing; et al.
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What is the Effect of Early Weight-Bearing Mobilization Without Using Any Support After Endoscopy-Assisted Achilles Tendon Repair?
A study was held to evaluate the impact of immediate weight-bearing mobilization with intensive rehabilitation on muscle strength and lower extremity functional level following endoscopy-assisted Achilles tendon repairs. Following a five-minute warmup at a self-chosen intensity on a stationary bicycle, 32 male patients were tested for bilateral peak concentric isokinetic ankle dorsi- and plantar-flexor torque, passive range of motion for ankle joint, one-leg hop for distance, single-leg vertical jump height, Achilles Tendon Total Rupture Score and perceived function using the Foot and Ankle Outcome Score (FAOS). Side-to-side differences were compared using a series of paired sample t tests. No substantial differences in hop and jump tests, dorsi- and plantar-flexor isokinetic muscle strength and dorsi- and plantar-flexion range of motion were observed between the affected and unaffected side of the patients. Pain score of FAOS was 95 ± 8, other symptoms score was 92 ± 11, function in daily living score was 95 ± 6, function in sport and recreation was 85 ± 16 and Quality of Life score was 85 ± 12. The average Achilles Tendon Rupture Score was 86.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (09/26/12) Doral, Mahmut Nedim
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Practice Management

Are You in Hot Water if Your Staff Doesn't Take Breaks?
A practice can get into trouble if office staff are not permitted to take lunch or coffee breaks, if employees are nonexempt. In a case pending for several years, the California Supreme Court made some definite decisions about employers' responsibilities to nonexempt employees, and attorney Pat Grady raises some relevant issues that could come up in a physician's everyday practice. A practice's requirement to furnish a meal period is fulfilled if the employee is relieved of all duty for an uninterrupted half hour and is allowed to leave the work premises, using the period for whatever purpose he or she wants. Management does not need to "ensure" that no work is performed during a meal period, but if the manager knew or reasonably should have been aware that the employee was working during the meal period, the practice will be liable for payment of the worker's regular, or overtime, salary for such time worked. The first meal period must be supplied after no more than five hours of work, and entitlement to a second meal period depends on no more than 10 hours of work elapsing.

The practice is required to provide an employee a 10-minute break for every major portion of four hours worked after the employee works three and a half hours, and although rest breaks and meal periods do not have to be taken in a specific order, in the context of an eight-hour shift, one rest break should fall on either side of the meal period. Meal and rest period claims can be appropriate for class-action litigation where the employer has a uniform policy or practice that conflicts with meal and rest period requirements.

Practices should ensure workers are informed that they are allowed to take meal and rest periods every day by maintaining a well-drafted meal and rest period policy in the Employee Handbook and prominently showing the policy along with all other employment-associated postings on the company bulletin board and/or by the time clock. Practices also should mandate all new workers to sign a document at the time of hire advising them of their right to take meal and rest periods. There also should be periodic publication of reminders to current employees regarding the company's meal and rest period policy and periodic reviews of timecard records to see whether meal periods are being accurately reported. Finally, mangers who discourage or instruct employees to miss meal or rest periods should be disciplined and counseled.

From the article of the same title
Medscape (10/11/12) Denning, Jeffrey J.
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Verifying Patient Health Benefits a Must at Your Medical Practice
Practices must ensure the confirmation of patient health benefits, so it behooves them to take the time to obtain the information they need from an insurance company. It is exceptionally important to verify the spelling of the patient's name and whether it matches the name on the card, especially with Medicare patients. Confirming the patient's birth date also is important, as the lack of the proper date will thwart verification of the patient's benefits. Determination of whether the patient is a subscriber is critical as well. Not all patients are subscribers on their own plan, and spouses are frequently covered under their spouse's plans, particularly with the TriCare/TriWest plans. Practices must have the date of birth and Social Security number for those plans' subscribers. The correct name and birth date for any subscriber is essential.

If the practice fails to confirm up front that the plan policy number provided by the patient is the correct one, then an immediate denial of benefits is a likely outcome. The practice will not know how much deductible and out-of-pocket payments to collect at the time of service unless the staff gets this information. Should the patient's insurance plan stipulate treatment limitations or preexisting conditions, the practice should adhere to them. If the patient requires a second appointment of the same type within the same calendar year, the practice must ask the patient to write a letter, and then the practice will write a letter of medical necessity and send it to its billing department. The insurance firm might take payment into consideration if medical necessity is demonstrated. Otherwise, the patient should be informed that they will be billed for the appointment, with the practice permitted to bill the amount it would have received from the insurance company.

Sometimes with plans that have different medical groups, they want the practice to send claims to an address that is not on the card. Practices should therefore call to make sure that the address is the proper one. Sending the claims only to an incorrect card address means the insurance company will take 30 days to pay them.

From the article of the same title
Physicians Practice (10/13/12) Cloud-Moulds, P.J.
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What to Do When Someone Badmouths a Physician or Practice
Because a physician’s good name can make or break a medical practice, it can seem like a crisis when someone is threatening it. Most surveys find that patients choose their doctors based on referrals from friends or other physicians, so someone who says bad things about a doctor or a practice could inflict a lot of damage. Still, any response needs to take into account who the person is, what he or she is saying and where it is being said. The first step is to identify who is saying what about a physician or practice. This may be accomplished by asking around or searching online. The next step is to decide whether action is needed. If the comments are uncommon or lack credibility, it may be best to ignore them, because responses can add fuel to the fire. Additionally, leaving the person alone may allow the negative comments to fade away.

However, if action needs to be taken, the next step may be direct contact. This is especially true if the other person is a medical professional. The meeting should be professional, polite and dignified, with the physician whose name is being questioned expressing concern and hopes for resolving the issues. If the person is a patient, the situation most likely will require a different track. If the practice can figure out who the dissatisfied patient is, getting in touch with that person to determine whether the problem can be addressed may end the negative comments.

Experts say that if these strategies do not work, and the badmouthing appears to have a very real effect, the next step may be to hire a lawyer to write a cease-and-desist letter. This may persuade the party who is badmouthing a medical practice to stop. After everything else has been done, it may be time to consider filing a lawsuit. However, a lawsuit should be reserved for when the badmouthing is slanderous and having severe effects. Winning these cases usually requires proving that the negative comments are untrue and have damaged the practice financially. Physicians have won these types of lawsuits, but they can be very stressful, time-consuming and expensive. As such, legal action should be taken only in extreme situations after all other methods are tried to minimize the damage and persuade the person to stop spreading falsehoods.

From the article of the same title
American Medical News (10/15/12) Stagg Elliott, Victoria
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Health Policy and Reimbursement

Countdown to ICD-10 Is On
Healthcare organizations should not count on another delay in the implementation of ICD-10 compliance. Healthcare organizations that may have stopped or slowed their ICD-10 preparations after HHS first announced its intent to consider a delay need to get back on track. It is important to ensure the organization’s implementation timeline includes time for adequate internal and external testing. Also, organizations will need to reevaluate ICD-10 planning and determine how preparation affects the organization’s other projects and priorities. They will also need to adjust timelines and budgets to make the best use of available time and resources.

Healthcare groups that are on track with the original compliance date can use the extra time to:
  • Conduct more thorough testing
  • Provide additional training
  • Continue to communicate with trading partners regarding their readiness
  • Assess risks
  • Develop strategies to mitigate risks and maximize opportunities for success
Examples of risk mitigation strategies include:
  • Using innovative approaches to staffing and education
  • Leveraging available resources
  • Ensuring the right training is provided to the right people at the right time
  • Planning for post-implementation monitoring

From the article of the same title
HealthLeaders Media (10/12/12)
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Facing Medicare Pay Cut, Many Doc Groups Ready to Curtail Service
Forty-five percent of physician group practices responding to an MGMA-ACMPE survey said they would cut back on appointments for new Medicare patients if Congress does not act to avert a steep Medicare physician pay cut. Meanwhile, more than three-quarters of those surveyed said they would reduce staff salaries and/or benefits, and six in ten reported they have delayed buying new equipment or facilities in the past decade as lawmakers made short-term fixes to Medicare's sustainable growth-rate formula. Absent congressional action, physicians who participate in the Medicare program will face a 27 percent reduction in reimbursement come February.

From the article of the same title
Modern Healthcare (10/22/12) Zigmond, Jessica
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Geographic Variation in Medicare Spending and Mortality for Diabetic Patients with Foot Ulcers and Amputations
A study was performed to determine whether geographic variation in Medicare spending does or does not have a bearing on mortality rates for diabetic patients with foot ulcers and lower extremity amputations (LEA). In 2007, diabetic beneficiaries with foot ulcers and LEA were enrolled in Medicare Parts A and B, and ordinary least squares regression was employed to explain geographic variation in per capita Medicare spending and one-year mortality rates. There was considerable variation in healthcare spending and mortality rates across the country for the two patient cohorts, but higher spending was not associated with a statistically substantial reduction in one-year patient mortality. Macrovascular complications for amputees were more frequent in parts of the country with higher mortality rates, but this association was not seen for the foot ulcer cohort. However, macrovascular complications were associated with increased per capita spending for beneficiaries with foot ulcers. An association also was perceived between rates of hospital admission and higher per capita spending and increased mortality rates for individuals with foot ulcers and LEA.

From the article of the same title
Journal of Diabetes and its Complications (10/12/2012) Sargen, Michael R.; Hoffstad, Ole; Margolis, David J.
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Medical Societies Offer Guidelines on Shift from SGR
A set of principles has been released by the American Medical Association (AMA) and more than 100 state and specialty medical societies that can support a federal migration from the sustainable growth-rate (SGR) formula to a "higher performing Medicare program." The groups sent a letter to Sens. Max Baucus (D-Mont.) and Orrin Hatch (R-Utah) urging legislators to rescind the Medicare physician payment formula, arguing that the SGR formula's removal is crucial to the development of a high performing Medicare program. It is the groups' recommendation that the transition plan offer physicians opportunities to select their own payment models, avoid the use of penalties and supply a way for physicians to show they are assuming accountability for quality and cost issues.

From the article of the same title
Modern Healthcare (10/15/12) Lee, Jaimy
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Surgery Safety Effort Could Hurt Hospital Revenue: Study
According to a study published online in Health Affairs, efforts to reduce post-surgical complications such as infections could lead to substantial drops in hospital revenue. Citing the current fee-for-service model, the authors of the study said such quality-improvement programs could result in far lower reimbursement rates for hospitals. Average reimbursement revenue for a surgical patient who experiences complications is $36,730, or about $13,000 more than the average reimbursement for a patient who experiences no complications. "Our analysis leads to a distressing conclusion: A program to reduce complications from surgery, while clearly in the interest of patients and payers, will result in a negative cash flow for hospitals whose case loads of surgical inpatients are not growing," the study's authors wrote. Boosting volume of inpatient surgical patients is one way hospitals can mitigate the financial consequences of a program targeting reductions in post-surgical complications, but hospitals can also benefit from setting up shared-savings programs with payers. These agreements would be more likely to encourage reductions in surgical complications and would add to hospitals' incentives to pursue such strategies.

From the article of the same title
Modern Healthcare (10/17/12) McKinney, Maureen
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Medicine, Drugs and Devices

CCHIT Details Work for Info Exchange Network
The Chicago-based Certification Commission for Health Information Technology (CCHIT) plans to test and certify the computer systems used by health information exchange organizations and the users of those products as part of a plan for a public-private version of the proposed Nationwide Health Information Network. The initiative is emerging as U.S. Department of Health and Human Services' Office of the National Coordinator for Health IT announced it was putting on hold plans to regulate the proposed national health information exchange infrastructure.

From the article of the same title
Modern Healthcare (10/12/12) Conn, Joseph
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The Doctor Can See You Now. Really, Right Now.
Appointment Status, a website that was created by a dissatisfied hospital patient and which is designed to improve appointment efficiency and give patients information to avoid long waits, is one of several digital developments meant to help patients. Created by Boston University freshman Parker Oks, the site makes it easier for patients to schedule appointments and find out if a doctor is behind on his patients before settling down in a waiting room chair. Other developers and entrepreneurs are beginning to tap into patients' frustration with waiting room times, which average about 21 minutes, according to the website Vitals.

Another service, ZocDoc, aims to help patients save time with their doctor visits by letting patients look into a doctor's appointment book and schedule a visit via the Web. ZocDoc has already been expanded to include a new tool, ZocDoc Check-In, to help eliminate another source of waiting-room boredom: filling out a clipboard of forms.

From the article of the same title
New York Times (10/15/12) Parker-Pope, Tara
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