October 26, 2011

Board Nominees Announced

After careful review and consideration of applicants to serve on the ACFAS Board of Directors, the Nominating Committee will recommend three Fellows for the December–January electronic election:
  • Kris A. DiNucci, DPM, FACFAS
  • Christopher Hyer, DPM, FACFAS
  • Bruce A. Scudday, DPM, FACFAS
Two 3-year terms will be filled in the election. Voters may cast one or two votes on their ballots. Regular member classes eligible to vote are: Fellows, Associates, Emeritus (formerly Senior) and Life Members. Nominations by petition are due no later than Nov. 26; see web link below.

Note: ACFAS will use start using electronic voting this year for board elections. All eligible voters will receive an e-mail with special ID information and a link to the election website no later than Dec. 18. After logging in, members will first see the candidate biographies and position statements, followed by the actual ballot. Biographies and position statements will also be posted on no later than Dec. 1. Eligible voters without an e-mail address will receive paper instructions on how to log in to the election website and vote. There will be no paper ballots. The deadline for voting is 30 days after voting opens.

For more information on nominations and elections, visit the ACFAS website.
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News From ACFAS

Plan Now for Preconference Practice Management Session
“Perfecting Your Practice” is a full-day workshop taking place in San Antonio on Feb. 29, 2012, before the start of the ACFAS Annual Scientific Conference on March 1. This comprehensive session will address timely topics including:
  • Changes to HIPAA, RAC and ICD-10
  • 2012 coding and billing updates
  • Buying and selling a practice
  • Retirement planning for all stages of your career
If you missed the last 2011 ACFAS Practice Management/Coding Workshop, which was sold out and met with rave reviews, don’t worry, because you’ll get the expert advice you need from the 2012 workshop leaders: ACFAS coding expert Douglas G. Stoker, DPM, FACFAS; and new ACFAS practice management faculty, Marcy Clair Blitch, RHIA, CCS. More information and online registration are available now at
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Knowledge, Skills and San Antonio: ACFAS 2012
Discover the appeal of sunny San Antonio as you attend the 2012 ACFAS Annual Scientific Conference, March 1–4. Visitors are captivated by the unique sights, sounds, tastes and history contained in its diverse array of neighborhoods. Downtown San Antonio, only 10 minutes from the airport, is built along the famously beautiful River Walk that offers restaurants, theaters, shopping, hotels and the Henry B. Gonzalez Convention Center, host to ACFAS 2012.

You’ll find all kinds of leisure-time activities within easy walking distance: great food and live music from a world of cultures; vibrant nightlife; art galleries and museums; and much more. If you have time to stay, you can explore the area’s parks, golfing, horseback riding, hiking or wine tasting.

Relax in the attractions of the heart of Texas while you add to your skill set in the camaraderie of your peers. Preconference workshops begin Feb. 29, and the full conference runs March 1–4, 2012. Find more information at
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Legal Briefs

Federal Appeals Court Says Nursing Home Need Not Reinstate Physician's Privileges
The U.S. Court of Appeals for the Eighth Circuit has affirmed the denial of a physician's motion for an order that would have required a nursing home to reinstate his privileges at its residential care facility. In Roudachevski v. All-America Care Centers Inc, the court said plaintiff Dr. Evgueni Roudachevski failed to show how the entry of a preliminary injunction requiring defendant All-American Care Centers to allow him to see patients at its Little Rock, Ark., facility would remedy the alleged irreparable harm he suffered as the result of his termination. Roudachevski was the medical director and held staff privileges at a nursing home taken over by All-American in 2008. In 2011, All-American terminated its relationship with Roudachevski, who then sued the company, alleging that it wrongfully terminated his privileges and tortiously interfered with his contract or business expectancies.

Roudachevski moved for a preliminary injunction that would require All-American to allow him to continue treating his patients who were residents of the facility. A U.S. District Court denied the motion after finding that the physician did not satisfy the four-part test for the issuance of such an injunction, which requires the moving party to show that he likely would succeed on the merits of his claims, that he would suffer irreparable harm if the injunction was denied, that the balance of harms favored him, and that the public interest favored him.

The appeals court focused on the irreparable harm factor. Roudachevski argued that he satisfied the irreparable harm factor because the termination of his privileges disrupted the physician-patient relationships he had built with residents at the facility. Disruption of a physician-patient relationship may cause irreparable harm, the court said, but not in the case at hand. The district court found for All-American on the balance of harms factor based on testimony that restoring Roudachevski's privileges would cause chaos because all his former patients had been transferred to other physicians. The district court said the preliminary injunction requested by Roudachevski would create a risk of further disruption of patient care. The Eighth Circuit agreed.

From the article of the same title
BNA Health Care Policy Report (10/20/11)
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Foot and Ankle Surgery

Accuracy of Plain Radiographs Versus 3D Analysis of Ankle Stress Test
Research was performed to assess the accuracy of plain film radiography in measuring translation of the talus during the anterior drawer (AD) test and the rotation of the talus during talar tilt (TT) stress testing, as well as to further define instability in the sagittal, coronal, and transverse planes. Twenty lower extremity specimens were positioned in a Telos ankle stress apparatus, and respective lateral and AP radiographs were taken during simulated AD and TT testing. Positional measurements were estimated from the films, and then a three-dimensional (3D) tracking system was employed to calculate these displacements. The anterior talofibular ligament and calcaneofibular ligament were sectioned to simulate an unstable ankle, followed by repeat measurement using both techniques. Movement calculated using the 3D system was compared to that of plain radiographs using a paired t-test. The average positional changes ascertained by plain film radiographs were found to be substantially lower than those measured by the 3D system in both AD and TT tests in the intact and sectioned states.

From the article of the same title
Foot & Ankle International (10/11) Vol. 32, No. 10, Hoffman, Eve; Paller, David; Koruprolu, Sarath; et al.
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Corrective Supramalleolar Osteotomy for Malunited Pronation-External Rotation Fractures of the Ankle
Researchers undertook a prospective study to analyze the outcome of 48 malunited pronation-external rotation fractures of the ankle in 48 patients treated by realignment osteotomies. In all patients, valgus malalignment of the distal tibia and malunion of the fibula were corrected. In some patients, additional osteotomies were performed. Patients were reviewed regularly, and the mean follow-up was 7.1 years. Good or excellent results were obtained in 42 patients (87.5 percent). Congruent ankles without a tilted talus (Takakura stage 0 and 1) were obtained in all but five cases. One patient required total ankle replacement.

From the article of the same title
Journal of Bone and Joint Surgery - British Volume (10/01/11) Vol. 93B, No. 10, P. 1367 Hintermann, B.; Barg, A.; Knupp, M.
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Intraoperative Incidence of Hallux Valgus Interphalangeus Following Basilar First Metatarsal Osteotomy and Distal Soft Tissue Realignment
A study was performed to assess the possible increase in the intraoperative interphalangeal angle (HIA) following basilar first metatarsal osteotomy and distal soft tissue realignment for hallux valgus (HV) correction. It also assessed the efficacy of an additional Akin osteotomy (AO). The study involved 54 feet with moderate to severe HV. HIAs and medial sesamoid subluxations (MSS) were quantified pre- and intra-operatively. An intraoperative measurement was used to assess the need for additional AO, based on the incongruency of the metatarsophalangeal joint (MTPJ). Following the DTSP and PCMO procedures, HIAs increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5. AO was added in 44 feet.

After a mean followup of 13.2 months in the Akin group, average VAS pain score declined from 5.7 to 1.2 and average AOFAS score improved from 57.8 to 90.2. Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group (p < 0.05).

From the article of the same title
Foot & Ankle International (10/11) Vol. 32, No. 10, Park, Jae-Yong
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Practice Management

How ICD-10 Will Affect Your Practice
The transition to the International Classification of Diseases, 10th Revision (ICD-10) will necessitate changes to business and systems across the healthcare industry, and all practice members should take an active role in seeing the changes through. The government-mandated conversion requires comprehensive evaluation of the areas of coding, claims, and information technology. Steps that need to be taken to ensure a successful migration include the establishment of a team that has a working knowledge of ICD-10 and how it diverges from ICD-9, and whose leader must deploy a transition plan that identifies specific actions, responsibilities, and deadlines. Also, an implementation budget must be set, involving the determination of the system changes costs and the intensity of coder training required for the new coding system.

The practice has to assess work, data, and operational flows so that its clinical documentation contains sufficient details to support the code assignment, given that higher levels of specificity are required under ICD-10. It will additionally result in amendments to procedures and/or diagnoses that require greater levels of detail, and evaluating documentation and areas of weakness will assist in the transition to new code sets and prevent loss of revenue once changes have been deployed. The practice's full staff needs to be educated, and training is being offered by many agencies and organizations.

From the article of the same title
Modern Medicine (10/10/11) Salz, Terry
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Medical Identity Theft a Growing Problem
A PwC report found that about a third of healthcare organizations, including physician practices, insurers, and pharmacies, have reported catching a patient using someone else's identity to obtain services. To prevent such identity theft, PwC advises medical practices to commit themselves to privacy of patient data, even beyond complying with federal standards such as the Health Insurance Portability and Accountability Act. For instance, health organizations should "deputize all workers as privacy champions," primarily by giving them privacy training that will demonstrate how to safeguard information while making them sufficiently confident in their jobs to access information when appropriate. PwC additionally urges practices to "make privacy part of the consumer experience and brand," showing patients the importance to the practice, and to the patients themselves, of maintaining the confidentiality of their information.

Security specialists say checking an ID and keeping a copy of it in the file to be referred to at each patient visit can help prevent fraud. Doctors also should monitor for warning signs in patient files, such as references to procedures they were not aware the patient received or mismatched patient information.

From the article of the same title
American Medical News (10/17/11) Dolan, Pamela Lewis
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Health Policy and Reimbursement

ACOs Seen As Tough Sell, Despite Concessions
The federal government has released a set of final rules governing accountable care organizations (ACOs), with major concessions to the original plan that had soured many healthcare leaders and physicians against participating. The final rule includes more generous shared savings incentives, deletes 32 of the 65 original quality measures, and gives ACO candidates more time to get started. A major change is that the rule no longer requires that 50 percent of participating physicians be approved under meaningful use requirements for electronic health record use.

Even with the changes, experts say the program will remain a tough sell for most healthcare providers. "I'm still not optimistic we are going to see a rush to the ACO door," said Michael Regier, general counsel and senior vice president of legal and corporate affairs for hospital purchasing group VHA. "For organizations that today are not quite far along the clinical integration route there is still an enormous investment required in infrastructure. Even with the improvement in rules, I don't know that the opportunity for return of capital is going to be sufficient enough to entice folks into this care model."

The final rule can be found here.

From the article of the same title
HealthLeaders Media (10/24/11) Commins, John
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ACFAS is analyzing these regulations and more information will be available to foot and ankle surgeons soon.

HHS Issues Regs to Reduce Red Tape
The Department of Health and Human Services (HHS) has released three regulations designed to make it easier for hospitals and doctors to work efficiently as part of efforts to cut red-tape across the federal government. Taken together the regulations could save hospitals and healthcare providers close to $1.1 billion annually and more than $5 billion in five years, according to HHS. The regulations are:

*a proposed rule that would revise the conditions of participation that hospitals and critical access hospitals must meet to participate in Medicare and Medicaid
*a proposed rule that would eliminate various duplicative or outdated requirements for groups such as end-stage renal disease facilities and durable medical equipment suppliers
*a final rule that revises the health and safety standards ambulatory surgical centers must meet to participate in Medicare.

From "CMS Issues Regs to Reduce Red Tape"
Kaiser Health News (10/18/11) Barr, Sarah
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Medicine, Drugs and Devices

A Comparison of Absorbable Screws and Metallic Plates in Treating Calcaneal Fractures: A Prospective Randomized Trial
A prospective, randomized study was held to compare the clinical results and complication corresponding to inta-articular calcaneal fracture stabilization with plates and absorbable screws, with a focus on 97 patients managed between February 2007 and March 2009. Plates were employed in 52 cases and absorbable screws were utilized in 47 cases, with follow-up conducted at an average of 23 months. No non-unions were observed radiographically in either group. Twelve months after operation in both groups, the mean adjusted AOFAS Ankle-Hindfoot scores were 71.6 plus or minus 12.5 and 72.3 plus or minus 17.4, respectively. The mean Foot Function Index scores were 21.4 plus or minus 6.6 and 22.7 plus or minus 5.2, respectively, and the mean calcaneal fracture scoring system scores were 73.5 plus or minus 8.3 and 75.1 plus or minus 6.9, respectively. Six cases of poor wound healing, one case of deep infection, and four cases of peroneal tendon irritation were seen in the plate group, while one case of superficial infection and no deep infection and soft tissue irritation were seen in the group with absorbable screws.

From the article of the same title
Journal of Trauma (10/13/11) Zhang, Jingwei; Ebraheim, Nabil; Lause, Gregory E.; et al.
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Legislation Aims to Spur Medical Innovation
The bipartisan Medical Device Regulatory Improvement Act to spur medical innovation and expedite the availability of such products to patients has been introduced in the Senate. The bill is designed to streamline the Food and Drug Administration's oversight of medical devices by clarifying the agency's least onerous mandates. The legislation would instruct FDA regulators to concentrate only on "relevant information" during the decision-making process, consider "appropriate alternatives" to reduce the time, effort, and cost of reaching regulatory decisions, and employ "all reasonable mechanisms" to lower review times when making their decisions.

From the article of the same title
Modern Healthcare (10/13/11) Daly, Rich
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Medical School Applications Hit New Record, Enrollment Up 3 Percent, AAMC Finds
U.S. medical schools officials saw a record number of applicants in 2011, with applicant ranks increasing by 2.8 percent from 2010, according to the Association of American Medical Colleges. A total of 43,919 individuals applied to U.S. medical schools in 2011, including 32,654 first-time applicants. First-year enrollment grew by 3 percent.

From the article of the same title
Modern Healthcare (10/24/11) Selvam, Ashok
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Those Scan Results Are Just an App Away
A variety of medical apps for smartphones and tablets are rapidly becoming available, but few of them are have received approval from the Food and Drug Administration. One app that has received clearance from the FDA is Mobile MIM, made by MIM software, that can turn a iPhone or iPad into a diagnostic medical instrument by allowing physicians to examine scans and make diagnoses based on magnetic resonance imaging, computed tomography, and other technologies. So far, only a handful of medical apps have been approved by the FDA for diagnostic use, but many more will probably soon be in use as more smartphones and tablets are adopted by physicians. To prepare for this trend, the FDA is developing guidelines for medical apps.

From the article of the same title
New York Times (10/15/11) Eisenberg, Anne
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