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October 30, 2013

News From ACFAS


ACFAS Supports ACA Non-Discrimination Clause
Members of the College are encouraged to join in supporting the Coalition for Patient Rights' (CPR) efforts to withhold the non-discrimination clause of the Affordable Care Act (ACA). This particular clause ensures that services provided by a full range of health providers – not just MD/DOs – are covered by insurance plans, yet there is an effort among Congress members to have it repealed.

ACFAS is a member of the Coalition for Patient Rights and fully supports the ACA's non-discrimination clause. Read CPR’s letter to Chairman Upton and Ranking Member Waxman explaining why we support the non-discrimination clause and oppose H.R. 2817.
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2014 Volunteer Leaders Sought
Help shape the advancement of the profession, the future of the College and, ultimately, the care of patients by volunteering for 2013-14 ACFAS committees. For information on becoming a committee volunteer, please visit acfas.org/volunteer. Current volunteers will receive a form from their staff liaison in the coming weeks. The deadline for applications is November 29, 2013.
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ACFAS Announces Recognized Fellowship Program
In addition to the five new fellowship programs announced last week, the College also recognizes The IMSC Sports Medicine Fellowship in Irvine, CA; led by Program Director Michael W. Heaslet, DPM, MS, FACFAS, as meeting the Fellowship Committee's minimal requirements to receive Recognized Status with ACFAS.

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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Benefits of ACFAS Membership Realized in Everyday Practice with Henry Schein
Are you taking full advantage of all your membership with the College has to offer? One benefit is access to group purchasing pricing through an ACFAS Benefits Partner Henry Schein Foot and Ankle. Group purchasing pricing equates to lower prices on medical supplies, orthopaedic goods, pharmaceuticals and equipment. Of course this premier pricing plan includes the highest level of service, next day delivery to 90 percent of the country, free shipping on orders over $100 and even a free cost-savings analysis with your current supplies.

To see how Henry Schein is a valuable partner to your practice’s success and to receive your free cost-savings analysis, call (800) 323-5110 or email Ryan Crothers at Henry Schein.
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Foot and Ankle Surgery


Percutaneous Tenotomy for the Treatment of Diabetic Toe Ulcers
A recent study has found that percutaneous tenotomy is a safe and effective technique for treating toe ulcers in patients with diabetic neuropathy. Researchers came to that conclusion after retrospectively analyzing the medical records of 83 patients who underwent 160 tenotomies for four indications. The study found that the healing rate for the 103 tip-of-toe ulcers treated with lexor digitorum longus tenotomies was 98 percent after four weeks, though transfer lesions in 8 percent of these ulcers required additional tenotomies. In the 26 extensor digitorum longus tenotomies used to treat cock-up/dorsal ulcers, the healing rate was 96 percent after four weeks. Healing at four weeks was 81 percent in the 21 kissing ulcers treated with extensor digitorum longus and/or flexor digitorum longus tenotomies. However, no healing was observed in the 10 plantar metatarsal ulcers treated with extensor digitorum longus with or without flexor digitorum longus tenotomy. As a result, researchers concluded that percutaneous tenotomy was not effective in treating plantar metatarsal ulcers.

From the article of the same title
Foot & Ankle International (10/13) Tamir, Eran; Vigler, Mordechai; Avisar, Erez; et al.
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Bear Down on Retained Surgical Items, Joint Commission Says
An organization that accredits U.S. hospitals and other healthcare organizations has released a report that includes recommendations for how to prevent the unintended retention of foreign objects (URFOs) during surgery. Among the recommendations included in the Joint Commission's Sentinel Event Alert is for hospitals and other healthcare organizations to draw up a set of policies and procedures that operating room staff members can use to count surgical objects before and after a procedure. Accurately counting these objects by having two staff members perform counts audibly and visibly, among other steps, will help reduce the number of surgical objects that are accidentally sealed inside patients' bodies. The Joint Commission also recommends that doctors inspect their surgical instruments for signs of breakage to ensure that pieces of those instruments have not snapped off inside their patient's body. Using surgical instruments and supplies that are made of material that shows up more clearly on X-rays and attaching radio frequency identification (RFID) tags to surgical objects will also help operating room personnel find these objects should they get lost, the report said. Finally, the commission urged operating room teams to hold meetings before a procedure as well as afterward to allow personnel to raise concerns about the possibility of an URFO.

From the article of the same title
Medscape (10/17/13) Lowes, Robert
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Practice Management


4 ICD-10 Staffing Strategies
Experts say there are four steps hospitals and health systems can take to ensure that they train and retain their medical coders ahead of the transition to ICD-10. For starters, hospitals and health systems should manage their productivity expectations by adjusting their productivity targets to allows coders to learn and practice using ICD-10 during the regular work day. In addition, hospitals and health systems should figure out how to get coders to work at their existing levels of proficiency in order to ensure that their productivity will not be negatively impacted, says Nelly Leon, the American Hospital Association's (AHA) director of coding and classification. The second step is for hospitals and health systems to bring in new staff members and allow existing ones to work additional overtime in order to meet compliance standards while training coders on ICD-10, says George Argus, who works with medical coding and classification strategies at AHA. Third, hospitals and health systems should check to see what their competitors are paying medical coders so that they are able to offer competitive benefits and retain employees, experts say. Finally, experts say hospitals and health systems should work to overcome the resistance some older coders have towards the transition to ICD-10 by using computer-assisted editing software that suggests answers for coding and helps employees spend less time worrying about making mistakes.

From the article of the same title
HealthLeaders Media (10/21/13) Rice, Chelsea
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Before Selling a Physician Practice, Weigh Tax Risks Carefully
Physicians who are considering selling their practices should take into account the tax implications of such sales. One consideration that should be made is whether the sale should be structured as a sale of assets or stock. Capital gains taxes may be an issue with stock sales if the current stock price is higher or lower than the price paid for the stock. The difference between the two prices is treated as a capital gain, even if the current stock price is higher than the price paid, and is taxed at a rate that ranges from 15 percent to 23.8 percent. If the sale is structured as an asset sale, physicians should take into account the valuation of their assets. Physicians who sell their practice will recognize a taxable gain or loss based on the difference between the allocated sale price and the tax basis of the practice's assets and liabilities. But as important as taxes are, they are not the only issue that physicians need to take into consideration when selling their practices. Attorney Neil S. Maxwell says that doctors should spend the year before a sale getting their practices in order so that they can get the best price possible from a prospective buyer. Maxwell also says that doctors should spend a year performing extensive planning and research before signing a contract.

From the article of the same title
Health Leaders Media (10/15/2013)
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Health Policy and Reimbursement


HealthCare.Gov ‘Will Be Running Smoothly’ By End of November, Zients Predicts
The leader of the effort to correct the problems with HealthCare.gov, Jeffrey Zients, says that the issues with the health insurance marketplace can be corrected and that the site will be running smoothly for all users by the end of this month. Zients said the team of experts working on the site are focusing on resolving issues on what he called a "punch list," which includes performance problems as well as "back end" issues. Zients did not provide any details about the specific nature of those problems. However, Zients did note that as few as 30 percent of users have been able to successfully sign up for health insurance coverage through HealthCare.gov. There have also been complaints from insurers who said that the system has sent them indecipherable or incorrect "834" forms, which are used to inform insurers that a patient has enrolled in a plan. Some problems have already been corrected. The site's enterprise identity management (EIDM) function was initially having problems that made it difficult for many consumers to create accounts. However, 90 percent of users are now able to create accounts using the EIDM function, Zients said.

From the article of the same title
BNA Snapshot (10/25/2013)
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Hearing with HealthCare.gov Contractors Reveals Last-Minute Changes, Late Testing
The House Energy and Commerce Committee held a hearing on Oct. 24 where executives from companies involved in the development of Healthcare.gov testified about the problems with the federal health insurance exchange and the steps that are being taken to fix them. Among those who testified at the hearing was CGI Federal Senior Vice President Cheryl Campbell, who noted that her company performed eight technical reviews before Healthcare.gov was launched on Oct. 1 and that it delivered the features that the Centers for Medicare and Medicaid Services (CMS) asked for to allow consumers to enroll in health insurance plans through the exchange. But Campbell conceded that her company and others involved in the launch of the exchange did not have several months for end-to-end testing of the system as they would have liked but instead only had several weeks. However, Campbell also said that the problems with the system are slowly being resolved and that her company is continuing to take steps such as reviewing system logs, fine-tuning servers, and analyzing code in order to rectify any remaining problems. Ranking member Rep. Henry Waxman (D-Calif.) said he believed that consumers will be able to sign up for plans through the exchange by mid-December, though Committee Chairman Rep. Frank Upton (R-Mich.) said he was concerned that the problems could only be a harbinger of additional problems with the implementation of the Affordable Care Act.

From the article of the same title
Modern Healthcare (10/24/13) Zigmond, Jessica; Conn, Joseph
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White House Turns to Insurance Industry Leaders for Advice on Fixing Federal Exchange
A number of insurance company executives met with Health and Human Services Secretary Kathleen Sebelius and other Obama administration officials on Oct. 23 to discuss ways to correct the problems with the federal health insurance exchange. The meeting specifically focused on the uneven implementation of the ASC X12 834 benefit enrollment and maintenance transaction, which was developed by the American National Standards Institute's Accredited Standards Committee. Problems with the implementation of this feature have in turn created problems with the communications between the exchange and insurance companies in the 36 states with federally-operated exchanges. Insurance companies that are participating in the exchanges, as well as the Centers for Medicare and Medicaid Services (CMS) and the primary contractor for the project are all working together to correct the problems. The meeting was part of the so-called "tech surge" that the Obama administration announced in response to reports of problems with the federal exchange, including reports of health insurance companies receiving inaccurate and incomplete information from the site. That effort includes a number of outside experts who are working to fix the problems with the federal exchange.

From the article of the same title
Modern Healthcare (10/23/13) Conn, Joseph
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Americans Will Have an Extra Six Weeks to Buy Health Coverage Before Facing Penalty
The Obama administration announced Oct. 23 that Americans who purchase insurance coverage through online health insurance marketplaces will have until March 31 to sign up for a plan before they face a penalty--a move which extended the deadline for purchasing insurance coverage by six weeks. Officials said that the move is intended to clear up confusion regarding the point at which penalties will kick in for consumers who do not have health insurance coverage as mandated by the Affordable Care Act. Until the administration's announcement, it had been unclear whether consumers needed to have signed up for health insurance by the time exchange's open enrollment period ended on March 31 or if their policies needed to take effect by that date. The administration's announcement means that consumers will simply have to purchase a policy by the end of the open enrollment period to avoid a penalty. Officials stressed that the six-week extension was not related to problems with the federal health insurance exchange, HealthCare.gov. CGI Federal, the primary contractor behind the exchange, has taken partial blame for the problems but said that the Centers for Medicare and Medicaid Services is ultimately responsible for the site's overall performance. CGI Federal also blamed the contractor Quality Software Services for the problems that made it difficult for some consumers to sign up for coverage when the site launched on Oct. 1.

From the article of the same title
Washington Post (10/23/13) Somashekhar, Sandhya; Goldstein, Amy; Eilperin, Juliet
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Running Out of Time
Experts say that the Department of Health and Human Services (HHS) is quickly running out of time to correct the problems that have plagued the online health insurance exchanges that launched earlier this month. These experts say that HHS likely only has until early- to mid-November to address the issues so that by mid-December consumers can sign up for health insurance coverage that takes effect on Jan. 1. If HHS fails to adhere to this timetable, experts say, it could spell political trouble for the Affordable Care Act (ACA) and could also mean that healthcare reform will be unable to meet certain milestones that have been set by President Obama. According to American Enterprise Institute resident fellow Tom Miller, congressional Republicans could have a stronger argument for delaying the ACA's individual mandate if HHS is unable to make the exchanges run better by Jan. 1, since they will be able to argue that it is unfair to punish people for not having health insurance coverage if they are unable to buy policies through the exchanges. Meanwhile, Federation of American Hospitals President and CEO Chip Kahn said that a large number of potential enrollees may not sign up for coverage through the exchanges unless the problems are quickly rectified. He added that it appears unlikely at this point that 7 million Americans will sign up for health insurance coverage under ACA by next year as the president had hoped.

From the article of the same title
Modern Healthcare (10/19/13) Zigmond, Jessica
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Reform Update: Providers Wary of New Budget Panel
Several healthcare industry observers are warning that the short-term budget agreement that President Obama signed to end the federal government shutdown could have a negative impact on healthcare providers and insurers. Among those concerned about the agreement, which retains the budget sequester cuts that have significantly impacted healthcare providers and insurers, is American Hospital Association Executive Vice President Rick Pollack. Pollack said he fears that the conference committee established by the budget agreement will approve a deficit-reduction package that would mitigate the effects of the sequester but will do so in a way that could hurt providers. Others say that the budget agreement signed by the president means that it is unlikely that the Medicare sustainable growth-rate formula will be repealed. Meanwhile, Eric Zimmerman, a partner with the firm McDermott Will and Emery, also said that providers could face greater cuts as a result of any agreement reached by the conference committee. Zimmerman noted that it is no coincidence that the short-term budget agreement funds the federal government until Jan. 15, which is the same day that the next set of sequestration cuts are scheduled to take effect. Aligning the end of the short-term budget agreement with the implementation of sequestration cuts will give lawmakers from both parties the opportunity they want to reopen the sequestration mandate, Zimmerman said.

From the article of the same title
Modern Healthcare (10/18/13) Zigmond, Jessica
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Medicine, Drugs and Devices


Achilles Tendinopathy Management
British researchers have performed a pilot randomized controlled trial that examined whether it will be feasible to conduct a larger trial that will examine the difference in Victorian Institute of Sports Assessment-Achilles (VISA-A) scores in Achilles tendinopathy patients who were treated with platelet-rich plasma (PRP) and those treated with an eccentric loading program. During the pilot study, 20 mid-substance Achilles tendinopathy patients with an average age of 49 were randomized to receive either a PRP or an eccentric loading program and had their outcome measures recorded at baseline, six weeks, three months and six months. Researchers expected no statistical difference in the mean VISA-A scores in the two groups after six months, and that was what they observed. Researchers said the pilot study played an important part in providing data to inform a larger study. The pilot study also showed that the methodology that will be used to perform the larger trial is feasible.

From the article of the same title
Bone & Joint Research (10/13) Vol. 2, No. 10, P. 227 Kearney, R.S. ; Parsons, N.; Costa, M.L.
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In Vivo Measurement of Human Achilles Tendon Morphology Using Freehand 3-D Ultrasound
A new study has found that freehand three-dimensional (3D) ultrasound is capable of accurately measuring phantom volume and length and is also reliable in performing in vivo measures of Achilles tendon (AT) volume, length and average cross-sectional area. The study involved 13 participants who were scanned using freehand 3D ultrasound on consecutive days under active and passive loading conditions. A two-point method and a centroid method, which takes into account the curvature of the AT, were used to measure in vivo AT length. Researchers found that all intra-class correlations coefficients were higher than 0.98. The average minimally detectable change for in vivo AT volume was 0.2 mL. Average minimally detectable changes for two-point length and centroid length were 1.5 mm and 2 mm, respectively. Researchers determined that curvature of the AT has a minimal effect on in vivo AT length, as the two-point AT length underestimated centroid AT length by 0.7 mm.

From the article of the same title
Ultrasound in Medicine and Biology (10/13) Obst, Steven J.; Newsham-West, Richard; Barrett, Rod S.
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