News From ACFAS

---

Cultivate your surgical skills for traumatic foot and ankle encounters by attending the Trauma of the Foot and Ankle Surgical Skills Course, which takes place on November 10-11. Reinforce your techniques as you perform surgical procedures using state-of-the-art equipment, learn new solutions through an unmatched curriculum and practice contemporary techniques on cadavers.

As you work together in the lab with your peers, your faculty will share critical insights they’ve gained through their extensive experience. There will be additional time for panel discussions and case presentations afterward.

Download the course catalogue. Does your practice have a website? Have you recently changed your work, home or e-mail address, or phone or fax number? Do you want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other valuable ACFAS mailings? We want to stay in touch with you! Update your contact information at acfas.org/profile (member login required).

Your contact information can be listed in the College’s online membership directory so your colleagues can find you, and you can also be listed in the “Find an ACFAS Physician” search tool so consumers can find you on FootHealthFacts.org. After completing your professional profile to include your website, hours, and up to three office locations, scroll down to “ACFAS Website Listing” and check “Yes” for “Consumer Physician Search” and “Members-Only Directory.”

Change can be a wonderful thing, but remember to let us know about any updates so you can keep yourself available to peers, potential patients and the College! Update your profile today. Visit the Journal of Foot & Ankle Surgery's online home page at acfas.org/jfas and click “Read Current and Past Issues Online,” then "Articles in Press" to get a leg up on the latest research in your profession. New articles are available as soon as their proofs have been approved — even before they're assigned to an issue.

Enjoy tomorrow’s news today, including original research, case reports, tips, quips and pearls. It's quick and easy with your free member access!

Foot and Ankle Surgery

---

A study was held to assess the outcomes of patients who have undergone arthroscopic treatment for mild to moderate ankle osteoarthritis and to determine the variables associated with unsuccessful outcomes. Analysis was performed on 63 patients with mild to moderate ankle osteoarthritis who underwent arthroscopic treatment. The possible correlations between the clinicopathologic features and clinical outcomes were investigated using the visual analog scale for pain and AOFAS Ankle-Hindfoot score, while the data was analyzed to clarify the impact of prognostic factors on clinical results. Visual analog scale and AOFAS scores were improved post-surgery for up to two years. The biggest improvements in clinical scores were seen after six months, followed by a steady decline thereafter. Body mass index and presence of associated intra-articular lesions exhibited a significant correlation with the clinical outcome. No association was observed between outcome and the patient's age, sex, duration of symptoms, type of osteoarthritis, treatment modality and coronal alignment.


A study was performed to reassess the visualization frequency of the sinus tarsi ligaments and to characterize their morphology on isotropic three-dimensional proton density imaging (3-D-PD). The purpose was to test the theory that use of 3-D-PD would demonstrate these ligaments in almost all pediatric patients. Patients were imaged on either 1.5- or 3-Tesla scanners using 3-D-PD, and 50 of the 174 reviewed patients satisfied inclusion and exclusion criteria. Successful visualization and characterization of the interosseous talocalcaneal ligament (ITC), the cervical ligament (CL) and the roots of the inferior extensor retinaculum (IER) were executed in three planes in 100 percent of the patients. Average ligament thickness was 4.22 mm for the ITC, 2.74 mm for the CL and 1.04 mm for the IER roots.


Researchers assessed the intra- and inter-rater reliability of a modified weight-bearing lunge measure of ankle dorsiflexion range of movement. Thirteen healthy subjects were recruited for the study. Each subject performed three repetitions of the lunging method with one rater and three more repetitions with a second rater within 30 minutes. The process was repeated within three hours. Intra-rater reliability results indicated excellent correlation of measurements (intraclass correlation coefficients (ICCs) of 0.98–0.99). Standard error of measurement (SEM), 95 percent limits of agreement (LOA) and coefficient of repeatability (CR) calculations indicated suitably low ranges of measurement variance (SEM = 0.4 cm, LOA = ±1.28 to ±1.47 cm and CR = 1.21–1.35 cm). Inter-rater reliability was also deemed excellent (ICC = 0.99, SEM = 0.3 cm, LOA = ±0.83 to ±1.47 cm, CR = 1.44 cm).

Practice Management

---

Physician practices can viably use social media platforms to market themselves, according to physicians interviewed by PhysBizTech. Dr. Neil Baum, a New Orleans-based urologist, said he spends 30 minutes a week writing a blog post that he pushes to other social media sites in order to up his practice's "search engine optimization." He does this, he said, by using "keywords, meta tags, links on" web pages and catchy titles, so that if a web user searches for "New Orleans" and "vasectomy," for instance, Baum's practice will be one of the top search results. He said he also engages his readers with more frank topics that are likely to catch peoples' attention, and then asks them to take action in the form of sending Baum an email if they want more information. "I am converting them from viewers to someone who is engaged in my website or blog," Baum added.

Dr. Jenny Conviser, co-director of Insight Psychological Centers and Inspire Health Centers in Chicago, along with her staff uses the social network Pinterest to reach "the population we see so much of -- to communicate where they are." Conviser added that Pinterest, which had 11.7 million unique users in 2012 and is the third-largest social network in the United States, has been "enormously successful" for her organization, and that it has provided a platform for delivering quality information about health and wellness.

North Carolina-based family physician Dr. Stephen Meyers, meanwhile, is currently working on a project called CHASM: Cultivating Healthcare Affordability with Social Media, which he says is the first social media initiative of its kind for education and collaboration on improving the quality of care and lowering healthcare costs. Meyers said social media does have "potential for benefit," but also noted that it is difficult for doctors to genuinely engage with their patients while privacy issues still remain so prevalent.


This article lists some of the reasons why some physicians prefer outsourced medical billing service. Medical billing specialists are trained to make billing procedures more efficient and ensure the highest quality and accuracy. This leaves healthcare providers with ample time to focus on their core responsibility of engaging patients rather than worrying about revenue collection. Another reason to outsource medical billing service would be cost reduction or cost effectiveness. Running an in-house billing department drives up overhead and often requires the already-existing staff to take on billing responsibilities, which wastes valuable time. Moreover, there have been instances where in-house billing departments have caused numerous claims denials. Studies show that outsourcing medical billing service can significantly reduce the number of denials, and a supporting evidence of this finding would be fewer coding errors. Interestingly, the established medical billing service provides and supplies physicians with financial reports -- helping them to gauge the financial health of their practice and also to develop strategies to increase practice productivity.


Some of the largest transition issues that physicians and their practices face include establishing the practice's value, building value within the practice and deciding when to hire a new physician to fill the spot of one who is retiring. Unlike a manufacturing company, a physician's practice is a service organization that creates little tangible value or products, and it is frequently argued that the only value is that of the individual physician's reputation which by definition makes the practice valueless once the physician retires. A practice is more valuable, therefore, when patients identify and have a strong connection with the entire staff rather than with only a single physician. Physicians who have their patients see or at least meet their partners actually add value to the practice as a whole, research shows. In the case of physician practices, the sole value is patient loyalty in conjunction with name recognition and the practice's reputation. If a transition is expected, it is of utmost importance that a new physician is hired well before the retiring physician leaves. The practice must guarantee that the new hire fits within the practice's culture and also that the patients are comfortable with the transition. Once you click the Web link, you can read a recent example in which a physician retired and his replacement was hired less than two months beforehand. This did not leave adequate time for a transition, and many clients were unsettled at the abrupt change, the writer states.

Health Policy and Reimbursement

---

Patterns of care vary widely among 23 top U.S. academic medical centers, according to a report from the Dartmouth Atlas Project. The report's authors suggest that these variations may be something medical students want to consider when choosing an institution for residency training. The report used 2010 Medicare data as well as Medicare data from 2008 to 2010 for surgical procedure measures and the U.S. Department of Health and Human Services Hospital Compare website for patient experience, patient safety and pneumonia-care quality comparisons.


The Center for Medicare Advocacy (CMA) has announced the settlement of a federal class action lawsuit in Vermont against the federal government that will end the practice of Medicare paying for skilled nursing, home health services and outpatient therapy coverage to Medicare beneficiaries only if their condition is expected to improve. CMA challenged the “Improvement Standard,” which is an interpretation of the Medicare Act the government used to deny coverage for tens of thousands of Medicare beneficiaries with chronic diseases when their condition was not expected to improve.


Sixty lawmakers are urging the Centers for Medicare & Medicaid Services (CMS) to drop plans for a proposed cut in physician payments when similar clinical activities are performed at the same facility on the same day. The expansion of multiple-procedure payment reductions and a 25 percent cut in the technical component for “potentially redundant direct practice expense inputs” were proposed earlier this year, and a final rule is expected in November. The first version of the payment cut for potentially redundant services, which was proposed last year as a cost-saver by the Medicare Payment Advisory Commission, was directed at radiology and will take effect Jan. 1. In a letter to acting CMS Administrator Marilyn Tavenner, the lawmakers reiterated a long-standing physician criticism: that the cut targets actions that are not redundant but required by different physicians in different parts of a practice or hospital for individual reasons aimed at providing comprehensive care for their patients.


Individual physicians, eligible professionals and selected group practices may apply online for a hardship exemption under the 2013 Medicare Electronic Prescribing Incentive Program from Nov. 1 through Jan. 31, 2013. This exemption includes an exemption category for physicians and other practitioners who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program and adopt certified EHR technology. Eligible professionals who do not meet the program's requirements or qualify for an exemption face a 1.5 percent reduction in their total allowable Medicare Part B charges effective Jan. 1, 2013. For help applying online, see the Centers for Medicare & Medicaid Services user guide and website.

Medicine, Drugs and Devices

---

All bloodstream infections were cut by 44 percent through universal bathing of all ICU patients with antibacterial agents rather than screening them for methicillin-resistant Staphylococcus aureus (MRSA), according to a study performed at 43 hospitals. Patients were treated with three strategies in the study: Nasal screening for MRSA and isolation of patients testing positive for colonization; screening, isolation and decolonization with chlorhexidine baths for five days and mupirocin for five days; and mupirocin treatment and daily chlorhexidine baths with no prior screening.

Effects using the standard screening protocol were monitored for 12 months, with 48,390 patients observed, and the outcomes in those patients were compared with a second intervention period involving 74,256 patients. Patients assigned to standard treatment developed bloodstream infections at the rate of 16.8 per 1,000 patients during the baseline period, while following intervention the rate of infection in those patients dropped by about 1 percent. The rate of infection fell by 22 percent in patients assigned to standard screening combined with antibacterial treatment, and by 44 percent in those assigned to universal antibacterial treatment.


There is no apparent connection between calcium supplements widely prescribed for bone health in women and cardiovascular risk, according to research presented at the ASBMR Annual Meeting. Analysis was based on outcomes for 74,272 women who filled out a food questionnaire in 1984, where participants itemized their routine intake of food, beverages and dietary supplements, and calcium was reported in four-year increments. Harvard Medical School's Julie Paik reports that the relative risk for cardiovascular disease was 0.86, and over the course of 24 years a total of 4,662 cardiovascular events occurred; 2,855 events were related to coronary heart disease, with 748 resulting in death, while 1,807 were strokes, 1,409 of which were ischemic. No significant risks for cardiovascular disease, nor any associations for stroke subtypes, were identified in an analysis studying outcomes for women who took more than 1,000 mg of calcium daily.