November 2, 2011

News From ACFAS

Join at No Cost: Free Webinar on PQRS
On Monday, Nov. 14, 2:00-3:00 p.m. ET, the American Hospital Association's Physician Leadership Forum is offering a free webinar on quality reporting for additional Medicare reimbursement, “Physician Quality Reporting: Getting Started and Driving Improvement.”

Physicians who successfully report quality measures are eligible to receive a 0.5 percent increase in their Medicare payments from 2012 through 2014. Physicians who do not report by 2015 will be subject to a 1.5 percent payment penalty. Quality reporting is also required to receive incentive payments under the Medicare and Medicaid Electronic Health Record program, and to participate in accountable care organizations, bundled payment and other reform initiatives.

Only 20 percent of physicians participate in the Medicare Physician Quality Reporting System (PQRS). Learn how using it in hospitals and clinics can drive performance improvement. Two physicians who are medical center administrators will share experiences and answer questions. In addition, staff will summarize key changes in the Nov. 1 release of the 2012 Medicare Physician Fee Schedule Final Rule, especially those related to physician quality reporting.

Click here to register. Questions? Contact Dan Paloski at 312-422-2914 or
Share Facebook  LinkedIn  Twitter  | Web Link
Recruiting Practices for ACFAS Multisite Study
If you'd like to contribute to the future of your profession, the College is recruiting investigative sites for a new multi-center retrospective study on predictive variables associated with successful and unsuccessful outcomes of subtalar joint arthroereisis in adults and children. Subjects and sites will be compensated for their time. To participate, please complete and return the application on the ACFAS website.

Criteria for site selection include:
  • Required one-year contractual commitment by the investigative site.
  • Primary investigator at each site in good standing with ACFAS.
  • Volume and variety of patients treated for symptomatic non-neuromuscular flatfoot with subtalar arthroereisis during the past 10 years.
  • Past participation in multi-center studies.
  • Professional reputation for scholarly activity.
Share Facebook  LinkedIn  Twitter  | Web Link
2012 Dues Reminders in the Mail
It’s that time of year again, and dues reminders for the 2012 calendar year of membership have been mailed to all members. Dues can be paid online now, or by mail or fax once your reminder arrives at your home or office. Payment is due by Dec. 31, 2011.

Be sure to take full advantage of all ACFAS to offer, now and throughout the year. Visit the ACFAS Member Center to learn more about the benefits your membership provides. To pay your dues online, visit

College membership brings you in contact with the best and the brightest foot and ankle surgeons in the world. Here’s to another great year of value in your membership!
Share Facebook  LinkedIn  Twitter  | Web Link

Legal Briefs

Hospital Operator Not Entitled to Dismissal of Doctor's Lawsuit for Breach of Contract
The U.S. District Court for the Western District of North Carolina has denied a hospital operator's motion to dismiss a breach of contract action filed by a physician it recruited to start a sports medicine practice, but never paid. In York v. Health Management Associates, the court rejected defendant Health Management Associates' (HMA) assertion that it was entitled to judgment as a matter of law because Dr. John York never fulfilled a condition precedent that required him to obtain a North Carolina medical license before the contract would take effect. HMA recruited York to start a sports medicine practice in Statesville, N.C. The parties signed a physician employment agreement. After signing the agreement, York worked with HMA personnel to complete and submit paperwork for his medical license application to the North Carolina Medical Board. York relocated his family, and while waiting for approval of his license application, began setting up his practice, meeting with referrals, and marketing the new practice, as required by the contract.

HMA never paid York any part of his salary, relocation expenses, or commitment bonus. York was told that no payments would be made until he received his medical license. York sued HMA for breach of contract. The hospital operator alleged a ‘Condition Precedent’ but a contract governed by North Carolina law will not be construed as such unless the contract language clearly required such, it said. Here, the contract did not contain an explicit provision that required York to obtain a medical license. The court found, however, that rather than creating a condition precedent, the agreement created a covenant for York to obtain a license, with the implication that it must be done within a reasonable period of time to avoid a breach of contract. HMA's argument, the court said, ignored the fact that the contract required York to perform duties outside the scope of North Carolina's definition of “practice of medicine," including promoting, developing, and extending the sports medicine practice and participating in community outreach programs. Because the contract required York to engage in activities outside the practice of medicine, obtaining a license need not be deemed a condition precedent to the contract, the court concluded.

From the article of the same title
BNA Health Care Policy Report (10/27/11)
Share Facebook  LinkedIn  Twitter  | Web Link - Publication Homepage: Link to Full Text Unavailable

Foot and Ankle Surgery

Evoked Spinal Reflexes and Force Development in Elite Athletes With Middle-Portion Achilles Tendinopathy
Research was performed to compare the neuromuscular function of the triceps surae muscle bilaterally in elite athletes with unilateral chronic Achilles tendinopathy, focusing on 14 college athletes exhibiting this condition. Bilateral quantifications of soleus reflex tests, including H-reflex and V wave, and rate of force development (RFD) were carried out, along with corresponding electromyography of the tibialis anterior and triceps surae muscles. For statistical analysis, within-subject and between-leg comparisons were executed. The V wave of the soleus muscle was significantly increased in the leg with tendinopathy, while a reduced normalized RFD (0-30, 0-50, and 0-100 ms) in plantar flexion was observed in the side with tendinopathy. Concomitant higher electromyography ratios between the tibialis anterior and soleus (0-30 and 0-50 milliseconds) also were seen during the early stage of explosive contractions. No significant differences were detected for H-reflex, maximal plantar flexion, and dorsiflexion torque, and absolute RFD.

From the article of the same title
Journal of Orthopaedic & Sports Physical Therapy (10/01/2011) Vol. 41, No. 10, P. 785 Wang, Hsing-Kuo; Lin, Kwan-Hwa; Wu, Yu-Kuang; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Free-Flap Resurfacing of Tissue Defects in the Foot Due to Large Gouty Tophi
A study was held to review the results of free-flap reconstructive surgery for treating the metatarsal joint defects of the feet caused by chronic tophaceous gout. Analysis was done of 10 patients with large tophus masses and ulceration on the feet admitted to a hospital between September 2006 and September 2010. Free-flap reconstruction was administered to six patients following debridement to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for exposed tendons. The average patient age was 49.8 years while average skin defect size was 92.2 square centimeters. Five subjects were treated using free anterolateral thigh flaps, and one was treated using a free medial sural flap. The flaps were safely raised and exhibited excellent functional and cosmetic results, with an average follow-up of 31.7 months.

From the article of the same title
Microsurgery (10/18/11) Lin, Chin-Ta; Chang, Shun-Chen; Chen, Tim-Mo; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

The Non-operative Functional Management of Patients With a Rupture of the Tendo Achillis Leads to Low Rates of Re-rupture
Evaluating the long-term rate of re-rupture following management of a tendo Achillis rupture with a non-operative functional protocol was the purpose of research that reports the results of 945 consecutive patients, or 949 tendons. The cohort consisted of 255 females and 690 males with an average age of 48.97 years, and delayed presentation was defined as establishing the diagnosis and starting treatment more than 14 days after injury. The overall rate of re-rupture was 2.8 percent or 27 re-ruptures, with a rate of 2.9 percent or 25 re-ruptures for those with an acute presentation and 2.7 percent or two re-ruptures for those with delayed presentation.

From the article of the same title
Journal of Bone and Joint Surgery (10/01/2011) Vol. 93B, No. 10, P. 1362 Wallace, R.G.H.; Heyes, G. J.; Michael, A.L.R.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management

Doctors Need More EHR Training, Survey Suggests
AmericanEHR Partners conducted an online survey where doctors from a selection of different medical societies filled out a questionnaire about using their electronic health record (EHR) system between April 2010 and July 2011. The results indicated that to achieve a level of familiarity that would allow doctors to meet meaningful use requirements for incentives, a training period of at least two weeks was needed. Nearly half of participants indicated that they only received three days of training or fewer, which the survey results indicated was the minimum amount of time for a doctor to feel as though the EHR was satisfying expectations.

From the article of the same title
Modern Healthcare (10/21/11) Robeznieks, Andis
Share Facebook  LinkedIn  Twitter  | Web Link

Electronic Records May Increase Malpractice Lawsuit Risk
Electronic health records (EHRs) may lower medical liability for some errors, but could create new kinds of liability and expose existing liability issues, according to a new report from the AC Group. The study urges federal officials to decelerate the federal Meaningful Use incentive program to get medical practices and hospitals to use EHRs, and the authors warn that the "artificially short deadlines" for deployment could heighten malpractice risks by prompting vendors to cut corners on developing products and rushing users through training.

The authors reviewed 65 ambulatory EHRs certified to meet federal 2011 Meaningful Use standards and learned that over 90 percent failed to offer "adequate medico-legal training" and that 95 percent raised specific legal issues; they wrote that "technology is advancing more rapidly than our ability to identify and address the medico-legal issues. The result of this uneven progression is that physicians and other stakeholders may be unknowingly exposed to medical liability risk." The authors advise EHR vendors to "strongly consider" external reviews of products for potential medical malpractice issues their clients could face.

From the article of the same title
InformationWeek (10/25/2011) Versel, Neil
Share Facebook  LinkedIn  Twitter  | Web Link

MGMA: Patient Safety Checklists Cut Costs at Physician Practices
Physician practices can boost their efficiency and their bottom lines by developing patient safety checklists that cover emergent events and routine activities, according to Elizabeth Wertz Evans of the Oncology Nursing Society in Pittsburgh, speaking at the annual conference of the Medical Group Management Association. She listed four steps a physician practice should take when developing such a checklist:
• Create the best checklist for the task at hand.
• Keep the list short, precise, and practical, with five to nine easy-to-remember items.
• Concentrate on critical items, such as medication or that the correct patient records are in the examining room.
• Practice the checklist to identify tasks that may not be properly executed or are obsolete.

From the article of the same title
HealthLeaders Media (10/26/11) Tocknell, Margaret Dick
Share Facebook  LinkedIn  Twitter  | Web Link

Residents' Desire for Hospital Employment Poses Recruiting Challenge for Practices
Group practices that do not offer rapid pathways to partnerships are losing appeal among residents, and a recently released Merritt Hawkins survey found that hospital employment is the most popular choice among residents nearing the conclusion of their training. "Physicians who want to be in a partnership ... [are] looking for partnership with some stability where it is possible to buy into the surgery center or the imaging center," notes Merritt's Troy Fowler.

Small practices may especially have to make a significant effort to attract a new physician, with Fowler saying that demonstrating a stable, growing practice and quality of life is key. "The stability would come from a practice that generates most of their collections from commercial insurance, as Medicare cuts are looming," he says. "The ideal quality of life would be a four-day workweek with little to no call. Financially, they would need to offer employment plus production bonus and would need to be above the 50th percentile for their specialty."

From the article of the same title
American Medical News (10/24/11) Elliott, Victoria Stagg
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement

Doc Pay Cut Revised Down to 27.4 Percent
An across-the-board Medicare payment reduction of 27.4 percent is expected, according to a new fee schedule released by the Obama administration, slightly less than the 29.5 percent cut the administration had previously anticipated. Another announced change will implement the third year of a four-year transition to new practice expense relative value units. Separately, the CMS proposed changes to several physician incentive programs, including the physician quality reporting system, the e-prescribing incentive program, and the electronic health-records incentive program.

Additional payment changes announced Tuesday include small increases in payments for the annual wellness visits of Medicare beneficiaries; changed values for 300 physician fee-schedule service codes deemed “misvalued”; and adjustments to the system used to tweak Medicare payments to account for varying local practice costs. Another change would reduce some imaging payments by up to 50 percent for repeated scans within the same visit.

From the article of the same title
Modern Healthcare (11/01/11) Daly, Rich
Share Facebook  LinkedIn  Twitter  | Web Link
Note from the College

ACFAS members should wait for an instructional letter from their Medicare Administrative Contractor (MAC) before revalidating their enrollment in Medicare. The MAC instructional letters will come in colored envelopes, to differentiate them from other CMS correspondence. Providers will be responsible for a $505 application fee for calendar year 2011 revalidations, and CMS will publish the CY 2012 application fee in an upcoming issue of the Federal Register. The first phase of the revalidation campaign began in the last two weeks of September, with contractors sending out 89,000 revalidation letters to providers not in the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Providers enrolled in PECOS can use that system to revalidate, rather than filling out the paper CMS-855 application. Future phases of the revalidation campaign will begin after Jan. 1. The new process will have CMS deactivate providers' numbers and reinstate them when it receives the required revalidation documents.

Study Evaluates Industry Payments to Orthopedic Surgeons
A report published in the Archives of Internal Medicine reveals that an analysis of financial payments made by orthopedic device manufacturers to orthopedic surgeons between 2007 and 2010 shows a reduction in the total number of payments, and the total funds distributed. Analysis also showed an increase in the proportion of consultants with academic affiliations. In 2005, the Department of Justice launched an investigation into payments made to orthopedic surgeons by the five largest makers of artificial hips and knees, reaching a settlement with these companies in 2007. Data made available by this settlement was used to examine the payments made by device manufacturers to orthopedic surgeons.

The research shows that mean payments from these device makers totaled $212,740 per surgeon in 2007. This total dropped to $193,943 in 2008, then increased again to $246,867 in 2009 and $233,108 in 2010. The proportion of surgeons with academic affiliations who received payments increased from 39.4 percent in 2007 to 44.9 percent in 2008. The researchers observed similar patterns in 2009 and 2010.

From the article of the same title
Ortho Supersite (10/24/11)
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices

Big Rig Full of Cadavers Excites LA Doctors
The nation's first mobile cadaver lab stopped next to Valley Presbyterian Hospital in Van Nuys, Calif., recently, demonstrating medical equipment while giving surgeons a chance to practice on real bone and tissue. The mobile cadaver lab allowed attending doctors and residents a chance to practice foot fusions. "I think it's one of the greatest skills to learn," said Dr. Ronald Belczyk of the hospital's Amputation Prevention Center, who gave a surgical demonstration for resident surgeons. "You can't reproduce exactly with a (bone) saw to Styrofoam. ... But you can with a cadaver. This is as close as it gets." Inside the lab, three teams of doctors practiced the procedure, while on nearby tables stood trays of screws, pins, jigs, plates and tools, including a cartilage remover.

From the article of the same title
Los Angeles Daily News (10/25/11) Bartholomew, Dana
Share Facebook  LinkedIn  Twitter  | Web Link

RFID Tags Used to Prevent Post-Op Mistakes by Hospitals
The University of North Carolina hospitals recently adopted a radio frequency identification (RFID) tagging system to prevent surgical instruments from being left in patient bodies following surgery. In this system, providers place a detection mat under a patient and after surgery, conduct a scan of the patient's body. All surgical devices are stamped with RFID tags, and are identified on the scan if they are still in the surgical cavity or elsewhere in or on the body.

From the article of the same title
Fierce Mobile Healthcare (10/20/11) Jackson, Sara
Share Facebook  LinkedIn  Twitter  | Web Link

Systems Study Med-Mal Self-Insurance
More healthcare systems are evaluating the advantages and costs of supplying malpractice coverage for physicians via in-house self-insurance plans amid the intensifying trend toward doctor empowerment by hospitals. A joint Aon/American Society for Healthcare Risk Management analysis finds that physicians insured by hospital-employers tend to have reduced liability loss rates versus their counterparts on commercial malpractice plans, although hospitals also assume added administrative burdens and general risk in the process.

Nearly three-quarters of hospitals in the study reported insuring their doctors in-house, and 24 percent employed commercial medical malpractice carriers and the rest used some mix of both. The mean loss rate for employed doctors on their hospitals' insurance plans was $6,100 last year, compared to $15,810 for physicians on commercial plans. Administrative simplicity and the courtroom benefits of having doctors and hospitals use the same defense teams in trials translated to additional savings.

From the article of the same title
Modern Healthcare (10/25/11) Carlson, Joe
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Copyright © 2011 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe click here.

Abstract News © Copyright 2011 INFORMATION, INC.
Powered by Information, Inc.