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This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Medicine, Drugs and Devices

News From ACFAS

Election Results: What It Might Mean for Healthcare

Republicans added more governors, won at least 60 additional seats in the House, capturing the majority, and now have at least 46 Senate seats, with three races yet to be finalized. What could this mean for the Obama healthcare agenda? Common sense says that although the law is unpopular with many, several components are very popular. Look for the GOP majority in the House to flex their muscle on the appropriations end. Without funding, much of the law can’t be implemented.

ACFAS members realize it's more important than ever that Congress act to permanently to fix Medicare reimbursement rates for physicians. Lawmakers return to Capitol Hill Nov. 15 for another round of likely temporary solutions. Let your existing or newly-elected representatives in Washington know your point of view!

In last week’s news, Title XIX was accidentally written as Title IX. This Week regrets the error.
FootHealthFacts a Hit on Medline, the ACFAS consumer information website, got more than 5,300 visitors from links on NIH web pages in September 2010.

In fact, ACFAS is one of the most-cited sources on NIH’s Medline “Walking Problems” topic page. And, the “Find an ACFAS Physician” search engine at is the sole link for a physician in the page’s “Directories” listing.

The Pew Internet & American Life Project found that 83 percent of Internet users have searched for health information online. Make sure they find your practice by completing your online professional profile today on the ACFAS website!
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 January’s board election:
  • Darryl M. Haycock, DPM, FACFAS
  • Laurence Rubin, DPM, FACFAS
  • John S. Steinberg, 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.

Candidate information and ballots will be mailed no later than Dec. 24, 2010. Completed ballots must be returned to the ACFAS office by mail or fax no later than Jan. 24, 2011.

Visit the ACFAS website for more information on nominations and elections.
Recent Research at Your Fingertips

Get quick reads on recent research with ACFAS’ Scientific Literature Reviews. Podiatric residents have prepared concise reviews of articles from journals you may not commonly read. Current abstracts include:

Calcaneocuboid Joint Involvement in Calcaneal Fractures, from the Journal of Trauma.
Reviewed by R Abram Swensen, DPM, OCPM/UHHS Richmond Medical Center.

Treatment of Diabetic Foot Ulcers Using a Blood Bank Platelet Concentrate, from Plastic and Reconstructive Surgery.
Reviewed by Emily M. Wasko, DPM, OCPM/UHHS Richmond Medical Center.

Read these abstracts and many more at Scientific Literature Reviews.

Foot and Ankle Surgery

Acute Achilles Tendon Rupture: A Randomized, Controlled Study Comparing Surgical and Nonsurgical Treatments Using Validated Outcome Measures

Researchers compared outcomes of patients with acute Achilles tendon rupture treated with or without surgery using early mobilization and identical rehabilitation protocols. Ninety-seven patients with acute Achilles tendon rupture were treated and followed for one year.

There were 6 reruptures in the nonsurgical group and 2 in the surgical group. The mean 6- and 12-month ATRS were 72 and 88 points in the surgical group and 71 and 86 points in the nonsurgical group, respectively. Improvements in ATRS between 6 and 12 months were significant for both groups, with no significant between-group differences. At the 6-month evaluation, the surgical group had better results compared with the nonsurgically treated group in some of the muscle function tests, but at the 12-month evaluation there were no differences between the 2 groups except for the heel-rise work test in favor of the surgical group. At the 12-month follow-up, the level of function of the injured leg remained significantly lower than that of the uninjured leg in both groups.

The researchers concluded that there was no statistically significant difference between surgical and nonsurgical treatment. Furthermore, the study suggests that early mobilization is beneficial for patients with acute Achilles tendon rupture whether they are treated surgically or nonsurgically. The preferred treatment strategy for patients with acute Achilles tendon rupture remains a subject of debate.

From the article of the same title
American Journal of Sports Medicine (11/01/10) Vol. 38, No. 11, P. 2186 Nilsson-Helander, Katarina; Silbernagel, Karin Grävare; Thomeé, Roland
Web Link - May Require Paid Subscription | Return to Headlines

Comparison Between Distally Based Peroneus Brevis and Sural Flaps for Reconstruction of Foot, Ankle and Distal Lower Leg

Skin defects of the foot, ankle and distal lower leg often require coverage by local or distant flaps. Researchers compared functional outcome and donor-site morbidity following transfer of distally based delayed sural (DSFs) or peroneus brevis flaps (PBFs). Fifty-two patients (24 DSFs and 28 PBFs) were included in the study. At the end of the follow-up period (minimum 12 months), patients filled out a modified FAOS questionnaire.

The researchers found that total hospital stay and total number of operations were significantly lower in the PBF group. Minor flap necrosis was observed in 21 percent of the DSF and 7 percent of the PBF group, and partial or total flap loss occurred in one and three patients from the DSF group, respectively. Patient satisfaction, FAOS results and range of motion were comparable in both groups.

The researchers concluded that donor-site morbidity and functional outcome after DSF and PBF are comparable. A higher rate of complications was observed in the DSF group. They recommended PBF as the first-line procedure for reconstruction of small- to medium-sized defects at the distal tibia, fibula, ankle, and heel. The sural flap might be chosen for extended skin defects, especially when a larger arc of rotation is required.

From the article of the same title
Journal of Plastic, Reconstructive & Aesthetic Surgery (10/21/10) Kneser, Ulrich; Brockmann, S.; Leffler, M.; et al.

Practice Management

6 Tips for Selling Your Practice to a Corporation

Todd Neely, president of NanoImproved, and Marybeth Regan, an expert in disease and care management, offer six tips for physicians considering the sale of their practice to a corporation.

1. Retain an attorney or business agent who has genuine expertise in contract law and in contact negotiations of this type.
2. Be ready to walk away, even at a late stage of the negotiations.
3. Determine your business' value.
4. Be absolutely clear about what you are selling.
5. Do not complete the sale unless the contract specifies—with the terms defined reasonably precisely—what you are to receive, long-term as well as short-term.
6. Have your lawyer investigate times the company may have been sued by other physicians.

From the article of the same title
HealthLeaders Media (10/29/10) Neely, Todd; Regan, Marybeth

Accelerating the Pace of Surgical Quality Improvement

Hospitals that have been given incentives to collaborate with one another can significantly reduce surgical complications, according to researchers. In a study funded by Blue Cross Blue Shield of Michigan (BCBSM) and its Blue Care Network, hospitals were paid to pool and share patient data in hopes of utilizing the information to help lower adverse events related to surgery. BCBSM also covered technology costs related to data acquisition and analysis.

Information on general and vascular surgeries was collected between 2005 and 2007 at 16 Michigan hospitals. Analysis found that blood infections, septic shock, prolonged ventilation use, and cardiac arrest decreased approximately 10 percent among hospitals that shared data, versus the control group that did not collaborate with one another and did not experience any measurable reduction in complications.

From the article of the same title
Archives of Surgery (10/01/10) Vol. 145, No. 10, P. 985 Campbell Jr., Darrell A.; Englesbe, Michael J.; Kubus, James J.; et al.

What Your Staff (Really) Wants From You

Expectations, recognition, and growth are the keys to staff happiness and outstanding performance, writes David Zahaluk, MD, founder and CEO of Ultimate Practice Builder in Dallas, Texas. It is much easier to manage a staff if you establish a clear system for measuring work performance and open the floor to frequent communication as a group or individually with the office manager. In addition, you have to be willing to hold your staff members accountable if they fail to accomplish their tasks or are not effective team members. Recognition and reward is also important. Something as simple as taking a staff member to lunch in recognition of doing something positive will speak volumes to the whole group, as will mentioning individual achievements in front of everyone else. The last item on the list is finding out what each member of your staff wants to learn in the next quarter and making sure they commit to their goals.

From the article of the same title
Medical Economics (10/08/10) Zahaluk, David
Web Link - May Require Free Registration | Return to Headlines

Health Policy and Reimbursement

Little-Known AMA Group Has Outsized Influence on Medicare Payments

Three times a year—most recently early October—29 doctors meet to decide how to divide up billions of Medicare dollars. The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the panel, known as the Relative Value Scale Update Committee, is enormous. CMS typically follows at least 90 percent of its recommendations in figuring out how much to pay doctors for their work.

From the article of the same title
Center for Public Integrity (10/27/2010) Eaton, Joe

Citing SGR Cuts, Physicians Mull Dropping Medicare Patients

Two-thirds of medical practices surveyed by the Medical Group Management Association say they will either limit the number of new Medicare patients they accept or stop seeing Medicare patients altogether if Congress does not halt reimbursement cuts that take effect by the end of the year. As part of Medicare's sustainable growth rate (SGR) formula, a reimbursement cut of 23.6 percent is slated to take effect Dec. 1, followed by an additional 6.5 percent cut on Jan. 1. If no action is taken to stop the reductions, 49.5 percent of medical groups said that they will stop seeing new Medicare patients, and 27.5 percent of respondents said they would cease treating Medicare patients. Additionally, 76 percent say they will likely delay the purchase of new clinical equipment and/or facilities, 60 percent will likely reduce the number of administrative support staff, 54 percent will likely reduce clinical staff and 45 percent will likely delay purchase of electronic health records systems.

From the article of the same title
HealthLeaders Media (10/26/10) Commins, John

In Medicare's Data Trove, Clues to Curing Cost Crisis

The Medicare claims database, called the Carrier Standard Analytic File, includes all doctor claims that Medicare pays directly in association with their care. It is widely considered the single best source of information on the U.S. healthcare system and may hold a key to cutting healthcare costs. But while the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers.

If it were fully available, with doctors clearly identified, experts say, the public could expose countless ways in which some healthcare providers abuse the system. The database could even provide some information on physician quality.

From the article of the same title
Wall Street Journal (10/26/10) Schoofs, Mark; Tamman, Maurice
Web Link - May Require Paid Subscription | Return to Headlines

Medicine, Drugs and Devices

Interobserver Reliability of Radiographic Measurements of Contralateral Feet of Pediatric Patients with Unilateral Clubfoot

Researchers hypothesized that the interobserver reliability of measurements obtained from radiographs of pediatric feet would be low, especially with regard to the infant foot, and that normal ranges and standard deviations would decrease in association with increasing patient age. They retrospectively reviewed 494 radiographs of 121 patients treated for unilateral clubfoot and studied the contralateral normal foot. All anteroposterior radiographs, lateral radiographs, and lateral radiographs made with the foot in maximum dorsiflexion were analyzed. The databases created by the three observers were statistically analyzed according to five predefined age groups: birth to less than three months, three months to less than twelve months, twelve months to less than three years, three years to less than seven years, and seven years to less than fourteen years.

The anteroposterior talocalcaneal angle was rated as having good interobserver reliability for all patients in each age group. Other angles that were associated with good interobserver reliability were the anteroposterior calcaneus-fifth metatarsal angle in the twelve months to less than three-year age group, the three-year to less than seven-year age group, and the seven-year to less than fourteen-year age group; the lateral talocalcaneal angle in the three-year to less than seven-year age group; the lateral tibiotalar angle in the three-year to less than seven-year age group; and the lateral talus-first metatarsal angle in the seven-year to less than fourteen-year age group. All other angles were rated as having very good interobserver reliability.

The researchers concluded that interobserver reliability with regard to the radiographic measurement of pediatric feet was higher than expected, although measurement discrepancies can be as great as 30° with the infant foot. Interobserver reliability tended to improve with increasing patient age. The standard deviation showed a trend toward a decrease as patient age increased, although the trend was less notable than expected.

From the article of the same title
Journal of Bone and Joint Surgery (American) (10/20/10) Vol. 92, No. 14, P. 2427 Radler, Christof; Egermann, Marcus; Riedl, Karin; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Less Promising Results With Sclerosing Ethoxysclerol Injections for Midportion Achilles Tendinopathy

Local injections of the sclerosing substance polidocanol (Ethoxysclerol) have shown good clinical results in patients with chronic midportion Achilles tendinopathy. For this study, researchers hypothesized that sclerosing Ethoxysclerol injections would yield good results in the majority of patients. In 113 patients (140 tendons) with Achilles tendinopathy, they identified 62 patients (70 tendons) showing neovascularization on color Doppler ultrasound. Fifty-three Achilles tendons (48 patients) were treated with sclerosing Ethoxysclerol injections, with intervals of 6 weeks and a maximum of 5 sessions.

Six weeks after the last injection, 35 percent of patients had no complaints, 9 percent had minimal symptoms, 42 percent were the same, and 14 percent had more complaints. Women were 3.8 times more likely to have unsatisfactory outcome than men. Pain correlated positively with neovessels on ultrasound. At 2.7 to 5.1 year follow-up, 53 percent had received additional (surgical/conservative) treatment; three of these patients (7.5%) still had complaints of Achilles tendinopathy. In six patients, complaints that were still present 6 weeks after treatment had resolved spontaneously by final follow-up.

The researchers concluded that their study did not confirm the high beneficial value of sclerosing neovascularization in patients with midportion Achilles tendinopathy and that injection of Ethoxysclerol may not be as promising as thought.

From the article of the same title
American Journal of Sports Medicine (11/01/10) Vol. 38, No. 11, P. 2226 van Sterkenburg, Maayke N. ; de Jonge, Milko C. ; Sierevelt, Inger N.; et al.

Top Prescribers Under Senate's Microscope

U.S. Sen. Charles Grassley (R-Iowa) has notified federal authorities that a study he commissioned has found potential examples of overprescribing after requesting lists from states of doctors who issued the most prescriptions for antipsychotic and narcotic medications in 2008 and 2009. The study was undertaken due to concerns that expensive medications are being overprescribed at great cost to Medicaid and Medicare. Grassley's findings do not prove fraud or overprescribing, but they could cause doctors to be removed from participation in the government health programs.

From the article of the same title
Minneapolis Star Tribune (MN) (10/23/10) Olson, Jeremy

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November 3, 2010