News From ACFAS

House Democrats introduced the Affordable Health Care for America Act, and there were not any huge surprises. The proposed bill includes a public option, authorizes the Secretary of Health and Human Services to negotiate rates with providers and includes a 5.4 percent tax on couples with incomes over $1 million and individuals with incomes greater than $500,000. The Congressional Budget Office estimates that the bill reduces the deficit and covers more than 96 percent of Americans. The legislation also meets the president's goal of spending less than $900 billion over 10 years.

The House bill no longer includes a permanent fix to the physician Medicare payment formula, which because of its price tag — around $300 billion — will be addressed in separate legislation.

House Republicans are reportedly close to introducing their own health reform proposal that will allow sale of health insurance across state lines, allow small businesses to pool together to purchase health insurance and include major malpractice reform.

This November, enjoy an eclectic mix of anytime education with three new additions to the ACFAS e-Learning library:

Podcasts

• Perioperative Vascular Assessment of the Diabetic Foot
  
  • Surgeons discuss criteria and approaches for evaluation and intervention with high-risk patients.

• How to Critically Evaluate a Peer Reviewed Journal Article
  
  • Panelists explain principles for analyzing the value of evidence and arguments presented in scholarly articles.

Scientific Session

• Surgical Techniques Caught on Video: Forefoot
  • Seven different surgeons share fine points of surgical techniques as they each narrate a surgery they filmed in progress.

Visit ACFAS e-Learning 24/7 to download podcasts, view scientific session videos and explore all of the online educational offerings.

In observance of National Diabetes Month in November, the ACFAS Consumer Education Committee has developed a media backgrounder on diabetes and amputation.

You can share this valuable information with your local media to help get the word out about the importance of preventive diabetic foot care, and dispel the myths often associated with amputation from the effects of diabetes.

The backgrounder is available in both English and Spanish on the ACFAS web site.

You can help shape the advancement of your profession, the future of the College and, ultimately, the care of patients. The College is looking for talented, dedicated ACFAS members to serve on 2010–11 committees.

Visit the ACFAS web site for more information on getting involved, including committee descriptions and application information. The 11 committees cover a wide range of responsibilities.

Applications are due at ACFAS headquarters by December 15, 2009.

Foot and Ankle Surgery

Bypass Flap Reconstruction, A Novel Technique for Distal Revascularization: Outcome of First 10 Clinical Cases

Combined distal venous bypass grafting and free flap transfer can achieve successful treatment of soft tissue defects due to advanced leg ischemia, but the combined approach is a complex technique involving multiple anastomoses on the same arterial axis with an increased risk of thrombosis. Researchers in this study proposed a new bypass-flap (BF) reconstruction technique using an arterial graft and a free flap supplied by a collateral branch of the graft to reduce the risk, documenting the outcome in the first 10 patients treated using the new technique. The researchers found bypass patency and healing of the covered defect in all cases, demonstrating the clinical feasibility of the BF reconstruction technique, which allows revascularization and coverage of tissue defects using a one-piece anatomic unit.



Combo Pill an Option for Diabetes-Related Nerve Pain

A single pill combining tramadol and acetaminophen can be as effective as the drug gabapentin for treating diabetes-related nerve pain, according to new research from the Catholic University of Korea. Gabapentin, an anti-seizure medication often prescribed for epilepsy, is regarded as a first-line therapy for diabetic neuropathy. Researchers in the study assigned 66 study subjects with painful diabetic neuropathy to receive the tramadol/acetaminophen combo pill and 73 to receive gabapentin. Over a six-week period, the two groups reported similar improvements in pain and related parameters, and they experienced significantly similar rates of treatment-associated side effects.



Correction and Prevention of Deformity in Type II Tibialis Posterior Dysfunction

Researchers assessed patient function and satisfaction after a modified Cobb reconstruction in Johnson and Strom Type II tibialis posterior dysfunction (TPD), assessing the ability of the technique to prevent subsequent fixed deformity. Thirty-two patients managed by this technique and a translational os calcis osteotomy with early flexible deformity after failed conservative treatment were tracked. The researchers concluded that the technique is a comparable method of treating early Johnson and Strom Type II TPD.



Leg Artery Disease Often Goes Undetected

Many middle-aged adults may have peripheral artery disease, or PAD, and not even know it, according to a study presented at the 2009 Canadian Cardiovascular Congress. In the study, 362 adults over age 50 were screened for PAD at 10 pharmacies in Canada. Approximately 5 percent had PAD, of which 80 percent did not know they suffered from the condition. The researchers concluded that while the U.S. Preventive Services Task Force currently does not recommend routine screening for PAD, it is worthwhile to screen people at high risk for the disease.

Practice Management

Delayed Again: Red Flag Rules Deadline Now June 1, 2010

In response to a request from Congress, the FTC has once again delayed enforcement of the “red flag” rules, which were scheduled to go into effect November 1, 2009. The deadline has been moved to June 2010. Congress is currently considering legislation that would exempt businesses with less than 20 employees from the regulation. Some observers suggest that an unintended benefit of compliance for small businesses — including physician practices — is reducing bad debt.



CMS Announces Payment, Policy Changes for Physicians Services to Medicare Beneficiaries in 2010

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule that sets physician payment rates and rules for 2010. The final rule, which is subject to a comment period, provides that Medicare will not pay for physician consultations except for G codes that are used to bill telehealth services. CMS plans to redistribute the savings to payment for evaluation and management services and to adjust global surgical packages to reflect the higher value of E/M services. Congress must still act to prevent a negative payment update for 2010.



Ask the Right Questions to Hire the Right Physician

Practice management consultants suggest that practices seeking to hire a new physician should start by identifying five to ten qualities that they desire — or want to avoid — in a candidate. Practices should tap as many sources as they can to find qualified candidates, including colleagues, former residency or fellowship programs, and colleagues from training and previous practices. Promoting vacancies in specialty journals or publications that reach a wider audience also can be beneficial.

Health Policy and Reimbursement

Providers Skeptical of Meaningful Use Reimbursement Process

At hearings in Washington last week, physicians and other providers expressed concern about the requirement that providers demonstrate “meaningful use” of electronic health records (EHR) to qualify for up to $44,000 in incentive payments under the 2009 stimulus package. For example, specialists are concerned that some of the standards in development will require reporting of quality measures rarely used in their practice. Small practices in rural areas note that they are averse to investing in EHR until they have confidence that it is truly interoperable. One practice noted that it interacts with 5 different hospitals, all on different health IT systems. Proposed regulations on meaningful use are expected by the end of the year.



Compare and Contrast

Minnesota's legislature recently passed a law requiring all medical practices to participate in a ratings system developed by Minneapolis-based nonprofit MN Community Measurement (MNCM). MNCM started publishing annual report cards for the state’s medical groups on a voluntary basis in 2004, and mandatory participation will begin in 2010. Participating groups have found that the public report cards provide an important incentive to take steps to improve quality of patient care. For example, physicians from the 14 clinics of HealthEast Care System get together to talk about ways to improve care on a monthly basis.



Healthcare System Wastes up to $800 Billion a Year

The U.S. healthcare system wastes between $505 billion and $850 billion annually, according to a report by Robert Kelley, vice president of healthcare analytics at Thomson Reuters. One example of the waste that was cited is a paper-based system that discourages sharing of medical records, which accounts for 6 percent of annual overspending. The report also found that unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure accounts for 37 percent of healthcare waste and that administrative inefficiency and redundant paperwork account for 18 percent of waste.



New Database to Help Set Payouts by Health Insurers

New York continues to be a leader in requiring transparency and fairness from health insurers in reimbursement for out-of-network services. Earlier this year, the state reached a settlement with more than a dozen health insurers over their use of a database that understated physicians’ “usual and customary” fees and consequently shortchanged physicians and patients. Last week, New York Attorney General Andrew M. Cuomo announced that funds from the settlement will be used to create a national database and web site to help patients determine their financial responsibility for out-of-network services. A nonprofit company will be created and will work with a number of state and private universities in New York to develop and operate the site, which will become operational within a year.

Technology and Device Trends

FDA Review of Adverse Events Caused By Medical Devices Is Inadequate

The FDA's Center for Devices and Radiological Health (CDRH), which regulates medical devices, does not systematically review adverse event reports, according to a review issued by the Office of Inspector General. The number of these reports, which are filed through the FDA's MedWatch program, doubled between 2003 and 2007 from 72,886 to 150,210. The report found that CDRH analysts read fewer than one-third of the reports for the first time within 30 days of receipt and less than half within 60 days.



Outcome and Complications of Treatment of Ankle Diastasis With Tightrope Fixation

Early clinical results of fixation of ankle syndesmosis injury with a fibre-wire tightrope indicate that it can remain in situ indefinitely without complications. Researchers here report on complications associated with the use of this device. Six patients were treated for ankle diastasis using the tightrope. In two cases, the device caused soft-tissue irritation with granuloma formation, necessitating subsequent removal. Examination revealed refractile material within giant cells, suggestive of foreign-body reaction. In all cases, the syndesmosis was reduced and held, even after device removal. Functional outcome was good and patients were satisfied.



UAB Creates National Network to Advance Personalized Medicine in Rheumatoid Arthritis

The University of Alabama at Birmingham (UAB) is heading an effort to create a national database and repository to enable researchers to identify predictors of effectiveness of various treatments for rheumatoid arthritis. A two-year, $3.3 million grant from the National Institute of Arthritis will be used to establish the Treatment Efficacy and Toxicity in Rheumatoid Arthritis Database and Repository (TETRAD), which will include treatment-response data and samples of DNA and blood cells from RA patients starting treatment with different drugs.



Abstract News © Copyright 2009 INFORMATION, INC.

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