November 7, 2012

News From ACFAS

ACFAS Member Elected to 113th Congress
Brad R. Wenstrup, DPM, FACFAS will become Brad R. Wenstrup, DPM, FACFAS, M.C. on January 3, 2013, when he assumes the role of Member of Congress (M.C.), representing Ohio's 2nd Congressional District. Wenstrup is the first podiatric surgeon ever elected to Congress. Congratulations, Congressman-elect and ACFAS Fellow Wenstrup!
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2013 Dues Reminders in the Mail
It’s that time of year again! Dues reminders for the 2013 calendar year of membership have been mailed to all members. You can go online anytime to pay your dues by visiting, or you can pay by mail or fax once your reminder arrives at your home or office. Payment is due by Dec. 31, 2012. And good news - there’s no dues increase!

College membership connects you to the best and brightest foot and ankle surgeons in the world. Here’s to your membership bringing you another great year of value!
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Book Your Room by Nov. 15 for a Chance to Win!
Did you know that you can have a shot at winning big before you even step foot in Las Vegas for ACFAS 2013? That’s right! If you book your hotel room at Mandalay Bay by November 15, 2012, you will be entered into a drawing to win an upgraded hotel stay. Try your luck by visiting to make your hotel reservation today. You could be a lucky winner!
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How Can a Trip to Vegas Improve Your Practice?
Are you up-to-date on the latest news and information concerning reimbursement, coding and billing, employment models, and foot care policies? Enhance your knowledge by registering yourself and your office staff for the ACFAS 2013 Pre-Conference Seminar: Perfecting Your Practice. Get answers to questions related to managing your practice that you may not even know you had. Learn correct coding to ensure you’re not leaving money on the table or at risk of submitting incorrect claims. In addition to proper coding, you will receive the most recent, valuable information on employment contracts and consider the pros and cons of future employment models.

How you manage your practice is the key to its overall success. Check out the Perfecting Your Practice Pre-Conference Seminar webpage for information on fees and everything included with your registration. Note: Office staff may register as well!
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Foot and Ankle Surgery

Clubfoot Ankle Osteoarthritis Risk Revealed
A study published in the November issue of the British edition of the Journal of Bone and Joint Surgery has found that patients over the age of 60 who have been treated for clubfoot have a low long-term risk of developing ankle osteoarthritis (OA). Researchers examined 60 patients with clubfoot who were 64 years old on average and had been treated using manipulation and casting alone or in addition to soft-tissue or bony procedures. The study found that evidence of severe OA was only seen in 7.9 percent of 89 affected ankles. The study also found that 12 percent of affected feet had severe OA of the talonavicular joint, which researchers said could be an indication that the ankle is not vulnerable to degenerative forces and that residual problems are more common in the midfoot than in the ankle. The study can be found here.

From the article of the same title
MedWire News (11/01/12) Williams, Lynda
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Effects of a Four-Week DBT Program Supplemented with Graston Instrument-Assisted Soft-Tissue Mobilization for Chronic Ankle Instability
Researchers examined the effects of Graston instrument-assisted soft-tissue mobilization (GISTM) in conjunction with a dynamic-balance-training (DBT) program on outcomes associated with chronic ankle instability (CAI). Thirty-six healthy, physically active individuals with a history of CAI as determined by an ankle-instability questionnaire volunteered to be in this study. Subjects were randomly assigned to one of three intervention groups: both treatments (DBT/GISTM, n = 13), DBT and a sham GISTM treatment (DBT/GISTM-S, n = 12) or DBT and control—no GISTM (DBT/C, n = 11). All groups participated in a four-week DBT program consisting of low-impact and dynamic activities that progressed from week to week. The DBT/GISTM and DBT/ GISTM-S groups received the GISTM treatment or sham treatment twice a week for eight minutes before performing the DBT program. Subjects in all groups post-test demonstrated an increase in Foot and Ankle Ability Measure (FAAM), FAAM Sport, range of motion and Star Excursion Balance Test in all directions but not in the visual analog scale, which decreased.

From the article of the same title
Journal of Sport Rehabilitation (11/01/12) Vol. 21, No. 4, P. 313 Schaefer, Jessica L. ; Sandrey, Michelle A.
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Percutaneous Reduction and Screw Fixation of Talar Neck Fractures
A study was held to assess the effectiveness of percutaneous reduction and fixation in treatment of talar neck fractures, particularly in cases with greater risk of soft tissue complications. The study involved 16 patients with talar neck fractures who received percutaneous reduction of fracture and percutaneous fixation with 3.5 mm cannulated screws between 2006 and 2008. A modified Hawkins classification system was used to classify injuries and patients were followed-up over an average of 48 months. About 88 percent of the patients were satisfied with the results and resumed their preoperative activities. The average AOFAS Hind Foot Scale was 89.25 points, and no poor outcomes were observed.

From the article of the same title
Foot and Ankle Surgery (12/01/12) Vol. 18, No. 4, P. 219 Abdelgaid, Sherif Mohamed; Ezzat, Farid Fouad
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Practice Management

Improve Staff Performance at Your Medical Practice
A frequent area of frustration for physicians in medical practices is the failure for staff performance to meet the basic requirements of responsiveness, productivity and accuracy. The cause may be rooted in a job design that prevents almost anyone from performing well. At the heart of the problem is a high level of responsiveness that is in direct conflict with productivity and high quality work for most tasks. Each task demands a certain amount of immersion time, and interruptions divert one from the task. Another period of immersion is therefore needed to resume productive work. Re-immersion time is all overhead that fails to advance the work, and this negatively impacts productivity. The amount of time actually needed to complete a task can easily be doubled or tripled as a result of interruptions. Meanwhile, accuracy is adversely affected due to time pressure.

Solutions include separation of the functions, in which the practice refrains from assigning a single staff member both simple and complex tasks. The work areas also should be separated for high-responsiveness staff and high-complexity staff. This will shield high-complexity staff members from the ancillary noise and activity affiliated with high-responsiveness staff members, as well as make it easier for high-complexity staffers to avoid jumping in to help. Segregating the day into blocks of time is another recommendation. The practice should stipulate that a certain part of each day, or a certain part of a certain day each week, should be reserved for a specific complex activity. During that time, everyone in the office does everything practical to avoid interrupting the staff member, up to and including putting the phone on forward.

If compelling reasons exist that all practice members must be immediately responsive at all times, it is critical to understand the tradeoff and accept the consequences, which include diminished productivity and a high rate of errors. Holding staff to standards that cannot be met is both unreasonable and unproductive, and explains a significant portion of turnover among medical office personnel.

From the article of the same title
Physicians Practice (10/31/12) Stryker, Carol
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Securing Your Medical Practice Data in a Natural Disaster
There are a number of HIPAA-compliant strategies medical practices can follow to secure their data in the event of a natural disaster and its aftermath. Practices that depend on cloud-based technology systems should first call their cloud providers and find out where data is housed. More robust companies will have a widely distributed backup system in at least two locations, which reduces the likelihood that the practice's data will be affected by a natural disaster. Other questions practices should ask cloud providers include whether they have made disaster-related provisions, where the data center is located, whether they have redundant backup in the event the primary data center is compromised, where the redundant backup is located and whether they have other backup for the practice's data.

Practices that are still open for business should prepare for an Internet outage when the disaster hits. Some of the systems will do local backups, and it is advised that the practice attempt to link to a wireless router, or to the Internet through some other source such as a cell phone. If this approach fails, then the practice may have to fall back on paper and enter data when the Internet connection is restored. Providers that use on-site hardware and software and are open for business should ideally have an uninterrupted power supply (UPS) in the event of a power outage. There also should be data backed up on a physical medium that providers can carry with them and shield from any natural disaster. It also would be prudent in cases where a specific location is susceptible to flooding to temporarily move the server to a safe, secure place until the threat is over.

However, HIPAA security issues need to be considered before equipment is taken offsite. Practices that own larger, rack-mounted systems should call their IT staff for help in getting it off-premises. Data should be stored at the most secure possible site, such as a satellite office based in a zone that is less likely to flood. Practices also should plan ahead for future disasters.

From the article of the same title
Physicians Practice (10/29/12) Torrieri, Marisa
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Some Early Signs That Your EHR is Working as Hoped
Setting goals, such as reaching pre-adoption benchmarks by a certain date, can keep a practice's employees and physicians focused and deliver early evidence of whether a new electronic health record (EHR) system is working. Here are some typical goals practices can create and evaluate. First, see if the EHR reduces the number of rejected claims that cost a practice time and money to resolve. One physician said that after a learning curve, it became "readily apparent" within a matter of months that the implementation had been successful because there were fewer insurance snafus and rejected claims. Second, expect job functions and duties to shift as a result of the implementation. For instance, the same physician said his front-office staff used to spend a lot of time on the phone with insurers handling claims before EHR implementation, but now most of their time is spent directly with patients. Third, if a system takes a long time to learn, it likely has less to do with adjustment time and more to do with the system itself, but many such problems can be fixed with customization or tweaking. Fourth, many consultants recommend that practices pare down their schedules by 50 percent in the first week or so after implementing the system and gradually increase it back to pre-implementation levels as the physicians feel more comfortable. While the time it takes to return to pre-implementation levels varies by practice, some experts say it should take no longer than six months. Finally, practice leaders should pay attention if initial grumblings persist and if the same complaints are made over and over again by numerous people.

From the article of the same title
American Medical News (10/29/12) Dolan, Pamela Lewis
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Health Policy and Reimbursement

AMA Joins Friend-of-the-Court Brief in Fla. 'Docs and Glocks'
The American Medical Association and nine other medical specialty societies have filed a friend-of-the-court brief opposing a Florida statute that prohibits physicians from asking patients and families about guns in their homes and from noting gun ownership in their medical records. In July, a U.S. District judge in Miami blocked enforcement of the law. The state of Florida appealed this decision. The brief filed by the medical societies is in opposition to Florida's appeal.

From the article of the same title
Modern Healthcare (11/05/12) Robeznieks, Andis
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CMS Posts Clinical Quality Measure Tech Specs
Beginning in 2014, health information technology users participating in the federal meaningful-use financial incentive program must electronically report their performance on clinical quality measures, and now the technical specifications for doing so are available. These specifications include required data elements, measure definitions and other factors necessary for the electronic capture, storage and transmittal of the data, according to the Centers for Medicare & Medicaid Services (CMS) website. The clinical quality measures were included in the Stage 2 meaningful-use final rule issued Aug. 23.

From the article of the same title
Modern Healthcare (10/26/12) Robeznieks, Andis
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HHS Backs Flat-Rate Payment Arrangements
The Office of the Inspector General of the Department of Health and Human Services has issued an advisory opinion the practice of hospitals paying flat rates to specialists for on-call emergency-room services. These payments come in addition to whatever payments the specialists receive from insures and are generally paid even if the specialist is not needed during the on-call period. Such payments have been criticized, however, as a potential vehicle for inducing or rewarding high referral volume.

In its opinion, the inspector general's office provided guidance for properly issuing flat rate payments to specialists. The rates of such payments should be based on independent valuations of current market rates and be set in advance. The rates should also be offered to all hospital staff specialists and be paid in return for actual and necessary services only.

From the article of the same title
Modern Healthcare (10/30/12) Carlso, Joe
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HHS Issues Medicaid, Medicare Payment Rules
The Department of Health and Human Services has released three rules affecting healthcare provider payments in 2013. One rule boosts Medicaid pay for doctors, another contains a cut to Medicare doctor payments, unless Congress intervenes, and the third sets pay levels for hospital outpatient and ambulatory surgical center care under Medicare. The Medicaid rule will boost Medicaid physician pay levels to match what Medicare pays, starting in 2013. HHS said the Affordable Care Act requires the Medicaid program to pay physicians in family medicine, general internal medicine, pediatric medicine, and related subspecialties at the Medicare levels in calendar years 2013 and 2014.

From the article of the same title
BNA Health Care Policy Report (11/01/12)
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Physicians Group Pushes Performance Measures to Combat Healthcare Misuse
The American College of Physicians is lobbying for greater use of performance measures targeting healthcare services overuse and misuse, arguing in a position paper that measures that quantify the use of "low-value services" can raise awareness about healthcare misuse and amend physician behavior. "Just as we need performance measures to assess underuse of high-value services, we need valid, evidence-based measures of overuse," the paper says. The paper's authors outlined various strategies for measuring physicians' usage of low-value services, such as the utilization of metrics that assess the appropriateness of a specific treatment given individual patients' circumstances. They also cited the frequent unavailability of standardized and detailed clinical information required for direct measures. Indirect measures were deemed to be more practical, with the paper noting, for instance, that high rates of negative tests can indicate that a particular diagnostic test was employed too often in low-risk patients. The authors projected that such measures will be used to give physicians feedback about their performance and could also be incorporated into public-reporting and pay-for-performance programs.

From the article of the same title
Modern Healthcare (10/29/12) McKinney, Maureen
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Medicine, Drugs and Devices

Musculoskeletal Ultrasound Helpful Tool for Rheumatic Diseases
A study published online in Arthritis Care & Research found that minimally invasive musculoskeletal ultrasound (MSUS) provides a fast, accurate diagnosis of rheumatic diseases. It also provides better measurement of treatment success, reduced procedural pain, and improved patient satisfaction. Researchers reviewed the literature for recommendations on the use of MSUS and found evidence for several applications, including further investigation into articular pain, swelling or mechanical symptoms without definitive diagnosis on clinical exam; further investigation of current or new inflammatory arthritis symptoms, shoulder pain or mechanical symptoms to evaluate underlying structural disorders but not for adhesive capsulitis or as preparation for surgical intervention; and evaluation of the parotid and submandibular glands in suspected Sjögren's disease. The researchers also found that MSUS could be used to guide articular and peri-articular aspiration or injection at sites that include the synovial, tenosynovial, bursal, peritendinous and perientheseal areas.

From the article of the same title
Diagnostic Imaging (10/29/12) Durning, Marijke Vroomen
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Researchers Discover New Technique for Detecting Bone Loss
Researchers at the Mayo Clinic have discovered a technique for detecting bone loss that is more sensitive and carries less risk than using X-rays. The technique involves analyzing calcium isotopes that are naturally present in urine. If unusual calcium isotope ratios are observed, it could be an indication that bone loss is occurring. The technique, which could eventually be used in clinical settings and could lead to the development of biosignatures used for detecting disease, is less risky than X-rays because patients do not need to ingest artificial tracers and are not exposed to radiation.

From the article of the same title
Medical Xpress (10/25/12)
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