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This Week's Headlines

News From ACFAS
Foot and Ankle Surgery
Practice Management
Health Policy and Reimbursement
Technology and Device Trends

News From ACFAS

This Week's Healthcare Reform Update

After passing its health system reform bill over the weekend, the House of Representatives plans to shift gears and take on reform of the Medicare physician payment formula beginning next week. HR 6931 would repeal the “sustainable growth rate” (SGR) formula that has resulted in negative physician payment updates, including a projected 21 percent decline beginning January 1, 2010. The legislation replaces the SGR with a “target growth rate” based on categories of service. The categories are evaluation and management services and “all other services.” The target growth rate defines physician services much more narrowly than the SGR, which will ensure that physicians are not penalized by the increased use of services for which they are not directly compensated.
Present a Puzzler in “Curbside Consult”

Have you ever had a difficult case, one that presented unique medical or management challenges? Share it with your colleagues in “Curbside Consult,” an innovative session debuting at the 2010 Annual Scientific Conference, February 23–26, 2010, in Las Vegas.

This new forum was designed to give you a place to get opinions and an unbiased read from your peers on your tough — or just plain interesting — case. Visit the Curbside Consult web page to submit an uncommon case today!
Stay Up-to-Date with the Latest Research

ACFAS' Scientific Literature Reviews help you stay up-to-date with research published in journals you might not usually have time to read. For November, residents at Yale New Haven Hospital and Central Alabama Veterans Health Care System have prepared abstracts of podiatry-relevant research from journals such as:
  • Vascular
  • Journal of Orthopaedic Traumatology
  • Journal of Rheumatology
  • Diabetes Research and Clinical Practice
Read the Scientific Literature Reviews day or night on the ACFAS web site.
ACFAS Wants to Stay in Contact with You

Have you recently changed your work or home address, phone or fax number, or e-mail address? Does your practice have a web site? Do you want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other ACFAS mailings? We want to stay in touch with you!

The College lists your contact information on the online membership directory to allow other members to find you, and also in the “physician search” feature on the consumer web site,

To keep yourself available to your peers, potential patients and the College, please take a moment to download the update form and provide your current contact information.

Foot and Ankle Surgery

Minimal Incision Techniques for Acute Achilles Repair

Researchers in this article review minimal incision techniques in the treatment of acutely ruptured Achilles tendon and the results that can be anticipated from these methods. They note that a lack of comprehensive prospective randomized studies on the treatment of Achilles tendon rupture makes it impossible to draw conclusions on optimal treatment strategies. Most of the evidence available suggests that surgical repair reduces rerupture rates compared with non-operatively treated tendon ruptures. Surgery does have potential complications, but using a mini-open or percutaneous technique of repair might result in highly satisfactory outcomes with acceptably low complication rates.

From the article of the same title
Foot and Ankle Clinics (12/01/09) Vol. 14, No. 4, P. 685; Davies, Mark S.; Solan, Matthew

Minimally Invasive Surgery May Be a Viable Option for Treating Calcaneal Fractures

Using percutaneous reduction and external fixation for calcaneal fractures can lead to earlier weight-bearing and avoid complications associated with open reduction and internal fixation, according to a study presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. In a study examining 31 patients treated with the procedure for 11 open fractures and multiple other fractures, the average AOFAS foot score was 66.

From the article of the same title
Orthopedics Today (11/09) Brockenbrough, Gina

Restless Legs More Common Than Previously Thought

New research suggests that 23 percent of people have restless leg syndrome (RLS), a much higher estimate than the previously reported rates of 3 percent to 10 percent. Furthermore, the study of 190 patients who were selected during visits to a primary care clinic and were evaluated for RLS found that non-African-Americans experience RLS four times more often than African-Americans and that 40 percent of Caucasian women have RLS, nearly four times the incidence of RLS in African-American women and the highest incidence among all groups. The average ages of the African American and non-African-American groups were 53 and 50 years, respectively.

From the article of the same title
Reuters (11/04/09) Brown, Anthony J.

Study: Children Can Fast for Just 2 Hours Before Surgery

A study published in November's issue of World Journal of Gastroenterology reports that children can consume liquids up to 2 hours before surgery with little risk of aspiration. Children who had liquid food 2 hours before surgery had the same amount of gastric residue (1 to 2 ml) and similar blood glucose levels and blood pre-albumin levels as those who had fasted for 3 and 5 hours before surgery, according to the study. Children who fasted 4 hours before surgery had lower blood glucose levels.

From the article of the same title
Outpatient Surgery (11/02/09) Steinriede, Kent

Practice Management

Patients See Benefits of E-mail and Web Communications —If Free

A recent survey of 1000 people found that many would be willing to use e-mail for communicating with their physicians on matters like receiving routine test results (59%), repeat prescriptions (53%), and updating their physician on their condition (51%). They cited avoiding long waits and avoiding exposure to sick people as major benefits. However, 46 percent said they would not be willing to pay for such consultations, and 31 percent said they would be willing to pay only if it was covered by insurance. Most respondents indicated their primary care physician does not currently offer e-mail communication.

From the article of the same title
Medical Economics (10/29/09) Rajecki, Ron

The Best States to Practice

Physicians Practice has created an interesting chart setting forth the “best” states to practice based on a number of variables, including the reimbursement environment, the cost of living, competition (number of physicians practicing in the state), and malpractice climate. The chart can be accessed at

From the article of the same title
Physicians Practice (11/09) Keaveney, Bob

Can Healthcare Workers Be Forced to Get Flu Shots?

Hospital workers in a number of states already must be immunized against measles, mumps, and rubella, but healthcare professionals are fighting back at efforts to require a flu shot as well. In New York, which recently became the first state to mandate vaccination of healthcare workers against seasonal and swine flu, getting inoculated could mean the difference between winning a new position or not, while failing to comply could be grounds for dismissal from an existing job. Critics say decisions about vaccination should be a private choice, and they challenge the legality of vaccination mandates.

From the article of the same title
Time (10/19/09) Park, Alice

Health Policy and Reimbursement

Senate Pressing Insurers on the Amount of Premiums They Spend on Care

The health insurance industry claims that 87 cents of every dollar in premiums is spent on medical claims. However, a new Senate analysis suggests that for-profit insurance companies are spending as little as 66 cents of each dollar paid in premiums toward doctor and hospital bills, with the rest covering administrative expenses, marketing, and company profits.

From the article of the same title
New York Times (11/02/09) Abelson, Reed

Health Care Spending for Middle-age Americans Booming

A recent government report found that the spending on Americans aged 45–64 accounts for a big part of spending growth. The Agency for Healthcare Research and Quality (AHRG) found that in 2006 there were 76.1 million people in that age group, compared to 54.2 million in 1996. The expenses per person nearly doubled during that time. It is unclear whether spending trends have been impacted by the recession. Experts note that the drivers of the increase are the tendency of baby boomers to want more procedures and services, combined with technological advances.

From the article of the same title
American Medical News (11/09/09) Elliott, Victoria Stagg

Medicaid Cut Could Prompt Refusals

Another state Medicaid program is being impacted by the ongoing recession. Effective Jan. 1, the state of Ohio will reduce its Medicaid reimbursement level by a further 3 percent to 20 types of community-based healthcare providers. There is concern among public health advocates that this will prompt local providers to refuse to accept Medicaid patients.

From the article of the same title
Crain's Cleveland Business (11/01/09) P. 1; Mortland, Shannon

Technology and Device Trends

Extracorporeal Shock-Wave Therapy Compared With Surgery for Hypertrophic Long-Bone Nonunions

Researchers report that certain cases involving nonunions respond very well to shock-wave therapy, saying that this non-invasive treatment is equally as effective as surgery when it comes to healing the bone. The study, which included patients who had nonunions of the tibia, found that shock-wave treatment stimulated healing of the bone within six months and provided a comparable outcome to surgery even two years following the treatment.

From the article of the same title
Journal of Bone and Joint Surgery (11/01/2009) Cacchio, Angelo; Giordano, Lucio; Colafarina, Olivo; et al.

Health Bills Aim a Light on Doctors' Conflicts

Current versions of the healthcare reform measure in the House and one of two health bills in the Senate would require the makers of drugs, medical devices and medical supplies to file annual reports to the government about their financial ties to doctors. The legislation would also require the establishment of an online public database that patients could search to see if their doctors had been paid by the companies whose products they prescribe.

From the article of the same title
New York Times (11/04/09) Singer, Natasha

State to Require OK for Medical Scans

A new program in North Carolina will require brain scans and high-tech body screenings for North Carolina Medicaid patients to be cleared by a private management company. The new system is supposed to save state taxpayers tens of millions of dollars on unnecessary CT scans, MRIs, and ultrasounds. Some health care economists have praised the plan as a timely strategy during a weak economy, but the plan has also raised concerns from people who may need scans that could be denied. Many privately insured patients already have to obtain approval before receiving diagnostic imaging. Some estimates place the national cost of medical imaging at $100 billion and rising, and diagnostic tools have become a way to make profits at some doctors' offices, stand-alone clinics, and hospitals. North Carolina's Medicaid program was predicted to spend $135 million next year on radiological scans and $149 million in 2011. The new program is unpopular with the state's radiologists, who worry that patients may be denied needed scans, including repeat images that are necessary when a first round of tests is not sufficient.

From the article of the same title
Charlotte Observer (NC) (10/29/09) Avery, Sarah

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November 10, 2009