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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

Register Now for Annual Scientific Conference

Online registration is now open for ACFAS 2011 Annual Scientific Conference in Fort Lauderdale, Fla., March 9–12. Explore brilliant minds, ideas and beaches — and save when you take advantage of early bird rates and register by Jan. 4, 2011.

The complete program has been mailed to all members; for immediate information and registration, visit the ACFAS website.
Online CME at Your Service

The class will start when you are ready at ACFAS e-Learning! ACFAS members can earn continuing education contact hours at no cost with selected materials on the website. The latest additions are:
  • Podcast: 2nd MPJ Pathology
    Surgeons discuss approaches for diagnosis and treatment of this challenging condition, including how to evaluate predisposing and contributing factors, options in conservative care, and when and what type of surgical intervention may be appropriate.
  • Scientific Session Video: Workers Compensation
    This video provides expert advice from a physiatrist and a lawyer on best practices in handling workers compensation patients, including understanding the independent medical exam process and determining disability rating.
Visit ACFAS e-Learning today to browse the entire archive of trusted information and educational tools.
2011 Dues Reminders in the Mail

It’s that time of year again, and dues reminders for the 2011 calendar year of membership have been sent to all members by mail and e-mail. 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, 2010.

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.

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!

Foot and Ankle Surgery

Less-Invasive Reconstruction of Chronic Achilles Tendon Ruptures Using a Peroneus Brevis Tendon Transfer

Researchers reported the results of a longitudinal study on reconstruction of chronic Achilles tendon rupture using a less-invasive peroneus brevis repair through 2 paramidline incisions. Thirty-two patients underwent surgery for chronic Achilles tendon rupture with a tendon gap during surgery less than 6 cm, occurring between 60 days and 9 months preoperatively. All participants were prospectively followed for 5 to 8 years.

All patients were able to walk on tiptoes, and no patient used a heel lift or walked with a visible limp. No patient developed a clinically evident deep vein thrombosis or sustained a rerupture. Five patients were managed nonoperatively after a superficial infection of one of the surgical wounds. At final review, the maximum calf circumference remained significantly decreased in the operated leg. The operated limb was significantly less strong than the nonoperated one. The Achilles tendon total rupture score at final follow-up was 92.5 ± 14.2.

The researchers concluded that the management of chronic Achilles tendon tears by a less-invasive peroneus brevis repair is technically demanding but safe. It allows good recovery, even in patients with a chronic rupture of 9 months’ duration. However, these patients should be warned that they are at risk for postoperative complications and that their ankle plantar flexion strength is likely to be reduced.

From the article of the same title
American Journal of Sports Medicine (11/01/10) Vol. 38, No. 11, P. 2304 Maffulli, Nicola; Spiezia, Filippo; Longo, Umile Giuseppe; et al.
Web Link - May Require Paid Subscription | Return to Headlines

Union Occurs 4 months After Screw Fixation of Hind and Midfoot Charcot Deformity

Ten of 12 patients with Eichenholtz stage 3b and 3c Charcot hind- and midfoot arthropathy who were treated with an internal method using cannulated screws achieved union, and at about seven months postoperatively all eventually ambulated, according to a study presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Association. Six patients with plantar ulcers of the foot and six patients without ulcerations were included in the study. All patients underwent bone grafting to supplement the screw-based reconstructions. Following surgery, patients wore a foot and ankle orthosis for three months, at which time a radiograph was taken of their feet to determine the extent of arthrodesis and whether immobilization should continue and/or if it needed to be modified.

From the article of the same title
Orthopedics Today (11/10)

Surgeon Distress as Calibrated by Hours Worked and Nights on Call

A study of nearly 8,000 surgeon members of the American College of Surgeons found that among surgeons who reported working less than 60 hours per week, 30 percent described themselves as burned out with their profession. Among those who worked 60 to 80 hours per week, 44 percent felt burned out, and among those surgeons who put more than 80 hours per week, 50 percent experienced significant feelings of burnout.

The number of nights spent performing overnight surgery call was also found to be a highly significant predictor of surgeon burnout. Long hours and overnight surgery were also highly statistically significantly linked to clinical depression, difficulties in finding a reasonable home-work balance, and increased conflicts at both home and at work. Additionally, the rates of both personal emotional exhaustion and feelings of depersonalization towards patients were directly associated with working more than 80 hours per week and with performing 2 or more night calls per week.

Excessive hours spent in clinical practice, as well as performing 2 or more overnight calls per week, also correlated with a significant increase in the number of self-reported medical and surgical errors. Nearly 11 percent of surgeons who worked more than 80 hours per week admitted to committing medical or surgical errors, compared to about 7 percent of surgeons who worked less than 60 hours per week.

From the article of the same title
Journal of the American College of Surgeons (11/10) Vol. 211, No. 5, P. 609 Balch, Charles M.; Shanafelt, Tait D.; Dyrbye, Lotte; et al.

Practice Management

Small-Practice Update: Three Key Steps to Survive and Thrive in the New Healthcare Era

Experts say small medical practices can survive the changes occurring across the healthcare field if they are willing to adapt. They recommend three key steps:
  • Because higher patient volumes will be necessary for small practices to survive, they encourage the addition of a nurse practitioner or physician assistant.
  • Practices are also urged to implement electronic health records systems, especially now that prices have fallen to around $15,000 for some systems and subscription-based systems are available for several hundred dollars per month.
  • Finally, small practices should roll out good, interactive websites to attract new patients, recruit new providers and get referrals from other doctors. Websites should feature articles, animations, videos and illustrations to educate patients on various health-related topics, as well as directions to the office, contact information and downloadable forms.

From the article of the same title
Medscape (10/18/10) Chesanow, Neil
Web Link - May Require Free Registration | Return to Headlines

Toolkit Aims to Prepare Physicians for Legal Implications of Social Media

The Ohio State Medical Association has released guidelines aimed at helping physicians better prepare for the legal and employment ramifications of engaging patients through online social media. Physicians and office staff posting to social media, Wikipedia, and online physician-rating and discussion sites could run afoul of federal civil rights, disability, advertising, and patient privacy laws, the guide warns, advising physicians to take care when accepting friends on Facebook or followers on Twitter. The tool kit includes sample best practices for social media use, including: be honest about who you are when posting and do not "post any derogatory, defamatory or inflammatory content about others."

From the article of the same title
American Medical News (10/28/10) O'Reilly, Kevin B.

When the Doctor Has a Boss

An increasing number of physicians are going to work directly for hospitals that are building themselves into consolidated healthcare providers rather than starting their own practices. A survey by the Medical Group Management Association found that the share of responding practices that were hospital-owned last year hit 55 percent, up from 50 percent in 2008 and around 30 percent five years earlier.

Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurance providers, struggling to get out-of-pocket fees from patients, and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions.

From the article of the same title
Wall Street Journal (11/08/10) Mathews, Anna Wilde
Web Link - May Require Paid Subscription | Return to Headlines

Health Policy and Reimbursement

CMS Releases Final MD Fee Schedule Cutting Reimbursements by 24.9 Percent

CMS has released a final 2011 physician fee schedule rule that cuts Medicare payments for providers under Part B by 24.9 percent. The payment rate is required to be reduced under the SGR system on Dec. 1, 2010, and then again on Jan. 1, 2011, unless lawmakers intervene. President Obama in June signed legislation that reversed a 21 percent pay cut for doctors and replaced it with a 2.2 percent increase through the end of November. Without congressional action, doctors' Medicare reimbursement will be reduced by 23 percent on Dec. 1, followed by the January reduction. The conversion factor, which determines particular payment rates, was calculated at $28.3868 as of Dec. 1, and at $25.5217 for 2011.

From the article of the same title
BNA Health Care Policy Report (11/04/10)

CMS Releases OPPS Final Rule for 2011

CMS has finalized four changes to its physician supervision requirements as part of the 2011final Outpatient Prospective Payment System rule. CMS changed the definition of "immediately available;" delayed enforcement of supervision requirements for rural and critical access hospitals; announced a plan to convene a panel beginning in 2012 to determine the level of supervision required for different services; and finalized a new category of "nonsurgical extended duration therapeutic services" that require direct supervision during an initiation period, followed by a minimum standard of general supervision.

From the article of the same title
HealthLeaders Media (11/04/10) Leppert, Michelle A.

Medicare Raises ASC Rates 0.2 Percent, HOPD Rates 2.35 Percent in 2011

Medicare payment rates for ambulatory surgery centers (ASCs) will increase by 0.2 percent across the board next year according to the 2011 final payment rule for ASCs and hospital outpatient departments (HOPDs). CMS has changed its payment rate update from the 0 percent change proposed earlier this year to the 0.2 percent increase, which takes into account the 1.5 percent inflationary update offset by a -1.3 percent productivity adjustment mandated by the healthcare reform bill. HOPD rates will increase 2.35 percent, based on the 2.6 percent hospital market basket update and the .25 percent reduction mandated by the Affordable Care Act. The final rule comment period lasts through Jan. 3, 2011.

From the article of the same title
Outpatient Surgery (11/03/10) Tsikitas, Irene

Doctor-Owned Hospitals Race to Beat Medicare Deadline

Hospitals garner about 50 percent of their revenue from federal healthcare programs, which is why a Dec. 31 deadline for doctor-owned hospitals has many executives concerned. After that date, doctor-owned hospitals can no longer participate in federal healthcare programs unless they are certified by Medicare, and existing facilities cannot expand unless they meet certain criteria. Hospitals interested in expansion must be located in states with a shortage of beds and in counties growing 50 percent faster than the overall state. Experts expect 30 new hospitals to be completed by the Dec. 31 deadline, but there are 44 other hospitals that are unlikely to meet the deadline and are unsure of their next moves.

From the article of the same title
USA Today (10/28/10) Weaver, Christopher

Medicine, Drugs and Devices

Realtime Elastography in Plantar Fasciitis: Comparison With Ultrasonography and MRI

Elastography is a new modality to evaluate the changes in the tissue elasticity of the plantar fascia. Researchers gauged its role in the evaluation of plantar fasciitis and to compare it with ultrasound and MRI. Twenty-five patients with bilateral heel pain were assessed using ultrasound, elastography, and MRI. Sensitivity, specificity and overall accuracy were determined followed by two-way analysis of variance to assess the statistical significance between the differences observed, with MRI being considered the gold standard for diagnosis. Elastography showed a 95 percent sensitivity and 100 percent specificity in the diagnosis of plantar fasciitis, while ultrasound was 65.8 percent sensitive and 75 percent specific. Elastography was shown to detect early stages I and II plantar fasciitis in 10 of 12 and in 15 of 16 patients, respectively, while ultrasound only detected four of 12 patients with stage I disease. The researchers concluded that the combination of elastography with ultrasound improves the accuracy from 68 percent to 96 percent and also stages the extent of disease, with the results being comparable to MRI.

From the article of the same title
Current Orthopaedic Practice (12/01/10) Vol. 21, No. 6, P. 600 Kapoor, Atul; Sandhu, Hardas Singh; Sandhu, Parvinder Singh; et al.

Robotic Limbs That Plug Into the Brain

The U.S. Defense Advanced Research Projects Agency has backed the development of two new sophisticated prosthetic limbs that can move with natural dexterity and can be controlled with human thought. The new designs have about 20 degrees of independent motion and can be operated using several different interfaces. One device can be consciously controlled using a system of levers in a shoe.

From the article of the same title
Technology Review (10/27/10) Singer, Emily

Qualms Arise Over Outsourcing of Electronic Medical Records

The U.S. government next year will begin to distribute billions of dollars to healthcare providers who adopt electronic medical records. Doctors also face a federal mandate to upgrade software as the United States switches to a new system of insurance billing codes. Indian outsourcing companies see in these mandates a huge opportunity, but U.S. healthcare providers have expressed reluctance to work with offshore vendors, citing the efficiency of doing work on site and the potential legal complications of shipping sensitive health information to other countries.

From the article of the same title
Wall Street Journal (11/01/10) Sharma, Amol; Worthen, Ben
Web Link - May Require Paid Subscription | Return to Headlines

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November 10, 2010