Banner
November 20, 2013

News From ACFAS


Surgical Workshops Head to East and West Coasts in 2014
ACFAS is continuing its journey across the US by bringing the Simple to Complex Forefoot Revisional Surgery Workshop and Seminar to Tysons Corner, Virginia and Manhattan Beach, California in 2014.

The program begins on a Friday evening with a presentation on "Common Forefoot Surgical Complications—How to Deal with Them," and continues on Saturday with a hands-on sawbone workshop where participants practice cutting-edge techniques. Attendees will learn to identify indications and contraindications for forefoot deformities, and apply and enhance a wide variety of fixation options to test their technical skills, and more – all while using the latest products and materials from a variety of manufacturers. There will be an intensive panel discussion to follow, as well as case presentations, so please bring your own cases to share.

Take advantage of this highly interactive program and earn 12 continuing education contact hours. To register or for more information, visit acfas.org/comingtoyou. Courses are filling up fast, so register today.
Share Facebook  LinkedIn  Twitter  | Web Link
New ACFAS e-Learning: Arthroscopic Update
Learn the best practices for small-joint arthroscopy treatment approaches in the newest ACFAS e-Learning Clinical Session “Arthroscopic Update.” This online seminar features an outstanding cross section of members who share their insights on advances and changes in arthroscopy, as well as understanding the management of impingement syndromes and evaluating arthroscopic assisted fracture reduction. Our intensive subject matter experts share their preferences in how they approach arthroscopic surgery, instrument setup, tips for how to identify normal versus abnormal anatomy, and important pearls and pitfalls gleaned from case-based presentations.

To view, visit acfas.org/e-learning and choose Clinical Sessions.
Share Facebook  LinkedIn  Twitter  | Web Link
The College Expands its Social Reach
Now you can find ACFAS in two more social network arenas – Google+ and a new ACFAS YouTube page. These new outlets add to our communications strategy to keep members informed and to continue to educate patients and referring audiences on the expansive and important role of foot and ankle surgeons in the full healthcare continuum. Share these new links on your website and on your social media pages. Each can be found at youtube.com/user/theacfas or google.com/+acfasorg.
Share Facebook  LinkedIn  Twitter  | Web Link

Foot and Ankle Surgery


Factors Associated with Recurrent Fifth Metatarsal Stress Fracture
A recent study has found that there are a number of factors associated with refractures of the fifth metatarsal after surgery is performed on an initial stress fracture. The study examined 157 patients who had undergone modified band wiring to treat a stress fracture of the fifth metatarsal and had subsequently experienced union of the fractured bone or refracture. The clinical features of patients in both the union and refracture groups, including age, weight, fracture classification, time to reunion, and reinjury were compared. Researchers also compared radiological parameters representing cavus deformity and fifth metatarsal head protrusion, including the mean fourth-fifth intermetatarsal (IMA4-5) angle on anteroposterior (AP) radiographs and fifth metatarsal lateral deviation (MT5-LD) on oblique radiographs, to investigate the influence of structural abnormalities. An association was seen between postoperative refractures and higher body mass indices (BMIs). A similar association was also observed between refractures and IMA4-5 on AP radiographs and MT5-LD on oblique radiographs, both of which are associated with a protruding fifth metatarsal head. The study also noted that eight of the refractures took place within three months of patients beginning rehab, while 13 cases occurred within six months of beginning rehab. The study concluded that patients with a protruding fifth metatarsal head and a high BMI should approach rehab carefully before returning to their pre-fracture levels of physical activity.

From the article of the same title
Foot & Ankle International (11/11/2013) Lee, Kyung-tai; Park, Young-uk; Jegal, Hyuk; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Distraction-Free Ankle Arthroscopy for Anterolateral Impingement
A recent retrospective study found that there are a number of significant benefits associated with the use of arthroscopic treatment in patients with soft tissue ankle impingement. The 24 patients who participated in the study suffered external ankle sprains and subsequently experienced anterolateral mechanical pain associated with edema. These patients underwent medical and rehabilitative treatment for more than six months before arthroscopy. Simple dorsiflexion was used to systematically perform arthroscopic debridement with joint lavage in these patients. Distraction was not used. All patients had good Kitaoka scores after an average follow-up period of 22 weeks, while 22 of the 24 participants had achieved excellent results. No septic complications or algodystrophy were seen in any of the participants. Researchers determined that the use of arthroscopic treatment reduced pain and edema and allowed patients to resume athletic activities more quickly. The study concluded that arthroscopic treatment of anterolateral ankle impingements is possible using simple dorsiflexion and no distraction, and that such a treatment could help decrease complication rates.

From the article of the same title
European Journal of Orthopaedic Surgery and Traumatology (11/13) Rouvillain, Jean Louis; Daoud, Wael; Donica, Adrian; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Health-Related Quality of Life Predicts Major Amputation and Death, but Not Time to Healing in Diabetes Mellitus Patients with Foot Ulcers
Researchers in Denmark have performed a study that aimed to determine whether health-related quality of life (HRQoL) was useful in predicting a variety of health outcomes in diabetes mellitus patients with foot ulcers. Nearly 1,100 patients with new diabetic foot ulcers were followed until ulcer healing, a major amputation, or death, for up to a maximum of one year. Patient and ulcer characteristics and a standardized instrument made up of five domains and a Visual Analogue Scale (VAS) for measuring HRQoL (EQ-5D) were measured at baseline. Researchers evaluated the prognostic influence of the EQ-5D domains by performing multivariable Cox regression analyses on the time-to-event data and by adjusting for baseline clinical characteristics of the ulcer and co-morbidities. The study found that low HRQoL is useful in predicting major amputation and death in diabetes mellitus patients with foot ulcers, though HRQoL did not increase healing. Researchers concluded that additional studies will need to be performed to examine the effects of HRQoL on ulcer outcome in order to reduce the rate of treatment failure and mortality.

From the article of the same title
Diabetes Care (10/13) Siersma, V.; Thorsen, H.; Holstein, P.E.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management


An Altered Electronic Order Set Could Create Cost Savings, Better Care
The journal Health Psychology has published a study that examined how an electronic order set in an electronic medical record (EMR) affects patient care and patient costs. The study by researchers at the University of Missouri involved physicians who were asked to select lab tests using three order set list designs on the same EMR: an opt-in design, in which no lab tests were pre-selected; an opt-out design, which required doctors to de-select lab tests they did not need; and a third design in which tests that had been recommended by pediatric experts were pre-selected. Researchers found that doctors using the opt-out design ordered three more tests than their counterparts who used the opt-in and recommended test designs, while those who used the recommended test design ordered more tests than those who used the opt-in design. In addition, the study found that including default selections in either the opt-out or recommended test designs resulted in an increase in the quality of lab tests that were ordered. However, the use of the opt-out method costs roughly $71 more per patient, while the use of the recommended tests design keeps costs down but requires a consensus about which tests to set as defaults. The study concluded that changing the design of an electronic order set in an EMR could lead to better care and greater cost savings for patients.

From the article of the same title
Healthcare Informatics (11/13) Perna, Gabriel
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Makes Perfect: ICD-10 Testing Strategies for Physician Practices
Physician practices need to develop and implement an effective testing plan to be sure that they are prepared for the transition to ICD-10 diagnosis codes on October 1, 2014, writes Robert Tennant of the Medical Group Management Association (MGMA). According to Tennant, such a testing approach begins by testing software used for practice management, billing, and health records to ensure that these applications can successfully generate ICD-10 codes. All practice staff members should receive training at this stage to ensure that they know how to generate ICD-10 codes in these programs, Tennant says. The next step in the testing process is usually workflow testing, which examines the ability of clinical staff to include the correct level of documentation during patient visits in order to provide sufficient coding support, and to eliminate the need to contact patients to fill in gaps in documentation after their visits. Once this is complete, practices can begin testing with external partners such as clearinghouses and health plans, Tennant says. He notes that physician practices would be wise not to forgo such testing, since doing so could result in delayed or denied reimbursements that can cause major disruptions to cash flow.

From the article of the same title
Modern Healthcare (11/08/13) Tennant, Robert
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement


Debate Over Delaying Individual Mandate Grows Louder
The American Academy of Actuaries and America's Health Insurance Plans are warning Congress not to delay the Affordable Care Act's individual mandate or extend the open enrollment period on the ACA's health insurance exchanges in response to the problems with Healthcare.gov. According to the American Academy of Actuaries, delaying the individual mandate or extending the open enrollment period will encourage healthier, lower-cost individuals to put off buying insurance, which in turn will result in a risk pool made up primarily of sicker, higher-cost individuals. The organization added that because premiums for next year are based on the assumption that the individual mandate and limited open enrollment period would be in effect, thus resulting in a balanced risk pool, 2014 premiums may not be sufficient to cover the cost of insuring higher-risk individuals. The actuaries noted that altering the individual mandate and the open enrollment period will also result in adverse selection that will affect premiums in 2015, since enrollment information from 2014 will be used in setting rates for the following year. However, the actuaries conceded that continued problems with Healthcare.gov may require the implementation deadlines and dates for the individual mandate and the open enrollment period to be changed. America's Health Insurance Plans, meanwhile, said delaying the individual mandate will result in higher premiums and more uninsured consumers, among other things.

From the article of the same title
Health Leaders Media (11/12/2013) Commins, John
Share Facebook  LinkedIn  Twitter  | Web Link

HealthCare.gov Sees Fewer Than 27,000 Signups in First Five Weeks
The Obama administration reports that less than 27,000 people have signed up for health insurance coverage through Healthcare.gov during the first five weeks of the federal health insurance exchange's existence. That figure, which includes people who have signed up for coverage but have yet to make any payments on their plans, works out to an average of about 750 individuals in the 36 states that use Healthcare.gov. A total of 106,000 people have signed up for coverage on both the federal and state-run exchanges--a number that is far less than the 500,000 people federal officials had hoped would sign up for health insurance plans during the first month of the enrollment period. Meanwhile, nearly 400,000 people were found to be eligible for either Medicaid or the Children's Health Insurance Program during the first six weeks of the enrollment period.

From the article of the same title
Modern Healthcare (11/13/13) Demko, Paul
Share Facebook  LinkedIn  Twitter  | Web Link

House Passes Bill to Allow People to Keep Their Health Plans
The House of Representatives passed a bill on Nov. 15 that will allow insurance companies that offered plans on the individual market as of Jan. 1, 2014 to continue to do so next year, assuming such plans are not already offered through the federal or state-run health insurance exchanges. The bill, which was largely supported by House Republicans and largely opposed by House Democrats, was passed in response to the cancellation of some insurance policies ahead of new requirements that take effect on Jan. 1, 2014. However, Democrats say the legislation would undermine the Affordable Care Act because it would allow insurers to continue to sell policies that do not meet the standards outlined in the healthcare reform law. Democrats also claim the bill would hurt policyholders suffering from serious diseases. The Senate is considering a similar bill. The House bill is unlikely to be taken up in the Senate, and it has also drawn a veto threat from President Obama. The passage of the House bill came one day after the administration announced it will allow insurance companies to renew existing policies in the individual and small group market through October 2014.

From the article of the same title
BNA Health Care Daily (11/15/13)
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

JCR Releases Free HEN Guide to Improve Bedside Care
Joint Commission Resources (JCR) has issued a free guide produced by the JCR Hospital Engagement Network (HEN) titled "Beyond the Bundles: How to Implement Best Practices at the Bedside." The guide covers negative drug events, catheter-associated urinary tract infection, central line-associated blood stream infection, early elective delivery, injuries from falls and immobility, pressure ulcers, surgical site infection, ventilator associated pneumonia and venous thromboembolism. Also included is an overview on using performance improvement methods for sustainable results, and reducing readmission cases. The guide is part of the national Partnership for Patients' effort to enhance the quality, safety and affordability of healthcare for all Americans. It is complementary to the free JCR HEN publication, "Patient Safety Initiative: Hospital Executive and Physician Leadership Strategies," offering approaches for leaders and physicians to use to reduce patient harm. Visit the JCR HEN website for more information.

From the article of the same title
Joint Commission Online (11/13/13)
Share Facebook  LinkedIn  Twitter  | Web Link

Medicare Payments Cut for More Than 1,400 Hospitals Under Value-Based Purchasing Program
Data released by the federal government shows that 1,231 hospitals will see an increase in their Medicare payments next year as a result of their performance under the Centers for Medicare & Medicaid Services' value-based purchasing program, while 1,451 will see a cut in their payments. The data also shows that the average increase in Medicare payments under the program--which measures hospitals' performance across 24 measures of clinical processes, patient satisfaction, and outcomes--was 0.24 percent. These bonuses are meant to reward hospitals for providing quality care to patients. The average cut, meanwhile, was 0.26 percent. However, about half of the hospitals that are participating in the program will break even next year. This is because the payment changes for these hospitals were between plus or minus 0.2 percent, meaning they will recover the across the board 1.25 percent cut in base-operating diagnosis-related group (DRG) payments that are used to fund the value-based purchasing program.

From the article of the same title
Modern Healthcare (11/15/13) McKinney, Maureen
Share Facebook  LinkedIn  Twitter  | Web Link

RUC Committee Takes Steps Toward Transparency
The American Medical Association (AMA) has announced a number of steps that it plans to take to make its Specialty Society Relative Value Scale Update Committee (RUC)--whose recommendations are often used by the Centers for Medicare & Medicaid Services in developing its annual fee schedule--more transparent. The move comes amid criticism among some who say that RUC has been overvaluing some procedures by as much as 100 percent. To quell such criticism and to make its meetings less opaque, RUC plans to begin publishing the minutes, dates, and locations of its meetings, which are held three times a year. That information, along with votes for individual current procedural codes, will be posted on AMA's Web site after CMS releases its annual fee schedule. In addition, the committee plans to increase the number of surveys it sends to physicians in order to set values for frequently-performed procedures. Procedures that are performed more than 100,000 times per year will require a minimum of 50 surveys, while procedures that are performed more than 1 million times annually will require at least 75 surveys. Shari Erickson, the vice president of governmental and regulatory affairs at the American College of Physicians, said the move was a positive first step in the direction of greater transparency at RUC.

From the article of the same title
Medical Economics (11/01/13) Marbury, Donna
Share Facebook  LinkedIn  Twitter  | Web Link

White House Relying More on Insurance Carriers to Help Fix HealthCare.gov
The Obama administration has reportedly sought the help of the insurance industry in addressing the problems with Healthcare.gov that have prevented many consumers from signing up for coverage. One way in which the White House has asked for the insurance industry's assistance is by prioritizing the ability of consumers to purchase plans directly from insurance companies' Web sites rather than Healthcare.gov. Dan Mendelson, the chief executive of the healthcare consultancy Avalere Health, says that it is important for the administration to shift to other methods for purchasing coverage in part so that the problems with Healthcare.gov can be corrected. However, technical problems are also plaguing efforts to enroll consumers directly through health insurance companies, including glitches in the federal system that have made it impossible for insurers to determine whether consumers are qualified for government subsidies. White House officials say that the increased focus on trying to enroll consumers through insurers' Web sites is not a contingency plan in the event of continued problems with Healthcare.gov. Officials also maintain that the federal health insurance exchange will be working for nearly all of consumers by the end of the month. Meanwhile, insurance company employees are also working with government employees to correct the problems with Healthcare.gov.

From the article of the same title
Washington Post (11/09/13) Eilperin, Juliet; Goldstein, Amy
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices


Comparison of the Efficacy and Safety of Subcutaneous and Intravenous Tocilizumab in Certain RA Patients
Subcutaneous (SC) tocilizumab is just as effective as the intravenous (IV) form of the drug at treating moderate-to-severe rheumatoid arthritis (RA), a recent study has found. Nearly 1,300 RA patients who had experienced an inadequate response to disease-modifying anti-rheumatic drugs (DMARD) were recruited to take part in the study. These patients continued to receive DMARD in addition to tocilizumab-SC 162 mg weekly plus a placebo administered intravenously once a week, or tocilizumab-IV 8 mg/kg every four weeks plus a SC placebo once a week. The study's primary outcome was the non-inferiority of tocilizumab-SC to tocilizumab-IV with regard to the proportion of patients in each group who achieved an American College of Rheumatology (ACR) 20 response after 24 weeks using a 12 percent non-inferiority margin (NIM). More than 69 percent of patients treated with tocilizumab-SC experienced ACR 20 response at week 24, compared to more than 73 percent of those treated with the IV form of the drug. The 12 percent NIM was also met. Researchers also found that both forms of tocilizumab had similar safety profiles, though injection-site reactions were more common in patients treated with tocilizumab-SC.

From the article of the same title
Annals of the Rheumatic Diseases (09/12/2013) Burmester, Gerd R.; Rubbert-Roth, Andrea; Cantagrel, Alain; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Osteoarthritis Pain Has a Significant Neuropathic Component: An Exploratory In Vivo Patient Model
A new study has found that intravenous lignocaine is effective at treating pain in patients with osteoarthritis. The study involved 28 adults who did not respond to more conservative treatments and subsequently underwent intravenous lignocaine therapy either in the rheumatology or pain relief departments. Researchers found that the average pain relief calculated from the Numeric Rating Scale (NRS) scores of these patients was 30.2 +/- 21.4 percent, while the average duration of pain relief was 10 +/- six weeks. The study also found that treating osteoarthritis patients with intravenous lignocaine infusion therapy resulted in significant improvements in pain intensity, pain relief, and mobility. Researchers determined that intravenous lignocaine therapy was effective because part of the pain mechanism in osteoarthritis patients may be neuropathic, and because intravenous lignocaine therapy has been found to be effective at treating neuropathic pain. However, researchers also said that more studies that examine the role of neuropathy in osteoarthritis pain are needed.

From the article of the same title
Rheumatology International (11/10/2013) Duarte, Rui V.; Raphael, Jon H.; Dimitroulas, Theodoros; et al.
Share Facebook  LinkedIn  Twitter  | Web Link





Copyright © 2013 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe click here.

Abstract News © Copyright 2013 INFORMATION, INC.
Powered by Information, Inc.