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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

The Senate opened debate on its health system reform bill Monday, with majority leader Sen. Harry Reid (D-Nev.) vowing to keep the Senate in session seven days a week until Christmas to get a bill passed. The first few days have been quiet as leaders on both sides of the aisle struggled to agree on a schedule for debating proposed amendments.

A Congressional Budget Office report released on Monday received a lot of attention. The report found that the bill would cost $848 billion over 12 years and cover 30 million more Americans. The report also found that the bill would not increase premiums for most Americans but would result in higher premiums in the individual market. However, coverage in that market would be better and premium subsidies would bring down costs for low and middle-income families.
On Change and Opportunity

“While the nation debates the future of our health care system, many of us in the medical profession are wondering — will we get it right this time?” begins ACFAS President-Elect Michael S. Lee, DPM, in “A Time of Great Change — and a Time of Great Opportunity.” You can read the rest of his powerful editorial in your Nov/Dec 2009 issue of the Journal of Foot & Ankle Surgery.

You can also access this article and the entire issue quickly and easily online:
  • Go to
  • Click on “Read JFAS Online” (member login required)
  • When you reach the JFAS home page, click on the journal image for the entire table of contents.

Thinking Through Ankle Instability

How do you define acute versus chronic ankle instability? What’s the best way to determine ligamental integrity? What is the diagnostic value of advanced imaging? And, should surgery be necessary, how do you answer questions about post-operative care, such as when to remove screws or allow weight-bearing?

The latest ACFAS e-Learning podcast, "Lateral Ankle Stabilization: Primary vs. Secondary," may help you draw your own conclusions. Moderator Allan Jacobs, DPM, leads a panel of your peers in foot and ankle surgery in a comprehensive discussion of approaches to the treatment of ankle instability.

This compelling new podcast and the entire e-Learning library are available to you 24/7 on the ACFAS web site.

Foot and Ankle Surgery

Clinical Evaluation of a Dynamic Test for Lateral Ankle Ligament Laxity

The dynamic anterior ankle tester (DAAT) has been shown to be reliable in testing anterior talar translation in earlier studies. Researchers in this study sought to be the first to evaluate the reliability of the DAAT in a clinical setting and to analyze its ability to detect increased ligament laxity. In 39 patients with unilateral chronic lateral ankle instability, the anterior talar translation of the affected and non-affected side was measured pre and postoperatively using the DAAT, Telos stress radiographs, and the manual anterior drawer test. The researchers found that, in contrast to both other tests, the DAAT was not able to accurately detect increased ligament laxity preoperatively or decreased laxity of the affected ankle postoperatively.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (11/19/09) de Vries, J. S.; Kerkhoffs, G. M. M. J.; Blankevoort, L.; et al.

Treatment of Distal Lower Leg Fractures: Results with Fixed-Angle Plate Osteosynthesis

In this study, 25 patients with closed distal tibial fractures were treated with a fixed-angle (locked) plate osteosynthesis. The researchers concluded that fixed-angle plate osteosynthesis is a good alternative to intramedullary nailing when treating closed distal lower leg fractures.

From the article of the same title
European Journal of Trauma and Emergency Surgery (11/17/09) Faschingbauer, Maximilian; Kienast, Benjamin; Schulz, Arndt P.; et al.

Smoking, Anesthesia & Surgery

People who smoke should give up cigarettes before surgery and for at least one week after, according to the American Society of Anesthesiologists. According to the society, smoking increases the risk of complications during surgery and recovery. Smoking also makes it more difficult to determine the safety and predictability of anesthesia.

From the article of the same title
Baltimore Sun (11/19/09)

Practice Management


The Centers for Medicare & Medicaid Services (CMS) has delayed until April 5, 2010, the implementation of requirements that health professionals who order items or services, such as durable medical equipment, for Medicare patients, or refer Medicare beneficiaries to other Medicare providers or suppliers, to establish a current enrollment record in Medicare or have claims rejected for those items. ACFAS members who see Medicare patients should ensure that they have a current enrollment record in the Medicare Provider Enrollment Chain and Ownership System (PECOS) before that date. Physicians who have not enrolled in Medicare or who are enrolled but have not updated information in more than six years do not have a PECOS record. To determine your enrollment status, visit

From the article of the same title
HomeCare (11/09)

Liability Premiums Stay Stable, but Insurers Warn This Might Not Last

The annual Medical Liability Monitor survey indicates that 94 percent of medical liability premiums stayed flat or declined this year, but liability insurers caution that this may not last. "It does ease the pain, but the pain is still there because rates are still dramatically higher" than they were before climbing in the early 2000s, according to The Doctors Company COO Robert D. Francis. Francis says that tort reform has played a significant role in the drop in lawsuit filing frequency, but he questions how long it can last.

From the article of the same title
American Medical News (11/23/09) Sorrel, Amy Lynn

Q&A: Tips to Save Money on Supplies

Practice management consultant Keith Borglum says that medical practices can save money on supplies by joining a purchasing group, such as one sponsored by a medical association, and by purchasing supplies online, in bulk,from discounters rather than retailers. In addition, Borglum suggests a simple, easy-to-use manual system to keep track of inventory. The first step is to ascertain the buying cycle for each item based on utilization and storage space. The next step is to determine the volume of each item typically used during each buying cycle, and then to purchase enough items to last two buying cycles. Employees can put reorder tags in an envelope to signal time to replenish, and then a staff person is assigned to process tags and order new items according to the buying cycle.

From the article of the same title
Medical Economics (11/06/09) Borglum, Keith

Health Policy and Reimbursement

MGMA Warns that HIT Stimulus Money Could Be Wasted

The Medical Group Management Association (MGMA) sent a strong letter to the Department of Health and Human Services setting forth its concerns and suggestions about implementation of the HIT incentive payment plan included in the American Recovery and Reinvestment Act of 2009. Under that legislation, beginning in 2011 providers have access to up to $44,000 in government funds if they install, maintain and “meaningfully use” electronic health records (EHR) systems. Beginning in 2013, practices that are not using EHRs will see a decline in Medicare payment. MGMA urged that meaningful use criteria must take into account current practice realities and be consistent with criteria already in widespread use in small and rural clinic settings because those practices may face the biggest challenges in EHR adoption. MGMA urged the government to conduct a pilot study with a small number of vendors and practices before the official 2011 program start date to identity potential roadblocks and solutions.

From the article of the same title
Modern Healthcare (11/23/09)
Find Out More Online

ACFAS encourages members who want to better understand the EHR incentive program to read the full MGMA letter, and to take advantage of the informational resources in the Business Technology section of the ACFAS web site.

COBRA Coverage Subsidy Ends Soon for Many

Federal funding to subsidize COBRA premiums for the many Americans who have lost their jobs in the past 15 months is scheduled to expire at the end of December, if an extension does not pass. The subsidy program, which was part of the economic stimulus bill, provides a 65 percent subsidy of COBRA premiums. With full premiums for a family averaging $1200 a month, losing the subsidy would be financially devastating to many Americans. Senate Democrats are pushing a bill that would extend subsidies six more months. The COBRA subsidy issue has a real impact on physicians, both in terms of possible increase in bad debt and patients postponing elective procedures.

From the article of the same title
Sacramento Bee (CA) (11/29/09) Calvan, Bobby Caina; Tong, Anna

Technology and Device Trends

Medicine by Micromachine

A combination of microelectromechanical systems and microfluidics may make it possible to target drugs to the precise areas where they are needed, and researchers at the Charles Stark Draper Laboratory and the Massachusetts Eye and Ear Infirmary are developing an implantable drug-delivery device for that purpose. The device is designed to treat hearing loss by delivering tiny pulses of a drug to the inner ear, allowing the regrowth of sensory cells. The device will feature a programmable micropump driven by a small battery and controlled by an electronic circuit, while a refillable reservoir will contain about a year's worth of medication. The device's central component is a push-pull mechanism, which injects the drug deep into the inner ear without flooding the ear. The technology has implications for the targeted delivery of other medications.

From the article of the same title
IEEE Spectrum (11/09) Vol. 46, No. 11, P. 36; Borenstein, Jeffrey T.

Passive Navigation Principle for Orthopedic Interventions With MR Fluoroscopy

For orthopedic interventions, magnetic resonance (MR) fluoroscopy is still in an early stage of development. A new innovative passive navigation method could potentially be applied to numerous MRI-guided musculoskeletal interventions. The new method eliminates the need to switch between different planes because the cross-sectional modality of the MRI is used as in the new navigation approach. For the study, a passive navigation device was constructed and evaluated in nine cadaveric ankle joint specimens. The interactive high-field MR fluoroscopy and the passive aiming device allowed for precise drilling of osteochondral lesions of the talus, even with the ankle's complex anatomy.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (11/09) Bail, Hermann J.; Teichgraber, Ulf K. M.; Wichlas, Florian; et al.

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December 2, 2009