News From ACFAS

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Reach out to your patients and your community with the latest edition of the FootNotes patient newsletter. This free, valued member benefit is available for download at acfas.org/marketing and features seasonal articles to help you communicate with existing and potential patients.

The Winter Edition features articles on heel pain in children, ankle fractures and sprains, and keeping your feet safe from frostbite. Coming soon to a mailbox near you: the newly designed ACFAS Update member newsletter! The newsletter boasts a fresh contemporary look designed to help you quickly find the news you want most and reflect the identity and brand of the College.

Get a sneak preview online at acfas.org/update. Take advantage of all that the 2012 Annual Scientific Conference in San Antonio has to offer! This year's conference offers a multitude of opportunities to improve your clinical skills and connect with colleagues; there is something for everyone!

Hear relevant "need to know information" in the Young Members
Forum

Your patients are surfing the web for pain solutions, be conversant with the latest in new technologies = different surgical approach, and attend the Speed Dating – New Technology workshop

Difficult Wounds…not Diabetic Wounds

Residency Educators Session…no trash talk--just a sharing, open discussion

Plan to attend the meaty one-day information-packed workshop, Perfecting your Practice practice management/coding workshop; it will change how you practice!

Register today at acfas.org/sanantonio to hear the most up-to-date research and to be a part of the latest debates.

Foot and Ankle Surgery

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A study was conducted to assess the five-year results of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise regime. Fifty-eight patients or 70 tendons were examined five years after they began such a program. The validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire score, pain status, alternative treatments received, and ultrasonographic neovascularisation score were recorded at baseline and at five-year follow-up. In 46 patients or 58 tendons, the VISA-A score rose substantially from 49.2 at baseline to 83.6 after five years and from the one-year to five-year follow-up from 75 to 83.4. Nearly 40 percent of the patients were completely pain-free at follow-up and 48.3 percent had received one or more alternative treatments. The sagittal tendon thickness decreased from 8.05 mm at baseline to 7.50 mm at the five-year follow-up.


Plantar pressure measurements were taken in 35 healthy subjects to determine the efficacy of various second submetatarsal offloading techniques. The plantar pressure was measured using an insole scanning system as they walked in shoes only, shoes plus metatarsal pads, and shoes plus metatarsal bars, placed either perpendicular or oblique to the foot axis. Both the bars and the pads reduced impulse in comparison with the shoes alone, while the bars reduced impulse more than the pads, and the oblique position of the bars reduced more pressure than the perpendicular position.


A study evaluated the effects of cigarette smoking on surgically treated acute ankle fractures. The rate of overall postoperative complications and deep wound infections were compared between nonsmokers (n = 721) and smokers (n = 185). Follow-up data at six weeks was available for 98.2 percent of the patients. Overall postoperative complication rate was 30.1 percent in smokers versus 20.3 percent in non-smokers (P=0.005) while that of deep wound infections was 4.9 percent in smokers versus 0.8 percent in non-smokers (P < 0.001). A regression revealed that smokers were six times as likely to result in a deep infection. A more complex fracture type, diabetes mellitus, and inadequate fracture reduction were also associated with occurrence of postoperative complications.

Practice Management

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A growing practice in Michigan is for hospitals to go into business with their doctors to help manage services and enhance patient care, with the St. John Providence Health System splitting ownership of three new companies equally between doctors and the health system. Management partnerships are "becoming the preferred way to integrate physicians with a health system's clinical protocol," says consultant Tony Colarossi, who adds that many Michigan hospitals are using some type of co-management model in areas of chronic care such as pulmonary or cardiology. Such partnerships are being formed to help hospitals with healthcare reforms in which they will be paid for the entire care of a patient rather than on a fee-for-service basis.


Personal health records (PHRs) must have relevance for both the patient and the healthcare provider, and many providers opt to have the PHR tethered to the electronic medical record so that the data can be connected automatically. "A shared connection [between patients and physicians] is what consumers really want," says the University of Pittsburgh Medical Center's G. Daniel Martich, MD. Engaging both patients and doctors in using the PHR involves educating both parties through tutorials or incentives such as contests, as UPMC has done; Holly Miller, MD, with MedAllies reports that patients with the most diagnoses are likeliest to use a PHR, while participation can be encouraged by permitting patients to link with others, as many patients like being part of a virtual community of people with the same diagnosis.


Despite the growing availability of healthcare quality and cost information online, for-profit websites that use anecdotal patient reports are the easiest to find using Google search. Out of the top 30 results that appear when searching for physician-related terms like "quality clinic" or "best doctors," 67 percent include information based on patient experience, but only 22 percent of the results feature data taken from evidence-based measures of physician performance. Over 80 percent of health rating sites that are "highly findable," those that show up regularly as top results, use anecdotal patient reports, half have quality information, and only a third contain cost data, according to a study published in the November issue of American Journal of Medical Quality.

Health Policy and Reimbursement

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The start date for Stage 2 of the electronic health records (EHRs) meaningful use program has been pushed back from 2013 to 2014 by the Department of Health and Human Services so that Stage 1 pioneers who attest in 2011 are not punished by narrow timeframes next summer for preparing for Stage 2. Under the Medicare and Medicaid EHR Incentive Programs, providers who attest early receive greater incentives. And now those providers who first attest in 2011 can get three payment years for meeting the Stage 1 expectations, while those first attesting in 2012 can only get two payment years under Stage 1 criteria.


The Centers for Medicare & Medicaid Services has developed a "comprehensive tool" to help guide physicians and other eligible professionals through all phases of the Medicare electronic health-record incentive payment program. The Web-based interactive resource includes chapters on program basics, eligibility and registration. It also has a description of all of the Stage 1 meaningful-use criteria and advises practitioners on how to choose the optional measures they will use as part of the attestation phase of the program. Physicians and other eligible professionals have until Dec. 31 to complete 90 consecutive days of meaningful use of a certified EHR and until Feb. 28, 2012, to report their data and attest that they have met the criteria to be deemed meaningful users in the Medicare portion of the program. The guide can be found here.


The Centers for Medicare and Medicaid Services (CMS) has announced application deadlines for Medicare accountable care organizations (ACOs) seeking to receive advanced payments for capital investments. Applications will be accepted between Jan. 3 and Feb. 1 for ACOs seeking to begin April 1, while ACOs hoping to begin July 1 will have between March 1 and March 30 to submit advanced-payment applications. The advanced-payment model would supply upfront payment of certain financial bonuses offered to ACOs. To be eligible, applicants must be one of two classes of ACOs: Those with less than $50 million in annual revenue, which cannot include a hospital; and those with annual revenue of less than $80 million, which can include critical access or Medicare low-volume rural hospitals.

Medicine, Drugs and Devices

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Engineers from Washington State University have developed a process to create a bone-like material for use in the repair of natural bones which have been damaged. The material becomes a scaffolding for new bones cells to adhere to as they grow to repair the damage. Tests in the laboratory indicate that new cells begin to cover the scaffolding within the first week of its attachment to the damaged area and show positive results in tests on rats and rabbits. The process involves the use of a printer originally designed to create three-dimensional metal objects, a ceramic powder strengthened by zinc oxide and silica, and a plastic binder. The binder is repeatedly applied to the powder in miniscule layers until complete, at which point the scaffolding is cleaned and then baked at 2282 degrees Fahrenheit for two hours.


The American Medical Association has been directed to encourage physician training to avoid misuse or abuse of controlled substances like prescription drugs by its House of Delegates. The House has also asked AMA to use screening tools to determine those who might abuse drugs and to make identification and treatment resources easily available to physician. Other tasks for the AMA Council on Science and Public Health include assessing the efficacy of current drug policies and making suggestions for preventing prescription fraud, as well as the possibility of expanding such monitoring programs into veterinary clinics, hospitals, Dept. of Veterans Affairs facilities, and opioid treatment programs. The administration is hoping that programs for monitoring prescriptions would be able to expand through the entire country. Proposed bills are currently in the House and Senate and would make 16 hours of training every three years a requirement to qualify to register to prescribe opioids. Some fear that these changes could make physicians less likely to prescribe such drugs, especially the painkillers.


An article posted online in the Journal of Medical Systems details a survey that was emailed to accredited graduate programs in medical education by researchers from the University of California San Diego. The survey shows that medical residents are looking for more ways to use smartphone applications in the clinical setting. According to the survey, over three-quarters of those who responded used a smartphone and half of those individuals made use of that smartphone and its applications for clinical purposes. The researchers note that this use is likely to grow, but will be limited by the lack of high-quality applications, and that several factors will determine whether smartphone application use will be a widespread success in the clinical setting. The reports showed that the most used applications, in ascending order, were pregnancy due date calculators, coding and billing applications, medical calculators, and drug guides.