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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

Newspapers are reporting that Senate Democrats have reached a tentative agreement on a public option alternative. The details have not been released, but it is believed to involve expanding Medicare and Medicaid in place of the public option.

In the case of Medicare, people aged 55 to 60 and older who could not find affordable coverage could buy coverage under Medicare. The coverage would be provided by private health insurers, and the federal Office of Personnel Management (OPM) would negotiate with the plans. For many years, OPM has negotiated with private insurers for federal employees.

Medicaid would be expanded to 150 percent of the poverty level.
December Research Reviews

You may not have time to read all the research you’d like to, but in just a few minutes you can enhance your knowledge with ACFAS’ Scientific Literature Reviews.

This month you’ll find quick reads on a variety of topics, including the effect of cigarette smoking on radiographic bone healing, risk factors for venous thromboembolic disease in podiatric surgery, and comparison of augmented and nonaugmented surgical repair of fresh total Achilles tendon rupture.

These reviews have been prepared for you by podiatric residents at the Botsford Hospital from the Journal of Bone and Joint Surgery (British), the Journal of Bone and Joint Surgery (American), Foot and Ankle International, and other research publications.

Catch up on recent research any time with ACFAS’ Scientific Literature Reviews.
Access JFAS Articles in Press for Up-to-the-Minute Research

Whether you're a researcher looking for the most current references, or just want to stay on top of the latest developments in the profession, you'll want to frequently visit "Articles in Press" on the JFAS home page. New articles are available as soon as their proofs have been approved — even before they're assigned to an upcoming issue.

It's quick and easy:
  • Go to
  • Click on “Read JFAS Online” (member login required)
  • When you reach the JFAS home page, click on “Articles in Press” in the menu on the left
Check out what's new, including original research, case reports, and tips, quips and pearls.

Socks for the Homeless

If you’re attending the ACFAS Annual Scientific Conference, February 22–26, 2010, in Las Vegas, please pack some new socks to donate to the homeless.

DOX Podiatry and the ACFAS Consumer Education Committee are supporting this year’s sock drive. All sock donations will go to The Shade Tree, a Las Vegas shelter for homeless and abused women, children and their pets.

Please help homeless Las Vegas residents maintain their foot and ankle health by donating one or more pairs of new socks!

Foot and Ankle Surgery

Negative Pressure Wound Therapy Shows a 97.8% Limb-salvage Rate for Diabetic Feet

Negative pressure wound therapy (NPWT) used in combination with debridement and/or partial foot amputation may lead to successful limb salvage in patients with severe diabetic foot infections, according to research presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. In a review of 45 diabetic feet with limb-threatening infections that underwent debridement and/or partial amputation and NPWT using a vacuum-assisted closure (VAC), successful limb salvage was achieved in 97.8 percent of cases.

From the article of the same title
Orthopedics Today (12/09) Brockenbrough, Gina

Reconstructive Surgery for Charcot Foot : Long-term 5-year Outcome

Diabetic neuropathic osteoarthropathy often leads to progressive malpositioning of the foot with subsequent ulcers and a high risk of amputation. There are very few reliable studies on long-term outcome. This study includes the largest follow-up collective ever carried out, examining 205 surgical procedures. Researchers found that use of a fixateur externe could prevent many amputations and improve patient's activity, concluding that the interdisciplinary teamwork between an orthopedic surgeon, orthopedic shoemaker and orthopedic technician is essential for long term success.

From the article of the same title
Der Orthopade (11/19/09) Illgner, U.; Podella, M.; Rümmler, M.; et al.

Practice Management

'Vital Signs' for Assessing Your Practice's Financial Health

There are key measures that physician practices should track to monitor financial health. For example, practices should monitor the total hours providers work compared to charges. If work hours are stable but charges decline, this needs to be examined. Charges can be affected by such things as coding skill variations, billing delays, changes in billing staff or declines in service volumes. Collections should be tracked as a percentage of charges. By reviewing collections monthly, practices can uncover such things as failure to collect co-pays or failing to follow up on denied claims.

From the article of the same title
Family Practice Management (12/09) Borglum, Keith
Improving Collections

For more tips on improving collections in your practice, visit the Coding and Billing section of the ACFAS web site to read "Improve Patient Collections: Improve Your Bottom Line."

No Free Lunch for Doctors, Brought to You by Jersey's AG

The New Jersey Attorney General has issued a report calling for new state regulations to crack down on relationships between physicians and drug and device makers. The report recommends that physicians be banned from accepting any food from these companies, whether in their offices, in a hospital or in a restaurant, and that when their licenses are reviewed, physicians must disclose anything over $200 worth of payment/gifts from the industry. It also recommends prohibiting the companies from buying prescribing data from pharmacies and then targeting physicians based on their prescribing patterns.

From the article of the same title
Wall Street Journal (12/03/09) Goldstein, Jacob

Tort Reform: Does Saying 'I'm Sorry' Help?

Increasing evidence suggests that patients are less likely to sue when physicians disclose medical errors, express sympathy and apologize. Physicians are traditionally reluctant to apologize after adverse events because their words can be used in malpractice litigation as admissions of fault. Many physicians say that an apology can hurt more than it helps in that it can be taken by attorneys as an admission of fault. In the interest of encouraging physicians to disclose medical errors, 36 states have enacted apology laws. In 28 of these states, apology laws prevent the use of expressions of sympathy, regret and condolence from being used against the physician in subsequent litigation. Because of the variation in state laws, physicians should become familiar with the degree of protection offered by the states in which they practice.

From the article of the same title
Medscape (11/16/09) Terry, Nancy

Health Policy and Reimbursement

Baylor Embracing a New Healthcare Approach

One option health leaders in North Texas are considering to curtail medical spending while boosting care is accountable care, which encourages collaboration among family doctors, hospitals, surgeons and other specialists to use evidence-based medicine and share payments. The Baylor Health Care System is pursuing the approach and says it will convert its 13 hospitals and 4,500 network physicians into an accountable-care organization by 2015.

From the article of the same title
Dallas Morning News (TX) (11/30/09) Roberson, Jason; Landers, Jim

Cash Flow Squeeze: 2012 IRS Rule Will Withhold Some Medicare Pay

Physician advocates are concerned about a provision in a 2005 tax bill that will result in a 3 percent withholding of payments to physicians who see Medicare patients. Under the law, the withholding would be refunded when physicians file tax returns for the year. With increasingly slim profit margins, the withholding could have a serious impact on smaller practices with a large number of Medicare patients. The provision is not directed specifically at healthcare providers, but applies to any contractor doing work for federal, state and local governments. Medicaid is not included because services are provided based on patient financial need. Physician groups are working to repeal the provision before it goes into effect.

From the article of the same title (12/07/09) Silva, Chris

Here There and Everywhere

The Medicare Payment Advisory Commission (MedPAC) issued a report last week, Measuring Regional Variation in Service Use, that provides more evidence of significant geographical differences in the use of Medicare services. Areas in the 90th percentile use about 30 percent more services than those in the 10th percentile. Observers believe that the report will provide even more impetus for Congress to rein in spending and overutilization in those regions to close the gap in service use.

From the article of the same title
Modern Healthcare (12/07/09) Lubell, Jennifer

Technology and Device Trends

First Human Embryonic Stem Cell Lines Approved for Use Under New NIH Guidelines

December 2 marked the announcement of the National Institutes of Health's (NIH) approval of the first 13 human embryonic stem cell (hESC) lines for employment in NIH-funded research under the NIH Guidelines for Human Stem Cell Research adopted this past July. Eleven of the approved lines were developed by Children's Hospital Boston while the other two were the work of Rockefeller University in New York City. Information about the events that transpire during human development is already being provided by research using hESCs, and researchers hope that cells differentiated from hESCs may eventually be utilized to treat many diseases, ailments, and disabilities as well as test the safety of new drugs under laboratory conditions. Over 30 NIH grants funded in fiscal year 2009 proposed to use hESCs, and these grants have been limited until approved hESC lines became available on the NIH registry; this grant group includes research using the cells for the regeneration of diseased or damaged heart muscle cells, devising systems for the generation of neural stem cells and different types of neurons from hESCs in culture, and creating a cell culture system for large scale hESC production and self-renewal.

From the article of the same title
NIH News Release (12/02/09)

High 5-year Revision, Complication Rates Seen With Three-part Total Ankle Design

A study investigating the New Zealand experience with the three-part Scandinavian Total Ankle Replacement shows a 27 percent revision rate at five years. The researchers added that the implants that remain in situ result in generally good quality of life outcomes. The problem, common with all total ankle replacements, is the unpredictable outcome which can stem from inaccurate bone cuts and inferior matching of implants to bone.

From the article of the same title
Orthopedics Today (12/09) Brockenbrough, Gina

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

German researchers used a fixed-angle plate osteosynthesis to treat 25 patients with closed distal tibial fractures, and a follow-up exam was conducted after an average of 16.6 months for all patients. Most patients achieved bone consolidation and full weight bearing after an average of 3.5 months. For all patients, the ankle range of motion was flexion/extension 18 degrees/35 degrees without restrictions on the walking distance, on average. The research supports the concept of fixed-angle plate osteosynthesis being a solid 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.

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December 9, 2009