News From ACFAS

Everyone needs a makeover now and then, and your weekly e-newsletter is no exception. Look for This Week @ ACFAS to launch a fresh new look in January that’s easier on the eyes and easier to skim for the news that interests you most.

ACFAS continues to team with Information Inc. to bring you the latest and most pertinent abstract news on coding and reimbursement, practice management, evidence-based medicine and other key topics. We welcome your comments and suggestions at thisweek@acfas.org.

The ACFAS EBM/Research Committee announces the 2010 ACFAS Clinical and Scientific Research Grant recipient.

Lowell S. Weil, Jr., DPM, MBA, FACFAS, Lowell Scott Weil Sr., DPM, FACFAS, and Wenjay Sung, DPM, will receive a grant for the proposed study, “Prediction of Plantar Plate Injury by Magnetic Resonance Imaging with Correlation to Intra-Operative Findings.”

For more information on research resources and opportunities, visit "Research and Publications" on the ACFAS website.

Peer review is an essential part of scientific publishing. Without the efforts of volunteer peer reviewers, we would not be able to assure the high quality of the content published in the Journal of Foot & Ankle Surgery.

Peer reviewers serve as the voice of a journal’s readership, providing constructive criticism on the scientific merit and overall interest a manuscript presents. Two hundred eighty-eight reviewers participated in evaluating manuscripts from October 2009 to September 2010. A list of their names appears at acfas.org/jfas.

If you’re interested in serving as a peer reviewer, please visit acfas.org/jfas and click on “Become a Reviewer.”

Dues invoices for 2011 have been sent to all members of the College. Renew by Dec. 31 to avoid a late fee. Dues can be paid online at acfas.org/paymydues, or by calling 773-693-9300 during normal business hours.

Start the new decade off right by continuing your relationship with the professional organization comprised of the best and brightest foot and ankle surgeons — ACFAS.

The ACFAS headquarters office in Chicago will be closed for the holiday on Friday, Dec. 31.

Happy New Year!

Foot and Ankle Surgery

Comparison of Surgical Outcomes of Intra-Articular Calcaneal Fractures by Age

Researchers compared the outcomes of internal fixation of intra-articular fractures of the calcaneus on the basis of patient age. For the study, 175 patients (191 fractures) who underwent internal fixation between 1992 and 2007 for a displaced, intra-articular calcaneal fracture were identified. Each patient was contacted to complete a follow-up survey from which clinical outcome scores were calculated. One hundred forty-six patients with 158 fractures were available for follow-up and were divided into two groups for comparison. Group I consisted of 108 fractures in patients who were less than 50. Group II was composed of fractures in 50 patients who were 50 or older. The mean duration of follow-up was 8.98 years. The average patient age was 36 years for Group I and 58 for Group II.

The average adjusted AOFAS score was 64 for Group I and 75 for Group II. The mean calcaneal fracture scoring system score was 66 for Group I and 76 for Group II. The average Foot Function Index was 24 and 15 for Groups I and II, respectively. Overall, the complication rates were similar between groups. Conversion to subtalar fusion was 15 percent for Group I and 8 percent for Group II.

The researchers concluded that the outcomes of older patients are at least equivalent to those of younger patients undergoing internal fixation for an intra-articular calcaneal fracture. Operative intervention appears to be a reasonable option for displaced calcaneal fractures in older patients. Physiologic age should be considered when evaluating older patients, and individualized treatment plans remain critical because patients with low physical demands or who have medical complications may be better candidates for nonoperative treatment.



Six Weeks of Balance Training Improves Sensorimotor Function in Individuals With Chronic Ankle Instability

Researchers have evaluated the impact of six weeks of balance training on sensorimotor measures previously found to be deficient in patients with chronic ankle instability (CAI). CAI occurs in 40 to 70 percent of individuals who have previously suffered a lateral ankle sprain, and understanding the effect of balance training on persons with CAI may allow optimization of protocols to better employ this rehabilitation technique.

The study involved the participation of 12 CAI patients and nine healthy volunteers, and subjects with CAI who completed a six-week balance training program and healthy controls who did not receive any training were pre- and post-tested at the start and at the conclusion. The individuals with CAI who carried out balance training exhibited improved performance over control participants on baseline-adjusted post-training measures of dynamic balance in the anterior medial, medial, and posterior medial directions, as well as on motoneuron pool excitability Hmax/Mmax ratio, single-limb pre-synaptic inhibition, and joint position sense (JPS) inversion variable error. No systematic differences for static balance or PF JPS tasks were observed.

Following six weeks of balance training, individuals with CAI demonstrated better dynamic balance, inversion joint position sense, and shifts in motoneuron pool excitability versus healthy individuals who did not train.



Temporary Screw Epiphyseodesis of the Distal Tibia: A Therapeutic Option for Ankle Valgus in Patients With Hereditary Multiple Exostosis

Researchers evaluated the impact of medial screw hemiepiphysedesis of the distal tibia to correct ankle valgus via a retrospective review of nine patients exhibiting multiple hereditary exostoses (HME) and ankle valgus deformity, with a total of 15 affected extremities. Average age at time of surgery was 11.8 plus or minus 1.6 years, and all patients were subjected to clinical and radiological assessment.

The researchers evaluated tibial tilt angle and Malhotra stations preoperatively, at time of screw extraction and/or at time of the most recent clinical follow-up, in order to define ankle valgus magnitude. The screws were taken out after a mean time of 22.6 plus or minus eight months in 11 extremities, and all patients were examined following an average time of 36.7 plus or minus 8.7 months after hemiepiphyseodesis. The average preoperative tibiotalar tilt was 14.3 plus or minus.4 degrees; at time of screw extraction the tibiotalar tilt was normalized to 0.4 plus or minus 1.7 degrees, according to an average rate of correction of 0.58 plus or minus 0.23 degrees by the month. Four ankles showed a change in the fibular station with follow-up, while no patients overcorrected into a severe varus and one patient developed a recurrent ankle valgus.

The researchers concluded that temporary screw hemiepiphyseodesis of the distal tibial physis is an effective, technically simple, and minimally invasive method for correcting ankle valgus deformity in children suffering from HME.

Practice Management

23 New ASC Codes for 2011

Twenty-three new ASC codes have been introduced for 2011. To prepare for the changes, practices should:

* Update internal CPT coding reference sheets
* Update practice management system with all CPT codes and HCPCS codes effective 2011. Check that all new CPT codes and revised CPT codes definitions are included.
* Update charge capture tools to include the new, revised, and deleted procedures related to ambulatory surgery billing
* Update charge tickets
* Update the list of Medicare and Private Payor approved procedures.
* Verify insurance and precertify all procedures to ensure the payor recognized the ASC as a valid place of service.

Click here for the ASC billable codes for 2011.



Electronic Health Records Incentives Registration Starts Jan. 3, 2011

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have announced the availability of registration for the Medicare and Medicaid electronic health record (EHR) incentive programs. Beginning Jan. 3, registration will be available for eligible healthcare professionals and eligible hospitals who wish to participate in the Medicare EHR incentive program. On that day, registration in the Medicaid EHR Incentive Program will also be available in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. In February, registration will open in California, Missouri, and North Dakota. Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.



Getting Patients to 'Like' Your Practice

Many physicians are missing out on an opportunity to expand their business by creating online social networking profiles on sites like Facebook and Twitter. The American Medical Association has issued a set of recommendations for practices regarding social networking. The AMA urges physicians to "maintain appropriate boundaries of the patient-physician relationship when interacting with patients online and ensure patient privacy and confidentiality [are] maintained," and to keep separate their personal and professional online presence.

Health Policy and Reimbursement

Health Insurers, Government Look to 'Accountable Care' Models

Insurers are piloting various accountable care organization (ACO) models with health systems and medical groups throughout the United States, while the federal government intends to release proposed regulations next month for a related share-savings program covering traditional Medicare beneficiaries, effective 2012. These rules are expected to shape private insurers' agreements with ACOs treating their commercial clients.

Among the insurers that have initiated pilots in recent years is Aetna, which began testing a model among physicians who cared for 20,000 of its Medicare Advantage plan members, using nurse case managers to aid in the coordination of care and the management of patients' conditions. The insurer says providers were alerted to gaps in patient care through the use of personal health records as a tracking tool. The information suggests that the ACO model has lowered duplicate or redundant services and improved patient health.



Panel Set to Study Safety of Electronic Patient Data

Only about 25 percent of doctors in large group practices have electronic health records installed, even though the government offered $19 billion in stimulus funding to help practices and hospitals transition to the paperless systems. However, there is growing concern that these systems are also causing medical mistakes due to computer errors, design flaws and communication breakdowns, and these mistakes could endanger patients. The U.S. Food and Drug Administration says it received 260 reports of malfunctions related to health information technology in February 2010, which may have caused 44 reported injuries and six deaths according to voluntary reports from hospitals. The Institute of Medicine recently established the 16-member Committee on Patient Safety and Health Information Technology to study the issue over 12 months and make recommendations to prevent medical mistakes.



Revise Unfair E-Prescription Policy, Doctors Say

The American Medical Association and over 100 other state and specialty medical groups are pushing for HHS to revise a Medicare e-prescription policy that punishes doctors with a financial penalty in 2012 if they do not meet specific e-prescribing criteria in the first six months of 2011. In a letter, the groups state their strong opposition to basing the 2012 and 2013 e-prescribing penalties on e-prescription activity that occurs in 2011, and say at the very minimum the CMS should extend the reporting period so physicians have more time to comply.

New regulation from CMS also prohibits physicians from receiving incentives from Medicare e-prescribing and the meaningful use program for electronic medical records. AMA and the others believe these new e-prescribing regulations are duplicative because the EMR incentive program already contains an e-prescribing aspect.

Medicine, Drugs and Devices

A Long Term Results of External Beam Radiation Therapy in Hemophilic Arthropathy of the Ankle in Children

The development of hemophilic arthropathy depends crucially on bleeding into joint space, and Korean researchers performed low dose external beam irradiation to reduce the frequency of bleeding in the ankle joint of 37 children with hemophilic arthropathy. Thirty-five patients followed up for longer than 12 months were enrolled for analysis.

The median number of bleedings per month was 3.6 during one year prior to radiation therapy; following therapy, it was lowered to 2.1 in the first year, after then it was maintained in the range of 1.0 to 1.5 until the tenth year. Bleeding frequency was lowered to 42 percent at the first year and was maintained in the range of 58 percent to 73 percent from the second to the tenth year. Significant decreases were observed in patients who had three or more monthly bleedings, and who had a magnetic resonance imaging score of more than 3. Growth disturbances and secondary malignancies were not uncovered during the follow-up period.

The researchers conclude that external beam radiotherapy can be considered for hemophilic patients who are not amenable to surgical or isotope treatments.



The iPad in the Hospital and Operating Room

The iPad is a very useful tool for work in the operating room, especially for facilitating convenient and easy access to previous patient imaging, according to the author of this article. He writes that the iPad "can also be useful in bypassing hospitals' restrictive networks to access remote files and office electronic medical records using the cellular 3G networks." The author says the freely available OsiriX and Dropbox applications together offer a helpful method for copying computed tomography (CT) or magnetic resonance imaging images from a patient's CD-ROM to the iPad.

The open source OsiriX is a digital imaging and communication in medicine viewer written for the Macintosh, and it boasts some features typically accessible only from costly imaging workstations, including 2D multi-plane and 3D surface reconstructions, and positron-emission tomography/CT fusion. Dropbox is a multi-platform file-syncing utility that can be used to export selected images to the iPad. The author's image exportation methodology involves inserting the patient's CD ROM into the computer and opening it with OsiriX, identifying key images of interest, exporting images as JPEGs, and viewing the images on an iPad via the Dropbox app.



Vibration Training Improves Balance in Unstable Ankles

The risk of ankle injury increases as a result of functional ankle instability (FAI) following a trauma, and whole body vibration training (WBVT) is a new rehabilitation technique that has been connected with improved balance and muscle function. Researchers randomly assigned 38 female dancers with self-reported unilateral FAI into two groups, a control group and one that underwent WBVT.

Absolute center of mass (COM) distribution during single leg stance, SEBT normalized research distances, and peroneus longus mean power frequency were quantified before and following a six-week training intervention. A substantial improvement in COM distribution over the six weeks from 1.05 plus or minus 0.57 square centimeters to 0.33 plus or minus 0.42 square centimeters was observed, as was four of the eight planes of direction in the SEBT Ant, Antlat, Med, and Antmed from 77.5 plus or minus 7.1 to 84.1 percent plus or minus 5.8 percent versus control groups during the course of the intervention.

Improvement in peroneus longus over time was not seen in either group. WBVT enhanced static balance and SEBT scores among dancers with ankle instability but did not impact peroneus longus muscle fatigue.



Abstract News © Copyright 2010 INFORMATION, INC.

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