News From ACFAS

Now that the Senate has passed its health reform bill, Congress will start the hard work of reconciling the House and Senate Bills. While special interest group lobbying will continue at a fevered pitch, a group of states is objecting to proposed expansions of Medicaid in the Senate bill that they say penalize them for being in the forefront of expanding Medicaid coverage. States including Arizona, California, New York and Wisconsin say that under the Senate bill, they will be forced to fund expanded coverage for states that now cover relatively few residents. The House bill provides some relief. The politics of this issue cannot be overstated: Sen. Ben Nelson, D-Neb., ultimately agreed to provide the crucial 60th vote when a provision was added to exempt Nebraska from paying to expand Medicaid.

The Winter 2010 edition of your patient newsletter, FOOTNOTES, is now available online. You can promote your practice while you share this issue’s great educational articles with your patients:

• Healthy Feet Make the Best Dancing Feet
• Take Care of Your Feet and Ankles in the Winter Wonderland
• Start the New Year with Healthy Feet

Visit acfas.org/footnotes and log in to download and customize the newsletter with your practice information. Be sure to distribute it in your waiting rooms, on your practice web site or at any upcoming community events in your area.


The January/February issue of JFAS is in the mail, but you can read this essential resource online today. This issue features a new JFAS Instructional Course, “Prevention and Management of Complications Arising from External Fixation Pin Sites,” plus 14 original research articles, reviews, case reports, commentary, and quips, tips and pearls.

Log in any time for free member access to the current issue, articles in press and the entire journal archive.

Legislators and regulators in states across the country are expected to move toward greater oversight and mandatory accreditation requirements for all office-based surgery in the next few years. In addition, health insurers are moving toward accreditation requirements.

ACFAS members should keep this on their radar and consider the benefits of accreditation. ACFAS has developed a short white paper outlining the steps to accreditation and providing links to the accrediting organizations. It’s available to members of the College any time on the ACFAS web site.

Foot and Ankle Surgery

Arthroscopic Ankle Debridement Relieves Pain, Improves Function in NFL Players

A new study indicates that arthroscopic ankle decompression is an effective procedure for professional football players with anterior ankle impingement. The procedure significantly relieves pain and improves outcome scores and dorsiflexion, said Bryson P. Lesniak, MD, presenting his findings at the American Orthopaedic Society for Sports Medicine 2009 Annual Meeting. The study examined 14 football players who had 16 consecutive ankle arthroscopies from the same surgeon, all of whom experienced isolated ankle pain with dorsiflexion and decreased range of motion. While the patients did not ultimately obtain full range of motion, all showed significant improvement, with their score on the Visual Analog Pain Scale falling from 4.7 points to 0.5 points after the procedure and their American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score rose from 66 to 98 points. All of the players returned to professional football two months after the procedure and played for at least one year.



Biomechanical Analysis of Stresses Occurring in Vertical and Transverse Scars on the Lower Leg

There is little knowledge of the effect of mechanical stimulation on injuries, and investigators set out to address this issue by biomechanically analyzing stresses that occur in vertical and transverse scars on the lower leg. The researchers used computer-aided design to produce a half-dozen isotropic lower leg models from computed tomographic findings, and generated vertical and transverse scars. Assigned to each scar were two types of elastic modulus--one for the early wound and one for the hypertrophic scar. The investigators applied a force of 10 N at the ankle to mimic dorsiflexion, and stresses transpiring in the scars were analyzed via the finite element technique. Early wound models exhibited a mean maximum stress that was three times as high in the transverse scars than in the vertical scars, while in the hypertrophic scar models the mean maximum stress was four times as high in the vertical scars than in the transverse scars. The researchers determined that traverse scars are a bad idea in the early healing phase because articular movement is consistent with the wound-opening direction. However, the vertical scars are subjected to higher stresses than the transverse scars after wounds stiffen, leading to the conclusion that vertical scars are unfavorable in the lower leg from a long-term perspective.



Full Weight-Bearing Rehabilitation Has Low Re-rupture Rate for Achilles Tendon Injuries

A prospective study of 80 consecutive patients with Achilles tendon ruptures treated between 2002 and 2008 in a functional, early weight-bearing brace found a low re-rupture rate in both surgical and nonsurgical cohorts. Patients in both groups wore a below-the-knee brace, with the surgical group wearing it shortly after surgery.



Fresh Osteochondral Allografts for Large-Volume Cystic Osteochondral Defects of the Talus

A study to assess the clinical outcomes of large-volume cystic osteochondral defects of the talus treated with fresh bulk osteochondral allograft transplantation was held involving 15 patients. The patients were evaluated using the pain score on a visual analog scale, which ranged from 0 to 10, and the American Orthopedic Foot and Ankle Society ankle-hindfoot score, which ranged from 1 to 100. The conclusion of the study was that bulk fresh osteochondral allograft transplantation to the talus is a workable reconstructive option for patients who suffer from large-volume cystic lesions of the talar dome. The procedure structurally and functionally maintains graft stability and viability over a mean follow-up period of 4.5 years.

Practice Management

CCHIT Certifies 14 Products for Meaningful Use

The Certification Commission for Health Information Technology has certified 14 electronic health record products that will qualify for funding under the American Recovery and Reinvestment Act of 2009. The products are certified under either the CCHIT Certified 2011 Comprehensive program or the Preliminary ARRA certification programs. A list of the 14 products can be found at
http://www.healthcareitnews.com/news/cchit-certifies-14-products-meaningful
-use.



How to Focus More Attention on Profits in Tight Economy

Many practices are struggling to deal with falling profits and declining patient volumes, largely a result of the growing number of unemployed and uninsured. Mark Jarvis, senior director of practice economics for the Ohio State Medical Association, says some doctors are exploring cost-saving options like sharing space with other physicians and streamlining their billing and collection programs. A growing number of physicians are placing a greater emphasis on the finances of healthcare. Jarvis says more physicians are using electronic payment transfers, credit card processing, and real-time claim adjudication, which allows providers to bill for services when a patient is treated.



Is Twitter a 'Must' for Doctors, or Just the Latest Fad?

The Twitter social networking service could be very helpful for physicians, with several applications to nurture doctor-patient communications and promote a practice. Kevin Pho, MD, points out that many adults already use the Internet to get health information, and doctors can use Twitter and other social networking tools to guide patients to trustworthy online medical information sources. Pho offers several tips for Twitter-using physicians, including refraining from discussing individual cases or providing patient advice through Twitter. He recommends using Twitter to promote the practice’s “brand,” and that physicians remind patients to exercise caution in terms of the medical professionals they follow on Twitter, as some who claim to be physicians may be imposters.

Health Policy and Reimbursement

Just the Holiday Gift Many Wanted: A COBRA Subsidy Extension

In good news for patients and physicians, Congress has approved an additional extension to COBRA subsidies to help unemployed individuals retain health benefits during lengthy job hunts. As part of the 2009 Recovery Act, Congress approved a significant premium subsidy to unemployed individuals who are not eligible for any other health insurance coverage. The original subsidy was limited to nine months, which meant the first eligible group was cut off at the end of November. The recently passed defense spending bill includes a provision to extend COBRA subsidies. The extension will expand the amount of time people can get the subsidy to 15 months.



U.S. Study: 1 in 5 Lost Health Insurance in Past Year

Nearly 20 percent of the U.S. population went without health insurance at some point since January 2008, according to analysis by the Centers for Disease Control and Prevention. Two-thirds of those who did not have coverage for at least part of the time were unemployed adults. The number of children enrolled in government health insurance programs, meanwhile, increased from 34.2 percent in 2008 to 37.4 percent in the first half of 2009, according to the study.

Technology and Device Trends

Discovery Presents a Vital Step Toward Efficient Treatment of Vascular Injuries

High blood sugar can set off a complex chain of events that lead to blood vessel damage and cardiovascular disease, but researchers with Lund University Diabetes Centre have determined how this chain can be broken. This series of events ultimately increases the protein osteopontin, which causes inflammation that damages blood vessel walls. Previous research has shown that high blood sugar also activates the protein NFAT, which then signals the increase of osteopontin. Patients with diabetes have higher levels of osteopontin in their blood, according to research. The Lund study team found that an immune-inhibitory substance that blocks NFAT will also block the hyperglycemia-induced elevation of osteopontin. The substance blocks all proteins in the NFAT family, however, and the researchers hope to further develop the substance so that it only blocks the protein that regulates osteopontin. The research has been published online in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.



Synthetic Platelets Quickly Stem Bleeding: Study

Synthetic blood platelets injected into patients at the scene of a traumatic injury can speed up blood clotting and stem internal bleeding, researchers reported in Science Translational Medicine. The synthetic platelets, comprised of polymers already approved by the FDA, bind with natural platelets that become activated at a wound and help blood clots form more rapidly. The artificial platelets worked 25 percent faster than recombinant factor VIIa, a drug now used in surgery and emergency rooms to stop uncontrolled bleeding.



Abstract News © Copyright 2009 INFORMATION, INC.

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