August 2010

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   Thomas S. Roukis, DPM, PhD, the author of the study, notes that the study only evaluated patients with diabetes and either an intact or ulcerated/infected skin envelope. He also notes that the study only evaluated aerobic bacteria and not anaerobic bacteria, fungus, yeast or mold. Dr. Roukis says further research is required to determine if the preparation would be as efficacious in those without diabetes and for other pathogens.

Will Surgical Preparation Have To Evolve As Pathogens Evolve?

As pathogens become more resistant to antibacterials, Dr. Roukis advocates a greater emphasis on the mechanical exfoliant action of more specialized surgical brushes and a need for longer duration of the preparation to maintain effectiveness.

    “The fact that this study demonstrated a high incidence of MRSE bacteria that persisted in some patients after the surgical preparation highlights the difficulty that exists in eradicating aerobic bacteria from the foot and ankle,” says Dr. Roukis, who is Attending Staff at the Department of Orthopaedics, Podiatry and Sports Medicine at Gundersen Lutheran Medical Center in La Crosse, Wis.

   In addition to surgical preparation, Dr. Roukis also emphasizes that surgeons follow proper hygiene practices. Routine use of a surgical preparation during outpatient or inpatient dressing changes can also decrease the development of postoperative infection and improve pedal hygiene, according to Dr. Roukis, a Fellow and member of the Board of Directors of the American College of Foot and Ankle Surgeons.

Congress Temporarily Raises Medicare Payments 2.2 Percent

By Brian McCurdy, Senior Editor

As it has in previous years, Congress recently halted a planned 21.2 percent cut in Medicare reimbursement payments. In June, both houses approved a 2.2 percent raise in payments, which is effective retroactively from June 1 and will expire Nov. 30.

   Does the payment increase keep pace with any increasing costs for podiatric practices? Yes and no, says Anthony Poggio, DPM. As he notes, the cost of living this past year has been reasonably stable so salaries and other costs have also been stable. He also points out that insurance rates, other than health insurance, have been stable.

   However, Dr. Poggio notes podiatric practices have faced repeated small decreases or even no increases in practice revenue as a result of insurance reimbursement over the past several years. Overall, he says the 2.2 percent increase does not make up for all those past losses that DPMs have had to absorb.

   This is not the first time that Congress has rejected a proposed Medicare cut. The Centers for Medicare and Medicaid Services has a formula to remain budget neutral, which calculates various medical costs, expenses and payments, and then derives a payment increase or decrease, according to Dr. Poggio. Unless the formula is changed, he says podiatric practices will see potential decreases in reimbursements every year.

    “Congress has had to step in to override the calculated formula amount every year,” says Dr. Poggio, who is board certified by the American Board of Podiatric Medicine and the American Board of Podiatric Orthopedics. “That brings politics into the mix. Congress has tried over the entire year to fix the problem but has only succeeded in deferring the problem, this time until the end of November 2010.”

   The American Podiatric Medical Association (APMA) notes that claims dated June 2010, which had been paid at the 21.2 percent negative update, will automatically be reprocessed at the 2.2 percent increase. Practices do not need to resubmit claims, according to the APMA.

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