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 Weekly Member Update - August 2, 2013





Dr. Elfar was recently awarded the AFSH Hand Surgeon-Scientist Award, a 5 year grant designed to support young faculty members at teaching institutions who have demonstrated success in research by receiving extramural research funding - K08 or K23 awards from the National Institutes of Health (NIH).  Here Dr. Elfar describes the research and AFSH funding that helped him along the way:
Currently, the newly-formed Elfar Lab (part of the University of Rochester - Center for Musculoskeletal Research) is focused on elucidating the role played by Erythropoietin (EPO) in peripheral nerve injury.  Some years ago, as a resident on a mandatory research rotation, I found that single doses of EPO given to mice with severe crush injuries result in accelerated profound recovery of function - within a week of injury - which is four times faster than untreated controls.  I was excited by the possibility of using EPO on humans because EPO is already approved for use by the United States Food and Drug Administration (USFDA) and has a favorable side-effect profile. 
After finishing residency and pursuing a fellowship with Dr. Peter Stern, I was encouraged to return to the University of Rochester and continue research on EPO for peripheral nerve regeneration. 
When I started my practice, I read about the AFSH Basic Science Grant and was encouraged by many members of the Hand Society and my chairman to apply for the grant as seed money to pursue programmatic work on our curious finding on EPO.  The AFSH generously awarded me the grant in 2009 to further studies on our curious finding in my second year in practice, and I began to dedicate a portion of my work-week to conduct studies to further uncover the variables which may contribute to the large effect EPO has on injury recovery after crush injury. 
Last year, the University of Rochester committed funding to form a research laboratory dedicated to the study of EPO for neuroregeneration under my direction as part of the Center for Musculoskeletal Research, chaired by Dr. Regis O'Keefe.  Using this lab, I was able to generate enough pilot data to be awarded a mentored scientist (K08) grant from the National Institutes of Health.  With this funding, I was able to secure the generous honor of the AFSH Surgeon Scientist Award to allow me the freedom to pursue our fundamental question of how and why EPO has an effect on neuroregeneration. 
This endeavor, over the course of about three years, has taught me innumerable lessons about the formation and funding of a research endeavor.  More importantly, it has also allowed us to delve into the inner workings of peripheral nerve injury in multiple models.  Unlike my days in residency, I now have patients of my own who may benefit from some of the translational research in which I am engaged.  Moreover, at least one cohort of patients overseas has been successfully treated with EPO based on our work. 
Recently in our own lab, we were able to define what types of crush injuries and even chronic compression injuries seem to best respond to EPO.  Perhaps equally interesting and exciting, we have performed experiments which call into question the classical methods of describing injury to a complex peripheral nerve according to our currently accepted models.  This owes to the colossal redundancy of function in the peripheral nerve and the ability, with the application of pharmacological agents, to temporarily awaken function which alters the class of injury exhibited - if only for a little while.  Such agents may be the tools of diagnosis in years to come and are going to be the subjects of our presentations and publications in future meetings of the ASSH. 
Taken together, the past three years have been quite a journey.  We have gone from a chance observation during a residency research rotation to a fledgling laboratory dedicated to the study of agents like EPO which promise to offer great benefit to the field of hand surgery.  I am excited to imagine the coming era when EPO and agents like it become part of the diagnostic and treatment armamentarium of the practicing hand surgeon.  I am humbled by the donors and mentors who are supporting me during this period of my life and I am very fortunate to be a member of the American Society for Surgery of the Hand.   
The Physician Payments Sunshine Act (Sunshine Act) requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.  Manufacturers are required to collect and track payment, transfer, and ownership information beginning August 1, 2013.  Manufacturers will submit the reports to the Centers for Medicare & Medicaid Services (CMS) on an annual basis.  Read more on the start of Sunshine Act reporting on the AMA website.
What does this mean to you?
  • By accepting monetary or in-kind “transfers of value” from manufacturers, your interaction with industry will be tracked and recorded for publication on a searchable website.
  • Note: ASSH-sponsored invitations to speak at CME activities are not considered a “transfer of value” and will not be reported.
  • Starting September 2014, CMS will publish the reporting website and you are strongly encouraged to check it periodically to ensure the information being reported is accurate.
  • You have the right to challenge industry reported financial values.  You may want to keep a personal record of values received so that you can easily track and make corrections to reported values.
  • Moving forward, review your relationships with industry and decide whether you will accept payments, other transfers of value, or maintain ownership interests that would result in the financial relationship being made public. 
  • If you are offered a payment or something of value, ask the manufacturer whether acceptance will result in reporting under the Sunshine Act and how it will be disclosed.  Although financial relationships don’t necessarily result in a conflict of interest, consider how acceptance could be perceived by the public/patients before you accept. 
For AMA resources concerning the Sunshine Act, click here.

This week's question comes from Young Leader LCDR. Leo T. Kroonen, MD:
Do you offer screw fixation for minimally displaced scaphoid wrist fractures?  If you do put in a screw, what is your postoperative protocol for these patients?
To submit your response, click here.
If you have a suggestion for a Clinical Question, please email

How Will You Navigate the Annual Meeting?

You already know that this year’s Annual Meeting in San Francisco is entirely paperless.  Are you positive your device will provide you with the best experience possible?  Our meeting app is supported by iPad, iPhone, Android phones and Android tablets, but we want you to navigate the program and abstract content with ease.  ASSH will offer attendees the opportunity to rent an iPad, the easiest and clearest method of viewing our Annual Meeting content.  The new iPads will house everything you need for this meeting on a large 7x9 screen, with 50% of the cost subsidized by ASSH.
$100               ̶          $50         =      $50
Cost per unit     ASSH subsidy     Attendee cost
To rent an iPad, you can call the ASSH Central Office (312-880-1900) or pay the one-time $50 fee online by modifying your registration.  The deadline to secure your rental is September 13.
Attendees may also access meeting content with a laptop computer.  The following will not support our content:
  • Kindle
  • Kindle Fire
  • Blackberry
  • Windows phones
  • Symbian
Is your device on this list?  If so, we strongly encourage you to rent an ASSH iPad.  If you have questions about navigating Annual Meeting with a device, please contact the ASSH Central Office at 312-880-1900 or email
Presidential Guest Lecture
The Future of Health & Medicine: Where Can Technology Take Us?
Daniel Kraft, MD
Examining rapidly emerging, game-changing and convergent technology trends and how they are and will be leveraged to change the face of healthcare and the practice of medicine in the next decade.
Your Digital Practice
Wednesday, October 2, 2013
Co-Chairs: Scott D. Lifchez, MD and Jonathan Tueting, MD
This course will instruct the attendees in how to use the internet for optimization of business, for marketing and for communication.  Each year, our reliance on paper becomes increasingly more remote.  With the advent of government regulations mandating electronic records and the patient demand for instant accessibility and communication, the reliance on the internet in our clinical practice has become more and more important.  This course is aimed both at the younger member who is beginning their practice as well as the more experienced member who needs guidance in learning how to optimize the use of digital resources in their practices to benefit their patients and their businesses.
2013 Coding and Reimbursement for Hand Surgeons
Wednesday, October 2, 2013
Co-Chairs: Mary S. LeGrand, RN; Daniel J. Nagle, MD
A precourse survey identified 3 main topics of interest for this year’s coding course.  These topics included E&M coding and documentation, how to avoid audits and modifiers.  Running closely behind these 3 main topics were interests in fracture coding and hand trauma. Based on popular demand, the course will address risk areas associated with EMR/EHR implementation, E&M utilization patterns, what payors are looking for and “What is in The News!”  We will provide an overview of E&M coding and documentation focusing on E&M categories, documentation requirements for the key components (history, exam and medical decision making) and how to “pull it all together” in reporting E&M services.
This course will also focus on coding rules related to the use of modifiers and hands-on skills application focused on common hand surgery cases, fracture coding and hand trauma.  As part of this year’s course we will introduce hand surgeons to some of the documentation changes required for ICD 10 and recommendations to conduct a gap analysis to further identify documentation gaps and opportunities.  This course, presented by the only nationally-recognized hand surgery coding specialist in collaboration with a hand surgeon, is intended for hand surgeons, billing managers and coding and billing staff.

Updated coding information is now available in Global Service Data, 2013 eBook edition, edited by Daniel J. Nagle, MD and
John M. Bednar, MD.  The eBook format allows for easy navigation, search, bookmarking codes and notes.  And with your purchase, you will be able to upload a single book to multiple locations, such as your iPad, work PC, laptop, etc.
Updated with important new coding information for 2013, this eBook is a vital resource for any hand surgery practice, containing commonly used hand surgery codes.  It is an invaluable tool for interpreting CPT codes and billing insurance.
Visit our website for more information about ASSH eBooks.
Experts in the care of elbow, forearm, and wrist injuries will bring you up to speed on the current approach to trauma of the elbow, forearm, and wrist. 
  • Recognize injury patterns in the elbow and forearm, the associated ligament and bone injuries, and how these direct optimal management.
  • Gain awareness of the major pitfalls in the treatment of arm trauma and how to avoid them.
  • Understand the areas of uncertainty and debate in arm trauma.
  • Discuss how patient preferences influence treatment decisions in elbow, forearm, and wrist trauma.
The emphasis on adult learning in a case-based format rather than the traditional lecture-based format will provide opportunities to interact with experts on the management of trauma in the upper extremity and the hands-on lab will provide education on the newest techniques in the subject.  Check out our program and register today!
Ralph M. Costanzo, MD
Randall A. Espinosa, MD, FACS
Steven L. Friedman, MD
Peter T. Gropper, MD
Robert G. Hansen, MD
Curtis C. Johnson, MD
Douglas R. Mason, MD
George A. Pianka, MD
Robert E. Schlenker, MD
Steven S. Shin, MD
Lis Z. Stark, MD
Christopher J. Walsh, MD
These donors have written a check, gone online, given through OREF or donated stock to support the Foundation.  Have you?  Visit today to make your 2013 annual contribution.