News From ACFAS

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Congratulations to the newly elected ACFAS board members from balloting that ended on January 6:

• Christopher F. Hyer, DPM (three-year term)
• Scott C. Nelson, DPM (three-year term)
• Randal Wraalstad, DPM (one-year term)

Also serving on the 2015–2016 Board of Directors are Richard Derner, DPM, President; Sean T. Grambart, DPM, President-Elect; Laurence G. Rubin, DPM, Secretary-Treasurer; Thomas S. Roukis, DPM, Immediate Past President; Byron L. Hutchinson, DPM; Aksone Nouvong, DPM; Christopher Reeves, DPM; and John S. Steinberg, DPM.

The new board will be installed on February 20 during the ACFAS 2015 Annual Scientific Conference in Phoenix.
The ACFAS Annual Scientific Conference in Phoenix is quickly approaching, but registration for this much-anticipated event is still open. Don’t miss your chance to join your fellow colleagues at what is considered the premier annual conference for foot and ankle surgeons nationwide.

Scheduled for February 19–22 at the Phoenix Convention Center, ACFAS 2015 will feature lively sessions and workshops, the back-by-popular-demand HUB (sponsored by PICA), spectacular special events, the second annual ACFAS Job Fair, hundreds of exhibitors and much more. Be part of the excitement and register today at acfas.org/phoenix! Make the most of your time at the Annual Scientific Conference in Phoenix—be a part of the always-popular special events planned throughout the conference. Attend one or all—ACFAS 2015 will feature that extra pizazz to help top off your conference experience, including the Premier Connection networking event, the ACFAS Honors and Awards Ceremony, the Wrap Party at Chase Field and much more.

Kick off your conference experience on Thursday, February 19 at the Premier Connection where we head to the streets of Phoenix for our opening event. Take advantage of the free-flow networking event to connect with colleagues, classmates and new friends, all while enjoying food, beverages and live music outdoors in the night air.

Make plans to support your colleagues during the annual ACFAS Honors and Awards Ceremony set for Friday, February 20. Congratulate the Manuscript, Poster, Honor and Merit Award winners, cheer on the new Fellows and meet the 2015–2016 Board of Directors.

Throughout your time in Phoenix, be sure to visit our annual scientific poster display to view more than 250 research studies and to meet the poster authors who will be available to answer your questions on Thursday and Friday. Plus, plan on attending our industry-sponsored satellite events, which include breakfasts courtesy of DePuy/Synthes, Aminox and OrthoSolutions and an after-hours get-together held by Nextremity, Zimmer and Stryker.

End ACFAS 2015 on a high note on Saturday, February 21 by joining us for a family-friendly wrap party at Chase Field, home of the 2001 World Series. Tour the clubhouse, see the World Series trophy and play baseball-themed games while dining on delicious food.

For up-to-the-minute details on ACFAS 2015 special events, visit acfas.org/phoenix and get ready to take your conference experience to a whole new level!

Foot and Ankle Surgery

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A study was held to assess the effect of unintentional partial Achilles tendon cut during percutaneous tenotomy on the success rate of Ponseti clubfoot management. Ultrasound was used to quantify the percentage of Achilles tendon cut following percutaneous tenotomy in 16 clubfeet. After an average of 21 months of follow-up, the final results were compared between patients with complete tendon cut and patients with partial cut. Also compared were complications and parameters such as feeling of pop during tenotomy and ankle dorsiflexion during tenotomy. No significant association was observed between the percentage of Achilles tendon cut and increase in ankle joint dorsiflexion, age at diagnosis or pop sensation. There also was no statistically significant difference between the two groups in their ankle joint dorsiflexion, feeling of pop and final follow-up Dimeglio score. The researchers identified no complications after tenotomy, although one patient required tibialis anterior transfer at his final follow-up visit. Partial cut of Achilles tendon following tenotomy does not necessarily compromise the final results of Ponseti management, and achieving more than 10 to 20 degrees ankle dorsiflexion even with a partial tendon cut can guarantee positive final outcomes.


A study was performed to determine whether osteodesis is an effective protocol for correcting hallux valgus in terms of deformity and improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score. Between February and October 2010, researchers conducted 126 operations to correct hallux valgus, 100 percent of which were osteodeses. Sixty-one patients were available for follow-up at a minimum of one year, forming the study cohort. The intermetatarsal angle was improved from a preoperative average of 14 degrees to 7 degrees at follow-up, the metatarsophalangeal angle from 31 degrees to 18 degrees, the medial sesamoid position from position 6 to 3 and AOFAS hallux score from 68 to 96 points. Neither patient age nor deformity severity impacted the efficacy of the osteodesis in correcting all three radiologic parameters, although the deformities treated in this series generally were mild to moderate. Observed were six stress fractures of the second metatarsal, five temporary metatarsophalangeal joint medial subluxations all remedied in one month by the taping-reduction method without surgery and six metatarsophalangeal joints with reduced dorsiflexion less than 60 degrees.

Practice Management

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Due to the Affordable Care Act and other pressures on employers to bring healthcare costs under control, the deductibles that patients will pay this year will continue to climb to record levels. More than 80 percent of families on the new health insurance exchanges have a deductible of at least $6,000, according to data from the U.S. Department of Health and Human Services. Practices therefore must ensure their readiness to collect the bulk of their revenue directly from patients through the first half of the coming year instead of from insurance companies. Steps they should take to prepare for this include making sure their billing is handled properly and guaranteeing fast submission of claims as well. Practices also should ensure their billing is up to date and that their back office is successfully executed. The boost in workload on account of healthcare reforms means the back office is left with little to no time to accommodate the key issues to keep a focus on the practice's bottom line. The practice should thus ensure staff take the time to guarantee that all processes are properly tracked, while sufficient time should be allocated to finding new and innovative ways of doing business.


Physicians must know when a patient's request to record conversations with them is reasonable and when it is not. Submitting to such requests can help encourage patient involvement, which can aid in greater patient compliance, better results and better patient satisfaction. Recording the conversation and replaying it later can enable patients to write down their questions and concerns, thus assisting in communication and understanding. Many companies provide prerecorded audio or videotapes on specific diseases or treatments, which offers safety for physicians so no possible omission or error exists on their part. Physicians who opt to permit the patient to record the conversation must be as clear and articulate as if they were writing it in the medical record, while also practicing warmth and compassion. Those uncomfortable with the recording must discuss their reasons personally with the patient. Physicians also may want to ask for a copy of the recording or ask that they record at the same time. A copy of any tapes should be saved, and everything should be documented. If the patient is making a recording at his or her lawyer's request, then the physician should probably refuse to be recorded. Physicians should remind patients that they can take notes while meeting with them and should stress that the conversation also will be documented in the medical chart. Physicians who wish to prevent patients from taking smartphone recordings in their office should give them advance warning.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) says it will delay issuing additional regulations dealing with provider networks until the National Association of Insurance Commissioners drafts a model state law on network adequacy. Insurers are concerned about CMS' proposal to require that drug formularies and provider directories be made available in "machine-readable" files, which they say would confuse consumers and put insurers at a competitive disadvantage. CMS also proposed that insurers be required to use pharmacy and therapeutics committees to advise them on drug formularies.


The Centers for Medicare and Medicaid Services recently released data on the quality of care provided by physician group practices, hospitals and Accountable Care Organizations (ACOs). The data is available on the Physician Compare, Hospital Compare and Medicare.gov websites, and is intended to provide patients and families with additional information they can use to make better informed decisions when selecting a hospital or physician practice. The data released by CMS includes information on Hospital Value-Based Purchasing Program 2015 payment adjustments, updated performance results on diabetes and cardiovascular care by some physician group practices and ACOs and hospital performance results on hospital-acquired conditions.


Physician advocates are urging doctors to pay close attention to the Centers for Medicare and Medicaid Services' (CMS) recently released Physician Quality Reporting System (PQRS) data submission deadlines because the 2014 data they will report will be used to calculate future Medicare payments. "I imagine that CMS is making an effort to be very explicit about the data submission deadlines because the penalty phase has begun," says Karen Ferguson, the American Medical Group Association's senior director for public policy. "The 2014 PQRS data that groups submit during the listed timeframes will have an impact on whether they receive a reduction in their Medicare payments in 2016." Physicians who fail to meet CMS reporting requirements for 2014 will face a 2 percent penalty and will receive only 98 percent of the payment amounts listed in the 2016 Medicare Physician Fee Schedule. The agency has tried to be more flexible in its requirements, but critics have argued that it has also made the program more complicated. The program has also shifted its requirements from providing a bonus for participation to penalizing non-participation. Physicians can submit their 2014 data as individuals or as part of a group practice, with several reporting-method options, formats and deadlines available.


The Obama administration's $30 billion health record digitization program could be threatened by massive spending, aggravating software and physicians frustrated by cuts in payments if they fail to demonstrate meaningful use of electronic health records (EHR). When the subsidy program was announced, 12 percent of physicians had EHRs, compared to 60 percent and nearly all hospitals now. Physicians who see Medicare patients can earn as much as $43,720 in federal payments for showing meaningful use of their computers, but eventually they are hit with penalties of up to 5 percent of those payments for failing to comply with the program. Physicians are angry that they must spend more time typing data into their computers when they could be using it to see patients and earn more income. Also frustrating is their submission to EHR software vendors whom some physicians say can charge healthcare providers whatever they like. Members of Congress who monitor health IT believe the program is going in the wrong direction, say House Energy and Commerce Committee staff. Thirty representatives have co-sponsored a bill that would protect more physicians from Medicare penalties. Optimists believe an $11 billion contract to reconfigure the military's EHR system could give software vendors the jolt needed to get the country's computer systems communicating with each other. The Department of Health and Human Services is considering a requirement that vendors outfit their health records software with a single programming interface.


Former Centers for Medicare and Medicaid Services (CMS) officials say eliminating the most pervasive problems relating to fraud, abuse and waste demands a shift in how the program pays providers, which would require Congressional action. However, Congress need not approve the agency's latest efforts to more strictly screen new Medicare enrollees and apply more rigor to enforcement to remove bad actors from the program. Still, CMS does not have the resources to manage the vast number of providers applying to enroll in Medicare, which amounts to about 45,000 per month. The agency also lacks the resources to visit every new provider, instead concentrating on provider categories that carry the highest risk of fraud and abuse. Some lawmakers complain that once bad actors are in the program, CMS and its contractors are too slow to jettison them. Other problems include the fact that CMS and the inspector general have different rules about when they can take action against medical providers and that recouping money for questionable billing is problematic, with the government winning just 26 percent of the nearly 600,000 Medicare appeals decided by administrative law judges since 2005, while 12 percent of cases were dismissed.

Medicine, Drugs and Devices

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Researchers in the UK have found that it took an average of five months after the onset of symptoms for gout patients to receive treatment advice. Most patients failed to received treatment even after becoming eligible for the recommended urate-lowering process. "Our study supports including urate-lowering treatment in the information about gout provided to patients around the time of first diagnosis," the authors wrote. "...In general, current consensus suggests patients with more severe gout (more frequent attacks) and those with other [simultaneous] diseases (such as renal diseases) should be treated."


New research investigates use of carbon materials for orthobiological applications, explores how feasible it is to fabricate hybrid fibrous carbon scaffolds modified with polycaprolactone and analyzes their mechanical traits and ability to support cell growth and proliferation. Carbon-based scaffolds' suitability as a cell-delivery vehicle was tested via environmental scanning electron microscopy, microcomputed tomography and cell adhesion and cell proliferation studies. Mechanical characteristics were assessed to examine load failure and elastic modulus. Generally, fibroblast adhesion and proliferation was greatest in lower-porosity carbon scaffolds with highly aligned fibers. Carbon-based scaffolds provide augmented biological response and tunability, and their tensile properties are comparable with those of current synthetic tissue scaffolds. In addition, cellular behavior on carbon-based scaffolds is enhanced by varying material orientation, porosity and crystallinity.


A study was held to assess the incidence of amputations/bone resections in a randomized controlled trial comparing human fibroblast-derived dermal substitute and conventional care with conventional care alone for the treatment of diabetic foot ulcers (DFUs). The research focused on 314 patients with full-thickness DFUs greater than six weeks' duration, and ulcer-related amputation/bone resection data was extracted from data on all adverse events reported for the intent-to-treat population. Amputations were categorized by type, such as below the knee, Syme, Chopart, transmetatarsal, ray, toe or partial toe. Occurrence of amputation/bone resection in the study was 8.9 percent overall, 5.5 percent for patients receiving human fibroblast-derived dermal substitute and 12.6 percent for patients receiving conventional care. All but one of the 28 cases of amputation/bone resection were preceded by ulcer-related infection.