News From ACFAS

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Now available for download—the 2015 ACFAS Annual Scientific Conference Mobile App! Keep all things ACFAS 2015 right at your fingertips! Simply download the conference app to your iPhone, iPad or Droid and you’ll instantly be able to:

• Keep track of your pre-selected sessions,
• Review all conference programs,
• Find your way around with convenient maps,
• Find the vendors you don’t want to miss,
• Read the latest conference happenings in our Twitter and Facebook feeds,
• Receive the latest conference alerts.

Download today through one of three ways:

1. On your mobile phone Web browser, type http://m.core-apps.com/acfas2015.
2. Search your app store for ACFAS 2015 (iOS and Android).
3. Visit acfas.org/phoenix for a link.

Once you've downloaded your app, you'll be able to populate it with your personal schedule and contact information through instructions and login information, which will be emailed to you prior to the conference and available on the back of your badge in Phoenix. Last year, a record number of potential patients learned more about foot and ankle health by visiting FootHealthFacts.org, the College’s patient education website! Thanks to an increase in social media activity and public relations efforts, the website hit a record-breaking 4.837 million visits in 2014. Of this all-time high, 4.107 million were new, unique visitors, which reflects a whopping 143 percent increase in new visitors to the site compared to 2013.

Statistics show most visitors find the site through Google searches, direct links in ACFAS social media posts or through the College’s health-topic press releases, which are distributed monthly as part of the national public relations awareness campaign.

Make sure your name and practice contact information are included in the physician search tool on FootHealthFacts.org by completing your Expanded Profile through your account on acfas.org. Also link your practice’s website to the valuable health information library on FootHealthFacts.org so your patients have the most up-to-date info at their fingertips! Check out the Marketing Toolbox at acfas.org/marketing for instructions. Perioperative Prophylactic Antibiotic Use in Clean Elective Foot Surgery, the first addition to ACFAS’ new Clinical Consensus Statements (CCSs) library, is now available and will also be published in the March/April issue of the Journal of Foot & Ankle Surgery. The new CCSs are intended to provide physicians with recommended approaches to the treatment of specific conditions and pathology. Two topics will be produced annually by appointed expert panels of ACFAS members.

The year’s second CCS, Risk, Prevention and Diagnosis of Venous Thromboembolism Disease in Foot and Ankle Surgery and Injuries Requiring Immobilization, will be released in March. Topics for 2016 are in development.

Visit acfas.org for the latest updates on ACFAS’ CCSs. Congratulations to Zeeshan Husain, DPM, FACFAS of Division 7: Michigan, and Daren J.L. Bergman, DPM, FACFAS of Division 8: New England, on being elected the new Treasurer/Secretaries for their respective Divisions.

These new officers’ terms will commence at the 2015 Annual Scientific Conference in Phoenix. If you would like to learn more about your ACFAS Division and have a voice in their activities for the rest of 2015, please plan to attend your Division's annual membership meeting at the conference. Each Division meets in a reserved section of the Exhibit Hall during the lunch hour. All ACFAS members who attend their Division meeting will be placed in a raffle to win one of two Apple iPad minis.

Many thanks to all local officer candidates for their interest in becoming involved in their ACFAS Division and to all of the ACFAS Division members who took a moment to vote in their local election.

Foot and Ankle Surgery

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Researchers performed ultrasonographic assessment in tandem with a double-blind randomized control trial administering Botox or placebo to correct clubfoot. Two-dimensional ultrasound was used to monitor the length changes to the gastrocsoleus and Achilles tendon unit at two time points: pre-injection and six weeks following the blinded injection. Gastrocsoleus and Achilles tendon length measurements were evaluated among placebo, Botox and contralateral controls using repeated ANOVA measures. The baseline gastrocsoleus length of the clubfoot prior to blinded injection appeared shorter than controls but did not achieve significance. The complex length within each of the three treatment groups exhibited no significant change between baseline and six weeks. The complex-tendon ratio and muscle-tendon ratio of the Botox treatment group were significantly reduced versus controls. When rendered as a proportion, an increase in Achilles tendon length and decrease in gastrocsoleus was observed for a short time when clubfeet were treated with Botox.


A prospective therapeutic cohort study was conducted to measure the reduction in opioid consumption and post-operative pain scores in the post-operative period when liposomal bupivacaine is used at the conclusion of forefoot surgery. The study involved 20 patients who received liposomal bupivacaine at the conclusion of their forefoot operation plus routine multimodal analgesic protocol and 20 patients in a control group who did not receive liposomal bupivacaine. Pain scores, number of narcotic pills consumed on post-operative days 1 through 4, need for refill, time to first refill and wound complications were assessed. The average number of narcotic pills consumed on the first and second post-operative days was significantly lower for the liposomal bupivacaine group compared to the control group. Daily pain scores were lower for those patients who received liposomal bupivacaine on the first through fourth post-operative days, although this was statistically insignificant. Fewer patients needed medication refills in the liposomal bupivacaine group compared to the control group, but this was statistically insignificant as well. No increase in wound complications in the liposomal bupivacaine group was observed compared to the control group.


Researchers have found that patients with primary gout, especially women, have a higher risk of developing diabetes than those patients with osteoarthritis or patients in a control group. The researchers studied a United Healthcare database covering the records of 13 million patients between January 2003 and December 2012. They ultimately sorted more than 200,000 patient records into three cohorts: those with gout, those with osteoarthritis and control group with neither condition. They found that the patients with gout developed diabetes much more readily than either of the two other groups. Patients with gout had a date-matched rate ratio of incident diabetes of 1.71 compared to the gout group. Among women with gout, that number was 2.42. The incidence rate of diabetes per 100 person years for patients with gout was 1.83 compared to only 0.98 among those patients without gout and 1.12 in patients with osteoarthritis.

Practice Management

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Although the impulse to give only positive performance feedback to failing employees is strong, negative feedback offers them more of an incentive to make constructive changes. Tips for practice managers to provide performance feedback to such employees include:

1) Readying a script by outlining talking points and practicing them out loud, which helps the manager stay on point and maintain composure when the time comes. Managers also should take some time to predict and practice responses to comments they might receive.

2) Maintaining a calm yet assertive energy to set a tone for the meeting and how the action plan will be managed.

3) Beginning the meeting on a positive note, such as a compliment expressing appreciation for the employee's detailed note-taking during the conversation.

4) Providing firm but gentle feedback. This helps to enlighten the practice manager's team and motivate them to do better.

5) Developing an action plan in collaboration with the employee, which boosts the likelihood he or she will be engaged in the improvement process. Practice managers should request suggestions first and then add their own. They should list their goals, outline which steps will be followed to improve and identify follow-up dates to check up on progress.


Practices can realize more efficient use of electronic health records (EHRs) in a number of ways, including using appropriate shortcuts for repetitive tasks and creating "triggers" within the EHR so physicians can document faster. Other helpful methods include consultation with EHR vendors on ways to make the records more efficient and adopting a portal to help physicians meet the patient engagement requirements in Medicare's EHR Incentive Program. Additional strategies include deployment of add-ons such as "smart" pens, speech recognition software or integrating traditional transcription services with EHR data entry to streamline documentation. Also suggested is consideration of additional EHR components that may be idle, such as messaging features and other built-in tools. Delegating EHR-related tasks to staff is another suggestion, as is fully employing all vendor training resources available to the practice, such as any webinars, whitepapers or training modules. The practice should always be kept up to date on any changes or enhancements the vendor makes to the EHR system and also should leverage the vendor's user groups. Finally, it would benefit practices to boost EHR-specific communication, which could uncover areas of improvement that are overlooked.

Health Policy and Reimbursement

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The Obama administration will institute historic changes to how the U.S. pays its annual $3 trillion healthcare bill in order to curb the practice of paying physicians and hospitals without regard to quality or effectiveness. Beginning in 2016, Medicare will base 30 percent of payments on how well health providers care for patients, which may put some providers at financial risk according to the quality they furnish. The objective is to put 50 percent of payments under the new system by 2018. For physicians and hospitals, the system will link tens, and later hundreds, of billions of dollars in payments to patient outcomes instead of to how much work a physician or hospital performs. This represents the first time the government has ever established specific goals to move the country away from fee-for-service payments. The program is expected to more than double the reach of programs that the U.S. estimates has saved $417 million and that have been a template for how the government hopes to influence, and curtail, health spending.


The Medicare Payment Advisory Commission (MedPAC) will propose a 1.4 percent payment cut to 75 percent of services in Medicare's Physician Fee Schedule (PFS) to continue funding for a 10 percent bonus payment for primary care physicians that expires at the end of this year. The per-beneficiary bonus payment is given to physicians who practice internal medicine, family medicine, general geriatrics and pediatrics as a way to improve reimbursements and encourage new physicians to study in those disciplines. Per-beneficiary payments are for assessment and management services provided during office visits, patient visits in a long-term care facility and home visits but not visits at hospitals. The American Academy of Family Physicians (AAFP) says MedPAC Chair Glenn Hackbarth does not want MedPAC's recommendations to Congress, to be submitted in March, to remove the urgency of a long-term remedy to the payment problems of primary care. "This is a stopgap," Hackbarth notes. "It's small ... and [won't] attract huge numbers of people to primary care." AAFP says MedPAC is split on how to create long-term, fair payment for primary care in the future. Commissioner William Hall wonders whether the bonus payment is sufficient incentive to fix the problems with primary care.


An analysis of the government's Open Payments database has found the system is riddled with mistakes. The database is intended to bring transparency to relationships between physicians and drug and medical device manufacturers. Including misspellings of drugs and devices investigators discovered that companies often record payments for a single drug numerous times. For example, H.P. Acthar Gel made by Questcor Pharmaceuticals recorded payments for the gel under eight different names. While the payments didn't total a large sum, it placed the drug in the top 20 for spending on doctors. Additional problems include 8.5 percent of the 4.3 million general payments reported to the database were not for a specific drug or device. Further, more than 140 companies failed to list the products in their payment records. The analysis also found that many companies use obscure language in payment forms and list products in the wrong category. Due to it being the first year companies needed to report the information publicly and to changing guidelines, the Pharmaceutical Research and Manufacturers of America says mistakes and errors were to be expected.


Lawmakers in nine states have formally proposed legislation to accelerate the licensing process for physicians to practice in multiple states. The Interstate Medical Licensure Compact legislation aims to make medical licenses more transferable so physicians can treat more patients, particularly in underserved populations, while maintaining oversight, accountability, and patient protection. The compact has been formally introduced in Iowa, Minnesota, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont and Wyoming.

Medicine, Drugs and Devices

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The Centers for Disease Control and Prevention (CDC) warns that the number of opioid pain medications being prescribed to women of childbearing age presents a "significant public health concern." A report published in a recent issue of Morbidity and Mortality Weekly Report finds that one fourth of privately insured women between the ages 15 and 44 and a third of their counterparts insured by Medicaid filled an opioid prescription between 2008 and 2012. CDC doctors warn that taking opioids during the early stages of pregnancy can result in birth defects and complications for the baby and mother. The risks include neural tube defects, congenital heart defects, gastroschisis and neonatal abstinence syndrome.


A new report by the Centre for Innovation in Regulatory Science shows that while the U.S. Food and Drug Administration (FDA) remains the fastest at approving new drugs, other global drug regulators are closing the gap. The study looked at the drug approval times of six regulators--FDA, Japan's Pharmaceuticals and Medical Devices Agency, Health Canada, the European Medicines Agency, Swissmedic, and Australia's Therapeutic Goods Administration--over 10 years. At the end of 10 years, FDA was the fastest, with a median approval period of 304 days in 2013, down from more than 400 days in 2004. The Japanese agency came in second, with a 2013 median approval time of 342 days, down from 600 in 2004. The other agencies all made impressive gains over the course of the decade, with the gap between the fastest and slowest agency closing from around 500 days in 2004 to only about 200 days in 2013, when Swissmedic was the slowest, with a median approval time of 511 days.


Some of the most highly reimbursed cardiologists in the U.S. are making millions of dollars from Medicare for performing stent procedures to unblock blood vessels in the arms and legs, as payments for relieving blockages in the heart have declined. The Advisory Board Company reports the number of procedures to open blockages in heart vessels slipped by about 30 percent from 2005 to 2013, while the number of similar procedures for vessels outside the heart climbed nearly 70 percent. Analysis of 2012 billing records for the 10 top-billing U.S. cardiologists found eight of them made about 50 percent of their Medicare reimbursements by conducting procedures to unblock vessels in the patients' arms or legs. These physicians claim they are saving Medicare money by doing these procedures outside a hospital, and they lower the number of more serious conditions. They also say the Medicare payments are warranted to cover their high expenses. However, critics such as the Society for Vascular Medicine are saying patients with peripheral artery disease typically do not need invasive treatment. Meanwhile, the increase in procedures follows a regulatory crackdown on unnecessary cardiac procedures. Experts anticipate stent peripheral artery procedures to continue to grow in number because they can be done at doctors' offices instead of hospitals.