News From ACFAS

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Before you leave for Las Vegas for the 75^th Anniversary Scientific Conference February 27–March 2 at The Mirage, download the free ACFAS 75 app for instant access to:

• your customized session schedule
• the exhibitor directory
• a complete listing of speakers
• live Tweets about ACFAS 75
• convention center maps
• and more!

Search your app store for ACFAS 75 or visit http://m.core-apps.com/acfas2017 to download the app then watch for an email coming soon from ACFAS with your login details for your personalized schedule. The U.S. Centers for Medicare and Medicaid Services (CMS) has announced an extension to the 2016 Physician Quality Reporting System (PQRS) Electronic Health Record reporting deadline. Eligible professionals must now report their 2016 data by March 13, 2017. The previous deadline was February 28, 2017.

Visit CMS' PQRS webpage for more information or contact the QualityNet Help Desk at (866) 288-8912 or qnetsupport@hcqis.org. This spring, refresh your approach to the forefoot procedures you perform most often. Register for ACFAS on the Road: Refining High-Frequency Forefoot Surgery, April 28–29 at the Tysons Corner Marriott in Vienna, Virginia, and discover bold new ways to treat even the most challenging forefoot injuries and deformities.

This two-day workshop begins on Friday evening with a presentation on common forefoot surgical complications followed by a panel discussion. Be sure to bring your own cases to present to the group. On Saturday, you’ll practice the latest surgical techniques in a state-of-the-art sawbones lab under the guidance of expert faculty.

Visit acfas.org/ontheroad to register, and stay tuned for more on this year’s ACFAS on the Road series.

Foot and Ankle Surgery

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This study aimed to analyze the treatment process for critical limb ischaemia (CLI) from referral to revascularization, discover possible delays and determine patients who would benefit the most from early revascularization. A retrospective analysis was performed on 394 patients and 447 affected limbs. Revascularization was scheduled for 246 limbs. Patients living with diabetes comprised the majority of the study population, with 159 diabetic feet undergoing revascularization. Endovascular treatment (ET) was performed on 221 limbs and open surgery (OS) on 45 limbs. There was crossover after ET in 17 percent of procedures, and re-revascularizations were required in 40.1 percent of cases after ET and 31.1 percent after OS. The median time from referral to revascularization was 43 days. The ischaemic limb required an emergency operation scheduled at the first visit for 11.8 percent of patients. Twenty-five patients required an emergency procedure while waiting for elective revascularization. When revascularization was achieved within two weeks, no difference was seen in limb salvage. When the delay exceeded two weeks, limb salvage worsened in patients living with diabetes.


Clubfoot in myelomeningocele patients traditionally has been treated with extensive soft-tissue release surgery with poor outcomes, so a recent study assessed the use of the Ponseti method to treat clubfoot associated with myelomeningocele. Eleven children with 18 myelomeningocele-associated clubfeet were included in the retrospective review, with an average follow-up duration of 4.5 years. The average age at presentation was 4.7 weeks, and the average Pirani score was 5.5. Initial correction was achieved in all patients with an average of seven Ponseti casts. Tendo-achilles tenotomy was performed in 17 of 18 feet. Nine patients achieved a satisfactory outcome at final follow-up. Recurrence occurred in five feet and was managed successfully with a second tendo-achilles tenotomy and Ponseti casting. Two patients failed Ponseti treatment.


A study investigated the association between menopausal factors and the development of serologic rheumatoid arthritis (RA) phenotypes. Data was pulled from Nurses’ Health Studies (NHS: 1976-2010, NHSII: 1989-2011). In total, 1,096 RA cases among female nurses were confirmed by questionnaire and chart review. Cox proportional hazards models were used to obtain multivariable adjusted hazard ratios of seropositive and seronegative RA associated with menopausal status, age at menopause, type of menopause, ovulatory years and postmenopausal hormone therapy (PMH). Postmenopausal women were found to have a two-fold increased risk of seronegative RA compared with premenopausal women. Natural menopause before age 44 was associated with an increased risk of seronegative RA. No menopausal factors were significantly associated with seropositive RA. PMH use of fewer than eight years was associated with increased risk of seropositive RA.

Practice Management

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The use of artificial intelligence (AI) to analyze patient data and healthcare trends could help providers improve patient outcomes and introduce cost-cutting measures. Evidence-based medicine supported by AI would assist primary care physicians in several areas, including the ability to determine appropriate treatments, monitor care, improve efficiency in workflows and reduce overall costs. Supercomputers can compare and analyze large sets of healthcare data to identify patient health risks and patterns that predict the start and trajectory of an illness. AI is also being used to analyze data to help patients take their medications on time, manage diabetes and improve practices in mental health. In addition, computational analysis can be applied to a variety of data sets associated with population health management, including data registries, electronic health records, data produced from team care, claims data and hospital readmissions data. According to Frost & Sullivan, the market for AI will grow from $634 million in 2014 to $6.6 billion in 2021. The firm also predicts that AI could improve health outcomes by 30 percent to 40 percent and cut treatment costs by as much as 50 percent.


With more than 380 million users and more than 1.5 million groups, LinkedIn can be an effective marketing tool for practices looking to expand their reach. When creating a personal profile on LinkedIn, physicians should include their skills, expertise and education to establish themselves as a medical professional. A complete profile outlines a physician's work history and professional goals, including relevant keywords that will increase the chances of showing up on LinkedIn's search feature. Physicians should join the most active LinkedIn groups that suit their professional interests and connect with fellow group members to share information and build networks. Posting relevant and engaging content, such as relevant links, articles and videos, can help drive traffic to the practice website or blog. Content should reflect the physician's area of expertise and add value to community discussions. In addition to creating a personal profile, physicians should consider creating a company page for their practice. The practice page will allow administrators to post content on behalf of all its staff, including job openings, news, rewards and recognitions.

Health Policy and Reimbursement

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Republican lawmakers seeking to replace the Affordable Care Act (ACA) will need to consider how much of the health law’s requirements and benefits to keep. The ACA affords beneficiaries a list of 10 benefits, including prescription drugs, mental health services and laboratory tests. Plans are also required to cover preventative services at no cost to enrollees. The rules contributed to making individual plans more expensive in many cases, but trimming certain benefit categories from the required list would hike the cost of those benefits for consumers who need them. Republican congressional leaders and President Donald Trump’s administration have vowed to reduce the federal regulation of health insurance and to provide greater flexibility to states. Trump’s executive order on the ACA provided his administration some regulatory leeway to adjust the ACA’s mandates without action by Congress. If Congress and the Trump administration move to cut benefits requirements, insurers may be reluctant to cover costlier benefits, gravitating toward offering plans that cater toward a healthier demographic.


Republican lawmakers and insurance industry representatives at a Senate Health, Education, Labor and Pensions Committee hearing agreed the first steps in repealing and replacing the Affordable Care Act (ACA) should focus on shoring up the individual marketplaces. Committee Chairman Lamar Alexander (R-Tenn.) noted that uncertainty regarding the future of the ACA could lead insurance companies to abandon the exchanges next year. Aetna and Anthem this week signaled their concern about continued participation in the individual market and indicated they would extract themselves if the market showed no signs of stabilizing. Marilyn Tavenner, president of America’s Health Insurance Plans, requested lawmakers to continue to provide subsidies in their entirety for the next two to three years and to enforce the individual mandate. “As long as current market rules that prohibit the exclusion of pre-existing conditions, require guaranteed issue of insurance policies and impose community rating requirements on insurers remain in place, there is a corresponding need for incentives for people to purchase and keep continuous coverage,” said Tavenner. Following the hearing, Alexander told reporters that the U.S. Department of Health and Human Services secretary could choose to implement many of the short-term suggestions through rulemaking.


Republican leaders of the Senate Finance Committee defied a Democratic boycott to usher through the U.S. Department of Health and Human Services nomination of Rep. Tom Price. Democrats had boycotted the initial meeting to vote on Price’s nomination, so Republican members of the committee voted to suspend the panel’s requirement that at least one Democrat be in attendance when voting on a nominee. The committee was then able to vote 14-0 to advance Price’s nomination to the full Senate. Democrat members of the committee cited concerns that Price may have misled the committee during his confirmation hearing and requested more time to question the nominee. Democrats do not have enough votes to filibuster in the Senate, so Price is expected to be confirmed.

Medicine, Drugs and Devices

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Wearable robots for walking assistance should maximize the user’s metabolic benefit while limiting the metabolic penalty of carrying the system’s mass. A new study aimed to characterize the relationship between assistance magnitude and the metabolic cost of walking while assessing changes to the user’s underlying gait mechanics. A tethered multiarticular soft exosuit was used during normal walking, with assistance directly applied at the ankle joint and indirectly at the hip. Seven participants walked on a treadmill at 1.5 meters per second under one unpowered and four powered conditions. Peak moment applied at the ankle joint varied from about 10 percent to 38 percent of biological ankle moment. With increasing exosuit assistance, net metabolic rate decreased within the tested range. With maximum assistance, the metabolic rate of walking was reduced by 22.83 percent relative to the unpowered condition.


Three of the biggest makers of diabetes treatments—Sanofi, Novo Nordisk and Eli Lilly—were named in a class-action lawsuit about price fixing filed by a group of patients. Filed in a federal court in Massachusetts, the suit said the companies have simultaneously hiked the price of insulin by more than 150 percent during the past five years. Plaintiffs claim that Sanofi, Novo Nordisk and Eli Lilly raised their public benchmark price for insulin products while maintaining a lower "true" price they charged large pharmacy benefit managers like Express Scripts, CVS Health and OptumRX.