News From ACFAS

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We’ve only just begun here in Orlando at the 2014 Annual Scientific Conference and already there’s so many opportunities being imagined by our over 1250 DPM attendees!

You can follow the entire Annual Scientific Conference through our social media outlets on Facebook, Twitter, YouTube, Google+ by using #ACFAS2014.

Tomorrow, the first full official day of ACFAS 2014 kicks off with innovative educational programs during the day and energizing networking events in the evening. Attendees will be inspired by thought-provoking sessions, including:

• An invigorating opening session by Danielle Ofri, MD on “The Amygdala and the Stethoscope” and how medicine is transforming at a breathless pace.
• The HUB--Practical information for practically everyone--learn about the essentials of publishing in JFAS, how to start a residency program and much more.
• The PICA Lessons Learned program at 4pm on February 27

Plans are already in place for next year! Plan now for the ACFAS’ 2015 Annual Scientific Conference, February 19-22, 2015, in Phoenix, Arizona.
Edwin Blitch, DPM, FACFAS, will be honored on Friday during the Honors and Awards Ceremony at the Annual Scientific Conference in Orlando as the 2014 recipient of the ACFAS Distinguished Service Award. This award, presented annually by the ACFAS Board of Directors, recognizes long-term, behind-the-scenes volunteerism to the profession and the College. Congratulations to Dr. Blitch and thank you again for your continued service and dedication to the profession and ACFAS.
Congratulations to new ACFAS President Thomas S. Roukis, DPM, PhD, FACFAS; President-Elect Richard M. Derner, DPM, FACFAS; Secretary-Treasurer Sean T. Grambart, DPM, FACFAS; and Immediate Past-President Jordan P. Grossman, DPM, FACFAS. The new officers will take office on Friday, February 28, at the Honors and Awards Ceremony along with the new and returning director members:

• Kris DiNucci, DPM, FACFAS
• Byron L. Hutchinson, DPM, FACFAS
• Christopher Hyer, DPM, FACFAS
• Aksone M. Nouvong, DPM, FACFAS, Division Presidents Council Chair
• Christopher Reeves, DPM, FACFAS
• Laurence G. Rubin, DPM, FACFAS
• John S. Steinberg, DPM, FACFAS

A special thank you to to retiring board members Michelle M. Butterworth, DPM, FACFAS and Randal Wraalstad, DPM, FACFAS for his service over the last two years on the Board as the Division Presidents Council Chair.

Foot and Ankle Surgery

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A recent study found that there are advantages to using washers to optimize screw fixation, a technique that is particularly suited for screw fixation of the distal tibia. During the study, partially-threaded 7mm cannulated screws were inserted with and without washers into synthetic bone blocks made to simulate cortical and cancellous bone. A load cell was used to measure the compressive force before and after screws were inserted into the simulated bone. Tests were performed on screws with a washer, those without a washer, and screws with a washer after being initially intruded. The results of these tests showed that screws inserted into bone with washers generated a significantly larger amount of compressive force than screws inserted without washers before screw intrusion. There was a significant decrease in compressive force in all of the screws after intrusion, which the study found could impair the quality of the fixation. However, screws inserted with washers were able to maintain a larger amount of compressive force than screws inserted without washers. In addition, screws with washers that were reinserted after intrusion without a washer produced almost as much compressive force as screws inserted without washers primarily. The study concluded that the use of washers allows for more compression to be generated before intrusion, and also makes it possible to salvage compressive force of intruded screws.


A recent study examined the safety and reliability of using abductor digiti minimi muscle flaps and free skin grafting to reconstruct exposed bone and osteomyelitis in patients with diabetic foot ulcers. Eight patients were chosen to participate in the study, six of whom had ulcers over the heel. The other two had ulcers on the lateral aspect of the forefoot. All of the flaps survived well, and there were no donor site complications. However, there was partial loss of the skin graft in three cases and infection and total loss of the graft in another. Nevertheless, the study concluded that abductor digiti minimi is a safe and reliable flap that provides a durable cover.

Practice Management

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Daniel Essin, MA, MD, says there are a number of steps that doctors' practices can take to avoid making expensive mistakes when implementing an electronic health record (EHR) system. For instance, practices should have a goal that goes beyond wanting to obtain the incentive money and comply with the mandates for implementing an EHR system, Essin says. Practices should instead have concrete goals, Essin notes, such as a desire to keep the amount of time a doctor spends charting a visit to under two minutes, or the need to eliminate duplicate recording of physician orders in the treatment plan and in the order entry system. Essin also advises practices to use what he says is the "Order-of-Magnitude Heuristic" to avoid paying too much for an EHR system. This process involves starting with a ridiculously small budget for adopting an EHR system and slowly increasing that budget until a figure is arrived at that can cover the cost of an EHR system that meets the practice's needs, and nothing more. Starting with a very small budget forces the practice to think creatively and encourages the adoption of solutions that best meet the practice's requirements, Essin says.


Concierge care medicine, particularly hybrid concierge care, is growing increasingly popular among patients, writes Wayne Lipton, whose company works with doctors' practices of all sizes across the country. Lipton notes that his company's membership marketing programs have seen a 30 percent increase in the member conversion rate in just the last six months. There are a number of reasons why patients are increasingly moving towards concierge care medicine, Lipton says, including the desire to lock in a relationship with their physician amid concerns that healthcare reform may prevent them from doing so. Lipton also says that concierge programs have become so common that patients living in many areas are not taken aback by the idea of paying for enhanced services. Indeed, more and more physicians are adopting concierge medicine models--particularly hybrid models--as well, Lipton says. One reason why physician groups are doing so, Lipton says, is because more and more patients are willing to turn to some form of self payment in order to obtain the high-level, personalized, convenient care that concierge medicine models offer. Lipton also points out that practices that have adopted concierge medicine models are generally seen as being better acquisition targets.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) has announced that it will offer "end-to-end" testing of Medicare claims using ICD-10 diagnostic and procedure codes, following months of pressure from a variety of groups that it do so. During the test, participating providers and suppliers will submit mock claims containing ICD-10 codes to CMS, which will process the claims and send out remittance advice documents that explain how the claims were processed. CMS hopes the tests will show that providers and other submitters are able to successfully submit claims containing ICD-10 codes to the Medicare fee-for-service claim system. CMS also wants to show that the new software put in place for the switchover to ICD-10 is able to make appropriate rulings on claims and produce accurate remittance advice. ICD-10 is scheduled to be implemented on Oct. 1.


Healthcare organizations that want to participate in the Centers for Medicare and Medicaid Services' Bundled Payments for Care Initiative (BPCI) can apply to do so during the open enrollment period the agency announced Feb. 14. Organizations that want to participate are being asked to submit an Open Period Intake Spreadsheet and an Open Period Intake Form by April 18. Those that are chosen to participate will be placed in Models 2, 3, and 4 of the initiative, each of which is intended for different types of healthcare providers. Following the conclusion of the open period, organizations that are chosen to participate in the initiative will be placed in Phase I of the program--a period of preparation before organizations assume financial risk--in July. Meanwhile, organizations already participating in BPCI can request to add episodes and/or Episode Initiators during the open period.


White House spokesman Jay Carney on Feb. 14 pushed back against criticism that the Obama administration is inflating its reports of enrollment figures for insurance plans offered through the nation's health insurance exchanges by including people who had not yet paid their premiums, and therefore are not officially covered. Carney said the administration has no idea how many people have yet to pay their premiums, since that information is closely held by insurance companies. However, Carney said the exchanges will eventually allow the administration to determine how many enrollees have paid their premiums. That capability, which will also allow consumers to immediately pay for their plans, will be added to the exchanges in the next several months. But Carney also cited a New York Times report that found that only about 20 percent of the 3.3 million consumers who have picked out a plan on the exchanges have yet to pay their premiums, saying that the report indicates that a large percentage of individuals have paid for their plans.


Eligible professionals and group practices participating in the Centers for Medicare and Medicaid Services' Physician Quality Reporting System (PQRS) can use a new interactive tool from the agency that will help them stay on top of PQRS deadlines. The first set of deadlines that the tool will remind eligible professionals and group practices about takes place on Feb. 28, including the deadline for PQRS participants to submit their 2013 PQRS data using electronic health record (EHR) reporting methods. Feb. 28 is also the last day for participants to submit 2013 clinical quality measures (CQMs) for the PQRS-Medicare EHR Incentive Pilot Reporting Program. By March 21, group practices will have to submit 2013 data through the Group Practice Reporting Option (GPRO) Web Interface. March 31 is the last day to submit 2013 PQRS data through the registry reporting method, as well as the last day for Maintenance of Certification Program entities to send in 2013 quality data. Reporting for the 2014 PQRS program year is scheduled to end Dec. 31 for group practices and individuals.

Medicine, Drugs and Devices

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Multiplanar reformatted (MPR) computed tomography (CT) images are somewhat superior to 3D color volume-rendered (VR) images in accurately diagnosing peroneal tendon dislocation in patients with acute calcaneal fractures, a new study has found, though the diagnostic accuracy of the two types of images are comparable. Radiologists came to that conclusion after examining 121 ankle CT studies from 105 consecutive patients with acute calcaneal fractures, as well as a number of 3D color VR images to determine whether the peroneal tendon was dislocated. Radiologists used three degrees of certainty--definite, probable, and possible--in determining whether a dislocation of the peroneal tendon existed. In addition, the diagnostic performance of the 3D images for peroneal tendon dislocation was evaluated by calculating the sensitivities, specificities, and area under the receiver-operating characteristic (ROC) curves. The examination of the MPR images showed that 48 percent of the 121 studies displayed evidence of peroneal tendon dislocation. The three readers who independently reviewed the 3D images measured sensitivities/specificities of 0.92/0.81, 0.88/0.90, and 0.81/0.92. The area under the proper binormal ROC curve based on all three readers (0.93, 0.94, and 0.92) was 0.93 with a 95 percent confidence interval of 0.89-0.98.