News From ACFAS

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Nearly 1,300 DPMs are converging today in San Antonio for the ACFAS 2012 Annual Scientific Conference!

The conference kicks off tomorrow with renowned physician, professor, and author Abraham Verghese, MD as the keynote speaker. His topic: “The Patient-Physician Relationship in the Microarray Era.”

Be a part of the conference and the conversation by following the daily commentary on Twitter #ACFAS2012. Don’t forget to download the 2012 ACFAS Annual Scientific Conference Mobile App!

Simply download the conference app to your iPhone, iPad, Droid or Blackberry and you can be connected to the latest happenings and your personal conference schedule right on your own device!

To download the app, search for ACFAS 2012 in the app store of your device.

Once you've downloaded your app, you can populate it with your personal schedule and contact information by entering a unique code provided by ACFAS. If you registered by February 15, you should have received an email and a fax providing you with your code. Enter it into your Contact button on the app. If you registered after February 15, go to the Registration Desk at the conference to get your code for synching.
The ACFAS Research-EBM Committee is conducting a survey on DVT Prophylaxis and needs your input.

If you're a licensed DPM, please take a few minutes to take the short, 15-multiple-choice-question survey at the web link below.

The survey is also available in the ACFAS 2012 Conference mobile app under the Polls button or in the ACFAS Membership Booth #663 in the Exhibit Hall at the conference for your convenience.

The survey closes on April 15, 2012.
ACFAS members can now take advantage of a new, member-only resource, the Credentialing and Privileging Advisory Team (CPAT). CPAT is designed to offer personalized assistance to those seeking help with credentialing and privileging issues at healthcare institutions.

The specially-trained and experienced group of ten peer mentors can help you navigate the complex and changing world of the medical staff. To access this service and receive collegial help, email credentialing@acfas.org.

Foot and Ankle Surgery

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A age, weight, height, and gender matched 310 subjects were allocated to three groups to identify risk factors for Achilles tendinopathy and Achilles tendon rupture. Eighty-nine subjects were allocated to a group with healthy Achilles tendons, 161 to a group with chronic Achilles tendinopathy, and 60 to a group exhibiting acute Achilles tendon rupture. A positive family history of Achilles tendinopathy was determined to be a risk factor for that condition, but not for Achilles tendon rupture. There was a lower prevalence of smoking and cardiac diseases in Achilles tendinopathy compared to healthy subjects, while the risk profile was not changed by the administration of cardiovascular medication.


The incidence of symptomatic venous thromboembolic (VTE) complications following a consecutive series of 2,654 patients undergoing elective foot and ankle surgery was assessed via retrospective study. A total of 1,078 patients received 75 mg of aspirin as routine thromboprophylaxis between 2003 and 2006 and 1,576 patients received no form of chemical thromboprophylaxis between 2007 and 2010. Overall VTE incidence was 0.42 percent with 27 patients lost to follow-up. If these were included to create a worst case scenario, the overall VTE rate was 1.43 percent. The use of aspirin had no apparent protective effect against VTE.


Researchers compared the responsiveness of the Manchester-Oxford Foot Questionnaire (MOXFQ) with other foot/ankle-specific and generic instruments. They enrolled 671 consecutive adult patients undergoing foot and ankle surgery and obtained MOXFQ, Short-Form 36 (SF-36), EuroQol (EQ-5D) questionnaires and AOFAS scores at 6 months pre- and 9 months post-operatively. The surgeries included multiple/whole foot in 8, ankle/hindfoot in 292, mid-foot in 21, hallux in 196, and lesser digits in 111 patients. Foot/ankle-specific MOXFQ, AOFAS, and EQ-5D generated larger effect sizes than any SF-36 domains, implying superior responsiveness. While the MOXFQ performed well in detecting foot/ankle difficulties, the SF-36 and EQ-5D did not. The MOXFQ was good versus the AOFAS for the same analysis.

Practice Management

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Beginning next year, Medicare-participating doctors who fail to report sufficient quality measures to the government will not only lose a bonus but also experience an across-the-board reduction in Medicare pay by 2015, and the latest Centers for Medicare & Medicaid Services (CMS) report indicates tepid participation in the quality program. Only about one-fifth of physicians and other eligible professionals sent quality data to Medicare in 2009, and only slightly more than 50 percent of those made a satisfactory enough effort to get a bonus. Although the physician quality reporting system (PQRS) is a pay-for-reporting program, Congress authorized CMS also to use PQRS quality data and cost information from claims to make additional payment adjustments to selected doctors; that payment modifier will cut pay for some doctors to reward other physicians who are deemed to supply higher-quality care at a lower cost relative to their peers. American Medical Association (AMA) president Peter W. Carmel says the AMA is among the organizations opposed to the CMS proposal for the pay-for-performance modifier, and is lobbying for the elimination of all PQRS penalties.


The proposed Stage 2 meaningful-use requirements raise the bar for hospitals and eligible professionals on the use of computerized physician order entry (Capote), electronic prescribing and electronic recording of several patient-health measures, according to officials at the Centers for Medicare & Medicaid Services (Cams), who previewed the Stage 2 measures in a presentation at the Healthcare Information and Management Systems Society's 2012 Conference and Exhibition. The proposed requirements were published on the Office of the Federal Register's webster on Feb. 23. They are slated to be published in the Federal Register on March 7.

Under the proposed standards, hospitals as well as eligible professionals, including physicians not employed by hospitals, would have to use Capote for more than 60 percent of medication, laboratory and radiology orders, double the share required under the Stage 1 standards. The requirement is one of more than a dozen core objectives that hospitals and professionals would have to meet as part of demonstrating their meaningful use of electronic health-record systems, which would make them eligible to receive federal health IT incentive payments.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services (CMS) is using a flawed Medicaid claims database that makes it nearly impossible for outside contractors to identify provider overpayments and fraud, according to a report released by the Department of Health and Human Services Office of Inspector General. More than a third of suspected overpayments identified by outside Review Medicaid Integrity Contractors hired by CMS were later invalidated when states matched the alleged overpayments with more complete information maintained in their own databases, said the report. It found that the claims database used by CMS—called the Medicaid Statistical Information System (MSIS)—contains only a subset of the claims information in state databases and fails to reflect later payment adjustments or provider identification data.


Some doctor practices are experiencing severe payment disruptions because of the migration to new standards for electronic transactions under the Health Insurance Portability and Accountability Act, and the American Medical Association and the Medical Group Management Association (MGMA) have encouraged the Centers for Medicare & Medicaid Services (CMS) to further postpone full enforcement of the standards until technical problems are resolved. CMS conceded the existence of initial processing delays and instances of missing claims with the new standards, but insists that those difficulties have been addressed. However, MGMA's Robert Tennant cites four readiness surveys indicating that the health industry was unprepared for the switch to HIPAA Version 5010, and notes that practices that transitioned to the new standard may think they are compliant but are not; for example, a common mistake is listing a P.O. box for a practice address rather than a physical street address. Tennant says that if CMS chooses to enforce 5010 starting April 1 as scheduled, physicians sending noncompliant claims might not find out until then that their errors no longer will be overlooked.

Medicine, Drugs and Devices

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To afford healthcare without insurance, many Americans are turning to alternative currencies. Trade Dollars is one local currency used among business owners near Fayetteville, Ark., to exchange goods and services without the use of U.S. currency. Trade Dollars, launched in 2009, are becoming more popular as the U.S. dollar loses buying power and consumers struggle to get by in the slow economy. Over the course of a year, the number of members using the currency grew from 300 to 548, 60 of which are health and wellness providers such as hospitals, chiropractors, dentists, and plastic surgeons. Business owners who first join the Trade Dollars network receive an interest-free line of credit ranging from 1,000 to 5,000 Trade Dollars and special checks linked to the accounts. In Philadelphia, the community currency Equal Dollars can be earned through community service, such as helping with odd jobs or selling belongings over the exchange's database. Members can save up to $5 per prescription by using their local currency. Timebanking, another form of alternative currency, lets members exchange time instead of money. Hour Exchange Portland in Portland, Maine, has more than 60 health providers among its members. With such systems, low-income members are able to access services they could not otherwise afford.


Studies looking at training programs in obstetrics found that as many as 30 out of every 100 program applicants claim to be involved in research publications that could not be found. Earlier studies have found the same problem in other specialties of medicine. Between 1 percent to 30 percent of training programs in specialties such as radiology, emergency medicine, and orthopedics include references to published research that reviewers were not able to locate. A research group at the University of Washington published their reports in Obstetrics & Gynecology. The team looked through 937 applications to a residency program in obstetrics and gynecology. Of these applicants, 357 put down that they had at least one research study that was published or about to be published in a peer-reviewed outlet. Among the 1,000 publications listed, 156 turned up missing when the researchers looked for them. One of the most significant errors was that 62 applicants listed a publication as "peer-reviewed" when it was not. Studies were unable to tell whether these were honest mistakes or intentional misrepresentations. To combat this problem, applicants may be required to include a copy of the paper or an identification number to look up. Medical schools may also consider adding training in authorship and peer review.


Six national health professions associations have formally joined to create the Interprofessional Education Collaborative (IPEC), which will focus on better integrating and coordinating the education of health professionals to provide more collaborative and patient-centered care. The founding members include the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health.