News From ACFAS

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The numbers are in, and the 75^th Anniversary Scientific Conference here at The Mirage in Las Vegas has been declared the largest in ACFAS history with 1,900 DPMs in attendance! With numbers this high and a conference of epic proportions, ACFAS 75 will be talked about for at least the next 75 years! Clinical sessions and workshops these past few days have been at max capacity, evening receptions were packed wall to wall and attendees are excited for tonight’s Wrap Party in the LINQ entertainment promenade. See Twitter and Facebook for photos from the opening general session, Premier Connection reception, Resident and Student Networking event, Honors and Awards Ceremony and more. Congratulations to new ACFAS President Laurence G. Rubin, DPM, FACFAS; John S. Steinberg, DPM, FACFAS, President-Elect; Christopher L. Reeves, DPM, FACFAS, Secretary-Treasurer; and Sean T. Grambart, DPM, FACFAS, Immediate Past President. The new officers were installed yesterday during the Honors and Awards Ceremony at ACFAS 75 in Las Vegas along with the new and returning Board members:

Michael J. Cornelison, DPM, FACFAS
Thanh L. Dinh, DPM, FACFAS
Meagan M. Jennings, DPM, FACFAS
Scott C. Nelson, DPM, FACFAS
Aksone Nouvong, DPM, FACFAS
Eric G. Walter, DPM, FACFAS
Randal L. Wraalstad, DPM, FACFAS

A special thank you to retiring Board members Richard Derner, DPM, FACFAS; and Byron L. Hutchinson, DPM, FACFAS, for their dedicated service. Congratulations to John T. Marcoux, DPM, FACFAS, recipient of the 2017 ACFAS Distinguished Service Award.

ACFAS presents this prestigious honor each year at the Annual Scientific Conference to recognize a member whose volunteer service and commitment to the College’s mission exceed expectations. ACFAS wants to know how often you perform total ankle arthroplasty. Take our new poll at right and be sure to visit acfas.org throughout March to see real-time results. We appreciate your input!

Foot and Ankle Surgery

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Lower-limb rotation can explain lack of reproducibility in assessing hindfoot alignment. A recent study used a mathematical model to predict how lower-limb rotation modifies radiographic hindfoot alignment measurements and compared the results with actual measurements on a cadaver leg. The sagittal and coronal planes on a cadaveric lower-limb were fixed using a custom clamp and standard anteriorposterior views were shot every five degrees. Measured hindfoot alignments were compared to the values obtained from a mathematical model. The simulation accurately predicted the variations of the hindfoot angle, which was 7.04° at 0° rotation and 2.11° at -90°. Intra-class and inter-investigator correlation was 0.863. T-test showed no significant difference.


Good clinical and radiographic short-term results have been reported for patients who underwent realignment surgery of the hindfoot for early- and mid-stage ankle oseoarthrosis, but no mid- to long-term results have been reported. Researchers analyzed 294 patients who underwent realignment surgery between 1999 and 2013. The mean time to follow-up was five years. The overall five-year survival rate was 88 percent. Thirty-eight patients had either secondary total ankle replacement or ankle arthrodesis. Risk factors for failure were age at the time of surgery and a Takakura score of 3b preoperatively.


Data from the German Cartilage Registry was analyzed to determine whether traumatic and posttraumatic osteochondral lesions cause more complaints and loss of joint function than idiopathic lesions. Researchers also investigated the effect of lesion localization, defective area, stage, patient age, gender and body mass index on patients’ complaints and loss of joint function. Complaints and joint function of 117 patients were assessed using the German versions of the Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS). There were no significant differences between the groups with traumatic/posttraumatic lesions and idiopathic lesions regarding most complaints and joint function, excluding the quality-of-life category of the FAOS score. Patients with idiopathic lesions had a significantly better quality of life. Lesion localization, defective area, patient age, gender and BMI were not significantly associated with patients’ complaints and joint function. A higher lesion stage was significantly associated with more complaints and loss of joint function in some categories of FAAM and FAOS scores.

Practice Management

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Healthcare leaders will rely on several key areas to drive financial growth over the next five years, according to the HealthLeaders Media Annual Industry Outlook Survey. More than half of senior healthcare leaders say expanding outpatient services will fuel growth at their organization, and 50 percent will develop or join a shared risk/shared savings effort. Seventy-seven percent of hospitals and 70 percent of health systems plan to expand outpatient services over the next five years, compared with 40 percent of physician organizations that plan to do the same. A greater share of health systems (53 percent) and hospitals (51 percent) than physician organizations (44 percent) mention shared risk/shared savings efforts to spark financial growth. Half of respondents expect their organizations to produce positive or strongly positive financial results in 2017, and 15 percent have a negative or strongly negative outlook. In comparison, the results in last year’s survey for positive or strongly positive outlook were seven percentage points higher, and the results for negative or strongly negative outlook were four points lower.


Transforming from fee-for-service to a value-based care model requires partnerships between small practices and commercial payers. According to Veeneta Lakhani, vice president of provider enablement at Anthem, insurers need to assess providers’ readiness to take on more risk and proactively manage their patients’ care. Payers should help smaller practices develop the right infrastructure, data access and appropriate staffing to succeed in value-based care. For Anthem, this involves a provider-facing portal with reports on high-risk patients, open care gaps, generic drug opportunities and other information. Most of the small- and medium-sized practices working with UnitedHealthcare are in so-called “metric-specific programs.” These programs reward practices that demonstrate they are proactively managing their patients’ health. As practices gain more experience in value-based care, they will be more equipped to handle bundled-payment arrangements, according to UnitedHealthcare's Scott Hewitt. The insurer also sends providers information on patient gaps, referral patterns, lab usage and pharmacy prescription patterns. To increase their success rate in value-based care, Hewitt recommends that practices engage with their payers to ensure they have mutually aligned goals. Practices should implement processes to provide the highest level of care and work with payers to determine where there may be inefficiencies in care delivery.


A new nationwide survey conducted by HIMSS Analytics for Navicure suggests that patients and providers have differing views on healthcare billing and payments. The survey found that a vast majority of provider organizations (75 percent) said they could provide a cost estimate upon request, but fewer than 25 percent of patients requested one on their last visit, according to a news release. Navicure also said 51 percent of providers claim it takes an average patient more than three months to pay his or her full balance, but just 18 percent of patients claim it took them longer than three months to pay their last balance. Furthermore, the survey cites credit card-on-file (CCOF) as patients' preferred payment method for charges of $200 or less, according to the release. Additional patient preferences include patient portal (18 percent), provider website (16 percent) and automated payment plans (9 percent). Providers regard CCOF as the best way to improve patient collections, Navicure says. Twenty percent view CCOF as the best way to reduce cost of collections (22 percent prefer online bill pay), 20 percent view CCOF as the best way to reduce patient days in accounts receivable and 29 percent view CCOF as the best way to reduce bad debt and write-offs. Despite broad patient acceptance of CCOF (78 percent), only 20 percent of providers currently use CCOF today. Navicure's Jim Denny says, "A new generation of tools are available to improve patient satisfaction and allow healthcare organizations to collect more, faster and at less cost."

Health Policy and Reimbursement

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The U.S. Centers for Medicare and Medicaid Services (CMS) are awarding $100 million to organizations over the next five years to train clinicians in the quality payment program of the Medicare Access and CHIP Reauthorization Act (MACRA). The funds will provide training for clinicians in individual or small group practices in rural areas and medically underserved regions of the country. Eligible clinicians and their practices can accept customized technical assistance and support from selected organizations. For example, clinicians will receive guidance in choosing and reporting on quality measures, supporting change management and assessing health information technology. According to CMS, about $20 million will go to 11 organizations in the first year of the program, and another $80 million will be awarded over the remaining four years.


The U.S. Department of Health and Human Services Office for Civil Rights will issue proposed regulations on compensating people who are harmed by healthcare privacy breaches as defined by the Health Insurance Portability and Accountability Act (HIPAA). Deven McGraw, deputy director for health information privacy at the Office for Civil Rights, spoke at the Healthcare Information and Management Systems Society’s annual meeting about the proposed rules, which should be released for public review by the end of the year. HHS is also working on guidance for communicating protected health information via text messaging and social media. According to McGraw, the guidance will advise covered entities to pay attention to permitted uses, disclosures and the circumstances under which authorization is needed to disclose protected health information. An additional HHS project includes guidance that outlines the process of a HIPAA case and how penalties and settlement amounts are calculated.


Republican lawmakers and the U.S. Department of Justice (DOJ) have requested more time to decide whether they want to move forward in the House's lawsuit over Affordable Care Act (ACA) cost-sharing subsidies. The House and DOJ made the request in a joint motion on February 21. The House filed the lawsuit two years ago, arguing that the subsidies to insurers are illegal because Congress has not provided a specific appropriation for them. The payments go to insurance companies to reduce the out-of-pocket costs for certain enrollees. Republicans are now considering whether they will continue the payments to keep the ACA exchange markets from collapsing as they work toward repealing and replacing the healthcare law. Insurers have threatened to leave ACA market exchanges if the payments are not continued, which could potentially leaving millions without healthcare coverage options during the transition. Leading Republican lawmakers have pushed for a continuance of the payments, including Sen. Lamar Alexander (R-Tenn.), chair of the Senate's Health, Education, Labor and Pension Committee, and Rep. Mark Meadows, (R-N.C.), chair of the House Freedom Caucus. The newly filed motion grants the House and DOJ until May 22 to file a status report with the court and establishes 90-day deadlines after that.

Medicine, Drugs and Devices

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Researchers evaluated the translation of the talus before and after mobile-bearing total ankle replacement (TAR) to determine whether talus translation is associated with coronal plane alignment of the lower limb and hindfoot. The study included 153 patients who underwent mobile-bearing TAR. Talar center migration (TCM) on anteroposterior radiographs quantified the location of the talus in the coronal plane. Researchers also measured radiographic parameters in the coronal plane, including mechanical axis deviation (MAD), lateral distal tibial angle (LDTA), hindfoot alignment angle and hindfoot moment arm. During the 36-month follow-up period, there was a strong relationship between the postoperative TCM and preoperative TCM. MAD, LDTA and hindfoot alignment were significantly associated with talar translation. Complications included five cases of medial malleolar impingement, one case of insert dislocation and two edge-loading cases.


A study was performed to determine whether the occurrence of local infection is reduced in patients who are administered prophylactic antibiotics for lesser toe fusion surgery. One hundred adult patients undergoing toe fusion surgery that required K-wires to remain in situ for four to six weeks were randomly divided into those who received prophylactic antibiotics (Group 1) and those who did not (Group 2). The overall infection rate was four percent. Three patients in Group 1 and one patient in Group 2 showed signs of low-grade infection that required treatment by oral antibiotics. There were no observed cases of osteomyelitis.


A bill introduced in the U.S. Senate would direct U.S. Health and Human Services Secretary Dr. Tom Price to adopt a streamlined process for inspecting domestic and foreign medical device manufacturers. The process would require advance notice of the type and nature of routine inspections, excluding for-cause investigations, and daily communication from U.S. Food and Drug Administration (FDA) inspectors on the investigation’s status. For investigations resulting in a Form 483 list of violations, the new resolutions would give FDA 45 days to answer the company’s response. The bill was referred February 15 to the U.S. Senate Committee on Health, Education, Labor and Pensions. If approved, Price would have 18 months to solicit public comments on the draft for the new procedures and to issue final guidance.