News From ACFAS

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Visit acfas.org/austin to log in and access exclusive handouts from those speakers who provided them for their ACFAS 2016 sessions. Use the handouts to review your favorite discussions, debates, demonstrations and case presentations. Handouts are only available until June 30, 2016.
Expose yourself to different insights when treating forefoot injuries and deformities at ACFAS on the Road: Complex Forefoot Surgery with Advanced Solutions in Houston April 15–16, 2016.

This two-day program kicks off on Friday night with a forefoot surgical complications presentation and case studies, where participants are invited to present cases for panel discussion. Saturday includes hands-on instruction in four sawbones labs as well as insightful lectures on topics ranging from First Ray revisional procedures to complex forefoot pathology. Earn 12 continuing education contact hours upon course completion.

Space is limited, so visit acfas.org/ontheroad to reserve your spot today.
If you ever need an answer on a denial claim or a tough coding and billing question, ACFAS coding consultant Jacqueline Reiss-Kravitz, CPC, is here to help. Jacqueline is available to answer those challenging questions by contacting her through coding@acfas.org.

A surgical podiatric practice administrator for more than 18 years, Jacqueline has worked with solo physicians, group practices and large groups. She also lectures for ACFAS’ practice management and coding seminars and consults with practices regularly.

For additional help with surgical coding or practice management, make plans to attend the Coding and Practice Management Workshop in Denver, July 8–9 or in Chicago, Oct. 21–22.

Foot and Ankle Surgery

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A recent study looked to add to the literature on concomitant peroneal tendon tears and assess clinical outcomes, patient satisfaction and objective power and balance data following single-state flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon transfers. Researchers observed nine patients who underwent lateral transfer of the FHL or FDL tendon. Results were expressed in SF-12 and Foot Function Index (FFI) scores, as well as range of motion (ROM) and manual strength testing. Following the procedure, all FHL and FDL patients reported satisfaction. Mean physical and mental SF-12 scores were 32 and 55, respectively, and the mean FFI total score was 56.7. No infections occurred. Losses of inversion and eversion ROM were 24.7 percent and 27.2 percent, respectively. Clinical examination and power and balance tests showed no significant differences between the FDL and the FHL group. The researchers concluded that the FHL and FDL tendons were successful options for lateral transfer despite the significant extremity deficits that could show up even years after the procedure. More studies are necessary to further clarify data differences.


The University of Iowa Hospitals and Clinics are using a predictive modeling program that has lowered surgical site infections (SSIs) by 74 percent. John Cromwell, clinical associate professor of surgery at Iowa, will present the results at HIMSS16. The process involves leveraging live surgical data to inform decisions. The project started in 2012 and within the first two years alone, SSIs tumbled 58 percent. Since SSIs are one of the most common complications resulting from surgery, the advance could significantly increase patient safety as it develops more over the coming years.

Practice Management

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Keeping your revenue cycle running smoothly is no easy task, and paying closer attention to certain metrics can yield more profitable results. Here are four key measures physicians should monitor to stay on top of their revenue cycle.

1. Point-of-service collections. This will show whether your employees are talking with patients about their responsibility and are asking for payments. Over time, these conversations should become more comfortable for all parties.
2. Patient receivables. This might be the most valuable metric to monitor, comparing what is available to collect against what you actually collect. A realistic goal is an 85 to 95 percent rate.
3. Registration accuracy. Be sure to collect the correct demographic and insurance information for all patients. This can help with better communication down the line.
4. Time to collect. This measures the efficiency of your collections effort and when patients are deciding to pay. Ideally, this metric should decrease over time because of an increase in communication.

Good customer service comes in many shapes and forms. The main goal is to satisfy customers while keeping costs manageable. Here are five methods for excellent, efficient customer service at your medical practice:

1. Provide an online pay portal for patients to pay their bill. A portal allows patients to pay their bills at their own convenience, which makes mail unnecessary and speeds up the process.
2. Call people back within a specific time. If a call comes in before 2pm, it should be returned within the same day. Any calls after that should be returned by 9am the following day.
3. Provide extended hours for people who work all day. Some people wake up earlier for work than others. If you have patients with particularly busy work schedules, consider having some staff members start their days two hours earlier to accommodate those patients.
4. Call patients back the next day after their appointment to check in on them. This can be done by any staff member and if the patient has questions, a message can be taken. These callbacks show that you care about the patient.
5. Keep your waiting room and bathrooms clean. If the bathroom is dirty, clean it. If the magazines in the waiting room are out of date, get some new material. These little things can color a patient's idea of your practice's professionalism and functionality.

Patients are becoming more comfortable with electronic health records (EHRs), according to a new study from the Office of the National Coordinator for Health IT (ONC). The data found that three-quarters of patients support their provider's use of EHRs even though a little more than half had persistent concerns about the privacy and security of their medical records. While that figure may seem large, it represents a significant decrease from 2013, when around 75 percent of patients had such concerns. In addition, individuals are less concerned about the unauthorized viewing of medical records when sent by fax or electronic means. In 2013, 61 percent felt wary, but in 2014, that number fell to 50 percent. The numbers are promising, but the brief mentioned that the results should be taken with a grain of salt. According to the numbers, it is "unclear" whether the decreases are a result of a trend or merely an anomaly.

Health Policy and Reimbursement

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The U.S. Supreme Court ruled that the Employee Retirement Income Security Act of 1974 precludes states from requiring that every healthcare claim involving their residents be submitted to a massive database. The ruling is a blow to those who have been working on developing efforts to track the quality and cost of healthcare, and it means that the industry will continue to rely heavily on data released by Medicare. The decision stems from a case in Vermont where Liberty Mutual Insurance objected all-payer claims databases. Liberty Mutual's stance was that there should be one set of rules from the U.S. Department of Labor and not a potential set of rules for all 50 states. For those hoping to have a more comprehensive view of healthcare spending data, the ruling is negative. But options are still available: self-insured plans could voluntarily provide their data to state-run databases, or the federal government could require self-insured plans to disclose their data. It is unclear whether either option will come to fruition in the near future.


The Obama administration has announced a "major overhaul" of Affordable Care Act (ACA) deadlines. ACA customers will now be required to prove they are eligible for the law's special enrollment periods, which allow people who missed the deadlines to buy coverage mid-year. The change comes as insurance companies cry foul, claiming that the current format is too easy to abuse and that people were waiting until they became sick to sign up for insurance. “Without verification, special enrollment periods are more easily subject to abuse and misuse that compromises affordability and stability for all enrollees,” wrote America's Health Insurance Plans, the nation's top insurer group.


States that reject Medicaid expansion are losing billions of dollars, according to figures. After states were granted the choice to expand or deny the changes, 17 of them decided to forgo expansion. While expansion states have seen a significant increase in the Medicaid population, states that denied expansion could potentially lose more than $400 billion in Medicaid funds. Uninsured beneficiaries are costing hospitals $44 billion alone. In Kansas, expansion rejection is costing the state more than a billion dollars, and hospitals throughout the state are feeling the hit in their revenue cycles. While Medicaid expansion can be tough for providers and hospitals, it allows them more choice when it comes to care delivery and payments. Yet those 17 states refuse to budge despite the costs. On the other hand, Alaska denied expansion until governor Bill Walker decided to accept it in the face of "healthcare or bankruptcy." It is still unknown how many other states will make the switch.


The Merit-based Incentive Payment System (MIPS), scheduled to be phased in by 2019, could spell doom for small physician practices across the country. MIPS, which is part of the Medicare Access and CHIP Reauthorization Act of 2015, will replace the current Physician Quality Reporting System (PQRS). Physicians who choose to participate in MIPS could be undone by the administrative burden and high costs of gathering data. Those who do not participate stand to lose up to nine percent of Medicare revenue automatically. According to health policy expert Robert A. Berenson, this could be a "death knell" for small practices. Only about 50 percent of physicians currently report under PQRS because the administrative burden is often too great to properly handle. Failing to adhere to PQRS only nets a two percent loss in revenue. MIPS also focuses on quality, resource use, clinical practice improvement activities and meaningful use of electronic health records systems, but many small practices do not have the resources or means to adequately report the data.


The U.S. Senate has confirmed Dr. Robert Califf as head of the U.S. Food and Drug Administration (FDA). Califf is a cardiologist and researcher and will step in immediately to address problems related to drug approvals and more. The rate of approvals is higher than it has been since 1996 and lawmakers and patient groups want FDA to move even faster. Califf's confirmation was expected and the vote in favor of his appointment was overwhelming. A group of senators, as well as Democratic presidential candidate Bernie Sanders, opposed Califf's appointment, citing his ties to the pharmaceutical industry.

Medicine, Drugs and Devices

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Pfizer has announced a new extended-release version of tofacitinib that treats moderate-to-severe rheumatoid arthritis. The U.S. Food and Drug Administration approved the once-daily drug, which can be taken with or without concomitant methotrexate or other disease-modifying antirheumatic drugs. The treatment, called Xeljianz XR, is a new treatment for patients who prefer oral drugs.


Only about 43 percent of iOS apps and 27 percent of Android apps are useful in fulfilling their express purpose of assisting individuals with chronic illness. A study from the Commonwealth Fund looked at 376 apps on the Apple iTunes store and 569 apps in the Android Google Play store and assessed usefulness based on engagement, relevance, ratings and most recent update. Study leader Karandeep Singh said that while these apps have the "tremendous potential" to help patients of all types, very few of them actually do that job adequately. This is particularly concerning because a similar study found that app stores will become the main distribution channel for mHealth apps for the rest of the decade. This is in stark contrast to previous surveys that claimed hospitals and physicians would be the top distributors. But currently, 35 percent of Android mHealth apps and 17 percent of iTunes mHealth apps were last updated prior to 2014. The research firm research2guidance concluded that the majority of mHealth apps "do not even come close to living up to their promise."


A new study from the Independent Security Evaluators has found that many hospital cybersecurity systems have flaws that leave them vulnerable. The report said the industry focuses too much energy on protecting patient health records and does not adequately address cyber threats in devices. Patient records are at risk of being stolen primarily by hacktivists or individuals looking for money; devices face the same threats but come with more risk because a hacked device can become a life or death situation. The biggest problem, according to the report, is that hospitals tend to have a lack of defined, implemented and auditable policy to deal with cybersecurity. The rise of ehealth has made a concrete cybersecurity policy a necessity. Companies are now creating advanced devices that use sonar and nanotechnology, making those devices more enticing for hackers.


Researchers at Wake Forest School of Medicine have created a way to 3D print human-scale bone, muscle and cartilage that survives in animals, opening new doors to the possibility of 3D printing revolutionizing surgery. The new process is called the integrated tissue and organ printing system. It could eventually allow surgeons to bioengineer body parts from the patient's own tissues, which has been difficult in the past because of the nutrition needs of large tissues. To fix the problem, the researchers created microchannels in the tissue models so that nutrients diffused to the printed cells. The ultimate goal is to print more complex tissues and solid organs to help surgeons.