News From ACFAS

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If you are a fellowship program director and would like to seek status with ACFAS, submit your application by May 1, 2016.

The ACFAS Fellowship Committee will meet in mid-August in Chicago to review any new applications and will communicate their decisions later that month.

Contact Michelle Kennedy, ACFAS membership director, to request an application or to learn more about the College's Recognized Fellowship Initiative.
Five of ACFAS’ Regional Divisions welcomed new Presidents into office at ACFAS 2016 in Austin.

Division 3: Javier LaFontaine, DPM, FACFAS (TX)
Division 4: Frederick Mechanik, DPM, FACFAS (CO)
Division 9: Robert Fridman, DPM, FACFAS (NY)
Division 10: Sean Keating, DPM, FACFAS (NY)
Division 12: Keith Cook, DPM, FACFAS (NJ)

Congratulations to these new Division Presidents! Visit acfas.org to learn more about your local ACFAS Division or watch your email for updates on activities in your area.
Congratulations to the 2016 ACFAS Division Scholars! Each Student Scholar received a scholarship from their respective ACFAS Regional Division to attend this year's Annual Scientific Conference in Austin.














Division 1: Pacific
CSPM: Brennan Menninger, Class of 2018
WesternU: Kale Meeks, Class of 2019

Division 5: Florida
Barry: Dylan Grau, Class of 2018

Division 6: Midwest
DMU: Joshua Wolfe, Class of 2018
Scholl: Tyler Mulkey, Class of 2018

Division 9: Greater New York
NYCPM: Calvin Davis, Class of 2018

Division 12: Tri-State
Temple: Brian Derner, Class of 2018

Division 13: Ohio Valley
Kent State: Emily Zulauf, Class of 2018

Foot and Ankle Surgery

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More than 50 percent of pediatric patients with clubfoot deformity suffer from amniotic band syndrome (ABS). The Ponseti technique could be a viable treatment for patients with ABS. To test this, researchers analyzed 12 patients with a total of 21 feet. They collected data including age, sex, amniotic band location and response to treatment. The average age was three weeks, and the average number of casts was six. The Ponseti technique corrected 20 of 21 feet, and recurrence was identified in just seven of 21 feet. The average follow-up was 3.9 years. Researchers concluded the Ponseti technique was viable for treatment in patients with clubfeet associated with ABS.


The current standard for treatment of severe hallux rigidus is arthrodesis of the first metatarsophalangeal (MTP-I) joint. A recent study assessed the results of a new three-component MTP-I prosthesis. Researchers included 29 MTP-I prostheses in 25 patients. Seven underwent one or more secondary surgeries, and four eventually had a conversion to MTP-I arthrodesis. Two patients died for causes not related to the procedure, which left 22 feet in 19 patients for the final follow-up. Researchers looked for the intraoperative and perioperative complications, surivorship of prosthesis components and rate of secondary surgery, prosthetic component stability and radiographic alignment, degree of pain relief and midterm functional outcomes. All but three of the prostheses showed stable osteointegration and no migration. The average American Orthopaedic Foot and Ankle Society forefoot score increased from 55 to 83.5, and the average pain score decreased from 5.9 to 1.2. Range of motion initially increased from 37.8 degrees to 88.6 degrees but decreased to 29 degrees at the latest follow-up. MTP-I leads to a high rate of revision surgeries but can lead to significant pain relief.

Practice Management

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The shift to value-based payments has caused many physicians to wonder about the best way to measure quality. Here are three important strategies to ensuring the best quality data reporting:

1. Choose the right system. Weigh the pros and cons of being placed in the Merit-Based Incentive Payment System or joining an alternative payment model. The merit-based system brings less risk with lower reward, while an alternative model can bring the highest possible reward with a greater risk.
2. Establish a baseline. The only way to track improvements across quality metrics is to have initial numbers with which to compare. Use your Quality and Resource Use Report to establish baselines and make it easier to track improvements.
3. Be patient-centric. Understanding patient behavior and making yourself more accessible can contribute to improved value. Anticipate trends and boost compliance using behavior management.

The Centers for Medicare and Medicaid Services (CMS) have released updated guidelines on how to address issues and questions about ICD-10. The latest update encourages providers to create a feedback system to review clinical documentation and code selection processes, system problems and issues with payers. A feedback system is helpful because it allows providers to target problem areas and resolve issues, especially those pertaining to clinical documentation and code selection. In addition, comparing pre- and postdocumentation will help providers understand how staff choose diagnosis codes and apply guidelines. CMS also suggested selecting a physician, or group of physicians, to be a resource in the organization for ICD-10 implementation and best practices. The feedback system also helps resolve issues with payers. Many providers suffered from a surplus of denials following implementation, and a feedback system could help get them back on track.


How can you properly manage budget season with an electronic health record (EHR)? Here are some tips to stay ahead of the curve:

1. Hardware and new computers. Invest in new hardware. This is also a good way to keep your software up to date, as many software updates require similarly updated hardware. Consult your EHR vendor or IT support person before making a decision.
2. Additional licenses for new providers. Include the cost of additional EHR licenses for new providers in your budget.
3. Training costs. Proper training is the only way to make EHRs work efficiently. Even if you have invested in training before, doing it again will help new clinicians and staff members who have since joined your team.
4. Tech support. Budget time, according to experts, is the best time to hire a full-time IT support person or outsource the job to a healthcare IT support company.
5. Population health software. Evaluate your current population health software. Assess whether your practice needs a new system. If you do not have a population health software system, consider investing in one.

Some providers work with app developers to create tools and trackers for patients who want to accomplish goals such as losing weight or adhering to medication. These apps must be HIPAA compliant and can often become difficult to manage in certain situations. Physicians should always evaluate the apps they recommend to patients to determine whether they are HIPAA compliant. If a doctor is recommending an off-the-shelf app, the evaluation process is fairly simple. But if a physician works directly with a developer, the necessity for compliance is greater. Recent guidance from the U.S. Department of Health and Human Services (HHS) could be a good place to start. The guidelines cover areas such as personal health information, which HHS defines as “individually identifiable health information that is transmitted or maintained in any form or medium (electronic, oral or paper) by a covered entity or its business associates, excluding certain educational and employment records.” Physicians should constantly be asking questions to ensure that all of their methods and all of the details involving an app are compliant. In addition, questions about encryption are critical. All apps should be encrypted, which gives patients an extra layer of protection in the event of a complaint.

Health Policy and Reimbursement

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Multiple healthcare organizations are calling for the Centers for Medicare and Medicaid Services (CMS) to set a 90-day reporting period for providers who want to qualify for meaningful use. Current regulations require that providers show data from a 365-day period in order to attest to achieving objectives in the program. Shorter reporting periods are generally easier because they ease data collection requirements. CMS changed the period to 90 days last year, and the latest letter from health organizations wants the agency to "continue this positive momentum." Some of the advocates include the Association of Medical Directors of Information Systems, the College of Healthcare Information Management Executives, the Federation of American Hospitals, the Medical Group Management Association and the Premier healthcare alliance. The letter states that allowing a 90-day reporting period will permit significant progress for providers who want to use technology to succeed in payment and care delivery models. A 365-day reporting period, they say, will make the process "significantly more challenging."


The Centers for Medicare and Medicaid Services (CMS) announced it will add an additional 5,500 new codes to ICD-10 beginning October 1, 2016. The new codes come exactly one year after ICD-10 implementation. The new codes for 2016 will update areas such as cardiovascular and lower joint body systems, as well as face transplant, hand transplant and donor organ perfusion. The large number of new codes is due in part to a freeze on updates prior to the original 2015 launch. The update will include that backlog of proposals for changes. CMS also said an additional 1,900 codes will be added by 2017. Written comments will be accepted until April 8.


Senator Orrin Hatch has asked 20 hospital systems to provide detailed records concerning the practice of concurrent surgeries, where a surgeon operates on more than one patient at a time. Hatch has requested data from 2011 to 2015, citing concerns that patients could be misinformed about the fact that they are sharing their surgeon with another patient. According to David Hoyt, MD, executive director of the American College of Surgeons, a panel is writing new guidelines for simultaneous surgeries and will issue the update in about a month. While Hoyt did not confirm what the guidelines would say, one panel member indicated that the rules will not support surgeons conducting concurrent surgeries that overlap for significant periods of time. The hope is that the new guidelines will improve transparency with patients who are too often unaware that their surgeon is overseeing a second procedure.

Medicine, Drugs and Devices

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The Centers for Disease Control and Prevention (CDC) have unveiled long-awaited guidelines to limit prescriptions of opioid painkillers in order to prevent overuse. The guidelines recommend limiting opioid prescriptions for patients suffering short-term, acute pain to three days or less in most conditions and say that more than seven days' worth of opioid drugs "will rarely be needed." CDC Director Tom Frieden said, "What we're trying to do with this guideline is chart a safer course that allows patients with severe pain to be treated but recognizes that for most patients with chronic pain, the risks of prescription opiates will far outweigh the uncertain benefits." Some states, insurers and doctor's offices have adopted their own prescription limits in recent years, but as the rate of drug overdose deaths from opioids tripled between 2000 and 2014, CDC was under more pressure to issue guidelines. Deaths from opioid painkillers rose 9 percent in 2014, and that same year, opioids were involved in 28,647 deaths, or 61 percent of all drug overdose deaths.


A Senate committee has unanimously voted for the Preventing Superbugs and Protecting Patients Act, which will require medical device manufacturers to submit clear instructions on how to clean and disinfect devices. The bill was proposed by Sen. Patty Murray, who led a long investigation into the poor cleaning practices of duodenoscopes by a device-making company. Tenets of the bill include requiring manufacturers to submit additional data on efficacy, labeling and disinfection. Murray noted that when hospital staff at the UCLA Ronald Reagan Medical Center were told to clean devices under the current protocol, some of the staff were unable to clean the devices properly even when following the manufacturer's instructions. It is unclear when a full Senate vote will be conducted.


Serotonin plays a critical role in the pathology of rheumatoid arthritis (RA), according to new research. In a paper published in The American Journal of Pathology, researchers found for the first time that serotonin is possibly associated with the onset of autoimmune reactions that cause RA. By analyzing two groups of animals, one with normal serotonin and another with lower levels, researchers were able to determine that animals with lower levels showed a marked increase in clinical pathologic arthritis scores. The animals with normal levels had a high serotonin content in their paws. The results suggested that serotonin has a "direct immunoregulatory role in arthritis." Developing treatments that target serotonin could present a new way to regulate immune response in RA.


Medicare's independent auditor suggested in a report that faulty medical implants are harming seniors and costing taxpayers billions of dollars. The inspector general wrote a letter to Sens. Chuck Grassley and Elizabeth Warren claiming that the best solution would be to collect unique device identification (UDI) data on claims forms. It would improve care while also strengthening Medicare's program integrity. Many have called for these changes, but the Centers for Medicare and Medicaid Services (CMS) have not developed any plans to support the ideas. To implement the UDI plans, the senators called on the U.S. Department of Health and Human Services to take action and ensure that CMS works with other agencies.