News From ACFAS

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Reach out to your community and patients with foot and ankle health education through three new PowerPoints in the Marketing Toolbox:

• Exercise Injuries to the Foot & Ankle
• Foot & Ankle Injuries in the Workplace
• Not So Golden Years: Foot Care & Safety for Older Adults

Download these free presentations from the ACFAS Marketing Toolbox and use them when meeting with patients at your office or when speaking at community health events. Each PowerPoint includes a customizable slide for your practice’s contact information as well as a script that coincides with each slide.

Visit the Marketing Toolbox often for other ready-to-use resources to help you promote your practice, such as the newly redesigned FootNotes patient newsletter, vivid infographics, fill-in-the-blank press release templates and more. Watch This Week @ ACFAS for announcements on new Toolbox products as they’re released throughout the year. Improve your coding confidence in our new Coding & Practice Management Workshop, set for July 8–9 (Denver) and October 21–22 (Chicago).

This interactive workshop breaks down the surgical coding process from start to finish. Case-based scenarios will teach you the nuts and bolts of diagnostic coding, procedural coding and billing so that by the end of the course, you can confidently code a sample patient encounter.

Expert faculty will dispel common podiatry coding myths that can tank your productivity. Session topics include:

• What’s New in Reimbursement & Coding
• Modifiers
• Interactive Surgical Coding Scenarios
• Where Do Level 4 Visits Fit into Your Practice?
• Utilizing Technology in Your Practice: Make It Work for You
• Denials & Appeals
• Putting It All Together: Coding a Patient Interaction from Beginning to End
• And more!

No other coding and billing course devotes this much attention to surgical procedures—visit acfas.org/practicemanagement for details and to register. All ACFAS members are eligible to join HealthCare Associates Credit Union (HACU), an ACFAS Benefit Partner. HACU is a not-for-profit institution that can help you increase your practice’s income and savings with fewer or lower fees than traditional banks.

As a credit union member, you’ll have access to checking and savings accounts, CDs, loan products and credit cards. HACU also offers auto loans, personal loans, mortgages and home equity loans and lines.

Visit hacu.org for more information or contact Norma Cantrell at (630) 276-5730..

Foot and Ankle Surgery

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A recent study looked to evaluate how ankle fracture surgery affects glycemic control in patients with diabetes. Sixty patients participated in the study and were followed one month postoperatively, using medical records. Mean fasting blood glucose (FBG) levels and cholesterol levels increased significantly compared with preoperative levels but decreased by 2.2 mg/dL per month and returned to the preoperative levels after a period of 8.1 months. Sex, age and type of ankle fracture did not significantly affect the monthly changes. Physicians should be aware of the one-month increase and monitor patients with diabetes, even several months post surgery.


A recent study compared the results of scarf and chevron osteotomy, two of the most-used treatments for hallux valgus. Researchers used the American Orthopaedic Foot and Ankle Society rating system to gather data and used the Short Form 36 questionnaire, Manchester-Oxford Foot Questionnaire and visual analog pain score for subjective evaluation. Thirty-seven feet were studied in the chevron group, and 36 feet were studied in the scarf group. Recurrence of hallux valgus occurred in 28 of the chevron feet and 27 of the scarf feet, and all pain scores and rating results did not differ significantly between groups. Both the chevron technique and the scarf technique showed similar results after two years, and neither was superior in preventing recurrence after 14 years.


Chronic Achilles tendon ruptures can result in a defect at the rupture site. Ruptures with defects of six cm or larger have not been adequately studied. A team of researchers combined a turndown of the proximal, central Achilles with a flexor hallucis longus (FHL) tendon transfer to treat the condition in 32 patients. In these patients, the gap between the ruptured ends of the Achilles ranged from six to 12 cm and after five months, all 32 patients achieved full healing. Mean Foot and Ankle Ability Measures scores jumped from 36.3 percent to 90.2 percent, and the mean visual analog pain scales decreased from 6.6 to 1.8. Only five patients experienced postoperative complications. Researchers concluded that Achilles rupture defects can be corrected at a high rate with a turndown of the proximal, central tendon and FHL augmentation.

Practice Management

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A new report indicates that concierge medicine can benefit both patients and physicians. Concierge medicine is a relationship between a physician and patients that requires an annual fee, and using it can generate revenue up to twice the rate per hour of a traditional practice, the report notes. A typical concierge visit last about 30 to 90 minutes, far longer than a traditional consultation. But this also means fewer patients, so doctors are not rushed and are allowed to get to know their patients better. In fact, 98 percent of patients in a recent survey from Concierge Choice Physicians said they had better communication with their physician using concierge methods. The caveat with this format is that physicians must set the correct price. Too high and your practice will not attract enough patients; too low and you will not see any significant value. Concierge medicine can also reduce costs around the country. Since it is based on an investment in wellness and prevention, it can lead to a reduction in acute healthcare events.


The Affordable Care Act has put the patient at the center of all healthcare services, meaning that digital services figure more prominently into the healthcare equation than ever. Mobile health has seen a meteoric rise in the last few years: 83 percent of consumers use hospital websites, 77 percent used the Internet to search for appointments and most consumers use their mobile devices throughout the day. According to ABI Research, mobile health apps will be worth $400 million by the end of this year, and global sales of smartphones are expected to hit 1.5 billion units. If your website is not mobile-friendly, your practice will fall behind and tumble in the search engine rankings, causing you to lose potential patients. Prioritizing a mobile strategy is critical to keeping your practice competitive. A poor mobile strategy will affect your online reputation, reviews and ratings. Making use of the available tools and realizing the potential of mobile health will help you meet the needs of digitally savvy consumers.


Monitoring your online reputation is critical in the age of digital medicine. You will see good reviews and bad reviews, and how you react to these reviews could determine how patients view your practice. Here are some tips to improve your online reviews:

1. Monitor rating sites. Designate an employee to search through rating sites and determine the state of your online reputation. Healthgrades, Vitals and Yelp are some good places to start.
2. Do not forget payer directories. Payer directories are often out of date, and inaccurate ones can send many patients to out-of-network physicians. This will make them unhappy, so be sure to monitor the directories every few months.
3. Resolve to communicate well with patients. Keeping patients in the loop about their care is one of the most important parts of maintaining a good reputation. A patient who is aware of your schedule and knows how long he/she could potentially wait will always be happier than one who is unaware.
4. Help patients understand payment responsibility. Payments can be confusing. Make sure you walk patients through their payments so that they are not hit with unexpected costs.
5. Check-in at check-out. Staff who are sincere and friendly at check-out can go a long way toward making a patient feel satisfied. Asking how their visit went can make a huge difference.
6. Aim to delight. Your practice policy should focus on pleasing your customers, from your staff all the way up to practice leaders. This not only makes patients happier, it will make your practice a happier place as well.

Health Policy and Reimbursement

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Because consumers are taking a more active role in managing their health data through mobile apps, data collection puts more people at risk. This is what Jessica Rich, director of the Federal Trade Commission's (FTC) Bureau of Consumer Protection, told the House Oversight and Government Reform subcommittees March 22. FTC is taking a tougher regulatory stance on healthcare information in an effort to protect consumer data, and lawmakers should expect more of the same. Recent enforcement actions include settling a complaint that a medical billing company deceived thousands of consumers who signed up for an online portal by failing to adequately inform them that the vendor would seek highly detailed information about them from pharmacies and insurance companies. “FTC clearly perceives a gap in the privacy laws where health information is being held by organizations that don't fall under HIPAA requirements,” said Bradley Merrill Thompson, an attorney at Washington, DC-based law firm Epstein Becker Green who counsels medical device companies on regulatory issues. Rich said FTC will continue to leverage its authority and bring enforcement actions against companies that fail to maintain reasonable and appropriate data security practices regarding consumer health information.


The Obama administration is planning to expand Medicare to cover diabetes prevention programs, which could improve nationwide health and lower spending. “If we can invest in preventing diabetes before it develops, we can improve people’s health and quality of life and also save money,” said Health and Human Services Secretary Sylvia Mathews Burwell. The move would be an expansion of benefits under the Affordable Care Act, which has pushed preventive care as a long-term strategy to lower health costs. The decision is based on data from a diabetes prevention program led by the National Council of YMCAs, which found prevention could save Medicare about $2,650 per person.


The 31 states and District of Columbia that expanded Medicaid have saved millions of dollars compared to states that have not adopted the program, according to a new report from the Robert Wood Johnson Foundation. Hospital care costs are estimated to have been 21 percent lower in 2014 than they would have been in the absence of Medicare expansion. Non-expansion states are twice as likely to have rural hospitals at risk of closure. These 19 states are headed by governors who have said they do not want taxpayers to foot the 10 percent of the cost after federal funds are reduced to 90 percent. But reports indicate that expansion states generate savings and revenue that can be used to finance other priorities and offset the state costs of expansion. In fact, Medicaid spending in expansion states grew by half as much as spending in non-expansion states.

Medicine, Drugs and Devices

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New rules from the Obama administration propose banning powdered surgeon's gloves, which the U.S. Food and Drug Administration (FDA) cited as being an "unreasonable and substantial risk of illness and injury." The powder is aimed at making the gloves easier to slip on and off, but FDA said they are dangerous for several reasons. They can cause health problems such as post-surgical adhesions, wound inflammation and airway inflammation. The proposed legislation will protect both doctors and patients, according to FDA. The public has 90 days to comment on the proposal.


After two years of escalating cyberattacks on health information systems, the Department of Health and Human Services (HHS) has developed a cybersecurity task force. Task force members will study ways of protecting health data and connected medical devices. HHS said, after internal discussion, the task force will report its findings to Congress and the public and will develop resource materials "ensuring every organization that plays a part in our healthcare system can protect the data that is part of this system." The 21 members of the Health Care Industry Cybersecurity Task Force represent healthcare systems, pharmaceutical companies, health insurers, tech and other industries along with the government. "Connected medical devices with cybersecurity vulnerabilities left unaddressed could pose a risk to patient safety," HHS said in the announcement naming the task force members. "Security of healthcare data and medical devices is essential to protecting patients and providing them with the highest level of care."


A new survey shows that consumers still do not prefer telemedicine despite it reducing healthcare costs for 90 percent of users. This is partly because 39 percent of respondents indicated they were not even aware telemedicine existed. Fourteen percent said they do not trust virtual providers to make correct diagnoses, and 42 percent noted they simply prefer traditional providers. Twenty-eight percent said they do not know when it is appropriate to use telemedicine, and 14 percent were not sure whether their health plan offered services. In addition, only one-third said their health plans offer services, although that low number appears to be changing as more plans and commercial payers use virtual platforms. Independence Blue Cross in Philadelphia, Blue Cross Blue Shield of Alabama and Blue Cross Blue Shield of South Carolina have all started offering telemedicine, and more than half of the states now mandate that private insurers treat telemedicine equally to in-person care.