News From ACFAS

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ACFAS’ Regional Divisions support the profession at the grassroots level by connecting their members through local seminars, meetings and labs. They also provide support to residents and students in their geography. Three of ACFAS’ 14 Regional Divisions welcomed new Presidents into office at the recent Annual Scientific Conference in Orlando.

Division 5: Florida's new President is Joanne Balkaran, DPM, FACFAS, of Mount Dora, Florida. View recent Division 5 activities and plans for the year on their webpage at acfas.org/division5.

Division 12: Tri-State covers the states of Delaware, New Jersey and Pennsylvania and their new President, L. Jolene Moyer, DPM, FACFAS, resides in Altoona, PA. A listing of Division 12 activities and goals for 2014 can be found on their webpage at acfas.org/division12.

Division 13: Ohio Valley covers the states of Indiana, Kentucky, Ohio and West Virginia. Julie Wieger, DPM, FACFAS, from South Bend, Indiana, is their new President. You can visit the Division 13 webpage at acfas.org/division13 to learn more about their activities and plans for the year.

Congratulations to the new Division Presidents! To learn more about your local ACFAS Division, visit acfas.org or watch your email for announcements of activities in your area of the country.
Register today to attend the ACFAS summer 2014 Coding/Practice Management Workshop set for July 18-19, 2014 at the Marriott San Diego Gaslamp Quarter in beautiful San Diego, California. Don’t miss the opportunity to learn the essentials to help you with the business side of your practice! During the two-day program, Jackie Reiss-Kravitz, CPC, will address the essentials of understanding coding for Evaluation and Management services, coding for surgical procedures and use of modifiers, how to attest for Meaningful Use, and how to provide and get reimbursed for durable medical equipment. The seminar will also include sessions on transitioning to ICD-10 and protecting yourself from malpractice claims

To register to attend visit, acfas.org. If you have questions regarding the seminar contact R. Dawn Brennaman, MPA, Director of Health Policy, Practice Advocacy and Research.
Short on time, but hungry for more knowledge? Take advantage of the latest research in a minimum amount of time through ACFAS' Scientific Literature Reviews (SLRs). The April 2014 edition is complete with reviews prepared by residents from Massachusetts General Hospital, Temple University Hospital, and Mercy Hospital and features articles from podiatry-relevant journals you may not regularly read, including:

• Cognitive Status and Self Foot Care Practice in Overweight Diabetics, Engaged in Different Levels of Physical Activity
• Comparison of Distal Soft-Tissue Procedures Combined with a Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: First Web-Space Versus Transarticular Approach
• Stable Surgical Repair with Accelerated Rehabilitation Versus Nonsurgical Treatment for Acute Achilles Tendon Ruptures: A Randomized Controlled Study.

Foot and Ankle Surgery

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A new study has concluded that tibialis posterior tendon transfer is an effective technique for treating the foot drop component of cavovarus foot deformity in Charcot-Marie-Tooth patients. The study involved 14 patients with Charcot-Marie-Tooth disease and cavovarus deformity. Twenty-three feet that displayed the foot drop component were treated with tibialis posterior tendon transfer. Surgeons performed a three-dimensional gait analysis on patients who underwent tibialis posterior tendon transfer, and found that there were significant increases in tibiotalar and foot-tibia dorsiflexion during the post-surgery swing phase. Meanwhile, a significant reduction in maximum plantar flexion at the stance-swing transition was seen, though there was no accompanying decline in active range of motion. Finally, significant improvements were seen in American Orthopaedic Foot & Ankle Society (AOFAS) scores. These and other findings indicate that tibialis posterior tendon transfer works as an active substitute foot dorsiflexion to prevent the treated foot from dropping.


Performing lateral ankle stabilization and retrograde drilling under arthroscopic and fluoroscopic guidance at the same time is an effective technique for patients with both osteochondral lesion of the talus and chronic lateral ankle instability (CLAI), a new study has found. The study involved 16 patients with CLAI that was accompanied by only subchondral bone lesion of the talus, all of whom underwent surgical repair or reconstruction of the anterior talofibular ligament and retrograde drilling on one foot. Surgeons examined the clinical outcomes in these patients, and found that average American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale scores rose from 73.4 to 91.2 after surgery, while mean visual analog scale (VAS) scores improved from 55 to 6.5. Mean lesion area improved as well, dropping from 33.9 mm2 before surgery to 11.8 mm2 afterward.

Practice Management

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Small- and medium-sized physicians' practices can download a new tool being offered by the Department of Health and Human Services (HHS) that will help them assess the adequacy of the security measures they are using to protect patient data. The tool is designed to take providers through the process of performing an information security risk assessment step-by-step, and will also help them quickly document a risk assessment and produce a report that can be submitted to auditors. HHS said in a statement that it is important for doctors' practices to perform information security risk assessments, since doing so can address security vulnerabilities and help prevent data breaches or other types of security failures. Such risk assessments are also required under the Health Insurance Portability and Accountability Act (HIPAA) and the terms of the meaningful use program.


Physicians need to be aware of the tax implications associated with electronic health record (EHR) incentive payments, experts say. A memo issued by the Internal Revenue Service's Office of the Chief Counsel in February 2013 stated that doctors must report such payments as gross income. The memo noted that this is because EHR incentive payments are not reimbursements for the expenses associated with implementing EHRs. In addition, EHR incentive payments are not subject to any exclusion provided by the Internal Revenue Code, the memo said. The document further noted that EHR incentive payments must be returned if doctors receive these payments as a conduit or agent of their practice groups. Experts say that doctors should be sure to discuss these and other tax issues with an accountant who is familiar with healthcare issues in order to avoid incurring IRS penalties and audits.

Health Policy and Reimbursement

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President Obama is touting what he says is the success of the Affordable Care Act (ACA), saying that 7.1 million people have signed up for insurance coverage through the federal and state exchanges. The president did not mention how many of those individuals were previously without insurance. President Obama also said the 3 million young adults who are now covered under their parents' insurance and the 100 million Americans who are receiving preventive care are also signs of ACA's success. Left unsaid, however, was how many younger consumers have obtained insurance through the exchanges or how many individuals who have enrolled in exchange plans have paid their premiums. Nevertheless, President Obama said that the statistics he cited are evidence that the debate over the repeal of ACA should be brought to an end. However, the budget plan introduced by House Budget Committee Chairman Paul Ryan (R-Wis.) on the same day the president made his remarks calls for the repeal of ACA.


Healthcare industry experts say that the upcoming release of information about payments made by drug companies and medical devicemakers to doctors is unlikely to put an end to efforts to address the potential conflicts of interest caused by such payments. Beginning Sept. 30, the public will be able to access a searchable database run by the Centers for Medicare and Medicaid Services (CMS) that contains information about payments or transfers of value of $10 or more a year made by drug companies and devicemakers to doctors. Companies have already begun submitting information about such payments, beginning with data from 2013, as called for by the Physician Payments Sunshine Act. But experts say that further steps could be taken to address the issue of payments made by the pharmaceutical industry and devicemakers to doctors even after the information is released. Those steps could include legislation aimed at addressing the potential conflicts of interest that are hinted at in the released information as well as new rules for how information about these payments is reported. The Pharmaceutical Research and Manufacturers of America says payments made by drug companies do not affect which drugs doctors prescribe, though some disagree.


The Senate on March 31 passed a bill already approved by the House that would prevent a 24 percent cut to Medicare physician payment rates from taking place as scheduled on April 1, after failing to find a way to pay for a permanent repeal of the sustainable growth rate (SGR) formula. As a result, Medicare physician payment rates will be the same until March 2015. Healthcare industry representatives and lawmakers alike expressed disappointment that a permanent repeal of SGR was not passed, with American Medical Association President Ardis Dee Hoven saying that the temporary patch does not eliminate the uncertainty physicians face with regard to their reimbursement rates and thus makes it more difficult for them to implement systems aimed at improving the coordination and quality of healthcare. Despite the failure of the SGR repeal effort, Sen. Orrin Hatch (R-Utah) said Congress needs to get back to work as soon as the temporary patch is signed into law to find a way to end the problematic payment formula. In addition to temporarily holding physician payment rates steady, the measure passed by the Senate will delay the implementation of ICD-10 for at least a year and partially delays the enforcement of the two-midnight rule for six months. The bill will now go to President Obama for his signature.


The Centers for Medicare and Medicaid Services (CMS) has issued a document containing a number of proposed rules that it believes will help improve the operations of the health insurance exchanges established by the Affordable Care Act. For instance, the document calls for overturning state laws that restrict the ability of federal consumer advisers--also known as navigators--to help consumers enroll in health insurance plans offered through the exchanges. In addition, CMS says that state laws that make it impossible for a health insurance exchange to adopt programs aimed at helping consumers enroll in plans also need to be overturned. Such laws have been passed in states where lawmakers are generally opposed to the health reform law. The document also calls for the exchanges to begin using surveys in 2015 and 2016 to assess consumers' opinions about the insurance plans being offered and to determine how well they are being served by the exchanges. Other issues addressed by the proposed rules include how health insurance plans should bill beneficiaries for time periods of less than a month, as well as the differences between the "cancellation" and the "termination" of a health insurance plan. All of the proposed rules would be implemented in 2015 and 2016 if they are approved.


The Agency for Healthcare Research and Quality (AHRQ) will provide funding for 12 research projects focused on Stage 3 meaningful use. The projects being funded by AHRQ will propose strategies that can be implemented to improve Stage 3 meaningful use at the policy level and will also examine how new features in electronic health records systems can help meet proposed meaningful use objectives. Among the projects that are being funded is one by a Northwestern University researcher that will examine best practices for integrating clinical decisions into clinical workflow. These best practices will be based on the CDS "Five Rights" framework, which states that EHRs should be able to send the right information to the appropriate person in the correct format through the right channel at the right time. Another project will focus on the feasibility, measurability, and clinical acceptance of six proposed Stage 3 care coordination objectives, including the reconciliation and tracking of referrals, care transition records, and the use of information to facilitate engagement with patients and clinical decision making. The projects will be evaluated by AHRQ, the Office of the National Coordinator for Health IT, and the Centers for Medicare and Medicaid Services after they are wrapped up in June. The findings will be used to develop the final set of meaningful use objectives.

Medicine, Drugs and Devices

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A study published in the Annals of the Rheumatic Diseases has found that dual-energy computed tomography (CT) scans may be better able to detect some cases of gout than needle aspiration tests, which are the current standard for testing for the disease. The study, which was performed by researchers at the Mayo Clinic, found that gout was diagnosed in a third of patients whose needle aspiration tests came back negative. Researchers found that CT scans were particularly useful in diagnosing gout in patients who had several negative needle aspiration tests but who nonetheless had experienced a number of flares similar to those seen in gout patients. This in turn allowed rheumatologists to provide these patients with the medication they needed to treat their gout. However, the study found that CT scans did not identify the presence of uric acid crystals in some patients with acute gout who were having their first flare-ups, though needle aspiration tests did. As a result, the researchers who performed the study are not recommending that patients who may have gout undergo CT scans before submitting to needle aspiration tests.


A new study examined how well white blood cell single photon emission computed tomography/computed tomography (SPECT/CT) imaging evaluated the remission of diabetic foot osteomyelitis. During the study, 29 cases of diabetic foot osteomyelitis were evaluated using radiographs, a three-phase bone scintigraphy, and a white blood cell SPECT/CT following the conclusion of antibiotic therapy. All of the patients were considered to be in clinical remission. Researchers observed a negative white blood cell SPECT/CT in 22 episodes of osteomyelitis, all of which were in remission. In addition, white blood cell SPECT/CT generally had higher sensitivity, specificity, positive predictive value, and predictive negative value in predicting osteomyelitis relapse following the end of antibiotic treatment than did radiographs and three-phase bone scintigraphy. The study concluded that negative uptake on white blood cell SPECT/CT is a good marker for diagnosing osteomyelitis remission and could be useful in determining how long patients with the condition should take antibiotics. Without a marker to diagnose osteomyelitis remission at the end of treatment, it can be difficult to determine how long patients should remain on antibiotics.


A recent study examined the risks associated with taking opioid painkillers one to two months following surgery for musculoskeletal trauma. The study involved 145 patients who underwent such surgery, all of whom were asked one to two months after their operation whether or not they were taking opioids. Patients were asked to complete a number of psychological questionnaires so that their levels of psychological distress, the effectiveness of their coping strategies, and their perceptions of their symptoms and disabilities could be evaluated. The study found that patients who continue to take opioids one to two months after undergoing surgery for musculoskeletal trauma are more likely to experience various forms of psychological distress, including catastrophic thinking, anxiety, post-traumatic stress disorder, and depression than patients not taking the drugs. This increased rate of psychological distress was seen regardless of the severity of patients' injuries, the location of fractures, or the surgeon who performed their operations. The study also found that patients who continued to take opioids for as long as two months after surgery also had less effective coping strategies and greater symptoms and disability than patients not taking opioids, regardless of their injury, surgical procedure, or surgeon.