News From ACFAS

---

The Sunshine Act requires drug manufacturers and medical device companies to disclose their financial relationship with doctors and teaching hospitals. This data is online for the public to view through the Centers for Medicare & Medicaid Services' Open Payments system.

From now until May 15, you can review and dispute the data shown in your Open Payments report.

To do this:

1. First, register in the Enterprise Identity Management System.
2. Then register in the Open Payments system.

If you've previously registered but have not logged in for 60 days, your account will need to be unlocked. If you've previously registered but have not logged in for 180 days, your account must be reactivated. Contact the Open Payments Help Desk at (855) 326-8366 for assistance.

Visit CMS.gov for more information or refer to the registration guides for Step 1 and Step 2.
See all that ACFAS 2016 and Austin had to offer—read the latest issue of ACFAS Update, which features a recap of the record-breaking Annual Scientific Conference as well as:

• interviews with this year's Manuscript and Poster Chairs and Distinguished Service Award Winner
• tips for incorporating ancillary services into your practice
• member recognition and appreciation
• news from the College
• and more!

Visit acfas.org/update to read the issue and watch your mailbox for the print edition. If you couldn’t make it to the Third Annual ACFAS Job Fair in Austin, you can still take advantage of the Job Fair virtually. Visit PodiatryCareers.org to post your resume online, view available jobs in your area or take advantage of ACFAS member discounts to post positions you’re trying to fill.

Plus, because of the success of the job fairs at the Annual Scientific Conferences, it will be back at ACFAS 2017 in Las Vegas! Watch for more details on how to participate as the event gets closer.

Foot and Ankle Surgery

---

A recent study analyzed survivorship and risk factors for failure of total ankle arthroplasty (TAA) by scanning a large, statewide database. TAA patients were identified and a multivariable logistic regression model was developed to assess risk factors. The study observed 1,545 patients who received 1,593 TAA. Failure was defined as occurrence of revision, arthrodesis, amputation or implant removal. The coded etiology of arthritis was primary osteoarthritis (55.2 percent), posttraumatic arthritis (30.2 percent), rheumatoid arthritis (8.4 percent) and other (6.2 percent). Patients with rheumatoid arthritis or who were readmitted within 90 days of TAA were at a significantly increased risk of failure. After five years, 90.1 percent of patients did not have failure of TAA.


Some total ankle replacement (TAR) procedures may require a fusion even after a successful replacement. The effects of this secondary procedure on hindfoot biomechanics and blood supply are unknown. Researchers analyzed a series of TARs to evaluate outcomes in 26 patients. In these patients, the mean time between TAR and secondary fusion was 37.5 months. The procedures required included a subtalar (18), talonavicular (3), talonavicular and subtalar (3) or triple arthrodesis (2). The average time to weight bearing after arthrodesis was 8.7 weeks, and the mean time to radiographic and clinical fusion was 26.5 weeks. No secondary complications were noted, and pain and functional scores increased significantly. Compared with 13 patients who had a subtalar fusion after an ankle arthrodesis, patients with TAR had higher fusion rates and similar time to fusion.

Practice Management

---

Healthcare providers are increasingly looking to electronic health records (EHRs) to improve in the area of value-based care. Here are five things that all orthopaedic surgeons should consider if they are looking for an EHR solution:

1. Accessibility. Many surgeons are often on-the-go and have little time to consult a system that is in a single location. Make sure your EHR is accessible on mobile devices so that you can use it wherever you are.
2. Multi-functionality. Select a solution that allows for specific documentation within subspecialties.
3. Proficiency in clinical documentation. Clinical documentation is important, and your EHR should be able to use technology to help you know where you stand in your documenting habits and abilities. Use an EHR that can provide real-time benchmarking on quality and cost.
4. Ease of use. A simpler EHR will be more effective than a complex one. Find a solution that automates ICD-10 codes for orthopaedic surgeons, for example.
5. Interoperability. Interoperability is a big issue in health IT, and many have voiced complaints that EHRs have not done enough to solve the interoperability puzzle. Be sure to select an EHR that takes interoperability seriously.

If you are looking to sell your practice, you can take a number of steps to get the best possible deal. According to John Fanburg, managing director and chair of the health law practice at Brach Eichler, you can grow your practice, join or affiliate with a group in your area, join or affiliate with a different type of group or sell to a hospital. The most important thing is to have a strategic plan in place so that you are in good standing three or four years after selling. Fanburg also notes that emotions can come into play. You should set realistic expectations so that emotions do not take over the strategy you put in place. Finally, prepare judiciously. Any prospective buyer will want to know about your successes and failures over the last couple of years. In addition, you will want to build in clauses that give you more rights in the event you are selling to a much larger institution. Build a relationship with the buyer to ensure you are getting the deal that fits your practice best.


Medical malpractice payouts reached $3.9 billion in 2014, but experts say that a simple "I'm sorry" can say volumes and reduce the financial hit. "I'm sorry" laws are difficult because it is generally recommended that physicians or surgeons do not say it in a tough situation. It could be construed as admission of guilt, which could play to the victim's favor in court. But many hospitals are encouraging doctors to use the "acknowledge and apologize" approach in the hope that admitting a mistake will mean more to the patient than denying it ever happened. In many cases, experts say, patients do not want to sue even if something horrible has happened. If a hospital is available and apologetic and offers to help a distraught patient, it could tempt the patient to stay away from court. Stanford University introduced a resolution program for these situations in 2015 and says the amount of money paid to compensate patients decreased by 27 percent and the amount of money spent defending lawsuits decreased by 24 percent. Making patients feel "whole" is the key, according to the hospital.


A new study from HIMSS Analytics and Symantec has found that more than half of hospitals with more than 100 beds dedicate between zero and three percent of their IT budget to security. Only 28 percent indicated they spend between three and six percent. Despite large-scale data breaches and widespread acceptance of the dangers of cybercrime, IT budgets do not seem to be reflecting the concern. Small budgets have led to cuts in important areas, both financially and physically. A whopping 72 percent of respondents said five or fewer people in their organization are dedicated to security. The report did not give suggested figures for ideal security but noted that "more" was the general conclusion. In addition, the report noted that investing more in security will inevitably pay off because of the decrease in breaches and data theft. A system-wide change requires extensive collaboration, according to experts. To date, the Office of the National Coordinator for Health Information Technology-initiated Interoperability Pledge, has garnered written commitments from healthcare organizations of all stripes across the nation. An initiative like this is a start, but more must be done.

Health Policy and Reimbursement

---

The Peterson Center on Healthcare has awarded a $628,000 grant to the University of Washington’s Institute for Health Metrics and Evaluation (IHME), according to reports. The grant is aimed at analyzing U.S. healthcare spending to help predict future spending trends. The project will use data analytics to understand the causes, risks and treatments for specific illnesses, which could lead to a better understanding of which treatments are most effective and financially feasible. Researchers hope to highlight how the entire system can work together to spend healthcare dollars more efficiently. By predicting future spending habits, IHME will also be able to craft benchmarks that can be compared to current forecasts released by the Congressional Budget Office and the Centers for Medicare and Medicaid Services.


The U.S. healthcare system spend billions of dollars on manual administrative processes for basic transactions, according to a new report. CAQH, a nonprofit dedicated to streamlining the business end of healthcare, found that fixing this issue could save the country $8 billion per year. In its report, CAQH determined that certain processes have been more fully implemented in electronic form: 94 percent of claims submissions are done electronically, for example, while only 6.2 percent of referral certifications are done electronically. Eligibility verification had a 70.5 percent adoption rate while prior authorization had a 10.2 percent adoption rate. The report also found that lack of resources is not necessarily the biggest culprit. Electronic transactions are available for certain processes, but the industry continues to handle high volumes of these specific transactions manually. Using automated processes to check eligibility benefits could save $5 billion alone. On average, the group found that each manual transaction cost providers and plans $2 more than automated electronic transactions. The report called for an evaluation of federal regulations and strategic plans to assess their efficacy.


Overcrowding continues to plague emergency departments around the country, and some hospitals are trying new strategies to cope with the overload. The problem, according to experts, is that the expansion of coverage under the Affordable Care Act is driving more patients to the ER than before. But hospitals seem to have done little to fix the problem, and overcrowding in many cases is not seen as a priority. At Massachusetts General Hospital, eight of 10 ER patients need to wait for care because of poor bed management. While that remains an issue, a new program in Syracuse could help break up the crowds. The Upstate at Home program uses house calls to treat patients whose conditions require treatment but not emergency transport and care. This program shows promise, although it is in its infancy and has limited reach. Some areas are trying out community paramedicine or mobile integrated healthcare-community paramedicine, where paramedics respond to provide preventive and interventional care for people not sick enough for emergency treatment. But until busy hospitals adopt common-sense measures, such as bedside registration that can reduce overcrowding, the troubles will continue for ERs around the country.

Medicine, Drugs and Devices

---

Patients with rheumatoid arthritis (RA) who undergo joint surgery have a higher risk of myocardial infarction (MI), according to a new study. Researchers looked at 308,589 joint surgeries, of which 3,654 were done in patients who had RA. Six weeks after surgery, the adjusted odds ratio for MI was 1.5 for patients with RA compared to those without. Patients with RA who underwent joint surgeries other than hip or knee arthroplasty had a higher risk for MI within 6 weeks and 12 months of surgery compared to patients without RA.


A 2015 national survey of more than 500 nurses found strong support for seamlessly connecting medical devices to electronic health records (EHRs). Even with security concerns surrounding hackers and data theft, it seems that many people are in favor of a more compatible system across the country. Study respondents noted that around 60 percent of medical errors could be reduced if medical devices were connected and shared data with each other automatically. But only one-third of U.S. providers has connected medical devices to EHRs. According to Robert Gordon, director of information systems for Halifax Regional Medical Center in Roanoke Rapids, N.C., this is unacceptable. Gordon says nurses often need to input vital signs every 15 minutes, leading to mass confusion and multiple mistakes. Device security is a valid issue, he says, but the problem still needs to be fixed in the name of accuracy. Gordon says the best way to do this is to make medical device integration a clinically driven project instead of an IT project. “Since the clinical informatics department was involved from the beginning, they wanted it to work. They had ownership," he says.


More than 86 million people have prediabetes, and the numbers continue to grow. While articles appear every day touting new breakthroughs in treatment, many of these never pan out. In contrast, a new program put forth by Medicare has shown fantastic preventive results, with little fanfare. The program, announced by Sylvia Mathews Burwell, will pay for lifestyle interventions focusing on diet and physical activity to prevent Type 2 diabetes. The move is based on work from an Indianapolis YMCA, which partnered with the Indiana University School of Medicine to design the Diabetes Prevention Program. More than 3,200 patients were included in the initial program. Group one was given an intensive lifestyle intervention, group two was treated with metformin and group three served as a control. The trial ended early because the results were so compelling: the medication groups saw a 31 percent reduction in risk while the intervention group saw a 58 percent reduction. After a formal evaluation, Burwell said “this program has been shown to reduce healthcare costs and help prevent diabetes.” Medicare reportedly saved $2,650 over 15 months for each person enrolled in the prevention program.