News From ACFAS

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Consider becoming a part of the diversified faculty of ACFAS and share your expertise and experience with your fellow members by becoming an instructor/faculty member of the College's educational programs. To complete an application, continue reading.

Over the years, ACFAS educational program committees have expanded the scope of topics offered at the Annual Scientific Conference and have also developed a series of outstanding surgical skills courses, regional symposia and e-Learning programs to meet the high educational standards and expectations of our members. With our growing offerings, the College looks to expand it's exceptional faculty to meet the needs of our members.

If you are an active Fellow member of ACFAS, attended ACFAS educational programs within the past three years and are interested in serving the College as an instructor, please complete an Education Program Faculty Application form or read more about the opportunity at acfas.org. Last year, the ACFAS Division Presidents Council approved the creation of the Division Scholars, who are students chosen from each of the nine podiatric medical schools deemed future leaders and deserving of scholarships to attend the 2014 ACFAS Annual Scientific Conference. The Division Scholars for 2014 included:

• Division 1: Pacific -- Myles Knutson, California School of Podiatric Medicine Class of 2016, and Catlea Gorman, Western University School of Health and Science Class of 2016. acfas.org/division1
• Division 4: Desert States -- Ryan Pinedo, Arizona Podiatric Medicine Program Class of 2016. acfas.org/division4
• Division 5: Florida -- Michael Sosinski, Barry University School of Graduate Medical Sciences Class of 2016. acfas.org/division5
• Division 6: Midwest -- Shawn Khademi, Scholl College of Podiatric Medicine Class of 2016 and Brandy Hooper, from Des Moines University College of Podiatric Medicine Class of 2015. acfas.org/division6
• Division 9: Greater New York -- Nam Tran, New York College of Podiatric Medicine Class of 2016. acfas.org/division9
• Division 12: Tri-States -- Emmanuella Eastman, Temple University School of Podiatric Medicine Class of 2016. acfas.org/division12
• Division 13: Ohio Valley -- Kevin Wang, Kent State University College of Podiatric Medicine Class of 2016. acfas.org/division13/

Congratulations to these nine students, future leaders in the profession, on being chosen as ACFAS 2014 Division Scholars!

Foot and Ankle Surgery

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A recent study examined the outcomes of using the dorsal and plantar advancement flap technique to treat central polydactyly, a foot condition for which there is little agreement about what is the best form of surgical management. The surgeons who performed this study observed significant narrowing of the forefoot in the 27 feet that were treated with the dorsal and plantar advancement flap technique following surgery as measured radiographically by the metatarsal gap ratio--a narrowing that was maintained even at the eight-year follow-up point. Surgeons also found that in seven of the unilateral cases, the average forefoot radiographic width of the affected side following surgical resection and reconstruction of the central polydactyly was 2 percent larger than it was in the contralateral, uninvolved side. Patients who were treated with the dorsal and plantar advancement flap technique achieved almost normal functional outcomes in itemized daily activities, itemized sports, and overall function categories as measured by the Foot and Ankle Ability Measure. The study concluded that the radiographic and functional outcomes were excellent. The study also found that 82 percent of the cases displayed persistent clinical widening of the forefoot following surgery, though surgeons said such widening is common even when surgery is successful.


The use of the syndesmosis procedure produces satisfactory short-term results when used to treat patients with hallux valgus, a new study has found. Researchers retrospectively assessed 27 patients who underwent the procedure on both of their feet. Measurements of plantar pressures indicated that the procedure was successful in restoring the function of the hallux. Measurements of average maximum force had risen 71.1 percent after treatment compared to the measurements taken before the procedure, while the force-time integral under the hallux region rose by 73.4 percent. In addition, the occurrence of the maximum force under the hallux region was delayed by 11 percent to 96.8 percent stance. Average American Orthopaedic Foot and Ankle Society (AOFAS) scores improved as well, rising from 62.8 to 94.4. The study also found that the average hallux valgus angle dropped from 33.2 degrees to 19.1 degrees, while the average intermetatarsal angle fell from 15 degrees to 7.2 degrees. Finally, the average medial sesamoid position changed from 6.3 to 3.6 as measured by the Hardy's scale. However, three patients did experience a stress fracture of the neck of the second metatarsal.


A recent study examined the use of a technique called modified sliding fibular graft repair to treat patients with recurrent peroneal subluxation, a condition that is generally treated with surgery if non-operative treatments fail in order to avoid functional impairment. The study involved 26 patients, all of whom were treated with modified sliding fibular graft repair. All patients also had redundant muscle excised and tendons repaired. Follow-ups were performed after at least three years, at which point surgeons observed an improvement rate of 88.5 percent in terms of American Orthopaedic Foot & Ankle Society (AOFAS) scores. After 4.4 months, 23 of the patients were functioning normally and had not experienced infections or non-union. None of these patients required an intra-articular screw replacement. However, eight patients experienced minor complications such as neurapraxia, synovitis, and stress fracture. Older patients also experienced less functional recovery because they were more likely to experience torn tendons and complications following surgery.

Practice Management

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Some healthcare websites could contain a vulnerability that could allow malicious hackers to carry out "catastrophic" cyberattacks, including thefts of confidential patient information, cybersecurity experts say. The so-called "Heartbleed" vulnerability exists in some versions of the OpenSSL encryption code that certain websites--such as provider sites, physician and patient portals, and secure e-mail systems--may use to protect Internet traffic while it is in transit. Michael Mathews of the systems security firm CynergisTek says that hackers may have been exploiting the Heartbleed vulnerability since it was discovered two years ago to steal confidential information transmitted to such sites. Mathews added that hackers could exploit this vulnerability fairly easily, given the high levels of computing power they have at their disposal as well as the motivation they have to attack healthcare IT systems. Mathews noted that it remains unclear how much it will cost the healthcare industry to correct the Heartbleed vulnerability--a flaw which he said could be a problem for some time to come.


There are a number of coding errors that physicians' practices need to avoid when billing Medicare to ensure that they are being properly reimbursed. For example, using the wrong code for a surgery, utilizing a lower level of Evaluation and Management (E/M) than what is supported by documentation, and billing for an established- rather than a new-patient E/M can all lead to underpayments for submitted claims. Underpayments, like other forms of improper payments, are incorrect because they are made for the wrong amount or because they fail to adhere to legal or other requirements. Doctors' practices should also be on the lookout for unbundling, in which claims for different tests and treatments provided to patients are submitted to Medicare separately. This practice is considered to be fraudulent billing and is illegal if done intentionally. Finally, physicians' practices should be sure to properly code claims for magnetic resonance imaging (MRI) scans to show that these procedures are being performed because they are medically necessary as defined by local coverage determinations (LCDs). Practices can avoid improperly coding claims for MRI scans by referring to their Medicare carrier's LCD or the national coverage determination (NCD) for the proper codes. Claims for MRI scans will be denied by Medicare if the diagnosis code is not on either one of those lists.


The American Health Information Management Association's director of health information management practice excellence, Angie Comfort, says there are a number of steps physicians' practices need to take in response to the 18-month delay for the transition to ICD-10. For instance, practices that were not prepared for the transition need to develop a plan for training coders, physicians, and other practice staff about the new codes, Comfort says. She notes that practices that fail to make such plans may not bill correctly or receive the payments they are due after the changeover is made, thereby heightening their risk of going out of business. However, practices that have not begun training employees on ICD-10 should wait until later this year or the first quarter of 2015 so that the training takes place as close to the ICD-10 implementation date as possible, Comfort says. Practices that have taken the time to train the relevant employees on how to use ICD-10, Comfort says, should allow these employees to use both ICD-9 and ICD-10 simultaneously so that they have the new codes fresh in their minds once the use of ICD-10 is required. Comfort adds that regardless of whether practices have prepared for the transition to ICD-10 or not, they should all take advantage of the delay by reconsidering budgeting for IT upgrades that they could not afford this year.

Health Policy and Reimbursement

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Health and Human Services Secretary Kathleen Sebelius announced April 10 that she will be resigning--a move that is drawing mixed reactions from health policy experts and other observers. Sebelius has refused to quit despite facing repeated calls for her resignation ever since problems with the federal health insurance exchange became evident last fall, though she has now decided to leave following the end of an open enrollment period that saw a higher number of consumers enroll in health insurance than expected despite those problems. The Obama administration says 7.5 million people have signed up for coverage through the exchange, surpassing its original goal of 7 million enrollees. Health policy expert Paul Ginsburg of the University of Southern California reacted to Sebelius' resignation by saying that the move came at the right time, following the apparent successful conclusion of the open enrollment period. Meanwhile, American Enterprise Institute health policy expert Joseph Antos said Sebelius' resignation was "overdue" as she was ultimately the one who was responsible for the problems with the rollout of Healthcare.gov. But Washington and Lee University School of Law professor Timothy Jost defended Sebelius by saying she faced a difficult, if not impossible, task in implementing the Affordable Care Act, given the complexity of the law and the amount of political opposition against it. Office of Management and Budget Director Sylvia M. Burwell will replace Sebelius.


Medical organizations and policymakers say there are limits to the usefulness of the Medicare billing data that was released by the Centers for Medicare and Medicaid Services (CMS) on April 9. That data includes information about how doctors are reimbursed for procedures performed on Medicare beneficiaries, but there are no details that could help someone looking at the data differentiate between a doctor who is engaging in Medicare fraud and one who is billing Medicare large amounts of money for legitimate reasons. For example, some doctors may need to bill Medicare large sums of money because they are including services performed by other healthcare providers in their claims. Other doctors may be specialists who have high-overhead costs, which are also reimbursable by Medicare, that drive up their billing amounts. Still others simply treat a large number of Medicare patients. Because the data released lacks information that can help put billing amounts into context, doctors have had to take steps to defend and explain their Medicare billing practices. In addition, the release of the data will likely put pressure on doctors not to draw attention to themselves by billing Medicare for amounts of money that could be deemed excessive, one observer says.


The Centers for Medicare and Medicaid Services' plan to expand Medicare's competitive bidding program for durable medical equipment is coming under fire from a bipartisan group of lawmakers and medical devicemakers, who are asking the agency not to move forward with the initiative. Under the plan, CMS will use information about the prices of durable medical equipment currently being purchased through competitive bidding to help it decide what to pay for equipment that is not being bought through the program. The plan comes in response to a mandate inserted into the Affordable Care Act that calls for the fees that are paid for durable medical equipment to be adjusted beginning January 1, 2016. But some lawmakers say the program is not transparent enough and that it does not include a mechanism for checking the financial health of the devicemakers who are awarded contracts. Medical devicemakers, meanwhile, have said that the plan encourages bidders to offer the least-expensive products rather than those that are best for Medicare beneficiaries. Devicemakers also say that beneficiaries are no longer able to access some medical devices that they need. But CMS has continued to defend the program, saying that it will save Medicare and its beneficiaries alike billions of dollars over the next decade.

Medicine, Drugs and Devices

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A recent study has found that different types of osteoarthritis drugs carry different levels of risk of non-fatal acute myocardial infarction (AMI), with some drugs having no risk at all and others having a relatively higher risk. The nested case-control study involved the analysis of a database that included information on non-fatal AMI patients between the ages of 40 and 90. Controls were randomly selected and matched for age, sex, and calendar year. Researchers assessed exposure to various types of osteoarthritis drugs--namely traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) like ibuprofen and aceclofenac, the non-narcotic analgesics paracetamol and metamizole, and symptomatic slow-acting drugs in osteoarthritis (SYSADOAs)--30 days before the index date. Researchers determined that ibuprofen carried a low risk of non-fatal AMI while aceclofenac had one of the higher levels of risk. However, there was a moderate significant association between using tNSAIDs longer than a year and non-fatal AMI. No increased risk of non-fatal AMI was seen in patients treated with paracetamol, metamizole, and SYSADOAs.


A study recently published in the Journal of the American Medical Association is raising questions about the potential for conflicts of interest to arise when the leaders of academic medical centers go to work for pharmaceutical companies. Researchers examined backgrounds of the members of governing boards at the world's 50 largest drug companies, and found that 16 of the U.S. companies it looked had at least one director in 2012 who was also a leader at an academic medical center, teaching hospital, or health system. Observers say the findings highlight some of the potential conflicts of interest that the Physician Payments Sunshine Act will shed light on. Study author Dr. Walid Gellad of the University of Pittsburgh School of Medicine says these conflicts of interest exist because academic leaders must meet their intitutions' educational and clinical goals, though when they go to work for drug companies they must also help please shareholders. These goals may sometimes be in conflict with one another, Gellad said. However, Harvard Medical School professor of medicine Eric Campbell says more research needs to be done on these potential conflicts of interest so that policymakers have the information they need to determine the acceptability of relationships between academic medical center leaders and drug companies.