News From ACFAS

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Take the confusion out of surgical coding and modifiers—register yourself and your office staff for the ACFAS Interactive Surgical Coding Workshop July 17–18 in Tysons Corner, VA (Washington DC).

Newly redesigned with you and your staff in mind, this interactive workshop gives you the chance to code actual cases with your fellow attendees and helps you navigate new requirements for modifiers, ICD-10, wound care coding, durable medical equipment and much more.

The fee for this two-day course includes 12 continuing education contact hours, a comprehensive reference guide, breakfast and lunch. If you’re unable to attend the summer workshop, a fall program is also set for October 16–17 in Las Vegas.

Register now at acfas.org/practicemanagement and get your revenue cycle management on the right track.
If you’re conducting innovative research you’d like to share with the foot and ankle surgery profession, consider showcasing it in poster format at ACFAS 2016 February 11–14 in Austin, Texas.

Poster abstracts must be submitted to ACFAS by September 1, 2015, slightly earlier than in years past, to be eligible for review. Poster format requirements and abstract submission guidelines will be available on acfas.org after June 1, so check back for more details. In the meantime, refer to 2015 Poster Committee Chair Harry P. Schneider’s, DPM, FACFAS, quick tips for seamless poster submission, which he recorded at ACFAS 2015.

A popular hotspot that consistently attracts some of the highest traffic at the conference, ACFAS’ annual poster display brings together the best in cutting-edge research. Don’t miss this opportunity to share your knowledge with your peers!
On the drive to work or while waiting for the OR, use your down time to access fresh perspectives on issues facing today’s foot and ankle surgeons with ACFAS’ Podcast Library at acfas.org/e-Learning. From Lisfranc controversies to Achilles tendon rupture vs. repair, our Podcast panelists let you inside their minds as they share their own experiences with each topic while outlining the pros and cons to provide a balanced view.

Listen to our podcasts anytime from any location and always be one step ahead of the latest trends in the profession. If you haven’t yet visited our podcast library at acfas.org/e-Learning, start with this month’s featured podcast, Sesamoid Fractures vs. Sesamoiditis, and work your way through all of our 2015 releases. A new podcast is added to the library each month, so visit acfas.org/e-Learning often for the very latest.

Foot and Ankle Surgery

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Researchers hypothesized that absorbable sutures would have clinical results similar to nonabsorbable sutures when each was used to repair an Achilles tendon with a suture-guiding system. A study was conducted, observing 48 patients with ruptured Achilles tendons. The patients were divided into two groups depending on suture type. After treatments, all patients achieved an intact Achilles. The American Orthopaedic Foot and Ankle Society clinical outcome scores for the nonabsorbable suture group and the absorbable suture group were 98 and 98.6, respectively. All patients returned to their previous work. The absorbable suture group had no postoperative complications; 12.5 percent of the nonabsorbable group experienced complications.


The rising popularity of talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) to treat symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction prompted a group of researchers to look at its clinical and radiological mid-to long-term outcomes. Eighty-four patients were treated with the modified triple arthrodesis and followed for a mean of 4.7 years. In 86 of the 95 feet (90.5 percent) for which radiographs were available, the follow-up revealed no loss of correction. Only 14.7 percent of feet needed secondary surgery. The most common complication was nonunion.


The Ponseti method with Achilles tenotomy has been proposed as an alternative treatment for the arthrogrypotic clubfoot. Researchers conducted a study to compare this treatment with the classic approach of using wide soft tissue releases (STRs). The study included 29 children with 57 arthrogrypotic clubfeet divided into two groups: the Ponseti group and the STR group, both observed five to 10 years post-treatment. The Ponseti group achieved 14 good and four satisfactory results, with a complication rate of 5.5 percent. The STR group finished with 20 good, eight satisfactory, and 11 unsatisfactory results, with a complication rate of 23 percent. In addition, the Ponseti method netted mean anesthesia and surgery times of 116.6 and 77.4 minutes, respectively; the STR group experienced respective times of 161.4 minutes and 102.8 minutes.

Practice Management

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Practices are training and preparing in advance of the ICD-10 deadline scheduled for Oct. 1, 2015. There will be a period where practices may need to use a combination of ICD-10 and ICD-9. The right approach can limit confusion. Which code set you use will depend on the date of service. Claims before Oct. 1 will need to be coded in the ICD-9 system. Claims after Oct. 1 will use the ICD-10 system. The key is to make this phase as brief and smooth as possible. Ideally, a physician should code any claims within 24 hours and no later than the next business day. Working quickly will ensure that the codes do not get mixed up or stay in the wrong format for too long. If this is not possible, the physician should focus on claims that tend to stay open for a long time.


More physicians are using patient web portals, but they often remain underutilized. Physicians can get more patients to enroll by using the parts of portals that patients care about most, such as appointment and refill requests. Portals can also include features such as bill paying, telehealth and health risk assessments. To achieve real portal use, patients should be able to experience the most ease in accessing health information. Patients should also be able to use the portal to submit information or data that the practice requests. The portal also should be able to be integrated effectively into the practice workflow. Patients who are being treated for chronic conditions, who receive significant testing or concurrent care from other specialists, who are involved with self-monitoring, who are receiving complicated treatment or who are in the recovery process will get the most use out of the portal.


The country's biggest health insurers are starting to view televisits similarly to traditional doctor visits. UnitedHealthcare recently announced a partnership with three telemedicine companies to cover online video-based doctor visits the same as it covers in-person visits. United says it will cover virtual doctor visits through NowClinic, Doctor on Demand and American Well, which connect patients with thousands of doctors through video chat. These doctor consultations generally cost $40 to $50 each, but with the United coverage, patients will only need to pay their usual co-pay. Peter Mueller, a healthcare industry analyst at Forrester, said United's acceptance of video doctor visits is a major step forward for the healthcare industry. "There are a lot of pros to telemedicine," said Mueller. "Convenience is one. Access is another. Then there's the immediacy of it, too."

Health Policy and Reimbursement

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Medical errors stemming from the automation of the U.S. healthcare system are increasingly involved in medical malpractice lawsuits. Experts are concerned that safety and data integrity problems could limit the benefits of electronic health records (EHRs) unless lawmakers and officials address the issues. The number of lawsuits involving EHRs doubled from 2013 to early 2014. These cases often allege a variety of mistakes and information gaps, such as typos that result in medication errors, voice recognition software that omits key words, doctors relying on old or incorrect records, and nurses' misinterpretation of drop-down menus. Additionally, discrepancies between what doctors and nurses see on both their computers and printouts of electronic records plaintiffs submit has discredited provider testimony and resulted in large settlements.


A bill has been introduced in the U.S. House of Representatives that could delay implementation of ICD-10, which has an adherence deadline of Oct. 1, 2015. According to the proposed Cutting Costly Codes Act of 2015, ICD-10 should be decried as "burdensome" and "bureaucratic" and is making life difficult for physicians across the country. The bill does not say outright that ICD-10 should be delayed. Rather, it is attempting to prohibit implementation so that ICD-9 remains the coding standard.


The Centers for Medicare and Medicaid Services (CMS) recently announced that the pilot Pioneer Accountable Care Organization (ACO) program saved Medicare nearly $400 million over two years and is the first alternative-payment model that cuts costs while improving quality. Participating patients spent less per month than non-affiliated patients, had fewer hospitalizations and tests and reported more timely care and better communication. U.S. Health and Human Services Secretary Sylvia M. Burwell announced earlier this year a goal of moving 50 percent of Medicare payments to ACO and other value-based models by 2018.

Medicine, Drugs and Devices

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The U.S. Food and Drug Administration (FDA) and the National Institutes of Health National Library of Medicine have partnered to create AccessGUDID, making data on devices with unique device identifiers (UDIs) publicly available for the first time. The UDI system is being phased in over several years, and the records of all medical devices required to have a UDI will eventually be included. "As we launch this beta version of AccessGUDID, we encourage everyone—healthcare systems, clinicians, patients, researchers and industry—to explore its contents, assess its functionality and provide us with feedback," FDA said in a press release. "This feedback will shape future enhancements, including advanced search and web services."


Lawmakers have introduced a bill that would provide funding for medical research at the National Institutes of Health (NIH). The 21st Century Cures bill comes as NIH reports its resources and funding have decreased over the years. The bill would provide about $35 billion to NIH by 2018, a $5 billion increase from current funding levels. The bill would set aside $10 billion over five years for an innovation fund at NIH. Those funds would help support young emerging scientists and precision medicine initiatives.


A partnership between Kobe University engineers in Japan and surgeons has resulted in the development of mangesium clips that dissolve effortlessly and safely inside the body, which could lead to the elimination of risk associated with classic titanium clips sometimes left inside the patient. Doctors have long relied on the more established methods, but leaving clips inside a patient can cause complications like clip migration and nerve problems. The new magnesium clips dissolve within the body and were shown in clinical trials on mice to have no effect on magnesium levels in the blood. The clips still have a long way to go before approval, the most important of those steps being human trials. Researchers think it would be realistic to expect the clips to make a debut within the next two or three years.