News From ACFAS

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ACFAS is once again building on its success by incorporating all research posters presented at the Annual Scientific Conference in Phoenix into electronic format! ACFAS 2014’s electronic submission pilot program for scientific posters was so successful and well received, we’re expanding the program to include electronic submission for all posters accepted for display at ACFAS 2015 and videotaping some of the more unusual topics, as well.

The heat is on for Phoenix 2015; if you have exceptional research you’d like to share with your peers at ACFAS 2015, take a look at the winners from ACFAS 2014 in Orlando at acfas.org and start planning your poster. Full details on requirements and instructions for submission will be available at acfas.org/phoenix soon. Deadline for submission is October 1, 2014.
Need some ideas for promoting your practice to new or existing patients? Take advantage of the spring weather and ACFAS’ free seasonal Fill-In-The-Blanks Press Releases in the ACFAS Marketing Toolbox to get the word out via your website, social media outlets or your local media!

Each press release is already written for you, all you need to do is fill in the "blanks" with your practice information and push out to your intended audiences. It’s that easy! Topics for spring include:

• Spring is Ankle Sprain Season in (CITY or REGION)
• Mow the Lawn, Not your Foot
• Foot Pain Ruining Your Golf Swing?
• Golfers: Don't be Handicapped with Foot Pain
• Popular Sandals Causing Foot Problems in Men?

You will also find dozens other topics for each season, as well as hot press release topics in the Toolbox. Plus, explore the many other free practice marketing tools ACFAS offers at acfas.org/marketing.

Foot and Ankle Surgery

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Ankle fracture patients who undergo open reduction and internal fixation have a low rate of surgical site infections, a new study has found. The age- and gender-matched case-control study involved the use of logistic regression analysis to determine odds ratios, and found that 4 percent of the 717 participants experienced a surgical site infection following open reduction and internal fixation. Eight of these patients, or 1.1 percent, had a deep infection. The logistic regression analysis also determined that diabetics, residents of nursing homes, and those who had experienced Weber C fractures were at significant risk of surgical site infection. Finally, the study found that the median ankle score among patients who had experienced an infection was significantly lower than patients who did not have an infection.


A new study has found that mini-incision repair with double-Tsuge loop sutures is superior in a number of ways to open repair with modified Kessler sutures as a treatment for acute closed Achilles tendon ruptures. The study involved 60 patients, all of whom underwent one of the two procedures and were followed up with after an average of 25 months after surgery. Several metrics were used to assess the effectiveness of the two procedures, including American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores, maximal ankle range of motion, and the time it took patients to perform 20 continuous single heel raises. The study found that patients who were treated with mini-incision repair using double-Tsuge loop sutures were able to perform the single heel raises in less time than their counterparts in the other group. Patients in the mini-incision group also had fewer complications than those treated with open repair using modified Kessler sutures. Finally, the study found that the mini-incision procedure resulted in better cosmetic appearance compared to open repair.

Practice Management

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Experts say there are several things doctors' practices can do to encourage their patients to use their patient portals. For instance, doctors should explain to patients how their patient portal works and tell them that they should use the system, says Steven Waldren of the American Academy of Family Physicians. Waldren noted that a study performed in the U.K. found that doing this made patients much more likely to use patient portals. Another step that practices can take to encourage the use of patient portals is to have an employee--preferably someone handling patient check-out--demonstrate how easy the patient portal is to use, experts say. This demonstration can include showing the patient how to view information about their appointment and how to set up an account. Management Resource Group's Tammie Olson says doing this is important because patients will not use portals if they believe they are too confusing or too difficult to use. Finally, practices should point out that using patient portals can make it easier for patients to make appointments, renew prescriptions, and perform other tasks, Waldren says. He adds that if all else fails, practices can offer rewards to patients who sign up for their patient portals, such as a chance to win an iPad. Encouraging patients to use patient portals is important because one of the key goals of Stage 2 Meaningful use requirements is to have more than 5 percent of patients using these systems.


Some IT experts are recommending that doctors' practices use language-to-code translators to help ease the transition to ICD-10. These translators are integrated into electronic health records systems, and are designed to show clinicians easy-to-understand descriptions of patient complaints, diagnoses, and procedures in either English or Latin when they perform tasks such as preparing or updating problem lists. After the clinician selects one of these words or phrases, the translator displays the appropriate code in ICD-10 or some other type of code set. IT experts say these translators could make it easier to find the necessary ICD-10 codes, which in turn could help minimize the disruption to physician workflows and cash flows that could result from the transition to ICD-10. But others disagree. Dr. Lyle Berkowitz, the medical director of IT and innovation at Northwestern Memorial Physicians Group, says translators create problems when coding a care episode in ICD-10 for billing purposes. "I can put (congestive heart failure) on my problem list, but for billing I need to be more specific," Berkowitz said, adding that this problem creates extra work when coding for ICD-10.

Health Policy and Reimbursement

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The recent decision by the Centers for Medicare and Medicaid Services (CMS) to cancel the planned first round of limited end-to-end testing of the new ICD-10 coding system is coming under fire from some in the healthcare industry. Among the organizations that have said the cancellation of the test is a bad idea is the Medical Group Management Association (MGMA), which is trying to get CMS to reverse its decision. MGMA's senior policy adviser, Robert Tennant, says that failing to perform end-to-end testing of ICD-10 that involves Medicare and other health plans increases the risk of cash flow disruptions at doctors' practices that could negatively impact patient care. Tennant says CMS should take the lead in carrying out end-to-end testing, even in a limited form, with any willing providers so that any problems with ICD-10 can be identified and corrected before the system's scheduled rollout on Oct. 1, 2015. He adds that CMS' decision to cancel the end-to-end test that had been scheduled for July casts doubt on its readiness for ICD-10 implementation. CMS, for its part, has hinted that end-to-end tests of ICD-10 will be performed sometime next year.


The Centers for Medicare and Medicaid Services (CMS) on May 7 issued a final rule that contains a number of reforms of Medicare and Medicaid regulations that govern healthcare providers. The rule, which is scheduled to take effect July 11, eases the requirements that ambulatory surgical centers (ASCs) must adhere to in order to provide and perform radiological services. Current regulations require ASCs to meet the same requirements as hospitals regarding radiological services, though they are only allowed to provide limited services that are deemed necessary for certain types of surgeries. CMS says that reducing the radiological services requirement for ASCs will provide these facilities with more flexibility for physician supervision requirements. Several other changes affect critical access hospitals (CAHs). For example, very small CAHs--along with health clinics in rural areas and federally qualified health centers--will no longer have to require that physicians be present on site at least once every two weeks. CMS says it is eliminating this requirement in response to the challenges physicians face in traveling to these facilities, and because the improvements in telemedicine technologies have made it unnecessary. CMS believes that these and other changes will improve patient care while also saving almost $660 million per year.


Medicare payments to Federally Qualified Health Centers (FQHCs) could go up by as much as 32 percent under the proposed Medicare prospective payment system that was recently unveiled by the Centers for Medicare & Medicaid Services (CMS). The new system calls for Medicare to pay FQHCs a single encounter rate for each beneficiary per day for all services, though there are some exceptions. For instance, CMS will take into account differences in costs in different geographic areas when setting payment rates and will also adjust rates to take into account the higher costs that are incurred when providing care to new patients. Dan Hawkins of the National Association of Community Health Centers says the new payment policy could result in FQHCs being reimbursed for nearly 80 percent of the costs they incur providing care to Medicare patients, compared to the roughly 60 percent they receive now. FQHCs will also no longer be subject to a payment cap as they are under the current system. CMS is taking comments on the proposal until July 1 and plans to issue a final version later this year. The new payment system is scheduled to be implemented gradually beginning Oct. 1, with the transition from the new to the old system stretching through next year.


The Centers for Medicare and Medicaid Services (CMS) has announced that it has canceled the end-to-end testing program for the new ICD-10 codes that had been scheduled for July. The agency said the test, which would have allowed some providers and Medicare to test the use of the codes in order to ensure that there were no technical problems in the payment system, was cancelled because of the recent delay in the implementation of ICD-10. However, CMS says that end-to-end testing of ICD-10 could be performed at least once next year. The agency did not provide much in the way of information about the scope of such tests.

Medicine, Drugs and Devices

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Zoledronate does not prevent bone erosion in patients with tophaceous gout, a new study has found. The study involved 100 patients who were randomized to receive an annual 5mg injection of zoledronate--which is intended to prevent the development of osteoclasts that can cause bone erosion in gout patients--or a placebo. Neither one of the two groups displayed any changes in foot computed tomography (CT) bone erosion scores from baseline to the two-year follow-up point. No differences in these scores were seen after one year either. Researchers also did not observe any changes in plain radiographic damage scores after two years. Both groups of patients also had similar scores after one year. Zoledronate did increase bone mineral density in a variety of locations and reduced several bone turnover markers, which researchers said suggests that there is a disconnect between the responses in the healthy skeleton and at locations in bodies of tophaceous gout patients where focal bone erosion is taking place.


A new study has found that an ankle robotic rehabilitation protocol that includes repetitive, goal directed biofeedback training is effective in rehabilitating patients with cerebral palsy in a clinical setting. The study involved 28 juvenile cerebral palsy patients with Gross Motor Function Classification System Level I, II, or III, who underwent the robotic rehabilitation protocol twice a week for six week. These appointments consisted of using the robotic device to perform ankle stretching and strengthening for 30 minutes, as well as 45 minutes performing functional activities. The results seen in these patients were compared to results seen in a cohort of 12 participants who were treated with the device in a research laboratory setting. Researchers found that patients who were treated with the ankle robotic rehabilitation protocol in the clinical setting experienced significant improvements in all of the primary outcome measures, including post-intervention measures of plantarflexor and dorsiflexor range of motion, strength, spasticity, and mobility. However, these patients did not display significant improvements in the Gross Motor Function Measure (GMFM). Nevertheless, most of the improvements seen in the patient cohort were comparable to those seen in patients who were treated in the research lab setting.


A recent study has determined that Type 1 diabetics who are given intensified conventional treatment (ICT) experience fewer ischaemic foot ulcers than those who are given standard treatment (ST) with insulin, as ICT results in better glycaemic control. The study involved 72 patients, all of whom were treated with either ICT or ST for an average of 7.5 years. All patients were also given topical iontophoresis with acetylcholine (ACh), sodium nitroprusside (SNP), and capsaicin acting as vasoactive stimuli. Patients were followed until they were hospitalized for an ischaemic foot ulcer or until 2011, resulting in a follow-up period with a median length of 28 years. During the follow-up period, three patients treated with ICT developed ischaemic foot ulcers, compared to 10 in the ST group. Patients in the ICT group also had hemoglobin A1c (HbA1c) levels that were lower than those in patients treated with ST. Finally, patients in the ICT group had higher rates of stimulated blood flow compared to those in the ST group with significantly increased perfusion units for ACh, SNP, and capsaicin.