News From ACFAS

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The Federal Trade Commission (FTC), the nation’s watchdog to protect the consumer and encourage competition, recently issued a policy paper encouraging state legislators to be cautious when evaluating bills that would limit the scope of Advanced Practice Registered Nurses (APRNs). The FTC states, “Even well-intentioned laws may impose …. restrictions on competition, thereby depriving healthcare consumers of the benefits of vigorous competition.” The FTC paper followed attempts by the MD lobby to limit scope changes for various non-MD healthcare specialties in several states. This FTC action was one of many in recent years to promote competition in the healthcare sector, which benefits consumers through lower costs, better care, and more innovation.

“ACFAS applauds the FTC’s continued activity in this arena,” said ACFAS President Thomas S. Roukis, DPM, PhD, FACFAS. ACFAS recently submitted comments to the FTC in response to a special healthcare competition workshop, which ACFAS attended along with fellow members of the Coalition for Patient Rights (CPR). The CPR is comprised of 38 non-MD healthcare specialty organizations who work together to counter the MD lobby’s anti-competitive behavior. The ACFAS Student Clubs on the nine podiatric school campuses are ending their school year, and along with that transition comes the beginning of a new term of ACFAS Student Club Presidents. The ACFAS Student Clubs provide students access to the foot and ankle surgical community by bringing in ACFAS members to speak at the clubs on surgical techniques and by adding to the basic knowledge taught at the podiatry schools by exposing students to more specific surgical techniques.

The new ACFAS Student Club Presidents for 2014-2015, are:

• AzPod: Kevin Fluckiger, Class of 2017
• Barry: Michael Sosinski, Class of 2016
• CSPM: Myles Knutson, Class of 2016
• DMU: Kelsey Millonig, Class of 2017
• Kent State: Kevin Wang, Class of 2016
• NYCPM: Nam Tran, Class of 2016
• Scholl: Mira Pandya, Class of 2017
• Temple: Emmanuella Eastman, Class of 2016
• Western U: Diana Perry, Class of 2017

The College welcomes these future leaders to the ACFAS family, and wishes them great success for the new school year! Looking for a buying partner to help cut medical supply costs for your practice? Did you know that ACFAS offers bulk buying power for its members through Henry Schein Medical? Henry Schein Medical is an ACFAS Benefits Partner offering high-quality medical supplies, pharmaceuticals and equipment at an economical price.

Take advantage of what Henry Schein Medical offers, including:

• Broad Product offerings at competitive pricing – no need to spend time researching where to buy products you use in your office every day – “Time spent away from profitable endeavors is money lost”
• Cash flow ideas while providing better outcomes –save money on the supplies you buy and how to more effectively make money on them for your practice
• Group Buying Power – As an ACFAS member and active buyer you are automatically enrolled in an Amerinet GPO lowering your cost on products and giving back to the College

If you are interested in learning more or for a pricing analysis, contact Ryan Crothers at ryan.crothers@henryschein.com to be connected with your specific representative.

Foot and Ankle Surgery

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A new study sought to shed some light on the biomechanics of gate in end-stage ankle osteoarthritis patients who undergo total ankle arthroplasty. The study involved 17 such patients, who underwent an ankle replacement and were evaluated retrospectively over a roughly five-year period. The study found that the biomechanics of gait in these patients was similar to a healthy ankle, and that the American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 31 to 83 by the time of the final follow up. The complication rate was similar to what was seen in previous studies. In addition, the study found that 83.3 percent of patients reported being satisfied with the ankle replacement.


Posterior ankle arthrodesis is both safe and effective in the debridement of cartilage and could reduce the risk of non-union of the ankle, a new study has found. During the study, standard arthroscopic debridement was performed on the tibiotalar joints of 10 fresh-frozen human lower leg specimens that did not show any signs of previous foot and ankle surgery. No iatrogenic damage was seen in any of the specimens when they were dissected to evaluate the safety of the posterior ankle arthrodesis procedure. The study also found that total talar joint surface area and total tibial joint surface area of 95 percent and 96 percent, respectively, was addressed during arthroscopic debridement. The study concluded that posterior ankle arthrodesis is effective and may lower rates of non-union of the ankle because it creates the optimal biology for fusion to occur.

Practice Management

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Using electronic access solutions can help healthcare providers improve the security of systems that store sensitive data while also helping them demonstrate compliance with the Health Insurance Portability and Accountability Act (HIPAA), writes Steve Spatig of the Electronic Access Solutions Strategic Business Unit at Southco. Electronic access solutions can consist of a variety of access control devices, including biometric readers and keypads, and can be installed outside of rooms where sensitive IT systems are located. These solutions can also be used with electronically-secured cabinets that contain patient information protected by HIPAA. One of the advantages of using an electronic access solution, Spatig writes, is that the technology is designed to log the credentials used to gain access to an area or cabinet as well as the time access was granted. This and other information creates an audit trail that can then be used to investigate a security breach should one occur. In addition, events recorded by an electronic access solution can be monitored remotely. Spatig says that another advantage of using electronic access solutions is the technology's ability to integrate with existing security solutions, such as Internet Protocol (IP) cameras. Integrating electronic access solutions with legacy security systems also makes it possible for employees to access areas protected with electronic access systems with the same credentials they use to enter other areas of the building.


Physicians' practices have several options available for managing insurance claims that have not been paid after 120 or more days. For instance, claims that have been denied because the practice exceeded its insurance visit or authorization limits can be appealed by asking the insurance company for retro-authorization or by proving that the visit or treatment was medically necessary. In order to prove medical necessity, practices will need to provide the insurance company with a prescription, chart notes, or other types of evidence. Practices can also opt to re-bill insurance companies for claims that have been "dropped" and not paid. A third step for managing unpaid claims involves examining the contracts practices have with insurance companies. Practices should particularly focus on when their contracts expire, when the timely filing limit is, and how many days the insurer has to pay a claim. Some contracts between practices and insurance companies also state that practices are due interest payments for claims that are unpaid after a certain time--a provision that practices should be proactive about enforcing, as insurers often forget to make such interest payments. Finally, practices that have taken steps to ensure that their claims have been filed correctly and that they are owed payments can opt to file complaints with their state's department of managed care in order to launch a further investigation into the matter.


ClinicSpectrum CEO Vishal Gandhi says doctors' practices can achieve a number of benefits by automating their billing and collections processes. For example, automating billing and collections can free up practice staffers for tasks such as welcoming patients, becoming more involved in the care they are provided, and ensuring that they do not switch to another practice, Gandhi says. In addition, Gandhi says that automating billing and collections allows doctors to focus more on practicing medicine and gives them additional time to collaborate with practice staff on finding ways to maximize profitability. Gandhi also notes that billing and collection processes could be performed more cost effectively if they are automated instead of carried out manually. Finally, automating the billing and collection processes allows practices to communicate with patients using methods they prefer, Gandhi says, which can also help make practice operations more efficient.

Health Policy and Reimbursement

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The House Ways and Means Subcommittee on Health has held a hearing to discuss the impact that Medicare's two-midnight and observation rules are having on hospitals. Among the hospital leaders who testified was Amy Deutschendorf, the senior director of clinical resource management at Baltimore's Johns Hopkins Hospital. Deutschendorf criticized the two-midnight rule by saying that it has created confusion and stress for both providers and patients and has been very difficult to implement. Deutschendorf added that the observation rules have resulted in patients being given observation status in order to reduce the likelihood of audits conducted by Recovery Audit Contractors, adding that the fear of audits has forced doctors into the difficult situation of trying to predict whether emergency room patients displaying multiple symptoms and comorbidities will need to stay at the hospital for longer than two midnights. In addition, patients who are assigned observation status sometimes refuse vital diagnostic studies and medications because their status means that Medicare Part A will not fully cover these items, Deutschendorf said. Ann Sheehy of the University of Wisconsin Hospital also criticized the two-midnights rule by saying that it results in patient status being determined on the basis of when they enter the hospital rather than their clinical needs.


A House subcommittee held a hearing May 20 on the Medicare payment appeals process--a process that some critics say is particularly burdensome for small hospitals. A variety of administration officials testified at the hearing, including Dr. Shantanu Agrawal, the director of the Centers for Medicare and Medicaid Services' (CMS) Center for Program Integrity. Agrawal said that the first two steps of the appeals process that are handled directly by CMS function well, though other administration officials noted subsequent appeals get bogged down because the Office of Medicare Hearings and Appeals (OMHA) has a backload of cases. Members of the subcommittee echoed concerns raised by the American Hospital Association (AHA) earlier this year that OMHA is unable to issue a final ruling on appeals within the timeframe mandated by federal law, forcing providers to wait for the payments they are due.


Former Centers for Medicare & Medicaid Services (CMS) Administrator Tom Scully says he has a mixed assessment of the impact that the Affordable Care Act will have on the nation's healthcare system as well as federal government spending. Scully, who served as the administrator of CMS during the George W. Bush administration, says that one positive aspect of ACA is that it has sparked a shift toward private at-risk health plans that provide incentives based on quality of care rather than patient volume. Scully added that the private health plans offered through the health insurance exchanges established by ACA also feature mechanisms that reduce overuse of healthcare services and improve care coordination. But Scully also sees a number of potential negative impacts on the nation's healthcare system as a result of ACA, including a possible destabilization of the employer-based healthcare system caused by consumers increasingly shifting to plans that are offered through the exchanges and paid for with the help of generous government subsidies. Those subsidies could also create problems for the federal government's budget, Scully says, since they will encourage even more people to enroll in health insurance exchange plans in order to receive financial assistance.

Medicine, Drugs and Devices

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Researchers have established normative diffusion tensor imaging (DTI) eigenvalues (Lambda 1, Lambda 2, and Lambda 3) in five asymptomatic foot muscles, and have determined that DTI can be used to assess anisotropy of water diffusion in foot muscles. The study that produced these findings involved 10 healthy adults, all of whom were examined using a 3-T magnetic resonance imaging (MRI) scanner. Researchers also evaluated DTI indices in the quadratus plantae, abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and abductor digiti minimi muscles. Lambda 1 values ranged from 1.88 × 10-3 to 2.14 × 10-3 mm2/s in these muscles, while Lambda 2 values were in the 1.39 × 10-3 to 1.48 × 10-3 mm2/s range. Lambda 3 values ranged from 0.91 × 10-3 to 1.27 × 10-3 mm2/s. Statistical differences were observed in some eigenvalues between pairs of foot muscles. The study also sought to establish the apparent diffusion coefficient and fractional anisotropy in foot muscles. The study found that the apparent diffusion coefficient ranged from 1.48 × 10-3 to 1.55 × 10-3 mm2/s, while fractional anisotropy ranged from 0.21 to 0.40.


A recent study evaluated and compared the usefulness of T1 and T2 relaxation times and off-resonance saturation ratios (OSRs) in diagnosing mild and severe Achilles tendinopathy when magnetic resonance imaging (MRI) is performed. Both Achilles tendons in 17 symptomatic and asymptomatic tendinopathy patients, as well as 42 healthy tendons, were investigated clinically with conventional magnetic resonance imaging (MRI) sequences on a 3T whole-body magnetic resonance (MR) scanner and a dynamic ultrasound examination. The study found that OSR values at a frequency offset of 2,000 Hz displayed more sensitivity and specificity in detecting mild and severe tendinopathy compared to both the T1 and T2 relaxation times.