News From ACFAS

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The College’s new referrers public relations campaign, “Take a New Look at Foot and Ankle Surgeons,” has launched its new website, TakeaNewLook.org, which features a “find a surgeon” tool, a special referrers’ video, surgeon profiles and infographics. The campaign is targeting nurse practitioners, diabetes educators and family physicians. Behind the scenes, the campaign will also include special advertising, email messages and conference exhibits. A Do-It-Yourself Kit for ACFAS members will soon be available to educate these practitioners on the education, training and certification of today’s foot and ankle surgeon.

To receive referrals, make sure your extended ACFAS profile is current. Log in to acfas.org to update your office hours and location(s), contact information and website address.
Prepare for the unexpected by registering for Complications 2016 Seminar: Minimize Your Complications and Maximize Your Patient Outcomes, October 22–23 at the New York Marriott Downtown.

This case-based course will demonstrate approaches to common—and not so common—complications and how they are resolved in foot and ankle surgery. Faculty will cover perioperative and postoperative management and will also hold a panel discussion to answer questions about your most challenging cases.

See the brochure for the full spectrum of discussions. Register today at acfas.org/education.
Spotlight your research and help influence the next 75 years of foot and ankle surgery—submit your manuscript by August 1 for a chance to participate in our annual Manuscript Competition at ACFAS 75 in Las Vegas.

All manuscripts submitted for consideration will be blind-reviewed and judged on established criteria. Winners will present their research at the conference and divide $10,000 in prize money.

Refer to acfas.org for manuscript requirements and submission guidelines. We look forward to receiving your manuscripts!
Add the new e-Book, Arthroscopy of the Foot and Ankle, to your virtual bookshelf and always have ready access to what has been called the resource for arthroscopic surgery. This first installment in an upcoming series of ACFAS e-Books includes:

• videos and images to guide you through procedures
• self-assessments after each chapter so you can earn CME
• intuitive navigation
• built-in note-taking and bookmarking functions
• and more!

Purchase the e-Book at acfas.org and watch for more book releases!

Foot and Ankle Surgery

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Children under the age of three can be exposed to anesthesia without facing any risk of cognitive issues, according to a new study from the Columbia University Medical Center. Several animal studies indicated that anesthesia may pose a risk to early-developing brains, a major concern since around two million children undergo anesthesia each year. The researchers analyzed the anesthetic responses for 105 children and found no differences in IQ scores between children who underwent anesthesia and children who did not. Secondary neurodevelopmental outcomes, including memory, learning, processing speed, visuospatial function, attention, executive function, language and behavior, were unchanged as well. The study authors warned that the study is not all-encompassing. More work must be done to determine the cognitive effects of anesthesia in girls and in children exposed to anesthesia more than one time.


A new study aimed to determine whether complication rates for patients in the first year after total ankle replacement (TAR) would be greater when combined with procedures through separate incisions. The review compared complication data between patients with and without additional procedures. Overall, 32 of 124 of patients had a complication. Fifteen had delayed wound healing, six had malleolar fracture and 11 had other complications. After one year, 24 of 89 patients without additional incisions and eight of 35 patients with additional incisions had any complications. The data did not show any significant association between additional procedures requiring a separate incision during TAR and early complications.


A Boston Globe article late last year highlighted concurrent surgeries (the practice of running more than one surgical case at a time) that resulted in poor outcomes. This article led to increased awareness about concurrent surgery and raised questions about the ethical and moral obligations that surgeons have to their patients. According to MDs M. Michael Khair and Anthony A. Romero, the decisions surrounding concurrent surgery should be based on patient care. A surgeon's decisions should always focus on the patient first. If a surgeon wants to conduct concurrent surgery, he or she has an obligation to provide the patients with accurate and comprehensive information about the procedure. When the patient is on the operating table, a surgeon must be committed to completing the operation in the safest and most effective way possible. Once the operation is over and the patient has recovered from anesthesia, it is the surgeon's responsibility to share findings and to report the outcomes in a clear manner. Some surgeons may face an ethical dilemma when training a younger, less experienced surgeon. Educators often suggest one of the best ways to solve this is by granting autonomy in a safe and secure environment during training. Carefully monitored autonomy for surgeon trainees is to perform concurrent surgeries—but the lead surgeon must still maintain the ethical and moral obligations to the patient.

Practice Management

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Many physicians still have concerns about the viability of telehealth, particularly regarding payment, workflows and less patient engagement. Telehealth is here to stay, so physicians should get on board and implement policies to help consumers who want greater efficiency and better care. Here are five reasons why it is beneficial to practice telehealth:

1. Get paid for things you are probably already doing for free. Most doctors spend time calling patients or answering messages. With telehealth, you can conduct this business through video while getting reimbursed for the care you deliver.
2. Improve access to care. Telehealth makes after-hours acute care a reality. Patients will be happy to talk to you in an emergency at an off hour, which can help build loyalty.
3. Make better use of midlevel and support staff. Telehealth can vastly improve your triage services. Videos can help assess new complaints. Technology can lead to more efficient pre- and postprocedure consultations. Ultimately, telehealth allows you to do more procedures with greater efficiency.
4. Enjoy real care coordination without the hassle. Instead of giving a patient a referral to see a specialist, you can invite the providers to see the patient right in your office with telehealth.
5. Make your patients' lives easier by eliminating unnecessary in-person visits. Patient are more satisfied with telehealth. Proper use allows for more access, less transportation and shorter waiting times.

To reduce stress and decrease the risk of burnout, physicians must take initiative and make a conscious decision to change. According to Sue Jacques, a medical and corporate professionalism consultant based in Calgary, Alberta, here are four decisions physicians must make to keep satisfaction high and burnout low:

1. Delegate responsibilities to others. For physicians who like being in control, this can be tough. Staff and colleagues should help take patient histories, conduct an initial exam and handle follow-up.
2. Diversify your practice and look for ways you can innovate. Alter business practices to inject some novelty into your daily routine.
3. Decline obligations that force you to work longer hours. This could even mean denying a patient's demands.
4. Decompress by setting time for yourself. Get away from the practice and do something you enjoy. Spend time outside with your family or engage in a hobby.

A new report from FAIR Health outlines the care preferences for U.S. adults. Here are three conclusions the report noted that could help you make healthcare decisions at your practice:

1. Patient education is key. Patients want to be educated, particularly when it comes to health plan benefits. Increasing a patient's healthcare literacy can help them make better choices, thereby reducing overall costs. This information should be imparted in a simple, accessible way so that patients can understand it completely. Use of social media could be important in this regard.
2. Encourage robust patient engagement. Providers should make a concerted effort to convince patients to take an active role in their own care. Patients should be engaged in advanced planning for their treatment plans, which will help them remain healthy while understanding the choices they make.
3. Identify and respect unique patient needs. Understanding the cultural impact of treatment plans or health insurance plans is crucial in ensuring that the patient is pleased with his or her care. To understand cultural differences, the report authors suggest consulting outside cultural immersion experts.

Health Policy and Reimbursement

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A recent study claims that the primary barriers to electronic health record (EHR) implementation include cost and hospital efficiency. A team of researchers identified 25 adoption facilitators and contrasted them with 23 adoption barriers. Facilitators included increased efficiency, hospital size, quality, access to health data, perceived value and ability to transfer health information. Barriers included cost, time consumption, provider’s perception of usefulness, transition of data, location of healthcare facility and implementation issues. Cost-associated fears appear to be the biggest issue. This mentality goes back to 2009, when critics cited high cost as an adoption challenge following the passage of the HITECH Act. Recent examples that could be feeding the cost-fearing frenzy include the recent implementation fiasco at Southcoast Hospital in Massachusetts, where an attempted EHR adoption resulted in 95 employees losing their jobs. Incidents like this tend to color perception, the researchers said. Depending on how a provider perceives the cost of EHR adoption, that provider might view it as either a barrier or a facilitator.


The Centers for Medicare and Medicaid Services (CMS) are working on easing complaints from the medical community concerning rewards and penalties for physicians who use electronic health records (EHRs) under the Medicare Access and CHIP Reauthorization Act (MACRA). Medical professionals believe the law needs new performance measures instead of old recycled ones to drive down costs and improve patient care. Interoperability is a big sticking point for physicians who think that CMS has not yet done enough to allow EHRs to communicate seamlessly with one another. Based on feedback from the medical community after the MACRA regulations debuted, it does not appear that CMS is successfully assuring its constituency. The American Medical Society and 36 other national medical societies say the government is off to a bad start. In a letter, they note that claims from vendors about the interoperability capabilities of their systems are off base. The medical societies fault the meaningful use requirements for focusing too much on how many times "voluminous documents" are transmitted. They believe that CMS should restructure MACRA so that it emphasizes quality of data over quantity of data.


The Senate Appropriation Committee's Labor, Health and Human Services Subcommittee has advanced a bipartisan health spending bill that includes significant funding boosts to federal research, precision medicine and anti-opioid programs. The bipartisan bill, the first of its kind since 2009, will soon reach the full committee. There are still worries that other Senate Republicans could push their own amendments on the bill, such as stripping the Affordable Care Act of funding, but negotiating Sens. Roy Blunt and Patty Murray hope it will avoid "poison pill" riders. The National Institutes of Health will receive an additional funding boost of about $2 billion, growing its total budget to $34 billion. The Department of Health and Human Services' opioid abuse programs will grow by 93 percent compared with last year and nearly 500 percent from two years ago.

Medicine, Drugs and Devices

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The Centers for Medicare and Medicaid Services (CMS) have cut spending on durable medical equipment, such as orthotics, prosthetics and other supplies, by more than $4 billion in the last five years. CMS has implemented changes to its device bidding system since 2011, when legislation mandated that the process occur. Data indicated that payments were excessive, so CMS slashed spending, cutting more than $580 million in an initial rebid and then $3.6 billion in a second round of rebidding. Earlier this year, CMS phased in the adjusted durable medical equipment fee schedule rates in non-competitive bidding areas. This new fee schedule has not resulted in any adverse health outcomes.


U.S. House Representatives Mike Fitzpatrick and Louise Slaughter are sponsoring the Medical Device Guardian's Act of 2016, which aims to require doctors and hospitals to report adverse events associated with medical devices while protecting them from the liabilities about which they report. The bill stems from a recent controversy with power morcellators, surgical tools used in minimal incision surgery. In 2014, the U.S. Food and Drug Administration (FDA) issued guidance warning that using these devices could excise tissue that is potentially cancerous, thereby risking metastatic growth. FDA's "lax enforcement of self-reporting requirements" is concerning to Hooman Noorchashm and Amy Reed, two Philadelphia-based physicians who led efforts to raise awareness about morcellator safety. They believe FDA policies have created a "culture of complacency" around medical devices, saying that the legislation is necessary to protect individual practitioners from liability. Current FDA policy requires manufacturers and hospitals to report all adverse events and additional labeling information to the agency, and the proposed bill would add doctors' offices to the list of reporters. FDA has not commented on the bill.


Patients with osseointegrated implants have minimal risk for severe infection, according to a new study in the Journal of Bone and Joint Surgery. Researchers developed a new infection classification system to track 91 press-fit osseointegrated implants. Thirty-six percent of patients using these prostheses had no side effects or complications while 34 percent developed grade one or grade two infections. No patients had grade 3 or grade 4 infections. Thirty percent of patients did not have an infection but reported other issues, such as hardware problems or fracture. The osseointegrated implants can provide more comfort and mobility for amputees, so these results may indicate more widespread use.