News From ACFAS

---

The deadline for responding to the College’s triennial Member or Practice Surveys has been extended to June 24. Make sure your voice is heard. Search your inbox for an e-mail from ACFASpresident@perceptionsolutions.com and respond ASAP to have a shot at winning your choice of an Apple Watch, free registration to ACFAS 2016 in Austin, or free 2016 membership dues.

All responses are anonymous and are only reported in the aggregate by a third-party survey consultant. Survey results will be available on acfas.org in late summer.
With patients to see, vacations to plan and warm weather to enjoy, marketing your practice may not be at the top of your summer to-do list. Let our latest issue of FootNotes take some of the pressure off!

Visit the ACFAS Marketing Toolbox to download the Summer issue, which includes these timely articles:

• Have You Checked Your Feet for Skin Cancer?
• Tips to Avoid Storm Cleanup Foot Injuries
• Protect Your Kids' Bare Feet This Summer

Customize page 2 of FootNotes with your office’s contact information and post it on your website or social media sites, put copies in your waiting room or distribute FootNotes at upcoming health fairs and speaking engagements. Just a few keystrokes and clicks can help you grow your practice and attract new patients this summer!

Be sure to check out our other free members-only resources at acfas.org/marketing, including the complete FootNotes archive library, patient education PowerPoint presentations, press release templates and more, to promote your practice year-round.

Foot and Ankle Surgery

---

A recent anatomic study looked to evaluate the feasibility of posterior arthroscopic tibiotalar fusion while determining arthroscopy entry points, mortise cartilage freshening quality and the risk of complications. A total of 10 specimens were observed. The entire plafond of the tibia could be debrided in all cases; the talar dome was debrided entirely 20 percent of the time. In 80 percent of cases, only the posterior two-thirds could be treated because of poor accessibility to the anterior portion approaching the neck of the talus. More than 50 percent of the area of the malleolar grooves was debrided. Researchers concluded that a posterior approach to arthroscopic ankle fusion could lead to adequate joint preparation and reduce nerve damage risk. The technique was feasible if there was no hindfoot deformity of tibiotalar equinus creating difficulty.


Few novel techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce complications following surgery. A retrospective cohort study looked to compare clinical outcomes and complications between open repair methods and a percutaneous Achilles repair system (PARS). Researchers reviewed 270 cases of operatively treated acute Achilles tendon ruptures. Ninety-eight percent of patients treated with PARS were able to return to physical activities by five months compared to 82 percent for the open repair group. There were no significant differences in rates of rerupture, sural neuritis, wound dehiscence, superficial and/or deep infection or reoperation. Overall, the study revealed that 8.5 percent of the treated Achilles ruptures experienced complications, and 88 percent of patients returned to baseline activities within five months.


Researchers attempted to determine the long-term effects on the donor site of the foot and ankle after vascularized fibular graft resection in children. Eight patients underwent the surgery and were followed-up between three and 12 years after the operation. Two patients who underwent resection of the middle shaft of the fibula developed abnormal growth of the distal tibia, which led to ankle valgus. One patient developed hindfoot valgus because of weakness of the tibialis posterior muscle. Researchers concluded that resection of the middle shaft of the fibula for the purpose of vascularized fibula graft had a significant correlation with abnormal growth of the distal tibial physis later in life. The surgery may also promote weakness in the area of the operation.

Practice Management

---

Traditionally, companies focus on retirement and investment when designing benefits packages for employees. According to Kelley Long, a resident financial planner with Financial Finesse, putting an emphasis on the "here and now" can also be a great way to design a stellar benefits package while boosting employee productivity and engagement. Granting annual raises and allowing for more immediate benefits can have a huge impact on overall productivity because surveys have shown that employee financial wellness can affect that of a company. Twenty percent of employees say their financial situations are a distraction at work, and 37 percent claim to spend three or more hours per week thinking about or dealing with their personal finances. In addition, reports have shown that financial distress is a key motivator in employee embezzlement. Employers should customize benefit programs to focus on generational issues. For younger employees, target educational debt, for example. For older employees, target elder care.


Boosting patients' engagement with a practice's Web portal can be accomplished in four ways, including:

1. Directing patients to access return to work or school slips on the portal. This suggestion even works for general or orthopedic surgeons who see numerous patients once for follow-up.
2. Acquiring tablets and implementing on-site patient training. A staffer should walk patients through signing into the portal and sending a message to the nursing staff to let them know why they are in the clinic today. This can be done in the waiting area or exam rooms while patients are waiting to see the provider.
3. Promoting the portal. Practices should ensure when they market their portal that they let patients know they can send and receive messages from staff, check lab results and request refills without waiting for callbacks.
4. Getting physicians to participate. One way to do this is to have physicians talk with patients about the portal. In addition, the physician can ask patients to check for a message from the clinic to see how they are doing following the visit.

Health Policy and Reimbursement

---

U.S. Rep. Gary Palmer (R-Ala.) has submitted legislation that would establish a two-year "grace period" following the ICD-10 compliance date during which providers would not be denied Medicare/Medicaid payments due to coding error. The Protecting Patients and Physicians Against Coding Act calls for a delay so providers can "focus on patient care instead of coding and receiving compensation" while ICD-10 is being fully implemented. Palmer warns that ICD-10's five-fold increase in codes compared to ICD-9 creates significant administrative challenges for rural and small town providers in particular, who may lack the resources to fully prepare for the ICD-10 implementation.


Starting Aug. 1, providers considered to be "high risk" for defrauding state Medicaid programs will need to undergo criminal background checks that include fingerprinting, and by March 2016 states' Medicaid and CHIP providers must be ranked as having limited, moderate or high risk of defrauding the program. States will need to repeat this process at least every five years. Only providers that pose a high risk will be required to undergo fingerprinting and background checks. The Centers for Medicare and Medicaid Services (CMS) started conducting fingerprint-based background checks for Medicare providers in August 2014. Last year, Medicaid provided medical services for approximately 60 million people at a cost of $310 billion. During that same year, CMS estimated that the improper-payment rate was 6.7 percent, or $17.5 billion, an increase of more than $3 billion from the previous year. "Strengthening and improving upon programs that provide vital services like Medicaid to millions of Americans is a continuous process, and at CMS we take seriously our responsibilities to taxpayers and beneficiaries," says Shantanu Agrawal, director of the CMS Center for Program Integrity. To avoid unnecessary cost and burden, a state Medicaid agency need not perform a background check on someone who just went through the process for Medicare or another state's agency. States may also require a higher-risk provider to pay the costs of obtaining fingerprints.


A new study finds that long-term-care hospitals frequently discharge Medicare patients during a window of time that would allow them to maximize Medicare reimbursement. The study, published in Health Affairs, examined patients who were on ventilators, although a recent Wall Street Journal analysis found the same pattern for all patients. Long-term care hospitals are paid under different rules than general hospitals, receiving smaller payments for shorter stays until a certain threshold is met, after which the payment increases to a lump sum.

Medicine, Drugs and Devices

---

A study presented at the American Diabetes Association 2015 Scientific Sessions indicates a possible role of vitamin D in the pathogenesis of painful diabetic peripheral neuropathy. The difference between this study and previous efforts is that this is the first one that accounts for seasonal differences in vitamin D exposure. Forty-five patients with type 2 diabetes were studied. All had their vitamin D levels measured and answered questions regarding sunlight exposure and neuropathy symptoms. Four groups were assembled: 17 in the painful neuropathy group, 14 with painless neuropathy, 14 with no neuropathy and 14 healthy volunteers. It was found that vitamin D levels were significantly lower in the painful neuropathy group. Study leaders noted that while more data needs to be gathered, supplementing poses no harm and could in fact be beneficial.


Knee-ankle-foot orthoses with drop locked knee joints can produce walking limitations in patients with weak quadriceps muscles. Developing stance control orthoses is a potential solution. A recent review aimed to compare the effect of stance control orthoses to knee-ankle-foot orthoses with drop locked knee joints in improving certain kinematic variables as well as energy efficiency. The literature review yielded 18 articles chosen for analysis. The results showed evidence that stance control orthoses designs can improve gait kinematics but not energy efficiency compared to knee-ankle-foot users. Research is still necessary to develop a design that provides a more normal walking pattern. Such an innovation could be a significant step toward improving the gait of knee-ankle-foot orthosis users.


Researchers have unveiled the world's first artificial leg with the ability to simulate the feelings of a real limb and fight phantom pain. Six sensors are placed on the foot sole of a lightweight prosthesis and linked to stimulators inside the shaft where the stump is. It allows the wearer to know that a foot is present and gives the impression that it rolls off the ground with each step.