News From ACFAS

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It’s Oscar season in the public relations world, and ACFAS’ Take a New Look at Foot & Ankle Surgeons campaign is sweeping the nation! The College’s national public relations campaign to help our members attract more patient referrals won three prestigious first place awards this past month:

• Public Relations Society of America (Silver Anvil Award)
• Publicity Club of Chicago (Golden Trumpet Award)
• Public Relations Society of America Chicago Chapter (Skyline Award)

All three awards were in the nonprofit brand/reputation management category and recognized excellence in planning, creativity and execution. Honored along with ACFAS was our PR agency-partner, Fleishman Hillard, and their Chicago-based Healthcare Practice Team.

The “Take a New Look” campaign, launched in 2015, educates nurse practitioners, diabetes educators and family physicians on why they should refer their patients to ACFAS members. You can use the campaign tools in your own practice. See how at TakeANewLook.org. Share your expertise with your colleagues and the profession by applying to join the ACFAS faculty. As a faculty member, you’ll help lead the College’s effort to continually expand its Surgical Skills courses, regional programs, e-Learning products and Annual Scientific Conference sessions.

If you’re an active Fellow member of the College, have attended our educational programs within the past three years and have been in practice for more than four years, complete a Faculty Application and fax it to the ACFAS Education Department at (800) 382-8270 or email it to Mary Meyers, ACFAS director of Education Curriculum and Alliances. Don’t let financial stress get in the way of your workday. HealthCare Associates Credit Union (HACU), an ACFAS Benefit Partner, offers financial wellness programs to help you manage day-to-day expenses and also plan for retirement.

No matter if you are graduate with high medical school debt, a resident taking on your first car or home loan or an established DPM interested in long-term investments, HACU provides free tools and products to help you save, budget and spend wisely.

HACU offers ACFAS members:

• Low rates on student loan financing and refinancing, personal loans, auto loans, credit cards and mortgages
• Savings, checking and money market accounts plus CDs
• Commercial loans, lines of credit and equipment loans to help grow your practice

To learn more, visit hacu.org.

Foot and Ankle Surgery

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A study was conducted to evaluate the utility of indocyanine green fluorescence imaging (ICG-FI) in the quality control of revascularization. A total of 104 limbs exhibiting critical limb ischemia in 101 patients were assessed via ICG-FI using SPY Elite before and after open or endovascular revascularization. Ankle-brachial index (ABI) and toe pressure (TP) also underwent measurement. Following ICG-FI, assessment of circulation was conducted with the time-intensity curve derived from the two regions of interest, with one in the plantar side of the foot and the other in the dorsal side. Three parameters were derived from the curves: maximum intensity, intensity rate and SPY10. Results were obtained from 62 limbs in Rutherford classification category three, 12 limbs in category four and 30 limbs in category five. Ninety-five technically successful procedures were realized, including 63 endovascular and 32 open surgical revascularizations. In nine patients, an in-line flow from the aorta to the foot was not accomplished due to a failure to recanalize the occlusion or because of distal embolization. ABI was unreliable in 58 patients mainly on account of pseudohypertension, and TP was unreliable in 49 patients mostly due to previous minor amputations. ICG-FI was successful in all patients. The average intensity values before and after the procedure in patients with successful revascularization were about 81 units and 120 units of intensity and intensity rates of 4.2 and eight, respectively. No changes in the hemodynamic parameters were observed in PTA patients with unsuccessful revascularization. Six patients who underwent technically successful revascularization had worse SPY values following revascularization compared to the baseline.


A study was conducted to simulate radiographs from isotropic three-dimensional (3D) magnetic resonance imaging (MRI) data, compare associations of angle and joint space measurements on simulated radiographs with corresponding two-dimensional (2D) MRIs and real radiographs (XR) and compare measurement times among the three protocols. Included were 24 consecutive ankles from eight males and 16 females, with an average age of 46 years. Segmented joint models simulating radiographs were generated from 3D MRI datasets. In all cases, simulated radiograph models were successfully generated. Good agreement was observed among all readers across all modalities and among most measurements. Absolute measurement values differed between modalities. Measurement time was substantially greater on 2D compared to simulated radiographs for most measurements and on XR versus simulated radiographs for nearly 50 percent of the measurements.


A new study published in Current Orthopaedic Practice found female runners with a body mass index (BMI) lower than 19 may have a higher propensity for stress fractures compared to women with a BMI of 19 or higher, and they also may take longer to recover from such injuries. The injury scoring system used by the researchers ran on a scale of one to five, considering not only patient symptoms, but also x-ray results, bone scan and computed tomography (CT) images, and magnetic resonance imaging (MRI) outcomes. Among patients with grade five stress fractures, women whose BMI was 19 or higher took about 13 weeks to recover. Those with a BMI lower than 19 took more than 17 weeks to recover and return to running.

Practice Management

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Mutaz Shegewi at IDC Health Insights observes that implementing revenue cycle management (RCM) systems is gaining a renewed sense of urgency as small physician practices enroll in pay-for-performance initiatives. "Typically, vendors offer physician practices everything beyond the patient encounter, including scrubbing the codes, generating and submitting claims and then posting the payment to the practice. In return, vendors ask for a percentage of the practice’s revenue and for some practices that’s a very appealing offer,” Shegewi says. However, this arrangement comes with many challenges because vendors and their clients typically do not communicate effectively and set the right expectations, says Shegewi. Moreover, practices frequently believe they need to do nothing beyond the clinical aspect of the patient encounter and outsource RCM to the vendor. This view causes problems because practices actually need to be following best practices. "For example, there are coding processes and tasks that need to be streamlined to ensure practices properly code items prior to the end of the encounter, which with the aid of the vendor and their capabilities can be identified and continuously improved on," Shegewi says. He recommends four key strategies that small practices deploy to help them improve their RCM operations: understanding their goals and the IT solution; aggressively evaluating RCM tools; staying vigilant during an RCM implementation project; and learning from, continually improving on and optimizing the RCM solution.


Marketing is essential to get a practice's information out to the public and can include Facebook and other social media. People can see what the practice is about as well as share that information with many others. Social media pages should include updates about the practice, photos and relevant health articles geared toward its patient population. Practices can also benefit from having a well-designed brochure with thoughtful content, updated business cards with new colors and layouts and a logo and printables, such as water bottles, baseball caps and t-shirts. As for advertising, practices could consider putting their practice information on pharmacy bags or grocery carts at retailers, sponsoring community events like 5K races or school sports teams and getting car magnets for staff and reimbursing them with gift cards for placing them on their cars. Practices should also consider volunteering their office at health fairs. People are happy to see their physicians at these events and are motivated to talk to other people. Practices should also reexamine their office space to see if the decor is up to date, whether the furniture looks worn or if the walls are scuffed. Finally, it is essential to look closely to see how clean the office is. Conducting a deep clean can brighten up the appearance of the office space.


A 2016 report by Medscape found that 57 percent of more than 15,000 physicians surveyed said having to deal with electronic records was reducing the amount of face-to-face time with patients. However, large health systems hope to leverage patient data to make better decisions. Kaiser Permanente of Oakland has developed an algorithm for hospital patients that factors in a combination of vital-sign monitoring with data pulled from electronic medical records to predict the risk of rapid deterioration. Dr. Pat Conolly, a Kaiser executive who oversees information technology efforts, says the early alert system will be implemented across all Kaiser hospitals. Medscape's survey found that 96 percent of physicians said they currently use or plan to implement an electronic medical record system, and despite the shortcomings, most agree that electronic records continue to improve. Matthew Douglass, a cofounder of electronic medical records company Practice Fusion, says the company routinely tests experimental features with small groups of volunteers and allows customers to submit ideas for improvements. Meanwhile, a company called Augmedix wants to give physicians a "hands-free" way to fill out their patients' records without having to break away to enter information on a laptop to tablet. Equipped with a Google Glass headset, doctors can interact with their patients while a trained medical scribe, linked to the doctor by audio and video, takes notes and fills out paperwork. The physician can quickly review the notes and approve them after the patient departs.

Health Policy and Reimbursement

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Pharmaceutical companies have faced increased scrutiny in light of skyrocketing drug prices. In an effort to bring relief to Americans, some insurers are beginning to educate doctors on costly drugs and how they are sold. Capital District Physicians' Health Plan (CDPHP) is doing its part by hiring former pharmaceutical representatives to have a greater impact. If insurance companies are successful in lowering drug costs, premiums will also decline. In fact, CDPHP has seen success and has helped keep the insurer’s annual drug cost increases in single-digit percentages.


Extreme swings and double-digit growth in employer medical costs appear to be in decline, according to a report by PricewaterhouseCoopers' Health Research Institute (HRI). It predicts a 6.5 percent growth rate in healthcare costs in 2018, only half a percentage point higher than this year. When taking into account anticipated changes in benefit plan design, such as changes to copays and network size, the net growth rate is expected to be one percentage point lower, at 5.5 percent. This reflects what HRI calls a "new normal," a continuation of medical cost trends hovering in the single digits and fluctuating only slightly, with significant cost spikes appearing unlikely for the foreseeable future. Among factors that will put upward pressure on medical costs in 2018, according to HRI, is rising general inflation. The U.S. economy is gaining strength amid a long expansion, and higher general inflation rates will affect the labor-intensive health sector, driving up wages and medical prices. HRI also predicts the movement to high-deductible health plans will start to diminish. And as fewer branded drugs come off patent, employers will have fewer opportunities to encourage employees to buy cheaper generics, another strategy they have historically used to keep costs down, according to HRI. Two factors that could curb those health spending increases are political and public scrutiny of drug prices and employers minimizing waste by better managing and deploying new treatments and technologies.


A new federal estimate indicates the GOP-led House's replacement bill for the Affordable Care Act (ACA) would lead to 10 million fewer people lacking health insurance in the next 10 years than calculated by the Congressional Budget Office (CBO), while also forecasting higher premiums for many customers of individual health plans. The Office of the Chief Actuary of the U.S. Centers for Medicare and Medicaid Services (CMS) reported there would be 13 million more uninsured Americans by 2026 if the House's American Health Care Act (AHCA) bill is signed into law. In comparison, CBO projected 23 million more people would become uninsured. If the ACA is retained, CBO estimated 51 million would be uninsured by 2026, while the CMS actuary estimated 41 million total uninsured under the AHCA. The actuary also projected average gross premiums to be about 13 percent lower in 2026 in the individual insurance plan market under the AHCA than under the ACA. However, he also said the average monthly cost of the insurance after government subsidies to customers is "roughly five percent higher than under current law." In addition, the out-of-pocket sum customers would pay for health services or prescriptions could average about 61 percent higher under the AHCA than if the ACA is kept.

Medicine, Drugs and Devices

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A 10-year study has found that men and women aged 75 or older who take aspirin daily to ward off heart attacks face a substantially elevated risk of serious, even fatal, bleeding. The implications of long-term aspirin use in seniors have remained unclear due to the fact that most of the clinical trials involve people younger than 75. However, the new study was split evenly between those over 75 and those younger. In total, 3,166 Britons who had suffered a heart attack or stroke and were taking blood-thinning medication to prevent a recurrence were included in the study. The research team stressed that their results did not mean older adults should stop taking aspirin. Instead, broad use of proton pump inhibitor heartburn drugs, such as omeprazole, is recommended. The study was led by Peter Rothwell, director of the Center for Prevention of Stroke and Dementia at Oxford University.


A study presented at the Annual European Congress of Rheumatology 2017 showed fluorescence optical imaging (FOI) is as good as ultrasound with power doppler (US/PD) at monitoring treatment response in juvenile idiopathic arthritis (JIA) and more effective than US/PD at spotting inflammation earlier. Twenty-four of 37 patients with polyarticular JIA were administered methotrexate, and 13 received a biologic for the first time. FOI images revealed a signal enhancement suggesting active inflammation in at least one phase in 38.7 percent, 29.2 percent and 27.6 percent of the joints at baseline, in week 12 and week 24, respectively. FOI identified the most signals suggesting active inflammation with 32 percent of joints versus 20.7 percent with US/PD and 17.5 percent by clinical examination. Many joints had FOI signals suggesting inflammation but were clinically inactive, while 20.1 percent of joints with FOI signals exhibited no effusion, synovial thickening or hyperperfusion on US/PD.


Researchers at The Johns Hopkins Hospital have discovered that 20 percent of hospitalized patients who received at least 24 hours of antibiotic therapy developed antibiotic-associated adverse drug events. Furthermore, 20 percent of adverse drug effects were attributed to antibiotics prescribed for conditions that did not require the use of antibiotics. The most common adverse side effects reported were gastrointestinal, kidney and blood abnormalities. The study, published in JAMA Internal Medicine, adds that doctors should be careful when prescribing antibiotics in order to reduce the chance for adverse drug events.