News From ACFAS

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The Council on Podiatric Medical Education’s new residency standards (CPME Documents 320 and 330) have been published, following a six-month comment period from the podiatric community. The standards retained, unchanged, the 300 surgical cases requirements for residents. An earlier proposed draft suggested two levels of surgical cases. Both ACFAS and the American Board of Foot and Ankle Surgery submitted comments to CPME urging that no changes be made to the surgical cases requirement.

“Although quantitative assessment is not the optimum measure of a resident’s progress, these numbers help standardize the process,” said ACFAS President Richard Derner, DPM, FACFAS. “We applaud CPME’s decision to maintain the 300 minimum surgical case requirement.”
New graduates, take the next step in your career development and join ACFAS—for free! Our Regional Divisions are proud to support first-year podiatric surgical residents with a complimentary first-year membership to the College. Receive all member benefits, including special pricing on conferences, products and services, free for one year (a $118 value).

You’ll enjoy access to acfas.org, the College’s premier website, and a subscription to the online version of The Journal of Foot & Ankle Surgery (JFAS), your source for the latest surgical techniques and research.

Join now to receive an additional three months of membership, through September 2016, and access JFAS that much sooner!
When you’re an ACFAS member, it’s easy to stay one step ahead of the latest Journal of Foot & Ankle Surgery (JFAS) research.

Just log in to your account at acfas.org/jfas, then:

1. Click Read Current and Past Issues Online.
2. Scroll down to Articles in Press.
3. Read new articles before they’re assigned to an issue.

Articles are posted as soon as their proofs are approved; log in often to get an inside look at what’s in store for future JFAS issues.

Foot and Ankle Surgery

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Researchers conducted an investigation to determine the effects of chronic ankle instability (CAI) and altered visual focus on strategies for dynamic stability during a drop-jump task. Nineteen patients with CAI completed the task and were compared against 19 healthy participants. All patients were required to complete a drop-jump task in looking-up conditions and looking-down conditions. For the looking-up condition, participants looked up to read a random number on a computer monitor. For the looking-down condition, participants focused their vision on the force plate. Hip, knee and ankle kinematics were recorded. The CAI group showed less hip flexion and knee flexion compared to the healthy group. No differences in kinematics or dynamic stability were recorded. The researchers concluded that centrally mediated changes associated with CAI may lead to global changes in relation to sensorimotor control.


Charcot osteoarthropathy (charcot foot) is a rare debilitating condition that can result in severe deformity and ulcers in bones and joints. These complications sometimes lead to amputation. A team of researchers observed patients with type 2 diabetes to determine the prevalence of charcot foot and its association with age, BMI, gender and duration of diabetes. Among 704 males and 1,227 females, 0.4 percent had charcot deformity. Bilaterally symmetrical neuropathy was found in 25.4 percent of patients. Diabetes duration showed an association with deformity, but age, BMI and gender showed no such relationship. The researchers recommended that patients with diabetes be handled carefully. Early identification and management of risk factors are two key elements in preventing charcot deformity.


A study presented at the European League Against Rheumatism (EULAR) Annual Congress showed for the first time that treatment-naive patients with early rheumatoid arthritis (RA) exhibit myocardial and vascular abnormalities, even at the earliest stage of their disease. This suggests patients may develop early cardiomyopathy that raises the risk of cardiovascular morbidity and mortality from the time of their diagnosis. Cardiac magnetic resonance imaging was administered to 66 patients with treatment-naïve early RA meeting American College of Rheumatology/EULAR classification criteria and with no previous history of cardiovascular disease. All patients had experienced RA symptoms for less than 12 months, were disease-modifying antirheumatic drug treatment-naïve and had a minimum disease activity score of at least 3.2. Thirty healthy controls were matched by age, gender, and blood pressure for comparison.  Aortic distensibility was substantially reduced in the early RA patients versus healthy controls, with other measures of arterial stiffness demonstrating similar significant differences. Left ventricular and right ventricular end-systolic and end-diastolic volumes were significantly lower in the early RA patient group compared to the control group.

Practice Management

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A good coder can be a huge asset to any practice. Practices can take certain steps to ensure they hire the best coder available. The first is to outline a concrete job description that says exactly what the coder is expected to do. In some offices, coders are expected to simply code; in others, they could be held responsible for every part of the claims process. Look for coders who are Certified Professional Coders. A non-certified coder is not necessarily a bad thing, but someone who is certified is virtually guaranteed to have the basics mastered. Credentialing organizations like the American Academy of Professional Coders can provide resources to help the search for the right coder.


Physician practices can safeguard their data from hackers by following five easy steps:

1. Be aware of what information you share with others over social media and other channels and avoid posting birth dates, graduation years or your mother's maiden name, which can often be used to answer security questions to access accounts online or via phone.
2. Choose a strong password that is extensive in length and contains many nonsensical characters. Longer, more complex passwords take a computer a long time to guess.
3. Use a two-step password if offered.  Facebook and Gmail have an optional security feature that, once turned on, requires users to enter two passwords: a normal password as well as a code that the companies text to the user's phone to access the user's account.
4. Do not use Wi-Fi hot spots frequently because such public access points are insecure.
5. Back up your data regularly via a simple and free backup system available on websites such as Crashplan and Dropbox.

A recent Medical Group Management Association poll revealed that managing teamwork and group dynamics within a practice is one of the most pressing challenges managers face. It is easy to see why this is a conundrum. Medical practices consist of people of a variety of ages doing a variety of jobs. Some are hourly, some are specialty trained, some are administrative. Keeping track of it all can be a daunting task. Luckily, some options are available to navigate this situation. It helps to first define your vision. If your vision is motivational and clearly articulated, it can go a long way toward unifying your practice. Next, be sure to communicate effectively. Communication is key and will always be the glue that holds your practice together. Poor communication can lead to dissent and confusion, which can have a negative impact on your practice. Another step is to be transparent. This engenders trust, promotes integrity and will make everyone work hard because they feel like an important part of the team. Finally, engage your employees so they show up to work excited and ready to take on all challenges. Engaging them and making the workplace a fun environment will lead to this.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services began to settle disputed recovery audit contractor (RAC) clawbacks with hospitals as of the start of June. The payouts will total $1.3 billion across 1,900 inpatient facilities, representing settlements of around 300,000 disputed claims. The RAC program was put in place six years ago to uncover suspicious claims, but accusations of overreach have followed and appeals for clawbacks have overwhelmed the system. Last year, the appeals of RAC clawbacks clogged the federal administrative law system. In 2013 alone, the program clawed back more than $2 billion in overpayments. These payouts have been questioned by government watchdog organizations, who believe the lack of transparency should be a "major concern to taxpayers, members of Congress and Medicare beneficiaries."


A draft bill released by the U.S. House Appropriations Committee on June 16 reveals multiple cuts for the Centers for Medicare and Medicaid Services (CMS). Chief among these cutbacks are the elimination of the Health & Human Services' Agency for Health Research on Quality (AHRQ), as well as a $344 million cut for CMS funding. In addition, the bill details a total of $7.1 billion in rescinded funds from the Center for Medicare and Medicaid Innovation and the Patient Center Research Outcomes Institutes. In response, the Association of American Medical Colleges (AAMC) released a statement calling the draft bill "troubling" and noted that terminating AHRQ is an action that would greatly affect development of evidence-based care. AAMC also claimed the bill is "insufficient to meet the nation's health needs."


A recent Supreme Court decision concerning regulation powers of state boards has prompted the Federal Trade Commission (FTC) to release guidelines that will clear up any confusion among state officials. The court's ruling said state licensing boards made up of active members of the profession, such as practicing doctors, are not immune from antitrust laws unless they are actively supervised by the state. The question at hand involves the definition of active supervision. Justice Anthony Kennedy's majority opinion noted that active supervision requires the state supervisor to review the substance of board decisions and to have the power to change decisions to ensure they fit in with state policy. The coming FTC guidelines will allow state officials to know exactly what their roles are and exactly what structure needs to be put in place.


Medicare's chronic care management (CCM) code 99490 pays physicians for non-face-to-face time spent on certain patients, but early returns show that doctors are turning down the money attached to the code because of the time and cost of adhering to its requirements. Physicians claim that Medicare created a system so frustrating that doing the services for free is the better option in many cases. To submit a claim for 99490, physicians cannot also submit claims for transitional care management, home health, hospice or certain end-stage renal disease service codes the same month. In addition, any practice's electronic health record system must have a clock on it to determine how much time was spent on each patient. In many cases, requirements like this actually cost money, so the physician is not ending up with any of the extra money promised by 99490 in the first place. Some physicians are satisfied with the code, saying that it rewards doctors and makes a solid attempt at a fee-for-service method. But according to physician Steven Green, a recent conference asked physicians whether or not they were using the code and "everyone in the room but one said 'No.'"

Medicine, Drugs and Devices

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A bipartisan bill known as the 21st Century Cures act will soon be sent to the House of Representatives, and House committee leaders are fighting back against opponents who claim the legislation endangers patients. The bill's main purpose is to speed up the Food and Drug Administration's (FDA) approval process for new drugs. Advocates claim it will make the approval process safer and more efficient. Opponents, including a former FDA commissioner and two Harvard medical school professors, say the bill's provisions will hurt the drugmaking process by making clinical trials less important. In essence, streamlining the process could lower the standards of approval. Committee leaders noted that the bill is also adding $10 billion for research at the National Institutes of Health and that other stipulations, such as a required post-market review after an approval, mean that there will be no change to consumer safety. The bill could be signed into law later this year.


A new study aimed to determine the effectiveness of using the Nintendo Wii Fit as potential treatment for lateral ankle sprains. A total of 90 lateral ankle sprain patients were assigned to a Wii Fit physical therapy group or a control group. The patients were observed for six weeks. Foot and ankle scores improved in all groups and pain decreased while walking. No significant differences existed between the two groups in the areas of delay before return to sport or patient satisfaction. It was determined that the Wii Fit could be used as exercise therapy to treat ankle sprain patients; however, Wii Fit therapy was no more effective than physical therapy or no therapy.