News From ACFAS

---

“To do is to learn” and what better way to practice this maxim than in ACFAS’ newly redesigned Interactive Surgical Coding Workshop? Set for July 17–18 in Tysons Corner, VA (Washington, DC), this hands-on course gives you the chance to code real cases with your fellow attendees, all while showing you how to maximize your practice’s revenue cycle.

Perfectly tailored to you and your office staff, sessions will address new requirements for modifiers, ICD-10, office policies and much more. You’ll also earn 12 continuing education contact hours and receive a comprehensive reference guide, breakfast and lunch. Space is limited, so register yourself and your office staff today.

And if you’re looking for more tools to help manage your practice, listen to ACFAS’ latest podcast, Problem Patient II, the follow-up to last fall’s popular Challenging Patient release. John N. Evans, DPM, FACFAS, and Joseph J. Menn, DPM, FACFAS, explain how to keep your emotions and ego in check when patients and their parents or caregivers are aggressive, manipulative or agenda-seeking. Remember, ACFAS’ e-learning offerings are available 24/7 to complement your classroom training.
Attract new patients and educate existing ones by sharing the newest ACFAS infographic, Pediatric Foot & Cleat Injuries: What Parents Need to Know, on social media, in your office or your website. This new marketing tool comes just in time for kids’ busy outdoor sports season and shows how to spot, prevent and treat foot and cleat injuries.

Visit FootHealthFacts.org to download the infographic then post it to your social media channels to help educate parents and coaches on when to see you for ankle and foot sports injuries. You can also leave copies of it in your waiting room or use the accompanying press release as a resource when speaking with your patients or giving community health talks this summer.

To make it even easier, you can also visit Foot Health Facts on Twitter or Facebook to retweet or repost ACFAS’ infographic post. And remember, there’s a plethora of other patient education materials in FootHealthFacts.org’s complete library of foot and ankle conditions and archive of member-developed articles, videos and podcasts for your patients.
If you’re an unmatched resident who has not yet found placement within a program, know that ACFAS offers a “Student-Transitional” membership category and provides graduated students a one-year transitional membership at no cost.

Through ACFAS, graduated students without a residency match can enjoy The Journal of Foot & Ankle Surgery online, student pricing for all ACFAS educational offerings and access to a network of proven leaders who can help them in their search for a match.

For more information on transitional status with ACFAS, contact the Membership Department at membership@acfas.org or (773) 693-9300.
A dynamic, eye-catching and easy-to-navigate website can not only attract new patients to your practice, but also make it easier for them to contact you. Officite, an ACFAS Benefit Partner, can help you take the first steps toward an improved web presence with a complete Web Presence Package, available for 50 percent off from now until July 31.

For more information on this limited-time offer, visit Officite’s website or call (877) 898-4006.

Foot and Ankle Surgery

---

Patients with chronic ankle instability (CAI) often experience neuromuscular dysfunction of the leg and thigh musculature, including decreased strength and postural control. A recent study aimed to assess the differences in spinal reflexive and corticospinal excitability of the fibularis longus and vastus medialis between limbs in patients with unilateral CAI and between CAI patients and participants servings as healthy controls. Of 56 patients observed, 21 had CAI and 24 were healthy controls. Outcome measurements included the Hoffmann reflex and transcranial magnetic stimulation. Active motor threshold (AMT) was defined as the lowest transcranial magnetic stimulation intensity required to elicit motor-evoked potentials (MEPs) of a certain strength, and MEPs were obtained at percentages ranging from 100 percent to 140 percent of AMT. Following observation, it was found that fibularis longus MEP amplitudes were greater in control participants than in CAI patients bilaterally at 100 percent AMT.


The traditional treatment of idiopathic congenital club foot is a serial casting according to the Ponseti method, followed by foot abduction orthoses. A research group aimed to evaluate this process to identify predictors for success or failure. Researchers evaluated 189 children with 279 club feet for the duration of toot abduction brace (FAB) use. Thirty-six feet required additional surgery, and the FAB duration revealed a significant effect. Operated children used the FAB for 28 months while non-operated children used it for 33 months. This led researchers to conclude that the duration of FAB treatment was the most influential factor on the functional results and rate of surgery. Longer duration reduced the chance of a close follow-up, and longer usage reduced the rates of recurrence.


Researchers analyzed data about the amount of opioids given to patients following ankle surgery with or without a tourniquet. They measured opioid use during the first 24 hours post-operation in 603 patients. Of those, 358 underwent surgery with a tourniquet. A correlation was found indicating an increase in postoperative opioid use by 0.43 mg for every 10 minutes using the tourniquet.

Practice Management

---

Being a successful practice manager is no easy task. The best practice managers have an eye for detail and are always planning and looking ahead. Here are five ways to become the best practice manager you can be. First, you must know the job. Know your tasks, know your staff's tasks and share your knowledge even if you feel lost at times. A staff responds better to someone who knows what they are doing, especially when the tasks are difficult. Second, plan well. Accomplishing your ultimate mission will only happen with solid planning and building toward an objective or goal. Great plans work well because they are designed knowing that sometimes not everything works out the way you want it to. Third, implement your plan. There are multiple tasks to juggle and numerous people to handle, so make sure everyone at your practice is on the same page and knows what to do and what the goals are. A methodical, repeated daily effort will increase productivity. Fourth, monitor all progress. A good plan is constantly monitored to ensure constant adherence. Finally, motivate your staff. Productivity comes with high morale, and inspiring your staff on a daily basis means that everyone will work hard for you in every aspect of their day.


Employee disputes can be prevented if medical practices are vigilant in avoiding a number of bad habits, including:  

1. Exercising inconsistent treatment of "good" and "bad" employees. All employees, exemplary and underperformers, require equal treatment. Preferential treatment of "good" employees and marginalization of "bad" employees stokes distrust and dissent. Good employees should be rewarded with fun, non-monetary perks they can earn. The practice manager should likewise coach and set goals for underperforming workers so they have a path toward improvement and success.  
2. Opposition to the promotion of "irreplaceable" employees. Denying a promotion that is rightly earned can breed resentment among the deserving employee. To help make the transition as smooth as possible, the manager should ask the employee to train his or her replacement.  
3. Explaining the reason underlying every decision. This should be done in moderation, as an excessive explanation of changes or new initiatives sets an expectation with employees that they are not expected to comply with unpopular decisions.  
4. Inconsistently following the policies in your employee handbook. This spurs disrespect from both bad and good employees. Avoiding the most common yet serious issues for employee disputes demands that the manager follow each policy consistently.

To achieve successful electronic health record (EHR) system implementation, a range of factors must be considered. First, conduct work flow studies to determine the best way to integrate an EHR into your practice. Second, compile a "wish list" of features and functionality before picking a vendor. Finally, examine your technical infrastructure. This includes things like hardware, Internet connection, bandwidth and battery life. To best complete these steps, a practice should form a group comprised of an administrator, physician, administrative staff member and clinical staff member. Pooling their ideas into a list of required EHR functions and capabilities will simplify the transition.

Health Policy and Reimbursement

---

The U.S. Supreme Court has ruled that the Affordable Care Act allows the government to provide nationwide tax subsidies to help poor and middle-class people buy health insurance, a sweeping vindication that endorsed the larger purpose of President Obama's signature legislative achievement. The 6-to-3 ruling means that it is all but certain the act will survive after Obama leaves office in 2017 and will give it a greater chance of becoming an enduring part of the social safety net in the United States. For the second time in three years, the law survived an encounter with the Supreme Court.


The House voted 244-154 to repeal the federal Independent Payment Advisory Board, a panel meant to find ways to reduce Medicare spending. Panel members have never been appointed, and it has never recommended Medicare savings. Republicans generally say that the board has too much power and would lead to the rationing of healthcare. Democrats argue, however, that the healthcare law specifically forbids the board from rationing care, increasing recipients' premiums or reducing their coverage. The panel's recommendations, therefore, would fall largely on providers. The White House has threatened to veto a repeal of the board, but the Senate has yet to consider its own version of the bill.


A failed proposal to include routine foot care by podiatrists for adult Medicaid recipients could result in the state of Nevada spending more money on injuries that could have been prevented. Foot and ankle care for adults is covered under Medicaid, but only general practitioners can carry out the services. Podiatrists claim they are better trained and more willing than most general practitioners to provide these services. The potential cost of podiatrist care would be around $1 million, but it would more than make up for the potential costs associated with avoidable complications, experts say. The proposal failed partly due to the expansion of Medicaid through the Affordable Care Act. About 160,000 newly eligible Medicaid clients were added, arousing concerns among policymakers about costs. The Nevada Division of Healthcare Financing and Policy has said it will reevaluate the benefits and consider possible policy changes.

Medicine, Drugs and Devices

---

A recent ruling in California will limit the amount of money that patients need to pay for specialty medicines. The landmark ruling is set to take effect in 2016 and aims to help Californians afford their expensive medications while keeping premiums affordable for everyone else. Last year, more than a half-million patients in the United States incurred medical costs in excess of $50,000. Starting in 2016, most consumers in California will only need to pay a maximum of $150 or $250 per prescription, per month. Some will have caps of $500. The policy will apply to the 2.2. million people who buy coverage on the individual market. State governments and insurers are calling for lower prices while the pharmaceutical industry stands by them. The Pharmaceutical Research and Manufacturers of America claim the prices are necessary for proper development; insurers believe higher costs lead to less adherence, and soon the costs of specialty drugs will force them to raise monthly premiums for everyone on the plan.


Wearable medical devices and convenient smartphone apps are changing the traditional methods of consumer healthcare, and receiving treatment exclusively at a doctor's office may soon become unnecessary. Some experts believe two principal business models will soon emerge: "Goldminers," who dig deep into one major area, and "Bartenders," who offer customized and convenient options to address routine needs. The Goldminer strategy involves large institutions creating value by more efficiently handling the 30 percent of patients with complex conditions that make up around 80 percent of all medical spending. This is a novel approach, but it is still very similar to the traditional approach to healthcare. The Bartender strategy is much more dynamic. It aims to circumvent the doctor-patient relationship to provide detailed data and personalized health information for consumers. The goal is a better experience for consumers. For example, someone with heart issues who uses the Goldminer stystem could be provided an app that is monitored by a clinical care team; in the Bartender approach, that person would have control over the data the app records and receive even more information about day-to-day living. According to experts, both ideas will create progress. Still, a forthcoming study showed the Bartender model could reduce healthcare spending by $400 billion per year by 2025, three times more than the Goldminer model.


Researchers conducted a systematic review of quantitative studies to identify, evaluate and synthesize evidence pertaining to the effect of kinesiotape applied to the lateral aspect of the ankle. A range of databases, including the Cochrane Library and Medline, were studied. Across a body of evidence consisting of eight studies and 276 participants, researchers determined that kinesiotape may increase posture control in healthy ankles. In addition, kinesiotape may improve proprioception, plantarflexor endurance and performance of activities in patients with injured ankles. No adverse events were reported in the studies. Evidence led to the conclusion that kinesiotape may be used clinically to prevent and manage lateral ankle injuries. Kinesiotape likely will not provide sufficient mechanical support to improve postural control in unstable ankles.