News From ACFAS

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Help your fellow colleagues visualize your latest findings by displaying your research in poster format at ACFAS 2016, February 11–14 in Austin, Texas.

Poster abstracts are due September 1, 2015, slightly earlier than in years past, to be eligible for review. Refer to our Poster Exhibit Guidelines for details.

Authors of ten of the most unique poster presentations will be invited to be recorded while discussing their research during ACFAS 2016. All accepted posters will be available on acfas.org after the conference.

Our poster competition grows in size and scope every year—don’t miss your chance to be part of the action!
On Oct. 1, 2015, every entity covered by the Health Insurance Portability and Accountability Act (HIPAA) is required to transition to ICD-10. ACFAS has linked to several important resources on acfas.org, including the Centers for Medicare and Medicaid Services’ Road to 10 website, targeted to help smaller practices during the transition.

Log in to acfas.org and refer to Coding & Reimbursement for everything you need to know about ICD-10.
Let your research take flight with funding from ACFAS. With more than $40,000 in grant awards reserved for this year, the College is ready to help you make your clinical- or laboratory-based research a reality.

If your research meets our criteria, submit your grant application to ACFAS by September 15, 2015. Visit acfas.org/grant today and do your part to advance the profession and the future of foot and ankle surgery.
Congratulations, promoting your practice this summer just got a whole lot easier! ACFAS’ Marketing Toolbox gives you free, ready-to-use resources to help you spotlight your practice and connect with your patients and community.

Download PowerPoint presentations or FootNotes, our patient education newsletter, and customize them with your practice’s contact information. Use our Media Pitch Guidelines and Template to share exciting news about your practice with the local media or use a fill-in-the-blank press release to announce your practice’s achievements. You can also learn how to link FootHealthFacts.org from your website, publicize your practice through Twitter and Facebook and incorporate the ACFAS logo into your communications.

ACFAS adds new materials to the toolbox regularly, so visit often to tinker with the tools that work best for your practice.

Foot and Ankle Surgery

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Many patients with type-2 diabetes suffer from plantar sensory neuropathy and require regular testing to avoid ulceration or other damage. Standard practice involves testing feet manually with a hand-held nylon monofilament probe. The process is cumbersome, prone to error and difficult to repeat. Researchers have presented a new method to automatically identify the pressure points on a patient's foot for the examination of sensory neuropathy via optical image processing incorporating plantar anthropometry. The method selects suitable test points on the plantar surface corresponding to those chosen by a podiatrist. This generic approach also finds the specific pressure points at different locations, namely the toe (hallux), metatarsal heads and heel (calcaneum) areas. It has shown 100 percent reliability on the available database used, which consists of Chinese, Asian, African and Caucasian foot images.


Ankle arthrodesis (AA) could lead to increased osteoarthritis due to compensatory increased range of motion in adjacent joints. A study was conducted to evaluate patient-reported outcomes after AA and to analyze post-AA radiographic results. Researchers enrolled 17 patients with unilateral AA and measured sagittal hind- and midfoot range of motion radiographically. Patients were provided validated questionnaires, which were compared to a control group. Mean combined hind- and midfoot sagittal range of motion after AA equaled that of the contralateral side and the tibiotalar angle after AA equaled that of the contralateral side. No increased sagittal range of motion in the hind- and midfoot after AA was found at 3.5 years of follow-up as compared with the contralateral side, and tibiotalar angles were equal. The talus was translated posteriorly. Patients scored lower than controls on self-reported outcome questionnaires but were satisfied with the result of AA.


Current methods for treatment of hallux rigidus combine skeletal and soft tissue interventions to achieve long-lasting pain relief. Researchers assessed a new technique that respects the anatomy and joint function and used a shortening osteotomy of the head of the first metatarsal. Forty patients with grade II and III hallux rigidus were evaluated. The American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating scale was used for clinical evaluation. A patient survey showed excellent and good overall satisfaction in 90 percent of the sample. The median global AOFAS score increased from 39 to 84 after follow-up. Researchers showed a shortening osteotomy of the first metatarsal head can correct stiffness and relieve pain while improving range of motion. It also led to rapid functional recovery.

Practice Management

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Cybercrime has evolved so rapidly in the past several years that in most cases, a medical data breach is almost inevitable. Any organization that collects, uses, discloses or stores protected health information is at risk. When a breach occurs, successful organizations have a plan in place to react and respond and to demonstrate publicly that the data loss is being handled responsibly and appropriately. You must conduct a security risk assessment to develop a comprehensive response plan. In most cases, the worst-case scenario should be considered when putting together the plan. When the breach plan is activated, an organization should immediately take all possible steps to minimize or limit the impact of the breach while documenting its efforts to do so. Finally, a successful response plan requires formal notification to individuals, Health and Human Services, and others. Once a breach has been internally confirmed, HIPAA requires official notification to all affected individuals and the Office for Civil Rights. Poor breach notifications can demonstrate organizational discord and misunderstanding. This can damage reputations and impede formal investigations later on. After the required notifications have been made, the organization should update its current risk management plan to reflect lessons learned and vulnerabilities addressed as a result of the breach.


The healthcare industry is in the midst of great change, and more practices are considering new delivery and payment models to reach goals involving improved care, better population health and lower costs. When preparing for these new payment and delivery systems, keep several goals in mind to help you move beyond your mission statement. Be sure to incorporate a patient's lifestyle, habits, literacy, comprehension and support systems. Do this with a team-based approach to fully realize the potential of patient-centered care. These teams can also enhance patient access to care by utilizing extended office hours and technology solutions. Take more responsibility for helping patients, especially the newly uninsured. Finally, increase data sharing and collaboration among providers, facilities and vendors. This will facilitate higher levels of care at lower costs.


Preparing your non-coding, nonclinical staff is essential to keeping your practice running smoothly once ICD-10 is fully implemented. A practice leader's focus on educating these staff members might include reviewing the following positions: scheduling, registration, accounts payable and accounts receivable, laboratory, revenue cycle specialists and file clerks. The ICD-10 planning phase begins with determining each staff's interaction with the revenue cycle. All staff members should be asked for the tools they use every day with ICD-9 codes so they can be updated to ICD-10 codes. Next, you need to have a comprehensive plan to train the staff. The training should be completed at least one month prior to Oct. 1, 2015, and around four to eight hours should be sufficient. A training agenda can include the following:

• An overview of the healthcare system and why it is expanding from ICD-9 to ICD-10.
• The differences between the two classification systems and the impact on various physicians and healthcare positions.
• How the medical practice is preparing for ICD-10, including timelines, parallel testing, upgrades and go-live date.
• A question-and-answer session.
• An overview of any current daily job tools, such as coding, billing or insurance software or interfaces.
• Updated policies and procedures to include the communication protocol with physicians regarding specific coding questions.
• Available resources: coding books, anatomy toolkits based on staff position, designated coder-of-the-day team member who can be contacted should a question arise, etc.

Health Policy and Reimbursement

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An annual report released by the Social Security and Medicare board of trustees on July 22 noted that Medicare's hospital trust fund is still on track to cover all obligations until 2030. At that time, Medicare would be able to pay 86 percent of costs. Despite more of the baby boomer generation hitting age 65, the program has not been overwhelmed with costs because boomers are healthier than older generations of Medicare beneficiaries. Medicare will, however, have difficulty with rising drug costs. After the report was released, John Rother, president of the National Coalition on Health Care and leader of the Campaign for Sustainable Rx Pricing, said, "The latest Medicare trustees report points to an alarming 10.9 percent increase in the cost of Part D drug coverage in the past year...We call for all stakeholders, including drugmakers, to come to the table and identify new ways to reward innovation without bankrupting our healthcare system." Health and Human Services has set a goal of tying 30% of payments under traditional Medicare to new models of care by the end of 2016 and an increasing share thereafter.


A recently released survey of healthcare providers from eHealth Initiative and the American Health Information Management Association reveals that most providers are optimistic about reimbursement and workflow following ICD-10 implementation. Still, some are concerned that reduced revenue will come into play once Oct. 1, 2015 passes. The key to retaining revenue is industry-wide preparation. If a provider is not ready for the change, it will suffer great financial risk once the switch happens. One report notes that one in four physician providers cannot handle the complexity of the switch, and 59 percent are most concerned about the specific impact of the transition upon their revenue and cash flow. A HealthITAnalytics.com survey shows that many providers have yet to conduct essential preparation steps, such as testing efforts. However, many practices are preparing correctly. Seventy-eight percent of healthcare organizations provided ICD-10 awareness and educational materials to staff, with 73 percent developing a team to lead efforts for implementation preparation.

Medicine, Drugs and Devices

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3D printing technology has shown the ability to create a vast array of objects, and now it is revolutionizing orthopedic surgery. According to Jason Koh, an orthopaedic surgeon at NorthShore University HealthSystem, computer modeling combined with 3D printing can increase the exactness of joint-replacement surgery. Three-dimensional scans can create a more complete picture on a screen for a surgeon who is replacing a joint. But these scans can also be used to print out models of whole bones or joints with challenging deformations. Koh says this is invaluable because for complex surgeries, test runs can be crucial to success in the operating room. The technology is especially effective for total ankle replacements. These operations used to be cumbersome and often resulted in problems with durability and fit; now, 3D printing offers an alternative to fusing the joint, which can severely hamper long-term range of motion. It also helps surgeons who would otherwise be wary about such a difficult procedure. "I’m really starting to trust how accurate they are. It’s taking a lot of the guess work and stress away," said Ryan Meineke, an orthopaedic surgeon at Scripps Memorial Hospital in San Diego.


More than half of ambulatory practice physicians access patient records and reference data from a mobile device, according to an annual client poll of more than 6,000 physicians released by market research firm Black Book. The poll also showed that about a third of physicians use smartphones as part of their patient management activities. Physicians in general surgery and orthopaedics were among those with the highest smartphone utilization rates. Additionally, 70 percent of respondents noted that they intend to use mobile electronic health record devices and software by the end of 2015.


Harvard professor Regina Herzlinger has published a patent application for a healthcare website that could help people better shop for healthcare services and insurance. The site would combine data from a variety of third-party sources to give consumers the information they need in a range of areas, including managing a health savings account, choosing a good insurance policy or selecting a doctor. “It is highly desirable for there to be a single system that will make needed healthcare information readily available from neutral third-party sources to assist (consumers) in making healthcare decisions in an economically and judicious manner,” according to the patent application. The system could be accessible through cell phones and other devices, and it would be capable of streaming updated information quickly. Consumers would also have access to their medical record, benefits information and other data, essentially making the site an all-in-one forum that combines the aspects of many different products currently on the market.


A rise in incidents involving cell phones in the operating room is prompting medical groups like the American College of Surgeons to warn about the dangers of phones as distractions. A patient in Texas died in 2011 after an anesthesiologist allegedly sent text messages and emails while the patient's oxygen dropped to fatal levels. Despite this and other examples, no federal regulations or industry-wide measures exist to address the phone use in hospitals. This lack of guidance could potentially bring major consequences. "Once we get into or start using our cellphones, we separate ourselves from the reality of where we are," said Peter Papadakos, a professor of anesthesiology, surgery, neurology and neurosurgery at the University of Rochester. "It’s self-evident: if you’re staring at a phone, you’re not staring at the monitors." Some hospitals have attempted to address the problem. The University of Rochester Medical Center requires staff to keep phones silenced when working with patients. However, some believe that smartphones can be useful in the operating room, providing assistance and information. This mix of positives and negatives complicates efforts to develop guidelines.