News From ACFAS

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Don't miss the opportunity to share your research with your peers at ACFAS 2015. Send us your manuscripts for presentation consideration no later than August 15, 2014 to be eligible for review by the manuscript judges.

Visit acfas.org/phoenix for manuscript submission guidelines. Be sure to also carefully read the 2015 Call for Manuscripts and Instructions for Authors Submitting a Manuscript before sending a submission.

ACFAS Manuscript Awards of Excellence winners divide $10,000 in prize money from a generous grant the College received from the Podiatry Foundation of Pittsburgh. The ACFAS Nominating Committee is looking for the finest, most fitting members to serve on the College's Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to take an active role in leading the profession, you are encouraged to submit a nomination application by September 10, 2014.

Visit acfas.org/nominations for complete details on the recommended criteria for candidates and the nomination application. You may also email Executive Director Chris Mahaffey or call him at (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Jordan Grossman, DPM, FACFAS, at j.grossman@mac.com or (330) 344-1980.

The Nominating Committee will announce recommended candidates to the membership no later than October 23, 2014. Candidate information and ballots will be emailed to all voting members no later than December 7, 2014. Electronic voting ends on January 6, 2015. New officers and directors take office during the ACFAS 2015 Annual Scientific Conference, set for February 19-22, 2015 in Phoenix, Arizona.
Reach out to your patients and attract new ones with the latest edition of ACFAS’ free FootNotes newsletter, which is available for download at acfas.org/footnotes.

Summer 2014 FootNotes includes the following articles:
• Avoid Sprains & Fractures This Summer
• 10 Tips for Healthy Outdoor Feet
• Do Not Let Bunions Sideline You

Let FootNotes help with your practice marketing efforts. Put copies in your waiting room, on your social media sites or practice website and don’t forget to distribute copies at health fairs or speaking engagements.

You can also take advantage of the many other easy-to-use resources available in the ACFAS Marketing Toolbox to help grow your practice and attract new patients. In July 16 testimony before Congress, the Federal Trade Commission (FTC) described how it evaluates the potential competitive effects of regulating occupations, including healthcare professions, and the agency’s efforts to promote competition among professionals.

Andrew I. Gavil, director of FTC’s Office of Policy Planning, said licensure may be an appropriate policy response to identified consumer protection or safety concerns. However, some licensure regulations can impede competition while offering few, if any, significant consumer benefits, the testimony stated.

FTC staff advocacy comments have addressed physician supervision requirements some states impose on advanced practice registered nurses (APRNs) because they enable some healthcare professionals to restrict access to the market by other healthcare professionals, potentially raising prices and reducing access to some primary healthcare services. Staff has suggested that mandatory supervision of APRNs may not be a justified form of occupational regulation.

“This is good news for College members,” said ACFAS Executive Director Chris Mahaffey. “The FTC is making it increasingly clear they see the American Medical Association’s policy of keeping non-MD scopes of practice restricted as being anti-competitive and anti-consumer.”

Foot and Ankle Surgery

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A new study has concluded that it is not necessary to perform inferior extensor retinaculum (IER) reinforcement in conjunction with the Broström procedure to restore ankle stability. Researchers came to that conclusion by comparing the outcomes seen in two groups of patients who were treated with the Broström procedure: one group of 31 patients who underwent modified Broström procedures in which IER reinforcement was feasible, and a group of 10 patients who underwent Broström procedures in which IER reinforcement was not feasible. Patients in the latter group could not undergo IER due to anatomic variations. No significant differences were seen between the two groups in terms of their post-operative clinical and radiographic outcomes. Patients in both groups experienced similar improvements in American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, talar anterior translation and talar tilt.


A recent study compared the load at failure, stiffness and mode of failure of Achilles tendons that were operated on using one of three distal Achilles tendon reconstruction techniques: one that used suture anchors, another that used a 5 mm tendon overlap and a third that used a 10 mm overlap. Nine matched pairs of fresh-frozen Achilles tendons in human cadavers were examined. The study found that average load to failure was significantly higher in the Achilles tendons that were were operated on using the 10 mm overlap compared to the tendons in the 5 mm overlap and suture anchor groups. In addition, the study found that failure in the 5 mm and 10 mm groups was caused by grafts pulling out through the substance of the tendon. Failure in the suture-anchor group, meanwhile, was caused by a variety of factors. No significant differences were seen between the groups in terms of stiffness. The study concluded that while all three surgical techniques provide sufficient primary load-bearing ability, the 10 mm tendon-overlap technique may be better at bringing about early post-operative rehabilitation.

Practice Management

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Although it is important for physicians' practices to strive to reduce the number of tasks that are completed incorrectly and subsequently need to be performed again, it is also important for doctors not to enable staff members to continue making such mistakes, writes Carol Stryker of the consulting firm Symbiotic Solutions. Stryker notes that doctors may be tempted to correct errors made by staff members themselves because they believe that doing so is more efficient. However, physicians who correct mistakes made by staff members are allowing these employees to avoid confronting their mistakes. As a result, such employees have no incentive to take the steps that are necessary to avoid similar mistakes in the future, Stryker says. She notes that a better approach is to require an employee who makes a mistake to correct the error. While this approach may require more time to be devoted to a particular task, Stryker says, it is the best way to reduce the error rate at a practice. Stryker adds that reducing errors brings about benefits such as improved patient care and satisfaction, lower costs and increased physician income.


Patrick Watterson, PA-C, the vice president of Bethany Medical Center in High Point, N.C., says physician practice leaders need to remember several things to successfully handle a crisis. For starters, practice leaders should stay focused and calm instead of reacting emotionally to a crisis, Watterson says. Doing so will allow practice leaders to handle whatever the problem is more effectively. In addition, Watterson notes that it is important for practice leaders to keep their staff up to date with efforts to resolve the problem in order to prevent rumors and other types of misinformation from spreading. Third, practice leaders should remember that they can obtain patient data from a variety of sources should an electronic health record system go down, Watterson says. For example, medication lists can be obtained from the hospital pharmacy, while patients' lab results can be obtained from lab vendors. Watterson also advises practice leaders to keep members of management focused by taking them out of stressful situations when necessary. Finally, Watterson advises practice leaders to provide staff and physicians with rewards such as free food or coffee during a time of crisis to make the situation more bearable.

Health Policy and Reimbursement

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The Department of Health and Human Services (HHS) has released its final rule regarding the implementation of ICD-10, in which it confirmed that healthcare providers will be required to use the new code set beginning Oct. 1, 2015. The move comes after President Obama signed a measure earlier this year that pushed back the implementation of ICD-10 to that date. HHS said in its final rule that delaying the implementation of ICD-10 until next year is the least expensive option and will also allow healthcare providers to benefit from the new code set as soon as possible. Meanwhile, there are indications that coders in the healthcare industry are getting ready for the implementation of ICD-10 despite the delay. A survey conducted by the American Academy of Professional Coders (AAPC) in June found that 75 percent of the organization's 5,000 members are making significant progress in their efforts to prepare for the implementation of ICD-10, while 25 percent reported having completed all necessary ICD-10 training. A separate survey conducted by Edifecs, eHealth Initiative, and the American Health Information Management Association in June found that 68 percent of respondents were planning additional ICD-10 training before the implementation of the new code set.


A spokesman for the Centers for Medicare and Medicaid Services (CMS) says the agency will provide detailed information about the payments being made by drug companies to doctors and teaching hospitals when the payment data is published online in September as required by the Sunshine Act. The details will include information about the nature of all payments or transfers of value that a drug company made to a doctor or a teaching hospital, as well as contextual information. The announcement by CMS comes after a group of more than 20 medical societies and organizations, including the Pharmaceutical Research & Manufacturers of America and the Biotechnology Organization, sent a letter to the agency asking it to provide contextual information about payments made to doctors when it publishes the data online in September. For instance, the organizations want the payment data to be presented in such a way that the public can make distinctions between payments for things such as speaking and consulting fees, food, research and gifts. The organizations are concerned that failing to provide contextual information about payments made to doctors could result in the public misinterpreting the payment data. The organizations also asked CMS to do more to educate doctors about the pending release of the payment data, which the agency subsequently said it is willing to do.


Some legal scholars believe that the U.S. Supreme Court's conservative judges could rule in the Obama administration's favor should the High Court decide to hear appeals in the legal challenges to the Affordable Care Act's (ACA) subsidies for consumers purchasing health insurance through the new health insurance exchanges. At issue is whether or not such subsidies can be provided to consumers purchasing coverage through federally operated exchanges despite language in the statute that says that such financial assistance can only be provided through exchanges created by "the state." The IRS believes that it can provide subsidies even to consumers who use the federal exchange, while ACA's opponents believe otherwise. But the dissent that the Supreme Court's conservative justices wrote in the 2012 case that upheld the ACA's individual mandate suggests that they could be reluctant to interpret the law in such a strict manner. The dissenting justices wrote in their opinion that striking down the mandate would result in the exchanges not operating "as Congress intended," and they may come to a similar conclusion regarding the importance of the subsidies. But the High Court may opt not to take the case at all, particularly if it is asked to hear an appeal of the Virginia federal appellate court's decision that the subsidies should be available to all eligible exchange users. The court could be reluctant to take that case if the full D.C. Circuit Court of Appeals, which ruled in favor of a narrow interpretation of ACA's language regarding subsidies, is still hearing the Obama administration's appeal of that decision.


Healthcare industry observers generally believe that the recent ruling by the District of Columbia Circuit Court of Appeals that significantly limits who can receive the Affordable Care Act's subsidies for purchasing health insurance will not result in consumers losing those subsidies. The ruling held that the subsidies can only be given to consumers in states that have their own health insurance exchanges and that financial assistance cannot be provided to consumers living in states that rely on the federal exchange. One reason why these observers believe that consumers are not likely to lose their subsidies is because the Obama administration plans to appeal the ruling to the full Circuit Court of Appeals, which is made up mostly of judges who are Democratic appointees. As a result, these judges are likely to rule in the administration's favor, these observers believe. In addition, observers point to the fact that the Fourth Circuit Court of Appeals came to an opposite conclusion as the D.C. Circuit Court of Appeals, saying that the subsidies can be provided to consumers in states where the federal exchange is used. But even if the decision by the D.C. Circuit Court of Appeal is upheld, observers say that states that partner with the federal government in running some aspects of their exchanges could meet the court's definition of having a state-run exchange, thus making their citizens eligible for subsidies. Some states could also opt to start their own exchanges if they have not already done so.

Medicine, Drugs and Devices

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A recent study has found that treating rheumatoid arthritis (RA) patients with anti-tumor necrosis factor (TNF) drugs plus methotrexate has some advantages compared to using methotrexate (MTX) alone. The study examined the clinical and radiological outcomes of two groups of early-stage RA patients: Group A, which consisted of 49 patients on first-line MTX monotherapy; and Group B, which was made up of 35 patients being treated with anti-TNF plus MTX. After one year of treatment, patients in Group B displayed significantly lower radiological progression compared to Group A. In addition, clinical non-responders in Group B also experienced decreased radiological progression. The same could not be said for clinical non-responders in Group A. However, patients in both groups experienced decreased disease activity as well as significant improvements in functional status.


A new study has found that a talar body prosthesis can provide satisfactory ankle and foot function. The study involved 36 talar body prostheses that were implanted using a transmalleolar surgical approach between 1974 and 2011 to treat osteonecrosis, comminuted talar fractures and talar body tumors. Twenty-eight of these prostheses were available for follow-up at 10 to 36 years. Five other prostheses had failed in less than five years. The study found no significant differences in the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score among three groups of patients whose prostheses were still in place at final follow-up: those who were followed up with for 10 to 20 years, those who had a follow-up period of 10 to 20 years and those whose follow-up period lasted 30 to 36 years. The study also noted that early prosthesis failure occurred most often because of size mismatch, though tumor recurrence, infection and osteonecrosis of the talar head and neck were also causes of failure. Three patients who experienced prosthesis failure were subsequently treated with tibiotalar arthrodesis, while two others were treated with either prosthesis revision or below-the-knee amputation.