News From ACFAS

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The ICD-10 compliance date is just around the corner! Make your transition easier with our new series of helpful hints from ACFAS.

In the weeks leading up to Oct. 1, identify the top 25 most commonly used ICD-9 codes in your practice setting and cross-walk those codes to ICD-10. Carry a “cheat sheet” with you until you become familiar with the change in code. Include information on updated documentation requirements, if applicable. This will help you avoid costly claim denials and help make the transition to ICD-10 smoother.

For more information on ICD-10 and how to make the transition, visit ACFAS’ ICD-10 resource page. Exhibit at ACFAS 2016 in Austin and get ready to stand out at the nation’s largest annual gathering of foot and ankle surgeons. As an exhibitor, you can expect:

• Access to 1,500+ foot and ankle surgeons and primary podiatric physicians
• Unopposed viewing time during which you can chat one-on-one with attendees, reach new leads and strengthen existing client relationships
• Ample Exhibit Hall space (more than 100,000 square feet) plus complimentary lunch each day

The Annual Scientific Conference offers plenty of other creative ways for you to promote your company. Sponsor an event or educational grant, advertise your wares in digital or print media or include your company logo on conference products.

View the Exhibitor Prospectus at acfas.org/austin for more information and help make the conference a showstopper for all involved. And, we’re coming to a city near you! The College and five ACFAS Divisions are teamed up to bring you ACFAS on the Road: Complex Forefoot Surgery with Advanced Solutions, a new regional program making stops in your neck of the woods.

Each workshop and seminar kicks off on Friday evening with a presentation and case studies. Saturday features lectures from expert faculty and four hands-on labs (sawbones). Plus, you’ll earn 12 continuing education contact hours all while learning treatment and fixation options for forefoot deformities and injuries.

You can be sure the world is turning your way when state-of-the-art learning is so close to home. Register today at acfas.org/ontheroad, and we’ll see you on the road soon!
Which state capitol is considered one of the fastest-growing cities in the U.S., enjoys 300 days of sunshine each year, has more than 200 historical structures and in just six months will host ACFAS 2016? Austin, Texas—the Live Music Capital of the World!

Join us February 11–14, 2016 for hitmaking sessions and workshops, dynamic exhibits from your favorite vendors as well as posters, papers and case studies that will bring you to your feet. Come to Austin a day early for our special preconference programs to get a feel for the excitement in store.

ACFAS 2016 is expected to be an encore performance of last year’s recordbreaking conference and one that captures the rhythm and beat of the latest advancements in foot and ankle surgery. Visit acfas.org/austin for continuous updates and get ready to be part of the College’s playlist!

Foot and Ankle Surgery

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Adhering to the Low Risk Ankle Rule leads to fewer unnecessary radiographs for children and saves money, according to a study published in the Annals of Emergency Medicine. The rule stipulates an x-ray of the ankle is likely not necessary to eliminate high-risk injury if a child presents with tenderness and swelling isolated to the distal fibula and/or adjacent lateral ligaments distal to the tibial anterior joint line. The researchers examined the costs and outcomes of implementing the Low Risk Ankle Rule among 2,151 children who presented with ankle injuries. Subjects were children aged 3 to 16 who presented to the emergency department (ED) with an acute ankle injury at several stages—healthcare provider visits, imaging and treatment at the index ED visit and days 7 and 28 post-ED discharge. There were 1,055 patients at the intervention EDs and 1,096 at the control EDs. The Low Risk Ankle Rule was implemented following the baseline phase 1, in phases 2 and 3 in three intervention EDs but not in the three pair-matched control EDs. According to the results, healthcare costs were $36.93 less per patient at intervention versus control sites, and out-of-pocket costs to the patients were $2.09 more per patient at intervention sites. The chief contributor to cost reduction was the 22.9 percent reduction in ankle radiography, and no significant differences existed in the frequency of missed clinically important fractures or follow-up use of healthcare resources.


Researchers compared 10-year outcomes of two postoperative regimens after Achilles tendon rupture repair: early weightbearing with early mobilization versus early weightbearing with early immobilization in tension. Fifty patients with acute Achilles tendon ruptures were randomized postoperatively to receive either early movement of the ankle between neutral and plantar flexion in a brace for six weeks (group 1) or Achilles tendon immobilization in tension using a below-knee cast with the ankle in a neutral position for six weeks (group 2). Patients were assessed at three, six, and 14 months and 11 years postoperatively. Thirty-seven patients (74 percent) were evaluated at a mean (±SD) of 11.0 ± 0.9 years. The mean Leppilahti score was 92.9 ± 5.6 in group 1 and 93.6 ± 7.2 in group 2 (P = .68). The mean isokinetic plantar flexion peak torque deficits or average work deficits in plantar flexion showed no differences between the groups with any angular velocity. Isokinetic strength changed minimally between one and 11 years compared with the unaffected ankle, but a mean deficit of 5 percent in peak torque and mean deficit of 8 percent in average work were still present after 11 years. On the contrary, isometric plantar flexion strength recovered significantly, with only a 2.4 percent difference at 11-year follow-up.


Researchers sought to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP) and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the "landmark line." A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC) or lateral calcaneal (LC) nerves. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in three of 10 MC nerves and three of 10 LC nerves. After percutaneous osteotomy, lacerations were found in two of 10 MC nerves and one of 10 LC nerves. No lacerations of the sural, MP or LP nerves were found with either osteotomy.

Practice Management

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Physicians need to review five financial reports no later than the tenth day of each month for the previous month's activity. The profit and loss (P&L) statement counts revenue and expenses for a given period and includes financial indicators such as gross revenue, net revenue and overhead. Physicians should start the P&L review with revenue and then focus on expenses. If they appear to be "high," the physician should investigate before cutting them. The next statement concerns aged accounts receivable (A/R), summarizing potential revenue from payers and patients for services rendered. Practices should begin with "Days in A/R," which tallies the average number of days it takes to collect on an account. "Days" of 30 or less is good, while "Days" of 50 or more is not. More than 10 to 15 percent of total A/R in the 120-plus days range signals trouble. The third report for review is the adjustments or "write-offs" report, which comprise the detailed categories to which staff post the difference between an actual payment and the standard fee. These include contractual adjustments and multiple procedure discounts, as well as adjustments for denials and A/R clean-up actions. A report containing broad categories such as "miscellaneous" or "insurance write-off" indicates a problem. The fourth report lists credit balances that staff have researched and confirmed every month, which should ideally be as close to zero dollars as possible. The final review concentrates on the patient balance "trio pack," which includes patient A/R, payment plan status and accounts recommended for collection or bad debt.


Health Insurance Portability and Accountability Act (HIPAA) compliance in physician practices frequently comes up short, with many organizations having insufficient policies and procedures to mitigate the risks of external audits. Practices should be mindful of a number of things as they strive to maintain compliance, including the ongoing threat of data breaches. Smaller practices may be more susceptible to HIPAA breaches because they are often unaware of all potential threats. Another factor to consider is that practice employees may unwittingly violate HIPAA rules without proper training. Staffers who take shortcuts to save time can also place the practice at risk and violate security regulations. Also worth consideration is patients' growing awareness and concern of their rights under HIPAA. Consequently, they have greater expectations about an organization's responsibility to consistently protect their privileged and sensitive information. Among the strategies organizations should follow to improve HIPAA compliance are conducting regular risk assessments via gap analysis. Developing a "live" HIPAA compliance plan can help ameliorate any risks discovered in the initial risk assessment. Moreover, practices need to ensure staff understand and can reliably execute compliance policies, by first including compliance in their orientation programs, and then supplying regular refresher training to keep personnel abreast of any new developments.


Experts recommend physician practices make education a mandatory component of the new technology implementation process and an ongoing priority. Communication is essential in the pre-implementation stage, with personnel being notified as to why you are making the investment and how new technology will affect their day-to-day jobs. Also important is customizing training for each job description, providing access to ongoing support and being alert to potential problems and opportunities to enhance efficiency. Optimizing training begins by evaluating staffs' computer literacy and familiarity with the new technology. Also critical is the appointment of "super users" to serve as resources throughout implementation. Making training relevant involves delivering an overview of the new system while also personalizing training to employees so they learn the functions they will use on a daily basis. Multiple strategies should be employed during initial training to guarantee employees remain engaged in learning. Leveraging online support offered by the technology vendor is useful as well, while employees should be given access to quick online reference guides that are easy to update and print for display around the office or at staff's desks. Continuous assessment is vital to the follow-up process to detect any gaps in training and to ensure employees apply their knowledge in practice.

Health Policy and Reimbursement

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Practices in affordable care organizations (ACOs) provide a slightly higher compensation for quality compared to practices in general, but both ACO and non-ACO practices are similar in compensation-based productivity and salary, indicating that the incentives for ACOs may not be significant enough to encourage practices to change physician compensation policies. An analysis of ACOs published in the Annals of Family Medicine examined whether practices in ACOs use compensation policies that are different from non-ACO practices that assume substantial risk for primary care costs. The researchers found that compensation for primary care physicians varied significantly across study practices. Physicians in both ACO and non-ACO practices without substantial risk for costs tend to receive half of their compensation from salary, less than half from productivity and about 5 percent from quality and other factors.  In comparison, physicians not in ACOs with substantial risk for primary care cost received two thirds of their compensation from salary, almost a third from productivity and about 1 percent from quality and other factors.


Health IT stakeholders, including the College of Healthcare Information Management Executives, are asking the Centers for Medicare and Medicaid Services to issue the final rule for the 2015-2017 Electronic Health Record (EHR) Incentive Program so that healthcare professionals can prepare for the final 90-day attestation period's Oct. 3 deadline. "If providers do not receive the final rule shortly, it will be very difficult to make workflow adjustments in a timely manner to meet programmatic deadlines and facilitate Meaningful Use tracking and reporting," warns the letter to U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell. The letter mentions specific aspects of the proposed rule that will require substantial preparation. For example, healthcare providers need ample time and resources to deploy bidirectional exchange for immunization registries, as well as time to prepare for the exclusionary pathways proposed in the rule. "As policy discussions continue on health information exchange/interoperability functionality, ensuring that the EHR Incentive Program is on track for 2015-2017 will reinforce the investments made to date and will support continued momentum toward the goals of enhanced care coordination and interoperability," the letter says.


The U.S. Department of Health and Human Services (HHS) has published guidance on the basics of Health Insurance Portability and Accountability Act (HIPAA) privacy, security and breach notification rules. HHS, in collaboration with education vendor Medscape, is offering six HIPAA educational programs with continuing medical education credits for physicians and continuing education credits for healthcare professionals. The guidance from HHS briefly explains each rule, who must comply and enforcement of the rules. The guidance also features multiple resources for additional information. The Medscape educational programs cover maintenance of privacy and security of electronic health records and mobile devices, the basics of HIPAA security risk analysis and risk management, patient privacy guides, examination of compliance with the privacy rule and how to build a culture of compliance.  

Medicine, Drugs and Devices

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Computers and Internet connectivity can make medical devices more accurate, but it also means that they are vulnerable to coding bugs. Federal regulators and cybersecurity experts warn that hackers could target connected medical devices, putting patients' lives at risk. U.S. regulators said recently that the Symbiq Infusion System, made by medical device-maker Hospira, could be hacked if someone gains access to a hospital's computer network. Unauthorized users could then control the device remotely and change dosages. The U.S. Food and Drug Administration has "strongly" encouraged healthcare providers to stop using the pumps, although no known cases exist of the issue being exploited in a healthcare setting. Even if it is not used to harm a patient, a hacked medical device could lead to other problems, such as compromising hospital or patient information.


The U.S. Food and Drug Administration (FDA) has revealed that it is working to develop a software platform for precision medicine and an informatics community for the platform.  FDA's Office of Health Informatics has contracted with DNAnexus to create open source cloud-based software for sharing genomic information.  The platform, called precisionFDA, can be used to evaluate bioinformatics workflows and essentially crowdsource reference data sets.  "To begin to realize this new vision, precisionFDA is designed to develop the necessary standards. PrecisionFDA will supply an environment where the community can test, pilot and validate new approaches,"  said FDA Chief Health Informatics Officer Taha Kass-Hout David Litwack.  When the precisionFDA beta opens, scheduled for December 2015, users will be able to access independent work areas for software code or data that can either be kept private or shared with others.


The U.S. Food and Drug Administration has approved the first 3D-printed drug. The drug is intended to treat certain types of seizures for epilepsy patients. It is manufactured by spreading several layers of the drug on top of one another until the correct dosage is reached. 3D printing allows a dosage of up to 1,000 milligrams and also allows the drug to dissolve faster.