News From ACFAS

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What can you expect from the 2015 ACFAS Annual Scientific Conference? The theme says it best—Limitless: Potential and Opportunities, which perfectly captures the impact the conference can have on your profession and practice.

So join us February 19–22, 2015, at the Phoenix Convention Center in Phoenix, Arizona, and see why Podiatry Today ranks our event as the most valuable conference in the profession. Experience the potential and opportunities at ACFAS 2015 with thought-provoking scientific sessions; intensive hands-on workshops; award-winning research, papers, posters and case studies; and a multitude of specialized exhibits.

Special pre-conference programs are set for Wednesday, February 18, so you can get a head start on the action that awaits you in Phoenix.

Watch acfas.org/phoenix and ACFAS publications for the latest on ACFAS 2015! Are you and your staff abreast of the latest changes in coding, billing and compliance practices? Are you receiving the appropriate reimbursement for your services? Don't lose out--register yourself and your office staff for the 2014 Coding/Practice Management Workshop, October 24–25, 2014 in Philadelphia, Pennsylvania.

Learn the valuable tools needed to code and bill for evaluation and management services, surgical procedures, wound care and durable medical equipment. Plus, get a head start on the Transition to ICD-10 and gain better understanding of the stages of Meaningful Use Attestation.

Give your practice the competitive edge and register today at acfas.org/practicemanagement/. It's not too late to take advantage of the latest free webinar just for residents, Maximizing Your ACFAS Resident Membership, set for August 19, 2014 at 8pm CDT. Join Eoin Gorman, DPM, PGY-3 at Columbia St. Mary’s Hospital, and Corey Fidler, DPM, PGY-3 at Washington Hospital Center as they answer many of the questions you may have as a resident member and show you how to take advantage of all ACFAS has to offer.

Don't delay—visit acfas.org to register now.

Foot and Ankle Surgery

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Surgery involving open reduction and internal fixation should not be used to treat displaced, intra-articular calcaneal fractures, a new study has concluded. The study found that patients with acute displaced intra-articular calcaneal fractures who were treated surgically were at a higher risk of complications and reoperations than their counterparts who underwent non-operative treatment. In addition, patients who were treated surgically and those who underwent non-operative treatment displayed similar symptomatic and functional outcomes two years following treatment. Both groups of patients had similar Kerr-Atkins scores for pain and function, American Orthopaedic Foot and Ankle Society scores, general health as measured by Short Form-36 (SF-36), quality of life, clinical examination, walking speed and gait symmetry after two years.


The first-ever study to present outcomes from using a single-lateral approach during triple arthrodesis to correct hindfoot deformities has found that the technique has an advantage over the double-incision lateral approach. The study involved 70 patients who underwent triple arthrodesis using either a double-incision or single-incision approach, most commonly as a treatment for Stage III planovalgus deformity. The study found that the single-incision approach was significantly faster, taking 86 minutes compared to the 95 minutes it took to perform the double-incision lateral approach. However, no differences were observed between the single-incision and double-incision groups in terms of deformity correction, wound healing, complications, reoperations or improvement in visual analog scale (VAS) pain scores. The study also found that a total of five patients, some of whom were in the single-incision group while others were in the double-incision group, experienced radiographic non-union of the calcaneocuboid joint. This finding suggest that fusion of this joint may not be important in terms of relieving symptoms or correcting a deformity.

Practice Management

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Physicians who have grown weary of working in independent practices, either because of increasing regulatory burdens or the large amount of paperwork that needs to be completed to receive reimbursements from insurers, may not necessarily need to go to work for hospital systems to escape these problems. Some physicians are opting to move from independent practices and join independent practice associations (IPAs), which allow them to achieve a number of benefits that come with banding together with other doctors while also maintaining a degree of autonomy. Physicians who join IPAs are independent but are part of an organization that contracts as a group to provide a variety of services. Another benefit associated with joining IPAs is that the organization can negotiate with insurers to obtain better reimbursement rates for participating doctors. In addition, insurers that have relationships with an IPA pay closer attention when physicians who are members of that organization make claims about missing reimbursements. Physicians who are considering joining an IPA should also be aware of the obligations associated with such a move. For example, IPAs are obligated to take steps to improve patient care and reduce costs. Doctors who decide that IPAs are not for them have other options short of going to work directly for a hospital system, including joining independent practice groups.


Leaders of physicians' practices should take steps to keep turnover among doctors as low as possible since high turnover rates can make prospective physicians hesitant to join a practice, writes Nick Weeks, a managing partner of the healthcare consulting firm Creative Healthcare Solutions (CHS). One key to holding down turnover, Weeks says, is to always conduct exit interviews with physicians who have resigned. Ideally, these interviews should be conducted by someone who can elicit candid responses from the physician as to why he or she is leaving. While it is important to be aware of how the physician's observations may be exaggerated, knowing why he or she is resigning can help the practice address any problems that may exist so that other doctors do not leave for the same reasons, Weeks says. This is particularly important because it is becoming increasingly difficult for practices to recruit new physicians, Weeks writes, and because physicians who hear that a practice they are considering working for has high turnover rates may be disinclined to join that practice, particularly if they hear about the negative experiences of fellow doctors who have worked there. Weeks also suggests that keeping turnover down by addressing issues observed by departing physicians can help ensure patient satisfaction and retention as well.


American Health Information Management Association ICD-10-CM/PCS trainer MeShawn Foster, MJ, RHIT, says medical practices need to take several steps to build effective ICD-10 training programs for the employees who need more intense forms of training. The first step is to identify which employees may need this more intensive type of training, whether they be medical coders, mid-level providers, physicians or employees who work in a case management department. Each of these types of individuals will have different needs when it comes to ICD-10 training, Foster says, so practices will need to develop different types of training programs for different types of employees. In addition, practices should identify documentation improvement areas for ICD-10-CM, Foster says. Once the training has begun, trainers should quiz trainees on their knowledge and periodically review material that may need more emphasis. At the same time, practices should be sure to document any potential trends that could have an impact on their finances, operations or administration, Foster says. Once ICD-10 has been in place for six months, Foster says, practices should use the data they have collected to develop more targeted training exercises. Finally, Foster says that fluctuations identified as trends that deviate from a certain baseline level should be used to adjust existing training programs.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) announced Aug. 7 that it is delaying two deadlines associated with the Open Payments System, the online database that contains information about payments drug and medical device companies made to doctors. Doctors originally had until Aug. 27 to dispute any information contained in the database, though CMS now says that a "reported issue" with the system has forced it to take the database offline temporarily. As a result, doctors will not be able to review and dispute the information contained in the Open Payments System until the problem is corrected. CMS is also pushing back the Sept. 30 public launch of the Open Payments System due to the same problem. The agency is investigating the issue and will announce new deadlines following the conclusion of that probe.


The American Medical Association (AMA) and roughly 100 other medical professional groups sent a letter to the Centers for Medicare and Medicaid Services (CMS) on Aug. 5 to ask the agency to move back the rollout date for the Open Payment System, the online database that will contain information about payments to doctors from drug companies and medical devicemakers. AMA and other organizations want CMS to push back the introduction of the database until March 31, 2015. The organizations said the delay is necessary because implementing the new system "without minimally a six-month period to upload the data, process registrations, generate aggregated individualized reports and manage the dispute communications and updates" could result in "inaccurate, misleading and false information" being released. The letter's signatories also said that physicians do not have enough time to review and dispute reports about payments they received due in part to the "complex" process of registering to review these reports.


The Justice Department on Aug. 1 asked the full D.C. Circuit Court of Appeals to hear its appeal of the court's decision in Halbig v. Burwell, in which a three-judge panel stated that the federal government could only give tax subsidies to consumers purchasing insurance coverage via state-run rather than federally run health insurance exchanges. The Justice Department cited several reasons why it believes the ruling is incorrect, including the fact that the Affordable Care Act (ACA) calls for both state and federal exchanges to report information to the IRS for use in administering the subsidies. Such a provision would not be necessary if the authors of ACA had intended to limit the subsidies to only customers of state-run exchanges, the Justice Department said. Government lawyers also pointed out that the Fourth Circuit Court of Appeals in Richmond, Va., has ruled that the subsidies are available to consumers regardless of what type of exchange they purchase coverage from. In addition, the Justice Department argued that allowing the decision made by the three-judge panel of the D.C. Circuit Court of Appeals to stand would make it very difficult for millions of consumers to afford coverage on the federally operated exchanges. If the full D.C. Circuit Court of Appeals decides to take the case, it may be likely to rule in the administration's favor, as it is made up mostly of judges nominated by Democratic presidents.

Medicine, Drugs and Devices

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A recent study examined the usefulness of ultrasound elastography in diagnosing plantar fasciitis early. During the study, ultrasound elastography was performed on 18 feet suspected of having plantar fasciitis but whose conventional ultrasound images appeared normal. Ultrasound elastography was performed on 18 asymptomatic feet as well. The use of ultrasound elastography uncovered greater softening of the plantar fascia in patients suspected of having plantar fasciitis compared to the control group of asymptomatic feet. This finding led the study's authors to conclude that ultrasound elastography is helpful in diagnosing plantar fasciitis early.


A recent study examined the effects that different numbers of applications of low-level laser therapy (LLLT) had on IL-1ß, COX-2 and PGE2 modulation in Wistar rats with partially injured Achilles tendons. The study's authors assigned 60 rats with injured Achilles tendons to one of six groups: the LASER 1, LASER 3 and LASER 7 groups, in which LLLT was performed on the rats one, three and seven times, respectively; and the Sham 1, 3 and 7 groups, in which LLLT was simulated the designated number of times. Five other rats were not injured and did not undergo any type of procedure; these animals served as the control group. After surgically removing and assessing the tendons, the study's authors found that IL-1ß was at an almost normal level in the LASER 3 group compared to the control group (uninjured animals). COX-2 and PGE2 modulation, meanwhile, were at near-normal levels in the LASER 3 and LASER 7 groups compared to the control animals. These findings led the authors to conclude that LLLT decreased the inflammatory process in the injured Achilles tendons.