News From ACFAS

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Committed, active ACFAS Fellow members are invited to consider being nominated to serve on the ACFAS Board of Directors. Interested? Visit acfas.org/nominations for complete details on recommended criteria for candidates and the nomination application. Applications are due September 4, 2015.

For additional information, contact Executive Director Chris Mahaffey via email or at (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Thomas S. Roukis, DPM, PhD, FACFAS via email or (608) 775-9673.

The Nominating Committee will announce recommended candidates to the membership no later than October 15, 2015. Candidate information and ballots will be emailed to all voting members no later than November 29, 2015. Electronic voting ends on December 29, 2015. New officers and directors take office during the ACFAS 2016 Annual Scientific Conference, set for February 11–14, 2016 in Austin, Texas.
To help avoid potential workflow interruptions and delayed reimbursements with the ICD-10 transition, start a conversation with your vendors and business partners. Many health plans have released FAQs and fact sheets to help them as they also prepare for the ICD-10 transition.

Use the Centers for Medicare and Medicaid Services' fact sheet to help guide your conversation or visit ACFAS' ICD-10 resource page for more tips and tools.
First-year podiatric surgical residents, kickstart your career with a complimentary first-year membership to ACFAS! Thanks to the Regional Divisions' support, your dues for the first year are waived (a $118 savings), plus you receive member pricing on conferences, products and services.

You'll also enjoy access to members-only resources on acfas.org and to the online version of the Journal of Foot & Ankle Surgery (JFAS) through the new JFAS iPad app.

Join now and receive an additional two months of membership, through September 2016.

Congratulations, Class of 2015! The Regional Divisions look forward to welcoming you to the College.
Your desire to care for others is one of the reasons why you entered this field; now it’s time to take a break from looking after everyone else to care for your own career.

Visit PodiatryCareers.org to do just that:

• Search hundreds of podiatry jobs nationwide
• Set job alerts to save time and ensure you don’t miss out on your dream job
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• Stay informed with the latest healthcare news, plus job search tips and career advice

PodiatryCareers.org is the place for healthy job hunting and career care at every stage. You care for others; PodiatryCareers.org cares for you and your career.

Foot and Ankle Surgery

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The rigid screw fixation and the flexible Endobutton fixation are two prevalent fixation methods to treat syndesmosis injuries. Both of these procedures can cause problems, so researchers designed a novel bionic fixation method that combines the features of both rigid and flexible fixations. The study used six normal fresh-frozen legs from amputation surgery. Syndesmosis, screw, bionic and Endobutton fixations were performed sequentially for each specimen. Axial and loading torque were applied in five different ankle positions. In most situations, the bionic group and the Endobutton group had comparable displacements. The displacements in the screw group were smaller than in any of the other groups. The researchers concluded that the bionic fixation at least equals the performance of Endobutton fixation. It also serves as a viable option for the fixation of tibiofibular syndesmosis.


A recent study applied oblique magnetic resonance imaging (MRI) planes parallel to the Lisfranc ligament for better visualization of the entire course of the ligament. Researchers then assessed the detailed MRI appearances of the Lisfranc ligament in cadavers and patients with presumed Lisfranc injuries. A small-diameter surface coil was used to examine 12 preserved cadaveric feet. Twenty-six MRI examinations from 23 patients were also evaluated. In the cadaveric study, the Lisfranc ligament was satisfactorily visible along its entire course in a single slice on long axis and oblique sagittal images. In the patient study, 11 MRI examinations led to diagnoses of complete tears of the Lisfranc ligament that were acute injuries mostly associated with disruption of the dorsal and plantar ligaments. Nine studies resulted in disagnoses of incomplete tears. Researchers concluded that MRI imaging demonstrated the integrity of the ligaments and was useful for diagnosing an acute Lisfranc injury.

Practice Management

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The implementation deadline for ICD-10 is fast approaching, and many practices are unclear whether their current coding processes will remain efficient with the increased code volume. To ensure that productivity is maintained after Oct. 1, all practices must employ three strategies: training, hiring and computer-assisted coding (CAC). The best method is to train intensively, well beyond a one-day or one-week educational session. Dual coding can be a great way to prepare, and effective training often involves continuous, ongoing practice in applying ICD-10 codes to actual patient health records. Hiring practices should also change. There are understandable concerns about hiring recent graduates, but doing so could be the change your practice needs to stay afloat. Recent grads often possess stronger, more current educational knowledge than those already active in the healthcare industry. Coding times have changed and being only familiar with the new instead of the old may prove quite beneficial. CAC can also make the transition easier. CAC can assist in assigning the codes from the documentation up front, and then the coders can verify the validity of the codes in an auditor-type role.


Perhaps the most challenging part of running a medical practice is being viewed as a leader by your staff. This becomes increasingly difficult amid rapid changes. Given the nature of medical practices, the ongoing shifts in the healthcare industry and the distinct personalities of each patient, healthcare providers must learn to deal with continual change and unpredictability. Here are some guidelines for physicians who seek to exhibit leadership and smooth transitions in the face of constant change.

• Mitigate threat. Provide timely communication and inform your practice of what to expect, why change is happening and the predicted outcome.
• Promote understanding. Deliver a compelling message because if staff does not understand what is going on, they will feel more threatened.
• Seek input. Help your staff feel like they are part of the solution rather than focus on the negative parts of change.
• Acknowledge discomfort. Pay attention to how your staff is coping and ask them how they are managing the changes.
• Present choices. Changes can create a perceived lack of autonomy; give your staff choices whenever possible.
• Seek fairness. Unfairness can be considered a social threat. Spread out work so everyone carries some of the burden.
• Be transparent. Mitigate any potential distrust by making sure you say what you will do and that you will do whatever you can to avoid surprises.

The Cisco Visual Networking Index found that global mobile devices and connections grew to 7.4 billion in 2014. This includes the 41- to 64-year-old demographic, where 23 percent now own smartphones. Patients are rapidly demanding greater access to physicians via mobile technology, so practices must develop a strategy to stay relevant and profitable. The first step is to claim your profile. To do this, search for your name on Google and find organizations that include you in their listings. Find out which of these you can claim and update. This will take time and should be done a few times each year. Find out what is important to your patients. Use online survey tools like Survey Monkey to ask your patients about their level of interest in mobile activities such as making payments, scheduling appointments and finding your office via a maps service. Finally, develop a roadmap. Create a checklist, establish a budget and outline the resources you need to achieve your mobile health goals. Outsourcing these activities is the most efficient strategy.

Health Policy and Reimbursement

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According to a recent report for the U.S. Government Accountability Office (GAO), there were indicators of potential prescription medication fraud and abuse among thousands of Medicaid beneficiaries and hundreds of prescribers during fiscal year 2011. Arizona, Florida, Michigan and New Jersey accounted for 13 percent of all Medicaid payments and among the four states, the GAO found that more than 16,000 of the 5.4 million beneficiaries potentially visited five or more doctors to receive prescriptions for antipsychotics or respiratory medicine. This "doctor shopping" came at a cost to Medicare of $33 million. In addition, about 700 beneficiaries received more than a one-year supply of the same drug in 2011 at a cost to Medicaid of $1.6 million. GAO recommends that the Centers for Medicare and Medicaid Services requires states to report information about specific drug utilization review controls to determine whether additional guidance is needed. The agency concurred with the recommendation and stated it will consider requiring states to report on these areas.


The Centers for Medicare and Medicaid Services is offering new ICD-10 guidance that will serve as "cheat sheets" for selecting the appropriate codes. The guidance is geared toward physician practices with multiple specialties and walks through typical clinical scenarios. The guides are not small; the family practice guide alone is 31 pages long, including specific codes for specific services within each treatment type.


The U.S. Senate has unanimously passed the Electronic Health Fairness Act, which would protect physicians who work in ambulatory surgery centers (ASCs) from being financially penalized by Medicare for not showing meaningful use of electronic health records (EHRs). The legislation addresses a blind spot in the Health Information Technology for Economic and Clinical Health Act of 2009. That law requires eligible professionals to use certified EHR technology in at least 50 percent of their patient encounters. Many physicians who work in ASCs do not have the certified EHRs required to show meaningful use. The Electronic Health Fairness Act of 2015, which was approved by the House on June 17, is now awaiting President Obama's signature.

Medicine, Drugs and Devices

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In 2002, the U.S. Federal Communications Commission (FCC) dedicated unused Channel 37 of the television band for hospital-only use to support wireless telemetry, but now FCC wants hospitals to share Channel 37 with unlicensed devices, such as wireless microphones and Bluetooth technologies. The American Hospital Association (AHA) is protesting this change. Recent tests conducted by AHA at three hospitals found that nearby unlicensed devices caused significant interference at distances of 315 to 1,000 meters from a facility. The association asked for an exclusion zone of three kilometers between hospitals and the use of newer devices to be allocated spectrum. FCC set an exclusion zone of 380 meters. An FCC spokesperson says that the commission initially proposed 100 meters between unlicensed devices and hospitals, and hospitals initially said they needed 300 to 360 meters. The spokesperson also said that FCC may be several years away from authorizing unlicensed devices to use the spectrum in Channel 37.


A recent Japanese study found that treatment of rheumatoid arthritis with abatacept (Orencia) and tocilizumab (Actemra) had similar clinical efficacy but differing baseline factors that predicted response. The baseline characteristics were statistically comparable. However, prognostic factors at baseline contributing to the Clinical Disease Activity Index at week 52 were different between the two groups. A higher rheumatoid factor (RF) titer and lower Simplified Disease Activity Index (SDAI) at baseline were associated with lower SDAI at week 52 in patients treated with abatacept, whereas patients receiving tocilizumab with a lower Health Assessment Questionnaire Disability Index and who were biologics-naïve at baseline had a lower SDAI at week 52. "We believe that innovative statistical methods such as propensity score matching can contribute to the growing body of clinical evidence and might lead to the development of tailor-made medicine using biological products for patients with rheumatoid arthritis," the authors concluded.


Amarin has won a court ruling that will permit the company to give doctors information about unapproved uses of its fish oil pill. The ruling could lead to more pharmaceutical companies encouraging doctors to use their drugs in ways that have not been approved by the U.S. Food and Drug Administration (FDA). The case involved Amarin's attempt to use its prescription-grade omega-3 fatty acid for use in patients with more moderately elevated triglycerides. The pill is currently approved for patients with very high triglycerides. Amarin argued that FDA was "chilling it from engaging in constitutionally protected truthful speech." Judge Paul Englemayer of the Southern District of New York said Amarin has the right to speak with doctors about treating patients with triglyceride levels that are not as high as FDA has approved.