News From ACFAS

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Do you have research you’d like to be considered for poster presentation at ACFAS 2014? If so, submit your application and abstract via the online submission system by October 15, 2013 (11:59 pm Central time). Visit acfas.org/asc, read the full 2014 Poster Exhibits Guidelines (PDF) closely, and click “Submit a Poster” to begin your submission – it’s that easy!

New This Year:

• Scientific Format posters, if accepted for presentation at the Annual Scientific Conference, must be submitted in both paper and electronic (PDF) format.
• At least one of the poster authors (both Scientific Format and Case Study Format) must register for and attend the Annual Scientific Conference in order for their poster to be displayed.

Submit your poster today at acfas.org/asc. Help implement evidence-based medicine to advance patient care by applying for the 2013 ACFAS Clinical and Scientific Research Grant.

The ACFAS research grant program is in its eighth year of supporting research conducted by members of the College, and we are proud to have the ability to award up to $40,000 in grant money. "The grant program has grown to a point where it is clear that the capacity and sophistication of our members’ research commands greater resources. As leaders in foot and ankle surgery, the College strives to support the vision of its members, and expansion of the research program is one way the college does just that,” says Dr. Robert Joseph, DPM, PhD, Chair of the Research Committee.

To apply, or for more information on grant award criteria, visit acfas.org/grant. Remember, research must be clinical or laboratory-based, with clearly defined research goals meeting all the criteria for grant submission, and all applications must be received by September 16, 2013. Class of 2013: Receive a complimentary first year of membership to ACFAS as a first-year podiatric surgical resident thanks to the support of the Regional Divisions. As a resident member, not only will you have your dues waived for the first year (a $116 savings) but you’ll also receive all the cost benefits of membership including member pricing on conferences, products and services.

Kick-start your career with ACFAS! We connect residents to a community of your peers — the best and brightest foot and ankle surgeons in the country. You will also have access to the College’s premiere website, and access to the prestigious Journal of Foot & Ankle Surgery (JFAS) through the new JFAS iPad app — a must have to increase your knowledge of the latest surgical techniques and research.

Applications for membership are available through the Resident Center at acfas.org. Joining now will provide you with free membership through September 2014 — and put JFAS in your mailbox right away! Once again, congratulations to the Class of 2013. The ACFAS Regional Divisions look forward to welcoming you to the College. The Foot & Ankle Specialists of Ohio Reconstructive Surgery and Deformity Correction Fellowship in Mentor, Ohio, has recently been named an ACFAS Recognized Fellowship by the ACFAS Fellowship Committee.

Under the direction of Stephen J. Frania, DPM, FACFAS, this fellowship previously received Conditional status by the Fellowship Committee during its inaugural year. After its first annual review, the committee determined that the program continued to exceed ACFAS’ minimal criteria, and upgraded the program to an ACFAS Recognized Fellowship.

For more information on this fellowship, visit acfas.org/fellowshipfrania. For a complete listing of the ACFAS Recognized and Conditional Status Fellowships or the ACFAS Recognized Fellowship Initiative, visit acfas.org/fellowshipinitiative.

Foot and Ankle Surgery

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Researchers at Baylor University Medical Center have performed a study that examined the outcomes of nonarthrodesis reconstruction in treating hallux valgus in patients with rheumatoid arthritis (RA). Unlike arthrodesis of the first metatarsophalangeal (MTP) joint, which is the standard treatment for hallux valgus in RA patients, nonarthrodesis reconstruction preserves the first MTP joint. Researchers examined 37 feet with hallux valgus in 27 RA patients who underwent a joint-preserving procedure of the first MTP joint. Ludloff osteotomies were performed on 20 feet, 15 feet had scarf osteotomies and two had chevron osteotomies. The radiographic and clinical outcomes of these procedures were measured preoperatively and postoperatively. The study concluded that RA patients who undergo a bunionectomy instead of arthrodesis to preserve the first MTP joint have satisfactory clinical and radiographic outcomes. The study also concluded that a bunionectomy was a reasonable alternative to first MTP arthrodesis in patients whose joints are relatively preserved.


A recent study examined the effects of a two-week anterior-to-posterior joint mobilization intervention in treating adults with chronic ankle stability. Researchers recruited 12 individuals with chronic ankle instability and treated them with talocrural Grade II joint traction and Grade III anterior-to-posterior joint mobilization six times over a period of two weeks. No significant differences in any measures of single-limb stance static postural control were seen after the intervention took place. Researchers also did not observe any significant difference in ankle arthrokinematics after the completion of the two-week treatment period. However, researchers said they still believe that talocrural joint mobilization has a role to play in the rehabilitation of chronic ankle instability patients.

Practice Management

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Two companies have released the results of a survey that examined how the use of electronic health records (EHRs) affects patients' perception of their doctors and the care they provide. The survey, which was released by the national marketing and research firms Aeffect and 88 Brand Partners on Aug. 5, found that 78 percent of patients who have connected to an EHR through a patient portal were generally satisfied with their doctors, compared to 68 percent of patients who had not accessed EHRs through patient portals. The survey also found that 82 percent of EHR users were confident in the quality of care they received, compared with 73 percent of non-EHR users. Aeffect and 88 Brand Partners explained the results by saying that patients who can directly access their health records through EHRs likely feel a greater connection to their doctors and what they are doing compared to patients who are unable or unwilling to access this information. However, the results of the survey were criticized by Robert Tennant, a senior policy adviser focusing on health IT at MGMA-ACMPE, an organization for medical practice managers. Tennant noted that seniors, who tend to be less technically-savvy than younger people, were not included in the survey. Had seniors been included, Tennant said, there likely would have been no significant difference between EHR and non-EHR users.


The latest Athenahealth Physician Sentiment Index shows that doctors have mixed feelings about the use of electronic health records (EHRs). Participants in the survey included 1,200 users of Athenahealth's Epocrates electronic decision-support and clinical workflow products, 70 percent of whom were specialists. Of those 1,200 respondents, more than three-quarters said that they worked at a practice that used an EHR. Only 52 percent said that they played an active role in purchasing these systems. Nevertheless, 69 percent of respondents said they had either a somewhat or a very favorable opinion about EHRs. But respondents were divided on the cost benefits of EHRs, with 51 percent saying that the financial benefits do not outweigh the costs and 55 percent saying that patient-care benefits outweigh the costs associated with the systems.

The survey also asked doctors about their views on the complexity of the payment processes used by private insurers, Medicare, and Medicaid. Nearly 80 percent said they agreed or strongly agreed that the payment processes used by private insurers had become more burdensome and complex, while 65 percent said the same about Medicare and Medicaid. However, doctors reported being less frustrated with these payment processes.

Health Policy and Reimbursement

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Pharmaceutical and medical-device companies this month began recording any type of compensation given to doctors under the terms of the Affordable Care Act's Sunshine Act provision. Some doctors are expressing concerns about the impact of the law, which requires drug and medical-device companies who make products covered by Medicare to provide the Centers for Medicare & Medicaid Services with reports on such things as sales representatives giving food to doctors as well as any money paid to physicians for providing advice on research. These physicians say that some patients could see the data, which will be posted on a public Web site beginning in September 2014, and begin to have doubts about their medical decisions. In addition, some doctors say that they will be more selective about the work they do for drug and medical-device companies as well as what they will accept from industry representatives. But some say that the Sunshine Act could be beneficial as well, as it could help doctors better evaluate research from other physicians who may be receiving payments from pharmaceutical and medical-device companies. The pharmaceutical industry, meanwhile, says that it is prepared to comply with the law and that it intends to continue working with doctors to improve science and medicine.


Medical Group Management Association (MGMA-ACMPE) President and CEO Dr. Susan Turney recently sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius asking her to delay the implementation of penalties levied against doctors who fail to meet the deadline for Stage 2 Meaningful Use. Turney noted that the delay is warranted because electronic health records (EHR) vendors are generally not ready to produce and deploy EHR products that meet Stage 2 requirements. There are currently only 75 products and 21 complete EHRs that meet Stage 2 criteria. That means that doctors will be hard-pressed to meet the Stage 2 requirements, which take effect for physicians on Jan. 1, and will be penalized with reductions to Medicare payments beginning in 2015, Turney said. She added that the only option for doctors to avoid the penalties, replacing existing EHRs with systems that meet Stage 2 criteria, is not feasible for most physicians. Turney said that HHS should address this problem by adopting an immediate suspension of these penalties for doctors, assuming that they have already successfully met Stage 1 meaningful use requirements. Other organizations have also asked for a delay in implementing Stage 2.


The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that spells out when Medicare patients are considered inpatients at hospitals. Under the rule, Medicare patients who spend at least two midnights at a hospital are considered inpatients and are eligible for Medicare Part A coverage. The rule also states that doctors can use the entire time a patient spent in the hospital as an outpatient when considering whether or not he or she has been at the facility for at least two midnights. The new rule is expected to result in an increase in inpatient encounters, which in turn is expected to result in a $220 million increase in expenses that CMS plans to offset with a 0.2 percent reduction in the amount it pays for hospital services. The goal of the new rule is to reduce long stays in observation at hospitals, which can result in large Medicare fees for patients. But the rule has been criticized by groups such as the Federation of American Hospitals, whose executive vice president said he was hoping that CMS would come up with a "clinical solution" to the problem of long stays in observation. American Medical Association Vice President and CEO Dr. James L. Madara said his organization opposes the rule as well because it is "overly complicated" and because it would "unduly extend beyond the current benchmark of 24 hours."


The Centers for Medicare & Medicaid Services (CMS) is accepting comments between now and Sept. 5 on a potential change to a decades-old policy prohibiting the release of Medicare doctor payment data. In an Aug. 6 blog post, CMS announced that it was considering releasing doctor payment data--including line-item information on claims for patient services or aggregated data for individual doctors--as part of the Obama administration's efforts to make Medicare billing more transparent. CMS also said in its blog post that it believes that releasing the data could promote initiatives that reduce costs and improve the quality of healthcare. CMS currently operates under a policy adopted by the Department of Health and Human Services in 1980 that prohibits the release of individually-identified Medicare payment amounts in order to protect the privacy of doctors. The American Medical Association has spoken out on the reconsideration of that policy, saying that while it supports improved transparency it is concerned about the potential for "misleading" and "harmful" effects caused by releasing raw Medicare claims data to the public. AMA added that it does not believe that releasing this data will provide patients with helpful information on quality of care or treatment options.


Consumers who plan to purchase health insurance coverage from one of the online marketplaces that are set to open in October will likely face limits on the number of doctors and hospitals they can visit for their healthcare needs. McKinsey & Co. recently analyzed 955 consumer exchange-plan filings in 13 states and found that 47 percent of those plans were health-maintenance organization or similar plans that generally did not pay for care obtained outside of their networks. The analysis also found that even some preferred-provider plans (PPOs), which generally do not carry the same restrictions as HMO plans, will give patients access to a smaller network of doctors and hospitals. Some plans that will be offered through the health insurance exchanges, including one in New York State, will allow patients to obtain care primarily from only one hospital system. Insurers are offering plans with smaller provider networks in order to appeal to cost-sensitive uninsured consumers. An insurance plan with a smaller network of providers that is being offered by Blue Cross and Blue Shield of Illinois, for example, will cost 20 percent to 30 percent less than other plans offered by the company that give patients access to a larger network of providers. These plans also may not pay for care at well-known hospitals, such as UCLA Medical Center in Los Angeles, because these institutions will likely be hesitant to accept discounted rates.

Medicine, Drugs and Devices

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A recent study examined the effectiveness of using the drug tofacitinib to treat rheumatoid arthritis (RA) patients who have not been helped by methotrexate and other disease-modifying antirheumatic drugs (DMARDs). The 792 patients who were recruited to participate in the study were randomly assigned to one of two groups: one in which patients were given five mg or 10 mg of oral tofacitinib twice a day, or another group that was given a placebo before being given five mg or 10 mg of tofacitinib twice daily. Researchers examined a variety of metrics to determine the effectiveness of tofacitinib, including a 20 percent improvement in American College of Rheumatology (ACR20) criteria, Health Assessment Questionnaire Disability Index (HAQ-DI) scores, and safety assessments. The study concluded that tofacitinib improved disease control in RA patients who had already been treated with nonbiologic DMARDs.


Researchers in Sweden have performed a study that examined whether the radiological superiority of biological tumor necrosis factor inhibitors also translates into better work loss outcomes in patients with rheumatoid arthritis (RA). More than 200 patients were recruited for the study, all of whom were unable to achieve low disease activity after taking methotrexates for three to four months. These patients were randomized to receive additional biological treatment with infliximab or conventional combination treatment with sulfasalazine and hydroxychloroquine. Researchers found that biological treatments did not result in better work loss outcomes in patients with early RA who did not experience significant benefits from taking methotrexate. The baseline mean work loss was 17 days per month in both groups of patients.