News From ACFAS

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Popular social media sites such as Facebook and Twitter have changed the way patients can interact and share with other patients and your practice. Your practice needs a social media presence if you want to start engaging with your current patients and connecting with hundreds of their contacts to grow your referrals.

Learn how to create an effective social media presence on the web, and learn how to integrate social media strategy by participating in Social Media: Leveraging Against Facebook, YouTube, Twitter, Google Plus, etc., the first webinar in our new practice management webinar series brought to you by ACFAS and Officite, our Benefits Partner, on Wednesday, September 26 at 8 p.m. CDT.

To register for Social Media: Leveraging Against Facebook, YouTube, Twitter, Google Plus, etc., or to see the full listing of webinars in the series, visit the website at www.officite.com/company/webinars.

Note: These are non-CME programs. Some of the highest rated programs ACFAS offers are the Surgical Skills Courses, with the next courses being offered this November. Reinforce your skills as you perform surgical procedures using state-of-the-art equipment; learn new solutions through an unmatched curriculum and practice ground-breaking, contemporary techniques on cadavers.

Register for and attend one of these November course offerings. Space fills quickly, so register today! Login is required:

• Surgical Solutions for Complications of the Forefoot
• Surgical Solutions for Complications of the Rearfoot and Ankle
• Trauma of the Foot & Ankle Surgical Skills Course

And remember, each surgical skills course has set high-standard objectives, so you know that by achieving these objectives you will be able to provide top foot and ankle surgical care for your patients.

Download the course catalogue here. Does your practice utilize the latest in patient-centered, all-inclusive information? If not, then consider purchasing one or both of these CD series’ compiled for ACFAS members’ use in the office, which can be found at acfas.org/marketing.

Each CD set includes printable handouts that you can provide to your patients before and after surgery to ease their worries. If your patient is non-surgical, there’s information for him or her as well! Also, each printout is fully customizable to suit the marketing needs of your practice, and it’s backed with the ACFAS logo, so your patients can rest assured that they are being treated by a quality foot and ankle surgeon.

Visit the Patient Education and Perioperative Education CD pages to check out all the topics they have to offer.

Foot and Ankle Surgery

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The medial distal tibial angle (MDTA) is use to determine ankle alignment. A study was held in which the MDTA was compared between the mortise view and the hindfoot alignment view (HAV) in 146 ankles and correlated to age and sagittal tibial tilt for each view. Differences in MDTA were evaluated according to gender and ethnicity, while diagnostic agreement between views was estimated. The MDTA quantified from the mortise view and HAV radiographs were 89 degrees and 86 degrees, respectively. The MDTA was comparable for both genders for both views and comparable in all ethnic groups for mortise and HAV. No statistically significant correlation between the measured MDTA and age was observed for both the mortise and HAV. The radiographic diagnosis of alignment was the same between views in just 47.3 percent of all ankles. Agreement between clinical and radiographic classifications was 60.3 percent for the mortise view and 52.8 percent for the HAV.


A study was held to investigate whether supplementing 0.5 percent levobupivacaine used for posterior sciatic nerve block with 150 µg perineural clonidine would extend the duration of analgesia. The analgesic traits of 20 mL plain levobupivacaine were compared to those of 20 mL levobupivacaine 0.5 percent plus 150 µg clonidine in a posterior sciatic nerve block for foot and ankle surgery, using 60 patients randomized and assigned to receive either levobupivacaine alone or levobupivacaine plus clonidine. Onset and duration of the block, hemodynamic changes during surgery, the need for rescue analgesia and technical or neurologic complications were measured over a 24-hour period. The onset of the sensory block was found to be closely similar, about 10 minutes on average, in both the levobupivacaine and levobupivacaine plus clonidine groups. The time to first request of pain medication also was similar. During surgery, 50 percent of patients in the levobupivacaine plus clonidine group exhibited a decline of more than 20 percent in systolic arterial pressure, versus 28 percent of patients in the levobupivacaine group. No complications in either group were observed over the 24-hour period.


A study was held to test the theory that fluconazole plus standard care for diabetic foot wounds infected with deep-seated fungal infections can accelerate healing faster than standard care alone. The study involved 75 patients with both fungal and bacterial infections in deep tissues of diabetic foot wounds, 37 of whom were assigned to a control group that received standard care, which consisted of surgical debridement, culture-specific antibiotics, offloading and glycaemic control. Thirty-eight patients were assigned to the treatment group to receive 150 mg of fluconazole daily in addition to standard care. Wound surface area was measured in two-week intervals until complete epithelialization or skin grafting was achieved. By the fourth week, the average wound surface area shrank from 111.5 square cm to 27.3 square cm in the treatment group, versus from 87.3 square cm to 67.1 square cm in the control group. Subsequently, the average wound surface areas were remarkably smaller in the treatment group versus the control group, and statistically significant differences in average wound surface area were seen between the treatment group and the control group by the sixth week. However, no statistically significant difference in complete healing was observed between the groups. Average wound healing time for the treatment group was 7.3 weeks, compared to 11.3 weeks for the control group. The likelihood of wound healing in the treatment group was 50 percent versus 20 percent in the control group at the tenth week.

Practice Management

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Although the fax machine has had a prevalent role in medical office operations since its widespread adoption in the 1980s, it may be time for practices to move on. In the current age, it is impractical to print an electronic document from a word processing or EHR system to convert it into a fax for transmission to another office. When a fax is received, it adds no value to print it on paper only to convert it to an electronic image. This requires the paper fax to be filed or shredded after it has been used to transmit the information.

Many practices keep the traditional fax machine because of the HIPAA Security Rule, which applies only to electronic protected health information (ePHI), which is PHI that has been created, received, maintained or sent electronically. The Security Rule exempts facsimiles and any PHI that was not electronic before it was sent, such as a telephone call between two persons. Alternatives to the fax machine each have their own advantages and disadvantages. This includes email or an email attachment, but emails are unacceptable for ePHI, as the information transmitted over the Internet is stored in places a practice cannot control.

Email attachments, however, may be acceptable if they are encrypted or password protected. An electronic fax service encrypts email attachments when the sender uses the service's proprietary program, then sends the encrypted file and the recipient's fax number to the service. The service then decrypts the file and sends it to the recipient as a traditional fax. These services must include a Business Associate (BA) agreement, which is required by HIPAA, and vary in price.

Practices may also consider data delivery via website, which many banks use with their online banking. To send information, the sender uploads a file to a secure website and sends a notification e-mail to the recipient. Then, the recipient can log onto the website and retrieve the file. A fax server operates much like an electronic fax service, intercepting faxes coming in on a telephone line and sending them to a specific website as an email attachment. Outgoing faxes are attached to an email and directed to the fax server, with the fax number of the recipient. Unlike an electronic fax service, it is managed by the practice, with the fax server behind the clinic or office firewall, and there is no need for a BA agreement.


Here are some online and offline tactics you and your practice administrators can use to gather intelligence about competing practices. You can either do this yourself or delegate the responsibility to a staff member.

1. Do a simple Google search

Start by searching for the name of your competitor's clinic or a competing physician. Pretend you’re a patient trying to use Google to find a local doctor who treats their ailment. For example, type in "ophthalmologist, Fairfax, Virginia." Since this is the type of search query a real patient would use, the results show you what clinics in the area have worked hard to promote themselves online. If your competition isn’t showing up in the search results, the field is wide open for you. Start creating, optimizing and broadening your online presence.

2. Set up Google alerts

Google alerts let you tell Google to search daily for a specific name or set of terms, then it delivers relevant results each day by e-mail. Set up an alert based on your competitor’s clinic name or the physician’s name. Any time their name comes up in Google, you’ll know about it instantly. This is a powerful tool that can even open your eyes to new marketing ideas or media outlets you wouldn’t have thought of otherwise.

3. Mystery shop your competitors

Call their clinic and get a feel for how they handle new patient phone calls. You can learn a great deal in just a few minutes. For example, is their staff friendly and helpful? Do they have long hold times? Are they using marketing messages while you’re on hold or just annoying elevator music? Other information can be gathered online. Sign up for their newsletter on their website or fill out a contact form, asking for more information.

4. Start collecting their advertising

Medical practices spend hundreds of thousands of dollars over the years getting their name publicized. You can find ads in local papers, local magazines and on billboards. Try to clip, photograph or otherwise save these bits of marketing material. Over time, you’ll see patterns of ad designs and marketing messages. Are they consistent? Are they repeated year-in and year-out? If so, they’re probably bringing in new patients and this means the local market is responding to them. You’ll want to consider adding your own spin on that message if you create a new ad campaign. Try to figure out who they’re targeting. Is there a group of patients they’re leaving out? If so, you could step in and market to that left-out group of patients. If there’s nothing special about their message, one way to beat your competition is to create a marketing message that is unique to your business; create a category where you alone are the only dominant force.

Health Policy and Reimbursement

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The U.S. Department of Health and Human Services (HHS) recently announced over $160 million in loans to help set up new nonprofit insurance carriers, or co-ops, under President Barack Obama's healthcare statute. The loans went to a Massachusetts and a Tennessee organization. The new co-ops are required to reinvest their profits toward providing better care or reducing premiums and would have to adhere to the same rules as traditional insurers. Advocates say co-ops will allow consumers to assume more control over their healthcare, with leaders elected by participants; co-ops also are seen as potential tools to boost quality and control costs because they are nonprofit entities. HHS' co-op loans now total more than $1.5 billion and cover 20 states, according to a department release.


The Medical Group Management Association (MGMA) is urging the Centers for Medicare & Medicaid Services (CMS) to combine its quality bonus incentives for electronic prescribing and remove financial penalties for physicians who fail to meet incentive requirements. MGMA called a proposal to reduce payments for specialists who perform multiple procedures on the same patient on the same day "arbitrary and not based on actual reduction in clinical labor activities." Specifically, the MGMA called for the CMS to deem that all physicians who meet meaningful-use requirements for federal healthcare IT incentives automatically receive Physician Quality Reporting System bonus credit for electronic prescribing. The group also recommended limiting the use of the value-based payment modifier to multispecialty groups of 100 or more doctors.


New projections from the Congressional Budget Office say that eliminating the sustainable growth rate (SGR) formula, which helps determine physician pay, and freezing Medicare doctor pay rates over 10 years would cost $245 billion. Officials had previously estimated that nearly $300 billion would be needed for a pay freeze, but with slower than expected growth in program spending, the SGR formula (which decreases doctor pay when predetermined spending limits are exceeded) would not lower doctor rates as much and would be less costly to reverse as a result.

Medicine, Drugs and Devices

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A study was conducted to evaluate whether intra-tendon delivery of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) would improve Achilles tendon repair in a rat collagenase-induced tendinopathy model. One of four intra-tendinous treatments—vehicle control, 1.02 µg rhPDGF-BB, 10.2 µg rhPDGF-BB or 102 µg rhPDGF-BB—was administered seven days following collagenase induction of tendinopathy. Treated tendons were evaluated for histopathological and biomechanical results. There was a substantial increase in cell proliferation with the 10.2 and 102 µg rhPDGF-BB-treated groups and in thickness at the tendon midsubstance in the 10.2 µg rhPDGF-BB group versus the controls by seven days post-treatment. By three weeks follow-up, all groups had equivalent results. A dose-dependent effect on the maximum load-to-failure was observed, with no significant divergence in the 1.02 and 102 µg rhPDGF-BB doses. However, the 10.2 µg rhPDGF-BB group had a significant increase in load-to-failure at seven and 21 days compared to controls. The rhPDGF-BB treatment induced a dose-dependent, transient gain in cell proliferation and sustained improvement in biomechanical properties in a rat Achilles tendinopathy model, showing the potential of rhPDGF-BB treatment in a tendinopathy application.


The International Osteoporosis Foundation (IOF) has published practical guidelines to assist clinicians in assessing treatment efficacy in patients who experience a fracture while on medication for osteoporosis. The position paper, published in the journal Osteoporosis International, outlines how the response to treatment in patients who have been complying with their treatment for at least six months can be assessed on the basis of the number of fractures, changes in bone mineral density and bone turnover markers.


Scientists from the Harvard School of Engineering and Applied Sciences have developed a stretchy yet strong water-based gel that could one day replace damaged cartilage. This new hydrogel can stretch to 21 times its original length and is self-healing and biocompatible. Aside from the possible applications of artificial cartilage or spinal disks, the hydrogel could be used in soft robotics, optics, artificial muscle and wound protection. The researchers created the new hydrogel by combining two common polymers: polyacrylamide, known for its use in soft contact lenses and as electrophoresis gel, and alginate, a seaweed extract often used to thicken food. These gels are both relatively weak on their own, but when combined in an 8:1 ratio, they form a complex network of crosslinked chains that reinforce one another. The new material is described in the journal Nature.