News From ACFAS

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To ensure the high-quality education programming you expect from ACFAS, the education committees are seeking new members to diversify its faculty by increasing the number of instructors available with expertise and experience in various areas.

If you are an active Fellow member and have attended our educational programs within the past three years, consider completing a Faculty Application today. Completed applications should be sent to the ACFAS Education Department for consideration via fax to (800) 382-8270.
One last tip before the big day tomorrow, the official start date of the ICD-10 coding system. If you are a Health Insurance Portability and Accountability Act-covered entity and supply durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), talk to your DMEPOS supplier to ensure:

• the items they order are supported by ICD-10 diagnosis codes and medical records.
• Medicare patients receive their DMEPOS items in a timely fashion.
• the supplier will be able to submit for reimbursement.

Remember, ACFAS is here for you long after Oct. 1--continue to refer to our ICD-10 resource page for transition tools and updates.

Foot and Ankle Surgery

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A single-center retrospective analysis compared one- and five-year amputation survival rates in patients undergoing angiography. All 78 patients were also treated with medical therapy or revascularization in addition to angiography. Patients were divided into two groups: those with critical limb ischemia (CLI) and those with claudication. In the CLI group, 30 patients were medically treated, resulting in a one-year amputation-free survival rate of 46.7 percent. The remaining 26 members of the CLI cohort were treated with revascularization and achieved a 50 percent survival rate. In the claudicant group, the one-year amputation-free survival rate was 75 percent for conservative treatment compared with 78.6 percent for revascularization. After five years, the CLI cohort had a 10 percent survival rate for conservative treatment and a 26.9 percent rate for revascularization. After five years in the claudicant group, medical treatment achieved a 37.5 percent survival rate, and revascularization resulted in a 71.4 percent rate. The researchers noted that while rates of amputation at one year were similar, the five-year rate was significantly higher in revascularized patients compared with medically managed patients.


Arthroscopic debridement can be used to address pain associated with ankle arthroplasty. Researchers conducted a study to determine the effectiveness of this procedure. The study looked at 12 patients complaining of anterior or posterior impingement pain. The median American Orthopaedic Foot and Ankle Society hindfoot score was significantly improved after the operation, from 64.6 to 73.5. Eight patients noted good pain relief, and four reported partial pain relief. Three patients with painful ankylosis experienced no improvement in the implant's total range of motion. The researchers concluded that arthroscopic debridement was effective in reducing pain in most cases, but ankylosis was only partially relieved.


Researchers evaluated a new intramedullary plate system to stabilize distal chevron osteotomy bunionectomy. Fifty-seven patients underwent the osteotomy using the intramedullary plate system, and all were evaluated preoperatively, postoperatively and at a final follow-up with the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. One patient expressed mild discomfort, but there were no hardware failures across the entire sample. All patients reported significantly improved AOFAS scores compared with preoperative values. The researchers concluded that the distal chevron metatarsal osteotomy bunionectomy with the plate system achieved desired function and relief and serves as a reliable implant.

Practice Management

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The ICD-10 deadline is right around the corner, and experts around the country are offering suggestions about how to handle the transition. Here are three implementation tips from industry experts:

• Consider going back to the future of claims management. According to Pam Jodock, HIMSS senior director of Health Business Solutions, understanding your annual trending patterns for pended claims is essential. You must know that history and put a plan in place for tracking the same activity under ICD-10. “If you see abnormalities in your reports after Oct. 1, 2015, work with the appropriate parties to get those issues resolved quickly,” she said.
• Accept that ICD-10 changes nothing about how to practice medicine. Michael Clark, chief operating officer at Evariant, believes that ICD-10 will not have the cataclysmic impact on medicine some are predicting. In fact, Clark says that the practice of medicine will not change; what will change is how visits are billed and coded. This will take time, but once mastered, physicians can begin to feel more comfortable about their respective disciplines.
• Expect an (artificially inflated) recovery period come November. Cecil Bohannan Jr. of CTG Health Solutions says that some providers will not be able to bill accordingly as the transition begins. This will look like costs are decreasing when in reality, "the real issue is you just don't know what the cost is because the providers haven't been able to send you a claim." Most payers collect data for a year before making any kind of major decision.

Telemedicine is quickly becoming essential for a functioning practice. Multiple risks are involved, including the threat of malpractice, so if you decide to invest in telemedicine, it is important to play by the rules and follow a few steps:

• Make sure the physician providing the telemedicine service is licensed in the patient's state. This is required by law. The Interstate Medical Licensure Compact can be used to streamline the process.
• Check whether you need to purchase extra coverage for telemedicine services. These services are often excluded from standard policies.
• Conform to standards of care. According to Garfunkel Wild, P.C. senior attorney Paul D. Squire, "A telemedicine provider must conform to the standard of care applicable and equivalent to what is expected for in-person care as appropriate to the patient's age and presenting condition."

Employees at a medical practice have diverse goals and aspirations, but they all value a good leader. To get the most out of your employees, you must lead by example and exude qualities that make people want to work for you. Here are a few examples of essential skills and qualities:

1. Make yourself seen. Working in isolation from your employees is the worst thing you can do when trying to connect with them. Staff will feel a stronger connection with a leader who engages with them on a regular basis. Ask questions and listen to queries. Showing interest is important to gaining trust and admiration.
2. Be a sponge. Your employees will respect you more if you have an adept knowledge of your craft. Attend lectures and search for ways to learn and listen. Soak the knowledge in like a sponge, and you will create an air of respect and wisdom that could go a long way toward looking impressive in your employees' eyes.
3. Take out the trash. See your employees eye-to-eye in stressful situations. If that means literally taking out the trash so that the person who normally does it can make a deadline, you should consider it. The employee will remember that hierarchy means little to a good leader.

Health Policy and Reimbursement

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Since the Affordable Care Act took effect five years ago, around 17.6 million Americans have enrolled in some form of healthcare coverage. That figure represents a 1.2 million increase from a previous estimate released earlier this year. The U.S. Department of Health and Human Services (HHS) also expects about one million fewer people to have active insurance through an exchange than the number who had selected and paid for a plan as of March 31. Little explanation was offered for this drop, although some people turn to employer-sponsored plans as the economy continues to recover. About 10.5 million uninsured Americans are eligible for marketplace coverage in the upcoming open enrollment, and HHS Secretary Sylvia Mathews Burwell said this group will be tough to reach. "We've found that costs are still a big concern—about half of the people who are uninsured have less than $100 in savings," Burwell said. The focus for HHS will reportedly be on areas with the highest numbers of uninsured who are eligible for exchange plans. This includes places like Dallas, Houston and Chicago. The regional approach makes sense, according to experts, because it represents a more targeted outreach.


A federal judge has ruled that the the U.S. Department of Health and Human Services (HHS) secretary must provide better justification for part of the two-midnight rule that would slash inpatient payments to hospitals. The ruling does not change the two-midnight rule, but it offers hope for changes. Currently, the rule directs Centers for Medicare and Medicaid Services payment contractors to consider short-term hospital stays as inpatient admissions if they span two midnights. The HHS secretary estimated that this change would cost Medicare $220 million, which would be recovered by reducing compensation for inpatient services by 0.2 percent. The unpopular change has hospitals hoping that the latest ruling will prompt a new proposal. The judge noted that the secretary omitted "critical material on which it relie[d], and thus deprive[d] commenters of a right … to participate in rulemaking.” The ruling is not a victory for hospitals yet since the two-midnight rule is still in place, but Michael Clark, special counsel at Duane Morris, deemed it a “partial victory in the sense that they've won their procedural challenge.”


The Affordable Care Act's focus on rewarding doctors who provide high-value care is one of the main catalysts for a new trend in medical schools. According to Kaiser Health News, many medical schools are now integrating discussions of costs, value and effectiveness into their lessons. Overall, 129 of 140 medical schools reported offering at least one required course on healthcare costs between 2013 and 2014. "It's becoming second nature for students to consider whether a test is necessary, given its price tag," the article noted. Schools like UCLA have incorporated the ideas into daily lessons, and initiating discussions with older mentors is encouraged.

Medicine, Drugs and Devices

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A research study from Vanderbilt indicates that patients prefer virtual care visits after a surgical discharge. The study found that when patients were given the option of a postoperative phone call with the doctor, a video-based virtual visit or an in-person visit, the virtual visit was the most-picked option. “These kinds of methods are really important in the climate we're in now,” said lead author Dr. Michael Vella. “So I think anything you can do to save money, see more patients and improve access to care is really important.” The authors noted that the study was relatively small and more work needs to be done to formulate a better conclusion. But telemedicine is now a mainstay in the healthcare industry, and patients are eager to use new technology. It cuts down on travel distances and remains efficient. The study found that no infections were missed with the use of telehealth technology after surgery.


The U.S. Food and Drug Administration's (FDA) Center for Devices and Radiological Health (CDRH) has formed a Patient Engagement Advisory Committee (PEAC) that will provide advice to the agency on topics related to medical devices and regulation. The nine-member committee is made up of experts in the fields of clinical research, primary care patient experience, healthcare needs for patient groups, methodologies for eliciting patient references and strategies for communicating information to patients and research subjects. The PEAC will primarily advise FDA on agency guidance and policies, clinical trial or registry design, benefit-risk determinations, available alternatives and other topics. “We are entering an era of ‘patient-centered’ medicine in which patients and their care partners participate actively in decision-making and priority-setting about all aspects of healthcare,” wrote Nina L. Hunter, Ph.D. Patient advocate groups applaud the new committee and believe it is a step in the right direction toward making medical device manufacturing more transparent. FDA noted that "patient preference information will not be used to justify approval of unsafe or ineffective devices."


Recent research presented at the 51st European Association for the Study of Diabetes Annual Meeting revealed that hyperbaric oxygen therapy improved long-term survival in diabetes patients. The research evaluated 75 patients with chronic diabetic foot ulcers and assigned them to either a hyperbaric oxygen therapy or a placebo. The hyperbaric therapy group had a mortality rate of 40 percent compared with the 60 percent rate in the placebo group. The process involves systematic treatment using high oxygen pressure, according to the researchers. Study leader Magnus Löndahl said the results are promising, but more information is needed to further explore the clinical efficacy of the method.