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October 1, 2014

News From ACFAS


Final Day to Submit ACFAS 2015 Posters
Today is your last chance to submit posters for ACFAS 2015 in Phoenix. Don’t miss this incredible opportunity to share your latest research with the best and brightest in the profession within the most trafficked area of the conference.

PDFs of all posters presented at the conference will also be posted on acfas.org following the meeting. And remember, ten of the most unique and innovative posters will be selected for video presentation during the conference and then posted on acfas.org afterward for all to see.

So, act fast and visit acfas.org/phoenix to submit your poster today by 11:59pm CDT!
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New PowerPoint Tool Added to ACFAS Marketing Toolbox
Looking for a presentation to give to your community or during a patient talk at your local hospital? Look no further than your ACFAS Marketing Toolbox. The first presentation in the free patient education series, Bunions and Hammertoes: What You Need to Know, is now available for download today. This condition overview presentation and script gives members the opportunity to educate potential and current patients on the basics of the conditions, symptoms and treatment options. The file also includes a slide that can be customized with your practice’s contact information so people can reach you if they have questions or would like to make an appointment.

Be sure to also take advantage of the many other resources available in the ACFAS Marketing Toolbox to promote your practice, including the FootNotes patient newsletter, press release templates, public relations and social media tools, patient education CDs and more. Visit the toolbox often—more PowerPoints on common foot and ankle conditions, ankle injuries are coming soon!
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Coding/Practice Management Workshop Registration in Last Weeks
Don’t be left in the dark on the latest coding and practice management issues--register yourself and your office staff today for ACFAS’ Coding/Practice Management Workshop set for October 24–25, 2014 in Philadelphia. Take advantage of this opportunity to learn the latest in coding, billing and compliance to give your practice a competitive edge.

During the two-day session, you’ll sharpen your understanding of appropriate documentation and gain the necessary tools to teach your staff how to accurately translate facts into codes. Expert faculty members will also guide you through the ICD-10 transition and the stages of Meaningful Use Attestation.

ACFAS’ hotel room block with reduced rates for this workshop expires on Thursday, October 3, so don’t miss out—visit acfas.org/practicemanagement to register today!
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Rearfoot Reconstruction Surgical Series Available in New Format
Rearfoot Reconstruction, the latest addition to ACFAS’ Surgical Series library, is now available via download or in DVD-ROM format. This surgical series boosts your knowledge of primary and revision surgical indications in rearfoot and ankle surgery and gives you front-row access to expert surgeons who provide surgical decision making through case presentations and visuals of nearly 20 procedures. You can also test your skills online for a chance to earn 7.25 CPME CE credits.

Purchase the complete series via download or DVD-ROM ($295 for members/$235 for resident members/$395 for non-members) or download individual procedures ($35 for members/$45 for non-members). Also, be sure to visit acfas.org/e-Learning for ACFAS podcasts, clinical sessions and more.
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Foot and Ankle Surgery


Effect of Pathology on Union of First Metatarsophalangeal Joint Arthrodesis
For the first time, a study has been published that compared the frequency of non-union among patients with symptomatic degeneration of the first metatarsophalangeal (MP) joint who experienced different pathologies and were treated with arthrodesis. The study involved 134 MP joints, 49 of which were diagnosed with hallux valgus. Hallux rigidus was present in another 46 joints, while inflammatory arthropathy was seen in 34. Five joints needed to undergo salvage surgery with identical joint preparation and fixation methods following the first arthrodesis. The study's authors found that the rate of non-union was significantly higher in patients diagnosed with hallux valgus. The study concluded that surgeons may need to use a stronger construct on MP joints with hallux valgus to reduce the rate of non-union.

From the article of the same title
Foot & Ankle International (09/14) Korim, Muhammad Tawfiq; Allen, Patricia E.
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Practice Management


Conquer Stage 2 of the EHR Incentive Program: 5 Tips
Divan Dave, the CEO of a meaningful use Stage 2 certified electronic health record (EHR) provider, says physicians' practices can take five steps to get the most out of Stage 2 meaningful use. For starters, Dave recommends that practices re-engineer their workflow around good EHR technology, as doing so will help them become more efficient. In addition, Dave recommends that doctors work with their administrative staffers to set aside one to two full or half days each month to focus exclusively on issues such as what needs to be done to achieve Stage 2 meaningful use, who is performing which tasks associated with attestation and when the next follow-up review will be. Physicians' practices may also want to consider placing laptops or tablets in their waiting areas to help them achieve the requirement in Stage 2 meaningful use that at least 5 percent of all unique patients during the reporting period view, download or transmit information electronically, Dave says. Fourth, Dave recommends that practices work with their EHR vendors to ensure they are getting all of the government incentives to which they are entitled. Finally, Dave says practices should ensure they are communicating effectively with patients to achieve Stage 2 meaningful use as well as a number of other benefits.

From the article of the same title
Physicians Practice (09/19/14) Dave, Divan
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Master Your Productivity Cycle: 4 Tips for Physicians
Jeff Davidson, who speaks and writes about work-life balance issues in the healthcare industry and other sectors, says physicians can achieve greater levels of efficiency without burning themselves out by paying attention to what he calls the "cycle of productivity." Davidson says physicians can take note of this cycle by being attentive to the times of the day when they have more energy and exhibit greater levels of creativity, as well as the times when they have less energy and are less creative. Physicians should perform difficult assignments when their cycles of productivity are at their highest levels, Davidson writes, although there will be urgent tasks that need to be performed at other times. Davidson adds that physicians will be more likely to complete tasks at times when they are more productive if they are given flexible due dates and advance notice of new assignments. Finally, Davidson advises physicians to work with others in their practices to avoid being given assignments that need to be completed when their energy and creativity levels are low as well surprise assignments, if at all possible.

From the article of the same title
Physicians Practice (09/19/14) Davidson, Jeff
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Health Policy and Reimbursement


Open Payments Website Reveals $3.5 Billion Paid to Docs, Hospitals
The American Medical Association (AMA) has issued a statement questioning the accuracy of data posted on the Open Payments website, which was accessible to the public for the first time on Sept. 30. The data shows that medical devicemakers and drug manufacturers made 4.4 million payments worth at least $3.5 billion to 546,000 doctors and 1,360 teaching hospitals during the final five months of 2013. But AMA President Dr. Robert Wah says the data includes inaccuracies and that such data can be misinterpreted by patients to the detriment of physicians' reputations and their perceived trustworthiness. There had been concerns prior to the launch of Open Payments that technical problems with the website were making it difficult or impossible for doctors to verify the accuracy of data that had been reported about them. In addition, there were reports that information about the payments made to certain doctors actually referred to payments given to physicians with the same name. Despite those concerns, AMA and others failed in their effort to delay the launch of Open Payments. But critics who had raised concerns that the data would be reported out of context were successful in getting the Centers for Medicare and Medicaid Services (CMS) to include a disclaimer on the website noting that the existence of a financial relationship between a doctor and medical device or drug company should not be taken as evidence of wrongdoing on the part of the physician.

From the article of the same title
Modern Healthcare (09/30/14) Lee, Jaimy
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HIX to Offer 25% More Plans in 2015, Says HHS
Health and Human Services Secretary Sylvia M. Burwell said Sept. 23 that the number of health insurance companies selling plans on the state and federal health insurance exchanges will increase by 25 percent next year. A total of 248 insurance companies will offer plans on the federal exchange in 2015, a number that is 30 percent higher than it was this year. Meanwhile, eight state exchanges that have already reported data for 2015 say they will have a total of 67 insurance companies selling plans next year, a 10 percent increase from 2014. Some of the insurance companies being added to the exchanges are among the nation's largest insurers, and they will all sell plans in more than 12 new states in 2015. Burwell went on to discuss the successes of the Affordable Care Act, including a 26 percent reduction in the number of uninsured adults compared to 2013. But Burwell also acknowledged that more needs to be done to improve the implementation of the statute, including conducting tests of new models in Medicare and Medicaid to identify cost-effective healthcare options amid the transition from volume- to value-based care delivery.

From the article of the same title
HealthLeaders Media (09/24/14) Commins, John
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Government Hackers Try to Crack HealthCare.gov
A vulnerability scan of Healthcare.gov earlier this year revealed the existence of a security flaw that if successfully exploited could have allowed an attacker to take complete control of the system, a report from the Department of Health and Human Services' Inspector General noted. However, ethical hackers with the Inspector General's office were not able to successfully exploit that vulnerability thanks to the security measures used by Healthcare.gov. The Inspector General's office also discovered two other critical vulnerabilities in databases used in conjunction with Healthcare.gov, although it did not reveal the nature of those flaws or that of the other vulnerability hackers were unable to exploit. The report also noted that Healthcare.gov has a number of security issues that need to be addressed, despite the steps the Obama administration has taken to reduce the security risks to the site and the consumer information it uses. For example, the health insurance exchange is using encryption technology that does not meet some government standards, the report found. The Obama administration says it has taken steps to address that problem.

From the article of the same title
Associated Press (09/23/14) Alonso-Zaldivar, Ricardo
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Obama Creates Taskforce to Fight Superbugs
The Obama administration has recently taken several steps to address the problem of antibiotic-resistant bacteria, including issuing an executive order to create a taskforce charged with creating a strategy for dealing with the matter. The taskforce will be required to submit a national action plan for dealing with antibiotic-resistant bacteria, which lead to infections that result in 23,000 deaths and 2 million illnesses each year, by Feb. 15, 2015. In addition to creating the taskforce, the order also requires the Department of Health and Human Services to review current regulations and propose new ones by the end of 2016 that require hospitals to adopt antibiotic stewardship programs that follow the Centers for Disease Control and Prevention's best practices. Ambulatory surgery centers will be encouraged but not required to implement such programs as well.

From the article of the same title
Drug Topics (09/22/14) Lowery, Mark
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Court Tosses Obamacare Mandate Lawsuit Brought by Doctors
A federal appeals court ruled Sept. 19 that the Association of American Physicians and Surgeons (AAPS) does not have standing to mount a legal challenge to the Obama administration's decision to delay the implementation of the Affordable Care Act's employer mandate. The lawsuit argued that the administration does not have the authority to delay the mandate, particularly if it does not also push back the implementation of the individual mandate, and that doctors would be financially harmed because consumers who pay penalties for not complying with the mandate would have less money to spend on medical care. But the court disagreed, saying in its opinion that "only persons seeking to advance the interests of the employer mandate would have a 'plausible' right to sue," and that the U.S. Supreme Court has rejected efforts by individuals "to litigate about the amount of someone else's taxes." An attorney who represented AAPS says a similar lawsuit being contemplated by the U.S. House of Representative could also potentially be thrown out because lawmakers lack standing, although the lawyer notes that House GOP members may be able to avoid that problem by adding to their suit an employee whose company was not observing the employer mandate due to the administration's decision.

From the article of the same title
Politico (09/22/14) Haberkorn, Jennifer
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Drug, Device CEOs Voice Concerns About O-Care Project
The Centers for Medicare and Medicaid Services (CMS) is continuing to come under fire for what critics say are its flawed plans for the rollout of the Sunshine Act's payments database, which will include searchable reports about payments drugmakers and medical device companies make to doctors. The CEOs of PhRMA, AdvaMed and the Biotechnology Industry say that CMS has not clearly stated exactly what data will be included in the database, nor has the agency said how that data will be presented. The executives note that CMS also needs to provide some type of context for the information it is including in the database so patients are not suspicious of all payments made by drug and device companies to doctors. The CEOs add that they have not been given the chance to examine how CMS plans to present such contextual information and have not been allowed to consult with the agency on the contents of the database.

From the article of the same title
The Hill (09/22/14) Viebeck, Elise
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Medicine, Drugs and Devices


A Phase III Study of 2 Dosing Regimens of Fostamatinib in RA Patients with Inadequate Response to a Tumor Necrosis Factor-a Antagonist
Treating active rheumatoid arthritis (RA) patients with fostamatinib 100 mg bid for 24 weeks is more effective than giving these patients fostamatinib 100 mg bid for four weeks followed by 150 mg qd, a new study has found. The study involved 323 active RA patients who were already taking methotrexate and had not experienced an adequate response while being treated with a single tumor necrosis factor-a antagonist. After randomizing these patients to one of three groups and assessing American College of Rheumatology 20 percent (ACR20) response at week 24, the study's authors found that 36.2 percent of patients in the group given fostamatinib bid for 24 weeks (Group A) achieved ACR20, compared to 27.8 percent of patients in the group who received fostamatinib 100 mg bid for four weeks followed by 150 mg qd (Group B) and 21.1 percent of those in the placebo group (Group C). The ACR20 response rate was significantly higher in Group A than it was in Group C, although the difference between Group B and Group C was not significant. The most frequently reported adverse events were diarrhea, hypertension and headache. The two patients who died during the study were in Groups B and C.

From the article of the same title
Journal of Rheumatology (09/14) Genovese, Mark C.; Van der Heijde, Desiree; Keystone, Edward; et al.
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Comparison of Rates of Union and Hardware Removal Between Large and Small Cannulated Screws for Calcaneal Osteotomy
Using 4.5 mm cannulated screws instead of 6.5 mm or 7.3 mm screws during a calcaneal osteotomy can reduce the likelihood that the screws will need to be removed to address post-operative posterior heel pain, a new study has found. The study involved 272 feet with hindfoot malalignment that were treated with a calcaneal osteotomy using one of the three sizes of cannulated screws. Of the 130 osteotomies performed with 7.3 mm screws, the screws had to be removed in 29.2 percent of cases. The removal rate for the 27 osteotomies performed with 6.5 mm screws was 33.3 percent. The removal rate was lowest among the 115 osteotomies that used 4.5 mm screws, coming in at 13 percent. In addition to bringing about a lower hardware removal rate, the use of 4.5 mm screws achieved sufficient compression and a high rate of union that was equal to that of the larger screws. No loss of position was seen in osteotomies that used the 4.5 mm screws, the study found.

From the article of the same title
Foot & Ankle International (09/14) Sayres, Stephanie C.; Gu, Yang; Kiernan, Samuel; et al.
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