News From ACFAS

---

As the ACFAS 2015 Annual Scientific Conference nears, unscrupulous hotel room “poachers” may try to sell you a discounted hotel room for our meeting in Phoenix, February 19-22. Don’t purchase your hotel room through these poachers. If you do, you may find yourself roomless in Phoenix and your deposit gone.

ACFAS’ official housing partner is OnPeak, and there’s only one place to reserve your room for ACFAS 2015, acfas.org/phoenix. ACFAS attendees are guaranteed the lowest hotel rates available. If you find a lower rate, contact ACFAS or OnPeak via acfas.org/phoenix.

And a special note to exhibitors: There are also “pirates” who sell attendee lists of our meeting. Don’t believe them--they usually have no data whatsoever. If you get approached, let us know as soon as possible. ACFAS’ latest clinical session, Fix Me Now or Fix Me Later: Life After Injury, sheds light on the evidence you can’t ignore when dealing with complex fracture injuries, neglected Achilles ruptures and malreduced syndesmosis so you can address these cases more confidently in your practice.

This free session includes seven individual presentations with leading experts who guide you through osseous and soft tissue components of injuries, index therapy, biomechanics and reconstructive options. Earn 2 CPME CE credits by taking a brief exam following the session. To view this session and the entire clinical session library, visit acfas.org/e-Learning. ACFAS wishes to recognize our loyal and dedicated members who have been a part of the College for 40 years or more. To thank these members for their commitment, ACFAS has awarded them Life Membership status. The ACFAS Board of Directors honors this year’s members:

• Steven K. Chase, DPM, FACFAS, Bartlett, TN
• Jared P. Frankel, DPM, FACFAS, Elmhurst, IL
• Ronald M. Freeling, DPM, FACFAS, Rochester, NY
• Renato J. Giorgini, DPM, FACFAS, Lindenhurst, NY
• Marc A. Kravette, DPM, FACFAS, Seattle, WA
• Anthony H. Mascioli, DPM, FACFAS, Newark, NY
• Michael J. Miller, DPM, FACFAS, Mesquite, TX
• Stanley G. Newell, DPM, FACFAS, Shoreline, WA
• Michael E. Pearlman, DPM, FACFAS, Waldorf, MD
• Toshifumi J. Saigo, DPM, AACFAS, Bellevue, WA
• Steven I. Subotnick, DPM, FACFAS, San Leandro, CA
• Vincent N. Tisa, DPM, FACFAS, Philadelphia, PA
• Leo M. Veleas, DPM, FACFAS, Southington, CT Wish you had time to read studies published relevant to podiatric surgery in other scientific specialty journals? Look no further than ACFAS to help. The College’s monthly Scientific Literature Reviews (SLRs), written by podiatric surgical residents, summarize the latest studies affecting your surgical cases and lets you get ahead of your reading that much faster!

Each SLR includes podiatric relevance, methods, results and conclusions and are available online at acfas.org/SLR monthly. During October, you’ll find the latest about nonoperative treatment of acute Achilles tendon ruptures, peroneal tendon displacement, autologous chondrocyte implantation of the ankle and much more. A complete archive is also available for you to catch up on any months you may have missed.

Foot and Ankle Surgery

---

For the first time ever, a new study compared the rate of complications associated with bilateral continuous popliteal sciatic nerve block to that of unilateral continuous sciatic popliteal nerve block in patients who undergo surgical repair of the hallux valgus. The study involved 130 patients treated with elective bilateral or unilateral hallux valgus repair who were divided into two groups, each of which received one of the two types of continuous regional anaesthesia. The groups displayed similar rates of catheter-related complications. In addition, no patients in either group had to make any unplanned ambulatory visits or be readmitted to the hospital because of complications. Finally, the study found that no complications related to regional anaesthesia were observed during the follow-up period. However, the study's authors warned that an outpatient study is needed to confirm these and other findings before bilateral continuous popliteal sciatic nerve block is introduced in an ambulatory setting.


A recent study compared the clinical outcomes seen in patients who underwent proximal metatarsal osteotomy, a procedure commonly used to treat hallux valgus with an increased intermetatarsal angle, with those seen in patients treated with proximal chevron osteotomy, another commonly used procedure but one that is technically difficult. After assessing several clinical outcome measures before surgery and at three, six and 12 months post-operatively, the study's authors determined that the procedures produced essentially the same results. The study also found that proximal wedge osteotomy lengthened the first metatarsal, while proximal chevron osteotomy shortened this bone. Both proximal metatarsal osteotomy and proximal chevron osteotomy resulted in significant improvements to intermetatarsal angles. In addition, the procedures required a similar amount of time to complete. However, the surgeons who performed the two procedures said they preferred proximal opening wedge osteotomy, in part because they believed it was less technically demanding than proximal chevron osteotomy.

Practice Management

---

Physicians' practices should keep four things in mind when creating operational plans that will help guide them through a crisis or some other problem, writes Nick Hernandez, MBA, FACHE, who provides consulting services to practices. For example, all operational plans should mention what the practice's desired outcome is, as well as what the purpose for achieving that outcome is and when the stated goals need to be accomplished. Hernandez notes that practices may need to accept some degree of uncertainty with their goals, due to the lack of certainty in the healthcare industry regarding a number of issues, and that it is better for practices to have unclear goals rather than none at all. In addition to noting what the practice's desired outcome is, an operational plan should also mention what steps need to be taken to achieve that outcome, Hernandez says. Next, operational plans should include a discussion of the resources needed to achieve the stated outcome. This discussion should mention the type and amount of resources needed as well as how those resources are allocated, Hernandez notes. Finally, Hernandez recommends that practices include a control process in their operational plans that will help managers and others determine when a change needs to be made to the plan.


Although physicians' practices may be tempted to focus solely on reducing employee salaries and cutting benefits when looking for ways to bring down labor costs, there are more effective ways to minimize staffing costs, writes medical practice consultant Carol Stryker. For instance, practices should be sure that they are not over or understaffed. Going to one of these extremes may actually increase costs in the long run by reducing productivity, Stryker says. Stryker adds that practices should also perform a cost-benefit analysis when considering hiring a new employee. Hiring someone with years of experience or a particular skill set may seem beneficial, although such a candidate may demand a higher salary that could unnecessarily drive up the practice's labor costs, Stryker notes. She adds that practices should consider the value of a candidate's experience or skills and determine whether they can get by with someone who has less experience and fewer skills who would be willing to accept a lower salary. Finally, Stryker notes that practices may want to consider moving away from having all employees on the same work schedule. For example, it may be more efficient to have employees who need to accomplish tasks that are best performed in the morning to come in earlier than their colleagues, Stryker says.

Health Policy and Reimbursement

---

Trade associations and individual companies that make up the medical device industry have responded in different ways to the transition toward value-based payments for healthcare products and services, with some accepting the trend and others fighting it. For example, the medical devicemaker Medtronic last year marketed some of its devices to highlight data from a study that showed that they could help hospitals prevent readmissions and avoid penalties levied by Medicare. Such efforts are an attempt to show hospitals and insurers that new medical devices can improve clinical care and offer economic value. But the Advanced Medical Technology Association (AdvaMed) has taken a different approach by highlighting what it says are the negative effects value-based payment systems have on patients. Among those are the possibility that physicians will choose not to adopt certain medical devices that benefit patients, says AdvaMed Senior Vice President David Nexon. But some experts disagree with AdvaMed's position, saying that insurers and providers will continue to use new medical devices that benefit patients and reduce future costs.


Two new studies from the pharmacy-benefit managers Express Scripts and Prime Therapeutics have found that consumers who signed up for insurance coverage via the Affordable Care Act's exchanges earlier this year were generally older and sicker than consumers with employer-sponsored coverage. Express Script's study found that the average ages of consumers with insurance policies purchased on exchanges and obtained through employers was 43.6 and 36.7, respectively, although the company also found that younger and healthier consumers began signing up for exchange coverage as the March 31 deadline approached. Prime's study found that spending on HIV and hepatitis C drugs was 228 percent and 160 percent higher among exchange plan patients, respectively, than it was among consumers who had insurance through work. The studies also found that patients who purchased coverage through the exchanges are filling their prescriptions at about the same rate as those who were covered by employer-sponsored insurance and that consumers covered through the exchanges are not showing any hesitation in using their coverage to pay for doctor visits.


Officials from the Department of Health and Human Services (HHS) held a press conference on Oct. 8 to highlight changes made to Healthcare.gov to make it easier for consumers to sign up for insurance coverage when the enrollment period opens in mid-November. Among the new features is a streamlined application that will cut the amount of time it takes to apply for coverage by half compared to last year. Mobile capabilities have been added as well. Officials did not say exactly how many consumers Healthcare.gov will be able to serve simultaneously, although Centers for Medicare and Medicaid Services Principal Deputy Administrator Andy Slavitt says he hopes the site's capacity will allow for more than 125,000 people, which was the peak user count recorded in March. Slavitt added that the changes are designed to ensure a "successful consumer experience" during this year's open enrollment.


Healthcare providers and hospitals having trouble complying with Stage 2 Meaningful Use, because 2014 certified electronic health record (EHR) software was unavailable or because they were unable to take advantage of flexibility rules previously issued by the Centers for Medicare and Medicaid Services (CMS), will be able to once again apply for hardship exemptions between now and 11:59 p.m. Nov. 30. Successful applications, which CMS announced were being accepted once again on Oct. 6, will allow providers and hospitals to avoid penalties for failing to comply with Stage 2 Meaningful Use. CMS said its decision to begin accepting hardship applications again was not in response to problems with the Web portal providers and hospitals use to attest to Stage 2 Meaningful Use. But Jeff Smith of the College of Healthcare Information Management Executives (CHIME) says he does not believe that claim or CMS' assertion that the Web portal has not had any problems to begin with. Smith noted that only 143 hospitals had attested to Stage 2 Meaningful Use, suggesting that issues with the Web portal are one reason why that number is so low. Dan Haley of the EHR vendor Athenahealth blamed the low attestation numbers on problems with the meaningful use program, which he said has certified poor quality EHR products that have made it impossible for providers to attest to Stage 2 Meaningful Use.


The Office of the National Coordinator for Health IT (ONC) JASON Task Force held a meeting on Oct. 1 in which members discussed problems with Stage 3 Meaningful Use that were raised by a recent white paper from Mitre Corp.'s JASON initiative. The paper noted that the effective exchange of health information is hindered by the fact that data resources for electronic health records (EHRs) are not interoperable and said that the Centers for Medicare and Medicaid Services (CMS) should address this issue by using Stage 3 Meaningful Use to create an interoperable health data infrastructure. Members of the ONC JASON Task Force largely agreed with the conclusions drawn by Mitre Corp.'s JASON initiative and are now creating a set of recommendations that call for the Stage 3 Meaningful Use's scope to be significantly limited to better emphasize interoperability. Members of the task force said Stage 3 Meaningful Use's requirements should focus on use cases that require interoperability so providers and vendors have the resources to implement and adopt public application programming interfaces (APIs). These public APIs should first be used to support data-sharing networks that promote EHR-to-EHR interchange as well as the ability of consumers to use patient portals to access core data services. These and other recommendations regarding the use of health IT may be tweaked before the task force finalizes them before the end of the month.

Medicine, Drugs and Devices

---

Infants with idiopathic clubfoot who are treated with the Ponseti method, which involves the use of cast immobilization and post-corrective bracing that could interfere with normal leg movements, are generally able to walk independently two months later than infants without the condition, a new study has found. The study involved 24 infants with idiopathic clubfoot, none of whom received any other treatment before being treated with the Ponseti method. After following up with these patients after a minimum of 24 months, the study's authors determined that the average age at which they were able to walk independently was 14.5 ± 2.6 months. In addition, the study found that 90 percent of patients were able to walk independently after 18 months. The study also found that the severity of the deformity and whether or not the patient had experienced a relapse both had an effect on when they were able to walk without assistance. Those whose deformities were very severe were able to walk independently after an average of 15.8 months, compared to an average of 14.2 months among patients whose deformities were moderate or severe. Patients who experienced a relapse before learning to walk began walking independently after an average of 15.9 months, compared to an average of 14.2 months in patients who did not have a relapse.


A novel treatment for plantar fasciitis called cryopreserved human amniotic membrane (c-hAM) injection may be just as safe and effective as traditional corticosteroid injection, a new pilot study has found. Twenty-three participants, 14 of whom were randomized to receive corticosteroid while the remaining nine were randomized to receive c-hAM, completed the full 12-week follow-up period. Each of the two groups was further divided into two cohorts, one that received only one of their respective injections and another made up of three patients who received a second injection six weeks after the first. No statistical difference was seen between the groups in most of the outcome measurements, including Visual Analog Scale (VAS) scores. However, patients who received two c-hAM injections displayed greater improvements in Foot Health Status Questionnaire (FHSQ) foot pain after 18 weeks. The cohort of patients who received one injection of corticosteroid displayed greater improvements in FHSQ shoe fit and FHSQ general health after six weeks and verbally reported improvement after 12 weeks.