News From ACFAS

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Be among the first to register for the ACFAS 2014 Annual Scientific Conference at the Gaylord Palms Resort in Orlando, February 27-March 2, 2014. Registrations are now being accepted at the Early Bird rate when you visit acfas.org/orlando. While registering online, get a sneak peak at all ACFAS 2014 has to offer including:

• A Variety of Interactive, Educational Opportunities Such as: Foot and Ankle Fusions – You Can’t Always Replace Us, TAR – The Not So Straightforward and Why I Don’t Do That Anymore
• Keynote Speaker Danielle Ofri, MD, PhD, Presents “Technology in Medicine—Transforming Medicine at a Breathless Pace”
• NEW! The HUB – Intimate Discussions for Niche Audiences
• NEW! ACFAS Job Fair

Plus, plan to come a day early and attend your choice of the three hands-on pre-conference workshops: Diabetic Deformity: Master Techniques in Reconstruction, Monday Morning Trauma: Advanced Reconstruction Techniques, and Advanced Tendon Repair and Fixation; or the intuitive Perfecting Your Practice: Coding/Practice Management Workshop on February 26.

Watch your mailbox for the official ACFAS 2014 program book or visit acfas.org/orlando for all the details on what's in store for you in Orlando! Learn specific methods for assessing and implementing measures to help improve your practice’s success and bottom line at ACFAS’ new Measuring Practice Success webinar set for Wednesday, November 20 from 7:30-8:30pm CT. This first-of-its-kind program, led by member Brian Harley, DPM, FACFAS, Practice Management Committee Chair, will also teach you and your office staff how to read practice performance indicators – whether your practice is in tip-top shape or needs some improvement – and use this new knowledge to keep your practice or department viable for the patients you serve.

According to Dr. Harley, "Many doctors are plagued by either not having enough information to analyze, or having surplus information and not knowing how to analyze it. In this webinar, we will provide 10 metrics you can use to measure your practice and plan for success."

Registration is $65 for ACFAS members and their staff, and $100 for non-members and non-members’ staff. Visit acfas.org/practicemanagement to register. ACFAS recognizes and thanks the loyal and dedicated members who have been a part of the College for 40 years or more. For their commitment, ACFAS awards members with such length of service a Life Membership status. The ACFAS Board of Directors honors this year’s recipients:

• Steven H. Glickman, DPM, FACFAS, Troy, MI
• Patrick J. Grisafi, DPM, FACFAS, Jamaica, NY
• J. Barry Johnson, DPM, FACFAS, Winston Salem, NC
• Larry J. Kipp, DPM, MD, FACFAS, New Port Richey, FL
• Robert G. Levine, DPM, FACFAS, Louisville, KY
• Henry N. Merritt, Jr., DPM, FACFAS, Fort Lauderdale, FL
• Paul R. Scherer, DPM, FACFAS, Napa, CA
• Paul Schwarzentraub, DPM, FACFAS, Lubbock, TX

Foot and Ankle Surgery

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A new study found that the use of open reduction in treating Lisfranc fracture dislocations brings about satisfactory results. However, the study also found that the severity of the soft tissue injury and non-anatomic reduction are both negative prognostic factors in the treatment of Lisfranc fracture dislocations. The study retrospectively analyzed 32 Lisfranc fracture dislocation patients who had been treated with open reduction and internal fixation. Researchers evaluated the severity of the soft tissue injury on the final clinical outcome and compared that with the effect of a variety of determinants on the disability in daily activities following open reduction and internal fixation of a Lisfranc injury. They found that patients with high grade soft tissue injuries had lower American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores when compared to Tscherne Grade 1 injuries. The severity of the soft tissue injury also had a similar negative impact on functional outcomes with regard to post-traumatic osteoarthritis and fracture type. Finally, the study found that there was a statistically significant difference between outcome measures and post-reduction quality.


A new study has found that there are benefits to using the Ilizarov external fixation technique to manage relapsed clubfoot deformity in older children. The study examined 42 relapsed clubfeet that were treated using the Ilizarov technique following previous surgeries. Excellent or good results were seen in 37 feet after an average follow-up period of 4.6 years. Poor results were seen in just five feet.


Intermittent pneumatic foot pumps (IPFs) are effective at minimizing swelling in ankle fracture patients who need open reduction and internal fixation (ORIF), which in turn means these devices are useful in reducing the time to surgery as well as the length of the hospital stays of ankle ORIF patients, a new study has found. The study examined 24 ankle ORIF patients, 12 of whom had IPFs applied before ORIF. The devices were kept in place until the procedure was carried out. Patients who were managed with IPFs had a statistically significant 50 percent reduction in time from presentation to surgery compared to those who were managed without the devices. Hospital stays were shorter in patients managed with IPFs as well.

Health Policy and Reimbursement

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A new report from the federal Agency for Healthcare Research and Quality has found that a small number of patients are responsible for a disproportionate share of the nation's healthcare spending. The report found that 1 percent of patients in the U.S. consumed 21 percent of the nearly $1.3 trillion that was spent on healthcare in 2010, or nearly $88,000 each. These patients are known as "super-utilizers" because they need frequent medical care for their multiple chronic illnesses, such as heart failure, diabetes, and kidney disease, as well as a range of significant psychiatric problems. In addition, many of these individuals are cared for in hospital emergency rooms rather than in less costly outpatient settings. Aetna Director of Nursing Susan Kosman says that it is important for players in the healthcare industry to have a coordinated care plan to address the problem of super-utilizers. Aetna, for example, has taken steps to connect previously separate mental health and medical teams so that they are able to manage the cases of super-utilizers more effectively. The University of Michigan, meanwhile, has developed a coordinated care plan in which case managers follow patients, accompany them to doctors' appointments, and help them with other needs. A recent study found that the program decreased annual spending on so-called dual-eligible patients by $2,500 each.


Experts say that the Physician Payment Sunshine Act, which requires the manufacturers of drugs, medical devices, and medical supplies who participate in federally-funded healthcare programs to disclose compensation or goods they provide to physicians, could have a significant impact in the relationship between doctors and the rest of the healthcare industry. According to Robert Hitchcock, MD, FACEP, most physicians may need to seriously reconsider any collaboration they may have with drug companies because they may not want their patients to know how much money they receive from these companies. Attorney Craig B. Garner agrees, saying that disclosures of even legitimate relationships between doctors and the companies covered by the law could make it seem as if these companies have an "undue influence" on the way doctors practice medicine. As a result, doctors will need to consider how much the income they receive from these companies means to them, Garner says. But attorney David Schweighoefer says he disagrees in part, because most patients will not be concerned about whether their doctors have financial relationships with healthcare companies. Doctors should be prepared to explain those relationships to patients who are concerned, Schweighoefer says. The Sunshine Act's reporting requirements take effect on March 31.


The ongoing budget impasse between congressional Democrats and Republicans is drawing attention to the 2.3 percent tax that the Affordable Care Act levies on medical devices. Congressional Republicans recently floated a bill that would repeal the tax and provide temporary funding for federal agencies, though Senate Democrats opposed the measure. Although some say that repeal of the tax is possible because several Senate Democrats come from states with large medical device companies, one observer says that the chances of repeal are still less than 50 percent. The medical device industry is opposed to the tax, which it believes will cut into its profit margins on products whose prices are declining.


The Medical Group Management Association's (MGMA) recent survey of over 1,000 medical groups has found that many doctors remain uncertain about the implementation of the Affordable Care Act (ACA). Forty percent of the medical groups surveyed say that they were still deciding whether or not to participate in the health insurance policies being offered through the ACA's marketplaces. The survey also found that more than 80 percent of medical groups are worried about patient collections and low provider reimbursement rates. According to MGMA President and CEO Susan Turney, MD, MS, some of the uncertainty may be the result of insurers asking practices to sign contracts for less than their current commercial rates but not providing doctors with specific information about how insurance policies offered through the exchanges will be administered. The survey also found that almost 70 percent of physician groups expected at most a slight increase in their patient base as the result of ACA and the insurance exchanges. As a result, more than 50 percent of those surveyed said that they did not plan to make any changes to their practices as a result of ACA. Less than 5 percent of those surveyed said they planned to hire new doctors, offer extended business hours, or hire clinical support staff.


Medical practices and hospitals alike will need to be aware of a number of potential issues associated with the Health Insurance Portability and Accountability Act's (HIPAA) new privacy, security, and breach notification rules, which took effect on Sept. 26. Among the changes is a new rule governing when medical practices and hospitals have to disclose security breaches involving patients' health information. Providers previously did not have to disclose the fact that they had suffered a security breach of patient information in some cases, such as when patient information went missing and was later recovered. Breach notifications are now mandatory in such cases. In addition to changing the rules regarding when breach notifications must be issued, the new rules also implement fines for security breaches that rise in proportion to the number of records that are compromised. Healthcare industry observers say that providers can also expect random HIPAA audits now that the new rules have taken effect, as well as more frequent communications from the Department of Health and Human Services' Office for Civil Rights that use stronger language than before. Finally, providers may also experience an increase in the number of formal complaints from patients who request their medical records but do not receive those records in a timely fashion.

Medicine, Drugs and Devices

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A recent study by researchers at Canada's McMaster University has found that selective serotonin-receptor inhibitors (SSRIs) increase the risk of fractures in post-menopausal women, more so than two other classes of drugs that are also known for increasing the risk of fractures. Researchers recruited women aged 55 and up who were using SSRIs, glucocorticoids (GCs), or proton-pump inhibitors (PPIs), and had them report any fractures they experienced over a five-year period. Patterns of fractures in these women were then compared with women who were not using any of the drugs. Following a multivariate analysis, researchers observed that women who took SSRIs experienced a significant increase in their risk of overall fractures, clinical spine fractures, and non-hip/non-vertebral fractures. Women who took glucocorticoids experienced an increase in spine fractures, while a statistically insignificant association was seen between PPIs and non-hip/non-vertebral fractures. McMaster University's Jonathan Adachi, MD, FRCPC, the study's lead author, said that one possible explanation for the findings could be that patients on SSRIs tend take the medications for a longer period of time and also tend to do a better job at following their doctors' instructions for taking the drugs compared to patients on GCs and PPIs. But other experts pointed out that study participants who took SSRIs reported experiencing more falls than patients on the other two types of drugs.


A recent study examined the usefulness of corticosteroid injections in managing plantar fasciopathy (PF), a condition that is a common cause of foot pain. Researchers performed a review and evaluation of core literature that examined the clinical efficacy of corticosteroid injections as a treatment for PF. While researchers observed a wide range in outcome measures, they found that there were both short- and long-term benefits to using the injections as a treatment. They added that corticosteroid injections guided by imaging technology were particularly effective. Researchers noted that their findings support the revised guidelines published by ACFAS that advocate the use of corticosteroid injections as a primary treatment option for PF.


A new study has found that using the anterior double-plate system when performing ankle arthrodesis brings about better primary stability and stiffness than does the three-screw fixation technique. Researchers examined six matched-pairs of human cadaveric lower legs and stabilized one specimen from each pair with the anterior double plate system, while the other specimen was stabilized using the three-screw technique. The two methods were tested by dorsiflexing the foot until the system failed, which was defined as rotation of the talus relative to the tibia in the sagittal plane. The amount of force that was required to bring about the failure was noted. To calculate stiffness, a linear regression was fitted to the force-displacement curve in the linear portion of the curve and its slope taken as the stiffness. The study found that more force was required to make the anatomically-shaped double-plate system fail than the three-screw fixation method. In addition, the anatomically-shaped double-plate system achieved an average stiffness of 56N/mm compared to an average of 10N/mm in the three-screw fixation method.