News From ACFAS

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ACFAS has two unique, exciting opportunities for foot and ankle surgeons to share their expertise on surgical quality measures and medical device technology.

First, the National Quality Forum is soliciting nominations for a standing committee to evaluate new surgical measures and review previously adopted measures addressing surgical events (pre-, intra- and post-surgical care), use of perioperative medications and adverse surgical outcomes. The time commitment to participate is a few hours per week, including four conference calls and one in-person meeting.

Second, the U.S. Food and Drug Administration is seeking College members to provide outside expertise and give clinical and scientific viewpoints on medical device development.

For more information about these opportunities, including expertise requirements and nomination materials, contact Sarah Nichelson, ACFAS director of Health Policy, Practice Management and Research, at sarah.nichelson@acfas.org.
Associate and Fellow members—watch your mailboxes for your dues reminders for the 2016 calendar year of membership. Pay your dues online now or via mail or fax once you receive your reminder. Payment is due by Dec. 31, 2015.

Visit our Member Center to learn more about the many valuable benefits your membership provides and to connect with ACFAS members.
If you became board-qualified by ABFAS over the summer, ACFAS invites you to join the College as an Associate Member.

As an Associate Member, you have the opportunity to promote your new board status by listing the credential “AACFAS” after your name and be eligible for many other member benefits, including:

• Complimentary membership for the remainder of 2015. Your dues payment will cover your membership from now until the end of 2015.
• A waived $95 processing fee.
• The opportunity to win an Apple Watch if you return your application by Dec. 31.
• Unlimited access to resources found on acfas.org, such as practice marketing materials, health policy updates and more.

Visit acfas.org/join or email the Membership Department for more information about ACFAS membership or the application process.

Foot and Ankle Surgery

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Channel-assisted minimally invasive repair (CAMIR) has similar outcomes to open repair in the treatment of Achilles tendon repair, according to a recent study. Researchers included 82 patients with ruptured Achilles tendons. The patients were divided evenly between CAMIR and open repair. Functional evaluations were completed using the clinical American Orthopaedic Foot and Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM) and isometric testing. CAMIR significantly decreased operative time, but no difference was detected between the groups in relation to plantar flexor strength, ankle ROM or calf circumference. The open repair group experienced large scar length. The CAMIR group had no wound complications, compared with four in the open repair group.


A recent study observed the effect of ankle dislocations on postoperative outcomes in SER IV patients. Researchers evaluated 108 patients and separated them into two groups. Seventy-three were in the non-dislocation group, and 35 were in the dislocation group. The dislocation group experienced a higher rate of open fractures, as well as a significant decrease in the accuracy of articular reduction. This group also had more pain and decreased activities of daily living after follow-up 21 months later. Researchers concluded that concurrent dislocation at time of ankle fracture is associated with worse radiological, functional and clinical outcomes.

Practice Management

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A successful practice is one that fosters strong physician-patient relationships, according to Julia Boisen, managing director for Navigant Consulting's Healthcare practice. "Advanced practice providers are doing many of the things that physicians used to do, and there's a growing recognition by patients of the role of the support staff in their care," Boisen said. To build long-lasting trust and ensure patient cooperation, all practices must prioritize four major concepts:

1. Set clear expectations of customer service and quality care.
2. Promote teamwork by planning the upcoming day with the entire staff.
3. Reduce patient complaints by planning ahead.
4. Respond positively to complaints by taking action.

A morning meeting can be one of the most effective ways to enhance your team's effectiveness and preparation. Planning your practice's daily strategy can go a long way toward making patients feeling cared for. Always look to improve by installing a more efficient hiring process, getting staff members to contribute across all disciplines and creating a healthy work environment.


Finding an entry point into long-term initiatives like population health management and accountable care is often difficult. Thanks to meaningful use, electronic health records (EHRs) are in place across multiple settings, and many organizations are unsure about how to proceed. According to Wendy Vincent, director of advisory services at audit and consulting firm KPMG, a strong strategic vision, firm grip on ongoing payment reforms and health IT tools that provide data analytics are all important components of a successful organizational change. “Organizations that do this well have very clear, well-defined care plans,” Vincent said. "They know exactly what needs to happen, and they execute those strategies efficiently. They also have contingency plans. When they see a patient heading south, they have controls in place to catch that and get the person back on track. That is very important.”


How satisfied are your patients? This is an essential question for anyone who wants to run a successful practice. Experts say most complaints to professional licensing boards are not about specific practice-based issues; most of these complaints are actually based on client expectation issues. If your practice can meet patient expectations, it follows that the patient will continue to be involved with your operation. The most efficient way of determining how your patients feel about their experience is to issue a properly constructed and thoroughly analyzed patient satisfaction survey. If your practice is a member of a medical malpractice insurance organization, the administration of a patient satisfaction survey may be a member service at no cost. If not, work with an independent consulting firm. Keep the survey simple. Focus on three primary areas: provide quality healthcare, make care accessible and treat patients with courtesy and respect. If the survey covers these three issues, you will reveal a patient's true opinion of their experience. This knowledge can have major effects on how you decide to run your practice, so following through on the responses is important regardless of how you feel about them.

Health Policy and Reimbursement

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The price of the benchmark Affordable Care Act (ACA) plan will jump by 7.5 percent on average next year, a new report indicates. This increase stands in contrast to the two percent rise from silver plans last year. About 70 percent of ACA enrollees have silver plans. The changes in pricing vary from state to state, with Oklahoma seeing a 35.7 percent increase compared with Indiana's estimated 12 percent decrease.


The Centers for Medicare and Medicaid Services (CMS) have published clarification concerning the alternate exclusion for providers not planning to attest to certain measures of the agency's 2015 electronic health records final rule. The rule permits certain exclusions for meaningful use Stage 1 and 2 requirements that qualifying providers are unable to meet. "We do not intend to inadvertently penalize providers for their inability to meet measures that were not required under the previous stages of meaningful use," CMS says. "Nor did we intend to require providers to engage in new activities during 2015, which may not be feasible after the publication of the final rule to successfully demonstrate meaningful use in 2015."


The new two-year budget deal working its way through Congress has drawn the ire of the American Hospital Association (AHA), which claims the cuts balance the budget "on the backs of patients." AHA specifically questioned a part of the budget that limits future payments by preventing facilities acquired in the future from upgrading to "outpatient hospital departments." "This untested idea may endanger patient access to care, especially among patients who are sicker, the poor, minorities and seniors who often receive care in hospital outpatient departments," said Thomas Nickels, AHA’s executive vice president. He called for the provision, which the Congressional Budget Office estimates could save $9.3 billion over 10 years, to be removed. Few hospital groups have voiced similar concerns. The Federation of American Hospitals offered support for the budget, saying that despite being opposed to budget cuts, they understood it was likely a necessary move.

Medicine, Drugs and Devices

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The European League Against Rheumatism-Pediatric Rheumatology European Society has produced nine "points to consider" for imaging to diagnose juvenile idiopathic arthritis (JIA). The task force analyzed 204 studies and formulated suggestions on how to best approach diagnosis. The nine points are:

1. Ultrasound and MRI are better than clinical exams. Clinicians should consider using both.
2. Conventional x-ray, MRI and/or ultrasound may be used to resolve diagnostic doubts.
3. Conventional x-rays are usually adequate for assessing joint damage, but ultrasound and MRI may detect damage earlier.
4. In certain situations, imaging may be more helpful than clinical exams.
5. Imaging may aid in JIA prognosis.
6. Ultrasound and MRI are usually more sensitive than clinical exams in monitoring JIA disease activity.
7. Clinicians should consider evaluating joint damage on a regular schedule.
8. Ultrasound can accurately guide placement of intra-articular injections.
9. When JIA is clinically inactive, MRI and ultrasound may detect inflammation.

Sens. Cory Gardner (R-CO) and Joe Donnelly (D-IN) have introduced two new bills designed to further streamline the U.S. Food and Drug Administration (FDA) approval process for certain medical devices. The Rare Device Innovation Act would broaden the threshold by which FDA could clear medical devices for treating rare diseases, including ALS, cerebral palsy, Hodgkin lymphoma, mesothelioma and tuberculosis. "By increasing the threshold from 4,000 to 8,000 patient cases, the Rare Device Innovation Act creates an incentive for manufacturers to develop medical devices for rare diseases to help people with rare conditions gain access to technologies they would not have access to otherwise," Gardner said. The other bill, the FDA Regulatory Efficiency Act, empowers FDA to transfer the initial review of medical devices seeking approval via the 510(k) pathway to agency-accredited third parties. Gardner and Donnelly say authorized third parties would only be able to sanction devices that do not entail major technology changes or changes in the use of a product. Devices presently approved via the 510(k) pathway are low-risk and must be significantly similar to already-approved devices. "This legislation allows FDA to spend more time reviewing new breakthrough technologies and expedite them to the market for patients who need them," Gardner noted. Donnelly also said the bill would still hold companies accountable for their quality systems.


Patients taking opioids for rheumatoid arthritis face a significantly higher risk of serious infection, according to a new study. The data reportedly adds to the growing body of evidence that the adverse effects of opioids outweigh the potential benefits. A cohort of 1,790 patients were enrolled in the study. Their rate of infection was 39 percent higher when taking opioids compared with periods of nonuse. The rate of infection was twice as high when they were using long-acting opioids. “It fits with our general sense these days that opioids really are a poor choice of analgesics in people with rheumatoid arthritis, but people continue to prescribe them because our analgesic armory is not that good,” said Dr. Samuel Whittle, consultant rheumatologist at the Queen Elizabeth Hospital in Adelaide, Australia. Further studies are needed to determine if this association exists in other patient populations.