News From ACFAS

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Attention all Associate and Fellow members--your dues reminders for the 2015 calendar year of membership have been mailed to you. Dues can be paid online now or via mail or fax once you receive your reminder. Payment is due by December 31, 2014.

Visit the Member Center to take advantage of the many valuable benefits your membership provides and to connect with the best and brightest in the profession. Do you have a compelling or challenging case to share with your colleagues? Submit it for inclusion at the Annual Scientific Conference’s Doctors’ Lounge, an interactive session in which a panel of three expert clinicians discuss the cases presented with submitters and an audience of peers.

To submit your case, visit acfas.org/phoenix, download and complete the Doctors’ Lounge Case Form and email it to Marilyn Wallace by December 19, 2014. Those whose cases are selected for presentation will be notified after a formal review of all submissions. If you are among the many who became board-qualified by ABFAS over the summer, ACFAS would like to welcome you to join the College as an Associate Member. As an Associate Member, you have the opportunity to showcase your new board status by listing the credential “AACFAS” after your name and to be eligible for many other member benefits offered by the College, including:

• Complimentary membership for the remainder of 2014. Your dues payment will cover your membership from now until the end of 2014.
• A waived $95 processing fee.
• The opportunity to win a free conference registration to the 2015 Annual Scientific Conference in Phoenix if you return your application by December 15.
• Unlimited access to resources found on acfas.org, such as practice marketing materials, health policy updates and more.

For more information about ACFAS membership or the application process, visit acfas.org/join or contact the Membership Department at membership@acfas.org. This is your chance to join a select community of more than 7,000 foot and ankle surgeons who are making a difference every day.

Foot and Ankle Surgery

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A new study has found that a minimally invasive technique for performing medial displacement calcaneal osteotomy can bring about excellent union rates in patients with acquired flexible planovalgus deformities or malunited calcaneal fracture while also avoiding the complications that can sometimes result from using the standard direct lateral or extended lateral approach. The retrospective study involved 29 acquired flexible planovalgus deformity patients who underwent tibialis posterior reconstruction and calcaneal osteotomy. One other patient underwent surgery for a malunited calcaneal fracture. All of the surgeries were performed by surgeons who had experience using the direct lateral approach and subsequently practiced the minimally invasive approach on cadavers. The study found that all 30 patients experienced radiological and clinical union and also experienced restoration of neutral hindfoot alignment. None of the patients experienced neurovascular or wound complications. The study's authors also noted that surgeons who are experienced in open surgery can quickly learn the minimally invasive technique through training.


Releasing the medial head of the gastrocnemius is a safe and effective way of treating sedentary patients with long-term tendinopathy of the main body of the Achilles tendon, a new study has found. The study's authors examined the clinical and functional outcomes seen in 18 patients who underwent this procedure and found that after an average of 54 months, all patients were able to perform the same work and daily activities they could perform before they began experiencing symptoms. The study also found that the average Victorian Institute of Sports Assessment–Achilles tendon (VISA-A) score improved from 52.3 before surgery to 75 at final follow-up. Finally, no significant differences were seen between the pre- and post-operative measurements of maximum calf circumference and strength in the treated leg. These measurements were significantly lower than in the contralateral leg, however.

Practice Management

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Physicians' practices should have effective onboarding processes in place to ensure new doctors do not become unsatisfied with their jobs and quit, according to Allison McCarthy and Susan Boydell of the physician relations and recruitment firm Barlow McCarthy. During this process, the new physician should be assigned several mentors to help the new recruit with any problems he or she may be experiencing. This group of mentors should include someone who is not a physician, including the practice manager, because doctors may not feel comfortable discussing certain issues with other physicians, McCarthy says. McCarthy adds that all of the mentors should be sure to follow through on promises to address any issues the new physician is having. After the onboarding process is complete, a plan should be developed that measures and addresses patient experiences and ease of use at the practice, McCarthy and Boydell say. Boydell adds that it is important to track patient experiences because any complaints can be used to help address any problems with the new physician. Boydell and McCarthy say that following these and other steps during and after the onboarding process can help keep turnover to a minimum, bring down recruitment costs and reduce the amount of time it takes to bring the new physician fully up to speed.


Physicians and practice administrators need to work together closely on a number of issues to ensure the success of their practice, according to Dr. Rebecca Fox and practice administrator Lucien Roberts. Speaking at the recent 2014 Medical Group Management Association (MGMA) Annual Conference, the two noted that one area where doctors and physicians need to work closely together is coding and documentation problems. Physicians need to be aware of coding and documentation issues caused by other doctors, Fox says, because these problems can affect the entire practice. In addition, physicians and administrators need to work closely together on human resources issues, Roberts said. He noted that the experience physicians have in addressing human resources issues can be particularly helpful when dealing with problem employees. Finally, Fox notes that physicians and administrators should communicate about financial matters such as the amount of money they charge patients, the number of patients they see and costs such as salary and malpractice insurance. This information can be provided to administrators in spreadsheets and is helpful in determining whether physicians are helping the practice maintain profitability, Fox says.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) says the final rule it issued Oct. 31 to eliminate the Sunshine Act's exemption for payments made by drug and medical devicemakers to physicians who participate in continuing medical education (CME) programs does not mean that all such payments will now be reported through the Open Payments database. In fact, most CME payments will not have to be reported due to the Sunshine Act's exemption for indirect payments, which remains in effect. Despite CMS' clarification about how its new rule will affect the reporting of CME payments, some observers say it remains unclear exactly what the implications of the end of the exemption will be. Others say that the new rule could exempt more CME payments from reporting requirements than was previously the case. The rule eliminates the exemption for reporting about educational activities accredited or certified by five accrediting bodies while retaining a prohibition on manufacturers directing CME payments to certain physicians or the selection of certain doctors who will speak at educational events.


The U.S. Supreme Court's ruling in North Carolina Board of Dental Examiners v. Federal Trade Commission (FTC) could have far-reaching implications for the healthcare industry, says healthcare anti-trust attorney Jay L. Levine. The central question of the case, which began after FTC filed a complaint against the board for illegally banning non-dentists from performing teeth whitening, is whether the state action doctrine exempts state regulatory boards from anti-trust laws if they are comprised of market participants elected by other market participants. Levine notes that if the High Court rules that state regulatory boards do not enjoy such an exemption and are considered to be private actors, which is FTC's position, regulatory boards made up of practitioners from the industry they oversee will need to be actively supervised by another state entity made up of people who are not from that industry. This could result in a government agency or official making rulings on board recommendations, such as recommendations about the length of time a provider needs to practice before obtaining state certification. On the other hand, a victory for the dental board will largely give state boards a free hand to do as they please, Levine says, until state legislatures pass measures that prevent them from doing so. A ruling in the case is expected early next year.


A study published in the New England Journal of Medicine has found that Blue Cross Blue Shield of Massachusetts' Active Quality Contract health plan has been successful in achieving its goals of reducing healthcare spending while improving quality of care. Under this payment model, healthcare providers receive a certain amount of money to care for patients instead of payments for every procedure and service. This is designed to encourage providers to control costs by keeping patients healthy, as they need to absorb any additional expenses above and beyond their budgets. The study found that spending on patients who participated in the Active Quality Contract increased 10 percent slower than for patients in traditional plans. A reduction in unnecessary tests and care resulted in increased savings from 2009 to 2012, the time period covered by the study. In addition, the study found that the Active Quality Contract helped boost the percentage of chronically ill patients whose diseases were under control from 60 percent to 74 percent. This is the fourth straight year the Active Quality Contract helped bring about reduced spending and improved quality of care, the study found.


A federal appeals court in Connecticut recently heard arguments in a case centered on the question of whether or not hospitals should be required to notify Medicare beneficiaries about whether they receive inpatient or observation status during visits. The plaintiffs in the case are seven Medicare beneficiaries or their estates who are being represented by the Center for Medicare Advocacy (CMA), whose attorneys argued that the appeals court should send the case back to the federal district court in Connecticut that dismissed the case in September 2013. CMA also wants the district court to require Medicare beneficiaries to be notified as soon as possible about their admission status as well as how their status could potentially affect their out-of-pocket expenses. Hospital visits that receive observation status are reimbursed at the relatively low Medicare Part B reimbursement rates, while inpatient visits are reimbursed at the higher Part A rates. CMA also wants the court to give beneficiaries a "clear appeal process" for challenging decisions about their status. Government attorneys, however, have argued that they cannot force hospitals to notify Medicare beneficiaries about their status and the associated financial ramifications because current law does not allow them to do so. They also say the issue is increasingly being rendered moot by a growing number of state laws that require hospitals to notify patients about their admission status. A decision in the case is likely several months away.


Healthcare industry observers are carefully parsing new language in contracts between the Centers for Medicare and Medicaid Services (CMS) and insurance companies that operate on Healthcare.gov for clues about how the administration views its chances of prevailing in legal challenges to government health insurance subsidies. The language notes that insurance companies could stop offering plans through the exchange should the subsidies be taken away during the term of their contracts. The inclusion of that language comes several months after two federal appeals courts handed down conflicting rulings about the legality of subsidies provided to consumers who purchase insurance coverage through Healthcare.gov. Oral arguments in the administration's appeal of the decision that struck down the subsidies are scheduled for Dec. 17, while an appeal of the decision that upheld the subsidies could be taken up by the U.S. Supreme Court if justices agree to do so. Michael Cannon, the director of health policy studies at the Cato Institute, notes that the contract language is an indication that the Obama administration is "nervous" that it could lose on those appeals. Timothy Jost, a professor at Washington and Lee University's law school, disagrees with the notion that the contract language is a tacit admission from the Obama administration that the case for the subsidies is not strong. A spokesperson for America's Health Insurance Plans, meanwhile, says it remains unclear how the insurance industry will respond if the subsidies are eliminated for people living in states using the federal exchange.

Medicine, Drugs and Devices

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A study published in the Canadian Medical Association Journal has found that ibuprofen may be better than oral morphine in treating pain in children who suffer broken bones and fractures, as it does not carry the same harmful side effects. The study involved 134 children between the ages of five and 17, 68 of whom were given ibuprofen while 66 were given oral morphine. Both ibuprofen and oral morphine were found to be effective at reducing pain, although oral morphine was associated with significantly more adverse events such as nausea, drowsiness and vomiting. Researchers say their findings are noteworthy because they can be used to help doctors choose the best option for treating pain in children with fractures or broken bones.


A recent meta-analysis has found that statins could be used to treat rheumatoid arthritis (RA) patients. Researchers examined results from 15 studies involving 992 RA patients, 487 of whom were given statins while the remainder were not. Declines in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were obvious after 12 months and were significant by the end of treatment. RA patients who were given statins also experienced declines in tender joint count (TJC) and swollen joint count (SJC). In addition, researchers observed a strong down regulation of the inflammatory factors tumor necrosis factor-a (TNF-A) and interleukin-6 (IL-6) in patients given a statin.