News From ACFAS

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Las Vegas may offer an unsurpassed variety of attractions, but from February 27–March 2, the best show in town will be the ACFAS 75^th Anniversary Scientific Conference at The Mirage. Expect more courses, more networking and more cutting-edge content that you can tailor to serve your professional and educational goals.

Visit acfas.org/vegas by December 12 to register at exclusive low rates and to book your hotel room. Our popular two-day Foot and Ankle Arthroscopy courses are still accepting registrants. Sign up now at acfas.org/education so you don’t miss out on:

• More than nine hours of hands-on laboratory time
• The chance to use the latest equipment and techniques on fresh cadaver specimens
• Presentations by expert faculty, including videos of actual arthroscopic cases
• A fireside chat, during which you can share radiographs of your most challenging case

Spaces for these courses fill fast—register today and visit acfas.org for course details. Have you educated yourself and your staff on false claims? A false claim is a claim submitted to the government that the provider knows is false and includes services that are:

• Upcoded
• Not provided
• Not supported by the patient’s medical record
• Part of a previously submitted claim

Watch this brief video on the False Claims Act with your staff to learn more.

This should not be considered legal advice. If you have any questions, please contact a healthcare attorney in your state. If you have not done so already, speak with your electronic health record (EHR) vendor about MACRA implementation. Your conversation could help ensure you:

• Comply with the U.S. Centers for Medicare and Medicaid Services' (CMS) Medicare Access and CHIP Reauthorization Act of 2015
• Do not receive a negative payment for your Medicare payments in 2019

As a physician, you can submit some of your data to CMS through your EHR. However, your EHR must be capable of receiving and transmitting data to CMS. Ask your EHR vendor if they are able to transmit this information. If software upgrades are needed, ensure that the upgrades do not interfere with practice flow.

Questions about MACRA implementation? Contact Sarah Nichelson, JD, ACFAS director of Health Policy, Practice Management and Research. ACFAS members can take advantage of free website setup plus two free months of website hosting through Officite, an ACFAS Benefit Partner. Visit officite.com or call (888) 511-9478 for more information. Offer ends November 30.

Foot and Ankle Surgery

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Severe motorcycle spoke injuries of the heel lead to Achilles tendon defects, calcaneal tubercle exposure and overlying soft-tissue defects. Spoke injuries in children are particularly troublesome, so researchers conducted a review of reconstruction options. The study included 31 cases of severe motorcycle spoke injuries of the heel in children. Flap transfer and Achilles tendon repair were performed based on the defect size of the Achilles tendon, the location of the soft-tissue defect and the distal residues of the Achilles tendon. Sixteen cases were reconstructed with sliding gastrocnemius musculocutaneous flaps, seven cases were repaired with saphenous neurocutaneous flaps, four cases had posterior tibial perforator flaps, three cases had sural neurocutaneous flaps and one case was reconstructed with a peroneal artery perforator flap. Three cases of flap partial necrosis and one case of local infection of the Achilles tendon were observed. Dorsiflexion of the ankle was initially limited, but patients gradually regained normal walking abilities within six months to four years of follow-ups.


A study was conducted to demonstrate the effectiveness of a highly hydrophilic polyurethane foam dressing in the treatment of diabetic foot ulcers. The study included a total of 208 patients with diabetic ulcers; 137 patients were treated with the polyurethane foam dressing, and 71 were treated with saline gauze. Within 12 weeks, complete wound healing occurred in 63.5 percent of patients in the polyurethane foam dressing group and in 39.4 percent of patients in the saline gauze group. The percentage of wound area reduction in both groups was statistically significant. Patients in the polyurethane foam dressing group who achieved complete healing within 12 weeks required a mean of 6.2 weeks for complete closure, compared with 7.3 weeks for the control group.


Two studies quantified the prevalence of myocardial inflammation in rheumatoid arthritis (RA) patients without known cardiovascular disease (CVD), evaluate its association with high disease activity and demonstrate how disease-modifying therapy may decrease this type of inflammation, according to research presented at the 2016 ACR/ARHP Annual Meeting. The first study examined 118 RA patients without prior CVD events who underwent cardiac 18F-fluorodeoxyglucose positron emission-computed tomography (18-F-FDG-PET-CT) scanning and 3D echocardiography. Average maximal standardized uptake value (SUVmax) was 12 percent higher in RA patients versus controls. Higher body-mass index and moderate-to-severe disease activity were positively associated with SUVmax in the RA patients. Use of 18-F-FDG-PET-CT scanning showed administering disease-modifying antirheumatic drugs to RA patients can improve measurement of myocardial FDG uptake.

Practice Management

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Healthcare data breaches are most likely to be caused by human error, according to Verizon’s 2015 Data Breach Investigation Report. To keep data security high on employees’ list of priorities, practices should develop and support information security training programs. When preparing to launch a training program, administrators first must define the program’s goals and outline the specific aspects of IT security that the staff needs to learn. An organization’s leadership must be educated on the importance of IT education and support the allocation of resources to the training program. Practices should also conduct risk assessments of existing security systems to identify any gaps, including an analysis of IT training. The training program should include education on practice policies and procedures as well as guidance related to specific staff roles and vulnerabilities. In addition, IT training must emphasize the importance of following practice rules and include discussion of the potential consequences for failing to comply. As new cyberthreats surface, practices must work to keep up with current threats and technology and share this information with staff.


Outsourcing administrative tasks, such as compliance requirements and training programs, allows physicians and other personnel to prioritize patient care and can alleviate burnout. As healthcare staff may not have the time and training to meet health and safety requirements and develop appropriate policies, outside companies that have the expertise to understand compliance regulations can help physician practices keep up with current rules. These companies can also develop an action plan and ensure that practices are aware of any updated rules or additions. In addition, external resources can prepare organizations for a visit from regulatory agencies and provide online tools and other educational materials to assist practices with training programs. If a practice does not want to outsource a task completely, it can turn to an external firm for guidance and support, relieving pressure on physicians and staff.

Health Policy and Reimbursement

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More than one million people have either renewed their existing insurance plans through the Affordable Care Act or enrolled for the first time in the first two weeks of sign-ups, according to the U.S. Centers for Medicare and Medicaid Services. From the market's open on November 2 to November 12, more than 246,000 new consumers and nearly 762,000 returning consumers selected coverage, outpacing last year by about 53,000 plans. The enrollment figures are only for the 39 states where the federal government runs enrollment and does not include states that have built their own sign-up systems. The deadline to sign up for coverage is December 15.


Following a campaign in which he vowed to repeal the Affordable Care Act (ACA), President-Elect Donald Trump is indicating he would like to keep two popular features of the healthcare law. In a recent interview on 60 Minutes, Trump said he supports the ban on insurers denying coverage to individuals with preexisting conditions as well as the provision allowing adult children under the age of 26 to stay on their parents’ plans. Trump plans to repeal ACA and replace it with new regulations without a gap in coverage. His initial plan, published on his transition website, calls for a solution that includes Health Savings Accounts and a return to health insurance regulations governed by individual states. The plan also states that high-risk pools would cover those with large medical expenses who otherwise are unable to maintain continuous coverage.


The Department of Health and Human Services’ Office of the Inspector General (OIG) will continue to scrutinize improper incentive payments made by the U.S. Centers for Medicare and Medicaid Services (CMS) to eligible providers and hospitals. The agency’s plan for fiscal year 2017 includes an emphasis on identifying payments that should not have been made to certain providers, such as those not meeting meaningful use criteria. The agency will also review CMS’ plans to oversee incentive payments and corrective actions. As part of the meaningful use program, OIG will assess certified electronic health records (EHRs). Covered entities that have received EHR incentive payments will be audited to ensure the security of electronic health information maintained by certified EHR technologies.


President-Elect Donald Trump is considering U.S. Rep. Tom Price (R-Ga.) to lead the U.S. Department of Health and Human Services. Price, an orthopaedic surgeon, is a member of the House Ways and Means Committee, which has jurisdiction over healthcare policy. A vocal critic of the Affordable Care Act (ACA), Price sponsored legislation that would repeal the ACA and provide refundable tax credits adjusted by age to buy health insurance. Price also supports the use of health savings accounts and tax break caps for employer-based plans. Although Price voted for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), he expressed concern that some of MACRA’S provisions could increase administrative tasks. Other possible picks to lead HHS include former Louisiana Gov. Bobby Jindal.

Medicine, Drugs and Devices

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The American Medical Association (AMA) has announced its support of value-based pricing for medications. AMA says growing pharmaceutical spending rates could be dampened by incorporating a balance of benefits and cost when pricing drugs. Prices should allow for physician discretion and take a drug’s public health value into consideration, according to the new AMA policy. The organization also is calling for prices to be set by objective, independent agencies using transparent processes. “The new AMA policy acknowledges the carte blanche approach to drug pricing needs to change to align with the health system's drive for high-quality care based on value,” says AMA President Dr. Andrew W. Gurman. “This transformation should support drug prices based on overall benefit to patients compared to alternatives for treating the same condition.” It is unclear how President-Elect Donald Trump's administration would address the issues of drug pricing and value-based care, but Trump has expressed support for price transparency, importation of foreign drugs and direct negotiations between Medicare and drugmakers.


Medicare has released data identifying the costliest prescription medicines. Many of the drugs with the biggest price increases in 2015 were generics, the data showed. Medicare released the data as an update to its online database, the “Medicare Drug Spending Dashboard.” The database, which attempts to shed light on prescription drug costs, was launched in December 2015.


A new study has found that statins reduce mortality by a third in patients with ankylosing spondylitis and psoriatic arthritis. Researchers studied 2,904 patients with either ankylosing spondylitis or psoriatic arthritis who started taking statins between 2000 and 2014. The patients were matched with 2,904 ankylosing spondylitis or psoriatic arthritis patients who did not use statins. Over 5.3 years, 271 of the patients who took statins died, while 376 of the patients who did not take statins died within 5.15 years.