News From ACFAS

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You asked—we delivered. Your responses to our 2015 Member Survey helped shape this year’s HUB session lineup!

New topics on the HUB schedule for ACFAS 2016 include:

• Telemedicine/virtual medicine and the key differences between the two
• Tips for bringing your new product idea to life, from design to development
• How to negotiate contracts with insurance companies for better reimbursements
• Streamlining your practice by hiring a PA or NP
• And more!

HUB sessions are presented on the hour in a casual 45-seat theater housed in the Exhibit Hall. Stop by the HUB to join lively conversations that last long after the conference ends and get practical advice for every stage of your career. View a complete listing of HUB sessions at acfas.org/austin. Don’t stress out if you need CME before the end of year…ACFAS has your back! Our e-Learning portal is your solution for free CME at your fingertips. Accessible 24/7 from any location, our portal offers you easy and convenient ways to earn CME:

• View our free monthly Clinical Sessions and podcasts
• Download individual Surgical Techniques videos
• Purchase entire Surgical Techniques series on DVD

You can also earn CME by registering for Complex Forefoot Surgery with Advanced Solutions, December 4–5 in Cincinnati. And if you're planning to attend ACFAS 2016 in Austin, you'll receive 28+ hours of CME.

Just pass an exam and submit it to ACFAS to obtain your continuing education contact hours—on your schedule. Visit acfas.org/e-learning today to get started! Are you a resident member whose poster or manuscript has been accepted for presentation at ACFAS 2016? You can receive funding from your local Division by submitting an application to your Division’s president (names and email addresses available on acfas.org).

Each Division will determine the amount of support it can provide based on the number of submissions received and will contact you directly with next steps.

Your Division officers are happy to be able to support the next generation of researchers. To learn more about ACFAS Division funding, visit acfas.org.

Foot and Ankle Surgery

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Surgeons must decide between revision total ankle replacement (TAR) and salvage arthrodesis (SA) in cases of TAR failure. A recent study looked to analyze outcomes pertaining to SA following a report that found revision TAR to be an inefficient option. First-attempt solid arthrodesis rate of SA was 90 percent, and 25 of 53 patients were satisfied or very satisfied. All scores and satisfaction rates were similar to those following revision TAR, but SA provided a significantly lower reoperation rate. Researchers concluded that while SA after failed TAR had good initial results, less than half of patients reported satisfaction and functional scores remained low. Neither option provides excellent patient outcomes, but SA should be the first choice until further research is done.


Researchers recently reviewed the posterior Achilles tendon-splitting approach for tibiotalocalcaneal (TTC) arthrodesis by looking at all TTC fusions performed at a single academic institution. The review included 41 patients who underwent the Achilles tendon-splitting method. The fusion rate was 80.4 percent, and eight patients developed a nonunion of the subtalar, tibiotalar or both joints. Seventeen patients had complications, with nonunion (19.5 percent) being the most common. One patient required amputation. Researchers concluded that the posterior Achilles tendon-splitting approach was safe and effective, and it provides the ability to access both the ankle and subtalar joints so that it is possible to preserve blood supply to the skin.

Practice Management

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Here are five powerful ways to use a practice management system (PMS) to improve daily activities at your practice:

1. Electronic remittance/batch posting: Electronic remittance advice (ERA) can ease the hassle of poring over explanation of benefits forms and transferring the balance to an account. ERA, also known as batch posting, can do all of this automatically, saving both time and money.
2. Recurring credit card payments: Enter patients’ credit card information into the system, let them agree to monthly payments over a certain amount of time and then watch as the system makes all of the payments for you. This can help immensely if you have a high volume of transactions.
3. Patient registration using a patient portal: It costs a monthly fee, usually around $50, but it is useful and necessary. Patient portals save time and let patients register themselves.
4. Appointment search versus scroll: A PMS can automatically find and organize your appointments by date, type and more.
5. Detailed reporting: Use the system to generate an accounts receivable report that shows insurance balances and patient balances separately.

Launching an accountable care organization (ACO) without the proper technology is difficult and labor-intensive. To create the ideal ACO, you must leverage all the technology at your disposal to achieve all the capabilities you are looking for. A good ACO has five critical components:

1. Interoperability: You must have a solution that seamlessly shares information across all platforms. Any information should be available regardless of where it is being accessed and where the patient received care.
2. Analytics: Technology that provides analytics comes with many benefits, including the ability to discover patients in greatest need of care. For example, ACOs can use data analytics to more efficiently determine which patients are not being managed appropriately for their individual medical issues.
3. Care management: Keeping in contact with patients you identify is important, and having care management technology allows you to have constant communication. You can track patient health between visits, provide education and engage patients.
4. Data integration: Using technology that merges clinical and financial information is a critical component of every successful ACO. It can help save money and more efficiently manage patient outcomes.
5. Contract guidance: Use a contracting solution to ensure that public and private contracts properly define achievable goals.

A doctor's role should be that of a caregiver, but each year seems to bring more administrative responsibilities to doctors around the country. A recent study showed that administrative responsibilities are the biggest cause of work-related stress, and the emergence of electronic health records (EHRs), new federal mandates, value-based care and decreased reimbursements have made it even tougher. EHRs in particular have caused a lot of grief, although they are absolutely necessary for a functioning hospital. One solution could be designating a medical scribe. On average, a scribe is able to complete 80 to 90 percent of a provider's administrative work. They can also assist with care coordination and system integration. This will reduce both paperwork and stress and will allow you to focus more on the patients. Having a medical scribe means that you need not worry as much about compliance with new laws. In short, it is the antidote to what ails today's overworked physician.

Health Policy and Reimbursement

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EPA has proposed a rule to ban healthcare facilities from disposing of hazardous pharmaceuticals by flushing them. The agency estimates that the proposal could prevent more than 6,400 tons of hazardous waste from being dumped annually. The public can comment until Dec. 24, and EPA is eager to hear what people have to say. The stricter rule applies to the roughly 20 percent of hazardous drugs not eligible for manufacturer's credit that are flushed down the toilet, but EPA encourages facilities to apply the rules to all hazardous waste. “We’re proposing to remove the traditional manufacturing-based hazardous waste generator requirements and instead provide a new set of regulations designed to be workable in a healthcare setting, while ensuring safe management and disposal of hazardous waste pharmaceuticals,” wrote Mathy Stanislaus, assistant administrator in the EPA’s Office of Solid Waste and Emergency Response.


Hospitals in 67 metropolitan areas learned they have no choice but to accept a single sum for the cost of care during 90 days after patients visit the hospital for hip and knee replacement surgery. This strategy is known as bundled payments and is generally viewed as evidence of federal officials' impatience with hospitals charging Medicare for all visits, tests and procedures. In addition, the program shows that federal officials expect hospitals to do more to coordinate care after patients leave. The start date is Apr. 1, 2016 and will save Medicare $343 million, but hospitals claim that is far too little time to analyze data and coordinate the multiple services necessary. Some organizations are holding training sessions to prepare employees and staff while some are already in the midst of the change after accepting the bundled payments in a volunteer test program.


Drug prices have caused heated debate among healthcare leaders and lawmakers. Some specialty medications cost more than $100,000 a year, and several drugmakers have significantly increased prices. Lawmakers may seek to address the foundational issues that create higher prices, or they may try to limit the financial consequences for consumers. The U.S. Department of Health and Human Services plans to hold a forum to discuss the issue. One idea is to restrict how much insurers can charge for specialty drugs, an idea implemented in California. U.S. Sens. Claire McCaskill (D-Mo.) and Susan Collins (R-Maine) say there will be a tentative meeting of the Senate Special Committee on Aging on the topic on Dec. 9. Earlier this month, House Democrats announced the creation of a drug-pricing task force to explore the reasons behind the price increases and consider how the government can negotiate lower costs. Industry officials argue that drug prices are not part of the rise in healthcare costs, saying that retail prescription spending has long made up about 10 percent of healthcare spending. Insurers, however, say that increased drug prices are one reason for rising insurance rates.


UnitedHealthcare, one of the nation's largest insurers, warned that it may leave Affordable Care Act exchanges within two years. In a statement, the company said that it is "evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017.” UnitedHealthcare estimates it will lose $425 million in the fourth quarter, and its exit could send major ripples through the marketplace.

Medicine, Drugs and Devices

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The American Medical Association (AMA) has called for a ban of direct-to-consumer advertising of prescription drugs. The organization said that greater transparency in drug prices is needed. Pharmaceutical companies spent $4.5 billion on prescription advertising last year, and this spending has rapidly accelerated over the past 18 to 24 months. AMA claims prescription drug ads result in higher healthcare costs because it promotes name brands. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate,” said AMA Board Chair-Elect Patrice A. Harris. To get results, Congress must pass legislation banning the ads. This would raise questions about First Amendment rights, so there is a good chance nothing significant will be done, especially since the U.S. Food and Drug Administration already regulates prescription advertising heavily.


Physician-owned medical device distributorships (PODs) have come under fire from lawmakers who claim they allow doctors to profit inappropriately from the devices they plant. The practice has continued despite Affordable Care Act language attempting to stymie conflicts of interest by requiring disclosure. In one example, a patient died after a back surgery when the surgeon failed to disclose his relationship with the company that made the rods and screws for the surgery. According to Dr. Scott Lederhaus, president of the Association for Medical Ethics, PODs are a large problem because they produce questionable healthcare quality without reducing costs. Sen. Ron Wyden (D-Ore.) said he is ready to work with colleagues to discuss the POD model, but no alternative legislation has been proposed.


First Health of the Carolinas adopted home-based telehealth patient monitoring services in 2005. The system was a success, but the organization upgraded its technology in 2014, adopting a remote monitoring platform from Health Recovery Solutions (HRS). The HRS platform was a considerable step above the initial technology. In 2014, the program comprised 25 units; now, 160 units are used to monitor chronically ill patients, and it serves more than 800 patients at home. The system uses 4G tablets, wireless Bluetooth devices and remote monitoring to provide comprehensive views of patient health. The older technology put much of the onus on the patient, but the newer system fosters enhanced patient and caregiver engagement. Overall, it shows that telehealth can play a big part in keeping customers connected and healthier than they would be without the technology.