News From ACFAS

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Fellow and Associate members, don't let your ACFAS membership lapse. Pay your dues by Dec. 31 at acfas.org/paymydues or by mail or fax to ensure your member benefits will continue.

You should have received your ACFAS dues reminders for 2016 both in your mailbox and your email. If you have questions or require another statement, contact Terry Wilkinson in the Membership Department.
Don’t spend a fortune on your hotel room for ACFAS 2016—book with onPeak, our official housing partner, and receive the lowest rates at specially selected hotels in Austin.

Hotels in our exclusive room block include:

• Hilton Austin (headquarters hotel): $229/night
• Courtyard Austin Downtown: $199/night
• Hyatt Place Austin Downtown: $209/night
• JW Marriott Austin: $229/night
• Residence Inn Austin Downtown: $209/night

Reservations are processed on a first-come, first-served basis, so visit acfas.org/austin or call onPeak at (800) 950-5542 today to get your best choice. And if you have not already done so, be sure to register for ACFAS 2016 at acfas.org/austin. See you in Austin! If you’ve put your practice marketing efforts on ice due to time constraints or a heavy workload, head to acfas.org/marketing to download the latest issue of FootNotes. Our free patient education newsletter can be easily customized with your office’s contact info and then printed or posted to your social media outlets or website to attract new patients to your practice.

Articles in Winter FootNotes include:

• Avoid Ankle Pain This Winter
• Protect Your Feet from Frostbite
• Ingrown Toenails Can Cause Big Problems for Kids

FootNotes is just one of many resources available in the ACFAS Marketing Toolbox to help you promote your practice any time of the year. New PowerPoint presentations, infographics and other products are regularly added to the Toolbox—keep checking acfas.org/marketing for updates! If you're looking to add a new practitioner to your staff in 2016, come to our third annual ACFAS Job Fair in Austin where you can post your open positions on bulletin boards or online through PodiatryCareers.org.

PodiatryCareers.org also allows you to schedule onsite interviews with potential candidates during the conference.

Visit acfas.org/austin for further details on how to use the job fair to attract the best and brightest talent to your practice!

Foot and Ankle Surgery

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The best method of subtalar arthrodesis fixation is unknown. A recent study supported the use of 2 screws for fixation of subtalar arthrodesis over a single posterior screw. The study looked at three different screw configurations: single posterior screw (SP), 2 posterior minimally divergent screws (MD) and a 2 screw highly divergent screw (HD). The HD screw had the highest torsional stiffness in both inversion and eversion torques, followed by the MD screw and the SP screw. The HD screw also had the highest maximum torque. All between-group differences were statistically significant.


A recent study assessed whether syndesmotic reduction quality had any effect on clinical outcomes following fixation of rotational ankle fractures with unstable syndesmotic injuries. Researchers used four previously utilized methods of syndesmotic assessment to analyze 155 patients. These methods had reliabilities from moderate to almost perfect, and measurements of the uninjured syndesmosis were consistent with previous studies. The mean measurement differences between the injured and normal ankles ranged from 1.32 to 1.88 mm of displacement and averaged 5.75° of rotation. Researchers concluded the quality of syndesmotic reduction did not significantly affect clinical outcomes. Study leaders noted that this result challenges prior beliefs about the clinical importance of minor syndesmotic changes.

Practice Management

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Entering data into electronic health records (EHRs) leaves patients with less satisfaction, according to a new study. Researchers used data from encounters between 47 patients and 39 doctors at a public hospital and found that doctors who entered the information during an appointment did less positive communicating. This led to lower patient ratings for the visit. About half of the 25 encounters with high computer use were rated as "excellent," while more than 80 percent of the 19 encounters with low computer use rated as "excellent." Study leader Dr. Neda Ratanawongsa said spending more time on the computer is not necessarily a bad thing. “EHRs give important health information to clinicians, which may help safety net patients with communication barriers like limited health literacy and limited English proficiency," she said. “On the other hand, maybe patients sense that their clinicians aren't listening as carefully to them." According to Ratanawongsa, one solution is for EHRs to be "more usable" so clinicians can properly assess a patient while still maintaining good communication.


An expiring health law program will cost many physicians some money in 2016. The incentive program started in 2011 was designed to address disparities in Medicare reimbursements between primary care physicians and specialists. The discontinuation of this program could slice a 10 percent bonus many physicians earned for caring for Medicare patients. Among the roughly 170,000 qualified practitioners, it will cost an average of $3,938 each. That may not seem like much, but it will be felt by smaller practices, and by practices with a substantial number of Medicare patients. For example, Andy Lazris, a doctor at a five-practitioner practice in Columbia, Md., says the $85,000 they received annually allowed them to make critical administrative hires. If they cannot get the bonus next year, it will likely mean a pay cut of $17,000 per practitioner. "There will be some physicians who say they can't take any more Medicare patients," said Wayne J. Riley, MD, president of the American College of Physicians.


Two months into the transition to ICD-10, about 80 percent of healthcare organizations say that the change is going well, a KPMG LLP survey found. The survey, which included 298 attendees of the KPMG “ICD-10: Just the Beginning” webcast, found that 28 percent reported a smooth transition. Another 51 percent reported "a few technical issues, but overall successful." Eleven percent said the transition was a "failure to operate in an ICD-10 environment." Challenges reported by respondents included rejected medical claims, clinical documentation, reduced revenue from coding delays, and IT fixes. The Centers for Medicare and Medicaid Services said that, as of Oct. 27, 10 percent of claims were being rejected, but only .09 percent were rejected because of invalid ICD-10 codes. Almost half of survey respondents said they were considering initiatives in clinical documentation improvement, revenue cycle optimization and electronic health record and IT optimization.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) experienced a few issues with ICD-10 implementation and recently issued clarifications regarding how it will resolve the issues. According to the CMS statement, there have been a few isolated issues with National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). Some errors also occurred because Medicare Administrative Contractors (MACs) still needed to update certain LCD criteria. CMS noted that it has addressed the errors quickly and efficiently. “Our contractors understand the challenges that updating CMS systems may bring to our providers and strive to provide quick resolution when issues are noted. For the handful of issues that were noted after Oct. 1, 2015, CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible and reprocessing claims to minimize impact on providers,” CMS said. CMS still maintains that it will take several pay cycles to get a real handle on how smoothly the ICD-10 transition went.


The Centers for Medicare and Medicaid Services (CMS) released a comprehensive strategy update focusing on the shift to value-based care. The 2016 Quality Strategy Update is the first of its kind in the past two years and touts legislative progress while hailing the success of payment reform. The update also mentioned a three-part mission that includes better patient care, improving outside influences on health and reducing healthcare costs across the board. These three initiatives were paired with six specific goals: reduce harm caused while delivering care, strengthen personal and family engagement together in care, effective communication and coordination of care, treatment and prevention of chronic disease, promote healthy living in communities and make care affordable. The stated goal is to have 85 percent of all traditional Medicare payments tied to quality or value and 30 percent of traditional Medicare payments tied to alternative payment models by the end of 2016.


The GOP Doctors Caucus recently wrote a letter to House Speaker Paul Ryan requesting a delay of meaningful use stage three and a blanket hardship waiver exception for meaningful use stage two. "We believe a simultaneous implementation of more stringent criteria…is likely to create a chilling effect on further EMR adoption as physicians conclude that the cost of implementation is simply not worth the bureaucratic hassle," the letter said. According to the Doctors Caucus, only 12 percent of physicians have managed to even reach stage 2 requirements. Part of the reason is that the proposed final rule for stage two and stage three included a 90-day reporting period even though fewer than 90 days were remaining in the calendar year at the time of the announcement.


The Affordable Care Act penalizes hospitals that have too many readmissions within 30 days of an inpatient stay, which theoretically leads to better follow-up treatment. At some hospitals, the trick seems to be working—the rate of heart failure patients who were readmitted at some hospitals has fallen, according to a Wall Street Journal analysis. But the statistics can be somewhat misleading. At many hospitals around the country, more patients are entering or reentering under "observation status," a category that keeps them out of the readmission tallies. These patients can remain in the hospital for days and receive care that is typically indistinguishable from inpatient stays. “The hospitals are responding to the incentive scheme that has been established for them,” said Eric Coleman, a geriatrician and University of Colorado professor. In 3,500 general hospitals facing the penalty program, readmission rates dropped nine percent from 2010 to 2013. Follow-up observation rates increased by about 48 percent.

Medicine, Drugs and Devices

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New medicines have changed rheumatoid arthritis (RA) treatment for the better, as shown by the rapid decline in assistive medical devices among RA patients. A study published in Arthritis Care and Research compared medical devices from two time periods, 2001 to 2003 and 2010 to 2012. The most recent comparison revealed a significant decrease in device usage, as well as reduced disease activity and less functional impairment. David Borenstein, MD, a clinical professor of medicine at the George Washington University Medical Center, said the results are promising. "Even though some of the medicines we prescribe are expensive, our belief has been that if we're able to use them in an effective manner, we end up with more functional human beings who in the long run may require less medical therapy," he said.


The Food and Drug Administration (FDA) approved 98 percent of all high-risk medical devices in the last fiscal year, the highest rate in more than a decade. Last year's approval rate was 86 percent and in 2012, it was 70 percent. It is the first time the approval rate has been in the 90s since 2005. Lower-risk devices also experienced a spike in approvals. The 85 percent rate represented the highest figure since 2010. The inflated numbers could be a product of congressional pressure on FDA, with lawmakers claiming the agency's approval process is too slow.


Avoidable complications affecting patients in hospitals has hit a plateau following three years of declines. According to a new federal report, there were at least four million infections and other potentially avoidable injuries in hospitals last year, or about 12 in every 100 hospital stays. The frequency was 17 percent lower than in 2010 but the same as in 2013, meaning that improvements have been made but seem to have stalled. The Affordable Care Act has focused on lowering hospital infections by penalizing poor-performing hospitals and incentivizing technology upgrades. The most significant improvement came from lowering the number of infections from central lines inserted into veins, down 72 percent from 2010. While the overall numbers remained flat over the last year, the report noted that some types of injuries became less common. For example, postsurgery blood clots dropped by more than 30 percent. “We think we addressed a lot of the areas where there was a strong evidence base on how to improve patient safety,” said Dr. Patrick Conway, chief medical officer for the Centers for Medicare and Medicaid Services. “We’ll now have to tackle that next wave that has multiple causes.”