News From ACFAS

---

Congratulations to the newly elected ACFAS board members from balloting that ended on Dec. 30:

• Christopher L. Reeves, DPM, FACFAS (three-year term)
• Thanh L. Dinh, DPM, FACFAS (three-year term)
• Randal L. Wraalstad, DPM, FACFAS (one-year term)

Also joining the board will be Eric G. Walter, DPM, FACFAS, who will serve a two-year term as Chair of the Division Presidents Council (DPC) and ex-officio board member.

Pursuant to the bylaws, the Board of Directors has appointed Aksone Nouvong, DPM, FACFAS, to fill a two-year vacancy in the term of Christopher Hyer, DPM, FACFAS, who is resigning from the board effective Feb. 7. Nouvong is completing a two-year term as DPC chair and ex-officio board member.

Also serving on the 2016–2017 Board of Directors are Sean T. Grambart, DPM, FACFAS, President; Laurence G. Rubin, DPM, FACFAS, President-Elect; John S. Steinberg, DPM, FACFAS, Secretary-Treasurer; Richard Derner, DPM, FACFAS, Immediate Past President; Byron L. Hutchinson, DPM, FACFAS; and Scott C. Nelson, DPM, FACFAS.

The new board will be installed on Feb. 12 during the ACFAS 2016 Annual Scientific Conference in Austin, Texas. Be a part of what’s on track to be yet another recordbreaking Annual Scientific Conference! Register now for ACFAS 2016 in Austin and get ready to:

• Hear fresh perspectives on trending therapies, rethinking surgical approaches, pain and infection management, diabetic limb salvage and more
• Take your surgical skills to new heights in hands-on workshops and sessions led by renowned experts
• Network, job hunt, get a new headshot and see hundreds of innovative industry products and services in the Exhibit Hall
• Meet up with your colleagues at exciting special events that capture the spirit of Austin

Your chance to help us make ACFAS history in Austin next month is only a click away—register now! Take advantage of the largest gathering of your colleagues to help grow your network and forge your career path at ACFAS 2016 in Austin. Job hunt, network, interview with potential employers, update your headshot and have your resume reviewed during the third annual ACFAS Job Fair, sponsored by PodiatryCareers.org.

Also meet new professional peers during the invitation-only Resident and Student Networking event, sponsored by the American Board of Foot and Ankle Surgery (ABFAS). Mingle with leaders in the profession while enjoying refreshments and taking part in prize drawings!

For complete details on all resident and student events at ACFAS 2016, visit acfas.org/austin.
Don’t run on fumes at ACFAS 2016—fill your mind and body at the popular satellite breakfasts on Friday, Feb. 12 and Saturday, Feb. 13 from 6:30–7:30am at the Austin Convention Center. Sponsored by Amniox Medical, Crealta Pharmaceuticals and DePuy Synthes, these breakfasts combine thought-provoking discussion with a delicious meal that will power you up for the day ahead.

Amniox Medical Breakfast Satellite
Friday, Feb. 12
6:30–7:30am
Room 16AB

Crealta Pharmaceuticals Breakfast Satellite
Friday, Feb. 12
6:30–7:30am
Room 19AB

DePuy Synthes Breakfast Satellite
Saturday, Feb. 13
6:30–7:30am
Room 19AB

Download the full conference program at acfas.org/austin for details.
Congratulations to the three recipients of 2016 Clinical and Scientific Research Grants:

Seeking Proof: Does Charcot Reconstruction Improve Physical Function?
Alan Catanzariti, DPM, FACFAS; Lisa Grant, DPM; Matthew Hentges, DPM

Plantar Plate Integrity Post Direct Surgical Repair: A Case Series
Katherine Dux, DPM, FACFAS; Jonathan Matzkin-Bridger, DPM

Objective Determination of the Effects of Foot Position on Clinical
Measurement of Ankle Joint Dorsiflexion
Mindi Feilmeier, DPM, FACFAS; Paul Dayton, DPM, FACFAS

Since its inception, ACFAS' Clinical and Scientific Research Grant program, administered by the Research Committee, has funded nearly 20 research studies that have led to major advancements in foot and ankle surgery, evidence-based medicine and patient care.

Visit acfas.org/grant for a complete listing of past award recipients.

Foot and Ankle Surgery

---

Researchers measured nine angles on standard radiographs of children with idiopathic clubfeet treated with the Ponseti method. Their goal was to establish a universal quantitative measurement to better understand and evaluate therapeutic outcome. Of the nine angles, three had predictive value. In the preoperative group, the lateral tibiocalcaneal angle with the ankle at maximal dorsiflexion measuring fixed equinus was larger than the nonoperated group, and functional outcome was better with smaller angles. The lateral talocalcaneal angle with the ankle at maximal dorsiflexion measuring hindfoot rigidity was smaller in the preoperative group than the nonoperated group, and functional outcome was better with larger angles. The lateral talo-first metatarsal angle with the ankle at maximal plantarflexion measuring foot cavus was larger in the preoperative group than the nonoperated group. Functional outcome was not associated with this angle. The lateral view with the foot in maximal dorsiflexion was found to be the most significant and useful view.

Practice Management

---

Almost 12 percent of physician net patient service revenue goes to pay for "excessive administrative complexity," according to a recent Health Affairs study, and medical billing inefficiencies account for 74 percent of those costs. To increase efficiency and save money, physicians should take a structured approach to organization:

1. Automate front-end processes. The best-performing practices have 1.29 to 1.38 full-time equivalents per physician for front-desk operations, according to the Medical Group Management Association. Standardize the process and assign a point person to be responsible. Automate your system to catch missing authorizations and streamline certification processes.
2. Collect from patients up front. This is especially important now that patient responsibility is more prominent. Communicate with your clients and train your staff on best practices for collecting.
3. Proactively slash your denial rate. An increase in denials is expected to occur in the wake of ICD-10. This could place a large burden on your staff. Implement a system that checks for current procedural terminology to diagnosis to modifier relationships, commercial unbundling, medically unlikely, global surgery periods, duplicate charges and partially or completely unbilled services.

An increasing number of physicians are starting to use Twitter, Facebook and other social media outlets to change the way they run their practices. Doctors are also trying to get the word out to colleagues within the industry about the benefits of using social media. According to Deann Attai, a surgeon at UCLA Health, "Patients are thirsty for good credible information, as well as guidance and support. Many patients seem to appreciate having a physician in the online space. Interacting with patients online also gives me the opportunity to correct myths and misconceptions in real time." Sites like Twitter provide versatility in communication, open access, brief communication and the ability to use hashtags and other tools to find information relevant to every doctor.

Health Policy and Reimbursement

---

The Centers for Medicare and Medicaid Services (CMS) issued a final rule mandating prior authorization for some medical devices and equipment. The rule requires documentation to meet authorization for durable medical equipment prosthetics, orthotics and supplies (DEMPOS). The documentation is needed earlier in the process to furnish the items. It will allow CMS to move from a "pay and chase model," which has seen CMS make payments on claims and then identify improper payments before recouping. CMS also listed 135 products that are frequently the subject of unnecessary utilization. The rule is the latest in a series of moves to battle improper payments associated with DEMPOS.


The Centers for Medicare and Medicaid Services (CMS) passed the 90/10 final rule, aimed at supporting states attempting to develop more effective Medicaid IT systems. The new funding will increase from 50 to 90 percent for new eligibility and will implement various initiatives to modernize technology. These initiatives include automated applications and renewals, efficient claims processing and integrated human services programs. In a significant change, the 90/10 ruling allows each department to establish its own system so that the system does not need to wholly function for changes to go into effect. "This is CMS saying the rules have fundamentally changed and the states need to step up to the plate to get this to work because Medicaid is too important," said former CMS CIO Julie Boughn.


Two health policy experts claim that Congress should craft a better cost-control mechanism for the Affordable Care Act (ACA) in the wake of the delay on the Cadillac Tax. The tax, a 2.3 percent excise on medical devices, is unpopular on both sides of the political spectrum and is unlikely to be reinstated. Former director of the Congressional Budget Office Douglas Holtz-Eakin and Henry Aaron, senior fellow at the Brookings Institution, both say it is important to use Sen. John McCain's proposed tax plan, which includes a cap on tax exclusion for employer plans—a plan that President Obama had sharply criticized. Some GOP members support limiting the tax exclusion, but it would be difficult to gain the trust of anti-tax Republicans because it would likely be considered a tax increase. Ultimately, Aaron says the goal should be to do away with the transgression of the ACA's tax plan. “Let's see if we can design a better way of achieving the goals of the Cadillac tax,” he said.

Medicine, Drugs and Devices

---

The new Sloan Kettering outpatient surgery center in New York will act as a home for emerging ideas in patient experience design, healthcare technology and data tracking. The $300 million Josie Robertson Surgery Center will track patients using plastic tracking badges that broadcast real-time locations, and a revolutionary waiting room design allows for semiprivate areas and charging stations. Operating rooms are also getting an upgrade and will include surgical robots and high definition anatomical imaging. While some physicians and patients feel all of the technology is a burden, particularly the tracking system, many also know how important it is to modernize medical systems. Hospital innovation is sweeping the nation with organizations turning to technology to upgrade the patient experience. One area where improvement needs to be made: communication. Many patients simply do not know the technology available, or the extent to which it permeates their lives. According to Dr. Brett A. Simon, the director of the new center, “We want to communicate the things we are doing that are new and that improve the patient experience without making them feel alarmed or that they are experimental animals. I'm not sure we have 100 percent figured out how to do that.”


The Federal Trade Commission (FTC) is looking to counter device cybersecurity threats by clamping down on wearable makers who fail to protect consumer data. As the Internet grows, threats become more imminent, and FTC is trying to combat the problem before it becomes larger. Earlier this year, FTC released a report giving six recommendations for companies to ensure that their products, including medical devices, have built-in security features from the outset. This added to a cybersecurity guidance document released the year before that included non-binding recommendations. The U.S. Food and Drug Administration is also getting in on the action, announcing device cybersecurity as one of its top ten priorities for 2016.