News From ACFAS

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ACFAS’ Practice Marketing Toolbox keeps getting larger! Just added for download—another new free patient marketing PowerPoint presentation, Heel Pain: What You Need to Know. This latest addition to ACFAS’ patient marketing library covers the causes and symptoms of plantar fasciitis plus surgical and non-surgical treatment options. Also included, a script and a customizable slide for your practice’s contact information so patients can schedule appointments with your office.

With the library growing rapidly, these professional marketing presentations are great out-of-the box solutions for any member to use to promote their practices. Use at community health talks or patient presentations at your hospital. Other presentations available for download include Bunions and Hammertoes; Ankle Injuries: Before and After; and more being added soon! Plus, while in the Marketing Toolbox, be sure to check out the other valuable marketing tools available to promote your practice! Students and residents, you have plenty to look forward to at ACFAS 2015 in Phoenix—not only can you expect intensive, hands-on clinical sessions and workshops tailored to young practitioners, you can take the next step in your career path by job hunting and interviewing with potential employers during the second annual ACFAS Job Fair (sponsored by PodiatryCareers.org). Take advantage of this opportunity to find the right fit for your skills and experience, and don’t forget, a photographer will be available once again in the Exhibit Hall to take free professional headshots for use on your resumes and social media profiles.

You’ll also be able to meet new professional peers and expand your circle at the annual invitation-only Resident and Student Networking event. Network with leaders in the profession while enjoying refreshments and taking part in prize drawings.

Visit acfas.org/phoenix for full details on student and resident events at the conference and get ready to kick 2015 into high gear! If you’re ABFAS-certified in foot and ankle or reconstructive/rearfoot ankle and want to elevate your surgical skills to a whole new level, consider applying to register for Total Ankle Arthroplasty, set for April 17–19, 2015 at the Science Care Lab in Denver, CO.

Those who meet the course prerequisites will spend an entire weekend performing primary implantation and revision implants of FDA-approved ankle replacement systems. Expert faculty will explain how total ankle arthroplasty is used to manage degenerative, post-traumatic and systemic ankle arthritis and will also review conservative management, complications and supplementary procedures.

This intensive hands-on course includes three cadavers for each accepted registrant as well as Saturday and Sunday breakfast, lunch and refreshment breaks.

Visit acfas.org/education for an application to register and take advantage of this opportunity to significantly advance your skills this spring.

Foot and Ankle Surgery

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A systematic review of the MEDLINE and Cochrane databases from January 1950 to August 2012 was held, with search criteria identifying all reports of vascularized, autograft and allograft Achilles tendon reconstruction plus free tissue transfer. Inclusion criteria included strict objective results of ankle range of motion and/or dynamometer testing. Fifteen retrospective studies met the inclusion criteria, representing 44 patients at an average age of 33 years. Fifty percent of patients had a localized infection before reconstruction. Average skin defect was 85.3 square cm, and average tendon gap was 7.8 cm. Sixty-eight percent of patients received free tissue transfer with vascularized tendon reconstruction, 16 percent had either nonvascularized autograft or allograft, 11 percent underwent a muscle interposition and 5 percent had combined vascularized and nonvascularized tendon repair. The general median total range of motion was 54.6 degrees. Reconstruction with vascularized tendon had an overall range of motion 80 percent of the unaffected side versus avascular tendon repairs, at an average range of motion 82 percent of the unaffected side. Dynamometric comparison with the unimpacted extremity yielded an average deficit for avascular reconstructions at 21.2 percent and 24.8 percent for 30 to 60 and 120 degrees/s, respectively, compared to an average deficit of 32.3 percent and 31.5 percent in the vascularized reconstructions. There appears to be no functional difference between vascularized and non-vascularized tendon repair.


A prospective study was held to ascertain whether gravity versus manual external rotation stress testing effectively identifies widening of the medial clear space in isolated ankle fractures when compared with the uninjured contralateral side. The researchers performed manual external rotation stress and gravity stress tests on injured and uninjured ankles of ankle fracture patients in a clinic environment. Medial clear space measurements were recorded, and differences between gravity and manual stress views were determined. Twenty consecutive patients with ankle injury participated in the study. Compared with the uninjured side, gravity stress views demonstrated a statistically significant increase in medial clear space widening versus manual stress view widening. The study suggests gravity stress views are as effective as manual external rotation stress views in detecting medial clear space widening in isolated fibular breaks.

Practice Management

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Health plans' prior authorization requirements for certain prescription drugs can be a hassle for physicians, but the burden on practices could be eased and patient satisfaction boosted concurrently through solutions from Surescripts and DrFirst that embed electronic prior authorization (ePA) in the e-prescribing process. The companies report their offerings will enable physicians and their staffs to request approval from pharmacy benefit managers and health plans within their electronic health records (EHRs). Consultants and physicians note this strategy could reduce the work and cost involved in prior authorizations, as well as make patients happier by allowing them to get a prescription approved before leaving the physician's office. The viability of ePA hinges on it becoming available in EHRs as part of the clinical workflow. DrFirst is including Patient Advisor ePA+ in the EHRs of all its vendor clients and including Patient Advisor ePA+ in its standalone e-prescribing programs. Observers concur ePA, if it works as promised, will probably sweep the industry because practices will demand it. Primary care nurses spend an average of 13.1 hours per physician per week on prior authorizations and 3.8 hours per week on formularies, according to a 2009 study, and ePA would enable these clinicians to transfer most of the prior authorization time to patient care duties. CoverMyMeds estimates ePA can lower the amount of time practices spend on prior authorizations by 70 percent.


Simply hiring additional staff will not address patients' rising expectations, and private practices should follow a number of tips to adopt policies and procedures that help staff provide exemplary care. Those tips include:

1) Hiring the right staff to achieve balance, which is particularly crucial at small practices. Critical is finding people who like to work and want to learn.

2) Making patient communication a priority for every staff member. Attention to engagement among staff and physicians creates loyal patients.

3) Teach staff to function as information guides to help patients determine which data applies to their situation.

4) Showing top-down loyalty, in which staff are favored over patients. For example, apportioning dedicated time when no appointments are booked enables a practice to accommodate emergencies and sends a strong message of respect for each patient's time and staff's value for office organization.

5) Managing staff size mindfully, as the practice's patient population may grow when the above policies and procedures are adopted. Physicians who want to expand their small practice should closely monitor state wage-hour laws, especially those dealing with overtime, meal and rest periods, and alternative work schedules.


Ensuring that the employees a practice hires are a credit to that practice requires caution and rigorous adherence to credentialing. Strategies for making sure the right staffer is hired include:

1) Asking enough questions of the candidate to establish certainty.

2) Making the credentialing process more thorough to see how candidates will perform on the job. A candidate who really wants the job and can withstand some rigor also will endure tough work challenges after the job is offered to him or her. The interviewer can talk through a few work scenarios, as well as ask the candidate to submit samples.

3) Asking tough questions and not shying away from getting personal. Asking hard questions once something worrisome about the candidate comes up is the best way to find out how that person will perform when that same situation arises.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) is looking for about 850 volunteers to participate in ICD-10 end-to-end testing during the week of April 26 through May 1, 2015. The CMS will review applications and choose participants that represent a broad cross-section of provider, claim and submitter types, including claims clearinghouses that handle claims for large numbers of providers. Participants will have the opportunity to join ICD-10 end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor. One goal of end-to-end testing is to demonstrate that providers and submitters are able to successfully submit claims with ICD-10 codes to the Medicare Fee-For-Service claims systems. If chosen, volunteer testers must be able to submit future-dated claims and must provide valid National Provider Identifiers, Provider Transaction Access Numbers and beneficiary Health Insurance Claim Numbers that will be used in the test. Another opportunity for end-to-end testing will be available during the week of July 20 through July 24.


The U.S. Centers for Medicare and Medicaid Services (CMS) announced a two-week postponement on claims for medical services submitted in 2015 under the Medicare Physician Fee Schedule (MPFS) so it has time to remedy technical errors found after the 2015 MPFS' November publication and to process claims correctly. Medicare administrative contractors will hold claims containing services paid under the 2015 MPFS for the first two calendar weeks in January. CMS thinks the hold should minimally impact healthcare providers' cash because current law stipulates "clean" electronic claims cannot be paid sooner than 14 calendar days after the date they are received. The agency says claims for medical services made on or before Dec. 31, 2014, will not be affected by the hold.


The Centers for Medicare and Medicaid Services (CMS) reminded eligible practitioners (EPs) of the upcoming meaningful use attestation deadline for 2014 in a recent announcement. EPs have until 11:59 p.m. ET on Feb. 28, 2015 to attest to 2014 data through the CMS Attestation System. The announcement reminds EPs that Medicare-eligible professionals who fail to successfully demonstrate meaningful use in 2014 and fail to receive a 2016 hardship exception will be subject to payment adjustments beginning Jan. 1, 2016. The application period for hardships exceptions is open as of early January. This announcement comes just weeks after CMS announced that some 257,000 EPs would be subject to payment adjustments in 2015 for failing to demonstrate meaningful use in 2013. Those payment adjustments went into effect on Jan. 5. The previous CMS announcement contained instructions for how providers subject to payment adjustments can challenge CMS' decision. CMS will be taking those applications through the end of February.

Medicine, Drugs and Devices

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A team of researchers has discovered a new antibiotic that shows no detectable resistance. Discovered in a screen of uncultured bacteria, the antibiotic, named teixobactin, inhibits cell wall synthesis by binding to a highly conserved motif of lipid II and lipid III. The researchers report that they "did not obtain any mutants of Staphylococcus aureus or Mycobacterium tuberculosis that were resistant" to the antibiotic. The findings suggest a possible new approach to developing antibiotics that avoid resistance.


The U.S. Food and Drug Agency is transitioning its Mini-Sentinel pilot program into the full-scale Sentinel System. The pilot program assesses the safety of medical products and will not replace the agency's active surveillance system. "While protecting the identity of individual patients, we can get valuable information from Mini-Sentinel that helps us better understand potential safety issues and can share with you information on how to use medicines safely," said Janet Woodcock, director of the FDA Center for Drug Evaluation. "We have used Mini-Sentinel to explore many safety issues, helping FDA enhance our safety surveillance capabilities and giving us valuable input in decision-making on drugs and vaccines."


An increasing number of people are turning to prolotherapy to treat chronic joint and muscle pain. Despite limited evidence to support its efficacy, the treatment, which involves injections of a non-active substance, usually dextrose, aims to stimulate the body's natural healing response. During each treatment session, the substance is injected into sites where tendons and ligaments attach to bones, and thus have lower blood supplies. The American Association of Orthopaedic Medicine has voiced its support for prolotherapy in back pain; however, some physicians are hesitant, and the Centers for Medicare and Medicaid Services and the Veterans Administration have recommended against third-party compensation for the treatment.


A team of researchers has developed a computer algorithm using the software, OSPREY, which predicts the most likely mutations that a bug develops in response to a new drug before the drug is given to patients. The researchers programmed the algorithm to identify the genetic changes that Methicillin-resistant Staphylococcus aureus (MRSA) would need to undergo to become resistant to a new class of experimental drugs. When they exposed MRSA to the new drugs, they found some of the genetic changes the software predicted took place.