News From ACFAS

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Hotel rooms are filling quickly, but our recently-lowered hotel rates are staying in place for a couple more weeks. Book your hotel room online with OnPeak to receive hotel discounts, a simple online tool to make your plans, and dedicated staff to ensure your trip goes smoothly. You can also phone toll-free by calling OnPeak directly at 800-950-5542. Hotel rates at Mandalay Bay are only $95 per night, and THE Hotel at Mandalay Bay – only $125 per night! If you plan on attending the ACFAS 2013 Annual Scientific Conference, but have not yet booked your hotel room, ACFAS encourages you to get in touch with OnPeak before February 1.

If you haven’t yet done so, register now until January 25 for the Annual Scientific Conference February 11-14, 2013 in Las Vegas! Visit acfas.org/vegas to view sessions and speakers. Make the best of your time in Vegas and attend one of the pre-conference workshops on February 10.

Visit acfas.org/vegas at any time to register or to find more information. You don’t want to miss these great rates and all ACFAS 2013 has to offer. Keep in touch with your existing patients and help promote your practice to new patients with the latest edition of FootNotes, the free, customizable patient education newsletter provided by ACFAS and reviewed by your peers. Access the winter edition at acfas.org/footnotes or by clicking on the web link below (login is required).

The articles featured in this edition are:

• Keep Your Dancing Feet Happy
• Heed Caution to Kids' Heel Pain
• Start the New Year with Healthy Feet

As an ACFAS Member, you have access to lower prices on medical & surgical supplies, pharmaceuticals, and equipment through ACFAS’s Benefits Partner, Henry Schein Foot and Ankle. Henry Schein can provide immediate access to a group purchasing contract which passes along volume pricing to all ACFAS members. When these savings are combined with a high level of service, same day shipping, wide breadth of products, and a dedication to the podiatric profession, Henry Schein is a valuable partner to your success. They offer a free cost savings analysis with your current supplies.

To take advantage of this partnership and for your free analysis please call 800-323-5110 or email ryan.crothers@henryschein.com.

Foot and Ankle Surgery

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Researchers assessed the effectiveness of arthrorisis with calcaneostop screw to treat flatfoot in children, with particular emphasis on correction of Talo-First Metatarsal-Index (TMT-Index) and clinical results including pedographic evaluation. A clinical follow-up study included all patients treated with the procedure between Sept. 1, 2006, and Aug. 31, 2009. One foot was operated at a time, and surgery was administered to the contralateral foot three months later if indicated. Fifteen kilograms partial weight-bearing was conducted for six weeks, post-surgery, and the screws were taken out after a follow-up period of two years. Assessment was carried out prior to surgery, at two-year follow-up and at 2.5-year follow-up. The evaluation involved staging of posterior tibialis insufficiency, radiographs with full weight bearing (TMT-Index), pedography and Visual Analog Scale Foot and Ankle (VAS FA). The study included 18 patients and 31 feet, and no complications were seen. The parameters posterior tibialis insufficiency stage, percentage of increased pedographic midfoot contact area and force were decreased in comparison with the preoperative parameters. TMT dorsoplantar/lateral/index and VAS FA scores were higher at both follow-ups, and no differences in parameters were observed between follow-ups.


Researchers studied the results of flexor hallucis longus tendon transfer in treatment of insertional or midsubstance Achilles tendinosis in 58 consecutive limbs in 56 consecutive older, sedentary patients, 10 of whom were lost to follow-up. The researchers saw substantial improvement between baseline and 24 months in terms of the Visual Analog Scale for overall pain intensity, the Short Form-36 physical score, the Ankle Osteoarthritis Scale pain and dysfunction subscale scores and execution of a single-leg heel rise. Significant improvement versus baseline was seen at three or six months in all scores apart from the single-leg heel rise. Improvements in terms of pain and function occurred over 24 months, with maximum improvement transpiring in the first 12 months.

Maximum gastrocnemius circumference was significantly less in the involved compared with the uninvolved leg at 24 months, while the average mean passive range of motion of the first metatarsophalangeal joint decreased from 85.1 degrees plus or minus 25.3 degrees preoperatively to 68.1 degrees plus or minus 36.7 degrees at six months. Most patients disclosed no hallux weakness and no loss of balance on account of hallux weakness. Postoperative peroneal tendinitis was exhibited in seven patients. Among the observed complications were deep-vein thrombosis, superficial infection or delayed wound-healing, scar pain and early disruption of the reconstruction due to a fall.


Researchers compared the effectiveness of iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL), T2-weighted fast spin-echo (FSE) and spoiled gradient-echo (SPGR) MR imaging to frequency selective fat suppression (FSFS) protocols for minimizing metallic artifacts in postoperative ankles with metallic hardware. The T2-weighted and SPGR imaging with IDEAL and FSFS were performed on 21 ankles of 21 patients with metallic hardware. IDEAL T2-weighted FSE and SPGR images enabled significantly improved visualization of articular cartilage (p<0.05), the size of metallic artifact (p<0.05), and the uniformity of fat saturation (p<0.05). However, no significant improvement was found in the visibility of ligaments.

Practice Management

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A new study published in Health Affairs suggests that technical assistance might be crucial to achieving quality improvements from the use of electronic health record (EHR) systems among small-practice physicians and those working in underserved areas. The study determined that EHR deployment by itself was insufficient to enhance the quality of care provided by the primary care physicians studied, while physicians receiving aid from the New York City Health Department's Primary Care Information Project ranked higher on selected quality measures than those not getting aid. The project supplied subsidized EHR software, clinical-decision support and onsite technical assistance to some 3,300 physicians at approximately 600 primary care practices. The study's outcomes may be helpful to federal regional extension centers tasked with helping providers adopt EHRs as the centers decide how and where to apportion resources, according to Weill Cornell Medical College Professor Andrew Ryan.


Keeping stable cash flow and managing the coming and going of your money is critical for managers looking to keep their practice afloat, especially in the event of a cash crisis arising from things like halted Medicare payments, unexpected purchases or delayed patient payments. Getting control of your cash flow means first establishing a budget. This can be accomplished by setting up a calendar with the past six months of major payments and expenses marked on it, including things like rent, salaries, utilities and insurance. This will allow you to estimate your expected expenses for the coming months and get a better view of where your practice is financially.

Once you have a budget established, it is time to try and save money. You can try to save money on bills by negotiating with vendors for discounts for early payments. You can also set up an inventory control system to streamline restocking procedures so that you only order what you need when you need it. And when ordering items for your practice, make sure your supplier is giving you a competitive price. Preparing for the unexpected is also important. You should have a reserve fund set up in the event of an emergency, either created with funds from your own paychecks or through a line of credit.

Keeping cash coming into the practice is as important as spending thriftily, and in order to do this you must make sure patients are responsible for paying their bills. Front office staff should be trained to constantly remind patients of upcoming or past-due payments, and you should avoid mailing out bills to patients because it usually just amounts to wasted time and resources when the patient simply ignores the bill. Establishing a method of online payment using credit cards and debit cards will help facilitate payments, especially among younger patients. Lastly, you should make sure the insurance companies who you work with are using correct coding and documentation so that you receive the entirety of your payments.


With the full implementation of the Affordable Care Act on the horizon, it is time for physicians to streamline their operations to make sure they are functioning in the most efficient way possible. Setting aside about five hours a week to take a step back and analyze your practice can help you trim unnecessary staff and functions and consolidate tasks to make for a more effective and profitable practice. Within these five hours you can look at your yearly business plan to make sure it still adequately applies to your practice, and if not then you can adjust it to better accommodate the goals and standards of your company. You can also analyze staff skill sets and positions to make sure each staff member is doing the job they are best suited for, thus keeping them energized, alert and motivated.

Another key aspect to look at is your marketing strategy, including looking over reviews of your office to see what you are doing right or what might need improvement. This time can also be taken to look over your computer systems to make sure they are all operating correctly and efficiently. Broken computers or systems running sluggishly because of poor maintenance can impact employees' abilities to do their jobs efficiently. Hiring an IT expert to fine tune the systems can save money and grief in the long-term.

Some of that time can also be set aside to clean up around your practice, particularly the bathroom. An unkempt workplace can negatively influence how patients feel about how sanitary your practice is, possibly driving them away if they feel it is too dirty. This time should also be used to take a look at your accounts receivable to make sure any adjustments that need to be made are being made. You should pay particular attention to possible errors that might prevent you from receiving payment, fix these errors as quickly as possible and then safeguard against similar errors being made in the future. Setting some time aside will also allow you to analyze which staff members are doing exemplary service and are deserving of reward or promotion. A staff member of particular note could be promoted to office manager to help you with these aforementioned tasks.

Health Policy and Reimbursement

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U.S. Rep. Mike Thompson (D-Calif.) plans to reintroduce legislation that will open up Medicare and Medicaid to telehealth services. In the last days of 2012, Thompson introduced the Telehealth Promotion Act of 2012, but the bill failed to gain traction, much like similar legislation Thompson submitted in 2009. The act eliminates federal exclusions of telehealth services and includes a number of other measures, such as a provision allowing healthcare providers licensed to operate in their home state the ability to offer telehealth services across the country. The bill also allows for telemedicine to be considered the equivalent of in-person care.


Medicare nearly doubled the size of one accountable care program as of Jan. 1 with 106 new accountable care organization (ACO) contracts that offer hospitals and doctors financial incentives to improve quality and slow health spending. The Centers for Medicare & Medicaid Services (CMS) announced its latest and largest round of ACOs under the Medicare shared-savings program, which launched in April last year with 27 ACOs. Another 89 ACOs were named to the program last July. The Center for Medicare and Medicaid Innovation separately launched 32 Medicare ACOs known as Pioneers roughly one year ago.


The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services has announced that it will not enforce operating rules under HIPAA until April 2013. Provisions in the Patient Protection and Affordable Care Act required the adoption of a single set of operating rules for each HIPAA transaction standard to improve its utility and reduce administrative costs. The operating rules — intended to make the application of the HIPAA standards more consistent and efficient — took effect Jan. 1 for HIPAA-covered entities.

According to the release, HHS is delaying enforcement action to reduce the potential disruption to the healthcare industry. However, if an entity is the subject of a complaint, it will be required to provide evidence of its compliance or a good faith effort to become compliant before April.


A three-year "medical neighborhood" demonstration project using health information technology to identify high-risk patients and coordinate their care is getting started, paid for with a $20.75 million grant from the Center for Medicare and Medicaid Innovation. The center expects it will see more than $53.8 million in savings from the participating 15 healthcare organizations. The grant was awarded in June and will cover services provided by TransforMED, a medical-home consulting service owned by the American Academy of Family Physicians; VHA, an Irving, Texas-based national network of not-for-profit healthcare organizations; and Phytel, a Dallas-based provider of population health-management tools. The organizations will help as many as six primary-care practices in participating communities transition to the patient-centered medical-home model, which emphasizes coordinated care, increased care access and continuous quality improvement. The intent then is to connect the practices with other providers in the communities to create a medical neighborhood network.

Medicine, Drugs and Devices

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Concerns have been raised by some that the ease with which information can be copied and pasted between electronic medical records might be causing medical records to become more disjointed and confusing. In a new study published in Critical Care Medicine, researchers from Case Western Reserve University School of Medicine attempted to evaluate to what extent electronic medical records were subject to copying and pasting of old, possibly inaccurate, information. The researchers used plagiarism-detecting software to examine the patient progress reports for 135 patients that were generated over a five month period by 62 residents and 11 attending physicians in the intensive care unit of a hospital in Cleveland, Ohio. The researchers found that 20 percent or more of the material in 82 percent of the notes submitted by residents and 74 percent of those submitted by attending physicians was information that had been copied and pasted from previous records. The researchers did not attempt to assess the motivations for this copying and pasting or its potential outcomes, but the study does cite one case in which copied and pasted information rendered a patient's records so indecipherable that doctors had to contact the diagnosing physician to have the records clarified.


A survey by the Mongan Institute for Health Policy examined the factors that play a role in a doctor's decision to prescribe a brand-name drug over a generic one. The survey, the results of which were published in the online edition of JAMA Internal Medicine, found that roughly 40 percent of physicians will at least sometimes give into their patients' requests for brand-name drugs instead of trying to persuade them to try a generic version. The survey also found that doctors were even more inclined to prescribe a brand-name drug instead of a generic when they receive drug samples and hold meetings with pharmaceutical company representatives. The authors of a report on the survey said that the costs associated with prescribing brand-name drugs instead of generics is adding a substantial amount of "unnecessary costs" to the nation's healthcare system.


According to a new study, central line-associated bloodstream infections (CLABSI) dropped by 52 percent when an alcohol-impregnated disinfection cap was used instead of standard scrubbing protocol. Researchers also assessed the cost-effectiveness of the cap and concluded that its use resulted in net cost savings. The study was undertaken because the standard protocol for manually disinfecting connector hubs, called "scrub the hub," often fails because time-pressed nurses are not always able to properly scrub IV connectors with alcohol. The "scrub the hub" method of manual disinfection, with its inherent challenges, is often cited as a potential cause when a hospital's CLABSI rate is high. The study was published in the January 2013 issue of the American Journal of Infection Control.