News From ACFAS

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Cap off an incredible three days of learning and networking with the Wrap Party for the ACFAS 75^th Anniversary Scientific Conference on March 1 at 6:30pm in Las Vegas’s famous LINQ entertainment promenade in the heart of the Strip. Enjoy a cocktail while taking a spin on the High Roller, the world’s tallest observation wheel, or improve your bowling average at Brooklyn Bowl amid live music, dancing, adult beverages and gourmet comfort food. This is also the place to pick up your special 75^th Anniversary socks!

Wrap party tickets are $40 per person, and families are invited. Just register for ACFAS 75, then select your ticket quantity. We look forward to celebrating 75 years of ACFAS history with you! $95 is your rate if you’re staying at Treasure Island during the 75^th Anniversary Scientific Conference February 27–March 2 in Las Vegas next month—it's been lowered from $109 to $95 per night! onPeak, the College’s official housing partner, continually monitors other booking channels and renegotiates to ensure you always receive the best price.

Rooms are still available at Treasure Island. If you haven’t reserved your room yet, visit acfas.org/vegas to book with onPeak at the new reduced rate. All residency directors, codirectors, faculty and administrators are invited to attend the fourth annual Residency Directors Forum, hosted by ACFAS and the Council of Teaching Hospitals (COTH). The forum will take place on Sunday, February 26 at The Mirage in Las Vegas the day before the ACFAS 75^th Anniversary Scientific Conference officially begins.

This year's forum is filled with take-home information to help build on every residency program’s foundation. Sessions will include:

• Alphabet Soup: What’s New from AACPM, COTH and CPME
• PRR 2.0: Clearing the Logjam
• All Aboard: Hear the Latest from the Boards Themselves
• Risky Business: Unsocial Media
• Assessments: Room for Improvement
• It’s Your Turn: Point-Counterpoint Discussion
• Open Forum/Cocktail Hour

This invitation-only event is complimentary for residency program directors and up to one other program representative.

Download the registration form at acfas.org/rdc and submit it to Michelle Kennedy by February 10, 2017. Register early since space is limited. Please note there is no onsite registration. Learn more about ACFAS activities and events close to home by attending your ACFAS Division meeting during the 75^th Anniversary Scientific Conference February 27–March 2 at The Mirage in Las Vegas.

All Division meetings are held during conference lunch breaks at reserved tables in the Exhibit Hall. A complete meetings schedule will be included in the ACFAS 75 mobile app, in the conference program and on signage at the meeting. Division meeting dates and times are also available on acfas.org.

All ACFAS members who attend their Division meetings will be placed in a drawing to win one of four $250 AMEX gift cards. Look for your raffle ticket in your registration packet. ACFAS’ 14 Regional Divisions are once again providing financial support to poster and manuscript presenters at the 75^th Anniversary Scientific Conference February 27–March 2 at The Mirage in Las Vegas. This year, they are supporting both residents and postgraduate fellows who are within their geographies.

Individual poster presenters who meet all requirements will receive $250 in support, and resident manuscript presenters will receive $500. To claim their funds, residents and postgraduate fellows need to submit an application to their Division, have their research accepted for presentation at the conference, attend the conference and also attend their Division’s membership meeting during the event.

Each Division is setting its own individual budget to determine how many awards it can provide this year.

Foot and Ankle Surgery

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Recent imaging of the Achilles tendon revealed nonuniform displacement patterns that may result from complex architecture and musculotendon interactions. To better understand which features of the Achilles cause the observed deformations, researchers used computational modeling to examine the effects of tendon twisting, intratendon sliding, retrocalcaneal insertion and differential muscle forces on tendon deformation. Intratendon sliding and differential muscle forces were the factors contributing most significantly to displacement nonuniformity between tendon regions. Elimination of intratendon sliding or muscle forces reduced nonuniformity by 96 percent and 85 percent, respectively. Elimination of tendon twist and retrocalcaneal insertion reduced nonuniformity by 35 percent and three percent.


A study compared the postoperative height of the second metatarsal head relative to the first metatarsal head among three osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy and distal chevron metatarsal osteotomy (DCMO). Researchers reviewed the axial radiographs and clinical findings of patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy or DCMO. There was significant postoperative change in the second metatarsal height on radiographs in all groups, greatest in the PCMO group (vs scarf: P = 0.013; vs DCMO: P = 0.008).


Several meta-analyses have been performed comparing early functional rehabilitation and traditional immobilization following surgical Achilles tendon repair after acute rupture. A new systematic review compiled six meta-analyses to determine the optimal postoperative rehabilitation strategy. Researchers assessed methodological quality by applying the Assessment of Multiple Systematic Reviews (AMSTAR) instrument and Jadad decision algorithm. AMSTAR scores ranged from six to ten. A meta-analysis with a greater number of randomized controlled trials was selected for closer examination. This meta-analysis showed that early functional rehabilitation was superior to cast immobilization in regards to patient satisfaction and return to premorbid sporting levels. There were no differences in terms of major complications or time before return to employment and sporting activity.

Practice Management

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Health and Human Services Inspector General Daniel Levinson last year announced the release of new guidelines for handling improper coding and overpayments and indicated increased compliance enforcement could be imminent. Levinson emphasized that practices should have active compliance plans to correct, train on and implement coding practices. Rules and regulations change annually, so it is important for staff to undergo on-site coding workshops and to gain a complete understanding of compliance issues and code changes. The evaluation and management coding practices of all physicians should be reviewed to ensure they are aligned with state and national standards. Conversations may need to be conducted with physicians who need to improve their coding or documentation. Many practices outsource tasks to collection agencies or external auditors and accountants, but the practice is ultimately responsible for claims. Thus, practices should have up-to-date business associate agreements with every vendor who handles protected health information. Practices must regularly evaluate the quality of their vendors' work and confirm that they have insurance to cover errors.


The requirements for the Medicare Access and CHIP Reauthorization Act (MACRA) reflect a larger shift in the industry toward value-based care, putting revenue at risk for practices that have not adapted. Regardless of a practice’s progress in preparing for MACRA and value-based care, physicians should look to take the next step, whether it means installing an electronic health record system or moving from Medicare shared savings track one to track two, as these investments can pay off over time. Katie Fellin, a senior manager at ECG Management Consultants, suggests providers report at least the minimum amount of data required for MACRA in 2017, select quality measures they can track and adopt a care delivery model that supports the transition to value-based care. Physicians can look to a program, such as the Transforming Clinical Practice Initiative, which offers expert advice on how to implement quality measures. As the healthcare industry consolidates, experts warn that small practices may lose their ability to negotiate their own rates. However, physicians are in the best position to control costs while providing quality care. “If you, as the physician, can make yourself valuable to the networks you are participating in and bring value, that’s how you will do well,” says David Manko of the Health Services Practice Group in Long Island, New York. “When you have practices that are high performers when it comes to value-based contracting, they become more valuable to the networks they participate in.”


Physicians are increasingly leveraging social media platforms, such as Twitter, to exchange information with their fellow practitioners, connect with patients and spread public health messages. Patients benefit from physicians’ use of social media, enjoying increased access to health information and a closer doctor-patient relationship. In 2016, an Augustana University student research team tracked more than three million tweets posted by English-speaking physicians, examining how physicians are using social media engagement practices to communicate with communities. Nearly 60 percent of physicians tweeted original content, while 43 percent retweeted content posted by others. The most commonly used hashtag among physicians was #Meded, referring to Twitter discussions of medical education issues. Researchers found that physicians of all ages use Twitter, with ages ranging from under 30 to 79. Pediatricians, chiropractors, dentists and optometrists use Twitter most often to reach their specific audiences. Most doctors tweet in the afternoon, but physicians enjoy the most engagement with followers when they tweet early in the morning or late at night. However, surgeons routinely tweet from 8am to 3pm, with the most engagement from 4am to 8am.

Health Policy and Reimbursement

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Senate Republicans have launched their effort to repeal and replace President Barack Obama's landmark healthcare program, approving a budget blueprint that they have dubbed the Affordable Care Act (ACA) "repeal resolution." The Senate voted 51-48 along party lines in favor of the measure, which depends on the same budget process used seven years ago to approve the historic healthcare law to now attempt to dismantle it. Kentucky Sen. Rand Paul, one of the most vocal Republican opponents of voting on a repeal bill before coming up with a replacement package, voted against the budget resolution. Democrats who are against repealing the ACA staged a protest during the vote, breaking with procedural rules by attempting to orally dedicate their votes to people they say would be harmed by repealing Obamacare.


President-Elect Donald Trump’s push on congressional Republicans to repeal and replace the Affordable Care Act (ACA) at the same time could slow down party leaders’ efforts to quickly overturn key parts of the law. Some Republican leaders have indicated they would prefer to move rapidly on the first steps of a repeal measure and take more time to craft a replacement, while others worry that rolling back the law without a replacement could trigger a collapse in the insurance market. Although congressional Republicans could introduce legislation repealing much of the ACA as early as January 27 and pass it with a simple majority vote, legislation to establish a new healthcare system would require 60 votes and Democratic support. A group of Republican senators introduced a measure pushing the deadline for repeal legislation to March 3 to give lawmakers more time to come up with a replacement.


Nuna, a San Francisco start-up, has developed a cloud-based database to help the federal government aggregate and analyze Medicaid data. As healthcare shifts from the fee-for-service model to value-based care, detailed and reliable data is critical for measuring outcomes and determining best practices. Traditional health data repositories are complex and time-consuming to maneuver, and people must be trained to use them. The new technology, however, is flexible, interactive and allows for real-time monitoring of diseases and billing patterns across disparate computer systems. The database of the country’s 74 million Medicaid patients could inform future debates on Medicaid spending. “This kind of data can help move healthcare policy from a partisan ideological debate to one informed by knowing who the people affected are and what will likely happen to Medicaid recipients,” says Drew Altman, president of the Henry J. Kaiser Family Foundation.

Medicine, Drugs and Devices

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Electronic health records could be used to collect and compile detailed health data from a wide range of sources, including genetic testing and patient questionnaires, to help shape an individual’s treatment and advance medical research. Kaiser Permanente’s Dr. Tracey Lieu has been working on a system that pulls relevant data about specific diseases that patients in the past have been treated for, providing current patients with information on the quality of life and other outcomes associated with certain treatment choices. Currently, getting that level of detail is a challenge, because it requires patients to fill out lengthy surveys. Gene scan integration is also a promising concept, as genetic testing becomes less expensive and more widely available. Gene scans stored in the electronic medical record could individualize patient care, but doctors are often unable to interpret most of the genetic results. Just 3.5 percent of patients studied by the Geisinger Health System had tests that produced easy-to-interpret and actionable results.


The American Diabetes Association’s (ADA) most recent guidelines revise neuropathy recommendations last published in 2004. The document, published in Diabetes Care, addresses prevention and management of distal symmetric polyneuropathy, diabetic autonomic neuropathies, including cardiovascular autonomic neuropathy, and other forms of neuropathy. According to the authors, electrophysiologic testing or referral to a neurologist is rarely needed to diagnose neuropathy. For treating neuropathic pain, the report advises pregabalin or duloxetine as first-line treatments. Opioids are advised only for patients with severe pain who have not responded to other treatment options. The document does not give any recommendation for disease-modifying treatments, as none are approved by the U.S. Food and Drug Administration.


A study published in Nature Chemical Biology describes an efficient way to produce artificial spider silk, which scientists believe could be used for biomedical applications, such as repairing wounds and controlling bleeding. The complexity and size of the proteins used by spiders to spin silk has presented challenges for scientists attempting to replicate the natural process for mass production. The new method involves the creation of a bioengineered hybrid protein from two different spider species and a device that mimics the silk duct of a spider. One liter of the new silk solution can produce a kilometer of spider silk, according to the study. However, the spinning process is slow and would need to be scaled up if production was to be commercially viable.