News From ACFAS

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Download the free ACFAS 2016 mobile app to your iPhone, iPad or Android device for instant access to session schedules, conference news alerts, convention center maps and more.

Get your free app through one of three ways:

1. Search your app store for ACFAS 2016 (iOS and Android).
2. On your mobile device Web browser, type:
    http://m.core-apps.com/acfas2016.
3. Visit acfas.org/austin for a link.

Watch for an email from ACFAS in early February with your login credentials for accessing your personalized schedule.
Register for ACFAS 2016 online before this Friday, Jan. 22 and save. After Jan. 22 you can still join us in Austin, but you must register onsite. To register in Austin, visit the registration desk in the Austin Convention Center starting at 1pm on Wednesday, Feb. 10.

ACFAS 2016 is already on track to be the largest Annual Scientific Conference ever! Don’t miss being a part of history with your colleagues while being immersed in all that ACFAS 2016 has to offer!
Meet and network with your Division officers and have a say in your Division's plans for the year by attending your Division meeting at ACFAS 2016 in Austin.

Division meetings are held during conference lunch breaks at reserved tables in the Exhibit Hall. A meeting schedule will be listed in your onsite conference brochure, on the ACFAS 2016 mobile app and on signage at the meeting.

All ACFAS members who attend their Division meetings will be placed in a drawing to win one of two Apple iPad Minis. Look for your raffle ticket in your registration packet.
Mark your calendars for ACFAS' new seminar, Practice Management and Coding for the Foot and Ankle Surgeon, set for July 8–9 in Denver and Oct. 21–22 in Chicago.

Interactive case-based sessions will teach you how to properly code for procedures you already perform.

Stay tuned for further details on this new seminar or contact Sarah Nichelson, ACFAS director of Health Policy, Practice Management and Research, for more information.

Foot and Ankle Surgery

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Using a close contact casting (CCC) method to treat unstable ankle fractures can result in outcomes similar to those found in open reduction and internal fixation (ORIF) in elderly patients, according to new research. The process can also save money, according to lead author Prof. Keith Willett. His team analyzed 620 patients with unstable malleolar fractures over 60 years of age. They were assigned to either CCC or ORIF and observed after six months. Results indicated that CCC had equivalent functional outcomes, while costing about $2,000 less than ORIF. Adverse effects were far more common in the ORIF group. Another significant difference was that most patients in the CCC group required a cast change. The process requires the cast to remain in "intimate" contact with the skin at all times.


A study was conducted to investigate the occurence of second metatarsal transfer lesions following a distal chevron metatarsal osteotomy (DCMO). Researchers analyzed 185 feet after DCMO. They measured the first metatarsal bone, which can shorten after the procedure, relative to the second metatarsal, using Morton’s and Hardy-Clapham’s methods. Five of the 185 feet developed second metatarsal transfer lesions and 24 of these were improved postoperatively. The median shortening of the first metatarsal bone after DCMO was 0.6 mm according to Morton’s method, and 1.9 according to Hardy-Clapham’s method. There was no difference in shortening of the first metatarsal bone between those with and without lesions, as measured by either method.

Practice Management

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About 46 percent of physicians say they experience burnout, according to a 2015 Medscape report. This can take a toll on health and quality of life, as well as your patients' experiences. Here are five signs that you may be suffering from burnout:

1. You are tired all the time. Sleep deprivation can hamper all facets of life, especially your job. But loss of sleep is not the only thing to be aware of. If you feel tired despite getting eight hours, you could be suffering from burnout.
2. You are acting like a jerk. If you start to notice that you are getting into conflict more often, burnout may be to blame. If you are not sure how people think about you, ask questions.
3. You feel like you are stuck. Keep your eye on the next opportunity or milestone in your career. This will help you stay engaged and motivated.
4. You are not as good at your job. If you find you are giving your patients less attention, take a step back. Burnout may be the reason for your inefficiency.
5. Your job is all you think about. If you are never able to turn off your brain when it comes to your job, even when you are at home, you could have a burnout problem. This is especially important to fix because continuing this mindset only makes the effects of burnout worse.

Almost half of all practices polled in a recent Physicians Practice survey reported having no problems at all with the ICD-10 transition and that their rate of claims was proceeding as usual. A quarter of respondents said the transition had gone "so-so," 14.5 percent said it was "miserable" and 12.5 percent said it was "too early to tell." The biggest challenge was training staff and physicians on the new codes, with 38.5 percent of practices saying the codes were often cumbersome. Around 53 percent said the transition had no impact on workflow but that this was because proper training and preparation had been done months in advance. Finally, almost 60 percent said that the 2014 delay to ICD-10 was unnecessary due to proper preparation.


Large, independent, physician-owned primary care groups are a viable alternative to hospital employment, according to a study published in the Annals of Family Medicine. Researchers studied five primary care physician (PCP) groups, interviewing group leaders and surveying randomly selected physicians. They found that PCP groups can offer imaging, laboratory services, health information technology and quality improvement infrastructure without sacrificing the autonomy and convenience that many physicians associate with the ideal practice environment. Eighty-one percent of physicians in PCP groups, which averaged 148 members per group, reported being somewhat or very satisfied with their medical careers. The biggest complaint was the challenge that came with balancing work and life. In addition, the report indicated that PCP groups often lack the financial means to support infrastructure growth. But the biggest advantage may be cost. Primary care costs are only five percent of healthcare costs, according to the report, meaning that PCP groups can focus on controlling the other 95 percent during negotiations without conflicting incentives.

Health Policy and Reimbursement

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More than 50 hospitals across the country filed a lawsuit against the U.S. Department of Health and Human Services (HHS) over cuts to inpatient service compensation mandated under the two-midnight rule. The agency expects the 0.2 percent cuts to offset the estimated $220 million per year in additional costs. Hospitals and hospital associations called the rule "arbitrary and capricious," and the lawsuit represents at least the fourth attempt to bring the issue to light in court. In a separate case in September, a federal judge ruled that the HHS secretary must provide better justification for the cut and reopen that aspect of the two-midnight rule to public comment. HHS stood by the cuts, but the hospitals continue to bring forth lawsuits, showing no signs of backing down. Even if the court ultimately vacates the regulation, there is no guarantee that it will apply to all hospitals. This is why many hospitals are piggybacking on the lawsuit trend, trying to protect themselves. The Centers for Medicare and Medicaid Services must accept comments and publish another notice by March 18.


The meaningful use program may end in 2016, according to Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services (CMS). The controversial program will be "replaced with something better," Slavitt noted in a Twitter post. The announcement comes just months after CMS touted Stage 3 as "what everybody will be doing" by 2018 and into the future. Stage 3 implementation was widely criticized by organizations claiming that Stage 2 had changed too much too fast and was not ready to be finalized. Many associations said that Stage 3 made many of the same mistakes Stage 2 made, and changes needed to occur. Ultimately, Slavitt said the goal of changing directions is to "get the hearts and minds of physicians back."


A debate currently at the heart of medicine in the United States involves doctors who expect deference and freedom at a time when the imperative to increase hospital efficiency is more prominent than ever. The core issue is the outsourcing of hospitalists, a practice that has become more common over the last several years. In many cases, mass numbers of hospitalists at a given organization can be outsourced to a new employer, a clear sign of trying to advance the efficiency agenda. While many doctors are in favor of efficiency gains, some bemoan the loss of professional judgement, something that doctors around the country rely on to connect with and correctly diagnose their patients. In Oregon, the issue came to a head after an outsourcing announcement: the staff called to unionize and affiliated themselves with the American Federation of Teachers. While a third of the group of 36 were outsourced, the union strategy worked and the company looking to outsource gave up on the effort. This does not mean that larger organizations looking to outsource jobs now have multiple insurrections on their hands. It simply means that the option is there should the hospital in question feel the need to address it. And it puts into perspective the divisive issue at hand, where doctors feel that having their discretion stepped on in the name of efficiency may be going too far.


The Obama administration announced the newest participants in Medicare's accountable care programs, which went live at the beginning of this month. The Next Generation ACO program is the most anticipated of these, comprised of 21 organizations and companies. The Centers for Medicare and Medicaid Services describe the Next Generation ACO model as "a new opportunity in accountable care" that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care and aims to attain the highest quality standards of care. The program is an important part of the government's desire to move Medicare away from the current fee-for-service payment system and move toward a value-based service that is patient-centered. By the end of this year, the U.S. Department of Health and Human Services wants 30 percent of all traditional Medicare payments to come from ACOs, bundled payments or other alternative payment models.


The U.S. Department of Health and Human Services has issued guidance for people to understand their rights to access their health information under HIPAA. This information is distributed in "record sets," which must fall under three characteristics:

1. Medical and billing records about individuals maintained by or for a covered healthcare provider.
2. Enrollment, payment, claims adjudication and case or medical management record systems maintained by or for a health plan.
3. Other records that are used in some way by or for the covered entity to make decisions about individuals.

Psychotherapy notes and information for use in a civil, criminal or administrative motion are not grouped under the right-to-access guidelines.

Medicine, Drugs and Devices

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Drugmakers have not let up on price increases with the start of a new year, despite mounting criticisms of prescription costs in the United States. Pfizer, Amgen, Allergan, Horizon Pharma and others have raised U.S. prices for dozens of branded drugs since late December, with many of the increases between 9 percent and 10 percent. Since New Year’s Day, Pfizer has raised list prices an average of 10.6 percent for more than 60 branded products with annual U.S. sales of at least $10 million. Prices for eight of the products increased by at least 20 percent. Politicians, healthcare payers, doctors and patients have criticized drug pricing in recent months, saying medicines are out of reach for many patients and straining healthcare budgets. U.S. prescription drug spending rose 12.2 percent in 2014, accelerating from 2.4 percent growth in 2013, the Centers for Medicare and Medicaid Services said last month. Presidential candidates Hillary Clinton, Bernie Sanders and Marco Rubio have attacked drug prices and proposed various measures to rein them in.


The company that makes 85 percent of the duodenoscopes used in the United States knew that their scopes could transmit bacteria even after thorough cleaning, a yearlong Senate investigation has found. Senator Patty Murray (D-WA) found that Olympus' duodenoscopes were linked to at least 250 cases of antibiotic-resistant infections worldwide from 2012 to 2015. Manufacturers are supposed to report to the U.S. Food and Drug Administration (FDA) within 30 days of learning of a device's potential to cause death or serious injury. Olympus, a company based in Japan, is still held to these standards. The company did not inform American hospitals or FDA until February 2015, the report said. The report also recommended that FDA quickly evaluate duodenoscope design and make a call for modification. In addition, it urged Congress to fund a national medical device evaluation system to better monitor device safety.