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January 22, 2014

News From ACFAS


ACFAS 2014: Register Today
Don’t miss out on your opportunity to have full access to all that ACFAS 2014 has to offer in Orlando, including premier clinical sessions and debates, The HUB, the latest research, valuable hallway dialogue and the largest network of your peers all in one place. The conference runs February 27-March 2 at the Gaylord Palms Resort and Convention Center in Orlando.

It’s easy to register and only takes a few minutes by visiting acfas.org/Orlando. Here you find all the information you’ll need to register, see the complete listing of sessions and events, or book your hotel. Have questions? ACFAS’ Education Department is available to help answer any questions you many have.
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ACFAS Complimentary Webinar: Maximizing your Membership
Attention new ACFAS members: Want to get the most out of your ACFAS Membership? Mark your calendars for the brief, complimentary webinar Maximizing your ACFAS Membership set for Thursday, January 30, 2014 at 8pm CST, to help answer the many questions you may have regarding your new membership in ACFAS.

Want to know how to access the ACFAS website and what’s there for you? Want to know how to properly market yourself as a member of the College with your new credentials? Join Russell Carlson, DPM, AACFAS, member of the ACFAS Membership Committee, and Michelle Butterworth, DPM, FACFAS, ACFAS Past President, as they go through these and many other questions new members have and explain how to take advantage of all that ACFAS has to offer. After the webinar, there will also be time for Q&A.

To register for the free 30-minute webinar, visit http://eo2.commpartners.com/users/acfas/.
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Make Your Social Connection at ACFAS 2014
Come for the education and stay for the networking and extra-curricular activities at the Annual Scientific Conference in Orlando! While the conference is known for its premier educational opportunities, there’s always some extra fun thrown in for attendees to enjoy and network with their colleagues from all over the globe.

To kick off the four-day event be sure to make plans to attend ACFAS’ Thursday evening event, The Premier Connection, to meet and greet colleagues while enjoying a sampling of great food and drink. Students and residents can also meet their professional peers at the Resident and Student Networking Hour earlier that evening. And to close the event, don’t miss the Wrap Party at Cuba Libre where you’ll be transported to Havana, Cuba in the ‘50s to enjoy the splendor of Old Havana with an evening of hors d’oeuvres, cocktails, Interactive Mojito Stations, photo booths and iPad Caricatures and much more!

Make plans to also attend the many other satellite programs hosted by industry partners throughout the conference, starting with a Wednesday evening event hosted by BME to get things started. Aminox Medical and Wright Medical Biologics Division are both holding breakfasts for attendees on Friday morning and Stryker Foot and Ankle has an invite only event for Friday evening as well. Plus, many reunion events will be taking place throughout the conference.

For the full schedule and to register for the Annual Scientific Conference or buy a ticket for the Wrap Party at Cuba Libre, visit acfas.org/Orlando.
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Foot and Ankle Surgery


Effect of Supramalleolar Osteotomy and Total Ankle Replacement on Talar Position in the Varus Osteoarthritic Ankle
A new study has found that total ankle replacement (TAR) is better than supramalleolar osteotomy (SMOT) at radiographically restoring hindfoot geometry in the neutral position. Orthopaedic surgeons examined 104 varus-tilted ankles, 52 of which were treated with SMOT and 52 of which were treated with TAR. Surgeons analyzed weight-bearing radiographs both before and after the operation in order to measure the talar position in all three planes, including the talar tilt angle (TT), the sagittal talocalcaneal inclination angle (TCI), and the talometatarsal 1 angle (TMT1). The analysis showed that TAR corrected the talar position in all three planes. TT was not fully corrected in ankles treated with SMOT, and TMI1 was unchanged in these ankles.

From the article of the same title
Foot & Ankle International (01/14) Colin, Fabrice; Bolliger, Lilianna; Lang, Tamara Horn; et al.
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Survivorship of Bipolar Fresh Total Osteochondral Ankle Allograft
A new study has concluded that bipolar fresh total osteochondral allograft (BFTOA) could be a viable alternative to arthrodesis and prosthetic replacement in treating severe post-traumatic ankle arthritis. The 26 patients who participated in the study underwent BFTOA that was performed using a direct anterior approach and allografts prepared with the help of specifically-designed jigs. Postoperative clinical and radiographic evaluations were performed at two, four, six, and 12 months, and at an average 40.9 ± 14.1 months of follow-up. Surgeons observed improvements in American Orthopaedic Foot and Ankle Society (AOFAS) scores from 26.6 ± 6 before surgery to 77.8 ± 8.7 after a mean follow-up of 40.9 ± 14.1 months. However, six failures occurred. Joint degeneration, meanwhile, was classified as two in 12 patients and as three in 14 others. Nevertheless, the surgeons concluded that BFTOA was a viable option for the treatment of severe post-traumatic ankle arthritis thanks to the precise allograft sizing, stable fitting and fixation, and delayed-weight bearing the procedure offers.

From the article of the same title
Foot & Ankle International (01/14) Giannini, Sandro; Buda, Roberto; Pagliazzi, Gherardo; et al.
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Suture Anchor Tenodesis in Repair of Distal Achilles Tendon Injuries
The suture anchor tenodesis technique for treating distal Achilles tendon avulsions is capable of achieving durable osteotendinous repairs without causing noticeable changes to a patient's gait or other problems, a new study has found. The study involved four patients with distal Achilles tendon avulsions or ruptures treated with tendon to bone repair using suture anchors. The leg that was operated on was immobilized with an above-knee cast for four weeks while patients walked non-weight-bearing. Full weight-bearing was allowed after the above-knee cast was replaced with a below-knee cast. Gait analysis was then performed at a minimum of one year after the operation. Average American Orthopedics Foot Ankle Society (AOFAS) ankle/hindfoot scores at the final visit was 88.75, while the average Achilles tendon total rupture score was 77.75. Average passive dorsiflexion of injured ankles was lower than uninjured ankles. In addition, all of the kinematic parameters of gait analysis were similar to the uninjured side. The maximum plantar flexion power of 1.4 W/kg in the injured ankle was significantly lower than the 2.38 W/kg seen in the contralateral side.

From the article of the same title
European Journal of Orthopaedic Surgery and Traumatology (01/14) Vol. 24, No. 1, P. 117 Kiliçoglu, Önder; Türker, Mehmet; Yildiz, Fatih; et al.
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Practice Management


A Busy Doctor’s Right Hand, Ever Ready to Type
Physicians working in clinics and emergency rooms are increasingly relying on scribes to help them enter patient information into electronic health record systems. ScribeAmerica CEO Dr. Michael Murphy says that there are almost 10,000 scribes working in medical practices and hospitals across the country, and that demand for scribes is rapidly accelerating. Doctors who have begun using scribes say they are now able to focus more on their patients' needs, and that they are spending fewer late hours completing electronic patient charts. Patients are noticing a difference too, as one study found that most patients who saw a doctor who used a scribe during their visits believed that the scribe helped the appointment run smoothly. However, another study found that 10 percent of patients were uncomfortable with having a scribe sit in on their doctors visits. Some physicians are also expressing concern about the privacy implications associated with using scribes. The $20 to $25 per hour that doctors must pay for scribes is also a concern, though some doctors say scribes essentially pay for themselves because the improved efficiency that they afford makes it possible for them to see as many as four extra patients per day.

From the article of the same title
New York Times (01/14/14) Hafner, Katie
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Strategic Planning for Your Medical Practice
Practice management consultants say that there are a number of steps doctors' practices need to take to have successful strategic planning meetings. For instance, physicians' practices should begin by identifying who should be involved in these meetings. Consultants say that at least the practice administrator, lead accountant, and practice owners should be present at strategic planning meetings, though it may be advisable to invite others as well. Practices should also gather information that will facilitate a discussion about any challenges as well as opportunities, including information about the budget, overhead rates, and the performance of accounts receivable. Interviews with physicians and an external analysis should also be performed before the meeting in order to identify any challenges that exist so these issues can be discussed during the meeting. Consultants say that once these preliminary tasks are complete, practices should schedule strategic planning meetings during a weekend morning or evening at an off-site location in order to minimize distractions. Once the meeting begins, consultants say, participants should focus on discussing problems as well as making specific plans and goals for the next year. The meeting should conclude with the development of a draft plan of action that identifies deadlines for achieving goals as well as the individuals who will be responsible for completing necessary tasks.

From the article of the same title
Physicians Practice (01/13/14) Westgate, Aubrey
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Health Policy and Reimbursement


MedPAC Votes for Site-Neutral Medicare Payments
Members of the Medicare Payment Advisory Commission (MedPAC) have unanimously voted to recommend that Congress reduce the differences in what Medicare pays providers based on where a service is delivered. Medicare currently pays different reimbursement rates to doctors' offices and hospital outpatient departments, even when they provide the same services to beneficiaries. MedPAC says the proposal would help reduce Medicare spending and beneficiary cost-sharing by $1.1 billion a year. MedPAC is also calling for making payments to long-term acute-care hospitals the same as those for acute-care hospitals for patients who spend less than eight days in an intensive-care or critical-care unit. This change could help improve collaboration between long-term and acute-care hospitals to ensure that patients are receiving the most appropriate care from the right provider in an optimal location, says HealthCare Partners Executive Vice President Dr. Craig Samitt. Finally, MedPAC has called on Congress to instruct the secretary of Health and Human Services to reduce the roughly 10 percent discrepancy between payments made to employers' group Medicare Advantage (MA) plans and non-employer MA plans.

From the article of the same title
Modern Healthcare (01/16/14) Dickson, Virgil
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Health-Insurance Sign-Ups by Young Adults are Off Pace Seen as Key to New Law’s Success
Health and Human Services (HHS) Secretary Kathleen Sebelius released a report on Jan. 13 saying that 2.2 million people have now signed up for insurance coverage through the Affordable Care Act's health insurance exchanges as of the end of December. In addition, the report noted that the number of consumers who have enrolled in coverage through the federal exchange has increased seven-fold since October and November of last year. However, the report found that only 24 percent of the 2.2 million people who have enrolled in coverage through the federal and state exchanges are between the ages of 18 and 34. About 33 percent of enrollees are between the ages of 55 and 64, the report found. Several analyses have found that roughly 40 percent of those signing up for coverage through the exchanges need to be young adults in order to prevent insurance companies from raising premiums to cover the cost of caring for older individuals with more health problems and to discourage insurers from dropping out of the exchanges altogether. However, administration officials are optimistic that more young adults will sign up for coverage through the exchanges before the open enrollment period ends in March.

From the article of the same title
Washington Post (01/14/14) Goldstein, Amy; Somashkehar, Sandhya
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Study: Navigator Laws Limit Health Exchange Outreach
A study released Jan. 14 by researchers at George Washington University has found that the nine states that have passed so-called navigator laws and have also decided not to expand Medicaid are limiting the effectiveness of health insurance exchanges in providing coverage to the uninsured. The navigator laws passed by Florida, Georgia, Indiana, Maine, Missouri, Montana, Tennessee, and Texas, all of which have also decided to opt out of the expansion of Medicaid under the Affordable Care Act, state that only licensed individuals called navigators are legally permitted to provide consumers with information about insurance plans. Study co-author Sara Rosenbaum says the laws are designed to ensure that consumers obtain information about health insurance plans from licensed agents, though she said the laws have also made employees at health clinics afraid to explain the Affordable Care Act to patients without health insurance. Rosenbaum added that the effect of these laws and the decision by some states not to expand Medicaid has made it difficult for the residents of these states to obtain access to healthcare. That conclusion is based on a survey of hundreds of clinics in states that decided to expand Medicaid as well as those that did, which found that clinics in states that did not expand the program were less likely to help uninsured patients obtain coverage.

From the article of the same title
USA Today (01/14/14) Kennedy, Kelly
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Survey: Most Providers, Health Plans Haven't Fully Determined ICD-10 Impact
Many of the healthcare providers and health plans surveyed by the audit, tax, and advisory firm KPMG late last year said they had not determined how they will be affected by the transition to ICD-10. Half of those surveyed said they have not estimated how their cash flow will be affected by the transition in the fourth quarter, while another 45 percent said they had not determined how the productivity of their coders would be negatively impacted by the transition. KPMG Principal Wayne Cafran said that these healthcare providers and plans likely have not taken the time to determine how ICD-10 will affect them because they have been focused on other issues, such as achieving meaningful use of electronic health records and developing accountable care organizations. But he urged healthcare providers and health plans that have not assessed the impact from ICD-10 to take steps to prepare for the transition, including contracting with vendors and coding companies. The survey did find that some healthcare providers and plans have taken steps to prepare for ICD-10. More than three-quarters of those surveyed said they had completed an ICD-10 impact assessment, while 72 percent said they had budgeted funds towards ICD-10 preparation efforts.

From the article of the same title
Becker's Hospital Review (01/08/14) Adamopoulos, Helen
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Medicine, Drugs and Devices


Google Lens for Monitoring Glucose Has Hurdles to Clear Before Hitting Market
Experts say that Google's glucose-measuring contact lens has to clear a number of obstacles before diabetics can begin using it instead of blood glucose measurement devices. For example, Google will need to demonstrate that the glucose levels in tears that the lens is designed to measure are similar to blood glucose levels, says American Diabetes Association Chief Scientific and Medical Officer Dr. Robert Ratner. Research has not definitively proven that measuring glucose levels in tears is a viable method for managing diabetes. Even if Google is able to prove that glucose levels in tears are comparable to blood glucose levels, Ratner says, it will still need to answer questions about how often the lens would need to be replaced and whether or not it can be worn while sleeping. Multiple clinical studies of the lens have already been performed, though Google is still in the process of testing prototypes. One such prototype would measure glucose levels in tears once per second and wirelessly transmit the readings to an external device. Google is hoping that prototype will help diabetics better monitor and respond to fluctuations in glucose levels.

From the article of the same title
Modern Healthcare (01/17/14) Landen, Rachel
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Real-World Effectiveness of Abatacept for Rheumatoid Arthritis Treatment in European and Canadian Populations
A six-month interim analysis of the two-year ACTION study has found that intravenous abatacept is both effective and well-tolerated in patients with moderate-to-severe rheumatoid arthritis. Patients who participated in the study were divided into two groups: a "first-line" group that consisted of biologic naive patents, and a "second-line" group made up of patients who had not been previously helped by a treatment with at least one biologic agent. The percentage of all patients who achieved good/moderate European League Against Rheumatism (EULAR) response was 67.4 percent. The incidence of serious adverse events (SAEs) in the entire patient population was 4.7 percent. Forty percent of first-line patients achieved Clinical Disease Activity Index Low Disease Activity State (CDAI LDAS), while 32.2 percent of second-line patients did so. Health Assessment Questionnaire-Disability Index (HAQ-DI) response rates were 60.3 percent and 43.1 percent in the first- and second-line groups, respectively. Finally, researchers observed that retention rates and effectiveness outcomes were higher when patients began taking abatacept in the early stages of RA.

From the article of the same title
BMC Musculoskeletal Disorders (01/11/14) Nüßlein, Hubert G.; Alten, Rieke; Galeazzi, Mauro; et al.
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New Guidelines Reflect Gout Evidence
A group of rheumatologists and experts have published a set of 10 recommendations for diagnosing and treating gout in the February edition of the Annals of the Rheumatic Diseases. The recommendations state that monosodium urate crystals should be obtained if possible to definitively diagnose gout. A diagnosis of gout could also be supported with imaging and classical findings such as tophi or quick response to colchicine therapy in the event aspiration is difficult. In addition, the recommendations call for allopurinol to be used as a first-line urate-lowering therapy, since it is safe, effective, and not too expensive. Any urate-lowering therapy should generally begin at low doses and gradually titrated until urate levels are below 6 mg/dL, the recommendations said, though the ultimate goal of therapy is to eliminate tophi and prevent acute attacks. Rheumatologists and experts also reviewed 26 studies of a variety of therapies for acute gout flares, including non-steroidal anti-inflammatory drugs, and found that all of them were equally effective. Instead of looking at the effectiveness of therapies for acute flares, the recommendations said, doctors should take into account a patient's characteristics and the drug's safety profile when deciding on a treatment.

From the article of the same title
MedPage Today (01/06/14) Walsh, Nancy
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