News From ACFAS

---

Not only is ACFAS taking over Austin with ACFAS 2016, but we’re also making our mark at the Austin Marathon during the conference. With more than 14,000 runners from 50 states and 25 countries, ACFAS will be on hand at the Finish Line and in the Race Expo Market Place to greet runners and promote the great work you all do as foot and ankle surgeons.

As giveaways in the booths, we’re handing out hot/cold packs and copies of our newest infographic, Preventing Foot & Ankle Running Injuries, to runners and their families. This latest promotional infographic is also available to you in the Marketing Toolbox.

If you’re attending ACFAS 2016, stop by the Market Place Expo on Feb. 12-13 and the Finish Line on Sunday, Feb. 14 to check our booths and see how ACFAS is working to promote you! If you’d like to help greet runners at the Finish Line or Expo for more exposure, please contact melissa.matusek@acfas.org.
Is it time for a new headshot photo for your resume and social media profiles? Stop by Booth 110 in the Exhibit Hall at ACFAS 2016 for a free professional photo taken by a HeadShot™ photographer. All photo sessions include a brief touchup with a makeup artist to make sure you’re ready for your closeup.

Visit the photo booth on Friday, Feb. 12, 10am–4pm or Saturday, Feb. 13, 10am–2pm to have your picture taken. You’ll receive both a hardcopy and electronic version of your photo that same day.

Whether you’re planning to bring a new product to market, hire a PA or NP, join a new practice or become a more confident public speaker, head to the ever-popular HUB in the ACFAS 2016 Exhibit Hall.

With presentations delivered on the hour by leading experts in the profession, you’ll have plenty of opportunities to learn about the issues keeping you up at night, gain strategies for negotiating that winning contract and bring your new product idea to life. You then can take these tips back to the office and start seeing real results.

Seats in this intimate 45-seat theater fill up fast; visit acfas.org/austin for the complete HUB schedule and to decide which sessions you’d like to attend. No preregistration is necessary.
Five of ACFAS’ Regional Divisions are welcoming new officers at ACFAS 2016 next month.

Division 3 (Southwest): Chester Williams, DPM, FACFAS, Wichita Falls, Texas, is the new Secretary/Treasurer.

Division 4 (Desert States): Jeffrey McAlister, DPM, FACFAS, Phoenix, is the new Secretary/Treasurer.

Division 9 (Greater New York): Dominic Catanese, DPM, FACFAS, Bronx, New York, is the new Vice President.

Division 12 (Tri-State): Jennifer Van, DPM, AACFAS, Philadelphia, is the new Director of Education.

Division 13 (Ohio Valley): Timothy Holmes, DPM, FACFAS, Pickerington, Ohio, is the new Director of Education; and Johnny Alayon, DPM, FACFAS, Niles, Ohio, is the new Director at Large.

Congratulations to these new Division Officers!

To learn more about ACFAS Divisions, plan to attend their membership meetings held in conjunction with the Annual Scientific Conference, February 11–14 in Austin. Visit acfas.org for meeting schedules.
Congratulations to John Paul Naughton, DPM, AACFAS, of Fargo, North Dakota! He is the lucky winner of an Apple Watch in a drawing of new Associate Member applicants. The Membership Committee sponsored the contest to recognize former residents who have recently passed the ABFAS Board Qualifying exam and have upgraded their membership to Associate Member with ACFAS.

Again, congratulations to Dr. Naughton and welcome to all of our new Associate Members. We hope to see you in Austin!

Foot and Ankle Surgery

---

A recent study compared augmented repair of total Achilles tendon rupture with simple end-to-end repair. Sixty patients received either treatment, with a mean follow-up of 14 years. The mean Leppilahti Achilles tendon score was 87.1 points for the end-to-end repairs and 91.5 for the augmented repairs. Strength parameters were not affected, and median work-displacement deficit difference was insignificant. The study showed that augmented repair of Achilles tendon ruptures had no advantage over end-to-end repair.


Hospitals with better nursing environments experience lower surgical patient mortality for similar costs, compared with hospitals with inferior nursing environments, according to a study published in JAMA Surgery. While previous studies determined that better nursing environments resulted in better quality of care, this study looked to find the relationship of cost versus quality. The study looked at 35 hospitals with good nursing environments, deemed "focal hospitals," and compared them with 293 control hospitals. Thirty-day mortality was a primary outcome, as well as 30-day cost. Mortality rates were 4.8 percent at focal hospitals and 5.8 percent at control hospitals. Focal hospitals also had lower 30-day failure-to-rescue rates, and their patients were in the ICU less often. In addition, surgical patients stayed in the hospital for shorter times. The costs were similar for both groups despite these differences. Per patient cost was $27,131 for focal hospitals and $27,292 for control hospitals. One improvement the study laid out was an improved nurse-to-bed ratio. In focal hospitals, the ratio was 1.51; in control hospitals, it was 0.69.


Elite athletes can often incur proximal fractures of the fifth metatarsal (zone II and III). These injuries can be difficult to treat because of a tendency toward delayed union, nonunion or refracture. Researchers reviewed 10 NBA players' records, seven of whom underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) and three of whom had open bone grafting in addition to fixation and BMAC. Three athletes experienced refractures, and the average time for return to play was 9.8 weeks. No significant difference was found in clinical features or radiographic measurements. Researchers found that these large players had a unique foot type associated with increased fracture and refracture of the fifth metatarsal. While the standard internal fixation method is still viable, the additional bone grafting can still be used to improve fracture healing and potentially decrease risk of refracture.

Practice Management

---

While most family physicians agree that telehealth is important for improving patient care, adoption of its use appears to be a slow process. Of the 1,557 responses to a survey about telehealth use, 15 percent of respondents indicated they had used the technology within the last 12 months. This is despite 78 percent agreeing patients would benefit and 68 percent agreeing it would improve continuity of care. Researchers determined that the biggest barriers were lack of training and lack of reimbursement, signaling a need to change the way telehealth is introduced into family practices. “Many of the barriers to wider adoption may be addressed by policy changes,” said study author Miranda A. Moore. The report offered solutions, including stakeholders offering new opportunities for training and payers increasing awareness of current telehealth service reimbursements.


Training physicians to use your new electronic health record (EHR) system can be difficult. Joncé Smith, vice president of revenue management at Stoltenberg Consulting, recommends that you keep it brief when discussing EHRs and offers these three tips for physician training:

1. Leverage a physician champion. Choose one of your more tech-savvy physicians as an internal expert and coach. Your staff is much more likely to respond to a colleague as opposed to an IT person. Include this person in all of the activities in which your EHR project team engages.
2. Prioritize time for education. Classroom training can only take you so far. Use your physician champion to show staff how the EHR can be used in the context of their daily activities. Making this a priority can save valuable time and in many cases, make the points stick better.
3. Prepare to deliver elbow-to-elbow system support. Create a team dedicated specifically to one-on-one support. There are many ways to do this, including setting up a special physician-only hotline to offer advice.

Many physicians, deserving or not, will likely receive a poor online review at some point in their careers. There are many ways to handle this situation. One of the biggest first steps can also be the hardest: accepting that the poor review may have merit. If the review is a capitalized diatribe, it is likely fine to ignore; if it is tough but fair, it is important to delve deeper into the situation. In fact, many experts agree that how you respond to a bad review can often determine whether or not another patient decides to choose your practice. While lawyers generally dissuade physicians from responding to reviews, a rational response could be a big part of keeping your reputation intact. Absolutely do not respond in anger, and do not file a lawsuit. The consensus is that neither action will result in good results. Instead, focus on what needs to be fixed to draw out more positive reviews. Whether you like it or not, reviews are essential for business: a study found that around 62 percent of prospective patients base their decision to use a practice on review sites. Focus on earning positive reviews and in some cases, request that a particularly good patient post one as a favor to your business.

Health Policy and Reimbursement

---

The Centers for Medicare and Medicaid Services (CMS) has published a column with detailed guidance related to the transition from meaningful use to a new electronic health record-based approach. According to Andy Slavitt, acting administrator of CMS, the changes will be influenced by how information technology fits into new reimbursement approaches. Four "critical principles" were outlined:

1. Rewarding providers for outcomes that technology helps them achieve.
2. Allowing providers the flexibility to customize health IT to their practice needs.
3. Promoting innovation and unlocking electronic health information through APIs.
4. Establishing federally recognized national interoperability standards.

The column admits that the transition will take time and that time should be used to communicate, plan and share information with the federal government.


Accountable care organizations (ACOs) cite a lack of interoperability between their health information systems and those of providers as the number one challenge they face, according to a new study. Of the 68 ACOs polled, 79 percent indicated that obtaining data from outside a network is complex. To manage large patient populations, ACOs need to integrate data from many different systems, and that integration process has become a struggle. This is especially true for medical specialists, who said that they have almost double the amount of data in comparison to any other healthcare setting. The survey found that 53 percent of ACOs have not integrated data from behavioral-health providers, and 48 percent do not have data integration with long-term and post-acute care providers. The incentive payment program prompting the use of electronic health records (EHRs) does not seem to be affecting much. While 97 percent of hospitals and 89 percent of eligible physicians have received at least one federal EHR incentive payment, IT adoption among ACO participants is lagging.


The Obama administration has announced steps that make it more difficult for consumers to buy health insurance after the annual open enrollment period. Insurance companies had issued complaints because latecomers drive up costs for people who sign up during the regular open enrollment period. More than 30 special enrollment periods have been created, and Kevin J. Counihan, the chief executive of the federal insurance marketplace, said these periods were not for people who are uninsured and obtain health insurance when they get sick. Six of these periods will be eliminated. Around 950,000 people used the special enrollment periods between February and June 2015. The goal is to motivate consumers to sign up by the Jan. 31 deadline and to prevent a torrent of sick people from hitting the market in the middle of the year.


Recent changes to meaningful use have left the future murky. Elliot Sloane, president of the Center for Health Information Research and Policy, will speak at HIMSS16 to answer questions and clear up any misconceptions. Sloane's theory is that a new meaningful use program will introduce "precision reimbursement." The Centers for Medicare and Medicaid Services (CMS) should continue to use certified electronic health records and electronic quality reporting but will focus more on quality. CMS will transition from meaningful use to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) with a stated goal of having 30 percent of Medicare payments tied to quality or value by 2016, with 50 percent by 2019. This shift to value-based care is consistent with stated government desires.

Medicine, Drugs and Devices

---

There is no short-term benefit to healthcare costs or outcomes for patients monitoring their health with connected devices, according to a Scripps Translational Science Institute study. Scripps observed 160 patients with various health issues, split into two groups. One group was given an iPhone 4 and a connected device; the other served as a control. No difference was found between the two groups, which were made up of patients with hypertension, diabetes or arrhythmia. The only difference was that patients who monitored their health were less likely to attribute their outcomes to chance. Any real difference appeared to be related to mentality rather than physical proof. Study leader Dr. Eric Topol said that the lack of variability in the two groups could be attributed to the brevity of the study. This was the first multisensor trial that has ever been reported, and it could affect the mobile health market if it prompts similar studies.


The U.S. Food and Drug Administration (FDA) has released draft guidelines to address medical device cybersecurity. In the wake of recent controversies surrounding the safety of some devices, the document aims to guide manufacturers with a risk management program that meets a set of requirements. The FDA wants to make sure that manufacturers are aware of vulnerabilities and know how to properly assess them, as well as know proper communication protocol in the event of a mistake. The program also looks to adopt a more efficient disclosure policy. The FDA also suggests the benefits of information sharing and analysis organizations, “strongly recommending” that manufacturers enter into an Information Sharing and Analysis Organization, or ISAO. Most of the actions taken would include things related to routine updates and patches, but the FDA also pointed out that the biggest threats can arise during simple maintenance.