January 28, 2015 | | JFAS | Contact Us

News From ACFAS

ACFAS 2015 Online Registration Closes at Noon on Feb. 5
Save and register for ACFAS 2015 today. After Feb. 5, know that you can still register onsite in Phoenix starting at 1pm on Feb. 18, 2015. Visit the registration desk (300 Level in the West Building) at the Phoenix Convention Center to make sure you don’t miss any of the action at the nation’s largest annual gathering of foot and ankle surgeons.

Share Facebook  LinkedIn  Twitter  | Web Link
Attend Your Division Meeting at ACFAS 2015
Want to find out about ACFAS activities close to home? Attend your ACFAS Division meeting at the Annual Scientific Conference in Phoenix!

Each Division holds a meeting of its members in conjunction with ACFAS 2015 next month. Join your fellow local colleagues to meet and network with your Division officers and have a hand in the plans for your Division in the upcoming year.

Division meetings are scheduled during conference lunch breaks at reserved tables in the Exhibit Hall. A complete schedule of meetings will be listed in your onsite conference brochure, on the ACFAS 2015 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. Your raffle ticket can be found in your registration packet.
Share Facebook  LinkedIn  Twitter  | Web Link
Promote Your Practice with New Ankle Arthritis Presentation
Try a non-traditional way to promote your practice to new patients by giving a health talk at your local hospital or health fair. Don’t have the time or skills to produce your own PowerPoint presentation? Let ACFAS help with its ever-growing library of foot and ankle health PowerPoint presentations in the free Marketing Toolbox at

The latest addition to the library—Ankle Arthritis: A Common Overuse Condition of the Ankle—includes professionally designed slides with a space for you to customize with your practice contact information and a full script for you to use while giving your presentation.

Visit to download this and other marketing presentations on bunions and hammertoes; common athletic injuries of the ankle; and heel pain. Plus, check out the many other free resources designed to help you work with local media, connect with your patients and promote your practice online and in print.
Share Facebook  LinkedIn  Twitter  | Web Link

Foot and Ankle Surgery

Correlation of Postoperative Midfoot Position with Outcome Following Reconstruction of Stage II Adult Acquired Flatfoot Deformity
A study was performed to determine whether a postoperative abducted or adducted forefoot alignment, as ascertained from anteroposterior (AP) radiographs, associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Midfoot abduction was defined on post-operative AP radiograph, in 55 patients from the authors’ institution who underwent flatfoot reconstruction for a stage II adult acquired flatfoot deformity, and was assessed at an average of 1.9 years post-operatively. The following measurements were categorized as abduction measurements: a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees and a talo-first metatarsal angle greater than 8 degrees. Patients with at least two measurements in the abduction category were classified as the abduction group, while those with one or fewer measurements in the abduction category were categorized in the adduction group. The pre-operative and post-operative FAOS values at an average follow-up of 3.1 years were compared between the two groups via Wilcoxon rank-sum tests. Patients corrected to a position of adduction exhibited significantly lower improvement in the FAOS daily activities and quality of life subscales. The average improvement in subscale scores for the adducted group was lower for pain and sports activities but did not achieve statistical significance. No significant difference in the FAOS symptoms subscale was observed between groups.

From the article of the same title
Foot & Ankle International (01/14/2015) Conti, Matthew S.; Chan, Jeremy Y.; Do, Huong T.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Long-Term Outcome of Joint-Preserving Surgery by Combination Metatarsal Osteotomies for Shortening for Forefoot Deformity in Patients with RA
Researchers detail the long-term results of joint-preserving surgery via a combination of metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis (RA), focusing on 43 patients. The patients underwent combined first tarsometatarsal fusion and distal realignment, shortening oblique osteotomies of the bases of metatarsals 2-4 and fifth ray osteotomy, with a follow-up period of between 64 and 108 months. Outcomes showed average post-operative Foot Function Index scores for pain, disability and activity were 10.3, 19.9 and 16.2, respectively. Average Japanese Society for Surgery of the Foot RA foot and ankle score rose from 52.1 points pre-operatively to 90.3 points post-operatively. Forty-one percent of patients reported some forefoot stiffness following surgery but exhibited no disability. None of the patients had residual deformity and callosity. Average hallux valgus and intermetatarsal angles declined following surgery from 48.5 degrees to 8.6 degrees and from 15.2 degrees to 4.6 degrees, respectively. Nonunion in two metatarsals, hardware breakage in three and mild infection in one were observed during follow-up.

From the article of the same title
Modern Rheumatology (01/21/15) Niki, H.; Hirano, T.; Akiyama, Y.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Medial Triceps Brachii Free Flap in Reconstructive Surgery: A Prospective Study in Eight Patients
A prospective study was held to present a series of medial triceps free flaps for coverage of ankle and foot complex defects coverage in eight patients and to discuss the benefits of this procedure. The patients underwent medial triceps brachii (MTB) free flap procedure to cover defects sited at the ankle and foot between January 2011 and December 2012. The average defect size to be covered was 21.8 ± 9.9 square cm. Bone was exposed at the level of the calcaneum in six cases, at the level of the forefoot in one case and at the level of the lateral malleolus in one case. Special attention was given to intra-operative findings. Flap survival and complications on both the donor and recipient site were prospectively assessed. The average MTB flap raising time was 51.3 ± six minutes. Survival was indicated for all flaps and no partial flap necrosis was observed. A skin graft was conducted after an average time of 11.8 ± 2.1 days post-operative. The average follow-up was 18.1 ± 3.8 months. Among the complications at the donor site level was one hematoma and a case of hypertrophic scar. Full healing of both the donor and recipient sites was accomplished in all cases.

From the article of the same title
Archives of Orthopaedic and Trauma Surgery (02/15) Vol. 135, No. 2, P. 275 Delgove, Anais; Leclere, Franck Marie; Villani, Federico; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management

How Physicians Should Negotiate with Payers
Analyzing and effectively negotiating healthcare payer contracts is a prudent strategy if a physician practice is to sustain viable revenue. Cost analysis should be conducted in an organized way to establish dollar value on tangible and intangible items. A clear understanding of business principles, current market trends and the cost of delivering quality healthcare is vital. The organization can perform strength, weakness, opportunities and threats (SWOT) analysis. Strengths can be assessed by reviewing the number of new patients enrolled in the plan, studying revenue and expenses, examining quality measurements and patient satisfaction reports, benchmarking quality and efficiency, determining whether the organization is providing service that is unique and new in the current market and assessing whether the practice is networking with counterparts at state and national levels. Weakness analysis involves examining the fee schedule, which is a percentage of the current Medicare fee. Creating a utilization report to capture and review data can help uncover the rates and address payment inequities, while a spreadsheet can be employed to determine the frequency of a current procedural terminology code and the number of times it was billed to that payer.

To prepare for negotiations, the organization must set a bargaining range that includes optimum and minimal target goals. Meeting face to face with the payer representative and presenting clear data and requests for change, as well as listening to the representative's advice, are recommended. Also advisable is knowing the issues of concern to the payer. The organization should then demonstrate efficiencies that lower costs. This can be done by showing the payer how many of their members avoided hospital re-admissions due to the effective, quality healthcare provided.

From the article of the same title
Medical Economics (01/09/15) Kurunthottical, Raju
Share Facebook  LinkedIn  Twitter  | Web Link

Human Resource Development and Your Medical Practice
The effective and efficient management of human resources is critical for guaranteeing that a satisfied, motivated workforce delivers quality health services at a medical practice, while also boosting staff performance and productivity, improving the practice's competitive advantage and contributing directly to organizational objectives. Essential to this is introducing an element of customer service in both human resource development and management. Inclusion of customer service elements in human resource management enables the practice to concentrate on need analysis, skill analysis and gap analysis so that it can plan for employee development programs of mutual benefit to both the practice and its staff. Methods for developing medical practice employees include:

1) Core training, in which new employees are taught the basics of their jobs, such as job duties, expectations and how to work on their electronic health record and related software.

2) Personal development plans, a method that emphasizes the employee's professional life. The method enables the practice to work with the employee to set individual professional goals. The practice and employee produce a list of goals such as rising to a higher level within the organization, and a plan for realizing them.

3) Leadership training, which is designed to help well-performing employees climb to a leadership level. It involves placing the best employees within a specialized training program that helps them cultivate the skills they need to become team leaders or supervisors, and these programs also frequently entail setting individual goals.

4) Mentor development programs, whereby a manager is matched with an employee to help the employee accomplish more in his or her professional life. Utilization of the mentor program helps a practice develop stronger employees and helps employees foster better relationships with management.

From the article of the same title
Physicians Practice (01/18/15) Gandhi, Vishal
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement

Docs Urge Big Changes to Health Record Program
A coalition of 35 medical societies, led by the American Medical Association, has sent a letter to the National Coordinator for Health Information Technology arguing that the meaningful use program for electronic health records (EHRs) threatens patient outcomes and should be changed. The coalition wants regulators to decouple the certification of EHRs from meaningful use and to reconsider alternative software testing methods. It also wants regulators to incorporate stakeholder feedback on technical matters relating to meaningful use.

From the article of the same title
The Hill (01/21/15) Viebeck, Elise
Share Facebook  LinkedIn  Twitter  | Web Link

MedPAC Voices Concerns about Growing Volume, Burden of Medicare Quality Measures
In December 2014, the Centers for Medicare and Medicaid Services (CMS) released a list of quality measures being considered for the Medicare program. In a January letter, Medicare Payment Advisory Commission (MedPAC) observed that the large volume of measures under consideration, more than 300, reinforces concerns that Medicare's provider-level measurement activities are expanding without regard to the costs or benefits of an ever-increasing number of measures. MedPAC suggests that CMS depends on too many clinical process measures that are not strongly related to health outcomes.

From the article of the same title
Health Industry Washington Watch (01/16/15) McCurdy, Debra A.
Share Facebook  LinkedIn  Twitter  | Web Link

States Stand Pat Ahead of Supreme Court Health Law Ruling
Due to political and practical hindrances to reworking the Affordable Care Act, it seems unlikely that most U.S. states will establish health insurance exchanges in the face of a Supreme Court ruling. At stake are subsidies mandated by the law that make health plans less costly for millions of consumers. In 37 mostly GOP-controlled states, the federal government partly runs the exchanges where consumers buy insurance. Nearly 5 million people in those states received billions of dollars in tax credits to counter the cost of insurance premiums for 2014, and more are expected to get these credits in 2015. Leaders of states that rely on the federal government to operate their exchanges do not appear to be developing contingency plans in the event the Supreme Court rules that tax credits for health plans bought through are invalid. "I'm not optimistic that states will move as a group to establish their own exchanges," says University of Michigan Professor Nicholas Bagley. "I think the prospects here are alarming." Republicans in Congress are already sending a message that they would try to use a high court ruling as an opportunity to retool the law, instead of voting through a fix to its wording that could reinstate the tax credits.

From the article of the same title
Wall Street Journal (01/16/15) Radnofsky, Louise
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

U.S. Healthcare Executives Say Obamacare Is Not Going Anywhere
U.S. healthcare executives say Obamacare will likely prevail, even in the face of Republican lawmakers' calls for repeal of the Affordable Care Act. Biogen Idec CEO George Scangos strongly doubts a repeal will happen, noting "[lawmakers] would somehow have to explain to millions of people that they will lose health insurance." Some drug and insurance industry executives attending a healthcare conference are not expecting Congress to repeal the law, nor do they expect congressional inaction should the Supreme Court rule that tax credits are not permitted for health plans bought via the federal exchange. Aetna CEO Mark Bertolini says industry officials are discussing ways to revise the law with members of Congress in the event the high court rules against the Obama administration. "Putting aside the Supreme Court challenge, I don't see a veto-proof majority" in Congress to repeal the law, says Merck CEO Kenneth Frazier. "I would expect changes in the structure of the law, not a wholesale repeal." Key changes Republicans are expected to focus on include Obamacare's employer mandate, which stipulates businesses with at least 50 full-time workers must offer health coverage to employees or pay a penalty. GOP lawmakers also want to redefine the law's characterization of "full time" as any employee who works 30 hours a week or more, provisions that reimburse health insurers for market losses and an excise tax on medical devices.

From the article of the same title
Reuters (01/15/15) Beasley, Deena; Morgan, David; Humer, Caroline
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices

FDA Offers Proposed Guidance on When a Wellness Product Becomes a Medical Device
The Food and Drug Administration (FDA) has issued its new draft guidance for how it characterizes a low-risk product advocating health management and when that device crosses into a different category of medical devices. FDA stated that a general wellness product becomes a medical device when it refers to its use for a specific disease or condition and that application is invasive or goes beyond the general goals of most wearables, like helping people monitor their exercise or heart rate. According to the draft guidance, devices that claim the product will treat obesity, an eating disorder, anxiety and more are not general wellness devices.

From the article of the same title
MedCity News (01/16/15) Baum, Stephanie
Share Facebook  LinkedIn  Twitter  | Web Link

Gout-Drug Competition Returning to Market After Court Fight
The U.S. Court of Appeals for the Federal Circuit on Jan. 9 issued an order that essentially allows the generic drug manufacturer West-Ward Pharmaceuticals Corp. to begin selling a new version of colchicine. The drug has been on the market for decades and is commonly used to treat gout. Takeda Pharmaceuticals USA, which makes the brand-name version of the drug and brought the lawsuit against West-Ward, also announced plans this week to partner with a separate manufacturer to bring generic versions of the treatment to market. Allowing generic manufacturers to market the drug is expected to lower the costs of a therapy that only a decade ago cost 10 cents per pill and now costs more than $5 per pill.

From the article of the same title
Modern Healthcare (01/15/15) Lee, Jaimy
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Free Registration

Hospitals Aim to Better Match Blood Donors and Recipients
Hospitals and blood banks are employing more accurate genetic techniques for screening blood donors and recipients to prevent mismatches. Fifteen U.S. health systems and 25 donor centers, including the American Red Cross, have adopted the PreciseType test, which is promoted as offering faster and more accurate results than traditional lab testing methods. Children’s Healthcare of Atlanta has begun using PreciseType, which was approved by the Food and Drug Administration in May. PreciseType uses DNA from blood samples to concurrently identify 35 antigens considered to have the highest potential to induce immune reactions. Older tests can take days and require technologists to seek a single antigen at a time in a test tube of blood; PreciseType takes six hours, is more accurate, and at about $350 costs about the same as traditional tests, according to Children’s Healthcare official Cassandra Josephson. She says broader use of the test could help significantly lower costs of future hospitalizations and treatment by preventing potential complications. In addition, the American Red Cross is using PreciseType to find donors suitable for sickle cell patients.

From the article of the same title
Wall Street Journal (01/19/15) Landro, Laura
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Senate Bill Targets Drug-Resistant 'Superbugs'
Senators Orrin Hatch (R-Utah) and Michael Bennet (D-Colo.) have introduced legislation to accelerate the approval of new antibiotics, particularly for the treatment of drug-resistant "superbugs." The bill, called the PATH Act, would allow the Food and Drug Administration to speed up approval of antibiotics designed to treat serious conditions affecting a limited number of patients. The medications would have to address an unmet need. The senators tied the bill to the threat that antibiotic-resistant bacteria poses to U.S. troops returning from Afghanistan and Iraq. More than a third of those service members have developed a bacterial or fungal infection that could be life-threatening due to their battle injuries, according to the Pentagon.

From the article of the same title
The Hill (01/16/15) Viebeck, Elise
Share Facebook  LinkedIn  Twitter  | Web Link


This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Robert M. Joseph, DPM, PhD, FACFAS

Daniel C. Jupiter, PhD

Jakob C. Thorud, DPM, MS, AACFAS

Contact Us

For more information on ACFAS and This Week @ ACFAS, contact:

American College of
Foot and Ankle Surgeons
8725 W. Higgins Rd.
Suite 555
Chicago, IL 60631
P: (773) 693-9300
F: (773) 693-9304
E: ThisWeek

Visit Us: Friend us on Facebook Follow us on Twitter Link us in on LinkedIn

This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of "This Week" are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS, and does not imply endorsement of any view, product or service by ACFAS.

Some publication websites may require user registration or subscription before access is granted to the links following the articles. If an article is unavailable online, a link is provided to that publication's homepage.

Copyright © 2015 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe, click here.

Abstract News © Copyright 2015 INFORMATION, INC.
Powered by Information, Inc.