February 3, 2016 | | JFAS | Contact Us

News From ACFAS

ACFAS 2016 Is Almost Here
We’re only one week away from ACFAS 2016 in Austin! Follow these useful tips as you pack your bags, and you’ll be one step ahead when you arrive:
  1. Check Austin’s forecast. Sunshine and mild temperatures are expected this time of year, but February can be a fickle month for weather. To stay comfortable, bring your jacket or sweater and dress in layers.
  2. Download the ACFAS 2016 mobile app. Search your app store for ACFAS 2016 or download the app at to access your customized conference schedule on your device. Check your email today for instructions on populating the app with your personalized schedule.
  3. Take SuperShuttle from the airport to your hotel. Receive a discount on your shuttle fare at
  4. Get to registration early. Sign in, pick up your materials and immerse yourself in ACFAS 2016.
  5. Wear your conference badge. Your badge is required for attendance at sessions, meetings, receptions and Exhibit Hall events.
  6. Follow #ACFAS 2016 on social media. Use #ACFAS2016 in your Twitter and Facebook posts and to search social media for conference updates.
  7. Enjoy special events. Network with your colleagues at the Premier Connection, mingle at industry-sponsored breakfasts and after-hours gatherings then cap off your last night in Austin with a Wrap Party at Buffalo Billiards.
  8. Visit the Exhibit Hall. Chat with exhibitors, soak in the latest award-winning research at our annual poster display, browse positions and candidates at the ACFAS Job Fair or have your headshot taken, at no cost, by a professional photographer.
  9. Complete your session evaluations on the mobile app. New this year—all conference sessions will be evaluated electronically through the ACFAS 2016 mobile app only.
  10. Have fun at ACFAS 2016!
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ACFAS 2016 Session Evaluations Going Green
New this year—all conference sessions will be evaluated electronically through the ACFAS 2016 mobile app only. Search your app store for ACFAS 2016 or visit to download the app to your mobile device and then share your feedback after each session you attend. Your input will help us determine session topics for next year’s conference.
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Don't Miss Your Division Meeting in Austin
Learn more about ACFAS activities and events close to home by attending your ACFAS Division meeting during ACFAS 2016.

All Division meetings are held during conference lunch breaks at reserved tables in the Exhibit Hall. A complete meetings schedule is included in the ACFAS 2016 mobile app, in the conference program and on signage at the meeting. You can also visit to look up the date and time of your Division’s 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 will be in your registration packet.
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Foot and Ankle Surgery

Early Weightbearing After Operatively Treated Ankle Fractures
A recent study investigated weightbearing's effect on fracture displacement and timing of displacement following surgical fixation of unstable traumatic ankle fractures. Researchers used cadaver models and assigned 24 lower extremities to three separate groups. Group 1 included bimalleolar ankle fractures, Group 2 included trimalleolar ankle fractures with unfixed small posterior malleolar fracture and Group 3 included trimalleolar ankle fractures with fixed large posterior malleolar fracture. Group 1 displacement of the lateral and medial malleolus fracture was 0.1±0.1 mm and 0.4±0.4 mm, respectively. Group 2 displacement of the lateral, medial and posterior malleolar fracture was 0.6±0.4 mm, 0.5±0.4 mm and 0.5±0.6 mm, respectively. Group 3 displacement of the lateral, medial, and posterior malleolar fracture was 0.1±0.1 mm, 0.5±0.7 mm and 0.5±0.4 mm, respectively. There was no significant displacement or new fractures, supporting further research into weighbearing protocols.

From the article of the same title
Foot & Ankle International (01/22/2016) Tan, Eric W.; Sirisreetreerux, Norachart; Paez, Adrian G.; et al.
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Practice Management

Few Frivolous Claims of Malpractice End in Payment
About six percent of physicians were involved in at least one paid malpractice claim between 2004 and 2014, according to new research. Those claims came out to a total payout of $13.6 billion, the vast majority of which involved death or major or significant physical injury. Sixteen percent of that group paid 32 percent of the total claims. General surgery accounted for 12 percent of all claims. While these numbers seem daunting, they reflect more the type of physician being sued than anything else. For example, physicians with a history of paid claims were far more likely to be hit with additional claims, although surgeons still had very high rates. The median payment amount was $204,750, with a mean of $371,054.

From the article of the same title
MedPage Today (01/27/16) Wallan, Sarah Wickline
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House Calls: A Blast from the Past and a Way to Embrace Value-Based Care
A recent study has found that house calls can reduce emergency room visits and hospital readmissions. Published in Health Affairs, the study looks at California-based HealthCare Partners Affiliates Medical Group, which uses its House Calls program to assist patients. After observing the program for three months, the study concluded that patients were not only admitted to the hospital less often, the program also decreased costs six months after patients left the program. Similar efforts in Texas and other states have experienced analogous results. The process tends to involve nurse practitioners who work with patients, monitoring them and communicating updates to their physicians. Social workers also play a part, assessing home environments and identifying potential issues such as fall risks. However, travel can put strain on a physician because there is less time to see patients throughout the day.

From the article of the same title
Fierce Practice Management (01/26/16) Cryts, Aine
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Six Keys to Motivating Medical Practice Staff
Your practice can benefit greatly from a well-trained, motivated and happy staff. Here are six recommendations for motivating your employees:
  1. Cross-train. Certain medical jobs can become rote and tedious. Cross-training or developing new roles can inject new energy into your staff.
  2. Encourage and fund offsite training. The Professional Association of Health Care Office Management, Medical Group Management Association and local colleges provide inexpensive and relevant educational opportunities.
  3. Praise publicly, correct privately. Hold meetings where staff can announce their accomplishments. If you need to correct an employee, do so in private.
  4. Hire slowly, fire quickly. Take your time hiring the best talent, but do not hesitate to terminate poor-performing or disruptive employees.
  5. Take some time to get to know your staff and their jobs. Employees respond to genuine effort. Interacting with your staff and being knowledgeable about their day-to-day activities can go a long way toward establishing a relationship.
  6. Avoid nepotism and strive to be fair and consistent. Do not demonstrate favoritism. This can alienate members of your staff. In addition, be particularly wary of hiring a spouse or family member.
From the article of the same title
Physicians Practice (01/27/16) Capko, Judy; Capko, Joe
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Health Policy and Reimbursement

CMS Tackles Medicare Spending, Medicaid Financial Incentives
Medicare and Medicare spending must align more closely so that healthcare providers can better manage costs, according to a new report from the Centers for Medicare and Medicaid Services (CMS). A collaborative project called the Financial Alignment Initiative is working to fix this issue by developing person-centered care delivery models that fully integrate medical, behavioral health and long-term services. The initiative also aims to focus on improving quality while keeping costs low. “A longstanding barrier to improving quality and reducing costs of care for Medicare-Medicaid enrollees has been a lack of alignment and cohesiveness between the two programs," said Patrick Conway, principal deputy administrator and chief medical officer. Thanks to the Affordable Care Act, healthcare providers can now participate in various models to help lower costs. CMS also revealed 2013–2014 spending data, showing a cost reduction of $21.6 million for Medicare, or six percent.

From the article of the same title
RevCycle Intelligence (01/26/16) DiChiara, Jacqueline
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Congress May Speed Overhaul of Payments for Post-Hospital Care
Medicare saw post-acute care payments more than double to $59 billion between 2001 and 2013. A lack of clear guidelines was a contributing factor, and now Congress is considering speeding up reform to implement a change that could potentially save $9.3 billion over a decade. Post-acute care generally refers to what the health industry provides after a patient is hospitalized for a major medical event. The White House's 2016 budget proposed packaging payments for clearly defined episodes of care to discourage unnecessary costs. Other bills have sponsored research into test programs to control costs. The Centers for Medicare and Medicaid Services have used a $10 billion program to test alternative approaches to current payment models. Congress could look at these tests to determine policy decisions that could be around the corner.

From the article of the same title
Roll Call (01/26/16) Young, Kerry
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How the Affordable Care Act Refines Revenue Cycle Management
The implementation of the Affordable Care Act (ACA) has had a significant effect on the healthcare revenue cycle. Here are four examples:
  1. The ACA is working to improve outcomes. According to Josh Gray, vice president of research at athenahealth, the ACA has lowered uninsured rates while dramatically improving access to healthcare.
  2. The ACA helps maintain affordable premiums. The Centers for Medicare and Medicaid Services (CMS) report that the ACA has helped moderate premium hikes and provide insurance buyers with greater value. CMS also noted that transparency has increased.
  3. The ACA supports the shift from volume to value. The current trend of value-based care has fit in with the ACA. It allows for greater revenue cycle management flexibility and allows providers opportunities to excel and differentiate.
  4. The ACA covers more women. Under the ACA, women are gaining more access to affordable healthcare, gender discrimination is absolutely forbidden and women are guaranteed preventative services.
From the article of the same title
RevCycle Intelligence (01/28/16) DiChiara, Jacqueline
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Study: GOP Win in ACA Suit Would Hike Spending
If Republicans win House v Burwell, cutting off certain payments to insurers under the Affordable Care Act (ACA), it could potentially create a large disruption in the law. A study from the Urban Institute shows that the House's challenge of the ACA's "cost-sharing reductions" could hike premiums to make up for lost money. A corresponding increase in government subsidies would protect people from paying the cost of these higher premiums. The study projects that the ruling could actually increase financial assistance because around 400,000 fewer people would be uninsured if the Republicans won the case. Linda Blumberg, one of the study's authors, noted that she failed to see the overall point of the lawsuit since the study shows that it would have no major positive or negative effects on the law other than disrupt the marketplace.

From the article of the same title
The Hill (01/27/16) Sullivan, Peter
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Study: Significant Meaningful Use Variations Exist Among Rural Providers
Considerable meaningful use variations exist among rural providers, despite having adopted health IT at the same time as their urban counterparts. A new study in Health Affairs shows that because of this, rural providers are more likely to skip a year of declaring they have met meaningful use requirements. This puts them at a financial disadvantage. In 2013, around 82 percent of rural physicians had adopted an electronic health record, compared to 78 percent of urban physicians. In addition, 97 percent of small rural hospitals achieved meaningful use by the end of 2014, and a higher proportion of rural providers registered compared with urban providers. But 38 percent of rural Medicare-registered providers skipped at least one subsequent year between 2012 and 2014. The research found that technical assistance from a Regional Extension Center was strongly associated with meaningful use achievement among rural providers. The lack of ongoing assistance for meaningful use may be one reason rural providers are less likely to return for subsequent years.

From the article of the same title
Healthcare Informatics (01/21/16) Leventhal, Rajiv
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Medicine, Drugs and Devices

Drug Shortages in American ERs Have Increased by More Than 400 Percent
A new study in Academic Emergency Medicine reveals that emergency room (ER) drug shortages in the U.S. have increased by more than 400 percent since 2001. Almost 1,800 shortages were reported between 2001 and 2014, 34 percent of which came from ERs. More than half of those shortages were lifesaving drugs, 10 percent of which had no suitable substitute. While shortages fell between 2002 and 2007, they've risen 435 percent in the last six years. Jesse Pines, director of the office for clinical practice innovation at George Washington University School of Medicine & Health Sciences, said it is a "crisis" that must be fixed. One big problem is manufacturing delays, which account for more than a quarter of drug shortages. Supply and demand and the availability of raw materials combine to make up 19.3 percent of shortages. "Business decisions" were responsible for 2.1 percent. But the biggest issue is the 46 percent of shortages that do not have a reason listed. The U.S. Food and Drug Administration has issued a plan to prevent shortages, but it cannot require pharmaceutical companies to make certain drugs or change the amount distributed. The lack of a clear solution means that the shortage crisis could get much worse in the coming years.

From the article of the same title
Washington Post (01/25/16) Blakemore, Erin
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Interoperable Medical Devices: FDA Offers Design, Labeling Considerations
The U.S. Food and Drug Administration (FDA) has released new draft guidance on how to design interoperable medical devices. The guidance also covers recommendations for labeling medical devices. As interconnected devices become more widely adopted, FDA noted it is important that device manufacturers consider various options for designing systems with interoperability as an objective, with security and efficiency in mind. Some of the design recommendations to consider include the type of devices that are meant to be connected, the method of data transmission, the timeliness and reliability of information and the use of data standards, among others. “Establishing and implementing appropriate functional, performance and interface requirements for devices with such interactions are important. One way to achieve this is through use of standardized architectures and communication protocols," FDA said. Labeling the devices is just as important. FDA recommends that labels adequately describe all facets of the device, from the purpose of the interface to a summary of the testing performed on the device. “If the device is meant to interact with only a few specific devices, the labeling should explicitly state that the medical device is meant to connect with the specific devices listed," FDA stated.

From the article of the same title
RAPS (01/25/2016) Brennan, Zachary
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New Imaging Technique Could Reduce Need for Amputation
A study published in the Journal of the American College of Cardiology describes a new imaging method that could bypass the need for amputation in people suffering from critical limb ischemia (CLI). The method maps blood delivered to the leg muscle immediately after operations on people with severely reduced blood flow to their limbs. Surgeons currently need to wait days or weeks to determine the surgery's outcome. The magnetic resonance imaging-based mapping technique was used to image how much blood was reaching the muscles in the legs of 34 people with CLI, before and after treatment, and in 22 healthy subjects. The researchers then obtained a small amount of leg muscle via biopsy to check that the results provided by the new technique were correct.

From the article of the same title
Newswise (01/27/16)
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Pain Remains for Many Patients with Early RA After Treatment with Methotrexate
Rheumatoid arthritis (RA) patients treated with methotrexate had a good response to the treatment but still had remaining pain. In a study by researchers from the Karolinska Institute in Stockholm, 1,640 RA patients were analyzed. Seventy-six percent were treated with methotrexate alone. Forty percent achieved good responses to the treatment, but 29 percent of those patients still had a Visual Analog Scale pain score greater than 20 mm after three months. The pain was associated with age, higher disability on a health assessment questionnaire, higher patient global assessment scores, higher tender joint counts and other factors.

From the article of the same title
Healio (01/27/2016)
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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

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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.

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