News From ACFAS

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ACFAS 2016 has taken center stage in Austin! With preconference workshops in progress and throngs of attendees arriving at the Austin Convention Center, the energy here is off the charts as everyone gets ready for tomorrow’s opening general session with Reed V. Tuckson, MD, FACP, the Premier Connection Opening Event, the Honors and Awards Ceremony on Friday, the HUB and Exhibit Hall, as well as the countless workshops and special events planned throughout the next few days!

ACFAS 2016 is in town until Sunday, Feb. 14, and plans for next year’s 75th-Anniversary Conference at the Mirage Hotel in Las Vegas are well underway. Mark your calendars now!
Whether you’re in Austin or at home, stay up to date on all things ACFAS 2016—follow #ACFAS2016 on our Twitter, Facebook and social media feeds through the conference’s mobile app. Don’t forget to also use #ACFAS2016 in your posts while in Austin. Don't miss a minute of what's expected to be our biggest conference yet!
The best way to keep track of your conference sessions and schedule is to download our free ACFAS 2016 mobile app to your smartphone or tablet. Search your app store for ACFAS 2016 to download the app.

Once you have your app on your phone, you can populate it with your personal schedule and contact info. Instructions and login information were emailed to you prior to the conference and are also available on the back of your conference badge.
Congratulations to new ACFAS President Sean T. Grambart, DPM, FACFAS, Laurence G. Rubin, DPM, FACFAS, President-Elect; John S. Steinberg, DPM, FACFAS, Secretary-Treasurer; and Richard Derner, DPM, FACFAS, Immediate Past President. The new officers will be installed this Friday, Feb. 12 during the Honors and Awards Ceremony at ACFAS 2016 along with the new and returning Board members:

Thanh L. Dinh, DPM, FACFAS
Byron L. Hutchinson, DPM, FACFAS
Scott C. Nelson, DPM, FACFAS
Aksone Nouvong, DPM, FACFAS
Christopher L. Reeves, DPM, FACFAS
Eric G. Walter, DPM, FACFAS
Randal L. Wraalstad, DPM, FACFAS

A special thank you to retiring Board member Christopher F. Hyer, DPM, FACFAS, and Thomas S. Roukis, DPM, PhD, FACFAS, for their dedicated service.

Foot and Ankle Surgery

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Ankle joint osteoarthritis (OA) can result in deformation of the talus and the distal tibia. A recent study tested whether flattening of the talus and broadening of the distal tibia surface occurred in end-stage OA. Researchers looked at 27 CT ankle joint examinations and assessed sagittal radius of the talus, talus height, and mediolateral and anteroposterior width of the distal tibial joint surface. They found that compared with controls, the medial, midsagittal and the lateral sagittal arc radii of osteoarthritic tali were significantly larger. There was also a statistically significant difference in the height of the contrasting talar, and the wide and sagittal curvature of the distal tibia was significantly larger in OA ankles. Researchers concluded that flattening of the talus appeared to be more pronounced in the frontal area, and the distal broadens anteroposteriorly.


A recent study found that 20 percent of patients with a history of surgery or open fracture treated for nonunions had positive intraoperative cultures from the surgery. Of more than 660 cases, 453 were found to be at risk of indolent infection due to surgical history, infection or open fracture. Despite the presence of inflammatory markers, 20 percent of cases had "surprise" positive cultures. Nine percent were cause by probable contaminants with no antibiotics provided. Eighty percent of patients who received antibiotics initially healed while 14 percent remained infected.

Practice Management

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Here are five areas to focus on to ensure your practice experiences its best year yet in 2016:

1. Billing: Analyze billing at the end of the year. Make sure to take an honest look at your billing system's effectiveness. In addition, consider examining the billing software your business uses, and keep your eye on the ultimate goal of improved cash flow.
2. Inventory: Determine what areas of your inventory optimization process need to be fixed, and do a thorough inventory analysis. Update any inventory software.
3. Taxes: Research how to streamline your tax return process. Remember, if you have software for billing and inventory, it will make the process much easier.
4. Personnel: Assess your staff and identify which employees or departments are not producing adequately. If more training is required, invest time and effort into those improvements. If your employees are not responding, it could mean turning to performance reviews.
5. Patient communication: Constantly strive to achieve success in your patients' eyes. Ensure they feel satisfied and improve services constantly. Additionally, hold patients accountable when they miss payments, and do your best to improve upon existing relationships.

Doctors training to be surgeons can work longer shifts without harming patients, according to a study in The New England Journal of Medicine. The study tracked patient outcomes after loosening the rules for doctors in 58 surgical residency programs. Compared with 59 programs keeping with established rules, the patients did not die or suffer more complications. The rules exist due to complaints from residents about sleep deprivation and overworking. They were enacted in 2003 and strengthened in 2011 but have now faced pushback from program directors concerned that the rules are potentially dangerous. They limit training possibilities for residents and also increase the number of occasions where a resident needs to leave in the middle of treating a patient to adhere to the guidelines. While the results have been corroborated by previous studies, some groups agree with these doctors. Public Citizen and the American Medical Students Association said the study was never likely to find significant differences because most elements of patient care remained unchanged. Dr. John Birkmeyer, chief academic officer at Dartmouth-Hitchcock, offered a solution. In an editorial, he argued that instead of rolling back on duty hours, surgeons should find safer ways to treat patients without relying on “overworked” residents.


Nearly 29 percent of hospitals are increasing spending on IT security, according to a new IDC study. Experts agree that healthcare data is among the most valuable commodities on the black market, and security upgrades are a must to protect sensitive information. The report indicated greater awareness of the need for increased security funding, but there are still signs of noncommittal. While about half of smaller and medium-sized hospitals invested in data security upgrades, only 33 percent of larger hospitals did the same. For larger hospitals, cloud security appears to be a more pressing concern, with 43 percent reporting that it is the highest priority. The increase in cyber awareness is due to the increase in health data breaches, including incidents with Anthem, Premera Blue Cross and Excellus, breaches that affected nearly 100 million individuals. The top ten healthcare breaches were tagged as "hacking/IT incidents," and 98 percent of incidents were caused by cybersecurity issues.


As payers establish stiffer quality metrics tied to reimbursement levels, providers must adapt and learn to properly analyze clinical data, according to a new report. Study author Brian Murphy said providers should expect Medicare to look more seriously at outcomes when it comes to setting payment rates. To adjust, providers will need a mix of information technology that supports data exchange. Electronic health vendors have already made progress and their analytic capabilities are starting to become more adept, but much work needs to be done. Many vendors excel at handling multiple types of data, and providers must find a way to get better deals out of these vendors.

Health Policy and Reimbursement

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1. Pay attention to revenue cycle compliance. Make sure that practitioners are set up and working adequately and that your expectations are in line across the board. Just because something has been done a certain way does not necessarily mean change is to be ignored.
2. Do not operate in maintenance mode. Do not simply try to maintain your revenues. Strive to improve current performance levels and net revenue while maximizing cash flow, and always consider cutting costs.
3. Automate to reduce likelihood of human error. Redundant tasks will inevitably yield mistakes at some point, so focus on automating certain processes. For example, automate your accounts receivable system to identify issues quickly and efficiently.
4. Keep track of expenses in, expenses out. You can never monitor your expenses too much. Incessant monitoring ensures you will not miss anything important. Work closely with providers and personnel to catch any errors.
5. Build up the expertise level of your staff. Be sure that the knowledge of your staff aligns with revenue cycle goals so that your practice can maximize profits. Educate them on the different facets of the revenue cycle.

New York and Minnesota are using a provision in the federal health law to create a "basic health program" for people with limited means. These programs are for people just above the Medicaid cutoff who would otherwise qualify for subsidized coverage on the health insurance marketplaces. Like marketplace plans, basic health program plans need to cover the 10 essential health benefits and need to be at least as affordable as those plans. More than 350,000 New Yorkers and more than 125,000 Minnesotans can now pay $20 per month or less for comprehensive health insurance with no deductibles and low copayments. The coverage is significantly more affordable than the alternative subsidized marketplace plans. The New York plan, for example, allows someone with an income of $23,540 to pay the monthly $20 premium with $15 copays, with a maximum out-of-pocket cap of $2,000. Compared with the least expensive New York plan available on the federal market, someone with an income of $24,000 would have a $131 premium and $30 copayments, with a maximum spending limit of $5,450. New York and Minnesota were already providing Medicare for many people now eligible for their basic health plans, so this move is economical, but for other states, the move would be expensive as it would be an expansion of coverage.


Lawmakers have introduced a new bipartisan bill aimed at expanding telehealth services while reducing healthcare costs. "Telehealth is the future of healthcare. It saves money and improves health outcomes," said Sen. Brian Schatz (D-Hawaii). The bill, known as the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, will try to improve healthcare in America by saving money and making the experience more convenient for patients. It would slash costs for patients and providers by using alternative payment methods and removing reimbursement restrictions under Medicare. Some estimates claim that the bill could save $1.8 billion over 10 years.

Medicine, Drugs and Devices

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The device industry is stepping forward to help hospitals calling for more efficient technology. Hospitals around the country have raised concerns that device prices have become too high. Now, three of the biggest makers of medical technology, Medtronic Plc, Abbott Laboratories and Stryker Corp., have announced acquisitions that target healthcare efficiency and quality, a move that could have major repercussions moving forward. As cost of care increases, device manufacturers are looking for ways to cut costs, changing the way they do business in the name of frugality. Both hospitals and health insurers claim that these prices must fall or care will suffer. Each of the deals bolsters the acquirers’ offerings in ways that address the needs of doctors and hospitals to control spending while reducing errors and waste.


Medical device security will continue to be an important focus in 2016, according to security researcher Billy Rios. Rios rose to prominence last year after pointing out infusion pump vulnerabilities to the U.S. Food and Drug Administration (FDA). He has found other devices with thousands of vulnerabilities, both known and unknown. He expects FDA to issue more advisories in 2016, and he also believes the Department of Homeland Security will increase its role as well. He said he is working with several organizations to develop a formal methodology for determining whether a given vulnerability poses a risk to patient safety. FDA recently released draft guidance for device manufacturers to address security issues.


Investment in on-demand healthcare is expected to quadruple by 2018, according to a report by Accenture released Tuesday. "On-demand healthcare is fundamentally changing—and enriching—the doctor-patient relationship, making the physician much more accessible to patients while simultaneously reducing costs," Kaveh Safavi, MD, JD, senior managing director for Accenture's global health business. "With no end to this type of investment in sight, there's an enormous opportunity for companies to offer fast, convenient and customized user experiences that ultimately improve the patient experience and outcomes." The industry, which was just worth $250 million a few years ago, is predicted by Accenture to top $1 billion by the end of 2017. The adoption of telehealth services—whether online, via smartphone or at a walk-in clinic—is driven by several factors. Primarily, payer support and consumer support have both increased, with large health plans and even the U.S. Centers for Medicare and Medicaid Services starting to reimburse for virtual care, and more consumers owning mobile devices that make the on-demand care platforms more accessible. Cost is another factor, as virtual visits have become a more economical alternative to an in-person visit. Telehealth services are also becoming more culturally accepted, especially among younger generations and seniors.