News From ACFAS

---

The countdown to ACFAS 2015 is on! As you prepare to travel to Phoenix, use this handy checklist to make the most of your conference experience.

1. Download the ACFAS 2015 mobile app. Visit http://m.core-apps.com/acfas2015, search your app store for ACFAS 2015 or head to acfas.org/phoenix to download the app and access your personalized conference schedule.

2. Check Phoenix’s forecast. Sunshine and warm temperatures are expected, but check the weather and pack accordingly.

3. Bring a sweater or jacket. Convention center rooms are kept cool, so wear layers to be comfortable.

4. Head to the registration area early. Sign in, pick up your materials and dive right into ACFAS 2015 as soon as you arrive in Phoenix!

5. Wear your badge. Your conference badge is required for attendance at sessions, meetings, receptions and Exhibit Hall events.

6. Follow #ACFAS 2015 on social media. Use #ACFAS2015 in your Twitter and Facebook posts and to search social media for conference updates.

7. Socialize at special events. ACFAS 2015 has plenty of opportunities for you to mingle with your colleagues. Network at the Premier Connection Opening Event, enjoy industry-sponsored satellite breakfasts and after-hours gatherings and top off your conference experience with the Wrap Party at Chase Field.

8. Check out the Exhibit Hall. Attend the HUB sessions, meet exhibitors, look for a new position or potential candidates at the ACFAS Job Fair and have your headshot taken by a professional photographer.

9. Complete your post-conference evaluation. Share your feedback via the app or the printed evaluations available at the conference.

Keep checking your ACFAS 2015 mobile app for the latest conference news and updates. We can’t wait to see you in Phoenix! Are you ready for your close-up? A professional photographer will once again be available in the Exhibit Hall in Phoenix to take free headshots for your resumes and social media profiles. All photo sessions include a brief meet and greet with a makeup artist to make sure you’re picture-perfect and photo-ready.

Stop by the photo booth on Friday, Feb. 20, 9:30am–4:30pm or Saturday, Feb. 21, 9:30am–2pm to have your picture taken. You’ll receive a hardcopy print of your headshot that day as well as a digital version via e-mail. Want to find out about ACFAS activities close to home? Visit your ACFAS Division meeting at ACFAS 2015 in Phoenix!

All Divisions hold meetings at the conference to allow members to have a hand in their Division’s plans for the upcoming year. Plus, it’s a great way to meet and network with Division officers and other members in your area.

Meetings are scheduled during conference lunch breaks at reserved tables in the Exhibit Hall. A complete schedule of meetings is listed on the ACFAS 2015 mobile app, in the conference program 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. Are you ABFAS-certified in foot and ankle or reconstructive/rearfoot ankle and want to put your surgical skills to the test? Consider applying to register for Total Ankle Arthroplasty, April 18–19, in Denver.

If you meet the course prerequisites, you’ll spend an entire weekend performing primary implantation and revision implants of all FDA-approved ankle replacement systems. Expert faculty will share case studies, as well as their own experiences, to help guide you in the OR.

Visit acfas.org/education to apply for this challenging hands-on course designed to build your surgical skills repertoire.

Foot and Ankle Surgery

---

A genome-wide association study of clinically defined gout cases was conducted, using 945 patients with the disease and 1,213 controls in a Japanese male population, to clarify associations between genetic variation and clinical subtypes of gout. This was followed by a replication study of 1,048 clinically defined cases and 1,334 controls. Five gout susceptibility loci were identified at the genome-wide significance level containing established urate transporter genes (ABCG2 and SLC2A9) as well as three additional genes: GCKR, MYL2-CUX2 and CNIH-2. MYL2-CUX2 and CNIH-2 are classified as novel gout loci. Moreover, among the identified single-nucleotide polymorphisms (SNPs), the study showed the SNPs of ABCG2 and SLC2A9 had differentially associated relationships with gout types and clinical parameters underlying specific subtypes, namely renal underexcretion type and renal overload type. The impact of the risk allele of each SNP on clinical parameters exhibited significant linear relationships with the ratio of the case-control ORs for two distinct types of gout for urate clearance and for urinary urate excretion.


A study was conducted to determine the medium-term patient-reported and radiographic results in patients receiving surgery for hallux valgus. A total of 118 patients and 162 feet underwent surgery between January 2008 and June 2009. The Manchester-Oxford Foot Questionnaire (MOXFQ) was employed to assess the post-surgical outcome. At an average of 5.2 years post-operatively, the median combined MOXFQ score was 7.8, while the respective median domain scores for pain, walking/standing and social interaction were 10, 0 and 6.3. A full 119 procedures were reported as satisfactory but just 53 feet were completely asymptomatic. The average correction of hallux valgus, intermetatarsal and distal metatarsal articular angles was 18.5 degrees, 5.7 degrees and 16.6 degrees, respectively. Multivariable regression analysis ascertained that an American Association of Anesthesiologists grade of greater than 1 and recurrent deformity were associated with substantially worse MOXFQ scores. No correlation was observed between the severity of deformity, the type or degree of surgical correction and the outcome. Use of a validated outcome score for the evaluation of post-surgical outcome showed long-term results are worse than anticipated in comparison with the short- and mid-term outcomes, with 25.9 percent of patients dissatisfied at an average follow-up of 5.2 years.


Researchers conducted a study to test the effect of clostridium collagenase ointment plus negative-pressure wound therapy (NPWT) in the treatment of six patients with diabetic wounds. The patients were chosen on the basis of a recurrent mixed fibrotic and granular wound base. They were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. They were monitored until healing, with visual representations of wound progression and time to full healing recorded. Concurrent application of these therapies appeared to accelerate wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. However, two patients were unable to reach full healing due to ulcer recurrence, possibly a result of their significant comorbid nature.

Practice Management

---

A physician practice can better attract and retain patients by following these tips:

1. Make sure the person answering the phone gives a good impression of the practice and is professional, caring and sympathetic.

2. Ensure staff members make patients feel welcome by acknowledging them, being friendly and explaining the examination process.

3. Ensure HIPAA guidelines are appropriately satisfied. For example, staff should not discuss patients' personal information publicly.

4. Train staff to speak quietly and thoughtfully.

5. Keep the waiting area and restroom clean.

6. Ensure the practice's support staff listens to patients.

7. Implement a solid and intact billing process and respond quickly to remedy patients' complaints.

8. Establish an online presence and use patient feedback as a way to improve practice behaviors, when necessary.


Strong practice managers have a talent for listening to employees in both individual meetings and at the group level, and managers can follow several strategies to foster this skill, such as:

1. Prioritizing listening. Managers should refrain from an impulse to talk or interject and should embrace a mindset that will enable them to hear what is being shared.

2. Being aware of your limitations so you can recognize what hinders you from listening. Extroverted and conversational practice managers typically dominate dialogues, while more introverted managers tend to be more empathic listeners. When managers are evaluating their own habits, they also should consider their upbringing.

3. Eliminating distractions by silencing phones, turning off your desktop monitor and putting away anything with the potential to divert attention from the conversation at hand.

4. Looking for nonverbal signals from employees. Managers should acknowledge the information they receive with such questions as “You seem excited about this. Can you tell me more?” or “I get the sense that this upsets you. Is there anything you need to share?”

5. Keeping your reactions, such as strong disagreement, under control. One way to do this is to practice sitting still, staying silent and avoiding the impulse to react or contradict.

6. Validating and asking clarifying questions to avoid assumptions.

Health Policy and Reimbursement

---

The new budget proposed by President Obama on Feb. 2 included numerous provisions aimed at cutting nearly $400 billion in spending out of Medicare, Medicaid and other Department of Health and Human Services programs over the next ten years. Among the cuts are a reduction in Medicare payments for graduate medical education by $16 billion and changes to prescription drug reimbursement, which is expected to save $116 billion. Other drug-related savings, estimated at $11 billion, would come from banning certain deals between drug manufacturers that the administration claims delay the marketing of generic drugs. The proposed budget would attempt to save $100 billion by reducing inflation updates for healthcare providers that care for Medicare beneficiaries after they are discharged from hospitals. Another $43 billion would be saved by "improving payment accuracy" in Medicare Advantage plans. The budget also seeks to bring in $66 billion over 10 years by increasing premiums for some higher-income Medicare beneficiaries. More savings would come from reducing Medicare payments to hospitals for "bad debt," or the share of bills they cannot collect from beneficiaries.


In a post on the official Centers for Medicare and Medicaid Services' (CMS) blog last week, Patrick Conway, CMS chief medical officer and deputy administrator for innovation and quality, wrote that the agency is considered additional rulemaking that would reduce meaningful use requirements in 2015. Conway wrote that the new rule would be published in the spring and is "intended to be responsive to provider concerns about software implementation, information exchange readiness and other related concerns in 2015." Among the proposed changes is shortening the EHR meaningful use reporting period in 2015 from a full year to 90 days. Other considerations include aligning meaningful use reporting periods with the calendar year and altering other aspects of the program to conform with long-term goals and to reduce complexity.


The U.S. government will start publishing Medicare physician-payment records on an annual basis and will solidify public access to how vast amounts of money are spent on healthcare. “The cost of healthcare is soaring, and we really need to get a handle on where the money is going,” says National Physicians Alliance President-Elect William B. Jordan. “I don’t think you can do that without transparency.” A spokeswoman for the Centers for Medicare and Medicaid Services (CMS) says the government had opted “to update the data annually” despite the concerns of physicians' groups. American Medical Association (AMA) has long contended a physician's right to privacy preempts the public's interest in how tax dollars are spent. The association has called on the Department of Health and Human Services not to issue any more payment information before improving the data set, warning information published last spring, covering payments in 2012, had inaccuracies and exposed its members to “sensationalist” news coverage. In a 2014 letter to CMS, AMA said any new data should provide more context for the services physicians performed. For example, total payments might seem high for some providers if they reflect several people from one office billing under a single provider number. AMA also cautioned the data did not always represent what physicians actually earned in income under Medicare.


The U.S. Department of Health and Human Services has proposed a plan to move most doctors, hospitals and their patients to national standards for handling electronic clinical data by the end of next year. National health information technology standards would help move the country away from a fee-for-service healthcare system. "We are especially pleased that the new roadmap focuses on interoperability not just among providers, but also patients and their family caregivers, recognizing them as equal partners in the continuum of care," Debra Ness, president of the National Partnership for Women & Families, said in a statement.

Medicine, Drugs and Devices

---

A study published in the International Journal of Medical Informatics found that WhatsApp Messenger can be used for viewing certain types of CT scans and radiographs. Researchers in Brazil got the idea to test WhatsApp, a popular messaging app, after reading a 2013 paper in Foot & Ankle International that assessed the utility of using mobile phones for interpreting ankle radiographs. WhatsApp was chosen over traditional text services because it allows users to send uncompressed, full-resolution images. Using an Apple iPhone 5, the researchers photographed hardcopy images of selected radiographs and CT scans from 14 patients who had been treated for tibial plateau fractures. They had the images independently classified by three consultants and then asked six orthopedic surgeons, each with more than 10 years of experience, to view the anonymized cases using WhatsApp on their own iPhones on two separate occasions 15 days apart.


Sources report U.S. Food and Drug Administration (FDA) Commissioner Margaret Hamburg is resigning after almost six years in office. Her position will be filled by chief FDA scientist Stephen Ostroff until a new commissioner is named. Hamburg's resignation comes as FDA prepares for what could be significant changes driven by both initiatives in Congress to further accelerate new drug development and by food safety proponents who desire the establishment of a separate agency merging the food safety functions of FDA and the Department of Agriculture.


The U.S. Food and Drug Administration (FDA) has requested $4.9 billion from the fiscal 2016 federal budget, up 9 percent from the previous year. That figure includes $109.5 million in funding for the Food Safety Modernization Act. "This budget accurately reflects the challenges FDA faces in a global regulatory environment, which is becoming increasingly complex and scientifically demanding," Commissioner Margaret A. Hamburg said. "As FDA's mission expands on several fronts—from the regulation of tobacco products to supporting the development of personalized medicine to ushering in a new era of food safety—we must possess the resources to run a modern agency that fosters innovation and ensures the safest possible drug and food supply for the American people."