February 15, 2017 | | JFAS | Contact Us

News From ACFAS

Ready for ACFAS 75?
We’re counting down the days until the 75th Anniversary Scientific Conference February 27–March 2 at The Mirage in Las Vegas! As you prepare for your trip, follow these handy tips for a smooth and successful conference experience.
  1. Check Las Vegas’ forecast before packing. Vegas is known for warm temps and sunshine, but late winter can be cool. Bring your jacket or sweater and dress in layers to stay comfortable.

  2. Download the ACFAS 75 app from your app store by searching for ACFAS 2017 and sign in with your custom login to access your conference schedule, updates, interactive maps, exhibitor lists and more through your device. Your personal access information will be emailed to you in the next week.

  3. Registration opens at 1pm on Sunday, February 26. Come to the registration area early to pick up your materials.

  4. Wear your conference badge at all times for security purposes. Your badge is required for attendance at sessions, meeting, receptions and Exhibit Hall events.

  5. Use #ACFAS75 in your social media posts and searches.

  6. Meet up with your colleagues at special events. Start with the Premier Connection opening reception then continue with industry-sponsored breakfasts and after-hours events, the ACFAS Honors and Awards ceremony and the Wrap Party in the LINQ entertainment promenade.

  7. Visit the Exhibit Hall to chat with vendors, have lunch, enter prize drawings, update your professional headshot and walk through the scientific poster display.

  8. Use the ACFAS 75 mobile app to evaluate the sessions you attend. Your input matters!

  9. Complete your postconference evaluation to share your thoughts and suggestions.

  10. Have fun celebrating 75 years of ACFAS!
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Register Now for 2017 Coding & Billing Seminars
Reserve your spot for ACFAS’ back-by-popular-demand seminar, Coding and Billing for the Foot and Ankle Surgeon, this year scheduled for July 21–22 in Philadelphia and October 13–14 in Phoenix.

Through interactive discussion and the chance to code realistic patient scenarios, you’ll learn new trends in surgical coding and how to get properly reimbursed for the care you provide. Expert faculty will also show you how to select the correct modifiers for complex, staged and multiple-procedure cases and where higher-level office visits fit into your surgical practice.

Visit to register and make 2017 the year you simplify and streamline your coding and billing process.
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Attend Your Division Meeting at ACFAS 75
Want to find out about ACFAS activities close to home? Attend your ACFAS Division meeting during the 75th Anniversary Scientific Conference February 27–March 2 at The Mirage in Las Vegas!

Each Division will hold a meeting of its members in conjunction with ACFAS 75 this month. Join your fellow local colleagues to meet and network with your Division officers and have a hand in the plans for your Division this coming 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 75 mobile app and on signage at the conference.

All ACFAS members who attend their Division meetings will be placed in a drawing to win one of four $250 AMEX gift cards. Look for your raffle ticket in your registration packet.
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Foot and Ankle Surgery

Simultaneous First MT Lengthening and MTP Joint Fusion for Failed Hallux Valgus Surgery with Transfer Metatarsalgia
Failed hallux valgus surgery may be associated with recurrent hallux valgus as well as transfer metatarsalgia. A study described a technique concerning the combination of fusion of the first metatarsophalangeal (MTP) joint and lengthening of the first metatarsal (MT) through a scarf osteotomy following a failed hallux valgus surgery. Six patients who had experienced a failed surgery with shortening of the first MT and degenerative changes in the first MTP joint underwent the proposed technique. After six months, all patients had complete healing of the osteotomy and arthrodesis sites. Patients were asymptomatic and fully active.

From the article of the same title
Foot and Ankle Surgery (03/01/17) Vol. 23, No. 1, P. 8-11 Chowdhary, Ashwin; Drittenbass, Lisca; Stern, Richard; et al.
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Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network
A study investigated predictors of recovery from drop foot resulting from degenerative lumbar diseases using a Bayesian network model as a decision support tool. Researchers treated 102 patients who had drop foot attributable to degenerative diseases with decompressive lumbar spine surgery. The two outcomes of interest were postoperative tibialis anterior muscle strength of three or greater and posttibialis anterior strength of four or greater at two years after surgery. Two separate Bayesian network models were developed for the outcomes of interest. Both Bayesian models showed that weaker muscle power before surgery and longer duration of neurologic injury before treatment were associated with a decreased chance of return of function by two years. Age, herniated soft disc and leg pain were determined to be indirect predictors. The probability estimates of posttibialis anterior muscle strength of three or greater and posttibialis anterior muscle strength of four or greater were 94 percent and 85 percent, respectively, in the most favorable conditions and 18 percent and 14 percent in the least favorable conditions.

From the article of the same title
Clinical Orthopaedics and Related Research (03/01/17) Vol. 475, No. 3, P. 872-880 Takenaka, Shota; Aono, Hiroyuki
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RSO in Hemophilic Arthropathy: Pathologic BPI on Pretherapeutic Bone Scintigraphy Is Not a Predictor of Treatment Success
In a recent study, researchers assessed the value of pretherapeutic blood pool imaging (BPI) for successful radiosynoviorthesis (RSO) in patients with hemophilic arthropathy. Thirty-four male patients underwent RSO after conservative treatment failed. Pretreatment triple-phase bone scintigraphy showed hyperemic joints in 17 patients, and 17 other patients had no increased tracer uptake on BPI. Patients were evaluated after six months by measuring changes according to the visual analog scale (VAS), bleeding frequency and range of motion. Pain relief occurred in 76.5 percent of patients, and the mean VAS decreased from 7.7 to 4.6. Joint bleeding frequency decreased from 4.5 to 2.1. No significant improved was observed for range of motion. For pain relief and bleeding frequency, patients experienced similar benefits from RSO regardless of pretreatment BPI.

From the article of the same title
European Journal of Nuclear Medicine and Molecular Imaging (03/17) Vol. 44, No. 3, P. 461-467 Sabet, Amir; Strauss, Andreas Christian; Schmolders, Jan; et al.
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Practice Management

How to Combat TV Drug Ads the Right Way
Prescription drug advertisements can generate unnecessary demand among patients, leading to time-consuming conversations that are otherwise not needed. Pharmaceutical marketers say direct-to-consumer advertising (DCTA) provides consumers information with which to make health decisions, but most research indicates the ads result in excessive costs for patients and payers. Surveys conducted by the World Health Organization show that physicians often will prescribe a drug if a patient asks for it by name. When a patient requests a drug that the physician would not ordinarily choose to prescribe for them, practitioners should explain their reasoning without dismissing the patient’s concerns. Physicians should act as their patients’ ally and consider factors that may be important to them, such as cost efficiency. Patients can be advised that heavily advertised drugs typically are new and expensive, while equally effective generics can save money for the patient and their insurer. When a drug is prescribed that is different from the one requested by the patient, the physician can assure the patient that the decision can be revisited later.

From the article of the same title
Medical Economics (02/06/17) Dawson, Milly
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CMS Extends 2016 Physician Quality Reporting System EHR Deadline
The deadline for 2016 Physician Quality Reporting System electronic health record (EHR) submissions, originally scheduled for February 28, has been extended to March 13. The EHR data submissions apply to eligible professionals, Physician Quality Reporting System group practices, qualified clinical data registries and qualified EHR data submission vendors. Those who do not report their quality measure data under 2016 Quality Reporting Document architecture requirements will receive downward payment adjustments for Medicare Part B Physician Fee Schedule services in 2018.

From the article of the same title
Becker's Health IT (02/06/2017) Cohen, Jessica Kim
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Study: Docs Spend More Time with Computers Than Patients
Doctors spend up to three times as much time with computers as they do with patients, according to a new study published in the Annals of Internal Medicine. Researchers focused on the day-to-day activities of 36 residents recorded between May and July 2015. They monitored the doctors' daily activities in real time using tablets, for a total of nearly 700 hours. On average, doctors spent about 1.7 hours a day with patients and 5.2 hours on computers, with about 13 minutes spent doing both. The distribution of time across activities was similar to those working night shifts, and doctors also spent a good amount of their after-hours time on computer tasks. Doctors report that time spent inputting data into electronic health records, searching for information and other computer tasks cuts into time with patients and contributes to their exhaustion and burnout.

From the article of the same title
Fierce Healthcare (01/31/2017) Minemyer, Paige
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Health Policy and Reimbursement

GOP Ramps Up Effort to Transform Medicaid into Block Grants
Congressional Republicans are debating plans to overhaul Medicaid and transition to a block grant or other capped spending program. Under the proposed system, Medicaid would transform from an open-ended entitlement program to one in which states receive a lump sum that they would control. A move to block grants has long been on the agenda for congressional Republicans, but Republican governors have raised concerns about the significant transfer of risk from the federal government to the states. Of the 16 states with Republican governors that expanded Medicaid coverage under the Affordable Care Act, several have said they want to keep the expansion if the health law is repealed. Some governors indicated they would welcome the flexibility of block grants depending on how the grants' amounts are determined.

From the article of the same title
Wall Street Journal (02/09/17) Levitz, Jennifer; Armour, Stephanie
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Trump Extends Timetable to Replace Obamacare
President Donald Trump has indicated that plans to overturn and replace the Affordable Care Act (ACA) may not be initiated until next year. In an interview with Fox News’s Bill O’Reilly, Trump said Congress should have the “rudiments” of the plan by the end of this year, but a full repeal might not come until 2018. Trump’s remarks appear to reflect congressional Republicans’ current predicament in fulfilling their ambition to strike down the ACA. Republicans’ slim majorities in the House and the Senate leave little room for defections by moderate or conservative GOP lawmakers seeking irreconcilable approaches. At least three Republican senators have said they are unwilling to vote to unravel the ACA without a new policy in place.

From the article of the same title
Wall Street Journal (02/05/17) Radnofsky, Louise
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About 9.2 Million Americans Sign Up for Health Plans on Federal Exchange
About 9.2 million Americans enrolled in the Affordable Care Act’s exchange by the January 31 deadline, down slightly from 2016’s 9.6 million enrollees. Roughly a third of this year’s enrollees bought policies through the exchange for the first time. About 400,000 consumers signed up during the final two weeks of enrollment, compared with nearly 700,000 in the same period last year. Following a Republican victory at the ballots in November, analysts had predicted enrollments would fall short of the 13.8 million projected by the Obama administration in October. Supporters of the health law say President Trump’s pledge to overhaul the system undercut confidence in policies bought through the exchanges. The administration has also been accused of rolling back prepaid advertising for the ACA that reminded consumers of the upcoming deadline.

From the article of the same title
Wall Street Journal (02/03/17) Hackman, Michelle
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Medicine, Drugs and Devices

Adults Urged to Get Vaccinated
Vaccination coverage rates for adults in the United States are poor, according to a new report from the Advisory Committee on Immunization Practices (ACIP) published in Annals of Internal Medicine. Just 44 percent of adults over the age of 19 have had a flu shot, 20 percent have had a Tdap vaccine and 20 percent of 19-to-64-year-olds at risk of pneumonia have had that vaccine. Less than 30 percent of those over 60 were vaccinated against herpes zoster, which reduces the risk of shingles by half. The ACIP guidelines recommend that all adults receive influenza vaccinations every year, a tetanus booster every 10 years, two pneumococcal vaccines when they turn 65 and a vaccine to prevent shingles when they turn 60. ACIP liaison Dr. Sandra Fryhofer also notes the racial, ethnic and economic disparities in vaccination rates; whites are more likely than all other groups to be vaccinated, and adults with health insurance are two to five times more likely to be vaccinated. “It’s a double whammy for those without insurance,” says Fryhofer. “They don’t have insurance coverage if they get sick, and they don’t have insurance coverage to pay for vaccinations that can help them stay well.”

From the article of the same title
Reuters (02/07/17) Larkin, Marilynn
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New Study Is an Advance Toward Preventing a 'Post-Antibiotic Era'
Researchers at the University of California, Los Angeles are exploring ways to address the threat of antibiotic-resistant bacteria. In 2016, they reported that combinations of three different antibiotics can often overcome bacteria's resistance to antibiotics, even when none of the three antibiotics on their own, or even two together, are effective. Their latest work, which has been published online and in the Journal of the Royal Society Interface, extended their understanding of that phenomenon and identified two combinations of drugs that were unexpectedly successful in reducing the growth of E. coli bacteria. A key to the study was realizing that the combinations of antibiotics must be chosen carefully and systematically. By evaluating drug combinations on plates in a lab, the researchers were able to develop a mathematical formula for analyzing how three or more factors interact and to explain complex, unexpected interactions. The researchers now are using the mathematical formula to test combinations of four antibiotics. The scientists tested every possible combination of a group of six antibiotics, including 20 different combinations of three antibiotics at a time. They found that among the three-drug combinations, two were noticeably more effective than they had expected. Those groupings used treatments from three different classes of antibiotics, so the combinations used a wide range of mechanisms to fight the bacteria. Five of the three-drug combinations were less effective than they expected, and the other 13 groupings performed as predicted.

From the article of the same title
UCLA Newsroom (02/07/17) Wolpert, Stuart
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Advisory Committee Recommends Recording Medical Device IDs in Claims
The X12 committee has recommended changes to enable the standard health insurance claim form to record the identifying codes for implanted medical devices. The proposed revisions to the routine claims forms that hospitals submit to Medicare and private insurance companies could result in data that would help the U.S. Food and Drug Administration, clinicians, hospitals and patients better understand the long-term safety of artificial hips, cardiac stents and other life-changing medical implants. Insurance claims forms presently lack key data on medical device brands and models. Hospitals, providers, health plans and patient organizations have long sought such changes. Members of Congress, such as Sens. Chuck Grassley (R-Iowa) and Elizabeth Warren (D-Mass.), also support the move. The key advisory committee, made up of hospital and health plan billing administrators, still must finalize its recommendations, which would then be reviewed by other advisory committees and eventually presented to the U.S. Centers for Medicare and Medicaid Services to develop final rules. The process could take a year or more.

From the article of the same title
Pew Charitable Trusts (02/01/17) Moscovitch, Ben
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Virtual Reality Can Make the Pain of Surgery Easier to Bear
Virtual reality (VR) could be used as an alternative to sedation during minor surgeries, according to José Luis Mosso Vazquez, a surgeon in Mexico City who has performed more than 350 operations using VR. The distraction technique, used in conjunction with local anesthetic, has seen some success in alleviating patient anxiety and pain during surgery. In one study of 140 patients undergoing surgery, Mosso’s participants using VR reported 24 percent less pain and anxiety during surgery than a control group. VR also halved the amount of sedation patients needed, and many patients did not need to be sedated at all. According to Mosso, using VR as a supplement or alternative to sedation could reduce the cost of surgery by about 25 percent. Cutting drug doses also would reduce complication risks and recovery times for patients. Mosso’s most successful results using VR are in minor day surgery, including procedures to remove lipomas, cysts and hernias.

From the article of the same title
The Atlantic (01/31/17) Marchant, Jo
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This Week @ ACFAS
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Mark A. Birmingham, DPM, FACFAS

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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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