News From ACFAS

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Thanks to YOU—ACFAS 2016 broke yet another record in Austin last week! With attendance surpassing last year’s numbers by 17 percent, this was the College’s biggest conference ever! More than 1,750 attendees and 140 exhibiting companies united in the great state of Texas to experience all that ACFAS and Austin had to offer!

“This year’s record-breaking conference proves ACFAS continues to be attuned to the needs of its membership,” said Sean T. Grambart, DPM, FACFAS, president of the American College of Foot and Ankle Surgeons. “Our members count on us each year to provide superior educational sessions and workshops that represent the very latest in foot and ankle surgery, and ACFAS 2016 delivered! Thank you to the Annual Scientific Committee for once again exceeding expectations and for finding new ways to keep the conference fresh and exciting. Plus, a big thank you to the attendees and exhibitors for joining us in Austin to help make ACFAS 2016 a huge success; we couldn’t have done it without you,” Dr. Grambart added.

See you next year in Las Vegas for our much-anticipated 75th Annual Scientific Conference, February 27–March 2, 2017!
Use our free Fill-in-the-Blanks Press Release to let your patients and community know you’ve attended ACFAS 2016 in Austin. Log in to acfas.org and head to the Marketing Toolbox to download the template. Open the template and fill in the blanks with your professional contact information then fire it off to your local media, include it in your newsletter or on your website and post it to your social media sites.

Throughout the year, take advantage of the many other free promotional tools available at acfas.org/marketing, such as the seasonal FootNotes patient newsletter, PowerPoint presentations on foot and ankle conditions and infographics designed to streamline your patient education efforts.
Congratulations to Troy J. Boffeli, DPM, FACFAS, recipient of the 2016 ACFAS Distinguished Service Award. Each year, ACFAS recognizes those who go above and beyond in volunteering their time, expertise and service to advance the College’s mission. This prestigious award is presented each year at the Annual Scientific Conference.

Thank you, Dr. Boffeli, for your exceptional service to the College and the profession!
Mark these important dates on your calendar to stay one step ahead of Meaningful Use and PQRS:

Meaningful Use
Jan. 4–March 11, 2016
Medicare Attestation for 2015 EHR Submission Period

Physician Quality Reporting System (PQRS)
March 11, 2016
Last day to submit 2015 claims for 2017 payment adjustment

Foot and Ankle Surgery

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Perfusion angiography (PA) is a post-processing software algorithm. A study was conducted to assess the effectiveness PA of the foot in patients with chronic critical limb ischemia (CLI). Data from 89 patients with CLI was used to test PA's feasibility. Sixty-eight patients were deemed suitable for the test. In 59 of them, PA showed an increase in volume flow in the foot after successful angioplasty of the crural vessels. The other nine patients showed no increase. Researchers concluded that PA could be used as a new endpoint for lower limb revascularization. It can also be used to identify certain types of patients with CLI.


A new technique can be used to correct foot drop in patients with common peroneal nerve palsy while also addressing the loss of toe extension that traditional methods miss. The new technique releases and transfers the flexor hallucis longus tendon and flexor digitorum longus to the toe extensors along with the anterior transfer of the posterior tibial tendon and was performed on 15 patients with complete common peroneal nerve palsy. The results were excellent in 60 percent of patients. Thirty-three percent achieved good results and one patient had moderate results. Toe extension evaluation was excellent in 47 percent, good in 33 percent and moderate in 20 percent. The operation was mostly successful in allowing active toe extension while strengthening ankle dorsiflexion.

Practice Management

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A recent study from Executive Insight found that no-shows can result in billions of dollars of revenue loss. No-shows happen for many reasons, mostly because of the long waits between scheduling the appointment and the actual date of the appointment. In addition, many patients feel better by the time of their appointment. Here are some ways to address the no-show issue:

1. Stop overbooking. Some practices overbook because they think they can fit everyone in when some do not show up. This is risky and can lead to physician burnout and stress, as well as patient dissatisfaction when wait times increase.
2. Telephone reminders. Reminding patients of their appointment 48 hours before they arrive can help fill in gaps and lighten the burden on your schedule.
3. Warning letters. Some physicians address chronic no-show patients differently. One viable option is to send a gentle reminder letter explaining the perils of no-shows and how this activity can prevent others from receiving proper care.

Some people believe that in most industries, the longer you work, the easier your job becomes and the more money you make. This may not be the case in medicine, where rates are federally regulated and determined by insurance companies. Here are a few ways to grow your practice:

1. Marketing. Use marketing as a service to your community. Educate patients about what you do and stress the importance of wellness. Become a resource.
2. Ancillary services. Most specialties have many ancillary services available. Select services that benefit your patients and increase your revenue stream.
3. Think bigger. Consider adding more providers to share current patients and bring in new ones. It will not be easy, but it could help you "move up the ladder."

Your practice website may not seem like a problem, but there is a chance it could come back to haunt you in many ways. Experts agree that careful monitoring of your online presence is critical to managing your brand reputation. Be sure to secure legal rights to any images used, as posting content that is not yours could land you in serious legal trouble even if you had no ill intent. Articulate the appropriate use of your content as well. A blog post dispensing medical advice could be misconstrued as real, official advice. Make sure your website explains that patients with particular health issues should contact the practice to address those concerns. On the technical side, consider purchasing domain names related to your practice. This will make it easier to create new sites and lessens the possibility of someone grabbing a name that could be confused with your practice and posting poor content. It is generally cheap to purchase domains. Finally, determine your strategy for handling negative patient reviews. Even if you believe your practice is perfect, there will always be patients who think otherwise. Do not respond to negative reviews passionately; lay out a strategy to ensure measured, helpful responses.

Health Policy and Reimbursement

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Electronic health record (EHR) documentation is more important for the revenue cycle than ever, and improving the EHR process can benefit your practice. But documentation is not a simple process, and the learning curve can be steep. Documentation is not taught in medical school, so adaptability is key to staying afloat. It is not something to overlook because EHR use is becoming more universal. In 2012 alone, 60 percent of providers used EHRs, and 97 percent of business managers believe that an EHR/practice management system will result in less financial dependence and increased revenue. “It solves your lost charge problems and helps make sure you have the right equipment at the bedside for the patient,” said Jon Rains, CEO of Carrus Hospitals. It does not matter if you are new to medicine or a veteran of many years: many resources are available to make the EHR process more efficient and understandable. Technology is available to analyze outpatient charge capture data, which can enhance the revenue cycle. This and other technologies can help practices focus on staying ahead in the digital age.


The federal government ended use of the Sustainable Growth Rate (SGR) to control spending by Medicare on physician services last year. But the repeal of SGR does not mean the physician payments battle is over. The legislation that ended SGR also aims to establish a new payment system that rewards quality over quantity, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new system will not go into effect until 2020, so practices around the country are preparing for the changes that are in lockstep with the push for value-based payments. In the summer, the administration will finalize new rules on quality reporting and payment policies. This will be a big step toward clearing up the information regarding payments. Federal health officials have vowed to include input from all stakeholders, from patient and provider groups to specialty associations. However, concerns still exist about how ready physicians will be by 2020. Some groups are already calling for a delay of the rule, claiming that five years is not enough time to prepare. This goes hand in hand with an announcement from Former Centers for Medicare and Medicaid Services Administrator Mark McClellan warning that changing doctor payment systems will be a much bigger task than many physicians currently realize.


President Obama unveiled a new budget proposal last week with several areas related to healthcare. The proposal includes Medicare funding for all states that expand or announce that they will expand in the future. The financing will last three full years and treat all eligible states equitably. The budget also funds CHIP, the program that helps provide affordable coverage to children from low-income families, through 2019. Medicaid and CHIP enrollment will be streamlined by proposals to cut out bureaucracy and allow states to use information they have already collected and verified to establish people's eligibility for certain programs. Finally, the budget reinstates health reform's temporary boost in Medicaid payments for primary care services and extends it to more types of primary care providers.


The CONNECT for Health Act could be passed with bipartisan support, substantially increasing Medicare coverage of telehealth and remote patient monitoring. The bill was proposed by Sens. Thad Cochran and Roger Wicker on Feb. 4 with the intent to define telehealth as the use of telecommunications technologies to deliver healthcare, information or education at a distance. This includes video conferencing, remote patient monitoring and store-and-forward technologies. Currently, the Centers for Medicare and Medicaid Services constrain telehealth reimbursement. Patients must be located at certain sites in particular areas, only certain physicians can provide the services and only certain reimbursable telehealth codes are available for use. CONNECT for Health aims to reduce these restrictions and make telehealth more usable. In addition, the measure could save Medicare $1.8 billion over the next decade.


In an article published in The New England Journal of Medicine, Michael E. Porter and colleagues argue that in order to improve value-based healthcare, outcomes measurement must accelerate. It will take a large effort, committing to measuring a minimum set of outcomes for every major medical condition and then standardizing that data nationally and globally. As value-based care continues to rise in importance over volume-based care, the initiative to continue growth is as important as ever. For many reasons, no effective measures have been put in place to standardize outcomes, which compromises the ability to compare performance, spark competition and foster learning. But if providers, payers, patient advocacy groups and regulators work together, they can create a process to agree on these outcomes for important conditions, which can then speed up measurement and efficiency. Some steps have already been taken, such as professional societies beginning to incorporate more outcome measures. If this positive trajectory continues, Porter argues, we will be able to look back at 2016 and wonder why we never committed to outcome measurement earlier.

Medicine, Drugs and Devices

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New technology is allowing surgeons around the country to engage with patients in ways previously considered impossible. The messaging technology, from a California startup called HealthLoop, sends out automated, personalized emails to patients to help improve their satisfaction and help keep them out of the hospital. The concept is known as "automated empathy," and it is used both before and after procedures to help patients and assist overextended surgeons, some of whom can take part in 500 or more surgeries every year. Using HealthLoop's technology, doctors can send daily emails with information timed to milestones in surgery prep and recovery. It can ask patients or caregivers for feedback on issues the patient may be experiencing during recovery. Doctors also have the option of writing their own emails and skipping the automation process altogether. So far, several examples of these emails have saved lives, such as the case of David Larson, who responded to an automated email and was told to come to the hospital to have a life-threatening blood clot removed. Driven by the Affordable Care Act's goal to decrease costs, the technology is one initiative that could contribute to lowering the annual $26 billion cost of Medicare hospital readmissions.


Bakul Patel, associate director for digital health in the U.S. Food and Drug Administration's (FDA) Center for Devices and Radiological Health, wrote a post on the agency's blog to discuss medical device interoperability and its importance. Saying that interoperability shows "great promise for the future," Patel laid out FDA's case for making interoperability a focus in the coming years. FDA has already made strides. In 2012, the agency conducted a Summit on Medical Device Interoperability to identify challenges related to the goal. In 2013, FDA released official guidelines for interoperability, and in 2015, it encouraged manufacturers to begin developing devices with interoperability specifically in mind. Patel says consumers should envision a world where a device collects a patient's vitals during surgery, and instead of manual entry to render it compatible with other functions, the patient would be connected to another device that can further take down data automatically. FDA is collaborating with hospitals, healthcare providers and other organizations to make these dreams a reality. Patel said it is time for all relevant parties to come together and build an ideal interoperability future.


This post from Enrico Coiera discusses the pros and cons of e-health, and makes the argument that the health community must avoid mistakes and maximize the upside of technological innovation to push forward into an evidence-based future surrounded by groundbreaking advances.


The Senate Committee on Health, Education, Labor and Pensions has reviewed a bill that would require manufacturers of reusable medical devices to submit cleaning instructions and validation data to the U.S. Food and Drug Administration (FDA) before bringing devices to market. According to a recent report, 25 incidents of drug-resistant infections stemmed from closed channel duodenoscopes between 2012 and 2015, leading to questions about device-cleaning protocols. The Preventing Superbugs and Protecting Patients Act would also clarify FDA guidance on when manufacturers should seek clearance before marketing their products. The legislation is partly due to a months-long investigation by Sen. Patty Murray.