News From ACFAS

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The full Annual Scientific Conference mobile app for 2014 is now ready for download!

While in Orlando, make sure you have all of what ACFAS 2014 has to offer in the palm of your hand, including:

• Your Personal Schedule (My Schedule)
• Full Conference Schedule
• Complete Listing of Exhibitors
• The HUB Schedule in Detail
• Conference Alerts
• Access to All the Social Media Buzz
• Online Access to Complete Session Evaluations

Watch your inbox tomorrow, Thursday, February 20, for your Attendee ID and password to import your personalized conference schedule. Miss your email? Your Attendee ID and password will be printed on the back of your conference name badge.

To download the app, from your mobile device or iPad visit http://m.core-apps.com/acfas2014. Be a part of the action at the 2014 Annual Scientific Conference even if you aren’t able to be in Orlando through ACFAS’ Twitter and Facebook feeds!

Follow #ACFAS2014 on Twitter or like our American College of Foot and Ankle Surgeons page on Facebook and Google+ and watch your news feed for all the latest buzz from Orlando!

You can also keep up with the latest through the social media feeds in the ACFAS 2014 Mobile App. Download your app today by visiting http://m.core-apps.com/acfas2014 on your mobile device. It's one week away -- ACFAS' 2014 Annual Scientific Conference in Orlando! We're here at headquarters putting the finishing touches on what is sure to be an invigorating conference and want to make sure you're prepared to take advantage of all ACFAS 2014 has to offer!

• Be sure to download the ACFAS 2014 Conference mobile app on your smartphone or iPad.
• Once you get to Orlando, you can pick up your badge for the conference at the Registration Booth in the Osceola 1-2 rooms at the Gaylord Convention Center between the hours of 1-6pm on Wednesday, February 26 or beginning at 6:30am on February 27.
• If you haven't already, stop by the Registration Booth and purchase your ticket to the Cuba Libre Wrap Party set for Saturday night. Don't miss Old Havana--ACFAS Style!
• A new must-do this year is to take time to attend a session in The HUB, where there is practical information on various topics for practically everyone. See your mobile app or the final program for the full schedule.
• Make a plan using your mobile app to visit Exhibitors you most want to talk to during the breaks and lunch.

Lastly, if you have any questions or need directions while at ACFAS 2014, look for an ACFAS staff person (we'll be wearing name tags with yellow Staff Ribbons) or visit us in the ACFAS Booth or at ACFAS Registration. We'll be happy to help you in any way we can.

See you soon and safe travels to Orlando! Operating a medical practice in today's environment presents many challenges—shrinking insurance reimbursements, changing regulations, rising business costs—all can feel like barriers to success. Help to remove some barriers and make plans to attend the ACFAS Perfecting Your Practice: Coding/Practice Management Workshop July 18-19, 2014 at the San Diego Marriott Gaslamp Quarter in beautiful San Diego, California.

In this day-and-a-half interactive, comprehensive course you’ll learn the essentials to help you with the business side of your practice. You and your staff will leave the program with the essentials of understanding coding for Evaluation and Management services, coding for surgical procedures and use of modifiers, how to attest for Meaningful Use, transitioning to ICD-10, and providing and getting reimbursed for durable medical equipment.

Watch for further information on this popular workshop. For questions, contact Dawn Brennaman, MPA, Director of Health Policy, Practice Advocacy and Research.

Foot and Ankle Surgery

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A new study has found that a modified version of the Broström-Gould procedure is safe and effective to use during reconstruction of the ankle lateral ligament. Sixteen patients (18 ankles) underwent a diagnostic arthroscopy and were subsequently treated with this technique, which involves triple-breasting the lateral ligament complex using suture anchors. Some patients had to undergo additional procedures beyond diagnostic arthroscopy, soft tissue debridement, and ligament reconstruction using the modified version of the Broström-Gould procedure, including debridement and microfracture, open excision of anterior calcaneal process, and arthroscopic anterior ankle cheilectomy. All ankles were subjectively and objectively stable at final follow-up, which was performed at an average of 25 months. Average American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 53 to 88, an increase that was statistically significant. Eight patients were able to resume playing sports and other activities that they had engaged in before their injury. However, eight patients experienced some decline in their normal activity levels.


A recent study found that the use of calcaneocuboid arthrodesis is a good option for revision clubfoot surgery in children between the ages of five and eight. Twenty clubfoot relapse patients (27 clubfeet) underwent revision soft tissue release and calcaneocuboid fusion and were subsequently followed up with after an average of 5.5 years. Ten of these patients (13 clubfeet) were reevaluated after an average of 17.5 years. The orthopaedic surgeons who performed the study expected to see a decline in functional measurements over the 17-year follow-up period, and the measurements they took of patients showed that there was such a decline. The current Hospital for Joint Diseases Functional Rating System (HJD FRS) for all feet was 65.9, which was down from an average of 77.8 at the original follow up. Current average American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire standardized core and shoe comfort scores were 84.6 and 84.5, respectfully. The results of the Clubfoot Disease-Specific Instrument questions, meanwhile, showed that patients were very or somewhat satisfied with status of foot in 76 percent of feet and appearance of foot in 46 percent of feet. Despite the drop in functional outcome, the results were similar to those of other studies involving patients with difficult revision cases.

Practice Management

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A survey published in the Journal of the American Medical Association has found that many consumers are using physician-rating Web sites such as RateMDs to help them make a decision about whether or not to see a particular doctor. The survey found that 65 percent of respondents knew about online physician ratings, and that 35 percent of those who used these ratings chose a doctor on the basis of good reviews posted by other patients. Another 37 percent said that they opted not to see a particular doctor because of bad reviews. However, 43 percent of the survey's respondents said that they did not trust the information posted on physician review sites and that they found verbal recommendations made by family, friends, and acquaintances to be more reliable. The report's co-author, Dr. David A. Hanauer of the University of Michigan Medical School, says that doctors should not dismiss the trend toward patients using rating sites to make decisions about which physicians to see. He adds that doctors should at the very least ensure that the information posted on these sites is truthful and representative about the care they provide.


There are five steps that doctors' practices can follow to implement Lean Six Sigma (LSS), a process-mapping strategy that uses statistics to measure and validate change and waste reduction in order to improve workflow and increase efficiency. Practices should begin the process of implementing LSS by educating members of a specially-created team about the processes and concepts involved in LSS. The practice's strengths, weaknesses, opportunities, and threats should also be analyzed. This analysis should include both training and execution of process mapping. The map should then be reviewed in the second step by measuring the process steps through data collection and analysis. Third, practices should seek to identify the issues that are causing the problems that were discovered when the process map was created. After these issues are identified, possible solutions should be tested if feasible in the fourth step. The fourth step should also include the development of a plan for addressing any issues that have been identified. Finally, the practice should implement its plan and measure its impact, re-evaluating goals and processes if necessary in the event the plan does not work.


Doctors who are presented with the opportunity to make a passive investment in an ancillary service provider should first check with an experienced healthcare lawyer to ensure that any such investment does not violate the Stark Law. This law limits but does not completely ban doctors from self-referring patients to providers of ancillary services of Designated Health Services in an effort to prevent conflicts of interest that could occur when a doctor owns a stake in an ancillary service provider to which he refers patients. Some people may attempt to get doctors to invest in ancillary service providers by claiming that such investments do not violate the Stark Law. Such "circumvention schemes" involve an investment plan that a doctor or entity knows or should know has the primary purpose of assuring referrals by the physician to a certain entity that would be banned under the Stark Law if the referrals were made directly. Although doctors may be tempted to participate in such investments in order to make up for the decline in Medicare reimbursements, they should be aware that they could face civil penalties of up to $100,000 if the scheme is uncovered.

Health Policy and Reimbursement

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Forty senators have added their voices to the growing chorus of healthcare industry and consumer groups calling on the Centers for Medicare & Medicaid Services (CMS) to not cut Medicare Advantage (MA) funding levels in 2015. The bipartisan group of lawmakers, including Sens. Michael D. Crapo (D-Idaho) and Charles E. Schumer (D-N.Y.) said in a Feb. 14 letter to CMS Administrator Marilyn Tavenner that keeping MA funding levels the same next year will "minimize disruption" to the program's beneficiaries. The cuts, which America's Health Insurance Plans (AHIP) says could be in the 6 percent to 6.5 percent range, are mandated by the Affordable Care Act as part of an effort to gradually make payments to MA plans the same as those for fee-for-service Medicare. AHIP, which has also spoken out against the cuts, says that a 6 percent reduction in funding levels--which includes the effects of star ratings, the end of a bonus demonstration program, and expected insurer fees--could result in MA premiums rising $35 to $75 per month per beneficiary. The letter from Crapo, Schumer, and other lawmakers came one day after a group of Republican House leaders called for Health and Human Services Secretary Kathleen Sebelius to develop a plan to ensure that senior citizens do not experience "further disruption" as a result of the cuts. The National Hispanic Medical Association and the National Caucus and Center on Black Aged have expressed their concern about the effects of the cuts as well.


The Food and Drug Administration (FDA) issued a final rule on Feb. 13 that calls for all medical device makers, including small ones, to begin electronically submitting reports of injuries or deaths associated with their products by August 14, 2015. These reports are currently submitted through the mail, and it can sometimes take three to six days or longer for the FDA to analyze them. Electronic submissions will make it easier for the FDA to review adverse events associated with medical devices and allow the agency to quickly inform hospitals, doctors, patients, the medical device industry, and others about suspected problems with devices. The new rule exempts hospitals and other user facilities. The FDA says that the medical device industry could incur $40 million in one-time training and IT costs as a result of the electronic reporting requirement. However, the agency says that the industry will save roughly $9.2 million a year thanks to the shorter amounts of time needed to submit documents electronically compared to the mail as well as reduced delivery costs. But medical device industry consultant Wally Pellerite says the rule will still be a significant burden for very small manufacturers, and says they should be allowed to continue to submit paper reports.


The Obama administration reported Feb. 12 that 1.2 million people signed up for health insurance coverage through the Affordable Care Act's online exchanges in January, which was higher than expected. Roughly 3.3 million people have now signed up for coverage through the exchanges, though federal officials had been expecting 1 million more people to have signed up by the end of January. The administration's report noted that 27 percent of those who signed up for coverage through the exchanges in January were between the ages of 18 and 34, which was up from 24 percent in the first three month's of the health reform rollout but is still below the 40 percent level that experts say needs to be achieved in order to maintain price stability for health insurance plans offered through the exchanges. The report did not mention how many of the consumers who purchased plans last month have actually paid premiums and now officially have coverage, nor did it discuss how many of these consumers are newly insured. Health and Human Services Secretary Kathleen Sebelius said the results were encouraging, though House Ways and Means Committee Chairman Dave Camp (R-Mich.) said the findings indicate that the Affordable Care Act is not meeting its goals.


Data reported under the Sunshine Act, a provision of the Affordable Care Act designed to shed light on the relationships between doctors and the drug and medical device industries, will be submitted to the Centers for Medicare and Medicaid Services (CMS) beginning February 18. CMS plans to begin preparing the data so it can be published online in September. Supporters of the Sunshine Act are hoping that publishing the data will increase transparency about funding provided to doctors by the drug and medical device industries and in turn identify potential conflicts of interest. Bringing these conflicts of interest to light will also help improve patient safety, supporters say.


Federal health officials sent a memo to health insurance companies on Feb. 6 outlining the limited circumstances in which consumers can make changes to plans purchased through Healthcare.gov. Between now and the end of the open enrollment period on March 31, consumers will be allowed to pick a new plan if they are not satisfied with the one they originally chose so long as they give two weeks notice of their intent to drop their current policy. The memo stated that consumers will be allowed to make such changes if they want to switch to a plan with a broader network of providers or for other "isolated circumstances," though that term was not explained. However, such consumers will be required to pick a new plan with the same insurance company that includes roughly the same level of coverage. In addition, consumers will be given greater leeway and a longer timeframe to obtain a new plan if they can prove that Healthcare.gov displayed inaccurate information about their current plan. Finally, Healthcare.gov is being altered to allow consumers to report major life events that could affect their insurance coverage, such as a marriage or the birth of a child. The changes come amid frustration among some consumers with the inability to make changes to health insurance plans through Healthcare.gov.


According to Medical Group Management Association (MGMA) Senior Policy Advisor Robert Tennant,neither the federal government nor other entities involved in the move to ICD-10 are taking the lead in making sure the transition is being carried out in a cohesive and coordinated manner. Although Tennant said some of the blame lies with healthcare providers and payers, he specifically mentioned Medicare's failure to release payment edits, as well as its decision to only partially test ICD-10 with providers next month--just seven months before ICD-10 is scheduled to go live--as other problems associated with moving to the new coding system. Tennant added that MGMA is concerned there will not be enough time to properly test ICD-10, and said that the failure to adequately test the system will cause clinical, administrative, and other problems that will negatively impact patient care and significantly affect practices' cash flow. Tennant called on federal officials to recognize the potential for problems with the transition to ICD-10 and to develop a contingency plan or a rollback for the new system in the event it is not possible to adopt the new codes on Oct. 1 as scheduled. Other healthcare industry observers say that while they are also concerned about the potential for problems, the deadline for ICD-10 adoption should not be rolled back. Instead, observers said, the federal government should consider delaying financial penalties for healthcare providers who fail to implement Meaningful Use Stage 2.

Medicine, Drugs and Devices

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A report released Feb. 10 by the Government Accountability Office (GAO) has found that the Food and Drug Administration (FDA) is preventing more potential drug shortages even as the number of actual shortages continues to grow. The report found that the number of potential shortages prevented by the FDA increased from 35 in 2010 to 154 in 2012, though the number of new and long-term shortages rose from 154 in 2007 to 456 in 2012. The most common shortages were for generic sterile injectable drugs, the report found, noting that shortages of these drugs were partly the result of temporary closings of production lines or factories due to the age of these facilities as well as quality problems. In addition, the report cited a study which found that the ability of companies to manufacture sterile injectable drugs did not keep up with the growth in production that took place between 2006 and 2010. The report also blamed other factors for the growth in the number of drug shortages, including changes in Medicare reimbursements. Group purchasing organizations that buy drugs for hospitals have also contributed to the shortages by reducing the prices that drugmakers get for their products, the report claimed. The report concluded by calling on the FDA to use its drug databases to identify patterns that can help prevent drug shortages.


A study by plastic surgeons in Japan has found that magnetic resonance imaging (MRI) is generally able to help doctors distinguish between osteomyelitis and reactive bone marrow edema when diagnosing diabetic foot ulcers. The surgeons came to that conclusion by comparing the results of pre-operative MRIs performed on 12 diabetics with infected foot ulcers with the histopathologic features of 67 parts of 45 resected bones. The cut ends of the bones were also histopathologically evaluated. Osteomyelitis was disclosed by MRI and histopathologically confirmed in 30 parts, while bone marrow edema was diagnosed by MRI in 29 parts but confirmed by histopathologic evaluation in only 23 parts. The other six parts displayed osteomyelitis. In addition, the surgeons found that 13 cut ends of 17 resected bones displayed bone marrow edema while the remaining four were normal. While MRIs are generally effective in diagnosing osteomyelitis in patients with diabetic foot ulcers, the surgeons concluded, there may be some special cases where the technology is not helpful in making a diagnosis.