News From ACFAS

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Register for ACFAS 2018 online by Monday, March 5 and save. After March 5, you can still register at the Gaylord Opryland Convention Center in Nashville starting at 1pm on Wednesday, March 21, but onsite registration fees will apply.

Don’t miss a minute of the excitement awaiting you in Nashville March 22–25—register today! On January 25, the Coalition for Patients’ Rights (CPR), of which ACFAS is a member, responded to a request for information from the U.S. Department of Health and Human Services regarding the promotion of healthcare choice and competition, including how existing regulations and policies may hinder these goals.

CPR’s comments addressed state and federal laws and regulations that restrict the scope of practice of certain healthcare providers and also limit:

• Patients’ ability to choose their healthcare providers
• Patients’ access to high-quality, cost-effective healthcare
• Competition

CPR believes the federal government can give consumers more healthcare choices and can lower the costs of care by prohibiting private health insurers, Medicare and Medicaid from excluding qualified healthcare providers (such as foot and ankle surgeons) from coverage.

Read CPR’s full comments at patientsrightscoalition.org. The U.S. Centers for Medicare and Medicaid Services has updated the Durable Medical Equipment, Prosthetics, Orthotics and Supplies Quality Standards to include new information on custom inserts effective January 9, 2018.

HCPCS code (K0903) has been issued (effective April 1, 2018) for inserts that are direct-milled from a CAD/CAM model. Congratulations to our 2018 ACFAS Scholars! Every year, the College recognizes our Student Club Presidents on each of the podiatric medical school campuses for all of the work they do throughout the school year on behalf of the organization.

Each ACFAS Scholar received a scholarship for $1,000 to defray their costs of travel and lodging to ACFAS 2018 in Nashville next month. They also received complimentary registration.

This year’s scholarships are generously supported by Medartis.

AZPod:
Kyle Schwickerath, Class of 2020

Barry University:
Elizabeth Ansert, Class of 2019

CSPM:
Lance Hopkin, Class of 2019

DMU:
Zachary Croy, Class of 2019

Kent State:
Britain Wetzel, Class of 2019

NYCPM:
Brent Blanck Singer, Class of 2019

Scholl College:
Michael Savisky, Class of 2020

Temple University:
Anthony Samaan, Class of 2019

WesternU:
Karanjot Kaur, Class of 2020 (Club Vice President, attending the conference in place of Club President Tommy Yates, Class of 2020)

Congratulations to these future leaders of ACFAS and the profession!

Foot and Ankle Surgery

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The Broström procedure is the most commonly used lateral ligament repair for chronic instability, but there is concern about the strength of the repair and the risk of reinjury. Researchers hypothesized that augmentation of the Broström repair with an InternalBrace™ would allow accelerated rehabilitation and return to activity and would aid in stability of the repair without a tendency to stretch. A study included 81 patients with lateral ankle instability procedures repaired with a Broström and InternalBrace™ augmentation who were evaluated at a one-time postoperative visit between six months and 24 months. Mean return to sport was 84.1 days. Average AOFAS Ankle-Hindfoot score was 94.3. A score of 90 or higher on the FAAM Sports subscale was seen in 79.0 percent of the subjects. The single-leg hop test showed that 86.4 percent of patients returned to normal or near normal function. The researchers suggest that suture tape augmentation of a Broström procedure is a safe and efficacious procedure that produces favorable outcomes in patients in terms of preventing recurrent instability in the ankle in the short term.


Researchers investigated the clinical outcomes of resection and joint-preserving arthroplasty for forefoot deformities in patients with rheumatoid arthritis. Sixteen feet of 14 women underwent resection arthroplasty of the metatarsal head, and 18 feet of 15 women underwent a metatarsophalangeal joint-preserving procedure with shortening oblique metatarsal osteotomies of the lesser toes. The mean disease duration in the resection and joint preservation groups was 23.6 years and 19.1 years, and the average follow-up period was 37.3 months and 33.5 months, respectively. The researchers concluded that the resection arthroplasty and joint-preserving procedure showed satisfactory clinical outcomes. However, determining whether both procedures can maintain the good clinical results without the recurrence of forefoot deformity will require longer follow-up.


Combined single-photon emission computed tomography and conventional computed tomography (SPECT/CT) is a hybrid imaging modality that shows a combination of metabolic and structural information about the ankle, including arthritis. Researchers believe that uptake in specific locations within the ankle joint can be both associated with clinical outcomes and may help predict which patients will have a successful SMO. Eighty-five preoperative SMO patients with varus, valgus or neutral alignment of the hindfoot were assessed using SPECT/CT. Patients with medial gutter activation had significantly worse AOFAS alignment (AOFAS-A) scores preoperatively. Patients with varus or valgus alignment did not differ in VAS pain scores, but those in valgus had worse AOFAS-P scores. Preoperative SPECT/CT evaluation of an ankle before a SMO can be used to clinically correlate patient-specific factors, such as pain and function, in the pre and postoperative period. Researchers cautioned against performing a SMO in patients with bipolar activation on a preoperative SPECT-CT scan.

Practice Management

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According to a report published in JAMA, the United States is in the midst of a physician burnout crisis. Experts say failure to address burnout can result in costs between $500,000 and $1 million to replace an existing physician. Some believe the costs could be higher than that estimate. Despite the risk, not every healthcare facility is addressing the problem. Christine Sinsky, vice president of professional satisfaction at the American Medical Association (AMA), believes there is fear to address the problem because many are unsure what to do in the first place. To help spur action, AMA created an online physician burnout calculator that shows the financial toll it can have. AMA also created a module called “Creating the Organizational Foundation for Joy in Medicine,” which provides ways that executives can tackle the issue.


A good staffing plan is critical to ensure a hospital continues to run smoothly when a key doctor must take time off or leaves. The following five tips can make staffing plans more effective:

• Identify immediate needs and challenges in the future.
• Research potential candidates and ensure benefits packages are competitive.
• Consider solutions like flexible hours for staff if it helps the facility.
• Involve staff during the process.
• Make sure the plan is flexible and adaptable to future changes.

The March deadlines for clinicians and groups to submit data for the 2017 performance period of the Merit-Based Incentive Payment System (MIPS) is approaching. Groups reporting through the U.S. Centers for Medicare and Medicaid Services web interface must do so by March 16 at 8pm ET. All other MIPS data must be submitted by March 31. MIPS is one of two tracks under the Quality Payment Program. Healthcare professionals can use the MIPS Participation Status Tool to determine if they must report for MIPS.

Health Policy and Reimbursement

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The Office of the Actuary at the U.S. Centers for Medicare and Medicaid Services released the projected national health expenditures for 2017–2026. National health expenditure growth is expected to average 5.5 percent annually over the next decade 2017–2026. Growth in national health spending is projected to be faster than projected growth in gross domestic product (GDP) by 1.0 percentage point over 2017–2026. As a result, the report projects the health share of GDP to rise from 17.9 percent in 2016 to 19.7 percent by 2026. The report also found that by 2026, federal, state and local governments are projected to finance 47 percent of national health spending, up from 45 percent in 2016. Among the major sectors of healthcare, spending growth is projected to be fastest for prescription drugs, averaging 6.3 percent for 2017–2026. This is due in part to faster projected drug price growth, particularly by the end of the period, influenced by trends in relatively costlier specialty drugs.


State and federal GOP lawmakers are increasingly mulling or supporting reinsurance proposals to curb premiums by offsetting insurers' costlier claims. Wisconsin Gov. Scott Walker, for instance, has proposed a $200 million reinsurance program. Bipartisan proposals in the Senate call for strengthening Affordable Care Act (ACA) markets by providing billions in reinsurance. Another proposal from Sens. Patty Murray (D-Wash.) and Lamar Alexander (R-Tenn.) would temporarily restore federal payments to insurers intended to cover ACA consumer subsidies. Democrats are now concerned that restoring the payments could cause higher prices for consumers, so they are seeking additional measures, such as larger tax credits; an increase in people eligible for them; a restoration of ACA outreach funding; and discouraging the sale of cheaper, less comprehensive policies. U.S. Department of Health and Human Services Secretary Alex Azar said during a February 14 budget hearing that the agency hopes to work with states to lower premiums, citing Alaska's reinsurance program.


The Trump administration's 2019 budget proposes cutting $1.7 trillion in funding from U.S. Department of Health and Human Services (HHS) programs, including Medicare, over a decade, while increasing funding to combat the opioid epidemic and high drug prices. HHS Secretary Alex Azar said the two issues, coupled with making insurance more affordable and improving Medicare so it pays more for quality than the quantity of services provided, demonstrate the administration's priorities. The budget proposed new strategies to address high drug prices by targeting areas, including what it called "perverse payment incentives," that reward the use of higher cost drugs. Under the budget, up to five states could participate in pilot projects to test drug coverage and financing reforms based on "best practices" at commercial insurers. These states could negotiate drug prices directly with manufacturers and set up their own drug formularies with an appeals process that would help patients get drugs that are medically necessary. The National Institutes of Health, meanwhile, would receive $100 million for a public-private partnership with the pharmaceutical industry to develop prevention and treatments for addiction, overdose-reversal and nonaddictive therapies for pain.

Medicine, Drugs and Devices

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Care+Wear is testing new hospital gowns with the goal of making them more comfortable and functional for patients. The new gown ties in the front similar to robe, has a pocket for cell phones and also features color-coded ties. There is also more coverage in the rear without sacrificing easy access to bed pans. Care+Wear partnered with the Parsons School of Design when making the new gowns. Designers who worked on the gown say they used the input of patients and doctors during the creation process. The new gown is being tested at MedStar Montgomery in Olney, Md.


A study published in the Journal of Bone and Mineral Research found routine body computed tomography (CT) scans may help clinicians predict an individual's risk of future osteoporotic fractures. The research team determined, in 507 older adults who received chest and/or abdominal CT scans for a variety of indications, whether a rapid density measurement of bone quality known as vertebral trabecular attenuation correlated with fracture risk in the following six years. Having a trabecular attenuation of the first lumbar vertebra below a certain threshold was linked with an elevated risk of future fractures.


The majority of states have proposed legislation to lower prescription drug costs, including six states that are considering bills to allow drugs to be imported from Canada. Both Vermont and Utah are considering proposals to legalize drug imports from Canada, where they cost an average 30 percent less than in the United States. One hope is that importing drugs can put downward pressure on domestic costs for all, said Utah state Rep. Norm Thurston, who introduced a drug import bill in his state. "It's not a Democrat-Republican thing," he said. Instead, Thurston said, "It makes [the pharmaceutical industry] compete against themselves." PhRMA, a trade group for drugmakers, argues the proposals would jeopardize people's health because quality could not be guaranteed. Thurston, however, contends that safety has nothing to do with the potential for tainted drugs from Canada. "The No. 1 threat to patient safety related to prescription drugs in our state is that the drugs are so expensive that people don't take them," he said. Federal drug import legislation is once again being considered by Congress, although it has been consistently blocked in the past by the powerful drug lobby.