February 22, 2017 | | JFAS | Contact Us

News From ACFAS

Don’t Forget to Download the ACFAS 75 App
With just five days to go until the 75th Anniversary Scientific Conference February 27–March 2 at The Mirage in Las Vegas, be sure to download the ACFAS 75 app before you leave for Vegas so you can access your session schedule, the exhibitor directory, social media feeds, convention center maps and more.

Search your app store for ACFAS 75 or visit to get the app. You should have received an email from ACFAS on Monday, February 20 with your login details. After you arrive in Vegas, you can also find your login information printed on the back of your name badge.
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Follow #ACFAS75 on Social Media
Be a part of the online buzz of ACFAS 75 in Vegas by using #ACFAS75 in your social media posts! You can also see the latest up-to-the-minute photos and videos from your colleagues by following #ACFAS75 through the conference’s mobile app social media button or through your own Twitter and Facebook accounts. Don’t miss a moment of the fun!
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Find New Careers & Candidates at the ACFAS Job Fair
Stop by the fourth annual ACFAS Job Fair during the 75th Anniversary Scientific Conference February 27–March 2 at The Mirage in Las Vegas and put your career or practice on the fast track to success!

Hosted by, this year's Job Fair will feature free resume consultations on Tuesday, February 28. Get expert advice on how to make sure your resume communicates all of your accomplishments to prospective employers. Sign up at the Job Fair as soon as you can on Monday, February 27 since time slots will fill up fast.

As always, employers can post printed descriptions of available jobs for free on the Job Fair bulletin boards and look through candidate resumes. Jobseekers can post their resumes on the bulletin boards and arrange onsite interviews with employers using's online scheduling tool.

Look for the Job Fair near the Member Center in the Rotunda outside the Exhibit Hall.
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Infographics Voted as Most Used Marketing Tool
Last month’s poll in This Week @ ACFAS asked which resource in the ACFAS Marketing Toolbox you use most often. Infographics came in first at 31 percent, while PowerPoint presentations took second place at 23 percent. Healthcare provider referral tools and press release templates tied for third with 15 percent each. For the 15 percent of respondents who are unaware of the Marketing Toolbox, bookmark stat and visit often to take advantage of the many free resources available to promote your practice.

As always, thank you for your feedback and watch for our next poll in the March 1 issue of This Week @ ACFAS. View real-time poll results throughout the month at
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Foot and Ankle Surgery

Factors Associated with Ulcer Healing and Quality of Life in Patients with Diabetic Foot Ulcers
A recent study of patients living with diabetes who have foot ulcers assessed the factors associated with the healing process or limb salvage and evaluated the impact of ulcer treatment on quality of life, which was determined using the Diabetic Foot Ulcer Scale-Short Form (DFS-SF). The study included 103 diabetic patients treated for ulcers. At 12 months, ulcer healing, minor amputation and major amputation rates were 41 percent, 41 percent and 18 percent, respectively. The mortality rate was 18 percent. Limb loss was associated with nonpalpable popliteal artery, longer hospital stays and referral delays. Quality of life improved in all domains of DFS-SF regardless of patient outcome. Significant improvement was observed in hygiene self-management between the first and the last assessment during the follow-up period.

From the article of the same title
Angiology (03/01/17) Vol. 68, No. 3, P. 242-250 Spanos, Konstantinos; Saleptsis, Vasileios; Athanasoulas, Athanasios; et al.
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Use of Locking Barbed Sutures in Foot and Ankle Surgery
Barbed sutures are a novel technique for wound closure, and a recent study using the Quill barbed suture showed positive outcomes. Researchers followed up with 123 surgical wounds after closure with bidirectional barbed suture. The total complication rate was 6.5 percent. One wound had a major infection that required surgery, and two wounds showed inflammation-related complications. Five wounds had minor complications that were resolved without surgical intervention. Seventy-eight percent of incisions were given a maximum score on the visual analog cosmesis scale.

From the article of the same title
Foot and Ankle Surgery (03/01/17) Vol. 23, No. 1, P. 57-61 Mayet, Ziyaad; Eshraghi, Hooman; Ferrao, Paulo N.F.; et al.
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Practice Management

Five Ways Physicians Can Create More Trust with Their Staff
To become a strong team leader, physicians must earn the trust of their staff. Employees will trust leaders they know on a personal level, so physicians should make the effort to get to know their staff and establish relationships. Showing vulnerability and openness is one of the most effective ways to build trust. It is the physician's job to help their staff expand their skills, but the most engaged employees are those who know their leader cares about their personal development and wants to see them succeed inside and outside of work. Micromanaging may be easier and faster in the short run, but physicians should teach their staff how to be successful in their positions and encourage innovation. Good leaders also find ways to communicate with their employees every day, updating the team about the practice's goals, strategies, physician rating and satisfaction scores. As trust increases, performance will improve. When recognizing individual accomplishments, positive feedback should be clear, immediate and sincere.

From the article of the same title
Physicians Practice (02/15/17) Byington, Melissa
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Top Tips for Physicians to Deal with Uncertainty
The election of President Donald Trump and healthcare policy changes under the Medicare Access and CHIP Reauthorization Act (MACRA) have created an air of uncertainty for physicians nationwide, as they anticipate reforms to the Affordable Care Act and a new head of the U.S. Department of Health and Human Services. According to Mark Werner, national director of clinical consulting for The Chartis Group, the Trump administration will enact healthcare changes quickly, shifting focus to price and cost-cutting regulations. Werner offers five strategies for physicians preparing for changes in insurance coverage, payment, services and reporting standards. Physicians are advised not to wait out any changes, particularly regarding MACRA. If a practice has already taken steps to gather data for reporting, they should continue to do so. Although physicians may be wary of introducing new initiatives amid the current instability, Werner recommends taking “no regret” actions, or actions that will be a good use of time and effort, regardless of what happens in the coming months and years. Downward pressure on revenue will continue, so practices must ensure they are working efficiently and optimizing operational and financial performance. Even if revenue is tight, practices should continue to invest in technology to better manage practice performance and satisfy MACRA requirements. Practice partnerships and clinically integrated networks can help meet these goals for smaller practices.

From the article of the same title
Medical Economics (02/13/17) Martin, Keith L.
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Why Practices Are Struggling to Exchange Records
More than 40 percent of medical record administrators experience difficulties exchanging patient records with other providers, according to a survey conducted by Black Book Research. Record exchange is particularly onerous when providers are not on the same electronic health record (EHR), even though EHR vendors are configuring systems to support data exchange. Seventy percent of surveyed hospitals only use patient information within their own EHR because data from external providers is not available in their EHR workflow, and 21 percent of hospital-based physicians do not trust the accuracy of data sent between different systems. Twenty-two percent of medical record administrators say transferred patient information is not delivered in a usable format. In addition, Black Book found that more than 80 percent of independent physicians are not confident they have the technology and skills necessary to handle the financial risk of quality payment programs.

From the article of the same title
Health Data Management (02/10/17) Goedert, Joseph
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Health Policy and Reimbursement

Independent Physicians Struggle to Get Paid Equally
Independent practices are often paid significantly less by insurers than practices belonging to a large healthcare system, according to the 2016 Physicians Practice Fee Schedule Survey. While the billing code for a new patient visit will average $58.40 in reimbursement for an independent practice, large healthcare systems will receive an average of $74 per instance. Hospitals have more leverage with insurers than small practices and can negotiate better rates. However, independent practices can level the playing field by being conscientious of how they code and which codes are used the most. Data on code frequency can demonstrate quality and the practice’s high standing among others in the area. Another strategy is joining an independent physician association (IPA) and taking advantage of collective bargaining to negotiate better rates with payers. Hiring an outside billing firm and consulting firm can help practices manage reimbursement and insurer contracts. As the industry shifts to value-based care, experts warn that any independent practices lagging behind in technology and quality programs will not have much leverage with insurers going forward.

From the article of the same title
Physicians Practice (02/13/17) Perna, Gabriel
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New HHS Secretary Tom Price Faces a Crushing Inbox
Newly confirmed U.S. Department of Health and Human Services (HHS) Secretary Tom Price is tasked with keeping insurers in the market for 2018 while Republican lawmakers work to repeal and replace the Affordable Care Act. HHS currently is drafting a rule that responds to insurers’ requests for changes, such as greater freedom to charge older patients higher premiums. However, it is unclear if Price will promote Medicare’s continued shift from fee-for-service to value-based payment models, which he has protested in the past. Price recently criticized the U.S. Centers for Medicare and Medicaid Services’ Innovation Center, particularly its bundled-payment programs for joint replacements and cardiac care. In addition, Price is expected to lead the push in Congress to restructure Medicaid and Medicare. Republicans in Texas, Wisconsin and Georgia plan to draft proposals to convert Medicaid into a program of federal block grants or per capita grants. Price may work with House Speaker Paul Ryan on a plan to transform Medicare into a defined-contribution program and increase the eligibility age to 67.

From the article of the same title
Modern Healthcare (02/11/17) Meyer, Harris; Dickson, Virgil
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White House Proposes New Rules to Steady Insurance Markets Under Health Law
The Trump administration has proposed new rules intended to stabilize the insurance marketplaces and temper rising premiums while Congress works to unravel the Affordable Care Act (ACA). The proposed changes come a day after Humana announced it would be withdrawing from public markets next year. Supported by congressional Republicans and insurance companies, the rules would cut the ACA’s open enrollment period from three months to six weeks. The rules also would limit opportunities for people to wait until they were sick to buy insurance and require consumers to provide documentation to prove their eligibility to enroll outside the standard enrollment season. The White House says these policies will create a smaller, healthier consumer base to stabilize the markets and attract more insurers in states with limited choices. Final rules are likely to be issued in March or April, as insurers must decide by early May what kinds of plans they will offer in 2018.

From the article of the same title
New York Times (02/15/17) Pear, Robert
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Medicine, Drugs and Devices

Door Opens to Gene Editing in Embryos
Gene-editing clinical trials involving the human germ line could be permitted under certain circumstances, according to the National Academies of Sciences and the National Academy of Medicine. A new report urged limiting trials to circumstances in which no other treatment exists, the condition is very serious and the genes are known to cause a particular disease. The introduction of the Crispr-Cas9 gene-editing approach has raised ethical and regulatory questions, and scientists continue to wrestle with what limits to impose on using Crispr in the lab. Studies on humans will also be difficult to organize, as gene-editing trials involving sperm, eggs and embryos would have to include oversight of the long-term health of future generations born to study participants. In addition, Congress has passed a provision in effect until at least April 2017 that bars U.S. authorities from reviewing proposals for clinical trials involving gene-editing of the human germ line.

From the article of the same title
Wall Street Journal (02/14/17) Marcus, Amy Dockser
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Intravenous Lidocaine Offers Alternative for ICU Patients' Pain
Intravenous lidocaine (IVLI) may be safe for reducing pain among patients in the intensive care unit, according to research published in the Journal of Clinical Pharmacology. A retrospective chart review was conducted on the safety and effectiveness of IVLI for pain in 21 ICU patients with organ dysfunction. The mean time needed to achieve a more than 20 percent reduction in pain scores was 2.2 hours from the start of IVLI. The median morphine dose equivalents were significantly higher six, 12 and 24 hours pre-IVLI compared with the same time periods after IVLI. Three patients experienced neurological side effects that were reversed upon discontinuation of lidocaine.

From the article of the same title
Physician's Briefing (02/09/17)
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U.S. Healthcare Costs to Escalate Over Next Decade: Government Agency
According to the U.S. Centers for Medicare and Medicaid Services (CMS), the cost of medical care in the United States will increase at a faster pace over the next 10 years. In addition, overall spending growth will outpace that of the gross domestic product. CMS says the aging of Baby Boomers and economic inflation are the main drivers of the increase in healthcare spending. The report predicts that by 2025, healthcare spending will be responsible for 19.9 percent of the economy. Concerning spending on prescription drugs, CMS believes that growth will occur at a rate of 6.4 percent a year between 2017 and 2025. That increase will be caused by spending on costlier specialty drugs.

From the article of the same title
Reuters (02/15/17)
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, AACFAS

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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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