News From ACFAS

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Join us this summer or fall for a course unlike no other. Practice Management and Coding for the Foot and Ankle Surgeon devotes unparalleled time and attention to surgical coding to provide you with the tools to help your practice soar.

Scheduled for July 8–9 (Denver) and Oct. 21–22 (Chicago), this always-popular seminar takes an interactive approach to surgical coding. Under the instructor’s guidance, you and your classmates will code for common (and not so common) surgical foot and ankle procedures and gain strategies for helping your practice get proper reimbursement.

No other coding and billing course gives this much attention to surgical procedures. Register now at acfas.org/practicemanagement and position your practice for sustained success.
Feb. 29 is the last day to sign up with a specialty registry in order to avoid a four percent cut in 2018 in Medicare Part B payments under Meaningful Use.

The Centers for Medicare and Medicaid Services website has an FAQs page on steps a provider should take to determine if a specialized registry is available or if the provider can claim an exclusion.

If you have further questions, contact coding@acfas.org.
Five of ACFAS’ Regional Divisions welcomed new presidents into office at ACFAS 2016 in Austin.

Division 3: Javier La Fontaine, DPM, FACFAS (TX)
Division 4: Fred Mechanik, DPM, FACFAS (CO)
Division 9: Robert Fridman, DPM, FACFAS (NY)
Division 10: Sean Keating, DPM, FACFAS (NY)
Division 12: Keith Cook, DPM, FACFAS (NJ)

Congratulations to these new Division Presidents! Visit acfas.org or watch your email for announcements of activities in your region.

Foot and Ankle Surgery

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Researchers tested a new method of treating posterior and anterior ankle impingement syndrome that involves combining the standard anteromedial and anterolateral approaches and dual posterolateral approaches. Twenty-eight patients were studied. Thirteen were treated with traditional methods, and 15 were treated with the novel method. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS) score were recorded before surgery and after an average of 16 months. The range of motion in all patients was restored postoperatively. No significant differences existed between AOFAS or VAS score in the two groups. Dorsiflexion and plantarflexion remained similar as well. The biggest change was that the novel method resulted in significantly reduced operation time. The dual posterolateral approach combined with standard approaches was safe and effective and proved faster than traditional methods.


Tibiocalcaneal (TC) arthrodesis can salvage limbs in patients with severe deformities when combined with necrosis and/or luxation of the talus. To test the clinical outcomes of this method, researchers identified 12 patients, seven of whom underwent TC arthrodesis by an external fixator and four who had nail arthrodesis. All of the nail arthrodesis patients achieved bone union, and four of the external fixation patients achieved the same. Eleven patients regained independent mobilization, and the mean American Orthopaedic Foot and Ankle Society score improved from 24.3 to 66.7. Satisfaction rate was good to excellent in 83 percent of patients, leading researchers to conclude that TC arthrodesis is both promising and effective in treating severe ankle deformities.

Practice Management

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Communication failure in medicine can produce catastrophic results, and a new report from CRICO Strategies says that changes need to be made. The report found that out of 23,658 medical malpractice cases filed between 2009 and 2013, communication failure was the most-cited reason (7,149 cases or 30 percent) for patient harm. Surgery was the hardest hit, showing up in 27 percent of the 7,149 cases. Clinician-to-clinician communication breakdowns were associated with information on a patient's condition (26 percent), poor documentation (12 percent) and failure to read the medical record (7 percent). Clinician-to-clinician failures also resulted in higher payouts than clinician-to-patient failures (49 percent to 35 percent). One possible solution is raising the medical malpractice cap, which has not been raised in almost two decades. A recent bill in Indiana was struck down after a proposal to raise the award for injury or wrongful death by $400,000 to $1.65 million, with future increases tied to inflation. The bill was likely killed because the Indiana State Medical Association argued raising the cap would drive up costs for its members.


Physicians and non-family caregivers are intertwined, but too often those relationships can break down and become inefficient. According to Lisa Price, chief medical officer at InnovAge, the problem is due to caregiver exhaustion and the physician's inability to include caregivers in treatment plans. Physicians often forget that many caregivers can spend 20 or more hours per week providing for a loved one in addition to having a regular job. Addressing this imbalance requires physicians to acknowledge and plan for the daily challenges caregivers face. This includes being more receptive to the caregiver's thoughts pertaining to goals, as well as improving the overall physician/caregiver relationship. Physicians may not be aware of the amount of effort a caregiver is putting in, so being understanding is crucial to giving a patient the most comfortable experience possible. All parties must pay attention to messaging and communication so that care is properly distributed and so caregivers do not make unnecessary decisions regarding the patient's well-being.


Patients are using the Internet more than ever to research health-related issues. Because Internet content is not regulated, these patients can more often than not uncover incorrect information that colors their opinions and expectations. Researchers scoured PubMed, MEDLINE and Google Scholar to examine articles discussing orthopaedic online information from 2010 to 2015, assessing the authorship, quality, and readability and assessment tools from online information. Thirty-eight articles that examined these traits were included in the assessment. There was significant variation in the quality of assessment methods used, the number of reviewers and the manner of reporting. Most of the reviewed information was of poor quality, leading researchers to conclude that online orthopaedic information is generally a lower standard than one would like. To fix this, researchers noted, the orthopaedic community must develop high-quality, readable patient information.


Using the data you collect to reach your performance improvement goals can be a daunting task. To properly assess your data, according to Wallace Simpson, you must first understand the relationships between data, information, knowledge and insights. Simpson notes the example of driving a new car. The car in question had a dashboard feature that provided instant access to the miles per gallon based on real driving results. For the first time, Simpson says, he was able to think about how his driving habits changed the results on the dashboard. This is an example of taking raw data and having it presented as information. As he drove, he learned ways to improve his mileage, therefore gaining knowledge from the information presented. Then, he was able to uncover insights into what helped him achieve those mileage goals. Simpson says physicians should apply the same principles to health data. The physician community must find ways to make hidden data more accessible so that people can glean information, knowledge and insights from the figures. This can unlock vast potential and help you meet your big performance improvement goals.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) have announced new core quality measures that aim to simplify physician reporting while improving patient care. Acting CMS administrator Andy Slavitt said that measures were based on the idea of streamlining as many processes as possible by reducing unnecessary complexity and accelerating the shift to value-based care. The measures cover seven categories, including Accountable Care Organizations and orthopaedics. The majority of the measures are already in use in CMS programs, but this collaboration offers a cohesive framework to spur future efforts to develop more quality solutions. The average physician practice deals with seven or more payers, including public and private plans, and each has its own performance system, so the hope is that the core measures will cut down on these processes.


A new rule from the Centers for Medicare and Medicaid Services (CMS) proposes several mandates in an attempt to improve Medicare compliance, reporting and self-identified overpayments. The goal is to fight Medicare fraud. Overpayments must be reported and returned if identified within a six-year window from when they were received. This will lessen the burden on both providers and suppliers. It provides clarity and consistency in reporting and is tied to several parts of the Affordable Care Act.


The recent growth of the U.S. healthcare economy may be coming to a halt, according to a report from the Altarum Institute's Center for Sustainable Health Spending. National health spending increased 4.9 percent in December 2015 compared with December 2014, and health spending overall rose from 5.3 percent to 5.9 percent. But these figures hide the fact that spending decelerated every month after February. 2014 was understandably a big year because of the Affordable Care Act's expansion of health insurance, and that spending boom continued into 2015. Hospital expenditures increased greatly, but demand for prescription drugs and hospital services plateaued and then declined. The report indicated that if the trend continues, 2016 health spending will drop even lower.


The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will continue to push healthcare toward value-based patient care, and meaningful use will be a cornerstone. But experts believe that unless meaningful use is significantly changed, better value and care will be unattainable. Alex Valadka, chair of the Department of Neurosurgery at Virginia Commonwealth University Medical Center, writes in a blog post that the rules needing implementation are simply a reflection of our nation's laws. The House has already recognized electronic health record interoperability as a critical issue, and by implementing MACRA, the healthcare community can truly build something to improve patient care. Valadka argues that changing meaningful use to reflect a patient-centric, nationwide infrastructure could provide access to the right information at the right time.

Medicine, Drugs and Devices

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To improve cybersecurity preparedness, healthcare organizations must do a better job of educating staff on medical devices. According to Stephen Grimes, a consultant at Strategic Healthcare Technology Associates, a lack of universal understanding could expose crucial vulnerabilities. IT teams, biomedical engineers, clinicians and anyone involved in the healthcare process should be aware of the risks and be able to more quickly react to risks inherent in devices, he says. The average 500-bed hospital can have more than 7,500 medical devices, each with security risks. The only way to ensure security is through a collaborative effort. Manufacturers must also be brought in to help secure devices. Grimes is one of several voices in healthcare technology advocating for a greater effort in this arena, including Billy Rios, a security researcher who became well-known after exposing critical deficiencies in certain devices.


New virtual-reality (VR) technologies coming to certain hospitals and medical institutions will enable physicians to see and interact with three-dimensional pictures generated by imaging equipment such as magnetic resonance imaging and ultrasound. In clinical trials, some VR simulations reduced surgical planning time by 40 percent and boosted surgical accuracy by 10 percent. The forms VR technologies take range from fully immersive VR studios, which could be useful for training in medical schools, to simulations that use VR viewers such as the Rift headset from Oculus VR. GE is collaborating with research hospitals on early-stage testing of technology that will permit a physician wearing a Rift headset to virtually tour a patient's brain and perhaps even determine how surgery might affect various parts of it. Meanwhile, pediatric surgeons at Stanford University Medical Center have employed a VR platform to plan operations on newborns missing pulmonary arteries. The platform enabled surgeons and radiologists to develop more accurate surgical plans in 40 percent less time, according to a presentation at a conference of the Radiological Society of North America in December 2013.


Since Congress suspended the Affordable Care Act's medical device tax, U.S. manufacturers have experienced a boost in revenue. In 2014, device companies shelled out $2.4 billion due to the tax; now, many companies are having to find uses for the savings incurred from not having to pay that money. Smiths Medical, a Minnesota-based firm that makes specialty medical products, now has an extra $10 million to spend on building the business and creating jobs. Minnesota is home to a high concentration of device makers, meaning the state will benefit greatly if the money retained by the companies is properly allocated. Minnesota alone paid an estimated 25 percent of the total device tax, so the tax's suspension could be a big deal for the state's economy. But some analysts wonder if the suspension will actually result in more jobs. The Congressional Research Service found that the tax had a minor effect on employment and payrolls only changed by two-tenths of one percent. It is likely that smaller companies will benefit more than bigger companies since the tax took a larger percent of their revenue. It is not clear if the tax will remain suspended beyond the original two years.