News From ACFAS

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Get a sneak preview of ACFAS 2018 and strengthen your surgical and coding skills at the same time—register now for preconference workshops scheduled for Wednesday, March 21 at the Gaylord Opryland Hotel in Nashville.

These special workshops are filling fast, but a few spots are still available. Choose from:

Coding and Billing for the Foot and Ankle Surgeon
(7:30am–5:30pm, 8 CE contact hours)
Learn how to maximize your surgical billing processes and increase your reimbursement.

Tendon Transfers: Common to Complex
(7am–Noon, 4 CE contact hours, includes wet lab)
Master several tendon transfer techniques to better manage common deformities.

Common Corrective/Realignment Osteotomies
(Noon–5pm, 4 CE contact hours, includes wet lab)
Perform common forefoot and rearfoot osteotomies step by step with expert faculty.

Visit acfas.org/nashville to register today so you don’t miss out! Visit the fifth annual ACFAS Job Fair (Booth No. 237), scheduled for March 22–24 during ACFAS 2018 at the Gaylord Opryland Hotel in Nashville, and revitalize your career or practice!

Once again hosted by PodiatryCareers.org, this year's Job Fair will feature free CV consultations on two days: Thursday, March 22 and Wednesday, March 23. Get expert advice on how to make sure your CV communicates all of your accomplishments to prospective employers. Sign up at the Job Fair as soon as you can on Thursday, March 22 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 can browse through candidate CVs. Jobseekers can post their CVs on the bulletin boards and arrange onsite interviews with employers using PodiatryCareers.org's online scheduling tool.

Also stop by the HeadShot^TM booth (No. 148) on Friday, March 23 from 9:30am–4pm or Saturday, March 24 from 9:30am–2pm to have your headshot taken for free by a professional photographer. Your photo session will include a brief touchup with a makeup artist, and you will also receive a hard copy and digital version of your headshot the same day.

Include your new photo in your CV and social media profiles to put your best face forward during your job search. The February poll in This Week @ ACFAS asked readers if they have seen an increase in ankle injuries this winter.

Sixty-two percent of respondents have not seen an increase in ankle injuries, while 38 percent of respondents have seen more ankle injuries these past few months.

Thank you to everyone who voted, and be sure to watch next week's issue of This Week @ ACFAS for the March poll.

Foot and Ankle Surgery

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A study was conducted to compare a system that correlates changes of the appearance of the foot phalanges to peak height velocity (PHV) with the recently described calcaneal apophyseal ossification grading system. A total of 94 children from the Bolton-Brush study, each with consecutive radiographs from age 10 to 15, were included. Using the anteroposterior view, the researchers analyzed the ossification patterns of the phalanges and developed a six-stage system. They then graded the PHV for each patient and defined its relationship with the system. The system was then compared with the previously established calcaneal system. The team estimated an Intraclass correlation coefficient (ICC) range of 0.957 to 0.985 with an average of 0.975 and interclass reliability coefficient of 0.993, indicating that this method is reliable and consistent. The system exhibited no substantial difference between gender with respect to PHV, which makes it a reliable substitute for determining bone age in pediatric and adolescent patients.


This study was conducted to determine the volume of saline required to detect traumatic arthrotomy of the ankle. The research included 42 patients undergoing elective ankle arthroscopy. For each patient, a standard 4 ml anteromedial portal was established. Next, an 18-gauge needle was inserted at the site of the anterolateral portal. Sterile saline was slowly injected through the needle until saline extravasated from the anteromedial portal. The saline volume required to achieve extravasation ranged from 0.2 ml to 60.0 ml. The median saline volume required to achieve extravasation was 9.7 ml; however, five of 42 patients required volumes between 50.0 ml and 60.0 ml. The researchers concluded that the previously recommended 30 ml of saline required to reliably detect traumatic arthrotomy of the ankle may be too small a volume.


Researchers conducted a study to quantitatively assess, by means of T1 imaging, changes over time in the biochemical health of grafted cartilage after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus. The study included nine patients who underwent AOT for an osteochondral lesion of the talus and in whom T1 mapping was performed one year and two years postoperatively. At one year, a significant difference existed between the mean T1 value of the grafted cartilage and that of the far-field cartilage. At two years, the mean T1 value of the grafted cartilage was significantly lower than that at one year. Moderate negative correlation was found between the one-year T1 ratio and one-year AOFAS score and between the two-year T1 ratio and two-year AOFAS score. The study found that the substantial restoration of the proteoglycan content of the grafted cartilage approximately two years after AOT for osteochondral lesions of the talus indicates that the content changes gradually and that the cartilage reparation process is slower than previously believed.

Practice Management

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Electronic health records (EHRs) were expected to reduce administrative costs for providers, but a study of a large academic healthcare system with a certified EHR system reveals that the estimated costs of billing and insurance-related activities were substantial and varied depending on the type of clinical encounter. Researchers from Duke University and Harvard Business School estimated the billing and insurance-related costs for five types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures and inpatient surgical procedures.


Physicians can take advantage of the Advancing Care Information (ACI) section of Medicare's Merit-Based Incentive Payment System (MIPS) to navigate the program's guidelines. ACI comprises 25 percent of the composite MIPS score for healthcare providers, which subsequently determines future Medicare reimbursement levels. Medical practices must report five mandatory ACI base score measures, including Security Risk Analysis (SRA), e-Prescribing, Provide Patient Access, Send a Summary of Care and Request/Accept Summary of Care. With the mandatory SRA also required for HIPAA compliance, meeting this standard should be routine. If not, practices can take actions to deploy the SRA to guarantee the safety of patient data while also gaining MIPS points. Physicians can also leverage their previous Meaningful Use reporting by running one of those reports from the electronic health record (EHR) for 90 continuous days and then extrapolating the data needed for base score reporting. If reporting as a group, ACI measures will mirror an aggregate of the data for those physicians/providers. It is also required to verify whether the EHR used for reporting ACI is certified to the 2014 edition or the 2015 edition. To fulfill the minimum ACI requirements, providers should also complete the “Prevention of Information Blocking Attestation” to confirm that clinicians have not knowingly or willfully limited or restricted the compatibility or interoperability of their certified EHR technology.


It is a common practice in the industry that those keeping track of the money coming in simply roll the dice and “hope” they get paid by insurance companies. But projecting the inflow monthly is a much better way, and it will help practice owners sleep better at night. Projecting inflow, which is based on current daily inflow and the number of working days in the month, is easy. However, practice owners will need to address a few matters up front to help ensure that they get their money as quickly as possible. Practice owners should have their staff complete their notes the day the patient was in, which decreases the number of days out that they will be paid and makes their predictions of monthly inflow much more accurate. Practice owners should bill claims out every day, which makes it easier to stay on point with their budget. They should also post monies coming in the same day they are received, which keeps their A/R in check and brings greater clarity to the paying habits of their payers. Practice owners can calculate their average inflow per day and multiply that by the number of working days in the month. This number will fluctuate, which is why it is important to send out claims daily and post daily.

Health Policy and Reimbursement

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The Center for American Progress proposed a new initiative dubbed "Medicare Extra for All," which would build on Medicare to guarantee coverage to consumers. Preventive care, treatment for chronic disease and generic prescription drugs would be free. Employers and individuals would have a choice of joining Medicare Extra, but it would not be required. Low-income people would pay no premiums or copays, which for others would be determined according to income. Medicare Extra would use Medicare's payment system as a framework to pool 1) working-age people and their families, 2) low-income people now covered by Medicaid and 3) seniors. The plan's authors acknowledge significant tax increases would be required. Options include rolling back some of the recently enacted GOP tax cuts for corporations and upper-income people, raising Medicare taxes on upper-income earners and instituting higher taxes on tobacco and sugary soft drinks.


The Trump administration has proposed new rules that would make it easier for consumers to buy insurance policies that do not comply with the Affordable Care Act (ACA). Current rules allow "short-term, limited-duration insurance" to last up to three months, but the proposal would expand the limit to 364 days. U.S. Secretary of Health and Human Services Alex M. Azar II said the proposed rules would provide additional options to people who could not afford to pay current insurance premiums. These short-term policies are intended for people who are between jobs or who need temporary coverage for other reasons. People who buy these plans are not eligible for subsidies under the ACA, and these plans do not need to provide the "essential health benefits" required under the law. Comments will be accepted on the proposal through April 23, with Azar hoping to issue final rules by late spring.


The U.S. Centers for Medicare and Medicaid Services (CMS) has announced a shift away from Obama-era Medicare goals that sought to significantly reduce the cost of the U.S. healthcare system. The Obama administration had a specific timeline, including a goal of linking 30 percent of Medicare payments to quality-based payment models by the end of 2016, which it realized a year early. CMS' new focus is on reviewing "the impact of new payment models on patients and providers," says CMS spokesperson Raymond Thor. CMS Administrator Seema Verma has in recent months criticized certain Obama administration tactics while withdrawing from some of her predecessor's projects to pay healthcare providers quality-based compensation.

Medicine, Drugs and Devices

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A dozen healthcare organizations are teaming with Apple to conduct a pilot test involving the company's iPhone Health app. Two major electronic health record (EHR) systems developed by Cerner and Epic will be used, along with Fast Healthcare Interoperability Resources, developed by Health Level 7. Initially, an upgrade to the app will enable a small percentage of patients of the 12 healthcare organizations to pull a portion of their medical records from their healthcare providers' EHRs and store them on their iPhones. These medical records will initially cover immunizations, lab results, allergies, clinical vitals, conditions, medications and procedures, according to Apple.


The U.S. Department of Health and Human Services (HHS) is working on additional proposals to reduce high drug prices, including some that could be enacted without congressional action, according to HHS Secretary Alex Azar. These include drug pricing proposals that could potentially see some action this year. Meanwhile, Trump administration budget proposals issued this month included a cap on out-of-pocket spending for enrollees in Medicare's prescription drug program and allowing up to five states to join together to negotiate drug prices for Medicaid. However, it has been traditionally challenging for Congress to pass controversial drug pricing measures, especially in an election year. "We look forward to working with Congress to get those proposals enacted, and we're continuing to work with more proposals that we'll move forward with on our own authority if we're able," Azar says.


A trial under way in federal court in Philadelphia is testing the power of the U.S. Federal Trade Commission (FTC) to crack down on drugmakers' alleged moves to thwart the sale of low-cost generics. The trial stems from a 2014 FTC lawsuit accusing AbbVie of filing baseless patent-infringement lawsuits against two generic drug companies to delay competition for its testosterone-replacement therapy. AbbVie denies the allegations. FTC is seeking a judge's order that AbbVie pay $1.32 billion to consumers as compensation for the delay in generic versions of the therapy. FTC has said delays in the introduction of generic drugs keep spending high by depriving customers of lower-cost alternatives and has long sought to block makers of brand-name drugs from using certain tactics to ward off generic competition. FTC has argued the tactics include filing baseless patent-infringement litigation against companies seeking to market generics, a step that can delay generic launch by many months.