News From ACFAS

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Another record-breaking conference is in the books thanks to you and everything you did to make last week’s 75^th Anniversary Scientific Conference in Las Vegas a huge success! With 1,900 DPMs in attendance and a sold-out Exhibit Hall, ACFAS 75 will be remembered as the College's biggest celebration ever.

“The 2017 Annual Scientific Conference was a milestone for the College. It was our 75^th anniversary, and ACFAS delivered in style. The conference offered informative lectures on relevant topics presented by some of the leading authorities in foot and ankle surgery. The workshops provided hands-on experience in a variety of cutting-edge techniques. Congratulations to the Annual Scientific Conference Committee on a job well done,” said Laurence G. Rubin, DPM, FACFAS, ACFAS president. “Thanks to the ACFAS staff for their continued commitment and to efficaciously achieving another record-setting attendance. Lastly, thank you to the attendees and exhibitors who helped make this a successful and memorable conference,” he added.

Join us next year for the 76^th Annual Scientific Conference March 22–25 at the Gaylord Opryland Hotel in Nashville. You’ve just attended the College’s biggest conference in 75 years—let your patients and community know about it! Download ACFAS’ free Fill-in-the-Blanks Press Release from the Marketing Toolbox, populate it with your professional contact information then send it to your local media to publicize your attendance. You can also include the press release in your newsletter or post it on your practice’s website and social media sites.

Visit acfas.org/marketing for many other free resources to promote yourself and your practice, educate your patients and increase referrals to your office. Several ACFAS 75 attendees didn’t need to hit the casinos to win big in Vegas. Congratulations to the following winners of daily prize drawings held last week in the ACFAS Member Center:

Amazon Echo
Brandon M. Scharer, DPM, FACFAS

Apple Watches
Rebecca A. Moellmer, DPM, FACFAS
Michael R. Zimmerman, DPM, AACFAS

American Express Gift Cards
$200 – Samantha Ann Sklar, DPM
$200 – Jesse R. Wolfe, III, DPM
$100 – Russell J. Buttars, DPM
$100 – Romy K. Patel, DPM
$50 – Rachel H. Albright, DPM
$50 – D. Hugh Fraser, DPM, FACFAS
$50 – Katherine M. Heugel, DPM, AACFAS
$50 – Ali Rahnama-Vaghef, DPM

ACFAS also congratulates the following attendees who each won a $250 American Express gift card in a raffle held during their Divisions’ membership meetings:

Division 1: Alayna M. Puccinelli, DPM
Division 4: Joseph Spencer Baker, DPM, AACFAS
Division 7: Kristopher W. Krannitz, DPM, FACFAS
Division 11: Stephen F. Stern, DPM, FACFAS

Foot and Ankle Surgery

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The hallux valgus interphalangeus (HVI) deformity has been described as rare, but a study hypothesized that the deformity is common and contributes significantly to the total valgus deformity of the hallux (TVDH). Researchers analyzed 285 pre-operative radiographs, measuring the hallux valgus angle, intermetatarsal angle, interphalangeal angle (IPA) and distal metatarsal articular angle. There was a statistically significant difference in the proportion of abnormal IPA in the Caucasian population (68.7 percent) compared with the African population (53.8 percent). The average contribution of the IPA to the TVDH was 37.9 percent. The contribution of IPA to TVDH was greater in feet without hallux valgus (58 percent) than feet with hallux valgus (28.3 percent).


A recent study examined the association between plasma fetuin-A levels and peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM). The study included 71 patients with T2DM and 57 participants without diabetes. Patients with T2DM had higher fetuin-A levels than the individuals without diabetes. Patients living with diabetes and PAD had lower fetuin-A levels than patients without diabetes and PAD. The odds of PAD for patients with T2DM increased with long diabetes duration, smoking, presence of arterial hypertension, dyslipidemia and lower fetuin-A levels. Researchers found a trend toward higher fetuin-A levels in subjects with less severe lower-extremity arterial calcification.


Autogenous bone graft (ABG) is considered the gold standard for joint fusion, but recombinant human platelet-derived growth factor-BB (rhPDGF-BB) has also been used for ankle and foot fusion in recent years. The goal of a recent study was to compare the radiologic effectiveness, clinical results and safety of rhPDGF-BB with ABG. Three randomized controlled trials involving 634 patients were included in the study. Radiologic outcomes revealed no significant difference between the two approaches. Analysis of clinical results found that the ABG group was superior in long-term Short Form-12 physical component scores. However, the autograft harvesting procedure was associated with donor site pain and morbidity, additional operative time, blood loss and scarring, all of which can be avoided with rhPDGF-BB.

Practice Management

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With the advent of electronic health records and a desire by patients for more transparency, many physicians are choosing to share all notes, lab results and X-ray images to improve the doctor-patient relationship. "Today, rather than physicians deciding what is important 'for' their patient, it is now better to decide 'with' their patient," says Donald Rebhun, corporate medical director of HealthCare Partners. "This leads to better understanding, improved adherence and better outcomes." Some physicians project patients’ records on large television screens during patient visits to encourage a more open dialogue and to identify potential inaccuracies in the medical record. Sharing records in a highly visible way makes a patient visit interactive and brings an element of transparency that enhances the collaborative doctor-patient relationship. The visualization of a patient’s health patterns also keeps patients motivated to avoid negative progress. Physicians may be concerned about patients being offended by their observations or seeing sensitive information. Some patient engagement platforms have text processing and data filtering capabilities that can detect and censor certain information, showing only generic visit and intervention information.


Physicians could violate the Health Insurance Portability and Accountability Act (HIPAA) simply by replying to a negative online review on Yelp and other rating sites. When patients post a negative review, physicians often defend themselves and their practice by replying to a patient’s comment or bad rating. However, this interaction could expose personal medical information and result in a HIPAA violation. Practices should have a clear procedure regarding responding to patient complaints as part of their HIPAA policies. Front office staff may be asked to periodically monitor reviews and ratings and to notify the physician of negative reviews. Physicians should approach interacting with an unhappy Yelp reviewer in the same manner they would speak to an unsatisfied patient in the office. Replies should be kept short and simple, and doctors should thank the reviewer for taking the time to share his or her concern. Ideally, physicians will invite an unhappy reviewer to schedule a phone conversation to discuss the matter privately. Patients are more likely to edit negative reviews if they know their concerns have been heard.

Health Policy and Reimbursement

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The U.S. Centers for Medicare and Medicaid Services (CMS) is expanding its primary care pilot known as Comprehensive Primary Care (CPC) Plus, but participation in the program has been lower than anticipated. CPC Plus, which pays physicians a monthly fee for primary care visits, seeks to improve outcomes and lower costs for Medicare beneficiaries as well as consumers covered by commercial plans. To better evaluate CPC Plus, the agency plans to divide participating providers into two groups, with one receiving CPC Plus payments, while the other will not. The test will allow CMS to assess the impact those incentives have on improving care, but health policy experts say the change will lead to less participation. In addition, it is unclear whether the randomized version of the program will count as an alternative payment model under the Medicare Access and CHIP Reauthorization Act. The overload of alternative payment models in recent years may be having a negative effect on interest in participating in alternative payment experiments.


About 30,000 of Vermont’s Medicaid patients will take part in a pilot program testing a new healthcare payment system designed to prevent unnecessary treatments, improve care and constrain growth in the cost of services and drugs. Vermont Gov. Phil Scott announced the formal launch of the pilot phase, with accountable care organization OneCare Vermont administering the program. OneCare’s network of hospitals and physicians already provide care to about 100,000 Vermont residents. The state will grant OneCare $93 million in monthly payments, or $3,100 per Medicaid patient. If OneCare spends less than that amount, the company and the state share the savings. If the program is successful, President Donald Trump and lawmakers may be inclined to retain a provision in the Affordable Care Act (ACA) that allows states to design their own health reforms. Governors of both parties have expressed support for an ACA replacement that grants states more flexibility to experiment with their health systems.


Governors attending the winter meeting of the National Governors’ Association met with President Donald Trump recently to discuss health policy and Medicaid funding. House Republicans are pushing to put a lid on future Medicaid funds in exchange for giving states more flexibility to run their programs. However, a rift has emerged between Republican governors who expanded Medicaid in their states under the Affordable Care Act and those who did not. Utah Gov. Gary Herbert told reporters he supports the proposal to cap funding and increase flexibility, but Gov. Brian Sandoval of Nevada, where more than 300,000 people enrolled in Medicaid after expansion, says changes to the funding formula could be detrimental to low-income people in his state.


During his speech to Congress on February 28, President Trump signaled support for giving tax credits to Americans who buy healthcare coverage. That proposal has received mixed reactions from Republicans. The proposal has the support of House Speaker Paul Ryan, but critics worry it could become another entitlement program. During his speech, Trump also called for the repeal of the Affordable Care Act, but Republicans also remain divided on that. Some lawmakers support a repair of the law, others want a replacement and some want a complete elimination. Democrats also remain skeptical of Trump's larger healthcare plans and their success getting off the ground.

Medicine, Drugs and Devices

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More researchers are choosing to open up their work to the wider scientific community and take advantage of social media to collaborate and share their findings. The change has quickened in pace in recent years as the cost of cloud computing plummets and scientists grow more comfortable in uploading their work. The social network ResearchGate was founded in 2008 as a platform on which scientists around the world can connect. ResearchGate has signed up 12 million scientists, and researchers upload about 2.5 million papers to the site every month. The shift toward openness and transparency extends to efforts aimed at the general public as well, such as online courses offered by MIT and Harvard that could redefine what it means to go to college. Cancer researchers are also reaching out to the public through a mobile game that allows players to participate in the crunching of complex data based on genetic sequencing from breast cancer patients.


Drugmakers are trying to quell the backlash over high drug prices by putting some limits on their increases in 2017. This January, pharmaceutical companies did not raise prices for as many drugs as last year and imposed fewer hikes of 10 percent or more, according to Raymond James & Associates. About 5.5 percent of the price increases reached the 10 percent inflation level, compared with 15 percent last year. However, the median price increase remained high at 8.9 percent, far above the U.S. inflation rate of two percent. These price increases can drive drug spending up by hundreds of millions of dollars. For example, Humira-maker AbbVie raised the drug's price 8.4 percent in January, representing as much as $850 million in additional U.S. healthcare spending this year. The most recent hike follows the 18.5 percent price boost AbbVie took last year for Humira.


The World Health Organization (WHO) has published a list of antibiotic-resistant “priority pathogens,” comprised of 12 bacteria families that pose the greatest threat to human health. The list was released in a bid to promote international research and development of new antibiotics as part of WHO’s efforts to address the growing resistance to antibiotics. WHO ranks the priority pathogens according to how urgently new antibiotics are needed. The critical group includes multidrug-resistant bacteria that are responsible for high mortality rates, particularly within healthcare facilities. Acinetobacter, Pseudomonas and various Enterobacteriaceae are included in the critical category. The high- and medium-risk tiers contain other drug-resistant bacteria that cause more common diseases, such as gonorrhea and food poisoning. According to Tim Jinks of the Wellcome Trust global health charity, the WHO list will be an important tool to steer research and generate new treatments. "Without new medicines to treat deadly infection, lifesaving treatments like chemotherapy and organ transplant and routine operations like caesareans and hip replacements will be potentially fatal," Jinks says.