News From ACFAS

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We’re just one week away from ACFAS 2018 at the Gaylord Opryland Hotel in Nashville! If you’re planning to attend, be sure to download the free ACFAS 2018 before you leave so you can easily access your personalized session schedule, the exhibitor directory, social media feeds, speakers list, convention center maps and more.

Search your app store for ACFAS 2018 or visit http://m.core-apps.com/acfas2018. You should have received an email this week from ACFAS with your login details to access your personalized schedule. Your login information will also be printed on the back of your ACFAS 2018 name badge, which you will receive in Nashville. See how just a few simple changes to your coding and billing procedures can lead to maximum reimbursement for the care you provide. Reserve your spot at the popular seminar, Coding and Billing for the Foot and Ankle Surgeon, set for July 13–14 in Portland, Oregon and October 19–20 in Chicago, and gain no-nonsense tips and tools on:

• How to structure your work week
• Correct coding for amputation, forefoot, rearfoot of ankle reconstructive surgery
• Proper evaluation and management coding
• How to use modifiers to avoid denials
• Coding for diabetic foot cases, minor office procedures and complex arthroscopy cases
• New government reimbursement systems and methods

You will also code real-life patient cases and scenarios alongside expert faculty. Register now at acfas.org/practicemanagement and take the first steps toward improving your office’s coding and bill processes. If you are a fellowship program director and would like to seek ACFAS status for your program, submit your application by May 1, 2018.

The ACFAS Fellowship Committee will meet in mid-August in Chicago to review any new applications and will communicate their decisions later that month.

Contact Michelle Kennedy, ACFAS director of Membership and Post Graduate affairs, to request an application or to learn more about the College's Recognized Fellowship Initiative.

Foot and Ankle Surgery

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A study was conducted to disclose experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury. A total of 218 consecutive patients with CLAI underwent surgery from January 2012 to December 2015. The patients were treated with tendon allograft reconstruction of the lateral ligament, and CLAI was combined with LB injury in 51.4 percent. The 112 patients with concurrent LB injury had this treated concurrently, and 36 patients underwent excision of the anterior process of the calcaneus, 68 underwent LB repair and eight underwent LB reconstruction. Patients came back for a postoperative clinical and radiologic assessment at an average of 31 months, with outcomes evaluated by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale pain scores, Karlsson scores and radiographic assessment. Of the patients with concurrent LB injury, 82.1 percent returned for final assessment. Although most patients had a good recovery, results were not ideal in those who underwent excision of the anterior process of the calcaneus, exhibiting significant postoperative decreases in talar tilt and anterior drawer but no significant postoperative improvement in visual analog scale pain score and AOFAS score. Patients receiving LB repair or reconstruction had an excellent or good outcome regarding patient subjective self-assessment, pain scores, Karlsson scores and AOFAS scores at final follow-up.


Researchers conducted a retrospective study of patients who presented with ischemic tissue loss and tibial arterial occlusive disease to the University of Pittsburgh Medical Center between 2006 and 2013 and underwent a surgical bypass to pedal arteries. They sought to evaluate the effects of prior tibial interventions on successive bypasses to pedal targets. Of 122 eligible patients, 27 had a prior endovascular tibial intervention (PTI) while 95 had no prior tibial intervention (nPTI) in the treatment of ischemic pedal wounds. At 12 months, those with a prior tibial intervention exhibited a shorter primary patency of the pedal bypass graft (34.8 percent vs. 60.2 percent, P = 0.04). Primary-assisted patency and secondary patency were similar between the two groups. Wound healing was improved in those patients who had a prior endovascular intervention with 63.8 percent healed at one year compared to only 34.8 percent of those without intervention, and survival was similar between the two patient populations. Despite a decline in primary patency, pedal bypass was not otherwise negatively affected by a prior tibial intervention, the researchers reported in Annals of Vascular Surgery. The results suggest an endovascular-first approach is a feasible treatment strategy to achieve similar clinical outcomes in the management of ischemic foot wounds.


New research examines the change in sagittal foot and ankle range of motion after revision total ankle replacement surgery. Researchers performed a retrospective medical record review of patients who had undergone revision total ankle replacement from January 2009 to June 2016. Thirty-three patients (33 ankles) underwent revision total ankle replacement surgery and met the inclusion criteria with a mean follow-up period of 28.39 ± 14.68 (range two to 59) months. Researchers used a novel radiographic measurement system with stable osseous landmarks to determine whether revision total ankle replacements would reduce compensatory midfoot range of motion. They investigated preoperative and postoperative weightbearing lateral radiographic images to determine the global foot and ankle, isolated ankle and isolated midfoot sagittal ranges of motion. Researchers found a significant increase in ankle range of motion and a significant decrease in midfoot range of motion from preoperatively to postoperatively. The change in global foot and ankle range of motion was not significant. The increased ankle range of motion effectively resulted in less compensatory midfoot range of motion.

Practice Management

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Common email mistakes include entering the wrong recipients, forgetting to add an attachment and neglecting to insert a link. Sending a follow-up email is the only way to address these errors. Recipients should be alerted to revisions by using the word "Correction" in the "Subject" line. The correction itself can be mentioned in the Subject line: "Correction: The Research Committee meeting is *Tuesday, May 8," for example. A simple apology and clarification in the body of the note should also be added that invites recipients to reach out if they have any questions. One way to avoid making such mistakes is reversing the order of how emails are composed. The content should be added first, followed by an attention-grabbing Subject line. Next, any attachments or links should be added. The email should then be looked over for accuracy, proofread and spell-checked. The last step of the process is to add the names or email addresses of the recipients. The acronym NOTES can be useful as a checklist, where N is for Name (Greet those with whom you are communicating by name); O is for Others (Check if anyone else needs to be included); T is for Topic (Ensure the specific purpose of the email is reflected clearly in the subject line); E is for Expectations (Declare your expectation and put a timeline around it); and S is for Signature (A professional and informative sign-off that includes contact information, website and links). Appropriate sign-offs include Regards, Respectfully, Sincerely, Thank You and Yours Truly.


A survey from Accenture found that 47 percent of health consumers said they would use an artificially intelligent (AI) virtual physician provided by their health service because it is available whenever they need it. As part of its 2018 Consumer Survey on Digital Health report, Accenture surveyed 2,301 U.S. adults to evaluate their attitudes toward healthcare technology, modernization and service innovation. The survey also noted that 29 percent of consumers said they prefer visiting their physician in person, while 26 percent said they do not know enough about how AI works.


The majority of healthcare stakeholders expect the transition to value-based care to gather steam in the coming years. A 2017 Quest Diagnostics survey of 450 primary care physicians and health plan executives found that 82 percent said the transition to value-based care will continue, irrespective of changes to healthcare policy at the federal level. The survey also found that just 43 percent of physicians said they have the tools to succeed in a value-based environment. It is essential for physicians to negotiate the correct terms in value-based contracts with payers. To this end, physicians should find a partner with the right skills, including compiling, mining and effectively documenting internal claims and patient data that clearly illustrate the practice’s history of delivering high-quality, cost-effective care. In some cases, that expertise is in-house, but others may benefit from working with technology and analytics partners with more experience in designing, evaluating, building, measuring and negotiating value-based reimbursement contracts that correlate financial targets with improved patient outcomes. Physicians also need to understand their data and practice readiness. This involves building a mutually beneficial relationship with payers. Physicians can increase their bargaining power with payers by using quality measures in such areas as cost, quality, utilization and population health. Finally, physicians need to be aware what is, is not and should not be negotiable. They need to carefully consider which quality measures will generate the most benefit for the practice as well as provide the most scope for improvements.

Health Policy and Reimbursement

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A memo reviewed by the Wall Street Journal suggests that the Trump administration wants any proposed congressional plan for stabilizing Affordable Care Act (ACA) markets to include conservative goals. For instance, the memo backs a permanent congressional appropriation for subsidies to insurers that decrease deductibles and copays for lower-income consumers in exchange for exclusions on abortion coverage by those insurers. It also wants to block funding from organizations that may have a role in abortion insurance coverage or procedures. Furthermore, the administration wants any ACA stabilization plan to allow for the renewal of short-term plans that do not comply with the health law, so these plans can operate more like traditional insurance. In addition, the memo encourages lawmakers to pass measures that allow insurers to charge older people five times as much as younger people, expand access to health savings accounts and increase the amount of money that people can contribute to them.


Arkansas will require Medicaid recipients in the state to work or take part in employment activities as a condition of receiving health insurance. Arkansas' waiver, which was submitted to the U.S. Centers for Medicare and Medicaid Services, calls for beneficiaries to work or participate in job training or job search activities for at least 80 hours per month as a condition of receiving Medicaid. Those who fail to meet the requirements for three months of a plan year will not be able to re-enroll until the following plan year. Arkansas Governor Asa Hutchinson did not specify when the requirements would take effect. Individuals exempted from the requirements include those who are medically frail, served by the Indian Health Service or tribal facilities, people in school, those caring for an incapacitated person or child under age 6, pregnant women and those in substance abuse treatment. The rules apply to people between 19 and 64 years old.


The U.S. Centers for Medicare and Medicaid Services (CMS) has unveiled an initiative aimed at giving patients more control over their own healthcare records. The program, called MyHealthEData, "will help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice," CMS said. Patients can receive an electronic copy of their health record and securely share their data with whichever provider they choose, CMS said. This will ultimately result in better patient outcomes and understanding as well as greater competition and lower costs, the agency said. In addition, CMS Administrator Seema Verma announced a Medicare patient records initiative dubbed Blue Button 2.0, which aims to revolutionize the way individuals view their health information. For example, Blue Button could enable "creation of health dashboards for Medicare beneficiaries to view their health information in a single portal or allowing beneficiaries to share complete medication lists with their doctor to prevent dangerous drug interactions," Verma said. She urged insurers to follow suit and give patients their claims data electronically. CMS also intends to require that patients' data follow them when they are discharged from the hospital.

Medicine, Drugs and Devices

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The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria's (PACCARB's) Immediate Action Subcommittee on March 2 passed two resolutions to maintain programs dealing with antibiotic-resistant bacterial infections and maintain or increase funding for such efforts. Morbidity and mortality associated with such infections is widespread in the United States and increasing. Executive Order 13676 included the establishment of PACCARB in 2014. PACCARB utilizes a One Health approach, which recognizes the connection between the health of people and the health of animals and the environment.


Erosions detected by MRI should not be overestimated in the diagnosis of rheumatoid arthritis (RA), as they may be detected in patients with other arthritides and in symptom-free persons from the general population, according to a study published in the Annals of Rheumatic Diseases. Although MRI is recommended for detecting early joint damage in RA, MRI-detected erosions may also present in symptom-free control patients, especially at older age. Whether RA-specific MRI-detected erosions can be distinguished from physiological erosions in symptom-free persons is currently unknown. The research found that MRI-detected erosions in unilateral metacarpophalangeal and metatarsophalangeal joints were not confined to RA, but were also present in patients with other arthritides and in symptom-free persons from the general population.


UnitedHealthcare said it would stop keeping millions of dollars in discounts it gets from drug companies and share them with its customers. Dan Schumacher, president of UnitedHealthcare, said the new policy will apply to more than 7 million people who are enrolled in the company’s fully insured plans, beginning next year. Not all drugs come with rebates that are paid to the health plan. People in plans with high deductibles who buy drugs that carry large rebates will see the greatest savings, Schumacher said. The decision by UnitedHealthcare is the latest in a series of steps taken by drug makers and health plans to try to lessen public discontent over drug prices. "The industry is taking criticism from a lot of different people," said Erik Gordon, a business professor at the University of Michigan. It is significant that UnitedHealthcare "felt compelled to do something," he said. The Trump administration recently floated the idea of requiring private drug plans under Medicare to pass on the savings to consumers at the pharmacy counter. HHS Secretary Alex Azar II called UnitedHealthcare's move "a prime example of the type of movement toward transparency and lower drug prices for millions of patients that the Trump administration is championing."