News From ACFAS

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Nearly 300 case study and scientific posters captivated ACFAS 2016 attendees during our annual poster competition. View them for yourself, as well as this year’s winners, at acfas.org/austin. With research in foot and ankle surgery moving at lightning speed, each poster provides a vivid snapshot of these latest trends and discoveries. Check acfas.org this summer for details on next year’s poster competition at ACFAS 2017 in Las Vegas.
Start your spring with fresh perspectives on everything from modified lapidus arthrodesis to ankle joint fusion. The March/April issue of The Journal of Foot & Ankle Surgery features more than 40 case reports and original research articles that bring you a multifaceted view of surgical techniques and discoveries rippling through the profession.

Watch your mailbox for your copy or log into acfas.org and visit the JFAS landing page for access. Also browse the JFAS archive for articles dating back to 1995 or preview the newly approved articles in press to see what’s in store for future issues.
Staying connected with the College and your fellow ACFAS members is easy with our social media sites. Follow ACFAS on Facebook, Twitter and LinkedIn for the latest updates on ACFAS activities and events and communicate with others who share your passion for foot and ankle surgery.

Also “like” FootHealthFacts.org, our patient education website, on Twitter and Facebook so you can share our timely tweets and posts on foot and ankle health with your followers, family and friends.

Foot and Ankle Surgery

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A team of researchers at Brigham Young University has developed surgical instruments that are small enough to enter the body through incisions as small as three millimeters wide. These miniaturized tools eliminate the need for pin joints and other parts. The idea is based on the mechanics present in paper origami and has helped develop devices that enter the tiny incision before fanning out and mimicking the movement of certain areas of the body. These ideas could change surgery, especially in today's age of non-invasive preferences. A team at the Hong Kong Polytechnic University is developing similar tools, including one that can complete various abdominal and pelvic surgical procedures after entering through a three-centimeter incision. Medical device makers are noticing the trend and starting to jump on board—the new technological features could help the market reach a worth of $20 billion by 2021.


Radiographic severity of arthritis can predict outcome following knee replacement. Some patients can undergo arthroplasty even without severe radiographic disease. A team of researchers looked to determine if this same principle could also apply to total ankle replacement (TAR). A total of 124 patients were reviewed in the study, and they were put into four subgroups based on degree of severity of radiographic grading for arthritis (A, B, C, D). Preoperative Foot and Ankle Outcome Scores (FAOSs) were similar for pain, function and stiffness. Group D achieved the most significant improvement in all FAOS domains. No significant differences were found in Short Form Health Survey (SF-36) scores. In group D, 91.1 percent of patients were satisfied at two years, compared with 50 percent in groups A, B and C. Group D patients also reported a 93.9 percent positive quality of life rate, with the other groups reporting 47 percent. Seventy-seven percent of Group D patients said they would have the operation again; only 52.2 percent of the other groups said the same. The study showed that radiologic severity is an important factor that surgeons must consider when determining how to adequately treat their patients.

Practice Management

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Many practices have an electronic heath record (EHR), complete with data, schedules, notes and more. Not everyone has a contingency plan for when the EHR runs into problems. If the power goes out or data is compromised, it is important to have a contingency plan in place so that operations can continue to run somewhat smoothly. One possible solution is to write down the names and numbers of the next several patients as soon as the power goes down. Gather as much pertinent information as you can so that when patients inevitably ask questions, you can answer them efficiently despite the lack of power. The crucial aspect is simply to be prepared. If you have a well-designed contingency plan, you may not be able to run your practice completely correctly in the event of an outage—but you will certainly be prepared to deal with the problems at hand.


Many physicians are unsure about the security of the cloud. Despite the cloud's growth, many still see it as a final option that is less safe than traditional security. According to health IT researcher Aiden Branch, the cloud is among the most dependable solutions for medical practices. You can feel secure knowing your data and sensitive billing information is safe, he explains. The biggest thing to consider is what solution best fits your practice. Branch lays out four questions every physician should ask before implementing cloud solutions: 1) Can you try out their system with your processes in what is called a “sandbox” environment to see if it will "play nicely?" 2) Does the software vendor understand and work with other physicians who share your specialty? 3) Does the vendor have a good track record of trustworthiness? 4) Will they provide references whom you may contact? Once you answer these questions, you are ready for the cloud. If you still feel wary, Branch notes several reasons why the cloud is the best option. It is easy to implement, is generally low maintenance, it can save you a lot of money because it is a streamlined solution, it can scale with your practice's growth seamlessly and most importantly, it provides greater security than any other type of system.

Health Policy and Reimbursement

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Physicians and healthcare providers are fighting a federal proposal to test whether paying doctors less for drugs administered under a Medicare program reduces spending. According to the Obama administration, the proposal will help patients and will not deny anyone access to drugs. But specialty doctors and industry groups called the plan "ill-conceived." Some believe independent practices will fold because the reimbursements from the drugs barely cover their costs. Most of the complaints stem from a proposed reduction in how much providers are reimbursed under Medicare Part B. It is a tough position for the Obama administration to be in because Medicare Part B has been criticized for reimbursing doctors more if they administer costlier drugs. Higher-priced drugs mean bigger profit. The new proposal aims to change that. While some groups would still be reimbursed the average sale price of a drug plus a six percent premium, others would get the average sale price, a premium of 2.5 percent and a $16.80 fee.


Value-based care costs US medical practices an estimated $15.4 billion each year, according to a survey. The study, published in Health Affairs, found that poor standardization of quality measures can cause physicians to overlap in the measures used by different insurers. Among four specialties (cardiology, primary care, multispecialty and orthopedics), physicians and staff reported spending an average of 15.1 hours per week per physician on quality measures. Physicians spent an average of 2.6 hours, with the rest falling to staff and assistants. In addition, all of this time added up to an average cost of $40,069 per physician per year. More than 80 percent of the practices said the effort spent on quality reporting has increased compared with three years ago.


A recent survey found that 56 percent of orthopedic departments are concerned about being unprepared for the new Medicare bundled payment model scheduled to take effect April 1. The survey had seven takeaways:

1. The Centers for Medicare and Medicaid Services’ Comprehensive Care for Joint Replacement (CJR) model will correlate payment with quality and patient satisfaction measures.
2. Ten percent of orthopaedic programs reported being fully prepared.
3. Seventy-five percent of respondents plan to hire new staff to coordinate patients and collect data.
4. Under the new model, providers must track and prove value in patient care and will be responsible for the cost of joint replacement care from the time of surgery through 90 days post-discharge.
5. The quality measures will include patient-reported outcomes.
6. FORCE-TJR tracked more than 25,000 joint replacement patients and found hospitals may underestimate readmission costs by 25 percent. This is because one out of four patients who have a readmission does not return to the hospital where they underwent the original surgery.
7. FORCE-TJR national benchmarks offer a diagnostic assessment of a hospital's readiness for CJR.

Medicine, Drugs and Devices

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The U.S. Food and Drug Administration (FDA) is testing a new system to speed up the review process for medical devices. Finding qualified reviewers can take as long as nine months, so the U.S. Department of Health and Human Services (HHS) is creating a network database of experts to help. FDA will then pick experts from the database. The test will determine whether using the database is more efficient than picking experts using current methods, including matching individuals based on their published articles and academic degrees. FDA believes the program will increase the speed and effectiveness of the device regulatory process, which can take an average of 266 days.


The American Nurses Credentialing Center and the Rheumatology Nurses Society (RNS) have launched a new certification program available to nurses involved with rheumatology. The goal of the program is to increase professionalism and address unmet needs in patients' treatment. It will fill the gaps not covered by a traditional education, help facilitate clinical trials and improve all aspects of rheumatologic care for patients who need it. The program was developed after extensive research and is awarded through a portfolio rather than a paper test. "A paper test can be out of date the moment it is completed," said Sheree C. Carter, past RNS president. "We spent a full year making sure we had everything we needed in this particular portfolio and reflected what a rheum nurse does."


About 165,000 health-related apps run either iOS or Android and by 2017, these apps will have been downloaded an estimated 1.7 billion times. While most apps are rarely used, the successful ones are highly popular. Most of them fall into the category of "wellness," but mhealth is starting to show promise in more serious medicine. A growing number of apps allow patients to talk directly with their doctors, and some apps allow for 24-hour access to a physician for a consultation with a fee. Mhealth also allows chronically ill people, who cost the healthcare system the most money, to monitor their health in ways previously impossible. Not only can these patients monitor themselves, their physicians and providers can also have access and intervene when something goes wrong. Because of the growing popularity of mhealth, the U.S. Food and Drug Administration (FDA) is starting to regulate it more. FDA has already released guidelines detailing an approach to controlling information to ensure that patients are never put in danger because of a misunderstanding. As the market continues to grow, mhealth will be a critical part of daily living for millions of people.