March 25, 2015 | | JFAS | Contact Us

News From ACFAS

Spring FootNotes Now Available
Put a little spring in your practice’s step with the latest edition of FootNotes, our patient education newsletter. Visit the ACFAS Marketing Toolbox to download this issue, which features the following articles:

• Don’t Let Foot Pain Slow Your Springtime Walk
• Is Your Job Tough on Your Feet?
• Don’t Ignore Ankle Sprains

Remember, all issues of FootNotes can be customized with your office’s contact information to help grow your practice. Put copies of FootNotes in your waiting room, distribute them at upcoming health fairs and speaking engagements or post FootNotes on your social media sites or company website—the possibilities are endless!

Be sure to take advantage of the other free resources available at, such as PowerPoint presentations, physician-to-physician information videos, press release templates and more to promote your practice this spring and throughout the year.
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Register Now for 2015 Surgical Skills Courses
Ready to gain a fresh perspective on advanced and restorative techniques in foot and ankle surgery? Register now for ACFAS’ 2015 lineup of surgical skills courses: Total Ankle Arthroplasty, Comprehensive Flatfoot: Reconstruction and Arthrodesis, Foot and Ankle Arthroscopy and Advanced Foot and Ankle Arthroscopy.

Through lectures with expert faculty, focused panel discussions, surgical demonstrations and hands-on workshops, you’ll explore state-of-the-art surgical pathways, orthobiologic adjuncts and the latest trends and also learn how to recognize risks associated with different treatment approaches.

With 75 percent of your time spent in the lab performing surgical procedures with personalized one-on-one instruction, you’ll see why our surgical skills courses have been part of ACFAS’ curriculum for more than 20 years.

Each course is worth 16 continuing education contact hours and includes breakfast, refreshment breaks, lunch and dinner, plus a fireside chat during which you can share your most difficult case with faculty and fellow attendees to obtain their advice and insight.

Visit to register today. If a course is sold out, contact Maggie Hjelm to be waitlisted.
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ACFAS Advocates for Wound Care Through Alliance
ACFAS serves as a key clinical specialty society voice to payers and other stakeholders through the Alliance for Wound Care Stakeholders. The Alliance unites wound care experts to advocate on public policy issues that may create barriers to patients’ access to treatments or care, with a focus on reimbursement, wound care research and wound care quality measures.

In 2014, the Alliance mobilized key stakeholders and advocated to delay what clinician and wound care groups collectively believed was a clinically inappropriate Durable Medical Equipment Medicare Administrative Carrier’s (DMEMAC) Local Coverage Determination on pneumatic compression devices. The Alliance convened a conference call with CMS and DMEMAC medical directors, submitted clinical evidence addressing policy inaccuracies and scheduled meetings on Capitol Hill to bring visibility to this issue. Of particular concern, the Alliance and ACFAS ensured DPMs were able to prescribe pneumatic compression devices despite an initial Centers for Medicare and Medicaid Services ruling to the contrary.

ACFAS and the Alliance have also addressed Physician Quality Reporting System wound care measures, medical-grade honey, physician fee schedule surrounding wound care, restrictive local coverage determinations and other areas affecting wound care, patients and providers.

Visit to learn more about ACFAS’ work with the Alliance and wound care advocacy.
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ACFAS Fellowship Committee’s Application Deadline Moves to May 1
Due to the steady growth of the ACFAS Fellowship Initiative, the ACFAS Fellowship Committee's deadline for new fellowship program applications seeking status with ACFAS has changed.

If you are a director of a fellowship program and would like to seek status with ACFAS, note that all applications must be submitted by May 1, 2015 instead of the previous deadline of August 31. Any program directors who have already requested an application from ACFAS may request more time from the College if needed, if they submit their requests by May 1.

The Fellowship Committee will meet in mid-July in Chicago to review any new applications. Their decisions will be communicated in early August.

If you are interested in the ACFAS Fellowship Initiative or would like to request an application, please contact Michelle Kennedy, Membership Director.
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Update Your Website with Officite, an ACFAS Benefit Partner
Is your practice website still strong, or does it leave your patients with a sour taste in their mouths? Here are a few signs that your website is past its prime:
  1. Your website fails the “thumbs test.”
    Your practice website should be accessible and readable from a smartphone or tablet.
  2. Your site doesn’t make a modern first impression.
    Your website functions as the face of your practice. Does your site make you appear ahead of the game or behind the curve?
  3. You need to call your developer every time you want to make a change.
    A site built through a modern company should have a system in place that allows you to make small changes on your own without requiring any knowledge of how to code or design a site.
  4. You have no social media integration.
    If your website doesn’t provide an easy portal for your patients to connect with you through social media, it’s letting new opportunities slip through the cracks.
  5. Your website is only a website.
    Your website needs social media, SEO and blogging to increase your online footprint.
Contact Officite, an ACFAS Benefit Partner, at (877) 708-4418 or online to learn how a modern Web Presence can attract new patients to your practice.
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Foot and Ankle Surgery

Total Ankle Replacement for Post-Traumatic Arthritis
Researchers assessed the results of total ankle replacement (TAR) performed for end-stage arthritis due to fracture or ligamentous injury. Eighty-eight consecutive patients who underwent TAR between 2001 and 2009 were monitored. Average follow-up for both groups was five years. Pre-operative varus deformity of 10 degrees or more was evident in 23 out of 40 ankles in the instability group. Survival analysis with revision or salvage fusion as an end point revealed 87 percent without revision or fusion in the post-fracture group and 79 percent in the instability group at six years. Progressive periprosthetic osteolysis was observed in 23 ankles and required salvage fusion in six patients. The number of reoperations was similar in both cohorts. Clinical results, as evaluated with two ankle scores and two questionnaires, showed good outcomes and was similar at the latest follow-up.

From the article of the same title
Acta Orthopaedica Belgica (03/15) Weme, Rebecca A. Nieuwe; van Solinge, Guido; Doornberg, Job N.; et al.
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Trends in Ankle Arthroscopy and Its Use in the Management of Pathologic Conditions of the Lateral Ankle in the United States
A study was conducted to characterize current trends in ankle arthroscopy across time, sex, age and region of the U.S., along with the use of ankle arthroscopy in lateral ankle instability management. Some 15,366 ankle arthroscopy procedures were identified in the PearlDiver national database from 2007 to 2011. A significant increase was observed in the overall number of ankle arthroscopies performed, from 2,814 in 2007 to 3,314 in 2011. Female patients underwent ankle arthroscopy more often than male patients. Most patients who had ankle arthroscopy were between 30 and 49 years of age. The use of ankle arthroscopy during lateral ligament repair procedures rose from 37.2 percent in 2007 to 43.7 percent in 2011. Occurrence of combined ankle arthroscopy and peroneal tendon retinacular repair increased 50 percent from 2.8/100 ankle arthroscopies in 2007 to 4.2/100 ankle arthroscopies in 2011.

From the article of the same title
Arthroscopy (03/12/15) Werner, Brian C.; Burrus, M, Tyrrell; Park, Joseph S.; et al.
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Practice Management

9 Crucial Rules to Remember When Having Difficult Conversations with Employees
Employers should not avoid having difficult conversations with employees, as such a practice will likely help the business evade or address potential problems earlier. Tips for managers to consider to prepare for difficult dialogues include:

1) Overcoming your fear of conflict and of upsetting the employee.

2) Diligently preparing for the conversation by gathering hard facts of the employees' problem areas, outlining expectations and explaining how employees are falling short of their goals. Documenting conflicts and having policies in place for certain scenarios are important.

3) Maintaining a positive tone throughout the conversation to reduce the chances employees will become defensive and argumentative. Avoiding language that may imply punishment is also suggested.

4) Keeping your emotions in check, with a strict emphasis on facts.

5) Choosing the right environment to set the tone of the meeting with employees.

6) Finding a third-party witness to be present at the meeting, especially when it involves dealing with anything that may require disciplinary coaching interaction.

7) Practicing consistency in dialogue and holding employees accountable to the same performance expectations.

8) Maintaining confidentiality when addressing conflicts between employees, while also being aware that depending on what they report, you may have a responsibility to take action or talk to others.

9) Terminating the meeting if the conversation gets out of hand and employees express rudeness or other forms of aggression.

From the article of the same title
Insperity Inc. News Release (03/11/15) Giallorenzo, Colleen
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Ongoing Staff Training Is Essential to EHR Success
Unhappiness with electronic health records (EHRs) can stem from usability issues as well as poor training of practice staffers. "Current EHRs ... are not meeting the needs of clinicians or the work flow, and many of the products were built without the clinician in mind," says the Health Information and Management Systems Society's Mary Griskewicz. "Particularly for the physician and end user, the work flow needs to be more agile for them so that they will use the technology to help them." Practices have control over whether personnel are using the EHR system to the best of their abilities. The core issue is how the EHR deployment and training process is implemented. "The keys are delivering better care and managing patients better and then [asking] how does the technology support those two goals," says consultant Trenor Williams. "Because that's what resonates with staff, nurses and doctors." Williams notes any EHR system entails an ongoing learning process and performance assessment. Through continuous training, physicians can learn a little bit more about how to use the EHR during specific situations and continually improve. Factoring training costs into post-deployment can also ascertain whether staff and physicians receive the appropriate training. Some practices may want to consider offering incentivized training for staff members to encourage personnel and physicians to participate. Frequent measurement and feedback can also show value and sustain progress throughout the implementation and adoption process.

From the article of the same title
Physicians Practice (03/16/15) Moore, Rodney J.
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The Revenue Cycle Decision
When it comes to deciding whether physicians should seek outside expertise for revenue cycle management, practices should first consider the benefits and pitfalls. Aspects worth considering include the size of the practice and the capabilities of its personnel, and managers should be aware that:

1) Internal billing is typically a more cost-effective approach for practices with no more than 15 physicians. Internal billing is something over which a practice maintains greater control.

2) If there are 15 to 30 physicians in the practice, the decision to outsource is based on the market and the staff’s experience with billing and collections. Once a practice surpasses 30 physicians, the number of office sites factors into the decision, along with the billing staff’s expertise.

3) Selection of a reputable vendor is important, and a firm with state-of-the-art technology offers greater assurance for shielding patient information in accordance with the Health Insurance Portability and Accountability Act.

4) The vendor should provide a business associate agreement, which is a formal arrangement in the healthcare industry for anyone dealing with sensitive patient data.

5) For cost analysis, the practice may opt to seek the advice of an independent consultant to assess the pros and cons of each situation and to help with the decision-making process. In-depth analysis should include a future forecast accounting for boosts in employee wages and benefit packages. This would compare the current costs of billing internally with the costs of employing an external vendor. The count should also measure current costs that would be removed with an outside vendor, labeling them as a percentage of total expenses and comparing that to the costs of using the vendor.

6) Physician groups that elect an in-house solution should expect future costs to maintain their systems of practice management and electronic health records.

7) Factors to be mindful of when evaluating your practice’s revenue cycle and accounts receivable processes include where payment is, accounts in collection, establishment of a payment plans account and consideration of older claims.

From the article of the same title
Medical Economics (02/25/15) Kreimer, Susan
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Health Policy and Reimbursement

Congressman Takes Aim at EHR Interoperability with Draft Bill
U.S. Rep. Michael Burgess (R-Texas), a physician and member of the House Energy and Commerce Subcommittee on Health, has drafted legislation that would establish a congressionally appointed advisory committee to develop an EHR interoperability standard required for certification. The draft bill calls for the replacement of both the Health IT Policy and HIT Standards Committees with a 12-member advisory committee composed of providers, qualified EHR developers, insurers, group health plans and stakeholders. Six committee members would be appointed by the House Speaker and minority leader, and six would be appointed by the Senate majority leader and minority leader. The committee would have until July 1, 2016 to recommend standards for measuring interoperability and to establish criteria for certifying that EHR technology is interoperable by Jan. 1, 2018.

From the article of the same title
Health Data Management (03/15) Slabodkin, Greg
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Medicare Panel Faults Payment Fix as Too Weak
A new report from the Medicare Payment Advisory Commission (MedPAC) has determined a planned revamp of Medicare payments to long-term hospitals falls short. MedPAC urged further revisions to discourage timing patient discharges to financial incentives. Long-term-care hospitals receive smaller payments for short patient visits, but after patients stay for a certain number of days the payments become much bigger lump sums. Medicare's planned overhaul seeks to restrict the number of patients qualifying for high long-term-hospital payments. Under the new rules, long-term hospitals will receive higher payments only for patients who have been in intensive care for at least three days at a general hospital, or who are on ventilators for at least 96 hours during their stays. However, a Wall Street Journal analysis of Medicare data suggests the new rules would have little effect on the incentive to discharge qualifying patients at specific times. MedPAC says Medicare could act to eliminate the incentive by removing the profitable jump in payments to the hospitals. The commission recommends that only patients who spent at least eight days, instead of three, at an intensive-care unit should be eligible for the higher lump-sum payments. Medicare officials and industry representatives say the new rules could address the discharge issue, since fewer patients would fulfill criteria for the higher payments and those who do would likely be more seriously ill patients who may require longer hospital stays.

From the article of the same title
Wall Street Journal (03/15/15) Weaver, Christopher; Mathews, Anna Wilde; McGinty, Tom
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Senate Bill Would Increase Access to Medicare Claims Data
Lawmakers have introduced a bipartisan bill intended to improve the transparency of healthcare costs by providing better access to Medicare claims data. The Quality Data, Quality Healthcare Act would modernize and reform the Qualified Entity (QE) program created by Congress that allows organizations to access and analyze comprehensive Medicare data. The lawmakers say that current law is too restrictive regarding which organizations can participate in the QE program, what can be done with the Medicare data and the degree to which QEs can support their own data maintenance infrastructures.

From the article of the same title
Health Data Management (03/15) Slabodkin, Greg
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Six Things That Could Kill the SGR Fix
A $200 billion-plus deal negotiated by U.S. House Speaker John Boehner and Minority Leader Nancy Pelosi to fix the Medicare physician-payment system's sustainable growth-rate (SGR) formula could still be derailed by a number of factors. Under the deal's scope, about 33 percent of the cost would be offset by payment cuts to healthcare providers and higher cost-sharing and premium contributions for Medicare beneficiaries, and those Medicare reorganization features are favored by Republicans. Part of the expense of the bill is a late addition of $7.2 billion in new funding for community health centers. Failure to pay for the entire package is a deal-breaker for some right-leaning proponents, who claim the deal is financially reckless. Compounding things is analysis by the nonpartisan Center for a Responsible Federal Budget showing the SGR deal would add $400 billion to the federal deficit by 2035, while the looming Congressional Budget Office scoring of the package analysis also could cripple the deal. Another potential challenge could be drumming up support among Senate Democrats. For example, Finance Committee Ranking Member Sen. Ron Wyden (D-Ore.) and his Democratic colleagues want a four-year funding reauthorization for the Children's Health Insurance Program instead of a two-year patch.

From the article of the same title
Modern Healthcare (03/21/15) Demko, Paul
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Medicine, Drugs and Devices

FDA Releases Final Guidance on Reprocessing of Reusable Medical Devices
The Food and Drug Administration (FDA) has released new recommendations intended to increase the safety of reusable medical devices between uses. The FDA document, “Reprocessing Medical Devices in Healthcare Settings: Validation Methods and Labeling,” covers topics on pre-market and post-market steps manufacturers should use for reprocessed devices. The document also lists six criteria that should be addressed in the instructions with every reusable device. Further, the document also recommends that manufacturers consider reprocessing challenges during device design phases and conduct validation tests to ensure cleaning techniques remain effective.

From the article of the same title
U.S. Food and Drug Administration (03/12/2015)
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Male Smokers Have Elevated Risk of Osteoporosis
Men who smoke have a greater risk for developing osteoporosis than other men or female smokers, according to a recent study published in the Annals of the American Thoracic Society. The researchers examined bone density and the severity of lung disease and sought small fractures in the vertebra of the spine in 3,321 current and former smokers along with 63 non-smokers. They discovered male smokers had a small, but significantly higher risk of low bone density and more vertebral fractures than female smokers. Such indications of osteoporosis were observed in 58 percent of study participants and in 84 percent of people with chronic obstructive pulmonary disease. There were one or more vertebral fractures in 37 percent of the study participants, who were mostly male, older than the group average, more likely to be current smokers and had smoked for a longer duration.

From the article of the same title
Reuters (03/13/15)
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New AMA, CDC Initiative Aims to Prevent Diabetes
The Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) have teamed up to prevent diabetes. The multi-year initiative, Prevent Diabetes STAT, expands on the work the two groups have already started to reach more people with prediabetes and stop the progression to type 2 diabetes. "The time to act is now. We need a national, concerted effort to prevent additional cases of type 2 diabetes in our nation—and we need it now," said Ann Albright, director of CDC's Division of Diabetes Translation. "We have the scientific evidence and we've built the infrastructure to do something about it, but far too few people know they have prediabetes and that they can take action to prevent or delay developing type 2 diabetes." CDC and AMA have developed a toolkit to help healthcare providers screen and refer high-risk patients to area diabetes prevention programs. The toolkit and other prevention information is available online, and an online screening toolkit is also available to help patients determine their type 2 diabetes risk.

From "New AMA, CDC Initiative Aims to 'Prevent Diabetes STAT'"
CDC News Release (03/12/15)
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FDA Proposal to Allow Drug Reps to Circulate Data Draws Protests
U.S. Health and Human Services Secretary Sylvia Burwell should withdraw a proposal permitting pharmaceutical companies to distribute medical literature that suggests a drug's risk is less than stated on the label, according to consumer watchdog Public Citizen. The U.S. Food and Drug Administration (FDA) proposed the change because a drug's safety profile evolves as exposure increases. There is no timeline for completion of the review. "Secretary Burwell appreciates hearing from stakeholders," a spokesperson said. "FDA is currently reviewing and considering all comments received from the dockets on the draft guidance."

From the article of the same title
Reuters (03/12/15)
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Robert M. Joseph, DPM, PhD, FACFAS

Daniel C. Jupiter, PhD

Jakob C. Thorud, DPM, MS, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of "This Week" are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS, and does not imply endorsement of any view, product or service by ACFAS.

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