March 28, 2018 | | JFAS | Contact Us

News From ACFAS

ACFAS 2018 Steals the Show
A big thank you to everyone who attended ACFAS 2018 at the Gaylord Opryland Hotel in Nashville last week and for making the conference such a huge success! With nearly 1,900 DPMs and 150 exhibiting companies in attendance, each day captured the very best in foot and ankle surgical education.

From the packed Opening General Session featuring astronaut Captain Mark Kelly to the sold-out Wrap Party at the Country Music Hall of Fame, attendees made the most of everything ACFAS 2018 and Nashville had to offer. Watch for the April issue of ACFAS Update for full coverage and photos.

"I view the overwhelming success of this meeting as a window into just how accomplished our profession is…and just how bright our future will be with ACFAS," says ACFAS President John S. Steinberg, DPM, FACFAS.

See you next year in New Orleans for the 77th Annual Scientific Conference, February 14–17, 2019 where we’ll laissez les bons temps rouler!
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New Board of Directors Takes Office in Nashville
Congratulations to new ACFAS President John S. Steinberg, DPM, FACFAS; President-Elect Christopher L. Reeves, DPM, FACFAS; Secretary-Treasurer Scott C. Nelson, DPM, FACFAS; and Immediate Past President Laurence G. Rubin, DPM, FACFAS. The new officers were installed on Friday, March 23 during the Honors and Awards Ceremony at ACFAS 2018 in Nashville along with the new and returning Board members:

Eric A. Barp, DPM, FACFAS
Michael J. Cornelison, DPM, FACFAS
Thanh L. Dinh, DPM, FACFAS
Meagan M. Jennings, DPM, FACFAS
George T. Liu, DPM, FACFAS
Harry P. Schneider, DPM, FACFAS
Randal L. Wraalstad, DPM, FACFAS

A special thank you to retiring Board members Sean T. Grambart, DPM, FACFAS; Aksone Nouvong, DPM, FACFAS; and Eric G. Walter, DPM, FACFAS; for their dedicated service.
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Promote Your Attendance at ACFAS 2018
Use the free Fill-in-the-Blanks press release available in the ACFAS Marketing Toolbox to let your patients and community know you attended ACFAS 2018 in Nashville. Simply download the press release, populate it with your professional contact information then send it to your local media to highlight 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 often for many other free resources to promote yourself and your practice, educate your patients and increase referrals to your office.
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Members Use Facebook Most for Patient Outreach
This month’s poll in This Week @ ACFAS asked members which social media platform they use most in their practices. The majority of respondents (53 percent) use Facebook as their primary social media outlet for connecting with patients. Twitter and LinkedIn each tied at 5 percent, while YouTube received no votes. Thirty-seven percent of respondents said they do not use social media in their practice.

Visit the ACFAS Marketing Toolbox for tips on how to boost your social media outreach. Be sure to also like and follow on Facebook, Twitter and LinkedIn and on Facebook and Twitter to stay up to date on College news and to share our posts with your colleagues and patients.
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Foot and Ankle Surgery

Custom 3D-Printed Total Talar Prostheses Restore Normal Joint Anatomy Throughout the Hindfoot
Researchers sought to determine the accuracy of three-dimensional (3D) printing in reproducing a synthetic talus and restoring normal anatomical relationships. Third-generation total talar prostheses (TTPs) are a viable option for talar avascular necrosis (AVN) in the absence of neighboring joint pathology. The researchers hypothesized that this mode of replication would restore and maintain normal radiographic alignment of the ankle, subtalar and forefoot joints in the setting of talar AVN. They conducted a retrospective analysis on 14 patients undergoing TTP implantation for the treatment of talar AVN between 2016 and 2017. Radiographic measurements taken preoperatively and postoperatively found that talar arc length and width were not significantly changed; however, talar height was significantly increased with use of TTP. Five alignment dimensions were measured, of which only talar tilt angle was considerably changed. The researchers concluded that 3D-printed TTP was successful in restoring talar height and talar tilt in the setting of AVN. In addition, the procedure maintained normal alignment in nonpathological joints. They said TTPs are a viable option to restore normal anatomical alignment.

From the article of the same title
Foot & Ankle Specialist (03/18) Tracey, Joseph; Arora, Danny; Gross, Christopher E.; et al.
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Short-Term Functional Assessment of Gait, Plantarflexor Strength and Tendon Properties After Achilles Tendon Rupture
Researchers conducted a study to examine the effect of early functional rehabilitation (EFR) on gait, plantarflexor strength and tendon properties in early postoperative follow-ups. The study involved 14 patients who received either EFR or conventional rehabilitation (CR) after percutaneous ATR repair. Functional gait analysis, maximal voluntary isometric contractions (MVICs) and Achilles tendon properties were assessed at eight weeks and 12 weeks postop. Researchers found that a comparison of EFR against CR yielded no statistically significant differences in ankle kinematics or kinetics, Achilles tendon properties or MVICs on the injured (INJ) ankle at either time point. During gait, only CR patients demonstrated significantly lower plantarflexion moments on INJ at eight weeks. Researchers concluded that while effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.

From the article of the same title
Gait & Posture (03/18) Vol. 62, P. 179 Agres, Alison; Gehlen, Tobias; Arampatzis, Adamantios; et al.
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Total Ankle Replacement Leads to High Revision Rates in Post-Traumatic End-Stage Arthrosis
Researchers studied revision rates and the underlying reasons for such revisions, as well as treatment outcome and quality of life after total ankle arthroplasty (TAA) in posttraumatic cases with sufficient follow-up. Seventy-four patients with posttraumatic arthrosis were treated using TAA with a Tornier Salto prosthesis, and 60 were followed up. The revision rate after TAA was 42 percent, and it was eight percent after 12 months and 18 percent after 24 months. Twenty percent of the patients had significant symptomatic periprosthetic bone cysts, 5 percent had impingement, 3 percent had soft-tissue infections, and, in 14 percent, revision was caused by other factors. Researchers found that total ankle replacement in posttraumatic end-stage arthrosis patients is associated with high revision rates. High rates of symptomatic periprosthetic bone cysts caused high rates of revision surgery and worse outcomes, which were not improved by secondary TAA.

From the article of the same title
International Orthopaedics (03/20/18) Gramlich, Yves; Neun, Oliver; Klug, Alexander; et al.
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Practice Management

Eight Ways to Reduce Physician Frustration with the EHR
Doctors spend as much time on electronic health record (EHR) data entry as they do meeting face to face with patients, research shows, and it can directly affect job satisfaction and contribute to burnout. Martin Pricco, MD, MBA, an internist and president of Gould Medical Group in Modesto, Calif., discussed changes to help physicians become more efficient and reduce their frustration with the system at the 2018 Health Information and Management Systems Society (HIMSS) conference in Las Vegas. First, improve the password process so physicians are not required to type passwords into workstations each time they enter a new room. Practices are also advised to install a printer in each exam room to save physicians the time of walking back and forth printing out information from the EHR. Furthermore, attend or provide individual optimization training to educate physicians on features that enable rapid access to data or customization options. "One of the most common doctor complaints is that they can't find what they are looking for in the EHR," Pricco says. In addition, figure out where physician time is being wasted by examining EHR charts, and share best practices to boost everyone's efficiency. Practices are also encouraged to customize the EHR to workflow and specialty for each individual physician. Furthermore, find the documentation time-saving method that works best for each physician, from voice recognition to templates. Finally, create a review process and a centralized prescription refill plan so physicians do not waste time on mundane prescription refills and approvals that other individuals could handle.

From the article of the same title
Medical Economics (03/09/18) Shryock, Todd
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Interns Like Limited Shift Hours, Training Directors Don’t
According to a study published in the New England Journal of Medicine, no correlation exists between limited shift lengths and how medical residents spend their time or how they score on tests of medical knowledge. The study authors also say that limiting first-year medical residents to 16-hour work shifts gives them a better work-life balance. David Asch, MD, with the Perelman School of Medicine at the University of Pennsylvania, says, "Many educators have worried that the shift work created by limited duty hours will undermine the training and socialization of young physicians. Educating young physicians is critically important to healthcare, but it isn’t the only thing that matters. We didn't find important differences in education outcomes, but we still await results about the sleep interns receive and the safety of patients under their care."

From the article of the same title
Health Leaders Media (03/21/2018) Commins, John
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Seven Financial Reports Your Practice Needs to Run
Learning about the business side of healthcare is essential to being a successful practitioner. While hiring a practice administrator or an office manager to put together a reporting structure can be an option, it is important for physicians themselves to understand the basics. Otherwise, they might be missing key data points that can help spot bad business decisions and the potential closing of their practice, warns Nick Fabrizio, PhD, principal consultant at MGMA Health Care Consulting Group. According to Fabrizio, financial reports provide key data points that can spot possible financial problems. In addition, these reports can shed light on areas to help grow the practice. A key area to be aware of is appointment analysis. Regarding patients who show up for appointments, Ada Stewart, MD, FAAFP, who is a member of the board of the American Academy of Family Physicians, says, "The ideal fill rate is usually about 90 to 95 percent. Calculate the actual fill rate and compare it to the desired fill rate to decide if any correction or additional action is needed." Meanwhile, a profit and loss statement can help track key performance indicators, such as total encounters, number of procedures, total charges and collections. Red flags could include a sudden drop in collections. Other things that physicians needs to be familiar with include a balance sheet, an accounts receivable aging report, provider productivity, claim denials and value-based reporting.

From the article of the same title
Physicians Practice (03/13/18) Watkins, Angela
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Health Policy and Reimbursement

Healthcare Programs to Receive Major Boost from Omnibus Spending Bill
The new $1.3 trillion omnibus spending bill features a $3 billion increase for the U.S. National Institutes of Health (NIH), bringing its budget to $37 billion for fiscal 2018. It also raises the U.S. Department of Health and Human Services' budget by $10 billion to $78 billion. Almost $4 billion more would be invested in opioid addiction, while $1 billion in grants is allocated to states and tribal groups for treatment and prevention, and $476 million to the U.S. Centers for Disease Control and Prevention for opioid overdose monitoring, a $350 million hike over fiscal 2017. In addition, $500 million will go to NIH for research on addiction support. The budget for Alzheimer's disease research will go up $414 million, $140 million more will go toward brain research, and the total spent on research for a universal flu vaccine will rise by $40 million, for a total of $100 million. "As we confront daunting health challenges from Alzheimer's disease to the opioid epidemic, it is our responsibility as a nation to advance the discovery, development and delivery of new treatments for patients anxiously waiting for the next medical breakthrough," says Research!America CEO Mary Woolley. "The increase will enable NIH to expand and sustain innovative initiatives that will deepen our understanding of complex diseases, furthering efforts to eradicate many of these health threats."

From the article of the same title
U.S. News & World Report (03/22/18) Levy, Gabrielle
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Payment Reform on Track, Medicare Chief Says
The U.S. Centers for Medicare and Medicaid Services' Demetrios Kouzoukas notified House members at a hearing on the implementation of the Medicare Access and CHIP Reauthorization Act that physician payment reform and patient empowerment remain in effect despite massive budget cuts. "We are working to make sure the programs we undertake and the way we implement them won't [harm] rural providers," he said of the possible cuts," he said. Kouzoukas cited the importance of mental health providers, especially with the opioid crisis. "We made changes last year to recognize that it's important for practices who don't have capital-intensive needs—who operate with [just] a desk, a chair and an office—to [increase] their reimbursement," he noted. "We set that out in the fee schedule last year; we look forward to hearing about the improvement it's hopefully made in addressing the issues you raise." U.S. Rep. Adrian Smith (R-Neb.) said the most common complaint from rural healthcare providers in his district was about "the amount of administrative burdens imposed on them by the government." Kouzoukas replied that Medicare seeks to resolve this issue by raising the claims threshold required for providers to have to participate in the collection of healthcare quality data, while also letting providers join "virtual groups" with physicians outside their own practice, in order to be measured on quality criteria as part of a larger group.

From the article of the same title
MedPage Today (03/22/18) Frieden, Joyce
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Virologist Robert Redfield Named as Next CDC Director
The U.S. Department of Health and Human Services (HHS) has named University of Maryland School of Medicine Professor Robert Redfield director of the U.S. Centers for Disease Control and Prevention (CDC). Redfield, a virologist, can assume the position without Senate confirmation. He is renowned for his extensive AIDS research and supervises clinical programs offering HIV care to thousands of people around Baltimore and Washington, DC. Redfield also oversees international care and treatment programs under the President's Emergency Plan for AIDS Relief. He advocated for mandatory HIV testing in the 1980s and has helped deploy an HIV-screening program at the Department of Defense. Forthcoming challenges for Redfield will include navigating this season's spike in flu cases and any related work on flu vaccine research. Other key responsibilities will include implementing the White House's plan to combat the opioid crisis and stay ahead of emerging infectious diseases. HHS Secretary Alex Azar says Redfield's background as a clinician running a treatment network for HIV and Hepatitis C patients in Baltimore will enable him to "hit the ground running" with the opioid epidemic.

From the article of the same title
Scientific American (03/21/18) Maron, Dina Fine
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Medicine, Drugs and Devices

House Passes Bill That Would Give Patients Access to Experimental Drugs
The U.S. House of Representatives passed a bill that would give patients with terminal illnesses a right to try unproven experimental treatments. The U.S. Senate approved a similar proposal last year, and the measure appears to have a good chance of becoming law. Supporters said the bill would give dying patients a chance to obtain potentially helpful prescription drugs without waiting for the completion of clinical trials or going through a U.S. Food and Drug Administration (FDA)-established process to allow the use of "investigational drugs" outside clinical trials. Several Democrats warned the bill would weaken the ability of FDA to protect patients. The bill was opposed by dozens of organizations that represent patients, including the lobbying arm of the American Cancer Society. President Donald Trump endorsed the right to try in his State of the Union address in January and again in March. Nothing in the bill would require pharmaceutical companies to provide experimental drugs to patients who requested them. Drug manufacturers sometimes turn down requests because they have only a limited supply or they are concerned about legal and medical risks. To address such concerns, the legislation would shield drugmakers, doctors and hospitals from some of the legal risks of providing unapproved drugs to patients. Doctors and hospitals would generally be protected unless they engaged in gross negligence or willful, reckless or criminal misconduct.

From the article of the same title
New York Times (03/21/18) Pear, Robert
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Motor Planning Error: Toward Measuring Cognitive Frailty in Older Adults Using Wearables
Researchers examined the accuracy of motor planning error (MPE) in identifying cognitive frailty in older adults. Thirty-two older adults were recruited. Using either the Mini-Mental State Examination or Montreal Cognitive Assessment (MoCA), 16 subjects were classified as cognitive-intact and 16 were classified as cognitive-impaired. In addition, 12 young, healthy subjects were recruited to establish a healthy benchmark. Subjects completed the instrumented trail-making task (iTMT), using an ankle-worn sensor, which transforms ankle motion into navigation of a computer cursor. The iTMT task included reaching five indexed target circles on the computer screen by moving the ankle joint while standing. The researchers say the study demonstrated feasibility and efficacy of estimating MPE from a practical wearable platform with promising results in identifying cognitive motor impairment and potential application in assessing cognitive frailty. The proposed platform could also be used as an alternative to a dual task walking test, where gait assessment may not be practical.

From the article of the same title
Sensors (03/18) Zhou, He; Lee, Hyoki; Lee, Jessica; et al.
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Trump Pledges to ‘Get Very Tough,’ Rein In Opioid Crisis
President Trump announced a "tough" law enforcement approach in the battle against opioids. "Addiction is not our future. We will liberate our country from this crisis," Trump said. Speaking at a community college in Manchester, NH, the president unveiled the next step of his administration's effort to stem the spread of the opioid epidemic. The plan calls for opioid prescriptions to be reduced by a third within three years, guaranteed access to naloxone and for the U.S. Justice Department to seek more death penalty cases against drug traffickers. The plan also supports expanded access to medication-assisted treatment.

From the article of the same title
Wall Street Journal (03/19/18) Radnofsky, Louise
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, FACFAS

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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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