News From ACFAS

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The American Association of Colleges of Podiatric Medicine (AACPM) has responded to recent news about the residency shortage with positive news that 34 hospitals are in the application stage of starting new training sites, and 69 additional facilities are evaluating whether to submit applications. Read ACCPM National Residency Facilitator Dr. Edwin W. Wolf’s message (PDF file). ACFAS recently revised its Principles of Professional Conduct to incorporate the increasingly familiar topic of social media and its professional implications. At a time when strategic marketing needs to be more social than strictly commercial, what is disseminated via social networks may put you or your practice at risk. All physicians need to be more judicious in what they advocate, provide feedback on, and share via social media.

The principles which were added or adjusted are the following:

• Part I, section F pertains to confidentiality and privacy rights of patients and their records
• Part II, section D refers to maintenance of your own social media outlets and ensuring the information you present is accurate, appropriate and professional
• Part V, section C discusses the importance of reporting information posted by others that is inaccurate, inappropriate or unprofessional
• Part VII, sections C and D advise on the necessity to be truthful in self advertising and methods through which to do so

Visit the Principles of Professional Conduct webpage to view these changes and determine whether your social media use meets these standards. The ACFAS Board of Directors recently approved updates to two position papers. The position papers, Cosmetic Surgery and Truth in Advertising, were originally drafted and approved in 2004 and 2011, respectively. Recently, the papers were reviewed and slightly modified by the ACFAS Professional Relations Committee as they systematically review all ACFAS position papers to ensure they reflect current ACFAS policy. The newly revised and adopted position papers, along with other ACFAS position papers, can be found at acfas.org/position.

Foot and Ankle Surgery

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A two-week, prospective, randomized, controlled clinical study was carried out from Jan. 1, 2010, to Jan. 1, 2012, among 36 consecutively admitted patients with diabetic foot ulcers to evaluate the therapeutic effect and oxidative stress of hyperbaric oxygen (HBO) treatment. Standard care including offloading, wound debridement and glucose control was randomly assigned to the 18 patients. The other 18 patients were assigned to the HBO treatment group, which received standard care and twice-daily HBO sessions for 90 minutes at 2.5 atmospheres absolute five days a week for two weeks. Transcutaneous oxygen pressure (TcPo2) at the edge of the ulcer and wound size were measured at baseline and after one and two weeks of treatment. Ulcer tissues were harvested on the seventh and 14th days to ascertain oxidative stress by quantifying malondialdehyde (MDA) and antioxidant enzyme (superoxide dismutase [SOD], catalase [CAT] and glutathione peroxidase) levels. Compared to baseline, TcPo2 in the HBO group increased on the seventh day and the 14th. Ulcer size reduction in the HBO group was greater compared to the control group, and MDA levels, SOD and CAT were all significantly higher in the HBO group versus the control group on the 14th day.


Researchers recently analyzed the long-term clinical and radiographic outcomes of arthroscopic debridement and bone marrow stimulation for talar osteochondral defects and found the initial success of the method was maintained over time. The researchers looked at 50 patients with a primary osteochondral defect treated with arthroscopic debridement and bone marrow stimulation after a mean follow-up of 12 years. They found the Ogilvie-Harris score for 20 percent of patients was excellent, for 58 percent of patients was good and for 22 percent of patients was fair. Berndt and Harty outcomes showed that 74 percent of patients rated the ankle as good, 20 percent rated it as fair and 6 percent rated it as poor. American Orthopaedic Foot & Ankle Society ankle-hindfoot score meanwhile achieved a median of 88. Some 94 percent of patients in the study group had resumed work and 88 percent had resumed sports activities in their follow-up examination. Radiographs showed an osteoarthritis grade of zero in 33 percent of the patients, a grade of I in 63 percent, II in 4 percent and III in no patients. Sixty-seven percent of radiographs showed no progression and 33 percent showed progression by one grade compared to preoperative osteoarthritis measurements.


Researchers conducted an analysis to determine a linkage between body composition and incident foot pain. In their study, the researchers looked at 51 participants from a previous study of musculoskeletal health who did not have foot pain at the study's beginning in 2008. The researchers measured foot pain using the Manchester Foot Pain and Disability Index and body composition using dual x-ray absorptiometry. The researchers found 11 of the 51 respondents developed foot pain. The researchers determined foot pain was positively associated with fat mass and fat-mass index.

Practice Management

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There are varying rules between code book guidelines, payer preferences and Medicare limitations, and practices must ensure appropriate reimbursement by following the right rules for the right situations when submitting medical claims. For instance, bilateral procedures can be disclosed in different ways, and the correct way is to follow payer preference, which can differ from payer to payer. Throughout its sections and subsections, the CPT code book offers coding that supplies valuable information for proper code selection. The guidelines frequently include a description of the procedures and additional procedures that can be billed when executed. Also valuable are the CPT code book's parenthetical notes, which are designed to help proper coding and are often ignored, which can lead to coding errors. Applying Medicare rules to all payers can be a major mistake, as it can cause improper reimbursement. However, information for private payers can be found in the provider-payer contract, payment policies and provider manuals. The majority of payers provide payment polices and provider manuals on their website. Coding requirements for Medicare also can be found on the Centers for Medicare and Medicaid Services website in the Medicare Claims Processing Manual, Local Coverage Determinations and National Coverage Determinations.


Meeting electronic health record meaningful use requirements is a task best suited for practice managers, who are better able to build the increased workload into their schedules. As practice managers become the project leaders tasked with meeting these requirements, they will need to take on four primary jobs. The first job is for them to become educated as to the intricacies of the meaningful use program and why the program is important. It will be the practice manager's job to convince other staff members of the project's worth. Practice managers will need to put together a team to help them carry out their duties, and this will require them to explain the program to others.

Each part of a practice, from front desk receptionists to clinical staff, should have an active role in achieving meaningful use. Practice managers along with their teams will then need to develop a plan that lists what goals need to be met and what pathways the team will take to meet those goals. It will be up to the practice manager to set goals for each team member's department. Throughout this process, the practice manager should make sure they and their team members meet often to discuss their progress and any need of additional time or resources. The practice manager should do regular test runs of reports that will be needed for meaningful use to determine if the practice is ready to tackle the requirement's objectives.

Health Policy and Reimbursement

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Insurance firms will have to pay out an average of 32 percent more for medical claims on individual health policies under President Obama’s healthcare overhaul, according to a new study from the Society of Actuaries. Some Americans could consequently face higher premiums. Americans with an employer plan will likely have less to be concerned about than those who are uninsured or who purchase their policy directly from an insurance company. The study expects costs to rise mainly because less healthy people will join the insurance pool, but the Obama administration is challenging the study's design, specifically its concentration on only one element of the overhaul while ignoring cost relief strategies in the Affordable Care Act. Administration officials also cite the potential price-reducing impact of competition in new state insurance markets that will go live Oct. 1 as another component the study disregards. The report concluded that most states will experience double-digit increases in medical claim costs per person in their individual health insurance markets. Still, some states will see double-digit declines, and the report found that the law will cover over 32 million currently uninsured Americans when fully entrenched.


Medicare should not adjust payments on a broad regional basis to reward hospitals and doctors that spend less to achieve high-quality care, an interim report issued Friday by the Institute of Medicine concluded. The report’s authors, who include prominent health policy experts, doctors and consumer advocates, were responding to the argument that Medicare should pay higher levels of reimbursement to areas of the country that deliver measurably good care at low cost and less to regions where costs are high and outcomes are poor.


New Health Insurance Portability and Accountability Act (HIPAA) rules went into effect March 26, but compliance with most of the rules will not be required until Sept. 23. Among those rules covered under the extended compliance deadline is the portion of the rules that expand HIPAA privacy and security requirements and direct liability for violations to business associates of HIPAA covered entities. Those organizations that had a HIPAA-compliant business associate agreement in place before the new rule's Jan. 25 official publication date will have until Sept. 23, 2014 to have a contract compliant with the new HIPAA rules, but those who did not have such an agreement in place will need to have a contract compliant with the rules by Sept. 23 of this year. New HIPAA rules will also allow patients who pay out-of-pocket to request their provider not share a record of the treatment with the patient's health insurance plan.


Two studies have shown limiting medical residents to a 16-hour work shift might not be bringing the increase in quality of life and decrease of patient-harming errors that it was expected to bring. A survey conducted by researchers at the universities of Michigan, Pennsylvania and other institutions looked at 2,323 residents from 14 different institutions. Of the respondents, 837 began their training after the 16-hour work restriction went into effect in 2011. About 22.3 percent of those new interns reported making a serious medical error compared to the 19.1 percent of residents who began their training before the 16-hour work restriction's implementation. The researchers noted the increase in medical mistakes could be attributed to an increase in patient hand-offs caused by the shorter shifts.

A study conducted by researchers with the departments of medicine and epidemiology at Johns Hopkins University in Baltimore meanwhile divided interns into three groups -- two 16-hour work restriction groups and one group that had a 30-hour work restriction. They found the amount of educational opportunities for residents decreased as their shift size lessened, especially if they worked overnight shifts and missed out on educational conferences and morning rounds. "Programs have expanded curricula to include evening teaching by attending physicians, but there will be inherent limitations in the content delivered during these hours because of faculty availability and patient convenience," the authors of the Johns Hopkins study wrote. Both of these studies were posted on the website of JAMA Internal Medicine.



Medical practitioners should be aware of the potential HIPAA privacy and security liability posed by their digital copying equipment. Investigative reports have indicated that printers, copiers, scanners, and fax machines built since 2002 contain hard drives that capture images of every document processed, and that it is extremely easy to retrieve the data stored on these devices.

The Federal Trade Commission's Bureau of Consumer Protection Business Center is offering a publication, “Copier Data Security: A Guide for Businesses” in which the FTC recommends that when organizations buy a copier they should evaluate options for securing the data on the device. The publication states that the typical approaches are data encryption and overwriting. Providers should be aware that overwriting data is different from deleting or reformatting. Deleting data or reformatting the hard drive does not actually alter or remove the data, but rather it only alters how the hard drive finds the data and combines it to make files; however, the data remains and may be recovered through special software programs.

It is important for providers and their associated businesses to plan ahead about how to dispose of the data that accumulates on their copiers. This may require checking the lease or purchasing an agreement to verify who will retain the hard drives at the conclusion of the lease, and to plan for the destruction of the data prior to the copier being sold, returned to the leasing company or otherwise disposed of.


The Centers for Medicare and Medicaid Services (CMS) is creating a new Consumer Assessment of Healthcare Providers and Systems Survey for Physician Quality Reporting (CAHPS) survey to augment its consumer-oriented Physician Compare website with quality and patient satisfaction scores. Physician Compare currently gives consumers physician contact information, specialties, clinical training, gender, foreign languages, affiliated hospitals, whether they are accepting new Medicare patients and Medicare-approved payment amounts and if they are participating in the Physician Quality Reporting System (PQRS) and Electronic Prescribing Incentive Program. CMS will now make available the quality measures collected under PQRS. Additionally, CAHPS will support inclusion of patient satisfaction ratings.

Medicine, Drugs and Devices

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Researchers presented a study at the 2013 American Academy of Orthopaedic Surgeons' annual meeting that examined the relationship between cigarette smoking and fracture healing. The study was actually an analysis of previous studies that examined a total of 6,480 patients who were treated surgically and non-surgically for fractures of the tibia, femur or hip, ankle, humerus and multiple long bones. Researchers found that the fractured bones of smokers took 30.2 weeks to heal, compared with 24.1 weeks in non-smokers. Fractured bones in patients who smoked were also 2.3 times more likely to result in non-unions than the fractured bones of patients who did not smoke.