April 18, 2018 | | JFAS | Contact Us

News From ACFAS

ACFAS Volunteers, We Appreciate All You Do!
In honor of National Volunteer Week, the College thanks you, our volunteer members, for donating your time, talents and expertise to advance the profession and cultivate change.

Everything you do to uphold ACFAS’ mission—whether it means serving as a committee or Board member, developing and teaching our educational programs or mentoring students and residents—deserves recognition, not just this week, but year-round.

Your continued commitment and service to your colleagues and patients embody the true spirit of volunteerism. Thank you for always going that extra mile to make a difference!
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Save the Date for ACFAS 2019 in New Orleans
Oh, we want you to be in our number when we go marching into The Big Easy next year for the 2019 ACFAS Annual Scientific Conference, February 14–17, 2019 at the New Orleans Convention Center.

Rich in history and resilient in spirit, New Orleans shines with a style all its own. World-famous chefs and cuisine and a round-the-clock live music scene fuel bustling enclaves, like the lively French Quarter, making New Orleans a one-of-a-kind city that has stood the test of time.

ACFAS 2019 will offer the advanced clinical sessions and workshops, state-of-the-art exhibits, exciting special events and endless networking opportunities you look forward to each year. The College is using your feedback from the ACFAS 2018 evaluations to develop next year’s conference programming. Mark your calendar now, and visit for ACFAS 2019 details and updates as they become available.
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Register Now for Coding & Billing Seminars
Receiving maximum reimbursement for the care you provide is much easier than you think. Register now for Coding and Billing for the Foot and Ankle Surgeon, July 13–14 in Portland, Oregon or October 19–20 in Chicago, and gain practical tools and tips for improving your office’s coding and billing procedures.

Code actual patient cases and scenarios as you learn how to:
  • Structure your work week
  • Code for amputation, forefoot, rearfoot and ankle reconstructive surgery
  • Code for evaluation and management
  • Use modifiers to avoid denials
  • Code for diabetic foot cases, minor office procedures and complex arthroscopy cases
  • Navigate new government reimbursement systems and methods
This course is worth 12 continuing education contact hours (Category 1 credit). Visit to register today.
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Foot and Ankle Surgery

Lateralizing Calcaneal Osteotomies and Their Effect on Calcaneal Alignment
Researchers used a digital model of a varus hindfoot to compare four different lateralizing calcaneal osteotomies (LCOs) in terms of deformity correction and amount of tuberosity lateralization required. A weightbearing computed tomographic scan of a patient with a varus hindfoot deformity was used to construct a three-dimensional digital model of the hindfoot, preserving weightbearing alignment. Four different LCOs were modeled: a standard oblique osteotomy, a Dwyer osteotomy, a modified Dwyer osteotomy involving lateralization in addition to wedge resection and a Malerba Z-type osteotomy with wedge resection and lateralization. The modified Dwyer osteotomy led to the greatest improvements in the vertical hindfoot angle and lateral translation, followed by the Malerba osteotomy. The standard and Malerba osteotomies allowed the most preservation of calcaneal length; the Malerba and Dwyer osteotomies had the greatest contact surface area. Researchers concluded that LCOs that involve wedge resection as well as lateralization were able to achieve the greatest correction of hindfoot varus.

From the article of the same title
Foot & Ankle International (04/18) Cody, Elizabeth; Kraszewski, Andrew; Conti, Matthew; et al.
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Net Ankle Quasi-Stiffness Is Influenced by Walking Speed but Not Age for Older Adult Women
Researchers investigated the effect of age on plantar flexor resistance in 113 participants above the age of 65 years. Researchers considered the confounding influence of gait speed, an aspect known to be reduced with old age. Ambulatory, community-dwelling older adult women with no current or recent lower-extremity injuries or surgeries underwent an instrumented gait analysis at a self-selected speed. Plantar flexor resistance was quantified via net ankle quasi-stiffness (NAS) defined as the slope of ankle joint moment-angle curve during late stance. The results showed that NAS was not significantly influenced by age and that the confounding factor of walking speed had a significant, positive relationship with NAS. Researchers say by determining that gait speed, not age, is related to NAS in older adults, this study represents the initial step toward objectively prescribing passive-dynamic ankle-foot orthoses bending stiffness to achieve a targeted gait speed for older adults with plantar flexor weakness.

From the article of the same title
Gait & Posture (05/18) Collins, John; Arch, Elisa; Crenshaw, Jeremy; et al.
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Weightbearing Radiographic Analysis of the Tibiofibular Syndesmosis
Diagnosis of distal tibiofibular syndesmotic injuries includes assessment of radiographs; however, no agreed-on standard diagnostic criteria exist. Researchers analyzed anatomical parameters using weightbearing films to assess for tibiofibular syndesmotic integrity. Measurements 1 centimeter above the tibial plafond for the anterior tibiofibular overlap (TFO) and tibiofibular clear space were recorded and standardized by the fibular width at two time points. Data were compared to check for agreement between the sets of measurements for each rater and agreement between investigators and to ascertain underlying gender differences. Researchers discovered there was good intraobserver correlation among investigators for each parameter. A significant difference in the TFO was noted between genders. The study authors say their results provide a more objective approach by utilizing weightbearing radiographs and performing all measurements 1 centimeter above the tibial plafond.

From the article of the same title
Foot & Ankle Specialist (04/18) Amin, Arsalan; Janney, Cory; Sheu, Christopher; et al.
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Practice Management

Choosing Words Wisely Can Contribute to Your Bottom Line
According to a report published in the Journal of the American Medical Association, the words doctors use carry more significance than they realize. The report says certain words can contribute to financial success and a better reputation. The report says patients may find four word-usage failures offensive or off-putting. Those failures are: using leading questions, saying "I understand" after delivering a serious diagnosis, calling patients "poor historians" if they are unable to recall symptoms and using words like "unremarkable" or "normal" when referring to test results. Experts recommend doctors work to build better relationships with patients, demonstrate empathy and try to understand how a medical problem may affect the life of the patient.

From the article of the same title
Medical Economics (04/09/18) Nelson, Jennifer
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Eight Ways to Play the Prior Authorization Game
Prior-authorization (PA) requirements for certain healthcare services can be frustrating for doctors. Adding to these frustrations is the fact that guidelines for PA services are often unavailable to practitioners. However, a number of options are available to doctors that can make navigating this complicated area easier. Among expert recommendations are to learn what is needed to get PA approval from insurers, have patients and human resources involved in the process by reaching out to the insurer, speak to the medical director or provider rep at the insurer and be diligent if a needed test is denied.

From the article of the same title
Physicians Practice (04/04/18) Girgis, Linda
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Physician Burnout Charter Sets Framework for Change
A charter published in the Journal of the American Medical Association aims to improve the well-being of physicians by reducing burnout. Creation of the charter was handled by the Collaborative for Healing and Renewal in Medicine. The charter also has the support of a number of national industry associations. The charter's best practices are grouped into societal commitments, organizational commitments, and interpersonal and individual commitments. Among the recommendations are: healthcare organizations supporting policies that promote the well-being of doctors; leadership including well-being programs in planning; and including coping skills in training or continued education.

From the article of the same title
Health Leaders Media (04/05/2018) Cheney, Christopher
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Health Policy and Reimbursement

Medicare Spending to Climb 7 Percent Each Year After 2018, with Nearly 5 Percentage Points Reflecting Cost Growth
A new forecast by the U.S. Congressional Budget Office (CBO) expects Medicare spending to increase to $1.2 trillion by 2028. CBO attributes the current slow spending growth to higher premium revenue and predicts Medicare enrollment will climb by 2.7 percent this year, versus 2.6 percent last year. For 2019–2028, the office says Medicare spending will rise an average of 7 percent annually, "driven by the rising per-beneficiary costs of medical care." CBO specifies that cost growth reflects almost 5 percentage points of the gain, while increasing enrollment only accounts for the rest. In addition, Medicaid's government cost should be higher mostly on account of rising per-capita costs. After 2018, CBO expects Medicaid spending will grow at an average rate of 5.5 percent yearly. Only 1 percent of the spending reflects growth in enrollment, while almost 5 percent is due to cost.

From the article of the same title
Becker's Hospital CFO Report (04/10/18) Haefner, Morgan
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The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care
People are increasingly going to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be met by professionals at far less expense than in a doctor's office. Meanwhile, office visits to primary care doctors fell 18 percent from 2012 to 2016, even as visits to specialists rose, according to analysis of insurance data by the Health Care Cost Institute. New mergers between insurers and major corporations are also straining small practices and threatening them with extinction. "With all of these deals, there is so much we don't know," says American Academy of Family Physicians President Dr. Michael Munger. "Will Aetna [beneficiaries] be mandated to go to a CVS MinuteClinic?" Physicians, such as Pennsylvania pediatrician Dr. Susan Kressly, are worried about losing customers to retail clinics or urgent care centers, while even more concerning is the risk of such customers receiving inappropriate treatment at those outlets. Dr. Mark J. Werner with the Chartis Group warns the convenience of care at such clinics is not equal to quality, nor is less expensive care. Opponents of retail clinics say customers are given short shrift by health professionals unfamiliar with their history and may receive unnecessary prescriptions. However, researchers argue neither has been proved in studies.

From the article of the same title
New York Times (04/07/18) Abelson, Reed; Creswell, Julie
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Trump Administration Rewrites ACA Insurance Rules to Give More Power to States
The Trump administration issued rules that add two broad exemptions from the Affordable Care Act's (ACA) individual mandate, retroactive two years. Under the rules, people living in areas where only one insurer is selling plans in the ACA marketplace can qualify for a "hardship exemption," along with those who oppose abortion and live in places where the only available plan covers abortion services. The rules—effective for ACA plans to be sold this fall for 2019 coverage—also devolve several significant decisions to states. The federal government will not jettison any of the 10 essential health benefits that must be covered by ACA plans but will enable states to allow fewer doctors' visits, for example, or to cover fewer prescription drugs. Among other things, the government is turning over to the 39 states that rely on the federal insurance exchange,, responsibility for ensuring that marketplace plans have enough doctors and other providers in their networks and will no longer require insurers to provide a standardized set of benefits to help consumers comparison shop.

From the article of the same title
Washington Post (04/09/18) Goldstein, Amy
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Medicine, Drugs and Devices

Diabetes Does Not Alter Anti-Osteoporotic Treatment Response
Clinicians should treat all patients with anti-osteoporotic drugs without adjusting the therapeutic algorithm when treating individuals diagnosed with diabetes, indicates a new study published in Endocrine. Researchers conducted a systematic review of the literature and identified nine retrospective, observational, prospective and randomized controlled trials published between 2004 and 2016 examining the efficacy of anti-osteoporotic medications in individuals with type 1 diabetes and type 2 diabetes, compared with individuals without diabetes. Researchers concluded that the presence of diabetes in an individual does not affect the fracture prevention potential of raloxifene, teriparatide or bisphosphonates (alendronate and risedronate), and therefore, equally prevents bone loss in these individuals. There is similar vertebral fracture risk in individuals with osteoporosis with and without diabetes, but current research evidence is not able to preclude equal antifracture efficacy. There are limited and inconsistent results regarding nonvertebral fracture risk, but diabetes does not seem to affect the fracture-preventative potential of the researched anti-osteoporotic drugs. The researchers concluded that the anti-osteoporotic response of increasing bone mineral density and risk reduction of vertebral fractures may not be altered in individuals diagnosed with diabetes.

From the article of the same title
Endocrinology Advisor (04/09/18) Kitabjian, Anna
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Doctors Bristle at Push for Opioid Prescription Limits
Limits on the amount of opioids that doctors can prescribe have sparked opposition from the American Medical Association (AMA). The group warns that the opioid rules are arbitrary and inhibit a doctor's ability to care for their patients on an individual basis. AMA "supports and encourages judicious prescribing of opioids," says Patrice Harris, chairperson of the association's opioid task force. But AMA has "grave concerns" about limits on both dosage and supply.

From the article of the same title
The Hill (04/11/18) Roubein, Rachel
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More than $500 billion Wasted in Nonoptimized Prescriptions
A new report estimates that the annual cost of drug-related morbidity and mortality caused by nonoptimized medication therapy was more than $500 billion in 2016, up from a 2008 estimate of $290 billion annually. Nonoptimized prescriptions are those that go unfilled, contribute to a new health problem or are not exactly the right medication or dose. "A more current estimate of the cost related to nonoptimized medication utilization can serve as a linchpin in policy, payment and healthcare delivery system reform," wrote Jonathan H. Watanabe, associate professor of clinical pharmacy at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, and colleagues in Annals of Pharmacotherapy.

From the article of the same title
Healio (04/09/2018) Miller, Janel
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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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