April 22, 2015 | | JFAS | Contact Us

News From ACFAS

Call for ACFAS 2016 Manuscripts
Help influence the future of podiatric medicine - submit your manuscript for presentation consideration at ACFAS 2016, February 11-14 in Austin, Texas.

Manuscript submissions are due August 14, 2015. ACFAS will begin accepting manuscripts after June 1, 2015.

In the meantime, please review our manuscript requirements and instructions for authors. Manuscripts submitted for consideration are blind-reviewed and judged on established criteria. Winners divide $10,000 in prize money.

Don’t miss this opportunity to share your latest research discoveries with your peers—start putting your manuscript together now!
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ACFAS Job Fair Unites Candidates & Companies
Job hunters and employers from around the country connected in Phoenix at the second-ever ACFAS Job Fair hosted by

This year's job fair made connecting easy, featuring bulletin boards where jobseekers and employers posted their resumes and available positions. Job hunters also scheduled onsite interviews with potential employers right at the show.

If you missed your chance to connect at ACFAS 2015, it’s not too late—visit to post your resume online, view jobs available in your part of the country or take advantage of ACFAS member discounts to post positions you're trying to fill. Then mark your calendar to be a part of the third annual ACFAS Job Fair at ACFAS 2016 in Austin!
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Foot and Ankle Surgery

Comparison of Outcomes for Osteochondral Lesions of the Talus with and without Chronic Lateral Ankle Instability
While it is known that prolonged instability of the ankle may lead to osteochondral lesions that cause osteoarthritis, no studies have yet compared osteochondral lesions in ankles with chronic lateral ankle instability (CLAI) against ankles without instability. A recent study aimed to determine characteristics associated with osteochondral lesions of the talus (OLT) in ankles with and without instability. Two groups of patients were observed: one group with CLAI and one without. The OLT group with CLAI had a higher proportion of lateral-side OLT and larger OLT than the other group. Most other scores between the groups were comparable, except for one notable exception. The CLAI group showed a significantly higher proportion of failure and inferior outcomes in the Foot and Ankle Outcome Score for the sport and recreation subscale. The researchers concluded that osteochondral lesions in ankles with CLAI were proportionally larger than non-CLAI patients. The group with CLAI also showed greater weakness and decreased athletic performance compared to the other group.

From the article of the same title
Foot & Ankle International (04/15) Lee, Moses; Kwon, Ji Won; Choi, Woo Jin; et al.
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Treatment of Hindfoot Instability in Charcot Foot Using a Hybrid Technique of Internal and External Fixation
Patients with Charcot foot do not have the ability to off-load, leading to an increase in the risk of internal fixation failure. A hybrid technique combining internal and additional external fixations guarantees reconstruction and improves surgical outcome. This surgery's goal was to obtain a plantigrade foot that can fit into custom-made orthopaedic shoes. Surgery was performed, followed by off-loading for three months. A CT scan then confirmed bony fusion, and the patients were placed in a cast or walker for four to six weeks. Then they were fitted with the shoes. After tibiocalcaneal fusion, 14 of 16 patients were able to fit into custom-made shoes. Two patients needed below-knee amputation, and three patients had stress fractures of the tibia. The 10 patients who had ulcers before surgery were healed. In one patient, an ulcer developed.

From the article of the same title
Operative Orthopädie und Traumatologie (04/02/2015) P. 101-113 Volkering, C.; Kriegelstein, S.; Kessler, S.; et al.
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Practice Management

Keeping Up with Changing Payer Policies
Physicians must have a clear view of the ways payers can hide behind red tape. According to David Doyle, CEO of revenue cycle management firm CRT Medical Systems, the biggest problem in working with payers is the inconsistency of the rules. No set rules exist that payers must adhere to in terms of how they approve or pay claims, and the rules that do exist vary wildly among payers. This also becomes a problem when dealing with claim submissions, which have an inconsistent methodology and often bog down an already overly complex process. A lack of communication between physicians and payers is also a culprit, and payers will often make false statements to prolong the process. This red tape can lead to the frustrating instance of delaying or dropping claims. The biggest insurers will use their size as an advantage and change contract terms, a common problem for physicians. Blue Cross's size makes it impossible to drop, so insurers like them will change contracts in their favor. Identifying problems and unfair practices is the first step toward ensuring a smooth relationship with payers.

From the article of the same title
Physicians Practice (04/06/15) Sprey, Erica
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Patient Portals and Tracking Devices Driving Engagement
A recent Harris Poll survey polled 2,000 adults across the U.S. and found that 84 percent of respondents have access to a patient portal via their physician's practice. Patient portals, telemedicine and other technologies have created a need to understand how these new tools impact patient engagement and what can be done to improve upon them. The poll indicated that 60 percent of respondents preferred scheduling doctor appointments via the portal. Physicians agree that the most important benefit the patient portal provides is allowing patients to view their own medical records. Sending alerts and appointment reminders is another major benefit. The patient portal makes the relationship between physicians and patients a simpler one. The portal is not the only technology making an impact on that connection. According to the survey, 37 percent of adults who wear a fitness tracking device wear it every day, and 80 percent consider the information gained by these devices essential to relay to their physicians. In addition, 64 percent of adults claimed they would prefer telehealth visits over an in-person visit for follow-up appointments. All of the data points to a growing trend of technology making it easier and more convenient for patients to interact with their physicians. Dr. Nick van Terheyden, chief medical information officer of Nuance Communications, suggests that physicians rearrange their offices and stay more focused on the patient. Physicians can also make use of the new technologies available to them to engage the customer.

From the article of the same title
EHR Intelligence (04/07/2015) Gruessner, Vera
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Social Media Leads the Way in Patient Engagement
Practices need to have an active presence on social media platforms to ensure they create a good first impression for patients. Around 40 percent of patients check online sources ahead of a visit with their physicians, while data from the Pew Research Project suggests patients often check Google or other search engines to find out if physicians hold social media accounts. One item patients may find when they run a search on a physician's name is patient reviews on physician review sites. Strategies practices can follow to take advantage of this trend include having physicians be aware of the reviews they are receiving online and posting photos and other information on such sites to generate a positive impression. Meanwhile, healthcare organizations can use social media to improve patient engagement via:
  1. community engagement;
  2. real-time patient education;
  3. outreach to referring physicians;
  4. customer service;
  5. crisis communications.
Practices can take a gradual approach to employing social media by:
  1. Setting up accounts and tracking what other practices and health organizations are doing on social media.
  2. Following colleagues and others they know in the industry. Following hashtags is one way to follow conversations on Twitter, for example.
  3. Establishing social media use policies and training staff to avoid inappropriate posts or posts that could breach patient privacy.
From the article of the same title
Physicians Practice (04/15/15) Kuehn, Bridget M.
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Health Policy and Reimbursement

Obama Signs Overhaul of How Medicare Pays Doctors
President Barack Obama signed legislation permanently changing how Medicare pays doctors. The bill overhauls a 1997 law that aimed to slow Medicare's growth by limiting reimbursements to doctors. Obama said the new law helps Medicare by giving assurance to doctors about their payments. "It also improves it because it starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied but whether or not people actually start feeling better," Obama said. "It encourages us to continue to make the system better without denying service." The bill blocked a 21 percent cut in Medicare payments that was due to take effect this month. It also revamps how physicians will be paid in the future by providing financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits.

From the article of the same title
Associated Press (04/16/15) Kuhnhenn, Jim; Fram, Alan
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ONC Updates Guide to Safety, Privacy of Electronic Health Information
The Office of the National Coordinator for Health Information Technology (ONC) has published a revised version of its Guide to Privacy and Security of Electronic Health Information, which was last published in 2011. The newest version accounts for new information related to privacy and security for small- and medium-sized providers, health IT professionals and the public at large. The updated version of the guide includes new examples of HIPAA privacy and security rules, offering examples to readers of how the rules may impact businesses and clients. The guide also offers a sample seven-step approach to implement a security management process, which ONC says providers can use as a reference.

From the article of the same title
Becker's Hospital Review (04/14/15) Jayanthi, Akanksha
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CMS Proposes Rule to Shorten MU Reporting to 90 Days for Next 2 Years
The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule that would change reporting requirements for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program from a one-year reporting period to a 90-day period. The proposed rule aims to better align current measures of meaningful use stage 1 and stage 2 with the proposed meaningful use stage 3 requirements and to reduce the burden and duplication of reporting requirements. CMS has proposed matching the reporting requirements for the next two years with those proposed for stage 3, meaning reporting periods would follow the calendar year for 2015 and 2016 instead of the fiscal year. Also, CMS proposes allowing new meaningful use participants to attest with any 90-day period within the calendar year in 2015 and 2016. Starting in 2017, all providers would follow an EHR reporting period of one full calendar year, as proposed in stage 3 rules.

From the article of the same title
Becker's Hospital Review (04/10/15) Jayanthi, Akanksha
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Medicine, Drugs and Devices

Switching from IV to Subcutaneous Tocilizumab Monotherapy in Patients with RA
A recent study from Japan evaluated the efficacy and safety of switching from IV tocilizumab (TCZ-IV) to subcutaneous TCZ (TCZ-SC) monotherapy in rheumatoid arthritis (RA) patients. Patients who had completed 24 weeks of TCZ-SC or TCZ-IV monotherapy were enrolled in an 84-week, open-label extension period in which they all received TCZ-SC monotherapy. Effects of the switch were studied at week 36. In all, 160 patients switched from TCZ-IV to TCZ-SC, while 159 continued with TCZ-SC. Clinical remission rates at week 24 were 62.5 percent for TCZ IV/SC and 50 percent for TCZ SC/SC. The rates were 62.5 percent and 57 percent, respectively, at week 36. A total of 9 percent of patients who had achieved remission at 24 weeks could not maintain remission 12 weeks later. Overall, the researchers determined that most patients can switch from TCZ-IV to TCZ-SC without risk of serious adverse events, although clinical efficacy may be reduced after switching for some, mostly heavier, patients.

From the article of the same title
Arthritis Care & Research (04/07/15) Ogata, Atsushi; Atsumi, Tatsuya; Fukuda, Takaaki; et al.
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The Effect of Training Shoes on Running Kinematics in Older Runners
A recent study indicated that elite adolescent athletes changed from a heel strike pattern to a forefront strike immediately after transitioning from a large heel trainer to either a track flat or barefoot running. The study opened up the question of whether or not the same transition would happen for more experienced runners. Researchers used 26 runners of greater than 10 years' running experience all over the age of 30 and placed them on treadmills at varying speeds. Participants ran in both their normal running shoes and in the barefoot condition. A motion capture system analyzed foot strikes. All running shoes were measured with respect to the height of the heel versus forefoot thickness. The study found that heel-to-toe thickness did not correlate with percent heel strike and that alterations in speed had similar results. Only when running barefoot did participants exhibit a significant drop in percent heel strike, although 40 percent of men and 20 percent of women continued with consistent strike patterns across all changes. Researchers concluded that alteration in foot strike pattern does not always occur immediately in older athletes when they change from a running shoe to the barefoot running condition. In addition, they reported that the switch comes with a higher potential for injury. Older runners should be cautious when switching from a running shoe to a barefoot or minimalist shoe regimen. The study was presented at the American Academy of Orthopaedic Surgeons annual meeting.

From the article of the same title
AAOS Now (03/15) Mullen, Scott M.; Toby, E.B.; Mar, Damon; et al.
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USPSTF Evidence Review Supports Prediabetes Screening
Screening asymptomatic people for type 2 diabetes does not improve mortality after 10 years of follow-up, but progression to diabetes can be delayed by detection and treatment of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), according to a literature review published in the Annals of Internal Medicine. Draft guidelines from the United States Preventive Services Task Force (USPSTF) advise screening for abnormal glucose in adults age 45 and older and younger individuals with risk factors. When finalized, the guidelines will replace the 2008 USPSTF diabetes screening guidelines, which target individuals with high blood pressure. The new guidelines, based on current evidence review studies, aims to identify people with IFG and IGT. "The systematic review found that in people with impaired fasting glucose or impaired glucose tolerance — [both] sometimes called 'prediabetes' — progression to diabetes can often be delayed or prevented with lifestyle modifications…or with medications, although medications may be associated with unwanted side effects," says Shelley Selph, MD, from the Oregon Health and Science University Schools of Medicine and Public Health. USPSTF has not yet announced a date for its final recommendation.

From the article of the same title
Medscape (04/13/15) Tucker, Miriam E.
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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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