April 23, 2014

News From ACFAS

Learn Invaluable Surgical Pearls in ACFAS Skills Courses
Experience the perfect blend of the proven and the cutting edge in ACFAS’ Surgical Skills Courses for 2014. This year’s hands-on offerings include: Foot and Ankle Arthroscopy, Comprehensive Rearfoot Reconstruction and Trauma of the Foot and Ankle courses—each designed as hands-on programs with one-on-one instruction to update practicing surgeons on the latest in essential surgical decision-making skills.

Take advantage of one of the following courses, where you’ll spend 75 percent of your time in a hands-on cadaver lab learning unmatched curriculum:
  • Foot & Ankle Arthroscopy Surgical Skills Course, Rosemont, IL
    June 13-14, or
    August 2-3, or
    November 1-2
  • Comprehensive Rearfoot Reconstruction Surgical Skills Course, Jersey City, NJ
    October 24-25
  • Trauma of the Foot & Ankle Surgical Skills Course, Aurora, CO
    November 8-9
Register today, as classes fill quickly and some are already sold out. Waitlists are available for certain classes. Register or find more information on the programs by visiting
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ACFAS’ First-Ever Job Fair a Booming Success
If you missed the ACFAS Annual Scientific Conference in Orlando, then you missed the chance to be a part of the College’s first-ever Job Fair, hosted by, ACFAS’ Benefits Partner and online career center host. brought the jobs and resumes from online to in-person, and hosted over 20 potential jobs and over 50 resumes in Orlando. Conference attendees seeking employment had a chance to view the available positions on bulletin boards and contact those employers who were present at the conference for impromptu interviews. Plus, those seeking jobs (which a majority were residents) were also provided an avenue to post their resumes on boards for potential employers to view and contact them.

Looking for a job or have a job to offer now? Visit to post your resume online, view jobs available in your part of the country, or take advantage of ACFAS-member discounts to post available positions you're trying to fill. Plus, don’t miss your chance to be a part of the second annual ACFAS Job Fair, which will be held at the 2015 Annual Scientific Conference in Phoenix!
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Foot and Ankle Surgery

Addressing Hindfoot Arthritis with Concomitant Tibial Malunion or Nonunion with Retrograde Tibiotalocalcaneal Nailing: A Novel Treatment Approach
A new study examined the effectiveness of a novel treatment for tibial malunion or nonunion with concomitant hindfoot arthritis: a single-stage procedure that includes tibial osteotomy and retrograde intramedullary nailing. Researchers reviewed the results seen in 25 patients who underwent the procedure, which is designed to correct angular deformity while achieving hindfoot fusion. The study found that Visual Analog Scale (VAS) pain scores improved from an average of 8.3 before the operation to a mean of 2.8 at final follow-up. The average American Foot & Ankle Society ankle-hindfoot (AOFAS-AH) score, meanwhile, was 76 at final follow-up, an improvement over the average of 43 that was recorded before surgery. Finally, 96 percent of patients reported being extremely satisfied or satisfied with the results at final follow-up, while just 4 percent--only one patient--reported being unsatisfied. The study concluded that the single-stage procedure is a viable alternative to multiplanar external fixation or a staged procedure in which tibial nonunion or angular deformity and hindfoot arthritis are treated separately.

From the article of the same title
Journal of Bone and Joint Surgery (04/02/2014) Kane, Justin M.; Raikin, Steven M.
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Two-Year Outcomes of MOBILITY Total Ankle Replacement
A new study has found that outcomes in post-traumatic osteoarthritis patients who undergo total ankle replacement using the MOBILITY Total Ankle System are similar to those seen in osteoarthritis and rheumatoid arthritis patients treated with the same procedure. No significant differences were seen in the American Orthopaedic Foot & Ankle Society (AOFAS) scores, other Foot and Ankle Outcome Score (FAOS) results besides measurements of pain, or patient satisfaction scores of the three groups at either the one- or two-year post-surgical follow-ups. However, the surgeons did observe some differences in the three groups of patients one and two years post-operatively. For example, the 28 patients in the post-traumatic osteoarthritis group and the 22 rheumatoid arthritis patients had better FAOS results regarding pain than did their 56 counterparts in the osteoarthritis group one year after surgery. Better scores for the general health domain of the 36-item Short-Form Health Survey (SF-36) were also seen in the post-traumatic osteoarthritis group at one-year follow-up. These scores remained significantly higher two years after the operation.

From the article of the same title
Journal of Bone and Joint Surgery (04/02/2014) Vol. 96, No. 7, P. 1 Ramaskandhan, Jayasree R.; Kakwani, Rajeshkumar; Kometa, Simon; et al.
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Practice Management

Develop an ICD-10 Training Plan for Your Practice
Doctors' practices should be sure to develop training programs that will properly prepare employees for the transition to ICD-10, which will take place in October 2015 or later, writes Barb Glondys, RHIA, of the American Health Information Management Association (AHIMA). Glondys notes that the process of developing an effective ICD-10 training program begins by asking physicians and staff members about their use of ICD and CPT codes to determine who assigns, interprets, and/or reports data coded in ICD-10. Physicians' practices can then determine what type and level of ICD-10 training providers and staff members should receive. Both providers and staff members will need foundational training that covers a basic overview of the details of ICD-10, though more specific training will also need to be provided to employees depending on their role within the practice. Providers, for example, will need to be given training that is relevant to their practice or specialty. After identifying the material to be covered during training, practices should then identify the best way to provide training to employees. Some employees may do better in traditional classroom settings, while others may prefer audio conferences, for example. Finally, practices should determine whether they will provide the training themselves or rely on a training vendor. Glondys says that taking these steps will ensure that the transition to ICD-10 goes smoothly and does not disrupt the practice's operations.

From the article of the same title
Physicians Practice (04/14/14) Glondys, Barb
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Three Tips for Recruiting and Retaining Top Physician Assistants
Physicians' practices may be able to achieve a competitive advantage by hiring and retaining talented physician assistants (PAs), writes CRT Medical Systems CEO David Doyle. But since PAs are in short supply and in high demand, Doyle says, doctors' practices need to have a strategy in place for recruiting talented individuals. Such a strategy may involve the use of a medical staffing firm that will take responsibility for the recruiting and hiring process from start to finish. Turning to such firms can help save practices time and money, Doyle says. However, practices that cannot afford to hire medical staffing firms may want to instead build relationships with students enrolled in entry-level education programs for PAs. Doyle notes that practices that build such relationships, which can include serving as rotation sites for students of PA educational programs, may be more likely to attract the best candidates. This is because students who work at practices that serve as rotation sites will want to stay at a practice they are already familiar with, Doyle says. Once PAs are hired, Doyle says, practices should take steps to retain these individuals by ensuring that they are satisfied with their work and that they have opportunities for professional development.

From the article of the same title
Physicians Practice (04/12/14) Doyle, David
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Health Policy and Reimbursement

Medicare Chief Jonathan Blum Leaving Obama Administration
Centers for Medicare and Medicaid Services (CMS) Principal Deputy Administrator Jonathan Blum will resign effective May 16 in order to pursue other career opportunities. Blum's resignation was announced in an e-mail sent to CMS staff from Administrator Marilyn Tavenner, who praised Blum for his work in making Medicare a driving force in the effort to provide incentives for healthcare quality, care improvement, and value. Tavenner also cited several other improvements that have been made to Medicare, including the development of regulations for accountable care organizations (ACOs) and the implementation of a quality framework for Medicare Advantage plans. Blum also oversaw the release of data on Medicare payments made to doctors.

From the article of the same title
Modern Healthcare (04/22/14) Demko, Paul
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Cut Prices for Low-Risk Hospital Outpatient Surgeries: HHS Report
The Department of Health and Human Services' inspector general has issued a recommendation that could result in Medicare payments to hospitals for certain outpatient surgeries being cut by 30 to 50 percent--a proposal that is almost certain to face opposition from hospital interest groups. The Centers for Medicare and Medicaid Services would need Congress' permission to implement the recommendation, which calls for hospitals that perform outpatient surgeries on patients at low risk of complications to be paid the same rates that stand-alone ambulatory surgery centers (ASCs) receive for surgeries. Medicare pays significantly lower rates to ASCs for surgeries than it does to hospital outpatient-surgery departments. The proposal does not specifically say who would be considered a low-risk patient, though it suggests that patients and doctors could make that determination themselves. The inspector general says the change could save both the government and Medicare beneficiaries billions of dollars. CMS Administrator Marilyn Tavenner appears to be wary of the proposal, saying that equalizing ASC and hospital rates could result in confusion because reimbursements paid to ASCs are currently based on the higher hospital rates.

From the article of the same title
Modern Healthcare (04/17/14) Carlson, Joe
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ACA Enrollment Hits 8 Million, Administration Says
The Obama administration announced April 17 that 8 million people have signed up for private health insurance offered through the new health insurance exchanges, a number that is 500,000 higher than it was just a week prior. In states that are using exchanges operated by the federal government, 35 percent of enrollees are under 35. An additional 28 percent of those who have enrolled are between the ages of 18 and 34. Finally, the administration announced that the number of people enrolled in Medicaid and the Children's Health Insurance Program has increased by 3 million between the time before the exchanges opened last fall and February.

From the article of the same title
BNA Health Care Daily (04/17/14)
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AHA Lawsuit Over 'Two-Midnight' Rule Called Uphill Battle
Legal observers say the American Hospital Association (AHA) could find it difficult to convince a judge to rule in its favor in its legal challenges to Medicare's two-midnight rule. The rule, which took effect October 1, 2013, has been controversial among hospitals because it calls for Medicare to pay inpatient rates only when doctors certify that they have good reason to believe that patients will have to stay in the hospital for two consecutive nights. In cases where patients do not stay in the hospital for two consecutive nights, hospitals are paid with the lower outpatient rates, even when patients receive inpatient services. AHA's two lawsuits seek to overturn this rule and its 0.2 percent cut to Medicare funding. Healthcare attorney Michael E. Clark says AHA and others challenging the rule face an "uphill battle," as past rulings by the U.S. Supreme Court have given the Department of Health and Human Services and other federal departments wide latitude in issuing rules to implement laws. AHA and others will have to prove that the Centers for Medicare and Medicaid Services violated its discretionary authority, Clark says. Others say that even if the legal challenges to the rule and its payment cut are successful, the issue will simply return to Congress, which could reinstate any cuts that are overturned in court.

From the article of the same title
Modern Healthcare (04/15/14) Carlson, Joe
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Manufacturers Prepare to File Sunshine Act Doc-Pay Disclosures
The drug and medical device industries are working to complete the disclosures of payments they make to doctors to study and promote their products, as mandated by the Physician Payments Sunshine Act. A significant number of those disclosures, which will be sent to the Centers for Medicare and Medicaid Services (CMS) beginning in May, will reportedly mention reprints of articles published in medical journals as well as chapters from textbooks that describe new research and are given to doctors free of charge. The pharmaceutical and medical device industry is disclosing this information even though the articles and textbook chapters are free because CMS says that they still have a monetary value. Under the provisions of the Sunshine Act, any transfer of value from a product maker to a physician that is worth more than $10 must be reported.

From the article of the same title
Modern Healthcare (04/12/14) Carlson, Joe
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Medicine, Drugs and Devices

The Association of Gender and Body Mass Index with Postoperative Pain Scores When Undergoing Ankle Fracture Surgery
A new study has found that adjusted body weight (ABW) is a good indicator of how much morphine to give obese patients while they are undergoing open reduction and internal fixation (ORIF) of an ankle fracture. The study examined 137 cases involving both obese and non-obese patients who underwent ORIF of an ankle fracture and were given general anesthesia as well as morphine-only analgesia to prevent the onset of pain after surgery. Researchers reviewed post-anesthesia care unit (PACU) records for pain scores at first report and 30 minutes later, as well as PACU opiate requirements. A post-hoc analysis of these records found that in the setting of similar pain scores, obese patients received a similar weight-based dose of morphine during the operation when ABW was used compared to their non-obese counterparts. Researchers also found that neither gender or Body Mass Index (BMI) resulted in any statistically significant differences in PACU pain score group. This led researchers to conclude that there is no association between obesity or gender and post-operative pain in patients who receive morphine-only pre-emptive analgesia while undergoing URIF.

From the article of the same title
Journal of Anaesthesiology Clinical Pharmacology (Spring 2014) Vol. 30, No. 2, P. 248 Grodofsky, Samuel Robert; Sinha, Ashish C.
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Foot Orthoses in Children with Juvenile Idiopathic Arthritis: A Randomized Controlled Trial
A new study has found that pre-formed fitted foot orthoses (FOs) with customized chair-side corrections are superior to FOs that do not include these corrections in improving pain and quality of live in juvenile idiopathic arthritis patients. The 60 children who participated in the study received one of the two types of FOs and were evaluated using a variety of metrics at baseline, three months, and six months. The study found that the children who were treated with fitted FOs experienced reductions in pain from baseline to six months, as measured by the visual analogue scale (VAS), that were significantly larger than what was observed in patients treated with FOs that did not include the customized corrections. Answers to the Pediatric Quality of Life questionnaire that were submitted by study participants and their parents or caregivers showed that the children treated with fitted FOs had a quality of life that was significantly better than their counterparts in the non-fitted FO group.

From the article of the same title
Archives of Disease in Childhood (03/14) Coda, Andrea ; Fowlie, Peter W.; Davidson, Joyce E.; et al.
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