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News From ACFAS

Bylaw Amendments Approved
In electronic voting that ended yesterday, 93 percent of ACFAS voting members approved amendments to the College’s bylaws. A two-thirds majority (66 percent) was required for passage (1,373 members voted; 24 percent of eligible voters). The changes are effective immediately. It was the first changes to the College’s bylaws in more than a decade.

The Region Presidents Council (formerly the Division Presidents Council) and the College's legal counsel recommended the amendments. Changes include aligning new and renewing membership requirements, deleting a state-by-state list of the regions to allow for redistricting when desired and aligning the bylaws with current federal and state not-for-profit organization laws.
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Applying for a Fellowship Just Got Easier
If you plan to apply for several fellowships that have established status (Recognized or Conditional) with ACFAS, you now only need to complete just one standardized application. The ACFAS Fellowship Committee created this application to ease the burden on prospective fellowship candidates who wish to apply to multiple programs for the 2017–2018 fellowship year.

This first step in the new application process collects your basic demographic information; educational background; postgraduate training; licensure information; board exam results; references; and legal history. ACFAS will update this form annually.

Upon completing the form, you will be asked to forward your application and submission materials to your program(s) of interest. Each program will then have its own secondary application requirements, processes and deadlines. Check their individual websites for more information.

If you have any specific questions about programs or their requirements, contact each individual program directly.
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Foot and Ankle Surgery

Early Complications and Secondary Procedures in Transfibular Total Ankle Replacement
A team of researchers assessed a new transfibular total ankle arthroplasty (TAA) system to determine whether it led to complications. Nineteen patients were evaluated using visual analog scale pain and function, range of motion and early radiographic outcomes. After 12 months, no fibular nonunion or implant failure was noted. Four of the patients required additional surgery to address anterior impingement, deep infection and symptomatic fibular hardware and symptomatic fibular hardware. The low complication rate and lack of system failures suggested that the TAA system is safe and effective for patients.

From the article of the same title
Foot & Ankle International (04/16) Tan, Eric W.; Maccario, Camilla; Talusan, Paul G.; et al.
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Outcomes and Complications After Open Versus Posterior Arthroscopic Subtalar Arthrodesis in 121 Patients
Patients with subtalar arthritis are typically treated with either an open or posterior arthroscopic technique. A new study analyzed these treatment options and compared their functional outcomes and complications in 121 patients. Fifty-seven patients underwent subtalar arthrodesis with open techniques, and 64 were treated with arthroscopic techniques. The primary outcomes were the visual analog scale (VAS) for pain, Short Form-36, Foot Function Index and Angus and Cowell rating scores. Both groups showed significant improvement in VAS, SF-36 and Angus and Cowell scores. The arthrodesis group had slightly better results with respect to union rate and time to union, but they were not statistically significant. The open group was more likely to experience nerve complications and a painful surgical scar; the arthroscopy group was more likely to suffer from hardware-related symptoms. Both options were deemed viable for patients with subtalar arthritis.

From the article of the same title
Journal of Bone and Joint Surgery (04/20/2016) Rungprai, Chamnanni; Phisitkul, Phinit; Femino, John E.; et al.
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Practice Management

3 Tips for Dealing with State Medical Board Investigations
Dealing with state medical board investigations can seem rote at times, but all complaints should be taken seriously. Even if a complaint seems frivolous, the power wielded by state medical boards should grab your attention immediately. There is no such thing as taking an investigation too seriously. Here are three tips for dealing with these investigations:
  1. Get a lawyer. Doctors who think they have done nothing wrong and try defending themselves are making a grave mistake. Physicians should get a lawyer immediately and focus on the main issues at hand.
  2. Remember, public activities count as much as professional ones. Boards do not distinguish between doctors' activities when they are on or off duty, according to healthcare attorney David L. Adelson. Even something as seemingly inconsequential as a social media post could come back to haunt you.
  3. Be transparent and responsive. Failure to respond to general requests promptly and transparently can lead to disastrous results. Follow through on all requests even if they seem mundane.
From the article of the same title
Fierce Practice Management (04/18/16) Kuhrt, Matt
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EHRs Can Save You Money, Too
An electronic health record (EHR), when programmed correctly, can be an efficient way for a practice to save money. According to healthcare IT expert Jeffery Daigrepont, EHRs are an adequate way for you to depend less on humans. Computers do not get sick or show up late, he says, and they do not complain about work. Aside from being free from the human flaws of a typical employee, an EHR can also be programmed to more efficiently oversee your revenue. If a patient is checked in and no payment is made, the computer can alert you. EHRs can also ensure you do not miss any associated charges on a visit and can prevent clinical mistakes by alerting you to potential contraindications to a medication you are prescribing to a patient. Healthcare is a human profession, Daigrepont notes, but computers are still valuable tools that can make operations more efficient without outright replacing your human employees.

From the article of the same title
Physicians Practice (04/18/16) Hurt, Avery
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Strategies for Integrating EHR Use into Patient Engagement
A recent study published in the Journal of the American Medical Informatics Association identified two categories of patient engagement barriers that could be solved by properly using an electronic health record (EHR). The first barrier was meeting patient demands, and the second was meeting the demands of the EHR system. This is often problematic because adhering to the EHR Incentive Program benchmarks can put a physician at odds with patient-centered care. Here are some strategies to help find a balance:
  1. Documenting between clinical encounters. Document in the EHR outside the care encounter. This often involves skipping lunch or working odd hours to ensure more time for patient-centered care.
  2. Document template use. Using prefilled templates allows you to focus only on the individualized patient information and provides more time for patient needs.
  3. Using the EHR as a patient engagement tool. Screen sharing is an effective way to engage patients with the technology and to give them a full picture of their personal health data and overall well-being.
  4. Bolstering patient buy-in for technology. Making patients aware of the benefits of the EHR makes them more understanding and more willing to accept the benefits and flaws. This transparency alleviates demands from patients.
  5. General multitasking. Engaging in small talk while documenting or inputing data while intently listening to the patient are excellent ways to mitigate the potential isolating effects of the EHR.
From the article of the same title
Patient EngagementHIT (04/18/16) Heath, Sara
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Health Policy and Reimbursement

Designing Successful Bundled Payment Initiatives
Bundled payments are becoming more popular as healthcare shifts to value-based models of care. These initiatives are aimed at improving the experience of care, improving overall population health and reducing total costs of care. To design a successful bundled payment, you must ensure that you maximize the benefits while minimizing the consequences:
  1. Bundled payments should be adequate for the care needed to achieve optimal patient outcomes. The ultimate goal should be improving patient health by delivering the right services at the right time. To find this balance, the bundles must be designed so that providers receive adequate compensation for clinically necessary services.
  2. Evidence-based treatment variability should be incorporated into the bundled payment. Compensation should be adjusted to account for variation of patient health status and required resources. If payment bundles use a one-size-fits-all approach, providers may lose money on the sickest patients or meet financial restraints.
  3. Quality metrics should be used to ensure appropriate care in a bundled payment program. Quality metrics can be difficult to properly assess, and proper oversight is necessary so that the incentive to use resources wisely does not shift care from potential overuse to significant underuse. Financial incentives should be tied to quality metrics.
From the article of the same title
Health Affairs Blog (04/20/16) Ciarametaro, Michael; Dubois, Robert
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Healthcare Is Now Top Industry for Cyberattacks, New Research Shows
Five of the eight largest healthcare security breaches since 2010 all occurred in the first six months of 2015, according to a new report from IBM. These attacks compromised more than 100 million healthcare records and revealed that the healthcare industry has the information most sought after by hackers. The report outlines four steps to develop a strategic cybersecurity program, including prioritizing business objectives, instituting a proactive plan and promoting a culture of security awareness. That last point is of particular importance because 60 percent of cyberattacks in 2015 were the result of an insider gaining access to an organization's assets. Whether or not those attacks were malicious or accidental, they could be stopped more efficiently by a proper employee education plan.

From the article of the same title
Healthcare Finance News (04/20/16) Siwicki, Bill
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Lawmakers Propose 90-Day Meaningful Use Reporting Period for 2016
Lawmakers introduced a bill April 20 aimed at reducing the meaningful use reporting period from a full year to 90 days. The goal is to implement the bipartisan legislation this year, which many healthcare organizations across the country have called for. In a March 15 letter, several medical organizations wrote to lawmakers saying that a 90-day reporting period needed to be installed in 2016. A full-year reporting period would likely require costly changes to many systems. Bill co-sponsor Rep. Renee Ellmers, who is also a nurse, said in a statement that “Today's bipartisan and bicameral legislation is critical to the ongoing conversation about how to best serve patients and supply relief to the provider community.”

From the article of the same title
Healthcare IT News (04/20/16) Monegain, Bernie
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UnitedHealth Pulling out of Most ACA Markets
UnitedHealth will pull out of Affordable Care Act (ACA) marketplaces in most states by 2017, according to a company statement. The insurer had previously hinted at the move in November when it said financial losses could force its hand. The Obama administration has countered by saying UnitedHealth is a comparatively small player in the marketplaces, overseeing about six percent of all enrollees. But a recent study found that a UnitedHealth exit would decrease consumer choice and increase the percentage of U.S. counties with only one or two insurers from 36 percent to 53 percent. UnitedHealth may not be the only insurer to make such a move. Blue Cross Blue Shield and other insurers have expressed similar concerns about financial losses, and insurance companies are expected to seek significant premium increases next year to make up for it. While Republican lawmakers have jumped at the opportunity to follow through on warnings that the ACA would "collapse under its own weight," the Obama administration said it expects insurers will come and go as the markets develop. It remains unclear in what states UnitedHealth will continue to offer ACA coverage, although it appears that the company will be leaving most of the 34 states where it now participates.

From the article of the same title
The Hill (04/19/16) Sullivan, Peter
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Medicine, Drugs and Devices

FDA Advisory Committee Recommends Premarket Approval of Synthetic Cartilage Implant for First MTP Joint
The U.S. Food and Drug Administration (FDA) has recommended a synthetic cartilage implant for premarket approval, voting that it is safe, effective and beneficial despite possible risks. The implant would treat degenerative and posttraumatic arthritis in the first metatarsophalangeal joint, and doctors say it has the potential to help patients with arthritis. FDA approved of the implant, but some members of the voting panel did not agree with the assessment that the device was effective. Citing study inefficiencies, some members noted that more work should probably be done to ensure the efficacy of the device. According to panel member James D. Heckman, the device should be given a chance, but it should be limited so that a longer-term study can be conducted.

From the article of the same title
Healio (04/20/2016)
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House Dem: FDA Guidelines Will Help Shield Medical Devices from Hackers
Rep. Jim Langevin has praised the Obama administration for moving on rules to better secure medical devices from hackers. In a letter to the U.S. Food and Drug Administration (FDA), Langevin lauded their new draft guidelines and said he "strongly" supports the agency's efforts. FDA's guidelines are non-binding and do not provide a specific list of requirements for device protection. Instead, it focuses on a risk-based approach that closely monitors digital traffic to the most vulnerable devices. As more medical devices are connected to the Internet, these assessments become more critical to ensuring device safety. Recent examples of hackers taking control of hospital tools have raised fear levels and prompted action. "I applaud the FDA for tackling a complex challenge that will affect the healthcare industry now and well into the future,” Langevin said.

From the article of the same title
The Hill (04/21/16) Bennett, Cory
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Why Medical Devices Are Not Safer
Medical devices frequently experience problems, and recalls are a common occurrence. Recent instances include nearly 200,000 defibrillators being recalled in 2011 and the ongoing duodenoscope situation that has been linked to hundreds of cases of antibiotic-resistant infections in the last few years. Medical devices contribute to about 3,000 deaths per year in the U.S., and because there is no formal way of tracking the products, officials know very little about them. Compared to prescription drugs, which are rigorously tracked for quality and safety, medical devices rely on a passive system that requires only some parties to notify the U.S. Food and Drug Administration (FDA) about issues. Doctors, nurses and other healthcare professionals need not abide by this rule, and FDA itself has noted that this method of data collection is "incomplete, inaccurate, untimely, unverified or biased.” The simple solution appears to be regulating devices in a similar way that prescription drugs are regulated, but that is not a simple task. Unique device identifiers are not required to be included in standardized medical claims data. Some lawmakers favor requiring these identifiers in medical claims, and legislation could be coming forward soon to address this. But the cost of this solution is a potential impediment: a medical device surveillance system would likely be about $50 million a year.

From the article of the same title
New York Times (04/18/16) Frakt, Austin
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

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Gregory P. Still, DPM, FACFAS

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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