April 29, 2015 | | JFAS | Contact Us

News From ACFAS

Coding Questions? ACFAS Can Help!
With less than six months to prepare for the ICD-10 transition and new modifiers added to the medical coding process, it’s no surprise billing errors are so prevalent among providers.

No worries though, ACFAS is here to help take the confusion out of coding for you and your office staff. Just send your questions to, and ACFAS’ Coding Coach, Jackie Kravitz, CCP, will send you a personalized answer.

Need more on coding? Spots are still available for ACFAS’ Interactive Surgical Coding Workshop, July 17–18 in Tysons Corner, Virginia (Washington, DC). Register yourself and your office staff today at
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First Orthopaedic Trauma Surgeon-Led Fellowship Receives Status with ACFAS
For the first time, a MD-led fellowship program, Foot and Ankle Trauma Fellowship at OhioHealth Grant Medical Center, has been granted Conditional Status by the ACFAS Fellowship Committee. Located in Columbus, Ohio and under the direction of Benjamin Taylor, MD, the program will be considered for upgrade to full Recognized Status once the first DPM candidate matriculates through the program.

“This is a unique opportunity to train ACFAS Foot and Ankle post-graduate Fellows under our orthopaedic trauma surgeon colleagues,” says Daniel Lee, DPM, PhD, FACFAS, Chair of the ACFAS Fellowship Committee. “It’s extremely rewarding to see, after many years since the inception of the ACFAS Fellowship Committee, the birth of this inter-collegial relationship. I hope this will not only set forth further fellowship relationships but also strengthen our professional ties with all specialties for the common goal of excellence in foot and ankle surgery.”

ACFAS highly recommends taking on a specialized fellowship for the continuation of foot and ankle surgical education after residency. If you are considering a fellowship, visit our Fellowship Initiative webpage to review a complete listing of programs and minimal requirements.
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SLRs Save You Time
You’ve just kicked off your shoes after a long work day and are ready to unwind. Feel like sifting through a pile of scientific specialty journals to read the latest research studies? Probably not.

Turn to ACFAS’ monthly Scientific Literature Reviews (SLRs) instead to stay on top of the latest studies that may affect your surgical cases. SLRs highlight a specific topic with podiatric relevance published in other specialty journals possibly not on your reading radar.

Visit to read this month’s reviews or browse through our SLR archive to catch up on studies dating back to 2009.

With SLRs, it’s easy to stay one step ahead of the latest research!
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Foot and Ankle Surgery

Adolescent Hallux Valgus: A Systematic Review of Outcomes Following Surgery
Both conservative and surgical treatments have downsides when managing adolescent hallux valgus (AHV). Non-operative management does little to prevent progression; surgery can often lead to recurrence of deformity. A study was conducted to review clinical outcomes following AHV surgery. To do this, researchers reviewed literature from a variety of sources. In the nine studies reviewed, 86 percent of 140 patients reported satisfaction with their outcome. It was also found that rates of recurrence and other issues are actually lower than previously reported. The researchers said more comprehensive studies must be conducted to determine the long-term clinical outcomes of this surgery.

From the article of the same title
Journal of Children's Orthopaedics (04/22/15) Harb, Ziad; Kokkinakis, Michail; Ismail, Hiba; et al.
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Effect of Age on Outcomes in Total Ankle Arthroplasty
A recent study investigated the effect of age on the clinical outcomes of total ankle arthroplasty (TAA) since little is known about these effects in younger patients. A total of 395 patients who underwent TAA from June 2007 to July 2011 were enrolled in the study. Patients were divided into three groups based on age at time of surgery (younger than 55, between 55 and 70 and over 70). Results showed that patients under the age of 55 had greater improvement in Short-Form 36 Vitality and American Orthopaedic Foot and Ankle Society function scores compared to their elder counterparts. Otherwise, there was little to differentiate between the groups. The study concluded that overall, outcomes of TAA in younger patients were similar to older patients. Researchers noted that more studies must be conducted to further determine long-term effects.

From the article of the same title
Foot & Ankle International (04/15) Demetracopoulos, Constantine; Adams, Samuel B.; Queen, Robin M.; et al.
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Isolated Syndesmotic Injuries in Acute Ankle Sprains: Diagnostic Significance of Clinical Examination and MRI
Syndesmotic injuries are prevalent in acute ankle sprains and often go unnoticed. A study was conducted to determine how often syndesmotic injuries occur in ankle sprains and how reliable clinical diagnosis tests are, compared to the reference standard of MRI. The study also analyzed inter-rater reliability of clinical tests and evaluated the role of clinical symptoms in diagnoses. A total of 100 patients with acute ankle injuries were enrolled. Overall, 14 patients (15 percent) had ruptured anterior interior tibiofibular ligament detected by MRI. The most efficient way to predict syndesmotic injuries was evidence of pain at rest. The study showed that detecting syndesmotic injuries by clinical examination was generally ineffective. The researchers concluded that MRI scanning should be the recommended course of action for patients with pain at rest following ankle sprains.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (04/21/15) Großterlinden, Lars Gerhard; Hartel, Maximilian; Yamamura, Jin; et al.
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Practice Management

Structuring Physician Leadership to Promote Accountable Care
Physician leadership has become increasingly important in promoting accountability in care, but many physicians are still not quite sure how to lead the correct way. This is especially true in the population health field, where physicians face challenges getting in the way of being effective leaders. Population health services have not been achieving intended outcomes, communication between physicians and health plans has been lacking, and trust between all parties is suspect. These challenges make it difficult for physicians to lead in population health management, leading to worse overall outcomes. One solution to gain favorable outcomes is to use a Population Health Services Organization (PHSO). These management service organizations ensure that people are available to satisfy every population health need. The PHSO is physician-led, and all physicians communicate and collaborate as necessary. If PHSO is mission-driven and strategies are in place, any organizational structure can be effective. Another way to ensure physician governance is to use the pod structure, a group of physicians organized into collaborative units for managing risk and improving quality of care as teams. Minimum pod size is at least 5,000 patients for no more than 15 physicians. This allows for proper sample sizes to measure and report outcomes. Finally, it is essential that local physician and practice leadership training is put into place. Research has shown that continually educating physicians is one of the best ways to ensure the smoothest-running practice possible.

From the article of the same title
Health Affairs Blog (04/17/15) Nundy, Shantanu; Oswald, John
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Tech Tools to Boost Patient Collections
Experts say that physicians should be developing more comprehensive strategies with the technology at their disposal to ensure maximum return on patient collections. Technology can do a number of things to help practices. It allows smaller practices to level the playing field and also streamlines the collection process so that it becomes faster and more efficient. Communication is key between practices and patients. Physicians should set up a patient portal that gives patients access to information and allows balance payments online. They should use automated appointment reminder services so that patients are not only aware of when their appointments are, but can also access their portal. Invest in online credit card processing, like mobile card swipers. They should set up automatic payments to ensure fewer missed payments. Finally, clinicians should research other resources, like the American Medical Association's free pricing toolkit, which helps practices collect what patients owe.

From the article of the same title
Physicians Practice (04/21/15) Colwell, Janet
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Training, Testing, Tools Crucial for ICD-10 Transition
The October transition to ICD-10 is imminent, and many practices across the country are still not prepared. To ensure a smooth transition, physicians should be trained in ICD-10. This is essential because a poorly trained staff leads to mistakes that could severely hamper day-to-day operations in a practice. Practices should test their IT systems well ahead of time to make sure they are capable of handling the transition. Practices should create a "payer grid" that lists the practice's largest health plans and their specific representatives, including direct phone numbers and email addresses. They can also establish a billing manager who will be the practice's designated ICD-10 expert. Finally, using IT tools to assist with the transition will help. Encoders, for example, can assist with generating accurate ICD-10 codes for as low as $400 per year. Even with this preparation, being ready for ICD-10 implementation will be difficult. Using all of the training and tools at one's disposal is the key to making sure the transition is as hassle-free as possible. Only a few months remain, so practices should employ strategies as soon as possible.

From the article of the same title
Medical Practice Insider (04/03/15) Baril, Arlene F.
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Health Policy and Reimbursement

CMS Rolls Out Five-Star Scale to Rank Hospitals on Patient Experience
The Centers for Medicare and Medicaid Services (CMS) has introduced a new feature on its Hospital Compare website that ranks hospitals on a five-star scale. The scale measures patient experience by ranking categories such as facility cleanliness and clinician communication. Out of the nearly 3,500 Medicare-certified acute care hospitals ranked, only 271 (seven percent) received a five-star rating. The most popular rating was three stars. Only 3 percent of hospitals received one star. While some have welcomed the new system, others do not support it. Specifically, the American Hospital Association (AHA) believes the scale fails to take into account several socioeconomic factors that lie outside of a hospital's control. In addition, AHA believes that simplifying hospitals' quality to a single number is the incorrect way to rank them. CMS, meanwhile, believes that the system will allow patients to get a better idea of which hospital they want to choose for care. In addition, it will promote an environment that rewards improvement. A hospital with a three-star rating will conceivably work very hard to achieve a higher rating. CMS also plans to use the star ratings in the future to rank hospitals on clinical outcomes and patient safety.

From the article of the same title
Fierce Healthcare (04/16/2015) Small, Leslie
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IPPS 2016 Proposed Rule Raises Hospital Pay, Emphasizes Quality
The proposed 2015 Inpatient Prospective Payment System (IPPS) rule will raise operating payment rates to hospitals by 1.1 percent. The Centers for Medicare and Medicaid Services (CMS) announced that the rate increase and other payment policy changes will increase IPPS operating payments by around 0.3 percent. The rule also includes language regarding implementation of the new ICD-10 and adds insurance against a possible delay that could extend past the scheduled Oct. 1 adherence date. The two-midnight rule, which in 2014 established a benchmark that stays expected to last two or more midnights would be considered appropriate for payment, will remain the same. CMS will continue to review and make decisions regarding short inpatient stays and long inpatient stays. In addition, CMS is requesting comments with regards to the potential of adding bundled payments for inpatient care.

From the article of the same title
HealthLeaders Media (04/21/15) Leppert, Michelle
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Telemedicine Reimbursement Gains Bipartisan Support on Capitol Hill
Telehealth advocates converged on Capitol Hill April 21 to discuss advancing the service to reach patients in more isolated rural areas. The Telehealth Advancement Act will aim to expand Medicare coverage for telemedicine services in these remote parts of the country. Two major points of concern for the bill are Medicare reimbursement and broadband connectivity. Recently, it was revealed that the expansion of telemedicine services reimbursed by Medicare may be left out of the House Energy and Commerce Committee's 21st Century Cures bill. Several senators in the most recent talks came out in support of reimbursement for telemedicine.

From the article of the same title
FierceHealthIT (04/22/15) Dvorak, Katie
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Medicine, Drugs and Devices

FDA Pilot Program Meant to Help Users of Home-Use Devices
The U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health is launching a pilot program that would create a searchable online database of the labeling of home-use medical devices and related package inserts. These devices are commonly used by the untrained, and the agency hopes that the database will be a valuable tool for patients and caregivers in the domestic environment. Instructions and labeling for these devices can become lost, and company websites are not always up-to-date. FDA officials are looking for nine volunteer home-use medical device-makers to help with the program.

From the article of the same title
Medical Device and Diagnostic Industry (04/20/15) Thibault, Marie
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FDA Unveils $1 Million Postmarket Surveillance Grant
The U.S. Food and Drug Administration (FDA) is offering a grant of up to $1 million in an effort to take vast amounts of electronic health record data and turn them into figures underlining postmarket risks of certain drugs. The plan to create a database of health records was announced in January. Around 150 million patient records are available online, and the goal is to display those numbers and data in a way that highlights safety trends. FDA says the task should determine the best uses for the data while taking into account its limitations, as well as biases in observational studies. Applications are due to by June 15, with the grant period beginning one month later.

From the article of the same title (04/21/15) Freund, Lena
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Simple Unpowered Walking Assist Clutch Puts a Spring in Your Step
The U.S. Defense Advanced Research Projects Agency (DARPA) is trying to make it easier for all people to walk, regardless of whether or not they have a disability. Their solution is a mechanical clutch that is small enough to fit in the palm of your hand. It requires no power source and is lightweight for the wearer. The boot-like apparatus, which is attached to the foot and ankle, makes it around seven percent easier to walk—the equivalent of taking off a 10-pound backpack. The device uses a spring that mimics the Achilles tendon and a clutch that stands in for calf muscles. The exoskeleton works in tandem with the muscles, meaning less force and strain are put on the body. Technology such as this has numerous uses for everybody, but it has especially positive possibilities for those with disabilities. Rehabilitation could be revolutionized, and someone who previously could not walk could walk and heal faster than ever before.

From the article of the same title
Next Big Future (04/16/15) Wang, Brian
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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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