News From ACFAS

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In order to provide better service, ACFAS has upgraded its member/customer database. In addition, we are also upgrading the acfas.org security. This increase in security requires members to use new website usernames and passwords for acfas.org. The new login details are now in effect.

New Login Details for acfas.org:

User Name: Your Member ID
Password: Your Member ID + first initial + last initial (both lower case)

Once you log in to the website, you can change your username and/or password to something more memorable, but it must contain:

User Name: At least five characters (letters, numbers and symbols)
Password: A minimum of six characters that contain at least one letter and one number

Please note, this is not the login to access JFAS directly through the Elsevier website. In order to access the Journal, please log in to acfas.org/jfas and click on the link at the bottom right “read current and past issues online.” Once on the JFAS website, you are not required to log in again.

If you have any questions about this change, please don’t hesitate to contact the College at 773-693-9300, or via email at membership@acfs.org. ACFAS can help you prepare for the future of your practice with the 2012 Practice Management/Coding Workshops.

Gather the inside scoop on the latest trends in podiatric surgical coding and CPT policy and get a deeper understanding of HIPAA, ICD-10 and fraud issues. Plus, explore financial strategies that you can implement into your practice and personal business development.

The next workshop is June 1-2, 2012, in Portland, Oregon.

For more information or to register, visit the web link below. For additional questions, email jane.battisson@acfas.org or call (800) 421-2237.

Foot and Ankle Surgery

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A study of 32 patients with functional ankle instability (FAI) and 32 without FAI was held to characterize fatigue's impairment of force sense (FS) in both types of subjects. Three eversion FS trials were captured per load using a load cell prior to and following a concentric eversion fatigue protocol. Trial error constituted the difference between the target and reproduction forces. Constant error (CE), absolute error (AE), and variable error (VE) were estimated from three trial errors, and a Group x Fatigue x Load repeated-measures ANOVA was carried out for each error. No significant three-way interactions or two-way interactions involving group were observed. CE and AE had a significant two-way interaction between load and fatigue, while VE had a significant main impact for fatigue, which all pointed to increased FS error with fatigue at 10 percent load. But at 30 percent load only VE rose with fatigue. The FAI cohort had greater error as quantified by AE, but not CE or VE.


A study was performed to evaluate the outcomes of minimally invasive fluoroscopy-guided retrograde core drilling and autologous cancellous bone grafting in undetached osteochondral lesions (OCL) of the talus. The procedure was applied to 41 OCL of the talus in 38 patients, and the treated lesions were then assessed by clinical scores and magnetic resonance imaging (MRI). The average time for follow-up was 29 months, plus or minus 13 months. A significant increase in the AOFAS score from 47.3 plus or minus 15.3 points to 80.8 plus or minus 18.6 points was recorded. The outcomes for grade I and grade II lesions tended to be superior to those for grade III lesions, while first-line treatments and open distal tibial growth plates led to substantially improved results. Score results were not influenced by age, gender, body-mass index, time to follow-up, defect localization, or a traumatic origin. Pain intensity fell from 7.5 plus or minus 1.5 to 3.7 plus or minus 2.6 on a visual analog scale, while subjective function rose from 4.6 plus or minus 2 to 8.2 plus or minus 2.3. Five patients exhibited a complete bone remodeling in MRI follow-ups, while demarcation was detectable in two cases.


Researchers reported the results obtained in the treatment of a group of patients with plantar plate tears by direct repair through a dorsal approach combined with a Weil metatarsal osteotomy with a minimum followup of 12 months. They prospectively treated 28 patients [55 metatarsophalangeal (MTP) joints] with lesser MTP joint instability, but only 22 patients (40 MTP joints) were treated by the direct repair of the plantar plate and were included in the study. The plantar plate of the second MTP joint was the most commonly affected joint (63 percent), and Grade III type tear (transverse and/or longitudinal extension tear) was the most frequent type. With the surgical treatment, the researchers were able to markedly improve the parameters
studied (pain, medial or dorsomedial deviation of the toe, joint stability, muscle balance, and joint congruence) to acceptable levels. The AOFAS score improved substantially from an average of 52 points preoperatively to 92 points postoperatively.

Practice Management

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John H. O’Neill Jr., vice chairman of the American College of Physicians Medical Practice and Quality Committee, offers the following advice for small practices:

• Analyze your top 10 charges/reimbursements by payer, then approach and negotiate with payers for better reimbursement.

• Identify and micromanage your overhead using accounting software.

• Pinpoint the procedures that best fit your practice, then track and optimize their use.

• Implement an electronic health record/practice management system to help you improve the care you provide and to optimize your billing and reporting. O'Neill recommends using the same vendor for both systems to ensure compatibility.
• Consider developing or becoming part of a Patient-Centered Medical Home (PCMH).

• Think about using midlevel providers in your practice; they can generate additional revenue.

About 85 percent of doctors now use mobile devices such as smartphones and iPads, and workers in the physician recruitment and staffing business say that such devices can aid the physician hiring process. The technology provides faster access to job information, social media news of possible positions, and networking opportunities. "The parts of the process that get you to the face-to-face can happen in a lot more efficient and user-friendly fashion [with mobile devices] than they ever could," said Ralph Henderson, president of healthcare staffing for AMN Healthcare.

A recent survey by AMN Healthcare Services found that 32 percent of clinicians used their mobile device for job or healthcare-related content in 2011, up from 12 percent in 2010. Alerts on job sites can be tailored specifically for the kinds of positions physicians want. Such alerts can also help employed physicians seek new jobs more passively, as many physicians are not actively looking for a new job, but would consider it for the right opportunity. Apps make it easier for doctors to send, receive, and store contact information, and even scan business cards to add the information into their device’s contact file. Some companies or recruiters conduct initial interviews through video chatting like Skype or Apple’s FaceTime. Mobile apps not only make it easier for physicians to look for a job, it also makes it easier for employers to have access to a wider range of applicants.

Health Policy and Reimbursement

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Starting in June, some hospital procedures for Medicare patients will receive prepayment review by a government auditor in 11 states. Physician organizations, including the American Medical Association, have serious concerns about these plans, which will target eight diagnoses in California, Florida, Illinois, Louisiana, Pennsylvania, Michigan, Missouri, New York, North Carolina, Ohio, and Texas. The associations sent a letter to the Centers for Medicare & Medicaid Services (CMS) on April 3, asking them to rescind the program. The recovery audit prepayment reviews are intended to make sure hospitals are compliant with Medicare payment rules before claims for procedures are paid. The Obama administration announced the demonstration project last November. The review is part of an effort by CMS officials to reduce improper payments by $50 billion and cut the Medicare payment error rate in half. The reviews are expected to prevent improper claims in states with high volumes of short inpatient hospitalizations or high rates of fraud. Although the prepayment demonstration will employ recovery audit contractors to review claims, physicians believe that past experience shows that such contractors cannot conduct reviews efficiently or accurately.


The Centers for Medicare and Medicaid Services (CMS) has issued a final rule requiring providers and suppliers to include their 10-digit National Provider Identifier (NPI) when submitting all Medicare and Medicaid payment claims or when applying for enrollment in either program. "To maintain program integrity and ensure quality, we must make certain that only qualified providers and suppliers participate in the programs and that they bill accurately for their services," CMS says in the regulation. Unlike the interim final rule, the finalized version contains provisions for CMS to deny rather than reject claims that do not include the NPI, while residents practicing in certain states where they are licensed to practice and order treatments will be permitted to enroll in Medicare; the teaching physician will need to provide an NPI in states where residents are not allowed to be licensed.


A proposal approved by the House Judiciary Committee in March includes earlier-passed medical liability reform legislation as a way to realize savings to avoid arbitrary, across-the-board budget reductions to federal programs in 2013. The House passed budget legislation that also asked six House panels to find savings in a reconciliation process to supplant sequestration that is scheduled to kick in in January. The House additionally cleared a bill that included a provision to repeal the Independent Payment Advisory Board established in the 2010 healthcare law; the tort reform measure would set a $250,000 ceiling on noneconomic damages of any malpractice suit in the U.S., while any punitive damages awarded would be up to $250,000 or as much as twice the amount of economic damages awarded, whichever is higher.


As a result of a program called Disclosure, Apology and Offer, it may become easier in the future for Massachusetts doctors to apologize for mistakes. The program, which targets "defensive medicine" will be enacted if an experiment by three major hospitals to reduce medical malpractice lawsuits succeeds. Many experts consider defensive medicine to be among the top drivers of soaring health care costs nationwide. The Massachusetts Medical Society hopes it will promote a less confrontational atmosphere between patients and doctors when medical mistakes occur and speed resolution of disputes.

The initiative, pattered after one pioneered by the University of Michigan Health Care System, will be piloted by Massachusetts General Hospital and Beth Israel Deaconess Medical Center in Boston, and Baystate Medical Center in Springfield. Four smaller hospitals will also participate. Hospitals would be required to swiftly disclose to patients and their families any unanticipated, negative outcomes of medical care and promptly investigate what happened. If it is determined that the hospital is at fault, it will issue an apology, as well as offer financial compensation. Patients who accept a financial offer would waive their right to future litigation, or they can reject the offer to pursue mediation or sue, if necessary. On the other hand, a hospital would not have to apologize or make a financial offer if it decides no errors were made and the medical outcome was unavoidable.

Medicine, Drugs and Devices

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The American Academy of Orthopaedic Surgeons (AAOS) has launched an online awareness campaign, A Nation in Motion, to remind consumers that they are the go-to specialists for a wide range of musculoskeletal issues. These range from broken bones and congenital deformities to injured muscles, ligaments and tendons. For the campaign, the AAOS lined up more than 400 patients willing to share their own success stories with orthopaedic surgery that users can search for by age and condition. It also encourages others to share their own stories through a link on the site. The site includes facts and figures as well as information about procedures and conditions. Also included is an interactive board game which has players spin for turns that land them on spaces such as “attempt to run marathon without treating Achilles tendon injury, go back three spaces” and “following successful knee replacement, can climb stairs, go hiking and get back to normal life, advance two spaces.”


Small and rural physician groups and hospitals are lagging behind their larger, urban equivalents in their adoption of electronic health record (EHR) systems, as determined by two studies published in the journal Health Affairs. One study used a survey to ascertain that by 2011, 14.7 percent of small hospitals had a basic EHR, versus 20 percent of medium-size hospitals and 24.5 percent of large hospitals. Also by last year, 19.4 percent of rural hospitals disclosed having a basic EHR compared with 29.1 percent of urban hospitals. "We believe that federal policymakers need to redouble their efforts among hospitals that appear to be moving slowly or starting from a lower base rate of adoption," said the study authors. The authors of the other study concluded that the government must "continue to aim incentives and support at small practices" and "may also need to focus on physicians outside of primary care" in order to boost EHR adoption among that segment.


The U.S. Food and Drug Administration (FDA) has issued a trio of reports that delineate the steps its Center for Drug Evaluation and Research (CDER) have followed to augment the FDA's postmarket drug safety program. "This report shows that the quality, accountability, and timeliness of postmarket drug safety decisions have been enhanced, and our public communication of this information is more effective," says CDER director Janet Woodcock. Since the passage of the Food and Drug Administration Amendments Act five years ago, the FDA has concentrated on four factors to bolster the postmarket drug safety program. Those areas of concentration include developing new capabilities for identifying and responding quickly to postmarket drug safety issues; improving the quality, speed, and transparency of the FDA's decisions concerning how to address specific drug safety problems; providing earlier and more effective public communications about drug safety; and developing stronger protection of patients from preventable medication mistakes. The FDA reports that it has raised the number of drug safety missives to consumers from 39 in 2010 to 68 in 2011. In the last four years the agency also has mandated 65 safety-related labeling changes, enlarged the personnel in CDER's Office of Surveillance and Epidemiology by 100 percent, and unveiled the Safety First, Sentinel, and Safe Use programs.