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News From ACFAS

Proposed Orthotics Rule on the Horizon
A proposed rule governing qualifications for providers of prosthetics and orthotics to Medicare beneficiaries will likely be published within the year. This proposed rule comes 16 years after Congress passed the Medicare, Medicaid and State Children’s Health Insurance Benefits Improvement and Protection Act (BIPA).

BIPA required the U.S. Department of Health and Human Services to promulgate a rule within a year of the bill’s passage on the accreditation requirements for orthotics and prosthetics dispensing. Under BIPA, a podiatrist is considered a qualified physician who would be able to provide prosthetics and orthotics. ACFAS staff will continue to monitor the issue because of its potential impact on members.

Send your questions about the proposed rule to Sarah Nichelson, ACFAS director of Health Policy, Practice Management and Research.
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Project to Help Model Safe Care for Practices Nationwide
ACFAS is collaborating with The Joint Commission and Centers for Disease Control and Prevention on a new project to help prevent patients from getting infections during outpatient care. Project participants will help expand the reach, uptake and adoption of guidelines by creating model infection prevention and control plans that practices nationwide can use.

Called ADOPT (Adaptation and Dissemination Outpatient Infection PrevenTion) Guidance, the three-year project includes collaborating with a variety of freestanding ambulatory settings and specialties. ACFAS is one of 12 outpatient-focused professional organizations and 10 ambulatory healthcare systems involved in the initiative. Barry Rosenblum, DPM, FACFAS of Beth Israel Deaconess Medical Center in Boston will represent the College.
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Foot and Ankle Surgery

Pledge to Keep Surgeons Current on High-Risk Surgeries Goes Largely Unanswered
Johns Hopkins Hospital and Health System, Dartmouth-Hitchcock Medical Center and the University of Michigan Health System created policies that said surgeons must perform a certain number of high-risk surgeries to continue performing the procedures. One year later, no other hospitals have joined this volume pledge. According to a Washington Post report, a volume pledge could help improve outcomes and mortality rates that skyrocket when surgeries are performed by surgeons who do not do a high volume of those procedures. These procedures include cardiovascular and joint replacement surgeries. Infrequently practiced procedures also raise the risk of death for common procedures. A recent study in Applies Health Economics and Health Policy, meanwhile, provides the opposite argument. In the study, a research team found that the link between high numbers of procedures and favorable outcomes has been overstated. By applying sophisticated statistical models, the researchers found that only certain procedures benefit from higher volume of practice.

From the article of the same title
Fierce Healthcare (04/26/2016) Bird, Julie
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Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated with Ankle Fractures
Osteochondral lesions (OCLs) associated with ankle fracture can lead to poor outcomes, so researchers designed a study to detect OCLs, associate them with a fracture type and investigate whether they influence clinical outcomes. The study included 100 ankle fractures requiring open reduction and internal fixation. OCLs were found in 10 of these fractures, and all were solitary talar lesions. Two were type I (subchondral compression), six were type II (partial, nondisplaced fracture) and two were type IV (displaced fracture). Mean OCL size was 4.4 ± 1.7 mm. There was no significant association between fracture type and OCL occurrence, and no differences were found in Foot and Ankle Outcome Scoring between patients with or without OCLs. While fracture type did not correlate with OCL, the OCLs only occurred in stage III/IV ankle fractures.

From the article of the same title
Foot & Ankle International (04/16) Nosewicz, Tomasz L.; Beerekamp, M. Suzan H.; De Muinck Keizer, Robert-Jan O.; et al.
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Transfibular Ankle Arthrodesis Using Burring, Curettage, Multiple Drilling and Fixation with Two Retrograde Screws Through a Single Lateral Incision
Ankle arthrodesis using burring, curettage, multiple drilling and fixation with two retrograde screws can result in a high union rate and functional score without serious complications, according to a recent study. Researchers evaluated 22 patients who underwent ankle arthrodeses for end-stage ankle arthritis. They removed articular cartilage with a single lateral incision and burring and curettage. Then, they drilled multiple holes and used two retrograde screws to achieve fixation. The resected distal fibula was fixed to the distal part of the talus and tibia. The mean postoperative ankle alignment was suboptimal, but there were few complications and the mean American Orthopaedic Foot and Ankle Society scores increased from 30 to 71.

From the article of the same title
Journal of Orthopaedic Surgery and Research (04/24/16) Lee, Hyun-Joo; Min, Woo-Kie; Yoon, Seong-Dae; et al.
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Practice Management

Ensure Practice Staff Works to the Top of Their License
Your practice staff need to be challenged to work on the most complex, difficult taks that their licenses and abilities allow. This is the best way to optimize your practice's work flow and revenue stream, so it is important to assess your staff and remind yourself of what they are capable of doing. In many cases, your staff is far more versatile than even they believe. Train medical assistants to answer routine medical questions on the phone instead of nurses, and train nurses to make medical decisions using standing orders. Challenge your providers to step out of their comfort zones and do tasks they may not be accustomed to. This can bring a procedure back in house while generating revenue. Allow your staff the flexibility to solve problems instead of only letting them identify issues. Creating a suggestion board with input from staff will make the practice run more smoothly. Your staff members have talents and abilities afforded to them by their licenses that must be discovered. Doing so will help your practice in countless ways.

From the article of the same title
Physicians Practice (04/28/16) Weinberg, Auren
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Human Element the Weakest Link in Healthcare Security, Says Verizon Report
Healthcare organizations do a poor job of protecting against data breaches and responding to those breaches, according to Verizon's ninth annual Data Breach Report. Phishing emails continue to be a persistent threat, with 30 percent of the malicious messages opened this year, up from 23 percent last year. Around 12 percent of users do not simply open a phishing email, they open the attachment as well, and 11 percent follow links in the email to online forms where they input sensitive data. Sixty-three percent of all breaches included the use of stolen credentials from schemes like phishing emails, up from 51 percent last year. These issues are universal across most industries, but they are far more critical in healthcare. Criminals can do more with the data they steal because healthcare data is the most valuable information available on the black market. Practices must implement solid cybersecurity policies and train employees thoroughly to prevent accidental information sharing that could lead to breaches.

From the article of the same title
Medical Practice Insider (04/28/16) Davis, Jessica
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Improve Online Physician Reviews with a Customer Service Focus
Improving customer service may be the key to improving your online practice reviews, according to a new study from healthcare marketing firm Vanguard Communications. By looking at Google Plus reviews of "Doctor" businesses, the study found that only four percent of complaints had to do with the actual quality of healthcare received. Meanwhile, the other 96 percent of complaints centered around customer service and delays. The survey echoes other reports that indicate the technical aspects of patient satisfaction could be more important to your practice's reputation than the healthcare dispensed. The best part of the report is that these pitfalls are relatively easy to fix if your practice seeks the right advice. It is far easier to fix customer service problems than it is to fix issues stemming from a lack of physician ability. The most important aspect of this service, the report noted, is reducing wait times. Other suggestions include improving communication with patients, allowing flexibility with appointment scheduling and ensuring staff members are willing to create a positive patient experience.

From the article of the same title
Fierce Practice Management (04/27/16) Kuhrt, Matt
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Health Policy and Reimbursement

CMS Plans to Reverse Two-Midnight Rule for Medicare Payments
The Centers for Medicare and Medicaid Services (CMS) are planning to eliminate the controversial two-midnight rule that produced 0.2 percent payment reductions for certain hospital inpatient services. The new rule would replace that figure with a 0.6 percent increase on payment rates in 2017. Additionally, the 2017 payments will increase by 0.8 percent to offset the reductions that hospitals were faced with from 2014 to 2016. The 0.2 percent payment reduction will be eliminated altogether, and the new rule will apply to 3,330 acute care hospitals and 430 long-term care hospitals. Almost immediately after it was introduced, the two-midnight rule faced pushback from various healthcare groups. The American Hospital Association, four other hospital associations and a number of individual hospitals challenged the rule in federal courts. In 2016, 55 hospitals filed a lawsuit against the U.S. Department of Health and Human Services regarding the compensation cuts. What was originally meant to be a solution to a payment and coding issue ended up being a divisive rule.

From the article of the same title
RevCycle Intelligence (04/26/16) Sampson, Catherine
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MACRA Proposed Rule Published by HHS, Streamlining Federal Programs Including Meaningful Use
The U.S. Department of Health and Human Services (HHS) has unveiled a proposed rule for MACRA, which could change how physicians are assessed for quality of care and use of information technology. The new rule would streamline aspects of certain programs, such as the Physician Quality Reporting System and the Medicare EHR Incentive Program, and would bundle them in an initiative called the Quality Payment Program. HHS says this will include two paths: the Merit-based Incentive Payment System, or MIPS, and advanced Alternative Payment Models, or APMs. The proposed rule states that 1) quality will account for half of a total score in year one of the program; 2) cost accounts for 10 percent of the total score and uses 40 episode-specific measures to account for differences among specialties; 3) advancing care information accounts for 25 percent of the total score, and clinicians can choose to report customizable measures to reflect their day-to-day technology use; and 4) clinical practice improvement activities account for 15 percent of the total score. The new program aims to "support the vision of a simpler, more connected, less burdensome technology" and will be aligned with several other initiatives to improve patient care and interoperability.

From the article of the same title
Healthcare IT News (04/27/16) Miliard, Mike
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Obama Administration Issues Sweeping New Medicaid Regulation
The Obama administration has revealed sweeping regulation pertaining to the Medicaid program that imposes new limits on insurers. These regulations update rules to Medicaid managed care, where states contract with private health insurers to provide benefits to low-income people. The new rule imposes requirements on how much of insurers' revenue must be allocated for paying medical costs as opposed to administrative costs of profits. While some welcome the legislation, others view it as a "one size fits all" solution that hinders states' decision-making. The rules also provide standards to ensure patients need not travel large distances to reach a doctor within their plan's network.

From the article of the same title
The Hill (04/25/16) Sullivan, Peter
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Medicine, Drugs and Devices

New Report Paints a Frustrating Picture for Telehealth Advancement
Connected health practices across the country vary dramatically from state to state, and most states cannot even agree on a definition for telehealth, according to a report by the Center for Connected Health Policy (CCHP). The analysis of state telehealth and Medicaid reimbursement policies found that some states are moving forward while others are falling back. The result is a "confusing environment for telehealth participants to navigate, particularly when a health system provides healthcare services in multiple states," say CCHP officials. Alabama, Rhode Island and New Jersey have no legal definition for either telehealth or telemedicine, said the report. Many other states define each term by restricting what the platform can do, such as enabling interactive visits between a doctor and patient but excluding remote patient monitoring and store-and-forward technology. The report also noted that Massachusetts, Rhode Island and Utah do not currently offer Medicaid reimbursement for telehealth, while other states differ greatly on what is reimbursed and what is not.

From the article of the same title
mHealth Intelligence (04/27/16) Wicklund, Eric
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Patient Attitudes Toward Diabetic Foot Ulcers Have 'Significant Effect' on Survival
Patients with diabetic foot ulcers are more likely to survive if they have positive expectations about their affliction, according to a new study out of the University of Nottingham. Over a five-year period, 169 patients were interviewed about their diabetic foot ulcers. Although depression was not a significant predictor of mortality, patients who believed their ulcers were associated with other symptoms died more quickly. These patients believed their ulcers would have more serious consequences for them, believed they would last a long time, found them distressing and believed they had little control over the situation. The findings suggest that illness beliefs could influence understanding of mortality risk, not just in patients with diabetic foot ulcers, but in patients with a variety of illnesses. More research is needed to determine if there could be future therapeutic interventions to improve survival.

From the article of the same title
Medical Xpress (04/25/16)
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Study Shows Increased Use of Mobile Devices in Clinical Settings
A study published in Orthopedics has found that use of mobile devices as a tool in a clinical setting is on the rise. During a 48-month period, researchers observed orthopaedic surgeons and trainees and sent questionnaires to 678 institutions to evaluate mobile device usage. Between 2010 and 2014, smartphone application use increased from 59 percent to 84 percent among surgeons, and from 41 percent to 62 percent among trainees. Tablet use also rose from 31 percent to 39 percent among surgeons and from 43 percent to 51 percent for trainees. Most surgeons reported feeling that their hospital should support smartphone use, but only half reacted positively when asked whether their hospital actually supported devices in a clinical setting. In addition, 46 percent of trainees and 31 percent of surgeons thought mobile devices could improve patient interactions, and 87 percent of trainees and 58 percent of physicians claimed mobile computing allowed them to be better physicians.

From the article of the same title
Healio (04/26/2016)
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Daniel C. Jupiter, PhD

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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