May 10, 2017 | | JFAS | Contact Us

News From ACFAS

Call for Posters for ACFAS 2018
If a picture is worth a thousand words, then a poster must be priceless. Display your latest discoveries in poster format at ACFAS 2018, March 22–25, 2018 at the Gaylord Opryland Hotel in Nashville, and help your colleagues visualize and apply your research in their own practice.

Poster abstracts must be submitted to ACFAS by October 2, 2017 to be eligible for review. PDFs of eligible posters are due December 15, 2017.

Check this summer for submission guidelines and criteria.
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Save the Date for New Advanced Sports Medicine Surgical Skills Course
Take your game to the next level. Plan to attend The Athlete’s Foot and Ankle: New Trends, Management and Surgical Treatment, a brand-new Surgical Skills course scheduled for October 8–9 at the Orthopaedic Learning Center in Chicago. The rapid evolution of surgical techniques demands that you acquire more diverse surgical skills, and this course will help you achieve just that.

Two one-day tracks—Open Procedures (Track A) and Advanced Arthroscopy (Track B)—combine panel and cased-based discussions with generous cadaveric lab time to help you confidently evaluate sports injuries and indications for surgery.

Sunday evening includes dinner and a fireside chat during which you can share radiographs of your cases (bring them on a flash drive). Registration details are coming soon, so watch This Week @ ACFAS for updates. Spots for this course will be limited.
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ACFAS Advocates in Favor of LCD Clarification Act of 2017
The Alliance of Wound Care Stakeholders is advocating in favor of the “Local Coverage Determination (LCD) Clarification Act of 2017” (S. 794). This legislation would improve transparency and accountability when Medicare contractors set LCD policies for physician services provided to Medicare beneficiaries.

The College is a member of the Alliance of Wound Care Stakeholders, an advocacy group for wound care specialists. See the Alliance's latest quarterly newsletter for an update on their legislative activities for the first quarter of 2017.
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Do You See Your Name?
You and 10,000 of your colleagues helped shape the College’s 75-year history, and you deserve recognition for it.

Find your name in the list of all known regular ACFAS members since 1942 in The Evolution of a Profession: The First 75 Years of the American College of Foot and Ankle Surgeons, available on The list runs from pages 107 to 150.

View or download the book online or request a hardcopy by sending your mailing address to
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Foot and Ankle Surgery

Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis
A literature review sought to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science and EMBASE. Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture. The rerupture rates showed no significant difference between augmented and nonaugmented repair. The study found that augmented repair, when compared with nonaugmented repair, was not found to improve patient satisfaction or to reduce rerupture rate or infection rate.

From the article of the same title
The American Journal of Sports Medicine (05/17) Zhang, Yi-Jun; Zhang, Chi; Wang, Quan; et al.
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Early Rehabilitation After Open Repair for Patients with a Rupture of the Achilles Tendon
Considerable debate surrounds the optimal rehabilitation protocols for incidents of Achilles tendon rupture. This study sought to examine if early rehabilitation is more effective than conventional rehabilitation. Researchers retrospectively reviewed the medical records of 56 patients who had been treated with open repair after a ruptured Achilles tendon, of whom 24 patients were treated postoperatively with below-knee cast immobilization for four weeks along with tolerable weightbearing rehabilitation at four weeks' follow-up. The remaining 32 patients were managed postoperatively with short leg splint immobilization for two weeks and started the tolerable weightbearing at two weeks' follow-up. Researchers evaluated the patients several times to identify when the single heel raise was possible and measured American Orthopedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) as a functional outcome. Patients in the cast group took significantly more time to return to work than patients in the splint group. AOFAS scores and ATRS were slightly higher in the splint group than in the cast group. Statistically significant differences existed between the two groups. The early rehabilitation did not lead to greater endurance, but it showed better results in the return to work and the Achilles functional score, according to the researchers. They concluded that early rehabilitation after open repair for patients with a ruptured Achilles tendon is helpful for functional recovery.

From the article of the same title
Injury (04/25/17) Kim, Uk; Choi, Yun Seong; Jang, Gyu Chol; et al.
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Noncompressible ABIs Are Associated with an Increased Risk of Major Amputation and Major Adverse Cardiovascular Events
Ankle-brachial indices (ABIs) are essential for evaluating the disease burden of patients with peripheral arterial disease. Although low values have been linked to adverse clinical outcomes, the association between noncompressible ABI (ncABI) and clinical outcome has not been evaluated among patients with critical limb ischemia (CLI). The goal of this study was to compare the clinical characteristics, angiographic findings and clinical outcomes of those with compressible (cABI) and ncABI among patients with CLI. Consecutive patients undergoing endovascular evaluation for CLI between 2006 and 2013 were included in a single center cohort. Major adverse cardiovascular events (MACE) were compared between the two groups. Of 284 patients with CLI, 68 (24 percent) had ncABIs. These patients were more likely to have coronary artery disease, diabetes, end-stage renal disease and tissue loss when compared to patients with cABI. Rates of infrapopliteal disease were similar between the two groups, although patients with ncABI had lower rates of iliac or femoropopliteal stenosis. Infrapopliteal vessels had smaller diameters with longer lesions among patients with ncABIs. After three years of follow-up, ncABIs were associated with increased rates of mortality, MACE and major amputation in comparison to patients with cABIs. Based on these findings, researchers concluded that ncABIs are associated with higher rates of mortality and adverse events among those undergoing endovascular therapy for CLI.

From the article of the same title
Vascular Medicine (03/20/2017) Singh, Gagan D.; Armstrong, Ehrin J.; Waldo, Stephen W.; et al.
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Practice Management

High-Priced Physician Practices Don't Deliver Better Care
A Harvard Medical School study finds that expensive physician practices generated little value when compared to cheaper physician practices. “We found that higher prices were associated with higher patient ratings of care coordination and management and slightly higher vaccination rates," wrote the authors of a study published in Health Affairs. "Higher prices, however, were not associated with higher overall patient ratings of care or physicians, improved access, better performance on other process measures of quality, fewer hospitalizations or lower Medicare spending,” they said.

From the article of the same title
HealthLeaders Media (05/03/17) Cheney, Christopher
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Pros and Cons of Messaging Patients Through the EHR
A medical practice's electronic health record (EHR) system can enable physicians to securely message their patients through an online portal. This approach functions similar to email where patients can generate new messages as well as forward date a message to automatically send patients a follow-up to an appointment. In addition, patients can enter their blood pressure results and glucose readings electronically, which appear in the physician's inbox at predetermined intervals. Physicians have the ability to respond to these readings instantly with a quick note, such as, "Blood pressures are looking good—stay on the same dose of your Lisinopril," or "I'm concerned about your blood sugars. What's been going on?" However, it is important to note that electronic messaging can misrepresent the intended message, leading to frustrated patients. There is also an expectation of near instantaneous responses, and patients tend to be reluctant to wait a day to receive a reply. Physicians need to be aware that patients often compose messages that are inappropriate and rude yet become part of the permanent medical record. It may be necessary to triage and evaluate messages prior to replying to them. Moreover, what is expected by the recipient and sender may not be clear to the other, leading to confusion and concerns. Just like any new clinical innovation, EHR technology requires trial and error, discovery and refinement. While technology may make physicians' lives easier, getting used to it can be a challenging process.

From the article of the same title
Physicians Practice (05/02/17) Frank, Jennifer
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Sourcing Public and Private Grants for Your Practice
Federal and private grants are often overlooked sources of revenue. However, medical experts say grant sourcing can be an effective means of raising revenue. Before sourcing for grants, medical practices should first detail what they hope to achieve and why the grant money is needed. This first step should also include a detailed description of the practice and who is served by the doctors. When it comes to finding available grant money, diligent website searches can be effective. Helpful websites include,, and

From the article of the same title
Physicians Practice (05/03/17) Madden, Susanne
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Health Policy and Reimbursement

House Republicans Pass Healthcare Overhaul
House Republicans narrowly passed a bill to overhaul the nation’s healthcare system, claiming a major victory even as the measure faces an uncertain fate in the closely divided U.S. Senate. Making good on their promise to repeal and replace the Affordable Care Act (ACA), Republicans pushed through the legislation after adopting a last-minute change that earned it just enough votes to pass. The House version fell short of some of the GOP's long-held goals, making major dents in large portions of the current law but not outright repealing it. The House bill would shift power to states to establish important health insurance rules. Additionally, it would end the ACA’s subsidies for eligible people who purchase health coverage via marketplaces created under the law, creating and substituting new tax credits.

From the article of the same title
Washington Post (05/05/17) O'Keefe, Ed; Cunningham, Paige Winfield; Goldstein, Amy
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New Health Bill or Old, Insurers Signal They're Ready to Make Big Changes
Several insurers are pushing for major premium increases for their 2018 Affordable Care Act (ACA) exchange plans, according to regulatory filings in Virginia and Maryland. Some insurers signaled they could seek even bigger boosts, or potentially pull back, without assurances that they will keep receiving federal payments that help with costs for low-income enrollees. CareFirst BlueCross BlueShield CEO Chet Burrell says his company requires a 52 percent average hike in Maryland and a 35 percent average increase in Virginia because of the Trump administration's anticipated nonenforcement of ACA's coverage mandate, as well as previous underpricing and an increasingly ill and expensive pool of enrollees. Several insurers that reported exchange-plan actions cited the uncertainty of ACA's future and key federal payments that help lower costs for low-income enrollees. Some insurers posted advisories in their rate filings that they may need to change their plans, with Cigna noting its “participation in Virginia's individual health insurance market in 2018 is contingent upon market conditions.”

From the article of the same title
Wall Street Journal (05/04/17) Mathews, Anna Wilde; Radnofsky, Louise
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CMS to Inform Clinicians of MIPS Participation Status in May
The U.S. Centers for Medicare and Medicaid Services (CMS) reports that all clinicians required to participate in the Merit-Based Incentive Payment System (MIPS) will receive notification of their participation status by the end of May. CMS is currently reviewing which doctors are required to participate in the payment system as part of the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015. Doctors must participate in the 2017 MIPS transition year if they bill more than $30,000 in Medicare Part B allowed charges a year and provide care for more than 100 Part B-enrolled Medicare beneficiaries a year.

From the article of the same title
EHR Intelligence (05/01/2017)
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Medicine, Drugs and Devices

Arthroscopic Correlates of Subtle Syndesmotic Injury
Researchers aimed to quantify syndesmotic disruption arthroscopically using a standardized measurement device. Ten cadaveric lower-extremity specimens were tested in intact state and after serial sectioning of the syndesmotic structures, including the anterior inferior tibiofibular ligament (AiTFL) and the interosseous ligament (IOL). Manual external rotational stress was applied across the tibiofibular joint. Custom-manufactured spherical balls of increasing diameter mounted on the end of an arthroscopic probe were inserted into the tibiofibular space to determine the degree of diastasis of the tibiofibular joint under each condition. A ball three millimeters in diameter reliably indicated a high likelihood of combined disruption of the AiTFL and IOL.

From the article of the same title
Foot & Ankle International (04/17) Guyton, Gregory P.; DeFontes, Kenneth; Barr, Cameron R.; et al.
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Diabetes Data Downloads Offer Important Keys to Glycemic Management
According to a presentation at the American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress, downloaded data from diabetes devices can give physicians clues needed to better understand the reasons for a patient's poor glycemic control, yet many clinicians are not reviewing this data due to time and cost issues. The lack of infrastructure to properly download device data in the office causes poor efficiency and the perception that there is insufficient time to download data. Few endocrinologists also have the training to perform this task. University of Washington School of Medicine Professor Irl Hirsch notes in patients living with diabetes, the HbA1c alone can be misleading, as hematologic conditions, physiologic state, medications, comorbidities and medical therapies can lead to an altered HbA1c in patients. “We have become too [HbA1c]-centric, and it's time to become more glucose-centric because we now have the glucose data,” Hirsch says. “We're not fighting the Hba1c. We're fighting the glucose, both on the hyperglycemia side and the hypoglycemia side.” Hirsch reports downloaded data will show endocrinologists the glucose variability that is often concealed by an HbA1c value. He also says the data can reveal hints of patient habits that, with alterations, may easily correct the course for a serious problem. Hirsch recommends that when downloading insulin pump therapy data, clinicians should examine basic insulin statistics, including the percentage of basal insulin used and the percentages of overrides for the bolus calculator.

From the article of the same title
Healio (05/03/2017) Schaffer, Regina
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Limits on Doctor-Drug Rep Interactions Tied to Prescribing Changes
A study by researchers from the University of California, Los Angeles Anderson School of Management reports that policies that limit interactions between doctors and pharmaceutical company representatives may affect what drugs are prescribed to patients. The researchers discovered that drugs promoted by pharmaceutical representatives, known as detailed drugs, lost market share after hospitals implemented similar rules. In contrast, drugs that were not detailed gained market share.

From the article of the same title
Reuters (05/02/17) Seaman, Andrew
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

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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