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News From ACFAS

1 Part History + 2 Parts Arthroscopy = ACFAS’ First e-Book
Make room at the top of your reading list for Arthroscopy of the Foot and Ankle, the College’s first e-Book! Written by nearly 40 experts in arthroscopic surgery, this 16-chapter masterwork features:
  • videos and images to guide you through procedures
  • self-assessments after each chapter so you can earn CME
  • intuitive navigation
  • built-in note-taking and bookmarking functions
  • and more!
Visit to purchase the e-Book. This is just the first installment in a series of exclusive ACFAS e-Books in the works—stay tuned for more releases!
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Two New Infographics Released in Time for Summer
Equip your patients with the tools they need to keep their feet and ankles healthy and safe this summer. Download and print our newest infographics, Protect Your Feet from the Sun and Keep Your Feet Safe at the Beach, from the ACFAS Marketing Toolbox and display them in your office or distribute them to your patients. You can also post them to your social media outlets and practice website.

These full-color infographics give useful tips for preventing injury and sunburn and for choosing the right summer footwear.

Visit for our complete infographics library and other free resources you can use throughout the year to educate your patients and promote your practice.
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Register for Hands-On Workshop on High-Frequency Forefoot Surgery
We’re packing up, shipping out and headed your way! Catch us this fall for ACFAS on the Road: Refining High-Frequency Forefoot Surgery, our popular regional program that gives you proven strategies for treating the forefoot.

Start your learning on Friday night with an in-depth surgical complications presentation and case studies, plus the opportunity to present your own cases for panel discussion. Continue the momentum on Saturday with riveting lectures from expert faculty then put your newly acquired skills to the test in four hands-on sawbones labs.

Register today at, and we’ll see you on the road soon!
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2 Exceptional New Surgical Skills Courses
Perfect your surgical skills in two interactive courses that inspire creativity and confidence. Register now for All About the Ankle or Comprehensive Reconstruction and elevate your surgical technique in just two days.

Each course combines generous lab time with personalized instruction from some of the most revered faculty in foot and ankle surgery. In All About the Ankle, you’ll learn how to successfully manage patients with ankle arthritis, ankle fractures, tendon tears and fractures using the newest surgical approaches. Explore the complexities of revisional surgery in Comprehensive Reconstruction while performing reconstructive and salvage procedures for the foot and ankle.

Visit to register today since space is limited. Contact Maggie Hjelm to be waitlisted for sold-out courses.
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Foot and Ankle Surgery

Clinical Outcomes and Development of Symptomatic Osteoarthritis 2 to 24 Years After Surgical Treatment of Tarsometatarsal Joint Complex Injuries
There are limited long-term results regarding clinical outcomes and the development of symptomatic osteoarthritis (OA) following surgical treatment for Lisfranc injuries. A new study aimed to assess these outcomes, the occurrence of symptomatic OA and risk factors for OA at two to 24 years after treatment with open reduction and internal fixation, or with primary arthrodesis. Sixty-one patients with Lisfranc injuries were assessed, and their results were recorded using the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Foot Function Index (FFI) and a visual analog scale (VAS) for pain. Following treatment, the mean AOFAS, FFI and VAS scores were 79.0, 16.9 and 2.5, respectively. In 72.1 percent of patients, researchers found radiographic evidence of OA. They found evidence of symptomatic OA in 54.1 percent of patients. Risk factors included nonanatomic reduction, fracture classification of Myerson type C and a history of smoking.

From the article of the same title
Journal of Bone and Joint Surgery (05/04/2016) Dubois-Ferriere, Victor; Lubbeke, Anne; Chowdhary, Ashwin; et al.
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Ground-Reactive Forces After Hallux Valgus Surgery
A recent study was conducted to evaluate the biomechanics of walking after first metatarsal osteotomy or metatarsophalangeal joint (MTP) arthrodesis. To quantify this action, researchers measured ground reaction forces (GRF). A total of 19 patients who underwent a Scarf osteotomy and 18 who underwent arthrodesis were observed in the study. A modified treadmill was used to detect GRF, and American Foot and Ankle Society (AOFAS) scores were also recorded. The epidemiological, radiographical and clinical data were comparable between the two groups. Better restoration of propulsive function was noted after osteotomy. A surgery effect was found on vertical forces, and a foot effect was found on anteroposterior impulse. Patients with the osteotomy returned to almost normal gait, while arthrodesis patients did not fully recover the propulsive forces of the forefoot.

From the article of the same title
Bone & Joint Journal (05/16) Ballas, R.; Edouard, P.; Philippot, R.; et al.
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Practice Management

3 Ways to Manage Patient Expectations in the ER
A doctor's diagnosis and suggested course of treatment sometimes do not align with a patient's expectations in an emergency room setting. This has become more prevalent in the Internet age, where patients tend to self-diagnose by searching their symptoms online before entering the ER. Here are three strategies to ease the tension in the event of a patient/physician disagreement:
  1. Educate patients. Take the time to explain the recommended treatment plan to the patient and emphasize that your suggestion is in line with research and evidence-based practices. This may involve helping the patient understand details of certain afflictions about which they may have preconceived notions.
  2. Use the Internet to your advantage. If a patient is putting too much trust in information s/he found on the Internet, counter by using the Internet to prove the validity of your diagnosis and treatment decision.
  3. Earn patient trust. Take time to answer all questions and remain calm. Make sure your patient is aware of the rationale for your decision and inform them that you know what is best for them.
From the article of the same title
Fierce Healthcare (05/04/2016) Ilene, MacDonald
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7 Ways Small Practices Can Maximize Their RCM
A medical practice that uses smart revenue management strategies will maximize its revenue cycle in addition to providing quality care. Here are seven tips to fully optimize your revenue cycle management (RCM).
  1. Treat RCM compliance seriously. Accurate billing is essential as you continue to transition to ICD-10. Make sure your billing team has realistic expectations and is willing to work hard on the issue.
  2. Always look for ways to improve. Do not become complacent. Ask yourself on a monthly basis how you can make your processes more efficient, reduce cycle time and improve current performance levels.
  3. Integrate electronic health record (EHR) and practice management software. Integrating EHRs with practice management software can help capture charges at the point of service. Charges can then be sent directly to the system where billing staff can review them and submit claims.
  4. Manage denials. Be proactive and develop processes to monitor denials as they come in. Always work to resubmit claims regardless of the size of the denial.
  5. Training. The more you and your staff can learn about the different aspects of RCM, the more you will be able to streamline the process and maximize revenue.
  6. Analytics. Track your cost containment efforts and stay ahead of the curve. Using analytics will help you maximize RCM and improve patient outcomes.
  7. Consider outsourcing. Outsourcing your billing can prevent errors that could alienate patients. It also frees up time for your staff.
From the article of the same title
Physicians Practice (05/04/16) Tate, Alex
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Patient Portals Helping Increase Revenue, Decrease Costs
Patient portals are versatile tools that can improve collections, reduce staff workload and help drive engaged patients with better health outcomes. One strategy is to use online portals to triage non-emergent patient questions. Doing so can restrict physician email responses to about 20 percent of patient inquiries, according to a report from aetnahealth. Portals can also help patients pay bills online, which can turn into financial rewards for your practice. Patients who can pay bills on a portal are 13 percent more likely to return, and the value of a patient who returns is eight to 20 percent higher than those who do not. The report noted that patients who return at least once generate more than $800 in ambulatory practice collections over three years, versus $147 for those who do not. Consumer engagement is critical in healthcare today, and thus using a proper patient portal can be beneficial for your practice.

From the article of the same title
Healthcare IT News (04/29/16) Geyer, Sherree
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Health Policy and Reimbursement

CMS Releases Guide on Developing Clinical Quality Measures
The Centers for Medicare and Medicaid Services (CMS) has released the final version of the Quality Measurement Development Plan, which establishes clinical quality measures and reporting programs that fit in with value-based reimbursement models. In a blog post, CMS called the plan an "essential" part of the transition to patient-focused care. The quality measures are intended to close gaps in quality measurement and performance that had been discussed during the comment period for MACRA. CMS also noted it will partner with healthcare providers and industry groups to improve quality measures; it will collaborate with patients to improve communication and streamline the patient experience; and it will coordinate with other federal agencies to decrease overlap and duplication of reporting. The finalized version of the plan includes numerous fixes pulled straight from the comment period, which could satisfy providers, patients and other parties who are unhappy with current reporting systems.

From the article of the same title
EHR Intelligence (05/03/2016) Belliveau, Jacqueline
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More Than 2,000 Doctors Join Call for Single-Payer Healthcare
More than 2,000 doctors have signed a single-payer healthcare plan released by the Physicians for National Health Program, an advocacy group that backs presidential candidate Bernie Sanders. The doctors who signed the plan argued that the Affordable Care Act (ACA) has still left too many Americans uninsured. According to Dr. Adam Gaffney, who helped create the proposal, the ACA has done little for the 30 million uninsured Americans, and the many more who are underinsured. The plan argues for progressive taxes and calls for administrative savings by shifting away from private insurance companies. The plan does not lay out the numbers behind the idea, though, and many believe that such a proposal will never be taken seriously unless it shows that the math adds up.

From the article of the same title
The Hill (05/05/16) Sullivan, Peter
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Providers Collect More Revenue Due to ACA Medicaid Expansion
Medicaid expansion under the Affordable Care Act (ACA) has resulted in financial benefits for low-income patients and health providers, according to a new report from the National Bureau of Economic Research. The report found that Medicaid expansion caused a reduction in unpaid balances in collections that ranged between $51 and $85 and also implied a decrease in collection balances of around $600 to $1,000. People who did not need to worry about massive medical bills had an easier time paying for their other bills and because more people had insurance coverage, hospitals had fewer unpaid medical bills. This decrease in bills also allowed third-party creditors to reap financial benefits. The study noted that Medicaid expansions could be integral to providing financial protection to low-income families, which could improve acccess to credit markets, increase savings and facilitate buying of other goods and services.

From the article of the same title
RevCycle Intelligence (05/05/16) Sampson, Catherine
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Tight MACRA Deadlines Could Result in Doc Penalties
The Centers for Medicare and Medicaid Services (CMS) have released a new plan detailing how it would select the quality measures used in MIPS. Payments or penalties under MIPS will be calculated against four performance categories: quality, resource use, clinical practice improvement activities and “advancing care information.” The changes are raising complaints from some healthcare organizations which claim they need far more than the two months CMS says is necessary to implement the new guidelines. This two-month window could become problematic in a number of areas, particularly software updates, which will be difficult to handle for smaller practices that run software that is not easily upgradable. Physicians will be subject to penalties if requirements are not met. Since MIPS requires reporting of quality measures all year long, even a short delay this year could cause physicians to be noncompliant and subject to penalty next year.

From the article of the same title
Modern Healthcare (05/03/16) Conn, Joseph
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Medicine, Drugs and Devices

Hospital Data Security: Are Cloud Apps a Pandora’s Box for Hackers?
Most hospitals have embraced some cloud services. The average healthcare organization uses 928 cloud services, according to a 2015 study by Skyhigh. Services vary from collaboration tools like Gmail and Evernot, to development tools like SourceForge and Github. The proliferation of cloud services can make hospitals safer and more efficient, but it also opens the doors for people with bad intentions. Cyber criminals routinely monitor cloud services to determine which sites healthcare employees like to frequent. Criminals can then compromise the sites to deliver an attack. There are countless other entry points as well. Software application program interfaces can be compromised, and if the cloud is not used properly, it can result in a domino effect that hits all of your interconnected services. To prevent these attacks, take these four critical steps: 1) Learn what applications are being used. Identify what is in use and how often it is in use. 2) Assess the security positions and overall risk that different services pose. Many services meet HIPAA requirements, but other do not. A security assessment is a critical component of a successful cyber strategy. 3) Understand users and proactively work with them. Accidental openings can be created by employees who are not well-trained. Be sure to take the time to help everyone understand the ins and outs of the cloud services. 4) Proactively respond. IT should be able to eliminate unsafe apps while still allowing employees to use safe and productive cloud-based tools.

From the article of the same title
HIT Consultant (05/03/16)
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Medical Error—the Third Leading Cause of Death in the U.S.
Medical error is not included on death certificates but still may be the third-leading cause of the death in the United States, according to a new study. The research, from Johns Hopkins University School of Medicine, estimates medical errors were responsible for 251,454 fatalities in 2013. This estimate accounts for about 9.5% of all deaths annually in the United States, the highest percentage behind only heart disease and cancer. One problem, say the researchers, is that the epidemic is not fully understood because it is underrecognized worldwide. The authors suggest that when a medical error results in death, both the physiological cause of death and the related problem with the delivery of care should be recorded. "To achieve more reliable healthcare systems, the science of improving safety should benefit from sharing data nationally and internationally, in the same way as clinicians share research and innovation about coronary artery disease, melanoma and influenza," write the researchers. They add, "More appropriate recognition of the role of medical error in patient death could heighten awareness and guide both collaborations and capital investments in research and prevention."

From the article of the same title
BMJ (05/03/16) Makary, Martin A.; Daniel, Michael
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Panel: Painkiller Training Should Be Required for Physicians
A new U.S. Food and Drug Administration (FDA) panel of outside experts has ruled that training for doctors who prescribe powerful opioids should be mandatory. Since 2012, FDA has required drug companies to underwrite voluntary educational courses on the medications, and many of those manufacturers surprisingly support rules requiring doctors to have specific training or expertise in pain management before getting a license to prescribe. The approved approach will ensure that prescribers get “appropriate training in pain management with opioids so their patients can continue to access treatment options." The American Medical Association (AMA), meanwhile, opposes the mandatory training because many doctors do not prescribe the drugs in the first place. Doctors who dislike the proposed measure, which also includes daily actions such as checking prescription databases, say that it takes up more time than necessary. FDA is not required to follow the advice of its panelists, although it often does. Prescription opioid doses reached nearly 19,000 in 2014, the highest number ever recorded.

From the article of the same title
Associated Press Worldstream (05/04/16) Perrone, Matthew
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Zoledronic Acid Improved Bone Health in Patients with Osteoporosis
A new study has found that using zoledronic acid to treat osteoporosis both enhanced bone mineral density and reduced bone turnover in patients. Researchers enrolled 154 patients with osteoporosis and administered an annual dose of 5 mg zoledronic acid intravenously. Of the patients, 66.2 percent had fractures prior to treatment, and 85 percent received at least two treatment doses. After 12 months, bone mineral density improved by 11 percent. After 48 months, it improved by 20.7 percent. Mean beta-C-telopeptide rates declined as well. Sixteen patients endured new clinical fractures, 12 of whom experienced a single fracture; both figures were considered clinically low. Zoledronic acid also showed a good safety profile while remaining successful, even in high-risk patients.

From the article of the same title
Healio (05/03/2016)
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This Week @ ACFAS
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Mark A. Birmingham, DPM, AACFAS

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Gregory P. Still, DPM, FACFAS

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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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