News From ACFAS

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Let your voice be heard! Today most members will receive either the 2015 ACFAS Member Insights Survey or Practice Economics Survey by e-mail. Six respondents will win their choice of an Apple Watch, free registration to the 2016 Annual Conference in Austin or free 2016 membership dues.

Your feedback influences the College’s decisions, so watch for an email from ACFASpresident@perceptionsolutions.com and respond ASAP!
Refining your surgical technique has never been easier with ACFAS’ Surgical Series. Available in online or DVD format, each collection of procedures puts you front and center with the experts. Choose from Diabetic Surgery, Common Foot and Ankle Procedures, Trauma or Rearfoot Reconstruction and learn new ways of managing these conditions when surgery cannot be avoided.

Case presentations and clinical scenarios are also included to help you determine the best approach for your patients. And if you pass the test that accompanies each set, you’ll earn 7.0 CPME CE contact hours.

Visit acfas.org/e-Learning to purchase the entire ACFAS Surgical Series ($295 for members/$235 for resident members/$395 for non-members) or download individual procedures ($35 for members/$45 for non-members).
Kick off your summer reading list with the latest issue of The Journal of Foot & Ankle Surgery (JFAS). With nearly 40 original research articles, a new ACFAS clinical consensus statement, case reports and more, the May/June issue covers everything from double plating of fibular fractures to “Jumping Stump” Phenomenon.

Log into acfas.org and visit the JFAS landing page to read this and past issues or to access a fully searchable archive of JFAS articles dating back to 1995. And to see what’s in the pipeline for future issues of JFAS, browse the Articles in Press for an inside look at newly approved articles.
ACFAS Benefit Partners Henry Schein and Amerinet have teamed up to provide a unique group of purchasing programs. Together, they offer contract prices with no membership fees and without waiting months for contracts to be loaded on items physicians need every day: medical, surgical, pharmaceutical, capital equipment—even office supplies!

As a customer, you'll:

• get all of your medical, pharmaceutical and office supplies from a single source;
• choose from 10,000 medical supplies and 2,500 pharmaceuticals from leading manufacturers;
• enroll in the Amerinet Group Purchasing Program with no fees;
• receive a Customized Savings Analysis to show you the savings in advance;
• save 15–20 percent.

To take advantage of these exclusive offers, contact a Henry Schein representative directly at (800) 323-5110, ext. 3944 or footandankle@henryschein.com.

Foot and Ankle Surgery

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While cigarette smoking is known to increase perioperative complication rates, there is no data studying its impact specifically in forefoot surgery. Researchers conducted a study involving 602 patients who had forefoot surgery between 2008 and 2010. Patients were stratified into three groups based on whether they were an active smoker, past smoker or nonsmoker. Active smokers were revealed to have a complication rate of 36.4 percent after forefoot surgery, compared to 16.5 percent for past smokers and 8.5 percent for nonsmokers. Rates for delayed union, infection, delayed wound healing and persistent pain were all higher for active smokers.


Researchers compared postoperative pain control in pediatric patients who underwent general anesthesia (GA) alone compared to those who had peripheral nerve blocks (PNBs) performed by nerve stimulation (NS) or PNB with both NS and ultrasound (US) guidance. A sample of 103 patients was divided among the three techniques. The results showed no significant differences in pain levels between groups for the first 12 hours. The US group experienced higher pain levels at 24 hours but had a significantly greater proportion of pain-free patients than the other two groups for the first six hours. The researchers concluded that using US guidance is beneficial in postoperative pain control and that both US and NS-guided PNB are better options than GA alone for pediatric patients.


Researchers sought to confirm the hypothesis that talofibular bony impingement can cause limited dorsiflexion of the ankle. Twenty patients with talofibular impingement and 19 patients with lateral ankle instability without talofibular impingement were observed. After removing the bony impingement, the range of dorsiflexion increased by an average of 7.9 degrees in the impingement group. The mean distance between the fibula and lateral process of the talus on weight-bearing anteroposterior radiograph of the ankle was 1.2 mm in the impingement group and 3.2 mm in the control group.

Practice Management

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A successful practice website must be mobile-ready to accommodate the advent and growing use of smartphones and handheld mobile devices, and it is imperative that practices furnish such sites. Strategies for ensuring the utility of a mobile-ready website include:

1. Using software that is adaptable to mobile devices.
2. Ensuring the site's content is easy to understand without requiring users to zoom in.
3. Sizing the content on the site to the mobile device to eliminate the need for users to scroll horizontally to view the entirety of the webpage text.
4. Enabling easy navigation by making sure links can be easily tapped, dragged or accessed.

Cash handling can be a delicate process for any practice, but some key guidelines can ensure efficiency and security. First, a physician should limit the staff who have access to cash and require that two employees count the cash. Physicians should also maintain a cash log of the money collected. Once cash is received and counted, it is essential to send a return receipt. This can simply be a confirmation email sent to a practice manager. Physicians should get a receipt from the bank as well and make sure they have online access to the bank account. It may seem like an obvious step, but it is essential to being absolutely sure that all of what you deposited actually made it into the account.


Physicians and staff can follow several strategies in preparation for the scheduled Oct. 1, 2015, rollout of ICD-10. Many companies offer training in multiple formats, such as online and face-to-face. Several factors should be considered when assessing a training program. Online courses offer the most flexibility and eliminate the need for travel, although they can be tough to come by, making webinars a better choice for some. Another option is textbooks, which may be less costly than the other options. Physicians choosing this route should purchase the textbook from a reputable ICD-10 training company.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for applying to conduct end-to-end testing with Medicare in July. Applications will now be accepted from May 11 to May 22. The testing will be conducted during the week of July 20 through July 24. A group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor for durable medical equipment suppliers. About 850 volunteer providers will be selected to participate in the testing.


The Centers for Medicare and Medicaid Services' (CMS) electronic clinical quality measures (CQMs) will soon receive their annual update following the federal government's recently announced measure changes for the 2016 reporting period. Providers will use the revised CQMs to electronically report 2016 quality data for the Physician Quality Reporting System, Inpatient Quality Reporting Program and the Electronic Health Records Incentive Programs. An update from the Office of the National Coordinator for Health IT includes 29 measures that have been updated for eligible hospitals and 64 measures updated for providers.


The U.S. Government Accountability Office (GAO) reported that limited data and “unclear policy” are severely impeding Medicaid provider payments. The report calls for greater oversight at government-owned facilities where payments exceed actual costs. GAO examined Medicaid payments to government and private hospitals in Illinois, New York and California, finding that the Centers for Medicare and Medicaid Services does not collect provider-specific payment and ownership information and does not have a policy for determining whether payments to individual providers are economical and efficient. Although states must capture all payments they make to individual institutional providers, they are not required to report them, GAO reported. The report recommends that Medicare make efforts to ensure that states report provider-specific payment data, establish criteria for assessing provider payments, develop a process to identify and review payments and expedite a review of hospital payments.

Medicine, Drugs and Devices

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A group of House Democrats have sent a letter to Speaker John Boehner and Minority Leader Nancy Pelosi that urges "timely passage" of a bill that repeals the Affordable Care Act's medical device tax. Rep. Scott Peters and his supporters claim that the 2.3 percent tax is prompting companies to cut their research and development budgets, something that stunts breakthroughs in medical technology.


Researchers in Germany have developed a prototype pressure monitoring stocking that could treat diabetic feet. The stocking has 40 elastic sensors that pool data and create a map of the pressure forces applied to the feet. It can tell its wearer when to change positions, take a rest or keep walking. Because patients with diabetic neuropathy are unable to feel pressure on their feet, the stocking could prevent serious wounds that in many cases lead to debilitating infections and sometimes amputations. While similar technology has been placed in shoe soles in the past, the stocking covers a much greater area, including the ankle and the top of the foot. Further development is planned to determine if the stocking is washable and if it can be miniaturized.