News From ACFAS

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Starting with today’s issue, This Week @ ACFAS will now feature a monthly poll to get your feedback on hot topics within foot and ankle surgery and to also find out how ACFAS can better serve you.

Participate in our first poll by answering the question to the right and look once a month in the same spot for more. See up-to-the-minute results here after you cast your vote or view them on acfas.org. We are excited to bring you this opportunity to share your opinion with us and your peers, and we look forward to receiving your responses!
Master new skills, advance your career and transform your institution. Register now for our new courses, All About the Ankle and Comprehensive Reconstruction of the Foot & Ankle.

We connect you to the most forward-looking programs in clinical medical education. Learn the latest approaches for treating ankle fractures, tendon tears and transfers in All About the Ankle. Case reviews performed with case examples will show you how to best manage complex primary and revision ankle procedures.

Comprehensive Reconstruction of the Foot & Ankle explores the “not so straightforward approach” to everyday complex revisions for second MPJ factors, joint fusions and sparing correction, neglected Achilles ruptures and more. Hear unbiased views of new technologies and techniques while comparing treatment strategies and principles.

Take advantage of thorough, hands-on and immediately relevant knowledge plus the opportunity to share your most difficult cases with faculty and attendees during a fireside chat.

Visit acfas.org/skills to reserve your spot today since space is limited. Contact Maggie Hjelm to be waitlisted for sold-out courses.
Get reimbursed for the care you provide. Attend our Coding & Practice Management Workshop July 8–9 in Denver and walk away with the tools you need to simplify your coding and reimbursement practices.

Expert faculty will guide you through multiple-procedure cases, open reduction and internal fixation of multiple fractures, diabetic foot surgery and more, as you code real-time patient scenarios from beginning to end for a firsthand look at the coding and billing process.

Visit acfas.org/practicemanagement/ to register today.
Officite, an ACFAS Benefit Partner, provides ACFAS members with specially priced online marketing platforms and responsive websites to help attract new patients to their practices. This service features unlimited technical support and no setup fees, contracts or obligations.

Visit OnlinePodiatrySites.com for more information or call (888) 932-5560 to speak with a website consultant.

Foot and Ankle Surgery

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Because the lateral extensile incision for fixation of displaced intra-articular calcaneous fractures is associated with high rates of soft-tissue complications, research has been done for less invasive methods. A new study evaluated the viability of a limited sinus tarsi approach to fix calcaneal fractures. Thirty-five patients received a limited sinus tarsi incision with plate fixation. Mean preoperative Bohler angle measurement was 7.7 degrees, and mean postoperative standing Bohler angle was 25.5 degrees. Postoperative CT demonstrated that subtalar articular reduction was within 2 mm of anatomic norms in 91% of patients. At one year follow-up, visual analog pain scores averaged three out of 10, with a quarter of patients feeling no pain. Researchers deemed the treatment an acceptable method for fracture reduction with low complication rate.


Supramalleolar osteotomy (SMOT) can manage early and midstage varus ankle arthritis, but there is controversy surrounding whether fibular osteotomy is necessary. A new study analyzed SMOT outcomes and compared them between patients with and without fibular osteotomy. Forty-one patients were included in the study. The mean postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 50.8 to 83.1, and the mean Maryland foot score increased from 58.3 to 81.6. Ankle osteoarthritis scores fell from 42.6 to 26.1 for pain and from 53.4 to 36.8 for function. All radiologic parameters improved except for tibial lateral surface angle. Researchers concluded that SMOT was promising and provided substantial functional improvement and correction in patients.


An online tool from the American College of Surgeons National Surgical Improvement Program can calculate customized risk estimates for patients planning to undergo surgical procedures. The tool, called the Surgical Risk Calculator, was created in 2013 to help surgeons and patients determine how to take the correct steps before surgery. In a study analyzing the calculator's effectiveness, researchers determined that the tool has "excellent calibration" and can provide accurate predictions and probabilities. Before recalibrating the tool, researchers found that the calculator tended to slightly overestimate surgical risk for the lowest- and highest-risk patients and to underestimate risk for patients at moderate risk of postoperative complications. Recalibration fixed this error. An update will be added to the calculator later this month to add predictions for several additional postoperative complications. It will soon be able to estimate risk for more than 1,500 different surgical procedures. Using factors such as age, body mass index, smoking status and health conditions, it can provide scores that surgeons can adjust based on their subjective assessment of a patient.

Practice Management

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All medical practices should consider cyberattacks to be inevitable. Protecting your electronic health records (EHRs) should be a priority regardless of cost. Here are five ways to prevent a cyberattack on your practice's EHRs:

1. Know your software. Every piece of software has a useful life, and most EHR vendors update software every three years. When this happens, it is a good time to consider investing in new hardware.
2. Conduct background checks. Most people who make money off of criminal activity are functioning members of society who have not been properly vetted. Doing comprehensive background checks can save you a lot of stress.
3. Education about cybersecurity should be ongoing. Conduct annual training on security awareness but also bring up security issues and practices during standard meetings or in daily emails.
4. Put technology safeguards in place. Use a spam filter that blocks emails containing malware. Consider preventing anyone from outside the United States from sending you an email.
5. Create a cyber-safe environment. Breaches often go unreported because employees are worried they will be fired for reporting one. Your practice should emphasize that employees face no risk of termination for reporting hacks.

A new survey in the New England Journal of Medicine reveals that face-to-face interaction with patients is still the most effective patient engagement strategy, even with the advent of mobile health tools. The study surveyed 340 healthcare professionals, 59 percent of whom said more face-to-face time with patients was the best strategy. Fifty-six percent of respondents said mobile health tools were the least effective engagement strategy. The study authors noted the unpopularity of mobile health could be due to the need for providers to rely on third-party resources, which can be problematic because it does not actually enforce core patient engagement behaviors. In the study, the authors wrote that technology alone does little to change patient habits, particularly for high-risk patients. Only when used in tandem with traditional engagement strategies are those newer strategies effective. The study results are not entirely conclusive because controversy still exists over which patient engagement measurement system is most effective. However, the study authors concluded that, independent of a system's validity, the results revealed the fluid state of patient engagement in healthcare.


Phone calls can make an important difference in a patients' perception of your practice, according to a new study from the Baird Group. Because a phone call is often the first impression you give to a patient, coming across as welcoming and knowledgeable is critical. Thirty-five percent of callers are not likely to return to a practice if they had a poor experience during the first phone call, according to the study. The report authored three suggestions for practices that want to ensure that first call makes a positive impression. First, make sure the staff answers the phone promptly instead of allowing it to ring. Train them to introduce themselves, give the name of the practice and offer assistance. Remind them that friendliness and a positive attitude can be the difference between retaining a patient and losing one. Second, do not interrupt a patient while s/he is speaking. This is perceived as rude, so train your staff to speak slowly and clearly and to listen to what the patient has to say. Finally, try and schedule appointments with patients sooner rather than later. The study found that first-time callers who were offered appointments more than two weeks out were 4.4 times less likely to stay with a practice.

Health Policy and Reimbursement

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The Centers for Medicare and Medicaid Services (CMS) is changing its stance on an estimate appearing in last month's proposed Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) regulations that showed most clinicians in groups of 24 or less will incur a penalty come 2019 in one track of the new payment system. According to Acting CMS Administrator Andy Slavitt, the estimate is not "reality," and he assured small practices that they have the same opportunities as larger ones as long as they report performance data. The estimate revealed, in table form, that the majority of Merit-Based Incentive Payment System underperformers were smaller practices, particularly solo practices. According to the table, around 87 percent were expected to be penalized, as opposed to 80 percent of the clinicians in groups of 100 or more members that were projected to earn a bonus. Slavitt attributed the data mostly to the failure of solo practices to report Physician Quality Reporting System (PQRS) data in 2014. He noted that the estimate ultimately means that making the reporting burden as light as possible is the real key. He also added that MACRA is "just a proposal," and he welcomes ideas from many sources to help improve the system.


The U.S. Food and Drug Administration (FDA) has published guidance pertaining to electronic health record (EHR) interoperability and its role in clinical investigations and research. The guidance provides clarity on whether and how to use EHRs as a data source in clinical investigations, as well as using EHRs that are interoperable with other systems. They also outline how to make sure data meets FDA requirements for recordkeeping and retention. FDA generally stays out of EHR-related issues, but the report noted that EHRs "may have the potential to provide clinical investigators and study personnel access to real-time and longitudinal healthcare data for review and can facilitate posttrial follow-up on patients to assess long-term safety and efficacy of medical products." The hope is that FDA guidance can help usher in a new era where the universal adoption of EHRs can improve patient safety and clinical trial efficiency.


Value-based care payment reforms are driving up costs for surgical complications, according to a new study published in the Journal of the American Medical Association. The study found that overall hospital profit margins shrank from 5.8 percent for patients without complications to 0.1 percent for patients with complications. The numbers show that when quality metrics are tied to payments, surgical complications can drastically affect revenue. Researchers also compared reimbursement costs and hospital costs between those with and without complications and found that the average overall costs were $19,626. In patients with complications, those costs were $36,060, or 199 percent higher. Patients without complications had an average cost of $16,434. Overall, average third-party reimbursement was $18,497. Third-party reimbursement for patients with complications was $35,870. Reimbursement for individuals without complications was significantly less at $17,373.

Medicine, Drugs and Devices

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A new study from the Spyglass Consulting Group shows that hospitals and health systems are turning to mobile communication solutions more than ever. The report found that 63 percent of respondents have deployed or plan to deploy a mobile communications platform supporting more than 500 smartphones over the next 12 to 18 months. Spyglass also recommended four factors that could determine how effective a smartphone-based communications platform can be:

1. Scalability. A highly reliable, scalable platform is an important part of fulfilling all mission and patient-critical communications.
2. Interoperability. The majority of respondents (78 percent) said integration and interoperability with IT infrastructure and medical devices are a critical part of the communication process.
3. Multi-device support. Cross-platform device support is a critical part of any communications initiative. Hospital-owned smartphones, personal devices and desktop computers should all work together to enhance and expand care team collaboration.
4. Hospital leadership. Strong hospital leadership, commitment and investment are critical to deploying and maintaining a large-scale smartphone-based communications platform.

A team of researchers from the University of California-Davis have identified and characterized osteoarthritis biomarkers to detect and track the progression of osteoarthritis (OA) in patients after joint injuries. The work is critical because many patients who develop OA show no signs of the disease until significant joint damage has occurred. At that point, the only viable long-term treatment options are joint replacement or pain management therapy. After identifying 1,446 genes differentially expressed in injured joints, including several known regulators of OA, researchers developed a tibial compression mouse model that helps reveal a more rapidly progressing picture of OA than the picture currently understood. The study is the first of its kind and could lead to new information regarding the progression of OA in all patients.


Hospira has debuted the first-ever patient-controlled analgesia (PCA) infusion pump that is integrated with electronic medical records (EMRs). The device can make routine hospital care safer and more efficient and helps streamline the documentation of infusion data so that all parties find it easier to treat and monitor patients. Pain management has become a critical part of every hospital's reputation, and the new device allows for greater transparency and less confusion. The pump is also the first of its kind to integrate bar code identification of drug vials, which can reduce medication errors. These errors harm 1.5 million people and cost the United States $21 billion a year.