News From ACFAS

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California’s Senate recently passed a bill that allows nurse practitioners to see patients without a medical’s doctor supervision. The state medical association opposes this new measure, but it appears lawmakers are more willing to make use of this trained workforce to fill the healthcare provider gap.

Christopher Glazek’s op-ed piece in the May 11 Los Angeles Times calls into question “doctors’ guilds’” tendency to protect their own and to prevent nurse practitioners from providing primary care. He maintains the guilds have created a physician shortage that requires nurse practitioners to meet the increased demand for healthcare services, especially in light of the Affordable Care Act.

Sound familiar? It should to DPMs. Fortunately, many other states are slowly but surely moving to break the MD stranglehold on medical care by broadening scopes of practice for other well-trained specialties. And the U.S. Supreme Court recently sent a strong signal when it ruled state licensing boards cannot use their powers to limit competition, a situation DPMs in some states have confronted.
ACFAS knows innovative scientific research and advancement in the foot and ankle surgical profession go hand in hand. That's why the College awards up to $40,000 in grant money each year to research-driven members like you through the ACFAS Clinical and Scientific Research Grant.

Applications for this year’s grant are due September 15, 2015. Your research must be clinical or laboratory-based, with clearly defined goals that meet all criteria for grant submission. ACFAS research grants are partially funded by the College’s 14 regional divisions.

To submit an application for the 2015 Research Grant, visit acfas.org/grant.
ACFAS welcomes the new Student Club Presidents for the 2015–2016 school year:

• AzPod: Matthew Mehlenbacher, Class of 2018
• Barry: Jason Spector, Class of 2017
• CSPM: Christopher Sullivan, Class of 2017
• DMU: Kelsey Millonig, Class of 2017
• Kent State: Nickil Nayee, Class of 2017
• NYCPM: Jonathan Srour, Class of 2017
• Scholl: Robert Burdi, Class of 2018
• Temple: Alexandra Spangler, Class of 2017
• Western U: Daniel Spencer, Class of 2018

The ACFAS Student Clubs provide students access to the foot and ankle surgical community by bringing in ACFAS members to speak to the clubs on surgical techniques and by adding to the basic knowledge taught at the podiatry schools by exposing students to more specific surgical techniques.

We wish these future leaders great success throughout the new school year!

Foot and Ankle Surgery

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Researchers evaluated the biomechanical strengths of a lag screw and a lateral or posterolateral neutralization plate on distal fibula fractures. A total of 40 osteotomies were created and reduced using a bicortical 3.5-mm stainless steel lag screw, two bicortical 3.5-mm lag screws, three bicortical 3.5-mm lag screws or a single 3.5-mm lag screw coupled with a stainless steel neutralization plate with three proximal cortical and three distal cancellous screws. The constructs were tested to determine the stiffness in lateral bending and rotation and failure torque. No significant differences were detected between the osteotomies fixed with three lag screws and a plate. Constructs fixed with one lag screw were weaker for both lateral bending and rotational stiffness, those fixed with two lag screws were weaker in lateral bending only, and no significant differences were found in the failure torque. While plate fixation requires larger incisions and increased costs and increases the probability of return surgery, many surgeons still prefer it due to concerns about lag screw-only stability. Clinically, lag screw-only fixation achieves similar stiffness to that of traditional methods.


A study was conducted to determine the effect of patient positioning on the osseous relations of the foot. A total of 17 patients had anatomical markers put on the outside of the foot. These markers were used to determine medial longitudinal foot angles among 10 postures. The study revealed that foot angles were significantly affected by the postures. A multiple regression analysis showed that weight on the foot and pressure distribution over the foot also had a large influence over foot angles.


A survey of 16 patients was conducted to gather self-reported information about outcomes for total Ankle Replacement (TAR) and contralateral ankle arthrodesis. The patients were asked to report their satisfaction by assigning a grade on a scale of one to five. The median satisfaction scores were two for both procedures.

Practice Management

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Informing a patient of bad news is never easy, but it is a staple of a doctor's life. Some organizations are coming forward to help physicians who must deliver bad news. One example is VitalTalk, a nonprofit that trains medical professionals in communication skills and empathy. VitalTalk discusses when to deliver news, how to deliver it and more. At Memorial Sloan Kettering Cancer Center in New York, medical oncologist Andrew Epstein preaches SPIKES: setting, patient perspective, information, knowledge, empathize/explore emotions and strategize/summarize. Studies have consistently shown that empathy and optimism are the most well-received forms of communication.


Negotiating with a payer, employer or other entity is never easy, but physicians can fall back on tried and true patient care strategies when the talks get tough. Creating a mission and purpose statement is the first step in any negotiation. First, physicians should determine the other entity's needs. Then, they should determine how the features and benefits that they offer will fulfill those needs. They should also revisit the mission and purpose statement before each event during the negotiation. Focusing on the other party is important as well. In doing this, physicians will understand that they do not know everything about the other person — who they are, what their circumstances are, etc. — and therefore must ask pointed questions. Physicians should also ask questions based on the mission and purpose statement to guide the discovery process.


Preparing for the switchover to ICD-10 will involve planning to minimize revenue disruptions. The first step in this process is for physicians to familiarize themselves with their practice's revenue activity under ICD-9. If it worked in ICD-9, chances are it will work in ICD-10, and anything that does not can be eliminated prior to the transition. Physicians should also keep an eye on their practice's spending habits and maintain four to six months of cash flow in reserve. They should seek to understand how much the transition will cost—estimates say that the overall expenditures per practice could be an average of $8,167—and document everything, keeping 25 to 50 codes handy.

Health Policy and Reimbursement

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Eligible professionals looking to avoid Medicare reimbursement cuts for not successfully participating in the Medicare Electronic Health Record Incentive Program in 2014 have until July 1 to apply for a hardship exemption. Reimbursement cuts for eligible professionals who did not successfully attest to meaningful use in 2014 will start on Jan. 1, 2016. Professionals looking for a hardship exemption must demonstrate proof of circumstances beyond their control and detail how the circumstances significantly impaired their ability to attest to meaningful use.


The incoming president of the American Medical Association (AMA) believes that ICD-10 should not only be delayed, it should be scrapped altogether in favor of ICD-11. Steven Stack supports the bill put forth by Rep. Ted Poe (R-Texas) and even thinks it should go a step further. Poe's bill, known as the Cutting Costly Codes Act of 2015, is unlikely to pass, but it still has support from people who think that ICD-10 will only cause disruption and chaos. The bill would prohibit the implementation of ICD-10 and would call for a study to identify steps to mitigate the disruption ICD-10 would have. Stack also supports bill H.R. 2247, which asks for a transition period during which providers could utilize dual coding while simultaneously taking steps to fully implement ICD-10 as quickly as possible. Many experts believe Poe's bill and H.R. 2247 are unlikely to pass.


Medicaid enrollment under the Affordable Care Act (ACA) is surging beyond expectations, with more than 12 million people signed up for Medicaid under the ACA since January 2014. Seven states have seen overruns totaling nearly 1.4 million low-income adults. The federal government is funding 100 percent of the expansion costs through 2016 and will gradually cut back to 90 percent, but some conservatives say the costs eventually falling to the states will be excessively burdensome.  ACA supporters say the enrollment expansion is providing billions of dollars to states, hospitals and doctors to cover low-income people, enabling them to save money on other programs that had been fully or partly funded through state dollars.

Medicine, Drugs and Devices

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A new study from researchers at the National University of Galway finds that stem cells from human bone marrow can be used to promote healing in diabetes patients’ broken bones. When a group of diabetic patients with bone fractures received stem cells from non-diabetic donors, they healed faster than those in a control group. The cells send signals that encourage the patient’s own cells to heal themselves more efficiently, and the stem cells do not remain permanently in the patient's tissue. The results indicate stem cells could significantly reduce the time it takes a diabetic patient’s fractures to heal, reducing pain and discomfort as well. The study was presented at the European Congress of Endocrinology in Dublin.


Men are at risk of major consequences associated with osteoporosis, but a recent survey shows that they are failing to take the steps necessary to prevent and identify the bone-thinning disease. At the American Geriatrics Society's 2015 Annual Scientific Meeting in Washington, D.C., study leader Irina Dashkova unveiled surprising numbers concerning men and osteoporosis. Less than 25 percent of men would accept an osteoporosis screening if one were offered. In fact, women were far more likely to be concerned about the risks, as the study revealed that females were four times as likely as men to take preventive measures. Dashkova said this is likely due to osteoporosis's decidedly gender-specific reputation among the public. This is probably because the disease affects mostly women, but two million men still face risks. In fact, eight to 13 million men in the United States have low bone density, which can lead to osteoporosis. However, patients are not the only ones making this mistake. Physicians are at fault too, as Dashkova said the results clearly indicate that doctors do not screen men until it is too late. The hope is that this study promotes greater awareness among the public and physicians.


A study was conducted to determine the safety and effectiveness of cellular bone allograft (CBA) in foot and/or ankle arthrodeses. After six months, fusion rates for all patients and all joints were 65.8 percent and 81.1 percent, in those with or without CBA, respectively. After 12 months, those rates increased to 71.1 percent and 86.8 percent. No adverse effects were attributable to CBA, and significant statistical improvements occurred in pain, function and quality of life.