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News From ACFAS

Register Now for New Revision Surgery Course
Shift into high gear with this newly developed advanced course, Revision Surgery: Managing Operative Challenges, October 26–27, 2019 at the MERCI Lab in Park Ridge, IL near O'Hare Airport.

Demo-perform-repair-repeat! This course takes place in the lab. Working in pairs on your own cadaveric specimen, you will perform multiple reconstructive procedures and then repair the failure. The unique learning format allows you to practice most of these procedures twice.

Also enjoy one-on-one personalized instruction, short videos and a fireside chat featuring targeted roundtable discussions on topics not always covered in the current literature.

Visit to view the full agenda and to secure your spot now!
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May Clinical Session Ready for Viewing in e-Learning Portal
See arthroscopy from an entirely different angle in our newest free Clinical Session, All Arthroscopy All the Time: Debating Advancement, available now at Gain a better understanding of the pros and cons of the latest arthroscopic techniques and determine which surgical approaches will result in the best outcomes for your patients.

Watch the following case-based presentations:
  • Arthroscopic Stabilizations Are the Future of Lateral Ankle Instability
  • Arthroscopic Ankle Fusions: The New Gold Standard?
  • Arthroscopic-Assisted Ankle Fracture: A Necessary Tool
  • Retrocalcanectomy/Achilles Debridement with a Scope: The Better Way
  • Arthroscopy of the First MTP: Is It Worth the Trouble?
Then complete a short CME test after you view them to earn 1.5 continuing education contact hours.

Access the full Clinical Session library at for convenient, remote learning that is always ready when you are.
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Selling Your Practice? Refer to Our Checklist
If you plan to sell your practice to another physician, group practice or hospital soon, check out ACFAS' Checklist for Physicians Selling a Practice on to guide you through the sale process.

Find out what steps you will need to take before developing prepurchase and purchase agreements with the buyer and learn what items you will need to have during each stage of the sale.

The checklist is not intended to provide legal advice or opinions or to substitute for legal advice, but it outlines some of the most common issues you may encounter as a seller. Download it now at
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Take Full Advantage of the ACFAS Marketing Toolbox
Cool tools await you at to help you turn up the heat on your practice marketing efforts this summer.

The ACFAS Marketing Toolbox is your destination for shareable and printable infographics, ready-to-use PowerPoint presentations and scripts, referral guides, fact sheets and more—all free and always available to make promoting your practice easy and fun. New products are added to the Toolbox regularly to give you variety and meet your marketing needs.

Be sure to also add a link to on your website and to refer your patients there for free foot and ankle health information. Follow on Facebook and Twitter too!
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Foot and Ankle Surgery

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading
A study sought to determine whether highly crosslinked polyethylene (HXLPE) has sufficient fatigue strength for total ankle arthroplasty (TAA) under simulated physiologically relevant motion profiles and loading in the ankle. The researchers incorporated profiles representative of walking gait within a computational model of a semiconstrained, fixed-bearing TAA to ascertain the loading state with highest stresses in the HXLPE bearing. Fatigue testing to 10 million cycles (Mc) at 5600 N was conducted to assess bearing strength. Peak stresses in the bearing were evaluated at peak axial load and peak dorsiflexion during gait, occurring near heel off. All samples tolerated 10 Mc of fatigue loading at that orientation without polyethylene bearing fracture.

From the article of the same title
Foot & Ankle International (05/15/2019) Bischoff, Jeffrey E.; Dharia, Mehul A.; Hertzler, Justin S.; et al.
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High-Volume Injection with and Without Corticosteroid in Chronic Midportion Achilles Tendinopathy
A study sought to determine the effect of corticosteroid in High Volume Injection (HVI) for treating chronic midportion Achilles tendinopathy (AT), using 28 men with chronic AT over 24 weeks. All performed eccentric training and were randomized to receive either HVI injection with corticosteroid or HVI injection without corticosteroid. Self-reported function (VISA-A score) and pain (VAS score) improved in both cohorts at all time points, with VISA-A improvement significantly greater in HVI with corticosteroid, but not at 24 weeks. Declines in VAS scores were significant greater in HVI with corticosteroid at six and 12 weeks, but not at 24 weeks. Tendon thickness decreased significantly in both cohorts at all time points, and it was higher in the HVI with corticosteroid group at six and 12 weeks, but not at 24 weeks.

From the article of the same title
Scandinavian Journal of Medicine & Science in Sports (05/02/19) Boesen, Anders P.; Langberg, Henning; Hansen, Rudi; et al.
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Two-Stage Surgery for the Malleolar Fracture-Dislocation with Severe Soft-Tissue Injuries Does Not Affect Functional Results
A study was conducted to assess two-stage surgery for the unstable malleolar fracture, including dislocations with severe soft-tissue injuries, versus one-stage surgery in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and Olerud-Molander ankle scores (OMAS). The researchers observed a statistically significant difference between the cohorts in terms of the mean total hospitalization times, waiting time from admission to surgery, gender and Tscherne soft-tissue injury scores. The average AOFAS hindfoot-ankle and OMAS of the groups did not differ statistically at a minimum of one year of follow-up.

A two-stage surgery can be safely conducted in the carefully selected patients with the unstable malleolar fracture, including dislocations with Tscherne grades 2 and 3 soft-tissue injuries. This procedure does not affect the postoperative AOFAS hindfoot-ankle and OMAS, statistically compared to a one-stage surgery at a minimal 12 months of follow-up.

From the article of the same title
Journal of Foot & Ankle Surgery (05/10/19) Tanoglu, Oguzhan; Gokgoz, Mehmet Burak; Ozmeric, Ahmet; et al.
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Practice Management

Conquer the Three Cs to Secure Financing
Whether starting a new practice, expanding an existing one or relocating to a new permanent space, physicians need to review the factors of cash, credit and character to obtain funding for their venture. Lenders will initially examine the aspiring borrower's complete financial profile, such as personal assets, expenses and financial history; borrowers also require a cash reserve for emergencies. Lenders also prefer to see a FICO score of at least 650 and will thoroughly vet the borrower's credit history.

Borrowers should get a copy of their credit report before approaching a lender and should confirm the information's accuracy. To leverage their reputation, borrowers should establish a relationship with the lender beforehand, which may make the lender more inclined to do business and offer appropriate assistance.

From the article of the same title
Physicians Practice (05/20/19) Marolis, Jessie
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Poorly Designed Systems Make Doctors 'a Slave to Their EHR'
Electronic health records (EHRs) are a major pain point for doctors, with research finding 50 percent to 70 percent of physicians are experiencing burnout due to EHR-related workloads. Most EHRs lack interoperability between different healthcare facilities, and some experts feel regulatory changes in how facilities receive Medicare and Medicaid reimbursements have exacerbated the problem. KLAS Research argues that "if healthcare organizations offered higher-quality educational opportunities for their care providers—and if providers were expected to develop greater mastery of EHR functionality—many of the current EHR challenges would be ameliorated." To be effective, an EHR or health information exchange must ensure that all healthcare stakeholders see value in the technology and efficiently fit within real-world workflows. The EHR also needs to prioritize trust in data accuracy and security above all.

From the article of the same title
Computerworld (05/22/19) Mearian, Lucas
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The Five-Step Process to Go from Doctor to Startup Founder
Transitioning from physician to founder of a healthcare technology startup can be accomplished in five steps, starting with identifying a major problem to solve, rather than a solution. The next step is to find a partner or to assume the duties of a CEO. The third step involves raising and allocating starting capital, while the fourth step is to become familiar with fundraising rules. The final step is to validate or invalidate business model assumptions and then put products into the hands of customers as expeditiously as possible.

From the article of the same title
Medical Economics (05/20/19) Ferres, Zach
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Health Policy and Reimbursement

'Medicare for All's' Rich Benefits 'Leapfrog' Other Nations
One current "Medicare for All" plan would charge no copays or deductibles for medical care, allow only limited cost-sharing for certain prescription drugs, cover long-term-care home and community-based services and include dental, vision and hearing coverage. This plan, if adopted, would place the United States far ahead of those countries that already offer coverage for medical services. "Medicare for All proposals would leapfrog other countries in terms of essentially eliminating private insurance and out-of-pocket costs and providing very expansive benefits," says Larry Levitt, a health policy expert with the nonpartisan Kaiser Family Foundation. Independent studies estimate that Medicare for All would dramatically increase government spending, from $25 trillion to $35 trillion or more over 10 years.

From the article of the same title
Associated Press (05/21/19) Alonso-Zaldivar, Ricardo
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CBO: Medicare for All Gives 'Many More' Coverage but 'Potentially Disruptive'
At a hearing in front of the House Budget Committee, Congressional Budget Office (CBO) Deputy Director Mark Hadley said, "Many more people would probably have health insurance as a result, but the government would take much more control over the healthcare system." Given that healthcare accounts for about one-sixth of the economy, he indicated that "those changes could significantly affect the overall U.S. economy" and could be "potentially disruptive." According to Hadley, if more people gained coverage while payment rates to doctors and hospitals went down, there could be a lack of supply of healthcare, causing "increased wait times and problems with access to care." He also said that in certain scenarios, "total national healthcare spending would be lower" under a single-payer system, "but the amount of care supplied and the quality of that care might diminish."

From the article of the same title
The Hill (05/22/19) Sullivan, Peter
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Health Insurance Inflation Hits Highest Point in Five Years
The Consumer Price Index (CPI) for health insurance in April increased by 10.7 percent over the previous 12 months, the largest increase since at least April 2014, according to an analysis of the U.S. Bureau of Labor Statistics' unadjusted monthly CPI data. The other categories that comprise the medical care services index, professional services and hospital and related services, rose 0.4 percent and 1.4 percent in April, respectively. The CPI for medical care services in April rose 2.3 percent. The likely reason health insurance inflation is rising is because of growth in managed care, including Medicare Advantage, Medicaid managed care and commercial insurance, say analysts.

From the article of the same title
Modern Healthcare (05/17/19) Livingston, Shelby
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Medicine, Drugs and Devices

Doctors Can Estimate Patient Adherence by Simply Asking About Medication Routine
A study in the Journal of General Internal Medicine says physicians were as likely to accurately estimate patients' adherence to medication from their descriptions of their medicine routines as by patients' direct reports of missed medication. Researchers asked patients to describe their daily routine for taking medication and to recall how many days during the last week they missed a dose. The researchers used a medication monitoring system to track compliance for the following month. The system attached to a medicine bottle and recorded the date and time when the bottle was opened. Patients' own estimates of their medication-taking routines were shared with doctors, whose estimates were compared with adherence rates calculated by the monitoring system.

From the article of the same title
EurekAlert! (05/21/2019)
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House Committee Proposes 6 Percent Increase in FDA Funding for FY 2020
A draft fiscal year 2020 funding bill for the U.S. Food and Drug Administration (FDA) calls for a $184 million increase in discretionary funding over this year's enacted level, according to the House Appropriations Committee. Total FDA funding would be $5.86 billion, slightly lower than the $6.1 billion that the Trump administration has requested for the agency. The bill includes a strong focus on continuing FDA's efforts to advance generic drug reviews and increase medical product manufacturing in the United States, the committee said.

From the article of the same title
Regulatory Focus (05/22/2019) Brennan, Zachary
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To Slash Prices, Colorado Moves to Import Canada's Prescription Drugs
Gov. Jared Polis of Colorado has signed legislation that would permit the importation of prescription drugs from Canada. Under the law, the Colorado Department of Healthcare Policy and Financing is charged with the creation of plan to safely import Canadian drugs and to present a proposal to HHS by September 2020. "As a pharmacist, I know there are many Coloradans who are having to choose between feeding their families or the life-saving drugs they depend on," said Rep. Jaquez Lewis, a Boulder-area Democrat who sponsored the bill. "We've seen drug price increases of nearly 500 percent. That's unacceptable, and those prices are drowning patients."

From the article of the same title
Governing (05/19) Wingerter, Justin
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Britton S. Plemmons, DPM, AACFAS

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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