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News From ACFAS

The Results Are In…
Our first monthly poll in This Week asked how much you think the Merit-Based Incentive Payment System (MIPS) will affect your practice. Fifty-nine percent of you indicated that MIPS will affect your practice “a lot,” and this could very well be the case.

With the MIPS system, the new Medicare reimbursement program will transition away from payments based on fee-for-service to payments based on quality, resource use, clinical practice improvement and advancing care activities. Based on your aggregate score across these four measures, you’ll see a maximum payment adjustment of plus or minus 4 percent in 2019, 5 percent in 2020, 7 percent in 2021 and 9 percent from 2022 onward.

Final poll results are shown below. For more on MIPS, visit or contact Sarah Nichelson, JD, ACFAS director of Health Policy, Practice Management and Research.

How much do you think the Merit-Based Incentive Payment System (MIPS) will affect your practice?
A lot: 59%
A little: 12%
Not at all: 12%
We won't participate: 6%
What's MIPS?: 12%

Thank you to all who participated in the first This Week @ ACFAS poll; watch monthly for new polls to share your insights. Don’t forget to check during each poll for real-time results.
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Promote Your Practice This Summer with FootNotes
Make FootNotes part of your practice marketing strategy this summer. Download the latest issue from the ACFAS Marketing Toolbox and customize it with your office’s contact information. Then print copies of it for your patients, post it on your website and social media pages or distribute it at any local speaking engagements you have scheduled for the coming months.

Articles in the Summer edition include:
  • Get Your Feet in Shape for Sandal Season
  • Beat the Heat with Healthy Summer Feet
  • Protect Your Feet from Lawnmower Injuries
Access other free members-only resources at, such as PowerPoint presentations, infographics, press release templates and more, to help your practice stand out year-round.
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Calling All Researchers!
Apply today for a 2016 ACFAS Research Grant and let the College help bring your latest discoveries to life.

Now in its 10th year, the ACFAS Research Grant provides up to $40,000 to support and advance evidence-based medicine that improves the clinical practice of foot and ankle surgery.

The ACFAS Research Committee has identified the following “wish list” of research topics it would like to see funded as part of the College’s grant awards:
  1. vitamin D in bone healing;
  2. plantar plate repair: osteotomy or no osteotomy?; and
  3. patient-reported outcome measures pre and post foot surgery.
Watch ACFAS Update for more on the 2016 Research Grant. Direct any questions to
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Connect with Us Through Social Media
The latest market research states more than half of women in the United States make healthcare decisions for their families, while seniors, Gen-Xers and Millennials comprise one of the largest healthcare consumer groups. Target these patients by sharing, retweeting and liking ACFAS' updates on your own social media sites. Also drive your patients to, ACFAS' patient education website, via Facebook and Twitter so they can learn the latest on common foot and ankle conditions.

To gain immediate access to what's going on inside the College, follow ACFAS on Facebook, Twitter and LinkedIn.

For more information on social media marketing for your practice, refer to the below article, "Providers Need to Embrace Social Media for Patient Engagement," in today's issue of This Week.
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Foot and Ankle Surgery

Distal-Based Sural Fascio-Cutaneous Flap: A Practical Limb Solution for Trauma Injuries
A recent study was conducted to determine the effect of mechanism of injury on wound healing when using a distal-based sural flap to treat defects of the lower leg, ankle and foot. Two groups of 19 patients each were selected. Group A included patients who had incurred road traffic accidents; Group B included patients with war injuries. Surgeons used a sural fascio-cutaneous flap tool for wound repair in both groups. Following the operation, researchers analyzed size of the defect, graft survival, its healing time and complications. Maximum wound size in Group A was 10 x 12 cm. In Group B, the maximum size was 15 x 38 cm. Recovery was uneventful in 17 of 19 cases in Group A. In Group B, seven of 19 were uneventful, without graft failure. Superficial epidermolysis was seen in 2 and 8 cases in Groups A and B, respectively. Researchers concluded that despite the differences in wounds between the two groups, distal-based sural flap was a promising treatment option in each.

From the article of the same title
Journal of the College of Physicians and Surgeons Pakistan (05/16) Ilyas Tahirkheli, M. Uzair; Ellahi, Irfan; Farooq Dar, Muhammad; et al.
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Quality Measures for Total Ankle Replacement, 30-Day Readmission and Reoperation Rates Within One Year of Surgery
A recent study analyzed 30-day hospital readmission rates following total ankle replacement (TAR), as well as the rate of additional surgery within a year of the operation. Researchers looked at the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) databases. The respective readmission rates for primary and revision ankle surgery were 2.2 percent and 1.3 percent. The revision rate within 12 months after the operation was 1.2 percent with increased odds in units performing less than 20 ankle replacements per year. For primary and revision TARs, the revision rates were 6.6 percent and 9.3 percent, respectively. The most common causes of reoperation were rheumatoid arthritis and use of cemented prosthesis.

From the article of the same title
BMJ Open (05/23/2016) Zaidi, Razi; Macgregor, Alexander J.; Goldberg, Andy
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Practice Management

How Patient Portal Assessments Can Improve Patient Engagement
Patient portals are an important part of care and engagement, but a new study has found that technology developers could be doing more to make them even more useful. Using the MyPreventiveCare portal as a baseline, the research team found that patients and providers had more negative comments than positive comments about the technology. Patients who reported positive feelings noted that they liked how the portal included instant access to lab and other test results, and the fact that the portal made them feel more involved and engaged in their care. These patients also saw improvements in their own wellness, a well-documented result of patient portal use. But patients who were dissatisfied with the portal were unhappy with the tool's impersonal and generic nature, as well as its inability for a clinician to communicate directly with the patient and the lack of website functionality. Researchers concluded that providers need to do a better job of educating patients on how they should use the portal.

From the article of the same title
Patient EngagementHIT (05/20/16) Heath, Sara
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Office Technology Solutions for Physician Practices
It is essential to provide your staff with the best cutting-edge tools to help them perform their jobs as effectively as possible. Investing in this technology can make your day-to-day operations smoother and can boost your revenue. Some of the most popular solutions include tools that empower patients to check-in, fill out demographic information and pay their bill without relying on your staff. All it takes is a modest financial investment and a willingness to spend some time implementing the solutions. Here are some of the top front-office technology solutions in which every practice should invest:
  1. Reminder systems to prevent no-shows. Patients who do not show up can take a chunk out of your revenue. These systems use email, text messaging and phone calls to ensure that your patients know exactly when to arrive for their appointment.
  2. Cost estimators and benefit verification systems. Powerful collection tools should be near the top of your technology list. This technology can provide critical data to help streamline the collections process.
  3. Credit card on file/online payments. Data shows consumers prefer to pay online and giving them that option will make it easier to receive outstanding or recurring patient balances.
  4. Check-in tablets and kiosks. Allowing your patients to check in seamlessly and pay quickly can save time, money and keep your patients happy.
From the article of the same title
Physicians Practice (05/25/16) Capko, Joe
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Providers Need to Embrace Social Media for Patient Engagement
Proper physician engagement is only possible by leveraging social media to target specific demographics, according to Geeta Nayyar, chief healthcare and innovation officer at Femwell Group Health. Fifty-nine percent of women in the United States make healthcare decisions for their families, from general checkups to surgeries. For working moms with kids under 18, that figure shoots up to 94 percent. Targeting women is a vital part of engaging not just female patients, but entire families. Women are influencing social networks such as Twitter and Facebook more than ever. In addition, physicians should look to social media to engage both Generation X and Millennials. People ages 30 to 45 are the "first true" generation of healthcare consumers, and people in the 20 to 30 age range are the future of healthcare. Engaging these individuals is crucial to the success of your practice. Even those older than 65 who are considered less tech-savvy are looking online to social media for information. Leveraging these demographics should be a priority for your practice.

From the article of the same title
Health Data Management (05/26/16) Slabodkin, Greg
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Why Your Medical Practice Should Have a Strategic Plan
Strategic planning and long-range planning for a medical practice are two separate ideas. Long-range planning involves determining what a practice should look like at the end of a specified period of time. Strategic planning involves determining what the practice wants to be in the future and how it will get there. It is about developing a vision for the organization and laying out the steps to reach it. Planning is a critical component of good practice management, so if your practice does not currently have a strategic plan, it is time to formulate one. Planning helps a practice respond to its patients' needs while monitoring results, assessing progress and observing the overall impact of changes. It allows for the establishment of goals to guide the practice. A concerted effort is necessary, though. Planning that focuses on a period of three years or more requires organized, serious effort with lots of dedicated time and energy. In addition, it must foster a culture change. Planning is not a one-time thing, it is constantly happening, so make sure everyone is aware of the fact that continuous effort is essential.

From the article of the same title
Physicians Practice (05/25/16) Hernandez, Nick
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Health Policy and Reimbursement

CMS Opens Requests for Proposals for New Initiative to Reduce Hospital Readmissions
A recent report released by the Agency for Healthcare Research and Quality showed that since 2010, there has been a 39 percent reduction in preventable patient harm in United States hospitals. The Centers for Medicare and Medicaid Services (CMS) has now issued a request aiming to continue progress toward a safer healthcare system, asking for proposals for a new initiative. The proposals should focus on achieving a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions through 2019. According to CMS Acting Deputy Administrator Andy Slavitt, organizations that have participated in similar proposal challenges in the past will still be considered but will compete against all other submissions from competing organizations. The winners will have access to information from former programs to help them support hospitals, patients and their caregivers in implementing evidence-based practices.

From the article of the same title
Healthcare Finance News (05/25/16) Morse, Susan
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House Subcommittee Passes Bill Exempting Ambulatory Surgical Centers from Meaningful Use
The House Ways and Means Committee has voted to pass a bipartisan bill as part of the "Helping Hospitals Improve Patient Care Act" in order to exempt ambulatory surgical centers from meaningful use rules and the Merit-Based Incentive Payment System. The bill would remain in place until the Office of the National Coordinator makes certified electronic health record technology available to certain caregivers. "Our bipartisan legislation will empower healthcare plans and providers to deliver the high-quality, affordable care patients deserve," House Ways and Means Chair Rep. Kevin Brady said in a statement. The bill would also extend the Rural Community Hospital Demonstration Program for another five years, thereby preventing hospitals in low-income communities from incurring penalties resulting from an increase in care.

From the article of the same title
Healthcare IT News (05/25/16) Davis, Jessica
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Providers Spend $15.4B to Report on Healthcare Quality Measures
Reporting healthcare quality measures costs providers more than $15.4 billion per year, according to a new report from Health Affairs. The figure amounts to an average cost of $40,069 per physician per year. Reporting, even with the help of staff, can take an extra 15.1 hours per physician per week, or 785.2 hours per year. Physicians by themselves take 2.6 hours per week to deal with quality measures. Almost half of participants in a recent study said reporting was a burden, and only 27 percent believed the current measures were "moderately or strongly representative" of the quality of care. Unfortunately, fixing the current reporting system would be difficult. Significant obstacle exist, such as a lack of electronic health record interoperability and functionality to facilitate obtaining data for quality measures.

From the article of the same title
RevCycle Intelligence (05/23/16) Sampson, Catherine
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Medicine, Drugs and Devices

Doctors Seek Opioid Alternatives for Postsurgery Pain Control
Surgeons are searching for alternative options to opioids for postsurgical pain treatment. Recent testing on patients who underwent rotator cuff surgery showed the effectiveness of alternative methods, mostly used in combination by way of a tactic known as multimodal management. Instead of exposing a patient to opioids and risking addiction and abuse, techniques, such as nonaddictive anesthetic injections, could be viable. Other options include implanting a catheter under the skin to deliver anesthetics for several days after surgery, wearing icing devices and using mechanical stimulation. Rotator cuff surgery is one of the most painful operations one can undergo, making it the perfect testing ground for alternative treatments. The advances discovered by testing these patients could someday be applied to patients with foot and/or ankle issues and patients who do not want to risk the dangers of opioid prescriptions.

From the article of the same title
Fierce Practice Management (05/25/16) Finnegan, Joanne
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FDA Approved High-Risk Women's Health Devices Without Proper Data: Study
Some high-risk women's medical devices were approved by the U.S. Food and Drug Administration (FDA) between 2000 and 2015 despite not having proper data. The findings from scientists at Northwestern University have cast doubts on FDA's approval process, which was described as "weak." Six of the 18 devices were not required to undergo post-market studies to monitor their safety. One device, Essure, was approved despite regulators receiving criticism for approving it with only short-term evidence. The fallout from these findings will likely renew the debate over FDA's approval process. The 21st Century Cures Act, which would decrease medical device regulation and has already passed in the House of Representatives, would also broaden the definition of "valid scientific evidence." The Northwestern team said FDA should seek more advice from its expert advisory committees and use higher-quality standards before approving products.

From the article of the same title
Fierce Medical Devices (05/23/2016) Wasserman, Emily
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, AACFAS

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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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