News From ACFAS

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You should have already received either the ACFAS Member Insights Survey or Practice Economics Survey via e-mail from ACFASpresident@perceptionsolutions.com. If you’ve not yet submitted your survey responses, please do so by June 17.

Don’t miss your chance to be one of six lucky respondents who will win their choice of an Apple Watch, free registration to ACFAS 2016 in Austin or free 2016 membership dues.

We value your feedback, so respond now and have a say in the College’s future!
Give your research the attention it deserves—submit your manuscript or poster to the College’s Annual Manuscript and Poster Competition set for February 11–14 at ACFAS 2016 in Austin, Texas. A time-honored tradition that attracts hundreds of entries from around the world, the competition is known as the venue to both showcase and absorb the latest research in foot and ankle surgery.

Manuscript submissions are due August 14, 2015. Review the manuscript requirements and author instructions before submitting your entry for consideration. All manuscripts are blind-reviewed and judged on established criteria. Winners divide $10,000 in prize money.

Poster abstracts must be submitted by September 1, 2015 to be eligible for consideration. Winners will receive cash prizes ranging from $500 to $1,000. Visit acfas.org for more on poster format and abstract submission.

Mark these dates on your calendar now so you don't miss your chance to be part of what's expected to be our biggest competition yet!
Find the balance between clinical expertise, available evidence and patient perspective in ACFAS’ newest advanced seminar, Taking a Scalpel to the Evidence, set for November 6–7, 2015 in Atlanta.

Learn how evidence-based medicine (EBM)—the foundation of clinical practice and patient care—applies to foot and ankle surgery using a bottom-to-top approach. Also hear expert faculty’s strategies for addressing cases where insufficient evidence exists or where patient preferences conflict.

Program includes breakfast and lunch both days plus 14 continuing education contact hours. Register today at acfas.org/education and let the evidence show that EBM is the path to improved patient care.

Foot and Ankle Surgery

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Following internal fixation of ankle fractures, patients often need immediate postoperative imaging. Since patients are typically immobilized at this stage, radiographs provide limited visuals. Researchers looked deeper into this issue and evaluated the utility and quality of formal radiographs that are done immediately after ankle fracture surgery. They observed 271 patients who underwent formal radiographs following ankle fracture surgery. Of those, 10.3 percent achieved good quality postoperative views. The lateral and mortise views were least commonly performed with good technique. The radiographs cost $191 per patient. The researchers concluded that routine use of formal postoperative radiographs did not provide additional value to patients or surgeons. The quality of the images were inferior to the quality of images obtained and saved intraoperatively.


Patients with limb-threatening ischemia can display uneven patterns of perfusion in the foot. This makes it difficult to determine adequate topographic perfusion by angiography alone. A recent study was conducted to evaluate the feasibility of reporting dynamic relative oxygen indices and tissue oxygen concentration from multiple locations on the foot during endovascular therapy using a novel micro-oxygen sensor (MOXY) approach. Researchers observed 10 patients who underwent endovascular therapy for limb-threatening ischemia. Prior to therapy, four microsensors were injected in each patient. Following therapy, microsensors were successfully read 206 out of 212 times in all patients. In 90 percent of procedures, at least one of the three MOXYs showed immediate change in the dynamic relative oxygen index. There was a statistically significant increase in the concentration of oxygen in the foot in preoperative levels compared with postoperative levels, and no adverse effects were recorded.

Practice Management

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Getting fully reimbursed for physician services is never an easy task, especially when it comes to tense relations with payers. According to experts, steps can be taken to ensure that physicians work better with their payers. First, it helps to know what payers do well. Using the PayerView results provided by athenahealth can help with this. PayerView ranks commercial and government health insurers according to specific measures of financial, administrative and transactional performance. These categories are pooled to determine which payers are easy or difficult to work with. The next step is to use strategies to work together with payers. Do not be afraid to negotiate contract terms. It is a difficult process, but it is a way for your practice to demonstrate its worth. Critically review financial data and create a pool of payers whom you know are easy to work and negotiate with. In addition, using payer tools at your disposal can be a huge help. Most payers have online tools like portals that practices can use to confirm information or track claims. Finally, the most important aspect is developing and solidifying your relationship with the payers. In-person visits are tough in a digital age but are rewarding for both sides. Document every conversation so that you have a history. Constant and efficient contact is the backbone of solid practice-payer collaboration.


Practice managers should be more aware of how physicians deliver care and how they can help them boost the efficiency of care delivery, while physicians have a vested interest in being cognizant of how their decisions influence the bottom line in the form of compensation. Practice managers can follow several strategies to enhance communication between providers and the administrative team, simplify processes and understand how their job affects clinical care. They include:

1. Realizing how managers impact clinical care. Administrators design and enable patient care systems that leverage technology, concentrate on chronic disease prevention and management and seamlessly integrate the practice's business and clinical activities. Managers should ensure they are in regular communication with physicians to gain better insights into what changes they can effect to help them provide higher quality care at less expense.
2. Improving communication between physicians and the administrative team. This will most likely entail managers listening to providers describe what they would like to correct at the practice, although what they do not mention can be even more helpful in determining what bothers them. Improving communication will require managers to learn about the larger issue that is giving providers difficulty.
3. Streamlining old processes. The first step is to examine staffers' roles to determine if they are working up to their licensure level. Through collaboration and staffing analysis, the administrator and physician can understand and make revisions so their staff is more efficient, effective and dedicated to patients.

For years, insurers have pooled cost and quality data to "economically profile" physicians. With the advent of the Affordable Care Act, this practice has increased in the least five years. Being pegged as a high utilizer can lead to higher copayments and may result in a practice being removed from a patient's network. Steps can be taken to prevent this. It is possible to appeal the designation and ask the insurer to give all details on how they produced the rating. Physicians should ask to see all relevant data.

Health Policy and Reimbursement

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For the first time in more than a decade, the federal government has revealed a regulatory package aimed at setting national standards for managed care under Medicaid. The Centers for Medicare and Medicaid Services (CMS) noted the changes will ease the administrative burden on issuers and regulators while also providing “an appropriate level of protection for enrollees." The rule is expected to face opposition from the 39 states that have had considerable leeway in their own use of managed care. Also in the literature is a proposal to set the medical loss ratio at 85 percent. The medical loss ratio sets the minimum amount of all premium dollars directly spent on healthcare. Since every state has already developed some form of medical loss ratio, opponents believe the proposed rules could "destabilize" state-level programs. Nearly 30 million people are enrolled through managed care, which is about two-thirds of people with Medicaid.


The Supreme Court is expected by the end of June to rule on a lawsuit seeking to invalidate subsidies to more than 7.5 million people under the Affordable Care Act. If the lawsuit is upheld, people who were previously subsidized would face a rise in cost that unsubsidized Americans already pay. The Obama administration has said it does not have a backup plan in the event subsidies are struck down, and leading Republicans believe such a ruling could provide a chance to replace the law. The public remains split on the law, with 43 percent reporting a favorable view and 42 percent claiming an unfavorable opinion. Striking down the subsidies could be catastrophic for families who rely on them. Unsubsidized citizens, who do not qualify for government assistance, already pay more because the law requires that policies offer broad coverage and greater protection against catastrophic medical costs. If a subsidized family is suddenly thrust into paying what unsubsidized families do, it would create financial troubles for the 7.5 million people who depend on that government assistance.


Alabama is the seventh state to join the Federation of State Medical Boards (FSMB), setting in motion an agreement designed to make it easier for physicians to be licensed in multiple states. The other states are Idaho, Minnesota, South Dakota, Utah, West Virginia and Wyoming. Securing seven states triggered the formation of the Interstate Medical Licensure Compact Commission. The commission will include physicians, administrators and members of the public who have been appointed to medical boards in participating states. Under the compact, physicians who wish to practice in more than one state can be licensed in additional states without having to submit a formal application or to provide another set of records to each state medical board, although they must still pay application fees set by medical boards. This process is expected to help physicians who practice in metropolitan areas that straddle state lines, as well as doctors who practice telemedicine across state lines. FSMB and the American Medical Association support the compact because it allows state medical boards to retain control over licensure and the disciplining of physicians who practice within their jurisdictions.

Medicine, Drugs and Devices

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Surgery and hospitalization can often cause patients to incur issues following their procedures. Now, hospitals are trying to learn of these problems sooner by using new early-warning systems that monitor patients all day and display possible signs of a worsening condition. One of these strategies is a wireless monitor that slips under a mattress and alerts staff to changes in breathing and heart rate. Another method rates a patient's risk of deterioration in real time based on lab results. A study of 7,643 patients revealed that these monitors and other strategies reduced hospital stay time and resulted in lower instances of code blue events.


A study from Kaiser Permanente states patients vulnerable to potentially fatal blood clots who take blood-thinners have a 17-fold higher risk of serious bleeding after undergoing surgery if given short-acting anticoagulants around procedures. Clinicians stop the use of Warfarin to reduce the risk of serious bleeding when patients undergo invasive procedures, but the interruption in medication exposes patients to an increased risk of blood clots three to five days before and after procedures. Physicians have used "bridge therapy," a faster-acting, shorter-lived anticoagulant, during the gap in Warfarin use to reduce the risk of blood clots. However, the Kaiser Permanente study found that bridging may create more risks than benefits for patients with low to moderate risk for blood clots.


A bipartisan bill known as the 21st Century Cures Act intends to increase U.S. medical-research funding, but it has raised concerns over provisions that would relax some safety regulations. If passed, funding for the National Institutes of Health would be raised by $10 billion over five years. The U.S. Food and Drug Administration (FDA) also could approve certain antibiotics without full clinical testing, and some other drugs could be approved based on “clinical experience” rather than full studies. Another provision would allow high-risk medical devices, such as pacemakers and hip implants, to receive FDA approval through anecdotal evidence or medical journal articles instead of full clinical studies. Drug and device companies could market products for uses not approved by FDA by disseminating “truthful and non-misleading” information. In a letter to House members, the health advocacy group Public Citizen wrote that parts of the bill “would undermine public health and threaten patient safety.” Other health groups, however, support the provision. Rep. Fred Upton (R-Mich.), who co-authored the bill, said the measure is meant to spur healthcare innovation. The bill unanimously passed the House Energy and Commerce Committee last week and could face a full House vote next month.