June 8, 2016 | | JFAS | Contact Us

News From ACFAS

Don't Miss Deadline for Meaningful Use Hardship Exemption
The deadline to apply for the meaningful use hardship exemption is 11:59pm ET on July 1. Healthcare providers required to report meaningful use will be exempt from the requirements if one (or more) of the following circumstances exist:
  • insufficient Internet connectivity;
  • extreme and uncontrollable circumstances in the form of a natural disaster;
  • practice or hospital closure;
  • bankruptcy or debt restructuring;
  • electronic health record certification/vendor issues, such as:
    –delays or decertification;
    –switching products;
    –issues related to insufficient time to make changes to the certified electronic health record technology (CEHRT) to meet regulatory reporting requirements.
  • lack of control over CEHRT availability;
  • lack of face-to-face interaction or follow-up.
For more information, visit or contact Sarah Nichelson, JD, ACFAS director of Health Policy, Practice Management and Research.
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You Asked, We Listened
Thanks to your feedback on the Annual Scientific Conference in Austin, you can expect even more new things at ACFAS 75 in Las Vegas. Enjoy brand-new sessions, such as “Knocked Down but Not Out” on resilience in the workplace, as well as a fourth original investigation session to give you an inside look at research that’s changing the profession. Once again, you’ll also be able to instantly share your input on sessions and debates by responding to polls using your mobile phone.

Mark February 27-March 2, 2017 on your calendar now so you can be part of 75 years of evolution and revolution in foot and ankle surgery!
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Include Podcasts in Your Summer Travels
If your summer travel plans include hours spent in a car or plane, make the most of that time with ACFAS’ free Podcast Library. Hear expert panelists weigh in on the latest topics and trends in foot and ankle surgery and what these mean for you and your practice.

This month’s podcast, “Tourniquets: Current Recommendations,” outlines indications for tourniquet use and offers guidance for pressure settings and placement.

Visit for the complete library and to start planning your summer playlist. New releases are added each month so you’re always in the loop and ahead of the curve.
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Foot and Ankle Surgery

Open Reduction and Internal Fixation of Posterior Malleolar Fractures Using the Posterolateral Approach
A new study analyzed the efficacy of a posterolateral approach in patients with trimalleolar fractures. Fifty-two patients were observed, 41 of whom had AO 44B-type fracture and 11 of whom had 44C-type fractures. The mean size of the posterior fragment was 27 percent of the tibiotalar joint surface. Reduction was anatomical in all patients. Nine of the C-type fractures resulted in stable syndesmosis and a screw was not required. No wound healing problems were recorded. Only one patient with a 44C-type fracture required additional surgery. The posterolateral approach allowed for adequate access to the posterior malleolus and permitted reduction and stable fixation.

From the article of the same title
Bone & Joint Journal (05/16) Verhage, S. M.; Boot, F.; Schipper, I. B.; et al.
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Tendon Entrapments and Dislocations in Ankle and Hindfoot Fractures: Evaluation with Multidetector Computed Tomography
A recent study used multidetector computed tomography (MDCT) to evaluate the incidence of tendon entrapments and dislocations associated with ankle and hindfoot fractures. Researchers studied 398 patients with ankle and/or hindfoot fractures. Tendon entrapment was detected in 30 patients, 31 showed tendon dislocations and three had both tendon entrapment and dislocation. The posterior tibialis tendon was the most commonly entrapped tendon (27 patients), and the peroneal tendons were the most frequently dislocated (27 patients). The majority of tendon entrapments resulted from pilon fractures, and the majority of dislocations stemmed from calcaneus fractures. In patients with complex fractures, tendon entrapments and dislocations were found to be common occurrences.

From the article of the same title
Emergency Radiology (05/16) Ballard, David H.; Campbell, Kevin J.; Blanton, Lee E.; et al.
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Practice Management

How IT Can Improve Patient Engagement Efforts
A 2014 study found that increased use of electronic health record (EHR) technology has not increased electronic communication among patients and clinicians. This dissonance may be due in part to a fundamental misunderstanding about what patient engagement really is. Patient engagement, according to some experts, is not the same as employing a patient-centered care model. Portals can only do so much—true engagement comes from giving the patient a consumer-like experience. A mixture of both portal methods and customer-based methods is ideal for most practices. It is important for physicians to adequately understand the interplay between patients and portals and how other technologies can continue to foster the relationship. The portal should be used as a tool, experts agree, in a broader patient engagement strategy. Adding technologies that allow patients to schedule appointments, pay bills and view records online can supplement the power of the patient portal to make every customer's experience efficient and informative.

From the article of the same title
Health Data Management (06/01/16) Lichtenwald, Irv
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How to Manage ICD-10 Implementation Updates, Maximize Revenue
American Health Information Management Association (AHIMA) has released a guide on how to implement upcoming ICD-10 updates. The Centers for Medicare and Medicaid Services (CMS) will release 5,500 new codes starting in October, so it is important for practices to be ready. The codes are a large update, but they are necessary to boost reimbursement while providing more clarity. CMS says the codes will be those that most providers were already seeking. These include codes for healthcare-specific devices as well as combination diagnoses and inpatient procedures. The hope is that the new codes will make the process simpler so that staff training is a more specialized, easier undertaking. It is important for health information professionals to assess the new ICD-10 codes and to determine how they will affect reimbursement and workflow. It may help to use computer-assisted physician documentation services to select specific codes for certain diagnoses and procedures. Proper training is the most important part of the ICD-10 equation. Good training can limit mistakes, increase efficiency and prepare a practice for future updates to the ICD-10 system.

From the article of the same title
RevCycle Intelligence (06/02/16) Belliveau, Jacqueline
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Medical Practice Staff Are Your Greatest Asset
Staff members are more than bodies in your practice's office—they are assets and resources that can ensure your day-to-day operations continue to run smoothly. A productive and efficient staff can often be the most important part of running a functional operation. Here are some tips for hiring, retaining and challenging your staff:
  1. Hire the right person. Look for employees who fit a personality profile consistent with your practice's culture. Sometimes, a new hire with a good attitude is better than one with the exact skill set you seek.
  2. Emphasize onboarding. Onboarding should be a gateway to additional training efforts to both develop and retain new employees. Your onboarding program must be comprehensive, informative and allow for new hires to ask questions.
  3. Develop a learning culture. Building and maintaining a productive office culture starts with instilling your mission in your new hires. Encourage and support employees who want to learn new things and foster an environment that motivates your staff to try new and better things.
  4. Challenge staff. You should challenge your staff to bring new ideas and thoughts to the table. Send them to outside conferences and move them around within your practice to see how they respond to different settings.
From the article of the same title
Physicians Practice (06/01/16) Dahl, Owen
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Six Ways to Streamline RCM Processes
Improving patient care requires physicians to streamline their revenue processes. The American Medical Association has released guidelines for physicians who want to manage their revenue more efficiently. After acquiring a proper practice management system, here are six things physicians should remember:
  1. Verify insurance eligibility electronically before visits. Practices can save time when scheduling or registration staff collects patient insurance information and submits the data electronically.
  2. Reduce prior authorization burdens through electronic transactions. New electronic pharmacy prior authorization transactions allow physicians to finish prior authorization requirements as part of the e-prescribing workflow.
  3. Submit claims electronically to save money. Automating this process and submitting electronically can save both time and money. Once the claim is submitted, it may be pre-audited before being submitted for an accuracy check.
  4. Determine the status of a submitted claim. An electronic claim status inquiry can determine whether or not a claim has been received. You can send several transmissions at once to check multiple claims at the same time.
  5. Use electronic remittance advice (ERA) to simplify processing of payment information. Standardized ERA can identify claims that require reworking and can save time so that staff can work on higher-priority tasks.
  6. Maximize collection of patient payment. Complete electronic eligibility checks in the office so that you can give the patient all information necessary. The goal is to collect payments while the patient is still in the office.
From the article of the same title
Becker's Hospital Review (05/31/16) Gooch, Kelly
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Health Policy and Reimbursement

Data Sharing Among Hospitals Increased in 2015, Yet Barriers Remain for Using and Integrating Data
The Office for the National Coordinator of Health IT (ONC) has released data showing that interoperability and information exchange among acute care hospitals is progressing despite barriers remaining in the way. According to the report, 85 percent of hospitals in 2015 indicated that they sent data outside their organizations, an increase over the 78 percent from 2014. In addition, 65 percent noted they received information from outside their organizations, up from 56 percent in 2014. Only 38 percent of hospitals reported using or integrating summaries of patient care records that were either electronically sent from outside their health system, or that the organization electronically found. More than a quarter of hospitals said they conducted some form of information finding, sending, receiving or using. The data shows that information sharing is slowly picking up speed and popularity. Interoperability remains a concern. Although ONC noted that interoperability is a national priority, less than half of hospitals reported having necessary patient information electronically available from providers at the point of care. This is primarily due to many organizations' inability to access relevant information from within their electronic health record.

From the article of the same title
Healthcare Informatics (06/01/16) Landi, Heather
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HHS and ONC Post Transparency Data to Make Buying EHRs Easier
The U.S. Department of Health and Human Services (HHS) and the Office of the National Coordinator (ONC) for Health IT have posted information for making certified electronic health record (EHR) software less confusing. Many EHR vendors support the initiative, which contains all of the transparency information ONC has on file. ONC and HHS have worked over the last few years to clear up misunderstandings regarding EHRs. The agencies' initiatives include improving the technology, fostering interoperability, increasing patient access to data and providing clearer information so that patients, purchasers and all physicians have a better idea about how the technology functions. According to National Coordinator Karen DeSalvo, market transparency and simpler guidelines are the most important part of educating all parties on the power of EHRs.

From the article of the same title
Healthcare IT News (06/01/16) Sullivan, Tom
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Study: Most Insurers Not Looking to Exit Affordable Care Act
A new analysis from the Commonwealth Fund has found that most insurers are not considering an exit from the Affordable Care Act (ACA) marketplace. Only one insurer, Humana, has publicly stated it will consider pulling out of the market, and the report indicated that some insurers could actually increase their participation. Despite significant financial losses on the ACA market, most insurers still see opportunities to grow their involvement while simultaneously adapting. However, insurers are not keeping quiet: many are still calling for policy changes that include tightening regulations on extra sign-up periods and loosening rules pertaining to what an insurance plan must cover. While not all insurers will find success in the new marketplaces, the data shows that most of them see a benefit in participating in and committing to the principles of the ACA.

From the article of the same title
The Hill (06/02/16) Sullivan, Peter
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Medicine, Drugs and Devices

Do Orthotics for Foot Injuries Really Work?
Foot orthotics are a booming business, but disagreement still exists within the foot care community about their potential benefit to patients. While the foot orthotics industry reached $4.7 billion in 2015 and will continue to grow through 2021, advanced kinesiologists maintain that training and physical therapy are superior solutions to the problems that foot orthotics aim to solve. The products are marketed as a fix to pain and dysfunction in the foot, but many experts say foot orthotics do not address the underlying biomechanical problems that cause that pain. They are not a permanent fix, according to Dr. Heather Vincent, director of the University of Florida Health Performance Center in Gainesville. Vincent says foot orthotics can actually worsen the conditions they are meant to treat if patients wear them too long. Instead, patients should focus on adopting movement patterns more like those humans used before orthotics were invented. Foot orthotics can provide temporary relief, but concentrated gait training is likely the best way to solve chronic foot problems.

From the article of the same title
Medscape (05/26/16) Harrison, Laird
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FDA's Mobile Health Innovation Program Sees Success in Its First Year
The U.S. Food and Drug Administration's (FDA) Expedited Access Pathway (EAP) program has seen success in its first year. Launched in April 2015, the program's goal was to allow innovative mobile health companies to get their potentially life-saving products to market quicker. Since the launch, 17 of 29 applications have been approved with decisions arriving in around 30 days. To become EAP-eligible, a device must treat an "irreversibly debilitating" disease or condition, address an unmet need and come with a data development plan outlining what will be included in future submissions to FDA.

From the article of the same title
mHealth Intelligence (06/01/16) Wicklund, Eric
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Four Reasons Telemedicine Is More Effective Than You May Think
Many physicians continue to question the benefits of telemedicine despite its growing popularity among patients. Here are four misconceptions about telemedicine that hold some doctors back and why they should be of no concern:
  1. High costs. Most of the time, telemedicine solutions are not very expensive. In fact, most patients only want simple communication methods to accomplish tasks, such as scheduling appointments and getting basic information.
  2. Security. A number of services can protect your telemedicine offerings. Physicians should not worry excessively about security. While important, it does not represent new ground in the era of smartphones and electronic bank accounts.
  3. Reimbursement. Many seem unclear about the reimbursement benefits of telemedicine, but more state and federal legislators are starting to see positive results.
  4. Workflow. New technology will inevitably change the way you work, but that does not mean it will make you less efficient. Telemedicine will allow you to more effectively deal with patients who do not need to take up time and resources with a physical visit.
From the article of the same title
Fierce Practice Management (06/01/16) Kuhrt, Matt
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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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