June 12, 2019 | | JFAS | Contact Us

News From ACFAS

Submit Your Manuscript for ACFAS 2020
Time for your original research study to shine! Enter the College’s annual manuscript competition, February 19–22, 2020 at ACFAS 2020 in San Antonio, and have a chance to win cash prizes. First Place $3,000, Second Place $2,500, Third Place $1,500 and Four Honorable Mentions worth $750 each.

Manuscripts must be in scientific format and must fall within one of the following categories:
  • Arthroscopy
  • Biomechanics and Anatomy
  • Diabetic Foot
  • Forefoot Reconstruction
  • Heel Pain
  • Orthotics/Prosthetics/Pedorthics
  • Peripheral Nerve Disorders
  • Physical Therapy/Rehabilitation
  • Rearfoot and Ankle Reconstruction
  • Trauma (Surgical/Conservative)
  • Wound Care/Infectious Diseases
Visit for submission guidelines and criteria. Entries are due August 15, 2019.
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See Coding & Billing Come to Life in Dallas Next Month
When your office's coding and billing procedures run smoothly, you save time, work more efficiently and receive more accurate reimbursement for the care you provide. Learn how to achieve this in Coding & Billing for the Foot & Ankle Surgeon, July 26–27 in Dallas.

This interactive course puts you and your fellow attendees in the driver's seat as you work together to code and bill for a week's worth of clinics, surgeries, calls, office procedures and complex cases typically seen in a foot and ankle surgical practice. Instructors will also guide you in how to use modifiers to avoid denials and win appeals.

A special breakout session focused on private and multispecialty practices will close the seminar.

Register at to secure your spot now!
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Spotlight Your Practice This Summer with FootNotes
Feeling the heat to increase your practice marketing efforts this summer? Keep your cool and download the latest issue of FootNotes from the ACFAS Marketing Toolbox.

Add your office’s contact information in the editable space on page 2, then:
  • Post this issue on your practice website and social media sites
  • Leave printed copies in your exam and waiting rooms
  • Distribute copies at any local health events you are scheduled to speak at this summer
Visit to access the complete FootNotes archive plus other free patient education resources you can use any time of year.
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Foot and Ankle Surgery

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus
A study sought to investigate the clinical and radiological results of the autologous matrix-induced chondrogenesis procedure for osteochondral lesions of the talus, extending the follow-up to eight years. Thirty-three patients with osteochondral lesions of the medial talar dome were retrospectively assessed after open AMIC repair at an average follow-up of 4.7 years. The average visual analog scale score improved significantly, while the mean American Orthopaedic Foot and Ankle Society score rose as well.

Complete filling of the defect was observed in 88 percent of cases, but 52 percent exhibited hypertrophy of the cartilage layer. All but one patient had persistent subchondral bone edema. Fifty-eight percent of patients underwent reoperation, primarily for symptomatic hardware after malleolar osteotomy.

From the article of the same title
American Journal of Sports Medicine (05/14/19) Weigelt, Lizzy; Hartmann, Rebecca; Pfirmann, Christian; et al.
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Percutaneous Plantar Fascia Release with Needle: Anatomic Evaluation with Cadaveric Specimens
A cadaveric study was held to conduct an anatomic evaluation of the percutaneous plantar fascia release technique using a conventional hypodermic needle, with 14 fresh-frozen cadaveric transtibial amputation specimens. The average width of the plantar fascia was measured as 20.34 plus or minus 4.25 mm. The mean thickness of the medial border of the plantar fascia was 3.04 plus or minus 0.54 mm. Partial fasciotomy was performed in all cadavers with 49.47 percent plus or minus 7.25 percent relative width of the plantar fascia.

No damage was seen in the lateral plantar nerve or its first branch Baxter's nerve, and the average distance from the deepest point of the fasciotomy up to the Baxter's nerve was 8.62 plus or minus 2.62 mm. The study showed partial plantar fasciotomy can be realized via percutaneous plantar fascia release with a conventional hypodermic needle without any nerve damage.

From the article of the same title
Journal of Foot & Ankle Surgery (05/24/19) Catal, Bilgehan; Keskinbora, Mert; Keskinoz, Elif Nedret; et al.
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Tibiofibular Syndesmosis in Asymptomatic Ankles: Initial Kinematic Analysis Using Four-Dimensional CT
Researchers sought to evaluate the reliability of ankle syndesmotic measurements and their changes during active motion using four-dimensional computed tomography (4DCT) examination in asymptomatic ankles. 4DCT was performed on the ankles of patients with signs and symptoms of unilateral ankle instability. Ankles from the asymptomatic side of 10 consecutive patients were included in this analysis. Five ankle syndesmotic measurements were adopted from the available literature and performed by two surgeons. The measurements included syndesmotic anterior distance (SAD), syndesmotic posterior distance, syndesmotic translation (ST), syndesmotic tibiofibular angle and ankle tibiofibular angle. A Monte Carlo simulation was also performed to obtain exact p-values with 99 percent confidence intervals.

Excellent interobserver reliability was observed among the two surgeons for four out of five measurements. The intra-class correlation coefficients values for SAD were not statistically significant. Among the five measurements, only ST measurements had significant changes during active motion. Of the measurements, only the ST measurements demonstrated a negative linear association with the tibiocalcaneal angle during active motion.

From the article of the same title
Clinical Radiology (07/19) Mousavian, A.; Shakoor, D.; Hafezi-Nejad, N.; et al.
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Practice Management

Amid Rising Costs, Personalized Healthcare Experiences Are a Must
Personalized healthcare across the entire patient experience is vitally important as medical costs escalate, and better data use and technology can make personalization a reality. Appointment check-in is one area that could be improved by using machine learning-powered personalization engines to eliminate much of the patient and provider administrative burden. Patient-specific health plan information also would help inform physicians' treatment decisions, with cost specific to each patient factored in.

A third area that could benefit is personalized healthcare payments. Sharing data between providers and payers could be an opportunity for practices to offer more personalized, friendly payment terms, like a payment plan, discounts or introductions to financial assistance programs.

From the article of the same title
Physicians Practice (06/03/19) Otto, Florian
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How Bots Will Change the Doctor-Patient Relationship
In an article published in the New England Journal of Medicine, researchers argue that the traditional doctor-patient relationship is hindering progress in healthcare. For instance, robots could manage a variety of common medical conditions, such as high blood pressure, diabetes and high cholesterol, and could be overseen by a nurse; physicians could provide support if needed. The insurance industry, both government and commercial, must explore new and potentially better models of care, and state-based regulation of insurance and clinician licensure must be replaced by a system that recognizes that healthcare is not always best delivered locally. Facilitated self-service creates efficiencies across state lines. It is likely that occasionally some of Wyoming’s 600,000 residents, for instance, would benefit from care delivered by someone outside the 1,000 physicians practicing in that state.

It is also essential to require the same standards of safety and efficacy for automated approaches to healthcare as is required for pharmaceuticals. Whether that regulation comes from the U.S. Food and Drug Administration or elsewhere, it needs to be ramped up to address the volume of potential new approaches. The organizations that currently credential clinicians might find they are also well suited to credential robots. Facilitated self-service healthcare does not challenge the appeal of the doctor-patient relationship, but it shifts it toward those elements of care that cannot as easily be handled by a machine. The lesson from other industries is that transformational change requires productivity change.

From the article of the same title
Harvard Business Review (06/04/19) Asch, David A.; Nicholson, Sean; Berger, Marc L.
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Seven Conveniences Patients Expect from Today's Medical Practices
Patients expect the modern physician practice to deliver seven key conveniences, including easy online appointment scheduling and less burdensome paperwork that is mainly electronic. Wait time of no more than 15 minutes is also highly desirable, as is quick responses to email or electronic health record portal-directed questions within a 24-hour window. Patients also appreciate modernized waiting rooms emphasizing comfort and transparent, easy-to-understand billing. Finally, practices that adapt their schedules to patients are more likely to have loyal customers.

From the article of the same title
Medical Economics (06/04/19) Shryock, Todd
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Health Policy and Reimbursement

CMS Asks for Input in Efforts to Reduce Paperwork
The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a request for information to stakeholders on its Patients over Paperwork initiative, whose goal is to cut the amount of manual documentation the healthcare industry faces. CMS calculates that its regulatory reforms in both final and proposed rules will save approximately 40 million hours and $5.7 billion through 2021. The agency is seeking public input on mandates for reporting and documentation, coding for Medicare and Medicaid payments, prior authorization, policies for rural institutions and beneficiaries, dually enrolled policies, beneficiary enrollment and eligibility determination and processes that CMS employs for new regulations and policies.

"In removing what doesn't add value, we're making room for what does," said CMS Administrator Seema Verma. "Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks."

From the article of the same title
HealthExec (06/06/19) Baxter, Amy
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Employers, Hospitals and Insurers Butt Heads over Transparency Proposals
Insurers and hospitals this week commented on the Senate health committee's draft legislation for healthcare transparency, with a proposed mandate on hospitals and insurers giving patients a cost estimate for any upcoming treatment within 48 hours of a request a point of contention. Insurers are on board with this mandate, but hospitals take issue with covering out-of-pocket cost estimates on behalf of contracted physicians. "These differences can be particularly marked where a patient suffers an unforeseen complication that necessitates additional services and increases the patient's cost-sharing liability," said Federation of American Hospitals CEO Chip Kahn.

He argued that insurers should be responsible for "good faith estimates" of prices. Meanwhile, insurers and hospitals are reluctant about reporting negotiated service rates, with Kahn demanding the removal of a provision barring insurers from agreeing to a gag clause that bans disclosure of a hospital's pricing or quality information to certain parties, including the patient.

From the article of the same title
Modern Healthcare (06/06/19) Luthi, Susannah
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In Win for Hospitals, Supreme Court Rules DSH Change Violated Law
The U.S. Supreme Court ruled that the U.S. Department of Health and Human Services (HHS) broke the law in changing the Medicare reimbursement formula for disproportionate share hospitals (DSHs), without giving them notice and opportunity to comment. HHS revised DSH payment calculation by adding Medicare Advantage enrollees to traditional Medicare participants to estimate how much compensation hospitals would receive.

"Because affected members of the public received no advance warning and no chance to comment first, and because the government has not identified a lawful excuse for neglecting its statutory notice-and-comment obligations, we agree with the court of appeals that the new policy cannot stand," argued Justice Neal Gorsuch. American Hospital Association General Counsel Melinda Hatton noted, "By evading the notice-and-comment process, HHS failed to consider the real-world impact of its changes, leading to policies that may adversely affect patients as well as providers."

From the article of the same title
Healthcare Dive (06/03/19) Elfin, Dana
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Medicine, Drugs and Devices

Hacking Diabetes: People Break into Insulin Pumps as an Alternative to Delayed Innovations
As some people invest in the latest advancements to help them cope with diabetes, others have found unconventional ways to manage blood sugar conditions like hacking into insulin pumps. Three separate technologies—including a continuous blood glucose monitor, an insulin pump and a computerized control system—have been used for decades to help people living with diabetes manually manage their health. However, in recent years, a loose network of "aggressive patients" began exploiting a security flaw in some of the pumps to make them automatically estimate blood glucose levels and adjust insulin levels accordingly. The U.S. Food and Drug Administration recently warned people living with diabetes against building their own artificial pancreas system to help control blood sugar levels after a patient using one suffered an accidental insulin overdose.

From the article of the same title
USA Today (06/05/19) Brown, Dalvin
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House Appropriators Target Areas for FDA Improvement
The House Appropriations Committee has voted to send its fiscal year 2020 spending bill for the U.S. Food and Drug Administration (FDA) to the House floor. The proposed funding bill would provide the agency with $3.26 billion in nonuser fee funding, a 6 percent increase above the FY 2019 enacted level. The committee urged FDA to increase the number of cancer immunotherapy trials and to work with researchers and the pharmaceutical industry to develop standardized templates for reporting toxicities in such trials.

In addition, the committee criticized FDA for being "more than three years late" in setting a federal licensing standard for third-party logistics providers and wholesale distributors under the Drug Supply Chain and Security Act. Regarding insulin and the migration of insulin products to biologics license applications by March 23, 2020, the committee urged FDA to take special care with certain applications to ensure they do not need to be resubmitted to the agency after the deadline. Furthermore, the committee called for the agency to combat a shortage of epinephrine auto-injectors and to hold a briefing on efforts to internationally harmonize technical and scientific standards for generic drugs.

From the article of the same title
Regulatory Focus (06/04/2019) Brennan, Zachary
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Pain Management Task Force Issues Final Report on Best Practices for Treatment of Pain
The federal Pain Management Best Practices Inter-Agency Task Force has released its final report on best practices for acute and chronic pain management. The report emphasizes the need to address stigma, risk assessment, access to care and education. It also highlights five broad categories for pain treatment: medications, interventional procedures, restorative therapies, behavioral health and complementary and integrative health approaches. The report calls for responsibly planning and managing opioid analgesics by allowing more time for history-taking, screening tools, lab tests and clinician time with patients to establish a therapeutic alliance and to set clear goals for improved functionality, quality of life and activities of daily living. Medication disposal and safe medication storage are also emphasized for patient safety.

The report includes a section highlighting the disparities and challenges faced by special populations, such as veterans, women, youth, older adults, Native Americans, palliative care patients and those with sickle cell disease and other chronic conditions. The task force is overseen by the U.S. Department of Health and Human Services, in cooperation with the U.S. Department of Veterans Affairs and the U.S. Department of Defense.

From the article of the same title
HHS News Release (05/30/19)
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Britton S. Plemmons, DPM, 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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