June 14, 2017 | | JFAS | Contact Us

News From ACFAS

Join Us in Philadelphia for July Coding & Billing Seminar
Register now for Coding and Billing for the Foot and Ankle Surgeon, July 21–22 in Philadelphia, and learn how to better navigate the path between the care you provide and proper reimbursement.

Expert faculty will show you how to simplify your coding and billing practices for:
  • multiple-procedure cases when performing forefoot, rearfoot or ankle reconstructive surgery
  • open reduction and internal fixation of multiple fractures
  • complex arthroscopy cases
  • diabetic foot surgery
You’ll also code real-time patient scenarios and receive customized handouts, checklists and forms to use back at the office. Visit to register today.
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June SLRs Posted on
Short on time but still want to stay up to date on the latest research? Read this month’s Scientific Literature Reviews (SLRs) for summaries of articles from prominent medical journals. Each SLR is written by a podiatric surgical resident and includes podiatric relevance, methods, results and conclusions. New SLRs are posted each month at to give you a snapshot of scientific studies that may affect your surgical cases.

Visit to read the June reviews or to browse the SLR archive for studies dating back to 2009.
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Support ACFAS Sponsors
Corporate grants and sponsorships help ACFAS provide you with the best educational opportunities to enhance your career as a foot and ankle surgeon. Visit the Corporate Sponsorship Mall on to learn more about our sponsors and the products and services they offer.
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Foot and Ankle Surgery

Foot-Ankle Complex Injury Risk Curves Using Calcaneus Bone Mineral Density Data
New research investigates different approaches to accounting for bone mineral densities (BMDs) in the development of human injury risk curves. Researchers subjected 12 postmortem human subject (PMHS) lower leg-foot-ankle specimens to underbody blast (UBB) loads. Using simulated UBB loading experiments, a comparison was made between treating BMD as a covariate and prescaling test data based on BMD. The mean forces of 3.9 kN and 8.6kN were associated with the five percent and 50 percent probability of injury for the covariate method of deriving the risk curve for the reference age of 45 years. The mean forces of 5.4 kN and 9.2 kN were associated with the five percent and 50 percent probability of injury for the prescaled method. The normalized confidence interval (NCIS) magnitudes were wider in the covariate-based risk curves (0.52–1.00) than in the risk curves based on the prescaled method (0.24–0.66). The prescaling method resulted in a generally greater injury force and a tighter injury risk curve confidence interval. Prescaling the force data using BMD is an alternate and likely more accurate method. Because of the proximity of the calcaneus bone to the impacting load, it is suggested to use and determine the BMD of the foot-ankle bone in future UBB and other loading conditions to derive human injury probability curves for the foot-ankle complex.

From the article of the same title
Science Direct (05/10/17) Yoganandan, Narayan; Chirvi, Sajal; Voo, Liming; et al.
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Isolated Talonavicular Arthrodesis and Talonavicular-Cuneiform Arthrodesis for Müller-Weiss Disease
New research seeks to introduce isolated talonavicular (TN) and talonavicular-cuneiform (TNC) arthrodesis for stage III and IV Müller-Weiss disease and to analyze their clinical outcomes. Thirty patients were divided into the TN arthrodesis group and TNC arthrodesis group according to perinavicular osteoarthritis by MRI scans. For the isolated TN arthrodesis group, 16 patients underwent TN arthrodesis with two 4.0 mm hollow headless compression screws. For the TNC arthrodesis group, 14 patients received the TNC arthrodesis with reverse “V” shape osteotomy and autoallergic iliac bone graft. In the TN arthrodesis group, the patients' mean was 39.8 months (range, 11–66 months) follow-up. The mean American Orthopaedic Foot and Ankle Score (AOFAS) ankle and hindfoot scores had improved from 38.3±5.1 preoperatively to 88.9±1.9 at the last postoperative assessment. In the TNC arthrodesis group, the mean follow-up was 51.7 months (range, 12–90 months). The mean AOFAS ankle and hindfoot scores were 40.1±7.9 preoperatively and 90.1±2.0 at the last postoperative assessment. MRI evaluation revealed that either TN or TNC arthrodesis for stage III or IV Müller-Weiss disease has good clinical outcomes with solid fusion rate and obvious improvement in patients’ quality of life.

From the article of the same title
Journal of Orthopaedic Surgery and Research (06/05/17) Cao, Hong-hui; Lu, Wei-zhong; Tang, Kang-lai
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The Application of Wireless NIRS on Detecting Peripheral Circulation in Patients with DFU when Doing Buerger's Exercise
The majority of patients with diabetic foot ulcer have peripheral arterial disease. The technique of near infrared spectroscopy (NIRS) used to monitor the dorsal foot blood circulation condition operates by measuring the absorption differences between oxy-hemoglobin and deoxy-hemoglobin. Patients with diabetic foot ulcer treated in a wound care center were divided into two subgroups based on Duplex ultrasound or angiography. Patients with peripheral arterial disease and nonperipheral arterial disease were divided into groups A1 and A2, respectively. Wireless NIRS was applied on the dorsal aspect of patients' feet to assess the peripheral circulation by continuously detecting the signal penetrating the tissue while patients were asked to do Buerger's exercise. The same procedure was also repeated on 15 healthy participants as control group B. Tissue concentration of oxygenated hemoglobin (HbO2) in each group varied similarly in all groups among five stages of Buerger's exercise. HbO2 concentration increases at postexercise stages in all groups (P=0.006 in Group A1, P=0.223 in Group A2, P=0.03 in Group B); however, there were significant difference in both pre- and postexercise stages (P=0.001 and P=0.01, respectively) between Groups A and B. Moreover, significant differences (P=0.0009) of HbO2 were also found between Group A1 and A2 in preexercise status, but no significant difference (P=0.294) was found in postexercise status. Similar results were also found in total hemoglobin concentration analyses.

From the article of the same title
Lasers in Surgery and Medicine (06/05/17) Chen, Min-Ling; Lin, Bor-Shyh; Su, Cheng-Wei; et al.
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Practice Management

Nailing Down Hiring and Retaining Staff at Your Practice
Staffing can be one of the most expensive factors for medical practices. As a result, replacing an employee can be costly. To help hire the best possible employee, practices should consider how much knowledge the prospect brings to the practice. Second, it is also important to consider the skills s/he possesses, and how they can be put to use in the practice. Finally, a potential employee's attitude should make him or her an easy fit with the rest of the team. Other things to consider are the offerings a practice may have for employees like tuition reimbursement, seminar funding, coaching programs and other training options.

From the article of the same title
Physicians Practice (06/07/17) Dahl, Owen
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Top 10 Tips to Unlock Telehealth’s Potential in Your Practice
Technological advancements have made it possible for telehealth to become a more popular method of delivering healthcare services. However, to successfully provide telehealth services, care providers must consider several things. Among them is an understanding of the hardware needed for patients, and it is important to know if that hardware is compatible with software used in a practice. Doctors will also need to confirm whether the proper amount of bandwidth is available. Securing data collected during examinations is vital as well. Purchasing an electronic health records system will make telehealth services easier to provide. Providers are encouraged to start small, conduct a test program and collect feedback from patients.

From the article of the same title
Medical Economics (06/07/17) Levy, Adam
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You're Fired! When Doctors Let Patients Go
Research published in JAMA Internal Medicine estimated that 67 percent of 794 primary care practices reported terminating the patient-physician relationship for one to 20 patients over two years. Meanwhile, 15 percent said they dismissed 21 to 50 patients, 10 percent reported no patient dismissals and eight percent said they dismissed 51 or more patients. A total of 443 practices were participants in the federal Comprehensive Primary Care initiative, and 351 were in a control group. The study was motivated by concerns that patient dismissals may increase because some insurers are starting to compensate doctors for health outcomes instead of services provided. "The providers stuck with their patients,"notes Mathematica Policy Research's Ann O'Malley. "They did not seem to be worried that just because they were in this initiative and being measured on some sort of quality metric that they needed to cherry-pick their patients." O'Malley says the number of patients dismissed was proportional to the size of the practice. Patients who were disruptive or who behaved inappropriately with staff or clinicians were the main concern, while about 78 percent of practices said they dismissed patients for violating chronic pain and controlled-substance abuse policies. Seventy-four percent pointed to patients repeatedly missing appointments and about 45 percent reported dismissing one or more patients for not following medical recommendations. Thirty-nine percent said they had dismissed one or more patients because they paid their bills late.

From the article of the same title
Wall Street Journal (06/05/17) Reddy, Sumathi
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Health Policy and Reimbursement

Anthem Exits From Ohio ACA Exchange
Anthem said it will pull out of the health insurance exchange in Ohio next year, leaving a second region of the country poised to have no marketplace options under the Affordable Care Act. Insurers are finalizing their plans for next year, and exchange choices have grown sparse in many markets around the country. While several insurers have said they plan to return for 2018 and metropolitan markets are expected to still have several choices, national companies like Humana and Aetna have already decided to leave the on-exchange market entirely.

From the article of the same title
Associated Press (06/07/17)
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Hospitals Now Tap Lawyers to Fulfill Patients’ Legal Needs
Hospitals are increasingly finding uses for lawyers inside healthcare facilities. This trend comes as healthcare systems transition to more comprehensive medical destinations for patients. Experts say including lawyers in patient care issues makes sense due to the legal problems that may result from bad medical outcomes. Attorneys may also be useful following certain procedures like gender transition surgery. Other hospitals have used lawyers to help needy patients ensure they have housing or are able to continue to afford medications. According to Ellen Lawton, codirector of the National Center for Medical-Legal Partnership at George Washington University, about 300 healthcare systems, children’s hospitals and federally qualified health centers have programs offering attorney assistance.

From the article of the same title
PBS NewsHour (06/06/17) Andrews, Michelle
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How ACA Repeal and Replace Proposals Could Affect Coverage and Premiums for Older Adults
With the House having approved the Affordable Care Act's (ACA) repeal and replacement, Senate negotiators are now confronted with policy decisions that could affect older adults who have not yet reached the age to qualify for Medicare. Among the ACA's provisions for older adults having difficulty finding more affordable health insurance coverage were guaranteed access to insurance, age rating restrictions and a ban on premium surcharges for people with preexisting conditions. The House-approved American Health Care Act (AHCA) would revise current law and lead to a 5.1 million increase in the number of uninsured 50- to 64-year-olds in 2026, the Congressional Budget Office (CBO) concluded. These amendments would disproportionately affect older adults with incomes below 200 percent of poverty, with 50- to 64-year-olds experiencing the most coverage loss. CBO forecast the share of uninsured low-income older adults would climb from 12 percent under current law to 29 percent under the AHCA by 2026. Should the AHCA trigger a meaningful boost in the uninsured population in their late 50s and early 60s, it is reasonable to assume that people who lose insurance will postpone care, if they can, until they turn 65 and go on Medicare and then use more services once they enroll. This would likely lead to an increase in Medicare. Moreover, the AHCA would rescind the Medicare payroll tax for high earners, expediting the insolvency of the Medicare Hospital Insurance Trust Fund and putting the underwriting of future Medicare benefits in jeopardy for current and future generations of older adults.

From the article of the same title
Kaiser Family Foundation (06/05/17) Neuman, Tricia; Pollitz, Karen; Levitt, Larry
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Medicine, Drugs and Devices

Compliance Dates for Unique Device Identification System Extended
Thomas Gross, MD, MPH, director of Office of Surveillance and Biometrics Center for Devices and Radiological Health with the U.S. Food and Drug Administration (FDA), has penned a letter to device labelers that the compliance dates for the unique device identification system (UDI system) requirements for medical devices will be extended. FDA will release guidance that will detail the agency's plans. Gross said in the letter, "To fully reap the public health benefits and a return on investment of a UDI system, high-quality UDI data must be available in standardized ways so that the healthcare community can and will use it with confidence."

From the article of the same title
U.S. Food and Drug Administration (06/02/2017) Gross, Thomas
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Drug Deaths in America Are Rising Faster Than Ever
Drug overdose deaths in the United States reached about 62,500 in 2016, according to an estimate by The New York Times, marking the sharpest annual spike ever recorded in the country. The estimate was based on preliminary data compiled from hundreds of state health departments, county coroners and medical examiners. Because drug deaths take a long time to certify, the U.S. Centers for Disease Control will not be able to calculate a precise number of drug overdose deaths until December. The estimate, which represents a 19 percent increase over the 52,404 drug overdose deaths recorded in 2015, offers a preliminary look at the extent of the drug overdose epidemic last year, now made even more deadly by an inflow of illicitly manufactured fentanyl and similar drugs. The initial data suggests significant hikes in drug overdose deaths in states along the East Coast—particularly Maryland, Florida, Pennsylvania and Maine—and an estimated more than 25 percent jump in overdose deaths in Ohio last year.

From the article of the same title
New York Times (06/05/17) Katz, Josh
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Virtual Reality Finally Catches On
Businesses are taking to virtual reality (VR) for training in industries from construction to medicine to sports. At Johns Hopkins University, for example, orthopaedic surgeons are developing a way to use VR to superimpose patients’ X-rays onto the inside of goggle lenses. This would allow the surgeons to refer to the X-rays as they repair complicated pelvic fractures. The use of VR is spreading especially quickly through medicine. VR 3-D modeling of the brain developed by Surgical Theater is already being used for planning and practicing neurosurgeries in hospitals at New York University, University Hospitals in Cleveland and Mount Sinai, among others. A clinical study published last year in the Journal of Neurosurgery found that preoperative practice with Surgical Theater’s rehearsal platform reduced the time it took to repair aneurysms, which suggests it also made the surgeries safer.

From the article of the same title
Wall Street Journal (06/06/17) Morris, Betsy
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This Week @ ACFAS
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Mark A. Birmingham, DPM, FACFAS

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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