June 22, 2016 | | JFAS | Contact Us

News From ACFAS

It’s a Tie
Last Wednesday, we polled This Week @ ACFAS readers to see how many employ a nurse practitioner (NP). Surprisingly, results were tied at 36 percent between those who do not employ an NP and those whose state does not allow it. Twenty-seven percent of respondents employ an NP.

To promote the foot and ankle surgical profession among NPs, the College’s “Take a New Look” campaign is exhibiting this week at the American Association of Nurse Practitioners’ 2016 National Conference in San Antonio. ACFAS President Sean Grambart, DPM, FACFAS, ACFAS staff and the FleishmanHillard team will use this opportunity to encourage NPs to refer patients to ACFAS members
for foot and ankle care.

Thank you to everyone who voted in this latest poll, and be sure to watch This Week @ ACFAS and for new monthly polls and up-to-the-minute results.
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Time Is Running Out: Register Now for Coding Workshop
The clock is ticking—register now for our new Coding and Practice Management Workshop July 8–9 in Denver and learn how to get reimbursed for the care you provide. Gain tools to simplify your coding and reimbursement practices as expert faculty walk you through:
  • multiple-procedure cases when performing forefoot, rearfoot or ankle reconstructive surgery;
  • open reduction and internal fixation of multiple fractures;
  • complex arthroscopy cases; and
  • diabetic foot surgery.
You'll also code real-time patient scenarios and leave with helpful handouts as well as customized checklists and forms specially created for this workshop.

Register today at
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Confused About MACRA? ACFAS Is Here to Help
In April 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA repealed the Sustainable Growth Rate, a method the Centers for Medicare & Medicaid Services used to control Medicare spending on physician fees and services.

Two new payment systems were created in response to the bill passing: the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Method (APM). These systems represent the transition away from reimbursement based on fee for service to reimbursement based on quality (among other factors). Physicians will now choose to participate in either MIPS or an APM.

Visit for resources that explain the differences between MIPS and AMP and for an in-depth explanation of how MIPS will affect you and your practice. For more information on MACRA, contact Sarah Nichelson, JD, director, Health Policy, Practice Management and Research.
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ACFAS Member Assists the College & Wins Big
Congratulations to Alex Scholl, DPM, FACFAS! The foot and ankle surgeon from Hastings, Minnesota won a $100 AMEX gift card for participating in ACFAS’ recent short survey on practice types, residency and podiatry school faculty appointments.

Many thanks to those members who took the time to give the College some feedback about their practice type. The College now has a better understanding of how our members practice and how many are involved with residencies and podiatric medical schools. Watch for follow-up to these questions in future This Week @ ACFAS monthly polls.
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Foot and Ankle Surgery

A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures
No agreement exists concerning the optimal treatment of acute Achilles tendon ruptures in active patients. A new study enrolled 60 patients with acute Achilles tendon ruptures to receive either surgery or nonsurgical treatment to compare clinical outcomes. Surgery was basic end-to-open repair; nonsurgical treatment included a week of cast immobilization, followed by a functional orthosis for six weeks, allowing full weightbearing after week one and active plantar flexion after week five. After follow-up, the mean Leppilahti score was 79.5 for surgery patients and 75.7 for nonsurgical patients. Surgery resulted in faster and better recovery of calf muscle strength, and at six months, the difference in range of motion varied 16 percent to 24 percent in favor of the surgery group. At 18 months, a 14 percent difference in peak torque also indicated a better outcome for the surgery group. That group also had better RAND SF 36-Item Health Survey scores for physical functioning and bodily pain. While each method had similar results, surgery provided clearer overall benefits.

From the article of the same title
American Journal of Sports Medicine (06/15/16) Lantto, Iikka; Heikkinen, Juuso; Flinkkila, Tapio; et al.
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Psychosocial Risk Factors for Postoperative Pain in Ankle and Hindfoot Reconstruction
A recent study aimed to examine factors associated with pain after ankle and hindfoot reconstruction. A total of 139 patients who underwent major ankle or hindfoot reconstruction over a three-year period were analyzed for factors, including demographics, comorbidities, tobacco and alcohol use, mood disorders and more. All patients reported visual analog pain scores (VAS), and the primary outcome was the cumulative amount of narcotic prescribed in the initial 90-day postoperative period. Narcotic prescriptions were required after 35 percent of surgeries at an average amount of 1,711 mg. Preoperative narcotic use, chronic pain disorder and mood disorder were significant risk factors for continued use past 90 days. Tobacco use and chronic pain disorder were also significant risk factors. The average VAS score after follow-up was 2.1. Any patient with the identified risk factors should be carefully analyzed. Physicians should be ready to discuss proper pain management strategies with these patients.

From the article of the same title
Foot & Ankle International (06/16) Mulligan, Ryan P.; McCarthy, Kevin J.; Grear, Benjamin J.; et al.
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Treatment of Acute Jones Fractures Without Weightbearing Restriction
Jones fractures are typically treated with a period of nonweightbearing or operative treatment. These options can result in adverse effects and can pose various risks to the patient. Researchers tested treatment without weightbearing restrictions to determine if it was a viable option. Twenty-seven patients with acute Jones fractures were treated without weightbearing restrictions. Twenty-four of the patients achieved clinical union after a mean of 8.0 ± 2.6 weeks. Complete radiographic union was achieved in 13 patients, while another 13 made significant progress toward that endpoint. One patient developed nonunion. The review revealed that Jones fractures can be adequately treated without weightbearing restriction.

From the article of the same title
Journal of Foot & Ankle Surgery (06/10/16) Marecek, Geoffrey S.; Earhart, Jeffery S.; Croom, William P.; et al.
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Practice Management

AMA Posts New Telehealth Ethical Guidance
The American Medical Association (AMA) has released new guidelines aimed at clarifying physicians' responsibilities during telemedicine interactions with patients. The guidelines note that telemedicine is the next stage in care delivery and patient engagement, and it should be looked at as a necessity and not as optional. Physicians should use the technology efficiently while also using discretion and prescribing therapy within certain safeguards. The models and methods of care will continue to evolve, but physicians must still maintain fundamental ethical responsibilities. While these technologies can be powerful, they also come with limitations. Physicians must take the appropriate steps to overcome these limitations. Interoperability remains a concern, and the guidelines said a coordinated effort is necessary to achieve telemedicine's full potential.

From the article of the same title
Healthcare IT News (06/15/16) McCarthy, Jack
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Top Three Factors Driving Patient-Centered Healthcare Initiatives
A recent report from Philips outlines three main factors behind the steady rise of patient-centered healthcare initiatives. These factors are patient access to healthcare, care coordination and patient technology adoption. Most providers believe the industry has been successful in the shift to patient-centered care thus far, and 75 percent believe that patients are able to access most tests required for adequate diagnoses. Patients, on the other hand, are not as confident. Healthcare costs remain a large concern for more patients, and 70 percent of patients believe the government should make reducing healthcare costs the country's highest priority. This is where care coordination comes in: providers believe proper coordination can reduce costs for certain aspects of healthcare, but both providers and patients believe bureaucracy is getting in the way of coordination. Providers indicate that adding healthcare technology into the mix could help with this issue. Proper technology can help patients get better access to better care while having a more positive experience. It can also help reduce costs, and more than half of patients reported using a health app of some kind on a daily basis. The interplay between patient-centered care, care coordination and health technology integration will be critical to defining the patient experience in the future.

From the article of the same title
Patient EngagementHIT (06/13/16) Heath, Sara
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Health Policy and Reimbursement

Replacing Joints Faster, Cheaper and Better?
Most U.S. patients receiving joint replacements face a long recovery and spend several days in a hospital bed before weeks or months of rehab. But advances in surgical techniques and technology are starting to change patient outlooks, and a growing number of surgeons are now moving their total joint replacement procedures out of the hospital and into outpatient facilities. Nowadays, surgeons can send some patients home within a few hours, and many do not require skilled nursing, rehab or home healthcare. Around 40 centers around the country are performing outpatient joint replacements, and the trend is starting to increase tensions between hospitals and surgeons. Moving these procedures cuts into hospital revenue since total joint replacements are among the most common and most profitable services that a hospital can offer. In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement, costing the government more than $7 billion for the hospitalizations alone. The new outpatient model is driven by the desire to lower costs and increase convenience. Surgeons who perform joint replacements at outpatient facilities can cut costs nearly in half. Hospitals are still trying to find a way to combat the loss of revenue, and some have become resigned to the notion that this is simply the direction in which healthcare is starting to move.

From the article of the same title
Modern Healthcare (06/04/16) Meyer, Harris
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CMS Makes $10 Million in Grants Available to Help with MACRA Transition
The Centers for Medicare and Medicaid Services (CMS) will award $10 million over the next three years to organizations that will help clinicians transition to the new payment system mandated by the Medicare Access and CHIP Reauthorization Act (MACRA). This is the second round of funding for the initiative, and its aim is to increase adoption of alternative payment models while keeping costs low. Thirty-nine networks will be called on to identify, enroll and provide tailored technical assistance to advanced practices in an attempt to reduce costs and transition efficiently to coordinated care. CMS will award cooperative agreement funding to successful applicants that may include healthcare delivery systems and healthcare delivery plans. Applications for the grant can be submitted at this time, and CMS expects to announce the winners in the fall.

From the article of the same title
Medical Practice Insider (06/10/16) Morse, Susan
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Hospitals Make Gains in Patient Safety, but Challenges Remain
New data shows that hospitals have made strides to improve patient safety, but more work must be done. According to an article in JAMA Viewpoints, the number of adverse events in hospitals has dropped by around four percent each year between 2010 and 2014, but the reasons for the decline are not clear. The article pointed out four possibilities: 1) increased research gave hospitals relevant information to make necessary changes, 2) new tools enabled hospitals to better address safety issues, 3) hospitals now have access to data and measures to assess safety culture and the rate of patient harm and 4) hospital leaders are more engaged in and committed to promoting patient safety. The question now becomes, what can be done to maintain or speed up the decline in harm that already exists? The article suggested that hospitals develop more reliable methods to measure adverse events, and leaders must continue to make safety a high priority. Minimizing diagnostic errors could be an important strategy to that end.

From the article of the same title
Fierce Healthcare (06/14/2016) Minemyer, Paige
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Coding Productivity Fell by 14 Percent After ICD-10 Implementation
Coding productivity and accuracy have marginally declined since ICD-10 began, according to a new study from the American Health Information Management Association. Overall productivity fell 14.15 percent, though overall accuracy only fell 0.65 percent. About 68 percent of respondents indicated a decrease in productivity while 5.8 percent noted an increase. About a quarter of respondents reported no change. Most respondents (61.5 percent) said there was no change in overall accuracy, 30 percent said there was a decrease and 26.9 percent saw an increase. Experts expected a dip in productivity as organizations adjusted to ICD-10, but it appears that for most providers, work is returning to pre-ICD-10 levels. The study also analyzed providers who used computer-assisted coding to adhere to ICD-10. Those who used computer-assisted programs saw productivity decline by 17.1 percent, though overall accuracy increased by 0.2 percent.

From the article of the same title
RevCycle Intelligence (06/14/16) Belliveau, Jacqueline
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Rise in Healthcare Spending for People with Diabetes In 2014, Increase in ER Visits and Use of Generic Prescriptions, Finds New Report
Healthcare spending for people with diabetes covered by employee-sponsored insurance (ESI) grew nearly six percent in 2014, compared to 3.2 percent for people without diabetes, according to a new study from the Health Care Cost Institute. Spending on people with diabetes grew to $16,021 per capita, $897 more than 2013 and more than $10,000 higher than people without diabetes. The report found that people with diabetes had twice as many doctor and ER visits and took five times more prescription drugs than those without diabetes. In addition, they used more services related to mental health and cardiovascular disease. Patients with diabetes also spent two and a half times more out of pocket than those without diabetes, an average of $1,944 compared to $752. Young adults (ages 19–25) with diabetes had four times more hospital admissions for mental health and substance use than did young adults without diabetes. With this data, researchers can try to learn better ways to address the complex needs of patients with diabetes.

From the article of the same title
Health Care Cost Institute (06/20/2016)
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Medicine, Drugs and Devices

FDA Issues New Guidance on Osteoporosis Drug Development
The U.S. Food and Drug Administration (FDA) has released new draft guidance calling for drugmakers to conduct long-term bone quality studies for osteoporosis treatments. These studies are necessary to determine whether the drugs lower bone quality over time. The studies will be nonclinical because "there are no validated and reliable methods for the noninvasive assessment of bone quality in humans." For most drugs, the guidelines call for companies to conduct studies in two animal species. In addition, certain specific recommendations are made in regard to postmenopausal osteoporosis, the most common form of the disease. In cases where biologics may not be required to conduct the tests, FDA says sponsors should choose an animal model based on pharmacological responsiveness. Finally, the guidance calls for drug companies to consider the carcinogenic potential of osteoporosis drugs.

From the article of the same title
RAPS (06/13/2016) Mezher, Michael
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National Security Agency Exploring Use of Biomedical Device Data
The National Security Agency (NSA) will soon work on collecting data from biomedical devices, according to Richard Ledgett, the agency's deputy director. Ledgett said this desired access is two-sided: it could provide NSA with a large amount of critical information, but it could also open devices to unwanted surveillance from terrorists or hackers. But digital health continues to grow, meaning that NSA will undoubtedly look to take advantage of the booming market. Fifty-seven percent of patients between the ages of 18 and 34 have at least one health monitoring device. Hospital and medical devices, meanwhile, are an estimated 10 years behind the industry security standard. Ledgett explained that the NSA was only interested in biomedical device data from a theoretical research point of view at this time, adding that the agency will continue to focus its efforts on technology that terrorists currently prefer to use.

From the article of the same title
Med Device Online (06/15/2016) Hodsden, Suzanne
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Neuroprosthetics Market Expected to Be Worth $14.6B by 2024
The global neuroprosthetics market will reach $14.6 billion by 2024, according to new data from Grand View Research. The increasing prevalence of neurological disorders, as well as the demand for new technologically advanced implants, will be the driving factor for growth. Motor prosthetic devices currently hold the largest market share, accounting for 35 percent of all neuroprosthetics. The demand is strongest in North America, where 43 percent of all neuroprosthetics are used. These devices can treat various neurological diseases and assist patients, particularly those who have trouble feeling or moving their lower extremities.

From the article of the same title
Healio (06/15/2016)
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This Week @ ACFAS
Content Reviewers

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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