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News From ACFAS

Give Us Your Feedback on Poster Printing & Delivery
To help the College exceed your needs, let us know if a third-party service offered through for poster printing and delivery to ACFAS 75 in Las Vegas next year would be helpful to you.

Take our poll to the right and let us know!
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Put ACFAS' e-Book at the Top of Your Summer Reading List
Arthroscopy of the Foot and Ankle, the College’s first e-Book, is well on its way to becoming a bestseller. This first release in an upcoming series of ACFAS e-Books breaks down arthroscopic surgery into 16 in-depth, yet digestible, chapters that feature:
  • videos and images to guide you through procedures;
  • self-assessments after each chapter to earn CME;
  • intuitive navigation; and
  • built-in notetaking and bookmarking tools.
Visit to purchase the e-Book and continue to watch This Week @ ACFAS for updates on new releases.
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Unmatched Residents: Sign Up for Student-Transitional Status
ACFAS offers a Student-Transitional membership category for unmatched residents who have not yet found placement within a program. The membership provides graduated students a one-year transitional membership at no cost.

Through ACFAS, graduated students without a residency match can:
  • access The Journal of Foot & Ankle Surgery online;
  • receive student pricing for all ACFAS educational offerings; and
  • network with ACFAS members who can assist in their search for a residency match.
Contact the ACFAS Membership Department at or (773) 693-9300 for more information.
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Foot and Ankle Surgery

Cortical Bone Thickness May Be Useful in the Prediction of Osteoporosis
Researchers measured cortical bone thickness (CBT) in standard ankle radiographs and found that the measurement may be a viable method for predicting osteoporosis. In the study, 167 patients were analyzed using both the gauge and average methods on the standardized anteroposterior, lateral and hindfoot alignment radiographs to measure CBT. The average measurements strongly associated with dual X-ray findings of the hip, femur and lumbar spine, and researchers noted that the reliability of the measurements was excellent. Use of 3.5 mm average CBT in the distal part of the tibia on anteroposterior radiographs for predicting osteoporosis, for example, showed 100 percent sensitivity, 25 percent specificity and 33 percent accuracy.

From the article of the same title
Journal of Bone and Joint Surgery (05/16)
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Rx for Better Orthopaedic Surgeons: Track Their Errors as Well as Their Skills
The best way to evaluate the operating skills of new orthopaedic surgeons is to track their errors in addition to observing performance, according to a small study from Johns Hopkins. Step-by-step checklists and measures of general surgical skills are helpful, but tracking errors can give a complete picture of a trainee's overall ability. Without tracking errors, residents rarely receive formal feedback on their motor skills or mistakes, and those mistakes can continue because they are never addressed. Researchers tested trainees using the Objective Structured Assessment of Technical Skills (OSATS), followed by the Global Rating Scale and a simple pass/fail system. Under the pass/fail system, residents received a failing grade if they made an egregious error. OSATS and the Global Rating Scale provided good, objective ways of measuring resident performance, while the pass/fail system gave residents unambiguous feedback. None of these evaluations, however, adequately captured all mistakes. It is still possible to perform well on OSATS even while making an egregious error. To correct this, researchers recommended adding safety steps, such as identifying and protecting important structures, to the checklist. The hope is that a comprehensive training protocol can be developed for use across multiple types of surgeries.

From the article of the same title
Medical Xpress (06/29/16)
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Successful Treatment of Foot and Ankle Neuroma Pain with Processed Nerve Allografts
Localized nerve pain in the foot and ankle is the most common complication following operative interventions. A new study discussed a novel method for managing this discomfort using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity. Twenty-two patients were given preoperative and postoperative pain assessments. The most common diagnosis for these patients was neuromas of the sural and superficial peroneal nerves. A three-centimeter nerve allograft was used in most of these cases. Eight patients had end neuromas, and 18 patients had neuromas in continuity. Mean ordinal pain scores decreased by 2.6. Patient Reported Outcomes Measurement Information System Pain Behavior and Pain Interference assessments decreased by 24 and 31 points, respectively. The allograft process was determined to be effective at improving localized nerve pain.

From the article of the same title
Foot & Ankle International (06/16) Souza, Jason M.; Purnell, Chad A.; Cheesborough, Jennifer E.; et al.
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Practice Management

Four Big Mistakes Doctors Make in Protecting Patient Data
Protecting patient data is a complex task, and physicians in both large and small practices are often readily exposing protected health information and paying hefty fines. Here are the four most common physician mistakes regarding patient data:
  1. Leaving laptops and other devices unencrypted. HIPAA privacy regulations require physicians to keep patient information confidential, and the best way to do so is by encrypting all devices. While large hospitals can spend up to $500,000 on encryption software, smaller hospitals can turn to more affordable options, such as BitLocker or FileVault 2.
  2. Opening an infected email link. Phishing scams as a result of accidentally clicking on a malicious email link remain the biggest threat to cybersecurity. These emails are hard to spot and less tech-savvy employees could easily expose sensitive information. The best way to limit phishing scams is to provide professional security training to your staff. In-person training and online resources are both effective.
  3. Relying too much on weak passwords. Weak passwords allow hackers unfettered access to your patient information. Hackers use complex software that can track keystrokes, as well as other methods, to uncover your password. Choose a phrase or short memorable sentence and then shorten it by using initials or other types of mnemonics.
  4. Failing to update your computers and antivirus programs. Simply employing an antivirus program is not enough to prevent hackers from gaining access to information. You must constantly update the software and applications in your practice. Never let antivirus subscriptions expire. It is recommended that you enable auto-update features to prevent mistakes.
From the article of the same title
Medscape (06/29/16) Cerrato, Paul
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Three Tips for Improving Your Practice's Profitability
Practices looking to become more profitable should start by cutting unnecessary costs, according to an article in HealthCare Business. Managing costs proactively is the best way to predict and adapt to changing regulations while remaining cost efficient. Here are three ways to drive down practice costs:
  1. Evaluate staffing practices. Employee salaries are likely to be a practice's largest expense, so it is important to make sure your staff is managed correctly. Analyze the number of people on staff, the type of workers employed and whether each position requires a full-time or part-time employee.
  2. Keep good financial and performance records. Measuring your financial and performance records will allow you to manage them more effectively. Evaluate your revenue cycle, liquidity, expenses and productivity measures.
  3. Focus on workflows. Take a look at your billing cycle to correct any inefficiencies that could be affecting your revenue. In addition, analyze the typical patient visit to figure out how best to make the process more efficient. Streamlining your workflows can eliminate unnecessary costs.
From the article of the same title
Fierce Healthcare (06/27/2016) Kuhrt, Matt
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Ways to Keep Your Private Practice Afloat
Around 30 percent of physicians reside in private practice despite increased regulations and burdens that often cause small practices problems. The new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may make private practice even more difficult. How can a practice stay afloat when so many changes are on the horizon? The most important first step is to know your practice's finances. If you are too busy, hire a company to perform a financial analysis. Fix any problems the analysis finds and find out what changes need to be made so that you get paid for almost all of your claims within 30 days. Review all overhead costs and compare options to see where you can make reductions and save money. Be sure to keep abreast with all new regulations so that you do not suffer consequences for noncompliance. Make smart device purchases and be sure you are confident that your staff is performing to the best of their ability. Do not overspend on advertising and if necessary, consider alternative models of practice, such as Direct Primary Care. Finally, talk with other physicians. The best ideas often come from people who have struggled through private practice themselves.

From the article of the same title
Physicians Practice (06/28/16) Girgis, Linda
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Health Policy and Reimbursement

House Reps Introduce Healthcare Transparency, Cost Info Bill
House Representatives Michael Burgess and Gene Green have introduced the Healthcare Price Transparency Promotion Act of 2016, which would require hospitals and health insurers to provide healthcare cost information to patients and beneficiaries before the point of care. The bill could lower healthcare costs by allowing patients to compare costs while also spurring competition between providers. "This bill is an important first step toward empowering patients and advancing value-based care,” Green said. Hospitals would be required to provide timely access to cost information, and insurers would be required to give beneficiaries a statement of the estimated out-of-pocket cost for specific items and services within a certain period of time. Ultimately, Burgess and Green want to help individuals gain more control over their healthcare decisions. The American Hospital Association commended the bill, saying it is an excellent way to build on existing state laws. Additionally, the bill calls for more research into healthcare costs. The Agency for Healthcare Research and Quality would conduct research related to out-of-pocket costs, price differences based on health benefits coverage and new methods for how to share information in a timely and convenient way.

From the article of the same title
RevCycle Intelligence (06/27/16) Belliveau, Jacqueline
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Report: Patients' Health Costs Jumped 13 Percent in 2015
A new report from TransUnion Healthcare reveals that patient deductibles and out-of-pocket costs both increased by 13 percent between 2014 and 2015. The average deductible was $1,278 and the average out-of-pocket cost was $3,740. In addition, the report found that more than half of American owed at least $1,000 in medical bills, and 77 percent owed at least $500. Study leader Jonathan Wilk said these changes are making healthcare providers be more proactive by informing patients of costs, discussing financing options and seeking payment in advance of procedures. Orthopaedics and general surgery were two of the three areas that had the highest out-of-pocket costs for patients. Patients have less revolving credit, too. For every $100 in medical bills, Americans had an average revolving credit availability of $1,720 in the first quarter of 2016, down significantly from the $2,250 in credit per $100 in medical bills in the first quarter of 2015. The report concluded by saying the data "emphatically" shows that patients are struggling to pay healthcare costs even with the Affordable Care Act.

From the article of the same title
Physician's Money Digest (06/16) Kaltwasser, Jared
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Study on EHRs Finds That Many Docs Adhere to 'Culture of Silence' Around Tech Issues
The implementation of electronic health records (EHRs) was meant to standardize care, improve communication and increase research and analysis. But a new study from Cleveland State University shows that clear challenges still exist, including increased workloads, trust issues, perceived over-reliance on technology and problems with training. The study also noted that many doctors have created "workarounds" that allow them to avoid using EHRs altogether, and some are reluctant to speak about persistent issues because of a "culture of silence" employed by medical institutions. The study authors said the report, the first of its kind to specifically examine physician perception of EHRs, can be used to increase communications within medical spaces. The data could help break down the culture of silence and address real issues. A larger study is in the works to add to this body of data, and it aims to assess how physicians perceive EHR costs and benefits.

From the article of the same title
Healthcare Informatics (06/29/16) Leventhal, Rajiv
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Medicine, Drugs and Devices

Can Digital Communication, Mobile Health Boost Patient Satisfaction?
A new study conducted by Salesforce found that while 91 percent of patients are satisfied with their primary care providers, there is still room for physicians to use more digital communication tools. Most patients use the telephone or in-person interactions for medical needs, including scheduling appointments, viewing health data, getting lab results and getting prescription refills. Meanwhile, less than a third of patients are using patient portals to look at health data, and only 23 percent use them to get lab results. The survey indicated that 62 percent of patients are open to more digital treatment options, and 60 percent said they would choose a primary care provider who offers home care treatment. Patients want convenience, and digital tools, such as portals and wearable devices, are the way to address that need. Three quarters of patients want their providers to have access to their wearable or app data, with a majority wanting their providers to have an up-to-date view of their health. According to Salesforce executive Joshua Newman, the survey reveals that patients are choosing their providers in part because of how well they use technology to communicate. Therefore, it is important for healthcare professionals to adopt more digital tools to adapt to evolving patient needs.

From the article of the same title
Patient EngagementHIT (06/27/16) Heath, Sara
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Doctors Wrestle with Mixed Messages When Deciding Whether to Prescribe Painkillers
Guidelines released this spring by the Centers for Disease Control and Prevention advise doctors to prescribe opioids in higher doses only when truly needed. While this was aimed to curb opioid abuse, a second federal policy linking hospital payments to patient satisfaction surveys could be undoing the positive steps. These surveys allow patients to evaluate how doctors managed their pain, but many physicians believe the reports can color a doctor's judgment. It could set up a system where doctor ratings get caught between patient demands and sound medical reasoning. Many mixed signals exist, according to Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. Physicians are being told not to prescribe opioids, she said, but they're also being told to manage patient pain effectively. Some organizations are pushing for action. The American Hospital Association and certain advocacy groups are calling on the Centers for Medicare and Medicaid Services to eliminate the questions or rephrase them, or even disconnect them from hospital payments.

From the article of the same title
Healthcare Finance News (06/29/16)
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How Telemedicine Is Transforming Healthcare
Telemedicine is having a growing impact on the delivery of U.S. healthcare, driven by faster Internet connections, widespread use of smartphones and changing insurance standards. More than 15 million Americans received some kind of medical care remotely last year, according to the American Telemedicine Association, which expects those numbers to grow by 30 percent this year. Insurance coverage varies from health plan to health plan. Medicare currently covers a small number of telemedicine services for beneficiaries in rural areas and only when the services are received in a hospital, doctor's office or clinic. Bills to expand Medicare coverage of telemedicine have bipartisan support in Congress. Some 32 states have passed "parity" laws requiring private insurers to reimburse doctors for services delivered remotely if the same service would be covered in person but not necessarily at the same rate or frequency. Related Story: Wall Street Journal (subscription)

From the article of the same title
Wall Street Journal (06/26/16) Beck, Melinda
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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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