July 10, 2013
Have you seen the all-new yet?

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News From ACFAS

Make the ACFAS Facebook Switch Before August 1
ACFAS’ Facebook accounts are going through a “status” change. Currently, we have both a Facebook Group and a Facebook Page for members to keep engaged in the world of ACFAS and foot and ankle surgery. But, starting on August 1, ACFAS will transition to only using the Facebook Page, American College of Foot and Ankle Surgeons, and closing the “Group.” Why the change? As a Facebook Page, any updates that are posted to the page will now show up in your Facebook Newsfeed so you don’t miss a beat of the latest. It also allows you to more easily share posts with your colleagues on Facebook.

Don’t be left out of the conversation—in order to be part of the Facebook Page, even if you are a part of the old Group, you MUST go to and “Like” the page before August 1, 2013. Share the new Page with your colleagues and encourage other members of the podiatric surgical community to join in.

Your attention to our new Facebook Page will not go unnoticed; in fact, in an effort to spread the word about where you can go to find the most up-to-date ACFAS member information, we will be drawing from our pool of "Likes" to award two $50 American Express gift cards during the last two weeks of July, and a $100 Am-Ex grand prize will be awarded on August 1 to one lucky follower.

Visit our new Facebook Page now and spread the word!
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iPad JFAS App Access Expands
Student Club and International Affiliate Members now have access to The Journal of Foot & Ankle Surgery (JFAS) through the new JFAS iPad app. Thanks to an agreement with Elsevier, online access to the Journal now expands to all our members! The new app gives unlimited access to view full articles published by experts in the field at the touch of your fingertips. To download the new iPad app and start reading the latest in foot and ankle surgery research, follow these steps:

1. Register yourself through the Elsevier JFAS website at
2. Next, on your iPad, visit Apple’s App Store through iTunes and search JFAS.
3. Download the new JFAS app to your iPad.

Once you've downloaded the app and you've opened your Elsevier account, each issue of JFAS will arrive in your Newsstand on your iPad for you to download and read. You can find instructions for how to activate the app’s up-to-the-minute alerts by searching “JFAS” in the iTunes store.

If you have questions or issues with access, please contact Michelle Brozell, ACFAS Membership Director.
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Solving the Coding Conundrum in Chicago - Last Chance to Register!
Although it’s only nine days away, it's not too late to register to attend the 2013 Perfecting Your Practice: Coding/Practice Management Workshop, which takes place July 19-20 in Chicago at the Millennium Knickerbocker Hotel. The course is designed for physicians, coders, billers, collectors, and other office staff who have experience in fundamental coding. Attendees are encouraged to bring CPT and ICD-9 books for easy reference during the course. You will earn up to 12 continuing education contact hours by participating in this course.

Don’t miss this opportunity to bring crucial information back to your practice so your office staff can be armed with the most-up-to-date changes in coding and practice management.
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Master Your Skills for Minimizing Complications and Maximizing Results
Ever found yourself in the midst of a difficult surgical case that took an unexpected turn? Share your experience and learn from your colleagues when you join your peers for the unique, comprehensive problem-oriented course, Minimizing Complications, Maximizing Results, October 11-12 in New Orleans. The skilled faculty for this two-day course will focus on complications associated with the management of foot and ankle surgery through a series of case-based presentations, panel discussions, debates and lectures. Leave the program with a more critical approach to preventing and dealing with surgical complications and the aptitude to analyze case-based approaches to improve patient outcomes.

Participants earn 14 continuing education contact hours and there is special pricing for ACFAS members, but hurry, space is limited. Be sure to
register today before this class is filled.
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Foot and Ankle Surgery

Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patients with Inversion Ankle Sprain
A recent study has found that a manual therapy and exercise approach (MTEX) is better than a home exercise program (HEP) in treating inversion ankle sprains. During the study, inversion ankle sprain patients were randomly assigned to an MTEX or a HEP group. All patients completed the Foot and Ankle Ability Measure Activities of Daily Living subscale (FAAM-ADL), the Foot and Ankle Ability Measure Sport subscale (FAAM-SPORT), the Lower Extremity Functional Scale (LEFS) and the Numeric Pain Rating Scale (NPRS). Outcomes were collected at baseline and again at four weeks and six months.

Researchers found that patients in the MTEX group displayed greater improvements in all the functional outcome measures and pain than did patients in the HEP group after four weeks and six months. Finally, researchers found that the overall group time interaction for the mixed model ANOVA, which was used to examine the effects of treatment on pain and disability, was statistically significant for the FAAM-ADL, FAAM-SPORT, LEFS and pain in the MTEX group.

From the article of the same title
Journal of Orthopaedic & Sports Physical Therapy (07/01/2013)
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Practice Management

Hospitals Seek High-Tech Help for Hand Hygiene
Poor hand sanitation causes infection in hospitals, but hospitals still have difficulty forcing workers to sanitize as often as is necessary. To combat this, some hospitals have begun to use a sensor-badge that flashes green when hands are clean, flashes red when they need cleaning, and records whether hands were cleaned at each opportunity. Success rates are reported at 97 percent and 99 percent. Other hospitals use video monitoring, a wireless network that tracks when hand sanitizing stations have been used, and wall-mounted stations that sense clean hands and notify workers if their hands need cleaning. The badge system has caused a reported 66 percent reduction of hospital infections at Miami Children's Hospital.

From the article of the same title
USA Today (06/28/13) Salter, Jim
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When a Patient Shuns Care, Doctor Checklist Includes Compromise
Some patients, particularly those who have a history of mental illness or substance abuse, ask to be discharged from the hospital even though their doctors do not believe that it is in their best interest to leave. This situation creates a dilemma for doctors, particularly because they feel torn between the desire to respect the patient's freedom while simultaneously wanting to protect themselves from any liability that may arise from discharging the patient early.

Doctors who find themselves in this situation should first assess the patient's capacity for decision making, says Dr. Andrew G. Shuman of Weill Cornell Medical College's Division of Medical Ethics. Physicians who feel that their patients lack adequate decision making capabilities should then turn to surrogate decision makers and ask them to decide for the patient, Shuman says. If patients are unable to make good decisions and no surrogates are available, Shuman says, doctors may need to override their patient's desire to be discharged. If doctors find that a patient is able to make a good decision, they should still carefully explore the reasons why the patient is asking to be released from the hospital, Shuman says. Shuman adds that doctors who disagree with the patient's decision to be released should be certain to clearly communicate their reasons why. If doctors do decide to grant the patient's wishes, Shuman says, they should ask the patient to sign a waver stating that they are leaving against medical advice in order to protect themselves from any liability.

From the article of the same title
American Medical News (07/01/13) Shuman, Andrew D.
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ICD-10 Training: 5 Resources to Help Medical Practices Get Started
Medical practices have a number of resources that they can turn to to help them prepare for the transition from ICD-9 to ICD-10, which is scheduled to take place on October 1, 2014. Among them are the provider resources offered by the Centers for Medicare and Medicaid Services (CMS), which include comprehensive checklists, tips and transcriptions from webinars. The American Academy of Professional Coders, meanwhile, offers a number of courses that providers, coders and other staff members can take to prepare for the transition. In addition, Medical Group Management Association (MGMA) sells a book on its website called "ICD-10 Implementation Guide for Physician Practices" that includes a timeline physicians can use for the transition as well as tests that they can use to help them determine their readiness for adopting ICD-10. State MGMA chapters may also offer educational opportunities for doctors in their area that could be helpful in preparing for the transition as well.

From the article of the same title
Medical Economics (07/01/13) Ritchie, Alison
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Health Policy and Reimbursement

Consultant Says Employer Mandate Delay Could Mean Sicker Enrollees in Exchanges
Healthcare consultant Peter Kongstvedt says that the Obama administration's decision to delay the implementation of a provision of the Affordable Care Act (ACA) could have significant ramifications for the online health insurance exchanges that are scheduled to be set up this October. The delay means that employers with the equivalent of at least 50 full-time employees will not be required to provide affordable health insurance of "minimum value" until 2015. Kongstvedt says that pushing back the date when the requirement takes effect could negatively impact online health insurance exchanges because it will force sick employees who work for larger employers to find insurance on the individual market. That will result in the online marketplaces covering a sicker group of individuals, Kongstvedt says, which in turn could result in increases in the rates on plans offered through these marketplaces.

The delay could have other ramifications as well, Kongstvedt says. He noted that while insurers than are planning to sell qualified health plans through the marketplaces have already filed rates, their actuarial assumptions could change following the decision to delay the employer requirement. That in turn could negatively impact pharmaceutical manufacturers, device makers, and others that would have received payments from the federal government under ACA, Kongstvedt says.

From the article of the same title
BNA Snapshot (07/08/2013) Hansard, Sara
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Health Law Penalties Delayed
The Obama administration announced July 2 that it was delaying the implementation of one of the Affordable Care Act's requirements until 2015. That requirement calls for companies with the equivalent of 50 or more full-time employees to offer healthcare benefits beginning January 1, 2014. The administration said that the delay would give large companies more time to adjust to the Affordable Care Act's requirements, though it also said that it hoped companies would strive to comply with the intent of the law next year. Healthcare industry observers say that the move could be a harbinger of additional changes to the Affordable Care Act, including the possible delay of the mandate that requires everyone to purchase health insurance or pay a fine.

From the article of the same title
Wall Street Journal (07/02/13) Radnofsky, Louise
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Massive Medicaid Gap Could Gut Health Care Law
An analysis by the Associated Press has found that the majority of uninsured low-income adults who qualify for subsidized insurance coverage under the Affordable Care Act may not be able to receive it. According to the analysis, 9.7 million of the 15 million adults who are potentially eligible for Medicaid coverage under the Affordable Care Act may not be able to obtain this coverage because they either live in states that have refused to expand Medicaid or are undecided about expanding the program. Among the states where there is significant opposition to expanding Medicaid are Texas, Florida, and Georgia. These and other states, many of which are led by Republican governors opposed to the expansion, were allowed to opt out of the Medicaid expansion thanks to last year's U.S. Supreme Court ruling on the constitutionality of the Affordable Care Act.

From the article of the same title
Associated Press (07/02/13) Alonso-Zaldivar, Ricardo
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Medicaid's Mounting Audit Pressure
Federal audit programs regarding Medicaid will soon become more rigorous to handle larger patient numbers and reduce the billions spent improperly on Medicaid. While hospitals and device makers are audited more often, physicians face demands they are less able to meet when they are audited. Healthcare professionals face audits from numerous sources, including the federal Medicaid integrity contractors and Medicaid recovery audit contractors, as well as state-level oversight. To prepare to withstand scrutiny, doctors are obliged to spend time completing documentation and inputting data that is useful neither to patient nor physician. Calls for reform include employing physicians or those otherwise with medical knowledge to take part in audits instead of outside contractors, and to increase communication between audit authorities to prevent a duplication of efforts that is extremely time- and resource-intensive for the subject.

From the article of the same title
American Medical News (07/01/13) Lubell, Jennifer
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Medicine, Drugs and Devices

Useful Screening Tools for Preventing Foot Problems of Diabetics in Rural Areas: A Cross-Sectional Study
Researchers in Taiwan have performed a study that examined the use of non-invasive assessment tools and physiological indicators in the early detection of diabetic foot problems (DFP) in people living in rural areas. Peripheral neurovascular function of the study's 387 patients was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), Ankle Brachial Index (ABI), optimal scaling combination (OSC) of MNSI and age. The King's College classification and Texas risk classification, meanwhile, were used to give researchers a better understanding of diabetic foot complications. Researchers concluded that using OSC, MNSI and ABI as community screening tools can help doctors detect neurovasculopathy early. MNSI or OSC may also be a cost-effective option when an ABI machine is not available, researchers said.

From the article of the same title
BMC Public Health (06/27/2013) Chang, C.H.; Peng, Y.S.; Chang, C.C.
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FDA Moves to Allow Updates of Generic Drug Warnings
Bowing to concerns from consumer watchdog groups, the Food and Drug Administration (FDA) announced July 3 that it would give generic drugmakers the authority to change safety labels on their products after new information about possible risks is found. Generic drugmakers are currently allowed to change their labels only if they are ordered by the FDA to do so or if changes have been made to the label of a generic drug's brandname equivalent. However, critics of that policy say that it creates a safety problem because hundreds of generic drugs have no brandname counterpart. Public Citizen, one of the consumer watchdog groups that has called on the FDA to change the policy, says that it will help improve safety for patients who take generic drugs.

From the article of the same title
Medill News Service (07/04/13) Pringle, Aubrey
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Variation in ED Imaging Rates Not Dependent on Physician Training
The journal Radiology has published a study that examined the factors that influence the variations in the use of imaging among doctors in emergency departments. Researchers analyzed nearly 89,000 emergency room visits at Boston's Massachusetts General Hospital in 2011, and found that patient and visit factors--including prior visits, referral sources and arrival modes--were the main predictors of the likelihood of imaging use. Busier emergency departments also tended to use imaging more frequently, the study found. The findings contradicted previous research that found that factors related to doctors, such as their experience, training or gender played a significant role in the variation of imaging rates in emergency departments.

From the article of the same title
American Medical News (07/01/13)
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AMA Meeting: Tougher Rules Needed to Stop Misleading Medical Device Ads
The American Medical Association (AMA) House of Delegates has approved a report from the Board of Trustees that calls for more stringent regulation of advertisements for durable medical equipment (DME). The report says that the AMA should lobby for legislation or regulations that require direct-to-consumer advertising for DME to note that patients need to meet certain criteria in order to be eligible to obtain DME and to receive coverage for such equipment. The ads should also list the actual criteria from an appropriate source, the report said, and should note that only a doctor can determine if a patient meets the standards. In addition, the report said that advertisements for DME should not state that the only thing a patient needs to obtain the equipment is a doctor's order or signature. Finally, DME companies should stop coercing doctors into signing prescriptions for the equipment, the report said.

AMA delegates believe that such regulation is needed because DME advertisers often promote their products without explaining how patients qualify to obtain them. Delegates also said that some ads cause patients to believe that they can obtain DME when in fact they do not qualify. Some delegates wanted the report to go further by saying that misleading ads for DME constitute fraud and that companies who place such ads will be prosecuted.

From the article of the same title
American Medical News (07/01/13) Gallegos, Alicia
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