July 19, 2017 | | JFAS | Contact Us

News From ACFAS

Save the Date for ACFAS 2018
March 22–25, 2018
Nashville, where music reigns as the universal language, is a city like no other. With live music at the honky tonk bars along Lower Broadway and a top-rated food scene, Nashville delights the senses and never fails to surprise you.

Join us in this extraordinary city for the 2018 ACFAS Annual Scientific Conference, March 22–25, 2018 at the Gaylord Opryland Hotel and experience the best of what Nashville has to offer plus:
  • Nonstop clinical sessions and workshops
  • Exhibits and scientific posters showcasing the latest technologies and techniques
  • Special events
  • Unlimited networking opportunities
  • And more!
Head to Nashville a day early for special preconference workshops on Wednesday, March 21 then top off your last night of the conference with the Wrap Party on Saturday, March 24 at the legendary Country Music Hall of Fame.

Mark your calendars now, and visit for ACFAS 2018 details and updates as they become available.
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Rethink Forefoot Treatment in New Regional Program
ACFAS’ new On the Road regional program, “In the Trenches,” moves beyond the gold standard in treating forefoot, soft-tissue and midfoot injuries and deformities. Expect new solutions to your most challenging cases and fresh approaches that you can put into practice immediately when on the frontlines.

This seminar begins on Friday evening with the presentation, “Controversies and Complications,” followed by an open discussion during which you can share your work cases. Saturday features a series of lectures presented by expert faculty plus two hands-on labs on the Big 6 Techniques and osteotomies.

Visit to register today.
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ACA Is the Focus of ACFAS Comments
As of today, the law of the land is still the Affordable Care Act, and it was the focus of recent comments by ACFAS via the Coalition for Patients’ Rights (CPR) on strengthening Section 2607(a) that prohibits discrimination against licensed healthcare professionals acting within their scope of practice.

By retaining and strengthening this clause, it would help DPMs be able to practice to the fullest extent of their license without being discriminated against. It will also help to ensure patients can get the foot and ankle care they need. Read the CPR letter here. For more information, contact Sarah Nichelson, JD, ACFAS director of Health Policy, Practice Management and Research.
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Foot and Ankle Surgery

Effect of First Tarsometatarsal Joint Derotational Arthrodesis on First Ray Dynamic Stability Compared to Distal Chevron Osteotomy
Hallux valgus affects gait by compromising first ray stability and function of the windlass mechanism at the late stance. However, comparative studies reporting the impact of different hallux valgus correction methods on gait are rare. Researchers in Finland conducted a study comparing distal chevron osteotomy and first tarsometatarsal joint derotational arthrodesis (FTJDA). The study matched two hallux valgus cohorts comprising distal chevron osteotomy and FTJDA. Seventy-seven feet that underwent distal chevron osteotomy and 76 feet that underwent FTJDA were available for follow-up, with a mean of 7.9 years and 5.1 years, respectively. Amid a follow-up time difference of a maximum 24 months, two matches were made based on the preoperative HVA and the HVA at late follow-up. Matching provided 30 and 31 pairs, respectively. Relative impulses of the first toe (T1) and metatarsal heads 1 to 5 (MTH1-5), weightbearing radiographs and American Orthopaedic Foot and Ankle Society scores were studied. The relative impulse of MTH1 was higher in the FTJDA group, whereas a central dynamic loading pattern was seen in the chevron group. This result remained when relative impulses were evaluated according to the postoperative HVA. The mean difference in the HVA at follow-up was 6.2 degrees in favor of the FTJDA group. The researchers concluded that the dynamic loading capacity of MTH1 was higher in the FTJDA group in comparison to the chevron group and that the follow-up HVA remained better in the FTJDA group.

From the article of the same title
Foot & Ankle International (07/17) Klemola, Tero; Leppilahti, Juhana; Laine, Vesa; et al.
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Improved Quality of Life After Transtibial Amputation in Patients with Diabetes-Related Foot Complications
The objective of this study was to examine health-related quality of life after major lower-extremity amputation in a cohort of patients living with diabetes mellitus. Researchers evaluated 81 patients with diabetes and transtibial amputation (TTA) who had a minimum of one year of follow-up. Of these 81 patients, 50.6 percent completed the Short Form Survey (SF-36) and the Foot and Ankle Ability Measure (FAAM) preoperatively and postoperatively. The median SF-36 physical component summary score improved from 26.2 to 36.6 preoperatively versus postoperatively, while the median SF-36 mental component summary score improved from 43.7 to 56.1 preoperatively versus postoperatively. Both the FAAM activities of daily living and FAAM sports scores improved significantly. The postoperative FAAM general/ADL score improved in 75.6 percent of patients and worsened in 24.4 percent. Patients who were nonambulatory postoperatively had significantly lower SF-36 general health subscale scores and lower FAAM scores than patients who were ambulatory postoperatively. In certain patients with nonfunctional lower extremities resulting from instability and/or chronic infection, TTA can result in significant improvement in quality of life and lower-extremity function. The researchers observed that although 25 percent of patients had a reduction in self-reported quality of life, 75 percent of patients improved their quality of life.

From the article of the same title
International Journal of Lower Extremity Wounds (06/01/17) Vol. 16, No. 2, P. 114 Wukich, Dane K.; Ahn, Junho; Raspovic, Katherine M.; et al.
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Female Runners with a Low BMI Are More Likely to Sustain Stress Fractures
A new study from the Ohio State University (OSU) Wexner Medical Center suggests female runners carrying less weight may be more vulnerable to stress fractures. "We found that over time, we were able to identify the factors that put female runners at an increased risk of developing a stress fracture," says OSU Professor Timothy Miller. "One of the most important factors we identified was low body weight, or low body mass index [BMI]." Specifically, female runners with a BMI of less than 19 are at a higher risk of suffering stress fractures than women with a BMI of 19 or higher. In addition, lighter women who developed stress fractures had longer recovery periods compared to the other runners. The three-year study involved assessing injuries in dozens of Division I college athletes using the Kaeding-Miller classification system. The system scores injuries on a 1 to 5 scale, considering not only the patient's symptoms, but also radiographic results, bone scan and computed tomography images and magnetic resonance imaging findings. The researchers determined among female runners with grade 5 stress fractures, women whose BMI was 19 or higher took about 13 weeks to recover. Women with a BMI lower than 19 were in recovery for more than 17 weeks. "It's imperative that women know their BMI and work to maintain a healthy level," Miller recommends. "They should also include resistance training in their training regimen."

From the article of the same title
Current Orthopaedic Practice (07/01/17) Vol. 28, No. 4, P. 393 Jamieson, Marissa; Schroeder, Allison; Campbell, Jason; et al.
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Practice Management

12 Ways to Improve Patient Portal Usage
Patient portals can help patients engage more in their own healthcare, yet many patients resist using them. Several health information officials offered advice on how to fully transition to an online system and get patients to embrace patient portals. Robert Murphy, MD, of the School of Biomedical Informatics, UTHealth, Houston, urges practices to adjust workflows to enable portal usage and says the portal must be time-saving. "Things will be adopted if they are more efficient and easier to use," he says. He also notes that patient engagement can be improved for some populations, such as older adults, by involving the family. Finally, Dr. Murphy says the goal would ultimately be patient-centric portals rather than practice-controlled portals. Bernie Traywick, CEO of May River Dermatology in Bluffton, S.C., recommends standardizing the experience to limit patient frustration, as well as emphasizing privacy. Regina Mixon Bates, CEO of the Physicians Practice S.O.S. Group in Atlanta, Ga., notes that persistence in pushing the portal is key and urges practices to make it worth patients' while by offering incentives. Donna Siu, Operations Project Manager for Stanford Children's Health, Packard Children's Health Alliance, advises practices to promote their patient portal; share best practices between locations; encourage healthy competition between practice locations; and keep up with innovation so that the portal continues to evolve and remain competitive.

From the article of the same title
Physicians Practice (07/06/17) Filip, Iulia
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Eight Ways to Improve Healthcare Email Marketing
It is vital to use the power of email marketing to grow your practice, especially as the number of email users is slated to rise to 244.5 million by the end of 2017. Here are several tips on conducting an effective healthcare email marketing campaign. First, the most important thing for an email to have is a catchy subject line. Use call to action phrases like "Get it now," "Hurry," and "Last chance" to increase your email open rate. Another important factor is personalization: reports show that personalized emails receive 27 percent higher click rates and 11 percent higher open rates than nonpersonalized emails. However, emailing too frequently will turn off consumers, so avoid sending personalized emails to people who are not existing patients. Further, a healthcare email campaign should be clear and concise; be designed creatively; and include clear instructions. Make consumers feel special by offering discounts to existing patients, for example, to build up loyalty and trust. In addition, since most people prefer checking emails on their mobile phones, an email design should be compatible on all devices. Finally, sending frequency is a key component of a healthcare email marketing campaign. Overmailing leads to a high level of unsubscribes, while not sending enough will reduce promotional opportunities. A minimum of six to eight emails per month is a good average.

From the article of the same title
Physicians Practice (07/06/17) Chauhan, Manish Kumar
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Health Policy and Reimbursement

CMS Proposes Slashing 340B Rates, Paying for Joint Procedures at Outpatient Facilities
On July 13, the U.S. Centers for Medicare and Medicaid Services (CMS) proposed significantly cutting hospitals' reimbursement for drugs purchased through the 340B discount program. The agency is proposing to pay hospitals 22.5 percent less than the average sales price for drugs acquired under the program. The current 340B payment for drugs is six percent on top of the average sales price. With the proposed changes, if a drug costs $84,000, CMS would pay just over $65,000, instead of $89,000. The Medicare Payment Advisory Commission earlier this year suggested eligible hospitals should receive the average sales price minus 22.5 percent as the average discount. The rule also suggests Medicare pay for knee replacement procedures that take place at outpatient facilities. It is also seeking comment on whether partial and total hip procedures should be eligible for Medicare reimbursement if performed at outpatient facilities. CMS is seeking feedback on how reimbursement of the procedures at outpatient facilities could harm the bundle pay initiative. Comments on the rule are due September 11.

From the article of the same title
Modern Healthcare (07/13/17) Dickson, Virgil
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Senate Republicans Unveil New Health Bill, but Divisions Remain
On July 13, Senate Republican leaders offered a new version of their health bill, which included changes meant to mollify both conservatives who favor less regulation and moderates who want to ensure all Americans have access to insurance. The revised proposal includes $70 billion more in funding to help states keep escalating premiums and out-of-pocket medical costs in check. Additionally, it would expand the use of health savings accounts; authorize carriers to provide affordable, bare-bones policies; and reinstate limits on tax deductions insurance companies can take for compensation paid to top executives. Other elements, including deep cuts to the Medicaid program, carry over from the initial Senate draft. Even with the new language, the bill faces an uphill battle as the GOP remains divided in its mission to repeal and replace the Affordable Care Act. Despite the challenge of unifying the GOP on the issue, Majority Leader Mitch McConnell hopes to land 50 willing senators so that he can take up the bill for debate, amendments and a final vote.

From the article of the same title
New York Times (07/13/17) Pear, Robert; Kaplan, Thomas
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Secretary Price Appoints Brenda Fitzgerald, MD, as CDC Director and ATSDR Administrator
On July 7, U.S. Department of Health and Human Services Secretary Dr. Tom Price appointed Dr. Brenda Fitzgerald as the next director of the U.S. Centers for Disease Control and Prevention (CDC) and administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). "Today, I am extremely proud and excited to announce Dr. Brenda Fitzgerald as the new director of CDC," said Price. "Having known Dr. Fitzgerald for many years, I know that she has a deep appreciation and understanding of medicine, public health, policy and leadership--all qualities that will prove vital as she leads the CDC in its work to protect America's health 24/7." Fitzgerald, a board-certified obstetrician-gynecologist, has served as the commissioner of the Georgia Department of Public Health and state health officer for the past six years. She will replace Dr. Anne Schuchat, who has been the acting CDC director and acting ATSDR administrator since January 20. Schuchat will return to her role as CDC's principal deputy director.

From the article of the same title
HHS News Release (07/07/17)
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Providers Still Scrambling to Gather Data Needed for New Reimbursement Approach
This year is deemed a performance period for the Merit-Based Incentive Payment System (MIPS)—the reimbursement system the government will use to move Medicare payments to a quality- and value-based approach. The program combines three federal reporting programs—measuring quality, value and the meaningful use of electronic health records—into one. The U.S. Centers for Medicare and Medicaid Services (CMS) will provide the baseline for calculations, generating an individualized report that providers will receive at the end of a reporting year from claims data. MIPS emphasizes quality measurements more at the outset, but the approach will eventually seek to grade clinicians based on their ability to control costs. Providers need to start scrambling now to ensure they are able to gather and act on cost data—not just from their own practices, but all costs that assigned patients incur, according to healthcare experts. They describe 2017, the initial year for MIPS, as a year of zero cost accountability and as an opportunity to figure out what data to identify and accurately capture; what analytical services will help track costs practicewide, down to the individual doctor; and the process to put this data in front of physicians so they make cost-effective decisions. “This will be one of the larger challenges [of MIPS]," says Karen Knecht, chief innovation officer of Encore Health Resources. "CMS will do the calculations for them, but they will want to anticipate what their calculated resource use will be.”

From the article of the same title
Health Data Management (07/05/17) Morrissey, John
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Is Your Surgeon Double-Booked?
The controversial practice has been standard in many teaching hospitals for decades, its safety and ethics largely unquestioned and its existence unknown to many. But over the past two years, the issue of overlapping surgery—in which a doctor operates on two patients in different rooms during the same time period—has ignited an impassioned debate in the medical community, attracted scrutiny by the U.S. Senate Finance committee that oversees Medicare and Medicaid and prompted some hospitals, including the University of Virginia, to circumscribe the practice. The decision about whether to allow the practice is left to hospitals, which are primarily responsible for policing it. Medicare billing rules permit it as long as the attending surgeon is present during the critical portion of each operation—and that portion is defined by the surgeon. Critics of the practice, who include some surgeons and patient safety advocates, say that double-booking adds unnecessary risk and erodes trust. Defenders of the practice, which has been the subject of a handful of studies with mixed results, say it can be done safely and allows more patients to receive care. No one knows how many of the nation’s 4,900 hospitals that receive Medicare payments—about 1,000 of which are teaching hospitals—allow the practice, the Senate Finance Committee noted in a recent report. The committee called on hospitals to adopt stronger policies and consent forms that go beyond opaque boilerplate statements that grant broad permission without specifying who is doing what.

From the article of the same title
Washington Post (07/10/17) Boodman, Sandra G.
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Medicine, Drugs and Devices

National Healthcare Fraud Takedown Results in Charges Against More Than 400 Individuals
More than 400 people have been charged in the largest-ever healthcare fraud enforcement action by the Medicare Fraud Strike Force, U.S. Attorney General Jeff Sessions and U.S. Health and Human Services (HHS) Secretary Tom Price have announced. The individuals—including doctors, nurses, pharmacists and other licensed medical professionals—are suspected of participating in healthcare fraud schemes involving about $1.3 billion in false billings. The charges aggressively target schemes billing Medicare, Medicaid and TRICARE for medically unnecessary prescription drugs and compounded medications that frequently were never even purchased and/or distributed to beneficiaries. Additionally, the charges involve individuals contributing to the opioid epidemic, especially medical professionals involved in the unlawful distribution of opioids and other prescription narcotics.

From the article of the same title
U.S. Department of Justice (07/13/17)
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FDA Commissioner Seeks New Standards for Some Opioid Prescriptions
U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, has announced plans to require drug manufacturers to provide expanded training for physicians and other healthcare professionals on immediate-release opioids. Speaking at the opening of an FDA workshop on opioid analgesic safety and abuse, Gottlieb said, "It's time to take direct action to address the close to 200 million opioid analgesic prescriptions each year that are for the immediate-release products. The new training will be aimed at making sure providers who write prescriptions for the IR opioids are doing so for properly indicated patients and under appropriate clinical circumstances." According to Gottlieb, FDA would require that training of healthcare personnel will broaden information about nondrug, as well as nonopioid, methods of managing pain. Additionally, the agency plans to launch a study of physicians' understanding of abuse-deterrent features of pain medications.

From the article of the same title
Wall Street Journal (07/10/17) Burton, Thomas M.
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Hacking of Medical Devices Rising as Next Threat
Medical devices are considered increasingly likely to be targeted by hackers. Healthcare providers, who often have hundreds if not thousands of devices in their facilities, need to conduct a comprehensive risk assessment and fix vulnerabilities to improve their defenses. "The problem with security is that hackers always follow the path of least resistance," says Sam Rehman, the chief technology officer at security vendor Arxan, which serves multiple industries and has a large footprint in healthcare. Providers also need to increase security levels for devices that are implanted in patients because many of those devices have wireless capabilities that enable hackers to interfere with them, Rehman says. Earlier this year, the U.S. Food and Drug Administration confirmed cybersecurity vulnerabilities in St. Jude Medical’s implantable cardiac devices and its Merlin@home transmitter. The vulnerabilities were originally announced by an investment group that threatened to make money by selling its stock short. "If someone can make money, this absolutely will happen," Rehman says.

From the article of the same title
Health Data Management (07/10/17) Goedert, Joseph
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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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