July 30, 2014

News From ACFAS

Resident Members: Register Now for Complimentary Webinar
Attention new ACFAS Resident Members: Want to get the most out of your ACFAS Membership? Mark your calendars for the complimentary webinar Maximizing Your ACFAS Resident Membership set for August 19, 2014 at 8pm CDT to help answer the many questions you may have regarding your new membership in ACFAS.

Led by Eoin Gorman, DPM, PGY-3 at Columbia St. Mary’s Hospital, and Corey Fidler, DPM, PGY-3 at Washington Hospital Center, the webinar takes you through many of the questions new resident members have and shows you how to take advantage of all ACFAS has to offer.

Visit to register.
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Recognized Fellowship Applications: August 31 Deadline
ACFAS’ Fellowship Committee’s annual application for new Recognized Fellowship Programs is due on August 31, 2014. If you are directing a fellowship, or are making inroads to start a new fellowship, and would like it to be considered for Recognition by the College, please contact Michelle Kennedy, Director of Membership, to request an application and the list of Minimal Criteria for Recognition by ACFAS. Once all applications are received, the Fellowship Committee will hold interviews with all programs in September.

ACFAS supports continuing education post-residency in the form of fellowships. The fellowship initiative has provided status to 30 fellowship programs that have shown their ability to meet, and in most cases, exceed, a list of minimal criteria that assures their ability to provide adequate post-graduate education to their fellows. A listing of these programs, with websites dedicated to each, can be found at

For more information, visit “Recognized Fellowship Initiative” on
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ACFAS Research Grant Applications Due September 15
Your work in the field of foot and ankle surgery depends on cutting-edge scientific research. ACFAS understands the necessity of research and each year awards up to $40,000 in grant money to members conducting valuable research to advance the field.

Applications for the 2014 ACFAS Clinical and Scientific Research Grant will be accepted until September 15, 2014. Research must be clinical or laboratory-based, with clearly defined goals that meet all criteria for grant submission.

“The progressive growth of the ACFAS research grant is the shining example of the College’s commitment to research and to the progression of all aspects of healthcare toward evidence-based medicine,” says Jeffrey Baker, DPM, FACFAS, chair of the ACFAS Research/EBM Committee.

To submit an application for the 2014 Research Grant, visit
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Foot and Ankle Surgery

Rheumatoid Forefoot Reconstruction: Outcome of 1st Metatarsophalangeal Joint Fusion and the Stainsby Procedure in the Lesser Toes
A recent study has concluded that fusing the first metatarsophalangeal joint and sparing the lesser toe metatarsal head can effectively reduce forefoot deformity and pain in patients suffering from rheumatoid arthritis. The authors of the study evaluated the results of 13 such procedures, which were performed on 12 patients between the ages of 55 and 71. Twelve months after surgery, the average American Orthopaedic Foot and Ankle Society (AOFAS) score was 72, up from 46 before surgery. The average hallux valgus angle six months after surgery was 14 degrees, down from 48 degrees before surgery. The mean intermetatarsal angle, meanwhile, dropped from 15 degrees before surgery to 10 degrees six months afterward.

From the article of the same title
The Foot (06/14) Vol. 24, No. 2, P. 56 Bass, Edward James; Shariff, Raheel; Sirikonda, Siva Prasad
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Lift, Drill, Fill and Fix (LDFF): A New Arthroscopic Treatment for Talar Osteochondral Defects
A new arthroscopic surgical treatment called lift, drill, fill and fix (LDFF) holds promise in treating primary talar osteochondral defects, a recent study suggests. The study found that American Orthopaedic Foot and Ankle Society (AOFAS) scores improved in seven patients who underwent the procedure, rising from 63 before surgery to 99 at follow-up. Follow-up was performed an average of 12 months after surgery. Numeric rating scales (NRS) of pain at rest declined from 2.9 before surgery to 0.1 at follow-up, which was seen as a significant improvement. NRS of pain with walking improved significantly as well, dropping from 7.6 to 0.1. Finally, the study found that five out of the seven patients exhibited remodeling and bone ingrowth when their final radiographs were taken. The authors of the study caution that additional research involving more patients and longer follow-up times is needed before any definitive conclusions can be reached about the effectiveness of LDFF.

From the article of the same title
Knee Surgery, Sports Traumatology, Arthroscopy (05/20/14) Kerkhoffs, G. M. M. J.; Reilingh, M. L.; Gerards, R. M.; et al.
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Practice Management

Four Ways to Evaluate Customer Service at Your Medical Practice
Nick Weeks, a managing partner with the healthcare consulting firm Creative Healthcare Solutions, says there are several ways that physicians' practices can evaluate the service staffers are providing to patients. One way is to stage a phone call from a person who could cause staff members to lose their patience, such as an individual who has trouble hearing or someone who demands to speak to a physician immediately. Staging such calls is an invaluable way to determine how well staffers react under pressure, Weeks says. Phone calls to the practice can also be staged to determine if employees are answering the phone as directed, handling sales calls appropriately or directing callers to the appropriate person. A third way to evaluate customer service at a physician's practice is to quiz employees to ensure they know what to say when they answer the phone or whom they would forward a call to if a provider was asking about a job. Finally, physicians' practices can proactively call patients who no longer visit the practice or a random sample of patients to ask them how they feel about the practice's customer service. Ensuring that the practice is providing excellent customer service is important, Weeks says, because patients can always choose another healthcare provider if they do not believe their needs are being met.

From the article of the same title
Physicians Practice (07/22/14) Weeks, Nick
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Why Online Patient Bill Pay Can Save Your Medical Practice Time, Money
Tom Furr, the CEO of a company that offers physicians' practices a cloud-based service that allows them and their patients to process and manage bills online, says that practices are by and large ignoring the growing consumer preference for online bill payment at their own peril. Furr notes that 98 percent of the bills issued by U.S. healthcare providers are in paper rather than electronic form, despite the fact that one survey found that more than 60 percent of Americans prefer to pay bills online. Some practices may be hesitant to begin billing their patients electronically due to concerns that adopting an electronic billing service can hurt operations and reduce productivity. However, Furr notes that the opposite is actually true. Using an electronic billing system eliminates the need for practice staffers to be involved in the process of crediting payments to patient accounts and reconciling accounts since online billing service providers can perform these tasks. In addition, practices are likely to be paid more quickly when they bill their patients electronically because online bills allow patients to see their charges in one place, unlike paper bills, Furr says. Yet another benefit of an online bill payment service is that it can reduce and possibly eliminate the need to send additional bills to patients who have not paid, Furr says, which in turn results in less money spent on paper, envelopes and postage stamps. Furr concludes that practices that fail to update their billing methods to meet changing consumer preferences face the risk of experiencing financial problems and possible failure.

From the article of the same title
Physicians Practice (07/20/14) Furr, Tom
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Health Policy and Reimbursement

4th Circuit Upholds ACA Insurance Subsidies
The 4th U.S. Circuit Court ruled July 22 that the federal government can provide subsidies for consumers purchasing insurance in all states, not just those who live in states that operate their own health insurance exchanges. The court noted that Congress intended to make such subsidies as widely available as possible, even though the Affordable Care Act states that such financial help is only available when purchasing coverage "through an exchange established by the state." That ruling conflicts with another opinion issued by the District of Columbia Circuit Court the same day, which strictly interpreted the language in the Affordable Care Act to mean that subsidies can only be given to consumers purchasing insurance through state-run exchanges rather than those operated by the federal government.

From the article of the same title
Modern Healthcare (07/22/14) Carlson, Joe
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Medicare Testing Payment Options That Could End Observation Care Penalties
Medicare could be on the verge of eliminating its controversial requirement that senior citizens can only receive nursing home coverage if they have been hospitalized for at least three days. Whether or not Medicare goes forward with eliminating that requirement depends on the outcome of pilot programs at hospitals and other healthcare providers across the country that aim to determine whether alternative payment arrangements can reduce costs or at least prevent them from rising while simultaneously improving the quality of care. One such pilot program, which involves roughly 600,000 senior citizens at more than 170 hospitals that are participating in Pioneer Accountable Care Organizations, allows patients to qualify for Medicare's nursing home benefit even if they have spent little or no time in the hospital. The three-day hospitalization rule is also waived for patients kept for observation. Under this program, Medicare makes a set payment on behalf of a patient that is shared with the patient's nursing home and other healthcare providers. If such pilot programs prove successful at saving Medicare money while also improving care, the three-day hospitalization requirement could eventually be waived for all seniors who need nursing home coverage.

From the article of the same title
Kaiser Health News (07/22/14) Jaffe, Susan
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New Patient Physician Visits Slump in Spite of ACA Expansion; Medicaid Increases
The Robert Wood Johnson Foundation and the electronic health record manufacturer athenahealth have released a report that describes the effects the Affordable Care Act is having on the number of new patients seeking care at physicians' practices, as well as whether more Medicaid patients are coming in for care. The report found that surgeons and several other categories of doctors saw the number of new patients they treated hold steady or even decline from January through May, compared to the same period last year. Among surgeons, 40.6 percent of the patients they treated were new patients during the January-May period, which was unchanged from January-May 2013. The report also found that surgeons and several other specialists have seen fewer patients overall from January to May of this year compared to the first five months of last year. In addition, the report found that surgeons and other specialists who practice in states that expanded Medicaid are seeing two to three times more Medicaid patients compared to their counterparts in states that did not expand the program. Among all physicians' practices in states that expanded Medicaid, 15.6 percent of patients were Medicaid beneficiaries as of May, compared to 12.3 percent at the end of 2013.

From the article of the same title
Medical Economics (07/18/14) Verdon, Daniel R.
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Medicine, Drugs and Devices

Eagle Pharma's Drug to Treat Genetic Condition Gets U.S. Approval
The Food and Drug Administration (FDA) has approved Ryanodex as a treatment for malignant hyperthermia, a rare condition that results in severe and potentially fatal reactions when inhaled anesthetics or the muscle relaxant succinylcholine are administered during surgery. Eagle Pharmaceuticals, the company that plans to begin selling Ryanodex next month, says the drug is more convenient to use than dantrolene sodium, the malignant hyperthermia antidote on which Ryanodex is based. For example, Ryanodex can be prepared and administered in less than one minute, compared to 15 to 20 minutes for other treatments. Using Ryanodex also results in a lower fluid load for patients, which in turn results in greater safety compared to other treatments, Eagle Pharmaceuticals says.

From the article of the same title
Reuters (07/23/14) Grover, Natalie
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Preoperative Radiographic and CT Findings Predicting Syndesmotic Injuries in Supination-External Rotation-Type Ankle Fractures
A recent study sought to identify the factors that are helpful in identifying syndesmotic injuries in supination-external rotation (SER)-type ankle fractures. The study involved 191 SER-type ankle fracture patients who underwent radiographs and computed tomography (CT) before being treated surgically. Patients were then placed in either a stable syndesmotic group or the unstable syndesmotic group. The two groups were compared in terms of fracture height, fracture length, medial joint space, extent of fracture and bone attenuation as measured by radiographs and CT scans. Once these comparisons were made, a binary logistic regression analysis was performed to identify factors that made significant contributions to unstable syndesmotic injuries. The study concluded that fracture height, medial joint space and bone attenuation were useful factors for detecting unstable syndesmotic injuries in SER-type ankle fracture patients before they underwent surgery. Cutoff values for predicting unstable syndesmotic injuries using CT scans were a fracture height of more than 3 mm and medial joint space of more than 4.9 mm, while the cutoff values for radiographs were a fracture height of more than 7 mm and medial joint space of more than 4.5 mm.

From the article of the same title
Journal of Bone and Joint Surgery (07/16/2014) Vol. 96, No. 14, P. 1161 Choi, Young; Kwon, Soon-Sun; Chung, Chin Youb; et al.
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Sonography of the First Metatarsophalangeal Joint and Sonographically Guided Intraarticular Injection of Corticosteroid in Acute Gout Attack
A recent study found that ultrasound is a sensitive tool for evaluating abnormalities in the first metatarsophalangeal joint (MTPJ1) in patients experiencing an acute gout attack and that an ultrasound-guided intraarticular corticosteroid injection in this joint is a safe and effective treatment method. The study involved 21 patients who underwent an ultrasound to evaluate the MTPJ1. The characteristic findings of those ultrasounds were then compared with features seen in conventional radiographs. In addition, all patients received an ultrasound-guided intraarticular corticosteroid injection in the affected MTPJ1. The study found that ultrasound was better capable of detecting erosion and tophus-like lesions compared to conventional radiographs. In addition, the study found that the injections brought down visual analog scale scores for pain, general disability and walking disability by an average of 48 mm, 35 mm and 39 mm, respectively, after two days. None of the patients experienced adverse events as a result of the injections.

From the article of the same title
Journal of Clinical Ultrasound (07/09/2014) Kang, Myung Ho; Moon, Ki Won; Jeon, Yong Hwan; et al.
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