August 9, 2017 | | JFAS | Contact Us

News From ACFAS

ACFAS Promotes You to Diabetes Educators
This past weekend, Take a New Look at Foot and Ankle Surgeons, ACFAS' national public relations campaign, exhibited to 3,000 diabetes educators (DEs) at the American Association of Diabetes Educators annual meeting in Indianapolis.

Drs. John Steinberg and Andrew Kapsalis plus staff met with DEs in the College's booth to discuss how foot and ankle surgeons can collaborate with DEs in patient care. They explained how foot and ankle surgeons' specialized training makes them a valuable member of the patient treatment care team and encouraged DEs to refer their patients to ACFAS members early on in treatment to prevent diabetic foot complications from occurring.

Dr. Steinberg presented to DEs on limb salvage during the conference and received positive feedback. Plus, those who stopped by the booth received a When to Refer Guide outlining who foot and ankle surgeons are and when to refer patients to them for help with diabetes-related foot issues.

Take a New Look will exhibit at the American Academy of Family Physicians' national conference next month in San Antonio. Visit for more on how to increase referrals to your practice.

Shown in the above photo are Fleishman Hillard team members Christine Spasoff and Eleanor O'Hara, John S. Steinberg, DPM, FACFAS, and ACFAS Executive Director J.C. (Chris) Mahaffey.
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New Grads: Your First Year of ACFAS Membership Is Free
Class of 2017, get your first year of ACFAS membership for free! Thanks to the Regional Divisions’ support, your dues for the first year are waived. As an ACFAS member, you'll receive: Apply for membership now at
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SLRs Give You Instant Access to New Research
Who says staying ahead of the latest foot and ankle medical research needs to be arduous and time-consuming? Read this month’s Scientific Literature Reviews (SLRs) for quick, digestible summaries of studies from leading medical journals. Each SLR is written by a podiatric surgical resident and includes podiatric relevance, methods, results and conclusions.

Visit to view the August SLRs and to browse through the complete SLR archive.
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Free Officite Webinar on August 16
Competition for top search rankings on Google is fierce. Learn how to make your practice website stand out from the crowd in the free Officite webinar, Modern Practice Marketing in Seven Simple Steps, scheduled for Wednesday, August 16 from 1–1:30pm (CDT).

Visit for more on Officite and ACFAS' other Member Benefit Partners.
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Foot and Ankle Surgery

A Toe Flexion NIRS Assisted Test for Rapid Assessment of Foot Perfusion in Peripheral Arterial Disease
A study was conducted to evaluate the feasibility, validity and diagnostic accuracy of a noninvasive dynamic ambulatory test using near infrared spectroscopy (NIRS) to assess foot perfusion in peripheral arterial disease (PAD). Eighty PAD patients, including 41 with coexisting diabetes, were participants, while 13 healthy subjects also were examined by echo color Doppler, identifying 160 diseased and 26 nondiseased limbs. Under identical clinostatic conditions, patients performed a 10-repetition toe flexion test with NIRS probes on the dorsum of each foot. Toflex area values were comparable to PAD values after blood flow restriction, consistent with PAD severity and correlated with dorsal pedis artery pressure. Toflex area exhibited similarity to echo color Doppler for detecting PAD following receiver operating characteristic curve analysis.

From the article of the same title
European Journal of Vascular and Endovascular Surgery (08/01/17) Vol. 54, No. 2, P. 187 Manfredini, F.; Lamberti, N.; Rossi, T.; et al.
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Compression Therapy After Ankle Fracture Surgery: A Systematic Review
A systematic review was conducted to investigate the impact of compression therapy on the perioperative course of ankle fractures and to characterize its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The goal was to suggest a recommendation to clinicians considering applying compression treatment in the standard care of ankle fracture patients, based on the existing literature. Included in the review were eight studies comprising 451 patients. Seven studies determined a significant effect on edema, two studies described a significant reduction in pain, one a beneficial impact on ankle movement, two a positive effect on wound healing, one a reduction in LOS and two a reduction in TTS. A systematic bias evaluation demonstrated that the included studies had methodological constraints influencing the confidence in the effect estimate. These limitations prevented making a solid conclusion on the effect of compression therapy on wound healing, LOS and TTS.

From the article of the same title
European Journal of Trauma and Emergency Surgery (08/01/17) Vol. 43, No. 4, P. 451 Winge, R.; Bayer, L.; Gottlieb, H.; et al.
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Severe Extraarticular Manifestations in a Community-Based Cohort of Patients with Rheumatoid Arthritis
A study was conducted to assess whether the administration of tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to probe potential predictors for ExRA development. A dynamic community-based cohort of 1,977 patients was studied, and a review of clinical records identified cases of severe ExRA. Information on exposure to TNF inhibitors was acquired from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent manner, and the incidence of severe ExRA in exposed patients was compared with occurrence in unexposed patients. During TNF inhibitor therapy, 17 patients experienced new onset of severe ExRA in 2,400 person-years (PY) at risk, versus 104 in 15,599 PY in those without TNF inhibitors. This correlated with an incidence rate ratio of 1.06. The age- and sex-adjusted HR for ExRA in anti-TNF-treated patients was 1.21, with similar outcomes in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Predictors for ExRA included male sex, positive rheumatoid factor, long disease duration and greater disability.

From the article of the same title
Journal of Rheumatology (07/17) Vol. 44, No. 7 Theander, Lisa; Nyhall-Wahlin, Brit-Marie; Nilsson, Jan-Ake; et al.
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Practice Management

How Do Physicians Care for the Digitally Isolated?
Technologies, such as remote monitoring devices and digital doctor visits, are transforming the healthcare arena. Although some patients are already benefiting from these advances enabled by high-speed Internet, others are missing out. The Federal Communications Commission's (FCC) 2016 Broadband Progress Report estimates that 34 million people, or 10 percent of all Americans, still lack access to benchmark service. And some groups are particularly hard hit, including 39 percent of rural Americans and 41 percent of Americans on Tribal lands. As part of the effort to overcome these coverage disparities, FCC's Connect2Health Task Force has developed a Mapping Broadband Health in America platform that allows users to visualize health and broadband Internet statistics at the county, state and national levels. The latest data update, announced in June, reinforces many of last year's findings—noticeable gaps between rural and urban areas. "By many measures, connected communities are simply healthier communities,” says Michele Ellison, chair of FCC's Connect2Health Task Force. For example, the least connected counties have 1.5 times as many preventable hospitalizations as other counties. "As the Task Force continues to conduct deep-dive analyses like these, we're consistently finding that areas that need broadband for health the most tend to have it the least."

From the article of the same title
Medical Economics (07/31/17) Nicolaus, Paul
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New Senate Bill Seeks to Reduce Restrictions on Telemedicine Use
A proposal introduced last week by U.S. Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) aims to expand the use of telemedicine as a cost-cutting measure. The Evidence-Based Telehealth Expansion Act of 2017 would empower the secretary of the U.S. Department of Health and Human Services (HHS) to lift Medicare's telemedicine constraints, provided the actuary at the U.S. Centers for Medicare and Medicaid Services (CMS) sees it delivering cost savings. Restrictions to be waived include any geographic limits and proscriptions on using store-and-forward technologies. The bill also seeks to remove limitations on the kinds of healthcare providers who can offer telemedicine services, as long as they are enrolled in Medicare. Limitations on specific codes designated as telehealth services would also be eliminated. The waivers would come with certain restrictions, as the HHS secretary would be required to ascertain that the waivers cut spending without causing a decline in the quality of care, while also improving care quality without hiking spending. In addition, the waivers must not deny or limit coverage or delivery of benefits for any given individual.

From the article of the same title
MobiHealthNews (07/31/2017) Lagasse, Jeff
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Physicians, Health Plans See Common Goal in Value-Based Care
Physicians and insurers both believe that better alignment between healthcare providers and health plans could accelerate the shift to value-based care, according to a recent survey sponsored by Quest Diagnostics and health tech firm Inovalon. Most physicians and health plan executives also believe that the industry's transition to value-based care will continue, regardless of what happens at the federal level, the survey shows. The survey, which was conducted for the second year in a row, included 452 respondents. Of those, 302 were primary care physicians in private practices, and 150 were health plan executives. The survey respondents acknowledged that fee for service still dominates healthcare. The percentage of respondents who said the system was already based on value-based care rose from 25 percent in 2016 to only 29 percent in 2017. However, nearly twice as many doctors (31 percent) who had been in practice for 20 years or less thought so, compared to those in practice 21 years or more (16 percent). Seventy percent of health plan executives but only 47 percent of doctors believed that progress is being made toward the alignment of payers and providers to accelerate the adoption of value-based care. But 83 percent of respondents said there was a need for cooperation between the two parties to achieve this goal. Forty-three percent of doctors and 53 percent of health plan executives said that physicians had the tools they needed to succeed in value-based care. By contrast, in 2016, only 29 percent of doctors and 44 percent of insurance executives answered that question in the affirmative.

From the article of the same title
Medscape (07/27/17) Terry, Ken
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Health Policy and Reimbursement

Even Without Congress, Trump Can Still Cut Medicaid Enrollment
After the Senate failed in its effort to repeal the Affordable Care Act, the Trump administration could potentially use its regulatory powers to downsize Medicaid. President Donald Trump's top health officials could trigger lower Medicaid enrollment by approving applications from several GOP-controlled states eager to control fast-rising Medicaid budgets. Indiana, Arkansas, Kentucky, Arizona and Wisconsin are seeking the administration’s permission to require adult enrollees to work, submit to drug testing or pay monthly premiums. Both Medicaid’s backers and critics believe waiver requests are a way to rein in the $500 billion program that currently covers 75 million Americans. Critics of the new requests say they could hurt those who are most in need. The National Health Law Program "is assessing the legality of work requirements and drug testing and all avenues for challenging them, including litigation," says Jane Perkins, the group's legal director. The administration has already said it favors work requirements and in March invited states to suggest new ideas. In Iowa, state officials have already won the authority to limit nonemergency transportation. Indiana received approval to charge premiums and lock out enrollees with incomes above the federal poverty level if they fall behind on paying premiums. "Now there is concern these more extreme measures would hurt enrollees' access to care," says George Washington University's Sara Rosenbaum, who chairs a Medicaid group that advises Congress.

From the article of the same title
Kaiser Health News (07/28/17) Galewitz, Phil
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Medicare Issues Projected Drug Premiums for 2018
The U.S. Centers for Medicare and Medicaid Services (CMS) reports that the average basic premium for a Medicare Part D prescription drug plan in 2018 is projected to drop to an estimated $33.50 a month. This is a decrease of about $1.20 below the actual average premium of $34.70 in 2017. "We are committed to making prescription drug plan premiums affordable so that seniors and people with disabilities in Medicare can access the prescription drugs that they need," said CMS Administrator Seema Verma. "This projection is a step forward in fulfilling the Trump administration's promise to lower the cost of prescription drug coverage, particularly for Medicare beneficiaries." The decrease in the average premium comes despite the fact that spending for the Part D program continues to rise faster than spending for other parts of Medicare, in large part driven by spending on costly specialty drugs. The projection for the average premium for 2018 is based on bids submitted by drug plans for basic drug coverage for the 2018 benefit year and calculated by the independent CMS Office of the Actuary. The upcoming annual Medicare open enrollment period begins on October 15, 2017, and ends on December 7, 2017.

From the article of the same title
CMS Press Release (08/02/17)
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Some Insurers Seek ACA Premium Increases of 30 Percent and Higher
New federal data found that major health insurers in some states are seeking increases as high as 30 percent or more for premiums on 2018 Affordable Care Act plans. Big insurers in Idaho, West Virginia, South Carolina, Iowa and Wyoming are seeking to raise premiums by averages close to 30 percent or more, according to preliminary rate requests published by the U.S. Department of Health and Human Services. Major marketplace players in New Mexico, Tennessee, North Dakota and Hawaii indicated they were looking for average increases of 20 percent or more. The filings show the uncertainty in the health insurance marketplaces as insurers around the United States try to make decisions about rates and participation for next year amid open questions about changes that could come from the Trump administration and Congress. Insurers face a mid-August deadline for completing their rates, and the companies have until late September to sign federal agreements to offer plans in 2018.

From the article of the same title
Wall Street Journal (08/01/17) Wilde Mathews, Anna; Radnofsky, Louise
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Medicine, Drugs and Devices

CBO: Americans Would Save $7 Billion Buying Prescription Drugs from Canada
Enabling U.S. pharmacies, wholesalers and individual patients to procure prescription drugs from Canada and elsewhere would save taxpayers almost $7 billion by 2027, the U.S. Congressional Budget Office reports. In 2014, Americans spent $1,112 per person on prescription drugs while Canadians spent $772 and Danes spent $325, according to Sen. Bernie Sanders (I-VT), pointing out how the same medications produced in the same factories by the same manufacturers cost much less in other countries. The lawmaker has proposed the Affordable and Safe Prescription Drug Importation Act, which would expand the U.S. Food and Drug Administration's regulatory reach in this arena.

From the article of the same title
United Press International (08/01/17) Downs, Ray
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Google Glass Enterprise Going to Work in Factories and Hospitals
Google Glass is reemerging as a wearable computer specifically for use in industry and healthcare. Glass Enterprise Edition is a lightweight computer with a transparent display that can be clipped onto a pair of eyeglasses or safety goggles. The technology is intended to give users a way to access information via their eyeglasses and view it within their line of sight. More than 50 companies, including Volkswagen, Sutter Health and NSF International, have been testing and using Glass Enterprise Edition for the past two years under a special Google program, according to blog statements by Glass project lead Jay Kothari. The positive feedback from those users has prompted Google parent Alphabet's X labs to make the smart glasses available to more organizations, he said. Google X has been working with a network of more than 30 partners to build specialized software for use with Glass Enterprise Edition, according to Kothari. Doctors at Dignity Health, for instance, have been using a Glass-specific application from Google partner Augmedix to take notes in the background while speaking with patients, Kothari said. The technology has helped to significantly reduce the time needed to type patient notes, freeing up more time for patient care. Glass Enterprise edition is more lightweight than its predecessor and has been designed in such a way as to ensure comfort during long-term use.

From the article of the same title
eWeek (07/20/17) Vijayan, Jaikumar
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White House Opioid Commission Calls on Trump to Declare National Emergency
The President's Commission on Combating Drug Addiction and the Opioid Crisis issued a preliminary report stating that its "first and most urgent recommendation" is for President Donald Trump to "declare a national emergency under either the Public Health Service Act or the Stafford Act." The commission, led by Gov. Chris Christie of New Jersey, states that the goals of such a declaration would be to "force Congress to focus on funding" and to "awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will." In addition to declaring a national emergency, the commission's first report includes a number of recommendations that public health experts and drug policy reformers have been advocating for years, including expanding capacity for drug treatment under Medicaid.

From the article of the same title
Washington Post (07/31/17) Ingraham, Christopher
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

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Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, FACFAS

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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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