News From ACFAS

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Don’t let the deadlines slip by! Share your research with your colleagues in the College by submitting it for presentation at the ACFAS 2012 Annual Scientific Conference, March 1–4, in San Antonio, Texas.

• August 15, 2011 — Manuscript submission deadline
• October 12, 2011 — Poster submission deadline

Visit the ACFAS website for applications and more details. ACFAS members are part of a dynamic healthcare team in an evolving model of care. In order to best assist foot and ankle surgeons, ACFAS has many partners and partakes in coalitions to gain insight and offer the foot and ankle surgeon’s perspective in policy and research arenas. On behalf of our more than 6,300 members, ACFAS is joining the American Hospital Association’s (AHA) new Physician Leadership Forum. This effort is designed to engage and partner with physicians to collaboratively advance excellence in patient care. We are proud to work with the AHA as they seek to gather input from physicians to inform AHA policy and advocacy efforts while advancing physician leadership within the healthcare delivery system. ACFAS is tweeting to alert you to the latest news in professional development, education, health policy and more from your College and around the nation. Follow the feed at twitter.com/ACFAS.

For news you can use to educate your patients, send them to the College’s consumer news at twitter.com/FootHealthFacts — or retweet timely topics yourself.

Don’t miss out; join the conversation today! ACFAS supports foot and ankle surgeons as an integral part of our nation’s academic health centers (AHCs). In July the ACFAS Board of Directors approved a new white paper, developed by a special task force, that advocates change in professional cultures, organizational structures, clinical partnerships, research activities, admissions, accreditation, and funding models in order to support the expansion of collaborative education effectively.

Including board certified and board qualified foot and ankle surgeons in the expansion of a collaborative and integrated academic model is the key to creating an efficiently functioning team that generates clinical benefits and ensures patients will receive high-quality care. Download the white paper now (150 KB PDF).

Legal Briefs

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The Missouri Supreme Court has ruled that an amended complaint filed against three physicians and their employer two years after the statute of limitations period expired must be dismissed. The court said a Missouri trial court erred in finding the claims brought in an amended complaint by Eric Katz against Drs. Neal W. Holzum, Scott L. Landry, David Poggemeier, and their employer, BC Emergency Physicians LLP, “related back”—for statute of limitations purposes—to the original complaint Katz filed against fictitious providers “John Doe” and “Jane Doe” a day before the statute of limitations was to expire. “There is nothing inherently fatal to an action in which the petition uses the wrong name, even a ‘John Doe' designation, but the identity of the actual person should be ascertainable from the contents of the petition so that when the party gets notice of the lawsuit, he knows or should know—as the rule specifies—that the action has been brought against him,” the court said.

Foot and Ankle Surgery

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Twenty-seven patients suffering from poliomyelitis were treated by classic ring Ilizarov fixator, aiming at producing a stable plantigrade and cosmetically acceptable foot and followed up for meanly 7.17 years. The mean time in frame was 4.2 months. All the patients were satisfied with their gait, compared to preoperative status. A painless and plantigrade foot was obtained in all patients, and limb-length discrepancy was always corrected where present. No major complications were encountered.


Researchers studied the effects of a platelet-rich plasma injection in patients with chronic midportion Achilles tendinopathy at one-year follow-up. Fifty-four patients with chronic tendinopathy two to seven centimeters proximal to the Achilles tendon insertion were randomized to receive either a blinded injection containing platelet-rich plasma or saline (placebo group) in addition to an eccentric training program. The mean Victorian Institute of Sports Assessment–Achilles score improved in both the platelet-rich plasma group and the placebo group after one year. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% confidence interval, −4.9 to 15.8, P = .292). In both groups, 59% of the patients were satisfied with the received treatment. Ultrasonographic tendon structure improved significantly in both groups but was not significantly different between groups (adjusted between-group difference, 1.2%; 95% confidence interval, −4.1 to 6.6, P = .647).


The extent to which prosthesis component positioning is crucial for the final range of motion was analyzed in a study involving 14 patients undergoing total ankle replacement who were evaluated preoperatively and postoperatively at seven and 13 months follow-up. X-ray images of the ankle were taken in static double leg stance and in maximum plantarflexion and dorsiflexion. Measurements were acquired by a computer program based on anatomical reference points digitized on the radiograms, enabling calculation of the position and orientation of the components in the sagittal and coronal planes, together with the joint range of motion. The average range of motion was about 34 degrees at the first follow-up and maintained at the second, while tibial and talar components were more anterior than the mid-tibial shaft in 11 and nine patients, respectively. Average inclination was approximately 4 degrees posterior for the tibial element and almost 1 degree anterior for the talar element. Ankles with the talar component both located and inclined more anteriorly than the tibial exhibited a significantly larger range of motion.

Practice Management

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Management consultant Keith Borglum says that the need for an office manager depends on the medical practice's size and the amount of management responsibility physicians are willing to accept. In Borglum's experience, small practices of one to three physicians do not need an office manager, as they are sufficiently small and simple that the physicians should be the managers. Not having an office manager can lead to lower overhead, and a small practice can manage without one by having physicians and staff convene once a week to talk about practice issues.

Practices that add a fourth provider probably will need an office manager. Among reasons for installing an office manager is the need for someone to inspire staff to exceptional performance, and to seek ways to improve. An office manager is typically someone who provides data and answers, guards the office’s internal and external information, and guarantees the practice' adherence to regulations and statutes. Borglum also points out that office managers make and implement decisions so that doctors do not have to.


The Agency for Healthcare Research and Quality (AHRQ) has funded a toolkit prepared by the University of Wisconsin-Madison’s Center for Quality and Productivity Improvement intended to help small and medium sized practices analyze workflow before, during, and after health IT implementation. The toolkit, Workflow Assessment for Health IT, includes tools to analyze workflow, examples of workflow analysis and redesign, and peers' experiences with health IT and workflow. More information can be found here.


A collaborative effort between Blue Shield of California, Catholic Healthcare West hospital, and the physicians group Hill Physicians Medical Group cut more than $20 million in costs last year and prevented an insurance rate hike for public sector workers in Northern California. Quality of care was also improved, with hospital stays becoming shorter, readmissions declining, and doctors and nurses more closely monitoring patients. The three partners revamped procedures for medical treatment and hospital care, starting with sharing closely guarded financial and medical information. The group discovered, for example, that a variety of elective procedures were some of the biggest cost drivers. The group also looked to reduce repeat visits by paying more attention to follow-up care.

Health Policy and Reimbursement

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A primary-care physician practice in Augusta, Ga., has filed federal litigation alleging that for decades the CMS has illegally relied on biased advice from the American Medical Association (AMA) in setting its payment formulas for general and specialty doctors. As a result, the litigating doctors say, the CMS has consistently overpaid specialty doctors relative to primary-care physicians, which has made it more difficult for much-needed general medical clinics to stay in business. The lawsuit seeks a judicial ruling to order the CMS to stop using fee schedules based on AMA information. Rep. Jim McDermott (D-Wash.), meanwhile, has introduced legislation that would require the CMS to consider other sources of data when setting the physician payment rates.


A letter to the Centers for Medicare & Medicaid Services Administrator Donald Berwick submitted on behalf of the American Medical Association (AMA) and 81 other physician organizations expressed concerns about the fairness and accuracy of reporting programs using physician-identified data. The letter stated that it was important “that physicians have the opportunity to review their data that forms the basis for any public report. Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process. Any such comments should also be included with any publicly reported data. ... Further, the data used to profile physicians must be based on the quality of care provided, and never on utilization of resources alone.”


Efforts are being taken to combat unethical testimony by physicians hired to sway jurors. In recent years, several states have enacted tighter restrictions on expert witness testimony in medical negligence cases. More medical associations and state medical boards, meanwhile, have created standards for proper expert witness testimony and acted against experts who violate those rules. Courts also are taking stronger stances against questionable experts. High courts in Arizona and Maryland, for example, upheld as constitutional state restrictions against expert witnesses in 2009.

Medicine, Drugs and Devices

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The FDA has announced plans to open a public docket to begin receiving comments on its 510(k) clearance process for medical devices, in response to a report from the Institute of Medicine (IOM) criticizing the program as ineffective for establishing the safety and effectiveness of moderate risk Class II devices. IOM wants the FDA to discard the 510(k) program and work out a new framework for review that "integrates pre-market clearance and post-market performance to assure the safety and effectiveness of a medical device through its life cycle." In evaluating the 510(k) program, IOM took especial issue with the "substantial equivalence" standard, which by law allows the FDA to clear for marketing a device that is similar to any previously cleared 510(k) device.


In an effort to ensure that patient safety is maximized, accredited organizations that perform sterilization or high-level disinfection (HLD) are encouraged to review their processes in detail. Comparison of organizational policies and procedures with relevant guidelines will help organizations make sure that their processes are up-to-date. Also, by observing the actual sterilization or HLD of instruments, leaders can gain valuable information that may help in identifying opportunities for improvement.


Sales of new drugs are threatened by various factors, among them doctors' concerns of prescribing new drugs with unknown side effects, a crackdown by the U.S. government on improper pharmaceutical marketing, and the difficulty drug companies face in getting money for expensive new products out of increasingly frugal insurers and government health systems. IMS Health reports that newly launched drugs rang up U.S. sales of $11.8 billion in 2005, versus $4.3 billion last year. Drug companies have organized teams to bombard insurers with data that they hope will prove that their drugs are worth the cost, and they also are redesigning clinical trials to try to demonstrate that their treatments save money and coaching sales representatives to express the new value message in meetings with insurers.