August 10, 2016 | | JFAS | Contact Us

News From ACFAS

Keynote Speaker to Bring New Insights to ACFAS 75
Hear new perspectives from Roni Zeiger, MD, when he takes the stage at the ACFAS 75 general session in February. Dr. Zeiger, CEO of Smart Patients and former chief health strategist at Google, developed cutting-edge technology like Google Flu and Symptom Search. He reimagined how patients can use their knowledge collectively to avoid misinformation. What shift will take place as a result?

ACFAS 75, set for February 27–March 2, 2017 at the Mirage Hotel in Las Vegas, will feature the clinical sessions, workshops and panel debates the Annual Scientific Conference is known for plus special events to celebrate the College's 75-year history. Visit the Exhibit Hall after Dr. Zeiger's presentation to view the latest offerings from industry vendors and to browse the entries in our annual Poster Competition. Meet up with your colleagues and past ACFAS presidents at the opening reception in Siegfriend & Roy's Secret Garden and Dolphin Habitat then top off your conference experience with a wrap party in the Linq promenade.

Put ACFAS 75 on your calendar now and watch This Week @ ACFAS and for updates.
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Research Grant Applications Due September 15
Don't miss your chance to let the College help fund your latest research—apply for the the ACFAS Clinical and Scientific Research Grant by the September 15, 2016 deadline.

ACFAS encourages members to conduct research to fill the gaps in the profession's knowledge base and to improve patient care in foot and ankle surgery. This year, the College will award more than $40,000 in grant awards to support these efforts.

Visit for further details and to apply.
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Hit the Road for a New Perspective on Frequent Forefoot Surgery
If you feel like you could perform forefoot procedures in your sleep, it might be time to switch up your routine and expand your skillset. ACFAS’ regional program, On the Road: Refining High-Frequency Forefoot Surgery, has just what you need to refresh your approach to the forefoot procedures you perform most often.

This two-day workshop (worth 12 continuing education contact hours) kicks off on Friday night with case studies and a presentation on avoiding forefoot surgical complications. Bring your most problematic case to share for panel discussion. Look forward to lectures and sawbones labs on Saturday that will outline the best treatment plans for forefoot injuries and deformities.

Three workshops are scheduled between now and the end of the year. Register today at
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Foot and Ankle Surgery

PTA Combined with Intra-Arterial Thrombolysis to Treat LE Arterial Occlusion in Thromboangitis
A study evaluates the effect of percutaneous transluminal angioplasty (PTA) and the intra-arterial infusion of thrombolytic drugs on the treatment of lower extremity (LE) arterial occlusion during thromboangiitis obliterans (TO). Researchers conducted PTA in 13 patients with TO and LE arterial occlusion. An antegrade approach with transfemoral access was performed in 17 procedures, and a retrograde approach through the contralateral common femoral artery was used in one procedure. The occlusions were dilated with a wire under fluoroscopic guidance and a deep balloon. Following dilation, a thrombolysis catheter was inserted to intra-arterially infuse the thrombolytic drug. PTA was successful in 39 of the 61 LE occluded arteries with no observed serious complications. There were significant differences in the Ankle Brachial Index and the self-reported maximum walking distance before and after PTA.

From the article of the same title
International Angiology (10/01/2016) Vol. 35, No. 5, P. 440-445 Li, FQ; Li, L; He XW; et al.
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Radiographic Evaluation of IMA Correction Following First MTP Joint Arthrodesis for Severe Hallux Valgus
Researchers sought to examine the efficacy of a first metatarsophalangeal joint fusion in patients with severe hallux valgus and metatarsus primus varus without the addition of a proximal first metatarsal osteotomy. Preoperative and postoperative radiographs of 19 feet in 17 patients with preoperative first-to-second intermetatarsal angles (IMAs) greater than 15 degrees were reviewed. The mean preoperative IMA was 19.2 degrees, and the mean hallux valgus angle (HVA) was 48.5 degrees. The mean postoperative change in IMA was 8.3 degrees, and the change in HVA was 36.4 degrees. Seven feet were corrected to a normal IMA of less than 9 degrees, and 15 feet were corrected to 12.3 degrees or less. In 15 feet, the postoperative HVA was less than 15 degrees. Both HVA and IMA were corrected without a proximal first metatarsal osteotomy.

From the article of the same title
Foot & Ankle International (07/16) McKean, R. Matthew; Bergin, Patrick F.; Watson, Geoffrey; et al.
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Ruptured Human Achilles Tendon Has Elevated Metabolic Activity Up to One Year After Repair
A study investigated tendon metabolism and vascularization at three, six and 12 months after Achilles tendon rupture using PET and power Doppler ultrasonography (PDUS). Twenty-three patients with surgically repaired Achilles rupture were studied at the three points after surgery. The triceps surae complex was loaded during slow treadmill walking, and vascularization was later measured in terms of PDUS flow activity. Patients reported outcomes using the Achilles tendon rupture score. PDUS flow was higher in repaired tendons than in intact tendons at three and six months, normalizing at 12 months. Relative glucose uptake was higher in repaired tendons than in intact tendons at all checkpoints. Glucose uptake was also higher in the tendon core than in the periphery at three and six months and lower at 12 months. Patient-reported outcomes suggest high metabolic activity six months after injury may negatively impact clinical healing outcomes.

From the article of the same title
European Journal of Nuclear Medicine and Molecular Imaging (09/16) Vol. 43, No. 10, P. 1868-1877 Eliasson, Pernilla; Couppe, Christian; Lonsdale, Markus; et al.
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Practice Management

'Minimum Necessary' Standard Perplexes Practices
The Health Insurance Portability and Accountability Act mandates that only the "minimum necessary" information is released when records must be shared in order to protect patient privacy. However, covered entities are responsible for adopting their own definitions and implementation practices for the minimum standard. The U.S. Department of Health and Human Services provides guidelines for developing an entity’s minimum necessary standard, but many in the industry have called for a uniform, unambiguous definition of minimum necessary information. According to a survey by the American Health Information Management Association (AHIMA), 38 percent of respondents were unsure if their organization had adopted a definition for minimum standard, and 14 percent said no definition had been adopted. A third of respondents reported no policies or procedures in place relating to the minimum standard. Angela Rose, director of practice excellence with AHIMA, said the practice's designated privacy officer should work with staff members and physicians to develop a suitable definition and minimum standard-related policies.

From the article of the same title
Modern Medicine (08/01/16) Stewart, Dava
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Giving Your Practice a 21st-Century Makeover
Medical residency trains doctors for the surgical and clinical aspects of the field, but it little prepares them for learning how to run a profitable practice and pull older practices into the 21st century. For Kansas podiatrist Brooks Young, his efforts to modernize the private practice bought from a retiring physician relied on trial and error. Physicians tasked with revamping a practice often must first confront the existing, outdated electronic health record (EHR) systems and find a cost-effective replacement with meaningful use guidelines. Young also needed to tackle a clumsy billing process that had not been updated in decades and had been left behind by changing insurance and billing standards. By hiring an in-house employee to handle billing procedures, the system was streamlined and required less involvement by the physician. Practices should be in regular contact with their biller to keep track of any changes in coverage for procedures and should consider the potential financial impact on patients. As Young’s practice matures, the next step is to establish an efficient system to check for the availability of certain services and to provide cost estimates to patients.

From the article of the same title
Physicians Practice (08/01/16) Perna, Gabriel
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How Healthcare Cybersecurity Relates to DHS Incident Reporting
Covered entities must adhere to Health Insurance Portability and Accountability Act (HIPAA) regulations when reporting potential cybersecurity incidents, but organizations should also review U.S. Department of Homeland Security (DHS) guidelines on how to report incidents to federal agencies. In addition to notifying the Office for Civil Rights, entities should contact local agencies to investigate the incident and help mitigate remaining vulnerabilities. Incidents can be reported at any stage, but reports are most helpful when they can provide agencies with details on what occurred, how the incident was detected and what response has already been taken. Once notified, the agency will coordinate with other relevant stakeholders to assess the damage, pursue any cybercriminals and share information to prevent future attacks. In a separate report, DHS issued an alert on how ransomware attacks could disrupt networked systems and discouraged organizations from paying ransom fees.

From the article of the same title
HealthIT Security (08/01/2016) Snell, Elizabeth
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Health Policy and Reimbursement

CMS Finalizes Controversial Hospital Overpayment Cut
The Centers for Medicare and Medicaid Services (CMS) will uphold a 1.5 percent cut to hospital reimbursement despite industry opposition to the move that seeks to recover $11 billion in overpayments. In 2012, Congress mandated that CMS recoup funds allegedly lost due to incorrect coding on hospital stays, and the reimbursement cut has remained at 0.8 percent since 2014. CMS states that another 0.8 percent reduction this year would leave the government $5 billion short by the deadline of 2017. CMS also plans to delay making changes to the disproportionate-share payments distribution to safety-net hospitals, as industry stakeholders claimed the proposed formula would favor hospitals that see large numbers of uninsured patients and reward states that chose to have fewer insured patients. Almost $6 billion in uncompensated care payments will be distributed next year, down $400 million from last year.

From the article of the same title
Modern Healthcare (08/02/16) Dickson, Virgil
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Doctors Are Improperly Billing Some on Medicare, U.S. Says
The Obama administration says doctors are improperly billing elderly Medicaid participants for deductibles, co-payments and other costs that should be exempted. The administration has also said doctors must accept Medicaid payments in full for Medicare patients. The Department of Health and Human Services says incorrect billing is "relatively commonplace" because “some Medicare providers unlawfully bill enrollees” after they have received payment from Medicare and Medicaid. Some doctors claim they are not aware which patients are exempt. In response, the government says it is increasing education to end confusion.

From the article of the same title
New York Times (07/30/16) Pear, Robert
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What Insurers Leaving Obamacare Exchange Means for Physicians
Significant losses in individual Affordable Care Act (ACA) markets and a shortage of enrollments have resulted in insurers leaving some ACA markets. About 10 million of the expected 21 million people have enrolled, causing rates to rise. Physicians who had contracts with insurers that exited the exchanges may lose patients, according to Payer+Provider Syndicate. Residents of 650 counties will have only one insurance company option next year, reducing the incentives to offer low, competitive prices. To control costs, carriers might limit their network access and reduce payments to providers. With fewer insurers on the market, providers may lose their bargaining power to negotiate better rates. To compensate for lost reimbursement revenue, doctors would need to take on more patients. “There is a high probability that insurers will continue to offer plans with high deductibles and a narrow networks of providers,” says Susan Nedza of MPA Healthcare Solutions. “Patients may forgo needed treatment due to co-insurance costs.” Unless the market stabilizes, physicians will need to spend more time dealing with additional paperwork and administrative issues, taking attention away from their patients.

From the article of the same title
Medical Economics (08/03/16) Loria, Keith
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Medicine, Drugs and Devices

FDA Expands Dysport (AbobotulinumtoxinA) Label to Include Treatment of Lower-Limb Spasticity in Children
The U.S. Food and Drug Administration has approved the supplemental biologics license application for Dysport (abobotulinumtoxinA) for injection for the treatment of lower-limb spasticity in pediatric patients two years of age and older. Dysport is the only FDA-approved botulinum toxin for the treatment of pediatric lower-limb spasticity. Dysport is an injectable form of botulinum toxin type A, which is isolated and purified from Clostridium bacteria producing BoNT-A. It is supplied as a lyophilized powder. Dysport was previously approved in the United States for the treatment of adults with cervical dystonia or upper-limb spasticity to reduce the severity of increased muscle tone in elbow, wrist and finger flexors.

From the article of the same title
Managed Care Magazine (08/16)
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FDA-Approved Knock-Offs of Biotech Drugs Could Safely Save Big Bucks
Copycat versions of biotech drugs work just as well as the originals and cost a lot less, according to an analysis of studies of the medicines by researchers at Johns Hopkins Bloomberg School of Public Health. The researchers looked at data from 19 studies of biosimilar drugs that treat rheumatoid arthritis, inflammatory bowel disease and psoriasis and found that they were comparable to the originals and would cost less. The research appeared in the August 2 issue of Annals of Internal Medicine.

From the article of the same title
NPR Online (08/01/16) Kodjak, Alison
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Supersizing: Hospitals Gear Up for Big Patients
Hospitals are gearing up for overweight patients, with super-sized equipment, surgical tools and furniture. The South and Midwest are especially hard-hit by obesity, but the trend holds true across the nation, according to Robert Cima, a colorectal surgeon with the Mayo Clinic in Rochester, Minnesota. One of the fastest-growing industries in surgery is designing equipment for obese patients, such as laparoscopic instruments long enough to reach organs through layers of fat, he said. And architects who design new medical centers or hospital wings now do so with obese patients in mind. Cima estimates that retrofitting or redesigning a hospital room for obese patients costs $50,000-$70,000. A 2014 report from Novation, a healthcare supply chain analytics and contracting company, found that making all renovations necessary to accommodate morbidly obese patients cost $100,000 at one hospital and $2.3 million at another. Virtually all of the 125 hospitals that responded to Novation's survey reported using durable medical equipment designed for the morbidly obese, such as big beds, lifts and stretchers.

From the article of the same title
Louisville Courier-Journal (07/30/16) Ungar, Laura
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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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