August 14, 2013
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News From ACFAS

ACFAS Coming to a Location Near You
The ACFAS Simple to Complex Forefoot Revisional Surgery Workshop and Seminar is coming to you. These hands-on learning opportunities for practicing surgeons and those still in training surgeons begin on a Friday evening with a presentation on "Common Forefoot Surgical Complications—How to Deal with Them," followed by case studies. Participants should bring cases to share. Saturday’s sessions will provide a full day’s schedule of succinct lectures followed by hands-on workshops featuring sawbones, where you will practice what you’ve learned in the preceding lectures. Program attendees receive up to 12 continuing education contact hours. Registration is open and workshops are filling fast. Pick your location and date and register today!

Dates and locations include:
  • October 18-19
    ACFAS and Division 5
    Jacksonville Marriott, Jacksonville, FL

  • October 25-26
    ACFAS and Division 6
    Chicago O’Hare Marriott, Chicago, IL (Rosemont)

  • November 8-9
    ACFAS and Division 3
    Hilton Anatole, Dallas, TX

  • November 15-16
    ACFAS and Division 9
    Sheraton LaGuardia East, New York, NY

  • April 25-26, 2014
    ACFAS and Division 11
    Tysons Corner Marriott, Tysons Corner, VA

  • May 2-3, 2014
    ACFAS and Division 1
    Manhattan Beach Marriott, Manhattan Beach, CA
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Exhibit at ACFAS 2014 in Orlando
Reach 1,300 of the finest foot and ankle surgeons by exhibiting in the Exhibit Hall at the ACFAS 2014 Annual Scientific Conference, February 27-March 2, in Orlando, Florida. Here you'll find yourself immersed in the largest one-stop shopping arena in this field.

Your Exhibitor Prospectus is in the mail with all the details and deadlines you’ll need to be involved in the popular Exhibit Hall – plus, you can read it online now at Here you’ll also find more information on the latest details about the Annual Scientific Conference, including submission specifics for manuscripts and posters.

For more information on plans for the ACFAS 2014 conference, see this article (PDF) from a recent ACFAS Update newsletter.
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Free Member-Focused Marketing and Public Relations Powerhouse
Have you taken full advantage of the new Marketing Toolbox on It’s full of peer-reviewed and member-approved public relations and marketing tools that you need to successfully promote your practice – and it’s all free to members!

Here are some of the tools you’ll find at
  • A New The Foot and Ankle Surgeon Brochure
  • Media Pitch Templates & Guidelines
  • Linking Your Website to
  • How to Use Social Media to Grow Your Practice
  • Fill-in-the-Blank Press Releases
  • FootNotes Patient Newsletter
  • PowerPoint Tools
  • Patient Education CDs
  • Member Logo Library
Take advantage of the tools you need to promote your practice by visiting the ACFAS Marketing Toolbox today.
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Foot and Ankle Surgery

Proximal Opening-Wedge Osteotomy of the First Metatarsal for Moderate and Severe Hallux Valgus Using Low Profile Plates
A recent study has found that the proximal metatarsal opening wedge (PMOW) osteotomy is effective at treating high-level hallux valgus deformities, regardless of whether the Darco BOW or the Arthrex LPS screw and plate systems are used. The study examined 41 patients with moderate and severe hallux valgus who were treated with the PMOW osteotomy using either the Darco BOW or the Arthrex LPS plate. Researchers found that American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from a mean of 50 to 82, while the sesamoid position improved in 79 percent of the feet. The HV, IM, DMA and IP angles improved by a mean of 14 degrees, eight degrees, 11 degrees, and seven degrees, respectively. The study concluded that both screw and plate systems corrected the osteotomy site and achieved stability.

From the article of the same title
Foot and Ankle Surgery (08/02/13) Nery, Caio; Ressio, Cibele; Chertman, Carla; et al.
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Comparison of the HINTEGRA and Mobility Total Ankle Replacements
A recent study found that there were largely no significant differences in the outcomes of HINTEGRA total ankle replacements (TARs) versus Mobility TARs. Researchers compared 32 HINTEGRA TARs and 35 Mobility TARs, and found that there were no significant differences between the two groups in terms of mean American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analogue scores for pain or range of movement of the ankle at the last follow-up. The radiological measurements of the two groups were also essentially the same. The most common grade of heterotopic ossification (HO), meanwhile, was grade 3 in the HINTEGRA group and grade 2 in the Mobility group. HO was found to be more frequent among patients who underwent HINTEGRA TARs compared to patients who underwent Mobility TARs, though this difference was also not statistically significant. The rate of intra-operative medial malleolar fractures was the same in both groups, at four each. One TAR in the Mobility group failed.

From the article of the same title
Bone & Joint Journal (08/13) Vol. 95-B, No. 8, P. 1075 Choi, G.W.; Kim, H.J.; Yeo, E.D.; et al.
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Practice Management

How to Get Tax Breaks for Your Medical Practice
Many federal, state, and local tax incentives are available to practices. In some instances, the process is as simple as filling out a form and building in the right location. However, other incentives, such as local tax abatements, may be complicated and lengthy, and require legal counsel. States often follow the U.S. Internal Revenue Service's policies, and what is federally deductible is often deductible at the state level as well.

A practice should research their state's economic development website to discover available incentives, forms to fill out, and contact information. While incentives vary by state, many states provide incentives based on building location and the hiring of unemployed or disadvantaged people, or even just for hiring. Federal incentives can be earned by hiring a veteran through the U.S. Department of Veteran's Affairs' Special Employer Incentive Program. The department may reimburse the employer for up to 50 percent of the veteran's salary for up to six months.

Many more incentives exist for practices in rural areas. The U.S. Department of Agriculture has a loan program and will offer grants for rural development. Also, many states and the federal government practice loan forgiveness for administrators who work in certain rural areas for a specified period. While the process can be slow and complicated, local tax abatements are often available as well.

Administrators can claim mileage deductions for work-related trips, but not for the standard commute. Airfare, meals, tips, and other expenses can be deducted if attending a medical education course or seminar, but not if most of the time is spent in tourist activities. Medical liability insurance, retirement plans, health insurance, and any other employee benefits, wages, and taxes are deductible, as are medical equipment, office supplies, uniforms, advertising, and promotion costs.

Lease and mortgage payments and taxes on the practice are deductible, including home offices. Gifts to employees and referring practices are deductible, but gym and club memberships should not be deducted unless a specific business link can be proven.

From the article of the same title
American Medical News (08/05/13) Caffarini, Karen
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Picking Your Best Option for Patient Interpretation Services
Physician practices have a number of options for complying with Title VI of the Civil Rights Act of 1964, which requires them to make a trained interpreter available to patients who have little to no ability to speak English. One option is to use a patient's family members or friends to translate for the patient. While this approach can be appealing to practices because it is free, it also comes with several disadvantages, including the fact that the patient's relative or friend may not understand medical terminology and may make a mistake during the translation as a result. Confidentiality issues also arise when asking a patient's family member or friend to act as an interpreter.

Practices can avoid these disadvantages by hiring on-site interpreters when they are needed, which reduces the risks of misinterpretation. On-site interpreters also follow a professional code of ethics that requires them to keep sensitive patient information confidential. But these interpreters usually cost anywhere from $50 to $145 an hour, and sometimes bill for at least two hours. Some interpreters also charge for the expenses they incur when traveling to offices.

Experts say that the solution that balances practice needs to keep costs down while ensuring patient confidentiality is to be bilingual themselves or to have bilingual staff members who can act as interpreters. The advantage to this approach is that the practice will not have to pay anything extra for an interpreter, since the person providing the translation services is already on staff. Practices will also not have to worry about being misinterpreted when they or one of their staff members provide translation services for patients.

From the article of the same title
American Medical News (08/05/13) Caffarini, Karen
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Using a Management Coach to Improve Medical Practice Performance
Physicians' practices that are losing money or are troubled in other ways can benefit from the use of an executive coach. Executive coaching offers a number of advantages, including teaching a practice's leaders how to avoid future problems. This in turn helps the practice avoid the disruption that occurs when there is an abrupt change in its leadership, and also helps the practice avoid hiring new leaders that do not have the requisite skills for heading up the practice. Executive coaches can help define the roles of the practice's administration and its physicians. By explicitly defining what each of these roles entails, practices can create a collaborative culture that allows the strengths and talents of physicians and management to benefit the entire practice.

Practices should consider a number of different factors before selecting an executive coach. For example, coaches should have a significant amount of experience in medical practice management, preferably in managing a variety of different types of practices. Such a variety of experience will make it more likely that coach will have a broad knowledge of the types of challenges a practice will face. Administrators/senior physicians should also be sure that they personally like any prospective coach, since this will make it more likely that they will listen to difficult advice from the coach.

From the article of the same title
Physicians Practice (08/04/13) Mertz, Greg
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Health Policy and Reimbursement

Insurers Pressed to Send Patient Coverage Information to Providers
The Centers for Medicare and Medicaid Services (CMS) has developed new rules for health insurers regarding their communications with healthcare providers about how much they will pay for doctors visits and procedures. Under the new rule, health insurance companies will be required to quickly send healthcare providers electronic communications about whether patients have health insurance coverage as well what the patient's co-payment split will be and how much the patient will have to pay under his policy's deductible and out-of-pocket limits. Rules that govern such communications have been in place for some time, though not all health insurance companies and other payers are complying with them.

From the article of the same title
Modern Healthcare (08/08/13) Conn, Joseph
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CMS, Health IT Coordinator Release Strategy to Accelerate Health Information Exchange
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health Information Technology introduced a three-pronged plan for increasing the sharing of healthcare data among providers and healthcare organizations. The first aspect of the plan, which was introduced on Aug. 7, calls for accelerating health information exchange (HIE). This will include promoting the use of HIE in existing Medicare and Medicaid programs by offering providers incentives that will eventually become payment adjustments. Both CMS and ONC hope to eventually require the use of HIE in order to participate in Medicare and Medicaid. The second aspect of the plan calls for ONC to continue using multi-stakeholder approaches to developing standards under its Standards and Interoperability Framework. In addition, CMS and ONC would align health IT standards for quality measurement and improvement programs across Medicare and Medicaid and would speed up the alignment of electronic clinical quality measures, electronic decision support, and electronic reporting mechanisms for Medicare and Medicaid. Finally, CMS and ONC hope to promote the universal sharing of healthcare data by improving consumer and patient engagement.

From the article of the same title
BNA Snapshot (08/08/2013) Plank, Kendra Casey
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Calif. Hospital Prices Drop as CalPERS Caps Coverage for New Knees, Hips
A study by researchers at the University of California has found that the California Public Employees' Retirement System's (CalPERS) decision to move to a "reference price" system for reimbursements for orthopaedic surgery helped bring down the costs of joint replacements at some hospitals in the state. The policy change involved CalPERS and the health insurance company Anthem designating 41 hospitals as "value" hospitals, or those that offered joint replacements for $30,000 or less, had a high volume of joint replacements and reported quality measures to the Joint Commission and the state government. Patients who had joint replacements at value hospitals were required to pay co-insurance up to $3,000, while patients who had the procedure performed elsewhere paid co-insurance up to the same amount along with any additional expenses beyond $30,000.

The study found that the average cost of a joint replacement at the most expensive hospitals in California dropped from $43,308 in 2010 to $28,465 after the reference pricing policy was put into effect. At the same time, value hospitals started peforming a larger proportion of joint replacements. Researchers say that reference pricing brings about changes in consumer behavior that result in lower prices for procedures because such policies require consumers, not employers, to pay any additional costs charged by the highest-priced hospitals. This in turn results in consumers shopping around for the best price, which causes hospitals to drop their prices in order to compete with other facilities, researchers said.

From the article of the same title
Modern Healthcare (08/05/13) Evans, Melanie
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ObamaCare Cost-Cutting Board Faces Growing Opposition From Democrats
A growing number of congressional Democrats are calling for the repeal of the Independent Payment Advisory Board (IPAB), the body that was created by the Affordable Care Act (ACA) to help reign in the growth of Medicare expenses. The healthcare reform law calls for IAPB to make recommendations for reducing Medicare spending when the growth of such spending exceeds a certain rate. While ACA explicitly states that IAPB cannot make recommendations that would directly ration healthcare, some congressional Democrats and others say that it would essentially do just that by cutting provider reimbursements, thus making it difficult for healthcare professionals to make money in Medicare. Supporters of IAPB say that the panel is necessary to make focused cuts to Medicare, particularly now that Medicare is moving to new payment models that are intended to lower costs while simultaneously improving care.

From the article of the same title
The Hill (08/08/13) Viebeck, Elise
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ObamaCare Months Behind in Testing IT Data Security: Government
A report released by the Department of Health and Human Services' inspector general has found that the Centers for Medicare & Medicaid Services (CMS) has missed several deadlines related to the Oct. 1 rollout of the Affordable Care Act's health insurance exchanges. The missed deadlines include the May 13 deadline for a CMS contractor to submit a plan to test the security of the information technology component of the exchanges. That missed deadline caused a test of the security of the IT component to be pushed back from early June to this week and next, and has also pushed back the date that CMS' chief information officer will be able to certify the IT system as being secure to Sept. 30. The inspector general noted that additional delays could result in CMS not having the information it needs to authorize the use of the IT system on Oct. 1, though the agency has said that the exchanges will open on time.

From the article of the same title
Reuters (08/06/13) Begley, Sharon
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Tavenner Grilled on Healthcare Reform Status
Centers for Medicare & Medicaid Services head Marilyn Tavenner appeared before the House Energy & Commerce Committee on Aug. 1 during what was a sometimes contentious hearing about the progress that is being made in implementing the Affordable Care Act. Among the issues that Tavenner addressed in her testimony was the delay of the employer mandate, which she said was not an indication that the implementation of the rest of the Affordable Care Act is behind schedule. Tavenner noted that a number of important deadlines associated with the Affordable Care Act will be met despite the delay, including the Oct. 1 launch of the health insurance exchanges. Perhaps the most contentious moment of the hearing was when Tavenner said that only a few employers had reduced their employees' hours to cope with the Affordable Care Act--a statement which was disputed by two Republican lawmakers.

From the article of the same title
HealthLeaders Media (08/05/13) Tocknell, Margaret Dick
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Medicine, Drugs and Devices

Foot CT Perfusion in Patients with Peripheral Arterial Occlusive Disease (PAOD): A Feasibility Study
Quantitative foot perfusion multidetector-row computed tomography (MDCT) is a feasible and reproducible technique in patients with peripheral occlusive artery disease (PAOD), a study by researchers in Italy has found. The study involved 10 patients over the age of 65, all of whom underwent foot CT perfusion examinations before endovascular treatment and again 72 hours afterward. Two blinded readers were used to calculate perfusion parameters, while Bland-Altman analyses and intra-class correlation coefficient were used to assess inter-observer and intra-observer agreement of perfusion CT analysis.

All of the study's participants displayed good inter-observer and intra-observer agreement. Researchers noted that good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. In addition, a comparison of perfusion parameters in the treated foot resulted in a significantly shorter mean transit time. This decreased MTT was indicative of improved flow in the arteries below the knee following revascularization.

From the article of the same title
European Journal of Radiology (09/13) Iezzi, R.; Santoro, M. ; Dattesi, R.; et al.
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