News From ACFAS

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This is the season of new beginnings, and ACFAS is happy to help commemorate your many career firsts:

• First year of residency?
  ACFAS congratulates you on achieving your DPM, and wants to help you celebrate by providing your first year of membership at no cost. Get all the benefits of the College, including the Journal of Foot & Ankle Surgery delivered to your mailbox, free for a year!
• Passed Part 1 of the ABPS Certification Exam in July 2011?
  After completing the written portion, you're on the road to Board Certification! Advertise your ABPS status, and enjoy the many educational resources ACFAS offers, by joining the College as an Associate Member. To help you make the transition from resident to practitioner, ACFAS is waiving the processing fee and dues for the rest of 2011.
• Passed Part 2 of the ABPS Certification Exam in July 2011?
  Congratulations on your certification! Become recognized as a Fellow Member of ACFAS, which will allow you to list the esteemed “FACFAS” credential after your name. Once you’ve received your exam results from ABPS, contact the College.

The sooner you apply, the more quickly you can enjoy all the benefits of membership. For questions or an application, contact membership@acfas.org.
If you’re looking to expand your skills with hands-on workshops in your area, look no further! This fall the College’s first-rate continuing education may be coming to a town near you with “1st MTPJ A-Z Workshop and Seminar.” ACFAS has teamed with Regional Divisions 1, 8, and 12 to bring this program to three new locations:

• Manhattan Beach Marriott, Manhattan Beach, Calif., Sept. 9–10
• Boston Marriott Burlington, Burlington, Mass., Oct. 21–22
• Best Western Lehigh Valley Hotel and Conference Center, Bethlehem, Pa., Dec. 2–3

More information and online registration is available now at the ACFAS website. Two 3-year director terms on the ACFAS Board of Directors are open for nomination this year. ACFAS Fellows who meet criteria for election are encouraged to submit a nomination application by Sept. 20. The Nominating Committee will announce recommended candidates to the membership no later than Nov. 3. Candidate information and ballots will be e-mailed to all voting members no later than Dec. 18. Electronic voting will end on Jan. 17, 2012. New officers and directors will take office during the ACFAS 2012 Annual Scientific Conference on March 1–4, 2012, in San Antonio, Texas.

For complete details on the recommended criteria for candidates and the nomination application, visit acfas.org/nominations, or contact Executive Director Chris Mahaffey at 773-693-9300 or mahaffey@acfas.org. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Michael S. Lee, DPM, FACFAS, at 515-440-2676 or mlee@dsmcapitalortho.com.

Legal Briefs

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A federal court has declined to dismiss, in part, a lawsuit brought by 29 hospital groups that challenged Medicare outlier payment regulations and their enforcement, ruling that at least part of the administrative record is necessary to determine if the lawsuit has merit. In Banner Health v. Sebelius, the U.S. District Court for the District of Columbia denied, in part, the secretary of Health and Human Services' motion to dismiss a claim by Banner Health and 28 other hospital owners and operators that the plaintiffs were deprived of more than $350 million in outlier payments from fiscal years 1998-2006. The plaintiffs are challenging as arbitrary and capricious the outlier payment regulation, the fixed loss threshold regulation, and the application of those regulations in fixing the amount of outlier payments to hospitals.

Foot and Ankle Surgery

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Researchers evaluated the clinical and computed tomography (CT) outcomes of surgically treated navicular stress fractures. The study examined 10 navicular stress fractures in patients, with an average follow-up of 42.4 months postoperative. The patients underwent a clinical examination and a CT scan of their operated foot. According to the CT scan evaluation, eight out of the 10 navicula had gone on to union. Clinical outcome scores on all patients were an average AOFAS hindfoot score of 88.5 and an average SF-36 score of 88.3. The feet with united fractures had an average AOFAS score of 92.1 and an average SF-36 score of 91.9. The two patients with nonunions had AOFAS scores of 74 and 74 and SF-36 scores of 70 and 78, respectively. Both nonunions were complete, displaced fractures on preoperative imaging.


Researchers theorized that patients at a higher risk for recurrence of hallux valgus following a proximal metatarsal osteotomy could be identified preoperatively and at the early follow-up on the basis of their radiographic assessment, and research was conducted to clarify the relationship between the hallux valgus angle, intermetatarsal angle, and recurrence of hallux valgus. A case-control study of patients treated with a proximal metatarsal osteotomy for hallux valgus was performed, and dorsoplantar weight-bearing radiographs of 72 feet were evaluated preoperatively, at the early follow-up interval of approximately 10 weeks, and at the most recent follow-up interval of about 33 months. The rate of recurrence was determined to be 13.9 percent, or 10 feet. A preoperative hallux valgus angle of greater than 40 degrees was the recurrence risk factor. Lower risks of hallux valgus recurrence were a hallux valgus angle of less than or equal to 15 degrees, and an intermetatarsal angle of less than 10 degrees at the time of the early follow-up with the numbers available.


Research was conducted to assess the feasibility of ultrasound-guided platelet-rich plasma (PRP) injections into the Achilles tendon (AT) and in the area between the paratenon and the AT, and to evaluate the distribution of PRP following injection into the AT and in the area between the paratenon and AT. Fifteen cadaveric lower limbs were injected under ultrasound guidance with Indian blue-dyed PRP. Five injections went into the AT at the midportion level, five injections were located anterior between the paratenon and AT, and five were posterior between the paratenon and AT. All injections into the AT demonstrated PRP infiltration in the AT and in the area between the paratenon and AT, while one of five limbs showed PRP leakage into the Kager fat pad following AT injection. All anterior and posterior injections exhibited PRP infiltration in the area between the paratenon and AT, and the AT was infiltrated with PRP after three of 10 paratenon injections.

Practice Management

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CMS has announced that its Electronic Health Record (EHR) Demonstration will end early after experiencing an unexpected drop in the number of participating treatment group practices. CMS has concluded that the final participation numbers will likely be insufficient for the demonstration evaluation to support any definitive conclusions. In 2007, the Secretary of the Department of Health and Human Services directed the Centers for Medicare & Medicaid Services to develop the initiative using Medicare waiver authority to reward the delivery of high-quality care supported by the adoption and use of EHRs. The goal of this demonstration was to foster the implementation and adoption of EHRs and health information technology (HIT) more broadly as effective vehicles to improve the quality of care provided and transform the way medicine is practiced and delivered.


In July, new rules went into effect at teaching hospitals around the country abolishing 30-hour overnight shifts for first-year residents, despite objection from nearly every major medical organization 79 percent of residency-program directors. A study published in 2004 in The New England Journal of Medicine showed that interns working the traditional 30-hour shifts made 36 percent more serious medical errors. In 2003, the Accreditation Council for Graduate Medical Education imposed the 80-hour limit on all U.S. training programs, prohibited trainees from direct patient care after 24 hours of continuous duty, and mandated at least one day off per week.

However, a national study of 14 million veterans and Medicare patients, published in 2009 showed no major improvement in safety after the 2003 reforms. While some mistakes made by doctors are no doubt linked to a lack of sleep, fixating on work hours has meant overlooking other issues, like lack of supervision or the failure to use more reliable computerized records. Furthermore, shorter shifts mean doctors have less continuity with their patients. Work-hour reductions lead to more handoffs of patients, and the number of these handoffs is one of the strongest risk factors for error.

Health Policy and Reimbursement

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The Centers for Medicare & Medicaid Services has launched a new website that allows users to compare hospitals, doctors, and nursing homes. The site compares facilities based on several criteria, including the satisfaction of previous patients. CMS also added new metrics for hospitals, allowing users to compare hospitals based on how well they protect against surgical infections and how well they treat possible heart attacks.


Medicare officials announced that they would extend the Physician Group Practice Demonstration by another two years from January 2011, after the program showed that physicians who coordinate care and keep their patients out of the hospital could achieve significant cost reductions. Ten physician groups were able to enhance the quality of care in conditions such as diabetes and heart failure while cutting costs by $134 million during the five-year experiment. Rather than compensating doctors more when they performed more tests or conducted more procedures, Medicare attempted to remunerate them for providing a better quality of care that saved money by keeping people out of the hospital or emergency department when they did not have to be there.


Interest groups representing thousands of American hospitals have filed briefs with the U.S. Supreme Court contending that healthcare providers should be allowed to challenge indiscriminate rate cuts through litigation. The high court has agreed to hear three consolidated suits on Oct. 3, in which three healthcare providers—a hospital, a nursing home, and a group of pharmacists—allege that California's 10 percent rate cuts in Medi-Cal in 2008 violate the terms of the Medicaid Act. The providers charge that by slashing rates, fewer physicians and facilities will accept Medicaid patients, who must then seek care in crowded emergency rooms. They say that the U.S. Constitution's Supremacy Clause should give federal ordinances such as the Medicaid Act priority over state budget policies, particularly when states disregard administrative rulings.

Medicine, Drugs and Devices

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The mission of the Patient-Centered Outcomes Research Institute (PCORI) established by the 2010 federal health law is to compare treatments to ascertain which medical options make the most sense for specific people. Among the challenges PCORI faces is identifying research priorities for patients based on the study of hundreds of medical conditions and the questions they pose; avoiding political criticism from opponents who claim that PCORI will ration care; maintaining support from medical device manufacturers and drug firms that are worried the institute will be simply a cost control mechanism; and developing strategies for performing studies to provide meaningful results. By year's end PCORI expects to make a number of grants to identify what they need to learn from patients, for instance, should they employ social media to ask people what kind of information they want to have before choosing treatment options. Dartmouth Medical School professor Harold C. Sox says that PCORI's research, if well executed, could empower patients to make informed treatment decisions and help them avoid needless and perhaps costly options, which is something that both sides of the political spectrum ought to advocate for.


A study from the American College of Surgeons and 20 other surgical specialty organizations provides new guidance on whether an operation may call for the use of a physician as an assistant during surgery. The Physicians as Assistants at Surgery report was last published four years ago and now accounts for 371 new Current Procedural Terminology, or CPT, codes. Organizations that participated in its publication reviewed codes applicable to their respective specialty in the surgery section of the American Medical Association's CPT 2010 to determine the need of a physician as an assistant. The study can be found here.


The Office of the National Coordinator for Health Information Technology is soliciting public comments on a set of "metadata" standards intended to facilitate exchange of health information. The move signifies the U.S. Department of Health and Human Services (HHS) is getting ready to propose rules for metadata that could be incorporated in Stage 2 of the Meaningful Use incentive program for electronic health records.