August 23, 2017 | | JFAS | Contact Us

News From ACFAS

Submit Your Application for ACFAS Board Nominations
The ACFAS Nominating Committee seeks dedicated members to serve on the College’s Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to help lead the profession, send your nomination application by October 1, 2017.

Visit for the nomination application and complete details on the recommended criteria for candidates. For more information, contact Executive Director Chris Mahaffey via email or (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Sean Grambart, DPM, FACFAS, via email or (217) 671-3634.

The Nominating Committee will announce recommended candidates to the membership no later than November 23. Candidate information and ballots will be emailed to all voting members no later than January 7, 2018. Electronic voting ends on January 22, 2018. New officers and directors will take office during ACFAS 2018, March 22–25 in Nashville.
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Find Ready-to-Use Surgical Solutions in the Trenches
We work in the trenches together, so no surgical challenge is too great. Join us on the road this fall for “In the Trenches,” a new regional program that shows you how to apply your technical and surgical skills in multiple fixation options for treating complex forefoot injuries and deformities.

This seminar kicks off on Friday evening with the presentation, “Controversies and Complications,” followed by an open discussion during which you can share your own work cases while refreshments are served. Saturday includes lectures presented by expert faculty plus two sawbones labs on the Big 6 Techniques and osteotomies.

By the end of the seminar, you’ll be able to:
  • Identify indications and contraindications for forefoot deformities
  • Address complications from forefoot injuries
  • Formulate treatment plans
  • Manage cases involving staging principles, positioning and fluoroscopy methods
Visit to register now.
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Don’t Miss the October Coding & Billing Seminar
Act now so you don’t miss the last coding and billing seminar of the year and all the tips and tools you need to receive proper reimbursement. Register for Coding and Billing for the Foot and Ankle Surgeon, October 13–14 in Phoenix, and learn how to simplify your coding and billing practices for:
  • multiple-procedure cases when performing forefoot, rearfoot or ankle reconstructive surgery
  • open reduction and internal fixation of multiple fractures
  • complex arthroscopy cases
  • diabetic foot surgery
Faculty will guide you through case-based and interactive procedures as you code real-time patient scenarios, plus you’ll receive customized handouts, checklists and forms to use when you return to the office. Don't miss out—register now at
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Hit the Books This Fall with ACFAS
School is back in session, and no matter your learning style, ACFAS’ education programs have just what you need to broaden both your skills and your horizons. Join us in a city near you this fall for courses on forefoot and midfoot injury and deformity, sports medicine and coding and billing, or grab a seat in our virtual classroom to tune into podcasts, clinical sessions and surgical techniques videos.

View the Education Calendar to register for any of our in-person educational opportunities, or visit the e-Learning Portal to access podcasts, clinical sessions and more.
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Foot and Ankle Surgery

Altered Leverage Around the Ankle in People Living with Diabetes: A Natural Strategy to Modify the Muscular Contribution During Walking?
A study was conducted to determine whether people living with diabetes exhibit a reduced external moment arm and larger effective mechanical advantage at the ankle versus controls, and independent of walking speed. This altered leverage around the ankle in people living with diabetes emphasizes a unique mechanism through which they can reduce the joint moment at the ankle in spite of the matching of walking speed between groups. The leverage at the ankle in people living with diabetes leads to a reduced contractile force required from the plantarflexor muscles, lowering the muscular demands of walking. The researchers enrolled 31 nondiabetic controls, 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN). A greater value for the effective mechanical advantage (EMA) at the ankle was discovered in the DPN and DM cohorts compared to controls. The higher EMA was chiefly induced by a smaller external moment arm in the DPN and DM groups. These findings suggest the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls.

From the article of the same title
Gait & Posture (09/17) Vol. 57, P. 85 Petrovic, Milos; Deschamps, Kevin; Verschueren, Sabine M.; et al.
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Medial Shoe-Ground Pressure and Specific Running Injuries: A One-Year Prospective Cohort Study
Achilles tendinitis, plantar fasciopathy and medial tibial stress syndrome injuries (APM injuries) account for approximately 25 percent of the total number of running injuries among recreational runners. However, reports on the association between static foot pronation and APM injuries are contradictory. New research seeks to investigate if running distance until the first APM injury depended on foot balance during stance phase in recreational male runners. Researchers measured foot balance during treadmill running at the fastest possible 5,000-m running pace in 79 healthy recreational male runners and calculated foot balance by dividing the average of medial pressure with the average of lateral pressure. They categorized foot balance into those that presented a higher lateral shod pressure (LP) than medial pressure and those that presented a higher medial shod pressure (MP) than lateral pressure during the stance phase. Researchers used a time-to-event model to compare differences in incidence between foot balance groups. APM injuries were seen more frequently in the MP group than in the LP group.

From the article of the same title
Journal of Science and Medicine in Sport (09/17) Vol. 20, No. 9, P. 830 Brund, Rene B.K.; Rasmussen, Sten; Nielsen, Rasmus O.; et al.
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Practice Management

Can Physicians Maintain Independence While Working as Part of a Large System?
More physicians are opting to join large hospital systems, which may mean having less autonomy than self-employed physicians. However, the reality of physician employment arrangements can involve a grey area that merges working for or within a large hospital system with varying degrees of independence. For instance, Eric Tait, MD, MBA, is a primary care doctor in Houston, Texas, who prior to joining IASIS Healthcare had already formed an investment partnership in an independent practice association (IPA). He agreed to a contract that allowed IASIS, his employer, to collect revenue from his clinical work and pay him a salary. Tait made it clear upfront that he would not share any of his IPA partnership rights with his employer. While this arrangement appears fair to most physicians, the reality is that many doctors have become embroiled in legal battles with employers who have claimed legal rights on physician revenue from outside business ventures. Tait advises physicians to "insist upfront on establishing walls between outside work and the reach of employers." Maria Armstrong, MD, in Medina, Ohio, has worked as a medical director for a rehabilitation hospital while maintaining control of several aspects of her physical medicine and rehabilitation practice. As a medical director, she works as a contractor, preserving power over a number of facets of her professional setting. She also works in an inpatient setting and enjoys the benefits of being part of a hospital system.

From the article of the same title
Medical Economics (08/16/17) Moawad, Heidi
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Facing the Medical Licensing Board
Indiana Deputy Attorney General Tim Weber routinely brings physicians before the state's Medical Licensing Board in response to complaints received by his office. The average number of consumer complaints received by Indiana's Office of the Attorney General (OAG) that pertained to the Medical Licensing Board over the last five full calendar year was 585, he says. Weber adds that most consumer complaints are closed after investigation. If charges are filed against a physician with the Medical Licensing Board, most physicians opt to retain counsel. Some of the major categories of consumer complaints include inappropriate prescribing practices, drug or alcohol use by the physician, criminal convictions, rudeness, billing disputes, failure to meet standard of care and receiving discipline in another jurisdiction. Consumer complaints regarding criminal convictions often come from the Professional Licensing Agency, while most complaints alleging that a physician was rude or abrupt come from patients, Weber observes. OAG regularly receives consumer complaints regarding misuse of social media. However, the prevailing issue occupying the work of every case analyst and deputy attorney general in the Medical Licensing Section is the opioid crisis. Some members of the medical profession are blamed for overprescribing or prescribing dangerous drug combinations, although others prescribe appropriately and provide insight to OAG and other agencies and organizations. Physicians need to speak out when they see colleagues who are engaging in unsafe or outdated prescribing practices, Weber says.

From the article of the same title
Physicians Practice (08/15/17) Sacopulos, Michael
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State Access Standards Did Not Improve Accessibility to Specialists
According to a study published in JAMA Internal Medicine, specialty access standards by state Medicaid agencies did not improve access to specialist physicians for Medicaid enrollees. Researchers from the Yale School of Public Health surveyed 20,163 nonelderly adult Medicaid enrollees in five states that were adopting access standards to determine how state access standards affect timely accessibility to specialist physicians. In addition, 37,290 Medicaid managed care enrollees from five matched states that adopted access standards previously (control states) were polled. The survey found that getting an appointment with a specialist before the policy implementation was always or usually easy for 69 percent of Medicaid enrollees and 75 percent of commercial enrollees, compared with 67 percent of Medicaid enrollees in control states. After the implementation of standards, access to specialty services did not change dramatically.

From the article of the same title
Healio (08/15/2017) Tedesco, Alaina
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Health Policy and Reimbursement

Affordable Care Act's Bare County Problem Looks Mostly Solved, for Now
The "bare county" problem in which large swaths of the United States could have lacked insurers willing to sell Affordable Care Act (ACA) insurance next year appears to have been addressed for the time being. The ACA relies on private companies to provide insurance to people who do not receive coverage through a government program or work. The federal government supplies subsidies on a sliding scale to help middle-income Americans cover premiums, but it does not force insurers to offer coverage if they have no desire to. Helping address the bare county problem has been state insurance commissioners coaxing hesitant insurers to cover the counties without an insurer. In addition, some carriers also see benefits to being the only provider in a given place. However, insurer participation for 2018 is not guaranteed, and contracts will not be signed until the end of September.

From the article of the same title
New York Times (08/15/17) Sanger-Katz, Margot
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End of U.S. Payments to Health Insurers Would Cause Premiums to Rise: CBO
The Congressional Budget Office (CBO) has determined that if President Trump makes good on his threat to halt billions of dollars of payments to health insurers, premiums for many beneficiaries on the Affordable Care Act individual insurance markets would climb 20 percent in 2018. In addition, stopping the payments would mean that five percent of Americans would live in areas lacking an insurer in the individual market in 2018. However, CBO calculated that more insurers would participate by 2020 because they will have seen how the markets function without the payments and most people would be able to buy insurance. The payments Trump has been threatening to terminate, known as cost-sharing reductions, add up to about $7 billion in 2017 and help cover out-of-pocket medical expenses for low-income Americans. CBO estimated the uninsured population would be slightly higher in 2018 but slightly lower in 2020 as more insurers join the market. Moreover, premiums would be 25 percent higher by 2020, which would boost the amount of government-provided tax credits to help protect low-income people from premium increases. The payments are the focus a lawsuit filed by House Republicans against the Obama administration that claimed they were illegal because they required congressional appropriation.

From the article of the same title
Reuters (08/15/17) Abutaleb, Yasmeen
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HHS Proposes Eliminating or Changing Mandatory Bundled Payment Programs
The U.S. Department of Health and Human Services (HHS) has proposed removing mandatory bundled payments across several areas of healthcare. Details of the proposal are still scant, but it could be a sign that HHS may overhaul the Medicare bundled payment program. The only information publicly available is the title, “Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model.”

From the article of the same title
Healthcare Informatics (08/14/17) Landi, Heather
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Medicine, Drugs and Devices

Climbing Cost of Decades-Old Drugs Threatens to Break Medicaid Bank
Older prescription drugs typically become less expensive over time as generic versions hit the market and drive down cost; however, even long-established medications are getting caught up in the price-escalation trend sweeping the pharmaceutical industry. Medicaid spent $258 million more last year compared with 2015 for 67 generics and other nonbranded treatments, according to a Kaiser Health News data analysis, while its outlays for 313 brand-name drugs climbed by up to $3.2 billion due to higher pricing. Of those drugs, 80 had been around for 20 years or longer. The medications driving the increases include everything from metformin hydrochloride for diabetes to the antipsychotic fluphenazine hydrochloride to the pain medication naproxen sodium. The more money Medicaid is forced to spend for drugs, the greater the burden on U.S. taxpayers, who subsidize health care for the program's nearly 70 million beneficiaries.

From the article of the same title
Kaiser Health News (08/14/17) Lupkin, Sydney
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Empowering Patients Effectively Improves Physician Hand Hygiene
A study published in the August issue of the American Journal of Infection Control finds that patients and parents enjoyed being able to remind healthcare providers to wash their hands, but about a little over half of doctors agreed patients should remind them to do so. The study was conducted by researchers from the West Virginia University School of Medicine. Researchers analyzed the attitudes patients, parents and doctors had toward a new patient empowerment tool (PET). A majority of patients felt empowered by the tool, but only 54.9 percent of doctors said patients should be involved in reminding doctors to wash their hands using the PET. The doctors preferred patients to make the request verbally instead of using a PET.

From the article of the same title
ScienceDaily (08/15/17)
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The New Conundrum About When to Stop Antibiotics
British infectious disease experts suggested in a recent BMJ article that doctors should stop making the recommendation that patients always finish their antibiotics. "We are challenging this now because antibiotic resistance is such an enormous issue," said Martin Llewelyn, a professor of infectious diseases at Brighton and Sussex Medical School in England. Llewelyn said the risk with stopping antibiotics too early is recurrence of the infection, not contributing to resistance. He adds, however, "We're not suggesting stopping antibiotics when you feel better is necessarily the right thing to do across the board." While many in the infectious disease community agree that finishing a course of antibiotics is not always necessary, the message continues in guidance from a number of health groups. A spokesperson for the World Health Organization said it agrees with the BMJ analysis and is assessing the evidence regarding the ideal course duration for different cases. Meanwhile, Lauri Hicks, director of the office of antibiotics stewardship at the U.S. Centers for Disease Control and Prevention, said the agency changed its guidance about a year ago, to take an antibiotic as directed by a healthcare provider.

From the article of the same title
Wall Street Journal (08/14/17) Reddy, Sumathi
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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, 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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