News From ACFAS

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Take advantage of expanded nonstop flight service to Austin, Texas and book your airfare to ACFAS 2016 today!

Expanded service into Austin Bergstrom International Airport (ABIA) service means getting to ACFAS 2016 this February is easier than ever from Orlando, Chicago, Seattle and everywhere in between!

Plus, ABIA is just 7.5 miles from the Austin Convention Center and is famous for its easy access, short lines, food options, art exhibits and live music performances. When you make your flight reservations for ACFAS 2016, know that your conference experience will begin the minute you step off the plane!
This is your last chance to be part of one of the Annual Scientific Conference’s most popular events—the annual poster competition set for February 11–14 in Austin, Texas.

ACFAS must receive all poster abstracts by September 1, so send us your submissions for consideration ASAP. See our Poster Exhibit Guidelines for details.

If you think your research findings will make attendees stand up and take notice, don’t delay. Submit your poster abstract now and bring your research to life!
Don't miss your chance to give your groundbreaking research the financial support it needs. If your clinical- or laboratory-based research meets the College's criteria, apply for a grant no later than September 15.

With more than $40,000 in grant awards reserved for this year, bringing your research from the clinic or lab to the forefront of foot and ankle surgery is closer than you think. Visit acfas.org/grant today for details and to apply.
Adding to your surgical skills repertoire need not be time-consuming. Register for any of our two-day Surgical Skills courses—Comprehensive Flatfoot: Reconstruction and Arthrodesis (October 17–18), Advanced Arthroscopy for Foot and Ankle (November 7–8) and Foot and Ankle Arthroscopy (December 12–13)—and learn the latest advanced and restorative techniques in just one weekend.

You’ll spend most of your time in an ultramodern lab performing surgical procedures with personalized, one-on-one faculty instruction. Focused panel discussions and interactive lectures will answer your questions about new surgical pathways, orthobiologic adjuncts and the risks of different treatment approaches.

Each course includes a fireside chat where you can share your most difficult case with faculty and fellow attendees, as well as breakfast, lunch and dinner. Register today at acfas.org/skills, and if a course is sold out, contact Maggie Hjelm to be waitlisted.

Foot and Ankle Surgery

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Researchers have discovered that autoantibodies in healthy relatives of patients with rheumatoid arthritis (RA) predict a higher risk of developing the disease. The study looked at 252 RA patients and 819 healthy relatives. The study found that positive predictive value (PPV) was 63.6 percent when both rheumatoid factor (RF)-IgM and second-generation anti-citrullinated protein antibody 2 (anti-CCP2) were positive. The overall annual incidence of RA for every 1,000 relatives was 4.9, but when both anti-CCP2 and RF were positive, the incidence increased to 262.5 per 1,000 subject-years. The study's authors noted that their findings could lead to more clinical trials to determine methods of primary RA prevention in high-risk healthy relatives.


Biologic disease modifying anti-rheumatic drugs (bDMARDs) can improve quality of life in patients with rheumatoid arthritis (RA), but adverse events are a problem. This is particularly true for patients with pre-existing comorbidities, but randomized controlled trials for bDMARDs in RA patients usually exclude such patients. These bDMARDs may not be contraindicated in patients with RA and certain comorbid diseases, so additional studies or precautions are recommended. Chronic disease registries give the best evidence for the long-term safety of bDMARDs in RA, but records of presence or absence of a comorbid disease is insufficient. There should be comprehensive data on the onset, severity and associated complications of these diseases and their interactions with bDMARDs. Analyses of this data can help determine potential benefits of bDMARDs on comorbid illnesses. Since a risk of exacerbations of comorbid disease from bDMARDs exists, potential complications must be fully disclosed to RA patients. Both disease and patient factors should be taken into account when bDMARDs are considered.


Studies investigating lower-extremity amputation or mortality rates for diabetic Charcot neuroarthropathy (CN) have been performed on patients who underwent generally conservative operations. A recent study looked at these rates in patients who underwent reconstructive surgery using circular external fixation. The study analyzed differences between two groups. Group one had a foot and/or ankle ulceration, and group two was a control. The ulceration group was further divided into an osteomyelitis group (1A) and a non-osteomyelitis group (1B). A total of 150 surgically reconstructed diabetic foot and ankle cases using circular fixation were observed. Below-knee amputations occurred in six percent of patients (1A = 1, 1B = 4, group 2 = 2). In addition, there were five mortalities (1A = 2, 1B = 2, group 2 = 1). The total amount of time until a lower-extremity amputation since the time of surgical reconstruction ranged from 230 to 1,777 days.

Practice Management

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The Occupational Safety and Health Administration (OSHA) requires organizations to adhere to certain stipulations to foster a safe work environment. Medical groups and other organizations are frequently in denial about how much risk is actually present in their facilities, which can lead to non-compliance despite the best of intentions. Failure to comply can result in major problems, including massive fines. To keep abreast of OSHA requirements:

• Create a written policy. If your organization undergoes an OSHA audit, this policy will be the first thing the inspector will ask for. Having this plan accessible and current is important.
• Seek best practices. Research the best ways to make your workspace safer and healthier. This can be as simple as establishing clear hand hygiene rules.
• Employ engineering controls. These are mechanically designed instruments that mitigate exposure risks. They may be somewhat expensive, but they are critical to stopping threats such as the spread of bloodborne pathogens.
• Use personal protective equipment (PPE) correctly. Proper PPE use can limit hazard exposure. This means attempting to employ it perfectly each and every time through extensive training and participation.
• Provide interactive training. OSHA mandates that staff training be performed annually, which can become dull. Spice it up by using interactive programs and technology to make training more interesting.

A survey from the Workgroup for Electronic Data Interchange (WEDI) revealed that less than half of physician practices are ready for the Oct. 1, 2015 switch to ICD-10. Only 20 percent of practices have started or completed external testing, 15 percent have conducted impact assessments and 40 percent said they would test only with clearinghouses. Some experts claim that these numbers do not paint as desperate a picture as it may seem. "Many of them may in fact be ready, even though they responded [negatively]. They may figure out a lot of the work is done for them, such as vendor software upgrades or other things that will help them along their preparation," said Jim Daley, director of IT at BlueCross BlueShield of South Carolina and co-chair of WEDI3. According to Daley, one of the main issues is many physicians believe they must know 68,000 new codes when in reality, it is unlikely they will use a significant portion of them. Practices should talk with training partners to learn more about how to properly handle the transition. One thing they should absolutely not do, Daley says, is hope for another delay. The change is coming, he says and no further legislation will postpone implementation.


New technologies, growing competition and a shift toward value-based payment models are just a few of obstacles to keeping an independent practice afloat. This may be why the percentage of physicians identifying as independent decreased from 62 percent in 2008 to 35 percent in 2013. If you think your independent practice is doomed, or if you are considering accepting a buy-out offer, here are some tips from physicians and practice administrators to continue providing excellent care while remaining independent:

• Realize that electronic health records (EHRs) are necessary to function in this day and age. It is important to use them to improve patient care.
• Look for ways to differentiate your practice in the eyes of payers. With the growth of value-based payment models, payers today are more willing to treat providers as partners in the drive to contain costs and improve quality.
• Develop a business strategy by focusing on population health management.
• Use government reporting mandates as opportunities to improve patient care.

In addition, it could be beneficial to form business alliances with other small practices. This can expand size, increase physician autonomy and governance, share costs and facilities and create an environment where the administrative hassles of an independent practice are made easier with collaboration.

Health Policy and Reimbursement

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The delay on the two-midnight policy has been extended by the U.S. Centers for Medicare and Medicaid Services (CMS) through Dec. 31, 2015. The policy states that if patient visits for treatment fail to span the course of two midnights, hospitals will not be reimbursed by Medicare for an inpatient visit. "From Oct. 1 through Dec. 31, 2015, patient status reviews conducted by the Quality Improvement Organizations will be based on Medicare’s current two-midnight policy. Beginning Jan. 1, 2016, patient status reviews will be conducted in accordance with any policy changes finalized in the Outpatient Prospective Payment System rule and effective in calendar year 2016,” the American Hospital Association (AHA) said. The two-midnight rule was initially delayed earlier in 2015 after the Sustainable Growth Rate (SGR) formula was repealed. AHA then sued the Department of Health and Human Services (HHS), reportedly due to concerns about factors such as CMS’s decision to withhold reimbursement for admissions spanning less than the course of three days, reimbursement policies for inpatient services and evolving inpatient definitions.


The healthcare revenue cycle management process (RCM) is undergoing rapid change after years of static consistency. Stuart Hanson, chair of the HIMSS Revenue Cycle Improvement Task Force says the biggest immediate impact on RCM is "the increase in consumer financial responsibility." Hanson notes that while providers collected about five percent of their revenue from patients 10 years ago, that number is now around 30 to 35 percent because of the Affordable Care Act. The shift toward value-based care is forcing the market to determine what value-based reimbursement actually looks like. The hope is that the changes will drive much-needed innovation in the realm of revenue cycle tools. "I think we're going to see more and more financial systems getting creative," said Pamela Jodock, senior director, health business solutions at HIMSS. Jodock points out two major reasons why innovation is necessary in the consumer age: first, consumers are more informed than ever, something that providers "don't quite understand." Second, analytics are becoming increasingly important. "We're going to rely very heavily on data to understand pricing structures," Jodock said. "Analytics will be critical to helping an organization."

Medicine, Drugs and Devices

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A new advanced prosthesis could revolutionize how amputees walk. Professor Robert Gregg of the University of Texas, Dallas is developing the leg. Sensors and software control motion, ensuring that it quickly adapts to the wearer's motion and keeps them balanced at all times. The lower-leg prosthesis may lead to a shift toward more technologically sophisticated and higher-powered artificial limbs. Typically, robotic prosthetics are controlled through stepping. Gregg's leg uses a control algorithm that determines the leg's position and motion using sensors. It then performs a calculation to determine when force should be applied. "The feedback from the amputee patients we've worked with has been very positive,” Gregg says. “They felt like the prosthetic leg seemed to be following them rather than them following the leg. They can start or stop, and the leg will respond; they can go faster or slower, and the leg will respond to that naturally." The technology is still in the development phase; the limb works well for walking, but it cannot yet move between different types of action, such as walking to climbing stairs.


New research from the Advanced Medical Technology Association reveals that high-risk medical devices are not studied adequately before and after hitting the market. The study comes on the heels of an imminent bill that aims to speed up the process for approving these devices. The testing of these devices, including stents, heart valves, hip implants and catheters, can vary widely. Researchers looked at 28 products approved by the U.S. Food and Drug Administration (FDA) from 2010 to 2011. There were 286 clinical studies of these devices, with 82 before approval and 204 after. Researchers found that about half of the premarket studies did not compare the device to the current method of treatment. Five of the 28 devices did not have any post-market trials. FDA typically asks for at least one of these studies, but no set guideline exists. The findings bring the 21st Century Cures Act into question. The House Energy and Commerce Committee is looking to fast-track the popular bill through the Senate. It creates a new approval pathway for breakthrough medical devices that treat life-threatening diseases. Critics claim this is not necessary, including Yale Professor Joseph Ross. "I am not exactly sure that this pathway is really needed," Ross said. "I don't think the regulatory burden is so high that we need to reduce evidentiary standards."


According to a study in the Annals of the Rheumatic Diseases, patients with rheumatoid arthritis (RA) who begin taking statins had significantly lower all-cause mortality than those who did not take statins. The study included individuals who had RA and at least one disease-modifying antirheumatic drug (DMARD). Patients were divided into two groups: initiators, patients who began taking a statin, and noninitiators, patients who would have been eligible for statin therapy but did not start a statin. Each group had 2,943 patients; the statin group had 432 deaths during the study, and the non-statin group had 513. Statin initiation was associated with a 21 percent lower risk of all-cause mortality among patients with RA. The authors speculate that, because of their elevated cardiovascular disease risk, patients with RA might particularly benefit from statins' dual anti-inflammatory and lipid-lowering effects.


A new study from the Harvard Business School shows that medical device companies have a longer path to U.S. Food and Drug Administration (FDA) approval than companies that develop new drugs. The research encompassed 30 years of FDA data and found that new medical devices take 34 percent longer to get approved, which results in an average delay of 7.2 months. Part of the reason for this is testing. FDA drug testing is streamlined; device testing is not. Devices are categorized by their function, not the underlying technology. This can lead to excessive testing on devices that have already been approved by the agency for other uses. These delays also cost money, approximately seven percent of total research and development costs. The study suggested FDA could speed up the process by "mitigating content and format-related uncertainties for medical device manufacturers," but also conceded that "the process for implementing any large changes to formal regulatory policy is complex, time-consuming and institutionally entrenched."