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August 27, 2014

News From ACFAS


Send Your Applications for Board Nominations
The ACFAS Nominating Committee is seeking members to serve on the College’s Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to take an active role in leading the profession, there is still time to submit your nomination application; all nominations are due by September 10, 2014.

Visit acfas.org/nominations for complete details on recommended criteria for candidates and the nomination application. You may also email Executive Director Chris Mahaffey. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Jordan Grossman, DPM, FACFAS, (330) 344-1980.

The Nominating Committee will announce recommended candidates to the membership no later than October 23, 2014. Candidate information and ballots will be emailed to all voting members no later than December 7, 2014. Electronic voting ends on January 6, 2015. New officers and directors take office during the ACFAS 2015 Annual Scientific Conference, set for February 19-22, 2015 in Phoenix, Arizona.
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Apply for ACFAS Research Grant by September 15
If you have a specific area of research you’d like to pursue but lack the financial means to do so, look no further than ACFAS for the help you need. Your College understands cutting-edge scientific research and advancement of the profession and evidence-based medicine go hand in hand. That's why ACFAS awards up to $40,000 in grant money each year to members, just like you, through the annual ACFAS Clinical and Scientific Research Grant.

ACFAS is accepting applications for the 2014 grant through September 15, 2014. All research must be clinical or laboratory-based, with clearly defined goals that meet all criteria for grant submission. Full details on the criteria and application process can be found at acfas.org/grant.

To submit your application for the 2014 ACFAS Research Grant today, visit acfas.org/grant.
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Submit Your Posters for ACFAS 2015 by October 1
Do you have exciting new research to share with your colleagues? Consider presenting it in poster format at ACFAS 2015 in Phoenix, Arizona. ACFAS 2015, the premier conference for foot and ankle surgeons, provides an ideal audience to showcase your research and to share your knowledge with your peers. Plus, ten of the most innovative posters will be selected for video presentation during ACFAS 2015 and posted on acfas.org after the conference.

Visit acfas.org/phoenix for details on poster format requirements and abstract submission. Don’t delay—posters must be submitted to ACFAS no later than October 1, 2014.
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Foot and Ankle Surgery


Devicemaker Sales Reps Being Replaced in the OR
Sales representatives from orthopaedic implant manufacturers are beginning to be excluded from their employers' interactions with hospitals. These sales reps generally provide technical assistance to surgeons and other staffers during operations, although hospitals are beginning to realize that manufacturers that offer this service are charging for it in the form of higher prices for implants. To help bring down these costs, several U.S. hospitals are working with implant manufacturers to train in-house hospital employees who are capable of providing technical assistance to surgeons and operating room staff. One such hospital is Loma Linda (Calif.) University Medical Center, which has seen the prices of the implants it uses drop by 50 percent since it implemented the so-called "rep-less" model. The hospital is saving money because implant manufacturers that have adopted the rep-less model are offering other ways of providing technical assistance to operating room staff, which in turn has enabled them to reduce the prices of their products. Flower Orthopedics, for example, sells kits containing all sterilized plates, screws and instruments used in foot or ankle surgery at a 30 percent markdown. However, the move towards the rep-less model seems to be limited, in part because it may not apply to most hospitals and because there are advantages for major implant manufacturers to continue allowing their sales reps to provide technical assistance to operating room staff.

From the article of the same title
Modern Healthcare (08/16/14) Lee, Jaimy
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Surgery for Heel Fractures Doesn't Improve Outcome Over Conservative Care: Study
A study published in the journal BMJ has concluded that closed displaced intra-articular fractures without severe displacement should not be treated surgically and should instead be treated with non-operative care. The study's authors based that conclusion on a comparison of the outcomes seen in 151 patients with typical, closed, displaced intra-articular calcaneal fractures who were treated with either surgery three weeks after injury or non-operative conservative care. Patients who underwent surgery had a far higher rate of complications, including infections and infected or painful screws and plates that had to be removed with subsequent surgery, than did patients in the non-operative care group. In addition, average patient-reported Kerr-Atkins scores for pain and function, the study's primary outcome, were 69.8 in the surgery arm and 65.7 in the conservative treatment arm two years after injury, a difference that was not significant. The study's authors also observed no differences between the two groups in a number of secondary subjective and objective outcome measures, including patient-reported general health and quality of life as well as five different measurements of gait.

From the article of the same title
Reuters (08/01/14)
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Practice Management


Doctors Targeted in Tax Refund Fraud
Fraudsters are reportedly stealing the identities of doctors in California and other states to file tax returns in their names and collect any refunds. Physicians are being made aware that they are victims after filing their tax returns, when they are told by the IRS that a return has already been filed under their names. Victims may also receive a 5071C letter from the IRS stating that they may have been defrauded. There is speculation among some that the fraudsters behind this scheme may have stolen physicians' national provider identifier (NPI) numbers after they were published in a recent Medicare report, although that has not been confirmed. Doctors who discover that their identities were stolen for the purposes of tax refund fraud are being advised to quickly contact local law enforcement, the attorney general in their state, as well as the IRS and other relevant federal agencies. Physicians may also want to place a fraud alert on their credit reports.

From the article of the same title
California Podiatric Medical Association (05/01/14)
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Positive Patient Experiences Linked to Quality Measure Improvements
A new study published in the journal Health Care Research and Review has found a possible link between the experiences patients have with healthcare providers and a variety of healthcare quality metrics. Researchers analyzed other studies that examined the connection between patient experience measures and other healthcare quality measures, particularly those that included results from the Consumer Assessments of Healthcare Providers and Systems (CAHPS) and the CAHPS hospital survey. They found that a variety of types of patient populations were better able to stick to their medication and disease management regimens if they visited healthcare providers with better communication skills. The study also found that higher patient hospital ratings were associated with better performance among hospitals on the Centers for Medicare and Medicaid Services' process measures for surgical care and several different health conditions. In addition, researchers found a positive association between good patient experiences and lower rates of a number of different complications, including post-operative respiratory failure.

From the article of the same title
Medical Economics (08/20/14) Bendix, Jeffrey
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Staff Meetings: Two Small Ways to Create a Big Impact
Physicians' practices can get the most out of staff meetings by developing an agenda in advance and by taking minutes that can be reviewed at a later time. Staff members should have a chance to review a meeting agenda before a meeting takes place and should also be given the opportunity to place issues on the agenda that they believe should be discussed. These issues should be itemized on the agenda. In addition, documents and/or reports should be attached to the agenda to help staff get up to speed on the issues that will be talked about at the meeting. A good agenda should also designate who will be in charge of leading the discussion during the meeting. Once a meeting begins, someone should be put in charge of taking minutes that can be reviewed by absent staffers. Minutes can also help doctors or other practice leaders review any staff recommendations made during a meeting. Finally, minutes can be useful in documenting important information about projects that were discussed during a meeting, including the names of the staffers involved, the project deadline and its budget.

From the article of the same title
Medical Economics (08/19/14) Bee, Judy
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Health Policy and Reimbursement


Under Proposal, CME Speakers No Longer Exempt from Sunshine Act
A controversy is brewing over a proposal from the Centers for Medicare and Medicaid Services (CMS) to eliminate a provision of the Sunshine Act that exempts drug companies and medical device makers from reporting direct or indirect payments to healthcare providers who serve as speakers for accredited continuing medical education (CME) programs. Those who favor keeping the exemption in place say that CMS's proposal could lead to several problems, including decreased funding for the CME industry. In addition, critics of the proposal say that CME attendees could be less willing to speak at educational sessions if payments made to speakers for CME programs have to be reported under the Sunshine Act. But supporters of the proposal say it will help ensure that CME programs do not become biased as a result of drug companies and device makers indirectly funneling money into exempted CME providers to avoid the Sunshine Act's reporting requirements. Others say that allowing the exemption to remain will undermine the Sunshine Act's goal of achieving greater transparency surrounding payments made to doctors and teaching hospitals by the pharmaceutical and medical device industries.

From the article of the same title
Physicians Practice (08/20/14) Adler, Ericka L.
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CMS to Withhold One-Third of Provider Data as Open Payments Website Problems Mount
The Centers for Medicare and Medicaid Services (CMS) has brought the Open Payments review website back online after it temporarily suspended registration for the site amid reports that information about the payments doctors received from medical device and drug companies is being commingled. In one case, data about the payments made to two doctors with the same name was combined. However, about one third of the payment data remains commingled, CMS is reporting. That data is not fit for publication on the Open Payments website, the agency says, and will be withheld until June 2015. Manufacturers and group purchasing organizations will have to correct and resubmit their data at a later time, although it is uncertain when the deadline for doing so will be. Sen. Charles Grassley (R-Iowa), who helped write the legislation that requires the release of information about the payments medical device and drug companies make to physicians and teaching hospitals, says the public will not be able to get a clear picture about the payments if the data is withheld as CMS says. Despite the problems with the Open Payments website, CMS says it will be made accessible to the general public on Sept. 30, as scheduled. However, CMS says it is now giving doctors and teaching hospitals until Sept. 8 to review the payment reports on the site.

From the article of the same title
Modern Healthcare (08/18/14) Tahir, Darius
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FDA Tightens 510(k) Program but Fast-Track for Medical Devices Remains
The Food and Drug Administration (FDA) has issued a set of largely voluntary guidelines for medical device makers that use its 510(k) program, which eliminates the need for some tests and studies of new medical devices if they are "substantially equivalent" to other products already on the market. The new guidelines state that FDA will no longer approve "split-predicate products," or devices that are similar to several other devices already on the market, without first requiring them to undergo the full range of tests and studies. But the guidelines also state that device makers may use multiple similar devices that are already on the market, which are known as predicate devices, to demonstrate substantial equivalence to a new device so long as the new product will be marketed for more than one use. In addition, the guidelines attempt to provide some clarification regarding the difference between a device's intended use and its indications for use as well as how the technologies used in new and predicate devices may raise a different question of safety or effectiveness. These and other changes included in the guidelines are aimed at improving "the predictability, consistency and transparency of the 510(k) program by describing in greater detail the regulatory framework, policies and practices underlying FDA's 510(k) review," the agency said.

From the article of the same title
Drug Watch (08/12/2014) Hooks, Beau
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Medicine, Drugs and Devices


Comparison of Continuous Nerve Block Versus Patient-Controlled Analgesia for Post-Operative Pain and Outcome After Talar and Calcaneal Fractures
The use of continuous peripheral nerve block (CPNB) does not result in a reduction of pain scores nor does it improve recovery or reduce hospital stay times in patients treated for talar and calcaneal fractures compared to systemic analgesics, a new study has found. The study involved 87 patients with calcaneal and/or talar fractures who underwent open reduction and internal fixation (ORIF) and who received either a CPNB catheter before surgery or intravenous patient-controlled analgesia (PCA) afterward. The study's authors found that neither ORIF or PCA had any significant advantages or disadvantages over the other in terms of pain scores, recovery or length of hospital stay. Median Numerical Rating Scale (NRS) scores one day after the operation were 1.0 in the CPNB group and 2.0 in the PCA group. Median length of stay, meanwhile, was four days in the PCA group and five days in the CPNB group. The main difference between the two groups was the amount of opioids required; the PCA group needed about 30-fold more opioids one day after surgery than did the CPNB group, although the PCA patients did not experience more side effects as a result of taking more opiods.

From the article of the same title
Foot & Ankle International (08/14) Luiten, Willem E.; Schepers, Tim; Luitse, Jan S.; et al.
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Researchers Discover Gene That Slows Bone Loss and Promotes Bone Formation
Researchers at the University of California, Los Angeles (UCLA), are working on a new therapeutic agent that promises to slow down bone destruction and encourage the formation of new bone. The therapy the researchers are developing uses the growth factor Wnt4 to treat osteoporosis and age-related bone loss. Researchers have found that injecting recombinant Wnt4 protein into mice with osteoporosis resulted in significantly less bone loss than what was observed in mice that did not receive the injections. In addition, the researchers found that a strain of transgenic mice in which the Wnt4 gene was overexpressed in osteoblasts experienced increases in bone mass compared to control animals. Wnt4 is believed to promote the formation of new bone by suppressing inflammation in the bone marrow. Researchers also found that the Wnt4 transgenic mice experienced significantly less bone loss than osteoporosis models. Finally, researchers discovered that Wnt4 suppresses osteoclast activity. The study was published in the journal Nature Medicine.

From the article of the same title
Medical Xpress (08/12/14)
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