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News From ACFAS

Last Call for Posters: ACFAS 2020
Don’t miss your chance to showcase your latest research in poster format at ACFAS 2020, February 19-22, 2019 in San Antonio. Help develop this year’s poster program and advance the profession by presenting your recent studies in foot and ankle research.

Poster abstracts for this year must be submitted to ACFAS by September 10, 2019 to be eligible for review. PDFs of eligible posters are due November 13, 2019.

Visit to view submission guidelines/criteria and submit your poster today!
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Final Call for Nominations to Serve on ACFAS Board of Directors
The ACFAS Nominating Committee seeks experienced 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 September 9.

Visit for the nomination application and complete details on the recommended criteria for candidates. For more information, contact ACFAS Executive Director J.C. (Chris) Mahaffey, MS, CAE, FASAE, at or (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair John S. Steinberg, DPM, FACFAS at or (202) 444-3059.

The Nominating Committee will announce recommended candidates to the membership no later than October 23. Candidate information and ballots will be emailed to all voting members no later than December 7. Electronic voting ends on December 22. New officers and directors will take office during ACFAS 2020, February 19-22, 2020 in San Antonio.
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Spread the Word of Good Foot Health
Use the two new PowerPoint presentations, Why Having Strong Bones Is So Important and In Diabetes, Proper Foot Care is Essential, to help spread the word about proper foot and ankle health while promoting your practice to existing and potential new patients. These two new PowerPoints, along with scripts, are available in the ACFAS Marketing Toolbox at

The latest release on diabetes explains why caring for your feet is so important when a person has diabetes and the bone health presentation shows the issues associated with bone loss and its effect on a person’s overall health. A customizable slide for your practice’s contact information, as well as a script, are included with each of the PowerPoints.

Record yourself giving the presentation and run it on a loop in your office, use it when speaking at a local health fair or post it on your website and social media pages.

Access the complete library of PowerPoint presentations at plus many other free resources, such as the seasonal FootNotes patient education newsletter, infographics and healthcare provider referral tools.
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Foot and Ankle Surgery

Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT
It is clinically important to recognize syndesmotic instability early on, but more subtle variants can be difficult to diagnose. The study aimed to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability and in a control group. Patients with unilateral syndesmotic instability requiring operative fixation underwent preoperative bilateral ankle weightbearing CT in both their injured and uninjured sides, which were then assessed against each other. For each CT, a series of seven axial plan tibiofibular joint measurements were used to evaluate parameters of the syndesmotic anatomy one centimeter above the tibial plafond. Values differed between the injured and uninjured in four of the seven measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation. In an uninjured control population, no differences were identified between any of the bilateral measurements. The study suggests that weightbearing CT can effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. The study highlights the utility and importance of using the uninjured side as a valid internal control when confirming potential syndesmotic instability. More research is needed to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question.

From the article of the same title
Foot & Ankle International (08/23/2019) Hagemeijer, Noortje Catharina; Chang, Song Ho; et al.
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Reliability of a Measurement Technique for Achilles Tendon Length
A number of recent studies deal with new methods of Achilles tendon (AT) length measurement. Most of these studies measured the AT length between the calcaneus and medial head of the gastrocnemius, but the reliability of such a measurement has not been satisfactorily presented. This study aims to determine the reliability of AT length within and between session. Researchers measured AT length with a combination of ultrasound imaging and optoelectronic stereophotogrammetry in 19 healthy athletes across six different days.

The AT length was measured on both lower extremities: from the calcaneus to the mid-point of the medial and lateral heads of the gastrocnemius and from the calcaneus to the soleus musculotendinous attachment. The results indicated high intraclass correlation coefficients, a low typical error and a standard error of measurement for all measured AT lengths for within and between sessions. This non-invasive reliable measurement method may be recommended for purposes related to sport science research.

From the article of the same title
Journal of Sports Sciences (10/19) Vol. 37, No. 20, P. 2389 Skypala, Jiri; Jandacka, Daniel; Hamill, Joseph
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Vertical Wire Forefoot Fixation: An Advanced Technique for the Dynamic External Fixation Apparatus
External fixation is used to correct certain foot and ankle deformities. The study finds the traditional forefoot crossing wire technique insufficient in terms of individual metatarsal control and forefoot manipulation when using a dynamic ring fixator to correct forefoot deformities. Researchers developed a forefoot fixation technique that uses five vertical wires to gain greater forefoot control while performing more precise skeletal manipulation for multiplanar deformity correction. The associated risks of infection, neurovascular injury and other soft-tissue injury should be investigated.

From the article of the same title
Journal of Foot & Ankle Surgery (07/23/19) Rasor, Zachary; Henning, Jordan; et al.
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Practice Management

Buying Medical Malpractice Insurance Independently as a Physician
Buying medical malpractice insurance can be one of the most important decisions and biggest costs involved in running an independent clinical practice. There are several factors to keep in mind when buying medical malpractice insurance independently. Even when a physician is insured through an employer or independently, it is not safe to assume that a medical malpractice policy will cover "outside" patient care, such as telemedicine, moonlighting or locum tenens work. Habits such as careful documentation can be useful risk-reduction strategies, but given that roughly 50 percent of physicians will be sued during their careers, doctors should insist on adequate professional liability insurance when taking on temporary clinical assignments.

Medical malpractice coverage from one job does not necessarily apply to other assignments, and doctors who arrange for locums assignments directly with a hospital often need to purchase their own medical malpractice insurance. When deciding on a policy, physicians should investigate the insurance company's experience and how they tend to respond to cases and should keep in mind that the best value option may not offer the lowest premium. A knowledgeable insurance broker can help identify the indemnity carriers with most experience in their state or specialty. Doctors should ensure that the coverage purchase includes support and defense costs for any licensing issues that may arise.

From the article of the same title
Medical Economics (08/21/19) Moawad, Heidi
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How Patient Engagement Impacts the Practice's Bottom Line
Patient engagement is a key way to deliver better health outcomes and lower costs, especially in the age of value-based care. Between the consumerization of healthcare and rising out-of-pocket costs, patients are looking for the most convenient service at the best value, meaning that independent physicians should adopt an entrepreneurial approach to patient engagement. Patients expect things like on-demand appointments, self-scheduling, cost transparency, mobile payments and regular, personalized communications. A study published in Mayo Clinic Proceedings noted that patients who left negative online reviews did so not because of the physician but because of negative experiences with front desk staff, wait time, physical environment, appointment access or billing. Physicians can foster loyalty through flexible and personalized engagement that addresses patient needs by understanding how they differ by population.

For example, telehealth appeals to younger patients largely because of convenience and flexibility, while older generations can use it to avoid doctor visits when health conditions or transportation issues make in-person appointments difficult to attend. Meanwhile, a poll by the Kaiser Family Foundation found that 45 percent of respondents under age 29 do not have a primary care physician, turning instead to freestanding clinics and telehealth services to access healthcare when it is convenient, efficient and cost-effective. Practices must embrace technology-driven features such as texting, self-scheduling and online portals in order to engage with these patients. Within this, practices should look to proven technology solutions that integrate patient communications into existing workflows.

From the article of the same title
Physicians Practice (08/26/19) Morgan, Michael
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Why Doctors Still Offer Treatments That May Not Help
According to an analysis in the British Medical Journal, there is evidence of some benefit for only 40 percent of the thousands of medical treatments it examined. While only 3 percent are ineffective or harmful and 6 percent are unlikely to be helpful, 50 percent are of unknown effectiveness. Uncertain and experimental treatments can be warranted, but in many cases, routinely delivered treatments go untested for years, their benefits assumed and harms ignored. In response, a growing movement aims to identify wasteful care and remove it from healthcare systems. The American Board of Internal Medicine’s Choosing Wisely campaign identifies five practices in each of dozens of clinical specialties that lack evidence, cause harm or for which better approaches exist, while another organization has identified more than 800 practices that officials there feel should not be delivered.

From the article of the same title
New York Times (08/26/19) Frakt, Austin
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Health Policy and Reimbursement

Immigrant Sponsors' Assets Will Factor into Medicaid Eligibility
The U.S. Centers for Medicaid and Medicare Services (CMS) told states they can count the assets and income of the sponsors of legal immigrants when determining whether the immigrants qualify for Medicaid or children's Health Insurance coverage. If the state wants to adopt an alternative methodology, it will need approval from CMS. The guidance is part of a broad White House strategy to tighten restrictions on legal immigrants who apply for public benefit programs. The guidance, which refers to the 1965 Immigration and Nationality Act, requires the sponsors of immigrants to reimburse state agencies for the cost of "most means-tested public benefits" when asked.

This could put sponsors on the hook for all their medical bills, potentially discouraging them from being sponsors given the financial risk of healthcare costs. Another provision of the guidance requires states to deny or terminate a legal immigrant's eligibility if the sponsor or applicant "fails to cooperate in providing information or documentation necessary to determine eligibility," with some limited exemptions for abused or "indigent" immigrants. The CMS also said states can offer sponsors some leeway on the income and asset calculations, but said it "would not be reasonable to use this option to categorically exclude all of a sponsor's income and/or resources in determining the eligibility of the sponsored immigrant."

From the article of the same title
Modern Healthcare (08/23/19) Luthi, Susannah
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Medicare Plan Finder Tool Revamped to Make Comparison Shopping Easier
The U.S. Centers for Medicaid and Medicare Services (CMS) has revamped its Medicare Plan Finder tool, which Medicare beneficiaries can use to compare their options. The update allows beneficiaries to compare prices among original Medicare plans, Medicare prescription drug plans, MA plans and Medicare supplemental insurance options (Medigap). It also lets beneficiaries compare up to three drug or MA plans side by side and let them import their list of medications so they can compare plans in light of their known needs.

The update also makes the tool more mobile-friendly, reflecting the fact that one in four Medicare beneficiaries accessed the Plan Finder tool on mobile devices last year, a significant increase from the year before. Both the old and new Medicare Plan Finder tools will be available online through the end of September 2020 as part of a phased rollout. CMS Administrator Seema Verma says the overhaul flows from the Trump administration's eMedicare initiative to meet consumers' needs and expectations, especially in light of the added flexibility the agency has granted to Medicare Advantage (MA) plans for covering supplemental benefits. She adds that the tool had not been updated in a decade, so "there were a lot of opportunities to just make it more user-friendly."

From the article of the same title
Health Leaders Media (08/27/19) Porter, Steven
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Survey: Physician Pay Increased, Productivity Remained Stagnant in 2018
According to a recent survey conducted by AMGA Consulting, overall physician pay increased by a median of 2.92 percent this year, compared to a 0.89 percent increase last year. Meanwhile, productivity increased by 0.29 percent, compared to a 1.63 percent decline in 2017 and compensation per work relative value unit (wRVU) ratio increased 3.64 percent compared to a 3.09 percent increase last year. In 2018, median compensation for primary care increased by 4.91 percent, up significantly from 0.76 percent in 2017, but productivity was flat. Medical specialties saw a 1.9 percent increase in median wRVU production from last year's survey, while the compensation per wRVU ratio increased by 2.65 percent and overall median compensation rose 3.39 percent. The survey also finds that care model changes are leading nurse practitioners and physician's assistants to work with their own panel of patients on a more frequent basis. However, pure production compensation models are less common for advance practice providers.

From the article of the same title
Healthcare Purchasing News (08/19)
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Medicine, Drugs and Devices

FDA Sees Benefits of Linking Universal Device IDs to EHRs
The U.S. Food and Drug Administration (FDA) says that universal device identifiers will let it actively monitor medical device performance and better identify patient safety concerns. At last week's Interoperability Forum, held by the U.S. Office of the National Coordinator for Health IT (ONC), an FDA official identified value in capturing universal device identifiers within electronic health record (EHR) systems. The practice can help link device use and distribution to patient health outcomes. The Global Unique Device Identification Database contains key device identification information submitted to the FDA about medical devices.

The FDA is working with the U.S. Centers for Medicare and Medicaid Services, ONC and the National Library of Medicine to make device-related adverse event reporting more accurate and expedite the resolution of device-related problems. The FDA official emphasized the importance of interoperability, including integration with EHRs and said that FDA and ONC can continue to collaborate in that area. She further said that modernized, active surveillance using real-world data is the future of medical device safety signal detection and identified it as a high priority for FDA.

From the article of the same title
Health Data Management (08/27/19) Slobodkin, Greg
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Report: E-Prescription Accuracy Has Increased by 64 Percent Since 2016
A recent report from Surescripts finds that e-prescription accuracy has increased by 64 percent since 2016. Despite this improvement, with 40 different data elements in each electronic prescription, the potential for conflicting, inaccurate or misinterpreted information means that manual intervention is often necessary. E-prescribing errors are time-consuming for providers and patients, sometimes leading to medication nonadherence, which creates up to $300 billion in avoidable healthcare costs in the U.S. each year. The reports also finds that the utilization rate of Structured and Codified Sig among electronic health records has grown from 1 percent of all new prescriptions in 2016 to 4 percent of all new prescriptions in 2018. The percent of prescribers enabled for Electronic Prescribing for Controlled Substances increased from 14 percent in 2016 to 32 percent in 2018, while the percent of controlled substance prescriptions sent electronically increased from 11 percent to 31 percent in the same period.

From the article of the same title
HIT Consultant (08/22/19) Pennic, Fred
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Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength
With 3 percent of U.S. adults reportedly taking in 4,000 IU or more per day of vitamin D, researchers probed whether or not high-dose supplementation actually benefits bone health. Final analysis of the single-site study included data for 287 healthy, community-dwelling adults aged 55–70 years with no osteoporosis. Participants had been randomly assigned to one of three doses of vitamin D supplement: 400 IU, 4,000 IU, or 10,000 IU. Followup at three years revealed no significant between-group differences in bone strength, measured in terms of failure load, in either the radius or the tibia. Bone mineral density, meanwhile, was significantly lower in the radius for the two groups that took higher doses of vitamin D. The same effect was observed in the tibia, but only with daily doses of 10,000 IU. The results do not support high-dose supplementation of vitamin D for bone health, which could be interpreted as potentially having some harmful effects, although additional studies are needed to flesh out that theory.

From the article of the same title
Journal of the American Medical Association (08/27/19) Vol. 322, No. 8, P. 736 Burt, Lauren A.; Billington, Emma O.; Rose, Marianne S.; et al.
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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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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