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News From ACFAS

ACFAS Comments on Proposed CCJR Rule
The College has urged the Centers for Medicare and Medicaid Services (CMS) to specifically exclude total ankle arthroplasty from the proposed rule: Comprehensive Care for Joint Replacement (CCJR) Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. While ACFAS applauds this proposed model’s efforts to support efficient and quality care for patients undergoing hip and knee replacements, the rule’s intent suggests a focus on hip and knee replacement episodes of care.

To encourage collaboration among healthcare professionals, CMS has proposed several measures that would determine hospital quality of care and eligibility for a reconciliation payment under the CCJR model. However, two of the three quality care measures only discuss total hip and total knee arthroplasty; ankle replacement is not mentioned. Specifically excluding total ankle procedures for this comprehensive care model is consistent with the fact that two of the mandatory quality metrics are specific to total hip and total knee arthroplasty; ankle replacement is not measured.

For more on the proposed rule, visit the CMS website.
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Board Nomination Applications Due This Sunday
Only four days left to submit your application to serve on the ACFAS Board of Directors. If you are an ACFAS Fellow and would like to help lead the profession, submit your application by Sunday, September 13, 2015.

Visit for details or email Executive Director Chris Mahaffey for more information. Contact Nominating Committee Chair Thomas Roukis, DPM, PhD, FACFAS for questions regarding eligibility criteria.

The Nominating Committee will announce recommended candidates to the membership no later than October 15, 2015. Candidate information and ballots will be emailed to all voting members no later than November 29, 2015. Electronic voting ends on December 29, 2015. New officers and directors take office during the ACFAS 2016 Annual Scientific Conference, February 11–14, 2016 in Austin, Texas.
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Promote Your Practice This Fall with New PPT Presentation
School’s back in session—the perfect time to educate parents on kids’ feet while promoting your practice at the same time. Download the latest PowerPoint presentation, When to Worry About Your Kids’ Feet, from the ACFAS Marketing Toolbox and schedule a talk with parents through your local hospital, park district or community center.

ACFAS makes promoting your practice easy with this newest addition to the Marketing Toolbox. The presentation outlines several foot conditions common among children and includes a fully written script, which coincides with each slide. It even includes a place for you to customize your contact information with your practice details so attendees can easily make an appointment with your office.

Visit the Toolbox often for new PowerPoint presentations and be sure to take advantage of our other resources to promote your practice throughout the year. Post or distribute the seasonal FootNotes patient newsletter, publicize your attendance at ACFAS 2016 or drive traffic to your website via our Twitter and Facebook pages.

More PowerPoint presentations are coming soon, so stay tuned!
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Fine-Tune Your Coding & Billing Skills After ICD-10
Take advantage of that critical period following the ICD-10 transition by giving your coding and billing skills a tune-up. Register now for ACFAS’ Interactive Surgical Coding Workshop, set for October 16–17 at the Monte Carlo Resort and Casino in Las Vegas, and get ready to:
  • Code actual cases with your fellow attendees
  • Learn new requirements for office policies, modifiers, durable medical equipment and more
  • Put your practice’s surgical coding process on the fast track
This two-day workshop includes 12 continuing education contact hours and a comprehensive reference guide. Space is limited; visit to register yourself and your office staff today.
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New Seminar Cuts to the Chase of Surgical Decision Making
Sharpen your understanding of the gray areas in real-time patient care where the evidence is insufficient or the patient preferences conflict. ACFAS’ latest advanced seminar, Taking a Scalpel to the Evidence, set for November 6–7, 2015 in Atlanta, delivers insight on these areas and much more.

A bottom-up approach provides a new spin on EBM basics as it delves deep into forefoot and trauma cases, surgical medicine and the diabetic foot. Expert faculty will use case presentations and lively debate to illustrate how you apply these to foot and ankle surgery and will give you a game plan for addressing cases where no evidence exists.

Seminar includes panel discussion Q&A plus the opportunity to earn 14 continuing education contact hours. Space is limited—visit to register today!
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Foot and Ankle Surgery

Gene Regulating Severity of Tissue Damage Caused by Rheumatoid Arthritis Identified
A report published in the journal PNAS reveals that scientists have identified a new protein which regulates the severity of tissue damage caused by rheumatoid arthritis (RA). Known as C5orf30, the protein could be studied to develop a cure for RA. Current drugs are only able to treat the disease. "Our findings provide a genetic marker that could be used to identify those RA patients who require more aggressive treatments or personalized medicine," said study leader Professor Gerry Wilson from the School of Medicine and Medical Science, University College Dublin. Wilson's team analyzed DNA and biopsy samples from more than 1,000 RA patients and hopes the discovery will prompt exploration into the protein's effect in terms of treatment. "The outlook for a person diagnosed with arthritis in 2015 is much brighter than it used to be. We are getting closer and closer to personalized medicine. This discovery is further proof that we are in the right space and investing our money wisely," said John Church, CEO of Arthritis Ireland.

From the article of the same title
Medical Xpress (08/31/15)
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Preventive Care, Proper Pedorthic Treatment Reduce Ulcer Risk for Patients with Diabetes
Therapeutic or protective footwear and insoles, additional footwear modification and regular clinic visits can significantly decrease recurring foot ulcers in patients with diabetes, according to a new study from the Paul and Margaret Brand Research Center at Barry University School of Podiatric Medicine. The six-month study found that 38 of 39 patients had no ulcer recurrence after being provided with a pair of therapeutic shoes, one pair of diabetic inserts and a log booklet. The patients were instructed to record information ranging from the time the shoes were worn to whether they experienced discomfort. Patients returned for follow-up every 30 days. Researchers noted only one wound recurrence, and even high-risk patients experienced significant progress. "Patients said they noticed significant decreases in redness and blisters compared to previous years, leading us to conclude that the modifications throughout the six-month study significantly improved how the shoes affected their feet," study author Christina M. Pena said. The researchers concluded that current Medicare guidelines, which call for providing one pair of therapeutic shoes and three inserts of durable medical equipment annually, are insufficient to prevent ulcer formation and recurrence.

From the article of the same title
Healio (09/01/2015)
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Practice Management

3 Ways to Sidestep EHR Interoperability Obstacles
Electronic health record (EHR) software can be frustrating to use because of missing or incomplete data governance policies, inconsistent implementation of interoperability standards and data sharing solutions integration problems. Vendors with inconsistent procedures can hamper a physician's optimal use of EHRs. It is likely these issues will not be solved in the near future, so here are three suggestions for physicians in the meantime:
  1. Leverage existing interface engine technology. You can program this to query external data sources. For example, a registration event sent as an HL-7 V2 A04 message may be used as a trigger for the interface engine to make an autonomous query to a health information exchange. Any retrieved information may be parsed by the engine and presented to the organization's EHR.
  2. Explore integrating web-based clinical records into your workflow. This may require additional effort on the part of your organization, but it is essential to work with your vendor to configure the EHR to launch a browser and transport data.
  3. Consider a secure email solution. There are many examples of secure email solutions, including HIN Direct. If you decide to go in this direction, also explore implementing a commercially supported, encrypted email server.
From the article of the same title
Medical Practice Insider (09/02/15) Agamalian, Bob
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4 Ways to Streamline Your Practice Planning Style
Planning is essential to running a functional practice, but strategizing to get the most out of your plans can be difficult. Here are some examples of how to create protocols to ensure that your practice plans correctly and runs as smoothly as possible:
  1. Always put one definitive point person in charge. This does not mean that one person does all the work. Instead, it is the person who can answer questions about a project's status or communicate whenever things go awry. Ultimately, this is the one person everyone in your practice should trust to be up to date.
  2. Work (and communicate) backward. Do not simply decide to reach point B. Focus on fully understanding point B, and figure out how to get to it from point A. This will allow for clearer, more efficient thinking and will streamline interactions with others within your practice.
  3. Be flexible. Not everything will go according to plan, and there will be times when you feel like all the planning you did was for naught. Plan to adapt and realize that things happen.
  4. Put a time limit on uncertainty. Waiting around for information is one of the reasons so many practices suffer from inefficiency. Always inform people of when to expect an answer.
From the article of the same title
Fierce Practice Management (09/02/15) Beaulieu-Volk, Debra
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Strategies to Get the Most from Payer Negotiations
Making the investment in preparation for payer negotiations can help turn your practice data into a significant tool for negotiations. Here are three strategies that can help you get the most out of these interactions:
  1. Know your data. Private practices that present data during payer negotiations could be awarded contract terms between three and ten percent higher than those who do not present data. Properly harnessing your data can make you stand out and make negotiating easier. In addition, having a comprehensive knowledge of your data also means that you know your practice inside and out, which can help turn negotiations in your favor.
  2. Prepare in advance. Allow 150 days before the contract end date to prepare. This will give you enough time to read everything as closely as possible. Designate someone in your practice who can lead payer-negotiation efforts, and make sure they know all of the key negotiation points.
  3. Anticipate working together. Due to ICD-10, it is estimated that claims denial rates will increase by up to 200 percent. This can affect your cash flow and business. Work with your payer to meet deadlines, and know where they stand on key metrics such as speed to payment. If you are aware of your payer's processes, you may have additional leverage in the negotiations.
From the article of the same title
Physicians Practice (08/31/15) Candage, Dan
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Health Policy and Reimbursement

CMS Establishes ICD-10 Coordination Center, Ombudsman Role
The Centers for Medicare and Medicaid Services (CMS) has established a new ICD-10 Coordination Center in Baltimore that will help manage the transition after the Oct. 1 implementation deadline passes. The center "will begin operations at the end of September and be responsible for managing and triaging issues and ensuring timely communications with all of you and with me in how we’re doing," according to acting administrator Andy Slavitt. It was also announced that William Rogers, director of the Physicians Regulatory Issues Team at CMS, has been named the agency’s "official ICD-10 ombudsman." His role will be to investigate and address stakeholder complaints during the switch. The coordination center and newly appointed ombudsman are part of a collection of CMS ICD-10 resources, guides and tools. In addition, acknowledgement testing is available to Medicare submitters through Sept. 30. "This testing will confirm whether you can successfully submit claims with ICD-10 codes to Medicare," Slavitt said.

From the article of the same title
Health Data Management (08/15) Slabodkin, Greg
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Drug Industry Rule Would Raise Medicare Costs
Pharmaceutical trade groups are supporting a patent law change that could cost federal healthcare programs $1.3 billion over the next ten years by delaying new generic medicines. The proposed change concerns Inter Partes Review (IPR), a procedure that has been used by hedge-fund manager Kyle Bass to challenge companies whose shares he is betting against or selling short. Bass's group has challenged more than 20 patents held by major pharmaceutical companies. These companies hope that Congress will alter the law so that brand-name pharmaceutical products will be exempt from IPR challenges. The potential implementation of the law has intensified opposition because it could raise drug spending. The Congressional Budget Office noted that the $1.3 billion increase would mostly come as a result of the exemption delaying the launch of certain generic products.

From the article of the same title
Wall Street Journal (08/31/15) Walker, Joseph
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Patients Much Likelier to Choose Hospital That Employs Their Doctor
A new study has found that patients who go to the hospital vastly prefer facilities where their doctor works. The report noted this was important because more physicians are working closely with hospitals under contracts with financial incentives to do so. While this has the potential to improve care and costs, that may not always be the case. Patients who saw their doctors at hospitals tended to pay more for lower-quality care; by contrast, patients who saw independent physicians often paid less for better quality. Study leader Lawrence Baker, a Stanford professor of health research and policy, said that crossing the low-cost, high-quality threshold for every patient will be a challenge. The Affordable Care Act includes financial incentives for hospitals to work more closely with physicians, but the results have been mixed. The report shows that this marriage of doctor and hospital does not work everywhere. Those who back integration claim that the increased coordination between doctors and hospitals is the best option to keep patients healthy and out of hospitals.

From the article of the same title
Modern Healthcare (09/01/15) Evans, Melanie
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Sanders to Introduce Bill Targeting High Drug Prices
Sen. Bernie Sanders (I-Vt.) is planning to introduce legislation that will fight high prescription drug prices. The bill would allow the Medicare prescription drug program to negotiate drug prices, which is currently banned. Drugs would also be allowed to be imported from Canada. Prescription drug spending increased by 12.6 percent last year, the largest increase since 2002 and more than twice the increase in overall health spending. “Americans should not have to live in fear that they will go bankrupt if they get sick,” Sanders said in a statement. “People should not have to go without the medication they need just because their elected officials aren’t willing to challenge the drug and healthcare industry lobby.” Sanders also said that he will introduce a single-payer healthcare bill, which would create government-provided insurance for all American citizens.

From the article of the same title
The Hill (09/01/15) Sullivan, Peter
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Medicine, Drugs and Devices

Antibiotics Are Linked to Type-2 Diabetes
People who develop type-2 diabetes used significantly more antibiotics before they were diagnosed compared with people without the disease, new research shows. The study, published in the Journal of Clinical Endocrinology and Metabolism, revealed that patients with type-2 diabetes received 0.8 prescriptions per year, and patients without the disease only had 0.5 prescriptions per year. This increased use of antibiotics was detected up to 15 years before people with type-2 diabetes were even diagnosed. In addition, an increased usage was also found post-diagnosis.

From the article of the same title
Time (08/27/15) Oaklander, Mandy
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DPP-4 Inhibitors for Type 2 Diabetes May Cause Severe Joint Pain
The U.S. Food and Drug Administration has warned that DPP-4 inhibitors, used to treat type 2 diabetes, could cause severe and disabling joint pain. The agency has added a new warning and precaution about this risk to the labels of all drugs in this class, which includes sitagliptin, saxagliptin, linagliptin and alogliptin. If patients experience severe and persistent joint pain, they are cautioned not to stop taking the drugs but to contact their healthcare provider immediately. Healthcare professionals should be alert to DPP-4 inhibitors as a potential cause of severe joint pain and have the patient discontinue the drug, if appropriate.

From the article of the same title
FDA MedWatch (08/28/15)
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Task Force Recommends Coordinated Registries Network for Medical Device Evaluation
The U.S. Food and Drug Administration has released a report recommending that the federal government and other stakeholders support an initiative to monitor medical devices after they become commercially available. This proposed task force would develop a coordinated registries network to track the performance of each device for each patient in a single integrated location. Currently, this information is stored in multiple locations and is difficult for regulators, doctors and patients to access and use correctly. The report noted many foundational characteristics for a national medical device evaluation system, including a continuously updated database, organized patient device data and the inclusion of pilot programs to create momentum for a centralized database. "Conceptually, this is the best way for us to make sure that physicians and patients get up-to-date, near real-time information about the performance of medical devices to be able to make informed choices about what works best for individual patients,” said lead author Art Sedrakyan.

From the article of the same title
Healthcare Informatics (08/28/15) Raths, David
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This Week @ ACFAS
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Mark A. Birmingham, 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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