September 11, 2019 | | JFAS | Contact Us

News From ACFAS

Think You Can Do Better?
Do you have ideas on how to improve ACFAS educational programming? If you’re interested in changing the course of our educational lineup to better suit members—now is your chance! It’s CME survey time and we want your feedback.

Help shape your member experience by answering a few short questions. Your responses will be kept confidential but will make a lasting impact ensuring the next three years of educational offerings are geared to your needs.

The survey will be sent via email from ACFAS later this month. You’ll be eligible to win one of six $100 American Express gift cards just for responding, so keep an eye on that inbox.
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Save the Date for 2020 Residency Directors Forum
Residency directors, program faculty and deans: mark your calendars – the 2020 Residency Directors Forum is set for Tuesday, February 18, 2020 in advance of ACFAS 2020 in San Antonio. This year's event will again be co-hosted by ACFAS and the Council of Teaching Hospitals (COTH).

Make this not-to-be-missed event your CPME and hospital requirement for faculty development. Attendees will earn 3.0 CME hours.

Session content will include discussions on choosing and teaching millennial residents; best practices dealing with negative reviews; at-risk residents; avoiding harassment claims; proper social media usage; CPME compliance; resident hours; and malpractice claims.

This is just a taste of the content to be presented at this year’s Forum. Watch your email for more event details and registration information in early fall.
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Additional Fellowship Program Receives Upgraded Status with ACFAS
The ACFAS Fellowship Committee recently determined the following fellowship exceeded the minimal requirements to be upgraded to Recognized Status with the College after their first successful year:

Foot and Ankle Fellowship of the Orthopedic Institute of Central Jersey
Wall Township, NJ
Program Director: Shane Hollawell, DPM, FACFAS

ACFAS highly recommends taking on a specialized fellowship for the continuation of foot and ankle surgical education after residency. If you are considering a fellowship, visit to review a complete listing of programs and minimal requirements.
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Foot and Ankle Surgery

Accelerating Anatomical 2D Turbo Spin Echo Imaging of the Ankle Using Compressed Sensing
A study was held to evaluate the feasibility and diagnostic value of compressed sensing (CS) for accelerating two-dimensional turbo spin echo imaging of the ankle. Ankles of 20 volunteers were scanned at 3?T MRI. Coronal and sagittal intermediate-weighted sequences with fat saturation as well as axial T2- and coronal T1-weighted sequences were acquired using parallel imaging based on sensitivity encoding (SENSE) only, as well as with a combination of compressed sensing (CS) and SENSE. There was a substantial to perfect agreement for the rating between the images acquired with SENSE only and with the combination of CS and SENSE when assessing cartilage, subchondral bone and ligaments (??=?0.75 - 0.89). Signal-to-noise ratio was slightly higher for CS plus SENSE versus SENSE alone, but this finding was not significant.

In addition, contrast-to-noise ratio of cartilage/fluid, subchondral bone/cartilage, ligaments/fluid and ligaments/fat did not exhibit substantial differences between the sequences acquired through SENSE only and CS plus SENSE. Interreader agreement was substantial to excellent for both methods.

From the article of the same title
European Journal of Radiology (09/01/18) Vol. 118, P. 277 Gersing, Alexandra S.; Bodden, Jannis; Neumann, Jan; et al.
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Comparison of Supervised Exercise and Home Exercise After Ankle Fracture
It is not clear which rehabilitation intervention should be performed after an ankle fracture. The study aims to compare the effectiveness of a supervised exercise program with that of a home exercise program and to determine and compare the costs of these programs. A supervised exercise program and a home exercise program were performed for eight weeks. The supervised exercise group consisted of 35 patients (mean age 39.23 years) and the home exercise group consisted 73 patients (mean age 41.78 years). The average follow-up was 27.86 months, and researchers recorded demographic information, injury details, type and classification of fracture, pain severity, and ankle range of motion. Clinical outcomes were determined with the Pain Disability Index, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, and the Short-Form 36 Health Survey, and surgical and rehabilitation satisfaction was evaluated with a numeric scale.

The home exercise group had statistically higher American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scores and better rehabilitation satisfaction. Total rehabilitation costs in the supervised exercise group were 1113.63 Turkish lira (US$310.25) versus 182.31 Turkish lira (US$50.79) in the home exercise group. Between the low costs and strong clinical outcomes of the home exercise group, the researchers recommend that patients with surgically treated isolated ankle fractures be followed up with a postoperative home exercise program.

From the article of the same title
Journal of Foot & Ankle Surgery (09/01/19) Büker, Nihal; Raziye Savkin, Raziye; Ök, Nusret
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Need for Concomitant Akin Osteotomy in Patients Undergoing Chevron Osteotomy Can Be Determined Preoperatively
A retrospective comparative study gauged the impact of concomitant phalangeal correction on the outcome of Chevron osteotomy following hallux valgus surgery, to define indicators for additional Akin osteotomy. In total, 859 feet undergoing distal Chevron osteotomy were grouped into group C with 785 feet and group AC, featuring Chevron plus Akin, with 74 feet. Radiological assessment including the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle and the proximal to distal phalangeal articular angle (PDPAA) was carried out preoperatively, postoperatively, after six weeks and after three months.

A significant improvement of all parameters could be observed to all points of survey, and loss of correction was identified for HVA and IMA with higher levels in group C. Preoperative PDPAA exceeding 8 degrees correlated significantly with loss of HVA correction in the same group.

From the article of the same title
Journal of Orthopaedic Surgery and Research (08/28/19) Vol. 277, No. 14 Kaufmann, Gerhard; Hofmann, Maximilian; Braito, Matthias; et al.
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Practice Management

Getting Your Medical Records Through an App? There's a Catch. And a Fight.
The U.S. Department of Health and Human Services (HHS) has proposed two new data-sharing rules this year to carry out provisions in the 21st Century Cures Act of 2016. One of the new rules would allow patients to send their electronic medical information directly to apps from their health providers, which will require EHR vendors to adopt application programming interfaces (APIs). To foster data-sharing, a coalition of tech giants had committed to using common standards to categorize and format health information. The second proposed rule, developed by the U.S. Centers for Medicare and Medicaid Services (CMS), requires plans in the federal health insurance marketplace to adopt APIs. DHS official Don Rucker says the new rules could help patients manage their health and medical costs, while prompting developers to come up with novel health products.

But physicians' groups and others warn that authorizing consumer apps to retrieve medical records could open patients to serious data abuses. They point out that current federal privacy protections no longer apply once patients transfer their data to consumer apps, who would then be free to share or sell sensitive patient information. Some warned that the spread of such information could lead to higher insurance rates or job discrimination, which patients may not realize. They said that because the rules fail to give people granular control over their data, providers could be required to share sensitive health information with apps and insurers against their better judgement. Rucker said that granular control could not be accommodated by current information-sharing standards, and said that physicians and hospitals are highlighting privacy concerns because they have a financial stake in keeping patients and data captive.

From the article of the same title
New York Times (09/03/19) Singer, Natasha
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How to Rev Up Practice Productivity
An American Medical Association study found that in 2018, employed doctors outnumbered those that had an ownership stake in a practice. Most practice owners cited financial difficulty as a main reason in giving up their independence, which highlights the importance of operating as efficiently as possible. This can mean increasing patient volume to balance out declining reimbursements, which comes down to strong customer service and more appointment slots. To schedule additional patients, practices can extend appointment hours, schedule appointments more strategically or double-book appointments with the expectation of no-shows. Practices should stay efficient and up-to-date in their billing, coding and collections, which should be done through an electronic patient portal and automated whenever possible. This is preferable to most patients and cheaper for practices while allowing staff members to use their time more effectively.

Practices can also generate more revenue and improve patient health by implementing a recall system that identifies when patients are due for a particular service. In terms of expenses, one of the biggest overhead costs is in staffing, and an easy target here is overtime pay, which practices should aim to eliminate even if it means hiring another employee. Practices should also develop an organizational chart and review it carefully to ensure they really need every employee they have. Practices can also look for savings in practice-related equipment and services by monitoring expenses and looking for ways to trim them without harming productivity. Options include looking at physician societies, which may offer discounts to their members and outsourcing vaccine-related services.

From the article of the same title
Medical Economics (09/02/19) Bendix, Jeff
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Nine Ways to Improve Your Patient Communications
Physicians can become too focused on measures, tasks, routines and job requirements at the expense of patient communication. The benefits of good communication include improved physician job satisfaction, improved market share and reputation and reduced medical errors and patient safety events. As part of a welcoming ritual, physicians can announce their entrance, smile and make eye contact and address the patient by name. The conversation can be started with something nonmedical, followed by questions about the patient's expectations or goals. It is also essential to pay attention to nonverbal communication, strive to be present and show empathy. Open-ended questions, such as, “Tell me what happened" or “Help me understand” should be followed by closed-ended questions to fill in gaps in understanding and construct a differential diagnosis.

Doctors should also ask the patient to describe his or her understanding of the issue and tell the patient in plain language about treatment options or other information, ideally conveyed in three pieces at a time. Finally, the patient should be asked if he or she understands. Developing shared goals for treatment helps motivate patients to adhere to the treatment plan. Physicians also need to summarize diagnosis, treatment and prognosis and review next steps: upcoming visits, phone calls, communication of test results and handoffs. The visit should end with an optimistic or hopeful expression.

From the article of the same title
Physicians Practice (08/29/19) Uppal, Rohit
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Health Policy and Reimbursement

IRS Says Reinstating ACA Insurance Tax Would Cost Insurers $15.5 Billion in 2020
The U.S. Internal Revenue Service (IRS) published a notice stating that health insurance companies face a $15.5 billion tax bill in 2020 if the Affordable Care Act's health insurance tax resumes as scheduled. The health insurance industry fee is an annual fee on health insurance providers based on premiums and a payer's market share. The fee was suspended by Congress this year due to concerns that it would boost insurance premiums and out-of-pocket costs for consumers.

According to a 2018 analysis by Oliver Wyman Actuarial Consulting, commissioned by UnitedHealth Group, the implementation of the tax in 2020 would increase insurance premiums by more than 2 percent, and it also could drive up costs for Medicare Advantage and Medicare Part D beneficiaries, small employers and states. Higher premiums could result in lower enrollment in the exchanges and a larger uninsured population, said the analysis, which assumed insurers would pay $16 billion in 2020 rather than the $15.5 billion stated in the IRS notice. Congress is considering bipartisan legislation that would suspend the tax through 2021.

From the article of the same title
Modern Healthcare (09/04/19) Brady, Michael
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Medicare Advantage Payment Cuts Did Not Affect Member Care Access
A study published in the American Journal of Managed Care finds that Medicare Advantage (MA) beneficiaries' access to care and health plan affordability did not change between 2009 and 2017. The study surveyed MA and Traditional Medicare (TM) beneficiaries in 2009, 2011 and 2017, asking whether enrollees had a provider, how often they visited and whether they had to wait to receive care. It found that MA beneficiaries were more likely to say they had a primary doctor and had seen their physician in the past 12 months compared to TM beneficiaries. Both Traditional Medicare and MA recipients attested to being denied a provider, having their insurance rejected and being let go from their provider.

Because the Affordable Care Act (ACA) decreased Medicare Advantage payments, MA plans cut down on their bids, dropping from 102 percent of the traditional Medicare price to 90 percent. In 2009, 7.4 percent of MA enrollees reported cost-related care postponement, which decreased to 5.6 percent by 2017 but remained one percentage point higher than TM. MA beneficiaries also had higher rates than TM enrollees, although this did not seem related to the ACA as the changes were slight. Enrollment rose in spite of the cuts, suggesting that rebates may be what continues to draw members to MA. Researchers also noted that MA plans benefited from higher quality scores, which impact performance-based rebates and revenue and some diagnostic coding changes that may have helped the risk adjustment program.

From the article of the same title
HealthPayerIntelligence (09/03/19) Waddill, Kelsey
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Policies Reducing Price Variations May Produce Savings, Study Suggests
In a study published in the September issue of Health Affairs, Harvard University researchers looked at variations in the prices paid by eight commercial insurers in 2015 for 291 predominately outpatient services in Massachusetts. They found that among service categories, the largest price variations occurred in physical and occupational therapy, which had 199 percent higher prices at hospitals than at other settings and laboratory and pathology testing services, for which prices were 100 percent higher at hospitals than at other settings. However, prices at hospitals were 25 percent lower for office visits compared with other settings.

Researchers conducted a price-steering simulation in which they reallocated services from providers above the 75th percentile within an insurer and an HSA to lower priced-providers, which they found would save payers 13 percent. They also calculated changes in total spending by capping the prices paid to high-price providers at the statewide 75th percentile and found that doing so would save payers 9 percent.

The study also found that providers in the highest-price decile for physical and occupational therapy and laboratory and pathology testing also had large market shares. These findings emerge in the middle of a heated debate about the large variation in prices for healthcare services, which has to do with private price negotiations between payers and providers. A CMS proposal from July would require hospitals to disclose payer-specific negotiated rates for about 300 non-urgent services in an easy-to-compare format, which hospitals and payers say would stifle market competition.

From the article of the same title
Healthcare Dive (09/04/19) Wilson, Linda
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Medicine, Drugs and Devices

Former Agency Heads, Health Groups Push for FDA's Sharpless to Be Permanent Commissioner
Former U.S. Food and Drug Administration (FDA) commissioners and dozens of health groups urged the White House to nominate acting agency chief Norman "Ned" Sharpless to become FDA's permanent commissioner. Supporters of Sharpless sent two letters to U.S. President Donald Trump and U.S. Department of Health and Human Services Secretary Alex Azar, stating that the agency needs a permanent commissioner, and Sharpless should be nominated and confirmed to lead it. Sharpless, a North Carolina cancer researcher who was appointed by Trump to be head of the National Cancer Institute, was tapped as acting FDA commissioner in March, when Scott Gottlieb announced he was leaving the agency. As the acting head, Sharpless can serve only until early November under federal rules.

From the article of the same title
Washington Post (DC) (09/04/19) McGinley, Laurie
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OIG Audit Reveals Medicare Overpaid Millions for Prescription Drugs in Hospice Care
A report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) indicates that Medicare Part D overpaid millions of dollars for prescription drugs that should have been covered by the Medicare Part A hospice benefit. OIG based its audit of the total Part D cost from 2016 payments. It used a nearly $400,000 random sample of prescription drug event records and contacted hospices that provided care. The report concluded that hospice organizations should have paid $160.8 million for drugs in 2016, but the cost was covered by Medicare Part D. Hospices also should have likely paid for many of the drugs in the remaining $261.9 million of the total cost of $422.7 million that year, even though hospices told OIG they should not have paid.

The report urged the U.S. Centers for Medicare and Medicaid Services (CMS) to work directly with hospice providers to ensure they are paying appropriately for prescription drugs and to form a strategy to prevent future overpayments. The hospice benefit consists of a payment to organizations for each day a beneficiary is in hospice care, irrespective of the services provided, and drugs are covered under this benefit. The savings to Part D would be at least $160.8 million, OIG concluded. The report stated, "We continue to recommend that CMS develop controls to stop the duplicate hospice drug payments."

From the article of the same title
HealthExec (09/04/19) Baxter, Amy
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Prescription Drug Databases Lead to Fewer Opioid-Related Inpatient Stays, ED Visits
A study published in Health Affairs indicates that states which require providers to use prescription drug monitoring databases (PDMPs) have an 8.92 percent lower rate of opioid prescriptions in the Medicaid population. The study, which analyzed Medicaid prescription and hospital utilization data across the United States from 2011 to 2016, also found that PDMPs seemed to reduce rates of opioid-related inpatient stays and ED visits by 4.27 percent and 17.75 percent, respectively. Researchers say their findings suggest that "the previously documented reductions in the overall opioid prescription rate and the rate of high-risk opioid prescriptions may have effectively translated into reductions in adverse healthcare events" as a result of opioid use.

PDMPs have been established in almost all of the United States, and recent state policy efforts have focused on improving providers' participation in the programs. Many states require all state-licensed prescribers and dispensers to register with and use the PDMP in most clinical circumstances. Some industry stakeholders say these databases may push people who have already become opioid-dependent to seek alternative, more dangerous drugs such as heroin, but the study authors say that while this is possible, the net effect of PDMPs remains positive. Researchers noted that PDMPs help promote referrals to opioid use disorder treatment, creating an opportunity for intervention.

From the article of the same title
Fierce Healthcare (09/04/19) Landi, Heather
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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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