News From ACFAS

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Board nomination applications are due to ACFAS no later than September 20, 2016. If you’re an active and committed ACFAS Fellow member who would like to serve on the College’s Board of Directors, submit your application as soon as possible.

Visit acfas.org/nominations for the application and complete details on the recommended criteria for candidates. For additional information, contact Executive Director Chris Mahaffey via email or (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Richard Derner, DPM, FACFAS, via email or (703) 491-9500.

The Nominating Committee will announce recommended candidates to the membership no later than October 31, 2016. Candidate information and ballots will be emailed to all voting members no later than December 15, 2016. Electronic voting ends on December 30, 2016. New officers and directors will take office during ACFAS 75, February 27–March 2, 2017 in Las Vegas. Don’t roll the dice on your accommodations for ACFAS 75 in Las Vegas! Reserve your hotel room with onPeak, the College’s official housing partner, and enjoy exclusive rates at our two official conference hotels, The Mirage ($168/night/headquarters hotel) and Treasure Island ($109/night).

Booking with onPeak in ACFAS’ hotel block protects you from unauthorized third parties claiming to be our housing partner and also helps ensure you get the best price. Room reservations are accepted on a first-come, first-served basis—visit acfas.org/asc today to reserve your room before the block fills up! Garner media attention and promote your practice with free, customizable press releases available exclusively in the ACFAS Marketing Toolbox. Our latest release, “Check Pain Management Off Your List of Surgery Worries,” addresses the concern of pain following surgery while highlighting today’s various pain management options.

Media outreach to your local newspapers, radio stations and broadcast news outlets not only helps you gain publicity, it helps build rapport with reporters, which can position you as a “go to” source for info on podiatric surgery.

Our Fill-in-the-Blank Press Release Library also includes announcements you can share with hospital public relations departments, alma maters or volunteer and community organizations. Visit acfas.org/marketing to start making these preformatted press releases your own. Congratulations to the following officers for the 2017–2018 term:

President: Laurence G. Rubin, DPM, FACFAS
President-Elect: John S. Steinberg, DPM, FACFAS
Secretary-Treasurer: Christopher L. Reeves, DPM, FACFAS
Immediate Past President: Sean T. Grambart, DPM, FACFAS

These new Board officers will be installed during ACFAS 75 set for February 27–March 2, 2017 in Las Vegas. New Board members will be elected in December. Watch This Week @ ACFAS for details in the coming months. Congratulations to Stephanie Eldridge, DPM, AACFAS, who in August joined the College as its 10,000^th all-time regular member. Dr. Eldridge of Carolina Foot and Ankle Associates, PLLC in Hickory, North Carolina first became involved with ACFAS as a student member and then as a three-year resident member. Her membership also comes at a time when ACFAS has achieved its highest membership overall, 7,285 at last count.

“Being the 10,000^th member signifies the College’s growth, and I’m so happy to be part of it,” says Dr. Eldridge. “I thank all previous and current members for their work and contributions to make the College what it is today.”

Foot and Ankle Surgery

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A study assessed the radiographic changes of weightbearing joints in patients with rheumatoid arthritis (RA) during tumor necrosis factor (TNF)-blocking therapies and determined the components related to the progression of joint damage. Researchers investigated the changes in clinical variables and radiological results in 243 weightbearing joints in 38 patients over three years of treatment with TNF-blocking agents. Seventeen proximal weightbearing joints showed apparent radiographic progression, whereas none of the proximal weightbearing joints indicated improvement or repair. Twenty distal weightbearing joints displayed radiographic progression, and eight showed improvement. The baseline Larsen grade for proximal weightbearing joints and disease activity at one year after treatment were identified as independent factors associated with the progression of joint damage. Analysis of distal weightbearing joints identified disease activity at one year after treatment as an independent factor related to damage progression.


Subtalar joint compression generated by headless screws relying on variable thread pitch to achieve bony contact has not been previously assessed. A new study measures subtalar joint compression achieved by two posteriorly placed contemporary headless screws and quantified the outcomes gained by placing a third screw anteriorly. Ten cadaveric subtalar joints were fixed using two diverging posterior screws inserted into the talar dome and talar neck, two parallel posterior screws ending in the talar dome and two parallel screws with an additional anterior screw inserted from the plantar calcaneus into the talar neck. The mean compression generated by two diverging posterior screws was 246 N. Two parallel posterior screws generated 294 N, and the third anterior screw increased compression to 345 N. Variable-pitch screws produced slightly less compression than reported for fixation with conventional headed screws, but compression was comparable with the addition of the third anterior screw.


A new study was conducted to examine whether heat or contrast therapy is most effective in reducing pain and swelling and increasing range of movement (ROM) of the grade I and II lateral ankle sprain in the prechronic stage of the subacute phase. Pain, volume and ROM of 115 participants with grade I or II lateral ankle sprain were recorded before and after treatment. Immediately after application, there was no difference between the two thermal modalities on ankle ROM. Heat reduced pain more than contrast therapy, and both modalities increased swelling. After three days of continuous application, no differences were found between the two modalities in terms of ROM and pain. Contrast therapy reduced swelling, and heat increased swelling after three days.

Practice Management

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The legal relationship between a practice and its billing company is key to a practice's ability to properly bill and collect payment from patients and third-party payers; however, many practices fail to carefully review their billing agreement. When entering into a new agreement or renegotiating an existing agreement, practices should first consider whether the chosen billing company can meet the practice's needs. A company may not have the experience, personnel and infrastructure to handle the volume and type of claims generated by some practices. Any agreement should specifically outline the duties and responsibilities of each party, including the timeframe for processing claims, reports provided by the billing company and policies regarding claim rejections and denials. An agreement should also cover the procedure for ending the partnership and switching to a different billing company. Both parties should discuss the billing company's obligation to transfer records and process existing claims during the transition period. Many practices rely on a billing company for additional services, such as education and compliance assistance. Depending on what role a company fills, the total liability of each party should be agreed upon prior to signing a contract.


Prescription databases are helping states analyze and probe doctors for irresponsible medical practices, proving to be an increasingly valuable tool in the fight against opioid abuse. The number of opioid prescriptions fell by about 12 percent from 2012 to 2015, but last year’s figure was still 39 percent higher than in 2000. The use of statewide databases has been associated with a 30 percent drop in the prescribing rate for opioids between 2001 and 2010. Every state but Missouri has a prescription monitoring database that enables advisory officials to look for doctors who prescribe dangerous amounts or combinations of drugs, such as mixtures of opioids and benzodiazepines. Flagged doctors are then investigated for medical misconduct and could have their licenses suspended or revoked. Since 2015, more than a dozen states have passed measures to improve their databases' effectiveness. In nearly three dozen states, practitioners must consult a database in certain circumstances to thwart doctor shopping by drug-abusing patients. For example, Massachusetts physicians will soon be required to check the database for patients' prescriptions histories before renewing opioid prescriptions.


Most physicians have encountered angry patients in the exam room, but few are prepared to handle a situation in which patients exhibit violent and threatening behavior. Patients can become frustrated if they are not receiving the treatment or diagnosis they expect, and some might be angered at a doctor’s refusal to prescribe a controlled substance. The first step to preventing exam room violence is identifying situations that have the potential to anger a patient, such as restricted access to opioid medication. Patients should be told up front about a physician’s policy regarding controlled substances. Physicians must be careful to never argue with a patient and should answer any questions in a calm and controlled manner. If a patient attempts to pressure the physician into doing something medically improper, the physician may leave the room or request that the patient find another provider. Patients who regularly behave aggressively or inappropriately must be discharged from the practice. If an individual becomes overly hostile or violent in the office, a physician or staff member should immediately call the police. If necessary, a practice can press charges or file for a restraining order.

Health Policy and Reimbursement

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In recognition of the wide diversity of physician practices, the Centers for Medicare and Medicaid Services (CMS) intend for the Quality Payment Program, set to begin on January 1, 2017, to allow physicians to pick their pace of participation. During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019. These options and other supporting details will be described fully in the final rule. Andy Slavitt, acting administrator of CMS, outlines the options in this article.


Public comment letters on proposed changes to Medicare’s 2017 Physician Fee Schedule offer praise for some plans to improve payments for primary care and preventative services while criticizing key elements of the rule. Payment improvements include increased payments for routine visits for patients with mobility-related disabilities, diabetes self-management training services and behavioral health services. The American Medical Association’s (AMA) comment letter praises the proposals for separate non-face-to-face prolonged Evaluation and Management service payments, separate payments for services under the Psychiatric Collaborative Care Model and the implementation of updated codes for Chronic Care Management (CCM) services. However, AMA opposes the plan to eliminate the payment increase provided under MACRA to fund payment for services provided to patients with mobility-related disabilities. The American Medical Group Association also praised the proposal to boost payments for CCM services, but expressed concern that use of CCM codes requires a 20 percent copayment, as those services had been previously provided for free.


Public Citizen is working to close a malpractice loophole that allows a physician to avoid being reported to the National Practitioner Data Bank (NPDB). Currently, practitioners can evade filing with the NPDB for malpractice payments if a plaintiff agrees to exclude the physician from a lawsuit or claim and names the healthcare institution as the sole defendant. Public Citizen says NPDB reporting rules are not consistent with the federal statute under which it was established and undermines the accountability of physicians. Last month, the advocacy group filed suit in a U.S. District Court to seek action from the Department of Health and Human Services. A survey conducted by NPDB revealed that 9 percent of hospitals searching the database found something about a physician they had not previously known. The database is intended to act as a protection against those who are dishonest when filling out applications with healthcare institutions, but Robert Oshel, former NPDB associate director for research and disputes, believes times have changed since the database was created. “When the law was passed, very few physicians were employed by hospitals or healthcare institutions at that point,” he says. “Now a majority of physicians are, and it's easier to sue a hospital than the physician, and it makes no difference to the insurer.”


The Medicare Access and CHIP Reauthorization Act (MACRA) will affect more than 800,000 clinicians and allocate more than $1.2 billion in bonuses and penalties in its first year. Under the proposed implementation rule for MACRA, physicians will receive payments through either the Merit-Based Incentive Payment System (MIPS), which uses a fee-for-service model, or alternative payment models (APMs). As an incentive to the shift toward APMs, MACRA provides a 5 percent bonus to providers participating in advanced APMs. The rule requires eligible providers to bear a greater financial risk for the costs of care, use quality metrics similar to MIPS and use electronic health records. Few clinicians in smaller practices will have the capacity to meet the proposed advanced APM financial risk requirements, and some advanced APMs have administrative requirements beyond a small practice’s capabilities, such as longitudinal electronic data integration. For clinicians not participating in an advanced APM, the proposed rule significantly reduces the number of quality measures to report under MIPS. Clinicians participating in MIPS will need to report six quality measures instead of the nine required by the Physician Quality Reporting System, and cost or resource use measures will not have to be reported.

Medicine, Drugs and Devices

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Almost $1,000 worth of unused medical supplies are wasted per surgical procedure, according to recent research by the University of California, San Francisco (UCSF). The study examined 58 neurosurgeries performed by 14 surgeons at UCSF Medical Center. Sponges, towels and gloves were the most commonly unused and discarded supplies. Surgifoam sponges were the most expensive items, costing up to $4,000 per sponge. In UCSF’s neurosurgery department alone, an estimated $2.9 million worth of supplies were discarded in a year. Researchers found that spinal procedures are among the most wasteful, and the length of a surgeon’s experience did not seem to correspond to the volume of wasted supplies. As healthcare costs continue to skyrocket, containing a facility’s waste can produce significant savings. A feedback system could allow surgeons to compare where they stand relative to their peers in terms of waste per procedure, encouraging more frugal management of supplies. Researchers also recommend reviewing surgeons’ procedure preference cards and removing unnecessary items. Additionally, some medical devices can be reprocessed by an FDA-approved company and sold back to the hospital for a fraction of the price. This strategy alone saved UCSF hospitals about $1.1 million over the last year.


According to new U.S. Food and Drug Administration (FDA) regulations, companies cannot sell hand soaps that contain several common antibacterial compounds. FDA said the new rule is in response to growing concerns about the safety of using antibacterial compounds over a long period of time. Additionally, FDA said there is no proof the chemicals provide greater benefits than regular soap. The new rule applies to 19 chemicals and soaps that should be lathered and washed off. However, the rule does not apply to antibacterial chemicals used in hospitals and doctor offices. The rule also does not apply to antibacterial wipes and hand sanitizers. Manufacturers have been working to remove the chemicals from their products before the rule was implemented. In 2013, research found that use of antibacterial chemicals could result in bacterial resistance and hormone disruption.


The U.S. Food and Drug Administration (FDA) will require new warnings to be placed on opioid painkillers and benzodiazepines product labels. FDA said that boxed warnings must be placed on 389 separate products and cough medicines that contain opioid. A boxed warning is FDA's strongest category at its disposal. The new regulation is intended to stem the rising number of Americans who are using opioid painkillers and benzodiazepines at the same time. Combined use of the two drugs can result in extreme sleepiness, respiratory depression, coma or even death. FDA says the number of patients prescribed an opioid and benzodiazepine has increased by 41 percent between 2002 and 2014. Meanwhile, the number of hospital visits relating to the abuse of the drugs has sharply increased and fatal overdoses have tripled.