News From ACFAS

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Take the first step to attending ACFAS 2015 in Phoenix and book your hotel reservations online today! Reservations are now being accepted by ACFAS’ official housing partner, onPeak, on a first-come, first-served basis, so be sure to sign up early to get your first choice of exclusive hotels. To make your reservations, visit onPeak's website.

The official ACFAS 2015 Hotels include:

Sheraton Phoenix Downtown Hotel (Headquarters Hotel): $229/night (closest to meetings)
Holiday Inn Express Hotel & Suites Phoenix Downtown: $199/night
Hotel Palomar Phoenix: $235/night
Renaissance Phoenix Downtown: $229/night (closest to meetings)
Springhill Suites Phoenix Downtown: $189/night
See website for map.

For full details and to get the lowest rates and most complimentary amenities at specially selected hotels for your stay in Phoenix, visit acfas.org/phoenix. And remember, onPeak is the only official housing company associated with ACFAS 2015, so be sure to book your room through the exclusive link at acfas.org/phoenix. Don’t keep your groundbreaking research under wraps—present it in poster format at ACFAS 2015 in Phoenix, the largest annual gathering of foot and ankle surgeons in the US. Each year, the poster exhibit ranks as the most-trafficked area of our conference, which translates into the best and brightest in the profession learning about your exciting new research!

Ten of the most unique and innovative posters will also be selected for video presentation during the conference and posted on acfas.org afterward.

For more information or to submit a poster for presentation consideration, visit acfas.org/phoenix. Remember, posters must be submitted to ACFAS no later than October 1, 2014.

Foot and Ankle Surgery

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A new study has found that a novel open surgical technique for treating midportion Achilles tendinopathy achieves mixed results when used on athletes. The study involved 20 patients suffering from midportion Achilles tendinopathy who were treated with longitudinal tenotomies and 32 who were treated with a novel technique involving the transfer of some soleus fibers into the degenerated tendon to improve its vascularization. Patients in the soleus transfer group were able to return to running more quickly than patients in the longitudinal tenotomies group. Post-operative functional scores in the two groups were similar, although patients in the soleus transfer group had a higher increase in the American Orthopaedic Foot and Ankle Society (AOFAS) and Victorian Institute of Sports-Assessment Achilles (VISA-A) scores than patients who were treated with longitudinal tenotomies. But the study's authors also found that 59.4 percent of patients in the soleus transfer group experienced tendon thickening following surgery, compared to 30 percent in the longitudinal tenotomies group. Nevertheless, the authors recommended that the novel technique be used to treat high-level athletes suffering from midportion Achilles tendinopathy.


A new study has concluded that a new, modified version of the Broström-Gould procedure is safe and effective in treating ankle lateral ligament injuries following arthroscopy. Surgeons treated 18 ankles with arthroscopy before using the new technique, which involves triple-breasting the lateral ligament complex using suture anchors. All of the ankles were subjectively and objectively stable at final follow-up, which was performed at an average of 25 months after surgery. The average American Orthopaedic Foot and Ankle Society (AOFAS) score rose from a pre-operative 53 to a post-operative 88, an improvement that was statistically significant. The study's authors also found that the modified procedure allowed eight patients to resume the same level of physical activity that they maintained before their injuries, including sports. However, eight others experienced reductions in normal levels of activity.

Practice Management

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Patrick Watterson, PA-C, a physician assistant and vice president of Bethany Medical Center in High Point, N.C., says physicians' practices can do several things to improve their chances of receiving prior authorization from insurance companies for medically necessary tests. For instance, practice staff members who are responsible for obtaining prior authorization should be courteous when speaking with insurance company doctors, as having a bad attitude may make it less likely that the doctor will grant authorization. Of course, simply being nice to the insurance company's doctor does not guarantee that the insurer will authorize a test. In addition, insurers are likely to deny authorization if paying for a particular test does not make financial sense for them. Physicians' practices should respond to such a refusal by suggesting other, more expensive ways to perform the test, Watterson says. He adds that doing so could force the insurance company's doctor to conclude that authorizing the requested test would result in less expense for the insurer than if the same test was performed by a more expensive provider. Watterson notes that these and other tactics have a 95 percent success rate in obtaining prior authorization for medical tests.


There are a number of legitimate reasons why a physicians' practice would need to get rid of its existing electronic health record (EHR) system and adopt a new one, although practices should consider several things before making the switch. For example, practices should determine whether or not the problem they are experiencing with their EHRs can be resolved with a simple call to tech support. Practices dissatisfied with their EHRs should also assess the responsiveness of their vendors; if a vendor is not responsive, it may be advisable to obtain an EHR from one that is. In addition, practices should determine whether their EHR is still compliant with standards for ICD-10 and meaningful use. Any systems not in compliance with the standards should be replaced. Finally, practices should find out whether their EHR software has been discontinued or soon will be. This is important because vendor support for discontinued software may eventually be withdrawn.

Health Policy and Reimbursement

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The Office of the National Coordinator for Health IT (ONC) on Sept. 10 issued the 2014 Edition Release 2 of electronic health records meaningful use certification, which replaces a planned finalized rule that would adopt criteria for an optional 2015 Edition. The 2014 Edition Release 2 includes a smaller subset of 10 meaningful use criteria taken from the original 2014 Edition Release, all of which are optional. Among the 10 criteria included in the 2014 Edition Release 2 are the separation of three CPOE types plus transitions of care, clinical information reconciliation and incorporation, ambulatory setting transmission to public health agencies of syndromic surveillance and automated numerator recording. Two of the 10 criteria already existed and have been revised. The "view/download/transmit" criteria has been altered to provide more transport method options, while the "safety-enhanced design" criteria has been changed to reflect the adoption of three distinct CPOE criteria that cover medications, lab and radiology/imaging orders. ONC and the Department of Health and Human Services noted that eligible professionals, eligible hospitals and critical access hospitals will not be required to upgrade their EHR systems to those that meet the new criteria. However, they are encouraged to consider "whether the 2014 Edition Release 2 offers any opportunities that they might want to pursue."


The journals Annals of Internal Medicine and JAMA Pediatrics have published studies that examine how the Affordable Care Act (ACA) is affecting different populations, including young adults. One noteworthy finding in the study published in Annals of Internal Medicine is that some young adults may opt to forego insurance and pay a penalty because premiums for even the least expensive plans offered through health insurance exchanges are too high. The study found that the annual median after-subsidy premium for a 27-year-old on the least expensive plan is $804, compared to a $230 annual penalty for not carrying insurance. The study's authors noted that if significant numbers of young adults conclude that it is wiser for them to not have insurance and pay the penalty, health insurance premiums could eventually rise for all age groups. Meanwhile, the study published in JAMA Pediatrics found that ACA's provision for allowing young adults to remain on their parents' plans until age 26 has increased health insurance coverage rates among 19 to 25 year olds from 68.3 percent in 2009, before the provision took effect, to 71.7 percent in 2012. But the study also found that the increase in insurance coverage resulted in no changes in members of this age group in their ability to afford doctor visits or purchase prescription drugs.


Hackers were able to breach security at HealthCare.gov, the website for the government’s health insurance marketplace, but no consumer information appears to have been stolen, Obama administration officials reported Sept. 4. The administration described the hack to Congress as “an intrusion on a test server” supporting the website and that the website itself was not the target. Aaron Albright, a spokesman at the Centers for Medicare and Medicaid Services, said that the test server should not have been connected to the Internet, its default manufacturer password had not been changed, and it had not been subject to regular security scans. Hackers had installed malicious software onto a test server of HealthCare.gov as part of a broader denial-of-service attack meant to disable other websites, as well.

Medicine, Drugs and Devices

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The journal Infection Control and Hospital Epidemiology has published the first national study to examine the problem of doctors unnecessarily prescribing several different antibiotics to hospital patients for a number of days. Researchers examined antibiotic prescription records from 500 hospitals from 2008 to 2011 and found that patients at 75 percent of those hospitals were still on more than one intravenous antibiotic after two days even though they generally should have been on only one antibiotic at that point. The authors concluded that this is a problem because the use of redundant antibiotics can increase medical costs and result in more side effects.


A review of 294 studies recently published in the journal Annals of Internal Medicine found that patients with low bone density can experience a 40 to 60 percent reduction in their risk of spinal fractures by taking bisphosphonates, denosumab or teriparatide compared to patients who do not take any of these drugs. The review also noted that patients who took one of these three drugs were 20 to 40 percent less likely to break other bones. However, patients who were treated with bisphosphonates had a higher risk of unusual thigh bone fractures. Those who took the injectable form of this drug were at a higher risk of breaking their jaw bones. An editorial that accompanied the study cautioned that the findings may not apply to patients over 75, including those 80 and up who have non-skeletal risk factors for falls, since only a small number of people in this age group were studied.


Adding a foot ring (FR) to the circular external fixator (CEF) is not necessary when treating extra-articular distal fractures, a new study has found. In fact, using a CEF without a foot ring may actually result in better functional outcomes compared to using a CEF with a foot ring. The study found that the average overall American Orthopaedic Foot and Ankle Society (AOFAS) score was significantly higher in the 56 patients who were treated with a CEF alone compared to the 24 patients treated with a CEF and FR. The CEF group had an average overall AOFAS score of 82.47, compared to an average score of 71.54 in the CEF-FR group. However, no differences were observed between the two groups in terms of their visual analog scale (VAS) scores.