September 18, 2013
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News From ACFAS

Don't Delay on ACFAS 2014 Poster
Time is running short – all poster submissions must be submitted by Tuesday, October 15, 2013 (11:59 pm Central Time). If you have research you’d like to be considered for poster presentation at ACFAS 2014, submit your application and abstract via the online submission system, but be sure to visit and read the full 2014 Poster Exhibits Guidelines (PDF) before you make your submission final.

New This Year to the Poster Submission Process:
  • Scientific Format posters, if accepted for presentation at the Annual Scientific Conference, must be submitted in both paper and electronic (PDF) format.
  • At least one of the poster authors (both Scientific Format and Case Study Format) must register for and attend the Annual Scientific Conference in order for their poster to be displayed.
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Celebrate Your Big Career Steps with ACFAS
Congratulations on your new beginnings! ACFAS is happy to help commemorate your many career firsts:

First year of residency?
As a new DPM, ACFAS wants to help you celebrate by providing your first year of membership at no cost. Get all the benefits of the College, including the Journal of Foot & Ankle Surgery delivered to your mailbox, free for a year!

Passed Part 1 of the ABPS Certification Exam over the summer?
After completing the written portion, you're on the road to Board Certification! Advertise your ABPS status, and take advantage of the many educational resources ACFAS offers, by joining the College as an Associate Member. Once you join, you can list the credential “AACFAS” after your name. And to help you make the transition from resident to practitioner, ACFAS is waiving the application processing fee and dues for the rest of 2013, as well as holding a raffle of all new Associate Member applicants (who passed the exam in 2013) that submit their applications by November 15, 2013. Your names will be put in a drawing to win an Apple iPad. The winner will be announced in an upcoming issue of ACFAS Update.

Passed Part 2 of the ABPS Certification Exam over the summer?
On this important milestone in your career, you can become a Fellow Member of ACFAS, which allows you to list the esteemed “FACFAS” credential after your name. Once you’ve received your exam results from ABPS, contact ACFAS to become a Fellow Member of the American College of Foot and Ankle Surgeons with full membership privileges.

For questions or an application, visit or contact the
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Welcome New Student Club Presidents
ACFAS is proud to welcome our newest leaders to the fold, the 2013-2014 ACFAS Student Club Presidents:
  • AzPod: David R. Hatch, Class of 2015
  • Barry: Philip Adam Jones, Class of 2015
  • CSPM: Benjamin McGrath, Class of 2015
  • DMU: Jordan Gardner, Class of 2016
  • Kent State: Nathan Shane, Class of 2015
  • NYCPM: Heidi Godoy, Class of 2015
  • Temple: Michael Berger, Class of 2015
  • Scholl: Blake Brannick, Class of 2016
  • WesternU: Bryant Nachtigall, Class of 2016
At the start of the school year, the ACFAS Student Clubs’ new presidents began their recruitment activities to strengthen their numbers, and to plan events to supplement the curriculum on campus with additional opportunities to learn about foot and ankle surgery, and the path to becoming a successful surgeon.

Liaisons from the ACFAS Board of Directors will be making trips to all nine campuses in the next month, to meet the incoming class of students, and offer lectures and workshops. The College wishes the best of luck for a successful year for all of our clubs, and looks forward to meeting these student leaders at the 2014 Annual Scientific Conference in Orlando in February.
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Foot and Ankle Surgery

Effect of Anterior Translation of the Talus on Outcomes of Three-Component Total Ankle Arthroplasty
A recent study examined the affect that anterior translation of the talus has on the outcome of three-component total ankle arthroplasty. The study examined 104 patients, all of whom had one osteoarthritic ankle and had undergone three-component total ankle arthroplasty. Fifty of the ankles that were examined had an anteriorly translated talus, while the remaining 54 ankles had a non-translated talus. An assessment of the patients' clinical and radiographic outcomes revealed that 46 out of the 50 ankles with anterior translation of the talus displayed relocation of the talus within the mortise after six months, while 48 ankles were relocated at 12 months after total ankle arthroplasty. Two ankles were not relocated until the final follow up. Finally, researchers found that the American Orthopaedic Foot & Ankle Society (AOFAS) scores, range of motion, and radiographic outcomes were essentially the same in ankles with an anteriorly translated talus and a non-translated talus.

From the article of the same title
BMC Musculoskeletal Disorders (09/05/13) Lee, Keun-Bae ; Kim, Myung-Sun; Park, Kyung-Soon; et al.
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Long-Term Results of the Retrocapital Metatarsal Percutaneous Osteotomy for Hallux Valgus
A recent study has concluded that the use of percutaneous retrocapital metatarsal osteotomy is effective over the long term in treating mild to moderate hallux valgus. Researchers examined the radiological and clinical outcomes of 115 feet 10 years after patients underwent percutaneous distal retrocapital osteotomy of the first metatarsal, and found that American Orthopaedic Foot & Ankle Society (AOFAS) scores improved by an average of 42.2 points compared to preoperative levels. The mean hallux angle remained below 20 degrees 10 years after surgery, while the mean intermetatarsal angle was 8.1 degrees at follow up.

From the article of the same title
International Orthopaedics (09/01/13) Vol. 37, No. 9, P. 1799 Faour-Martín, Omar; Martin-Ferrero, Miguel Angel; Garcia, Jose Antonio Valverde; et al.
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Practice Management

How Physicians Can Increase Productivity at Their Practice by Utilizing Staff
There are several things that physicians need to keep in mind in order to ensure that their practices are running as efficiently as possible. For example, they should not perform tasks that other staff can take care of, and they should also be working at the highest level of licensure at all times. That means that other practice employees who are working towards the same goals and at the same rate as the physician should be working alongside him or her. For instance, registered nurses should be used to handle tasks such as patient education, clinical call backs, and triage, so that medical assistants are free to room patients, take vitals, clean specula, and keep patient traffic moving. In addition, physicians should be sure that patients are adequately educated so that they are not calling the practice with questions after a visit. Properly educating patients can involve the use of a staff member to reinforce the doctor's recommendations and answer any general questions, using literature and visual aids that are easy for patients to understand, and teaching staff how to communicate with patients effectively. Following these and other steps can help the practice increase reimbursements and thus improve its financial situation.

From the article of the same title
Medical Economics (09/10/13) Bee, Judy
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How to Make Payment Plans Work for Patients
Physicians practices that want to offer financing to patients who have inadequate or no insurance have several options from which to choose. One option is for the practice to act as a conduit for a finance company that provides a loan to a patient, which can be used to pay for medical care. Such finance companies typically offer two types of loans: recourse loans, which require the practice to pay the finance company if the patient is unable to pay; and non-recourse loans, which do not require the practice to pay the money back if the patient defaults. One of the advantages of working with a finance company is that the practice gets paid immediately.

Practices that do not want to work with a finance company can instead offer financing to patients directly. Physicians' practices that want to go this route will have to establish the financing protocols, create the appropriate forms, process payments, train their staff members, collect past-due payments, and meet any federal and state Truth in Lending requirements. Offering financing to patients directly will allow the practice to earn the interest on its loans, though some patients may not be as responsible in making their payments as they would if they took out a loan through a financing company. Practices should be certain to speak with their accountants or attorneys about applicable government requirements before selecting any of these options.

From the article of the same title
Medical Economics (09/10/13) Borglum, Keith
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Turn Physician, Administrator Vacations Into Staff Learning Opportunities
Practice administrators who are planning vacations or other absences should prepare their staff members ahead of time in order to prevent any major problems from occurring while they are gone. Such preparations should begin one to two weeks before the administrator is scheduled to be out of the office. During this period, the administrator should provide their staff members with written policies to follow while he or she is gone and communicate their expectations.

Administrators should also use this period of preparation to observe how staff members complete tasks to ensure that employees meet their standards when performing their responsibilities. Once an administrator returns, he or she should examine the causes of any breakdowns that may have occurred. Doing this will allow the administrator to determine how to handle the problems in order to prevent them from occurring again in the future. This could include ensuring that staff members are being given the guidance they need to perform their jobs in a way that meets expectations. Administrators should also be sure to use any problems that occurred while they were gone as the basis for targeted training.

From the article of the same title
Physicians Practice (09/07/13) Cloud-Moulds, P.J.
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Policing Medical Practice Employees After Work
Although physician practices can attempt to regulate how staff members behave outside of work, they must be careful that the behavior they are trying to discourage, as well as how they discourage it, do not run afoul of legal and ethical protections, which are a gray area. If there is no state ordinance specifically referring to the behavior practices are focusing on, then employers should be prepared to explain the nature of the legitimate business interest that would warrant this intrusion, says one expert. Employers are most successful at regulating the off-duty conduct of employees if the conduct has a bearing on activity that directly affects the employee's ability to perform his or her job.

Among the behaviors that practices are considering or instituting prohibitions for is obesity, because the condition can impact a practice's bottom line, as overweight or obese individuals are more likely to have co-morbidities that are expensive to insure and treat. A practice trying to promote healthy patient habits may feel that personnel should embody the practice mission. However, many diseases and conditions caused by or associated with obesity can be protected under regulations of the Americans with Disabilities Act. Office- and company-sponsored wellness programs have recently been the subject of increased regulatory scrutiny. One expert says such programs are generally mandated to be voluntary, but there is a continuing debate over the definition of voluntary. Practices must not forget that information collected in a wellness program must stay confidential and off-limits to supervisors and employers.

Meanwhile, in terms of social media, employees are entitled to discuss employment terms and conditions with other employees, as stipulated by the National Labor Relations Act. Still, communications that do not uphold the mutual aid and protection of fellow employees or that are not related to a legitimate work issue are worthy of scrutiny by employers. Action may be required if the Health Insurance Portability and Accountability Act is violated by the posting. Finally, employees seen engaging in off-duty behavior deemed potentially embarrassing or unethical should be approached with caution. Unless such activities clearly inhibit the person from doing his or her job, the practice may likely have no right to regulate it.

From the article of the same title
American Medical News (08/26/13) Cash, Sheryl
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Health Policy and Reimbursement

House Approves Bill Requiring Verification of Income for Subsidies on Marketplaces
A bill passed by the House on Sept. 12 requires the Obama administration to implement a program to verify the incomes of people applying for health insurance subsidies on health insurance exchanges before it will be allowed to provide subsidies to those individuals. The bill was prompted by a final rule issued by the Centers for Medicare & Medicaid Services that says that exchanges operated by 16 states and the District of Columbia will not be required to verify household income in every case where the applicant's income had fallen by more than 10 percent below data available from the IRS. Full-income verification is required in all such cases when applicants apply for coverage through one of the 34 other exchanges that will be completely operated by the federal government. Supporters of the bill, most of whom are Republicans, say the measure will curb fraud by requiring the Department of Health and Human Services' Office of Inspector General to certify to Congress that there is a program in place to verify the incomes of people applying for government subsidies through the exchanges. Democrats maintain that the legislation is part of a Republican effort to block the implementation of the Affordable Care Act. Regardless of the bill's intent, it is unlikely to be taken up by the Senate and would be vetoed by President Obama even if it was passed by Congress.

From the article of the same title
BNA Snapshot (09/12/2013) Lindeman, Ralph
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HIX Data Hub Readiness Questioned by Lawmakers
A House Homeland Security Committee panel held a contentious hearing on Sept. 11 concerning the readiness of the federal data services hub, which is a key component of the online health insurance exchanges that are being rolled out early next month. Kay Daly, the assistant inspector general for audit services in the Office of the Inspector General at the Department of Health and Human Services, testified at the hearing that the security authorization for the hub was completed on Sept. 6 following the end of security testing. This means that the hub, which will connect the various federal databases that will be used to verify the information consumers provide when purchasing insurance through the exchanges, is now operationally ready. The assertion stunned panel chairman Patrick Meehan (R-Pa.), who noted that Daly's office had previously said last month that the security authorization would not be completed until Sept. 30. Meehan said that he found it difficult to believe that beta testing on the hub had been completed when officials were unable to certify several weeks ago that such testing had begun.

From the article of the same title
Health Leaders Media (09/12/2013) Tocknell, Margaret Dick
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Paying Doctors for Better Care Improves Quality: Studies
A study published in the Journal of the American Medical Association has found that paying small bonuses to doctors who work in small practices and meet certain quality of care standards can help increase the number of patients who receive the recommended treatments for their conditions. The study randomized 84 small medical practices in New York City and divided them into two groups: one group of 42 practices that received bonuses of no more than $200 for each patient who was appropriately prescribed aspirin or a smoking cessation treatment and had normal blood pressure and cholesterol levels, and a second group of 42 practices that were not paid bonuses. Both groups of practices received quarterly performance reports. In addition, both groups of practices had the same average characteristics, such as patient age, sex, and insurance. By the end of the nearly year-long study, both groups of practices had increased the percentage of patients who had met treatment guidelines for their conditions. However, researchers found that patients treated at practices where the doctors received bonuses were more likely to be given guideline-based care than their counterparts at practices where bonuses were not paid.

From the article of the same title
Reuters (09/10/13) Seaman, Andrew M.
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Lawmakers Pass Prescription Drug Reform Bills
The California state Assembly on Sept. 9 passed two bills that proponents say will help curb prescription drug abuse. The first bill would establish a steady stream of funding for California's prescription drug monitoring program, CURES, by raising fees on doctors and other prescribers. The prescription drug monitoring program, which requires pharmacists to report every narcotic prescription they fill, is currently used very little because of budget cuts. The California Medical Association has said that it opposes the fees that the bill would levy. A second bill would require coroners to report prescription drug overdose deaths to the Medical Board of California, which supporters say would make it easier for officials to see patterns of prescription drug overdose deaths that are connected to the same prescriber.

From the article of the same title
Los Angeles Times (09/09/13) Girion, Lisa
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Medicine, Drugs and Devices

Ankle Laxity: Stress Investigation Under MRI Control
A new study has found that there are benefits to using stress examination under MRI control when assessing mechanical ankle instability. During the study, researchers developed an MRI-compatible stress device and tested it for MRI safety. In addition, 50 volunteers with and without clinically evident subjective instability of the ankle joints underwent bilateral MRI stress examinations. The study found that the MRI stress device was both suitable and safe for use in the MRI environment, and that the use of the device allowed the talocrural and subtalar joints to be assessed at the same time. Researchers also found that the use of the device allowed for the objective imaging and measurement of unusual looseness of the lower ankle joint as well as direct simultaneous comparison with the upper ankle joint.

From the article of the same title
American Journal of Roentgenology (09/13) Vol. 201, No. 3 Seebauer, Christian J.; Bail, Hermann J.; Rump, Jens C.; et al.
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Computer Aided Surgery in Foot and Ankle: Applications and Perspectives
A researcher in Germany has found that there are benefits to using intraoperative three-dimensional imaging (3D), computer assisted surgery (CAS) and intraoperative pedography during foot and ankle surgery. An analysis of several ongoing experimental and prospective studies showed that the use of 3D resulted in reduction/correction and/or the correction of implant position in roughly one third of cases. The analysis also showed that CAS guidance for the correction of deformities of the ankle, hindfoot, and midfoot/tarsometatarsal joint (TMT) joint resulted in greater accuracy, a faster correction process and better scores after a minimum follow up period of two years compared to surgeries where CAS as not used. Finally, the analysis found that the additional use of IP as the only difference between two groups with correction and/or arthrodesis at the foot and/or ankle led to better improvements in outcome scores after an average follow up period of two years.

From the article of the same title
International Orthopaedics (09/01/13) Vol. 37, No. 9, P. 1737 Richter, Martinus
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