News From ACFAS

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ACFAS’ national public relations campaign, Take a New Look at Foot & Ankle Surgeons, promoted you to 3,500 attendees last week at the American Academy of Family Physicians (AAFP) annual conference in San Antonio.

Marque Allen, DPM, FACFAS, D. Martin Chaney, DPM, FACFAS, and ACFAS staff answered FPs’ questions and explained how foot and ankle surgeons’ specialized expertise can benefit their patients. Many of the FPs who visited the College’s booth said they already refer their patients to ACFAS members and spoke highly about their experiences.

Booth visitors received When to Refer guides and other handouts detailing why foot and ankle surgeons’ qualifications and training make them a valuable partner in patient care. They also received pens branded with the Take a New Look logo and website address.

Learn more about ACFAS’ referral campaign at TakeANewLook.org, and visit acfas.org/marketing to download healthcare provider referral tools you can use in your own practice. Board nomination applications are due to ACFAS no later than October 1, 2017. If you are 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 Sean Grambart, DPM, FACFAS, via email or (217) 671-3634.

The Nominating Committee will announce recommended candidates to the membership no later than November 23. Candidate information and ballots will be emailed to all voting members no later than January 7, 2018. Electronic voting ends on January 22, 2018. New officers and directors will take office during ACFAS 2018, March 22–25 in Nashville. Residents, don’t let your ACFAS membership expire on October 1! Renew by September 30 to continue receiving:

• discounts on ACFAS CME offerings, including conferences, courses and e-Learning
• The Journal of Foot & Ankle Surgery, Student & Resident Update, ACFAS Update and This Week @ ACFAS
• full access to acfas.org and the PodiatryCareers.org career center
• regional support through ACFAS Division activities and Division funding support for resident manuscripts and posters
• and much more!

Resident member dues are just $120. Pay online or fax the invoice you received by mail or email with your payment information to (773) 693-9304.

Remember, first-year residents (PGY-1) receive a complimentary year of membership during their first year of residency courtesy of ACFAS and its Divisions. Second-year (PGY-2) and third-year (PGY-3) residents must pay the annual dues. While some residency programs may pay for annual dues, it is not done automatically.

Questions about your resident membership? Contact ACFAS Membership Manager Jessica Brown.

Foot and Ankle Surgery

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Researchers sought to compare the U.S. national rates of perioperative (in-hospital) complications between a statistically matched cohort of patients who underwent either an ankle arthrodesis or a total ankle arthroplasty (TAA). Researchers studied 4,192 patients treated with TAA and 16,278 treated with ankle arthrodesis. They were able to statistically match 1,574 patients who underwent a TAA (37.5 percent) with a patient who underwent arthrodesis. A major in-hospital complication occurred in 8.5 percent of the 1,574 patients in the ankle arthrodesis group compared with 5.3 percent of the 1,574 in the TAA group whereas a minor complication was found in 4.7 percent in the ankle arthrodesis group compared with 5.9 percent in the TAA group. Researchers concluded that in a matched cohort of 3,148 patients treated with either TAA or ankle arthrodesis, ankle arthrodesis was associated with a 1.8 times higher risk of a major complication but a 29 percent lower risk of a minor complication.


Researchers sought to evaluate the efficacy of limb salvage procedures in terms of functional and oncological outcomes. The study included data on eight patients who underwent surgical treatment between 1992 and 2015. Limb salvage surgery (LSS) was the index surgery in 43 patients. In the LSS group, 28 received preoperative radiotherapy and 13 underwent complex reconstruction. The outcomes were assessed with Musculoskeletal Tumor Society scores. The results of the study found that the functional scores were significantly higher in the LSS group, but no significant difference was detected between amputation and LSS patients in terms of survival rates. In conclusion, LSS performed in specialized centers is an effective treatment method for malignant tumors of the foot and ankle.

Practice Management

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After two hurricanes struck different parts of the United States, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) is urging healthcare organizations to have contingency plans that include data backups and disaster recovery. Experts note that the HIPAA Privacy Rule and Security Rule is not suspended during natural disasters. As a result, organizations must make sure that their electronic protected health information remains secure and available during emergencies. To help organizations during emergencies, OCR has created an online tool that helps recovery planners determine how to access protected health information.


The Health Care Industry Cybersecurity Task Force recently released its report on what healthcare providers must do to protect patient data. The report authors said many respondents placed little importance on cybersecurity matters. However, Robert Tennant, MA, director of health information technology policy for the Medical Group Management Association, says the report should be a wakeup call to doctors. Tennant says the following are simple steps physicians can take to address data security: Establish rules that prevent the opening of suspect emails; consider technology that allows suspicious emails to be opened in a safe manner; keep antivirus software updated; conduct tests on cybersecurity systems; ban and discourage unauthorized access to sensitive data and information; and review data recovery and business continuity plans.


A successful open house can be the first step to ensuring a prosperous practice. Michael Woo-Ming, MD, says the following six steps should be followed to ensure an open house event reaps benefits. First, open house planning should begin weeks in advance. Next, practice owners should define the goals of an open house and prepare a budget for the event. If a practice shares a building with other businesses, it is a good sign of courtesy to alert them of the open house. Owners should also consider diverse marketing and advertising tools like social media sites to get the word out. Finally, making an open house fun and entertaining can be an ideal way to lure new patients to seek care at the practice.

Health Policy and Reimbursement

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New data from the U.S. Census Bureau estimated the number of people lacking health insurance hit a record low of 8.8 percent last year, down from 9.1 percent the year before. The total number of uninsured Americans decreased by 900,000 over that timeframe to 28.1 million, marking the third annual decline in a row. The estimates signal that the uninsured rate was lower in the 30 states that expanded Medicaid under the Affordable Care Act (ACA), compared to nonexpansion states. The uninsured population started to noticeably decrease in 2014, when many of the ACA's coverage provisions were enacted. Before the ACA's deployment, about 41 million people were uninsured, slightly more than 13 percent of the national populace. These statistics further complicate Republican efforts to repeal the ACA, which have stalled in recent months.


On September 13, two groups of senators revealed details of contrasting health proposals reflecting a partisan divide. Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) unveiled a bill to allow states to use federal Affordable Care Act (ACA) funds via block grants as they choose, possibly marking the final push by the GOP to undo the ACA. Meanwhile, Sen. Bernie Sanders (I-Vt.), along with 16 Democrats, unveiled a plan to build a Medicare-like government insurance system that would cover all Americans. Both proposals face major hurdles, and several healthcare analysts believe Congress will be able to make incremental changes at best. A bipartisan effort being led by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) is struggling to gain traction, and the White House has suggested President Donald Trump would not sign it. The Alexander-Murray proposal would authorize payments to insurers to offset subsidies to low-income consumers, while giving states added flexibility under the ACA.

Medicine, Drugs and Devices

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Physicians and hospitals are starting to use electronic alerts embedded in patients' digital medical records that force clinicians to reconsider possible treatment, and they are triggered when physicians write orders that may be outdated, unnecessary and even potentially harmful. Such alerts have helped reduced needless radiation exposure from imaging in one instance. For example, the American College of Cardiology recommends the prevention of redundant cardiac imaging tests using such alerts. Physicians should not conduct stress cardiac imaging on new patients unless they have other issues that place them at risk, such as diabetes among older adults, according to the college's recommendation. The cardiac alert was one of the first to be added to Intermountain's updated computerized medical records, and hospital officials say it quickly cut costs for cardiac imaging tests by $15 million a year.


Three-dimensional (3D) printing is being used to enhance healthcare, and GE in particular is concentrating on converting images from various sources into 3D objects. The printers employ data from magnetic resonance imaging (MRI), computed tomography (CT) scans, ultrasounds and 3D pictures to fabricate objects, layer by layer, using materials ranging from plastics to metal to human tissue. GE Healthcare's Jimmie Beacham says a key challenge for hospitals in deploying 3D printing is the technology's "hidden cost" of operating the equipment. Engineers are required to translate dense digital images from MRI, CT and ultrasounds into data that can be printed into a 3D model. However, the potential benefits can include cost savings in other areas, such as less time in the operating room, and fewer intermediaries in the supply chain and less waste.


A study presented at the American Society for Bone and Mineral Research Annual Meeting determined women diagnosed with osteoporosis who use medications persistently for at least 60 days can reduce their fracture risk compared with those who do not take their medications persistently, reports Healio. Data was assessed on 294,369 women 66 years or older diagnosed with osteoporosis who took medications from 2009 to 2011. Participants were covered by Medicare Part A, Part B or Part D for at least 12 months before the medication initiation date to ascertain persistence and fracture risk. Follow-up was performed until death, a loss of coverage, 18 months of follow-up, the end of 2012 or diagnosis of Paget's disease, hypercalcemia or cancer. A total of 32.9 percent of participants could be classified into the persistent cohort. Fracture rates were high in the six months prior to medication initiation and lower through follow-up by 74.4 percent in the persistent cohort and by 61.6 percent in the nonpersistent cohort. In comparison to the seven to 12 months before medication initiation, fracture rates decreased by 38 percent in the persistent group and by 18 percent in the nonpersistent group in the sensitivity analysis.


A new study from AARP confirms drug costs are snowballing, with retail prices for some of the most popular prescription drugs climbing 9.6 percent in 2015, the fastest yearly change in the past 10 years. The annual cost for treatment with those specialty drugs was $52,486, which is more than three times higher than it was in 2006. That yearly price tag is slightly lower than the average household income but twice the average income for Medicare beneficiaries. "American families can't afford to keep paying for prescription drugs that cost more money than their salaries," warns AARP Chief Public Policy Officer Debra Whitman. "These price increases are particularly hard on older adults, who take an average of 4.5 prescription drugs per month and often live on fixed incomes." The costs for specialty drugs were significantly higher than for generics. Specialty medication prices experienced less growth than brand name products, which rose by more than 15 percent. Meanwhile, generic drug costs declined by 19.4 percent from 2014 to 2015. Drugs witnessing some of the biggest percent changes include Forteo, which climbed 31.8 percent. Adcirca and Gleevec respectively rose 24.7 percent and 20.9 percent. "While specialty drug products are used by a relatively small, but growing, share of the overall population, they account for the fastest growing portion of U.S. drug expenditures in recent years," the study authors note. "There are strong indications that specialty drugs will become the largest share, and the majority, of drug expenditures in the next few years."


Infection Control & Hospital Epidemiology has published a study that discovered nurses wearing scrubs with antimicrobial properties did not prevent bacterial contamination from occurring. Duke University researchers followed 40 nurses who wore three different types of scrubs for three straight 12-hour shifts. The researchers analyzed 2,919 cultures from hospital furniture and 2,185 cultures from the scrubs worn by nurses. Ultimately, they found no differences in contamination based on the type of scrubs worn. The mostly commonly transmitted pathogens were Staphylococcus aureus, MRSA and methicillin susceptible S. aureus.