News From ACFAS

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Residents, don’t let your ACFAS membership expire on Oct. 1! Renew by Sept. 30 to continue receiving:

• Discount pricing 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 $118. 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 Terry Wilkinson. New free marketing tool just released for National Diabetes Month in November, the Dos and Don’ts of Diabetic Feet PowerPoint presentation.

Schedule a community education talk with your local hospital or invite your patients to an informal education program at your office to share the best way to care for diabetic feet—all while promoting your practice!

This presentation and many other promotional tools are available for download in ACFAS’ Marketing Toolbox, your members-only resource for stress-free DIY marketing. The Alliance of Wound Care Stakeholders, of which ACFAS is a member, recently submitted two sets of formal comments to the Centers for Medicare and Medicaid Services in response to:

• proposed rules on Hospital Outpatient Prospective Payment and Ambulatory Surgical Center reimbursement for outpatient services; and
• payment policies under the Physician Fee Schedule.

These comments address proposed changes that can potentially affect wound care services and procedures. They also address changes that include:

• inappropriate restructuring and reclassification of procedures, which could cause lower reimbursement rates that do not correctly reflect procedure costs; and
• broad payment classifications that do not appropriately reflect resource distinctions.

Refer to the full comments for more information.

Foot and Ankle Surgery

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Split peroneal tendon lateral ankle stabilization is biomechanically stable and can treat severe or recurrent chronic lateral ankle instability. A recent case series aimed to determine the safety and efficacy of this method. Thirty patients were observed. Five patients developed recurrent ankle instability, and four of them required revision surgery. Two patients experienced stiffness. Eight had surgically induced neurologic complaints. Two patients developed complex regional pain syndrome.


Patients with talocalcaneal coalitions (TCCs) can be treated with coalition resection to restore motion and improve pain, but views differ regarding this treatment for patients with severe hindfoot valgus deformity. A study was conducted to determine the outcomes and complications following surgical reconstruction, with or without coalition resection, in patients with TCCs and severe hindfoot valgus. The study enrolled 13 patients. Seven underwent simultaneous resection of the coalition and reconstruction; six received isolated reconstruction. Clinical evaluation was made according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Postoperatively, all radiographic values improved significantly. The mean AOFAS score improved in the simultaneous resection group from 45 to 98 points. In the isolated reconstruction group, the mean AOFAS score jumped from 60 to 92.3. The study showed that surgical reconstruction with or without coalition resection is a successful option in patients with TCCs and severe valgus deformity.


As obesity rates in the United States rise, this comorbity's effects on third-generation total ankle replacement (TAR) remain unknown. A study looked to assess the functional outcomes and complications after TAR in obese patients. Researchers divided patients into groups determined by their body mass index (BMI). The control group had 266 patients with a BMI under 30. Another group (Obese I) had 116 patients with a BMI between 30 and 35. The last group (Obese II) was made up of 73 patients with a BMI greater than 35. Age, race and smoking history in the obese group were not significantly higher in the control group. No differences in complications, infections or failure rates were detected. All groups achieved significantly improved functional outcomes after one-year follow-up; however, Obese II patients had lower Foot and Ankle Outcome Score pain and SF-36 scores and higher Foot and Ankle Disability Index and Short Musculoskeletal Function Assessment functional scores. Researchers concluded TAR in obese patients was a relatively safe procedure. Although obese patients had lower functional outcome scores compared with the control group, the scores were nonetheless improved.

Practice Management

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eHealth Initiative recently conducted a poll to determine the top challenges that accountable care organizations (ACOs) face. The survey polled 69 ACOs about these challenges, and 78 percent indicated that accessing data outside their own network is among the most significant problems. Other challenges noted included data integration (62 percent), change management (55 percent), new health IT costs (38 percent) and obtaining provider participation (33 percent). The survey also discovered that medical practices not receiving meaningful use incentive payments were least likely to be integrated with an ACO.


Many technology tools exist to help medical practices streamline workflow, but revenue management experts claim that these tools are often used ineffectively because small to mid-sized offices do not budget enough time and money for training. The most successful offices prioritize training in the budget and incorporate it into daily practice. Here are some tips for running a well-trained staff:

• Create a formal training program. Many practices tend to do away with training once the initial vendor education is complete following implementation. Successful practices never stop training and instead create a program where training for tech tools is a continuing process across the office.
• Appoint super users. Every office should appoint one or more super users that verify employees are optimizing their use of technology and following practice protocol.
• Cross train. Train both administrative and clinical staff. “Everyone should have an appreciation for one another's jobs and an understanding of the revenue cycle from beginning to end,” said Lucy Zielinski, vice president of The Camden Group, a Los Angeles-based healthcare business advisory firm.
• Focus on individuals. Group training is effective at times, but individual attention is by far the best method for ensuring employees are well-versed in the new technology. Be available to your employees and answer questions, as well as provide help in any way necessary.
• Share goals. Everyone in the office should have a discussion about the practice's overall goals and revenue targets. This way, there will be no waste or loss of revenue.

The University of Missouri Health System is ready for ICD-10, but a series of delays have allowed the organization to fine-tune its methods. One of those methods is clinical documentation, something that MU Health ICD-10 program manager Gregory Brown says is the most essential factor in a successful ICD-10 transition. According to Brown, the focus on clinical documentation has led to a more prosperous relationship with clinicians. "Early on we realized it really wasn't about coding; it's about fantastic documentation. If you do fantastic documentation, it doesn't matter if it's ICD-9, -10, -11 or whatever version that might be out there, you're going to be successful. That's what we have worked on," he said. Solid documenting provides laterality, and the relationships developed with clinicians can make the transition much easier. It ensures that every doctor knows what to do within their specialty. "You don't need to know hundreds of thousands of codes; you have to be a good documenter," Brown said.

Health Policy and Reimbursement

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Broader health insurance coverage under the Affordable Care Act has allowed facilities to enjoy a significant influx of patients, as well as higher revenues. But a new report from Fitch Ratings indicates that hospitals should expect slower growth in "patient volumes" for the rest of the year. The report said, "Due to a decreasing pace of coverage expansion, the magnitude of the tailwind to levels of uncompensated care and patient utilization of healthcare services is logically tapering.” In addition, the political climate entering the 2016 elections means that it is less likely for state lawmakers to approve expanding Medicaid. In fact, a tally from the Kaiser Family Foundation shows that only one state is discussing adoption of Medicaid expansion.


The Office of the National Coordinator (ONC) has created an online form where users can log complaints about certified products. The new tool is a response to growing provider frustrations with electronic health record (EHR) functionality and usability. Acting Deputy National Coordinator for Health IT Jon White suggests that users should submit issues only after unsuccessful dialogue with the developer or vendor. According to White, ONC wants to hear about challenges related to data blocking, inability for EHRs to share or receive information, usability issues, failure for certified products to perform as expected and any concerns about health IT safety. "Submitting your concerns to us also helps us better understand the extent and nature of potential problems so we can more accurately represent them to Congress and our federal partners and work with them to develop solutions," White said.


A new project headed by a doctor at the University of Utah Health Care aims to determine the costs of goods and services provided by hospital systems. According to Dr. Vivian Lee, no one on her staff could say what a minute in an MRI machine was worth or how much an hour in the operating room costs. The goal of her initiative is to save money while improving care, and it seems to be working. While costs at other academic medical centers in the area have increased by an average of 2.9 percent per year, the University of Utah's have declined by 0.5 percent per year. At the heart of the project is a computer program with 200 million rows of costs for items such as drugs, medical devices, or a doctor's time in the operating room. The software tracks days in the hospital and readmissions and has successfully determined the cost per minute in the emergency room (82 cents), in the surgical intensive care unit ($1.43), and in the operating room for an orthopedic surgery case ($12). Michael Porter, an economist and professor at Harvard Business School visited Utah and concluded that the hospital group was one of the few in healthcare to properly measure the costs of care.

Medicine, Drugs and Devices

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President Barack Obama has nominated veteran heart researcher Robert Califf, currently the U.S. Food and Drug Administration’s (FDA) deputy commissioner for medical products and tobacco, to be the next head of FDA. Califf has been considered by many a likely candidate, according to reports. He ran numerous large clinical trials regarding heart research for 30 years as a top administrator at Duke University before coming to FDA in early 2015. "He's thoughtful and personable, and I'm sure he will be a strong advocate on behalf of FDA during a very critical period,” said Aaron Kesselheim of Harvard Medical School. Califf's confirmation is not assured, but should the Senate deem him acceptable, he would succeed Margaret Hamburg, who stepped down this past March.


A new advisory from the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration warns that contaminated medical equipment and devices pose a similar risk in outpatient settings and in doctor's offices. The advisory comes on the heels of a recent Joint Commission inspection of Kadlec Health Systems clinics in Washington, which found multiple flaws in the clinic's device-cleaning protocols. According to the note, all healthcare facilities and clinicians should immediately review all device-cleaning protocols and train the employees responsible for reprocessing the devices. It also states that all facilities should hold regular audits for adherence to cleaning, disinfection, sterilization and storage procedures. Protocols should be put in place in the event of any errors.


Researchers at the University of Massachusetts Amherst are trying to create better-fitting, more efficient lower-limb prostheses by using detailed models and controlled simulations to optimize loading conditions in amputees. The project is funded by a grant from the National Science Foundation and will involve reverse engineering the results of predictive simulations to develop robotic ankle prostheses that create the best possible gait performance. The ultimate goal is to restore natural joint strength in amputees and relieve patients of discomfort due to poorly fitting prosthetics. “The major outcome … will be an improved approach for designing prosthetic devices that reduce loading on the body and make walking easier,” said Frank Sup, director of the Mechatronics and Robotics Research Laboratory in the Mechanical and Industrial Engineering Department and a researcher on the project.