September 27, 2017 | | JFAS | Contact Us

News From ACFAS

Your New Login Details for
Check your email! Yesterday, we updated the login system to make it easier for you to access your member-only benefits, including The Journal of Foot & Ankle Surgery, and to increase web security.

Now, you will use the email address you requested to receive your ACFAS communications as your username to log into the website. The new instructions on how to access the site, including your new password, were emailed to you.

If our email did not reach you or we do not have your email on file, you will receive a letter in the mail within the next week with your new login instructions.

Questions? Contact Terry Wilkinson, Membership Manager, at (773) 444-1301 or
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Board Nominations Deadline Extended to October 10
The deadline for Board nomination applications has been extended to October 10, 2017. 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 before the deadline.

Visit 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.
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Is Your ACFAS Profile Up to Date?
Keep in touch with the College by making sure your ACFAS member profile is current. To update your profile, log into your account at then:
  • Update your work and personal email addresses, fax number and your work, home or cell numbers.
  • Confirm your preferred mailing address for The Journal of Foot & Ankle Surgery and ACFAS Update.
  • Allow your colleagues to contact you through the College’s online membership directory.
  • Include yourself in the “Find an ACFAS Physician” search tool on
Let us know of any updates throughout the year so you can stay connected with your colleagues and the College!
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Poll Results Show FPs Collaborate with You in Patient Care
The latest poll in This Week @ ACFAS revealed that readers work together often with family physicians (FPs) when treating patients. Sixty percent of respondents said they frequently consult with FPs and receive referrals from them, while 13 percent said they occasionally work with FPs and seven percent said they rarely do. Twenty percent would like to learn more about working with FPs in patient care.

For tips and tools to help you establish relationships and garner referrals from FPs or other specialties, visit the ACFAS Marketing Toolbox.

Look for the October poll in next week’s issue of This Week @ ACFAS.
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Foot and Ankle Surgery

Effect of Preoperative Deformity on Arthroscopic and Open Ankle Fusion Outcomes
A study was conducted to evaluate whether preoperative coronal ankle joint deformity influenced the outcome of arthroscopic ankle fusion. Participating were 97 patients who had 62 arthroscopic and 35 open ankle fusions between 2005 and 2012. Clinical outcomes were prospectively recorded via use of the Ankle Osteoarthritis Scale (AOS) and Ankle Arthritis Scale (AAS) preoperatively and at six, 12 and 24 months and final follow-up. The arthroscopic cohort had less tibial deformity, while at final follow-up, the mean AOS was 34.2 for arthroscopic compared to 33.9 for open. The AAS at final follow-up was 26.0 for arthroscopic versus 27.5 for open. Both cohorts had the same tibiotalar angle, lateral talar station and lateral tibiotalar angle at follow-up. Regression analyses found no influence of type of surgery, preoperative deformity, postoperative radiological alignment, age, sex, body mass index, smoking status, etiology of the arthritis and requirement for bone grafting on outcome scores.

From the article of the same title
Foot & Ankle International (09/17) Schmid, Timo; Krause, Fabian; Penner, Murray J.; et al.
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Obese Patients Have Fewer Wound Complications Following Fixation of Ankle Fractures
A new study sought more clarity on factors associated with surgical wound healing, specifically the relationship between wound healing and body mass index following ankle fracture treatment. The work involved 127 consecutive, isolated, closed and malleolar ankle fractures treated with open reduction and internal fixation at a level-1 trauma center between 2008 and 2012. Patient, injury and treatment factors were recorded and clinical records were reviewed to identify wound complications. Six major and 18 minor complications were observed, and the overall rate of wound complication of any type was significantly lower in obese patients at 11.7 percent versus 25.4 percent in nonobese patients. When controlling for other factors, obesity was linked to significantly lower risk of developing a wound complication, as was low energy mechanism. No other covariates tested had a connection with a higher risk of a wound infection. Ankle anatomy may present a unusual scenario in which obesity may protect against wound complications. Further studies are required to validate this clinical observation and to demonstrate the mechanism through which this may happen.

From the article of the same title
Foot & Ankle Specialist (09/17) Vol. 10, No. 5 Matson, Andrew P.; Morwood, Michael P.; Peres Da Silva, Ashwin
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Quantitative Magnetic Resonance Imaging Analysis of Anterior Talofibular Ligament in Lateral Chronic Ankle Instability
A study was conducted to quantitatively assess and define the dimension and signal intensity of anterior talofibular ligament (ATFL) using 3.0 T magnetic resonance imaging (MRI) in a mechanical ankle instability group both pre- and postoperatively. Ninety-seven participants were enlisted, including 56 with mechanical chronic ankle instability (CAI) and 41 controls who lacked ankle instability. Twenty-five of the CAI patients accepted modified Broström repair of ATFL and underwent a MRI scan at follow-up. The ATFL dimension and signal/noise ratio (SNR) were quantified according to MRI images. The CAI cohort was found to have a significantly higher ATFL length or ATFL width versus the controls. The average SNR value of the CAI group was significantly higher than that of the control group, and the average SNR value of the ATFL following repair surgery was significantly lower than that of the ATFL prior to surgery. However, no significant postsurgical change of ATFL length or ATFL width was noted.

From the article of the same title
BMC Musculoskeletal Disorders (09/01/17) Liu, Wei; Li, Hong; Hua, Yinghui
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Practice Management

Almost All Large Employers Plan to Offer Telehealth in 2018, but Will Employees Use It?
An annual survey by the National Business Group on Health finds large U.S. employers intend to concentrate more on how healthcare is delivered and paid for while still controlling expenses via traditional strategies, such as cost-sharing and plan design changes. More employees will have access to a wider range of healthcare services, including telemedicine, centers of excellence and onsite health centers during open enrollment while not enduring major cost hikes. The poll estimates 96 percent of employers will introduce telehealth services in states where it is permitted next year, while 56 percent plan to offer telehealth for behavioral health services. Close to 20 percent of employers are experiencing employee telehealth utilization rates of eight percent or more. American Well CEO Roy Schoenberg says employers' telehealth offerings are being driven by two primary factors. "The first are the return on investment numbers showing telehealth replacing higher-cost care settings, primarily urgent care and emergency rooms," he notes. "These numbers are coming from payers but are applicable to self-insured employers just the same. Net cost savings around $200 per visit are quoted." Schoenberg says the second factor is the increasing appeal of telehealth as a perk for employees. He notes that encouraging more telehealth usage by employees will likely require branding by traditional healthcare providers.

From the article of the same title
Healthcare Finance News (09/18/17) Siwicki, Bill
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Keeping a Practice Compliant for Deaf Patients
Physicians are required by the Americans with Disabilities Act (ADA) and other federal disability discrimination laws to assist disabled patients to allow for more effective communication. A common patient ADA issue that crops up in a practice is the need to provide service auxiliary aids and services to a hearing-impaired patient in order to assure an effective and meaningful patient-physician interaction. This might entail the services of a qualified interpreter as well as real-time computer transcription services, telephone handset amplifiers, assisted listening devices, closed caption decoders or text telephones. It is not sufficient to ask that a patient's family member or companion translate for the physician or that the patient communicate only though written notes with the physician. It also is critical to ensure that the auxiliary aids offered are in working order and give patients the ability to effectively communicate. Practices should bear in mind that the provision of auxiliary aids is not only applicable to patients, but also to any relative, friend or associate who accompanies the patient to the appointment. Finally, the type of auxiliary aid will vary between patients, and practices should consult with patients to determine what kinds of aids work best for them. Aids must be supplied in a timely manner and in a way that shields the privacy and independence of the disabled patient.

From the article of the same title
Physicians Practice (09/20/17) Adler, Ericka L.
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Six Ways to Prepare Staff for Value-Based Reimbursement
American Medical Association (AMA) President David O. Barbe offers six strategies to prepare medical staff for value-based reimbursement, starting with acceptance of its inevitability by physicians. Barbe says AMA is excited about the potential of the Medicare Access and CHIP Reauthorization Act and the Quality Payment Program, as both offer the organization a framework for a more rational approach to value-based reimbursement. Also advised is acknowledgment that the time is right for such reimbursement, while a third recommendation is to transition to the framework gradually, with physicians able to adopt it at a low level of participation this year and to avoid a penalty in 2019. Barbe also suggests physicians select a quality measure that makes sense for their practice, which may not lead to an upside bonus payment in the first year, but can help get into the positive performance payment mode and help avoid a penalty. Also advised is for the practice to use free resources for assistance, including the Payment Model Evaluator. Barbe's final suggestion is to leverage opportunities for financial reimbursement to build the necessary resources for value-based reimbursement into the practice.

From the article of the same title
Medical Economics (09/20/17) Stephens, Stephanie
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Health Policy and Reimbursement

After Single Payer Failed, Vermont Embarks on a Big Healthcare Experiment
Vermont has launched an alternative payment model intended to keep people in the state healthy while simplifying how private and public insurers pay for healthcare. The premise is to reward doctors and hospitals financially when patients are healthy, not only when they come in sick. Vermont hopes to expand its model statewide and apply it to 70 percent of insured state residents by 2022. The state also hopes to limit the growth in overall annual healthcare spending to 3.5 percent annually. In an effort to change financial incentives for doctors, lump sum payments are made for X-rays or checkups rather than paying for each singly. In addition, the state's largest hospital system is encouraged to invest in housing and to have doctors ask about patients' housing, transportation, food and other services. Some are concerned that Accountable Care Organizations assigned to oversee healthcare payments would lack sufficient oversight.

From the article of the same title
Washington Post (09/17/17) Johnson, Carolyn Y.
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CMS to Grant Hurricane Irma Medicare Exceptions
The U.S. Centers for Medicare and Medicaid Services (CMS) will permit exceptions to certain hospitals and other healthcare facilities affected by Hurricane Irma for Medicare quality reporting and value-based purchasing programs and will not mandate that they submit an extraordinary circumstances request. Acute care hospitals, Prospective Payment System-exempt cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, renal dialysis facilities, long-term care hospitals and ambulatory surgical centers are among the facilities that CMS says qualify for the exceptions. "These providers will be granted exceptions without having to submit an Extraordinary Circumstances Exceptions request if they are located in one of the Florida counties, Puerto Rico municipios or U.S. Virgin Islands county-equivalents listed, all of which have been designated by the Federal Emergency Management Agency as a major disaster county, municipio or county-equivalent," CMS notes. "All of the exceptions are being granted to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities."

From the article of the same title
Health Data Management (09/18/17) Slabodkin, Greg
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Republican Leaders Defy Bipartisan Opposition to Health Law Repeal
Despite bipartisan legislative urgency for the Senate to kill an 11th-hour push to repeal the Affordable Care Act (ACA), Republican sponsors are digging in. The latest repeal measure would dismantle much of the ACA and give states tens of billions of federal dollars to manage as they see fit. The bill would terminate the expansion of eligibility under the ACA, which has supplied Medicaid coverage to 13 million people. In addition, the entire program, which serves more than 70 million people, would be put on a budget, eliminating the current open-ended entitlement. States would instead get a per-beneficiary allotment of federal funds. States with high healthcare costs, particularly if they expanded Medicaid under the ACA, would experience a general hemorrhaging of money, while low-cost states that did not expand Medicaid would see gains. The American Medical Association (AMA), the American Hospital Association and AARP are among the most vocal opponents of the new repeal bill, which AMA CEO James L. Madara warned in a letter to the Senate "would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets and decrease access to affordable coverage and care."

From the article of the same title
New York Times (09/19/17) Pear, Robert; Kaplan, Thomas; Abelson, Reed
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Medicine, Drugs and Devices

Opioid ODs Have Reduced U.S. Life Expectancy: CDC
A U.S. government study published in the Journal of the American Medical Association determined Americans' life spans are being reduced due to the rising mortality rate among opioid abusers. Although life expectancy experienced a general increase from nearly 77 to 79 years between 2000 and 2015, the death rate from drug overdoses more than doubled, while opioid-related deaths more than tripled, according to Deborah Dowell with the U.S. Centers for Disease Control and Prevention. Opioids were found to have cut 2.5 months off U.S. life expectancy by 2015, with Caucasians suffering the worst. Another study found heroin-related deaths rose 533 percent nationally between 2002 and 2016, from slightly less than 2,100 deaths to more than 13,200. "There is an urgency to this problem," says Columbia University Medical Center Professor Adam Bisaga. "The tragedy is, we have medication to treat opioid addiction. But death rates keep going up." Bisaga notes while such medications are effective, only a "small portion" of U.S. doctors prescribe them, likely due to a lack of training or concerns about the safety of those medications. "We need to prevent more people from becoming addicted to opioids in the first place," Dowell says. She stresses a "critical" part of that effort would be wiser prescribing practices.

From the article of the same title
HealthDay (09/19/17) Norton, Amy
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Survey: Costly Drugs to Weigh on U.S. Employers' Expenses in 2018
New research from Mercer indicates that U.S. employers are preparing for higher healthcare expenses next year as spending on new specialty drugs is expected to rise more than seven percent. According to the consultancy firm, between 40 and 50 new specialty drugs are expected to reach the market each year over the next five years, potentially increasing costs by $25 billion annually. Preliminary findings from Mercer reveal that spending on specialty drugs had increased by about 15 percent compared with prices that were factored into health plans for 2017. "It's not so much that the cost of any one drug is going up, but that new drugs are being introduced," explained Beth Umland, Mercer's research director for health and benefits. Mercer noted that more than 2,300 drugs are in active development. Companies expect average health costs per employee will rise 4.3 percent next year. To cut costs, 46 percent of employers say they would take cost-cutting steps, such as high-deductible plans, preliminary survey responses suggest.

From the article of the same title
Reuters (09/18/17) Grover, Divya
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Why Are Drug Prices So High?
The New York Times and ProPublica, the nonprofit investigative journalism organization, joined forces to investigate why drug prices are so high. Surveys have shown that high drug prices rank near the top of consumers’ healthcare concerns. Insurance companies sometimes require patients to take brand-name drugs—and refuse to cover generic alternatives—even when that means patients need to pay more out of pocket. Insurers say that they are doing their part to keep prices down by placing limits on new prescriptions for addictive opioid analgesics. They also note they are doing more to monitor doctors’ prescribing patterns and to catch abuse by patients. Several insurers said they had seen declines in monthly opioid prescriptions, a sign of progress. But their behavior has infuriated many patients, who say they want to avoid taking opioids if possible. They argue that insurers are too focused on a drug’s cost, since many of the opioid analgesics with a lower risk of addiction are more expensive.

From the article of the same title
New York Times (09/18/17) Thomas, Katie; Ornstein, Charles
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, FACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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