News From ACFAS

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February might seem far from today, but ACFAS 2013 and the Poster Exhibit will be here sooner than you know it! If you haven’t yet done so, please submit your research poster for consideration to be presented at the Annual Scientific Conference, Monday, February 11 – Thursday, February 14, 2013 in Las Vegas. The final deadline for all posters is October 15, but act now so you’re not racing against time!

For information on how to submit your poster, visit acfas.org and click on “2013 Poster Guidelines.” It is crucial that these guidelines are read to ensure you properly develop and submit your abstract. And remember, all posters must be submitted to ACFAS headquarters no later than October 15, 2012 to be eligible for review by the committee. Didn’t catch the latest ACFAS-Officite webinar, "Social Media: Leveraging Against Facebook, YouTube, Twitter, Google Plus, etc."? ACFAS members can access previously presented practice management webinars, free of charge, via the ACFAS website acfas.org/pmwebinars. All you need to do is enter your email address to view.

Mark your calendar for the next webinar, “Securing More Referrals and New Patients” on Thursday, November 1. Registration information will be available soon.

Stay up to date on upcoming webinars by reading This Week @ ACFAS and by checking the website at acfas.org/pmwebinars.
You can help shape the advancement of the profession, the future of the College and, ultimately, the care of patients by volunteering for 2013-14 ACFAS committees. For information on becoming a committee volunteer, please visit acfas.org/volunteer. Current volunteers will receive a form from your staff liaison. The deadline for applications is October 31, 2012.

Foot and Ankle Surgery

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A study was conducted to explore the relationship between the expression of leptin and its long-form receptor, OB-RL, and injury healing in diabetic foot ulcers. Examination of biopsies from 10 patients with diabetic foot ulcers (DU group), 10 with non-diabetic foot ulcers (NDU group) and 10 with normal skin (normal control, NC group) was undertaken, and leptin and OB-RL mRNA and protein levels were respectively evaluated with RT-PCR and immunohistochemistry analyses. The DU and NDU groups were found to have significantly greater cuticle thickness and a significantly lesser epidermal layer. The DU and NDU groups also had substantially higher leptin protein expression than the NC group. OB-RL mRNA and protein expressions were significantly reduced in the DU group and significantly elevated in the NDU group. A negative correlation between diabetic foot ulcer duration and OB-RL protein expression was observed, and lower OB-RL may lead to reduced leptin signaling in diabetic foot ulcers.


A study was held to assess the effectiveness of ultrasound-guided high-volume injection and relevance of neovascularity on outcome in Achilles tendinopathy, focusing on 32 patients with recalcitrant unilateral mid-substance Achilles tendinopathy. Outcome measures used were Victorian Institute of Sport Assessment-Achilles tendon (VISA-A), Visual Analogue Score (VAS), modified Ohberg score and average maximum tendon thickness. Substantial improvements in both VAS and VISA-A scores at one month were observed and maintained at three months. Symptomatic tendons were considerably thicker at baseline than the asymptomatic side. Also observed was a significant decrease in maximum tendon thickness in the symptomatic tendons at baseline and at three months. Average Ohberg neovascularity scores showed a significant decrease between baseline and three-month review, and there was a significant difference in neovascularity at baseline for the symptomatic and asymptomatic sides. Baseline neovascularity was positively correlated with the difference in VAS scores at baseline and three months. Patients with higher baseline Ohberg scores had a more positive outcome.


A study was held to evaluate the effectiveness of the Mitchell-Ponseti (MP) foot abduction orthosis in maintaining correction of 84 idiopathic clubfeet in 57 infants treated using the Ponseti method and followed for a minimum of two years. Heel-cord tenotomy or lengthening was performed on 79 feet, and the families of 37 patients were adherent with the postcorrective brace protocol. Eight patients exhibited skin problems, with six suffering superficial dorsal skin abrasion. None of the sandals needed customization by an orthotist. Forty feet had recurrence, and in all instances correction was regained with manipulation and cast application. Nineteen feet in 14 patients underwent, or are scheduled for, an anterior tibial tendon transfer. At latest follow-up, all feet were plantigrade and had a minimum of 10 degrees of dorsiflexion. None of the patients required surgical releases. Twenty-six of 31 patients followed for at least three years used the MP brace for a minimum of three years.

Practice Management

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Most practices have made efforts to trim expenses and improve their profitability, but money may still be going out faster than it's coming in. Cutting costs often requires the ability to break habits and think outside the box. Besides cutting costs, there are innovative ways to save money on some of your current expenses. Here are some suggestions:

1. Share or rent out some of your space

Find someone, perhaps another professional who complements your practice, to share your office space or rent out the space to an industrial medicine corporation as an after-hours clinic. In addition to charging them rent, you can require them to pay a percentage of your utility bill and, if you share a receptionist, a portion of the receptionist's pay.

2. Consider changes to your insurance policies or change carrier

It's a good idea to get an annual checkup from a respected broker. You want enough insurance to cover your risk, but there's no reason to go beyond that. Some insurers offer additional discounts if you have multiple policies with them, such as a homeowner's policy or auto insurance, so check to see whether that option is available to you.

3. Outsource low-volume and less profitable procedures

Identify procedures that are expensive to offer and operate. It may be cheaper to refer patients to a service provider who does the procedure and reports the results to the referring physician. It also may be worthwhile to hire a consultant to analyze the operating costs and profits for individual procedures or service lines in order to see which ones you may want to outsource. Equipment takes up space, and not having to keep or maintain it could open you up for other profit opportunities.

4. Collect copayments and deductibles before seeing patients

You can cut down on billing and collection costs by collecting these charges before seeing the patient. Patients should be informed of their copay and deductible responsibilities when making appointments, and a note can be put in their computer file to remind the secretary to collect the required fees at the time of service.

5. Let patients schedule their own appointments

With online appointment scheduling, you can reduce support staff's phone time and provide a way for patients to request appointments at any time of the day or night.

6. Save staff phone time by using a patient portal

Patient portals, which are Web-based applications that enable patients to interact with your office, are not only convenient for patients but also save staff time. The portals allow your patients to receive medical records and test results electronically, request appointments and medication refills, send communications and view statements. Portals typically require a set-up charge and monthly maintenance fees, but the return on investment is realized quickly.

Be sure to list your hours and locations in your patient portal. Intake documents can be made available for download to allow first-time patients to print them on their own paper and bring them in.

7. Get useful consulting advice at a lower price

An outside consultant can analyze your practice objectively and make recommendations for new strategies and ways to become more profitable. If your practice is financially strapped, the cost of bringing in a consultant might be prohibitive. However, some hospitals provide consulting help at no charge. Staff should be encouraged to participate in the evaluation process.

8. Really go solo and save on all personnel overhead

It's not for everyone, and there are some definite downsides, but this approach eliminates all staff costs and makes use of computer software and technology to accomplish most of the functions that staff would typically perform.

9. Shop smart and cut the cost of office supplies

Don't stop at comparison shopping. While it may be tempting to get the latest, and often most expensive, technology or software version, it may not be necessary. Joining a medical buying group could offer benefits by providing discounts you couldn't get if you purchased the items on your own. Ordering supplies online can be a money-saver, too.

10. Get rid of your pager

A large percentage of physicians have ditched their medical exchange and pager, opting only for a cell phone and thereby reducing their communications expenses. Other "out with the old" tactics can also save money for your practice. For example, efax can be used to communicate with patients, other physicians and suppliers rather than "snail mail" or hard-copy fax.

11. Market your practice for free via social media

Facebook and Google are the new Yellow Pages. It's important to show up in local searches, so develop web pages for your practice on Google Places, Yahoo! Local and other sites that will help your practice come up in local searches.

12. Keep the money in your practice

Finally, once you've made money-saving cuts, make sure the money stays in your practice. One of the easiest ways for a practice to save money is by not letting it illegitimately leak out the door after it's earned. Be sure that you have adequate internal controls for whomever handles incoming payments and makes deposits. Only authorize payments for invoices of vendors you recognize, and only pay from original invoices, not statements.


Many practices are adopting an electronic health record (EHR) system for the first time, and they find it frustrating when blunders affect the patient experience. Still, many of these mishaps are common and can be prevented by learning from the mistakes of other physicians. Many of the common stumbling blocks can be linked to how the technology is implemented and how it is used. Common pitfalls include lack of necessary infrastructure, i.e. the hardware and bandwith used to connect the computers in a network; lack of workflow assessment; lack of training; lack of buy-in from employees; and unprepared patients.


Twitter offers a way for practices to connect with patients or prospective patients by getting them to read educational material and sharing timely information with them. A deep practice-patient connection will likely result in the patient remaining with the practice and referring the practice to friends. Relatively frequent Twitter updates are advised, with information and links to information the physician finds online or information/articles that the physician has written. One technique for getting Twitter updates out to potential patients is for the practice to publish them on its Facebook Fan Page, and link the two company accounts using the options in your account settings and by clicking on "Resources" then "Link to Twitter."

The first step to composing a Twitter update is considering your audience, with emphasis on benefits that the information you are providing will give to your patients or their families, and how the information will protect them or prevent them from committing an error. Subdividing your audience into groups of people such as mothers, grandparents, working mothers, stressed parents and so on also can be advantageous. Finding something patients would like to read using the Twitter search function is the second step. Once you have come up with a subject to share with patients, you can type that subject in as a search term and browse information that others are already sharing.

The third and final step is writing the Twitter update, which can be structured as either a question Tweet, a breaking news Tweet or a teaser Tweet. A question Tweet uses questions to generate interest in the topic among readers, encouraging them to learn more. The breaking news Tweet should be reserved for recent-news type information, such as recently published research, a story in the media, reports from national medical conferences and articles from recent editions of consumer publications. The headlines of breaking news updates should only be of sufficient length to compel the reader to learn more by clicking on the link. Practices also should use this type of Tweet to notify patients of office closings or recent news about the practice and services they provide. The teaser Tweet promises interesting or useful information for readers if they click the link to the article or information, and one method for composing such a tweet is to highlight a piece of useful or surprising information in the article without giving too much away.

Health Policy and Reimbursement

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Medical schools could be forced to rethink their admission policies if the U.S. Supreme Court rules in an upcoming case that race and ethnicity cannot be considered as factors, a decision that medical organizations warn could constrain opportunities for minorities and adversely affect healthcare for an increasingly diverse U.S. population. "In this case, if there's a restriction on the utilization of race and ethnicity as one factor of many, it restricts our ability to look at all areas of an individual's background," says Association of American Medical Colleges Chief Diversity Officer Marc Nivet. Minnesota attorney David Goldstein says the fact that the high court is hearing the case may indicate that justices are weighing overruling affirmative action policies.


An analysis performed by the New York Times shows that the use of electronic medical and billing records may be contributing to increased costs for Medicare. The analysis found that hospitals that received incentives from the federal government to move towards using electronic records showed a 47 percent increase in Medicare payments at higher levels between 2006 and 2010, compared with a 32 percent increase in such payments at hospitals that did not receive any government incentives to adopt electronic records. All told, the amount of Medicare reimbursements that hospitals received jumped by $1 billion between 2005 and 2010, in part because the use of electronic medical and billing records makes it easier for hospitals and doctors to bill more for their services regardless of whether they actually provide their patients with additional care, the New York Times said. Hospitals and doctors counter that they receive higher payments because electronic medical and billing systems allow them to better document the care they provide their patients.


A pilot project under consideration by the White House aims to make it possible to collect information from patients reporting medical errors and unsafe practices by physicians, hospitals, pharmacists and other treatment providers. A draft questionnaire asks patients to "tell us the name and address of the doctor, nurse or other healthcare provider involved in the mistake," and requests patients' consent to share the reports with healthcare providers "so they can learn about what went wrong and improve safety." Federal officials say the reports would undergo analysis by RAND Corp. and ECRI Institute researchers, and chairman of the American Academy of Orthopaedic Surgeons' Council on Research and Quality Kevin J. Bozic says it is critical to match the patients' disclosures with information in medical records. The Obama administration envisions a reporting system where patients and their relatives report medical mistakes and near misses via a website and in phone interviews.

Medicine, Drugs and Devices

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Easing the Food and Drug Administration's (FDA) assessment process for mobile health applications is the goal of Rep. Mike Honda's (D-Calif.) Healthcare Innovation and Marketplace Technologies Act (HIMTA), which would set up a special Office of Mobile Health at the FDA to provide recommendations on mobile health app issues. HIMTA also would establish a mobile health developer support program at the Department of Health and Human Services to help app developers ensure they are operating within privacy regulations. Smaller mobile health app companies are hoping such an office would help simplify and expedite the regulatory process that they go through.


Researchers at Penn State College of Medicine have discovered a technique for coating bone grafts that could increase the likelihood that implants will be successful. The technique involves sterilizing bone grafts, coating them with a layer of the inorganic compound hydroxyapatite less than several hundred nanometers thick, and using physical vapor deposition to make the surfaces of the grafts rough. Doing so made the bone grafts almost as osteogenic as grafts that are not processed with chemicals and radiation before they are implanted in order to prevent the transmission of disease. Researchers say that their technique could be used for soft musculoskeletal tissue implants and orthopaedic device implants.


Patients remain at risk of having surgical items such as gauzelike sponges left inside their body after operations because of hospitals' resistance to updating technology and other surgical team procedures to avoid such mishaps, despite the insistence of groups such as the American College of Surgeons. Although hospitals traditionally require that surgical team members count, and then recount, all sponges used in a procedure, studies indicate that the team has declared all sponges accounted for in four out of five cases where sponges are left behind. Technological solutions such as radio-frequency tags and bar codes have been shown to help surgical teams more precisely track sponges and reduce the likelihood of miscounts, yet electronic tracking is utilized by less than 1 percent of U.S. hospitals, mainly because they do not want the extra cost.

In a study published in the October issue of The Journal of the American College of Surgeons, researchers looked at 2,285 cases in which sponges were tracked using a system called RF Assure Detection. Every sponge contained a tiny radio-frequency tag, about the size of a grain of rice. At the end of an operation, a detector alerts the surgical team if any sponges remain inside the patient. In the study, the system helped recover 23 forgotten sponges from almost 3,000 patients over 11 months.