October 5, 2016 | | JFAS | Contact Us

News From ACFAS

Cast Your Vote in This Month's Poll
We're planning our practice management programs for the coming year and would like your input on the topics that would most entice you to attend.

Take our new poll at right and let us know which topic appeals to you. Visit to view real-time results throughout the month. Thank you for voting—we appreciate your feedback!
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Don’t Miss Out on New Complications Seminar
Turn the tables on complications in Minimize Your Complications and Maximize Your Patient Outcomes, October 22–23 at the New York Marriott Downtown.

Just a few spots are left for this game-changing, problem-based seminar. Through presentations with experienced faculty, audience participation and discussion, you’ll change the way you approach complications and find new solutions for even your most challenging cases.

Register now at before openings run out!
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New Tactics for Treating the Forefoot
Get on tour with us this fall as our new regional program, ACFAS on the Road: Refining High-Frequency Forefoot Surgery, heads to the East Coast and Southwest with state-of-the-art techniques in tow to help you see common forefoot procedures in a different light.

Join us for our first stop in Bethlehem, PA this weekend or the following weekend in Tampa, FL for two days of eye-opening case studies and lectures, intensive sawbones labs and interactive panel discussions with faculty. By the end of the workshop, you’ll have 12 continuing education contact hours under your belt plus a new slate of skills for treating forefoot injuries and deformities.

Visit for the complete 2016–2017 schedule and to register now.
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Keep Your ACFAS Profile Up to Date
The best way to keep in touch with the College is by making sure your ACFAS member profile is current. To update your profile, log into your account at

Once you're logged in, you can:
  • 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 (choose “Yes” next to Members-Only Directory).
  • Include yourself in the “Find an ACFAS Physician” search tool on the new (choose “Yes” next to Consumer Physician Search).
Keep us posted of any updates throughout the year so you can stay connected with your colleagues and the College!
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Foot and Ankle Surgery

Relationship of Prolonged Operative Time and Comorbidities with Complications After Geriatric Ankle Fractures
The incidence of geriatric ankle fractures and associated complication rates have increased in recent years, so a new study aimed to identify risk factors for perioperative complications following open reduction and internal fixation of geriatric ankle fractures. Researchers analyzed the complications associated with operative treatment in 237 patients over the age of 65 years. In 68 patients, 74 complications were documented, with the most common complications being impaired wound healing and operative site infections. The operative time was the only independent risk factor for the development of a complication. The operative time and the presence of an open fracture were risk factors for needing revision surgery.

From the article of the same title
Foot & Ankle International (09/16) Aigner, René; Salomia, Constantin; Lechler, Philipp; et al.
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Mortality Rates After Lower-Limb Major Amputation in Hemodialysis Patients
The clinical outcomes after major amputation in hemodialysis patients with peripheral artery disease are unclear, so researchers examined the mortality rates after major amputation in such patients. One hundred and eight hemodialysis patients undergoing their first major amputation were monitored following the procedure. During the median follow-up period of 11.5 months, 74 percent of patients died. The survival rates were 83 percent at 30 days following the procedure, 56 percent at one year and 15 percent at five years. The causes of death were cardiac (45 percent), sepsis (29 percent), cerebrovascular (4 percent) and other causes (22 percent). An additional 31 patients underwent a second amputation with a median time between amputations of 2.5 months. The survival rates associated with an additional amputation were 39 percent at one year and 9 percent at five years. Previous minor amputation and low hematocrit level were associated with the 30-day mortality rate, and age was associated with the five-year rate. Ambulatory patients had a significantly higher survival rate than bedridden patients or those using wheelchairs.

From the article of the same title
Journal of Vascular Surgery (09/22/16) Vol. 64, No. 4, P. 1018-1025 Serizawa, Fukashi; Sasaki, Shigeru; Fujishima, Shinobu; et al.
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Redefining the Chronic-Wound Microbiome: Fungal Communities Are Prevalent, Dynamic and Associated with Delayed Healing
A study demonstrated for the first time that fungal communities in chronic wounds can predict healing time and can cohere into mixed fungal-bacterial biofilms. A longitudinal profile of 100 nonhealing diabetic foot ulcers with high-throughput sequencing of the pan-fungal internal transcribed spacer 1 locus was organized, and it was estimated that as much as 80 percent of wounds contain fungi, while cultures performed in parallel captured only 5 percent of colonized wounds. The mycobiome was highly heterogeneous over time and between subjects. Fungal diversity rose with antibiotic administration and onset of a clinical complication. The proportions of the phylum Ascomycota were significantly higher at the start of the study in wounds that took more than eight weeks to heal. Wound necrosis correlated with pathogenic fungal species, while taxa identified as allergenic filamentous fungi were associated with low levels of systemic inflammation. Directed culturing of wounds stably colonized by pathogens showed interkingdom biofilms formed between yeasts and coisolated bacteria. The combined analyses offer enhanced resolution of the mycobiome during impaired wound healing, its role in chronic disease and effect on clinical outcomes.

From the article of the same title
mBio (09/06/16) Vol. 7, No. 5, P. e01058 Kalan, Lindsay; Loesche, Michael; Hodkinson, Brendan P.; et al.
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Practice Management

Six Ways to End a Doctor-Patient Relationship
When a relationship becomes toxic or dysfunctional, physicians have the right to dismiss the patient from the practice. However, a physician who does not terminate the relationship properly may be held liable for patient abandonment. Before choosing to terminate, all abusive behaviors and interactions should be documented so that the decision is clear to anyone who may later read the patient’s chart. Providers must issue written notifications of dismissal, as patients may not take verbal terminations seriously. The notification itself need not name the reason for termination. Send the notification letter through certified mail to ensure delivery. Legally, the physician must make an honest attempt to notify the patient, but it does not matter if the patient actually received and read the letter. After termination, physicians must still remain available to the dismissed patient for a reasonable period of time while the patient looks for a new provider. Doctors should also suggest ways the patient can secure new medical services. If a patient is not given adequate time to find another doctor, the terminating physician can be held liable.

From the article of the same title
Physicians Practice (09/29/16) Girgis, Linda
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Doctors Dig for More Data About Patients
Hospitals and physicians are mining behavioral, consumer and financial data to more accurately predict their patients’ medical future and provide better preventive care. Some of this data is collected from patients themselves, but many providers are seeking data from companies that sell consumer information and from federal agencies that provide statistics on poverty and unemployment. Proponents of this approach say a more thorough understanding of patients could help doctors tailor medical interventions to their patients’ needs. Advocate Health Care’s facilities in Illinois began using an algorithm in 2012 to predict which hospital patients would be readmitted less than a month after leaving. In the first nine months of its use, the tool cut readmissions for high-risk patients by 20 percent. However, a recent study published in the British Medical Journal found predictive models using medical information to identify high-risk patients were inconsistent, with only two out of more than 70 models considered strong. To create a reliable algorithm, providers would need to collect a wide range of medical and nonmedical data, which can be difficult and time-consuming to obtain.

From the article of the same title
Wall Street Journal (09/25/16) Evans, Melanie
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Financial Pressures Reshape Medical Practices
A survey of more than 340 small practices commissioned by TD Bank estimated half of physicians either have or would consider purchasing, buying into, merging or selling their practice, and 73 percent expected to do so within the next four years. Forty-six percent reported being under pressure to make the change because running a practice is growing too costly. TD Bank's Dan Croft says more and more healthcare providers are buying into practices with a partnership or purchasing an existing practice in their push for additional financial security and well-established businesses. With 43 percent of respondents expecting to raise revenue over the next two years, women and millennials have the most optimistic outlook for expected growth. Meanwhile, 36 percent of women reported owning their practice for less than five years, while 47 percent of men have been in practice for more than two decades. The poll also found timely reimbursements from insurance providers, managing overhead costs and keeping up with technology to be the biggest issues currently faced by practitioners. Moreover, 56 percent of physicians anticipate partners or colleagues taking over the business when they retire, and 30 percent will need to put off retirement to later than originally planned.

From the article of the same title
HealthLeaders Media (09/20/16)
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Health Policy and Reimbursement

The End of ICD-10 Flexibilities Is Coming: Are You Ready?
The leniencies allowed by the U.S. Centers for Medicare and Medicaid Services (CMS) following the launch of ICD-10 last year ended October 1, 2016. The grace period provided some degree of flexibility in the specificity of the codes submitted by providers. Once the grace period ends, providers submitting unspecified codes should prepare for more audits and denials of claims. To reduce claims denials and receive proper reimbursement, providers should ensure codes are as specific as possible, including the laterality of the diagnosis. Codes must match physicians' documentation, so an equal amount of specificity should be reflected in the documentation. Communication between providers and billing staff will also be crucial to minimize documentation errors. Providers are advised to review the ICD-10 resources on the CMS Road to 10 website, which includes downloadable guides, common codes and clinical scenarios for providers in various specialties. As of October 1, there are nearly 2,000 new codes, 422 revised codes and 305 deleted codes.

From the article of the same title
Medical Economics (09/26/16) Douglas, Hannah
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EHR Health Data Collection to Affect Health Industry Shift
Significant change in the healthcare industry is being driven by the transition to value-based care, the growth of health technology and a focus on patients as consumers, according to a report from the PwC Research Health Institute. Swift data collection is becoming an integral part of the healthcare ecosystem, so organizations may consider improving the speed and accuracy of their data flow and feedback loops. Healthcare professionals should support this emphasis on data collection through electronic health record standardization and health data interoperability, bolstering efforts to connect and share information gathered from wearable devices, biosensors, implantable devices and mobile health applications. As the industry shifts its focus from volume to value, providers may need to devote more attention to understanding different patient populations and determining which medical devices are best suited for certain demographics. Organizations should assess the effect of these changes on their employees and consider how different data standards will affect clinical care.

From the article of the same title
EHR Intelligence (09/23/2016) Heath, Sara
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Medicine, Drugs and Devices

For Patients Who Need Bone Grafts, a 3D-Printer Could Come to the Rescue
Researchers at Northwestern University have created a 3D-printed hyperelastic bone that can be manipulated easily by surgeons, leading the way toward less expensive and more effective bone grafts. The composite material described in Science Translational Medicine is biocompatible, porous, pliable and does not need to be cured by heat. Ninety percent of the material’s weight is hydroxyapatite, which is typically used to repair damaged bone. The remaining 10 percent is made of a soft, porous polymer coating, giving it enough flexibility to be compressed to less than half of its original height without suffering structural damage. Scientists found that the hyperelastic bone expedited spinal fusion in rats two to three times faster than typical regrowth. The 3D fabrication process could give developers freedom to print different types of bones for various bone breaks and defects. Antibiotics and other drugs could also be incorporated into the scaffolding to reduce infection and encourage growth.

From the article of the same title
Los Angeles Times (09/28/16) Khan, Amina
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Apple Said to Expand HealthKit from Tracker to Diagnosis Tool
Apple plans to turn its HealthKit software into a diagnostic tool that can extrapolate health data from wearable devices. Healthcare experts have been recruited to build electronic health record software to help doctors and patients interpret the data collected from Apple Watch apps that gauge sleep patterns, fitness levels and heart rates. It is unlikely Apple will add medical sensors to the watch, such as a glucometer or blood-pressure sensor, as they would require approval from the U.S. Food and Drug Administration. The ultimate goal of Apple’s medical technology projects is to turn data into actionable information while allowing that data to be securely transferred between databases. As part of that effort, Apple has acquired Gliimpse Inc., a startup that builds software to share health records between databases in different formats and stores the data in a central location.

From the article of the same title
Bloomberg (09/26/16) Webb, Alex
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Study: Hospitals Need to 'Expose' Tweaks to Electronic Health Records
Some providers have made simple adjustments to their electronic health record (EHR) implementation but are not sharing these fixes or seeking automated workflow improvements. A study analyzing physician perceptions of EHRs is under review for publication with Medicare Care Research and Review and was presented at the Academy of Management’s annual meeting in August. Since the use of EHRs was mandated in 2009, providers have faced many challenges, including physician workload, technology investments and user training. The study found that physicians will often tweak their EHR processes to make the technology less obtrusive and complicated. Tracy Porter, who conducted the interviews for the study, says providers should share these adjustments with each other and meet with information technology specialists to possibly improve the technology itself. “If [providers] have workarounds that can be automated, we want to help them automate them and make them workflows,” says Dr. Sumitra Khatri from Cleveland Clinic’s Office of Professional Staff Affairs. “I think the biggest hurdle is when something’s a struggle, they just work around it, no matter how painful it is.”

From the article of the same title
Crain's Cleveland Business (09/25/16) Coutre, Lydia
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This Week @ ACFAS
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Mark A. Birmingham, DPM, 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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