October 10, 2012

News From ACFAS

Why Do You Love Your Career? Send Us a Video!
ACFAS Members: You are invited to send us a video of yourself answering these questions:
  • Why do you love being a foot and ankle surgeon?
  • What attracted you to this profession?
  • Whose lives have you changed and how?
  • Who had the greatest impact on your career?
  • What is your vision for your professional future?
We’re going to tell your stories at the Opening General Session of the ACFAS 2013 Annual Scientific Conference on February 10-14 in Las Vegas. See the web link below for more information. Act by October 31 to ensure your story is heard!
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Board Nominees Announced
After careful review and consideration of applicants to serve on the ACFAS Board of Directors, the Nominating Committee will recommend the three following Fellows for the upcoming electronic election:
  • Sean T. Grambart, DPM, FACFAS (Incumbent)
  • Paul Dayton, DPM, FACFAS
  • Christopher L. Reeves, DPM, FACFAS
Two, three-year terms will be filled by election. Candidate profiles and position statements will be posted on in early November. Voters may cast one or two votes on their ballot. Regular member classes eligible to vote are: Fellows, Associates, Emeritus (formerly Senior) and Life Members. Individuals who intend to nominate by petition must notify ACFAS by October 17 and petitions are due no later than November 10; see web link below.

Note: ACFAS will use electronic voting again this year from November 29-December 29. All eligible voters will receive an e-mail with special ID information and a link to the election website no later than November 29. After logging in, members will first see the candidate biographies and position statements, followed by the actual ballot, pursuant to the bylaws. Eligible voters without an e-mail address will receive paper instructions on how to log in to the election website and vote. There will be no paper ballots.
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ACFAS 2013 – Last Chance to Submit Your Poster
Only five days left to submit your research poster abstract for the exhibit at the Annual Scientific Conference 2013, which will take place February 11-14 in Las Vegas. Those of you who are involved in a study that would be beneficial to the profession are encouraged to present your poster abstract for this high-profile event. The final deadline for all posters is October 15, so act fast if you’d like your research to be considered for presentation.

To learn more about how you can submit a poster, and to view the 2013 poster guidelines, visit and click "Posters.” Please be sure to read the 2013 Poster Exhibits Guidelines, as these are crucial to ensure proper development and submission of your abstract. And remember, all poster abstracts must be submitted to ACFAS headquarters no later than October 15, 2012 to be eligible for review by the committee.
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Help Us Reach 1,000 Twitter Followers
ACFAS is close to 1,000 followers on our patient-based Twitter account, @FootHealthFacts and we need your help! Tell your patients, family, friends and office staff about this useful tool that posts the latest news and facts about foot and ankle health. Join the conversation and we’ll keep you updated on what’s happening with your favorite athletes’ injuries, share tips for preventing and recognizing foot and ankle ailments and assist in finding the answers you need on general foot and ankle health-related questions.

Visit and click “follow” today!
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Foot and Ankle Surgery

Comparison of Structural Bone Autografts and Allografts in Pediatric Foot Surgery
A retrospective analysis of 161 children who underwent foot surgery requiring 182 allografts and 63 autografts from 1982 to 1994 was conducted to compare the rate and completeness of graft incorporation and the relative safety of autograft and allograft structural bone in pediatric foot surgery. Both groups exhibited graft-host union within 12 weeks, with the average healing time in both groups slightly more than seven weeks. There was one nonunion, three graft displacements due to technical error requiring reoperation and one partial displacement that did not require reoperation in the allograft cohort. Technique rather than graft type was the cause of these complications. Neither infections nor disease transmission were observed, and no complications were reported in the autograft group.

From the article of the same title
Journal of Pediatric Orthopaedics (10/01/12) Vol. 32, No. 7, P. 714 Vining, Neil C.; Warme, Winston J.; Mosca, Vincent S.
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Inter- and Intra-Observer Reliability of a Smartphone Application for Measuring Hallux Valgus Angles
A smartphone application offers an alternative way of measuring radiological angles in the planning of the management of patients with hallux valgus. Researchers compared the reliability (inter- and intra-observer) of this method to the use of a picture archiving and communication system (PACS). Radiographs of 30 feet from new patients referred with hallux valgus were examined and angles (HVA, IMA and DMAA) recorded using the smartphone application and PACS. The smartphone application provided good inter-observer reliability for HVA and IMA (r=0.93 and r=0.79 respectively). Intra-observer reliability for HVA and IMA was also found to be good (r=0.93–0.97 r=0.82–0.93 respectively). The inter- and intra-observer reliability for using this method to measure DMAA fell below useful levels (r<0.60 in each case).

From the article of the same title
Foot and Ankle Surgery (10/01/12) Walter, Richard ; Kosy, Jonathan D.; Cove, Richard
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Practice Management

Google Ads and Physicians: Get the Most for Your Money
There are too many practices investing in designing websites and then jumping right into Google Ads to promote their services, which ends up being a waste of money. Google Ads are not cost-effective for several reasons, including the fact that many such ads for practices are unethical. Those who promote themselves as the best or exceptional in Google Ads only serve to make patients suspicious and their efforts do not go toward differentiating themselves from the competition. Therefore, practices ought to vet ads prior to their publication. Additionally, Google Ads require constant refinement, relevance and daily monitoring for cost-effectiveness.

Benefits from Google Ads that practices should be on the lookout for include great website content. One example of this is a practice to whom Google Ads returned more than 90 patient calls, displaying everything about their online behaviors, demographics, socioeconomics and the precise reasons they were seeking a physician. Such data led to some outstanding content for the surgeon's website. Another benefit that Google Ads should yield is patient selection and screening, in conjunction with site content. Real-time tweaks can be made to Google to filter out patients who may not be fully qualified for your practice, and this can save thousands of dollars on Google advertising campaigns.

A third advantage of Google Ads is that they can test how the practice operates. For example, in the practice mentioned above, the person answering the calls was failing to convert calls into appointments. The most frequently asked question was "Do you accept 'X' insurance?," and the answer unfailingly was "no, the doctor sees only out-of-network patients." This led to an immediate cessation of calls without the scheduling of an appointment, but once the person answering calls was instructed to say that the physician "accepts out-of-network benefits from X, Y and Z insurance companies," conversion rates from Google Ads climbed to 10 percent, returning an ROI of $63,000 gross to $4,500 spent.

From the article of the same title
Physicians Practice (10/01/12) Sikorski, Simon
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How to Prevent Employee Embezzlement
Employee theft is more likely at smaller medical practices, where it also has a disproportionately larger impact, so these medical practices should be strongly diligent. The first step is to hire the right people by screening potential employees, avoiding all nepotism and conducting background checks, including their credit and criminal history. Employers should not only ask for references from potential employees, but contact them and verify them. This can provide information such as the candidate's work ethic and strengths and weaknesses. Other candidate information, such as employment history, licensure and education should also be verified. After hiring the employee, other policies can help prevent theft.

For employees who handle cash, such as the bookkeeper or practice manager, a requirement of employee bonds can help protect against fraud or embezzlement. Practices should routinely back up tapes and records and not allow the same person who creates the records to back them up. Practices should also reduce or eliminate the opportunity to easily steal. Financial and bookkeeping functions should be separated as much as possible; the employee who collects payments should not be the same employee who takes deposits to the bank or who opens the mail. Other controls include requiring employees to use vacation days and take time off -- which will let managers and physicians check the employees' work while they are gone -- and rotating jobs among employees. Practices can conduct monthly internal audits and look for unusual amounts, discrepancies or patterns. Petty cash should also be eliminated, and adequate insurance purchased. If there is reason to suspect employee theft, such information should be strictly confidential to avoid potential defamation claims and notification to the potential embezzler.

The practice should contact an independent certified public accountant (CPA) to offer a neutral opinion. The suspected employee should be interviewed last with a witness present and asked for an explanation as the interviewer details the discrepancies found. Employees who are confirmed embezzlers should be immediately suspended and not given the opportunity to cover his or her tracks or manufacture an excuse. If certain about the suspicions of theft, the practice manager or physician should notify law enforcement immediately, but should not threaten the employee with prosecution. However, failure to actually prosecute the employee responsible for theft will send the wrong message to other employees and the public.

From the article of the same title
Medical Economics (09/25/12) Indest, George F.
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Patients Report Better Rx Adherence When Docs Share Notes: Study
A study published in the Annals of Internal Medicine has found that it can be beneficial for doctors to allow patients to read their notes. Of the 13,500 patients at three hospitals who participated in the study, between 60 percent and 78 percent at each site said that they were better able to take their medications as prescribed after they were allowed to read their physicians' notes. In addition, the study found that the majority of the doctors at each of the three hospitals believed that sharing their notes with their patients was a good idea. This was despite the fact that physicians had expressed concern before the study began about the potential for longer visits with patients, increased numbers of patients' demands and allowing patients to see candid comments if they shared their notes with them.

From the article of the same title
Modern Healthcare (10/01/12) Robeznieks, Andis
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Health Policy and Reimbursement

GOP Lawmakers Urge Halt on Meaningful-Use Payments
The U.S. Department of Health and Human Services (HHS) should suspend incentive payments to providers in the electronic health-records program and delay penalties to those that do not integrate health IT until the federal department can define clear, interoperable standards, House Republican leaders suggested in a letter to HHS Secretary Kathleen Sebelius. The lawmakers said that nearly $10 billion in federal dollars may have been wasted because the recent Stage 2 Meaningful Use program rules from the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology are “weaker” than the Stage 1 rules released three years ago. The lawmakers also called on HHS to expect more from meaningful users. “For example, requiring a summary transfer when a patient moves to a different care setting in electronic format only 10 percent of the time is insufficient,” they wrote, adding that also only requiring radiology and laboratory orders to be electronic 30 percent of the time and medication reconciliation and electronic prescribing to happen 50 percent of the time is “woefully inadequate.”

From the article of the same title
Modern Healthcare (10/04/12) Zigmond, Jessica
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Medicare Launches Pay-for-Performance Efforts
Medicare has launched new initiatives to reward hospitals for good clinical practices while penalizing them for high readmission rates. The efforts, mandated by the healthcare reform law, are meant to encourage better and more standardized care in the Medicare program. Starting Oct. 1, Medicare will retain 1 percent of its hospital reimbursements and redistribute the money based on how well hospitals adhere to clinical guidelines and score on patient-satisfaction surveys. If a hospital tends to follow a recorded protocol, for example, it is more likely to receive some of the estimated $850 million available this year.

Medicare will also begin penalizing those with high readmission rates among heart attack, heart failure and pneumonia patients. Hospitals that do poorly will lose 1 percent of their reimbursements, or about $280 million total this year. Both initiatives — to reward hospital quality and discourage high readmission rates — will expand in the coming years to involve greater financial incentives or penalties and stricter performance standards.

From the article of the same title
The Hill (10/01/12) Viebeck, Elise
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Recovery Auditor Improper Payments Ratchet Up
The Centers for Medicare & Medicaid Services has issued its latest statistical report on the amount of overpayments and underpayments, and the trend continues to point upward with the agency once again correcting an increasing number of improper payments than in the previous quarter, this time for $701.3 million in total. Consultant Elizabeth Lamkin says the trend once again demonstrates the need for healthcare providers to fortify their billing and documentation on the front end. "Put the bulk of your care management staff and resources on the front end with bed status determination [inpatient or observation], use second-level physician advisor reviews and have a clinical documentation improvement specialist reviewing concurrently," she recommends.

From the article of the same title
HealthLeaders Media (10/03/12) Carroll, James
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When Doctors Stop Taking Insurance
Some patients say it is becoming harder to find an in-network doctor as insurers move to tamp down healthcare costs by holding down physician fees. A new survey of more than 13,500 doctors nationwide found that over the next one to three years, more than 50 percent intend to take steps to reduce patient access to their services, and nearly 7 percent plan to switch to cash-only or concierge practices.

From the article of the same title
New York Times (10/01/12) Rabin, Roni Caryn
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Medicine, Drugs and Devices

ACR Puts Out Gout Guidelines
A task force at the American College of Rheumatology has released new guidelines for the management of gout. The new guidelines are intended to reflect the growing range of therapeutic options, greater awareness of the need to control ureter and the increasing burden and prevalence of the disease. For example, either of the zenith oxides inhibitors, all of the Feb (Ulrich) or the newer Feb (Ulrich) can be used as a first-line urea therapy. Additionally, the target serum ureter levels should be under 6 mg/dL, and many patients may need to have it below 5 mg/dL, the task force reports in the October issue of Arthritis Care & Research.

From the article of the same title
MedPage Today (09/29/12) Walsh, Nancy
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Can a Computer Game Help Practices Keep Data Secure?
Many small practices have not succeeded in creating a culture of security and data protection, says the U.S. Health and Human Services Department's Office of the National Coordinator (ONC) for Health Information Technology. This failing is often due to insufficient staffing or budget limitations. In response, the ONC created a free, Web-based game that seeks to help practices understand the Health Insurance Portability and Accountability Act (HIPAA) and the importance of using data security measures and appropriate data protection policies. The ONC hoped to address the experiences and issues that many practice staff were facing when adopting health information technology, such as electronic health records, said Laura Rosas, MPH, privacy and security professional for the ONC’s Office of the Chief Privacy Officer.

Many small practices have had trouble implementing effective training for this technology, as many lack the time or resources for proper training materials. Rather than having to read a variety of manuals on HIPAA compliance, practice employees can play a 30-minute game to learn best practices in keeping a password secure, protecting patient data, controlling access to that data, securing and encrypting mobile devices and using virus protection software. Practice administrators can view results of employees' games to see where there are knowledge gaps and a need for review.

The game, called “Cybersecure: Your Medical Practice,” looks similar to the virtual reality game “The Sims.” The player experiences different scenarios that involve HIPAA privacy and security rules. Players experience the game as an avatar physician practice worker and answer questions based on each scenario. Right or wrong answers can cause the player to add or lose exam rooms, office equipment and points. At the end of each of the game's three levels, players receive feedback on their answers, including explanations of why their answers were right or wrong. A certain score is required to advance to the next level. The game also includes tips and a glossary for understanding certain terms.

From the article of the same title
American Medical News (10/01/12) Dolan, Pamela Lewis
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For ACOs, IT Startup Costs Top $1 Million
The IT needs for launching an accountable care organization will cost smaller ACOs upwards of $1 million and big ACOs as much as $4 million before they start operating, according to a Black Book survey. Twenty-eight percent of ACO-participating providers say they already have their basic health information exchange (HIE) and interoperability strategies in place, and the report says these providers will concentrate on community or regional exchanges for the foreseeable future. Ninety-five percent of the surveyed hospital and healthcare system executives said they were expediting their HIE, electronic health records, clinical decision support, care coordination, business intelligence and complex revenue cycle management system acquisitions to prepare for ACOs and other care delivery models tied to new reimbursement methods. Consultant Doug Hires says smaller, physician-led ACOs would probably have little difficulty raising the needed capital for their IT startup costs because they can obtain the funds from hospitals or payers.

From the article of the same title
InformationWeek (09/27/12) Terry, Ken
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