October 11, 2017 | | JFAS | Contact Us

News From ACFAS

Publish Your Research Globally with JFAS Open Access
Spotlight your research on the world stage by publishing an Open Access article in The Journal of Foot and Ankle Surgery (JFAS).

The Open Access option brings your research to millions of readers worldwide, including nonsubscribers of the Journal, and gives them free, immediate and permanent online access to your work through ScienceDirect. You decide how readers can share and use your article, and as an ACFAS member, you receive a 50 percent discount on the Open Access publication fee.

Visit to learn more about Open Access publishing in the Journal or to submit your article.
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Save the Date: 2018 ACFAS Residency Directors Forum
If you're a residency director who plans to attend the 2018 ACFAS Scientific Conference March 22–March 25 in Nashville, come a day early for the fourth annual Residency Directors Forum on March 21 from 1:30–5:30pm at the Gaylord Opryland Hotel.

Residency program codirectors and faculty are also invited to attend, with up to two attendees per program. And for the first time, chief residents are invited to the Forum, but they must be accompanied by their residency’s program director.

This invitation-only event, cohosted by ACFAS and COTH, will include:
  • updates from COTH, AACPM, CPME and PRR as well as the Boards (ABFAS and ABPM)
  • information on the ins and outs of residency program funding
  • the latest in PRR logging—new changes and improvements to the process and CPME’s latest efforts to streamline program site visits
  • a follow-up discussion on the dos and don’ts of social media for residents
  • a discussion regarding graduating student readiness for residency and efforts to raise the bar
  • information about the DPM Mentors Network, which aims to strengthen the profession's future
  • a session on local program collaboration and ACFAS Regional support of residency programs
  • multiple timeslots for breakout sessions and open Q&A to give time for burning questions to be answered
Stay tuned for more details on the specific sessions, schedule and how to register!
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New Study Underscores Need for Wound Care Quality Measures
A new study in Value in Health documents the full burden and cost of wound care in the U.S. Medicare population. The study demonstrates that wounds affect nearly 15 percent of Medicare beneficiaries (8.2 million) at an estimated annual cost to Medicare of $28 to $32 billion.

Yet, with quality measure-based payment models driving Medicare reimbursement under MACRA, wound care practitioners, foot and ankle surgeons and other providers have been particularly challenged with few reportable measures relevant to wound care.

The findings illustrate the need for policymakers at the U.S. Centers for Medicare and Medicaid Services to develop quality measures, episode of care measures and reimbursement models that are appropriate to wound care, which can then in turn drive better health outcomes and smarter spending in the wound care space.

The Alliance of Wound Care Stakeholders, of which ACFAS is a member, will continue to monitor this issue. Visit for more information.
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Foot and Ankle Surgery

A Midterm Review of Lesser Toe Arthrodesis with an Intramedullary Implant
Lesser toe deformities are common conditions podiatric surgeons treat. However, due to the complex nature of these deformities, there has been no perfect solution when surgical correction is needed. The advancement of interphalangeal joint arthrodesis with an intramedullary implant could be a viable solution. This study examined patient outcomes and complications six months and three years after undergoing lesser toe proximal interphalangeal joint arthrodesis with a polyketone intrameduallary implant. After six months, 94.7 percent of patients felt that their original complaint was better or much better. After three years, 92.8 percent of patients felt that their original complaint was improved. Researchers found that most complications were observational and asymptomatic. The study shows that the procedure is a safe and effective method for certain toe deformities.

From the article of the same title
Foot & Ankle Specialist (10/17) Harmer, James; Wilkinson, Anthony; Maher, Anthony
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Foot and Ankle Reconstruction with Vertically Designed Deep Inferior Epigastric Perforator Flap
The free vertically designed DIEP (deep inferior epigastric perforator) flap may be an option for selected lower-extremity, soft-tissue reconstructions, according to a new study. Researchers used free vertically designed DIEP flaps in eight patients (seven male, one female) whose age is in a range of 20–66 years for soft-tissue reconstructions in the ankle and foot region over a five-year period. The range of defects' size was from 8 cm by 5 cm to 15 cm by 7 cm. The causes were electrical burn, trauma and diabetic foot infections. Flap dimensions varied from 10 cm by 6 cm to 17 cm by 9 cm. All the flaps had two or more perforators, and all flaps survived completely. There were no early or late complications. Researchers followed up the patients for 10 months on average and observed no functional problems, especially in main motions of foot and ankle like eversion, inversion, flexion or extension except one patient. Donor site scars were acceptable in all patients.

From the article of the same title
Wiley Online Library (10/03/17) Akdag, Osman; Karamese, Mehtap; Yildiran, Gokce Unal; et al.
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In-Hospital Costs of Diabetic Foot Disease Treated by a Multidisciplinary Foot Team
This study sought to understand the costs of diabetic foot ulcers (DFUs) and to determine the in-hospital costs linked to treatment of DFUs. The study involved 89 patients. The average in-hospital costs totaled $10,827 per DFU episode. Primary healed DFUs cost on average $4,830, single minor amputations on average cost $13,580, multiple minor amputations cost $31,835 and major amputations cost $73,813 per episode. However, cost differed greatly among the patients. Researchers concluded that DFUs are connected with significant and long-term in-hospital costs.

From the article of the same title
Diabetes Research and Clinical Practice (10/01/2017) Vol. 132, P. 68 Rinkel, Willem; Luiten, Jacky; van Dongen, Jelle; et al.
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Practice Management

Blockchain Interest Gaining, but Cost Questions Cause Providers Pause
The popularity of blockchain technology has ballooned in the healthcare sector, with a study from Black Book estimating 88 percent of payers considering deploying or currently deploying blockchain. Almost all payers with plans with more than 500,000 members are considering or implementing blockchain, and 14 percent are participating in trial deployments. Twenty-nine percent of hospital leaders and 82 percent of health insurance executives reported having a "working understanding" of blockchain. However, blockchain adoption is being hindered by a dearth of technical standards and its current immaturity. Luckily, the healthcare industry expects some federal rules to arrive next year and for blockchain integrations to explode in 2018. Although 70 percent of all payers expect blockchain to be integrated into their systems by the following year, only nine percent of healthcare providers and systems have firm plans for blockchain deployment by 2018, which 88 percent of provider leaders said is due to the undetermined costs. In addition, just 19 percent of hospital executives said their organizations are considering deploying or are currently implementing blockchain, with the undefined implementation costs the biggest obstacle.

From the article of the same title
Healthcare IT News (10/03/17) Davis, Jessica
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Five Ways Building Digital Connections with Patients Makes for a Healthier Practice
Technology provides practices an excellent opportunity to improve business by connecting with patients. For example, a practice's reputation can be greatly improved by using online reviews. These reviews also provide an opportunity for doctors to improve the care they provide. Communicating with patients through popular channels, such as email and text, could improve relationships with patients. Extending that communication by maintaining a presence online through social media websites could also provide benefits. Finally, offering the ability to schedule appointments online will draw in younger patients and bring a practice in line with modern trends.

From the article of the same title
Medical Economics (09/25/17) Higgins, Jim
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Seven Things to Consider When a Physician Goes Part Time
When doctors consider a transition to part-time work, experts say practices should consider a number of factors before approving the change. First, practice leaders should create a part-time work policy when in the early stages of establishing rules for the business. Managers should also think about how much advance notice they will need for a doctor wishing to work part time. A practice should also determine how long a doctor will be allowed to work part time. Other factors to consider include whether more than one doctor can work part time and whether a switch to part time changes how much that doctor is paid.

From the article of the same title
Physicians Practice (10/04/17) Adler, Ericka
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Health Policy and Reimbursement

10,000 Boomers Retiring Each Day
Pew Research and the Social Security Administration estimate an average of 10,000 baby boomers retire each day, raising the question as to whether the healthcare industry can manage the associated medical load, writes Allure Group founder Joel Landau. He cites industry data that retiring boomers will more than double Medicare and Medicaid expenses by 2020, while Medicare taxes and the Trust Fund will cover less and less as the growth rate of healthcare costs tops that of the economy. "Americans are unique in that a vast majority feel personally responsible for retirement preparation," Landau notes. As medical costs climb with age, he says difficulties are compounded. Fidelity Investments calculates the average 65-year-old couple in retirement can expect to pay $275,000 in out-of-pocket expenses for healthcare. "But by some estimates, they only have a 50 percent chance of covering these costs," Landau says. "If there is an upside, it's that exorbitant health spending by baby boomers has driven innovation in healthcare," Landau says. "Not all innovation leads to lowered costs, though; in fact, sometimes the opposite can occur. As new innovations, drugs and processes are created, demand for these services rise, increasing spending by an order of magnitude." Landau believes while medical innovation is important, "if we want to decrease costs, we should focus on streamlining care to preempt the need for expensive treatments."

From the article of the same title
CNBC (10/03/17) Landau, Joel
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HHS Secretary Tom Price Resigns
U.S. Department of Health and Human Services Secretary Tom Price resigned under pressure after drawing fire for taking chartered flights at U.S. taxpayers' expense. President Trump tapped Don J. Wright, a deputy assistant secretary for health and the director of the Office of Disease Prevention and Health Promotion, to serve as acting secretary. Possible candidates for a successor include Seema Verma, the administrator of U.S. Centers for Medicare and Medicaid Services, and Scott Gottlieb, the commissioner of the U.S. Food and Drug Administration.

From the article of the same title
New York Times (09/30/17) Baker, Peter; Thrush, Glenn; Haberman, Maggie
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HHS Withdraws Three Proposed Rules, Including Drug Payment Model
The U.S. Centers for Medicare and Medicaid Services (CMS) has officially withdrawn a proposal to test new models for how Medicare Part B pays for prescription drugs supplied in physician offices and hospital outpatient departments. The American Hospital Association had voiced concerns with the proposed rule and its inclusion of hospitals, which have little control over which drugs physicians prescribe. Furthermore, the U.S. Department of Health and Human Services rescinded a proposed rule to require health plans that run their own business activities to demonstrate compliance with standards and operating rules for three types of healthcare electronic transactions under the Health Insurance Portability and Accountability Act. Hospitals can still request health plans to show their compliance to the standards by undertaking voluntary certification via the CAQH CORE alliance. CMS also withdrew a proposed rule to amend certain conditions of participation for healthcare providers, conditions for coverage for suppliers and mandates for long-term care facilities. The rule would have changed specific definitions and patients' rights provisions to guarantee their consistency with the Supreme Court decision in United States v. Windsor, which held that Section 3 of the Defense of Marriage Act was unconstitutional. CMS believes a subsequent high court decision on same-sex marriage, Obergefell v. Hodges, "has addressed many of the concerns raised" in the original rule.

From the article of the same title
AHA News (10/03/17)
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Medicine, Drugs and Devices

FDA Aims to Speed Up Arrival of Complex Generic Drugs
The U.S. Food and Drug Administration (FDA) recently announced a slate of measures designed to expedite the commercialization of generic versions of complex drugs, such as Mylan NV's emergency EpiPen, to address the climbing cost of pharmaceuticals. FDA Commissioner Scott Gottlieb says the measures are supposed to boost competition in the market by permitting generic competition with complex drugs. "Drug access is a matter of public health concern," he notes. "We know that enabling more generic competition, where Congress intended, helps reduce prices, enable more access and improve public health." Gottlieb also says in some cases, expensive, branded complex drugs "have lost their exclusivity but are subject to no generic competition." His position on complex generics expands the scope of a wider migration by his agency from a simple consideration of safety and efficacy. FDA is being pressured by Congress to account for broader social ramifications, particularly as they relate to its opioid drug endorsements. "If consumers are priced out of the drugs they need, that's a public health concern that FDA should address," Gottlieb says.

From the article of the same title
Reuters (10/02/17) Clarke, Toni
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IBM to Congress: Watson Will Transform Healthcare, So Keep Your Hands Off Our Supercomputer
IBM says its Watson supercomputer could be the next innovation for the medical industry. The company says the computer could combine human knowledge and technology to provide custom treatment advice. However, federal regulators believe Watson could pose particular risks for patients and should be regulated by the U.S. Food and Drug Administration (FDA). Now, FDA is set to release new guidelines on which software products will be exempt under the 21st Century Cures Act. IBM insists that Watson should be free from regulation, and the computer company has deployed lobbyists to make their argument. FDA says it will release the guidelines in early 2018.

From the article of the same title
Stat News (10/04/17) Ross, Casey; Swetlitz, Ike
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One Needle, One Syringe, Only One Time? A Survey of Physician and Nurse Knowledge, Attitudes and Practices Around Injection Safety
Researchers have surveyed 370 physicians and 320 nurses from eight states in an effort to assess provider knowledge, attitudes and practices related to unsafe injection practices. The team is seeking to inform development and reach of materials from a national injection safety campaign. Unsafe injection practices were reported by both physicians and nurses across all surveyed physician specialties and nurse practice locations. Twelve percent of physicians and three percent of nurses indicated syringe reuse occurs in their workplace; nearly five percent of physicians indicated this practice usually or always occurs. A higher proportion of oncologists reported unsafe practices occurring in their workplace. Researchers conclude that there is a dangerous minority of providers violating basic standards of care. They note that practice patterns may vary by provider group and specialty.

From the article of the same title
American Journal of Infection Control (09/01/2017) Vol. 45, No. 9, P. 1018 Kossover-Smith, Rachel A.; Coutts, Katelyn; Hatfield, Kelly M.; et al.
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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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