News From ACFAS

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Get a jump on ACFAS 2016 and your learning with our three Preconference Workshops scheduled for the day before the conference starts—Wednesday, February 10. Sharpen your surgical technique or learn the ins and outs of coding in these hands-on classes guaranteed to challenge you and pump you up for the exciting three days that lie ahead:

• Practice Management/Coding Workshop
  (8am–5:30pm, 8 CE Contact Hours)
   
• Diabetic Deformity: Master Techniques in Reconstruction
  (7am–Noon, 4 CE Contact Hours)
   
• High-Frequency Foot Surgery Techniques
  (Noon–5pm, 4 CE Contact Hours)

Space for these special preconference programs is limited; register now at acfas.org/austin. If your practice or home contact information has changed recently, be sure to update your ACFAS member profile by logging into your account at acfas.org.

Once you’re in your member profile, you can also:

• Update any email addresses you use (work or personal) as well as your fax number and your work, home or cell number.
• Confirm you’re receiving your Journal of Foot & Ankle Surgery and ACFAS Update at your preferred address.
• Make your contact information available to your colleagues through the College’s online membership directory by clicking “Yes” to the Members-Only Directory.
• Include yourself in the “Find an ACFAS Physician” search tool on FootHealthFacts.org. Just click “Yes” for “Consumer Physician Search.”

Let the College know about any appropriate updates throughout the year to stay connected with peers, potential patients and ACFAS! To thank those loyal and dedicated members who have been a part of the College for 40 years or more, ACFAS has awarded them with Life Membership status. The ACFAS Board of Directors honors this year’s members:

• David V. Chazan, DPM, FACFAS, Rochester, NY
• Joel R. Clark, DPM, FACFAS, San Francisco, CA
• Warren M. Johnson, DPM, FACFAS, Fremont, CA
• Michael H. Kent, DPM, FACFAS, Shelby Township, MI
• James R. LaRose, DPM, FACFAS, Upland, CA
• Marshall G. Solomon, DPM, FACFAS, Warren, MI
• George V. Tsoutsouris, DPM, FACFAS, Highland, IN
• Gary A. Wasiak, DPM, FACFAS, Highland, MI
• Frederick M. Weil, DPM, FACFAS, Hoffman Estates, IL
• Charles R. Young, DPM, FACFAS, Farmington Hills, MI
• Kerry Zang, DPM, FACFAS, Mesa, AZ

Foot and Ankle Surgery

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A recent study examined a national database to determine the association between obesity and complications following primary Achilles tendon repair. A total of 18,948 patients were assessed, 2,962 of whom were coded as obese or morbidly obese. Obese patients had significantly higher rates of postoperative wound complications, infection, venous thromboembolism and medical complications compared with nonobese patients.


A new study published in the Journal of Bone & Joint Surgery found anti-osteoporotic therapy for increasing bone mineral density and retarding the loss of bone tissue can decrease the risk of future fractures in osteoporosis patients by 40 percent. During a three-year period, researchers studied 31,069 patients who were 50 years of age or older and had sustained a fragility fracture. Patients were clustered into either a treatment group of about 3,200 patients or a no-treatment group. Patients included in the treatment group needed to be prescribed anti-osteoporotic therapy by a physician and be at least 80 percent compliant with the prescribed therapy for at least six months. The study determined the age- and sex-adjusted anti-osteoporotic therapy group experienced a 34 percent reduction in hip fractures, a 43 percent reduction in spine fractures, a 50 percent reduction in wrist fractures, a 52 percent reduction in upper arm fractures and a 40 percent reduction in all fractures combined.


A new study has found that there are multiple causes of infection after open ankle fracture, including diabetes and the use of immunosuppressant medications. Other factors associated with infection were male gender and smoking. In this study, the incidence of growth purulence was 12 percent, and the figure increased to 17 percent with the inclusion of wound dehiscence. Despite these risks, doctors can take steps to prevent them. Most important is time to closure, which the study showed had a clear effect on infection.

Practice Management

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As expected, ICD-10 caused headaches across the board in healthcare–but it certainly was not the chaotic riot that many were presuming would take place. In many areas, much work still needs to be done:

• Payers. According to a survey, "nearly three-quarters [of payers] have begun or completed external testing" by July 30. These impressive readiness numbers are likely skewed toward larger payers, so it may be months before definitive trend lines emerge providing more information on who was or was not prepared.
• Technology. Nearly all charts, ledgers and other physical recordkeeping will soon be obsolete. It is important to recognize this as the transition continues. Everything will be digitized.
• Manual processes. Eliminate as many manual processes as possible during the transition. This can cut down on productivity loss and introduce your practice to new, more efficient technologies.
• Internal communications. ICD-10 is more than just a coding change. It is a massively complex transition that requires seamless communication within your practice. Continual, efficient communication is essential to prevent repeated errors.
• Clearinghouses. Continuing to work with clearinghouses after the deadline should be a priority. Many were universally prepared for the transition and will continue to provide testing opportunities after Oct. 1.
• Physician documentation. The steepest learning curve belongs to physicians, who will have to document everything to stay afloat. Physician practices should assign a dedicated resource to review physician documentation, identify areas for improvement, provide the necessary feedback and limit the use of unspecified codes.

Presenters at this year's Medical Group Management Association (MGMA) conference in Nashville emphasized patient engagement as a major part of succeeding in a time of transition within the industry. According to Stephen Cavalieri, chief medical officer for Central Virginia Health Network, engagement is the linchpin in any successful healthcare transformation. This includes becoming an accountable care organization and improving outcomes as well as implementing solid communication practices throughout your practice. Physician leaders need to engage in face-to-face conversations with employees "as many times as it takes" to help them understand the ins and outs of specific tasks. In addition, it is important to show employees physician-to-physician comparisons, because according to Cavalieri, "physicians respond to competition." Finally, the communication must be constant and ongoing. This will ensure you get the most out of your employees as the healthcare industry continues to change.


The increased role of team-based care has made constant interaction between physicians and staff more important than ever. In-practice communication can be improved in many ways. Here are five tips from Krista Hirschmann, co-director of faculty development for the American Academy on Communication in Healthcare, who spoke at the recent Medical Group Management Association annual conference in Nashville:

1. Work together as human beings. "Take off your badges, your titles … and you have a team of human beings who want to do it right," Hirschmann said. Healthcare teams must learn to talk to each other as individuals.
2. Establish agreed-upon communication pathways. Email is not for everyone. Ask your employees whether they prefer emails, phone calls or face-to-face contact.
3. Understand role clarity. Everyone needs to know what their role in the practice is. Make it clear who will work on what, who will accomplish it and who will oversee the work.
4. Establish a feedback loop. Feedback often only comes when things go wrong, so this can be challenging. Focus on appreciation and positive reinforcement, which can make a huge difference in the culture of a medical practice.
5. Foster co-leadership. Leaders at a medical practice need to interact and communicate with one another. "We need to develop our leaders and make sure they have the ability to connect with other leaders and co-leaders at our practice," Hirschmann said.

Health Policy and Reimbursement

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A new proposed bill would require drugmakers and medical device manufacturers to publicly disclose their payments to nurse practitioners or other physician assistants. The legislation put forth by Sen. Charles Grassley and Sen. Richard Blumenthal would close a loophole in the Physician Payment Sunshine Act, which requires companies to report the aforementioned payments to doctors, dentists, chiropractors, optometrists and podiatrists. “We think that the void should be filled to have a complete record,” Grassley said. “Transparency isn’t an end to itself. Transparency is meant to bring accountability.” The lack of public information on payments to assistants makes it unclear how much money non-doctors are given. In recent years, though, a few cases involving practitioners and assistants taking illegal money have cropped up in Connecticut and Rhode Island. Blumenthal said the Connecticut case was “a clear, loud alarm bell. Doctors need to be held accountable, but so do all the other providers."


The ICD-10 Oct. 1 deadline has passed, but Bonnie Sunday, MD, chair of HIMSS ICD-10 Task Force, reports that not all organizations have made the transition. The ICD-10 Transition Step-by-Step Guide was created to help those who have not transitioned to the new code set. The guide helps providers navigate short- and long-term solutions for processing ICD-10 claims; handling ICD-10 claims sent to payers but for which reimbursement has not been received; and processing claims filed by payers with mismatched reimbursement amounts. For providers who have made the transition, the guide provides troubleshooting for incorrect reimbursement or rejected claims.


The Health and Human Services Office of Inspector General (OIG) released a reminder for industry stakeholders that information blocking can violate anti-kickback statutes, and in certain situations, it is not considered a safe harbor condition. OIG officials said, "Arrangements involving the provision of software or information technology to a referral source should be scrutinized for compliance with the federal anti-kickback statute." The office added that a safe harbor exists for situations involving the provisioning of interoperable electronic health record platforms. The purpose of that safe harbor is "to protect beneficial arrangements that would eliminate perceived barriers to the adoption of EHR without creating undue risk that the arrangements might be used to induce or reward the generation of business." OIG also noted that the safe harbor is not applicable to laboratories. Information blocking has become a concern due to growing complaints over IT developers charging fees for customers to send, receive, or export health information stored in electronic records.

Medicine, Drugs and Devices

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A team of doctors in Ontario created the Hamilton Early Warning Score (HEWS) earlier this year, which uses an algorithm that uses real-time data points from medical devices that predict which patients are at a higher risk for a medical emergency. The HEWS system was created in less than three months and provides clinicians with copious amounts of data, often allowing them to act before a patient situation worsens. The real-time aspect is the part that stands out, according to Mark Farrow, CIO of Hamilton Health Sciences. “It doesn’t help to capture a lot of electronic health information, but then eight hours later at the end of your shift to come back and say your patient probably had a cardiac arrest four hours ago. Instead we can say we think your patient could be in trouble in the next couple of hours, and you may need to intervene in their care to move them in the right direction. Our system shows this,” he said. The algorithm depends on seven components made up of vital signs and observations, which, when put together, yield a score. A healthy person would earn a "1," and a person at serious risk would earn a "5"; based on that score, you could predict how a patient's condition would get better or worse.


Researchers at the University of Arizona have developed a new microscope technology that could help surgeons work with more accuracy than previously possible. Known as augmented microscopy, it shows diagnostic information layered over real images of tissues and structures. "By displaying information through the surgical scope itself, the surgeon then sees the information with his or her own eyes," said Brian Pogue of Dartmouth College. The technology is only a prototype now, but Pogue believes it is not far off from clinical implementation. The microscope can maintain full three-dimensional stereoscopic vision, retain the imaging environment familiar to surgeons and help improve laser surgery.


Bacteria are more prevalent in hospitals than many realize, according to a new report in JAMA Internal Medicine. In the study, researchers asked hospital workers to remove gowns and gloves smeared with fake bacteria. When they did, the fake bacteria ended up on their skin or clothes 46 percent of the time. Employees at all four hospitals studied were equally likely to contaminate themselves, and all of the different kinds of workers–nurses, doctors, phlebotomists, dietitians and others–were equally likely to make a mistake in putting on or taking off their personal protective equipment. In response to the results, one hospital launched an effort to train employees on how to don and doff gowns and gloves according to protocols recommended by the Centers for Disease Control and Prevention. After training, the contamination rate for the hospital dropped from 60 percent to 19 percent. The results help explain why multidrug-resistant bacteria are such a stubborn threat in hospitals. The authors suggested the most logical solution would be to redesign personal protective equipment so that it is easier to remove without being contaminated.