News From ACFAS

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Help advance the profession, patient care and the future of the College by volunteering to serve on one of the 2016 ACFAS committees.

To apply to be a volunteer committee member, visit acfas.org/volunteer. The application deadline is Nov. 20, 2015.
Special early bird rates for ACFAS 2016 won’t last long! Register before Dec. 1 and get ready for:

• in-depth scientific sessions with renowned speakers
• intensive hands-on workshops
• award-winning papers, posters and case studies
• our largest Exhibit Hall to date
• practical learning in The HUB (supported by Integra)
• the ACFAS Job Fair
• unlimited networking opportunities with 1,500+ of your peers and much more!

Visit acfas.org/austin for full details on everything that awaits you in Austin and watch your mailbox for our official ACFAS 2016 program book. The College’s only official housing partner is OnPeak, LLC. Hotel poachers, or organizations that falsely represent themselves as our official housing partner, are unauthorized third parties not related to ACFAS 2016. If anyone other than onPeak contacts you, do not give them your credit card information or a cash deposit.

Don’t end up without a room in Austin. The safest and most secure way to reserve your room for ACFAS 2016 is through acfas.org/austin. We guarantee our attendees the lowest hotel rates available.

Exhibitors: Unauthorized parties may try to sell you attendee lists of our meeting. If someone approaches you, contact us as soon as possible.

Foot and Ankle Surgery

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A study looked to add to current knowledge about functional outcomes following repair of partial peroneal tendon tears. Data was gathered for 201 patients who underwent primary repair of the peroneous brevis tendon, all of whom completed a follow-up questionnaire. A total of 83.1 percent of patients reported a return to regular exercise and sports. After one year postoperatively, 76.5 percent of patients returned to the same preinjury activities, and 62.3 percent returned to the same level of preinjury activity. The vast majority of patients were satisfied with the procedure (85.9 percent), and more than 90 percent of patients noted they would undergo the same procedure again if necessary. The data gathered showed that primary repair of peroneous brevis tendon resulted in improvement in functional outcomes in the majority of patients.


A recent study looked to determine whether a diminished baseline Mental Component Summary (MCS) score on the SF-36 is predictive of functional outcome after end-stage ankle arthritis surgery. MCS scores were compared with Ankle Osteoarthritis Scale (AOS) scores at the time of midterm follow-up. Researchers reviewed 337 ankles and found no correlation between the preoperative MCS score and the change in the AOS score. Patients with a preoperative MCS score of <50 and those with a preoperative MCS score of >50 showed no difference in change. Researchers concluded that preoperative mental health status did not predict functional outcome.

Practice Management

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Solid patient engagement has been proven to lower costs and improve patient outcomes. Healthcare has come a long way with patient engagement, particularly through the use of technology. Statistics show that one in 20 Google searches involves health-related information, 80 percent of Internet users seek online health information and 44 percent use the web to find information about doctors and other health professionals. Technology has produced numerous upsides to patient engagement. Costs are lower, communication is better and patients are more satisfied. But there are challenges as well. Health professionals face obstacles such as difficulty shifting behaviors, finding universal communication preferences, utilizing technology properly and reluctance to adapt to changes. To become more efficient in patient engagement, it is important for practices to perform analytics and measurements to figure out how best to use technology. Evidence-based measurements can go a long way toward finding the best patient engagement strategy, and it is a necessary tool for planning and implementing initiatives.


To thrive in a new market, patient-centered care must become a focus of your practice, according to experts. "It has to start from the top because if staff doesn't see it prioritized by the physician, they won't care as much," says Lauren King, director of customer service at DoctorsManagement, a medical and healthcare consulting firm. The most important way to improve customer service is to train your staff. This is critical because all staff members need to know their roles and how they improve patient satisfaction on an individual level. In addition, establishing protocols will provide the staff with the tools they need to deal with patient encounters without oversight. Experts say it is crucial for staff members to be able to handle certain issues without consulting the doctor, which can snarl daily routine and lead to restless patients. Staff members also need to know they will be held accountable in customer satisfaction. This will ensure optimal compliance with your practice's guidelines and all but guarantee that the patient will have a good experience.


Electronic health record (EHR) adoption has steadily grown among practices of all sizes, but accountable care organization (ACO) success is still hard to achieve. According to Farzad Mostashari, former U.S. National Coordinator of Health Information Technology, ACO success comes from truly optimizing the EHR. There are many ways to do this, starting with creating templates for particular visit types. “You want to be able to efficiently do wellness visits and transition-of-care visits. That’s key within an ACO," Mostashari said. Decision support capabilities are important as well. These tools can help notify physicians when patients need medication changes and are critical for keeping patients healthy and communicating with them. Use of your patient portal can help your patients understand every aspect of their care and allows them to more readily know when you are available. “You have to be able to reach out to your patients and send them messages to let them know that you haven’t seen [them] in six months and they need to come in for an appointment," Mostashari said.

Health Policy and Reimbursement

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Drug makers are circumventing efforts of pharmacists to nudge patients toward generic components. By using a process called "Prescriptions Made Easy," Horizon Pharma, for example, urges doctors to submit prescriptions directly to a mail-order specialty pharmacy affiliated with the company, cutting out the step of sending a patient to the drugstore with a prescription. The drug company's goal is to prompt physicians to prescribe expensive drugs instead of suggesting other options, such as combining two cheaper drugs. “It lowers one barrier to using their products,” said Dr. Kenneth Beer, a dermatologist in West Palm Beach, Fla. Specialty pharmacies are known for providing complex drugs that treat cancer and multiple sclerosis; the drugs dispensed through the specialty pharmacies controlled by drug makers are expensive options for treating common ailments like arthritis, acne and toenail fungus. Analysts note the process is legal, providing that co-pay assistance is not used for patients covered by Medicare or other federal programs.


New forms of payment triggered by the Affordable Care Act have prompted providers to add services and constrain costs to combat tumbling revenues. For example, a supply management team for BJC HealthCare's network of hospitals in the Midwest invested millions of dollars to attach RFID tags to medical devices, which reduced the amount of stock facilities had to keep on hand by 23 percent. There are far fewer errors than the alternative method of counting by hand, and the health system expects to make back its investment in under 18 months. Health systems are also paying more attention to costs because of the Obama administration's effort to move to a value-based care system. Systems like Ascension Health are moving their hospitals to a single management system, and they use scanning technology and new software to monitor inventory and keep track of products. Hospitals have been slow to adapt to non-traditional methods, particularly the ones used in retail, but the changes are becoming more universal.


A new study in JAMA Internal Medicine reveals that as hospitals continue to acquire independent practices, the prices for outpatient medical services have increased. According to J. Michael McWilliams, an associate professor at Harvard Medical School and an author of the paper, the increase in outpatient spending is most likely due to the stronger negotiating clout held by hospitals in comparison with most physician groups. In a community where physician-hospital integration increased by five percent over a four-year period, overall outpatient spending would be about $75 higher a year. For a particular individual whose doctor's practice was acquired by a hospital, the increase would be around $1,400. Doctors continue to work for hospitals, and some experts, such as professor Paul Ginsburg of the University of Southern California, believe "we should be very concerned." The American Hospital Association, meanwhile, issued a statement saying the study "is not reflective of the changes happening in today’s healthcare market."

Medicine, Drugs and Devices

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Microsoft and Johns Hopkins have teamed up in an initiative aimed at improving ICU device interoperability and preventing injuries and other complications. Project Emerge will yield a tablet app that integrates data from multiple patient monitors onto a centralized platform. In addition, Project Emerge is also piloting a tablet app for hospital bed use. "We are excited to collaborate with Microsoft to bring interoperability to these medical devices, to fully realize the benefits of technology and provide better care to our patients and their families," Johns Hopkins said in a statement. The initiative is the second recent partnership between Microsoft and the university. In May, Microsoft sponsored Johns Hopkins' FastForward incubator to encourage growth in the health IT space.


Intervention with person-centered physical therapy improved fatigue scores in patients with rheumatoid arthritis (RA) in a recent study. Seventy patients with RA were split into two groups: 36 received intervention and 34 continued normal care. The intervention involved a plan developed between the physical therapist and the patient. It focused on balancing life activities and putting together a physical activity plan with moderately intense aerobic activity for more than 30 minutes for five days per week, vigorous aerobic activity for more than 20 minutes for three days per week or a combination of activities. The intervention group experienced reduced fatigue compared with the normal care group, as well as less anxiety, increased leg strength and endurance, improved health and better self-rated efficacy.


The U.S. Food and Drug Administration (FDA) has issued numerous warnings over the past several months concerning security flaws in certain medical devices. In one instance, a line of drug pumps was determined to have a vulnerability that could allow an attacker to deliver a fatal dose to a patient. Research has shown more than ever that devices are not as secure as we may think, so why are there such lax cybersecurity regulations for these devices? FDA has formal guidelines but "does not establish legally enforceable responsibilities." While this seems bleak, security researchers note that FDA is starting to get on board with regulations. For example, when SAINT Corporation security researcher Jeremy Richards discovered the drug pump vulnerability, he said he was surprised at the government support he received. The vulnerabilities were discovered and the warnings were issued quickly, proving that FDA is on the right track. The biggest problem now is likely the process for approval of medical devices. "The challenge that medical device manufacturers face is that from concept, to design, to fed approval to deployment can take five years,” Richards wrote. “If you’re looking at a device that has been deployed for five years it is very likely it’s a ten-year-old computer...it's a tough problem to solve."