November 1, 2017 | | JFAS | Contact Us

News From ACFAS

Book Your Hotel Room with onPeak & Save
No need to search countless travel websites to get the best deal on your hotel room for ACFAS 2018 in Nashville. Just book with our official housing partner, onPeak, and reserve your room at the Gaylord Opryland Hotel (a Marriott Rewards partner) for only $229 a night. This price includes a reduced resort fee of $18 per day.

When you book with onPeak, you are guaranteed the best rate. You can also rest easy knowing that you are protected from unauthorized third parties who may claim to be our housing partner and overcharge you.

Planning to fly Delta to Nashville on March 20 or 21? Enjoy further savings by using discount code NMR4D when reserving your flight at or by calling Delta directly.
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Have a Presence in the ACFAS 2018 Exhibit Hall
Don’t miss your chance to present your product or service in the ACFAS 2018 Exhibit Hall, March 22–25 at the Gaylord Opryland Hotel in Nashville. As an exhibitor, you’ll network with 1,800 foot and ankle surgeons from around the world who are interested in what you have to offer. You can further increase your reach by opting to:
  • Sponsor a conference event or educational grant
  • Advertise in ACFAS digital or print media
  • Display your company logo on ACFAS 2018 products
This year’s Exhibit Hall will cover more than 140,000 square feet, and space is filling fast! Download the Exhibitor Prospectus now at for details on how to reserve your booth.
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Thank You to the Division Presidents Council
In advance of the 14 ACFAS regional Divisions redistricting into nine Regions starting January 1, 2018, the Division Presidents Council (DPC) met for the last time on Saturday, October 21 in Chicago. The following Division presidents are retiring from their positions at the end of the year:
  • Tony Kim, DPM, FACFAS: Northwest/Canada Division 2
  • Harry Schneider, DPM, FACFAS: New England Division 8
  • Sean Keating, DPM, FACFAS: Upstate New York Division 10
  • Mark Dollard, DPM, FACFAS: Mid-Atlantic Division 11
  • Julie Wieger, DPM, FACFAS: Ohio Valley Division 13
  • Joe Menn, DPM, FACFAS: Southeast Division 14
The DPC discussed final steps to transition from Divisions to Regions and standardization of local educational programming throughout the new Regions.

The Regions will hold membership meetings at ACFAS 2018 this coming March in Nashville. View the new ACFAS Regions map on
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How Have You Participated in MIPS This Year?
Cast your vote in this month’s poll at right to let us know how you have participated in the Merit-Based Incentive Payment System (MIPS) so far in 2017. Visit throughout November to view real-time results, and thank you for sharing your input!
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Foot and Ankle Surgery

Peripheral Nerve Block in Ankle Fracture Surgery: A Qualitative Study of Patients’ Experiences
New research assesses the benefits of peripheral nerve blocks in acute ankle fracture surgery. Researchers sampled adult patients scheduled for ankle surgery with nerve blocks as the primary mode of anaesthesia, interviewing 14 within 48 hours postoperatively. They found that despite preemptive ibuprofen and paracetamol, some patients experienced excruciating rebound pain for up to two hours, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. They had difficulty understanding the effect and course of the nerve blocks. Moreover, there were misunderstandings regarding the blocks’ effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. The researchers recommend that patients be given thorough and repeated information, which they believe is crucial in preventing undesirable responses from patients and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.

From the article of the same title
Wiley Online Library (10/19/17) Sort, R.; Moller, A. M.; Herling, S. F.; et al.
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Reliability, Validity and Responsiveness of the German Self-Reported Foot and Ankle Score in Patients with Foot or Ankle Surgery
Patient-reported outcome measures are essential for evaluating the efficacy of orthopaedic procedures and are increasingly used in clinical trials to assess outcomes of healthcare. The objective of this study was to develop and culturally adapt a German version of the Self-Reported Foot and Ankle Score (SEFAS) and to evaluate reliability, validity and responsiveness. Forward and backward translation was performed according to Cross Cultural Adaptation of Self-Reported Measure guidelines. The German SEFAS was investigated in 177 consecutive patients, all of whom completed the German SEFAS, Foot and Ankle Outcome Score (FAOS), Short-Form 36 and numeric scales for pain and disability (NRS) before and in 118 patients six months after foot or ankle surgery. Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German SEFAS demonstrated excellent test-retest reliability with ICC values of 0.97. Cronbach’s alpha (a) value of 0.89 demonstrated strong internal consistency. No floor or ceiling effects were observed for the German version of the SEFAS. As hypothesized, SEFAS correlated strongly with FAOS and SF-36 domains. It showed moderate (ES/SRM > 0.5) responsiveness between preoperative assessment and postoperative follow-up. The researchers concluded that the German version of the SEFAS demonstrated good psychometric properties. It proved to be a valid and reliable instrument for use in foot and ankle patients.

From the article of the same title
BMC Musculoskeletal Disorders (10/10/17) Arbab, Dariusch; Kuhlmann, Katharina; Schnurr, Christoph; et al.
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Two Different Placement Paths in Popliteal Fossa with a Novel Nerve Block Needle with External Indwelling Cannula for Postoperative Analgesia
Previous studies have documented that single injection near the sciatic nerve bifurcation influences the anesthesia and analgesia effect, but this has not been explored for preoperative continuous popliteal sciatic nerve block. Researchers conducted a trial to compare two paths (proximal to the bifurcation and at the bifurcation) of ultrasound-guided continuous popliteal sciatic nerve block in foot and ankle surgery. They recruited 40 subjects who were randomly assigned to receive ultrasound-guided continuous popliteal sciatic nerve block at the puncture path proximal to the nerve bifurcation or at the nerve bifurcation. Subjects received an injection using a novel nerve block needle with external indwelling cannula guided by ultrasound invented by the corresponding author. The external indwelling cannula was inserted for postoperative analgesia. The primary outcome was numeric rating scale (NRS) scores (at rest and during movement) at 24 hours after surgery, and the secondary outcomes included measurements related to the performance of the nerve block and efficacy of analgesia, such as anesthesia effect grade, grade of nausea and vomiting, number of cases of patients with cannula leaking, occlusion or slipping and patient satisfaction. During the surgery, six subjects in the proximal group needed additional analgesic, significantly different from one in the at-bifurcation group. There was a significant difference in anesthesia effect pre to post in the proximal group, which received 2.1±1.6 of NRS on rest at 24th and 1.7±1.5 at 48th. The at-bifurcation group received 0.9±1.4 at 24th and 0.7±1.1 at 48th. The proximal group received more PCA times during 6th-24th and 24th-48th and had lower satisfaction scores. Continuous popliteal sciatic nerve block at nerve bifurcation had better analgesic effect and higher patient satisfaction, as compared to proximal to the bifurcation, the researchers concluded.

From the article of the same title
Minerva Anestesiologica (10/12/2017) He, Miao; Ling, Dandan; Cai, Guang-Yu; et al.
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Practice Management

EHR: A Bigger Role in Malpractice Claims
A study by the Doctors Company, a physician-owned medical malpractice insurer, found that as use of electronic health records (EHRs) increases, so does the technology's involvement in malpractice claims. Between 2007 and 2010, only two claims involved EHRs. However, between 2011 and 2016, that figure jumped to 161. The study found that hospital clinics and doctor offices are the primary location for EHR-related claims. The study authors wrote that EHR "has great potential to advance both the practice of good medicine and patient safety. However, there are always unanticipated consequences when new technologies are rapidly adopted, and the EHR is no exception."

From the article of the same title
MedPage Today (10/22/17) Pecci, Alexandria
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RA Patients and Their Docs Often Differ on Disease Severity
According to research published in Arthritis Research & Therapy, a third of patients with rheumatoid arthritis (RA) disagreed with their provider regarding the severity of their disease. Researchers say 29 percent believed their disease severity was worse than what their doctors assumed. Divya Challa, of the Mayo Clinic in Rochester, Minn., says patients with RA who also have fibromyalgia, depression or nonerosive disease were more likely to disagree with doctors on the severity of their disease. Researchers also say the disagreements between patients and doctors can lead to decreased work productivity, reduced likelihood of remission and the possibility of increased radiographic joint damage.

From the article of the same title
MedPage Today (10/21/17) Weiss, Gregory
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Should Patients Be Allowed to Record Their Doctors?
Is it OK to record advice that a doctor provides? More physicians may face this question soon. Cellphones are ubiquitous, and patients are increasingly accustomed to using these tools to document their daily lives. According to one recent U.K. study, 15 percent of patients are secretly recording doctor visits already and another 34 percent would record if given permission. The study's author, Glyn Elwyn, MD, a professor at Dartmouth Institute for Health Policy and Clinical Practice and former primary care physician, and colleagues have found that patients want to record visits to help them better remember and understand the information, as well as to share it with caregivers. However, some physicians object to recordings over concerns that they could be done for malicious reasons or to support a lawsuit. The legal picture is confusing, with laws that vary by state and have not kept up with technology, as well as a lack of clear guidelines from medical associations. Elwyn's group is working with organizations to try to help them come up with policy and is working with practitioners to develop an easy-to-use recording service.

From the article of the same title
Medical Economics (10/18/17) Collier, Lorna
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Health Policy and Reimbursement

Medicare Advantage Market Continues to Look Good
Many health insurers are avoiding the Affordable Care Act public exchange program this fall but are leveraging the Medicare Advantage program. Mark Farrah Associates says Medicare Advantage plan business is so enticing that insurers "invested in this segment have been preparing to diligently market their products in anticipation of enrolling more members." Mark Farrah analysts calculate the number of distinct Medicare Advantage plans has risen to 2,619 this year from 2,311 in 2016, and the number of plans available with no out-of-pocket premium expenses for enrollees has climbed from 896 to 1,053. The population of Medicare Advantage Special Needs Plans, designed to serve people with chronic health problems, rose from 589 to 640. Furthermore, in September, Medicare Advantage plan enrollment totaled about 20 million, up seven million year over year. With Medicare Advantage, private insurers can employ Medicare Part A hospitalization funding and Medicare Part B physician and outpatient services program money to offer an alternative to traditional Medicare coverage. The U.S. Centers for Medicare and Medicaid Services (CMS) applies a bidding process to encourage insurers to hold down total program costs and to boost plan quality ratings. Although insurers often claim CMS' efforts to exact more money from them will push issuers away from Medicare Advantage, this year, the program appears to be more attractive to insurers than to the commercial individual major medical market.

From the article of the same title
ThinkAdvisor (10/23/17) Bell, Allison
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Republican Lawmakers Propose More Conservative Obamacare Fix
Republican Senator Orrin Hatch, chair of the Senate Finance Committee, and Republican Representative Kevin Brady, chair of the House Ways and Means Committee, have made proposals intended to stabilize Affordable Care Act (ACA) health insurance markets. The proposals from Hatch and Brady include provisions that would suspend requirements for individuals and employers to buy health coverage under the ACA. Their proposals would also reinstate money that is used to subsidize payments to insurers that President Trump ended recently. Hatch's and Brady's plan is also meant to compete with proposals made by Sens. Lamar Alexander (R) and Patty Murray (D).

From the article of the same title
Reuters (10/24/17) Abutaleb, Yasmeen
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Uninsured Rate Rises to 12.3 Percent in Third Quarter, Up From 11.7 Percent
A new Gallup and Sharecare poll reveals that the uninsured rate has increased by 1.4 percent since the end of 2016, with the greatest increase being among those who paid for their own insurance either on or off the Affordable Care Act (ACA) exchanges. The number of adults with self-paid plans has declined from 21.3 percent to 20 percent. Higher uninsured rates put providers at risk for treating those without coverage who may also not be able to pay for care out-of-pocket. The survey found the largest increases in the number of uninsured is from lower-income and middle-income adults rather than from higher-income consumers. The 1.4 percent increase represents 3.5 million Americans. Gallup and Sharecare said other ACA factors are contributing to the growth of the uninsured rate, such as higher premiums, fewer insurers offering ACA plans, uncertainty about the healthcare law amid efforts by Republican lawmakers to repeal it and President Donald Trump's policies, which have helped destabilize the market. Consumers may also feel that the individual mandate to have insurance or face financial penalties will not be enforced. The report said, "Without Congress and President Donald Trump taking steps to stabilize the insurance markets, the number of uninsured Americans likely will continue to rise. Enrollment for 2018 plans on the ACA exchanges begins November 1, and recent developments suggest premium costs will continue to increase." The uninsured rate has risen by 1.8 points among those aged 35 to 64, compared with slightly smaller increases among younger adults.

From the article of the same title
Healthcare Finance News (10/20/17) Morse, Susan
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Medicine, Drugs and Devices

Biosimilars Have Potential to Cut Health Spending by $54 Billion Over Next Decade
A new analysis from RAND Corp. suggests that introducing biosimilar versions of complex biologic drugs could reduce healthcare spending in the United States by $54 billion over the next decade. The savings estimate is about 20 percent larger than estimates from a similar analysis conducted by RAND researchers three years ago, reflecting improved analysis methods and rapid growth in overall spending for biologics, which are the fastest-growing segment of prescription drug spending. About one percent to two percent of the nation's population is treated with a biologic annually, but the drugs accounted for 38 percent of prescription drug spending in 2015. Biosimilars are similar to already approved "reference" biologics in terms of potency, safety and efficacy but manufactured by different companies, the authors said. The Biologics Price Competition and Innovation Act authorized the U.S. Food and Drug Administration to create a new approval pathway for biosimilars with the goal of promoting competition. The researchers estimate that biosimilars will cut spending on biologics by about three percent over the next decade, with the range of the new savings estimate varying from $24 billion to $150 billion from 2018 through 2027 based on factors like the price and market share of biosimilars.

From the article of the same title
Healthcare Finance News (10/23/17) Lagasse, Jeff
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Only Nine Percent of Providers Meeting 2015 CEHRT Requirements
A survey of leaders at hospitals, health systems and physician practices finds that only nine percent of respondents have fully implemented products that meet requirements established by the 2015 edition of Certified EHR Technology (CEHRT). However, 41 percent said they are in the process of implementing the products. The survey also found that about 13 percent are in planning or evaluation stages; 12 percent are waiting for guidance from IT vendors; and seven percent said they have not started the process at all. Experts say the lack of full implementation reveals why major healthcare organizations supported the use of the 2014 edition CEHRT for reporting in the Merit-Based Incentive Payment System in 2018.

From the article of the same title
HealthExec (10/24/17) Gregory, John
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U.S. Hospitals Wrestle with Shortages of Drug Supplies Made in Puerto Rico
The damage caused by Hurricane Maria is beginning to have ripple effects in the healthcare industry on the U.S. mainland. The hurricane, which knocked out much of Puerto Rico's power grid, has halted the production of many drugs and devices used by hospitals in the U.S. and around the world. In most cases, production of products is occurring at limited levels. Currently, 10 percent of all drugs used by U.S. residents are made in Puerto Rico, and 80 companies make medical products there. Meanwhile, healthcare providers are being forced to find alternatives for products and drugs that are experiencing shortages.

From the article of the same title
New York Times (10/23/17) Thomas, Katie
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This Week @ ACFAS
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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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