November 12, 2014 | | JFAS | Contact Us

News From ACFAS

View Board Candidate Profiles Online
Profiles and position statements of the five candidates nominated for the ACFAS Board of Directors are now posted at Voting opens December 5, and each eligible voting member will receive an email with a unique link to the election website. After logging in, members will first see the candidate biographies and position statements, followed by the actual ballot. Eligible voters without a valid email address will receive instructions on how to log into the election website and vote by U.S. mail. There will be no paper ballots.

Two three-year terms and one two-year term will be filled by election. The ballot appearance is prescribed in the bylaws. Eligible voters may cast one, two or three votes on their ballot. Regular member classes eligible to vote are Fellows, Associates, Emeritus (formerly Senior) and Life Members.
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PCD Rx Exclusion of DPMs Delayed
Centers for Medicare & Medicaid Services’ (CMS) Local Coverage Determination (LCD) on Pneumatic Compression Devices (PCDs), which would have prevented DPMs from prescribing such devices, has been delayed. Four CMS Durable Medical Equipment Medicare Administrative Contractor (DME-MAC) jurisdictions issued a notice stating the rule would be delayed. While CMS deliberates, the current LCD rule, which allows DPMs to prescribe the device, will remain in effect.

Both ACFAS and APMA have been on the frontline of this issue, starting in 2011 when both organizations appeared before a CMS hearing. No policy change was proposed until a few months ago when the DME-MAC ruling was published. The Alliance of Wound Care Stakeholders, of which ACFAS is an active member, arranged a conference call with DME-MAC in early October, including APMA, vascular surgeons, and physical therapy and nursing organizations. Stephen C. Wan, DPM, FACFAS, represented the ACFAS Professional Relations Committee on the call.

The Alliance asked the four MAC medical directors for a reconsideration of the LCD rule because: 1) it was not evidence-based, 2) new evidence has been published since the draft LCD in 2011, 3) the new LCD rule conflicts with national policy and 4) there was no comment period. In late October, DME-MAC published a notice stating that all four jurisdictions would delay implementation of the LCD, but no “next steps” were mentioned. In the meantime, the current LCD is in effect, which allows DPMs to prescribe PCDs.
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CMS Sides with ACFAS, APMA on Sunshine Act CME Exclusions
Centers for Medicare & Medicaid Services (CMS) has sided with ACFAS and APMA on a small detail in the Affordable Care Act’s (ACA) “Sunshine” Open Payments regulations. CMS has removed language that would have exempted continuing medical education (CME) accredited via the Accreditation Council for Continuing Medical Education (ACCME, the “CPME” for MD CME) but no other accrediting agencies. CMS said other language in the ACA accomplishes the same objective without naming specific accrediting agencies.

“All we wanted was a level playing field,” said ACFAS Executive Director Chris Mahaffey. “CMS listened to us, agreed the original language was flawed and proposed a change in July. That change is effective January 1, 2015.” The CMS rule change will not directly affect physicians but could have had a chilling effect on educational grants to non-allopathic CME providers. ACFAS and APMA staff met with CMS’ Open Payments staff last January through the efforts of US Representative Danny Davis (D-IL).
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Final Call for 2015 Volunteer Leaders
Don’t miss your chance to help shape the future of ACFAS and the profession by volunteering to serve on one of 11 College committees for 2015-2016. If you would like to volunteer, visit All applications must be received by this Friday (November 14, 2014).
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Foot and Ankle Surgery

Manipulation and Brace Fixing for the Treatment of Congenital Clubfoot in Newborns and Infants
A new study has found that the use of manipulation and above-the-knee brace fixation is an effective technique for correcting clubfoot deformities in infants, which are some of the most common congenital deformities seen in children and can pose a challenge for orthopaedic surgeons. Of the 56 deformed feet treated with the technique, 52 had a normal appearance three to six months after treatment. The average Pirani score, which was used to assess the effectiveness of the treatment, changed from 4.893 +/- 1.02 before treatment to 0.21 +/- 0.09 one year after treatment. None of the 32 infants and newborns treated with the technique required additional treatment with percutaneous Achilles tenotomy. The study's authors concluded that manipulation and above-the-knee fixation is a good alternative to percutaneous Achilles tenotomy.

From the article of the same title
BMC Musculoskeletal Disorders (10/31/14) Su, Yuxi; Nan, Guoxin
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Treatment of Hypertrophic Distal Tibia Nonunion and Early Malunion with Callus Distraction
Callus distraction histiogenesis is an effective treatment for patients with hypertrophic nonunion and early malunion of distal tibia fractures, which can result in deformities that are difficult to treat, a new study has found. The study involved eight patients who were treated with callus distraction using either an Ilizarov fixator or Taylor Spatial Frame. These devices distracted the nonunion or early malunion to correct alignment and shortening. All of the eight patients achieved union after an average of 5.8 months. The study also found that the five patients who were treated with the Taylor Spatial Frame experienced deformity correction to within 5 degrees of neutral alignment in the coronal and sagittal planes. The three patients treated with an Ilizarov-type fixator experienced correction within 5 degrees of neutral in one plane and within 10 degrees in the other. The study's authors noted that the use of a computer-assisted 6-axis frame improved the correction of the multiplanar deformities. The study also found two complications that required reoperation and one persistent discrepancy in limb length. Finally, the study found that the median American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 82.5 after an average follow-up of 30.4 months.

From the article of the same title
Foot & Ankle International (10/30/2014) Schoenleber, Scott Jacob; Hutson Jr., James Jackson
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Practice Management

The Power of Medical Payment Software
Practice management systems can offer physicians' practices a number of important benefits that can allow them to cut costs and increase revenue. One beneficial feature included in practice management systems is automated claims submissions. In most practice management systems, this feature includes "scrubbers" that compare diagnosis, procedure and modifier codes used by the practice with the standard coding edits and rules used by insurers to verify their accuracy. This gives the practice time to edit inaccurate codes before they are submitted, which in turn reduces denials, says Lynn M. Anderanin, the senior director of coding compliance and education at the consultancy Healthcare Information Services. The use of appropriate codes can also increase revenue. In addition, electronic claims submissions can reduce claim submission costs at the average practice by more than 55 percent, the American Medical Association (AMA) says. Another beneficial feature that can be added to some practice management systems verifies patients' insurance eligibility before services are rendered. This allows practice staffers to avoid having to make phone calls to verify insurance eligibility and also prevents claim denials. AMA says physicians' practices can potentially save thousands of dollars each year by automating the process of insurance eligibility verification.

From the article of the same title
Physicians Practice (11/05/14) Colwell, Janet
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Forging New Bonds with NPs and PAs
While physicians' practices can enjoy a number of benefits from having non-physician providers (NPPs) on staff, it may be difficult to realize these benefits if patients insist on being seen only by doctors or if they are not confident in the care provided by NPPs. However, experts say physicians' practices can take several steps to overcome these obstacles to greater patient utilization of NPPs, beginning with offering patients a choice between seeing a physician or an NPP when they call to make an appointment. Lori Foley, a principal with the healthcare consultancy Pershing Yoakley & Associates, says front-office staff should inform patients that there would be a delay in seeing a physician but that NPPs would be readily available. Foley notes that the greater availability and flexibility provided by NPPs may encourage hesitant patients to see these providers. Another effective practice for encouraging patients to see NPPs is to have physicians introduce them, says Medical Group Management Association (MGMA) Health Care Consulting Group principal Rosemarie Nelson. She notes that these introductions can take place in person, at which point the physician should explain that he or she will be working closely with the NPP to care for the patient, or by mentioning that the patient's next visit or other services will be performed by the NPP.

From the article of the same title
Physicians Practice (11/03/14) Schwartz, Shelly K.
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Health Policy and Reimbursement

Meaningful Use Payments Reach $25B as of Sept. 30, CMS Says
Representatives from the American Medical Association and three other major healthcare organizations have expressed disappointment about recently-released data regarding meaningful use incentives and attestation rates. The Centers for Medicare and Medicaid Services (CMS) says it has paid more than $25 billion in incentives to eligible professionals and hospitals participating in the meaningful use program as of Sept. 30, which is up only slightly from the $24.8 billion that had been paid through the end of July. CMS' Office of eHealth Standards and Services also said over 500,000 active participants had signed up for the incentive program as of Nov. 1, although not all of these providers are participating. CMS says 43,898 eligible professionals attested to meaningful use for the 2014 reporting period, while 1,903 eligible hospitals had done so. For Stage 2 of the meaningful use program, 11,478 eligible professionals and 840 eligible hospitals have attested, CMS says. The agency expects attestation rates to increase as the Nov. 30 and Feb. 28, 2015 deadlines for eligible hospitals and eligible providers, respectively, approach. But American Medical Association President-Elect Steven Stack said the data shows that strict pass-fail requirements and a large number of overlapping regulations are keeping doctors from participating in meaningful use. Stack says a number of changes to the program are in order, including ending CMS' "one-size-fits-all approach" to creating a "secure and interoperable infrastructure."

From the article of the same title
iHealthBeat (11/04/14)
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Medicaid Expansion Faces New Hurdles
The results of the gubernatorial elections held on Nov. 4 suggest that Medicaid is not likely to be expanded further, while expansions that have already taken place could be rolled back in some states. In Florida, Georgia, Maine and Wisconsin, for example, Republican incumbents who either opposed expanding Medicaid outright or failed to propose legislation that would expand the program were all re-elected. Meanwhile, the newly elected Republican governors of Arkansas, Illinois and Massachusetts have said they will change or end their state's expansion efforts. But the expansion of Medicaid appears to be safe in Arizona, where Gov.-elect Doug Ducey (R) has said he would only end the state's expansion program if a significant decline occurs in federal funding. The expansion of Medicaid could also begin in Pennsylvania under the new administration of Democrat Tom Wolf.

From the article of the same title
Modern Healthcare (11/05/14) Dickson, Virgil
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Report: Healthcare Organizations Vary in ICD-10 Readiness
The American Health Information Management Association and the eHealth Initiative released a report on Nov. 4 that discussed healthcare providers' readiness for the ICD-10 conversion as well as recommendations for how they can prepare to switch over to the new codes on Oct. 1, 2015. Of the 454 people at physicians' practices, hospitals and other healthcare settings who participated in the survey, 65 percent said their organizations would be prepared to perform end-to-end testing before the mandated switch over to ICD-10. Just 10 percent of respondents said their organizations did not have such plans. Forty-five percent of these individuals worked at physicians' practices or clinics, the survey found. The survey also found that healthcare organizations were planning to take additional steps to prepare for ICD-10. For example, 70 percent of respondents said their organizations were planning to conduct additional training for staffers and give them more opportunities to practice with the new code set. Another 62 percent of respondents said they were working to improve the integrity of clinical documentation. The report also had several recommendations for how healthcare organizations could prepare for ICD-10, including performing testing early and at every stage of implementation.

From the article of the same title
iHealthBeat (11/06/14)
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Republican Midterm Results Set Up Obamacare Battle
Republican members of the new GOP-controlled Senate that will be seated in January are likely to attempt to repeal or modify the Affordable Care Act, as new senators largely ran on their opposition to the law. Sen. Mitch McConnell (R-Ky.), who will likely serve as the next majority leader, has vowed to completely repeal the Affordable Care Act. However, such repeal efforts will largely be symbolic as the GOP lacks the two-thirds majority needed to override an expected veto or the 60 votes needed to end a Democratic filibuster. That could force Senate Republicans to focus instead on potentially more realistic goals such as ending the individual mandate and repealing the tax on medical devices.

From the article of the same title
Modern Healthcare (11/04/14) Demko, Paul
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Medicine, Drugs and Devices

More Evidence Arthritis/Pain-Relieving Drugs May Contribute to Stroke Death
A recent study published in the journal Neurology has found that patients who currently take COX-2 inhibitors for arthritis and pain are at a higher risk of dying from a stroke than those who do not take these drugs. Researchers examined the records of 100,243 people who had been hospitalized for their first stroke in Denmark from 2004 and 2012 and determined whether these patients were current, former or non-users of newer COX-2 inhibitors, older versions of these drugs or non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Current users of COX-2 inhibitors were 19 percent more likely to die after having a stroke than their counterparts who did not take these drugs, while new users of older COX-2 inhibitors such as diclofenac were 42 percent more likely to die after having a stroke compared to non-users. However, no connection was found between chronic use of any of the three types of drugs and fatal strokes, nor was a link seen between the use of non-selective NSAIDs and an increased risk of fatal strokes. The study's authors concluded that more needs to be done to ensure patients at an elevated risk of stroke are not prescribed COX-2 inhibitors when other medications are available.

From the article of the same title (11/06/14)
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Sustained Remission with Etanercept Tapering in Early Rheumatoid Arthritis
A recent study examined the effects of reducing and withdrawing treatment in rheumatoid arthritis patients who experienced remission while being treated with a combination of etanercept and methotrexate. The study found that patients who dropped from a 50 mg dose of etanercept plus methotrexate to a 25 mg dose of etanercept and methotrexate experienced better disease control than did patients whose treatment was completely withdrawn or who switched to methotrexate alone. In addition, the study found that more patients who received the lower dose of etanercept along with methotrexate experienced sustained remission after 39 weeks than did patients who were treated with methotrexate alone or those who were given a placebo. This continued to hold true after 65 weeks, the study found.

From the article of the same title
New England Journal of Medicine (11/06/14) Emery, Paul; Hammoudeh, Mohammed; FitzGerald, Oliver; et al.
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Focal Ankle Joint Cooling Does Not Facilitate Hoffmann Reflexes of Ankle Muscles in the Standing Position
A new study sought to determine whether focal ankle joint cooling (FAJC) increases Hoffman (H) reflex amplitudes in the soleus and fibularis longus muscles when patients are standing in the bipedal and unipedal positions. The study involved 15 young adults with chronic ankle instability (CAI) and 15 healthy controls, all of whom were treated with FAJC, which involved applying a bag of ice to the ankle for 20 minutes. Participants also received sham treatments. Before and after each treatment, the study's authors measured maximum amplitudes of H-reflexes and motor waves while participants stood in quiet bipedal and unipedal stances. The study found no increases in H-reflex amplitudes of the soleus and fibularis longus muscles while participants were in the bipedal or unipedal standing positions, regardless of whether participants had CAI or not.

From the article of the same title
Journal of Sport Rehabilitation (10/14/14) Kim, Kyung-Min; Ingersoll, Christopher D.; Hertel, Jay
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Robert M. Joseph, DPM, PhD, FACFAS

Daniel C. Jupiter, PhD

Jakob C. Thorud, DPM

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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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