November 19, 2014 | | JFAS | Contact Us

News From ACFAS

Register Now & Save on ACFAS 2015!
Are you among the many ACFAS members already registered for ACFAS 2015 in Phoenix? If not, register now for access to top-notch clinical and scientific sessions, cutting-edge research, hands-on workshops, the HUB in the Exhibit Hall, unlimited networking opportunities and more—all set to take place in the nation’s sunniest city!

Early bird rates are available until December 5, 2014, so don’t miss out—visit today to save on registration and to receive the best hotel rates through our official housing partner, onPeak, LLC.
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Something for Everyone in the ACFAS 2015 Exhibit Hall
Want to see the latest industry products and services, get answers to your questions on issues facing today’s foot and ankle surgeon or look for a new job? Be sure to then visit the Exhibit Hall at the Annual Scientific Conference where you’ll be able to do all of these things and more in 100,000+ square feet of space!

The popular HUB, set to make its second appearance, will include sessions on practical and timely topics such as cyberliability, contracts and effective public speaking. Sponsored by PICA, this small, interactive theater housed in the Exhibit Hall is the place to ask questions, get answers and learn from the best.

Also returning to the Exhibit Hall is the ACFAS Job Fair, sponsored by, where you’ll be able to hunt for jobs or potential candidates, post and view resumes and coordinate interviews while on site. Plus, a photographer will be available once again to take professional headshots for your resumes and social media profiles.

Visit for more on the HUB, Job Fair and other conference activities and events.
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ACFAS Regional Divisions 7 & 8 Seek Officers
If you live in Michigan, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island or Vermont, ACFAS Division 7: Michigan and Division 8: New England need you! Both Regional Divisions are seeking volunteers to fill the Secretary/Treasurer officer positions, as their current officers succeed up their slates.

The Secretary/Treasurer is responsible for keeping the books of the Division; providing financial oversight for Division funds; compiling biannual financial reports to the Division Presidents Council Finance Committee; and assisting with leadership of the Division.

If you want to participate in ACFAS at the local level and provide superior care to foot and ankle surgical patients through education, research and the promotion of the highest professional standards, get involved in your local ACFAS Division. All interested ACFAS Members can submit their CV and statement of interest, or any questions, to

The deadline for response is December 19, 2014, and electronic ballots of all candidates will be sent to Division 7 and 8 members in early January. The new terms begin in February 2015.
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Don’t Be Swindled By Hotel Poachers for ACFAS 2015
With the 2015 Annual Scientific Conference in Phoenix just around the corner, you may find organizations falsely representing themselves as our official housing partner and soliciting conference attendees and exhibitors. Please remember that the College's only official housing partner is OnPeak, LLC. If any organization other than OnPeak contacts you, do not give your credit card information or cash deposits.

You can safely make your ACFAS 2015 hotel reservation through OnPeak by visiting
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Foot and Ankle Surgery

Knotted Versus Knotless Suture Bridge Repair of the Achilles Tendon Insertion
A recent study was performed to compare the effectiveness of knotless suture bridge fixation to knotted suture bridge fixation in the surgical treatment of insertional Achilles tendinopathy, as few if any studies have examined this topic. The study involved a single specimen from each pair of 10 cadaveric Achilles tendons that were randomized to either the knotted or knotless suture bridge repair groups. A significantly higher load to failure was observed in the knotted suture bridge repair group compared to the knotless group. However, tendon strain after cyclic testing was significantly greater in the knotless suture bridge group than in the knotted group. In addition, the study's authors observed that all of the constructs failed at the tendon-suture interface. No significant differences were observed between the two groups in terms of footprint size, stiffness and repair site displacement. The study's authors concluded that the use of knots at the proximal suture anchors resulted in significant improvements in the biomechanical strength of the repair. The study's authors also noted that surgeons should be aware of the biomechanical differences between knotted and knotless suture bridge fixation because they can affect the post-operative rehabilitation protocol as well as surgical complication rates.

From the article of the same title
American Journal of Sports Medicine (11/01/14) Vol. 42, No. 11, P. 2727 Cox, Joseph T.; Shorten, Peter L.; Gould, Gregory C.; et al.
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Arthroscopic Treatment of Anterior Ankle Impingement
A new study examined the mid-term outcomes of arthroscopic debridement in 46 patients with ankle impingement but without osteoarthritis, as the results of this procedure in such patients are unclear. All of the patients were assessed pre-operatively, treated with standardized arthroscopic debridement followed by uniform post-operative management and were assessed again at various intervals during a follow-up period that lasted at least five years. The study's authors observed significant improvements in functional outcome scores after five years. For example, the average Foot Functional Index score improved from 20.5 before surgery to 2.7 at final follow-up. A slight improvement was seen in ankle dorsiflexion, which rose from a pre-operative average of 24.7 degrees to a mean of 27.0 degrees at final follow-up. However, 84 percent of patients experienced a recurrence of radiological osteophytes. In addition, plain radiographs performed at final follow-up showed no significant changes in the Scranton and McDermott classification grade or tibial osteophyte size compared to before surgery.

From the article of the same title
American Journal of Sports Medicine (11/01/14) Vol. 42, No. 11, P. 2722 Walsh, Stewart J.; Twaddle, Bruce C.; Rosenfeldt, Michael P.; et al.
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Practice Management

Six Ways to Avoid a RAC Audit
Physicians' practices of all sizes need to concern themselves with the possibility of audits by the Centers for Medicare and Medicaid Services' Recovery Audit Contractors (RACs). Practices can avoid or minimize their risk of such audits by refraining from copying and pasting documentation and instead using patient-specific documentation, writes Lucien W. Roberts, III, MHA, FACMPE. Roberts, who works as a practice administrator and has helped practices with issues such as billing and collections, adds that RACs are likely to pay greater attention to the issue of copied and pasted documentation next year and beyond at the behest of the Department of Health and Human Services' Office of Inspector General. Roberts also recommends that practices avoid relying on the evaluation and management (E&M) services code selector included in electronic health record systems, as this tool is known to be inaccurate. RACs are paying particularly close attention to the use of E&M codes, Roberts says, as the use of Level 4 and Level 5 codes for E&M services has risen more than 60 percent since 2001. Roberts says physicians' practices should be sure that the E&M codes they use match the complexity of their decisionmaking.

From the article of the same title
Physicians Practice (11/12/14) Roberts, Lucien W.
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Three Tips for Successful EHR Training
Experts say physicians should ensure practice staffers are properly trained on how to use electronic health record (EHR) systems so that they get the most out of this technology. One way to achieve this goal is to use a constant training process rather than one that ends after one or more training sessions. Such constant training can include elements like online tutorials, workshops and training support provided by EHR vendors. In addition, physicians' practices should ensure EHR trainers have all the information they need to tailor their courses to the practice's unique needs, including how the practice's work flow is set up. Finally, the Office of the National Coordinator for Health Information Technology suggests that practices identify tech-savvy staffers and designate them as "super users" who learn about every aspect of the EHR system and then impart their knowledge to colleagues who are less tech-savvy. However, physicians' practices should be sure that their super users are not the only staffers adequately trained to use the EHR system since failing to properly train all employees could result in a breakdown in the practice's "flow." This can in turn result in greater levels of patient dissatisfaction, backlogs of work and an interrupted revenue cycle, one expert says.

From the article of the same title
Physicians Practice (11/11/14) Hurt, Avery
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Health Policy and Reimbursement

End to Global Payments a "Nightmare," Surgeons Say
The American College of Surgeons (ACS) is criticizing a final rule recently issued by the Centers for Medicare and Medicaid Services (CMS) that calls for global surgical payments to be gradually phased out in favor of separate payments for individual procedures and services. ACS Medical Director Frank Opelka, MD, says the rule is overly burdensome for surgeons because it will be very difficult for them to keep track of all the different payments they receive for different services. The policy is expected to affect roughly 25 million procedures per year, an ACS analysis of statistics from 2013 suggests. In addition, the new policy could result in lower payments to some surgeons, Opelka says. Opelka adds that patients could also be harmed by the move away from global surgical payments, as the new system could prompt some to pass on necessary healthcare procedures in the name of saving money. He also noted that while the new payments system could result in lower costs for many patients who require fewer services, patients with complex comorbidities who require more services could see significant increases in costs. The higher costs for these patients will surpass any savings that may be achieved, Opelka says, resulting in higher costs for Medicare. The new policy will be phased in beginning Jan. 1, 2017 and will be completely in place one year later.

From the article of the same title
Health Leaders Media (11/12/2014) Clark, Cheryl
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AMA Calls for Coverage Expansion, SGR Repeal
The American Medical Association's (AMA) recent House of Delegates meeting produced a number of policy recommendations that were a direct response to the results of the mid-term elections, in which Republicans took control of the Senate and several conservative governors opposed to the expansion of Medicaid were re-elected. Although the re-election of these governors is seen as making the expansion of Medicaid in their states less likely, AMA delegates nonetheless called for these states to expand the government health program by developing expansion waivers that will give low-income adults more coverage options. In addition, the Centers for Medicare and Medicaid Services (CMS) should approve waivers that will help expand insurance coverage, AMA delegates said. Meanwhile, AMA President Robert Wah, MD, told delegates Congress should repeal the sustainable growth rate formula during its lame-duck session. Wah said he is optimistic Congress will pass a repeal at some point even if it fails to do so during the current session. Delegates also called for an end to Meaningful Use penalties, noting that just 2 percent of physicians have demonstrated Stage 2 Meaningful Use.

From the article of the same title
Health Leaders Media (11/13/2014) Commins, John
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Health-Law Enrollment in 2015 Won't Meet Forecast
The Department of Health and Human Services (HHS) has released new enrollment goals for private health insurance plans offered through health insurance exchanges that are lower than predictions the Congressional Budget Office (CBO) released in April. Between 9.1 million and 9.9 million people are expected to have enrolled in and paid for such plans by the end of 2015, according to HHS. CBO expected 13 million people to have enrolled in private health insurance plans next year. HHS officials said the discrepancy is the result of several factors, including the CBO's assumption that more consumers would turn to the exchanges after losing insurance offered through their employers--a scenario that has not come to pass. Observations made during the first enrollment period as well as data about participation in other health programs aimed at a wider swath of people also led HHS to issue lower enrollment forecasts.

From the article of the same title
Wall Street Journal (11/10/14) Radnofsky, Louise
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Court Challenge Stirs ObamaCare Angst
Healthcare industry observers are expressing concern about how the Affordable Care Act could be negatively impacted should the U.S. Supreme Court strike down some of the subsidies given to consumers to purchase health insurance coverage. According to Elizabeth Carpenter, the director of the healthcare consultancy Avalere Health, the Supreme Court's decision to take the case in which it will consider the legality of the subsidies has created a "cloud of uncertainty" regarding the implementation of the Affordable Care Act. Meanwhile, RAND Corporation healthcare economist Chrissy Eibner says the end of some of the subsidies could be the beginning of a vicious circle that makes the Affordable Care Act unworkable and forces Congress to amend the statute. A decision in the case, King v. Burwell, is not expected until the spring.

From the article of the same title
The Hill (11/08/14) Ferris, Sarah
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Medicine, Drugs and Devices

Efficacy and Safety of Certolizumab Pegol in Patients with Active Rheumatoid Arthritis
Researchers who performed the first-ever prospective blinded trial of certolizumab pegol (CZP) in patients with active rheumatoid arthritis (RA) who stopped taking a tumor necrosis factor (TNF) inhibitor despite its effectiveness found that CZP is a safe and effective form of treatment for these patients. The study found that 61.5 percent of patients who were given CZP achieved a 20 percent improvement on the American College of Rheumatology's scale of measuring changes in RA symptoms (ACR20) compared to none of the patients who were given a placebo. The rate of ACR20 in patients who were given CZP was higher than what was seen in previous studies of patients who had stopped taking an initially effective TNF-inhibitor. The study also found that CZP was both safe and tolerable, as no serious adverse events occurred in patients who were given the treatment.

From the article of the same title
Annals of the Rheumatic Diseases (12/01/2014) Vol. 73, No. 12 Schiff, Michael H.; Von Kempis, Johannes; Goldblum, Ronald; et al.
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Structural and Functional Outcomes of a Therapeutic Strategy Targeting Low Disease Activity in Patients with Elderly-Onset Rheumatoid Arthritis
Elderly-onset rheumatoid arthritis (RA) patients can realize significant benefits from being treated with a therapeutic strategy that targets low disease activity (LDA), a new study has found. The study involved 151 methotrexate-naive patients with an average age of 74.9 years, all of whom were initially treated with non-biologic disease-modifying anti-rheumatic drugs followed by tumor necrosis factor inhibitors or tocilizumab. After 52 weeks of treatment, structural remission and functional remission were achieved by 49.7 percent and 63.4 percent of patients, respectively, while 51 percent achieved LDA. The study also found that clinical responses at weeks 12 and 24 were significant independent predictors of clinically relevant radiographic progression, which were examined using multivariate logistic regression models.

From the article of the same title
Rheumatology (10/08/14) Sugihara, Takahiko; Ishizaki, Tatsuro; Hosoya, Tadashi; et al.
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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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