News From ACFAS

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Tomorrow, ACFAS voting members (Fellow, Associate, Life, and Emeritus members) will receive an email from the College’s independent election firm to confirm their email address for the 2012 Board of Directors Election that opens December 16. The email will come from acfas.ballot@intelliscaninc.net.

This is a test only, no action is necessary at this time. On Friday, December 16, you will receive an email with a unique login to the voting site. Members without a valid email address on file will receive a letter with login instruction. The College is implementing online voting at the request of 95 percent of its members.
The candidate profiles and position statements for the three recommended candidates in the Board of Directors election are now available for review at the web link below. Take a few minutes to read this information before you vote starting December 16 (see item above). The profiles will also be a part of the online voting web site.

Foot and Ankle Surgery

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Researchers evaluate the biomechanical results of various deltoid ligament reconstruction techniques using finite element analysis. A three-dimensional finite element model of the ankle including six bony structures, cartilage and nine principal ligaments surrounding the ankle joint complex was developed and validated. Also, superficial deltoid-deficient, deltoid-deficient, Wiltberger reconstruction, Deland reconstruction, Kitaoka reconstruction and Hintermann reconstruction models were simulated. The forces in the ligaments and grafts and the kinematics of talus and calcaneus were then predicted for an eversional or external torque through the range of ankle flexion. No reconstructions could completely restore the values for ankle flexibility and the stresses of the lateral ligaments to normality. The Kitaoka procedure was the most effective technique in eliminating external rotation displacement. The Deland procedure restored better the talar tilt than the other three reconstructions.


Researchers assessed heterotopic ossification following total ankle replacement to see whether the degree of ossification was related to the clinical outcome. The study involved evaluation of 90 ankles in 81 consecutive patients who underwent total ankle replacement, and heterotopic ossification was assessed according to proportional involvement of the ankle joint. No significant correlation was uncovered between the formation of heterotopic ossification and the clinical outcome, and the degree of heterotopic ossification in the posterior ankle joint was not significantly associated with posterior ankle pain, the AOFAS score, or range of movement.


Researchers conduced a prospective analysis on 30 physically active individuals with chronic insertional tendinopathy of the tendo Achillis. Using a transverse incision, the tendon was debrided and an osteotomy of the posterosuperior corner of the calcaneus was performed in all patients. At a minimum post-operative follow-up of three years, the Victorian Institute of Sports Assessment scale – Achilles tendon scores were significantly improved compared to the baseline status. In two patients a superficial infection of the wound developed which resolved on antibiotics. There were no other wound complications, no nerve related complications, and no secondary avulsions of the tendo Achillis. In all, 26 patients had returned to their pre-injury level of activity and the remaining four modified their sporting activity. At the last appointment, the mean pain threshold and the mean post-operative tenderness were also significantly improved from the baseline (p < 0.001). In patients with insertional tendo Achillis a transverse incision allows a wide exposure and adequate debridement of the tendo Achillis insertion, less soft-tissue injury from aggressive retraction and a safe osteotomy of the posterosuperior corner of the calcaneum.

Practice Management

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The Centers for Medicare & Medicaid Services (CMS) is providing educational resources aimed at healthcare providers to prepare for the transitions to Version 5010 standards for electronic health claims and ICD-10 medical coding. CMS has created an interactive widget and corresponding printer-friendly compliance timelines to help providers remember important action items and meet milestones for the switches. The widget and timelines are available here.


There is opportunity for healthcare providers to augment quality of care in the impending upgrade to ICD-10 through the higher specificity of the coding structure, according to El Camino Hospital CIO Greg Walton; still, he thinks the U.S. healthcare sector will not realize the benefits of the ICD-10 mandate for about five years. Cleveland Clinic Health System's Lyman Sornberger says ICD-10 will lead to more accurate diagnoses by forcing providers to be more granular in their documentation, and a major component in ensuring that quality of care improves as a result of the mandate is obtaining physician and personnel buy-in. The thousands of ICD-10 codes will produce a corpus of data that will provide healthcare leaders with an opportunity to better analyze care and ultimately enhance patient outcomes.


Physicians practices rely heavily on referrals to expand. Practices should keep non-physician sources in mind when going over their acknowledgment program. However, it is important that the referral acknowledgment gift not be mistaken for a bribe or kickback. Referral sources should be thanked every time they refer the practice with a personal note or call, and should be organized in a computer database. About once or twice a year, the practice should send something nice without mentioning a particular patient to convey that the sources are valued. Consultants recommend perishable gifts like food or flowers. Physicians may also consider something that has proven beneficial to their practice, such business or medical books, coffee table books, articles, or even cartoons. Colleague who have a nice conference room may appreciate receiving a tray or pitcher etched with the practice's name, logo, or other message.


Increasingly family members are joining patients during doctor appointments, sometimes as caregivers and sometimes because of concerns or to provide support. There are a number of things which doctors should do to ensure that this participation provides the best outcome for the patient. The first, and arguably most important, aspect is to find out who the relative is and whether the patient actually wants them at the appointment. It is also important to find out why the relative came, such as having particular concerns about the patient's condition. Getting the participation of a patient-approved relative can play into best practices by giving the doctor more medical history and current information, by asking questions that might not be thought of at the time, and helping a patient adhere to scheduled visits, medication regimens or lifestyle practices.

It is, however, vital to take time alone with the patient, as there are often things that a patient simply does not feel comfortable discussing with anyone but their doctor. The American College of Physicians' Ethics, Professionalism and Human Rights Committee advises that doctors focus on the patient and regularly make sure how much and what kind of participation the patient wants from family members. Some other recommendations include making sure that the patient and the relatives understand any conditions or prognosis and what type of care the patient wants.

Health Policy and Reimbursement

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Democratic Party leaders in the House are calling for an extension of the sustainable growth-rate Medicare payment formula fix in order to delay a scheduled 27.4 percent cut in provider reimbursement that will take effect in January unless action is taken. In a letter to House Speaker John Boehner, Minority Leader Nancy Pelosi of California, Democratic Whip Steny Hoyer of Maryland and Assistant Minority Leader James Clyburn of South Carolina called on Republicans to ensure an extension of the SGR fix by December 16.


Center for Medicare and Medicaid Services Administrator Donald M. Berwick has notified colleagues that he will step down Dec. 2, nearly a month before the expiration of his recess appointment. The Obama administration will nominate Marilyn Tavenner, Medicare’s deputy administrator, as his replacement. In announcing her nomination, the White House highlighted Tavenner’s nearly 35-year healthcare career, “including almost 20 years in nursing, 3 years as a hospital CEO and 10 years in various senior executive level positions for Hospital Corporation of America.”


Physicians will no longer be notified if someone is checking their record in the Health Resources and Services Administration's National Practitioner Data Bank (NPDB), according to an HHS final rule. The rule will exempt the use of NPDB information from certain provisions of the Privacy Act, including those that mandate notifying a physician if their information has been requested as part of a criminal, civil or regulatory investigation; allowing individuals who are the subject of an investigation to correct or amend their information; and letting individuals know—upon their request—if the NPDB contains information on them.

Medicine, Drugs and Devices

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The Centers for Medicare and Medicaid Services (CMS) have put together an initiative that will award as much as $1 billion in grants for concepts that can rapidly furnish cost savings and higher-quality care to the Medicare program. The effort will supply three-year grants of $1 million to $30 million to healthcare providers, payers, local government entities, and public-private partnerships, including collaborative projects among multiple payers.


A recent survey conducted by the Computing Technology Industry Association finds that within the next year, almost half of all doctors will use tablets and other mobile devices as an everyday tool for work. Already, a quarter of healthcare providers surveyed use tablets and another 21 percent expect to do so within a year. These devices will be used to access patients information in the form of electronic medical records (EMRs), a system the federal government wants more than half of all healthcare facilities to use by 2014. If facilities use EMRs, and prove their meaningful use, they can eligible to receive reimbursement funds under the American Recovery and Reinvestment Act of 2009.


A financial study published at the beginning of November in the Journal of the American Medical Informatics Association revealed that emergency physicians' use of health information exchanges (HIEs) for immediate access to patient records would save millions of dollars. The study looked at almost 15,800 patients whose records were accessed via HIE and the same number of patients, with matching criteria, whose records were not accessed. The use of HIE electronic files minimized paper summaries, hospital admissions, and laboratory tests, as well as the number of unnecessary CT scans that would have exposed patients to high amounts of radiation pointlessly. The total annual savings from the use of the HIE, less the operating cost of the system, was close to $1.07 million. The authors of the study were careful to point out that this annual cost savings was for less than 10 percent of patients seen at the emergency departments in the one metropolitan region.