News From ACFAS

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On Monday, ACFAS eligible voting members received an email from the College’s independent election firm with a unique link to the 2016 Board of Directors Election website. If you are a Fellow, Associate, Life or Emeritus member, please take a few minutes to cast your vote for your elected leadership. Your vote is important to advancing our profession and surgical specialty.

If you have not voted yet, two more reminder emails will be sent to you in the next few weeks. If you do not have a valid email address on file with the College, watch your US mail for voting instructions. Voting remains open until Dec. 30.
When superior education meets the bright lights and big sounds of Austin, the result is an unforgettable conference experience that gives you everything you need to expand your knowledge and your network, all in just three days.

Register now for ACFAS 2016 and join your colleagues for a dazzling array of scientific sessions, workshops and exhibits that will reignite your passion for foot and ankle surgery and energize you for the year ahead.

Visit acfas.org/austin to register today and book your hotel reservations—don't miss your chance to be part of the profession's biggest event!
If you're excited to get a head start on ACFAS 2016, don't wait—come to Austin a day early on Wednesday, Feb. 10 to participate in any one of three hands-on workshops:

• Practice Management/Coding Workshop
  (8am–5:30pm, 8 CE Contact Hours)
• Diabetic Deformity: Master Techniques in Reconstruction
  (7am–Noon, 4 CE Contact Hours)
• High-Frequency Foot Surgery Techniques
  (Noon–5pm, 4 CE Contact Hours)

Take advantage of this opportunity to flex your surgical muscles, refine your coding skills and get a behind-the-scenes look at ACFAS 2016 before it officially opens. Space is limited for these special programs, so register now at acfas.org/austin. If you're a Residency Director who plans to attend ACFAS 2016 in Austin, come down a day early for the second annual Residency Directors Forum set for Wednesday, Feb. 10 from 1:30–5:30pm at the Austin Convention Center.

This invitation-only event will cover HIPAA Compliance for Training Programs; Teaching Complex Skills Using Performance Cues; Managing the Problem Resident and more. Space is limited and there will be no onsite registration, so register before the Jan. 29 deadline.

Visit acfas.org for details on the schedule and speakers.

Foot and Ankle Surgery

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A recent study analyzed the outcomes in diabetic patients undergoing Chopart amputation. Researchers looked at 83 patients, 38 of whom had gangrene, 31 with abscess and 14 with osteomyelitis. Forty-seven patients healed at a mean period of 164.7 days, and 15 had ulcer recurrence. Of the 83 patients, 38 died due to history of stroke, urgent surgery and age. Because Chopart amputation represents the last chance to avoid major amputation for diabetic patients with serious complications, the researchers determined that the success rate was great enough to deem the procedure viable.


Little information exists regarding return to sports and physical activities after primary partial arthrodesis for Lisfranc injuries. Researchers in a recent study compared various activities in young patients following the procedure. Thirty-eight patients responded for follow-up. There were 29 different and 155 total physical activities reported preoperatively, and 27 different and 145 total physical activities reported postoperatively. These activities included walking, bicycling, running and weightlifting. Difficulty in performing these activities was the same for 66 percent of patients and increased for 34 percent of patients. Participation improved in 11 percent of patients, increased in 34 percent and impaired in 25 percent. The average exercise time postoperatively was 4.2 hours per week. While most patients were able to return to their previous physical activities following primary partial arthrodesis for a Lisfranc injury, some results suggest that some patients experienced limitations. Future studies are necessary to determine a comprehensive comparison.

Practice Management

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Research has shown that collaborative communication between providers and patients leads to increased patient satisfaction, treatment adherence and decreased rate of readmissions. It can also cut safety risks and insurance costs. Research shows that an alarming number of physicians have never received professional development on how to carry out this communication appropriately, but viable options exist for those who want to learn. Some physicians are using new conversation-practicing simulations with virtual patients. These provide a risk-free environment where physicians can work on their interpersonal skills while building knowledge of specific topics and learning to exude certain qualities during discourse. The simulations can help regulate emotions and cue physicians to when and how to say certain words and phrases. This can be particularly helpful in cases of chronic disease, where identifying intrinsic motivators and developing patient trust and satisfaction affects treatment compliance.


Practices looking to reduce taxes should have a plan in place and know the intricacies of the system. Dr. Steven Podnos, CFP, says the first thing to do is to organize and fully fund a retirement plan with pretax dollars. Podnos says he can "think of no better way to build wealth" than this system. A pretax retirement plan allows you to deduct contributions while in a high-tax bracket. Another suggestion is to use a business as a way to take deductions. For physicians with an independently owned practice, this allows you to take regular business deductions associated with your practice that you cannot as a strict W2 employee. In addition, consider opening a Health Savings Account (HSA). An HSA is the only way in which you never pay taxes on some income. Withdrawals are also tax free if they are for healthcare expenses. Finally, if you are in a high-tax bracket, think about changing some of your fixed income to municipal bonds and make smart investments long term to avoid taxation while they grow in value.

Health Policy and Reimbursement

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U.S. Food and Drug Administration (FDA) investigators have found that inaccurate medical tests put patients in harm's way while raising medical costs. "Patients have been demonstrably harmed or may have been harmed by tests that did not meet FDA requirements," federal investigators concluded in a recent report to Congress. "Doctors and patients rely on these tests to make well-informed healthcare decisions. If they get inaccurate results, they can make the wrong decisions, and people get hurt as a result," said Jeffrey E. Shuren, MD, director of FDA's Center for Devices and Radiological Health. Inaccurate tests also hinder the development of new advanced medicines. Some of these new medicines can be tailored to individuals' genetic characteristics; a defective test could render any new treatment ineffective. The threats posed by these tests is a hot topic in Congress. The Obama administration is seeking new regulatory powers, and Republicans are discussing similar legislation. Experts also note a shift in perception. According to Jeffrey N. Gibbs, a lawyer representing medical device companies and laboratories, people who were once opposed to laboratory regulation are now more receptive to the idea.


Anthem and Aetna said they would keep operating under their Affordable Care Act (ACA) plans, one day after UnitedHealthcare announced it would likely pull out within two years. UnitedHealthcare's concerns surrounded its financial future under the ACA. Aetna and Anthem both experienced hits to their stock after the announcement but saw slight rebounds the following day. Aetna noted that it will be "continuing our dialogue with policymakers and regulators regarding how we can improve the stability of the individual market." Molina and Centene, which have about 200,000 and 150,000 ACA customers, respectively, also said they were staying put in the exchanges.

Medicine, Drugs and Devices

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New research shows that a preoperative diagnostic blood test could determine how long it will take for a patient to recover from surgery. Researchers at Stanford University compared immune responses among patients with certain surgical procedures and found that the activity of white blood cells that form new connective tissue predicted about half as much postoperative pain variation versus white blood cell count or a patient's mental state. The test could help surgical teams craft individual perioperative management strategies for patients based on the results. "Our research indicates that we can capture important aspects of each individual patient's biology that accurately predict how they will handle and recover from surgery. This may ultimately enable us to provide personalized, cost-conscious approaches to aid recovery and have a major impact on perioperative medicine," said study author Martin Angst.


Ransomware in medical devices is the biggest cybersecurity threat for 2016, according to a new report from research firm Forrester. Ransomware is a type of malware in which attackers can steal or delete the contents of users’ computers if they do not pay a ransom. While there are no known cases of ransom by medical device, experts agree that anything connected to the Internet is at risk–and medical devices represent one of the most enticing options for criminals. According to the FBI, most hackers ask for $200 to $10,000, but hacking a medical device could drive that price higher based on the necessity of the device in question. Users cannot put digital security measures in place to protect their biomedical devices. Those choices are in the hands of the manufacturer.