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December 11, 2013

Annual Scientific Conference Early Bird Savings Rate Ends December 16


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News From ACFAS


Prepare to Vote
This Friday, ACFAS voting members (Fellow, Associate, Life, and Emeritus members) will receive an email from the College’s independent election firm with their unique link to the 2014 Board of Directors Election website. The email will come from acfas.ballot@intelliscaninc.net. If you do not have a valid email address on file with the College, you will receive voting instructions via US mail.

Please watch for this email and cast your vote for your elected leadership. Your vote is important to advance our profession and surgical specialty.
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Last Week for ACFAS 2014 Early Bird Rates
Don’t miss out on the Early Bird Rate to save on your registration to the Annual Scientific Conference in Orlando—the last day to take advantage of this rate is December 16.

Register today at acfas.org/Orlando to save $75 or more on your ticket to the premier educational event for foot and ankle surgeons. Experience expert speakers, cutting-edge clinical and practice management topics, and hands-on interactive workshops.

Imagine the opportunities at ACFAS 2014 -- February 27-March 2, 2014 at the Gaylord Palms Resort. Visit acfas.org/Orlando to download the Program Guide, register and make your hotel reservations!
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Don't Forget to Renew Your Membership
All ACFAS members should have received their 2014 ACFAS dues reminders in the mail. Don't let your membership in your professional organization slip; renew your membership today by visiting acfas.org/paymydues or via mail or fax to ensure your member benefits will continue. Payment is due by Dec. 31, 2013.

As always, your College membership connects you to the best and brightest foot and ankle surgeons in the world. Here’s to your membership bringing you another great year of value!
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Transitioning Your Practice to ICD-10 Webinar
ICD-10 is coming, and with its unprecedented changes to coding, documentation, and reimbursement, there's a lot of new information to learn. To educate members and help them prepare for the transition, ACFAS is presenting the one-hour webinar "Transitioning Your Practice to ICD-10" on February 12, 2014 at 7:30pm.

Join Marcy C. Blitch, RHIA, CCS and ICD-10 Certified Trainer as she walks listeners through the new, radically different coding system and helps them to start to prepare for the implementation into their practice.

Registration is $65 for ACFAS members and their staff, and $100 for non-members and non-members’ staff. To register, visit www.acfas.org/practicemanagement.
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Foot and Ankle Surgery


Hindfoot Arthrodesis for Rheumatoid Hindfoot Disease: A Clinical Study of Patient Outcomes and Satisfaction
A new study by orthopaedic surgeons at Britain's Royal Infirmary of Edinburgh has found that hindfoot arthrodesis is an effective treatment option for advanced rheumatoid arthritis disease, particularly when conservative forms of treatment have been ineffective. A surgeon performed 42 hindfoot arthrodesis procedures on 37 rheumatoid arthritis (RA) patients, all of whom were assessed before the surgery and again six and 12 months after surgery. Statistically significant improvements were seen in all measured outcomes--including the Manchester-Oxford Foot Questionnaire index, visual analogue pain score and satisfaction scores, and radiographic assessment--at both the six- and 12-month followups. The union rate was 97.6 percent, while the satisfaction rate was 92.5 percent. The complication rate, meanwhile, was 7.1 percent. The surgeons who performed the study concluded that advanced rheumatoid hindfoot disease patients should be referred to foot and ankle surgeon specialists soon after the failure of conservative treatments.

From the article of the same title
Clinical Rheumatology (12/01/13) Vol. 32, No. 12, P. 1777 Ohly, Nicholas E.; Breusch, Steffen J.
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Arthrodesis of the Lisfranc Joint Complex with a New Multidirectional Locking Plate: Midterm Results
A new study has found that metatarsal cuneiform arthrodesis using a new multi-directional locking plate is an effective technique for treating Lisfranc injuries. The study examined 14 patients who underwent a metatarsal cuneiform arthrodesis of the medial arch of the affected Lisfranc joints using a multi-directional locking plate, though some patients also underwent an additional fusion of the middle Lisfranc joint using a 3.5 mm lag screw. Researchers performed clinical and radiologic followup on 11 of the 14 patients after an average of 16 months. The etiology of these 11 metatarsal cuneiform arthrodesis patients was posttraumatic in four cases, primary in one case, secondary in three others, and degenerative in seven. Ten of the 11 patients, or 91 percent, experienced union after an average of 143 days. However, there may not necessarily be a correlation between nonunion and poor function or pain. The patient who did not experience union had an American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score of 91, while the visual analog scale score dropped from 10 before the operation to 0 at followup. The average AOFAS score for the entire group was 85.64, while the average visual analog score fell from 8.36 before the operation to 1.82 afterwards.

From the article of the same title
Techniques in Foot & Ankle Surgery (Fall 2013) Vol. 12, No. 4, P. 210 Brehm, Manuel; Aufdenblatten, Cristoph; Schirm, Andreas
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Stable Surgical Repair with Accelerated Rehabilitation Versus Nonsurgical Treatment for Acute Achilles Tendon Ruptures
A recent study examined how well non-surgical treatment of acute Achilles tendon ruptures and stable surgical repair with accelerated tendon loading improved patient-reported outcome and function. The 100 acute total Achilles tendon rupture patients who participated in the study were randomized to either surgical treatment that included an accelerated rehabilitation protocol or nonsurgical treatment. Symptoms, physical activity level, and function were evaluated at three, six, and 12 months. Researchers found that none of the patients who were treated with surgery experienced reruptures, though five patients in the nonsurgical group did. There were also no major soft tissue-related complications in the surgery group. In addition, researchers observed a trend toward improved function in the surgery group. These results were significantly superior when assessed by the drop countermovement jump and hopping. However, surgery was not significantly superior to nonsurgical treatment in terms of quality of life, physical activity, or functional results.

From the article of the same title
American Journal of Sports Medicine (12/01/13) Vol. 41, No. 12, P. 2867 Olsson, Nicklas; Silbernagel, Karin Grävare; Eriksson, Bengt I.; et al.
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Practice Management


How CPOE Will Make Healthcare Smarter
The growing use of computerized physician order entry (CPOE) is seen by some as a positive trend that will improve the quality of healthcare. Under Stage 1 meaningful use requirements, providers must use CPOE for at least 30 percent of medication orders entered by certain licensed healthcare professionals. Using CPOE will result in the accumulation of a healthcare provider's knowledge into a central system--knowledge that can then be coded into decision-support systems that should eventually make CPOE smarter. North Hawaii Community Hospital senior general surgeon William Park, MD, says that CPOE offers other benefits as well, including the fact that it makes orders legible and clear. But Park noted that CPOE is currently not a quality improver, nor is it "terribly intelligent" or a time-saver. In addition, Park said the fact that doctors still have to dictate or type clinical notes when performing CPOE is problematic because it could encourage some physicians to copy and paste notes from one patient record to another--a practice that has been condemned by federal officials as being illegal and representative of bad patient care. That being said, Park believes that there is room to improve CPOE, particularly if providers push for a system that is better-designed and easier to use. For example, doctors who are preparing orders for IV fluids should be told if they are writing something that is inappropriate for a patient's admission chemistry, Park said.

From the article of the same title
HealthLeaders Media (12/03/13) Mace, Scott
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Injuries Among Surgeons Carry Hidden Costs
A study published in the Journal of Bone and Joint Surgery has found that orthopaedic surgeons are commonly being injured while on the job, and that these injuries can have a high economic cost. The study was based on a survey of all 495 orthopaedic surgeons in Tennessee, 28 percent of whom responded. Among the surgeons who decided to participate, 44 percent said they had suffered at least one occupational injury during the course of their career. The study found that the injuries most commonly occurred in the hand, followed by the lower back, neck, and shoulder. The injuries in 10 percent of respondents were serious enough to force them to miss work, sometimes as much as three or four weeks, the study found. Such injuries can have significant economic consequences, the study found, since orthopaedic care is less readily available when surgeons are forced to miss work. Physician injuries can also result in significant expenditures for training personnel as well as overhead costs for each surgeon, the study noted. The author of the study, Manish K. Sethi, MD, said the problem of injured surgeons is a serious one because demand for orthopaedic services is likely to grow rapidly at a time when the workforce is aging. The study concluded that hospitals and health system can help to address the problem by making occupational safety an "institutional priority" that is supported by upper-level management.

From the article of the same title
Health Leaders Media (12/02/2013) Nucci, Cora
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Health Policy and Reimbursement


CMS Delays Stage 3 of Meaningful Use Program
The Centers for Medicare & Medicaid Services announced Dec. 6 that the beginning of Stage 3 of the meaningful use program and the reporting timeline for Stage 2 are both being pushed back from 2016 to 2017. Officials say the delays will allow CMS to ensure that Stage 2 is successfully implemented, and will also give healthcare providers and hospitals more time to implement the technology upgrades and clinical workflow requirements for Stage 3. Despite the delays, healthcare providers and hospitals who accept Medicare will still need to meet meaningful use requirements before 2016 in order to avoid having their Medicare reimbursement rates reduced. In addition, hospitals and healthcare providers who have received incentives for at least two years under Stage 1 meaningful use will still be required to begin Stage 2 next year.

From the article of the same title
BNA's Health Care Daily Report (Email) (12/06/13)
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No, There Won’t Be a Doctor Shortage
Concerns that the implementation of the Affordable Care Act (ACA) will create a shortage of doctors and increase patient wait times are overblown, according to Scott Gottlieb, who served as a senior official at the Centers for Medicare and Medicaid Services during the Bush administration, and Ezekiel J. Emanuel, a former health policy adviser in the Obama administration. The two say that the experience Massachusetts has had with healthcare reform is instructive. The Bay State implemented healthcare reforms similar to the ACA that resulted in 400,000 people obtaining insurance coverage, though there was no significant increase in wait times. Gottlieb and Emanuel also point out that the expanding role non-physicians such as nurse practitioners and health aides play in providing care will offset any decline in the number of doctors. However, Gottlieb and Emanuel say that a number of policy changes need to be made in order to fully realize the benefits of team care. Such changes include adopting new payment models that reward investments in money-saving technologies, reforming medical malpractice laws so healthcare providers do not have to continue using inefficient practices to reduce their risk of liability, and providing medical school students with training in team care.

From the article of the same title
New York Times (12/05/13) Gottlieb, Scott; Emanuel, Ezekiel J.
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Reform Update: Abandoning Fee-for-Service Would Affect ER Care, Docs Say in Health Affairs
A group of four emergency medicine physicians are speaking out against dumping the volume-based payment framework and moving to an alternative such as bundled or capitated payments. Supporters of these alternatives say they will create strong incentives that will help bring about needed change in practice patterns. But George Washington University's Dr. Jesse Pines and three other emergency medicine physicians wrote in a recent article that ending the volume-based payment framework would have a number of consequences, including threatening the ability of providers to give emergency room patients the care they need. Pines said in a separate interview that capitation contracts that pay hospitals a lump sum per patient could result in hospitals and physicians losing money if actual costs exceed that lump sum. That in turn could force safety-net hospitals to consider closing emergency departments that are losing money, Pines said. Pines and the other authors offered a number of alternatives to ending the volume-based payment framework, including the development of a hybrid payment model that consists of emergency department quality and resource-use measures that could be tied to bonus payments and volume-based payments. Such a model would provide hospitals with more incentive to continue to provide emergency care, the authors said.

From the article of the same title
Modern Healthcare (12/04/13) Evans, Melanie
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Insurers Warn 'Back-End' Problems Persist with HealthCare.Gov
Officials at the Centers for Medicare and Medicaid Services (CMS) said they have resolved most of the problems that were causing Healthcare.gov to send insurers enrollment files containing inaccurate information. CMS said most of the problems were the result of a flaw that resulted in Social Security numbers being reported incorrectly. That bug has since been fixed, CMS said. However, CMS said problems remain and that it will work to correct them. A spokeswoman for the agency also said that the Washington Post's recent report that errors in 834 forms have affected about a third of individuals who have signed up for coverage through the federal health insurance exchange is not an accurate reflection "of what is happening right now." Meanwhile, some insurance companies have said the accuracy of information in 834 forms has improved, though an industry trade group said some forms contain missing or incorrect information. Some insurance companies are also reportedly receiving duplicate forms or none at all. Insurance companies are hoping the problems with 834 forms will be resolved by Jan. 1, 2014, when plans offered through the exchange take effect, so that they will receive the federal subsidies they are eligible for at the proper time.

From the article of the same title
Modern Healthcare (12/03/13) Demko, Paul
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Dec. 31: EHR Incentive Program Reporting Deadline
The Centers for Medicare and Medicaid Services (CMS) has sent out a reminder to eligible professionals (EPs) about reporting deadlines for both the Medicare and Medicaid Electronic Health Records (EHR) Incentive programs. The first is the EHR Incentive Program reporting deadline on Dec. 31. In addition, CMS says that EPs who participate in the Medicare EHR Incentive Program must attest to demonstrating meaningful use of data collected during the reporting period that ends Dec. 31 by the end of the day on Feb. 28, 2014. Deadlines for attestation information in the Medicaid EHR Incentive program, meanwhile, vary by state. EPs who are participating in both the Medicare and Medicaid EHR Incentive programs can choose to demonstrate meaningful use under one or the other. Beginning Jan. 1, 2015 EPs who failed to demonstrate meaningful use will see their payments adjusted based on the results of the current reporting period. 2014 will be the last year in which Medicare EPs can sign up to participate in the EHR Incentive Program and earn incentives, CMS said. In addition, CMS noted that Stage 2 meaningful use will begin Jan. 1, 2014 for EPs who have completed a minimum of two years of Stage 1.

From the article of the same title
EHR Intelligence (12/02/2013) Freeman, Nicole
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Medicine, Drugs and Devices


Macrophage Stimulating Agent Soluble Yeast ß-1,3/1,6-glucan as a Topical Treatment of Diabetic Foot and Leg Ulcers
A new study has found that soluble ß-1,3/1,6-glucan (SBG) is a safe and effective form of local treatment for diabetic foot ulcers, though researchers say additional studies need to be performed to confirm their findings. Sixty patients with Type 1 or Type 2 diabetes and lower extremity ulcers were recruited for the study and randomized to receive SBG or methylcellulose locally three times per week for up to 12 weeks. Patients also continued to be treated with the conventional management scheme. Fifty-four patients completed the study. Median time to complete healing was 36 days in the SBG group, compared to 63 days in the methylcellulose group. By week 12, 59 percent of the ulcers in patients in the SBG group had healed, while 37 percent of the ulcers in those in the methylcellulose group had healed by that point. The weekly percentage reduction in ulcer size was also significantly higher in the SBG group between weeks one and two, three and four, and five and six. Finally, fewer serious adverse events were seen in the SBG group than the methylcellulose group.

From the article of the same title
Journal of Diabetes Investigation (12/02/2013) Zykova, Svetlana N.; Balandina, Ksenia A. ; Vorokhobina, Natalia V.; et al.
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Efficacy, Safety and Tolerability of Tofacitinib in Patients with an Inadequate Response to Disease Modifying Anti-Rheumatic Drugs
A meta-analysis of a number of double-blind randomized clinical trials of tofacitinib has found that the drug is effective at treating certain patients with active rheumatoid arthritis (RA), though it is associated with a number of adverse effects. After analyzing studies that involved active RA patients with an inadequate response or intolerance to at least one of the nonbiologic or biologic disease-modifying antirheumatic drugs (DMARDs), researchers found that patients treated with tofacitinib were more than four times as likely as patients given a placebo to achieve at least a 20 percent improvement in the American College of Rheumatology scale (ACR 20). The discontinuation rates due to adverse events were the same in the tofacitinib and the placebo groups. However, researchers observed an association between taking tofacitinib and infections, lower neutrophil counts, and higher levels of low-density lipoprotein cholesterol (LDL) and liver enzymes.

From the article of the same title
BMC Musculoskeletal Disorders (11/26/13) Berhan, Asres
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