December 18, 2013

Voting is Open: Don't forget to vote for the 2014 Board of Directors.

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News From ACFAS

DPMs in Medicaid Included in Senate SGR Bill – Act Now!
For many years the podiatric profession has tried to get Title XIX (the Medicaid law) fixed to include DPMs under the definition as physicians, just as the Medicare law does.

There is now a serious chance this could happen if the Senate Finance Committee’s version of the Sustainable Growth Rate (SGR) fix bill is passed - first by the full Senate, then in 2014, by the House. Senators Schumer (D-NY) and Grassley (R-IA) were instrumental in getting the podiatry issue included, indicating bipartisan Senate support.

Title XIX Podiatry “Fix” in Senate Version of HR 2810:

It would NOT:
  • Mandate new Medicaid services or benefits, or
  • Require any Medicaid patient to seek care from a podiatric physician, or
  • Expand the scope of practice.
It WOULD simply:
  • Provide that Medicaid patients have a full range of choices to see the physicians who are best trained for the foot and ankle care they seek, and
  • Define DPMs as “physicians” in the Medicaid program, just like the Medicare program.
The U.S. House version of the SGR Fix bill does not include the podiatry amendment. But the Senate version must be approved first. Only then would the House consider the Senate’s version when the two bills are sent to a conference committee for reconciliation.

Call or write your U.S. Senators right now and urge them to pass the Senate Finance Committee's SGR Fix bill. Use APMA's eAdvocacy tool to contact your senators.
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Pre-Conference Workshops – Bonus Opportunities at ACFAS 2014
Don’t miss out on the opportunity to experience all that ACFAS 2014 Orlando has to offer -- register today for the ever-popular Annual Scientific Pre-Conference workshops set for Wednesday, February 26, 2014. Registration is filling quickly for these hands-on, comprehensive programs focusing on the most-advanced techniques in podiatric surgery and practice management issues. Programs include:
  • Perfecting Your Practice: Coding/Practice Management Workshop (All-Day Program)
  • Diabetic Deformity: Master Techniques in Reconstruction (Morning-Only Cadaveric Program)
  • Monday Morning Trauma: Advanced Reconstruction Techniques (Afternoon-Only Cadaveric Program)
  • Advance Tendon Repair and Fixation (All-Day Cadaveric Program)
Attendees can earn up to 8 Continuing Education Contact Hours and all programs are held at the Gaylord Palms Resort and Convention Center, the site for ACFAS 2014. To reserve your place or to learn more about the Annual Scientific Conference in Orlando, February 27-March 2, visit
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ACFAS Board of Directors Election
Last Friday, ACFAS voting members (Fellow, Associate, Life, and Emeritus members) received an email from the College’s independent election firm with their unique link to the 2014 Board of Directors Election website. The email came from If you do not have a valid email address on file with the College, you received voting instructions via US mail.

If you haven’t had a chance to vote yet, please take a few minutes to cast your vote for your elected leadership. Your vote is important to advance our profession and surgical specialty.
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ACFAS Regional Divisions 5 and 12 Seek Officers
Do you live in the states of Florida, Delaware, New Jersey or Pennsylvania? If so, ACFAS Divisions 5: Florida and 12: Tri-State need you! These two Regional Divisions are seeking volunteers to fill open officer positions, as their current officers succeed up their slates. Division 5 is in need of a Treasurer, and Division 12 is seeking a Secretary/Treasurer.

If you’re interested in getting involved in ACFAS at the local level, and helping to 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 additional questions, to

Deadline for response is January 8, 2014, and electronic ballots of all candidates will go out to Division 5 and 12 members in mid-January.
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Maximize Your Membership with a Complimentary Webinar
Attention new ACFAS members: Want to get the most out of your ACFAS Membership? Mark your calendars for the complimentary webinar Maximizing Your ACFAS Membership set for January 15, 2014 at 8pm CT, to help answer the many questions you may have regarding your new membership in ACFAS.

Want to know how to access the ACFAS website and what’s there for you? Want to know how to properly market yourself as a member of the College with your new credentials? Join Russell Carlson, DPM, AACFAS, member of the ACFAS Membership Committee, and Michelle Butterworth, DPM, FACFAS, ACFAS Past-President, as they go through many of the questions new members have and learn how to take advantage of all ACFAS has to offer. After the webinar there will be time for Q&A as well.

Save the date, and watch your email for more information on registration after the start of the new year.
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Foot and Ankle Surgery

Orthopaedic Disorders in Myotonic Dystrophy Type 1: Descriptive Clinical Study of 21 Patients
A recent study examined orthopaedic impairments seen in 21 patients with Myotonic Dystrophy Type 1 (DM1), which is the most common form of hereditary myopathy seen in adults. Patients who participated in the study were interviewed and examined, though researchers also reviewed the surgery reports of those who were hospitalized. Researchers found that the most common orthopaedic impairments in patients with DM1 included contractures of the lower and upper extremities and foot deformities such as equinus deformity, club foot, and pes cavus. Researchers concluded that patients with severe foot deformities or contractures should undergo surgery, while those with foot deformities can be treated with orthopaedic custom-made shoes, orthoses, or insoles.

From the article of the same title
BMC Musculoskeletal Disorders (12/01/13) Vol. 14, No. 1, P. 338 Schilling, Lisa; Forst, Raimund; Forst, Jürgen
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A New Technique of Treatment of Fracture-Subluxation of Chopart Joint
A recent study describes a case study in which a 39-year-old man who suffered a fracture-subluxation of the Chopart joint and was subsequently treated with a new technique that researchers say is superior to existing forms of treatment. The treatment involves the use of a pretensioned hamstring autograft for the reconstruction of the Chopart joint. Researchers say that the advantage of this technique is that it does not violate the articular surface, and that it allows for the reconstruction of the damaged medial ligamentous complex. The patient who underwent this procedure was able to fully resume manual labor as well as a number of different athletic activities after 28 weeks. The patient's American Orthopaedic Foot & Ankle Society (AOFAS) score was 100 with full functional arc of movement of ankle and hindfoot. The AOFAS remained at 100 a year after treatment. The patient also displayed normal clinical and radiographic position at 28 weeks and at one year.

From the article of the same title
Techniques in Foot & Ankle Surgery (Fall 2013) Vol. 12, No. 4, P. 201 Kadakia, Anish R.; Ho, Bryant S.; Molloy, Andrew P.
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Long-Term Follow-Up of Mobile-Bearing Total Ankle Replacement in Patients with Inflammatory Joint Disease
A new study by orthopaedic surgeons in The Netherlands examined the minimum 10-year outcome of mobile-bearing total ankle replacement (TAR) in patients with end-stage arthritis of the ankle, particularly those with inflammatory joint disease. Surgeons followed 76 patients who underwent a total of 93 TARs, using either the low contact stress (LCS) or Buechel-Pappas designs, during an 11-year period. At the last follow-up, which was performed at an average of 14.8 years, 30 patients had died. The original TAR remained in situ in 28 patients. The cumulative incidence of failure 15 years after surgery was 20 percent, while the average American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients was 80.4 at the final follow-up. Surgeons also found that 21 patients had to undergo additional surgery. Three patients underwent implant exchanges, another three underwent bearing exchanges, and 17 underwent arthrodeses. Surgeons concluded that while neither LCS or Beuchel-Pappas are currently available, there is still justification for performing TARs using current mobile-bearing designs on patients with end-stage arthritis of the ankle caused by inflammatory joint disease.

From the article of the same title
Bone & Joint Journal (12/13) Vol. 95B, No. 12, P. 1656 Kraal, T.; Van der Heide, H. J. L.; Van Poppel, B. J.; et al.
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Practice Management

MGMA Urges 'End-to-End' ICD-10 Testing
The Medical Group Management Association (MGMA) sent a letter to Health and Human Services Secretary Kathleen Sebelius on Dec. 9 warning that the planned transition to ICD-10 in October 2014 could be prone to major problems unless comprehensive tests are performed on the diagnostic coding system. MGMA President Susan L. Turney, MD, said in the letter that HHS' planned front-end testing of the system will be insufficient, adding that the department should instead perform complete end-to-end testing with any physician's practice that is willing to participate. Such testing should involve returning remittance advice to practices to allow them to see how ICD-10 will affect their reimbursement rates, Turney said. She added that HHS should perform end-to-end testing with a sufficient number of physicians' practices from a variety of different specialities if it is unable to perform testing with all willing providers. Turney said comprehensive end-to-end testing offers a number of benefits, including helping software developers ensure that applications are correctly configured for physicians' practices. She added that failing to perform such testing increases the likelihood that there will be serious disruptions to practices' cash flow. But one healthcare industry consultant dismissed MGMA's concerns as being exaggerated, and said Turney's letter was written out of opposition to ICD-10.

From the article of the same title
HealthLeaders Media (12/10/13) Commins, John
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Theft in a Medical Practice: Why it Happens and How to Stop It
Physicians' practices can take a number of different steps to mitigate the threat from embezzlement and theft committed by employees, writes Robert C. Scroggins, JD, CPA, CHBC, a management consultant and principal with Cincinnati-based Clayton L. Scroggins Associates. For starters, doctors' practices should be on the lookout for employees who have the motive to steal, including those whose financial situations seem to be spiraling downward, individuals who are living lifestyles well beyond their means, and those who engage in excessive gambling. Practices should also focus on protecting their cash rather than other tangible assets such as office or clinical supplies, since the misappropriation of funds is a more common problem. Scroggins urges practices to be on the lookout for signs that employees may be misappropriating funds, such as personal charges on the practice credit card and duplicate payments to the same vendor. In addition, Scroggins says that tasks involving the handling of practice funds should involve at least two people, including one who acts as a control person to verify the cash handling process. Finally, practices should tell their employees upfront that embezzlement or theft is grounds for termination and prosecution, since doing so will make it more likely that practices will follow through with these punishments.

From the article of the same title
Medical Economics (12/10/13) Scroggins, Robert C.
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Six Ways Physicians Can Prevent Patient Injury and Avoid Lawsuits
Experts say there are a number of steps that doctors can take to reduce their risk of being sued for medical malpractice following a patient injury or some other type of unanticipated patient outcome. The Medical Protective Company's Chief Medical Officer, Graham Billingham, MD, FACEP, FAAEM, says the best thing that doctors can to do minimize the risk of a medical malpractice suit is to engage in open and honest communication with patients so that patients have the information they need when told about an unexpected outcome. Billingham notes that such communication should involve thorough documentation, providing patients with unambiguous answers and instructions, and showing patients that steps will be taken to ensure that the error in question does not occur again. People's United Insurance Agency Rob O'Connor, CPCU, stressed the importance of informed consent, saying that doctors need to provide their patients with both verbal and written notification about a procedure's risks before the procedure takes place. Patients should also be sure to sign the written notifications so there is evidence that they gave their consent to the procedure and that they were informed about any potential risks, O'Connor says.

From the article of the same title
Medical Economics (12/10/13) Kreimer, Susan
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Health Policy and Reimbursement

Budget Deal Would Extend Medicare Sequester Cuts
Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wis.), the lead budget negotiators for their respective houses of Congress, announced a budget agreement on Dec. 10 that extends cuts to Medicare for an additional two years. The bill, known as the Bipartisan Budget Act, would restore $63 billion in funding that had been cut to defense and other programs as a result of the sequester, though it would partly accomplish that by extending sequester cuts to Medicare providers through 2023. Extending those cuts would result in roughly $28 billion in savings. The Senate could amend the bill to extend the Medicare sustainable growth rate (SGR) formula for three months. Lawmakers could opt to pay for the roughly $7 billion cost of extending SGR by rebasing Medicaid disproportionate share payments, among other things. Another provision included in the Bipartisan Budget Act as it stands now is one that would allow states to hold off on paying for potentially fraudulent Medicaid claims as long as doing so would not hurt the ability of a beneficiary to obtain access to care. That provision, which is designed to help prevent Medicaid fraud and abuse, could save roughly $1.4 billion. President Obama has signaled that he supports the bill.

From the article of the same title
Modern Healthcare (12/11/13) Zigmond, Jessica
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Healthcare Exchange is Vastly Improved, Users Say
Reports from people using to purchase health insurance or helping others do so seem to confirm the Centers for Medicare and Medicaid Services' claim that the site is working for the vast majority of users. The New York Times interviewed consumers and navigators, or people who work to help consumers navigate the health insurance exchange, about their experiences with roughly a week after the Obama administration's self-imposed deadline of having the site running smoothly by the end of November. The Times found that applicants generally reported that they were able to successfully select a healthcare plan on the site. Indeed, statistics show that 112,000 consumers were able to select plans on during the first week of December, compared to 100,000 for all of last month. The increased enrollment comes after hardware and software fixes for the site were put into place. However, some users are still reporting technical problems that are preventing them from choosing plans. Other users are unexpectedly being told that they have to wait to sign up for coverage until a decision has been made about their eligibility for Medicaid. This is because the Affordable Care Act prohibits consumers from receiving tax credits for private insurance if they are eligible for minimal coverage from Medicaid and Medicare.

From the article of the same title
New York Times (12/10/13) Alvarez, Lizette ; Preston, Jennifer
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Specialists Notch Victory in New CMS Rule on Quality Reporting
Specialist medical societies are cheering a decision by the Centers for Medicare and Medicaid Services (CMS) to determine the quality measures specialists will report when the Physician Quality Reporting System (PQRS) takes effect on Jan. 1, 2014. Specialist societies had been upset over a common set of quality measures that was developed for PQRS, which they said would put specialists at a disadvantage compared to primary care and family physicians. One problem with the common set of quality measures is that the existing surgical measures lean toward inpatient operations instead of outpatient procedures, said Dr. Arthur Lerner of Technology Education Consulting in Healthcare. As a result, many specialists were willing to pay the penalty for not participating in PQRS--which amounts to 1.5 percent of their 2013 Medicare Part B charges--rather than take part in what they see as a flawed system, Lerner said. But Lerner noted that CMS' recent decision will encourage specialists to participate in PQRS and will give them the chance to take control of the reporting process. But Medical Group Management Association Senior Government Affairs Representative Jennifer Gasperini said the complexity of the new rule may not encourage as many specialists to participate in PQRS as CMS would like.

From the article of the same title
Modern Healthcare (12/04/13) Robeznieks, Andis
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Medicine, Drugs and Devices

Treatment of Osteochondral Defects of the Talus with a Metal Resurfacing Inlay Implant After Failed Previous Surgery: A Prospective Study
The use of a metal resurfacing inlay implant is a promising form of treatment for osteochondral defects of the medial talar dome following unsuccessful surgery, a new study has found. Orthopaedic surgeons prospectively studied 20 consecutive patients for an average of three years after surgery using a metal implant. Surgeons observed that patients experienced a statistically significant reduction in pain while at rest and when walking, climbing stairs, and running. Median American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores improved from 62 before the operation to 87 at final follow-up, while the average Short-Form 36 physical component scale improved from 36 to 45 during the same period of time. However, radiographs showed that two patients experienced progressive degenerative changes of the opposing tibial plafond. One patient needed to undergo additional surgery to correct the osteochondral defect.

From the article of the same title
Bone & Joint Journal (12/13) Vol. 95B, No. 12, P. 1650 Van Bergen, C. J. A.; Van Eekeren, I. C. M.; Reilingh, M. L.; et al.
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The Use of ‘Off-the-Shelf’ Foot Orthoses in the Reduction of Foot Symptoms in Patients with Early Rheumatoid Arthritis
Patients diagnosed with early-stage rheumatoid arthritis (RA) could benefit from using off-the-shelf foot orthoses, a new study has found. Researchers recruited 35 patients with painful and swollen foot joints, all of whom were prescribed a customized off-the-shelf foot orthosis with chair-side modifications. Foot pain was measured using the Visual Analogue Scale at baseline and at three and six months, while the number of tender and swollen foot joints were counted on the same schedule. Researchers observed a trend toward fewer swollen and tender joints after three months, though some minor improvements in symptoms continued to take place and were seen at six months. A statistically and clinically significant reduction in pain level was also observed, most of which took place after three months. Researchers said additional studies need to be performed to confirm their findings.

From the article of the same title
The Foot (12/13) Vol. 23, No. 4, P. 123 Cameron-Fiddes, Vicki; Santos, Derek
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