News From ACFAS

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All members should have received their 2013 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, 2012.

Remember, there is no dues increase for 2013, and 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! Don't gamble on your ability to attend the courses you want most at the Annual Scientific Conference in Las Vegas this February; register today!

While a few workshops are already sold out, there are still opportunities for quality education. Courses at ACFAS 2013 are first-come, first-served; so check out the course brochure and register now to ensure your attendance to your preferred courses.

Remember, discounted registration for ACFAS 2013 is still available until January 24, 2013. Plus, ACFAS is passing along savings just received from our hotel partners to members on new, significantly-reduced hotel rates, so book now to take advantage of the new rates. Enhance your practice management knowledge by registering yourself and your office staff for the ACFAS 2013 Pre-Conference Seminar, Perfecting Your Practice, on February 10, 2013, in Las Vegas. Here you'll find answers to questions related to managing your practice that you may not even know you had! Plus, learn correct coding protocol to ensure you’re not at risk for submitting incorrect claims or leaving money on the table. You will walk away from this course with the most recent and valuable information on employment contracts, and the pros and cons of future employment models.

Ensure that your entire office is up-to-date on the latest news and information by registering yourself and your staff today! Log in and check out the Perfecting Your Practice Pre-Conference Seminar webpage for information on fees and everything that's included with your registration.

Foot and Ankle Surgery

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Researchers assessed the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes. Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure>200 kPa) were targeted for pressure reduction (goal:>25 percent relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications, pressures were measured. At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23 percent, 21 percent and 15 percent, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 24-28 percent, compared with pressures in the control group.


Researchers evaluated the outcome of unilaterial surgical treatment for patients with midportion achilles tendinopathy. The study included 13 patients with chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was an ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery.

Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In two of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. There were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally.

Practice Management

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A recent study found that shorter rotations among attending physicians can reduce burnout and emotional exhaustion while leaving unchanged the amount of unplanned patient revisits. The study compared two-and four-week inpatient rotations among 62 attending physicians at teaching hospitals in the United States in 2009. Those physicians on shorter rotations reported lower levels of burnout and emotional exhaustion than their longer-rotation counterparts, and patients were not ill-affected by the shorter rotations. However, house staff and medical students gave those shorter-rotation physicians lower scores in their ability to evaluate trainees, presumably because the doctors did not have enough interaction with them. "Both trainees and educational leaders have decried short rotations as disruptive because they truncate student-teacher relationships," wrote Dr. Brian Lucas, a physician with Cook County Health and Hospitals System in Chicago and the study's author. "Shorter rotations may nonetheless benefit the psychological health of attending physicians, whose responsibilities are oversubscribed." The study was published in the Journal of the American Medical Association.


Many physicians could discover that just because they implement an electronic health record (EHR) system that is certified to meet meaningful use doesn’t mean it is capable of connecting with all the entities with which doctors want to exchange data. Experts are advising doctors who are adopting EHRs to think about what data exchange they plan to do and ensure that the system is capable of doing it. And that goes beyond checking for meaningful use certification.

"Notwithstanding the improved information flow that an electronic health record makes possible within a hospital or medical practice, even certified EHRs often have limited capacity to share important care-related data with other EHRs, in effect creating electronic information silos,” said Kenneth W. Kizer, director of the University of California, Davis Health System’s Institute for Population Health Improvement (IPHI). The IPHI developed the HIE (Health Information Exchange) Ready Buyers’ Guide, which addresses these limitations by rating EHR systems on their ability to perform certain data exchange functions.


As the year draws to a close, it is time for practices to start planning their year-end reporting, insurance re-verification, staffing and budget. On January 1, a majority of health plans start over with all new deductibles. Many plans will change, leaving patients and practices unaware. Oftentimes, a group number will change, a deductible or copay increase, or a plan will terminate completely. The plan can also change what is a covered benefit. Depending upon the size of a practice, it may work to assign one to two people to perform re-verifications, which each take four to seven minutes online and longer by phone. Practice staffing and budget tend to be reviewed together.

The next area where time should be invested is year-end reporting. Most billing departments close previous months by the middle of the following month; so, by mid-January, a practice should be ready to spend about 20 hours gathering its 2012 data, reviewing it and modifying its business plan, policies and procedures. Some areas to be looking at include days in AR; where AR is within the industry's standard; write offs that were the result of practice errors (someone not obtaining the proper authorization, going over an insurance visit limit, not collecting co-pays/deductibles/co-insurance, etc.); patient visits; and inflow goals.

There are many other areas in a practice that can be reviewed, including the overall budget that includes profit and loss statements, expenses, payroll, etc. The most important thing for a practice to remember is to allow its staff the necessary time to get through those first few weeks and know that as the month progresses things will settle back down.

Health Policy and Reimbursement

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The most recent offer from the White House as part of its negotiations with congressional Republicans to avert the so-called fiscal cliff reportedly includes path to permanently fix Medicare's physician payment system. A House Democratic aide said that the proposal contained a one-year fix for 2013 and a promise to adopt a permanent fix as part of talks expected next year on a larger budget deal that likely will contain entitlement program reforms. The aide added that the cost of a permanent fix to Medicare's payment system for doctors—as much at $250 billion over 10 years—would be included in a larger deal. House Republicans plan to bring a standalone, two-year doctor pay fix to the floor soon, according to congressional and industry sources, paid for by recapturing overpayments from individuals and families who received more of an insurance tax credit than they were eligible for under the Affordable Care Act.


The U.S. Centers for Medicare and Medicaid Services (CMS) is looking for feedback from healthcare providers concerning its Consumer Assessment of Healthcare Providers and Systems survey for Physician Quality Reporting, a government-mandated method of publicly reporting physician performance data. The agency is looking for physicians to give their honest opinion on the usefulness and potential burden of collecting this data. The data will be published to CMS' Physician Compare website, which was launched in 2010 but currently only lists Medicare-eligible healthcare providers by geographic region. CMS said much of the data that will appear on Physician Compare will come from its Physician Quality Reporting System, which was launched in 2007 and offers physicians incentive payments for reporting their performance data.


The U.S. Government Accountability Office (GAO) reports that the U.S. Centers for Medicare and Medicaid Services (CMS) could save tens of millions of dollars by standardizing the methods used to determine which Medicare claims get denied for payment. A recent GAO study found that in 2010 CMS contractors had saved some $114.7 million by using standardized audit methods, of which $14.7 million in payments were withheld because they were in violation of CMS national coverage rules and $100 million in payments were withheld because they were in violation of local contractor rules.


Putting additional hurdles in the way of incentives for meaningful use of electronic health records (EHRs) could impede adoption of health information technology, officials said following the release of an investigation critical of integrity safeguards in the incentive program. The Centers for Medicare & Medicaid Services (CMS) has paid roughly $4 billion to about 82,500 professionals and 1,500 hospitals for adopting and using certified EHR technology, but the incentives lack a thorough accounting that ensures pay goes to those actually achieving meaningful use of the paperless records, according to a report by he U.S. Department of Health and Human Services' Office of Inspector General (OIG). The agency criticized CMS for failing to confirm the information reported by physicians and facilities before sending out bonus payments.

Physicians can earn up to $44,000 from Medicare or up to $63,750 from Medicaid by reporting that they met certain minimum objectives signifying meaningful use of EHRs. The agency is paying out annual lump-sum bonuses for meaningful use, but in 2015, federal law requires Medicare to start lowering rates paid to eligible physicians who do not use EHRs.

Health professionals receive incentive payments after attesting that they met meaningful use requirements. OIG wants CMS to certify the information reported by physicians in those attestations before the checks go out the door. The Inspector General recommended that CMS review supporting documentation from selected professionals and hospitals before payment.

But CMS opposes the suggestion for enhanced prepayment reviews of meaningful use claims, said Acting CMS Administrator Marilyn Tavenner in a memo to OIG. CMS already has implemented certain prepayment verification protocols. For instance, it validates all EHR system certification numbers reported by physicians and hospitals.

Medicine, Drugs and Devices

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AstraZeneca has released the results of a six-month Phase IIb clinical trial of its experimental oral rheumatoid arthritis drug fostamatinib. The trial found that while fostamatinib was better than the placebo at some doses, it was not as effective as Abbott Laboratories' injectable rheumatoid arthritis drug Humira. Previous studies of fostamatinib have had mixed results, including side effects such as increased blood pressure in some patients. A Phase III trial that will examine the use of fostamatinib in combination with other drugs will be performed in the first half of next year.


Researchers at the Rensselaer Polytechnic Institute have for the first time shown that osteocalcin plays a role in helping bones resist fractures. The study, published in the Proceedings of the National Academy of Sciences, found that an impact on bone can result in osteopontin and osteocalcin being physically deformed, which in turn can result in the formation of nanoscale holes. These holes can prevent further damage to the bone, though bones that lack osteocalcin and/or osteopontin will crack and fracture. The findings could lead to additional studies that will examine the relationship between osteocalcin and bone strength and foods that are rich in vitamin K, such as broccoli and spinach.


A study presented at the American College of Rheumatology's Annual Meeting has found that the risk of atypical fractures that is associated with the use of bisphosphonates is small and that it does not outweigh the benefits of using the drugs. The study by researchers at the Dartmouth Institute for Healthy Policy & Clinical Practice examined the results of 257 studies performed between 1948 and 2012 that reported atypical fractures in osteoporotic patients using bisphosphonates. Researchers found that just 30 patients out of every 10,000 patients treated for a year had atypical fractures. When adjustment for patients with atypical fractures was confirmed by X-ray, the number decreased to 10 or fewer patients with atypical fractures per 10,000 patients treated with bisphosphonates.