December 23, 2015 | | JFAS | Contact Us

Happy Holidays from ACFAS! Our office will close at 2pm (CST) on Dec. 23 and will reopen on Dec. 28.

News From ACFAS

Final Weeks for Membership Dues
December 31 not only marks the end of the year, but also the final day you can pay your ACFAS membership dues. Don’t let your ACFAS membership slip through the cracks; renew your membership today at or via mail or fax to ensure your member benefits will continue.

All ACFAS Fellow and Associate Members should have received their 2016 ACFAS dues reminders in the mail and via email. If you have questions or need another statement, contact the Membership Department.

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You Deserve Proper Payment for the Care You Provide
Get ready for the next level of reimbursement—attend ACFAS’ newly revamped Practice Management and Coding Seminar in 2016.

Learn how to generate RVUs and negotiate a fair conversion factor for payment to ensure your success in the new year and beyond. RVUs play an important role in healthcare economics—hear how they can help you receive proper payment for the procedures you currently perform.

Watch ACFAS publications for the dates and locations of this new seminar or visit
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Foot and Ankle Surgery

Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus
A recent study looked for information regarding outcomes after autologous osteochondral transplantation (AOT), which is used to treat osteochondral lesions (OCLs) of the talus. Researchers assessed 85 patients and took preoperative data via the Foot and Ankle Outcome Score (FAOS). The mean FAOS improved postoperatively from 50 to 81, and the Magnetic Resonance Observation of Cartilage Repair Tissue score was 85.8. Superficial T2 values in graft tissue were higher than control tissue, and deep T2 values were similar to control values. Researchers concluded that AOT was a clinically viable treatment for OCLs of the talus, although the long-term implications have yet to be determined.

From the article of the same title
Foot & Ankle International (12/15) Flynn, Sean; Ross, Keir A.; Hannon, Charles P.; et al.
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Conversion of Tibiotalar Arthrodesis to Total Ankle Arthroplasty
Conversion of ankle arthrodesis to total ankle arthroplasty is a controversial procedure. A recent study looked to find further evidence of its efficacy and safety to give surgeons more confidence in its outcomes. Researchers evaluated 23 ankle arthroplasties that had undergone prior ankle arthrodesis. The mean visual analog scale pain score improved from 65.7 to 18.3 following the procedure, and five patients were completely pain-free. The mean Short Musculoskeletal Function Assessment indexes also improved, as did the Short Form-36. The implant survival rate was 87 percent, and 10 patients had minor complications not requiring repeat surgery.

From the article of the same title
Journal of Bone and Joint Surgery (12/16/2015) Pellegrini, Manuel J.; Schiff, Adam P.; Adams Jr., Samuel B.; et al.
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Practice Management

How to Deal with Negative Online Reviews
Online review websites can often determine whether or not a patient decides to use your practice. Reviews matter, and negative ones can derail your practice. Here are some tips on how to deal with negative reviews:
  1. Don't delete, respond instead. Deleting a poor review can send the wrong message. Instead, address the reviewer's concern with professionalism. Most people will be reasonable if you are gracious.
  2. Move the conversation offline. If you identify a negative reviewer, contact the person over the phone. Express your appreciation regardless of the content of the review. Ask what you can do better.
  3. Ask for reviews. Asking patients to leave reviews can combat negative ones. If you request a review and one is posted, it is likely because the patient felt good enough about the visit to follow through on the request. More good reviews push the poor ones to the bottom of the list.
  4. Track reviews with alerts. Set up alerts for mentions of the business name, as well as names of employees. This allows for a quicker overview of online discourse about your practice.
  5. Don't let the feedback go to waste. Tracking reviews may take a lot of time, but it can do wonders for your practice. Many times, a bad review is actually well-deserved, and it is important to correct whatever it was that caused the patient to become upset.
From the article of the same title
Physicians Practice (12/14/15) Weber, Steph
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Improving the Performance of Medical Practice Staff
To keep a strong and motivated staff, you must cultivate an environment suited to their talents and needs. Here are some questions to ask yourself as you prepare for 2016:
  1. Are you actively cultivating your high performers? There is a difference between passively engaging your employees and actively doing so. Be sure to give them opportunities for learning and skill-building.
  2. Is there a plan for training and coaching your average performers to go from good to great? This need not be a complicated program. Simply consider each employee's knowledge and determine how to build it. Self-paced learning through journal articles and e-newsletters is a great place to start.
  3. Is anyone on the team struggling? There will always be people who struggle. Give them some time and schedule meetings to discuss how things can improve.
  4. Could some employees benefit from coaching? Whether you conduct coaching meetings or hire outside help, coaching benefits employees in terms of both productivity and profitability.
  5. How well is your "old growth" performing? It is common for medical practices to have long-term employees who do the same type of job for many years. It is important to motivate them to try new things.
From the article of the same title
Physicians Practice (12/16/15) Toth, Cheryl
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New Care Model May Improve Outcomes in Medical, Surgical Units
A new study published in the Journal of Hospital Medicine reveals that a new model of care can drastically improve outcomes of care in medical and surgical areas. The model, which involved calculations for length of stay, case-mix index-adjusted costs, readmission rates and overall patient satisfaction score, was implemented at a large hospital. The model led to decreases in length of stay and direct costs. While no improvements were found in readmission or patient satisfaction, 95.8 percent of providers said the model improved both the quality and safety of care.

From the article of the same title
Endocrinology Advisor (12/16/15)
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Health Policy and Reimbursement

ACA Fear After Tax Freeze
The budget deals negotiated by Congress delay or halt three Affordable Care Act (ACA) taxes, meaning that President Obama will need to make major concessions when the bill reaches his desk. The biggest change is the much-debated Cadillac tax, a device tax that will be delayed until Congressional leaders make further rulings on it. The fear among ACA backers is that the delay of these taxes will essentially kill them altogether. In total, the delays take $35 billion out of the ACA's revenue stream, according to analysts. If just the other two taxes are delayed (health insurance tax and medical tax), experts say it would not have too meaningful an effect. But the Cadillac tax, which brings in significant revenue, could cost the administration $20 billion all by itself.

From the article of the same title
The Hill (12/17/15) Ferris, Sarah
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AMA Calls for Meaningful Use Reforms if Stage 3 Is to Succeed
The American Medical Association (AMA) wrote a letter Dec. 15 to the Centers for Medicare and Medicaid Services (CMS) acting administrator with a proposed revision to the final Stage 3 rule released in October. According to the letter, a revised Stage 3 involves addressing the current challenges with electronic health records and providing a path toward a new Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). AMA recommended that CMS should provide flexibility and eliminate a pass-fail program design, allow for multiple methods to achieve goals, remove threshold requirements for measures outside a physician's control and more. Some organizations are still pushing for a delay in the start of Stage 3 until at least 2019. It is still planned to start in 2018.

From the article of the same title
Health Data Management (12/16/15) Slabodkin, Greg
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Data Flaws Affect Hospital Reimbursement
There are "glaring flaws" in the Nationwide Inpatient Sample (NIS), which is used to calculate hospitals' risk for readmission or surgical complications. According to researchers at Johns Hopkins University School of Medicine, a drastic underreporting of patients' alcohol and tobacco use, as well as body mass measurements, has led to inaccurate readings in the sample. For example, the NIS claims that 9.6 percent of Americans are obese; according to data from the federally sponsored Behavioral Risk Factor Surveillance System (BRFSS), that figure is more accurately around 27.4 percent. The NIS says that alcohol abuse is prevalent in 4.6 percent of the population; the BRFSS shows that it is closer to 18.3 percent. "A very high number of patients are having their risk coded as lower than it actually is," said study author Susan Hutfless. Yet the information is still being collected. The issue is that a disconnect occurs when downloading and transferring the information. According to Huftless, one solution is to merge databases so that publicly available information could be used to complete missing data. Another suggestion is to incorporate meaningful use measurements into datasets.

From the article of the same title
MedPage Today (12/13/15) Pecci, Alexandria Wilson
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State: Hospitals Are Driving Increases in the Cost of Care
Massachusetts health officials say that hospitals are to blame for recent increases in healthcare spending. According to officials, data supports their claim by showing that large hospitals can pass through higher pricing by taking outpatient care from non-hospital settings and acquiring smaller practices. The data revealed that outpatient spending spurred healthcare spending from 2010 to 2014. Hospitals are acquiring practices and upcharging for procedures that are now tied to a larger hospital. “This is the same practice, same service, same doctor performing the service, but now they bill at a higher outpatient rate,” said Sara Sadownik, a senior manager for research and cost trends with the Health Policy Commission. For example, chemotherapy in a community setting would typically cost around $177; in a hospital, it can reach $298. Experts say this is why it is important for consumers to have access to price data when considering options for care.

From the article of the same title
Boston Business Journal (12/18/15) Bartlett, Jessica
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Medicine, Drugs and Devices

At UCLA, It's Medicine 2.0
The UCLA Center for Advanced Surgical and Interventional Technology (CASIT) is pushing the boundaries of surgical science and allowing surgeons to interact with engineers to create new, efficient methods for important procedures. The goal of CASIT is to make healthcare more accessible by accelerating the process of turning basic research into medical tools and then manufacturing them. UCLA is working on technologies like bone replacement and do-it-yourself prosthetics, as well as 3D-printed structures that can make surgery safer and easier. Researchers are also developing wearable tools that allow doctors to learn even more about patients instead of relying on patients' memories. This information can be used to determine the proper course of action for a specific patient and expedite his or her release from the hospital. Interoperability between wearable tech and social media is also a focus so that doctors and patients can interact in ways previously impossible.

From the article of the same title
UCLA Newsroom (CA) (12/15/15) Voight, Joan
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FDA Struggles with Regulation of Mobile Health
Mobile health apps and technology are developing so quickly that the U.S. Food and Drug Administration (FDA) cannot keep up, according to experts. Speaking at the recent Food and Drug Law Institute Conference in Washington, experts said regulation is an issue that will remain in flux for the foreseeable future. "FDA doesn't have a depth of experience here that necessarily justifies them heavily regulating this area,” said Jeffrey K. Shapiro, of Hyman Phelps & McNamara P.C. In addition, FDA's existing regulatory framework is not a good fit for these technologies. For example, the clear line established between manufacturer and customer may not apply to certain types of software. FDA seems to be aware of their issues and has even hinted at indifference toward proper legislation. In a 2013 agency release, FDA said it would not seek to regulate consumer use of medical mobile apps and noted that it would limit enforcement to certain situations. Meanwhile, the device industry is pining for guidance from FDA that simply has not yet arrived. FDA announced it would release draft guidance in 2015, but this has not come to fruition. “It may come next year,” Shapiro said, “but I'm not holding my breath.”

From the article of the same title
Bloomberg BNA (12/17/15) Elfin, Dana A.
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Lost Devices Account for Bulk of Healthcare Security Incidents
Lost or stolen devices account for 45 percent of all breaches in healthcare, according to a new report from Verizon. These numbers stand in contrast to Verizon's larger report, which covers all industries. In that release, lost and stolen devices only accounted for 15 percent of industry breaches. In fact, lost and stolen devices are only typically reported by healthcare organizations. This is also the easiest type of breach to address, according to Verizon, since encryption solves most of the problems. Proper encryption can vastly improve device safety and can help healthcare employees keep better track of medical devices.

From the article of the same title
CSO Online (12/16/15) Korolov, Maria
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

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Daniel C. Jupiter, PhD

Jakob C. Thorud, DPM, MS, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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