News From ACFAS

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Tomorrow, Thursday, December 27, all eligible ACFAS members who have not yet voted will receive a final email reminder to vote in the 2013 Board of Directors election. This email will have a unique link to the voting website, and it will come from acfas.ballot@intelliscaninc.net with the subject line: ACFAS Board of Directors Election Closes Saturday, December 29. You will have 48 hours to vote before the ballots close at 11:59 pm EST on December 29.

Please take a few minutes to select members of your Board of Directors. If you have questions accessing the ballot site, please contact our independent election firm at johnarbitell@intelliscaninc.com. Remember – voting ends Saturday, December 29. As surgeons, we know that surgery isn't just black or white; there are many grey areas. Patients, on the other hand, need to be made aware of these grey areas before they agree to go through with surgery. If complications or issues were to arise, how would you respond? Visit acfas.org and listen to the latest 46 minute ACFAS podcast, Staying Positive with Patients under Pressure, to understand some of the issues your peers face and how they have adapted their practices to better deal with them.

After listening to this insightful discussion, you will have a better idea for how to respond to the following dilemmas you may someday come across, and more:

• Mentally preparing patients for what may occur post-surgery before they sign paperwork
• Why is it important to consider what the patient might be dealing with at home and trying to accommodate that?
• How to deal with patients that may have had a complication and don't want to pay their bill
• Pediatric patients - handling pressure from parents of athletes to get their child back in the game, and probing for when a "parent-ectomy" might be necessary

Listen to this podcast and you will get a glimpse into what some of these foot and ankle surgeons have faced as well as what they have done to address these situations.

"Having clear-cut guidelines in all aspects of our practice will certainly mitigate a lot of problems." - Kris DiNucci, DPM Looking to make a job change in 2013? Let the College and PodiatryCareers.org, the official ACFAS online career center, help. PodiatryCareers.org is free to all members of ACFAS, and through this site, members can search and apply to jobs directly online. It's simple -- once you register, create your professional profile and upload your resume on PodiatryCareers.org, you can effortlessly apply to any open job posting on the site. We have great podiatry jobs posted right now! Visit PodiatryCareers.org today to discover a new opportunity.

Foot and Ankle Surgery

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Assessment of the advantages of infrapopliteal endovascular revascularization guided by an angiosome model of perfusion in the healing of diabetic foot ulcers was the purpose of a study involving evaluation of 250 consecutive legs with diabetic foot ulcers in 226 patients who had undergone the revascularization procedure in a single center. The legs were divided into two groups according to whether direct arterial flow to the site of the foot ulcer based on the angiosome concept was realized (direct group) or not realized (indirect group). A propensity score as employed for adjustment of differences in pre-treatment covariables in multivariate analysis and for 1:1 matching. Forty-eight percent of the legs achieved direct flow to the angiosome feeding the ulcer area, versus 52 percent of the legs where indirect revascularization was accomplished. Healing was improved in foot ulcers treated with angiosome-targeted infrapopliteal percutaneous transluminal angioplasty, while the ulcer healing rate was mean 72 percent at 12 months for the direct group compared with 45 percent for the indirect group. In addition, the direct group retained a significantly better ulcer healing rate than the indirect group when adjusted for propensity score.


A meta-analysis of randomized trials was performed to compare surgical treatment of acute Achilles tendon rupture with conservative nonsurgical treatment in terms of the re-rupture rate, the general rate of other complications, return to work, calf circumference and functional outcomes, as well as to study the impact of early range of motion on the re-rupture rate. When functional rehabilitation with early range of motion was employed for the nonsurgical group, re-rupture rate was not significantly different from the surgical group. Refraining from using functional rehab with early range of motion supported an absolute surgical risk reduction of 8.8 percent, while an absolute risk increase of 15.8 percent for complications other than re-rupture was related to surgery. Patients who underwent surgical treatment went back to work 19.16 days sooner, and no significant difference between the two treatments with regard to calf circumference, strength or functional outcomes was observed.

Practice Management

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Many practices don’t find out what they need to do to comply with workplace safety requirements until it’s too late. Strong workplace policies and procedures are critical at all practices because employee injuries come at a heavy cost. Here are some tips to ensure workplace safety is a top priority at your practice:

1. Get help. Talk to your insurance carrier and see what resources it can provide, such as a pamphlet or core workplace safety program to follow. Also, don’t hesitate to use the Occupational Safety and Health Administration (OSHA) as a resource.

2. Have written programs in place. Practices need to have a program that they are adhering to that’s identified as an injury and illness prevention program, or a safety program. The program should include steps to control safety issues relative to your practice, identify who will manage your workplace safety program, and lay out a training and education program.

3. Brief the safety officer. Often practices will assign the safety officer role to a staff member who lacks adequate knowledge and experience. The best way to get that experience is to reach out to your insurance manager. Have them come out and look for hazards they can identify and give you recommendations on how to correct those hazards. At this point, the risk of bringing in anybody is that they’re going to find things that you have to comply with.

4. Communicate and educate. Successful workplace safety programs include staff members in discussions about safety issues. They make them a part of the process, and that’s a core value that they put in place in their own practices. Also, ensure staff members know what to do if an injury occurs and who to report it to.

5. Be prepared. A good way to prepare is by having a company policy on how to respond to an inspection, training employees on how to respond, identifying who will handle the inspection, and ensuring your safety program is up-to-date.


Medical practice staffers responding to health crises frequently run the risk of serious injury if they slip or trip because the floors are often uncarpeted to prevent the risk of infectious diseases. Following certain steps can reduce this risk at little expense, which in turn can add up to higher employee morale, less absenteeism and less possibility of costly litigation. Occupational medicine physicians cite talking to staffers about potential problems they perceive as a first step, while the next step is having someone—perhaps a physician or a medical practice manager—walk through the office looking for potential dangers. A hazard evaluation also can be conducted with the assistance of the practice's liability insurer.

Falls can be commonly caused by the accumulation of water and other substances on the bare floors near sinks and hand gel dispensers, while electrical cords also can snake into spaces where people walk. Uneven floors and small, unmarked steps can be additional hazards. Fallen decorations also can be troublesome, while rain and snow can be tracked in, slicking up smooth surfaces such as linoleum. Moreover, spilled coffee and other liquids can be hazardous.

Once threats have been identified, the next step is for medical practices to decide how to manage them. Additional warning signs may need to be posted, while more employee education also may be necessary. Electrical cords may require bundling, covering or removal, and painting steps and uneven floors in bright colors such as yellow or red can be beneficial. There should be on-hand supplies for cleaning up spilled beverages, while placing slip-resistant absorbent mats or warning cones in areas that tend to be become wet in inclement weather also would be helpful.


New tips and online tools to help physicians protect patient data when using mobile devices have been released by the U.S. Department of Health and Human Services (HHS). The toolkit includes educational resources such as videos, downloadable fact sheets, and posters to promote ways to safeguard patient health information. “The use of mobile health technology holds great promise in improving health and healthcare, but the loss of health information can have a devastating impact on the trust that patients have in their providers. It’s important that these tools are used correctly,” says Joy Pritts, chief privacy officer at HHS’ Office of the National Coordinator for Health Information Technology. “Healthcare providers, administrators, and their staffs must create a culture of privacy and security across their organizations to ensure the privacy and security of their patients’ protected health information.”

HHS says the tools are direly needed today, citing research that reveals that only 44 percent of surveyed healthcare providers encrypt their mobile devices. The toolkit can be accessed here.

Health Policy and Reimbursement

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The National Quality Forum (NQF) has endorsed 12 patient safety-related measures covering topics such as patient falls, nurse staffing levels and healthcare-associated infections. This is the third group of measures endorsed this year by the NQF's patient-safety endorsement project. In June, the group's Patient Safety-Complications Steering Committee approved 14 measures, addressing a range of issues, including medication safety in elderly patients, wrong-site surgery and postoperative embolism. In August, the committee green-lighted two additional measures for venous thromboembolism and medication documentation. More information on the latest measures can be found here.


In a letter to congressional leaders, the Alliance of Specialty Medicine is calling on Congress to create a permanent replacement for the sustainable growth-rate (SGR) Medicare payment formula by the end of the year. If Congress does not act, an SGR-driven 26.5 percent pay cut will take effect Jan. 1. The letter from the alliance—a coalition of 13 medical specialty societies—notes that there is also the potential for another 2 percent Medicare pay decrease if lawmakers fail to stop across-the-board cuts called for in 2011's Budget Control Act. This payment uncertainty has led to physicians not making investments in electronic health records or other improvements to their practice infrastructure, the alliance said in the letter. It added that others are reconsidering their Medicare participation or limiting the number of Medicare patients they see. Ultimately, they argued, these potential cuts threaten seniors' access to healthcare and lead to longer waits to see a physician.


The White House has called for some $400 billion in healthcare cuts as well as a permanent fix to Medicare's sustainable growth-rate (SGR) formula, although House Speaker Rep. John Boehner (R-Ohio) generally dismissed the proposal. He said the GOP leadership intends to unveil legislation this week to extend current tax rates to Americans who make $1 million or less, but he would not elaborate on whether the proposal would include issues such as the Medicare physician payment formula. Not included on the items that the proposal would reportedly address was the Budget Control Act's sequestration process, which would impose a 2 percent cut to Medicare rates, among other across-the-board reductions, early next year. Rep. Phil Gingrey (R-Ga.) said he supported a Medicare physician payment fix during an earlier GOP conference, but Boehner "did not say one way or another whether there would be a doc fix in [the House plan]." Gingrey still expects lawmakers will agree to a SGR formula fix, probably for 12 months, in a final pact.

Medicine, Drugs and Devices

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Researchers have developed a synthetic substance that may help stem cells adhere and develop more effectively. The synthetic porous foam-type material mimics the extracellular matrix necessary for stem cells to link with other cells, according to a study published online in the Journal of the American Chemical Society. What distinguishes the substance from previous attempts at recreating the extracellular matrix, the researchers noted, was the random distribution of sticky spots, which helps maximize adherence. The research also yielded better understanding of the nature of stem cell adherence. The researchers found that the cells need the amount of uniform and randomized sticky areas "to be just right"—neither too sticky nor not sticky enough—to properly mature.


The nonprofit Patient-Centered Outcomes Research Institute (PCORI) has announced that its initial round of 25 comparative-effectiveness research projects will receive more than $40 million over three years. PCORI on Nov. 20 issued a call for $12 million in funding for methodology-focused projects that address gaps in comparative-effectiveness research, and the winners will be announced next spring.