December 28, 2016 | | JFAS | Contact Us

News From ACFAS

Three Days Left to Vote for ACFAS Board of Directors
The ACFAS Board of Directors election closes on Friday, December 30. If you have not yet voted, check your email for the reminder with the subject line: ACFAS Board of Directors Election—We Need Your Vote! that was sent this morning from with your unique link to the election. Members without an email address or who were unable to receive our test email were sent voting instructions by U.S. mail in mid-December.

Please vote to ensure your voice is heard. If you have questions about accessing the ballot site, contact our independent election firm at
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ACFAS Looks Back at 2016
The many accomplishments ACFAS achieved this past year would not have been possible without you, our dedicated members. Your commitment to your patients and the profession is the reason why the College will soon be celebrating its 75th anniversary.

Following are highlights from 2016:
  • Membership peaked at more than 7,400 for the first time ever.
  • The ACFAS 2016 Annual Scientific Conference beat our Phoenix numbers with record attendance and exhibitors. Austin was wonderfully weird for ACFAS!
  • The College launched a new nationwide public relations campaign, “Take a New Look at Foot & Ankle Surgeons.”
  •, the campaign website, debuted with referral guides, surgeon spotlights, infographics and more.
  • “Take a New Look” exhibited at annual conferences to reach diabetes educators, family physicians and nurse practitioners.
  • ACFAS gave its patient education website,, a fresh new look to better align with the College's brand.
  • now features updated health information, an improved physician search tool, a video library and access to a new consumer version of FootNotes newsletter.
  • The College distributed 10,000 hot/cold packs and injury prevention tips to runners at the Austin Marathon and at the Chicago Marathon Abbott Health and Fitness Expo.
  • The Journal of Foot & Ankle Surgery now allows authors to publish their research as an Open Access article. ACFAS members receive a 50 percent discount on the cost for Open Access publication.
  • ACFAS conducted the CME Gap Analysis in 2016.
  • The College published its first e-Book, Arthroscopy of the Foot and Ankle.
  • A second e-Book, The Art and Science of Orthobiologics for the Foot and Ankle, will debut at ACFAS 75.
  • ACFAS introduced the Surgical Skills Course, All About the Ankle, as a sell-out in 2016.
  • Two successful practice management seminars held in 2016 used real case studies to teach participants correct surgical coding procedures.
  • Four new fellowship programs received status through ACFAS’ Recognized Fellowship Initiative, bringing the total number of programs with status to 37.
  • Regional Divisions increased their financial support to all ACFAS 75 poster and manuscript presenters who reside in their region, supporting both residents and postgraduate fellows for the first time.
  • The Division Presidents Council put together a process to redistrict the 14 Divisions into nine Regions.
  • The Research Committee provided $40,000 in educational and scientific grants to five studies in 2016.
  • A new clinical consensus statement on perioperative management will be released in early 2017.
  • The College submitted letters to congressional and administration leaders to advocate for MACRA changes and to urge support of the U.S. Department of Veterans Affairs Provider Equity Act (S.2175).
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Elective Surgery on the Rise as 2016 Comes to a Close
The last This Week poll of 2016 asked readers if they have seen an increase in elective surgery as the end of the year approaches. As suspected, the majority of respondents—55 percent—have seen an increase while 43 percent have not. Three percent have not been tracking this trend.

Thank you to everyone who voted! Look for the next poll in the January 4 issue of This Week @ ACFAS, and remember to visit throughout the month to view real-time poll results.
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Foot and Ankle Surgery

Aging, Deep Vein Thrombosis and Male Gender Predict Poor Outcome After Acute Achilles Tendon Rupture
A study examined the effects of age, gender and incidence of deep vein thrombosis (DVT) on patient outcomes after acute Achilles tendon rupture (ATR). Ninety-five men and 16 women with an acute total ATR were assessed. At one year postoperatively, patients were given an Achilles Combined Outcome Score (ACOS), which combined the Achilles tendon Total Rupture Score, heel-rise height test and limb symmetry heel-rise height. The strongest independent predictor of a good outcome one year after ATR was an age of less than 40 years old, followed by female gender. Patients who did not have a DVT while immobilized postoperatively had a better outcome.

From the article of the same title
Bone & Joint Journal (12/16) Domeij-Arverud, E.; Anundsson, P.; Hardell, E.; et al.
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Can Ultrasound Imaging Predict the Development of Achilles and Patellar Tendinopathy? A Systematic Review and Meta-Analysis
Researchers investigated the ability of ultrasound imaging to predict the development of symptoms in the Achilles or patellar tendon. The review included prospective studies that performed ultrasound imaging of Achilles or patellar tendon structure in asymptomatic patients. Meta-analysis revealed that tendon abnormalities on ultrasound are associated with future symptoms of both patellar and Achilles tendinopathy (Risk ratio = 4.97). Subgroup analysis indicated that tendon abnormalities at baseline were also associated with an increased risk of both patellar (RR = 4.35) and Achilles (RR= 7.33) tendinopathy.

From the article of the same title
British Journal of Sports Medicine (12/01/16) McAuliffe, Sean; McCreesh, Karen; Culloty, Fiona; et al.
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Early Reconstruction of Distal Leg and Foot in Acute HVEB: Does Location of Pedicle in Zone of Injury Affect the Outcome of Distally Based Sural Flap?
Researchers aimed to compare the outcome of early aggressive debridement and reconstruction of distal leg and foot after acute high-voltage electrical injury using distally based fasciocutaneous sural flap between high-risk and low-risk patients, as defined by the anatomic proximity of the flap pedicle to the injury. Fifty-one patents with a contact point of high-voltage electrical burn (HVEB) in the distal leg and foot undergoing distally based fasciocutaneous sural flap were included in the study. In 28 patients, the flap pedicle was not involved in the contact point of HVEB (low-risk group), whereas the contact point was located inside the zone of injury in 21 patients (high-risk group). Wound dimensions were relatively similar between the two groups. Complications of flap survival and other minor complications did not differ significantly between the groups.

From the article of the same title
Annals of Plastic Surgery (01/01/17) Vol. 78, No. 1, P. 41-45 As'adi, Kamran; Salehi, Seyed Hamid; Shoar, Saeed
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Practice Management

2016 Year-End Tax Planning Tips for Physicians
With Republicans gaining control of the presidency and Congress, it is widely anticipated that there will be significant tax law changes next year, and it is likely that future tax law changes will be retroactively applied in 2017 to the beginning of that calendar year. As part of the Affordable Care Act, a 0.9 percent surtax on income above $200,000 and a 3.8 percent Medicare surtax on capital gains, rental income and other unearned income were added. There are proposals to eliminate these taxes, so the surcharges can be avoided or reduced by delaying some earned income into 2017 and deferring capital gains and rental income. Changes in deductions and elimination of the deductibility of real estate taxes and state income taxes are also under discussion. For those considering converting a retirement plan or individual retirement account into a Roth, the conversion should be postponed until 2017 since tax brackets may be lower. Finally, there are proposals to cut business income taxes to 15 percent and to possibly apply tax cuts to pass-through entities, such as LLCs, partnerships and sole proprietorships, reducing income taxes for private practices.

From the article of the same title
Medical Economics (12/17/16) Schiller, David J.
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Seven Predictions for Practice Management in 2017
Physicians and staff should prepare for significant changes in reporting standards, payments, regulations and technology demands in the coming year, starting with the Affordable Care Act (ACA). President-Elect Donald Trump’s administration and a Republican Congress will work to repeal the ACA, but the results may not bring immediate or dramatic change. Given Republicans’ narrow majority in the Senate, actions that weaken rather than completely eliminate the ACA are more likely. Implementation of the Medicare Access and CHIP Reauthorization Act of 2015 will also be rolled out gradually. Rather than giving physicians a hard start date, the U.S. Centers for Medicare and Medicaid Services has modified the initial year of the program with three options that allow physicians to adjust to participation. Practices may face new cash flow challenges as new government practices, higher deductibles and premiums and rising medication costs place a heavier burden on patients. The proposed mergers between Aetna and Humana and between Anthem and Cigna will also affect both physicians and patients; if the companies merge, there will be serious implications for patient choice and physicians' ability to negotiate. Finally, increased reporting and administrative responsibilities will place more pressure on practices to optimize their technology and to acquire new tools to align their care with the value-based health system. Patients will come to expect technical conveniences, such as online portals for accessing test results, prescription information and scheduling appointments.

From the article of the same title
Diagnostic Imaging (12/19/16) Rowh, Mark
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Telehealth Alone Will Not Increase Healthcare Access for the Underserved
Telehealth can bring medical care to communities with limited access to providers, reducing wait times and improving convenience. However, telehealth alone may not be enough to address access inequities in underserved areas. Telehealth evaluations can identify problems that require follow-ups and further care, generating new demand for services that cannot be performed through video conferencing. If no local specialists are available to take new patients, patients may need to travel long distances to have a face-to-face appointment. In a recent study of teleretinal screening, which identifies diabetics at risk of vision loss from diabetic retinopathy, 38 percent of screened patients required in-person follow-up. However, patients were confronted with wait times of several months before being seen by a specialist. A potential solution for telehealth programs is working with local providers to create designated slots for telehealth patients who require in-person follow-ups. To meet the greater demand, providers may need to work longer hours, hire extra staff or allow wait times for all patients to grow. Additionally, healthcare entities could use telehealth to restructure how all referrals and in-person appointments are scheduled. For example, a clinic or integrated delivery system could require a telehealth consultation before any in-person appointments can be made. By deterring a large fraction of in-person consultations, specialists' time will be freed up for the patients who most need it.

From the article of the same title
Health Affairs Blog (12/15/16) Uscher-Pines, Lori; Mehrotra, Ateev
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Health Policy and Reimbursement

CMS Adds Advanced APM Opportunities Under MACRA
The U.S. Centers for Medicare and Medicaid Services (CMS) are reopening applications for physicians to participate in two value-based care models in 2018, both of which qualify as advanced alternative payment models (APM) under the Medicare Access and CHIP Reauthorization Act's Quality Payment Program. The new offerings are the Comprehensive Primary Care Plus model and the Next Generation Accountable Care Organization model. With the new additions, CMS believes one-quarter of physicians will join advanced APMs by 2018. Physicians participating in advanced APMs are eligible to earn a lump sum bonus of up to five percent on Medicare payments. American Medical Association President Andrew Gurman praised the announcement. "By being part of these models, physicians will have more time with patients and more flexible payments to support care coordination and improvements in access and quality," says Gurman. "This will result in healthier patients and more satisfied physicians, a win-win that is a good holiday present for everyone."

From the article of the same title
Becker's Hospital CFO (12/16/16) Rappleye, Emily
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CMS Finalized New Marketplace Payment Rule, Effective January 17, 2017
The U.S. Centers for Medicare and Medicaid Services (CMS) have issued the Benefit and Payment Parameters rule for 2018, which finalizes dozens of proposals intended to strengthen the marketplace risk pool and improve enrollment. The rule addresses modifications of the Affordable Care Act’s guaranteed issue and renewability regulations, age rating requirements for children, changes in the risk adjustment program for the next two years and 2018 payment parameters. Plan benefits, eligibility requirements, marketplace oversight rules and special enrollment governance rules also have been modified. The final rule, or payment notice, typically is released in late February or early March, but CMS accelerated the timetable so the rules for 2018 could be established before the presidential transition period in January. The rule is subject to the Congressional Review Act and could be disapproved by a joint resolution of the new Congress.

From the article of the same title
Health Affairs Blog (12/17/16) Jost, Timothy
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Senate Report Shows Martin Shkreli Is Just as Bad as You Think He Is
A report from the Senate Special Committee on Aging determined shocking increases in prescription drug prices are a threat to the health and economic stability of Americans for whom vital medications are unaffordable. "The skyrocketing prices of prescription drugs affect every American family, particularly our seniors," notes Committee Chair Sen. Susan Collins (R-Maine). "We must work to stop the bad actors who are driving up the prices of drugs that they did nothing to develop...just because, as one executive essentially said, 'because I can.'" The panel summarized this year's probe of records from four pharmaceutical firms and public hearings concentrating on sudden price hikes in decades-old medicines and the pricing decisions instituted by drug industry entrepreneur Martin Shkreli and other industry executives. Sen. Claire McCaskill (D-Mo.) describes the current drug pricing model as "immoral for the patients and taxpayers who ultimately foot the bill—especially for generic drugs that can be made for pennies a dose." According to the Senate report, the four drugmakers employed variations of a business model that identified and secured off-patent, sole-source drugs for which "they could exercise de facto monopoly pricing power, and then impose and protect astronomical price increases."

From the article of the same title
USA Today (12/21/16) McCoy, Kevin
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Medicine, Drugs and Devices

FDA Bans Powdered Gloves
The U.S. Food and Drug Administration (FDA) is banning the use of powdered medical gloves beginning January 19, 2017. The ban was proposed in March due to mounting evidence that the gloves posed health risks to patients, including airway and wound inflammation, postsurgical adhesions and allergic reactions. Specifically, FDA will ban the manufacturing, distribution and sale of all powdered surgeon’s gloves, powdered patient examination gloves and the absorbable powder used to lubricate surgeon’s gloves. According to FDA, the majority of comments submitted to the proposed rule favored the ban, with most comments in opposition to the ban claiming that nonpowdered gloves were more difficult to put on and less comfortable. FDA also rejected claims that newer, reduced-powder gloves are safer than previous powdered gloves. To facilitate the ban, FDA will amend the classification regulations for medical gloves to distinguish between powdered and nonpowdered gloves.

From the article of the same title
Regulatory Affairs Professionals Society (12/16/2016) Mezher, Michael
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New Concerns About Anesthesia for Young Children
The U.S. Food and Drug Administration has issued a statement warning that repeated use of general anesthesia in children under three years old may harm brain development. Longer surgeries lasting three hours or more may also interfere with development, but a single use of anesthesia for a short period of time is unlikely to have negative effects. Studies have found that repeated and prolonged exposure to general anesthesia kills nerve cells in the brain, potentially causing learning, memory and behavioral problems later. FDA now requires safety warnings to be added to the labels of 11 general anesthetic and sedation drugs and has called for further research to determine how early anesthetic exposure affects development. Randall Flick, president of the Society for Pediatric Anesthesia, expressed concern that the FDA warning may cause parents to delay important surgeries for their children, given that no clear alternatives to general anesthesia exist for certain operations. “Parents and clinicians should be cautioned that delays in needed procedures may have unintended negative consequences,” says Flick.

From the article of the same title
Wall Street Journal (12/19/16) Reddy, Sumathi
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Only Some Shoe Inserts Tied to Lower Risk of Injuries
A new study published in the British Journal of Sports Medicine found contoured orthotics designed to modify gait while walking and running might help reduce the risk of stress fractures, but shock-absorbing insoles will likely not prevent such injuries. The researchers analyzed data from 11 trials of foot orthotics and seven studies of shock-absorbing insoles that included more than 3,200 people. Generally, foot orthotics were associated with a 28 percent lower risk of injuries and a 41 percent lower risk of stress fractures. However, shock-absorbing insoles were not associated with a statistically meaningful reduction in injuries or stress fractures. Foot orthotics usually have a contoured profile and are used to optimize foot function. These inserts help shift weight distribution and pressure as the foot hits the ground and help alter muscle activity and running mechanics. Shock-absorbing insoles typically are relatively flat and mainly used to reduce the force of impact when the foot strikes the ground, potentially preventing muscle, tendon and bone damage. One trial of insoles actually demonstrated a higher risk of injuries associated with these products, while the other trials in the analysis simply found no benefit.

From the article of the same title
Reuters Health (12/16/16) Rapaport, Lisa
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, FACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

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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