December 30, 2014 | | JFAS | Contact Us

News From ACFAS

Did You Vote?
The ACFAS Board of Directors election closes next Tuesday, January 6. If you haven't voted yet, watch for a reminder email, with the subject line: "ACFAS Board of Directors Election—We Need Your Vote!", to arrive later this week from with your unique link to the election. The small percentage of members without an email address were sent voting instructions by US Mail in mid-December. Please be sure to vote to ensure your voice is heard. If you have questions about accessing the ballot site, please contact our independent election firm at
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2014 ACFAS Year in Review
As 2014 comes to a close, ACFAS would like to thank you, our dedicated members, for your hard work throughout the past year. The College appreciates everything you do to advance the profession and to make a difference in the lives of your patients and colleagues. Here's a recap of ACFAS' accomplishments from 2014:
  • Membership surpassed 7,100—a record high. Plus, student club membership reached a record high of 1,750 students.

  • The ACFAS 2014 Annual Scientific Conference had record attendance and exhibitors, plus three new Exhibit Hall features: the HUB, the ACFAS Job Fair and a photography booth with free professional headshots.

  • A new Clinical Consensus Statements initiative was launched with the first two topics on antibiotic prophylaxis and deep vein thrombosis set for publication in the first quarter of 2015.

  • ACFAS worked closely with APMA to urge CMS to revise the Affordable Care Act’s “Sunshine” Open Payments regulations, which would have been discriminatory to podiatric CME.

  • The Journal of Foot & Ankle Surgery’s (JFAS) journal impact factor, which measures JFAS’ influence based on citation frequency data, increased to 0.979—its highest ever.

  • The number of visitors to jumped from 1.7 million in 2013 to a record 3.92 million in 2014.

  • CPME adopted more stringent CME accreditation standards advocated by ACFAS.

  • Two new PowerPoint presentations, Bunions & Hammertoes and Ankle Injuries: Before and After, were added to the ACFAS Marketing Toolbox.

  • The new Rearfoot Reconstruction Surgical Techniques DVD debuted.

  • A record amount of money was awarded to three winners of the 2015 ACFAS Clinical and Scientific Research Grant.

  • The College’s most frequently downloaded document, the Credentialing, Privileging and Surgical Delineation Position Statement, was revised.

  • Significant new guidelines for conflict of interest and interaction with companies were adopted by the Board of Directors.

  • Three new ACFAS Recognized Fellowship Programs were accepted, bringing the total to 32 programs.

  • Two new webinars on ICD-10 and modifiers are available for purchase and download on

  • ACFAS offered its first advanced workshop and seminar on Forefoot Reconstruction and Complications.

  • ACFAS’ first-ever e-book on arthroscopy of the foot and ankle is in production.

  • ACFAS expanded the use of its coding support specialist.

  • Regional Divisions created standard financial support to all ACFAS 2015 resident poster and manuscript presenters who reside in their region.
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Foot and Ankle Surgery

Calcaneal "Z" Osteotomy Effect on Hindfoot Varus After Triple Arthrodesis in a Cadaver Model
The closing-wedge calcaneal "Z" osteotomy is not effective at correcting bone misalignment and lateral forefoot overloading in a cadaver model of varus malunited triple arthrodesis, a new study has found. Researchers found that hindfoot alignment in the 10 cadaveric feet used in the study did not change after calcaneal "Z" osteotomy was performed compared to before the procedure. The study's authors also found that the osteotomy brought about no change in second cuneiform inclination, which is representative of midfoot alignment. Finally, the study found no changes in medial and lateral peak plantar pressures after osteotomy compared to before varus triple fusion was performed.

From the article of the same title
Foot & Ankle International (12/14) Vol. 35, No. 12, P. 1350 Zanolli, Diego H.; Glisson, Richard R.; Utturkar, Gangadhar M.; et al.
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Preoperative Radiological Factors Correlated to Long-Term Recurrence of Hallux Valgus Following Distal Chevron Osteotomy
A recent study of 100 hallux valgus patients treated with distal chevron osteotomy has found that radiological recurrence of the condition is common following the procedure. The study's authors observed radiological recurrence of hallux valgus deformity in 56 feet at final follow-up, which was performed an average of 7.9 years after surgery. Radiological recurrence of hallux valgus deformity was noted in feet where the hallux valgus angle (HVA) was 15 degrees or more. Forty-four feet displayed moderate recurrence of hallux valgus deformity, while 11 feet had mild recurrence and one had severe recurrence. The study's authors determined that long-term hallux valgus recurrence was significantly affected by factors such as Distal Metatarsal Articular Angle, pre-operative congruence, sesamoid position and HVA. However, none of the patients who experienced recurrence needed revision surgery because recurrence did not cause any pain.

From the article of the same title
Foot & Ankle International (12/14) Vol. 35, No. 12, P. 1262 Pentikainen, Ilkka; Ojala, Risto; Ohtonen, Pasi; et al.
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Coalition Resection and Medial Displacement Calcaneal Osteotomy for Treatment of Symptomatic Talocalcaneal Coalition: Functional and Clinical Outcome
Combining talocalcaneal coalition (TCC) resection and medial displacement calcaneal osteotomy results in significant improvements in a variety of metrics of functional and clinical outcomes in patients with symptomatic TCC, a new study has found. The study involved 27 patients with symptomatic rigid pes planovalgus caused by TCC, all of whom were treated with the two procedures and were followed up with after an average of 27.44 months. The study's authors found that the average American Orthopaedic Foot and Ankle Society hindfoot score rose from 39.88 before surgery to 84.37 at final, a statistically significant improvement. Visual analogue scale scores, which were used to measure pain, improved significantly as well by dropping from 8.48 before surgery to 3.70 post-operatively. In addition, mid-foot pressure during standing and walking declined significantly after surgery compared to before. Finally, the study found that heel valgus improved from 15.03 degrees before surgery to 3.09 degrees afterward.

From the article of the same title
International Orthopaedics (12/01/14) Vol. 38, No. 12, P. 2513 El Shazly, Ossama; Mokhtar, Mohammed; Abdelatif, Nasef; et al.
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Practice Management

Incorporating the Holiday Season into ICD-10 Prep
The holiday season and the end of the year are perfect times for physicians' practices to take steps to prepare for next year's transition to ICD-10, writes ADP AdvancedMD ICD-10 project manager Michael Bearnson. One recommendation Bearnson has is to use reporting and analytics functions in practice management and electronic health record systems to identify the most commonly used codes as well as codes that are most often denied. Doing so is an important part of planning the transition to ICD-10 and updating the practice's workflow, Bearnson says, and can help make the transition to ICD-10 go more smoothly than would otherwise be possible. In addition, Bearnson recommends that practices establish goals and set milestones for their plan to transition to ICD-10. Bearnson adds that physicians' practices should work with their trading partners in a joint effort to meet these goals and milestones during the ICD-10 testing process. Physicians' practices should then determine which parts of their ICD-10 implementation plans need improvement, Bearnson says. Finally, Bearnson recommends that physicians' practices break the process of planning to transition to ICD-10 into small chunks so that personnel involved do not feel overwhelmed.

From the article of the same title
Physicians Practice (12/23/14) Bearnson, Michael
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Health Policy and Reimbursement

CMS' Latest ICD-10 Claims Testing Sees 76% Acceptance Rate
Results from the recent ICD-10 acknowledgement test show that 76 percent of the more than 13,000 submitted claims were accepted by Centers for Medicare and Medicaid Services (CMS) contractors. CMS says the acceptance rate improved over the course of the test, which involved 500 healthcare providers, billing companies and claims clearinghouses, reaching a high of 87 percent at one point. The agency says some of the most common reasons why claims were rejected include invalid national provider identifiers, the use of future dates and missing companion qualifiers. There were no problems with Medicare fee-for-service claims systems during the test, CMS says. Health information technology consultant Stanley Nachimson says the 24 percent non-acceptance rate is not worrisome, adding that some of the rejections were the result of participating entities deliberately choosing to submit bad claims. Further acknowledgement tests are planned for March 2 - March 6 and June 1 - June 5.

From the article of the same title
Modern Healthcare (12/23/14) Conn, Joseph
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FDA Moves Forward on UDI System Initiative
The Brookings Institution recently released a report that includes 17 recommendations for adopting the Food and Drug Administration's Unique Device Identifier (UDI) system for medical devices. The recommendations included in the report address how providers should integrate UDIs into electronic health records, hospital inventory management systems and billing records. Other recommendations address how UDIs will be used in administrative transactions, including claims data and payment information, as well as how the identifiers will be integrated into patient-directed tools such as mobile apps. Integrating UDIs into consumer-oriented tools, the report said, would allow patients to receive safety alerts and other information about the devices they use while also collecting data about experiences patients have with their devices. These benefits could result in improved patient experiences and outcomes, the report concluded.

From the article of the same title
Health IT Outcomes (12/23/2014) Kern, Christine
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Supreme Court to Hear King v. Burwell on March 4, Decision Likely in June
The first legal briefs were filed Dec. 22 in King v. Burwell, the legal challenge to the subsidies provided to consumers under the Affordable Care Act (ACA). The briefs, which were filed by the plaintiffs in the case at about the same time the U.S. Supreme Court announced it will hear oral arguments beginning March 4, claim that language used in ACA that allows for subsidies to be provided to consumers who purchase coverage through exchanges created by "the state" was deliberately inserted by Congress to encourage states to create their own exchanges. The plaintiffs also say that Congress did not intend for the Internal Revenue Service (IRS) to decide for itself whether to extend subsidies to consumers living in states where the federal government is operating exchanges. IRS has said it interprets ACA to mean that subsidies should be available for eligible consumers regardless of whether they live in a state with its own exchange or not. ACA's supporters also say the provision in question may have been worded incorrectly and that the High Court should allow the IRS' interpretation to stand under a 1984 Supreme Court precedent. A decision in the case is expected by the end of June.

From the article of the same title
Modern Healthcare (12/22/14) Schencker, Lisa
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New Guidance on End-to-End ICD-10 Testing with Medicare
The Centers for Medicare and Medicaid Services has released guidance for how healthcare providers should prepare claims for end-to-end ICD-10 testing with Medicare. The guidance states that participants who volunteer and are given permission to take part in end-to-end testing must submit data, including no more than two submitter identifiers, as many as five national provider identifiers or provider transaction numbers and up to 10 health insurance claim numbers for actual living beneficiaries, to their Medicare Administrative Contractor before a round of testing begins. One such round is scheduled to start next month. This data can be used in any combination on up to 50 test claim participants that will be sent to Medicare Administrative Contractors during testing. Returned to Provider claims count toward the 50-claim limit and cannot be resubmitted. Tested ICD-10 claims must also contain specific dates that are different for each type of test claim submitted. Professional claims, for example, must have a date of service on or after Oct. 1, 2015, while inpatient claims must have a discharge date on or after Oct. 1, 2015. Professional and institutional claims must be dated Dec. 31, 2015 or earlier. Finally, any test claims submitted cannot include both ICD-9 and ICD-10 codes.

From the article of the same title
Health Data Management (12/14) Goedert, Joseph
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Medicine, Drugs and Devices

A Comparison of Two Podiatric Protocols for Metatarsalgia in Patients with Rheumatoid Arthritis and Osteoarthritis
A recent study compared the effectiveness of two methods for treating metatarsalgia in rheumatoid arthritis (RA) and osteoarthritis patients (OA). Thirteen OA patients and 11 RA patients were divided into two groups: Group A, which wore polypropylene terephtalate (PPT) insoles for 30 days and then wore the insoles along with custom silicone toe orthoses for another 30 days; and Group B, which wore the insoles and the orthoses for 30 days and wore the insoles alone for an additional 30 days. The study found that the method of treatment used in Group A was more effective of the two. Although both forms of treatment reduced Foot Function Index (FFI)-pain, -disability and -functional limitation scores at the end of 60 days, better improvements in FFI-pain and -disability scores were seen in Group A compared to Group B. The treatment method used in Group A was also superior to the method used in Group B at decreasing right foot plantar pressures and increasing foot contact areas.

From the article of the same title
Clinical and Experimental Rheumatology Online (12/01/2014) Vol. 32, No. 6, P. 855 Bongi, S. Maddali; Del Rosso, A.; Mikhaylova, S.; et al.
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A Randomized Trial of Discontinuing Versus Continuing Methotrexate After 6 Months of Etanercept and Methotrexate Therapy in Rheumatoid Arthritis
Transitioning active rheumatoid arthritis (RA) patients who are methotrexate (MTX)-inadequate responders from a treatment regimen that combines etanercept (ETN) and MTX to MTX monotherapy is not non-inferior to keeping these patients on the combination treatment, a new study has found. The study involved 205 RA patients who were treated with ETN/MTX for six months and were randomized to continue taking the combination or to being treated with ETN alone for 18 months. The study's authors observed that the adjusted difference in the change in disease activity score 28 (DAS28) between the ETN/MTX group and the ETN monotherapy group during weeks six to 12 was 0.4. This was below the non-inferiority margin of change of 0.6. DAS28 was found to be stable in patients who continued to take the ETN/MTX combination after six months, while it increased slightly in the ETN monotherapy group during weeks six to 12. The study concluded that switching patients to ETN monotherapy after six months of treating them with ETN/MTX did not result in the same improvements between weeks six and 12 as did continuing to treat patients with ETN/MTX.

From the article of the same title
Annals of the Rheumatic Diseases (12/01/2014) Vol. 73, No. 12, P. 2144 Pope, Janet E.; Haraoui, Boulos; Thorne, J. Carter; et al.
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Robert M. Joseph, DPM, PhD, FACFAS

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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