News From ACFAS

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The ACFAS Board of Directors election closes tonight. If you haven't voted yet, check your email for the reminder with the subject line: "ACFAS Board of Directors Election—We Need Your Vote!" that was sent last Tuesday, Dec. 22 from acfas.ballot@intelliscaninc.net with your unique link to the election. Members without an email address were sent voting instructions by US mail in late November.

Please vote to ensure your voice is heard. If you have questions about accessing the ballot site, contact our independent election firm at kwier@intelliscan.com.
With 2016 just around the corner, ACFAS would like to thank you—our dedicated members—for everything you’ve done throughout the year to advance the profession and patient care.

Your commitment and service helped ACFAS accomplish the following in 2015:

• The Board of Directors adopted the Code for Interaction with Companies to curtail conflict of interests in the College’s governance, CME, Journal of Foot & Ankle Surgery and research grants.
   
• The ACFAS 2015 Annual Scientific Conference beat our Vegas numbers with record attendance and exhibitors. It also stopped traffic in downtown Phoenix with a fabulous street party.
   
• Membership slightly surpassed last year’s record highs of 7,200 (overall membership) and 1,750 (student club membership).
   
• A new e-book on Arthroscopy will debut at ACFAS 2016.
   
• FootHealthFacts.org broke another record with more than 5.95 million visits to the patient education site in 2015.
   
• The ACFAS Marketing Toolbox has expanded with a new Infographic section and even more free downloadable PowerPoint presentations, with more to come.
   
• The Journal of Foot & Ankle Surgery renewed its contract with Elsevier to offer even more to members with an exciting Open Access option coming in 2016.
   
• ACFAS offered its second annual Total Ankle Replacement course and is planning more for 2017.
   
• The first-ever Taking a Scalpel to the Evidence course used case-based learning to discuss complications and how surgical decision-making is evolving.
   
• The Practice Management Committee has developed a new surgical coding curriculum for the practice management seminars. The new curriculum includes real-life scenarios to demonstrate how to code for procedures a physician is already performing.
   
• The College conducted its triennial Membership Opinion and Practice Economics surveys. The Board studied the results, and all ACFAS committees are now using the data to improve ACFAS products and services.
   
• The first new Clinical Consensus Statements were published on antibiotic prophylaxis and deep vein thrombosis.
   
• Six new fellowship programs received status through ACFAS’ Recognized Fellowship Initiative, bringing the total number of programs with status to 36.
   
• Regional Divisions continued their standard financial support to all ACFAS 2016 resident poster and manuscript presenters who reside in their region.

Foot and Ankle Surgery

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Researchers evaluated 86 knees to determine whether ankle joint orientation may become parallel or less parallel to the ground after high tibial osteotomy (HTO). They then investigated how orientation may affect ankle symptoms. The main measurements were tibial plafond inclination (TPI), talar inclination (TI), talar tilt (TT) and lateral distal tibial angle (LDTA). Patients were divided into two groups depending on whether TPI and TI values increased or decreased. In group A, mean TPI and TI changed from 6.9° ± 3.6° and 8.0° ± 3.8° to 2.8° ± 3.1° and 3.9° ± 3.0°; in group B, the changes were from -1.3° ± 3.7° and 0.6° ± 4.5° to -6.0° ± 4.2° and -4.6° ± 5.9°. Pain scores did not alter significantly in group A but increased significantly in group B.


Total ankle replacement (TAR) sometimes results in devastating wound complications and infections. A new study investigated the use of flaps and their successes and complications related to difficulties following TAR. A total of 19 TARs were studied. The mean time to flap procedure was 13.1 weeks, and the most common reason for flap coverage was a non-healing anterior wound. The average size of the wound was 5.4 × 3.8 cm. Sural pedicle flap, followed by a propeller flap, was the most common type of flap used. No deep infections were recorded following a successful flap unless they were preexisting. There were four flap failures. The study showed that a variety of flap reconstruction options are available to be used to manage ankle wounds following TAR.

Practice Management

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The transition to value-based care means that many customers now depend on their relationship with their physician more than ever. When a well-liked physician retires, it can throw a wrench in patients' relationship with your practice. Establishing a continuity of care is important for retaining those patients. Here are three tips to keep things running smoothly in the event of a retirement:

1. Transparency: This is important for both the patient and all employees at your practice. Be sure people are aware of the retirement well in advance and also provide suggestions to patients regarding new physicians.
2. Communication: Instead of making an announcement and dictating the retirement to your staff, work with the retiring physician to formulate a communication plan that is less corporate and more friendly. Staff satisfaction is an important factor.
3. Fairness: You should ensure that departing physicians are not penalized for their gradual productivity decrease and that new physicians are not expected to assume full risk immediately.

Workforce security education will be more important than ever in 2016, according to Randy McCleese of the St. Claire Regional Medical Center. As vice president of information security and the chief information officer at St. Claire, McCleese has experience in identifying threats and determining solutions. His biggest concern is medical device security, especially devices at smaller practices that tend to keep older machines on hand for 10 to 15 years. Putting these devices on a separate, virtual network is one way to prevent them from infecting the overall network infrastructure in the event of a breach. Most of all, McCleese stresses practice staff training. Organizations must stress cybersecurity by creating a culture of security and ensure that every employee is aware of their individual role in protecting patient information. This is especially true in practices that allow bring-your-own-device policies.


Cross-training employees is an overlooked practice that can pay big dividends, according to consultant P.J. Cloud-Moulds. It allows for more flexibility and ensures that operations run smoothly through times of uncertainty. By cross-training your entire staff, you have the ability to hire new employees with less constraint, and you also have a current employee or two who can step in and perform the necessary functions that are not specific to their particular position. If someone is out sick or on vacation, someone is already trained and ready to cover for that person. Cross-training need not be difficult, just efficient, and should be made up of a simple protocol that allows employees to learn the basics of each position they may need to fill at some point in their tenure with your practice. The best aspect of cross-training, Cloud-Moulds says, is that it gives you the chance to make better staffing decisions. Redeploying staff and diversifying the workload lets you know exactly what needs to be done and who needs to provide additional help.

Health Policy and Reimbursement

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Some professional organizations claim that a new federal rule could result in higher out-of-pocket costs for consumers who need emergency care outside of their providers' network. The law does not prohibit doctors and hospitals from "balance billing" consumers, and advocates say this harms consumers. Emergency services providers say nothing can be done because federal law requires them to treat anyone who comes through the door. Consumer advocates and researchers say the government should take a consumer-friendly approach and eliminate balance billing for emergency care altogether. New York already took this step in April so that insured customers cannot be billed for out-of-network emergency care. "It's promising what New York did because they extract consumers so they can't be used as leverage between the providers and insurers," says Kevin Lucia, a senior research fellow at Georgetown University's Center on Health Insurance Reforms, who co-authored a study examining state efforts to protect consumers from balance billing.


Congress passed a $1.1 trillion spending and tax extender bill, which includes language creating a healthcare industry cybersecurity task force to study how other industries combat cyber threats. It also establishes a single pipeline of information on cyber threats that can be accessed for free in real-time. The provisions are part of the controversial Cybersecurity Information Sharing Act, which allow for greater information sharing between private companies and the federal government. The addition also comes in the wake of one of the worst-ever years for healthcare data security. The last year saw four of the five largest healthcare breaches since 2009, with more than 90 million records compromised. These massive breaches are even beginning to affect providers' credit ratings, according to analysts.


A blanket hardship exception from meaningful use passed in Congress as part of the Patient Access and Medicare Protection Act. The Centers for Medicare and Medicaid Services previously "could only grant such exemptions on a case-by-case basis, and that exemption process was inadequate and tedious," according to Texas Rep. Pete Sessions. Eligible professionals must apply for exemptions by March 15, 2016 and hospitals must do so by April 1.

Medicine, Drugs and Devices

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Managing rheumatoid arthritis (RA) is a burden for 1.5 million people nationwide, but many therapies are coming that promise both effectiveness and relief. Specialty drugs, while expensive, have helped patients for the last 15 years, and four new drugs expected to be approved will compete with existing treatments in the near future. The downside is that all four of the drugs will cost around $40,000 per patient per year, although that figure is "consistent with the pricing for current treatments." In addition, a biosimilar drug for Humira may soon become available, which could ease cost concerns for many patients. The exact cost reduction is unknown, but it could be substantial.