News From ACFAS

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Did you recently move or have a change to your practice’s website, phone or fax? If your contact information hasn’t been updated to your ACFAS profile on FootHealthFacts.org, potential patients may not be able to find you through the “Find a Physician” tool! Update your profile to keep your information on file with the College current. The changes will also be updated on the acfas.org website, so other members of the College can continue to reach you through the "Find a Colleague" directory. Additionally, you may want to change your “preferred address” for receiving the Journal of Foot & Ankle Surgery and other ACFAS mailings through your profile.

How do I update my profile? First, log in to acfas.org and update your contact information through the profile link at the top of the home page near your name. After completing your professional profile to include your website, hours, and up to three office locations, scroll down to “ACFAS Website Listing” and check “Yes” for “Consumer Physician Search” and “Find a Colleague" directory.

Don’t forget to keep ACFAS abreast on how you and your practice are growing so that we can make sure you are available to peers, potential patients and the College! Update your profile today. Register and make your hotel reservations today for the ACFAS Coding and Practice Management Seminar July 18-19 at the Marriott San Diego Gaslamp Quarter. Last date to reserve your hotel is June 17, but registration for the program remains open. Designed for the practicing foot and ankle surgeon and their staff, this day and a half, high-impact course is filled with essentials to help you with the business side of your practice.

Jackie Reiss-Kravitz, CPC, a seasoned and respected expert in the areas of coding and billing for podiatric/surgical practices, will address the essentials of understanding coding for Evaluation and Management services, use of modifiers, how to attest for Meaningful Use, and how to provide and get reimbursed for durable medical equipment. Jerry Noll, DPM, Chair, Practice Management Committee, will explain the complexities of coding for podiatric surgical procedures and Marcy Blitch, RHIA, CCS & ICD 10 Certified Trainer will provide hands-on training for transitioning to ICD-10. Attorney James Parrett, JD, will provide guidance on avoiding malpractice claims.

To register online and view the course agenda, visit acfas.org/practicemanagement/. To make hotel reservations, contact the hotel directly at (877) 622-3056 and reference ACFAS for group rate. For additional questions contact Maggie Hjelm in the Education Department, or phone (800) 421-2237.

Foot and Ankle Surgery

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A new arthroscopic fixation technique known as lift, drill, fill and fix (LDFF) could be a good treatment option for patients suffering from primary osteochondral talar defects, a new study has found. The study involved seven patients who underwent a pre-operative clinical assessment and were followed-up with at an average of 12 months after being treated with the procedure. All patients experienced improvements in American Orthopaedic Foot and Ankle Society (AOFAS) scores, which rose from 63 before surgery to 99 at follow-up. Numeric rating scales (NRS) of pain at rest and during walking improved in all patients as well. NRS pain at rest scores dropped from 2.9 to 0.1, while pain during walking scores fell from 7.6 to 0.1. In addition, weight-bearing radiographs taken at follow-up showed that five patients experienced remodeling and bone ingrowth after the procedure. However, the study cautioned that research involving more patients and longer follow-up times is needed in order to draw any conclusions about the effectiveness of LDFF and whether the results of the procedure are lasting.

Practice Management

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Doctors' practices and hospitals in the United States are increasingly using artificial intelligence to improve the care they provide to their patients and to reduce hospital readmissions in response to mandates included in the Affordable Care Act. The systems used by physicians' practices and hospitals combine data from a variety of sources to perform a number of different tasks, including identifying patients who might be at risk for certain conditions and developing more personalized treatment plans. Other systems, particularly those that draw on data from patients' electronic health records, alert doctors when a patient with a certain genetic makeup is likely to not benefit from taking a particular drug. Doctors can then quickly prescribe an alternative medication using the same system. Despite the growing use of such technologies, the doctors who use them are quick to point out that they do not replace their medical judgment when caring for patients. These technologies also have a number of limitations to their usefulness, including the fact that it is difficult to obtain access to high-quality data and to develop and program these systems to identify patterns in patients. In addition, it is also difficult to create a comprehensive database of medical information for these technologies since most EHR systems are incompatible with one another.


Researchers at Brigham and Women's Hospital and Partners Healthcare in Boston have discovered that notifying a patient's physicians of tests pending at discharge (TPADs) can significantly improve physician awareness of patient status and improve care. The researchers say that physician awareness of results pending at discharge is poor. "We developed an automated system that notifies responsible physicians of TPAD results via secure, network e-mail. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results," the researchers write in the Journal of the American Medical Informatics Association. The researchers had previously determined that 41 percent of patients left the hospital before all test results were reported, and 9.4 percent of those results were considered potentially actionable. Physician awareness of TPAD doubled among physicians who received notifications, 76 percent versus 38 percent of physicians in a control group. The researchers conclude that the automated notification system is practical for any healthcare network using secure external messaging for clinical communication. "In theory, this strategy could facilitate electronic acknowledgement, transfer of responsibility, and subsequent actions, thereby improving patient safety during care transitions," the researchers write.

Health Policy and Reimbursement

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Sylvia Mathews Burwell faces a number of important tasks ahead of her now that she has won Senate confirmation to serve as the Secretary of Health and Human Services. For example, Burwell will need to deal with ongoing issues related to the implementation of the Affordable Care Act as well as the 2015 open-enrollment period that begins Nov. 15. Some of Healthcare.gov's back-end operations are still not functioning properly and will need to be resolved so insurance companies can receive accurate payments and consumers can easily re-enroll in coverage. Meanwhile, there are concerns that Oregon and Nevada's decision to ditch their troubled state-run exchanges in favor of Healthcare.gov could create technical problems with the federal exchange during the upcoming open enrollment period. Observers say that Burwell will also need to deal with the process of updating rules for essential health benefits before the 2016 open-enrollment period begins. Elizabeth Carpenter, a director at the consulting and research firm Avalere Health, says that Burwell will need to decide whether to continue to allow the states to have a great deal of latitude in creating coverage rules or take a different approach. Guidance on the rules for essential health benefits for the 2016 open enrollment period is expected to be issued as early as this fall.


The Obama administration is planning to make a number of changes to Healthcare.gov ahead of the start of the 2015 open enrollment period in order to avoid a repeat of the problems that occurred when the site was launched last year. Perhaps the biggest change, and the one that some contractors say is the riskiest, is the replacement of software used by Healthcare.gov that allows consumers to create accounts and log in. Problems with that software prevented a large number of consumers from accessing the site last fall. One government contractor who spoke about the replacement of the software said that it cannot be replaced and be ready in time for the start of the open enrollment period on Nov. 15, though it could be retained and modified so that it works better. The Centers for Medicare and Medicaid Services (CMS) is also planning to make changes to the application that most consumers will fill out to obtain coverage, the tool that allows them to compare and shop for plans, and other features of the consumer-facing portion of Healthcare.gov. Tests of the new functions are scheduled to begin this summer. The changes, which CMS says represent improvements of the existing system rather than a complete overhaul, are causing concern that this fall's open enrollment period could be just as troubled as last year's.


The Centers for Medicare and Medicaid Services (CMS) on June 1 opened the first stage of a process that will allow doctors and teaching hospitals to review and potentially dispute payments and gifts given to them by pharmaceutical companies and medical device makers. The first stage of the process involves physicians and teaching hospitals registering using CMS' Enterprise Portal, which will allow them to access the information about payments and gifts that drug companies and medical device makers are required to report under the Physician Payments Sunshine Act. The second stage begins in July, when doctors and teaching hospitals will be allowed to register in the Open Payments system so they can review and dispute data about payments and gifts. Any data that is disputed but not corrected by drug and medical device makers will be released by CMS on Sept. 30, though it will be marked as being under dispute. The American Medical Association (AMA) has criticized the launch of the review process by saying that CMS has missed almost every deadline contained in the Sunshine Act and associated regulations. Nevertheless, the organization is calling on doctors to register to take part in the review period in order to ensure that the data about any payments and gifts they received is accurate.


An analysis of four Medicare accountable care organizations (ACOs) has found that surgeons are largely absent from the executive committees of these organizations. The analysis, published in the journal Health Affairs, included a survey of early Medicare ACOs that were operating in 2012 as well as case studies of four of these organizations. Of the 28 respondents who participated in the survey, half said that no surgeons were members of their executive committees. The case studies also showed that surgeons were not among the executive committee members at two of the four Medicare ACOs. In addition, the analysis found that none of the top strategic priorities at any of the ACOs included surgical care. Researchers offered a variety of reasons for why surgeons are largely absent from ACO executive committees, including the fact that none of the Centers for Medicare and Medicaid Services' ACO quality measures directly address surgery or surgical care. The analysis also noted that surgeons are largely choosing not to join ACOs because ACO incentives are not strong enough to prompt them to change their behavior on quality or cost targets. Finally, the analysis found that 88 percent of the ACOs that were surveyed were unaware of the role and cost of surgical care in total spending. Failing to take into account the role and cost of surgical care, the analysis found, may result in the loss of any savings that ACOs achieve by meeting their chronic disease management goals given the significant role surgical care plays in both hospital expenses and total healthcare spending.

Medicine, Drugs and Devices

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The Food and Drug Administration (FDA) has given Mylan Pharmaceuticals and Teva Pharmaceutical Industries the green light to market generic versions of celecoxib, which is used to treat rheumatoid arthritis, osteoarthritis, and acute pain. Teva's generic celecoxib, which will be sold in 50 mg, 100 mg, 200 mg, and 400 mg doses, are expected to go on sale in December or possibly earlier. Mylan Pharmaceuticals, meanwhile, plans to sell a 50 mg dose of generic celecoxib. The FDA says that these and other generic products will be required to meet the same quality and potency standards as their name-brand counterparts.


A short controlled ankle movement (CAM) walker boot may be a better rehabilitative tool than a rigid post-operative sandal or standard athletic shoe for patients treated for fractures of the fifth metatarsal base, a new study has found. The study involved 20 people with no recent history of foot injury, all of whom were asked to walk, heel walk, and pivot while wearing a short CAM walker boot, a rigid post-operative sandal, or a standard athletic shoe. Peak pressure, contact pressure, and impulse at the base of the fifth metatarsal were then measured while patients were wearing each of these devices during the aforementioned gait activities. The study found that the short CAM walker boot was more effective than the sandal or the standard athletic shoe at offloading the fifth metatarsal while patients performed the gait activities. Compared to the post-operative sandal, the use of the CAM walker boot resulted in significantly lower peak pressure at the fifth metatarsal during walking and heel walking and also significantly reduced contact pressures at this location of the foot while patients performed these actions. In addition, the CAM walker boot resulted in significantly lower peak pressure and significantly reduced contact pressures at the fifth metatarsal during heel walking compared to the athletic shoe.