News From ACFAS

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If you have registered in the U.S. Centers for Medicare & Medicaid Services (CMS) Open Payment systems, be advised that CMS has now made Open Payments (Sunshine Act) data available to you before it goes public on September 30, 2014.

Registration is optional but required if you wish to review data related to your financial interactions with industry. No official deadline has been given for physicians who need to complete their registration, but to review or dispute industry data submitted for the 2013 reporting period, you must be registered and have reviewed any data reported about you no later than August 27, 2014.

CMS recommends completing the registration process as soon as possible and not waiting until the end of this initial review-and-dispute period.

Click here for more on the Sunshine Act. Each year, the College raises the bar for posters presented at the Annual Scientific Conference, and ACFAS 2015 will be no exception. While poster formats will still be categorized as scientific and case study, dollar awards have been increased for scientific posters to better reflect and recognize the scope of work and quality of research involved.

Ten presentations with the most unique topics or most unusual findings will be invited to be recorded and then available at the poster exhibit on Friday, February 20. All accepted posters will be posted on acfas.org after the conference.

Details on poster format requirements and abstract submission are posted on acfas.org/phoenix. Posters should be submitted to ACFAS no later than October 1, 2014.

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Foot and Ankle Surgery

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The findings of a recent study suggest that the all-inside arthroscopic modified Broström operation is a viable option for treating chronic lateral ankle instability. The study involved 11 matched pairs of ankle specimens taken from cadavers, which were operated on using the all-inside arthroscopic modified Broström procedure using a suture anchor and the open modified Broström operation. Ligaments were then loaded cyclically 20 times and tested to failure. Torque to failure, degrees to failure, and stiffness were measured to compare the biomechanical parameters of the all-inside arthroscopic Broström procedure to those of the open modified Broström operation. No significant differences were observed between the all-inside arthroscopic Broström procedure and the open modified Broström operation in terms of torque to failure, degrees to failure, and working construct stiffness. These findings led researchers to conclude that the arthroscopic modified Broström procedure is a reasonable alternative for treating chronic lateral ankle instability.


A recent study has concluded that patients who undergo total ankle arthroplasty (TAR) experience only minor functional improvements compared to those treated with ankle arthrodesis (AAD). The study involved 101 patients who underwent TAR and 40 who were treated with screw arthrodeses whose gaits and outcomes were analyzed and assessed during a follow-up exam. The study found that patients who were treated with TAR experienced significant improvements in pain compared to patients who underwent AAD, although patients in the TAR group experienced limited functional gains. Both procedures resulted in significant asymmetry in gait, reduced range of motion compared to normal, and improvements in outcomes as assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Foot and Ankle Outcome Score (FAOS) questionnaire. Finally, the study found that both procedures resulted in the same amount of adjacent joint degeneration.

Practice Management

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All types of physicians' practices should look for opportunities to participate in patient-centered care programs since doing so can encourage patients to adhere to their treatment plans more closely while also improving other aspects of their health, writes practice management consultant Judy Capko. Practices can participate in several different patient-centered care programs, all of which are designed to improve communication between patients and clinicians to strengthen the relationship between the two, help patients obtain more information about their health, and encourage patients to become more involved in their care. One such program is the Patient-Centered Specialty Practice, which requires specialty practices to maintain referral agreements and care plans with primary-care doctors and to provide patient-centered care that involves the patients and family members or caregivers as much as possible. Medical management, text tracking and follow up, and the flow of information during care transitions are all evaluated under this program to determine how these things affect clinical outcome and patient experience. Capko says that if practices decide to participate in this or another patient-centered care program, they should provide training to all staff members to teach them to continually focus on improving patient experiences at every touch point.


It is essential for physicians to develop strong relationships with their medical assistants since doing so can reap benefits like increased patient satisfaction and greater productivity, writes Jennifer Frank, MD, FAAFP, a physician in private practice in Wisconsin. Frank notes that physicians can do many things to nurture such relationships, including taking the time to educate medical assistants about various aspects of patient care. Physicians should also be sure to set and communicate clear expectations for their medical assistants, Frank writes, since medical assistants cannot know what is expected of them if they are not told. Frank says that a third step to building a strong physician-medical assistant relationship is to give both positive and negative feedback to the assistant about his or her performance. Doing so can help uncover the reasons why something went wrong, whether it be a lack of knowledge on the part of the medical assistant, unclear expectations, or some circumstance of which the physician was not aware, Frank says. Finally, Frank recommends that physicians strive to be as approachable as possible so that medical assistants feel free to discuss concerns, questions, or observations with them.

Health Policy and Reimbursement

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Healthcare industry observers say that insurers' risk pools could be overburdened with a larger than expected number of sick or chronically-ill consumers if a ruling issued by a three-judge panel of the District of Columbia Circuit Court of Appeals on July 22 is allowed to stand. That ruling stated that federal income tax subsidies for purchasing health insurance coverage are only available to consumers who buy policies on state-run health insurance exchanges, not the 34 exchanges run by the federal government. The majority noted in its decision that the Affordable Care Act explicitly says that the subsidies are only available for coverage purchased "through an exchange established by the state." However, the dissenting judge noted that reading that provision of the Affordable Care Act in such a literal manner undermines the statute's intent of providing insurance coverage to as many people as possible, which shows that Congress did not intend to have the law interpreted in such a narrow manner. The Obama administration is likely to opt to appeal the ruling either to a full panel at the D.C. Circuit Court or to the U.S. Supreme Court. Economists say that the court's ruling could cause many of the 6.5 million people who have purchased insurance with the subsidies to drop their plans rather than pay for them on their own, though the sick or chronically ill would try to find a way to pay for their coverage. That could leave more sick consumers in insurers' risk pools, economists say, which in turn could result in prices rising dramatically.


Observers are trying to determine what the Obama administration's plans are for the Affordable Care Act's employer mandate, which is scheduled to take effect Jan. 1 after being delayed two times. Businesses say they have yet to hear about a final decision from the administration about whether they will be required to track and report how many of their workers are receiving healthcare coverage from them, nor have they received forms and guidelines from the Treasury Department to help them comply with the mandate. Those forms and guidelines were supposed to be released July 4, and the delay is causing some to believe that the enforcement of the employer mandate could also be delayed again. A number of business lobbyists, however, say that another delay in the implementation of the entire employer mandate is unlikely, given the fact that the administration is already facing political pressure from Republicans to enforce the mandate. House Republicans recently filed suit against President Obama over his delays of the employer mandate, saying that he does not have the authority to push back the requirements because doing so amounts to a re-write of the Affordable Care Act. Some believe that the administration will instead issue less-stringent reporting requirements sometime before the November mid-term elections.


The American Hospital Association (AHA) as well as a number of hospital operators have filed a motion asking for a summary judgement in a lawsuit against the Department of Health and Human Services (HHS) over the Medicare claims appeals process. Both the lawsuit and the motion seek to force HHS to resolve those appeals at the administrative law judge (ALJ) level within 90 days, as required under federal law. The hospitals noted in their motion that they are in dire straits because the Medicare claims appeals process is taking too long. One of those operators, Tennessee-based Covenant Health, says it is losing money in large part because it is waiting to resolve appeals on the denial of more than $7 million in reimbursements. Arkansas-based Baxter Regional Medical Center, meanwhile, says its patients are being affected because it does not have the funds to purchase necessary equipment, such as beds for its intensive care units, or to make needed updates to its catheterization laboratory. Baxter is disputing denials of nearly $3 million in reimbursements.


The Centers for Medicare and Medicaid Services (CMS) needs to give providers more time to meet Stage 3 Meaningful Use requirements, according to the Health Information Management Systems Society Electronic Health Records Association (EHRA). The organization wrote a letter to CMS and the Office of the National Coordinator of Health IT (ONC) saying that hospitals and electronic health record (EHR) vendors need a total of 18 months between the time Stage 3 Meaningful Use guidance is finalized and the time they must meet these requirements, although the current timeline gives them less than 12 months, which EHRA says is not sufficient. As a result, CMS should push back the enforcement of Stage 3 Meaningful Use reporting requirements from October 2017 until at least 2018, EHRA says. The organization added that allowing a short amount of time between the finalization of Stage 2 Meaningful Use guidelines and the deadline for implementing those requirements was a mistake. Only about 34 percent of eligible providers and 7 percent of eligible hospitals attested to Stage 2 Meaningful Use as of July 1. Finally, EHRA suggested that CMS and ONC clarify and expand the types of scenarios that would prevent providers from meeting Stage 2 Meaningful Use requirements.


The U.S. Supreme Court announced July 14 that it will hear oral arguments this fall in a case that could decide how much authority state medical boards have to regulate doctors. The case is centered on a years-long dispute between the North Carolina Board of Dental Examiners and the Federal Trade Commission (FTC) over the regulation of who can perform teeth whitening services. The dental board sued the FTC after it sought to prevent the panel from forbidding hygienists in locations such as spas and malls from using hydrogen peroxide solutions to whiten teeth. The board maintained that these hygienists were illegally performing dentistry services, while the FTC said that such individuals should be allowed to perform teeth whitening services to encourage greater competition with dentists in order to drive down prices. But the dental board says that the FTC does not have the authority to prevent it from forbidding hygienists from performing teeth whitening services. The FTC, which won an appeal in federal court in 2013, maintains that North Carolina officials were not adequately supervising the dental board, and that adequate supervision is necessary if the practicing dentists who sit on the board can be allowed to make scope-of-practice decisions that affect their own income. Observers say that if the High Court rules in favor of the FTC, state officials could respond by staffing their medical boards with fewer practicing physicians--a prospect that has been decried by several healthcare organizations who say that practicing doctors are "best qualified to promote public health."

Medicine, Drugs and Devices

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A recent study sought to use quantitative magnetic resonance imaging (MRI) to evaluate cartilage repair following microfracture treatment in adults with unstable osteochondritis dissecans (OCD) in their ankles and to analyze correlations between MRI and clinical outcomes in these patients. The study's 48 patients all underwent MRIs, including 3D-DESS, T2-mapping, and T2-STIR sequences. All patients were also evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score, thickness index, T2 index of repair tissue (RT), and volume of subchondral bone marrow oedema (BME). Patients were then divided into two groups: Group A, which consisted of patients who were treated three to 12 months previously; and Group B, which had undergone treatment within the past 12 to 24 months. Group B displayed a higher thickness index and AOFAS score than did Group A, although Group A displayed a higher T2 index and BME. The study found a correlation between thickness index, T2 index, BME, and AOFAS score. No correlation was observed between BME and the thickness and T2 indices. The study concluded that significant improvements in patients who undergo microfracture treatment can be expected on the basis of the outcomes of quantitative MRI and AOFAS score, and that a correlation exists between MRI and AOFAS score. BME, on the other hand, is not an adequate independent predictor to evaluate the quality of microfracture repair.


Patients who experienced functional ankle instability (FAI) experienced improvements in proprioceptive awareness after wearing kinesio tape (KT) around a sprained lateral ankle for 72 hours, a new study has found. The study involved 14 FAI patients who wore the tape, and a control group of 14 patients who had no history of ankle injuries. Patients in the FAI group had significantly more eversion force sense errors at baseline and immediately after KT was applied than did patients with no history of ankle injuries. However, the FAI group had similar rates of eversion force sense errors after wearing KT for 72 hours compared to the control group.