News From ACFAS

---

All applications for the 2013 ACFAS Clinical and Scientific Research Grant are due in less than one week – Monday, September 16 is the final date the College will accept applications.

The grant, now in its eighth year of supporting research conducted by members, awards up to $40,000 in grant money. To apply, or for more information on grant award criteria, visit acfas.org/grant. Remember, research must be clinical or laboratory-based, with clearly defined research goals meeting all the criteria for grant submission. September 15, 2013 is the final date the ACFAS Nominating Committee will accept applications for nominees to serve on the College’s Board of Directors. If you are an ACFAS Fellow member, believe you are qualified, and would like to take an active role in leading the profession, please submit a nomination application, which can be found at acfas.org/nominations, before the final deadline.

The Nominating Committee will announce recommended candidates to the membership no later than October 31, 2013 and candidate information and ballots will be e-mailed to all voting members no later than December 15, 2013. Electronic voting will end on January 14, 2014. New officers and directors will take office during the ACFAS 2014 Annual Scientific Conference set for February 27-March 2, 2014 in Orlando, Florida.

For complete details on the recommended criteria for candidates and the nomination application, visit acfas.org/nominations or contact Executive Director Chris Mahaffey. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Michelle L. Butterworth, DPM, FACFAS, or via phone at (843) 355-9690. As a member of ACFAS, you receive online access to the Journal of Foot & Ankle Surgery through acfas.org/jfas, jfas.org or through the new JFAS iPad app. For access to your free subscription and full article text, you must authenticate your membership by logging in to one of the access points by following the below instructions.

Access Through acfas.org
To access JFAS and authenticate membership through the ACFAS website, visit acfas.org/jfas and select Read Current and Past Issues Online, which will prompt you to log into acfas.org with your ACFAS Member ID number and password. Once logged in, you will be directed automatically to jfas.org for full access to the Journal.

Access Directly Through jfas.org and Elsevier
You can also access the Journal and its full text directly by creating a new, separate Elsevier ID and password at jfas.org. By registering with Elsevier, JFAS’ publisher, at jfas.org, you will also receive exclusive Elsevier and Journal benefits online and via email.

To Read JFAS and Download the JFAS iPad App
Visit the iTunes Store and download the JFAS app. Then you must register with Elsevier at the jfas.org website to authenticate your membership and have access to the Journal through the iPad app.

If you have any issues with accessing the Journal, you can contact ACFAS Headquarters or Elsevier directly.

Foot and Ankle Surgery

---

An investigation was held to report the clinical outcomes of a series of patients who underwent arthroscopic autologous chondrocyte implantation (ACI) of the talus at an average of seven ± 1.2-year follow-up. Arthroscopic ACI was administered to 46 patients with osteochondral lesions of the talar dome between 2001 and 2006, and they were clinically assessed using AOFAS score pre-operatively and at 12 months, 36 months and at final follow-up of 87.2 ± 14.5 months. The average pre-operative AOFAS score was 57.2 ± 14.3. The average score was 86.8 ± 13.4 at 12 months after surgery and 89.5 ± 13.4 at 36 months. At final follow-up of 87.2 ± 14.5 months the score was 92.0 ± 11.2. Three failures were observed. Histological and immunohistochemical assessments of specimens obtained from failed implants generally exhibited several aspects of a fibro-cartilaginous tissue associated with some aspects of cartilage tissue remodeling as indicated by the presence of type II collagen expression.


This study investigated whether blood haemoglobin levels predicted diabetic patients' responsiveness to surgical treatment of ankle fractures. The relationship between blood HbA1c levels and surgical outcomes of diabetic patients undergoing open reduction internal fixation was analyzed. HbA1c levels correlated with poor radiological outcomes, with poor outcomes higher among individuals with higher HbA1c levels and lower among individuals with lower levels. HbA1c levels appear to be predictive of risk and complication rates in the treatment of diabetic patients with ankle fractures.


The long-term outcomes of the Lapidus procedure and a Hohmann distal closing wedge metatarsal osteotomy were compared through a prospective, blinded and randomized study to evaluate their effectiveness in correcting hallux valgus. The study cohort included 101 feet in 87 patients; 50 feet were treated with a Hohmann procedure while 51 were treated with a Lapidus procedure. Hypermobility of the first tarsometatarsal joint was assessed pre-operatively via clinical examination. Ninety-one feet in 77 patients were available for follow-up after an average of 9.25 years. No difference in clinical or radiological results was observed between the two procedures, nor was there a difference in outcome between the procedures in the subgroup clinically assessed as hypermobile.

Practice Management

---

There are challenges in using email as a communications medium at medical practices in terms of relating the intended tone, but the perception of emails can be kept on point by following a number of tips. Brevity is key, and the most important point should be made first, with supporting details provided if necessary. Short, easy-to-read paragraphs are recommended. The messenger should avoid losing the tone in translation, so the email should stay on point while the use of words such as "thank you" and "please" also can be beneficial. The practice should refrain from assuming the intent or tone of an email it receives as well, so it is always best to ask specifically the intent of the email. Replying to email when you are in a state of anger or irritation is discouraged, and it is often the case that the recipient gets worked up over something that is simply an error in the translation of the tone.

It is best to send one email per subject for easy repeatable reference in the subject line, while in instances where you are sending three or more emails, consider sending email with multiple attachments rather than including pages of text in the body of a single message. It is suggested that the practice use zip files to ensure that the recipient can open the attached files, as PDF is frequently the optimum document format. The use of if-then options reduces the back and forth of emailing, especially for appointment scheduling. Typing in all small or all upper caps is a habit to be avoided, while text formatting should be limited. For example, text should not be underlined unless it is a link, while multicolor and multi-font presentation can make reading the email difficult. Finally, closing emails politely and respectfully with words such as "Thanks," Sincerely," and "Best regards" sustains a good tone and is a mark of professionalism.


Lock box services are important for practices when choosing banks, due to the security they provide for payer financial information. Long-term relationships with banks should be cultivated, as they help to reduce fees. While practices may not always have the luxury of finding the best rates on loan interest due to their unique needs, banking with a community bank will provide them service that may make up for the deficiency. While mobile and internet banking options are growing more popular, they are not necessarily optimal for practices that require the systematic procession of many payments every day. While credit unions provide more personal interaction and attention, commercial banks are often more convenient and offer more ATM locations.


According to a recent viewpoint published in JAMA, while social media guidelines for practices often focus on the separation between the personal and professional identities of practitioners, a policy more in keeping with the realities of social media would be to post only what is appropriate for a practitioner to say in public. Any practitioner's professional and personal social media profiles can be quickly and easily discovered online with the same search; to post something as personal content does not ensure that it will not be viewed in a professional context. Also, for some practitioners, the reason to use social media in the first place is to increase transparency and blur the lines between a personal and professional identity

These lines are further blurred by the nature of the profession, as a professional identity is based on a personal identity. Practitioners are not required to avoid personal contact with patients offline, and there is no good reason to do so when using social media. In certain communities, personal contact with patients is not only unavoidable, but beneficial. Instead of trying to divide between a personal and professional online presence, social media policies should seek to prevent practitioners from posting anything they would not like to be visible in a public space.

Health Policy and Reimbursement

---

The American Medical Association (AMA) is preparing a legislative campaign to remove the Medicare sustainable growth rate (SGR) formula and create a new system that concentrates on patient care. The association launched a website, FixMedicareNow.org, designed to inform patients, physicians and policymakers on the harm that Medicare payment policy has inflicted on the program, particularly for participating practices. Physicians are facing a 24.4 percent SGR cut next year unless Congress rescinds the reduction by Dec. 31, but for the first time there has been bipartisan action to terminate the policy of temporary SGR fixes and reform the Medicare payment system. The legislation contained the three central components the AMA and other organized medicine groups asked for: a repeal of the SGR formula, a period of annual pay boosts for five years and models accounting for quality of care. The bill currently lacks a budgetary offset, and the dialogue about covering the $139 billion cost of the SGR's elimination will happen later. Eugene Sherman with the American College of Cardiology Advocacy Steering Committee believes the 0.5 percent yearly pay updates are low, while a quality update incentive program could lower physician payments. In addition, other potential penalties from the value-based modifier, physician quality reporting system and electronic health record meaningful use program would still be in effect.


There is growing optimism that Congress will replace Medicare's sustainable growth rate (SGR) formula with a new provider reimbursement system by the end of this year. One reason for the optimism is that the effort to replace SGR has support from lawmakers of both parties. The strong support for repealing SGR was seen in July, when the House Energy and Commerce Committee unanimously approved a bill that would replace SGR with a new system in which Medicare reimbursements would be based on how well doctors and other healthcare providers meet new quality guidelines that will be developed over the next several years. In addition, the legislation calls for doctors to receive annual reimbursement rate increases of 0.5 percent beginning next year and lasting until the new system is fully implemented in 2019. The bill also would give doctors the choice of participating in demonstration programs that include alternative payment models aimed at coordinating care and improving the quality of care given to patients. But some obstacles to a repeal of SGR remain, including the fact that the House Energy and Commerce Committee has not yet said how it would pay for the new reimbursement system. There could also be a competing SGR repeal bill written by members of the Senate Finance Committee.


Medicare's recovery audit program is more accurate than hospital lobbyists claim, according to the U.S. Department of Health and Human Services Office of the Inspector General. Of the 1.1 million cases in 2010 and 2011 where a recovery auditor recommended denying payments, only 6 percent were appealed; 44 percent of those appeals were won by hospitals. The auditing firms in those years discovered errors in half of the 2.6 million patient encounter records they requested, most often for care delivered in settings that where too expensive or billed incorrectly. The average payment denial was $507. The auditing firms have been heavily criticized by hospitals who claim that 40 percent of denials are appealed and 70 percent of those are successful. Also, although recovery auditors are required to report evidence of fraud, they only reported six cases nationwide in 2010 and 2011.

Medicine, Drugs and Devices

---

The U.S. Federal Drug Administration (FDA) is considering how to evaluate medical devices constructed with a 3D printer. Currently, 3D-printed devices are treated the same way it treats all other medical devices. But because 3D-printed devices are manufactured differently, they may require additional or different testing. The FDA's Functional Performance and Device Use Laboratory uses computer modeling to evaluate slight differences in designs that may occur as devices are customized for individual patients or groups. The FDA's Laboratory for Solid Mechanics tests the strength and durability of the devices, which will help the FDA to set parameters that ensure patient safety.


A team of chemists and bioengineers at Penn State University and Boston University have invented a method involving the targeted delivery of healing drugs to cracks in bones via self-powered nanoparticles. Cracks in bone release ions, creating an electric field and pulls the negatively charged nanoparticles towards the crack. The methods improve on the old technique of circulating medicines passively in the blood-stream, which did not guarantee dosages sufficient to begin healing would encounter bone cracks. The scientists delivered the osteoporosis drug polylactic-co-glycolic acid, which is widely used and approved by the U.S. Federal Drug Administration.