News From ACFAS

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Don’t wait another minute to register for this year’s Annual Scientific Conference in Austin February 24-27! You have less than one month to register before on-site fees apply.

Grab your cowboy boots and join us for four days of advancing your knowledge and skills with cutting-edge sessions, hands-on workshops and the opportunity to network and reconnect in person with your friends and colleagues.

Don’t miss the chance to celebrate 80 years of advancing the profession together in person! Register now at acfas.org/Austin. This course is a must have in your pocket to get the best foundation started for your coding needs. Coding Fundamentals is set for February 23 in Austin, TX as part of the Annual Scientific Conference.

Whether you’re new to coding, a resident or a new employee in a practice, take advantage of this comprehensive workshop, which covers the fundamentals of coding and billing for foot and ankle surgeons and explains the foundation of the coding and billing process from expert colleagues. The course can be taken before the ACFAS Coding and Billing for the Foot and Ankle Surgeon course.

Residents can also take this course as a part of a full day of Resident learning at ACFAS 2022 when pairing it with Residents Day at a discounted rate. Register for Residents Day in the morning and learn the foundation of coding and billing in the afternoon with Coding Fundamentals.

Register today at acfas.org/PracticeManagement and take the next step to becoming a coding pro! We’re looking for runners to participate in the race and volunteers to help promote the profession in the ACFAS booth at the upcoming Austin 5K, Half and Full Marathon on Sunday, February 20 before ACFAS 2022!

If you’re a runner, join the ACFAS Team! Sign up at the Austin Marathon website and choose ACFAS under the “Team Name” pull down menu. You can also choose to run either the full, half or 5k event that day. Each runner on our team will get an ACFAS athletic shirt to wear during the race to show who you are as a foot and ankle surgeon. Packet pickup will start the afternoon of Thursday, February 17 and run through Saturday, February 19 at the ACFAS booth in the Palmer Event Center. If you’re interested in running the marathon, contact Michelle Kennedy, Director of Member Engagement and Post Graduate Affairs by February 18.

If you’re interested in volunteering, join Team ACFAS and man the College’s booth on the marathon expo floor – join us either Friday, February 18 or Saturday, February 19. Plan to promote yourself and the profession to show what a qualified surgical DPM can do to assist runners from all over the country with all their foot care needs. To volunteer, contact Melissa Matusek, Director of Public Relations and External Initiatives, to get more information and to sign up by February 11.

We hope to see you in Austin at the expo and the race! Poster Presenters – no need to carry your poster to ACFAS 2022. This year, the College has partnered with PosterPresentations.com for your poster printing needs. It is a simple and convenient way to have your poster printed with free shipping and ready for pickup on site at the meeting.

Visit PosterPresentations.com for more information and fees.

Foot and Ankle Surgery

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Research sought to biomechanically compare three different fixation methods for posterior malleolar fractures, including anteroposterior (AP) lag screw, posteroanterior (PA) lag screw and posterior buttress plate. The authors produced fracture models with a thin blade power saw after drawing the fracture line, with the resultant fracture involving 30 percent of the joint on the distal tibial joint surface and extending with an angulation of about 50 degrees using 15 tibia composite bone samples. Following anatomical reduction, fixation was realized with 3.5-millimeter cortical screw in PA direction and in AP direction for group PA and AP, respectively. Fixation in the double loop group (Group DL) was accomplished with a closed-loop double endobutton. Group DL required the highest compression force to generate all displacement amounts, and the strongest fixation against compression was a double loop. The PA group had the second strongest fixation, and the AP group was the biomechanically weakest.


Researchers analyzed the COVID-19 Research Database of recent US aggregated insurance claims to identify patients who underwent ankle fracture surgery from April 1 to June 15, 2020, to ascertain if COVID-positive patients receiving this procedure are at elevated risk for perioperative adverse outcome. A total of 9,835 patients undergoing ankle fracture surgery was detected, of which 57 were COVID-positive. COVID-positive ankle fracture patients exhibited a higher prevalence of comorbidities, including chronic kidney disease, diabetes, hypertension and obesity. Following propensity matching and controlling for all preoperative variables, multivariate analysis determined that COVID-positive patients were at higher risk of any adverse event, a serious adverse event and a minor adverse event. This indicates that not only must treatment teams be protected from COVID transmission in such situations, but the increased incidence of perioperative adverse events must be taken into account.


A retrospective study was conducted to determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. The authors examined adult patients from two major trauma centers and nine trauma units who underwent fibula nail fixation for AO/OTA 44 fractures. Ninety-five patients were included, average age 66 and 57.9 percent female. The average body mass index was 30, and 69 patients (72.6 percent) suffered a Weber B while 24 (27.4 percent) suffered a Weber C fracture. Moreover, 26.3 percent were open fractures and all patients exhibited soft tissue compromise impacting the lateral malleolus. The calculated infection rate for fibula nail was 4.2 percent and metalwork complication rate was 5.2 percent. The nonunion and malunion rate was 8.4 percent while rate of removal of hardware was 2.1 percent. The average time to union was 12.5 weeks, and length of inpatient hospitalization was 9.4 days. The results show the fibula nail is apparently a safe procedure for treating patients who have a physiologically higher risk of surgery, poor skin condition and a complex fracture pattern.

Practice Management

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Physician practices can run afoul of the Health Insurance Portability and Accountability Act (HIPAA) without adequate email safeguards. The legislation defines its email encryption requirement as "addressable," meaning it only requires implementation if a risk assessment determines it is necessary for managing protected health information (PHI); PHI that is transmitted electronically should be encrypted "whenever deemed appropriate." Covered entities that deem encryption not the best course of action must document their reasoning and deploy an equivalent PHI-protective measure. Although many email providers automatically encrypt messages via Transport Layer Security protocol, not all email services support encryption, so practices must find a comprehensive email encryption solution that shields all outgoing messages at rest and in transit. Employees should receive continuous training on email security protocols, covering topics including cybersecurity policies and procedures, safe use of electronic devices and recognizing and blocking malicious emails. Robust inbound email security can also help maintain HIPAA compliance by preventing data breaches, especially since human error is unavoidable.


A Medical Economics audience poll on the coming year's biggest challenges for medical practices highlights hiring and retaining staff as a major issue. Although higher salaries and better benefits are the most obvious incentives, practices can leverage additional perks like flexible hours, treating employees to lunch twice a week or paying for transportation costs. Medical Group Management Association CEO Halee Fischer-Wright says alleviating boredom is critical for retaining staff and recommends that physicians make an effort to eliminate repetitive tasks that are habitual rather than necessary. Cross-training staff will enable different personnel to alternate tasks while reducing the chances of burnout, while more communication among staff means issues can be flagged earlier. "What we see in workers today is that they want this delightful combination that's almost impossible to achieve—both flexibility and certainty," Fischer-Wright says. "What we find in medical practices is often they work by need-to-know, so we're encouraging a much more holistic communication strategy even within the smaller practices so people understand what's going on."

Health Policy and Reimbursement

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The Biden administration has rescinded a Trump-era model that would have linked prices for drugs reimbursed under Medicare Part B to prices paid by countries overseas. The US Centers for Medicare and Medicaid Services (CMS) issued a final rule last week that pulls the Most Favored Nation model, which providers have denounced over issues of reimbursement. The model would have identified 50 Part B single-source drugs and biologics and tied the reimbursement price to an average paid by several nations, but multiple lawsuits from the drug industry led to a legal stay on its enactment. Several provider organizations said in comments to CMS that the rule would have harmed reimbursement for providers as they still combat the COVID-19 pandemic. Some providers were concerned that the model would have made it impossible to build stockpiles of certain drugs since prices would be subject to quarterly fluctuation. Providers like oncology practices were worried that they could purchase the drug at one price but then be compensated at a lower price when it is administered later.


Starting Jan. 1, many out-of-network medical bills are banned by federal law, putting the onus on doctors and health insurers to resolve their payment disputes. This means many Americans should no longer face unexpected charges from doctors who are out of network. Patients must still pay in-network copays, deductibles and other cost-sharing expenses, but additional out-of-network bills are now prohibited for emergency care in a hospital emergency room (ER), a freestanding ER or urgent care center. Bills for elective care at an in-network hospital or surgery center where doctors—specifically anesthesiologists, pathologists, radiologists and assistant surgeons—may be out-of-network are also prohibited, although ground ambulances are excluded. Should the two parties fail to agree on a payment rate within 30 days, either can request the federal arbitration process. The doctor and insurer then bring the arbiter their best offer, and the arbiter chooses one. The government says the arbiter has to "select the offer closest" to the median in-network rate unless other information "clearly demonstrates" the median in-network rate is inappropriate. A lawsuit filed by medical providers claims the median in-network rate should not be the guiding factor for the arbiter, which consumer protection experts have criticized as an attempt by providers to continue to assess higher rates.

Medicine, Drugs and Devices

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The Nightingale Open Science health dataset cache launched in December by the University of California, Berkeley's Ziad Obermeyer could help train artificial intelligence to forecast medical conditions earlier. The datasets, each curated around an unsolved medical mystery, include 40 terabytes of imagery from patients, with each image annotated with the patient's medical outcomes. Obermeyer compiled the datasets over two years from hospitals in the U.S. and Taiwan; he made them free to use, and intends to expand the trove to Kenya and Lebanon in the months ahead. "What sets this apart from anything available online is the datasets are labeled with the 'ground truth,' which means with what really happened to a patient and not just a doctor's opinion," Obermeyer said.


Drug companies raised the prices of more than 400 drugs on January 1, with most prices up 5 percent on average. The increases are comparable with those of recent years. The beginning of the new year is when most drug companies favor raising prices, and more increases will likely come later in January.


With the omicron wave surging, physicians are urging people to replace cloth face masks, either by pairing them with surgical models or switching to stronger respirator masks. The Mayo Clinic began requiring patients and visitors to wear surgical masks or N95 or KN95 masks. Infectious-disease specialists say single-layer cloth masks are less effective in blocking smaller aerosols or particles carrying the virus. The latest guidance from the US Centers for Disease Control and Prevention recommends masks, including cloth ones that are multi-layered and tightly woven, that fit snugly and have an adjustable wire nose bridge. Also suggested are layering masks, using a disposable mask beneath a cloth mask and reserving N95 masks for workers in care settings.