News From ACFAS

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Clear your schedule and mark your calendars—registration for ACFAS 2021 in Las Vegas opens February 1! It’s been a tough year but with vaccinations already being distributed, we’re looking forward to safely coming together to learn from all we’ve been through this past year and to celebrate the future of the profession! In just a couple weeks, you can finally secure your spot to join us in-person or virtually in Las Vegas May 18-21 for another ACFAS Annual Scientific Conference of cutting-edge clinical sessions, hands-on surgical workshops, award-winning research and more!

Keep an eye on your inbox and visit acfas.org/LasVegas to see what we have in store for this year’s meeting in Vegas. Welcome Home! We’re kicking off a new year with another issue of ACFAS Update! Watch your email and your mailbox for the most up-to-date news from ACFAS, including counting down until ACFAS 2021, congratulating our 40-year members, the release of a new clinical consensus statement, exciting changes on the College’s Fellowship web content, more patient education tools to help you in your practice, a listing of the 2021 line up for the ACFAS Virtual Journal Club, the release of a new issue of FootNotes and more!

Can’t wait to read the latest issue? Visit acfas.org/Update to read it now and check out all past issues in the ACFAS Update archives.

Foot and Ankle Surgery

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This study prospectively evaluated the results of 12 patients who received autogenous bone grafting for repair of osteochondral defects of the first metatarsal head. Clinical outcomes were evaluated by the visual analog scale for pain and the Roles and Maudsley (RM) score. Between 2009 and 2016, 12 patients with an average age of 43.5 years received treatment for this particular surgical intervention, and their outcomes were measured with an average follow up of 52.3 months. The average return to activity was 4.7 months; the average Pre-operative RM score was 4.0 and post-operative RM score was 1.4.


This study used magnetic resonance imaging (MRI) to determine the association between ankle tendon, ligament and joint conditions and anterior talofibular ligament (ATFL) injuries. A case-control MRI study was carried out to compare the presence of ankle muscle, tendon, ligament and joint conditions in 25 patients with injured ATFLs and 25 patients with non-injured ATFLs. Achilles tendinopathy was present in 1/25 (4 percent) patients with injured ATFLs and 7/25 (28 percent) non-injured ATFL subjects. Injured calcaneofibular ligaments were present in 19/25 (76 percent) patients with injured ATFLs and 1/25 (4 percent) non-injured ATFL subjects. Injured tibiotalar joints were present in 16/25 (64 percent) patients with injured ATFLs and 5/25 (20 percent) non-injured ATFL subjects. Other musculoskeletal structure injuries occurred at similar rates between patients with injured ATFLs and those with non-injured ATLFs.

Practice Management

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Healthcare providers are preparing for the implementation of the 21st Century Cures Act, including new rules around interoperability and information blocking. The new rules aim to provide patients better access to their health data and leverage that data more effectively in making medical decisions. The rule is focused on making health data truly interoperable and accessible while keeping it secure. The "patient-centered" rules are tied to the idea of moving the US healthcare system to a "value-based approach".


This year will bring significant changes to Medicare coding guidelines for outpatient evaluation and management services, reflecting new federal policies meant to reduce administrative work for care providers. Starting on Jan. 1, time spent obtaining or reviewing patient records and tests prior to a visit will be calculated by the “total time” the provider spent on that day. The same goes for ordering medications or procedures and counseling patients, family members and caregivers, among other tasks. The new rules will help to ease the coding and documentation burden for outpatient services. Provider organizations can help themselves in this regard by equipping coders with adequate tools, providing physician education and aligning hospital revenue cycle departments.


Cybersecurity firm Check Point calculated a 45 percent increase in cyberattacks against the global healthcare sector since November, versus a 22 percent uptick against all worldwide industries in the same time. Attack vectors include distributed denial-of-service hacks, social engineering, botnets, phishing and ransomware. Check Point researchers said the Ryuk ransomware strain is currently the most popular malware in such exploits, followed by Sodinokibi. Overall, an average 626 attacks against healthcare organizations were recorded weekly in November, compared with 430 in October.

Health Policy and Reimbursement

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Haven Healthcare, the joint healthcare venture between Amazon, JPMorgan Chase and Berkshire Hathaway, will shut down less than three years after it pledged to use the companies' combined strength to lower costs and improve care. The announcement of the joint venture in January 2018 wiped out tens of billions of dollars in the value of other leading healthcare companies as many observers expected it to disrupt the spiraling costs of US healthcare. Expectations were further heightened at the appointment of surgeon Atul Gawande as the venture's chief executive, though Gawande stepped down last May to become Haven's chairman.


Illinois recently became the first state to provide public health insurance to all low-income noncitizen adults age 65 and older, even if they are undocumented. The new policy is initially expected to cover 4,200 to 4,600 immigrant seniors, at an approximate cost of $46 million to $50 million a year, according to John Hoffman, a spokesperson for the Illinois Department of Healthcare and Family Services. Backers of the initiative point out that many unauthorized immigrants pay taxes without being eligible for programs such as Medicare and Medicaid and that spending on preventive care saves money in the long run by curbing costlier treatment for emergencies. Andrea Kovach at the Shriver Center on Poverty Law in Chicago notes that the new program is state-funded, so it is likely not subject to the federal "public charge" rule designed to keep out immigrants who might end up on public assistance.

Medicine, Drugs and Devices

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A new analysis from health research firm 46brooklyn shows that drugmakers raised list prices on more than 500 drugs to kick off 2021. This includes more than 300 price increases from companies like Pfizer and GlaxoSmithKline reported by Reuters late last week. Nearly all the increases were below 10 percent, and the median hike was 4.8 percent, down slightly from last year, 46brooklyn said.


The US Food and Drug Administration (FDA) has clarified that the Coronavirus Aid, Relief and Economic Security Act includes authorities intended to enhance FDA's ability to identify, prevent and mitigate possible drug shortages by, among other things, enhancing its visibility into drug supply chains. The specific authorities include a number of reporting and risk management requirements for manufacturers. This includes requiring the manufacturers of certain drugs to provide information on circumstances that may lead to a meaningful disruption in supply to FDA. The effective date of this reporting requirement was September 23, 2020. FDA has not yet begun collecting these data and does not intend to begin this collection until it is able to do so through an electronic data submission portal.


Newly finalized guidance from the US Food and Drug Administration (FDA) aims to make it easier for device manufacturers to improve the safety of existing treatment and diagnostic options for certain diseases and conditions. The Safer Technologies Program for Medical Devices (STeP) is intended for devices and combination products that target conditions that are less serious than those covered by FDA's Breakthrough Devices Program, after which it is modeled. To qualify for STeP, devices should "significantly improve the benefit-risk profile of a treatment or diagnostic through substantial safety innovations," FDA said.