News From ACFAS

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Don’t miss out on the event everyone is talking about—ACFAS 2019 in New Orleans!

Online registration fees for ACFAS 2019 will apply after Monday, January 28. Register at acfas.org/neworleans or at the Ernest N. Morial Convention Center in New Orleans starting at 1pm on Wednesday, February 13.

Register online now and save! Stay connected to all ACFAS 2019 events and activities by downloading the free ACFAS 2019 mobile app now!

This year's app is multivent, which means you only need to download it once to keep it on your device from year to year. As new information is added to the app for each Annual Scientific Conference, you will be able to easily access the app’s features without needing to redownload.

Use the ACFAS 2019 app to:

• Keep track of your preselected sessions
• Review all the conference happenings
• Find the Exhibitors you don’t want to miss
• See the bus schedule
• Rate and comment on the sessions you attend
• Receive real-time alerts and reminders
• Explore convention center maps
• Share your photos and experiences through live social media feeds

Search your app store for ACFAS 2019 (iOS and Android) or visit https://www.core-apps.com/dl/acfas2019 to download the app. Watch your email for your login credentials plus instructions for adding your personal schedule and contact information to the app. As they say down in New Orleans, come “pass a good time” with us in the ACFAS 2019 Exhibit Hall!

Explore the latest industry products and services from more than 140 vendors, take part in daily prize drawings and stroll through hundreds of case study and scientific posters showcasing the profession’s newest research. The Exhibit Hall is also your spot for catching up with friends over lunch or for grabbing a quick pick-me-up during regular refreshment breaks.

Be sure to check out the HUB in the Exhibit Hall for hourly sessions on trending topics to help you manage your day-to-day practice then visit the ACFAS Job Fair to search open positions and available candidates. And if your profile photo needs a refresh, head to Booth No. 751 to have your picture taken for free by a professional photographer.

Visit acfas.org/neworleans for more on the excitement that’s just a few short weeks away! Congratulations to our 2019 ACFAS Scholars! Every year, the College recognizes our Student Club Presidents on each of the podiatric medical school campuses for all of the work they do throughout the school year on behalf of the organization.

Each ACFAS Scholar received a scholarship for $1,000 to defray his or her costs of travel and lodging to ACFAS 2019 in New Orleans next month. They also received complimentary registration.

This year’s scholarships are generously supported by Medartis.

AZPod:
Kyleigh Pierson, Class of 2021

Barry University:
Misha Tavaf, Class of 2020

CSPM:
Varsha Salunkhe, Class of 2020

DMU:
Robert Clements, Class of 2020

Kent State:
Natasha Bhagat, Class of 2020

NYCPM:
Jonathan Shalot, Class of 2020

Scholl College:
Sherjeel Hassan, Class of 2021

Temple University:
Stephanie Golding, Class of 2020

WesternU:
Byron Lemon, Class of 2021

Congratulations to these future leaders of ACFAS and the profession!

Foot and Ankle Surgery

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The purpose of this study was to identify whether implant arthroplasty or arthrodesis of the first metatarsophalangeal joint is superior for the treatment of advanced hallux rigidus through a meta-analysis of comparative studies. A comprehensive search of the MEDLINE, EMBASE and Cochrane library databases was conducted. The literature search, data extraction and quality assessment were conducted by two independent reviewers. The primary outcomes were clinical scores and patient satisfaction. The rate of reoperation and complication were also investigated. Seven comparative studies were included (two prospective and five retrospective studies). No significant differences were found between the two groups in the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal score, patient satisfaction rate, reoperation rate or complication rate. However, the visual analogue scale for pain was significantly lower in the arthrodesis group than the implant arthroplasty group.


A study using magnetic resonance imaging (MRI) was conducted to prove the fracture pattern and periosteal entrapment in adolescent distal tibial physeal fractures. A total of 50 patients with displaced Salter-Harris type II, III or IV distal tibial physeal fractures were retrospectively reviewed. Of the 15 type II, 12 type III and 23 type IV fractures, 72 percent presented with periosteal entrapment. Among all type II and triplane fractures, periosteal entrapment was present in the anterolateral corner when there was any displacement on that corner. Meanwhile, just one of eight Tillaux fractures presented with periosteal entrapment. The metaphyseal fracture line was parallel to the intermalleolar axis on axial plane in nearly all supinated foot injuries of type II and triplane fractures. The researchers concluded that Salter-Harris type II and triplane fractures have a high risk for periosteal entrapment especially in the anterolateral corner. Therefore, even without preoperative MRI, surgical repositioning of entrapped periosteum should be considered after failed closed reduction, they said. In cases of supinated foot injuries of type II or triplane fractures requiring surgical fixation, a metaphyseal fracture plane parallel to the oblique coronal plane connecting the medial and lateral malleoli may assist surgeons in achieving appropriate metaphyseal fixation.


A study was conducted to explore the relationships between gait parameters, patient-reported outcome measures and health-related quality of life measures in patients treated with circular external fixation for the correction of deformity related to tibial malunions. Eleven patients with a mean age of 42 were examined. The mean Edinburgh Visual Gait Score (EVGS) was about 2.6, the mean Foot Function Index (FFI) was about 29.6, the mean EQ5 Index Value was about 0.7, the mean EQ5 VAS was about 85.4, the Short Form 12 mean Physical Component Score (PCS) was about 46.7 and the mean Mental Component Score was about 55.2. The relationships between EVGS and FFI, EVGS and PCS and FFI and EQ5 were rated strong and significant. The results of this study suggest that correction of deformity with realignment and restoration of normal anatomy was associated with improved functional outcomes and physical well-being. Patient-reported quality of life is strongly associated with patient-perceived functional outcome but not with objective gait parameters.

Practice Management

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Burnout among physicians is on the rise, according to the Medscape National Physician Burnout, Depression & Suicide Report 2019. The survey, which queried about 15,000 physicians across 29 specialties last year, found that 44 percent of physicians meet the criteria for burnout, up from 42 percent in last year's report. In addition, 11 percent are colloquially depressed and 4 percent are clinically depressed, the report found. The responses show that 14 percent of physicians have had thoughts of suicide but have not attempted it. Most who have had thoughts about suicide tell someone, typically a therapist or a family member, the responses indicate.

Women had much higher burnout rates in the survey than their male counterparts (50 percent versus 39 percent), perhaps due to higher likelihood of admitting the problem and a disproportionate burden of child care and household responsibilities. When asked what leads to burnout, 59 percent of physicians said too many administrative tasks, 34 percent said spending too much time at work and 32 percent said increased computerization of practice, such as the use of electronic health records (EHRs).

Burnout numbers were similar across practice settings, although the prevalence of burnout among solo practitioners was slightly lower. When asked how they cope with burnout, physicians' top answer was exercise, followed by talking with family and friends and isolating themselves. Of those reporting burnout or depression, only 16 percent said they are seeking help or plan to.


Electronic health records (EHRs) can be less burdensome for doctors by first standardizing and reducing payer-imposed requirements. The U.S. Centers for Medicare and Medicaid Services is beginning to reduce these requirements via its Patients over Paperwork initiative, and private payers ought to adopt the same principles and agree on a set of standards, requiring documentation only when it truly adds clinical value. A second tactic is to continuously enhance EHR workflows, and organizations estimate a potential to improve these workflows by about 20 percent, on average, by eliminating steps that lack value. Another strategy is to leverage innovation. Technology advancements, such as voice recognition, digital scribes and connected devices are helping to automate and reduce time spent inputting information into the EHR. Third-party innovators could potentially streamline things further by dramatically augmenting both the user experience of clinicians and the health of patients.


The beginning of the year is a good time for physicians to review their personal and professional goals. This means taking stock of your current place of work, where you are in your career and whether your organization is treating you as well as they should be.

The most fundamental question for all professionals to consider is whether you are happy. If you decide that what you are doing now is not for you, start taking immediate daily steps to get out of your current situation. Whether that entails sending out quick online applications or making a call every day, doing something constantly will help overcome feelings of stagnation and being stuck in your current job. In addition, consider what your relationship is like with administration. Identify those leaders who are making your life difficult and not communicating as well as they should.

Ask yourself if you know any other colleagues who are happy. If you hear of places where physicians of your specialty are satisfied in their job and give you glowing recommendations of their workplace, talk to them and consider if you should be making a move. This is why networking as much as possible within your specialty is crucial. Finally, consider your long-term goals. Do you want to stay in full-time clinical practice, do a variety of "gigs" or go a nonclinical route? Without these clearly defined goals, it is almost impossible to ever be happy with where you are.

Health Policy and Reimbursement

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Observers are pessimistic about the chances for major healthcare reform this Congress, but some optimism remains around less controversial issues and action on the state level. "We might see work around stabilizing health insurance markets," said Fred Isasi, executive director of the consumer group Families USA, at a recent event sponsored by the Council for Affordable Health Coverage. Also, "two places where we may see relatively substantial movement are around prescription drug costs and surprise billing. States have been really active [on those issues]," and Washington may well follow suit, he said.

Experts anticipate efforts to repeal and replace the Affordable Care Act (ACA) are on pause for now. Doug Badger, JD, a senior fellow at the Galen Institute, said although little action is expected from Washington, "we're seeing an enormous amount of activity in the states." For example, state legislatures are not only being proactive by passing their own reinsurance legislation to financially protect the ACA exchanges, they are also working to limit some White House initiatives, such as short-term, limited-duration (STLD) health plans. On the other hand, "some states are allowing [STLD plans] to forward, and we'll see what the effect is. I think the center of gravity in health policy is shifting from the federal government to states, at least for this interim period," Badger said.

States are also working to limit their Medicaid programs through the use of tactics, such as work requirements for non-disabled, childless adults who have been added to Medicaid programs through the ACA's Medicaid expansion. Surprise billing, in which patients getting procedures done at in-network facilities are hit with big unexpected charges because one of their providers turns out to be out of network, is another area where states have been active.


House Oversight and Reform Committee Chair Elijah Cummings (D-MD) has sent letters to 12 different drug companies seeking detailed information and documents about how the companies price their medications. The request is part of a new sweeping investigation into the industry's pricing practices and comes ahead of a hearing on drug prices slated for January 29. "For years, drug companies have been aggressively increasing prices on existing drugs and setting higher launch prices for new drugs while recording windfall profits," Cummings said. "The goals of this investigation are to determine why drug companies are increasing prices so dramatically, how drug companies are using the proceeds and what steps can be taken to reduce prescription drug prices." Cummings noted that the committee is seeking detailed information and documents on price increases, investments in research and development and corporate strategies to preserve market share and pricing power.


U.S. Department of Health and Human Services Secretary Alex Azar and innovation official Adam Boehler expect to introduce at least six trials over the next six months at the U.S. Center for Medicare and Medicaid Innovation (CMMI). They say the goal of the projects is to transition medical payment to better reward physicians and hospitals for providing quality and efficient healthcare. Upcoming CMMI projects include a new way for providers to perform emergency triage, treatment and transport; a new strategy for developing insurance plans to incentivize quality, efficient care and a new course in an existing initiative to bolster primary care. Other pilots could concentrate on better kidney care, establishing a network of preferred providers and broadening use of direct contracts between payers and providers. A U.S. Centers for Medicare and Medicaid Services (CMS) spokesperson says beneficiaries are the top priority and that CMS is soliciting input from stakeholders via model-specific listening sessions, webinars and informational sessions.

Medicine, Drugs and Devices

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A new report from the National Safety Council found opioid overdoses have for the first time displaced vehicle collisions as the highest probable cause of death for Americans. Americans currently have a one in 96 chance of dying from an opioid overdose, while the likelihood of death from an car crash is one in 103. "The nation's opioid crisis is fueling the Council's grim probabilities, and that crisis is worsening with an influx of illicit fentanyl," said the report. The Council has recommended increasing pain management training for opioid prescribers, making the potentially lifesaving drug naloxone more widely available and broadening access to addiction treatment as solutions to the epidemic. The lifetime chances of an American dying from a preventable, unintentional injury have also risen over the past 15 years. "It is affecting our workforce and our fathers and mothers who are still raising their children," warns the National Safety Council's Ken Kolosh. He says accidental deaths typically affect people in the "core of their life," with greater financial and emotional burdens than deaths of those in later years.


The partial government shutdown has concerned various stakeholders in the medical device and pharmaceutical industries about the potential effect on the world of clinical research. The U.S. Food and Drug Administration's (FDA) budget for fiscal year 2019 is on hold until the shutdown ends and Congress can appropriate funds. FDA Commissioner Scott Gottlieb recently tweeted, "The lapse in funding represents one of the most significant operational challenges in FDA's recent history … It's not business as usual at FDA. Many key functions aren't getting done." About 40 percent of FDA employees have been furloughed since December 22 due to the shutdown. FDA's reduced staff have been allowed to continue performing specific duties related to the regulation of clinical research using funding generated from carry-over user fee balances that were paid in 2018.

However, while the agency has been able to continue to carry out existing reviews of new medical device registration applications that were funded during fiscal year 2018, these funds are finite. Gottlieb has warned that agency funds from Prescription Drug User Fee Act user fees may run dry within a month and that medical device user fees may be close behind with only two or three months of funding remaining. As long as the government shutdown is underway, FDA is not legally authorized to accept any new medical device registration applications or human drug applications. Other issues related to the shutdown include ceasing support for certain routine regulatory activities, the delay in release of several medical device guidance documents and potential delays in FDA approval decisions.


Drug manufacturers have sharply increased prices of some older, low-cost prescription medicines amid supply shortages and recalls. For example, at least three sellers of the widely used blood pressure medication Valsartan have raised prices since a series of safety-related recalls of the drug by other manufacturers began in the summer of 2018. Of the nearly 120 drugs listed by the U.S. Food and Drug Administration (FDA) as currently or recently in shortage, about one-third had price increases after the shortages started, according to a review of pricing data provided by RELX Group's Elsevier health information unit.

The increases can mean higher costs for pharmacies and patients on what are generally cheaper generic drugs. Drugmakers say the increased prices reflect higher costs they have incurred to help fill supply voids that have become relatively common in recent years. When shortages arise, health regulators, such as FDA, sometimes ask other suppliers to boost production. A study published last year in the journal Value in Health found that average prices rose about 14 percent for drugs in shortages lasting at least 18 months and 6 percent during shortages of less than six months.