News From ACFAS

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We are excited to welcome attendees in-person and are committed to providing an environment that helps ensure the safety and well-being of all members, faculty, exhibitors, staff and guests attending ACFAS 2022.

As part of that commitment, ACFAS will observe and comply with CDC guidelines, along with all state, local, and facility ordinances and regulations at all conference venues. Currently, the City of Austin mandates that face masks are to be worn regardless of vaccination status in or on city property, and on property the city owns, manages or controls. This includes the Hilton Austin and Austin Convention Center.

In addition to abiding by state and local mandates, all individuals will be required to comply with one of the ACFAS 2022 Health and Safety Policies and Protocols in order to enter our space.

• Attendees should upload their proof of vaccination ahead of time using our secure app. If you are unable to use the app, you can bring your digital or print vaccine card with you. Watch your email and check the ACFAS 2022 Health and Safety Policies and Protocols for instructions on how to submit your proof of vaccination.
• In lieu of proof of vaccination, those requiring a vaccine exception can upload a negative COVID-19 test within 48-hours of arriving at the conference using our secure app.

Visit acfas.org/Austin for more information and any updates on the safety policy for ACFAS 2022. Get a crash course in working with the media at ACFAS 2022 with free media training! Being media savvy can go a long way in helping you promote your practice and the profession. You’ll get the opportunity to learn the PR basics plus how to speak to the media on behalf of the College during a free, formal training program held during ACFAS 2022, February 24–27.

Your personalized one-hour training session with a professional media trainer will include:

• One-on-one media training
• On-camera training with feedback
• ACFAS media training tips

Slots are limited, so reserve your session now by contacting Melissa Matusek, ACFAS director of Public Relations and External Initiatives, at melissa.matusek@acfas.org. Curious to know about available foot and ankle surgical fellowship programs and how they can help you on your career path? Join us in Austin during the 2022 Annual Scientific Conference and start your day on Saturday, February 26 by stopping by the Fellowship Fair for breakfast and to learn more about 41 of the fellowships that carry the ACFAS stamp of approval.

Dust off your dress clothes, grab some coffee and show off your best selves to the program directors attending the breakfast:

J. Joseph Anderson, DPM, FACFAS – Alamogordo, NM
Andrew Belis, DPM, FACFAS – Fort Myers, FL
Brian Burgess, DPM, FACFAS – Joliet, IL
Craig A. Camasta, DPM, FACFAS – Atlanta, GA
Scott Clark, DPM, FACFAS and David Seegmiller, DPM, FACFAS – Salt Lake City, UT
James M. Cottom, DPM, FACFAS – Sarasota, FL
Albert D'Angelantonio, DPM, FACFAS – Philadelphia, PA
Lawrence A. DiDomenico, DPM, FACFAS – Youngstown, OH
Jeffrey Haupt, DPM, FACFAS – Newport Beach, CA
Austin Hewlett, DPM, FACFAS – Huntington Beach, CA
Mark H. Hofbauer, DPM, FACFAS – Monongahela, PA
Shane Hollawell, DPM, FACFAS – Wall Township, NJ
Byron Hutchinson, DPM, FACFAS – Seattle, WA
Meagan Jennings, DPM, FACFAS – Mountainview, CA
Paul Klutts, DPM, FACFAS – Louisville, KY
Kevin Lam, DPM, FACFAS – Naples, FL
Bradley M. Lamm, DPM, FACFAS – West Palm Beach, FL
Lawrence Lavery, DPM, MPH, FACFAS – Dallas, TX
Carl Brandon Lindberg, DPM, FACFAS – Los Altos, CA
Daniel Logan, DPM, FACFAS – Newark, OH
Mark Mendeszoon, DPM, FACFAS – Chardon, OH
J. Michael Miller, DPM, FACFAS – Indianapolis, IN
Mica Murdoch, DPM, FACFAS – Des Moines, IA
Ralph C. Napoli, DPM, FACFAS – Hackensack, NJ
Brian Neerings, DPM, FACFAS – Atlanta, GA
Alan Ng, DPM, FACFAS – Denver, CO
Jason Nowak, DPM, FACFAS – Redding, CA
Adam Perler, DPM, FACFAS – Largo, FL
Mark Prissel, DPM, FACFAS – Worthington, OH
Sandra Raynor, DPM, FACFAS – Indianapolis, IN
Larry Rubin, DPM, FACFAS – Mechanicsville, VA
Ryan Scott, DPM, FACFAS – Phoenix, AZ
Mohammad Sharif, DPM, FACFAS – Atlanta, GA
Jonathan Sharpe, DPM, FACFAS – Concord Township, OH
Mark E. Solomon, DPM, FACFAS – Cedar Knolls, NJ
Matthew Sorensen, DPM, FACFAS – Libertyville, IL
John S. Steinberg, DPM, FACFAS – Washington, DC
Michael Subik, DPM, FACFAS – Lyndhurst, NJ
Warren Windram, DPM, MS, FACFAS – Plantation, FL
Jacob Wynes, DPM, MS, FACFAS – Gwynn Oak, MD
Michael Younes, DPM, FACFAS – Lancaster, PA

For a complete listing of all fellowship programs with ACFAS status and details about each program, please visit acfas.org.

Foot and Ankle Surgery

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A three-dimensional weightbearing computed tomography (WBCT) analysis isolated and measured multiplanar rotational deformity in the midfoot of Charcot-Marie-Tooth (CMT) disease patients. Researchers compared 27 WBCT scans from 21 CMT patients to control WBCTs from 20 healthy unmatched adults. Maximal rotational deformity in CMT patients happened at the transverse tarsal joints, averaging 61 degrees of external rotation compared to 34 degrees among controls. Peak adduction deformity in the midfoot also occurred at the talonavicular (TN) joint, exhibiting an average talonavicular coverage angle of 12 degrees versus -11 degrees in controls. These outcomes support the performance of soft tissue release at the TN joint to abduct and derotate the midfoot as an initial step for correcting targeted deformity.


A systematic review was held to ascertain whether double or triple hindfoot arthrodesis is advisable in cases of severe deformities. Double or triple arthrodesis within 13 studies was warranted by posterior tibial tendon dysfunction, tarsal coalition, degenerative joint disease, osteoarthritis, rheumatoid arthritis, Charcot Marie Tooth, Multiple Sclerosis, Polio, neuromuscular disorder, cerebral palsy, acrodystrophic neuropathy, clubfoot and posttraumatic and seronegative arthropathy (spondyloarthritis). In all, 343 (six to 95) subjects' extremities were operated on. The overall fusion rate for double arthrodesis was 91.75 percent (289/315) versus 92.86 percent (26/28) triple arthrodesis fusion rate, p-value 0.8370. Mean time to double arthrodesis fusion was 17.96 ± 7.96 weeks versus 16.70 ± 8.18 weeks for triple arthrodesis, p-value 0.8133. Triple arthrodesis carries risks including increased surgical times, lateral wound complications, residual deformity, surgical costs and peri-articular arthritis. In view of the advantages of double arthrodesis over triple arthrodesis and the nearly equal fusion rates and time to fusion, double arthrodesis is an effective substitute for triple arthrodesis.


A retrospective study of 39 patients was conducted to determine the value of postoperative computed tomography (CT) compared to postoperative plain radiography in detecting lateral hinge fractures following medial opening-wedge supramalleolar osteotomy of the ankle joint. The occurrence of lateral hinge fractures was 48.7 percent (19/39) on plain radiographs and 61.5 percent (24/39) on CT scans. Five cases of lateral hinge fractures additionally visualized on CT scans were stable fractures, while all had been classified as no fracture on plain radiographs. The unstable fractures that were subclassified according to plain radiographs remained the same on CT scans. No factors were associated with the presence of lateral hinge fractures on plain radiographs and CT scans. Postoperative CT is therefore only advisable when lateral hinge fractures are not visible on plain radiographs.

Practice Management

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When contending with complaints to medical boards, Mandelbaum Salsburg partner Alex Keoskey says physicians should retain legal counsel whenever the hazard of an adverse action exists. Medical board complaints can be prevented by following protocol and understanding the patient's expectations. When those expectations are not satisfied, empathy and professionalism should be practiced. KOMahony Law attorney Kevin O'Mahony recommends that practices properly train, supervise and employ support staff and allied professionals. They also should learn about patients' individual characteristics; identify and accommodate their individual needs when possible; show courtesy and respect; be receptive and responsive to questions and complaints; minimize delays and call attention to anticipated time frame issues as soon as possible and guarantee proper and rigorous medical recordkeeping and billing documentation. Physicians should further document informed consent, properly refer patients to other qualified providers when appropriate, have a formal policy for identifying and resolving complaints in place and apologize — without admitting liability or fault — when appropriate. General physician and consultant Liana Casusi says physicians wishing to avoid complaints should review the rules of their medical board and let them inform their lifestyle, while from a practical standpoint, they should "be thorough before arriving at a diagnosis — and, of equal importance, record everything in the chart."


Collecting medical debts can be less disputable with proper preparation and compassionate respect. Windel Stracener, who runs a family practice in Indiana, says some staffers monitor changing insurance rates to ensure that doctors avoid financially devastating healthcare decisions for patients. Andrew Hajde with the Medical Group Management Association advises using technology before patients come in to see what they will be billed; also important is informing patients of their financial obligations up front. "I think it's critical that throughout the process all the way from when the patient walks through the door the first time, through when their claim's paid, that whoever is in charge of the billing department for that practice is in constant communication with the patient to about their balances and continuing that relationship with a positive interaction with that patient," he says. Maintaining cost transparency is key, while setting up a payment plan with patients that would allow them to stagger out payments could also help. It is best to send a bill to a collection agency only when all other options have been exhausted, although Stracener says sometimes this is unavoidable. However, Hajde warns that this recourse means the practice will receive less money, minus the collection fee charged by the agency itself. "By that point, the practice has already lost a lot of money if they didn't engage the patient early and make sure that they work with them on paying their bills up front or as early as possible," he notes.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services has issued new guidance clarifying compliance deadlines for covered healthcare facilities in 25 states where its vaccine mandate regulation had been stayed. The new Phase 1 compliance deadline is Feb. 14. By this deadline, all eligible staff, including contractors, should have received the first dose of the Pfizer or Moderna vaccine or the single dose of the Johnson & Johnson vaccine or should have sought an appropriate medical or religious exemption. New hires are not given an extended period to come into compliance. Facilities also should have appropriate processes and plans in place to address vaccine status documentation and tracking.

The new Phase 2 compliance deadline is March 15. By this date, all staff—who have not received a medical or religious exemption—should have received a full round of the Covid-19 vaccine. Beginning with each of these compliance deadlines, surveyors will begin assessing facility compliance with the vaccine mandate. Failure to comply after the opportunity for correction could lead to civil monetary penalties, denial of payment or termination from participation in Medicare or Medicaid.


The Medicare Payment Advisory Committee (MedPAC) will recommend increasing hospital reimbursement for both inpatient and outpatient services in fiscal year (FY) 2023 in their March 2022 Report to Congress. The American Hospital Association reports that MedPAC agreed to call for a 2.5 percent increase for inpatient hospital reimbursement and a 2 percent increase for hospital outpatient reimbursements. MedPAC analysts detailed in a Jan. 13 presentation that the pandemic significantly affected Medicare payment adequacy for hospitals in 2021. They suggested MedPAC consider for the draft recommendation that Congress keep payments sufficiently high and close to hospital costs to guarantee beneficiary access to efficient delivery of high-quality care, adding that payments should also "maintain fiscal pressure on hospitals to constrain costs." MedPAC was also advised to consider minimizing differences in payment rates across care sites for similar services. The committee additionally recommended no further updates to the 2023 Medicare reimbursement rates for long-term care hospitals or for physicians and other healthcare professionals. Clinicians would also be mandated to use a claim modifier to identify audio-only telehealth services.


Some 32 lawmakers have signed a letter to US Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure requesting a reevaluation of the proposed 14.5 percent Medicare Part B premium hike in 2022. US Health and Human Services Secretary Xavier Becerra voiced a similar sentiment, while the lawmakers added in their letter that the premium increase jeopardizes seniors who are already finding healthcare costs difficult to afford. They further advised CMS to more proactively combat rising prescription drug costs.


According to a new report, a quarter of Medicare Advantage plans now offer chronically ill beneficiaries healthy food, transportation and other special supplemental benefits in 2022, representing a nearly 40 percent year-over-year increase in carrier uptake of these unconventional services. About 1,292 Medicare Advantage plans offered special supplemental benefits this year, up 383.8 percent from 267 carriers in 2020, the report said. The US Centers for Medicare and Medicaid Services has proposed requiring Medicare Advantage plans to report the amount they spend on such supplemental benefits.

Medicine, Drugs and Devices

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Updated masking guidance from the US Centers for Disease Control and Prevention (CDC) recommends properly fitted N95 or KN95 masks, rather than cloth masks, as the best protection against COVID-19. Prior to this, CDC in September began recommending that people use disposable N95 masks in certain scenarios, such as where people are more susceptible to severe illness, are caring for someone at risk and while traveling. The agency still endorses reserving a special category of masks called "surgical N95" masks for healthcare workers. Their design helps shield against blood splashes and other operating room mishaps. Since not everyone feels comfortable in an N95, CDC also emphasizes that the best mask is one that fits well and is easy to wear consistently. "Our main message continues to be any mask is better than no mask," said CDC spokesperson Kristen Nordlund.


Healthcare providers in several states say Anthem's use of an artificial intelligence (AI)-powered payment algorithm from Cotiviti caused significant underpayment and other issues. State insurance commissioners in Maine and Georgia are investigating Anthem's market conduct, while New Hampshire's insurance commissioner said he is working with Anthem to resolve payment delays. Wisconsin's insurance commissioner said the office helped providers resolve their issues with Anthem's computer issues, but one case is ongoing. The insurance commissioner in Ohio encouraged affected providers to come forward, while Colorado's insurance commissioner continues to look into complaints about the insurer. Officials from three other states said privacy laws prohibit them from discussing whether they have launched a formal audit of Anthem's business practices.


Medical cybersecurity platform Cynerio's 2022 State of Healthcare IoT Device Security Report estimates that 53 percent of connected medical devices in hospitals have critical flaws, including one-third of bedside devices. Cynerio analyzed more than 10 million medical devices at over 300 global hospitals and medical facilities. Seventy-three percent of infusion pumps, constituting 38 percent of a hospital's Internet of Things (IoT), possess some type of vulnerability. Relatively simple bugs like outdated programs or weak default passwords caused some vulnerabilities. Cynerio warns hacked medical devices would affect service availability, data confidentiality and patient safety.