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January 29, 2020 ACFAS.org | FootHealthFacts.org | JFAS | Contact Us

News From ACFAS


Last Day for Savings: Register for ACFAS 2020 Today & Save
Don’t miss the state-of-the-art event of the profession—ACFAS 2020 in San Antonio! Time is running out to register and save.

Onsite registration fees will apply after today Wednesday, January 29. Register now to join us in San Antonio. Visit acfas.org/sanantonio or register onsite at the Henry B. Gonzalez Convention Center in San Antonio.
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Stay Connected with the ACFAS 2020 App
You can check out this year’s Annual Scientific Conference before landing in San Antonio by downloading the free mobile meeting app—your all-access pass to ACFAS 2020! In the palm of your hand you’ll find:
  • A list of your pre-selected sessions
  • The entire conference schedule
  • Session evaluations
  • Exhibitor directory
  • Important meeting alerts & announcements
  • Convention center maps
  • Live Twitter & Facebook feeds
  • And more!
Before you leave, download the app in one of two ways: If you have downloaded this app in previous years and it's not automatically updated to the 2020 version, check your app store for updates.

Once you’ve downloaded this year’s app, you’ll be able to add your personal schedule and contact information to connect with other attendees. Just follow the instructions and login information, which will be emailed to you prior to the conference. App instructions will also be available on the back of your badge in San Antonio.
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Ask the Coder in San Antonio
There are a few slots left at ACFAS 2020 to get your coding questions answered. The Practice Management Committee is hosting a free “Ask the Coder” opportunity at the Membership Booth in San Antonio. Sign up for a free half-hour consultation with our coding consultant, Jacqueline Kravitz, CPC, AAPC Fellow. Sessions are being offered on a first-come, first-serve basis in the ACFAS Membership Booth, so don’t wait to sign up! Time slots include:

Wednesday, February 19
10am–4pm

Thursday, February 20
9:30am–4pm

Friday, February 21
9:30am–1:30pm

Email Melissa Matusek, director of Marketing and Communications to reserve your time slot.
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Start Your Day with Industry Satellite Breakfasts
Breakfast is the most important meal of the day, and you won’t want to miss the Satellite Breakfasts (non CME) at ACFAS 2020. Breakfasts are offered Wednesday, Thursday and Friday during the conference, so take your pick and stop by!

Wednesday, February 19
Wright Medical
Current Solutions for Neuropathic Reconstruction and Wound Management (Didactic and Lab)
Featuring SALVATION™ 2 Midfoot Nail and BIOSKIN
6–7:30am
Henry B. Gonzalez Convention Center
Room 206AB

Thursday, February 20
Amniox
Orchestrating Regenerative Healing in Podiatric Surgery
6:30–7:30am
Henry B. Gonzalez Convention Center
Room 217B

Organogenesis Surgical & Sports Medicine
Regenerative Medicine in Foot & Ankle Surgery
6:30–7:30am
Henry B. Gonzalez Convention Center
Room 216AB

Friday, February 21
DePuy Synthes
Optimizing an Opioid Sparing Multimodal Approach to Control Post-Surgical Pain
6:30–7:30am
Henry B. Gonzalez Convention Center
Room 216AB

For more detailed information on these non-CME events visit the Industry Events section on acfas.org.
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A Coffee for Your Thoughts
ACFAS is working to improve our website and we need your help! We’d like to hear from you, our members, and your experiences using acfas.org.

During ACFAS 2020 in San Antonio, our website design vendor will be onsite in the ACFAS Membership booth conducting research with member’s to get their feedback when looking for helpful information on acfas.org. We will be having both 15-minute quick interviews in the booth and also longer 30-minute research sessions where members will be asked to answer questions regarding website goals, user experiences, membership needs and overall impressions of acfas.org.

If you have time during ACFAS 2020, stop by the membership booth for quick 15-minute interview—no appointment necessary. If you have a little more time to spare, please schedule a more in depth 30-minute research session during the conference by visiting sandstormdesigninc.setmore.com.

As a thank you, all participants will receive a Starbucks gift card. Thank you in advance for your help in improving your experience at acfas.org!
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Foot and Ankle Surgery


Confirmation of Tenotomy Healing at Three Weeks Using the Ponseti Protocol
The study aimed to evaluate the mean duration of Achilles tendon gap (ATG) closure and the weekly percentage of feet that achieved ATG closure after percutaneous Achilles tenotomy. In 37 feet of 25 patients under five years old with idiopathic clubfoot, the Achilles tendon was assessed clinically and ultrasonographically before and after tenotomy. The immediate post-tenotomy ultrasonographic mean tendon gap area was five plus or minus 2.8 millimeters, and the mean duration of the tendon stump gap was 1.9 plus or minus 0.8 weeks when assessed clinically and 2.6 plus or minus 0.9 weeks as assessed ultrasonographically. Researchers conclude that the significant difference between clinical and ultrasound methods of assessing the Achilles tendon gap closure appears to establish casting removal and ambulatory walking at three weeks after tenotomy for the group studied.

From the article of the same title
Journal of Foot & Ankle Surgery (01/15/20) Anipole, Olalekan A.; Adegbehingbe, Olayinka O.; Ayoola, Oluwagbenga
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Effects of Diabetes Mellitus on Functional Outcomes and Complications After Torsional Ankle Fracture
The goal of this study was to determine the effects of diabetes on complications, secondary operations and functional outcomes after torsional ankle fracture. The study retrospectively reviewed 979 adult patients treated surgically for a torsional ankle injury over 13 years. Demographic information, injury characteristics, secondary complications and secondary procedures were recorded, and patient-reported outcome surveys were obtained after a minimum of 12 months. Multivariable analysis was done to account for confounding variables.

Study authors found that 13.4 percent of the patients examined had diabetes. These patients were older on average, with no difference in sex or race, and had a higher body mass index and incidence of medical comorbidities. Twenty-six percent of diabetics experienced complications, especially deep infections, and diabetics had more secondary procedures including débridement, arthrodesis and amputation. Diabetes was a significant independent predictor of worse FFI activity limitation scores but was not predictive of worse outcomes on any other subscore of the Short Musculoskeletal Function Assessment. The authors conclude that while diabetes was associated with more complications and secondary operations, functional outcomes including pain and dysfunction were not markedly affected by these clinical outcomes, potentially due to diminished sensory function and less baseline physical activity among diabetic patients.

From the article of the same title
Journal of the American Academy of Orthopaedic Surgeons (01/09/20) Schmidt, Tegan; Simske, Natasha M.; Audit, Megan A.; et al.
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Effectiveness of Distal Tibial Osteotomy with Distraction Arthroplasty in Varus Ankle Osteoarthritis
The purpose of this study was to examine the effect of distal tibial osteotomy (DTO) with joint distraction using a circular external fixator for treating ankle osteoarthritis. A total of 21 patients with medial ankle arthritis were examined; arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia. The ankle joint was stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of about 5.8 millimeters was performed.

The anteroposterior and lateral mortise angle during weight-bearing, talar tilt ankle and anterior translation translation of the talus on ankle stress radiography were improved significantly. Signal changes on magnetic resonance imaging also improved in all patients, as did visual analog scale and American Orthopaedic Foot & Ankle Society scores. No severe complications were observed. The authors conclude that DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity.

From the article of the same title
BMC Musculoskeletal Disorders (01/14/20) Nozaka, Koji; Miyakoshi, Naohisa; Kashiwagura, Takeshi; et al.
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Health Policy and Reimbursement


US Supreme Court Declines to Fast-Track Affordable Care Act Appeal
The US Supreme Court has rejected a bid by the House of Representatives and 20 Democrat-led states to fast-track consideration of their appeal seeking a definitive ruling that the Affordable Care Act (ACA) does not violate the US Constitution. The brief order means that the court is almost certain not to hear arguments or issue a ruling in its current term, which ends in June. This means that the fate of the ACA will remain uncertain until after the 2020 presidential election.

The House and states behind the appeal want the Supreme Court to hear their appeal of a December ruling by the New Orleans-based 5th US Circuit Court of Appeals that the law's "individual mandate" that required people to obtain health insurance violated the Constitution. Texas and 17 other states filed a lawsuit challenging the ACA, and a district court in Texas ruled in 2018 that the entire law was unconstitutional. As part of December's appeals court ruling, the district court judge has now been tasked with taking a second look at whether the law needs to be struck down in full or whether provisions aside from the individual mandate could be retained.

From the article of the same title
Reuters (01/21/20) Hurley, Lawrence
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Trump Administration to Soon Issue Guidance on Medicaid Block Grants
The Trump administration reportedly plans to release guidance as soon as this month for granting states waivers to convert Medicaid funding to block grants, paving the way for a transformation of the program. The impending release comes as a surprise after the Office of Management and Budget, which reviews regulatory actions, indicated in November that block-grant instructions had been withdrawn. Medicaid is the main source of longterm care coverage for Americans and is a guaranteed benefit for eligible individuals. Lawmakers in Tennessee, Alaska and Oklahoma have already expressed an interest in pursuing block grants. Supporters of block grants say the change would free states from federal requirements and give them more flexibility to try new ways to increase coverage and cut costs. Consumer groups and Democrats say that converting to a block grant means thousands of people could lose Medicaid coverage or be unable to enroll if states’ costs rise or enrollment swells.

From the article of the same title
Wall Street Journal (01/19/20) Armour, Stephanie
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Trump Opens Door to Cuts to Medicare and Other Entitlement Programs
President Trump suggested on Wednesday that he would be willing to consider cuts to programs like Medicare to reduce the federal deficit if he wins a second term. The president made the comments while attending the World Economic Forum in Davos, Switzerland. Asked if cuts to entitlements would ever be on his plate, Trump answered yes. “At some point they will be,” Trump said, before pointing to United States economic growth. “At the right time, we will take a look at that.” Trump suggested that curbing spending on Medicare, the government health care program for older adults, was a possibility. “We’re going to look,” he said. The president has already proposed cuts for some safety net programs. His last budget proposal called for a total of $1.9 trillion in cost savings from mandatory safety net programs, like Medicaid and Medicare. It also called for spending $26 billion less on Social Security and other safety net programs. Spending on Social Security, Medicare and Medicaid is expected to cost the federal government more than $30 trillion through 2029, according to the Congressional Budget Office.

From the article of the same title
New York Times (01/22/20) Rappeport, Alan; Haberman, Maggie
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MedPAC: 340B Hospitals Don't Use More Expensive Drugs
New federal research finds that the 340B Drug Pricing Program does not create strong incentives for participating hospitals to use more expensive drugs. The US Medicare Payment Advisory Commission's (MedPAC) staff said at a meeting on Thursday that hospitals participating in the 340B program spend about $300 more on drugs for prostate and lung cancers but not breast, colorectal, or leukemia-lymphoma cancers.

The higher spending at 340B hospitals seems to be driven by the type of cancer that people are treated for rather than 340B's financial incentives. The spending differences may have to do with the fact that 340B hospitals are more likely to care for younger patients who need more aggressive cancer treatments and to use more advanced and expensive therapies. However, differences in patients' social determinants of health could also be at play, as hospitals in 340B serve 43 percent more Medicare-Medicaid dual-eligible patients than nonparticipating hospitals. Because poorer people tend to be sicker and are more likely to delay care, hospitals might be spending more on certain types of cancer drugs because their patients need more treatment. The research looked at data from 2013 to 2017, so it does not account for the lowered reimbursements that 340B hospitals have received since 2018.

From the article of the same title
Modern Healthcare (01/17/20) Brady, Michael
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Major Doctors' Group Calls for US to Assure Coverage for All
The American College of Physicians has called for sweeping government action to guarantee healthcare coverage for all, reduce costs and improve the basic wellbeing of Americans. The organization said it endorsed either of two general approaches being debated by Democratic presidential candidates: a government-run "single-payer" system or a new "public option" government plan that would offer comprehensive coverage to compete with private insurance.

Doctors' groups have traditionally been central to the nation's health care debates, as the American Medical Association has been instrumental in helping pass the Affordable Care Act and led efforts to prevent its repeal. Recent polling by the nonpartisan Kaiser Family Foundation finds that about half of US adults support a national Medicare for All plan, while two-thirds support a public option. Both ideas face strong opposition from health insurance companies and other industry players. The group's president, Robert McLean, said his group is seeking comprehensive solutions that address coverage, cost, quality and complexity. His organization's framework was outlined in a series of papers published in its journal, Annals of Internal Medicine.

From the article of the same title
Associated Press (01/20/20) Alonso-Zaldivar, Ricardo
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Medicine, Drugs and Devices


WHO Warns that Pipeline for New Antibiotics is Running Dry
The World Health Organization (WHO) said that a lack of innovation in the development of new antibiotics and falling private investment are hindering efforts to fight drug-resistant infections. "We urgently need research and development," said Sarah Paulin, technical officer of Antimicrobial Resistance and Innovation at the WHO. "We still have a window of opportunity but we need to ensure there is investment now so we don't run out of options for future generations."

A new WHO report analyzed products being tested on patients, while another examined therapies in the early stages of development. The WHO noted the economic realities that have been affecting investment in the antibiotic arena by major drug companies and stifling the few remaining small companies that have come to dominate development of antimicrobial treatments. In recent months, several US drug companies with promising new antibiotic products have failed.

From the article of the same title
New York Times (01/17/20) Jacobs, Andrew
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Health Insurers Take on Big Pharma, Plan to Manufacture Their Own Drugs
A group of leading US health insurers plan to start manufacturing versions of generic medications, hoping the competition with pharmaceutical companies will bring down costs. The $55-million effort is led by a consortium of 18 independent and locally owned Blue Cross and Blue Shield health plans, spearheaded by Blue Shield of California. The Blue plans have not disclosed which drugs they will manufacture, but officials said the list would include generic medications widely used by patients with common chronic illnesses.

The insurers, which cover about 40 million people, hope to make the first lower-priced drugs available to patients by early 2022. They are working with Civica Rx, a Utah-based nonprofit with 18 medications in production, which was founded two years ago with a group of US hospital systems to manufacture lower-cost medications that were frequently subject to shortages or exorbitant pricing. Ben Wakana, executive director of advocacy organization Patients for Affordable Drugs, says that the partnership may bring real relief for some Americans but is not likely to transform the pharmaceutical market, which will require federal intervention.

Generic medicines are credited with helping control overall costs as they are generally less expensive than name-brand versions, but they represent only a fraction of total drug spending. The generic market has been plagued by predatory pricing and deals among prescription drug companies that delay the introduction of lower-priced generics. Legislative attempts to address the root of the problem have been rejected by the Senate and the White House.

From the article of the same title
Los Angeles Times (01/22/20) Levey, Noam N.
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How Fast Can A New Internet Standard For Sharing Patient Data Catch Fire?
Technology companies are pushing the healthcare industry to embrace an internet-based common standard, called Fast Healthcare Interoperability Resources (FHIR), that would make it easier to store and share patient information. Industry analysts say growing demand for freer exchange of health care information is creating an electronic health record market that may reach $38 billion by 2025.

The idea behind FHIR is to share specific pieces of information, such as symptoms, procedures or diagnoses, without passing along entire documents. Proponents of the new standard say it would ensure the seamless exchange of data among providers across the industry. FHIR has met considerable resistance in part because, until recently, few business incentives existed and limited advocacy by health care providers to create the necessary demand for FHIR's adoption. Beyond its potential to revolutionize medical records requests, FHIR may also provide the first reliable gateway for patient-generated health information from millions of smartwatches, fitness trackers and blood pressure monitors to merge with clinical data in doctors’ offices.

From the article of the same title
Kaiser Health News (01/22/20) Rae-Dupree, Janet
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Patients with Newly Diagnosed Musculoskeletal Pain are Prescribed Opioids More Often Than Recommended
Contrary to clinical recommendations, research shows that patients with a new diagnosis of chronic musculoskeletal pain often leave their first physician visit with an opioid prescription in hand. They are less likely, meanwhile, to be steered toward non-opioid and nonpharmacologic treatment pathways to begin managing their disease.

"Particularly when the patient is experiencing pain that may become chronic, that first clinical encounter can set the course for patient care moving forward," remarked study co-author Helene Langevin, MD, director of NIH's National Center for Complementary and Integrative Health. She and colleagues from McMaster University and the University of Montreal in Canada examined data from the National Ambulatory Medical Care Survey for the years 2007–15. They found that only 10 percent of patients were prescribed physical therapy during their initial consultation, while counseling was offered 15.2 percent of the time and other nonpharmacologic treatments were recommended 14.3 percent of the time.

Opioids, meanwhile, were prescribed for 21.5 percent of new patients and nonopioid medications—NSAIDs especially—were offered to 40.2 percent. Reporting in the Journal of Pain, the researchers noted that family practitioners were more likely than internists, orthopedists, neurologists, oncologists and general surgeons to prescribe opioids. Patient characteristics that influenced initial treatment, meanwhile, included age, gender, body mass index, smoking status, race and ethnicity and payer status.

From the article of the same title
NIH News Release (01/16/20)
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS


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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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