News From ACFAS

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Time is running out to register for the College’s coding courses in Austin. Pick one of the courses depending on your level of knowledge and walk away a coding pro!

New! Coding Fundamentals
2:30-5:15pm | 2.5 continuing education contact hours
Take the first few steps to coding and billing by joining us for this all-new comprehensive workshop covering the fundamentals of coding and billing for foot and ankle surgeons. Learn the foundation of the coding and billing process from expert colleagues before taking the ACFAS Coding and Billing for the Foot and Ankle course.

Coding and Billing for the Foot and Ankle Surgeon
8am-5:30pm | 8 continuing education contact hours
This interactive and comprehensive workshop will cover pertinent issues related to properly coding surgical procedures and evaluation and management services. Learn how to code just one or two procedures properly, you will cover the cost of this course and see an immediate return on investment in your own practice.

Visit acfas.org/practicemanagement to register for one of these workshops today. Learn how to be your own publicist for your practice and become a spokesperson for the College. Sign up now for free formal media
training, which will take place in Austin, and see how just a few easy-to-implement PR tips and tools can help you promote your practice and be a more confident speaker, both on and off camera.

A limited number of time slots still remain for personalized one-hour training sessions with a professional media trainer. Reserve your session by contacting Melissa Matusek, CAE, director of Public Relations and External Initiatives at melissa.matusek@acfas.org. Stop by the ACFAS Member Center on Thursday, 2/24, from 12:30-1:30 PM for an open Q & A with Careers consultant, Christopher Hood, DPM, FACFAS. Dr. Hood will be available to answer your job-search questions on the A-Zs of the processes: CV and cover letter writing, interviewing, employment agreements, contract negotiation, and more. If you’re thinking about job-searching, don’t miss your chance to seek valuable advice from a pro!

While you’re at it, get ready to put your best foot forward and whip your CV into shape by signing up for virtual CV review. Sign up information can be found in the ACFAS Member Center in Austin and throughout ACFAS 2022. Spots are limited, so don’t delay! Congratulations to Harsh Varshney ’24, Anthony Hernon ’23 and Nathan Fischer ‘23, the 2022 Mirmiran Family Scholars and students at Western University College of Podiatric Medicine.

The family of Roya Mirmiran, DPM, FACFAS, based in Sacramento, CA, provides scholarships every year to top students who are hand-selected to attend the ACFAS Annual Scientific Conference. The students will use their scholarships to offset their travel costs.

The Mirmiran Scholarship opportunity rotates to a different campus every year. For 2023, students from Midwestern University - Arizona College of Podiatric Medicine will be recognized.

Foot and Ankle Surgery

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A cross-sectional study was held to ascertain any differences between the muscle architecture of the medial gastrocnemius and the morphology of the Achilles tendon among typically developing children (TDC) and clubfoot patients with and without a relapse clubfoot and to define relationships between morphological and functional gait outcomes. Fifteen clubfoot patients, 10 clubfoot relapse patients, and 19 TDC were included. There were no observed differences between clubfoot patients and those with and without a relapse in terms of morphological and functional gait parameters, except for lower maximal dorsiflexor moment in clubfoot relapse patients. Clubfoot and relapse patients exhibited lower functional gait outcomes and shorter and more pennate muscles with a longer Achilles tendon compared to TDC. This longer relative tendon was related to higher ankle power and plantarflexor moment in all clubfoot patients. Comprehending these relationships in all clubfoot patients could potentially enhance knowledge about clubfoot and assist with future treatment planning.


Researchers analyzed radiodensity in Hounsfield units (HU) to compare bone quality of medial column fixation targets using computed tomography (CT) scans between patients with and without midfoot Charcot neuroarthropathy (CN). Age and body mass index showed no significantly difference between the CN and control groups. The CN cohort maintained greater mean HU than the control group at the metatarsal head and talar body sites. The difference in average HU of these bones had no statistic significance between Stages 0-1 and Stages 2-3 or Brodsky Types 1 and 2. Average HU differences among talus positions also were not statistically significant. Indirect bone density analysis using HU indicated a higher density in CN patients with no significant difference among talar body sites or midfoot Charcot stages and types. These results may help in the optimization of fixation length, while future studies may examine these densities in ankle CN.


A cross-sectional study investigated the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) according to muscle strength, postural control (PC) and range of motion (ROM) in adults with chronic ankle instability (CAI). The study included 50 enrollees, mean age 27.2 ± 6.3 years and mean body mass index 26.4 ± kilograms/square meters. Fifty-eight percent of participants were male and 42 percent were female, while 18 (36 percent) had unilateral and 32 (64 percent) bilateral CAI. FAAM results were associated with the Motor Control Test, the modified Star Excursion Balance Test, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, external hip rotator muscles strength and the modified Balance Error Score System. Both the FAAM and FAOS were validated for assessing postural control and muscle strength in patients with CAI, while no association was observed in relation to ankle dorsiflexion.

Practice Management

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A practice's employee handbook should incorporate eight guidelines to prevent problems, starting with a social media policy that allows negative comments. If the state the practice is based in has an at-will employment law, the handbook should include a statement that it cannot be considered a contract and that the practice is entitled to make changes in an employee's status whenever it feels it is necessary. Disciplinary procedures and disciplinary actions should be specified, along with a statement that harassment will not be tolerated and should be reported by any employee subjected to it. Employee benefits should be properly indicated in the handbook to ensure they comply with federal and state laws. An explanation of how vacation, sick leave and personal time off is calculated is also a necessary handbook item, in addition to when the employee will qualify for such benefits. The handbook should further state whether any benefits can be carried over at the end of the year or if employees must use or lose benefit time. Finally, compensation guidelines in the handbook must be consistent with current state law as well as the latest rulings from the National Labor Relations Board.


Practices can follow four simple steps to collect payments while sustaining the practice-patient relationship. The first step is to incorporate eligibility verification into the patient check-in process. The second step is to try to collect payments at the time of service. Statements ought to be processed daily and sent within three days of the claim adjudication. The third step is to improve the patient experience with new technologies, including digital check-ins. The fourth and final step is to analyze practice staff to ensure appropriate staffing levels and high-quality staff in every role.


In approximately half of US states, healthcare workers who are unvaccinated against SARS-CoV-2 are now required to receive a first dose of a COVID-19 vaccine. The mandate will eventually affect roughly 10 million healthcare workers in 76,000 hospitals, nursing homes, home-health agencies, and other facilities that participate in Medicaid and Medicare. A Supreme Court decision issued on January 13 blocked the Biden administration's vaccine-or-test mandate for large employers, but upheld a vaccination requirement for healthcare workers at facilities subsidized by federal funds. The vaccine requirement takes effect in states that did not challenge the mandate in court, including California, Hawaii, Minnesota, New York, and all US territories. Medical facilities in these states will lose funding if they are not in compliance with the mandate, according to federal officials. Healthcare workers in most of the remaining states, where a lower court blocked the mandate, have until February 14 to receive a first dose. For Texas, the deadline is on February 22. To retain their jobs, all healthcare workers must be fully vaccinated 1 month after their first COVID-19 vaccine dose. Some in the nursing home sector are concerned that the mandate could worsen staffing shortages and weaken care for older patients and prefer that a testing option be available.

Health Policy and Reimbursement

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Primary care doctor Maria Byron at the University of California, San Francisco (UCSF) is leading an experiment to relieve doctors from being swamped by emails by allowing them to bill insurers for certain correspondence. She said doctors, nurse practitioners, physician assistants and other UCSF clinicians have been able to bill payers for patient emails that require medical assessment or more than several minutes to respond, since November. This follows pandemic-era directives from the US Centers for Medicare and Medicaid Services allowing Medicare reimbursement for such e-Visits, and Byron said most commercial insurers UCSF works with have copied this policy. "If it's not valued and recognized via any payment, it's very difficult for the healthcare organization to move [email] into a sort of daytime activity," she explained. UCSF has witnessed an average reimbursement of $65 per e-Visit, although patients usually pay much less if at all. If successful, the effort could serve as a template for other health systems.


President Biden announced that a record 14.5 million Americans got private health insurance for this year under the Affordable Care Act (ACA) with assistance from his administration. The Centers for Disease Control and Prevention estimated that one in seven uninsured people were covered between the end of 2020 and September 2021, with lower-income Americans gaining the most coverage.

Medicine, Drugs and Devices

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The nonprofit Emergency Care Research Institute (ECRI) has determined that cybersecurity attacks remain the top technological threat to healthcare organizations, largely due to the sophistication of the attackers and the growing value of medical data. "Responding to these risks requires not only a robust security program to prevent attacks from reaching critical devices and systems, but also a plan for maintaining patient care when they do," said ECRI President Marcus Schabacker. He added that health systems are increasingly reliant on connected technology and integrated data systems, whose exploitation could lead to rescheduled healthcare appointments or medical procedures, diversion of emergency resources or even closure of departments of organizations. Other dangers include hacked digital health devices or platforms that fail to function as designed, potentially putting patients at risk or allowing access into the home through compromised smart devices. Supply-chain shortages were the No. 2 healthcare threat on ECRI's list, while telehealth ranks fifth.


A study published in Rheumatology found magnetic resonance imaging (MRI) of the hand and foot may forecast rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA). The authors studied 405 patients with criteria-based UA and 564 with expert opinion-based-UA, who were derived from a cohort of early arthritis patients who underwent contrast-enhanced MRIs of the hand and foot at baseline and followed over one year. Twenty-one percent of criteria-based UA patients developed RA, and MRI-detected synovitis and tenosynovitis were predictive. An independent connection between MRI-detected tenosynovitis and RA progression was observed, especially among patients with anticitrullinated peptide antibody-negative UA. The prior risks for RA development among UA patients with monoarthritis, oligoarthritis and polyarthritis were 3 percent, 19 percent and 46 percent, respectively. The MRI results for those with oligoarthritis changed this risk the most, with positive predictive value and negative predictive value 27 percent and 93 percent, respectively. Expert opinion-based-UA had similar results. "MRI had the highest additional value in autoantibody-negative UA patients presenting with oligoarthritis, in whom a negative MRI for tenosynovitis almost excluded imminent RA," the researchers concluded.