News From ACFAS

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The final ACFAS 2020 program is here! Look and see what you can expect in San Antonio.

Get the full list of sessions, exhibitors, speakers and posters while seeing an overview of the convention center and Exhibit Hall layout. Color-coded maps will help you find your way around the convention center.

We’re only a couple weeks away from San Antonio, so flip through the ACFAS 2020 program and prepare yourself for another great conference! On January 17, 2020, ACFAS President Christopher Reeves, DPM, MS, FACFAS sent a letter on behalf of the College to the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in response to the agency’s request for input and recommendations on policy changes that could limit many providers from practicing to the full scope of their education, training, certification and licensure.

A similar letter was sent to CMS from the Coalition for Patient’s Rights, of which ACFAS is one of 16 members.

The letters urged the agency to take the following actions:

• Revise regulations that restrict healthcare professionals to such a degree that they are prevented from practicing to the full extent of their education, training, certification and licensure.

• Revise policies that exclude qualified healthcare providers from coverage. This would include any providers who practice within the scope of their applicable state license or state law and who can provide a service that would otherwise be covered if offered by a different type of provider.

For a copy of the letters, please email Erin Ravelette at erin.ravelette@acfas.org. Don’t miss all the Exhibit Hall has to offer at ACFAS 2020 coming up February 19-22 in San Antonio, including the chance to win some awesome prizes!

Stop by and explore the newest services from 140+ companies, participate in interactive product demos, explore the posters during the Grand Rounds from 1-2pm, speak with authors and network with colleagues. You can also check out the HUB theater for hourly sessions on trending topics or stop by the Job Fair to search for your next job or new hire.

Plus, check out the fabulous prizes you can win when you scan your badge at various prize tables throughout the Exhibit Hall. Prizes include American Express gift cards, upscale wine, a Getaway package and more! Tables will be set up for each prize. To enter, find the table with the prize you want to win and scan your badge. It’s that easy!

Visit acfas.org/sanantonio to find out what else you’ll find awaiting you in San Antonio in a couple weeks! Keep your ACFAS 2020 experience going into the evening with more Industry Events. Choose any of these non-CME evening events and get an in-depth look at the newest surgical technologies.

Tuesday, February 18
Zimmer Biomet
New Solutions for Foot Fusion Management in the Surgery Center
6:15 – 8:45pm
Henry B. Gonzalez Convention Center
Room 216AB

Thursday, February 20
DePuy Synthes
Intersecting Continuous Compression Implants for Lapidus Procedures
6:15 – 7pm Didactic Session (dinner, beer and wine will be served)
7 – 8pm Cadaver Lab
Henry B. Gonzalez Convention Center
Room 216AB

Orthofix
Complex Charcot Solutions: Pre-Op to Post-Op Featuring HEX-RAY™ software, TL-HEX™, TrueLok™, G-Beam™, and Trinity ELITE™
6:15 – 6:35pm (Reception with heavy hors d’oeuvres beer and wine)
6:35 – 7:30pm
Henry B. Gonzalez Convention Center
Room 217B

Treace Medical Concepts, Inc.
Lapiplasty^® Cadaveric Symposium
6:15pm
Henry B. Gonzalez Convention Center
Room 217CD

Zimmer Biomet
Stratum Foot Plating System Innovation: Zimmer Biomet BioSkills Lab
6:15 – 7:15pm (Cocktails and brief presentation)
7:15 – 9pm Mobile BioSkills Lab
Henry B. Gonzalez Convention Center
Room 217A

For more details about industry events, visit acfas.org/sanantonio. Don’t forget to pack your CV and stop by the seventh annual ACFAS Job Fair in the ACFAS 2020 Exhibit Hall in San Antonio!

Hosted by PodiatryCareers.org, the Job Fair invites available candidates to post their CVs on the Job Fair bulletin boards and for employers to hunt for a new employee by posting descriptions of open jobs.

Need a professional headshot? Be sure to dress your best and visit the Headshot booth in the Exhibit Hall on Thursday and Friday to have your picture taken for free. Your photo session will include a brief meet and greet with a makeup artist, and you will receive both hardcopy and digital versions of your headshot.

Foot and Ankle Surgery

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The study aimed to evaluate the pedobarography and ankle kinematics of idiopathic clubfoot post-surgery compared to controls. Twenty-two juvenile patients (33 clubfeet) and 22 normal children (44 feet) were involved in the study. Their demographic data, plantar force measurements and ankle kinematic data were recorded and compared between clubfoot patients and controls by pedobarography and three-dimensional gait analysis. The plantar force in clubfoot patients was significantly lower than controls, and clubfoot patients demonstrated a longer contact time, larger contact area, lower peak pressure and force relative to body weight in toe, midfoot and heel areas.

The impulse was comparable between the two groups but the contact area, force and force times integral concentrated at the midfoot region of the clubfoot. Ankle kinematics in clubfoot patients demonstrated a dorsiflexed position through the late toe off, and range of dorsiflexion in the clubfoot was significantly higher than in controls. Foot adduction during stance, limited inversion-eversion and limited plantar flexion during loading response and toe off were observed in the clubfeet. The results highlight the importance of limited soft tissue release during clubfoot surgery as muscle weakness and flatfoot deformity are prevalent, though the procedure could preserve range of motion at the ankle joint.


The study evaluates the relationship between the accessory anterolateral talar facet (AALTF) and different types of tarsal coalitions. Researchers evaluated 187 patients with tarsal coalition or sinus tarsi syndrome for an AALTF on CT and MRI, excluding based on acute ankle trauma, recent surgery, motion or metal artifacts. They evaluated the AALTF length and height, the lateral talocalcaneal structures for associated findings and the presence of rare coalitions including alcaneonavicular (CNC), intra-articular middle facet talocalcaneal (MFTCC), posterior facet talocalcaneal (PFTCC) and extra-articular posteromedial talocalcaneal (EATCC).

The AALTF prevalence in the study population was 31.55 percent, 40.91 percent in men and 23.23 percent in women. The average AALTF length was 4.5 millimeters and average height was 8.9 millimeters. The AALTF was significantly associated with talocalcaneal osseous changes such as cortical thickening and cystic changes, as well as with sinus tarsi edema on MRI, EATCC and MFTCC. No significant association was found with CNC, PFTCC or other rare coalitions. The study concludes that the AALTF is common and significantly associated with some tarsal coalitions, specifically EATCC and MFTCC.


The study documents the incidence of heteropic ossification for a novel fourth-generation fixed bearing two-component prosthesis and reports a systematic review of the literature. Researchers reviewed the incidence and functional outcome of patients who underwent primary Infinity total ankle arthroplasty (TAA) between 2013 and 2015 in a prospective observational study. The incidence of heterotopic ossification was 70.5 percent in the 61 patients who underwent primary TAA in the case series. There was no association between heterotopic ossification and American Orthopaedic Foot and Ankle Society (AOFAS) score, foot function index (FFI), visual analogue scale (VAS) and ankle osteoarthritis scale (AOS). A systematic review of all studies between 1998 and 2018 reporting the incidence of heterotopic ossifcation post-TAA was conducted.

In the 16 studies included, the overall incidence of heterotopic ossification after TAA was 66 percent on average at 3.6 years. Four of the studies did not address functional outcomes, while 11 studies reported no association between heterotopic ossification and functional outcomes. One study reported a statistically significant difference in range of motion and AOFAS score. The authors conclude that, although the incidence of heterotopic ossification after TAA is considerable, there is insufficient research to suggest that heterotopic ossifcation after TAA impacts range of motion or functional outcome.

Practice Management

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US Department of Health and Human Services Secretary Alex Azar criticized healthcare stakeholders who oppose a proposed rule that would enable patient access to electronic health records as defending a "balkanized" and "segmented" status quo. Last March, the US Office of the National Coordinator (ONC) issued a proposed rule requiring healthcare provides to offer patients access to their electronic health information through secure, standards-based application programming interfaces. Last week, health IT vendor Epic Systems emailed the heads of some major US hospital organizations urging them to opposed the proposed rule, which it said would increase healthcare costs, harm patient care and endanger patients' control of their confidential health information.

Azar told an ONC meeting that the new rule is about "access and choice," allowing patients to access their health records at no cost by moving towards greater interoperability. While Epic said it "strongly agrees" with ONC's support for patients' ability to access their own data, it also contends that "by requiring health systems to send patient data to any app requested by the patient, the ONC rule inadvertently creates new privacy risks." Epic also warned that “there are no transparency requirements to make it very clear to the patient what data the app is taking and what the app will do with that data.” To address these risks, Epic recommended that transparency requirements and privacy protections are established for apps gathering patient data before the ONC rule is finalized. The American Medical Association agrees with this sentiment, claiming that ONC is making a policy decision to leave health information vulnerable to inappropriate secondary uses and disclosures from third-party apps.


The article describes some of the key features of a successful quality collaborative. One factor is open dialogue and routine communication between care management and provider relations departments. This includes holding routine meetings and maintaining a consistent point-person who is well-versed in medical terminology, healthcare practices and value-based purchasing to help bridge the gap between payers and providers. It also helps to have a shared mission that establishes a consensus between payers and providers on what paths and goals will have the most positive impact. Successful quality collaboratives set achievable timelines that consider the details of putting data transfer and reporting systems into place. This includes accounting for how latent the data may be and how much quality course correction is needed.

Efficient data exchanges are critical to avoiding penalties by the Medicare Star program for reporting insufficient results. Finally, quality collaboratives benefit from incentivizing healthcare outcomes through bonuses and quality reimbursements, which will encourage a results-driven culture and go beyond merely reporting measurable outcomes. One way to do this is to build quality clauses to be inserted within hospital contracts in anticipation of contract renewals. For hospitals on Indefinite Duration Contracts, it is best to consult with legal counsel to determine how to overcome potential legislative barriers when approaching these perpetual agreements.


In many practices, there is one person in the office who seems especially proficient with technology. These "superusers" are subject matter experts who gain additional expertise in technology to help bridge the gap between their peers in their field and technology developers. While a defined superuser role is less common in smaller organizations, it is possible for independent practices to recognize tech-savvy employees' contributions and craft an appropriate role for them. Doing so starts with recognizing the extra work these superusers have been doing and the expertise they have acquired. Invest in these employees with courses, conferences and even certifications to help them increase and refine their skills.

Manage their workload appropriately to make sure they can still do the job they were hired to do and protect them from excess stress by setting limits on how much attention the rest of your employees can expect. Protect superusers from abuse and burnout by reminding your physicians and staff that superusers are part of the team and not responsible for bugs or delays that make things run less smoothly. Finally, resist the temptation to force an employee to become a superuser, allowing the best candidates to reveal their interest and motivation in tech on their own.

Health Policy and Reimbursement

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A new analysis by the Medicare Payment Advisory Commission (MedPAC) finds that the 340B program, which was designed to help certain hospitals treat large populations of patients who rely on Medicare, has a minimal effect on overall health care spending. The analysis found that spending on cancer drugs for 340B hospitals was about 2 percent to 5 percent higher than for non-340B hospitals and 1 percent to 7 percent higher than for physician offices, representing a modest increase in overall health care spending since 2018. MedPAC also found that spending on cancer drugs was only higher among 340B hospitals for prostate and lung cancer, and these increases could not be definitively linked to incentives from the 340B program.


A new RAND Corporation analysis published in the New England Journal of Medicine suggests that Medicare is overpaying surgeons for many medical procedures. Using Medicare data, RAND researchers estimate that if Medicare payments to surgeons were adjusted to remove the money allocated for undelivered postoperative care, reimbursements for the procedures in question would have been 28 percent lower in 2018. In 2015, the US Centers for Medicare and Medicaid Services (CMS) proposed removing postoperative visits from bundled payments, instead having surgeons bill for each individual postoperative visit. Surgical physician groups opposed the changes, and Congress passed legislation preventing any payment changes until CMS collected more information about the number and level of postoperative visits provided by surgeons.

Medicine, Drugs and Devices

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A retrospective review aimed to characterize the distribution and patterns of opioid prescribing in the United States during 2003–17, based on data from a private insurer with nationwide coverage. During the study period, 3.9 million patients received 8.9 million prescriptions for opioid analgesics. Analysis determined that US providers engage in responsible prescribing overall, with most writing their orders for less than the recommended maximum dosage and days. The top 1 percent of providers aside, medical professionals wrote 86 percent of their prescriptions for fewer than 50 morphine milligram equivalents per day, and 71 percent prescribed opioids for fewer than seven days.


Hundreds of regional grocery stores are closing or selling pharmacy counters, which have been struggling as consumers make fewer trips to fill prescriptions and community pharmacy chains tighten their grip on the US market. Grocery pharmacies are too small to wrest competitive reimbursement rates on drugs, according to industry analysts. Also, they generally lack walk-in clinics and other health services that draw many customers to CVS and Walgreens locations.


Many Americans report that their insurance plans sometimes do not cover a drug they need — and nearly half of those to whom this happens say they simply do not fill the prescription, according to a new poll on income inequality from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. Among lower-income adults: 49 percent reported that they were told their health insurance plan would not cover a drug prescribed by their doctor, compared with 41 percent of the highest-income adults and 32 percent of middle-income adults.

"What you see is insurers are not paying for some drugs that physicians are recommending and that patients think they need," says Robert Blendon, professor of health policy and political analysis at the Harvard T.H. Chan School of Public Health, who directed the poll. When that happened, most of the highest earners paid for the medication themselves. But Blendon says that this was not the case for everyone else. "One-half of the people who are lower or middle class are not getting them," he says, "because they cannot afford to go out and pay for it themselves."


Several major hospitals have granted companies including Microsoft Corp., IBM, and Amazon.com Inc. the ability to access identifiable patient information as part of deals to crunch millions of health records. The breadth of access was not always fully articulated by hospitals and tech companies when the deals were struck. The scope of data-sharing in these agreements shows hospitals acting as brokers to technology companies as they enter the healthcare sector.

Hospitals can share patient data as long as they follow federal privacy laws, which contain limited consumer protections. There is no indication of wrongdoing in the deals, and officials at the companies and hospitals say they have safeguards to protect patients, but some have raised concerns about privacy. The Health Insurance Portability and Accountability Act (HIPAA) lets hospitals confidentially send data to business partners related to health insurance, medical devices and other services. While the law requires hospitals to notify patients about health-data uses, they do not have to ask for permission and are not required to notify patients of specific details. Data that can identify patients can be shared if it is deemed necessary for treatment, payment or hospital operations, and deals with tech companies to develop apps and algorithms can fall under these broad umbrellas.