News From ACFAS

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Congratulations to Roya Mirmiran, DPM, FACFAS, recipient of the 2018 ACFAS Distinguished Service Award. Dr. Mirmiran will be recognized during ACFAS 2018 next month in Nashville, TN.

ACFAS presents this prestigious honor each year at the Annual Scientific Conference to an “unsung hero” who has served in a wide variety of behind-the-scenes volunteer roles in the College.

"It is a great honor to be able to present Dr. Mirmiran with this distinguished award,” says ACFAS President Laurence G. Rubin, DPM, FACFAS. "Dr. Mirmiran has been actively involved in our profession on multiple levels over the years, and wherever she serves, she is a pleasure to work with. Her dedication is truly appreciated," he adds.

Learn more about Dr. Mirmiran's experience as a volunteer leader with the College in the next issue of ACFAS Update. ACFAS would like to know if you have seen an increase in ankle injuries so far this winter. Share your input by voting in this month's poll at right, and visit acfas.org throughout February to view the latest poll results. Calling all night owls—attend an evening industry event during ACFAS 2018 next month at the Gaylord Opryland Hotel in Nashville to enhance your conference experience and get an inside look at the latest surgical technologies. Choose from:

Cartiva Evening Event
The Difference Is Data: First MTP OA Level 1 Clinical Evidence
Friday, March 23
6:15pm
Gaylord, Governor’s Room C
RSVP to llee@cartiva.net.

DePuy Synthes Evening Event
Experiences with Nitinol Continuous Compression Implants in Podiatric Surgery
Friday, March 23
6:15pm
Gaylord, Governor’s Room B

Treace Medical Concepts, Inc. Evening Event
Lapiplasty® Procedure Cadaveric Symposium
Friday, March 23
6:15pm
Gaylord, Room Canal BC
RSVP to MedEd@treace.net.

Wright Evening Event
Advancements for End-Stage Ankle Solutions
Friday, March 23
6:15pm
Gaylord, Governor’s Room A

Zimmer Biomet Evening Event
Details to come

Watch This Week @ ACFAS for details on other upcoming industry events at ACFAS 2018.

Foot and Ankle Surgery

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A pilot study was conducted to investigate the feasibility of a new portable single-use negative pressure wound therapy (NPWT) device in patients undergoing major foot and ankle surgery. The primary outcome was surgical site infection within 30 days as classified by the criteria from the U.S. Centers for Disease Control and Prevention. Patients in the prospective cohort were case-matched with a historical cohort from the same trauma center. The study included 60 patients, and the NPWT failed in seven patients and treatment was halted. Indications for surgery were midfoot, calcaneal, talar and ankle fractures. In 53 patients, four surgical site infections occurred, including two superficial and two deep infections. A match was available for 47 patients. The occurrence of surgical site infection was not significantly different between the prospective cohort and retrospective matched cohort. This also was the case when studying superficial and deep surgical site infections separately.


A study was conducted to assess the utility of subtalar arthroscopy in the operative treatment of Sanders type two calcaneus fractures using a sinus tarsi approach. The researchers consecutively treated 46 Sanders type two calcaneal fractures, with intraoperative fluoroscopy used to evaluate fracture reduction in the first 23 patients, while intraoperative fluoroscopy and subtalar arthroscopy were used in the latter 23. At the last follow-up, clinical outcomes in addition to Böhler's angles and calcaneal widths did not differ between the groups. On immediately postoperative CT, reduction of the posterior facet showed a higher-than-good grade in 17 feet (73.9 percent) in the fluoroscopy group and a higher-than-good grade in 22 feet (95.7 percent) in the arthroscopy group, and these values were significantly different between the groups (P = .04).


A prospective randomized study was conducted between August 2015 and January 2016 to determine whether the timing of ankle block administration in relation to ankle tourniquet inflation affected perceived pain and narcotic consumption, with patients assigned to three groups. An ankle block was performed before ankle tourniquet inflation in group A, immediately after ankle tourniquet inflation in group B and immediately following ankle tourniquet inflation with additional local anesthetic placed around the incision at the end of the procedure in group C. The only statistically significant distinction in average visual analog scale (VAS) scores transpired at 24 hours, when patients who received an ankle block after tourniquet inflation with local incisional anesthetic at closure had an average VAS score 2.8 points lower than those who received only an ankle block after tourniquet inflation. No difference in narcotic consumption was observed between groups at 24 and 48 hours. The researchers concluded that the timing of the ankle block in relation to tourniquet inflation did not have an effect on pain control in forefoot, midfoot and hindfoot reconstruction.

Practice Management

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Preventing and ending sexual harassment has become a highly discussed topic recently. The medical industry is no different from other fields in that protections are in place to prevent sexual harassment and to respond to reported incidents. Title VII of the Civil Rights Act of 1964 covers sexual harassment and applies to employers with 15 or more workers. It also applies to employment agencies, labor organizations and the federal government. However, it does not proscribe all conduct of a sexual nature in the workplace. A Supreme Court ruling provided the following as actions an employer can take when dealing with sexual harassment:

• Determine whether sexual conduct is unwelcome.
• Evaluate evidence of harassment.
• Determine whether a work environment is sexually hostile.
• Prevent sexual harassment by supervisors.
• Evaluate preventive and remedial action taken in response to claims of sexual harassment.

The Health Insurance Portability and Accountability Act (HIPAA) can complicate how doctors manage or respond to online reviews of their practice. For example, HIPAA would be violated if a doctor revealed medical details or confirmed someone was a patient when responding to a critical review. When responding to a negative review, the doctor should determine why the patient is unhappy, speak to the review website, talk with the disgruntled patient directly and only respond when other options have been exhausted. When responding, doctors should be cordial and professional and should offer further help if necessary.


Staples' Annual Workplace Survey of 1,004 full-time U.S. and Canadian employees, 12 percent of whom work in healthcare, found healthcare employees assigned their workplace a "B" grade. In comparison, employees in other industries gave their workplace a "B-." In addition, the poll found healthcare employees are likelier than other employees to include "a private place to rest" and "breakroom" on their workplace wish list. Twenty-six percent desired private places to rest, versus 21 percent of employees in other industries. Nineteen percent of healthcare employees also wanted more breakrooms compared to 12 percent of employees in other industries. Staples also found 49 percent of healthcare employees have taken a mental health day.

Health Policy and Reimbursement

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Healthcare associations want U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to give more information on the voluntary Bundled Payment for Care Improvement-Advanced (BPCIA) model. CMS says that model will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Medicare Access and CHIP Reauthorization Act’s Quality Payment Program. The performance period for BPCIA begins on October 1 and ends on December 31, 2023. However, several healthcare organizations wrote in a letter to Verma that "generally, the information included in the request for applications and Frequently Asked Questions lacks sufficient detail for clinicians and hospitals to determine if they should enter the model." They are requesting that CMS provide "detailed programmatic information by February 15 and delay the application deadline from March 12 to March 31, 2018."


The U.S. Department of Health and Human Services on January 31 announced that U.S. Centers for Disease Control and Prevention (CDC) Director Brenda Fitzgerald has resigned from her post following disclosure that she bought shares in a tobacco company. The stock in Japan Tobacco was one of about 12 new investments Fitzgerald made following her installation at CDC. Fitzgerald was already under congressional investigation for slow-walking divestment from older assets that government officials said posed potential conflicts of interest and prevented her from testifying before Congress.


A study from the Kaiser Family Foundation calculated out-of-pocket healthcare costs for Medicare beneficiaries will likely consume half of their average Social Security income by 2030. More than half of beneficiaries in traditional Medicare older than 85 or with incomes of less than $20,000 spent at least 20 percent of their total income on healthcare costs in 2013. Furthermore, among all beneficiaries, average out-of-pocket health-related costs depleted 41 percent of their average Social Security income in the same year. "This is substantially higher than the share reported by the Medicare actuaries for the same year (23 percent) because it takes into account the full array of out-of-pocket health expenses that people on Medicare face," the report noted. The median out-of-pocket healthcare spending burden for beneficiaries in traditional Medicare is anticipated to climb from 14 percent to 17 percent of their total income between 2013 and 2030. "Even if there is a segment of the Medicare population that is healthy and a segment that is wealthy, there are many people who are struggling to make ends meet and paying a chunk of their limited income on health expenses," says the Kaiser Family Foundation's Tricia Neuman. She also notes beneficiaries' burden would worsen if policymakers try to cut federal spending by shifting more costs onto them. "This report shows just what the burden already is today in the absence of any program cuts," Neuman says.

Medicine, Drugs and Devices

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Apple has announced a spring update to its operating system for iPhones and iPads that will have a new "Health Records" feature to import and store medical data about allergies, conditions, immunizations, lab results, medications, procedures and vitals. Twelve hospitals will participate, with physicians noting Apple will gain the advantages of more consolidated hospital networks and concentration among medical record systems. KLAS Research says Apple has obtained participation from Epic Systems and Cerner, which collectively account for more than half of medical-records management, as well as Athenahealth.


With federal officials unable to come up with legislation to control rising drug prices, that task is increasingly moving to the states. The pharmaceutical industry has responded by putting money and muscle into opposing state measures, regulatory disclosures and corporate filings. State lawmakers are likely to consider drug price transparency bills this year in Connecticut, Michigan, Oregon, Washington, New Jersey and elsewhere. The Pharmaceutical Research and Manufacturers of America is widely credited with stalling federal drug price measures for years, with lobbying, advertising and political contributions. Now states are getting a dose of the same medicine. Pharma companies "definitely have not seen that kind of activity aimed at them at the state level before and have raised their presence to address that," said Leanne Gassaway, top state lobbyist for America’s Health Insurance Plans, a major insurance trade group.


Despite widespread desire to lower drug prices, congressional efforts are at a standstill, writes Erin Mershon. Lobbyists, lawmakers and congressional staffers say the most powerful health industry players disagree about exactly how to move forward, making it unlikely that high drug prices will change any time soon. One factor hindering progress is that healthcare lobbyists are stuck playing defense as drug makers work to vilify other players in the industry, a tactic that is successfully creating confusion and diverting lawmakers' attentions toward the rest of the supply chain. In addition, beyond hearings, Congress is not jumping to act on drug pricing. The CREATES Act to ease obstacles for generic competitors is one of the few pieces of drug price legislation that has broad support in the industry, but it is languishing on Congress's to-do list. Meanwhile, even when they do agree, each industry group has very different priorities and strategies. Academics even suggest the lack of consensus and effort on drug prices by healthcare industry groups is because they all profit from the current system. Finally, trade association officials and lawmakers note that no one clear, easy solution exists upon which groups can agree. The piecemeal approach of backing policies such as CREATES, and then turning to other smaller issues may be the best way to address the issue, they note.