News From ACFAS

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Don’t miss your chance to get your coding questions answered at ACFAS 2020! 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—there are only a few spots left during these days:

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 today to reserve your time slot. Access ACFAS 2020 before you leave for San Antonio—download the free mobile meeting app for your all-access pass to this year’s conference, including:

• 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 leaving for San Antonio, download the app in one of two ways:

• Search your Apple or Google Play app store for ACFAS 2020 (iOS or Android).
• Visit core-apps.com/dl/acfas2020

If you already have the app downloaded from last year’s conference and it’s not automatically updated to the 2020 version, check your app store for updates.

Once you have 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 was emailed to all registrants last Friday, February 7. Login information will also be available on the back of your badge in San Antonio. Whether you're in San Antonio at ACFAS 2020 or at home, you can get the inside scoop and behind the scenes look at this year’s conference by following #ACFAS2020 on social media.

Follow the College's social media feeds through the conference's mobile app or from your own social media accounts. If you're joining us at the conference, share your Annual Scientific Conference experience with us and your colleagues by using #ACFAS2020 in your posts throughout the event.

We look forward to sharing the #ACFAS2020 experience with you! Want to meet local colleagues while at the upcoming conference? Attend your ACFAS Region meeting during ACFAS 2020!

Your ACFAS Regions will hold membership meetings in San Antonio and will discuss their 2020 plans for educational events and support of local schools, residencies and fellowships. Attend your meeting to hear all about it and offer your opinions!

Region meetings are scheduled during conference lunch breaks at reserved tables in the Exhibit Hall. A complete schedule of meetings will be listed in your onsite conference brochure, on the conference mobile app and on signage at the conference.

Attending your meeting will also put you in a drawing for one of nine $100 Amazon gift cards! You must be present to win, so don’t miss out! All meetings will take place at reserved tables in the Exhibit Hall.

Foot and Ankle Surgery

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The purpose of this meta-analysis was to report the current published evidence about the outcomes of deltoid ligament repair in ankle fractures. Several databases were searched through May 2019 for comparative studies, focusing on the primary outcome of medial clear space correction and the secondary outcomes of medial clear space reduction, pain scores, functional outcome and total complications if any. Three comparative studies met the inclusion criteria, representing a total of 192 patients, 81 in the deltoid ligament repair group and 111 in the non-repair group. The medial clear space correction and maintenance thereof on final follow-up radiographs were superior in the deltoid ligament repair group. Though pain scores were better in the repair group at the final follow-up, this did not lead to a better functional outcome, with similar total complication rates.


The study examines the incidence of nonunion of operative ankle fractures and risk of deep vein thrombosis (DVT) in patients who did and did not receive postoperative aspirin (ASA). A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship-trained orthopaedic surgeons at a single institution. Out of the 506 patients who met inclusion criteria, 152 received ASA and 354 did not. Radiographic healing at six week was demonstrated in 95.9 percent of those who received ASA and 98.6 percent of those who did not; this difference was not determined to be significant. There was no significant difference in time to radiographic union or in risk of postoperative DVTs between groups. The study concludes that postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT.


The study aimed to evaluate the effect of craniocaudal and posteroanterior angular variations from the true lateral radiograph on Böhler's and Gissane's angles. Fifteen embalmed, skeletally mature, human anatomic lower limb specimens were used in this radioanatomical study. True lateral radiographs of 15 embalmed, skeletally mature, human anatomic lower limb specimens were obtained. Angular variations from this radiograph were made from –30 degrees to +30 degrees deviation in the craniocaudal and posteroanterior direction at 5 degrees intervals, and Böhler's and Gissane angles were independently assessed by two experienced trauma surgeons. Böhler's angle decreased with increasing caudal angular variations, and it also increased with increasing posterior angular variations, though all deviations were within the measurement error. The deviation of Gissane's angle was most pronounced in the cranial direction, and it was not significantly affected by varying angular obliquity in the caudal and posteroanterior direction. The study concludes that foot malpositioning during the making of a lateral radiograph has little influence on Böhler's and Gissane's angles.

Practice Management

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A growing number of clinicians say their feelings of burnout stem from "moral injury," referring to the fact that systemic barriers related to the business side of healthcare prevent them from delivering quality care. Clinicians across disciplines point to barriers such as insurance preauthorization, trouble making patient referrals, emergency room overcrowding, bureaucratic hurdles to discharging patients and endless clicking in electronic health records. These barriers can be especially intense in emergency medicine, where clinicians describe a model of care that forces them to practice a "provider-in-triage" model that prioritizes speed and profitability at the cost of quality care.


Strong teamwork is essential to effective care delivery, which means promoting a sense of "psychological safety" within a team. This means having an environment where team members believe it is "safe" to share their thoughts, ideas, experiences and mistakes without fear of judgement or retribution. One way to cultivate this is to establish a shared mission or purpose for the team, then develop team agreements that ingrain these shared values into day-to-day operations. Team agreements should outline ways that team members will act to develop greater trust, make group decisions, manage conflict and ensure that all members are heard. Clarify what is expected of each individual team member and set concrete goals for the team with a common set of metrics. Encourage people to openly discuss errors and near misses so they can continually improve patient care and safety and provide opportunities for team members to get to know each other, such as personality workshops.


Small and independent practices often face challenges in competing for talent against larger entities with more resources for recruitment, compensation and retention. Prospective employees are often unfamiliar with smaller practices, how they operate and why they can be good places to work, as younger physicians typically train at hospitals or in larger practices. Independent practices should use professional networks and physician associations to look for candidates who come from rural areas and understand what rural life is like and has to offer. Independent practices should also work with medical schools and regional medical associates, such as area colleges and vocational schools, to attract potential candidates.

To offer the most competitive compensation possible, small and independent practices should plan strategically and start budgeting for new positions at least a year ahead of recruiting and hiring. Offer a variety of options on employment and ownership arrangements whenever possible, structuring compensation to reward hard work and finding other ways to boost the total compensation package. This could mean establishing a profit-sharing arrangement for employees and being open to various types of employment arrangements. Practice owners should also determine what benefits or perks they can offer and highlight those to prospective employees. There should be formal policies and procedures regarding available benefits so that employment packages do not seem capricious, even if they are individualized.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) has announced the Health Adult Opportunity (HAO). This optional demonstration initiative is meant to help states design innovative health coverage programs tailored to the unique needs of adult beneficiaries while holding states accountable for results and protecting the most at-risk populations. The HAO is focused on helping states meet the needs of adult beneficiaries under 65 who are not eligible on the basis of a disability or their need for long-term care and for whom Medicaid coverage is optional for states. HAO will let participating states adopt a formulary similar to those provided in the commercial market, in exchange for taking on increased accountability for the program's results.


The US Supreme Court has listed a case seeking to strike down the Affordable Care Act for discussion at the justices' private conference on February 21, where they will decide whether to take up the case and on what schedule. While the justices could choose to take the case this term, most observers expect a ruling will not come until after the 2020 election. A coalition of GOP-led states and the Trump administration argue that the Supreme Court should wait for lower courts to process the case, while Democratic-led states have argued that justices should end uncertainty by quickly taking on the case and affirming the law now.


The US government proposed an average 0.93 percent increase in its 2021 payments to the health insurers that mange Medicare Advantage insurance plans for about 22 million people. The rate, which will be finalized in April, affects how much insurers charge for monthly premiums and plan benefits, as well as how much they profit. Medicare Advantage covers about one third of those enrolled in the government's Medicare program.

Medicine, Drugs and Devices

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Manufacturers of medical masks are boosting output globally in response to the increased demand in China as it deals with the coronavirus, which has spread across that nation and beyond. Hospitals, meanwhile, are rationing the masks, which are essential protective gear for medical workers treating patients potentially infected with the coronavirus. China is one of the world’s top producers of medical masks and other gear. Now officials there are directing much of that supply to the front lines of the outbreak, leaving customers in the United States and other countries to look elsewhere for masks as global supplies tighten.


A study published in Diabetes Care found that adults who take glucosamine supplements may be less likely to develop type 2 diabetes compared to those who do not, especially if they also have elevated levels of C-reactive protein. The study evaluated type 2 diabetes development across 8.1 years of median follow-up among 404,508 adults from the UK Biobank who did not have diabetes at baseline. The researchers evaluated C-reactive protein levels in blood samples taken between 2006 and 2010 and identified diagnoses of type 2 diabetes in medical records. In fully adjusted models, including those adjusted with different exclusion criteria, people who took glucosamine had a 20 percent reduction in type 2 diabetes risk compared to those who did not. This reduction was more pronounced in participants with high C-reactive protein levels.


A study published in Health Affairs found that patients widely received antibiotics with no record of seeing a doctor, despite public health recommendations that doctors physically screen patients to prevent unnecessary prescriptions. Researchers from Brigham and Women's Hospital and Northwestern University examined the medical bills of 53 million people enrolled in Medicaid between 2004 and 2013. Out of the 300 million antibiotics prescribed to these patients during the period, nearly 83 million, or 28 percent, were prescribed and filled with no record of an associated doctor visit. The new research also found patients who filled 17 percent of antibiotic prescriptions included in the study had no record of an infection diagnosis.