March 4, 2020 | | JFAS | Contact Us

News From ACFAS

PJ Andrus Takes the Helm
ACFAS officially welcomes Patrick (PJ) Andrus, MBA, CAE this week as our new Executive Director! After working alongside former Executive Director J.C. (Chris) Mahaffey, MS, CAE, FASAE for the last few months, PJ officially took the reins on Monday and is looking forward to getting started. “I am truly honored to serve as the Executive Director of ACFAS and look forward to working alongside the volunteer leaders to advance our mission.”

As PJ steps into the leadership role, his primary goal is to fully immerse himself and learn. “I plan to spend a lot time of in the field connecting with our members and volunteer leaders to better understand their challenges and how the College can continue to serve them.” He is also focused on improving the member experience at every point of engagement, which includes a website redesign that is currently in its early stages.

When he’s not busy learning the College ropes and hitting the road, PJ enjoys spending time with his family, which will be growing as he, his wife and two-year-old daughter welcome a baby girl next month. It certainly is an exciting time for PJ, and we look forward to seeing all the future has to offer!
Share Facebook  LinkedIn  Twitter 
Claim Your ACFAS 2020 CME Credits Now
If you attended ACFAS 2020 in San Antonio, you can now visit to claim your Continuing Education Contact Hours (CME). An email with instructions on claiming your CME was recently sent to all attendees. To claim your CME, log into and choose CME Credits under Latest News and Information. You will then be linked to the ACFAS Education Documentation and CME Tracking Center where you can print your certificate and list of sessions attended.
Share Facebook  LinkedIn  Twitter  | Web Link
ACFAS is Headed Back On the Road
Join us this spring for more small group discussions, quick lectures and hands-on training with Fixing a Flat: Comprehensive Approach to Pes Plano Valgus Workshop and Seminar!

Starting in May, we’re hitting the road to bring you more two-day workshops giving attendees the chance to roll up their sleeves, work together and learn from each other. Workshops provide 12 hours of Continuing Contact Hours and over the course of two days you’ll learn valuable tips talking one-on-one with faculty, participate in small group discussions and pick up new techniques and pearls you can take back to the office with you.

The learning starts in May, so visit to see the schedule and register. We look forward to seeing you on the road!
Share Facebook  LinkedIn  Twitter  | Web Link
Online Learning is One Click Away
Access the new home for our most in-demand online education resources with ACFAS On Demand. This easy-to-navigate portal streamlines your online learning process giving you a better experience.

OnDemand offers a variety of clinical sessions designed to help keep you on top of your surgical game; complimentary podcasts for quick, deep dives into a wide range of topics from clinical to practical; surgical techniques available for purchase to download and share with your staff; and a medical bookstore to make our e-book series accessible from laptop, desktop, tablet or smartphone.

Class will start when you’re ready. Visit to access your new learning portal today!
Share Facebook  LinkedIn  Twitter 

Foot and Ankle Surgery

Early Protected Weightbearing After Open Reduction Internal Fixation of Ankle Fractures with Trans-syndesmotic Screws
This case series aimed to assess the outcomes of early protected weightbearing after operative treatment of acute ankle fractures with syndesmotic instability requiring screw stabilization. Researchers reviewed the electronic medical records and radiographs of 58 consecutive patients for surgical and patient characteristics, postoperative complications and maintenance of reduction. Patients initiated walking at an average of 10 days postoperatively. Surgical treatment consisted of operative reduction with standard fixation devices and one or two trans-syndesmotic screws that purchased four cortices. All patients maintained correction after surgery when allowed to weightbear early in the postoperative recovery. Five complications occurred, including three superficial infections and two cases of neuritis.

From the article of the same title
Journal of Foot & Ankle Surgery (02/10/20) King, Christy M.; Doyle, Matthew D.; Castellucci-Garza, Francesca M.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, In Situ Forces of Reconstructed Graft
The study investigated the effects of internal graft tension on anterior talofibular ligament (ATFL) reconstruction. Twelve cadaveric ankles were tested by a system with six degrees of freedom to apply passive plantarflexion and dorsiflexion motions and a multidirectional load. A repeated measures experiment was designed with the intact ATFL, transected ATFL and reconstructed ATFL at initial tension conditions of 10, 30, 50 and 70 N.

Researchers found that initial tension of 10 N was sufficient to imitate normal ankle kinematics and laxity. The in situ force on the reconstructed graft tended to increase as the initial tension increased, and in situ force on the reconstructed graft >30 N was significantly greater than that of intact ankles. The in situ force on the ATFL was 19 N at 30 degrees of plantarflexion. In situ forces of 21.9, 30.4, 38.2 and 46.8 N were observed at initial tensions of 10, 30, 50 and 70 N, respectively, at 30 degrees of plantarflexion.

From the article of the same title
American Journal of Sports Medicine (02/13/20) Sakakibara, Yuzuru; Teramoto, Atsushi; Takagi, Tetsuya; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Utility of Dehydrated Human Amniotic Membrane in Total Ankle Arthroplasty
The study aimed to determine whether implantation of a dehydrated human amniotic membrane (DHAM) allograft in total ankle arthroplasties (TAAs) decreased overall postoperative wound complications. Researchers looked at 170 patients with end-stage ankle arthritis to conservative management who underwent TAA, 91 of whom underwent closure of the anterior incision with addition of DHAM. In their analysis, there was no significant difference in postoperative complications between patients closed with DHAM and controls. Return to the operating room occurred in 8.9 percent of controls and 15.4 percent of the DHAM group. There were also no significant differences in postoperative plastic surgery, wound communication with the implant, implant removal, neurolysis and tendon debridement between the control and DHAM groups.

From the article of the same title
Foot & Ankle International (02/10/2020) Horn, Andrew; Saller, Jeremy; Cuttica, Daniel J.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Practice Management

Pharma Payments to Doctors Lead to Nearly 4 Percent Boost in Prescription Spending: Study
A new study from the National Bureau of Economic Research (NBER) found that drug company payments to physicians led to a 4 percent uptick in prescriptions. Researchers looked at the prescribing behavior of physicians who did and did not receive payments from pharmaceutical companies using Medicare Part D claims from 2013 and 2015. Researchers found that drug spending began to increase shortly after doctors received a payment. The effect was more pronounced for drugs in classes that had five or fewer promoted drugs, as spending on these drugs increased by $25 per month in the first year after payment was received, which translates to a 12 percent increase. NBER found no evidence that paid physicians transitioned their patients to generics more slowly than physicians who don't get payments, but paid physicians were more likely to put patients on a new formulation of a drug.

From the article of the same title
Fierce Healthcare (02/20/20) King, Robert
Share Facebook  LinkedIn  Twitter  | Web Link

Physicians, Hospitals Meet Their New Competitor: Insurer-Owned Clinics
Physician groups and other hospitals face increasing competition from insurer-owned clinics, who capitalize on recent deals and steer patients toward facilities they own. In this way, insurers are controlling both delivery and payment for health care. Generally, plans that are built around a health insurer's own clinics include smaller networks with limited provider choices. Hospitals' biggest concern may be the power that primary-care doctors have over where their patients go for care such as imaging scans and specialist procedures. Hospitals rely on doctors to direct patients to them for such services, and insurer-owned clinics might refer patients away from certain hospital systems, cutting off important revenue. Buying up health care providers like clinics can create complications for insurers and they won't own enough to offer every health care service, so they have to keep working with outside doctors and hospitals.

From the article of the same title
Wall Street Journal (02/23/20) Mathews, Anna Wilde
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

What Physicians Should Do If They Are Sued For Malpractice
Physicians sued for malpractice should notify their insurer and, if applicable, employer as soon as possible. They should only talk about the case with their attorney, and should become familiar with their malpractice insurance policy to understand their exact coverage and responsibilities. It is unwise to go back and change medical records, as plaintiff attorneys will portray any alterations as an attempt to destroy or conceal information. Investigating the case oneself is also unwise as it could involve talking to colleagues, staff, and others involved in the case, which can be seen as an effort to block the investigation or cover up wrongdoing.

Physicians should not use their personal attorney, opting instead for a malpractice expert appointed by the insurer or employer. Moreover, they should understand that most settlements are driven by the insurer's decision that it is easier and less expensive than going to trial and involve no admission of wrongdoing.

From the article of the same title
Medical Economics (02/18/20) Sweeney, James F.
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement

CDC Officials Warn of Coronavirus Outbreaks in the US
The new coronavirus, COVID-19, will almost definitely spread in the United States, and hospitals, businesses and schools should start making plans, said the US Centers for Disease Control and Prevention (CDC). "It's not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen," said Nancy Messonnier, director of CDC's National Center for Immunization and Respiratory Diseases, in a news briefing. "We are asking the American public to work with us to prepare, in the expectation that this could be bad," Messonnier added.

From the article of the same title
New York Times (02/26/20) Belluck, Pam; Weiland, Noah
Share Facebook  LinkedIn  Twitter  | Web Link

US Office of the National Coordinator Releases National Health IT Research Priorities Policy and Agenda
The US Office of the National Coordinator for Health Information Technology has articulated a new policy and development agenda for health IT. The agenda is informed by a review of relevant literature and programs, as well as workshops with representatives from federal agencies, technology vendors, researchers and other stakeholders. The agenda's two main goals are to leverage high-quality electronic health data for research and advance a health IT infrastructure to support research. As part of the first goal it aims to improve data quality at the point of capture, increase data harmonization to enable research uses and improve access to interoperable electronic health data. As part of the second goal it seeks to improve data storage and discovery services, interrogate emerging health data sources, improve methods and tools to support data aggregations, leverage health IT systems to increase education and participation and accelerate knowledge integration at the point of care.

From the article of the same title
Healthcare Purchasing News (02/20)
Share Facebook  LinkedIn  Twitter  | Web Link

Medicare's Private Option Is Gaining Popularity and Critics
Many Medicare-eligible patients are opting for Medicare Advantage, a private managed-care alternative. Medicare Advantage enrollment is expected to jump to 47 percent of all Medicare beneficiaries in 2029 from 34 percent this year, fueled by heavy investment in marketing and regulatory changes that favor the programs. The alternative does have additional benefits, including access to gyms and good prescription drug coverage, for essentially the same price as Medicare. However, once people select Advantage, the choice is often irrevocable if they are diagnosed with cancer or other diseases that can be considered pre-existing conditions. Critics cite federal investigations indicating that Medicare Advantage programs have high levels of denial of care and widespread confusion about network providers. In 2016, out-of-pocket spending in the program averaged $3,166, excluding premiums.

From the article of the same title
New York Times (02/21/20) Miller, Mark
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Medicine, Drugs and Devices

Coronavirus Outbreak Could Cause Shortages of 150 Drugs: Report
Shortages of approximately 150 prescription drugs could occur as the coronavirus outbreak widens, according to information from people familiar with a list of at-risk drugs from the US Food and Drug Administration (FDA). China supplies many of the ingredients used in medications, so any decreased Chinese production capability as a result of the outbreak could threaten supplies of antibiotics, generics and branded drugs, the sources said. An FDA spokesperson said, "If a potential shortage or disruption of medical products is identified by the FDA, we will use all available tools to react swiftly and mitigate the impact to US patients and health care professionals."

From the article of the same title
The Hill (02/23/20) Budryk, Zack
Share Facebook  LinkedIn  Twitter  | Web Link

Mobile Patient Portal Access Can Improve Diabetes Care
A study published in JAMA Network Open found that mobile patient access to portal self-management tools may help significantly improve diabetes care. The study looked at 111,463 patients with diabetes treated at Kaiser Permanente Northern California from 2015 to 2017, all of whom had an oral diabetes prescription at baseline with no insulin use. For patients with no prior portal access, adding computer-only portal access was associated with an increase in monthly percentage of days covered (PDC) of 1.16 percentage points and a change of -0.06 percentage points in HbA1c level. Adding both mobile and computer portal access was associated with a 1.67 percentage point increase in PDC and a change of -0.13 percentage points in HbA1c level. Patients with higher clinical need at baseline experienced greater improvements with added mobile portal access.

From the article of the same title
Drug Topics (02/24/20)
Share Facebook  LinkedIn  Twitter  | Web Link

Upping Opioid Dose May Not Be Helpful in Chronic Pain
A recent study published online in Pain found that an increase in opioid dosage appears to offer no clear benefit for patients with chronic musculoskeletal pain. Researchers tracked 517 patients who were receiving long-term opioid therapy and found that, over the course of the study, 19.5 percent of participants had prescription-opioid dose increases. After controlling for covariates, there were no significant changes on any variable following dose escalation; 3 percent of this group experienced a clinically meaningful improvement in pain. During the study period, participants overall experienced small improvements in pain intensity, depression and a lower risk of prescription-opioid misuse, though sexual functioning worsened over time. The researchers say their findings support "an important change in the approach to long-term management of pain with opioids."

From the article of the same title
Medscape (02/20/20) Douglas, David
Share Facebook  LinkedIn  Twitter  | Web Link


This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

Contact Us

For more information on ACFAS and This Week @ ACFAS, contact:

American College of
Foot and Ankle Surgeons
8725 W. Higgins Rd.
Suite 555
Chicago, IL 60631
P: (773) 693-9300
F: (773) 693-9304
E: ThisWeek

Visit Us: Friend us on Facebook Follow us on Twitter Link us in on LinkedIn

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.

Some publication websites may require user registration or subscription before access is granted to the links following the articles. If an article is unavailable online, a link is provided to that publication's homepage.

Copyright © 2020 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe, click here.

News summaries © copyright 2020 SmithBucklin