News From ACFAS

---

We’re excited to be able to bring ACFAS’ Annual Scientific Conference to Las Vegas for a limited capacity, in-person conference May 18-21 as well as a virtual conference to your office! Registration opens up the week of March 15.

With two ways to take part in the conference, you have the choice to access the virtual conference from the safety of your home or office or to attend the in-person conference, which will comply with the safety guidelines as mandated by the State of Nevada and the CDC. No matter which way you join us this year, you can experience the same cutting-edge educational programming, sessions and new educational highlights for 2021.

Don’t wait to register if you are planning to attend the in-person program in Las Vegas; the event will sell out quickly. Watch acfas.org/LasVegas to register for either the in-person or virtual-only event, book your hotel and also get the most up-to-date information regarding the event. Congratulations to the new ACFAS Board of Directors! The 2021-2022 Board officially took office during the March 4 membership meeting.

Serving on the 2021-2022 Board of Directors are Thanh Dinh, DPM, FACFAS, President; Michael J. Cornelison, DPM, FACFAS, President-Elect; Eric A. Barp, DPM, FACFAS, Secretary-Treasurer; Scott C. Nelson, DPM, FACFAS, Immediate Past President; Christopher Lotufo, DPM, FACFAS; Alan MacGill, DPM, FACFAS; Alan Ng, DPM, FACFAS; Barry Rosenblum, DPM, FACFAS; Matthew Williams, DPM, FACFAS; George T. Liu, DPM, FACFAS and Andrew J. Meyr, DPM, FACFAS. Thank you to Christopher Reeves, DPM, MS, FACFAS for his years of service as he retires from the Board this year. If you are a fellowship program director and would like to seek ACFAS status for your program, submit your application by May 1.

The ACFAS Fellowship Committee meets annually in late July to review any new applications and will share new programs in August.

Contact Michelle Kennedy, ACFAS director of Membership and Post Graduate Affairs, to request an application or learn more about the College's Recognized Fellowship Initiative on acfas.org.

Foot and Ankle Surgery

---

This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. Researchers performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males and 45 females treated between April 2014 and February 2018, with a mean follow-up of 21.05 months. Clinical assessments and ultrasound examination were carried out before treatment, after one week and then after one, three, 12 and 24 months. Heel pain improved in 92.5 percent of patients. In the group of patients whose heel pain improved, nine experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. No nerve complications, vascular injuries or wound-related problems were recorded.


Researchers evaluated a new clinical protocol that was developed to improve podiatry care for rheumatoid arthritis, osteoarthritis, spondyloarthritis and gout. An educational program for the new protocol was developed and delivered to 32 podiatrists in the Netherlands, who then used the new protocol in practice for three months. Participants received a digital questionnaire to evaluate the educational program and were also asked about facilitators and barriers they experienced in the use of the protocol. The mean satisfaction with the educational program was 7.6 on an 11 point scale. Practical knowledge on joint palpation, program variation and the use of practice cases were valued most. The protocol appeared to provide support in the diagnosis, treatment and evaluation of foot problems in rheumatic disorders. The main barrier for use of the protocol was time, as the protocol has not yet been implemented in the electronic patient file, making it more time-consuming.


There are a limited number of studies evaluating the clinical care of patients with wound botulism, owing to its rarity. This study presents an infected tibial non-union with botulism who underwent a successful radical excision and bone transport. The patient tolerated the procedure well.

Practice Management

---

In order to provide a personalized experience for their patients, providers need to look beyond clinical information and leverage consumer data, including social determinants of health, which drive 80 percent of a patient's health outcome. Individual-level data should be analyzed and aggregated into a master patient index,in which each patient has one file that provides a 360-degree view of the patient. Providers should also try to empower patients, listen to them and help them break down the barriers preventing them from achieving their best health. For example, a patient experiencing food insecurity could be connected to a local community food bank.


The author talks about the benefits of switching her practice from a traditional insurance-based model to a direct primary care (DPC) model. Doing so has lessened administrative burdens and paper work, as she has fewer patients overall and no longer bills insurance for her services. By opting out of billing Medicare and insurance, she is no longer required to collect and submit “quality data” just to be paid for an office visit for a patient. Moving to a DPC model has also made it easier for her to get paid and see enough patients, and it has increased physician autonomy while lessening the potential for burnout. The author adds that moving to DPC has allowed her to adopt a much more usable EHR and also made it easier to hire and maintain clinical staff. Since her patients pay by a monthly membership, not by the visit, she does not need to worry about competition from telemedicine clinics or urgent cares. The DPC model also incentivizes physicians to be accountable directly to patients, seeking patients' best interest above the financial profits of a third-party payer.

Health Policy and Reimbursement

---

The American Medical Association (AMA) estimates that physicians reported $9.4 billion less in Medicare claims in the first half of 2020 than were anticipated at the start of the year, with spending down 19 percent as seniors deferred care during the pandemic. Medicare spending fell by as much as 57 percent at the peak of the crisis in April, and spending for services reached its lowest levels in that same month before resurging in June to declines of 10 percent for assessment, disease management and imaging services and 15 percent for procedures and tests. Many providers resorted to telehealth to see patients, with virtual visits among Medicare enrollees rising from 0.1 percent at the start of 2020 to comprising 6 percent of appointments in June. Telehealth spending rose 16 percent in the first half to total $1.8 billion. The AMA suggested that the decline in physician spending could be much higher, given the study's exclusion of Medicare Advantage members. AMA president Susan Bailey said Medicare providers' slippage in revenue reflected the problems physicians faced industry-wide, regardless of clients. "For practices that have struggled to remain viable as the pandemic stretches on, many will face a difficult and precarious road to recovery," she forecast.


Data released Wednesday by federal health officials revealed that a total of 206,236 Americans signed up for Affordable Care Act health plans during the first two weeks of an extended enrollment period ordered by President Biden. The data showed that the number of consumers who opted for coverage through HealthCare.gov from February 15- 28, 2021, was nearly 3 times higher than during the same period last year and roughly 3.5 times greater than in 2019. The enrollment during the first 2 weeks of the most recent regular enrollment time was considerably higher, when 1.6 million Americans signed up during the first half of November. HHS spokesman Sean Higgins says a nationwide network and cable advertising campaign to highlight the sign-up period began on February 15 and will air throughout the extended enrollment period. Health officials also announced this week they were providing $2.3 million to community groups that serve as navigators to assist consumers with signing up for plans.


The bipartisan House Committee on Energy and Commerce's health subcommittee approved permanent expansion of Medicare reimbursement to include telehealth. Ranking subcommittee member Rep. Brett Guthrie (R-Ky.) admitted that "the genie is out of the bottle concerning telehealth flexibilities and expansion," although he called for protections against fraud and abuse of the technology and cited broadband as a limiting factor. Jack Resneck Jr. with the American Medical Association Board of Trustees agreed with many representatives said broadband is a obstacle in both rural and urban areas, while Rep. Cathy McMorris Rodgers (R-Wash.), said the issue of cost was raised by the ranking member of the full House committee. Meanwhile, Harvard Medical School's Ateev Mehrotra, contended that full telehealth access should not be upheld because it "can be too convenient in some circumstances." He pushed for emphasis on high-value applications. Purchaser Business Group on Health CEO Elizabeth Mitchell said it is critical to strike the right balance in order to adopt payment models with value-based accountability.


Researchers from Drexel University and Brown University analyzed nearly 17,900 member responses to the annual Medicare Current Beneficiary Survey from 2010 to 2016. They found that 10.5 percent of rural Medicare Advantage members switched to fee-for-service Medicare, while 5 percent of urbanites switched from the public-private relationship to the government program. Nearly 12 percent of rural Medicare Advantage members who said they had poor health switched to traditional Medicare, compared to just 6.2 of enrollees with similar health status in non-rural areas. Moreover, 16.8 percent of rural beneficiaries who stayed in a healthcare facility switched to traditional Medicare, compared to 8.3 percent of non-rural residents. Most rural individuals said they were unsatisfied with their access to nearby care facilities, and 17 percent reported switching to traditional Medicare after they were unable to find information about their prescriptions and treatment over the phone.

Medicine, Drugs and Devices

---

Hospitals say cyberattacks are complicating their operations and hurting profits, adding to pressure on a $1.2 trillion sector that is under heavy strain from the coronavirus pandemic. Attorney Alfred J. Saikali said significant ransomware attacks often go unreported, and experts say hackers believe hospitals will make swift payments to restore lifesaving technology. In a quarterly review of incidents among clients, Coveware Inc. found that as COVID-19 hospitalizations soared in the final three months of 2020, there were more ransomware attacks in healthcare than any other industry. The Federal Bureau of Investigation, the US Department of Homeland Security and the US Department of Health and Human Services warned hospitals in October of an "increased and imminent" threat from hackers. Hospitals are advised to invest more in cybersecurity.


A study in JAMA Network Open found clinicians and patients under Medicare Part D asked for brand name prescription drugs over generics 30 percent of the time when a brand name drug was dispensed in 2017. Medicare Part D would have saved $977 million if all branded prescription drugs requested by clinicians had been swapped with its generic substitute, and another $673 million in savings would have been added had all branded drugs requested by Medicare patients swapped with a generic option, for a total $1.7 billion saved. Of the 169 million filled prescriptions analyzed, 8.5 million entailed dispensing a brand name drug when a generic was available. Seventeen percent of claims involved the clinician requesting a brand name drug over a generic, and 13.5 percent involved patient requests. Medicare patients would additionally have saved $270 million if the dispensed brand name drugs with available generics were swapped with their generic option.