News From ACFAS

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Residents’ Day is going virtual on May 17 for ACFAS 2021. This year, you’ll be able to watch all of the highly anticipated sessions ahead of time – right in the ACFAS 2021 Digital Portal. Then during the livestream portion of the event, you’ll be able to tune in on May 17 to ask your questions to our panelists live. Either way, you’re in store for an exceptional program this year with a great line-up of presenters.

Hear about their experiences, their ups and downs, get real-world tips and tricks and straightforward advice on everything from job search and interview prep to practice types and managing difficult cases. Residents will benefit from the topics offered this year and take some pearls back with them to use in their practice and future career.

Don’t miss the chance to hear about individual journeys of these seasoned surgeons and leaders in the profession. Visit acfas.org/LasVegas to see the full schedule and register for the virtual event now. The American Board of Foot and Ankle Surgery (ABFAS) is in the process of transitioning its ten-year Maintenance of Certification programs to a process of continuous certification based on a longitudinal assessment—a new process wherein ABFAS diplomates will answer a set number of questions per quarter and get immediate feedback on their performance. When the program goes live in 2022, ABFAS will replace its recertification and self-assessment examinations with the new program LEAD: Longitudinal Education and Assessment for Diplomates.

ABFAS’ desire to explore alternatives to the traditional, once-every-ten-year recertification and self-assessment examinations represents an exciting new method of keeping current on knowledge relevant to foot and ankle surgery and stems from recent trends in the recertification processes for member boards of the American Board of Medical Specialties (ABMS).

The program features several innovations designed to make certification easier for diplomates:

• a continuous, self-paced online assessment instead of a traditional recertification or self-assessment examination
• a set number of questions to answer each quarter, anytime and from anyplace, using a computer, tablet, or smartphone—with no need to travel to a testing center
• instant feedback on questions including the correct answer, rationale, and references, enabling diplomates to identify potential knowledge gaps
• an easy-to-understand standard demonstrating whether each diplomate is keeping current on knowledge relevant to foot and ankle surgery

Learn more about the ABFAS shift to continuous certification on their website at abfas.org/lead.
Congratulations to our 2021 ACFAS Scholars! Every year, the College recognizes our Student Club Presidents from each of the podiatric medical school campuses for all the work they do throughout the school year on behalf of the organization.

Each ACFAS Scholar will receive a scholarship for $1,000 to defray their costs of travel and lodging to ACFAS 2021 in Las Vegas in May. They also receive complimentary registration.

AZPod:
Kayla Weber, Class of 2022

Barry University:
Karissa Badillo, Class of 2022

CSPM:
Shane Hall, Class of 2022

DMU:
Travis (Drew) Anderson, Class of 2022

Kent State:
Hamidat Momoh, Class of 2022

NYCPM:
Justin Erfanian-Taheri, Class of 2022

Scholl College:
Trevor Page, Class of 2023

Temple University:
Alexandra Brown, Class of 2022

WesternU:
Kevin Trinh, Class of 2023

Congratulations to these future leaders of the College and profession!

Foot and Ankle Surgery

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The study aimed to analyze bacterial flora in diabetic foot infection, empiric and targeted antibiotic (ETA) therapy and factors influencing wound healing duration. The study involved a review analysis of data in 118 cases of diabetic foot among 98 patients. The patients were divided into subgroups: ETA+ (compatibility of empiric-targeted antibiotic), ETA- (non-compatibility of empiric-targeted antibiotic), no empiric antibiotic and no targeted antibiotic. Staphylococcus aureus and Enterococcus faecalis were identified in most cases, and 16 patients received gentamycin locally. Amoxicillin with clavulanic acid, clindamycin and levofloxacin were the most frequently used antibiotics as empiric therapy; in targeted therapy, amoxicillin with clavulanic acid and levofloxacin were most frequently used. Empiric and targeted antibiotic therapies were compatible in 55.1 percent of cases. The duration of healing did not differ between selected subgroups and was longer in obese patients. Other variables did not influence the healing time.


This 12-month cohort study investigated the risk factors related to limited ankle joint range of motion (ROM) in 228 young baseball players, tracking shoulder and elbow injuries throughout the season. Univariate and multivariate analyses were performed to identify risk factors for shoulder and elbow injuries among participants divided into non-injured and injured groups. Univariate analysis showed that age, height, weight, ROM of elbow flexion in the dominant arm, muscle strength ratio of shoulder abduction and the likelihood of being a pitcher or a catcher were significantly greater in the injured group than in the non-injured group. ROM of shoulder abduction-external/internal rotation, shoulder total arc on the dominant arm, ankle joint dorsiflexion and plantar flexion on the back and front legs were significantly less in the injured group than in the non-injured group.


This study examined the differences in toe flexor strength and foot morphology in 84 older people requiring long-term care due to changes in the way they mobilize in everyday life. Patients were divided into those who could mobilize without a wheelchair (54 patients) and those who used a wheelchair to mobilize (30 patients). No significant between-group difference in foot morphology was found. The factors related to the differences in ways of ambulating in daily life were history of fracture, heart disease and toe flexor strength. After comparing the muscle strength of the wheelchair group with the mean values of the walking group, researchers found that the toe flexor strength was significantly lower than the hand grip strength.

Practice Management

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Local search engine optimization (SEO) refers to tactics that increase the online visibility of a business with a physical location. An important local SEO tactic for practices is to take an active role in building online listings. First, practice owners should find out where they are already listed online and create a spreadsheet of those listings. Business/provider names, addresses and phone numbers are especially vital pieces of information for SEO. Practice owners should do their best to update any listings with outdated contact information. The title of a listing is also important as even slight variations can confuse search engines. It is also important for practices to provide as much information as possible in their listings. Additionally, some platforms have allowed providers to include information relating to COVID-19 restrictions and telemedicine availability. Reviews also influence local visibility and reputation, so providers should make it as easy as possible for satisfied patients to leave reviews.


Healthcare leaders must prioritize initiatives that improve the user experience in electronic health records (EHRs). In particular, stakeholders should consider EHR usability improvements that improve patient care, increase physician productivity, ensure accurate reimbursement and reduce operational expenses. Adding technologies that work to capture and interpret the billing and coding details from clinical documentation can minimize burnout and improve care delivery. EHRs should also be able to review everything in a patient's chart, intelligently filter the information in real-time, identify all the potentially relevant data points and deliver pertinent details in a single view. Clinicians also need workflows that support the automatic identification and interpretation of the disorganized and complex array of medical information from an array of sources. To minimize data entry and ensure appropriate information is captured for accurate reimbursement, EHRs need technologies that work in the background to verify billing, compliance, coding and quality measurement. EHRs should also automate these processes when possible.

Health Policy and Reimbursement

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The Biden administration will consider extending the special enrollment window for Americans to purchase Affordable Care Act (ACA) health plans beyond the current end date of May 15, say officials. The administration will not make a decision until closer to that date, an official says, noting that private discussions are still ongoing. More than 200,000 people signed up for ACA coverage in the first two weeks of the new enrollment period, according to officials. The combination of the special enrollment window, extra assistance from the American Rescue Plan and a possible extension are likely to help boost health insurers with large footprints in ACA marketplaces. Biden ordered a new enrollment period from Feb. 15 to May 15 to give Americans affected by the pandemic a chance to purchase ACA health plans outside of the usual year-end window.


The US Senate has confirmed Xavier Becerra to lead the US Department of Health and Human Services (HHS). The first Latino to lead HHS, Becerra will oversee all the federal health agencies, including the US Centers for Disease Control and Prevention and the US Food and Drug Administration, and will be responsible for carrying out the Biden administration's health agenda. During his confirmation hearing testimony, Becerra pointed to his experience working on various healthcare legislation as a former member of the House Ways and Means Committee when he served in Congress.

Medicine, Drugs and Devices

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Although its healthcare venture with Berkshire Hathaway and JPMorgan Chase dismantled last month, three years after starting, Amazon is still trying to carve out a niche for itself in the market. The company is taking Amazon Care telehealth nationwide this summer and plans to open it up to other companies. The program—already available in Washington state, where the online retailer is headquartered—runs on an app that arranges prescription deliveries and coordinates video or chat appointments between patients and medical professionals. The in-home care component, which dispatches providers to draw blood or perform clinical tasks, will be extended to other cities in the coming months, including Baltimore and the District of Columbia. Executives in the remote-care industry say Amazon's sales approach will largely determine whether it can compete with established telehealth providers.


The Biden administration has reversed policy changes made under the Trump administration related to the Part D Payment Modernization Model, a voluntary model that analyzes changes to the program. The US Centers for Medicare and Medicaid Services reversed two changes poised to take effect in 2022 that gave insurers more flexibility on how they structure their formularies. Specifically, one change would let participating Part D plans treat five of six protected drug classes as they would other drug classes. Another change would have allowed Part D plan participants to include on their formulary at least one drug per class rather than the current requirement of two.


Judge Sarah Evans Barker of the U.S. District Court for the Southern District of Indiana has blocked the Biden administration from implementing the 340B Drug Pricing Program administrative dispute resolution (ADR) rule to handle disputes over the 340B drug discount program. Eli Lilly filed a lawsuit against the federal government over the rule. In her ruling, Barker focused on whether the US Department of Health and Human Services adhered to federal law when the rule was finalized last December. The decision puts on hold a key mechanism that hospitals, community health centers and other 340B providers intended to use to challenge drug companies that restricted sales of discounted products to contract pharmacies.


Draft guidelines from the US Preventive Services Task Force recommend that screening for Type 2 diabetes and prediabetes should start at age 35 for people who are considered overweight, instead of the currently recommended age 40. The update, prompted by the rising number of Americans who are overweight or obese, could result in millions more being eligible for the blood test as part of regular medical exams. Excess weight is a major risk factor for diabetes. At least 31 million US adults have Type 2 diabetes, the seventh leading cause of death in the country, according to the Centers for Disease Control and Prevention. The new guidelines are significant because early intervention can not only improve diabetes control but also reduce risk of chronic kidney disease and cardiovascular disease, said Dr. Emily Gallagher from the Icahn School of Medicine at Mount Sinai.