News From ACFAS

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Don’t miss the annual Residency Directors Forum, co-hosted by the Council of Teaching Hospitals (COTH), on May 17, 8am-12:30pm Pacific Time via Zoom. With the program streamed live, attendees can participate from anywhere in the country. The Forum will once again review and discuss the current and future state of podiatric residency programs as well as the unexpected 2020 pandemic, which led to many changes in the overall education of our trainees.

The Forum is complimentary for attendees and is by invitation only for school deans, residency directors and faculty. But new for 2021, all fellowship directors and faculty are also invited to attend. With the event virtual this year, there is no limit to the number of attendees per program.

The 2021 Residency Directors Forum is approved for a maximum of 4.0 Continuing Education Contact Hours.

Visit acfas.org for more information, the Forum’s complete session line-up, timing and link to register. We hope to see you there. Whether you’re joining us in-person or online for ACFAS 2021, be sure to make time to hear Zubin Damania, MD, (or how you may know him as ZDoggMD) this year’s 2021 Keynote Speaker.

Dr. Damania is an internist and the founder of Turntable Health—an innovative healthcare clinic created as part of an ambitious urban revitalization movement in Las Vegas. While a hospitalist at Stanford, Dr. Damania started a shadow career as a stand-up comedian creating parody videos for medical audiences around the world—all under the pseudonym ZDoggMD. Today, Dr. Damania shares how we can build this idea of Health 3.0, combining technology and evidence-based medicine to seamlessly support healthcare teams and give patients the outcomes that matter to them while also improving the wellbeing of their caregivers.

During our captivating opening session, Dr. Damania will dive into the challenges of delivering compassionate healthcare in a severely dysfunctional medical system, through humor, song and storytelling. Dr. Damania discusses ways to revitalize the medical system while also examining how we might work together to collectively transform the current system making the future in medicine bright.

You won’t want to miss ZDoggMD! Visit acfas.org/LasVegas for more information. Congratulations to Christie Stawicki and Anthony Schwab, the 2021 Mirmiran Family Scholars and members of the Temple University School of Podiatric Medicine Class of 2022.

The family of Roya Mirmiran, DPM, FACFAS, based in Sacramento, CA, provides scholarships every year to top students who are hand-selected to attend the ACFAS Annual Scientific Conference. In light of the pandemic, Christie and Anthony will use their funds to offset their cost to attend next year’s ACFAS Annual Scientific Conference in Austin.

The Mirmiran Scholarship opportunity rotates to a different campus every year. For 2022, students from Western University will be recognized.

Foot and Ankle Surgery

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Sixteen participants were subjected to Dry Immersion model (DI), which reproduces various space flight factors, for five days. Computer plantography and measuring the stiffness of the soft tissues of the foot and superficial muscles of the shin (mm. tibialis anterior and peroneus longus) were performed twice before DI exposure, on days two and four of DI exposure, as well as on the second day of the recovery period. DI exposure raises the longitudinal arch and flattens the transverse arch; this is accompanied by a decrease in the soft tissues stiffness of the foot and superficial muscles of the shin. The work reveals the phenomenon of compensating the longitudinal arch state by changing the characteristics that reflect the transverse arch state. The results of the study for the first time demonstrate the correlation of the foot morphological characteristics, with a decrease in stiffness of mm. peroneus longus and tibialis anterior.


The study examined the rate of complications in insulin-dependent diabetes mellitus patients, non-insulin-dependent diabetes mellitus patients and patients without diabetes in the 30-day postoperative period following ankle fracture surgery. Patients who underwent operative management for ankle fractures between 2012-2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. A total of 19,547 patients undergoing ankle surgery were identified from 2012-2016. Of these patients, 989 had insulin-dependent diabetes mellitus, 1,256 had noninsulin-dependent diabetes mellitus and 17,302 did not have diabetes mellitus. Compared to patients without diabetes, patients with insulin-dependent diabetes mellitus had significantly greater adjusted odds of superficial surgical site infections, deep surgical site infections, osteomyelitis, wound dehiscence, pneumonia, unplanned intubation, mechanical ventilation, urinary tract infection, cardiac arrest, bleeding requiring transfusion, sepsis, hospital length of stay, unplanned readmission, unplanned reoperation and death following ankle fracture surgery.


This paper details the impact of COVID-19 on foot and ankle activity in the United Kingdom. The overall COVID-19 infection rate across 6,644 patients was 35 patients. The cumulative percentage of COVID-19 infection across the audit was 1.37 percent. Both the COVID-19 infection rate and timing of the peaks of COVID-19 infection differed significantly across the country. National surgical activity significantly reduced for all cases during lockdown. However, in the post-lockdown period there was normalization of activity in trauma and diabetic surgery.

Practice Management

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The CARES Act provided $100 billion to HHS to be issued to eligible healthcare providers to reimburse healthcare related expenses and revenue losses attributable to COVID-19. To accept a payment from this Provider Care Relief (PRF) fund, providers must agree to report information to HHS on use of funding. HHS will require PRF recipients that receive at least $10,000 in payments to submit reports to the agency on how funding has been used and to demonstrate that the funds were used to cover expenses and revenues losses related to COVID-19. Providers may wish to implement internal accounting systems that track expenses and revenue losses attributable to COVID-19 that could potentially be reimbursed using PRF payments. As providers evaluate whether to use PRF payments to cover expenses that have been incurred related to COVID-19, providers should also make sure they have documentation in place to demonstrate that the expenses are allowable. Lastly, providers should proceed with caution with how they discuss using the PRF funds.


Physicians have had to become more agile and nimble than ever in providing care to patients during the COVID-19 pandemic. Among other things, the pandemic underscored the necessity of updating policies, procedures, staff training, documentation, communication and overall mindset for how physicians approach patient care in the new reality of an infectious world. Despite the PREP Act’s immunity protections for healthcare providers, countless COVID-19 lawsuits have already been filed, and new ones are emerging daily. It is critical to demonstrate that policies, procedures and protocols are based on federal, state and county health guidance. Cleaning protocols must be carefully documented, in addition to screening procedures. To reduce the risk of litigation in the first place, every practice should conduct an immediate internal audit to reveal potential weaknesses in current policies, staff training and documentation protocols.


A Washington Post-Kaiser Family Foundation poll reveals that 52 percent of front-line healthcare workers said they had received their first dose of COVID-19 vaccine at the time they were surveyed, while more than a third expressed concern about how well the vaccines were tested for safety and effectiveness. The survey, conducted from February 11 through March 7, involved more than 1,300 front-line healthcare workers. According to the data, about two in 10 healthcare workers said they had scheduled a vaccine or were planning to, while three in 10 said they were unsure about getting vaccinated or not planning to do so. Additionally, up to one in six said they would leave their jobs if their employers required them to get vaccinated.

Health Policy and Reimbursement

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The Biden administration is extending a special Affordable Care Act enrollment season it opened for the pandemic, giving Americans three more months to shop for health coverage. President Joe Biden during his first weeks in office opened a new special enrollment period, citing increased need for coverage. The Covid relief package made subsidies more generous for low-income shoppers on the marketplace and extended them to middle-income Americans for the first time. His administration said the enhanced health insurance subsidies will become available to shoppers on the federal enrollment site, HealthCare.gov, on April 1. The enhanced subsidies are temporary, though lawmakers are expected to push to make them permanent. More than 200,000 people signed up on HealthCare.gov during the first two weeks of the enrollment season, which is about triple the rate of the same period in the previous year.


The US Centers for Medicare and Medicaid Services (CMS) has opened applications for the second cohort of the Primary Care First (PCF) value-based payment model which seeks to drive down costs and increase quality of care. The PCF model will explore if switching from fee-for-service to Medicare performance-based payments could increase quality of care and reduce overall Medicare costs. Through the model’s performance-based payment adjustments, participating practices in eligible regions will be rewarded for positive patient outcomes. These practices will also have more flexibility in tailoring their care delivery approaches to address the needs of unique patient populations than practices in traditional fee-for-service models.


The US Department of Health and Human Services (HHS) has postponed the implementation of a Trump-era Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) rule. The rule would sunset most HHS regulations after 10 years if they are not assessed and reviewed based on criteria set out in the Regulatory Flexibility Act and requires HHS to review nearly all its regulations within five years. Earlier this month, the county of Santa Clara, CA, and a coalition of health groups sued HHS seeking to invalidate the rule, calling it "rushed" and "arbitrary and capricious." In a Federal Register notice, HHS said it is delaying the implementation of the rule by one year while the court considers the case and that, based on its own review of the rule, the court "could find merit in some of Plaintiffs' claims."


Hospitals that have published their previously confidential prices to comply with a new federal rule have also blocked that information from web searches with special coding embedded on their website, according to a Wall Street Journal review. The code keeps pages from appearing in searches, such as those related to a hospital's name and prices. The information must be disclosed under a federal rule aimed at making the $1 trillion sector more consumer friendly.


Senate lawmakers voted to confirm Vivek H. Murthy, MD, as US surgeon general. Murthy previously served as surgeon general in the Obama administration. The surgeon general usually serves as a spokesperson on public health issues and also supervises the US Public Health Service (USPHS) commissioned corps, a uniformed service of roughly 6,000 public health workers. USPHS members have assisted with the nation's COVID-19 response and administering vaccines. "The most important job of a doctor is to help patients heal," Murthy testified to the Senate health committee in his confirmation hearing. "And if confirmed, that will be my mission as surgeon general — to do whatever I can to help heal our communities and our nation."

Medicine, Drugs and Devices

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According to a new analysis, Medicare Part D plans put generic prescription drugs on generic tiers 45 percent of the time for 2021, down from 64 percent in 2016. Since 2017, plans have had the option to include a greater proportion of generic drugs on the non-preferred tier if they replace the "non-preferred brand" tier with a "non-preferred drug" tier. This analysis from Avalere, which has been run annually and with the same methodology since 2016, again finds that Part D plan sponsors are increasingly placing generic drugs on higher tiers over time. Meanwhile, the proportion of generic products placed on non-generic tiers has increased over time. Last year was the first year since the launch of the Part D program that generics were placed on non-generic tiers more often than on generic tiers, and this figure increased in 2021, with 55 percent of covered generic products now placed on non-generic tiers.