News From ACFAS

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Did you miss last week’s Practice Survival During COVID-19 Webinar? No worries—the webinar and handouts are now available online!

Listen in to last week’s webinar as physician compensation attorney Robert Wade, Barnes & Thornburg, LLP, Ross Taubman, DPM, president and CMO of PICA and Danielle Butto, DPM, FACFAS break down what you can do to keep your practice open and thriving through this unprecedented time.

Access the recording and webinar handouts now at acfas.org/pracmgmtwebinars. Keep checking acfas.org/COVIDResources for more on how to keep managing your practice successfully throughout this challenging time. In response to the COVID-19 crisis’ effect on ACFAS Members who are facing new and unprecedented challenges, the ACFAS Board of Directors voted to extend the College’s final dues payment deadline to June 30.

If you would like to renew your membership today, visit acfas.org/paymydues and pay online. Or contact the College to pay with a credit card over the phone, request a PDF invoice to pay with a check, or to request assistance with your login details.

Have questions? Please contact Terry Wilkinson, Membership Manager, at (773) 444-1301 direct or at membership@acfas.org. As ACFAS continues to monitor the COVID-19 situation, we are looking ahead to the future. Coding and Billing for the Foot and Ankle Surgeon will be back this summer and fall—secure your spot now at one of these upcoming courses.

July 31-August 1
(Friday/Saturday)
Disney Swan & Dolphin Hotel
Orlando, FL
Register

September 11-12
(Friday/Saturday)
Palmer House Hilton
Chicago, IL
Register

Join us soon and walk away with the tools you need to simplify your coding and reimbursement practices. Visit acfas.org/practice management to register now! In an effort to aid residency directors, fellowship directors and school faculty with didactic learning during the COVID-19 crisis, ACFAS’ Post Graduate Affairs (PGA) Committee has created recommended educational learning pathways. The pathways are not intended to replace standard curriculum; however, they should be used to supplement student and resident education during this time of need. All students, residents and post graduate fellows have been granted access to the ACFAS OnDemand online learning platform at no cost during this time of crisis.

The learning pathways are divided into basic, intermediate and advanced categories then organized into specific topics. Each pathway includes a variety of educational materials from the ACFAS OnDemand platform and links to journal articles, primarily to The Journal of Foot & Ankle Surgery (JFAS). Additional content will be added on teaching research and additional opportunities for webinars and other live courses.

The pathways were created by the PGA COVID-19 Educational Pathways Task Force as part of the Post Graduate Affairs (PGA) Committee and led by Jason Piraino, DPM, FACFAS. If you have any comments or questions, please contact Dr. Piraino.

Foot and Ankle Surgery

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The study compared the clinical outcomes of patients who underwent the arthroscopic and open Brostrom-Gould technique for the repair of lateral ankle ligament over a 12-month follow-up period. In a retrospective review of the database in a tertiary hospital foot and ankle registry from 2015 to 2019, researchers performed a 1:1 matching of 26 ankles that underwent the arthroscopic Brostrom-Gould technique to 26 ankles with the open technique. The arthroscopic group demonstrated significantly less pain in the perioperative period and had higher American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores at six months and 12 months. No complications were reported in either group. Twenty patients in the arthroscopic group had preoperative intra-articular abnormalities compared with 24 patients in the open group. Researchers conclude that the arthroscopic Brostrum-Gould technique produced better clinical outcomes than the open technique at 12 months of follow-up.


The study aimed to investigate the effects of midfoot joint mobilizations and a one-week home exercise program (HEP) compared to a sham intervention and HEP on pain, patient-reported outcomes, ankle-foot joint mobility, and neuromotor function in young adults with recent lateral ankle sprains. All participants were instructed in an HEP and randomized a priori to receive midfoot joint mobilizations or a sham laying-of-hands. Midfoot joint mobilization had greater effects in reducing pain one-week post, and increasing Single Assessment Numeric Evaluation and Global Rating of Change compared to a sham treatment and HEP.


The study compares the clinical outcomes of posteroanterior (PA) lag screws versus posterior buttress plate fixation in treatment of posterior malleolar fragments (PMFs) in spiral tibial shaft fracture. The study included 48 patients with PMFs associated with spiral tibial shaft fracture, who were divided evenly into the screw group and the plate group. At the mean follow-up period, all patients in both groups had bone union without severe wound problems or complications. There were no significant differences in American Orthopaedic Foot and Ankle Society and visual analog scale scores between the groups at final follow-up. No significant differences were found between the groups in injured/contralateral ankle range of motion or posttraumatic ankle arthritis scale postoperatively.

Practice Management

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Healthcare providers can stay connected to patients who are quarantined with COVID-19 in a number of ways. Physicians can automate regular check-ins with quarantined patients by leveraging patient-centric technology to engage with patients, such as a solution that allows the automatic distribution of pre-screen forms and information via text message. Certain populations of patients, such as those with pre-existig conditions, can be grouped together and sent specific group messages through filters. In all messaging, physicians should be consistent in tone and cadence as they pass on new information from the CDC, updates about the virus in their community and reminders about prevention and treatment. Physicians can also check in virtually with telehealth visits to determine whether patients are in need of an examination or hospitalization. Providers may want to check in daily with patients who are sick and at home, keeping an eye on each patient's progression and identify concerns as they arise.


Practices can take many steps to reduce the risk of coronavirus transmission in their waiting rooms. This starts with deep-cleaning every surface of the room and, when possible, arranging chairs so as to facilitate social distancing. Healthcare organizations with multiple locations may want to designate certain offices for solely seeing patients with suspected COVID-19. If multiple locations are not available, this separation can be achieved by designating certain times of day on particular days for older at-risk noninfectious patient appointments. Some practices have completely closed their waiting rooms, inviting patients to wait in their cars in the parking lot until they receive a text when the exam room is available for them. Practices can also change care utilization patterns by using telehealth visits to evaluate patients with COVID-19 remotely, minimizing the risk of contagion for office staff and providers while referring seriously ill patients to the emergency department with prior notice of their arrival.


Telemedicine is entering into the mainstream thanks to the COVID-19 pandemic, but the change is testing its ability to keep up with soaring demand and forcing innovation on the fly. Telemedicine has been slow to take hold because of government regulation and a lack of interest from patients and big companies. These telemedicine companies are now in heavy demand, with some reporting more than a 50 percent increase in calls and longer response times. Teladoc said it has added thousands of doctors to its network. Companies are rolling out new products, like Kry International AB's introduction of a new, free service that allows any doctor in the world to send a link to a video consultation via text message instead of through the app. Currently, telemedicine is a patchwork of efforts by big and small firms around the world.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) announced an expansion of the Accelerated and Advanced Payment System to a broad group of Medicare providers and suppliers during the public health emergency. The program provides expedited Medicare reimbursements to participating providers when there is a disruption in claims submissions or processing. As healthcare providers across the care continuum face significant operational disruptions, many organizations are facing serious cash flow issues. To qualify for upfront Medicare reimbursement through CMS, providers and suppliers must have billed Medicare for claims within 180 days immediately prior to the date of signature on the request form. Eligible providers and suppliers will have to request a specific amount using an Accelerated or Advance Payment Request form, which can be found on each Medicare Administrative Contractor's website. Most providers and suppliers will be able to request up to 100 percent of the Medicare payment amount for a three-month period.


According to recent government data, about 11.4 million consumers signed up for health coverage on Affordable Care Act exchanges this year. It marks the third straight year that sign-ups have remained steady. Among consumers in the 38 states that use the HealthCare.gov platform, the average monthly premium before subsidies was $595 in the 2020 open enrollment period, according to the Centers for Medicare & Medicaid Services. That marks a 3 percent drop from 2019. Eighty-seven percent of consumers in states that use the federal platform were eligible for subsidies that reduce premiums.


The US Centers for Medicare and Medicaid Services (CMS) have unveiled a host of new flexibilities for hospitals amid the COVID-19 pandemic. Among other adaptation, temporary new rules will allow hospitals to transfer patients to outside facilities while still receiving hospital payments under Medicare. In announcing the change, CMS Administrator Seema Verma said many ambulatory surgery centers, which are delaying or canceling elective procedures, could be devoted to "hospital-like care." The agency's move will also allow physician-owned facilities to increase bed capacity without sanctions. The regulatory flexibility will last as long as the national public health emergency for the COVID-19 pandemic is active.

Medicine, Drugs and Devices

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The US government's emergency stockpile of respirator masks, gloves and other medical supplies is running low and is nearly exhausted due to the coronavirus outbreak, officials from the US Department of Homeland Security report. The demand for safety equipment is both immediate and widespread, with health officials, hospital executives and governors saying that their shortages are critical and that healthcare workers are putting their lives at risk while trying to help the surging number of patients. Officials at the Federal Emergency Management Agency said the government had anticipated the Strategic National Stockpile would be exhausted, and the administration is moving swiftly to procure and distribute supplies.


The US Food and Drug Administration (FDA) loosened regulations on what kinds of alcohol can be used to manufacture hand sanitizers in response to the COVID-19 pandemic. FDA says ethanol made at factories that produce fuel ethanol can be used if it contains no additives or chemicals and if companies can ensure water purity and appropriate sanitation of equipment. FDA says it will consider each site on an individual basis and grant approval only if a factory meets quality control specifications.


Although infections caused by multidrug-resistant (MDR) bacteria associated with healthcare were down in 2017 from 2012 rates, an analysis finds that antimicrobial resistance remains a significant burden in this country. The researchers employed data from a cohort of 890 hospitals nationwide, accounting for 41.6 million hospitalizations during the study period. In 2017, they determined, MDR caused approximately 622,390 infections among hospital inpatients. About 83 percent of the cases were classified as community-onset, with the other 17 percent considered to be hospital-onset.