News From ACFAS

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What an incredible year for the College and what a perfect time to recognize those who made it happen! In honor of National Volunteer Week, ACFAS thanks you, our volunteer members, for selflessly donating your time and expertise to the profession.

No matter if you serve on ACFAS’ committees or Board of Directors, lead our educational programs or mentor students and residents, you always go above and beyond in supporting the College’s mission.

Your dedication to helping others exemplifies the true meaning of giving back, and we thank you for everything you do year-round to serve your colleagues and patients. We are expanding our catalogue of Surgical Skills courses, On the Road programs, e-Learning products and conference sessions.

If you are:

• An active Fellow member of the College;
• Have attended the Annual Scientific Conference or other education programs within the past three years;
• Have been in practice for five years or more; and
• Working 20+ hours a week;

Complete a Faculty Application and send it to Marilyn Wallace, ACFAS assistant director of Education Curriculum and Alliances, or Mary Meyers, ACFAS director of Education Curriculum and Alliances. What has blades that whirl at 3,000 revolutions per minute and can produce three times the kinetic energy of a .357 handgun? It’s a power lawnmower, and it can easily turn a person’s lawn into a “toe-away” zone.

However, ACFAS’ newest infographic, Keep Your Feet Safe from Lawnmower Accidents, outlines several precautions your patients can take to protect their feet from serious injury when using a power lawnmower.

Download this infographic from the ACFAS Marketing Toolbox then print and display it in your office, hand out copies to your patients and referring physicians or share it on your social media pages. The infographic also includes an editable box in the lower righthand corner for your practice’s contact information.

Visit acfas.org/marketing for more free infographics, PowerPoint presentations, healthcare provider marketing tools and other resources designed to make marketing your practice easy—and fun! Help your patients spot the signs and symptoms of neuroma early on with the new PowerPoint presentation, A Pebble in Your Shoe? It Could Be a Neuroma, available now in the ACFAS Marketing Toolbox.

This newest release explains how neuromas develop and why early diagnosis and treatment are so important. A customizable slide for your practice’s contact information, as well as a script, are included with the file.

Run the presentation on a loop in your office, use it when speaking at spring health fairs or post it on your website and social media pages.

Access the complete library of PowerPoint presentations at acfas.org/marketing plus many other free resources, such as the seasonal FootNotes patient education newsletter, infographics and healthcare provider referral tools.

Foot and Ankle Surgery

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A study compared the biomechanical properties of the suture-external button and internal suspension fixation techniques in cadavers. The primary and secondary results were displacement of suture-fixation construct during dynamic loading and static loading, respectively. Nine adult cadaver feet were acquired, and both the external button and internal suspension methods were tested once in each cadaver, in random order. Internal suspension fixation was found to have significantly less mean displacement of the tendon within the bone tunnel compared to the external button technique during dynamic and static loading.


Researchers defined the early clinical and radiological outcomes in patients who underwent Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) conducted by nondesigner surgeons. Thirty consecutive patients underwent total ankle replacement with a Zimmer TM TAR surgery between July 2013 and January 2016. The average preoperative Foot Function Index-pain (FFI-P) value was 53.67 and the FFI-disability (FFI-D) was 64.19. At the last follow-up visit, the FFI-P and FFI-D were 16.95 and 20.76, respectively. Before surgery, the mean visual analog scale for pain and American Orthopaedic Foot and Ankle Society score were 7.81 and 40.95, respectively and at the last follow-up 2.29 and 86.38. The mean angles calculated using Wood and Deakin's method were “a”= 89.02 degrees, “ß”= 85.11 degrees and “y”= 27.54 degrees, postoperatively. At final follow-up, the same values were respectively 89.43, 85.18 and 29.94, while the mean offset ratio was 0.06.


Achilles tendinopathy, both insertional and noninsertional, is a common cause of posterior ankle pain, and in some cases, patients can develop chronic symptoms. A study examining the outcomes of patients after extracorporeal shock wave therapy plus a home exercise program reveals median (interquartile range [IQR]) values for average self-reported pain improved from 6.5 of 10 (IQR 5.0 to 7.8) at baseline to 3.5 of 10 (IQR 2.0 to 5.1) at three months and to 2.0 of 10 (IQR 0.6 to 4.8) at six months for patients with insertional Achilles tendinopathy. This compares to improvements from 7.0 of 10 (IQR 7.0 to 8.0) at baseline to 6.0 of 10 (IQR 5.6 to 6.8) at three months and to 6.0 of 10 (IQR 3.0 to 7.0) at six months for patients with noninsertional Achilles tendinopathy.

Statistically significant improvements were seen in insertional tendinopathy across a range of outcome measures, but no significant differences were seen in the outcomes for patients with insertional and noninsertional tendinopathy. Despite the improvements seen in the aspects of pain and function, physical activity levels had not increased following the treatment. The study involved a total of 39 patients, with a mean follow-up duration of 163 (range 65 to 385) days.

Practice Management

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Physicians should prepare for their first days of working in a new medical facility by first becoming familiar with the new environment as much as possible beforehand. Advice includes knowing the layout of the floors and where everything is, learning as much as possible about the electronic healthcare record system and practicing on it before the first day.

A second recommendation is to know all important contact numbers, including those of one's immediate supervisor. A third suggestion is to start work early and expect to finish late.


Medical practices often merge or acquire others to increase market share, gain new capabilities or diversify their product offerings. Sometimes, however, these tie-ups do not go as planned, and those failures can often be attributed to workplace culture and a failure to address the differences in culture between the merging practices. Nick Hernandez, MBA, FACHE, founder and the CEO of ABISA, a consultancy specializing in strategic healthcare initiatives for physician practices, says these problems can also be exacerbated by a lack of effective communication. Be sure to communicate with employees, collect feedback to take targeted action for retention and provide ongoing support, he says. To avoid losing employees, Hernandez says, speak with them before the deal closes to gauge which areas of the business have the highest risk of turnover and take steps to reassure employees of job security to reduce the risk of a mass exodus.

Before the merger, practices will need to choose one business culture to be carried on, create a new culture that combines the best from both medical practices or create a completely new culture and communicate that decision practicewide. Employees not only want to be reassured about job security, but also be kept in the loop about when benefits transition, how time off and other policies will change, how performance reviews will be conducted and when and how compensation will be reviewed. Offering career path training pre- or postmerger is a great way to prepare and support employees, and Hernandez adds that practices should consider conducting onboarding for acquired employees, same as you would for any new hire.


Patients should consider a host of factors to help determine when their physicians should retire amid declining performance due to age, writes Jonathan Maltz, a family physician practicing in Bethesda, Md. Among the telltale signals is the failure of the doctor whom the patient has known for many years to recall the patient or to confuse him or her with someone else. Doctors who start acting dismissive or impatient, as opposed to their usual comportment, is another warning sign. Also to be considered is when physicians give the patient a confusing or convoluted answer to questions and asking follow-up questions does not clarify the issue.

Repeated forgetfulness in ordering tests or procedures that the clinician promised to do should be another indication of decline, along with a habit of referring patients to another medical professional for nearly every ailment. Patients should also look for vision and hearing difficulties and shaky hands.

Health Policy and Reimbursement

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A survey by Gallup and West Health indicates that over the last year, Americans borrowed an estimated $88 billion to pay for healthcare, and one in four Americans skipped treatment because of the cost. Nearly one-half of the respondents said they are worried about bankruptcy in the event of a health emergency. Even among households earning $180,000 or more a year, a third of the respondents said they were concerned about the threat of personal bankruptcy due to a health crisis. Many American families earning less than that are compelled to cut back on other expenses to pay for healthcare or to skip appointments and prescription refills, leading to future health risks. Twelve percent of respondents said they had borrowed money for care.


The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized updates to Medicare Advantage and Part D plans as part of its effort to increase plan choices and benefits. The "changes give plans the ability to be innovative and to offer benefits and services that address social determinants of health for people with chronic disease," said CMS Administrator Seema Verma. "With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that focus on preventing disease and keeping people healthy."

Beginning in 2020, chronically ill patients with Medicare Advantage will be able to access a broader range of supplemental benefits that are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees. These benefits can address social determinants of health for beneficiaries with chronic disease. CMS is encouraging Medicare Advantage plans to take advantage of new flexibilities to offer targeted supplemental benefits, cost-sharing reductions for patients with chronic pain or who are undergoing addiction treatment and encouraging Part D plans to provide at least one opioid-reversal agent on a lower cost-sharing tier.


Walmart and other employers want more say over which doctors care for their workers. Many big companies are mining data from health plans and public records and working with consultants to compare physicians, searching for those with the best results and competitive costs. More than 5,000 members of Walmart's health plan have seen doctors chosen for performance under the retail giant's program. Results have convinced Walmart executives that choosing top doctors is vital, said Lisa Woods, who helps oversee the company's health benefits. Employees in the program spend less time in the hospital, need less expensive follow-up care and return to work more quickly, the company reported last month.

Medicine, Drugs and Devices

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Websites for various medicines let people self-diagnose and select the item they want and then enter some personal health and credit card information. A doctor then assesses their choice, with no in-person consultation. If approved, the product arrives in the mail days or weeks later. The sites invert the usual practice of medicine by turning the act of prescribing a product into a service. Instead of doctors making diagnoses and then suggesting treatments, patients request products and physicians serve largely as gatekeepers. Some of these companies operate in a regulatory vacuum that could increase public health risks, according to some physicians, former federal health regulators and legal experts. Federal and state health laws have not kept pace with online services, they say. "It's restaurant-menu medicine," said Arthur Caplan, a medical ethics professor at New York University School of Medicine.


Express Scripts said it will immediately begin offering employers, labor unions and other clients the option to cap at $25 a month the copayments and other out-of-pocket costs that patients living with diabetes must pay to fill their insulin prescriptions. The cap, if picked up by employers, would save the average patient about $15 a month, or 40 percent, and even more for patients covered under a typical high-deductible health plan. Patients could start benefiting from the lower out-of-pocket costs in the next few months, depending on when employers decide to opt in, according to an Express Scripts spokesperson.

The rising list prices for insulin have figured prominently in mounting criticism of medication costs. Patients, doctors and lawmakers have criticized Lilly, Novo Nordisk and other drugmakers for raising prices, while the pharmaceutical companies have sought to shift blame to pharmacy benefit managers.


The U.S. Food and Drug Administration (FDA) has announced it is developing a framework for regulating artificial intelligence (AI) products used in medicine that continually adapt based on new data. The move represents the most forceful step FDA has taken to assert the need to regulate a category of AI systems whose performance constantly changes based on exposure to new patients and data in clinical settings. FDA Commissioner Scott Gottlieb released a white paper describing criteria the agency proposes to use to determine when medical products that rely on AI will require FDA review before being commercialized.