April 14, 2021 | | JFAS | Contact Us

News From ACFAS

Get New 2021 Coding Changes From Home
Hear the latest coding changes, including the new E&M coding changes, from coding and billing experts in the comfort of your home or office via the live-streamed workshop Coding and Billing for the Foot and Ankle Surgeon on May 17.

Get expert tips and insights on simplifying your coding and reimbursement practices in this condensed, information-packed five-hour program. Learn what you need to know to code and document properly in 2021. The program also includes an interactive Q&A session.

Visit to register or for more information to get a leg up on the new coding changes.
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Don't Miss This Year's Virtual Residency Directors Forum
Join the annual Residency Directors Forum, co-hosted by the Council of Teaching Hospitals (COTH), set for May 17, 8am-12:30pm PT via Zoom. The program will be streamed live so 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 for more information, the Forum’s complete session line-up, timing and link to register. The deadline to register is May 7.
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Don’t Miss Tomorrow’s Virtual Journal Club
You have another chance to get the latest in research with the next ACFAS Virtual Journal Club set for April 15 at 7pm CT. This installment on Fibular Nailing is hosted by the Hinsdale Orthopaedic (IBJI) Foot and Ankle Fellowship in Joliet, IL and presented by Curt Martini, DPM.

To participate, register at
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Foot and Ankle Surgery

Complications of Charcot Reconstruction in Patients with Peripheral Arterial Disease
The study sought to determine the rate of complications in patients with peripheral arterial disease and diabetic Charcot neuroarthropathy who underwent osseous reconstruction. In a cohort of 284 patients, the rate of peripheral arterial disease was 20.8 percent. Bivariate analysis for delayed healing found hypertension, peripheral arterial disease and smoking history to be statistically significant factors. Delayed healing was 2.012 times more likely in the presence of peripheral arterial disease. Bivariate analysis for major lower extremity amputation found renal disease and peripheral arterial disease (0.0001) to be statistically significant factors. Major amputation was 4.414 times more likely in the presence of peripheral arterial disease.

From the article of the same title
Journal of Foot & Ankle Surgery (03/31/21) Cates, Nicole K.; Elmarsafi, Tammer; Akbari, Cameron M.; et al.
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Is Double-Strut Fibula Ankle Arthrodesis a Reliable Reconstruction for Bone Defect After Distal Tibia Tumor Resection?
The purpose of this study was to investigate the biomechanical effect of double-strut fibula ankle arthrodesis by finite element analysis (FEA). Computer-aided design software was used to establish three-dimension models. Three different models were constructed: normal tibia-fibula-talus complex (model A), double-strut fibula ankle arthrodesis (model B) and reconstruction by ipsilateral fibula (model C). Simulated load of 600 N was applied to the tibial plateau to simulate balanced single-foot standing. For axial load, model B was stiffer than the construct of model A (524.8 N/mm) and model C, indicating model B was more stable. Maximum stress on the fibular graft occurred on the proximal end. The von Mises stress and stress distribution of fibular graft in model B and model C were similar. In model B, the ipsilateral fibula in model B has a higher value of stress than that in model A, indicating the ipsilateral fibula shared load after fusion with talus.

From the article of the same title
Journal of Orthopaedic Surgery and Research (03/29/21) Zhao, Zhiqing; Yan, Taiqiang; Guo, Wei; et al.
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Reliability of Distally Based Sural Flap in Elderly Patients: Comparison Between Elderly and Young Patients in a Single Center
Reconstructions the soft-tissue defects of the distal lower extremities in the elderly patients can be challenging. The study examined the clinical application of the distally based sural flap in the elderly patients. Between March of 2005 and December of 2019, 53 patients aged over 60 and 55 patients aged 18 to 30 who underwent the procedure were included. The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors were compared between the group A (at least 60 years old) and group B (ranging from 18 to 30 years old). The partial necrosis rate in group A was higher than group B, but the difference is not significant. The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method was 96.22 percent and 98.18 percent in group A and B, respectively. The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B.

From the article of the same title
BMC Surgery (03/28/21) Peng, Ping; Dong, Zhonggen; Wei, Jianwei; et al.
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Practice Management

Five Ways to Maximize Your Referral Program
Physician referral programs have gone digital, which can work well for practices. To attract and maintain the interest of referring physicians, practices need to offer resources of value on their websites, including educational content and information such as insurance details, procedures and services offered and contact information. Strong email communications are essential as well. Providers may want to create a monthly newsletter showcasing the content on their website, sprinkling it with links to interesting third-party articles. Practices should also use Google Customer Match advertising to reach referring physicians through paid, targeted ads. Practices should be sure to advertise on Facebook and LinkedIn and seek ways to ensure a positive online reputation. More than a third of US patients are referred to a specialist each year, so the opportunity is huge.

From the article of the same title
Physicians Practice (04/06/21) Bailey, Kerry
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What to Look For in a Telehealth Vendor
Roland Therriault, president and executive vice president of sales at InSync Healthcare Solutions, says it’s important for a forward-thinking telehealth vendor to offer seamless electronic health record integration, among other traits. Solutions should allow information exchange between stakeholders and operate the claims process as much as possible. When evaluating a potential telehealth vendor, practices should ask how much of their budget is dedicated to research and development, as well as whether the solution allows providers to document druing a session. Practices should look for a solution they can tailor to their needs, while remaining HIPAA-compliant.

From the article of the same title
Medical Economics (04/07/21) Zimlich, Rachel
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Health Policy and Reimbursement

Medicaid Expansion Is Under Reconsideration in Red States
A bill passed by Congress that boosts federal funding for two years to states that expand Medicaid would more than cover a state's cost for increasing eligibility for the program. Since its passage, Georgia Gov. Brian Kemp has "rolled out significant reforms aimed at expanding access," Alabama Gov. Kay Ivey has signaled that she's open to discussing funding for expansion, and Wyoming Gov. Mark Gordon is looking at the long-term implications of expanding Medicaid. However, the Biden administration's move to withdraw federal approval for Medicaid work requirements for Arkansas and New Hampshire last month could hamper further expansion of Medicaid in GOP-led states, say experts. Medicaid advocates are planning to push the remaining 12 states to expand Medicaid, saying it's essential for lowering the US uninsured rate and improving healthcare.

From the article of the same title
Wall Street Journal (04/03/21) Armour, Stephanie
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More Than a Half Million Americans Gain Medical Insurance Coverage
The federal government says more than a half million Americans have taken advantage of the Biden administration's special health insurance sign-up window linked to the COVID-19 pandemic. Officials anticipate that sign-ups will continue to rise because millions of people became eligible effective Apr. 1 for extended subsidies under President Joe Biden's COVID-19 relief legislation. The special sign-up opportunity for Affordable Care Act plans will be available until Aug. 15. Data from the Centers for Medicare & Medicaid Services indicates that 528,005 people newly signed up for government-sponsored private plans from Feb. 15 to Mar. 31. Nationwide enrollment figures will be higher when totals are factored in later on from states that operate their own insurance websites. In addition, more than 870,000 people who went to the website or reached out to the call center were found to be eligible for Medicaid.

From the article of the same title
Associated Press (04/07/21) Alonso-Zaldivar, Ricardo
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Medicine, Drugs and Devices

New Guidelines on Antibiotic Prescribing Focus on Shorter Courses
New clinical guidelines promote shorter courses of antibiotics for the treatment of uncomplicated cases of pneumonia, urinary tract infection, cellulitis, chronic obstructive pulmonary disease exacerbations and acute bronchitis. The American College of Physicians updated the recommendations, which indicate that a five-day course of antibiotics usually works just as well as longer regimens under these circumstances—with the added benefits of fewer adverse effects and reduced overall antibiotic exposure. Considering the significant share of patients who receive antibiotics needlessly or for longer than necessary, the guideline authors emphasized the importance of accurately diagnosing patients. "If a patient is not improving with appropriate antibiotics, it is important for the clinician to reassess for other causes of symptoms rather than defaulting to a longer duration of antibiotic therapy," they wrote, cautioning that longer-course antibiotics should be "the exception and not the rule."

From the article of the same title
Medscape (04/05/21) Haelle, Tara
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The People in This Medical Research Are Fake. The Innovations Are Real
Medical researchers and data scientists are generating artificial patients algorithmically from real-life datasets to accelerate the development of innovations with real-world applications. Allan Tucker at the UK's Brunel University London said, "The key advantage that synthetic data offers for healthcare is a large reduction in privacy risks that have bugged numerous projects [and] to open up healthcare data for the research and development of new technologies." The Covid-19 pandemic fueled demand for synthetic-data solutions as medical providers and researchers raced to understand the pathogen and develop treatments. Israel is a major testbed, using the MDClone startup's platform for creating synthetic data from medical records, for example. Not all synthetic-data research relies on real-life medical records: US nonprofit Mitre's open source Synthea tool can generate populations of artificial patients from scratch, using publicly available data sources.

From the article of the same title
Wall Street Journal (04/06/21) Lieber, Dov
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Trial of Upadacitinib and Adalimumab for Psoriatic Arthritis
A Phase III randomized study explored the safety and efficacy of upadacitinib for patients with psoriatic arthritis who do not benefit from nonbiologic disease-modifying antirheumatic drugs. Researchers recruited 1,704 participants and equally divided them into four treatment arms: 15 milligrams (mg) of upadacitinib daily, 30 mg of upadacitinib daily, 40 mg of subcutaneous adalimumab every other week or placebo. At 12-week followup, 70.6 percent and 78.5 percent of patients in the low- and high-dose upadacitinib cohorts, respectively, had an American College of Rheumatology 20 (ACR20) response to treatment. Response was defined as a decrease of 20 percent or more in the number of tender and swollen joints and a 20 percent or better improvement in at least five other domains. ACR20 response was observed in 65 percent of patients in the adalimumab group, demonstrating noninferiority of upadacitinib at both doses. Only the 30-mg dose, however, was superior to adalimumab. Although just 36.2 percent of the control participants met the primary outcome, they were less likely to experience adverse events—including hepatic disorders and infections.

From the article of the same title
New England Journal of Medicine (04/01/21) Vol. 384, No. 13, P. 1227 McInnes, Iain B.; Anderson, Jaclyn K.; Magrey, Marina; et al.
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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