April 15, 2020 | | JFAS | Contact Us

News From ACFAS

ACFAS Statement on Healthcare Shortage
The College recently released a position statement regarding the COVID-19 crisis: COVID-19 has created an unprecedented healthcare crisis in the United States. As leaders in foot and ankle surgery, ACFAS supports its member physicians' and surgeons' voluntary contribution during this crisis to their level of education, training, experience, and expertise. Additionally, the College supports state and federal efforts to temporarily mobilize our physicians and surgeons, within their training and expertise, without regulatory impediment during the COVID-19 national health emergency.
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New! Research Webinar Series
ACFAS is now offering another way to access education from home. Join us April 16 for the first in a Research Webinar Series—Formulating a Research Topic/Performing a Literature Search.

This first installment is geared to help fellows, residents and students engage in research. Moderator Rachel Albright, DPM, MPH, AACFAS and Elizabeth Ansert, DPM, MBA, MA will review how to develop a strong research question and perform a good literary search. The important elements of a good research question as well as a research objective and hypothesis development will be reviewed.

Don’t miss the kickoff of this webinar series—Wednesday, April 16 at 8pm CT. Visit to register today!
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Educational Programming & COVID
We want to thank you all for your patience during this challenging time with COVID-19. We hope you and your families are safe and well. ACFAS has cancelled or rescheduled its programs and meetings for April and May, however the College is planning to continue with the remainder of its 2020 programs as scheduled. We are following CDC guidance and will continue to evaluate the situation as our scheduled programs draw closer. Thank you for your understanding during these uncertain times.
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How Members are Coping with COVID-19
Everyone is being forced to adjust to a new normal amid COVID-19, and medical practices are no exception. Many members are trying to strike a balance between patient and staff safety while keeping their practice thriving.

Here’s some things ACFAS members are doing along with their practices to continue thriving throughout COVID-19:
  • Incorporating telemedicine through various apps, including Hippo Health, Facetime, Skype and Zoom, etc.
  • Only seeing necessary post-op or trauma patients
  • Screening patients before and at the time of the appointment to ensure no one is sick
  • No scheduling of patients over 60 or with comorbidities unless there’s an urgent concern
  • Increasing spacing within practice waiting rooms or scheduling with gaps to eliminate patient crossing
  • Eliminating waiting room usage and having patients go straight into exam rooms
  • Frequently cleaning office, including spraying alcohol and using medical grade UV lights to disinfect masks
  • Allowing admin staff to work from home to separate them from clinical staff
What are you and your practice doing to stay safe during this time? Follow our social media accounts to see what else your colleagues are doing and share your tips with us by emailing
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New Research Videos Online Now
A new library of research videos are now available on This growing library, developed by the ACFAS Research Committee, will be filled with videos focusing on various aspects of research--from basic research design to IRB submission and publication--in order to help increase the College’s research initiative for the profession. To start the collection, the first two videos available include:

Conducting Research: From Initial Idea to Publication
Moderator: Paul Kim, DPM, MS, FACFAS
Panelists: D. Scot Malay, DPM, MSCE, FACFAS; Rachel Albright, DPM, MPH, AACFAS; Mark Prissel, DPM, FACFAS

Why Should I Do Research
Moderator: Monica Schweinberger, DPM, FACFAS
Panelists: Adam Fleischer, DPM, MPH, FACFAS, Katherine Raspovic, DPM, FACFAS

The library also pairs equally well with ACFAS’ charge to provide more resources to students, residents and fellows during the COVID crisis. Please watch for more videos and research resources in the coming weeks.
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Foot and Ankle Surgery

Evaluation of Anterior Inferior Tibiofobular with 2D Oblique Coronal Imaging and 3D Isotropic Resolution T2-Weighted Fast Spin-Echo Sequences
The study compared diagnostic performance of additional two-dimensional (2D) oblique coronal view and three-dimensional (3D) T2-weighted fast spin-echo (FSE) images for diagnosing injury of the anterior inferior tibiofibular (AiTFL) and anterior talofibular ligaments (ATFL). The study included 48 patients with ankle sprain who had undergone standard MRI and two additional sequences with 2D oblique coronal and 3D isotropic images, followed by arthroscopic surgery. Retrospectively, two radiologists each reviewed three image sets of MR including 2D axial image only (set 1), 2D axial and oblique coronal images (set two) and 2D axial with 3D-isotropic images (set three). Arthroscopy confirmed 13 AiTFL and 41 ATFL injuries. For AiTFL, area under the curve (AUC) value was significantly higher for set three than set one, but there was no significant difference between AUC values for set two and set three sequences for either type of tear. For ATFL, there was no significant difference in AUC values between set one and set three and between set two and set three.

From the article of the same title
Journal of Medical Imaging and Radiation Oncology (04/20) Khil, Eun Kyung; Cha, Jang Gyu; Lee, Young Koo; et al.
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Single-Stage Debridement with Implantation of Antibiotic-Loaded Calcium Sulphate in 34 Cases of Localized Calcaneal Osteomyelitis
The study describes the outcomes of cortical bone windowing followed by eggshell-like debridement and implantation of antibiotic-loaded calcium sulphate (CS) for localized calcaneal osteomyelitis (CO) in 34 patients. Infection followed trauma or orthopedic surgery in 30 patients and hematogenous spread in 4 patients. Thirty-one patients had a sinus tract, accompanied by a soft tissue defect in three patients. All patients received cortical bone windowing, debridement, multiple sampling, local implantation of vancomycin- and gentamicin-loaded CS, skin closure or flap coverage and culture-specific systematic antibiotic treatment in a single-stage procedure. Infection was eradicated in 29 patients after the single-stage surgery, and all of the five recurrent infections were cleared by repeated surgery without amputation. Other adverse events included 11 patients with aseptic wound leakage and one unrelated death. Compared with those before surgery, the median postoperative scores of the American Orthopaedic Foot and Ankle Society ankle hindfoot scale and the visual analog scale for pain improved.

From the article of the same title
Acta Orthopaedica (04/02/20) Jiang, Nan; Zhao, Xing-qi; Lin, Qing-rong; et al.
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Weightbearing Cone-Beam Computed Tomography of Acute Ankle Syndesmosis Injuries
This prospective comparative study recruited 39 consecutive patients with proven unstable syndesmoses and an uninjured contralateral ankle to a weightbearing computed tomography (CT) database. The syndesmosis area was measured for both ankles in non-weightbearing and weight-bearing positions and compared. Syndesmosis area of the unstable ankle was significantly greater than the uninjured ankle of the same patient, which was a significantly greater difference than that observed with non-weightbearing CT. Dynamic change in area, from non-weightbearing to weightbearing, of the unstable ankle was significantly greater than that of the uninjured ankle. Weightbearing CT demonstrated significantly greater diastasis in unstable ankles than did conventional non-weightbearing CT.

From the article of the same title
Journal of Foot & Ankle Surgery (03/01/20) Vol. 59, No. 2, P. 258-263 del Rio, Andres; Bewsher, Samuel M.; Roshan-Zamir, Sasha
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Practice Management

CMS Issues New Wave of Infection Control Guidance Based on CDC Guidelines to Protect Patients, Healthcare Workers from COVID-19
The US Centers for Medicare and Medicaid Services has issued new guidance documents focused on infection control to prevent the spread of COVID-19 in a variety of care settings. The guidance is meant to help healthcare systems and local hospitals rapidly expand their capacity to isolate and treat patients infected with COVID-19 from those who are not. The guidance includes new instructions for dialysis facilities as they work to protect patients with End-Stage Renal Disease. The guidance includes the option of providing Home Dialysis Training and Support services and establishment of Special Purpose Renal Dialysis Facilities, which can allow dialysis facilities to isolate vulnerable or infected patients. The revised guidance also allows hospitals to screen patients at a location offsite from the hospital's campus to prevent the spread of COVID-19. For outpatient clinical settings, the guidance discusses recommendations to mitigate transmission including screening, restricting visitors, cleaning and disinfection and closures.

From the article of the same title
Healthcare Purchasing News (04/20)
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Coronavirus: AMA Produces Guide to Help Telemedicine Implementation
The American Medical Association (AMA) has produced a new guide for physicians to help implement real-time audio and visual appointments with patients. The new guide will help physicians to adopt the new technology, which has been critical to practices looking to integrate telehealth options as quickly as possible during the COVID-19 pandemic. “The Playbook series not only offers a clear and efficient path to scaled implementation, but also access to institutional knowledge and best practices curated from experts in the field,” said AMA Chair Jesse M. Ehrenfeld. Before the pandemic, AMA research between 2016 and 2019 found that the percentage of physicians utilizing telehealth increased from 14 percent to 28 percent. Each Playbook in the series provides a 12-step process for implementing digital health solution. The steps are: identifying a need, forming a team, defining success, evaluating vendors, making the case, contracting, designing the workflow, preparing the care team, partnering with the patient, launching the program, evaluating success and scaling the program.

From the article of the same title
Medical Economics (04/07/20) Reynolds, Keith A.
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Practicing Social Distancing in the Practice and More
Physician practices should implement the Centers for Disease Control and Prevention's (CDC) guidance on social distancing to prevent the community spread of COVID-19, which will require thoughtful planning and coordination. For example, in waiting rooms, practices can limit the number of patients waiting at any given time and ask family members to wait outside the practice. Observing social distancing in the waiting room may require extending the hours of operation. Epidemiologist Tista Ghosh says practices should consider using telehealth to treat patients while limiting physical contact. Physician practices also need to consider other building tenants, coordinating with landlords and/or property owners to limit building access. Practice administrators should aim to make thoughtful decisions about furloughing or laying off employees. Practices should be clear about their methodology behind staff reductions and avoid making guarantees to employees that they will be hired back.

From the article of the same title
Physicians Practice (04/01/20) Crysts, Aine
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Health Policy and Reimbursement

CMS Has Doled Out Nearly $34 Billion in Advance, Accelerated Payments to Providers to Combat Covid-19
The US Centers for Medicare and Medicaid Servies (CMS) announced Tuesday that it has reduced the processing time for advance and accelerated provider payments to four to six days, down from the earlier timeframe of three to four weeks. “In a little over a week, CMS has received over 25,000 requests from healthcare providers and supplies for accelerated and advance payments and have already approved over 17,000 of those requests in the last week,” CMS said in a release. Before COVID-19, the agency had only approved a little over 100 of such requests. Many healthcare providers have had to furlough workers as revenues dwindle. The payments are available to Medicare Part A providers and suppliers in Part B. The agency said that while most providers and suppliers can receive three months of their reimbursements, certain providers can receive up to six months. CMS noted that the funding for the accelerated and advance payments is separate from the $100 billion in funds passed as part of the economic stimulus package.

From the article of the same title
Fierce Healthcare (04/07/20) King, Robert
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COVID-19 Job Losses Could Drive Down Employer Plan Enrollment by as Much as 35 Million, Report Shows
A new analysis by Health Management Associates (HMA) estimates that between 12 million and 15 million people will lose employer-sponsored coverage amid COVID-19 as unemployment skyrockets. If unemployment reaches 10 percent, HMA projects that enrollment in employer plans would decline from 163 million to 151 million, while Medicaid enrollment would increase from 71 million to 82 million. Marketplace coverage would likely stay the same, and the number of uninsured could increase from 29 million to between 30 million and 31 million. If unemployment reaches 25 percent, enrollment in employer coverage could drop to 128 million, while Medicaid enrollment would skyrocket to 94 million and the number of uninsured could reach 39 million to 40 million.

From the article of the same title
Fierce Healthcare (04/03/20) Minemyer, Paige
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Pandemic Delays Federal Probe into Medicare Advantage Health Plans
The US Centers for Medicare and Medicaid Services (CMS) has temporarily halted some efforts to recover hundreds of millions of dollars in overpayments made to Medicare Advantage health plans, so the agency and insurers can focus patient care during the COVID-19 pandemic. Medicare Advantage plans are offered by private health insurers under contracts with Medicare, covering more than 24 million Americans, most of them seniors. Critics warn that the move is an "abdication of oversight." Some of these plans have said they will waive copayments for COVID-19 testing and care. CMS announced earlier that there would be a 1.66 percent rate increase for these plans in 2021. However, CMS audits are the tool used to curb overcharging by these plans, to which the government pays more than $200 billion a year. Those audits are years behind schedule, even as recent reports suggest that the government has overpaid these plans by nearly $30 billion in the past three years alone. CMS has said it will continue reviewing some audit materials but suspend the collection of records for reviews of 2015 payments and beyond until "the public health emergency has ended."

From the article of the same title
Kaiser Health News (04/08/20) Schulte, Fred
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Medicine, Drugs and Devices

Doctors Are Improvising Coronavirus Treatments, Then Quickly Sharing Them
Healthcare workers are writing the playbook for treating coronavirus patients on the fly, knowing they cannot wait for peer-reviewed articles or studies in established medical journals. Instead they are tapping into social media, podcasts, medical blogs and text-message groups to share improvised solutions to supply shortages and patient care, forcing hospitals to quickly re-evaluate their practices. "This has been a rapidly evolving process," said Joshua Farkas, MD, who has treated COVID-19 patients in the intensive care unit at the University of Vermont in Burlington. "As we struggle with how to treat a disease that so recently was totally unknown, this rapid exchange and updating of information is crucial."

Farkas and the EMCrit blog are part of a movement known as FOAM or FOAMed—free open access medical education—a network of podcasts and blogs where healthcare workers can share medical resources and ideas. Advocates say FOAM has proven particularly vital in the battle against COVID-19 as a platform for rigorous exchange of practitioner insight and advice. Reuben Strayer, MD, associate medical director of emergency medicine at Maimonides Medical Center in Brooklyn, has launched a COVID-19 data-sharing program on his blog, Emergency Medicine Updates, featuring real-time, anonymized patient data from Maimonides' intensive care unit. Another website and podcast, Rebel EM, has spread guidance from Italian healthcare professionals on the conditions of people in hospitals and how to prepare emergency rooms for the pandemic.

From the article of the same title
Wall Street Journal (04/09/20) O'Brien, Rebecca Davis
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More Coronavirus Vaccines and Treatments Move Toward Human Trials
Companies are escalating their efforts to combat COVID-19 by creating new vaccines and launching clinical trials for potential treatments. Maryland-based Novavax says it plans to start human trials in Australia in mid-May for its vaccine candidate, which triggered a robust immune response in lab and animal experiments. The goal is to produce antibodies that could fight off the coronavirus. Stem-cell company Mesoblast says it was starting a 240-patient clinical trial supported by the US National Institutes of Health that would test whether cells derived from bone marrow could help patients who develop a dangerous immune reaction to the coronavirus.

A vaccine made by the biotech company Moderna is already in a clinical trial, which started on March 15. Another vaccine developed by Inovio Pharmaceuticals was injected into the first adult volunteers on Monday. Moderna's approach uses RNA technology, while Inovio developed DNA technology. Johnson & Johnson anticipates starting clinical trials in September and has received a nearly $500 million partnership via a division of the US Department of Health and Human Services. Experimental vaccines developed by researchers at the University of Pittsburgh and Baylor College of Medicine in Houston are also waiting for permission from the US Food and Drug Administration to begin testing in people.

From the article of the same title
New York Times (04/10/20) Sheikh, Knvul; Thomas, Katie
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NIH Clinical Trial of Hydroxychloroquine, a Potential Therapy for COVID-19, Begins
The US National Institutes of Health (NIH) has launched a clinical trial to test the safety and effectiveness of hydroxychloroquine for the treatment of adults hospitalized with COVID-19. The first participants in the Outcomes Related to COVID-19 treated with hydroxychloroquine among In-patients with symptomatic Disease (ORCHID) study have enrolled at the Vanderbilt University Medical Center in Nashville. The blinded, placebo-controlled trial—which is being conducted by the National Heart, Lung and Blood Institute (NHLBI) at NIH—aims to enroll more than 500 adults who are currently hospitalized with COVID-19 or in an emergency department with anticipated hospitalization. All study participants will continue to receive clinical care as indicated for their condition, and those randomized to the experimental intervention will also receive hydroxychloroquine. James P. Kiley, director, Division of Lung Diseases, NHLBI, said: "Hydroxychloroquine has showed promise in a lab setting against SARS-CoV-2, the virus that causes COVID-19 and preliminary reports suggest potential efficacy in small studies with patients. However, we really need clinical trial data to determine whether hydroxychloroquine is effective and safe in treating COVID-19."

From the article of the same title
NIH News Release (04/09/20)
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

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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