News From ACFAS

---

ACFAS 2021 is coming to you in the comfort of your home or office! Join us virtually for the Annual Scientific Conference May 18-21 in Las Vegas!

Here’s what’s in store for ACFAS 2021:

• keynote speaker Zubin Damania, MD (or you may know him as ZDoggMD) an internist and founder of Turntable Health as he speaks about Health 3.0;
• 26 CME hours of educational content recorded at the conference–watch them anytime/anywhere for up to 60 days after the conference ends;
• ability to browse the virtual exhibit hall and virtual product showcase;
• access to ePosters;
• a wide variety of additional, non-CME education, including industry webinars, videos and more!

Watch acfas.org/LasVegas for the latest information about ACFAS 2021. We can’t wait to get together again (in-person or online) in May! Residents’ Day is going virtual starting on May 17 as part of ACFAS 2021. From your home or office, you’ll be able to watch all the highly anticipated sessions at your convenience on the ACFAS 2021 Digital Portal. Whenever you watch, you’re in store for an exceptional program with a great line-up of presenters.

Hear about their experiences as well as their ups and downs plus real-world tips and tricks with straightforward advice on everything from job search and interview prep to practice types and managing difficult cases. Residents will benefit from the topics offered and take some pearls from the session with them to use in their practice and future career.

Join us for the chance to hear about individual journeys of these seasoned surgeons and leaders in the profession. Visit acfas.org/LasVegas to see the full schedule and register for the virtual event now. ACFAS Regions are Zooming for 2021! All College Members and ACFAS Student Club Members are invited to attend their local Region Meetings via Zoom. Meetings are scheduled to be held evenings in May, either the week before or the week after the ACFAS Annual Scientific Conference in Las Vegas. Meetings are one hour in length.

Join your local colleagues to meet your Region officers and to hear about educational opportunities, plans for the year, how the Regions are supporting local research and any open officer positions. Also, all members who attend their meeting will be placed in a raffle to win one of two $100 Amazon gift cards.

You can register for your Region’s Membership Meeting below:

Monday, May 10:
Gulf States Region – AL, AR, LA, MS, OK, TX
6-7pm CT
Register Here

Great Lakes Region – IN, KY, MI, OH
8-9pm ET
Register Here

Tuesday, May 11:
Midwest Region – IL, IA, MN, MO, WI
6-7pm CT
Register Here

Northeast Region – CT, ME, MA, NH, NY, ON, QC, RI, VT
8-9pm ET
Register Here

Wednesday, May 12:
Mid-Atlantic Region – MD, NC, SC, TN, VA, DC
8-9pm ET
Register Here

Pacific Region – AK, CA, GU, HI, OR, WA, BC
6-7pm PT
Register Here

Monday, May 24:
Tri-State Region – DE, NJ, PA
7-8pm ET
Register Here

Tuesday, May 25:
Southeast Region – FL, GA, PR
7-8pm ET
Register Here

Big West Region – AB, AZ, CO, ID, KS, MT, NE, NV, NM, ND, SD, UT, WY
6-7pm MT
Register Here

Foot and Ankle Surgery

---

The review sought to ascertain whether arthroscopic subtalar arthrodesis improves the functional outcome of treated patients, and to compare the two techniques of subtalar arthroscopy (posterior and lateral) with each other. MEDLINE and Cochrane Library databases were accessed by two independent reviewers. Inclusion/exclusion criteria were predefined. National Institute of Health risk of bias assessment tool was used to determine the methodological quality of the included studies. A total of ten studies with 234 patients (240 feet) were included. The most common indication for arthroscopic subtalar fusion was posttraumatic subtalar arthritis. Weighted pre and postoperative American Orthopaedic Foot and Ankle Society scores were 47 and 80.7 respectively. Average time to fusion was 10.2 weeks and weighted mean fusion rate was 95 percent. Although improvement in functional scores was higher and complication rate lower with the posterior group, a better fusion rate was seen with the lateral approach.


This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. There were no perioperative complications in any of the cases. The mean overall Foot and Ankle Outcome Score was 78 for the nine cases in which patient-reported outcomes were available. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal and in three as abnormal.

Practice Management

---

Healthcare providers have a responsibility to ensure the patient experience is as seamless, accurate and pleasant as possible, as consistently as possible. This means providers must communicate with patients even when they are out of the office, which entails eliminating outdated practices like sending cookie-cutter communications, convoluted pricing, automation of human interaction and reliance on separate back-office systems. Providers should adopt an omnichannel approach to communication that delivers an integrated customer experience through various channels, enabling customers to choose how they interact with the people overseeing their patient bill care. Patients also should be informed of service costs before their appointments, while technology and live communication should be balanced. Finally, a centralized system will help to create a seamless experience for both patients and providers.


A survey published in Annals of Internal Medicine found over 40 percent of older Americans said they used online ratings or reviews when choosing their doctor. The researchers analyzed answers from 2,256 Americans aged 50 to 80 years, mostly female and white. The results indicated that 42.9 percent said they had acquired online ratings or reviews for a physician when choosing one for themselves. More women than men opted for this process, as did subjects with at least one chronic medical condition and those with at least some college education or higher compared with those with a high school education or less. Meanwhile, the criteria older adults deemed "very important" when choosing a doctor included whether they took their health insurance and whether they were the same race/ethnicity as them. Online physician ratings and reviews were considered almost as valuable as verbal recommendations and were thought to be "very important" more often among racial/ethnic minorities and less often among respondents with at least a bachelor's degree. "There is often a perception that online information sources are more used by and useful to younger patients, but our results suggest that many older patients are engaging with this information too," said University of Michigan Professor Jeffrey T. Kullgren.


Revenue cycle management (RCM) carries two major benefits for physician practices: cost reductions associated with automating and digitizing claims, billing and reimbursement functions; and improved revenue collection from insurers and patients. RCM software should collect patient insurance and demographic data before they arrive at the point of care and verify it at the time of appointment. Also needed is the ability to confirm insurance information and coverage with respect to the recommended course of treatment and collect co-pay based on insurance information and recommended treatment. Other desirable software capabilities include proper coding and submission of claims to payers using Current Procedural Terminology and International Classification of Disease codes, management of claims processes and delivery of customizable reporting and analysis tools.

Health Policy and Reimbursement

---

Under new federal requirements, both hospitals and insurers must reveal previously confidential pricing data, including the rates that insurers pay for services. Hospitals were supposed to post data at the start of this year, while insurers must comply beginning in 2022. Federal regulators in new guidance say healthcare pricing data that health insurers must post under a new requirement shouldn't be blocked from web searches. The US Centers for Medicare and Medicaid Services (CMS) issued new guidelines after The Wall Street Journal reported that hundreds of hospital pricing-data websites included special coding that kept them from showing up in searches on Google. CMS said the new guidance "helps clarify the intent of this regulation — make the files public and accessible."


According to a Google survey conducted by Insure.com, about 40 percent of respondents said they have put off getting some kind of healthcare because of the pandemic, and 35 percent said they expect to use more healthcare services over the coming year than they used last year. The share of survey takers who said they expect to use more care in the coming year ranged from 30-33 percent for participants ages 18 through 64. In the 65-and-older age group, 39 percent of participants predicted they would use more care.


The Kaiser Family Foundation (KFF) estimated that Medicaid and Children's Health Insurance Program (CHIP) enrollment followed expected patterns by increasing through November 2020, after declining for two years. Actual data indicated the Medicaid and CHIP combined enrollment from February 2020 to October 2020 totaled 7.2 million, while preliminary data led to forecasts that that number would rise by 500,000 to reach 7.7 million enrollees in November 2020. A data note said these estimates "reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid and CHIP enrollees to access a temporary increase in the Medicaid/CHIP match rates." Back in 2017, the number of uninsured children rose to 5 percent, concurrent with a 2.2 percent decline in children's enrollment in CHIP and Medicaid in 2018. KFF researchers think enrollment in Medicaid and CHIP might continue to grow.


A new Kaiser Family Foundation analysis estimates that private insurance companies may pay out $2.1 billion in rebates to consumers this fall, the second highest amount ever issued under the Affordable Care Act (ACA). Individual market insurers account for most of the payments, with expected rebates of at least $1.5 billion, according to the analysis of data reported by insurers to the US Centers for Medicare and Medicaid Services. Rebates in the small and large group insurance markets are expected to be $308 million and $310 million, respectively. The rebates are the result of insurance companies not meeting the ACA's medical loss ratio (MLR) threshold, which requires insurers to spend at least 80 percent of premium revenues (85 percent for large group plans) on health care claims or quality improvement activities. Most people in large group plans are in self-insured plans where the MLR does not apply.

Medicine, Drugs and Devices

---

More than one year into the COVID-19 pandemic, foreign suppliers are still crucial to satisfying elevated demand for personal protective equipment (PPE), prompting manufacturers to urge the federal government to take action so that the United States is more prepared for any future global health crises. Since the start of the pandemic, federal grants, loans and partnerships have boosted the US' PPE manufacturing capacity. Before the pandemic, the US government did not track how much PPE was produced domestically, leaving it short of data to guide its response last spring. When imports of PPE became difficult to obtain as countries around the world grappled with the novel coronavirus, US companies and industries pivoted to manufacture much-needed products. Roughly 95 percent of members of the National Council of Textile Organizations, for example, retooled to produce PPE for the first time. 3M, the largest manufacturer of N95 mask manufacturers, quadrupled its domestic production, while Honeywell added enough domestic capacity to produce one billion N95 masks per year. In spite of these steps, PPE supply remains unstable and prices remain high. Manufacturers also say the federal government has not addressed their questions about the kind of demand they should anticipate in the months to come.


Microsoft's $16 billion deal for Nuance Communications is the latest sign that the next battleground for technology giants will be in healthcare, an industry whose need to embrace data and software was underscored by the pandemic. Analysts and healthcare executives said Microsoft's acquisition of Nuance will let the tech giant tap into Nuance’s big business selling its software to healthcare systems. Speech recognition software, including the software developed by Nuance, is emerging as an important new tool in medicine as doctors seek to speed up documentation of patient work with dictation. Meanwhile, the pandemic showcased healthcare's potential as a growth area for tech companies.


A case study by researchers at North Carolina State University and the University of North Carolina at Chapel Hill showed that a prosthetic ankle powered by neural control technologies could help amputees regain a wide range of abilities with training. Researcher Helen Huang said, "This case study shows that it is possible to use these neural control technologies, in which devices respond to electrical signals from a patient's muscles, to help patients using robotic prosthetic ankles move more naturally and intuitively." The case study focused on activities that are challenging with typical prostheses, like squatting. The powered prosthesis responded to electrical signals from two residual calf muscles that control ankle motion. Researcher Aaron Fleming said, "It is much more similar to the way people move intuitively, and that can make a big difference in how people respond to using a prosthesis at all." Details of the study were published in Wearable Technologies.