News From ACFAS

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It’s been a challenging year thus far, but as April is National Volunteer Month - it makes it the perfect time to thank all our outstanding volunteers for their hard work and dedication to the College.

Whether it’s serving on a committee, the Board of Directors, mentoring students and residents or leading educational programs as a faculty member, we couldn’t do what we do without your help. We are thankful for volunteers like you always going above and beyond to further the College’s mission.

We celebrate our wonderful volunteers all year because we wouldn’t be able to do what we do without you. Lately everyone’s experiencing new challenges as we adjust to life during a global pandemic. From a foot and ankle surgeon’s standpoint, there are many issues that can arise. However, there are things you can to do to not only manage your patient load and keep your staff safe, but to ensure your practice is thriving now and after the health crisis passes.

For some, the move to telemedicine and adjusting to a slower patient volume in the office means more downtime. While this is anxiety inducing for some, it doesn’t have to be. New Jersey-based foot and ankle surgeon Maryellen Brucato, DPM, FACFAS suggests looking at the silver lining in the situation, "Instead of worrying about how slow your office is, be grateful to have the time to refocus and reorganize.” She also adds, “Beyond COVID, we all need to be prepared to be extremely busy!”

Here are ways to take advantage of the downtime and thrive throughout this crisis to prepare for the “reignite.”

• Develop a post-COVID-19 marketing plan – use the ACFAS Marketing Toolbox for help – acfas.org/marketing
• Write content for your blog or social media accounts so your posts will be ready to go and already done when you’re busy seeing patients again
• Refresh and update patient handouts and patient education materials
• Participate in industry-led practice management webinars, including ones from the College
• Earn CME with ACFAS online educational resources—ACFAS OnDemand and new webinars are a great option to keep fresh – acfas.org/OnDemand
• Reach out to other healthcare specialists you know to make them aware you are open/still seeing patients
• See if your hospital has volunteer opportunities due to short staffing/overwhelming demand
• Feature local small businesses in your area on your socials to help get them more customers/followers

Dr. Brucato also suggests using this time to ramp up networking, improve patient education and outreach and work on long-term projects. “The connections you can make with your community during these tough times will have a long-term impact on your practice,” she adds. “You’ll be grateful you took advantage of the unprecedented time once we transition back into our normal routines.” The College has had to shuffle some courses as the nation moves to flatten the COVID-19 curve. We’re taking steps in the right direction, and now have two rescheduled courses coming your way this fall—On the Road: Fixing a Flat has been moved to September and November.

September 11–12, 2020
(Friday/Saturday)
On the Road with ACFAS - Fixing a Flat
DoubleTree Suites by Hilton Charlotte SouthPark
Charlotte, NC

November 13–14, 2020
(Friday/Saturday)
On the Road with ACFAS - Fixing a Flat
Embassy Suites by Hilton St. Louis Downtown
St. Louis, MO

We’re looking forward to getting back to a new normal and hope to see you in Charlotte and St. Louis this fall! Visit acfas.org/OnTheRoad to register today.
There have recently been numerous reports of a correlation between foot rashes and COVID-19. In response, two registries have been created to study the effects of COVID-19 on feet.

The American Academy of Dermatology (AAD) has created a dermatology registry and podiatric physician and forensic podiatrist Michael Nirenberg, DPM and Congressman Brad Wenstrup, DPM, FACFAS have created a foot registry. Both registries are asking for all healthcare professionals who have provided care for COVID-19 patients who also developed skin rashes or other discoloration to fill out a survey.

This is a collaborative effort that is dependent on participation from the healthcare community. Please consider sharing this with your colleagues and complete the foot registry or dermatology registry surveys if you’ve seen patients with these types of symptoms. The ACFAS Board of Directors approved six Policy Position Statements at the February 2020 Board Meeting in San Antonio. These position statements were updated by the ACFAS Health Policy Committee.

• Credentialing of Podiatric Foot and Ankle Surgeons and Guidelines for Surgical Delineation of Privileges Statement
• Guidelines for Institutional Credentialing and Privileging and Due Process Rights Statement
• Practice Management Competencies for Foot and Ankle Surgeons Statement
• Total Ankle Replacement Surgery Statement
• Cosmetic Surgery Statement
• Uniform Licensure of Doctors of Podiatric Medicine Statement

These updated position statements are now available on the Health Policy and Advocacy section of acfas.org. Here you can also view all past position statements.

Foot and Ankle Surgery

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The study sought to evaluate independent risk factors associated with non-home discharge following total ankle arthroplasty (TAA) as well as risk factors associated with a prolonged hospital length of stay (LOS). Researchers conducted a retrospective analysis of 722 TAAs, wherein 68 patients experienced a non-home discharge following the surgery. Independent factors for a non-home discharge were a LOS greater than two days, age being 65 years, being female and having hypertension. A total of 174 patients stayed in the hospital for more than two days. Significant risk factors for a longer length of stay were age equalling 65 years, being female, operative time greater than 150 minutes and an inpatient admission status.


In this study, researchers used magnetic resonance imaging (MRI) to examine the variations of the Achilles tendon (AT) insertion point in the calcaneal bone (CB) in relation to age and sex. A total of 202 foot and ankle MRIs were reviewed and patients were allocated into age three groups based on whether they were under 18, between the ages of 18 and 65 or over 65. Researchers found that the distance between the most inferior point of the CB and the most inferior part of the AT insertion into the CB increases with age. Moreover, the height of the AT insertion into the posterior aspect of the CB appears to decrease with age, as does the length of the AT insertion into the posterior aspect of the CB. The terminal insertion point of the AT on the CB was more distal in younger subjects and more proximal in older subjects.


The study investigates whether opioid use disorder (OUD) patients have increased costs of care, emergency room visits and readmission rates after open reduction and internal fixation (ORIF) of ankle fractures. ORIF patients with a 90-day history of OUD were identified using an administrative claims database and matched to controls. A total of 2,184 patients underwent ORIF, including 485 with OUD. OUD patients incurred significantly higher costs of care compared with conrols and had higher incidence and odds of emergency room visits. The 90-day readmission rates were not significantly different between patients with and without OUD.

Practice Management

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Approximately 9,000 healthcare workers have had positive coronavirus tests as of April 9, according to a US Centers for Disease Control and Prevention (CDC) analysis released Tuesday. Although most were not sick enough to be hospitalized, 27 died, CDC said. These numbers are believed to be an undercount of infections due to the continuing lack of available tests in many areas. Some regions and institutions are no longer testing healthcare workers, reserving kits for the sickest patients. A separate CDC report on a case at a hospital in Solano County, CA, found that a patient who arrived on February 15 was discovered to have had COVID-19 11 days later. The report noted 121 staff had been exposed to the virus. Of the 43 staffers who subsequently experienced flu-like symptoms and were tested with nasal swabs, three had confirmed infections—making them among the first known cases of occupational transmission in a hospital. While two of those three workers were involved in higher-risk procedures that tend to kick the virus into the air, the third was not. "These findings underscore the heightened COVID-19 transmission risk associated with prolonged, unprotected patient contact," said CDC, which also called for early identification and prompt isolation of patients who are infected.


In the most recent MGMA Stat poll, 89 percent of healthcare leaders said that their organizations still use on-premise fax machines, creating an obstacle to electronic health record (EHR) interoperability. Digital fax companies are partnering with practices and EHR companies to drive the move from paper to digital paths for exchanging data. Physician's practices can implement cloud fax technology to modernize their document processing capabilities without changing their existing health IT infrastructure. Existing fax numbers can be easily ported to a digital fax service, allowing the full, secure exchange of patient information between EHR and other healthcare applications. The technology eliminates the need for traditional on-premise fax infrastructure, reducing associated manual work and costs and also improves the security of protected health information. Cloud-based fax and AI technology solutions have not eliminated the need for human oversight, and work still needs to be “checked," but the improvements they make are still significant.


There are a number of ways that physicians can use technology to optimize their work-life balance. One way is to make use of mobile applications that provide HIPAA-compliant ways to communicate with patients and access medical information remotely. Practices can also use mobile-friendly technology to offer patients an electronic payment option where they can receive a text and securely pay through their phone. Physicians can shape the technology they use around their needs if they choose a practice platform that has flexible notes, reports, tabs and dashboards, allowing for faster documentation. Practice managers should actively monitor their financial data to understand where the process can be improved. Technology can also help physicians enhance face-to-face patient interactions, allowing them to review medical information, improve understanding and generate more meaningful time together.

Health Policy and Reimbursement

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According to a study by private health insurance marketplace eHealth, 17 percent of insurers plan to raise rates by no more than 5 percent. eHealth received responses from 33 health insurance companies between March 30 and April 2. Ninety-seven percent of respondents also said they were waiving out-of-pocket fees for COVID-19 tests. Fifty-eight percent of respondents said they would cover out-of-pocket costs for treatment. Within the group of insurers who said they would waive the costs of treatment, 80 percent say they will cover all associated costs, but 20 percent are covering a portion of costs.


The Trump administration has issued guidance clarifying coverage requirements for private payers in two bills passed to fight the outbreak of COVID-19. Under the bills, commercial health plans are required to access the free COVID-19 testing available at doctor's offices, urgent care centers and emergency departments. “It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” said US Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in a statement. “Today’s action under the leadership of President Trump allows millions of Americans to access the vital health services they need to fight COVID-19, including antibody testing once it becomes widely available.” Many insurers have waived cost-sharing for telehealth and inpatient admissions related to COVID-19. CMS said that the antibody testing will be critical to easing the current social distancing requirements and getting Americans back to work.


According to the White House, hospitals taking money from the $2 trillion stimulus bill passed by Congress will have to agree not to send "surprise" medical bills to patients treated for COVID-19. Surprise bills typically happen when a patient with health insurance gets treated at an out-of-network provider during a procedure or in an emergency room. The prohibition on surprise billing will protect patients covered by government programs, employer plans or self-purchased insurance. Hospitals that accept the grants will have to certify that they won’t try to collect more money than the patient would have otherwise owed if the medical attention had been provided in network. The ban on surprise billing appears to apply to doctors as well as hospitals.

Medicine, Drugs and Devices

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Analysis has identified 440 clinical studies that have been suspended since March 1 due to the COVID-19 pandemic. About a quarter of these studies were for cancer treatment, and some of them involved as many as 200,000 people. Drugmakers, university medical centers, hospitals and community research centers have all suspended various research projects because of the outbreak. Many institutions try to keep studies going if they have a "direct benefit" for patients, but where to draw that line can be unclear. A key consideration is whether study participants' extra visits to healthcare facilities are worth the risk of catching the coronavirus. Another factor is whether healthcare staff are available to continue running trials despite the added burden COVID-19 is putting on hospitals and clinics. Clinical trials can be crucial for patients with serious conditions, some of whom do not have access to other care. Some studies are able to adapt, however, as the FDA has published guidelines allowing for more flexibility during the COVID-19 pandemic. This may mean restricting visitors or sending pharmaceuticals via mail instead of through an in-person consultation.


The US Food and Drug Administration (FDA) has issued an emergency use authorization (EUA) that could decontaminate approximately 4 million N95 or N95-equivalent respirators per day in the United States for reuse by healthcare workers in hospital settings. The EUA to Advanced Sterilization (ASP) for the STERRAD Sterilization Cycles, which uses vaporized hydrogen peroxide gas plasma sterilization. There are approximately 9,930 STERRAD systems in approximately 6,300 hospitals across the United States, and each system can reprocess approximately 480 respirators per day.


Google is rolling out new features in its Search and Maps products to direct those seeking medical care to available doctors, including available telehealth options. Healthcare professionals can set up their own virtual care offering in their Google business profile, and Google will then surface the option “to get online care” and schedule a visit when people are searching for a provider. In a blog post introducing the feature, the company said it has seen “interest in virtual care and telehealth rise dramatically" during the COVID-19 pandemic. Google wants to facilitate virtual care delivery so that fewer people need to leave their homes in the midst of a pandemic. Google recently introduced a website that shows the level of social distancing taking place in various locations based on information collected from Google apps and services on people's phones.