News From ACFAS

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Don’t miss your chance to be a part of Virtual ACFAS 2021. The last day to register for the virtual event of the year is May 12 so secure your spot today to be a part of ACFAS’ Annual Scientific Conference May 18-21.

Here’s what’s in store for you through the ACFAS Digital Portal:

• 26 CME hours of Educational Content Recorded at the Conference – this is not a live-streamed event
• Ability to Browse the Virtual Exhibit Hall and Virtual Product Showcase
• Access to the ePosters
• Plus, Be a Part of the Wide Variety of Additional non-CME Education, Including Industry Webinars, Videos and More

Visit acfas.org/LasVegas to register today! Whether you're in Vegas for ACFAS 2021 or at home, get a behind the scenes look at this year’s conference by following #ACFAS2021 on social media.

The College’s social media feeds can be found through the conference's mobile app or from your own social media accounts. If you're joining us at the conference or virtually, let us know!

We look forward to experiencing #ACFAS2021 in a new way with you! The ACFAS Animation Video Library is growing with fun new ways to educate your patients. Check out the patient animation video library for another way to educate your patients:

• Foot Care for Those Living with Diabetes: offers patients dealing with diabetes conditions to watch out for and how to check feet to avoid issues
• Post-Surgical Care Instructions: gives post-op recovery tips and shows how to get around safely on crutches
• Proper Foot Stretching Techniques: for stretching techniques to help battle conditions like plantar fasciitis or Achilles tendonitis
• Knee Walker/Roll About Use: for those patients who are looking to get around safely while recovering from an injury

The videos are available for you to share with patients during their visit, on your website or social media accounts to explain some of the most common instructions you give during appointments.

Visit the Marketing Toolbox at acfas.org/Marketing to download a video today, and keep checking back for additions to the series.

Foot and Ankle Surgery

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A single-center, retrospective case-control study evaluated the impact of computer-controlled cooling versus no cooling on pain levels in adult patients surgically treated for an ankle or hindfoot fracture. The research involved patients who used a computer-controlled cooling device pre- and post-surgery between January 1, 2015, and January 1, 2017. Pain scores in the 18-patient cooling group did not statistically diverge from the 17-patient non-cooling group. Following surgery, less patients in the cooling group used paracetamol and NSAIDs, and patient satisfaction of both groups was eight out of 10 points. Total hospital length of stay (HLOS) was 14 days in the cooling group and nine days in the non-cooling group, mostly due to the difference in pre-operative HLOS and time to surgery. Complications and revision surgery did not diverge.


Research presented at EHRA 2021, an online scientific congress of the European Society of Cardiology, indicates that annual foot assessments in diabetic patients can help detect atrial fibrillation. The 12-month study included 300 patients with diabetes attending their annual foot screening appointments, and subjects with rhythm abnormalities during pulse palpation of their foot arteries received a Doppler ultrasound. Participants were 60 years old on average, with 180 men and 120 women. Fifty-one patients (17 percent) had previously undiagnosed atrial fibrillation, with the disorder diagnosed in a similar proportion of men and women. Patients were told to visit a cardiologist for an electrocardiogram to reinforce the diagnosis and discuss treatment. "The study has identified a simple, quick and low-cost way to identify patients with diabetes who have a heart rhythm disorder they were unaware of," said Ilias Kanellos at the European University of Cyprus. "This intervention has the potential to avoid strokes and preserve quality of life in this patient group."


A prospective cohort study assessed potential risk factors leading to a poor patient-reported functional outcome at two and five years post-ankle fracture fixation. Follow-up data was available for 82 out of 180 patients at two years and 94 patients at five years. At two years, age 60 or more predicted worse Lower Extremity Functional Scale (LEFS), while a body mass index of 30 or higher was a predictor of worse Olerud-Molander Ankle Score (OMAS). Severely deformed ankle at presentation exhibited worse OMAS and LEFS score, yet these predictive factors were not significant at five years. An anatomically reduced ankle fracture fixation was more likely to lead to a better functional outcome at the two- and five-year follow-ups. OMAS reduction at two years anticipated possible ongoing issues after surgery, which consequently raised the odds of worsening OMAS at five years.

Practice Management

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Since 2012, prescriptions for new opioid analgesics declined by more than one-half as more physicians became aware of their addictive qualities. However, physicians in the United States continue to prescribe significantly more of the drugs compared with those in other countries, says Andrew Kolodny, medical director of opioid policy research at Brandeis University. The US Centers for Disease Control and Prevention estimates that more than 88,000 Americans died from overdoses during the 12 months ending in August 2020. A new study found that for every 1,000 long-COVID patients, known as "long haulers," who were treated at a Veterans Affairs (VA) facility, physicians wrote nine more prescriptions for opioid analgesics than they otherwise would have, along with 22 additional prescriptions for benzodiazepines that are used to treat anxiety. The new study is the first to demonstrate that physicians are using more addictive medications, says study lead author Ziyad Al-Aly, MD, chief of research and education service at the VA St. Louis Health Care System. The study, published in Nature, found that many patients have considerable muscle and bone pain. More than 3 million of the 31 million Americans who contract COVID-19 develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety and memory problems. Al-Aly is concerned that even a potentially small increase in the inappropriate use of opioid analgesics could cause a resurgence of the opioid crisis.


Email phishing attacks remain a significant threat for physician practices, and providers should consider a multilayered protective strategy. Email authentication tools like Domain-Based Message Authentication, Reporting and Conformance block all bogus attacks that spoof trusted domains. Domain monitoring is also worth investing in to automatically identify and flag potentially risky domains that were recently registered by fraudsters. Security awareness training can give employees the skill to recognize and report cybersecurity threats, and domain name spoofing emails can be blocked with an inbound email security protocol which prevents them from reaching the inbox.


KPMG's Chris Ober and Lori Robbins discuss the financial challenges of selling a physician practice, with Ober noting that bidding is somewhat more minimized because most health systems are required to be within a framework-of-value safety range stipulated by the Stark laws and anti-kickback rules. "Basically, investors are interested in what the return on investment would be in terms of the cash flows being generated in the business going forward," he says. Ober adds that primary physician practices "that historically been paid above what fair market value ranges for physicians of similar productivity and similar collections and so forth, based on the benchmarking data...may expect that when they align with that health system." Robbins recommends that physicians should get their own tax advisers, "because sometimes a buyer will come to a physician practice and want them to actually do some restructuring before the sale ever occurs. And the doctor should be looking to make sure that their own interests are being protected and not just rely on the buyer to represent them."

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) released the proposed fiscal 2022 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital rule, and it projected that hospital payments would increase by $2.5 billion in the 2022 fiscal year that begins October 1. CMS also proposed a 2.8 percent increase in operating payment rates for acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and are users of meaningful electronic health records. In addition, CMS proposed to extend an add-on payment for new COVID-19 treatments through the end of the fiscal year when the public health emergency ends. Further, CMS said it is eliminating the Trump-era requirement for hospitals to post their privately negotiated Medicare Advantage rates in their Medicare cost reports because it could impose an "unnecessary burden on hospitals." The agency is seeking public comments on the entire proposed rule until June 28.


Researchers at Johns Hopkins Bloomberg School of Public Health report that Americans face significant costs from out-of-network bills for clinical laboratory services. Their retrospective cohort study covered claims data for more than 3.9 million people with private health insurance who underwent lab work on an outpatient basis in 2018. Within the sample population, 5.9 percent of patients were billed for lab services designated as out of network. Out-of-pocket spending for an out-of-network lab service was $25 higher than for comparable service provided in-network. On average, the investigators calculated, patients potentially had to pay an estimated additional balance of $80.63. Moreover, out-of-network billing for lab work affected far more people than out-of-network billing for other kinds of services. Just 4.9 percent of patients with emergency department visit claims and 3.4 percent of those undergoing anesthesiology, for example, were billed for out-of-network services.

Medicine, Drugs and Devices

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President Biden gave his first joint address to Congress to mark his first 100 days in office, with much of his speech focused on the future of healthcare in this country. Medicare should be empowered to negotiate prices, he said, which would lower prescription drug costs. "We pay the highest drug prices of anywhere in the world right here in America," Biden noted. "Nearly three times for the same drug, nearly three times what other countries pay. We can change that." The president also wants to lower premiums and deductibles under the Affordable Care Act, which has netted an additional 800,000 subscribers this year through a special enrollment period opened by his administration.


More than 100 patient advocacy groups and medical organizations are calling on the US Department of Health and Human Services (HHS) to make prescription medications more affordable. In a letter to HHS Secretary Xavier Becerra, the organizations say the issue has become worse during the COVID-19 pandemic. The groups list five potential solutions to the drug pricing issue, including putting spending caps on prescription drugs. Meanwhile, AARP sent a letter to President Biden asking the administration to work on drug pricing issues, noting that older adults with fixed incomes are particularly at risk. "We know this will be a hard fight, but the time to act is now," the letter said.


The US Centers for Disease Control and Prevention's opioid prescribing guideline has failed to reduce addiction and overdoses, significantly worsened the quality of pain care in the United States and should be revoked, according to a large new survey of patients and healthcare providers by Pain News Network, an independent, non-profit news organization. Nearly 4,200 patients and providers participated in the online survey, which was conducted as the Centers for Disease Control and Prevention prepares to update and possibly expand its 2016 guideline, which discourages doctors from prescribing opioid pain medication.