News From ACFAS

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The College surveyed members last week to identify their biggest professional and practice-related challenges they expect to face in the next year due to the COVID-19 crisis.

While there was a range of concerns listed, the overwhelming majority were tied to keeping practice doors open. Top concerns included patient and surgery volume; providing a safe environment for patients, self and staff; combating fear of going to doctors' offices; covering office expenses; obtaining CME; maintaining salary base/cash flow; telehealth setup and maintenance; job security and availability; ability to keep and pay staff; and stress and burnout.

This feedback is extremely important and will help ACFAS strategize ways to better support you as we continue navigating this uncharted territory together. Watch ACFAS newsletters for the latest news and resources put together to help members. ACFAS expanded its national public relations campaign in coordination with the COVID crisis to keep consumers healthy and aware that foot and ankle surgeons are still available to help them, both virtually and in the office, during this unprecedented crisis.

The campaign includes an expansion of touch points to consumers through a new “We’re Open & Here for You” paid social media ad campaign and daily social media posts featuring news articles from FootHealthFacts.org on appointment availability and ways to stay active and healthy during the pandemic. A national press release was also distributed on ways to access your foot and ankle surgeon both through telehealth and in-person, and has reached over 144.5 million people and the reach keeps going.

Watch for the summer edition of FootNotes, coming soon, which will also feature similar articles on availability of care and safety concerns for returning to the office that you can share with your patients and potential patients. Visit acfas.org/Marketing for all the resources you’ll need to help market your practice through COVID-19. Take advantage of the time at home with endless learning opportunities from ACFAS OnDemand. Stay one step ahead of your annual licensure and privileging requirements.

Check out the College’s e-Learning portal and access a wide range of podcasts, Clinical Session videos, e-Books, Surgical Techniques DVDs and more to earn CME hours at your convenience. New products are added to the e-Learning Portal every six months, and each tool in the portal includes a short exam you can complete and submit to obtain your CME.

Class starts when you’re ready! Visit acfas.org/OnDemand to see all ACFAS OnDemand has to offer. Get your research ready! The Annual Conference Program Committee will soon be accepting applications/papers for scientific manuscript presentations at the 79^th Annual Scientific Conference, February 25-28, 2021 in Las Vegas.

Information on submission criteria and applications will be available on the Annual Scientific Conference web page early next month, so you have time to start gathering your research submissions.

Foot and Ankle Surgery

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The study investigated the impact of heterotopic ossification after Achilles tendon ruptures on clinical outcomes and whether early mobilization or weightbearing prevents the development of heterotopic ossification. Researchers conducted a retrospective analysis of 69 patients that had been treated with one of three different early rehabilitation protocols after surgery: late weightbearing and ankle immobilization, late weightbearing and ankle mobilization and early weightbearing and ankle mobilization. Postoperative radiographs were analyzed for heterotopic ossification, which was detected in 19 percent of patients at 52 weeks. Heterotopic ossification had no adverse effects on patient-reported outcomes, tendon strain or range of motion. In fact, patients with heterotopic ossification tended to have a better HRI at 52 weeks compared with patients without. Neither the occurrence nor the heterotopic ossification severity differed between the three rehabilitation groups. Seventeen percent of the patients with early functional rehabilitation had heterotopic ossification, while late weightbearing and immobilization resulted in heterotopic ossification in 13 percent of the patients.


The study presents a novel surgical technique using a periosteal-only medial femoral condyle (pMFC) free flap in the treatment of talus avascular necrosis (AVN). We retrospectively reviewed six pMFC free flaps performed in five female patients with a mean age of 44.2 years from 2016 to 2018 in the precollapse stage of talus AVN. Surgical management included an ankle arthroscopy, talus core decompression and ipsilateral pMFC free flap to the talus. Foot and Ankle Ability Measure–Activities of Daily Living (ADL), ADL single assessment numeric evaluation and visual analog scale (VAS) pain scores showed significant improvement after operation. No reoperations or flap complications were observed, and there was one minor complication involving postoperative paresthetsias at the pMFC harvest site. Postoperative x-rays showed no subsequent collapse, and postoperative magnetic resonance imaging (MRI) illustrated progressive improvement of bone marrow edema, decreased surrounding areas of AVN and decreased joint effusion compared to preoperative MRI.


The study analyzes the outcomes of percutaneous reduction and 2.7 millimeter cortical screw fixation for low-energy Lisfranc injuries, aiming to determine whether the procedure is a safe alternative to traditional screw fixation using a larger screw size. Thirty-one patients undergoing this procedure were assessed for demographics, foot function index (FFI), numerical rating scale (NRS) for pain, patient satisfaction and complication rates. The FFI and NRS for pain were 17.2 and 3.1 ± 2.3 points, respectively, at the 12 month followup visit. One patient underwent arthrodesis for the development of posttraumatic arthritis; all other patients recovered without sequelae. Screw breakage was identified in seven patients. There was no significant difference between patients with and without screw breakage in terms of FFI, NRS for pain, patient satisfaction or complication rate. Body mass index (BMI) was significantly higher in patients with screw breakage. Receiver operator characteristics curve analysis demonstrated a strong relationship between BMI and screw breakage.

Practice Management

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It is important for healthcare organizations to review their cybersecurity practices as new vulnerabilities arise from the COVID-19 pandemic. Remote work and care delivery has given rise to a host of security complications around the increased usage of personal computers, various network resources and access methods and third-party conferencing platforms. Practices need to be wary of phishing emails and text messages that exploit patients' and providers' sensitivities to pandemic-related communications. Hackers are also seeking vulnerabilities in network devices like gateway and virtual private networks. Many physicians now relying on online video conferencing tools could inadvertently give an unauthorized person the ability to enter a patient visit. Cloud technology, meanwhile, has some security advantages over desktop access, because as long as sensitive data remains in the cloud, other apps cannot access it. Practices can also use built-in security mechanisms provided by the mobile operating system to securely store encryption keys.


Policymakers and insurers across the country say they are eliminating co-payments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason. However, a fragmented health system means the shift to cost-free telemedicine for patients is going far less smoothly than announcements suggest. In some cases, doctors are billing for telephone calls that used to be free. Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it's covered by insurance. Insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers, and executives at telehealth organizations say insurers have been slow to update their software and policies. One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only.


Understanding optimal screening, diagnostic and treatment strategies is imperative for effectively addressing opioid use disorder (OUD), writes Sarah E. Wakefield, MD, of Massachusetts General Hospital and Harvard Medical School. While there currently is no screening tool available specifically for OUD, she suggests that a robust approach in care settings might be to simply ask the number of times in the past year that a patient has used an illegal drug or taken a prescription drug for nonmedical reasons. For diagnosis, the standard is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—which includes 11 factors such as difficulty controlling opioid use, continued opioid use resulting in a failure to meet normal obligations and use despite associated health problems.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) is suspending its Advance Payment Program to Medicare Part B suppliers. The agency is re-evaluating the amounts it will pay under the program, which is available to fee-for-service Medicare providers such as hospitals, in light of the $100 billion already sent to providers through the program. CMS had expanded the loan programs to ensure providers and suppliers had resources needed to combat COVID-19, approving more than 24,000 applications and advancing more than $40 billion to Part B suppliers in the last several weeks. Prior to COVID-19, the agency had only approved just over 100 of such requests.


The US Supreme Court ruled that the federal government must live up to its promise to shield insurance companies from some of the risks they took in participating in the exchanges established by the Affordable Care Act. Justice Sonia Sotomayor wrote for the majority, while Justice Samuel Alito was the lone dissenter. Sotomayor wrote that the court's decision upholds "a principle as old as the nation itself: The government should honor its obligations." The Affordable Care Act promised insurers they would be protected through so-called risk corridors, a promise that ended up putting the government on the hook for payments as losses outpaced gains for insurers. But Congress enacted a series of appropriation riders that seemed to ban the promised payments, prompting a lawsuit from insurance companies. The US Court of Appeals for the Federal Circuit sided against the insurance companies, who then brought the case to the Supreme Court. In his dissent, Alito contended that Congress had not authorized the payments to insurers, making them invalid.


Experts say healthcare spending declines related to delayed elective surgeries and other care have more than offset the added costs of COVID-19 care. Those gains, however, could be short term, depending on how quickly the coronavirus outbreak subsides and healthcare business begins to return to something close to normal. While extended hospital stays, particularly in intensive care units, can rack up massive bills for individuals, that pales in comparison to the savings from millions of Americans delaying care. Those savings also outpace the costs to insurers of waiving COVID-19 related co-pays, deductibles, tests and other care. Federal authorities have said hospitals could resume more routine care as appropriate as states begin to ease some social-distancing measures.

Medicine, Drugs and Devices

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To safely deliver prescription medications to residents in a Florida retirement community, CVS Health and UPS are collaborating with the Federal Aviation Administration (FAA) to use drones. Starting in May, the 135,000 residents in The Villages' age-restricted community can receive their medications via Matternet's M2 drone system. UPS says the drones will drop off prescriptions to a location near the community, and a truck will complete the delivery. The initiative is intended to assist a vulnerable community during the COVID-19 pandemic. UPS and CVS starting examining drone delivery last year. UPS Flight Forward and its partner Matternet were the first drone delivery services to receive full certification from FAA to operate a drone airline.


A survey of 32,000 nurses by the American Nurses Association found that more than half say they are short or have ran out of critical healthcare equipment, including N95 masks, surgical masks, gowns, goggles, hand sanitizers and face shields. The survey also found that 68 percent are concerned about being short-staffed, and more than 87 percent are afraid to go to work. Twenty-six percent of respondents have struggled to isolate vulnerable patients and 36 percent have treated patients with infectious diseases without the proper protection. Furthermore, 26 percent of respondents report making their own surgical masks, 17 percent made their own N95 mask, and 14 percent have made hand sanitizer, goggles and face shields. Meanwhile, 50 percent said they did not have the training to perform COVID-19 testing.


A new OnePoll survey indicates that when prescribed a new medication, four in 10 Americans feel they were not well informed about the drug. The survey of 1,000 Americans who were prescribed medications found that 41 percent had unanswered issues after receiving a prescription, including medication safety (53 percent), potential adverse effects (61 percent) and cost (54 ppercent). The survey also found that 76 percent of respondents were unaware of potential treatment options, while 37 percent felt they have little to no control over what the pharmacy hands them.