News From ACFAS

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Feeling like your office’s coding and billing procedures could use a refresh? Then register now for Coding & Billing for the Foot & Ankle Surgeon, July 26–27 in Dallas, and see how just a few simple changes can strengthen your coding and billing process and lead to more accurate reimbursement.

You and your fellow attendees will work together to code and bill for a week’s worth of actual clinics, surgeries, calls, office procedures and complex cases. Instructors will walk you through each step and help you identify gaps in your own procedures. A special breakout session focused on private and multispecialty practices is also included in the seminar.

Space is limited and filling fast—secure your spot now at acfas.org/practicemanagement and take a hands-on approach to coding and billing. Stay one step ahead of your annual licensure and privileging requirements with the ACFAS e-Learning Portal.

Explore a wide selection of podcasts, Clinical Session videos, e-Books, Surgical Techniques DVDs and more that allow you 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.

Visit acfas.org/e-learning now to browse through these resources and stay tuned for an enhanced e-Learning Portal to debut later this year. The valuable work you do every day to improve your patients’ lives deserves national awareness. If you have an inspiring patient success story to share, please contact us so we can include it in our ongoing public relations campaign.

Let us know how you:

• Helped a patient get back on his or feet through the use of a new surgical procedure
• Restored hope in a patient who felt his or her foot or ankle condition could not be treated
• Helped an athlete recover from a foot or ankle injury
• Worked with a patient to adjust after an amputation
• Detected a life-threatening illness in a patient before it was too late
• Transformed the lives of those in your community

Send your patient story to Melissa Matusek, CAE, ACFAS Marketing and Communications director, at melissa.matusek@acfas.org and watch for updates on this awareness campaign in future ACFAS publications.

Foot and Ankle Surgery

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A systemic review compared radiographic correction, clinical outcomes, complications and reoperations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in pediatric patients. The review included 21 LCL and 13 AR cohorts, with change in anteroposterior talo-first metatarsal angle greater in the LCL than in the AR group. The change in calcaneal pitch was greater in the LCL than in the AR group, while improvements in the American Orthopedic Foot and Ankle Society ankle-hindfoot score were higher in the LCL compared to the AR group.

Percentage of satisfaction was similar between both groups, while the complication rate was higher in the LCL than in the AR group. The most frequently occurring complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively, and reoperation rate was similar between both cohorts.


A study was conducted to assess the results of treating osteochondral lesions of the talus (OLTs) with osteochondral allograft transplantation. A review was performed of 30 athletes with 31 OLTs that were refractory to marrow stimulation or predicted to be refractory based on size and location of the lesion. Lesions treated had an average area of 1.37 square centimeters, and overall excellent outcomes were achieved in 11 ankles. Nineteen ankles realized good or excellent occupational outcomes, and 12 exhibited poor occupational outcomes, making the patients unable to continue their previous active occupations.

Patients had a mean pain scale score of 3 of 10 at a mean of 21 months after operative management. Osteochondral allograft transplantation is an option for treating selected athletes with large OLTs, as well as lesions that are refractory to marrow stimulation techniques.


A study aimed to assess the surgical procedure and clinical significance of posterior tibial artery perforator flaps carrying partial gastrocnemius muscle for subjects with soft-tissue defects with dead space in the ankle area. Fourteen subjects between 20 and 58 years old were hospitalized in the First Affiliated Hospital of Soochow University in China between August 2015 and August 2017. All injuries entailed damage to the ankle area and formation of soft-tissue defects with dead space. Posterior tibial artery perforator flaps carrying partial gastrocnemius muscle were transplanted to cover soft-tissue defects with dead spaces in all patients.

The duration of hospitalization ranged from 10 to 20 days, with all flaps surviving and healing well. Follow-up six to 24 months later showed all patients had undergone successful recovery in terms of aesthetic and functional aspects.

Practice Management

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A PatientPop survey clarified the critical role online reviews of healthcare providers play in patients' selection. The poll found 74.6 percent of more than 800 respondents had researched providers online, with 69.9 percent calling a positive online reputation very or extremely important in choosing a provider. Moreover, 51.8 percent of patients who had submitted negative online reviews about a provider had not been contacted to address their concerns, and addressing bad reviews was found to trigger a doubling of patient satisfaction.

The survey's results suggest failing to foster a strong first impression with online reviews makes the difference between a newly acquired patient and a lost one for doctors and practices.


For the Medical Economics 2019 Physician Report, 22 percent of physician respondents said their practice is doing better than a year ago, 52 percent are doing about the same and 26 percent are doing worse. Most respondents doing better said seeing more patients boosted their revenue. Experts suggest adding staff can be a good starting point for increasing revenue.

The next step is raising productivity by removing inefficiencies, so more patients can be seen throughout the workday. Value-based contracts are another tool for increasing revenue, using Medicare patients as a focal point. Finally, practices can negotiate better payer contracts with proper preparation.


Few physician practices are aware of the Eliminating Kickbacks and Recovery Act of 2018 (EKRA), whose broad classification of a “healthcare benefit program” and “laboratory” makes the statute potentially applicable to almost all practices and clinical labs. Practices have countless interactions with labs, which EKRA assigns the same meaning as used in the Clinical Laboratory Improvement Amendments, applying its proscription to any compensation associated with any referral for such services, regardless of whether the lab test is related to addiction treatment or recovery.

Critically, EKRA only exempts compensation when the employee's and independent contractor's reimbursement does not vary by the number of individuals referred, the number of tests or procedures performed or the amount billed or received. As such, the limitations on compensation for independent contractors and employees are basically identical.

Health Policy and Reimbursement

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States are dramatically cutting health benefits for current and future retirees to deal with mounting liabilities and budgetary austerity. The National Association of State Retirement Administrators says states have been reducing benefits, hiking premiums and fees and narrowing eligibility requirements. According to Eaton Vance, the gap for postemployment benefits, mainly comprised of retiree healthcare, comes to about $600 billion. Meanwhile, the Pew Charitable Trusts calculates that states must pay $1.4 trillion for promised pension benefits. Compounding the issue are U.S. Governmental Accounting Standards Board regulations that forced many states to quantify retiree healthcare obligations.


According to an examination of job-based health insurance by the Los Angeles Times, annual deductibles in job-based plans have nearly quadrupled in the last 12 years, averaging more than $1,300 today. However, more than four in 10 workers enrolled in a high-deductible plan say they do not have enough savings to cover the deductible. Further, one in six Americans with job-based insurance say they have made "difficult sacrifices" to pay for healthcare in the last year, such as cutting back on food, moving in with friends or family or taking extra jobs. Another one in five say healthcare costs have swallowed all or most of their savings.


The U.S. Congressional Budget Office (CBO) reports that creating a single-payer healthcare system in the United States would be a "major undertaking that would involve substantial changes" to medical coverage, and the transition would be "complicated, challenging and potentially disruptive." However, CBO says disruption could be minimized by phasing in changes gradually. CBO also indicated that adopting universal coverage "would significantly increase government spending and require substantial additional government resources," and total medical spending in a single-payer system "might be higher or lower than under the current system," depending on its design.

Medicine, Drugs and Devices

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Forty-four percent of doctors said electronic health record (EHR) systems have reduced the quality of care in the primary workplace, while 40 percent said the technology has increased it, a new Medscape survey shows. The survey of nearly 300 respondents also found that 42 percent of nurses and advanced practice registered nurses said EHRs have increased the quality of care, while 35 percent said the technology decreased it. Few physicians or nurses were involved in the decision of which EHR to use in their primary workplace, the poll revealed.


The Maryland General Assembly recently cleared legislation that made the state the first to create a panel to review expensive prescription drugs and cap what public agencies will pay for them. The effort has prompted lawmakers in Nevada, Maine and Massachusetts to consider legislation to create similar boards. The bill's backers express confidence that the measure can survive court challenges that have stalled other efforts in Maryland and elsewhere on drug price reform.


A review of studies of patients at 10 academic U.S. hospitals determined that most prefer physicians wearing the traditional white coat, without realizing that the apparel can be a breeding ground for dangerous bacteria and viruses. White coats were found to be frequently contaminated with strains of harmful and sometimes drug-resistant bacteria linked to hospital-acquired infections. As many as 16 percent of white coats contained MRSA, while up to 42 percent had bacterial class Gram-negative rods.

In addition, stethoscopes, phones and tablets can be laced with harmful bacteria. A study of orthopaedic surgeons demonstrated a 45 percent match between the species of bacteria found on their ties and in the wounds of patients they had treated. Potential fixes include antimicrobial textiles.