Banner
May 18, 2022 ACFAS.org | FootHealthFacts.org | JFAS | FASTRAC | Contact Us

News From ACFAS


More Comprehensive Fixation for Residents Coming in November
If you missed last week’s Comprehensive Fixation for the Ankle and Foot: A Resident’s Course, don’t panic! You have another chance November 9-10 to join us for a deep dive into podiatric internal fixation surgery.

This course offers a small resident to faculty ratio allowing for close mentorship, and a redesigned agenda focused on shorter lectures with ample time for hands-on learning. With this course, you’ll gain real-life experience in:
  • Major rearfoot and ankle arthrodesis techniques
  • Complications that can result from internal and external fixation
  • Specialty plating and external fixation techniques
  • Preoperative planning
  • Psycho-motor skills
Earn 17.25 CME credits as you learn about and execute the principles and techniques for stable internal fixation for fracture management, aspects of diagnosis, and treatment and subsequent management of these injuries.

Visit acfas.org/skills for more information and to register today!
Share Facebook  LinkedIn  Twitter  | Web Link
New ACFAS Update is Hitting Mailboxes Soon
Get all the latest College news with the latest issue of Update hitting mailboxes soon. Newest issue of ACFAS Update

We’re wrapping up ACFAS 2022 with highlights from this year’s record-breaking meeting in Austin. In this issue you’ll also find all the latest College news and upcoming courses including Arthroscopy Skills, another Comprehensive Fixation course and Coding and Billing being offered both virtually and in person. It’s all in this issue of Update!

Can’t wait to get yours in the mail? Visit acfas.org/Update to read the latest in College news now.
Share Facebook  LinkedIn  Twitter  | Web Link

Foot and Ankle Surgery


An Umbrella Systematic Review and Meta-Analysis of Systematic Reviews on the Topic of Foot and Ankle Arthrodesis Nonunion Rates
A systematic review and meta-analysis were held to appraise and integrate available reviews disclosing nonunion incidence and prevalence in foot and ankle arthrodesis surgeries. Researchers searched the Cochrane Library and MEDLINE for relevant systematic studies from inception to January 2022, with 14 reviews of eight types of joint arthrodesis procedures selected for meta-analysis, constituting 138 studies with 5,793 joint arthrodesis procedures. The pooled prevalence for foot and ankle nonunion rate stood at 8.1 percent, while overall prevalence of nonunion for single joint foot and ankle joint arthrodesis was 6.1 percent. Subgroup analysis determined that the highest rate of nonunion occurred during tibiotalocalcaneal arthrodesis with 27.1 percent. The nonunion rates are lower than previously published statistics.

From the article of the same title
Journal of Foot & Ankle Surgery (05/04/22) Coye, Tyler L.; Tirabassi, Nathan; Foote, Courtney M.; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Callus Distraction for Brachymetatarsia — a Comparison Between an Internal Device and the External Fixator
A study highlighted the advantages and shortcomings of treating severe brachymetatarsia via callus distraction with external mini-fixator (EF) and internal device (ID), examining 21 metatarsal bones in 12 patients. Twelve metatarsals were treated with ID and nine underwent EF. The mean lengthening distance was 17.3 mm with EF and 11.7 mm with ID. Adverse results were noticed in 89 percent of metatarsals treated with EF and in 33 percent treated with ID. Postoperative surgical intervention was necessary in 33 percent using EF versus 0 percent using IS. The mean total German Foot Function Index improved from 49 to 33 using EF and from 47 to 22 via ID.

From the article of the same title
Foot and Ankle Surgery (04/22/22) Toporowski, Gregor; Thiesen, Roman; Gosheger, Georg; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Rotation Scarf + Akin Osteotomy for Severe Hallux Valgus With a New Evaluation Index: Distance Between the First and Second Metatarsals
A retrospective study sought to assess the outcomes of rotation scarf in combination with Akin osteotomy on severe hallux valgus. The parameters assessed included the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position (TSP), length of first metatarsal bone and ratio between the vertical distance from the lateral of the first metatarsal head to the medial of the second metatarsal head and the vertical distance of lateral of the second metatarsal head to the medial of the third metatarsal head (MT-I to II/II to III distance). Significant improvement was seen in all radiological parameters, including HVA, IMA, DMAA and TSP. An average shortening of 3.1 mm was observed on the length of the first metatarsal. The MT-I to II/II to III distance was also reduced to 1.8 following surgery and 3.3 prior to surgery. The visual analog score and the American Orthopaedic Foot & Ankle Society Forefoot Score was also statistically significant before operation and at the last post-surgical follow-up.

From the article of the same title
BMC Musculoskeletal Disorders (05/05/22) Vol. 23, No. 421 Xie, Wenyong; Lu, Hao; Li, Guicheng; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

Practice Management


Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians
A pilot randomized clinical trial of 101 female resident physicians investigated whether a six-month online group-coaching program centering on various learning styles could mitigate burnout, moral injury and impostor syndrome while improving self-compassion. Following six months of professional coaching, emotional exhaustion declined in the intervention group by a mean of 3.26 points versus a mean gain of 1.07 points in the control group. The intervention cohort also experienced a significant reduction in presence of impostor syndrome compared with controls . Self-compassion scores rose in the intervention group by a mean of 5.55 points compared with a mean reduction of 1.32 points among controls. No statistically significant differences in depersonalization, professional accomplishment or moral injury scores were noted.

From the article of the same title
JAMA Network Open (05/05/22) Fainstad, Tyra; Mann, Adrienne; Suresh, Krithika; et al.
Share Facebook  LinkedIn  Twitter  | Web Link

How to Streamline Claims for Rural Practices
Claims for rural practices can be significantly eased by processing them in both UB-04 and 1500 billing environments. UB-04 edits should be enhanced with appropriate claims software, which should also issue early claims denial alerts, leaving billers more time to examine each anomalous claim and take proactive steps to submit a claim that will receive proper reimbursement. Software should also examine every explanation of benefits (EOB), matching claims and sending any aberrations back to billing staff immediately. They can trace the reasons for payment anomalies and determine the next remedial steps.

From the article of the same title
Physicians Practice (05/03/22) Stuart, Rob; Lutton, Logan
Share Facebook  LinkedIn  Twitter  | Web Link

Medical Education Programs Tell How Climate Change Affects Health
Hospitals, medical schools and public health programs are offering future doctors as well as veteran medical professionals new educational initiatives focused on climate change and its health impacts. "With increasing attention on our climate, we really recognize there's a real gap in physician knowledge, both in pediatric and adult care," explains Marilyn Howarth, MD, at the Philadelphia Regional Center for Children's Environmental Health. The center will train providers on better screening protocols for climate-caused health risks and treatment for related conditions such as lead poisoning and asthma. Howarth said the outreach component will target providers who treat patients with illnesses associated with climate change. The Harvard T. H. Chan School of Public Health also offers a program that researches climate and health and educates people ranging from high school students to healthcare veterans. Aaron Bernstein, MD, MPH, interim director at the School's Center for Climate, Health and the Global Environment, says, "There's clearly a wave building here, and I think it really started with education and people younger than the people in charge calling them into account."

From the article of the same title
Medscape (05/10/22) Kalter, Lindsay
Share Facebook  LinkedIn  Twitter  | Web Link

Medical Practice Efficiency Is Possible Even With a Small Staff
Medical practices can maintain high levels of efficiency with a small staff, as Michigan Surgery Specialists' Nicole Fick recalls. Her company did this during the pandemic by switching its electronic medical record to a cloud-based, specialty-specific electronic health record system, significantly cutting down on faxing and scanning paperwork. Another successful strategy involved upgrading front desk technology. That included replacing manual check-ins and appointment scheduling with e-check-in options for patients. Fick's practice also migrated to a patient engagement platform that highlights easy communication. Also beneficial was the rollout of a patient portal to transform patient-practice communication, which offered patients easier access to medical records where and when they need them. Staff billing fully transitioned to a remote-work format, which eliminated the cost of maintaining a building for billing staff personnel.

From the article of the same title
Medical Economics (05/11/22) Fick, Nicole
Share Facebook  LinkedIn  Twitter  | Web Link

Health Policy and Reimbursement


Hospitals Look to Raise Treatment Costs as Nurses' Salaries Increase
Some hospitals are pushing health plans to increase payouts by up to 15 percent as nurses' wages rise. Sources familiar with negotiations say some hospitals are asking to hike their prices by 7.5 percent to 15 percent. Employers and insurers say hospitals typically seek 4 percent to 6 percent increases and garnering the raises they are after would likely lead to higher premiums for employers and workers. Insurer and employer groups are balking and say the priciest hospitals can take in higher labor costs without raising their rates. Purchaser Business Group on Health CEO Elizabeth Mitchell says the highest-priced hospitals are paid over five times the rates paid by Medicare, which she finds unjustifiable. Premier Inc. estimates that average yearly base pay for hospital nurses had reached $86,674 as of March, up 9 percent from $79,172 in June 2021, when the Delta variant gripped the country.

"If payers are unable to give us sufficient rate increases at a minimum to sort of absorb at least a portion of this inflation and particularly the labor inflation, [then] I think we're willing to cancel contracts," declared Universal Health Services Chief Financial Officer Steve Filton. HCA Healthcare CEO Samuel Hazen said the group will ask insurers and employers for higher prices to start in 2023 after incurring $500 million in higher-than-expected labor costs this year. 'We believe our pricing is competitive in the markets we serve, and transparency helps demonstrate that," stated an HCA spokesperson.

From the article of the same title
Wall Street Journal (05/08/22) Evans, Melanie
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Millions of Americans Could Lose Medicaid Coverage when COVID-19 Pandemic Ends: Report
An analysis by the Kaiser Family Foundation estimates that millions of consumers who gained Medicaid health insurance during the COVID-19 pandemic could lose coverage this year or in 2023, after the Biden administration determines that the COVID-19 public health emergency has concluded. The analysis believes sign-ups for full and partial Medicaid coverage will increase by 25 percent to 110 million by the end of September. To cover Medicaid enrollees during the pandemic, states received more than $100 billion in Medicaid funds and fiscal relief over the past three fiscal years while spending an estimated $47 billion. However, the additional federal funding will stop during the quarter in which the public health emergency is declared over. The federal government will continue to pay a portion of the Medicaid tab for enrollees, but the federal match will be less generous. As a result, some states may seek to conduct rapid eligibility evaluations to ensure that only those who fully qualify remain in the program. The public health emergency is tentatively scheduled to end on July 15. Officials at the US Department of Health and Human Services say the Biden administration will inform states 60 days before ending the emergency, indicating that the notification would need to come next week if the Biden administration intends to end the emergency in July. If the emergency ends, state Medicaid agencies will have 12 months to determine the eligibility of every person and notify those who no longer qualify.

From the article of the same title
USA Today (05/10/22) Alltucker, Ken
Share Facebook  LinkedIn  Twitter  | Web Link

Medicine, Drugs and Devices


COVID Shutdowns in China Are Delaying Medical Scans in the US
US doctors are delaying medical imaging because pandemic-related shutdowns of manufacturing facilities in China have choked off supplies of contrast media. Medical staff must inject contrast media into blood vessels so computed tomography scanners and other imaging devices can look inside the body. The shortage has forced many doctors to prioritize the most seriously ill patients and postpone more routine tests for those who can wait until the contrast media shortage ends. GE Healthcare told hospital officials that capacity at its plant in Shanghai was at 25 percent this week, and it expects to resume normal capacity by the end of June. University of Michigan Professor Matt Davenport said millions of patients worldwide could have tests postponed in the coming month. Soumi Saha at medical group purchasing agent Premiere said the crisis "further demonstrates the fragility of the supply chain, where a few weeks' disruption in manufacturing results in several months of disruption to patient care."

From the article of the same title
Washington Post (05/11/22) Rowland, Christopher
Share Facebook  LinkedIn  Twitter  | Web Link

Lawmakers Wade into a Contentious Battle over Orphan Drug Monopolies
US Sens. Bill Cassidy (R-LA) and Sen. Tammy Baldwin (D-WI) have proposed legislation to shed light on how drugmakers may monopolize orphan drugs. Under existing law, pharmaceutical firms receive incentives to seek broad orphan drug designations from the US Food and Drug Administration (FDA), even if they study only a limited subset of patients. Companies that gain orphan drug designation receive a seven-year monopoly that prevents potential competitors from obtaining FDA approval for a different use or other groups of patients. Cassidy said, "Vague laws can be exploited, resulting in fewer patients getting the treatments they need to survive. This bill clarifies the law to ensure incentives to innovate continue to produce lifesaving cures for our rarest diseases." The bill was introduced in response to a legal dispute that the US Supreme Court was asked to review about a treatment for Lambert-Eaton myasthenic syndrome (LEMS), a rare neuromuscular disorder. A federal appeals court earlier this year refused to revisit a ruling that FDA improperly approved a drug sold by Jacobus Pharmaceuticals to treat LEMS. The agency eventually withdrew final approval for the medicine, enabling Catalyst Pharmaceuticals to have a monopoly over the US LEMS market.

From the article of the same title
STAT News (05/11/22) Silverman, Ed
Share Facebook  LinkedIn  Twitter  | Web Link - May Require Paid Subscription

Prescription Drug Rebates on the Rise
A study in JAMA Health Forum indicates that prescription drug rebates from drugmakers to commercial health plans are steadily rising. The authors note, "While drug rebates can reduce plans' net costs, rebates do not reduce patients' cost sharing." The authors concluded that this can "incentivize drug manufacturers to inflate list prices and pharmacy benefit managers to distort drug formularies to favor high list price and high-rebate therapies." The authors also said this issue is about fairness, in particular for people who purchase individual plans. Ge Bai, a professor of accounting at Johns Hopkins Carey Business School who was one of the study authors, points out: "We have the sick people paying more than their fair share for the drug and the rebate goes back to the plan to reduce premiums for the healthy." The issue has been attracting the attention of a bipartisan group of lawmakers who seek to prohibit rebates as part of a legislative measure to cap the price of insulin.

From the article of the same title
Axios (05/09/22) Reed, Tina
Share Facebook  LinkedIn  Twitter  | Web Link


     

This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS


Contact Us

For more information on ACFAS and This Week @ ACFAS, contact:

American College of
Foot and Ankle Surgeons
8725 W. Higgins Rd.
Suite 555
Chicago, IL 60631
P: (773) 693-9300
F: (773) 693-9304
E: ThisWeek @acfas.org

Visit Us: Friend us on Facebook Follow us on Twitter Link us in on LinkedIn



This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

Some publication websites may require user registration or subscription before access is granted to the links following the articles. If an article is unavailable online, a link is provided to that publication's homepage.

Copyright © 2022 American College of Foot and Ankle Surgeons

To change your email address, please click here. If you wish to unsubscribe, click here.

News summaries © copyright 2022 Smithbucklin