News From ACFAS

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Prepare yourself for the new E&M coding changes set to hit January 1, 2021 by attending Coding and Billing for the Foot and Ankle Surgeon. Register for one of two workshops available this year in September and now December, to replace the July date because of the COVID crisis.

September 11-12
(Friday/Saturday)
Palmer House Hilton
Chicago, IL
Register

December 4-5
(Friday/Saturday)
Walt Disney Swan & Dolphin Hotel
Lake Buena Vista, FL
Register

Join experts and walk away with the tools you need to simplify your coding and reimbursement practices. Visit acfas.org/practicemanagement to register now! As some states are slowly returning to normal, ACFAS would like to remind you we’re here for you and continuing to work to bring you helpful tips and information through our COVID Resources webpage and behind the scenes.

The ACFAS COVID Resources page includes exclusive resources to help you in your practice, including: position statements, practice management tip sheets, information on ACFAS OnDemand, tips for communicating with your patients and information for students and residents to access ACFAS online resources.

Visit acfas.org/COVIDResources to access the latest information. We continue to update the page as new information becomes available, so check back regularly. If you have any questions or need further assistance, contact an ACFAS team member. Summer isn’t looking like the “normal” summers we are used to – but it’s still an opportune time to reach out to your patients with the latest issue of FootNotes—available now in the ACFAS Marketing Toolbox.

This issue is a timely resource for patients finding themselves dealing with foot and ankle conditions amid the COVID-19 crisis. The lead article helps patients know they can still visit you in your office or via a virtual appointment and also outlines what practices are doing to keep patients and staff safe and healthy. Articles also include safety tips for runners who are able to get outside as a release from stay-at-home orders, ways to spot a Morton’s neuroma and how to keep your feet pain free and safe while making the transition into flip flops this summer.

Use FootNotes to maximize your reach and market your practice to current and potential patients by adding your practice information into the customizable second page. Distribute in it in your office, post to your website or share on social media. Visit the Marketing Toolbox at acfas.org/marketing to read the latest issue now. Stuck at home? Use this time to polish your CV and post it to the College’s job board PodiatryCareers.org. Here you can post your resume, view available jobs in your area or read articles on hiring and interviewing during the pandemic. If you're an employer recruiting new talent, be sure to take advantage of the ACFAS member discount to post your openings!

The annual ACFAS Job Fair returns during ACFAS 2021 in Las Vegas and will include open positions, resumes from job seekers and individual appointments with a professional resume reviewer. It’s not too early to start planning now! Watch for more details on how to participate as the event gets closer.

Foot and Ankle Surgery

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The study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence reaction (PPR) for the treatment of Haglund syndrome. Twelve patients who underwent DCWCO and 32 patients who underwent PPR were evaluated using the American Orthopaedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler’s angle and calcaneal pitch angle preoperatively and postoperatively. Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS and VISA-A scores than the PPR group at six months and three months, respectively, but had higher scores for both at the latest follow-up. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler’s angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group.


The study aimed to determine differences in pain scores in patients undergoing preoperative block versus postoperative block versus no block. Researchers conducted a retrospective cohort analysis of 302 consecutive patients undergoing unilateral open reduction and internal fixation of ankle fracture under general anesthesia. They identified three patient groups: preoperative block, postoperative block or no block. Researchers determined that patients receiving preoperative block had significantly lower pain scores, less intraoperative or postanesthesia care unit opioid use and shorter postanesthesia care unit dwell time compared with patients receiving postoperative block or no block. They conclude that preoperative popliteal sciatic and adductor canal blocks in patients undergoing ankle fracture surgery appears to be more effective than either postoperative block or no block.


Researchers collected data on the pain medication use of fifty consecutive patients undergoing outpatient percutaneous foot surgery. A mean of 3.3 tablets of oxycodone were consumed during the first two weeks. No patient was taking narcotics after two weeks, and mean time to return to work was 18.9 days. The authors conclude that percutaneous foot and ankle surgery led to a significant reduction in narcotic consumption.

Practice Management

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As of March 17, the US Department of Health and Human Services' Office for Civil Rights (OCR), which enforces the Health Insurance Portability and Accountability Act, has held that video chat tools are now available to physician practices for treating patients remotely. Practices should secure confirmation that patients understand that the platform used to receive telehealth-based care is not secure. Moreover, they should communicate to providers that they must completely document the interaction with patients to ensure accurate billing. According to the OCR guidance, providers should not use public-facing video communications platforms when providing care to patients.OCR's March 20 guidance says that a telehealth-based visit doesn't have to be for a COVID-19-related condition. Practices should require remote billing staff to log into the practice's systems using two-factor authentication and discourage employees from saving any files onto the hard drives on their computers at home, among other security measures.


This document outlines some of the clinical, operational and financial actions that practices should take to reopen. This includes ensuring that sanitation procedures are visible to ensure that patients are calm and attend their scheduled appointments. Patients want to hear from their providers, not administrators, so practices should make sure their physicians have an outlet and a voice. Flexibility is key, and practices should be prepared to reschedule patients in the event of a sudden closure. Larger practices should keep in mind that, if there is a resurgence of the virus, the subsequent shutdowns will be localized to a particular region. Practices need to know their supply chains and maintain regular contact with vendors and local hospitals, especially those hospitals' capacity for transfer in the event of post-surgical complications. From an economic perspective, it may be more efficient to add capacity to an existing surgery center than to build a new one as volume increases.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services has issued the Final Notice of Benefit and Payment Parameters for the 2021 benefit year, containing several provisions intended to promote affordable insurance coverage. Under this design, an issuer can offer a plan that provides high-value services with zero cost sharing. The rule also makes it easier for plans in the individual market to offer wellness incentives to enrollees by recognizing certain incentives as quality improvement activities. The final rule maintains the lower user fee rates set in the 2020 payment notice for issuers participating in the federal exchanges. Federal and state-based user fees for the 2021 benefit year will be maintained at 3 percent of premium and 2.5 percent of premium, respectively, the hope being that insurers will pass on savings to consumers in lower premiums. In addition, the rule strengthens policy around the mandated annual reporting of state-required benefits. The rule also finalizes changes to the periodic data-matching processes to reduce the risk of incorrect advance payments of tax credit payments to deceased or dual-enrolled patients.


Even after abandoning the Affordable Care Act (ACA) exchanges in the program's early years, health insurers now view the exchanges as a way to expand their base and earn profits as job-based health insurance faces the threat of COVID-19 as businesses trim payrolls. There also have been major cuts to Medicaid. Insurers now view the ACA marketplace as stable, especially if more healthy enrollees enter the marketplace. UnitedHealthcare, for example, said it's re-entering Maryland's ACA market and plans other expansions after abandoning 34 states' ACA exchanges since 2016. Anthem and Cigna have also made incremental moves over the past two years. A recent Kaiser Family Foundation study found insurers serving ACA patients saw continued profits last year, and that there were no signs that the elimination of the law's individual mandate which took effect in 2019 led to a widespread exodus of healthy customers. Almost 27 million Americans could lose their job-based coverage due to the pandemic, according to Kaiser.


The US Internal Revenue Service has introduced a new policy that will make it easier for employers to allow workers to adjust their health insurance plans and flexible spending accounts in response to the COVID-19 pandemic. Under the new guidance, employers can let their workers drop out of their health insurance or sign up if they failed to do so earlier in the year. Workers could also be allowed to add more family members to their plan or switch from one workplace plan to another. Under the new guidance, employers will also be able to allow workers to make changes to pretax flexible spending accounts that pay for health expenses and dependent care. Employers may also offer exceptions on rules for rollovers. The new guidance does not allow for extensions for flexible spending accounts that began their year in January, but people in those accounts can generally halt their savings and try to spend what they have accumulated so far.


The US Centers for Medicare and Medicaid Services (CMS) have proposed a rule that would updated Medicare payment policies for hospitals paid under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital PPS for fiscal year 2021. The rule proposes a separate hospital payment category for Chimeric Antigen Receptor T-cell therapy (CAR-T), which are currently paid at the same rate as bone marrow transplants and qualify for additional payments through a temporary add-on that is set to expire this year. The new inpatient hospital payment category for CAR-T will provide a predictable payment rate for hospitals administering the therapy. The rule includes proposals to remove barriers to new antimicrobials. To support access to these critical antibiotics for Medicare beneficiaries, CMS is proposing changes for the new technology add-on payment, an additional payment to hospitals for cases using eligible high-cost technologies.

Medicine, Drugs and Devices

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The American Medical Association (AMA) has issued new privacy principles supporting an individual's right to access, control and delete personal data collected about them. AMA says it will use the new privacy principles to engage lawmakers on the future direction of regulatory guardrails needed to restore public confidence in data privacy protections. The update comes as COVID-19 has led to unprecedented reliance on remote care technologies, like telehealth, to help people avoid leaving their homes. Similarly, many private and public efforts are underway to collect, use and disseminate public health surveillance data to help inform public health officials and policymakers about the spread of the novel coronavirus. AMA believes the primary purpose of boosting guardrails around data use is to build public trust, not to inhibit data exchange.


As many hospitals face shortages of personal protective equipment (PPE), projects and websites have emerged to match hospitals with non-traditional sources of equipment. The collaborations fill gaps until supplies from regular distributors arrive and also help the finances of hospitals that have seen revenue plummet during the crisis. One such platform is The Exchange at Resilinc, a new online trading platform from Stanford Health Care, Premier and Resilinc. In its first two weeks, The Exchange had posted requests for more than 575,000 items and offers of 1.8 million items as of May 11. Other platforms include Vizient, which has a site for hospitals with spare supplies to donate or sell them to other hospitals; Cohealo, which is coordinating a national reserve of ventilators and Helping Hospitals, which is finding medical workers whose regular jobs have been disrupted to work temporarily at hot-spot hospitals. Meanwhile, several foundations are focused on sourcing donated PPE to hospitals facing shortages.


An increasing number of patients are turning to mail or courier to get their prescription drugs during coronavirus lockdowns. During the last week of March, mail-order prescriptions rose 21 percent from the previous year to bring their share of the prescription drug market to 5.8 percent, the highest share in at least two years, according to data from SunTrust Robinson Humphrey analyst Gregg Gilbert. To compete, many local pharmacies have ramped up their own mail-order and home-delivery services during the pandemic, said Douglas Hoey, CEO of the National Community Pharmacists Association. He said many patients prefer interacting with pharmacists and worry about their medicines arriving on time.