News From ACFAS

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J.C. (Chris) Mahaffey, MS, CAE, FASAE, executive director of ACFAS since 2003, has submitted his intent to resign effective February 29, 2020, following the 2020 Annual Scientific Conference.

“Associations also have circles of life, and this is one of them. The College and I are both ready for change,” said Mahaffey. “I leave with great pride in the growth and maturity of the College while working side by side with so many passionate leaders and staff over the years.”

The ACFAS Board has developed a thoughtful succession plan and will engage a CEO succession consultant to assist in selecting an executive search firm who will then meet with the Board in July. It is premature for search firms or candidates to make any contact with the College currently. This process follows the current best practices in association CEO succession.

ACFAS President Christopher Reeves, DPM, FACFAS, saluted Mr. Mahaffey’s leadership in the College. “Few associations have had the benefit of a more dedicated executive than Chris. For over 16 years, his vision along with the strong leadership of our past and current leaders, has propelled ACFAS to be ‘The’ organization for foot and ankle surgeons.”

Notable achievements during Mahaffey’s tenure include ACFAS becoming an independent organization; growth in membership, revenues, CME attendance and net assets; many new programs and services; strong ethics policies; and award-winning PR programs—all with staffing and operational costs below industry means. Where else will you experience seven total ankle implants in just two days? Register now for Total Ankle Arthroplasty, September 6–8, 2019 at the Science Care Lab in Denver.

Expand your surgical skills as you implant seven replacement systems (five primary and two revisions) while working step by step with instructors in an interactive cadaver lab. Hone your decision-making processes and gain new insights on TAA’s role in managing degenerative, posttraumatic and systemic ankle arthritis in your patients.

Space for this course is limited to just 16 participants. Download the registration form from acfas.org/skills to determine if you meet the course prerequisites. Fax the form with required documentation to (800) 381-8270 or email it to hjelm@acfas.org. Strengthen your professional relationships with referring physicians in your area by encouraging them to visit the Take a New Look at Foot & Ankle Surgeons website, TakeANewLook.org.

There they can access:

• When to Refer guidelines
• Surgeon Spotlights
• Fact sheets
• FAQs
• The “Find a Foot and Ankle Surgeon” search tool
• A video detailing foot and ankle surgeons’ training and qualifications plus their role in diabetes care

Show other providers how you can partner with them to improve patient care. Refer to TakeANewLook.org often and also log in to acfas.org/marketing for more free referral tools to help you promote your practice and the profession. Like, share and comment on ACFAS’ Facebook posts to connect with the College and your colleagues and to stay up to date on the latest ACFAS news. Start a conversation, write a review or let us know if you will be attending one of our upcoming seminars or courses.

Also be sure to follow FootHealthFacts.org, our consumer website, on Facebook so you can share foot and ankle health tips with your patients. If you are an incorporated practice owner and routinely meet with patients at other local hospitals, clinics or practices, having a company car help save your personal vehicle from added wear and tear. Also, when you own or lease a vehicle for your practice, you can:

• Deduct mileage for business-related travel during tax time
• Write off a percentage of your monthly car payment and any gas expenses

If you’re interested in purchasing a car for your practice, Healthcare Associates Credit Union (HACU), an ACFAS Member Benefit Partner, is offering a reduced rate on loans for new or used cars. Visit hacu.org to learn more.

Foot and Ankle Surgery

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A study sought to assess maximal dorsiflexion versus neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome, using 20 matched pairs of anatomical ankle specimens. In neutral position, 13.7 plus or minus 1.2 mm of the talar dome was achieved laterally and 14.0 plus or minus 1.0 mm medially.

In maximal dorsiflexion, the distance was 19.0 plus or minus 1.1 mm laterally and 19.8 plus or minus 1.4 mm medially. In noninvasive distraction, it was 16.1 plus or minus 1.5 mm laterally and 15.7 plus or minus 1.0 mm medially. Statistical comparison showed a significantly augmented reach in dorsiflexion laterally and medially.


A study was held to determine the early range of motion, complication rates and one-year patient-reported outcomes following Achilles tendon repair, using a modified giftbox suture loop technique. Sixty consecutive patients received Achilles tendon repair via this technique. Range of motion at the final follow-up visit, Achilles tendon rupture score (ATRS) and the complication rates at 12 months were obtained with 83 percent follow-up.

Overall rerupture rate was 1.7 percent, wound complication rate was 1.7 percent and overall complication rate was 6.7 percent. No predictors of complications were observed, and complication rates did not differ between the first 30 and the second 30 cases. The mean ATRS at one year was 81.8 plus or minus 16.8 points, while rerupture and overall complication rates by one year were low. Range of motion, particularly dorsiflexion, improved through at least six months, and patients with diabetes had lower one-year ATRS than patients without diabetes.


A study was conducted to characterize pneumatic tourniquet inflation's impact on tissue oxygenation in the inducement of tissue ischemia during extremity surgery. The researchers analyzed data on 26 patients. Tourniquet inflation time was 120 plus or minus 31 minutes. Following rapid desaturation from 77 plus or minus 8 percent preinflation to 38 plus or minus 20 percent at 10 minutes postinflation, somatic oxygen saturation (SstO2)-distal slowly and continuously desaturated and reached the nadir toward the end of inflation.

Following deflation, SstO2-distal quickly resaturated from 16 plus or minus 11 percent to 91 plus or minus 5 percent, while SstO2 monitored proximally to the tourniquet and on contralateral leg had significant but small desaturation. Cerebral tissue oxygen saturation remained stable. Desaturation load correlated significantly with resaturation magnitude, as did desaturation duration with hypersaturation magnitude. The researchers concluded that tissue dysoxygenation following tourniquet application can be reliably monitored using tissue oximetry.

Practice Management

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More social interaction between surgeons and patients can go a long way toward making patients feel more comfortable, especially when they face serious medical procedures. Part of this new presurgical protocol includes the surgeon emailing patients' family members long before the operation is scheduled, while just before the procedure, the surgeon pauses and reads the responses. These and other forms of interaction are essential for ensuring practitioners do not lose sight of their empathy. By learning about patients' lives and their effect on other people, healthcare providers are less likely to dehumanize the people they treat. In this way, they avoid becoming "comfortably numb" and unwittingly perpetrating this dehumanization.


The growing frequency of active shooters and workplace violence demonstrates the need to include active shooter insurance in practice risk management strategy. Many physicians own unrelated commercial real estate and may also sponsor public events, which must be assessed for the same security and insurance issues as the practice itself. Active shooter insurance can cover areas, including physical damage, legal liability and litigation defense, crisis management and public relations, business interruption coverage and medical, funeral and death benefit liability.

Practice leaders should also strive to guarantee that the policy does not include any exclusions that reduce or negate its value. Such exclusions can include terrorism, casualty threshold limits, employee or vehicle exclusion, mental anguish and domestic violence.


A study found physicians in direct primary care (DPC) models learn that their overhead declines compared to the insurance reimbursement-based model, with a 40 percent overhead reduction for DPC practices. The main reason is they require fewer staff members because they do not bill insurance, but they also employ fewer to no midlevel professionals, as the physician assumes the entire clinical role.

Starting any practice from scratch may require additional costs to rent, buy or outfit the office, and it can take time for physicians in DPC practices to earn a salary equal to their traditional practice days. Prior to starting a practice, physicians should consider the eventual patient panel size, how much time to allocate per visit and how many days and hours providers will spend seeing patients in the office. They should also forecast overhead like office space, insurance, office supplies and programs, such as electronic healthcare records.

Health Policy and Reimbursement

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In recent months, the Trump administration has been working behind the scenes on a strategy to force greater price disclosure across much of the healthcare industry. Sources say the strategy relies on existing administrative tools, including U.S. Labor Department powers under the law that set minimum standards for private health plans and current hospital payment rules under Medicare. The sources note the administration is interested in forcing insurers to publicize the negotiated rates they pay for services, including insurers providing coverage in the private employer market. In addition, they say the White House wants doctors and hospitals to give patients their total price of care before they receive services or treatment, whether or not the healthcare provider is in the patient's insurance network.


U.S. House Energy and Commerce Committee Chair Frank Pallone Jr. (D-N.J.) and ranking member Greg Walden (R-Ore.) released a draft bill aimed at tackling surprise medical bills. A bipartisan group of lawmakers in the Senate plan to release their own version of the legislation, while other senators are working on their own measure as part of a broader package to lower healthcare costs. The bills comes as President Donald Trump has said the administration would hold insurance companies and hospitals accountable. Officials want to make sure patients have the same out-of-pocket costs in network or outside and that patients are better informed about potentially unexpected payments. The House bill would set the rate that insurers would pay doctors. The Senate group plans to use an arbitration approach.


The U.S. Centers for Medicare and Medicaid Services (CMS) issued guidance for Medicaid and CHIP managed care plans regarding the calculation of a plan's Medical Loss Ratio (MLR), which represents the percent of premium revenue that goes toward actual claims and activities that improve healthcare quality, as opposed to administrative costs and profits. CMS regulations require Medicaid and CHIP managed care plans to report an MLR and use an MLR target of 85 percent in developing rates. The target means that only 15 percent of the revenue for the managed care plan can be for administrative costs and profits. CMS is concerned that some managed care plans are not accurately reporting pharmacy benefit manager spread pricing when they calculate and report MLRs.

Medicine, Drugs and Devices

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The U.S. Food and Drug Administration (FDA) issued final guidance regarding the pathway for "interchangeable" biologics, which may be substituted without the involvement of the prescriber. The guidance on interchangeability will be of use to developers who want to demonstrate that their proposed biological product meets the statutory interchangeability standard under the Public Health Service Act. According to Acting FDA Commissioner Ned Sharpless, the "final guidance gives an overview of important scientific considerations in demonstrating interchangeability with a reference product and explains the scientific recommendations for an application or a supplement for a proposed interchangeable product."


Civica Rx, a nonprofit drugmaking venture established by a group of hospitals, plans to begin distributing vancomycin hydrochloride and daptomycin before the end of September. The antibiotics are an important staple of hospital efforts to deal with drug-resistant bugs. Hospitals use the antibiotics often to treat bacterial infections that other antibiotics cannot. Vancomycin has been in and out of shortage since 2002. Daptomycin grew scarce more recently.


Many people have become captivated by the idea of using stem cells to fix their damaged joints, and some claim to have been helped. However, no clear evidence exists that these treatments work, and their safety has yet to be established. Most researchers think that efforts to sell therapies involving adult stem cells have gotten way ahead of the science. Even so, hundreds of clinics in the United States are trying to meet the demand. Some of these clinics also inject joints with platelet-rich plasma, a solution of platelets extracted from the patient's own blood. A few employers have even agreed to provide insurance coverage for the treatments.

There is almost no regulatory oversight of orthopaedic procedures using bone marrow extracts or platelets, which are regarded as low risk. While the U.S. Food and Drug Administration insists that it has the authority to regulate stem cell treatments, it adopted an industry-friendly approach in 2017 by giving companies a three-year grace period in which to describe their products or treatments so the agency can determine whether they meet the criteria of drugs that would require agency approval. So far, few companies have submitted any information.