News From ACFAS

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Take advantage of the next coding and billing educational courses in Orlando August 25-27 to sharpen your coding and billing skills.

Coding Fundamentals starts the educational series off on August 25 for a half-day course teaching the foundation of coding and billing. Then stay for the full course, Coding and Billing for the Foot and Ankle Surgeon August 26-27. Each course can be taken separately or together as a series with special bundle pricing.

Coding Fundamentals
August 25
Walt Disney World Dolphin Resort
Orlando, FL

Coding and Billing for the Foot and Ankle Surgeon
August 26-27
Walt Disney World Dolphin Resort
Orlando, FL

Courses are open to residents, practicing surgeons and their office staff. Don’t leave money on the table - learn from the experts on how to get reimbursed properly for the care you provide.

Visit acfas.org/practicemanagement for more information. Registration opens soon for both courses. You have plenty of chances to join us for our popular Arthroscopy of the Foot and Ankle Surgical Skills Course in 2022! Don’t miss a chance to get the latest techniques, didactic lectures and surgical demonstrations at this ACFAS workshop in Chicago.

July 9-10, 2022 (Sold Out)
October 1-2, 2022
November 12-13, 2022
December 10-11, 2022

These two-day, interactive courses led by skilled arthroscopy surgeons will give you the opportunity to learn and practice established and cutting-edge techniques in foot and ankle surgery with 9+ hours of hands-on lab time with the latest equipment and techniques. The lecture presentations will include videos of actual arthroscopy cases with ample time for faculty interaction.

Courses are selling out fast, so visit acfas.org/skills to register and secure your spot at one of these upcoming courses!

Foot and Ankle Surgery

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A study was held to compare the results from ankle distraction arthroplasty and supramalleolar osteotomy for treatment of Takakura-Tanaka stage 3 post-traumatic varus ankle arthritis. Thirty-two patients received ankle distraction arthroplasty while 41 underwent supramalleolar osteotomy from January 2016 to December 2019. Significant improvement in visual analog scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, range of motion and most radiographic parameters was observed at an average of 32 months compared to preoperative baselines for both groups. Yet neither group showed significant diversion n terms of VAS or AOFAS, excellent and good rate, overall rate of postoperative complications or various radiographic parameters. The ankle distraction arthroplasty cohort exhibited better postoperative ankle motion than did the supramalleolar osteotomy cohort as measured by plantarflexion, dorsiflexion, varus and valgus.


Researchers conducted a study to assess a model to forecast severe rebound pain after foot and ankle surgery entailing single-shot popliteal sciatic nerve block. Included were 1,365 patients undergoing lower limb surgery with popliteal sciatic nerve block from January 2016 to November 2019. The multivariable logistic regression model for severe rebound pain was defined as transition from well-controlled pain in the post anaesthesia care unit to severe pain within 48 hours. The primary outcome was summarized in 1,311 patients, with 652 seeing severe rebound pain. Internal validation indicated poor model performance, with area under the receiver operating characteristic curve 0.632, Nagelkerke's R² 0.063 and scaled Brier score 0.047. Calibration slope achieved a score of 0.832. Given the model's poor predictive performance, prospective studies involving other patient-related predictors are necessary.


An analysis was conducted to rate the content and quality of YouTube videos about hallux valgus on YouTube, focusing on the first 50 videos published by typing "hallux valgus" in the search engine. All videos were analyzed with JAMA, DISCERN, GQS and VPI scores. Six of the videos (12 percent) were from academic sources, 14 (28 percent) came from commercial product vendors, 13 (26 percent) were fby medical animation organizers, eight (16 percent) originated with physicians, four (8 percent) were from physiotherapists, two (4 percent) were from physical training trainers, one (2 percent) was from patients and two (4 percent) were from trainers. The videos' mean JAMA score was recorded as 2 (1-4), GQS at 3.02 (2-5), DISCERN at 37.56 (26-68) and Video Power Index at 41.35 (0-470). This indicates that video quality about hallux valgus is low.

Practice Management

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A prospective randomized clinical trial at three US hospitals in metropolitan areas estimated how much expansion increases patient understanding of 10 common abbreviations in their health records. Only English-speaking adult patients with diagnosed heart failure were included, and 30 controls were individually randomized to read clinical text with abbreviations, while another 30 read abbreviations with expansions. The abbreviations and expansions included were hrs (hours), MD (medical doctor), BP (blood pressure), ED (emergency department), yo (year old), pt (patient), HF (heart failure), hx (history), HTN (hypertension) and MI (myocardial infarction). Sixty randomized patients, whose mean age was 66 and who were 30 percent female, completed the trial and were included in the analysis.

Comprehension scores were significantly higher among patients in the intervention group who got expansions compared to controls who received abbreviations. Significant differences in comprehension were noted only for moderately difficult terms such as HTN, while a subgroup analysis of controls found only inadequate health literacy significantly corresponded to comprehension of fewer abbreviations. These outcomes suggest post hoc or automated expansion of medical abbreviations and acronyms can enhance patient understanding of their health information and may work to the advantage of national initiatives to provide patients with electronic access to their own documentation.


By setting up a digital front door, medical practices can remove impediments to care by streamlining a complicated process into a patient-focused online experience. Its benefits include the convenience of 24-7, yearlong access to care through phone, desktop or mobile app. A second advantage of a digital front door is affordability through the cost savings of giving patients the right care at the right time for the right price. A third benefit is direct access to doctors, sometimes within minutes, who can respond on the platform each patient is using. A fourth advantage of a digital front door is the ability and opportunity it offers to re-engage patients and reinforce their preventative and continuing care. A fifth benefit is the digital front door's enhancement of the overall patient experience of personalized care.


Researchers recently reported their findings about a tool designed by the US Department of Veterans Affairs to decrease the use of potentially inappropriate medications (PIMs). Lifespan, a Rhode Island-based nonprofit health system whose partners include Brown University, reported a significant decline in the number of such prescriptions to older adults on discharge from the emergency department. After Lifespan implemented EQUiPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department), the number of PIMs among monthly prescriptions fell by roughly 26 percent at Lifespan's three adult acute care EDs. The researchers evaluated ED prescribing 13 months before and 16 months after they deployed the tool in August and September of 2019. When clinicians used the tool, they gained access to medication order sets embedded in electronic health records, individualized benchmark reports and education about medication safety in older adults.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) issued a rule two years ago that called for pharmaceutical companies, starting in January 2023, to provide the full value of cards and coupons to patients. CMS said this rule must be adhered to if drug companies want these forms of patient assistance to be excluded from calculating best prices, which drugmakers must offer the government to participate in Medicaid. US District Court Judge Carl Nichols dismissed the rule on Wednesday in a lawsuit filed by the Pharmaceutical Research and Manufacturers of America. The group contended that pharmacy benefit managers' use of copay accumulators undermine the financial assistance provided to patients and that, if the rule was allowed to remain, it would become more difficult to offer assistance programs to commercially insured patients. Judge Nichols ruled the federal government "lacks the statutory authority to adopt the accumulator adjustment rule. That conclusion holds true even though commercial health insurers have developed accumulator adjustment programs intended to capture some (or all) of a manufacturer's financial assistance to a patient."


A new RAND report finds employers and private insurance plans in 2020 paid hospitals 224 percent of what Medicare paid for the same services, with inpatient and outpatient care rates varying widely between sites. Hospitals constitute about 37 percent of health spending for the privately insured, and even people who do not use hospital services cover some of the cost through their premiums. The Kaiser Family Foundation estimated the average premium cost of an employer-sponsored family plan was more than $22,000 in 2021, a 47 percent hike from 2011. States like Hawaii, Arkansas and Washington had relative prices under 175 percent of Medicare prices, while others like Florida, West Virginia and South Carolina had prices at or above 310 percent of Medicare levels.

COVID-19 inpatient hospitalizations averaged 241 percent of Medicare in 2020, which is close to the relative price for all inpatient procedures. Although prices for common outpatient services performed in ambulatory surgical centers like imaging and colonoscopies averaged 162 percent of Medicare payments, Medicare pays the centers less than it pays hospital outpatient departments for the same services. Meanwhile, hospitals claim Medicare reimbursement rates are too low, so they must charge privately insured patients more to make ends meet.

Medicine, Drugs and Devices

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The US Food and Drug Administration approved tirzepatide, a type two diabetes treatment that observers say has blockbuster potential. The injectable drug is the first to control blood sugar through both the glucose-dependent insulinotropic polypeptide hormone and the glucagon-like peptide-1 that is targeted by existing therapies. In clinical studies, a 15 mg dose lowered blood glucose levels by 1.6 percent more than placebo when used alone and by 1.5 percent more when paired with insulin.


A survey of 926 patients was conducted to understand public perceptions of the use of artificial intelligence (AI) in diagnosis and treatment. Respondents included 471 women and 455 men, and most thought AI would improve healthcare a great deal (10.9 percent) or somewhat (44.5 percent), whereas some believed AI would make healthcare somewhat worse (4.3 percent) or much worse (1.9 percent). Sixty-six percent considered AI's role in their diagnosis or treatment very important and 29.8 percent considered it somewhat important. Thirty-one percent felt very uncomfortable and 40.5 percent were somewhat uncomfortable with receiving a diagnosis from an AI program that was accurate 90 percent of the time but could not explain its rationale.

Comfort with AI varied by clinical application, while most respondents were very or somewhat concerned about AI's unintended consequences, such as misdiagnosis, privacy breaches, less time with clinicians and higher healthcare costs. A higher percentage of respondents who self-identified as members of racial and ethnic minorities signaled great concern about these issues, versus whites.


The first-ever clinical trial of robot-assisted surgery determined the procedure accelerated recovery time and reduced blood clotting. The three-year trial by researchers at University College London (UCL) and University of Sheffield involved 338 patients with non-metastatic bladder cancer; half underwent robot-assisted bladder removal and reconstruction, and the other half received open surgery. The researchers learned that patients undergoing robot-assisted surgery recovered faster and went home sooner, staying hospitalized for an average eight days compared to 10 days for the open-surgery group. Robotic surgery also lowered patients' odds of readmission by 52 percent, which fueled a 77 percent reduction in the prevalence of blood clots. UCL's John Kelly said, "In light of the positive findings, the perception of open surgery as the gold standard for major surgeries is now being challenged for the first time."