News From ACFAS

---

If you’ve visited the ACFAS website today, you’ll notice we’re rocking a new look. The College is excited to announce the launch of the new ACFAS.org!

The College’s redesigned website was created to bring you a better user experience with a more modern look to help you access the latest College news and information with ease. Head to the website today and take it for a spin. We think you’ll be happy with what you see! Manuscript submission is now open for ACFAS 2023 in Los Angeles! If you’re currently involved in a study that would be beneficial to the profession, submit yours today for a chance to present in LA. Manuscript winners will divide $10,000 in prize money.

Visit annualconference.acfas.org for guidelines, instructions and to submit your manuscript before the August 3 deadline.

Foot and Ankle Surgery

---

Researchers explored the impact of age and body mass index (BMI) on sonographic findings of plantar fascia in a normal population. Ultrasonography was used to measure the plantar fascia thickness of 148 healthy adults (54 males and 94 female) over one year. The mean plantar fascia thicknesses at 0.5, 1.0 and 2.0 centimeters distal to the insertion of the plantar fascia were 1.76 ± 0.32 millimeters, 2.50 ± 0.50 millimeters and 2.11 ± 0.41 millimeters, respectively. The mean plantar fascia thickness for individuals =45 years and BMI =25 were significantly higher than that of individuals < 45 years and BMI < 25. In a normal population, the thickness of the plantar fascia calculated by ultrasound measurement was less than 3 millimeters. The authors advise using the position 1.0 centimeter distal to the calcaneal insertion of the plantar fascia as the reference point for diagnosing plantar fasciitis. Although plantar fascia thickness significantly increased with age and BMI, gender, walking activity, exercise and running did not seem to have an effect.


Research was conducted to investigate whether modified Chevron osteotomy plus distal soft tissue release would fix moderate to severe hallux valgus (HV) deformity and specify the minimal clinical important difference (MCID) for objective and subjective evaluating parameters. Forty HV patients were enrolled, including four males and 36 females, whose average age at surgery was 50.95?years. Thirty-seven patients exhibited satisfied result at a mean 14.3-month follow-up. Two patients cited about residual pain at the bunion, and overcorrection (hallux varus) occurred in one patient. There was no nonunion observed, and being female, older than 60, residual hallux valgus angle deformity and a post intermetatarsal angle of more than 9 degrees indicated no statistical relationship with the post-operation residual pain. Nevertheless, high Visual Analog Scale (VAS) score prior to surgery correlated strongly with residual pain. Subjective MCID value was 9.50 for American Orthopaedic Foot and Ankle forefoot score, 18.92 for Foot Function Index and 1.27 for VAS, respectively.


Research sought to measure the surface area of the talus accessible with a uniplanar and a biplanar medial malleolus osteotomy, as well as quantify the weightbearing area that each procedure impacts on the tibial articular surface. The researchers dissected eight ankle joint specimens and performed the uniplanar osteotomy first. A K-wire marked the limits of access at angle of 90 degrees and 30 degrees, with boundaries marked with a skin marker. Wedges were then assembled on the tibia plafond, and the osteotomy was modified into a biplanar one. Almost the whole of the sagittal plane was accessible with both procedures. At a 30 degree angle, bone purchase was realized for 67.7 percent of the talar articular surface with the uniplanar osteotomy and for 74.8 percent with the biplanar osteotomy. At a 90 degree angle, uniplanar osteotomy accessed 32.7 percent of the talar articular area, whereas the biplanar osteotomy achieved an average coverage of 52.8 percent. On average, 25.3 percent of the weightbearing area of the tibial plafond is impacted when a biplanar osteotomy is conducted.

Practice Management

---

Nearly 90 percent of healthcare facilities used locum tenens physicians or advanced practice professionals to fill gaps in their staffs last year, according to a survey of 202 hospital, medical group and other healthcare facility managers by AMN Healthcare. Seventy percent of those surveyed indicated they use locum tenens physicians and other providers to maintain services while they seek to fill openings in their permanent staffs. Twenty-five percent use them to meet rising patient demand, while 13 percent use them to address provider burnout, which has become more prevalent due to COVID-19. The majority (54 percent) of hospital and medical group managers said they are adding new incentives, such as signing bonuses, to their recruiting packages. An additional 49 percent are implementing new retention efforts, including offering retention bonuses to providers. Forty-three percent are adding temporary employees, and 35 percent are expanding telehealth services.


A partner buy-in agreement is a crucial sign of entry to the ownership and management of the practice for physicians, and healthcare attorney Jeffrey Sansweet says such agreements should be carefully vetted. Terms of the buy-in agreement are typically negotiated separately, after the physician has been with the practice for two to five years, to allow the associate and partners to assess each other and the partners to learn the associate's revenue-generating capacity. Lawyers generally agree that physicians aspiring to become partners should hire a healthcare attorney to negotiate on their behalf. There are three ways of calculating a practice's value: the market method, basing value on recent sales of comparable practices nearby and the revenue method, which bases value on practice profitability. The third option is to base value on assets like equipment, real estate an inventory and to calculate the cost of a ground-up build.

The buy-in payment can be framed as a lump sum, which is rare, or as payment through years of deductions from the new partner's salary or a combination of the two. Although buyouts are typically negotiated as part of the buy-ins, many contracts include provisions to renegotiate when a partner decides to leave or retire. To truly determine the practice's value, aspiring partners should also analyze the buyout agreements of current partners, especially if they area approaching retirement age. Other factors worth considering include power in the management of the practice, administrative responsibilities and noncompete clauses that limit an exiting partner's options to join another practice or launch a new one.


Physician practices shopping for a succession planning strategy should follow four steps, starting with choosing a designated successor. The second step involves drafting a buy-sell agreement to ensure the plan's legal security. The agreement allows the physician-owner to make provisions governing what will happen when they decide to leave, which include naming their successor, how shares will be allocated in the event of multiple owners and at what price to sell shares. Step three requires the departing owner to train the successor to successfully run the practice while they are still able to advise, and they should be ready to cede more control as retirement looms. The final step is to inform patients and referring physicians about the succession, assuring them that the new owner will provide the same level of service they have come to expect.

Health Policy and Reimbursement

---

Medicare recipients will not see a premium reduction until 2023, echoing what US Health and Human Services Secretary Xavier Becerra called an overestimate in costs of covering a new and expensive Alzheimer's drug. Medicare Part B premiums rose by $22 a month to $170.10 for 2022, partly due to the cost of Biogen's Aduhelm, which was approved despite weak evidence that it could slow Alzheimer's progression. Biogen has halved the cost of the drug to about $28,000 annually, and the US Centers for Medicare and Medicaid Services (CMS) factored in this reduction and the limitations on coverage in determining that cost savings could be handed to Medicare beneficiaries. In a report to Becerra, CMS said the premium recommendation for 2022 would have been $160.40 per month had the price cut and the coverage determination both been in place when officials calculated the figure. The premium for 2023 for Medicare recipients will be announced in the fall.


A task force of the American Medical Association (AMA) says physicians should undergo more training on treating patients with opioid use disorders. However, AMA has expressed opposition to the proposed Medication Access and Training Expansion Act, which would require physicians to complete a one-time, eight-hour training course on treating patients with opioid and other substance use disorders in order to prescribe controlled substances. Members of the US House Energy and Commerce Committee recently voted 46-8 to include the measure in a substance use and mental health package. The proposal has the support of nearly every medical group related to addiction treatment. Regarding the measure, AMA said: "A one-time training mandate for substance use disorders, no matter how well-intentioned, will not have a meaningful impact on reducing drug-related overdose." Josh Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, supports the measure, saying: "The medical profession should be looking for reasonable opportunities like this to help doctors become more of a solution to the overdose crisis." Regina LaBelle, who heads Georgetown University's Addiction and Public Policy Initiative, says regarding the legislation's potential usefulness: "We haven't done it, so we don't really know." AMA's letter said the group's rejection of the bill derives from its opposition to federal mandates on the practice of medicine, which is usually the responsibility of states.

Medicine, Drugs and Devices

---

Healthcare providers are collaborating with electronic health record (EHR) companies to upgrade the technology platform so it is more responsive to clinical needs. Clinicians at Hendrick Health in Abilene, Texas, have been examining day-to-day interactions on its Sunrise EHR and using that feedback to refine the software. Allscripts partnered with Hendrick to identify key patterns for the enhanced EHR to respond to, including a push for simplicity, helping physicians focus more on basic tasks, containing regulation-fueled triggers and alerts in the EHR and focus on patients. Hendrick's Joshua Reed says the redesigned Sunrise EHR functions as a true digital assistant to the clinician, which can be tailored to the needs of a particular hospital or health system without being over-personalized. "Customization is taking a basic set of software and modifying a few of the things to make it work better for that system," he explains.


Technology for connected healthcare has taken enormous strides in the last few years, with smart watches and other wearables able to collect broader and finer data about health and wellness than what medical provides gather conventionally. While connected technology complements medical-grade devices in some instances, it can also substitute for them at lower cost. The data collected by such devices can also be used by healthcare organizations and insurers to perform research and to visualize aggregate statistics and trends that were not easily discernible previously. University of South Carolina Professor Benjamin Schooley points to an underutilization of connected health technology by many providers because they see no direct monetization, although some organizations are starting to embrace changes.

EY's Rachel Hall emphasizes the need to build an information technology platform to support connected health. This includes a cloud-first architecture, combining Internet-of-Things and edge technologies, data standards, more refined interactive apps, partnerships and fostering skillsets to support innovation and operations. "Interoperability, data aggregation and data insights are critical. Executives should be focused on creating value," she says.


A report from the University of Southern California's Schaeffer Center for Health Policy and Economics indicates that Americans are overpaying billions for generic drugs because of the business practices of pharmacy benefit managers (PBMs). According to the most recent estimates cited in by the report, generic medications are dispensed 97 percent of the time when they are available. Although insurance companies are covering more medications, sellers began raising the prices because the majority of consumers did not know the actual cost of their prescriptions, the report noted. Moreover, PBMs utilize such practices as "spread pricing," which is when they reimburse a pharmacy for one price while charging insurers a higher price and retaining the difference. The report said, "Commercial tactics such as spread pricing, copay clawbacks and formularies that advantage branded drugs over less expensive generics have funneled the savings from low-cost generics into intermediaries' pockets, rather than the pockets of patients." The report recommended implementing transparent reporting policies for PBMs to enable regulators to track how money is spent in generic drug transactions. The paper also suggested requiring PBMs to use fixed fees in their transactions to discourage the selection of costlier drugs.


University of California, San Diego (UCSD) researchers implemented the Tele-Untethered pilot, which lets patients join visits without waiting in virtual waiting rooms. The program utilizes a text-to-video link to improve clinic flow, reduce virtual waiting room reliance, enhance throughput and potentially improve patient satisfaction. The quality improvement pilot enlisted patients seen in a single vascular neurology clinic, with 22 scheduled over 2.5 months. Of those arriving, 76 percent were Tele-Untethered and 24 percent were Standard Telemedicine. Text-for-video link was employed for 94 percent of Tele-Untethered patients and 55 percent were seen early. A 55-minute-per-session time savings was observed. "As our initial UCSD Tele-Untethered successes included patient flexibility and time savings for patients and providers, it can serve as a model as enterprises strive for optimal care and improved satisfaction," the authors concluded.