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News From ACFAS

New! Comprehensive Internal Fixation Course
Join expert faculty for a three-day deep dive into internal fixation surgery!

August 19-21 (Thursday-Saturday)
Hyatt Regency DFW International Airport, Dallas
CME: 20 hours

The all-new, hands-on course (continuing on from the previous AO/AAFAO workshops) brings together many innovators in the field of internal fixation surgery. Faculty will present thorough and up-to-date information on osteosynthesis in the lower extremity.

You’ll walk away with the skills to:
  • Apply the principles of internal and external fixation to foot and ankle surgery—including major rearfoot and ankle arthrodesis techniques.
  • Identify the problems, complications, and intraoperative difficulties that can result from internal and external fixation.
  • Implement principles and techniques in a wide variety of complex foot and ankle fractures, multiple revisional and reconstructive surgical techniques of the lower extremity—including specialty plating and external fixation techniques.
  • Avoid complications and improve outcomes through preoperative planning.
  • Apply psycho-motor skills developed in extensive practical lab exercises.
Visit to register today or to learn more about this program.
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More Arthroscopy Courses Coming
ACFAS’ popular Arthroscopy of the Foot and Ankle Surgical Skills Course is back with more upcoming dates for 2021! Join us for this popular course and get the latest techniques, didactic lectures and surgical demonstrations at the Orthopaedic Learning Center (OLC) in Rosemont, IL.

August 14-15, 2021
October 2-3, 2021
December 11-12, 2021

Visit to secure your spot today or for more information!
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ACFAS Fellowship Fair a Virtual Success!
A pandemic could not sideline the ACFAS Fellowship Fair for 2021! Forty fellowship program directors with ACFAS status submitted short, introductory videos about their programs while current post graduate fellows responded to a “Meet the Fellow” Q&A to give prospective fellows the inside scoop about their fellowships of choice.

Students and residents considering seeking a fellowship can also visit the virtual Fellowship Fair to find contact information for scheduling visits and interviews as well as email addresses for current fellows to ask follow-up questions about each fellowship piquing your curiosity by visiting the 2021 Virtual Fellowship Fair.

We hope this virtual substitute is only temporary, and that we will see y’all next year in person in Austin for the 2022 ACFAS Fellowship Breakfast Fair!
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Foot and Ankle Surgery

Association of Acute Inflammatory Cytokines, Fracture Malreduction and Functional Outcome 12 Months After Intra-Articular Ankle Fracture
A prospective cohort study sought to specify malreduction criteria and inflammatory cytokines linked to functional outcome after ankle surgery. The researchers collected synovial fluid from the fractured and healthy contralateral ankles of 46 patients during surgery for chemiluminescence analysis of 22 inflammatory cytokines and metabolic proteins. Scores on the American Orthopaedic Foot and Ankle Society (AOFAS) scale, the Danish version of Foot Function Index (FFI-DK), the EQ-5D-5L index score, the Kellgren-Lawrence score and joint space narrowing were recorded at three and 12 months. Tibiofibular (TF) overlap and dime sign showed correlation with FFI-DK, and tibiotalar tilt correlated positively with joint space narrowing at three months and 12 months. TF widening correlated with FFI-DK, AOFAS and EQ-5D-5L. Consistent correlations between synovial cytokine levels and functional outcomes were not observed at 12 months.

From the article of the same title
Journal of Orthopaedic Surgery and Research (05/25/21) Vol. 16, No. 338 Pham, That Minh; Kristiansen, Emil Bjoertomt; Frich, Lars Henrik; et al.
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Effects of Eccentric Exercises on Improving Ankle Dorsiflexion in Soccer Players
A study was conducted to ascertain how targeted eccentric calf muscle exercises impacted ankle dorsiflexion compared to regular training in healthy adolescent soccer players with a decreased ankle dorsiflexion. Male players 14 to 21 years old from two professional soccer clubs were evaluated with the Weight Bearing Dorsiflexion Lunge Test (WBDLT) at baseline and 12 weeks later. Participants with decreased ankle dorsiflexion conducted stretching and eccentric calf muscle exercises three times a week versus regular training in the intervention group and regular training in the control group. Forty-seven of 107 eligible players had a decreased ankle dorsiflexion, and WBDLT increased in the intervention group from 7.1 to 7.4 centimeters and in the control group from 6.1 to 8.2 centimeters. The difference in change of WBDLT between both cohorts was statistically significant.

From the article of the same title
BMC Musculoskeletal Disorders (05/26/21) Vol. 22, No. 485 Lagas, Iris Femmigje; Mueffels, Duncan E.; Visser, Edwin; et al.
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Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus Using Weight-Bearing Computed Tomography
Multiple image assessments based on weight-bearing radiography and computed tomography sought to elucidate factors associated with the callosity in hallux valgus deformity. The researchers retrospectively evaluated 50 feet, and multiple logistic analyses via the stepwise method showed that the first metatarsal–lateral-sesamoid distance was the only radiographical factor linked to callosity formation among all the tested variables. As the severity of the grade of the callosity increased, so did the lateral shift of the lateral sesamoid. The position of the sesamoid bone seems to play a vital role in the assessment and choice of therapeutic protocols. Further investigation into the relationship with the position of sesamoid bone is necessary to clarify the mechanism of callus formation.

From the article of the same title
Journal of Foot & Ankle Surgery (05/25/21) Murahashi, Yasutaka; Iba, Kousuke; Teramoto, Atsushi; et al.
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Practice Management

How to Find the Right Revenue Cycle Partner
Dingwell Law CEO Kelly Dingwell says revenue cycle management (RCM) can be a daunting challenge for physicians and in considering whether to take on a new partner, "it's important for physicians to know what their strengths are and what their knowledge gaps are." Experity's Monte Sandler says the push to improve RCM is often driven by a "trigger event," and the COVID-19 pandemic is a case in point. He adds that physicians may be missing out on revenue by failing to optimize their coding and billing, while Heather Richards at MPowerHealth says RCM improvement begins with the physician having a vision for their practice's future. "An optimal revenue cycle partner is going to have a road map in mind to continuous improvement," she notes. Dingwell says physicians should plot the revenue cycle revamp incrementally rather than all at once, starting at the point of patient registration, in verification of eligibility, authorization and payment method. Most experts concur that outsourcing the largest segments of the revenue cycle, like coding, billing and credentialing makes the most sense. Mediversity Health's Saira Ahmed says physicians seeking a revenue cycle partner should consider whether candidates are certified coders/billers; are familiar with the practice's specialty and electronic health records; their reporting capabilities; billing frequency; and their management of denials.

From the article of the same title
Medical Economics (06/02/21) Rosenfeld, Jordan
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Pandemic Fuels Rise in Attacks on Health Staff
The COVID-19 pandemic has compounded the risk of violence against medical staff, with a 2020 study by Liberty Mutual estimating it to be the third-leading cause of serious workplace injuries in the healthcare sector. GB Healthcare's Pamela Popp said violence has migrated to non-acute settings such as physician offices, and "it does appear that the pandemic has made it worse." She explained that people are scared and "have a feeling of a lack of control" because of the coronavirus and are more likely to enter healthcare facilities in an unsettled state that can easily escalate. Liberty Mutual's Jeff Duncan cited a lack of "broad, consistently followed" violence prevention standards, and proposed federal legislation would require healthcare employers nationwide to establish a comprehensive program and protocols to prevent such violence. Thirteen states have also unveiled bills to create minimum standards for healthcare workplace violence prevention plans and training. Popp and others recommend measures such as regular training in de-escalation tactics and violence intervention, recurring reassessment of violence prevention programs and maintenance-type upkeep like outside doors being secured at all times and security cameras in constant operation.

From the article of the same title
Business Insurance (06/01/21) Childers, Angela
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Tailoring Your Practice's RCM to Changing Times
Physician practices would do well to update their revenue cycle management (RCM) strategies in order to guarantee accurate and complete capture of all reimbursement opportunities amid a changing industry. RCM has to evolve so practices can weather trends fueled by recent events like the pandemic, including the expansion of high-deductible health plans, bigger out-of-pocket costs and self-pay. Other factors to account for include an increase in denials and major declines in other financial key performance indicators. Practices should focus on four areas in particular to ensure their RCM's long-term success: eligibility checks, price transparency, denial trends and write-offs and old debt. Checking and rechecking eligibility is critical in 2021, when job losses and health plans can shift suddenly. Practices must also disclose the costs of their services upfront and offer incentives for pre-payment and financing health procedures. Providers also should keep a closer eye on trends like telehealth claims from a Medicare Advantage plan taking longer to get paid, and analytics platforms can help in this respect. Finally, practices should follow up on unpaid claims sooner and design fair and manageable plans with patients.

From the article of the same title
Physicians Practice (06/02/21) Davis, Todd
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Health Policy and Reimbursement

Amazon and Walmart Have an Rx for Healthcare. The Cure Won't Be Easy
US companies want to enter the healthcare industry, but they will likely find it confusing. The United States is estimated to spend roughly $4 trillion on healthcare this year, according to data from the US Centers for Medicare and Medicaid Services, representing nearly a fifth of gross domestic product. Prices vary considerably for even basic healthcare services depending on who is paying for it. Artificially high costs are passed on to patients, employers and taxpayers in the form of higher premiums and deductibles. Both Walmart and Amazon are exploring telemedicine and strengthening their respective primary care and pharmacy offerings. Meanwhile, JPMorgan Chase is building a new unit that will work on health initiatives for its employees and invest $250 million in healthcare technologies and startups.

From the article of the same title
Wall Street Journal (05/29/21) Grant, Charley
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The Pandemic Is Leading Doctors to Rethink Unnecessary Treatment
The COVID-19 pandemic has furnished an unprecedented database for doctors to compare patients who received a particular test or treatment with those who did not, revealing insights that could radically change their approach to reducing unnecessary treatment. A study in Health Affairs by the Research Consortium for Health Care Value Assessment determined that COVID provided an important new metric by analyzing outcomes for patients who received treatment before hospitals canceled care due to the pandemic and those who had their care canceled. Tests of interest that were performed less often during the pandemic included colonoscopies on patients older than 85; hemoglobin blood work for Type 2 diabetics; semi-elective surgeries like knee arthroscopy for articular cartilage surgery; and annual dental x-rays. Heather Lyu of Brigham and Women's Hospital and Harvard Medical School said much testing and care was skipped because of patients' anxiety about contracting the virus in a medical setting and because medical facilities and staffers were struggling just to keep pace with COVID cases. Boston College Professor Susan Gennaro said COVID unlocks opportunities not just to study unnecessary medical care, but also to review areas of insufficient care, like mental health.

From the article of the same title
PBS NewsHour (05/27/21) Alpert, Bruce
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Medicine, Drugs and Devices

Meet VR, Your New Physical Therapist
Researchers and therapists are exploring virtual reality (VR) applications as a physical and occupational therapy tool. Brennan M. Spiegel at Cedars-Sinai Medical Center in Los Angeles said VR can help patients acclimate their bodies to motivate them to perform physical therapy (PT), "both by reproducing precisely what that physical movement is supposed to be and hopefully providing some additional motivation to do the exercise." The increased adoption of telehealth during the coronavirus pandemic has accelerated VR's use for rehabilitation. Massachusetts resident Pamela Pleasants received PT for her shoulder via a VR headset supplied by XRHealth, and a physical therapist remotely assigned and trained her on a regimen of exercise applications. XRHealth's apps are gamelike, including one where the patient pops virtual balloons with a sword, while users can switch programs by a controller or eye gaze.

From the article of the same title
The New York Times (05/05/21) Tugend, Alina
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Newer Methods May Boost Gene Therapy's Use for More Diseases
People afflicted with rare genetic disorders are being offered hope by new gene therapy regimens. University of California, San Diego researchers are treating people using an experimental therapy that adjusts the supply of DNA needed to alleviate their symptoms. Certain therapies, such as ones for hereditary blindness, inject the treatment into the eye, while others often remove some of a patient's blood cells, modify them in the lab to carry the desired gene and return them intravenously. Of growing interest to scientists are better and safer vectors, or disabled viruses that transport the gene into cells. Doctors recently reported that a gene therapy using modified human immunodeficiency virus from UK-based Orchard Therapeutics gave a working immune system to 48 infants and toddlers who lacked one. Some researchers envision gene editing as eventually offering a long-term solution that permanently revises a patient's native DNA to insert a gene or remove a dysfunctional one.

From the article of the same title
Associated Press (06/02/21) Marchione, Marilynn
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White House Urges Court to Toss Lawsuit Preventing States From Importing Prescription Drugs
The White House on May 28 requested a federal court to reject a lawsuit initiated by pharmaceutical companies that would prevent states from importing low-cost prescription drugs from Canada, arguing that legal action was premature. "To date, no [statutory import programs] have been authorized," wrote the Biden administration, adding that "[a]lthough two proposals have been submitted to [the US Food and Drug Administration], no timeline exists for the agency to make a decision. Thus, the possible future injuries to Plaintiffs' members are overly speculative and not imminent, involving an attenuated chain of possibilities with independent third-parties and discretionary decisions of various government actors." To date, only Florida and New Mexico have made formal requests to the federal government to get approval for importing drugs from Canada. Florida Gov. Ron DeSantis estimates that the state's plan could save consumers up to $150 million in its first year. "We want the Biden administration to approve this," he declared. "We think if they act immediately, we'll be able to provide safe and effective drugs to drive down prescription costs here in Florida."

From the article of the same title
The Hill (05/29/21) Axelrod, Tal
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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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.

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