News From ACFAS

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Join experts for Coding and Billing for the Foot and Ankle Surgeon and prepare yourself for the new E&M coding changes set to hit January 1, 2021. You have two opportunities to get the tools you need to simplify your coding and reimbursement practices.

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

This seminar is worth 12 continuing education contact hours. Register now at acfas.org/practicemanagement! Help reassure worried patients you are taking extra measures to keep them safe upon returning to the office after COVID with the newest infographic - How Foot & Ankle Surgeons Are Keeping the Office Safe.

Share this with your patients on your website, social media channels, in the office, in your billing statements or any way you can to make sure they know you’re open and it’s safe to seek care. The infographic highlights different steps foot and ankle surgeons are taking to ensure the safety of their staff and patients, including:

• Cleaning and disinfecting of all high-touch surfaces
• Implementing new patient protocols, including prescreening of patients, mandatory wearing of masks while in the office, social distance measures in waiting rooms and spaced out appointments to limit the crossing of patients
• Offering TeleHealth appointments for patients suffering from minor issues including, heel and arch pain, skin rashes or athlete’s foot, tendinitis, Plantar warts, big toe pain, gout or arthritis

Access the newest infographic along with a library of others on various topics in the ACFAS Marketing Toolbox at acfas.org/marketing. Another free source for CPME credit is now available on ACFAS OnDemand! Check out the newly-released clinical session Managing Complications of Lesser Ray Surgery.

This clinical session covers various techniques used to manage digital complications and revision surgery, contributing factors associated with complications, pearls and pitfalls and mal- and non-unions, surgical management and solutions. This session's contributors are Thomas J. Chang, DPM, FACFAS; Michelle L. Butterworth, DPM, FACFAS; Michael H. Theodoulou, DPM, FACFAS; Sebastien G. Demoiny and Thanh L. Dinh, DPM, FACFAS.

View the latest lecture and complete the CME test for CPME credit hours. It’s available now at acfas.org/OnDemand! It’s the perfect time to catch up on some reading, and new research is at your fingertips with the latest Scientific Literature Reviews (SLRs)! A new collection of published articles, studies, case reports, literature reviews and more are now posted for June.

This month’s article summaries include various topics including, Functional Outcomes of Tillaux and Triplane Fractures, Lower-Limb Lymphatic Drainage Pathways, Tranexamic Acid in the Perioperative Period, Minimally Invasive Tenodesis for Peroneus Longus Tendon Rupture and more!

Add the newest research to your summer reading list! Read this month’s articles and all archived SLRs by visiting acfas.org/SLR now.

Foot and Ankle Surgery

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The study aimed to identify foot health factors related to quality of life in patients with rheumatoid arthritis (RA). A total of 294 subjects were analyzed, 229 of whom had both foot pain and RA (the RA group) and 64 having foot pain but no RA (the control group). Significant differences were observed between the RA and the control group with regard to Visual Analogue Scale for pain (VAS pain), Manchester Foot Pain Disability Index and the Foot Function Index. In terms of anthropometric measurements, significant differences were only recorded for midfoot and forefoot width. Multivariable linear regression with the parameters age, gender, VAS pain and the presence of RA presented an R2 value of 48.8 percent, while for the mental health component the corresponding value was 5.6 percent. Authors conclude that the presence of RA, a higher score on VAS pain (general), female gender and older age are all associated with the physical component of the quality of life of patients with RA.


The peroneal artery perforator propeller flap is commonly used for distal lower extremity reconstruction; however, closure of the donor-site defect can limit the utility of this flap. To overcome this limitation, we introduced a perforator propeller flap relay technique to reconstruct the donor-site defect in nine patients between July 2015 and February 2019. In each case, a peroneal artery perforator propeller flap was transferred to repair a defect in the distal lower leg or the foot, and a neighboring perforator propeller flap was also transferred to close the donor-site defect. Donor-site closure was accomplished using the relaying propeller flaps based on perforators from the peroneal, medial sural and lateral sural arteries. Normal contour of the lower leg was preserved with acceptable scars, and additional time for the second flap procedure was less than one hour in each case. One peroneal artery perforator flap presented with partial flap necrosis, while other flaps survived completely without complication.


The authors describe their experience in adapting to the COVID-19 pandemic as a department of 10 foot and ankle surgeons at New York Presbyterian's Weill Cornell Medicine campus. Based on guidelines set forth by the American College of Surgeons, a list of essential procedures was determined, with no additional essential surgeries defined for foot and ankle. In the Foot and Ankle Department, all non-urgent new patient and follow-up appointments were converted to online telehealth visits. Clinic visits at the main hospital were transitioned from the department office building to a centralized location. Imaging and physical therapy remained available onsite for patients who required it. To optimize staff and supply allocation, all orthopedic surgeries were consolidated into one main floor with five active running operating rooms. In April, the Foot and Ankle Department had over 600 telehealth appointments and 200 in-person appointments. Residents and fellows continue to assist with orthopedic cases and seeing patients in urgent care centers.

Practice Management

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A new report from the US Centers for Disease Control and Prevention (CDC) reveals that the COVID-19 pandemic caused a significant decline in emergency room visits nationwide, with visits dropping 42 percent over four weeks in April, compared with the same period in 2019. The declines were greatest among children aged 14 years and younger, wome, and people in the Northeast. There was a slight rebound in the last week of May, with visits down 26 percent compared with figures from a year earlier.


The coronavirus pandemic has increased fear among the American population about visiting healthcare facilities. This sentiment extends to hospitals, emergency departments and outpatient clinics. Healthcare professionals worry this trend could result in people with serious medical issues avoiding care. Experts say education and transparency will be needed to encourage people to seek care. For example, outpatient facilities will have to develop internal and external communication about efforts being made to protect patients and staff. Hospitals and clinics will also have to adopt thorough cleaning processes and use personal protective equipment when necessary. These efforts will boost confidence needed to ease the fears of patients when they need to visit a healthcare facility during and after the pandemic.


Physicians should start saving for retirement as soon as possible, preferably just out of residency. In addition to getting a late start, physicians often do not save enough to maintain their preferred standard of living into retirement. Physicians should not access their retirement funds before they actually retire for other life goals, like buying a house or paying for a child's tuition, as this often comes with a high tax burden and potential penalty fees. Moreover, even physicians are susceptible to underestimating the escalating cost of healthcare. Physicians may also overlook long-term care considerations until they are so close to retirement that insurance rates make obtaining a policy cost-prohibitive. Many doctors also lack estate planning documents, such as financial powers of attorney and medical directives. Without these documents, their families could face a lengthy probate process and costly attorney fees. Working with a financial adviser can make planning for retirement significantly easier.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would change how it audits the Affordable Care Act's risk-adjustment program. The agency would change how the program audits the accuracy of data submitted by payers under the risk-adjustment program. This would affect how CMS calculates a health insurer's "error rate," which is used to determine whether it should adjust an insurer's risk scores and payments. The error rate is based on an insurer's rate of failure to validate a members' diagnoses and conditions. For 2019 and beyond, the agency proposed changing the way it groups medical conditions in the risk-adjustment data validation program within the same hierarchical condition category groups.


A rising number of health insurers are offering premium discounts as surgeries and other types of care decline because of the ongoing pandemic. Anthem, for instance, said it would provide $2.5 billion to customers, healthcare providers and others in various forms. "We just feel like they need to give the consumer a break," says Mississippi Insurance Commissioner Mike Chaney, who says he asked health insurers in his state to consider consumer rate reductions. Washington State Insurance Commissioner Mike Kreidler notes that health insurers are "not paying out much in the way of claims and have an awful lot of premiums coming in. This is one where I think insurers have a real moral responsibility." Larry Levitt at the Kaiser Family Foundation points out that by granting premium credits, health insurers are likely reducing rebates that they could end up owing to consumers under the Affordable Care Act.


According to a FAIR Health report, there has been a dramatic increase (4,347 percent) in private telehealth insurance claims across the United States, including a 15,503 percent increase in the Northeast in March. Mental health conditions were the leading reason patients used telehealth, followed by acute respiratory diseases and infections, joint/soft tissue diseases and issues and hypertension. As the pandemic hit, health systems and providers ramped up their telehealth services to reduce the risk of disease transmission from in-person visits and continue providing care to patients who need it.

Medicine, Drugs and Devices

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According to research from scientists at University of Utah Health, Harvard University and Brigham and Women’s Hospital, electronic health records (EHRs) do not detect up to one in three potentially harmful drug interactions and other medication errors. The researchers found that EHR systems failed to identify errors that could injure or kill patients. David Classen, MD, professor of internal medicine at University of Utah Health, said one problem is that hospitals customize their EHR software to suit their needs. As a result, it becomes harder to keep up with changes in drug safety. So a serious drug interaction may trigger an EHR warning at one hospital, but not another. The findings come as EHR systems have become common at hospitals around the country. The study was published in JAMA Network Open.


The US Food and Drug Administration (FDA) has found high levels of a potentially cancer-causing impurity in some versions of the diabetes drug metformin. According to agency spokesperson Sarah Peddicord, FDA detected N-Nitrosodimethylamine (NDMA)—which the World Health Organization classifies as a probable human carcinogen—in higher than acceptable amounts in some extended-release versions of metformin. Peddicord said the FDA has not found increased levels of NDMA in immediate-release metformin, and patients should not stop taking the diabetes drugs without talking to their healthcare provider first.


A new analysis of 172 studies, funded by the World Health Organization (WHO), confirms N95 and other respirator masks are far superior to surgical or cloth masks in protecting essential medical workers against the coronavirus. N95 masks offered 96 percent protection, the analysis found, while the figure for surgical masks was 77 percent. Experts say the results, published on Monday in The Lancet, make it clear that WHO and CDC should recommend that essential workers such as nurses and emergency responders wear N95 masks, not just surgical masks.

The new analysis also suggests that covering the eyes with face shields, goggles and glasses may provide additional safeguards for healthcare worker. WHO has not endorsed universal wearing of masks, although most of its member governments adopted the practice months ago. CDC did not recommend masks till April 3. Even now, its guidance says surgical masks offer enough protection for healthcare workers unless they are involved in procedures that produce aerosols.