June 25, 2020 | | JFAS | Contact Us

News From ACFAS

Up Next in ACFAS Journal Club
Join us for the sixth installment in our virtual Journal Club series, Ankle Fractures on Thursday, June 25 at 7pm CT.

This live event is hosted by Silicon Valley Reconstructive Foot and Ankle Fellowship and presented by Eric Shi, DPM, AACFAS, Matt Doyle, DPM, MS, AACFAS, Nilin Rao, DPM, PhD and Ryan Sherick, DPM.

Register now to join us tomorrow and learn more of the As to Zs in research. Visit to see all past installments.
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Prep for ABFAS Changes with New Podcast
Curious to know about the recent changes to the American Board of Foot and Ankle Surgery (ABFAS) examination process? Want best practice tips to navigate the various Board exams? Check out the new podcast “ABFAS Certification Processes.”

Join Michelle Butterworth, DPM, FACFAS, Laura Sansosti, DPM, AACFAS and Sofie L. Pinney, DPM, MS, FACFAS as they discuss the ABFAS certification process, recent changes and rationale behind them and their own unique experiences attaining Board certification. Access the newest podcast now at
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2020 Grads: Complimentary First Year of ACFAS Membership
PGY1 ACFAS Resident Membership is free! Don’t miss this opportunity to take advantage of all the College has to offer. Already a member? Be sure to share this information with your colleagues and friends who could benefit.

Resident Members receive:
  • In-print and online access to The Journal of Foot & Ankle Surgery
  • Discounts on education such as Arthroscopy of the Foot and Ankle Surgical Skills Course
  • Information on ACFAS Recognized Fellowships
  • Access to research resources and scientific literature reviews
Download a membership application today from
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Foot and Ankle Surgery

Does Gender Influence the Outcomes of Total Ankle Arthroplasty in Patients with Ankle Osteoarthritis?
The study evaluated outcomes, survivorship and complication rates of total ankle arthroplasty according to gender differences. The study looked at 187 patients (195 ankles) that underwent mobile-bearing HINTEGRA prosthesis at a mean follow-up of 7.5 years. Patients were divided into a men's group (106 patient's, 109 ankles) and a women's group (81 patients, 86 ankles). Clinical scores on the Ankle Osteoarthritis Scale for pain and disability, and American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved with no significant difference between the two groups at the final follow-up. There were no significant differences in complication rates and implant survivorship between the two groups. The overall survival rate was 96.4 percent in men and 93.4 percent in women.

From the article of the same title
Journal of Orthopaedic Surgery and Research (06/05/20) Lee, Gun-Woo; Lee, Keun-Bae
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Footwear and Insole Design Features That Reduce Neuropathic Plantar Forefoot Ulcer Risk in People With Diabetes: A Systematic Literature Review
This systematic review evaluated the evidence for footwear and insole features that reduce pathological plantar pressures and the occurrence of diabetic neuropathy ulceration at the plantar forefoot in people with diabetic neuropathy. Twenty-five studies with a total of 2,064 participants were reviewed, including repeated measure, case control, prospective cohort, randomized crossover and randomized controlled trial designs. Eleven studies investigated footwear, 14 studies investigated insoles as an intervention, and six studies investigated ulcer recurrence. The most commonly examined outcome measures were peak plantar pressure, pressure-time integral and total contact area. Strong evidence existed for rocker soles to reduce peak plantar pressure. Moderate evidence existed for custom insoles to offload forefoot plantar pressure. There was weak evidence that insole contact area influenced plantar pressure.

From the article of the same title
Journal of Foot and Ankle Research (06/04/2020) Ahmed, Sayed; Barwick, Alex; Butterworth, Paul; et al.
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Interference Screw for the Treatment of Pediatric Flexible Flatfoot
The study looked at the use of interference screw in subtalar arthroereisis for the treatment of pediatric flexible flatfoot. From January 2016 to June 2017, researchers operated on 21 children (39 feet) between the ages of eight and 14 years. The clinical assessment was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hind-foot scale and the Chippaux-Smirak Index (CSI) measurements. The postoperative AOFAS scores and CSI measurements were improved compared with preoperative AOFAS scores and CSI measurements. Postoperative anatomical parameters, as measured by radiographs and photographs, achieved significantly better results than preoperative anatomical parameters.

From the article of the same title
Journal of Foot & Ankle Surgery (06/10/20) Hong, Jianjun; Dai, Gaole; Weng, Qihao; et al.
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Practice Management

Overcoming Telehealth Reimbursement Risks
Telehealth has taken on a newly critical role during the COVID-19 pandemic, but for many practices it is uncharted territory for many practices, posing risks for reimbursement. Providers must have processes in place that ensure full capture of documentation necessary to support coding and billing activities. Because telehealth is untested from a claims denial standpoint and is certain to face future regulatory scrutiny, physician practices are wise to adopt an attitude of “over-documenting” patient visits in great detail. Documentation must reflect audio and visual capabilities and include proof of patient consent to use technology that does not qualify as privacy-protected. Physician practices should actively monitor telehealth claims to quickly identify how payers are responding to documentation. Providers should also continually audit telehealth claims for proper coding and clinical documentation to minimize denials. It may be necessary to reassign or retrain staff so as to prevent problems during the transition and optimize resources.

From the article of the same title
Physicians Practice (06/15/20) Nassiopoulos, Vasilios
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The Doctor Is In, but Coronavirus Changes the Look and Feel of the Office Visit
Doctors' offices are slowly reopening across California, but the patient experience may never return to normal. Patient volume declined 60 percent to 70 percent statewide during the COVID-19 shutdown, leaving private physicians with high overhead costs and reduced revenue. California lifted a statewide hold on hospital elective procedures on April 22, allowing doctors to again schedule non-emergency medical appointments as long as they meet certain protocols. This includes limiting visits, requiring staff and patients to wear personal protective equipment and rearranging work areas to maximize social distancing. Physicians will screen patients by telephone to determine whether they have COVID-19 symptoms. Although testing has increased throughout California, infectious disease specialists say there still is not enough to confidently determine the full dimensions of the crisis. The lack of testing means that, for the time being, many small practices have to operate at a loss, though recent policy changes and loan programs have ameliorated this situation.

From the article of the same title
San Francisco Chronicle (06/15/20) Fimrite, Peter
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Virtual Scribes Can Reduce Physician Workload While Increasing Reveneue
Virtual scribes can help physicians document visits more effectively. These scribes do not have direct patient contact; in addition to taking notes, they can also remotely control the electronic health records and navigate to various sections that the attending physician needs to see. The scribe can perform a pre-visit review of the patient's chart and help identify any preventive tests for which the patient may be due. The resulting documentation is also often more comprehensive, translating to higher reimbursement by reminding physicians to address additional complications. Physicians often use an Alexa-type device managed over a secure connection with secure mobile phone apps as a backup in case of connectivity issues. Smaller recording devices are used when the encounter recording is provided to off-line scribes without two-way audio communication between the physician and scribe.

From the article of the same title
Medical Economics (06/13/20) Eramo, Lisa
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Health Policy and Reimbursement

Bipartisan Senators Call for Making Telehealth Expansion Permanent Post-Coronavirus
A bipartisan group of 30 senators want to make the recent expansion of telehealth services permanent. In a recent letter to Senate leaders, the senators call for provisions from the CONNECT for Health Act included in previous COVID-19 legislation be extended after the public health emergency is over. Advocates say enhanced telehealth capabilities could result in improved service with lower fees even beyond the pandemic that prompted them. "Doing so would assure patients that their care will not be interrupted when the pandemic ends," the senators wrote. "It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment."

From the article of the same title
The Hill (06/15/20) Rodrigo, Chris Mills
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CARES Act Provider Relief Fund: Reporting FAQ Updated
The US Department of Health and Human Services (HHS) recently clarified there is no quarterly reporting requirement for healthcare providers receiving Provider Relief under the CARES Act. HHS will be requiring recipients to submit future reports, and content and due dates(s) of such reports will be available in the coming weeks.

From the article of the same title
HHS News Release (06/13/20)
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Healthcare Advocates Push Back Against President's Erasure of Transgender Rights
Hospitals, medical groups, insurers and civil rights associations are critical of the Trump administration's roll back of protections for transgender patients, in particular during a pandemic. A rule issued by the administration narrows the legal definition of sex discrimination in the Affordable Care Act (ACA) so that it omits protections for transgender people. The rule also would enable healthcare providers to refuse to treat patients who have had abortions. The ACA changes were first proposed last year.

From the article of the same title
The New York Times (06/13/20) Kaplan, Sheila
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Medicine, Drugs and Devices

Court Strikes Down Trump Rule That Drugmakers Disclose Price
The US Court of Appeals for the District of Columbia Circuit has ruled that the Trump administration lacks the legal authority to force drug companies to disclose prices in their TV commercials. The unanimous decision did not address a core argument of the pharmaceutical industry, that forcing companies to disclose their prices in advertising violates their free speech rights. Instead the three-judge panel ruled that the US Department of Health and Human Services overstepped its legal authority by requiring disclosure under the umbrella of its stewardship of Medicare and Medicaid.

In Congress, a bipartisan bill from Sens. Dick Durbin (D-IL) and Chuck Grassley (R-IA) would achieve essentially the same results as the Trump administration rule, requiring companies to list prices of their prescription drugs in their advertising. Although an act of Congress would carry more weight in the courts, its path forward appears unclear.

From the article of the same title
Associated Press (06/17/20)
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Majority of People in US Say They've Had to Make Healthcare Adjustments Due to COVID-19
More than 75 percent of consumers nationwide say they have experienced disruption to some aspect of their health care due to the pandemic, according to a new survey by GoodRx. More than 1,700 people were asked about changes they had to make as a result of COVID-19, with approximately a third of the respondents citing canceled or rescheduled physicians appointments because of pandemic-related disruptions. About 10 percent said they could not fill their prescriptions because of shortages. The drugs most frequently mentioned by respondents as being unavailable were albuterol and hydroxychloroquine.

From the article of the same title
STAT News (06/17/20) Chakradhar, Shraddha
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Those Most in Need Least Likely to Get Newer Diabetes Medications
Researchers say that certain racial and socioeconomic populations are not being prescribed DPP-4 inhibitors, GLP-1 receptor agonists and SGLT2 inhibitors even though they may benefit most from the second-line diabetes drugs. The odds of initiating treatment with one of these newer—and, typically, more expensive—medications were 29 percent lower for African Americans and 49 percent lower for Native Americans, according to the Look AHEAD retrospective study. "This is particularly concerning, because they might have a greater need for these new diabetes medications, but reduced access," remarked researcher Ahmed Elhussein of the Johns Hopkins Bloomberg School of Public Health.

From the article of the same title
Medscape (06/14/20) Bowser, Andrew D.
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This Week @ ACFAS
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Caroline R. Kiser, DPM, AACFAS

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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