News From ACFAS

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Secure your spot for September ‘s 2019 Coding and Billing for the Foot and Ankle Surgeon Seminar in New Jersey to help ensure your practice is properly reimbursed for the care you provide.

You’ll leave with the fundamentals of new government reimbursement systems and methods as expert faculty take you through a week in the life of a practice: clinics, surgeries, calls, office procedures and the complex cases.

Enroll yourself and your office staff today for the September 20-21 class in Teaneck, New Jersey as space fills quickly for this popular session.

To register, visit acfas.org/practicemanagement.
Experience the unique learning environment of all the FDA-approved total ankle implant systems in two days at this cadaver workshop. Taught by total ankle replacement faculty specialists, you will engage as they share their experiences and surgical decision making and debrief with your peers following each procedure. Proven tips from the instructors will help you learn which systems work best with your patients.

Download the application/registration form or visit acfas.org/skills to learn more. Completed application forms can be faxed or emailed to Maggie Hjelm, ACFAS Education.
First-year podiatric residents who join ACFAS now can receive their first-year membership for free, thanks to the support of our local Regions.

This complimentary membership gives new residents all the advantages of College membership. Highlights include access to acfas.org, an online subscription to The Journal of Foot & Ankle Surgery (JFAS); and special pricing on conferences, products and services.

Get a head start on your career development with this $120 value and see how membership can improve and enhance your practice.

Resident membership runs from September until October. By joining now both July and August are included as a bonus.

Foot and Ankle Surgery

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A prospective monocentric study sought to evaluate the reliability of per-wound bone biopsy (PWB) cultures by comparing them with concomitant transcutaneous bone biopsy (TCB) cultures acquired through healthy skin. Included were patients seen in consultation for clinical and radiological diabetic foot osteomyelitis (DFO) with positive probe-bone tests between April 2015 and May 2018. Sixteen of the PWB and TCB pairs had identical culture outcomes, but the TCB cultures were sterile in 17 percent of cases.

For 38 paired cultures with positive TCB, the correlation between PWB results and TCB results was 58.4 percent. PWB showed all microorganisms found in the transcutaneous specimen in 26 out of 38 samples, while culture results of specimens taken by per-wound biopsies in DFO patients did not correlate well with those obtained by TCB.


Researchers conducted a two-year surveillance of cardiovascular events in antiplatelet-treated arteriosclerosis obliterans patients in Japan, assessing risk factors for limb ischemia in patients with peripheral arterial disease (PAD) and ankle-brachial index (ABI) lower than 0.90. Patients were stratified according to ABI, including normal, borderline and abnormal. In comparison with normal ABI, patients with ABI lower than 0.90 had a substantially higher risk of any vascular event, all-cause death and any limb-specific peripheral vascular event.

Among the risk factors for limb-specific vascular events were a history of lower extremity revascularization/amputation, chronic kidney disease, diabetes and ABI lower than 0.4 or 0.7. These outcomes verified the greater vascular risk of patients with PAD and ABI less than 0.90.


A prospective, double-blinded, randomized controlled trial was held to compare the results of noninvasive interactive neurostimulation (NIN) in terms of improvement of a foot functional score, lower level of reported pain and return to sports in two cohort groups of contact sport athlete affected by a grade I or II lateral ankle sprain. Of the study's 70 athletes, 61 eligible patients were randomized using random blocks to group I and group II. Group I patients exhibited better improvement in terms of functional impairment, reported pain and daily intake of etoricoxib 60 mg. Athletes of group I also resumed sport activities faster.

Practice Management

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Between changing regulatory requirements and an array of medical research and new treatment options, healthcare providers are facing rapid transformative change. To manage this, leaders must fully communicate why change is necessary to their staff, illustrate the strategy behind it and implement best practices to help staff transition to a future mindset. The articles list several common mistakes that cause change efforts to falter and provides advice on how to avoid this. Leaders should help employees engage physicians and provider leaders when forming strategy and use data to inform solutions to the specific problems they have identified.

When planning for change, leaders should invite input from provider leaders on certain changes and clarify each staff member's role in the change process. They should also use clear metrics and strategy to plan the implementation process, course-correct effectively and express their appreciation for staff efforts to carry out change.


Patients are demanding the same expectations from practices that they do from restaurants or retailers and practices must highlight convenience to retain them. Experts say that competition comes from urgent care facilities as often as other medical practices. Growing businesses such as private equity-backed GoHealth Urgent Care, which has 125 centers, use technology to center their services around convenience for the patient.

Practices must adapt to the patient as a consumer — accommodating patient demands for convenience without neglecting the patient-doctor relationship. Experts recommend starting with small initiatives, such as asking patients what convenience factors they'd most want to see through short, focused questionnaires and to involve staff in discussing survey results and potential improvements. Practices must also communicate new conveniences to existing and potential patients as they are added, illustrating changes from the patient standpoint whenever possible.


Administrators at hospitals, cancer centers and medical research organizations nationwide say their facilities are being burdened by robocalls.

Scammers often adopt a technique known as spoofing, making it appear calls are coming from local area codes. Healthcare workers would then assume a nearby patient needs care. Dave Summitt, chief information security officer for the H. Lee Moffitt Cancer Center and Research Institute, testified in front of the House Energy Committee in March, saying robocalls represent a "serious threat" to his Tampa-based facility that serves more than 60,000 patients each year. He said over a 90-day period, robocallers rang more than 6,600 times using numbers that mimicked Moffitt's, which he estimated had consumed 65 hours of hospital response time. Those were in addition to about 300 robocalls that appeared to be coming from numbers affiliated with the U.S. Department of Justice, he told Congress.

Summitt said those callers sought to trick physicians into providing information that might make it easier for scammers to obtain prescription drugs. In an interview, Summitt said the cancer center tried to obtain help from its telecom carrier, CenturyLink. However, CenturyLink officials said the problem was not severe enough over a 72-hour period to warrant their help, he said. Experts say the Federal Communications Commission needs to fully overhaul the nation's anti-robocall rules to effectively curb the problem.

Health Policy and Reimbursement

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A study has found Arkansas' attempt to attach work requirements to Medicaid caused almost 17,000 adults to lose this healthcare coverage within the first six months. In 2018, Arkansas became the first state to tie Medicaid to work requirements, mandating Medicaid enrollees between 30 and 49 work 80 hours per month — excepting full-time students, pregnant women and people with disabilities. Combining Medicaid and marketplace coverage into a single category to account for Arkansas' unusual implementation of the Affordable Care Act, the research found the percentage of Arkansas respondents aged 30 to 49 years who lacked health insurance rose from 10.5 percent in 2016 to 14.5 percent in 2018, compared to a flat 16.2 percent in the control states. Meanwhile, the percentage of Arkansas respondents aged 30 to 49 who worked 20 hours followed the same patterns as in the control states.


The U.S. Federal Communications Commission (FCC) has announced it will vote on a proposal to expand telehealth services for low-income Americans by launching a $100 million pilot program. The Connected Care Pilot Program would improve health care by providing rural healthcare providers $100 million to cover the qualifying costs of telehealth services for veterans and people in medically underserved areas. The program would also provide an 85 percent discount on qualifying services for three years and would fund efforts to assess benefits, costs and savings enabled by telehealth and remote monitoring technology. The July 10 vote will also consider support for pilot projects in diabetes management, opioid dependency and pediatric heart disease.


The Senate health committee has introduced bipartisan legislation to prevent surprise medical bills by capping the pay for out-of-network care at a regional insurer's typical negotiated rate. The health committee had also presented an arbitration arrangement and an "in-network guarantee" option which would force hospitals to bring their doctors into their insurance networks or eat the extra cost. The American Hospital Association has urged the committee to reconsider the benchmark rate, arguing it could create even narrower networks with fewer provider choices for patients while adversely affecting access to care at rural and community hospitals serving vulnerable communities. The Senate panel's decision reinforces the House committee as hospitals and physician groups fight for rival proposals from Sen. Bill Cassidy (R-La.) and Rep. Raul Ruiz (D-Calif.) which would keep their reimbursements more fluid.

Medicine, Drugs and Devices

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On June 17, the Centers for Medicare & Medicaid Services (CMS) announced a proposal to update prior authorization requirements for the Medicare Part D prescription drug program. The proposed rule would expedite the process under Part D's e-prescribing program, allowing clinicians to complete prior authorizations online. The electronic option enables clinicians to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy, which works to prevent patients from arriving at a pharmacy counter only to find that their prescription cannot be filled. The proposal would take effect in January 2021.


A small study published in the European Journal of Radiology finds that compressed sensing (CS) can reduce the acquisition time of conventional ankle MRIs while preserving imaging quality. Standard ankle imaging protocol comes with long exam times and limited resolution due to the inherent complexity of the ankle. Researchers sought to determine if CS, which acquires less data, could reduce overall scan time while maintaining diagnostic image quality. Scanning 20 patients with a mean age of 30.2 years old, researchers acquired images using either parallel imaging based on sensitivity encoding (SENSE) alone and when using a combined method of CS and SENSE.

Two radiologists graded image quality on a 5-point Likert scale and assessed the signal-to-noise (SNR) ratio and contrast-to-noise (CNR) ratio of different anatomical structures in the ankle scans. Overall, CS reduced acquisition time by 20 percent, and radiologists found “substantial to perfect” agreement between images produced with SENSE only and the combination of CS and SENSE.


Responding to allegations the pharmaceutical industry influenced its guidelines, the World Health Organization (WHO) announced it will discontinue two publications on prescribing opioid painkillers.

U.S. Reps. Katherine Clark and Hal Rogers released in May a congressional report alleging WHO was influenced by opioid manufacturer Purdue Pharma in crafting guidelines downplaying the risks of opioid prescription.

The contested documents, from 2011 and 2012, claim "opioid analgesics are known to be safe and there is no need to fear accidental death or dependence." The congressional report finds the claim to defy known science about opioid addiction and tracks how the documents were influenced by Purdue, which has denied the allegations. WHO director-general Tedros Adhanom Ghebreyesus wrote to Clark and Rogers that the contested guidelines would be removed in light of "new scientific evidence," adding that the agency has strengthened its ethics policies since the reports were first published.