June 29, 2022 | | JFAS | FASTRAC | Contact Us

News From ACFAS

Submit Your Manuscript for ACFAS 2023
Be a part of ACFAS 2023 in Los Angeles! If you’re currently involved in a study that would be beneficial to the profession, submit your manuscript today for a chance to present in LA. Manuscript winners will divide $10,000 in prize money.

Visit for guidelines, instructions and to submit your manuscript before the August 3 deadline.
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Find Coding & Billing Magic at Disney
Help put some pixie dust magic into your coding and billing skills when you learn from the experts at ACFAS’ Coding and Billing Education Series in Walt Disney World August 25-27.

Start with Coding Fundamentals and stay for Coding and Billing for the Foot and Ankle Surgeon with your newly established foundation. Courses can be taken individually or as a series with bundle pricing.

Coding Fundamentals | August 25
Earn 3.5 CECH and be able to:
  • Understand the use of Evaluation and Management (E&M) and Current Procedural Terminology (CPT) codes in your practice
  • Recognize the most common modifiers and their use
  • Identify how to code minor in-office procedures
Coding and Billing for the Foot and Ankle Surgeon | August 26-27
Earn 12 CECH and learn to:
  • Understand trends in surgical coding, including how to code for new advances in the practice of foot and ankle surgery
  • Appropriately select modifiers for complex, staged, and multiple procedure cases
  • Understand where higher level E&M codes fit into your surgical practice
Don’t miss out! Join us at the most magical place on earth to walk away with the tools you need to simplify your coding and reimbursement practices. Discount hotel and Disney World admission tickets are also available for attendees and their families. Register now at
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Another Jump in JFAS’ Journal Impact Factor for 2021!
More great news for The Journal of Foot & Ankle Surgery (JFAS) —The Journal Impact Factor (JIF) increased once again from 1.286 (2020) to 1.345 for 2021. The JIF is a journal metric measuring the success of a journal. Many factors are considered including the volume of publication and citations, characteristics of the subject area and type of journal.

Our JIF is an exceptional number for a specialized journal, and as it keeps increasing, so will visibility and global interest in publishing in the journal. JFAS Editor Naohiro Shibuya, DPM, MS, FACFAS shares, “This Impact Factor is great for the profession as it’s a direct reflection of the scientific interest in our profession.” He adds, “As the number of submissions increases, the editorial board has been able to be more selective in quality publications in turn increasing interest from researchers from around the world to publish in our journal.” These factors combined will keep improving visibility and take JFAS to the next level.

Thank you to past editor D. Scot Malay, DPM, MSCE, FACFAS, Dr. Shibuya, the entire editorial board and the Council for Journal Management for their efforts to increase the value and visibility of the Journal!
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Foot and Ankle Surgery

One-Stage Reconstruction of the Massive Overlying Skin and Achilles Tendon Defects Using a Free Chimeric Anterolateral Thigh Flap with Fascia Lata
Researchers conducted a reconstruction of the massive Achilles tendon and overlying skin defects using free chimeric anterolateral thigh flap (ALT) with fascia lata (FL) in five patients, 43 to 62 years old. All five patients exhibited full-layer defects of the Achilles tendon with infection, while the sizes of skin defects ranged from 6 centimeters (cm) x 4 cm to 12 cm x 10 cm. The size of the ALT flap ranged from 10 cm x 5 cm to 15 cm x 12 cm, while the size of the FL flap ranged from 7 cm x 4 cm to 10 cm x 8 cm. The mean perforator length for the skin flap and FL was 3.3 cm and 5.3 cm, respectively. Four patients underwent skin flap thinning up to 57 percent to 79 percent of the flap thickness, while one patient required no debulking. ALT flap thickness ranged from 6 millimeters (mm) to 13 mm. All flaps survived completely and postoperative courses had no complications. The follow-up time ranged from 12 to 51 months. All patients could stand and walk and were happy with the reconstructive outcomes.

From the article of the same title
Microsurgery (06/18/22) Son, Tran Thiet; Dung, Pham Thi Viet; Thuy, Ta Thi Hong; et al.
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Predictive Value of MRSA Nares Colonization in Diabetic Foot Infections: A Systematic Review and Bivariate Random Effects Meta-Analysis
A meta-analysis was held to measure the negative predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs in MRSA diabetic foot infections, yielding 86 studies. Six studies with 8,706 diabetic patients were included. The bivariate meta-analysis' pooled sensitivity and specificity was 41.7 percent and 94.1 percent, respectively. In low-moderate MRSA prevalence levels, negative predictive value of MRSA nasal swab was >90 percent and positive predictive value was <55 percent. The implication is that the nasal swab MRSA screen has a poor positive predictive value but excellent negative predictive value in areas of low to moderate prevalence of MRSA diabetic foot infections.

From the article of the same title
Journal of Foot & Ankle Surgery (06/17/22) Coye, Tyler L.; Foote, Courtney; Stasko, Paul; et al.
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Radiographic Cutoff Values for Predicting Lateral Bony Impingement in Progressive Collapsing Foot Deformity
New research explored the correlation of common radiographic parameters quantified on standard weightbearing radiographs with talocalcaneal and calcaneofibular distance assessed with weightbearing computed tomography (WBCT) and designed radiographic cutoff values to detect bony impingement as identified on WBCT. The researchers examined 91 patients treated for progressive collapsing foot deformity (PCFD) via standard preoperative radiographs and WBCT. Talocalcaneal distance narrowing at the sinus tarsi showed strong correlation with talonavicular coverage angle (TNC). The calcaneofibular distance narrowing had moderate correlation with the hindfoot moment arm (HMA), yet it was optimal among the parameters. TNC and HMA offered the best predictive ability for sinus tarsi and calcaneofibular bony impingement, respectively. A TNC threshold of 41.2 degrees yielded a 100 percent positive predictive value (PPV) for forecasting sinus tarsi impingement, while an HMA threshold of 38.1 millimeters had a 100 percent PPV for calcaneofibular impingement.

From the article of the same title
Foot & Ankle International (06/14/2022) Kim, Jaeyoung; Rajan, Lavan; Fuller, Robert; et al.
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Practice Management

Black Doctors Are Forced Out of Training Programs at Far Higher Rates Than White Residents
A STAT investigation found Black residents either leave or are ejected from training programs at far higher rates than white residents, blocking them from lucrative and highly white medical specialties and undermining diversification. Interviews revealed that many Black residents said they received unclear communication about what errors they had supposedly committed, were written up for infractions that went unpunished for white residents and had few opportunities to address missteps or defend themselves. They viewed the appeals processes to be a joke, while their institutions offered them little aid. Analysis by the Accreditation Council for Graduate Medical Education estimated that although Black residents constitute about 5 percent of all residents, they comprised nearly 20 percent of those who were dismissed in 2015. Black residents also were dismissed at rates higher than white residents. Many Black physicians in highly attractive specialties view this trend as a reflection of systemic racism. University of Cincinnati Professor Owoicho Adogwa cited unconscious bias by mainly white residency program administrators as a significant factor.

From the article of the same title
STAT (06/20/2022) McFarling, Usha Lee
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HHS Offers Advice to Help Healthcare Organizations Strengthen Their Cyber Posture
The US Department of Health and Human Services' Health Sector Cybersecurity Coordination Sector (HC3) has released guidance to help healthcare organizations enhance their cyber posture. Among its recommendations is conducting regular security posture evaluations, watching networks and software for vulnerabilities, defining which departments account for risks and delegating managers to specific risks, regularly vetting security control gaps, defining key security metrics and establishing incident response and disaster recovery plans. HC3 also advises complying with cybersecurity best practices outlined by the US Cybersecurity and Infrastructure Security Agency for protecting against cyber threats. The agency highlights the security risk assessment, which has been difficult for many healthcare organizations to conduct. It focuses on identifying threat sources, threat events and vulnerabilities, gauging the probability of exploitation and its impact and rating risk as a combination of likelihood and impact. Healthcare organizations can prioritize risk management based on the data provided by risk assessments.

From the article of the same title
HIPAA Journal (06/20/22)
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Small Business Loan Documentation Requirements for Medical Practices
Practices should check off a number of documentation items when applying for a small business loan. Small Business Administration (SBA) 7(a) Loan applicants must provide a borrower information form for everyone who owns 20 percent or more of the business, all officers and directors, managing members, day-to-day operations managers and anyone guaranteeing the loan. Also needed are personal background and financial statements (SBA Form 912 and SBA Form 413) to authenticate personal credit, net worth and investment history, which apply to all partial owners, general partners, proprietors and managing members of the practice. Business financial statements range from a profit and loss statement current within 180 days of application to projected financial statements to a year-end balance sheet for the last three years to reconciliation of net worth to an interim balance sheet and interim profit and loss statements. Ownership and affiliation documentation is also necessary, as is a business certificate or license, loan application history, income tax returns, resumes customized to the loan application process for each principal, a business overview and history and the business lease.

The same documentation needed for an SBA loan should be provided for bank loans, while less documentation is necessary for alternative lenders' online application forms. Usually applicants should provide the amount of funding they are seeking, monthly revenue, time in business, company name, up to three years-worth of signed personal and business federal income tax returns, the three latest bank statements for business and personal accounts, cash flow, personal ID and a copy of the business' lease or a letter from the landlord explaining lease terms.

From the article of the same title
Physicians Practice (06/16/22) Carmine, Andrea
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Health Policy and Reimbursement

Citing a Disastrous Pandemic Response, an Expert Panel Calls for an Overhaul of the US Public Health System
A bipartisan panel of experts want to see the US public health system transformed on a wide scale, going beyond smaller changes now being explored in the US Congress. Members of the Commonwealth Fund Commission on a National Public Health System point to a bungled response to the COVID-19 as the most recent evidence that a new approach is needed, but they cite drug overdoses, maternal mortality and diabetes as other areas that deserve more and better attention. US lawmakers are considering legislation that would require Senate confirmation of the US Centers for Disease Control and Prevention director and introduce other measures to facilitate coordination among the country's different public health agencies. The panel experts believe the government's role should be expanding to a much greater extent. Among other ideas, their recommendations spelled out in report include creating a new position within the US Department of Health and Human Services to oversee the US public health system. The so-called Under Secretary for Public Health would coordinate efforts of multiple agencies involved in public health affairs and would be empowered to establish minimum health standards for the states.

From the article of the same title
New York Times (06/21/22) Stolberg, Sheryl Gay
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State by State, Some Patients Are Losing Telehealth Access to Doctors
Many states are blocking patients' telehealth access to doctors in other states, potentially undermining telemedicine's durability. "Most states now are back to the pre-pandemic licensure rules, where you must be licensed in our state if you're going to see patients in our state," said Johns Hopkins Medicine's Brian Hasselfeld. The Federation of State Medical Boards estimates that only 12 states still have pandemic-era waivers that allowed residents to virtually visit doctors based in other states, compared to 26 a year ago. University of California, San Francisco telehealth programs director Linda Branagan said changes to state laws and regulations are "operationally untenable," especially when patients are frequently in vulnerable situations.

From the article of the same title
NBC News (06/19/22) Ingram, David
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UnitedHealth Rejected by High Court on Medicare Overpayments
The US Supreme Court rejected an appeal by UnitedHealth Group, leaving in place a federal rule designed to allow the government to recoup billions of dollars in overpayments from insurers that participate in the Medicare Advantage program. UnitedHealth and its allies argued that the 2014 US Centers for Medicare and Medicaid Services rule will gut the program, forcing insurers to reduce coverage and benefits or raise premiums for many of the 26 million seniors who are enrolled. In court papers, UnitedHealth said the disputed rule “seriously compromises” Medicare Advantage and its payment system. The rule implements a 2010 law that requires Medicare Advantage insurers to return overpayments they discover within 60 days. The rule defines overpayments to include those based on diagnoses that aren’t supported by the beneficiary’s medical record. UnitedHealth contended the rule violates a separate congressional requirement that the government’s payments to Medicare Advantage plans reflect an “actuarial equivalence” with the fee-for-service payments under traditional Medicare. A federal appeals court in Washington upheld the rule on a 3-0 vote, saying the actuarial-equivalence provision describes the overall aims of the payment model but “does not separately apply to the requirement that Medicare Advantage insurers avoid known error in their payment requests.”

From the article of the same title
Bloomberg (06/21/22) Stohr, Greg
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Medicine, Drugs and Devices

Bipartisan Pair of Senators Unveils Bill to Lower Insulin Costs
A bill proposed by US Sens. Jeanne Shaheen (D-NH) and Susan Collins (R-ME) calls for capping patients' out-of-pocket costs for insulin at $35 per month. The bill also includes provisions to incentivize pharmaceutical firms to reduce the overall price of insulin. However, its passage in the Senate is uncertain because it would require nine additional votes from GOP lawmakers to reach a 60-vote threshold. Only 12 House Republicans voted for the House version of insulin legislation in March, with some described the bill as proposing "price controls." To attract more bipartisan support, Shaheen and Collins focused on the overall price of the drug by eliminating rebates that drugmakers pay to pharmacy benefit managers if the drugmaker kept the overall price of insulin below a certain level. Meanwhile, US Sen. Raphael Warnock (D-GA) is pursuing an insulin bill to cap patient costs at $35. Democrats are also discussing a party-line package on President Biden's economic agenda expected to include reductions in insulin costs alongside broader measures to curb drug prices, which could affect the outcome of a stand-alone insulin measure. US Senate Majority Leader Chuck Schumer (D-NY) said he would put the legislation up for a vote "very soon" and try to persuade Republicans to support it.

From the article of the same title
The Hill (06/22/22) Sullivan, Peter
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FDA Has Sent to Congress Its Report on Drug Shortages for CY 2021
The US Food and Drug Administration's (FDA) Report on Drug Shortages for Calendar Year 2021 has been sent to the US Congress. The objective of the ninth annual report was to highlight major actions taken by the agency to prevent or mitigate drug shortages in the United States. The number of new drug shortages has declined over the years, but 2021 was particularly stressful for manufacturers in the United States and internationally as they faced ongoing capacity and quality issues. Nevertheless, FDA experienced significant progress in helping to curb drug shortages. There were 41 new shortages in 2021 and 317 potential shortages were averted.

From the article of the same title
FDA News Release (06/17/22)
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Industry-Funded Studies on Cost Effectiveness Often Favor Pricier Drugs, Study Finds
As medicines become costlier, public and private payers are turning to assessments of cost-effectiveness to justify coverage. However, such assessments sponsored by drugmakers tended to favor setting higher prices for their medicines, according to a study in BMJ. It found that one-third of cost-effectiveness analyses conducted by drugmakers had more favorable conclusions compared with independently conducted analyses. Feng Xi, who heads the Program for Health Economics and Outcome Measures at McMaster University and is a co-author of the study, noted that in general, a "favorable cost-effectiveness profile (for a medicine) can be used by the manufacturer to justify higher prices for its product. Payers may end up paying more because of the sponsorship bias." The study authors used the Tufts Cost-Effectiveness Analysis Registry to examine nearly 8,200 cost-effectiveness studies, 30 percent of which were sponsored by companies. They focused on a metric known as a quality-adjusted life year (QALY). Drugs that offer less-than-full quality of life are rated lower on the QALY scale and may not qualify for coverage. The study found that industry-sponsored studies were twice as likely to report that a medicine was cost-effective at a "willingness-to-pay" threshold of $50,000 per QALY. An accompanying editorial said more clarity is needed in creating the economic models used to determine cost effectiveness.

From the article of the same title
STAT News (06/22/22) Silverman, Ed
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This Week @ ACFAS
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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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