News From ACFAS

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The 2021 Call for Manuscripts is open! The Annual Scientific Conference Program Committee is now accepting applications/papers for scientific manuscript presentations for the 79^th Annual Scientific Conference, February 25-28 in Las Vegas.

Get your research ready and submit it by the application deadline of Wednesday, September 23. Visit the Annual Scientific Conference page at acfas.org/asc for information on submission criteria and applications. Now’s your chance to prepare for upcoming coding changes set to hit in January 2021. Join experts for one of two Coding and Billing for the Foot and Ankle Surgeon seminars September 11-12 in Chicago and December 4-5 in Orlando.

We want attendees to feel comfortable attending in-person programs, which is why we’re taking COVID-19 safety precautions to ensure you feel safe. Here are some adjustments you can expect at the Coding and Billing course:

• Masks are required throughout courses
• Seating will be allocated to allow for a six-feet distance
• Hotel’s new standard of cleaning and disinfection protocols: Marriott Commitment to Cleanliness | Hilton CleanStay
• Any waivers will be signed electronically in advance
• Registration packets will be distributed in clear bags
• Lunch and breakfast selections will be individually packaged

Don't miss the chance to walk away with the tools needed to simplify your coding practices. Register now for Chicago or for Orlando. Show your patients what you’re doing to keep them safe upon returning to the office for care. Share pictures of the safety measures you’re taking in your practice – plexiglass coverings, hand sanitizer readily available, masks, etc. – on your social media pages, in emails to your patients and on your website. The more you can visually show, the more it may help to ease safety concerns of those needing care.

Your safety photos will also complement ACFAS’ national “Welcome Back!” public relations campaign aimed at highlighting ways in which foot and ankle surgeons are creating safe, CDC- and state-regulated compliant office environments. The campaign is being shown as ads and posts on social media channels, Google Ads and in press releases.

We also encourage you to send your “safety” photos to us here at ACFAS so we can share them nationally in our campaign. Send your photos to publicrelations@acfas.org. And don’t forget to also share the latest ACFAS infographic, How Foot & Ankle Surgeons Are Keeping the Office Safe, which shows ways you are helping to keep patients safe in a colorful graphic. Download it today from the Marketing Toolbox at acfas.org/Marketing.

Together we can help your patients get the care they need during this still uncertain time.

Foot and Ankle Surgery

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Research was conducted to determine the prevalence of ankle osteoarthritis (OA) among former professional football and rugby players, assess the association between ankle injuries or ankle surgeries with ankle OA and compare the mental and physical quality of life (QoL) between former professional football and rugby players with and without OA. Researchers conducted a questionnaire-based observational study of the players. Overall, 553 former professional football and rugby players were enrolled in the study. Ankle OA prevalence among former professional football and rugby players was 9.2 percent and 4.6 percent, respectively. Football players were more likely to suffer from ankle OA following every ankle injury and/or surgery. The study concluded that former professional football and rugby players had higher ankle OA prevalence than the general population. Football players are more likely to suffer from ankle OA following every ankle injury and/or surgery. No clinically relevant difference was seen for physical or mental health-related QoL among football and rugby players.


Researchers at Hebei Medical University in Hebei, China, conduced a retrospective study to investigate the preoperative incidence and locations of deep venous thrombosis (DVT) in patients undergoing surgeries for ankle fractures. From January 2016 to June 2019, 1,532 patients undergoing surgery of ankle fractures were included. Their inpatient medical records were analyzed for demographics, comorbidities, injury-related data and preoperative laboratory biomarkers. DVT of bilateral lower extremities was diagnosed by routine preoperative Doppler examination. To identify independent risk factors, univariate analyses and multivariate logistic regression analyses were used. A total of 98 patients had a preoperative DVT, indicating an incidence rate of 6.4 percent.

A total of 164 clots for six veins were found, representing an average of 1.7 for each patient. The detailed DVTs involving veins comprised two in femoral common vein, seven in superficial femoral vein, two in deep femoral vein, 16 in popliteal vein, 49 in posterior tibial vein and 88 in peroneal vein. In the multivariate model, five risk factors were identified to be associated with DVT, including age (10-year increase), gender, lower albumin level, reduced lymphocyte count and elevated D-dimer level. There was a tendency for diabetes mellitus to increase the risk of DVT, although there was no statistical significance. These epidemiologic findings on DVT may help counsel patients about the risk of DVT, individualized risk assessment and risk stratification.


A meta-analysis was conducted to evaluate the survivorship of total ankle replacement implants currently in use. Researchers studied 97 articles, of which 10 articles studying 1963 implants met all prospective inclusion criteria for analysis. Overall survivorship of all implants was 93.0 percent using a random effect model. There was significant heterogeneity between the studies. Meta-regression identified an inverse relationship between survivorship and study follow-up duration. Furthermore, age and implant type versus did not have a statistically significant impact on survivorship. However, patients with higher preoperative functional scores had improved survivorship. The results from this meta-analysis revealed a promising overall survivorship of current implants in use for total ankle replacement; however higher quality studies with standardized outcomes measures are needed.

Practice Management

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Rebekah Bernard, a family physician, spoke with several physician experts on racism. She says the conversations led to her developing skills to identify and overcome implicit biases. She says the first step is to recognize areas of implicit bias. Christina Girgis, MD, says this may be difficult for some as it forces people to acknowledge negative thoughts they have about others. Health care workers should also seek out help to process emotions so as not to effect others. A psychiatrist or psychologist can help with this process. Nurses and doctors can also benefit on doing research on the systemic issues that may affect patients. Doing so can result in better care outcomes. Finally, health care professionals can work to develop anti-racist thoughts and behaviors. This can be accomplished with the help of a colleague and build stronger working relationships.


With telehealth visits enjoying unprecedented takeup, there is a push to bolster cybersecurity and privacy safeguards so that protected data remains that way. Experts say telehealth firms that fall short will regret it. "Over time, breaches will weed out the providers that aren't prioritizing security," said Ted Wagner of SAP National Security Services. "Clients will opt for teledoc providers they feel they can trust, and those will be the ones with information protection frameworks." Sebastian Seiguer, CEO of mobile health company emocha, said, "The onus is on companies to protect their end users. If they do not, the new consumer — the patient — will take their business elsewhere."


Doctors are beginning to reopen their practices and treat patients again. Experts say now is a good time for physicians to review their employment agreements and make any needed changes. With a second wave of COVID-19 infections a possibility, doctors may want to consider employment contracts that allow them to adjust compensation, terminate a contract under certain circumstances and the ability to assign employees to different hours. Insiders say many physician practices were unprepared for the impacts of the coronavirus, but there is an opportunity to adapt to the challenges that emerged. Doctors can develop practical solutions for potential disruption of business of a number of reasons.

Health Policy and Reimbursement

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Legislation aimed at reducing drug prices has stalled even as the country is rocked by COVID-19 and many drugmakers are working to create a vaccine and other treatments. Millions of Americans, including droves of newly unemployed, are stuck with increasing out-of-pocket costs for medication in the middle of a historic health crisis. Many say the problems with prescription drug costs have only increased with the pandemic. US Senate Finance Committee Chairman Chuck Grassley (R-Iowa) plans to call for his bill on drug pricing to be included in the next round of coronavirus relief legislation that Congress is expected to consider later this summer, according to a senior Republican aide. However, US Senate Majority Leader Mitch McConnell (R-Ky.) has not said whether he would entertain the issue. Democrats also have said they want to lower drug costs; the House passed a measure in December. Grassley's bill would cap the growth of drug prices in Medicare at inflation level and impose a $3,100 limit on out-of-pocket costs for tens of millions of seniors and Americans with disabilities enrolled in its drug coverage program. The plan would provide nearly $100 billion in savings, according to the Congressional Budget Office.


Although Congress has set aside billions of dollars to pay for virus-related care for the uninsured, Americans who have lost their employer-sponsored health coverage are likely to face more expenses related to ordinary medical care. The COVID-19 shock had likely pushed more than 16 million workers off employer-provided health insurance as of early May, according to the Economic Policy Institute (EPI). Including dependents like spouses and children, the Kaiser Family Foundation estimated that almost 27 million people could have lost their employer-sponsored coverage and become uninsured between March and May. It said that while most of those are eligible for some kind of subsidized coverage through Medicaid or the Affordable Care Act marketplaces, about 5.7 million probably aren't. However, with a second wave of COVID-19 cases expected, some 6 million white-collar jobs are vulnerable to layoffs and those employees will likely lose health coverage as well, according to the EPI.

Medicine, Drugs and Devices

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Gilead Sciences outlined its pricing plans for the COVID-19 drug remdesivir, saying it will charge US hospitals $3,120 for a typical patient with commercial insurance. The government price will be $390 per dose, or $2,340 per patient for the shortest treatment course and $4,290 for a longer treatment course. Gilead said it will charge nongovernment US buyers such as hospitals about $520 per dose, or a third more than the government price, for patients who are commercially insured.


The United States saw a surge in long-term use of skeletal muscle relaxants (SMRs) in recent years, a new report finds, in part because of questionable prescribing to older adults. Researchers examined 12 years' worth of data from the National Ambulatory Medical Care Survey. They documented 27.7 million office visits in 2016 where SMRs were prescribed as ongoing therapy, even though guidelines limit use to between two and three weeks due to the risk of adverse events. The count was nearly triple that of 2005, when 8.5 million visits included continued SMR therapy. By comparison, office visits for new SMR prescriptions held steady at about 6 million per year during the study period.

Investigators also calculated that about two-thirds of the office visits for continued SMR prescription entailed concomitant therapy with an opioid—a dangerous combination—and that the share of "potentially inappropriate" SMR prescriptions among patients aged 65 years and older almost doubled to 4.3 million in 2016 from 2.2 million in 2005. "Efforts to limit the long-term use of SMRs may be needed, especially for older adults, similar to efforts used to limit the long-term use of opioids and benzodiazepines," the study authors wrote in JAMA Network Open.