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News From ACFAS

Don't Miss Coding & Billing OnDemand
Get the valuable coding and billing information you missed at ACFAS 2021 on your own time. Coding and Billing for the Foot and Ankle Surgeon is available OnDemand from July 15 to August 15 and registration is required.

You and your office staff can access this previously recorded course at your convenience to hear the same expert tips and insights shared at ACFAS 2021 in Las Vegas. Walk away with knowledge on simplifying your coding and reimbursement practices as well as 4.5 CME hours. The course covers timely topics, including what’s new in foot and ankle surgical coding, telehealth coding and addresses changes such as coding for prolonged services and several CCI edits relating to foot and ankle surgery.

Don't forget registration is required by visiting today to take advantage of this valuable recording.
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Clinical & Science Research Grant Program Opens Tomorrow
The ACFAS Clinical & Scientific Research Grant Program officially opens tomorrow for application submissions! Thanks to support from PICA and the ACFAS Regions, the College is offering funding of up to $75,000 each year for an established investigator and up to $25,000 for a new researcher.

Letters of intent should be submitted by September 15 at 5pm CT and final applications are due by October 15 at 5pm CT. Visit for more information.
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Register for July's Journal Club
Join us Wednesday night, July 15, for another look at the latest in foot and ankle research with the ACFAS Virtual Journal Club. This month's session starts at 7pm CT and features the Use of External Fixators in the Lower Extremity hosted by the MedStar Georgetown University Hospital Foot and Ankle Research Fellowship in Washington, DC and presented by Jayson Atves, DPM, AACFAS and John Miller, DPM.

Register for tomorrow’s Journal Club now at

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Foot and Ankle Surgery

Early Clinical, Functional, and Mortality Outcomes for Heel Ulcers Treated With a Vertical Contour Calcanectomy
A study sought to characterize outcomes related to the Vertical Contour Calcanectomy (VCC) procedure for treating heel ulcers in 51 patients, representing the largest number of patients that have undergone the procedure and their outcomes at one year to date. Patients who demonstrated healing without recurrence, amputation or mortality at one year follow-up comprised 31.4 percent of study participants. The post-VCC total limb salvage rate was 68.6 percent at one year at a mean follow-up 663.9 days, plus or minus 464.7 days. One-year all-cause mortality after VCC was 9.8 percent. Post-VCC function at one-year follow-up reflects 79.3 percent of patients having the same or improved function than their perioperative state.

From the article of the same title
Journal of Foot & Ankle Surgery (07/03/21) Cook, Helene; Kennedy, Christopher; Delijani, Kevin; et al.
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Patient Pain and Function After Correction of Posterior Malleolar Malunion
A study assessed the outcomes of intra-articular osteotomy via a transfibular procedure for correcting an ankle malunion involving the posterior malleolus. A retrospective review of 26 patients treated in this way was conducted. Radiographic evaluations via plain radiographs and computed tomographic (CT) scans were performed, and clinical outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS), active range of motion of ankle and the 36-Item Short-Form Health Survey score. Postsurgical anatomic correction of articular surface and anatomic reduction of syndesmosis were realized in all patients as assessed by CT scans. No evidence of progression was observed 18 of 26 patients at final follow-up, and the median AOFAS score rose from 42.0 to 81.5. Median pain VAS score declined from 6.0 to 1.0. A positive clinical outcome correlated with a short interval from original injury to correction surgery and a lower grade of preoperative arthritis, but not with the posterior malleolar fragment size. Yet time interval, the posterior malleolar fragment size and the grade of preoperative arthritis did not correlate with the post-injury progression of arthritis grade.

From the article of the same title
Foot & Ankle International (07/01/2021) Li, Yaxing; Chen, Yu; Liu, Xi; et al.
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COVID-19 Lockdown Disrupts Support Networks Integral to Maintaining Foot Health: A Mixed-Methods Study
A population-based cross-sectional study using a Web-based platform collected quantitative and qualitative data to describe the COVID-19 lockdown's impact on support networks essential to maintaining foot health. The poll was completed by 255 respondents, of whom 193 reported an ongoing foot pain or problem that had been present for four weeks or more, while 49 cited a new pain or problem. Pain was the most frequently reported symptom, while change in the foot's appearance was also commonly noted, often alongside swelling. Musculoskeletal foot symptoms were often reported and significantly associated with less physical activity. Qualitative analysis highlighted five core themes, of which one was of the lockdown disrupting formal and informal support networks.

From the article of the same title
Journal of Foot and Ankle Research (06/30/2021) Vol. 14, No. 46 Cherry, Lindsey; Gates, Lucy; Culliford, David; et al.
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Practice Management

Why Asking for Patient Feedback Is Important
Patient feedback must be solicited if physician practices are to improve their ratings and care. A review is much more likely to be provided if the physician asks in person, and requesting patient reviews in person also will reduce negative reviews and can help shield the organization against malpractice. Patients who would have said they were fully satisfied with a doctor's care are 10 percent less likely to say that after billing, but someone who makes an "on the record" endorsement is much more likely to defend that position later, even if circumstances change. Most online reviews are positive, with a Small Business Trends report indicating that 66.8 percent of all Yelp reviews are between four and five stars. However, 56 percent of clinicians lack patient reviews on Healthgrades, according to a meddkit analysis. A few negative reviews is not catastrophic, if a physician requests reviews from, say, 10 patients each day and just half of them agree. The practice's average score on clinician reviews websites is what most prospective patients base their judgments on.

From the article of the same title
Physicians Practice (07/01/21) Tornetta, Jonathan
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Four Areas to Address to Improve Your Bottom Line
Medical practices can address four areas to strengthen their bottom lines and stay ahead of the curve as billing and payment dynamics shift. Checking and rechecking eligibility is vital especially this year, when job losses and health plans can change rapidly. Another critical area is price transparency, as practices must be upfront about the costs of their services and offer numerous opportunities for pre-payment and financing health procedures. A third priority area are denial trends, with a Medical Group Management Association correspondent noting in a recent op-ed that "most practices find that 80 percent of their denials are a result of 20 percent of the problems." Providers should more closely watch trends like telehealth claims from a Medicare Advantage plan taking longer to get paid, and analytics platforms can help in this regard. The fourth area to address concerns following up on unpaid claims sooner, and developing fair and manageable plans with patients. This may require additional training so that administrative and billing teams are up to date.

From the article of the same title
Medical Economics (07/05/21) Davis, Todd
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10 Customer Service Habits for Your Medical Practice
Logan Lutton registered nurse Audrey Mclaughlin offers 10 customer service strategies of benefit to clinics. Her first tip is to ensure that all workers can make a good first impression for customers, and they should be skilled in helping people. The second recommendation is for all staff to meet any commitment they make to customers, and the third is to show gratitude and appreciation to patients. Practices also should provide solid customer service training, and deal with and act seriously on any complaint. Also recommended is to over-deliver on patient expectations by paying close attention to every aspect of delivery of services. The seventh tip involves making the patient's office experience as stress-free as possible by keeping waits to a minimum and comfort to a maximum, while also offering amenities whenever possible. Admitting to and apologizing for mistakes and offering remedies is also advised, was is getting to know patients as well as possible to ensure they are receiving the best possible care. Finally, clinics should treat their staff and each other with the same respect and courtesy as customers.

From the article of the same title
Physicians Practice (07/06/21) Mclaughlin, Audrey
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Health Policy and Reimbursement

Biden Calls for Efforts to Lower Drug Prices as Part of Executive Order to Foster Competition
President Biden signed an executive order on July 9 to spur his administration to encourage more competitive practices. In the health care arena, he will direct federal and state officials to form plans to safely import medicines from Canada. The directive also will urge the US Federal Trade Commission to prevent pharmaceutical companies from paying their generic counterparts to delay the entry of lower-price versions of medications into the market. Such a proposal also is part of legislation currently before the Senate.

Administration health officials add that the executive order will call for encouraging more competition among hospitals and health insurers, in addition to directing the US Department of Health and Human Services to reissue a rule for health plans sold within Affordable Care Act (ACA) marketplaces. The Obama administration required insurers selling in ACA marketplaces to offer at least one option with a standard benefit design to make it easier for consumers to compare plans from different providers. In 2019, the Trump administration removed the standard benefits requirement from marketplace plans. A person familiar with the directive says insurers will need time to adjust to a standard design, so the order will not specify when that will be restored. Overall, 72 initiatives involving more than a dozen federal agencies are to be included in the Biden's executive order.

From the article of the same title
Washington Post (07/09/21) Goldstein, Amy
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Hospitals Often Charge Uninsured People the Highest Prices, New Data Show
A Wall Street Journal analysis of thousands of prices at hundreds of hospitals determined that hospitals frequently charge top prices to uninsured patients who pay cash out of pocket, higher than the prices hospitals have negotiated with insurers. About 21 percent of the hospitals in the study billed uninsured patients at their highest rates, while the cash rates at 71 hospitals were higher than all of the rates billed to insurers. On average, across the 1,166 hospitals that included rates for Medicare Advantage (MA) plans in their disclosures, fees for uninsured patients were 3.6 times the average rates paid by the MA plans. Although hospitals do offer financial aid, those policies often vary widely and are poorly promoted, leaving many saddled with expensive medical bills.

From the article of the same title
Wall Street Journal (07/06/21) Evans, Melanie; Mathews, Andrea Wilde; McGinty, Tom
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US Supreme Court Agrees to Hear Hospital Lawsuit Challenging HHS' 340B Cuts
The US Supreme Court on July 2 said it would hear a case that challenges cuts to the 340B Drug Discount Program. The case, which will be heard during the High Court's next term that begins in October, is called American Hospital Association v. Becerra. At issue is the Medicare reimbursement rate paid for outpatient medications and whether the US Department of Health and Human Services (HHS) singles out 340B-covered entities.

Although HHS traditionally established reimbursement rates for drugs based on their average sales price, applying it for all hospital groups, the lawsuit asserts that practice changed three years ago, when HHS singled out 340B hospitals. HHS said the cuts were intended to ensure that Medicare payments were more in line with the costs expended by the hospital to acquire the medication, which would be lower at a 340B hospitals. In response to the Supreme Court's decision to hear the case, the American Hospital Association's general counsel, Melinda Hatton, said: "We are hopeful the court will reject the appellate court decision deferring to the government's interpretation of the law that clearly imperils the important services that the 340B program helps allow eligible hospitals and health systems to provide to vulnerable communities."

From the article of the same title
Fierce Healthcare (07/02/21) King, Robert
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Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2021
A study by the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) found that Medicare Part D plans offer wide coverage of medications commonly prescribed to patients who qualify for both Medicare and Medicaid. Because most of these beneficiaries get drug coverage through Part D, the Affordable Care Act requires the OIG each year to measure the extent to which Part D formularies meet those prescription needs.

Of the top 200 drugs used most often by "dual eligibles" in 2021, the OIG report noted that 195 are included under Part D. There are 453 unique formularies in use under the plan and, on average, each covers 97 percent of those 195 medications. About three-quarters of the drugs are covered across the entire Plan B network. Additionally, the formularies applied utilization management tools to about 29 percent of the drugs reviewed this year, on par with last year. The overall findings were mostly unchanged from previous OIG reports on dual-eligible drug coverage and, as such, the report offered no recommendations.

From the article of the same title
HHS Office of Inspector General (06/28/21)
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Medicine, Drugs and Devices

Study: Opioid Prescribing Preferences, Practices Among Surgical Residents and Faculty Differ
A study in Surgery determined that opioid prescribing preferences and practices among surgical residents and faculty differ, based on a poll of 56 residents and 57 faculty in the University of Colorado (CU) School of Medicine Department of Surgery. Faculty favored prescribing more opioid tablets than suggested by Opioid Prescribing Engagement Network (OPEN) guidelines in five of the 14 surgical procedures, while residents did so in nine of the procedures. "I think the most striking aspect of the study was just how much faculty and resident prescribing preferences differ from each other," said CU Professor Sarah Tevis. She suggested CU's large catchment area may be one reason providers may prescribe more than advised by the OPEN guidelines. CU's Victoria Huynh believes that residents apparent preference for prescribing more opioids than faculty could be partly due to the limited postsurgical engagement between residents and patients. Meanwhile, 80 percent of residents and 75 percent of faculty amenable to seeing regular reports of personal opioid prescription practices, and most also were open to seeing how their numbers measured up against their peers.

Huynh and some of her co-residents are establishing programs within the Department of Surgery to address over-prescription of opioids, including a dashboard that provide regular feedback to anyone opioid prescribers on the amount they are prescribing and how their prescribing practices compare with their peers. Also developed have been pathways, or Enhanced Recovery after Surgery protocols, that providers can follow through a patient's electronic medical record. The pathways recommend the pain drugs to order before and after surgery, including how many opioids to prescribe for certain procedures based on OPEN guidelines.

From the article of the same title
News-Medical (07/08/21) Henderson, Emily
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Patient Drug Prices Can Vary by $50 a Dose Among US Hospitals
GoodRx Holdings recently conducted a study to examine the prices of 12 common generic drugs at 16 hospitals, finding that drug costs can vary among hospitals by more than $50 per dose. Some health centers charged a nearly 6,000 percent markup, on average, compared with the pharmacy price for the same drug. For instance, depression and anxiety medication sertraline costs $57 per tablet at a Las Vegas hospital, but just 50 cents per tablet at a Tennessee hospital.

As of January 1, a ruling by the US Centers for Medicare and Medicaid Services requires hospitals to disclose prices for all drugs and services. But GoodRx found that the data being released frequently contained discrepancies and complex medical terms. The penalty for noncompliance is $300 a day, which may not be sufficient to force adherence, says Tori Marsh, director of research at GoodRx. Marsh adds that it is "very unlikely" for patients taking a common generic drug to be able to bring their supply from home. That means those who require medications such as antidepressants or opioids during a multiday hospital stay need to pay hospital prices. Meanwhile, research from the Kaiser Family Foundation (KFF) indicates that uninsured patients may pay two to four times what insurers pay for a hospital service. KFF also found that just 9 percent of the adults it surveyed said hospitals were required to disclose prices on their website, while 69 percent said they were unsure and 22 percent said hospitals were not required to release such information.

From the article of the same title
Bloomberg (06/30/21) Torrence, Rebecca
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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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