July 17, 2019 | | JFAS | Contact Us

News From ACFAS

Poster Competition Now Open for ACFAS 2020
Ready to showcase your original research to your peers? Submit a poster abstract for this year’s competition at ACFAS 2020 in San Antonio, due September 10, 2019.

Every year, the poster competition presents the very best and latest research in Case Study, Scientific and Student Club categories. Poster grand rounds will take place at 1 pm on Wednesday, February 19, and Thursday, February 20, in the Exhibit Hall with authors at their posters ready to discuss their previously unpublished science with attendees. Always a crowd pleaser, posters are available to view during Exhibit Hall hours each day of the Annual Scientific Conference.

Submit your poster abstracts for this year’s competition to ACFAS by September 10. Submission guidelines and criteria are now available at
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Register for TAA Course — Only a Few Spots Left!
This intense cutting edge two-and-a-half-day program is designed to take attendees to the next level on the latest Total Ankle Arthroplasty techniques. A combination of lecture and hands-on lab, September 6–8, 2019, at Denver’s Science Care Lab is a do-not-miss.

You will perform seven total cadaveric ankle replacements—five primary and two revisions systems. Working with experienced instructors you’ll hone your surgical decision-making processes and learn more about managing degenerative, posttraumatic and systemic ankle arthritis in your patients using TAA.

Space for this course is limited. Download the registration form at to determine if you meet the course prerequisites. Fax the form with required documentation to (800) 381-8270 or email it to
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Wherever You Go, #KeepYouOnYourFeet
Wherever your feet take you this summer, snap a photo of your feet relaxing, working or on vacation and post on your social media channels to show us how you keep yourself on your feet! Be sure to use the hashtags #KeepYouOnYourFeet and #ACFAS to help spread the word on how foot and ankle surgeons keep themselves and their patients moving.

This social media hashtag—part of an ongoing social media campaign at ACFAS—shows the public how important foot and ankle surgeons are for keeping people “on their feet” and active in the summer and all year long. Encourage your success story patients to post their own photos using #KeepYouOnYourFeet, and to tag your practice’s social media in the post, too!

You can also email your photos to along with your name, the location and/or action in the photo and where you practice. The College may post your photos on its social media channels!
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Foot and Ankle Surgery

Identification of Bone Marrow Edema of the Ankle: Diagnostic Accuracy of Dual-Energy CT in Comparison with MRI
A study was conducted to evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) to identify bone marrow edema (BME) of the ankle. Included were 40 consecutive patients examined with DECT and magnetic resonance imaging (MRI) within 10 days. DECT visualized BME in 23 out of 25 patients, with sensitivity, specificity, PPV and NPV and accuracy via DECT image evaluation 92.0, 86.6, 92.0, 84.6 and 90.0 percent for reader 1 and 88.0, 86.6, 91.6, 78.6 and 87.5 percent for reader 2, respectively.

Interobserver and intraobserver agreements were close to perfect. DECT numbers diverged significantly between positive and negative cases with a p value of less than 0.001. Via -20HU cutoff to identify BME, the sensitivity, specificity, PPV and NPV and accuracy of the quantitative analysis were 88.0, 92.6, 95.7, 92.6 and 87.5 percent, respectively. The researchers concluded that DECT represents an accurate imaging tool for demonstration of BME of the ankle when compared to MRI.

From the article of the same title
La Radiologia Medica (07/19) Foti, Giovanni; Catania, Matteo; Caia, Simone; et al.
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Radiographic and Clinical Comparison of Proximal Interphalangeal Joint Arthrodesis Between a Static and Dynamic Implant
A study assessed and compared clinical improvement, radiologic fusion and complication rates between dynamic and static implants for proximal interphalangeal joint arthrodesis. Ninety-five patients, mean age 63.6 years in the dynamic group and 62.3 years in the static group, were involved. Mean follow-up was 11.5 months. The position of the implants was more often satisfying in the dynamic cohort. Fusion rates at four months were 67 percent and 80 percent in the dynamic and static groups, respectively.

Radiologic osteolysis occurred more often in the dynamic group and pain remained present in 3 percent in the dynamic group at the last follow-up versus 7 percent in the static group. Complication rate was 7 percent in the dynamic cohort and 4 percent in the static cohort. The static titanium implant appears superior to the dynamic memory shape implant in Nitinol alloy in terms of fusion, complications and revision rates.

From the article of the same title
Journal of Foot & Ankle Surgery (07/01/19) Vol. 58, No. 4, P. 657 Ferrier, Maxime; Mattei, Jean-Camille; Desmarchelier, Romain; et al.
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The Majority of Patients Have Diagnostic Evaluation Prior to Major Lower Extremity Amputation
A study determined significantly more patients underwent vascular evaluation prior to major lower extremity (LE) amputation at a tertiary care referral center when a vascular surgeon conducted the amputation. Retrospective analysis found 281 patients required major LE amputation over four years, with above-knee amputation performed in 39.1 percent and below-knee amputation performed in 60.9 percent. Amputation was performed because of critical limb ischemia in 92.9 percent of patients while 7.1 percent of amputations were performed due to diabetes or other reasons.

Preoperative vascular evaluation was conducted in all patients undergoing major LE amputation. Vascular surgeon pulse examination was most frequent, followed by pulse volume recordings/ankle–brachial index, angiography, computed tomography, duplex ultrasonography and magnetic resonance angiography. Amputations most commonly occurred due to Rutherford classification VI, with 97.2 percent of patients having Rutherford IV–VI classification.

From the article of the same title
Annals of Vascular Surgery (07/01/19) Vol. 58, P. 78 Hardy, David M.; Lyden, Sean P.
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Practice Management

Doctors Slow to Adopt Tech Tools that Might Save Patients Money on Drugs
A growing number of health systems and insurers are providing real-time drug pricing information to physicians, which can estimate how much a patient will pay out of pocket based on their insurance and chosen pharmacy. The tools can also allow doctors to find cheaper alternatives and begin the process of getting authorization for a drug if one is required by an insurer. Such tools can make cheaper options more accessible to consumers, many of whom face increasing copayments and higher deductibles. However, doctors have been slow to adopt the technology, which has some limitations. Because of price negotiations among insurers—drug makers and pharmacy benefit managers are often highly competitive and secretive—the tools don't have useful data for every patient.

Last month, the U.S. Centers for Medicare and Medicaid Services mandated all Medicare drug plans to embed such a tool in their doctors' electronic prescribing system starting in 2021, hoping to push the industry to provide a centralized pricing tool. Even without such a standard in place, the tools can save money for both providers and patients.

From the article of the same title
NPR (07/05/19) Galewitz, Phil
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Practices Need to Draft Policies for Physician Marijuana Use
As more states move to decriminalize recreational cannabis use, employers in the health care industry should consider how this may affect their drug use policies. Currently, many practices and hospitals bar physicians from using all recreational drugs and refer those who test positive to physician health programs; this can jeopardize physicians' jobs and even their medical licenses. To form balanced approaches to the issue, practices and hospitals can balance their options by first accounting for the legal status of marijuana in their state. In states that do allow the recreational use of cannabis, employers should be aware of their protections, which are often addressed in legislation. For example, in Illinois, the law states employers are not required to permit employees to be under the influence of cannabis in the workplace and may discipline or terminate employees who violate employment drug policies.

However, employees may legally use cannabis on their own time and still test positive for cannabis in the workplace. Employers may also discipline or terminate employees who appear to be under the influence of cannabis, so it is important to understand and document the signs of impairment at work. Employers should also know what accommodations they must provide to employees with a legal right to use medical marijuana.

From the article of the same title
Physicians Practice (07/05/19) Adler, Ericka L.
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Risks of EHRs
A recent investigation by Kaiser Health News and Fortune showed electronic health records (EHRs) have been blamed for a variety of errors. When the HITECH Act of 2009 forced EHRs into widespread adoption, the government allowed competing vendors to develop their own EHRs, resulting in a patchwork of systems that don't always work together. As long as this remains the case, practices can take several steps to prevent errors, such as testing their EHR on a regular basis. Physicians often have no idea how frequently EHRs can make mistakes and thus several health centers offer free tools that allow practices to test their EHRs.

Practices should also create backups and contingencies in case an EHR does fail and be sure to report problems to vendors as they arise. In addition, practices should ban the copying and pasting of information from one form or page to another, which can propagate incorrect or outdated information. Some practices employ medical scribes to handle the system, which can reduce entry mistakes caused by divided attention and reduce the number of EHR system users. Practices must also educate employees about using their EHR by implementing any workarounds as practice policy and sharing fixes among users.

From the article of the same title
Medical Economics (06/29/19) Vol. 96, No. 13 Sweeney, James F.
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Health Policy and Reimbursement

Appeals Court Seems Skeptical About Constitutionality of ACA Mandate
A panel of federal appeals court judges seemed likely to uphold a lower-court ruling that a central mandate of the Affordable Care Act (ACA) is unconstitutional, specifically the mandate that requires most people to have health insurance. Two of the three judges at the pane appeared to believe the mandate should be scrapped and debated whether Congress had fully intended to keep the rest of the ACA when it eliminated the penalty for going without insurance as part of its 2017 tax overhaul. Despite legal precedent directing courts to limit damage to major statues when considering which provisions to throw out, the judges doubted whether the rest of the ACA would stand without the insurance mandate, referring to past statements that it would not.

From the article of the same title
New York Times (07/09/19) Goodnough, Abby
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Even Researchers Don't Know Which Doctors Medicare Advantage Covers
A new study found it can be difficult, if not impossible, for Medicare Advantage enrollees to determine which doctors are available and where. The study, published in the American Journal of Managed Care, found Google was more accurate than Medicare Advantage provider directories. "Directory accuracy is hard," said Michael Adelberg, the study's lead author and a leader of health care strategy at the Faegre Baker Daniels law firm. "But when a consumer joins a plan to get to a doctor in the directory and then cannot, that consumer has a very legitimate beef."

Further, research reveals there is no single source that meaningfully compares Medicare Advantage plans' networks in the aggregate or by specialty. Meanwhile, a recent study published in Health Affairs found 80 percent or more of Medicare Advantage plans provide access to at least 70 percent of primary care physicians in their markets. However, because there is no way for Medicare Advantage beneficiaries to compare plan networks, people could easily enroll in a narrow network plan without knowing it.

From the article of the same title
New York Times (07/08/19) Frakt, Austin
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HHS Announces Quality Summit to Streamline and Improve Quality Programs Across Government
The U.S. Department of Health and Human Services (HHS) has announced the formation of the Quality Summit. The Summit will bring together key industry stakeholders and government leaders to discuss how HHS can adjust its current quality programs to deliver a value-based care model focused on improving patient outcomes. The Summit's formation responds to a June 24 executive order directing federal agencies to develop a Health Quality Roadmap that would align and improve reporting on data and quality measures across federal health programs. HHS quality programs aim to reduce provider burden, improve transparency and bring about better outcomes for program beneficiaries through expanded public reporting of performance results.

From the article of the same title
Healthcare Purchasing News (07/19)
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Medicine, Drugs and Devices

Drugmakers Boost Prices Up to 909%, Defying Political Pressure
Wells Fargo & Co. reports that despite bipartisan efforts to lower drug prices, drugmakers have continued to raise drug prices at an aggressive rate. The firm's analysis of Wolters Kluwer PriceRx data found that companies raised medicine costs by 27% on average in June. Noting that the number of price increases in June went up from May, one Wells Fargo analyst said as political criticism has quieted down, companies are returning to a more aggressive pursuit of drug price increases.

From the article of the same title
Bloomberg (07/09/19) Darie, Tatiana
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FDA Committee to Hold Public Meeting on Cybersecurity in Medical Devices
On September 10, the U.S. Food and Drug Administration (FDA) will hold a public meeting of the Patient Engagement Advisory Committee to discuss the use and regulation of medical devices. The FDA said that because medical devices are increasingly connected to the Internet, hospital networks and other medical devices, it is necessary to practice continuous vigilance and communicate effectively about evolving cybersecurity risks. The committee will provide recommendations addressing which factors should be considered by FDA and industry when communicating cybersecurity risks to patients and to the public. The recommendations will also address patient concerns about changes to their devices to reduce cybersecurity risks as well as the role of other stakeholders, including healthcare providers, in communicating cybersecurity risks to patients.

From the article of the same title
Healthcare Purchasing News (07/19)
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Judge Blocks Trump Administration's Move to Require Drug Prices in TV Ads
U.S. District Judge Amit Mehta has blocked the Trump administration from implementing a new rule that would force pharmaceutical companies to include the wholesale prices of their drugs in television advertising. In doing so, the judge sided with drugmakers Amgen, Eli Lilly and Merck by halting the U.S. Department of Health and Human Services' (HHS) rule from going into effect. HHS Secretary Alex Azar announced the rule on May 8, saying that forcing drugmakers to disclose their prices in direct-to-consumer TV advertising could help drive down skyrocketing prescription drug costs if the companies were embarrassed by them or afraid they would scare away customers.

From the article of the same title
Fox Business (07/08/19)
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This Week @ ACFAS
Content Reviewers

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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