News From ACFAS

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If you missed the Arthroscopy Skills Course this month, you still have three more chances to join us in person for two full days of hands-on skills training.

Take your learning to the cadaver lab where you’ll be performing surgical procedures alongside colleagues and experts in the field covering topics from avoiding common mistakes, establishing portals, understanding triangulation, to reproducible technical pearls and more.

August 29-30, 2020
(Saturday/Sunday)
Chicago, IL
Register

October 4-5, 2020
(Sunday/Monday)
Chicago, IL
Register

October 24-25, 2020
(Saturday/Sunday)
Chicago, IL
Register

We continue taking necessary protective measures and safety precautions to keep our attendees and staff safe at all upcoming courses. To learn more about how we’re keeping you safe, visit acfas.org/SafetyPrecautions. Join us November 7-8 for our newest course, Advanced Arthroscopy and Cartilage Restoration, perfect for foot and ankle surgeons at all career stages wishing to learn the most up-to-date pearls form leading surgeons.

Featuring classic as well as more recent state-of-the-art cartilage restoration techniques, including arthroscopic lateral ankle ligament repair, classic OATS resurfacing and particulate cartilage resurfacing techniques, en bloc resection and replacement techniques, subtalar joint arthroscopy and arthroscopic STJ fusion technique. Come to learn new techniques or just complement your current skill level with tips, quips and surgical pearls from expert faculty.

To register for this course, attendees must have previously taken the basic Arthroscopy of the Foot and Ankle Course. Check back for more information as registration opens soon, visit acfas.org/education. Class of 2020, join ACFAS and take the next important step in your career path! Thanks to the support of our local Regions, first-year podiatric surgical residents receive a complimentary first-year membership in the College (a $124 value). Take advantage of all the member benefits such, including print and online copies of The Journal of Foot & Ankle Surgery, discounted registration for skills courses, information on ACFAS Recognized Fellowships and more.

The resident membership year officially begins October 1, but you can get a head start by joining now to get membership for August and September included as a bonus! Download an application from acfas.org/join.

Foot and Ankle Surgery

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The study aimed to describe midfoot beaming constructs and postoperative complications after midfoot reconstruction with and without subtalar arthrodesis. Researchers reviewed medical records of 30 patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct, all with Sanders-Frykberg II/III classification of Charcot neuroarthropathy and at least three months of follow up. Twenty-two patients had concomitant subtalar arthrodesis and midfoot beaming. Postoperative radiographs were evaluated for evidence of hardware failure at the latest followup evaluation. Overall complications were lower in patients with subtalar arthrodesis (40.9 percent) than those without subtalar arthrodesis (75 percent). Furthermore, increased number of screws used in the midfoot construct was negatively correlated with complications. An intramedullary midfoot beaming superconstruct with subtalar arthrodesis has previously been proposed to provide better fixation after midfoot beaming CN reconstruction.


The study examined the relationship between hallux valgus (HV) angle, functional activity, toe flexor strength and plantar pressure. Researchers assessed 94 young females, with 39 and 55 participants in the HV and no HV groups, respectively. Functional reach (FR) and maximum step length (MSL) did not differ significantly between the HV and no HV groups. Toe flexor strength differed significantly between the HV and no HV groups. During walking, plantar pressure was lower in the second through fifth toes in the HV group. During FR, plantar pressure was significantly greater in the first metatarsal in the HV group. HV angle was negatively correlated with toe flexor strength and plantar pressure during walking in the second through fifth toes and positively correlated with plantar pressure during FR in the first metatarsal. Toe flexor strength was negatively correlated with plantar pressure during FR in the second through fourth metatarsals, and there was a positive correlation with MSL.


The study evaluated the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. Intraoperative ultrasonography was used to identify and mark the course of the small saphenous vein and the sural nerve. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein. No sural nerve injury or other complications were found intraoperatively and postoperatively. All patients returned to work and light sporting activities at a mean of 12.78 weeks and 17.28 weeks, respectively. The mean American Orthopaedic Foot and Ankle Society (scores saw a statistically significant improvement from 59.17 preoperatively to 98.92 at the time of 12-months follow-up.

Practice Management

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Atrius Health, a large practice operator in Massachusetts, provides enhanced patient access such as same-day appointments. About 80 percent of Atrius Health's patient population is registered on the organization's online portal.Atrius Health has a price transparency phone line in its billing department that provides service pricing including insurance coverage. Atrius Health has made catering to consumers a primary objective, says Marci Sindell, former chief marketing officer and senior vice president of external affairs. Sindell identifies four primary consumer-friendly facets at Atrius Health: access, technology, convenience and price transparency.


Every practice must consider the steps that will be taken if a patron refuses to wear a mask or comply with other precautions related to the COVID-19 pandemic. First, practices should establish and share all practice policies in advance so that patients know what to expect when they arrive. There should be no exceptions made to allow a patient to enter the practice without a mask. If a patient becomes belligerent, either security for the building or 911 should be called. Having a chain of command can be reassuring to staff who may not be comfortable handling a difficult patient. Some patients have been showing up with laminated cards that indicate they have a “medical condition” that allows them to not wear a mask. These are not legitimate, and a practice is required to accommodate only the reasonable needs of their patients. Patients do not generally have a right to demand or receive services from any particular practice.


There are certain best practices for successfully integrating telehealth into care delivery. This includes ensuring that telemedicine systems are as integrated, making them as simple to introduce and manage as possible. Practices should have a clear plan for pre- and post-visit communication that reduces the burden on office staff. It helps to standardize telehealth workflows, as complexity and room for error increase when each provider is using a different platform. Telemedicine is more complicated than any single-use solution, however, and practices should not sacrifice income and care quality to fit everything into a video visit. Transparent reporting and documentation is critical for telehealth visits, especially as payers start to implement more restrictions. Practices should also maintain high levels of security when using telehealth to ensure that no future issues arise around HIPAA compliance.

Health Policy and Reimbursement

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The American Hospital Association (AHA) has appealed a decision upholding a Trump administration rule that requires hospitals to disclose the rates they privately negotiate with insurers. AHA contends that the rule goes beyond the statutory intent of the Affordable Care Act and violates the First Amendment by forcing hospitals to disclose proprietary information, according to its filing with the US District Court of Appeals for the District of Columbia Circuit. The appeal also stated that the Department of Health and Human Services' "interpretation would implausibly produce thousands of different 'standard charges' for each of the thousands of items and services that hospitals offer — or millions of data points." The price-disclosure requirements would cover the nation's more than 6,000 hospitals that accept Medicare. The rule is scheduled to take effect in January 2021, with hospitals facing fines of up to $300 a day if they don't disclose negotiated rates.


According to a recent federal rule, people who have lost their job-based health insurance have more time to decide whether to hang onto their employer-sponsored health insurance or find an alternative. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), people who lose their job-based coverage have 60 days to decide whether to continue with that same health plan. But under the new rule, the countdown doesn't start until the end of the COVID-19 "outbreak period," which started March 1, and it will continue for 60 days after the COVID-19 national emergency is declared to be at an end. That end date hasn't been determined yet. With this extension of the time frame to sign for up for COBRA coverage, people have at least 120 days or longer to decide. However, COBRA coverage can be costly as workers would have to pay both their portion of the premium and their former employer's share, plus a 2 percent administrative fee. Waiting too long to decide to purchase coverage from the Affordable Care Act exchanges, however, could leave many without coverage.

Medicine, Drugs and Devices

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New research, based on focus groups conducted with primary care providers in four US cities, reveals that antibiotic resistance was seen as a lower priority compared with other health concerns. The eight focus groups—conducted by the Pew Charitable Trusts and the American Medical Association in Chicago, Los Angeles, Philadelphia and Birmingham—involved family medicine and internal medicine physicians and pediatricians. Participants were asked to rank several public health issues in terms of importance and then questioned regarding their attitudes and perceptions of antibiotic use and stewardship. The discussions revealed two key themes: that antibiotic resistance is considered less of a threat than concerns such as obesity, diabetes and opioid use, and that it does not affect the participants' patients or their daily practice.


A report from the American Medical Association's Opioid Task Force reveals that opioid prescriptions decreased for the sixth consecutive year in 2019. There was a 37 percent decrease in opioid prescriptions in 2019, dropping from more than 244 million in 2014 to about 154 million in 2019. The report also indicates there was a 64 percent increase since 2018 in physicians' use of state drug monitoring programs. More physicians are also prescribing naloxone, a medication designed to rapidly reverse opioid overdose, according to the report. It found that more than 1 million prescriptions of naloxone were dispensed last year, more than two times the number prescribed in 2018.


Testifying at a hearing of the US House Energy and Commerce Oversight and Investigations Subcommittee, pharmaceutical company officials expressed differences in how they would price their potential COVID-19 vaccines, with some indicating they would not seek a profit from the vaccines while others indicated they would. AstraZeneca and Johnson & Johnson executives said they would sell their vaccines at the cost of production, at least until the pandemic subsides. Officials from Moderna and Merck said they would set prices exceeding their manufacturing costs. A Pfizer executive suggested the company would not charge too much for the vaccine it is developing with partner BioNTech SE, saying the price would reflect the "extraordinary times" of the pandemic. Drug manufacturers have not said what they plan to charge, but analysts say the firms could earn billions of dollars. "Ensuring the safety and efficacy of COVID-19 vaccines is critical, but it will mean nothing if the price is a barrier to all Americans getting it," Rep. Jan Schakowsky (D-IL) said during the hearing.