August 19, 2020 | | JFAS | Contact Us

News From ACFAS

Build Your Own Bundle with Complication Webinar Series
Summer is winding down, but our e-learning opportunities are heating up! You have three more chances to join us for our Complication Webinar Series—and you can even build your own bundle and get three webinars for the price of two, so take your pick!

Up next in the webinar series:
Wednesday, August 26
Metatarsal Fracture Conundrums: A Minor Trauma Played in F Sharp
8pm CST | CME Hour: 1 Credit
Fees: Member $20 | Non-Member $30

Coming this fall:
Wednesday, September 23
Making That Tough DecisionReconstruct or Destruct?
7pm CST | CME Hour: 1 Credit
Fees: Member $20 | Non-Member $30

Wednesday, October 28
Menacing ConditionsHow to Make Them Nice
8pm CST | CME Hour: 1 Credit
Fees: Member $20 | Non-Member $30

Don’t let Webinar Wednesday pass you by! Pick any three available (live or recorded) webinars and only pay for two! Visit to see all upcoming webinars and start building your bundle today!
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Wound Care Advocacy Update: New CMS Proposed Rules
The Center for Medicare and Medicaid Services released for comment its proposed CY 2021 updates to the Hospital Outpatient Prospective Payment System and Physician Fee Schedule. The provisions the Alliance has identified as particularly impacting wound care clinicians, which the Alliance will be tracking and preparing comment on are:
  • Physician Fee Schedule: Telehealth, Payment cuts for surgery, quality payment program, evaluation and management and CPT and HCPCS codes
  • Hospital Outpatient Prospective Payment System: Payment methodology for cellular or tissue-based products for wounds (CTPs), Payment threshold for CTPs, HCPCS Codes for Wound Care Products and Site-neutral payment.
The Alliance will be vetting these and other provisions with members to provide comment submission for both and provide recommendations for change on other provisions. All stakeholders are asked to submit comments by the deadline of October 5, 2020. See a full summary of the provisions for more information.
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Eight Fellowship Programs Receive Status with ACFAS
The ACFAS Fellowship Committee recently determined the following fellowships exceed the minimal requirements to be upgraded to Recognized Status with the College after their first successful year:

Associates in Medicine & Surgery - Sports Medicine/Reconstructive Foot & Ankle Fellowship
Fort Myers, Florida
Program Director: Eugene A. Batelli, DPM, FACFAS

St. Petersburg Innovative Foot & Ankle Surgery Fellowship
Largo, Florida
Program Director: Adam D. Perler, DPM, FACFAS

Foot & Ankle Institute Fellowship
Program Director: Sandra R. Raynor, DPM, FACFAS

University of Maryland Limb Preservation and Deformity Correction Fellowship
Gwynn Oak, Maryland
Program Director: Jacob Wynes, DPM, MS, FACFAS

South Central Pennsylvania Reconstructive Foot and Ankle Fellowship
Lancaster, Pennsylvania
Program Director: Michael B. Younes, DPM, FACFAS

The following fellowships have been granted Conditional Status with ACFAS since the programs are new to the College and have not yet had a fellow matriculate through:

Hinsdale Orthopaedic (IBJ) Foot and Ankle Fellowship
Joliet, Illinois
Program Director: Brian J. Burgess, DPM, FACFAS

Rocky Mountain Reconstructive Foot and Ankle Fellowship
Program Director: Alan Ng, DPM, FACFAS

Virginia Fellowship in Reconstruction, Revision and Limb Preservation Surgery of the Foot and Ankle
Mechanicsville, Virginia
Program Director: Laurence G. Rubin, DPM, FACFAS

All Conditional Status programs are considered for Recognized Status with ACFAS after they have received status and the first fellow completes the program.

ACFAS highly recommends taking on a specialized fellowship for the continuation of foot and ankle surgical education after residency. If you are considering a fellowship, visit to review a complete listing of programs and minimal requirements.
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Foot and Ankle Surgery

Comparison of Effectiveness of Density and Number of Sessions of Extracorporeal Shock Wave Therapy in Plantar Fasciitis Patients
This study investigated the effect of density and number of sessions extracorporeal shock wave therapy (ESWT) on quality of life in patients with plantar fasciitis (PF). Between September 2019 and December 2019, a total of 94 patients with the diagnosis of PF were randomly divided into three groups. Group 1 (n=33) received seven sessions of high-energy flux density (H-ESWT), group 2 (n=31) received three sessions of H-ESWT and group 3 (n=30) received seven sessions of low-energy flux density with three days interval. There was a statistically significant decrease in the Visual Analog Scale (VAS), Functional Assessment of Chronic Illness Therapy-Fatigue Scale and Foot Function Index scores in all groups after treatment compared to baseline. Only the Short Form-36 and Six-Minute Walking Test subscale scores were statistically significantly higher. There was also a statistically significant difference in the scale scores in Group 1 versus Group 2 and in Group 2 versus Group 3.

From the article of the same title
Journal of Foot & Ankle Surgery (08/07/20) Gezginaslan, Omer; Basar, Gokhan
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Mortality and Morbidity of Surgical Management of Geriatric Ankle Fractures
The study investigated the mortality and complications of open reduction and internal fixation used to treat ankle fractures in geriatric patients. The patient cohort included 2,353 ankle fractures: 1,877 were among 65 to 79 years of age and 476 were among 80 or older. Thirty-day mortality was 3.2-fold higher in the 80 to 89 years of age group compared with the 65 to 79 years of age group. However, after controlling for the ASA class, 80 to 89 years of age patients no longer had a significantly higher mortality. Similarly, revision surgery rate, transfusion requirement, urinary tract infection and length of stay were all significantly higher in the older age group. However, after controlling for the ASA class, 80 to 89 years old patients no longer had a rate of complications in comparison to the 65 to 79 years old age group.

From the article of the same title
Journal of the American Academy of Orthopaedic Surgeons (08/15/20) Gil, Joseph A.; Goodman, Avi D.; Kleiner, Justin; et al.
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Outpatient Surgery in Patients with Ankle Fractures Miminizes Hospital Admissions and Utilization of Healthcare Resources
The purpose of this study was to examine the outcomes of an outpatient surgery protocol for acute closed ankle fractures. In this retrospective study, 262 patients underwent outpatient surgery for their closed ankle fractures at authors' level-1 trauma centre, with a total of 196 patients included in the final analysis. Thirty-two patients (16.3 percent) had an unplanned emergency department visit within 30 days of fracture fixation and two patients (1.0 percent) required hospital readmission within 30 days of their surgery. Sixteen patients (8.2 percent) developed a surgical site infection (SSI), including 11 (5.6 percent) superficial and five (2.6 percent) deep infections. The authors conclude that strategic outpatient management of acute closed ankle fractures is associated with acceptable rates of unplanned emergency department visits, hospital readmissions and SSIs.

From the article of the same title
International Orthopaedics (08/08/20) Bullock, Travis S.; Gutierrez-Naranjo, Jose M.; DelBello, Robert G.; et al.
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Practice Management

For Doctors of Color, Microaggressions Are All Too Familiar
Microaggressions are “subtle, stunning, often automatic and nonverbal exchanges which are ‘put downs’” of Black people and members of other minority groups. Black doctors across specialties have said that such experiences are common, with one likening repeated experiences to "death by a thousand papercuts." Only 5 percent of the American physician work force is African-American, and 2 percent are Black women. More than a dozen Black women interviewed said that they frequently heard comments from colleagues and patients questioning their credibility and undermining their authority. Despite studies showing that Black patients have improved outcomes when seen by Black doctors, many Black physicians struggle to advocate for themselves and their patients within the rigid hierarchies of the medical system. Experts say that hospital and residency directors looking to address the problem should begin with hearing and validating the experiences of Black doctors. Continued diversification is also critical so that Black physicians are not working in isolation.

From the article of the same title
New York Times (08/11/20) Goldberg, Emma
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How to Evolve Your Patient Communication Strategy During COVID-19
Practices should adapt their communication strategies to ensure its relevance and flexibility for an evolving landscape. Many patients in the community have not been seen by the practice recently, but it is still critical to connect with all patients to share best practices, keep patients healthy and address any misconceptions. A subset of patients may experience symptoms that indicate a COVID-19 infection. There are tools that assist physicians in identifying and triaging infected patients. Patients with COVID-19 need to be triaged appropriately to ensure they receive proper care while reducing the risk to others. Telehealth can help a care team monitor a patient's symptoms to see if they are worsening or require in-person treatment. Beyond COVID-19 patients, a “hybrid” model of in-person and virtual care is critical in treating a practice's patient community.

From the article of the same title
Physicians Practice (08/06/20) Ekram, Tashfeen
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Overcome Your Bias Blind Spots to Better Help Patients
The article reflects on racial bias in the medical field and provides advice for physicians on how to recognize and combat implicit bias. Everyone can struggle with implicit bias, but recognizing this is "an opportunity to become aware and act," specialists say. Psychiatrists suggest taking the Harvard University's Implicit Associations test, which can at least begin to raise our self-awareness. Another good way to avoid blind spots is to focus on patients as individuals. Mental health providers can help physicians examine and understand their feelings on these issues, making the underlying fears easier to resolve. Physicians can gain a better understanding of the issues their patients face by educating themselves on relevant issues, including the effects of racism on medical outcomes. Doctors should take time to reflect on the care they provide and know that implicit bias increases when they are rushed or stressed.

From the article of the same title
Medical Economics (08/08/20) Bernard, Rebekah
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Health Policy and Reimbursement

COVID-19 Data Reporting System Gets Off to Rocky Start
A month after states were ordered to report COVID-19 data directly to the US Department of Health and Human Services (HHS), bypassing the US Centers for Disease Control and Prevention, the public release of hospital data has slowed dramatically. Public health experts say the release of key indicators is lagging by a week or more. This is significant because the data is used to allocate antiviral drugs and personal protective equipment and gauge the stress on the US hospital system. HHS officials say twice as many hospitals are reporting coronavirus-related data each day now than under the previous system. However, a senior HHS official indicated that more time is needed to analyze the data and establish confidence in the results. Said Johns Hopkins Center for Health Security's Jennifer Nuzzo, "This switch happened at a very vulnerable moment, and there is a data consistency and quality problem."

From the article of the same title
Wall Street Journal (08/11/20) Whelan, Robbie
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Trump Administration Announces Initiative to Transform Rural Health
The US Centers for Medicare and Medicaid Services (CMS) announced a new value-based payment model for rural healthcare providers. According to CMS, the Community Health Access and Rural Transformation (CHART) model ties payment to value, increases choice and reduces costs for patients. The model will provide "support through new seed funding and payment structures, operational and regulatory flexibilities and technical and learning support," the agency said in a statement. Providers interested in the CHART Model have two options for participation: the Community Transformation Track and the Accountable Care Organization Transformation Track.

From the article of the same title
CMS Press Release (08/11/20)
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Medicine, Drugs and Devices

CDC Issues a Dire Warning for the Fall if Coronavirus Measures Are Not Followed
US Centers for Disease Control and Prevention (CDC) Director Robert Redfield, MD, is urging Americans to follow recommended COVID-19 measures or risk experiencing the worst fall season in the nation's public health history. He said, "For your country right now and for the war that we're in against COVID, I'm asking you to do four simple things: wear a mask, social distance, wash your hands and be smart about crowds." He also advised people to get an influenza vaccine.

CDC has purchased 10 million doses of the influenza vaccine for uninsured adults this year, up significantly from the typical 500,000 doses. Regarding a vaccine for COVID-19, Redfield is cautiously optimistic that one or more will be ready by the start of 2021. A CNN poll conducted in May, meanwhile found that a third of Americans said they would not get vaccinated against coronavirus, even if the vaccine were widely available and inexpensive.

From the article of the same title
CNN (08/13/20) Karimi, Faith; Almasy, Steve
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FDA Guides Drug-Drug Interaction Studies for Therapeutic Proteins
The US Food and Drug Administration (FDA) issued new draft guidance to help companies evaluate drug-drug interactions (DDIs) for therapeutic proteins. The draft guidance addresses therapeutic proteins (TPs) licensed as therapeutic biological products, but FDA say the general concepts could be applied to other biological products, such cellular and gene therapies regulated by the US Center for Biologics Evaluation and Research. Sponsors are advised to consider the potential mechanisms for DDIs between TPs or between TPs and small molecules.

From the article of the same title
Regulatory Focus (08/10/2020) Oakes, Kari
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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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