August 21, 2019 | | JFAS | Contact Us

News From ACFAS

Nominations Open to Serve on ACFAS Board of Directors
The ACFAS Nominating Committee seeks experienced members to serve on the College’s Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to help lead the profession, send your nomination application by September 9.

Visit for the nomination application and complete details on the recommended criteria for candidates. For more information, contact ACFAS Executive Director J.C. (Chris) Mahaffey, MS, CAE, FASAE, at or (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair John S. Steinberg, DPM, FACFAS at or (202) 444-3059.

The Nominating Committee will announce recommended candidates to the membership no later than October 23. Candidate information and ballots will be emailed to all voting members no later than December 7. Electronic voting ends on December 22. New officers and directors will take office during ACFAS 2020, February 19-22, 2020 in San Antonio.
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Showcase Your Poster at ACFAS 2020
Display your latest discoveries by submitting a poster abstract for this year’s poster competition at ACFAS 2020 in San Antonio. All posters are due September 10, 2019.

Every year, the poster competition presents the very best and latest research in Case Study, Scientific and Student Club categories. Posters will be on display for viewing in the Exhibit Hall during 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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Surgical Skills Courses Refreshed
Big changes are afoot for the Surgical Skills Courses. Thanks to the valuable feedback from attendees and 2016 GAP analysis results, starting this October with the Managing Surgical Complications of the Foot course in Chicago, you can expect to see a dramatic shift in the approach and format of the courses, resulting in a more advanced, intensive learning experience.

Perhaps unsurprisingly, feedback indicated an interest in shorter lectures in favor of increased lab time. In response, the Surgical Complications course will adopt a new format that effectively eliminates the lecture portion of the program and replaces it with preliminary materials and videos at the meeting. When you arrive for the course, you will go straight into the lab for brief faculty-led demos leading to intensive procedure time that will allow for both honing fundamental skills and acquiring elite skills.

Summarized as Demo-Perform-Repair-Repeat, this new approach is designed to maximize hands-on lab time. Prior to the course, you will receive the surgical outline for each procedure you will be practicing. Essentially a step-by-step “recipe,” it also includes all references for follow-up and additional information. Everything you need to prepare will be provided to you to review at your own pace, prior to the course.

To register for this newly formatted course set for October 26-27 at the MERCI Lab in Chicago, visit
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Foot and Ankle Surgery

Effect of Extensive Tenosynovectomy on Diffuse Flexor Hallucis Longus Tenosynovitis Combined with Effusion
Researchers examined the clinical and magnetic resonance imaging (MRI) outcomes of extensive tenosynovectomy on patients with diffuse flexor halluces longus tenosynovitis combined with effusion (DFHLT-E). The researchers analyzed 14 consecutive patients undergoing extensive tenosynovectomy for DFHLT-E in the same foot and ankle center from January 2013 to December 2016. Patients with a minimum one-year follow-up were evaluated with physical examination, MRI, American Orthopaedic Foot and Ankle Society (AOFAS) clinical midfoot scale and visual analog scale (VAS) pain scores.

There were no recurrences in any of these patients, and researchers found statistically significant improvement in AOFAS and VAS scores from before surgery to the final follow-up. MRI examination revealed two patients with small residual and limited effusion with no clinical symptoms. Superficial pin infection was observed in one patient, and two patients had transient neurostimulation. The findings indicate that extensive tenosynovectomy is an effective option for the treatment of DFHLT-E with fewer postoperative complications and a lower rate of recurrence.

From the article of the same title
Journal of Orthopaedic Surgery (07/31/2019) Qu, Wenqing; Liu, Tong; Chen, Wentao; et al.
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Gender Trends in Authorship of Foot and Ankle Academic Literature over 24 Years
The study describes a retrospective bibliographic analysis of the representation and longevity of female investigators among the authors of articles in three foot and ankle research journals from 1993 to 2017. Researchers identified authors from Foot and Ankle International, The Journal of Foot and Ankle Surgery and Foot and Ankle Clinics, noting the proportion of female authors who were first, middle and senior authors and the total publication count per author. Six thousand five hundred and ninety-seven (81.1 percent) of the articles published from 1993 to 2017 had an accessible author list, from which researchers were able to identify and gender-match a total of 9273 unique authors, 19.2 percent of whom were female. Female representation rose for first and senior authors rose from 6.5 percent and 5.9 percent (1993 to 1997) to 16.9 percent and 13.1 percent (2013 to 2017), respectively. However, female authors were less likely to continue publishing five years after initial publication, and they published fewer articles on average. Of the 2691 authors who first published between 2006 and 2011, 369 (13 percent), of whom 8.1 percent were female and 15 percent were male, continued to publish five years after their initial publication.

From the article of the same title
Journal of Foot & Ankle Surgery (07/24/19) Vora, Molly; Kuripla, Casey; Ouyang, David; et al.
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Role of Rotation in Total Ankle Replacement
Researchers aimed to better understand the axial rotational profile of patients undergoing total ankle replacement (TAR). They examined the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA) and the tibiotalar angle in 157 standardized computed topography scans of patients with end-stage ankle arthritis planning to under primary TAR surgery. The researchers assessed the variation between the medial gutter line and the line bisecting both gutters, and they also measured the foot position in relation to the TMA with the foot plantigrade. They found a large variation in rotational profile of patients undergoing TAR, especially between the medial gutter line and the TMA. Their findings indicate that consistent methods are needed to guide surgeons toward judging the appropriate axial rotation of their implant on an individual basis. The authors recommend careful clinical assessment and preoperative CT scans in order to determine the correct rotation.

From the article of the same title
Foot & Ankle International (08/12/2019) Najefi, Ali-Asgar; Ghani, Yaser; Goldberg, Andy
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Practice Management

How Patient Rapport Managers Save You Time and Money
Regular follow-up calls greatly enhance patient care, but not every doctor has the time or need to make them personally, which is where patient rapport managers come in. Patient rapport managers are team members with healthcare experience who deliver delivering ad hoc follow-up that bridges any gaps between patients and practitioners. Patient rapport managers might touch base with patients after a procedure, a sudden illness, a trauma or an emotional event. They can also review standard protocols; assess the compliance and effectiveness of prescriptions or treatments; notify patients about scheduling changes or delays; and suggest appropriate after-hours referrals for agencies.

Most importantly, patient rapport managers can detect and notify doctors of any medical red flags that warrant their attention, helping them give more proactive care. Patient rapport managers can be part-time or full-time, in-house or remote, depending on what a practice is looking for. In addition to the emotional and service-oriented benefits, hiring patient rapport managers frees up physicians' time to see more patients and ultimately saves money. Practices looking to hire patient rapport managers can start by looking at their current staff for potential candidates, or they can look to hire a medical professional with experience as a hospital patient liaison or care ambassador.

From the article of the same title
Physicians Practice (08/14/19) Jacques, Sue
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Seven Tips to Get More Out of Your Patient Portal
Patient care portals can act as a one-stop center for health records, communications, education and interaction with physicians, creating opportunities for patient engagement while helping practices meet MIPS requirements and maximize their reimbursement potential. For example, the portal can be used to share a patient’s full picture of their records, helping them manage their health more proactively. It can also be used to monitor patient engagement activity, which is critical to determining which interventions are most successful at an individual patient level. The portal can be used to give patients the ability to schedule their own appointments online or through a mobile app, saving time for front-office staff.

Importing data into the electronic health record system so it only has to be completed once reduces friction in the patient experience and makes data collection more efficient. Additionally, portals can give patients a choice about how they receive communications. It can be used to coordinate medication refill requests, pay bills, provide educational materials and supply visit and discharge summaries, as well as to enable secure messaging between patients and practice staff. Portals can also enable home monitoring by storing data transmitted by wireless monitoring devices such as glucose and pulse oximeters. This helps patients manage their chronic conditions while assisting clinicians in forming their care plans, spotting trends and improving their clinical and financial outcomes.

From the article of the same title
Medical Economics (07/31/19) Mazzolini, Chris
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To Boost Workforce, Medical Schools Try to Sell Rural Life
A number of medical schools across the United States have programs dedicated to bolstering the number of primary care doctors in rural communities, sending students to live in small towns and train with rural doctors. Some also organize outings and cultural experiences to try to convince students to live there after graduation. According to the U.S. Department of Health and Human Services, most of the 7,000 facilities, population groups and areas in the United States facing a shortage of primary care physician are rural, and almost 4,000 more physicians are needed to close the gap.

While many of the students who come to these programs are not from rural areas, all of them expressed an interest in working with underserved populations. For students from small towns, the programs can help maintain their enthusiasm for rural life, whereas urban medical programs often push students to become specialists and avoid primary care. Administrators of rural track medical school programs say their graduates go into rural practice at considerably higher rates, although the students' prior inclination to practice in a rural area may mean those figures exaggerate the programs' success.

From the article of the same title
Associated Press (08/09/19) Thanawala, Sudhin
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Health Policy and Reimbursement

Administration Hits Brakes on Law to Curb Unneeded Medicare CT Scans, MRIs
Five years after the U.S. Congress passed a law to reduce unnecessary MRIs, CT scans and other diagnostic imaging tests that could harm patients and waste money, federal officials have yet to implement it. The law requires that doctors consult clinical guidelines set by the medical industry before Medicare will pay for many common exams for enrollees. Healthcare providers who go beyond clinical guidelines in ordering these scans will, under the law, be required after that to get prior approval from Medicare for their diagnostic imaging. However, the Trump administration has delayed the law until January 2020. Next year, the U.S. Centers for Medicare and Medicaid Services (CMS) will test the law, and even if physicians do not check the guidelines, Medicare will still pay for an exam. CMS also said it won't decide until 2022 or 2023 when physician penalties will begin.

From the article of the same title
Kaiser Health News (08/14/19) Galewitz, Phil
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Data Shows Drop in Coverage Among People Ineligible for ACA Subsidies
Data from the U.S. Centers for Medicare and Medicaid Services shows that health insurance enrollment fell by 1.2 million people between 2017 and 2018. That decline occurred among people with incomes too high to qualify for Affordable Care Act (ACA) subsidies. Over the same time period, enrollment increased by 300,000 people who do qualify for financial assistance under the ACA. The figures highlight that the ACA remains stable due to subsidies available to lower-income individuals. However, premium increases have encouraged high income earners to leave the program. Premiums have jumped by 26 percent between 2017 and 2018. Meanwhile, about 10.6 million people had coverage on ACA exchanges as of February, close to the same number of people from the same time last year.

From the article of the same title
The Hill (08/12/19) Sullivan, Peter
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Hospitals Call for Overhauling Medicare Advantage Prior Authorization Rules
In response to the Trump administration's request for information on its Patients over Paperwork initiative to cut Medicare red tape, hospitals say prior authorization is a complicated system where payment isn't guaranteed even if they follow all the steps insurers lay out for them. Hospitals and health systems are demanding that the U.S. Centers for Medicare and Medicaid Services (CMS) establish national rules for how insurers manage prior authorization and payment for pre-approved claims in Medicare Advantage. Some also say the appeals process is burdensome, with some stating that they have to appeal unpaid Medicare Advantage claims at least three times, and even if an appeal is successful, it can take six months to a year to get paid.

Some suggest that CMS should urge electronic health record (EHR) vendors to allow clinicians to enter codes for coverage determinations and prior-authorization requirements into the records. EHRs also could have documentation requirements within the system to refer to the CMS guidelines before submitting prior-authorization requests. House lawmakers have introduced legislation to establish an electronic system for approvals, cut the number of preauthorizations for routine services and eliminate them entirely for "medically-necessary services performed during pre-approved surgeries or other invasive procedures."

From the article of the same title
Modern Healthcare (08/13/19) Luthi, Susannah
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Medicine, Drugs and Devices

Doctors Can Change Opioid Prescribing Habits, but Progress Comes in Small Doses
A Michigan study in the New England Journal of Medicine gauged adherence to surgery-specific guidelines for opioid prescription. The researchers found surgeons reduced by nearly one-third the number of pills they prescribed patients seven months after guidelines were imposed, with no reported decline in patient satisfaction or elevation in reported pain. Physicians generally prescribed eight fewer pills per patient—from 26 to 18—across nine common surgical procedures.

Patients also reported taking fewer pills, falling from 12 to nine on average, possibly from being prescribed fewer medications to begin with. The difficulty of changing prescribing habits remains a challenge, as by the time the study concluded the average number of pills prescribed surpassed the latest recommendations for all procedures.

From the article of the same title
Kaiser Health News (08/14/19) Appleby, Julie; Lucas, Elizabeth
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Reduced Bone Loss Is Associated with Reduced Mortality Risk in Subjects Exposed to Nitrogen Bisphosphonates
A study was conducted to determine whether the association between bisphosphonates and mortality is mediated by a reduction in the rate of bone loss. Participants from the population-based Canadian Multi-center Osteoporosis Study were followed prospectively between1996 and 2011. Comorbidities and lifestyle factors were collected at baseline and bone mineral density at baseline and at years three, five and 10. Rate of bone loss was calculated using linear regression. Information on medication use was obtained yearly. Bisphosphonate users grouped into nitrogen bisphosphonates (nBP; alendronate or risedronate) and etidronate and non-users were matched by propensity score, including all baseline factors as well as time of treatment. Rapid bone loss was associated with more than twofold increased mortality risk compared with no loss. Mediation analysis indicated that 39 percent of the nBP association with mortality was related to a reduction in the rate of bone loss. This finding provides an insight into the mechanism of the relationship between nBP and survival benefit in osteoporotic patients.

From the article of the same title
Journal of Bone and Mineral Research (08/19) Bliuc, Dana; Tran, Thach; Adachi, Jonathan; et al.
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To Find the Next Antibiotic, Scientists Give Old Drugs a New Purpose
Researchers from Brown, Emory and Harvard universities say they can kill antibiotic-resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), by repurposing bithionol, a drug formerly used to treat parasitic infections in horses. In a study published in the Proceedings of the National Academy of Sciences, the scientists looked for existing drugs that could attack a bacteria's membrane to eliminate infections. They screened more than 80,000 known drugs on MRSA-infected worms and found only a few of them could penetrate the bacteria's membrane, including bithionol.

The team reports that bithionol was able to kill MRSA in a lab dish within 24 hours. When combined with gentamicin, bithionol in a lower dose could kill 90 percent of MRSA infections in mice. While the study suggests that bithionol is a promising treatment for MRSA, the findings also indicate that scientist could address antibiotic resistance by exploring new ways to use old drugs and using them in combination with traditional antibiotics.

From the article of the same title
NPR (08/12/19) Torres, Luisa
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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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