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News From ACFAS

Accepting ACFAS Board Nomination Applications
There’s still time to apply to be on the ACFAS Board of Directors! We’re now accepting applications for the best and brightest to serve on the College’s Board. If you are an active ACFAS Fellow, believe you are qualified and would like to help lead the profession, submit your application by September 15.

Visit for details on recommended candidate criteria and the nomination application. For more information, contact ACFAS Executive Director Patrick (PJ) Andrus at If you have questions regarding eligibility criteria, contact Nominating Committee Chair Christopher Reeves, DPM, FACFAS at

The Nominating Committee will announce recommended candidates to the membership by November 27, 2020. Candidate information and ballots will be emailed to all voting members no later than December 11. Electronic voting ends on December 28.
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New Grads: Take Advantage of Complimentary Membership
It's easy to join! Dues for PGY-1 residents are waived thanks to the local ACFAS Regions’ support. Your new ACFAS membership will help you get a head start on your post graduate training with the help of the many resources available to ACFAS members: Don't miss out on this valuable membership—download an application today.
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Foot and Ankle Surgery

Diabetic Foot Problems During the COVID-19 Pandemic in a Tertiary Care Center: The Emergency Among the Emergencies
The study evaluated clinical features and amputation risk of individuals with diabetes and diabetic foot ulceration (DFU) admitted to an Italian tertiary care center during the COVID-19 lockdown. The study population included 63 patients, of whom 25 patients were admitted in 2020 and 38 patients in 2019. There were no significant differences between groups in age, diabetes duration and HbA1c levels. The proportion of patients coming from the outpatient clinic was significantly lower in the 2020 group and the proportion of patients admitted for emergency was significantly higher. The urinary albumin-to-creatinine ratio was significantly higher in the 2020 group. A significantly higher prevalence was found in the 2020 group for gangrene and for the proportion of patients requiring amputation. Researchers suggest that the COVID-19 lockdown may have increased amputation risk because of the sudden interruption of DFU care and lower limb preservation pathways, resulting in delayed diagnosis and treatment.

From the article of the same title
Diabetes Care (07/20) Caruso, Paola; Longo, Miriam; Signoriello, Simona
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Endosinotarsal Device Exerts a Better Postroperative Correction in Meary's Angle than Exosinotarsal Screw from a Meta-Analysis in Pediatric Flatfoot
The study aimed to provide a meta-analysis for the outcomes of the subtalar extra-articular screw arthroereisis and the endosinotarsal device for pediatric flexible flatfoot. A systemic search for correction of pediatric flexible flatfoot using subtalar arthroereisis was conducted mainly in Pubmed and Scopus though Dec. 31, 2019. The standardized mean differences of postoperative versus preoperative calcaneal pitch and Meary's angle were defined as the primary outcomes, with the preoperative versus postoperative American Orthopaedic Foot & Ankle Society (AOFAS) scores defined as secondary. The meta-analysis included 12 comparative studies comprising 2,063 feet in total. The quantitative analysis showed a marked improvement in Meary's angle of endosinotarsal cone implant group than exosinotarsal screw group. There was no significant difference between both groups in calcaneal pitch and AOFAS.

From the article of the same title
Scientific Reports (08/11/20) Hsieh, Chiun-Hua; Lee, Chia-Che; Tseng, Tzu-Hao; et al.
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Short Term Radiographic and Patient Outcomes of a Biplanar Plating System for Triplanar Hallux Valgus Correction
The study sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing in treating hallux valgus deformity. Patient reported outcomes were obtained using the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal, Foot and Ankle Ability Measure and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were seven complications and mean follow-up time was 45.7 weeks. Age over 62.5 years was associated with an increased risk of complications. Males had an increased rate of complications (71 percent) compared to females. Radiographic parameters were significantly improved from preoperative values at all time points. Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at three, six and 12 months.

From the article of the same title
Journal of Foot & Ankle Surgery (08/15/20) Manchanda, Kshitij; Chang, Alice; Wallace, Blake
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Practice Management

Six Considerations for Integrating Medical Transcriptions into Your Operations
Practices looking to use transcription to streamline their operations should consider a few key factors. This includes workflows, which vary from practice to practice and play a vital role in influencing what type of transcription service will be most effective. Legal and regulatory considerations should also be taken into account, including HIPAA compliance. It is important to understand what to expect from a third-party service when carrying out negotiations and build quality metrics into the contract. As per industry standards, healthcare organizations should aim for 98 percent accuracy for major errors. Practices should thoroughly scrutinize pricing models to make sure they are only paying for what they need. They should also check that the service interfaces well with their existing systems. Finally, practices should conduct thorough research of the provider before entering a contract to ensure they are prepared to offer the services they claim.

From the article of the same title
Physicians Practice (08/12/20) Walker, Ben
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The Pros and Cons of Outsourcing Billing
When practices start to encounter issues with their patient accounting system, credentialing and reimbursement models, outsourcing may be a cost-effective strategy. Outsourcing billing can provide “a trusted partnership,” says Dan Schulte, senior vice president of healthcare at business outsourcing company HGS. Additionally, an outsourcing partner can offer helpful analytics that allow the practice to have a clear picture of what is happening with their accounts. They can also help physicians negotiate better contracts with payers if analytics reveal that the current contract is lacking. Schulte notes that internal billing and coding staff come and go, while an outsourcing relationship ensures that a trained team will always be available to handle claims. However, some specialists may have more complex billing procedures that require clinical review, and an outsourcing service may not work as well for these practices. For practices that decide to outsource, Schulte suggests looking for partners with proven expertise, solid references, transparency and current technology.

From the article of the same title
Medical Economics (08/17/20) Rosenfield, Jordan
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FDA Guides on Selecting Respirators For Healthcare Facilities
The US Food and Drug Administration has authorized the emergency use of certain filtering facepiece respirators (FFRs) for use in healthcare settings by healthcare personnel to prevent exposure to pathogenic biological airborne particulates during FFR shortages resulting from the COVID-19 outbreak. In order to identify a respirator to use, providers should search the National Institute for Occupational Safety and Health (NIOSH) certified equipment list that shows both disposable and reusable air purifying respirators of different types from different manufacturers. Before selecting a respirator, they should review the NIOSH Counterfeit Respirators list to identify if NIOSH-approval has been misrepresented.

From the article of the same title
Healthcare Purchasing News (08/20)
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Health Policy and Reimbursement

Judge Blocks Administration Officials' Attempt to End Transgender Health Protections
Judge Frederic Block of the US District Court in Brooklyn blocked the Trump administration's new rule that erases protections for transgender patients against discrimination by doctors, hospitals and health insurance companies. The rule was finalized in mid-June by the US Department of Health and Human Services' (HHS) Office for Civil Rights, but the US Supreme Court had ruled that employers cannot discriminate against transgender people in the workplace. Judge Block said, "When the Supreme Court announces a major decision, it seems a sensible thing to pause and reflect on the decision's impact. Since HHS has been unwilling to take that path voluntarily, the court now imposes it." The rule at issue sought to reinterpret a civil rights provision of the Affordable Care Act that barred discrimination in healthcare settings on the basis of race, national origin, sex, age or disability. Judge Block will still read briefs and hear arguments from both sides of the case before issuing a final opinion, and any decision will still be subject to appeal.

From the article of the same title
New York Times (08/17/20) Sanger-Katz, Margot; Weiland, Noah
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The Supreme Court Will Hear a Suit Seeking to Overturn ACA a Week After the Election
The US Supreme Court announced that it would hear arguments in the latest case seeking to invalidate the Affordable Care Act on November 10, a week after the presidential election. The suit awaiting the Supreme Court argues that when Congress in 2017 zeroed out the law's penalty for failing to obtain health insurance, it rendered the entire law unconstitutional. The case was filed by Republican state officials in 2018 and is supported by the Trump administration.

From the article of the same title
The New York Times (08/19/20) Goodnough, Abby
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Two-Fifths of Working-Age Adults Lacked Reliable Insurance in First Half of 2020, Commonwealth Fund Says
More than two-fifths of working-age adults in the United States did not have reliable health insurance in the first six months of 2020, according to a new report. The Commonwealth Fund surveyed nearly 4,300 adults aged 19-64 years between January and June of this year and found, among other things, that more than one-third of Latino adults, small business workers and low-income adults reported being uninsured in the past year. In addition, one-quarter of working age adults with adequate coverage said they had problems affording their medical bills or debt in the past 12 months.

From the article of the same title
Healthcare Dive (08/19/20) Pifer, Rebecca
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Medicine, Drugs and Devices

FDA Creates First-Ever Medical Supply Shortage List
The US Food and Drug Administration (FDA) has for the first time made a list of medical devices that are facing a shortage. Included on the list are ventilators, respirators, masks, surgical gowns, gloves and sterile swabs. The list specifically does not include product manufacturers, aiming to prevent any stockpiling or hoarding of supplies.

From the article of the same title
The Hill (08/14/20) Seipel, Brooke
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Flu Season Will Be a Test Run for the Biggest Ever US Vaccine Campaign
With influenza season fast approaching even as the COVID-19 crisis persists, public health officials hope that one vaccination campaign will boost the other. The hope is that alternative approaches to immunizing vast numbers of Americans against influenza this fall will prepare authorities for a massive COVID-19 vaccination effort once a viable product becomes available. While it helps that a number of drugstore chains have set up infrastructure for COVID-19 testing that could support future vaccine delivery, America has not previously been able to successfully vaccinate the country against pandemic threats. Experts say the task will be no easier with the current health crisis. In addition to logistical challenges—such as keeping the vaccine properly refrigerated and ensuring that recipients get both required doses—there is also the matter of public resistance. Results of recent Gallup poll revealed that one-third of Americans would decline a COVID-19 vaccine, even if it was free.

From the article of the same title
Bloomberg (08/18/20) Tozzi, John; LaVito, Angelica
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Opioid Use in Medicare Part D Continued to Decline in 2019, but Vigilance Is Needed as COVID-19 Raises New Concerns
The US Department of Health and Human Services' Office of the Inspector General (OIG) reports that while opioid use in the Medicare Part D community declined last year, the emergence of the COVID-19 pandemic renews concerns going forward. According to a new brief released by the OIG, approximately one in four Part D beneficiaries received opioids in 2019, down from the previous three years. The finding, coupled with a corresponding increase in the share of Medicare patients receiving the overdose antidote naloxone or medication-assisted treatment for opioid use disorder, signals progress in the fight against the opioid crisis. Even so, the OIG brief warns, "it is critical to remain vigilant," particularly in light of the current public health crisis.

From the article of the same title
HHS Office of Inspector General (08/13/20)
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

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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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