News From ACFAS

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ACFAS members asked to make the membership renewal process easier and more efficient with an auto-renewal process—where members submit a credit card or check/EFT payment method and future dues each year will be automatically paid with no effort from members.

Your wish is our command—starting with the 2021 ACFAS membership dues renewal cycle, which starts this October, the College is implementing an auto-renewal process to the standard membership dues renewal process. How does it work? Pay your dues in 2020 for the 2021 membership year, opt into auto-renewal for future years, and your dues will automatically be paid with no need to wait for an invoice. Stay tuned for more details on how to take advantage of this new ACFAS offering to make your life easier. Get more top-notch e-learning opportunities from ACFAS with clinical sessions! All sessions are videos of live presentations and are available for free to members to supplement any continuing education hours needed. Check out the latest addition to our library and what’s coming up next:

Now Available for August:
Optimizing Arthrodesis

Next up for September:
Debating the Bunion: Surgical Decision Making in the “Grey” Areas
A debate style session providing opposing points of view to common procedures leaving you with knowledge from both sides.

Coming in October:
Biologics – Why, When and Where

Sessions are released on the 15^th of each month, keep checking back so you don’t miss one! Visit the ACFAS OnDemand learning portal at acfas.org/OnDemand to access all available ACFAS clinical sessions and other e-learning resources.

Foot and Ankle Surgery

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The study sought to meta-statistically compare the effects of operative and non-operative management of fifth metatarsal base fracture. A systematic identification of literature was performed on four academic databases. Out of 1,170 records, 11 articles including 404 participants were included in this review. The meta-analysis reveals beneficial effects for operative interventions by demonstrating a medium to large reduction of rate of non-union, duration to union, duration of return to activity, visual analog scale and enhancement of the American Orthopaedic Foot & Ankle Scale score as compared to non-operative intervention. The current systematic review and meta-analysis recommend the use of operative interventions for managing the fifth metatarsal’s base fracture.


The study aimed to identify patient groups prone to nonadherence to wearing therapeutic footwear for diabetes and modifiable factors associated with adherence. A questionnaire was mailed to 1,230 people with diabetes who had been fitted with therapeutic footwear. A total of 429 (34.9 percent) questionnaires were analyzed. Multiple regression analyses showed significant associations between higher adherence and paid employment, current foot ulcer, previous foot ulcer, satisfaction with follow-up, self-efficacy, understanding of lost/reduced sensation as a risk factor for foot ulcerations, visible storage of therapeutic footwear at home, storage of conventional footwear out of sight, consistent choices about which footwear type to wear and a belief that therapeutic footwear promotes ulcer healing.


The study retrospectively evaluated the surgical repair with the use of an interosseous suture button for Lisfranc injuries with isolated ligamentous disruption. The study included 84 patients who, from 2008 through 2016, underwent open reduction internal fixation of the Lisfranc complex with a suture button and stabilization of the medial and intermediate cuneiform with a four millimeter screw. The mean return to full weightbearing was 11 days protected in a controlled ankle motion boot. American Orthopaedic Foot & Ankle Society and visual analog scale scores improved from 30 and 8.4, respectively. The mean preoperative step-off between the second metatarsal base and intermediate cuneiform was 3.15 millimeters. The immediate postreduction weightbearing radiograph measured 0.25 millimeters and 0.43 millimeters at the final follow-up evaluation, a difference that was found to be significant. No revision arthrodeses were performed, and there was no removal of the suture button during this time period.

Practice Management

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Physician contract attorneys are especially attentive to contract provisions pertaining to billing and collections. Nearly without exception, every single physician employment agreement addresses the issue. The applicable contract provision should include a promise that the employer will utilize proper billing practices. Experts estimate that up to 42 percent of claims are coded incorrectly and the number of False Claims Act cases has been steadily increasing every year. While physicians are responsible for the initial documentation of their services, it generally falls on professional coders and billers to officially enter the diagnosis and procedure codes for submission. Regardless of whether the wrongful billing practices we're considering are negligent or intentional, physicians are well advised to seek protection against potential liability. It may seem expected that employers would assume this responsibility at the outset; however, few employers readily assume this responsibility in their contracts.


Concierge care, which offers personalized medical services for people who can afford it, has grown rapidly during the pandemic as patients seek direct access to physicians. Basic telemedicine can bring with it cumbersome insurance protocols and hard-to-navigate health care portals. Concierge care gets around restrictions placed on doctors and other health care providers. However, prices for services can be two to three times higher on top of annual fees, and it is typically not covered by insurance. When more than 173,000 people in the United States have died from the coronavirus and millions of Americans remain out of work, the growing interest in concierge medical services may seem out of touch with the devastation the pandemic has inflicted.

But the concept is expanding in other areas, as the affluent are able to pay a premium for a luxury pursuit that was relatively affordable before the coronavirus crisis. Doctors say they have had to expand their services or create new ones to meet the expectations of their wealthy patients. “This stuff always starts at the top of the market because insurance companies are not paying for this,” said Dr. Yves Duroseau, an emergency room physician and adviser to OpenClear, which has offered about 600 in-home coronavirus screenings in Miami and the New York area since March.

Health Policy and Reimbursement

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According to the new research, more than 12 million Americans have lost employer-sponsored medical coverage amid the COVID-19 pandemic. "Because most US workers rely on their employer or a family member's employer for health insurance, the shock of the coronavirus has cost millions of Americans their jobs and their access to healthcare in the midst of a public health catastrophe," according to Josh Bivens, director of research at the Economic Policy Institute. Obtaining replacement coverage can be hard if Americans are unable to afford premiums for Affordable Care Act plans or COBRA plans. Some Americans may be able to obtain health insurance from their partners' or parents' employer-sponsored plans, but Medicaid and other types of public insurance have not expanded enough to cover all of those losing their job-based insurance.


In response to reports highlighting obstacles to equitable care for diabetic patients at risk for amputation, the American Diabetes Association (ADA) has introduced its Health Equity Now campaign to address the cost of diabetes care, nutrition and discrimination. As part of the project, the association has built a Health Equity Bill of Rights, asserting that all diabetes patients are entitled to affordable drugs, healthy food, the latest medical advances and other protections.


The US Centers for Disease Control and Prevention (CDC) recently revised its COVID-19 testing guidelines to exclude people who do not have symptoms of the disease, even if they were recently exposed to the novel coronavirus. Models indicate that roughly one-half of transmission events can be linked to individuals still in the pre-symptomatic stage. CDC's guidance says that people who have been in close contact with an infected individual—which is typically defined as being within six feet of a person with COVID-19 and for at least 15 minutes—"do not necessarily need a test" if they do not have symptoms. CDC said exceptions might be made for "vulnerable" individuals, or if healthcare providers or state or local public health officials advise testing.


The COVID-19 pandemic has hit families and the economy hard, with some patients developing long-term medical problems that can require extended and, sometimes, expensive medical treatment, which further stresses families' finances and taxes the healthcare system. Doctors and researchers warn that patients with long-term COVID-19 health effects could place a burden on safety-net programs like Medicaid and leave many patients with significant medical debt. About 33 percent of 270 nonhospitalized adults who tested positive for coronavirus said they hadn't returned to normal health two to three weeks later, according to a survey by the US Centers for Disease Control and Prevention. The total cost to the US health system just from inpatient hospitalizations due to COVID-19 is projected to reach up to $17 billion in 2020, according to a June report from Avalare Health.

Medicine, Drugs and Devices

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With a COVID-19 vaccine still months off, researchers are pinning their hopes for now on monoclonal antibodies (mAbs), human-made proteins made from living cells that attach to other proteins that drive disease. The drugs, which leverage the body's natural defenses, promise to arrest viral activity soon after a person becomes infected and before he or she falls seriously ill. In healthy individuals, especially high-risk populations such as healthcare professionals and nursing home residents, mAbs might serve as a short-term vaccine against the virus. Regeneron Pharmaceuticals, Eli Lilly and AstraZeneca are among the manufacturers already testing the drugs in the context of COVID-19.


The US Food and Drug Administration (FDA) announced that it will not begin collecting drug manufacturing volume data in September, as required by the Coronavirus Aid, Relief and Economic Security Act (CARES Act). Section 3112 of the CARES Act establishes new reporting requirements for drug manufacturers intended to improve the response to drug shortages. Drugmakers are also now required to report manufacturing volume data annually under Section 3112(e) to FDA, including "the amount of each drug ... that was manufactured, prepared, propagated, compounded or processed for commercial distribution." The act gives the HHS secretary discretion to exempt biologics from some or all of the manufacturing volume data reporting requirements. While the requirements established under Section 3112 are set to take effect on September 23, FDA says the electronic data submission portal it intends to use will not be ready by then.


A report by the US Department of Health and Human Services' Office of Inspector General (OIG) reveals that Medicare Advantage insurers seldom include identification numbers for clinicians when ordering certain medical services in patient records they submit to the US Centers for Medicare and Medicaid Services (CMS). The report found that 60 percent of 2018 Medicare Advantage encounter records for durable medical equipment, prosthetics, orthotics and supplies, clinical laboratory, imaging and home health services were missing a national provider identifier (NPI) for an ordering clinician. That's largely because CMS does not require Advantage insurers to submit NPIs, even though most insurers already collect that information, the OIG said. The lack of NPIs for the ordering provider impedes the federal government's ability to identify questionable billing and ordering practices and other Medicare Advantage fraud, OIG concluded in its report. Four in 10 insurers said that collecting identifiers for ordering clinicians is important for preventing fraud.