News From ACFAS

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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 next Tuesday, September 15.

Visit acfas.org/nominations for the nomination application and complete details on the recommended criteria for candidates. For more information, contact ACFAS Executive Director Patrick (PJ) Andrus, MBA, CAE, at pj.andrus@acfas.org or (773) 693-9300. Questions regarding eligibility criteria should be directed to Nominating Committee Chair Christopher Reeves, DPM, FACFAS at docreeves1@yahoo.com or (407) 443-0166.

The Nominating Committee will announce recommended candidates to the membership no later than November 27. Candidate information and ballots will be emailed to all voting members no later than December 11. Electronic voting ends on December 28. New officers and directors will take office in February 2021. Head into fall with more e-learning opportunities and the Forefoot Complications webinar series. You have more chances to build your bundle and get three webinars for the price of two.

Wednesday, September 23
Making That Tough Decision—Reconstruct or Destruct?
7pm CST | CME Hour: 1 Credit
Fees: Member $20 | Non-Member $30

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

Get started and build your bundle now. Pick any three available (live or recorded) webinars and only pay for two! Visit acfas.org/OnDemand to see all upcoming webinars and get started on more e-learning now! It's time to catch up on the latest research in foot and ankle surgery right from your home—September’s Scientific Literature Reviews (SLRs) are now available.

Get the newest batch of short, digestible summaries of research from non-podiatric journals on the latest developments in foot and ankle surgery. September’s topics include Effects of Gender Bias and Stereotypes in Surgical Training, Effect of Age on Outcome and Revision in Total Ankle Arthroplasty, Effect of Platelet-Rich Plasma on Nonsurgically Treated Acute Achilles Tendon Ruptures and more.

Catch up on the latest research for September now. Visit acfas.org/SLR to view this month’s articles and all archived SLRs.

Foot and Ankle Surgery

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The authors conducted a systematic review and meta-analysis of the current comparative studies to make a generalized analysis. Three databases were searched from inception to April 2020. The comparative results of clinical outcomes, stress radiographic outcomes and complication rates between two groups were pooled. Nine comparative studies for a total of 473 patients were included. For the clinical outcomes, a significant difference was found in favor of arthroscopic repair with regard to American Orthopaedic Foot & Ankle Society and visual analog scale scores. No significant difference was found regarding to stress radiographic outcomes. The total complication rate and the nerve complication rate of arthroscopic repair group was not significantly different from that of open repair group.


Authors reviewed 62 patients who underwent midfoot arthrodesis for symptomatic midfoot arthritis using locked dorsal compression plates over a seven-year period. A total of 173 joints were spanned for fusion. In the joints reviewed, there was a 81.5 percent fusion rate and 14 patients experienced nonunion. There was a statistically significant difference in the average number of joints spanned in patients with nonunion and patients with union. Locked dorsal compression plate arthrodesis is a viable technique for achieving midfoot fusion. This mechanical method of compression does not, however, lend itself to improved fusion rates compared with prior reports. Authors conclude that a greater number of arthrodesis sites is associated with a higher nonunion rate.


This study compared the operative outcome of percutaneous repair (modified Bunnell suture technique) versus open repair (bundle-to-bundle suture technique) of acute Achilles tendon rupture. Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated. Thirty-six patients were treated using the bundle-to-bundle suture technique (group A), and 36 patients were treated using the modified Bunnell suture technique (group B). A total of 61 patients were followed up. The mean follow-up duration did not significantly differ between group A and group B, but there were significant differences between groups in the heel-rise test and length of the Achilles tendon. The calf circumference of the injured side was significantly larger in group A, and the cross-sectional diameter of the Achilles tendon was significantly smaller. At final follow-up, there were no significant differences between the two groups in any of the metrics used.

Practice Management

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The article offers strategic guidance for medical practice acquisitions. Every medical practice needs a strategic growth plan, as growth for its own sake does not benefit the acquirer or potential target. Physician owners should define the parameters of the practice they want to buy and articulate their plan to grow the new combined business. Once this exercise is complete, the acquirer can start targeting the right practice, either by finding one already listed for sale or approaching an owner with an offer. Buyers should do their best to ascertain the exact nature of the business they are buying and how it will integrate into their own.


A decline in telemedicine visits across the United States is forcing providers to recalibrate their services. Electronic health record company Epic estimates that telehealth visits fell from 69 percent of total encounters at the early height of the COVID-19 crisis in April to 21 percent by the middle of July. In the wake of this slippage, hospitals that scrambled to retrain staff to deliver virtual care in March are now struggling to rebalance according to shifting patient preferences and requirements. "We're trying to right-size, but it's really hard because during the pandemic we switched to nearly 100 percent virtual in some clinical areas, and we know that's not realistic or sustainable," said Michigan Medicine's Jessie DeVito.

Several large health systems said the transition involves careful consideration of which clinical conditions should prioritize in-person attention and which cases can be handled just as effectively with virtual appointments. Also vital is determining when hybrid in-person/virtual visits will be most cost-efficient for providers as they attempt to optimally manage both patients and bottom lines after months of plummeting revenue. Not all specialities are seeing declines, as traditional providers are still conducting most mental health visits over phone or video, while specialists that usually provide more hands-on care -- like orthopedists -- are seeing more clients return to their offices.


Healthcare providers need to start focusing on getting patients back in for the care they need. One of the critical pieces to getting patients to come in for the care they need is communication. Patients need their healthcare providers more than ever, but they also need to know what has changed, what to expect and what providers are doing to protect them. A good strategy is to be proactive in communication with patients, anticipating the questions patients are likely to have. After initial communications are sent, practices should reiterate key information at the time of scheduling and in intake forms and reminders.

Health Policy and Reimbursement

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The American Medical Association (AMA) recently updated codes for office and outpatient visits to address the COVID-19 pandemic and tech-enabled care. The changes to the evaluation and management office visit codes include eliminating history and physical exam elements for code selection, basing code selection on medical decision making or total time and adding more detail to code descriptions. The Medical Group Management Association said the updates will alleviate physicians' administrative burden, streamline requirements and provide more flexibility. While the American College of Radiology (ACR) noted the commitment to reduce documentation requirements, the codes penalize thousands of physicians who do not frequently bill evaluation and management services. The college joined more than 50 other physician and non-physician organizations in asking Congress to waive the budget neutrality requirement, ACR noted.


Medicare could approve coverage of some "breakthrough" medical devices the same day that the US Food and Drug Administration (FDA) green-lights them, under a proposed rule published September 1 in the Federal Register. The Trump administration plan aims to address the nearly year-and-a-half gap between FDA approval and coverage decisions by the US Centers for Medicare and Medicaid Services (CMS) on new medical devices. The president signed an executive order last fall to improve Medicare service, and CMS Administrator Seema Verma said that this proposal "would give seniors immediate access" to novel products targeting life-threatening or irreversibly debilitating diseases or disorders. Coverage approval would coincide with the start date of FDA market authorization and remain in place for four years. The rule also probably would expand Medicare reimbursement for breakthrough devices, by changing the criteria that determines whether they are reasonable and necessary to diagnose or treat a medical issue. Public comment on the proposal will be accepted for 60 days.

Medicine, Drugs and Devices

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The CARES Act allocated $2.5 billion to assist in the development of COVID-19 tests. The money is being divided between the National Institutes of Health's (NIH) Rapid Acceleration of Diagnostics (RADx) program and an agency within the US Department of Health and Human Services. To date, NIH distributed $372 million to 16 companies, whose tests must demonstrate compliance with US Food and Drug Administration (FDA) standards for safety and accuracy before they can be sold. Dr. Bruce J. Tromberg, who oversees NIH's test development program, estimates that the country needs to test roughly 6 million people per day, based on reports from Rockefeller Foundation and other groups. He believes that in the absence of federal assistance, companies could at most manufacture only half of that number by the end of the year.

One of the new tests is what Tromberg describes as a "dipstick" antigen test that uses a nasal swab and can deliver results in 15 minutes without external equipment. However, the test has not yet received FDA approval, but he says, "we're excited." NIH Director Dr. Francis S. Collins says such over-the-counter technology continues to face regulatory hurdles. One of the grant recipients is developing a test that collects saliva samples to be processed in laboratories. It hopes to expand its manufacturing capacity to more than 1 million tests per day by the end of March 2021. Another company is using genome sequencing to detect the coronavirus, and company officials hope to run about 250,000 coronavirus tests a day.


California's legislature has approved a measure under which the California Health and Human Services Agency would partner with one or more drug companies by January to produce or distribute several generic or biosimilar drugs. The bill specifies the production of "at least one form of insulin, provided that a viable pathway for manufacturing a more affordable form of insulin exists at a price that results in savings." Bill SB-852 seeks to ensure that state-developed generics would be "widely" available to public and private purchasers across the state. Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, said: "If California can pull it off, it would be a model for other states and federally."