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News From ACFAS

ACFAS 2022: Register Now to Reboot in Austin
Dust off your cowboy boots, we’re heading to Austin! Registration is officially open for the 2022 Annual Scientific Conference, February 24-27.

Join us to enhance your knowledge and skills with four days of cutting-edge sessions, hands-on workshops and the chance to reconnect in person with your friends and colleagues. It’s all happening in Austin, and we can’t wait to see everyone together again.

Visit for more information on this year’s meeting or to register today.
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What’s Next in the Student Research Lecture Series
If you missed the first installment of the College's new student-led webinar series, don’t worry, another one’s coming up next month!

Tuesday, October 19 | 7pm CT
IRB Processes and Ethics

New York College of Podiatric Medicine, Student Club President Gregory Rose, DPM, '23 and Paul Jicman, '23
ACFAS Regions Case Speaker
Robert Fridman, DPM, FACFAS
ACFAS Research Committee Volunteer
Elizabeth Ansert, DPM, MBA, MA

Each month’s lecture features three 20-minute segments on various topics of the research process each lead by an ACFAS Student Club President, a member from the ACFAS Regions and a member of the ACFAS Research Committee.

Visit to learn more about the lecture series or to register today.
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Residents Day is Back for 2022!
Join us at ACFAS 2022 in Austin, February 23 for the not-to-be-missed Residents Day! Register today to hear from experienced foot and ankle surgeons who will provide tips from finishing residency strong to transitioning to a successful practice.

Come to Austin a day early to get real-world advice and wisdom to help you tackle the end of residency. You will also get an understanding of the ins and outs of CPME’s 320 Standards, skills for conflict resolution and advice on dealing with issues of harassment and give insight on how to establish work/life balance.

The program will also give you the tools to help with post-residency life such as promoting yourself properly, illustrating the importance of proper documentation and informed consent and give you advice on how to find a job.

Plus, don’t forget to stay for the afternoon session – Coding Fundamentals – where you’ll learn the foundation of the coding and billing process from expert colleagues. Special bundle pricing for both programs is available. Visit to learn more and register today!
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Foot and Ankle Surgery

Anatomic and Treatment Descriptive Features of Foot Infections Presenting with Radiographic Soft Tissue Emphysema
An investigation was conducted to classify anatomic features and clinical outcomes associated with the presence of soft tissue emphysema in foot infections. A retrospective chart review was performed of 62 subjects, mainly male with a history of diabetes mellitus and no history of previous lower extremity revascularization, meeting selection criteria. The forefoot was the primary radiographic location of the soft tissue emphysema, followed by the midfoot and rearfoot. Soft tissue emphysema was most frequently noted primarily in the dorsal foot tissue, followed by both dorsal and plantar foot tissue and plantar foot tissue; soft tissue emphysema was restrained to the primary anatomic location in 74.2 percent of subjects, while 25.8 percent exhibited extension into a more proximal anatomic area. Eighty-two percent of subjects received a bedside incision and drainage procedure on presentation in the emergency department, and 95.2 percent had a formal incision and drainage procedure in the operating room at 1.05 ± 0.79 post-admission days. Twenty-seven percent had an unplanned 30-day readmission and 17.7 percent underwent an unplanned reoperation within 30 days following index discharge. Fifty-two percent received a minor or major amputation during the index admission, and 33.9 percent eventually had major limb amputation within 12 months.

From the article of the same title
Journal of Foot & Ankle Surgery (09/08/21) Shim, Hyun; Varakin, Nicholas; Meyr, Andrew J.
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Isolation and Characterization of Bacteria from Diabetic Foot Ulcer: Amputation, Antibiotic Resistance and Mortality Rate
A study sought to determine risk factors associated with mortality in patients with diabetic foot ulcer (DFU) by probing bacterial drug resistance in survived or deceased patients around amputation. All diabetic patients who had DFU or minor or major amputation at Hebron Governmental Hospital from 2013 to 2020 were covered. This included 84 patients 64.8 ± 12.58 years old, 63.1 percent male with DFU ulcer and minor or major limb amputation between 2013 and 2020. Forty tow patients exhibited DFU, 28 patients had major limb amputation and 14 patientsdied from minor amputation. Average FBS was 292.8 ± 136.33 mg/dl and average HbA1C was 8.55 percent ± 1.89 percent. Mortality rate was 9.5 percent. The Chi square test uncovered a significant relationship between mortality and type of isolated bacteria and between diabetic complications and mortality. A significant association was also observed between antibiotic use and mortality, particularly with metronidazole and colistin, if they were employed around limb amputation.

From the article of the same title
International Journal of Diabetes in Developing Countries (09/10/21) Shaheen, Muamar M.A.; Al Dahab, Sewar; Abu Fada, Maryiam; et al.
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The Association Between Body Mass Index and Skin Problems in Persons with a Lower Limb Amputation: An Observational Study
A survey sought to gauge the prevalence of obesity in Dutch persons with a lower limb amputation and to consider associations between body weight, body mass index and skin problems of the residual limb and the occurrence of prosthetic repairs. A total 413 persons were enrolled, of whom 39 percent were overweight and 28 percent were obese. In all, 77 percent disclosed reported one or more skin problems in the past month. Body weight and body mass index were associated with either the presence of skin problems overall or with the number of prosthetic repairs. Individuals with severe skin problems had a slightly lower body mass index (26.6 kg/square meter versus 28 kg/square meter, while those with skin problems were younger than those without.

From the article of the same title
BMC Musculoskeletal Disorders (09/09/21) Vol. 22, No. 769 Mollee, Terezka S.; Dijkstra, Pieter U.; Dekker, Rienk; et al.
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Practice Management

Eight Things You Must Do Before Firing a Practice Employee
Firing a practice employee requires eight steps, starting with giving out an employee handbook detailing the practice's policies and a termination section, which is signed off by an employment attorney prior to issuance; each employee should sign that they received and understood the handbook. When a new worker does not seem to be working out, practices should make changes sooner to avoid undermining their unemployment insurance tax. Poor performers should be dismissed as soon as possible, and practices should make sure employees are focused on their work and not bringing their personal problems into the office. Practices should also be aware of legal ramifications, as those with fewer than 15 workers are exempt from certain federal rules and can fire anyone for any reason. Those with at least 15 employees, however, can be sued for discrimination, harassment and disability, while employers with 50 or more can have the Family Medical Leave and American With Disabilities Acts invoked. Feedback and remediation should be attempted with problem workers before firing them, and firings should always be done with a witness present to take notes in case of litigation. Finally, dismissals should be done in person.

From the article of the same title
Medical Economics (09/13/21) Shryock, Todd; Lutton, Logan
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Tips for Improving Your Practice's Online Reputation
A practice can improve its online reputation by following four strategies. The first involves assessing the practice's current reputation by checking comments through searches and on review platforms such as Yelp, RateMDs, Healthgrades, Vitals or Angie's List. Another strategy is to launch a website as an online marketing tool, highlighting the positives and hopefully creating an outstanding first impression among visitors. A third tip is to use social media to proactively engage potential and current patients, and a fourth suggestion is to respond to all reviews. The practice should designate someone to do this, especially for negative reviews and be certain of not responding with any information that would compromise patient privacy. Responses will show that the practice is listening to and addressing patients' concerns.

From the article of the same title
Physicians Practice (09/14/21) Membrillo, Alex
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Health Policy and Reimbursement

Census Bureau: 28 Million Americans Lacked Health Coverage in 2020
The US Census Bureau estimated that 28 million Americans lacked health insurance in 2020, or about 8.6 percent of the population. The remaining 91.4 percent had coverage for either all or part of the year, which did not mark a significant change in the uninsured rate compared to 2018. Some 66.5 percent of Americans had private insurance, while 34.8 percent were enrolled in public insurance, with some having more than one coverage type over the course of the year. Just over 54 percent had employer-sponsored insurance at some point last year, with 87 percent of full-time workers enrolled through their employer, compared to 85.1 percent in 2018. Part-time workers were less likely to have access to employer plans, with 66.7 percent enrolled in 2020 versus 68.5 percent in 2018. The number of people enrolled in public coverage since 2018 rose slightly, with those in private plans declining concurrently.

From the article of the same title
Fierce Healthcare (09/14/21) Minemyer, Paige
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Health Insurance Exchanges to See More Competition, Uncertainty Next Year
As insurers prepare for the coming enrollment season on Affordable Care Act exchanges, they face such things as rising competition, regulatory changes and pandemic uncertainty. UnitedHealth Group will expand into seven new markets in 2022, while Aetna is returning to the exchanges after exiting them in 2018. The individual market has evolved to become one of the most profitable lines of business for insurers, second only to the Medicare Advantage market, says the Kaiser Family Foundation. Meanwhile, the Centers for Medicare & Medicaid Services says it will direct $452 million from the American Rescue Plan Act to more than a dozen states' reinsurance programs, which directly compensate insurance companies for some of their costliest claims. While the cash will affect insurers' operations for 2021, the money will likely inform their pricing and subsidize their business for the years ahead, says Adam Block at New York Medical College.

From the article of the same title
Modern Healthcare (09/13/21) Tepper, Nona
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Nearly Three Million Get Health Coverage During COVID-19 Sign-Up
The White House announced that 2.8 million consumers took advantage of a special six-month period that ended August 15 to sign up for private health insurance coverage made more affordable by his COVID-19 relief law. The special enrollment period allowed people who lost their jobs and healthcare benefits due to the pandemic the opportunity to sign up for coverage for themselves and their families. That coverage then became more affordable in April due to enhanced subsidies in the COVID-19 relief law, which attracted even more enrollment. The regular annual sign-up season for the Affordable Care Act starts November 1.

From the article of the same title
Associated Press (09/15/21) Superville, Darlene; Alonso-Zaldivar, Ricardo
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Medicine, Drugs and Devices

Linking US Prescription Drug Prices to Those Paid in Other Nations Could Cut Costs in Half
A RAND Corporation study in the Journal of the American Medical Association suggests linking US prescription drug costs to those in other high-income nations could have at least halved American spending for the drugs in 2020. The researchers determined that implementing the Elijah E. Cummings Lower Drug Costs Now Act would allow the US Secretary of Health and Human Services (HHS) to negotiate prices with drugmakers on behalf of Medicare and private insurers, up to a cap of 120 percent of prices in Australia, Canada, France, Germany, Japan and Britain. This would have reduced US spending on insulins and 50 top brand-name drugs by 52 percent last year, saving $83.5 billion.

From the article of the same title
Healthcare Finance News (09/10/21) Lagasse, Jeff
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Medicare to Repeal Medical Device Rule Pushed by Trump Administration
The US Centers for Medicare & Medicaid Services (CMS) is proposing to repeal a Trump-era regulation finalized earlier this year requiring Medicare to pay for any medical device deemed as a "breakthrough" by the Food and Drug Administration (FDA). In response to public feedback, CMS decided that the regulation was "not in the best interest of Medicare beneficiaries because the rule may provide coverage without adequate evidence that the breakthrough device would be a reasonable and necessary treatment." The medical device industry welcomed the rule, as it would have ensured four years of Medicare coverage for all FDA-designated breakthrough devices, which often do not demonstrate any clinical benefit and have safety risks. The rule also did not obligate device manufacturers to perform follow-up studies to show their devices specifically helped Medicare patients. CMS said that the rule could be disastrous, as it would automatically pay for devices, "even in the absence of data demonstrating that the device is reasonable and necessary for Medicare patients."

From the article of the same title
Axios (09/14/21) Herman, Bob
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To Lower Prices, Senate Leaders, FDA Chief Urge US Patent Officials to Rethink Intellectual Property on Drugs
US Food and Drug Administration (FDA) and Senate lawmakers are requesting the US Patent and Trademark Office (USPTO) to consider how it can curb the actions of pharmaceutical firms that use patent-based approaches to extend their control over drug monopolies. In a letter to USPTO, FDA Acting Commissioner Janet Woodcock referred to a study which found that 78 percent of the new patents issued between 2005 and 2015 were for existing drug products rather than for new drugs entering the market. She also mentioned the practice of "product hopping," which compels patients to switch to new formulations of a newly patented drug that has little or no therapeutic difference. A letter written by US Senators Patrick Leahy (D-VT) and Thom Tillis (R-NC) of the Senate Judiciary Intellectual Property Subcommittee to USPTO Acting Director Andrew Hirshfeld pointed out that patent applicants often make conflicting statements on their products to other federal agencies. The senators asked USPTO to consider requiring applicants to disclose those statements.

From the article of the same title
Fierce Pharma (09/14/21) Dunleavy, Kevin
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, FACFAS

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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