News From ACFAS

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Volunteer to serve on a 2021 ACFAS committee, Clinical Consensus Statement panel or as a reviewer of scientific literature. ACFAS is asking members who are leaders, thinkers, team players and hard workers to work with the College to shape the future of our profession.

To volunteer, visit acfas.org/volunteer. The application deadline is October 31, 2020.
Join us for Advanced Arthroscopy and Cartilage Restoration and take the next step to leading edge arthroscopy skills! Attendance at the Arthroscopy of the Foot and Ankle course is a pre-requisite. Don’t wait, space is limited.

November 7-8 (Saturday/Sunday)
Orthopaedic Learning Center (OLC) | Chicago, IL
Fees: ACFAS Member $2295 | Non-ACFAS Members $2600
Maximum 16 Continuing Education Contact Hours
View Agenda | Register

Learn the latest techniques and more on cartilage restoration from leading surgeons. Arthroscopic lateral ankle ligament repair, classic OATS resurfacing and particulate cartilage resurfacing techniques, en bloc resection and replacement techniques, subtalar joint arthroscopy and arthroscopic STJ fusion technique.

Please note, attendees must have previously taken the Arthroscopy of the Foot and Ankle course, if you attended a basic arthroscopy course not through ACFAS, fax certificate and agenda from the program attended. Don’t wait, this will sell out! Visit acfas.org/education to register now. Another chance to join Webinar Wednesday is coming your way in October! The next webinar in the Forefoot Complications Series will give you an in depth look at malunions of the foot requiring a surgical solution and case presentations from the faculty panelists.

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

Register today and check out the other available webinars to build your bundle. Pick any three available (live or recorded) webinars and only pay for two! Visit acfas.org/OnDemand to register for the webinar and to see all upcoming e-learning opportunities.

Foot and Ankle Surgery

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The study investigated whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for 80 adults with chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. Thirty-nine participants were randomised to a high volume injection without corticosteroids and 41 to placebo. Participants were instructed to perform an exercise program for 24 weeks combined with one 50 milliliter high volume injection of saline and lidocaine (intervention group) or a two milliliter placebo injection of saline and lidocaine (placebo group) at baseline. Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks. The estimated mean VISA-A score improved significantly, from 40.4 at baseline to 59.1 at 24 weeks in the high volume injection group and from 36.9 to 58.5 in the placebo group. The VISA-A score over time did not differ between the groups.


The study analyzed the difference in frontal plane rotation of the entire first ray in patients with and without hallux valgus using standing weightbearing computed tomography (CT). Ten feet of 10 patients with hallux valgus and 36 feet of 36 patients without hallux valgus were examined. Standing weightbearing CT scans and radiographs were taken for all subjects. There was a significant increase in pronation of the sesamoid apparatus and first metatarsal head in patients with hallux valgus. There was a significant increase in first metatarsal torsion toward pronation in patients with hallux valgus. No significant difference was detected in the rotation at the first tarsometatarsal joint or the frontal plane orientations of the first metatarsal base and medial cuneiform.


Age-related reduction in toe flexor strength (TFS) is associated with impairments of functional performance. The study investigates whether foot posture influences the relationships between TFS and functional performances in 70 community-dwelling older women. Based on the foot posture index score, participants were allocated to pronated, neutral or supinated group with 33, 26 and 11 participants, respectively. TFS was assessed using a toe grip dynamometer in a seated position. TFS positively correlated with comfortable walking speed in the pronated and supinated groups, but not in the neutral group. For the two significant relationships, an analysis of covariance suggested a similar relative contribution of TFS to comfortable walking speed between the pronated and supinated groups. In addition, TFS tended to negatively correlate with timed up-and-go time in the pronated and supinated groups and positively correlate with 30-second chair stand score in the pronated group.

Practice Management

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More employees than ever are working from home as a result of the COVID-19 pandemic. Although it is difficult to assure complete patient privacy in the home, there should be policies in place that define a minimum level of expectation when working from home. HIPAA generally requires that covered entities, such as medical practices, take certain precautions to protect a patient’s protected health information (“PHI”). Practices should establish strong security protocols on devices being used from home. They should also discourage or prohibit the use of work software on devices in the home that may be used by family or friends. It is also important to make sure that protocols are in place for employees to secure documents containing PHI in the home. Moreover, practices must remind employees about confidentiality of all verbal and video discussions.


There are benefits and drawbacks to outsourcing billing. Dan Schulte of HGS says outsourcing can provide practices with clear direction to improve revenue and review regulatory issues. Additionally, he says that 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 the analytics reveal that the current contract isn't working for the physician. Schulte adds that in an outsourcing relationship, there's always a team of people available to make sure your claims are handled. However, some specialists may have more complex billing procedures that require clinical review, which does not lend itself to outsourcing. Any other situation in which “an intimate relationship between case management and care planning for a particular patient requires a closer touch” may not work for an outsourcing service.

Health Policy and Reimbursement

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During the COVID-19 public health emergency, rates for vaccinations and primary and preventive services among children in Medicaid and the Children's Health Insurance Program (CHIP) have dropped sharply, according to the US Centers for Medicare and Medicaid Services. The agency, which released preliminary Medicaid and CHIP data, warned the "decline may have significant impacts on long-term health outcomes for children, as Medicaid and CHIP cover nearly 40 million children, including three-quarters of children living in poverty and many with special healthcare needs that require health services." Additionally, as many schools are still closed for in-person instruction, many key services that children receive may be postponed, such as child screens and vaccinations prior to the start of the school year or in-school services such as speech therapy, physical therapy and occupational therapy.


The Centers for Medicaid and Medicare Services (CMS) is proposing a rule to shift 1,740 specific procedures from inpatient care settings to outpatient ambulatory surgical centers (ACS). The rule, CMS-1736-P, also calls for phasing out an "inpatient only" (IPO) list of services over a three-year transitional period, with complete removal of the IPO list by calendar year 2024. The proposed rule would likely lead to increased price shopping, which Medicare prefers, but clinical laboratories of hospitals and health systems could see reduced inpatient test orders. Meanwhile, hospital outreach labs that serve ambulatory surgical centers and other outpatient settings may have an opportunity to gain additional medical laboratory test referrals. The proposed rule was published in the Federal Register on August 12, 2020 and is open for comments until October 5, 2020.


A study was conducted to evaluate monetary trends in Medicare reimbursement rates for 20 commonly utilized orthopedic trauma surgical procedures over a twenty-year period. The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for 20 common Current Procedural Terminology codes in orthopedic trauma, and reimbursement data was extracted. After adjusting for inflation, the average reimbursement for all procedures decreased by 30.0 percent from 2000 to 2020. Total RVUs during this time increased by 4.4 percent on average. Procedures about the foot and ankle demonstrated the greatest decrease in mean adjusted reimbursement at -42.6 percent, while procedures about the shoulder and upper extremity demonstrated the smallest mean decrease at 23.7 percent during the study period. The researchers concluded that when adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2020. Increased awareness and consideration of these trends will be important for policymakers, hospitals and surgeons in order to assure continued access to meaningful surgical orthopedic trauma care in the United States.

Medicine, Drugs and Devices

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Insufficient supplies of reagents are slowing down COVID-19 testing and compelling health systems to restrict who gets tested. Mark Steadham, president and CEO of Morris Hospital and Healthcare Centers near Chicago, says the company can perform only about a third of the testing it was doing in the summer because it is receiving only about a third of its previous weekly allocation of 20 Abbott rapid-testing kits due to the reagent shortage. Each kit runs two dozen tests. The Advanced Medical Technology Association estimates that the overall number of COVID-19 tests distributed nationwide has grown from 15.8 million in April to 37.6 million in August. However, medical experts say shortages of reagents and other supplies are being caused by regional higher demand when infection rates rise, schools reopen and new testing requirements take effect, such as those for nursing homes.


The US Food and Drug Administration (FDA) has updated its database of injuries and deaths associated with medical devices. The agency said the database now includes more adverse-event summaries, in addition to a higher number of events and exemption number fields in its eMDR, eSubmitter and Manufacturer and User Facility Device Experience Database. Furthermore, FDA included a data field called "patient problem code," an outcome code assigned to an adverse events that was previously redacted from public view.


As drug prices continue to climb, federal and state lawmakers have attempted to address the problem in limited ways, focusing primarily on insulin. Prices for the drug have more than doubled between 2012 and 2017, but proposals to rein in drug prices have stalled in Congress because of the pandemic, prompting a handful of states to enact insulin payment caps of less than $100 per month. In addition to insulin, millions more patients struggle to afford unchecked increases for drugs treating HIV/AIDS, depression, asthma, autoimmune disorders and other diseases. A 2019 survey from the Scripps Research Translational Institute found that the costs of 17 top-selling branded drugs more than doubled from 2012 to 2017. Meanwhile, pharmaceutical companies and their trade groups are releasing ad campaigns emphasizing the sector's value and need to invest in research.


Among the several COVID-19 vaccines now under development worldwide, only three have advanced to Phase III trials. Of those, candidates from Moderna/NIH and Pfizer/BioNTech must be kept at a near constant deep freeze because they are made with genetic materials that are damaged at warmer temperatures. Pfizer expects its vaccine to be stored in temperatures as low as -80 degrees Celsius, while Moderna's will need to be kept at -20 degrees Celsius. Meanwhile, AstraZeneca/Oxford University's candidate vaccine must be kept cool but not frozen. Many pharmacies are unlikely to have the equipment to store large quantities of vaccines at ultra-cold settings. In August, CDC disease expert Kathleen Dooling warned the White House coronavirus task force that strict temperature requirements "will make it very difficult for community clinics and local pharmacies to store and administer" vaccines.