News From ACFAS

---

Secure your spot and your hotel for the ACFAS 2022 Annual Scientific Conference, February 24-27 in Austin, TX!

Don’t miss the chance to advance your knowledge and skills with four days of cutting-edge sessions, hands-on workshops and the opportunity to network and reconnect in person with your friends and colleagues.

And if you’ve already registered, be sure to book your hotel with our official housing partner, onPeak. Booking through onPeak guarantees you the lowest hotel rate and also protects you from unauthorized third-party vendors or “hotel poachers.” ACFAS will not be responsible for any room reservations or deposits made through other companies or websites, so please book through onPeak for your own safety. Hotel reservations can be made online at acfas.org/Austin, by calling (800) 950-5542 or by email at acfas@onpeak.com.

Visit acfas.org/Austin for more information on ACFAS 2022 and to register or book your hotel. Help advance the profession by volunteering to serve on a 2022 ACFAS committee, Clinical Consensus Statement panel or as a scientific literature reviewer where you’ll have an active role in helping to shape the future of our profession.

To volunteer, visit acfas.org/Volunteer. Applications are due October 31, 2021. Get a leg up on your research skills and register for two upcoming virtual research programs: the ACFAS Student Research Lecture Series and the next ACFAS Virtual Journal Club.

Student Research Lecture Series | Tuesday, October 19, 7pm CT
The second in the series, this program features three 20-minute segments on IRB processes and ethics and is hosted by the New York College of Podiatric Medicine.
Register Now

ACFAS Virtual Journal Club | Thursday, October 21, 7pm CT
This month’s installment features Options for Lateral Ankle Reconstruction hosted by the South Central Pennsylvania Reconstructive Foot and Ankle Fellowship in Lancaster, PA.
Register Now

Don’t miss this week of research!

Foot and Ankle Surgery

---

Researchers investigated Distal Tibia Nail (DTN) as a fixation option for supramalleolar corrective osteotomies (SMOT) in a study involving 16 Sawbones tibiae implanted with either a DTN or Medial Distal Tibia Plate (MDTP) and a SMOT simulated. The envisioned surgical outcome scenarios included a "best-case" scenario representing an intact lateral cortex and a "worst-case" scenario representing a fractured lateral cortex. All samples underwent compressive and torsional testing and were assessed using calculated construct stiffness from force–displacement data, interfragmentary movement and Von Mises’ strain distribution. The DTN showed greater compressive stiffness for the best-case surgical scenario, while the MDTP exhibited higher stiffness for the worst-case scenario. The DTN was more resistant to torsion in the worst-case surgical setup for both ± 4 Nm and ± 8 Nm. The equivalent stiffness of the DTN against the MDTP supports the use of this implant for SMOT fixation and should be considered as an option, especially in patients presenting vascularization where the MDTP is an inappropriate choice.


A study was held to assess a measure of the responsiveness and reliability of the pulse volume recording upstroke ratio (PVRr), using a database of 389 subjects undergoing lower extremity revascularization. Subjects were included if they had undergone pedal radiographs, had PVRs performed pre- and post-lower extremity revascularization and had regular pulsatile digital waveforms with a pressure recording on both PVRs. PVRr responsiveness was evaluated via a post-operative percent change compared to the digital pressures. A statistically significant negative correlation was noted, indicating that the PVRr fell as digital pressures rose. Measurement of the reliability of the PVRr also was performed on a selection of 10 recordings by two residents and three board certified surgeons. The intraclass correlation coefficient of measurements was 0.960. This investigation yielded evidence that supports the responsiveness and inter-rater reliability in the estimation of the PVRr.


An incremental cost-utility analysis sought to ascertain the most cost-effective treatment pathway for symptomatic Morton neuromas that have failed conservative management. The researchers compared a direct to surgical neurectomy strategy with three injection selective strategies in which one or more ultrasound-guided injection therapies was attempted before surgery for non-responders. The three injection selective strategies included steroid selective, alcohol selective and successive steroid/alcohol selective. Outcome was cost per quality adjusted life year (QALY) with a time horizon of three years. Using the base input values, the steroid/alcohol selective strategy was dominant and returned an incremental cost-effectiveness ratio of $4,401/QALY versus no treatment. The probabilistic sensitivity analysis backed this strategy in 74 percent of 10,000 simulated trials. Outcomes were strong with low sensitivity to most input parameters, but when the probability of successful alcohol injection treatment came under 40 percent the steroid selective strategy was most cost-effective.

Practice Management

---

Providing negative feedback can be less onerous for physicians through thoughtful planning. Before providing feedback in the work setting, physicians should confirm that they are in a position to give this type of assessment. If providing unscheduled feedback to a peer with the goal of getting fair treatment for themselves, improving the process for their team or responding to a patient care issue, doctors must be clear on several points. These include why this feedback is important; why they are the ones delivering it; why feedback is required at this time and the overall purpose and desired outcome. The 1/3 rule remains a solid strategy for negative feedback, particularly for those who might be highly sensitive to criticism. Doctors should open with praise, clearly articulate their criticism, then conclude with praise. Also valuable is making suggestions for improvement, and for cases where communicating improvement strategy is difficult, the physician might implement a continuing medical education program with instructions covering the area to be improved.


Recommended marketing strategies for medical practices include identifying the target audience based on the services the practice offers and applying marketing collateral like postcards, ads and brochures. A personalized website with contact details, patient forms, details about staff and a chat plugin for anytime availability is also necessary. The website must be optimized with relevant keywords through resources like Google Keyword Planner, and paid search services ought to be utilized. Practices should make keeping a social media presence a religious habit and build strong relationships with patients through treatment, urgent care facilities, good staff, follow-up and more. Investing in promotional services like ads is a given, and practices should track the leads and conversions incurred from different mediums to budget wisely. Finally, offering benefits like no-wait appointments, free dental consultation and more will make patients feel more valued.

Health Policy and Reimbursement

---

The Biden administration has finalized consumer safeguards against "surprise" medical bills, which officials said are slated to take effect January 1. Thanks to the new rules, patients will not be charged for emergency medical services if the closest hospital emergency room is outside their insurance plan's provider network. They will also be shielded against unexpected fees if an out-of-network doctor participates in a surgery or procedure conducted at an in-network hospital. The rules specify a behind-the-scenes dispute resolution system that hospitals, doctors and insurers will use to negotiate fees, without ensnaring patients. When an insurer and a service provider clash over fair payment, either side can initiate a 30-day negotiation protocol and refer the matter to an independent arbitrator if they fail to reach an agreement. The new rules will also outline a new channel for uninsured people and patients who pay their own way to receive an estimate of charges for medical procedures and a process for them to resolve billing disputes.


The US Centers for Medicare and Medicaid Services (CMS) has in its latest Medicare Physician Fee Schedule proposed for the first time a set of remote therapeutic monitoring (RTM) Current Procedural Terminology (CPT) codes. CMS indicates that these codes can be used to track medication compliance. The National Institutes of Health estimates that preventable hospitalizations and emergency department visits related to medication non-adherence cost more than $300 billion annually in the US. Including medication adherence programs in CMS' proposed RTM codes is a key toward addressing a major healthcare challenge and modernizing reimbursement for digital health. The RTM codes are similar to those for remote physiological monitoring, which compensates providers for the review of physiological data that is automatically transmitted from a device, but can specifically monitor medication adherence and can include cases when patients self-report clinically relevant health data.


The US Department of Health and Human Services (HHS) has awarded nearly $1 billion in American Rescue Plan funding to finance major healthcare construction and renovation projects at health centers. HHS said nearly 1,300 Health Resources and Services Administration Health Center Program-funded health centers will use the funds for COVID-19-related capital needs, building new facilities, renovating and expanding existing facilities to enhance response to pandemics and buying new equipment. The funds will be allocated to health centers that serve medically underserved and other vulnerable populations and communities. Constructing new facilities or renovating and expanding existing facilities will give these communities more equitable access to high-quality primary healthcare. "Thanks to American Rescue Plan funds, we're modernizing facilities across the country to better meet the most pressing public health challenges associated with COVID-19," said HHS Secretary Xavier Becerra. "This historic investment means we get to expand access to care for COVID-19 testing, treatment and vaccination—all with an eye towards advancing equity."


A fact sheet from the Urban Institute indicates a widespread lack of awareness among uninsured adults of their Affordable Care Act (ACA) coverage options. The survey found 48.2 percent of all uninsured, nonelderly Americans had heard of ACA marketplaces, while about 70 percent said they had not heard any information or only a little information about the health insurance subsidies available to qualifying uninsured groups. Most of the uninsured individuals who had heard about the marketplaces but had not enrolled in coverage cited cost as their primary concern and barrier to enrollment. Younger adults and unemployed individuals were more likely unaware of the marketplace plans or the subsidy options available. Of those who had not heard anything or had heard very little about their ACA marketplace and financial aid options, 27.7 percent spoke Spanish or were bilingual, 15.5 percent lacked Internet access, 47.8 percent were unemployed and 20.6 percent had a high school degree or less. The researchers said the results indicate that policymakers should concentrate on refining outreach efforts for younger adults and should work through unemployment offices to reach the jobless with marketplace and subsidy information.

Medicine, Drugs and Devices

---

A lawsuit filed against Alabama's Springhill Medical Center alleges that a 2019 ransomware attack directly contributed to the death of a newborn. If proven in court, this would mark the first confirmed death resulting from a ransomware attack. Teiranni Kidd was admitted to the hospital nearly eight days into a ransomware attack that left patient health records inaccessible and left fewer eyes on fetal heart rate monitors because they could not be displayed at the nurses' station. Attending obstetrician Katelyn Parnell, said the death of Kidd's daughter was preventable had she seen an indication from the monitor that the fetus was in distress. Springhill refused to pay the ransom when the hackers, believed to be the Russian-based Ryuk gang, resulting in a network outage that lasted at least three weeks.


A study published in JAMA Network Open demonstrated that wearable health monitors could predict infections, even before a person feels symptoms. The researchers recorded biometric data from young participants before and after they were inoculated with H1N1 influenza and human rhinovirus. In comparing each participant to their uninfected baseline metrics, researchers detected infection with up to 92 percent accuracy and differentiated between mild and moderate disease with up to 90 percent accuracy. Once exposed to the viruses, subjects reported daily symptoms and researchers measured their viral shedding. A machine learning algorithm then forecast the presence and severity of infection based on how each participant's biometric data changed after exposure compared to their baselines. Scripps Research Translational Institute epidemiologist Jennifer Radin said the study framework was particularly useful for studying presymptomatic and asymptomatic cases, and being able to identify infections would be "a very useful public health tool" for a disease like COVID-19.


The US Office of the National Coordinator for Health Information Technology reports in the Journal of the American Medical Informatics that the number of apps that integrate with certified electronic health records (EHRs) has increased by more than 20 percent in 2020. The number of unique apps and developers rose from 600 to 734 and 517 to 610, respectively. Administrative apps that managed scheduling, check-in and billing comprised 42 percent of available apps, while clinical apps accounted for 38 percent. Other apps handled care management (31 percent), patient engagement (20 percent) and research (5 percent). Fast Healthcare Interoperability Resources-enabled apps showed no statistically significant growth. Areas meriting further exploration include the role of secure, standards-based application programming interfaces (APIs), which may help apps link to multiple EHR data systems without the need for proprietary APIs for each integration.