News From ACFAS

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The Annual Scientific Conference is moving to Tuesday, May 18-Friday, May 21, 2021 at the Mandalay Bay Resort & Convention Center in Las Vegas. The move is in response to COVID-19 and the ongoing effort to offer members the option to learn and connect with colleagues in-person at the 79^th Annual Scientific Conference.

Also, mark your calendars to arrive early to attend the pre-conference programming on Monday, May 17, which includes:

• Pre-Conference Hands-on Workshops
• Residents’ Day
• Coding & Billing for the Foot and Ankle Surgeon
• Residency Directors Forum

New Deadlines
Manuscripts Deadline: December 16, 2020
Posters Deadline: January 13, 2021

As the response to COVID-19 continues, ACFAS will communicate plans to ensure a safe environment for all attendees and staff as well as any programming updates. Information will be dispersed as it becomes available but visit acfas.org/LasVegas for more details. Don’t get left behind when the new coding changes hit January 2021. Join us in person in Orlando for another Coding & Billing for the Foot and Ankle Surgeon Course.

December 4-5
(Friday/Saturday)
Walt Disney Swan & Dolphin Hotel
Lake Buena Vista, FL
Register

This course is a perfect opportunity to get ahead of the new E&M coding changes set to begin January 1, 2021. Attendees will also learn about other timely topics, including telehealth coding; coding and billing changes, such as coding for prolonged services; and several CCI edits relating to foot and ankle surgery.

Don’t fall behind the coding changes. Register yourself and your office coding staff today at acfas.org/PracticeManagement. The College released a new position statement on board certification in the specialty of foot and ankle surgery. The statement supports the recognition of one board per specialty as determined by the Joint Committee on the Recognition of Specialty Boards (JCRSB) of the Council on Podiatric Medical Education (CPME) and recognizes the American Board of Foot and Ankle Surgery (ABFAS) as the certifying board in the specialty of foot and ankle surgery.

View the full position statement at acfas.org/PositionStatements. Dan McNeill, MA, is the new Director of Education for the College. Dan joined the College this week and brings over 25 years of experience developing and executing in-person and virtual education programs and conferences. His unique combination of skills made him the perfect fit for this position. College Executive Director Patrick (PJ) Andrus, MBA, CAE shares, “Dan brings a wealth of passion, leadership and knowledge for adult education to the College and we are thrilled to have him as part of our team"

Dan has hit the ground running and will be working closely with the Education team to continue planning for the Annual Scientific Conference and ACFAS’ other educational programming. Please join us in welcoming Dan to the College!

Foot and Ankle Surgery

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A meta-analysis sought to determine whether suture-button (SB) fixation was better than syndesmotic screw (SS) for treating unstable syndesmosis injuries. Twelve clinical studies involving 320 patients in the SB group and 334 patients in the SS group were reviewed. The American Orthopaedic Foot & Ankle Society (AOFAS) score was significantly higher at three-month and two-year follow-up and the Olerud-Molander Ankle score at one-year follow-up, for subjects treated with SB. That cohort also had significantly better results in malreduction, implant failure, implant removal and local irritation. No statistical differences were observed in the AOFAS at six months and one-year follow-up. The meta-analysis indicated no significant difference in postoperative radiological measurements, and no sufficient evidence supporting the improved clinical outcomes compared with SS fixation group. Yet SB techniques could enhance functional outcomes, and reduce the rate of implant removal, implant failure, local irritation and malreduction without increasing risk of other complications.


Researchers conducted a study to compare the pain and functional outcomes between platelet-rich plasma (PRP) and corticosteroid (CS) or placebo for plantar fasciopathy through meta-analysis and provide the best evidence. Literature was searched systematically to explore related studies that were published in Cochrane Library, PubMed, Embase, Medline, SpringerLink, OVID and ClinicalTrials.gov. Articles regarding comparative research about the outcomes of PRP therapy and CS or placebo injection were selected. Thirteen RCTs were included and analyzed. Analysis results showed significant superiority of PRP in outcome scores when compared with CS, whereas there is no statistical difference in well-designed double-blind trials. In the comparison of the PRP and the placebo, the pooled mean difference was -3.76. The researchers reported that no superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.


A study was conducted to evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures. Researchers performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records and analysed from a societal perspective. In total, 246 patients had data available for analysis. Fewer radiographs were obtained in the reduced imaging group compared with the usual-care group. Functional outcome was comparable in both groups. The difference in QALYs was 0.008 and the difference in OMAS was 0.73. Imaging costs were lower in the reduced imaging group. Researchers concluded that reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care and may result in reduced costs.

Practice Management

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Insurance companies have begun to roll back some of the terms they put in place regarding telehealth coverage. Earlier this year, insurers began offering deadlines, reimbursement strategies and charges in response to the coronavirus pandemic. However, doctors and hospitals say the rules have been confusing and resulted in cost-sharing issues that discourage patients from visiting doctors. For example, Anthem and UnitedHealth have implemented changes that apply to certain plans and don’t include virtual visits related to the coronavirus, which will continue to be free for patients. Yet, other insurers have ended cost-sharing waivers for telehealth visits earlier in the year. Thomas Owens, senior vice president of Duke University Health System, warns, "Shifting the copayment back to patients now presents a risk that patients will cancel telehealth appointments or seek in-person visits that heighten the threat of infections. Though many people with insurance would be charged only a flat copay for virtual visits, others might owe the full cost or a share of it, depending on their plan."


Nick Hernandez, MBA, FACHE, the CEO and founder of ABISA, offers recommendations physicians can keep in mind if they have to enter negotiations. Hernandez says before beginning negotiations it is important to have a clear understanding of the priorities for the talks. Physicians should then determine what the offer will be and what can be compromised on. Other important topics to determine before talks begin are price, personnel matters and voting rights. Some of these issues have particular importance if a practice is being merged with another or a doctor is buying into a practice. Hernandez adds that it is also important to have boundaries in negotiations. He says physicians should know what their deal breakers are and stick to them during discussions. He says physicians should also be sure to sure listen carefully, maintain composure if negotiations become tense and never negotiate alone. Hernandez says a consultant can be very helpful if negotiations become tense and continue for a prolonged period of time.


As economies slowly begin to reopen and people begin returning to work and school, healthcare experts say enhanced interoperability will be needed to monitor the spread of the coronavirus and perform contact tracing. Phil Hearth, director for provider engagement at DataLink, says point-of-care solutions will be needed to allow doctors to extract and electronically export patient data from a meaningful use-certified electronic health record to a continuity of care document. "Physician practices should look for an innovative approach that enhances workflows and clinical decision-making. This can virtually eliminate human transmission errors which can result from faxing and uploading documentation for supplemental data.Most importantly, this automated approach closes quality care gaps in near real-time. Ideally, the solution should also offer secure, electronic transmission of a patient’s vital medical information, which is especially critical during the COVID-19 pandemic," says Hearth. He adds, "Now more than ever, physicians across the country need this level of innovative technology solution to drive data interoperability, optimize care quality, reduce administrative burden, enhance value-based care initiatives and improve financial performance and communication."

Health Policy and Reimbursement

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A study from the US Centers for Disease Control and Prevention (CDC) estimates that approximately 2.5 million more working-age Americans were uninsured last year, even before the pandemic. The CDC's National Health Interview Survey found that 14.5 percent of adults ages 18 to 64 were uninsured in 2019, compared to 13.3 percent in 2018.


New data from the Centers for Medicare and Medicaid Services reveals that roughly 4 million additional Americans turned to Medicaid last spring amid the coronavirus pandemic. More than 2.4 million adults enrolled in Medicaid, an increase of 7.2 percent, while 1.4 million children signed up for Medicaid or the Children's Health Insurance Program (CHIP), a jump of 4.1 percent. The Congressional Budget Office now expects an additional 9 million people to be enrolled in Medicaid and CHIP in 2021.


The US National Institutes of Health (NIH) is funding a nationwide study that seeks to determine the cause of several unusual types of diabetes. Someone with atypical diabetes may be diagnosed and treated for type 1 or type 2 diabetes, but they may not have a history or symptoms consistent with their diagnosis. The new study, which will be conducted at 20 research institutions, aims to identify new forms of diabetes, understand what makes them different, and learn their causes. The network will screen about 2,000 people with unknown or atypical types of diabetes that do not match the common features of type 1 and type 2 diabetes.

Medicine, Drugs and Devices

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Researchers at unmanned aviation solutions provider MissionGO and the Nevada Donor Network organ procurement organization last week announced successful test flights of drones carrying a human organ and tissue in Las Vegas. One flight on September 17 flew research corneas from one hospital to another about 2.5 miles away; a second flight on the same day transported research kidneys 10 miles, from an airport to a site outside a small town in the Las Vegas desert. The second run was the longest organ delivery flight in drone history, and biopsies performed before and after the flight found no changes to tissue architecture and cell viability. Drone deliveries could reduce flight time and the chances of organs becoming nonviable and discarded or failing after implantation. Meanwhile, MissionGO's Sister company MediGO aims to add global-positioning software that monitors the quality of the trip and the transported organ.


The US Food and Drug Administration (FDA) finalized guidance for device makers seeking to submit 510(k)s for prescription point-of-care and over-the-counter blood glucose monitoring systems, two years after FDA reexamined concerns over its previous guidance. FDA observed, "It has become increasingly clear that these different use settings comprise distinct intended use populations with unique characteristics that can impact device design specifications, and that manufacturers should take these unique characteristics into account when designing their devices." Specific risks include the potential for transmitting bloodborne pathogens between patients and the devices' use for patients who are more likely to be "acutely ill and medically fragile and are more likely to present physiological and pathological factors that could interfere with glucose measurements relative to lay-users."


The US Justice Department has sent Medtronic a civil subpoena formally requesting more information as part of an antitrust investigation. Specifically, the department wants to examine if Medtronic's prior acquisitions hindered competition in ventilator manufacturing, contributing to device shortages during the coronavirus pandemic. In 2012, Covidien PLC acquired Newport Medical Instruments, a small California-based manufacturer of ventilator systems, for $108 million, and nearly three years later, Medtronic purchased Covidien in a roughly $50 billion deal. The Federal Trade Commission (FTC) granted antitrust clearance for both transactions. In April, Democrats on a House antitrust subcommittee sent a letter to FTC Chairman Joseph Simons questioning whether the Newport acquisition contributed to ventilator scarcity and requested additional information from the commission. The lawmakers wrote: "Covidien's purchase of a potentially market-disrupting competitor that threatened to drive prices down has all the hallmarks of a killer acquisition, where an incumbent firm acquires and then shuts down a key rival."