News From ACFAS

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October kicks off the annual membership renewal, so what better time to refresh your memory about all the meaningful benefits that come with being an ACFAS member? Your dues give you access to our robust education and professional development offerings, practice growth and management tools and our top-rated Annual Scientific Conference.

Planning is underway for ACFAS 2022 and promises to be another exciting learning and social event that you won't want to miss, so renew your membership today so you can register at the member rate! You can renew online or via mail or fax. Please reach out to the Membership Department at membership@acfas.org or visit the Member Center at acfas.org if you have any questions about your membership benefits. Don’t miss the College’s newest course—Coding Fundamentals. This comprehensive workshop covers the fundamentals of coding and billing for foot and ankle surgeons and explains the foundation of the coding and billing process from expert colleagues. This is a perfect course for those new to coding or for those who want to brush up on their coding knowledge. The course can be taken before the ACFAS Coding and Billing for the Foot and Ankle Surgeon course and will be offered at ACFAS 2022 in Austin as a pre-conference program and prior to any future full ACFAS Coding and Billing for the Foot and Ankle Surgeon courses.

Residents can take this course as a part of a full day of Resident learning at ACFAS 2022 when pairing it with Residents’ Day at a discounted rate. Register for Residents Day in the morning and learn the foundation of coding and billing in the afternoon with Coding Fundamentals.

Visit acfas.org/PracticeManagement for full course information and to register to step up your coding game today. Get all the latest College news with the latest issue of Update hitting your inboxes and mailboxes soon!

We’re kicking off ACFAS 2021 with registration opening and outlining what’s in store for you at this year’s meeting, including a new coding course and the first-ever Virtual Career Fair. In this issue you’ll also find advice on managing online patient reviews, how the College is busy promoting you with our different PR efforts, highlights from the July Board Meeting and fellowship programs that received status with ACFAS. It’s all in this issue of Update!

Visit acfas.org/Update to read the latest in College news now.

Foot and Ankle Surgery

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A study was conducted to compare the clinical and radiological outcomes between supramalleolar osteotomy (SMOT) with and without fibular osteotomy (FO) in the treatment of varus ankle osteoarthritis. The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. Both groups achieved significant improvements in AOFAS scores, modified Takakura stage and AOS pain and functional scores. The ROM of the ankle joint in the SMOT group was significantly decreased. No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle and hindfoot alignment angle in the SMOT with FO group were significantly smaller than those in the SMOT group. Researchers concluded that SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced.


Researchers examined the relationship between the screw level relative to the tibiotalar joint and syndesmosis malreduction in postoperative radiographs of ankle fractures treated with partially threaded screws. They retrospectively analyzed 129 patients who underwent surgery due to lateral malleolar fractures between 2011 and 2019. They also measured the distance between the screw and the tibiotalar joint and stratified the patients per their screw level as either transsyndesmotic or suprasyndesmotic. Researchers found postoperative syndesmosis malreduction in 20 cases. Eight cases had medial clear space mismatch. As the distance of the screw to the joint increased, postoperative medial clear space values increased. The relationship between postoperative syndesmosis mismatch and the level of the syndesmotic screw was statistically significant. In syndesmosis repair with a partially threaded screw, as the distance of the screw from the joint increases, the over-compression caused by the screw may cause an increase in postoperative syndesmotic malreduction rates.


With an extensive outbreak of chilblain-like lesions (CLL) noted during the COVID-19 pandemic, a study sought to analyze skin and blood endothelial and immune system activation in CLL compared with healthy controls and seasonal chilblains (SC), defined as cold-induced sporadic chilblains occurring during 2015 and 2019, with chilblain lupus excluded. The authors studied 50 patients in Paris and found similar histological patterns and overlapping transcriptomic signatures in both the CLL and SC cohorts, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were defined by higher IgA tissue deposition and greater transcriptomic activation of complement and angiogenesis factors versus SC. CLL exhibited a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73 percent of patients and elevated type I interferon blood signature compared with healthy controls. Endothelial dysfunction in CLL was confirmed through the use of blood biomarkers related to endothelial dysfunction and activation and to angiogenesis or endothelial progenitor cell mobilization.

Practice Management

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Author and doctor Talya Miron-Shatz writes that leaving patients for the most part on their own to decide their course of medical care, even with the Internet and other platforms providing a wealth of information at their fingertips, can be detrimental. Research from University College London researchers determined that while patients often cite such information to help them advocate for treatment, they still prefer to defer to doctors when making a final decision. The sheer amount of data available can be overwhelming, and unofficial sources like RxList and WebMD have been taking up the slack. Miron-Shatz suggests telemedicine can be another valuable source for better answers, while also being a convenient tool for doctors. However, this can conflict with the American Medical Association's recommendation that practitioners tailor services to each patient in its Code of Ethics. "Beyond providing care, they have a duty to help patients choose based on evidence and medical knowledge," Miron-Shatz writes. "The first step toward this is establishing rapport and trust, followed by delivering clear, valid information — to give patients a chance to use both System One and System Two thinking. Patients, meanwhile, need to be aware of their own tendency to react intuitively and make sure to pursue information they can process."


Practices are using texting to better support and increase patient interaction, including appointment reminders that list date, time and location. Recall campaigns are another useful application to help ensure that patients comply with their routine care schedule. Patients or caregivers may also need to complete tasks that support recovery or reduce the potential for infection or other complications, and regular texts can alert them to this need. Text messaging can also help overcome some of the usage and engagement obstacles for telehealth for patients and caregivers, as well as notify patients about the availability of vaccinations. Two-way texted patient satisfaction surveys are critical to gauging practice performance, while texting offers practices a simple way of asking patients to leave online reviews, especially for positive experiences.


Practices can significantly reduce hiring costs though a six-step process, starting with defining their staff requirements in terms of desired personality, work ethic, appearance and manner. Step two is to flesh out the ideal candidate by describing how such a person would respond in two or three hypothetical scenarios. The third step is to adjust candidate requirements, the job or both as necessary. Step four is to set up a process that lets casual candidates self-filter themselves out of the search, while step five involves independently authenticating the candidate's résumé or application. The sixth and final step is to offer new hires an easy way to quit following a short trial period if they turn out to be unsuitable.

Health Policy and Reimbursement

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US National Institutes of Health (NIH) Director Francis S. Collins, MD, PhD, announced that he would step down from his position by the end of the year. Collins, the longest serving presidentially appointed director, has served three US presidents over more than a dozen years. "It has been an incredible privilege to lead this great agency for more than a decade," said Collins, noting he is "proud of all we've accomplished." He said that he believes "no single person should serve in the position too long, and that it's time to bring in a new scientist to lead the NIH into the future."


The US Department of Health and Human Services has published guidelines for employees and employers to clear up misconceptions about COVID-19 vaccines and the Health Insurance Portability and Accountability Act (HIPAA). The guidelines emphasize that HIPAA does not bar businesses or individuals from asking customers about their COVID-19 vaccination status and only applies to covered entities like hospitals, payers and their business associates. The guidelines also specify that HIPAA does not prevent individuals from reporting their vaccination status to business owners or employees of an establishment. Moreover, the legislation does not block a covered entity or business from mandating that employees disclose their vaccination status to their employers, nor does it apply to employment records, even covered entities, when they function as employers. Also important to note is that physicians offices are not prohibited from disclosing protected health information, including COVID-19 vaccination status, to a patient's employer.


With the 2022 Medicare Advantage open enrollment period around the corner, major payers shared updates to their benefit offerings and their expansion plans for the new year. They are also making more services available via home healthcare and maintaining lower cost-sharing for telehealth. Aetna said next year more than eight in 10 Medicare-eligible beneficiaries will have access to its zero-dollar premium Medicare Advantage plan, while about 75 percent of Aetna Individual Medicare Advantage plan members will have no out-of-pocket costs for primary care or lab services. Aetna's Medicare Advantage plans will address social determinants of health needs by covering telehealth services for primary care, urgent care, specialty care and mental healthcare. Cigna said its Medicare Advantage plans will be accessible in 108 additional counties and three new states, and it will cover virtual care for primary care, behavioral healthcare and physical therapy services with no cost-sharing. Meanwhile, Humana added 72 new health plans for 2022, including Medicare Advantage prescription drug plans, Medicare Advantage only plans and special needs plans. UnitedHealth Group will launch the UCard, which combines members' UnitedHealthcare identity card with their over-the-counter benefit and healthy food benefit cards and which members can use to redeem rewards at retail locations and online.

Medicine, Drugs and Devices

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A new consensus statement on the management of type 1 diabetes in adults covers the novel clinical needs of the population compared with those of children with type 1 diabetes or adults with type 2 diabetes. The final version of the joint American Diabetes Association /European Association for the Study of Diabetes statement includes diagnosis of type 1 diabetes, goals and targets, schedule of care, self-management education and lifestyle, glucose monitoring, insulin therapy, hypoglycemia, psychosocial care, diabetic ketoacidosis (DKA), pancreas transplant/islet cell transplantation, adjunctive therapies, special populations and emergent and future viewpoints.


University of Toledo (UT) researchers have found a prospective new vaccine-based treatment for rheumatoid arthritis (RA) that was highly effective in preliminary animal studies. The work focuses on the protein 14-3-3 zeta, suspected of playing a key role in the onset of RA. The team hypothesized that removing the gene in arthritis mouse models would prevent inducement of the condition, only to learn that RA accelerated instead, concurrent with the depletion of anti-14-3-3 zeta antibodies. The researchers then formulated a novel protein-based vaccine to stimulate anti-14-3-3 zeta antibody production, which successfully inhibited RA development in several animal models. "We happened to hit a wrong result, but it turned out to be the best result," said UT's Ritu Chakravarti. "Those kinds of scientific discoveries are very important in this field." The research was detailed in the Proceedings of the National Academy of Sciences of the United States of America.


A telehealth satisfaction study from J.D. Power found 36 percent of patients have accessed telehealth services in the last year, versus 9 percent in 2020 and 7 percent in 2019. Usage is consistent across all generational groups, with rates highest among millennials and so-called "Pre-Boomers." Top utilization motivators were convenience, safety and the ability to receive care quickly. The most frequent discouraging factor was that patients preferred to see their doctor in person, while safety, ease of use and lack of trust with features contributed. Over half of respondents cited limited services, lack of awareness of costs, confounding technology requirements and little information about providers as hindering their use of teleheath. Satisfaction tended to be lower among patients with the lowest self-reported health status than those who considered themselves to be in excellent health.