News From ACFAS

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After careful review of applicants applying to serve on the ACFAS Board of Directors, the Nominating Committee recommends these Fellows to run for three open seats in the upcoming election:

• Shane Hollawell, DPM, FACFAS
• Alan A. MacGill, DPM, FACFAS
• Jason A. Piraino, DPM, MS, FACFAS
• Brett D. Sachs, DPM, FACFAS
• Amber M. Shane, DPM, FACFAS

There are two (2) three-year terms and one (1) two-year term that will be filled by election. Candidates will be posted on the ACFAS website and highlighted in the November 24 issue of ThisWeek. Online voting will be open December 10-27. Eligible voters will receive an email with a unique link to the election website when the election opens.

ACFAS sincerely thanks the 2021-2022 Nominating Committee for their service on this important committee: Chair – Scott C. Nelson, DPM, FACFAS; Lacey Clawson, DPM, FACFAS; Thanh Dinh, DPM, FACFAS; Brandi Johnson, DPM, FACFAS; Michael Lee, DPM, FACFAS; Ronald Ray, DPM, FACFAS; Erin Robles-Sherman, DPM, FACFAS. Sunday is the deadline to volunteer to serve as an ACFAS committee member, Clinical Consensus Statement panelist or Scientific Literature reviewer. Don’t miss your chance to help the College shape the future of our profession in 2022. If you would like to volunteer, visit acfas.org/volunteer to apply. Are you currently a first-year resident interested in getting more involved with ACFAS? Are you interested in helping to advance the profession, patient care and the future of the College by volunteering to serve on an ACFAS committee? The College is looking for members like you!

For 2022, there are a very limited number of volunteer positions available for first-year residents on the following ACFAS committees: Consumer Education, Health Policy, Membership, Post Graduate Affairs, Practice Management and Research/EBM. You can find information about each committee on acfas.org.

Interested in being considered? Please go to the online application and submit your CV and a short statement of interest. Applications are due by October 31, and committee selections will be notified in January 2021.

Have questions? Please contact Michelle Kennedy, Director of Member Engagement & Post Graduate Affairs.

Foot and Ankle Surgery

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Researchers conducted a study to analyze the effects that common beam parameters have on medial column arthrodesis using a set of five subject-specific finite element models. A full-factorial design of experiments was conducted with three factors: implant stiffness, threaded portion and cannulation. Increasing implant stiffness, threaded portion and using a solid beam all significantly increased medial column stiffness from 13.9 to 20.0 N/mm, 15.2 to 18.8 N/mm and 13.6 to 20.4 N/mm, respectively. Moreover, simultaneously increasing all 3 factors resulted in a 172 percent increase in medial column stiffness, as well as a 33 percent decrease in maximum von-Mises stress, 70 percent decrease in strain energy and 44 percent decrease in the average normal force in the implant during bending; all of which were significant. The study found no significant increase in contact area in any of the joints, but there was a significant decrease in micromotion in each joint, ranging from 63 percent-66 percent. Based on the parameters tested, a stainless steel, fully threaded, solid intramedullary device would produce the most stable construct for medial column arthrodesis under ideal conditions.


Researchers sought to analyze the differences in static (including conventional and modified [single-leg heel-raise balance]) and dynamic postural stability and muscle endurance between patients with chronic ankle instability (CAI) and healthy controls and to determine the reliability and usefulness of the single-leg heel-raise balance test in patients with CAI. Twenty-six patients with CAI and 26 healthy controls were enrolled. Postural stability was assessed using a postural stabilometry system. Muscle endurance was measured in dorsiflexion and plantarflexion using an isokinetic device. Modified static postural stability and dynamic postural stability were significantly poorer in the affected ankles of patients with CAI than in the controls. Plantarflexion endurance was significantly lower in the affected ankles of the patients with CAI than in the controls. Modified static postural stability significantly correlated with plantarflexion endurance in both groups. Researchers said given the reliability of the modified static postural stability test, clinicians and therapists should consider using it to assess improvements in postural stability and muscle endurance in patients with CAI before and after rehabilitation.


A study was conducted to investigate the relationship between vitamin B6 and the incidence of fractured ankles in patients with osteoporosis. A total of 101 patients with osteoporosis participated in the study. Pearson's chi-squared and spearman test were performed to analyze the correlation between fractured ankles and relative parameters. Researchers found a strong relation between the expression level of vitamin B6 and fractured ankle. The expression of vitamin B6 has a clear correlation with whether the patients have fractured ankles via the univariate logistic regression analysis. In terms of multivariate logistic regression level, vitamin B6 was significantly associated with fractured ankle. In addition, expression level of vitamin B6 was significantly associated with Maintenance time from recovery to recurrence of patients with osteoporosis. Researchers found enhanced vitamin B6 is significantly correlated with the poor prognosis of patients with osteoporosis and the increasing incidence of fractured ankles.

Practice Management

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Physicians should ask eight critical questions before taking out a loan. The first is whether lenders require personal collateral, and the second is whether the loan will be posted on the provider's credit report, which can hurt their credit score. Also to be asked is the kind of rate the lender is offering and how soon they make approval decisions. Physicians should also find out if the lender has any experience working with others in the medical industry and how quickly they deposit funds into accounts after approval. The length of time physicians have before they must repay what they owe must also be answered, and the final question should ask how much time and work is needed for the loan application process.


A survey by NPR, the Robert Wood Johnson Foundation and the T.H. Chan School of Public Health of patients in August and September found some 42 percent said someone in their household had used telehealth. Of those, 82 percent were satisfied, although 64 percent would have preferred an in-person visit. "I think people just really like that face-to-face visit," said Florida family physician Rebekah Bernard, who is on the board of Physicians for Patient Protection. However, she acknowledged that telehealth can be an essential lifeline in places where in-person visits are unavailable. "I'm sure in rural areas or places where, for example, they don't have a lot of specialists like psychiatrists, we really need to make sure we have access to telehealth for those patients," Bernard said.


Physician practices can boost their search rankings to acquire more patients by following three simple search engine optimization (SEO) strategies. The first involves optimizing for the practice's location by geotagging office photos in the website. The second is to look up SEO keywords for the healthcare sector every three months, at minimum. The practice's website content should also be updated as needed according to the competition's latest keywords. The third strategy is to have the practice concentrate on low-competition keywords with high search volumes for its specialty. This can elevate the practice to the top of the search results and boost its reputation as one of the leading industry experts for a specific trend. The practice should then write and publish content featuring those keywords or topics before the competition can move on them.

Health Policy and Reimbursement

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A report published in The Lancet Countdown outlines the conclusions of researchers from 43 academic institutions and United Nations (UN) agencies about the link between health and climate change. Marina Romanello, PhD, lead author and research director for The Lancet Countdown, warns that for the first time, the situation has reached code red for a healthy future. The report comes before the start of the UN Framework Convention on Climate Change 26th Conference of the Parties. Romanello and colleagues are concerned that many current COVID-19 recovery plans are not compatible with the Paris Agreement, which calls for limiting global warming to below 2 degrees Celsius compared with preindustrial levels. The report concludes that it is feasible to respond to climate change alongside recovery from the COVID-19 pandemic. For instance, the report estimates that rapid de-carbonization could prevent most of the 3.3 million deaths attributed to air pollution annually. The report notes that only 0.3 percent of the total funding for adaptation to climate change has been allocated for use by health systems. It also said that climate change creates ideal condition for the spread of infectious diseases, including dengue fever, chikungunya and Zika. Romanello advises healthcare practitioners to learn about the health effects of climate change. She says: "They should also say, 'Reduce your exposure to air pollution, reduce your car journeys, reduce your consumption of red meat.'"


The Office of Inspector General (OIG) for the US Department of Health and Human Services has suggested that Medicare Advantage plans may be making their beneficiaries look sicker than they really are to maximize payments from the federal government. Jonathan Blum, principal deputy administrator of the US Centers for Medicare and Medicaid Services (CMS), said the agency also is concerned about Medicare Advantage payments. The OIG report found that 20 of the 162 Medicare Advantage companies drove a disproportionate share of the $9.2 billion in payments from diagnoses that were reported only on chart reviews and health risk assessments and on no other service records. Those assessments are typically conducted by the health plan or vendors hired by the health plan, OIG said. Blum said CMS is considering regulation to address the issue. Meanwhile, the percentage of Medicare beneficiaries enrolled in private plans is expected to reach 50 percent by 2030.


Telemedicine grew over the course of the COVID-19 pandemic, as many patients relied on the technology for doctor visits. Insurers are hopeful that patients liked telemedicine enough to embrace new types of health coverage that encourage video visits or insist on them as part of patient care. While some suggest that using telemedicine for routine care can reduce costs, others are concerned that symptoms or other factors will be missed, leading to larger healthcare concerns down the road. Priority Health in Michigan and Harvard Pilgrim are two insurers offering coverage that requires online visits first for nonemergency primary care. Many insurers offering virtual-first plans hire outside firms to provide medical staff, but while physicians may hold licenses in several states, they may not be located near their patients. Insurers say these plans enable patients to be seen more quickly and obtain referrals for in-person visits.

Medicine, Drugs and Devices

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US lawmakers who crafted last year's law addressing surprise billing say a rule issued by the Biden administration to implement the law may cause legislative disputes. At issue are the parameters an arbiter should consider when determining payment for a surprise bill that a health plan and provider cannot determine on their own. The law directs the arbiter to look at a range of factors when determining the ultimate outcome. However, a recent interim final rule dictates that the in-network median payment rate should be the default payment amount. Some lawmakers, doctors and hospital groups say this rule doesn't adhere to the legislation, which was enacted as part of a 2020 year-end spending law. Other lawmakers say the rule by the US Health and Human Services, Labor and Treasury departments and the US Office of Personnel Management meets Congress' intent and should take effect in January.


A review of quarterly data reveals that the US Food and Drug Administration (FDA) approved a rising number of competitive generic therapy (CGT) abbreviated new drug applications (ANDAs) in fiscal year (FY) 2021 while the number of priority generic approvals leveled off. FDA approved 29 priority ANDAs in FY 2021, up from 28 approved in FY 2020. There was an increase of approximately 8 percent in the number of priority ANDAs awaiting agency action, from 210 in FY 2020 to 227 in FY 2021. The number of competitive generics approved by FDA increased from 35 in FY 2020 to 53 in FY 2021, while the number of CGTs awaiting agency action rose from 390 in FY 2020 to 521 in FY 2021. The FDA Reauthorization Act of 2017, which reauthorized the Generic Drug User Fee Act for 5 years, calls for FDA to report on ANDAs subject to priority review and certain ANDAs with a competitive generic therapy designation.