News From ACFAS

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Get Even More Out of ACFAS 2022
Kick off your ACFAS 2022 educational experience a day early by joining us in Austin for some fabulous Pre-Conference Workshops. This year’s lineup is sure to have something for everyone and covers a wide range of innovative trends and topics in foot and ankle surgery.

Coding and Billing for the Foot and Ankle Surgeon
7:30am-5:30pm | 8 continuing education contact hours
This interactive and comprehensive workshop will cover pertinent issues related to properly coding surgical procedures and evaluation and management services. Learn how to code just one or two procedures properly, you will cover the cost of this course and see an immediate return on investment in your own practice.

New! Coding Fundamentals
2-5:15pm | 2.5 continuing education contact hours
Take the first few steps to coding and billing by joining us for this all-new workshop covering the fundamentals of coding and billing for foot and ankle surgeons. Learn the foundation of the coding and billing process from expert colleagues before taking the ACFAS Coding and Billing for the Foot and Ankle course. Open to beginner coders or to anyone wanting a refresher course on coding.

Forefoot Revisions: Managing Failed Procedures (Cadaveric)
7am-Noon | 4 continuing education contact hours
Learn techniques to streamline revision surgery in the forefoot while gaining an understanding of fixation methods and implants. Identify the failure points of the index procedures before they happen and review post-operative protocols.

Essential Rearfoot Procedures (Cadaveric)
Noon-5pm | 4 continuing education contact hours
Improve skills and become familiar with a variety of fixation methods and implant devices. Learn to execute essential skills to obtain adequate correction when performing corrective osteotomies and soft tissue repair.

We can’t wait to see everyone in Austin! Learn more about this year’s Pre-Conference Workshops at acfas.org/Austin. If you’re looking for a career change or want to find the right person to hire for your practice, join us tonight for the ACFAS’ Virtual Career Fair from 5-8pm ET. Limited spots are still available by signing up now!

This new career fair gives job seekers the chance to meet with viable prospective employers, and it gives employers the opportunity to connect with the best and brightest foot and ankle surgeons from the comfort of your own home or office! Job seekers – upload your CV and details you’re seeking in a new position. Employers – there’s still time to host a virtual employer booth to promote open positions or access the CV Library filled with interested candidates. Plus, everyone will have the chance to chat in real time with potential applicants or request a video chat on the spot! Kicking off ACFAS 2022 in Austin is featured keynote speaker Myron Rolle, MD, a former NFL safety, Rhodes Scholar and neuroscience resident at Massachusetts General Hospital, who shares his mantra of the 2 Percent Way.

Dr. Rolle’s mantra, instilled in him by his former coach at Florida State, Mickey Andres, is the way he lives each day by improving just two percent every day in all he does with practicing medicine, raising his family and personal relationships and his work through his foundation. With a rare combination of experience in the education, sport and the field of medicine, Dr. Rolle’s career has taken him from the football field to the front lines as he currently works and volunteers to aid the hospital in the fight against the COVID-19 global pandemic. As he shares his daily way of life, he hopes his experiences will help others live their lives two percent better each day.

Don’t miss Dr. Rolle at this year’s ACFAS 2022 in Austin! Visit acfas.org/Austin to learn more about this year’s meeting and register today.

Foot and Ankle Surgery

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A study tested the effectiveness of a semirigid ankle brace on joint congruency in a plantarflexion/supination position with and without load on 25 patients. A custom-built ankle arthrometer implementing a novel three-dimensional-stress magnetic resonance imaging technique was used to assess the brace's stabilizing effect. This supported an increase in cartilage contact area when the foot was placed in plantarflexion and supination. This effect was visible for all three compartments of the upper ankle joint, while axial loading did not result in significant differences. The subjective stability provided by the brace was uncorrelated to the magnitude of the improvement of the overall joint.


A study evaluated the results of innovative minimally invasive reduction and fixation techniques in tibial plafond fractures based on a computed tomography classification and compared short and long-term outcomes. Fractures were classified into varus, valgus, anterior, posterior and neutral types. Ninety-one pilon fractures (90 patients) received minimally invasive reduction and fixation, of which seven fractures (7.69 percent) needed open reduction due to intraoperative failure to achieve anatomic reduction. Of the 84 fractures that underwent successful minimally invasive reduction and fixation reported, 35 fractures (41.7 percent) saw excellent outcomes, 40 fractures (47.6 percent) had good outcomes, six (7.1 percent) had fair outcomes and three (3.6 percent) had poor outcomes for the long-term American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score at a follow-up of 60 months or more. This demonstrates that minimally invasive treatment is an effective and durable option for intraarticular pilon fractures.


A study was held to assess the measurement properties of the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) in comparison with other patient-reported outcome measures (PROMs) used following treatment for acute Achilles tendon rupture. A total of 103 patients with acute Achilles tendon rupture were included. Functional outcome was assessed via the PROMIS PF computerized adaptive test (CAT), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), FAAM–Sports and Achilles Tendon Total Rupture Score (ATRS). Eighty-two patients underwent operative repair and 21 underwent nonoperative management. Average time between treatment and collection of PROMs was 25.3 months while mean scores were 55.4 ± 9.2 (PROMIS PF), 92.9 ± 12.2 (FAAM-ADL), 77.7 ± 22.9 (FAAM–Sports) and 83.0 ± 19.4 (ATRS). The ATRS was correlated with FAAM-ADL and FAAM–Sports. The PROMIS PF was correlated with the FAAM-ADL, FAAM–Sports and ATRS The PROMIS PF showed zero absolute floor ceiling effects, while those observed in FAAM-ADL, FAAM–Sports and ATRS were substantial.

Practice Management

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Online engagement is the first step medical practices must follow to find patients, so they must optimize their chances of creating a good first impression. Slow-loading websites, outdated appearances or social media accounts and poor response to complaints are turn-offs that should be avoided. Best practices for improving digital presence include maintaining an updated and consistent visual presence featuring current and consistent information across all platforms. Timely and thoughtful responsiveness to complaints is also key, while positive feedback should be encouraged if patients are satisfied. Inactive social media channels should be removed, while a subscription-based social media service can automate posts on all channels. Practices should also strive for website optimization by combining functionality with streamlined, elegant design and modernized technology specifications. Finally, practices should examine their peers' digital presence strategies to gain helpful insights.


Many hindrances can slow the hiring of physicians, with inefficient and error-prone provider credentialing and lengthy onboarding procedures particularly frustrating. One solution can be found in easier and faster credentialing and onboarding processes. An automated credentialing system can streamline the process for physicians by transferring information directly from primary sources like state licensing boards to create a physician profile that can be extended among health system locations. Integrated solutions that facilitate primary source verification from state licensing boards, Drug Enforcement Administration sites, American Medical Association sites and other sources can also lighten the load for staff by automatically updating providers' license and credentialing status. An integrated system that centralizes and simplifies a balkanized and time-consuming process imbues practices with greater transparency, saves time and reduces costs by limiting clerical errors while slashing paperwork.

Health Policy and Reimbursement

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The US Department of Health and Human Services plans to repeal a regulation that would eliminate department rules after 10 years, according to a Federal Register notice. The department finalized that regulation in the waning days of President Donald Trump's term. The policy, which never fully took effect, would have sunset HHS regulations after 10 years unless the department reviewed them and justified leaving them in place. President Joe Biden's administration delayed enforcement of the rule in March; the new HHS notice spells its imminent demise.


In its tenth yearly round of penalties against hospitals with excessive patient readmissions, Medicare is cutting payments to 47 percent of the nation's hospitals, affecting 2,499 facilities. The average penalty is a 0.64 percent reduction in payment for each Medicare patient stay from the start of this month through September 2022. The fines can be heavy, averaging $217,000 for a hospital in 2018, according to Congress' Medicare Payment Advisory Commission (MedPAC). The Hospital Readmissions Reduction Program was created by the 2010 Affordable Care Act and implemented in October 2012. MedPAC has found that readmission rates declined from 2008 to 2017 after the overall health conditions of patients were taken into account.

Medicine, Drugs and Devices

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Amazon announced two new programs that integrate Alexa into hospitals and senior living communities, the company announced today. In hospitals, the Alexa Smart Properties program lets nurses communicate with patients through the calling and intercom-like drop-in features without having to enter patient rooms. Patients could ask questions, or nurses could check on how someone is feeling through the feature. For senior living communities, Amazon Echo devices could be used to send announcements or other messages to residents’ rooms. Residents can also place calls through Alexa to family members or friends without having to rely on a staff member.


Along with its UK and Canadian counterparts, the US Food and Drug Administration (FDA) released a list of "guiding principles" aimed at helping promote the safe and effective development of medical devices that use artificial intelligence (AI) and machine learning (ML). The FDA noted that AI and ML technologies have the potential to radically expand the healthcare industry but their complexity also presents unique considerations. The 10 guiding principles identify points at which international standards organizations and other collaborative bodies could work to advance the initiative.


The US National Institutes of Health (NIH) and Food and Drug Administration have partnered with 10 pharmaceutical companies and five nonprofit groups to help speed the development of gene therapies. The new Bespoke Gene Therapy Consortium, part of the NIH Accelerating Medicines Partnership program and project-managed by the Foundation for the National Institutes of Health, seeks to optimize and streamline the gene therapy process. "Most rare diseases are caused by a defect in a single gene that could potentially be targeted with a customized or 'bespoke' therapy that corrects or replaces the defective gene," said NIH Director Francis S. Collins. "There are now significant opportunities to improve the complex development process for gene therapies that would accelerate scientific progress and, most importantly, provide benefit to patients by increasing the number of effective gene therapies."