News From ACFAS

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There’s a new way to educate patients—ACFAS Animation Videos are here! First up in the video library is Foot Care for Those Living with Diabetes, released just in time for National Diabetes Awareness Month this month.

The colorful, cleverly animated video is a great resource for patients dealing with diabetes and offers foot care tips, condi­tions to watch out for and how to check feet for any issues that may cause complica­tions if not treated early.

Share these valuable, easy-to-follow animated patient education videos with your patients during their visit, on your website or on your social media sites to explain some of the most common instructions you give in each visit.

Visit acfas.org/Marketing to download the new video now and keep checking back for more in the animation video series. Next up will be Post-Operative Care Instructions, which includes crutch use! Get the scoop on the 2021 coding and billing changes now on ACFAS OnDemand! While decision was made to cancel December's in-person Coding and Billing Course to ensure attendees' safety, it doesn't mean you have to miss out on the valuable coding and billing information you need for 2021.

Coding and Billing for the Foot and Ankle Surgeon Virtual Course
Available November 15-December 15, 2020
Fees: ACFAS Member $395 | Non-ACFAS Member $500
8 Continuing Education Contact Hours for viewing the entire program and answering questions

For a limited time, access this virtual course at your convenience for expert tips and insights on simplifying your coding and reimbursement practices. The course also covers timely topics, including telehealth coding and will address coding and billing changes such as coding for prolonged services and several CCI edits relating to foot and ankle surgery.

Grab your coding staff and register today to take advantage of this limited-time OnDemand program! For more information and to view the full agenda, visit acfas.org/PracticeManagement. As residency directors and faculty, do you fully understand all the ins and outs of residency program funding? If you don’t, you’re not alone.

Attend this complimentary webinar on Thursday, December 3 at 8pm CT to learn about topics such as why is it important to track your off-facility training; funding alternatives for faculty; determining if your key attendings should be compensated, and if so, how; and how to earmark CME funding for residency education from GME.

For more information or to register for the webinar, visit acfas.org.

Foot and Ankle Surgery

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The authors describe their experience on the reconstruction of soft-tissue defects of the lower extremity using distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps. Between 2005 and 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. Overall, 47 flaps had survived completely in one stage, while nine developed partial necrosis. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 centimeters, the total length of the flap was shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from three centimeters to six centimeters and was greater than three centimeters in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top edge located in the eighth zone was significantly lower than that in the ninth zone.


The study assessed the impact of a diabetic foot ulcer prevention program incorporating once-daily foot temperature monitoring on hospitalizations, emergency department and outpatient visits. It also measured rates of diabetic foot ulcer recurrence and lower extremity amputations for patients with recently healed foot ulcers. The retrospective analysis included 80 participants with a healed diabetic foot ulcer in a year-long foot ulcer recurrence prevention program across four outpatient centers within a large integrated healthcare system in the United States. Unadjusted data showed high initial rates of resource utilization and recurrence before enrollment in the program, followed by lower rates during the program, higher rates of resource utilization and similar rates of recurrence in the period following the end of the program. The adjusted data showed lower rates of hospitalizations, number needed to treat, lower extremity amputations and outpatient visit during the program. There were also lower rates of foot ulcer recurrence during the program in the adjusted data, particularly for wounds with infection or greater than superficial depth.


The study investigated the outcomes following minimally invasive medial displacement calcaneal osteotomy (MDCO) for correction of pes planovalgus deformities. The study included 160 consecutive patients who underwent 189 minimally invasive MDCO procedures. Osteotomy healing complications were present in 7 percent of cases during the six-year study period. A 12-month case cluster of osteotomy healing complications was observed. Healing complication rates were 28 percent during the cluster and 0.7 percent outside of the cluster. No definitive cause was found for the case cluster. Osteotomy healing complications were significantly associated with higher American Society of Anesthesiologists classification, female sex, current tobacco use and higher body mass index. Healing complications were not associated with osteotomy technique or fixation type. Other complications included wound dehiscence, surgical site infection, transient nerve symptoms and persistent nerve symptoms. Nerve symptoms were significantly associated with an increased number of concomitant procedures.

Practice Management

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The upcoming presidential election poses some non-medical risks that practice managers and owners should consider. Some risks may affect practices based on their physical proximity to sites of potential conflict like a polling place, hospital, government building or any other site that may be considered to be politically charged. Moreover, at least ten states are at elevated risk for militia-related political violence before, on and after election day. A variety of disinformation and conspiracy theories are being promoted across social media, some of which target medical providers and the healthcare industry, creating a physical security risk for both people and facilities. Practices should examine the adequacy of their firearms related risk management policies. They should also review their business loss and liability insurance coverage in all areas including specialized coverage for acts of violence. Practices should be prepared to manage additional, politically motivated aggression and frivolous arguments to be made by those that may be triggered by office safety, screening and mask policies.


The study analyzed patterns in telemedicine use among podiatric physicians during the COVID-19 crisis. Anonymous responses to a survey of practice metrics as well as subjective impressions of telemedicine efficacy were collected from 246 respondents. Physicians in areas of lower COVID-19 prevalence were found to dispense DME more frequently in-office and conduct more post-op telemedicine visits, with fewer visits for infections and trauma. Podiatrists in these regions also rated telemedicine more effective for medical and musculoskeletal pathologies; fewer of their practices had modified office hours, and more of them advertised telemedicine services. Physicians more likely to offer telemedicine post-COVID-19 had significantly higher new patient volume and increased acuity of cases. These physicians ranked the effectiveness of telemedicine more highly for every pathology surveyed. ACFAS region and years in clinical practice were not statistically associated with likelihood of offering telemedicine visits post-COVID-19.


This article covers ways to connect with patients virtually. Two-way texting is critical, as 47 percent of patients say they want the ability to text back and forth with their provider. The use of automated calls or emails to remind patients of care instructions can help reinforce the feeling that providers care about the patient's health. Healthcare organizations should also send out regular educational communication in the form of newsletters or emails. Even automated messages reminding patients of upcoming appointments or overdue bills can deepen a relationship with patients.

Health Policy and Reimbursement

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The Trump administration has finalized new requirements for insurance companies to inform consumers up front about the actual prices for common tests and medical procedures. The intent is to empower patients to become better consumers of health care, which would help drive down costs. However, the requirements would take effect in stages over a four-year period. For instance, starting in 2022, insurers would be required to make available data files on the costs of various procedures and allow technology companies to design apps to allow patients to see costs not only under their plan but also other insurers’ plans. Insurance companies say the rules would hurt their ability to bargain with hospitals, drug companies, physicians and other industry players. The new rules are being issued jointly by the US Health and Human Services Department, Labor Department and Treasury, which share jurisdiction over health insurance plans.


Unions representing nurses and healthcare workers have filed a lawsuit against the US Occupational Safety and Health Administration (OSHA). The lawsuit alleges OSHA’s decision not to set safety standards about infectious diseases violates of a federal law requiring the agency to issue standards for significant health risks. The lawsuit seeks a writ of mandamus, which would require OSHA to fulfill its duties. OSHA has received 9,818 coronavirus-related complaints during the pandemic and issued 112 citations. The CDC reports that 192,000 healthcare workers have been infected with the coronavirus and at least 771 have died. The complaint describes OSHA's efforts to draft a rule for infectious diseases for healthcare facilities, which the Trump administration effectively shelved. Unlike a recently-dismissed AFL-CIO case, which sought a temporary emergency standard, the new lawsuit seeks the resumption of the existing rulemaking process for a new permanent safety standard for healthcare workers.


The US Centers for Medicare and Medicaid Services said Medicare beneficiaries will receive any coronavirus vaccine approved by the US Food and Drug Administration for free. The new policy calls for providers to receive the vaccine at no cost and for Medicare to reimburse for the cost of administering the injection. Additionally, the policy calls for most private health insurance plans as well as state Medicaid agencies to cover a vaccine without cost sharing—at least while the pandemic is ongoing.

Medicine, Drugs and Devices

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The US Centers for Disease Control and Prevention has launched Project Firstline, a national training program designed to help prevent the spread of infectious diseases in US healthcare settings. The training collaborative will support the development and dissemination of Project Firstline’s infection control training and tools for healthcare workers, including training videos, live webinars and telementoring.


The US Federal Bureau of Investigation, Department of Homeland Security and Department of Health and Human Services issued a joint alert on Oct. 28 stating that they had "credible information of an increased and imminent cybercrime threat to US hospitals and healthcare providers" in an effort to cause "data theft and disruption of healthcare services." The alert comes amid a spike in cases of COVID-19 nationwide. At least five US hospitals were hit by the ransomware attacks recently. The attacks, by an Eastern European criminal gang, identified as UNC1878, involve the Ryuk strain of ransomware, which Microsoft has been working to counter. Hold Security's Alex Holden said the cybercriminals are demanding ransoms of more than $10 million per target and have discussed plans on the dark web to attack more than 400 hospitals, clinics and other medical facilities.


The US Centers for Medicare and Medicaid Services is proposing coverage and payment policy changes regarding Medicare's durable medical equipment, prosthetics, orthotic devices and supplies. The proposed changes would widen the definition of when external infusion pumps are suitable for use in the home and can be covered as durable medical equipment under Medicare Part B. The rule also calls for reducing administrative hurdles, including certain coverage, payment and coding processes that prevent innovators from promptly getting their products to Medicare beneficiaries, and would provide more choices for beneficiaries with diabetes