News From ACFAS

---

Become a coding pro in Austin with the College’s newest Annual Scientific Conference pre-conference course—Coding Fundamentals set for February 23 in Austin!

Hear from the experts as they explain the foundation of the coding and billing process exclusively for the foot and ankle surgeon, The course is perfect for those new to coding or for those who want to brush up on their coding knowledge. Plus, residents can take the 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. As part of the Joint Task Force of Orthopaedic and Podiatric Surgeons, ACFAS made efforts to gain access for podiatric medical students and graduates of podiatric medical schools to the US Medical Licensing Examination (USMLE). These efforts included the white paper published this spring and a resolution submitted to the AMA House of Delegates. They also included some direct conversations with the National Board of Medical Examiners (NBME).

To our surprise, without any follow-up discussion with members of the task force, the NBME recently sent a letter declining the Task Forces’ request.

ACFAS is reviewing the response and will discuss how to move forward with input from our members and the task force. While we believe that NBME is not fully aware of the level of education and training podiatric physicians have achieved, ACFAS is taking into consideration the many options for achieving parity moving forward along with the interest and support of the membership. The not-to-be-missed Residents Day is back for ACFAS 2022! Head to Austin a day early to hear from experienced foot and ankle surgeons who will provide tips from finishing residency strong to transitioning to a successful practice.

Residents Day is the place for real-world advice and wisdom to help you tackle the end of residency. You will also get an understanding of the ins and outs of CPME’s 320 Standards, skills for conflict resolution and advice on dealing with issues of harassment and give insight on how to establish work/life balance.

The program also gives you the tools to help with post-residency life such as promoting yourself properly, illustrating the importance of proper documentation and informed consent and give you advice on how to find a job.

Plus, don’t forget to stay for the afternoon session – Coding Fundamentals – where you’ll learn the foundation of the coding and billing process from expert colleagues. Special bundle pricing for both programs is available. Visit acfas.org to learn more and register today! The College’s annual Residency Directors Forum is back for ACFAS 2022 in Austin! Co-sponsored by the Council of Teaching Hospitals (COTH), this year’s forum is happening Wednesday, February 23 from 1-5:30pm.

This year’s line up will include various topics to assist resident educators in optimizing their resident review and oversight such as milestones, resident remediation and resident burnout. The day will continue with tips to teach the teachers, like why good documentation is important and a primer on Sim Labs and virtual education options. The day will end with a session on program mergers and acquisitions and updates from an A to Z list of resident education stakeholder organizations.

The Forum is complimentary for all residency directors, faculty and program coordinators (up to two representatives from each program), fellowship directors and school Deans. Registration is open now, so visit acfas.org to save your spot today.

Foot and Ankle Surgery

---

New research sought to characterize the effect of the arthroscopic suture-bridge repair technique on the avulsion of the talar insertion among 122 patients who had recurrent ankle sprain. Eleven patients with this injury were diagnosed and treated with the aforementioned procedure, with clinical outcomes assessed using the Karlsson-Peterson score, the American Orthopaedic of Foot and Ankle Society's (AOFAS) ankle and hindfoot score, the Sefton articular stability scale and the Visual Analog Scale (VAS). Average value of the follow-up time was 30 months. The median value of the Karlsson-Peterson score, AOFAS ankle-hindfoot score and VAS at final follow-up was 90, 90 and 1, respectively. Ten cases were in the excellent or good category based on the Sefton stability scale. No wound infections and no neurovascular injuries were observed, nor was revision surgery necessary. Just one patient complained about mild local irritation at the knotless anchor site.


A study measured and visualized degenerative patterns of the distal tibia and fibula caused by unilateral varus ankle osteoarthritis (OA). Computed tomography images of both feet of 33 patients, 22 with OA and 11 controls, found statistically significant surface depression of about 2.5 millimeters on the anterior articular surface of the medial malleolus and surface elevation of approximately one millimeter on the anterodistal edge of the tibiofibular joint and the lateral malleolus in OA patients. These degenerations correlated with those on the other side of the ankle joint, the medial margin of the talar trochlea and the lateral articular surface of the talus, respectively. However, the amount of bone depression on the plafond was smaller than previously expected. Such data on stereotypical patterns of bone degeneration in ankle OA would inform the comprehension of ankle OA development and possible therapeutic interventions.


Modified Mini-open repair and percutaneous repair of acute Achilles tendon rupture were compared. Between January 2016 and November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment and control cohorts. Subjects were then treated with different surgical techniques and followed up for at least 24 months. The Mini-open repair group exhibited reliably higher American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score and Achilles tendon Total Rupture Score than the control group in functional assessment. No cases of sural nerve injury were seen in the Mini-open repair group, whereas the percutaneous repair group had five cases. Differences between the calf circumference, range of motion of the ankle or wound complications between the two groups at the end of the follow-up time were insignificant. However, the percutaneous repair group had a shorter average operating time compared to the Mini-open repair group. The Mini-open repair system may represent a superior surgical procedure.

Practice Management

---

Practices wishing to implement an effective cell phone policy for employees should consider a number of strategies. Common provisions include forbidding cell phone use in front of patients, at the front desk or in patient areas; only allowing usage in the break room/outside the practice/in a designated area and disallowing the use of cell phones on the clock, except during designated breaks. A separate policy on photos is likely necessary. Practices should also have an employment law or human resources expert on hand to draft and periodically review federal, state and local policies on cell phones. Overregulating cell phone use on breaks should be discouraged to avoid unwanted scrutiny from the National Labor Relations Board, while all employees should be retrained on Health Insurance Portability and Accountability Act bans against sharing patient information or photos through cell phones, social media and/or online every year. Practices must be cognizant of the technology- or device-related policies they must comply with, as well as appropriate enforcement and disciplinary actions for specific violations.


Owning a medical practice building can be a financial windfall as rental fees can boost net worth, facilitating a new revenue stream without assuming additional overhead. Practices will usually be told to form a Limited Liability Company (LLC), and the practice entity can pay the LLC for rent and operating costs, allowing the owner to save on taxes as they would if they were paying an external landlord. The LLC holding the property can also write off many other additional costs—like mortgage interest, property taxes, repairs, maintenance, cleaning fees and landscaping—and lower the LLC's tax liability from the earned rental income; the LLC can also depreciate the building and other major improvements to reduce liability further. Owning the property can also give the owner a retirement/exit strategy, with selling the building to the practice buyer either by cashing out or using the 1031 exchange and purchasing another similar property one option. Losses from real estate activity can also be used to offset the owner's income for tax purposes, although such losses are only acceptable up to $25,000, and if the owner has participated significantly in the management decisions of the building. Finally, cost segregation can boost cash flow by expediting depreciation.

Health Policy and Reimbursement

---

In an effort to halt the Biden administration's COVID-19 vaccine mandate for healthcare workers, 10 states filed a lawsuit in US District Court in eastern Missouri. The lawsuit asserts that the US Occupational Safety and Health Administration lacks the authority to dictate such policy, and that US Centers for Medicare and Medicaid Services' rule issued last week "threatens with job loss millions of healthcare workers who risked their lives in the early days of the COVID-19 pandemic to care for strangers and friends in their communities." The states also warn that any additional job losses in the sector will put patients at risk and cause "devastating adverse effects on healthcare services." The Biden administration's mandate sets a deadline in January for all 17 million healthcare workers nationwide to be fully vaccinated at healthcare facilities that receive government funding under Medicare or Medicaid. Employees of hospitals, nursing homes and other medical sites would not have the option of testing instead of getting vaccinated.


A new Kaiser Family Foundation survey found that getting family health insurance on the job now costs workers and their employers more than $22,000 a year on average. Employees are responsible for about $6,000 of the tab, while companies pick up the rest. The survey found that the average annual premium rose 4 percent this year to $22,221, while the average annual premium for a single staffer in 2021 reached $7,739, also up 4 percent. Individual workers pay about $1,300, and employers cover the remainder. Roughly 155 million Americans rely on employer-sponsored coverage, and they are paying more than they were a decade ago. The average family premium has increased 47 percent, more than wages or inflation, which rose 31 percent and 19 percent, respectively, Kaiser found. Meanwhile, the average deductible is about $1,669 among workers subject to an annual deductible, about the same as last year but up 68 percent over the past 10 years.


The US Supreme Court is considering a case that could lead to major changes in how health coverage works in the country. The case, CVS Pharmacy v. Doe, involves patients with HIV who say a health plan's prescription benefits rules discriminate against enrollees with disabilities. The patients assert that having HIV is a disabling condition, and that health plan specialty pharmacies' use requirement interferes with their ability to have "meaningful access" to treatment for HIV because of a restriction that is not imposed on people seeking other types of drugs. The patients contend they can sue if a health insurance plan's rules have a "disparate impact" on people with disabilities, even if the plan's terms and conditions appear to be neutral toward people with disabilities. Section 1557 of the Patient Protection and Affordable Care Act prohibits disability-based discrimination at federally funded health programs.


University of California, San Diego Professor Richard Kronick said moving seniors to Medicare Advantage (MA) plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare. According to his study, Medicare overpaid private health plans by $106 billion-plus from 2010 through 2019 because of how they charge for sicker patients, with almost $34 billion incurred in 2018 and 2019. "It's hard to miss the big red flag that Medicare is grossly overpaying these plans when you see that beneficiaries have more than 30 plans available in their area and are being bombarded daily by TV, magazine and billboard ads," notes West Health's Cristina Boccuti. But opposition to cutting MA payments is stiff, with 13 senators recently claiming they "could lead to higher costs and premiums, reduce vital benefits and undermine advances made to improve health outcomes and health equity" for enrollees.

Medicine, Drugs and Devices

---

The novel legal strategy widely employed against opioid makers was rejected recently by a California trial judge and by the Oklahoma Supreme Court. Both decisions found no merit to the plaintiffs' core argument that, under state law, the drugmakers created a "public nuisance" by overplaying the benefits of their opioid products and downplaying the risks. The rulings call the legal strategy into question and provide ominous indicators for upcoming trials. The public nuisance approach became the foundation for more than 3,000 lawsuits against drugmakers nationwide. Jury trials are currently underway in New York and Ohio, while a federal judge's decision is pending in West Virginia. The rulings could also impact ongoing settlement talks, suggested Adam Zimmerman, a law professor at Loyola Law School in California. "If this keeps up across the other jurisdictions, it could really shift the ground in ongoing settlement talks," Zimmerman said.


Robert Lodder, a professor at the University of Kentucky's School of Pharmacy and a biopharmaceutical entrepreneur, is turning his passion for video gaming into a powerful tool to identify defective and dangerous drugs. Lodder has created a video game to help hospitals and pharmacies ferret out shoddy drugs. The idea is to recognize patterns that may signal foul play within the drug industry. "The government's been doing this for a long time," Lodder said. "It goes back to Rand Corp. and war games, but nobody's done it for the pharmaceutical industry." The videogame relies on inputs from real world experience including one gleaned from another project Lodder helped to develop. As part of that other project, pharmacy students run quality tests on drugs that come through the university's hospitals and clinics under the University of Kentucky healthcare system umbrella. Examples of quality measures include whether a medication contains all the ingredients a company claims and whether it harbors impurities that could signal contamination. The game is still in early beta form but it will help Lodder’s pharmacy students prioritize which drugs to test in real life since analyzing everything that comes through the university's healthcare system is not feasible.