News From ACFAS

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Watch your email this Friday, December 6 for the email providing your unique link to vote for the ACFAS Board of Directors and Bylaw Amendments. Voting member classes eligible to vote are: Fellows, Associates, Emeritus and Life Members. The email will be sent by our independent voting company from the email acfas.org@inteliscaninc.net.

Eligible members will be able to vote to fill two, three-year terms and one, two-year terms on the ACFAS Board of Directors as well as proposed bylaw amendments. Voting will close at 11:59 pm on December 22. The ACFAS Board of Directors is pleased to welcome Patrick (PJ) Andrus, CAE, as the new executive director. Andrus will officially take the reins on March 1, 2020, replacing retiring Executive Director J.C (Chris) Mahaffey, MS, CAE, FASAE. Andrus will attend the 2020 Annual Scientific Conference on February 19-22 in San Antonio.

“We are very excited to welcome PJ to ACFAS as the next executive director,” Christopher Reeves, DPM, MS, FACFAS and president of the ACFAS Board of Directors, said. “His expertise and background will be a great asset to help us lead the College into the future,” he added. “I’d also like to thank Chris Mahaffey for his almost 17 years of dedicated service to the College and congratulate him on a well-deserved retirement.”

Andrus comes to the College from the Veterinary Emergency and Critical Care Society (VECCS) where he served as the CEO. Prior to VECCS, Andrus spent 13 years at the American Hospital Association (AHA) in various roles with the most recent as the Executive Director of the American Society for Health Care Engineering of the AHA, an organization dedicated to representing 13,000 hospital engineering professionals.

“I am thrilled to join the ACFAS community. It is an honor to succeed Chris Mahaffey and serve as the next Executive Director of an organization with such a rich history and important mission. I am eager to get to work with the Board of Directors, volunteer leaders and the ACFAS team to support the needs of our members and the patients they serve,” Andrus, said.

Andrus earned his Certified Association Executive (CAE) from the American Society for Association Executives in 2013. He completed is MBA from DePaul University – Charles H. Kellstadt Graduate School of Business (Chicago) in 2011 and his Bachelor of Science degree in marketing with a minor in finance from the University of Dayton (Dayton, Ohio) in 2003. Don’t wait another minute! Register now to save $90 and secure your spot at the most anticipated event in the profession and surgical specialty—ACFAS 2020!

Join us in San Antonio February 19-22, 2019 for the #1 rated foot and ankle surgical conference. Learn the latest advances in foot and ankle surgery, connect and collaborate with fellow surgeons and reignite your passion for your profession! Consider coming a day early for one of this year’s pre-conference workshops. Early-bird registration ends December 12, 2019.

Visit acfas.org/sanantonio and join 1,900+ of your peers and colleagues in San Antonio to experience that true Texas charm! Are you looking to hone your public speaking skills? Speaking coaching sessions are now being offered at ACFAS 2020 in San Antonio.

These informal coaching sessions are the perfect opportunity to get one-on-one training and tips. Learn old tricks and new methods to speak confidently and command any audience whether it’s a College event, at your hospital or community health events.

Sign up to get the tips and tools that will take your speaking skills to the next level! Contact Mary Meyers at mary.meyers@acfas.org for more information.

Foot and Ankle Surgery

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The Ponseti method has had strong outcomes in treating idiopathic clubfoot. Most previous studies evaluated the process of serial casting by using the number of casts required to achieve correction, but difficulties that occurred during serial casting were rarely studied. The present study reviewed 47 patients with severe idiopathic clubfoot and a follow-up period of about four years by focusing on difficulties during the Ponseti casting and their related factors. All events requiring temporary discontinuation and/or delay of scheduled casting were considered difficulties.

Difficulties occurred in 18 patients, and those patients had greater initial Dimeglio scores, shorter foot length and more casts on average than the remaining 29 patients. In the regression analysis, both subcomponents of equinus and foot length showed the significance for the occurrence of difficulties. During the roughly 8.7 years, further surgery was needed in 35 patients because of residual or recurrent deformity, and the ratio was higher in patients with difficulties.


Researchers compared two different surgical techniques of plantar fasciitis surgery. Forty-eight patients who were diagnosed with plantar fasciitis and treated conservatively for at least six months with no response were involved in the study. Patients were randomly assigned to endoscopic plantar fascia release (EPFR group) or cryosurgery (CS group), then evaluated using American Orthopaedic Foot and Ankle Society ankle/hindfoot scale (AOFAS-AHS) at baseline, three weeks, three months, six months and 12 months post-surgery. Patient satisfaction was determined at the final follow-up appointment using the Roles-Maudsley score.

Out of the 43 patients who completed the one-year follow-up examination, patients undergoing EPFR had significantly greater AOFAS-AHS scores after three months post-operative. The success rate in the EPFR group at month 12 was 87 percent compared to 65 percent for the CS group. The study associates both EPFR and CS with statistically significant improvements at one-year follow-up, but after three months postoperatively, EPFR was associated with better results and higher patient satisfaction rates than CS.


Researchers aimed to identify common errors in ankle X-ray reporting between initial interpretation and final assessment at the virtual fracture clinic and to assess time of initial reporting as a causative factor for discrepancy. The researchers reviewed 2,947 reports by standard of agreement to initial interpretation. Where discrepancy was found, it was classified and collated by specific finding, and comparison was made between reports with discrepancy and the complete dataset to establish rates of error by finding. Reports containing discrepancy were further classified time period and compared against an established value to establish if initial reporting outside of routine working hours was as accurate as that conducted within routine working hours.

Out of the reports reviewed, 94.4 percent were in agreement with the initial interpretation, 2.9 percent contained minor discrepancy, and 2.7 percent contained major discrepancy. There was no radiologically observable injury in 45.6 percent of reports, and 16.4 percent of reports contained a lateral malleolar fracture. Forty percent of all navicular fractures and 33.3 percent of all cuboidal fractures were not commented upon in the initial reporting. An increased proportion of major discrepancy reports were generated from 00:00 to 07:59, and a greater than expected number of minor discrepancy reports were found between 20:00 and 23:59.

Practice Management

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Certain specific tax strategies are heavily marketed to physicians, often with significant time pressure towards the end of the year. One basic rule to keep in mind is that using legal means to pay the minimum amount of taxes allowed is a business necessity in the current provider compensation environment. Moreover, even plans that are based on sound legal principles and current tax law carry significant risk if they are abused and lack compliance in how they are actually sold and implemented.

Providers should also be wary of affinity fraud, intentional or not, wherein someone peddles incorrect information. Anyone suggesting that, for example, you can "opt-out" of the tax system by transferring assets to their tax-free trust, should be immediately removed from the advisory team. Finally, remember that due diligence on your tax plan and your adviser is a vital first line of defense.


Home medical technology, which includes technology such as email and patient portals, consumer wearables, virtual care offerings and remote patient monitoring, will be a $30 billion industry by 2025. Home technology is often touted as a way to scale the efforts of a healthcare provider to manage multiple patients remotely, but providers and health systems should put their patients' diverse needs above all else. For example, an online scheduling app may appeal to busy young people but fall flat with elderly patients. At the same time, making decisions based on just who is using the technology may lead to missed opportunities for patient engagement.

Consider whether the home technology is being "pushed" on patients or "pulling" them in and treat technology as an extension of how the provider personally delivers care. Moreover, keep in mind that the needs of specific communities will vary, and simply offering technology to all patients will not solve poverty-related barriers to care. Review the literature on home technology and regulatory trends around it, which are generally supportive but worth understanding.


United Parcel Service Inc. (UPS) plans to launch a service that uses sensors and data analytics to track medical packages' exact location in near-real time. The service, UPS Premier, will prioritize the handling of medical shipments to ensure that packages arrive at exactly the right time and place. Sensors on the packages will let UPS staff know where they are at any given time, instead of relying at a few points throughout the delivery cycle.

The new service is the latest example of how technology is being used to improve the complex healthcare supply chain, which often involves packages that are temperature-sensitive and can expire quickly. For example, FedEx Corp. has a healthcare-focused logistics service called SenseAware that customers can use to monitor location of shipments, as well as keep track of the precise temperature, light exposure and barometric pressure. The need for precision logistics has increased because of a growing older population and trends toward personalized health.

Health Policy and Reimbursement

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The U.S. departments of Health and Human Services, Labor and the Treasury have suggested a rule that would require employer-sponsored group health plans to provide plan enrollees with estimates for their out-of-pocket expenses for services from different health care providers. The proposal is part of the Trump administration's attempt to create price competition in the health care marketplace. Among other obligations, group health plans and health insurance carriers would be required to make out-of-pocket costs for all covered items and services available through a self-service website and to make negotiated in-network rates publicly available.


The federal government recently redesigned a digital tool that helps seniors navigate Medicare choices, but consumer advocates say the tool often provides inaccurate cost estimates and is causing problems for some states during the open enrollment period. Alicia Jones, administrator of the Senior Health Insurance Information Program in the Nebraska Department of Insurance, says she has flagged roughly 100 errors with the new tool since October 1, some small but others more significant.

For instance, Jones found that the tool failed to import the correct quantity of drugs, specifically with tubes of medication. The tool was citing more medicine than needed, "so if you didn't look at it close, it would give very high prices," she says. At one point, the figures for someone she was helping enroll in a prescription drug plan were off by $2,000, so the tool was no longer being used as of October 28 to better assess the situation, according to Jones.

Medicine, Drugs and Devices

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Google has revealed that it is testing its new electronic health record (EHR) search function that will allow medical providers to search the medical record for specific information. The search technology will let providers find individual pieces of medical information in their EHRs, making these tools more usable. Earlier this year, University of New Mexico researchers found that nearly 40 percent of clinician burnout can be credited to unworkable EHRs.

Google's EHR search tool is still in the pilot testing phase but aims to bring the company's user experience expertise to EHRs. Google also recently addressed the patient privacy questions that have followed it in the weeks since announcing a partnership with Ascension. Google outlined the business associate agreement (BAA) established between Google and Ascension and said that because of HIPAA regulations, Google cannot and will not use patient data for any type of advertisement. Google has also established guidelines for any of its employees that may need to come into contact with identifiable patient data as a part of developing the Google Health suite.


According to a recent analysis of U.S. Centers for Disease Control and Prevention (CDC) data from 2015 to 2017, antibiotic-resistant healthcare-associated infections (HAIs) were more often from using temporary medical devices than from surgical procedures. The CDC study, published in Infection Control & Hospital Epidemiology, examined several kinds of limited-use devices at acute-care hospitals and inpatient rehabilitation facilities. It found that antimicrobial resistance was higher for device-associated HAIs than for the same bacteria identified after surgical procedures in all phenotypes analyzed except CRE E. coli. The three most frequently reported pathogens were E. coli at 17.5 percent, Staphylococcus aureus at 11.8 percent and Klebsiella at 8.8 percent.


Diabetes, when poorly controlled, can affect many key bodily systems and have costly, life-disrupting and even fatal consequences. Especially when inadequately controlled, type 1 and type 2 diabetes can harm the heart, kidneys, eyes and nerves. Still, a recent study found that many people with diabetes do not adequately control the four major factors that increase the risk of serious complications: blood glucose, blood pressure, blood cholesterol and smoking. Experts note that insurance is a big obstacle for many people who need to keep their diabetes under control—many necessary medications are financially out of reach, and policies often do not cover consultations for diet and exercise, which can reduce the need for some medications but may require more than the 15-20 minutes allocated for a doctor visit.

The study, which was published in JAMA Internal Medicine in October, looked at data from the National Health and Nutrition Examination Survey for 1,742 nonpregnant adults with known diabetes and 746 adults with diabetes that had not been previously diagnosed. The study found that while 94 percent of those with known diabetes were receiving care for their disease more than 75 percent did not meet all four treatment goals set by the American Diabetes Association. Furthermore, the researchers found there has been little improvement in the diagnosis or treatment of diabetes from 2005 through 2016.