News From ACFAS

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Watch your email this Friday, December 11 for an email providing your unique link to vote for the ACFAS Board of Directors. Two three-year terms will be filled. ACFAS Fellows, Associates, and Emeritus members are eligible to vote. Voting will close at 11:59pm ET on December 28.

The email will come from acfas.ballot@intelliscaninc.net. If your email system blocked the test email from our election company, your voting instructions were sent by US mail. Only a few days left to get ahead of the 2021 coding and billing changes with ACFAS OnDemand! Don't miss out on the valuable coding and billing information you need for the new year.

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

You have until December 15 to 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.

Share this with 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. Have you visited the ACFAS Marketing Toolbox recently? There are two new member-exclusive PowerPoint presentations ready for you to educate patients and promote your practice—Charcot Foot and Ankle and Broken Bones in the Foot and Ankle–Treat or Not?

Charcot Foot and Ankle gives background on this degenerative condition, symptoms and risks for developing it and how it’s diagnosed. Broken Bones in the Foot and Ankle covers different types of fractures and their treatments, common fractures and the importance of early treatment.

Both presentations were created for you to use as you wish—whether it’s in your office or in the community for patient education, as slideshows in your practice waiting room, shared on your social media accounts or presenting at a community health event. They’re freely available for you to use whenever you need more educational resources.

Get the newest additions to the library today by visiting the Marketing Toolbox at acfas.org/Marketing. Here you can also access the full PowerPoint library and countless other resources available to promote your practice and educate patients throughout the year.

Foot and Ankle Surgery

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Methods for detecting impaired microvascular vasodilatory function in patients with diabetes may have the potential to identify sites at risk of ulceration prior to clinically identifiable signs. Spatial frequency domain imaging (SFDI) uses patterned near-infrared and visible light spectroscopy to reveal distinct microcirculatory and oxygenation changes that occur prior to neuropathic and neuroischemic ulceration. In this study, 35 patients with diabetes mellitus and a history of diabetic foot ulceration were recruited for monthly imaging with SFDI. Two patients who ulcerated during the year-long longitudinal study were selected for presentation of their clinical course alongside the dermal microcirculation biomarkers from SFDI. One patient developed a neuropathic ulcer portended by a focal increase in tissue oxygen saturation and decrease in superficial papillary hemoglobin concentration three months prior. The second patient developed bilateral neuroischemic ulcers showing decreased tissue oxygen saturation and increased superficial papillary and deep dermal reticular hemoglobin concentrations.


Researchers compared duration of surgery, length of stay and rates of postoperative adverse events in patients undergoing open reduction internal fixation of ankle fracture using spinal versus general anesthesia. The study included 10,795 adult patients who underwent open reduction internal fixation of a closed ankle fracture from 2012. Of the patients included, 9,862 (91.36 percent) received general anesthesia and 933 (8.64 percent) received spinal anesthesia. Using propensity-scored matching, 841 patients in the spinal cohort were matched to 3,364 patients in the general cohort. Spinal anesthesia was associated with increased length of stay. There were no differences in the rates of major/minor complications, mortality, transfusions, unplanned readmissions or duration of surgery.


The study evaluated the role of blood parameters in detecting complications in patients with diabetic foot osteomyelitis (DFO). A cross-sectional prospective study was carried out with 116 DFO patients, among whom 85 (73.3 percent) developed complications. Researchers investigated the association between the values of various blood parameters and the onset of complication events. They found that higher values of lymphocytes and albumin were predictive factors at the 12-month follow-up once the ulcer had healed. Higher values of erythrocyte sedimentation rate had predictive and diagnostic value for the onset of complication events, and higher values of C-reactive protein and hyperglycemia were diagnostic factors as they were elevated during the occurrence of an event.

Practice Management

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A panel advising the US Centers for Disease Control and Prevention (CDC) voted to give healthcare workers and long-term care facility residents the first COVID-19 vaccine doses when they are cleared for public use. The CDC's Advisory Committee on Immunization Practices estimates there are roughly 21 million healthcare workers and 3 million long-term care facility residents nationwide. Dr. Nancy Messonnier at the CDC's National Center for Immunization and Respiratory Diseases said most states and local jurisdictions expect to vaccinate all of their healthcare workers within three weeks. The vote comes as states prepare to distribute the vaccines, potentially within weeks. Moderna and Pfizer have both requested emergency clearance from the US Food and Drug Administration. States don't have to follow the CDC's guidance, but it gives them a framework to work with, says Dr. Karen Landers at the Alabama Department of Public Health.


The article discusses best practices for onboarding new locum tenens physicians. There are four key players in making onboarding the best it can be: the employer, their recruiter or HR person, the physician's recruiter (if there is one) and the physician themselves. It is critical that these parties communicate effectively. For the employer, the most important detail to establish is the need for their practice, which will drive the kind of support they will need and for how long. Next, it's critical employers be able to share how many patients or how many shifts the physician needs to cover, how much support they are going to need and what other resources they may require to do the job efficiently while they are there. For the client representatives and the physician's recruiter, they need to establish all of the above but also housing needs, travel/relocation needs and vehicle needs for the physician. For the physician it is best to have an interview with the office/practice manager and the medical director of the facility.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) released its 2021 Medicare physician fee schedule rule. The changes it made further cement the use of telehealth in Medicare, as well as certain reporting changes to the Medicare Shared Savings Program. The final rule permanently allows Medicare providers to use telehealth to carry out home visits for evaluation and management services and some visits for people with cognitive impairments. It also temporarily continues telehealth services for emergency department visits and other services. At the same time, CMS finalized plans to align quality measurement standards in the Medicare Shared Savings Program with those in the Quality Payment Program. CMS also went forward with modifying quality measurement in the Accountable Care Organization program. CMS also lowered the fee schedule's conversion factor from $36.09 to $32.41.


The US Centers for Medicare and Medicaid Services (CMS) has released the proposed annual Notice of Benefit and Payment Parameters for the 2022 benefit year. The proposal includes lowering exchange user fee that issuers must pay from 3 percent to 2.25 percent of premium, and it will also allow issuers to pass on these savings to consumers. To lower premiums further while promoting program integrity, the rule also proposes to require State-based Exchanges to verify eligibility for special enrollment periods. The CMS rule also proposes various updates to the risk adjustment model, looking to improve its predictive power.


A new order in Canada prohibits bulk exportation of certain medications in cases in which a domestic shortage would be created. Canadian Health Minister Patty Hajdu explained, "Certain drugs intended for the Canadian market are prohibited from being distributed for consumption outside of Canada if that sale would cause or worsen a drug shortage. Companies will now also be required to provide information to assess existing or potential shortages, when requested and within 24 hours if there is a serious or imminent health risk." The order, which took effect on November 27, responds to a move by the Trump administration to allow Americans to import some prescription drugs.

Medicine, Drugs and Devices

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To encourage the development of novel drug development tools (DDTs), the US Food and Drug Administration (FDA) said it will test its new Innovative Science and Technology Approaches for New Drugs (ISTAND) program. FDA intends to provide developers with early feedback on proposed DDTs that are "out of scope for existing DDT qualification programs" and provide a path to qualification or other outcomes when qualification is not appropriate. Examples of potential DDTs suitable for the ISTAND program include clinician-reported outcomes (ClinROs), patient-performed digital photography and the development of novel nonclinical pharmacology/toxicology assays. Other potential DDTs my include the use of "tissue chips" to assess safety or efficacy questions and the use of artificial intelligence to evaluate patients, develop novel endpoints or inform study design. DDTs regarded as appropriate for qualification will go through a three-step qualification process before being qualified for use by other drug development programs within the qualified context of use.


Federal officials are counting on pharmacists to undergo additional training and help reverse the slump in child immunization rates caused by the coronavirus pandemic. Fears over COVID-19 have led parents to avoid the doctor’s office and pediatricians to curtail in-person care. As a result, many children are missing routine vaccinations. In August, HHS took steps to override restrictions in many states that kept state-licensed pharmacists from immunizing children. However, challenges remain in getting pharmacists fully integrated into the nation’s framework of childhood vaccinations, immunization experts said. A key issue is that few pharmacists participate in the Vaccines for Children (VFC) program, a federal initiative that purchases vaccines for the nation’s neediest kids. One-half of children in the United States receive immunizations through the program. Compared with last year, VFC-funded orders for vaccines overall are down 9.6 million doses as of November 9.


Hospitals in large metropolitan areas have largely stabilized their supply chains for masks and other personal protective equipment (PPE), but facilities and communities that serve vulnerable populations are still struggling to get what they need. They are turning to grassroots networks that mobilize manufacturers, logistics experts and other entities to help fix the PPE shortage. An analysis by the nonprofit Get Us PPE reveals that in October, more than 90 percent of PPE requests it received were from such facilities as homeless shelters, natural disaster relief groups and nurses’ offices in schools. Smaller hospitals are also struggling.