December 15, 2021 | | JFAS | FASTRAC | Contact Us

News From ACFAS

Vote Now for ACFAS Board of Directors
Last Friday, December 10, ACFAS eligible voting members received an email from the College’s independent election firm ( with a unique link to the 2022 Board of Directors Election website. If you are a Fellow, Associate, or Emeritus Member, please take a few minutes to cast your vote for your elected leadership. Your vote is important to advancing our profession and surgical specialty.

If you have not yet voted, two more reminder emails will be sent to you before the election closes on Monday, December 27, 2021. If your email system blocked the test email from our election company, your voting instructions were sent by US mail.
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Don’t Miss Coding Fundamentals
Become a coding pro in Austin with the College’s newest course—Coding Fundamentals. This comprehensive workshop covers the fundamentals of coding and billing for foot and ankle surgeons and explains the foundation of the coding and billing process from expert colleagues. This is a perfect course for those new to coding or for those who want to brush up on their coding knowledge. The course can be taken before the ACFAS Coding and Billing for the Foot and Ankle Surgeon course and will be offered at ACFAS 2022 in Austin as a pre-conference program and prior to any future full ACFAS Coding and Billing for the Foot and Ankle Surgeon courses.

Residents can also take this 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.

Step up your coding game today! Visit to register for this course now.
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ACFAS Meets with Anthem/AIM Regarding Policy Changes
Concerns over updates to the AIM Musculoskeletal Program site of care reviews led ACFAS and fellow Joint Task Force of Orthopaedic and Podiatric Surgeons members the American Podiatric Medical Association (APMA), the American Academy of Orthopaedic Surgeons (AAOS), and the American Orthopaedic Foot & Ankle Society (AOFAS) to meet with Anthem Blue Cross and Blue Shield (Anthem) and AIM Specialty Health (AIM) to discuss the updates, which become effective January 1, 2022.

The changes state that the AIM Musculoskeletal Program will include site of care review in addition to their base program medical necessity review for certain joint and interventional pain procedures for Anthem commercial members in Colorado, Georgia, Indiana, Kentucky, and Ohio. The policy update is available here and codes and clinical guidelines included in the program can be found on the AIM Musculoskeletal Program website. During the meeting, Anthem shared the guideline which informs the policy. Free training sessions to explain the changes are being offered which impacted ACFAS members can utilize.

ACFAS continues to focus advocacy efforts on this change at Anthem and is working with task force partners to ensure that health care payors consider the input of health care providers, and the impact policy changes have on providers and patients.
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The HUB is Back for 2022
What would an Annual Scientific Conference be without the HUB? Our open-space theater and go-to spot on the exhibit floor for interactive learning is back for ACFAS 2022! Here are some highlights to stay tuned for this year:
  • “Let’s Talk”—Lessons Learned from Your Complicated Cases: We all have had complicated cases. Ever wanted to get a second opinion on how others may have handled it? Bring your complicated case to this HUB session to discuss it with our speakers and share it with the group!
  • Balancing Act/Controlled Chaos—Tips for Maintaining a Work/Life Balance: With physician burnout on the rise, it is more important than ever for physicians to manage stress and maintain an appropriate work/life balance. This is a candid discussion on the reality of burnout and physician stress, depression, and anxiety.
  • Developing a Product: You have a great idea for a new product. Now what? In this exciting HUB session, learn from speakers who have been in your shoes. They will share their experiences taking a provisional idea from concept to reality and everything in between!
  • Know Your Worth and When to Make a Move: Thinking about changing jobs? About to renegotiate your contract? Attend this HUB session to learn more about your options, the right time to make a move, and knowing your worth. Panelists will discuss various practice models, red flags to look for in your current employment, and how to approach the difficult conversation of giving notice. Contract review will also be covered, including how to formulate your “ask” and how to negotiate to maximize your potential. This session is not to be missed, especially for residents and young practitioners.
  • Office Emergencies: Are you prepared should a patient emergency occur in your office? This talk is focused on common patient emergencies that may occur in your office and the appropriate treatment and response.
  • Denying Surgery in the Persistent Patient: The best surgeons know when to operate and what the red flags are to be aware of for elective surgery patients.
Don’t miss your chance to engage with your peers on a variety of topics you won’t find anywhere else. Visit for more information today.
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Poster Printing Service for ACFAS 2022!
Poster Presenters – don’t carry your poster to the conference, ACFAS has partnered up with for your poster printing needs. It is a simple and convenient way to have your poster printed with free shipping and ready for pickup on site at the meeting. Visit for more information and fees.
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Foot and Ankle Surgery

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity
A single-center retrospective study conducted from prospectively collected registry data sought to describe intra- and interobserver reliability and the frequency of each class in the new Progressive Collapsing Foot Deformity (PCFD) classification. The researchers assessed a consecutive cohort of PCFD patients from February 2015 to October 2020, including 92 feet in 84 patients. Average sample age was 54.4, while 38 percent of patients were male and 62 percent were female. The most common subclass was 1ABC (25.4 percent), followed by 1AC (8.7 percent) and 1ABCD (6.9 percent). Only a small portion of patients had isolated deformity. Class A was the most common component (89.5 percent), followed by C (86.2 percent). Moderate interobserver reliability was seen for overall classification, and very good intraobserver reliability was noted; close to half (49.3 percent) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B) or with (D) or without subtalar joint involvement (D). The new system may encompass all possible combinations of the PCFD, offering a comprehensive description and guiding treatment in a systematic and individualized manner, although this initial study proposes an opportunity to enhance overall interobserver reliability.

From the article of the same title
Foot & Ankle International (12/01/2021) Lee, Hee Young; Mansur, Nacime Salomao Barbachan; Lalevee, Matthieu; et al.
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Simultaneous Limb Lengthening with Ankle Fusion Using an Internal Lengthening Nail
A review of 18 limbs in 17 patients who underwent ankle fusion with simultaneous tibial lengthening with a magnetic internal lengthening nail was conducted. All patients had preoperative limb length discrepancy (LLD) with ankle deformity, and the ankle was fused from medial or lateral approaches using screws/plate constructs positioned adjacent to the retrograde Precise nail. Lengthening was executed by a distal 1/3 tibial osteotomy, with clinical and radiographic measures performed after a mean follow-up of 20 months. The mean amount of lengthening performed was 4 centimeters while final mean LLD was 1 centimeter deemed statistically significant compared to preoperative. The foot was plantigrade in all cases and the mean foot rotation was 10 degrees external, relative to the knee. All patients disclosed minimal to no pain at final follow-up, and all were walking with more functionally than pre-surgically. Ankle fusion and limb lengthening was realized in all cases. This represents the first report of such a combined treatment of ankle fusion with internal tibial lengthening nail.

From the article of the same title
Journal of Foot & Ankle Surgery (12/03/21) Paley, Dror; Lamm, Bradley L.; Robbins, Craig; et al.
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Treatment, Recurrence Rates and Follow-up of Tenosynovial Giant Cell Tumor of the Foot and Ankle — a Systematic Review and Meta-Analysis
Research characterized different treatment options and surgical complications for tenosynovial giant cell tumor (TGCT) of the foot and ankle, to develop a follow-up regime according to a systematic literature review and meta-analysis. The researchers included 25 studies published between January 1966 and June 2021 covering 382 patients, of whom 212 had a diffuse TGCT (dTGCT) and 170 a localized TGCT (lTGCT). Patients with a dTGCT were 36.6& #177 8.2 years old on average and 55 percent were female. The overall complication rate was 24 percent in dTGCT regardless of therapeutic procedure, and the mean follow-up was 37.9 ± 27.4 months with a recurrence rate of 21 percent. Recurrences occurred between three and 144 months, with most (86 percent) within the first five years post-intervention. Patients with a lTGCT had a mean age of 31.2 ± 5.7 years, and 53 percent were female with complications occurring in 12 percent. The mean follow-up was 51.1 ± 24.6 months, recurrence rate was 7 percent, and recurrence occurred between one and 244 months following intervention. The proposed follow-up regime for the dTGCT includes a clinical survey and magnetic resonance imaging (MRI) three months post-intervention, followed by twice-yearly intervals for the first two years, yearly intervals up to year five and further individual follow-up due because recurrences can even occur for years later. For the lTGCT a clinical survey and MR tomopgraphy is proposed after three to six months after intervention, then annual clinical examination for three years and in case of symptoms MRI.

From the article of the same title
PLOS ONE (12/02/21) Siegel, M.; Bode, L.; Sudkamp, N.; et al.
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Practice Management

A Title Fight Pits Physician Assistants Against Doctors
Physician assistant (PA) Leslie Clayton, who practices at a clinic in Minnesota, wants the term "assistant" removed from her professional title, claiming it causes patients to wrongly assume she is an aide rather than a medical provider. She and other PAs want to be rebranded as "physician associates," with their national group formally changing its name into the American Academy of Physician Associates in May. The group further wants state legislatures and regulatory bodies to legally certify the rebranding in statutes and rules, and estimates the entire cost of revision will total nearly $22 million. Physicians are balking and say some patients will wrongly think a "physician associate" is a junior doctor. The head of the American Medical Association said this "will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice." In addition to the name change, PAs want to eliminate state mandates that they must be formally supervised by physicians or have written agreements with a doctor outlining the PA's role. PAs complain that the title foments discrimination, as in some states doctors must meet regularly with PAs, periodically visit them in person if they work at a different location and review sample patient charts on a recurring basis. States also generally require less oversight for nurse practitioners, increasing their appeal to some employers.

From the article of the same title
Kaiser Health News (12/03/21) Rau, Jordan
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How to Lower Your Monthly Rent During a Lease Renewal Negotiation
Medical practices can position themselves favorably to negotiate a lower monthly rent by not asking the landlord for a proposal. Requesting one would indicate that the tenant does not know the current real estate market and has not performed due diligence, empowering the property owner to dictate terms that could be significantly inferior. The medical provider should secure the services of an expert agent to advise and handle the negotiation process. The adviser would contact the landlord before the landlord contacts the provider and inform them that the company has multiple properties jockeying for the company. The landlord now expects to receive a proposal from the adviser that includes terms that are competitive with what other landlords and property owners are offering. A reduced monthly lease rate becomes the most likely result.

From the article of the same title
Medical Economics (12/08/21) Carr, Colin
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Six Benefits of Using an Electronic Visit Verification App
An electronic visit verification (EVV) app carries multiple advantages for home health organizations and patients, including reduced documentation errors and easier scheduling. An EVV mobile app also can ensure more accurate provider check-in and check-out times, as it automatically timestamps them and confirms if the caretaker arrived at the scheduled appointment time. The result is accurate data for payroll, reimbursements and patient health records. Another benefit is quick, efficient billing for homecare, since EVV allows medical staff to enter their time and patient notes in real time, while instant billing code uploading eliminates processing time delays. Payments can also be accelerated, which can streamline and enhance a home health agency's revenue cycle management and enable faster growth. A sixth benefit of EVV is better patient outcomes stemming from an improved work experience for homecare staff and better patient interactions and experience.

From the article of the same title
Physicians Practice (12/03/21) Al-Maskari, Khalid
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Women Earn $2 Million Less Than Men in Their Careers as Doctors
A survey of more than 80,000 physicians published in Health Affairs found female doctors earn less than males starting from their very first days on the job, amounting to a pay gap of at least $2 million over the course of a 40-year career. The investigators analyzed survey data collected between 2014 and 2019, and lead author and RAND Corporation health economist Christopher Whaley said the pay gap has likely grown since then as the pandemic has forced women to leave the workforce and assume child care and other household responsibilities. In comparing wages between men and women with the same amount of experience, the researchers estimated that, over a simulated four-decade career, male doctors earned an average of $8.3 million while their female peers made about $6.3 million — a nearly 25 percent difference. More men also become surgeons, which earns more money than any other physician specialty, while more women enter primary care. Moreover, women have been shown to spend more time with patients, leading to a lower volume of services and procedures that can be billed for. Salary gaps began at the start of a doctor's career and continued to widen until around the 10th year without recovering, and this gap remained stable for the remainder of their careers, with women never drawing level to men. Whaley said the findings suggest the wage gap could be closed with policy changes that affect younger doctors, like offering more paid family leave and more flexible scheduling.

From the article of the same title
New York Times (12/06/21) Ghorayshi, Azeen
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Health Policy and Reimbursement

Doctors and Hospitals Make Late Bid to Change Surprise Billing Ban
Physician and hospital groups have filed a lawsuit to block part of an upcoming prohibition on surprise medical billing that was scheduled to come into force in January. The American Medical Association, American Hospital Association and a few hospitals and providers filed suit on grounds that Biden administration regulators have wrongly interpreted the law, causing harm to medical providers. The plaintiffs aim to modify how contract negotiations occur between insurers and providers. The lawsuit could potentially impact which hospitals and doctors opt to go in-network with insurers and cause insurance premiums to grow. The law bans surprise bills and prevents physicians from billing patients directly. The lawsuit includes affidavits from two hospital executives who express confidence that the regulations will cause insurers to cancel contracts or demand that hospitals reduce their fees. To win their case, the medical providers have to demonstrate that the Biden administration was "arbitrary" or "capricious" in interpreting the law or lacked statutory authority.

From the article of the same title
New York Times (12/09/21) Sanger-Katz, Margot
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Higher Costs Prompt Patients to Switch From Telehealth to In-Person Care
A study published in JAMA Network Open found patients who favored telehealth visits were more aware of out-of-pocket costs than those who preferred in-person visits, based on the American Life Panel Omnibus Survey of 2,080 RAND American Life Panel members. Roughly 45 percent of participants reported having had one or more telehealth visits with healthcare providers since March 2020, and just 2.3 percent of this number said they were unwilling to use it again in the future. When out-of-pocket costs did not factor into the decision to seek care, 53 percent of respondents said they preferred an in-person visit, 20.9 percent preferred a video visit and 26.2 percent had no preference or did not know. Of the respondents who had participated in a video visit since March 2020, 31.4 percent preferred a video visit, although only 12.2 percent of those without any prior telehealth experience preferred a video visit versus 60.2 percent who preferred an in-person visit. Patients who favored in-person care when cost was not a consideration were offered a scenario in which the cost of an in-person visit was $30, while a video visit was $10; 49.8 percent still preferred an in-person visit and 23.5 percent switched and said they now preferred a video visit. In a scenario when participants who preferred video visits were faced with a more costly video visit than an in-person visit, only 18.9 percent still preferred a video visit, while some 61.7 percent switched and said they would rather have an in-person visit.

From the article of the same title
mHealth Intelligence (12/02/21) Vaidya, Anuja
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How ACA Marketplace Premiums Are Changing by County in 2022
Although premiums for ACA Marketplace benchmark silver plans are decreasing on average across the US in 2022 for the fourth straight year, premium changes differ widely by location and metal level, with premiums increasing in several cases. Unsubsidized premiums are holding level or declining on average nationally across metal levels, but actual payments net of subsidies vary significantly depending on location and income. Many subsidized enrollees may find premium payments for low-cost bronze plans are actually higher in 2022, while payments net of subsidies for silver plans are similar and for gold plans are lower. With benchmark premiums falling on average while lowest-cost bronze premiums are plateauing, 2022 subsidies will cover a somewhat smaller number of bronze premiums than they did this year. Yet because lowest-cost gold premiums are dropping at a faster rate than benchmark premiums, the tax credit may pay for a bigger share of the premium for gold plan enrollees.

From the article of the same title
Kaiser Family Foundation (12/07/21) Ramirez, Giorlando; Fox, Lucas; Amin, Krutika; et al.
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Medicine, Drugs and Devices

How the Supply Chain Upheaval Became a Life-or-Death Threat
The pandemic-driven global shortage of computer chips has made filling orders difficult for continuous positive airway pressure machine manufacturer ResMed, which for patients can mean the difference between life and death. ResMed CEO Michael Farrell says medical device companies in need of chips often lose out to giants like automakers and large technology firms, and his business is "producing less than 75 percent of what our customers need." Farrell is pleading suppliers to provide him more goods, so ResMed can work through a mounting backlog of orders. Gartner estimates that medical device manufacturers have spent about $6.4 billion on computer chips this year, while the automotive sector and wireless communications companies have spent $49 billion and $170 billion, respectively. Experts say chipmakers are favoring their biggest clients, so small and midsized medical equipment companies are less prioritized. Adding to their woes is the fact that medical device manufacturers all over the world comply with strict product safety standards that constrain their adaptation to disruptions.

From the article of the same title
The New York Times (12/09/21) Goodman, Peter S.
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Medical Records Data Offers Doctors Hope of Better Patient Care
Researchers are tapping massive electronic health record (EHR) databases to diagnose the healthcare system through advances in artificial intelligence, search capabilities and other analytics. "You can get a lot of outcomes information from medical records that can help change care for individual patients," said Jackie Gerhart with EHS system maker Epic Systems. More than 80 percent of US hospitals and physician practices maintain computerized patient records, and the American Society of Clinical Oncology (ASCO)'s Clifford Hudis believes harnessing this resource can enhance clinical care. ASCO has compiled a database of 6 million patients from over 100 cancer practices under its CancerLinQ project, which Hudis said has improved health equity by measuring and encouraging oncologists to close gaps in treatments offered to Black and white patients. Hudis said standardized reporting is critical for ensuring patient records' quality and accuracy.

From the article of the same title
Wall Street Journal (12/03/21) Winslow, Ron
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This Week @ ACFAS
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Caroline R. Kiser, DPM, FACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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