December 18, 2019 | | JFAS | Contact Us

News From ACFAS

Don't Forget to Vote!
Voting for the ACFAS Board of Directors and Bylaw Amendments closes this Sunday, December 22. If you are an eligible voter and have not yet voted, a reminder emailed with the subject line: ACFAS Board of Directors Election. We Need Your Vote! to you last Friday (December 13) from containing your unique link to the election.

Members without an email address or whose email system rejected our test email were sent voting instructions by US mail earlier this month. If you do not see the email and did not receive a letter, please check your junk mail folder.

Please contact our independent election firm at or (484) 920-8106 if you are unable to locate your unique link or have questions about accessing the ballot site.
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Avoid a Late Fee: Pay Your Membership Dues by 12/31
December 31 is the final day you can pay your ACFAS membership dues and avoid a late fee! Renew your membership now at or via mail or fax to continue your member benefits.

All Fellow and Associate Members should have received their 2020 ACFAS dues reminders by mail and email. If you have questions or need another statement, please contact the Membership Department at (773) 693-9300.
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Free Archived Webinars: Practice Models & Malpractice Mysteries
Did you miss your chance to watch last month’s free webinars on practice types and malpractice pitfalls? You’re in luck —archived recordings are now available on The webinars give solid information on four types of practice models and unraveling malpractice mysteries. Each presentation runs about an hour in length.
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Foot and Ankle Surgery

Outcomes Study of an Innovative Method of Direct Repair of Metatarsophalangeal Joint Instability with an Angiocatheter Needle
The authors present an innovative repair method for plantar plate tears that uses low-cost materials available in most operating room settings: an angiocatheter needle. A review was performed to identify patients treated with this method; clinical position and patient satisfaction of the involved joints were evaluated. Six patients (nine joints) underwent plantar plate repair using this method and were evaluated at a median follow-up time of 19 months.

The mean visual analog scale pain score at final follow-up was 0.8 ± 2.0, and the median sagittal plane position of the toe was two millimeters from the plantar skin of the digit to the ground. Five of the six patients stated they would have the procedure again. The authors concluded that they were able to obtain satisfactory outcomes with good alignment by repairing the plantar plate with this method and that the method can be used as an effective way to treat metatarsal phalangeal joint instability.

From the article of the same title
Journal of Foot & Ankle Surgery (11/19/19) Kindred, Kristin B.; Rusher, Anthony S.; Baker, Andrew M.; et al.
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Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis
Researchers compared results obtained from proximal medial gastrocnemius release (PMGR) with those obtained from open plantar fasciotomy (OPF) for recalcitrant plantar fasciitis (RPF). Results were measured in terms of pain, satisfaction, health-related quality of life and American Orthopaedic Foot & Ankle Society (AOFAS) score. Patients with RPF for at least nine months were included and were randomized to be operated on with OPF or PMGR, and follow-up was carried out for up to one year. No differences were found in terms of the AOFAS, visual analog scale or any item of the SF-36. Satisfaction was very good in 85.8 percent of the PMGR group and 89.5 percent of the OPF group. Faster recovery was observed in the PMGR group.

From the article of the same title
Foot & Ankle International (12/06/2019) Gamba, Carlo; Serrano-Chinchilla, Paula; Ares-Vidal, Jesus; et al.
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The Risk of Ankle Fusion or Arthroplasty After Operatively and Non-Operatively Treated Ankle Fractures – A Matched Cohort Population Study
Researchers sought to define the risk and incidence of post-traumatic ankle arthritis requiring ankle arthroplasty or fusion after ankle fracture in a large cohort, then compare that rate to matched healthy patients. Multiple databases were used to identify patients treated for ankle fractures, and each patient was matched to four individuals with no prior treatment for ankle fracture. Kaplan-Meier analysis was used to compare the incidence of fusion and replacement. The study identified 44,133 and 88,266 patients who had undergone operative management of ankle fracture (OAF) or non-operative OAF (NOAF) by an orthopaedic surgeon, respectively.

It found that 0.65 percent of patients who had OAF eventually underwent fusion or arthroplasty after a median 2.8 and 6.9 years, respectively. Among NOAF, 0.17 percent of patients underwent fusion or arthroplasty after a median of 3.2 and 5.6 years, respectively. Compared to a matched control group, and after adjustment for medical co-morbidity, rotational ankle fractures requiring surgical open reduction internal fixation increased the likelihood of arthroplasty or fusion by 3.5 times.

From the article of the same title
Journal of Orthopaedic Trauma (12/19) Axelrod, Daniel; Veljkovic, Andrea; Zochowski, Thomas; et al.
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Practice Management

74 Percent of Female Physicians Say Male Peers Earn Higher Compensation
In a recent survey from physician search firm Merritt Hawkins, 76 percent of female physicians said they have experienced gender discrimination as medical students and professionals. The most commonly-cited form of gender discrimination was inappropriate or offensive verbal communication from another physician. For 73 percent of respondents, gender discrimination lowered their morale and career satisfaction, and 29 percent of respondents said discrimination had prompted them to reconsider their career choice. Thirty-nine percent of respondents believe they are paid less than equally qualified male physicians.

From the article of the same title
HealthLeaders Media (12/09/19) Cheney, Christopher
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New Rule on "Bad Actors" Means More Work for Practices
Effective November 4, the US Centers for Medicare and Medicaid Services (CMS) will require Medicare, Medicaid and Children's Health Insurance Program providers and suppliers to disclose certain affiliations they may have with other providers and suppliers who are “bad actors.” This new rule aims to cut down on fraud, abuse and waste and to save taxpayer money, but the administrative burden to healthcare providers will be significant. Practices will have to determine which entities qualify as an "affiliated relationship."

According to CMS, affiliated relationships include those with at least 5 percent direct or indirect ownership interest by an individual or entity in another organization; a general or limited partnership interest in another organization; an interest where an individual or entity exercises control over the day-to-day operations of another organization or any reassignment relationship under Medicare regulations. To track down those relationships, practices will need to look at its provider and vendor relationships, then ask those with which it has any affiliations to disclose whether its relationship must be reported to CMS. Practices will likely to have to avoid any identified "bad actor" entirely to protect themselves. Failure to comply with the new rule may result in loss of enrollment with Medicare.

From the article of the same title
Physicians Practice (12/05/19) Adler, Ericka L.
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Treating LGBTQ Patients
Lesbian, gay, bisexual, transgender, queer, intersexual or asexual (LGBTQIA) patients may feel marginalized and disrespected in healthcare settings, and the literature shows that these patients do in fact receive lower-quality care than those who fit prevailing heterosexual norms. Stigma leads LGBTQIA patients to avoid healthcare encounters. The chair of family medicine for Northwell Health recommends five ways that physicians can make clear their commitment to treating LGBTQIA patients with the same respect and high-quality care that other patients receive.

One step is to provide more options on all intake forms, differentiating between the sex that a patient was assigned on their original birth certificate and their current gender identity. You will need to do basic preventive screenings based on the assigned sex at birth. Other physical exams and tests may be called for depending on whether or not the person has had surgery as part of their transition and the stage of any such surgery. Moreover, be sure to address the patient as they would like to be addressed, which means asking them what pronoun they prefer. Use the patient's preferred pronoun consistently and make sure that other staff members do so as well. Be self-aware enough to recognize if your own discomfort or disapproval disqualifies you from caring for a gender-nonconforming patient and be prepared to provide referrals if that is the case.

From the article of the same title
Medical Economics (12/09/19) Dawson, Milly
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Health Policy and Reimbursement

Supreme Court May Back Insurers in $12 Billion ACA Case
The US Supreme Court heard oral arguments on December 10 about three consolidated cases related to the Affordable Care Act's (ACA) risk corridors program. Under the program, the federal government sought to limit insurance companies' gains and losses on coverage sold in ACA marketplaces from 2014 through 2016. However, losses substantially outpaced gains, and under the terms of the law, the government was required to make up much of the difference. Congress later enacted appropriation riders that seemed to prohibit the promised payments.

Paul D. Clement, a lawyer for the insurance companies, said his clients had been the victims of "a massive government bait-and-switch," an argument questioned by Chief Justice John Roberts. However, Roberts did tell the government's attorney that the insurance companies had relied on the statutory promise. Attorney Edwin S. Kneedler countered that statement by indicating a statutory promise to cover the companies' losses was ineffective without a separate congressional appropriation of money. Justice Samuel A. Alito Jr., was the only justice who consistently asked questions supportive of the government's position.

From the article of the same title
New York Times (12/10/19) Liptak, Adam
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US Watchdog Finds $6.7 Billion in Questionable Medicare Payments to Insurers
According to a report released by the US Health and Human Services Inspector General's Office, health insurers selling Medicare Advantage plans to seniors and the disabled received an estimated $6.7 billion in 2017 after adding diagnoses to patients' files that were not supported by their medical records. The report indicates that Medicare Advantage insurers had added diagnoses for diabetes, heart disease and other conditions in 99.3 percent of chart reviews of patient information, even though they did not appear in records from doctors, hospitals or other medical providers. Insurers deleted incorrect diagnoses less than 1 percent of the time, the inspectors found.

From the article of the same title
Reuters (12/12/19) Terhune, Chad
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More Americans Delaying Medical Treatment Due to Cost
A Gallup poll found that a record 25 percent of Americans say they or a family member have delayed treatment for a serious medical condition because of the cost, up from 19 percent last year, while another 8 percent put off treatment for a less serious condition. When Gallup first asked this question in 1991, only 11 percent of respondents said they delayed treatment for a serious condition. Since 2006, the rate of Americans putting off any kind of treatment for cost reasons has averaged 30 percent.

From the article of the same title (12/09/19) Saad, Lydia
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Medicine, Drugs and Devices

Senate Confirms Stephen Hahn to Head FDA
The US Senate has confirmed oncologist Stephen Hahn as commissioner of the US Food and Drug Administration (FDA). Hahn, chief medical executive at the University of Texas MD Anderson Cancer Center, was nominated by President Trump to replace Scott Gottlieb, who stepped down from the position earlier this year. The agency has been run by two acting commissioners in the meantime.

From the article of the same title
New York Times (12/12/19) Kaplan, Sheila
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Up to 43 Percent of Antibiotic Prescriptions in the United States Are Unnecessary or Improperly Written, Analysis Finds
As many as 43 percent of antibiotic prescriptions in the United States may be "inappropriate," new research shows. The study, published in BMJ, looked at more than 28,000 medical visits in the 2015 National Ambulatory Medical Care Survey and found that antibiotics were prescribed in 13.2 percent of those visits. While 57 percent of those prescriptions were deemed appropriately written for treating conditions known to respond well to antibiotics, 25 percent were written for known inappropriate reasons, such as "treating" viral illnesses, and 18 percent were not well-enough documented to measure the prescription's validity.

From the article of the same title
Time (12/19) Ducharme, Jamie
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New FDA Policy May Speed Biosimilar Insulins to US Market
The US Food and Drug Administration (FDA) has issued new draft guidance for insulin biosimilar manufacturers that could help get these products to market more quickly. FDA decided that manufacturers will not necessarily have to conduct studies that compare immunogenicity to the reference product. The guidance offers no guarantees that biosimilar insulins will be less expensive than branded insulins. Meanwhile, leaders of the US House Energy and Commerce Committee have written to the nation's largest insurers to demand that they provide information on their involvement in the rising price of insulin.

From the article of the same title
Medscape (12/09/19) Ault, Alicia
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This Week @ ACFAS
Content Reviewers

Caroline R. Kiser, DPM, AACFAS

Elynor Giannin Perez DPM, FACFAS

Britton S. Plemmons, DPM, AACFAS

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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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