December 23, 2019 | | JFAS | Contact Us

News From ACFAS

2019 in Review
We’re closing out 2019 and reflecting on another incredible year in the books for ACFAS. We’d like to thank you, our devoted members and volunteer leaders, for your continued commitment and service to the College over the past year. Here’s a look back at some of 2019’s accomplishments!
  • Four new Clinical Consensus Statements finished and set for 2020 JFAS publication
  • Bylaw amendments adopted
  • Record Annual Scientific Conference attendance in New Orleans
  • Search conducted for new CEO to start March 1, 2020
  • Historic ACFAS-AOFAS-APMA-AAOS Task Force movement on parity issues
  • ACFAS reinforces 1999 policy on separate surgical certification board
  • College responds to questionable data in JBJS and JAAOS article
  • New position statement on opioid prescribing
  • #KeepYouOnYourFeet and Walk a Mile national public relations campaigns
  • 5.3 million views of
  • 5 new PowerPoints and 8 videos to educate public/patients on what foot and ankle surgeons do
  • 4 new Infographics to promote members' practices and educate their patients
  • 3 sold-out Coding and Billing for the Foot and Ankle Surgeon seminars
  • Membership set new record at 7,700
  • 8 new fellowship programs in ACFAS’ Recognized Fellowship Initiative (now 53 total)
  • ACFAS/COTH Residency Directors Forum attracted more than 100 attendees for the first time ever
  • 2 new programs: Residents’ Day at ACFAS 2019 and Managing Surgical Complications
  • 2 more Skills Courses for members in practice over 10 years: Surgical Management of the Active Patient and Advanced Arthroscopy
  • Triennial CME/Gap Analysis Survey conducted
  • New ACFAS OnDemand portal - ALL online resources now in one easy to use site: videos, podcasts, eBooks, JFAS and more!
  • New On The Road program: Fixing a Flat: Comprehensive Approach to Pes Valgus
Thank you again for all your hard work during the year. Here's to another successful year in 2020!
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Use Your Member Discount on Certificate Frames
Do you have your member certificate displayed in your practice? If not, now’s your chance to order your certificate frame today. For a limited time only, our benefit partner Church Hill Classics is offering members $10 off your purchase of $100 or more when using the code ACFAS10 (not including shipping and tax). Visit to see their selection of eye-catching frames and desk sets available.

If you need additional member certificates suitable for framing, you can order those through our website. Please allow 8-10 weeks for the certificate to be delivered by our certificate partner.
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Foot and Ankle Surgery

Assessment of Basic Ankle Arthroscopy Skills in Orthopaedic Trainees
The study evaluates an objective model for assessing basic ankle arthroscopy knowledge and operative skills on a cadaveric ankle. The Diagnostic Ankle Arthroscopy Skills Scoring System included an oral questionnaire, an operative task-specific checklist and a global operative skills rating. Thirty-three orthopaedic residents and medical students performed a diagnostic ankle arthroscopy on a cadaveric ankle and were assessed by a single observer, while a subset were tested by two evaluators to determine interobserver reliability. There was a strong correlation between educational level and scores on the global operative skills rating scale, task-specific checklist and oral questionnaire.

The most notable year-to-year increases in skill were between post-graduate year (PGY) one and two and between PGY two and PGY three. Oral questionnaire and task-specific checklists were significantly lower for medical students than PGY1 residents. There was also significant improvement in the oral questionnaire between senior and junior residents, as well as a moderate correlation between number of self-reported ankle arthroscopy cases and scores on the global operative skills score. Researchers conclude that the study reveals a valid measure to objectively assess trainees' ankle arthroscopy clinical knowledge and operative skills in a bioskills laboratory.

From the article of the same title
Foot & Ankle International (12/13/2019) Johnson, Jeremiah D.; Cheng, Christopher; Schmidtberg, Brian; et al.
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Intramedullary Nailing as an Alternative to Plate Fixation in Patients with Distal Fibular Fracture
The study examines whether the intramedullary nailing (IMN) can be used as an alternative to plate fixation (PF) in patients with distal fibular fracture with displaced fragments. Thirty patients who received IMN and 31 who received PF were evaluated at three, six, nine and 12 months postoperatively, for which functional outcome measures include differences in the American Orthopaedic Foot and Ankle Society Scores (AOFAS) and the Olerud Molander Ankle Scores (OMAS) between the two groups. At three months, the AOFAS and OMAS were significantly higher in the IMN group as compared with the PF group. At six months, the AOFAS were significantly higher in the IMN group but there were no significant differences in the OMAS between the two groups. At nine and 12 months, there were no significant differences in the AOFAS and OMAS between the two groups. These results indicate that the IMN group achieved a faster recovery than the PF group. At 12 months, the radiological outcomes were similar in the two groups; all the patients of each group achieved a bony union; and the percentage of frequency of postoperative complications was significantly lower in the IMN group than in the PF group.

From the article of the same title
Orthopaedics & Traumatology: Surgery & Research (12/19) Ko, Duk-Hwan; Kim, Hyeong-June; Kim, Byung-June; et al.
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Outcomes of Foot Infections Secondary to Puncture Injuries in Patients with and Without Diabetes
The study compares clinical outcomes in people with and without diabetes admitted to the hospital for an infected puncture wound. Researchers evaluated 114 consecutive patients from June 2011 to March 2019 with foot infection resulting from a puncture injury, 83 of whom had diabetes and 31 of whom did not. Patients with diabetes were 31 times more likely to have neuropathy, eight times more likely to have PAD, seven times more likely to have kidney disease, nine times more likely to have osteomyelitis and were 14 times more likely to have amputations. They were also more likely to require surgery, required more surgeries and had longer hospital stays. The study suggests that infected puncture wounds in patients with diabetes often fare much worse with more detrimental outcomes than those in patients without diabetes.

From the article of the same title
Journal of Foot & Ankle Surgery (11/01/19) Vol. 58, No. 6, P. 1064 Truong, David H.; Johnson, Matthew J.; Crisologo, Peter A.; et al.
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Practice Management

A 2020 Asset Protection Checklist for Physicians
The article provides a series of questions for providers to ask themselves when formulating an asset protection plan for 2020. They ask whether the medical practice has an appropriate and legally compliant corporate formation; whether it is properly insured, including special liability insurance; whether a provider has both personal and business income protection and whether a medical practice partnership has an up-to-date buy-sell agreement that is funded with all required insurance.

As for personal estate and asset protection planning issues, physicians should check whether they have a sufficient personal liability umbrella insurance policy; whether they know all their risk factors beyond malpractice and what assets are exposed to them; whether personal assets and passive investment streams have been legally organized as distinct from professional or personal liability; whether they have an up-to-date estate plan that properly protects the estate and heirs from liabilities and the coverage status and financial literacy of their spouses and/or children, as applicable.

From the article of the same title
Physicians Practice (12/16/19) Devji, Ike
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Four Ways to Rein In Your Practice's Hidden Billing Costs
The article reviews some common hidden billing costs for physician practices. Many of these occur in the realm of benefits and eligibility verification, which is rife with inefficiencies to be pared and manual claims inquiries, which are the costliest of any administrative billing expense tracked by the Council for Affordable Quality Healthcare. Moreover, research shows that the ability to provide out-of-pocket estimates reduces collection costs. Practice leaders should consider investing in tools that calculate patients' out-of-pocket costs at the point of registration; training front-end staff to have financial discussions with patients prior to the point of service and equipping physicians with cost information so they may engage in cost discussions with patients.

Cash posting is another process that is tedious, highly manual and often relegated to entry-level staff. The inefficiencies associated with manual payment posting result in lost productivity and higher transactions, and they also threaten practice revenue and patient loyalty. Automating cash posting is a sensible financial approach for physicians that provides real-time visibility into payments, streamlines remittance advice management, more quickly identifies opportunities to better manage denials and reduces the costs associated with medical billing.

From the article of the same title
Medical Economics (12/17/19) Richards, Dan
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Health Policy and Reimbursement

Affordable Care Act Insurance Mandate Is Struck Down by Federal Appeals Court
A federal appeals court on Wednesday struck down a central provision of the Affordable Care Act (ACA), ruling that the requirement that people have health insurance was unconstitutional. But the appeals panel did not invalidate the rest of the law, instead sending the case back to a federal district judge in Texas to “conduct a more searching inquiry” into which of the law's many parts could survive without the mandate. The 2-1 decision, by a panel of the US Court of Appeals for the Fifth Circuit in New Orleans, left the fate of the law in limbo. The ruling was issued almost exactly a year after Judge Reed O'Connor of the Federal District Court in Fort Worth struck down the entire law, saying the individual mandate could not be severed from the rest of ACA because it was “the keystone” of the law, essential to its regulation of the health insurance market. With Judge O'Connor now facing a time-consuming assignment from the appellate court, the case is unlikely to be resolved before next year's presidential election.

From the article of the same title
New York Times (12/19/19) Goodnough, Abby
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Budget Deal Puts Access to Healthcare Above Curbing Costs
The just-passed federal spending bill will protect access to healthcare under the Affordable Care Act (ACA) but also drops one of the law's main cost controls. The deal would repeal a cost-control measure known as the Cadillac Tax, an unpopular levy on benefit-rich health insurance plans scheduled to take effect in 2022. The Cadillac Tax was intended as a levy on the most generous plans, pegged at 40 percent of the value above a certain threshold; economists and health policy experts supported the tax but employers and labor unions have vocally opposed it. The repeal of the Cadillac Tax and two other unpopular ACA levies will add about $400 billion to the federal deficit over 10 years.

The budget deal also repeals the ACA's health insurance tax and its sales tax on medical devices; blocks the Trump administration from ending the health law's automatic re-enrolment provision of shutting down a state-level workaround called "silver loading," which has helped stabilize ACA premiums and extends and increases Medicaid funding for US territories. The deal does not address curbing prescription drug costs or ending surprise medical bills.

From the article of the same title
Associated Press (12/16/19) Alonso-Zaldivar, Ricardo
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Eliminating Out-of-Network Billing at In-Network Hospitals Could Reduce Spending by $40 Billion
A recent study finds that annual healthcare spending for patients with employer-sponsored health insurance would drop by $40 billion if specialists were not allowed to bill out-of-network, and privately insured patients would see their physician payments fall by 13.4 percent. More than 11 percent of cases involving anesthesiology, pathology or an assistant surgeon at in-network hospitals in 2015 were billed out-of-network and nearly 6 percent of claims from a radiologist also resulting in an out-of-network charge. In addition, for-profit hospitals had 4.6 percent more out-of-network providers than nonprofit hospitals, and areas with greater income inequality were more likely to have out-of-network providers.

From the article of the same title
Health Leaders Media (12/16/19) O'Brien, Jack
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Medicine, Drugs and Devices

Trump Administration Unveils Plan to Allow States to Buy Cheaper Drugs from Canada
The Trump administration unveiled a plan to allow states, drug wholesalers and pharmacies to import some cheaper drugs from Canada. However, officials could not say when the plan might go into effect, and many questions about its possible scope remain unanswered. US Department of Health and Human Services Secretary said that while the administration is "moving as quickly as we possibly can," it still needs to collect public input and he could not predict the timetable for the plan's implementation. Azar said he could not predict possible cost savings because he did not know how many states might come forward with plans or what those plans would entail.

Several states have shown interest in importing drugs from Canada. It also remains unclear whether the plan will survive expected legal challenges from the pharmaceutical industry, and whether it will be possible to import significant quantities of drugs from Canada. The Canadian government has fiercely pushed back against importation proposals, warning that the drug supply for Canada's 37 million residents cannot possibly fulfill the demands of the much larger US market and that allowing importation would cause severe drug shortages for Canadians.

From the article of the same title
Washington Post (12/18/19) Abutaleb, Yasmeen; McGinley, Laura
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Use of 3D Printing Grows Rapidly Among Orthopaedic Surgeons
A recent article in an orthopaedic journal discusses how three-dimensional (3D) printing is currently being used to create a model of a patient's specific fracture pattern or bone pathology. The authors note that 3D printers are becoming smaller, more affordable and more accessible to physicians, and increasing access to open-source 3D imaging software has made it more feasible to implement the technology on a wide scale. Advanced imaging studies, like CT scans, can be used to create 3D bone models, providing orthopaedic surgeons with a wide variety of uses. Researchers are looking at new ways to use the technology for orthopaedic purposes, and the article looks at potential applications on the horizon.

From the article of the same title
Health Data Management (12/16/19) Bazzoli, Fred
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The Hidden Drug Epidemic Among Older People
Polypharmacy is common among older adults, according to research. Individuals aged 65–69 years take an average of 15 prescriptions a year, while those aged 80–84 years take an average of 18 prescriptions annually, the American Association of Consultant Pharmacists reports. Plus, many take over-the-counter (OTC) products, herbal remedies, vitamins and minerals as well. Among people older than age 65 years, 44 percent of men and 57 percent of women take five or more nonprescription and/or prescription drugs a week, while 12 percent take 10 or more. Contributing to the issue is that some physicians do not routinely ask patients about their use of nonprescription remedies, and patients may not volunteer such information unless questioned directly.

From the article of the same title
New York Times (12/16/19) Brody, Jane E.
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Newly-Revised ISO Standard Will Help Device Manufacturers Address Risk Management
The International Organization for Standardization has unveiled its revised standard on risk management for medical devices. The revised standard replaces the second edition from 2007 and introduces several new definitions. Among other changes, the method for evaluating overall residual risk are now to be defined in the risk management plan. Moreover, the revised standard clarifies and restructures a variety of production and post-production activities. For example, prior to commercial distribution of the medical device, manufacturers will have to determine how to execute its risk management plan and document the results in a report. Clarifications to the overall residual risk are made to allow for the use of reviewing data and literature for the device and similar devices.

From the article of the same title
Regulatory Focus (12/17/2019) Brennan, Zachary
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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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