News From ACFAS

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Voting for the ACFAS Board of Directors closes next Monday, December 28. If you are an eligible voter and have not yet voted, a reminder email with the subject line, ACFAS Board of Directors Election. Don't Forget to Vote! was sent on December 20 from acfas.ballot@intelliscaninc.net. This email contained 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 kwier@intelliscaninc.com or (484) 920-8106 if you are unable to locate your unique link or have questions about accessing the ballot site. Everyone knows December 31 is New Year's Eve but it's also the deadline for renewing your ACFAS membership. Make a resolution to do something great for yourself, your practice and your patients, by ensuring ongoing access to all the great benefits that come with your ACFAS membership. You can renew online or via mail or fax. You can also visit the Member Center or reach out to the Membership Department at membership@acfas.org if you have any questions about your membership benefits. Want to spoil yourself a little and start the new year with pride? Head to the ACFAS Logo Store and get decked out in College gear! The ACFAS Logo Store has shirts, jackets, pullovers and scrubs in a wide range of colors and sizes. You can also pick up drink wear, pens and other one-size-fits-all items to show off your membership in the College to your healthcare colleagues.

Visit acfas.org/logostore now to shop the full collection of ACFAS-branded merchandise.

Foot and Ankle Surgery

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A single-blind parallel group randomized clinical trial considered replacing the application of ice with neurocryostimulation (NCS) for functional recovery, pain, edema and ankle dorsiflexion range of motion in persons undergoing physiotherapy treatments for acute lateral ankle sprains. Forty-one subjects were randomly assigned either to a group that received in-clinic physiotherapy treatments and NCS or to a cohort that received the same in-clinic physiotherapy treatments plus traditional ice application. There was no significant group-time interaction or group effect across all outcomes following intervention, although large time effects were observed throughout. The implication is that NCS is no more effective than traditional ice application.


This study evaluated the clinical and radiological outcomes after knotless all-insider arthroscopic modified Broström operation for lateral ankle instability. Clinical and radiological features were evaluated preoperatively and three, six and 12 months postoperatively using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score, visual analogue scale score for pain, anterior talar drawer test and talar tilt angle. Among the 28 patients included in the study, there were three complications but no knot-associated pain. The clinical and radiological outcomes were significantly improved 12 months postoperatively compared with preoperative outcomes.


This case series study evaluated outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus. The study involved 100 patients who underwent the MIIND procedure with a mean follow-up of 97 months. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA) and tibial sesamoid position were assessed. The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 and patients' satisfaction was 8.7. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex, severity, associated procedures and preoperative angle showed significant association with HVA correction and its persistence over time. Complications were nine cases of superficial wound infection and six recurrences.

Practice Management

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To remain competitive, physician practices will have to keep up with consumerism and price transparency demands. Existing regulations include pricing disclosure requirements that are not consistent for hospitals and providers, while price transparency has ongoing legal challenges. In this situation, the best strategy is to stay ahead of regulators, proactively meet growing consumerism demands and offer patients price transparency before it becomes mandatory. There are three essential elements of transparent pricing programs: knowledge of state laws, the use of technology to predict patient demands and a transparency culture.


With diabetes increasing patients' vulnerability to severe COVID-19, it is imperative that diabetics limit potential exposure to the coronavirus, and technology like Continuous Glucose Monitoring (CGM) is helping to accomplish this. "CGM use provides real-time information to patients and their caregivers about blood sugar levels and provides alerts and alarms to the patient to immediately inform them when their blood sugar leaves the target range established by their provider," says Jill Brodsky at CareMount Medical. "Some CGMs enable patients to scan a reading device across the sensor to get readings, while others provide continuous readings via a Bluetooth connection between their CGM and their cellphone or smartwatch." Telehealth also is a vital tool for diabetics, and Current Health CEO Chris McCann says managing diabetes can entail regular visits to the doctor and unforeseen hospitalizations. Replacing these sessions with video visits can minimize patients' risk of exposure while helping them maintain diabetic control through virtual engagement. Since patients respond differently to different communication channels, physicians should weigh various solutions to connect with patients, with phone calls ideal in certain situations or secure texting, email or secure messaging via patient portals the optimal choice in others.


Results of a survey of 1,085 physicians at Michigan Medicine, published in JAMA Network Open, found that among doctors raising a family, women were more likely than men to turn down a project or a participation on a committee. Researchers administered the survey online in October 2019. Respondents also felt that parenting negatively affects promotion for women in medicine, but not men. Both male and female physician parents have struggled discussing parenthood with their divisional and departmental leaders or finding time to present at national conferences.

Health Policy and Reimbursement

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The Trump Administration announced via the Health Resources and Services Administration (HRSA) its completion of reviewing Phase 3 applications from the COVID-19 Provider Relief Fund (PRF) program and will distribute $24.5 billion to more 70,000 providers, up from the $20 billion originally planned. The extra money is being used to meet nearly 90 percent of each applicant's reported lost revenues and net change in expenses caused by the pandemic in the first half of this year. Payment distribution began on Dec, 16 and will continue through January 2021. PRF applicants that have not already received a baseline payment of 2 percent of yearly revenue from patient care were eligible to do so. The U.S. Department of Health and Human Services (HHS) augmented the Phase 3 distribution to consider the actual revenue losses and expenses suffered by providers that were attributable to COVID-19. As a result, previously eligible PRF applicants were invited to apply for extra funding, along with first-time applicants. The additional funding will distribute to providers up to 88 percent of their reported losses.


The US Centers for Medicare and Medicaid Services (CMS) in early December released the annual Physician Fee Schedule (PFS) final rule, increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The final rule will add more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the COVID-19 public health emergency, and more data will be gathered to evaluate whether more services should be added in the future. The final rule will also increase the value of many services that are similar to evaluation and management office visits, such as occupational therapy evaluation services.

Certain non-physician practitioners, such as nurse practitioners and physician assistants, will be able to supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians. Further, physical and occupational therapists will be able to delegate "maintenance therapy" – the ongoing care after a therapy program is established – to a therapy assistant. Also, physical and occupational therapists and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient's medical record.


TThe US Department of Health and Human Services' Office for Civil Rights (OCR) in December issued a notice proposing a number of significant changes to the HIPAA Privacy Rule. Most of the proposed changes fall into three areas: expanding an individual's access to protected health information, modifying Notice of Privacy Practices requirements and allowing more flexibility for disclosures about patients experiencing substance use and mental health disorders. The public has 60 days to comment on these proposed changes.


The US Centers for Medicare and Medicaid Services announced it is seeking public comment on a new Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility (IRF) services. This demonstration looks for improved ways to prevent Medicare fraud and ensure that the right payments are made at the right time for IRF services. CMS plans to implement the demonstration in Alabama, then expand to Pennsylvania, Texas and California. The demonstration would incorporate flexibility and choice for IRFs, as well as risk-based options to reward IRFs who demonstrate compliance with Medicare IRF policies. Rather than creating new documentation requirements, the IRF RCD would require submission of the same information IRFs are currently required to maintain for Medicare payment.


Newly-released data from the US Centers for Medicare and Medicaid Services show that healthcare spending increased 4.6 percent in 2019 to $3.8 trillion, roughly in line with the rate of growth in prior years. Spending for personal healthcare such as goods and services accounted for 84 percent of total healthcare spending last year, increasing 5.2 percent, largely due to higher spending in hospital care. Physician and clinical service spending slightly increased by 4.6 percent. The suspension of the Affordable Care Act's health insurance tax for 2019 led to much slower growth in health insurance spending, which had an increase of 3.7 percent last year.

Medicine, Drugs and Devices

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Healthcare workers around the country have received the first doses of the COVID-19 vaccine, kicking off what could be the largest vaccination effort in US history. Health experts know a wary public is watching the vaccination campaign. For now, the hurdle is to rapidly distribute vaccines to high-risk populations, which includes not just doctors and nurses but other at-risk health workers, such as janitors and food handlers, and then deliver a second dose three weeks later. Hospitals are staggering employee vaccinations because the shots can cause temporary fever, fatigue and aches.


The COVID-19 pandemic has given health researchers a chance to assess whether certain aspects of routine medical care may be excessive. Before the pandemic, an estimated 50 million US patients were subjected to at least one instance of healthcare overuse each year, costing $106 billion. As the pandemic took hold, elective surgeries were canceled and radiology equipment stood abandoned as patients and doctors avoided non-urgent procedures. If downstream care declines during the pandemic without a significant impact on hospitalization and death rates, this will suggest that those procedures aren't worthwhile and should be limited. Researchers might compare the health of patients scheduled for questionable procedures before and after those elective procedures were suddenly shut down.