News From ACFAS

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Join us for the live-streamed Coding and Billing for the Foot and Ankle Surgeon course June 9-10. Taught by coding and billing experts, this comprehensive workshop is the perfect opportunity to take your coding and billing skills to the next level of reimbursement for the care you provide.

Gain knowledge of the ever-changing pertinent issues related to properly coding surgical procedures and evaluation and management services. Plus at the end of the course, you’ll have the tools you need to code more efficiently and effectively—it’s an easy way to see an immediate return on investment in your practice.

If you need an introduction to coding and billing before taking this course, register for Coding Fundamentals available on ACFAS onDemand from May 2-June 7. Visit acfas.org/PracticeManagement for more information on the upcoming coding courses. If you’re considering a fellowship post-residency, you have one more chance to get your questions answered in tomorrow’s final Fellowship Zoom Room.

This series of Zoom Meetings brings together a list of specific fellowship programs for short presentations, to meet prospective future fellows and to answer any burning questions you may have. Don't wait to register, the last Zoom Room is coming up tomorrow, Thursday, April 28 at 7:30pm CT and you won’t want to miss it.

Visit acfas.org/FellowshipZoomRooms to register and to see the full listing of participating programs. If you’ve done your spring cleaning and need a closet refresh, the ACFAS Logo Store has you covered to show your College pride and get decked out in new 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 drinkware, 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 study was held to compare midterm functional outcomes and reoperation rates of unstable distal fibula fractures treated with open reduction internal fixation (ORIF) of the fibula and either deltoid ligament repair, trans-syndesmotic fixation or combined fixation. Skeletally mature subjects received distal fibula ORIF and trans-syndesmotic fixation, deltoid ligament repair or combined trans-syndesmotic fixation and deltoid ligament repair. None of the three cohorts' American Academy of Orthopaedic Surgeons Foot and Ankle Module outcomes questionnaire scores diverged significantly. No patients in the deltoid ligament repair group received reoperation versus 26 percent in the trans-syndesmotic fixation group and 23 percent in the combined fixation group. Reoperation was most commonly warranted by removal of hardware, which was performed in 18 percent of subjects in the trans-syndesmotic fixation group and 12 percent in the combined fixation group.


Researchers theorized that regional anesthesia (RA) would lower inpatient opioid consumption and barely impact outpatient demand in patients undergoing ankle and distal tibia fracture surgery versus those not receiving RA. A total of 1,310 patients aged 18 years and older undergoing ankle and distal tibia fracture surgery at a single institution between July 2013 and July 2018 were examined. Higher rates of high-energy mechanism of injury, additional injuries, open fractures and additional surgery were seen in patients without RA compared with those with RA. Adjusted models indicated less inpatient opioid consumption in patients with RA, but no significant difference after that time. Estimated cumulative outpatient opioid demand was much higher in patients receiving RA at all intervals.


A study aimed to identify the risk factors for subtalar arthrodesis (STA) within the first few years following primary tibiotalar arthrodesis (TTA). There were 240 patients in all who underwent primary TTA included in the study, with median follow up of 13.8 months. Twenty patients received STA after TTA because of symptomatic nonunion of TTA in 13, progression of symptomatic subtalar Osteoarthritis (OA) in four, and symptomatic nonunion of primary TTA combined progressively symptomatic subtalar OA in two. Preoperative radiographic subtalar OA severity and postoperative radiographic alignment did not correlate with subsequent STA. Diabetes mellitus, A significant association was observed between harcot arthropathy, neuropathy, alcohol use, substance use disorder and psychiatric disease and a subsequent STA. The salvage of symptomatic ankle nonunion rather than subtalar joint disease was the most frequent postoperative contributing factor for subsequent STA following primary TTA.

Practice Management

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New research published in the American Journal of Infection Control found US healthcare workers were most likely to be infected with COVID-19 at work during the pandemic's first year, in contrast to previous research suggesting that risk was highest outside the job. The authors analyzed US Centers for Disease Control and Prevention (CDC) data on almost 84,000 healthcare workers diagnosed with the virus between March 1, 2020, and March 31, 2021, and whose source of exposure was established. Workplace exposure was more likely (52 percent) than in the home (nearly 31 percent) or community (approximately 26 percent). Workplace-associated exposures hit a peak in April 2020 at 84 percent. Roughly two-thirds of healthcare workers who reported a specific type of on-the-job exposure said they had been in contact with patients or other healthcare workers with the virus.

Spikes in community rates of COVID-19 correlated with greater numbers of healthcare workers reporting workplace exposure and fewer reporting household or community exposure. "These results emphasize the continued need for improved infection prevention and control measures in occupational settings, as well as the need for improved surveillance to identify and reduce occupational exposures to SARS-CoV-2," said Rachael Billock with the CDC's COVID-19 Response Team.


Medical practices can counter medical misinformation by knowing trusted sources and what they are saying and by following clinical guidance from the appropriate medical societies. Also advised is addressing specific issues patients have, without being condescending. Providers should take time to answer patients' questions and admit when they do not have an answer. Finally, doctors should only post on social media those things that they stand by in real life.


Medical practices can eliminate tedious administrative and regulatory tasks in a number of ways, starting with tailoring workflows to fit electronic health records (EHRs). Another strategy is to delegate EHR documentation to scribes, while a third tactic is to build customized order sets and templates. Encouraging patients to submit basic medical data for EHR integration could also potentially improve efficiency. A fifth suggestion is to minimize the prior authorization burden by compiling a running list of which procedures and medications require such authorization from which insurers and under what conditions. The sixth and final strategy is to work out prior authorizations with payers during contract negotiations.

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) has proposed increasing inpatient hospital payments by roughly $1.6 billion in fiscal 2023, a 3.2 percent hike from the year before. The agency also wants to add health equity measures to the hospital inpatient quality reporting program, including one to monitor hospital commitment to health equity. The proposed pay hike refers to general acute-care hospitals participating in the Hospital Inpatient Quality Reporting Program and that employ electronic health records. "Considering that labor accounts for nearly 68 percent of the CMS market basket calculation, the proposed payment update fails to cover the actual costs," said Blair Childs at group purchasing organization Premier.

CMS estimates that Medicare disproportionate share hospital payments and Medicare uncompensated care payments will decline by about $800 million next year, while payments to Medicare Dependent Hospitals and low-volume hospitals could lose $600 million if Congress fails to extend additional payments that are set to expire this year. Long-term care hospitals could receive a $25 million boost. To stabilize year-to-year, CMS proposed applying a 5 percent annual cap on wage index decreases.


The US Centers for Medicare and Medicaid Services (CMS) has proposed 1,495 changes to the ICD-10-CM diagnosis code set in the fiscal year 2023 inpatient prospective payment system proposed rule. The agency has also unveiled a minimal amount of new ICD-10-PCS procedure codes, including codes for knee joint replacement reportage. The proposed changes also include a reissue of the COVID-19 vaccine status-related ICD-10-CM codes and the COVID-19 vaccine administration ICD-10-PCS codes previously implemented on April 1. Once finalized, these revisions will be applied by the revenue cycle's coding team starting October 1.


The US Centers for Medicare and Medicaid Services (CMS) has published a health equity strategy for agency-wide application and is encouraging healthcare leaders to participate in creating sustainable, equitable approaches. Strategies include broader outreach of existing programs, assessing policies to determine how CMS can uphold safety-net providers and expanding and standardizing data usage. The agency is also urging health leaders to seriously consider health equity seriously and embed it within their own system's strategies by gathering providers, leaders, insurers and state officials to exchange best practices and learn how to create effective health equity programs. "I am inviting the healthcare industry to work alongside CMS as we transform the way patients are cared for in our country," explained CMS Administrator Chiquita Brooks-LaSure. "Health equity will be embedded within the DNA of CMS and serve as the lens through which we view all of our work."


Research from the Better Medicare Alliance advocacy group estimates that seniors save nearly $2,000 on average per year in total healthcare spending in Medicare Advantage (MA) compared to fee-for-service Medicare. Seniors spent $1,965 less, including premiums and out-of-pocket costs, on MA versus fee-for-service, in 2019. Historically disadvantaged populations benefited especially, according to Allison Rizer at consulting firm ATI Advisory. Average total spending in 2019 per beneficiary was $3,524 in MA compared with $5,489 for traditional Medicare enrollees. "Specifically, Black Medicare Advantage beneficiaries report $1,104 less in total health spending compared to [fee-for-service] Medicare beneficiaries, while Latino Medicare Advantage beneficiaries see average savings of $1,421," stated a release accompanying the study. The analysis comes as the MA program faces greater scrutiny from critics and lawmakers over risk adjustment tactics like up-coding that have hiked spending on MA compared to traditional Medicare.

Medicine, Drugs and Devices

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Specialized delivery robots deployed at hospitals are helping to counter nurse burnout. About 15 Moxi robots from Diligent Robotics have been installed in some of the largest US hospitals during the pandemic, conveying objects like smartphones to patients in emergency rooms when visitors were forbidden by COVID-19 protocols. Moxi uses a camera and a light detection and ranging sensor to map hospital floors and detect people and items to be avoided and also features a robotic arm and a digital face. Another 60 Moxies are slated to deploy later this year, and Diligent Robotics CEO Andrea Thomaz says nearly every healthcare system "is thinking about robotics and automation or has robotics and automation on their strategic agenda." A review by the American Nurses Association found nurses appreciated Moxi for letting them interact with patients more and for saving them energy.