News From ACFAS

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Don’t leave money on the table; register and book your hotel now to join the experts at ACFAS’ Coding and Billing Education Series at the Walt Disney World Dolphin Resort in Orlando August 25-27. Special hotel rates are available when you book and register before July 25.

Start with Coding Fundamentals and stay for Coding and Billing for the Foot and Ankle Surgeon with your newly established foundation. Courses can be taken individually or as a series with bundle pricing.

Coding Fundamentals
August 25
3.5 CECH

Coding and Billing for the Foot and Ankle Surgeon
August 26-27
12 CECH

Register now and walk away with the tools you need to simplify your coding and reimbursement practices. Discount Walt Disney World admission tickets are also available for attendees and their families. Visit acfas.org/practicemanagement for more information.
Membership has its perks, especially if you’re a PGY-1 resident! PGY-1 resident membership is free through September 30, 2023, so you have a chance to join the ACFAS ranks at no cost to you.

As an ACFAS resident member, you’ll have access to:

• Discounted registration for ACFAS 2023, February 9-12 in Los Angeles
• 70+ hours of recorded clinical sessions in ACFAS OnDemand
• 15+ in-person CME opportunities offered annually
• A listing of over 54 fellowship programs with ACFAS status—including program contacts, details and application information
• Virtual ACFAS Journal Clubs held each month
• Monthly Scientific Literature Reviews
• A growing podcast library featuring surgical and non-clinical occupation-related topics

Take your career to the next level with ACFAS! Join the College now to benefit first-hand from the College’s mission of empowering our members to be proven leaders and lifelong learners who positively impact the lives of their patients. Visit acfas.org to join today! ACFAS’ July Arthroscopy of the Foot and Ankle Surgical Skills Course may be sold out, but there are more heading your way! Secure your spot now to get the latest techniques, didactic lectures, and surgical demonstrations at this ACFAS workshop at the Orthopaedic Learning Center (OLC) in Chicago.

July 9-10, 2022 (Sold Out)
October 1-2, 2022
November 12-13, 2022
December 10-11, 2022

This two-day, interactive course is led by skilled arthroscopy surgeons giving you the opportunity to learn and practice established and cutting-edge techniques in foot and ankle surgery with 9+ hours of hands-on lab time with the latest equipment and techniques. The lecture presentations will include videos of actual arthroscopy cases with ample time for faculty interaction.

Courses are selling out fast, so visit acfas.org/skills to register and secure your spot at one of these upcoming courses!

Foot and Ankle Surgery

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A study analyzed a fixation protocol for the medial malleolar component of unstable bi- or tri-malleolar ankle fractures in 257 patients who sustained such injuries between January 2005 and August 2019. Substantially more patients in the supracollicular group said they had pain when this type of fracture was not fixed versus fixed, as did significantly more patients in the anterior collicular subgroup. No difference was observed among number of patients reporting pain in the intercollicular group who were fixed versus not fixed. These observations indicate that fracture pattern should be factored into the treatment algorithm for the medial malleolar component in bi- and tri-malleolar fractures.


Researchers ascertained the ankle, hindfoot and subtalar joint alignment before and after supramalleolar osteotomy using autogenerated three-dimensional measurements based on weightbearing computed tomography imaging. They retrospectively analyzed 29 patients with a mean age of 50.4 ± 10.6 years. Inclusion criteria included correction of ankle varus deformity by an opening wedge (22) or dome osteotomy (seven). Exclusion criteria were an additional inframalleolar arthrodesis or osteotomy. The preoperative radiographic parameters of the ankle joint alignment showed significant improvement relative to their postoperative equivalents. Radiographic parameters of the hindfoot and subtalar joint alignment improved significantly from preoperatively to postoperatively, and no significant pre-/postoperative differences were noticed in the coronal plane alignment of the subtalar joint. Further studies on the variation of subtalar joint alignment change are recommended prior to recommendations on inframalleolar procedures in conjunction with supramalleolar osteotomies.


Researchers compared the post-operative surgical site infection (SSI) rate between posterior crural fasciotomy (PF) and vacuum suction drainage (VD) in open Achilles tendon repair surgery. Patients underwent either PF or VD from two experienced surgeons. In all, 60 patients qualified and were included in the final analysis, split evenly between the PF and VD cohorts. Two patients in the PF group and five in the VD group saw post-operative SSI. Inverse-probability-treatment-weighted (IPTW) propensity score analysis showed the PF group had a significantly lower SSI rate than the VD group. IPTW propensity score analysis of Achilles Tendon Total Rupture Score and crude analysis of total Functional Foot Index and visual analogue scale also significantly improved in the PF cohort compared to the VD cohort. PF during open Achilles repair was associated with substantial reduction in post-operative SSI infection rate versus VD.

Practice Management

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Practices should apply five strategies for realizing value-based care (VBC) through leverage of patient data. To reduce overall costs of care and deliver useful programs to help patients, a provider's clinical data and a payer's claims data need to be leveraged for total understanding of high-risk patients and their needs, thus ensuring that patients can utilize member programs that best suit their requirements. Providers must take care to seek expert guidance and practice caution when entering into risk-sharing partnerships with health plans. A second VBC-encouraging habit is to factor in all data that can influence patient outcomes, including social determinants of health, non-medical behaviors, circumstances and demographics. Providers should also integrate data silos for informed decision-making and identify gaps at the point of care. Finally, providers should focus on the future in differentiating themselves, especially in relation to data sharing and guaranteeing a high-quality, seamless patient experience.


Compensation for healthcare management and nurses is increasing in the presence of industry-wide staffing shortages. The 2022 edition of the MGMA DataDive Management and Staff Compensation found compensation across all management levels climbed between 2019 and 2021. Executive positions grew the most with a 19.73 percent gain, while senior management had a 5.07 percent increase; compensation for general management rose 4.28 percent. The western United States saw the largest increase in management pay, with executive management positions in that region receiving more than a $23,000 pay hike versus the eastern US Senior management received a $31,000-plus raise and general management saw a $23,000-plus increase in the western region compared to the southern region. Meanwhile, triage nurses saw the biggest increase of 13.91 percent between 2019 and 2021 and licensed practical nurses saw the second largest increase with 7.09 percent.

However, as of November, 30 percent of medical groups saw themselves coming in below their 2021 productivity goals for last year. "To stay competitive, medical practice leaders must stay on the pulse of macroeconomic forces and invest in strategies that create rewarding and fulfilling workplaces," said Medical Group Management Association CEO Halee Fischer-Wright. "This latest data provides invaluable compensation benchmarks for job titles throughout a medical group practice—from the C-suite to the front desk—to help healthcare practices overcome retention and recruitment challenges."

Health Policy and Reimbursement

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As of July 1, health insurers and self-insured employers are required to release the prices they have negotiated with providers for each healthcare service offered, with the exception of prescription drug prices paid unless administered in hospitals or doctors' offices. The data is expected to show consumers how their insurers are doing in terms of price negotiations with providers, and the disclosure could affect how employers contract for healthcare. Jeffrey Leibach of Guidehouse said insurers have to post what they paid for "every physician in network, every hospital, every surgery center, every nursing facility." Insurers also face higher potential federal fines for noncompliance than hospitals.


According to a recent Kaiser Family Foundation (KFF) report, insurers have not fully adopted disclosure requirements under the Affordable Care Act (ACA) for in-coverage services, including information on claims, enrollment and cost-sharing. The US Centers for Medicare and Medicaid Services has not collected data for all fields expected under the ACA, including out-of-network claims submitted and paid. The KFF report found that of the 18 percent of in-network claims denials, 10 percent were denied for lacking prior authorization or referrals, 16 percent were denied for an excluded service, 2 percent were denied for medical necessity, and over 70 percent were denied for "all other reasons." About 20 percent of ACA insurers denied over 30 percent of in-network claims, and about 20 percent of medical necessity denials in 2020 were for behavioral health services. Mississippi and Indiana had the highest average denial rate for in-network marketplace plans in 2020 at around 29 percent.

Medicine, Drugs and Devices

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A growing number of health insurers want to implement more customized medical interventions for policyholders based on data analytics and artificial intelligence (AI) algorithms from claims documents, electronic medical records and other sources of information. These companies are now examining how to get patients to participate, which may require the use of consumer behavior specialists and guiding nurses on how to extract data from phone calls. The companies say the goal is to better predict when a member could be vulnerable to complications from a future or existing condition, including heart disease, diabetes, obesity and depression. For example, policyholders could be contacted via text, email or phone call to become a member of a program offered by the company to help them deal with a particular health issue if their blood sugar or cholesterol numbers rise.


An article published in the New England Journal of Medicine calls for federal lawmakers to focus on issues cited by the US Food and Drug Administration (FDA) related to accelerated approvals, in particular the withdrawal of drugs from the market. The article comes as US lawmakers consider accelerated approval pathway reforms as part of a "must-pass" reauthorization of FDA's medical product user fee programs. The House passed a version of the legislation in June (H.R. 7667) and the Senate's version cleared the Committee on Health, Education, Labor & Pensions in June (S. 4348). The authors note that those bills include "weaker versions" of the changes proposed by House Energy and Commerce Chairman Frank Pallone (D-NJ) earlier in the year. Rep. Pallone's bill, H.R. 6963, called for allowing the expiration of accelerated approvals one year after the target date to complete a confirmatory trial or five years after the drug's accelerated approval without a confirmed benefit. The bill also proposes to widen FDA's authority by allowing it to require that confirmatory trials are underway before accelerated approval is granted. The accelerated approval provisions in the user fee reauthorization bills omit the automatic withdrawal provision proposed by Pallone and would require FDA to hold an advisory committee meeting at the sponsor's request and provide opportunities for public notice and comment proceedings before withdrawing accelerated approval.


More than eight in 10 healthcare executives expect the metaverse to have a positive impact on the healthcare industry, according to a report from Accenture. The Accenture Digital Health Technology Vision 2022 report called the metaverse "the next horizon" in healthcare, where surgical teams can learn new procedures without having to be physically in the same operating room.


California Governor Gavin Newsom announced that his state will be producing its own “low-cost” insulin, stating, “People should not go into debt to get lifesaving medication.” Newsom said that the state budget he recently signed includes $100 million for California to “contract and make [its] own insulin at a cheaper price, close to at cost, and to make it available to all.” He said $50 million of that budget will go to the development of the low cost insulin, while the additional $50 million will go toward a California-based manufacturing facility for the drug. The action comes amid a push on Capitol Hill to cap insulin costs. A bipartisan insulin bill from US Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) is expected to be voted on as soon as this month.



Researchers performed a comparative effectiveness clinical trial of first line un-titrated, low-dose benzbromarone (LDBen) uricosuric therapy with xanthine oxidase inhibition urate-lowering therapy with low-dose febuxostat (LDFeb) in gout with renal uric acid underexcretion. They randomly assigned 196 participants to receive 25 milligrams (mg) daily of LDBen or 20 mg daily of LDFeb for 12 weeks. All patients were administered daily urine alkalization with oral sodium bicarbonate. More LDBen group members achieved the serum urate target than LDFeb. Adverse events, such as gout flares and urolithiasis, did not differ between cohorts, apart from greater transaminase elevation in the LDFeb cohort. LDBen yielded superior urate-lowering and similar safety in the relatively young and healthy patients exhibiting gout of renal uric acid underexcretion type.