News From ACFAS

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ACFAS is deeply saddened to learn of the passing of Samuel S. Mendicino, DPM, FACFAS.

Dr. Mendicino had a long history of service to the College, serving on many committees and chairing the Annual Scientific Conference Committee. He was honored with the Distinguished Service Award in 2007 for his work on the ACFAS Surgical Skills Program. Dr. Mendicino will be remembered for his commitment to his residents and colleagues. His talent, humor and approach inspired everyone he touched to be their best.

Dr. Mendicino graduated from the Dr. William Scholl College of Podiatric Medicine in 1983. He completed a residency in foot and ankle surgery at the Harris County Podiatric Surgical Residency and was involved in postgraduate medical education throughout his career, serving as the director of residency and fellowship training at West Houston Medical Center's Podiatric Medical and Surgical Residency Program and its Fellowship in Reconstructive Ankle and Foot Surgery.

Dr. Mendicino is the brother of past ACFAS President, Dr. Robert Mendicino. We extend our sincerest sympathies to both Dr. Robert Mendicino and Dr. Samuel Mendicino’s family. There’s still time to be a part of ACFAS 2023 and submit your manuscript. If you’re currently involved in a study that would be beneficial to the profession, submit yours by August 3 for a chance to present in LA February 9-12. Manuscript winners will divide $10,000 in prize money.

Visit annualconference.acfas.org for guidelines, instructions and to submit your manuscript before the August 3 deadline. Wondering if you’re being compensated for your hospital on-call time at fair market value?

ACFAS is conducting an anonymous survey of all Fellow and Associate Members on their hospital’s on-call pay rates/policies. The results will be broken down into regions across the nation and made available to members to share with their local hospitals to help set the standards of on-call pay for foot and ankle surgeons across the profession.

Watch for the survey in your email on August 1. ACFAS’ Arthroscopy of the Foot and Ankle Surgical Skills Course is back October 1-2! Secure your spot now to get the latest techniques, didactic lectures, and surgical demonstrations at the Orthopaedic Learning Center (OLC) in Chicago.

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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Researchers retrospectively analyzed the medical records of 998 patients who received forefoot amputation of diabetic feet from March 2002 to February 2021. In all, 288 of the 508 patients with a follow-up period of at least six months had repeated lesions in the forefoot, while 220 had none. Of the patients exhibiting repeated lesions, 142 and 104 on the ipsilateral and contralateral sides, respectively, were compared and examined. Repeated lesions showed statistical significance in diabetic polyneuropathy, vascular calcification and dialysis, yet no significant difference was observed in the anatomical positions of diabetic foot lesions, their causes, anatomical amputation levels, number of surgeries and management duration. Contralateral lesions transpired eight months later than ipsilateral lesions, but reamputation above the Lisfranc joint occurred more often and had a poorer prognosis.


A study was held to compare the complication risk of different treatments for displaced intra-articular calcaneal fractures (DIACFs), covering interventions with conservative treatment, surgery with a minimally invasive approach, surgery with a percutaneous approach (PA) and open surgery with the extensive "L" lateral approach (ELA). Complications and wound infections were evaluated as well. Twenty-six published trials fulfilled the inclusion criteria, involving 2,538 patients surgically treated for acute DIACFs. The mean incidence rate in the ELA for total complications was significantly higher than the rates in other treatments. No significant differences were observed in wound infections among the groups. The area under the cumulative ranking curve showed the PA was most likely to be the best management for minimizing complications. The ELA was also associated with a higher risk of complications among all management methods, while the PA was most likely to be the ideal choice when only complications were taken under consideration.


A study employed the PearlDiver nationwide administrative claims database to compare baseline demographics between total ankle arthroplasty (TAA) and ankle fusion (AF) and to ascertain whether patients who had a TAA had elevated utilization, in-hospital length of stay (LOS) and costs of care. There were 21,433 patients undergoing primary TAA (7,126) and AF (14,307). Patients undergoing TAA had a significantly greater Elixhauser comorbidity index due to arrythmias, congestive heart failure, diabetes mellitus, electrolyte/fluid disorders and iron deficiency anemia than patients receiving AF. TAA utilization rose from 21.5 percent to 49.4 percent of procedures from 2005 to 2013, while in-hospital LOS declined for patients with TAA compared with AF. Total ankle arthroplasty reimbursements were stable, while charges per patient climbed from $40,203.48 in 2005 to $86,208.59 by the end of 2013.

Practice Management

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A survey of 215 physicians aimed to determine their ability to calculate the overall probability of a medical outcome resulting from two independent events. Most respondents (78.1 percent) estimated that likelihood to exceed the probability of at least one of the two events, which was found to be mathematically incoherent. Because many diagnostic and prognostic decisions require more than one step or the consideration of more than one likelihood, diagnostic and prognostic errors resulting in misestimation of the overall probability of success are likely when two or more independent events are involved. This biased calculation, consistent with the conjunction fallacy, may have significant ramifications for diagnostic and prognostic decision-making.


The buy-in agreement influences many of the most critical aspects of a physician's career, including compensation, ownership stake, management responsibilities and terms under which the physician can leave through retirement or resignation. "A partnership agreement is a crucially important agreement that could be in place for 30 years or more and it should be approached that way," advises healthcare attorney Jeffrey Sansweet. Although buy-in agreements differ from the employment contracts physicians enter into when joining a practice as an associate, employment contracts often determine the time of service and other conditions required for an associate to be considered for or automatically offered a partnership. The terms of the agreement are often negotiated separately, after a physician has been with the practice for two to five years.

Ascertaining the value of the practice is crucial to a fair agreement, and it can be calculated by the market method based on recent sales of comparable practices nearby, the revenue method based on practice profitability or practice assets. Sansweet says the practice should make its books available to an associate physician during negotiations, including any existing valuations, additional firms owned by the practice, leases, revenue, tax returns, balance sheets, debt and buyout agreements for current partners. Goodwill is often included in valuations, and buyout terms are also essential components. Also worth considering in agreements is the power in the management of the practice.


Medical practices should know important aspects of remote patient monitoring (RPM) and its benefits before integrating it. RPM uses information technology to send patient-generated health data gathered outside the clinical setting to the patient's healthcare team so they can evaluate the patient's progress and intervene to improve outcomes if necessary. RPM could potentially help healthcare professionals care for millions of Americans with manageable chronic ailments. A key barrier to practices' adoption of RPM is a lack of awareness, as well as the misconception that only Medicare covers the cost for RPM services. In view of RPM's benefits, it likely pays to at least initiate an integration, especially if the practice treats patients with chronic conditions.

Health Policy and Reimbursement

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The Biden-era US Federal Trade Commission (FTC) is poised to more aggressively fight healthcare consolidation, having denied four hospital mergers. Experts concur that consolidation has hiked US medical costs, giving some hospital groups almost monopoly-level pricing power. Yet antitrust experts admit it will take time to find the right cases on which to apply more aggressive enforcement, which will likely cause resistance from some commissioners, the healthcare industry and the courts. Some experts are uncertain that rigorous FTC antitrust enforcement will help patients and employers who are paying a high cost in areas controlled by one or two health systems and believe that direct regulation of prices may be warranted.


The US Department of Justice charged 36 people for allegedly running healthcare fraud schemes across the country, including laboratory owners and company executives accused of ordering $1.2 billion in unnecessary or fraudulent medical tests. The defendants are charged with using telemedicine to obtain orders for the medical tests, which were then allegedly billed to Medicare and other insurers. Court documents indicate the tests and equipment were frequently ordered without any patient engagement and yielded little of value for patients or their primary care physicians. The owners and operators of medical laboratories are in many cases accused of paying illegal kickbacks and bribes to telemedicine companies, medical professionals and medical equipment firms in return for patient referrals to boost business for their personal aggrandizement. "This enforcement action demonstrates that the department will do everything in its power to protect the healthcare systems our communities rely on from people looking to defraud them for their own personal gain," declared Assistant Attorney General Kenneth Polite, head of the Justice Department's Criminal Division.


To improve the COVID-19 pandemic response and federal handling of other national crises, the Biden administration is launching a two-year effort to reorganize the US Department of Health and Human Services (HHS). As part of the changes, the Office of the Assistant Secretary for Preparedness and Response (ASPR) will become the Administration of Strategic Preparedness and Response, its own division within the department. The new agency will enjoy equal standing with the US Centers for Disease Control and Prevention (CDC) and Food and Drug Administration, independent HHS divisions that have often clashed with the current ASPR team. The overhaul will empower ASPR "to mobilize a coordinated national response more quickly and stably during future disasters and emergencies while equipping us with greater hiring and contracting capabilities," Dawn O'Connell, who currently leads ASPR and will take the helm of the standalone division, told staff members in a memo. Advocates hope the effort will eliminate interagency rifts that undermine emergency response, while critics argue that ASPR has its own shortcomings and that the reorganization does nothing to resolve long-standing challenges at CDC.

Medicine, Drugs and Devices

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A new analysis from the US Centers for Disease Control and Prevention reveals that gestational diabetes has become a big problem over the last 30 years, especially as Americans became more sedentary during the COVID-19 pandemic. Longer-term trends, such as the climbing age of women giving birth and the shifting ethnic demographics of mothers, also have contributed to the growing prevalence of gestational diabetes, which can cause problems during delivery and create ongoing health complications for babies. Experts say the research underscores a need for greater awareness, earlier diagnosis and more providers trained to treat and manage the growing caseload. Patient barriers to care, such as the cost of glucose test materials and insulin supplies, add another layer of challenge to the issue.


New draft guidance from the US Food and Drug Administration (FDA) seeks to help sponsors integrate dose banding information in drug labeling for ready-to-use containers in new drug applications, biologics license applications or supplements to those applications. Dose banding refers to dosing a drug product based on weight or body surface area (BSA), and labeling can include a range of different strengths. FDA said this strategy reduces "significant drug waste" from discarded single-dose vials and eliminates the need to calculate and extract partial doses from vials. In addition, FDA said that model-informed drug development approaches can be used to compare the dose based on weight or BSA and using strengths available in ready-to-use containers. FDA further said the labeling should take into consideration situations when the dose based on weight or BSA falls outside the dose range of ready-to-use infusion bags. The aim is to "(1) clarify that use of the bags is not recommended for patients of this weight or BSA because the calculated dose cannot be achieved and (2) recommend that use of another drug product containing the same active ingredient be considered," FDA said.


A group of 181 bipartisan House lawmakers has signed a letter urging the US Department of Health and Human Services (HHS) to clamp down on drugmakers that have stopped offering or reduced price breaks to the 340B Drug Discount program. The lawmakers warned these actions are raising costs for hospitals and clinics and adversely affecting patients. Although months have passed since several of the companies were warned about being penalized, HHS' Office of Inspector General has not taken action. In a July 15 letter, the lawmakers wrote: "Every day that drug manufacturers violate their obligation to provide these discounted drugs, vulnerable communities, federal grantees and safety net healthcare providers are deprived of resources Congress intended to provide. Further delay of enforcement actions emboldens more manufacturers to begin overcharging safety net providers, threatening the integrity of the entire 340B program."