News From ACFAS

---

The ACFAS Nominating Committee is looking for the best and brightest to participate in the upcoming election to serve on the College’s Board of Directors. If you are an ACFAS Fellow, believe you are qualified and would like to help lead the profession, submit your nomination application by September 23, 2023. Visit acfas.org/nominations for more information, including complete details on the recommended criteria for election candidates.

The Nominating Committee will announce recommended candidates to the membership on October 26, 2022. Online voting for members will start no later than November 28, 2022 and will end on December 14, 2022. The elected directors will be announced shortly thereafter and will start their term of service at the ACFAS 2023 Scientific Conference on February 9-12, 2023 in Los Angeles. Don’t leave money behind, learn from the experts at ACFAS’ Coding and Billing Education Series in Orlando! Register for just one course or both with special bundle pricing and see the coding and billing process come to life with actual patient cases and coding scenarios at the Walt Disney World Dolphin Resort August 25-27.

Coding Fundamentals
August 25
3.5 CECH

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

Register now and get the tools you need to simplify your coding and reimbursement practices. Visit acfas.org/PracticeManagement for more information and to register today. More Arthroscopy of the Foot and Ankle Surgical Skills Courses are coming up! Secure your spot now to get the latest techniques, didactic lectures, and surgical demonstrations at the Orthopaedic Learning Center (OLC) in Chicago.

October 1-2
November 12-13
December 10-11

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.

Visit acfas.org/skills to register and secure your spot at one of these courses today.

Foot and Ankle Surgery

---

Researchers evaluated and compared the radiological results between a new suture fixation procedure for the Akin osteotomy of the proximal phalanx. There were a total of 89 patients, including 30 treated with a metal implant and 59 who received a joint capsule suture. The mean distal articular set angle corrections were 6.43 and 7.36 degrees in the implant and suture cohorts, respectively, without statistically significant differences. Two local pain complications and 1 case of wound infection occurred in the suture and implant groups, respectively. Akin osteotomy with suture fixation resulted in comparable radiological outcomes to metal implant fixation without increasing associated complications.


A study was held to determine a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo total ankle replacement (TAR). The investigators recruited and peer-matched 15 patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief with 15 control subjects. The Ankle joint's contribution to the total foot and ankle positive work rose substantially following TAR, while a significant decline in the contribution to the total foot and ankle joint positive work was discovered at the Chopart joint. The foot joints combined generated a significant increase in a net mechanical work from +0.01 J/kilograms (kg) before surgery to +0.05 J/kg after TAR.


A study was held to assess the role of the plantaris in intramuscular gastrocnemius recession and the prevalence of the plantaris among 89 patients. Fourteen patients lacked a plantaris. A mean dorsiflexion of 9 degrees was acquired following transection of the plantaris tendon, and an additional mean 8 degrees was obtained following recession of the gastrocnemius aponeurosis. Increased dorsiflexion correlated positively after plantaris transection and gastrocnemius recession. Every one-degree of dorsiflexion increase with plantaris transection was accompanied by a predicted dorsiflexion increase of 0.69 degrees with gastrocnemius recession.

Practice Management

---

All physicians are recommended to follow certain steps to maximize the likelihood a court will find a document is privileged in keeping with the definition of peer review materials. Physicians should sequester all discussions, files, documents and communications about quality assurance and adverse outcomes from other business and committees. It is also critical to obviously indicate when a committee begins and ends an investigation through protocols to alert a committee when an adverse outcome is being reviewed and to secure and develop information expressly for the panel. Identifying documents detailing how a peer review committee operates and quality assurance documents is also required; labeling them "Confidential Peer Review Materials" will confirm their purpose and the committee's legitimacy to outside observers.

To ensure committee members maintain control over information disclosed through the peer review process, material should be kept separate from other business, and the committee meeting should be closed with the proceedings' confidentiality acknowledged. Peer review issues should not be discussed outside of the committee, and confidential materials must be labeled to alert others to the nature of the material and remind committee members of confidentiality's importance. Finally, given that the extent of privilege can differ based on the laws of the jurisdiction where a patient is receiving care, physicians should reach out to a local healthcare lawyer or professional liability insurer for state-specific guidance on the necessary steps for protecting privileged information.


A 2,000-patient survey by practice technology leader ModMed found that respondents will seek new doctors who fit better with factors like timeliness, staff friendliness and use of modern technology. According to the poll, 73 percent of patients are likely to keep a "mental scorecard" of what they like and dislike about a new doctor's office, and they give offices an average four chances before deciding to find a new doctor. Sixty percent of patients are likely to favor one doctor over another if able to make appointments online, while 61 percent value the ease of making payments when considering whether to continue seeing a doctor. Meanwhile, 47 percent of respondents strongly agree and 42 percent somewhat agree that office staff seem more engaged since introducing new technology at the office.

Most patients concur about the frustration of calling for an appointment and having to leave a voicemail and wait for a callback, with 48 percent preferring email, texting or using an online portal over a phone call to book appointments. Sixty-seven percent are also more likely to prefer chat over calling to make an appointment or request lab results. When being examined, 46 percent prefer their doctor use a tablet to review patient history and 54 percent strongly agree that their doctor seems more attentive with new technology. Moreover, more than half of respondents are more likely to pay a bill faster than usual if they get a text message reminder or if they have an online option.


The Physician Flash Report for August indicates rising physician productivity and revenues in 2022, with patient volumes gaining between the first and second quarter. Yet higher volumes have fed into higher investments/subsidies to help physician practices, while also leading to continued cost hikes as practices encounter inflation and a tight labor market. Operating costs, mainly fueled by labor expenses, show continued appreciation and have reached a six-quarter peak. Providers worked diligently to meet higher patient demand, as reflected by expanding volumes.

Health Policy and Reimbursement

---

The US Centers for Medicare and Medicaid Services (CMS) has released the fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule. Its policies build on key priorities to promote health equity, including better quantifying healthcare quality disparities and making maternity care safer and of better quality. CMS will uphold policies finalized in the FY 2020 IPPS/LTCH PPS final rule to solve wage index disparities impacting low wage index hospitals. The agency is also finalizing a policy to cap year-to-year decreases in hospitals' wage indexes, as well as a new supplemental payment for Indian Health Service/Tribal hospitals and hospitals in Puerto Rico. This rule also revises graduate medical education policies to boost flexibility to rural hospitals participating in a rural track program. Changes to hospital and critical access hospital (CAH) conditions of participation for infection prevention and control and antibiotic stewardship programs are also included. They mandate that hospitals and CAHs, after the conclusion of the current COVID-19 public health emergency, must maintain COVID-19 and seasonal influenza disclosure.


New guidance issued by the US Department of Health and Human Services and the Department of Justice aims to combat discrimination in telehealth that can result in barriers to care. The guidance calls for equitable care for individuals with disabilities, including those who are blind, deaf or not fluent in English. Among other things, providers can offer sign language interpretation and language assistance services, and make other changes to policies and practices to support disabled individuals seeking care via telehealth.


The US Department of Health and Human Services (HHS) announced that the number of Americans without health insurance hit a record low of 8 percent in 2022. They partly attributed the decline to enhanced Affordable Care Act subsidies passed under the COVID-19 relief bill, which could be extended under legislation under consideration in Congress. Prior to last year, the uninsured rate had been in the double digits for decades. The announcement followed Democrats' formulation of a massive climate, healthcare and tax deal that would extend generous federal subsidies for people who purchase private health insurance that are credited with reducing the uninsured rates; they have proposed spending $64 billion to extend those price breaks for three additional years. Some 26 million Americans currently have no health insurance. "We know that access to quality, affordable healthcare is key to healthier lives, economic security and peace of mind," stated HHS Secretary Xavier Becerra.

Medicine, Drugs and Devices

---

A detection algorithm reduced the hospital mortality rate from sepsis cases by 18 percent by helping doctors and nurses treat cases nearly two hours earlier on average. Suchi Saria and colleagues at Johns Hopkins University developed the Targeted Real-Time Early Warning System (TREWS), an algorithm that scans patients' electronic health records for factors that compound sepsis risk and combines that information with patients’ vital signs and laboratory tests to produce a score indicating the likelihood they will experience septic shock. Saria's team spent two years incorporating TREWS into the workflow of roughly 2,000 healthcare providers, who used the algorithm in more than 760,000 encounters with patients, including over 17,000 who developed sepsis. TREWS flags a patient's electronic health record to alert providers that the patient is at risk of sepsis, along with reasons why.


A study considered the use of electronic health record order entry-based interventions to reduce the usage of iodinated contrast media. The authors analyzed the records of 78,792 patients who underwent CT scans before and during implementation of interventions between April 1 and July 3, 2022. A 12 percent reduction was observed in the number of patients who underwent contrast-enhanced imaging per day, as well as a 15.2 percent decrease in the number of contrast-enhanced exams ordered per day. The study was published in the American Journal of Roentgenology.


The US Department of Health and Human Services (HHS) recently introduced a service that lets hospitals monitor the availability of medications, supplies for trauma patients, products used for burn patients and personal protective equipment. The Disaster Available Supplies in Hospitals (DASH) tool aims to help facilities estimate how much medical supply they require within 48 hours of a "mass casualty incident" or an infectious disease emergency, according to its website. HHS worked with Healthcare Ready and the technical department of HHS' Assistant Secretary for Preparedness and Response to develop DASH.