News From ACFAS

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The ACFAS Clinical & Scientific Research Grant Program is accepting applications! Thanks to support from PICA and the ACFAS Regions, the College will again be offering funding of up to $75,000 for an established investigator and $25,000 for a new researcher.

Letters of intent should be submitted by September 15 at 5pm CT and final applications are due by October 15 at 5pm CT. Awards will be announced in December and funding will be provided in January 2023. All applications must follow a modified NIH R21 format.

Visit acfas.org/ResearchGrant for more information. 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.

Foot and Ankle Surgery

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A study compared the functional and radiographic outcomes of primarily ligamentous and combined osseous and ligamentous Lisfranc injuries treated with reduction and fixation. A retrospective review was conducted on all Lisfranc injuries treated operatively in a single institution over six years, with injuries classified as primarily ligamentous or combined by independent evaluation of available computed tomography (CT) or magnetic resonance imaging. CT of 29 patients was conducted at last follow-up to assess reduction and degenerative changes. Thirty-eight of the 56 patients identified were available for follow-up, which was 3.8 years on average. There were 26 combined injuries and 12 primarily ligamentous injuries. Outcomes were excellent among all patients and no statistical difference in Short Musculoskeletal Function Assessment scores was seen in any category between the groups. Follow-up CT showed all injuries were anatomically reduced, and 26 of 29 patients exhibited degenerative changes.


Researchers disclosed the short-term outcome of one-stage debridement and fusion for ankle joint tuberculosis in 26 patients. The Foot and Ankle Ability Measures score improved from 43.38 ± 9.51 to 62.19 ± 6.63 percent. All sinuses had been subsided, while modified radiographic union score for tibia exposed various fusion rate results, ranging from 5 to 11. The results highlight the importance of patient selection, because any comorbidities or secondary infection may complicate fusion.


A study sought to assess the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton's neuroma. Twenty-seven patients (29 feet) diagnosed with Morton's neuroma after clinical and radiological evaluation received DMMO and percutaneous DTML release between January 2018 and November 2019. The median age of participants was 66 years and the follow-up time was 28 months. The visual analog score for pain decreased 5.7 points and the American Orthopaedic Foot and Ankle Society score rose 19.9 points following the surgical procedure. One case of superficial infection and one patient required neurectomy). The majority of patients (89.7 percent) were satisfied and deemed the procedure outcome as excellent or good.

Practice Management

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A poll of 1,000 healthcare workers conducted by All Points North finds about half are either at their breaking point or looking for new jobs because of work-related stress and trauma. Forty percent of respondents reported feeling anxiety or dread about going to work, while 64 percent said the overturning of Roe v. Wade either worsened their stress or created feelings of betrayal. Roughly 20 percent of healthcare workers said they had checked into a rehab or a detox facility in the previous three months, but 14 percent said they did not want to admit they have a problem. Moreover, male healthcare workers were more likely to struggle with alcohol or substance abuse compared to female workers. APN CEO Noah Nordheimer said persuading healthcare workers to get help for mental health problems involves "chipping away at the stigma of mental health in healthcare from all angles — raising awareness around burnout, normalizing mental health days, encouraging organizational initiatives for work-life balance and providing clear pathways for non-judgmental help."


Complaints and lawsuits alleging racial discrimination at the Kaiser Permanente Bernard J. Tyson School of Medicine highlight an endemic problem in US medical education and practice, baked in over centuries. A 2020 study of 27,500 graduates found nearly 25 percent of medical students who identified as an underrepresented minority reported racism in medical school. A later study estimated that about 4 percent of medical students who experience recurrent discrimination or mistreatment ultimately leave medical school, and minority students of color are disproportionately likely to wind up in that category. Research also shows that Americans of color experience poorer healthcare than whites, especially when treated by doctors of a different race. The medical education system continues to depend heavily on standardized tests and other similarly one-dimensional performance metrics, despite research implying that they impose racist and culturally biased admissions processes. Current and former Kaiser medical school employees partly blame this numbers-focused system for the school's failure to meet its anti-racism goals.

Health Policy and Reimbursement

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Medicare Advantage (MA) will soon surpass traditional Medicare as the way most qualifying beneficiaries get coverage, according to a new analysis of Medicare enrollment by the Kaiser Family Foundation. The study finds MA enrollment could exceed 50 percent of the eligible Medicare population in 2023 from about 48 percent now. Meanwhile, 70 percent of MA enrollees pay no premium beyond part B for prescription drug coverage, while almost all those who receive coverage through plans open to general enrollment have access to some benefits, like eye and hearing exams and glasses and hearing aids, that are not covered under traditional Medicare. Yet 99 percent of MA enrollees are in plans requiring prior authorizations for some services, including physician-administered prescription drugs and inpatient hospital and skilled nursing stays.

The analysis also found that two-thirds of MA enrollees are in plans generally available to everyone for individual enrollment, with the rest in employer or union-sponsored group plans or special needs plans. UnitedHealthcare and Humana account for almost half of MA enrollment and for at least 75 percent in nearly a third of counties. Furthermore, state-level percentages of Medicare beneficiaries in MA programs range from under 20 percent in Alaska, North and South Dakota and Wyoming to 93 percent in Puerto Rico. Finally, government spending on MA quality bonus payments has gained every year since 2015 and is projected to reach at least $10 billion this year.


The US Centers for Medicare and Medicaid Services (CMS) said the Medicare Shared Savings Program, through its work with Accountable Care Organizations, saved Medicare $1.66 billion in 2021 compared to spending targets, while still providing high-quality care. This represents the fifth straight year of overall savings and high-quality performance results. "The Medicare Shared Savings Program demonstrates how a coordinated care approach can improve quality and outcomes for people with Medicare while also reducing costs for the entire health system," said CMS Administrator Chiquita Brooks-LaSure. As of January 2022, Shared Savings Programs cover more than 525,000 participating clinicians who care for over 11 million Medicare beneficiaries. CMS has set a goal that all Traditional Medicare enrollees will be part of an accountable care relationship by 2030. "Just last month, we proposed ways to further grow and expand this successful program, especially in rural and underserved communities," said Health and Human Services Secretary Xavier Becerra. "The Biden-Harris Administration will continue to do everything we can to strengthen Medicare and ensure everyone can access high-quality, affordable healthcare."


US Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky has appointed Mary Wakefield to oversee a structural and budgetary overhaul, which will involve appealing to career CDC scientists, dissident members of Congress and a disenchanted public. Former colleagues said Wakefield's background as a nurse, congressional staffer, policy wonk and administrator give her the perspective and skills to meet these goals. Walensky has emphasized that, as part of the revamp, she wants the agency to give Americans clear, accurate and timely guidance on community health crises. In the wake of an internal audit, she announced plans to retool the CDC's public communications, remove bureaucratic redundancies and help the agency better engage with other parts of the federal government. Former Health and Human Services Secretary Kathleen Sebelius described Wakefield as a "change agent" who won the trust of Health Resources and Services Administration staffers when she ran the agency as an Obama appointee.

Medicine, Drugs and Devices

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An international competition demonstrated the use of artificial intelligence (AI) algorithms for diagnosing rheumatoid arthritis (RA). Participants were charged with developing automated methods to quickly and accurately quantify overall RA damage, joint space narrowing and erosion from x-ray images of hands and feet. Experts fielded 173 entries from 26 teams in seven countries and found the top three contenders offer feasible, rapid and accurate methods to measure RA-associated joint damage. "These algorithms alone or in combination could be incorporated into electronic health records, contributing to more informed and precise management of RA," the authors wrote.


Prior to his confirmation as commissioner of the US Food and Drug Administration (FDA) earlier this year, Robert Califf pledged to assess the risks of prescription opioids and their role in the US drug overdose crisis. In an update, he said that a review is still ongoing at the agency. Califf also wrote in a blog entry that FDA is examining "what revisions are needed to support appropriate use" of opioid analgesics and "lessons learned" by the agency. The update comes as part of a broader effort by FDA to curb drug misuse and addiction. Califf observed, "FDA does its best when it has high quality evidence, and we don't have high quality evidence now," adding that government-run studies may ultimately be needed to determine long-term opioid safety and effectiveness. US overdose deaths reached an unprecedented 107,000 last year, primarily because of illicit opioids such as fentanyl. Prescriptions of opioid analgesics have declined by roughly 40 percent over the past decade, but deaths linked to the drugs remain at 13,000-14,000 annually.


The US Department of Health and Human Services' under-resourced Office for Civil Rights (OCR) is burdened by a massive caseload. The office is not sufficiently equipped to meet its goals of enforcing the Health Insurance Portability and Accountability Act and helping medical organizations protect themselves. Its 2022 budget is a paltry $38 million, and it relies on the cooperation of institutions that may be reluctant to report cyber breaches out of fear of financial penalties for non-compliance. The OCR anticipates seeing 53,000 breach cases in the 2022 fiscal year, and as of 2020 it had just 77 investigators, some of whom must probe civil rights violations and other crimes. The Biden administration has requested Congress to hike the agency's budget by about 58 percent in fiscal 2023, which would allow it to add 37 new investigators.