News From ACFAS

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Don’t miss the final chance to sign up for the first webinar in the NEW Practice Management Webinar Wednesday series with discounted pricing!

Insurance Reviews: Get the Inside Scoop for Proper Reimbursement offers 1.5 CME credits and provides a behind the scenes look at the dos and don’ts of surgical billing from both the insurance reviewer and the biller’s sides tonight at 7:00 pm CT. Maryellen Brucato, DPM, FACFAS, David Wander, DPM, FACFAS and Kyle Berger, CPB will share documenting pearls to help your surgeries get paid and discuss what to do in an insurance audit.

Practice Management Webinar Wednesday continues with:

How Do I Know If My Practice is Doing Well?
October 19 | 7-8:30pm CT | 1.5 CME
Bela Pandit, DPM, FACFAS and Heraj Patel, DPM, FACFAS
Listen in as faculty show you how to do a deep dive analysis of your practice by accurately determining and measuring your top revenue makers…and losers…and how to adjust accordingly—all without hiring an outside consulting company!

Malpractice Preparation: Because it Happens to Everyone
October 26 | 7-8:30pm CT | 1.5 CME
Ellianne Nasser, DPM, FACFAS; Ross Taubman, DPM; Al Ng, DPM, FACFAS; Barry Rosenblum, DPM, FACFAS and Maryellen Brucato, DPM, FACFAS
While nobody can fully exempt themselves from a possible malpractice case, experts share some tools to help you avoid getting into litigation with patients. You’ll also hear tips and pearls for documentation, peri-operative management and discussions on complications with patients.

Register today and get the entire series for only $149! Learn more and secure your spot at acfas.org/practicemanagementeducation.
There is still time to volunteer to serve on a 2023 ACFAS committee, Clinical Consensus Statement panel or as a reviewer of Scientific Literature. ACFAS is looking for members who are leaders, thinkers, team players, and hard workers to work with the College to shape the future of our profession.

To volunteer, visit acfas.org/volunteer. Don’t delay - the application deadline is October 31. Secure your spot now to get the latest techniques, didactic lectures, and surgical demonstrations December 10-11 at the Orthopaedic Learning Center in Chicago.

Arthroscopy of the Foot and Ankle is a two-day, interactive course led by skilled arthroscopy surgeons. Learn and practice established and cutting-edge techniques in foot and ankle surgery with 9+ hours of hands-on lab time using 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 now for the final course of 2022!

Foot and Ankle Surgery

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Researchers theorized that unnecessary magnetic resonance imaging (MRI) requests for ankle injuries can be reduced by checking the American Orthopaedic Foot and Ankle Society (AOFAS) score beforehand. They scanned ankle MRI images of patients who underwent the procedure due to ankle trauma between January 2018 and December 2020, and 328 patients who satisfied the criteria were included. Patients suffering from ligament damage due to MRI examination were 21.3 percent and patients without any ligament damage were 78.7 percent. AOFAS scores between the group with ligament damage and the group without ligament damage were significantly different. Receiver operating characteristic analysis showed the AOFAS threshold value for MRI request was 80.5, including 84.3 percent sensitivity and 72.3 percent specificity. Given the threshold value, 73 patients who had unnecessary MRI would have been eliminated, reducing the number of MRIs by 42.6 percent.


Researchers analyzed 1,944 patients between the ages of 15 and 35 in the American College of Surgeons National Surgical Quality Improvement Project database who underwent primary Achilles tendon repair between years 2011 and 2020. There were 1,659 non-smokers and 285 smokers. Neither groups differed in terms of 30-day readmission, reoperation and minor complications, although Black non-Hispanic patients were 0.3 times as likely to develop minor complications compared to White non-Hispanic patients. The frequency of wound-related complications after Achilles tendon repair was low in younger patients, with no statistically significant difference in clinical outcomes between non-smokers and smokers.


A retrospective study assessed the clinical effect of the posterolateral approach for treating posterior malleolar fracture (PMF) and present results among 72 patients with different types of Bartonicek classification. All the PMFs were directly reduced and fixed by a posterolateral approach using lag screws and/or buttress plates. Patients were classified as type II (42), type III (18) and type IV (12). Bartonicek type II patients were further divided into subtype IIa (19 cases), subtype IIb (16 cases) and subtype IIc (seven) cases. Sixty-eight patients realized ieved good or excellent reduction of PMF after surgery; their mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 81.35 ± 6.15 at six months and 90.56 ± 4.98 at the final follow-up. The visual analog scale (VAS) score was 6.62 ± 1.03 one week after surgery and 1.20 ± 0.92 at the final follow-up. Radiological evaluation at the final follow-up indicated primary bone union was achieved in all patients and 65 patients received no (KL grade 0) or just doubtable (KL grade 1) post-traumatic osteoarthritis. AOFAS scores fell substantially significantly with the severity of Bartonicek classification at six months and final follow-up, while no statistical difference of VAS pain score among different types of Bartonicek classification was seen. Reduction quality and the presence of osteoarthritis did not correlate to Bartonicek classification, and AOFAS scores at the final follow-up differed statistically different among three subtypes of Bartonicek type II fractures; Bartonicek subtype IIa fractures had the highest AOFAS scores as 93 ± 4.99. Presence and severity of osteoarthritis was lower in patients with subtype IIa PMF compared to other subtype groups.

Practice Management

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Healthcare providers should be cognizant of certain guidelines to better ensure the smooth closure of a practice. They should properly notify affected parties, including patients, federal and state agencies and licensing boards, employees, payors, vendors and other business associates. The practice should also obtain Health Insurance Portability and Accountability Act-compliant authorizations to transfer health records at the patient's request; where records are not transferred, they must be stored by the practice for a period of time. Furthermore, the practice will have to guarantee that both it and its providers are covered by liability insurance via a "tail" policy or some other type of continuing coverage. Accounts receivable also need to be collected, all debts and liabilities repaid and malpractice premiums covered. It is recommended that the practice keep certain funds for a period of time to pay for unexpected or otherwise unknown liabilities that may arise later, as well as consult with legal counsel to complete certain legal documents to properly disband the practice entity with the state of formation. Finally, the practice should consult with its accountant to ensure any tax-related issues are resolved.


Practices can reduce denials and post-payment recoupments through coding and documentation compliance. They can avoid denials based on incorrect patient status by properly coding patients as new or established. Practices should also report the correct evaluation and management (E/M) codes, know when to disclose prolonged services, note minimum time thresholds for Medicare versus non-Medicare and record all face-to-face or non-face-to-face time with patients on the date of the encounter, as well as why additional time beyond the usual service was necessary. Invalid medical code-based denials are avoidable by keeping up to date on annual coding changes, while unspecified diagnosis codes should be avoided as much as possible. Having thorough knowledge of specific payer policies for medical necessity can reduce denials based on the lack of same, and training desk staff on verification of benefits, policy language and precertification can help avoid denials on the front end of the billing process. Providers should also vet documentation to make sure it meets incident-to billing criteria and consider waiting a week before billing a virtual service to avoid providing a related E/M service during that same period.


An analysis of physician payments from the 15 highest-grossing US medical supply companies between 2013 and 2019 found male doctors are paid significantly higher than their female peers. Among the 1,050 payments reviewed, 96.9 percent of the five highest earners were men and 3.1 percent were women. Female physicians were paid an average $41,320 over the study period compared to male physicians' $1,226,377. Meanwhile, the payment gap between female and male physicians rose from $54,343 to $166,778. Male physicians also received higher median payments across all specialties; the largest payment gap was observed in orthopaedic surgery, where male doctors received median payments of $1,752,573 compared to $24,387 for female doctors. Even female-dominated specialties like obstetrics were not immune from the pay gap.

Health Policy and Reimbursement

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Federal funding legislation that took effect on October 1 included the renewal of the US Food and Drug Administration (FDA) user fees program, known as the Prescription Drug and Biosimilar Use Fees Act. The program was set to run out on September 30 and needs to be renewed every five years. The renewal enabled FDA to retain its entire staff and continue its reviews of experimental drugs. FDA Commissioner Robert Califf said the agency will "focus attention on the policies that are very important to public health so that we can bring them through Congress by year-end."


A study published in the Journal of the American Medical Association regarding the benefits and drawbacks of prior authorization (PA) policies for Medicare found that if used effectively, they can reduce overuse, contain rising healthcare costs and improve the appropriateness of care. Ineffective implementation and substantial administrative burdens of PA policies, however, can lead to unnecessary care delays that can undermine patient care and both patient and clinician confidence in the process. The study suggests that accountability and transparency improvements can increase high-value care to Medicare beneficiaries with PA policies.


The US Supreme Court has refused to hear a challenge to a vaccine mandate for workers in healthcare facilities that receive funds from the federal government. The justices rejected an appeal by the states after a lower court turned away their request to immediately consider their claims that the vaccine rule violates federal administrative law and infringes states' authority. The federal healthcare worker rule requires vaccination for roughly 10.3 million workers at 76,000 healthcare facilities nationwide, including hospitals and nursing homes that use funds from the Medicare and Medicaid. The Supreme Court in January concluded that Biden's regulation conforms with the power Congress conferred on the federal government to impose conditions on Medicaid and Medicare funds. It concluded that ensuring that medical providers take steps to avoid transmitting a harmful virus to their patients is consistent with the "fundamental principle of the medical profession: first, do no harm." Missouri sued alongside Nebraska, Alaska, Arkansas, Iowa, Kansas, New Hampshire, North Dakota, South Dakota and Wyoming; these states won an injunction against the requirement. In addition, the mandate had been blocked in 15 other states following litigation there.

Medicine, Drugs and Devices

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Google unveiled a new line of artificial intelligence tools from its cloud unit to help healthcare organizations use its software and servers to read, store and label X-rays and other medical images. The Medical Imaging Suite enables hospitals and medical companies to search through imaging metadata or design software to quickly mine images for diagnoses, and it can help medical professionals automatically annotate images and formulate machine learning models for research. Google Cloud's Alissa Hsu Lynch said Google has no access to patients' protected health data, and none of the information from the service would be used for the company's advertising initiatives. The company claims the service also complies with the Health Insurance Portability and Accountability Act. Google has partnered with a handful of medical organizations, with Hologics using the suite for cloud storage while also developing tech to enhance cervical cancer diagnostics. Meanwhile, the New Jersey-based Hackensack Meridian Health provider network is using the tools to purge identifying information from millions of gigabytes of X-rays.


The US Department of Health and Human Services (HHS) reports that between 2021 and 2022, the prices of over 1,200 prescription drugs increased faster than the rate of inflation. These medications had average rate increases of 31.6 percent, compared to the 8.6 percent rate of inflation. Additionally, HHS said some medications experienced price increases of over 500 percent this year. An Inflation Reduction Act provision mandates rebate payments to Medicare from drug manufacturers if price increases exceed the inflation rate, with the report being released just a day prior to the provision taking effect.


The FLASH-UK clinical study explored the potential value of intermittently scanned continuous glucose monitoring for users with type one diabetes. The trial population consisted of 156 patients with type one diabetes and elevated levels of glycated hemoglobin. One-half of the participants were randomized to an intervention arm and assigned to intermittently scanned continuous glucose monitoring, with optional alarms for out-of-range levels. The remainder were allocated to a standard-care arm and directed to independently monitor their blood glucose levels using fingerstick testing. The main endpoint was glycated hemoglobin level at 24-week followup, which was observed to be significantly lower in the continuous monitoring group than in the usual-care group. Patients equipped with continuous monitoring also kept their glucose levels within target range 130 minutes longer per day than the fingerstick participants and spent 43 fewer minutes in a hypoglycemic state.