News From ACFAS

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We can’t wait to see you in Los Angeles February 9-12 for ACFAS 2023! Still looking for reasons to register?

Education
Learn techniques from international authorities around the world, immerse yourself in challenging cases, get hands-on, and enhance your skills with more than 50 sessions of exclusive content. Earn up to 34 CECH with pre-conference programs beginning on February 8!

Inspiration
Keynote Speaker Victoria Arlen went from being in a coma and paralyzed to competing in Dancing with the Stars and a career at ESPN! She will discuss the perspective we give to the obstacles in our lives, how to change it, and how to push off of those roadblocks to achieve greater heights as she shares her inspirational story.

Connections
Join over 2,000 foot and ankle surgeons and network with leaders in the profession.

Resources
Visit over 150 companies from across the globe showcasing their products and services in the Exhibit Hall.

Entertainment
ACFAS 2023 will take place inside L.A. LIVE, L.A.’s largest entertainment district with restaurants, sports and music venues, a bowling alley, a movie theatre, and more fun for all ages!

Save when you register by November 30! View the preliminary schedule and register at acfas.org/asc. The 2023 Residency Directors Forum is going Hollywood! Co-hosted by the Council of Teaching Hospitals (COTH) and sponsored by Organogenesis, this year’s event will be held on Wednesday, February 8 from 12 – 6:30 pm. Lunch will be provided.

Designed to assist resident educators in optimizing their resident review and oversights, the Forum’s agenda includes sessions on social media dos and don’ts, CPME mock site-visits, DEI advancement within our residency learning environments, and curriculum building for both residents and faculty. You’ll also get an update on the CPME 320/330 re-write status.

The Residency Directors Forum is complimentary for all residency directors, faculty and program coordinators (up to two representatives from each program), fellowship directors and school Deans. All attendees will earn 5.0 CME. Stick around afterwards for a dinner meeting to hear the detailed changes to CPME’s 320/330 documents, how they’ll affect your residency training, and how site evaluators will check to be sure the new changes are met when they visit your program. Register now at acfas.org/asc.
Make plans now to head to ACFAS 2023 and prepare for your career as a foot and ankle surgeon when you join us for Residents Day! You won’t want to miss a full day of education, fun and prizes on Wednesday, February 8 from 8:30 am – 2:15 pm. Breakfast and lunch will be provided.

Experienced foot and ankle surgeons will provide tips on completing your post graduate education with discussions on non-surgical topics including:

• The Simple Rules of Achieving Board Certification
• The Art of Negotiation: From CVs to Interviews and Contracts
• Why Can’t We All Just Get Along? Conflict Resolution
• Post-Residency Bazinga: Making the Next Step the Right One

You can also stick around for Coding Fundamentals, immediately following Residents Day, to learn the foundation of coding and billing and get a head start on preparing for your future practice.

This year’s Residents Day is generously sponsored by Organogenesis. Visit acfas.org/asc for more information and to save your spot for one or both courses. On behalf of the The Podiatry Foundation, please see the below opportunity for ACFAS members:

As a member of ACFAS, you appreciate the value of research in the field of podiatric medicine. To stimulate the interest in this critical area, The Podiatry Foundation has developed a Request For Proposals for research covering most areas of podiatry.

We invite you to review this proposal and apply online through your IRS approved not-for-profit organization (as either a 501c3 or 501c6) for a research grant. Submit your intention to participate by November 30, 2022. Proposals received between October 1, 2022 and June 30, 2023 will be considered for support.

If you have any comments, questions, or concerns, please email david@thepodiatry.foundation.

Foot and Ankle Surgery

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A retrospective study explored the healing response of juvenile osteochondritis dissecans of the talus following conservative treatment in 55 patients (55 ankles). The patients' management regimen was cast immobilization followed by activity restriction. After nonoperative treatment, 18 (33 percent) of 55 lesions had not progressed toward healing. Older age and a completely detached but undisplaced (grade III) lesion at time of diagnosis predicted conservative treatment failure. Optimal predicted healing was facilitated by a multivariate logistic regression best predictor model that incorporated age and grade and yielded an area under the curve of 0.920.


A study by Yamaguchi et al. detailed how the round sign increases on digitally reconstructed radiography captured by computed tomography (CT) when pronation of the first metatarsal is applied. The researchers evaluated the shape of the lateral edge of the first metatarsal head on weight-bearing dorsoplantar radiographs. They classified 90 radiographs of adults presenting hallux valgus deformities as mild-to-moderate, based on hallux valgus angle and intermetatarsal angle. The global average observations were 3.72 ± 3.92, and the interclass and Spearman correlation coefficients were poor for inter-observer measurements and statistically significant. The linear model revealed no substantial variability between the repetitions corresponding to each observer.


A study investigated midterm clinical outcomes and radiographic results following symptomatic subfibular ossicle resection combined with ligament repair following the modified Broström procedure (MBP). Retrospective evaluation was conducted on 26 consecutive skeletally immature patients who received the procedure. Fourteen girls and 12 boys underwent surgery at a mean age of 12.7 ± 2.4 years, and mean postoperative follow-up time was 40.0 ± 10.8 months. Mean visual analog scale pain score improved from 4.1 preoperatively to 0.5 at final follow-up, and mean American Orthopaedic Foot & Ankle Society score, Karlsson score and Tegner score all improved from 62.0, 54.0 and 2.8 preoperatively to 95.5, 94.0 and 5.4, respectively. Average time of return to sports was 17.0 weeks. Mean talocrural angle, fibular length and tape-measured leg length of the injured ankle did not differ significantly from those of the contra-side at the final follow-up. All patients were satisfied with the outcomes, and repeat ligamentous injury occurred in two patients. No cases of wound infection, nerve injury, compartment syndrome or any other complications occurred.

Practice Management

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Medical practices have a number of strategies for recruiting and retaining top talent, with employee potential and development, internal processes and their effect on staff workloads, benefits of working for the practice and competitive compensation factors to consider. Assessing people based on their potential is recommended, and candidates coming directly from graduation are often keen to learn and open to the practice's culture and standards. Employees also should be trained and developed via skill-based workshops and informal learning experiences to fulfill their potential. Practices should also implement standard operating procedures like cross-training to prevent heavy employee workloads. A competitive compensation framework can help the practice attract and retain top talent while keeping itself profitable. Finally, prioritizing employee recognition strengthens the practice's culture.


Supply chain leaders at healthcare providers can realize resiliency by building the necessary infrastructure. The first step in this process is to amass data from multiple sources to solve inventory issues and to optimize all supply chain functions in order to achieve supply chain accuracy. The second step involves assessing strengths and weaknesses of information systems and deploying resiliency capabilities for supply chain and clinical systems. The third step is to design a supply chain performance dashboard by targeting key metrics associated with contracting, requisitioning, purchasing, inventory management and supplier performance. The final step is to work with critical data suppliers to build collaboration tools.


Medical practices can beef up their protection by conducting cybersecurity training. A good starting point is consulting with a reliable cybersecurity provider to tailor an appropriate cybersecurity and employee training program; training also is mandated by the Health Insurance Portability and Accountability Act (HIPAA). Employees also need to be trained on the practice's data incident reporting procedure when an employee's device is infiltrated by a virus or performs abnormally. Practices should also stay up to date on HIPAA Privacy and Security Rules as part of cybersecurity training. Strong passwords are recommended as well, and unknown emails should be regarded with suspicion.

Health Policy and Reimbursement

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The US government is officially cutting Medicare payments to physicians in 2023 by 4.5 percent, but doctors and lobbyists are ready to campaign against the reductions, which they claim will be closer to 8.5 percent. "There's a certain sense of panic out there among physicians," said internist John Goodson at Massachusetts General Hospital. "I think Congress is not going to be able to withstand that pressure." The Medicare Payment Advisory Commission told Congress in March it would be reasonable to set physician payments "by the amount determined under current law," adding that any trims would not actually "affect beneficiaries' access to care or providers' willingness and ability to furnish care."

Yet doctors think the disparities in federal rules are making it tougher for them to practice on their own. Medicare incorporates rising inflation into hospital inpatient and outpatient services, but not physician services, which opponents say forces physicians to sell to hospitals if it means the same services provided in offices will be worth at least twice as much simply by switching ownership. The imminent payment cuts also gloss over some of the system's severe gaps, such as how doctors largely set their own compensation. In response to the proposed rule, a coalition of ex-Medicare officials and payment experts argued that Medicare should have more in-house experts to oversee more of the process.


The US Centers for Medicare and Medicaid Services (CMS) has released a final rule with updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year (CY) 2023. The agency is also updating data used to develop geographic practice cost indices and malpractice relative value units. Meanwhile, the American Medical Association Current Procedural Terminology (CPT) Editorial Panel approved amended coding and updated guidelines for other Evaluation and Management (E/M) visits (including hospital inpatient, hospital observation, emergency department, nursing facility, home or residence services and cognitive impairment assessment). Changes to CPT code definitions include new descriptor times where relevant, revised interpretive guidelines for levels of medical decision-making, choice of medical decision-making or time to select code level and a required medically appropriate history and exam for determining code level.

"We finalized the proposal to maintain the current billing policies that apply to the E/Ms while we consider potential revisions that might be necessary in future rulemaking," CMS added. Also finalized was a 12-month delay of the split or shared visits policy established this year. History, performing a physical exam, medical decision-making or spending time will be considered the substantive portion of a visit. CMS is also finalizing policies related to Medicare telehealth services, like making several services that are temporarily available for the public health emergency available at least through CY 2023 to allow additional time for the collection of data that may support their permanent inclusion.


The US Centers for Medicare & Medicaid Services (CMS) issued a final rule on October 28 that would expand special enrollment periods (SEPs) for Medicare beneficiaries and commerce coverage the month following initial enrollment to eliminate delays. Individuals who enroll in Part B if they failed to enroll in Medicare during their initial enrollment period for reasons including disasters, emergencies or material misrepresentations by employers or plans would be eligible for the SEPs without penalty. CMS Administrator Chiquita Brooks-LaSure added that "individuals who have had a kidney transplant will now be able to receive extended Medicare coverage for immunosuppressive drugs."


Under Medicare's Hospital Readmissions Reduction Program, annual penalties for hospitals with higher-than-expected readmission rates declined to the lowest levels since 2014, according to a Kaiser Health News analysis. Hospitals are penalized when Medicare patients return to the hospital within 30 days at higher-than-expected rates. The decline in penalties is related to the US Centers for Medicare and Medicaid Services' (CMS) decision to exclude the first six months of 2020 from its calculation due to the pandemic and to exclude Medicare patients readmitted with pneumonia over a three-year period because of its similarities to COVID-19. CMS issued penalties to 2,273 hospitals, with an average payment reduction was 0.43 percent. The reductions in Medicare payments will amount to $320 million across a 12-month period from October 1, 2022, to September 2023.


A newly report from the US Senate Finance Committee indicates companies selling private Medicare plans to older adults have masqueraded as the Internal Revenue Service and other government agencies, deceived customers about the size of their networks and exploited vulnerable people with dementia and cognitive impairment. The analysis catalogs complaints from 14 states, disclosing that many individuals said they were enrolled in plans without their knowledge. The plans are part of the Medicare Advantage program, and the committee said enrollees both in traditional Medicare and those already in a private plan have been inappropriately switched. The report also said insurers' TV commercials and mailings often falsely suggested that switching to Medicare Advantage would boost beneficiaries' Social Security benefits.

"It is unacceptable for this magnitude of fraudsters and scam artists to be running amok in Medicare, and I will be working closely with [the Centers for Medicare and Medicaid Services] to ensure this dramatic increase in marketing complaints is addressed," said Sen. Ron Wyden (D-Oreg.). "Medicare Advantage offers valuable plan options and extra benefits to many seniors but it is critical to stop any tactics or actors that harm seniors or undermine their confidence in the program."

Medicine, Drugs and Devices

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A 2022 update for the US Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain — United States includes recommendations for managing acute, subacute and chronic pain. The recommendations are inapplicable to pain pertaining to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the areas of determining whether or not to initiate opioids for pain; choosing opioids and determining dosages; deciding duration of initial opioid prescription and performing conducting follow-up and evaluating risk and addressing potential dangers of opioid use. CDC advises that persons with pain undergo appropriate pain treatment, with diligent consideration of the benefits and risks of all options as related to the patient's circumstances. Recommendations should not be considered rigid standards of care across patient populations. The guideline is designed to improve communication between doctors and patients about the benefits and risks of pain treatments, including opioid therapy; enhance the efficacy and safety of pain treatment; ameliorate pain; improve function and quality of life for patients with pain and lower the risks associated with opioid pain therapy such as opioid use disorder, overdose and death.


Evidence suggests that new classes of antihyperglycemic drugs may have added benefit for patients who have chronic obstructive pulmonary disease (COPD) in addition to type two diabetes. Researchers used data from a sizable primary care database in the United Kingdom that is reflective of the general population. They formed three active comparator cohorts consisting of 1,252 new users of glucagon-like peptide one (GLP-1) receptor agonists, 8,731 new users of dipeptidyl peptidase four (DPP-4) inhibitors and 2,956 new users of sodium-glucose co-transporter-two (SGLT-2) inhibitors. Results from each cohort were compared against control groups of new users of sulfonylureas, a type of diabetes intervention that is typically initiated at the same disease stage as the novel study treatments and that has never been known to influence COPD exacerbations. Compared with the sulfonylureas, SGLT-2 inhibitors and GLP-1 receptor agonists correlated to a 38 percent lower and 30 percent lower risk, respectively, of severe or moderate exacerbation. The effect with DPP-4 inhibitors, if any, was negligible. The authors of the study suggest additional investigation is needed to explore the therapeutic potential of GLP-1 receptor agonists and SGLT-2 inhibitors for patients with concomitant type two diabetes and COPD.