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What a Baptist-Brookwood Merger Means By SteVe SPenCer
Mission Work at Home OB/GYN Finds Satisfaction in Volunteering Before he retired from delivering babies a few years ago, obstetrician/ gynecologist Ronald W. Orso, MD estimates that he delivered some 5,000 during his career. But one of them in particular is commemorated with a photo on his office wall ... page 3
Using Bacteria to Cure Pancreatic Cancer The communication system used by bacteria may soon prove to be the most innovative and harmless treatment for fighting cancer. Senthil Kumar, an assistant research professor and assistant director of the Comparative Oncology and Epigenetics Laboratory ... page 7
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Big news hit Birmingham on December 15th when Baptist Health System announced that it had signed a non-binding Letter of Intent with a subsidiary of Tenet Healthcare Corporation, the parent of Brookwood Medical Center, to form a new, jointlyowned company that will include all Baptist Health System hospitals, Brookwood Medical Center, and their related businesses. The parties are now in a due diligence period, which is intended to result in a definitive agreement. If this merger goes through, the combined entity will be huge. Brookwood has 3000 employees while Baptist employs 4300. The two organizations would combine for over 60,000 annual admissions with 1650 credentialed physicians. According to Bill Cockrell of Cockrell, Egeland and Associates, the proposed combination holds several opportunities for the hospitals and their patients. “In the current environment, it’s difficult to increase revenue,” Cockrell says. “So it’s important to control costs.
The biggest cost saving opportunity is to increase efficiency by eliminating redundant services. For example, maybe you consolidate the cardiology programs at one hospital. That’s going to be difficult to do because most hospitals don’t want to give up a service line. “So the most likely cost savings will come through the purchasing departments. This alliance gives Baptist access to Tenet’s buying power which should reduce their expenses. That’s a big deal.” And while increasing revenue is difficult, Cockrell explains that the combined, larger entity might grow volume because, with more physician-patient experiences to study, the organization (CONTINUED ON PAGE 6)
PUBLIC HEALTH FOCUS
E-cigarettes Reveal New Danger to Children By Jane ehrhardt
A search for electronic cigarette stores in Birmingham quickly generates 30 listings on the Yellow Pages site. “If e-cigarettes could totally replace combustible products, it would appear—for a large volume of adults now smoking—that it would have some benefits from a public health perspective,” says Donna Arnett, PhD, professor and chair of the UAB Department of Epidemiology. But research has shown that, instead, most smokers are dual product users. “They’re using e-cigarettes when they can’t smoke,” Arnett says, continuing the conundrum over the benefits and hazards of e-cigarettes. The positive of e-cigarettes comes from producing a vapor (CONTINUED ON PAGE 6)
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HEALTHCARE SPOTLIGHT
Mission Work at Home OB/GYN Finds Satisfaction in Volunteering By dale Short
Before he retired from delivering babies a few years ago, obstetrician/gynecologist Ronald W. Orso, MD estimates that he delivered some 5,000 during his career. But one of them in particular is commemorated with a photo on his office wall. It was taken during a delivery by a patient’s husband, and the frame is inscribed “The Impossible Dream.” The story, says Orso, is that in the 1970s a woman came to him who was expecting at the age of 46. She told him that her earlier five pregnancies had all ended in miscarriages. “I told her there were some things we could try,” he says, “and we put her on aspirin and the hormone progesterone. But down deep, I was afraid we were going to lose this baby and it would be another sad story. Every time she came back, we did ultrasounds, ready for bad news, and every time there was a heartbeat. “I told her if we could get to 14 weeks we’d be in good shape, and we did. The next milestone was 24 weeks, and at that point, if we had to deliver the baby it would have a 50/50 chance. The next step was 28 weeks where we’d have a 90 percent chance. “But the baby--a girl--made it to 38 weeks before she was delivered. She was a really special baby. She still comes to see me today, and she’s now had babies of her own. It’s just a miracle, and I always keep that photograph there to remind me that God moves in His own way.” A native of Bessemer, Orso grew up on a farm and became interested in medicine at age 11 when visiting his brother-in-law, a medical student in New Orleans. “He was doing a pediatric internship, and he made house calls. He carried me into these terribly poor areas of the city, and when I saw all these sick kids he was helping, I left there wanting to be a pediatrician. “But along the way, at the UAB of Medicine, I changed to an ENT residency, and then changed again to obstetrics. “I’m just an old farm boy who never thought I’d get into medical school, but I’ve had the most wonderful life as a physician. I wouldn’t change it for the world. I’m still working as hard as ever, and even though I’m past retirement age I have no plans to quit. I’ve been blessed with good health, and that’s what counts.” Along the way, he and his partners developed one of the area’s largest OB/ GYN practices, Birmingham Obstetrics and Gynecology. “I’ve been blessed to have great partners, and we’re fortunate to be where we are,” Orso says. “The most satisfying part of my practice these days is seeing patients come back who I delivered. I once delivered a baby for a husband and wife who I’d both delivered, so that was special.” All of this, while serving for 32 years
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in the National Guard and running an evacuation hospital in Saudi Arabia during Operation Desert Storm. Another great source of satisfaction is his volunteer work with M-Power, a faithbased social services agency that provides adult education and medical services to residents in poverty throughout metro Birmingham. “M-Power is a free clinic where people in Jefferson County can come and see a physician for basic care with a pharmacy that fills their prescriptions at no cost,” Orso says. “We strive to be a bridge for them while they’re getting their life back together--getting drug or alcohol treatment, finding a job, whatever their situation. On the evening I volunteer, I see about 25 patients, all of whom have nothing. “Often we see people who, for example, are diabetic; they’ve been to a hospital and are discharged with a handful of prescriptions. But they have no money for the medicine, so soon they’re back in the hospital. It’s satisfying to know we can help with their medical care, give them medicine, and refer them to other clinics if needed. “One problem is that after Cooper Green Hospital closed, many of the clinics that were helping these patients are gone and they have nowhere to receive care. So that’s what I help them do, and that’s what I enjoy the most right now. “People at church often ask me when I’m going on a mission trip, and I joke with my pastor that I go on a mission trip here every month, and it’s very special to me.” In December, Orso received the Hettie Terry Community Service Award from the University of Alabama National Medical Alumni Association for his volunteer work with M-Power. M-Power is seeking new physician volunteers, and Orso invites doctors who are interested in helping to contact him for more details.
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What’s in a Flu Vaccine search on Influenza located in Atlanta, (CDC); London, England; Melbourne, AustraFlu strains migrate across lia; Tokyo, Japan; and Beijing, the world like flocks of birds. China. But they garner far more attenTwice a year, WHO contion. On their typical passage sults with the directors of those from east to west, flu viruses Collaborating Centers and are monitored by more than representatives of key national 140 national influenza centers laboratories. Then, based on in 111 countries as they spread their review of the surveillance across the continents. results, laboratory and clini“It all starts in Southeast cal studies, and the availability Asia,” says Craig M. Wilson, of vaccine virus strains, they MD, professor of epidemiolrecommend what strains to inogy and director of the UAB clude in the influenza vaccine Sparkman Center for Global for that year. Health. The new strains arise in Each hemisphere has that area because of the unique their own vaccine. The meetcongregation of birds, pigs and ing in February determines the people. composition of the vaccine for “That’s the magical combithe Northern Hemisphere’s nation,” Wilson says. The birds upcoming fall flu season. The are natural influenza carriers, September meeting does the because the disease does not imCraig Wilson, MD sees a young patient in Nepal while fulfilling his epidemiological studies. same for the Southern Hemipact them. “The pigs are the insphere’s vaccine. cubators. Then they’re taken to Then each individual country decides the big Asian markets where there’s a lot birds where it’s mutated enough for huwhich strains should be included in the flu of birds, a lot of pigs, and a lot of people,” mans to contract it. Its potency and spread vaccines licensed in their country. In the Wilson says. “We don’t have the same dydepends on its human-to-human transmisUnited States, the Food and Drug Adminnamics here, though we do have big bird sion efficiency. Fortunately, many never istration (FDA) makes that determination. farms and big pig farms, but not together, achieve that sophistication. “We have a bit of an advantage here and not around a whole lot of people.” When an influenza strain begins to in this country, because the viruses generWilson says there’s no evidence that hospitalize humans in their area, the naally arise and become a problem in Asia,” humans acquire the virus from pigs. “It’s tional centers take note. They send those Wilson says. “There aren’t emerging more from the birds. We think the mixviruses for additional analyses to the five strains in the U.S. But some do get their ing takes place in the pigs,” he says. Then World Health Organization (WHO) Colnames here because they’re identified it transfers back to the prime carriers of laborating Centers for Reference and ReBy Jane Ehrhardt
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here.” Usually the names reference locations. This year’s vaccine includes the California/7/2009 (H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012like virus. Some of the vaccines also protect against an additional B virus (B/ Brisbane/60/2008-like virus). Another important practical factor in determining the contents of the flu vaccine rests on whether a vaccine strain exists that could protect against the invading virus. Vaccine viruses must be similar to the invading virus, and, according to the CDC, they must be grown from a clinical specimen in eggs or special pathogen-free chicken kidney cells, but not in any other cell lines. The vaccine strains must also be tested and available in time for production. That generally means about six months. As a result, occasionally, a threatening virus cannot be identified in time to include in the upcoming year’s vaccine. That’s what happened this year. A strain, called Switzerland, flared up in September. “So we don’t know how this season will go. There’s a possibility that the vaccine won’t be as effective as previous years,” Wilson says. But Wilson warns that even without an exact match of viruses, the vaccine still has potency and public health value. “There’s cross reactivity in vaccine viruses, so people are still less likely to get sick if they have the vaccine even if they did not get it exactly right,” he says. For example, during the 2003-04 influenza season, the vaccine strains were not optimally matched to the strains hitting the country. But in a study of 50-64 year-olds that year, inactivated influenza vaccine effectiveness against laboratoryconfirmed influenza was 60 percent among persons without high-risk conditions, and 48 percent among those with high-risk conditions. Even better, the vaccine effectiveness was 90 percent against laboratory-confirmed influenza hospitalization. Because of that even partial, but significant, protection, Wilson says the more people who are vaccinated, the more the entire population is protected, even if the strains don’t match perfectly between virus and vaccine. “It’s called herd immunity. When enough people have even some immune response, then a virus cannot be as impactful on the population as when no one is vaccinated,” he says. For the last few years, an estimated 25,000 to 35,000 people have died from flu-related causes in the U.S. “And with a billion people traveling every year, there’s plenty of easy movement of viruses these days,” Wilson says. With that in mind, he adds, people should understand the value of getting vaccinated this year for themselves and for those around them.
PUBLIC HEALTH FOCUS
BUILD Health Challenge Issued …
National collaborative awarding up to $7.5 million to improve community health By CINDY SANDERS
The Advisory Board Company, Robert Wood Johnson Foundation (RWJF), de Beaumont Foundation and The Kresge Foundation recently joined forces to launch a major public health initiative known as the BUILD Health Challenge, which will award up to $7.5 million in grants, low-interest loans and programrelated investments over the next two years to improve health in low-income neighborhoods within cities that have a population of 150,000 or more. Starting from a premise that good community health takes more than just healthcare, the four organizers seek to identify, accelerate and spotlight best practice models and innovative approaches to addressing nonclinical factors that influence health through collabora-
Applications & Key Dates Information from web conferences held in December plus details about the challenge, partners, eligibility requirements and overall process are online at buildhealthchallenge.org. To be eligible, BUILD Health applicants must include, at a minimum, a partnership between a hospital or health system, local health department, and nonprofit community organization or coalition of organizations. The nonprofit community organization must serve as the lead applicant in each proposal. Activity should be focused within a delineated ZIP code(s), census tract(s), or neighborhood(s) experiencing significant health disparities within a city of 150,000 or more residents. Also, participants must be willing to engage in a learning collaborative and openly share ideas, action plans, and results. Applications can be submitted online through the website. Below are key dates going forward: • Jan. 16: Deadline for Round 1 applications. • Feb. 12: Invitations extended to select applicants for Round 2. • April 10: Deadline for Round 2 applications. • June 9: Winners announced.
tive partnerships between hospitals and health systems, local health departments, and nonprofit community organizations. The goals of the funding program are to promote health equity, reduce per capita health spending, shift resources from treating illness and chronic conditions to the upstream social conditions that impact population health, and to identify and promote scalable best practices. “Tackling today’s biggest health challenges is not the work of one organization … it’s not the work of one sector,” Abbey Cofsky, senior program officer with RWJF, pointed out. “The aim of the BUILD Health Challenge really is to increase the number and the efficiency and effectiveness of the types of partnerships Abbey Cofsky that we know it will take to improve health. And that means bringing together hospitals, community leaders and public health leaders to collaborate in efforts that are going to move the needle on health and ultimately really change the dynamic around cost.” James Sprague, MD, chairman and CEO of the de Beaumont Foundation, noted, “There is much work that has to be done to improve population health, and this BUILD Health Challenge, we hope, will identify promising models
across the nation that will be replicable and sustainable in order to address health problems before they get started.” Brian Castrucci, chief program and strategy officer with de BeauDr. James Sprague mont, said the United States provides access to some of the best medical care in the world using some of the most advanced technologies and treatments available. However, he continued, “Its (the healthcare Brian system’s) impact is diCastrucci minished when patients return to neighborhoods with limited access to fresh fruits and vegetables, no options for safe or affordable physical activity, or no options to fill pharmacy prescriptions.” He noted individuals often present with chronic or complex conditions exacerbated by lifestyle choices that are impacted by the social determinants of health. “The simple truth is that our traditional model of healthcare delivery doesn’t really work anymore.” Castrucci added, “It was designed to respond to acute illnesses like polio and typhoid and not address causes of disease that occur far beyond the clinic walls.”
Chris Kabel, senior program officer with The Kresge Foundation, echoed those sentiments, noting there is a growing awareness that most of the nation’s health is determined outside of the healthcare system. “Unfortunately, health-promoting resources are not equitably distributed and tend to be least prevalent in low-income neighborhoods and communities Chris Kabel of color,” he said. Kabel added, “One reason why most traditional health education campaigns have proven ineffective is they’ve done nothing to change the local opportunity infrastructure in which people live, learn, work and play.” With the BUILD Health Challenge, Kabel noted local communitybased organizations are a critical component for success since their members truly understand the neighborhoods they serve including challenges, assets, obstacles and opportunities to maximize health. Dennis Weaver, MD, chief medical officer and executive vice president with the Southwind Consulting and Management division of The Advisory Board Company, highlighted the emerging role hospitals and health systems are beginning to play in building healthier communities as providers move into a world (CONTINUED ON PAGE 18)
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E-cigarettes Reveal New Danger to Children, continued from page 1 instead of smoke. Using a battery-powered heating element inside the device, generally shaped like a tube, the e-cigarette turns a flavored, nicotine-laced liquid into a vapor inhaled by the user. Currently, neither the devices nor the juice are regulated. As a result, no safeguards exist to ensure the contents contain nothing harmful, including the nicotine. “We know heavy metals have been found in some lower-cost, e-cigarette preparations,” Arnett says. “But nicotine is a poison too.” 60 milligrams of nicotine drunk orally Donna Arnett is enough to kill a 150pound adult, according to the CDC. Some e-cigarette refills pack as much as 72 mg. “So if an adult drank the whole refill at once, it could potentially be enough of a poison to kill them,” Arnett says. Since e-cigarettes hit U.S. markets in 2007, people reported feeling strong enough adverse symptoms from e-cigarettes to call poison centers. That number has skyrocketed from one per month in September 2010 to 215 per month as of last February. The CDC reported 42 percent of those e-cigarette-related calls involved adults over 20 years of age. “It’s not the vaping of the products that’s the known danger to adults,” Arnett says. “It’s accidently falling into the hands of someone who would drink it.”
Children are becoming more prone to that danger. More than half (51.1 percent) of the calls to poison centers surrounding e-cigarettes involved children under age five. “It’s a very small dose of ingested nicotine that can be poisonous to a child—one teaspoon for children under six,” Arnett says. “The thing that worries me as a public heath advocate is that the flavors are really targeting children and adolescents, like bubblegum and chocolate,” Arnett says. Though many e-cigarette flavors fit a more adult palette, such as black walnut, raspberry, and champagne, many would appear to be more enticing to a child’s taste buds, such banana and cookies and cream. “Here’s cool mint menthol listed on this site. And right under that is cotton candy,” Arnett says. “It’s hard to imagine an adult smoking cotton candy.” Besides drinking the juice, children and adults can be harmed by absorption of the liquid through the skin and eyes. Meaning the bottles, which do not require childproof lids, need to be kept out of reach of children. The prevalence of the devices among children is rising as well. According to the CDC’s 2013 National Youth Tobacco Survey, 4.5 percent of all high school students reported using e-cigarettes within the last 30 days. And use by high schoolers doubled between 2011 and 2012. With the Surgeon General’s report finding that nicotine use has adverse effects on adolescent brain development,
nicotine use by youth in any form—combusted, smokeless, or electronic—is unsafe. As a result, 41 states have outlawed the sale of e-cigarettes to minors so far, including Alabama, which set the age limit at 19. Arnett says physicians should ask about e-cigarette use in the household. “People think the juice is harmless. They can be completely unaware of the danger to their children—or children visiting their home—by drinking or touching the colorful liquids,” she says. Though there is not enough research to know what ill effects to adults can occur from consuming nicotine through e-cigarette vapor, Arnett allows that they may help with cessation. “These products may be useful to reduce combustible cigarette consumption. That’s the positive about them,” Arnett says. “We don’t really know about inhaled nicotine through e-cigarettes being harmful to adults, but we know combustibles are. So switching to e-cigarettes in theory should reduce the level of toxicity.” A greater sense of safety may soon be at-hand for e-cigarettes. The government has begun seeking oversight of their production and distribution. “The FDA issued a proposed rule to extend authority to monitor and regulate e-cigarettes,” Arnett says. “I think regulations will happen within a year because of the confusion this is causing in the workplace and other areas where we have clean indoor air laws. And there’s lot of public pressure. But you can never predict with the government.”
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Merger, continued from page 1 could have an advantage in tracking quality measures resulting in more best-practice providers. For example, if the hospital pinpoints a physician who is doing the best job with joint replacement and they are able to duplicate that physician’s best-practices throughout the system, then the organization will have more quality providers of joint replacement. “Healthcare reimbursements are moving toward a model based on quality and efficiency,” Cockrell says. “Primary care physicians will want to refer patients to providers that have the highest level of quality and efficiency because this reduces the overall cost and many incentive plans are based on the total cost.” Will the combination mean more referrals from Bill Cockrell within the network? Possibly, but on the other hand, location still matters and a physician on one end of town might continue referring patients to providers close by. “The argument to that,” Cockrell says, “is that a doctor can say: ‘if I refer you to a doctor in our network, your records will get there quicker and I’m in better communication with them.’ And the patient-centered medical homes require that when doctors refer patients to a specialist, the referring doctor must keep track of the patient’s condition, so communication with the specialist is important.” It’s uncertain as to whether or not this potential merger will affect other area hospitals. The competing hospitals are all part of large networks with buying power so there shouldn’t be a big cost advantage to the new organization. Cockrell believes that any possible effect on the market might more likely result from a centers-of-excellence perspective. “For example,” Cockrell says, “Brookwood is known for their expertise in women’s health. Baptist is, of course, good in this area too, but Brookwood has a strong niche in this. If that could be duplicated at the Baptist hospitals, and they could leverage the women’s health reputation, it could affect other providers.” Cockrell also notes that primary care is the key to hospitals and this merger expands the hospitals’ reach considering the primary care clinics Baptist and Brookwood both have. “I think the marketing opportunity for Baptist/Brookwood is to tell consumers that they have a high quality primary care network that is closely tied to some of the top specialists and because they are one network, they can streamline the process of getting the patient from primary care to the specialist,” Cockrell says. Whether or not the merger actually happens is, of course, yet to be seen. And if it does go through, no one can predict the level of success. It will be important for Baptist to be able to maintain their faithbased identity. And it will be more difficult to maximize the benefit of a large merger in a market like Birmingham which is very territorial from a hospital, provider and patient standpoint. But without question, there are a number of interesting possibilities here.
Using Bacteria to Cure Pancreatic Cancer minor infections and about 400 deaths a year, according to the Centers for Disease Control. But when the researchers treated human pancreatic cancer cells grown in culture with its O-DDHSL molecule, the cancer cells stopped multiplying, failed to migrate, and began to die. Luis F. Pineda, MD, a Birmingham oncologist, says the medical community has overlooked the ability of bacteria to aid the body for too long. “This is the most exciting thing happening right now,” he says. “But if I came out and said I was going to treat something with bacteria, everyone would look at me as if I Luis F. Pineda, was crazy.” MD Pineda adds that even bacteria in the environment regularly communicate with and aid the human immune system. “The brain doesn’t know what viruses or bacteria are outside the body, but there are bacteria that know. And they get inside you through your skin, nose, eyes, and gastrointestinal tract and get in contact with the immune system cells. They exchange genetic information from the outside to your lymphocytes, and this is the way your body can prepare for infection,” he says. Yet one of the most interesting aspects of this new use of bacteria to Pineda is that it doesn’t require the participation of the
By Jane ehrhardt
The communication system used by bacteria may soon prove to be the most innovative and harmless treatment for fighting cancer. Senthil Kumar, an assistant research professor and assistant director of the Comparative Oncology and Epigenetics Laboratory at the University of Missouri (MU) College of Veterinary Medicine, says this communication system can be used to Senthil Kumar signal cancer cells to not only take certain actions, but also to die on command. Bacterial communication, triggered during an infection, relies on the release of molecules that contain certain messages, Kumar explained in an MU news release. “Depending on the type of molecule, the signal will tell other bacteria to multiply, escape the immune system, or even stop spreading,” he says. In their study published in PLOS ONE, Kumar and co-author Jeffrey Bryan, an associate professor in the MU College of Veterinary Medicine, culled the “stop spreading” molecule N-3-oxo-dodecanoylL-homoserine lactone (O-DDHSL) from Pseudomonas aeruginosa bacteria. This commonplace bacteria causes a multitude of
immune system. “It’s direct communication from the bacteria to the cancer cells,” he says. That could mean less impact on the body and fewer side effects. Kumar and Bryan chose pancreatic cancer for their study because those are the most robust and hard-to-kill cancer cells that can occur in the human body. “Because this treatment shows promise in such an aggressive cancer, we believe it could be used on other types of cancer cells,” Kumar says, adding that their lab is in the process of performing that additional testing now. The next step in their research is to find a more efficient way to introduce the molecules to the cancer cells before animal and human testing can take place. “At this time, we only are able to treat cancer cells with this molecule in a laboratory setting,” Kumar says. “We are now working on a better method that will allow us to treat animals with cancer to see if this therapy is truly effective. The early-stage results of this research are promising. If additional studies, including animal studies, are successful, then the next step would be translating this application into clinics.” If further testing proves fruitful, Pineda can foresee the use of other bacteria and fungi as purely biological treatments for anything from acne to schizophrenia. “We’re going to see an explosion of this type of research that will be absolutely astonishing,” he says. But it will likely be at
least another five years before even Kumar’s approach makes it through the FDA approval process and wins acceptance by the establishment. “We are seeing the latest concept of how bacteria influence human cells,” Pineda says. “I really think we will see this approach come through with significant healthcare solutions in the next several years.”
Every Monday and Thursday, we’ll feature healthcare professionals discussing important medical topics.
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One result of the Republican victories last November may be an acceleration of consumer-driven healthcare as an alternative to Obamacare. A basic premise behind this approach is an alignment of payment for health care services and health care decision-making. This model involves patients exercising greater autonomy and responsibility in the purchase of healthcare insurance and the selection of health care providers and services. It may also involve a redesign of employer-provided insurance to provide greater choice and premium responsibility for the typical worker. Consumer-driven healthcare involves patients or consumers paying a greater percentage of their healthcare expenditures out of pocket or from health savings accounts such as health savings accounts, flexible spending accounts or health reimbursement accounts where consumers may roll over balances in their health savings accounts from year to year and from job to job. In most cases, these accounts are coupled with lower-premium and high-deductible health plans which may only cover catastrophic medical expenses but provide patients with the advantage of discounted pricing and negotiated rates. In many variations, employers are contributing a fixed amount to employee healthcare and providing more alternatives to employees in plan selection. Consumers or employers are also able to select health plans based on premiums, deductibles and coverage. To be successful, consumer-driven healthcare requires the free exchange of pricing and quality information in a form that the average patient can understand. If a patient cannot obtain advance pricing and quality comparisons when he or she is making healthcare decisions, patient behavior may not change significantly. Several smart phone applications have been created recently that allow consumers or patients to compare pricing and outcome measures among healthcare providers. Of course, the long-term usefulness of these types of comparisons depends entirely on the accuracy and utility of the underlying data. Employer or insurer initiatives may accelerate the move to employee responsibility and the free flow of pricing and quality information. Economist John Goodman, one of the leading experts in consumer-driven healthcare, cites the experience with the California Public Employees Retirement System (calPERS), in collaboration with WellPoint, Inc., for reference pricing for hip replacement and knee surgery. Under this initiative, calPERS paid a fixed fee for the various operations at pre-selected “high-quality, low-priced facilities.” Employees who
wanted to go to other facilities with higher charges paid the difference. Thereafter, Goodman demonstrated that the “highpriced facilities cut their rates by onethird” in order to stay competitive. Greater insurance pricing transparency in a system with multiple plans may also accelerate change. Employees or health insurance consumers may sign up for cheaper plans with more limited networks if they are paying a greater portion of the health care premium. Recent experience in Chicago shows remarkable market share growth under the exchange for low cost insurance plans that require patients to utilize lesser known hospitals and their affiliated physicians with no coverage for out-of-network facilities or physicians. In the event that consumer-driven healthcare becomes prevalent, providers may see a number of changes in patient behavior. Patients may be much less willing to pay higher co-payments or deductibles to have procedures in hospital-based settings. Unless hospitals can convince the typical patient that routine diagnostic and other non-emergency procedures are higher quality or achieve better outcomes in hospital settings, patients are going to opt for procedures in less expensive physician offices or ambulatory surgery centers. Furthermore, patients and their family members may be more likely to question multiple diagnostic procedures or frequent office visits. Telemedicine offered at a lower cost or with lower outof-pocket charges may prove to be more palatable. Patients may also be more likely to accept capitated arrangements or limited provider networks in order to achieve savings. Likewise, they may be willing to travel in order to obtain cheaper pricing for elective procedures. Consumer-driven healthcare must be approached carefully. Obviously, making healthcare decisions is much more complicated than purchasing a new set of tires. Physicians and health care professionals must be available to advise patients about their healthcare choices because cost and quality data may not tell the entire story. Healthcare frequently requires an individually-focused approach that depends on a long-term patient/physician relationship for success. Certainly, consumers and patients may make short-term decisions for money-savings reasons to forego tests or procedures that may be necessary for their long-term health. However, consumerdriven healthcare may be part of the answer to stop or slow down efforts to create a single-payor bureaucratic system. Colin Luke is a partner practicing health care law with Waller.
THE 40TH ANNUAL
BRUCE A. HARRIS SYMPOSIUM
Progress in OB/GYN 2015 for Physicians and Nurses Presented by UAB faculty with guest faculty James W. Orr, Jr. MD – Medical Director, Florida Gynecologic Oncology & Regional Cancer Center, Fort Myers, FL C.M.A. “Max” Rogers, IV, MD – Partner, Obstetrics & Gynecology Associates, Adjunct Associate Professor, USA Dept of OB/GYN, Mobile, AL Learn about the most recent advances in OB/GYN, including gynecologic oncology, reproductive endocrinology, gynecology and obstetrics from outstanding course faculty. The Bruce A. Harris Symposium offers educational sessions, opportunities for networking, posters detailing research in various topics of OB/GYN and the ever-popular “Stump the Professor” luncheon.
Up to 13.25 AMA PRA Category 1 Credits™ Maximum of 14.6 Contact Hours
FEBRUARY 19-20, 2015 Hyatt Regency - The Wynfrey Hotel, Riverchase Galleria Birmingham, Alabama
UAB Department of OB/GYN Alumni Reception Thursday, February 19, 2015 5:00–7:00 p.m. RSVP by February 15 to (205) 934-5631 or cgoudy@uabmc.edu The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Alabama School of Medicine designates this educational activity for a maximum of 13.25 AMA PRA Category 1 Credits™. Physicians should only claim the credit commensurate with the extent of their participation in the activity. This symposium is also approved for 14.6 Contact Hours if attending both days. UAB Hospital’s Nursing Continuing Education Department is an approved provider of continuing nursing education by the Alabama Board of Nursing (Provider Number: ABNP0055, Expiration date: June 1, 2017). UAB Hospital’s Nursing Continuing Education Department is an approved provider of continuing nursing education by the Alabama State Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (Provider Number: 5-69, Expiration date: June 1, 2017
Complete agenda, course registration, accreditation, continuing education credit information and hotel registration information are available at uab.edu/medicine/obgyn/progress-in-obgyn. Please call (205) 934-5631 or email cgoudy@uabmc.edu with questions. Sponsored by the UAB Department of OB/GYN, Division of Continuing Medical Education and Hospital’s Nursing Continuing Education Department. The University of Alabama at Birmingham is an equal opportunity/affirmative action institution.
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JANUARY 2015 • 9
Acute Care Hospital Seeks Move to Brookwood By Ann B. DeBellis
Plans are under way to relocate Select Specialty Hospital’s long term acute care services from Trinity Medical Center to Brookwood Medical Center. Administrators anticipate regulatory approval for the move in early 2015. When Select Specialty moves its 38-bed operation to Brookwood, it will continue caring for chronically and critically ill patients in its hospital-within-a-hospital model. “We are a separate company and will have a separate staff from Brookwood,” says Andrea White, Chief Executive Officer of the Select Spe- Andrea White, fourth from right, with staff members from Select Specialty cialty Birmingham Hospital. “We will lease beds nursing facility, nursing home or an acute from Brookwood and will contract with rehabilitation facility. “Our main focus is them for services such as dietary, linens, our pulmonary program, primarily weanradiology and laboratory services that are ing patients off the ventilator,” White says. not feasible for us to do ourselves.” “For many critically ill patients, we are a A Long Term Acute Care Hospital post-ICU destination. These patients have (LTACH) cares for patients with serious a lot of complex medical problems, so in conditions that require special treatment addition to vent weaning, many of them for an extended time, usually 25 or more need services like dialysis, wound care, indays. These facilities offer more individufectious disease and rehab.” alized and intensive care than a skilled
Member of the National CPA Healthcare Advisors Association (HCAA)
Select Specialty’s LTACH has been located within Trinity since 2001 and has served many patients in Alabama. White says the decision to move was a result of Trinity’s upcoming move to its new location on U.S. Highway 280 where it will become Grandview Medical Center. “We leased the space from Trinity, so we didn’t have a license for the beds. When their move was approved, Trinity said they
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would not have room for us in the new facility,” White says. Select Specialty, which operates more than 110 LTACHs across the country, is going through the Certificate of Need (CON) process and has received opposition from Noland Health Services, another LTACH provider in the Birmingham area. As a result, Select Specialty went before an administrative law judge and is anticipating his ruling in time to get their request on the agenda for the January CON meeting. “We are optimistic we will have a good outcome,” White says. In making her case, White points out that because patients from all over the state use Select Specialty’s LTACH, its elimination would leave only Noland to serve these severely ill patients. “We serve an average of 330 patients each year,” White says. “I’m not sure Noland could accommodate the increased volume if we no longer existed. Also, without our facility, patients would lose the ability to choose where they go for care. And we provide 125 jobs in the community using specially trained nurses and respiratory therapists.” Stephen Preston, Vice President of External Affairs at Brookwood Medical Center, says their hospital has sent many patients to Select Specialty’s LTACH over the years and wants to keep these services in Birmingham. Brookwood has never had an LTACH facility on its property and saw this as an opportunity to provide continuation of these services within the community. “Select Specialty has been in Birmingham for 13 years, and it would be a loss to the community if their services no longer existed,” Preston says. “Their special skills complement the services we provide at Brookwood Medical Center, so we made the commitment to lease 38 beds to Select Specialty for the LTACH. They will have a dedicated unit within our hospital. This is an important service that we already have in our state, and people come from as far north as Huntsville to use it. Our partnership with Select Specialty is not necessarily about what they bring to us, it’s about what would happen to very sick patients in our community and our state if their services are lost.”
The Secret Suffering of Doctors
Ophthalmologist pens book about the looming crisis in medicine, a remedy for burnout By JulIe Parker
Missed family gatherings and soccer games, frustration with bureaucracy, dwindling self-worth and utter exhaustion often overshadow the initial call to heal others. In the environment of protracted work days, countless rounds, scarce breaks, and pagers ringing incessantly have led many physicians to opt for early retirement, second-guess their chosen profession, and/or suffer professional burnout. Alarmingly, more than 400 doctors commit suicide annually; the suicide rate is four times higher for women physicians than women in other professions. According to a recent Medical Economics survey, more than one-third of physicians reported that if they could go back in time, they would choose a different specialty – or a different career altogether. With an estimated 90,000 too few physicians practicing by 2020, America’s doctors will continue to work overtime to
meet the demand. “Most of us followed a calling to serve others through practicing medicine,” said Starla Fitch, MD, author of Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine (Langdon Street 2014) “We’ve dediPress, 2014). cated our time, talent and treasure to healing others, but as we (did), many of us forgot how to heal ourselves.” Encountering burnout led to an experience for Fitch, a board-certified ophthalmologist specializing in oculoplastic surgery, which renewed her spirit. One result: she established the popular lovemedicineagain.com, an online community to help medical professionals reconnect with their passion for the practice after surviving life-altering burnout. A featured blogger for Huffington Post, certified life coach and CBS contributor, Fitch wrote Remedy for Burnout to benefit colleagues and doctors-in-training. “The level of burnout among physicians is at an all-time high,” said Fitch.
“A great many of my burned-out colleagues are frustrated with the changes in the relationships within medicine.” One such dysfunctional relationship: the tie between doctors and Dr. Starla insurance companies. Fitch Case in point: a large managed-care network recently removed Fitch’s practice from its list of preferred providers. “Had we not taken good care of our patients? Weren’t we available for those patients 24/7? Did patients complain that my partners and I didn’t deliver quality care? No. No. And no. The managedcare network decided to provide the types of services we provide,” Fitch explained. “It opted to move the services in-house to save money, regardless of the consequences to its patients.” The impact of that decision? One affected patient had been diagnosed with eyelid cancer. Surgery had been scheduled to remove the growth, followed by another surgery for reconstruction, Fitch said. “The loss of continuity that has emerged in our healthcare system hasn’t only disrupted our patients’ health,” she
Ty Thomas, MD Chad Austin, MD Alex Pisaturo, MD Brian Thoma, MD
We do. Leg pain is one of the most common complaints we see. It can be mechanical, referred, radicular, neuropathic, and or vascular. Leg pain is usually a manifestation of an underlying chronic disease, which if not identified and treated, can result in serious complications. Leg pain can be quite difficult to diagnose and is often a mixed bag of neuropathic and vascular pathology. We specialize in diagnosing complicated leg pain and have excellent treatment options available to return function and quality to patients’ lives.
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said, “it’s disrupted physicians’ quality of care.” Fitch’s personal prescriptions call for doctors to: Develop resilience. Practice faith, which Fitch describes as “front and center faith … the kind we doctors have when we make that first incision and trust we’ll be able to later close the wound.” Cultivate self-worth. “Too often, we see ourselves incorrectly,” explained Fitch. “Instead of looking in the mirror and seeing the specialness we possess, we allow what we think other people think about us to enter the equation.” Promote creativity. “Your staff has more creative tips up their sleeves than you can imagine,” said Fitch. “Brainstorm with them on ways to improve patient flow, appointment time congestion, or any number of things that will allow for happier employees and healthier patients.” Fitch also included a section on interpersonal prescriptions, encouraging physicians to: Foster support. “’Grinning and bearing it’ isn’t a successful coping mechanism,” said Fitch. “The stigma around doctors asking for help lingers, unfortunately.”
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Birmingham Medical News
JANUARY 2015 • 11
Planning for a Successful 2015 By Gerard J. Kassouf, CPA
As physicians, most of your time is allocated to your patients and to patient care. Little, if any time is allocated to the business of medicine. However, the business of medicine will be the beginning point of your key to a successful year in 2015. You can best begin by understanding how the practice fared in 2014 and looking at the business strengths and challenges you faced last year. Start by reviewing your financial data for 2014. How much income did the practice generate, and how much was actually collected? Review your collection policy to see if policies are reasonable in today’s business environment, and confirm the policies are being enforced.
Co-pays and deductibles can be collected at the time of the patient’s visit, and doing so can save the time and expense to send a bill and the work to collect the amounts by mail. In the past few months, there has been a surge of new health plans established, and many provide both a primary and secondary payment plan for all eligible employees. This requires a change to handling patient payments. First, understanding the amount of the Co-pays and deductibles. This is accomplished by acquiring patient data (two cards instead of one), collecting the amounts at time of the patient visit, filing a primary claim--collecting it and then filing a secondary claim for the balance of the payment due. It will be more important than ever before to verify all insurance
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coverage at each visit, as the Affordable Care Acts allows grace periods which could improperly report available coverage. If you can’t collect a valid amount due from your patient determine if your collection protocol is active and efficient. Be certain that a collection agency provides routine reporting of accounts it is collecting on your behalf and the status of each account. Take a look at expected 2015 revenue. Review information from insurance companies and government programs to understand changes that may affect revenue. Review your fee schedule at least annually, and when major payers publish new schedules. Review your 2014 expenses--use the
financial statement to budget your 2015 anticipated expenses. It is important for cash flow purposes that you know what expenses to expect or equipment that must be purchased during the year. Meet with your practice administrator to put together the budget. Verify major expense categories, such as salary, retirement plan, supplies and insurance. Take a look at expenses that are expected to rise-- for example, many rental agreements have annual increases built into the lease. Confirm your banking arrangements and available line of credit. With health care changes such as payer payment slowdowns or ICD-10 looming in 2015, you need to have cash available if funds slow down. The plan needs to include a payment strategy and compensation arrangement to complement the anticipated practice income. Review your staffing to confirm that you have the proper number of full time equivalent employees. Every practice is different. But having the right number of employees is crucial to proper practice profitability. Review your practice employee handbook to confirm it is current and up-to-date. Other important topics to consider going into 2015 are the Medicare Incentive Programs. For 2015 The Centers for Medicare and Medicaid Services (CMS) has added 28 new individual measures and removed 73 measures, so that in 2015 there will be a total of 240 measures in its Physician Quality Reporting System (PQRS). Meaningful Use for eligible professionals will provide incentive payments if certain requirements to meet and attest are met. Both PQRS and Meaningful Use provide incentives if met and payment reductions if not met. Visit the CMS website at www.cms.gov for the details. Blue Cross Blue Shield of Alabama Value-Based Payment program allows an opportunity to earn additional amounts for “value-based payment reimbursement codes” found on the BCBS of Alabama website. The three areas of qualification are 1) Cost Efficiency--a risk adjusted score based on acuity and cost efficiency; 2) Patient Focus--including patient satisfaction scores, and participation in NCQA Patient Centered Medical Home or NCQA Diabetes Recognition Programs, and 3) Clinical Effectiveness. More information on this program is available at www.bcbsal.org. The business of medicine constantly changes. Keeping up with patients has transformed with electronic health records. Moving patient information through the “system’ requires information to provide the best patient care, while obtaining information and demographics for proper payment. Both are important for a successful practice in 2015. Gerard J. Kassouf, CPA/PFS, CFP© is a director in the Birmingham, Alabama Accounting and Business Consulting firm of L. Paul Kassouf & Co., P. C. He can be reached at gkassouf@kassouf.com
Birmingham Medical News
JANUARY 2015 • 13
The Literary Examiner BY TERRI SCHLICHENMEYER
Dr. Mütter’s Marvels by Cristin O’Keefe Aptowicz; c.2014, Gotham Books; $27.50 / $32.00 Canada; 384 pages You’ve made an important decision: next year, you’re going under the knife. It’s nothing important, just a medical issue that you’ve put off long enough. Treatment and technology are on your side now although, as you’ll see in “Dr. Mütter’s Marvels” by Cristin O’Keefe Aptowicz, some of the methods your doctor uses may be nearly two centuries old. Young Thomas Mutter was a spoiled child. His parents doted on him and gave him everything: toys, clothes, a Shetland pony, all the accoutrements befitting an early-1800s upper-class Virginia lad. After Thom’s parents, siblings, and grandmother died all within four years’ time, however, everything changed: seven-yearold Thom went to live with a guardian,
who considered the boy somewhat of a burden. Still, he made sure that his ward got an education but at the end of college, Thom fell ill. He was told that the malady would plague him for the rest of his life and he was advised to quit school; instead, impressed with the care he’d received, he decided to become a doctor. He proceeded to medical school in Philadelphia, then to Paris where it was said that a doctor could gain more experience. When Mütter returned to Pennsylvania, he came bursting with ideas and an umlaut in his name. Healthcare in America in the early1800s was, to say the least, lacking. Tuberculosis, cholera, yellow fever, and syphilis were common and misunderstood. Other
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afflictions were the result of workplace conditions or home accidents. Those were the things Mütter focused on; extraordinarily compassionate and very beloved, he’d learned the art of reconstruction in Paris and had devised a way to repair the wounds of burn victims, thus saving those “monsters” from a hidden life. Between teaching at Philadelphia’s Jefferson Medical College and performing surgery, Mütter lobbied for a hospital and recovery rooms for patients, rather than sending them straight home after surgery. He embraced new technologies of anesthesia and the idea of preventing disease through cleanliness. He was, says Aptowicz, a genius – albeit, an ailing one who knew his health problems would shorten his life. And so, before he died in 1859 at age 47, Thomas Dent Mütter strove to leave one last legacy. So you say you love a good drama? “Dr. Mütter’s Marvels” gives you plenty of that, plus intrigue, history, bickering, backbiting, and biography. But while that last feature, a biography on Thomas Mütter, is the focus here, author Cristin O’Keefe Aptowicz doesn’t at ignore the other talented and
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innovative physicians who appeared in and influenced Mütter’s life and his work. Aptowicz’s inclusion of these other men (women weren’t allowed into medical school then) enhances what we learn about Mütter, who would’ve been lauded today but now seems slightly forgotten. I loved this book for its biography, but I stuck with it for its history and I think that if you’re up for a good tale, then you’ll like it, too. For the medically-minded, historians, or for anyone who likes a good bio, “Dr. Mütter’s Marvels” is a delight, no matter how you slice it. Terri Schlichenmeyer. Terri is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.
The Secret, continued from page 11
Embrace compassion. When Fitch asked a colleague advice he would give his 29-year-old self, the doctor said: “Try to be more empathetic. That’s more important than anything else. Having some idea of a patient’s situation really changes the way you treat people.” Encourage connection, “the spark that ignites when you have a conversation in the doctors’ lounge and you laugh at the same jokes, commiserate over the same wins or losses of sports teams, or offer congratulations or condolences for the highs and lows we all experience,” she said. “These relationships have a profound impact on doctors’ lives and are, therefore, the ones that need fostering.” Going forward, Fitch hopes physicians find their own personal remedy to overcome burnout. She uses “entrainment,” a word from the biomusicology world that means “the synchronization of organisms to an external rhythm, often produced by other organisms with which they interact socially.” “Sometimes when I’m in the OR, I ask the anesthesiologist to slightly turn down the volume of the patient’s pulse oximeter,” she said, “as I can feel my own pulse trying to keep time with the patient’s rhythm.” Fitch encourages physicians to “be brave and reach out to others in the community.” “Together,” she said, “we can all find meaning in medicine.”
Remedy: Telemedicine
In the New Health Economy, telemedicine eases physician shortage, improves patient satisfaction and promotes competition By JULIE PARKER
Telemedicine is the key to reforming healthcare, say Telehealth Resource Centers (TRCs) leaders, who are promoting telehealth activity – especially to underserved populations – via 14 regional and national offices, funded by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) Office of Rural Health Policy. “Access to care is becoming more of a problem and telemedicine is the answer, especially because fewer primary doctors are coming out of residency … and more new physicians are moving into specialties,” said Paula Guy, CEO of Global Partnership for TeleHealth and the Florida Partnership for TeleHealth. “Technology is allowing the physician to go to the patient instead of vice versa, and in telemedicine, there are truly no limits.” Paula Guy Early last month, the Southeastern Telehealth Resource Center (SETRC) hosted the first-of-its-kind Florida TeleHealth Summit – Transforming the Delivery of Healthcare – in Orlando, along with the Florida Part-
nership for TeleHealth and Florida State University College of Medicine, to connect state lawmakers and healthcare leaders in preparation for the Florida 2015 legislative session, starting March 3. “Florida’s one of the states that isn’t yet in full swing with telehealth initiatives, which is a direct result of the lack of support from some legislators in the state government,” said attendee Nick Hernandez, CEO of ABISA LLC, a practice management firm based in FlorNick ida. “Legislators need to Hernandez be involved to take it to the next level. Telemedicine isn’t the future … it’s now.” Where’s the Money? Telemedicine advocates have lobbied state lawmakers to pass telehealth legislation that includes, among other provisions, reimbursement for telehealth at the same rate as an in-clinic visit. Only 21 states mandate telemedicine compensation at the same rate as in-person care. “The key to shaping telemedicine policy is to show insurance companies how telemedicine saves lives,” said Hernandez,
who also attended the Florida TaxWatchhosted Telehealth Cornerstone Conference a month earlier in Tallahassee, Fla. “Countless studies across the nation easily prove this.” According to a survey from Foley & Lardner LLP, a national law firm specializing in telemedicine, reimbursement remains one of the biggest obstacles to immediate adoption of telemedicine. Forty-one percent of physician respondents said they’re not reimbursed for telemedicine services; 21 percent reported receiving lower rates from managed care companies for telemedicine than in-person care. “The reimbursement landscape is already changing, and there are many viable options for getting compensated for practicing telemedicine,” said Larry Vernaglia, chair of Foley’s Health Care Practice. Telemedicine already plays an important role in lowering hospital readmission rates, which also allays financial penalties for reimbursement, Guy pointed out. “Heart failure is a great example,” she said. “Telemedicine allows the necessary follow-up and patient education opportunities for those who have been recently discharged. Patients can use simple technology to record heart rhythms and submit other patient biometrics.”
Before telemedicine can truly be embraced, provider licensing and connectivity in rural areas must be addressed, Hernandez pointed out. “It’s a significant barrier (that) a physician must be licensed in each state where he’s practicing,” he said. Only 10 states extend a conditional or telemedicine license to out-of-state physicians: Alabama, Louisiana, and Tennessee in Medical News’ coverage area, and Minnesota, Montana, Nevada, New Mexico, Ohio, Oregon and Texas. “Florida’s been chewing on it for a couple of years at the capitol,” said SETRC director Rena Brewer. “We’re hopeful 2015 is the year for meaningful telehealth policy for Florida.” Problems with broadband connectivity have also hindered telemedicine advancement. “Many believe the proliferation of 4G may be the answer,” noted Hernandez. The Global Picture After an industry conference in Rome Oct. 7-8, 2014, The Economist reported that telemedicine on an international level was “stuck in the waiting room.” “Even smartphones and tablets have (CONTINUED ON PAGE 16)
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always feels like home, because it always comes right from the heart. Our services – include right in the comfort of home. nursing, therapies, disease and pain management, and hospice. So when For more information, please contact: you need us, we’ll be ready with leading clinical solutions and compassionate care For more information, please contact: more please – right in information, the comfort of home.contact: Gentiva HomeFor Health Gentiva 205.941.9981 Home Health 205.941.9981 Gentiva Home Health 205.941.9981 Gentiva Hospice 205.682.9441 Home Health & Hospice Gentiva Hospice 205.870.4340 Home Hospice Gentiva Hospice 205.870.4340 Gentiva Hospice 205.682.9441 Home Health Health &&Hospice For more information, please contact: Gentiva Home Health 205.941.9981 We accept of patients for care regardless age, race, color,sex, national origin,being religion, sex, disability, being a qualified disabled veteran, being aveteran qualified veteran ofor theany Vietnam ents for care regardless age, race, color, nationaloforigin, religion, disability, a qualified disabled veteran, being a qualified disabled ofdisabled the Vietnam era, other era, category Weother accept patients protected for care regardless oforage, race, color, nationaladvance origin, religion, sex, disability, a qualified being a qualified disabled veteran of the Vietnam era, or any other category or any category by law, decisions regarding directives. © 2011 being Gentiva Health disabled Services,veteran, Inc. 3550 Gentiva Hospice 205.682.9441 Home Health & Hospice aw, or decisions regarding © 2011advance Gentiva Health ©Services, Inc. Health 3550 Services, Inc. 3550 protectedadvance by law, or directives. decisions regarding directives. 2011 Gentiva Birmingham Medical News JANUARY 2015 • 15 We accept patients for care regardless of age, race, color, national origin, religion, sex, disability, being a qualified disabled veteran, being a qualified disabled veteran of the Vietnam era, or any other category protected by law, or decisions regarding advance directives. © 2011 Gentiva Health Services, Inc. 3550
HIPAA Privacy During Emergency Situations by
you release to the public? Do you need the patient’s consent to warn the public about the potential exposure? The U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”), the entity responsible for overseeing compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), recently issued guidance on how to address HIPAA privacy in emergency situations, such as the one described above. Importantly, while there are a number of ways in which protected health information can be shared in an emergency situation, you should keep in mind that the protections of HIPAA are not set aside during an emergency. Thus, while it is important to alert the public to the potential exposure, it must be done in a manner that is compliant with HIPAA. HIPAA, however,
Kelli Fleming
A patient arrives at your facility with Ebola-like symptoms. After taking the necessary precautions, you run the requisite tests, conduct a patient interview, and determine that in fact the patient has contracted the Ebola virus. You also learn that the symptoms have been present for a couple of days, but like many people, the patient delayed seeking treatment until the symptoms got worse. After questioning the patient, you discover that since returning from West Africa one week earlier, the patient has returned to work, visited with family, attended church, and been shopping at the local mall, all while exhibiting symptoms. Thus, hundreds of people living in the community have potentially been exposed. What do you do? What information can
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does provide several mechanisms through which information may be released: Public Health Activities: Information protected by HIPAA may be shared without patient consent or authorization to certain public health authorities for certain public health activities. For example, you may disclose to the Centers for Disease Control and Prevention (“CDC”) information required for reporting cases of patients exposed to or suspected of having the Ebola virus. In addition, if other law, such as state law, authorizes you to notify persons at risk of contracting or spreading the disease, you may do so as necessary to prevent or control the spread of the disease. Imminent Danger: Consistent with applicable laws and standards of ethical conduct, information protected by HIPAA may also be shared without patient consent or authorization as necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public. Persons Involved in Patient’s Care: Information protected by HIPAA may also be shared without patient consent or authorization with a patient’s family members, relatives, friends, or other persons identified by the patient as being involved in the patient’s care. You should obtain verbal permission from the patient before doing so, if possible, or be able to reasonably infer that the patient does not object to such disclosure. Further, the information released may only be that which is directly relevant to the person’s involvement in the patient’s care. Facility Directory: Upon request for information regarding a particular patient by name, and as long as a patient has not
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objected, you may release limited facility directory information to acknowledge that a person is a patient and provide general information regarding the patient’s condition (e.g., treated and released, decreased, stable, etc.). However, this provision does not allow you to initiate reports to the media about a patient or disclose detailed information regarding specific tests, procedures, treatment, etc. Patient Authorization: Finally, the simplest and most straightforward way to release information to the public is to obtain written authorization from the patient allowing you to do so. The written authorization must be compliant with HIPAA and must cover the disclosure being made. If the patient will not provide written authorization for the disclosure, the disclosure must fall under one of the items listed above (or another applicable provision of HIPAA) in order to be released. Additional information on the types of disclosures HIPAA does and does not allow in emergency situations is available at: http://www.hhs.gov/ocr/privacy/hipaa/ understanding/special/emergency/emergencysituations.pdf. Kelli Fleming is a partner at Burr & Forman LLP who works exclusively within the firm’s Health Care Practice Group.
Remedy, continued from page 15 failed to usher in the telemedicine revolution,” it said, pointing out that one of the first documented telemedicine practices occurred in 1924, when a recovering patient at home consulted with his doctor via a television link. Telemedicine had been touted as healthcare’s future since NASA began monitoring astronauts in space in the 1960s. “Governments have been slow to embrace an approach that could improve coverage and outcomes … but are under increasing pressure from aging populations and a surge in chronic diseases, just as public budgets are being squeezed.” The situation in the European Union is simpler than in the United States, said The Economist. “Countries may not pass laws that would stop doctors practicing telemedicine, and doctors need only be licensed in one country to practice at all. But member states don’t agree on whether to pay for care that’s administered remotely; some, including Germany, rarely pay for it at all.” In Israel, whose healthcare system is completely digitized, the health ministry saw a spike in telemedicine in 2010; informal guidelines were introduced in 2012. For American physicians, telemedicine offers opportunities to assist in underserved areas of the world. For example, African countries such as Rwanda often consult with U.S. oncologists on difficult cases. “The smartest thing (U.S.) organizations can do now,” said Vernaglia, “is to continue developing programs, and be ready for the law to catch up – because it will.”
Hot Button Legal Issues to Watch in 2015 By CINDY SANDERS, ELISABETH BELMONT & JOEL HAMME
Already one of the most highly regulated industries in America, 2015 looks to be another active year across healthcare’s legal landscape. Two past presidents of the American Health Lawyers Association, Elisabeth Belmont and Joel Hamme, took time to share insights and predictions for the coming year. Subsidies in the Health Insurance Exchanges Under the Affordable Care Act, individuals with incomes between 100 and 400 percent of the federal poverty level are eligible to receive federal tax credit subsidies for purchasing health insurance on the exchanges. Hamme noted that in King v. Burwell, the Fourth Circuit court ruled the IRS acted lawfully in interpreting such subsidies were permissible not only for state exchanges but also for federally run exchanges and those that are a federal-state partnership. However, the Supreme Court has agreed to review this decision. Hamme explained, “Of the 50 states and the District of Columbia, only 17 have state established exchanges; 7 have partnership exchanges and the remaining 27 are federally operated. Thus, if the Supreme Court were to overturn the
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forego the financial advantages of expansion or whether this erosion is abated by those fiercely opposed to the ACA.” He added it will be interesting to see how flexible the federal government might be with respect to work and work search requirements and beneficiary cost-sharing obligations for states that are seeking waivers for alternate expansion models.
About the Experts Elisabeth Belmont, Esq. serves as corporate counsel for MaineHealth, ranked among the nation’s top 100 integrated healthcare delivery networks. She is a member of the Board on Health Care Services for the Institute of Medicine and its Committee on Diagnostic Error in Health Care. Belmont is also a member of the National Quality Forum’s Health IT Patient Safety Measures Standing Committee. In addition to serving as a past president of the American Health Lawyers Association, she is also the former chair of the organization’s HIT Practice Group and the current chair of the Inhouse Counsel Program. In 2007, Modern Healthcare named her to their list of “Top 25 Most Powerful Women in Healthcare.” Joel Hamme, Esq. is a principal with Powers, Pyles, Sutter & Verville in Washington, D.C. He joined the firm in 1998 and focuses his practice on long term care, Medicare and Medicaid reimbursement issues, provider licensure and certification matters, and litigation in his areas of expertise. He is a member of the District of Columbia and Pennsylvania bars, as well as the bars of the Supreme Court of the United States and numerous federal appeals courts. A past president of AHLA, Hamme is a frequent speaker and lecturer on healthcare issues and has authored numerous articles and book chapters relating to healthcare law.
Fourth Circuit’s decision, individuals in two-thirds of the 51 jurisdictions would be ineligible for subsidies for purchasing health insurance on the exchanges.” He added that while there was some debate as to how detrimental such a decision would prove to be to the ACA, certainly it would be a major setback. “The King case essentially represents the last major legal hurdle for the ACA. If the subsidies challenge fails, ACA opponents will be relegated to trying to repeal or significantly modify the ACA by legislative and executive branch actions.” Medicaid Eligibility Expansion Since the Supreme Court ruling that mandatory Medicaid expansion wasn’t permissible, 29 states voluntarily have au-
thorized Medicaid eligibility expansion or obtained federal approval of an alternate expansion plan to take advantage of generous federal financial support tied to the program. However, Hamme pointed out, the 2014 election results impacting governorships and state legislatures seem to have strengthened the numbers of those opposing such expansion in several states that were still weighing the options. “In at least one state, it is conceivable that Medicaid eligibility expansion will be rescinded after having been implemented,” he said. Hamme continued, “For 2015, the key Medicaid eligibility expansion development will be whether the slow erosion of state opposition to expansion continues as states decide that they do not want to
ACA Going Forward As Hamme pointed out, the ACA has already generated several legal decisions and navigated a number of political and operational obstacles in its relatively short life. However, a number of hurdles … including the decision on exchange subsidies and the law’s unpopularity among large swaths of the public … remain. “During 2015, interested observers should look to various barometers to assess whether the ACA is working … and equally important … whether it is gaining the public acceptance needed to assure its political survival,” Hamme said. He added some of those measures would include the administration of the exchanges, whether offerings to consumers were deemed acceptable in terms of plan choices and affordability, a continued decline in the number of uninsured, and whether or not the ACA could continue to withstand legal and political assaults. “Like 2013 and 2014, the coming year will witness numerous developments that will lead either to the ACA’s longterm viability or its premature demise,” Hamme concluded. Fraud and Abuse On Oct. 31, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released the FY-2015 Work Plan. Always eagerly anticipated, the document gives insight into the OIG’s planned reviews and activ(CONTINUED ON PAGE 18)
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Hot Button Legal Issues to Watch in 2015, continued from page 17 ities with respect to HHS programs and operations. Belmont noted, “In the introduction to the Work Plan, OIG stated that, in the coming year, the agency plans to continue to focus on issues such as emerging payment, eligibility, management, IT security vulnerabilities, care quality and access in Medicare and Medicaid, public health and human services programs, and appropriateness of Medicare and Medicaid payments.” Belmont highlighted a few areas of interest for this year: Hospitals: With 22 substantive areas under review, the OIG is deeply engaged with hospital reviews both on the billing and payment side, and quality of care issues, which are a particular priority for current Department of Justice (DOJ) and OIG enforcement efforts. OIG continues to scrutinize CMS contractors’ implementation of outlier reconciliation (of
which the OIG has been critical for many years) and remains intensely interested in inpatient versus outpatient payments, the “two midnight” rule for inpatient admissions, and cardiac catheterizations. Hospice: Hospice billings for general inpatient care, a focus of relators and the DOJ, is under close review by the OIG. Freestanding Clinic Providers: OIG continues to examine certain payment systems such as provider-based services and freestanding clinic payments, with an eye toward reducing disparity of payments based on site of service. Laboratories: OIG added a review of independent clinical laboratory billing requirements, without further specifying the billing requirements at issue. This may coincide with increased local coverage determinations by contactors, OIG enforcement against clinical laboratories under its Civil Monetary Penalties Law
authority, and OIG’s general heightened scrutiny of technical billing and payment compliance by clinical laboratories, especially specialty laboratories. Accountable Care Organizations: OIG intends to conduct a risk assessment of CMS’ administration of the Pioneer ACO Model. Medicaid Managed Care: OIG added a review of state collection of rebates for drugs dispensed to Medicaid managed care enrollees. Medicare Part D: This is an area where there will be continuing scrutiny of the quality of Part D data submitted to CMS. The OIG also plans to follow up on the steps CMS has taken to improve its oversight of Part D sponsors’ Pharmacy and Therapeutics Committee conflict-of-interest procedure in the wake of the OIG’s critical 2013 report.
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Health Information & Technology “Data now is recognized as one of a healthcare organization’s most valuable assets, especially as a result of the transition to a more analytically driven industry,” Belmont said. “Given the increasing importance of data to a healthcare organization, it is advisable for the organization to implement appropriate data governance best practices.” With the accumulation of data also comes an obligation to make sure protected health information (PHI) stays protected. “In 2015, healthcare privacy and security compliance will continue to expand with respect to the scope, number of enforcement bodies and increased enforcement activity, and overlapping sets of requirements,” Belmont said. “In addition to the requirements of the HIPAA Privacy and Security Rules, healthcare providers also will need to navigate requirements promulgated by the Federal Trade Commission, Centers for Medicare and Medicaid Services, Office of the National Coordinator, and state attorney generals. Additionally,” she continued, “increasing exposure for privacy and security breaches may occur as the result of state common or statutory law, despite there being no private right of action with regard to HIPAA violations. As a consequence, healthcare organizations and practitioners need to manage the complex daily operational processes required to maintain appropriate privacy and security of protected health information and devote necessary resources to ensure regulatory compliance.”
BUILD Health Challenge, continued from page 5 of population health management. “Most health systems are comfortable with the clinical determinants of healthcare but often don’t focus as much on the social and economic determinants of healthcare which are so critically important to population health because they feel that they can’t effect, essentially, a change in those areas,” Weaver said. He added the exciting part of the BUILD Health Challenge is that it brings the key stakeholders together to address those upstream barriers going forward. Awards include up to $3.5 million in grants and up to $4 million in low-interest loans. On the grant side, there will be up to five planning awards across a one-year period of up to $75,000 and as many as nine implementation awards of up to $250,000 each across a two-year period. Cofsky said the planning awards are really designed for new partnerships looking to develop a well-defined community health improvement plan, whereas the implementation awards are geared toward collaborations that are already active or have gotten past the initial thought process but need an infusion of resources.
Birmingham Medical News
JANUARY 2015 • 19
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Dealing with Osteoarthritis By Ryan Cordry, DO, MBA
Our body is, of course, our main mode of transportation. Whether you are physically active, exercising several times a week; if you walk to work; or just stroll back and forth from the kitchen to the couch - it takes your body moving to get there. And that involves all those bones inside rotating around, rubbing on each other, and stabilizing your body. Your joints are where all this happens. I want to bring to your attention a common disorder called osteoarthritis (OA). It develops from aging and prolonged or extreme activity on a joint. It typically appears in the hips, knees, shoulders, and spine; all places that bear weight and stress. First, know that OA is a normal occurrence of aging, and the symptoms usually begin showing up around middle age. And if you are 70 years old or older, it is very likely that you are showing at least some symptoms of OA. Also, people with a family history, who are obese, or have suffered trauma will see increased risk of OA. The symptoms of OA include pain in the joints, especially after exercise or when putting weight on the joint. Another sign of OA occurs when you have stiff joints that are difficult to move. This may begin with a cracking sound when the joint moves. Many OA sufferers have morning stiffness where they have difficulty with movement for the first 30 minutes or so, after waking in the morning. While OA is a normal occurrence with age, it is possible to both expedite the onset of OA or to reduce the effects of OA. It has a lot to do with your lifestyle choices. As I mentioned, your body is your main mode of transportation. Some of us have bigger bodies than others. And some of us have bodies that are too big for our personal frames. Preventing obesity will
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help prevent osteoarthritis. Which makes sense, right? The less inactive weight you carry around with you is still pressing down on those joints. The ratio goes at one pound of body weight is equal to five pounds on the hip and knee joints. Exercise helps. Some light impact exercises such as cycling, swimming, elliptical machines, and walking can decrease stress on your joints. You can control the symptoms of OA by keeping the arthritic joint mobile and strengthening the muscle around it. If you give that hurting joint a little bit of help, it will probably reward you with less pain. For OA treatment, it’s best to discuss with your personal doctor. They can help you best get a plan that works you individually. OA Treatments Include: 1) Ice/heat the afflicted area 2) Compression 3) Just resting the joint 4) Changing your activities (do a different exercise) 5) Braces can assist with joint relief and provide stability 6) Medications can be prescribed 7) Physical therapy 8) Injections 9) Surgery. Joint replacement is an option for severe cases. For just about all of us, OA is something we are going to have to deal with at some point. But do what you can in order to lessen the effects of it. Staying healthy, avoiding excess weight, and making smart decisions when it comes to your activities can help you live a more pain-free life.
Ryan Cordry, DO, MBA practices orthopedic surgery at Medical West.
Sleepy Heads By kellI taPley, md
While we encourage our adolescent patients to get enough sleep, we are aware that few are actually getting the recommended 8.5 to 9.5 hours each night. Results from a National Sleep Foundation poll showed that as many as 59 percent of 6th to 8th graders and 87 percent of high school students in U.S. get less than the recommended amount of sleep on school nights and the average amount of schoolnight sleep obtained by high school seniors is fewer than seven hours. However, 71 percent of parents believed that their teen was getting sufficient sleep. For the first time the American Academy of Pediatrics has weighed in on the topic of adolescent sleep. In August the AAP issued a policy statement on school start times, urging middle schools and high schools to begin classes no earlier than 8:30 am, citing research showing the “average teenager in today’s society has difficulty falling asleep before 11 p.m. and is best suited to wake up at 8:00 a.m. or later.” But why is it happening and why weigh in now? Is it simply that they have too much to do before going to sleep (homework and after-school activities)? Or is it due to electronic devices (iphone, ipad, TV) in their bedrooms? Yes, to all of the above but there’s more going on here. Hormonal changes in adolescents result in a delay in the secretion of nocturnal melatonin causing a decrease in sleep drive. Additionally, there is a potential link between screen time and disruption of circadian rhythm. Caffeine also plays a role in shorter sleep duration,
increased wake time after sleep onset and increased daytime sleepiness. The effects of sleep insufficiency are long lasting and potentially fatal. Restricted sleep has been found to increase risk of car crashes, delinquent behavior, depression, and difficulty maintaining focus and attention, and obesity. While there are schools in the US that currently delay starting their day until after 8:30, most do not. The Center for Applied Research and Educational Improvement, citing a study done in Minnesota in which school districts delayed start times for 9th through 12th grades until 8:30, reported higher GPAs, significant increase in attendance rates as well as graduation rates, statistically less depression, as well as fewer school counselor visits for emotional problems and psycho somatic complaints. Not to be understated, 92 percent of their parents reported they were easier to live with. The problem won’t be resolved simply by delayed school start times. The AAP also suggests Pediatricians make sleep part of their well-child care visits with adolescents by educating parents and young people on how much sleep they need on a regular basis and that extra sleep on weekends and caffeine use are not substitutes for regular sufficient sleep. Parents should set bedtimes and enforce a media curfew. Kelli Tapley, MD practices pediatric medicine with Birmingham Pediatric Associates.
Treating Neurological Diseases with LSVT BIG By Sonya l. PearSon, Pt, dPt
LSVT BIG is an evidenced-based neuro-rehabilitation treatment program originally designed to treat the motor impairments related to Parkinson’s Disease. The treatment evolved from the efficacious speech treatment LSVT LOUD (Lee Silverman Voice Therapy). The primary manifestations of Parkinson’s Disease include bradykinesia (slowness of movement) and hypokinesia (decreased amplitude or range of movement). Individuals with Parkinson’s Disease often report that they move slower, have greater difficulty getting dressed, write smaller and are often asked to speak up, all of which can be attributed to the effects of bradykinesia and hypokinesia. The basic principles of LSVT BIG are aimed at increasing the amplitude of movement during everyday activities. The four basic principles of LSVT BIG include high effort, progressive movements, continuous activity and motivation. The delivery of this innovative Physical and Occupational therapy is a hallmark feature of LSVT BIG. The program schedule includes 16 individual therapy sessions, delivered four days a week over the course of four consecutive weeks.
During a typical one-hour LSVT BIG session, participants will perform repetitious exercises, which include whole body movements, functional component tasks and BIG walking trials. In addition to the high frequency of delivery, participants perform LSVT BIG carryover exercises and homework practice one to two times a day while away from therapy during the course of their treatment. This high level of intensity and frequency assists in increasing the amplitude and speed of movement in their everyday lives. Participants in this therapy can potentially experience a number of improvements. Many find that they begin to walk faster with bigger steps. They often have improved balance and increased trunk rotation which can result in improved confidence and restore some hope to the sufferer. Although LSVT BIG was originally designed to treat motor impairments related to Parkinson’s Disease, it has since been successfully used to treat other neurological diseases and injuries including: Stroke, Brain Injury and Multiple Sclerosis. Sonya L. Pearson, PT, DPT is an LSVT BIG Certified Clinician at HealthSouth Lakeshore Outpatient Therapy.
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Grand Rounds UAB’s Federal Research Funding Up Significantly
Funding for UAB from the National Institutes of Health rose more than 20 percent in fiscal year 2014 compared to the previous year. NIH funding to the university totaled $225 million, up from $188 million in 2013, placing UAB 10th in NIH funding among public universities. “This increase in NIH funding underscores UAB’s success in pushing the frontiers of science and advances our aim of being among the nation’s elite, researchintensive institutions,” said UAB President Ray Watts, MD. “These dollars will be leveraged to make potentially gamechanging strides in translational medicine, patient care, and economic development for our community.” NIH funds research at UAB’s professional schools at a substantial level. According to the Blue Ridge Institute for Medical Research rankings, the School of Dentistry is second among dental schools in NIH funding at $11,775,000 in 2014, and the School of Public Health is ninth with grants totaling $28,964,000. The School of Health Professions had NIH funding of $5,696,000 last year, and the School of Optometry had more than $4 million. Since 2008, overall grant funding to the School of Nursing has increased by more than 160 percent, placing the school 31st in NIH funding at $1,621,000.
The School of Medicine secured more than $156.3 million in 2014. This moves the school ranking to No. 26 nationally, up from No. 31 the previous year. Key areas of funding growth include three newly formed research institutes in genomic medicine, personalized medicine and informatics. UAB investigators are making revolutionary strides toward new therapies, including one that potentially could prevent diabetes. Construction of a new Genomic Medicine and Data Sciences Building could help secure an estimated $48 million in additional NIH funding that could create upward of 580 new jobs and have an economic impact of $100 million on Birmingham.
Faculty from Samford’s Cumberland School of Law and College of Health Sciences, as well as compliance professionals from the community, will participate in the program. The program includes coursework in health law, regulatory affairs, public policy, insurance and healthcare administration, with a particular emphasis on healthcare compliance. The online program takes two years to complete. The new online program is one of only eight programs nationally to be accredited by the Compliance Certification Board. The M.S. degree does not replace a traditional juris doctor degree because the M.S. will not qualify graduates for admission to the bar.
Samford Announces Master of Science in Health Law and Policy
Egeland Joins Cockrell
Samford University’s Cumberland School of Law is accepting applications for a new online master of science (M.S.) in health law and policy degree, where professionals in the fields of compliance, human resources, insurance and healthcare administration will gain expertise in health law and policy. The degree also will benefit recent graduates who plan to enter the field of health-care compliance or administration, as well as attorneys interested in health law.
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CVA’s Dye Named President of Brookwood Medical Staff
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Rodger Egeland has joined Bill Cockrell’s consulting firm as a Member and part owner. The firm has been renamed Cockrell, Egeland and Associates, LLC. Egeland has over 25 years of healthcare experience beginning with his role as Division Director of Baptist Health Centers where he was responsible for the growth and development of a 56-provider primary care group with 22 clinic locations. He later served as Executive Administrator of UAB Primary Care, and then Administrator of Montgomery Otolaryngology. This move allows the company to expand its healthcare management and consulting operations in addition to allowing for the addition of a general management and consulting division. With a healthcare focus of management, quality and incentives program design and implementation and strategic planning the company plans to expand its role in Alabama and the southeast.
Larry E. Dye, MD, FACC, cardiologist with Cardiovascular Associates (CVA), was named President of the Medical Staff at Brookwood Medical Center. He will serve a two year term beginning January 2015. Dye received his medical degree from the Uni- Larry E. Dye, MD, FACC versity of Louisville School of Medicine, and did an internal medicine residency at UAB, followed by a Fellowship in Cardiovascular Disease at UAB. He has served in various leadership roles at CVA, where he has practiced as an interventional cardiologist since 1977. “I am honored to serve in this role and continue to work with all of the physicians at Brookwood Medical Center,” Dye said.
New Clinic to Open in Leeds
UAB Medicine will open a $5 million, 17,000-square-foot clinic in Leeds in
the summer of 2015. The internal medicine and pediatric facility, which will be located near the Bass Pro Shop off I-20, will feature double-board-certified physicians who have appointments in the departments of Medicine and Pediatrics. A UAB Hospital outpatient diagnostic center, immediately adjacent to the clinic, will feature MRI, CT, ultrasound, digital X-ray, bone-density scanning and mammography. Full ambulatory lab services also will be provided on-site, and UAB specialists will conduct weekly clinics there. “We are excited about this project,” said Reid Jones, chief operating officer for UAB Health System. “The eastern market is growing so much, and many of our patients from that area travel downtown to receive lab, X-ray and other services. UAB Medicine-Leeds will enable these patients to receive services in a location more convenient to them.” Brasfield & Gorrie are directing the construction of the clinic, and Birmingham-based Johnson Development is leading the planning, financing, and management of the project. UAB Medicine-Leeds will replace the current UAB Medicine-Moody clinic. Stephen Russell, MD will lead the new clinic in its plans to provide enhanced care. “The plan is to have four physicians and two nurse practitioners working together when we are fully functional,” Russell said. “Because we will have radiologists there with six primary care providers practicing simultaneously, we will have many of the diagnostic services you can find at The Kirklin Clinic radiology available to us in Leeds. When you add the specialty suite and the outpatient laboratory, it ensures our patients will continue to receive the quality of care they have come to expect from us.”
Coffin is New CEO of SourceMedical
James M. Coffin, PhD has been named the new Chief Executive Officer of SourceMedical. Coffin mostly recently served as the Worldwide Vice President of Dell’s Healthcare and Life Sciences Division. In his six years at Dell, Coffin James M. transformed the Dell busi- Coffin, PhD ness unit from a PC manufacturer in the HCLS industry into the world’s leading provider of healthcare IT services. Prior to Dell, Coffin held several senior leadership positions within IBM, including his last position as Worldwide VP for IBM’s Healthcare and Life Sciences Industry. “I am honored by the Board’s decision and wish to thank them for extending to me this exciting opportunity to lead the SourceMedical team to the next level in its evolution,” Coffin said.
Grand Rounds Merlin Honored in Hospice
Jessica Merlin, MD, MBA, an assistant professor in the Division of Infectious Diseases at UAB, has been named an inspirational leader in hospice and palliative medicine under the age of 40 by the American Academy of Hospice and Jessica Merlin, Palliative Medicine. MD, MBA Merlin, who earned her medical degree at the University of Pennsylvania, is particularly interested in management of chronic pain within the context of palliative care. Her focus is in patients with HIV. “These patients have higher rates of mental illness and substance use, and I am particularly interested in treating pain and emotional suffering among individuals with these complex co-morbidities,” Merlin said. “There is little research on chronic pain in HIV, and few palliative care physicians choose chronic pain as their focus. This award is very meaningful to me as it brings attention to this understudied area.”
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Kathleen E. McKeon, M.D.
Steven R. Nichols, M.D.
Norman E. Waldrop, III, M.D
Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 • FAX 205.437.1193 Ad Sales: 205.978.5127 All editorial submissions should be mailed to: Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: editor@birminghammedicalnews.com —————————————————— All Subscription requests or address changes should be mailed to: Birmingham Medical News Attn: Subscription Department 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: steve@birminghammedicalnews.com Birmingham Medical News is published monthly by Steve Spencer ©2015 Birmingham Medical News, all rights reserved. Reproduction in whole or in part without written permission is prohibited. Birmingham Medial News will assume no reponsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.
SPECIALTIES
Foot & Ankle • General Orthopaedics • Hand & Wrist Hip • Joint Replacement • Spine & Neck • Sports Medicine Non-Operative Sports Medicine for Adults & Children
Birmingham
Hoover
805 St. Vincent’s Dr, Ste 100 201 Doug Baker Blvd Birmingham AL 35205 Hoover AL 35242
Pelham
3143 Pelham Pkwy Pelham AL 35124
Gardendale
2217 Decatur Hwy, Ste 101 Gardendale AL 35071
205.939.3699 AndrewsSportsMedicine.com
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www.birminghammedicalnews.com Birmingham Medical News
JANUARY 2015 • 23
Relax. Recover. Regain.
Therapy & Medical Services
Full rehabilitation services including orthopedic rehabilitation, neurological rehabilitation cardiac recovery, specialty skin services, and IV therapies. Our resort-like facility has nonstop 24-hour registered nursing care. With a physician order, we can provide on-site nurse practitioner services available to give you even more personalized care. Our Physical Therapy includes two state-of-the-art gyms encompassing over 5,000 square feet and specialty therapy equipment, such as our Zero Gravity System and Omni Virtual Reality System.
Amenities
Our concierge service means there is someone to help you at every corner in the Aspire facility. A full-service spa is available for beauty needs and relaxation. To further your recuperation, Aspire meals are created and prepared by a full-time chef and overseen by a registered dietician.
Facility
Your recovery time at Aspire will be like a luxury vacation with the comfortable feel of home. Our beautiful covered porches offer a wonderful view, and our beautifully appointed living rooms are warmed by fireplaces. Visit the bistro for refreshments and freshly-prepared pastries. Accommodations include high-speed WiFi internet access, in-room refrigerators, highdefinition cable TV, private showers, and telephone services. aspireathoover.com
Contact Anna Rush at 205-721-6200 for more information Conveniently located off Hwy 31 in Hoover 575 Southland Dr | Hoover AL 35226 Medicare, Medicare Advantage Plans and other insurances accepted.
MEET SOME OF OUR STAFF
Dr. Michael Murray
Anna Rush
Nick Beckham
James Tullidge
Medical Director
Community Relations Director
Executive Director
Assistant Executive Director