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Incontinence Ankle Implant Improves Bladder Control By Laura Freeman

Life shouldn’t be measured by the distance to the bathroom. But as urge urinary incontinence (UUI) develops and grows worse through the years, patients tend to find their world shrinking. Where the go, what they do, when they feel comfortable being close to loved ones, and even the dimensions of their dreams can become limited by how far it is to the facilities. Several therapies have been developed to keep patients from being tethered to a toilet, but many come with their own limitations. Now a new op-

tion has become available that meets the middle ground between the need for long-term effectiveness and major invasive procedures. It is designed to offer consistent symptom relief with minimal disruptions to everyday life. “Ankle-based Implantable Tibial Neuromodulation (ITMN) allows simpler placement than a sacral implant. It’s less cumbersome, and we expect the battery to last 15 years rather than the 10 years typically offered by most sacral implants,” Tracey Wilson, MD, professor with the UAB Department of Urology, said. Wilson is the first physician in Ala(CONTINUED ON PAGE 10)

Early Testing and Modern Hearing Technology Can Improve Quality of Life By LeaH kavanagH, aud, ccc-a

When people think about their health, they often prioritize annual physicals, eye exams, and dental visits. Hearing health, however, is frequently overlooked, often until communication becomes difficult. The truth is that hearing loss usually develops gradually, making it easy to miss the early warning signs. Understanding what to look for and knowing when to seek a hearing evaluation can help preserve not only your hearing, but also your overall health and quality of life. Recognizing the Early Signs of Hearing Loss One of the most common complaints

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is feeling like people are mumbling. You may find yourself asking others to repeat themselves more often, especially in noisy environments such as restaurants, family gatherings, or social events. Other common warning signs include: • Turning up the television or radio louder than others prefer • Difficulty following conversations in groups • Feeling exhausted after social interactions or conversations • Avoiding activities or gatherings because hearing has become frustrating • Experiencing tinnitus, commonly described as ringing, buzzing, or humming in the ears (CONTINUED ON PAGE 10)

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Boxing for Cancer By Laura Freeman

some fear. Being 43 rather than 23 makes a difference For psychiatrist Aaron in how you feel a punch Hawkins, MD, stepping and how much physical back into the ring at 43 has resilience you have to rebeen a refresher course in cover from it. This was a practicing what he teaches. U. S. sanctioned event in “I tell patients that Huntsville, so it was the real courage isn’t the absence thing. No one wants to step of fear,” Hawkins said. in front of an audience and “It’s facing the fear and not do well. So I had to find moving forward anyway. what it took to face it. To do that, it helps to con“As I tell patients who nect with something bigger Aaron Hawkins, MD are dealing with anxiety, than yourself that you can panic disorders and phobia, turn to for motivation when things get you can’t limit yourself by avoiding the tough.” fear. What helps is having something beFor Hawkins, that motivation was an yond yourself in place that means enough opportunity to support a friend who has to you to be worth the effort.” stage four colon cancer. Looking for a way Board certified in psychiatry and to help, Hawkins decided to participate in neurology, Hawkins has served as a conthe Russel Hill Cancer Foundation Fight sultant for ABC News on multiple proNight in Huntsville in early August. grams. He was determined to get in the “It was a way I could show my friend best shape possible before the match. and his family support by helping to raise That meant a lot of training and cutmoney for the foundation and building ting back on what he ate so he could get awareness that might lead to earlier testdown to the weight to qualify against his ing and treatment for others,” Hawkins opponent. said. “The opportunity to help gave me “I got a real life reminder of what pasomething bigger than myself that I could tients who were trying to overcome eating turn to when preparing for the fight. disorders, smoking and other addictions “You don’t get back into the boxing and lifestyle changes face every day,” ring after so many years without at least Hawkins said. “But when I didn’t want to

get up to work out, when I was missing foods that weren’t on the meal plan, I had something I cared enough about to motivate me, which made the decision easier. “Since I work with athletes on sports psychology, I knew to expect the mental side of preparation. Performance has so much to do with confidence and being able to The boxing match with Hawkins on left. quiet stress enough to stay in control or regain it if a cooler side of your mind be in charge. case of the yips throws you off. In many That’s a lesson and a skill that can be ways, sports can have a positive effect on beneficial in everyday life,” he said. mental health. There’s a lot it can teach When Hawkins isn’t training or seeabout discipline, patience and the resiling patients, he is CEO and Medical Diience to try again.” rector of the Hawkins Group, which has At first glance, boxing may seem to offices in Shelby County, across Alabama be something that attracts people who and into Tennessee. He often works in the have anger issues. Although it can seem Auburn location, and also teaches at the counterintuitive, Hawkins says many of Edward Via college at Auburn. the people who go into boxing and stay People have asked me what I learned with it for a while seem to become more after stepping into the boxing ring,” adept at controlling their anger. Hawkins said. “The answer has very little “When you aren’t controlling your to do with boxing. I lost the fight, but I anger, you make mistakes and mistakes walked away feeling like I had won somehave immediate consequences. It doesn’t thing far more valuable: a deeper appretake many times of landing hard on your ciation for the courage of the families we bottom to learn the wisdom of letting the were there to support.

Birmingham Medical News

AUGUST 2026 • 3

A Team Approach Opens New Paths to the Pediatric Skull Base By Steve Spencer

The skull base sits at one of the body’s most crowded intersections, where the nose and mouth meet the bottom of the brain. Tumors, birth defects and traumatic injuries here were once only reachable through large craniotomies that pulled the scalp back to work from above. Over the past two decades, endoscopic techniques traveling through the nose have made many of the same lesions accessible with far less trauma to the patient. At UAB and Children’s of Alabama, that shift has taken a particularly unusual form: it is being done routinely in children. Jessica Grayson, MD, an otolaryngologist and rhinologist, and James Johnson, MD, a pediatric neurosurgeon, have built a skull base program around their two areas of expertise. Grayson opens the corridor through the nasal cavity and sinuses. Johnson takes over once the anatomy shifts to brain tissue, cranial nerves and major blood vessels. Both are on faculty at UAB and operate at Children’s, and their partnership predates the COVID19 pandemic.

4 • AUGUST 2026

(left to right) Jessica Grayson, MD and James Johnson, MD.

“What’s interesting about this area, and I think that’s one of the reasons why this partnership is so important, is it’s really the interface between the nose and the mouth, and then the base of the skull and the brain,” Johnson said. “We’ve built a powerful partnership based on Dr. Grayson’s expertise with access to this area through the nose, and my expertise with working with these conditions once you get inside the skull.”

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The conditions the pair treats fall into three categories. Traumatic fractures at the skull base can cause spinal fluid leaks that lead to meningitis. Congenital defects can leave an opening through which brain tissue descends into the nasal cavity, conditions known as encephaloceles or meningoceles. And a range of tumors, from benign pituitary lesions to malignant growths, can sit in a location traditional neurosurgical approaches struggle to

reach. Grayson describes her portion of the procedure as sinus surgery, performed with a camera and small instruments through the nostrils and no incisions on the face. Once the team reaches the interface between nose and brain, the anatomy changes and so does the risk, with optic nerves, carotid arteries and other structures controlling eye and facial function all running through that narrow corridor. That planning has become more efficient the longer the two have worked together. “Just like a group of musicians who’ve been playing for a while,” Johnson said of the shorthand they’ve developed. Johnson determines the surgical angle and how much of the brain he needs to visualize. Grayson then decides how much bone can safely be removed and how the space will be closed, a step she said has been the biggest factor in allowing them do more complex cases. (CONTINUED ON PAGE 5)

A Team Approach Opens New Paths to the Pediatric Skull Base, continued from page 4 One of the more difficult cases the pair has handled involved a teenager with a transclival chordoma, a rare tumor growing in the clivus, a bone shaped like an ice cream cone between the sinuses and the top of the spine. The mass had compressed a cranial nerve controlling eye movement, leaving the patient with double vision. Because that location sits directly in front of the brainstem and basilar artery, the team could not rely on imaging alone to know what they were dealing with. “You often need tissue to confirm that,” Grayson said. “Once you open this space, you’ve potentially exposed an artery and the brain fluid, which increases the risk for meningitis. So you have to have a diagnostic and therapeutic plan up front.” A separate case, involving a two-yearold, shows how easily these conditions can be missed. The child had chronic nasal congestion that appeared to be enlarged adenoids, and a different ENT physician removed adenoid tissue to clear the airway. The obstruction was actually an encephalocele, brain tissue that ha d descended through an opening near the pituitary gland that should have sealed during fetal development. Because the defect connected directly to the spinal fluid surrounding the brain, and the nose is not sterile, the child developed meningitis before the true cause was identified. “The problem with these encephaloceles is that if there is a connection between the brain and the nose, obviously the nose is not sterile,” Grayson said. “Occasionally we’ll have children with this who present with meningitis, and we treat the meningitis, and then go in and repair it.” Before transnasal techniques existed, repairing that kind of defect required a craniotomy, opening the skull from above to seal the opening from the top down, a far more difficult recovery for a small child. Grayson’s fellowship training

in Australia in advanced rhinology and anterior skull base surgery gave the partnership the tools to avoid that approach, though the case carried its own risk: the pituitary gland was intertwined with the defect, and damage to it in a toddler could mean a lifetime without normal growth hormone production. “I’m never afraid to ask a question, even if it may sound stupid, because the worst thing you could do is assume that you know and never ask,” Grayson said. “In something like this, where every decision is very important, we do a lot of double checking, even in the middle of a case.” Johnson agreed the back-and-forth is central to how the team avoids mistakes. “Jessica’s not afraid to tell me if she thinks something’s not a good idea, and it helps me improve my treatment plan,” Johnson said. “Our team approach leads to much better outcomes.” The program handles roughly 15 to 25 combined cases a year, small compared with the hospital’s broader surgical caseload, but substantial for a pediatric skull base program. Most programs of this kind nationally are adult-focused, with adult neurosurgeons occasionally treating children, rather than physicians trained specifically in pediatric neurosurgery. Johnson trained in both before completing a pediatric fellowship and now practices exclusively in pediatrics. Grayson is currently the only physician in Alabama performing this combined procedure at a children’s hospital, making Children’s of Alabama the only in-state option for many families. “Some of this was born a little out of curiosity on each of our parts individually, and some of it out of having a heart for the parents and kids of Alabama, and not wanting them to have to go somewhere else,” Grayson said. “So it matters to us for lots of reasons. We’re both parents, and we care very much about how that affects families.”

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AUGUST 2026 • 5

Routine Procedure, Unprepared System: A Closed Claim Review By Erika Roberts

This closed claim review began like many pain management procedures conducted across America. A familiar patient. A modest dose of Versed. A routine procedure. Unfortunately, when an unexpected complication arose, a rapidly evolving emergency tested a clinical team’s readiness and ended in a tragic loss. The patient, Michael Jameson1, arrived at Dr. Charles Clover’s office for what both anticipated would be another straightforward pain management procedure. Dr. Clover had been treating Mr. Jameson for his chronic back pain for many years. Mr. Jameson had previously undergone a lumbar medial branch block with IV sedation with Dr. Clover, and this procedure was the second one planned. He was on a complex medication regimen, including chronic pain medications, a morphine pain pump, and other pain medications. On the day at issue, the medical assistant, Jasper Crace, managed the intake process but failed to conduct or 1 Names, some facts, and other details have been altered to respect the privacy of the individuals involved.

Erika Roberts

document a medication review and did not obtain Mr. Jameson’s signature on a sedation consent form. He started the IV, drew up 2.5 mg of Versed, showed the syringe to Dr. Clover to confirm the dosage, and administered the medication for situational anxiety. Mr. Jameson was placed faced down on the fluoroscopy table at the start of the procedure. His body was supported for comfort and to allow access along the spine, and Dr. Clover used fluoroscopic imaging to mark the appropriate levels before needle placement. The procedure was completed without any noted complications.

Dr. Clover remained in the room for several minutes afterward, observing Mr. Jameson and conversing with Mr. Jameson’s family member, who was also present. He reported that the patient appeared stable, was breathing comfortably, and had oxygen saturation in the upper 90s. He then left to see his next patient, and Mr. Crace oversaw recovery. Shortly after, Mr. Crace attempted to rouse Mr. Jameson, who did not respond. The wife testified that she was the first to notice he was not breathing and that his lips appeared blue. Mr. Crace

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Birmingham Medical News

and another MA moved Mr. Jameson to a recovery stretcher while he remained facedown. Mr. Crace called out for help and then went to get Dr. Clover. Unbeknownst to Dr. Clover, Mr. Crace had removed the IV and pulse oximeter. When Dr. Clover returned, Mr. Jameson had been turned over and already had a nasal trumpet placed with oxygen applied. He had no palpable pulse, prompting the initiation of CPR. Dr. Clover began airway maneuvers, including a jaw thrust, while instructing staff to call 911, bring the crash cart, (CONTINUED ON PAGE 7)

Routine Procedure, Unprepared System: A Closed Claim Review, continued from page 6 and locate another anesthesiologist (Dr. Alan Conway) for assistance. Dr. Clover attempted intubation twice, but each attempt resulted in esophageal placement, likely due to Mr. Jameson’s difficult airway anatomy. He resumed bag mask ventilation between attempts. Dr. Conway also attempted intubation without success. During this time, oxygen saturation readings no longer registered on the monitor. Dr. Clover established IV access during the code and administered 1 mg of epinephrine per ACLS protocol. Additional medical assistants assisted with chest compressions and bagging. EMS arrived within minutes and ultimately achieved a return of spontaneous circulation. Mr. Jameson was transported by EMS to a hospital, where he remained hospitalized for several days. During that time, his neurological condition did not improve. Dr. Clover visited him in the ICU and attempted to stay informed, though the family later requested no further updates. Mr. Jameson ultimately passed away from complications of an anoxic brain injury. No autopsy was performed. The Jameson family’s shock and grief evolved into anger, and they directed their frustration toward Dr. Clo-

ver and the clinic, whom they perceived as ultimately responsible for Mr. Jameson’s safety. The medical records revealed that neither Mr. Crace nor Dr. Clover documented a day of procedure medication review or confirmed the timing of the morphine pump bolus. The sedation consent form was incomplete, and the clinic’s policies on monitoring, vital sign documentation, and post sedation observation was not followed. The lack of contemporaneous code documentation was also noted. A healthcare liability lawsuit was filed against Dr. Clover and the pain clinic. The plaintiffs (Mr. Jameson’s wife and their children) alleged that inadequate monitoring, delayed recognition of respiratory distress, and deficiencies in the emergency response led to the respiratory arrest, anoxic brain injury, and eventual death. As the suit progressed, the parties moved through depositions, expert review, and exchange of opinions. Plaintiff’s counsel emphasized the family’s emotional loss and concerns about monitoring practices and emergency readiness. Certain testimony, particularly from Mr. Crace, highlighted inconsistencies in documentation and workflow. In response, the defense emphasized Dr. Clover’s longstanding relationship with

the patient, his prior uneventful experience with the same procedure, and expert opinions that the small dose of Versed administered could not, by itself, account for the respiratory arrest. Dr. Clover followed ACLS protocol during the resuscitation, and the return of spontaneous circulation would not have been possible without the combined efforts of Dr. Clover, Dr. Conway, and the clinic staff. Ultimately, the parties reached a resolution that reflected the uncertainty of the facts, disputed causation theories, and the seriousness of the outcome. Key Takeaways Routine procedures still require reliable systems. Even familiar patients and

low dose sedation can become high risk when documentation, communication, or workflow processes are inconsistent. Medication reconciliation must be verified and recorded. A day of procedure

review is especially critical for patients with complex pharmaceutical regimens. Consent and monitoring policies must be followed every time. Incomplete forms

and gaps in documentation increase both clinical and legal vulnerability, even if the procedure itself is uneventful. Clear delegation does not replace oversight. Even where medical assistants can

manage recovery, physicians may still be held responsible for ensuring staff are trained and prepared for emergencies. Emergency readiness determines outcomes. Effective resuscitation requires

available equipment, defined roles, and practiced response. When an event occurs, an unprepared system can magnify its impact. This closed claim highlights how unexpected complications can reveal gaps in even wellintentioned and experienced clinical teams. No single misstep likely caused the outcome; rather, a sequence of errors, communication gaps, and unpracticed processes exposed vulnerabilities at a critical moment. When all members of the care team, regardless of role, share a clear understanding of clinic policies, monitoring expectations, and emergency response workflows, patient safety remains the priority, even during routine procedures. Erika Roberts is a Claims Attorney at SVMIC. She obtained her undergraduate degree from Lipscomb University, and earned her Juris Doctor from the University of Tennessee College of Law. Prior to joining SVMIC, Erika worked for the Tennessee Supreme Court and the Tennessee Court of Appeals and in private practice defending, in part, physicians and other medical providers in healthcare liability claims.

Birmingham Medical News

AUGUST 2026 • 7

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Charging Patients Credit Card Processing Fees: What Is Permissible and What Is Prohibited By Howard Bogard

cally be interpreted as permission). Before implementing a credit card surcharge for any patient population, providers should conduct a comprehensive review of all applicable payor contracts.

As credit card processing fees continue to rise, many healthcare providers are exploring whether they can pass those costs on to patients. The answer depends on a complex interplay between individual payor agreements, credit card network rules and state law. This article provides an overview of the key considerations Alabama providers need to know before passing credit card fees on to patients, known in the industry as surcharging. Commercial Payor Rules and Requirements Effective January 30, 2026, BlueCross BlueShield of Alabama allows PMD providers to impose a credit card surcharge on covered members who use a credit card to pay their copayments or coinsurance. However, the surcharge may not exceed the lesser of the provider’s credit card transaction processing cost or three percent of the payment amount. In addition, the provider must offer members at least one payment option that does not incur a surcharge, such as cash or check. This announcement has generated considerable interest among healthcare

providers. Many providers have long absorbed credit card processing fees, which typically range from 1.5 percent to 3.5 percent per transaction, as a cost of doing business. With rising transaction volumes and thinning margins, the ability to pass these costs to patients is understandably appealing. However, BlueCross’s announcement applies only to its PMD providers and in-

sured members. Each commercial payor maintains its own distinct standards, contract terms and restrictions. A provider that participates in multiple commercial networks must review each payor agreement and associated rules and policies to determine whether surcharging is permitted. Some payors may expressly prohibit surcharging; others may be silent on the issue (but silence should not automati-

Medicare’s Prohibition: A Hard Line While the recent BlueCross policy change offers providers flexibility for BlueCross commercial patients, the rules governing Medicare beneficiaries are far more restrictive. The Medicare program’s statutory and regulatory framework strictly limits what a provider may collect from a beneficiary and credit card surcharges are not permitted. When a physician or other provider participates in Medicare, the provider enters into a Medicare Participating Physician or Supplier Agreement (Form CMS-460), under which the provider agrees to “accept assignment” from Medicare. By accepting assignment, the provider agrees to limit its charges to Medicare beneficiaries to the deductible (if not yet satisfied) and the 20 percent coinsurance applied to the Medicare-approved amount. Specifically, the Agree(CONTINUED ON PAGE 11)

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Incontinence Ankle Implant Improves Bladder Control, continued from page 1 bama to implant the new ankle device. “Unlike botox, the effectiveness of the tibial implant doesn’t wear off in a few months. It’s also less likely that patients will experience the kind of side effects that can occur with medications. They don’t have to suffer for years until their condition warrants the risk of a more invasive surgery. They also don’t have to risk dehydration trying to stay dry by drinking too little,” Wilson said. The device can be quickly implanted in an outpatient procedure using local anesthesia. When healed, it’s barely visible. Either the left or right ankle can be used if the patient doesn’t have uncontrolled diabetes or other severe conditions affecting the feet and legs. “We’re seeing a 65 percent improvement in symptoms and patients like the way it helps them stay dry. About 85 percent tell us they would recommend

Tracey Wilson MD

the procedure to other patients,” Wilson said. The device works by sending a pulse to stimulate the posterior tibial nerve that disrupts the nerve impulses that cause the bladder spasms which result in UUI leakage. The battery powering

the implant only needs to be charged once or twice a year and can be easily recharged through the skin in about fifteen minutes. The relatively new device may not yet be covered by all insurance companies, but it has been covered by Medicare. Urge Urinary Incontinence is often thought of as something that happens in women as they age, but it is a major burden on quality of life that is also common in men and can happen in any age group. At any one time, overactive bladder affects around one in five people and UUI alone impacts seven to 10 percent of women and three to five percent of men with prevalence increasing with age. It is frequently underreported and under treated. “UUI shouldn’t be considered an inevitable part of aging,” Wilson said. “People shouldn’t suffer in silence when

there is now a lot we can do to help them.” In addition to the psychological costs of anxiety, embarrassment and isolation, UUI can cause skin irritation and disruption of sleep. It also adds the financial burden of buying pads, extra clothing and sheets and doing more laundry. Having dry shoes that don’t smell shouldn’t feel like a luxury. People should be able to enjoy a trip to the beach without having to worry about how far it is between rest stops. They should be able to stay in hotels, and visit family and friends overnight without having to worry about how they will keep the sheets and carpet dry on the way to the bathroom. They need to know that help is now available—and it’s okay to ask for it.

Early Testing and Modern Hearing Technology, continued from page 1 Many people assume these changes are simply part of aging, but they may be signs that it’s time for a professional hearing evaluation.

daily communication. For adults over age 50, a baseline hearing test can be a valuable part of routine healthcare.

Why Everyone Should Consider a Baseline Hearing Test A baseline hearing test serves much the same purpose as an annual physical or eye examination—it establishes a starting point for your hearing health. For many adults, the last hearing test they received was during childhood or a school screening. Without a baseline measurement, it can be difficult to determine whether hearing has changed over time. A comprehensive hearing evaluation allows audiologists to identify even subtle

Hearing Loss Affects More Than Your Ears Many people view hearing loss as simply an ear problem. In reality, hearing involves much more than the ears alone. Our ears are just the way in—we actually hear with our brain. When sound isn’t reaching the brain clearly, the brain must work harder to fill in the missing pieces. This extra effort can lead to what experts call listening fatigue, leaving individuals feeling mentally drained after conversations or social interactions. Research has also linked untreated

Leah Kavanagh, AuD, CCC-A

hearing loss and monitor changes as they occur. Early detection often leads to more effective treatment options and can help prevent hearing difficulties from affecting

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hearing loss to several serious health concerns, including: • Social isolation • Depression and anxiety • Increased risk of falls • Cognitive decline Because communication plays such a vital role in daily life, untreated hearing loss can impact relationships, emotional well-being, and overall independence. How Hearing Aid Technology Has Changed One reason some people delay treatment is because they still picture hearing aids as bulky, uncomfortable devices from decades past. Today’s hearing technology is dramatically different. Modern hearing aids are essentially miniature computers designed to help users hear more naturally and comfortably. Advanced features can automatically reduce background noise while enhancing speech, making conversations easier to follow in challenging environments. Many devices also offer Bluetooth connectivity, allowing users to stream phone calls, music, podcasts, and other audio directly to their hearing aids. This seamless integration helps people stay connected at work, home, and during social activities. The result is improved communication, greater confidence, and a better overall listening experience. Leah Kavanagh, AuD, CCC-A is the Director of Audiology at ENT Associates of Alabama. She can be reached at 888-368-5020.

Charging Patients Credit Card Processing Fees: What Is Permissible and What Is Prohibited, continued from page 9 ment states: “The participant shall not collect from the beneficiary or other person or organization for covered services more than the applicable deductible and coinsurance.” Further, under 42 U.S.C. § 1395cc, a provider that enters into a Medicare provider agreement commits “to limit its charges to beneficiaries and to other individuals on their behalf ” to the amounts permitted under Medicare law. Physician compliance guidance issued by the United States Department of Health and Human Services Office of Inspector General (“OIG”) states: “It is legal to charge patients for services that are not covered by Medicare. However, charging an ‘access fee’ or ‘administrative fee’ that simply allows them to obtain Medicare-covered services from your practice constitutes double billing.” While this statement was not issued with respect to credit card fees, it is instructive as to how the OIG might view surcharges. In 2004, the OIG published an alert warning physicians that charging additional fees for covered services would constitute a violation of their assignment agreements and could lead to civil monetary penalties or exclusion from the Medicare program. Imposing a credit card fee on top of allowed payments causes the Medicare

beneficiary’s total payment to exceed the approved amounts and therefore violates the provider’s agreement with Medicare and relevant statutory requirements. The regulatory framework focuses on what the beneficiary actually pays, not if the provider categorizes the payment as a “pass-through” expense. The consequences of violating these Medicare prohibitions are significant. Providers who charge Medicare beneficiaries impermissible fees face potential exclusion from the Medicare program, fines and potential criminal sanctions for knowingly, willfully and repeatedly charging amounts not permitted under assignment rules. Credit Card Network Rules and State Law Limitations: Additional Compliance Layers Even where commercial payor rules permit surcharging, providers must also comply with the contractual rules imposed by the major credit card networks. The Visa, Mastercard and American Express networks each permit merchants in states without anti-surcharge statutes, including Alabama, to impose surcharges on credit card transactions. However, providers must satisfy several conditions. First, the surcharge cannot exceed the

provider’s actual cost of processing the card or three percent of the transaction amount for Visa and four percent for MasterCard, whichever is lower. American Express rules revolve around an “Equal Treatment” mandate, meaning a provider cannot surcharge American Express cards at a higher rate than other credit card networks. Second, the provider must give advance written notice to the card network before implementing the surcharge. Third, the surcharge must be clearly disclosed to the patient or customer at the point of sale and separately itemized on the receipt. Providers should review their merchant agreements with each network for specific terms. Critically, Visa and Mastercard network rules prohibit surcharging debit card transactions. This ban applies nationwide, regardless of state law, and covers both PIN-based and signature-based debit transactions. Providers who surcharge a debit card violate their network card acceptance agreement. Therefore, providers must ensure their systems distinguish between credit and debit transactions. Alabama law does not prohibit merchants, including healthcare providers, from imposing credit card surcharges on customers and patients. However, some

states have enacted prohibitions or heavily restrict surcharges, including Connecticut, Maine and Massachusetts, while other states, including Colorado, Nevada, New York, Minnesota and Virginia, impose disclosure requirements and/or fee limits. Thus, from a state-law perspective, an Alabama provider may impose a credit card surcharge on patients for nonMedicare transactions, subject to specific commercial payor requirements and the card network rules discussed above. Practical Compliance Steps Providers that elect to surcharge non-Medicare patients where permitted by the applicable payor should: (1) register with applicable card networks before implementation; (2) post clear signage at the point of sale disclosing the surcharge; (3) ensure the surcharge appears as a separate line item on receipts; (4) cap the surcharge at the lesser of the provider’s actual credit card processing cost, or three percent or four percent as applicable to the card network; and (5) never apply surcharges to debit card transactions. Howard Bogard is a Partner at Burr & Forman LLP and works exclusively with health care providers on corporate and regulatory matters. He can be reached at (205) 458-5416 or at hbogard@burr.com.

Surgical precision in a soothing environment Alabama DDS Needs Part-time Medical Consultants The Alabama Disability Determination Service (DDS) invites letters of interest from physicians wanting to work part-time as a medical consultant. The work involves reviewing disability claims in the Birmingham or Mobile offices. An Alabama medical license is required.

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Birmingham Medical News

AUGUST 2026 • 11

Crossing the Highway Blindfolded: Why Primary Prevention Fails By Tushar Mishra, MD

It is 2:00 AM. A 50-year-old father of two college-bound teens is flown in from a neighboring county. He hasn’t seen a physician in over ten years. He has smoked since high school, has been heavy since his thirties, has probably needed diabetes medication for years. Tonight, his sudden chest pain escalated into a full cardiac arrest. After a shock to snap his heart out of an arrhythmic dance, he lands on our cath lab table. Thanks to modern medicine - after a few stents, a few days on mechanical support and luck on his side, he gets a second chance at life. Driving home in the quiet hours of the morning, the same question always surfaces. This catastrophic event was decades in the making. He had a massive lead time to course-correct long before coming so close to crossing the one-way door between life and death. As physicians, we know with fair certainty what would likely have prevented, or at least delayed, this disaster. Yet, why do so many willingly cross a busy highway blindfolded, refusing to stop until they are hit?

Tushar Mishra, MD

The answer lies in understanding the mindset of our shared human condition. Fundamentally, we do not want to be patients. Historically, the healthcare system has been conditioned to be viewed as a transactional repair shop: a “pill for an ill.” Patients come to the clinic expecting a rapid, tangible resolution to an immediate discomfort. Primary prevention, however, works on a completely different wavelength. It asks a patient to dedicate their limited daily bandwidth toward a slow, silent, and invisible effort. The abstract benefit of avoiding a myocardial infarction or stroke a decade from now

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rarely competes with the immediate comfort of long-standing habits. Until their body explicitly bothers them, focusing on an intangible threat feels unnecessary. Furthermore, we are asking them to fight their environment. Our mind naturally craves novelty and immediate reward, whereas the daily discipline of prevention is notoriously monotonous. Patients also rely heavily on survivorship bias—they remember their friends and family maintaining identical lifestyles without obvious consequence, making clinical warnings feel exaggerated. They

have also seen people doing all the “right” things, but still facing disease, suggesting the futility of the efforts. Worse, for our most vulnerable populations, there is a steep “Prevention Premium.” The sheer cost in time and money required to secure healthy food, access exercise spaces, and maintain wellness often makes healthy living feel like an inaccessible privilege rather than a medical baseline. Knowing what works clinically is no longer enough. We must understand why it fails behaviorally. Our current strate(CONTINUED ON PAGE 13)

GRAND ROUNDS

BioCryst Closing Birmingham Facility BioCryst Pharmaceuticals is closing its Discovery Center of Excellence in Birmingham by the end of 2026. This change is part of a broader shift to stop internal research and focus instead on external partnerships and licensing “The company is moving away from in-house lab work to find new treatments through outside deals,” CEO Charlie Gayer said. Closing the Birmingham site and ending internal programs reduces expected 2026 non-GAAP operating expenses to about $420 million.

Hoover Approves Grandview FED In July, the Hoover Planning and Zoning Commission approved a conditional-use request for a freestanding emergency department associated with Grandview Medical Center. The 11,000-square-foot facility will be located on Valleydale Road across from the Southlake medical complex. It will house 12 exam rooms with two full-time physicians, and a peak staff of about 20 employees.

Novo Nordisk Gives UAB $4 Million Novo Nordisk has given UAB $4 million to expand its Live HealthSmart Alabama program. Founded in 2019, the program offers free mobile pop-up wellness screenings, resources to help Alabamians access fresh fruits and vegetables, and health and nutrition education initiatives. The funding will be disbursed to Live HealthSmart Alabama over the next three years. The money will go toward expanding the program’s reach in rural areas, starting with Clanton and Oneonta, as well as urban centers like Montgomery. Novo Nordisk first partnered with Live HealthSmart Alabama in 2023 with a $2.7 million investment to expand the program’s reach in communities including Selma, Demopolis and Dothan.

Breast Cancer Research Foundation of Alabama Call for Proposals The Breast Cancer Research Foundation of Alabama (BCRFA) is accepting research proposals for all areas of breast cancer research, including basic science and population-based studies, with the goal of helping investigators secure future extramural funding. Funding Opportunities The BCRFA is currently accepting applications for two distinct funding tracks: 1. Two-Year Research Grants ($100,000) • Designed to support sustained, multi-year research initiatives. • Funded at $50,000 per year over two years. 2. Catalyst Awards ($25,000) • A specialized, single-year grant designed to support early-career investigators. Proposal Submission and Funding Timeline • Proposals will be accepted between August 1 and October 1, 2026. • Grant Award Notifications: December 1, 2026

Crossing the Highway Blindfolded, continued from page 12

gies rely far too heavily on raw data and sheer willpower, because that’s what we are good at. To truly minimize these catastrophic, late-night emergencies, we must re-think our approach. We need to advocate for systems that make the healthy choice the path of least resistance, integrating it so seamlessly into our patients’ lives that it requires no more conscious

Discovery happens When physicians, scientists and researchers with extraordinary talent and passion are given the technology, the facilities, and the support, they achieve great things. The discoveries, innovations and clinical trials happening today will help shape the future of treatments and lead to cures.

effort than brushing their teeth. Tushar Mishra, MD is a board-certified Interventional Cardiologist with Cardiology PC at Baptist Health Princeton Hospital. He completed his cardiovascular fellowship at Wayne State University—where he was named Outstanding Fellow of the Year—and served as Chief Fellow during his interventional training at Mount Sinai Hospital in New York. He has authored over 25 peer-reviewed articles and holds multiple advanced cardiovascular certifications. Brand-DISCOVERY-Bham-Medial-News-Newsprint_4.88x13-PROD.indd 1

Birmingham Medical News

3/4/26 9:29 AM

AUGUST 2026 • 13

GRAND ROUNDS

CCHS Residency Program Appoints New Director

When it comes to your health

EXPERIENCE MATTERS

Russ Guin, MD, clinical assistant professor in the CCHS Department of Family, Internal, and Rural Medicine, has been appointed Director of The University of Alabama Tuscaloosa Family Medicine Residency Program, which is operated by the College. He previously served as the residency’s assistant director for Patient Safety, OSCEs and Community Preceptor Engagement. Guin earned a bachelor’s degree in health sciences at The University of Alabama and his medical degree from The UA School of Medicine. He completed his residency at the UA Tuscaloosa Family Medicine Residency Program and his sports medicine fellowship at CCHS. Guin also cares for patients at University Medical Center’s Family

Russ Guin, MD

Medicine Clinic and Dr. Bill deShazo Sports Medicine Center. He serves as a team physician for UA Athletics and Northside High School. CCHS operates UMC.

Moses Joins UAB Callahan Eye

For us, your health comes first. You are never just another case. If you suffer from allergies or other ear, nose, throat, or hearing problems, we don’t want you to treat your healthcare lightly or ignore symptoms

Ophthalmologist Mary “Mollie” Moses, MD has joined UAB Callahan Eye, and is seeing patients at Lions Eye Clinic, downtown, and Vestavia Moses earned her medical degree from the Medical College of Georgia at Augusta University, where she also completed focused training in biomedical ethics, and holds a Bachelor of Science in Biology from the University of Georgia, graduating magna cum laude. She completed ophthalmology residency at the UAB Department of Ophthalmology and Visual Sciences, where she developed clinical expertise across medical and surgical ophthalmology. She gained extensive experience managing complex ocular disease in both outpatient and surgical

Mollie Moses, MD

settings, with an emphasis on diagnostic accuracy, continuity of care, and thoughtful clinical reasoning.v

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