Birmingham Medical News May 2015

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On Rounds Neurologist Combines Stroke Intervention and Cuban Cooking Camilo R. Gomez, MD has a personal history that few physicians share: he and his family twice had to leave their home countries--first Cuba, then Venezuela-because of what he now calls the “political deterioration” of both nations, before eventually moving to the U.S. ... page 3

True Vision

New Vestibular Ocular Reflex Lab Captures Data for Assessing Concussions

By Laura Freeman

Does “I feel great, doc,” mean a young athlete has recovered from a concussion sufficiently to return to the fray of contact sports? Or could the eagerness to play be greater than the understanding of what can happen if a brain injury isn’t allowed to heal? And with a condition that doesn’t always show up on a standard CT or MRI, how do you monitor patients who are too young to speak for themselves, or who have other difficulties in communicating?

Between an increasing number of traumatic brain injuries and Alabama’s new law requiring that a physician sign off before young athletes with suspected concussions return to play, having to make a judgment call with very little objective evidence is a situation clinicians are facing more often.

“Both diagnosing and monitoring recovery from a traumatic brain injury can be hindered by an absence (CONTINUED ON PAGE 10)

UAB Kicks Off Clinical Study of Drug to Treat Preeclampsia, Decrease Infant Mortality An ongoing Phase III clinical trial for a drug to treat preeclampsia in pregnant women enrolled its first patient at UAB. A successful outcome using this drug could be a significant step toward reduction of pre-term births and infant mortality which have increased significantly over the past 20 years ... page 7

Katherine Weise OD, MBA, FAAO and Claudio Busettini, PhD test a patient with the head accelerometers/oculomotor system.

WOMEN’S HEALTH

New Device Promises Improved Bowel Control in Women

By Ann B. DeBellis

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Dr. Holly Richter, right, performs surgery on a patient.

A new intravaginal device recently approved by the Federal Drug Administration (FDA) and tested at UAB has been proven effective in improving fecal incontinence, a condition that affects more than 20 million women.

The Eclipse System, developed by California-based Pelvalon, Inc., is the first product to use a vaginal insert to control accidental bowel leakage. Restoring bowel control through the vagina is a new concept, and research results of the LIFE study are encouraging for women who suffer from this devastating condition. The results of the trial are described in the March 2015 edition of the journal, Obstetrics and Gynecology.

“The primary treatment for fecal incontinence is conservative behavioral and medical management composed of patient education, fiber supplements, medications to treat diarrhea, and behavioral techniques such as a scheduled toileting regimen and pelvic exercises. Surgical treatments also exist including sphincterplasty, bulking agents and neuromodulation with (CONTINUED ON PAGE 6)

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2 • MAY 2015

Birmingham Medical News

12/12/13 10:10 AM

HEALTHCARE SPOTLIGHT

Neurologist Combines Stroke Intervention and Cuban Cooking

By DaLe shOrt

Camilo R. Gomez, MD has a personal history that few physicians share: he and his family twice had to leave their home countries--first Cuba, then Venezuela--because of what he now calls the “political deterioration” of both nations, before eventually moving to the U.S. What lessons has the world-hopping experience taught him? “Mainly that the U.S. is the greatest country in the world, and I have no interest in living anywhere else,” he says.

Gomez’s American education--a postgraduate one--took place at St. Louis University’s medical center, where he was chief resident in neurology and director of the hospital’s stroke center before he was recruited by UAB in 1995. As a neurologist, his specialty is stroke intervention, and another part of his bio that sets him apart is the number of techniques and terms he’s either introduced, or popularized, in the field.

For example, he coined the cogent phrase “Time Is Brain,” which means that for a patient who’s just suffered a stroke, every second spent awaiting treatment is a precious one. He also introduced the phrase “Code Stroke,” while creating a system similar to the widely used “Code Blue” for cardiac arrest, at a time when there wasn’t such an equivalent for strokes.

“Congress declared the 1990s the ‘Decade of the Brain,’” Gomez says, “with a big push for brain and stroke research. We know that any stroke intervention has to be applied very early to be successful. Time wasted is literally brain wasted. Today that idea is paramount, but at the time it wasn’t. Many physicians were nihilistic in regard to the treatment of stroke.” At the time, he wrote an editorial on the subject that received mixed responses from other doctors.

At UAB, Gomez collaborated with the Birmingham Regional Emergency Medical Services System’s (BREMSS) executive director Joe Acker to create a regional system for stroke management that’s often cited as a national model.

“People have attempted to replicate it, but

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Camilo R. Gomez, MD

there’s nothing else at our level,” Gomez says. “When Brookwood [where he now practices] was recently visited by The Joint Commission, its representative was pleasantly surprised by how the system operates.”

His schooling also includes an MBA degree. “That education has allowed me to better understand the business aspect of medicine and made me better at ne-

gotiating the obstacles in the labyrinth of regulatory issues we deal with daily. I only wish I’d completed that program a decade earlier, because the tools have been so helpful. They’ve given me the ability, for instance, to communicate in the language of administrators. In the future I think you’ll see many more doctors getting MBA degrees.”

In his off-time, he’s made use of his Cuban childhood to become a gourmet cook. “I picked it up from my mother, who was a very good cook. When she was alive, the two of us loved to cook together.

“My original major was chemistry, and cooking is a lot like chemistry. You take these ingredients and then you magically come up with a result that’s better than the sum of all the individual parts.

It’s also not dissimilar to interventional neurology--every procedure has its own equipment and methodology, just as recipes have ingredients and execution.”

People who taste authentic Cuban cuisine for the first time are often surprised, he says. “Contrary to popular belief, it isn’t spicy at all. Certainly nothing like Creole or Cajun dishes.” (Coincidentally, Gomez was part of a team of volunteers from Brookwood Hospital in the annual Cajun Cook-off fundraiser for Girls, Inc. His team won top prize in the

dessert category, for its White Chocolate Bread Pudding. “I had never cooked for so many people before,” he says with a laugh.)

He also helped create an authentic Cuban Food Night at Primeaux Cheese & Vino Restaurant in Birmingham, whose owners are his friends. “They’re from New Orleans. He’s an anesthesiologist, and his wife is an attorney of Cuban descent.”

The five-course menu, with wines, included two roasted pigs Cuban style; other recipes ranged from black beans bisque with a citrus-sherry gelato, to ceviche--a fresh raw seafood dish whose side elements can include corn, avocados, plantain, or other vegetables. And to top it all off, three types of flan for dessert. “It was a lot of work,” Gomez says of the experience, “but it was a great meal, if I do say so.”

As to last month’s historic normalization of relations between the U.S. and Cuba, Gomez says he feels the same way many Cubans do: ambivalent.

“On one hand, the embargo should have been lifted many years ago, for a variety of reasons, if nothing else because it is simple common sense. On the other hand, the devil is in the details, and I don’t completely trust the motivation of the government. It’s like we’re all waiting to see what’s behind Door Number Two.”

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Birmingham Medical News

MAY 2015 • 3

PAIN MANAGEMENT

When the Hurt Goes On Empowering Patients to Cope With Chronic Pain

By Laura Freeman

Few things make a person feel as helpless as relentless pain. When you wake up in the morning, the only thing you can be sure of is hurting. How much on any given day may vary.

Will you be able to work today? Will you be able to play with your grandchild, or lift your toddler into the car seat? Will you be able to stand at the stove long enough to cook meals? Can friends come over--or are you living in dread that someone might drop by before you feel well enough to catch up on housework?

For someone who has never lived with

chronic pain, it may be difficult to fully appreciate how much it can impact almost every aspect of everyday life.

When aspirin and over the counter pain killers no longer take the edge off, when even the prescription you used next week’s grocery money to buy is hit or miss, when the pain goes on for weeks, months, years—it can become almost as painful to the spirit as it is to the body.

The management of chronic pain is a medical specialty geared to giving people back their lives.

“It’s important to help patients own their pain and give them strategies they can use to deal with it on a daily basis,”

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Chad Austin, MD, of Alabama Pain Physicians, said. “We work with patients to help them find what works for them.

“The first thing is to make sure we have a solid diagnosis. Some- Chad Austin, MD times more than one thing may be going on.

What at first could appear to be a spinal issue may turn out to be arthritis in the lumbar area, which needs an entirely different treatment.

“Patients who have been experiencing chronic pain for a while may already be taking pain medicines, which can cloud the issue and make the source of the pain more difficult to find. Sometimes we have to work backwards.

“When we have a clear sense of what seems to be happening in that particular patient’s case, we can start putting together the best combination of medications, procedures and support strategies that are likely to be most effective.

“No one single thing is right for everyone and every type of pain,” Austin said.

“We use multiple modalities in our practice to attack the pain from several approaches at one time. That may include non-opiate pain killers, antiinflammatories, injections, blocks or radioablation. Bracing, physical therapy and massage may help. The psychology of pain is also an essential factor.

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and depression that come with chronic pain can make a difference.

“Instead of feeling helpless, we want patients to feel empowered. At each visit, we ask them what they are doing to deal with their pain. For some, it may be listening to music or getting involved in hobbies they enjoy. It may be stretching or doing relaxation exercises. Finding what works for them helps them to feel they have at least some power over their pain instead of feeling like a victim of it.

“If other medications are not enough, there are some cases where opiates may be necessary. However, they are never the sole treatment,” Austin said. “If a patient comes back every couple of months asking for a higher dose, that may not mean they are just wanting more of the euphoria that opiates can provide. It could be a sign that their condition is changing or getting worse, and we need to look at that. After a time, they may be developing a tolerance, and we may try rotating drugs or varying the dosage.”

What happens if someone needs an opiate, but can’t take it?

“If there is a history of addiction, Suboxone can be a good option. It blocks the receptors that cause euphoria and will also block euphoria from other meds,” Austin said.

“Overall, chronic pain is treated like a chronic disease. We work to get it stable and knock it down to a manageable level to improve function. Managing patient expectations is also important. Not everyone is going to be 100 percent pain free. Most will have at least some pain, some of the time, but having a plan in place for dealing with it, and knowing that help is there when they need it can make a tremendous difference in quality of life.”

All patients come to Alabama Pain Physicians by referral, and the clinic works closely with the referring physician to coordinate care.

If a physician is considering referring a patient for pain management, Austin advises, “the sooner, the better. If we can start treatment early enough, we might be able to intervene before it becomes a chronic problem.”

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colostomy as a last resort,” says Holly E. Richter, PhD, MD, director of the Division of Urogynecology & Pelvic Reconstructive Surgery at UAB and past president of the Society for Gynecological Surgeons. She was the national principal investigator of the LIFE study trial. “The Eclipse intravaginal device can be used in conjunction with the mainstay conservative treatment approach and tried before surgical treatments are considered,” she adds.

The prevalence of fecal incontinence in women, young and old, is approximately four to 20 percent with greater occurrence among older women. “The most common causes are anatomic and neurologic injury,” Richter says. “The primary inciting event for most women is childbirth, however, there are other functional causes such as chronic diarrhea and fecal urgency that are treatable.”

The LIFE study followed 61 women at six U.S. sites, including UAB, who experienced four or more bowel incontinence accidents over two weeks and used the Eclipse System for one month with an option to continue to three months. Results showed that at one month, 86 percent of women who used the system saw improvement in bowel control. The success rate at three months was similar, suggesting that this effect is maintained. The women experienced a significant improvement in bowel incontinence episodes and quality of life without serious adverse events related to the device.

The device comes in various sizes and is initially fitted by a clinician. After proper fitting, the patient is taught to inflate and deflate the balloon in the device as needed.

It works by exerting pressure on the rectum through the vaginal wall, just where a tampon typically is positioned, effectively closing off the rectum. When a trip to the bathroom is needed, the woman deflates the device then re-inflates it using an external pump that she carries with her. “Its effects are quality-of-life altering, and it is easy to use,” Richter says. “Women learn how to place and remove the device, how to pump it up and how to deflate it. It promises to be quality-of-life-changing for many.”

Pelvalon has not started marketing the device which was approved by the FDA in February. They are preparing for another study that will look at longer-term outcomes.

Richter will again lead this multi-site study and UAB will again be a site for the new LIBERATE study. Research sites will begin enrolling participants in May 2015. Anyone interested in more information and/or in participating in the study can call (205) 934-3178.

“For this study, participants will first be fitted with a test device that will not be their permanent device. Just as with other vaginal devices, sometimes you have to change them out a time or two to get the right fit,” Richter says. “Once fit and the permanent device is provided, the primary outcome of the study will be at three months, and we will also look at outcomes as far out as a year. We are very excited about that.”

Richter is also happy about the possibility of being able to offer these patients a low-risk, nonsurgical treatment option for immediate bowel control. “This approach to therapy provides immediate effectiveness and allows patients to be proactive partners with their doctors in the management of a condition that keeps them from being active in family and social events,” she says.

WOMEN’S HEALTH

UAB Kicks Off Clinical Study of Drug to Treat Preeclampsia, Decrease Infant Mortality

By Ann B. DeBellis

An ongoing Phase III clinical trial for a drug to treat preeclampsia in pregnant women enrolled its first patient at UAB. A successful outcome using this drug could be a significant step toward reduction of pre-term births and infant mortality which have increased significantly over the past 20 years.

Preeclampsia affects about five percent of pregnant women and often presents early in pregnancy with el- Dr. Alan Tita talks with a patient. evated blood pressure and kidney cies and medical conditions such as diabetes abnormalities, among other symptoms. The and chronic hypertension.” condition can have serious and often fatal imCurrently, the only treatment that can plications for both mother and baby. reverse preeclampsia is delivery of the baby, “It is one of the major causes of death but Tita is hopeful that the Federal Drug and disability for the pregnant woman and Administration (FDA) approved medicine her offspring. The cause is unknown, but it is ATryn® - an antithrombin recombinant – thought to occur because of certain changes being tested in the PRESERVE-1 trial will in the placenta,” says Alan Tita, MD, PhD, prolong pregnancy in mothers with earlyprofessor of Obstetrics and Gynecology in onset preeclampsia and reduce the high rates UAB’s School of Medicine and a lead invesof perinatal mortality and disability it causes. tigator for the trial. “The number of cases is The medicine is already being used for the increasing because of increasing frequency prevention of blood clots in pregnant women of risk factors that include older materand surgical patients who have a natural nal age, obesity, first pregnancies in older inability to produce enough of their own women, prior preeclampsia, twin pregnan-

antithrombin, but the safety and effectiveness of the drug in early-onset preeclampsia has not been studied.

“ATryn® is already approved for use in pregnant and non-pregnant populations for other reasons and has anti-inflammatory and blood-thinning capabilities that may work against some of the mechanics that we think are involved in preeclampsia.” Tita says. “Based on preliminary studies, there is promising information to support this study.”

Preeclampsia can typically occur anytime between 20 weeks of pregnancy and full-term at 40 to 41 weeks. Those who develop the condition early, develop it prior to 34 weeks. The PRESERVE-1 study will test the safety and efficacy of antithrombin in women with preeclampsia that occurs between 23 and 30 weeks of pregnancy, because early-onset of the condition is the most serious form.

“We are enrolling women who develop preeclampsia prior to 30 weeks, because that defines a high-risk population that is likely to have severe outcomes for both mother and baby,” Tita says. “If we are able to show a benefit to this group through the trial, we then could mount another study for those

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patients who develop the condition later in pregnancy.”

UAB is among many medical centers participating in the trial, Tita says, and continues to enroll the largest number of participants in the study because of the high-risk population served statewide, referrals from primary providers and the dedication of the clinical and research teams. He encourages Alabama healthcare providers with patients who may have early onset preeclampsia to contact study investigators. “We are happy to offer the opportunity for eligible patients to participate in this trial,” he says. “They can contact the Maternal/Fetal Medicine (MFM) physician on call at UAB to arrange medical transfer and to discuss the possibility of participation in the study. The MFM provider on call will alert the study team.”

Tita hopes this trial will demonstrate that the medication will prolong pregnancy and lead to improvements in pregnancy outcomes for the baby. “If it is a positive trial, that means we will have been able to prolong pregnancy,” he says. “And when you prolong pregnancy, you also increase gestational age which likely leads to an improvement in the ultimate outcomes for the babies born to women with early-onset preeclampsia.”

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Birmingham Medical News

MAY 2015 • 7

WOMEN’S HEALTH

Society for Women’s Health Research Celebrating 25 years of moving the science forward

By CINDY SANDERS

Are women being adequately represented in clinical trials at the National Institutes of Health?

That simple question, pondered by Florence Haseltine, PhD, MD more than a quarter of a century ago, has led to sweeping changes in the way women are viewed on a physical, behavioral … and now … molecular basis.

Changing the Status Quo

In the mid-1980s, Haseltine was working at the National Institute of Child Health and Human Development, which focused almost exclusively on women’s health in terms of maternal issues. Haseltine, who coined the term ‘sex-based biology,’ began gathering friends and colleagues together to champion additional women’s health concerns including endometriosis and ovarian cancer. Quickly, the mission grew to encompass much broader issues that disproportionately or differently impact women beyond the narrow scope of gynecologic disease.

The result was the formation of the Society for Women’s Health Research (SWHR) in 1990. One of the people tapped to be part of that early volunteer board was Phyllis Phyllis Greenberger, who Greenberger

agreed to go to Capitol Hill with Haseltine to speak to the Congressional Caucus for Women’s Health Issues. “It turns out there was a 1985 Public Health Service report that was written by two doctors at the NIH that looked at whether there was enough attention on women’s health issues and were women being included in research. We used that report as ammunition,” Greenberger recalled, noting the answer to both questions was a resounding ‘no.’

At the behest of Greenberger and other SWHR volunteers, several members of Congress asked the Government Accounting Office (GAO) to investigate the NIH’s inclusion of women. Greenberger noted at that time the focus was on the disease without consideration of gender … even when the disease in question

was known to disproportionately affect women, such as osteoporosis. “Nobody had any sort of separate designation for women, and it was mostly men in clinical trials,” she said. Greenberger added the safety profiles and effectiveness data of many drugs were based on outcomes of the mostly young, healthy, white men who populated clinical trials.

In the aftermath of the severe birth defects that resulted from use of thalidomide and DES, women of childbearing years had been generally excluded from participating in pharmaceutical trials by a Food & Drug Administration (FDA) guideline released 13 years earlier. When NIH directors were effectively ‘called on the carpet’ as a result of the GAO audit, Greenberger said the excuse for not using more women (of any age) was pinned on hormonal changes that could make it more difficult to measure results, coupled with a belief that men and women were basically alike except for the reproductive system.

A Big Year for Change

By 1993, the volunteer group made the decision to formalize and become a 501(c)(3) organization. Greenberger, who viewed the daunting task of changing the status quo as “fun and challenging,” applied for the founding staff leadership position with SWHR. As president and CEO, Greenberger has witnessed tremendous change in how women are as-

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similated into biomedical research but still sees the long road ahead to fully embrace diversity from bench to bedside.

That same year, Congress passed the NIH Revitalization Act of 1993, which SWHR had worked tirelessly to get passed. The legislation mandated women and minorities be included in clinical research and required Phase III trials be analyzed by gender. In light of the changes at the NIH, the FDA rescinded its earlier guideline mandating the exclusion of women with childbearing potential.

Moving the Science Forward

Although 1993 was a landmark year in terms of new rules and regulations for women’s health, Martha Nolan, JD, vice president of Public Policy for SWHR, noted it was simply a starting point.

“Just changing the law didn’t necessarily turn a switch and have everyone be in agreement,” Martha Nolan, JD she said. “There was a lot of pushback.”

One example of the uphill battle to institute change is evident in the amount of time it took to codify various women’s health initiatives across the federal government. The 1993 Revitalization Act made the Office of Research on Women’s Health at the NIH permanent. However, a number of other similar initiatives were soon launched across federal agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA) and CDC. The Women’s Health Office Act (WHOA) was an effort to make these new entities permanent.

“In 1994, then Rep. (Olympia) Snowe (R-Maine), who became Sen. Snowe, introduced this legislation for the first time,” Nolan said. “It became law in 2010 when it passed in the Affordable Care Act.” Greenberger added, “It took us 16 years to get the women’s health offices into law to protect them.”

It only took about one-third of that time to get the Institute of Medicine to acknowledge the validity of sex-based biology. The organization submitted a proposal to Congress to have the IOM chart the future of medical research in terms of sex in 1996. Five years later, “Exploring the Biological Contributions to Human Health: Does Sex Matter?” concluded that, indeed, it does.

“Phyllis’ effort between 1993 and 2001 was to try to change the scientific and medical practice perspective,” said Nolan. SWHR launched scientific advisory meetings designed to engage the research community in debate and discussion about the role of sex and gender differences in a variety of diseases and conditions including the autoimmune sys(CONTINUED ON PAGE 14)

House Passes Permanent Doc Fix Bill to Repeal SGR

By Philip M. Sprinkle II, Esq. and Natalie R. Majeed, Esq.

The House of Representatives voted on March 26, 2015 to pass the Medicare Access and CHIP Reauthorization Act of 2015. The Bill proposes to permanently repeal the Medicare sustainable growth rate (SGR), strengthens Medicare access by improving physician payments, reauthorizes the Children’s Health Insurance Program (CHIP), and implements other measures that target fraud and abuse as well as quality incentives. The Bill is now in the hands of the Senate, which expects to address the Bill soon after it reconvenes in mid-April. The SGR Bill received unusual bipartisan support in the House: a vote of 392 in favor to 37 opposed (last year’s corrective legislation was torpedoed with the addition of last minute political changes unrelated to the SGR).

For decades, Congress has routinely “doc fixed” (suspended) the fee schedule adjustments on a temporary basis so that physician reimbursement is not cut at the steep SGR level. Since 2000, there have been no less than 13 stopgap measures to avoid the significant reimbursement reductions required by the SGR. Nevertheless, Medicare payments still effectively

decreased every year as a result of a failure to keep pace with inflation.

Under this year’s SGR formula, physicians face a decrease in Medicare reimbursement rates of approximately 21 percent beginning on April 1st. Historically, CMS has delayed claims processing until there has been an SGR fix, and it is anticipated that it will do so again this year, until the Senate has had a chance to vote on the Bill. A final vote is anticipated as of the date of this article’s publication.

If implemented, the Bill would increase physician payments under the Medicare Physician Fee Schedule (MPFS) by 0.5 percent per year through 2019, halt any increase between 2020 and 2025, and then increase rates in one of two ways for 2026 and beyond. For most providers, the increase will level at 0.25 percent. For those using alternative payment models, the increase will be set at 0.75 percent.

Although repeal of SGR has long been recommended by, among others, the Trustees of the Medicare program, the Bill contains a number of other potentially more important changes. For example, the overhaul of the current physician payment system based on the SGR formula is replaced with a new system that rewards use of quality and accountability models.

This is not a surprise as the quality trend is quickly replacing fee-for-service systems.

Once the MPFS rates halt, bonus and incentive plans become active. The Bill offers a five percent bonus for physicians who receive at least 25 percent of their Medicare revenue from alternative payment models centered on quality by 2019, and these incentives increase in future years for physicians who meet yet-to-beestablished quality criteria, utilize EHR and participate in managed care plans or certified patient centered medical homes.

The theme of the Bill is quality enhancement and payment for quality successes. For example, the Bill also adopts a Merit Based Incentive Payment System (MIPS) that consolidates the electronic health records incentive program, the Physician Quality Reporting System and the value based payment program. Under MIPS, bonuses and penalties start at four percent in 2019, increase to five percent in 2020 and seven percent in 2021, and then cap at nine percent in 2022 and beyond.

Providers who use alternative payment systems would be exempt from MIPS. Performance is scored based on quality, resource use, clinical practice improvement activities and meaningful use of certified EHR technology.

HEALTHCARE CODING BOOT CAMP

Consistent with the theme of quality and risk controls but apart from repeal of the SGR, the Bill also addresses other isolated issues, in some cases increasing restrictions and in some cases relaxing them.

For example, the bill tightens Medigap utilization by (i) making new Medicare beneficiaries ineligible from obtaining Medigap policies which provide coverage of the Part B deductible starting in 2020, and (ii) issuing an income-related premium adjustment for Parts B and D, effectively requiring more affluent seniors to pay higher premiums. However, the Bill relaxes the gainsharing law by imposing penalties only when there is a reduction of medically necessary services but authorizes the development of an AKS “safe harbor” for gainsharing. The gainsharing law currently imposes civil monetary penalties (CMPs) when payments are made by hospitals to “reduce or limit services” to Medicare beneficiaries.

Other major components of the bill include extending CHIP for two years, the development of incentives for States to participate in Medicare expansion, requiring Medicare administrative contractors to conduct outreach and training programs on improper billing, delaying (CONTINUED ON PAGE 14)

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MAY 2015 • 9

True Vision, continued from page 1 of reliable biomarkers. Some functional and metabolic neural alterations aren’t well visualized with existing imaging technology,” UAB Vision Sciences researcher Claudio Busettini, PhD said.

“However, even if young athletes who want to get back to their team overstate how well they are doing, eye movements from vestibular ocular reflexes are a test that can’t be fudged.”

UAB School of Optometry and the Department of Rehabilitation are joining forces with Children’s Hospital of Alabama to make a powerful new diagnostic tool available that can provide objective, real-time data on what is happening inside the brain. The new Vestibular and Oculomotor Research Laboratory, or VORLab, will assess signs of acute traumatic brain injury and the cumulative effects of head injuries using a new technology that tracks eye movement in

response to changes in body position. The VORLab is the first in Alabama and one of only a few in the United States.

Like a steadycam movie camera with built-in gyros that keep the picture level when a cameraman walks alongside an actor, the vestibular-oculo-reflex system keeps vision clear while the body is in motion. Input from sensors in the inner ear interacts through the brain with eye movements to stabilize retinal images as the body moves through three dimensional space. Patterns of eye movement in the normal brain tend to change with brain injuries. Ongoing research is fine tuning the science of tracking, measuring and monitoring these movement patterns to detect acute injuries and progress as the healing process continues.

Co-director and technical manager of the new facility, Busettini said, “Due to their sensitivity and specificity, vestibular

and oculomotor testing may offer powerful biomarkers for both initial diagnosis and short and long-term rehabilitation.

The initial focus of the lab will be oculomotor research and evaluating children with mild traumatic brain injuries, with broader applications in research and diagnosis as the program develops.”

The centerpiece of the new lab is a chair system by Neuro Kinetics that performs horizontal, vertical and torsional movements with real time digital tracking of binocular eye movements and stimulus feedback without lag time. The chair can accommodate patients up to 400 pounds, and analysis software tracks and correlates eye movement with the movement of the chair to detect patterns that might indicate a problem.

Katherine Weise, OD, MBA, FAAO is a co-director of the project and heads up the UAB Eye Care Pediatric Clinic,

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which sees 6,000 patients under 18 each year.

“Younger patients account for a large percentage of traumatic brain injury cases. Their neck muscles tend to be less developed, which puts them at greater risk for rotational injuries. This project is a collaborative effort. We’re working with the departments of Ophthalmology, Neurology, Neurosurgery, and Rehabilitation, as well as Sports Medicine and Bioengineering and other specialties.”

Traumatic brain injuries are the most frequently occurring brain disorder, ahead of stroke and dementia. In very young and elderly patients, falls are the most common cause. Traffic accidents, job related injuries and combat injuries in military personnel add to the toll. Recreation and sports-related injuries are common, particularly in older children, teens and young adults. The American Academy of Pediatrics estimates that up to 3.8 million recreation and sports-related concussions occur annually in the United States.

“In addition to evaluating when it is safe for patients to return to play, what makes an accurate assessment of injuries and healing important in young people is that the brain needs time and rest to heal,” Weise said. “Injured brain cells need more glucose, and returning to study or demanding mental work too soon can compete for resources the healing brain needs and interfere with recovery.”

UAB is also involved in outreach programs to help prevent injuries and increase awareness of symptoms so possible concussions are recognized and children receive appropriate care.

“Among some high school athletic teams, especially in the inner city, being able to take a hard hit and just walk it off is considered something of a badge of honor,” Busettini said. “We’re working with the CDC’s Heads Up initiative and the Wise Up initiative sponsored by the Al and Sharyne Wallace Family Foundation.

We want athletes and coaches to be aware that concussions are something to take seriously. We also want to help them learn to recognize symptoms so they will know when an athlete may need follow up.”

Busettini hopes to be on the football sidelines soon testing a more portable form of concussion detection that uses a handheld device to measure changes in pupil movement. In the lab, he and the VOR team will continue doing research looking for new biomarkers to detect concussions.

In the future, the VORLab would potentially be useful in the assessment of NASA astronauts, helping veterans with blast injuries and research into a wide range of conditions including Alzheimer’s and cerebral palsy.

REPRINTS: If you would like to order a reprint of a Medical News article in a PDF format or request an additional copy of an issue, please email: subscribe@medicalnewsinc. com for information.

10 • MAY 2015

Birmingham Medical News

Where Have All the Practice Administrators Gone?

By Jane Ehrhardt

“There’s already a shortage, and it’s going to get worse,” says Jim Stroud, a CPA with the Warren Averett healthcare consulting group. According to local job listings, medical practices and hospitals are finding it hard to fill practice administrator openings.

“I run the job board Jim Stroud, CPA for the Birmingham Medical Group Management Association (MGMA),” says Jason Biddy, past president of the group and administrator at Alabama Allergy and Asthma Center in Birmingham. “In the Jason Biddy past year, the volume of posts for administrators and practice managers has continually increased. We have seven on the board right now.”

In 2012, administrator jobs appeared on the board only occasionally and stayed up for a short period. “But there’s one right now for an orthopedic group that has been open for three months,” Biddy

says.

The acquisition of practices by hospitals seems to have generated a surge in opportunities. “If you’re managing one or two doctors, it’s a pretty simple process so you don’t have to have highly skilled managers,” says Mickey Trimm, PhD, UAB associate professor and director for the Center for Healthcare Management and Leadership. “But Mickey when you join a hospital Trimm, PhD with a practice of 15 to 30 doctors, all of a sudden it’s big business and complex and difficult to manage.”

Unlike the small to medium practices they purchase, hospitals need administrators used to supervising middle management and strategizing expansions and revenue generation. “The hospital may also be thinking they can get someone cheaper than the current administrator, because he’s been there for 25 years and doesn’t meet their education requirement with only a high school diploma,” Stroud says.

Most hospitals want administrators with master’s degrees. “Most of the grad students coming through our program get scooped up by big healthcare systems,”

Trimm says. “We put a lot into Baptist and Tenet.” UAB turns out 30 to 35 graduates a year from their masters in health service administration program. “It’s effectively an MBA in healthcare,” he says.

All the grads have jobs before graduating. Practices rarely get a chance to compete, because students serve a year-long residency with a health system as part of the school’s program. “And they typically get hired into that organization,” Trimm says. Most become COOs and CEOs of hospitals. “The degree is in high demand.

We turn away three times as many students as we accept.”

Biddy says these highly qualified students bypass positions at private practices out of ignorance. “What MGMA is doing with UAB is making sure the grad students are aware that these jobs are in many cases six-figures and very fulfilling,” he says.

Though hospital executive positions may offer an advanced career path with, ultimately, double or more the salary, working for large practices frees administrators from corporate restrictions and satisfies their entrepreneurial spirit. “As a practice administrator, you’re literally in charge of a small business,” Biddy says.

“In my case, it’s a $6 million business. For people who don’t want to be in a corporate structure, that’s appealing.”

It’s not just the grad students at UAB benefitting from the scarcity of administrators. “Our undergrads are getting hired left and right too, and a lot are hired into practice management positions,” Trimm says. UAB graduates 75 to 100 undergrads a year with healthcare management degrees. “I know one is over at Brookwood primary care now. He’s been running practices since he got out two years ago.”

UAB students hired at practices also report quicker promotions. “They’re saying that after six months, the practice opens another office and they’re running it, whereas before, that might take two years,” Trimm says. “That’s probably an indication that there’s not a lot of seasoned people to pull from.”

With the pool of qualified and available administrators dwindling, practices may want to start grooming successors. A retiring practice administrator at one orthopedic group recruited and trained his successor on-the-job for three years. “That tells you how hard that job is,” says Sae Evan, a CPA with Warren Averett.

For now, physicians need to value their good administrators. “The attitude needs to change,” Evan says. Investing in a practice administrator with business savvy will pay off. “Physicians need to (CONTINUED ON PAGE 12)

Birmingham Medical News

MAY 2015 • 11

PAIN MANAGEMENT

Coping With Chronic Pain When Is It Time To Refer?

By Laura Freeman

Pain can be a survival trait, warning us of imminent danger or the need to seek help. It can be a vital sign providing clues in diagnosing an acute illness or injury. But when it lingers too long without adequate treatment, pain can become the problem.

The neuroplasticity of the brain and nervous system is what creates body memory. It allows us to learn to tie our shoes without thinking about it. It’s how budding tennis prodigies and young violinists improve with practice.

As one observer put it, “neurons that fire together, wire together” to form neural connections. Pain that persists too long can form pathways for chronic pain that may continue long after the initial cause of symptoms is gone.

Physicians are accustomed to treat-

ing the acute pain that comes with an injury, illness or procedure. When that pain doesn’t resolve as expected, it may be time to consider contacting a pain specialist for an evaluation.

“Better early treatment usually helps us achieve better outcomes,” Scott Kendrick, MD, of Southside Pain Specialists, said. “If a patient isn’t responding to early treatment, if the pain is greater than expected, or if it lingers too long, an evaluation can help to clarify what is Scout going on and what type of Kendrick, MD interventions may bring relief.”

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from Johns Hopkins have estimated that the annual cost of medical care for pain in the United States is as much as $635 billion. There is also the cost of lost productivity and wages, lost quality of life, and sometimes the loss of life itself when unrelenting pain leads to organ damage from too much self medicating or an overdose. ”We see two types of pain,” Kendrick said. “Sometimes there are verifiable, objective findings that correlate with the pain patients are reporting, or nociceptive pain.

In other cases, the source of the pain may not show up in tests, but that doesn’t mean it isn’t there. It can be neuropathic pain from nerve injury, diabetic neuropathy, or something developing through a neuropathic process. There are also mixed conditions, complex regional pain syndrome, failed back surgery syndrome, and other disorders.”

All patients who come to Kendrick and his colleagues are referred by their physician. The most common complaint is low back pain. However others seek help with discomfort from other pain sites such as the neck, knee, hip or spine.

“We treat the whole patient with a multimodal approach that may include a combination of medications, blocks, physical therapy, psychological support and help with coping strategies,” Kendrick said. “All pain is impacted by psychology and is higher when the patient is under stress or dealing with any source of anxiety.

We rely on consulting psychologists, rheumatologists, surgeons and other medical professionals available to help as needed.”

Medications are selected in a combination and tailored to the patient. These include opioid and non-opioid adjunctive medications.

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“Opiates are not always appropriate for every pain condition or patient. Often it will respond to the right combination of other medications,” Kendrick said. “Physical therapy, gradual conditioning and in some cases targeted procedures may be part of the treatment plan.”

When it hurts to move, there can be a tendency to inactivity to avoid pain. That leads to deconditioning and more pain, which may limit range of motion and make achieving optimal recovery more difficult.

Rebuilding strength and flexibility can often be an important part of improving function and reducing discomfort.

“Depending on the type of pain and where it’s coming from, a range of procedures can be performed to ease the discomfort,” Kendrick said. “We can do epidural injections into the spine and inject joints and trigger points. For more refractory pain, we can perform neuroablation or spinal cord stimulation to interfere or decrease the transmission of pain impulses.”

In most cases, with a clear diagnosis and a treatment plan tailored to the patient, pain management can bring significant relief.

“Chronic pain tends to come in cycles of improvement and exacerbation,” Kendrick said. “We’re here to help patients feel better and get past those flares. We follow progress regularly and monitor improvement. Our goal is to help them improve function and enjoy a better quality of life.”

Where, continued from page 11 think of it as paying for someone to earn additional revenue for their practice,” he says. Just ensuring the practice qualifies for the myriad of incentive payments from payers makes a good administrator worth their high-end salary.

“Make their bonus tied to increases in the physicians’ income,” Stroud says.

“It’s motivation, and you’re paying it out of your excess.”

For those seeking to fill administrator jobs now, Biddy suggests recruiting from those with any type of management, finance or accounting education or experience. “You can learn the medical portion,” he says. “A lot of the job is human resources, accounting, and legal knowledge.”

Trimm says the whole job description will be changing again shortly with the advent of accountable care organizations (ACOs). The administrators of large healthcare systems will soon be overseeing not only hospitals, but practices, nursing homes, pharmacies, home healthcare, and the entire gamut for healthcare provision.

“It’s going to be a completely changed landscape,” he says. “It used to be doctors on one side of the street and hospitals on the other side. All that’s going away. It’s all going to be intertwined.”

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MAY 2015 • 13

Society for Women’s Health Research, continued from page 8 tem, cardiovascular health and addiction.

Although getting more women into trials was certainly important, Nolan said it was only part of the battle. “Just including women in equal numbers doesn’t matter if you’re not analyzing for differences,” she noted. Who benefitted? Who got hurt?

Was it equal among subgroups, or was one outcome more predominant among men or women? Drilling down in the data was crucial.

In fact, Greenberger noted, “A 2001 GAO report that was an investigation of the FDA found that eight out of 10 of the most recent drugs pulled off the market

had disproportionate adverse effects for women.”

Recently, Nolan added, another victory was achieved in moving the needle on meaningful analysis by SWHR and other advocacy organizations. “In 2012, we managed to get an amendment attached to a ‘must pass’ bill – the FDA Safety & Innovation Act – on demographic reporting that forced the agency to really look at how well demographic subgroups were represented in drugs already approved and to what extent demographic analysis played in the approval process and issue a report … which it did in 2013.”

Since then, she said, an action plan has been crafted to explain how the FDA will address research gaps. “There are 27 points to that action plan, which gives us much to digest and work on with the agency,” she noted.

Drilling Even Deeper

“What we learned after the IOM report is it isn’t just clinical science, it’s basic research, too,” Greenberger said.

Nolan added, “Our priorities are a continued focus on both the FDA and NIH due to changes that have occurred over the last several years. One is the de-

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termination by the director of NIH that sex be a variable and be considered in preclinical research. This is wonderful … it’s something we’ve been focused on for quite some time.”

While recognizing it will take time to implement such changes, Nolan promised, “The key is they’re going to do it, and we’re going to make sure they do it.”

Similarly, SWHR’s attention on molecular diagnostics and precision medicine also aims to discover the benefits of drilling deeper to find genomic variations and mutations impacting women’s health and treatment options.

What started as a simple question about how women were plugged into medical research and discovery has turned into a 25-year journey toward better health for half the nation’s population.

Although there are many more miles to go, the SWHR remains committed to its unwavering goal of optimizing women’s health through education, advocacy, and research.

the implementation of the two-midnight rule for the next six months (through September 2015), and requiring, in an effort to address questionable bid practices by DMEPOS suppliers, bid surety bonds and compliance with State licensure requirements for suppliers of DMEPOS (i.e., durable medical equipment, prosthetics, orthotics and supplies) as a condition of bidding.

The Bill is multi-faceted and contains far more examples of a changing health care system than the popular SGR “fix.”

Although the Bill has a better chance than usual for success in the Senate, it has not yet been made into law. Nevertheless, hospital and physician providers alike would be well advised to secure and review the terms of the Bill as it reveals the emphasis on quality and population control provisions that should be anticipated for the American health care system over the next two decades—whether or not the Bill in its current form is adopted.

Postscript: Since this article was drafted, the Senate voted in favor of the permanent “doc-fix” bill, and the legislation is on its way to the President for signature. It was approved in the Senate by an overwhelming majority – 92 to 8.

Philip M. Sprinkle II is the managing partner of the Health Care Practice Group of Balch & Bingham LLP. Natalie R. Majeed is an associate in Health Care Practice Group at Balch and Bingham LLP.

Read Birmingham Medical News Online: BIRMINGHAM MEDICAL NEWS.COM

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Birmingham Medical News

MAY 2015 • 15

HIT: Optimization Through Integration

By CINDY SANDERS

You can love it, hate it, fear it or revere it … but technology has become an integral part of healthcare processes on both a clinical and operational level.

Therefore, you might as well learn to optimize it.

That was a key part of the message Chris Miller, principal with Nashvillebased Cumberland Consulting Group, and Deb Dulac, director of PRISM and business systems for the University of Vermont Medical Center, shared with audiences at the recent HIMSS15 Annual Conference & Exhibition. More than 38,000 professionals flocked to Chicago last month to attend the premier health information technology conference, which included more than 300 peer-reviewed education sessions, vendor exhibits touting the latest technology options, updates on government regulations impacting the industry and keynote speakers ranging from Bruce Broussard, president and CEO of Humana, to George W. Bush, 43rd president of the United States of America.

“Over the past five years, there has been a huge shift towards technology largely because of the HITECH Act of 2009 and government programs like Meaningful Use that have helped drive the technology in healthcare,” Miller said.

Although slower to adopt technology into daily operations – particularly in a clinical setting – than many other industries, healthcare has increasingly been pressed to take an ‘all in’ stance.

Miller noted that over the last few years, technology has fundamentally changed the way providers … both large and small … operate. He added the challenge is balancing the adoption of technology with everything that brings.

“Today anything a healthcare organization wants to change in a business or clinical process requires a change in their

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technology, and likewise, any change in their technology has an impact on the care they provide or their revenue,” he said.

“I think healthcare entities were used to thinking of technology as a separate entity, but now it’s so intertwined,” added the Atlanta-based HIT expert.

In their HIMSS presentation, Miller said he and Dulac focused on how to manage and optimize technology now that it has become so pervasive, while at the same time accounting for all the other changes happening in healthcare including a switchover to ICD-10, meeting ongoing and new Meaningful Use requirements, actively engaging patients, supporting accountable care models, and the myriad other programs that require attention.

The bottom line is that thinking of each of these mandates or initiatives as individual tasks to conquer leads to madness … or at least extreme frustration. Instead, Miller said the question should be, “How can organizations effectively manage all of those together with a higher degree of efficiency and lower overall cost?”

He continued, “When I think implementation, somewhere between 25-30 percent of the time spent on these changes is spent on testing so if you can group – effectively overlap testing on these programs – you can significantly save time.”

More than just testing, though, Miller said very deliberately grouping initiatives under a single governance project structure helps with a range of other issues from interoperability to simplification for end users. “Being able to group things together almost makes it irrelevant as to what changes were made,” he said of the finished product in the minds of those actually using the technology.

The ‘ripping off the bandage’ approach means one educational update for those end users as opposed to having to create an educational module for each individual initiative. Not only does a rolling schedule of changes often feel more overwhelming, but also the time away from desks learning the new processes would typically be less under a grouping structure than to have 10 separate trainings for 10 separate initiatives.

Miller was quick to admit that creating overarching technology structures could be difficult without staff or contracted expertise, which makes it more problematic for small practices.

“Whether you see it as a good or bad thing, there’s certainly a lot of consolidation in the market. Small private practices are becoming more and more rare,’ he said. “I think one of the reasons is it’s becoming increasingly difficult for groups like that to manage all these changes.”

Miller added larger practices or health systems enjoy the economies of scale that make it easier to incorporate the rapid number of changes taking place.

However, he added that in addition to HIT consultants, software vendors typically also offer at least some assistance in helping clients assimilate new processes into their workflow.

“Managing technology is only getting more complex,” he concluded. “Organizations need to be intentional and strategic in how they do that … whether that’s implementing analytics platforms, system upgrades, system optimization, Meaningful Use programs, or ICD-10. They need to be looking at ways they can consolidate those initiatives to be more effective with their resources and increase the return on their technology investment.”

Birmingham Medical News

MAY 2015 • 17

Population Health Advances Physicians are buzzing about the new healthcare paradigm

By JULIE PARKER

America’s independent physicians met mid-March in San Antonio, Texas, for the 20th annual national meeting of TIPAAA – The IPA Association of America, the largest trade association serving independent and integrated physicians in the United States.

The focal point: population health, a relatively new front burner issue unfamiliar to many practitioners. Congress included the model as a component of mandates in the Patient Protection and Affordable Care Act (ACA).

“We covered a lot of ground at our annual meeting to educate independent physicians about population health,” said Al Holloway, founder and president of TIPAAA. “Once we fully understand what it is, then we’ll find tools, products and services that can assist independent physicians in their daily practice.”

One question that repeatedly popped up: What’s the difference between popula-

tion health and public health?

“Some view population health as a more modern version of public health, which itself – improving the health of the public – may be a goal, a measurement system, and a conceptual framework that undergirds a profession and a scientific field,” wrote Michael A. Stoto, PhD, in “Population Health in the Affordable Care Act Era,” published by Academy Health (Feb. 21, 2013).

“Population health differs from public health, at least perceptually, in at least two respects,” Stoto explained. “First, it’s less directly tied to governmental health departments. Second, it explicitly includes the healthcare delivery system, which is sometimes seen as separate from or even in opposition to governmental public health.”

David B. Nash, MD, MBA, founding dean of the Thomas Jefferson University School of Population Health, pointed out that population health “builds on public health foundations.”

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Among the building blocks, according to Nash: • Connecting prevention, wellness and behavioral health science with healthcare David Nash, MD, MBA delivery, quality and safety, disease prevention/management and economic issues of value and risk – all in the service of a specific population. Examples: a city, provider’s practice, employee group, hospital’s primary service area or pre-school children.

• Identifying socioeconomic and cultural factors that determine the health of populations, and developing policies that address the impact of these determinants.

• Applying epidemiology and biostatistics in new ways to model disease states, map their incidence and predict their impact.

• Using data analysis to design social and community interventions and new models of healthcare delivery that emphasize care coordination and ease of accessibility.

“When applied to healthcare delivery, population health differs from conventional healthcare by emphasizing value rather than volume of services rendered,” said Nash.

How will population health affect physicians?

Monumentally, said Kathy Jordan, president of Jordan Search Consultants.

“The primary care practice of the future will look much different than it does today,” she said. “Instead of one-on-one encounters between the patient and their provider, the patient interaction process

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will include phone visits, email consultations, group visits, education programs and encounters with a variety of care team members. Out-of-office contact will become the new norm as patient health improves. Additionally, primary care physicians of the future must exhibit leadership and interpersonal skills, as well as a passion for top-tier service delivery. How well they manage the team will directly translate to how well the health of their patient population is being managed, which will directly impact future compensation models.”

Important financially: To be eligible for incentivized government funding, organizations must prove their commitment to, and implementation of, population health, said Jordan.

“They’ll be required to improve the patient care experience, the overall health of populations, and lower per capita costs of case,” she said. “As a more comprehensively integrated system focused on population health begins to dominate, the healthcare industry, healthcare experience and provider recruitment initiatives must also evolve.”

Enter population health management.

Regina Levison, vice president of client development for Jordan Search Consultants, said that “while population health is defined as the health outcomes of a group of individuals comprising a specific demographic population, population health management is a Regina business model centered Levison on the delivery of comprehensive care and management of total risk.”

The foundational shift in the healthcare experience will morph from an industry driven by reactivity to an industry driven by proactive measures, said Levison.

“The goal of population health is to keep a patient population as healthy as possible and minimize the need for costly interventions, procedures, emergency room visits, and hospitalizations,” she said.

As an increasing number of healthcare organizations move to models of accountable care, the overall healthcare experience will be reconstructed, said Jordan.

“Within this transformation, we’ll see an altered patient and physician experience,” she said. “With an emphasis on proactive preventative care, evidencebased protocols, managed care teams, care coordination, and multidisciplinary teams, population health management will reward value in care, versus volume of patients seen.

“Although the results of these initiatives won’t manifest for a decade or more, population health management will almost certainly improve the quality of lives for millions of individuals throughout the country.”

Mastering Population Health Thomas Jefferson University offers nation’s first MS-PopH program

By JULIE PARKER

The hottest new advanced degree in healthcare, beyond medical school, focuses on a game changer for the nation’s healthcare delivery system: population health.

Thomas Jefferson University (TJU), home of the nation’s only School of Population Health, received approval March 5 to become the only institution of higher learning in the United States to offer a new graduate-level degree program: Master of Science in Population Health (MS-PopH).

The program is accepting applications for this fall.

“Population health is catching fire.

It’s a raging inferno at the moment,” said David B. Nash, MD, MBA, founding dean of the Jefferson School of Population Health and the Dr. Raymond C. and Doris N. Grandon professor of health policy at Thomas Jefferson University.

Nash, a board-certified internist, became involved in promoting quality improvement and lobbying for healthcare policy change in the 1980s. He joined the university in 1990 as a faculty member; the former university president asked him to build the School of Population Health for the campus, which opened in 2008 as the first U.S. academic institution fo-

For additional information on the Jefferson School of Population Health degrees – program content, admissions requirements, deadlines, and tuition and fees – visit http://www.jefferson.edu/university/population-health/degreesprograms/population-health/about.html.

cused on population health. Already, 25 students have completed the graduate certificate online program, which takes 12 to 20 months to complete. Its focus: to help current and emerging healthcare leaders understand the new population health paradigm. More than 100 students have completed the onsite Population Health Academy, a 40-hour continuing education program, providing an overview of basic concepts in population health.

“Healthcare inside a medical facility is only 15 percent of the story; 85 percent of healthcare happens outside the hospital,” noted Nash. “We have to reach outside the four walls of our hospitals to coordinate with community pharmacies, nursing homes, extended care facilities and the like, and link all of these care providers – from the hospital’s board of trustees to the folks delivering home infusion medication. It’s a big operational challenge. We’re going to have to become a well-oiled, organized, value-generating

team.”

Kathy Jordan, president of Jordan Search Consultants, said the new degree program is well-timed.

“The healthcare landscape is shifting more dramatically right now than it has since its inception,” she said. “As an increasing number of healthcare organizations move to models of accountable care, the overall healthcare experience will transform. With an emphasis on proactive preventative care, evidence-based protocols, managed care teams, care coordination, and multidisciplinary teams, population health management will reward value in care, versus volume of patients seen. In some cases, this may require new types of training.”

The comprehensive MS-PopH online graduate degree program will help students develop competencies in five key public health areas – behavioral and social sciences, biostatistics, environmental health sciences, epidemiology and health

policy. Students will also develop proficiency in the application of population health skills and principles, culminating in a Capstone project applying theory and lesson in real-world situations.

Already in place at Thomas Jefferson University: a doctoral degree program – PhD in Population Health Sciences –that started four years ago and has 14 students.

The first two graduates will receive their degrees this month.

The doctoral degree is studied onsite, with the goal of preparing leaders with global vision to analyze the determinants of health. Doctoral candidates specialize in one of four areas: health policy, healthcare quality and safety, applied health economics/outcomes research and behavioral/health sciences.

“The PhD in Population Health Sciences isn’t intended for those new to the discipline,” noted Nash. “Preference is given to applicants who’ve completed a master’s degree or master’s level coursework in appropriate fields of study, such as public health, social work, health policy and behavioral sciences.”

The addition of the MS-PopH program came soon after Stephen K. Klasko, MD, MBA, relocated from the University of South Florida (USF) Morsani College (CONTINUED ON PAGE 22)

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Birmingham Medical News

MAY 2015 • 19

Same Sex Marriage Issues for Employers

By DeBra maCkey

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In the case of Searcy v. Strange, 2015 WL 328825, the federal Court for the Southern District of Alabama held that Alabama’s ban on same-sex marriage is unconstitutional. Alabama headlines have been filled with same-sex marriage talk ever since, and the Alabama Supreme Court has weighed in on the issue. The status of the Searcy case is up in the air, with conflicting views on the constitutional issues involved. So what are the implications of Searcy for Alabama employers?

First, let’s review how we got to where we are.

The federal Defense of Marriage Act (DOMA) (Pub.L. 104-199, 110 STAT. 2419, enacted September 21, 1996, 1 USC § 7 and 28 USC § 1738C) defined marriage for federal law purposes as a legal union between one man and one woman as husband and wife, and defined spouse as a person of the opposite sex. These definitions were struck down as unconstitutional in the case of U.S. v. Windsor, 133 S.Ct. 2675 (2013). DOMA also provides that states are not required to recognize a same-sex marriage that occurs in another jurisdiction. This part of DOMA still stands. As a result, legally married samesex couples are entitled to the same federal rights as are legally married opposite sex couples, but states are not required to recognize a same-sex marriage from another jurisdiction.

In the aftermath of Windsor, federal agencies issued guidance stating that the agencies will apply a “state of celebration” rule to determine the legality of a marriage. Under this rule, the marriage will be considered legal for federal law purposes if it was legal when and where celebrated (e.g., the location of the marriage ceremony), regardless of the couple’s state of residence. Windsor does not apply to state law, but Searcy does.

The Searcy Court entered a temporary stay on its holding, which stay was lifted causing it to become effective on February 9, 2015. The Alabama law invalidated by Searcy had provided: no marriage license shall be issued in Alabama to parties of the same-sex; the state of Alabama shall not recognize as valid any same-sex marriage that occurred in another jurisdiction; and the state of Alabama shall not recognize as valid a

common law marriage between same-sex parties. Chief Justice Roy Moore of the Alabama Supreme Court ordered all probate judges in the state not to issue marriage licenses to same-sex parties. Many probate judges did, many did not. Then, on March 3, the Alabama Supreme Court ordered a halt to the issuance of same-sex marriage licenses in the state. Any marriages performed during the intervening period however, are unaffected.

On April 28, 2015, the U.S. Supreme Court hears oral arguments on a set of same-sex marriage cases consolidated as Obergefell v. Hodges. This case will answer the following questions nationwide: does the U.S. Constitution require a state to issue marriage licenses to same-sex parties; and does the U.S. Constitution require one state to recognize a same-sex marriage lawfully performed in another state. The Supreme Court should rule on this case by June 30, 2015.

So, for employers, let’s look at this in two contexts: general employment law and employee benefits General employment law. There is no Alabama or federal law that prohibits discrimination based on sexual orientation.

In a real sense, this means that nothing has changed. However, the landscape is changing. Since 2011 the EEOC has issued decisions involving same-sex claims by federal employees, finding that the same-sex claims are protected by Title VII’s prohibition against discrimination based on sex (i.e., gender). Historically, these types of claims were not protected because they were seen as based on sexual orientation. Title VII prohibits discrimination based on sex, but not sexual orientation. Just last year, a federal court in Washington allowed a same-sex marriage based claim to proceed. In Hall v. BNSF Railway Company, 2014 WL 4719007 (W.D. Wash. Sept. 22, 2014), Title VII and Equal Pay Act claims survived a motion to dismiss as claims based on sex, not sexual orientation. The employer’s health plan covered spouses but defined marriage as between a man and a woman. The Court said the claim was that the male plaintiff, who was married to a male, was treated differently than his female coworkers who were married to males — which the Court characterized as a distinction based on sex. The case was dismissed after

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PAIN MANAGEMENT

Life Beyond Pain

Improving Quality of Life within the Alabama Pain Management Act

By Laura Freeman

You’ve heard the news stories before.

Sadly, they sound so much the same. Michael Jackson, Elvis Presley, Whitney Houston—again and again, a celebrity death involving prescription pain medication makes news. What doesn’t grab as many headlines are the thousands of other deaths of people who weren’t celebrities to anyone but their families or friends. They lost their battle with pain when they combined too many drugs and died from either organ damage or an overdose.

According to the CDC, Alabama is among the top 20 states in deaths from prescription drugs. To combat the problem of multiple drugs from numerous sources and doctor shopping to acquire more, recent legislation has established requirements for registration of providers, tracking of prescriptions, and testing of patients to verify that the medications meant to ease suffering aren’t being combined into a potentially lethal cocktail.

“Managing pain that continues beyond the acute phase and doing the follow up required under the Alabama Pain Management act can be time consuming,” Nitin Chhabra, MD of the Birmingham Pain Center said. “There is a trend toward shifting pain management to speNitin cialists who are equipped Chhabra, MD to deal not only with the additional testing and tracking, but also to treat chronic pain with multiple modalities that can be tailored to each patient. We work closely with the referring physician in these cases.”

The Alabama Pain Management Act requires that all physicians who provide pain management services register with the Board of Medical Examiners. When drugs are prescribed for the management of chronic pain, it also requires close monitoring and follow-up.

“As registered pain physicians, we have access to a database we can check before we prescribe to make sure the patient doesn’t already have a prescription from another source for a medication that might be a problem,” Chhabra said. “In some cases, a patient may be doctor shopping for a drug, seeking the euphoria, or they may have developed a tolerance and think they need more. Often, however, the potential problems we see are from combining drugs that may interact or increase the impact of a medication. Patients may not realize that combining a pain medication with a sleeping aid and an antidepressant or other drugs may overburden their organs and put them at risk.”

Another reason for testing is to make sure the patient isn’t consuming other substances that could create a danger.

“When a patient is taking medications that shouldn’t be mixed with alcohol, recreational drugs or over the counter drugs, we test for compliance to make sure there aren’t any safety issues that need to be addressed,” Chhabra said.

Fortunately, there is a wide choice of medications, treatments and other measures that can be tailored to each patient to make life with pain more livable.

“There’s more focus now in treating chronic pain on multiple fronts through other receptors of pain. In some cases, we might use interventional procedures, a variety of non-opiate medications, physical therapy, biofeedback, and coping tools like relaxation. Often, there’s a psychological component, which is why we have a psychologist on staff. Sometimes stress, anxiety and depression are preexisting, but being in pain for an extended period, and dealing with the limitations it causes can exacerbate pain. Managing the psychological effects helps in managing the physical pain,” Chhabra said To prevent acute pain from becoming chronic, there is more emphasis now on treating pain early and effectively.

“For example, in surgery cases, many anesthesiologists are using multi-modal anesthesia to block pain impulses in different areas. Neurotonin or Lyrica and antiinflammatories are being used immediately after surgery as a preventive measure so pain is less likely to become a long-term issue. When pain doesn’t resolve as it should, physicians are sending patients to us as soon as possible to find out why,” Chhabra said.

In many cases, pain can be managed without the need for opiates. However, there are situations where opiates may be necessary to bring relief. Some patients may be reluctant to take them because they fear becoming addicted.

“There is a lot of confusion between addiction and dependence. Addiction comes from seeking euphoria and pleasure from opiates. Dependence can occur when opiates are necessary to cope with pain,” Chhabra said.

“A problem with opiates is that with tolerance, they can become less effective over time. Medications may need to be adjusted. Hyperalgesia can also develop so that patients who have been on opiates for an extended period may have an exaggerated response to pain and feel it more intensely.

“That’s why we focus on finding the right combination of other medications and using interventional procedures if needed, plus other measures to help our patients live more comfortably.

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MAY 2015 • 21

Same Sex Marriage Issues for Employers, continued from page 20 a private settlement. Prior to the settlement, the employer voluntarily changed the terms of its health plan to extend coverage to same-sex spouses. While the cases seem to be trending in the direction of recognizing same-sex marriage claims as a sex based claim, there is no such binding precedent applicable to employers in Alabama.

A recent change in FMLA regulations modifies the definition of spouse to include a same-sex spouse, and replaces a state of residence rule with the state of celebration rule to determine the legality of a same-sex marriage. This means that the FMLA will apply to all legally married couples (opposite sex, same-sex, common law) — except in four states. On March 26, 2015 a federal court in Texas issued a temporary injunction to prevent the enforcement of the new regulation in Texas, Arkansas, Louisiana and Nebraska. A

hearing is set for April 14, 2015. This expansion of FMLA rights applies to employers in Alabama now.

Employee benefits. Turning to employee benefits, we must make a distinction between qualified retirement plans and all other benefits. Qualified retirement plans are the benefit most directly affected by the same-sex marriage issues under Windsor. Qualified retirement plans include pension, money purchase, profit sharing, 401(k), and 403(b) plans that are subject to ERISA. The Internal Revenue Code and ERISA mandate certain survivor benefits and related rights for the spouse of a qualified retirement plan participant, such as qualified joint and survivor annuities, qualified pre-retirement survivor annuities, spousal consent to benefit elections and designations of beneficiary, as well as rights under qualified domestic relations orders. After the Windsor decision, quali-

fied retirement plans are required to extend survivor benefits and related rights to same-sex spouses or else fall out of tax and ERISA compliance.

There is no federal mandate to provide health plan coverage or other welfare benefits to a spouse. Most employer sponsored group health plans do extend coverage to spouses. Currently neither federal law nor Alabama law require that samesex spouses be covered, even if opposite sex spouses are covered. Whether coverage is provided is solely a function of the terms of the plan.

Frequently, especially prior to Windsor, spouse and marriage were not defined in these plans, even though they provided spousal coverage. In that case, whether a same-sex spouse is included in the word “spouse” is a question of interpreting the plan language. This issue has not been litigated. The Searcy case does not re-

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quire that coverage be offered to samesex spouses either. Beginning in 2015, federal health care reform requires insurance carriers offering non-grandfathered insured plans to offer the employer the option of extending coverage to same-sex spouses in any policy that covers oppositesex spouses. Whether to extend coverage to a same-sex spouse is the decision of the employer. Self-insured plans remain free to establish their own eligibility terms.

Aside from the narrow mandates for qualified plans, there are no benefit mandates for spouses — opposite sex or samesex. When spouses are covered under health and other welfare plans, it is important to know how spouse and marriage are defined and it may be necessary to add a definition in order to minimize litigation risks. Employers should review any employment policies involving spouses. Despite the lack of a legal mandate to extend coverage to same-sex spouses, employers are moving in that direction for a variety of reasons.

Stay tuned. The Supreme Court will provide more answers this summer.

Debra Mackey practices at Burr & Forman LLP in the firm’s Employee Benefits group.

Mastering, continued from page 19 of Medicine and USF Health, where his transformative ideas took the Tampa medical school to unprecedented heights.

Klasko is in his first year as president of Thomas Jefferson University and president/CEO of the Thomas Jefferson University Hospital System, now the largest healthcare system in Philadelphia, Pa., the nation’s sixth largest city.

“We’re moving healthcare from a Blockbuster mentality to a Netflix mentality,” said Klasko, pointing out the university began offering population health “before anybody put population health in the same sentence.”

“At Thomas Jefferson University, we created a whole new mission and vision, where health is all we do,” he explained.

“Our vision is to reimagine healthcare education discovery to create unparalleled value. Jobs will be needed in healthcare in 10 years that aren’t even yet imagined, and a good many will be in population health.”

Nash, who also serves as a government and private-sector consultant, chairs the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council and is a board member of various healthcare organizations, including Humana.

“The great thing about Dr. Nash’s school, it’s not a Johnny-come-lately. He’s devoted his life to population health,” said Klasko. “In most universities, population health is part of another school and lacks the panache … that puts us at the forefront.”

Help Wanted: Population Health Physician Leaders

Filling positions may be a tall order; job-getters will enjoy top-of-license roles

By JULIE PARKER

Finding presentable candidates for population health physician leaders is a tall order, especially since many doctors remain unfamiliar with the new paradigm in posthealthcare reform.

Personnel represents one of three key ingredients to implementing population health management. It’s the glue to connecting data and the changing nature of the overall healthcare experience. The hard shift in practice management has healthcare organizations scrambling to secure topnotch population health physician leaders, a move that keeps physician recruiters like those at Jordan Search Consultants quite busy.

“Our clients know the organizations able to most effectively aggregate and distribute data—to collaborators, team members, and even patients themselves—will succeed,” said Kathy Jordan, president of Jordan Search Consultants. “Healthcare systems are now implementing robust software systems and population health management programs that help automate data integration, analysis, reporting, and com-

munications so that real-time evaluations— and adjustments in patient care plans—can be made instantaneously. Having the right IT systems – and IT personnel – in place is critical to advance clinical outcomes, improve care, and lower costs. Organizations with the ability to master data control and predictive analytics to generate decisiondriving insights will succeed in population health management.”

Unfortunately, the shortage of primary care physicians (PCPs) – the leaders of population health management – continues to escalate. As population health management becomes the dominant healthcare model, the demand for their roles will be unprecedented.

“As physicians continue to leave the private practice model in favor of employed physician models, cultural fit within an organization will become a key recruitment parameter,” said Regina Levison, vice president of client development for Jordan Search Consultants. “In addition, PCPs will be recruited based on their ability to build consensus, manage teams, and lead a diverse care team to better patient health. Organizations must understand

what physicians are looking for clinically, financially, and administratively to ensure a fit with the organization. Physicians who embrace the care team model, understand how to utilize advanced practice providers, and enjoy leadership opportunities will be in high demand. In addition, recruits must understand new incentive and reimbursement structures. Physicians will be rewarded for meeting care management needs of patients; reimbursement will be tied to quality as opposed to quantity.”

Characteristics of a potential population health physician leader, according to Jordan Search Consultants, include: • A minimum of five to 10 years of practice experience.

• Board certification.

• A good understanding of the way Electronic Medical Records (EMRs) work.

• A plan to help move the population health management team to the next level.

• Mentoring ability.

• Advanced education.

“We’ve changed how we evaluate physician candidates and physician leaders so

we can provide a better slate of candidates to our clients,” said Jordan. “We want to assess their ability to embrace population health, their understanding of population health, and their attitude and ability to treat patients under a population health model.

We have to dig more deeply. The physician leader of the population health management team will be working at the highest end of their license. We evaluate their ability to give direction and make assignments to the team and to educate their colleagues.

They’ll need to assess where the team is strong, and where it needs additional education, training and support. It’ll be dictated not only by geography, but also by the socioeconomic element of the population being served.”

Clients are thrilled, said Jordan, when the consulting firm finds a candidate who already knows the EMR system they’ve implemented.

“That’s one less bridge to cross,” she said.

One of the most pleasant surprises Jordan Search Consultants’ recruiters have discovered in physician leader candidate pools (CONTINUED ON PAGE 24)

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Birmingham Medical News

MAY 2015 • 23 3/30/15 10:31 AM

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24 • MAY 2015

Birmingham Medical News

The Literary Examiner

BY TERRI SCHLICHENMEYER

Tales from Kentucky Nurses

by William Lynwood Montell; c.2015, University Press of Kentucky; $24.95 / higher in Canada; 281 pages The procedure didn’t hurt at all.

That was a pleasant surprise. You were prepared for pain but that never happened. And it didn’t even take as long as you anticipated.

Ah, the wonders of modern medicine!

It’s nothing like it was when you were a child, naturally, but as you’ll see in the new book Tales from Kentucky Nurses by William Lynwood Montell, there’s much more to the story.

Remember when doctors made house calls? It’s not unheard-of today, but it’s rare. So imagine your medical care arriving on horseback from a professional who stayed for a few days to ensure your recovery.

That was what residents of many mountain counties in Kentucky used to expect.

From the 1920s until as recent as the early 1970s, it was often impossible to practice medicine as usual: many Appalachian homes were inaccessible by road, indoor plumbing was sometimes scarce, and medical facilities were far apart. This book is filled with oral histories from nurses who worked under those conditions in both the Frontier Nursing Service and in small-town Kentucky hospitals and clinics.

In rural areas, as many nurses point out, folk remedies and home treatments were often used instead of modern medicine. That led to medical complaints and attempted cures that major hospitals would never see today. In a few stories here, you’ll read about people who had never seen a doctor in their lives, until situations became dire.

You’ll read tales of babies born at home or in a neighbor’s house, sometimes with a midwife’s help and sometimes not.

Superstitious beliefs often show up in these stories, and you’ll read about tragedy as well as joy.

H e r e , you’ll read of nurses who stood up to authority, and why. Payment, for some of the nurses here, was made in eggs or meat – if payment even came. Patient care was often simple and low-tech. Pantsuits were forbidden, nurses were expected to stand when a physician walked in, white stockings were mandatory, and caps were “pinned neatly to our hair.” People (including doctors) still smoked in the hospital. One nurse tells of a calf being named in her honor. And one mourns because “nurses are human and we can’t save everyone.”

There’s something to be said about walking a mile in someone’s shoes – which is easy to do when you read Tales from Kentucky Nurses.

Through interviews with local individuals who can tell their favorite stories and oral histories collected from other sources, author William Lynwood Montell takes readers back as far as 90 years in Kentucky medicine and culture in stories of varying length and emotion. I was captivated by the breadth of experience inside this book, and by the memories of nurses whose work would otherwise be unsung.

Be aware that tales are often not edited, which might be challenging but which preserves particular language nuances. And that, of course, is what you want in an oral history book so find a chair, find Tales from Kentucky Nurses and, well, you know the procedure.

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.

Help Wanted, continued from page 23 is the growing number of physician candidates who have, or are pursuing, advanced business degrees, such as an MBA, perhaps with a concentration in healthcare management, MHA (masters of healthcare administration), MPH (masters of public health), MHI (masters of healthcare informatics), MMM (masters of medical management), or MS-PopH (masters of population health).

“The MMM is a relatively new degree,” Jordan said, adding the MS-PopH degree program is a brand new offering at Thomas Jefferson University, the nation’s only school to offer that particular advanced degree. “They’re educating themselves to lead the charge.”

On the flip side, PCPs who otherwise might be excellent candidates for those positions simply lack time to pursue higher

education.

“The rank-and-file practicing physician in a community doesn’t need a degree in population health to see his patients,” said Al Holloway, founder and president of TIPAAA (The Independent Physicians Association of America). “No, that doesn’t make sense. Having an understanding of population health will impact his practice, but he doesn’t need a degree in it.”

The need for these type of leaders is unprecedented, said Jordan.

“As the demand increases, and we continue to have a very limited supply of physician professionals for these leadership positions, automatically the compensation goes up,” she said. “That’s something I hope potential candidates will strongly consider.”

Grand Rounds MagMutual First to Allocate Millions for Loyal Policyholders

MagMutual Insurance Company, the Southeast’s largest medical professional liability insurer, has announced that it will set aside the full value of its obligation for the Owners Circle® loyalty program. By voluntarily specifying these funds on financial statements, MagMutual becomes the first medical liability insurer to allocate funds for loyal policyholder-owners.

Since 2012, MagMutual has declared $200 Million in loyalty funds beyond dividends, including $50 million this month.

CEO Dr. Joseph Wilson said the company can do this without impacting the ability to pay claims. MagMutual reported 2015 financials including total admitted assets of more than $1.6 Billion, with over $773 Million in surplus – the strongest in its 33year history.

Starting with the next quarterly statement filed, balance sheets will reflect a line item for Owners Circle® segregated surplus.

“We’re the only company in the industry to voluntarily set aside these monies because we intend to honor our promise to policyholders,” said Wilson.

Each year, MagMutual’s physicianled board of directors considers whether and how much the company will allocate to the Owners Circle®. Credits to each policyholder’s account are calculated based on the expiring premium for each eligible named insured physician. Mag-

Mutual makes account distributions after an insured physician retires from practice or becomes fully disabled or dies. Policyholders are automatically enrolled in the program after the first year of medical liability insurance coverage.

“What’s promised in return for your loyalty is reflected on our financials” said Neil Morrell, president of MagMutual. “ Morrell said the industry is in danger of pledging more money than it has because NAIC accounting rules potentially allow insurers to understate the full liability of loyalty program declarations.

Alabama Legislature Recognizes HudsonAlpha

The Alabama House of Representatives paused during session to recognize HudsonAlpha as a key asset for the state and to welcome renowned clinical genomics expert Howard Jacob, PhD, who announced last month that he and multiple research teams from the Medical College of Wisconsin will be relocating this summer to the HudsonAlpha Institute for Biotechnology in Huntsville.

Jacob’s expertise in using clinical genomics to discover undiagnosed disorders, when combined with the existing research expertise at HudsonAlpha, will accelerate the interpretation of genomic data for the benefit of patients in Alabama and beyond.

“One of my goals at HudsonAlpha,” said Jacob, “will be to enable millions of patients and their doctors to use the

knowledge from the patient’s DNA to improve healthcare.”

In the next five years, Jacob and the research teams expect an additional 200 jobs on the HudsonAlpha campus as a result of the move.

“In seven years, we’ve gone from

two faculty members and eight companies to where we are now, with 15 faculty members and more than two dozen companies,” said Rick Myers, HudsonAlpha President and Science Director. “Think about where we’re going to be in another seven years.”

First Installation of Major Equipment at Grandview Medical Center

One of the first major equipment installations has taken place at Grandview Medical Center. Using a 350-ton crane, the new 13,600-pound MRI was lifted over the parking deck connector and placed inside the building. This is one of three MRIs that will be installed at the Grandview campus. It marks the first in a series of major installations as the hospital prepares to open in the fall.

“This is an exciting milestone as we look forward to moving into our new campus this fall,” said Keith Granger, Chief Executive Officer, Grandview Medical Center and Trinity Medical Center. “Our patients who need MRIs will have access to leading technology.”

The new MRI is designed to help maximize comfort for patients undergoing MRI exams. It features a wide opening, or bore, to add more space than standard MRIs; a table surface with different cushion densities designed to alleviate pressure points; and feetfirst imaging for all exam types.

Advanced technology in the new MRI gives physicians the tools needed to make MRI is lifted by crane to place inside Grandview. accurate diagnoses. This new system offers imaging capability for the most advanced and demanding exams with, high resolution imaging from the top of the head to the soles of the feet.

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Birmingham Medical News

MAY 2015 • 25

Grand Rounds Healthsouth Breaks Ground on Inpatient Hospital

HealthSouth Corporation has broken ground on HealthSouth Rehabilitation Hospital of Williamson County, Tennessee, a 49,000-square-foot inpatient rehabilitation hospital with 40 private patient rooms. HealthSouth Williamson County, located at 1000 Physicians Way near the Williamson Medical Center campus, will provide physical inpatient rehabilitation services in a hospital setting for patients who have experienced stroke, trauma, brain and orthopedic injuries, as well as other major illnesses or injuries.

The development is expected to represent a $23 million investment in the community and will create approximately 100 fulltime jobs. The hospital is proposed to open in the fourth quarter of 2015.

HealthSouth Williamson County is HealthSouth’s eighth inpatient rehabilitation hospital in Tennessee.

CRMC Joins the American Joint Replacement Registry

HealthSouth Central Region President Barbara Jacobsmeyer breaks ground at future location of HealthSouth Rehabilitation Hospital of Williamson County.

Cullman Regional Medical Center (CRMC) has become a participant of the American Joint Replacement Registry (AJRR).

“Joining the AJRR will help ensure that we can continue to provide patients with the best orthopaedic care possible,” said James Clements, CRMC President/ CEO. The AJRR serves as a central clearinghouse for data on total joint replace-

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ment procedures performed at CRMC and other participating sites throughout the country. The AJRR aims to monitor the implanted devices throughout a recipient’s lifetime and trace revision rates in a database containing information about the patient, the surgeon who performed the procedure, and the site where the procedure took place. Data collected will help more quickly identify implants that are performing poorly, and will help match patients, procedures, and devices to ensure that every patient is provided the best care possible.

CRMC is one of only two hospitals in Alabama that are participating in this registry, according to Orthopedic Surgeon and CRMC Medical Staff ImmediatePast President Vince Bergquist, MD who has been leading the initiative locally.

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Kassouf & Co introduces Compliance Plus — a comprehensive HIPAA readiness, management, Home Health & Hospice Family of Companies and documentation solution.

HomeHome Health & Hospice Health & Hospice Family of Companies Family of Companies COMPLIANCE PLUS is much more than just an online HIPAA program. Compliance Plus connects our staff and resources with your staff, creating a collaborative portal to successfully implement a customized and ongoing HIPAA compliance program.

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Birmingham Medical News

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Grand Rounds James Andrews, MD Honored

James R. Andrews, MD was honored for his lifelong dedication and contributions to the field of sports medicine, injury prevention and research when he was presented the Lord Wedgwood Award at the 2015 James Wedgwood Blue Dinner Andrews, MD Party on April 26 at The Club.

Tim Brando, national sports commentator for FOX SPORTS, served as emcee of the event. A number of sports and entertainment figures attended, including Roger Clemens, Rachel Baribeau, Tony Barnhardt, Taylor Hicks, Condredge Holloway, Bobby Humphrey, Jon Lieber, former Atlanta Braves players –Brian Jordan and John Rocker - as well as many others.

Proceeds from the dinner party and celebrity golf tournament support the Lord Wedgwood Charity. Since its establishment, the Lord Wedgwood Charity has raised in excess of $420,000 and placed more than 325 Automatic External Defibrillators in Alabama, Georgia, Tennessee, Florida, Virginia, Mississippi, Louisiana, Pennsylvania and Texas. The charity is proud that at least five lives have been saved due to its donations.

Stock companies serve their shareholders, we serve our physician policyholders

Waller Launches Online Resource

Waller has launched an online resource to help healthcare clients navigate changes shaping the healthcare industry.

The website can be accessed at www. wallerhealthcareblog.com.

“Today’s healthcare environment is changing at a rapid pace, and our clients are seeking resources that will provide them with the information they need to stay informed,” said Ken Marlow, chair of Waller’s Healthcare Department.

The blog will discuss trends, new regulations and breaking news that impacts healthcare companies in a variety of sectors, including hospitals and health systems, post-acute care, life sciences, healthcare IT, physician practices, private equity and venture capital and more. It will also include reporting from the various conferences at which Waller attorneys speak and other events attended by members of the firm’s multidisciplinary Healthcare Department.

Caring.com Names Danberry One of Best

Danberry at Inverness retirement community has been named one of the Caring Stars of 2015 by Caring.com.

Caring Stars awards are based on online reviews from older adults, family caregivers, and industry experts on Caring.com, a leading senior website with 2.5 million monthly visitors. To qualify for the 2015 award, a community with assisted living or memory care had to: Have an overall average rating greater than four stars (based on all reviews for all time) Have no unresolved negative reviews.

Additional criteria, such as other online reputation information, were also considered.

We’ve given back more than $150 million in dividends to doctors, not to stockholders MagMutual is committed to physician ownership and leadership: • Consistent physician dividends* • Owners Circle® rewards program • Alabama attorneys and claims representatives • Doctor2Doctor® peer support

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Birmingham Medical News

MAY 2015 • 27