Birmingham Medical News April 2022

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Forge Breast Cancer Survivor Center By Laura Freeman

Hearing the words “breast cancer” may be the loneliest moment some women ever face. However, from the day of diagnosis, patients in the four-county Birmingham metro area are never alone. They have the support, resources and volunteers of the Forge Breast Cancer Survivor Center standing with them. “Our peer match program teams each patient with a survivor who has been through the same experience,” Claire Gray, Forge Community Outreach Coordinator, said. “Patients who are newly diagnosed usually have a lot of questions. It can be difficult to absorb everything you hear in those early office visits, and some things can only be answered by someone

Forge is housed in a Victorian home in Five Points.

who has been through the same thing. “Sometimes it’s good to just have another set of ears and a person you can talk with without having to be brave. Survivors learn a lot from each other and share ideas about coping with everyday life while in treatment.” Created as a special project funded by the Community Foundation of Greater Birmingham’s Women’s Breast Health Fund and partnering with local hospitals and health care providers, the Forge Breast Cancer Survivor Center is geared not to duplicate available services, but to fill the gaps. These gaps became larger recently when a major national support organization closed its local offices across the country. (CONTINUED ON PAGE 3)

New Relief for Massive Irreparable Rotator Cuff Tears By Jane ehrharDT

What used to be a long and arduous treatment and rehabilitation for massive and irreparable rotator cuff tears has been cut in half with a procedure now being performed at UAB. Amit Momaya, MD, UAB Chief of Sports Medicine, completed the first subacromial balloon spacer technique in Alabama in January. Most massive and irreparable rotator cuff tears occur in older adults over 55. “Not to say we couldn’t do this in someone under 55, you’re just not likely to see this condition in the young because they

don’t have this muscle atrophy and wasting,” Momaya says. Typically, this severe condition occurs as an aging disfunction where blood supply to the rotator cuff wanes allowing for tears that worsen over time. “Some people may not even know they have a tear, until it’s affecting their function,” Momaya says. “If it goes untreated, the rotator cuff tears more and more and can get scarred and become not repairable.” When the tendons and muscles of the rotator cuff that surround the shoulder joint tear, it allows the humeral head— (CONTINUED ON PAGE 8)

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Forge Breast Cancer Survivor Center, continued from page 1 “The Forge is locally-based and supports breast cancer survivors in Jefferson, Shelby, Blount and Walker Counties,” Gray said. “In addition to linking survivors to learn from each other, we give them access to experts to help with multiple areas of life impacted by breast cancer. For example, at our Coffee Conversations , a pharmacist recently discussed hormone therapy and a financial advisor talked about managing the financial impact of cancer. “When patients are sick and can’t work, we never want them to have to choose between paying their rent and buying groceries, so in difficult situations, we offer grocery gift cards and gas cards or transportation vouchers so they can make their appointments. “We look at the whole person and work to meet their needs. That includes mental health services through Oasis counseling to help patients and families manage the stress of a serious illness.” Wellness after a cancer diagnosis is important, so the Forge brings an oncology nutritionist to show patients how to eat healthy and how to make healthy meals that are appetizing. There is also yoga and a variety of classes from gardening to fly fishing to help keep survivors active, enjoying life and learning new things. “Our lifestyle programs include classes in journaling and creative arts.

Breast cancer survivors enjoy the Forge holiday party.

The Forge Haute Pink fashion show fundraiser.

There are also classes using social media and recording that can be accessed any time,” Gray said Another recent development is the expansion of services to include the Spanish-speaking community. The Forge has also established two

support groups for patients who are likely to be dealing with different types of concern. “One is our support group for younger cancer patients, generally under 45, who may have small children at home or are dealing with the added concerns of launching a career, dating or build-

ing a relationship in a new marriage,” Gray said. “The second is our Metastatic Support Group for patients with stage 4 cancer. They may be interested in exchanging information about clinical trials, medications and discussing their concerns and personal journey.” In addition to funding by the Community Foundation of Greater Birmingham, the work of the Forge is supported by two annual fundraisers. With an office in a beautiful old Victorian home in Five Points South with a great view of Vulcan, so during the Forge’s Fourth at the Forge fundraiser, the group invites guest to come for dinner and enjoy the fireworks over Red Mountain. The second and primary fund raiser of the year is the Haute Pink fashion show during October Breast Cancer Awareness Month. “We pair clients, friends and volunteers with local designers who create looks especially for them,” Gray said. “How breast cancer survivors see themselves, their feminine identity, is important. The fashion show is a wonderful opportunity to showcase these women as beautiful and empowered. They get to dress in fabulous clothes with great hair and makeup and feel as beautiful as they are. “In the end, these strong women find the power within themselves to handle whatever challenges life may bring.”

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Sickle Cell Gene Therapy By Laura Freeman

For centuries, people with Sickle Cell Disease have suffered the excruciating pain of a crisis. The muscles and organs of their body are starving for oxygen because there are too few healthy red blood cells to carry it. Compared to other diseases with the same or lower incidence, research has been underfunded, resulting in fewer treatments and medications to ease the effects. Now, however, we are beginning to see more new options. One of the most exciting is a gene therapy called LentiGlobin being developed with the help of research from the University of Alabama at Birmingham. A report on the progress of the therapy was just published in the New England Journal of Medicine. Principal investigator Julie Kanter, MD, director of the UAB Adult Sickle Cell Clinic, says patients in Group C treated with the most recent form of this therapy are seeing significantly improved outcomes, and so far, a complete resolution of severe pain crises. “In Sickle Cell disease, the hemoglobin is broken and there is a genetic spelling error in the blueprint for making it. There are several approaches we can take using gene therapy to correct

Julie Kanter, MD

an error. We can edit it or turn the gene off to silence it. In this case we’re using a viral vector like an envelope carrying a letter to add or transfer a healthy gene that has been producing stable amounts of red cells containing hemoglobin,” Kanter said. Several years ago, the trial began with patients in group A. Researchers were pleased to see improvement, but there wasn’t as much improvement as they had hoped for. The trial was paused when two patients developed leukemia. After more investigation, they concluded

that it wasn’t the therapy that seemed to be causing the leukemia. It was more likely the stress of an inadequate response that led to the problem. Several improvements later, Group B was launched and the response in patients was much better. “The therapy inserts HbAT87Q , a gene that makes a slightly different type of hemoglobin that is less likely to cause cells to sickle and it can be measured more accurately, allowing doctors to determine how much hemoglobin a patient is producing and how much is coming from transfusions,” Kanter said. After more fine-tuning, research with group C began. The response has been exciting. People in this group have been producing stable hemoglobin for three years. There might be a temptation to call it a cure, but Kanter is cautious, though hopeful. “We haven’t yet been able to see whether the therapy is slowing or stopping the damage to organs,” she said. “We will have to follow patients a few years before we have answers to that question. We also still don’t know whether the new cells are as strong and durable as those in people who don’t have the disease. Red blood cells normally live for around 120 days. Initial findings suggest the new cells may not

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live as long. Could that have a cumulative effect that could be a problem?” Even with these questions unanswered, a therapy that can end the pain for so many people is a major step forward. The CDC estimates that around one in 13 African Americans carry the Sickle Cell trait, and one in 365 is born with the disease. Contrary to the general impression, almost anyone can carry the trait or have the disease, especially if they have ancestors that come from an area that is at high risk for malaria. One theory suggests that Sickle Cell disease evolved as a genetic adaptation to fight malaria. “Sickle Cell Disease is a problem in India and a major concern in Africa and it is also found in the Middle East and in Africa,” Kanter said. “We still have spaces available for volunteers in the current trial. “We want everyone living with Sickle Cell to know that we want to help, even if they are not in a trial. This has long been one of the great health disparities. Everyone living with this disease deserves to have the care of a Sickle Cell doctor and access to new medication and treatments that are becoming available.”


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ANA Reveals Top Federal Legislative Priorities By LYNNE JETER

The American Nurses Association (ANA) recently unveiled its leading federal legislative priorities for Congress covering safe staffing, nursing workforce development, home health, the opioid epidemic, workplace violence and COVID-19. HEALTH SYSTEM TRANSFORMATION Renovating America’s health system tops the list and calls for following four major principles: • safeguarding universal access to a standard package of essential healthcare services for all U.S. residents, • optimizing primary, community-based and preventive care, while also supporting the cost-effective use of technology-driven hospital-based services, • boosting mechanisms to stimulate the cost-effective use of healthcare services while also minimizing burdens on those without the means to cost-share, • delivering a sufficient supply of a skilled workforce dedicated to providing quality healthcare services. “Universal access includes an essential benefits package to provide access to comprehensive services, prohibition of the denial of coverage due to pre-existing conditions, inclusion of children on parents’ health coverage until the age of 26, and expansion of Medicaid as a safety net for economically disadvantaged people,” said Willa Fuller, BSN, RN, executive director of the Florida Nurses Association, and a national ANA spokesperson. Optimizing care calls for primary healthcare focused on developing an engaged partnership with patients, and includes preventive, curative, and rehabilitative services. It also means removing barriers that hinder RNs and APRNs from fully contributing to community patient care; and care coordination that lowers costs and improves outcomes via consistent and sustaining payment models. “Encouraging mechanisms to stimulate the cost-effective use of healthcare services starts with a partnership between the government and private sector to address healthcare affordability,” Fuller said. “Payment systems must reward quality and the effective use of resources. Also, beneficiaries paying a portion of their healthcare should be provided an incentive for the efficient use of services while being assured that deductibles and co-payments do not negatively impact care.” Elimination of lifetime caps or annual limits on coverage should be part of the plan, and federal subsidies based on an income-based sliding scale should assure insurance coverage. SAFE STAFFING The ANA calls for increased funding via grants or loan repayments for educational programs to increase the

Willa Fuller, BSN, RN

primary care workforce, which should include an adequate number of highlytrained RNs. This funding should elevate support for expanding nursing faculty and workforce diversity. “The ANA continues to lobby for safe staffing ratios critical to achieving the correct staffing levels,” said Fuller, noting that Congressmen Peter Welch (D-Vermont) and Morgan Griffith (R-Virginia) recently coauthored a letter to the White House COVID-19 Task Force calling for an investigation into staffing agencies’ price gouging during the pandemic. Collaborative efforts have resulted in state-level safe staffing laws in Oregon, Texas, Illinois, Connecticut, Ohio, Washington and Nevada. NURSING WORKFORCE DEVELOPMENT Because nurses continue to represent the largest group of healthcare providers whose services are linked to quality and

cost-effectiveness, fully-trained nurses are critical. According to the Pew Research Center, an estimated 10,000 people are turning 65 on a daily basis, a trend that will continue until 2030. “As such, the healthcare workforce will need to grow to keep up with the demand for nursing care in traditional acute care settings along with the expansion of home and long-term care,” Fuller said. In 2020, Congress signed into law the Title VIII Nursing Workforce Reauthorization Act that was included in the CARES Act. It reauthorizes nursing workforce development programs through fiscal year 2024. This is the largest source of federal funding for nursing education, and the ANA will continue to lobby Congress and the Administration to appropriate more annual funds to the Title VIII programs. Major grant programs within Title VIII cover advanced education nursing; workforce diversity grants; grants for nurse education, practice, and retention; national nurse service corps’ Nurse Education Loan Repayment Program; nurse faculty loan programs; and comprehensive geriatric education grants. HOME HEALTH The ANA promotes the authorization of APRNs to provide timely care for their home health patients, instead of allowing patients needing the service to languish while waiting for physician

approval, particularly in rural and underserved areas. For now, the CARES Act allows NPs and CNs to order home health services for Medicare beneficiaries without physician approval. OPIOID EPIDEMIC “The opioid epidemic must be addressed with a comprehensive approach from community-based programs to government action at every level,” Fuller said. During the past two Congresses, dozens of bills have addressed this issue. In 2018, the SUPPORT for patients and the Communities Act gave NPs and PAs permanent authority to prescribe Medication Assisted Treatment (MAT), which also grants clinical nurse specialists, certified RN anesthetists, and registered nurse-midwives this authorization through 2023. Last year, the Mainstreaming Addiction Treatment Act of 2021 aimed to eliminate the separate registration requirement for dispensing certain narcotic drugs for maintenance or detoxification treatment. “Current law requires prescribers to apply for a waiver to prescribe buprenorphine to treat addiction after completing a multi-hour educational course,” Fuller said. WORKPLACE VIOLENCE Because one in four nurses has been abused in the workplace, the ANA has led the charge to end nurse abuse at the federal and state levels. Last February, (CONTINUED ON PAGE 8)

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New Relief for Massive Irreparable Rotator Cuff Tears, continued from page 1 the top of the upper arm bone—that normally fits into the shoulder joint to float upwards and out of the socket well. That leaves the humeral head free to rub against the bony tip of the outer edge of the shoulder blade, the acromion, causing pain and limiting the arm’s ability to roll and lift. The subacromial balloon spacer greatly relieves that pain by placing a temporary pillow of saline between the two bones. “It pushes the humeral head down where it belongs, and that allows the shoulder to function better and the body to retrain the remaining musculature and use it more efficiently,” Momaya says. The arthroscopic procedure begins by inserting a camera inside the shoulder joint to ensure an accurate diagnosis by first cleaning out any scarring and bone spurs. Making standard portal

site incisions of about one afterwards.” to two fingernails long, Momaya and assistant the surgeon then inserts a professors Aaron Casp, sheath that pushes in the MD, and Will Brabston, empty polymer balloon. MD, published the first Next, a saline-filled syringe composite study covering is inserted to inject into 204 shoulders over three the balloon a set measureyears with a mean age ment. of 67.6 years and mean “That’s about it,” Mofollow up of 19 months. maya says. “It feels like a Only three percent had waterbed inside the shoulcomplications. Amit Momaya, MD der once it’s deployed. The “Pain is decreased sigtemporary spacer requires nificantly,” Momaya says. no means of attachment. It doesn’t mi“The pain scores we see in studies was grate around. After several months, it at least a 50 to 75 percent improvement starts to deflate slowly, and within a year in most patients.” it disintegrates. The biggest surprise Because the balloon spacer allows about this procedure is how quickly it for so much more movement and allecan be done and how quickly and agviates so much pain, rehab can begin gressively you can rehab the shoulder more quickly and be more aggressive

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than after other rotator cuff treatments, such as injections and partial repairs. Following the standard rotator cuff repair surgery, rehab can last six to 12 months. With the balloon spacer, rehab for massive and irreparable rotator cuff tears takes only about three months. The need for a sling lasts a week or two versus the four to six weeks of immobility after the standard repair surgery. “Even if you could work through the pain and try rehab without this procedure, you couldn’t achieve the results,” Momaya says. With the humeral bone not resting properly in the socket, the muscles would be adapting to wrongly placed bones and unable to attain the right motions. Momaya sees additional ways to utilize the balloon spacers beyond just these extreme irreparable rotator cuff cases. “We could augment what we already do,” he says. “The standard rotator cuff repair still has rate of failure much higher than we would like. So we could augment that with a balloon procedure and make our current procedures better.” That’s likely in the future. “The interest in this procedure is growing exponentially,” Momaya says. “I expect UAB to do 10 to 20 subacromial balloon spacer techniques in this first year, and double that in the near future. But if we start using them on current procedures we already do, for example on top of a rotator cuff repair, that opens up the market dramatically to put in many more.”

ANA Reveals Federal Priorities, continued from page 7

the House of Representatives introduced the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1195) to require Occupational Safety and Health Administration (OSHA) to develop enforceable standards to protect employees. This legislation passed the House last April 16 with wide bipartisan support on a 254-166 vote. The ANA is working with bill sponsors to facilitate its passage and be signed into law by President Biden this Congress.

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COVID-19 “As response to the pandemic evolves, so too has the nature of ANA’s work – addressing priority issues from availability of Personal Protective Equipment (PPE) and decontamination to vaccine rollout and distribution guidance,” said Fuller, adding that ANA also promotes improved public health infrastructure funding, mental health and hazard pay, and controversial vaccination requirements.


The Waiting Is the Hardest Part By JD Thomas and Andrew Solinger

Consider this common scenario: A new physician joins your practice – whether from out-of-state, residency, or another practice. Your practice is contracted with a multitude of payors including Medicare, Medicaid, TRICARE, managed care organizations (MCOs) that administer some of these programs, and various commercial payors. You’re busy, and you want your new physician to start seeing patients immediately. But before you can bill any of these payors, the physician needs to be credentialed and enrolled with each of them. It’s a time-consuming and convoluted process, different for each payor and full of many hurry-up-and-wait moments. Our example describes a medical practice, but it’s not just physicians who require credentialing. Dentists, counselors and many other healthcare providers must also be credentialed by their respective payors in order to bill for the services that they provide. Some providers are waiting 30 days to as much as a year for MCOs and other payors to verify documentation, review applications, and make approval decisions. Unfortunately, this growing backlog for government and private payors can lead to the temptation

to cut corners when submitting claims during the gap between application submission and approval, but by doing so they may ultimately create significant civil, and possibly criminal, liability. So, how can a practice bill for a new provider’s services after a credentialing application is submitted, but before it has been approved? JD Thomas Andrew Solinger Claims submitted for new and as-yet uncredentialed Claims Act and other civil – and even providers must be carefully considered criminal – laws. in order to avoid compliance issues. A Most payors – including federal significant area of concern during the healthcare programs, MCOs, and comcredentialing/enrollment process is the mercial payors –retroactively approve potential for a practice to bill for services providers’ credentials back to the date of rendered by new practitioners using the application. This presumes, however, that credentials of an already-credentialed the application is ultimately approved, and provider in the same practice. Staff may that the provider complies with all other see this as an easy way to avoid holding requirements set forth by the payors. If a claims, but it comes with tremendous risk. credentialing application is denied for any Depending on how the claim is billed, it reason, whether it’s incomplete data, faillikely results in inaccurate claims being ure to meet the payor’s standards, or on submitted, and any claims submitted by any other basis, a new application must be the still-un-credentialed provider may eisubmitted, and the retroactive approval ther be denied or, if already paid, may date will typically be the new application lead to overpayments. Medicaid and date. This means that the period between other government payors typically view the first application and the application such claims as fraudulent under the False denial is lost for purposes of submitting

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claims, and any claims submitted by that provider during that period run the risk of either being denied or resulting in potential overpayments. Regardless of how a practice decides to handle new providers’ claims, it is imperative to understand each payor’s rules and regulations. Medicaid payors have increased their focus in this area. If a practice participates in government healthcare programs, additional attention must be paid to ensure that all claims are accurate and submitted for properly credentialed providers. Buyers considering the purchase of a medical or dental practice or practice management company would be wise to verify that no claims have been billed for non-enrolled/non-credentialed providers under another provider’s number. Failure to exercise due care in this area can lead to significant liability. JD Thomas is a partner at Waller and a former federal prosecutor. He advises healthcare clients in government investigations and prosecutions, qui tam and False Claims Act defense and other enforcement actions. Andrew Solinger is an associate at Waller where he assists clients in responding to investigations, audits and other inquiries brought by federal and state government agencies and regulators.

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Osha Prepares Final Rule Related To Healthcare Providers – Stakeholders Must Submit Comments By April 22nd by

Lindsey Phillips

On June 21, 2021, the Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) that was designed to protect healthcare workers from exposure to COVID-19 in settings where people with COVID-19 were reasonably expected to be present. The ETS is separate and apart from OSHA’s vaccine mandate, which has been held unenforceable. On December 27, 2021, OSHA announced that it was withdrawing certain aspects of the ETS, but other portions of the ETS (e.g. the COVID-19 log and reporting requirements) would remain in effect. At that time, OSHA stated it would work expeditiously to issue a final rule. OSHA is now prepared to issue a final rule and is requesting additional feedback regarding the ETS during a comment period. This comment period supplements the initial comment period that ended on August 20, 2021 when the ETS was first issued. On March 22, 2022, OSHA announced that it is reopening the com-

ment period to allow for additional public responses and feedback on specific topics. OSHA is requesting comments from stakeholders on three main categories: 1) potential changes from the ETS; 2) additional information and data; and 3) information necessary for economic analysis. Impacted stakeholders should closely review the specific topics to determine their impact and whether commentary is warranted prior to implementation of the new standards. POTENTIAL CHANGES FROM THE ETS OSHA announced in its notice that there are several provisions it is considering implementing in the final rule that would deviate from those set out in the ETS. Accordingly, OSHA is providing the public an opportunity to comment. Those deviations include, but are not limited to, the following: • Alignment with CDC Recommendations for Healthcare Infection Control Practices – OSHA has acknowledged that there are inconsistencies between CDC recommendations and the ETS

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requirements; multiple stakeholders made note of this in the initial comment period in 2021. Accordingly, OSHA is considering whether it is appropriate to align its final rule with current CDC recommendations. • Additional Flexibility for Employers – In the initial comment period, some employers expressed that the provisions of the ETS were too rigid and inflexible. The rule required providers to develop specific policies and procedures along with hazard plans. Additionally, the ETS specified how employers were required to implement particular polices and procedures. In response, OSHA is considering restating various provisions as broader requirements and providing a “safe harbor” for employers who are in compliance with the CDC guidelines applicable during the relevant time period. • Tailoring Controls to Address Interactions with People with Suspected or Confirmed COVID-19 – OSHA is considering whether there is a need to have COVID-19 control measures in areas where healthcare workers are not reasonably expected to encounter people

with suspected or confirmed COVID19. For example, OSHA might consider removing facemask requirements for staff who are not exposed to COVID-19 patients. If OSHA were to make this adjustment in its final rule and tailor control requirements to particular areas of a facility or particular staff, it would still require an “outbreak provision,” which would require employers to implement stricter control measures during an outbreak. • Requirements for Vaccinated Workers – In the initial comment period, stakeholders voiced that the ETS requirements should be relaxed or eliminated based on either the vaccination status of the specific employee involved, the general vaccination rate of the entire staff, or the general vaccination rate of the community. OSHA is now considering whether to relax facemasking, barrier, and physical distancing requirements in accordance with this feedback. • Evolution of SARS-CoV-2 into a Second Novel Strain – OSHA has acknowledged that it is possible that a future variant of SARS-CoV-2 will have (CONTINUED ON PAGE 13)

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Strategic Planning and Analyzing Mid-Year Results of Operations Can Improve Your Profits By Gerard Kassouf, CPA CFP®

Over one-quarter of the calendar year of 2022 is completed. At this point, if you analyze the three-month results of your practice operations, you have an opportunity to end this year more profitably. Take a look at areas of your practice such as strategic planning, billing and collections, cash flow, potential revenue sources, personnel salaries, operating expenses and equipment needs. Let’s review some of the most important planning matters. STRATEGIC PLANNING The most profitable health care practices and facilities operate with a written operational plan, reset annually. A planning retreat, away from the office without interruption, with a specific agenda and an outsider to facilitate the meeting will allow your group to define goals, objectives and opportunities for your practice. Determine who should attend from your practice--physicians, non-physician providers and the leadership team. Develop agendas for specific sessions where

all attend, and some limited to only the group’s physicians. Set two to three goals, along with timelines and expectations to be accomplished. Make them SMART goals—specific, measurable, achievable, relevant and time-bound. BILLING AND COLLECTIONS It is important to review the monthend reports for billing and collections on a physician by physician basis. Also review any ancillary revenue by procedure. Make sure that each physician routinely receives data, especially if compensation is based on production because this provides a scorecard of performance. Set production and collection goals and provide information on prior year comparative data, or include several years for an even better trend line. Remember to include both production and collection data and a collection percentage for gross and net collections. This will assist in tracking the efficiency of each producer. In today’s environment of being paid using wRVUs, consider software to provide data as often as daily to providers to monitor actual work against projected work. In addition to these operational is-

sues, it’s important to review the charges for each procedure your practice performs and the reimbursement being paid by major payers. Be sure that every procedure you perform is being billed at a level to adequately compensate the practice for that service. Review your insurance company remittance forms. Make sure that your staff is satisfied with the explanation provided by the payers before writing off any rejected claim amounts. Making sure that the billing staff, the physicians and the payers are working towards the same goal means open communication regarding what services have been performed and reimbursement amounts expected. CASH FLOW Even if you are having a good year, you need to review your cash position. Schedule out major expenses to be paid before year end and be sure your group is informed of them. Keep surprises to a minimum with open communication. Make a preliminary calculation of the practice’s staff bonuses, retirement plan contribution and professional liability insurance premium payment dates. Also schedule out any note payments

due, or payments for equipment you plan to purchase before year end. Look at the practice’s cash balance. If there is more cash than is needed for operations, invest a portion to generate some additional income, contribute funds to your retirement account or pay down some debt early. POTENTIAL REVENUE SOURCES Always be on the lookout for additional revenue sources. This may come from hiring a new physician, or from providing additional ancillary services to your patients. Use your specialty group web site or national publications to determine what services your patients may be receiving in other practices, and consider providing them at your practice. Review the number of procedures you are referring out, the cost of the equipment, personnel, other direct and indirect expenses to be sure the services will be profitable to you. Prepare a projection of anticipated revenue and expenses for any additional service you want to provide. (CONTINUED ON PAGE 13)

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New Treatment Options for Cardiac Amyloidosis By Jane Ehrhardt

ATTR results from genetics or if it stems from the wild There are now type, which is the most commedications for treatmon in older patients with an ing cardiac amyloidosis, average age at diagnosis of 74 specifically ATTR-CM, years. African Americans are that increase the value of most likely to carry the amydiagnosing the disease. loidosis genes at around four Rayan Saab, MD “If you see a pattern of percent of that population. symptoms, keep cardiac “That does not mean they amyloidosis in mind because we have have amyloidosis. They just have the mutreatment options for the disease itself,” tation and may live without ever presentsays Rayan Saab, MD with Cardiology ing the disease,” Saab says, stressing that PC. “Put it on your differential, don’t disa genetic mutation test can help make a miss it.” diagnosis, but a positive genetic test is not Cardiac amyloidosis comes in two a reason to treat for the disease. forms. Light chain amyloidosis (AL) be“The gold standard for cardiac amhaves more like a blood disorder, where yloidosis testing is to biopsy the heart,” the immune system produces too much Saab says, if a definitive yes or no is of the light chain protein which clumps needed. “But if you take too big of a bite, together and deposits into different organ you can end up with bad complications. systems, including the heart. “You treat Perform the other tests first and then if that with chemotherapy, like you would everything is pointing to amyloidosis, go treat blood cancer, like blood myeloma,” ahead and treat for it.” Saab says. Two medications exist for ATTRThe breakthroughs in the past few CM. They work a little differently with years have come in treating transthyretin the same goal of stabilizing the transamyloidosis cardiomyopathy (ATTRthyretin protein, which slows the proCM). The condition results from the gression of the disease. Diflusinal, a transthyretin protein, which helps carry non-steroidal, anti-inflammatory medicathe thyroid hormone and vitamin A in the tion, has had FDA approval since 1996, blood, building up directly in the heart but not for ATTR-CM use. tissue causing it to thicken. In the past, Though used off-label, it was the nothing existed to treat the disease itself, only option until 2019 when the FDA leaving only treatment for the symptoms approved tafamidis. “We like tafamidis of congestive heart failure. because it prevents the dissociation of The way ATTR-CM symptoms the protein into the lower component mimic congestive heart failure makes it that eventually clumps to form the amyeasy to overlook. The heart continues loid protein with no anti-inflammatory pumping in the normal range for a long effects, unlike diflusinal which has antitime, despite more protein clumping in inflammatory properties that can lead to the tissue. “When looking at the echofluid retention and enlargement, which cardiogram, clinicians see stiffness and inhibits the heart’s ability to remodel and thickness, but assume it is resulting from redistribute the remaining heart cells in a chronic high blood pressure,” Saab says. better way to recover function. “Everybody is reassured because no one “Can we keep amyloid controlled for is reporting symptoms, and they treat it 20 to 30 years? It’s too early to tell, but with diaresis, but do not treat the underlythe data is promising. Having been out ing pathology.” for only three years, the short-term effect An echocardiogram offers a more on ATTR-CM patients shows mortality specific scan for both ATTR and AL now has dropped by about 30 percent, with with strain patterns that reveal the typical a similar reduction in hospitalization. It appearance of amyloidosis. used to be that with ATTR amyloid, we If there are any suspicions of amytreat you for heart failure and keep you loidosis, perform a technetium pyrophosgoing for as long as we can. Now we can phate scan, which uses a unique tracer slow it down so patients may live with it that binds to that particular protein and for a long time.” lights up on the nuclear camera. “We What impedes the use of the drugs compare the uptake in the heart to the is lack of diagnosis. “Because diagnosis is lung or body uptake,” Saab says. “It not made early, we catch these patients has to have a certain ratio, and it’s very at the tail end,” Saab says. “Because we specific to ATTR. But it’s close to 100 now have treatment options, physicians percent accuracy excepting timing and should rule out amyloidosis and be aware human error.” of other symptoms, such as kidney disA genetic test can ascertain if the ease or carpal tunnel syndrome.”


Strategic Planning and Analyzing Mid-Year Results, continued from page 11 PERSONNEL SALARIES The largest expenditure of your practice is salaries and fringe benefits. Make sure you are on track with your costs. Use your specialty group data to determine if you have adequate personnel on staff. Review any personnel needs and hire only those at a level of expertise for the task they will perform. Make sure you plan for salary adjustments if necessary and spend time with personnel to provide positive feedback on their performance. Hiring additional providers will help maintain continuity as people retire, and growing your practice can improve profitability as fixed costs are shared by more producers.

EQUIPMENT NEEDS Look around the office, talk to the physicians and staff to determine what equipment will need to be replaced or added before the end of the year. Having time to search for the best deals will allow you to save a few dollars. It will also give you the opportunity to contact multiple vendors and equipment manufacturers. Make sure the management team is agreeable with the purchases, and the method of payment. If you use cash in the bank to purchase equipment, it may make you cash short at year end. Do the math and understand the options before signing for the equipment. Check out your options to lease as it may be a good alternative to a purchase.

OPERATING EXPENSES Keys to a successful practice include controlling expenses. Take time to review your year to date expenses by category and determine which of them have changed from last year. Don’t just look at the account totals, but review them by vendor. Analyze variances and find why good or bad variances occurred. It could be an important bit of knowledge to help you end the year on the positive side.

CONCLUSION Practices that plan strategically and review financial issues are generally more profitable. Taking time to study and plan will provide other clues to areas of the practice that can be improved upon. By pulling together the various items, management will have information upon which to improve all aspects of the practice. Gerard Kassouf, CPA CFP® is a director in the regional tax, accounting and advisory firm of Kassouf & Co., P.C.

Osha Prepares Final Rule Related To Healthcare Providers, continued from page 10 a significant genetic drift to be designated another novel coronavirus strain but will still result in a disease that has similar effects to the current virus. With this in mind, OSHA is considering whether its final rule should explicitly state that it applies to potential subsequent related strains of the virus and not just COVID-19.

ADDITIONAL INFORMATION AND DATA OSHA is also requesting that stakeholders provide additional information and data for its consideration in implementing the final rule. The additional information and data OSHA is requesting includes but is not limited to: • The percentage of healthcare workers that have taken days away from work due to a COVID-19 infection and the average number of days healthcare workers have taken away from work, • The rates of infection, hospitalization, and death among healthcare workers compared to that of the general population, • The vaccination rate among healthcare workers and the health effects for fully vaccinated employees, and • Unintended consequences, such as decreases in staffing retention, due to the potential alternatives raised in its notice.

INFORMATION FOR ECONOMIC ANALYSIS The last category OSHA is seeking feedback on is related to information needed to conduct an analysis of the financial impact of the final rule. When implementing a rule, OSHA estimates how much it would cost for an affected entity to be in compliance. In order to determine whether OSHA made a correct analysis in that regard with the ETS, it is requesting information from providers to determine the number of providers impacted and the costs associated with compliance, which may vary by type of provider. The public comment period opened on March 23, 2022 and closes on April 22, 2022. Stakeholders are encouraged to provide their feedback on these three categories and can do so by submitting a comment electronically to the Federal eRulemaking Portal. A public hearing on the final rulemaking will be held virtually on April 27, 2022 and will continue for subsequent days if necessary. People interested in testifying at the hearing or providing documentary evidence must file a written notice of intention to appear using the Notice of Intention to Appear (NOITA) web form by April 6, 2022. Lindsey Phillips is an associate at Burr & Forman LLP practicing exclusively in the firm’s Healthcare Industry Group.

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APRIL 2022 • 13


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UAB and DCH Partner to Bring Maternal-Fetal Specialists to Tuscaloosa

have a high risk of complications during pregnancy. Brocato and the UAB team will see patients at DCH on a weekly basis. They will provide specialized care for patients with pregnancy concerns including advanced age, diabetes, complicated pregnancy history, hypertension, multiple fetuses and preterm birth. UAB’s Maternal-Fetal Medicine program is one of only 14 centers in the country and the only Alabama program to participate in the Maternal-Fetal Medicine Units Network. All UAB high-risk care physicians hold board certifications in both obstetrics and gynecology and maternal-fetal medicine. Members of the division are actively involved in ongoing clinical trials and studies on topics such as hypertension in pregnancy, diabetes, preterm birth and labor management.

University of Alabama at Birmingham maternalfetal medicine specialists are providing high-risk obstetrical care at DCH Health System in Tuscaloosa in a partnership that Brian Brocato, DO began in February. “Many women in West Alabama with complicated pregnancies have to travel to Birmingham to meet with a maternalfetal medicine physician,” said Brian Brocato, DO, assistant professor in the UAB Division of Maternal-Fetal Medicine. “This partnership brings state-of-the-art ultrasound and maternal-fetal care to their community.” Maternal-fetal medicine specialists from the UAB Marnix E. Heersink School of Medicine focus on the diagnosis, treatment and ongoing care of women who

Noland Health Services Opens hospital at Ascension St. Vincent’s Birmingham Noland Health Services has opened a longterm acute care facility within Ascension St. Vincent’s Birmingham to serve patients who need long term acute care and Robert Russell, are not well enough to Administrator of Hospital at return home, go to a re- Noland St. Vincent’s. habilitation facility or a nursing home. Many of these patients are COVID survivors who still need ventilators or additional therapy. “After being in bed for weeks with respiratory issues, some no longer know how to walk. Others still might not be able to breathe on their own, because of muscle weakness or injury to their lungs,” said Jeffrey Garner, MD, the medical director of the Noland Hospital

at Ascension St. Vincent’s Birmingham. As a long term acute care hospital, Noland typically provides several weeks of additional care for medically complex patients. That may mean working to wean patients off ventilators, providing wound care or services such as respiratory, occupational or physical therapy to help patients recover from a range of illnesses, surgeries or injuries. The facility opened in January in what had been regular hospital space for St. Vincent’s. It features all private rooms in newly renovated space. “While it is located in St. Vincent’s, Noland’s patients also can come from other hospitals,” said Robert Russell, Administrator of the facility. The new hospital is the company’s sixth site, with other locations at Regional Medical Center in Anniston, Jackson Hospital in Montgomery, DCH in Tuscaloosa, Southeast Health Medical Center in Dothan and Ascension St. Vincent’s East.

UAB Callahan Eye Opens in Pelham The new UAB Callahan Eye – Pelham Clinic on Pelham Parkway is now open. The 4,000-square-foot clinic offers patients access to pediatric and comprehensive eye care specialists with a diagnostic imaging center, and an on-site optical store. The clinic offers family eye care, eye exams, cataract evaluations, glaucoma screenings, cornea diagnosis and treatment, and contact lens evaluations. All Callahan patients are also eligible to receive a minimum 15 percent discount on all sunglasses and eyeglasses. “We are consistently looking for ways to better serve our patients, and this new location allows us to provide the Pelham community the expert care they are used to receiving from UAB Callahan Eye in a more convenient manner,” said Rett Grover, UAB Callahan Eye chief executive officer.

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Brookwood Baptist Health Appoints New Group Chief Financial Officer

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Brookwood Baptist Health (BBH) has named Charles Tyson as its new Group Chief Financial Officer for the five hospital healthcare system. Charles Tyson Tyson comes to BBH from Steward Health Care System in the Miami-Dade Market, where he served as Chief Financial Officer of a five hospital system with a combined 1,775 licensed beds. Before being acquired by Steward Health Care, he was CFO when the hospitals were owned by Tenet Healthcare. Tyson holds a bachelor’s degree in banking and finance from the University of Georgia and master’s degrees in health administration and accountancy from Florida Atlantic University. “I am excited to serve the Brookwood Baptist Health organization,” Tyson said. “I look forward to supporting the hospitals employees and physicians in their commitment to providing quality, compassionate care to our patients.”


GRAND ROUNDS

Princeton Baptist Medical Center Celebrates 100 Years EDITOR & PUBLISHER Steve Spencer VICE PRESiDENT OF OPERATIONS Jason Irvin CREATIVE DIRECTOR Katy Barrett-Alley CONTRIBUTING WRITERS Jane Ehrhardt, Laura Freeman, Lynne Jeter, Marti Slay Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 AD SALES: Jason Irvin, 205.249.7244 All editorial submissions should be mailed to: Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: editor@birminghammedicalnews.com —————————————— All Subscription requests or address changes should be mailed to: Birmingham Medical News Attn: Subscription Department 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: steve@birminghammedicalnews.com FOLLOW US

Princeton Baptist Medical Center is celebrating its centennial year serving the Birmingham community. The hospital was the first of four Birmingham area Baptist hospitals and opened its doors in the West End community on January 20, 1922. “We are proud to mark this milestone by reflecting on our hospital’s legacy and embracing the exciting things that are in store for our team,” said Princeton Baptist CEO Mike Neuendorf. Birmingham Baptist Hospital, now known as Princeton Baptist, opened with 39 patients in house. Additionally, there were eleven more patients admitted that day. At that time, the facility was a 90-bed hospital. Now, Princeton is licensed for 505 beds. Prior to being purchased by the Bir-

Princeton Baptist Medical Center mingham Baptist Association, it was the Birmingham Infirmary. The hospital was built on Christian principles that are still present in daily

UAB Cyclotron Facility Joins DOE University Isotope Network The University of Alabama at Birmingham Cyclotron Facility has been selected to join the United States Department of Energy Isotope Program as a University Partner. The UAB Cyclotron Facility is the third university to join the University Isotope Network. This partnership will bring three new isotopes to the Isotope Program’s product catalog: cobalt-55, manganese-52 and vanadium-48. “We are honored that UAB has been selected to join the DOE University Isotope Program,” said Suzanne Lapi, PhD, UAB Cyclotron Facility director. “This program is incredibly selective and allows us to continue enabling new activities in the radio pharmaceutical space that will ultimately lead to the development of novel imaging agents to identify new markers of diseases.” The Department of Energy selected UAB for this program to bring up the next generation of isotopes. The goal of the isotope program is to enhance isotope supply and work to make them nationally available.

The facility will produce isotopes for the DOE Isotope Program. UAB’s isotopes are developed with the Cyclotron Facility’s TR24 cyclotron, a unique resource for an academic medical center in the United States. This powerful cyclotron is a particle accelerator that cre-

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