Birmingham Medical News August 2022

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Brain Health Program Can Help Prevent Dementia By anSLey FranCo

An estimated one in five Americans 65 years or older has mild cognitive impairment, and one in seven has dementia.

By 2050, the number of Americans with dementia is expected to triple. In response to this coming challenge, the University of Alabama at Birmingham has started a pilot program at two primary care clinics that focuses on helping patients prevent cognitive decline. The Brain Health Advocacy Mission (BHAM) will encourage patients make smart choices to improve their brain health.

“It is now well-understood that risk factors of cognitive decline and dementia are largely treatable,” said Ronald Lazar, PhD, a UAB professor of neurology and director of the Evelyn F. McKnight Brain Institute. “It's not that these risk factors

for the BHAM clinics. The clinics provide patients a roadmap to maintaining brain health that is built around the AHA’s Life’s Simple 7, a set of lifestyle targets that include managing blood pressure; maintaining healthy cholesterol levels; reducing blood sugar; physical activity; healthy diet; healthy weight; and not smoking, along with five other factors that impact brain health - depression, social isolation, excessive alcohol use, sleep disorders and hearing loss.

“A large number of Americans are affected by these lifestyle issues. About one-third of our population has hypertension, and approximately 10 percent has diabe-

Ronald Lazar, PhD

cause dementia. They just make the brain more vulnerable to these things that cause dementia. And when we attack these early, it makes dementia much less likely to occur later on.”

Lazar was the lead author of A Primary Care Agenda for Brain Health, a scientific statement issued by the American Heart Association that provides the framework

(CONTINUED ON PAGE 3)

UAB Neurosurgeons Expand Their Toolbox

By Laura Freeman

Radiofrequency ablation made big news in the 1990s when it became the standard of care for correcting some types of heart arythmmias. In the years that followed, it became a tool for treating disorders in many areas of the body. Now two neurosurgeons from UAB Heersink School of Medicine are using the technology to treat drug resistant focal epilepsy for the first time in Alabama.

Nicole Bentley, MD and Kirsten Riley, MD of the department of neurology teamed up for the first case. It involved Ashley Williard a recent college graduate. Despite having seizures since

Nicole Bentley, MD

Kirsten Riley, MD

early childhood, Williard was active in ballet, swimming, tennis and cheer. However, her seizures had increased in frequency to about twice a week in college, which was making her life more difficult.

“Focal epilepsy is triggered by lesions in specific areas of the brain,” Bentley said. “The first step to eliminate the lesions is to locate them. This requires implanting electrodes and waiting to

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capture a seizure in real time as it is happening so we can precisely map out the location of lesions triggering the attack and the areas they affect.”

Riley said: “The mapping procedure is known as stereo-electroencephalography. Electrodes are placed directly in the brain in areas that the epileptologist and neurosurgeon have identified as the most likely seizure onset zone. The temporal lobe is where most problems begin.”

By taking advantage of the electrodes that are already in place, the RF procedure offers minimally invasive access to areas near the focal lesions without the need for a craniotomy.

(CONTINUED ON PAGE 3)

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Birmingham Medical News

Brain Health Program Can Help Prevent Dementia, continued from page 1 tes. Almost half of the US population is obese,” Lazar said.

Operating as a clinic within a clinic at UAB Hospital-Highlands and UAB Hoover Primary & Specialty Care, a BHAM Brain Health nurse investigator will meet with interested patients to establish a baseline brain health score based on the lifestyle targets. From there, the nurse will offer a choice of strategies and resources to improve their scores, and patients will decide for themselves which initial targets they want to address.

“We allow patients to make their own choices about what they want to focus on and then we tailor the program to them,” Lazar said. “We direct them to resources in the community depending on what lifestyle target they want to work on.

For example, if someone wants to exercise more, we help them find the various places they can visit for that, as well as giving them examples of activities they can do for exercise.

“It’s important to note that all our recommended strategies are evidencebased. Unfortunately, there are many products out there that have no supporting evidence, but people take them anyway because of advertising.”

The BHAM Brain Health program chose to locate in the two primary care clinics because primary care providers see people throughout their life so they are a good fit for strategies that need to be practiced continually.

The BHAM Brain Health pilot project has enrolled 50 patients at each clinic, all of

whom are over age 18 with no significant brain issues such as stroke or cognitive decline. The program will follow these participants for a year to determine whether their brain care scores improve after incorporating the suggested strategies.

To spread the message of brain health, Lazar’s project group is building a website to make the information more accessible to people who are not in the program. “We hope to put this into more clinics in the Birmingham area, potentially more throughout the state of Alabama and we want to create a national model that people can follow,” he said.

Lazar also wants to expand the program into areas where healthcare disparities are apparent such as the African-American church community in Birmingham. “It's

important for us to go into those communities, and rather than telling them what they should do, listen to them first and find out what their concerns are because we have to establish trust,” Lazar said.

Future plans include building a brain health app based on community needs and desires. “We see an app as a way to engage people in a way that will be motivational and individualized to each person,” Lazar said. “The app would serve as a tracker, motivator and source for links to places where people can get help with achieving any of the targets — where to purchase healthy foods, for example.

Through social media, it will also provide an opportunity bring people together with common health interests.”

UAB Neurosurgeons Expand Their Toolbox, continued from page 1 “After we have identified the exact location of the lesions that are triggering seizures, we can connect RF energy to any electrodes that are near enough to the seizure onset zone to target it,” Riley said.

Bentley said: “Usually we would welcome any improvements in symptoms as a step toward our ultimate goal of getting the patient to the point of being seizurefree. We would normally expect to follow up with either laser ablation or traditional surgery to fully eliminate the lesion. How-

ever, our first patient, Ashley Williard, was very lucky. She has been completely free of seizures since the procedure.”

“Her lesion was extremely tiny,” Riley said. “And we had the good fortunate to place the electrode directly on top of it.”

Other cases using RF ablation have been successful, but have needed a typical follow-up procedure to eliminate all of the lesion that is causing problems.

“To some degree, depending on the individual anatomy, the RF procedure can

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be predictive of what we might expect in the follow-up procedure,” Riley said. “If we see fewer seizures and milder symptoms after the ablation, we can feel more optimistic about the quality of data from the mapping and the outcome we are likely to achieve from the follow-up surgery. If there are any unexpected changes, they may offer clues that we need to be particularly vigilant in protecting an area that may influence primary functions.”

For patients with focal epilepsy who are

not candidates for surgery because the lesions triggering their seizures are too near eloquent structures controlling essential function, radiofrequency ablation may offer at least some hope for reducing the number and severity of seizure. That would depend on the brain’s individual anatomy.

Bentley is hopeful. “Epilepsy care has come so far in recent years,” she said.

“Our goal for all our patients is to help them become seizure free so they can enjoy their lives to the fullest.”

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AUGUST 2022 • 3

PEDIATRIC FOCUS

The Sunrise Clinic Helps Child Trafficking Victims Busy Trafficking Routes Runs Through Birmingham

By Laura Freeman

Next time you are Atlanta-bound on I-20, you’ll probably notice the busy truck traffic. But you may not realize that other travelers on the road can include underage teens from Mississippi or New Orleans. There could be little girls and boys from Birmingham’s poorest neighborhoods or runaways from an affluent home with secrets. They aren’t on their way to a fun time at an amusement park.

They are the entertainment, headed to Atlanta and points along the east coast to meet the demand for sex workers at high profile events.

If you’re surprised that Birmingham is on the crossroads of a sex trafficking trade that includes an appalling number of children, you’re not alone. However, local police are not surprised, and neither are the physicians, psychologists and social workers of Sunrise Clinic at Children’s of Alabama.

“We had assumed most of the traffic was passthrough on the way to big metropolitan areas. But it turns out that 40 percent of domestic trafficking happens in the south,” Debra Schneider, LICSW, PIP said. Schneider is Executive Director of Children’s Hospital Intervention and Prevention Services (CHIPS) and the Sunrise Clinic, which opened last year

to meet the needs of children who have been trafficked.

“Each child’s story is different,” Schneider said. “Runaway teens are the primary target of traffickers. Kids who leave home, often because of abuse, end up on the street without food or shelter and do what they have to do to survive.

Some are trafficked by boyfriends who persuade them to have sex with friends for money or they might take pictures and use them to threaten the girl into complying.

Others are children from desperately poor homes. They may feel they are helping to bring in money to help the family survive.

In particularly sad cases, parents who are addicted may be desperate enough to exchange access to their child for drugs.

“Some trafficked children live at home, and others are shuttled from city to city to work big events when big sports or entertainment attractions come to town,” Schneider said. “We were meeting with police and organizers of the World Games months in advance to make sure we had health care and mental health resources in place to care for the influx of trafficked children we expected to be here during the event. It’s the same story for football games, concerts and other events that attract large crowds.”

How do ‘customers’ connect with underaged children for sex?

“It’s a well oiled machine using social media, phones and ads with coded phrasing offering ‘merchandise,’” Schneider said. “Through websites, people shopping for sex can specify age, gender and appearance to find exactly what they like. Some are pedophiles and others don’t ask about age as long as other preferences are met.”

In addition to providing medical and mental health services for children who have been trafficked, the Sunrise clinic works to teach hospital staff and the medical community what to look for in order to recognize a child who is being trafficked.

Kara Huls, MD is the Medical Director of the Sunrise Clinic.

“If you see a tattoo, especially on a child younger than the usual age for body art, ask them to tell you about their tattoo. It may be a bar code or a name that isn’t the child’s name. Some gangs use tattoos to signify ownership,” Huls said.

“Most of the underage children involved in sex trafficking here were born in the U.S. Although they may be transported across state lines, we aren’t seeing many transported across international borders in this area.

“When adults who accompany a child to the doctor’s office don’t seem to want to let the child talk and try to do all the talking for them, or when they don’t know much about the child’s medical history, that is suspicious behavior. Try to separate the child from that adult so it is safe

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Kara Huls

for them to speak freely. Ask them about things like school and home and any signs of previous injuries.

“Children trafficked involuntarily may not have been getting regular medical and dental care. My first case was a girl who came to me with terrible heartburn that had been untreated for years.

The person trafficking her didn’t care that she was suffering and didn’t take her to seek care.

“Some of our patients at the Sunrise Center were identified when they came into our ER or the mental health center. They may have the same injuries as victims of sex abuse, or came in after attempting suicide. People who have been trafficked are at much higher risk for suicide. The emotional trauma can exacerbate other conditions like depression that were already there.”

Sunrise Clinic patients are given a comprehensive health evaluation including screenings for sexually transmitted diseases, pregnancy and mental health.

They are treated for illnesses or injuries, and the Department of Human Resources is called in to evaluate their home to determine whether it is safe for the child to return. If not, alternative housing arrangements are made. The goal is to free them from trafficking and start them back on the road to recovering a normal life with the help of follow up medical and mental health care at the Sunrise Clinic.

“Globally, the biggest market for trafficking is labor,” Huls said. “We haven’t identified much of that in Birmingham, but it does happen. If children show up with injuries you’d expect to see in factories, processing plants or agriculture, ask questions about the injury, school and activities. It’s a dangerous situation for both children and adults who are essentially slave labor. We hope to be expanding our expertise in the future to offer help to children involved in labor trafficking.”

If you have a patient under 18 that you strongly suspect is being trafficked, you can refer them to the Sunrise Clinic at Children’s Hospitals’ CHIPS Center.

PEDIATRIC FOCUS

Challenges with Pediatric Mental Health

By Laura Freeman

Even in the best of times, surviving childhood and adolescence to become a healthy, functioning adult can be complicated. Just as you’re trying to figure out who you are and think your way through a flood of hormones, you have to learn to cope with new problems, new feelings and adults’ expectations with a brain that hasn’t yet developed impulse control.

Children and adolescents coming of age today are facing an unusually difficult world. They have been through two years of isolation and loss from the pandemic.

Daily news of war, climate disasters, and random shooters make it hard to feel safe.

Meanwhile, the economic worries and stress of parents trickle down, and instead of role models, children are seeing endless videos of adults acting like badly behaved children, which makes it more difficult for children to learn appropriate social interaction.

“Before people become too discouraged, I remind them that there have always been hard times - the great depression, world wars and plagues far worse than our pandemic,” Children’s of Alabama pediatric psychologist Dan Marullo, PhD said, “Better times have always followed. We need to teach our children to be resilient and we should model the behaviors they will need to

learn to help them cope with the ups and downs of life.

“It wouldn’t be surprising if pediatricians are seeing more reports of headaches, stomach aches and eating disorders. Stress can have an effect on children’s health, just as it does with adults. When children come in for an office visit, it’s a good idea to see how they are doing psychologically.

“Clinically and in pediatric ERs, we’re seeing an increase in anxiety and depression, especially in girls. There is also more suicidal ideation. Suicide is now the second leading cause of death in people under 24. Homicide is the third leading cause of death, and both are ahead of childhood cancer. ” As children of the great depression downsized to move into assisted living, many of their family members can attest to the lifetime effects a scarcity mentality had on their tendency to hang on to a basement full of things they intended to fix someday just in case they needed it.

Are children of the pandemic likely to be dealing with similar lingering effects?

“The impact of living through lockdown will differ depending on the child and what each experienced. For those who are academically, socially or athletically oriented, switching to online classes probably felt like more of a loss.

For students who were introverts or often

Dan Marullo, PhD

bullied, it may have been a relief. Their stress came when it was time to return to the classroom.”

The environment children lived in during lockdown will likely be the greatest influence on whether there is a lingering impact. Parents were also experiencing the emotional effects of stress, fear and eventually the short tempers that come from being in a confined space for too long. The situation was perfect for magnifying family dysfunctions and the potential for abuse.

With more than a million Americans dead from the virus, many children lost loved ones. In addition to the depression that comes with loss, an early awareness of death and the fact that bad things can happen may require an extra effort to help children feel safe, especially if they are fearful that something could happen to a parent or other loved one.

Sooner is Better

Fear is also entering the school room. After every school shooting, children are expressing their fears that a shooter might come to their school.

Calming this anxiety will take a lot of listening and working with schools to take steps to help children feel safer.

“For so many kids, violence is nothing new,” Marullo said. “Before they are out of elementary school, many inner city children know someone who was killed in the streets. Even those living in suburbs may see violence at home.”

With each news story showing the face of a teen who went on a shooting rampage, we ask again how it could happen. Understanding the psychology of a killer is too complex for a quick generalization. Not every teen who is depressed or bullied becomes a killer, but it is often true that bullies were once bullied and those who are violent once experienced violence.

Disappointment and lack of hope are also common threads in teens who direct their anger outward in violence or inward in eating disorders, behaviors like cutting and suicide. It is also seen in young adults who seem to lose direction in life and come home to couch surf at age 40.

“Resilience is one of the most important gifts we can teach our children,” Marullo said. “They need to learn that (CONTINUED ON PAGE 9)

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Birmingham Medical News

AUGUST 2022 • 5

Cryoablation Now Included in Guidelines for Initial Treatment for Atrial Fibrillation

By Marti Webb Slay

Dr. Kaufmann gets access to perform a Cryoablation for Afib.

“Atrial fibrillation is associated with an increased risk of stroke and cardiovascular events,” said Michael Kaufmann, MD, who practices cardiology and electrophysiology at the Huntsville Hospital Heart Center and Heart Institute “So it’s important to identify these patients and get them appropriate treatment.”

‘Appropriate treatment’ continues to evolve. In June of 2021, the FDA approved cryoablation as an alternative to antiarrhythmic drug therapy as an initial strategy for symptomatic paroxysmal atrial fibrillation. Kaufmann has successfully provided care under the new guidelines.

Cryoablation, or freezing balloon, was first approved by the FDA in December 2010. Two years later, the second generation balloon was approved. Until last year, however, drug therapy was the first option for treatment, and ablation was indicated only after medication failed to address the condition.

“We offer the approach to patients,” Kaufmann said. “Some still prefer to try medication first, but younger patients

often opt for ablation as frontline therapy.

Some patients have contraindications for heart rhythm medications. It’s nice to have the option of proceeding directly with cryoablation.”

Before the approval of cryoablation in 2010, Kaufmann said ablation was done using radio frequency. He estimates that nearly half of ablations performed in the country today are still radio frequency ablations, but he primarily uses cryoablation.

“It’s a common procedure that can be performed relatively safely,” he said. “We go up through the groin, and the patient can’t push, pull or lift anything heavy for a week while the groin site heals up. We keep them overnight for observation and discharge the following morning.”

While both forms of ablation are efficacious, Kaufmann quotes studies that show a slightly lower rate of needing repeat ablation with cryoablation.

“Unfortunately, there is no cure for atrial fibrillation,” he said. “We have treatments, and even an ablation is not a cure.”

Whether a patient is treated with medication or ablation, they still require monitoring and may need medication or a second ablation in the future, although cryoabla-

tion for paroxysmal atrial fibrillation has an 80 to 85 percent success rate.

There is a whole array of symptoms that might be associated with atrial fibrillation, including palpitations, fatigue, activity intolerance and shortness of breath. “Patients with atrial fibrillation who are symptomatic should be referred early,” he said. “Ablations have a higher success rate if we ablate early on. Atrial fibrillation ablation success rates are not as high if patients have been in atrial fibrillation for a prolonged period of time and kind of settled in.

“The current guidelines are for symptomatic patients. There are certain circumstances where we may opt to treat patients who are asymptomatic - for instance if their heart rate is particularly fast or their heart pumping function is low - but the strongest indication for treating atrial fibrillation is symptomatic atrial fibrillation.

Sometimes if patients are asymptomatic we may opt to put them on medications that will slow down their heart rate and blood thinner medicine to prevent stroke.”

A large proportion of cardiac patients are on blood thinners to prevent stroke.

(CONTINUED ON PAGE 9)

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8 • AUGUST 2022

Birmingham Medical News

By Jane Ehrhardt

Mobile-based Infirmary Health recently added Rodney Rocconi, MD to their cancer care team as Associate Director and Director of Research. With the appointment, Rocconi will practice in Mobile with Infirmary Cancer Care (ICC), while also serving as professor of gynecologic oncology at UAB, the only National Cancer Institute Comprehensive Cancer Center in Alabama.

“This dual appointment will allow me to serve in a leadership role at ICC as well as enhance cancer clinical trials to collectively provide the best care possible for all cancer patients in the Gulf Coast region,” Rocconi says. With his arrival, ICC will provide its patients with a toptier gynecologic oncology program.

Rocconi brings with him a productive research career supported by numerous NIH/NCI, DOD, PCORI, and foundation grants focused on clinical trials and translational research, along with research awards, national leadership positions, and seven co-patents in diagnosing and treating ovarian cancer.

This placement in Mobile of a noteworthy UAB cancer researcher represents the most recent step in the clinical partnership formed in 2018 between UAB and Infirmary Health, which brought together two of the largest health care providers in the state.

“This affiliation extends the clinical expertise and medical research capabilities of UAB to southwest Alabama,” says Mark Nix, president and CEO of Infirmary Health, the region’s leading healthcare provider. “Together, these two organizations will bring UAB clinical trials and research to patients currently served by Infirmary Health.”

UAB had been seeking a clinical partner in the Mobile Bay region for years. Infirmary Health fit their mission and aims. The largest non-governmental

Rodney Rocconi, MD

healthcare system in the state, the Infirmary system represents more than 700 active physicians on their medical staff and 6,000 employees. Started by civicminded ladies 111 years ago, the nonprofit organization now serves the region with four acute care hospitals, three post-acute care facilities, three ambulatory surgical centers, and more than 60 physician practice locations.

The collaboration improves access for southwest Alabama patients to certain procedures performed at UAB, such as in cancer and transplantation, that are not available elsewhere in the state. It will also allow these patients to continue the bulk of their medical care nearer home, alleviating costly and stressful travel or short-term relocation.

As part of the affiliation, UAB will create exposure to potential medical residency positions and rotations at Infirmary Health. “Opportunities to train UAB medical school graduates at Infirmary facilities will create access to more physicians throughout our region for years to come,” Nix says. With more residents training in the Mobile Bay area, more physicians may choose to remain in the state, especially with exposure to a coastal lifestyle.

The link between UAB and community physicians also increases opportunities for collaboration on patient care.

UAB’s CEO at the time, William Ferniany said: “to really impact health, (CONTINUED ON PAGE 9)

Challenges with Pediatric Mental Health, continued from page 5

it’s okay to try and fail. It’s important for children to have an opportunity to practice overcoming adversity. This is one area where sports can help. Learning to work together as a team also helps children build empathy.

“Don’t always try to rescue your children from failure or make everything perfect. Don’t immediately fulfill every wish.

Let them succeed through their own efforts.

“Children learn what they see adults.

If you want to teach a child to be patient, model patience. If you want them to be truthful, kind and respectful, let them see you being truthful, kind and respectful.

When you talk with them about difficult subjects such as the loss of a pet or grandparent, or troubling events in the news, be honest. Don’t over-shelter them, and don’t inundate them. Use words that are age appropriate and keep the content within the range that they can understand.”

Another pediatric psychology topic in the news relates to gender. If children

or young teens begin to show behaviors that suggest a gender identity other than their birth identity may be emerging, what is the appropriate response? How does a parent or healthcare provider distinguish between a momentary thought that is part of the “trying on” of identities some children go through or a fundamental aspect of personality that might benefit from counseling?

“A referral to a psychologist trained in gender issues can be helpful in determining whether follow-up is needed. If so, counseling can be beneficial to both the patient and family,” Marullo said.

Although, childhood has never been as simple and idyllic as storybook images suggest, today’s children do have challenges to overcome. With the help and example of caring family, community, healthcare providers and mental health professionals, children can grow up to become the well adjusted adults they were meant to be.

Guidelines for Initial Treatment for Atrial Fibrillation, continued from page 6 “From a symptom standpoint, some can benefit from ablation,” Kaufmann said.

But ablation isn’t indicated for patients who simply want to come off their blood thinner. “The way the guidelines are currently written, your need for blood thinners is based on a CHADS2VASC score.

After an ablation for atrial fibrillation, if your score is still elevated, you would still need blood thinner even if the ablation appears to be successful. Those guidelines may change in the future. There are ongoing studies looking at stroke risk after successful ablation, but right now, wanting to come off blood thinner is not a reason to pursue ablation. The abla-

tion is to reduce symptoms.”

Atrial fibrillation is often thought of as a condition for older patients, but Kaufmann does see patients in their 20s and 30s. “That’s uncommon. We see many fewer patients for that condition in that age group, but it can occur for a variety of reasons,” he said.

That brings Kaufmann back to his original message: ablation, whether cryo or radio frequency, is most successful when done early. He urges his colleagues to refer patients of any age with symptoms before their heart has settled into atrial fibrillation for a long period, even if it is paroxysmal, or in and out.

UAB and Infirmary Health Expand Partnership, continued from page 8 you need partners near the people you are serving.” Partnering with Infirmary Health expanded the University Health System to a statewide network that now consists of 19 owned, managed, and affiliated hospitals in 12 Alabama counties.

“These hospitals, like the hospitals in Infirmary Health System,” Ferniany said, “are partners to work together to leverage the resources of UAB to improve care.”

The collaboration shares more than expertise and opportunities. It brings a $4 billion combined annual budget to the buying table, with Infirmary adding 25 percent to that total. Prices drop on supplies and equipment when negotiating bulk pricing to cover the needs of multiple hospitals statewide. “You might

not get a reduced bill today, but in the long run what that should do is slow the rate of the cost increase,” says Nix. Along with cost savings, the alliance offers both health systems areas of expansion, including telehealth access to UAB experts for Infirmary Health patients, telemedicine consultations between physicians, and greater access to participation in clinical trials and research.

“The opportunities this affiliation brings to southwest Alabama are significant and almost limitless,” Nix says.

“Healthcare organizations pooling resources and working together to improve care and control costs is the future of healthcare.”

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AUGUST 2022 • 9

The No Surprises Act’s Good Faith Estimates – What Every Provider Needs to Know

By Howard Bogard

The No Surprises Act (“NSA”), which became effective January 1, 2022, protects consumers against surprise medical bills. However, a lesser known part of the NSA, called the Good Faith Estimate provisions, requires health care providers make available a good faith estimate (“GFE”) of charges for items and services provided to an uninsured patient and to an insured patient who elects not to submit a claim to his health insurance for coverage. If an uninsured or self-pay patient receives a bill from a provider that is $400 or more above the GFE, the patient may dispute the bill with the U.S. Department of Health and Human Services (“HHS”).

Which providers must offer a GFE?

Providers covered by the GFE requirements include physicians, behavioral and mental health providers, other State licensed professionals and air ambulance providers, as well as any health care facility licensed to operate under laws of the State in which it is located, including hospitals, hospital outpatient departments, critical access hospitals,

Howard Bogard

ambulatory surgery centers, rural health clinics, federally qualified health centers, clinical laboratories and imaging centers. Under the GFE rules, the provider or facility scheduling the primary service or item or who receives an initial request for a GFE from an uninsured or self-pay patient is referred to as the “convening provider or facility.”

Which patients are entitled to receive a GFE?

At the time of scheduling an item or service, a convening provider or facility must ask the patient whether the patient has insurance. If the patient is uninsured, or if insured and the patient asks that the item or service not be billed to her insurer

(self-pay), then the patient is automatically entitled to a GFE of expected charges, but only if the service is scheduled at least three business days in advance. An uninsured or self-pay patient is also entitled to a GFE upon request, but again only if the service is scheduled at least three business days in advance. Any discussions or inquiry by an uninsured or self-pay patient regarding potential costs of items and services to be provided should be considered a request for a GFE. If the convening provider or facility is out-of-network with the patient’s insurer, the patient will only be considered self-pay if he requests to pay the claim directly without insurance billing. Most urgent care or walk-in clinics will not be required to provide a GFE since these types of providers rarely schedule appointments three or more business days in advance. However, if an urgent care or walk-in clinic schedules a follow-up visit with an uninsured or self-pay patient more than three business days in advance, a GFE would be required.

Notice of GFE rights.

Each covered provider and facility must prominently display in a clear man-

ner information regarding the availability of a GFE on its website, in its office or facility and on-site where scheduling or questions about the cost of items or services may occur. A GFE informational notice developed by HHS can be found at https://www.cms.gov/regulationsand-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10791.

Providers and facilities must also provide information about the availability of a GFE to uninsured and self-pay patients when scheduling an item or service or when questions about the cost of items or services occur. A GFE must be available in accessible formats and in the language(s) spoken by individual(s) considering or scheduling items or services.

What is Included in a Good Faith Estimate?

A GFE is a written (either on paper or electronic) notification from the convening provider or facility that outlines for an uninsured or self-pay patient (or their authorized representative) the reasonably expected charges for a scheduled or requested item or service. After January 1, 2023, the GFE from the con(CONTINUED ON PAGE 11)

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The No Surprises Act’s Good Faith Estimates, continued from page 10 vening provider or facility must also include information from co-providers or facilities so that the patient receives only one GFE covering all items and services to be offered to the patient. Under the GFE rules, a “co-provider or facility” is a provider or facility that provides items or services in connection with the primary service offered by the convening provider or facility. For example, if after January 1, 2023 an uninsured or self-pay patient schedules knee surgery with a physician’s office at least three business days in advance (the physician office in this example would be the convening provider), the GFE will need to include all items or services that are reasonably expected to be provided from the date of admission for surgery through discharge, including fees associated with the surgeon, hospital or ambulatory surgery center, anesthesiologist, prescription drugs and durable medical equipment. A separate GFE would be provided for any pre- or postop items or services, including, for example, pre-operative laboratory testing or post-discharge physical therapy. Any GFE issued to an uninsured or self-pay patient must be included as part of the patient’s medical record.

A GFE includes pertinent information about the item or service to be provided and the anticipated cost, including the following information: • Patient name and date of birth; • Description of the primary item or service to be provided in clear and understandable language (and if applicable, the date the primary item or service is scheduled); • Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service; • Name, National Provider Identifier, and Tax Identification Number of each provider or facility represented in the GFE; • List of items or services that the convening provider or facility anticipates will require separate scheduling and that are expected to occur before or following the expected period of care for the primary item or service; • A disclaimer that informs the uninsured or self-pay patient that there may be additional items or services the convening provider or facility recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the GFE; • A disclaimer that informs the uninsured or self-pay patient that the information provided in the GFE is only an estimate and that actual items, services or charges may differ from the GFE; • A disclaimer that informs the uninsured or self-pay patient of that individual’s right to initiate a dispute

resolution process if the actual billed charges are substantially in excess of the expected charges included in the GFE. This disclaimer must include instructions about how to initiate the dispute resolution process and state that the initiation of the process will not adversely affect the quality of health care services furnished to the individual by a provider or facility; and • A disclaimer that the GFE is not a contract and does not require the uninsured or self-pay patient to obtain the items or services from any provider or facility identified in the GFE.

A GFE template developed by HHS can be found at https://www.cms.gov/ regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/ cms-10791 When does a GFE need to be provided?

If an uninsured or self-pay patient is entitled to a GFE, the convening provider or facility must comply with the following timeframes: • When a primary item or service is scheduled at least three business days before the date the item or service is scheduled to be furnished, the GFE must be provided no later than one business day after the date of scheduling.

• When a primary item or service is scheduled at least ten business days before the date the item or service is scheduled to be furnished, the GFE must be provided no later than three business days after the date of scheduling.

• When a GFE is requested by an uninsured or self-pay patient, the GFE must be provided no later than three business days after the date of the request. If, however, the GFE request is for an item or service to be provided within less than three business days, no GFE is required.

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Any anticipated change in a GFE (such as changes to the expected charges, items, services, frequency, recurrences, duration, providers or facilities) must be provided to the patient no later than one business day before the item or service is scheduled to be furnished. If any change in expected providers or facilities represented in a GFE occurs less than one business day before the item or service is scheduled to be furnished, the replacement provider or facility must accept the GFE for the relevant item or service being furnished that was provided by the replaced provider or facility.

Dispute Resolution Process.

When billed charges for any provider or facility are in excess of the GFE provided to an uninsured or self-pay patient by $400 or more, the patient has the right within 120 days after receiv-

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Birmingham Medical News

AUGUST 2022 • 11

Operating a Medical Practice in a Time of High Inflation By gerard J. KaSSouF CPa, CFP®

When reviewing medical practice financial statements during 2022, many practice administrators have been challenged to reassess day-to-day operations. Reimbursement rates have not kept pace with the increased practice operating costs over the past few years, which has eroded owner compensation and reduced the amount of funds available for expansion and new equipment.

Practices that routinely analyze their financial position have the best chance of working through these issues that continue to put pressure on cash flow.

How can your practice cope with finances? First, put a few key physicians along with your practice administrator in charge of the financial side of the practice. Create a timetable to have financial statements prepared and reviewed each month, including an analysis of how your practice stands against a reasonable budget. If you can’t prepare a detailed budget, start with the key practice expenses: • Staff compensation • Retirement plan contribution • Professional liability and property and

Gerard J. Kassouf

casualty insurance • Occupancy costs, including rent and maintenance • Billing and collection costs, including software • Supply costs, and more importantly, high-cost reimbursables • Other significant costs associated with your practice Utilize this information to develop a financial strategic plan—a portion of the overall strategic plan that every healthcare organization should utilize.

Calendar routine meetings to review and discuss ways to improve profitability.

Let’s review some specific opportunities to help generate a greater profit

during times of inflation. These will include the possibility of additional topline income, controlling expenses and ultimately increasing the bottom line.

Look at operational opportunities to control expenses. In most practices, staff salaries and benefits are the number one expense. While each practice operates to the desires of the owners, reviewing staff scheduling and the practice’s operating hours could create an opportunity for savings. First, review overtime to determine if the workday scheduling is appropriate. Then, look at productivity during the workday. In one practice, a new human resource member noticed that some staff were spending the last

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Birmingham Medical News

30 minutes to an hour each day with little to do. When asked, the individuals told the HR member that they had to stay until 5:00 whether they had work to do or not. The group rearranged the work schedule allowing those who had completed their workday to leave before 5:00. The individuals were happy to get home earlier in the day, and the practice saved salary costs not having to pay for unproductive time.

Most healthcare practices provide a great benefit with an employer provided retirement plan contribution. It may be a match to a 401(k) deferral or an employer profit sharing contribution, or (CONTINUED ON PAGE 13)

The No Surprises Act’s Good Faith Estimates, continued from page 11 ing the disputed bill to file a challenge through a dispute resolution process called a Patient-Provider Dispute Resolution (“PPDR”) process. While the PPDR process is pending, the provider or facility must not pursue collection efforts against the patient. An HHS selected dispute resolution (“SDR”) entity will evaluate the claim and obtain information from the patient and the applicable provider or facility. Within thirty business days after receiving all necessary information, the SDR entity will determine the amount owed by the pa-

tient and whether the provider or facility has provided credible information to demonstrate that the difference between the billed charges and the expected charges in the GFE reflect the costs of a medically necessary item or service and is based on unforeseen circumstances that could not have reasonably been anticipated by the provider or facility when the GFE was provided to the patient.

Howard Bogard is a Partner at Burr & Forman LLP and chairs the firm’s Health Care Practice Group. He can be reached at hbogard@burr. com or at 205-458-5416.

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Operating a Medical Practice in a Time of High Inflation, continued from page 12 both. Take a look at your plan’s design.

Have a professional review your retirement plan to determine if the design is optimal for your group. There could be cost savings in the retirement plan contribution options and in the charges for plan investments, recordkeeping and reporting. If the practice is currently paying the operating costs of the plan--such as investment fees, recordkeeping fees, and the audit fee consider having them paid directly from the plan instead.

Take a look at the practice professional liability insurance coverage and cost, as well as other business insurance.

Determine if you have appropriate coverage - who is covered and the cost of the coverage. Business insurance includes coverage on equipment, workers’ compensation, retirement plan, cyber liability, directors’ and officers’ liability, and other coverages specific to your practice. Raising the deductible amount could reduce premium costs. Eliminating unnecessary insurance and bundling coverages could also save premium dollars.

Is your lease near a renewal or expiration date? Summarize all leases and lease terms. Consider all leases—including those for equipment and automobiles for the practice. Assess the amount of space you use and need, the equipment you lease and whether owning is better than leasing. Also consider if the satellite locations remain appropriate.

As you move towards the end of the year, re-think holiday parties and gifts.

Many practices have warm and meaningful gatherings without all of the expense and glamor of those of yesteryear. Open your home with catered food on a weekend to show appreciation to your staff in lieu of a night out at an expensive restaurant. Having a cozy time socially with your staff could generate much needed goodwill and be well received.

A few other areas to consider on the expense side. Many healthcare practices sponsor events and teams. Review those that the group supports to confirm that the sponsorship builds value for all in-

volved. Review continuing education costs for physicians and staff. Many events are held in both live and virtual formats. While it’s great to attend in person, consider rotating the events so that there is some virtual attendance. Or rotate the staff to alternate years of inperson attendance and attend the other years virtually. Utilize group discounts where fees are lower if two or more attend from the same group. Review services and subscriptions. Since many groups have removed magazines during the pandemic, be sure subscriptions are cancelled. Look at your cable bill to see if the programming could be curtailed.

There are also several considerations from the revenue side of the practice to consider. Add providers who can generate additional income for the practice.

New providers can practice without significantly increasing the practice’s fixed costs. Consider splitting fixed costs by x + one. If you move from one provider to two providers, fixed costs are shared equally. If you move from four providers to five providers, fixed costs are shared 20 percent vs. 25 percent each. The difference for each provider can significantly increase practice net income.

Review your practice revenue cycle management operations. Review practice explanation of benefit forms and confirm that you are properly billing for services performed, and that you are capturing all charges.

Monitor the billing and collections of high-cost drugs and supplies used by the practice. One lost opportunity to collect could cost thousands of dollars.

Remember, every practice is unique.

Consider how this information could affect your specific practice before making major changes. It is important to consider new options and applications to move the practice forward and better operating results.

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Gerard J. Kassouf, CPA CFP® is a director of Kassouf & Co., P. C, a regional accounting firm headquartered in Birmingham. He practices in the area of health care, financial planning and tax compliance and planning. He can be reached at gkassouf@kassouf.com.

Birmingham Medical News

AUGUST 2022 • 13

CMS Expands the Open Payments Program Works Works for for

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In June, the Centers for Medicare and Medicaid Services (“CMS”) published its 2021 data from the Open Payments Program. The Open Payments Program makes information available to the public about financial relationships between certain are not employees of the manufacturers and group purReporting Entities, and James Henry chasing organizations (“Reteaching hospitals. In 2021, porting Entities”) who make payments CMS added physician assistants, nurse or transfers, and certain recipients, who practitioners, clinical nurse specialists, are known as Covered Recipients. Covcertified registered nurse anesthetists, anered Recipients are health care providers esthesiologist assistants, and certified nurse of various types, including physicians. midwives to the list of Covered Recipients.

In 2021, CMS expanded the Open Open Payments of $10.9 billion Payments Program by adding five new were reported during 2021, consisting provider types as Covered Recipients of 12.10 million records. The largest and three additional Nature of Payment Nature of Payment Category in terms categories. Further, device identifiers for of dollar value was research payments, medical devices were added, as well as which were reported at $7.09 billion. the NPIs of Covered Recipients.

The largest number of payments were Open Payments consist of payin the General Payments category, with ments and other transfers of value, 11.42 million payments being reported. along with ownership and investment Physicians received both the largest interests in the Reporting Entities. The number of payments and the greattypes of payments that are reported are est monetary value of payments, with categorized into Nature of Payment 533,056 payments worth $3.37 billion.

Categories, which include: 1) General The Open Payments Program conPayments, which are not associated sists of four phases of activities: 1) Data with a research agreement or research Collection; 2) Data Submission; 3) Preprotocol; 2) Research Payments, which Publication Review, Dispute, and Corare made in connection with a formal rection; and 4) Data Publication. research agreement or research protoDuring the Data Collection phase, col; and 3) Physician Ownership Inforwhich covers a calendar year, Reporting mation, which consists of ownership or Entities collect data about payments they investment interests held in the Reportmade to physicians and other Covered ing Entities. In 2021, CMS added new Recipients and ownership or investment Nature of Payment Categories for debt interests held by Covered Recipients. forgiveness, long-term medical supply or During the Data Submission phase, device loans, and acquisitions. which lasts from February 1st through C overed Recipients include physiMarch 31st of each year, Reporting Encians (excluding medical residents) who (CONTINUED ON PAGE 17)

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AUGUST 2022 • 15

Coronaphobia, a Perplexing Social Anxiety Disorder

Slow pandemic reintegration posing a problem for healthcare professionals

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Coronaphobia, a newly minted term, perhaps best describes patients suffering from social anxiety spurred by the pandemic – and it’s a problem for doctors.

Some patients have become so accustomed to sequestering in their homes during the early stages of the pandemic – while also transitioning to zoom meetings and phone calls with medical providers – that they’re reluctant to return to inperson visits, especially when restrictions are placed on companions in the waiting room. The problem has led to more-thanusual cancellations and no-shows.

“Coronaphobia describes the excessive fear of contracting the virus and the stress and avoidance of public places and situations that result from fear,” said Mary-Catherine Segota, PsyD, cofounder of Counseling Resource Services in Florida. “An increase in anxiety during the pandemic led to fears of leaving the house for some, and eventually symptoms of agoraphobia and panic disorder. What does this mean for healthcare providers, and how does it influence how we screen and probe for psychiatric issues?

“The initial adjustment to the shock of the sudden lockdown and dealing with such issues as virus contagion, contamination fears, distance from loved ones, changes in patterns and routines, and isolation was difficult for almost everyone. Adding to this was the unanticipated extension of the pandemic spanning two-plus years, which led to additional difficulties adjusting and more distress.

Now that we are beginning to return to integrated social interactions and a ‘new normal,’ we see that some people have not adjusted as well as anticipated nor resumed their prior level of functioning.”

“Preliminary anxiety related to the pandemic was initially associated with obsessive compulsive disorder and healthrelated anxieties. An increase in anxiety during the pandemic led to fears of leaving the house for some and eventually symptoms of agoraphobia and panic disorders.

Agoraphobia typically lasts six months or longer and is accompanied by symptoms characteristic of panic disorder.”

Brian Thoma, MD an interventional pain specialist for Cahaba Pain and Spine Care in Hoover, said the nearly six-week surgical shutdown in early 2020 greatly impacted patients who rely on pain-relieving procedures to stay functional. That includes the new SGB block for patients

Brian Thoma, MD

with PTSD that many military veterans call a game-changing reset.

“Early in the pandemic, a young woman was referred to us for an epidural blood patch, a procedure we’re asked to do for patients with a terrible headache after a lumbar puncture,” Thoma said.

“The patient was reluctant to come in, but ultimately the headache was bad enough that she wanted the procedure.

Fortunately, it worked well for her.”

“As society transitions to a new phase of the pandemic, it’s essential to ask critical questions to help assess the presence of clinical anxiety and to help differentiate disorders,” Segota said. “I would suggest that practices implement a questionnaire that assesses COVID-related stressors and socialization reintegration difficulties.

“Ask about the following stressors: financial problems (difficulty paying bills, debt); work problems (unemployment, decreased hours/roles, conflicts with colleagues); educational problems (difficulty completing course work); housing problems (instability, moves); relationship problems (isolation, separation or divorce, conflict with family or friends, intimacy problems); personal or loved one’s health problems (new or worsening illness, medication issues, disability) and caregiving problems (emotional stress, time demands). Ask about mood and adjustment to changes, sleep, energy, appetite, and desires for activities outside the home. Ask about attempts to increase activities outside the house or avoidance of those activities.”

Some health systems have introduced new programs to address these problems.

For example, beginning this month Kaiser Permanente is offering on-demand emotional support to its members through the (CONTINUED ON PAGE 17)

CMS Expands the Open Payments Program, continued from page 14 tities submit data that was collected during the previous calendar year.

During the Pre-publication, Review, Dispute, and Correction of Data phase, physicians and other Covered Recipients have the opportunity to review reported payments and other transfers of value – such as investment interests – that have been attributed to them. From April 1st through May 15th, Covered Recipients have the opportunity to dispute or inquire about data submissions that are believed to be inaccurate or incomplete.

The process of disputing a payment is relatively simple. A dispute may be filed by logging into the Open Payment system via the CMS Enterprise Portal at https://portal.cms.gov/ and select the “Review and Dispute” tab on the menu bar. Search functions can be used to select the appropriate Covered Recipient and the record to be disputed. A “Dispute Record” button opens the “Dispute Record” page and the reason for the dispute can be entered into a text box and submitted directly from the website.

In 2021, there were 409 disputed payments, with a monetary value of $13.42 million. So, although Covered Recipients are not required to review the submitted data, it seems like a good practice and CMS encourages the reviews.

When a Covered Recipient initiates a dispute or inquiry, the Reporting Entity has 15 days to respond and ensure that

the final report is accurate, by either confirming or correcting the reported data.

Accordingly, the period for the reported data to be either confirmed or corrected before publication ends on May 30th.

In the interest of accuracy, however, reported data may be corrected or updated after May 30th, and the correction or update will be reflected in subsequent data refreshes or publications.

The Data Publication phase requires that the submitted data be published by June 30th of each year and the data is displayed by CMS at http:// openpaymentsdata.cms.gov.

As mentioned above, it is a good practice for physicians to review Open Payment data to make certain that any payments attributed to them are accurate. CMS provides a number of resources for that purpose, including an extensive user guide and a tutorial for the dispute process, which may be accessed at https://www.cms.gov/OpenPayments/ Resources/Covered-Recipients.

Additionally, for assistance with Open Payments-related inquiries, CMS provides a help desk that can be reached by telephone at 1-855-326-8366 or by email at openpayments@cms.hhs.gov.

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Jacqueline Hobbs, MD, PhD, an associate professor in the University of Florida College of Medicine’s department of psychiatry, emphasized the importance of the pandemic not being over.

“It’s a pandemic seemingly with-

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The pandemic is so prolonged that it has become a chronic stressor. People don’t feel like there’s an end in sight. We get little glimpses of the finish line, but then we’re right back at it.”

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AUGUST 2022 • 17

GRAND ROUNDS

Burr & Forman Launches BurrCyber.com Burr & Forman has launched www.

BurrCyber.com as a resource center for businesses and their insurance carriers to address the increasing risks and costs posed by cybersecurity attacks, the management of personal data, and compliance with evolving data breach notification and data privacy laws.

“With the increase in cybersecurity attacks, the rising dependence on digital connectivity for businesses, and the increased collection of personal information, this site marks our commitment to helping clients navigate the uncertainties of business in the digital age,” said Elizabeth Shirley, who is co-chair of Burr & Forman’s Cybersecurity & Data Privacy team.

Weaver Elected to National Academy of Sciences Casey Weaver, MD, professor in the UAB Department of Pathology, has been elected to the prestigious National Casey Weaver, MD Academy of Sciences which is one of the highest and rarest honors offered to scientists in the United States. He was among 120 new members invited to the National Academy this year.

For 30 years, Weaver has studied T

cells, and has published more than 180 peer-reviewed papers in prestigious journals, including Science, Nature, Cell, Nature Immunology, Journal of Clinical Investigation, Journal of Experimental Medicine, Science Immunology, Nature Medicine and eLife, and he is an author of Janeway’s Immunobiology, one of the leading immunology textbooks.

“Science is a team sport, and this honor is a tribute to the incredible people I’ve had the good fortune to work with at UAB — especially the trainees,” Weaver said. “I’m also pleased that the work this acknowledges was done at UAB over the last 30 years. It’s truly homegrown.”

ImmunoTek Opens Plasma Center in Anniston ImmunoTek Plasma, the largest independent blood-plasma donation center operator in the country, has opened its newest location in Anniston.

Plasma is used to create medicines and plasma-based therapies that treat patients with a variety of diseases and disorders including shock and burn patients, bleeding disorders, transplant patients, those suffering from autoimmune diseases, and many others.

The United States provides 75 percent of the world’s plasma, and demand increases by six to eight percent yearly.

“We are excited to add Anniston to the ImmunoTek family,” said Blair McKinney, COO of ImmunoTek Bio Centers.

“In addition to donor compensation, the new ImmunoTek donation center will create new jobs in Anniston and we anticipate making a $5 million economic impact yearly.”

UAB Selects Interim UAB Medicine Leaders The University of Alabama at Birmingham has selected several leaders to serve in the roles that will be vacated by Anupam Agarwal, MD Selwyn Vickers, MD, who will become president and CEO of Memorial Sloan Kettering Cancer Center in September.

Heersink School of Dawn Bulgarella Medicine Executive Vice Dean Anupam Agarwal, MD will serve as interim senior vice president of Medicine and interim dean of the School of Medicine for a second time, as well as interim chair of the Health Services Foundation Board. He first served in these interim roles in 2013 when Watts vacated them to become president. Agarwal also directed the Division of Nephrology from 2008 to 2021 and serves as the Program Director of the NIDDK funded O’Brien Center for Acute Kidney Injury Research while maintaining an active role in clinical medicine, teaching, research and administration.

Dawn Bulgarella will serve as inter-

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Birmingham Medical News

im CEO of the UAB Health System and continue to serve as president of the UAB Health System and CFO for the UAB/Ascension St. Vincent’s Alliance.

Bulgarella spent 15 years in operations before becoming the senior associate dean of Finance and Administration in the UAB Heersink School of Medicine and ultimately the first president and CFO of the UAB Health System.

Reid Jones will continue his role as CEO of UAB Medicine. Jones has been at the center of UAB’s health care administration and operations for more than 30 years and has served in several key positions, including executive vice president for the UA Health Services Foundation, and COO of UAB Medicine.

Jason Alexander, CEO of Ascension St. Vincent’s, also will continue as a key member of the senior leadership team in the UAB/Ascension St. Vincent’s Alliance.

Watts says the stability this leadership group provides will allow for thoughtful planning that will continue UAB Medicine’s upward trajectory.

“Dawn, Reid and Anupam have been invaluable and visionary leaders for UAB Medicine for decades and comprise a veteran leadership team that provides stability and a dedication to excellence,” Watts said. “Our community is grateful to Selwyn for his service to UAB since his return to Birmingham almost a decade ago, and I wish him the best. He helped recruit and retain incredible talent, which is among the

GRAND ROUNDS

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many reasons UAB remains in a position of strength to ensure a smooth transition as we continue to grow and serve the people who count on us.”

Hughes Appointed to National Advisory Council Krista Hughes, BCPA, the founder and CEO of Hughes Advocacy and Passion 4 Patients, was appointed by U.S. SecreKrista Hughes tary of Health and Human Services Xavier Beccera to serve a three-year term on the National Advisory Council for the Agency for Healthcare Research and Quality.

The council, which consists of 21 members from the private sector, provides advice to the secretary of the U.S. Department of Health and Human Ser-

vices on federal research needed to improve the way health care is delivered.

With over 25 years in the medical industry, Hughes’ mission is to advocate for patients by educating and empowering them to be proactive with their health.

“I believe that bringing the patient’s voice to this council will be instrumental in improving quality and patient safety across the country,” she said. “All patients should be treated equally with dignity, compassion, and respect, and given the highest quality care.”

New Gene Therapy Treatment at UAB Callahan Eye Hospital UAB Callahan Eye Hospital has been designated as a treatment center for two rare genetic eye diseases that

cause blindness.

The hospital has been named a site for delivering Luxturna, the first directly administered gene therapy approved in the U.S. Luxturna is used to treat a subset of patients suffering from either Retinitis Pigmentosa or Leber’s Congenital Amurosis who have mutations in both copies of the RPE65 gene and remaining healthy cells as determined by their treating physician.

Brian Samuels, MD, a member of the Alabama Academy of Ophthalmology and the interim chair for the UAB Department of Ophthalmology and Visual Sciences, said: “Our location, in Birmingham, is an asset because of our reputation as a top national eye center and the accessibility of our city for those living in the Southeast.”

Cullman Regional Opens Newly Expanded Emergency Department On July 26, Cullman Regional Medical Center held a ribbon cutting to officially open the hospital’s newly expanded Emergency Department. The expansion project has increased the capacity of the ER by 80 percent and allowed the hospital to renovate or newly construct all ER patient care areas.

“For patients and their families there can be so much anxiety when coming to the ER,” said Cullman Regional Chief Nursing Officer Charna Brown. “We want to do everything we can to make the patient experience better and this new facility helps us achieve that goal.”

The $9.5 million dollar expansion adds an additional 6,021 square feet to the facility and features 17 new treatment rooms, three new trauma rooms, a dedicated behavioral health patient care area with nine new behavioral treat-

Cullman Regional team, Congressman Robert Aderholt, and community leaders mark the opening of the newly expanded ED.

ment rooms and a larger, more modern waiting area.

Patient visits to the Cullman Regional ED had increased significantly over the past few years, causing the ED to operate slightly over capacity, a situation that the expansion has relieved.

With continuing population growth in north and central Alabama, the hospital leadership decided to take proactive steps to stay ahead of the growth.

“It’s vital that our hospital invest in facilities, talent and technology that will provide the healthcare our community needs now and in the future,” said Cullman Regional CEO James Clements.

The hospital has another expansion project underway. A four-story tower addition, scheduled to be completed next year, will enable the hospital to double the size of its critical care unit and add more beds to its medical surgical unit.

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Birmingham Medical News

AUGUST 2022 • 19

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Physicians Robert Agee, MD Birmingham/Vestavia Robert Dean Lolley, MD Hoover/Hueytown Michael Patterson, MD Chilton/Shelby County Mark Prevost, MD Walker County Joseph M. Sherrill, MD Birmingham/Vestavia Kendall Vague, MD Walker County John Young, MD Birmingham/Vestavia