Birmingham Medical New August 2023

FDA Approves Groundbreaking Alzheimer’s Drug

By laura Freeman

Early diagnosis of Alzheimer’s Disease has just become more urgent.

“Now that we have a therapy that can slow the progression of Alzheimer’s Disease (AD) by 25 to 35 percent, we can finally do something to delay the damage,” said David Geldmacher, MD, FACP, neurologist and director of UAB’s Division of Memory Disorders and Behavioral Neurology.

Clinical trials conducted at UAB gathered evidence that led to the accelerated limited approval of Lecanemab, commercially known as Leqembi, in January. Further trials confirmed the effectiveness of the drug in slowing progression

when administered to patients early in the course of the disease. That led to the Leqembi becoming the first new AD therapy to receive full FDA approval in 20 years.

This approval has also opened the door to Medicare coverage of the medication, with the provisions that patients must be in the early stages of AD, and they are required to participate in a registry that will continue to track the benefits of the drug and its safety.

“The drug is a protein antibody that binds to amyloid plaques and is administered as an infusion in a healthcare setting every two weeks for 18 months,” Geldmacher said. “About 26 percent of patients may benefit from over-the-counter Tyle-

Mental Health Resource Shortage Creates Crisis for Emergency Departments

By marti WeBB Slay

The shortage of resources for mental health patients is resulting in a problem for hospital emergency departments, which are seeing an increasing number of psychiatric patients.

“It’s a daily struggle,” said Elizabeth Caine, MSHA, MBA, associate vice president and administrator for UAB’s Center for Psychiatric Medicine. “It causes a backlog for patients seeking medical care and trauma care.”

By June 30, UAB had boarded psychiatric patients in the emergency de-

partment for more than 2,600 hours per month, on average. “We are delivering

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care, but it takes up space and prevents the emergency department from turning

the beds over and seeing other patients who come in,” Caine said.

The problem of emergency department backlog isn’t unique to psychiatric patients. “Almost every emergency department in our state deals with boarding crises on a daily basis,” said Jeremy Rogers, MD, FACEP, associate medical director of the department of emergency medicine at Grandview Medical Center. “Many days, our Alabama hospitals have prolonged wait times when there are no inpatient beds available. This is not just a psychiatric care issue. It is a general situa-

Jeremy Rogers, MD, FACEP Elizabeth Caine, MSHA, MBA

Succession Planning Starts Early

By Laura Freeman

Years of working from goal to goal is a near universally shared experience for those who choose to become a physician. Once established in a busy practice, the focus tends to shift from what comes next to the here and now

However, even for physicians in the early years of their career, it’s good to continue thinking about the future and considering how you might respond if the unexpected comes along. Like patients, physicians are equally at risk for illnesses, injuries and family issues that can be career limiting. If your spouse is transferred to another city, or you become interested in a subspecialty or procedure that requires more training, or if you decide to move to a practice with a different culture or more opportunities, how would you adapt?

For many physicians, succession is a topic that only comes up as they approach retirement.

“The best time to begin succession planning depends on your specialty, how many people are in your practice to share the load in transition, and where your practice is located,” Georgina Perry, CPA, CMPE , Director of Physician Services for Carr, Riggs and Ingram LLC

said. “If you are in a popular specialty that is graduating a lot of medical students, finding someone to fill your space is easier. However, if you are in primary care, there is already a physician shortage and finding a candidate could take a while. This is especially true in rural and underserved areas.

“Before recruiting begins, it also helps to consider the additional roles you play in your practice and the qualities that a candidate would need to fill those roles. For example, in addition to being a physician, you may have a leadership role in practice management. Leadership and management abilities would be desirable in your ideal candidate.

“The more active phase of succession planning typically begins from three to five years before retirement. The first step in the formal succession process is notifying partners and practice managers that you are planning to retire and when.

“Before our clients announce their plans to retire, we like to put them in touch with a personal financial planner who can review the assets they have in place for retirement, and help them work out a budget that will allow them to live the life they want and do the things they’ve looked forward to doing.”

Many of the details involved in transferring the value of your shares of the practice to your personal assets will be governed by the partnership agreement or other contracts that were set up when you joined the practice. Some physicians work as employees rather than as partners and you only need to give notice that you are leaving. Others own shares that are sold back to the practice. In both cases, the practice will then be responsible for finding a successor.

“Some physicians, including solo practitioners, will need to find someone to buy out their share of a practice,” Perry said. “Although you may be responsible for recruiting and sale, if you have partners, be aware that they will be the

people working with the new person and may want to have input on whether the new physician is a good fit.”

Whether you will be selling your shares back to your practice group or selling it to the physician who will be taking over for you, it can help to consult with a medical practice financial specialist to work out a fair valuation and get advice on other business details.

Finding good candidates for recruitment can be challenging. You can begin by asking for recommendations from other physicians you know, contacting instructors at medical schools, or talking with the nursing and health professions staff at a teaching hospital to ask about physicians in training. Suppliers may also know physicians who might be interested in joining a group practice.

Being a guest lecturer, mentor or teaching a class at a medical school can acquaint you with candidates who will be looking to join a practice in a few years. Your practice could also offer internship opportunities. You could serve as an advisor for outreach programs, clinics and medical mission trips with participants who will soon be graduating.

“It’s often customary to stay on for a while during the transition to advise your replacement on fitting into the culture

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Georgina Perry, CPA CMPE

FDA Approves Groundbreaking Alzheimer’s Drug,

nol or Benedryl if they experience a typical mild infusion reaction. After 18 months of treatment, PET scans show that most of the amyloid protein has been removed.

“We aren’t yet sure where or when the drug antibodies bind to the amyloid proteins, but it may be in the bloodstream. We hope the amyloid protein won’t return and that the time gained while using the drug will continue to push forward the progression of worsening symptoms to a time later than they would have appeared.

“This medication is a treatment, but not a cure. It doesn’t reverse damage to neurons that have already been compromised, so unfortunately it isn’t for patients whose symptoms have progressed to the point they are no longer independent. The drug is aimed at plaques, but it doesn’t address the tangles that are already there. We don’t know yet how reducing amyloid plaques will affect the formation of tangles, which are the other half of the equa-

tion in progression of the disease.

“Our goal with this medication is to give patients more time to live independently and enjoy being with their family and friends. We want to delay the need for a caregiver, and give families more time to live without the burden and expense of caregiving. ”

The drug is continuing to be studied in hopes of improving it. Researchers are working on a form that could be selfinjected much the same as insulin. Other

continued from page 1

drug companies are working on medications with a similar mode of action. Eli Lily is developing a medication that we think is likely to be approved this year.

It’s always good to have multiple options, since a patient who may not be a candidate for one drug could possibly benefit from another,” Gelmacher said. “I should add that Leqembi shouldn’t be given with a blood thinner, since a small percentage of patients have experienced side effects of small brain bleeds or swelling. The swelling usually resolves and the bleeds are sometimes so slight they only show up on imaging, but it is enough of a concern to make blood thinners a contraindication. These rare side effects seem to be more likely to occur in patients with an APOE-4 variant, so those with that genetic profile should be closely monitored.”

Additional research is underway to develop drugs that target the formation of tangles. New uses of drugs already approved for other applications are also

Mental Health Resource Shortage, continued from

tion hospitals find themselves in.

“Studies show that psychiatric patients are generally two times as likely to be admitted to the hospital as medical patients. And the need for access to mental health resources has significantly increased. A recent study showed that emergency department encounters with mental health patients have increased by 44 percent. From 2010 to 2016, there was a 13 percent decrease nationwide in inpatient psychiatric beds. So more patients are attempting to access mental health resources while there has been a contraction of resources. This nationwide trend is also taking place in Alabama and certainly in Birmingham.”

Caine agreed. “It’s really a nationwide problem, specifically in urban areas, but also in rural areas where there is often not access to psychiatrists or outpatient psychiatry programs.”

“With beds closing and the lack of inpatient treatment options, we are see-

ing more return visits to the emergency department,” said Carrie Wynn, BSN, RN, service line director of emergency services at Decatur Morgan Hospital.

“Some of the mental health patients stay in the ER for days. We had one patient for 20 days. So you have a treatment bed in your ER tied up for nearly a month, waiting for us to find them a bed to transfer to.

“In addition, if patients are at risk for suicide or a threat to others, regulations now require a one-to-one sitter while they are in the ED. You can imagine the impact that’s having on our healthcare staffing, especially with some of the long stays. And the ED is not a therapeutic environment for these patients. When you have a paranoid schizophrenic who is having auditory hallucinations in a noisy ED, that’s not beneficial for them. We offer care, but there’s a line between what an ER physician can do for them versus what a psychiatrist would do.

“This crisis is also causing problems

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with allocation of EMT resources. Because there are so few available beds in the state, we find one across the state, so we’re frequently sending our ambulance crews six hours away. If it’s a six-hour trip, that’s 12 hours the ambulance is out of service. It keeps a crew from answering 911 calls locally.”

All the providers say there are no simple solutions here. More beds are needed, as well as more caregivers. A better system for care before patients become emergent would result in less traffic in EDs. Better follow-up care would cut down on repeat visits. An automated system for tracking available beds would free up personnel who are currently searching for availability institution by institution. But these are all long-term answers that will require funding and a concerted effort by state leaders.

In the meantime, Rogers offers some suggestions for steps EDs can take to help manage the situation: Since routine is important for psychiatric patients, regular meals are important, and many need nicotine supplements. If restraints are needed, they should be discontinued as soon as possible. Hospitals should provide a dedicated space in order to consolidate resources and board psychiatric patients further away from the activity of the emergency department. Telehealth access to psychiatrists can help provide better care for hospitals that don’t have an inpatient psychiatric facility.

Rogers acknowledged the frustration of providing quality care to all patients in the ED under difficult conditions.

“We want to take good care of our patients,” he said. “It’s frustrating when we are overburdened. This is a difficult and complicated issue.”

being studied to see if they might benefit Alzheimer’s patients.

“One area with a great deal of potential is drugs for diabetes, including those that are now being used to help with obesity,” Gelmacher said. “There is something about insulin resistance that seems to be involved in the development of AD.

“Since Alabama has the third highest death rate from Alzheimer’s Disease in the nation, every step forward really matters to the people all around us.

“The takeaway for physicians and other health professionals is that we need to watch for indications of possible Alzheimer’s Disease every time we encounter patients who may be at risk. In the past, there was a social tendency to avoid bringing up the possibility of a memory disorder until it became obvious. Now we can make a real difference in the course of the disease and the quality of patients’ lives, but to get the full benefit, we have to start early.”

Succession Planning Starts

Early, continued from page 3

and using systems and equipment. You’ll introduce them to other physicians and the staff, and to providers who refer patients to you, along with physicians you refer your patients to.” Perry said.

On the personal side of succession planning, there’s more to consider about retirement than finances. The people who do best in retirement tend to think of it as retiring to something rather than retiring from. There are only so many hours a day to golf or fish before it becomes boring.

Will you travel? Make sure your passport is up to date and start looking at brochures. Some of the best trips are booked up to a year in advance.

“If you would like to continue using your skills and the wisdom you’ve learned as a physician, there are many ways to do it,” Perry said. “You can earn extra money for travel and other activities by reviewing files for insurance companies and attorneys. Volunteer at clinics or outreach programs. Mentor, teach or write a book or article on a topic that interests you. Work with local medical organizations or speak to community groups.”

If a local medical organization is putting together a mission trip to help needy people in Central America, go with them as a physician. Make a difference. See the world.

Whatever you choose to do in retirement, enjoy it. You’ve earned it.

David Geldmacher, MD, FACP

Assessing Reimbursement Performance with KPIs

By Jane ehrhardt

“We often find that clients know how much money is going in the bank, but they don’t know how they’re doing,” says Philip Allen, director of revenue services with MediSYS. Following key performance indicators (KPI) offers a clearer look at reimbursement performance and can pinpoint where, within the cycle, adjustments need to be made or resources can best be allocated for solutions.

For example, collections will go up and down. “These metrics provide the information to look objectively at why things fluctuate,” Allen says. Reviewing these numbers can reveal that a drop in visits resulted from a doctor being at a conference or that because of flu season, the practice had shifted to primarily providing a type of service with a different level of reimbursement.

“A few indicators allow you to see whether your in-house billers or billing company is collecting everything that’s possible. Unlike overall revenue intake, the net collections percentage KPI compares net charges to net payments, which takes into consideration the insurance

contractual deduction, usually around 20 percent. So if you collect 100 percent— which is almost impossible—then you know you’ve collected everything that insurance has allowed to be paid.”

The clean claim rate or first pass rate can expose faults within a reimbursement cycle. Both of these KPIs show what percent of claims go through without denials versus claims that need edits or additional information. The goal is greater than 95 percent. ”That should be pretty achievable, but numerous factors are going to affect that on an individual basis,” Allen says.

“You reach a point where you want to steer away from some payers if, for example, cumbersome payment methods outweigh the revenue,” he says. “The revenue per patient visit per payer KPI can help clarify the need for that decision. It provides the average reimbursement per payer, whether an insurance company, Medicare, or the patient. That displays the distribution of visits among payers and the proportion of patients by insurance companies. Look at the trends there. If it's changing—maybe Medicare is up and Blue Cross, which has higher reimbursements, is down—that makes a

difference in your revenue.”

In the claim denials KPI, the primary reason for failure usually points to insurance eligibility problems, often in the status of a patient’s insurance coverage versus their eligibility for the treatment. This KPI should be below eight percent. If not, the solution lies with the front desk. Staff should ask about the patient’s insurance every time they come in because Medicare advantage plans can change.

When denials are at an unhealthy high rate or the first pass KPI is at an unhealthy low, then the outstanding accounts receivable KPI will also likely be over its target of remaining below 20 percent. “If it hits over 20 percent, then investigate,” Allen says. “Don’t wait to see if it goes down next month. Waiting means the problem, which usually lies with unpaid claims older than 90 days, grows and claims time out, leaving no hope of getting paid for work done.”

This is why key performance indicators are not about making progress, but reaching a target. They serve as alarm bells to problems and point the way toward solutions. For instance, the outstanding encounters KPI shows the number of

Philip Allen

visits not yet closed. “Some people think this would be common sense, since you aren’t going to get paid until it’s completed and closed,” Allen says, which is why as a potential unseen problem area, it needs to be monitored. For instance, at one clinic where revenues had fallen, the cause fell on one doctor not closing out more than 100 encounters.

The charge lag KPI can illuminate a multitude of potential bottlenecks in the cycle. It shows the number of days between the service provided and the submission of the claim. “You’re trying to reduce the time at each step of the process,” Allen says. “And there’s a lot to track through the process. For instance, outstanding revenue can appear as falsely high if it takes four or five days to post payments into the system.

“KPIs are a kind of thermostat. If you look at a trend and see something going the wrong way, it should prompt you to investigate and take action.”

Building and Retaining a Solid Billing Staff

By Jane ehrhardt

Administrators now spend more time handling recruitment, retention, and staffing shortages than before the pandemic. “These shortages and continuous training of new staff members place a strain and backlog in the revenue cycle,” says Tammie Lunceford, CMPE, CPC, a senior healthcare consultant with Warren Averett.

The shortage of qualified candidates coincides with the end of the pandemic slump, exacerbating the problem. Patients are avidly seeking to schedule delayed visits and procedures, especially in surgical specialties like orthopedics, where knee and hip repairs are at record levels.

As a result, Lunceford is seeing both large practices and new startups facing reimbursement situations that point back to staffing. “The root of their problem is they can’t hire enough staff or they have a large turnover of those who had the knowledge,” she says.

Once staff comes on board, practices can fail to utilize or keep them by stinting on training, leaving new hires to learn on their own. “Make sure that each position has a checklist of vital functions to create consistency and clarity,” Lunceford says.

“That includes the front desk personnel because they are starting the claim when the patient arrives. And tell new hires their role in the reimbursement cycle and how you’re relying on them. When employees understand their relevance, it creates a buy-in for them in the success of the business.”

For the first 90 days, assign new staff members a mentor to help meet their checklist functions and guide them through practice nuances. If the new hire hasn’t become proficient in their checklist after 90 days, let them go.

To maintain the most efficient usage of the technology, assign any training to a super-user of that software or device in each department, such as front desk, clinical, billing, and scheduling. These are the personnel with extensive training who not only know how to use the tech, but also how it applies to that department, keeping the workflow consistent and avoiding the legacy of hand-me-down errors.

Keeping staff long enough to become super-users requires an ongoing training investment many clinics mistakenly bypass. The alternative is not only constant

turnover, which costs more money, time, and resources to resolve, but a less adept staff. Longevity of staff allows time to grow their expertise, which leads to improved workflows for a more successful revenue cycle.

When there is not an ongoing training program, staff often get blamed for inefficiencies when the problem actually lies with underusing the technology. “Administrators may have no problem with purchasing technology, but then they don’t ensure it’s working optimally for them,” Lunceford says, about practices that get mired in staff or administrative turnover and lose focus. They move away from tapping into all the resources it offers.

For instance, a check-in kiosk system that could be better integrated with the practice management or EMR system could relieve staff of performing multiple steps in the workflow. “You don’t want to pay for technology and not get good results with your staff or your patients,” Lunceford says. “Training, such as attending annual user conferences, leads to a higher investment in the business by staff and likely money-saving adjustments.

“As updates roll out, make sure managers are updated on software, as well.

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Tammy Lunceford teaching at a coding event.

Refiling Claims Pays Off

By Jane ehrhardt

Change Healthcare found that 86 percent of claims denials are likely avoidable, according to their 2020 Revenue Cycle Denials Index. It also found that providers do not resubmit 65 percent of denied claims.

“The biggest problem with most groups we see is the follow-up after the payment comes in from insurance company,” says Bill Cockrell with Medical Billing and Consulting Services (MBCS). “The payer might only deny a portion of the claim, rather than the whole thing; or maybe they didn’t pay the claim in full. Just because they say it’s not payable, doesn’t mean it isn’t something fixable.”

With the claim, the insurer includes an explanation of benefits that states the doctor’s fee schedule for the services, the payer’s fee schedule, what the patient is responsible for, and then the contractual adjustment because of the billing agreements between the provider and the payer. For instance, a doctor may charge $100 for an office visit, but the fee schedule with the payer is $75.

“So if the claim was filed correctly, the physician should get $75 minus the patient copay,” Cockrell says. “If the payer doesn’t pay that full amount, there has to be a reason, and that shows on the explanation of benefits as a rejection

code. Some groups always write off that unpaid difference rather than refiling.

“But that write-off could be lost revenue from something as simple as resubmitting with a corrected or missing modifier that would rectify the insurer’s fee. Or it may only need the submission of a missing piece of documentation.”

The contractual adjustment — the difference between what the healthcare provider charges and the agreed-upon amount the payer will reimburse — are an unavoidable write-off. Some practices staff a clerk to review claims and write off these contractual adjustments. “What we see happen is some groups just write off everything the insurance company didn’t pay,” Cockrell says. No reviews, no refiling.

Sometimes the write off happens simply because the clean claim window closed, which generally allows a minimum of 90 days up to a full year, depending on the insurer. “We see that more often than you could believe,” Cockrell says.

The unchecked write-offs often become the norm rather than a stopgap. “The group becomes comfortable doing that because sometimes they don’t have time to deal with it,” Cockrell says. “If you don’t write it off and don’t do anything else with it, your accounts receivable isn’t realistic. It’s not reflective of

happens Discovery

how well your business is doing.”

The solution is a new layer to the review process. “Someone on staff needs to go through and match the electronic payments with the explanation of benefits to make sure the payer is covering all they should be,” Cockrell says.

Use the adjusted collections rate to assess the efficacy of collected reimbursements. Divide payments (the net of credits) by charges (net of approved contractual agreements) during a specific time frame. Then multiply by 100 to get the percentage. That number reflects how much of every fee allowable is being collected.

“Typically, you should be collecting 97 percent,” Cockrell says, leaving 3 percent bad debt, which allows for things such as patients not paying. “If that number is 100 percent, I know from the start they have problems, because the only way to do that is to write off everything—what the insurance didn’t pay and what the patient did not pay you.”

The amount of revenue lost can be staggering. “It’s not unusual to cover our fees in what we’re able to do to help groups by doing a better job on followup,” Cockrell says. For one group, the follow-ups improved their gross collections by 5 percent. Even increasing gross collections by 2 percent in a million-dol-

lar-a-month practice would add another $240,000 revenue a year.

Yet physicians usually balk at hiring additional office staff or outsource the billing in order to right the reimbursement process to generate the most revenue. “They see it as costing them money, rather than looking at it as this is going to improve my bottom line,” Cockrell says.

They also tend to not fire those staff responsible for the ongoing and often notable loss of revenue over significant time. “They don’t chop off people’s heads. They say, we gotta fix that and not let it happen again,” Cockrell says.

“You don’t know you lost it, if you never see it,” Cockrell says. But once that lost revenue comes to light, move quickly to realign the claims-handling processes. Because time results in actual money, when it comes to refiling claims.

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

Bill Cockrell

OIG Issues Favorable Advisory Opinion About Online Health Directories and Advertisements

By angie Cameron Smith

Does your practice pay to advertise in online directories? Or do you contract with a website to allow patients to book appointments or look for services? If the answer to these questions is “yes”, you may be interested in a recent Advisory Opinion issued by the Office of Inspector General (“OIG”) -- Advisory Opinion No. 23-04.

On July 11, 2023, the OIG published a favorable opinion in response to a request about payments for advertising in online directories and the use of sponsored ads by health care providers. The request specifically sought an opinion from the OIG whether such advertising could result in sanctions under the Federal Anti-Kickback Statute or the Beneficiary Inducements Civil Monetary Penalty provisions. Based on the facts presented to the OIG, such an arrangement would not subject the operator of the website to sanctions.

Background

The opinion was requested by a technology company (the “Requestor”)

that operates a website and mobile application that allows people to search and book medical appointments with a number of different types of practitioners such as physicians, nurse practitioners, dentists, chiropractors and other medical professionals (“Providers”). Those Providers contract with the Requestor to appear in the directory. Someone looking for services using the directory (a “User”) can enter search criteria such as geographic location, type of service needed and insurance accepted to find the type of practitioner needed and po-

tentially book an appointment for services. The Requestor that operates the website is not a provider or supplier of any medical services and is not affiliated with any provider or supplier.

Providers who contract with the Requestor pay a fee based on new patients who book appointments using the website (“Per-Booking Fees”), but the fee has no correlation to the type of insurance the patient has. Additionally, the fee charged does not take into account the “value of the Federal health care program” or business generated by the website.

The Requestor provided, or was requested to provide, very specific data about how Providers appear in search results performed by Users. According to the Requestor, its proprietary algorithm lists search results using 180 different criteria. The algorithm does not filter by the amount Providers pay the Requestor or the volume of Federal health care program business generated for Providers through the website.

In addition to the Per-Booking Fee, Providers may also purchase banner ad-

vertisements, but these advertisements do not promote any particular item or service. These ads are visible to all Users and do not specifically target Federal health care program beneficiaries. The Provider pays the Requestor on a per-impression basis or per-click basis for these ads, neither of which depends on the insurance status of the User nor is it dependent on the volume or value of items or services the Provider furnishes to the User.

Analysis

The Federal Anti-Kickback Statute makes it a crime to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce, or in return for, the referral of an individual to a person for the furnishing of, or arranging for the furnishing of, any item or service reimbursable under a Federal health care program. Remuneration includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind. Violation of the statute is a felony punishable by a maximum fine of

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RISK ADVISORS

Angie Smith

Precision Sports Gets First Flex X-ray System in the Southeast

By Jane ehrhardt

“It’s like the crème de la creme of x-ray machines,” says Jeffrey Cuomo, MD, orthopedic surgeon at Precision Sports Medicine & Orthopedics in Jasper. The practice became the first in the Southeast to acquire the state-of-art KDR Flex Overhead X-ray System in January.

The smart radiography system, made by Konica Minolta, delivers a host of innovations that enhance workflow, along with being Dynamic Digital Radiography (DDR) ready. DDR, a technology engineered by Konica Minolta in 2020, shows the images as if the body is in motion to enable orthopedic specialists to provide faster and more detailed diagnoses.

Composed of a table, wall stand, and overhead tube crane, Cuomo was impressed by the automation among the Flex’s components. “The tube is on a track, so it’s almost like it’s robotic,” he says. The movement of the overhead crane smoothly glides, tilts, rises, and swivels by itself to meet the needs of the image programming or the tech’s directions.

The most useful feature to Cuomo came from the Flex’s ability to automatically position itself and the settings for an array of specified images. “Certain knees need different strengths of the camera or penetrance. In this machine, that’s automated,” he says.

That automation also alleviates the usual differences inevitable with human handling because different techs have different positioning. “But this machine automatically positions itself so the views are very consistent,” Cuomo says. “That autopositioning by the machine versus humans brings exacting consistency between initial images and ones taken over time during the healing process, even weeks or months later. So we don’t have to wonder if rotation was off.”

The overhead tube crane can track and align to both the table and wall stand. “We used to have to move the patient, then move the tube,” Cuomo says. “Now it’s a more streamlined, seamless process. And we get a good product every time, so we don’t have to do it multiple times.”

The table lowers from 36 to 21 inches to enable easier patient onboarding, and holds up to 770 pounds lifting weight. The wall stand adapts to allow for specialty wheelchairs, such as for scoliosis patients, along with long leg shots, with imaging by the overhead tube starting at the bottom to capture the ankle.

Those low shots of the ankle were

not always possible with the previous x-ray machine. “The camera couldn’t get low enough, so the patients had to stand on a platform,” Cuomo says. “Some elderly patients were not able to get on that platform, so we couldn’t do that view.” Shoulder and spine patients also no longer need to position themselves into painful positions to capture certain views, since the Flex has such mobility.

Whether shooting from the stand or on the table, the Flex’s precision produces seamless and quick stitching. After shooting a series of images of the whole body, standing legs, or spine images, the system meshes those into a single, high-resolution image within 12 seconds. Pediatric stitching can include up to the three images.

Because the techs are not involved in trying to align the patient, the process avoids any parallax in motion. It also quickens the x-ray experience and reduces the patient’s exposure to radiation. “The less times they have to click that button, the less radiation that patient is getting,” Cuomo says. “Fewer x-rays also result from the clarity of these digital images. We don’t have to get two or three views. Now it’s more reliably a good picture every time.”

Transferring from manual to auto to semi-auto, only takes a touch. At any time, when the tech grabs the overhead crane, it automatically switches to manual motion with unlimited capabilities and can be moved anywhere in the room.

Cuomo estimates the clinic, part of Brookwood Baptist Health Specialty Care Network, with its four orthopedic surgeons and three physician assistants, uses their Flex system at least 100 times a week. He says it’s not unusual for patients to arrive from outlying clinics with their x-rays. “The views or the penetrance is terrible,” he says. “But with this machine, I know we will get a good image and the patient will not have to spend more money to get another one.”

Jeffrey Cuomo, MD

Welcome Our Newest Doctor

Rachel A. Taylor, MD

Rachel A. Taylor, MD is a board-certified internal medicine doctor with a sub-specialty in gastroenterology. She attended Baylor University and Baylor College School of Medicine. She completed her residency for internal medicine at Tulane University School of Medicine in New Orleans, and her fellowship at the University of Alabama Birmingham in Gastroenterology and Hepatology. Dr. Taylor is a member of the American College of Gastroenterology and American Society for Gastrointestinal Endoscopy. She currently serves on the University of Alabama Birmingham Program Evaluation Committee and the Wellness Committee.

Dr. Taylor is now accepting new patients.

GI Associates of West Alabama has provided gastroenterology care to Tuscaloosa and West Alabama for over 30 years. Please join us in welcoming Dr. Taylor to our growing practice.

C. Donald Howe, MD | J. DeWayne Tooson, MD | Jennifer L. Palmer, MD | Michael L. Palmer, MD

Youth Baseball Injuries to be Aware Of

By miChael ellerBuSCh, md

Ah, baseball. Few things are more enjoyable than watching your child play America’s favorite pastime. However, baseball is not all fun and games, especially when it comes to your child’s physical health. In fact, there are thousands of baseball-related injuries every year, mostly related to the elbow and shoulder, that are linked primarily to overuse. And while baseball fosters a healthy love of competition, dedication, and teamwork, it can also lead to lifelong injuries that can impact your child’s body and their daily life. That’s why it’s important to be aware of potential baseball-related injuries.

Little League Elbow

This most often affects pitchers and overhand throwers ages eight through15. Little League Elbow generally presents as pain on the inside of the elbow, due to an injury to or inflammation of the growth plate, that can be very sore and stiff, especially during or after throwing or pitching. The best way to avoid this condition is to stick to the pitch count recommendations and adequate pitching techniques for your child’s age group. If he does develop Little League Elbow, it’s important to rest the injured arm and seek a specialist’s opinion to

avoid making the injury worse and to determine treatment options. A good rule for young players is to never throw through pain or never throw through an altered throwing form.

Little League Shoulder

Much like Little League Elbow, Little League Shoulder (formally known as osteochondrosis of the proximal humeral epiphysis) is caused by overuse, relative shoulder or scapular weakness, or altered throwing mechanics. This generally occurs in children ages 11 to 17 years old. If your child is complaining of pain in his shoulder, this is a most likely cause. This pain is caused by the inflammation or widening of the growth plate in the proximal humerus (top of

the upper arm bone) at the shoulder. The best way to combat this injury is to adjust the number of pitches, to assure proper pitching form, and to strengthen the muscles around the shoulder. If your child is having this problem, take him to a specialist so that they can have an X-ray to check out the area. Potential treatments include resting, physical therapy, and symptom management.

Ankle Sprains

Like all sports that require running, baseball sees its fair share of ankle sprains. A sprain is a type of injury in which the ligaments that connect bones together are stretched or partially torn or completely torn. There are several ligaments in the ankle that can be in-

jured playing baseball, but the most common are the ligaments on the outside of the ankle that connect the fibula (small lower leg bone) to the foot and heel bones. While most sprains will heal up on their own over time, it’s a good idea to see a specialist to confirm that no more intense damage has been done, including potential injury to the growth plate or cartilage. This injury may even require an X-ray to determine if there is also a fracture present. Treatment may include relative rest, physical therapy, breaking/taping, and symptom management.

Concussions

Concussion from baseball happen more often than you would expect. High-speed running, colliding with opponents, or getting knocked in the head with a ball can all result in a concussion. Concussions occur when a player receives a direct blow to the head or an injury that shakes the brain around, causing any neurological symptoms. If a concussion is suspected, pull your child from practice or the game immediately and take them to their physician for evaluation. Although most concussions are mild and heal spontaneously, if a concussion is suspected, Alabama State

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Erika Issis Vasha, PA-C Orthopedics

Jessica Ramos, DO Family Medicine

Jeremy Dornier, MD Family Medicine

Jason Gamble, MD Internal Medicine

Courtney Issis-Banuelos, CRNP Internal Medicine

Jessie Matus, CRNP Gastroenterology

Tick-Borne Diseases and Outdoor Adventures: Navigating Risks with Knowledge and Safety

By Bertha hidalgo, Phd

As an epidemiologist, I believe in the power of knowledge to promote public health and prevent disease. In today's blog post, we will explore the fascinating world of tick-borne diseases and discuss ways to enjoy outdoor adventures while minimizing the risks associated with these tiny, but formidable creatures. So if you're an outdoor enthusiast, this article is for you.

Ticks are small arthropods that can transmit diseases to humans through their bites. These diseases, known as tick-borne diseases, are caused by various pathogens like bacteria, viruses, or parasites carried by ticks.

Lyme disease is the most prevalent tick-borne illness worldwide. It is caused by the bacterium Borrelia burgdorferi, transmitted through bites from infected black-legged ticks, also called deer ticks. Early detection and treatment with antibiotics are vital to prevent long-term complications. Prevention is key in reducing the risks of tick-borne diseases. Here are practical measures to safeguard yourself when you’re outdoors:

• Wear Protective Clothing: When

you’re in tick-prone areas, wear long-sleeved shirts, long pants, and tuck your pants into your socks or boots to create a barrier against ticks.

• Use Effective Tick Repellents: Apply EPA-approved insect repellents containing DEET or picaridin to exposed skin. Treat clothing and gear with permethrin, an insecticide designed for this purpose. Follow repellent instructions carefully.

• Perform Thorough Tick Checks: After being outdoors, inspect your body for ticks. Pay close attention to hard-to-see areas like the scalp, behind the ears, under the arms, and around the waistband. Use finetipped tweezers to promptly remove attached ticks.

• Stick to Designated Trails: Stay on well-maintained trails to minimize contact with ticks in tall grasses and shrubby areas.

• Create Tick-Safe Zones: Keep your outdoor living spaces less attractive to ticks. Maintain lawns, remove leaf litter, and establish barriers between wooded areas and recreational spaces.

• Educate Yourself: Learn about prevalent tick-borne diseases in your area. If you experience concerning symptoms after a tick bite, consult a healthcare professional. By taking these precautions, you can enjoy the wonders of nature without compromising your health. Stay safe, stay informed, and embark on your outdoor adventures with confidence!

Note: The information provided is for educational purposes only. Consult a healthcare professional or local health department for personalized advice on tick-borne diseases.

Bertha Hidalgo, PhD is an Assistant Professor in the Department of Epidemiology and Associate Scientist in the UAB Nutrition Obesity Research Center.

Medical Billing and Consulting Services recognized

Youth Baseball Injuries,

continued from page 12

Law requires evaluation and clearance by a Physician before an athlete can return to sports. It is also important to watch for red flag symptoms such as a worsening headache, increased sleepiness, and difficulty to arouse, delayed vomiting, loss of consciousness, seizures, and other worsening symptoms. Should this occur, we recommend taking the athlete to the Emergency Room. While injuries from baseball can’t always be avoided, it’s important to be an advocate for your child when it comes to keeping him healthy. Encourage him to do an appropriate throwing program before the season starts, and to warm up before practice and games. Make sure he adheres to the published guidelines for pitch count, rest time, and maximal pitches per day. And encourage him to let you know if he is experiencing any pain so that you can get him needed care.

Michael Ellerbusch, MD is a non-surgical sports medicine physician with Southlake Orthopaedics Sports Medicine & Spine Center.

Updates in Chronic Obstructive Pulmonary Disease

By anand S. iyer, md, mSPh1,2,3 and r. Chad Wade, md1

Chronic obstructive pulmonary disease (COPD) is a serious respiratory illness that impacts over 15 million Americans and an estimated 380,000 Alabamians. Navigating the world of COPD treatments can be complicated, and clinicians may feel that treatment options are limited for people as the disease progresses. However, there is a lot we can still offer and much to come on the horizon.

First, COPD Basics

A diagnosis of COPD requires three elements: 1) exposure, 2) symptoms, and 3) spirometry. Smoking remains an important cause of COPD and accelerates loss of lung function over time. However, smoking is just one of the many causes of COPD. An estimated 50 percent of COPD results from smaller lungs. The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) highlighted this through a new classification system for COPD that includes different exposure domains such as the environment (air pollution), genetic causes (alpha-1 antitrypsin deficiency), and early developmental abnormalities. Clinicians should think broad about potential exposures that can lead to COPD. When it comes to symptoms, hallmark

COPD symptoms include progressively debilitating breathlessness and chronic cough, but clinicians should consider other conditions such as interstitial lung disease or bronchiectasis, which cause similar symptoms as COPD. Measuring symptoms using the Medical Research Council Dyspnea scale (mMRC) and COPD Assessment Test (CAT) surveys is important to help quantify and track symptoms and should be implemented at all clinic visits. It is also important to document exacerbations, which increase the risk of death, cause significant burden for patients and their families, and are important factors in COPD staging. Finally, a diagnosis of COPD requires post-bronchodilator spirometry with airflow obstruction (defined by FEV1/FVC <0.70). Spirometry helps quantify the severity of COPD and helps clinicians decide on treatment. Furthermore, inhalers are unlikely to benefit people who do not have a clear COPD diagnosis, so spirometry is key to establishing a firm diagnosis. The debate over fixed airflow obstruction versus lower limit of normal criteria for diagnosing COPD is important but is a topic for another time.

Updates on Treatment

– GOLD 2023

GOLD 2023 guidelines focus on treating the whole patient and taking into account comorbidities, which can

listen.

That’s the difference in having the attorneys at Cloud Willis & Ellis represent your medical practice in managing your accounts receivables. We provide the complete services of an agency and a law firm or anywhere in between — you choose. We will collaborate with you to design a collection strategy that helps limit unpaid invoices and medical bills. Then we will implement that strategy in our office, and help you implement the strategy in yours. We have the experience and know-how in medical collections to make it better for you.

be many in someone living with COPD. When it comes to treatment, clinicians must engage their patients in tobacco cessation counseling from the beginning, refer to accredited pulmonary rehabilitation across COPD stages and ages, and keep patients up to date on vaccinations. Other updates include new letter groupings (from GOLD Groups A, B, C, and D to Groups A, B, and E), and treatment recommendations that emphasize starting with combined long-acting bronchodilator inhalers (long acting muscarinic +/- long acting beta-agonist) for those with a high symptom burden and not using an inhaled corticosteroid initially. When symptoms or exacerbations get worse (i.e. GOLD Group E), then we recommend adding an inhaled corticosteroid for those with a high serum eosinophil count (>300 cells/µL) and generally try to minimize how long someone stays on this due to important side effects. If patients continue to experience high symptom bur-

den or exacerbations, clinicians can add oral anti-inflammatory agents such as roflumilast or azithromycin for select people. Finally, supplemental oxygen therapy should be started for those with severe hypoxemia and stopped when no longer meeting criteria. For those who meet criteria (e.g. hyperinflation), clinicians should consider referring patients to a center that performs bronchoscopic or surgical lung volume reduction. For those still getting worse despite maximum therapies, a “treatable traits” approach can be considered. In this model, clinicians reframe someone as person with “end-stage COPD” to a person with COPD and set of traits each with unique treatment approaches, e.g. refractory breathlessness, emotional symptoms, frequent exacerbations, hyperinflation, or chronic respiratory failure. Utilizing this approach can help clinicians proactively implement interprofessional strategies to help these patients which include referral to specialists in geriatrics and palliative care, nutritional support, psychosocial counseling, and others.

On the Horizon – UAB’s Lung Health Center Leading the Way

The future of COPD will focus on identifying distinct disease subtypes and personalized treatment strategies. The Lung Health Center at the UAB is at the forefront of investigating novel pharmaceutical, device, and behavioral interventions to change the trajectory of COPD. Actively enrolling studies in-

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When people receive a communication from a law firm, they

OIG Issues Favorable Advisory Opinion About Online

Health Directories and Advertisements, continued from page 9

$100,000, imprisonment up to 10 years, or both, and a conviction can result in exclusion from Federal health care programs, including Medicare and Medicaid. In addition to potential criminal prosecution, civil monetary penalties (“CMPs”) may be imposed through administrative proceedings.

Under the Beneficiary Inducements Civil Monetary Penalty provision, any person who offers or transfers remuneration to a Medicare or Medicaid beneficiary that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner or supplier for the order or receipt of any item or service for which payment is made, in whole or in part, by Medicare or Medicaid may be subject to the imposition of CMPs. Remuneration under this statute is the “transfer of items or services for free or for other

Updates in Chron-

ic Obstructive Pulmonary Dis-

ease, continued from page 14

clude trials attempting to gain further insight into emphysema progression or muscle wasting, cutting edge bronchoscopic interventions to reduce mucous production and improve airway obstruction, disease phenotyping using novel diagnostic imaging modalities, and behavioral interventions. Exciting treatments in the pipeline include AIRFLOW-3, which is investigating the use of targeted bronchoscopic lung denervation to improve airflow obstruction and reduce exacerbation risk, Ensifentrine, a novel drug targeting inflammatory pathways to alleviate symptoms and reduce healthcare utilization, and Dupilumab, which recently demonstrated tremendous benefit in exacerbation reduction and quality of life improvement. In addition to cutting-edge basic science and clinical COPD research, UAB also has a Southeast Institute for Innovation in Palliative and Supportive Care, and we are actively conducting research on geriatrics and palliative care in COPD to help patients age successfully in their communities and improve quality of life for patients and their families.

Dr. Iyer and Dr. Wade are pulmonologists at the UAB Division of Pulmonary, Allergy, and Critical Care Medicine and the UAB Lung Health Center. Their clinical interests and research focus are on COPD. Dr. Iyer also directs clinical pulmonary services for Cooper Green Mercy Health Services Authority. Inquiries about UAB Lung Health Center studies or referrals can be emailed to lunghealth@uabmc. edu or call to (205) 934-5555.

than fair market value.”

The OIG determined that Requestor’s arrangement implicated the Federal Anti-Kickback Statute based on the following three facts: (1) Providers pay the Requestor to recommend them to Federal health care program beneficiaries;

(2) Providers pay the Requestor to “arrange” for the provision of items and services through the appointment-booking feature of the website; and (3) Requestor provides remuneration to Users in the form of free use of the website which may lead to the User purchasing items or services reimbursable by a Federal health care program. Although the OIG determined that the arrangement implicated the Federal Anti-Kickback Statute (and no safe harbor applied), it performed an analysis based on the “totality of the circumstances” to determine whether it would impose sanctions. Those factors

include: (1) amount and structure of compensation; (2) identity of the party engaged in the advertising and relationship to the target audience; (3) nature of the marketing activity; (4) item or service being marketed; (5) the target population; and (6) any safeguards to prevent abuse. Through this analysis, the OIG determined that the risk of fraud and abuse was sufficiently low, allowing OIG to issue a favorable opinion and state that it would not impose sanctions.

Similarly, under the Beneficiary Inducement CMP analysis, the OIG concluded that the free use of the website to Federal health care program beneficiaries could influence a User to select a Provider that would render services reimbursable by a Federal health care program, which would make the Requestor subject to potential CMPs. However, the OIG states in the opinion that it would

exercise “its discretion” and not impose sanctions in connection with the described arrangement.

Takeaways

As with all OIG Advisory Opinions, the Opinion states that it cannot be relied upon by any other person other than the Requestor. That being said, health care providers should be cautious of paying for referrals of any sort, including paying for listings on websites that might drive patients to make appointments or advertising.

The full opinion can be found at https://oig.hhs.gov/documents/advisoryopinions/1127/AO-23-04.pdf

Angie C. Smith is a Partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Practice Group. Angie may be reached at (205) 458-5209 or acsmith@burr.com.

Building and Retaining a Solid Billing Staff,

Management must learn the technology in order to hold staff accountable and troubleshoot problem areas. When you grow your staff in their knowledge, you are investing in the person, and they know it. They stay engaged that way and can help you work out problems.”

The managers of each department dealing with reimbursements, including front desk and clinical, need to meet to review month-end reports to assure any

technology issues, staffing problems, and trends are resolved moving forward.

“Look at the key performance indicators and brainstorm on how they are different from last year at this time, as well as last month,” Lunceford says, “because the doctors are going to have questions. Know what answers you are going to give. Make sure you have a plan.”

Personnel are becoming more expensive, not just to find, but to keep. Re-

continued from page 7

cent salary survey results for Alabama show a 10 percent increase in pay on average over the last two years for front desk personnel, billers, and coders. “It only makes sense,” Lunceford says, “to keep staff trained, efficient, and knowledgeable enough to work the clients and get the money produced.”

37 YEARS STRONG

Surgical Pathways

CHAP Trial Awarded Clinical Trial of the Year

The UAB-led Chronic Hypertension and Pregnancy (CHAP) trial received the David Sackett Trial of the Year award from the Society for Clinical Trials.

The CHAP trial evaluated the effects of prescribing blood pressure medication to pregnant women with mild chronic hypertension. Results published in the New England Journal of Medicine showed treatment improved pregnancy outcomes without compromising the baby’s growth and health, which has been a primary concern for physicians. CHAP results have since led to changes in national guidelines.

“Chronic hypertension causes serious and life-threatening complications for pregnant women and their babies,” said Alan Tita, MD, PhD, professor of obstetrics and gynecology in the UAB Marnix E. Heersink School of Medicine. “Between 70 percent and 80 percent of pregnant women with chronic hypertension fall into the ‘mild’ category, where there was not a medical consensus for treatment.”

Investigators launched the CHAP program in 2014 with funding from the National Institutes of Health’s Heart, Lung

and Blood Institute. From September 2015 to March 2021, CHAP enrolled more than 2,400 pregnant women with mild chronic hypertension whose blood pressure was greater than 140/90 mmHg but less than 160/105 mmHg.

Notably, the CHAP trial is one of the most comprehensive and diverse studies of its kind. The black patient population is disproportionately affected by chronic hypertension, and almost 50 percent of study participants were black mothers.

Secure Exchange Solutions and BlueCross & BlueShield of Alabama Win Award

BlueCross & BlueShield of Alabama (BCBS) and Secure Exchange Solutions

(SES) won the first K2 Peak Award for innovation in provider-payer collaboration. The award recognizes innovative programs that reduce provider friction and create alignment between payers, providers, and their technology partners. SES and BCBS earned a KLAS Points of Light award, which highlighted the program to engage primary care physicians to deliver impactful results, including:

•Real-time health event alerts at the point of care, reducing administrative burden.

• A 50 percent decrease in hospital readmissions.

• Reduced emergency department (ED) visits, leading to a 46 percent decrease in costs.

With Care Alerts from SES Notify, BlueCross & BlueShield of Alabama minimizes inefficiencies related to inpatient and ED admissions by improving communication with primary care providers. Care Alerts help providers keep track of their patients’ health, improve patient outcomes, and reduce repeated ER visits. These alerts improve patient visibility at the point of care and lead to better follow-up care.

Children’s of Alabama Awarded Grant to Support Child Safety

The Honda USA Foundation has awarded a grant to Children’s of Alabama to support the Health Education and Safety Center at Children’s of Alabama. The Children’s of AL Health Education and Safety Center conducts several child safety programs, including ThinkFirst Alabama and Child Passenger Safety.

ThinkFirst Alabama is an evidencebased curriculum taught in schools statewide. It uses age-appropriate concepts to teach children about helmet use, bicycle safety, pedestrian safety, concussion awareness and prevention and ATV safety.

The Child Passenger Safety Program educates caregivers about choosing, installing and checking their child's appropriate

car seat or booster seat. Thanks in part to support from the Honda USA Foundation, the program will provide car seats and booster seats to families who need them. This includes families discharged from Children’s of Alabama and families identified through community partners.

GRAND ROUNDS

Alan Tita, MD, PhD

Brookwood’s SICU Unit Receives Award

The American Association of Critical Care Nurses awards several distinctions each year for excellence, including the Beacon Award, which recognizes units within hospitals that set the standard of excellence and surpasses benchmarks both regionally and nationally.

In June, Brookwood’s Surgical Intensive Care Unit (SICU) was awarded the Silver

level of the Beacon Award. The unit will hold this award for the next three years and will be recognized at the next National Teaching Institute & Critical Care Exposition conference in Spring of 2024. With this award, Brookwood’s SICU is one of only 10 units in the state of Alabama to hold this distinction and one of 546 units in North America.

Jayla Smith, MD Joins St. Vincent’s

Jayla Smith, MD has joined Ascension St. Vincent's Primary Care in Oneonta. Smith, who is board-certified in Family Medicine, has special interests in chronic illnesses, routine preventive treatments, women's health, rural community health and treating adolescents.

She earned her medical degree at the University of Alabama Birmingham and a Master of Science in Human Environmental Science - Rural Community Health at the University of Alabama in Tuscaloosa

HIPAA Webinar On Healthcare Cyber Fraud

On July 27th, SIP Oasis held a webinar to educate practice administrators on the security protocols they need to put in place to protect their practice from any of the 84,000 new malware threats that are released every day.

The panel included Ron Shoe of SIP

Oasis, Joe Parker with the Cybersecurity & Infrastructure Security Agency, and Thomas Stroud of PNC Healthcare Banking. The experts talked about the latest strikes, the strongest defenses, and how HIPAA plays a part.

Jennifer Cork Named New Executive Director of Birmingham MGMAof Birmingham MGMA

At the July meeting of the Birmingham chapter of Medical Group Medical Group Management Association (MGMA), Jason Biddy, outgoing Executive Director, turned over the role to Jennifer Cork, CMPE. As Executive Director, Cork, who is the CEO of Total Skin & Beauty Dermatology Center, will oversee all aspects of the chapter, including managing membership, soliciting sponsorship, and fostering community awareness about the group. In addition to attending all board meetings and monthly luncheons, she will also serve as a representative of the Birmingham Chapter to the Alabama State MGMA.

MGMA Birmingham was founded in 1976 and is the state's largest and oldest local chapter affiliate with over 200 current members. MGMA Birmingham's members are primarily administrators and managers of medical practices, clinics, large and small group practices, and freestanding, hospital affiliated and university affiliated medical groups. MGMA Birmingham typically hosts nine luncheons a year with guest expert speakers who present information on healthcare topics.

Jayla Smith, MD

(L to R) Jason Biddy & Jennifer Cork

Kassouf to Host Workshop on AI in Healthcare

Kassouf & Co will be hosting a healthcare workshop on September 13 at 11:30 a.m. The meeting will include a panel of experts to discuss all AI has to offer the healthcare industry.

The complimentary event will be offered in a hybrid format with a limited number of tickets for in-person attendees, along with a virtual option that will take place over zoon. Learn more and register via www.kassouf.com.

New Law Addressing Alabama’s Doctor Shortage in Effect August 1st

Listen

When the Medical Association of the State of Alabama (MASA) outlined its 2023 Advocacy Agenda, one of the top priorities was to address the growing physician shortage in Alabama. According to MASA, Alabama needs more physicians just to meet current healthcare demands.

With that in mind, Representative Paul Lee in the House and Senator April Weaver sponsored and helped pass the Physician Workforce Act (PWA), which is a proactive effort to help confront the shortage and build tomorrow’s physician workforce.

NowThe Physician Workforce Act will cut red tape and remove unnecessary barriers by

eliminating the Special Purpose Exam (SPEX) exam that some out of state physicians are required to take before becoming licensed to practice in Alabama, making from physicians moving from other states to begin practice here.

International Medical Graduates, who make up 20 percent of Alabama’s current physician workforce, will be able to gain full medical licensure after two years of residency and passage of the final licensure step instead of three years.

It establishes an apprenticeship style program for medical school graduates who did not match in to residency that allows Medical School graduates to work

under the direct supervision of a physicians under a one-year permit as they reapply for residency the next year. The Alabama Board of Medical Examiners will begin crafting rules to govern the apprenticeship-like program.

“The Physician Workforce Act will expand the pool of trained physicians practicing in our state, improve patient access to timely care and put Alabama on the path toward a healthier future,” said George Koulianos, MD, a Mobile doctor who serves as President of the Medical Association.

Healthy is a fee ling we should all

Senator April Weaver George Koulianos, MD Representative Paul Lee

Cullman Regional Expansion Project Adds 30 Beds

Cullman Regional is now a 175-bed hospital with the recent completion of a four- story, 30-bed tower expansion. The project added 13 new critical care beds, 12 new medical/surgical beds and five beds were created by renovating existing space in the hospital. Current patients will be moved to the new patient rooms and crews will begin renovating the old patient rooms in the critical care and medical/surgical units. After final approval of the renovated beds by the Alabama Department of Public Health, both units will fully open this fall.

“North Alabama’s population growth is a significant driver for projects like this, and the pandemic also has hospitals evaluating their ability to care for patients when volumes are high,” said CEO James Clements.

The tower expansion is the third in a series of four major expansion projects the hospital expects to complete within three years. Prior to the ER and tower expansions, Cullman Regional’s Hartselle Health Park opened in 2021 bringing needed outpatient services to south

Morgan County residents. After recently receiving state approval, the hospital will begin construction on a fourth project - a freestanding emergency department in Hartselle set to open in 2024.

Kara Conti, MD | Ashley Gooding, MD | James Head, MD | Jessica Rodriguez, MD Malcolm Simmons, MD | David Spangler, MD | Mackenzie Woodson, MD | George Zaharias, MD

Rendering of the completed project.

Athletic Care. Better Together.

Offering Care in Multiple Locations Across

Whether you play football, basketball, soccer or another sport, Precision Sports Medicine and Orthopedics is on your team. We’re here to cheer you on and provide the care you may need. Let us help you get off the bench and back in the game.