Birmingham Medical News December 2022

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Construction Starting on New Cooper Green Facility

By January, construction will begin on the new Cooper Green state-of-the-art medical facility where their parking deck once stood on 6th Avenue. The glistening five-story building will cover 207,000 square feet and solve numerous restrictive and costly problems lingering in the current 50-year-old building. “We’ll save hundreds of thousands of dollars just from reduced utilities,” says Laura Hurst, administrator of the clinic since 2019.

A German Psychiatrist Comes to America

“I had the luck of the late birth,” says Birmingham psychiatrist Godehard Oepen, MD, PhD, about having been raised in West Germany shortly after WWII. “But we were living in the shadow of it.”

His father spent his years in Nazi Germany undermining the regime by joining the Neue Deutschland, a Catholic-based resistance. His grandfather had Huntington’s disease during the Nazi rule. A degenerative disease disorder that strikes as an adult, it manifests as irregular jerky movements from head to foot. They can only remain still while sleeping.

The Nazis initially castrated his

grandfather. Later, they killed him during Tiergartenstraße 4, the five-year campaign of mass murder by involuntary euthanasia of 275,000 psychiatric patients.

“The so-called ‘useless members of society,’” Oepen says. “That was the motivation for my father to get into medicine, and me as well, to see if there was something else we could do besides let them die.”

The treatment of his grandfather had a lifetime effect. “It was a major

factor in my life to realize it’s not the main importance what you can do and enjoy and achieve and how much money you make and power and glory,” Oepen says. “It’s how much of what you do is actually useful to others, especially those who are considered useless.”

Oepen’s fascination with the human brain led him to medical degrees on two continents, three residencies, and a PhD, all related to neurology and psychiatry.

“I wanted to better understand what makes humans tick and why we continue to make foolish decisions that you cannot rationally explain,” Oepen says.

Initially, after getting his first medical degree studying in both West Germany and Switzerland, he became a surgeon. But in less than two years, he

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3) Rendering of the new Cooper Green facility.
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Godehard Oepen, MD, PhD
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Cooper Green, which provides quality healthcare to Jefferson County residents regardless of ability to pay, has been serving as an ambulatory care center for the last 10 years in a building designed to be a 319-bed hospital.

“Our current setup isn’t efficient,” Hurst says. “We’re moving so we can get patients in and out more effectively. It will also be more work-friendly for our staff. For example, old nurses stations currently serve as sign-in desks, which forces our staff to repeatedly walk the long hallways of old inpatient rooms — now exam and treatment rooms — just to retrieve paperwork.”

Cooper Green worked to involve patient groups in the planning process. Two committees — patient advisory and community advisory — relayed their insights on an ideal clinic from a patient’s perspective. Their feedback led the planners to locate the waiting rooms at the front of the building to allow for an open space with natural light, and to have one glass side in the stairwells.

The new facility, though smaller, also solves space problems with designs specifically suited to Cooper Green’s diverse services. The physical, speech and occupational therapy services, which see around 1,300 patients each month, will move into a spacious suite that includes a covered outdoor section for enhanc-

ing skills such as navigating curbs. The pharmacy will expand to provide the room needed for storage of outpatient prescriptions.

Space is also planned for the teambased approach that Cooper Green employs with their patients. “We take care of the patients’ needs completely while they’re here,” Hurst says. “It’s not just a visit between you and your provider; it includes everyone who needs to be a part of that patient’s care,” Hurst says. Those professionals might include their social worker, behavioral health specialist, diabetic educator, pharmacist, and nutritionist or any of the 17 specialties offered within the clinic.

Patients can get their lab services and imaging done in-house, as well,

with the new building expanded to include Cooper Green’s first MRI suite. A separate phlebotomy and injection clinic will streamline their laboratory visits and improve vaccination process.

The oncology infusion suites will now sit along the glass walls in the new building to let in natural light and offer semi-private areas for those who don’t want to be part of the group setting. “So you can sit for four hours for your treatment in some privacy, if you want, with your own TV but with no doors, so nurses can still check in quickly,” Hurst says. “It’s a significant upgrade for us.”

Several of Cooper Green’s current tenants, including the Recovery Resource Crisis Center and Cahaba Dental will also move into the new facility. Two new tenants will be the UAB School of Nursing PATH clinic, which offers team-based care centered on chronic diseases such as diabetes, and UAB Community Psychiatry. “Everybody can always benefit from more mental-health care. So we’ll get more synergy with them here,” Hurst says.

UAB became an integral part of Cooper Green in April 2020 through an agreement with the Jefferson County Commission. Funding still comes from the Jeffco Commission, but UAB now manages the operations. The new board consists of three Jeffco Commission members and four UAB Health members.

“We benefit from a lot of UAB services,” Hurst says. “They provided positions for quality patient safety, compliance, and infection prevention, along with IT support, and they added Cooper Green to their computer network. It’s fabulous. We get to still serve our patients and provide quality care, but we have access to this wealth of expertise. We’re not on an island by ourselves anymore.

“We want people to know that now Cooper Green is both a provider and a payer. We’re not insurance, but we enroll you. Jefferson County residents without insurance or those who may need extra coverage beyond Medicare and who meet the criteria can find their medical bills paid, even if they’re taken to other facilities for care. So please enroll with us now. It’s too late if you get in a car accident, and you have a fat bill from the emergency department. But if you’ve enrolled with us, we would cover the whole bill and your follow-up care. If you needed rehab for the next three years, we pay for that.”

Currently, Cooper Green has about 3,600 low-income residents enrolled. About 52 percent have Medicare or Medicaid. The other 48 percent have no coverage. “I know there are more than 3,000 uninsured people who need us,” Hurt says. “Make an appointment. Come in and let’s talk.”

Birmingham Medical News DECEMBER 2022 • 3
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A German Psychiatrist Comes to America,

found it was missing something. “I discovered that there is not much meaning in it,” Oepen says. “There’s action, it’s good money, and it’s very rewarding in terms of the work. But you don’t have personal connection to patients, and I didn’t realize that was important to me until then. So I changed venues.”

He has since spent a lifetime on research and clinical work focusing on behavioral neurology, producing 110 articles, book chapters, and three edited books covering anything from neuropsychiatric illness (Huntington’s disease, Parkinson’s disease, MS, schizophrenia, bipolar disorder) to borderline personality disorder, psychopharmacology, and philosophical issues in psychiatry.

“For me, the single brain of a patient is not the most important thing. It’s how is this person is relating in their context,” Oepen says, explaining that context includes their past, education, living situation, family, and especially their hopes, beliefs, and expectations for the future. “If you want to understand somebody, take some time to cover all these contextual factors.” Then, he says, you may be able to give more effective and beneficial advice to change something for those patients.

In 1989, NATO offered Oepen a grant to come to America and continue his research and clinical activities at Har-

vard University. Because the U.S. medical community does not accept foreign medical degrees, he spent nearly four years earning his second MD at Harvard.

“The hard part was to be an intern again at 37,” he says. “Harvard is spectacular. I’ve never seen anything like it in Germany. If you work with really, really brilliant people, they want to share their ideas and breakthroughs and methods, while the mediocre people hide what they do. There was more mediocrity in my experience in Germany.”

He admits he would feel better as a psychiatric patient in Germany. “In America, we have degenerated into a checklist approach to psychiatry, I’m sorry to say,” he says. “We have good people here, but you are under pressure as a psychiatrist to get patients in and get them out because you’re paid more for admission and for a discharge then for a follow-up.” Inpatients tend to stay four days or so, but not long enough for medications to reach full potency and the outcome to be assessed appropriately.

On the other hand, Oepen applauds the team approach in the U.S., which includes post-stay care by social workers, nurses, and case managers. “If you have a good team, it can make up in part for the shortcoming of the ‘get them through quickly’ approach,” he says.

Oepen’s widespread travel since he

was a child has enhanced his outlook into humans and his personal philosophies. At 12—with a mutual post-war hatred still lingering between the two countries—he lived with a French family as an exchange student for a summer. At 15, he worked on a merchant marine boat taking him to Russia, Poland, Sweden, Norway and Holland. Since then, conferences and family travel have taken him to at least another eight countries on three continents, though he can’t remember them all.

The most memorable was with his brother, a physician who worked on public health projects in Africa for 25 years. They visited a village in the Republic of Upper Volta in West African and met a family living in one-room hut on $3 a year. “I had a hard time believing that. They had absolutely nothing,” Oepen says. “But they were smiling and laughing and hugging us. They also offered me a gift of their wooden spoons that I had admired, and refused my offers of help. These people were the most loving, magnanimous, happy people. I was touched by their humanity and their selflessness. And my bottom feeling was, this is really what life’s all about.”

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If you’re close to or have met your annual insurance deductible, your out-of-pocket costs could be significantly reduced. Now could be the ideal time to schedule any appointments or procedures you’ve been putting off. Why wait to start feeling better? Make an appointment today.

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It’s no secret that employers today are having trouble finding, motivating and keeping staff. It’s a problem for every industry, but when someone’s health lies in the balance, solving that problem is even more critical.

“At the last Birmingham MGMA (Medical Group Management Association) meeting, we discussed that it is only going to get worse,” said Jennifer Neal, business office manager of Andrews Sports Medicine. “I think most of it is burnout from all we went through with the pandemic. People are overworked, positions are more stressful, they are doing four people’s jobs instead of the duties they were hired for. It has been a long battle for everyone.”

Andrews recently conducted retention surveys to better understand their employees’ concerns and to learn what would make them want to stay. “We’ve put some of those suggestions into place,” Neal said.

In her recent presentation to the Birmingham MGMA, Sheri Smith, FACMPE said 45 million workers left their jobs throughout November 2021, and healthcare was the second largest affected industry behind accommodation and food service. Reasons for leaving

included low-wage jobs without opportunities for career growth, rising costs of childcare, increasing responsibility and grueling work conditions amid Covid19 surges, and fatigue and burnout from the pandemic.

“It’s tough to keep people,” said Greg Rollins, administrator at Pulmonary Associates of the Southeast. “We used to compete practice to practice within the same industry. Now, especially in entry level positions, we are competing with retail and fast food res-

taurants. I saw a sign recently that said Hobby Lobby was hiring at starting pay of $18.50. It’s hard for a small practice to hire at that rate and be competitive.”

Smith says that, despite the shortage, if you have a good organization, people will want to work for you. She made the following points:

• The Wall Street Journal published “People don’t leave jobs, they leave managers.”

• Communication is named the most influential factor as to whether an employee respected their boss or not.

• It costs on average six to nine months’ salary to replace an employee. In fact, it can cost as much as twice their annual salary, especially for an executive-level employee.

“We have been relatively lucky at retaining employees,” Rollins, of Pulmonary Associates, said. “We look for longevity on resumes and we’re starting new employees at a higher pay than before to stay competitive. It’s also a culture thing. We try to keep our staff happy and engaged. When there are problems, we

6 • DECEMBER 2022 Birmingham Medical News
Jennifer Neal with the Andrews coloring poster.
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Strategies

UCA Offers New Treatment for ED

Duolith

Shockwave Therapy

The impact of erectile dysfunction is far more than physical. It can create anxiety and undermine a man’s sense of self, while putting stress on his closest relationship, which can affect his and his partner’s quality of life.

Although it may not seem as serious as disorders that directly threaten life and health, for someone alone, the undermining of confidence by ED can lead to social isolation, which has been linked to increased risk for heart attack as well as mental health issues.

Fortunately, new medications and combinations of therapies are improving function in many patients and reducing the negative effects of erectile dysfunction on quality of life. One of these new treatments is Duolith Shockwave Therapy, offered in Birmingham by Urology Centers of Alabama.

“It seems to be making a real difference in many cases,” said Eric Westerlund, CRNP, who administers the treatment. “About 60 to 70 percent of our patients are seeing positive results and better function. This option gives patients an alternative that may prevent or delay the need for surgery, injections or stronger medications.”

Erectile dysfunction can be caused by nerve damage, stress or emotional dif-

ficulties, but vascular issues are involved in most cases. Duolith Shockwave Treatment focuses on improving circulation.

“It’s used in combination with Tadalafil, a vasodilator,” Westerlund said. “Pulsed acoustic energy waves help regenerate blood vessels and encourage improvement in circulation.”

The waves are directed toward key treatment zones and on the perineum. Patients report that the treatment is comfortable and doesn’t require anesthesia.

“The appointment usually takes half-hour or less, with the treatment it-

Strategies for Retaining Employees,

continued from page 6

try to include them and make them part of the solution.

“We try to do little things like decorating the office for Halloween, which boosted morale and lightened things up.”

Andrews Sports Medicine also takes the opportunity to celebrate holidays with a Halloween party after clinic. “It boosted morale for everyone involved,” Neal said. Andrews also has a Christmas party and even a tailgate party during football season.

Both administrators also stressed the importance of being sensitive to the needs of employees. “We have a lot of single parents on staff who have childcare to worry about,” Rollins said. “We’ve learned to have some flexibility there. We have some people who stagger shifts. We also close the office at noon on Fridays, so everyone is out of the office by 1:00.”

Andrews also offers flexibility in scheduling. “If someone on the clinical side is overwhelmed, they can work at home one day a week and knock out all the work they can’t do at the office because they are being pulled in three

different ways in the middle of clinic,” Neal said.

In addition, Andrews has posted a six-foot coloring poster with markers at the office. When employees need a break, they can take a few minutes to color the poster. “That’s been kind of fun,” Neal said. “It’s been up a couple of months now, and it’s not completed yet, but someone colors on it every day. It’s little things like that that help employees get through the day.

“It’s also important for employees to feel appreciated. Six of our doctors came to our annual staff meeting, and they told everyone they appreciated us and couldn’t do what they did without us. We can all feel like we are being taking for granted, so we hope that will impact staff retention.”

Neal and Rollins both said it will take creativity and work to maintain staff in coming years. “We just have to start thinking out of the box and working at more creative ways that we never had to explore before to keep everyone happy,” Neal said.

self lasting around 10 to 15 minutes,” Westerlund said. “We can adjust the acoustic wave vibration level to each patient’s comfort level. We generally schedule a series of six treatments over a period of six weeks. Some patients start seeing improvement after three to four treatments. The therapy is also reported

to be helpful in some cases of Peyronie’s Disease and pain syndromes.”

The gentle vibration of shockwave therapy has been shown to be helpful in treating several types of conditions. It isn’t recommended for anyone who takes blood thinners and wouldn’t be part of a treatment plan for someone whose prostate has been removed.

”We can’t predict yet how long the positive effects of the therapy will continue in any one patient, since physical conditions differ from person to person. However we’re seeing reports of the benefits lasting a year or two, and we expect that in most cases we will be able to repeat treatment later if needed,” Westerlund said.

Aging is the most common predictor associated with erectile dysfunction. By age 40, around 40 percent of men begin to experience at least occasional episodes of ED. The prevalence increases as the years pass, rising to 70 percent by age 70, when 15 percent of men are experiencing complete dysfunction.

As with several previous ED treat-

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Birmingham Medical News DECEMBER 2022 • 7
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In OIG Advisory Opinion No. 2216, the Office of Inspector General of HHS determined that an arrangement to provide $25 gift cards to Medicare Advantage enrollees for the purpose of promoting health literacy about surgical procedures would not constitute the basis for administrative sanctions under the federal Anti-kickback Statute or the imposition of sanctions under the Beneficiary Inducements CMP Law, which prohibits offering money or services that are likely to influence a Medicare beneficiary to select a particular health care provider, practitioner, or supplier.

The arrangement proposed a program to provide a $25 gift card to each Medicare Advantage enrollee who completes an online patient education program about the potential risks, benefits, and expectations regarding surgeries. The program would contain two modules, each of which would have three components. The first module would be intended to help patients understand their diagnoses and symptoms; educate patients about discussing their diagnoses with their care providers; and inform patients about nonsurgical treatment options. The second module would be for patients who have already chosen surgery and would be intended to educate patients on various types of surgical facilities; prepare patients for surgery; and provide information on post-operative care, in order to reduce the chance of complications and facilitate the patient’s recovery.

The program would be designed to tailor the information it provides to each

individual patient. To do so, a questionnaire would ask the patient a series of questions that about the patient’s clinical information, such as diagnosis, symptoms, personal risk factors and comorbidities, and whether the patient has already decided to have surgery. If the patient has already decided to have surgery, the program would not provide alternatives to the selected surgical procedure but would instead provide information on preparing for surgery.

An enrollees who participates and completes the first module of the program, along with a survey, would receive a $25 gift card to a retailer, which could be a big box store or an online vendor. The gift care could be used to purchase a variety of goods or services. Enrollees could use the program multiple times but would only be eligible to receive one $25 gift card per year. The gift card would not be contingent on undergoing surgery; pursuing non-surgical treatment options; receiving additional treatment; or dem-

onstrating surgical literacy.

The program and gift cards would be available to all enrollees regardless of whether they are facing a decision about surgery. Use of the program would be voluntary, and the requester cited the health literacy value of patients having an understanding about surgical decision making, even in the absence of any imminent decision about surgery. Further, the program would be intended to generally increase healthcare literacy skills for making medical treatment decisions and preparing for medical procedures.

In analyzing the arrangement, the OIG determined that provision of the $25 gift cards to Medicare Advantage enrollees - who are federal health program beneficiaries – would constitute remuneration that could induce the enrollees to self-refer to a particular Medicare Advantage plan. Further the gift cards could be considered a cash equivalent, because they would be redeemable at big box or online vendors that sell a wide variety of items. Nonetheless, the OIG determined that the arrangement would present a low risk of fraud and abuse under the Anti- Kickback Statute for three reasons. First, it would be unlikely to increase cost or result in inappropriate utilization, because it would be designed to improve patient literacy regarding surgery, reduce the incidence of medically inappropriate surgeries, and mitigate surgical complications, errors, and infections. This could have the effect of improving patient safety and reducing inappropriate utilization, thereby decreasing federal health

care program costs. Second, the OIG determined that the arrangement would be unlikely to influence a beneficiary’s selection of a particular Medicare Advantage plan because the gift care program would not be advertised to beneficiaries who are not existing enrollees, and the Medicare Advantage organization would not include information about the gift card program in its marketing communications to prospective enrollees. Third, the arrangement was found to be unlikely to affect competition among providers, practitioners, or suppliers, because it would not recommend any particular one.

In analyzing the arrangement under the Beneficiary Inducements CMP Statute, the OIG again noted that the gift card program would not refer to or recommend any particular provider, practitioner, supplier, or service and, in fact, would provide no information about any of them. Accordingly, although the gift card program would constitute remuneration, it would not be likely to influence an enrollee’s selection of a particular provider. To the extent the gift card could influence the beneficiary to select a particular Medicare Advantage plan, the OIG noted that Medicare Advantage plans are not providers, practitioners, or suppliers, under the Beneficiary Inducements CMP Statute.

In conclusion, the OIG determined that it would not impose administrative sanctions in connection with the arrangement under the AntiKickback Statute and the arrangement would not constitute grounds for the imposition of sanctions under the Beneficiary Inducements CMP Statute.

8 • DECEMBER 2022 Birmingham Medical News
The OIG Analyzes Arrangement to Promote Surgical Health Literacy by Providing Gift Cards to Medicare Advantage Enrollees
Jim Henry is a partner in the law firm of Phelps Dunbar LLP. He may be reached at jim.henry@ phelps.com or 205-716-5257.
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Women are different. Unlike men, whose DNA is the same in every cell of their bodies, women are mosaics. Assuming the law of averages, roughly half of the cells in a woman’s body are likely to be identical. The other half would tend to display a different active X chromosome.

“Very early in the development of a female embryo, most of the genes in one of the two X chromosomes are switched off,” said Bruce Korf, MD, Associate Dean for Genetic Medicine at UAB. “The process of selecting which X chromosome to inactivate seems to be random in each cell. On average, the probability would be that female babies would be born displaying the X chromosome from one parent in about half their cells and from the other parent in the rest.

“Usually you aren’t able to see the difference by looking at a woman except in the case of a rare pigment disorder that develops from a gene on the X chromosome. While we don’t want to overstate the protective effects, it is true that in a disease like Duchenne Muscular Dystrophy that develops from a gene on the X chromosome, women have an advantage. Since men only have one copy of X, if

they have a defective gene for a disorder coded on that chromosome, they will develop the disease. With genes from two copies of the chromosome, women usually have at least one good gene to protect them. It would require the same mutation on a gene from both her father and her mother for a woman to have the full blown disease. She would be more likely to be only a carrier. It would be very long odds for her to develop the disorder, since few males born with the Duchenne gene live long enough to pass it on.”

There is a huge difference in the size of the X and Y chromosomes and the number of genes each carries. The X chromosome has around a thousand genes, some of which are yet to be fully understood. The Y chromosome has be-

come smaller over time and now only has around 100 genes, some 80 of which are involved in the development of the male reproductive system.

“The Y chromosome is highly specialized,” Korf said. “Perhaps the biggest health difference in men comes from its role as the first domino. It starts the development of male organs that produce testosterone in quantities capable of influencing the traits we associate with maleness like body hair and muscle strength.”

Testosterone also affects the brain. Even the structure of the brain, arm muscles and pelvic bones differs between men and women to equip them to produce and protect the next generation. Unfortunately, the Y chromosome doesn’t give male bodies the same protection estrogen gives women against heart disease and other risks.

When some people hear the term mosaic, they think of an archeological dig from the Roman era with tiny stones creating decorative images in the floors found in Pompeii or Roman Britan.

When medical people hear the term, they tend to think of problems faced by people who have a genetic anomaly that makes them neither XX nor XY, but XXY or XYY or an even more complex

combination of X and Y that may be associated with health and even behavior problems.

But in women, being a mosaic isn’t a disorder. Women’s bodies are capable of inactivating one of their two X chromosomes within each cell. Without this ability, XX women might not survive. In rare cases, women are born with only one copy of the X chromosome, which results in a disorder known as Turner syndrome that is associated with short stature, ovarian failure and heart issues. The XX mosaic capability seems to be an adaptive ability that evolved to help protect women and the next generation. It will take more research to understand its full effects.

Women can’t give the men in their families the protection of the mosaic effect. However, there are other ways they can help to protect their sons, nephews and grandsons.

“When a man gives a family history to your doctor, don’t forget to include the women in your family. Women who have ovarian, uterine or breast cancer tend to have male relatives who have prostate and other reproductive system cancers. The same is true of other conditions. People

Birmingham Medical News DECEMBER 2022 • 9
(CONTINUED ON PAGE 14) The XX Advantage MEN’S HEALTH
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Bruce Korf, MD

From preparing the next generation of scientists, to sharing how primary care doctors can improve care for neurological disorders, to addressing disparities in the field, Brenda Orffer provides insight into pressing national issues facing academic neurologists and neuroscientists.

What are the top issues going into 2023, legislatively and otherwise?

Continued funding for research and development and treatment of neurological disorders remains a priority. The National Institute of Neurological Disorders and Stroke September Legislative Update provides a good overview of legislation focused on neurological disorders and funding for critical research.

Considering the burden of neurological disease on Americans, it’s critical that Congress and state legislators ensure that people suffering with neurological disease have access and ability to pay for treatment, a sustainable system of healthcare delivery, and well-resourced research and clinical trials to identify treatments and potentially cures.

It’s also important that academic neurologists have the resources to continue to engage in research, test emerging treatments, and invest in future leaders. Academic neurologists are the first to implement new treatments and technologies for neurological diseases, and we need their work now more than ever.

The ANA recently held its Annual Meeting in Chicago. What new information or trends

in neurology emerged from the meeting that excites you?

There was such a rich array of cutting-edge research presented during ANA 2022 that it’s hard to narrow it down to a few, but there were a couple that stand out. In the presidential symposium on Neurologic Dark Matter: Exploring the Exposome that Drives Neurological Disorders, speakers discussed the sheer volume of chemical exposures affecting the public and presented evidence linking Parkinson’s disease and ALS with environmental exposures. In Advancing Neurologic Equity: Challenges and Paths Forward, speakers spotlighted neurologic health inequities—from the effects of multiple sclerosis and disproportionate impacts of Alzheimer’s among black and Latino populations to inadequacies in neurologic healthcare affecting LGBTQ communities. Both symposia are examples of the innovative research that’s providing new insights and avenues for reducing the burden of neurological diseases.

How is the ANA working to foster the development of young scientists in the field?

The ANA is passionate about helping early-career academic neurologists and neuroscientists build their professional skills and find community and support. Over the past few years, Nadine Goldberg, PhD, led the organization to develop focused educational programs, opportunities to present research, and ways to connect to mentors who will inspire our early-career members and invest in their professional growth. We’re continually working with this cohort

on initiatives that address their needs. So far that work has been successful: at the 2022 ANA annual meeting, 71 percent of registered attendees were junior or early-career academic neurologists/ neuroscientists, ranging from students and trainees to assistant professors/instructors. Our annual meeting includes a Junior & Early Career Members networking event and educational sessions tailored to the early stages of professional development.

The ANA is also committed to developing junior and early-career academic neurologists and neuroscientists across the globe. The recent annual meeting included early-career neurology and neuroscience experts from Sub-Saharan Africa who shared insights on the challenges faced in other countries, work and research being done, and how they collaborate with their counterparts in the U.S. to improve neurologic care globally.

The ANA also creates opportunities for junior and early-career academic neurologists through awards and scholar-

ships, including the Derek Denny-Brown Young Neurological Scholar Award, the ANA-Persyst IDEAS Professional Development Award, and the Grass Foundation - ANA Award in Neuroscience, along with travel and poster awards.

Our former Executive Director and current Chief Program Officer, Nadine Goldberg, is a driving force behind many of these initiatives, along with much of our other work, including our Annual Meeting and educational programs. We continue to work together to expand our capacity to address the needs of earlycareer and under-represented physicians.

What should doctors look out for, and how can they better help patients with neurological issues?

Recent research has revealed environmental contaminants are emerging as a major public health and health equity issue. Pollutants, chemical additives, pesticides, heavy metals, and the like— the exposures collectively known as our “exposome”—are directly affecting the brain and its function. They also increase the risk for diseases like dementia, Parkinson’s, ALS, and peripheral nerve disease. In addition, studies on healthcare inequities are beginning to reveal the vast differences in outcomes for people marginalized on the basis of race, ethnicity, sexual orientation, gender identity, physical and mental disability, and other social or structural disadvantages. One of the most important things doctors can do to better help patients with neurological issues is to consider the whole patient and their environment.

What is the ANA currently doing to address disparities within the field of neurology?

The ANA and the field of academic neurology/neuroscience are responding to the need to confront systemic discrimination to improve neurologic care for all. Through the leadership of our past President Dr. Justin McArthur, current President Dr. Frances Jensen, and Drs. Allison Willis and Lesli Skolarus, the ANA has implemented several initiatives to address diversity and inclusion.

These initiatives began with establishing a Task Force and listening tour and have led to a social justice symposia and webinars, editorial content in the Annals of Neurology, lectureships and awards to address disparities, and supporting the creation of a neurology department at Morehouse College School of Medicine. We’re listening and working to move towards greater equity in neurologic care and research, in the field at large, and in the way the ANA operates. You can learn more on our website www.myana.org.

10 • DECEMBER 2022 Birmingham Medical News
ARMSA is administered by the Alabama Office of Primary Care and Rural Health and is supported by the Office for Family Health Education & Research, UAB Marnix E. Heersink School of Medicine For details visit https://aohw.org/2021-armsa or email ARMSA@uabmc.edu Apply for ARMSA today! Answer the call to practice in rural Alabama The Alabama Rural Medical Service Award (ARMSA) incentivizes primary care physicians and NPs to practice in rural, medically-underserved areas in Alabama. Eligible PCPs receive $50,000 a year and NPs receive $30,000 a year for up to 3 years as a service loan payable by years of service. PCP and NP must not have practiced in the rural area within 3 years of October 1, 2021. We’re looking for NPs in family medicine and for physicians in the primary care fields of: • family medicine • internal medicine • general pediatrics • internal medicine/pediatrics Earn $50,000 a year! ARMSA
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Brenda Orffer, CAE

Why Do Men Have a Lower Life Expectancy?

Not that many generations ago, it was traditional for Scottish brides to begin weaving and sewing their burial shrouds the day after the wedding. Deaths from childbirth and related infections occurred so often it wasn’t uncommon then for men to bury two or three wives before they reached the ripe old age of 40.

Modern maternity care, antibiotics and birth control have since turned life expectancy tables upside down. Although people of both sexes are likely to live decades longer than they did a century ago, women outlive men so often that it’s fair to wonder whether women really are the weaker sex.

A child born in the US today can look forward to a life expectancy of 81 years if she is a girl, but only 77 if he is a boy. Rising life expectancy numbers have come down in recent years due to the pandemic, the opioid crisis and increasing suicide rates, but women still live significantly longer.

Why do men die earlier? Why are men at risk for so many illnesses and injuries, and why are their outcomes so often worse? Even male babies are less likely to survive infancy and 60 percent more likely to be born premature.

“It’s a combination of biology, behavior, hormones and culture,” Irfan Asif, MD, Chair of the Department of Family and Community Medicine at UAB, said.

While only women have ovarian cancer and only men get prostate cancer due to basic anatomy, there are some disorders found only in men, and many others that males are at much higher risk of developing. They are almost twice as likely to have Parkinson’s Disease; around 70 percent of Idiopathic Pulmonary Disease patients are men; and more men have ALS, alcoholism, cirrhosis, HIV, colon cancer, pancreatic cancer, kidney cancer, lung cancer and virtually all cancers not related to female reproduction. In the first year of the Covid-19 pandemic, men died at significantly higher rates than women.

“Men have diseases like Duchenne Muscular Dystrophy and Hunter syndrome,” Asif said. “They are also much more likely to have hemophilia, autism, color blindness, and to develop an abdominal aortic aneurysm, and a number of other disorders. Women have two X chromosomes. Men have only one, and if a gene on that chromosome has a mutation, there’s no backup to mitigate the risk. They also don’t have the estrogen levels that give women an extra decade

of protection against the more deadly cardiovascular conditions.

“Men get more testosterone, which gives them a deeper voice, a beard and more muscle. Testosterone also makes teen boys more impulsive and aggressive several years before the judgment centers of their brain mature. That’s one reason we lose so many young men to high speed auto crashes and violence.”

The tendency of young men to take risks and to act aggressively while at the same time being in the best condition of their lives is also why societies have always depended on them to be the soldiers who fight the wars. Many young men don’t come home, and those who do bring with them memories that can affect their mental and physical health for years, assum-

ing they live those years. Men are also between three and four times more likely to die by suicide than women.

“Work related illnesses and injuries also tend to be more common in men. More men than women have jobs that involve dangerous situations, equipment and toxic exposures. More do heavy labor in harsh conditions that take a toll on the body and long-term health,” Asif said.

In addressing the disparity in men’s health and longevity, there are some factors we can change, some we can’t, and some risks we can influence—if we can get past cultural expectation of what being manly is and get more men to take ownership of their health.

“One of the reasons we often see worse outcomes in men is that they tend to wait longer to seek help and many don’t take the time for screenings that would have detected problems earlier when they were more treatable. Some men think they have to be strong and they say they are fine when they aren’t,” Asif said.

Somehow masculinity became confused with playing when hurt, working when sick, and settling for years in a stressful job to measure up to self-expectations as a provider.

“Some men don’t treat themselves

Birmingham Medical News DECEMBER 2022 • 11
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Irfan Asif MD

On September 15, 2022, Deputy Attorney General Lisa Monaco announced significant updates to the Department of Justice (the “Department”) corporate criminal enforcement policies, with an emphasis on individual accountability, stricter requirements for corporate cooperation credit based on past conduct, and a call for organizations to self-report misconduct. The new policies mean the Department will take a more aggressive approach to corporate criminal enforcement, including enforcement against individuals, and health care providers should be mindful of this heightened scrutiny.

Individual Accountability and Self-Reporting

Individual accountability was described by the Department as a “number one priority” and the policy changes are designed to expedite investigation and prosecution of not only culpable health care providers, but also individuals involved in the misconduct. Under this new enforcement policy, providers are expected to fully disclose to the Department culpable individuals and all related information connected with corporate misconduct. Health care providers that fail to timely report and fully cooperate with the Department are more likely to forfeit the ability to secure a non-prosecution agreement (NPA) or deferred prosecution agreement (DPA). NPAs and DPAs provide the government with tools to reach a settlement agreement with

providers. An NPA typically does not result in any charges being filed against the provider and it does not require the provider to admit liability. A DPA is an agreement which requires the provider to admit to the underlying conduct and if the provider fulfills certain conditions, which can include a term of probation, restitution, community service or other relevant conditions, the government agrees to dismiss the charges. The obvious benefits to both a non-prosecution and deferred prosecution is that you avoid a criminal conviction.

While voluntary disclosure of corporate and personal misconduct is stated by the Department to be “the clearest path for a company to avoid a guilty plea or an indictment”, such action must be carefully considered since it alerts the Department to conduct that it might not otherwise identify. In the absence of aggravating factors, the Department will not seek guilty pleas if the provider voluntarily and timely self-reports, coop-

Policy on Corporate

What it Means for

erates fully, and remediates the conduct. It should be noted that some health care laws require mandatory reporting and return of overpayments to federal and state health care programs, where failure to do so could result in sanctions under the federal False Claims Act. The Department has made clear that it favors and rewards providers that disclose misconduct rather than attempting to cover up or downplay the fault. To earn credit for cooperation, providers must be proactive and genuine in efforts to cooperate and remediate the situation. This includes a willingness to name individuals suspected of wrongdoing, linking compensation to compliance, and implementing policies to claw back compensation for those who participated in the misconduct.

The Department’s emphasis on “moving faster” will likely accelerate the pace of health care fraud investigations and in some instances could force a provider to address decisions about connections to criminal conduct before having the benefit of a complete internal investigation. It is important to engage experienced counsel early in the process to navigate the decision to cooperate, to negotiate cooperation credit up front and/ or to secure additional protections while at the same time conducting a robust internal investigation into the misconduct.

History of Misconduct

The Department’s corporate enforcement policy also includes details on how prior misconduct will be evaluated by prosecutors. The Department will

consider misconduct occurring within the past 10 years, particularly misconduct involving the same personnel or management. In evaluating whether to prosecute a provider or individual, prosecutors will consider facts and circumstances surrounding the prior misconduct and whether the conduct reflects a broader cultural or compliance weakness. As a practical matter, the Department will treat health care organizations and individual providers similar to how individuals are treated in the justice system – when prosecutors are required to consider the individual’s criminal history. Habitual corporate offenders will face more serious consequences, particularly for their failures to reform. Hence, a robust and effective corporate compliance program is critical in avoiding systemic compliance issues.

Elements of a Strong Corporate Health Care Compliance Program

1. Written policies, procedures, and standards of conduct — A compliance program must have clearly defined policies and expectations that are published and available to all employees. The policy should include an affirmative commitment to compliance with all applicable state, federal, and regulatory laws.

2. Designation of a compliance officer or compliance committee A compliance program should have a dedicated compliance officer or compliance committee to oversee the implementation and enforcement of the policy. The compliance officer and/or committee should report directly to senior management.

3. Effective Training — Providers must ensure all employees are appropriately trained on compliance. This should include new employees as well as routine refresher training with all employees.

4. Open lines of communication — Employees at every level of an organization need to have an opportunity to ask questions, seek clarification, express concerns and/ or report potential noncompliance without fear of retaliation.

5. Risk Assessment — Implementation of a system for conducting an internal audit of the compliance program in order to measure the effectiveness of the program. The audit may include an annual audit and/or periodic monitoring to ensure adherence to regulations and identifying compliance risks.

12 • DECEMBER 2022 Birmingham Medical News
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continued from page 7

ments when first introduced, routine insurance coverage of Duolith Shockwave Therapy is yet to be established.

“We understand how important erectile dysfunction is in the lives of our patients, so we’ve worked to make Urology Centers of Alabama one of the most affordable providers of Duolith Shockwave Therapy anywhere. Care Credit can also be arranged,” Westerlund said. “The results we’re seeing have been so encouraging that we want anyone who

could benefit to be able to choose this option. It makes such a difference in the lives of our patients and the people who love them.”

The ideal candidates for this therapy are men who are experiencing mild to moderate ED symptoms, especially those who aren’t responding well to medication or who prefer to avoid medication and are looking for an alternative to invasive treatment or surgical options.

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can inherit the health they start with from both sides of their family,” Korf said.

When family history isn’t known, patients may want to consider getting a clinical evaluation. Some home DNA kits cover a few genetic disorders. The All of Us project and the Alabama Genomic Health Initiative are two research programs open to local volunteers. They are looking for specific gene-linked disorders and will alert those who wish to know if they are at high risk for a treatable dis-

from page 9

order. A 30-year-old who was unaware of being at high risk for colon cancer on both sides of the family was alerted in time to have numerous polyps removed that could have been lethal before the usual screening age.

“However, if you are concerned about knowing what your genetic risks may be, you may want to consider a full clinical evaluation and counseling, which is available at UAB. The risks you know are easier to avoid,” Korf said.

Why Do Men Have a Lower Life

Expectancy,

continued from page 11

as well as they do their car,” Asif said. “Guys who would never miss an oil change say they don’t have time for a checkup. They put off prostate exams, colonoscopies and avoid seeking help with mental health issues. You don’t see them until something is really wrong or when their wives make them come in for a blood pressure check or to get a medical opinion about symptoms.”

Although men from younger generations seem to be showing more interest in a healthy lifestyle, too many still smoke, work long hours, and find it hard to come to terms with the fact that they can’t get away with eating the same way they did when they were young.

Patient care generates a large amount of data that must remain accessible 24/7/365 to keep your doors open. Our team takes that seriously. Our engineers work around the clock to ensure your network is consistently monitored and downtime is minimized. And should concerns arise, our Healthcare IT is just a phone call away—any time, every day.

In the not too distant future, genetic screening and editing will help men overcome some of the health disadvantages they are born with. Even then, as now, the greatest opportunities to help men live longer, healthier lives will come from helping them take ownership of their bodies and become proactive about their health care. Health care providers can help them understand they have a choice. They can treat themselves like an old jalopy just waiting to break down by the side of the road—or shine like a classic sports car, well worth the care to stay in peak condition for years.

New Department of Justice Policy,

continued from page 12

6. Enforcement — Clear, written policies must apply appropriate discipline to those who fail to comply with the program’s expectations and policies.

7. Corrective action — If a significant compliance risk or vulnerability is discovered through a reported incident, compliance breach, or internal review, the compliance committee should take timely, decisive action that will reduce the risk of non-compliance.

In the wake of the recent Department policy on corporate enforcement, health care providers should evaluate the effectiveness of their corporate compli-

ance programs. Also, the Department’s renewed focus on compliance provides providers, and particularly their general counsel and/or chief compliance officer, with justification for greater investment in corporate compliance programs. Investigators will evaluate a provider’s compliance program, and the failure to have an “effective” program may inhibit a successful resolution.

Robin B. Mark is a partner at Burr & Forman LLP. She represents individuals and corporations facing government enforcement actions. She assists clients with conducting internal investigations, navigating their potential civil and criminal exposure and responding to law enforcement inquires. She may be reached at rmark@burr.com or (205) 458-5473.

14 • DECEMBER 2022 Birmingham Medical News 866.951.7676 | DYNAMICQUEST.COM BIRMINGHAM | HUNTSVILLE | MONTGOMERY | MOBILE

Kassouf CIO Honored by FBI

Hulsey Joins Birmingham Infectious Disease

Greg Hulsey, FACHE, CMPE has joined Birmingham Infectious Disease & Infusion where he is serving as Chief Executive Officer. Prior to this, he spent the past six years as the CEO of Maynor & Mitchell Eye Center in Huntsville.

Hulsey has a wealth of experience in Alabama healthcare, including positions with Children’s of Alabama, Alabama Bone & Joint, Orthopaedic Specialists of Alabama and Baptist Health Centers.

He earned his Bachelors of Science in Health Care Management at the University of Alabama before receiving a Masters of Health Administration and a Masters of Business Administration at UAB.

Hulsey is a member of the American College of Healthcare Executives, the National Medical Group Management Asso-

Kassouf Principal and Chief Information Officer Russ Dorsey was honored with the FBI Director’s Community Leadership Award. The FBI recognized Dorsey for his achievements fostering outreach, education, and information sharing among the FBI, Department of Homeland Security, and other agencies, organizations, and businesses.

“I have a deep respect for law enforcement, and now that I’ve come to

know so many over at the FBI office, to be acknowledged for contributing anything worthwhile in return is truly humbling,” Dorsey said.

Dorsey leads all information technology efforts at Kassouf with a crucial emphasis in cybersecurity awareness and training. He is also the President of the InfraGard Birmingham Members Alliance and a Board Member of TechBirmingham.

Johnson’s Donation will Support Groundbreaking Alzheimer’s Research

Jim and Sallie Johnson have donated $5 million to the University of Alabama at Birmingham to support Alzheimer’s research. The grant will fund a human cell modeling initiative, using a new technology called induced pluripotent stem cells (iPSC). This technology has the potential to significantly advance Alzheimer’s research, allowing new therapies to be developed with the goal of developing a treatment for the disease.

The Johnsons’ gift will help UAB hire an iPSC researcher and establish a lab to develop the technology as soon as next summer.

The decision to make the gift was a personal one for the Johnsons. Jim Johnson’s grandmother, mother and sister have all suffered from the disease, and he is familiar with the toll the disease takes not just on the person diagnosed, but on the entire family.

“Lots of people have a relative with Alzheimer’s,” Johnson said. “It’s not fully recognized how traumatic it is. Current treatment is a hopeless continuation of decline for the patient and their family.”

“It’s going to be transformative for Alzheimer’s and UAB,” Sallie Johnson said.

“This gift allows us to bring an important technology to UAB,” said David Standaert, MD, PhD and chair of the Department of Neurology “It’s an amazing technology.

For years, we thought cell development was a one-way path, and once the cell developed, there was no going back. The discovery of how to make iPSCs changed all of that and earned a Nobel Prize in 2012. Now, you can take a cell, like a piece of skin, grow a skin cell in a dish, and turn back the clock and turn it into a stem cell. It can then become any type of cell, so if we’re studying Alzheimer’s, we can induce it to become a brain cell in a dish.”

ciation (MGMA), as well as the Alabama and Birmingham MGMAs. He current serves as President of Alabama MGMA.

UAB Joins International Study of Promising Alzheimer’s Treatment

Study is Looking to Recruit People at Risk for Alzheimer’s

Researchers at the University of Alabama at Birmingham are recruiting volunteers for a study testing an investigational treatment that aims to help prevent the earliest memory loss due to Alzheimer’s disease.

The AHEAD Study is the first Alzheimer’s disease research study to recruit people as young as 55 years old who are at risk of developing symptoms of Alzheimer’s disease as they get older. It introduces a personalized approach that will tailor treatment dosing levels to a participant’s particular risk of memory loss related to Alzheimer’s disease.

Funded by the National Institutes of Health and Eisai Inc., a United States subsidiary of Eisai Co., Ltd., the international AHEAD study seeks to enroll 1,165 participants from North America ages 55 to 80 without a diagnosis of Alzheimer’s disease or other dementia. UAB is one of more than 100 study locations around the world.

“The tailored approach of this study, starting treatment years before memory loss has begun, has the potential to be a breakthrough in our aim to prevent Alzheimer’s disease,” said Marissa Natelson Love, MD, associate professor in the Department of Neurology, Heersink School of Medicine and primary investigator at UAB. “It can potentially serve as a model to improve clinical trials in Alzheimer’s research and other diseases.”

The AHEAD Study consists of two different clinical trials testing the same investigational treatment, an anti-amyloid antibody called lecanemab. Participants are enrolled in one of the two trials based on the level of amyloid in their brain. Amyloid is a protein that builds up in people who can go on to have memory problems and develop Alzheimer’s disease. Earlier studies suggested that lecanemab slowed cognitive decline in patients

with early stage Alzheimer’s disease. Individuals interested in volunteering for the AHEAD study can go to aheadstudy.org and click Join Study, or contact Princess Carter, DNP, in the UAB Division of Memory Disorders and Behavioral Neurology, at 205-934-6223 or pqahhaar@uabmc.edu.

The sixth leading cause of death in the United States, Alzheimer’s is the only disease among the top 10 causes of death that cannot be prevented, cured or slowed.

The AHEAD study is supported by the NIH’s National Institute on Aging under award numbers R01AG054029 and R01AG061848. The AHEAD Study, clinical trial number NCT04468659, received funding from NIH and from nongovernmental sources.

Birmingham Medical News DECEMBER 2022 • 15 GRAND ROUNDS
Russ Dorsey (left) receives the award. Sallie and Jim Johnson Marissa Natelson Love, MD Greg Hulsey, FACHE, CMPE

Cullman Regional to build North Alabama’s First FED

Grandview Adds New Technology to Enhance Maternal and Fetal Safety

The childbirth team at Grandview Medical Center is now using an artificial intelligence-based maternal-fetal early warning system called PeriWatch Vigilance to enhance patient safety during labor and delivery. The system monitors maternal vital signs, fetal heart rate, contractions, and labor progression to help clinicians quickly identify any concerning developments for faster intervention.

Cullman Regional is taking steps to build North Alabama’s first freestanding emergency department at Hartselle Health Park, an outpatient facility opened by the hospital in 2021. The facility had nearly 14,000 patient visits since opening its urgent care clinic, diagnostic imaging center and two physician clinics. The new freestanding emergency department will be constructed where the urgent care clinic is currently located. Urgent care services will relocate to a different area in the same building.

“Freestanding emergency departments are especially important for communities without a hospital,” said Bill Smith, MD,

chief medical officer at Cullman Regional. “This project means Hartselle residents will not have to leave their community for lifesaving emergency services.”

The Hartselle Health Park ER will operate 24/7 and will be staffed by board certified emergency medicine physicians. It will offer on-site imaging including MRI and CT, lab capabilities and pharmacy services. The facility will also be equipped with an ambulance bay and a helipad.

Cullman Regional submitted a Letter of Intent to Alabama’s Certificate of Need Board on October 31, and will begin construction once the CON application is approved, which may take several months.

“While most births happen without complication, there are some inherent risks in the delivery of a newborn,” says Alison Heaton, MD, medical director of the women’s services unit at Grandview. “This technology adds another layer of protection throughout the labor process to help our maternity team recognize, prevent and respond to avoidable

complications.”

Through pattern recognition, the technology can also pinpoint opportunities for overall improvement based on consolidated data from multiple births.

As the maternity team reviews trends and identifies areas where improvement is possible, the hospital can use that information to develop protocols that further increase safety and may lead to better outcomes.

Alabama saw an increase in new-onset Type 2 diabetes among youth during the COVID-19 pandemic. Results from a University of Alabama at Birmingham retrospective study using data from Children’s of Alabama showed the increase and indicated that Medicaid enrollees and males were disproportionately affected by the disease.

While the state had already been experiencing a worrisome increase, the rate of Type 2 diabetes skyrocketed during the COVID period. Prior to the start of the pandemic, the average monthly rate

of new pediatric diagnoses was 11.1 new cases. After April 2020, the monthly rate increased to 19.3 new cases.

“Approximately 53 percent of all children in Alabama are enrolled in Medicaid,” said Jessica Schmitt, MD, assistant professor in the Division of Pediatric Endocrinology and Diabetes at UAB and Children’s. “In addition to medications, maintaining a healthy diet and activity level are important in management of Type 2 diabetes. This can be difficult for children living in lower socioeconomic conditions.”

16 • DECEMBER 2022 Birmingham Medical News
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Cullman Regional Earns National Recognition

Construction Starts on Ascension St. Vincent’s East New FED

Cullman Regional has received two American Heart Association Achievement Awards, one of which has been awarded to the hospital for three consecutive years. The awards recognize Cullman Regional for implementing quality improvement measures that help ensure stroke and cardiovascular patients receive the most appropriate treatment according to nationally recognized, research-based guidelines.

The American Heart Association’s Get with The Guidelines program helps reduce barriers to prompt treatment for cardiovascular events. The Get with The Guidelines Achievement Awards recog-

nize Cullman Regional for applying the most up-to-date evidence-based treatment guidelines to improve patient care and outcomes.

This year, Cullman Regional received the following Achievement Awards:

• Get with The Guidelines®Stroke GOLD PLUS (3rd consecutive year) with Honor Roll Elite Plus and Type 2 Diabetes Honor Roll (2nd consecutive year)

• Get With The Guidelines®Heart Failure SILVER PLUS

Ascension St. Vincent’s East recently held a groundbreaking ceremony for their new Freestanding Emergency Department that will be located in Trussville, just off the I-59, Chalkville Road exit.

“Because Trussville is growing at a rapid rate, the need for 24/7 emergency care close to where people live and work is paramount,” said Jason Alexander, president and CEO of Ascension St. Vincent’s.”

Construction on the $20 million project began in November. The 16,800-square-

foot facility will also feature 12 treatment rooms, decontamination treatment area, onsite lab and imaging, including x-ray and CT, and a helipad for air ambulance transfers. Emergency care will be available to all ages, and the facility will be staffed by a physician, nurses, radiology and lab technicians.

The site of the project sits on roughly nine acres that hospital leadership says can be further developed in the future to continue to meet the growing needs of the community.

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Cullman nurses earned this recognition. Father Paul Asih blesses the guests and land at the groundbreaking

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Infrared Cameras in Telemedicine Visits to Diagnose Arthritis

According to the Centers for Disease Control and Prevention, approximately 24 percent of adults in the United States have some form of arthritis. Early diagnosis of rheumatoid arthritis can reduce the risk of joint damage, functional impairment and pain.

Diagnosing arthritis begins with a physical examination to look for signs of inflammation: swollen joints, joint stiffness, joint pain and tenderness, and a decrease in range of motion. However, since not all signs of arthritis are visible to the naked eye, making accurate diagnosis during telemedicine visits is a challenge.

Rheumatologists at the UAB Marnix E. Heersink School of Medicine plan to bridge this information gap by incorporating imaging using thermography cameras into telemedicine visits. These cameras use infrared radiation to provide

detailed images of inflamed areas.

Through a grant from Pfizer, the UAB research team will first optimize protocols for infrared thermography using musculoskeletal ultrasound as the standard.

The team will then train nursing staff at Whitfield Regional Hospital in Demopolis and John Paul Jones Hospital in Camden,

both members of the UAB Health System, on how to use the cameras to obtain images of a patient’s hands and feet.

Images will be sent to UAB rheumatology clinicians. The team will test whether the infrared thermography imaging can be effectively implemented to enable remote examination for joint inflammation.

Alabama and Birmingham MGMA Chapters Award Scholarship to Samford

At the November meeting of the Birmingham Medical Group Management Association (MGMA), the Alabama MGMA and Birmingham MGMA presented an endowed scholarship for the Healthcare Administration program at Samford University.

“This is the first endowment for our healthcare administration program, a profound gift that we will be forever grateful for,” said Courtney Haun, PhD, MPH, Assistant Professor and Director of the Healthcare Administration Undergraduate Program. “The MGMA has become a professional development and community home for many of our students and faculty over the past several years. It is such an honor to join together in efforts to develop our healthcare leaders of tomorrow, and this endowed scholarship is an example of just that.”

Ascension St. Vincent’s Birmingham Bariatrics Earns National Quality Accreditation

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Ascension St. Vincent’s Birmingham Surgical Weight Loss has earned accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). MBASQIP is a joint Quality Program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).

To earn MBSAQIP Accreditation, Ascension St. Vincent’s Birmingham Surgical Weight Loss met essential criteria for staffing, training, facility infrastructure and patient care pathways, ensuring its ability to support patients with obesity. The center also participates in a national data registry that yields semiannual reports on the quality of its surgical outcomes and identifying opportunities for quality improvement.

After applying for MBSAQIP Accreditation, centers undergo an extensive site visit by an experienced bariatric surgeon who reviews the center’s structure, processes, and clinical outcomes data.

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Left Image shows no inflammation. Circled area on the right image is inflamed. Samford’s Courtney Haun (4th from left) with MGMA Officers. Aimee Rothe, BSN, RN (right) director of the surgical weight loss center.

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