Birmingham Medical News January 2024 by Birmingham Medical News

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Worldwide Transitions Aims to Alleviate Our Nursing Shortage By Steve Spencer

When Judy Kendall was a little girl, she loved thumbing through her parents’ National Geographics, imagining the adventure of traveling the globe, and after her children were grown, she decided to live that dream, and traveled to Africa for a three-week safari. While there, she visited Zambia where she was stunned at the level of poverty, unlike anything she had ever seen, and this inspired her to start Anchor of Hope, a charity designed to help Zambia’s children. Since 2006, Kendall has raised millions of dollars and Anchor of Hope has provided aid to approximately 50,000 children. It was the Anchor of Hope experi-

ence that eventually led Kendall to finding a solution for our nursing shortage. It started in 2013 when Kendall, who was a Project Director with the Indiana University School of Medicine/Indiana University Health, sat in on a board meeting in which executives were discussing ways to improve care and/or reduce costs. As the executives went down the list, line eight, an unreimbursed care provided by the hospital system, was the result of one single person, a woman named Mary. “Mary had been in the hospital for five years,” Kendall said. “She had traveled to the U.S. from Zambia to see her daughter, and had overstayed her VISA. At that point, she was considered Kendall’s non-proﬁt has provided aid to 50,000 Zambian children.

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Bariatric Surgeon says GLP-1 Drug he is Revolutionizing the Weight-Loss Weig oss Industry Ind By Lauren JoHnSon

Medical professionals from Ascension St. Vincent’s Birmingham Bariatrics say that Glucagon-like peptide-1 receptor agonists (GLP-1) are the most effective weight loss medications. While other weight-loss drugs can help patients see up

to a 12 percent weight loss, GLP-1 routinely results in about 15 to 20 percent excess body weight loss, and in some cases more than that. Not only are GLP-1 agonists an option for some patients in place of bariatric surgery, but they can also help patients who regain weight after surgery. (CONTINUED ON PAGE 5)

Katie Novitski, MD, (fourth from left) celebrates the 200th surgery (now over 300) with colleagues.

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Birmingham Medical News

Worldwide Transitions Aims to Alleviate Our Nursing Shortage, continued from page 1 undocumented. When she got sick, she couldn’t go to a doctor’s office because she wouldn’t have any form of payment, so she waited until it got bad and then she went to the hospital. They removed a tumor on her brain that left her in a condition like she had had a stroke. At that point, she would need a caretaker after she left the hospital, but her family had disappeared. Her daughter, who was here legally, was probably afraid she would get in trouble with immigration services. “It was a tremendous cost to the hospital, and since I had experience in Africa, they asked me to help. I was able to find Mary’s siblings in a remote village. I then determined what was needed in order for them to take care of Mary. We put a well in so they would have running water, and we added on to the house. The hospital paid me to get her home. I did it to help the health care system, but of course, it was a benefit for Mary too.” When Kendall learned that patients like Mary accounted for $20 billion of expenses in the healthcare system, a business idea bloomed, and she started Worldwide Transitions (WWT) which helps patients like Mary return home, relieving a financial burden from U.S. hospitals. In the meantime, she continued her philanthropic work in Zambia with Anchor of Hope, and in the process, she learned that there were over 60,000 unemployed nurses in the country. With the imminent nursing shortage in the U.S., Kendall realized that she was looking at a true win-win situation, and she added a staffing solution service line to WWT designed to both ease of shortage in the U.S., and provide an opportunity for Zambian nurses. At this time, WWT has placed around 300 Zambian nurses in the U.S. with another 200 recruits who are yet to be placed. Kendall has been careful about advertising her service in Zambia so as not to get more nurses than she can place. “We put it on a Facebook page there, and pulled it back after one day because we got such a big response,” she said. When nurses find the Worldwide Transitions website, they input their credentials, along with their resume. After Kendall and her staff review the information, they set up interviews with qualified candidates. “Once we feel that someone is a good candidate, we start working with them - first, to help them prepare for the National Council Licensure Examination (NCLEX), which is necessary in order to practice in the U.S.,” Kendall said. “This way, they’re credentialed before they come here. Either before or after they’ve passed the exam, our goal is to marry them up with a client. We also lead them through the Certified Nursing Assistant class so they can have this completed before they arrive. “The VISA process takes about a

year, and during that time, we’ve developed a curriculum which we deliver every two weeks. We try to cover everything they could need for their new life. For example, we have a whole class on interviews. And we teach them about every day things like learning to drive on the left side of the road; where to shop; how to turn on your electricity; getting a driver’s license etc. And they get a medical exam with all the required immunizations. “We pick them up when they arrive here, and we support them for their first two months. We make sure they have a place to stay, along with all the things they need. They have a list of references they can call for various needs, and we (CONTINUED ON PAGE 5)

Judy Kendall has been to Zambia over 30 times.

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Birmingham Medical News

JANUARY 2024 • 3

After Over 50 Years in Medicine, Andrews Turns Over the Reins By Steve Spencer

After five decades in medicine, James Andrews, MD has announced his retirement from daily practice as of the end of 2023. To put his career in perspective, Lyndon Johnson was President when Andrews, who had been an SEC pole vault champion as an undergrad, entered the LSU School of Medicine. After completing an orthopaedic residency at Tulane in 1972, followed by surgical fellowships in sports medicine at the University of Virginia School of Medicine and at the University of Lyon in France, Andrews joined a practice in Columbus, Georgia before starting his Birmingham practice in 1986. From there, the James Andrews story is so well-known as to almost be legend. Having performed more than 45,000 surgeries in his career, he’s helped some of the most elite athletes in the world: Bo Jackson, John Smoltz, Drew Brees, Charles Barkley, and Michael Jordan, just to name a few. What isn’t so well known, however, are the relationships Andrews has built with the numerous surgeons that he’s mentored, including Drs. Lyle Cain,

Jeff Dugas, and Benton Emblom, who all practice at Andrews Sports Medicine & Orthopaedic Center. “The first time I met Dr. Andrews, my impression was that he was a regular, everyday guy,” Cain said. “To this day, Dr. Andrews is a true Southern gentleman, and I believe that’s why patients have always liked and admired him.” “Dr. Andrews really has been like a father in the business to me,” Dugas said. “He has always been one of those surgeons that exudes education. If you can’t learn from Dr. Andrews, you can’t be taught.” Benton Emblom, MD agrees. “One of Dr. Andrews best skills was teaching us how to take care of people; how to take care of athletes; how to perform surgery and when not to perform surgery,” he said. “He trained us how to perform surgery, but Dr. Andrews was a master at knowing who not to operate on at certain times and who to operate on at other times. He was great at sharing that intuitive, decision making when we were fellows and later as colleagues.” (CONTINUED ON PAGE 10)

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Birmingham Medical News

(L to R): Drs. Emblom, Dugas, Andrews, and Cain.

(L to R): Andrews, Cain, and Emblom on the Alabama sideline in 2015.

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Bariatric Surgeon says GLP-1 Drug is Revolutionizing the Weight-Loss Industry, continued from page 1 Aimee Rothe, BSN, RN, the director of Metabolic and Bariatric Surgery at Ascension St. Vincent’s Birmingham, said that St. Vincent’s physicians have performed almost 300 bariatric surgeries since 2020, and starting in 2022, they began including obesity medicine like GLP-1 agonists. This class of drugs, first introduced in 2005, were primarily used to treat diabetes before being approved for weight loss in 2014. “GLP-1 drugs have revolutionized the weight-loss industry,” said Katie Novitski, MD, MPH, a bariatric surgeon at Ascension St. Vincent’s Birmingham. “It’s a great tool to have in our arsenal, but I don’t think they will ever replace surgery. It’s important to note that bariatric surgery is a metabolic surgery, so we actually change the metabolic processes by going in and altering the patients’ anatomy. It’s possible for patients to see anywhere from 60 to 75 percent excess body weight loss with bariatric surgery. They can also see remission and improvements in other health conditions like heart disease, liver disease, high blood pressure and diabetes. Likewise, anywhere from 40 to 90 percent of these patients are able to come off all their medications.” Novitski and her colleagues follow up with patients at least six times within the

Katie Novitski, MD, MPH

first year of surgery. After the first year, the patient has annual checkups. These checkups help the patients stay accountable and continue on the right track to keep the weight off. St. Vincent’s also offers a back-on-track weight-loss program for bariatric surgery patients. This classroom session includes information on the three-pronged approach – diet, exercise and metabolic workup. “If a patient starts to regain some weight after surgery, GLP-1 agonist is a great tool to use, along with an appropriate diet and exercise routine,” Aimee Rothe said. “We want to help decrease the stigma around bariatric surgery by making patients aware of the GLP-1

medication and its use after surgery. A patient can experience a self-perception of failure if they regain weight post-surgery. So, understanding that we’re treating a medical problem, and even though they may be in remission by losing weight, they still have obesity.” Novitski said GLP-1 offers a new opportunity for patients. “After bariatric surgery, you actually have a spike in your own hormone GLP-1. In other words, we see the same metabolic response within the body, post-surgery, that we get when some takes the GLP-1 agonists. This metabolic response helps the body regulate insulin, glucagon and sugar. It can also help decrease appetite. This encouraged me to begin offering the medication to patients. If we can get the same response with a medication, then the patients can have a great result.” For consideration of medications, the patient needs to have a BMI (body mass index) of 28 with an obesity-related comorbidity, like high blood pressure, diabetes, liver disease or sleep apnea. For patients in need of long-term results or patients with a BMI greater than 35, Novitski said surgery is the best option. This way patients won’t need to take medication for an extended period of time, or in some cases, a lifetime.

Worldwide Transitions Aims to Alleviate Our Nursing Shortage, continued from page 3

connect them with local people from their homeland. There are Zambians here in Birmingham who I know well. And that’s a big key to this – unlike the typical recruiters, I know Zambia inside and out, having been there 30 times with my non-profit. I know members of Parliament, people with private companies. I know rural areas, urban areas. I know school system administrators, University administrators. I know our US ambassador there. I’m practically a Zambian. I have a heart for these people.” Judy Kendall is working exclusively with healthcare systems in Indiana and Alabama, where she has resides. However, not every provider will fit. “We’re working with health care systems that will embrace the cultural blend,” she said. “As an example, the Chief Nursing Officer for one of our hospital system clients is planning to go with us on a trip to Zambia to meet some of the nurses before they come. She wants it to be a great experience for everyone. They’re embracing the culture. That’s what will make it successful.”

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Birmingham Medical News

JANUARY 2024 • 5

Treating Chronic Pelvic Myofacial Pain With Light Laura Freeman

Decades after laser instruments revolutionized surgery, the healing power in a simple beam of light can still evoke a sense of wonder. “Seeing how the near infrared light of a SoLa Pelvic Therapy Laser triggers biochemical changes within cells is amazing. The effects are particularly pronounced in mitochondrial respiration and cytochrome C oxidase,” Alex J. Childs, MD said. Childs, who is a pelvic pain specialist at Ob-Gyn South, became the first physician in the state to use the system in patient care last summer. He has been very impressed with the results. “I’ve actually been surprised that the improvement in symptoms is better that I was expecting,” Childs said. “About 75 percent of our patients are responding to this treatment, with many reporting a noticeable improvement after only three or four sessions.” With a Fellowship in Chronic Pelvic Pain, OB-GYN Childs knows first-hand how difficult it can be to diagnose and treat this condition in women. And this is a growing problem, as chronic pelvic

6 • JANUARY 2024

pain is now affecting up to 24 percent of the women in the world. Unfortunately, many of these patients live with this pain because they don’t realize that anything can be done to relieve it, and there were limitations with most of the prior therapies. For instance, physicians have been reluctant to prescribe many pain relievers due to the risk of dependency. And although Botox can be injected into vaginal trigger points, a number of women are reluctant to choose this option. Pelvic pain can come from a number of different causes, but 85 percent of patients living with chronic pelvic pain have a component of hypertonic pelvic floor dysfunction. Tight pelvic muscles can be a significant factor contributing to their pain. Alex Childs MD with a SoLa Pelvic Therapy Laser. “Patients referred for help with pelvic muscle dysfunction can presadds emotional pain and stress to intient with a number of symptoms in mate relationships. different combinations,” Childs said. “SoLa therapy has been very well re“They may have painful urination or ceived by our patients. They were excited bowel movements, pain with excessive to learn that they now have an option that sitting or standing, and pain that makes doesn’t involve needles for trigger point intercourse difficult or impossible, which

Birmingham Medical News

injections or other uncomfortable treatments. Patients say they only feel a slight warming. There may be minor irritation for a day or two, but nothing significant. “Treatments only take a few minutes. We usually schedule three appointments a week for a total of nine sessions over three to six weeks. The light energy is delivered through a small vaginal probe with a disposable tip. Before proceeding, we always check to make sure there are no active infections, uti’s or vaginal bleeding, and address those issues, if needed.” Contraindications for using the laser treatment include pregnancy, cancer in the urogenital area and the use of medications that are heat or light sensitive. The SoLa Pelvic Therapy System is a nonablative class IV nearinfrared laser that transmits at both 810nm and 980nm wavelengths. No cutting is involved. It is the only photobiomodulation device now available for vaginal use and cleared for treatment of (CONTINUED ON PAGE 10)

ALPQC Launching Obstetric Hemorrhage Initiative By Laura Freeman

Amid the joy of new life, one of the cruelest ironies is that giving birth still brings death to too many new mothers around the world. And it can be shocking to learn that maternal death rates in the United States are higher than in many smaller, less-developed countries. Sadly, these rates have actually been rising in recent years. A lot of effort is going into understanding why this is true and how we can change it. One thing we do know is that maternal hemorrhage is one of the most lethal factors killing new mothers—and with a more focused effort many of those deaths don’t have to happen. That’s why the Alabama Perinatal Quality Collaborative (ALPQC), supported by the CDC and March of Dimes, is focusing its 2024 maternal health initiative on obstetric hemorrhages. “Our objective is to share resources and training with hospitals and health professionals across the state who might find themselves caring for a woman in labor,” Program Director Britta Cedergren, MPH, MPA said. “Lives depend on being able to recognize and assess the risk of hemorrhage early and to have preparations and resources in place ready to respond.” Brian Brocato, DO, who is head of maternal fetal medicine at UAB, serves as Obstetrics Lead for the collaborative. “Early recognition is the key,” he said. “Pregnant women should be assessed in advance for risk factors that could increase the likelihood of a hemorrhage, and assessment should continue through labor, delivery and post partum care as conditions change. Women carrying multiple or larger than average babies, older mothers and those who have given birth multiple times, as well as women with platelet issues or other health conditions are likely to be at higher risk. “It’s essential to measure blood loss so you have a reliable basis for knowing when it’s time to take action. It’s all too easy for blood to seep through clothing and bedding unnoticed and suddenly the situation becomes critical. You need a hemorrhage cart already prepped, a plan of action and a support team that has trained together so you can act quickly.” The ALPQC is housed at the UAB School of Public Health, where Lora Ham, RN, MSNRN works in quality improvement and the Department of Health Policy and Organization. She has a very personal reason to champion the Obstetric Health Initiative. “When I was born, a doctor saved my mother and me from a hemorrhage that could have killed us,” Ham said.

Britta Cedergren, MPH, MPA

Lora Ham, RN, MSNRN

“We want to improve the odds for a good outcome for any mother in the state who finds herself in a similar situation.” The collaborative is putting together educational materials, training programs and resources that can be accessed online any time. They will be working with health care facilities and putting them in touch with each other to share ideas and collaborative efforts. “One of the problems we have in Alabama is access. We’ve lost so many hospitals, and quite a few hospitals no longer deliver babies,” Cedergren said. “That doesn’t mean they won’t find a woman with a high risk pregnancy coming into the ER in an emergency. We want to make obstetric hemorrhage training and

Brian Brocato, DO, FACOG

preparation available to those hospitals, too, so they’ll have what they need and know who they can call for support.” Brocato added, “We have the MIST program here at UAB to advise rural hospitals, and our OB/GYN specialists get calls from ERs around the state. Sometimes babies just won’t wait for a hundred mile drive to get to a neonatal unit, so the nearest hospital may be where the mother has to go.” Access to prenatal care is another challenge ALPQC is working to overcome. “Disparity is an issue,” Ham said. “Mortality rates and obstetric hemorrhages are more common in ethnic populations including black, native American and Alaska native. It’s hard to get prena-

tal care when you don’t have transportation or insurance and the doctor is 100 miles away. Many of these rural areas that are underserved are also the poorest. That also affects nutrition and how healthy the mothers are before they become pregnant.” Brocato said, “When people can’t afford insurance or healthy food, or to take time off work to drive a long way to see a doctor, we start to see the effects of diabetes, hypertension and other co-morbidities that are so common in our state. When it happens to a pregnant woman who doesn’t have access to a doctor until it is time to deliver, she is at a disadvantage in overcoming complications that might arise.” In addition to improving outcomes and reducing disparities related to obstetric hemorrhages, the ALPQC is sponsoring a second initiative in the year ahead to help newborns. “Preventing hypothermia in newborns is the focus,” Cedergren said. “When babies leave the warm womb, they can lose so much heat very quickly. Getting chilled puts them at risk for more problems. Strategies for keeping them warm will be part of the information we’ll be sharing.”

Birmingham Medical News

JANUARY 2024 • 7

A New Year’s Resolution: Update Your Compliance Program Based on New Government Guidance By: Howard E. Bogard, Esq.

While health care organizations are not required to maintain a compliance program, if an organization is For the year ending subject to a fraud investigaSeptember 30, 2023, federal tion or prosecution, having False Claims Act settlements an “effective” compliance and judgments exceeded program that is tailored to $2.5 billion, much of which the organization and used as came from the health care a “self-monitoring” tool may industry. The largest, at over Howard E. Bogard help reduce any penalties. $487 million, stems from a Beginning in 2024, the OIG will publish finding by a federal jury in Minnesota that industry specific compliance guidance for a provider of ophthalmic products viodifferent types of health care providers lated the Anti-Kickback Statute resulting and suppliers. Of note, the GCPG recogin the submission of 64,575 false claims nizes the growing prominence of private to Medicare. So, what is a health care equity in the health care industry and organization to do in order to minimize cautions that private equity firms should compliance risk? One prudent step is to “carefully scrutinize their operations and make sure your compliance program (you incentive structures to ensure compliance have one right?) is updated and effective. with the Federal fraud and abuse laws To help, on November 6, 2023, the Ofand that they are delivering high quality, fice of Inspector General (“OIG”) issued safe care for patients.” The GCPG can be a 91 page compliance reference guide for found at https://oig.hhs.gov/documents/ health care organizations, which contains compliance-guidance/1135/HHS-OIGcompliance advice, recommendations GCPG-2023.pdf. and guidance. The GCPG reiterates the OIG’s The OIG’s General Compliance view that an “effective” compliance proProgram Guidance (“GCPG”) is a usergram contains seven elements: friendly resource manual which applies to all individuals and entities involved in ELEMENT 1 Written Policies the health care industry. It addresses not and Procedures: only the seven elements of an effective This element includes a code of compliance program, but also provides conduct and relevant compliance polias a summary of the various fraud and cies and procedures to address common abuse laws that impact health care orgarisk areas, including billing, coding, sales, nizations, specifically the Anti-kickback marketing, quality of care, patient incenStatute, the Stark Law, the False Claims tives and arrangements with other health Act, the Civil Monetary Penalty Laws, the care organizations. exclusion authority statutes and HIPAA.

ELEMENT 2 Compliance

Leadership and Oversight:

This element includes appointing a Compliance Officer with defined responsibilities, a Compliance Committee (depending on the size of the organization) and establishing governing body oversight. ELEMENT 3 Training and Education:

This element includes annual compliance training for all owners, employees and certain contractors. Training should address the specific needs and risks presented by the health care organization. ELEMENT 4 Effective Lines of Communication:

This element includes developing and publicizing methods by which individuals in the organization may bring compliance questions or concerns to the Compliance Officer or other individuals in leadership. ELEMENT 5 Enforcing

Standards (Consequences and Incentives):

For a compliance program to be effective, a health care organization should establish appropriate consequences for instances of noncompliance, as well as incentives for compliance. Consequences may involve remediation, sanctions, or both, depending on the facts. Incentives may be used to encourage compliance performance and innovation. ELEMENT 6 Risk Assessment, Auditing and Monitoring:

Risk assessment is an annual process

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for identifying, analyzing and responding to risk. The compliance program should include a schedule of audits to be conducted based on risks identified by the annual risk assessment. Examples of routine monitoring of known risks include: monthly screening of the Federal and State Medicaid exclusion lists; regular screening of State licensure and certification databases; and annual review of the organization’s policies and procedures. ELEMENT 7 Responding

to Detected Offenses and Developing Corrective Action Initiatives:

An effective compliance program should include processes and resources to thoroughly investigate compliance concerns, take the steps necessary to remediate any legal or policy violations that are found, including reporting to any Government program agencies or law enforcement where appropriate, and analyze the root cause(s) of any identified impropriety to prevent a recurrence. The GCPG recognizes that compliance programs will likely be structured differently depending on the health care organization’s size and financial resources. The GCPG notes that “[s]mall entities, such as individual and smallgroup physician practices, or other entities with a small number of employees, may face financial and staffing constraints that other entities do not.” Among the recommendations for small entities, the GCPG suggests that: • Small organizations that cannot support a compliance officer on either a full-time or part-time basis should consider designating one person as the organization’s compliance contact and have them be responsible for ensuring that the organization’s compliance activities are completed. This person should not have any responsibility for the performance or supervision of legal services to the organization and, whenever possible, should not be involved in the billing, coding, or submission of claims. • Small organizations may provide compliance education through a variety of means, including during meetings, through email, on a website or through postings in physical or virtual common areas. • Small organizations should use user-friendly methods appropriate to their size and setting to facilitate communication about compliance concerns and potential issues. This may include: an explicit “open door” policy for personnel to raise concerns (CONTINUED ON PAGE 10)

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Birmingham Medical News

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Birmingham Medical News

JANUARY 2024 • 9

After Over 50 Years in Medicine, Andrews Turns Over the Reins, continued from page 4

Cain said, “One of the many things that makes Dr. Andrews unique is that he realizes that the patient has a lot of influence on how things go with their recovery. One of Dr. Andrews mantras is ‘the patient is always right.’ If a patient tells you that they’re ready, that they’re recovered from rehab, and are back to normal, you have to take them at their word sometimes. Dr. Andrews has always been on the forefront of letting patients and patient improvement determine how athletes get back to sports, instead of using the standard, book answer. He would let the patient’s own experience, fears, and their own abilities help decide when they are physically and emotionally ready to get back to playing their sport.”

Drs. Cain, Dugas, and Emblom are just a few of the doctors who have learned from Andrews. “Dr. Andrews has trained many of the best orthopaedic surgeons in the world,” Cain said. “Through his fellowship programs, he has trained more than 400 orthopaedic surgeons over the last 35 years.” “Dr. Andrews is a phenomenal mentor,” Emblom said. “Even today, he’s always available for his patients and for his fellow doctors. If we ever need anything, we can call him and he picks up the phone. Dr. Andrews mentorship is an important part of what we do, and he has done an unbelievable job at helping us at, in turn, become mentors to the next generation of orthopaedic surgeons.

Treating Chronic Pelvic Myofacial Pain With Light, continued from page 6

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chronic pelvic pain and muscle spasms in the pelvic floor. Photobiomodulation has been used for over 20 years to treat muscle conditions in other areas of the body. It results in increased production of ATP and a release of nitric acid. In addition to relaxing both smooth and skeletal muscles, it can reduce muscle pain, decrease inflammation and improve circulation and oxygenation. “We’re also hearing good things about how long the improvement in symptoms lasts from clinics in other states that have been using the system longer,” Childs said. “Their patients are reporting relief anywhere from 12 to 18 months.

Patients can follow up with additional treatments as needed. “As of now, insurance doesn’t usually cover this treatment. Our clinic is offering a series of nine treatments for around $2,000. “ In addition to helping with myofacial pain, we’re seeing good research data and anecdotal reports of improvements in other types of chronic pelvic pain. We’re hoping this will lead to an expansion in FDA approved uses, which in turn could lead to broader insurance coverage. It will make a huge improvement in women’s lives if they don’t have to live with chronic pain.”

A New Year’s Resolution, continued from page 8 with the compliance contact, the owner, or the CEO; the creation of a userfriendly process (such as an anonymous drop box) for effectively reporting erroneous, improper or fraudulent conduct; a policy indicating that there will be no retribution for reporting conduct that a reasonable person acting in good faith would have believed to be erroneous, improper or fraudulent. Precision Orthopedics

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• Small organizations should assess their compliance risks at least once a year. This includes an annual audit to identify potential risks, such as claims denials, recoupment of overpayments, challenges to medical necessity and patient safety data (e.g., fall rates, product return rates, complaints). • Small organizations should ensure that they have enforcement and disciplinary mechanisms in place before violations of compliance policies, government health care requirements or other applicable laws occur. When implementing a compliance program, small organizations should anticipate

that the program may uncover potential legal violations or other noncompliance. Small organizations should be prepared to designate someone, whether it is the compliance contact, an organization leader, or another designated employee, to determine whether a violation exists and the steps necessary to correct any problems.

An effective compliance program will assist health care organizations in decreasing errors, improving the quality of patient care and patient safety and preventing, detecting and addressing fraud, waste and abuse. The GCPG is required reading for all health care organizations seeking to address these compliance risks and provides easy to understand examples and helpful “tips” that highlight critical areas identified by the OIG. Howard Bogard is a Partner at Burr & Forman LLP and chairs the firm’s Health Care Practice Group. He can be reached at (205) 458-5416 or at hbogard@burr.com.

Multifidus Dysfunction: An Overlooked Culprit in Chronic Low Back Pain By Bradley S. Goodman, MD

offer crucial insights, revealing multifidus muscle deconditioning and guiding personalized rehabilitation plans tailored to individual needs.

Back pain affects millions globally, impacting daily lives and hindering mobility. While variRecognizing the ous factors contribute to Telltale Signs this discomfort, one often Multifidus dysfuncoverlooked culprit is multion manifests in various tifidus dysfunction. Deep Bradley S. Goodman, MD ways, from tightness and within your back, the mulpoor posture to herniated tifidus muscle plays a pivdiscs. Significantly, weakened multifidus otal role in spinal stability. Understanding muscles can compromise your entire this complex connection and exploring core, increasing the risk of low back pain innovative solutions is vital to managing and injuries. Identifying these symptoms chronic low back pain effectively. early is critical to effective management The Multifidus Muscle: and prevention. A Core Player in Back Health Embracing Innovations The multifidus muscle, located along for a Pain-Free Future the spine, facilitates essential movements, It’s imperative for individuals sufallowing your back to extend, bend, and fering from conditions like chronic low stretch. Its harmony with other core back pain to consider the array of availmuscles ensures spinal stability. However, able therapies. From traditional methods when weakened due to immobility, into innovations like ReActiv8 Restorative activity, or underlying health conditions, Neurostimulation, the options are exit compromises this stability, leading to panding, offering new avenues for relief. chronic lower back pain. Advanced mediThese advancements signify more than cal imaging techniques, like MRI scans,

just scientific progress. They represent healing for people seeking a pain-free future. By staying informed about innovative therapies, individuals can actively participate in their healthcare journey, making well-informed decisions that pave the way for a brighter tomorrow.

chronic low back pain in some patients. How ReActiv8 Works ReActiv8 involves the implantation of a sophisticated system that precisely stimulates the multifidus muscle’s medial branches. This precise neuromodulation allows patients to experience natural muscle contractions, promoting lumbar stability. With just 30-minute therapy sessions conducted twice daily, patients can manage their pain comfortably, and reclaim control over their lives.

Innovation in Pain Management: ReActiv8 Restorative Neurostimulation In the realm of pain management, ReActiv8 Restorative Neurostimulation, developed by Mainstay Medical, stands as a beacon of hope. This revolutionary therapy directly targets multifidus dysfunction, improving neuromuscular control, enhancing spinal stability, and reducing pain. What sets ReActiv8 apart is its focus on addressing the root cause, going beyond traditional palliative care to provide long-lasting relief for chronic low back pain sufferers. The uniqueness of ReActiv8 lies in its comprehensive approach. With over three years of clinical validation, this minimally invasive therapy has showcased remarkable results. Patients experience a significant reduction in pain, improved functionality, and even resolution of

Empowering Patients, Transforming Lives Raising awareness about multifidus dysfunction is paramount in the journey to manage chronic low back pain effectively. By delving into the underlying causes and embracing innovative solutions like ReActiv8, patients can regain control of their lives. With the power of knowledge and cutting-edge therapies, the path to a pain-free, active life becomes more apparent, offering hope to millions around the globe. Bradley S. Goodman, MD is a sports medicine doctor with OrthoAlabama Spine & Sports.

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Three Tips to Protect PHI While Promoting Your Healthcare Facility By Andrew W. Coffman & S. Blake Adams

Hospitals and medical clinics take wonderful care of patients, and every organization wants to celebrate the work done by its medical professionals. However, sometimes marketing and promotions can open health care providers up to HIPAA claims. As you consider publicizing the great work of your doctors and nurses, be sure not to disclose protected health information (PHI). On Nov. 20, 2023, the Department of Health and Human Services’ Office of Civil Rights (OCR) announced a settlement with a New York hospital relating to the disclosure of PHI in an article on the hospital’s response to the COVID-19 pandemic. The article contained photographs and information about the hospital’s patients. OCR determined the hospital disclosed three patients’ PHI to the Associated Press without obtaining written permission. This information had the effect of disclosing the patients’ COVID19 diagnoses, current medical status, prognosis and treatment plans. Based on this disclosure, the hospital agreed to pay

Andrew W. Coffman

S. Blake Adams

an $80,000 civil penalty and implement a corrective action plan, including drafting new written policies and procedures. OCR media guidance makes clear that covered entities cannot invite or allow media personnel, including film crews, into treatment or other areas of their facilities where patients’ PHI will be accessible in written, electronic, oral or other visual or audio form, or otherwise make PHI accessible to the media, without prior written authorization from each individual who is or will be in the area or whose PHI will otherwise be accessible. Before promoting your services

through the media, consider these tips: • Members of the media may access areas of health care facilities that are otherwise generally accessible to the public. • Any patient whose PHI is disclosed must sign a release before disclosure. • If a provider contracts with a media company to produce promotional materials that may involve the disclosure of PHI, in addition to any required patient authorizations, the provider must enter into a HIPAA-compliant business associate agreement with the media company.

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This agreement must ensure that the media company will safeguard the PHI it obtains, only use or disclose the PHI for the purposes provided in the agreement, and return or destroy any PHI after the work for the health care provider has been completed. As a business associate, the media company must comply with the HIPAA Security Rule and a number of provisions in the Privacy Rule, including the Rule’s restrictions on the use and disclosure of PHI.

Health care providers are important parts of our communities. The services offered by those entities should be widely reported. HIPAA allows covered entities to inform the media of their treatment services and programs so that the media can better inform the public, provided that, in doing so, the covered entity does not share individuals’ PHI without their prior authorization. Andrew W. Coffman and S. Blake Adams practice at Phelps where Coffman serves member of our Intellectual Property team, and Adams practices with the Health Care team.

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Renaissance of Regional Anesthesia Provides Benefits for Patients and Hospitals By martI weBB SLay

There is currently a renaissance in pain management that is improving pain scores and decreasing hospital stays, according to Chris Godlewski, MD, MSHA, Associate Professor in the UAB Department of Anesthesiology & Perioperative Medicine. “Now more than ever, anesthesiologists are in a position to make a positive impact,” Godlewski said. “With the advances in techniques and technology in anesthesia practice, we can do much more than just getting a patient through surgery safely: we can actually alter the trajectory of the operative and post-operative course. “For many procedures, it’s the pain that keeps patients in the hospital. Now we are able to intervene pre-operatively and perform nerve blocks or tailor-made anesthetic plans that shorten hospital stays. Depending on the situation, we can sometimes get high-risk patients or those with difficult airways through cases without having to put them to sleep. “In the seven years I’ve been at UAB, the regional anesthesia and acute pain management section has grown exponentially. When I started, there were days when we didn’t do any blocks. Now we could be doing 20-plus pain procedures in a day. We are favorably placed with the people and technology to do a lot of sophisticated perioperative procedures that can substantially impact the operative and post-operative course.” The terms ‘regional anesthesia’ or ‘block’ can refer to a variety of approaches to treat pain and/or provide anesthesia, including a peripheral nerve

Chris Godlewski, MD, MSHA

block. Medicine can also be injected into the spinal fluid to help with post-operative pain, and nerve block catheters can stay in place for days, allowing patients to be more comfortable following surgery. “From a hospital stay duration standpoint, another big source of dissatisfac-

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tion is nausea,” Godlewski said. “If we can do a nerve block and the patient doesn’t have to take as much opioid pain medicine, you can potentially cut down on nausea and other unpleasant side effects that opioid medications can cause, so it can be a far-reaching intervention. “In older days we did procedures that were very dependent on the state of the patient’s coagulation status, which is dynamic and can always change. We are now figuring out ways to better and more safely serve these patients. We are getting better at being able to offer a wide array of services to more people.” More anesthesia options and better pain management has benefits for both the patients and the hospitals. “There are surgeries that historically required patients to stay in the hospital, and now they no longer do,” Godlewski said. “That can alleviate strains on hospi-

tal systems, beds, and can allow medical staff to better address higher acuity patients and serve more citizens. It has long reaching effects.” Pain management on the whole, in concert with nerve blocks, has made tremendous advances. For example, trauma patients with broken ribs and chest trauma can be tricky to take care of because opioids ease the pain, but suppress respiratory drive. “This can result in a patient being intubated for longer than we would like. We have been trying to find interventions to help these patients, and so far, we have some promising possibilities to provide pain relief and potentially facilitate removing the breathing tube” Godlewski said. Reducing a reliance on opioid medications is important overall, particularly for patients who are recovering from addiction. “I had a gentleman a couple of weeks ago in solid recovery,” Godlewski said. “He didn’t want anything that could potentially jeopardize his recovery or cause a positive drug test. I offered to write a letter that he was having surgery, but if he had a positive test, he would be suspended while an investigation occurred. We got him through the surgery without giving him anything that would trigger a relapse or cause a positive drug screen. “Most folks in good recovery are well-educated about their needs and are up front about volunteering the information we need to tailor make an anesthetic to them. Usually one of those regional anesthesia techniques is the bedrock of that, depending on what the surgery is. “I often compare modern medicine to the iPhone. It’s moving along at such a blistering pace, that a year from now there’s a chance what we are doing right now may be on its way to obsolescence. It’s an exciting time to be practicing regional anesthesia and acute pain medicine.”

Job Board The place for Alabama healthcare jobs

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Children’s of Alabama Named Among Nation’s Best Employers Forbes Magazine recently released its 2023 list of America’s best employers by state, and it named Children’s of Alabama among America’s Best Employers. Children’s is one of only four hospitals and health systems in the state to make the list. Forbes partnered with statistics firm Statista to compile data from a survey of more than 70,000 U.S. employees. Survey participants were asked if they

would recommend their employer to potential new hires based on working conditions, diversity, compensation packages, potential for development and company image. Additionally, they were asked about their views about other companies in their industry. Employees were contacted online without the involvement of their employers, and responses were submitted anonymously.

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Canon Named President of UAHSF and Chief Physician Executive of UAB Health System Cheri Canon, MD has been selected as the next president of the University of Alabama Health Services Foundation, and chief physician executive of the UAB Health System. She will formally transition into the roles on May 1, 2024. With a career spanning 30 years at UAB, Canon has served as the chair of the Department of Radiology since 2011 and holds the Witten-Stanley Endowed Chair of Radiology. She is also the chief clinical integration officer for the UAB Health System. “It is an honor to serve as the next HSF president and UAB Health System chief physician executive, following Dr. Tony Jones and the foundation he has laid,” Canon said. Responsibilities of the HSF president include leading the development and implementation of the HSF’s strategies aligned with the strategic plans of the UAB Health System and the UAB Marnix E. Heersink School of Medicine, and developing and fostering effective relationships and collaboration with HSF Clinical

Sports Medicine & Orthopaedic Center

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Sight Savers America (SSA) has named Dawn K. DeCarlo, OD, PhD as CEO. This position was previously held by Jeff Haddox, who founded and led SSA for 26 years until deciding to retire. Prior to accepting the CEO role, DeCarlo was a member of the UAB Department of Ophthalmology and Director of the UAB Center for Low Vision Rehabilitation. Her research was focused on reading and pediatric vision impairment. DeCarlo and SSA had a long-term partnership that provided low vision evaluations and aids for Alabama children and adults with low vision. This partnership eliminated the backlogged need for visual assistive technology for Alabama children and continues to maintain this success. DeCarlo also played an important role in helping SSA develop its Low Vision and Blindness Program into a national model. Sight Savers America is an Alabamabased 501(c)(3) non-profit that identifies

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and secures treatment for unmet vision needs, from a first pair of eyeglasses to extensive sight-saving treatment and high-tech vision aids for those with severe low vision. SSA now serves the eye care needs of over 100,000 children and adults each year in 16 states. For more information, visit www.sightsaversamerica.org.

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Birmingham Medical News

JANUARY 2024 • 15

Non-Surg for Ad

GRAND ROUNDS

Fabricio Goncalves, MD is Honored Fabricio Goncalves, MD, a pediatric neuroradiologist at Children’s of Alabama, was recently honored by the Society for Pediatric Radiology with the Walter E. Berdon Award for the Best Clinical Research Paper. The paper, which appeared in Pediatric Radiology in 2022, investigated the role of apparent diffusion coefficient histogram metrics for differentiating pediatric medulloblastoma histological variants and molecular groups. Goncalves has specialized training in MRI and neuroradiology, having completed two fellowships at the University of Brasília. Additionally, he has pursued a Neuroradiology Fellowship at McGill University in Montreal and a Pediatric Fellowship at both SickKids in Toronto and the Children's Hospital of Philadelphia. His experience also includes four years

Fabricio Goncalves, MD

of Research Fellowship at the Children's Hospital of Philadelphia. He holds a European diploma in neuroradiology and pediatric neuroradiology. He has been with Children’s since August of 2023.

UAB Nurse-Family Partnership Awarded $8.8 million to Increase Maternity Care Access

NFP partners mothers in adverse situations with a nurse.

The UAB School of Nursing NurseFamily Partnership of Central Alabama (NFP) has received an $8.8 million Integrated Maternal Health Services grant from the Health Resources and Services Administration. The grant will fund the expansion of the NFP of Central Alabama to 27 additional counties in Alabama within the next five years. Established in 2017 as a branch of the national Nurse-Family Partnership, the program partners pregnant and parenting mothers experiencing adversity related to economic or social barriers with their own personal nurse. The grant will enhance NFP’s current services and increase access to maternity care in Alabama by fully integrating nurse-midwives into the care team and providing additional behavioral health and primary health care services. “The mothers who participate in our NFP program have better outcomes in preterm birth, breastfeeding and employment as compared to state and August Healthcare Ad.indd 1

16 • JANUARY 2024

8/11/23 10:25 AM

Birmingham Medical News

county averages,” said Candace Knight, PhD, director of the Nurse-Family Partnership of Central Alabama and associate professor in the UAB School of Nursing. “NFP moms also have quick access to mental health treatment should they need it and see improvement in mental health screening scores.” Program nurses connect mothers with vital resources ranging from prenatal care and nutrition to educational and career opportunities to achieve the best possible outcomes during pregnancy, postpartum and parenting. The program currently serves Jefferson, Walker, Winston, Fayette, Marion, Lamar, Shelby and Bibb counties. It has graduated 194 moms since 2020. The expansion of the program also provides training opportunities for undergraduate and graduate nursing students — including nurse midwifery students — as well as other health professions students.

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Birmingham Medical News

JANUARY 2024 • 17

New Sports Medicine Clinic at UAB The newly expanded Sports and Exercise Medicine Clinic at UAB is now open. Supported by the departments of Family and Community Medicine, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, this multidisciplinary clinic offers a full spectrum of sports and exercise medicine services, including non-operative and surgical sports medicine. The clinic will also offer multiple sub-specialties, including nutrition, orthobiologics, cardio sports medicine, exercise in pregnancy, and physical medicine and rehabilitation. UAB Sports and Exercise Medicine specializes in the evaluation, management, rehabilitation and prevention of injury and disorders in patients of all ages. The clinic offers cutting-edge sports science with the latest therapies and injury prevention programs not found anywhere else in the region, including its concussion, cardiac and exercise is medicine programs. It is the first site in Alabama to offer a new procedure for ACL repair that allows the body to repair its own ACL. The clinic is equipped with 22 exam rooms, two procedure rooms, two radiology and ultrasound suites, and an exercise room. The clinical staff includes physicians, care coordinators, certified athletic trainers, physical therapists, radiologists, psychologists, nutritionists and pedorthists who have years of experi-

ence treating high school, collegiate, professional and adaptive athletes. The new clinic is located at UAB Hospital-Highlands. To schedule an appointment, call 205-930-8339 or visit uabmedicine.org/sports. UAB Sports and Exercise Medicine works with athletes from multiple organizations, including UAB Athletics, Alabama Ballet, Birmingham Legion FC, Bulls Hockey, United States Football League, Vulcans Rugby, Birmingham United Soccer Association, Hoover-Vestavia Soccer Club and multiple local high schools. The newly expanded Sports and Exercise Medicine Clinic at UAB is now open. Supported by the departments of Family and Community Medicine, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, this multidisciplinary clinic offers a full spectrum of sports and exercise medicine services, including non-operative and surgical sports medicine. The clinic will also offer multiple sub-specialties, including nutrition, orthobiologics, cardio sports medicine, exercise in pregnancy, and physical medicine and rehabilitation. UAB Sports and Exercise Medicine specializes in the evaluation, management, rehabilitation and prevention of injury and disorders in patients of all ages. The clinic offers cutting-edge sports science with the latest therapies and injury prevention programs not found anywhere else in the region, in-

The clinic has 22 exam rooms.

cluding its concussion, cardiac and exercise is medicine programs. It is the first site in Alabama to offer a new procedure for ACL repair that allows the body to repair its own ACL. The clinic is equipped with 22 exam rooms, two procedure rooms, two radiology and ultrasound suites, and an exercise room. The clinical staff includes physicians, care coordinators, certified athletic trainers, physical therapists, radiologists, psychologists, nutritionists and pedorthists who have years of experience treating high school, collegiate,

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professional and adaptive athletes. The new clinic is located at UAB Hospital-Highlands. To schedule an appointment, call 205-930-8339 or visit uabmedicine.org/sports. UAB Sports and Exercise Medicine works with athletes from multiple organizations, including UAB Athletics, Alabama Ballet, Birmingham Legion FC, Bulls Hockey, United States Football League, Vulcans Rugby, Birmingham United Soccer Association, HooverVestavia Soccer Club and multiple local high schools.

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Princeton Renovated Surgical Unit EDITOR & PUBLISHER Steve Spencer

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In December, Princeton Baptist Medical Center held a ribbon cutting on the newly renovated 4West Surgical Unit located on the hospital’s fourth floor. The renovation process began in May of this year and includes new flooring, paint, redesigned bathrooms and showers in patient rooms and several other amenities. The approximately $3 million project was aimed at improving the patient experience and staff engagement at Princeton. The unit will be fully func“We are thrilled to see this renovation be completed,” said Princeton CEO Mike Rickman (2nd from left.) tional in early 2024.

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JANUARY 2024 • 19

You focus on patient care. We’ll focus on you. At the heart of one of the most highly regulated industries in the nation, health care facilities and providers face challenges that draw attention and resources away from their mission to provide quality patient care. Burr & Forman’s health care team works alongside you to address and anticipate your needs by providing preventative guidance and pragmatic solutions, enabling you to focus on providing care and achieving healthy outcomes.

Alabama Health Care Team

Birmingham | Mobile | Montgomery Jessie Bekker Howard Bogard Richard Brockman Kelli Carpenter Fleming

Jim Hoover Catherine “Cat” Kirkland Angie Cameron Smith

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