Birmingham Medical News July 2022

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Generations of Physicians Serve the Princeton Baptist Medical Center Community By marti weBB sLay

Princeton Baptist Medical Center in Birmingham’s west end is celebrating 100 years of service this year. As they commemorate providing healthcare to generations of Birmingham families, they also boast generations of healthcare providers. John L. Mathews, DMD, MD, FACS, general surgeon and director of Bariatrics, completed his surgical residency within the Baptist Health System. Following three years serving as a missionary in Haiti, he returned in 1985 to join Princeton, where he has helped build the surgery department for 40 years and kept it on the cutting edge. “The surgical residency program has been a major part of our service and ministry here,” Mathews said. “We

already had innovative surgeons when I joined. In 1990, we were among the first in the state to do laparoscopic cholecystectomy. We became a center of minimally invasive surgery, and we’ve done that MI approach for all kinds of surgery. With that same spirit, in 2010 we started doing robotics, and now we do most of our surgeries robotically. Baptist Health System/Tenet has been supportive in helping pursue minimally invasive robotic surgery to this day.” The medical center recently expanded the department with 16 new fully-integrated operating rooms. Mathews views providing care to the west end community through Princeton as a sort of calling. “It’s thanks to the hand of the Lord work(CONTINUED ON PAGE 5)

Over 30 years ago, Daniel Avery III, MD helped his father

Daniel Avery Jr., MD (left) with son Daniel Avery III, MD.

Thoracic Outlet Syndrome What to Look for and Expect By Laura Freeman

The patient had been in unrelenting pain for more than 20 of his 78 years. Despite multiple nerve blocks, rounds of physical therapy, visits to different doctors and a wide range of pain relievers and anti-inflammatories, nothing seemed to help. Even more discouraging, none of the imaging or testing could find anything likely to be the source of the pain. Finally, when a specialist couldn’t find any orthopedic problems, he referred the patient to David Whitley, MD at Vascular Institute of Birmingham for an evaluation.

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“In reviewing tests and talking with the patient about his history, it was soon clear that thoracic outlet syndrome was likely to be the root cause of his pain. An echo confirmed it,” Whitley said. After undergoing corrective surgery at Ascension St. Vincent’s Medical Center, the patient was so happy with the relief that he was asking how soon he could have the other side done when he was barely out of recovery. “Thoracic Outlet Syndrome often presents with symptoms similar to the pain of an orthopedic condition or the numbness of a neurological problem,” (CONTINUED ON PAGE 4)

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The Value of Community Health Workers By Jane Ehrhardt

“We’re different than anybody else,” says Trinita Ashford, MPH, executive director of ConnectionHealth in Birmingham. “We’re the only community-based organization in town that recruits, trains and employs community health workers.” The community health workers (CHW) at the nonprofit serve as messengers, supporters, and well trained resource guides for the area’s most vulnerable populations in Jefferson County and into the Black Belt region of rural Alabama. “The ideal recruit comes out of the community,” says Lynetta West, program manager. “They’re a trusted member and they’re familiar with that community.” Every recruit undergoes a lengthy training developed by ConnectionHealth in partnership with the UAB Diabetes Research Center and Department of Medicine, Division of Preventive Medicine. Based on a review of nationwide CHW certification and licensing programs, the 60-hour course includes lectures, selfstudy, simulations, and case studies. Once hired, the training advances into the field for another 20 hours of shadowing and in-service education. The more than 170 CHWs who have gone through this course so far emerged with skills ranging from moti-

family there and could vaccinate all the family members,” West says. The same situation was in play at Baby-Palooza where pregnant mothers were accompanied by their extended families at times. Educated by the trained and trusted CHWs, entire families were vaccinated. The CHWs also aim to teach people to advocate for themselves. That self-advocacy has been put into action in the nationally-recognized From Day One program created by the Jefferson County Department of Health. Through referrals from the county’s health centers and obstetric complication clinics, a community health worker gets paired with the pregnant women. “Our program is different from most,” West says. “This is not their first baby, and that sets us apart.” Additional children multiply the responsibilities on the expectant mother and complicates finding solutions. The CHW finds sources for anything from essentials and mental health counseling to childcare. “We’re not only focusing on the baby, we focus on the mom,” West says, by getting the mother thinking beyond the pregnancy. “When we leave, we want to make sure mom has set up a plan for moving on in life. Does she want a job? More education?” Her

ConnectionHealth holds training courses for community health workers.

vational interviewing to chronic disease management, conflict resolution, and client-centered counseling for behavioral change. “That’s why institutions, like UAB, partner with us,” Ashford says. “Because we can reach out and get information into the different communities.” During the height of the pandemic, ConnectionHealth partnered with MedsPLUS Consulting, which hosted vaccination clinics in areas with low vaccine

rates. “We provided CHWs for canvassing neighborhoods, registering people, arranging their second vaccine, and waiting with people,” West says, explaining how residents would more readily listen to the facts on the vaccine from the relatable CHW over the healthcare professionals. ConnectionHealth also partnered with Birmingham school system for inschool vaccination clinics. “The parents had to sign onsite, so we had the whole

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Thoracic Outlet Syndrome, continued from page 1 Whitley said. “It can go misdiagnosed for a long time until someone realizes that the lack of positive test results could be an indication that the source of the problem lies elsewhere.” Symptoms arise when spacing is too tight to allow adequate blood flow through the vein and artery exiting over the top rib in the clavicle area. It can develop on one side of the body or to a greater or lesser degree in both. Left untreated, symptoms can range from pain and numbness to the possibility of a blood clot if a vein is damaged, or rarely, an aneurysm if there is enough wear on the artery. “We can make any necessary vascular repairs when we do the surgery,” Whitley said. “In mild cases, physical therapy may be enough to stretch the space to offer some relief, depending on the individual anatomy. However, when

David Whitley, MD

patients can’t live with the discomfort any more, we start looking at whether surgery offers the best option.” To open up space for adequate blood flow during the surgical procedure, it may be necessary to remove a section of the top rib and possibly release some of the muscle tissue.

What causes thoracic outlet syndrome and who is most likely to develop the problem? “I’m seeing more young, athletic people lately, particularly those involved in sports that require a lot of throwing or repetitive motion,” Whitley said. “Occupational risks also include repetitive motion and carrying heavy loads can also contribute to the problem. If a person is involved in an accident, injuries to bone structures may change spacing. Basic anatomy and posture also play a role. People with sloped shoulders tend to be at higher risk.” Whitley is one of the most highly regarded vascular surgeons in the nation who performs the corrective procedure for thoracic outlet syndrome. He is also one of the busiest and finds this type of surgery especially rewarding. “Some of my happiest patients are

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those who have had thoracic outlet surgery,” he said. “The relief from pain makes such a difference. I just wish more practitioners would remember to consider whether it might be a possibility earlier in the diagnostic process so patients didn’t have to wait so long for the correct diagnosis and the relief it can bring. No one should have to live with pain when relief is available.”

A Thoracic Outlet Syndrome Patient Discusses Her Experience

Thoracic Outlet Syndrome relieved Sarah Beth Roberson’s shoulder pain.

When Sarah Beth Roberson was in high school and college studying to become an elementary school teacher, she loved being active and playing sports. “Then one day, out of the blue, I tried throwing a ball and a pain shot through me. I thought I’d torn or sprained something. I couldn’t even raise my arms without it hurting,” she said. She tried the usual locker room remedies for sports injuries, but nothing helped. So she made an appointment with a doctor and went through the usual treatments and medications. Physical therapy actually seemed to make it worse. Then, hoping to get to the root of the problem, she went to a sports medicine orthopedic specialist. “When nothing showed up on the imaging, I couldn’t believe it,” Roberson said. “Something had to be wrong, considering the pain I was in. The specialist said it might be Thoracic Outlet Syndrome, so he referred me to Dr. Whitley. My mom is a surgical nurse and she had worked on several procedures so she knew what it was. “It only took Dr. Whitley a couple of minutes to figure it out and the echo he ordered confirmed it. Then we talked about surgery. I was a little worried about having a scar with summer coming. He said he only needed a tiny incision and he had a special way of doing stitches so they didn’t show much. “It was amazing. Now you can barely see it. Best of all, my shoulder doesn’t hurt.”


Generations of Physicians, continued from page 1 ing here that we still have a hospital and ministry to serve this community,” he said. “Geographically, it requires much more effort to maintain a viable place in the community as we daily compete with UAB and Ascension for patients. Many of our patients come from this zip code.” He passed his commitment for service on to his son Winn Mathews, MD who is now a part of the senior Mathews’ practice. “I told Winn not to be a doctor,” said his father. “When he went to medical school, I told him not to be a surgeon. Now here he is, and he’s a very good one.” “I didn’t originally plan to join my dad’s practice,” Winn Mathews said. “Doors opened and closed, and as I progressed, the opportunity came along, and we worked well together

Value of Community Health Workers,

so we decided to continue. I’m glad it turned out this way.” Like his dad, he sees his work as a calling. “Princeton is more of a mission field,” he said. “It’s in an area of Birmingham that is underserved, with a lot of uninsured patients. We are here to help that population. We are blessed to be supported with the latest technology in robotics to help us take care of these patients better. “It’s become like a family with the people here. It’s a home away from home for us, and my family has been a part of it for years. It’s a great place to come and get well. It feels different from other hospitals because there’s a close-knit community.” Daniel M. Avery III, MD agrees. An orthopedic upper body and hand specialist, Avery is also a second-gener-

ation Princeton physician. “The main thing about Princeton is how friendly everyone is,” he said. “You walk through the halls and everyone speaks as you pass by. That warm family feeling that Princeton has is special and makes it unique amongst other hospitals in the area. “Although I didn’t work here at the same time as my dad, I have fond memories of Princeton from childhood. It was nostalgic to come back here. When I was probably six years old, I would come here before church while my dad went on rounds. He would take me to the doctors’ lounge, and I’d have a doughnut. Then we’d walk down the hallways that look similar today.” While the look of the hallways may evoke memories of time past, Avery is quick to point out how the hospital has

stayed up to date. “The updates they’ve done to the operating rooms are absolutely phenomenal. I work in several other institutions, but Princeton has amazing ORs, the staff is great, and we have wonderful teams. Princeton is the little diamond in the rough. Not everybody realizes how great the care here is. We really do an outstanding job of taking care of patients.” His dad agrees. When Daniel M. Avery, Jr. MD was considering moving his ob/gyn practice to Princeton in 1989, a cousin who had worked there for many years told him the hospital had survived all these years because they gave great patient care. “I found that to be the case,” he said. “The 100th anniversary attests to that.”

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CHW partner then helps her map out the necessary steps. That same pairing model is being used in a pilot program currently underway with UAB Hospital. The one-year effort pairs a CHW with an emergency room patient being discharged to increase post-discharge primary care visits, reduce 30-day hospital readmissions, coordinate social services for patients and provide ongoing support for self-management. “We also train for other people,” says Ashford. ConnectionHealth recently received a request from Prosper Birmingham, a workforce development program, to recruit and train 25 of their participants in community health worker skills. “They’re also going to learn computer skills from another organization, then do a four-month internship, then hopefully be placed with a job,” Ashford says. Primarily, ConnectionHealth receives requests to deploy CHWs for programs from the healthcare community. Those requests are growing. Recently, Alabama Department of Public Health in Montgomery requested a proposal for more than 80 CHWs. “They have funded organizations that will have CHWs, and they want the same group to train all those CHWs,” Ashford says. In some states, CHWs can earn official certification and insurance covers certain services performed by them. Twenty years ago, Ashford says, it was quite different. “We called them lay health advisors, and they were all volunteers,” she says. “Now they’re called community health workers, and it’s a career nationwide.”

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Birmingham Medical News

JULY 2022 • 5


IT FOCUS

Email as a Doorway to Breaches By Jane Ehrhardt

practice on an email to you is enough.” In 2020, when hackPractices risk violating ers began intensely targetthe PHI regulations even ing healthcare, providers when the billing department accounted for 79 percent of emails the front desk a list of all breaches in the healthcare patients coming in that week field, according to Fortified with a balance due. “They Health Security. “Today, more think they’re sending that Brian Driskill and more of those breaches are information within the pracbecause of protected health information tice, but if someone outside gets into that in email,” says Brian Driskill, president of email account, it is a breach,” Driskill says. Jackson Thornton Technologies. Safeguards lie beyond utilizing Email has become a forgotten complex passwords. But that’s a start. source of risk. Healthcare has traditionImplementation of multifactored authoally focused their security assessments rization, which requires the additional and protection protocols on the bulk lostep of inputting a code sent by phone or cation for protected health information fob, adds a more robust protection layer. (PHI), their electronic medical records. “If you just did those two things, you’ve But email can not only serve as a path gone a long way,” Driskill says. “Multifacto that cache of PHI, it can also be an tored authorization would have stopped unsecured carrier of it. “If somebody the breaches I’ve seen.” gets in your email account, and there is Because users tend to present the even one email with protected health ingreatest email vulnerability, practices formation, it is a breach,” Driskill says. should hold quarterly mock trainings that At one clinic, the staff would email the can be as simple as sending staff a video daily patient schedule to various departon what not to fall for in emails, followed ments in the office without a thought of by a test. At Driskill’s firm, staff must parthat list being PHI. “If a patient is named ticipate or lose network privileges. in an email that can be identified as going “Ask yourself if each person needs to that practice, it is a breach,” Driskill an email account,” Driskill says. Consays. “Just having the signature of that sidering EHR systems tend to allow for

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internal messaging, many positions, especially clinical ones, may not require access to email. “If you do limit email, be really careful those people don’t start using their personal email account on the network,” he says. Banning the use of or access to personal emails on the network avoids trouble when the staffer leaves the practice, since they had access to patient information and can still continue to receive privileged email. “We see that with doctors on their laptop,” Driskill says. “Prohibiting personal emails needs to become written policy. Then if it causes a breach, you can prove the staff member violated policy, and you have at least protected your organization to some extent.” Practice policies should also delineate what content and types of emails should be encrypted along with how long emails are to be stored on the system. “I suggest that practices shouldn’t store emails more than a year,” Driskill says. “That way, if a hacker gets in, you’ve only exposed one year of information instead of ten.” If the organization uses Microsoft 365, it can add layers of data loss protection by upgrading the license level or with the new extensive Microsoft Purview solution, which combines Microsoft 365 compliance with the former Azure Pur-

view. The tool identifies, monitors, and automatically protects data according to guidelines input by the practice. Then, for example, when someone attempts to share medical information in an email, the tool can pop up an alert, present options, and even block the action. Smaller practices tend to underestimate the importance of written policies for governing email and protecting their business. “People tend to follow policy, but if you don’t have it, they don’t know what they should and shouldn’t be doing,” Driskill says. “If you don’t state what is accepted and tell your employees this is our policy, it’s the wild west.” If a breach occurs, written policies serve as the guidebook, which should include an incident response policy. “Just knowing what you’re going to do, who you’re going to call for forensics, and how to even determine whether a breach occurred should be part of your policies,” Driskill says. The cyber insurance company may be the first call to make, as coverage may include forensics and guidance on handling compliance protocol correctly. “Defending against a breach relies on written policies you put in place per HIPAA guidelines,” Driskill says. “The people who haven’t dealt with the risk will have the bigger problems.”


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JULY 2022 • 7


IT FOCUS

Cyber Insurance Becoming Harder to Renew By Jane Ehrhardt

cess to data or a workstation, which generally involves enIn healthcare, the numtering a password and then ber of people affected by a a code that is sent to their data breach has tripled since phone. 2018. “This is primarily be“MFA is pretty easy to cause healthcare attackers get implement and it’s free,” all the pieces of information Woods says. “However, many they want in one place,” says healthcare professionals reAaron Woods with Dynamic Aaron Woods with Dynamic Quest sent the time it takes for the Quest. Data handled at most extra step throughout their healthcare entities not only includes day, so clinics put off installing it. But incredit cards, but email addresses, date of surance companies know if that you’re birth, social security number, insurance doing MFA, the chance of you getting information, and health information. breached is less than one percent. With this explosive rise in attacks, insur“Three weeks ago, a salesperson at ers that provide cyber insurance have bea client that had not implemented MFA come more cautious and thorough in their got hacked through his mailbox. The renewal requirements. 2022 renewal applimalware forwarded every email to the atcations ask applicants many more questions tacker. The hacker then generated a fake regarding their system security protocol email impersonating a vendor, asking for than in previous years. In fact, according to their payment of $330,000 to be wired to Woods, with nearly 80 percent of the questheir new bank, and the salesperson did.” tions, clients have to answer “no.” Knowing the reliable protection The two big reasons for being dethat one extra step adds, cyber insurnied during the annual renewal are a ance renewals have become adamant lack of user awareness training, which about MFA being used for specific acinvolves unscheduled simulated phishing counts. “If cyber insurance does not attacks with employees, and multifactor renew, most all the time it’s because of authentication (MFA). questions about MFA on privileged acMFA requires users to verify their counts,” Woods says. These accounts reidentity in at least two forms to gain acquire administrative-level credentials to

access. Larger entities are often expected to invest in software to specifically track those accounts and auto generate new passwords on a weekly or daily basis. Woods knew of one healthcare entity that needed to implement MFA along with higher-end scanning of their internal software and an insurgent-prevention device that uses artificial intelligence that can shut down traffic automatically, but they refused because of price. They got hacked, and it closed them down for four days. “They still didn’t sign off on what they needed,” Woods says. “Unfortunately, six weeks later, they got hit again by the same group. After that, they made the changes. They have been running that same security for three years and not had any issues.” The area where healthcare regularly falls short on their cyber insurance requirements relates to third-party vendors. Specialty practices are specifically vulnerable with hosts of state-of-the-art devices that tap into their network to integrate with their EHR, such as for imaging and monitoring. Vendors for that equipment regularly require access to the network to support their software and perform upgrades. “We see time and again, where clinics give them unattended access to get into the system

without disabling vendor accounts when they’re finished. There should be no open door access,” Woods says. “And business associate agreements do not compensate for security measures when it comes to gaining cyber insurance coverage.” Woods says there is no reason to think the trend in escalating cyber attacks will lessen. “This has been the story for the last five years,” he says. “You think you’re not going to get hit, but essentially everybody has probably been exposed and just not known it.” As a result, cyber insurance requirements will continue to become more stringent. Hackers now burrow in behind the scenes looking for the cache of data and spend months not doing anything malicious. Then they forklift all the accounting data and medical records through legitimate software used in everyday tasks, like email, and sell the data. “That can be stopped with good internal auditing software that monitors activity on the network. It would trigger an investigation of that data movement,” Woods says. With the goldmine of data now available through healthcare facilities, cyber insurers are shifting their security requirements ever closer to the level of the banking industry. “Healthcare data demands the highest prices on the dark web,” Wood says.

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JULY 2022 • 9


Empowered By Heersink Gifts, UAB and Canadian University Join Forces By Laura Freeman

If there is a textbook example of a combination being more than the sum of its parts, here is a prime case in point. The allied efforts of UAB Heersink Medical School and McMaster University’s Michael G. DeGroot School of Medicine are set to turn the two research centers into next level powerhouses of innovation and expertise in global health. “We’re seeing so much enthusiasm for working with our counterparts at McMaster. They are a great partner for us,” UAB Provost and Senior Vice President for Academic Affairs Pam Benoit, PhD, said. “Both universities are well known for health sciences, education and research, and both have strong records of innovation. There are a lot of commonalities that can be leveraged to benefit both, as well as resources that are complementary. “Through campus visits and discussions, we’re getting to know each other, and identifying areas that offer good opportunities for teamwork. We hope to set up student and faculty exchanges so we can learn from each other. One of the key

Mary & Dr. Marnix Heersink

Alan Tita, MD

steps will be matching the research interests of our investigators and connecting them with their McMaster counterparts so they can start exploring areas where their work can benefit from an exchange of expertise. “The $95 million gift from Dr. Heersink to UAB will be transformational. It is the largest donation ever to a university in Alabama. This will allow us to advance in areas where we already had presences, such as biomedical innovation and global health initiatives, and take them to the next level. We are so grateful for his generosity and for introducing us to the wonderful partnering opportuni-

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ties with McMaster.” Born in the Netherlands and educated in Canada, Marnix E. Heersink, MD and his wife Mary moved to south Alabama where he set up an ophthalmology practice. “All six of our children went into health professions, and five of them studied at UAB,” Heersink said. “It’s a great privilege to be in a position to help other people. Medicine is my vocation and I’m still a practicing eye surgeon, but it was through my entrepreneurial work that I built the resources that give me the opportunity to help others. “GIVE is an acronym that guides

John Kelton MD

my thoughts in charitable donations. G is for gratitude. I’ve been fortunate. I is for investment and inspiration. When I give I also consider it an investment in other people, and I hope the example also leads others to give when they can. V is for vision and values. I look for opportunities that line up with what I hope the gift will achieve. E is for excellence. I want what I give to have the potential to create something excellent.” In addition to the Marnix E. Heersink Institute of Biomedical Innovation, the Heersink donation also supports expansion of global health efforts (CONTINUED ON PAGE 12)

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3/14/22 3:17 PM


Legal Issues to Keep in Mind Before Making the Switch to Concierge Medicine By: Kelli C. Fleming and Jessie Bekker

Getting in to see your doctor is not always as easy as picking up the phone. Often, there is a several-week-long wait for an opening, and the doctor your insurer covered last year may no longer be in-network this year. That is where concierge medicine comes into play. Often termed “direct to consumer” or “direct primary” care, concierge medicine is leaving behind the paperwork and roadblocks tied to insured care and offering primary care and preventative services to individuals at flat membership rates. For patients, the model comes with benefits like 24/7 access to a physician and same-day or next-day appointments. Some clinics offer family membership rates in addition to individual rates. Often, services extend beyond the typical office visit to include fitness evaluations and personal vitamin need analyses. For those seeking holistic care at a predetermined rate, the concierge model can be incredibly attractive. Clinicians find benefit in the model, too. In Alabama, some physicians have left their insurance-based practices for

Kelli Fleming

the promise of more time with a smaller subset of patients. Even some institutions are getting in on the concierge medicine game, developing clinics under their organizational name that operate on the membership model. Still, there are important legal considerations for physicians and physician practices considering entering the concierge medicine industry to ensure compliance with federal and state laws. Consider whether to opt out of Medicare. Some concierge models will continue to bill Medicare for patient care, especially for services the monthly annual fee does not cover. In that case,

physician practices should be aware that it is against the law to charge Medicare beneficiaries a membership fee for services already covered by Medicare, and violation of federal Medicare requirements can result in civil monetary penalties and exclusion from Medicare and other federal health programs. Thus, concierge practices should take precaution when determining which services it offers as part of the concierge package, as anything covered by Medicare should not be included. For example, paying a membership fee for access to a certain provider (who participates in Medicare) would not be permissible. Practices that, instead, choose to opt out of Medicare can avoid some of the hassles of delineating covered from non-covered services. Still, there are some requirements for opt-out practices too, including that the physician must include certain mandated provisions as part of their private contracts with Medicare beneficiaries. For some physicians, opting out of Medicare is a financial consideration, as Medicare accounts for a significant portion of reimbursements in many practices.

Enter into contracts with patients detailing the services provided and the cost. Contracts with patients should clearly list the services provided by the practice under the membership fee, and should include a list of services not covered by the fee. Contracts with patients should also include details regarding payment, including the amount owed, the date it will come due, and the cost of services not covered by the membership fee. If the practice plans to bill insurers, including Medicare, the contract should include information about what services will be billed, billing practices, and the procedures followed. The contract should include termination provisions, term length, and renewal guidelines. Importantly, the contract should be drafted in clear and simple language and signed by patients voluntarily and with full understanding of the terms of the arrangement. Other federal and state laws still apply. Even though concierge medicine provides the benefit of not having to bill insurers, other laws and regulations may still apply. For example, (CONTINUED ON PAGE 12)

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Empowered By Heersink Gifts, continued from page 10 through the Mary Heersink Institute for Global Health. As an international food safety advocate, Mary took up the fight against food borne illnesses shortly after their seven-year-old son spent more than six weeks in intensive care during an e coli outbreak. She has testified before Congress and served on boards fighting food borne illnesses in Canada, the Netherlands and India. “The institute and funding will allow us to ramp up our global health initiatives,” said Alan Tita, MD, PhD who serves as the Associate Dean for Global and Women’s Health at UAB. “McMaster also has a strong global health background and they are working toward offering a PhD program in global health. We hope to build on their experience. One of our initial ideas for partnering is to put together a joint symposium on global health in an international setting within the next few years.” As the hard lessons of the pandemic have shown, health problems anywhere can affect health everywhere. “Once vaccines became available, delays from infrastructure and supply lines became obvious. McMaster’s global health program identified the same vaccine hesitancy problems we saw in other countries and here at home. We need to find solutions for these problems as soon as possible before we are challenged by

12 • JULY 2022

Birmingham Medical News

other outbreaks,” Tita said. UAB’s past initiatives have included work in Zambia, Cameroon, Uganda and other parts of west and east Africa as well as Latin America. “With McMaster, we hope the Institute will soon be collaborating on projects in India, Thailand, Sudan and other countries,” Tita said. “Cross pollination of ideas has long been recognized as a major stimulus for creativity,” said Rubin Pillay, MD, Associate Dean for Health Innovation at UAB. “With UAB and McMaster working together, we have two tier-one partners with similar strengths. Another major strength is how we’re different. The partnership gives us a wider base of resources. For example, UAB’s School of Engineering and bioengineering program can be helpful to McMaster in developing and testing new products. “We also have very different patient populations. Birmingham has a higher African-America population than most cities, and McMaster is situated in an area with more people who have an Asian or India subcontinent background. Both schools have solid backgrounds in clinical testing. The difference in populations will allow us to test how a new medication performs across a broader genetic background. Testing across more diverse populations is something pharmaceuti-

cal companies and the FDA have been requesting, and we are well-positioned to fulfill that objective.” From the Canadian side of the collaboration, John Kelton, MD, who is the Executive Director of McMaster University’s Initiative for Innovation, said: “McMaster and UAB are well-matched for partnering. Both are highly regarded for cutting edge research. They are about the same size, so it is a match of equals. Our strengths and resources complement each other, and both are located in cities that have evolved from industry-based to knowledge-based economies.” A friend of Dr. Heersink since medical school, Kelton was involved in some of the early discussions on funding collaboration between the two universities. “Dr. Heersink is an eye surgeon by profession, but he has always had a talent for entrepreneurship,” Kelton said. “He started out with a paper route as a child, renovated a house in medical school, and went on from there. That’s probably why he wants innovators to have the opportunity to learn to be entrepreneurs. It’s important to him that the economic benefits of new ideas flow to those who create them, the institutions that help develop them and the local economies where healthcare innovators and their patients live and work.”

Legal Issues to Keep in Mind, continued from page 11

physician practices may still be subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its privacy provisions if they are engaging in “standard transactions.” Alabama laws regarding the practice of medicine also still apply, including scope of practice and licensure rules and regulations. Finally, physicians should check the American Medical Association’s guidelines for ethical practices. The concierge care model has the opportunity to benefit both physicians who are seeking to provide deeper-level care for patients and patients who want greater access to and attention from their primary care physician. However, as concierge care becomes more prevalent, it is important to structure these practices and the arrangements with patients in a legally compliant manner. Kelli Fleming is a Partner at Burr & Forman practicing exclusively in the firm’s healthcare practice group. Kelli may be reached at (205) 458-5429 or kfleming@burr.com. Jessie Bekker is a law student who attends St. Louis University.


DOJ is Not Slowing Down its Pursuit of COVID 19–related Fraud By JD Thomas and Andrew Solinger

Rarely does a day go by without the Department of Justice announcing an investigation, indictment, plea or conviction in cases involving COVID-19 fraud schemes. In June, a federal jury convicted a Michigan man for a wire fraud and money laundering scheme to obtain more than $4.1 million in Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDLs) guaranteed under the Coronavirus Aid, Relief, and Economic Security (CARES) Act by the Small Business Administration (SBA). Also last month, eight defendants were charged with fraudulently obtaining more than $7 million in PPP loans, EIDLs and pre-pandemic Small Business Administration (SBA) loans. These cases, however, are comparatively small potatoes compared to the DOJ’s recent announcement that it is pursuing criminal charges against 21 defendants in nine different federal districts in connection with the defendants’ alleged involvement in fraud schemes arising out of the COVID-19 pandemic. The DOJ claimed this alleged fraud resulted in a total of $149 million in false and fraudulent charges to federal programs and federally funded pandemic assistance. The alleged fraud schemes included: • Collecting patients’ personal identifying information and fluid samples through COVID-19 tests and using the information and samples to submit false claims for unrelated, medically unnecessary tests or office visits that did not occur. • Exploiting COVID-19 related policies that the Centers for Medicare and Medicaid Services (CMS) implemented to increase access to telemedicine by billing for telemedicine sessions that did not occur and ordering unnecessary genetic testing in exchange for telemedicine patients. • Misappropriating financial assistance intended for frontline medical providers from the Provider Relief Fund. • Manufacturing and distributing fake COVID-19 vaccination cards. At the same time, CMS’s Center for Program Integrity also announced that it has initiated 28 administrative actions against providers, asserting fraud, abuse and waste schemes related to the provision of COVID-19 care and other allegedly opportunistic schemes. These moves come nearly a year after U.S. Attorney General Merrick B. Garland created the COVID-19 Task Force to “marshal the resources of the

You handle Healthcare. We handle Healthcare Technology. Department of Justice in partnership with agencies across [the] government to enhance enforcement efforts against COVID-19 related fraud.” Some of the earliest PPP fraud cases involved schemes that amounted to little more than the simple theft of pandemic relief funds. Citing the federal government’s efforts to provide critical relief to offset the economic impact of the pandemic and the potential for relief programs to be abused, Attorney General Garland said, “The Department of Justice will use every available federal tool—including criminal, civil, and administrative actions—to combat and prevent COVID-19 related fraud.” As Task Force Investigations progress, healthcare providers should anticipate an increase in government enforcement actions related to fraud associated with COVID-19 activities. We expect DOJ to focus on schemes that involve personal protection equipment (PPE), including the unauthorized distribution of PPE, Paycheck Protection Program loans, including the improper receipt of PPP loans, misuse of PPP loan funds, and the submission of false statements in PPP loan applications, and Provider Relief Funds, including improperly retained or calculated Provider Relief Funds. Due to the expected increase in enforcement, healthcare providers would be wise to carefully review their billing practices for any COVID-19 care, including telemedicine, and track their receipt or use of any pandemic-related financial assistance. Providers should also consider putting protections in place to ensure that COVID relief funds are not diverted or misused, lest they find themselves the target of what we can expect to be a growing list of investigations, prosecutions and convictions published each week by the Department of Justice. JD Thomas is a partner at Waller and a former federal prosecutor. He advises healthcare clients in government investigations and prosecutions, qui tam and False Claims Act defense and other enforcement actions. Andrew Solinger is an associate at Waller where he assists clients in responding to investigations, audits and other inquiries brought by federal and state government agencies and regulators.

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Easing the Toll of PTSD for Military Veterans Only 10 VA facilities offer the game changing SGB procedure By LYNNE JETER

A shot in the neck has proven to be a much needed reset for military veterans suffering from post-traumatic stress disorder (PTSD). Veterans who have received the treatment – Stellate Ganglion Block (SGB) – call it “a godsend,” “a gamechanger,” with one confessing after learning about the procedure: “I’m bawling. Hope came back.” Used for decades to treat chronic pain, SGB has only recently been tried for PTSD on veterans. The treatment gained interest after the VA realized its impact on countering suicide, which has become an epidemic, affecting roughly 20 veterans a day. However, only 10 VA clinics across the U.S. offer the breakthrough procedure that has a Stellate Institute published success rate of 85 percent. “This treatment is moving at a snail’s pace,” said Lance Price, a veteran, and director of the Florida chapter For the Love of a Veteran, Inc. “I’m not sure why, but if we had to guess, it would be because SGB isn’t considered an established first-line treatment for PTSD at this time because the evidence is not conclusive.” The procedure is typically completed in the pain clinic of a VA facility and may

require a referral from psychiatry. However, because so few VA centers offer the treatment, veterans may have to search for help elsewhere. For example, in Florida Richard Gayle, MD, a pain management specialist, offers the treatment. Financially strapped veterans who need to access care outside the VA may receive assistance via For the Love of a Veteran, which covers the medical costs for SGB shots. Lance Price, who received SGB treatment in October 2021, said: “my flashbacks, night terrors, insomnia have dramatically decreased. The SGB has given me a quality of life that I haven’t had since 2007. After the injection I slept 15 hours. I woke up refreshed like a cloud had been lifted or I literally was rebooted. If nothing else, the SGB treatment has given me the opportunity to get closer to my friends and family without constantly thinking about the worst-case scenario.” While Price hasn’t needed a second SGB shot, many veterans do. SGB is not perceived as a miracle drug and may not work for all patients, many of whom may need multiple shots to receive continuing benefits. Shay Seaborne, CPTSD, has had five SGB procedures. “I find great relief with each,” he said. “Unfortunately, my

trauma is severe and complex, so the relief only lasts a couple of weeks. But each shot builds on the last, so I hope this will help me reclaim my nervous system.” Marine Sgt. Henry Coto, who spent months patrolling war-torn Iraqi towns, and self-medicated post-military with alcohol and marijuana, had a dozen medications that didn’t help before SGB helped relieved him of his PTSD symptoms. Sean Mulvaney, MD, who administers SGB treatment, said: “These people wrote a blank check to their nation that included their life. As citizens, we need to help them when they come home.” In the meantime, researchers are working to pinpoint changes in the brain associated with PTSD. The newest theory is based on research that shows PTSD isn’t only psychological. Repeated

exposure to bomb blasts and the protracted stress of hazardous re-deployments may cause physical changes to the brain, making it hyperactive, according to Michael Alkire, MD, general anesthesiologist at UCI Medical Center in California. He noted that post-treatment, four of five veterans reported relief from depression and suicidal thoughts. “There are very few things in medicine that work that quickly,” he said. “At this time, we need to do more conclusive studies to prove what this treatment is truly capable of doing.” He encourages veterans to never stop fighting for the life-changing treatment just as diligently as they never stopped defending the U.S. “If one treatment doesn’t work, find another. The answers are out there for everyone to have a successful and fulfilling life. Never give up.”

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St. Vincent’s Chilton and UAB Enter Telemedicine Partnership

UAB Operations Center for remote consultations. Ascension St. Vincent’s Chilton has partnered with UAB Medicine to bring a tele-critical care unit and tele-stroke unit to Chilton County. The remote consultation sessions will take place from an operations center located at UAB Hospital. UAB specialists will connect via video into hospital rooms to conduct remote exams of patients and work with St. Vincent’s care teams to develop a treatment plan. UAB will continue to monitor the patient each day as needed while they remain in St. Vincent’s care. When patients come to St. Vincent’s Chilton emergency department presenting with stroke-like symptoms, the team will utilize the tele-stroke program to request an on-demand stroke consult. One

of UAB’s responding neurologists will assess the patient using the NIH stroke scale and a physical exam, assisted by the onsite emergency room physician or nurse. The neurologist will review the patient’s CT scans and provide a recommendation based on their assessment. St. Vincent’s Chilton will then provide inpatient care in their hospital or transfer the patient to the appropriate level of care that is needed. Access to health care is limited in many of the state’s rural counties, a situation that telemedicine programs can help alleviate. St. Vincent’s Chilton is one of 10 hospitals to join UAB’s tele-critical care program and one of 20 hospitals to join the tele-stroke program.

Nurse-midwifery Program Returns to UAB The UAB School of Nursing is bringing back Sharon Holley, DNP the nurse-midwifery specialty track in its Master of Science in nursing program. It is the only nurse-midwifery pathway offered in the state, and one of only a few offered in the southeastern United States. UAB will admit its first cohort of students to the nurse-midwifery track in fall 2022. Students will be equipped to manage the obstetrical and gynecological care that make up women’s reproductive health, as well as the care of their infants in the first days of their lives. “The first goal of bringing back this program is to increase the workforce of nurse-midwives in Alabama in order to improve perinatal outcomes,” said Sharon Holley, DNP, associate professor and Nurse-Midwifery Pathway director. Alabama has one of the highest rates of adverse perinatal outcomes in the country, including low birth weight and preterm birth, according to data from the March of Dimes. Additionally, only onethird of the state is categorized as having adequate access to maternity care.

Suzanne Pugh Named Chief Operating Officer of Walker Baptist In May, Walker Baptist Medical Center (WBMC) named Suzanne Pugh as its Chief Operating Officer. Pugh previously served as the hospital’s associate Suzanne Pugh

administrator. “With more than 20 years of proven and successful healthcare leadership, Suzanne is certainly deserving of this advancement,” said Walker Baptist Medical Center CEO, Mike Neuendorf. “I am excited for this opportunity to grow in my career at Walker Baptist Medical Center,” said Pugh. “I look forward to continuing to work with our employees and physicians as we strive to provide quality, compassionate care to our patients.”

Staff Changes at the Jefferson County Medical Society After 38 years of service, Juanita Pruitt is reJuanita Pruitt tiring from the Jefferson County Medical Society (JCMS). She has undertaken many roles including Membership Director; Administrator of the JefMegan Franks, ATC, MSHA ferson County Ob-GYN Society, the Jefferson County Pediatric Society and the Alabama Society of Plastic and Reconstructive Surgeons; Executive Assistant; and Answering Service Billing and Accounts Receivable Manager. Megan Franks, ATC, MSHA has joined JCMS where she will serve as Membership Director/Administrative Assistant. She received her Bachelor of Science in Athletic Training from the University of Alabama and her Master of Science in Healthcare Administration from UAB. She has worked as an Athletic Trainer, Clinical Coordinator, and Surgery Coordinator before joining the Society.

Bradford Health Services Acquires The Estate at River Bend Bradford Health Services, the southeast’s largest substance use disorder treatment provider, has acquired The Estate at River Bend, a Mississippi-based substance use disorder treatment facility that has been in operation since 2018. Located near the Mississippi Gulf Coast, the 108-acre campus features an onsite detox facility, residential cottages, fitness center, and amenities for nature-based experiential therapies. With this acquisition, Bradford now offers services through 40 facilities across Alabama, Arkansas, Mississippi, North Carolina, and Tennessee.

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Care Clinic when it opens later this year. Until then, he will see patients in the Cullman Regional Multispecialty Clinic.

CU2RE Primary Care Pipeline Program Address Primary Care Shortage in Underserved Areas The UAB Comprehensive Urban Underserved and Rural Experience (CU2RE) program has launched the CU2RE Primary Care Pipeline Program. The program aims to increase the preparedness of undergraduate students from medically underserved and rural communities in Alabama and neighboring states to successfully enter medical school and pursue a career as a primary care physician. According to the Health Resources and Services Administration, 62 of Alabama’s 67 counties have a shortage of primary care physicians. To maintain current rates of utilization, Alabama will need an additional 612 primary care physicians by 2030, a 23 percent increase compared to the state’s current 2,646 PCP workforce, according to the Robert Graham Center. The program admitted its first cohort last month, welcoming 13 undergraduate students who are interested in careers in medicine. The program is open to sophomores and juniors who are enrolled in a fouryear degree program and interested in applying to medical school. After being accepted into the program, students will be able to access the tools needed for a successful medical school application, such as opportunities to tour medical facilities and shadow primary care providers, educational experiences and guided discussions, mentorship from current medical students, and more.

Brookwood Baptist Health (BBH) names Mia Mothershed as its new Group Marketing Director for the five-hospital healthcare system. With over 20 years of experience, Mothershed comes to BBH from Jackson Hospital and Clinic in Montgomery, where she led internal and external communications, media relations, digital marketing and reputation management for the health system. “I am excited about the opportunity to serve this amazing team of healthcare professionals,” she said. “I look forward to elevating the message about the amazing work they are doing.” Mothershed holds a dual degree in Communications and Business from Alabama A & M University and an MBA from Auburn University Montgomery. Mia Mothershed

St. Vincent’s Files Plan for Freestanding ED and Clinic in Pelham Ascension St. Vincent’s has asked for state approval to build an ambulatory center to include a freestanding emergency department, along with space for St. Vincent’s and UAB Medicine to offer primary and specialty care services. The site for the new facility is located off Interstate 65 at exit 242 in Pelham. More than 40 local leaders have submitted letters of support for the project to the CON Board.

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GRAND ROUNDS

EDITOR & PUBLISHER Steve Spencer

Thurston and Williams-Davis Endow First Scholarship for Diverse Nurse Anesthesia Students

UAB Cardiothoracic Surgery Unit Receives Award UAB Cardiothoracic Surgery Unit

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

Kesha Thurston and LaDana Williams-Davis UAB alumnae Kesha Thurston, DNP, and LaDana Williams-Davis, DNP, have endowed a scholarship to the UAB School of Nursing which will be open to students who are in good academic standing and are currently enrolled in or admitted to the Nurse Anesthesia program. Thurston and Williams-Davis have served as certified registered nurse anesthetists at UAB Hospital-Highlands and UAB Hospital, respectively, for over 10 years. They hope their scholarship will increase diversity within the nurse anesthesia profession by supporting students who are underrepresented in the field. “LaDana and I have worked in many hospitals together over the years, and we still hear from patients that we are the only Black CRNAs they’ve ever seen and how great it is that they can relate to someone of the same culture and demographic,” Thurston said. “Depending on the literature you read, the percentage of Black CRNAs in the nation is three percent, and so anything we can do to help facilitate the matriculation into the program, we will do.”

The UAB Cardiothoracic Surgery Unit has been awarded the silver-level Beacon Award for Excellence by the American Association of Critical-Care Nurses. This award recognizes healthcare organizations that provide exceptional care through positive patient outcomes and greater overall patient satisfaction. To be considered for the Beacon Award, hospital units must submit three years of data that demonstrates how they are setting the standards of excellence in recruitment and retention, education, training and mentoring, research and evidence-based practice, patient outcomes, leadership and organizational ethics, and creation of a healthy work environment. According to the AACN, nurses who work in organizations and units that meet this standard for excellence report

healthier work environments and express higher satisfaction with their jobs. UAB Hospital’s Cardiothoracic Surgery Unit consists of 20 private rooms with specially trained staff. The unit focuses on pain management, pulmonary management, early ambulation and physical therapy. It utilizes a fast-track protocol developed specifically for this patient population with the goal of helping the patient gain independence in their personal care and daily activities before their return home. UAB will hold this designation for three years. This unit is one of the two units at UAB to have this award and one out of only 10 in the state of Alabama.

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