Birmingham Medical News March 2023

Alabama Hospitals Facing Financial Collapse

Hospital Association in the fall of 2022.

Hospital margins in Alabama have dropped 79 percent since the start of the pandemic, despite receiving fi nancial assistance directly from the federal government and federal funds distributed through the state. Currently, 50 percent of Alabama’s hospitals are operating in the red. These jarring statistics came from a report released today by Kaufman Hall, a nationally known healthcare and higher education consulting firm, prepared at the request of the Alabama Hospital Association. Kaufman Hall prepared a similar national report for the American

“Last year was the worst year financially for hospitals nationwide, but the situation in Alabama is much worse,” said Erik Swanson, senior vice president of data and analytics with Kaufman Hall and the lead on the national and the Alabama reports. “Since the beginning of the pandemic, Alabama’s hospitals have lost $1.5 billion dollars, money they couldn’t afford to lose. The report clearly shows that Alabama’s hospitals are in serious financial difficulty which creates a huge threat to the ability of Alabamians to have access to healthcare.”

“This study demonstrates that we

are likely on a collision course with disaster, and we have only a short window to avoid losing access to services or seeing some hospitals close,” said Donald E. Williamson, MD, president of the Alabama Hospital Association. “While the access crisis will be worse in already underserved rural areas, as local hospitals close and patients pursue care in larger centers, many of the fi nancially precarious urban facilities may not have the resources to absorb the volume. This report should be the canary in the coal mine for our

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Improving the Odds Against Lung Cancer

By Laura Freeman

It’s the most lethal cancer in the United States. However, advances in screening, diagnostics and new therapies are at last improving the prognosis for lung cancer—if it can be detected in time.

“We saw a 20 percent reduction in mortality in a national research program using low dose CT for early screening of patients who are most at risk,” UAB radiology professor Nina Terry, MD said. “Based on those findings, new guidelines suggest an annual screening CT between the ages of 50 and 80 (50 and 77 for

Medicare patients) who smoke 20 packs per year or more, and those who have quit smoking for less than 15 years. Since the CT is low dose, we can screen annually, like we do for breast cancer.”

If there is a questionable area on the image, it can be either watched with follow-up scans or biopsied. Advances in biopsy technology are also making this more comfortable for the patient, as well as more accurate. Interventional pulmonologist Aline Zouk, MD said. “Robotic bronchoscopy allows us to get answers in a less invasive way. Patients can

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FrOm the aLaBama hOSpitaL aSSOciatiOn:

Doctors at the O’Neal Cancer Center looking over x-rays.

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Alabama Hospitals Facing Financial Collapse, continued from page 1

state and national leaders to ensure the system avoids collapse.”

“A collapse of the system would have a ripple effect on the state’s economy as a whole,” said Joseph Marchant, CEO of Bibb Medical Center and chairman of the Alabama Hospital Association. “There is not one area of our state and local economic infrastructure that doesn’t depend on hospitals and other healthcare providers. In Bibb County, our hospital is one of the largest employers, and because of the hospital, our county has doctors, pharmacies, home health and other services. We also help attract new businesses, support existing ones

and contribute substantially to the local tax base.”

HIGHLIGHTS FROM THE KAUFMAN HALL REPORT:

Operating margins for Alabama hospitals have decreased 79 percent in 2022 compared to pre-pandemic (2019) levels despite receiving federal financial support. Without that assistance the operating margins would have declined by more than 100 percent.

More than 50 percent of Alabama hospitals have negative operating margins, which has increased by 125

percent since 2019.

In 2022 Alabama hospitals lost $738 million from operations compared to 2019. Since the beginning of the pandemic, hospital income declined by almost $ 1.5 billion. Without federal funds, the lost income would have been more than $2.4 billion.

75 percent of the increased labor costs for Alabama hospitals were due to increases in pay and benefits for existing staff, including hazard pay, retention bonuses and other compensations. Approximately 25 percent of the increased labor costs were the result of significant increases charged by staffing agencies for

contract labor during the pandemic.

Costs have increased by $443 million for Alabama hospitals for medication and supplies over the period.

Even though COVID has become less disruptive, hospital capacity remains a challenge due to greater patient acuity coupled with staffing shortages in both the acute and post-acute settings.

The net effect of these challenges is a continued worsening of the financial condition of Alabama hospitals with losses of income growing from $124 million in 2020 to $738 million in 2022 even with federal relief funds.

The Legislature Could Save Alabama Hospitals with Medicaid Expansion

By Steve Spencer

In 2014, the Affordable Care Act offered to fund states’ Medicaid expansion with the federal government paying 100 percent of the costs for the first three years and 90 percent after 2020.

Alabama chose not to participate. Since then, 10 Alabama hospitals have closed. And today, the situation is worse: Alabama Hospitals lost $1.5 billion in the last two years. Without help, much of our state will soon be without healthcare coverage.

Under the Families First Coronavirus Response Act, states were prevented from removing people from Medicaid during the COVID emergency. This means about 200,000 Alabamians kept their Medicaid throughout the pandemic with the federal government paying large share of the costs. Even with this, Alabama hospitals were pummeled with catastrophic losses. How long can they survive when this program ends in March?

Opponents say accepting the government’s help with Medicaid expansion will cost too much. But will it? The Public Affairs Research Council of Alabama estimates that expanding Medicaid would cost an average of $225.4 million per year. However, expansion would result in

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the federal government paying $397.88 million in annual expenses currently paid by the state. As a result, the state could expand coverage, and at the same time, reduce the amount paid to support healthcare for Alabamians by $172 million annually.

Likewise, a study conducted by David Becker, PhD at UAB found that after netting out the state’s share of the coverage with estimated new state and local tax revenue, expansion would have a net-positive impact on Alabama’s overall budget. His study estimated that expansion would have an annual

economic impact on the state of more than $2 billion.

Pie in the sky? Not if you look at the results of other states that have expanded Medicaid. Since joining the program, Arkansas with an economy similar to ours, has not lost a single rural hospital. Arkansas’ benefits don’t end there. $1.7 billion federal dollars flowed into the Arkansas economy in the first year alone. The state’s uninsured rate was cut in half. Arkansas hospitals had a 55 percent reduction in losses from uncompensated care. “Our Medicaid expansion has had tangible,

positive results,” said Joe Thompson, MD, MPH, who served as the Surgeon General of Arkansas from 2005 to 2015. That sounds well and good, but maybe Arkansas’ success was an outlier. Nope, not at all. In Kentucky, Medicaid expansion added 12,000 new jobs, cut uncompensated care losses by 55 percent, and added $300 million to state coffers. Louisiana added 19,000 jobs and $103 million in new state tax dollars. The list goes on, but you get the idea.

Bottom line: the Federal Government is offering to pay 90 percent of our Medicaid costs. This will save hospitals, jobs, and actually add to our economy. Why won’t Alabama legislators take the win?

Steve Spencer is the Founder of the Birmingham Medical News.

Steve Spencer

Improving the Odds Against Lung Cancer, continued

go home the same day, and there’s no external incision or scarring.

“If we need to biopsy a suspicious node, the new robotic bronchoscopes allow us to get into much smaller areas to access very small nodules in the early stages of change. We also have a specially designed CT to guide our placement and make sure we are exactly where we need to be to get the most accurate sample. From there, testing the tissue can tell us a lot about what we’re dealing with.”

Lung cancer may be non-small cell, which is more common, or small cell, which tends to be more aggressive. There can also be differences in cells that are specific to the patient, and genetic testing of the tissue can offer insights into which types of treatment is likely to be most effective.

If the patient is facing a diagnosis of lung cancer, the multidisciplinary tumor board reviews the case and begins mapping out the course of treatment that is considered most likely to be effective. Clinicians will continue to follow the patient’s progress, making adjustments to fine-tune therapies as needed.

Surgical removal of an abnormal node with good margins and examination of nearby lymph nodes is usually part of the treatment plan. Until recently, chemotherapy was standard for

most patients, but advances in immune treatment are expanding its role in teaching the body’s own immune cells to fight back.

“Our options are not one-sizefits-all anymore,” Maya Khalil, MD, associate scientist in the O’Neal Comprehensive Cancer Center, said. “We’ve learned a lot about the biology of the cancer of the specific patient in front of us and how to treat it best. No two patients are alike.”

Immune therapy is usually less toxic and easier to tolerate. An infusion of antibodies activates the body’s immune system to kill cancer cells. For some patients who do not get a good response to immune therapy, novel medications in

clinical trials may improve response.

“It’s crucial to perform molecular or genetic testing on cancer tissue from patients presenting with metastatic lung cancer to identify drivers early on,” Khalil said. “Targeted therapies are available that seek out and block certain pathways that drive cancer growth caused by genetic mutations. Highly specialized drugs work on specific proteins and inhibit their division. There are many new generations of these drugs with multiple different targets. The options we have available today are changing the prognosis for lung cancer.”

The O’Neal Comprehensive Cancer Center is a powerhouse of research with a large portfolio of ongoing clinical trials. This offers oncology patients

opportunities to participate in cutting edge therapies.

Risk factors for lung cancer include smoking, family history, and exposure to cancer-causing agents including chemicals, radon and second hand smoke. Although coverage for screening is geared to current and former smokers, testing to rule out symptoms in patients with other risk factors may be a consideration.

Increasing awareness of new screening guidelines among physicians and patients who smoke could save many of the 236,740 people who will be diagnosed with lung cancer this year. The surest cure for lung cancer is still prevention. Don’t smoke. But if you do, test.

Nina Terry, MD

Maya Khalil, MD Aline Zouk, MD

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Why Isn’t Lumbar Disk Replacement Covered in Alabama?

By Jane ehrhardt

Currently, although BlueCross BlueShield of Alabama covers cervical disk replacement, the insurer does not reimburse for a lumbar total disk replacement (TDR). “Their guidelines still say it’s experimental, even though it’s one of the most studied topics in spine,” says Mark Prevost II, MD and orthopedic spine surgeon with Southern Orthopedic.

Last year, Aetna faced a 239-patient class action lawsuit over their lapse in coverage for lumbar disc replacement, having deemed the procedure as “experimental and investigational”, according to Becker’s Spine Review. They settled that suit in December. In other states, BlueCross entities have already approved the procedure. “It’s not ‘if’ it’s going to happen here, too, but when it’s going to happen,” Prevost says.

During his fellowship at Texas Back Institute, which celebrated their 3,000th lumbar disk replacement over a 20-year span, Prevost estimates that he completed around 100 disk replacement procedures. He returned

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to Birmingham to practice four months ago. “Thankfully, we can do cervical disk replacements here in Alabama,” he says. Last week, his most recent cervical disk replacement patient came in for her six-week follow-up. She presented with no neck pain, no arm pain, and was granted no restrictions.

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Both surgical options have been around for nearly 20 years. Approved by the FDA in 2004, the biggest advantage for patients with lumbar TDR versus fusion is the preservation of motion in the disk. “If you keep motion, then you’re not stressing the level above and below,” Prevost says. “This helps prevent further need for surgeries down the road. For lumbar disk replacement, a very small percentage of patients - roughly one percent - need an additional surgery, which you’d think insurance would like.”

Prevost has four patients awaiting BlueCross special approval for lumbar TDR, all between 27 to 35 years old. “The 27-year-old can’t play with her kids,” he says. “I could do a fusion right now, but the adjacent level gets stressed when you do a fusion, so there’s a high likelihood she will need another surgery down the road.”

In 2008, the Harrop study of lumbar disk replacement data found that in over three to 22 years of follow-up, nine percent of disk replacement patients developed ASD versus 34 percent in those who had lumbar fusion. Four years later, a study published in the International Journal of Spine Surgery mined charts of 1,000 lumbar disk replacements, and found only two percent resulted in reoperation for adjacent segment degeneration (ASD).

Cervical disk replacements had similar results, according to a 2019 metaanalysis in the Journal of Spine Surgery. Though ASD was similar in the shortterm, at five years out to seven years, 4.3 percent TDR required reoperations versus 10.8 percent who had fusions.

A new study published in Spine compared data on cervical disc replacement to anterior cervical fusion gathered between 2008 and the end of 2009. It included 6,635 fusion patients

and 327 disc replacement patients all covered by various Blue Cross entities. After three years, 10.5 percent of the fusion patients required reoperations compared to 5.7 percent for those with TDRs.

They found that not only had disk replacement saved on further surgeries, but the initial surgeries, along with the 90-day expenses, cost almost $5,000 less for the TDR group. The insurers had paid out $34,979 for the disc replacements compared to $39,820 for the fusion patients.

Part of the savings on TDR may be caused by the discrepancy in the fee paid to the surgeons. Right now for a cervical total disk replacement in Alabama, BCBSAL pays surgeons 24 RVU (relative value unit) versus 41 RVU for fusions. “The time for the surgery and the risk for the surgery are fairly equal,“ Prevost says. “Fusions may have to at times handle greater arthritic degeneration, adding on another 10 minutes or so. So it’s a relative similar time for almost half the payment.”

This could also play a small part of why Alabama orthopedic surgeons are not pushing more for lumbar disk replacement coverage, along with producing the same level of short-term relief to those in constant pain. “And it can be tough to get a doctor to change to what they’ve been doing for 20 years,” Prevost says. “But I don’t think it’s fair for patients to continue suffering when there’s a procedure available with hundreds and hundreds of articles that prove it’s better.”

Prevost thinks the approval by BCBSAL for lumbar disk replacements will come, but with his past experience with its outcomes, it can’t come fast enough. “It’s just a matter of time,” he says. “But that’s not helping patients

Mark A. Prevost II, MD

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Samford Student’s Research Published in The Journal of the Alabama Academy of Science

By Laura Freeman

Experience can be a strong source of inspiration. Many who go into healing professions can trace their interest back to a time when they or someone near them went through a health challenge.

For Luke Bice, being born with a serious heart defect originally led him to want to become a neonatal cardiothoracic surgeon. “I wanted to help save babies with congenital heart defects,” he said. “After a couple of years studying biology on the premed track, it seemed that treatment for these types of disorders was already well-advanced. I talked with a friend’s father who worked with a large healthcare organization and realized that healthcare administration offered the potential for creating beneficial changes on a broad scale. So I changed my major at Samford University to Healthcare Administration.”

During a course in contemporary issues in healthcare, Bice went to instructor Courtney N. Haun, PhD, MPH, to ask about opportunities to participate in research.

“I challenged Luke to think about

topics that would be of particular interest to him,” Haun said. “He shared that he had been born with a critical congenital heart defect (CCHD). I suggested that he look into the topic to see if he could identify an area where more data research was needed.”

Bice, who grew up in Geneva, Illinois, was diagnosed at birth with dextro-transposition of the great arteries (D-TGA), with the aorta and pulmonary artery reversed where they connect to the heart, preventing it from pumping oxygenated blood throughout the body.

“I was air lifted to UNC Children’s Hospital, where I received an open heart surgery called an Arterial Switch operation,” he said. “Since then, I have been blessed with good health and have not been physically or mentally limited. The condition is not expected to cause any future problems.”

In reviewing related literature, Bice found a study in JAMA about newborn screening for heart defects and the lives those screenings had potentially saved. He noticed that the findings in the study had only been reported through 2013.

“Luke set out to bring those findings

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up to date and expand the study as far out as available data allowed,” Haun said. “We worked together to set up a format for gathering aggregate statelevel data from the CDC for analysis to evaluate CCHD and CCHD-related deaths in the U.S. between January 1, 2007 and December 31, 2019.”

Bice said, “The study includes data from before and after implementation of mandatory screenings for CCHDs. 13 conditions included in the study were identified through the CCHDrelated ICD-10 codes provided by the National Library of Medicine’s Newborn Screening and Coding Terminology Guide.”

Findings from the research project showed a decline in early infant death rates due to CCHDs associated with a nationwide mandatory screening policy. This provides support for policies such as a pulse ox mandate that improves care and saves lives.

Haun said, “The research project was an incredible accomplishment for an undergraduate student. The initial findings were presented at the 2022 Alabama Academy of Sciences Conference. Positive feedback and suggestions helped to tailor the study design. Then Luke presented a poster at the 2022 Samford Research Colloquia.”

Before submitting an article on

the research for publication in a peerreviewed journal, Bice and Haun felt the project could be further improved by input from experts in the field.

David Naftel, MD, 2021 Pediatric Heart Transplant Society Lifetime Achievement Award recipient, came to Samford and met with Bice and Haun. His expertise in statistics and pediatric heart health provided insights that were beneficial in preparing the manuscript. The Status of Critical Congenital Heart Defect Infant Deaths After PulseOximetry Screening Mandates has been accepted for publication in The Journal of the Alabama Academy of Science.

Mentoring is another form of paying it forward, passing on skills and knowledge to the next generation.

“It has been a blessing to serve as a research mentor to Luke, connect with experts in this particular area, and see Luke’s passion for this field be brought to fruition,” Haun said.

“Dr. Haun’s guidance and help were essential to making this research possible,” Bice said. “We hope our research will provide insights into the effectiveness of such policies and support their continued use in reducing infant mortality as well as saving lives and improving health in people of all ages.”

Courtney Haun, PhD (left) with Luke Bice.

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Stats Speak for Themselves

Fake Nursing Licenses on the Rise

The scope of this fraud scheme is astonishing

By Lynne Jeter

If you employ nurses with nursing degrees from Siena College, Palm Beach School of Nursing, or Sacred Heart International Institute, all located in Florida, it may be time to review their files for fraudulent activity.

The U.S. Attorney’s Office for the Southern District of Florida recently charged 25 individuals with wire fraud for selling fraudulent nursing degree diplomas to more than 7,600 people across the country. These people purchased the bogus diplomas to use as credentials to sit for their nursing board exams. Thousands of them then became licensed nurses, easily slipping under the human resources radar.

“The scope of this fraud scheme is astonishing,” said David Schumacher, a former deputy chief of the Health Care Fraud Unit for the U.S. Attorney’s Office for the District of Massachusetts, and co-chair of the Fraud & Abuse Practice at Hooper Lundy law firm.

“The obvious victims are the patients who were treated by nurses who didn’t have the training and qualifications

necessary to provide quality, safe care. But hospitals, health systems and other organizations that are desperate to find qualified nurses were also victimized by this scheme.”

David Weinstein, a former federal prosecutor in the Southern District of Florida and a partner at Jones Walker LLP in Miami, said the trend emanated from the COVID outbreak. “During COVID, as with many industries, both a shortage of potential employees and forced movement to online certifications proliferated the healthcare industry,” he said. “As a result, unscrupulous individuals took advantage of the

situation and created a scheme to profit from these events.”

Employers who hired these fraudulent nurses had little way to know about the bogus diplomas.

“As with all due diligence checks, you rely on the information that’s in the database,” Weinstein said. “If transcripts and diplomas are submitted as a requirement to sit for licensing exams, unless there is obvious fraud in the appearance of these documents, it won’t set off any red flags. Moreover, by the time a candidate applies for employment, they have already used the fraudulent transcripts and diplomas to sit for and pass their exams.”

Schumacher pointed out that all three nursing schools are accredited. “Human resources and compliance departments at health systems should review employment records from all their nurses to determine if any of them listed diplomas from these three schools,” he said. “If so, they should investigate the diplomas, and if they’re found to be fraudulent, they should immediately terminate the nurses.

“It’s critical that health systems take

these steps to mitigate harm. It’s not inconceivable that health systems will have to answer inquiries from patients and families that were treated by nurses involved in this scheme, and federal and commercial insurance payors could demand to recoup any services performed by the nurses, as well.”

Some state nursing boards are already taking action. For instance, the Georgia Board of Nursing has sent letters to at least 22 nurses who had diplomas from one of these schools, asking them to voluntarily surrender their nursing licenses, and the Atlanta VA medical center has removed three such nurses. “Boards of Nursing in other states will surely follow suit,” Schumacher said.

Moreover, if there are thousands of nurses in practice who obtained their licenses under false pretenses, there could be years of collateral litigation, including additional indictments, nursing board licensure actions, and potential lawsuits from their employers and families.

David Weinstein David Schumacher

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When people with extraordinary talent and passion are given the technology, the facilities, and the support, they achieve great things. The discoveries and innovations happening today will help shape the future of treatments and lead to cures. And it benefits not only the patients and families who come to Children’s of Alabama, but people across the country and around the world for years to come.

Get Ready for Medical Marijuana

By Jane ehrhardt

Medical marijuana could become a part of Alabama physicians’ options for alleviating pain and making numerous conditions more endurable as soon as next year. “This topic can be difficult to keep up with but needs to be put back on physicians’ radar due to patient demand,” says Harrison Irons, MD, a pain management physician with Alabama Pain Physicians.

Last September, the Alabama Medical Marijuana Commission (AMCC) began accepting medical cannabis business applications for cultivators, processors, secure transporters, state testing laboratories, dispensaries, and integrated facilities. By the close of the submission period, 80 applications had been received to fill the 35 spots in the limited license categories.

“It’s all going to be done in-state, like farm-to-table marijuana,” Irons says. “I’m very happy with Alabama doing this in a methodical and scaleddown fashion.” For instance, the state is issuing only nine dispensary licenses with 25 total sites allowed.

Oklahoma, on the other hand, has over 2,400 dispensary sites. They took a fast and furious route to unrolling medical cannabis and created a fiasco. The Oklahoma Bureau of Narcotics and Dangerous Drugs now estimates about 2,000 medical marijuana license holders obtained permits fraudulently or are masking illegal sales. “The number of dispensaries is fighting to be in the ranks of the number of cows in Oklahoma,” Irons jokes. The state also issued enough medical marijuana cards for one in 13 adult residents to possess one, according to Oklahoma Watch.

Alabama has announced that once the business licenses have been awarded, physicians can begin the certification process to be able to recommend medical cannabis to qualified patients, according to the AMCC website (amcc. alabama.gov). Certification involves obtaining an annual Alabama Medical Cannabis Certification Permit from the Alabama Board of Medical Examiners.

Requirements include numerous, expected conditions for drug prescriptions along with having been in practice for at least a year and be registered with the Alabama Medical Cannabis Patient Registry System maintained by the AMCC. Physicians must also attend a four-hour course and pass the subsequent exam. The initial application fee runs $300. “It’s similar to being able to prescribe opioids,” Irons says. “It’s continuing education relating to medical cannabis—who qualifies, how to dose—for category 1

credits. Hopefully we will soon see more data involving the mixture of the two medications.”

Based on the conditions currently listed as approved for treatment with medical cannabis, the array of specialties that may want to certify spans from oncology, pain, neurology, psychiatry, obstetrics, hematology, and orthopedics to any physician dealing with chronic pain and terminal illness.

“I imagined the scope of conditions that Alabama would allow for use would be end of life care, nausea, vomiting, and maybe certain chronic painful conditions,” Irons says, thinking the list would align more with FDA-approved conditions for Marinol, the synthetic version of a chemical found in marijuana. “It’s great that they were open to more conditions. It means there must be a lot of good data and science behind these or they would not have listed them.”

Beyond the expected cancerrelated and pain issues on the list, the 14 approved conditions include multiple mental afflictions, such as depression, PTSD, autism, and Tourett’s, along with some general symptoms, such as spasticity and seizures.

Irons is disappointed, however, that Alabama is not allowing the use of opioids with medical cannabis. “The verbiage for chronic pain sounds like it has to be medical marijuana or opioids, but not both,” he says. “A lot of people are stable on marijuana, but need a pain medication for bad days.

“Alabama has only slightly limited the routes of administration of the drug to help alleviate the typical recreational avenues, such as smoking and edibles. You can’t buy buds at a dispensary or vape it. And although children can qualify for medical marijuana use, other rules on how you administer and manufacture it appear to minimize its appeal to children.” The list does offer a wide array of options beyond pills, including gels, suppositories, liquids for inhalers, and transdermal patches.

The current and complete regulations outlining all the aspects of usage, dosage, certifying, and administration of the drug

Harrison Irons, MD

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I f y o u ' r e f e e l i n g u n c e r t a i n a b o u t t h e i m p l i c a t i o n s , d o n ' t w o r r y O u r t e a m o f h e a l t h c a r e a d v i s o r s h a v e s t u d i e d t h e s e s c h a n g e s a n d a r e s p e c i a l l y t r a i n e d t o h e l p y o u t h r o u g h t h e p r o c e s s . S p e n d y o u r t i m e c a r i n g f o r y o u r p a t i e n t s w h i l e y o u r K a s s o u f h e a l t h c a r e a d v i s o r h a n d l e s t h e e x p i r a t i o n ' s e f f e c t s F r o m t h e M e r i t - B a s e d I n c e n t i v e P a y m e n t S y s t e m ( M I P S ) E x t r e m e a n d U n c o n t r o l l a b l e C i r c u ms t a n c e s ( E U C ) t o t e l e h e a l t h f l e x i b i l i t y g u i d e l i n e s , o u r t e a m o f 4 0 + c e r t i f i e d p u b l i c a c c o u n t a n t s a n d a d v i s o r s w i l l g u i d e y o u e v e r y s t e p o f t h e w a y .

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End of an Era: COVID-19 Public Health Emergency is Ending

By: KeLLi carpenter FLeming

The resort-like amenities at Aspire will create a soothing environment for your rehab stay. Our licensed physical therapists will work with you personally to restore your strength and ability.

Our facility boasts the latest in rehabilitation options, including two state-of-the-art gyms with specialized equipment to get you back in action. Our ceiling-mounted Zero Gravity System suspends patients for secure guidance to get you on your feet faster. Our therapists utilize the latest Omni Virtual Reality System to stimulate progressive therapy through walking, jogging, and other movements. We also have recovery services for hip and knee replacements, plus strength and conditioning programs following rheumatologic conditions.

The Biden Administration recently announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, over three years since the COVID-19 pandemic began. While there have certainly been significant changes over the past three years since the COVID-19 pandemic began, there will also be significant changes when the public health emergency ends. For example, coverage and costsharing obligations for COVID-related treatment and tests may increase. In addition, many of the waivers relaxing regulatory requirements will end. In that regard, the Centers for Medicare & Medicaid Services (CMS) developed a roadmap for the end of the public health emergency that all providers should review in preparation for May 11, 2023.

There are some changes, however, that arose from the COVID-19 pandemic that are here to stay, in some form or fashion, following the end of the public health declarations.

CYBER-SECURITY FOCUS

When the COVID-19 pandemic shut down the world, in many industries, there was a shift of employees from an office environment to a work from home environment. As a result, businesses experienced an increase in cyber-incidents, causing businesses to focus more (and spend more) on cybersecurity efforts and prevention. While some employees have returned to work, there are still a number of individuals working remotely or working a hybrid schedule. This, combined with the level of sophistication of cyber-incidents, will result in businesses continuing to experience cyber-threats. Healthcare entities are prime targets given the vast amount of personal information they maintain. Thus, investments in technology upgrades, cyber-security prevention, and employee education will continue to be of concern for healthcare entities following the end of the public health emergency.

STAFFING CHALLENGES

While healthcare providers have faced staffing challenges and nursing shortages for years, the COVID19 pandemic certainly exacerbated those challenges. Over the past three years, almost all industries have faced staffing shortages, as people opted for employment where they could work

from home and have more flexibility. However, the healthcare industry seemed to experience the worst impact— with record high volumes of patients to treat and record low volumes of staff to treat such patients. Unfortunately, many predictions indicate that the staffing challenges in the healthcare industry are long-term and will force healthcare providers to re-think how healthcare is delivered. If healthcare providers have learned anything during the COVID19 pandemic, it was how to pivot, and this long-term staffing challenge will certainly present some unique opportunities to pivot.

TELEHEALTH

Telehealth services exploded as a result of the COVID-19 pandemic. Most indications are that increased usage of telehealth services will remain post-pandemic, with third-party payors implementing new payment policies with respect to such services. While some of the telehealth relaxations from the COVID-19 pandemic may no longer be in effect following the end of the public health emergency, the prevalent use of telehealth services will continue. In fact, the Medicare telehealth flexibilities will remain in place through December 2024 as a result of the Consolidated Appropriations Act, 2023. Patients realized they liked not having to go to a physician office to be treated (with the difficult parking and long wait times). Physicians realized they liked being able to more efficiently treat patients via telehealth with a lower overhead expense. Employers realized that they liked employees having the option to “see” a physician quickly during a lunch break without having to take off the entire day. Thus, we will continue to see a larger percentage of healthcare services being delivered via telehealth, as well as significant advances in technology in that regard.

Healthcare providers have learned a

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WHEN IT COMES TO YOUR HEALTH

We’re Growing To Serve You Better Now With 10 Locations

We’re Growing To Serve You Better Now With 10 Locations

If you suffer from allergies or other ear, nose, throat or hearing problems, we don’t want you to treat your healthcare lightly or ignore symptoms that could lead to more serious issues.

For a complete and thorough evaluation make an appointment today to see one of our 14 board certified physicians, 2 highly trained, licensed PA’s, or 13 clinical audiologists - all available to serve your needs at any of our 9 locations

At our practice, your health comes first; and we strive to treat each patient as a person, not just another case. Our goal is to deliver a positive personal experience along with a positive outcome.

ENT Associates of Alabama, P.C. is the largest Otolaryngology practice in Alabama with 10 locations,15 physicians, and over 600 years of combined staff and physician experience.

ENT Associates of Alabama, P.C. is the largest Otolaryngology practice in Alabama with 10 locations,15 physicians, and over 600 years of combined staff and physician experience.

Our practice includes general ear, nose, and throat, head and neck diseases and surgeries, cosmetic surgery, robotic procedures, inoffice balloon sinuplasty, allergy treatment, and hearing solutions. We concentrate our training and experience in these areas to provide the best possible medical care for our patients.

Our practice includes general ear, nose, and throat, head and neck diseases and surgeries, cosmetic surgery, robotic procedures, inoffice balloon sinuplasty, allergy treatment, and hearing solutions. We concentrate our training and experience in these areas to provide the best possible medical care for our patients.

At ENT Associates of Alabama, P.C. the patient’s experience matters. We treat each patient as a person, not just another case. We pride ourselves in delivering a positive personal experience along with a positive outcome

At ENT Associates of Alabama, P.C. the patient’s experience matters. We treat each patient as a person, not just another case. We pride ourselves in delivering a positive personal experience along with a positive outcome

For your convenience, we have same day appointments available, as well as early morning, evening, and Saturday appointments. Please call 1-888-ENT-5020 (1-888-368-5020) for more information, visit us on our website at www.entalabama.com, and scan the QR code below to follow us on social media.

Birmingham | Hoover | Cullman | Gardendale |

Birmingham - Princeton - Hoover - Cullman - Gardendale

Alabaster - Jasper - Pell City - Trussville - Valleydale Rd. www.entalabama.com or call toll free 888-368-5020

Birmingham - Princeton - Hoover - Cullman - Gardendale

Alabaster - Jasper - Pell City - Trussville - Valleydale Rd. www.entalabama.com or call toll free 888-368-5020

Lumbar Disk Replacement

Covered, cont. from page 12

are downloadable on the Laws and Rules page of the AMCC website.

In May 2021, when Alabama became the 37th state to legalize the medical use of cannabis products, Irons says his office was inundated with calls from patients asking if they qualified and how to get their medical marijuana card. “These facilities are going to be up and dispensing before we know it,” he says, knowing the calls will flood in again. “For doctors who fall into this range, this could be another good tool to add to our patient treatment plan.”

End of an Era,

continued from page 14

lot over the past three years and have faced many challenges. However, from every challenge comes an opportunity for growth and change, some good and some more difficult. Nonetheless, healthcare providers need to position themselves to address the changes arising from the COVID-19 pandemic that will extend beyond the end of the public health emergency.

Kelli Fleming is a Partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Practice Group. Kelli may be reached at (205) 458-5429 or kfleming@burr.com.

Providing exceptional real estate advisory services to physicians and medical groups

Alabama Oncology Recognized for High-Quality Care

When we started with Veritas, there was so much that we didn’t know, especially since we were starting a new practice. The Veritas team provided information and resources that exceeded our commercial real estate needs. They balanced providing informative guidance with letting our team direct the process, and in the end, we found a space that is perfect for our practice. I cannot say enough about this knowledgeable team and how grateful we are that they were a part of our process.

Dr. Cayce Paddock

Rich Campbell

Nancy Ferren

Peter Jameson 205-304-1010 www.veritasmre.com

Alabama Oncology has been recognized by the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO), for practices that meet nationally recognized standards for quality cancer care.

Alabama Oncology is only the 2nd practice in Alabama to currently hold this certification.

“We are proud to be among the distinguished practices that have received this certification,” said Managing Partner, Brian Adler, MD.

In applying for certification, Alabama Oncology participated in a voluntary comprehensive site assessment against specified standards that are consistent with national guidelines and was successful in meeting the standards and objectives of the program.

The University of Alabama at Birmingham Marnix E. Heersink School of Medicine’s Multidisciplinary Sarcoidosis Clinic has joined the Foundation for Sarcoidosis Research as a founding member in their Global Sarcoidosis Alliance.

This new network of specialty clinics in the United States and globally creates a network for patient and clinician education, innovates sharing of information to advance new therapies for treatment of sarcoidosis, and creates collaborative referral networks to connect patients with complex sarcoidosis with specialists familiar with their disease.

Sarcoidosis is an inflammatory disease characterized by the formation of granulomas in one or more organs of the body. When left unchecked, chronic inflammation caused by granulomas can lead to fibrosis. This disorder affects the lungs in approximately 90 percent of cases, but it can affect other organs. Despite increasing advances in research, sarcoidosis remains difficult

to diagnose, with limited treatment options and no known cure.

Disease presentation and severity vary widely among patients. In some cases, the disease goes away on its own. In others, the disease may not progress clinically, but individuals will still suffer from some symptoms that challenge their quality of life. The rest of patients — up to a third of people diagnosed with the disease — will require long-term treatment.

It is estimated that the prevalence of sarcoidosis in the United States ranges from 150,000 to 200,000, with an estimated 1.2 million individuals worldwide.

“We are excited to contribute to this new alliance and push the margin forward in understanding and eventually curing sarcoidosis,” said Joseph Barney, MD, professor in the UAB Division of Pulmonary, Allergy and Critical Care Medicine and director of UAB’s Multidisciplinary Sarcoidosis Clinic.

UAB is Founding Member of Global Sarcoidosis Alliance

(L to R): Kevin G. Dsouza, MD; Ishan Lalani, MD; Joseph B. Barney, MD; Maria del Pilar Acosta Lara, MD; Kelli Montz, RN; Lanier O’Hare, PhD.

Brian Adler, MD

Grandview Medical Center received an “A” Hospital Safety Grade from The Leapfrog Group, which recognizes the hospital’s achievements in protecting patients from preventable harm and errors.

“I am proud of what is being accomplished here. This takes a team with our medical staff and employees working together,” said Daniel McKinney, CEO of Grandview Medical Center.

Kassouf Webinar in March

The Kassouf & Co healthcare advisors team is hosting a complimentary webinar on March 13 from 11:30 a.m. to 1 p.m. The experts will cover topics such as the MeritBased Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception applications; telehealth flexibility guidance; COVID-19 vaccines, testing, and treatment; controlled substances prescriptions; stark law flexibilities; and workforce staffing flexibilities, to name a few. Register at www.kassouf.com or call 205-443-2500.

UAB’s Research Funding Tops Record $715 million

CEMS is the first in Alabama to be certified as a Critical Care Paramedic service.

Cullman Regional’s ambulance service, Cullman Emergency Medical Services (CEMS), is the first ambulance provider in Alabama to provide blood treatment in the field. This enables paramedics to perform emergency blood transfusions on scene and give patients with significant blood loss a better chance to make it to an emergency room.

CEMS was also the first in the state to be certified as a Critical Care Paramedic service, which is the highestlevel paramedic license. Critical care paramedics can carry out advanced

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lifesaving emergency techniques in the field that standard paramedics cannot, such as placing chest tubes and administering advanced medications. CEMS has 13 critical care paramedics on staff.

As part of its licensure to provide blood treatment, CEMS developed protocol and procedures to ensure clinically appropriate storage and use of blood products and has since been asked to share those guidelines with other ambulance agencies in the state that are interested in pursuing their own licensure.

UAB is in the top one percent of organizations funded by the NIH.

The University of Alabama at Birmingham received more than $715 million in research grants for the 12-month period ending September 30, 2022, up $67.8 million from the previous year, a 10.5 percent increase for the year and a nearly 50 percent increase during the past five years.

For FY 2022, UAB ranks among the top five percent of U.S. universities, based on all federal research and development expenditures, and in the top one percent of all public, private and international organizations funded by the National Institutes of Health.

percent to $11.5 million, and support from the CDC has increased by 152 percent and is now over $20 million.

Other growth areas include industry and clinical trials. Total industry awards, which include grants, funded trials and services, more than doubled (106 percent) since 2018 to exceed $150 million in 2022. Specifically, overall clinical trial expenditures exceeded $105 million for the first time.

Come

Some of that results from an increasingly diversified portfolio. For example, UAB’s $388 million funding from the National Institutes of Health is substantial, and this year represents 54 percent of overall awards while just four years ago, it represented 60 percent. This is due to growth in other funding sectors since that time.

Meeting info & to join: bhmgma@gmail.com bhmgma.com

“UAB is experiencing growth in other sectors, and that is what we want,” said Christopher Brown, PhD, vice president for Research. Since 2018, awards from nonprofits and foundations have increased 48 percent to $53.5 million, National Science Foundation funding has increased 29

“An important part of our research is translating discoveries and advancements into real-world applications,” Brown said. “The Bill L. Harbert Institute for Innovation and Entrepreneurship helps translate research into an economic benefit by shepherding patents, licensing, spinoffs and startups that, in turn, benefit our research enterprise because those services attract and benefit faculty.”

Grandview Medical Center Awarded ‘A’ Hospital Safety Grade

Cullman Regional EMS First in State to Provide Blood Transfusions in the Field

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Kassouf Promotes 13 Employees and Hires New Principal

Kassouf has promoted 13 team members, naming two new directors. Three team members were promoted to principal, and a new principal joined the firm.

Kassouf’s new directors include Margaret Cook and Joni Wyatt, who both work in Kassouf’s Healthcare Group. They are the first shareholders at Kassouf who are not Certified Public Accountants, further solidifying Kassouf as an advisory firm.

Cook is graduated from Samford University with an undergraduate degree and Master of Business Administration. She has over 30 years of experience in healthcare, providing consulting services with an emphasis on physician practice management. She is a Certified Medical Practice Executive and is involved with the Medical Group Management Association (MGMA.)

Wyatt earned her undergraduate degree from College of Charleston and a Master of Healthcare Administration and Master of Health Information Administration from Medical University of South Carolina. She has over 20 years of experience in healthcare, specializing in new practice startups, health information systems, and healthcare compliance. She is a Certified Professional in Health Information Management Systems, a member of the MGMA, and a Health Information Management Systems Society Fellow.

Kassouf’s team members who were promoted to principal include Sally Bradley, James Dicks, and Rachelle North. Shannon Pike recently joined the firm as a principal.

Bradley graduated from UAB and is a CPA and Certified Global Management Accountant. She works in Kassouf’s Business Services Group.

Dicks graduated from Troy University with undergraduate degree and Master of Business Administration from the university. He works in Kassouf’s Healthcare Group, providing accounting, tax compliance, advisory, and practice management services to healthcare clients. Dicks is a CPA and Certified Valuation Analyst.

North graduated from Lee Uni-

versity and is a CPA. She works in Kassouf’s Healthcare Group, specializing in accounting, tax, and consulting services for physician practices. She is a member of the Alabama Society of Certified Public Accountants and the American Institute of Certified Public Accountants.

Pike holds over 25 years of experience in financial planning and is a Certified Financial Planner. a

Margaret Cook, MBA, CMPE

James Dicks, CPA, CVA

Rachelle North, CPA, CGMA®

Joni Wyatt, MHA, MHIA, CPHIMS

40 years of state-of-the-art surgical excellence performed with world-class skill.