Birmingham Medical News May 2023

Revolutionary New Clinic Offers Higher Quality of Life for ALS Patient

Ansley FrAnco

Amyotrophic lateral sclerosis, or ALS, is a complex, incurable neurodegenerative disease that affects the motor neurons –neurons that control motor function in the brain, brainstem and spinal cord. Patient care includes going to several healthcare providers such as a neurologist, physical therapist and occupational therapist, etc.

“In order for us to take care of those patients, we need a multidisciplinary approach. You cannot ask a patient who has such a devastating diagnosis to go to visit all of those providers on separate occasions. A patient will simply spend their

entire lifetime going to doctor’s appointments or medical providers’ appointments,” said Mohamed Kazamel, MD, ALS clinic co-director and associate professor in the Department of Neurology, Marnix E. Heersink School of Medicine.

The University of Alabama at Birmingham’s new ALS clinic allows a patient to see eight health care providers in one visit, with one co-pay. The patients will interact with their neurologist, physical and occupational therapist, dietitian, speech therapist, psychologist, social worker and respiratory therapist.

“Before the clinic, the patient typically does not see all the providers. We

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Non-Invasive Encircling Laser Treatment Can Help Prevent Retinal Detachment

By MArti WeBB slAy

Ophthalmologist Robert Morris, MD, founding physician of Retina Specialists of Alabama and president of the Birmingham-based Helen Keller Foundation for Research and Education, has documented a non-invasive laser treatment that can reliably prevent most retinal detachments in eyes known to be at high-risk.

Since retinal detachment is the leading cause of sudden sight loss in the aging eye, Morris wants fellow phy-

sicians to be aware of the procedure for their patients who have a history of retinal detachment.

The procedure entails using a laser to weld the peripheral retina to the eye wall, effectively preventing tears that can cause blinding retinal detachments.

“This encircling laser treatment has been around for quite a while,” Morris said. “But nobody has defined exactly how to do it, and we have.”

Knowing how to best do the procedure is only the first step, however. Knowing when to do it is also important. Most adult patients with retinal detachment

get their macular vision back, but many don’t. For those patients, the insurance of this procedure on their remaining good eye is an important consideration.

Others are at risk for retinal detachment as well. “There are a lot of risk factors for people getting a detachment,” Morris said. “One is if you have had a cataract extraction. (You should not avoid a cataract extraction, however, because the risk is still low.) Also, people who are highly nearsighted, and people who have a family history of retinal detachment. But if you look at all those risk factors together, it’s still hard to quantify how high a risk each patient faces.

“We’ve shown that if a patient and their doctor decide they are at an un-

acceptably high risk after evaluating all these factors, then there is a treatment that is not invasive which can reliably prevent detached retina. We’re not telling doctors who should get it. That’s ultimately a decision the patient has to make when they are fully informed. That’s something a doctor and a patient may discuss over many visits.”

Because it can be difficult to assess who is at risk for retinal detachment, proving this procedure could prevent it was elusive, until Morris was visited in 2012 by a father and son with Stickler Syndrome. Stickler Syndrome is a rare, inherited disease affecting children and teenagers. “Retinal detachment

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Robert Morris, MD

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Employee Retention Requires Communication

By MArti WeBB slAy

Keeping staff positions filled in today’s economy is a continuing challenge for hospitals. Two chief nursing officers say that that it is essential to engage with employees and build a culture of teamwork in order to retain associates and build morale.

Russell Harbin, MSN, RN, who serves as CNO at Medical West Hospital, says the nursing staff most often lists workplace stress as the reason for leaving bedside nursing. “We are trying to focus on management being out on the floor with the staff about 60 percent of their day, so the staff doesn’t feel like they’re drowning,” he said.

He strives to be visible by making several daily rounds himself. “When I say visibility, I mean doing more than just asking employees how they are,” he said. “When we see that they are really busy, we want to offer our help, like maybe giving medicine while the nurse attends to something else. We are evolving into a management style where if we have the skill set to do something, we get in there and do it.

“It’s important to provide support on

all shifts. Our managers meet with night shift and weekend staff once a month. A lot of times, the night shift and weekend staff tend to be forgotten. We have started focusing on them to make them feel equally important. That has helped our night shift staff feel more engaged.”

Helping new hires fit in is also important. “I personally meet with every nurse who hires into the hospital at the six-month mark,” he said. “They come to my office, and we have a sit-down. I ask about how it’s going for them, how they are doing with their manager, how the orientation went. That’s been very positive, and we’ve gotten great feedback from that.”

Amy Shelton, MSN, RN, who is CNO

at Ascension St. Vincent’s, says communication goes both ways, and listening to associates means responding to their concerns. “We have focused on the wellbeing of our associates,” she said. “They’ve said they need a more flexible schedule, and we’ve made that happen. We’ve always let our associates have a voice, but it’s more critical now than ever. Any good leader needs to hear what the associates have to say, whether it’s what you want to hear or

not. It’s important that the associate has a voice and that we respond.

“We have associate engagement surveys, and most important, we have taken those results and made changes. We have created forums for the associates to have their voices heard, and we’ve made pathways to make sure responses get back to the associates.”

One such response has been the

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Amy Shelton, MSN, RN

(L to R) Nina Howze, RN with Russell Harbin, MSN, RN

Law Enforcement Exception to HIPAA: What Providers Need to Know

By Andy BAer, Md

Healthcare providers are well-versed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule and the broad protection it offers to patient information held by healthcare providers and plans.

However, they might not be as aware of key exceptions to the rule — one of them being requests for protected health information (PHI) from state and local police and other law enforcement agencies.

A healthcare professional or practice may receive a verbal or written request for PHI or copies of medical records from law enforcement officials as part of an investigation. For example, they may be following up on suspected child abuse or investigating an altercation that resulted in a crime. It’s important that healthcare organizations understand how to appropriately respond to such a request to avoid a HIPAA violation and the associated fines.

HIPAA Law Enforcement Exception Defined

The HIPAA Privacy Rule exception for law enforcement purposes, 45 CFR § 164.512(f), permits a covered entity (generally, healthcare providers, health plans and their business associates) to disclose PHI to law enforcement officials without patient authorization under certain circumstances:

• If a court order, court-ordered warrant, subpoena or administrative request has been issued

• To identify or locate a suspect, fugitive, material witness or missing person

• To answer a law enforcement official’s request for information about a victim or suspected victim of a crime

• To alert law enforcement of a person’s death if the organization suspects that criminal activity caused the death

• When an organization believes that PHI is evidence of a crime that occurred on its premises

• In a medical emergency not occurring on the organization’s premises, when it’s necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

The definition of law enforcement official is broad and applies to an officer or employee (state or federal) who investigates or conducts an official inquiry into a potential violation of law. It also applies to law enforcement officials who prosecute or otherwise conduct a criminal, civil or administrative proceeding arising from an alleged violation of law. Examples of law enforcement officials include officers, investigators or detectives from a sheriff’s office, the FBI, and state detec-

tives or investigators.

Responding to a Records Request

If a law enforcement official sends a letter requesting records, the letter will likely describe where to send the requested records in addition to providing the law enforcement official’s contact information. Many times, the cover letter or request will not copy the other party because the investigation is sensitive or confidential.

Law enforcement officials also may verbally request PHI or copies of medical records from a healthcare organization either over the phone or in person. If a law enforcement official comes to an organization’s office in uniform and provides proper identification, then it is appropriate to produce the PHI.

However, if the request is made over the phone, a healthcare organization is

required to obtain further verification before releasing PHI. Ask the caller to provide a formal request in writing and cite the requestor’s source of statutory authority under state or federal law. The request can be made on official letterhead or by email if the message includes the source of authority and is sent from the official’s work email address.

Healthcare organizations generally do not have to obtain an individual’s written authorization before disclosing PHI if they receive an appropriate written or verbal request from a law enforcement official. However, if the official is requesting the PHI of an adult patient who is a victim of abuse, an organization usually must obtain authorization from the patient before disclosing anything to law enforcement.

Preparing Your Practice to Comply

Communication and training are key to making sure a healthcare practice complies with the law enforcement exception (and all other HIPAA requirements). The following actions can help an organization remain compliant.

• Conduct annual HIPAA training for staff members that includes information regarding Privacy Rule exceptions.

• Establish a process for flagging and handling medical record requests from law enforcement.

• Implement a checklist with the steps

necessary to respond to medical record requests from law enforcement.

• When unsure about the legitimacy of a request, contact the law enforcement office involved, ensure that it made the request and clarify the reason for it.

• Share only the patient records requested and nothing more.

• Transmit records in a HIPAAcompliant manner.

The wrongful release of patient health information to law enforcement doesn’t happen often. However, if a healthcare organization inappropriately discloses PHI, it could face a HIPAA violation and the associated fines. Understanding the law enforcement exception to the HIPAA Privacy Rule and implementing processes to answer requests are key to responding appropriately and avoiding penalties.

Disclaimer: The information provided in this article does not constitute legal, medical or any other professional advice. No attorney-client relationship is created and you should not act or refrain from acting on the basis of any content included in this article without seeking legal or other professional advice.

on results.

Andy Baer, MD serves as the Chief Medical Officer of MagMutual.

Andy Baer, MD

Clinic Offers Higher Quality of Life for ALS

Patient, continued from page 1

thought that the care for patients was very deficient, in the sense that we focused on the most important aspect and leave other aspects of patient care,” Kazamel said. “The care is efficient now.”

Because of a grant from the Alabama Department of Commerce Innovation Fund, the clinic now supports 150 patients who visit every three months instead of every six months, like previously. The patients can come on the third Monday or Friday of the month. In the beginning, the clinic was only able to see seven to eight patients a month. Now, 16 to 18 patients can be seen. On their visits, patients will sit in the same room for three hours while each health care provider comes to them.

According to Nan Jiang, MD, PhD, ALS clinic co-director and associate professor of neurology, the clinic provides for patients who live outside of Alabama. “We see patients from Mississippi, Florida, sometimes Nashville and Georgia, so basically the surrounding states,” she said. “Sometimes people will drive four or five hours to get here.”

The ALS clinic recently hired a clinical trials coordinator, Olivia Scogin, to continue to collaborate with the Northeast Amyotrophic Lateral Sclerosis Consortium clinical trials. Last year, the NEALS research organization enrolled multiple ALS patients from UAB to participate in an international trial of a new drug that may help prolong overall survival by up to two years.

“For clinical trials, she [Scogin] helps patients get their labs, other medical examinations, questionnaires that the study requires answered and takes the patients

to the investigational pharmacy to get their medications. Her role is essential for clinical trials to be done at UAB,” Kazamel said.

Jiang and Kazamel said they are excited to see the clinic double its patient intake to help those diagnosed with the devastating disease.

“People really suffer from this disease and can have a poor quality of life. Though they can’t live forever, with our clinic, they can have a relatively good quality of life,” Jiang said. “Their appreciation makes me feel like my job is rewarding.”

Kazamel said he believes that most physicians and neurologists don’t like to give an ALS diagnosis to a patient because it is a horrible disease, but it is a very humbling experience to care for those diagnosed. “We are quite excited about the clinical trials in the pipelines that could potentially help our patients, especially in the era of precision medicine,” Kazamel said. “Now every patient is different, and we are hopeful that we live one day to see where there is a cure for the disease.”

Employee Retention Requires

Communication, continued from page 3

establishment of a nurse empowerment and engagement council. “We are pulling nurses from all across the health system for this council, and they will be the voice of the nursing community. Any scheduling changes, bonus contractsanything that will impact nursing - that team will evaluate it and make a decision based on the parameters they’ve been given,” Shelton said. “We have nurses with 40 years of experience and we have some with 20 months with us. They are excited about being part of a team that will impact their work environment.”

“Communications between shifts can also be important,” Harbin said. “During staff meetings, employees have complained that other shifts didn’t work as hard as they did. There was a lot of that back and forth. So management made it a priority to hold everyone to the same level of accountability. We’ve gotten a lot of positive feedback from that. People can’t leave things for the

next shift. Spending the time to make sure everyone is held to the same accountability has really helped.

“During the pandemic the thought process was often, ‘If I can get a body here to work, I’m happy.’ Now that things are starting to settle down a little bit, just having a body here may not be the best thing. You have to have everyone on the same page and work with each other equally.”

Shelton agrees that a culture of teamwork is critically important. “Healthcare is all about the group you are working with,” she said. “Patients coming into the hospital are sicker than they’ve ever been. The nurse has so much a responsibility now that to have a good patient care tech or unit secretary or transporter, those support services that are there and committed to the patient is extremely important. It impacts patient care. It impacts retention in a department. The culture and the patient experience comes from the entire team.”

Mohamed Kazamel, MD, ALS clinic co-director

FTC’s First-Ever Health Breach Notification Rule Enforcement: Pixel Users Beware

By Ashley l thoMAs, shAnnon Britton hArtsField, Anthony e. direstA hollAnd & Knight

The Federal Trade Commission (FTC) recently initiated its first enforcement action under the Health Breach Notification Rule against a company for failing to notify consumers and others of alleged unauthorized disclosures of personal health information to Facebook, Google and other companies. The company will be required to pay a civil monetary penalty of $1.5 million.

Adopted in 2009, the Health Breach Notification Rule requires certain businesses not covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify their customers and others if there is a breach of unsecured, individually identifiable electronic health information. The FTC adopted a policy statement on Sept. 15, 2021, emphasizing that developers of digital health apps, connected devices and other health products have obligations under the Health Breach Notification Rule and signaling that enforcement was coming.

The GoodRx Case

In a proposed order the U.S. Department of Justice (DOJ) filed on behalf of

the FTC, the FTC alleges that GoodRx, a direct-to-consumer telehealth and prescription drug discount provider, failed to notify consumers and others of its unauthorized disclosures of consumers’ personal health information to Facebook, Google and other companies. As part of its services, GoodRx lets users keep track of their personal health information, including to save, track and receive alerts about their prescriptions, refills, pricing and medication purchase history. GoodRx made public promises that it would never share personal health information with advertisers or other third parties.

According to the FTC, GoodRx repeatedly violated these promises by sharing sensitive user information with third-party advertising companies and platforms like Facebook, Google and Criteo among other third parties. The complaint states that GoodRx used thirdparty website and mobile app tracking tools, including pixels and software development kits (SDKs) to gather individual data that could be used for data analytics and other services. The use of pixel trackers was also called into question by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights

(OCR) in a memorandum issued on Dec. 1, 2022, applicable to HIPAA-covered entities and business associates.

As part of the settlement, GoodRx will be permanently prohibited from sharing user health data with applicable third parties for advertising purposes, which is a first-of-its-kind settlement stipulation.

As part of the settlement, GoodRx is required 1) to obtain users’ affirmative express consent before disclosing user health information with applicable third parties for other purposes, 2) direct third parties to delete the consumer health data that was shared with them and inform consumers about the breaches, 3) limit how long it can retain personal and health information according to a data retention schedule that will be publicly posted and 4) adopt a comprehensive privacy program with security safeguards.

The information GoodRx shared included its users’ prescription medications and personal health conditions, personal contact information and unique advertising and persistent identifiers. GoodRx shared this information without providing notice to its users or seeking their consent. The FTC also alleged that GoodRx exploited the information shared with

Facebook to target GoodRx users with advertisements on Facebook and Instagram. Using Facebook’s ad-targeting platform, GoodRx matched specific users to their personal health information and designed campaigns that targeted users with advertisements based on their health information – all of which was visible to Facebook.

In addition, the FTC found that GoodRx 1) failed to limit third-party use of personal health information, 2) failed to maintain sufficient policies or procedures to protect its users’ personal health information and 3) falsely claimed it was HIPAA compliant by displaying a seal on its website. Alleged false statements about HIPAA compliance were also the subject of an FTC enforcement action in 2021. As a result of these alleged deficiencies, the FTC determined that GoodRx violated the Health Breach Notification Rule by failing to notify consumers, the FTC and the media about the company’s unauthorized disclosure of individually identifiable health information to Facebook, Google, Criteo, Branch and Twilio.

Moving Forward

Direct-to-consumer healthcare apps and product companies should carefully

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is caused by vitreous gel moving in the eye,” Morris said. “When you are 20, the gel is solid and clear. But as you age, the gel starts to turn liquid and move around. That movement can cause a tear, resulting in retinal detachment.

“In Stickler children, vitreous gel never forms completely, so they have a partial gel floating around just like older folks, from birth onward.” As a result, Stickler patients have a 65 percent lifetime risk of retinal detachment.

When the two family members with Stickler Syndrome came to see Morris, they had both lost vision in one eye, and they were looking to protect the vision in their good eyes. They had been told there was nothing they could do. Morris performed the encircling laser bonding.

“We found a back door proof that encircling laser treatment provided reliable

prevention for detachment, even in older people. We connected the dots showing that what works in a kid with Stickler Syndrome should also prevent the more common retinal detachments in older folks, because they have the same pathogenesis of peripheral retinal tears,” he said. Morris has performed the procedure for other Stickler patients in the ensuing years, and the Helen Keller Foundation released the results in January. “It reduced Stickler Syndrome retinal detachment 10-fold on average from all reports,” according to the release. “Our conclusions are subject to continuing medical peer review, starting with this publication, but the ultimate judgment will be made by each informed patient who faces a high risk of retinal detachment and chooses preventive laser treatment or continued observation.”

FTC’s First-Ever Health Breach Notification

, continued from page 6

review privacy practices and evaluate whether online or public privacy notices accurately reflect current data sharing practices and ensure that they are not doing anything with data that has not been disclosed to consumers.v

There are a number of resources that healthcare mobile apps and products can utilize to better understand respective regulatory obligations. The FTC’s website has a webpage covering the Health Breach Notification Rule with the text of the Rule, blog posts and other materials.

The webpage also includes the form that entities covered by the rule may use to report breaches of health information. The FTC also developed a web-based tool for developers of health-related mobile apps, which is designed to help them understand which federal laws and regulations might apply to their apps.

24/ 7 EYE EMERGENCY ROOM

Encircling Laser Treatment, continued from page 1

Ashley L. Thomas is senior counsel and Anthony DiResta is a partner in Holland & Knight’s Washington, D.C., office. Shannon Britton Hartsfield is a partner in the firm’s Tallahassee office.

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h a t w a s b e c a u s e y o u g u y s c a r e d a n d a p p r e c i a t e d o u r s e n s e o f u r g e n c y . H o n e s t l y , I d o n ’ t s e e h o w w e c o u l d h a v e d o n e t h i s o n o u r o w n . W e a r e t r u l y g r a t e f u l f o r y o u a l l . ” – O w n e r & P h y s i c i a n , O b s t e t r i c s & G y n e c o l o g y

Treatment Breakthroughs for Kidney Stones

By JAne ehrhArdt

Kidney stones impact one in ten people in this country, and about 10 to 30 percent of those cases require some sort of intervention, such as shock waves or invasive surgery. Though the three main treatment approaches have not changed in the last five years, advances in the tools and technology utilized in those treatments have expanded the options for patients.

The most pronounced advancement arrived four years ago with the FDA approval of the thulium fiber laser (TFL). “The energy it creates allows for a higher frequency of delivery, making it more efficient in breaking them,” says Kyle Wood, MD, associate professor and vice chair of research in the UAB Department of Urology.

Prior to thulium, holmium lasers were used and are still in play. “But at UAB, because we’re a tertiary referral center, we see more complex cases requiring longer operating time, and the thulium technology has become a game changer for us,” Wood says, whose training included a two-year fellowship in the advanced surgical techniques and dietary treatment of kidney stones.

To reach larger kidney stones, surgeons make an incision through the back to access the kidneys and then break up

and remove the stone. That procedure generally takes one to over two hours of surgical time. The thulium laser’s higher frequency, however, breaks up stones more quickly which shortens the time needed in the operating room. “In larger cases, this laser typically saves 15 to 20 minutes,” Wood says. “Those become meaningful differences to a patient under anesthesia.”

With the power of the thulium and the advancement in smaller instrumentation, some of these more severe cases are now handled noninvasively. “There’s no cutting. We enter through the normal anatomy channels and up through the ureters to reach the kidney, then use the laser to break up the stone,” Wood says.

Smaller instruments have also enabled more less-invasive approaches to kidney stones, including navigating through the ureter. “We use a lot of accessories, like

mini baskets and wires. And it’s a bunch of small advancements in all those things that have led to better surgery,” Wood says.

Even more drastic has been the developments in optics, which have empowered urologists to reach more stones through the body’s natural channels. “When TVs and cameras get better, it trickles down into surgery rooms,” Wood says. “We usually follow a few years behind what we get in our living rooms. Fiber-optic cameras have been replaced with digital ones, which has led to them becoming smaller. We’re working in millimeters here, so a tiny difference makes a big difference to us.”

Positioned at the end of the ureteroscope—the thin tube used to reach the kidneys through the bladder and ureters— the cameras now measure just a few millimeters in diameter.

The reduction in size now allows urologists to access more deviations and sizes of ureters, which vary among individuals irrelevant of the person’s size or age. “Before the new optics, the ureter was too tiny to fit the camera. It’s very rare now where we can’t get up to the kidney through the ureter,” Wood says.

The ultra-high definition also offers a new level of detail of the lining of the ureters and kidneys. “Not only can we navigate the anatomy in order to put the technology where we need it, but we can

see so much better,” Wood says. “It’s not pixelated. We can tell the difference between tissue and stone.”

Not surprisingly, the new tech is pricey. A flexible catheter runs $20,000 to $30,000 for just one camera per operating room. But fragile tech is known to break every eight to 10 cases, which can cost into the thousands to repair.

With 30 to 50 percent of patients getting another stone within 10 years and 10 percent tending to have more than three stones in their lifetime, Wood says finding the cause should become a priority for physicians. Knowing the makeup of a stone is a vital step, since the cause can vary from low urine pH to genetics. “Physicians should get a metabolic and genetic work up of the stones,” he says. “We need a more personalized medicine approach to kidney stone diseases. Getting at the heart of the cause will lead to better treatment options.”

The South rates high on prevalence of kidney stones. At 12 percent, it’s nearly double that of the Northeast. And it’s no longer a predominantly male affliction. “In the last decade, women have almost caught up,” Wood says, though no one knows why. “It used to be a Caucasian dominate disease, too, but now AfricanAmericans have caught up. It’s probably dietary and trends in comorbidities.”

Kyle Wood, MD

Pelvic Organ Prolapse Giving Women Options

By lAurA FreeMAn

It’s not the first topic women tend to bring up during their regular doctor visits. Too often, they suffer in silence, embarrassed and perhaps unaware that they are far from alone.

“Pelvic organ prolapse is very common, especially in women who have gone through childbirth, or are getting older. Connective tissue disorders, heavy lifting and straining are also risk factors,” said Geneva Dunivan, MD, director of UAB’s division of urogynecology and reproductive surgery. “Sometimes we see younger women after childbirth, but most of the cases we see are women in their 60s or older.”

When the pelvic floor weakens, and muscles and ligaments are no longer able to hold organs in place, gravity takes its toll, pulling downward on the uterus, bladder, rectum and vagina, causing one or a combination of the organs to bulge out of place.

“Women may feel a heaviness or experience a frightening bulge of pelvic tissue where it shouldn’t be,” Dunivan said. “Prolapse can cause or worsen incontinence symptoms, affect a sexual

relationship and undermine confidence. Women may begin limiting their social interactions and activities as they become unsure of where they can go and what they can wear or do.”

A spectrum of treatment options are available, depending on how far symptoms have progressed, which organs are involved, and what a woman’s goals for treatment are.

“Some women simply need the peace of mind of knowing what is happening and may want to stay with conservative measures,” Dunivan said. “We talk with them and give them the information they need to make a personal decision. In milder cases, pelvic floor exercises can help to strengthen muscles and support structures. Medications to help with urinary incontinence may have a role, and estrogen creams can help tissues. When bulging is the primary problem, women may choose to be fitted with a silicone device that can be inserted to hold organs in place.”

As symptoms become more advanced or interfere with daily activities and relationships, patients may want to consider surgical options.

“In choosing from different types of surgeries, our recommendation will de-

pend on the type and degree of the individual patient’s symptoms, their health, as well as their goals and preferences,” Dunivan said. “Again, it is important give them the information they need to make the right decision for themselves.

“One option for prolapse cases that can be approached vaginally is native tissue repair. This procedure has been around awhile and attaches stitches to ligaments and other stronger pelvic tissue to make repairs and support the organs.

In some cases, we might use a permanent surgical material to connect to a ligament for extra support. In the past, a hysterectomy might be part of the repair, but we are seeing more patients who want to keep their uterus and this is usually possible.

“Laparoscopic and robotic surgeries also offer advantages when we need to make repairs through the abdomen. We can work through a smaller incision with greater precision and minimize recovery time.”

Reserved for patients in fragile health who are no longer sexually active, there is another procedure that closes the vagina or shortens it.

“It’s a faster surgery that reduces the time patients are under anesthesia,” Dunivan said. “It also avoids the need for an abdominal incision, which also reduces risk, and helps older and more fragile patients recover faster.

“Pelvic organ prolapse is a topic women should feel free to discuss with their doctors. There is a lot of ground to cover in a primary care visit, and there may not always be time to bring up the topic. But it should be discussed occasionally as female patients have children, get older or deal with other risk factors like

(CONTINUED ON PAGE 19)

Geneva Dunivan, MD

Split-Shared Visit Rules Impact Team Based Care

By tAMMie lunceFord

In the last 10 years, NPPs or NonPhysician Providers have become more prevalent in medical offices and hospitals to allow physicians to care for more patients. As the shortage of physicians continues to increase and the costs continue to rise, the NPP is a reasonable option to cover call or round in the hospital setting.

In 2022, CMS made changes to the Split-Shared visit rules which included a new FS modifier to identify visits conducted by physician/NPP teams. SplitShared visits are only allowed in the facility setting. They are no longer an option in the office, with 2022 being a transitional year. In previous years, the NPP would perform the history, exam and some medical decision-making. Then the physician would conduct a face-toface on the same date to finalize the visit. Even if the physician spent minimal time with the patient, he could bill for the inpatient/observation encounter. The new rules state that only one provider must see the patient face-to-face, and the documentation should indicate the elements

performed by each provider. The billing provider must perform a “substantive” portion of the visit by performing the history, exam, or the medical decisionmaking in its entirety.

The 2023 Physician Fee Schedule finalized a second transitional year for Split-Shared visits due to the outcry of physician groups who were concerned that 2023 would impose split-shared visits billed only by total time. In 2023, the facility Evaluation & Management guidelines were updated to using medical decision-making or time as options if one provider conducts the visit. CMS is allowing history, exam, MDM or more

than 50 percent of the time if the visits is split-shared.

Physicians are realizing that the only way to utilize NPPs in the hospital is to forfeit 15 percent of the revenue. Some physicians say they are involved in every decision of the inpatient visit, but utilize the NPP as a scribe. Others say that they can accept the cut in revenue if they are receiving call pay. The 2024 PFS will surely finalize billing Split-Shared visits using only total time spent by the two providers conducting the visit with whoever spent more than 50 percent of the time will billing for the visit. Physicians and NPPs are not accustomed to documenting time when conducting an E&M visit so administrators should assure training on the “substantive” portion and on how to document total time. This training should update the group Compliance Plan. The coders will likely need to review the documentation to identify visits conducted by two providers to total the time, identify the billing provider, and add the FS modifier.

Some groups are already receiving requests for documentation related to Split-Shared visits. The FS modifier

is mandatory and will serve as a flag for targeted review. Specific specialties are more likely to utilize NPPs in the hospital setting, cardiology, pulmonology, urology, neurology, and orthopedics. These changes are causing great disruption in the way some groups function. There will be much discussion on how to manage this change with minimal loss of revenue, but compliance should be as important as revenue.

Split-Shared Visits can occur in the following services by physicians and NPPs in the same group.

• New and Established patients (remember hospital/facility settings only in 2022

• Initial and Subsequent visits

• Critical Care Services,

• Certain SNF visits,

• Prolonged Services (excludes those related to ED and Critical Care visits)

• Emergency Department (POS 23)

• Observation Care

• Discharge Management NOTE: Splitshared billing is still not allowed for procedures or consultations (9924199255)

Tammie Lunceford is a Healthcare Consultant with Warren Averett.

Tammie Lunceford

New Injectable Bulking Agent for Stress Urinary Incontinence

By JAne ehrhArdt

“We’ve had a lot of enthusiasm from women about this product over the last three years,” says Brent Parnell, MD, a urogynecologist with OB-GYN South. For the 15 million American women experiencing stress urinary incontinence (SUI), this newest injectable bulking agent could relieve them of embarrassing leakage every time they cough, laugh, run, sneeze, or jump, and without surgery.

Called Bulkamid, the water-based filler is injected via a cystoscope through the urethra under the skin of the bladder neck to bulk-up the space between the skin and the muscle. “That provides a little bit of an obstruction at the bladder neck to protect women from leaking,” Parnell says.

Injectables have been used for decades, but the success of the fillers has not been stellar. Initially, these injectable fillers were based on bovine collagen. However, allergies to the compound were common. Its effectiveness also tended to fade fairly quickly. Women were leaking again as soon as six to 12 months later. “It was rarely used because of these early failures, and went off the market,” Parnell

says. The next fillers were made out of calcium products. The calcium created a pseudo-stone that surrounded the urethra. “They did last better, but they had a lot of unfortunate side effects,” Parnell says, listing irritated voiding, symptoms similar to bladder infections, and discomfort. “So it was used sparingly.”

Bulkamid, however, has been popularized in Europe for the last 10 years, where it was developed by Contura, and is currently marketed in 25 countries. Approved by the FDA in January 2020 for SUI, the smooth, polyacrylamide hydrogel filler is 97.5 percent water. “When placed in the body, it remains a gel-like product that’s very soft and not notice-

able,” Parnell says. “It feels like toy slime. It’s clear with a really squishy, soft, sort of tacky feel, and it maintains that consistency in the body.”

However, multiple injections may be needed. Parnell has done repeat injections as early as one or two months after the initial one. “When you inject patients a second time, you still see where the previous gel was injected, but it’s still soft,” Parnell says. “We simply go under the previous injections and fill in that space a little more. The bladder neck compresses, and they’re back to their daily life.”

The maximum number of injections documented so far is three, with most women who needed more filler requiring only one additional injection. “I’m not aware of any maximum number of repeat injections,” Parnell says. Should the hydrogel not work at all, then nothing prevents the women from switching to a surgical option.

For women with SUI who want to have more babies, Bulkamid offers potential for relief now, since surgical intervention has not been possible. “That’s because the support procedure is on the vagina, so when the baby passes through the vagina, it can tear up what has been

done or potentially cause injury to the surrounding organs,” Parnell says. But with Bulkamid injections, the worst that can happen from a vaginal birth is needing to be reinjected.

“It has been a really phenomenal product,” Parnell says, showing 90 percent of the women satisfied with outcome. “That’s the highest rate we’ve ever had with one of these fillers. The past ones were around 60 percent.” Seven years After receiving the Bulkamid treatment, 67 percent of women in a 2021 study still reported feeling cured or improved.

That retrospective study published in Neurourology and Urodynamics included 1,500 women who had undergone Bulkamid injections since 2005. Just over 32 percent completed the seven years of follow-up. Of those, 2.3 percent reported a worsening of their incontinence, while 11 percent reported no change. Twenty percent had received a subsequent other incontinence procedure.

“It’s been revolutionary, especially for really active women who don’t want to stop what they’re doing to recover from a surgery,” Parnell says. “Patients go

(CONTINUED ON PAGE 19)

In the little moments and major milestones of childhood, we are here for our patients and their families – helping, healing, teaching and discovering.

Brent Parnell, MD

Transitioning from Public Health Emergency To A New Normal

By lAurA FreeMAn

With the end of the National COVID-19 Emergency in April and the COVID-19 Public Health Emergency on May 11, American healthcare is in a season of change.

Several of the policies, waivers and flexibilities put in place to cope with the overwhelming challenges of the pandemic are expiring. Many requirements that were moved to the back burner during the COVID crisis are being shifted back to the must-do list of things that will be enforced. Other programs and waivers are scheduled to continue through December 31, 2024.

To avoid a possibly expensive or inconvenient misstep as we work toward the new normal, now is a good time for providers to schedule their own internal checkup to see if there are any issues that need attention.

“Medicaid is one area where providers will want to make sure patients understand that they need to reapply to verify their eligibility for benefits,” Janet Day of Kassouf CPAs and Advisors said. “Letters have been going out for a while now, but we’ve heard that

some Medicaid patients didn’t see them or didn’t know to expect them, while in other cases, the letter didn’t get to the right person.

“It’s going to be up to the patient or whoever is legally responsible for their care to open the letter, fill out the application and make sure it is mailed back in time.”

Credentialing for hospital privileges and other professional requirements is another area that may have slipped by the wayside during the pandemic when providers were struggling to find anyone who was qualified to care for patients. All credentialing and deadlines for important documents should be re-checked to make sure ev-

erything is current.

Telemedicine flexibility should continue through the end of 2024, but there are changes, mostly related to geography, HIPPA privacy rules and prescribing of controlled substances. HIPPA temporarily waived penalties for possible inadvertent violations, but this provision is ending.

“We are going to see some tightening of telemedicine requirements,” Day said. “Video telemedicine, behavioral and mental health visits have been extended through next year. Some of the public video apps we used during the pandemic may no longer qualify. To protect patient privacy, telemedicine video visits will need to be made using a secure video platform. This function may be available through some practice management or electronic medical records programs. Visits can originate from Federal Qualified Health Centers and Rural Health Clinics.

“Medicare will once again require providers to report their home address on the Medicare enrollment record. To continue making tele-visits from their home address, providers will need to complete a credentialing application

and be approved by Medicare.”

Perhaps the most fundamental thing to know about telemedicine is that it can no longer be used to dispense controlled substances. Although this was a tremendous advantage for cancer patients and other immune compromised or housebound patients needing pain medication during the pandemic, physicians will now need to see patients in person before prescribing controlled drugs.

“Workforce flexibilities that allowed some nonphysician providers to work without direct physician supervision are returning to guidelines that were in place before the pandemic.” Day said. “Vaccinations will continue to be covered at no cost to patients by Medicare and most health plans. However, testing is another situation. Most free test kits have already gone out and future testing will likely need to be done at a health facility and most health plans will require patients to share the cost through co-pays or deductibles,” Day said.

Although the official emergency is expiring, the virus lives on. It has

Janet Day

Focus on Electronic Health Information

By Kelli cArpenter FleMing

There have been several recent governmental actions which highlight the balance between securing electronic patient information and the need for interoperability and appropriate exchange of such information. This article will summarize two of those recent actions.

ONC Proposed Rules

The Office of the National Coordinator for Health Information Technology (“ONC”) recently announced proposed rules designed to improve ONC’s Health IT Certification Program and increase interoperability entitled “Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing” (the “Proposed Rule”). The Proposed Rule addresses four (4) key ONC priorities: building the digital foundation of health record information, making interoperability easier, promoting information sharing, and ensuring proper use of health IT tools.

Included in the Proposed Rule are proposals to implement the EHR Reporting Program as a new Condition of

Certification for developers of certified health IT; to modify and expand exceptions within the information blocking regulations to support health information exchange; and to update and reformulate several certification criteria to support health IT functionality in a way that adequately and appropriately supports interoperability and the access and use of health IT. The Proposed Rule also includes new policies aimed at promoting greater trust in the predictive decision support interventions used in healthcare technology. The focus of the Proposed Rule is to enhance the movement of electronic health information in a safe and compliant manner and to improve transparency with regard to health IT.

With regard to the Proposed Rule, Micky Tripathi, PhD, national coordinator for health information technology, said “In addition to fulfilling important statutory obligations of the 21st Century Cures Act, implementing these provisions is critical to advancing interoperability, promoting health equity, and supporting expansion of appropriate access, exchange, and use of electronic health information.”

The Proposed Rule was published on April 18, 2023 and will be open for public

comment by interested parties for 60 days.

HHS Cybersecurity Task Force

On April 17, 2023, The HHS 405(d) Program announced the release of several resources designed to address cybersecurity concerns among healthcare providers and to secure electronic health information. These resources are beneficial tools for providers aiming to bolster cybersecurity efforts.

Knowledge on Demand offers free cybersecurity training on social engineering, ransomware, loss of theft of equipment and data, insider accidental or malicious data loss, and attacks against network connected medical devices. Providers looking to enhance employee training in these areas should consider utilizing Knowledge on Demand. All training should be documented.

Another resource, the Health Industry Cybersecurity Practices, was updated to include a discussion on the danger of social engineering attacks. These attacks are designed to trick employees into revealing information that can be used to infiltrate a system or network. The Health Industry Cybersecurity Practices

include various cybersecurity guidelines, practices, methodologies, procedures and processes healthcare organizations can use to improve cybersecurity and better protect electronic health information.

Finally, the Hospital Cyber Resiliency Initiative Landscape Analysis provides an overview of how hospitals are or are not protecting themselves against certain cybersecurity threats, identifying best practices and areas of improvement. Every hospital should review this analysis to determine how well it is protecting its electronic information in comparison to industry peers.

Both of these recent initiatives support the government’s increased focus on the security and exchange of electronic health information.

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.

Kelli Fleming

UAB Department of OB/GYN Ranked Number Five in the Nation

By lAurA FreeMAn

Alabama has one of the best OB/ GYN facilities in the nation at UAB, which is ranked number five in U.S. News and World Report’s best hospitals for its excellence in obstetrics and gynecology. But it’s a sad irony that even the best hospitals alone can’t counter the economic, social and health-access issues that have led to our state having one of the worst infant and maternal mortality records in a country that ranks significantly lower than most first-world nations. In 2020, Alabama had the third highest maternal death rate in the U.S. In 2021, the U.S. had ten times the rate of maternal deaths as a number of comparable countries including Australia, Japan, Israel and Spain.

“Having a baby today is much safer than it once was. People forget that dying in childbirth or shortly after was not uncommon before modern obstetric and gynecological care,” said Warner Huh, MD, FACOG, FACS, professor and chair of the UAB Department of OB/GYN. “We’ve turned that around so that women now tend to live longer

than men.

“However, we’re seeing a disturbing uptick in maternal and infant mortality, and that needs to be addressed. As a state and a country, we’re also nowhere near where we should be compared to our global peers.”

The recognition the UAB has received can reassure Alabama women that quality OB/GYN care is available

here. “What sets UAB apart is a culture of commitment and excellence,” Huh said. “Our exceptionally talented and highly trained teams are focused on advancing women’s health and offering our patients the very best in everything we do. High-risk pregnancies including the sickest women and babies from across the state and region are referred here because physicians know we will put every effort into helping patients achieve the best possible outcome. Working with difficult cases every day also gives us the depth of expertise to deal with rare and challenging situations.”

UAB also has pockets of excellence in research and clinical care that expand the department’s capabilities in finding and developing innovative solutions. It is one of the few OB/GYN departments doing cutting edge research that changes the standard of care and incorporates it into clinical practice.

“We offer the only uterine transplant program in the south—and perhaps the only truly active program in the nation, as well as an excellent egg and fertility preservation program that can be particularly comforting to young cancer patients who want to become

parents,” Huh said. “We are one of a handful of pediatric gynecology clinical programs in the US with an associated fellowship – ours is the only one in the Southeast region. Our researchers are making tremendous advances in reproductive cancers and understanding the role of HPV in cervical cancer. What we have learned is being translated into screening and treatment advances that are saving lives.”

Also highly ranked in best doctors, staff and patient satisfaction surveys, the department’s outstanding fellowship training and medical education programs, the medical center is also working to address some of the factors behind Alabama’s poor maternal and infants health scores.

“Poor outcomes are disproportionately found in patients of color and those who live in medically underserved areas,” Huh said. “We work with larger numbers of patients from those populations than most medical centers, and we have extensive research going on to investigate the reasons for health disparities and address them. Teamed with the School of Public Health, we’re looking

(CONTINUED ON PAGE 19)

RISK ADVISORS

Warner Huh, MD

Pelvic Organ Prolapse, continued from page 11

lifting heavy weights or straining. Even having an item on a symptoms checklist can get the conversation going or alert the physician that this is a health issue that needs follow-up.”

If a physician doesn’t have time to deal with the problem personally, the patient can be referred to specialist who

deals with it every day.

To women experiencing prolapse, Dunivan’s message is: “You don’t have to suffer in silence. There is nothing to be embarrassed about. It’s something that happens to many women, and there are a lot of things that can be done to make it better. So speak up.”

New Injectable Bulking Agent for Urinary Incontinence,

home the same day with no restrictions to resume their normal activities that day or the next, including work and exercise.

“Bulkamid has offered that in-between option we’ve needed for so long between the less effective conservative management and the more effective surgical management. It’s been a real game-

continued from page 14

changer.”

Parnell has done 150 Bulkamid procedures. Only three have moved on to surgery. “Every time I do one, I’m more convinced that it’s a low risk/high reward procedure,” he says. “If patients are willing to accept that it may not be permanent, there’s really no downside to trying it.”

Transitioning from Public Health

Emergency, continued from page 15

killed more than a million Americans and continues to kill more than 1,000 a week at current levels. In addition, a sizeable percentage of the people who survived the acute phase of infection are dealing with lingering health issues that may need treatment for an unknown amount of time.

Whether a patient needs care for a new infection or the lingering after effects, out of pocket expenses for some treatments may change, depending on the individual’s health coverage. Gen-

erally, COVID-related care is likely to be handled much the same as for any other illness.

Although any transition can have its bumpy spots, compared to the long days and nights of stress most health care providers went through trying to save lives while keeping themselves and their families safe, transitioning is just housekeeping.

And finally, the day we all wished for, when the pandemic would finally be over, may at last be near.

UAB Department of OB/GYN Ranked

Number Five in the Nation continued from page 18

into some of the root causes of poor outcomes and strategies for addressing them. One of our research programs is investigating the possible role of cardiovascular diseases in maternal mortality.

“We’re also working on the healthcare access problem. There are numerous, significant obstetric deserts in the state where patients may have to travel more than a hundred miles for care and may not have transportation. We’re hoping the new certified nurse midwife program we’re launching in cooperation with the School of Nursing will help to ease that situation.”

UAB Ob/Gyn offers the complete spectrum of care for women at every age and stage of life. In addition to the department’s number five ranking, it received a top score of “excellent” in numerous areas, including advanced technologies, patient services, and nurse staffing. It also received a score of “high

performing” in the area of ovarian cancer surgery.

“I’m incredibly proud of our department and the high level of quality health care that we offer all women in Alabama,” Huh said.

Despite being an island of excellence in a region that is lagging behind in maternal and neonatal health, Huh points out that health care providers can’t solve the problem of high maternal and neonatal deaths alone. So many of the factors that lead to crisis situations occur long before patients reach a hospital.

“It’s going to take everyone working together to change policies, economic factors, social and lifestyle influences, access to care and the stress that people in difficult circumstances have to live with on a daily basis,” he said. “We can come together and change things for the better.”

The University of Alabama at Birmingham

Department of Pathology

Academic Surgical Pathology

The Department of Pathology at the University of Alabama at Birmingham (UAB) is pleased to announce a recruitment for an additional academic surgical pathologist. We are inviting applications from qualified candidates at all ranks for a fulltime, tenure earnings/tenured position through the Department of Pathology. The candidates should have an M.D. or D.O. or M.D. Ph.D., Board Certification in Anatomic Pathology, and be eligible for a license to practice medicine in Alabama. Subspecialty expertise in gastrointestinal (GI) and bone & soft tissue pathology will be favorably considered.

The University of Alabama at Birmingham (UAB) is currently processing over 60,000 surgical pathology specimens per year. The surgical pathology services in the Division of Anatomic Pathology includes approximately 25 faculty members with subspecialty expertise in multiple areas.

A pre-employment background investigation is performed on candidates selected for employment. In addition, physicians and other clinical faculty candidates who will be employed by the University of Alabama Health Services Foundation (UAHSF) or other UAB Medicine entities must successfully complete a pre-employment drug and nicotine screen to be hired.

Interested candidates should apply here: https://uab. peopleadmin.com/postings/10497

Interested candidates should submit a cover letter and application packet including curriculum vitae, research interest/ expertise, and the names of three references. Evaluation of applications will occur as they are received and will continue until the position is filled.

For additional information about the Department of Pathology, please visit http://uab.edu/medicine/pathology

To learn more about the University of Alabama at Birmingham, please visit http://uab.edu/home

Coming Soon

Job Board

The place for Alabama healthcare jobs

East Alabama Medical Center Receives Three 2023 Women’s Choice Awards as one of America’s Best Hospitals

East Alabama Medical Center (EAMC) has been named as one of America’s Best Hospitals by the Women’s Choice Award®. The award signifies that EAMC is one of the top healthcare providers in the country based on a review of almost 5,000 hospitals. EAMC was recognized as a top provider in cancer care, obstetrics and orthopedics.

The Women’s Choice Award identifies the nation’s best healthcare institutions based on criteria that considers patient satisfaction, clinical excellence, relevant accreditations and women’s preferences when it comes to treatment and hospital experience. Additionally, each service line award has supplementary criteria specific to the service line. Only the top 10 percent of hospitals in the nation can qualify.

EAMC earned designation as a Best Hospital for Cancer Care award because it met the comprehensive cancer care standards of the Ameri-

George Howard, DrPH, Named Leading Stroke Scientist by the American Stroke Association

The American Stroke Association has named George Howard, DrPH, distinguished professor of Biostatistics in the UAB School of Public Health, the winner of the David G. Sherman Lecture Award. The award recognizes lifetime contributions for investigation, management, mentorship

can College of Surgeons Commission on Cancer, as well as achieving excellence in clinical performance regarding cancer care measures and for their high patient recommendation rate. EAMC ranked in the top nine percent for cancer care in the nation.

EAMC earned the Best Hospitals for Obstetrics award based on its exceptional scores for patient recom-

and community service in the stroke field.

Howard’s career in public health and medicine spans more than 40 years, with more than 20 years at UAB. He has published 21 book chapters, 565 articles and eight letters in an array of biomedical areas, with emphasis on biostatistics and epidemiol-

mendation. Other factors were an analysis that weighs criteria identified as the most important to women for patient satisfaction, including early elective delivery rates, having a Level III/IV NICU, and having infection and surgical complication scores that were ranked below the weighted national average for patient safety. EAMC is recognized for ranking in the top 10 percent for obstetrics care.

By offering a full range of diagnostic and specialty services for patients with injuries or conditions of the muscles, bones, or joints, EAMC earned recognition as one of the Best Hospitals for Orthopedics. Apart from being a comprehensive facility, EAMC has high patient recommendation and recovery ratings, and low adverse surgical event scores. For orthopedics, EAMC ranks in the top seven percent of hospitals in the nation.

ogy methods, stroke, chronic disease epidemiology, and neurological diseases. He is the principal investigator for the UAB REasons for Geographic and Racial Differences in Stroke study, or REGARDS, a national study that examines why more African Americans die from strokes than other races, and why people in the Southeast develop more strokes. The study has received nearly $100 million in funding from the NIH since it began in 2003.

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

East Alabama Medical Center

George Howard, DrPH

Welcome Our Newest Provider

Gregory L. Bearden, MD General Surgery

Gregory L. Bearden, MD is a board-certified general surgeon with over 20 years of medical experience in Birmingham, AL. He attended Birmingham-Southern College and the University of Alabama School of Medicine. He completed his residency with Baptist Health System in 2006 and opened his practice at Princeton in 2009. He is a fellow of the American College of Surgeons and a member of The American Society of Breast Surgeons and The Wound Healing Society.

Special Interests Include:

• General Surgery

• Gastrointestinal/ Colorectal

• Abdominal Hernia

• Breast Biopsy/ Breast Cancer

• Endoscopy

• Thyroid/ Parathyroid

Dr. Bearden is accepting new patients.

Brookwood Baptist Health

Princeton Surgical Specialists

801 Princeton Ave. SW, POB I, Suite 520 Birmingham, AL 35211

Phone: 205-776-8600

Fax: 205-776-8603

Rampart IC Announces Collaboration with Boston Scientific

Rampart IC, a Birmingham-based medical device company specializing in radiation shielding and orthopedic protection, announced a collaborative agreement with Boston Scientific to promote radiation safety and orthopedic protection solutions to medical professionals. The companies will work together on sales program offerings.

In addition to its own international growth, Rampart IC has agreements to sell products in the United States for Fluke Corporation and Mavig GmbH, a provider of personal protective equipment used in hospitals.

Dugum Joins Gastro Health

Bob Foster, MD

The Rampart IC system is already employed by several American healthcare systems. Rampart IC will handle direct sales within the United States, and the company has signed distribution agreements in the Middle East, Asia, Europe and North America, providing its radiation-shielding solution to healthcare professionals in 62 countries.

“I’m very excited about the next generation of operators who are going to be able to work in a better environment both from an orthopedic and radiation standpoint,” said Bob Foster, MD, Rampart IC Founder. “The 100-year-old solution of heavy aprons will soon become obsolete.”

Mohannad Dugum, MD has joined Gastro Health and is practicing gastroenterology and advanced endoscopy at the Grandview Medical Center location.

Dugum received his medical degree with honors from Jordan University of Science and Technology. He completed an Internal Medicine residency at Cleveland Clinic where he was elected to the highly competitive Clinical Scholar Program. He then completed a fellowship in Gastroenterology followed by an additional fellowship in Advanced Endoscopy at the University of Pittsburgh Medical Center. He joins Gastro Health from Duluth, Minnesota where he’s been practicing for three years.

Dugum is trained and experienced in all forms of advanced endoscopy including ERCP, Endoscopic Ultrasound,

Endoscopic Mucosal Resection, Barrett’s esophagus therapy, small bowel enteroscopy (Double Balloon), endoscopic suturing, and enteral stent placement. Additionally, he has acquired several teaching and research awards and authored multiple peer-reviewed publications.

Children’s of Alabama Physicians Honored by U.S. Department of Homeland Security

Kara Huls, MD, and Ashley Hodges, PhD, CRNP, both with Children’s of Alabama, received the inaugural “Outstanding Victim Protection in Countering Human Trafficking” award from the Center for Countering Human Trafficking (CCHT) within the U.S. Department of Homeland Security.

CCHT recognized Huls, Hodges and other members of Birmingham’s Multidisciplinary Team. The group includes law enforcement officers, judicial officials and other service providers working together to improve the detection and care of trafficking survivors. It also works to increase accountability for perpetrators.

Huls and Hodges provide medical care to survivors of childhood sex trafficking at the Sunrise Clinic at Children’s. The clinic, founded in partner-

ship with UAB, offers medical care to survivors of child trafficking. The Sunrise Clinic is held within Children’s Hospital Intervention and Prevention Services Center. It comprises nurses, case managers, therapists and medical staff who are devoted to the care of survivors of child abuse.

Complete Women’s Care Opens Grandview Clinic

Complete Women’s Care of Alabama has opened a new office in Grandview Physicians Plaza II located on the campus of Grandview Medical Center. This location will have ultrasound, mammography and lab.

All eight Complete Women’s Care physicians will be rotating at the new location, including Drs. Kara Conti; Ashley Gooding; James Head; Jessica Rodriguez; Malcolm Simmons; David Spangler; George Zaharias; and Mackenzie Woodson.

New patients can call 205.664.9995 to schedule an appointment or visit online at www. cwcalabama.com.

The Alabaster Complete Women’s Care of Alabama location will remain open and continue to serve current and new patients.

Mohannad Dugum, MD

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UAB Joins as Founding Member of the Global Sarcoidosis Alliance

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

This new network of specialty clinics creates a network for patient and clinician education, innovates sharing of information to advance new therapies for treatment of sarcoidosis, and creates referral networks to connect patients with complex sarcoidosis with specialists.

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 disor-

der affects the lungs in approximately 90 percent of cases, but it can affect almost any organ in the body. 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 with sarcoidosis worldwide.

The FSR Global Sarcoidosis Clinic Alliance brings together sarcoidosis clinics and hospitals committed to finding a cure and offering evidence-based care for those living with sarcoidosis.

State Approves Freestanding ED at Hartselle Health Park

In April, the State Health Planning & Development Agency Certificate of Need Review Board approved Cullman Regional’s application to build a freestanding emergency department in Hartselle. The approval sets in motion an estimated 12-month construction phase to complete the new healthcare facility, which will serve Hartselle and south Morgan County communities.

The 17,934 square foot facility will operate 24/7 and will be staffed

with board certified emergency medicine physicians capable of caring for patients in critical medical conditions. It will offer on-site imaging including MRI and CT as well as lab and pharmacy services. The facility will also be equipped with an

ambulance bay and a helipad.

In 2021, Cullman Regional opened Hartselle Health Park and has since added two physician clinics, a diagnostic imaging center and an urgent care clinic.

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

Architect rendering of future Hartselle ER.