Birmingham Medical News September 2022 by Birmingham Medical News

“When a malignancy is detected, we pinpoint its location and begin

Vials of LUXTURNA

Only Hospital in the Southeast

By laura FreeMan

Ascension St. Vincent’s East New CT Tech Improves Tumor Targeting

UAB Callahan is the only location in the southeast. The two nearest loca-

(CONTINUED ON PAGE 3)

The center’s new Varian TrueBeam Linear Accelerator is one of only three in Alabama. The system’s nextgeneration hardware and software track the micromovements of breath-

“I had two sisters from Alabama who traveled to Texas,” she said. “Their visual ability has basically doubled since the procedure. Before the treatment, as soon as it started to get dark they would go inside because they couldn’t see. Now they can stay out at night. They recently saw fireworks for the first time. They’re cheerleaders and now they can go to cheer practice

By Steve SPencer

Up, down, left, right—pitch and pivot to the optimum angle—advances in CT innovation have mastered spatial coordinates for cancer detection, radiation planning and treatment. Now precision timing is enhancing accuracy for the Cancer Treatment Center at Ascension St. Vincent’s East.

Drs. Jason Crosson and Richard Feist Jr. of Retina Consultants of Ala-

tions are Bascom Palmer Eye Institute in Miami and Baylor in Houston. Dawn DeCarlo, OD, PhD, who serves as the Director of the UAB Center for Low Vision Rehabilitation, has several patients who traveled to get the treatment before Callahan was chosen as a site.

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Leber congenital amaurosis is an extremely rare condition, occurring in two to three per 100,000 newborns. It was chosen because the RPE65 mutation occurs naturally in a breed of dog called Briard, making it easier to conduct animal studies.

bama will perform the procedure for Callahan. The surgeons insert a functioning copy of the RPE65 gene under the retina via a non-lethal virus. It is a precise operation, requiring one surgeon to position the needle and hold it in place while the other surgeon injects the virus containing the gene.

(CONTINUED ON PAGE 3) The TrueBeam offers precision to less than one milimeter.

The UAB Callahan Eye Hospital has been named as one of only 14 treatment sites for Spark® Therapeutics’ LUXTURNA®, the first FDAapproved gene therapy treatment for Leber congenital amaurosis, an eye disease that results from mutations in both copies of the RPE65 gene. This condition, which can only be confirmed by genetic testing, causes patients to begin losing vision in their first five years of life and gets worse as they age.

ing to deliver radiation only when the patient is in the optimum position. This is particularly helpful in treating cancers in the lungs, breast and torso where immobilization devices aren’t able to prevent small changes in position as the lungs expand to take in air and contract to release it.

“With precision down to less than a millimeter, this system makes it possible for us to deliver higher doses of radiation for maximum effectiveness while protecting more healthy tissue and minimizing side effects,” radiation oncologist Laura Dover, MD, said. “This also allows us to complete

UAB Callahan Eye Hospital Performing Cutting-Edge Genetic Therapy for Eye Disease

the course of treatment sooner. Patients who have had radiation before are usually surprised and pleased to find they will be finished with fewer appointments than they expected, particularly those who have to travel a long distance or take time off work to schedule treatments.”

The CT system is designed to combine diagnostic imaging with mapping and planning capabilities that are used to guide radiation delivery. It’s an all-in-one place, in one system.

2 • SEPTEMBER 2022 Birmingham Medical News

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“It’s wonderful to be back and I have to say I consider it an honor to help bring such world class CT diagnostic and treat ment capabilities to the people in my home state,” she said.

Ascension St. Vincent’s East New CT Tech, continued from page 1

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A native of Alabama, Dover was working at Memorial Sloan Kettering in New York when she was recruited to come home to launch the new CT sys tem in the Cancer Treatment Center.

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Now that UAB Callahan is an ap proved site, the hospital has several pa tients in the pipeline for treatment. “We have screened potential patients and the surgeons thought there was enough vi able tissue to make them candidates,” De Carlo said. “However, it takes months to get the insurance approval. The surgery costs is over $400,000 per eye. Fortunately,

UAB Callahan Eye Hospital Cutting-Edge Genetic Therapy,

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“The anatomy of each patient is unique, and the locations and types of cancers tend to differ and can come with different challenges. Each cancer has to

be individually evaluated, mapped and matched to the radiation delivery system. The CT and treatment couch give us won derful control in programming the best po sition. We can move from side to side, and roll the pitch for the best angle. I can also tilt the head and foot of the couch up and down to make the patient more comfort able and get the exact placement we need.

Thanks to the success of this treat ment, and with other gene therapies for vision in phase two and phase three clini cal trials, UAB Callahan now has free ge netic testing eye disease. “In the past, we weren’t genetically testing everybody and the genetic testing for eyes is not covered under insurance,” DeCarlo said. “With

“Another patient of mine was one of the first people treated after it was FDA approved. He was 15. He couldn’t get a driver’s license before this, but he qualified after the treatment. I had been seeing him since he was around five years old. These three people describe this as nothing less thanAlllife-changing.”thesepatients got the treatment when they were in their teens, which is help ful because this is a degenerative condition.

using the data to develop the most effective treatment plan,” Dover said. “We bring the patient in for a preliminary appointment to calculate placement and create a custom mold around the body. It’s a bit like working with wet sand on the beach. The mold helps us precisely position the patient at each appointment and it provides support to make it easier for patients to stay in the right place for an extended period.

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even when it’s getting dark. They can now go to Friday night football games.

Spark® Therapeutics drug has an entire department dedicated to working with in surers for “Evenapproval.preparation for the surgery re quires training. The Callahan pharmacy had to be trained in how to handle it be cause it’s frozen at -80 degrees, it has to be thawed and then reconstituted. So the procedure involves a big team.

So our message to doctors is if you have a patient with a retinal disorder and they haven’t been genetically tested, UAB Calla han has free testing. We can’t guarantee we will find the genetic cause of a person’s eye disease with this test. A lot we do, but some we don’t. But in the future, we may get a re port from the genetic testing company that says we have reclassified this gene for your patient. So it’s valuable information.”

“Staying still can be difficult for any one. The mold helps patients maintain the best position and we also use other immobilization tools to help them, which can vary depending on the type of can

At this point, clinicians don’t know for certain whether the results of the treat ment will last a lifetime, but there was good longevity in the animal models and people from the early treatments are still are doing well, which is vital because it surgeons would probably not be able to re-treat because of a number of complexities involved.

these free inherited retinal disease panels, we can now make sure we don’t miss any of these patients. We can help them find a treatment and give them information about relevant clinical trials. They may or may not want to participate, but we can help them make an informed decision.

continued from page 1

“It is too late when you don’t have any cells left to treat,” DeCarlo said. “It is also too early if you are not at least one year of age because the retina is still developing.”

with greater precision may also allow more leeway to treat tumors that might have been considered too difficult to reach in the past.

cer and where it’s located. For example, if we are dealing with a brain tumor, a custom mask could be created to support the head and neck and keep the patient perfectly positioned. Treating brain or spinal tumors is a good example of how the new system’s accuracy down to the millimeter or less can be so important. Neurons vital to cognitive or physical function are sometimes very close to the malignant tissue we’re trying to eliminate. The more precise our targeting, the bet ter the outcome is likely to be.”

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Dr. Ilorah is board certified by the American Board of Psychiatry & Neurology. He attended medical school at Nnamdi Azikinwe University in Nigeria. He served his residency at the University of Illinois-Peoria and earned his fellowship at Saint Louis University School of Medicine. He earned his Vascular Neurology and Endovascular Surgical Neuroradiology Fellowships at Saint Louis University School of Medicine.

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Brookwood Baptist Health Specialty Care Network is proud to welcome Dr. Chike Ilorah. Dr. Ilorah is a practicing interventional neurologist and is affiliated with Brookwood Baptist Medical Center, a Joint Commission certified Primary Stroke Center and a 2021 GWTG Gold Plus Target: Stroke Honor Roll Elite Plus Advanced Therapy. He and the team at Brookwood Baptist Health Specialty Care Network – Neurology are dedicated to 24/7 care for all stroke patients.

Interventional Neurology Chike Ilorah, MD, MPH

“It allows you to be tested where you are,” says Liz Read, founder and CEO of “That’sClearMINDnow.partoftheran domness to an effective monitoring program.”

By Jane ehrhardt

The results not only rely on the test

duped, ClearMINDNow asked known drug test deceivers to try and fool the test.

The system centers around a phone app and a testing kit about the size of a #10 envelope. Sev eral times a month, the app randomly pings the recovering addict with a text message to take a test within a specified amount of hours. “All you need is your phone, a Wi-Fi or cell signal, and a test packet,” ReadThesays.test takes about 15 to 20 min utes to complete, fitting the timeframe of a typical work break. The app, which guides the user through every step, begins by triggering the video screen that initial izes facial recognition to verify the identity of the person holding the phone. The en tire saliva-based test is videoed.

A person would obviously fail the test if a substance is detected, but it is also con sidered a fail if they decline to test, miss a test, or if they don’t follow the instructions needed to maintain a chain of custody. “There are certain things you have to fol low in our protocol in order for your test to be viable,” Read says. “That’s really key. Because if we’re going to help families re build trust, they have to trust our process.”

ing cube for the chemi cal analysis, but also get interpreted by AI in the cloud. “And we have humans who review the video that we’ve taken of you testing to verify the results,” Read itschoseClearMINDNowsays.salivatestingforconvenience,cost,and

Cost was also a driving factor for Read, since actively recovering addicts need up to five or more tests a month. Choosing to use saliva testing, which be came available a few years ago, makes the frequent testing realistically affordable.

“They helped us develop something that we feel is impossible to cheat, as far as we know,” Read says.

On September 1, a Birmingham company launched the first appdriven remote monitoring service for narcotics use.

While a urinalysis runs $60 to over $100 per test, the ClearMINDNow pro gram costs $30 per test. “And you get ev erything you need,” Read says, including the app, test kit and results, as well as a phone stand and testing mat, along with auto-sharing of the results, the engagement of the supporters, in-app education, and a wellness plan. That personalized plan lists the consequences unique to that person if they falter, as well as the rewards, like more visitation time with children or continuing financial support, for staying clean.

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The user places the test stick in his mouth to absorb saliva for about five minutes. Then she inserts the stick into a small test cube which detects the metabo lites present. The app displays the positive or negative result and sends that outcome to the person’s monitoring partner and a supporter of their choice.

because it is difficult to cheat. “It’s impossible to adulterate your saliva while someone is watch ing you take it,” Read says, unlike a urinalysis which can be tainted even while being monitored by in gesting certain substances beforehand that throw off the chemical results or by simply theirTooverhydrating.ascertainwhetherprotocolcouldbe

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At this time, the service officially is only available to people who are coming out of the area treatment centers that are currently partnering with ClearMindNow. “But it will be available to everyone later on,” Read says. “In about six to nine months, the app will also direct members to the nearest lab should that be needed. We will offer ways to do lab confirmation with saliva and urine through onsite lab partners.”

“That’s when the balance of forces comes into play,” Read says. “The imme diate awareness by others invested in the person’s recovery creates accountability. The monitoring partner might be a treat ment center case manager, therapist, or even an attorney. The supporter is usu ally a loved one. In the app, you and your supporters can see all your testing history. You can build up a great documentation of clear tests.”

“Ultimately, the intent of our service is to provide monitoring that empowers people,” Read says. “Testing should not feel like a punishment. We want to make it easy and dignified.”

The discoveries, innovations and clinical trials 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.

(CONTINUED ON PAGE 9)

“However, we don’t consider this sur gery to be minimally invasive. The size of

“It depends on how you break down the numbers,” said David Moore, MD, joint replacement specialist at Andrews. “My understanding is that from 2018 to the present, Ascension St. Vincent’s is number one in the country, but as the technology has become more popular, we are falling off the pace a little bit, because there are more big institutions utilizing it Undernow.”theurging

The surgeons urged other physicians to stop considering joint replacement as a last resort. “Some patients wait too long, until they are crippled,” Moore said. “Implants are vastly improved and robots make it a better experience. The proce dure has been undersold in the past.”

Cancer_Month-DISCOVERY-Bham Medical News_10x6.38-PROD.indd 1 8/17/22 9:14 AM ORTHOPEDICS

“It’s still a big surgery,” Davis said. “It still takes four to six weeks to feel like your self again and have the same energy level that you had before the surgery.”

Andrews Sports Medicine Leads in Using Robots for Joint Replacement Surgery

of Moore, Andrews was the first practice to bring Stryker’s Mako SmartRobotics technology to this area in 2017. They had lobbied Ascen sion St. Vincent’s Birmingham to make the purchase, and ultimately were so con vinced it would improve care that the prac tice purchased it themselves and leased it back to the hospital. The hospital now has three of the machines, which stay busy.

“Joint replacement isn’t 100 percent successful and it isn’t a panacea,” Davis

“We’ve completed well over 5,000 cases,” said Jeffrey Davis, MD, orthopae dic surgeon and joint replacement special ist at Andrews. “We are pleased with the outcomes and it’s an improvement in the way we perform the surgery. It allows for better planning, more accuracy and con sistency, and x-ray outcomes are definitely better. It’s like the difference between fly ing an airplane visually versus having in strumental input.

By Marti WeBB Slay

As robotics play a larger role in total joint replacement surgeries, the proce dures are proving to be more effective than ever. Andrews Sports Medicine & Orthopaedic Center in Birmingham has used the technology more than almost any other institution in the U.S.

The technology allows the surgeon to be more precise, with less trial and error. “It helps the surgeon protect tissue that doesn’t need cutting. It can put some boundaries around what you’re doing, so the instruments stop and don’t let you cut something unnecessarily,” Moore said. “Part of getting a total knee to last as long as possible is getting the implants in the correct position. Previous technologies didn’t allow us to us to be as precise as we would have liked, but with this we can make sure all the cuts we do are correct for each individual patient. I haven’t done a surgery without Mako technology since we got it. It’s that much better.

L to R: Jeffrey Davis MD and David Moore, MD with the SmartRobotics technology at Ascension St. Vincent’s

the scar depends on the size of the im plants. It’s not minimally invasive in terms of the incision, but there’s less soft tissue damage and less in and out of the wound. In that sense, it’s less invasive a surgery than it used to be, and less damaging.”

Discovery happens here•

When physicians, scientists and researchers with extraordinary talent and passion are given the technology, the facilities, and the support, they achieve great things.

To learn about the more than 90 current clinical trials for childhood cancer and blood disorders, visit ChildrensAL.org/cancer-clinical-trials.

6 • SEPTEMBER 2022 Birmingham Medical News

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that one piece of information can require a time-consuming adaptation while the patient is on the table. “Bone loss on a sub stantial area of the glenoid is a critical factor because as you lose more bone on glenoid, a small area to begin with, it changes how you place the implant. If you’re too far off one way or the other or remove more than you should, it can change what you’re able to do and can affect your outcome.”

The computer builds the 3D view from CT scans. “That gives you imag ing in several different planes, instead of one single picture like with an x-ray, so through serial slices you can see the entire shoulder socket and blade and entire hu merus,” Isbell says.

In post-care advancements, shoul der procedures have become opioid-free. “Shoulder replacements can be done with no narcotic pain management if you use a multi-modal approach,” Isbell says. By working with anesthesiologists, using nerve blocks preoperative, the shoulder can be numbed for the crucial 12 to 16 hours post-operative. With several medi cations as simple as Tylenol and anti-in flammatories, and local anesthetics, the patient experiences minimal pain the first few sensitive days after surgery.

P: (205) 481-8510

That precision saves time, which low ers risks. Standard shoulder replacements generally take 60 to 90 minutes or longer with more complex cases, such as signifi cant deformity on the glenoid. “But when you know exactly what kind of replace ment you need, and when things go well, even though it’s a pretty difficult case, it can go very smoothly, and take 20 to 30 minutes less,” Isbell says.

Shoulder Replacement Advances

Now seeing patients in Vance.

Not only has the post-care and re covery improved on these procedures, but the number has skyrocketed in the last few decades. From 2005 to 2017, shoulder re vision surgeries rose 210 percent and 730 percent since 1995, according to a 2020 paper in The Journal of Bone & Joint Surgery. “The indications have grown, more surgeons are being trained, and we’ve found a lot of better ways to do this over the years,” says Isbell, who practices at SouthlakeTechnologicalOrthopeadics.advances in the last decade have improved the process. Be fore digital software options entered the field, surgeons had only x-rays to assess the shoulder’s condition and determine placement options for the components beingTheseinserted.days, a 3D rotatable image of the patient’s joint area appears on a

With the age of 90 percent of shoulder replacement patients dropping from the 70s to the 50s, and the procedure evolving to become available to a wider array of con ditions, including severe rotator cuff tears, the procedure is destined to become more common. “This means better things for the field,” Isbell says. “With more indica tions, more surgeons becoming comfortable doing replacements, and people getting more active and living to older ages, that will drive more innovation.”

“At least 50 to 75 percent of shoulder replacements have gone home the same day,” says Jonathan Isbell, MD, about the 100-plus surgeries he performed in the past year. “Five years ago, 100 percent would have been admitted for at least a night.” Without a required overnight stay, shoulder surgeries have grown beyond hospital boundaries and are now being performed in ambulatory surgery centers.

The enhanced view not only offers a 360-degree view of the surgical area, but reveals information that can change the pro cedure and the outcome. “Sometimes x-rays underestimate how much bone loss there is or how much tilt there is,” Isbell says.

Since bone loss determines the viabil ity of a site for the guide pin and anchors to hold the implant, any inaccuracy of

reamers sit atop that pin to smooth and expose exactly where needed to suit the implant. “If you feel you have very, very little room for error in the OR and very little room for variability, you can have these patient-specific guides made to allow you to put everything exactly where you have it planned,” Isbell says.

Welcoming our newest Nurse Practitioner

By Jane ehrhardt

For the complex cases, makers now offer custom-built guides, opening the door for life changing improvements to those restricted by the pain and limita tions of decimated shoulders. The guide pin is stationed in the socket. A series of

Jonathan Isbell, MD in surgery.

Medical West is proud to welcome Brandi Hubbard , DNP, CRNP, FNP-c, to our team of medical professionals. Brandi is a board-certified Family Medici ne Nurse Practitioner. She received her Associates of Science in Nursing degree from Jefferson State Community College and her Masters of Science in Family Nurse Practioner and Doctor of Nursing Practice in Advanced Practice Resarch from Samford University. Brandi is now seeing patients at the Medical West Vance Health Center. Raised in Vance herself, Brandi is excited to serve the patients in her own community.

BRANDI HUBBARD, CRNP

ORTHOPEDICS

To schedule an appointment, scan the QR code or call (205) 481-8510.

8 • SEPTEMBER 2022 Birmingham Medical News

screen alongside the available shapes, lengths, and sizes of the replacement ele ments being inserted. “You see the differ ent components, different augmentations, rotations, sizes—all on the PC,” Isbell says. “Then when you start the case, you know exactly where the implant will go.”

Medical West Vance Health Center 18704 Hwy 11 North Vance, AL 35490

surgery rather than whatever tools they use,” he said.” But there’s no question the robot makes us more accurate. We are still very much in control, and we are at the patient’s side. It’s very hands on. It’s truly robot-assisted surgery.

Patterson,MichaelMD

Andrews Sports Robots, continued from page 6

After deciding to pursue medicine, Patterson thought orthopedic surgery would fit well with his love of sports. Though he didn’t have any major injuries during his time playing for Florida State, Patterson did spend time with the team physician and thought that was something he would like to do. “It’s been special for me, as an adult, to have a career involved in something I have a passion for.”

“My job is to try to return people to play in a safe manner, as soon as we can,” Patterson said. “So if someone hurts their knee in a game, and you can examine that person and tell them they have a ligament injury and it’s not safe to return. Then you’re going to help that person by getting them taken care of and not letting them cause any further damage to their knee.

According to Patterson, most wellpopulated schools such as those in Bir mingham, Montgomery and Huntsville have access to physicians on the sidelines of their high school football games while rural areas may not even have trainers. Patterson is actively trying to find a way to provide these rural towns in Alabama with access to great orthopedic care. said. “But it’s as good a surgery as there is to improve quality of life. It’s a viable option earlier in the process.”

with sports medicine, both at the high school and college level here has been very satisfying.”

ORTHOPEDICS

ChoiceYour TotalOutpatientFor Joint & Spine

“For me as a former player, being in volved with a team and just feeling like you’re there as part of the team is always a great experience,” Patterson said. “So when you show up at a game, and the coaches ap preciate you being there, the players know you and respect you and you’ll see players come back to games that come up and shake your hand or hug you, it’s like being a part of that family. And I think when, as a physician to have that feeling and to be part of that, that’s your goal, whatever level it is.”

“Not everything that’s new is better, but if it is better, we want to be industry leaders in that. We are thoughtfully cutting edge.”

Michael Patterson, MD has always had a passion for sports. He played four sports in high school but fell in love with football. After being off the field for years now, Patterson can still be seen on the sidelines of Friday night high school football games, but not in a jersey.

It all started for Patterson in 1985 when Coach Bobby Bowden recruited him to play football at Florida State University in Tallahassee as a cornerback. “We lived in Homestead, Florida so it was a little bit away, but I loved it when I went there. It’s worked out great for me in the long run,” Patterson said. “My biggest claim to fame is that I watched Deion Sanders play up close. We were freshmen together and played the same position, cornerback. He obviously had a lot more football prowess than I did, so I figured I needed to do something else to make a living.”

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Once completing medical school at the University of Florida, followed by an Orthopedic Residency in Orlando and a Sports Medicine Fellowship in Birming ham at the American Sports Institute, Patterson took several jobs out of state before settling in Alabama.

“I wanted to come back to Birming ham because I enjoyed my fellowship ex perience here so much. I think it’s been a great, great experience for me,” Patter son said. “We got exposed to high school, college and professional athletes and just being around that environment was fun. To come back and be able to be involved

Patterson now focuses on high school and college-level football athletes such as the University of Montevallo, Law son State and three-time defend ing state 7A champion, Thompson High School. He and his team offer Wednesday afternoon clinics where Thompson High School football players can receive medical care such as x-rays, suturing and casting. After Friday night games, injured players can get evaluated at the after-hours clinic. This eliminates the need to wait until clinics re-open on Monday to receive information about the player’s abilities to play the following week.

Despite the improvement technology has made to the procedure, Moore says the robot is still only a tool, and it’s up to the surgeon to use it effectively. “Experi ence is still the most important thing when you are trying to decide who will do your

Former College Football Player Returns to the Field to Help Younger Generations of Athletes

Birmingham Medical News SEPTEMBER 2022 • 9 Solutions as unique as your business George Morris, Partner 2001 Park Place North Birmingham, ALHealthphelps.comcare providers with business interests across the South turn to Phelps for counsel on their legal needs. With 13 office locations in the U.S. and in London, we serve clients in the region’s major commercial centers. Our 300-plus lawyers focus on six core areas: health care, litigation, labor and employment, business, insurance coverage and admiralty. But it’s more than our casework that sets us apart. It is energy and passion for solving our clients’ challenges.

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The suspect business models typically in volve a health care business that requires a prescription from a practitioner to sell its product proactively reaching out to potential patients via a call center or tele marketer. While these suspect business models have been in existence long before the advent of telemedicine, coordinating a practitioner-patient visit on a large scale using telemedicine is now relatively easy.

On the same day as the July 20, 2022 DOJ announcement, the HHS Office of Inspector General issued a Special Fraud Alert aimed at telemedicine practitioners. The Special Fraud Alert enumerated many “suspect characteristics” that pres ent a heightened risk of fraud and abuse. The OIG carefully pointed out that not all telemedicine companies are suspicious and the Special Fraud Alert was not in tended to discourage legitimate telemedi cine arrangements. Indeed, for most the expansion of telemedicine is viewed as a positive advancement in promoting ac cess to care. However, the Special Fraud Alert emphasizes that the OIG will exer cise heightened enforcement scrutiny of

The quality of the telemedicine visit is critically important for all tele medicine business models, even for the most legitimate use of telemedicine. The quality of the telemedicine visit is many times the undoing of the entire busi ness model. The stronger the quality of the telemedicine visits, the stronger the defense against allegations of fraud. A quality telemedicine visit creates the support for the medical decision-making and the medical necessity for any recom mendation or prescription.

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Telemedicine saw a dra matic increase during the COVID-19 pandemic. A recent study from the U.S. Department of Health and Human Services (HHS), released in December 2021, showed an increase in Medicare telemedicine visits during the pandemic from approximately 840,000 in 2019 to 52.7 million in 2020. The rapid improvement of information technology has led to the increase in the use of telemedicine as a legitimate delivery platform with the COVID-19 pandemic placing telemedicine in the mainstream of health care Notwithstandingdelivery.

Other important factors include the quality of and access to the patient’s med ical records by the practitioner. Practitio ners must be able to defend their medical

Jim Hoover

such arrangements.Themostcommon char acteristics that appear to catch the DOJ’s attention when examining the use of telemedicine in various busi ness models is the reason for the telemedicine visit and the quality of the telemedicine visit.

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This latest crack down continues a trend of enforcement actions against business models involving telemedi cine companies. For example, previous DOJ initiatives include 2019’s Opera tion Brace Yourself, 2019’s Operation Double Helix, 2020’s Operation Rubber Stamp, and the telemedicine component of the 2021 National Health Care Fraud Enforcement Action. The Operation Brace Yourself Telemedicine and Dura ble Medical Equipment Takedown, ac cording to the DOJ, alone resulted in an estimated cost avoidance of more than $1.9 billion in the amount paid by Medi care for orthotic braces in the 20 months following that enforcement action.

(CONTINUED ON PAGE 17)

By JiM hoover

telemedicine’s le gitimate use as a health care delivery model, the questionable use of telemedi cine in certain business models has led the Department of Justice (DOJ) to take an aggressive review of arrangements using telemedicine. On July 20, 2022, the DOJ issued a press release announc ing a concerted effort to combat specific areas of health care fraud, including telemedicine. The release highlighted criminal charges brought against 36 de fendants in 13 federal districts totaling over $1.2 billion in criminal proceeds (over $1 billion of which stem from un lawful telemedicine practices).

The quality of the telemedicine visit involves such things as the level of in teraction between the practitioner and patient, the modalities used during the visit and the tools available for the prac titioner to make a definitive diagnosis and recommendation. Quite simply, does the practitioner have sufficient con tact with the patient and/or information about the patient to meaningfully assess the medical necessity of the items or services ordered or prescribed. Many times the answer to this question reverts back to the reason for the telemedicine visit, e.g. was it because the patient was truly seeking out health care advice and treatment options or was it because a telemarketer, call center or sales repre sentative called the potential patient and connected them with the practitioner?

The DOJ Continues to Scrutinize Telemedicine

Another obvious suspect character istic is the payment methodology used to pay the practitioners. Very few arrange ments are brazen enough to compensate the practitioner per prescription. Most ar rangements pay the practitioner per visit or based upon a time element such as per hour. These methods can become closely linked to a “per click” arrangement, par ticularly if there is an incentive such as a bonus payment for the practitioner.

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Managing Volatile Construction Costs & Supply Chain Disruptions

The report points out three practical, time-sensitive changes that have occurred to accommodate market fluctuations:

(CONTINUED ON PAGE 17)

Over a decade ago, a tornado de stroyed St. John’s Regional Medical Center in Joplin, Missouri, ripping off most of the building’s walls, windows, and roof system. Five patients died when ventilators lost electrical power.

3. Because disruption caused by spiking material pricing caught industry workers off-guard, it’s become more important than ever to communicate with “Thistransparency.recentshift requires a new mindset and includes the need to reset past practices,” said Kevin Harney, AIA, vice president of New Jersey-based ESa Architects.

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The pandemic set in motion radical changes in building and renovating hospitals, clinics and medical practices

2. The ongoing level of material shortage and resulting cost escalation requires changes in procurement strategy, including the strong consideration of early purchasing advantages.

The consequences of this tragedy and related natural disaster losses led to recently adopted wind-load standards. This year, a new and emerging edition of the energy codes require a higher level of thermal performance from the exterior envelope,

The 2020 pandemic set off a chain reaction of challenges for the healthcare construction community, altering the way hospitals and medical practices are being built and Birmingham-basedrenovated.Robins & Mor ton recently unveiled a study, The State of Healthcare Construction, which highlights market trends and shows how building and design partners have re sponded to dramatic changes.

Supply chain bottlenecks are cou pled with the doubling in demand of materials and labor. For example, more than one million construction jobs re main unfilled across the nation. These challenges, combined with a recordbreaking surge of creating alternate care facilities to treat COVID patients in 2020, have put the industry in the lurch.

including roofs, windows, and walls.

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“In many ways, the past year has been even more disruptive than 2020, creating challenges that everyone in healthcare con struction will face in the year ahead,” said Bill Morton, CEO of Robins & Morton.

The report’s findings underscore the importance of a collaborative ap proach in addressing escalating costs, supply chain issues and labor shortages. The report reviews how the pandemic accelerated changes in traditional ap proaches to healthcare construction, and how those best practice lessons are being applied to these challenges.

“Hospital owners realize the cost and risk attached to doing long-term constant maintenance,” said Sam Burnette, AIA, principal at ESa’s design firm. “We’ve learned that you can achieve a tremen dous return on investment and a lower life cycle cost when you build with better quality exterior building envelopes.”

By lynne Jeter

Soaring construction costs, severe labor shortages, chemical plant shut downs, wildfires in timber forests and a re cord-setting residential boom have greatly hindered healthcare construction projects.

“Building these facilities so quickly showed everyone the benefits of a com mitted partnership and opened our eyes to questioning the status quo,” said Patrick Duke, managing director of Dallas-based CBRE Healthcare. “That experience changed the notion of what was possible when everyone came to the table together to solve a daunting problem.”

The State of Healthcare Construction

Burnette has noticed a dramatic reduction in expense and patient dis ruption from repairing leaky glass to upgrading building exteriors to correct poor energy Parenthetically,performance.noise mitigation is often an overlooked factor in building envelope decisions. “If the patient isn’t

MOVING BEYOND CODE WITH RESILIENT BUILDING ENVELOPES

1. The siloed approach in healthcare construction has diminished. Instead, scenario planning across disciplines during pre-construction is essential.

“Fortunately, at the time I was teaching at a medical center and was able to arrange for her care at no charge. But the incident got me thinking—how would other patients deal with this kind of expense? Would their surgeons have to share in the cost or face a lawsuit? I was active in professional orga nizations and knew this would be an issue of concern for most of our members. I also knew people in the insurance field and started talking with them about the possibil ity of insurance for complications of plastic surgery.” That led Grotting to launch Cos metAssure almost 20 years ago.

Thecame.procedure went well, and it looked like the investment she had made in herself was going to pay off in great results that would boost her confidence and self image. But when she was in recovery, her plastic surgeon noticed that something unexpected was going on with her blood pressure.

“In this particular case, the patient’s blood pressure was still far too high to send her home,” Grotting said. “She needed to be monitored closely for a day or two until her blood pressure returned to normal. But the cost of inpatient care would be a lot for her to have to pay out of pocket since health insur ance generally doesn’t pay for anything that could be related to an elective procedure. I felt really bad for her. She had already paid for her surgery. She was going to be happy with how she looked, but no one would be happy facing a large unexpected bill.

“In some patients—few, fortunately— there can be an unusual response to an esthesia. Blood pressure that was normal before surgery can suddenly rise to danger ous levels and stay there.” James Grotting, MD

James C. Grotting MD

tects a large percentage of board certified plastic surgeons and their patients across the U.S. In addition, the information gleaned from the insurance provides a database of all covered elective procedures per formed over almost two decades, detailing risks associated with vari ous types of plastic surgery, as well as the most likely complications as sociated with different procedures, which helps patients make better informed decisions and alerts sur geons to potential complications.

“To apply for coverage, a physician must be a board certified plastic surgeon and a member of at least one of two pro fessional organizations, either the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery,” said Amy Fuqua, a Senior Account Executive with CosmetAssure. “The insurance cov ers treatment for complications that arise within 42 days of the procedure or possi bly longer in rare conditions that take more time to become apparent.

Grotting said: “when the idea first came to me, I was thinking of something like travel insurance. Patients could choose to opt in or opt out. But after discussing it with insurance industry friends, it made more sense to insure all procedures so costs could be spread out over a larger number of people. If only the most at-risk patients chose insurance, the cost would be too high to be practical. Spread out over all proce dures, the cost could be quite low and the same for all procedures. The only exception is the Brazilian butt lift. There’s more that can go wrong, so the premium on that pro cedure is higher. Some plastic surgeons add the premium to their bill as a line item, but I just build it into the basic cost.

“It’s a relief to know that we now have insurance for complications for all our pa tients. We don’t have to worry about them having to cope with unexpected bills. We can do our work and concentrate on giving them beautiful results.”

Available through the Bir mingham office of USI Insurance Services, one of the leading privately held insurance brokers in the country, the cover age was the first of its kind in the U.S.

of the foremost plastic surgeons in the country, Grotting has served as presi dent of the American Society for Aesthetic Plastic Surgery, is chairman elect for the American Board of Plastic Surgery and has taught the specialty at two major medical schools. Yet even he, despite his highly re garded skills, has had to deal with the unex pected. And in the real world, when dealing with anything as complex as the human body, the unexpected can happen any time.

Amy Fuqua

Today CosmetAssure coverage pro

“The most common claims are related to relatively minor complications; for ex ample, hematomas and occasionally infec tions at the surgical site that may need more aggressive treatment. Depending on skin type and how well post-op care instructions are followed, some scars may be more no ticeable than others and require revision or other follow-up.”

She had done her homework and found a board-certified plas tic surgeon she trusted. Since the elective procedure wasn’t covered by her health insurance, it had taken a while to save enough to pay for the surgery, but finally the big day

CosmetAssure Protects Plastic Surgeons and Patients

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Rural Emergency Hospitals Start to Take Shape

• Have an organized medical staff that operates under bylaws approved by the hospital’s governing body;

The proposed rule defines the condi tions that a rural emergency hospital must meet to participate in the Medicare pro gram. Under these conditions, a rural emer gency hospital must, among other things:

The proposed rule also states that rural emergency hospitals must staff their emergency services in the same way that critical access hospitals do. Under this requirement, practitioners do not have to be on-site at all times. Instead, a physician, physician assistant, nurse practitioner, or clinical nurse specialist must be on call and able to get to the

• Have an agreement with at least one level I or level II trauma hospital for the referral and transfer of patients who re quire emergency care beyond the rural emergency hospital’s capabilities.

CMS recently published a proposed rule describing the conditions of par ticipation for a new type of Medicare provider, the rural emergency hospital. Noting that rural communities repre sent one-fifth of the U.S. population, in announcing the proposed rule CMS Administrator Chiquita Brooks-LaSure said “the new Rural Emergency Hospi tal provider type will maintain access to essential healthcare services and help to reduce disparities in rural communities.”

16 • SEPTEMBER 2022 Birmingham Medical News

(CONTINUED ON PAGE 17)

• Have a pharmacy or drug storage area maintained by a pharmacist or other qualified individual in accordance with state law;

Congress established this new provider type in the Consolidated Ap propriations Act of 2021 to address concerns about the continuing closure of rural hospitals, which CMS tallies at 138 since 2010. As CMS stated in a press release, the alarming closure of rural hospitals means people living in rural communities “experience shorter life expectancy, higher mortality, and have fewer local healthcare providers, leading to worse health outcomes than in other communities.” CMS called the new provider designation “an opportu nity for small rural hospitals and critical access hospitals to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities.”

• Maintain, or have available, diagnostic radiology services, including a full-time or part-time consulting qualified radi ologist (or other qualified personnel) to interpret radiologic tests the medi cal staff determines require specialized knowledge;

By nate lykinS

• Provide (either directly or through a contract) basic laboratory services es sential to the immediate diagnosis and treatment of patients; and

Beginning January 1, 2023, Medicare will reimburse rural emergency hospitals at 105 percent of the rates in the Hospital Outpatient Prospective Payment System, and rural emergency hospitals will receive an additional monthly facility payment. In a separate proposed rule, CMS proposed that the facility payment in 2023 would be just over $268,000 per month, for a total of around $3.2 million per year for each rural emergency hospital.

Rural emergency hospitals may only provide inpatient services in distinct part units licensed as skilled nursing facilities, and a rural emergency hospital’s annual per patient average length of stay may not exceed 24 hours. Additionally, a rural emer

In general, rural emergency hos pitals provide emergency department, observation care, and certain additional outpatient medical and health services, which the proposed rule states are items and services commonly furnished in a physician’s office or another entry point into the healthcare delivery system (e.g., radiology, laboratory, outpatient reha bilitation, surgical, maternal health, and behavioral health services) that “align with the health needs of the community served” by the hospital.

gency hospital must have been a critical ac cess hospital or rural hospital with no more than 50 beds on December 27, 2020.

The State of Construction,Healthcare

Learn

KEY TAKEAWAYS:

them appropriately and in compliance with the Anti-Kickback Statute and other state and federal laws. Enforcement scru tiny will continue and will likely take the form of grand jury or administrative sub poenas, search warrants, civil investigative demands, HHS-OIG inquiries and state investigations or audits.

Hand, Wrist & Upper Extremity Specialist more about Dr. Beaumont

and delivery intervention is necessary.

• Early in the process, the options for building envelope components should be considered by an integrated team of designers, consultants, builders, and hospital facilities staff.

Comments regarding these issues must be received by August 29, 2022, to be con sidered while comments to the proposed rule addressing the monthly facility fee must be received by September 13, 2022.

• Building envelope decisions extend far beyond today’s code requirements to include long-term opportunities for futureproofing hospitals.

Charles C. Pitts, Jr., MD

Birmingham Medical News SEPTEMBER 2022 • 17 Now Accepting New Patients (205) AcceptingAndrewsSportsMedicine.com939-3699NowNewPatients (205)939-3699AndrewsSportsMedicine.comWELCOMES Now Accepting New Patients at Our Birmingham Clinic (205) 939-3699 AndrewsSportsMedicine.com Christopher M. Beaumont, MD ORTHOPAEDIC SURGEON

hospital within a specific time, usually 30 minutes. CMS has requested comments about this requirement to gain insight about whether it is appropriate not to require that a practitioner be on-site at a rural emergency hospital at all times.

Nate Lykins is an associate at Waller where he assists healthcare providers with regulatory compliance matters ranging from the Stark Law and the Anti-kickback Statute to licensing regulations, Medicare certification, and other operational issues.

Duke said the pandemic experience of the past two years “makes the human side of the business more important. Company leaders and our clients are more willing to question past methods and ask how to do it better.

ORTHOPAEDIC SURGEON

Foot & Ankle Specialist more about Dr. Pitts

For example, when the Carilion Ro anoke Memorial Hospital’s expansion was underway for The Crystal Spring Tower in Roanoke, the team of players was extended to another level: including conversations with community residents.

Bagby suggests team members ob serve the function part of the project. “Talk to the forward-thinking nurse man ager or the maintenance workers and ask them what they dream about to make their work easier,” he said. “When we find individuals who behave that way, every thing else becomes easier to accomplish.”

decision-making if ever challenged. As a result, the medical record maintained by the telemedicine company must be readily retrievable and/or accessible by the practi tioner. It should be formatted as a standard medical record and sufficiently document the encounter to justify the medical deci sion-making. The axiom in health care of “if it is not documented it did not happen” is zealously adhered to by prosecutors.

When BayCare Health Systems ex pedited the opening of multiple patient floors on a new tower at St. Joseph’s Hospital in Tampa, a host of players – the client, contractor, architect, engi neer, trade contractors, vendors, city and state inspectors and city officials – forged new ways of collaboration.

INCREASING COLLABORATIONTRUST-BASED

Telemedicine companies and practi tioners should evaluate their arrangements with care to ensure that they structure

“These conversations revealed the real purpose of the hospital expansion - not just build a hospital, but to help to take care of people for generations,” said Josh Farr, a su perintendent at Robins & Morton.

• The strategic choice to avoid the need for costly revision and re-work years later should be supported by research, testing, and envelope mockups.

CMS also requested comments about whether rural emergency hospitals should be permitted to provide low-risk labor and delivery services and whether they should be required to provide out patient surgical services if surgical labor

Rural Emergency Hospitals Start to Take Shape, continued from page 16

getting a restful night’s sleep or can’t nap following medical procedures, they’re not likely to give the hospital a positive score on noise management,” Burnette said.

• A set of decisions with lasting impact on building resilience, patient and staff safety and service continuity for the hospital should be considered by the frequency and extent of natural disasters.

“The important thing is to have people who understand what we’re try ing to accomplish with the project,” said Larry Bagby, assistant vice president at AdventHealth Tampa. “It may be a little uncomfortable, but it’s so important to go outside your comfort zone and seek out learning that’s beyond your own day-to-day environment.”

The DOJ Continues to Scrutinize Telemedicine,

Jim Hoover is a trial attorney and Partner at Burr & Forman LLP practicing exclusively in the firm’s health care group. Jim may be reached by telephone at (205) 458-5111 or by E-mail at jhoover@burr.com.

continued from page 13

continued from page 10

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Drs. Christopher M. Beau mont and Charles C. Pitts, Jr. have joined Andrews Sports Medicine & Ortho paedic Center and they will see patients in the Bir mingham clinic location.

Thomas Cunningham, DO has joined Grandview Internal Medicine located in Grandview Physicians Plaza on the Grandview campus. He earned his medi cal degree from the University of North Texas Health Science Center and com pleted his residency at Brookwood Bap tist Health Internal Medicine Residency Program. He Cunningham is a Veteran of the U.S. Marine Corps.

sion, along with his role as a mentor to minority students.

An Atlanta native, Beaumont gradu ated with a Bachelor of Science in biol ogy from the University of Georgia. He received his medical degree from the University of Louisville School of Medi cine. He went on to complete an intern ship and orthopedic surgery residency at UAB in 2021, followed by a hand & upper extremity fellowship at Florida Orthopaedic Institute in Tampa.

Surgeons Join Andrews Sport Medicine & Orthopaedic

Pitts graduated with a Bachelor of Arts in neurobiology from Harvard Uni versity. He received his medical degree from Wake Forest School of Medicine. After medical school, he completed his orthopaedic surgery residency at UAB in 2021, followed by a foot & ankle fel lowship at OrthoCarolina in Charlotte.

Patrick Louis, DDS, MD

Named for former UAB president and SOD dean Scotty McCallum, DMD M.D., the endowment provides impor tant support to the chair holder in their research, teaching and clinical efforts.

Gerald Simon, OD

“I am grateful for my career and I find purpose in encouraging young minori ties to pursue the optometric profes sion,” Simon said. “I am happy to give back to a profession that has beautifully impacted my life.”

Mark Whitworth, MD has joined Grand view Primary Care – Pelham. He earned his medical degree from Tulane University and completed his residency at UAMS North Central Family Medicine.

GRAND ROUNDS

Louis is a graduate of the Louisiana State University School of Dentistry and the UAB Marnix E. Heersink School of Medicine. A board-certified oral and maxillofacial surgeon, he is a diplomate of the American Board of Oral and Max illofacial Surgeons and a fellow of the American Association of Oral and Maxil lofacial Surgeons. As an active member of the health care community, he has served on numerous university, local and national committees and has written multiple articles in peer-reviewed jour nals in oral and maxillofacial surgery.

18 • SEPTEMBER 2022 Birmingham Medical News

Neil Tindell, DO has joined Grandview Primary Care – Cahaba Heights. He earned his medical degree from Alabama College

Gerald Simon, OD, the as sociate dean for Student Affairs at the UAB School of Optometry, has been named 2022 Optometrist of the Year by the National Optometric Association.

of Osteopathic Medicine and completed his residency at the University of Alabama, Tuscaloosa Family Medicine Residency.

Charles C. Pitts, Jr.

Christopher M. Beaumont, MD

Grandview Medical Group’s primary care network has added three physicians.

James Sosnowchik, MD • H.

Pitts is a Birmingham native who specializes in foot & ankle surgery. He has extensive training in both general and orthopaedic surgery and complex sports medicine techniques. He wel comes the opportunity to care for pa tients ranging from pediatric to geriatric age groups. He is able to help patients suffering from a wide variety of pathol ogy, including sports injuries, trauma and fractures, congenital and acquired deformities, ankle and foot arthritis, dia betic foot conditions, and more.

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Simon Named Optometrist of the Year

Patrick Louis, DDS, MD has been named the Charles A. McCallum Chair of Oral and Maxil lofacial Surgery at the UAB School of Dentistry.

Practice like the Pros something for everyone Adds Physicians

Beaumont specializes in hand, wrist and upper extremity surgery, treat ing patients with disor ders, instability, injuries Andrew Wilson,

“It is an honor to be named the Charles A. McCallum Chair of Oral and Maxillofacial Surgery,” Louis said. “I hope to build on the department’s strengths by continuing to improve the oral health of residents across our state, and by training and mentoring the next generation of oral health leaders.”

Louis Named Charles A. McCallum Chair of Oral and Maxillofacial Surgery

Simon, the associate dean of Student Affairs, also received the Dean’s Distin guished Service award in 2022 to ac knowledge his leadership, service to the community and the optometric profes

and arthritis of the hand, wrist, forearm and upper extremity. He is experienced in the latest techniques regarding these complex parts of the body.

Thomas Cunningham, DO Neil Tindell, DO Mark Whitworth, MD

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Children’s ECMO Center named Center of Excellence

UAB Opens Surgery Clinic at Northwest Regional Health

Jane Ehrhardt, Laura Freeman, Lynne Jeter, Marti Slay

Birmingham Medical News

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CONTRIBUTINGWRITERS

GRAND ROUNDS Rich

When our physicians were looking to establish a satellite location, I exhausted all available options, and was close to settling on a space I did not feel was ideal for our practice when Nancy Ferren asked if the Veritas team could take on the feat. Veritas came through with a great location to be redeveloped to match our culture and create an opportunity for ownership. Simultaneously, Veritas identified an off-market build-to-suit option for another satellite where we were also having challenges with site selection.

McBride believes recent technology upgrades contributed to this year’s rec ognition. The center has replaced its en tire eight-machine ECMO fleet with new pumps that offer advanced safety features and integrated technology that will allow the Children’s ECMO team to pull safety and quality reports.

a fellowship in colon and rectal surgery at the Mayo Clinic. He is seeing patients at the Winfield clinic and is also performing surgeries at Northwest Regional Health.

The trial will determine whether pro thrombin complex concentrate, also known as Kcentra®, reduces mortal ity in trauma patients who will require large volume blood transfusions. PCC contains multiple blood-clotting factors and is currently approved for use as a therapy for hemophilia and to reverse the effects of anticoagulant medications, such as warfarin. If shown to be effective, treatment with PCC could transform the standard of care for bleeding trauma pa tients and save thousands of lives.

The trial will be conducted in about 140 leading trauma centers in several countries and will include 8,000 patients, making it the second-largest trauma trial ever conducted.

Birmingham Medical News is published monthly by Steve Spencer ©2021 Birmingham Medical News, all rights reserved. Reproduction in whole or in part without written permission is prohibited. Birmingham Medial News will assume no reponsibilities for unsolicited materials.

A Children’s nurse in the ECMO Center.

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Northwest Regional Health and UAB Medicine have partnered to open a new UAB surgery clinic to serve northwest Ala bama patients. The clinic, located on Car raway Drive in Winfield, opened in August and is led by Greg Kennedy, MD, PhD, the John H. Blue Chair of General Surgery at the UAB Heersink School of Medicine.

The Center for Injury Science, in the UAB Marnix E. Heersink School of Medi cine, was awarded $5,507,307 by CSL Behring to help conduct the study, which is one of the largest clinical trials ever conducted in the field of trauma.

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Northwest Regional Health in Winfield.

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The trial’s principal investigator is Jan Jansen, MBBS, PhD, director of CIS.

a Gold Level Center of Excellence for the second straight cycle.

Jason Irvin, 205.249.7244

Birmingham Medical News

The Extracorporeal Life Support Organi zation, an international organization dedi cated to ECMO support, has recognized the Children’s of Alabama Extracorporeal Membrane Oxygenation (ECMO) Center as a Gold Level Center of Excellence.

The Children’s ECMO center cares for about 50 patients each year, which Mc Bride says is a high volume compared to other ECMO programs.

EDITOR & PUBLISHER Steve Spencer VICE PRESiDENT OF OPERATIONS Jason Irvin

Kennedy graduated from the University of Washington School of Medicine and received his PhD in cancer biology from the University of Wisconsin. He completed

CREATIVE DIRECTOR Katy Barrett-Alley

UAB has also added surgeon Joseph Walker, MD, who sees patients at both fa cilities. Walker earned his medical degree at UAB and completed residency training at Brookwood Baptist Health.

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Birmingham Medical News SEPTEMBER 2022 • 19

www.veritasmre.com205-304-1010Providingexceptionalrealestateadvisoryservicestophysiciansandmedicalgroups

Since that time,Veritas has been on retainer for Andrews Sports Medicine and Orthopaedic Center, handling everything from lease renewals to new construction. Having the entire Veritas team do what they do best by serving as our internal real estate officers allows the ASM team to do what we do best!

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Are you an ADMINISTRATOR in SHELBY or CHILTON County? JOIN OUR LOCAL MGMA GROUP. Gather with other administrators facing the same changes and challenges while getting advice and info on the latest happenings in our ﬁeld during our monthly programs. MEETINGS EVERY 2ND TUESDAY 11:45AM – 1:00PM SHELBYCHILTONMGMA.COM Contact Erin at eﬁsher@shelbydermatology.com for more information & answers.

UAB InternationalLeads Study

Children’s has been recognized as a Center of Excellence every year since 2013. ELSO announces Award for Excellence winners every three years, and Children’s is

UAB researchers are leading an inter national study to see whether a bloodclotting agent, given soon after arrival in the emergency department, can im prove survival.

Birmingham Medical News

Attn: Subscription Department

“I am proud of each team member’s contribution to this recognition,” Martha McBride, NP, clinical coordinator of the Children’s ECMO Center, said.

Northwest Regional Health became a member of the UAB Health System in January.

John Holcomb, MD is the co-principal investigator and Shannon Stephens, CCEMTPis the program manager.

—Lisa Warren, CEO

Prostate cancer is the second leading cause of cancer-related death in American with the American Cancer Society estimating approximately prostate cancer will be diagnosed in Alabama in 2022 alone, with 480 deaths.

Early detection is key to successfully treating prostate cancer. If you have a patient 40 or older, please let them know it’s important to schedule a prostate exam.

Every 2.1 minutes, a new case of prostate cancer is diagnosed in the U.S. CALL 205-930-0920 or visit www.UrologyCentersAlabama.com. REFER A PATIENT TODAY

September is Prostate Cancer Awareness Month

Urology Centers of Alabama has been at the forefront of prostate cancer treatment for over two decades, and is one of the highest volume centers for robotic prostatectomy in the country.