Birmingham Medical News September 2023

New Software Captures Tens of Thousands in Lost Surgical Revenue

By Jane ehrhardt

When a practice of 43 sports medicine and orthopedic physicians began using the new Surgical Pathways software, it found over 270 unbilled surgeries in one month. The resulting claims generated $12 million in revenue for the clinic.

“There’s a disconnect between the billing and the clinical side in practices,” says Kevin Bonner, CEO of Systemedx, creators of the program. “They think they got it to billing, but we can find one to three surgeries missed per doctor per month.

“There are a few similar software programs, but they don’t bridge this gap. We’re the first one to marry the billing and clinical sides. And that’s where the

(CONTINUED

Kevin Bonner meets AI.

Physical Therapy Protocol Helps Parkinson’s Patients Slow Disease Progression

By marti WeBB SLay

Until a cure is found for Parkinson’s disease, a physical therapy protocol called LSVT BIG is helping patients improve the quality of their movements and slow progression of the disease.

“Parkinson’s makes people move smaller,” said Nick Stanton, PT, DPT and LSVT certified clinician at Radius Physical Therapy in Trussville. “Their movements become small, their steps become small, their posture becomes small. It makes them become drawn in. The BIG protocol gets people to move

bigger. After four weeks of treatment, we see larger amplitude arm swings and increased stride or step length, which all helps gait speed, decreases fall risk, and improves function overall.”

LSVT, which stands for Lee Silverman Voice Treatment, began as a speech therapy approach, which is referred to as LSVT LOUD. “People with Parkinson’s disease (PD) often have difficulty with their speech and their ability to be properly understood in conversation,” Stanton said. “Their voice may not be as loud, or their articulation as clear as it

(Left to Right) Nick Stanton, PT, DPT with a Parkinson’s patient.

New Software Captures Tens of Thousands in Lost Surgical Revenue, continued from page 1

big money is. Two-thirds of the missing surgeries have been found among traumas handled after hours. The doctors will just fail to get it all into the system. Surgical Pathways solves much of that using AI-driven billing, task functions, and smart phones.”

Using the app, a surgeon at the hospital can send all of the patient information to the clinic by shooting a photo of the hospital’s information form. That gets encrypted and sent to the main office, allowing staff to manually enter the data. A future update will automatically pull the data from the photo and input it into the system.

Physicians can also use the app for a wide range of access and input including looking up charts, meds, and allergies, manipulating their task list, and viewing their bonus for the month.

Once in the system, Surgical Pathways automatically fills in the CPT codes that are most used by that doctor for that procedure. “All you have to do is okay it or you can massage it a bit,” Bonner says. “The AI can currently guess about 80 percent of the surgeries, but it also learns. It will watch the provider and the billing person as they make adjustments. And the next time, it will recommend that highest percentage of the correct code.”

It works the same way with ICD codes on claims in order to suit the insurer and generate the greatest revenue. For instance, because it knows that insurers pay 100 percent on the first procedure during a surgery and 50 percent on the second, it lists the higher-pay procedure first.

Should a claim be rejected, the AI files an appeal automatically. A staff member only has to approve it. “The AI knows the tricks that insurance companies play to avoid paying,” Bonner says. “And it’s learning all the time.”

The AI also hunts for rogue surger-

ies. For instance, if the hospital faxes operation notes for a patient, it looks for the procedure on the schedule or in billing. If it can’t find it there, it drops that surgery in the rogue bucket to be investigated so that the surgeon gets paid.

When a surgery is scheduled, a task list specific to that procedure gets automatically generated, which includes everything from cardiac clearance, ordering outside equipment, and generating lab orders to reserving the OR and signing the pre-certification.

The AI portion of the task lists automates, digitalizes, and speeds up a multitude of tasks, beyond just populating and submitting digital forms needed for the procedure. It also pulls info off scans, such as pre-certification authorization numbers, and marks those tasks as com-

pleted, identifying the user and time.

Complex tasks get simplified. When a surgeon orders a knee replacement, the AI automatically sends the outside vendor an email alerting them to the order. The vendor clicks on the link to the website to view the specifics. The AI marks the task as completed when the vendor clicks the website link and when they click to accept the order or not. If it’s not accepted, an alert pops up on the task list.

Currently, Surgical Pathways is in beta testing in a few clinics, with ten sales already on the books. “The real world always changes it a little bit so you want to go slow at the beginning,” Bonner says. “We’re on the third install, and now it’s getting smooth.”

At the latest conference unveiling, the AI billing component of the program

caused the most excitement. “We think we‘re going to blow away the industry,” Bonner says, adding that Surgical Pathways has been generating an additional average per physician of $50,000 a year from the overlooked surgeries.

But Bonner sees further revenue opportunities by utilizing AI to stay on top of government and insurance regulations. Even something as simple as the AI reminding a physician to ask two additional health questions would qualify the patient visit for an additional $80, which multiplied over a year of visits adds up. “AI is going to revolutionize how we document and bill,” Bonner says. “That lets you focus on seeing patients.”

Vaughan, M.D.

Evan Carstensen M.D Daryl Dykes, M.D. Michael C. Gerhardt, M.D. Lloyd Johnson Ill, M.D.

Capel, M.D.

Bonner clicks on the surgery dashboard.

Kevin Bonner (center) with the Systemedx staff.

Andrews Expands Comprehensive Spine Center

By Laura Freeman

It’s a rare human who lives a long life without experiencing back pain. Time and rest are often enough to heal minor discomforts. However, between work and recreational injures, trauma, diseases, degenerative progression and congenital issues, many patients will need expert help to ease pain and restore optimum function.

“We’ve come a long way in treating spinal conditions with new tools and techniques, advances in medications, rehabilitation, and surgical procedures that weren’t possible before,” said Andrews Sports Medicine & Orthopaedic Center spinal surgeon Andrew Cordover, MD. “Because there are so many types of spinal disorders, along with a wide range of treatments, it’s impossible for any one person to maintain expertise in all of them. That’s why, when I merged my practice with Andrews Sports Medicine 14 years ago, I began working toward building a comprehensive spinal center here, where patients can seek state-of-the-art treatment for a broad range of spinal conditions.”

An orthopaedic spine surgeon who has treated NFL, WWE, and other elite athletes, Cordover is part of a network of sports medicine physicians who share updates on advances in the field.

“I apply the same strategies that I use with professional athletes to help high school and college athletes, weekend warriors and other patients who may have had been involved in an accident, a slip on the stairs, or be dealing with degenerative issues,” he said.

“However, not every back condition requires surgery. There are many nonsurgical options that can often bring relief before we have to consider surgery. That’s why I was so pleased when Charles Carnel, MD joined our practice. He’s an interventional physiatrist specializing in the nonsurgical treatment of low back, neck and neurological conditions. In addition to overseeing all our nonsurgical back care, he also performs nerve blocks, RF ablations, and cement augmentations.”

Adding Carnel’s skills to the team was part two in building a comprehensive spine center that is able to offer a broad range of care for many types of spinal conditions.

“We can triage our patients to determine whether they are likely to respond to conservative measures like physical therapy, anti-inflammatory medications or perhaps injections, or whether more aggressive treatment is indicated,” Cordover said. “Now, with Daniel Kim, MD joining our team, the depth of our expertise is even more robust. Dr. Kim is

nationally known for his skill as a spinal surgeon and in using advanced techniques in innovative surgeries and minimally invasive procedures.”

Named to the 20 Under 40 list of top young spinal surgeons in the country by the North American Spine Society, Kim was the first surgeon in Birmingham to offer endoscopic spine surgery. He will begin sharing his time between the Andrews Sports Medicine office on the Ascension St. Vincent’s campus and the new Hoover Highway 150 office opening in October. Kim will be performing procedures at both Ascension St. Vincent’s and Grandview Medical Center.

Kim said, “I want my patients who drive an hour or more from rural Alabama to receive the same exact quality of care in my office and operating room as they would if they were in Chicago, New York or Los Angeles.”

The new location of Andrews Sports Medicine & Orthopaedic Center on John

Hawkins Parkway will be convenient for patients who live in southern neighborhoods and the underserved west Hoover area. It’s also accessible by Highways 459 for communities west and east, and by Highways 119 and 280 for patients further south and in rural areas.”

In addition to healing spinal problems, an important part of the follow-up is helping patients prevent future injuries. “Whether I’m talking with a professional athlete, a teenage gymnast or a high school baseball player, the question I hear most often is when can they return to play,” Cordover said. “We have established return-to-play criteria, and for a professional athlete, the decision can be a question of both health risks and career.

“We want to make sure our patients are recovered enough to play safely with minimal risk of re-injury. We look at how the injury occurred and what can be done to modify the risk. That can involve protective equipment, bracing and strength conditioning, along with improving training strategies.

“A number of injuries occur in performance training, rather than on the field. The old ‘no pain, no gain’ philosophy is gone. We can prevent many sportsrelated back injuries by ensuring proper form and technique while performing higher risk exercises—such as dead lifts, power cleans and squats.”

Around 80 percent of the population will have back pain at some point in their lives. In some cases, seeing an orthopaedic specialist for an evaluation and treatment earlier in life can be a good investment in avoiding more serious problems later.

“Sometimes patients have congenital issues like curvature of the spine, or foot or knee issues that can cause problems later on,” Cordover said. “Poor posture or weak muscles can also put a person at a higher level of risk. If their job involves lifting heavy weights and they don’t know how to properly lift, or how to cope with having to sit or stand for prolonged time periods, repetitive motion or working in an awkward position, we need to help them learn how to reduce risks.

“Life itself is a degenerative process. The trick is learning to mitigate and correct the damage so we can enjoy living without pain.”

Andrew Cordover MD Charles Carnel, MD Daniel Kim, MD

Shoulder Injuries: Repair or Replace?

By Laura Freeman

Shoulder injuries can bring even the most stoic tough guys to tears. A simple dislocation can be righted quickly, leaving only the fading memory of pain. However, years of work, play, and injuries tend to take their toll, and eventually the discomfort becomes too much to shrug off.

“We usually start with conservative measure if the damage isn’t too severe. Physical therapy, injections, medications, icing and rest may be enough to promote healing,” orthopaedic surgeon Jonathan Isbell, MD, a shoulder, elbow, hip and knee specialist at Southlake Orthopaedics, Sports Medicine & Spine Center PC, said. “However, if trauma, tears or other damage is too extensive, it may be time to talk about surgery.”

The big question is what type of surgery is likely to be most beneficial to the patient.

“When a rotator cuff tear is smaller and the patient is young, with good circulation and plenty of healthy tissue for anchoring, the odds are better that a repair will be successful,” Isbell said. “However,

even under the best conditions, the blood supply in the area is less robust than in other parts of the body, so complete healing is going to take longer than surgery in other parts of the body. It can take up to six months, depending on the patient’s condition and the types of demands their work places on them. Even if the outer part of the shoulder feels fine, patients should listen to their surgeon and not put too much demand on their shoulder too soon or the repair may fail.”

The wait for full healing can be difficult for people whose livelihood depends on physical work, and those eager to return to sports or their favorite activities. Likewise, remembering not to pick up a grandchild who wants to play isn’t easy.

“In older patients or in anyone with diminished circulation or poor tissue quality that offers few good anchor points, it’s difficult to make lasting repairs that bring long-term relief,” Isbell said.

Even in younger patients, there are cases in which one surgery to replace the joint may offer advantages over attempting repairs that may need to be repeated, ultimately leading to a joint

replacement anyway.

“In the last few years, there have been advances in techniques and prosthetics that have expanded the number of situations where replacement may offer clear advantages,” Isbell said.

“Some surgeries can be done on an outpatient basis, depending on whether the patient has other health issues that need to be monitored. Rehab is highly recommended to achieve optimum range of motion and build strength to help the shoulder heal and avoid reinjury.

“We also recommend that patients stop smoking. Maintaining good circulation is critical to healing, and in an area where maintaining an adequate flow is already challenging, there’s no margin for diminishing blood supply.

Sleep is another consideration that may be difficult when there’s shoulder pain, or when recovering from surgery. Patients may find sleeping in a recliner

easier for a while.”

Although aging is a primary factor that contributes to the need for shoulder repairs and replacement, and an aging population is increasing the number of surgeries that are being done, more young people are finding their way into the shoulder specialist’s office due to sports injuries and accidents that happen when active young people have an unfortunate encounter with gravity.

(CONTINUED ON PAGE 7)

Jonathan Isbell, MD in surgery.

Shoulder Injuries: Repair or Replace?

“Due to the nature of the movement, we’re seeing a lot of baseball injuries in high school and college athletes, and dislocations and injuries in other sports that involve falls, impacts and sudden changes in motion,” Isbell said. “A shoulder that begins to repeatedly pop out can be very painful for young athletes. When there is damage, the research shows that it is better to fix the shoulder the first time rather than allow the damage to accumulate.”

To help patients avoid the need for surgery or delay the time when it becomes necessary, it helps to identify which patients are most likely at risk. Aside from age and genetics, some occupations and

continued from page 6

activities put people at greater risk.

“If a job involves a lot of lifting or repetitive movement of the shoulder such as turning a crank or throwing a fast ball, or if there’s a lot of reaching overhead as a carpenter would reach up with a hammer to nail boards, the risk for shoulder problems increases,” Isbell said.

Physician can help by monitoring for symptoms, and suggesting protective equipment, strengthening exercises and anti-inflammatory and self-care management strategies to help keep the weight of the work-day world off of patients’ shoulders.

Physical Therapy Protocol,

continued from page 1 once was. They may speak in a monotone voice which does not convey the emotion that listeners expect to hear. LSVT aims to recalibrate the perception of loudness that a person with PD has of their voice, prompting participants to speak at a more normal volume.

“LSVT started out as a way to help Parkinson’s patients speak louder and more clearly. It was helping train larynx muscles to speak, and that led therapists to wonder whether this could be applied to protocols for other muscles in the body, to help them with daily activities.”

The physical therapy treatment, referred to as LSVT BIG, consists of four one-hour sessions each week for four weeks. “It’s an intensive treatment,” Stanton said. “It’s hard work to get the brain to calibrate to larger movements. Historically, treatment for Parkinson’s was low intensity and low frequency, as therapists worried about wearing the patients out. But that’s not really what’s beneficial for them. They need that high intensity to make lasting neuroplastic changes. Moving big is how we get calibration with these patients. We encourage them to move bigger with reaching, standing, and stepping.

“It’s up to the physical therapist to provide the patient with movements that are challenging, but not overwhelming. We are going to meet somebody where they’re at. It’s our job to find where it’s challenging and make them work, but so hard that they want to quit. We have to use our best judgment, and a big part of that is encouraging people and giving them the confidence to work through the difficult things. It’s been pretty significant to see changes in people’s gait. And not only in the quality of their gait, but also in their gait speed, and their balance.”

The sessions consist of seven daily maximal exercises, along with functional movement tasks and hierarchy tasks. Functional tasks are basic movements like

standing up from a chair, something people do every day. Hierarchy tasks, on the other hand, are more complex and take multiple steps, but are still movements that people do daily. An example of a Hierarchy task would be getting in and out of a car, which involves walking to the car, turning toward the seat, and sitting down. This obviously requires more movements than standing up from a chair.

In addition to the four sessions per week with a therapist, patients are expected to do the daily maximal exercises at home once daily on therapy days and twice a day the other three days of the week. Those personal workouts continue when the organized therapy sessions end after four weeks.

“When the patient feels like they are starting to move smaller again or having difficulty with daily activities or seeing a progression in the disease, they are encouraged to return for a tune-up,” Stanton said. “That doesn’t mean they have to do four times a week for four weeks again. They’ve completed the program and don’t need the recalibration. They usually only need a couple of visits to get moving better again. One of my patients just came in for his third tune-up.

“I recommend my patients continue with some other activity in addition to the exercises, such as dancing or Tai Chi. One of my patients participates in a PD fight club, a boxing group. That’s a really good way to progress from LSVT.

“Parkinson’s is a progressive disease, and this treatment doesn’t cure it. But it does, according to the evidence, slow down the progression. Sometimes it can even cause a stop of the progression, even if only for a year or two. It gives the patient confidence to have something they can help themselves with.”

LSVT-trained clinicians can be found at www.lsvtglobal.com/LSVTFindClinicians

Kennedi is cured of sickle cell disease thanks to a life-changing bone marrow transplant she received from her sister here at Children’s of Alabama. The amazing treatments, discoveries and innovations for pediatric blood disorders and cancer happening here are helping change lives for the children of Alabama, across the country and around the world.

Ten Things to Know About Telehealth Compliance

By Shannon Britton hartSFieLd and JenniFer rangeL

Providing care via electronic communication when patients and providers are in separate locations, known as telemedicine or telehealth, has been possible for decades. The circumstances sparked by the COVID-19 pandemic, however, led to a telehealth boom. Pre-pandemic, telehealth was constrained by limited reimbursement, cross-border licensure requirements and access to technology. The coronavirus expedited the necessity to deliver care in new ways and, along with increased flexibility in reimbursement, led to explosive growth in these services. Delivering care via telehealth, however, requires special compliance considerations due to myriad state and federal healthcare regulations covering its use.

1. Make Sure Data

Stays Private and Secure.

During the public health emergency (PHE), the U.S. Department of Health and Human Services' (HHS) Office for Civil Rights (OCR), which enforces the Health Insurance Portability and Accountability Act (HIPAA), temporarily

waived certain data security requirements. For example, providers could use certain HIPAA-compliant communication platforms even without a HIPAA business associate agreement in place. OCR's decision to exercise enforcement discretion with respect to certain HIPAA requirements during the PHE expired on May 11, 2023, with a 90-day grace period that ended on Aug. 9, 2023. Telehealth providers can no longer rely on that enforcement discretion in the event their telehealth platform fails to meet HIPAA standards.

2. Do You Know Where Your Patient Is? Adhere to State Licensure Laws.

Human physiology is the same across state lines, but licensure requirements are not. Telehealth practitioners serving patients in other states or countries need to be aware of licensure laws in the jurisdictions where the patients are located. Under the law in most states, the practitioner must be licensed in the state in which the patient is located at the time the telehealth services are offered. A telehealth practitioner practicing in many states likely needs to be licensed in those states. Some states have a more limited license available but many

require full licensure. Telehealth practitioners should be familiar and in compliance with state licensing laws.

3. Pay Attention to Corporate Structure.

A number of states prohibit the corporate practice of medicine, which impacts how a telehealth platform is structured as the platform itself is typically a lay entity and not permitted to directly employ or contract with practitioners to provide professional telehealth services in these states. Thus, consideration must be given to compliance with corporate practice of medicine laws including an affiliation with a physician practice or friendly physician entity to provide professional medical services in states that prohibit the

corporate practice of medicine.

4. Beware of Risky Compensation Arrangements. Certain compensation arrangements may create risks under state or federal law. If a telehealth app or online platform receives a percentage of the practitioner's professional fee as compensation, or a compensation arrangement is not fair market value, the arrangement could violate state and federal fraud and abuse laws, such as laws prohibiting kickbacks or fee splitting. A good place to learn more about potential fraud and abuse concerns in telehealth arrangements is the HHS Office of Inspector General (OIG) Special Fraud Alert dealing with

(CONTINUED ON PAGE 12)

Shannon Britton Hartsfield

Jennifer Rangel

We give Medical Practice Managers a Proven

Health Effects Of Extreme Weather Are Expanding The Range Of Diseases

By Laura Freeman

When you hear hoofbeats, don’t look for zebras. Every medical student has been reminded of that sage advice. However, considering how climate extremes are expanding the diagnostic possibilities for cases that may walk through a doctor’s door, a useful addendum comes from Sherlock Holmes. When you have eliminated the impossible, whatever remains, however improbable, must be the truth.

The truth these days is that even if your patient hasn’t been anywhere this summer, if it looks like malaria and acts like malaria, it just may be malaria.

“We’ve already had reports of community acquired malaria in both Florida and Texas, and Eastern Equine Encephalitis in Mobile,” epidemiologist and assistant professor at UAB School of Public Health and UAB Heersink School of Medicine Katia Bruxvoort, PhD said.

From those locations, we are only one Midwestern tourist stopover up I-65 from a mosquito biting the wrong person and going next door for dessert.

According to the NASA Goddard

Institute for Space Studies, July 2023 was hotter than any other month in the global temperature record. Struggling shrubs and trees that survived a destructive winter cold wave are being burned into crispy fire fodder. In an ironic twist, extreme heat in the southern hemisphere near Australia has been pushing the jet stream up into the arctic circle. It returns to us, swooping down with one polar vortex after another and making food planting seasons anything but predictable.

“Not long ago, if we suspected Lyme disease, the first question was whether a

patient had travelled north in regions where deer ticks were found. Now North Carolina is having an outbreak,” Bruxvoort said.

The North Carolina cases have proven that, given crowding, predator pressure, and the continuing search for food, water and a comfortable place to live, deer can walk south along the Appalachian trail and bring their ticks with them. That mountain chain ends with Red Mountain and Shades Mountain here in Birmingham.

Some local physicians are also puzzling ouat why patients who have never had allergies before are turning up in ERs in the middle of the night with lifethreatening anaphylactic shock. Standard diagnostic rule of thumb previously said that food allergies act quickly, not several hours after dinner. Now local allergy specialists report seeing Alpha-Gal syndrome more frequently. Caused by sensitivity developed after a bite from a Lone Star tick, patients begin to react to red meat. That means no more steak or pork chops, and either going vegetarian or relying on poultry or fish.

Until recently, the southern limits of

the Lone Star range was thought to be Tennessee. Given the number of hunters in North Alabama who are testing positive, that tick is also moving South.

“Temperatures and cycles of rainfall and drought are turning our area into a suitable habitat for a growing list of vectors that carry diseases that we rarely saw before,” Bruxvoort said. “New mosquitoes and ticks are moving into the area. Fleas can carry both infectious diseases and parasites. Now we are also seeing new fungal diseases.

“State health agencies are also monitoring closely for any signs of Zika, West Nile virus, Dengue fever, and the broad range of other vector-borne infectious diseases. Fortunately, we haven’t had any indication of Yellow Fever recurring in the U.S., but some public health specialists are urging close monitoring of ships that pass through the Panama Canal and other infected areas before docking at southern ports.”

Some of the recent heavy rains across the country that resulting in drowning deaths and casualties from high winds, the storms left standing water for mosquito breeding grounds. Where there was

(CONTINUED ON PAGE 13)

Katia Bruxvoort, PhD

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

Ten Things to Know About Telehealth Compliance,

continued from page 8

"purported telemedicine companies" issued on July 20, 2022. This alert discusses how certain unscrupulous telemedicine companies pay kickbacks to practitioners to further fraudulent schemes.

5. Consider Informed Consent.

Patients need to consent to the treatment they receive. For patients to provide informed consent, they must understand the potential risks of a potential course of treatment. To the extent that telehealth care could create risks, patients should understand the potential challenges and shortcomings if care is provided via telehealth technology. A number of states require consent to receive care by telehealth in addition to the general informed consent requirements.

6. Stay Up to Date on Prescribing Laws.

The PHE also brought relaxed requirements for prescribing controlled substances. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration have extended these flexibilities until Nov. 11, 2023, and may extend them further in certain circumstances. On March 1, 2023, the DEA issued proposed rules dealing with telehealth prescribing

that may bring about more changes. Consideration should also be given to state law restrictions when prescribing controlled substances via telehealth, as well as state and federal laws regarding prescribing legend drugs via telehealth.

7. Examine Evolving Standards of Care.

In the not-too-distant past, doctors practicing exclusively through audio and video feeds, with no in-person examination, was something out of science fiction. Today, it is commonplace for many types of ailments and healthcare needs. Even so, standards of care for physicians can vary from community to community. Telehealth practitioners need to ensure that the telehealth environment provides sufficient information to make an appropriate diagnosis. In addition, each state has different laws and regulations governing telehealth, including the technological requirements such as whether two-way video is required or if store-andforward technology is sufficient. It is important to understand and comply with the telehealth requirements in each state in which a patient is located.

8. Remember to Make a Record.

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

Our practice includes general ear, nose, and throat, head and neck diseases and surgeries, cosmetic surgery, robotic procedures, inoffice balloon sinuplasty, allergy treatment, and hearing solutions.

We concentrate our training and experience in these areas to provide the best possible medical care for our patients.

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

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

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

Birmingham - Princeton - Hoover - Cullman - Gardendale

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

Providing care to patients via telehealth still requires physicians and other practitioners to maintain medical records in accordance with their particular licensure requirements. Detailed recordkeeping is important to justify the care provided, comply with applicable laws and support the reimbursement received.

9. The Payment Party May Be Ending.

Lack of reimbursement for telehealth impeded its growth for many years. During the PHE, payers were willing to pay for telemedicine care. If health plans and insurers see costs rise as a result of increased accessibility to care offered by telehealth, they may start to limit reimbursement under certain circumstances or restrict payment by increasing the requirements to bill and collect for telehealth.

10. Stay on Top of Legal Developments.

The only thing certain about the future of telehealth is that it will continue to evolve. Laws and regulations develop much more slowly than technology evolves. Telehealth practitioners must continue to keep abreast of regulatory requirements on a federal basis and in all states into which they provide telehealth services and make sure that they have robust policies and procedures to help them remain in compliance.

Rich Campbell

Nancy Ferren

Peter Jameson 205-304-1010

www.veritasmre.com

Shannon Britton Hartsfield is a partner in Holland & Knight's Tallahassee, Florida, office. Jennifer Rangel is a partner in the firm's Austin, Texas, office.

Providing exceptional real estate advisory services to physicians and medical groups

The Veritas team was one of the best things that happened to us as we started setting up our independent practice. We quickly realized why they established themselves as a niche team for medical practices. Rich jumped into action when he recognized our needs on a relatively tight deadline, and the team made it happen. The Veritas team has a keen eye to your needs as a medical practice and develop a very elaborate plan around your needs. Everything is datadriven, and backed by their vast experience and tight connections. We are thankful for our partnership with Veritas, and still lean on them for advice!

—Dr. Archana Jain

Health Effects Of Extreme Weather,

heavy runoff, there was also an increased risk for water-borne illnesses when septic tanks, trash dumps, stock yards and swamps flooded, and contaminated private wells and public water sources.

“Thankfully, modern sanitation has helped us avoid the cholera and typhoid epidemics of the old days, but there are plenty of strains of e-coli, rotavirus, and a huge number of other water-borne diseases and parasites that can cause extreme digestive distress and even death,” Bruxvoort said. “Our big vulnerability is that even here, in the affluent United States, we have some of the same problems with access to clean, safe water that are plaguing third world countries.

“We have to face the fact that with infectious diseases we are only as safe as our poorest residents. The great plagues have always tended to simmer in poor areas that don’t have as much access to treatment before they break out to infect the general public. Too many places in Alabama don’t have access to clean water and sanitation. That has to change before our luck runs out.”

Although fungal diseases are frequently associated with damp conditions, there is one that becomes a problem during drought. The fungus is soil-borne. When farmers and others inhale the dust, it begins to attack the respiratory system.

In June, the eastern half of the U.S. experienced just how bad the impact of hot, dry conditions can be over a broad area when smoke from Canadian wildfires overwhelmed northern and Midwestern doctors’ offices, affecting air quality as far south as Birmingham.

“It’s what western states have been dealing with for years. We’ve had our own smoke problems from dump fires that can’t be put out. People near the smoke can develop serious lung problems. It doesn’t take that much to put patients who have heart disease in real trouble. The effects on eyes and sinuses are pure misery,” Bruxvoort said.

Heat itself is the killer in too many cases. A Birmingham fire fighter tells the story of finding an elderly man dead with

his face in the sink and water running. He had been too poor for air conditioning and too afraid of violence to open his windows or go to a cooling shelter.

Human bodies simply aren’t built to cope with the heat indexes we’re seeing. Adaptation takes time, and change is happening too quickly. Even workers who have braved outdoor heat in the past are finding themselves no match for heat stroke, dehydration and severe muscle cramps. Hospitals in Las Vegas are using body bags filled with ice to quickly cool tourists who misjudged what 112 degrees can do.

People in fragile health are particularly vulnerable, and chronic conditions that were stable can quickly become a crisis. Patients should be cautioned about staying cool and informed about cooling shelter options.

Before the jet stream makes its next northern detour and releases a polar blast, it might be helpful to review strategies for managing exposure, frostbite and the flood of respiratory infections that come when too many people have been sharing indoor spaces for too long.

“Health care providers can’t solve climate problems alone, but they can be mindful of related health issues and help their patients deal with them. We’re also depending on providers to be vigilant in monitoring and reporting any sign of infectious diseases that may be new to the area so public health can respond quickly,” Bruxvoort said.

One thing for certain is that nature is on the move, and we can all expect the unexpected. That includes bears that have been cooling off in Gulf Shores waters, in swimming pools and frolicking in back yards as near as Trussville. It also includes alligators that have been attacking people and their pets from golf course ponds as far north as Huntsville—which brings a whole new meaning to the term water hazard.

If the unexpected turns up at your door, remember: the definition of impossible isn’t what it used to be.

Brookwood Offering Minimally Invasive, No-Scar Hysterectomies

By marti WeBB SLay

Heidi Straughn, MD, ob/gyn at

Brookwood

Women's Health, P.C., read-

ily admits that taking a class in vNOTES (vaginal natural orifice transluminal endoscopic surgery) sounded like a good idea in large part because it was an excuse to go to New Orleans. She had seen references to the surgery in medical publications, but she didn’t fully understand the concept. Once she saw the procedure, however, she recognized what it could mean for her patients. The minimally invasive, no-scar surgery is now her choice for hysterectomies and other gynecological procedures.

vNOTES uses a vaginal incision, eliminating the need for any incisions in the abdomen. The vNOTES device is inserted in the small incision, and a camera provides visualization for the uterus, fallopian tubes and ovaries. The procedure promises a shorter hospital stay, less postoperative pain, and faster recovery than laparoscopy.

vNOTES uses a special gel port for all the instruments. “We put two incisions around the cervix, and we put in an Alexa retractor,” Straughn said. “Then we put the gel port outside the vagina. We insert the instruments through that and go through the vagina and past the cervix.

“It’s hard to visualize, but once I took the class, I realized I wanted to do this. I like vaginal surgery, and I like laparoscopy, and this is the natural progression. This gives us a route that is more minimally invasive than any other. You don’t even have to get new credentials for this, because it uses techniques we are already doing.”

Straughn saw the benefits to her patients immediately. “My patients were doing so well and going home quickly,” she said. “Now that I’m getting more comfortable with it, I’m letting them go home the afternoon of the surgery, which is not that different from robotic surgery, but I’ve had some patients go home and not take any narcotic pain medication afterwards, so it’s pretty impressive.” In fact, one of her patients returned to work a week later without any narcotics post surgery.

The improved visualization enables Straughn to make better decisions during surgery. “It allows you to do anything that involves the tubes or the ovaries, which is hard to do without the vNOTES component, because you can’t always see the tubes and ovaries without vNOTES,” she said. “We are taking the tubes out of most women with hysterectomy because it lowers the risk of cancer in the future.

vNOTES allows me to always take the tubes when I take the uterus. If I need to take the ovaries out for some reason, I can do that. Or if they have a cyst on their ovary, I can take that out also.

“Usually, when a surgeon approaches the uterus from above, the blood supply is below the incision, but with vNOTES, blood supply is one of the last pedicles taken. It’s really good for limiting blood loss.”

She also sees benefits for teaching medical students with vNOTES. “I hope this takes off in terms of teaching,” she said. “One of the problems with vaginal surgery is you can’t see when you are assisting. Only the person doing the surgery has visualization. With this, you have the camera in there, and the visualization is amazing. It helps with understanding the anatomy, so it’s a teaching tool. It’s going to be really useful in training.”

Straughn is still learning about the procedure and how much can be done with vNOTES. “I haven’t done a really large uterus yet,” she said. “I think a 14week uterus is the biggest I’ve done. It’s hard to remove just a cyst from the ovary, technically. It’s more challenging, and I haven’t done that. Some of the more difficult cases I’ve posted to possibly change the approach if I’ve needed to, but I haven’t had to.”

According to the vNOTES website, Straughn is the only surgeon in the Birmingham area doing the surgery, but she said her partners and others at Brookwood are now beginning to take the course and do the surgery as well. She anticipates it will continue to be embraced by the ob/ gyn community as they become more familiar with its benefits. “It’s my preferred method of hysterectomy if I can do it that way,” she said. “I want to see more surgeons doing this surgery. I keep asking why we aren’t promoting this more. It’s the greatest thing since sliced bread!”

Heidi Straughn, MD

Women’s HealthCare.

Welcome Our Newest Providers

Our team specializes in the following:

• Cervical and breast cancer screenings

• Contraceptive counseling

• Gynecologic care for adolescents and adults

• General and high-risk obstetrical care

• Pregnancy and infertility issues

• Prenatal care

• Well-woman visits and pap tests

For over 40 years, Eastern Obstetrics and Gynecology have treated our patients with the core belief that medicine is not only about excellent care but should also prioritize meaningful, long-term relationships. Our partnership with Brookwood Baptist Health Specialty Care Network allows us to continue those long-term patient-care relationships by expanding our footprint and providing patients with more routine care and delivery options. With delivery services and adding an office location at the Women’s Center at Brookwood Baptist Medical Center, we can work closely with women throughout their pregnancy journeys providing support and encouragement every step of the way.

The physicians and staff of Eastern OB/GYN are accepting new patients at our new Brookwood Baptist Medical Center Women’s Center location.

Stacy Williams, CRNP; Christian Dey, MD; Ludwig Francillon, MD; Lia Johnson, WHNP; Bryan Pruitt, MD

FTC Accelerates Enforcement Actions to Protect Consumer Digital Health Information

By roBin B. mark

The Federal Trade Commission (FTC) has been aggressively pursuing enforcement actions that involve companies using applications that share consumer personal health information with third parties in violation of the Health Breach Notification Rule.

What is the Health Breach Notification Rule?

The Health Breach Notification Rule (HBNR) was issued more than a decade ago to ensure even HIPAA-exempt entities that maintain personal health records notify affected consumers following a breach involving unsecured information. The HBNR applies to (1) vendors of personal health records (PHR), (2) PHR-related entities, and (3) third-party service providers for vendors of PHRs or PHR-related entities. A PHR vendor is a business that offers or maintains PHRs. A common FTC example of a PHR vendor is a health app that collects information from consumers and has the ability to sync with a consumer’s fitness tracker. PHR-related entities sell products or services through the vendor’s website, such as a company that operates a fitness tracker and relays information to health apps. A third-party servicer uses, maintains, discloses, or disposes of health information to vendors or related entities.

If a breach occurs, a business must provide notice to: (1) each affected person who is a citizen of the United States; (2) the FTC using a Notice of Breach of Health Information form found on the FTC website; and (3) in some cases, the media. Provisions include specific time frames when notice must be issued based on the date of discovery of the breach, which may be as short as 10 business days.

FTC Escalates HBNR Enforcement

The HBNR was dormant for years. However, the upsurge in health apps and digital health companies led the FTC in October 2021 to issue a policy statement warning health apps and connected device companies that collect health information to comply with the HBNR. The FTC issued its first enforcement action in February 2023 by imposing a significant $1.5 million civil penalty on telehealth company Good Rx for its failure to notify consumers and others of the unauthorized disclosure of personal health information to third party advertising companies and advertising platforms, such as Facebook, Google and other companies.

Even more recently in May 2023, the FTC settled with Illinois-based Easy

Healthcare Corporation in an action related to its fertility-tracking app known as Premom. Easy Healthcare developed, advertised, and distributed a mobile application called Premom Ovulation Tracker that allows users to input and track personal health information.

FTC’s complaint alleged that Easy Healthcare deceived users by disclosing sensitive health data to third parties without notifying consumers of these unauthorized disclosures. The FTC alleged that Easy Healthcare promised Premom users in its privacy policies that: (1) it would not share health information with third parties without users’ knowledge or consent, (2) that the shared information would not be identifiable data since only users’ IP addresses were given, and (3) information would only be used for the companies’ own analytics or advertising.

The FTC further alleged that Easy Healthcare failed to take reasonable steps to address the privacy and security risks created by using software development kits (“SDKs”) that shared consumers’ health information with third parties. In reality, the SDKs allowed Easy Healthcare to track and analyze Premom users’ interactions with the app and to transfer the data, including information about users’ fertility and pregnancies, to the publisher of each SDK. The FTC concluded this violated the unfairness and deception prongs of Section 5 of the FTC Act and the HBNR.

In both the Good Rx and the Easy Healthcare enforcement actions, the FTC alleged that the companies shared sensitive health data for advertising purposes in violation of promises they would not do so. In addition to significant civil monetary penalties, both companies are required to alert their customers to the unauthorized disclosures and to comply with extensive remedial obligations and restrictions.

FTC Proposes HBNR Rule Changes

On June 9, 2023, the FTC published

a Notice of Proposed Rulemaking in the Federal Register that would revise the HBNR to clarify its application to health apps and other similar technology. The FTC proposed introducing a broader definition of covered entities and an expansion of the types of activities that trigger the rule’s notification obligations. Specifically, the proposed changes would add “health care provider” and “health care services or supplies” to the definition of “PHR identifiable information.” The proposed changes would also expand the use of email for providing breach notices to consumers. If these changes are approved, health tech companies must evaluate how best to comply with the revamped HBNR. Regardless, the FTC is expected to continue enforcing the rule and looking out for consumers whose data may be at risk.

Key Take Away for Businesses Maintaining Digital Health Information

Companies using applications that collect, use, or store personal health data should review the proposed amendments carefully including, but not limited to, some of the following provisions:

Many health apps and other similar technology are not covered by HIPAA, but under the proposed amendment, they would be covered by the HBNR.

Companies that offer wellness services should take note because they are likely within the scope of the proposed amendments.

The proposed changes expand the definitions beyond “websites” to include online services, including mobile applications. The FTC recognizes that consumers are increasingly using mobile applications to access their health information online.

Companies should monitor the use and disclosure of personal health information to third-party service providers and consider removing any personally identifying information before sharing the information with a third-party service provider.

Companies sharing information with any third party should ensure that the disclosures are authorized by the consumer. Under the proposed amendments, an unauthorized disclosure would explicitly qualify as a security breach, which is consistent with the most recent FTC enforcement actions.

Robin B. Mark is a partner at Burr & Forman LLP. She focuses her practice on the representation of individuals and corporations facing government enforcement actions. She assists clients with conducting internal investigations, navigating their potential civil and criminal exposure, and responding to law enforcement inquires. Robin may be reached at rmark@burr. com or (205) 458-5473.

GRAND ROUNDS

Mike Rickman Named CEO of Princeton Baptist Medical Center

Mike Rickman has been named the new chief executive officer of Princeton Baptist Medical Center. He is returning to the Brookwood family, having served in several roles, including as CEO at Shelby Baptist Medical Center.

“I’m thrilled to have Mike rejoin the Brookwood Baptist Health family,” Jeremy Clark, CEO of Brookwood Baptist Health said. “Princeton is an outstanding facility that holds a special place in the community it serves, and I’m confident Mike will continue to build on that legacy.”

Rickman has held several healthcare executive roles during his 30-year career, most recently serving as the President and Chief Executive Officer of Bradford Health Services in Birmingham. Rickman also co-founded Practice Partners in Healthcare, where he also served as Chief Operating Officer.

He received his Bachelor of Science in Accounting from Auburn University, and his Master of Business Administration from the University of West Alabama.

Matthew Beidleman, MD Joins Andrews

Matthew Beidleman, MD has joined Andrews Sports Medicine & Orthopaedic Center.

Beidleman treats patients of all ages and activity levels, including sportsrelated injuries and non-sports-related musculoskeletal conditions ranging from sprains, strains, and fractures to osteoarthritis. He also serves as McAdory High School’s team physician.

Beidleman is well-versed in utilizing orthobiologics for treatment, and employing diagnostic and interventional ultrasound techniques to provide accurate diagnoses and targeted interventions.

Beidleman graduated from the University of Alabama with a bachelor’s degrees in biology and psychology, received his medical degree from UAB, and completed a family medicine residency at the University of Tennessee Medical Center. He returned to Birmingham to complete his training with a primary care sports medicine fellowship at Andrews Sports Medicine and the American Sports Medicine Institute.

Robin B. Mark

Mike Rickman

Matthew Beidleman, MD

HealthCare.

Better Together.

Offering Hernia Surgery in Three Locations

Birmingham - Jasper - Homewood Call

After hernia surgery, many of our patients say, “Why did I wait so long?” Life gets busy, and it can be easy to put off a procedure. A hernia repair may help you get back to living life with ease. The surgeons of Brookwood Baptist Health Primary & Specialty Care Network are here for you, offering minimally invasive surgical options that may lead to less pain and a faster recovery.

Gregory Bearden, MD General Surgery

Michael B. Littleton, MD General Surgery

Kyle Packer, MD General Surgery

Kassouf Earns National Awards Honoring Performance, Culture

Kassouf recently earned three national awards recognizing both the firm’s business growth and inclusive company culture. The awards include INSIDE Public Accounting’s Top 300 Firms, Accounting Today and Best Companies Group’s Best Firms to Work For, and COLOR Magazine and Best Companies Group’s Inclusive Workplaces.

“We’re thrilled to receive these honors from the accounting industry’s top publications and a top magazine for inclusiveness across industries,” said Managing Director Jonathan Kassouf, CPA, PFS. “Being recognized for both client service and company culture is especially exciting.”

Howard Board Certified ABOIM

Micah Howard, MD has been Board Certified by the American Board of Integrative Medicine (ABIM.)

The ABIM is a certification that is offered by the American Board of Physician Specialties, one of the three most prominent multi-specialty certifying entities in the United States.

Howard, who practices family medicine in Decatur, Alabama, earned his medical degree from University of Alabama School Of Medicine in 2010.

Daniel Kim, MD Joins Andrews

Daniel Kim, MD has joined The Spine Center at Andrews Sports Medicine.

Kim, who was recognized by the North American Spine Society’s “20 Under 40” list of the top spine surgeons, was the first spine surgeon in Birmingham to offer endoscopic spine surgery.

Kim attended medical school at the University of Kentucky, completed his orthopaedic surgery residency at the University of South Alabama, followed by a spine fellowship at Twin Cities Spine Center in Minneapolis. In 2021, he moved to Birmingham, Alabama to pursue a career in orthopaedic surgery.

Shelby Baptist Prayer Garden Updated

Thanks to a grant of approximately $15,000 from the Baptist Health Foundation, the Shelby Baptist Medical Center Prayer Garden, which was originally opened in 2007, has received a landscaping refresh that includes adding pavers for increased accessibility, adding/replacing floral arrangements, adding a new cross

at the rear of the garden and installation of new outdoor furniture.

“We are incredibly grateful to the Baptist Health Foundation for their generosity,” said Shelby CEO Holly Dean. “Our prayer garden is a sacred space for patients and hospital staff, so we are thrilled to see it growing.”

The Kassouf team celebrates the first Kassouf House Cup Competition.

New pavers and cross.

Micah Howard, MD

Daniel Kim, MD

LOCAL ROOTS. NATIONAL REACH.

With the largest healthcare practice in the country, Holland & Knight has more than 400 experienced attorneys covering virtually every segment of the healthcare industry, from transactional matters, regulatory compliance and real estate to litigation, government enforcement and public policy issues.

Our dedicated healthcare attorneys and professionals – in Birmingham and throughout the country – have the insight, experience, depth and resources to help promote and protect your interests.