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What Will Alabama Lose by Not Expanding Medicaid?

ON ROUNDS Children’s Hospital Joins Prestigious Pediatric Cancer Consortium In February, Children’s of Alabama was accepted into the Pacific Pediatric NeuroOncology Consortium (PNOC), a collection of hospitals focusing on clinical trials for children with malignant brain tumors. ... 6

By Steve Spencer

In 2014, the Affordable Care Act offered to fund states’ Medicaid expansion with the federal government paying 100 percent of the costs for the first three years while phasing down to 90 percent by 2020 where it will stay. Alabama chose not to participate. Since then, eight rural Alabama hospitals have closed. Arkansas, on the other hand, joined the program and the result: not one single Arkansas rural hospital has closed in that time. Arkansas’ benefits don’t end there. $1.7 billion federal dollars flowed into the Arkansas economy in the first year alone. The state’s uninsured rate was cut in half. Arkansas hospitals had a 55 per-

Jan Skowronski, MD has Passion for Medicine, Fencing and Travel Everyone considering job possibilities has a list of requirements for their prospective new home. ... 7

Outpatient Infusion Centers Expand with Growing Demand The first outpatient infusion centers started over 30 years ago in oncology clinics because of the intravenous delivery needed for chemotherapy drugs. ... 8

Pickens County Medical staff tried to save the hospital.

cent reduction in losses from uncompensated care. “Our Medicaid expansion has had tangible, positive results,” said Joe Thompson, MD, MPH, who served as the Surgeon General of Arkansas from 2005 to 2015. That sounds well and good, but (CONTINUED ON PAGE 4)

“Medicaid is essential to the state’s entire health care system. Our state Medicaid program is very, very bare bones. The health care industry has huge needs for capital investment over time. For example, four years ago Children’s of Alabama moved into the new Benjamin Russell Hospital. That $400 million project could not be done in the Medicaid atmosphere in Alabama today.” Will Ferniany, PhD, CEO UAB Health System

Kenneth Sigman, MD Performs Alabama’s First ERCP With Single-Use Duodenoscope By Laura Freeman

The invention of the flexible fiberoptic endoscope by Basil Hirschowitz, MD, who founded UAB’s Division of Gastroenterology and Hepatology, was one of the great leaps forward in modern medicine. Now one of his former office mates is helping to take the technology a step farther as the first Alabama gastroenterologist to evaluate and use in

clinical practice a new, single-use version of an Ambu duodenoscope, the aScope Duodeno. A great deal of time, effort and expense go into cleaning and sanitizing conventional endoscopes to prepare them for the next procedure. The difficulty in sanitizing duodenoscopes used in endoscopic retrograde cholangiopancreatog raphy (CONTINUED ON PAGE 3)

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The Ambu aScope Duodeno


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Kenneth Sigman, MD Performs Alabama’s First ERCP With Single-Use Duodenoscope, continued from page 1 (ERCP) procedures is that the tip design doesn’t lend itself to cleaning. “The tip is turned to access the gall bladder and pancreas,” gastroenterologist Kenneth Sigman, MD, of Gastrohealth, said. “That makes it harder to clean thoroughly so that it’s absolutely sterile. In spite of diligent cleaning and sanitizing efforts, in the past it has been linked to outbreaks of infection. To eliminate the possibility of cross contamination, Ambu developed a single use duedonoscope.” Due to Sigman’s academic background in his years at UAB and his extensive experience in performing ERCP procedures, Ambu contacted him to be among the first physicians in the country to evaluate their new single use duodenscope. After the FDA approved the technology and granted it Breakthrough Device Designation, Sigman began using it to perform procedures for his Gastro Health patients. “I started using the device in procedures at Grandview Medical Center several weeks ago,” he said. “The initial touch was a bit different, but more alike than different when you compare it to traditional scopes. You quickly get the feel for it. After using the aScope Duodeno in around a dozen cases the first month, my reaction has been quite positive. The visual definition is excellent. It allows me to examine and biopsy organs, remove stones, place stents and perform all the same interventions as traditional scopes. There have been no infections after any of these procedures.” The single use device has also been well received by patients. “Since the pandemic began, patients have been reluctant to schedule procedures or even come to a medical office,” Sigman said. “They seem to feel more comfortable when I tell them we will have a single use duodenoscope that is sterile and fresh out of the package. They like knowing they will be the first person using it.” Although sterilizing endoscopes for their next use has always been a high priority, studies have shown that even the best efforts aren’t always effective. One such study found that up to 15 percent of duodenoscopes may still be contaminated after reprocessing. Eliminating that doubt is one of the strongest benefits of the new technology. However, it is also proving to be cost effective. “With traditional endoscopes, in addition to the initial capital cost of the purchase, which can be substantial, there are also monthly service contracts to pay, and the cost of staff time, supplies and equipment used in cleaning and disin-

fecting,” Sigman said. “If repairs are needed, that’s another expense, along with the cost of revenue lost to delays. “Traditional scopes have to be individually hand cleaned after each use and then soaked in expensive solutions and run through a specialized washer. That takes up valuable space for the processing and more space for storing to keep everything sterile until the next use. With the single use scopes, you simply open the sealed, sterile package and dispose of it when you’re finished.” Sigman often performs ERCP procedures when symptoms suggest blockages, stones or strictures and conditions ranging from pancreatitis to cancer. In the next few weeks he is also scheduled to do a trial use of the Exalt single use

duodenoscope from Boston Scientific. “Over the past few years, single use scopes have been available for pulmonary and ENT procedures,” he said. “It’s good to see this advance coming to gastroenterology. In Europe, disposable scopes are already being used in colonoscopies and other gastroenterology procedures. In the future, they should be available here. “Eventually, if all the endoscopic procedures we typically do in the lab could be done with single use scopes, the valuable space that’s being taken up by the cleaning process could be put to more productive use. That should help to reduce health care costs for everyone.” Sigman in surgery with Single-Use Duodenoscope

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What Will Alabama Lose by Not Expanding Medicaid? continued from page 1 maybe Arkansas’ success was an outlier. Nope, not at all. In Kentucky, Medicaid expansion added 12,000 new jobs, cut uncompensated care losses by 55 percent, and added $300 million to state coffers. Louisiana added 19,000 jobs and $103 million in new state tax dollars. The list goes on, but you get the idea. As of today, with 39 states, including Georgia, having adopted Medicaid expansion, the Biden administration has decided to offer an additional bonus to the handful of states that remain uninsured. Before we delve into this, however let’s gain a better understanding of Alabama’s program. “Alabama pays the least in the nation,” said Dane Howard of the Alabama Hospital Association. “A family of three has to earn less than 18 percent of

Hospitals employ 90,000 people statewide and support an additional 96,000 jobs.

Alabama hospitals have $20 billion annual economic impact.

the Federal Poverty Level (FPL) in order to qualify.” This means that in 2021 the family can’t earn more than $3,953. Per year. In Mississippi, this family qualifies at income below $29,207. That’s right – Mississippi. On people who fall within these state guidelines, the federal government pays 70 percent and the state pays 30 percent. The ACA would pay 90 percent on an expanded group that

88 percent of rural Alabama hospitals are losing money. Many will close without expansion.

Medicaid expansion would cover 340,000 Alabamans, 70 percent of whom are working.

includes everyone between age 18 and 64, whether or not they have kids, who earn less than 138 percent of the FPL. Now, the Biden administration offers to pay an extra five percent on the existing Medicaid costs for the noninsured states for the next two years in addition to the payment for expanded insured citizens. “A national study found that this would mean about $740 mil-

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Estimates that expansion would generate $11.4 billion in new economic activity in Alabama.

lion additional money for Alabama in the first two years, which is far more than we need to cover our part of the expanded group,” Howard said. So Alabama could expand Medicaid without any cost for the first two years. What does this mean for Alabama? A study that was conducted by David Becker, PhD of UAB found that after netting out the state’s share of the coverage with estimated new state and local tax revenue, expansion would have a net-positive impact on Alabama’s overall budget of $31 million over the initial four-year period. It is important to note that this study was conducted BEFORE the Biden administration’s new offer of an additional five percent, meaning that the budget benefits to the state should be even greater. Overall, Becker’s study found an expansion could have an annual economic impact on the state of more than $2 billion. Health care is important to our state. Alabama hospitals employ over 90,000 people and support an additional 96,000 jobs with a $20 billion economic impact. 88 percent of rural Alabama hospitals are losing money. Without Medicaid expansion, more rural hospitals will close, meaning a loss of jobs. Unemployed people don’t spend money and don’t pay taxes. Medicaid expansion would cover over 340,000 Alabama citizens, 70 percent of whom are working in jobs that don’t pay health insurance with incomes too low to qualify under the current state Medicaid program. So far, in every state that has taken the expansion benefit, credit scores have risen. People who aren’t stuck with thousands of dollars in hospital bills have money to spend. They buy shoes, cars, appliances and the shoe store, car dealer and appliance store have money to spend. In fact, according to the Alabama Hospital Association, expansion would generate $11.4 billion in new economic activity. Good healthcare means economic development. Very few companies want to locate in a community without a hospital, which is quickly becoming the majority of rural Alabama counties. And of course, healthy citizens are productive. With all this in mind, why wouldn’t the legislature jump on this? “When we speak with them, they ask us what happens after the first two years, after the five percent addition ends. What kind of sustainable funding will we need,” Howard said. “We’re working with them on that. But I know that if someone offers me $10 for every $1 I spend, I’ll take that every day.”


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Children’s Hospital Joins Prestigious Pediatric Cancer Consortium By Jane Ehrhardt

In February, Children’s of Alabama was accepted into the Pacific Pediatric Neuro-Oncology Consortium (PNOC), a collection of hospitals focusing on clinical trials for children with malignant brain tumors. The membership joins Children’s with 27 other top pediatric hospitals from the United States, Canada, Australia and Europe, accessing 225 pediatric brain tumor specialists. In pediatric oncology, over 95 percent of the time, research institutions need to work in collaboration with each other to be able to run clinical trials. “Cancer is not very common in pediatrics,” says neuro-oncologist Girish Dhall, MD, director of the Division of Pediatric Hematology, Oncology and Blood & Marrow Transplantation at Children’s and UAB. “Therefore, any single institution cannot run clinical trials by themselves, because we don’t have the numbers.” But PNOC opens an even more exclusive path to cutting-edge and stateof-the-art clinical trials on pediatric brain tumors. “PNOC is different because its major mission is on personalized therapy trials,” Dhall says. “Their

Girish Dhall, MD

main focus is clinical trials specific to a patient’s tumor.” Children’s was selected to be a part of PNOC due to the transformative work ongoing at its Alabama Center for Childhood Cancer and Blood Disorders, where more than 1,500 young patients seek treatment each year. Children’s belongs to several clinical trial consortia, including the Children’s Oncology Group (COG), funded by the National Cancer Institute with almost 200 children’s hospitals in the country. However, COG mostly runs clinical trials for newly diagnosed patients. The customized approach at PNOC

to the biology of each individual’s tumor, however, creates opportunities for clinical trials rarely found for children. “Unfortunately, we don’t have too many options for the unlucky children who have the disease return,” Dhall says. “The biggest difference is PNOC really believes in treating each tumor differently rather than putting all the tumors in one bucket and doing a clinical trial.” This enables trials to focus on testing new therapies derived to maximize a treatment’s effectiveness for that child. Now as part of PNOC, the hospital saves children and their families the complexity and stress of needing to travel outside Alabama to access these trials. “This allows us to present treatment options for patients who have really difficult diseases,” Dhall says. “They can stay at home.” Dhall was one of the founding members of the unique consortium. “When I was in Los Angeles around 2012, we started off as only Pacific Coast institutions—Seattle, Portland, San Francisco, LA and San Diego.” Since then, PNOC has slowly expanded across the country and beyond U.S. borders. Unlike other consortia, PNOC’s

clinical trial portfolio includes neurosurgery trials with techniques such as convection-enhanced delivery, fluorescent agents, and advanced imaging compounds. “Traditionally we use chemotherapy or radiation therapy for these cancers, but both just kill rapidly dividing cells and don’t discriminate between cells inside the cancer and cells that might normally be rapidly dividing inside the body,” Dhall says. The quest to replace broadly applied treatment therapies, like radiation, with targeted ones is growing rapidly. “It is not just brain tumors, but the field of oncology is trying to understand at a molecular level what makes tumors grow, so can we target just the tumor itself,” Dhall says. Beyond medications and biological agents, immuno-oncology researchers have begun finding ways to harness the body’s own immune system to specifically attack cancer cells. “There are a lot of clinical trials through PNOC on these approaches,” Dhall says. “Currently, PNOC has 26 clinical trials underway. The investigational agents being researched are not new chemotherapy drugs anymore. (CONTINUED ON PAGE 7)

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PHYSICIAN SPOTLIGHT

Jan Skowronski, MD has Passion for Medicine, Fencing and Travel By Marti Webb Slay

Everyone considering job possibilities has a list of requirements for their prospective new home. For Interventional Cardiologist Jan Skowronski, MD of Cardiovascular Associates, part of the Brookwood Baptist Health Specialty Care Network, one of his must-haves was a quality fencing club. Luckily for Birmingham-area heart patients, the Birmingham Fencing Club fit the bill, and when he accepted a position with CVA, he joined the fencing club on his first day. Skowronski’s interest in fencing began when he was a pre-teen in his native Poland. “On my street we had a good fencing club that raised two world champions,” he said. “I fenced for six years and was on the Polish Junior National Team as a teenager. I wasn’t on the Olympic team because I was too young and too weak.” His career choice put his hobby on hold for 20 years, but while living in Chicago where he served as the cath lab director at OSF, St. Anthony Medical Center, he began fencing again. “It was like riding a bike,” he said. “I got back into it, and I was pretty good.” Skowronski, who fences with an épée, which is the largest of the three weapons for the sport, fences at the club with fellow members every Saturday including, occasionally, his 13-year-old son, Alexander. “We try not to fence against each other much because I’m still better than he is,” he said. “But recently we fenced, and he was very close. I don’t think it will be long before he beats me.” Skowronski is passionate about the sport. “I don’t think I would be as successful a physician if it weren’t for fenc-

Children’s Hospital Joins Prestigious Pediatric Cancer Consortium, continued from page 6

They’re new biologic drugs or immunotherapy trials that are targeting the tumor itself.” But these new approaches have a way to go before becoming the primary treatment in oncology. “We’re not there yet. We’re still using chemotherapy and radiation,” Dhall says. “But it’s where the field is going, and needs to go.” To learn about any open clinical trials in pediatric brain cancer, contact either Bridget Tate btate@peds.uab.edu or Dhall at gdhall@peds.uab.edu

ing,” he said. “It’s a strategic game. You have to be fit physically, but it’s mostly about strategy. How do you overcome your opponent with technical skills and your mental strength? It’s a great individual sport. “In America we are into team sports like football, soccer and basketball. But I think for teenagers who are developing their ego and their own personality, fencing a great sport. It lets you make decisions in front of an opponent, one on one. It’s great training for forming character and making split-second decisions. Before the fight, you have to think about the strategy. I recommend that parents encourage their children to try it. It’s an elegant sport.” Skowronski did rotations in London and Chicago and completed his residency and cardiology fellowship in Minnesota, followed by an interventional cardiology fellowship in Maryland. He has been a U.S. citizen for 18 years. Reflecting on his childhood in Poland, he says, “we were not destitute, but not rich either. My father was a university professor, my mother was an assistant professor, and my grandfather was a recognized scientist. Communists were in charge, but we tried not to pay attention to them. We even had an expression called ‘internal immigration.’ Meaning

that you physically lived in the country, but you didn’t pay attention to official news because it was all lies. We didn’t really listen to the government’s official party line. We had close-knit families and groups of friends and just tried to ignore the Communist government as much as possible. But we read a lot and had access to worldclass literature. Our teachers were relatively strict, but comparatively good. I read a lot. I would read four to six books a month. I wish I had the same pace now.” He has no regrets about coming to the U.S., but says his friends in Poland have done very well. When he goes back to visit, they insist on paying for his drinks. “They say I’m just a poor doctor in America, so they pay the bill,” he said with a laugh. He hopes to return soon to visit his mother. He also loves to travel with his family. He has been to the Holy Land often, and when his son was 11, they completed a night ascent to Mount Sinai to see the sunrise. It required waking at 1:30 a.m. and doing the five-hour ascent

Skowronski at the Birmingham Fencing Club

in complete darkness. When it is safe to travel again, he hopes to take his family to Uganda to track mountain gorillas. But despite his travels, Skowronski always looks forward to returning home to Birmingham. “I live here and enjoy every single day. We have been proud recipients of Southern hospitality. The transition from Chicago to Birmingham has been much easier than I thought it would be for the whole family,” he said. “I just show up every day and try to help.”

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Outpatient Infusion Centers Expand with Growing Demand By Steve Spencer

The first outpatient infusion centers started over 30 years ago in oncology clinics because of the intravenous delivery needed for chemotherapy drugs. In the past decade, a number of outpatient infusion clinics that deliver a wide range of drugs have sprung up, driven by growth in biologics, most of which are delivered via infusion. “Some of the earliest biologics were approved for gastrointestinal conditions like Crohn’s Disease and Ulcerative Colitis,” said David Bush, RPh, owner/manager of AcDavid Bush, RPh provides information to a patient cuRX Infusion Center. at the AccuRX Infusion Center. Since then, the conditions that are treated by infuthe wave of the future. “I think we’re just sion of biologics have expanded. “We starting to see the beginning of it,” Bush now have 35 biologics on our formusaid. “There are two biologics now in the lary,” said Joseph Williams, the CEO pipeline for Alzheimer’s. Aducanumab of Birmingham ID & Infusion. “We is under FDA review and Donanemab treat a number of conditions, including just finished Stage 2 trials. If either of Inflammatory Bowel Disease, Rheuthese are approved, the infusion market matoid Arthritis, Multiple Sclerosis, will explode. There is very little excess Psoriasis, Psoriatic Arthritis, Lupus, infusion center capacity right now, so as ALS, and Migraines.” these and other drugs come out, existBiologics, which are isolated from ing centers will need to expand or new living sources and are more target-specenters will have to open.” cific than chemically derived drugs, are Indeed, Birmingham-area outpa-

rosis drug costs the provider around $40,000 for one treatment. And the complete course for the new biologic for thyroid eye disease is in the neighborhood of $250,000 a year. So it’s a big investment, and with only a 10 to 15 percent profit margin, you can mess up the paperwork on one patient and not get paid, costing you all the profit on your whole program.” Williams said, “a medical practice would need to dedicate staff to work through the pre-authorization process and the insurance benefits, to order drugs and get everything in place, while making sure patients know their deductibles and co-pays. Sharon Veasey, RN (left) and Lindsey Laney, Operations Manager We have a team that manages at Birmingham ID & Infusion. and tracks all of this.” While the costs and patient infusion centers are already seeing perwork can fall within the economfast growth. “Birmingham ID & Infuics of a large practice, it usually makes sion has gone from 25 outside infusion more sense for many smaller and midreferrals in 2018 to 450 patients now,” size practices to refer patients. Before Williams said. “We just moved into our freestanding outpatient infusion cennew infusion center last month and we ters entered the market, most practices are renovating our existing site.” referred to hospitals. However, that With such a rapidly expanding marhas been changing due to a number ket, why don’t specialists build infusion of factors, starting with costs. A 2017 facilities within their clinics? “There are report by Magellan Rx Management several reasons many don’t do that,” found that the same medication, adBush said. “First, biologics are very exministered with the same method, is pensive. For example, the Multiple Scleover twice as expensive in the hospital setting compared to outpatient sites. It cost $10,995 to administer Remicade in the hospital versus $4,691 in outpatient clinics. As a result, health insurers have increasingly created programs to move patients from hospitals to outpatient providers with BlueCross BlueShield of Michigan and Priority Health going so far as to eliminate most hospital infusion services from coverage. In addition to the cost advantage, outpatient infusion clinics offer greater convenience. Patients can drive up to the retail location rather than maneuver hospital parking decks and they don’t have to go through the hospital admissions process for a 45-minute infusion. Both AccuRX and Birmingham ID & Infusion have free WIFI, refreshments and TV for patients. In addition to their open area, Birmingham ID & Infusion has two private suites that include an infusion chair for pediatric patients with a seating area for parents. “We’ve found that it’s a great model of care,” Williams said. “We are able to save payors and patients money with a smoother process for referring physicians, along with a convenient, nice environment for patients. What’s not to like?”

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APRIL 2021 • 9


The Accelerating Trend Toward Big-Box Primary Care By James F. Henry, Phelps Dunbar

Amazon just announced that it will be expanding its Amazon Care program across the U.S. this summer. Originally only available to its employees, Amazon will now offer Amazon Care to other companies. The Amazon Care model uses a dedicated app to provide direct live chats between patients and either a doctor or a nurse. In-person care is handled by house calls from medical professionals who are licensed in the appropriate disciplines. Any prescriptions ordered for the patient would be delivered by Amazon to the patient’s home. Amazon joins the likes of CVS, Walgreens and Walmart in leading the charge toward corporatized primary care. Apple and Google have also signaled their intentions to be players in the primary care space. These corporatized primary care ventures promise to deliver value and convenience to patients due their integrated structures, but at what cost? Although companies like Amazon, CVS and Walgreens enjoy enormous purchasing power that can drive down costs, they also have enormous corporate overhead. These corporate primary care ventures are in their infancy, and how successful they will be is yet to be determined, but many commenters are skeptical of whether these integrated models of care can actually reduce costs

or improve health outcomes. As Marni Jameson Carey, Executive Director of the Association of Independent Doctors, observes, “Regardless of what the merging parties say about streamlining care and greater efficiencies, when health care entities merge, costs only go one way: up, way up. Ask those trying to convince you of the benefits to point to one study that shows costs go down after a merger, or that quality goes up. They can’t.” Corporatized primary care ventures are also soaking up large numbers of primary care practitioners who, as we know, are in very short supply. These ventures can provide certain attractive features to providers, such as better control of lifestyle and personal time off. On the other hand, employment contracts with such large entities tend to be standardized and prescriptive, often leaving practitioners feeling as though they have little opportunity or incentive to employ creativity in how they do their jobs. This can lead to a reduced sense of loyalty and connection between providers and employers and a greater tendency for providers to switch jobs. Perhaps the greatest question mark in this emerging era of corporatized primary care is how these models will affect the physician-patient relationship. With our country’s aging population, more patients present with complex

medical histories and multiple chronic conditions. A model of care that fails to emphasize the primary care provider’s role in coordinating the patient’s overall health care would seem to be ill-suited to provide optimal health outcomes to these complex patients. Some have called this type of care “assembly line” or “band-aid” medicine because it relies heavily on pharmaceuticals to put out fires and deemphasizes disease prevention and lifestyle counseling. So, how can smaller or independent medical practices compete with the bigbox primary care providers? First, smaller or independent primary care practices can focus on knowing their patients and maintaining the sanctity of the physicianpatient relationship. There is still value in patients having confidence that their

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physicians have a solid understanding of their overall condition, their medical history and their social history, all of which goes much deeper than the patient’s presenting complaint. Second, despite the financial pressures on physician practices, practices can strive to create compensation systems and personnel policies that balance the need for productivity with lifestyle factors. This can reduce burnout and turnover, both of which can impose tremendous costs on the practice. Over the longer term, physicians can support legislative and regulatory reforms that focus on patients as the most important stakeholders in the delivery of health care. One helpful initiative would be to allow patients additional flexibility in their health savings accounts to pay for alternative models of care, such as direct primary care, periodic fee, and membership subscription services, which would encourage patients to choose providers who emphasize individualized care. Physician practices can also support initiatives to reduce paperwork requirements that are put in place simply for the purpose of data gathering by Medicare and private insurers. Streamlining prior authorization requirements is another worthwhile initiative. The trend toward corporatization of primary care seems to only be increasing. By focusing on the physician-patient relationship and physician retention, along with supporting legislative and regulatory initiatives favorable to patients in small practices, physician practices can position themselves to compete with the big boxes in this new era. James F. Henry practices in the Phelps Dunbar healthcare industry group.

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QA &

Questions & Answers on Herd Immunity with Suzanne Judd, PhD in UAB Dept Public Health Why is the number of people who had the disease but never tested positive so high at ten to one? Early on in the pandemic, there was not much access to testing, particularly in places like New York city that were hit very hard in March. So it’s not surprising to see numbers like that there. We’ve done similar tests at UAB, looking at people’s blood for antibodies, and we see more like five to one in our area.

How will the virus variants impact the estimates of when we reach herd immunity?

Suzanne Judd, PhD

We believe that we are getting closer to herd immunity thanks to the vaccine, along with new scientific data which shows that more people got covid than were tested. We’ve learned from studies at Columbia, John Hopkins, and here at UAB, that there could be as many as ten people who had COVID-19 but didn’t have a positive test for every one person who tested positive, which means that there may be many more people with antibodies that we originally believed.

The more people there are who have immunity, the less the virus will spread and the safer it will be for us to interact with one another. There is no magical number that signifies herd immunity. Each virus is different. They mutate at regular intervals so the number needed for herd immunity can move, but at the moment public health experts believe that once about 72 percent of the population is immune, we’ll reach herd immunity. Current estimates are that

we’ll reach 72 percent sometime in late spring or early summer in Alabama, but this depends on many factors, including the rate of vaccination, and the number people actually have antibodies or immunity who didn’t have a positive test. And it depends on whether or not the virus mutates in the next few months. So we’re excited to know that we might reach herd immunity somewhere between May and June.

It depends on how the virus mutates. There are some mutations that will be covered by the immune response the body has already developed. There are other mutations that could escape the immune system and require a vaccine booster. So we have to watch the variants carefully. That said, it’s something we do all the time with flu. The CDC has a Flu Vaccine Effectiveness Network (Flu-Net) that runs continual surveys to keep track of the various flu strains that are circulating to make sure the current flu vac(CONTINUED ON PAGE 13)

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APRIL 2021 • 11


CYBERSECURITY

WONDERING IF YOU’RE VULNERABLE?

Vaccine FAQ’s FAQ for Healthcare Professions By Wendy Shurette

It’s great to see the continued momentum in the state’s quest to get all Alabamian’s vaccinated. As COVID-19 vaccine availability expands to include more age groups, providers are naturally going to get more questions about the vaccine, potential side effects, interactions, etc. The Risk Consultants at Inspirien Insurance Company have compiled a list of 10 frequently asked questions regarding the vaccine to expedite clinical visits and support clinicians in their quest to combat COVID-19. These FAQ’s were obtained from evidenced based sites such as the CDC, The American Medical Association, and The New England Journal of Medicine. 1. Is a patient who is immunecompromised, has an immune disease or has cancer eligible to take the COVID-19 vaccine?

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According to Dr. Carlos del Rio, a Global Health Expert at Emory University “there is no contraindication in my mind to take the COVID-19 vaccine.” Dr. Rio goes on to note that clinical trials did not include those individuals in an immunecompromised state, so the efficacy of the vaccine is still unknown and may not be the same as an individual who is not in an immuno-compromised state. Patients are advised to not take the vaccination if they have had an allergic reaction to the vaccine or any component of the vaccine. 2. What are the most common side effects after getting the COVID-19 vaccine, and how long do they last? According to the CDC, it is normal to experience some side effects that may last for a few days after receiving the vaccine, the most often seen side effects are: • Pain/swelling at the injection site • Fever/Chills/Fatigue • Headache/Achiness 3. Should a patient who has already had COVID-19 take the vaccine? Yes, it is recommended that patients who have had COVID-19 take the vaccine for further protection. Dr. Rio says that people who have had COVID-19 are advised to wait 90 days before receiving their first dose to ensure their immune system is the most responsive. 4. What is known about the efficacy of each vaccine and is one vaccine preferred over the other?

Wendy Shurette

According to the vaccine FAQ’s from the New England Journal of Medicine, Dr. Paul E. Sax, a professor of Medicine at Harvard Medical School and an infectious disease expert, says that both vaccines are “remarkably effective.” Dr. Sax also notes that the results of the clinical trials were highly successful, making the effectiveness of the vaccine comparable to the effectiveness of the measles vaccine, and protection from disease is far better than anticipated. Ultimately, both the Pfizer and the Moderna vaccine are equally effective in disease prevention. There are age requirements for each vaccine. The Pfizer/BioNTech vaccine is authorized for ages ≥16 years, and Moderna’s for ≥18 years. Apart from the age requirements, there is no benefit of one over the other. Once the vaccination process is started, it is recommended that patients receive both doses from the same manufacturer. https://www. nejm.org/covid-vaccine/faq 5. If a patient has had the first dose of the COVID-19 vaccine and then tested positive can they still get the second vaccine dose? Yes, and this is quite common. For optimal protection, Dr. Rio recommends that people who test positive after receiving their first dose wait 21 to 28 days before taking the second. However, people who received convalescent plasma or monoclonal antibodies should wait 90 days before completing the vaccine process. 6. Once fully vaccinated, how long will the vaccine last? Per the CDC, currently, researchers are still working on determining the length of immunity from the vaccination. https:// www.cdc.gov/coronavirus/2019-ncov/ vaccines/faq.html 7. What is the best way to approach vaccine hesitancy in my patients? Dr. Sax says there is no one size fits all approach to addressing vaccine hesitancy. The best method is to provide facts and credible information (CONTINUED ON PAGE 13)


Vaccine FAQ’s, continued from page 12

on how vaccines work and vaccine efficacy, and address patient concerns in a non-confrontational way. The CDC has prepared a vaccine communication toolkit, https://www. cdc.gov/vaccines/covid-19/healthsystems-communication-toolkit. html to help support vaccination efforts. https://www.nejm.org/covidvaccine/faq 8. What instructions should be given to patients after vaccination? Clinicians may provide patients with information from the Emergency Use Authorization fact sheet issued by the FDA for each vaccine, which can be found at the link: https://www.cdc.gov/ vaccines/covid-19/eua/index.html 9. Can a patient with a history of allergic reactions still receive the vaccine? Yes, unless the patient has had a severe reaction to the first dose. Dr. Sax recommends that patients who have had prior allergic reactions to vaccines be observed for 30 minutes post-vaccination, rather than the standard 15 minutes. 10. What documentation is required when administering the COVID-19 vaccine? According to the CDC, health care providers enrolled in the COVID-19 Vaccination program are required to: • Document in their medical record system the vaccine administration within 24 hours, including: • Location of administration and address • Recipient name, ID, Sex, DOB and address • Administration date • CVX (product) MVX (manufacturer) lot and dose number • Administering providers name and suffix and address if different than administration address • Administration site • Vaccine expiration date • Route of administration • Report administration data no later than 72 hours to their jurisdiction’s IIS after vaccine administration. Additional reporting requirements can be found here: https://www. cdc.gov/vaccines/covid-19/ reporting/requirements/index.html • According to the jurisdiction, providers may report daily inventory using VaccineFinder https://vaccinefinder.org/ or to their jurisdiction’s IIS to upload to VaccineFinder. • Vaccine administration errors, serious adverse events, and cases of COVID-19 who have been admitted to the hospital or died following a vaccine should be reported to https://vaers.hhs.gov/index.html

Q&A Herd Immunity, continued from page 11 cine is effective. They have now started Covid-Net that is collecting data on Covid cases around the country in order to stay aware of variants. And again, a mutation does not necessarily mean that the vaccine we have won’t work.

How much of your herd immunity timeline is predicated on new vaccines like Johnson & Johnson coming to the public and how much is based on information on the supply in Alabama? This is a conservative estimate. It assumes a very low level of vaccines. The May deadline assumes roughly 50,000 doses will be administered each week, which is probably lower that what we’re doing in Alabama right now. It also assumes a three to one ratio of people who had Covid and never tested versus those

who tested positive, while our studies look closer to five to one. So if we scale up and vaccines come online faster, we could reach herd immunity a little sooner.

How many people do you estimate in Alabama have had the virus but never tested positive? My guess, based on the data we see, is that we’ve seen about 500,000 total positive tests so you’re looking at maybe 1.5 million who have possibly had covid and therefore have the antibodies, even though they’ve never tested positive. Some of them might have never even had symptoms.

What would herd immunity mean for large gatherings?

True herd immunity would allow us to start getting back together again. It would mean that we could have concerts and sporting events. In that regard, we’ll monitor the weekly number of cases carefully. As long as it trends down and stays below about five to ten cases per 100,000 population and we have decent testing in the state, then we’ll know that it’s safe to get people back together. Vaccinations also keep people out of the hospital if they do get SARS-CoV-2 infection. And at this time in Alabama, fewer people are winding up in the hospital after positive test for SARS-CoV-2. If that number keeps going down and we see fewer people hospitalized even when infected, then we can start moving around again too.

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Birmingham Medical News

APRIL 2021 • 13


A Fireside Chat on COVID & Health Equity

More Experience

James Hildreth, PhD, MD takes part in the virtual fireside chat.

By Cindy Sanders

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Recently, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to President Joseph Biden, sat down for a virtual fireside chat with James Hildreth, PhD, MD, one of 12 national leaders tapped for the president’s new COVID-19 Health Equity Task Force and a member of the Food & Drug Administration’s Vaccines and Related Biological Products Advisory Committee. The two infectious disease leaders compared perspectives on COVID-19, with Fauci delivering his outlook on the worldwide pandemic. “I’ve been through a lot of infectious disease crises,” he said. “I’ve never been through one that immobilized the world for a year.” They spoke at length about the development and distribution of vaccines, as well as addressing confidence in the vaccine among minorities. “The virus has had the largest impact on our communities of color with underlying health conditions. Without our immediate attention and a national effort to fight this virus, we will be dealing with its impact for years to come,” Hildreth said. Of ongoing concern is a distrust among many in the African American community about the safety of the vaccine. Fauci, who has been actively addressing black churches and organiza-

tions, noted this distrust is understandable based on the egregious violations of ethical principles in the past. “The hesitancy we see in African Americans relates to something we need to deal with. It’s an extraordinary, unfortunate history that African Americans were subjected to under federal programs that related to health issues,” he said of the infamous Tuskegee experiment. “The horror of that and other experimentation on black populations has been handed down through generations. “You have to respect that hesitancy. You have to acknowledge what happened was real and isn’t something to be simply set aside. However, the next you do is to tell people that since that time, there have been ethical constraints and guidelines put into place that would make something like that impossible to happen today.” Once the historical fear has been addressed, Fauci said the number one reason for reluctance is a feeling that the vaccines were created too quickly, so perhaps corners were cut. He stressed the vaccine candidates have been through exhaustive reviews and are safe and effective. He pointed out the rapid development of COVID-19 vaccines merely reflects the “extraordinary advances in the science of vaccine platform technology.” Hildreth, who is dean of Meharry Medical College in Nashville, one of (CONTINUED ON PAGE 17)

Vaccine FAQ’s, continued from page 13 The CDC recommends providers to refer to their COVID-19 vaccination provider agreement for all provider requirements. We encourage readers to check out our website at www.inspirien.net for our complete COVID-19 Toolkit, as well as more information about the services we offer and how we could best assist with any of your Risk Management needs. Our Risk Management and Loss Control Consultants are always monitoring

and updating information. To stay up to date on the last information available, we recommend you check the ADPH and CDC websites at www.alabamapublichealth.gov and www.cdc.gov. The team at Inspirien would like to extend a heartfelt thank you to the clinicians and healthcare providers who have so diligently fought this virus over the last year. Wendy Shurette is a Risk Management Consultant with Inspirien.


Fighting Cancer in a Year Like No Other AACR Annual Report Highlights Progress, Barriers By Cindy Sanders

In the lead-up to their April meeting, the American Association for Cancer Research (AACR) released their annual report outlining progress made during a year of unprecedented challenges. With a mission to prevent and cure all cancers through research, education, communication, collaboration, research funding and policy and advocacy, the AACR highlighted breakthroughs across the spectrum of cancer care. Last year, the U.S. Food and Drug Administration (FDA) approved 19 new therapeutics to treat various forms of cancer and green lighted another 14 previously approved therapeutics for treating new types of cancer. The AACR annual report noted: “Remarkable advances in our understanding of the biology of cancer, including the identification of numerous genetic mutations that fuel tumor growth in certain patients, are continuing to drive the development of new therapeutics that target specific molecules involved in cancer. 16 of the 19 new therapeutics approved in 2020 belong to this category of molecularly targeted therapeutics.” Immunotherapy is another area of rapid expansion. In 2020, one groundbreaking application of immunotherapy targeted solid tumors that are characterized by the presence of the specific biomarker tumor mutational burden-high (TMB-h). The discovery and subsequent approval allows certain adult and children with tumors characterized by this biomarker to receive treatment with pembrolizumab. Such targeted therapies, which are part of the evolution of precision medicine, continue to improve survival times and quality of life after a cancer diagnosis. “In the next 10 years, I expect that scientific discoveries will ignite another revolution in cancer treatment and further improve outcomes for patients with cancer,” said 2020-21 AACR President Antoni Ribas, MD, PhD in the AACR Cancer Progress Report 2020. During 2020, the organization held their annual meeting virtually across two sessions in April and again in late June. Among the advances highlighted across 170 clinical trial presentations, special attention was given to immune checkpoint inhibitors and combination therapies. While immune checkpoint inhibitors have yielded unprecedented long-term responses across numerous cancer types, not all patients respond to the immunotherapy and many who respond initially come to develop treatment resistance over time. The April 2020 meeting looked at three specific trials that used an immune checkpoint inhibitor in combination with a targeted therapeutic to assess patient benefit and/

MARK YOUR CALENDAR AACR Annual Meeting 2021 Virtual Meeting Week 1: April 10-15 Week 2: May 17-21 For registration and information, go online to aacr.org

Pictured (L-R), AACR CEO Margaret Foti, PhD, MD (hc); 2019-20 AACR President Elaine Mardis, PhD, AFFAR; and 2020-21 AACR President Antoni Ribas, MD, PhD, FAACR

or delay to treatment resistance. While two of the trials indicated improvement, a third had to be halted when the combination trial resulted in slightly poorer results than the current standard of care. The varying outcomes highlight the need for continued research to establish which combinations and in what dosages could ultimately improve outcomes. Despite successes during 2020, the organization also recognized new and persisting barriers that have hampered access to care and cutting-edge research. The new barrier came in the form of COVID-19 as clinical care and research struggled to maintain momentum in the face of lockdowns. AACR took meetings and educational workshops online for virtual offerings where possible but logistics made it impossible to hold the full slate of planned programming. The AACR Scientific Publishing program also moved quickly to ensure researchers had continued access to key information as facilities around the world began shutting down in the wake of the rapidly spreading virus. By May, the organization had formed a COVID-19 and Cancer Task Force, chaired by Ribas, to set priorities and develop new AACR initiatives to address the pandemic. A persisting barrier the organization made strides in addressing is the ongoing racial inequality in cancer research. Last fall, AACR released a first-of-its-kind disparities progress report focused on outcomes and clinical trial participation for racial minorities. While research is making great strides in the fight against cancer, AACR leadership noted the grim reality is that everyone hasn’t benefited equally. For more than four decades, black Americans have had the highest overall cancer death rate of any racial group in the United States. Although the landmark report was new in 2020, AACR CEO Margaret Foti, PhD, MD (hc), noted work in this area has been ongoing. “Health disparities in general, and cancer health disparities in particular, are an enormous public health challenge,” she said. “While the pandemic has highlighted and sadly exacerbated many of these issues, confronting and addressing health inequities has been a high priority for the AACR for decades.” Minorities in Cancer Research

(MICR) celebrated its 20th anniversary in 2020 and has increased participation by minority researchers in the field of cancer. “Diversity and inclusion in our field are important for accelerating the pace of progress against cancer, and a lack of racial diversity in both the cancer research and healthcare workforce is one of the major factors contributing to cancer health disparities,” Foti said. While still unacceptably high, the overall cancer death rate among racial and ethnic groups compared to white patients dropped nearly 20 points between 1990 to 2016. Still, minority groups continue to face an overall death rate 14 percent higher than their white counterparts. Yet, several recent studies have shown the effectiveness of tailored outreach and

patient navigation, while others have focused on completely eliminating disparities by creating equal access to standard of care. The goal of the new disparities progress report and member committees focused on the issue is to map out a strategic plan to harness momentum and hasten equal access to clinical trials and community care. Founded with 11 members in May 1907, today the AACR is the largest cancer research organization with more than 48,000 members, including 53 Nobel laureates, across 127 countries and territories. Members include laboratory, translational and clinical researchers, along with other healthcare professionals and advocates. To review the full annual report, go online to AACR.org.

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Three HIPAA Increases Potentially on the Horizon

By Lindsey Phillips

On December 10, 2020, the Office for Civil Rights (OCR) at the United States Department of Health and Human Services (HHS) announced proposed changes to the regulations implementing the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed changes, which are set out in the Notice of Proposed Rulemaking (NPRM), are a part of the broader initiative to promote value-based care, enable better coordination among healthcare providers, and facilitate patient autonomy and engagement. This article discusses some of the proposed changes and recent updates contained in the NPRM.

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One of the primary goals of the NPRM is to increase patients’ access to their protected health information (PHI) and enhance individuals’ engagement in their healthcare decisions. Accordingly, there are several proposed changes within the NPRM that are designed to facilitate this goal. First, covered entities would only have 15 calendar days after receiving a request from a patient for PHI to provide a response. In addition, covered entities would have the opportunity for an extension of no longer than 15 calendar days. This differs from the present rule in that covered entities are currently allowed 30 calendar days to provide a response and have the opportunity for an extension of 30 calendar days. Secondly, the changes would expressly allow patients to inspect their PHI in person. Not only would individuals have the right to inspect their PHI in person, but they would also have the right to take notes and use personal resources to capture images, videos, and audio with no fee. Third, the proposed modifications would reduce the current identity verification burden individuals have when

they are exercising their access rights. For example, requiring individuals to obtain notarization on an access request would constitute an unreasonable barrier to access and would therefore no longer be allowed under the proposed modifications. Covered healthcare providers and health plans would also be required to respond to certain records requests received from other covered healthcare providers and plans if such requests are directed by individuals pursuant to their right of access. OCR provides the following example: If an individual from California was involved in an automobile accident in Virginia, and is being treated by a variety of specialists, orthopedists, neurologists, physical therapists in Virginia, the individual can send a request to one of the treating doctors in Virginia to obtain an electronic copy of the individual’s records from their primary care physician in California to assist the Virginia treating physicians in providing care to the individual. The Virginia doctor would be required to forward the request within 15 days and the California doctor would be required to respond to the request within 15 days. This change would allow patients to exercise autonomy and better control the sharing of their information, and it would further facilitate coordinated care, which is a primary goal of OCR.

Increased Permission to Disclose PHI Another key theme found in the NPRM is expanded permission to disclose PHI in certain circumstances. For example, the proposed rule changes would allow covered entities to disclose PHI in circumstances where individuals are experiencing an emergency or health crisis. The current standard for disclosure of PHI in an emergency or health crisis is based on the covered entity’s professional judgment. The proposed modification relaxes this standard (CONTINUED ON PAGE 17)


Three HIPAA Increases Potentially on the Horizon, continued from page 16 slightly in that it would allow a covered entity to disclose PHI in an emergency situation or health crisis when the covered entity has a good faith belief that the disclosure is in the best interest of the individual. A good faith belief could be based either on direct knowledge of relevant facts or representations by a person who can reasonably be expected to know relevant facts. Mental illness and substance abuse crises are included in the types of crises for which a disclosure of PHI would be allowed. In addition, under the proposed rules, covered entities would be allowed to disclose PHI to prevent a threat to health or safety when the threat is “serious and reasonably foreseeable.” The current standard is considerably more stringent in that it allows the disclosure of PHI to avert a threat to health or safety only when the threat is “serious and imminent.” This proposed change would hopefully empower covered entities to disclose PHI in situations where harm is likely without being fearful of HIPAA penalties because the harm was not imminent. Under the proposed modifications, covered entities would further be allowed to disclose PHI to coordinate care with social and community services. Covered

entities would be expressly permitted to disclose PHI to social services agencies, community-based organizations, home and community based service providers, and similar third parties.

Increased Time to Provide Comments and Feedback On March 9, 2021, OCR announced that the public comment period for the NPRM would be extended from its original deadline of March 22, 2021, to May 6, 2021. The NPRM contains an extensive number of proposed changes that span over 300 pages. While HHS has stated that the proposed modifications support the Department’s Regulatory Sprint to Coordinated Care, the proposed changes do present some concerns among stakeholders. Accordingly, all stakeholders are encouraged to participate in the public comment and feedback process and now have until May 6th to do so. While these are currently only proposed rules, we would expect to see some of these “increases” implemented through final rulemaking. Lindsey Phillips is an associate at Burr & Forman LLP practicing exclusively in the firm’s Healthcare Industry Group.

A Fireside Chat on COVID & Health Equitycontinued from page 14 only four HBCU medical schools in the country, along with other prominent black physicians and community leaders, have helped address many of those fears by publicly receiving vaccines. Speaking honestly and clearly about where the science has led public health practice is a key factor, as well. Hildreth pointed to a recent award Fauci received from Israel for speaking truth to power while serving on the coronavirus task force during the Trump administration. Fauci said the fact that there was any type of discussion or disagreement over items that should have been purely in the public health realm – masks, congregate settings – was discouraging. He was astounded by reports of overwhelmed ICUs filled with COVID patients who claimed the pandemic was a hoax. “One lesson to be learned from the past year is to recognize how the politicization of the CDC and FDA affects public health,” Fauci said. “Counterproductive is a mild word. We must remain acutely aware that it can happen. Some organizations should be completely free of political influence. “I believe the Biden administration’s move to rejoin the World Health Orga-

nization is a significant step forward. Obviously, we have to take care of our own country, but we live in a global community. Even if the pandemic is brought under control in the United States, a failure to help the rest of the world means we will continually be threatened by mutant strains from overseas.” The virtual health summit was the first in a three-part series. The goal is to open a dialogue with stakeholders and health experts nationally to develop a community-centered approach that prioritizes prevention of disease and eliminates COVID-19 healthcare disparities among minority groups. “These conversations have never been more important,” Hildreth said. “COVID-19 has only illuminated the health disparities gulf that exists between majority and minority communities across our country, particularly in rural communities. Over the last year, we have further focused our efforts on addressing these disparities, and this summit will provide our community with the opportunity to engage around how best to make lasting changes that will impact the lives of all people.”

DON’T MISS THE Birmingham Medical News BLOG BLOG SCHEDULE  APRIL 6 Curtis Woods with Integrated Solutions The Types of Anti-Virus and When You Need Which Type  APRIL 13 Stephen Gould, MD with Cullman Regional Medical Group Innovative Therapies with Orthobiologics  APRIL 20 Tammie Lunceford, CMPE CPC with Warren Averett 2021: A Year of Scrutiny  APRIL 27 Phillip Langston with AssuredPartners Protecting Your Practice in a Constantly Changing Environment  MAY 4 Micah Howard, MD Evidence on Shinrin-yoku and the Therapeutic Effects of Nature  MAY 11 Brent Parnell, MD of OB-GYN South Women’s Health

TO VISIT OUR BLOG Go to www.birminghammedicalnews.com and click blog on the far right column or go directly to www.birminghammedicalnews.com/mod/blogpress/index.php While there, you are welcome to scroll down for past blog articles.

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Birmingham Medical News FOX 6 TELEVISION Ask the Doctor will feature Kathryn Ashley Bentley, MD of OrthoSports Associates on Monday, April 19. Birmingham Medical News

APRIL 2021 • 17


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It is a rare opportunity to work with someone who is both knowledgeable in their craftfortunate and professional in the way We were to be introduced to they Rich conduct business. Veritas Real Campbell and MedicalMedical Real Estate Rich their was anVeritas instrumental player Estate ‘met and expectations Advisors. Richexceeded’ helped usmy determine our in assisting our start-up medical inspace both categories. They placedpreferences, tremendous needs and our location effort the research phase practice. His in strategy. lease and didinto a great job ofskills evaluating all of the Their ability collaborate andbusiness, provide options. Hetoreally knows the negotiation, knowledge of the creative innovative ideasuswith the the local and market, and guided through Birmingham real estate market business team involved in thetotransaction the process from beginning end. He is was terrific. Veritas’ knowledge ofhandle thevalues local and ability to predict and professional, personable, and really market, togetherwith withhistheir experience the relationships clients. Rich obstacles were essential. Anywill and knowledge of the real estate industry continue to be our go-to guy for real estate medical real estate transaction make them ‘gowould to’ forhighly anyone looking to needs, anda we recommend purchase or leaselooking commercial real estate. in theto Birmingham area should Veritas anyone for medical office

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Jackson Thornton Technologies Promotes Three Jackson Thornton Technologies (JTT), a subsidiary of Jackson Thornton CPAs and Consultants, has promoted Brian Driskill to President; Brian Driskill Chris Bell has been promoted to Vice President, Technical Services; and Nic Cofield has been promoted to Vice President, Client Services. Driskill has been with the Chris Bell firm for almost seven years, previously serving as JTT’s Vice President & General Manager. With more than 25 years of experience in executive management, Driskill Nic Cofield holds degrees from both Samford University and Troy University, including an Executive Masters in Business Administration with a concentration in Accounting. Bell has been in the IT field for almost 25 years and has been with the firm since 2009, serving as JTT’s Director of Technical Services since 2017. He serves on the Alabama Technology Foundation Business Advisory Board and is a graduate of Auburn University Montgomery. Cofield has been with the firm since 2005 and was in the role of JTT’s Director of Client Services for more than three years. He is a recognized speaker and

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trainer and has served as a presenter for many organizations throughout the Southeast on technology best practices. He is a graduate of Auburn University.

James Markert, MD Named President-elect of AAcNS James Markert, MD, MPH, the Chair of the Department of Neurosurgery at UAB, is the presidentelect of the American Academy of Neurological Sur- James Markert, MD, MPH gery for 2020-2021. Markert has served on the Executive Committee of the Academy for several years, including serving as its secretary for the last three. Additionally, Markert has held leadership positions within the UAB Department of Neurosurgery since 2006. “I look forward to furthering the mission of this wonderful organization” Markert said. “It is an honor to represent UAB Neurosurgery in this national position, and I hope to build on the successes of past presidents-elect while also forming a new legacy for the AAcNS.”

Warren Averett Recognized in America’s Best Tax Firms and America’s Best Accounting Firms Warren Averett, LLC has been recognized by Forbes on the list of Amer-

ica’s Best Tax Firms and America’s Best Accounting Firms for 2021. Forbes determined results using independent surveys of tax and accounting professionals who provided thousands of recommendations. Respondents were recruited via an online survey as well as through a profiled online-access panel. Recommendations from professionals working at tax and accounting firms and clients of firms were considered in equal measure. Self-recommendations were excluded from the analyses, and multiple quality reviews were conducted prior to publication. “Warren Averett is honored to be recognized by Forbes on both lists: America’s Best Tax Firms and America’s Best Accounting Firms for 2021,” says Chief Executive Officer, Mary Elliott. “Our team is dedicated to providing the best services catered to each of our client’s individual needs. This honor reflects our dedicated employees and the great clients we serve.”

Brookwood Melissa Cole Award The Medical Staff of Brookwood Baptist Medical Center recently honored six members of hospital staff with the Melissa Cole Award. The award, named in memory for the team member who personified dedication and compassion in her role as a Cardiac Intensive Care

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Unit nurse, is presented annually to nurses and staff who demonstrate the same outstanding qualities that defined Melissa’s career. The award recognizes individuals who have made a significant career commitment to the care of patients at Brookwood Baptist Medical Center and who define the standards of great care and serve as role models for all. The 2020 Melissa Cole Award recipients are as follows: Catherine Akhtar, RN – Cath Lab Jason Duke, CST – Main OR Laura Dunham, OTR/L – Behavioral Health Ann Johnson, RN – Emergency Department Lisa Williams, RN – 4 Main Shelly Miller, RN – Women’s Medical Center

Cullman Regional Emergency CON Approval Cullman Regional Medical Center has received Emergency Alabama Certificate of Need (CON) approval to add an additional 30 beds to the hospital including 13 additional critical care beds. During the final months of 2020 and into 2021, Cullman Regional’s Critical Care reached a capacity of 200 percent with twice as many critical care patients as critical care beds available. This was the highest capacity of any ICU in the United States. “We want to thank Dr. Swaid and the CON Board for their approval of this expansion project,” Cullman Regional CEO James Clements said. “This project allows us to create a better infrastructure in the event of another surge of COVID patients in the future.”

Construction recently began on the Emergency Department Expansion project to add additional emergency department treatment rooms and dedicated behavioral health space in the Emergency Department. The Emergency CON allows this construction project to be expanded in order to add an additional 30 beds to the medical center. Since March 2020, Cullman Regional has had over 7,200 confirmed COVID-19 patient days. Although current COVID-19 cases are declining, with the new variants of the virus circulating rapidly, now is the time to prepare for a possible additional spike in hospitalizations. According to an article in the Washington Post, the new variant first seen in Britain is significantly more transmissible than the older variants. In the United States, if unimpeded, it could drive daily new case counts back to the January peaks of more than 200,000 increasing hospitalizations and deaths too.

House Calls Program Brings COVID-19 Vaccine to Homebound Patients Homebound people are extremely vulnerable to COVID-19, and they are at risk of contracting the disease if a caregiver inadvertently brings it into their

home. To protect this population, members of the House Calls team at UAB are bringing the vaccine to their patients and eligible caregivers. The House Calls team, which includes a physician, nurse practitioners, medical assistants and a social worker, began administering vaccinations in patients’ home on March 15, and so far, they have vaccinated 30 patients and caregivers and plan to administer up to 130 doses by mid-April. “Most of our patients never leave their home due to extreme frailty, multiple chronic conditions, and functional and/or cognitive limitations. They are among the most vulnerable people in our area and are at the highest risk of serious illness and death from COVID,” Marianthe Grammas, MD said. “Many of them are exposed to a number of different caregivers coming in and out of the home, all of whom have the potential to spread infection to the patient.” “It is also important to vaccinate the caregivers because many of them are homebound as they can’t leave their loved one alone. Since we come to them, the caregivers don’t have to worry about how they would get their loved one to a vaccine site for inoculation. In many of their situations, this would be nearly impossible.”

House Call team members plan for 130 vaccinations by mid-April.

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