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St. Vincent’s Expands and Upgrades Cath Labs Features New FlexArm Imaging

ON ROUNDS

By Laura Freeman

A cardiac catheterization can be a stressful experience for patients. To start with, the patient is likely worried about the ailment with his heart, and then he is wheeled into a procedure room that often has a cold, sterile feel, and at times during the catheterization, the staff may need to turn him onto an uncomfortable position to give the cardiologist a better view. In an effort to improve the patient experience, Ascension St. Vincent’s has expanded and upgraded

Vulcan Imaging Gives Around the Globe “They had a need,” says Eric Blackman, CEO at Vulcan Imaging Associates (VIA). That’s all it took for the 30 radiologists at the medical group to agree to donate their time to read hundreds of x-rays per month from Christ Health Center, a local nonprofit medical facility. ... 4

Alabama Practices Restructure Even before the pandemic, change was in the air. Medical practices were working to keep up with regulatory requirements, shifts in technology, constantly changing reimbursement rules and economic fluctuations. ... 6

Enhancing the Patient Experience “We want to anticipate what is needed and put ourselves in the patient’s place,” says Mellissa K. Meadows, Practice Manager at Hoover Primary Care ... 12 FOLLOW US

Patients can choose the color of the soft lighting in the cath lab.

(CONTINUED ON PAGE 7)

UAB Builds Functional Genomics Database to Guide Covid-19 Research By Laura Freeman

tighter. So many lives and futures depend on finding better The pace of discovery ways to defeat a virus that is has always depended on the plaguing the world. tools that guide the seekers. To aid in this search, a Venturing across unUAB bioinformatics team has known seas, early explorers created a functional genomic navigated by lodestars at night, SARS CoV-2 database that and lodestone compasses by gives researchers free, searchday. Touchstones sorted true able access to almost 12,000 nuggets of precious metals pieces of data on genetic facfrom false, and Rosetta stone tors that are powering the paninscriptions helped scholars demic. It includes annotated unlock the mysteries of Egyp- PAGER-CoV offers a precision medicine approach to help better understand COVID-19. gene lists, genetic signatures, tian hieroglyphics. and details about pathways the Americans than died in World War II and Today we are engaged in one of the virus is using to attack body systems. millions more around the globe. The race most urgent quests for new discoveries in “When the virus invades, it triggers between vaccines and variants is getting generations. Covid-19 had killed more (CONTINUED ON PAGE 3)

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UAB Functional Genomics Database to Guide Covid-19 Research, continued from page 1 how a certain cell type very different responses in behaves under different different people by activatconditions. A gene signaing a variety of pathways,” Jake Chen, PhD, associate ture is a unique pattern director and chief bioinof gene expression within a cell from a single or formatics officer of the group of genes, providUAB School of Medicine Informatics Institute, said. ing information about the “Understanding more activity of those genes in about how the genes of the cell. the virus behave and in“Over the sumteract with a patient’s inmer my colleagues and Jake Chen, PhD I began to adapt the dividual susceptibilities PAGER format to collect could spark ideas for new genetic information currently available therapies and provide clues about which related to the virus and to add more as therapeutics we may already have that new findings were reported. Part of the could be effective against the disease. data search used automated integration, It would support a data-driven precibut much of it was done with individusion medicine approach to matching the right therapy to the right patient.” ally curated searches. We recruited our The database is known as PAGERdoctoral students who had been diverted CoV. It grew out of the infrastructure of from their regular work by the pandemic PAGER (pathways, annotated gene lists to assist us in combing through the new and gene signatures), a database of gene literature. Before we entered new inforsets developed by Chen over the past ten mation in the database, we ran the same years primarily through his work with research again to verify the findings,” the genetics of cancer. Chen said. Pathways are the roadmap that deA report of the work was published in January in Nucleic Acids Research, a rescribes how genes are turned on and off, and how they establish connections with spected international science publication. each other. Annotated gene lists provide The important role of genetics in empirical information that researchers understanding the virus became evident collect from experiments or literature. early in the pandemic with the extreme Gene lists help researchers understand variability in the course of the disease.

“We wondered why some patients become very ill and die, while others show only mild symptoms or none at all. Why are different organs and systems affected? What determines who becomes a long hauler with persisting symptoms? Understanding the genetics should help us find the answers,” Chen said. Each point where the genes of the virus interact with the genes of the patient could offer an opportunity to intervene. “Something about the hE2 cells deep within the lungs is vulnerable to the virus,” Chen said. “That’s where it anchors to ACE receptors and begins trying to hijack the body’s cells to begin replicating its RNA. Then it starts down molecular pathways, turning genes on and off as it attacks.” As vulnerable genes linked to specific symptoms are identified, researchers may be able to identify therapies to counteract the effects. This could be particularly important to people with severe or persistent symptoms. The body’s response is also responsible for much of the damage. Individual genetic vulnerabilities, existing health conditions and other biological factors can trigger an over-response by the immune system, releasing a cytokine storm or creating a perfect environment where the virus can thrive. Learning how the body’s genes affect response could lead

to better strategies for regulating the immune system to prevent damage. “SARS CoV-2 is a new virus with 15 genes and there is still much we don’t understand about how the virus proteins are interacting with human cells and their downstream effects or what we can do about it,” Chen said. “We invite researchers worldwide to make use of the portal and to participate in this community-based knowledge curation effort.” PAGER-CoV is freely available to the public without registration or login requirements at http://discovery.informatics.uab.edu/PAGER-CoV. The data is available for download based on the agreement of citing the work while using the data from the PAGER-CoV website. Joint first authors on the paper published in Nucleic Acids Research are Zongliang Yue, PhD and Eric Zhang. Additional co-authors are Clark Xu, Sunny Khurana, Nishant Batra, Son Do Hai Dang and James J. Cimino, PhD. PAGER-CoV was developed with support from the University of Alabama at Birmingham Informatics Institute, UAB Academic Enrichment Fund, the UAB Center for Clinical and Translational Science, National Cancer Institute, and the National Center for Advancing Translational Sciences of the National Institutes of Health.

Birmingham Medical News

MARCH 2021 • 3


Vulcan Imaging Gives Around the Globe By Jane Ehrhardt

“They had a need,” says Eric Blackman, CEO at Vulcan Imaging Associates (VIA). That’s all it took for the 30 radiologists at the medical group to agree to donate their time to read hundreds of x-rays per month from Christ Health Center, a local nonprofit medical facility. That was three-plus years ago. Since then, the Center’s needs have grown, and so has VIA’s commitment to them. “We’re their only source for interpreting all their work, including ultrasounds, which are a new service,” Blackman says. At their four Birmingham locations, Christ Health Center served 21,500 patients last year from the area’s underserved population, offering primary care services from their staff of 44 providers, plus pharmacists, counselors and a dentist. Blackman estimates VIA radiologists read 20 to 50 ultrasounds a month now in addition to the x-rays, but he expects that number to rise rapidly. “And any one of our radiologists can read them when they come in. This is a groupwide effort.” VIA even provides the clinic with file storage through their partnership with FINAO Solutions in Huntsville. The growing availability of ultrasound machines and CT scanners has meant impoverished clinics around the world may gain access to one. The problem becomes finding someone trained to use the machines and interpret the im-

Eric Blackman

Dean Thornton, MD (center) with two Kenyan radiology technologists.

ages. A nonprofit called Hope Imaging fills that gap. “They identify places all over the world and send sonographers— which are ultrasound techs—or radiologists to teach them how to use it,” says Shane Wear, MD, a radiologist at VIA. He started working with Hope in 2015. “You go for one week at a time,” Wear says. “But because there is only so much you can teach someone in a week, you can come back in six months.” Wear’s two trips were to Haiti. The second trip was to the same outlying clinic. “It was more fun because I had built re-

Shane Wear, MD

lationships with some of them already,” Wear says, adding that unlike other charity work, these missions are more finite. “Our goal is to go there and to work ourselves out of a job, so they’re good enough they don’t need us anymore.” During his first trip, a woman arrived with abdominal pain. Because of the scans, they discovered an ectopic pregnancy, where the egg implants outside the uterus. Though rare, the condition is life-threatening to women. “We got her onto a bus and into a hospital for surgery. Had she not been diagnosed

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at that time, there’s a good chance she would have died at some point in her pregnancy,” Wear says. “That made me see that we are making a difference.” Back in Birmingham, The Save A Life Ministry devotes mission work to helping pregnant woman and has the same need for training personnel to do ultrasounds. So every other week, Dean Thornton, MD, another radiologist at VIA, teaches nurses how to perform and read ultrasounds. “I’ve trained a bunch of nurses so that they can offer that service pretty much whenever their doors are open there,” he says. “And I get to do the ultrasounds, which I enjoy.” The clinic provides help to women who face an unexpected pregnancy and may feel financially or socially ill equipped to raise a child. Save A Life offers a host of financial and social resources to help them carry forth with their pregnancy and have successful families. “The ultrasound is a very powerful tool. Seeing the baby on the ultrasound, wriggling and moving, makes it real for the mom,” Thornton says, who’s been volunteering since 2007. “They go from despair to hope, as they are able to get all the resources they need. Then, as new mothers, they’ll often bring their newborns back to show us and they will tell us how much they love their child. It’s very fulfilling to be small part of that process.” Thornton also works with World Medical Mission, an arm of Samaritan’s Purse, which has hospitals all over the world. In 2014, he traveled to southwestern Kenya to volunteer at Tenwek Hospital a 300-bed facility that had a new CT scanner. “I fell in love with the place and the program,” Thornton says, who runs every day, including while he was in Africa for those two weeks. One of his fondest memories is of a group of young, smiling children who joined his run as he came down their road, some holding his hand as they jogged together. Back home, he continues his support by spending a week every other month reading two to four scans each night. “Almost every case there is weird,” Thornton says. “Tropical diseases, terrible car wrecks, and the biggest tumors you have ever seen. Last week, I saw a woman who had been attacked with a machete. It’s a different world.” Wear says the array of volunteer opportunities for radiologists surprised him. “It’s been great to see that our specialty can participate in this kind of work,” he says. Vulcan Imaging as a whole, says Blackman, simply wants to help. “We have a calling from the group to serve the community, especially those who can’t help themselves.”


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Birmingham Medical News

MARCH 2021 • 5


Alabama Practices Restructure By Laura Freeman

Even before the pandemic, change was in the air. Medical practices were working to keep up with regulatory requirements, shifts in technology, constantly changing reimbursement rules and economic fluctuations The impact of the lockdown reminded many practices of the value of regularly reviewing their business structure to determine how it fits their priorities and how well it positions them to deal with future challenges. “We were already doing due diligence for several clients who were looking at a variety of options, and we had recently completed oversight of the sale of a dermatology practice to an equity fund,” said Jonathan Kassouf, CPA, PFS, who is a health care business specialist at Kassouf & Company P.C. “In this particular case, some of the physicians in the practice were approaching retirement and were looking for a transition that would allow them use more of their time doing what they loved, which was practicing medicine, rather than constantly dealing with the stresses of business management. So far, it has worked out well for them.” Selling to an equity company wasn’t their only option and isn’t necessarily

Miles E. Gresham MD

Jonathan Kassouf, CPA, PFS

the best option for everyone looking to change their business structure. They could have chosen a merger, hired a management company or added the expertise of a consultant, or a business manager, IT specialist or whatever knowledge was needed in-house. “So much depends on what your goals are,” Kassouf said. “Are you willing to swap some of your autonomy for less stress and more time practicing medicine? You will have the proceeds of the sale in hand to put toward your personal financial priorities, but you will be working under an employee contract. However, you will continue seeing your own patients, which could be an advantage compared to going to work for a hospital or other third party. “You’ll likely also receive equity in the equity company, but I always caution people to be sure they are happy with

what they are being paid for the sale of their share of the practice because the value of equity they receive is likely to be hard to determine for some time. Most of all, it helps to have good attorneys, good accountants and other professionals who have experience in these types of transactions and will work together to see that you have a seamless transition.” Another local practice that has recently restructured is SouthEast Gastro, which chose a more classic merger to become Gastro Health. “We had previously merged with another local practice and saw the advantages in economies of scale and strength in numbers,” Miles E. Gresham MD, VP Clinical Affairs at Gastro Health Alabama, said. “In our specialty, large regional practices merging with local practices in different cities is becoming common. We looked at a couple of possibilities, and were particularly impressed with Gastro Health, which has grown up the coast of Florida and is now in Alabama. “I would strongly recommend that anyone considering a merger do due diligence and actually go and talk with people in another practice that has already joined the group you are considering. See for yourself what the daily routine is like and talk with the people

who work there. We received rave reviews from other members of the group who seemed to be quite satisfied. “We’ve been well satisfied ourselves since joining the group. When you have economies of scale, you can afford a higher level of expertise in your IT and management staff. They’ve done a great job upgrading our IT, and there seemed to be advantages in numbers in getting supplies, especially when PPE was hard to locate. “You’ll want to have people who understand this type of transaction handling the legal and accounting side. That’s another part of due diligence to avoid surprises and make sure everyone is happy with the transaction.” Perhaps after a review, you’ll decide the current structure of your practice is exactly what it needs to be, or it may be that working in pandemic mode has given you ideas for improving what you already have. You may decide to crosstrain more of your staff so there’s always backup, and you may know more now about your key positions, who you can count on in a crunch, and whether there are work policies that could be adjusted to work better. Soon, we hope, this pandemic will be behind us. But one lesson we’ve all learned is that it’s never too soon to start getting ready for whatever lies ahead.

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St. Vincent’s Expands and Upgrades Cath Labs Features New FlexArm Imaging, continued from page 1 the catheterization labs at St. Vincent’s downtown and St. Vincent’s East with a number of improvements that include lighting, sound and equipment. “The environment is much more relaxing to work in and it seems to help put the patient at ease. After years of doing cath procedures, I’d have to say this is the best lab I have ever seen,” David E. Cox, MD of Cardiology Specialists of Birmingham said. “The lighting system is incredible. You can even adjust the colors of soft lighting to give you the best view and the most calming feeling. To patients, it probably looks more like a spa than a lab, so that helps to improve the mood and lessen the tension.” The lighting, with colors patients can choose from, will sync with music and visuals during procedures. “The sound system is wonderful,” Cox said. “We’ve always tried to use music to ease the stress for patients and to create a better working environment, but we often had to settle for whatever we could find on the radio. With this sound system, we can give patients just about any type of music they want. Working in the new labs seems to brighten staff morale, too. “And I’m impressed with the cutting-edge tech that makes our work easier. The monitors are larger than life, and the clarity and resolution are excellent. This really helps when you’re working with vessels that are about the size of spaghetti, especially in branching areas that can be more difficult.” As part of the upgrade, they installed the new Philips Azurion with FlexArm in both the St. Vincent’s Downtown and East labs, making the two hospitals the first in Alabama to feature this advanced imaging technology. The FlexArm moves on eight different axes, all controlled with its single Axsys controller, resulting in a 270‑degree range of movement which significantly reduces the need to reposition the patient. A study at Miami Cardiac & Vascular Institute found clinicians using the system were able to reduce table repositioning by 30 percent. “The new Flex C Arm is great for both the cath team and the patient,” Cox said. “The footprint gives us much more flexibility in positioning the patient for the best view. It’s also more comfortable for patients, since they don’t have to stay in a difficult position for an extended period. “This new technology also allows us to get good results using the smallest dose of radiation possible. This is better for the patient, and much better for the cath lab team, since we do a lot of procedures and less cumulative exposure is important in keeping everyone healthy.” The labs are set up to automatically

When it comes to your health

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David E. Cox, MD

save digital imaging and data from all procedures. “When I see patients who had a previous cath, I always want to compare the images. Text reports are good, but nothing gives you a clearer view of how the patient’s condition is changing than pictures,” Cox said. Cox also has praise for the construction, design and equipment teams that managed to build the expansions during the pandemic. “I remember just as the virus was hitting, seeing workers clearing the space to make room for construction,” he said. “I don’t know how they did it, but somehow they managed to build the labs and bring everything together in spite of the challenges. It has made a big difference to patients, cardiologists and the staff.” The new cath labs are equipped for a range of interventional cardiovascular procedures, from diagnostic to dealing with blockages and implanting stents to restore blood flow. “In addition to vessels supplying the heart, we also do interventional procedures in peripheral areas including the head, arms, abdomen and mostly the pelvis and legs,” Cox said. “These procedures can save lives, limbs and relieve a lot of pain. It’s wonderful to have such a great environment where we can do the work.”

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Enhancing the Patient Experience by Jane

Ehrhardt

“We want to anticipate what is needed and put ourselves in the patient’s place,” says Mellissa K. Meadows, Practice Manager at Hoover Primary Care, when asked about enhancing the experience patients have while interacting with the practice. “Time is of the essence for patients,” she says. “Everyone is always in a hurry, we’re all multitasking, so we want to make the visit as productive as it can be in the timeframe it’s scheduled.” In that regard, Hoover Primary Care uses digital options to connect with patients at their convenience, especially new patients. “A lot of information has to be input in the beginning and that can be a deterrent for someone,” Meadows says. New patients are sent an invitation to join the portal for pre-visit sign-ins, complete with all their basic demographic information already entered, but with an incentive to join now. “When we send that link, if they sign up within a five-to-tenminute window of time, all they have to do is create a username and password and verify the information already provided,” she says. If they go beyond that time limit, they have to enter all their information themselves. Other pre-visit requirements can

Mellissa K. Meadows

Mike Candelaria

also be met virtually with the portal. Patients can pay their copay and click on their agreement to the consent form. “So they don’t have to physically sign a form, and they have a contactless experience at the office,” Meadows says. The process saves patients’ time at the office, since they don’t need to arrive so far in advance to fill out paperwork for their appointment. “They get here a few minutes early to go through the COVID screening process and, at that point, they’re checked in,” Meadows says. “We’re still evolving with it and trying to get more people to use it. But patient usage has been rising. When we started the portal last year, one or two patients out of 100 each day would use the e-check in. Now it’s up to 30 percent. Surprisingly, it’s not limited by age. Senior patients have been very tech savvy with it and the adult children who are the proxy of our older patients

are choosing it.” Medisys has tapped into an even more popular communication mode for patients. “We implemented a check-in text,” says Mike Candelaria, who handles computer support with Medisys. “Texts not only get sent to remind and confirm the patient for their appointment, but also to guide them through the check-in process that, with COVID, can change day-to-day. The text explains the check-in procedure before they arrive, so instead of having a big sign on the door for patients to read when they arrive, the patient sees that in their text.” Should things change, the patient can get an update on that process when they text to announce their arrival at the office and, if needed, their parking spot number—all without leaving their car. “All customizable, because practices have different policies,” Candelaria says. If a patient needs a lab test done, a text directs them to go straight to the lab upon arrival instead of the front desk, and the patient clicks on a notification when they’ve left the lab. “So when the patient is done following instructions, the front desk knows,” Candelaria says, and can move them on to an exam room or check them out. Medisys also set up texts to facilitate payments. “They get a text to pay

this amount now with a link. When they click that, it opens a browser to a secure website to fill out the payment form,” Candelaria says. “Once the patient pays, the front desk knows it—it’s all on one screen for them.” For Mellissa Meadows, the virtual check-in has created a natural path to qualify for e-visits and avoid the need for patients to travel to the office all-together. Different than telehealth, e-visits are basically live text chats through the secure portal. To qualify, the patient lists a few symptoms during their echeck-in. The doctor reviews that and offers them the option of an e-visit, if possible. “It can’t be something that sight is needed for, nothing over 10 minutes, but something like a sinus issue or a UTI that has recurred,” Meadows says. “It allows patients to have the visit at their convenience. High-risk patients, in particular, have enjoyed this option.” “This has been a strange year for medicine,” Meadows says, with the focus shifting to providing quality care from a distance. But it has forced the creation of more avenues to interact with and serve patients. “It’s about valuing their time and valuing them.”

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QA &

Questions and Answers on E&M Coding Changes for 2021

By Tammie Lunceford, CMPE, CPC

guidelines are the compliant option.

Effective January 1, 2021, evaluation and management coding (E&M) guideline changes were finalized as part of the Centers for Medicare & Medicaid Services (CMS) 2020 Physician Fee Schedule, but these changes are reflected with all payers. Here are a few answers to some frequently asked questions about the E&M coding changes in 2021.

What is the focus of the new guidelines?

Why were these changes needed? 1995 and 1997 documentation guidelines have not changed drastically in over 25 years, and more simplified guidelines are needed to reflect current circumstances. (The 1995 and 1997 guidelines will continue to be used in hospitals, ER, observation, nursing homes, etc.) Mid-level practitioners have flooded the healthcare market, resulting in more difficulties with the previous complicated coding process. Additionally, patient behaviors have changed: they don’t visit their primary care phy-

Tammie Lunceford

sicians or specialists regularly. This can lead to some visits being more detailed than they may have been in the past. CMS and the AMA effectively put these changes in motion to decrease documentation burdens, decrease audits and expand key definitions, decrease unnecessary documentation and ensure E&M payment is resource based. There is no option to continue to use the 1995 or 1997 guidelines for new and established office visits. The 2021

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Medical Decision Making (MDM) or time is the focus of these new guidelines. MDM is the ordering of test, counseling, reviewing and collaborating with other health professionals and discussing treatment. Total time is an option in selecting the level of service. The guidelines allow documentation time (the day of the encounter) and other provider time in preparing for the visit, as well as the time spent with the patient face to face. Practices still need the documentation to be meaningful by telling the story of the patient’s visit, and data collection is an asset for practices that will still be obtained through updated documentation.

Are the codes changing? The guideline change is taking place in the patient visit descriptions; the codes themselves are mostly unchanged. The 2021 guidelines will cover only 99202-99205 and 99211-99215. The 2021 Code descriptions for CPT 99202-99205 and 99211-99215 no longer include the elements of history and physical exam to determine the level of the visit. If it’s medically necessary to perform any extent of history or physical exam to treat the patient, it should be performed and documented. While the new guidelines are flexible in the recording of the history and exam, it is still the basis of treatment. The new guidelines require a medically necessary history and exam but will not hold the provider to box checking in the EMR to meet a certain level of history or exam. All other E&M services are not changing.

Are criteria for new vs. established patients changing? New patient visit descriptions will now use codes 99202-99205, and 99201 is deleted. Established patient visit descriptions 99211-99215 comprise 20% of all Medicare allowed charges, which gave these descriptions priority to be updated first. Criteria for deciding if a patient is new or established will not be changing, meaning a new patient is defined as a person who has not received professional services from a physician in the same specialty in the same practice for three years. When the NP or PA is

working with a physician, they are considered as working in the exact same specialty and the exact same sub-specialties as the physician.

Are the descriptions changing? Some examples of E&M description changes include 99203 and 99213. These codes represent Office or Other Outpatient Services/New Patient and Office or Other Outpatient Services/ Established Patient, respectively. Both codes now allow for a medically appropriate history and/or examination along with a low level of medical decision making. 99203 and 99213 highlight how 2021’s changes simplify the way physicians handle new and established patients.

How is clinical workflow impacted? Every physician has a different workflow, even in a group practice. Some have scribes, some have a midlevel provider and often there are different ways to utilize the EMR. Some practices utilize a paper superbill, and others utilize the electronic superbill, which allows for the use of a coding calculator. All these workflows should be considered in preparing physicians for the changes in the coding guidelines.

How is reimbursement impacted? The work Relative Value Unit (wRVU) for the new and established office visits is increasing. Specifically, the established office visit codes are increasing by 10-15%. It will be important for practices to monitor utilization patterns prior to the change and moving forward. Assure physicians are aware of the changes, and encourage them to improve documentation to support of the level of service. Diagnosis coding and proper use of ICD 10 will support the level of service. Using codes to reflect social determinants of health will support higher levels of service.

How can I learn more? To learn more about these changes, you can view Warren Averett’s webinar about the E&M changes at warrenaverett.com/EMOnDemand. Tammie Lunceford, CMPE, CPC serves as the Senior Healthcare Consultant with Warren Averett.


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MARCH 2021 • 11


UAB Named Exploratory Alzheimer’s Disease Research Center by NIH and NIA By Laura Freeman

Just growing up in the South increases your risk of developing Alzheimer’s Disease. If your background is African American, that risk goes much higher. Why? That’s a good question— one UAB’s Alzheimer’s Disease Research Center (ADRC) is working to answer. Consider this a call for volunteers—especially African Americans over 55 who would like to make a real difference in the health of future generations. “We’re now part of a network of 31 ADRCs in 21 states, and each center has a particular focus on different aspects of Alzheimer’s research. We’re the only exploratory ADRC in the four-state region of Alabama, Mississippi, Arkansas and Louisiana, and we are focusing our grant on the theme of ‘Deep South Disparities of Alzheimer’s Disease.’ “The grant and the work we do will also enable us to support more local research,” Erik Roberson, MD, PhD, director of the UAB ADRC, said. “For example, UAB has expertise in a broad range of medical specialties. If someone from our ophthalmology department thinks they may have found a biomarker

Erik Roberson, MD, Phd

for Alzheimer’s that we can observe and track in the eye, it will be much easier to do the research to test that hypothesis. They won’t have to start at zero and find the funding to recruit volunteers, do all the basic testing and hope to still have enough left to do the eye research. We will have already laid the groundwork in recruiting and testing volunteers who now have their data on file.” The findings of these local studies should provide answers that apply to the

overall population, including people of both European and African ancestry. “In the past, most research volunteers came from a European gene pool,” Roberson said. “What we learned applied to them, but it didn’t necessarily apply to everyone. We were seeing too many disparities in people from other populations. For this research, one of our primary objectives is to recruit more African Americans and other under-represented populations so our results will better reflect the people who live here.” In the South, particularly in African Americans, diseases contributing to dementia are more common, including hypertension, diabetes and cardiovascular disease. Maybe the southern diet and the tendency to move less in the heat have something to do with it, but it’s far from the whole story. There are still disparities between southerners, with African Americans having higher rates of the disease. “Multiple factors seem to be involved,” Roberson said. “We know there are economic and social influences. Poverty limits the type of food people can buy and their living environment. It increases their stress and reduces the

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leisure time they might have for sleep and healthy activity. Social factors, particularly in the past, limited educational opportunities. Many of the African Americans who are older now may not have had the opportunities to prepare them for life-long learning. “Adding new forms of mental stimulation seems to slow down the progression of the disease. It can be puzzles or good conversations with friends at the coffee shop—anything to avoid drifting into long periods of passive daydreams. That happens in a part of the brain that is especially vulnerable to damage.” As might be expected in a disease with disparities between populations, there seem to be significant genetic differences in people who develop the disease, how early it occurs and how it progresses. “We have identified quite a few genes that seem to be associated with Alzheimer’s Disease, but even within the genetics, there are surprises,” Roberson said. One surprise is the APOE4 gene. Its strong association with the risk for Alzheimer’s Disease is why commercial gene testing programs like 23andMe offer (CONTINUED ON PAGE 15)


The Case for Preparedness Turning Lessons Learned into Action

By Cindy Sanders

Even prior to the public health and natural disasters of 2020, experts from across the healthcare spectrum were already looking into policy and regulatory recommendations to improve the country’s ability to prepare for and respond to crises. In February, the Healthcare Leadership Council and Duke-Margolis Center for Health Policy released their recommendations in a report focused on ways to maximize resources and strengthen disaster preparedness infrastructure going forward.

The COVID Impact Neil de Crescenzo, president and CEO of Change Healthcare, served as executive committee chair of the Healthcare Leadership Council (HLC) during much of the work on this project. “We actually started this process before COVID, but it took on a whole new importance once the coronavirus was identified,” he said. The members of HLC, a coalition of chief executives across all subsectors of the American healthcare industry, were already aware of policy and communication gaps prior to the pandemic. However, COVID-19 response underscored barriers and a

Mark McClellan, MD, PhD

Mary Grealy

lack of coordination hampering a rapid, adequate response to emerging threats. Calvin Schmidt, senior vice president and worldwide leader for Government Affairs & Policy with Johnson & Johnson, noted that every sector of healthcare stepped up to meet the occasion of the pandemic. “But the goal is to put infrastructure in place so we aren’t reliant on heroes but are instead prepared,” he said. “We need to know that an overwhelmed hospital can get their hands on what they need without delay.” Schmidt, who chairs the HLC task force on patient safety and quality, said that one section of the report recommendations addresses capacity, modernizing the supply chain and ensuring more resilient stockpiles. “We should never again have a situation where states

and healthcare providers are feverishly competing against each other for supplies,” he said. Mark McClellan, MD, PhD, founding director of the Duke-Margolis Center for Health Policy, concurred, noting, “The COVID-19 pandemic and immediate response has exposed vulnerabilities in the nation’s ability to handle a national-scale crisis. Fragile supply chains that rely on single sources outside the country were tough. There is broad agreement that we need more robust supply chains that include domestic sourcing, as well as multiple sourcing. “The new report is intended to be actionable based on shortfalls identified in dealing with the pandemic. We want to learn from what didn’t work and build on what did.”

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“Public emergencies will continue to happen and may become more frequent and severe,” said HLC president Mary R. Grealy. “The next pandemic, natural disaster, or global crisis can be handled more effectively with better preparedness. That begins with the government at all levels and the private sector taking action now, while lessons from COVID19 are still being learned.” The recommendations call for some of the temporary steps taken to address the pandemic becoming permanent going forward, particularly in terms of making it easier to create public-private partnerships, streamlining regulations to allow providers to practice where they are most needed without some of the more unwieldy state licensure issues, and enhancing communications and data sharing. McClellan noted the recommendations are a combination of actions that could be ramped up quickly and those that are more aspirational and factor into long-term plans. Experts agree the pandemic exponentially enhanced telehealth adoption for patients and providers. Andrea Willis, MD, senior vice president and chief (CONTINUED ON PAGE 15)

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MARCH 2021 • 13


Alabama Enacts COVID-19 Liability Protections for Business and Healthcare Providers By Angie C. Smith

Like many states, the Alabama legislature passed, and Governor Ivey signed into law, a bill that provides civil liability protections to Alabama businesses and healthcare providers related to COVID19. On May 8, 2020, Governor Ivey issued an executive order providing similar civil immunity to businesses and healthcare providers, but this legislation provides further protection to ensure businesses are able to remain open and to provide much needed protection for healthcare providers on the front lines of fighting COVID-19.

Who is protected? “Covered entities” can claim this protection. The legislation defines “covered entities” as businesses, healthcare providers, educational entities, churches, governmental entities, cultural institutions as well as the officers, directors, managers and employees of those entities. Each of these has a definition in the Act, but it covers a broad range of entities.

What is protected? There are two types of activity covered – healthcare services or treatment and health emergency claims. Although it may sound like this is only applicable

Angie C. Smith

to healthcare entities, it is much broader. For healthcare providers, the Act applies to acts or omissions where the conduct complained of “resulted from, was negatively affected by, was negatively impacted by a lack of resources caused by, or was done in response to” the COVID19 pandemic. As written, the Act should cover claims against a healthcare provider that may not directly involve the contraction or exposure of COVID-19. Additionally, a “Health Emergency Claim” is any claim that arises from or relates to COVID, including any mutation of the virus. For a business (and any covered entity), immunity is available

for any claim for “an actual, alleged or feared exposure to or contraction of COVID-19.” Additionally, a covered entity can claim immunity if it is sued for efforts related to testing, monitoring or tracking or using precautionary equipment or supplies. For example, this would cover claims for negligence in the use of personal protective equipment or claims by a business patron that he/she contracted COVID while on the premises of the business. Although the Act was only recently enacted, it is retroactive and applies to lawsuits filed on or after March 13, 2020, when the state of emergency was declared. Additionally, the liability protections afforded extend through December 31, 2021, or one year after a declared health emergency relating to COVID expires, whichever is later. Because we continue to be under a state of emergency, the immunity provisions will likely extend well into 2022. In fact, the current Presidential administration has indicated the national state of emergency will continue through the end of 2021.

What does it mean? Like all immunity statutes, this does not mean a business or healthcare provider will not be sued for COVID related issues. Those lawsuits are sure to come. However, the covered entities

will have the ability to assert immunity and would be entitled to dismissal. An individual suing a covered entity would have to show by “clear and convincing evidence” that the covered entity was acting wantonly, recklessly, willfully or with intentional misconduct to keep the claim alive. If a lawsuit is filed and it is not dismissed based on the immunity provisions, claims for personal injury are limited to actual economic damages unless there is a serious physical injury. Serious physical injury is defined as a “death or injury that requires inpatient hospitalization of at least 48 hours, permanent impairment of a bodily function or permanent damage to a body structure.” In other words, if a person sues for damages related to exposure or contraction of COVID, the only damages he/she could pursue would be out of pocket expenses for the alleged injury, such as medical expenses, and he/she would not be entitled to damages related to emotional distress or mental anguish. If a lawsuit is filed for the death of an individual and the court does not dismiss based on immunity, punitive damages would be available because those are the only damages available under Alabama law. It is important to note that this Act does not affect an individual’s rights to receive benefits under the Workers’ Compensation Act. Therefore, a business’s employees could still seek recovery for contracting COVID-19 while on the job as a Workers’ Compensation claim.

What should you do? If you are a covered entity or you operate a covered entity, you should:

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• Abide by all public health guidance related to COVID-19, including proclamations, orders or rules issued by the Governor, the State Health Officer or the State Board of Health.

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• Document your efforts to comply with public health guidance. • Consider obtaining informed consent from patrons, visitors or patients regarding the possible risk of exposure to COVID-19.

The Governor’s executive order can be found at https://www.alabamapublichealth.gov/legal/assets/soe-covid19liability-protection-050820.pdf, and the legislation can be found at https://legiscan.com/AL/text/SB30/id/2289784/ Alabama-2021-SB30-Enrolled.pdf. Angie Smith is a Partner at Burr & Forman LLP practicing in the firm’s Health Care Industry Group.


UAB Named Exploratory Alzheimer’s, continued from page 12

the option for testing whether that gene is present. The surprise is that while it is common in whole countries in Africa like Nigeria, for some reason it doesn’t have as strong an effect as it does in the European gene pool. Why? Are there protective genes present? Something else? “We still have a lot to learn, and we hope the research we’re doing will tell us more to help detect the disease earlier and treat it.” Roberson said. Volunteers who are 55 or older, healthy or with mild cognitive issues, are being recruited to participate in research. After gathering information including

cognitive screenings, medical histories, physical exams, genetic tests and brain imaging with MRI and PET scans, participants will be tracked over time. Areas of investigation will range from the basic mechanisms of disease to managing the symptoms and helping families cope with the effects. UAB investigators will conduct basic, clinical, translational and behavioral research and train the next generation of scientists. To learn more about enrolling as a volunteer, contact the Alzheimer’s Research Center at the UAB School of Medicine.

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Case for Preparedness, continued from page 13 medical officer for BlueCross BlueShield of Tennessee, said, “Looking at how we did telehealth expansion, we saw a lot of single providers jump into the fray to make sure patients could get the care they needed. We’re grateful to them. It helped us broaden our thinking on what we can do to support them.” Another area of focus coming out of the pandemic is a heightened sense of urgency to address health inequities. While many clinicians were already aware of disparities in care, the pandemic shone a bright spotlight on the issue. “The exacerbations were right there in our faces,” Willis said, adding social determinants must factor into preparing for future disaster responses. “The pandemic laid bare the need to improve both our public health and data infrastructure,” Grealy said. “I think there is an opportunity in the short term to move quickly on this.” While the gaps are glaring, an appetite to change the status quo seems to

be a growing in both the public and private sector. McClellan, who previously served as administrator of the Centers for Medicare & Medicaid Services and commissioner of the U.S. Food and Drug Administration, has been heartened by the information sharing and cooperation seen during the pandemic. “A positive sign was the organizations and people in the healthcare space who typically are competitors showing willingness to work together for the good of all Americans.” Grealy agreed, “There is a commitment on the part of the private sector to work with the government. We need to begin preparing now for what my come in the future.” Links to the recommendations and to a compendium of best practices and lessons learned by HLC members are available on the home page of the Birmingham Medical News website at www.birminghammedicalnews.com

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RECOMMENDATION HIGHLIGHTS Among the report’s recommendations, experts highlighted the following essential changes:

• Launching a standing disaster preparedness group, appointed by and working with the White House, that will include private sector expertise in areas such as production capacity, supply chain and distribution, data exchange, financing and acute care delivery.   • Modernizing the healthcare supply chain through digitalization, automation, and predictive analytics, with standardized approaches for allocating resources based on need and equity to prevent bidding wars between states and healthcare providers. • Creating measures to ensure health equity and address disparities, identifying high-risk vulnerable populations and directing resources accordingly.

• Improving economic resilience with strategic incentives such as zero percent loans, federally guaranteed purchase commitments, and geographic diversification of production for critical medical products. • Building a 21st century public health early warning system that will utilize all available electronic health records and public health data collection. • Passing legislation and regulatory reform to create rapid response capabilities  in areas such as medical licensure portability, telehealth accessibility, and swift access to PPE stockpiles. • Making it easier and more secure for private industry and government to share data by updating anti-trust laws, enacting strong privacy protections, and ensuring broad access to the data. 

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Brent Parnell, MD Named One of Only Thirteen Axonics® Centers of Excellence Honorees Nationwide Brent Parnell, MD, credentialed urogynecologist with OB-GYN South, has been recognized by Axonics® Modulation Technologies, Inc. Brent Parnell, MD as a Center of Excellence – one of only 13 honorees nationwide. This designation recognizes Parnell for his high level of proficiency with Axonics Therapy and his commitment to changing the lives of patients suffering from bladder and bowel dysfunction. The Axonics Center of Excellence program recognizes highly trained and experienced physicians and clinical practices that are committed to patient education and providing exemplary care to achieve optimal clinical outcomes and patient satisfaction.

Kassouf Promotes 19 and Names Four Principals Kassouf & Co promoted 19 team members in January, including four employees who were named principals. “We are proud of these team members for continually striving for excellence, especially during a tumultuous year like 2020,” said Kassouf Director and Shareholder Gerry Kassouf.

Joni Wyatt, MHA, MHIA, CPHIMS

Russ Dorsey

Margaret Cook, MBA, CMPE

Kassouf’s new principals include Michelle Carney, CFP®, AEP®; Margaret Cook, MBA, CMPE; Russ Dorsey; and Joni Wyatt, MHA, MHIA, CPHIMS. Carney is a financial planner with Kassouf Wealth Advisors, and Dorsey leads Kassouf’s information technology. Cook and Wyatt are healthcare advisors in Kassouf’s healthcare consulting business. The list includes several professionals in the Kassouf & Co healthcare practice: Georgina Perry, CPA, CMPE and Janet Day, MBA, CMPE were both promoted to Senior Healthcare Advisor.

Darryle Bullard, MD Joins Cullman Regional Medical Group Cullman Regional welcomes board-certified Pulmonologist Darryle Bullard, MD, to the Darryle Bullard, MD Cullman Regional Medical Group. A native of Mobile, Bullard is a graduate of Spring Hill College and completed medical school at the University of South Alabama. He also completed his post-doctoral training in Internal Medicine and his Pulmonary

Disease Fellowship at the University of South Alabama. He has previously provided care for patients in the Mobile area for more than 18 years. Bullard treats patients 16 and older for conditions such as: • Asthma • Bronchitis • Chronic obstructive pulmonary disease (COPD) • Cystic fibrosis • Emphysema • Interstitial lung diseases • Occupational lung diseases • Lung cancer • Pulmonary nodules • Shortness of breath

Family Nurse Practitioner Joins Chilton Medical Associates Natalie Ellison, family nurse practitioner, has joined Chilton Medical Associates in Clanton. Ellison received a Natalie Ellison, RN, NP Bachelor of Science in nursing from the University of Alabama at Tuscaloosa, Magna Cum Laude, and her Master of Science in nursing from Troy University. While obtaining her bachelor’s degree, she was a member of Sigma Theta Tau International Honor Society of Nursing, and Tau Sigma Honor Society. She is also the recipient of DAISY award at Brookwood Baptist Medical Center.

Cabaniss Johnston Joins Phelps Dunbar Two leading law firms have combined forces to provide increased legal services to their clients, as Cabaniss, Johnston, Gardner, Dumas & O’Neal has joined Phelps Dunbar, giving Phelps offices in 13 cities throughout the Gulf South and in London. Phelps’s clients will enjoy expanded legal resources in the Alabama community and Cabaniss Johnston clients will have access to a broader footprint across the region. The Firm will have 16 total practice rankings and 50 total recognized attorneys in Chambers and Partners. “Like us, Phelps puts client interests ahead of their own,” said Hal West of Cabaniss Johnston.

David Qi, MD Joins Urology Centers David Qi, MD has joined Urology Centers of Alabama, practicing in the Grandview and David Qi, MD Homewood offices. Qi is a graduate of Cornell University and The Pennsylvania State College of Medicine. He focuses on the Urological issues of urethral stricture disease, female and male urinary incontinence, ED, Peyronie’s disease, overactive bladder, neurogenic bladder, genitourinary fistula disease, pelvic floor prolapse, and genitourinary trauma.

(CONTINUED ON PAGE 17)

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Taub and Uswatte Conducting Trial on Therapy to Clear Post-COVID Brain Fog Even after their bodies have cleared the virus that causes COVID-19, many patients experience long-term effects. One of the most troubling is a deterioration in cognitive function, commonly called brain fog, that is marked by memory problems and a struggle to think clearly. This condition has shown up in a number of reports. For instance, a hospital network in Chicago found that nearly onethird of a group of 509 COVID patients experienced altered mental function. Similar numbers were reported from a study in France, among others. Although, there are no current treatments for COVID-related brain fog, UAB researchers are starting a clinical trial to test a rehabilitation method that has proven to restore lost function. Known as Constraint-Induced Therapy, it was developed by Edward Taub, PhD, director of the Constraint-Induced Movement Therapy Research Group, in collaboration with colleagues at UAB. CI Therapy is used around the world to help patients regain limb function and language abilities after stroke. Taub and his longtime collaborator, Gitendra Uswatte, PhD, professor in the UAB Department of Psychology, have demonstrated the positive effects of CI Therapy on patients with stroke, multiple sclerosis and cerebral palsy. 97 percent of the thousands of stroke patients who have taken part in CI Therapy have seen meaningful improvement, and the average patient uses her affected limb five times more post-therapy than pre-therapy. The improvement in function remains even after years have passed. MRI scans have shown that CI Therapy rewires the brain, which leads Taub and Uswatte to believe that the therapy could restore cognitive function in the same way it restored a person’s ability to move their arms or legs. “We found in the motor rehabilitation work that the therapy is effective for a number of different types of brain damage,” Uswatte said. Because of this, the researchers postulate that CI Therapy can alleviate the brain fog conditions that so many postCOVID patients suffer from. So, with pilot funding from UAB’s Integrative Center for Aging Research, Taub and Uswatte will recruit at least 20 adult patients, age 18 or older, who have recovered from COVID-19, but are experiencing memory loss, brain fog or other cognitive issues. Participants will receive CI Therapy training at no cost. This involves 35 hours of therapy in the clinic, including the computer-based speed-of-processing training and a component called shaping, which involves training simulated cognitive activities in the clinic that are made progressively harder over time. “At the end of each session, participants are assigned 10 homework tasks that they use in their everyday lives to focus on transferring the gains they have made in the lab,” Uswatte said. “These are tasks that are important to the person and

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Gitendra Uswatte, PhD (left) & Edward Taub, PhD

will challenge their cognitive skills.” “The activities might include cooking a meal with more than three ingredients, starting a conversation, remembering medication, doing the laundry or making out a shopping list,” Taub said. “One of the requirements of the program is that participants have a caregiver or person who lives with them who can prompt them to do this homework. We also call them once a week for the first month after the end of training and then once a month for the next 11 months to help participants hold onto their gains.” “The challenge of adapting CI Therapy to a new condition is exciting,” Taub said. “We have proved that the therapy works in other conditions. What got us interested here was the fact that current brain-training techniques that aim to help with brain fog work fine in the lab or in the training setting, but they don’t transfer robustly to real-life situations. And if it does not transfer to life situations, why bother?” Individuals who think they can benefit are welcome to contact the project directly at 205-934-9768 or learn more about the study at uab.edu/citherapy.

Mike Slive Foundation Awards Six Prostate Cancer Research Grants in 2020 The Mike Slive Foundation for Prostate Cancer Research, which was founded in Birmingham in 2017 by former SEC Commissioner Mike Slive and attorney Ed Meyerson, has awarded six new research grants to help eradicate prostate cancer. The recipients include Duke University, the University of Texas MD Anderson Cancer Center, H. Lee Moffitt Cancer Center & Research Institute, and the Tulane University School of Medicine Cancer Research Center. Two researchers at the University of Alabama at Birmingham received grants from the foundation: Selvarangan Ponnazhagan, PhD for studying how targeting the androgen receptor axis affects macrophage polarization in castration-resistant prostate cancer; and, in funding partnership with the O’Neal Comprehensive Cancer Center, Runhua Liu, MD, PhD to study CD24-mediated Tumor Metastasis and Targeted Therapy in Prostate Cancer. The Mike Slive Foundation has now funded a total of nearly one million dollars to 18 prostate cancer research grants across the country since its inception in 2017. This year, the Foundation received 35 applications representing 15 research institutions across the country.

 MARCH 16 The Medical Association of the State of Alabama How Physicians Can Tackle Vaccine Hesitancy  MARCH 23 The Inspirien Risk Management Team Vaccine FAQ’s for Healthcare Professions  MARCH 30 Nic Cofield with Jackson Thornton Vendor Management and Remote Access Security  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.

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

MARCH 2021 • 17


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Cullman Regional Offers Signing Bonus for Paramedics

Cullman Regional Medical Center is offering a $2,000 sign-on bonus for paramedics for the Cullman EMS Ambulance Team. “EMS Services across Alabama and throughout the United States were experiencing staffing shortages prior to COVID-19,” Chief Operations Officer Nesha Donaldson said. “Those issues have increased due to COVID-19. Throughout the past year, the COVID-19 pandemic has caused staffing challenges for Cullman EMS as many of our team members have contracted the virus, with some having to take extended absences.” In December, RPS, the other local ambulance transport provider, chose to

leave the service area due to decreased demand for their primary service – nonemergent transfers – due to the COVID-19 pandemic. These combined challenges have created an opportunity for Cullman EMS to expand its workforce and its fleet. In December of 2020, Cullman Regional purchased an additional ambulance to add to the Cullman EMS fleet in order to absorb any additional transfer volume following RPS’s departure from the market. For more information about the paramedic positions available through Cullman Regional and Cullman EMS, call at (256) 737-2620 or visit online at www.CullmanRegional.com.

Alabama AHEC Creates Network to Address COVID Vaccines in Underserved Communities Last year, the Alabama Statewide Area Healthcare Education Centers (AHEC) formed a network to create a coalition of community partners from across the state by providing training to teams involved with COVID-19 testing in rural and underserved Alabama. AHEC has also produced a playbook, How to Establish a CommunityBased Vaccination Site for the Moderna COVID-19 Vaccine, that will enable any organization in the state to follow a series of steps to establish vaccination sites as vaccines become available for distribution. The Network partnership comprises the AHEC Program Office, housed in the UAB Department of Family and Community Medicine, and its five regional AHEC centers; the Alabama Civil Air Patrol; UAB Infectious Disease Laboratory; Alabama Emergency Management Agency; Alabama Department of Public Health and instrumental community partners identified by region. Since May 2020, the AHEC Network has reached out to underserved populations, particularly Hispanics and African Americans, and administered 3,927 tests at 62 testing sites across the state. The success of this initiative will allow the network to target these same rural and

Nurse gives vaccine at drive-through site.

underserved populations where vaccine hesitancy is high, and to assist other organizations interested in doing the same. The vaccination effort will be a massive undertaking that will require the commitment of partners throughout Alabama’s health care community. Rural vaccination efforts will be particularly difficult due to the disparity of access, and shortages of health professionals. Organizations interested in setting up a vaccination site in their community are encouraged to review the Alabama AHEC Network playbook at www.alahec.network.

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UAB Ranked the No 1 Best Large Employer in the United States EDITOR & PUBLISHER Steve Spencer VICE PRESiDENT OF OPERATIONS Jason Irvin CREATIVE DIRECTOR Katy Barrett-Alley CONTRIBUTING WRITERS Cara Clark, Ann DeBellis, Jane Ehrhardt, Laura Freeman, Cindy Sanders, Marty Slay Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 Ad Sales: Jason Irvin, 205.249.7244 All editorial submissions should be mailed to: Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: editor@birminghammedicalnews.com —————————————— All Subscription requests or address changes should be mailed to: Birmingham Medical News Attn: Subscription Department 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: steve@birminghammedicalnews.com FOLLOW US

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The University of Alabama at Birmingham has been named America’s No. 1 Best Large Employer by Forbes, topping the list of more than 500 public and private corporations, hospitals, universities, and Fortune 500 companies. In order to create the Forbes 2021 list, Statista anonymously surveyed 38,000 Americans working for businesses with at least 1,000 employees. Respondents were asked to rate on a scale of zero to 10 how likely they would be to recommend their employer to friends and family, and then encouraged participants to nominate other organizations they do and do not recommend. The final list ranks the 500 large and 500 midsize employers that received the most recommendations. “What makes Forbes’ recognition so meaningful is that it is based largely on whether our employees would recommend UAB to friends and family,” UAB President Ray Watts said. “Especially after such a challenging year, knowing that our people are proud to be part of the UAB family is humbling and gratifying. UAB, which is Alabama’s largest public employer and home of one of the region’s largest academic medical centers, employs more than 23,000 people across its university and hospital entities with over 22,000 enrolled students, and has an annual economic impact exceeding $7 billion on the state. In a year marked by uncertainty, UAB navigated caring for hundreds of COVID-19 patients while pivoting research priorities to help advance therapeutics to fight the pandemic, and managed to keep its academic entities moving forward through a fluid hybrid learning approach. Employees were provided access to resources such as personal protective equipment, mental

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health tools and wellness days, and access to assistance resources like food supplementation and child care support, among others. UAB boasts many nationally ranked programs, with 16 graduate and professional programs in the schools of Health Professions, Nursing, Medicine, Engineering, Education, Business and Public Health and the College of Arts and Sciences all ranked in the 2020 U.S. News Best Graduate School Rankings. The Master’s in Health Administration program in the School of Health Professions received the No. 1 ranking as the best in the country. With annual research expenditures exceeding a record $600 million, UAB is a leader in federal research funding, ranking 20th in the nation in National Institutes of Health funding to climb 11 places on the NIH rankings in the past five years. During that time period, UAB’s total NIH funding rose more than $100 million, topping the $234 million mark in 2018. Only seven other

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academic medical centers in the United States increased their NIH funding by more than $100 million during that same timeframe, placing UAB among an elite group of eight academic medical centers. UAB Hospital is among the 20 largest hospitals in the United States. UAB Hospital’s American College of Surgeons Verified Adult Level 1 Trauma Center is the only one of its kind in Alabama. UAB Hospital and clinics saw more than a million patient visits last year. The U.S. News & World Report Best Hospitals report listed eight of UAB’s medical specialties in the nation’s top 50 programs of their kind, seven of those within the top 30, along with two others noted as being “high performing” in the 2020-2021 Best Hospital rankings. UAB also has the O’Neal Comprehensive Cancer Center, the only NCI-designated comprehensive cancer center in Alabama and its fivestate region.

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