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OCTOBER 2019 / $5

Shelby Baptist Celebrates 60 Years with New Facilities and Enhanced Services


By ann B. deBelliS

SRT Treatments for Skin Cancer Available in Birmingham Birmingham now has access to a non-invasive, low-dose radiation treatment for nonmelanoma skin cancer, the most common cancer in humans. Only four other cities in Alabama offer the superficial radiation treatment (SRT) to patients ... 3

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Workplace safety is not a concern unique to healthcare institutions, but it is important. And as incidents of violence increase, it’s most often nurses who are the victims ... 9 FOLLOW US

Cities in Shelby County are among the fastest growing in Alabama. In conjunction with the expanding population, Shelby Baptist Medical Center in Alabaster has undergone upgrades and renovations within the hospital as part of a $10 million capital project which was completed in September in conjunction with the 60th anniversary of the hospital. The three-fold project includes a new hybrid operating room, the complete renovation of nine operating rooms, and a new cystoscopy lab. “We cover most of central Alabama, so Shelby Baptist is the first hospital you come to in the Birmingham metro area if you are driving from Prattville, Alexander City or Selma,” says Daniel Listi,

In Search of the Rare Gene By laUra FreeMan

thing that has been seen before. Other members of a family may have the same or similar symptoms. The effects may be complex or involve a pairing of When a disease touches millions of lives, the silmultiple body systems such as the heart and kidneys, ver lining is that it can be easier to find funding for intellectual disabilities, or distinct physical features. research to prevent or cure it. “With more than 7,000 known genetic disorHowever, if someone is suffering from one of ders, many are difficult to recognize without testing, the thousands of diseases caused by a rare genetic even if a test exists. In fact, tests for hundreds of variant, it has usually been difficult to find answers genetic disorders are available, but unless there is that would result in treatment, leaving the idea of a a way to narrow the list, attempting even a small cure to be a distant hope. percentage of them would involve an overwhelming That, to some degree, may at last be changing. amount of time and expense.” “In the past, the first challenge was to deterThe advent of more affordable gemine whether an unknown condition pattern had a Bruce Korf, MD, PhD nomic sequencing now makes it practical to test genetic basis,” Bruce Korf, MD, PhD, Director of 22,000 genes simultaneously. the UAB Department of Genetics, said. “There are sometime con(CONTINUED ON PAGE 8) stellations of clinical problems that form a pattern similar to some-

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2 • OCTOBER 2019

Birmingham Medical News

SRT Treatments for Skin Cancer Available in Birmingham By Jane Ehrhardt

Birmingham now has access to a noninvasive, low-dose radiation treatment for non-melanoma skin cancer, the most common cancer in humans. Only four other cities in Alabama offer the superficial radiation treatment (SRT) to patients. “Before this, patients’ only option was surgery,” says CEO Jennifer Cork with Total Skin & Beauty Dermatology Center. “Now if a patient doesn’t want to have surgery again or has other issues that preclude surgery, the patient has SRT as an option.” SRT sends a low Jennifer Cork dose of radiation into the skin at a depth up to six millimeters and can be given in a dermatologist’s office by a radiation therapist. “SRT is an image guided treatment,” says lead radiation therapist Jennifer Garrett, who administers the treatments at Total Skin & Beauty. “We use ultrasound to help us determine the depth of the lesion. Protocols then mandate the correct energy of radiation—50, 70 or 100 kilovolts—to deliver at different depths for maximum efficacy to ensure clear, noncancerous margins around the lesion. “It’s a very low dose. You actually get more radiation exposure from a chest x-ray.” The level of kilovolts used depends on the depth the radiation needs to penetrate and the type of non-melanoma skin cancer. “Squamous cells are a little more aggressive so you have to treat it differently. It’s the same with nodular basal cell,” Garrett says. Nodular basal cell carcinoma comprises about 60 to 80 percent of non-melanoma skin cases and occurs most often on the head. In the past year, Garrett has treated close to 100 patients. “The cure rate is 95-percent plus,” she says. “A lot of these patients were Mohs candidates and didn’t want to undergo surgery again. They’ve chosen the SRT route.” Mohs is the surgical option for treating skin cancers. It progressively removes thin layers of cancer-containing skin and examines them microscopically until only cancer-free tissue remains. The other option for skin cancer radiation treatment is through hospitals and cancer treatment centers that currently utilize linear accelerators. Unlike SRT, these machines are built to deliver targeted, far more powerful radiation throughout the body. With a linear accelerator, treatments for skin cancer are performed five times a week for the needed 20 treatments versus three times a week with SRT. “SRT allows you to keep the 95-percent cure rate, but with fewer treatments per week,” Gar-

rett says. “The radiation only reaches the depth of the skin, about six millimeters. 100 percent of the radiation goes to the skin. It’s not affecting anything internally.” That low-dose of SRT also makes the treatment possible in dermatologists’ offices, because it can be given by a radiation therapist versus a radiation oncologist. However, most dermatologists would not be able to afford the outlay for the needed equipment and access to medical experience. With this in mind, Total Skin & Beauty decided to partner with SkinCure Oncology in order to bring the treatment modality to their practice. “By doing that, we have access to a radiation therapist and have a radiation oncologist on-hand as needed,” Garrett says, along with equipment maintenance and calibration needs. Garrett, who has been administering radiation therapy for 14 years, including with linear accelerators and now superficial radiation therapy, is on-lease to Total Skin & Beauty. She does weekly consultation calls with the oncologists at SkinCure. “It’s like a tumor board at a hospital. We discuss cases to make sure we use the best approach, because every tumor is not the

Garrett administers superficial radiation treatment.

same,” she says. “Our radiation therapist is the liaison between SkinCure Oncology doctors and our dermatologists,” Cork says. “Alone, it is extremely cost prohibitive to employ a radiation oncologist. But with this partnership, we have all that knowledge available




to our patients and physicians.” The only downside to the in-office set-up is the current lack of coverage by BlueCross BlueShield of Alabama on their commercial plans. “It’s covered by almost all carriers and Blue Advantage plans, BlueCross Federal, BlueCross in other states, like Texas—all cover it, but BlueCross BlueShield of Alabama does not cover it in a dermatology setting,” Cork says. Though Alabama’s BlueCross does cover outpatient radiation therapy, it requires that it be administered by a radiation oncologist, limiting the treatment by default to hospitals and cancer centers. “I’m hopeful that BCBS will recognize this as a beneficial modality for non-melanoma skin cancer,” Cork says. The patients on commercial plans by BlueCross who come for SRT treatments have been paying the $6,000 to $9,000 cost themselves. “If there’s a hardship, we work with the patient to process their hardship requests,” Cork says. “Because it’s a burden no one should have to bear when the treatment is covered in all the other markets.”

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Birmingham Medical News

OCTOBER 2019 • 3

Shelby Baptist Celebrates 60 Years, continued from page 1 CEO of Shelby Baptist Medical Center. “Over 80 primary care practices refer to us for patient treatment throughout central Alabama. Our ability to add these specialized services and suites allows us to provide a high level of service at our hospital.” The hybrid OR is a combination catheterization laboratory suite and an operating room that typically is used to treat high-risk patients. “We wouldn’t want to send those patients to a regular cath lab for a procedure. We want to have surgical services available and at the bedside if needed,” Listi says. “In the past, patients who required immediate care would have to be moved from the cath lab to an operating room. That takes time and delays the patient’s heart care. The hybrid suite allows us to do all procedures in the same room, making is safer and more convenient for patients.”

The project to update the nine regular OR suites will make a big impact on hospital services. “All of those suites were built about 20 years ago. Modernizing those areas will allow for greater efficiencies and can attract more surgeons to our campus,” Listi says. “The updates will make Shelby an innovator and leader for attracting the brightest physicians.” Listi says there has been tremendous increase in heart disease in Shelby, Bibb and Chilton counties. The Heart South Cardiovascular Group is a growing practice in the area and currently provides the majority of the cardiologists at Shelby Baptist. “Heart South has a big impact on the services we offer,” he says. “Last year, Shelby Baptist collaborated with Health South to start a structural heart program that focuses on doing tiny procedures through the groin to repair heart valves. They also do the Watchman

procedure for stroke prevention without opening the heart. Rehab alone for those open-heart procedures is a tremendous burden for patients. Being able to use a small percutaneous line in the leg without opening the chest is a huge win.” A new cystoscopy lab is the third part of the renovation. The suite will be used by urologists to perform catheterizations and minimally invasive procedures. “For the urologists, this new suite is a big step forward,” says orthopedic surgeon Daryl Dykes, former Chief of Staff at Shelby Baptist. “The room is large and the equipment has top-quality digital imaging which is a big advancement. In addition, by moving the Urology Department to the new room, it opens up another operating room for other doctors.” Dykes points out that whenever renovations such as these are done, better and more modern diagnostic imaging

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equipment is installed in the hospital. “In general, these upgrades give us the ability to do digital imaging in the ORs and gives us better monitors to use. In my case, the better resolution on the new screens allows us to greatly enlarge photos of broken bones on an X-ray. I can see from across the room, and the clear picture makes it easier for me to place screws in the correct position,” Dykes says. “I think all of these upgrades will help Shelby Baptist keep pace with other facilities from a modernization standpoint.” At the end of this year, Shelby Baptist will be completing accreditation with the Joint Commission as a primary stroke center. “All of our data and outcomes today exceed the targets given by the American Heart Association,” Listi says. “We are excited to take credit for the hard work that the community and staff members are doing for stroke care. It is something that has tied the hospital together because it touches every department on this campus.” Future renovations are already in the planning stages. First will be a dialysis and radiology update at the main campus, followed by a second-floor renovation. “We’ve seen so much growth in cardiac care, vascular care and stroke care that we are envisioning a 50-bed area that will be dedicated to treating those patients. It will be an amazing service for the community,” Listi says. “Our hospital is a great gem that Baptist has preserved over the years. The county also took good care of it and made the right investments when it was manager. Because of that, I’m not worried about the infrastructure and the level of care. We’re trying to get everything to look and feel great for our patients who have supported us over the years.”


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4 • OCTOBER 2019

Birmingham Medical News

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Considerable Surprises May Lurk in “No Surprises” Legislation By deniSe BUrKe and COlin lUKe

The term “surprise billing” is used to describe the situation when a patient receives a bill for the difference between the out-ofnetwork provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductible. Patients often assume that providers such as radiologists, pathologists, physician anesthesiologists, emergency physicians and trauma surgeons are in-network because the treating hospital is in-network, thus they are “surprised” that the charges are not covered by their insurance. The issue of surprise billing has been hotly debated by the 116th Congress as an estimated 40 percent of patients received a surprise bill in 2018. Multiple pieces of legislation have been proposed and it seems likely that legislation will be passed, although the exact substance is yet to be determined. There is considerable agreement between the proposals on protecting patients in emergency situations, but there are notable and important differences beyond that agreement. For example, the Cassidy Senate Bill (“Protecting People from Surprise Medical Bills Act”) prohibits surprise billing when a patient is seeking non-emergency care by an out-of-network provider at an in-network facility. The version from the Energy and Commerce committee, (the “No Surprises Act”) would allow such billing if the patient is provided with written and oral notice and

consent. The “Protecting People from Surprise Medical Bills Act” (HR 3502), would prohibit surprise billing for out-of-network after-emergency care when a patient cannot travel without medical transport, as well as for out-of-network imaging or lab services when ordered by an in-network provider. The Senate HELP Bill would require that patients receiving out-of-network ancillary services only pay the in-network cost-sharing amount and unstable patients who receive services emergency services would be responsible only for the amount they would have paid innetwork. The Senate HELP Bill would also require that patients be given advance notice of any out-of-network care, an estimate of the costs, and referrals for alternative options for in-network care. If a patient is not provided the required notice, the patient would not be responsible for the out-of-network cost. The Senate HELP Bill proposes to set rates for practitioner or facility based on the median in-network contracted rate for services in that geographic area and does not include arbitration style provisions. The No Surprise Act and the Cassidy Senate Bill incorporate a dispute resolution process (that does not involve the patient) to resolve issues between providers and health insurers when no agreement can be reached between the parties. The American Medical Association is supportive of alternative dispute resolution models, noting successful implementation in several states.

While all stakeholders agree that patients need to be protected from surprise bills, it remains to be seen whether consensus can be reached or what unintended consequences may arise. For example, adoption of a fixed payment standard might incentivize insurers to rely on default payments rather than contract with providers to join networks. The legislation might also lead to broader rate setting for physicians. Myriad practical considerations will also need to be addressed. For instance, the logistics of implementing some of the proposed notice requirements

in an Emergency Department seem daunting. Right now there appears to be general consensus among Democrats, Republicans and the President that the issue needs to be addressed but with the current unpredictable political climate, there are probably more than a few “surprises” in store. Denise Burke and Colin Luke are partners with Waller Lansden Dortch & Davis, LLP.

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Alabama Healthcare Fraud Summit In September, the FBI, US Attorney’s Office, BlueCross BlueShield of Alabama, and several local law firms participated in a full day educational summit focused on healthcare fraud. The summit was presented by the Birmingham InfraGard Members Alliance (IBMA) and the FBI, Birmingham Division, in partnership with Southern Medical Association, Kassouf & Co, and the Birmingham MGMA. The summit, which was held at The Club, included seven sessions on topics including CMS and insurance fraud; opioid fraud and abuse; Qui Tam Whistleblower statutes; Stark Law and the perils of sub-lease agreements and kickbacks. The audience of over 160 included area physicians, practice mangers, attorneys, students, investigators, and compliance officers from hospitals, insurance companies, Alabama Medicaid and other healthcare professionals. “Because of InfraGard’s partnership with the FBI and our committee members’ relationships in the local healthcare community, we saw an opportunity to create

160 physicians, practice managers and hospital executives attended the summit.

a unique event with Federal experts presenting the investigative and prosecutorial topics balanced by some of our area’s top healthcare attorneys speaking on relevant legal topics,” said Russ Dorsey, Manager of Information Services at Kassouf & Co and Vice-President of the InfraGard Birmingham Members Alliance. “We spent considerable time on the content, working with the speakers as a group to coordinate content across all the sessions.

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“We also worked to insure this summit followed the InfraGard mission – to protect our Nation’s critical infrastructure, in this case our Healthcare systems, through a public / private sector partnership based on information sharing and education. It is important that the content had real value and that the event was accessible to a large audience. Our team was able to get the full day’s content approved for continuing education credits for physi-

cians, lawyers, accountants and Alabama law enforcement.” The morning opened with comments by FBI Special Agent in Charge Johnnie Sharp, Jr. and Assistant US Attorney Lloyd Peeples. They were followed by Dan Harkness, FBI Supervisory Special Agent of the FBI Healthcare Fraud Unit in Washington, DC, who spoke on the origins and (CONTINUED ON PAGE 8)

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Birmingham Medical News



Exploring the Genescape of the Brain HudsonAlpha Awarded Grant to Map Transcription Factors in Alzheimer’s By laUra FreeMan

Of all the wonders in creation, perhaps the most amazing can be found in the beauty of a single thought. The ability of the brain to perceive, understand, feel, imagine and remember is as remarkable as it is complex and delicate. In recent generations, science has learned a great deal about the biology of the brain and how it works. However, that new knowledge has also brought a fuller appreciation of how much more there is to know. HudsonAlpha Institute of Biotechnology in Huntsville is noted for its expertise in studying the epigenetic effects of genes known collectively as transcription factors and how the proteins they produce regulate the expression of other genes. A major study currently underway has been mapping transcription factors that seem to play a role in regulating genes implicated in the development of psychiatric illnesses including schizophrenia, bipolar disorder and depression. A new grant from the National Institute of Mental Health has just been awarded to expand the project to study 16 transcription factors that may influence the development of Alzheimer’s Disease.

Senior scientist Jacob Loupe, PhD said the new endeavor will build on what has been learned in earlier phases of the study by researchers working in the labs of Rick Myers, PhD, and Greg Cooper, PhD. “While genetic researchers often work with cell lines and focus on mutations, Jacob Loupe, PhD we study primary human tissue samples at different stages of progression,” Loupe said. “We are also looking for a different type of gene that modifies how other genes behave. A person can have a copy of a gene implicated in a brain disease, but whether and when that gene is expressed and to what degree can depend on the epigenetic effects of a constellation transcription factors.” The proteins produced by transcription factors act like a sound mixing board. They can turn the effects of a key gene on or off, dial the level of expression up or down, and together, they regulate how the disease presents and develops in an individual patient. “Working directly with tissue samples to map multiple transcription factors can be an intricate process, but we’ve had good success with the techniques we’ve developed,” Loupe said. “Our progress in studying transcription factors in mental health disorders also gives us a head start

in investigating Alzheimer’s Disease. Since we’ve already sequenced and mapped tissues from healthy brains as controls, that data is already in place to compare with what we find in different stages of Alzheimer’s Disease.” Mapping transcription factors goes well beyond the regions of the brain. “Every cell in the body has the same genetic code,” Loupe said. “When we probe for what a transcription factor is binding to, we look at the entire genome for global effects. In some cases, it may also be binding to genes in other areas and modifying how the gene is expressed. Getting a clear footprint of where the transcription factor is binding can sometimes suggest new areas of investigation.” Loupe also noted the importance of including brain tissue from early stages of the disease in the investigation. “If we can see what Alzheimer’s looks like early in the disease process, we should be able to diagnose the disease sooner and begin implementing emerging treatments when they have the potential to do the most good,” he said. What are the root causes of Alzheimer’s Disease? That is a complicated question that will require a great deal more work to answer, but the need to find those answers is growing more urgent. According to the American Alzheimer’s Association, the disease is now the sixth leading cause of death and is increasing in incidence.

One of the genes most implicated in the risk of developing Alzheimer’s Disease is APOe, but it is far from the only factor that may increase the odds of developing the disease. “Age, environmental exposure and a variety of other genetic and health influences seem to increase the risks, but the simple truth is that as of now we can’t definitively say what triggers the onset of Alzheimer’s Disease,” Loupe said. “We’re learning more every day and we hope that what we learn in this study will bring us closer to earlier diagnosis and new treatments to slow the progression of the disease and perhaps one day to stop it.” Findings related to transcription factors in psychiatric disorders are expected to be reported soon. HudsonAlpha labs are gearing up to begin the Alzheimer’s Disease phase of the study shortly and investigators hope to complete it sometime late next year.

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Birmingham Medical News

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Alabama Healthcare Fraud, continued from page 6

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Birmingham Medical News

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history of healthcare fraud and current trends in Medicare and Opioid abuse. In the second half of his session, he showed Chasing the Dragon, a film that takes a compelling look at the human cost of opioid addiction, produced by the FBI. Attendees were given a copy of the DVD. The morning sessions concluded with Blake Henson, Network Integrity Man(Left to right) Zach Bennett, Joni Wyatt and Jeff Dance of Kassouf & Co ager at BlueCross BlueShield of Alafollowed with a session on Qui Tam and bama, who talked about healthcare fraud Whistleblowing statutes. Jim Sturdivant and how Blue Cross monitors claims activity with Sirote & Permutt, spoke on crimito detect fraud. Henson cited current cases nal healthcare offenses from a defense and real-world examples of current schemes. attorney’s perspective. Michael Tucker, After lunch, Chinelo Diké-Minor, with Baker Donaldson, spoke on sublease Assistant United States Attorney and the agreements, Stark law and anti-kickback Health Care Fraud Coordinator for the statutes. Northern District of Alabama, spoke on The afternoon concluded with a fraud and abuse from her perspective as a round table in which the four attorneys Federal prosecutor. Brad Robertson, Partanswered questions from the audience. ner at Bradley Arant Boult Cummings,

In Search of the Rare Gene, continued from page 1 “About a third of the time, we have a clear answer when the results come back,” Korf said. “Sometimes it is something we simply hadn’t thought of before. Another third leaves us with questions that science isn’t able to answer yet, but may be able to answer in the future. The final third puts us in a middle ground where we identify variants that aren’t commonly seen and may be difficult to prove as being the source of the problem, but there are indications you are on the right track. “This is where international databases can be helpful. The NIH has a catalog of conditions associated with specific variants. If you don’t find an answer there, you can go to the Matchmaker Exchange online. There you can describe the variant you have found on that specific gene and post details about symptoms you are observing. You may find that someone in Germany has a patient with the same variant and similar symptoms, and when you exchange emails, you find that the patients look enough alike to be brothers.” When the mystery of which of millions of possible variants are significant remains unsolved, how do you narrow the possibilities? “Using informatics, we can filter out more common genetic disorders that would probably be recognized,” Korf said. “You can also filter for variants that tend to have more severe effects, and may also be able to search for those that are likely to be expressed in specific body systems. “Another possibility is to sequence

other family members to determine if they have a variant in common that isn’t usually seen in most people. If a baby has a variant neither parent has, it is likely a new mutation. If a child has two copies of a gene and each parent has only one, a recessive gene is likely to be involved. “An excess or deficiency of certain proteins in the bloodstream can also be a clue that other genes are influencing how a variant is expressed.” What are the benefits for patients when the genetic basis of a rare disease is found? “For some, it’s the peace of mind of finally knowing what is going on,” Korf said. “If we can find someone else half a world away who has experienced the same disease, we can look at how their symptoms progressed to help us manage the disease. We may find that the other patient developed kidney disease, so we will have an early warning to help reduce risks.” As researchers learn more about the nature of rare genetic disorders, they are often finding that existing medications may be effective in treating symptoms. “The more we learn about rare diseases, the more help we can offer patients,” Korf said. “Neurofibromatosis is one of those relatively rare diseases that has been a focus of my research. Until recently, there was little we could offer these patients. Now we’re in clinical trials testing medications that at last show hope of providing the kind of help these patients have been seeking for so long.”


How do We Reduce Violence against Nurses? By Marti Slay

Workplace safety is not a concern unique to healthcare institutions, but it is important. And as incidents of violence increase, it’s most often nurses who are the victims. “Nurses spend more time with patients than any other sector in healthcare,� said Sarah Wilkinson-Buchmann, DNP, RN, president of the Alabama State Nurses Association (ASNA). “That makes them the natural target when patients take their anger out in violent ways. Patients who are naturally stressed about a health problem may feel frustration, which could be exacerbated by a long waiting time or other difficulties, but there is a proper way to address that frustration, and taking it out on the healthcare worker who is trying to provide a service isn’t the right way.� Wilkinson-Buchmann ultimately sees policy as the long-term answer. “This begins with the opportunities that are provided within our state for access to care. It goes back to our legislature and policy formation,� she said. “11 rural hospitals have closed in Alabama, and that trend is

safety of patients as well.� One such effort has been to place signs in clinical waiting areas to remind everyone that it has been a felony in Alabama to assault a healthcare worker since 2006. When the ASNA surveyed Alabama nurses last year, they found that most nurses weren’t aware that violence against them was a felony. If the nurses didn’t know, the ASNA found it reasonable to conclude that patients and even hospital administrators didn’t know either. They decided it was time to launch a public awareness campaign. In the last legislative session, State Representative Nurses at the ASNA conference hold the signs that are posted in clinics alerting patients that violence against nurses is a felony. April Weaver and Senator Greg Reed sponsored a joint resolution to have signs posted in clinigoing to continue. People don’t have insurto avoid worsening the nursing shortage. cal waiting areas, in hopes of reminding ance and don’t have coverage. It’s too ex“We are approaching a shortage of nurses patients and healthcare workers alike of pensive for them to see a private physician by over 30 percent for next year so this is the law. The signs read, “We respect you. when they can’t pay the bills, so they flock hardly a time to deter people from enterPlease respect our staff. Assault of a healthto the ERs in vast numbers, which leads to ing the profession over fear of their safety,� care worker is a FELONY. Alabama Law frustration.� she said. “We need to keep as many nurses Code: 13A-6-21.� While the biggest issue is concern for as possible. The ASNA is looking to do evWeaver, the only nurse currently servthe safety of healthcare workers, Wilkinerything we can to protect our nurses and ing in the Alabama legislature, has worked son-Buchmann said the problem of vioallow them go about patient care safely. (CONTINUED ON PAGE 10) lence also needs to be addressed in order That benefits not only the nurses, but the

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Birmingham Medical News

OCTOBER 2019 • 9

N; r; P


Compact License Legislation Opens Alabama to Nurses from Other States By Marti Slay

With a stated mission to promote excellence in nursing, the Alabama State Nurses Association (ASNA), seeks to affect policy and promote legislation that will benefit nurses. They achieved a big win in the last legislative session with the passage of the compact licensure bill, and they Nurses were engaged with state legislators in 2019. hope to ride that success into a developing camthe healthcare needs of Alabama, especially times of disaster, it was paign to pursue the oprural areas where we have a shortage of prodifficult for nurses to portunity for advanced viders. Currently the practitioner must have come into the state to practice nurses to practice A large crowd turned out for Nurses Day at the Alabama state capital. a collaborating physician, and that’s difficult assist. Now out of state to the full extent of their when you don’t have physicians in the area nurses can come in to education and training. to collaborate with. help.” “Compact licensure was enormous,” the compact. With the passage of the bill She also pointed to the economic opState Representative April Weaver said Sarah Wilkinson-Buchmann, DNP, in the last legislative session, Alabama beportunities that such legislation would offer and Senator Greg Reed sponsored the bill. RN, president of the ASNA. “It was a huge came the 32nd compact licensure state. The the state. “It would open up employment Weaver, who is also a nurse, said the comgain for nursing and for healthcare in our Board of Nursing is now in the process of opportunities in rural areas, not only for pact license bill had the support of nurses state. The ASNA fully supported compact implementing the law, with a target date of the practitioners, but for the support staff around the state. “Last year, I saw nurses licensure.” January 2020. as well. When you look at it from the bigengaged at a level I have not seen in the 10 The compact license law enables Once implemented, the law will reger picture, it would be a boost to the local years I have served in the legislature,” she nurses to obtain a license that allows them quire Alabama nurses to go through a economy,” she said. said. “It was all due to the compact licento practice in other states that are part of process of fingerprints and background Wilkinson-Buchmann has not set a sure bill. So many nurses in Alabama have checks if they wish to obtain a compact timetable for this effort. They are contactmultiple state licenses, and they were all exlicense. And nurses from other states who ing stakeholders for the steering committee cited to have the opportunity for Alabama have their compact license will be able to and will move forward when the committee to participate in the compact.” practice here. has reached consensus and feels they are The ASNA hopes to translate the com“There are many reasons why comready to launch the campaign. pact win into another accomplishment, as pact licensure is a good thing for Alabama In the meantime, the ASNA will they begin working on behalf of advanced healthcare,” Wilkinson-Buchmann said. continue to work on behalf of Alabama practice nurses. “We are forming a steering “We can help fill the gap in rural areas nurses. She stressed that the ASNA is not committee with a number of stakeholders to with nurses who can come here from out a union and doesn’t participate in collecpursue the full scope of practice for advance of state. This will also be important for tive bargaining. “We promote excellence practice nurses in Alabama,” Wilkinsonmilitary spouses who are nurses. They in nursing, and excellence in nursing proBuchmann said. “Unfortunately, we are far KNOWLEDGE. EXPERIENCE. move every few years, so they can practice motes positive patient outcomes,” she said. behind other states regarding nurse practifrom one compact state to the next without COMPASSION. “And everyone is about positive patient tioners’ range of duties. If we can expand having to jump the hurdle of obtaining an At Cox Disability Law, our attorneys outcomes.” NP responsibilities, it will also help meet Alabama license. In addition, previously in bring you 35 years of experience on social security disability claims from thousands of clients. We know you have enough to worry about, and we understand the importance of your trust. As a past attorney with the Social Security Administration, Jan Cox also delivers a unique insider’s perspective.

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How do We Reduce Violence, continued from page 9 with the ASNA on legislation in the past, and she agreed to co-sponsor the resolution. “I have worked in situations that were very volatile, especially in emergency rooms,” she said. “I certainly understood the concern of the nursing association and agreed to carry that legislation for them.” The resolution was well received and passed without problem. Wilkinson-Buchmann credited Weaver for her help. “We couldn’t have done it without Representative Weaver or Senator Reed,” she said. Now the signs have been printed and the ASNA is beginning to distribute them to hospitals and clinics throughout the state. They are appearing at UAB and Huntsville Hospital and will soon be vis-

Birmingham Medical News

(Left to Right) Ernest Grant, President American Nurses Association, Representative April Weaver, Sarah Wilkinson-Buchmann President of ASNA.

ible in more institutions. “This initiative is gaining momentum,” Wilkinson-Buchmann said. Wilkinson-Buchmann hopes more nurses will join Representative Weaver in the process of making policy decisions. “Nurses need to be included in decision making, and not simply dictated to,” she said. “We are the ones who provide most of the care and have the birds-eye view of what’s going on in our facilities. Nurses need to be involved not only in policy formation, but in boardroom decisions as well.” For more information or to get copies of the signs for your institution, contact the Alabama State Nurses Association at


Moving the Science Forward IACRN Helps Prepare, Support Clinical Research Nurses By Cindy SanderS

A relatively young organization, the International Association of Clinical Research Nurses (IACRN) was founded 11 years ago to support and advance the specialty practice of clinical research nursing. Later this month, members will gather in Philadelphia for the annual conference focused on education, best practices and key issues impacting the field. “It is the only conference and only organization dedicated to and run by research nurses specifically,” said 2019 IACRN President Mary E. Larkin, RN, MS, CDE. Larkin, the nurse manager and assistant director of the Massachusetts General Hospital Diabetes Research Center, said the organization was Mary Larkin, RN, founded by a group MS, CDE of nurse managers from general clinical research centers who recognized the research environment was beginning to change. “They realized they needed to branch out to other areas, so they broadened their mission and founded the IACRN,” Larkin explained. “We have

370 members now, and they represent 21 countries,” she continued. From its inception, the chief goals of the organization have been to define the role of research nursing and support those practicing, as well as to spark interest for the next generation of clinical trial nurses to come. While many research nurses are still concentrated in large academic centers or regulatory settings, clinical trials increasingly are expanding into community settings, requiring trained professionals to manage implementation of the research protocol. Larkin noted that the basic qualification to become a clinical research nurse is to be a licensed or registered nurse (or the non-U.S. equivalent in other countries). “Research nurses bring to the clinical arena their skills as a nurse, then they learn a whole new body of knowledge, which is all about research,” said Larkin. “They are the key members of the research team who bridge those two disciplines.” Larkin said the most important quality is to “first and foremost be a skilled nurse.” Additionally, she said research nurses need to learn and understand the science of the research protocol, be meticulous in implementing and following that protocol precisely and in collecting quality data, focus on clinical care and safety first, and advo-

cate on behalf of patients enrolled in the trial. Without an eye to detail, Larkin said it’s far too easy to miss data points or wind up with poor quality data. As with many medical specialties, there is a shortage of practitioners. “By highlighting the awareness and contribution of research nurses in the scientific community, we are on our way to helping new nurses choose this as a field,” said Larkin. IACRN is currently developing new educational programming to provide to undergraduate nursing programs that introduces the research specialty to nursing students earlier in their studies. While there are some graduate courses in research nursing, Larkin said most of today’s professionals have honed their skill with on-the-job training. “In 2016, we published the scope and standards of practice for clinical research nursing. That makes IACRN the ‘go to’ place for resources and education,” said Larkin, adding that while there are other clinical trials-based organizations, none are solely focused on the role of nurses in the process. The professional association is also in the process of creating a certification program to signify excellence in the field. The upcoming conference is another opportunity to enhance knowledge by addressing issues from query resolution to

mitigating risk and by sharing best practices. In addition to a focus on clinical skills, Larkin said the conference also includes sessions on trials administration and data collection methodology. Connie M. Ulrich, PhD, MSN, RN, FAAN, professor of bioethics and nursing at the University of Pennsylvania School of Nursing, is delivering this year’s keynote address: “Ethical Issues in the Recruitment and Retention of Patient-Participants in Clinical Research.” Additionally, the conference includes 37 on-site posters and, new this year, virtual poster presentations from international colleagues unable to attend in person. “We are really working toward building an international community of research nurses learning about research nurse practice throughout the world,” said Larkin. With a quest to continue to grow the organization and raise awareness of the field, she added non-members working as research nurses or those interested in the field are welcome to register for the threeday conference. Information is online at “Research nurses have the ability to impact the outcomes of clinical trials and really move the science forward,” Larkin said of the profession. “We think clinical research participants all deserve to have a nurse at their side.”


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OCTOBER 2019 • 11

CMS Is Adding to Its Enforcement Toolbox by

Kelli Fleming

A well-equipped toolbox can be an asset when it comes to demolishing an outdated room in your home in order to allow for a better, newly-improved room to take shape. However, if you use the wrong tool in the wrong manner, home renovation disaster can ensue---think a large hole in the wall when all you were trying to accomplish was the removal of a tiny shelf. Not speaking from personal experience, I promise… Similarly, when it comes to oversight of federal healthcare programs, the right administrative tool and remedy can be an asset to the federal government in eliminating fraud and abuse within the Medicare program in order to allow for a more profitable and effective federal healthcare program to take shape. However, when the Centers for Medicare & Medicaid Services

(“CMS”) uses a tool in the wrong manner or without appropriate discretion, disaster can ensue---think quality providers departing the Medicare program. Pursuant to a new rule, entitled Program Integrity Enhancements to the Provider Enrollment Process, CMS is adding to its collection of tools to help in combatting fraud and abuse within the healthcare industry. If used appropriately, the recently-adopted new rule is designed to keep “bad actors” out of the Medicare program and stop fraud and abuse before it occurs. “Now, for the first time, we have tools to stop criminals before they can steal from taxpayers. This is CMS hardening the target for criminals and locking the door to the vault. If you’re a bad actor you can never get into the program, and you can’t steal from us” said CMS Administrator Seema Verma.

Under the new rule, CMS will be able to identify individuals and entities that pose a fraud and abuse risk solely based on “affiliations” with other entities that have been sanctioned by CMS. CMS can then take steps to prevent such identified individuals and entities from participating in the Medicare program. At the request of CMS, enrolling providers will disclose any current or previous “affiliation” with an organization that has uncollected debt (regardless of amount and regardless of appeal status), experienced a payment suspension, been excluded, or had its billing privileges denied or rescinded (regardless of the basis). As used within the new rule, “affiliation” would include, among other things, an individual with 5% or greater indirect or direct ownership interest, officer, director, individual with operational or managerial control, or any reassignment relationship.


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By way of example, under the new rule, if an entity is initially enrolling in Medicare and one of the owners identified on the initial 855 enrollment application was listed in the CMS database as being “affiliated” with a Medicare enrolled entity that has previously experienced a payment suspension (regardless of the basis or the duration), CMS can deny the enrollment application on this basis alone. There have been a number of concerns with this new rule expressed by the provider community, as the new rule gives a tremendous amount of discretion to CMS without much notice or remedy to the provider. Take, for example, the scenario described above. Under the new rule, an owner with a five percent minority interest in an entity who has had its payments suspended (an approach frequently used by CMS), due to no action or oversight by the minority owner (or even unbeknownst to the minority owner), could cause a secondary entity in which the owner also has a five percent minority interest to be denied enrollment in the Medicare program. Consequently, in light of this new tool, Medicare providers and suppliers need to carefully and thoroughly examine any individual with whom it has an “affiliation” relationship. The new rule takes effect on November 4, 2019. Time will tell if CMS is using this new tool in an appropriate manner or actually creating a renovation disaster.



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How to Treat People: A Nurse’s Notes by Molly Case; c.2019, Norton; $25.95; 279 pages Of all the things you ever learned, considerably older than her mother, and one lesson unlocked nearly everything other children teased Case for it. She told else. You probably don’t him it didn’t bother to even remember when it have a grandpa-age dad, happened, when you but, in reality, it did. Still, realized that squiggles she adored her father and, and angles could help while in nursing school, you to know all there she remembered his hugs is to know. Indeed, the and the feel of his breath A-B-Cs were just the beon her cheek. Cheek-toginning. And in the new lips is one way for a nurse book How to Treat People to check for an open airby Molly Case, the A-Bway. Cs help stave off an end. “B” is for breathing, When a nurse bethe next step in the assessgins the training needed ment: is the patient doing to save lives, one of the it? Case tells of witnessing Molly Case first things he or she last breaths then, hours learns is also one of the first things learned later, going upstairs to the “birth centre,” as a toddler: ABCDE. Five simple letters where she heard the wail of someone takthat, in order, stand for the things that ing their first. nurse will look for when faced with someCase says that her father’s health also one who needs critical care. helps her remember “C” for circulation. “A” stands for airway which, says His was poor, and as a result, he had sevCase “is always where we start,” and it’s eral operations on his leg. where she starts her story: her father was “D” is for disability, she says, which is

the “neurological assessment of the patient.” Is the brain functioning correctly? Are they conscious, or seizing or, as with one of her more memorable patients, forever unable to communicate? The final letter “E” merely asks a nurse to note the patient’s overall condition. Is he bleeding, injured, or pale? Should she start the alphabet over? “E” is for exposure but “it does not represent the end.” Filled with Britishisms – author and cardiac nurse Molly Case works in London – How to Treat People really is a genuine treat, even despite its quirks. There’s a good bit of biography in Case’s story, which will instantly capture readers. Her memories of her early career

are wrapped up with vivid, affectionate recollections of her family. This leads to tales about unforgettable patients, and accounts of the care they needed, relevant to ABCDE. The quirk comes in the too-frequent passages in which Case muses on ancient medical practices. They’re interesting – at least, at first – but after awhile, their presence begins to feel like filler. You’d be forgiven for jumping past them. But don’t jump too far. The overall atmosphere inside How to Treat People is too good to miss, especially if you’re a nurse, love one, or are beholden to one. For anyone who’s ever needed care, or will, this book is a worthwhile “A.” Terri Schlichenmeyer is a professional literary reviewer.

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OCTOBER 2019 • 13

Final Rule Updates CMS PACE Program By CINDY SANDERS

CMS recently updated regulations for Programs for All-Inclusive Care for the Elderly (PACE) to strengthen protections for participants and allow more operational flexibility for providers. PACE seeks to provide comprehensive, whole person care to some of the nation’s most vulnerable citizens, allowing them to stay in their homes. Although still a small part of overall senior care from the Centers for Medicare & Medicaid Services, PACE organizations (POs) have doubled over the last decade from 63 to 124. Today, more than 45,000 older adults are enrolled in programs across 31 states, including Alabama. PACE programming combines medical, social and long-term care services for frail individuals, allowing them to continue living in their homes and communities instead of being

institutionalized. PACE organizations provide services in the home, community and PACE center. Participants might be required to use a physician in the PACE network, but the

PO contracts with numerous area specialists and support service providers. Most PACE participants are dually eligible for Medicare and Medicaid benefits. To qualify, an individual must be age 55 or over, live in a service area where there is a PACE organization, be eligible for skilled nursing care but be able to live safely in the community with some supports in place. A capitated program, the interdisciplinary team of providers can use the fixed amount of funding to deliver whatever type of services an individual might need instead of only providing those reimbursable under Medicare or Medicaid fee-for-service plans. A recent final rule, released at the end of May, made the first updates to the program since 2006. According to a CMS spokesperson, the National PACE Association (NPA) and POs have requested updates and changes to the PACE program

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Birmingham Medical News

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for more than a decade. Their comments have focused primarily on providing more administrative flexibility and ensuring that PACE requirements align with today’s standards of care and practice. “This rule is the first major update to the PACE program since 2006 and reflects updates to best practices in caring for frail and elderly individuals, as well as changes in technology,” said the spokesperson. For example, the update allows for the use of electronic communication and the automation of certain processes. Additionally, the rule revises and updates PACE requirements for application and waiver procedures, enforcement action and administrative requirements, participant rights, quality assessment and performance improvement, participant enrollment and disenrollment, federal and state oversight and monitoring, data collection, and reporting requirements, among other issues. “The finalized changes provide greater operational flexibility, remove redundancies and outdated information, and codify existing practice,” said the spokesperson. “For example, we are implementing a more flexible approach to the composition of the interdisciplinary team that is central to the coordinated care participants receive from PACE organizations in order to allow the team to better meet participants’ needs. Now, one individual will be able to fill two separate roles on the interdisciplinary team in certain circumstances, which will strengthen the ability of the PACE organization to provide more seamless care and better tailor care to individual participants.” Prior to the final rule, team members could only fulfill one role on the care team. In order to expand access to PACE, the spokesperson said CMS is finalizing a number of other flexibilities, including allowing certain non-physician primary care providers to deliver some care in place of a physician where appropriate. Other regulation changes are focused on increasing participant protections by: • Clarifying POs that are offering qualified prescription drug coverage must comply with Part D requirements unless the requirement has been waived, • Implementing changes to enforcement action authority to enable CMS to hold POs accountable for non-compliance, • Increasing transparency and making the regulations more comprehensible for participants and providers, Adding language to help ensure individuals with a criminal conviction for offenses related to physical, sexual or substance abuse or use could not be employed in any capacity where their contact might pose a potential risk. Additionally, the final rule codified an existing practice by CMS of relying on automated review systems for processing initial applications to become a PACE organization or for existing POs to expand. For more information on the PACE program or how to apply to become a PACE provider, please go online to and click on the PACE Fact Sheet.


Cullman Regional Offers Newest Technoloby in Total Knee and Hip Replacement Cullman Regional is the first hospital in central Alabama to offer robotic-arm assisted total knee and total hip replacements with its Mako System. This latest advancement in joint replacement surgery transforms the way total knee and hip replacements are performed. The demand for joint replacements is expected to rise in the next decade. Total knee replacements in the United States are estimated to increase by 673 percent by 2030, while primary total hip replacements are estimated to increase Surgeons using the Mako System. by 174 percent. Yet studies have shown that approximately 30 percent of patients are dissatisfied after conventional surgery. “With Mako, our orthopedic surgeons can provide each patient with a personalized surgical experience based on their specific diagnosis and anatomy,” said William Smith Jr., MD, Cullman Regional Chief Medical Officer. “Using a virtual 3D model, Mako allows surgeons to create each patient’s surgical plan pre-operatively. During surgery, the surgeon can validate that plan and make any necessary adjustments while guiding the robotic-arm .” The Mako Total Knee application is a knee replacement treatment option designed to relieve the pain caused by joint degeneration due to osteoarthritis. Through CT-based 3D modeling of bone anatomy, surgeons can use the Mako System to create a personalized surgical plan and identify the implant size, orientation and alignment based on each patient’s unique anatomy.

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Scott joins Alabama Allergy and Asthma Center Thomas Scott, MD has joined Alabama Allergy and Asthma Center. He comes to Alabama Allergy from Ascension Medical Group in Wichita, Kansas where he served as the Medical Director. He also served on the faculty for the University of Kansas School of Thomas Scott, MD Medicine where he was a lecturer, clinical preceptor, and student mentor. Prior to that, he practiced in Tuscaloosa where he served as a member of the faculty at the University of Alabama School of Medicine. Scott attended medical school at Meharry Medical College in Nashville. He performed his residency in internal medicine at Western Reserve Care System in Youngstown, Ohio and did a fellowship in Allergy and Immunology at the National Institute of Health in Bethesda, MD. During his medical training he received the National Medical Fellowship Award and Internal Medicine Resident of the Year. He is published and has provided many allergy and asthma presentations throughout his career. Scott has a special interest in allergy, asthma, rhinitis, sinusitis and aspirin allergy. Allergy is a peak interest for him and

he enjoys the new discoveries and innovative treatment aspects of the specialty.

Max Cooper Receives Lasker Award for immunology Max Cooper, MD, an internationally renowned immunologist who spent 40 years at UAB, has received the 2019 Albert Lasker Basic Medical Research Award. The Lasker Award is America’s most prestigious biomedical research award. Cooper, currently at Emory University School of Medicine in Atlanta, is being honored for identifying two distinct

at UAB during his 40 years on our faculty,” said Seth Landefeld, MD, chair of the UAB Department of Medicine. “His discoveries elucidated the evolution and function of the adaptive immune system and laid the foundation for our understanding and treatment of immunological diseases and many cancers in humans. Dr. Cooper is especially loved for nurturing the hearts and minds of younger colleagues and fostering their careers. All of us are thrilled that this year’s Lasker Award recognizes Dr. Cooper for his extraordinary work.”

UAB opens Multidisciplinary Endocrine Tumor Clinic On October 1st, the University of Alabama at Birmingham opened its new Multidisciplinary Endocrine Tumor Clinic. Located on the third floor of The Kirklin Clinic of UAB Hospital, the clinic is a one-stop shop for patients with thyroid, parathyroid, pancreas and adrenal tumors. Patients will have the opportunity to see a team of specialists in a single, initial consultation in order to accommodate patients and expedite their treatment plans. The Multidisciplinary Endocrine Tumor Clinic offers comprehensive, multidisHerbert Chen, MD and nurse practitioner Kelly Lovell speak to a thyroid patient at The Kirklin Clinic. ciplinary and streamlined care for patients with benign or malignant tumors of the endocrine organs, such as neoplasms like thyroid cancer, hyperparathyroidism, multiple endocrine neoplasias and functional adrenal tumors. The clinic is led by co-directors Deepti Bahl, MD, Ronadip Banerjee, MD, PhD, and Brenessa Lindeman, MD, and is additionally supported by UAB Department of Surgery Chair Herbert Chen, MD.

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classes of lymphocytes, B and T cells. The discovery revealed the fundamental organizing principle of the adaptive immune system and launched the course of modern immunology. Max Cooper, MD “I had many happy years at UAB, and I still have fond memories and great affection for the institution,” Cooper said. “It was a fruitful time, and I am grateful for my time there.” “Dr. Max Cooper was an intellectual leader and a revered colleague

Birmingham Medical News


UAB Receives Grant to Address HIV Disparities Researchers in the UAB Division of Infectious Diseases and the Research Informatics Service Center at the Center for AIDS Research have been chosen as the national program office for HIV Care Connect. The new $7 million, five-year initiative is funded by the Merck Foundation. It is designed to help reduce disparities in access to care and improve health outcomes for persons with HIV living in underserved southeastern United States communities. As the national program office, UAB will work with Care Resource in Miami, Florida; Medical Advocacy and Outreach in Montgomery, Alabama; and the University of Mississippi Medical Center in Jackson, Mississippi, supported through the HIV Care Connect initiative. “We believe the HIV Care Connect initiative has the potential to be transformative in our region,” said Michael Mugavero, MD, co-director of UAB’s CFAR and national program office director of Michael HIV Care Connect. Mugavero, MD The program requires collaboration among local

health organizations and communitybased support agencies to address barriers to care associated with social determinants of health. These can include economic stability, neighborhood and physical environment, education, stigma, social context, and trust in health care system. UAB CFAR is one of 19 Centers for AIDS Research established by the National Institutes of Health.

Ashley Ketchum, DO Joins Internal Medicine & Pediatrics of Cullman Ashley A. Ketchum, DO has joined the Cullman Regional Medical Staff where she will practice with Internal Medicine & Pediatrics of Cullman. Ketchum is a boardcertified pediatrician. A native of Saginaw, Michigan, she is a gradAshley A. uate of Albion College Ketchum, DO in Albion, Michigan and completed Medical School at Lincoln Memorial University — DeBusk College of Osteopathic Medicine in Harrogate, Tennessee. She completed her post-doctoral training at the University of South Florida.

Princeton Baptist Medical Center Marks 250th WATCHMAN™ Procedure The heart team at Princeton Baptist Medical Center recently completed their 250th WATCHMAN™ procedure. The only FDA-approved implant proven to reduce stroke risk in people with atrial fibrillation not caused by a heart valve problem (also referred to as non-valvular AFib), the WATCHMAN offers an alternative to the lifelong use of warfarin. The implant, which is produced by Boston Scientific, is about the size of a quarter and made from light, compact materials. It fits into the left atrial appendage and is designed to permanently close it off and keep those blood clots from escaping.

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Birmingham Medical News

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Cox and Plaisance join Cardiology Specialists

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David Cox, MD and Benjamin Plaisance, MD have joined Cardiology Specialists of Birmingham. Cox and Plaisance are now accepting patient appointments with same-day/nextday availability on the David Cox, MD St. Vincent’s Birmingham campus as well as the St. Vincent’s One Nineteen campus. Cox is board-certified in Interventional Benjamin Cardiology. He pro- Plaisance, MD vides care to patients with coronary artery disease, ischemic heart disease, valvular heart disease, dysrhythmia, peripheral arterial disease and heart failure. He has a special interest in coronary artery disease, congestive heart failure, peripheral arterial disease and advanced interventional cardiology therapies. Plaisance is board-certified in Internal Medicine, Cardiovascular Disease, Echocardiography and Nuclear Cardiology. He treats patients with a variety of conditions, including coronary artery disease, congestive heart failure, valvular heart disease, and arrhythmias. He has a special interest in hypertension, valvular heart disease, and risk factor modification both before and after heart disease develops.

BlueCross of Alabama Expands Initiative to Further Improve Access to Primary Care

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pand access to primary care physicians. According to the Alabama Rural Health Association, 54 of Alabama’s 56 rural counties are entirely or partially classified as primary care shortage areas. There are 4.1 primary care physicians per 10,000 people in Alabama’s rural counties compared to 7.9 for urban residents. In addition, these 54 rural counties are also classified as mental healthcare shortage areas. To help meet this need, BlueCross is investing in the future of its Primary Care Physician Network by making available $3.2 million in scholarships, over a six-year period, to the Edward Via College of Osteopathic Medicine (VCOM) for medical students who agree to practice as primary care or behavioral health physicians in an underserved area of Alabama. “Providing Alabamians access to high quality healthcare continues to be one of our top priorities,� said Tim Vines, President and CEO, Blue Cross and Blue Shield of Alabama. “Having access to primary care results in in lower healthcare spending and improved outcomes.� “We are so excited about the investment that Blue Cross and Blue Shield of Alabama has made in future physicians to care for underserved populations in the state,� said Elizabeth Palmarozzi, DO, FACOFP, VCOM-Auburn Campus Dean. “The Blue Cross and Blue Shield Scholars Program will produce 42 new physicians to serve in Alabama over the next six years.�

BlueCross BlueShield of Alabama has begun an initiative to further ex-

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Birmingham Medical News October 2019  

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Birmingham Medical News October 2019  

Your primary source for professional healthcare news