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Mutant Protein May Change Treatment Plans for Prostate Cancer By ANN B. DeBeLLiS

A Promise to Help When Sandra Ford, MD was eight years old, her father took her to the doctor. At that time, Alabama was under segregationist laws, so the seven-hour wait that young Sandra and her father had to see the doctor wasn’t unusual. However, that particular visit that left an indelible mark on her that not only shaped her career in medicine, but it also marked the beginning of her spiritual path ... 3

UAB Comprehensive Cancer Center Goes Global to Fight HPVAssociated Cancers The human papilloma virus (HPV) is responsible for approximately 42,700 HPVassociated cancers in the United States each year based on estimates from the U.S. Centers for Disease Control and Prevention ... 5

DECEMBER 2018 / $5

Prostate cancer is the most common non-skin cancer in American men and remains a significant health risk. Scientists at Southern Research in Birmingham are studying a mutated protein that could hold the key to both development and treatment of this disease and possibly make the cancer more susceptible to radiation treatment. Rebecca Boohaker, Assistant Fellow in Southern Research’s Drug Discovery Oncology Department, and postgraduate researcher Joshua Fried are focusing on the Speckle-Type POZ Protein (SPOP) which is mutated in up to 20 percent of primary prostate tumors and can define a distinct subclass of prostate cancer and possibly determine the aggressiveness and progression of the disease. “There are five relevant mutations that appear in the patient population, but we are focusing on the SPOP because it is involved in DNA damage repair mechanisms,” Fried says. “If you look at the three-dimensional representation of proteins, most mutations occur in the same domain of the protein that is responsible for targeting other (CONTINUED ON PAGE 4)

Rebecca J. Boohaker, Ph.D., and colleagues are researching a mutated protein that may define a distinct subclass of prostate cancer.

Medicaid Expansion Would Provide Economic Benefits for Alabama By mArti weBB SLAy

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Danne Howard

Editor’s note: Last month we covered the Alabama Hospital Association’s campaign to expand Medicaid in Alabama and how expansion would improve access to care. This month we continue the coverage with a discussion about the economic benefits expansion would bring to the state’s healthcare providers. “Medicaid is a complicated subject,” said Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association (AHA). “And unfortunately, there’s a lot of misinformation out there. Under the current program, the majority of those covered are children or the aged, infirm or disabled. Most people don’t understand that.” The AHA campaign, ALhealthmatters.com, is intended to educate the public, healthcare providers and elected officials about the benefits of expanding Medicaid in Alabama. Medicaid expan(CONTINUED ON PAGE 6)

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HEALTHCARE SPOTLIGHT

A Promise to Help By Lori Quiller

When Sandra Ford, MD was eight years old, her father took her to the doctor. At that time, Alabama was under segregationist laws, so the sevenhour wait that young Sandra and her father had to see the doctor wasn’t unusual. However, that particular visit that left an indelible mark on her that not only shaped her career in medicine, but it also marked the beginning of her spiritual path. “During segregation, the doctor could only take so many patients,” Ford said. “So we sat. But I still remember that day vividly. I was sitting in the doctor’s office, and there was this elderly woman just suffering sitting in the chairs with us. It seemed like they were passing her by. I couldn’t understand why no one could help her. It bothered me a lot. And then Sandra and Henry Ford’s nonprofit organization is in its 16th year serving Alabama’s Black Belt counties. I watched her take her last breath. At the age of eight, I mission of God because we don’t enjoy the Each month’s mission presents its watched her die.” benefit of grants. This is just people helpown logistical challenges. Using Ford’s That one visit to the doctor as a child ing other people. This is the hand of God small medical practice in Birmingham as a changed Ford’s life. It planted a seed, moving all of us. People give what they base of operations, donations of clothing, which grew through the years. “This is can, and we accept that to give to others.” medicine, equipment and other necessities how A Promise to Help started,” she said. A Promise to Help is a nonprofit medical missionary organization founded by Ford and her husband, Henry, which is now in its 16th year. The organization serves Alabama’s Black Belt counties, including Barbour, Bullock, Butler, Choctaw, Samford University’s Dallas, Greene, Hale, Lowndes, Macon, Marengo, Montgomery, Perry, Russell, Sumter and Wilcox Counties. “We’ve been to the most underserved, underprivileged and underinsured counties in this state. A Promise to Help is a volunteer-based organization whose goals are to assist in eliminating health care disparities in Alabama. We have physicians, Concentration in Health Law and Policy nurses, ministers, media specialists, counselors, social workers, business leaders, skilled laborers, community activists and Fully online, part-time format others all working together with one thing Complete 36 credit hours in 24 months in mind — to help others,” Ford said. The organization hosts volunteers  &RPSHWLWLYHWXLWLRQƓQDQFLDODLGDYDLODEOH worldwide who come to Alabama once a month to visit communities in the most need. Relevant course work; expert faculty provide There are 12 missions a year, and although in-depth coverage of the topics that impact the organization is designated as a nonprofit, your career it operates almost completely on the generos-

are stored in every spare space waiting to be deployed once the location has been secured. After local county resources and ministries are contacted and a liaison is in place, it’s time to roll out the mobile health clinic. The mobile health clinic has two exam beds and is larger on the inside than it looks from the outside. It serves a higher purpose to bring more than just needed health care and medicine to the residents of what Ford and some volunteers have come to call Alabama’s Third World. “It takes us a while for us to gain the trust of the people in these communities,” Ford said. “So many different studies and research projects have come through these areas looking for information, but these things never really touched these people’s lives. And that’s what we want to do. Believe it or not, we have no agenda. This is just something that God has put in our hearts to do.” A Promise to Help is part of the Spirit of Luke Charitable Foundation™ cofounded by the Fords. If you would like more information about either organization, to make a donation, or to volunteer, visit www.spiritofluke.com

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ity of others by donations, not grants. “My husband and I are both ordained ministers, so this is a ministry for us,” Ford said. “It’s a holistic health care initiative where we can minister to the entire body. We have a medical team, a mentoring team, a ministry team and a team to address their immediate needs such as clothing and food. This is truly a

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Birmingham Medical News

DECEMBER 2018 • 3


ONCOLOGY

Reaching Those at Greatest Risk By CINDY SANDERS

Lung cancer is the number one cause of cancer deaths in America and the nation’s second most common cancer in both men and women, not counting skin cancer. While prostate cancer is more common in men and breast cancer in women, lung cancer is responsible for far more deaths than both of those combined. In fact, the American Cancer Society estimates nearly 14 percent of all new cancers are lung cancers. Despite knowing significant risk factors for the disease including smoking and exposure to secondhand smoke, lung cancer often isn’t caught until symptoms have progressed to a point where the disease is already at an advanced, non-curable stage. While it has been challenging to catch the disease early, the National Lung Screening Trial showed using low-dose CT (LDCT) scans to screen people at higher risk for lung cancer did detect abnormalities before symptoms started. The study included more than 50,000 current and former smokers ages 55 to 74 who were in fairly good health. Those enrolled in the study had to have a 30 pack-year history, and former smokers had to have quit within the past 15 years. Study participants were randomized to either three LDCT scans or three chest x-rays given a year apart. The study found those who received LDCT had a 20 percent lower

chance of dying from lung cancer than those who received chest x-rays. Now the University of Alabama at Birmingham has the opportunity to reach out to high-risk populations in seven counties to use LDCT screening for early identification and intervention. Claudia Claudia Hardy, Hardy, MPA, proMPA gram director for the Office of Community Outreach for UAB Comprehensive Cancer Center, said her office is working in partnership with Lung Cancer Alliance on a $1.6 million grant from the Bristol-Myers Squibb Foundation to reach underserved Alabamians who are most at risk for lung cancer. The three-year grant establishes the Alabama Lung Cancer Awareness, Screening and Education program (ALCASE). “It’s going to allow us to expand our existing infrastructure to lung cancer, as well as breast, cervix and colorectal cancers,” Hardy explained of building on their already successful screening and education programming. “The ultimate goal is to screen 250 men and women between the ages of 55 and 75 for lung cancer.” Hardy said ALCASE will combine Lung Cancer Alliance’s expertise in screening with UAB’s Deep South Net-

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work Community Health Advisor model to decrease disparities. The Community Health Advisors (CHAs) are lay individuals within a community who have been identified as leaders and trained in cancer education and outreach. “They are trusted individuals in their community. They’re an extension of our office, and they enable us to go into communities that we otherwise would not be able to get into,” Hardy said. In fact, it was the previous use of CHAs that helped secure UAB’s participation in the current grant. “We were able to successfully reduce or reverse the disparities that existed for mammography screening rates between African American and Caucasian women who were Medicare recipients through our Community Health Advisor model,” she said. “That’s the beauty of the program,” Hardy continued. “They are an extension of the office, but they are right there in the community 24/7 to link individuals to services and care.” ALCASE will be deployed in seven counties. Jefferson County captures the urban Birmingham metropolitan area with the six other counties being in the Alabama Black Belt, an area of the state known for its rich black soil and deep agricultural roots. Choctaw, Dallas, Greene, Hale, Marengo and Sumter counties will all be part of the rural cluster that features a large African American population, limited financial resources, and access to care issues. Hardy noted access and treatment will have to be addressed through a number of mechanisms including transportation assistance. The grant requires the LDCT screening be conducted in designated cen-

ters of excellence. “There are less than five radiology centers of excellence in these areas,” Hardy noted. “Some of the counties don’t have a hospital at all.” With lung cancer disproportionately impacting people of color, there is certainly a need for improved education and awareness in the region. Unlike the wellestablished guidelines for mammography, cervical cancer screening and colonoscopies, Hardy pointed out screening for lung cancer isn’t promoted in the same way as these other cancers. Further complicating the diagnosis and treatment process, she continued, “For this particular cancer, many of the symptoms may mimic lesser issues like a sinus infection, common cold or pneumonia.” By the time the symptoms have progressed to a point where an individual seeks medical care, the cancer has often advanced past the early stages. Currently, Hardy’s office is actively working to create the curriculum for lung cancer awareness, education, risk stratification and screening. The team is also getting staff in place before reaching out to potential CHAs, who will spend about two months training for their role. “We won’t begin screenings and referrals for screening until late spring,” she said of the timeline. Hardy added, “Local healthcare providers can definitely contact us if they have high-risk individuals who need assistance with getting a screening done or if they know of someone who would be a great Community Health Advisor.” Reach out to Hardy through her email – chardy@ uab.edu – or by phone at (205) 975-5454.

Mutant Protein, continued from page 1 proteins for degradation. As a result, mutations render the SPOP ineffective in a way that contributes to the disease progression, because the turnover of normal proteins is altered.” Data has revealed that the presence of mutant SPOP causes an enrichment of genes that previously had been associated with mutant BRCA1, a gene that is mutated in some breast and ovarian cancers. The identity of the affected genes suggests that SPOP not only affects DNA repair pathways but also blocks a process called homology-directed repair, a method that cells normally use to repair doublestranded DNA breaks. Boohaker says they recently isolated a specific mutation, Serine 119 to Asparagine. “We have been trying for a while to characterize this specific mutation that prevents a protein from being phosphorylated by an upstream protein that is responsible for DNA damage repair,” she says. “We want to use this as a biomarker which says that if you do have a mutation in this protein at this specific location, it will make your prostate cancer more susceptible to radiation treatment.” The presence of the SPOP mutation could change a patient’s treatment plan based on the aggressiveness of the cancer. It would be specific to each patient and in-

clude radiation treatment or some kind of DNA damaging chemotherapy. “We want to spare patients from treatments that may not be as effective and streamline them into those you know will work best,” Fried says. “Chemotherapy and radiation can be tough, so we want to spare patients from seemingly unnecessary treatments.” Boohaker isn’t sure how many people are using these recent findings which are available in multiple databases, but she is sure that the findings have important implications for prostate cancer treatment. “I think the S119 mutation is present in about 10 percent of the population, but when you consider the number of men diagnosed with prostate cancer each year in the United States and around the world, the numbers add up quickly,” she says. “ Next steps in their research are to leverage the new proteins that have been dysregulated by the mutated SPOP and explore the options those proteins might provide. “We have to validate which targets are the most appropriate to pursue in our discovery efforts,” she says. “Then we will try to implement some of these findings into a clinical setting where they can be considered by physicians who are diagnosing and developing treatment plans for prostate cancer patients.”


ONCOLOGY

UAB Comprehensive Cancer Center Goes Global to Fight HPV-Associated Cancers By Ann B. DeBellis

The human papilloma virus (HPV) is responsible for approximately 42,700 HPV-associated cancers in the United States each year based on estimates from the U.S. Centers for Disease Control and Prevention. Cervical cancer is the most common HPV-associated cancer among women, while oropharyngeal cancers are most common among men. A preventive vaccine for HPV is available for children as early as nine years of age, but more education for parents and pediatricians is needed in order to facilitate the prevention of these cancers. “This preventive cancer vaccine offers the most protection from HPV-associated cancers, but children and pre-adolescents need to be vaccinated at a young age before they are exposed to the virus. Studies have shown and recommendations are that we vaccinate children between ages 11 and 12, although we can start as early as nine years,” says Isabel Scarinci, PhD, MPH, a professor in the UAB Division of Preventive Medicine and associate director for Globalization and Cancer at the UAB Comprehensive Cancer Center. “If children get the vaccine up to age 14,

RAJINI K. MURTHY, MD

they will need only two doses. Those 15 and older will require three doses.” The Food and Drug Administration (FDA) recently approved expansion of the vaccine for people Isabel C. Scarinci, up to age 45. “We PhD, MPH want as much coverage as we can get for people. However, the vaccine’s emphasis should be for younger children, because their immune systems will give them higher protection,” Scarinci says. “The data says the vaccine offers protection up to age 45, but it will not provide the protection that it gives younger people.” Scarinci contracted polio when she was eight months old because, due to illness, she missed the second dose of the polio vaccine during a polio epidemic. As a result, she has made HPV vaccination her mission. “I have been fortunate, but I saw how polio affected the world,” she says. “If you had told my mother in 1963 that polio would be eliminated, she would have laughed. But today there are only three countries remaining that have not

A. MICHELE HILL, MD

eradicated polio. HPV-associated cancers are also diseases we can prevent. The main difference is that I got polio almost immediately after missing the vaccination, but our un-vaccinated children may get HPVassociated cancers in their adulthood.” Scarinci says they are tackling HPV prevention on two fronts: first, by educating pediatricians so they can provide a stronger message to parents about the benefits of the HPV vaccine. “The early release of the vaccine was associated with discussions of sexual activity, which caused concern for many parents. Even though those parents had their children vaccinated at birth for hepatitis B – also a sexually transmitted infection – the many different stakeholders felt that this link to sex had to be removed,” Scarinci says. “The second piece is parental education. Parents need to be more informed so they can be advocates for their children and promote HPV vaccinations in schools.” The UAB Comprehensive Cancer Center has established a statewide Alabama HPV Vaccination Coalition to integrate efforts that can help increase the vaccination rate in Alabama. The latest data from the Alabama Department of Health shows a 19 percent HPV vaccina-

GARY D. MONHEIT, MD

tion rate for children 11 to 15 who received the required doses. 39 percent only got one dose. “We need to mobilize parents and providers to get the vaccinations,” Scarinci says. “Our cancer center is committed to not only finding the cure for cancer, but also to prevent cancers.” Another aspect of preventing HPVassociated cancers is the need to screen adults who never received the vaccine. Women need to continue to be screened for cervical cancer, and men and women need to work with their dentists for early detection of oropharyngeal cancer. “There are places in Alabama and other states where cervical cancer is prevalent but could be prevented with regular screening. Many women avoid screening because of multiple barriers such as lack of transportation, not wanting to go to a doctor’s office, embarrassment, and competing demands,” Scarinci says. Cervical cancer annual rates have declined by 75 percent or more in the U.S. over the past 50 years because of the introduction of regular Pap tests. However, the decline has not been the same for all women. African American women have

JAMES M. KRELL, MD

(CONTINUED ON PAGE 16)

MELANIE L. APPELL, MD

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Medicaid Expansion Would Provide Economic Benefits, continued from page 1 sion would also include the working poor who are currently in a gap, earning too much to qualify for Medicaid, but not enough to afford health insurance. The AHA estimates an additional 300,000 Alabamians would have health coverage as a result. Expansion would also have significant economic impact for the state, according to Howard, including healthcare providers. “Alabama has great job numbers, but those jobs are not translating into more people with health insurance, and the uninsured rate of patients in the ER has gone up,” she said. “If we continue on the current trajectory, more hospitals are going to have to cut back services and have layoffs. “When more people are covered and have access to care, it creates more opportunities for providers, whether that be physicians or hospitals, to provide

services. The more providers who are getting reimbursed, the more who are willing to see those patients,” said Mark Jackson, Medical Association of the State of Alabama executive director. Jackson said Alabama primary care physicians are reimbursed at a reasonable rate under Medicaid because of a “primary care bump” the Alabama legislature has kept in place. “Under the Affordable Care Act, the legislation required that Medicaid reimburse primary care physicians at the Medicare rate,” he said. “In Alabama, that was significantly higher than what Medicaid had been paying. That provision expired after two or three years, but Alabama kept that bump in place. Now we have to work on the specialty rate, so specialists will be more willing to take Medicaid patients.” Howard also pointed to the economic importance Medicaid expansion will have

The Alabama Medical Association completed a study in partnership with the American Medical Association (AMA) earlier this year. Here’s what they found: • Physicians in Alabama generate an estimated 101,000 jobs across the state • Physician practices generate an estimated $565 million in state and local taxes • One physician generates on average 10 additional jobs • One physician generates $839k in total wages and benefits • One physician generates $1.9 million in economic output

6 • DECEMBER 2018

Birmingham Medical News

with rural hospitals. The campaign website says “Investing in the rural health care infrastructure is critical as Alabama works to improve rural prosperity. Alabama’s rural hospitals are an anchor in their communities‒creating jobs, providing critical care, and supporting other industries. When a rural hospital closes, other mainstays in the community often follow - local pharmacies, physicians, banks, and grocery stores to name a few. When a rural hospital closes, it’s very difficult to attract new business. Rural hospitals in Medicaid expansion states are less vulnerable. Expansion states have seen fewer hospital closures than non-expansion states. In fact, hospitals in expansion states are 84 percent less likely to close than hospitals in non-expansion states.” Rural hospitals are not the only beneficiaries, however. “In Alabama, 75 percent of all hospitals have red operating margins, meaning their reimbursement is not enough to cover the cost of care,” Howard said. “It’s 88 percent for rural hospitals. Alabama hospitals do an amazing job, considering the obstacles, but what business can continue to operate on that kind of margin? When you have that volume of hospitals struggling to make ends meet, to keep the lights on, to make payroll, to purchase and be participants in advancements in medicine and diagnostic technology, and one thing we can do to help is provide insurance

The ALhealthmatters.com site provides information about the positive effect expansion could have on Alabama’s economic infrastructure: • AL Hospitals have $20 billion annual economic impact. • Hospitals employ 90,000 people statewide and support an additional 96,000 jobs. • Good health care is critical in recruiting new businesses and keeping existing ones. • Medicaid is a vital part of Alabama’s health care system. It supports thousands of jobs and billions of dollars in the health care sector. • Without Medicaid, many providers (hospitals, doctors, pharmacists) could not survive, leaving communities without access to health care.

coverage to more people, how could we not do that? It’s an investment we cannot afford to miss.” For more information about the campaign, visit http://www. alhealthmatters.com.


Birmingham Medical News

DECEMBER 2018 • 7


Don’t Get Caught in a Copay Conundrum By JeNNA rotoN, CPA

In the current environment of increasing patient deductibles and copays, the billing and collection of the patient portion of your services is top of mind. In the Department of Health and Human Service’s report dated May 2017, Alabama’s average monthly health insurance premium amounts increased 223 percent from 2013 to 2017, versus the national average increase of 105 percent. In real dollars, average monthly premiums jumped from $178 to $575. With deductibles and copay amounts increasing as well, it’s becoming more difficult to collect the patient’s portion of the bill. As a provider, you are more than aware of these financial hardships your patients are facing, especially your sicker patients who absolutely need care. You

might routinely waive the patient portion of your services because you sense a financial issue. Maybe you treat other physicians or colleagues and write off their portion of the bill as a professional courtesy. You might even provide care to your team of employees at a reduced rate as a perk of their job. But did you know that all three of these scenarios can land you in hot water? These practices, while intended to be a gesture of goodwill, could put your practice at risk of violating federal antikickback statutes and violating contracts with insurance carriers - not to mention impacting your practice’s financial bottom line. According to the Office of Inspector General, the federal Anti-Kickback Statute (AKS) is a criminal law that prohibits the knowing and willful payment of “re-

The Do’s and Don’ts of Deductibles and Copays Do: • Always bill the full amount. • Make a reasonable effort to collect from the patient. • When a patient states an inability to pay, establish policies to determine financial need and keep adequate documentation. • Work out a payment plan with a patient, or agreement for paying a certain amount each visit. • Collect up front - rather than later. Each statement sent costs you time and money.

Don’t: • Routinely or systematically write off copays or deductibles. • Advertise that you will forgive copays. • Accept the in-network copays if you are an out of network provider. • Devalue your services by waiving or reducing the copay and deductibles due.

muneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the federal health care programs. Violating the federal AKS can lead to criminal penalties and administrative sanctions. The penalties for physicians who pay or accept kickbacks can be up to $50,000 per kickback plus three times the amount of the remuneration in question as well as imprisonment and exclusion from future participation in federal healthcare programs. The HHS’s A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud & Abuse states the following: “Where the Medicare and Medicaid programs require patients to pay copays for services, you are generally required to collect that money from your patients. Routinely waiving these copays could implicate the AKS and you may not advertise that you will forgive copayments. In this case, the HHS would determine a practice is violating the AKS if their standard practice is to waive copays. Patients would become the referral source and would be receiving the benefit of a waived copay.” From an insurance carrier’s point of view, if you routinely write off patient’s copays and deductibles, you are in essence decreasing the total charge for the service you are providing. A $100 visit with a $20 copay that is waived has become an $80 visit. Insurers can view this as a breach of contract, and they have recently been cracking down on enforcement of collections. Insurers can stipulate that the copay portion is required to be paid in order to reimburse the practice its portion. If they find out you have been waiving the patient portion for services, they can seek repayment of funds they’ve already paid for those patients. Profit margins for services are getting smaller, and as a medical practice in today’s post-ACA world, your bottom line

cannot afford the consistent waiver, or poor collection of copays and deductibles. To navigate this issue, we recommend you review/update or implement policies and procedures guided by these best practices: • Immediately stop any current practices of routinely waiving or reducing copays and deductibles. • Where financial need is an issue, develop a policy with outlined procedures to document a patient’s financial hardship. Having a patient sign a document stating they have a financial hardship is not enough to substantiate the patient’s inability to pay. Have a designated staff member document the patient’s financial need. You need to perform due diligence with the patient to prove they are unable to pay. The HHS’s Roadmap for New Physicians states, “you are free to waive a copayment if you make an individual determination that the patient cannot afford to pay or if your reasonable collection efforts fail. Train front desk and billing staff on these policies and procedures to ensure consistent enforcement.” • Bill the copays and deductibles and make adequate attempts to collect from the patient. We recommend at least three statements and a phone call as a best practice. Document all collection efforts in the patient’s file to provide an adequate audit trail. • If these three practices bear no fruit, you can write off the patient’s copay or deductible. As you can see, justifiable circumstances of financial hardship are situations where you can discount or waive copays. Use these best practices to implement consistent policies. Steer clear of routine waivers and discounts of copays, and you shouldn’t find yourself in a copay conundrum. The information in this article is not intended as tax or legal advice. Please contact your lawyer or CPA for specific information regarding your individual situation. Jenna Roton, CPA practices with Jackson Thornton.

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Birmingham Medical News


Complete In-Office Reflux Testing By JANe eHrHArDt

“Physicians are all aware of the indications for testing for gastroesophageal reflux,” says John Touliatos MD, with Advanced Surgeons. “But they may not know that we can now do the full evaluation for those patients in an office setting.” Advanced Surgeons opened its Heartburn Center in an effort to provide a conve- John Touliatos, MD nient and less expensive way of evaluating those patients who are not responding to medications, and possibly provide alternative treatment. “Medications can reduce the amount of acid in the stomach, provide heartburn relief, and heal esophagitis. But they do not treat the root cause of the disease, which is a defective lower esophageal sphincter, and they may be masking other issues such as Barrett’s esophagus, a pre-cancerous lesion,” Touliatos says. Over time, the reflux of stomach contents into the esophagus can damage the lining of the esophagus and cause the cells to become abnormal. This can occur in chronic sufferers of reflux despite medications. Testing for reflux generally re-

quires a visit to the hospital or surgery center. However, the Heartburn Center at Advanced Surgeons offers an equivalent alternative without the complexities and costs. Physicians at the center use a methodical approach to diagnosis and treatment which can contribute to a high success rate in identifying and addressing the root cause of heartburn, as opposed to just treating the symptoms. Typically, the first test is an endoscopy which uses a scope to view the esophagus. This allows the physician to identify any pathology associated with disease such as a hiatal hernia, narrowing of the esophagus, or undertreated esophagitis. Performing this at a hospital would require sedation and take a significant amount of time. “We only need to spray some local anesthetic in the back of the throat, because we have smaller scopes,” Touliatos says, estimating that the test can be done in as few as five minutes. For patients who may want to consider surgery or have other alarm symptoms, the next test would be an esophageal manometry, which measures the effectiveness of the esophageal contractions and the position and function of the lower esophageal sphincter (LES). “In real time, it shows us the motor function of the esophagus, how strong the contractions of the muscle are, and if the LES

relaxes normally,” Touliatos says. This test can be run in ten to thirty minutes. The manometry study also allows the physicians to identify where to place the test probe to measure the acid in the esophagus. This pH test can be as easy as attaching a tiny capsule, about the size of a pencil eraser, inside the esophagus that sends data to a cell-phone-size radio transmitter worn a belt by the patient for 24 to 48 hours. In time, the capsule will dislodge and be passed without the patient even knowing it. “It’s great for testing acid reflux and won’t influence their daily routine,” Touliatos says. About ten percent of patients present with atypical symptoms that necessitates a more intensive pH test in which a tiny catheter is threaded through the patients’ nose into the esophagus and is worn for 24 hours. This test not only measures acid, but also the direction of flow in the esophagus for those patients who reflux non-acid or weakly acidic fluid. It accomplishes this by adding impedance sensors to the catheter. Patients may actually be refluxing bile, which can be picked up by the catheter. Touliatos says the biggest advantage to using the one-stop shop is convenience. “Patients can get in for testing usually faster than at a hospital,” he says. “And the physician can run all the tests at the

same time, sometimes on the initial visit. We typically get the results within 24 to 48 hours after the study is complete.” Advanced Surgeons does not do therapeutic endoscopy. “We use gastroenterologists for any therapeutic endoscopy, like polyp removal or endoscopic treatment of Barrett’s esophagus,” Touliatos says. “We are just evaluating reflux and offering surgical options. “About 86 percent of patients have excellent long reflux control with only one surgery. So for people who are unhappy with their reflux not being controlled by medications, high costs of long term treatment, or side effects of medications, we have a discussion about the risks and benefits of surgery and let the patient decide.”

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DECEMBER 2018 • 9


ONCOLOGY

O’Neal Industries Gift will transform the UAB Comprehensive Cancer Center

O’Neal Industries have given the largest single gift in UAB history — a $30 million donation to the UAB Comprehensive Cancer Center. The center will be known as the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham. “The O’Neal family has built a legacy in Birmingham, first in the city’s steel industry and now in the city’s future as a biomedical and technology hub,” said Ray Watts, MD, president of UAB. “We are proud that our cancer center will bear the O’Neal name.” Members of the O’Neal family have been business and political leaders in Alabama for generations. Edward O’Neal was Alabama’s 26th governor, and his son Emmet served as the state’s 34th governor. Kirkman O’Neal was a pioneer in Birmingham’s burgeoning steel industry, founding what was to become O’Neal Steel in 1921. “This is an opportunity to give back to a cause that is important to everyone,” said Craft O’Neal, chairman and CEO of O’Neal Industries and grandson of Kirkman. “We hope the gift will be used in ways that will yield the greatest results.” “This gift will enhance the profile of Craft O’Neal the cancer center as a premier national destination” said Selwyn Vickers, MD, dean of the UAB School of Medicine. The UAB Cancer Center was one of the original eight comprehensive cancer

O’Neal Comprehensive Cancer Center at UAB

centers established by the National Cancer Act in 1971. “We have made great strides in cancer treatment,” said Will Ferniany, PhD, CEO of the UAB Health System. “In the years ahead, the promise of proton therapy, precision oncology, advanced genomics and new therapeutics should reduce the burden of cancer on patients, and on the health care system. The generous O’Neal gift will be a driving force that transforms cancer care.” UAB is the only National Cancer Institute-designated cancer center in its four-state region. It also maintains joint ventures with Russell Medical Center and North Alabama Medical Center and manages the Deep South Network for Cancer

Control, an outreach into underserved communities. The UAB Health System maintains a Cancer Community Health Network in Alabama, Florida, Georgia and Mississippi. The O’Neal family has been touched by cancer. Kirkman’s son, Emmet, died from emergency surgery associated with colon cancer, and his daughter Libby O’Neal White was a breast cancer survivor. Her husband, David White, succumbed to cancer, as did Craft O’Neal’s mother Mary Anne and his brother Kirk. The O’Neal Comprehensive Cancer Center at UAB is home to more than 400 physician-scientists and is involved in over 200 clinical trials of promising therapeutics, many using therapies that were

y s a E e Breath ... and Enjoy the Season!

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10 • DECEMBER 2018

Birmingham Medical News

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developed at UAB. The center treats an estimated 5,000 new patients each year. O’Neal industries have a history of philanthropy with UAB. Craft O’Neal is a longtime member of the cancer center’s advisory board, and over the years, O’Neal Industries and family members have supported departments across UAB, including the Comprehensive Cancer Center, the Collat School of Business, the Department of Neurology, the School of Nursing, the Comprehensive Diabetes Center and UAB Athletics. “Our company has a nearly 100-year history here,” O’Neal said. “We believe in giving back to the community that has been so good to us. UAB is the economic engine of Birmingham and, to a large extent, the state of Alabama. My hope is that others will see the exciting developments at the cancer center and want to invest in its future and that of our city.” O’Neal Industries represents a family of six companies with 80 business locations, including 15 international facilities on four continents, employing more than 3,200 people. “My grandfather’s and father’s generations of O’Neal employees laid the foundation for the success we enjoy today,” O’Neal said. “I hope each of our employees, customers and suppliers will take pride in this gift, because without their contributions, we would not be able to give back in such a meaningful way.” According to Michael Birrer, MD, PhD, director of the center, the gift will help: • Recruit talented scientists and clinicians to UAB, along with the federal grants they garner. • Expand the number of cancer treatment clinical trials at UAB, potentially tripling the number. • Plant the seed for a UAB/Biotech collaboration that can grow into a future Birmingham biotechnology park, much as Cambridge, Massachusetts, has transformed in the past three decades from an aged manufacturing area to a biotechnology boomtown. • Expand patient access and care. • Create a distinctive brand around the center for UAB and Alabama.

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WELLNESS

Wellness for Life

Getting an Early Start on Living Longer By LAurA FreemAN

A funeral can teach you a lot about yourself, especially a family funeral where you see the toll of time on a room full of relatives you haven’t seen in years. As the pews fill, the tremor of hands on canes makes you reassess your notion that no one in your family gets Parkinson’s Disease. You look around the room and see case after case of arthritis, diabetes, and heart disease, and then you notice the faces that are missing. Like Scrooge meeting the ghost of Christmas yet to come, you see what could be your future in the deck of genetic cards spread out before you. Then a spry 89-year-old walks by, followed by a cousin who is old before his time, and you wonder—is it the cards you are dealt or how you play them that will determine what your life will be like in the coming years? What if we looked at wellness not as just something we start in January to get ready for swimsuit season, but as something we do as an everyday part of life to live and feel better every day we’re alive? “If you want to be a healthy 90-yearold, choose your parents carefully. If you can’t go back and do that, make health a priority throughout life. A healthy older person comes from a healthy middle aged person, who comes from a healthy young adult, who comes from a healthy baby,” Andrew Duxbury, MD, of UAB’s Division of Gerontology, Geriatrics and Palliative Care, said. “The most important thing in aging well is coming to grips with Andrew Duxbury, the understanding MD that aging is change,” he said. “As we grow up, we’re very adaptable until we are around 25. Then we have a sense we will always be the person we were then. But the years do have a physical and mental impact. By making wellness behaviors a habit and by learning to adapt as changes come, we can, at least to some degree, have a positive effect on our health and quality of life as we age.” Regular exercise may not keep you from eventually getting one of the diseases of aging, but it could affect how well you live with the symptoms. “Use it or lose it tends to hold true for both physical and cognitive abilities,” Duxbury said. “One of my patients who developed Parkinson’s Disease had been a professional dancer and continued to be active. Unlike most Parkinson’s patients, she didn’t have a problem with falling. Her dance training had given her such a good sense of where she was in space along with strength and awareness of her muscles. She was able to compensate.” What and how much we eat also

matter. “The pace of modern life makes us think of what is convenient to eat rather than what is healthy,” Duxbury said. “Having so much less-than-healthy food available may make it harder for boomers to live as long as their parents. The people who are now living into their 80s and 90s are the last of the generation that grew up in the depression and World War II. They had enough food to survive, but there wasn’t a lot of extra to eat. We evolved as hunter gatherers who ate less except when the hunt was good, and then everyone feasted. New studies come out every week about different enzymes or nutrients that might help this or that. A simpler approach to nutrition is to eat enough, but not to overfill—and make sure it’s real food. If grandma wouldn’t recognize it as food, look for something better.” Another part of staying healthy through life is getting enough sleep. “As we age, sleep gets harder for most people,” Duxbury said. “You will probably need to be more mindful of things like when you drink coffee, getting exercise, and creating an environment that makes it easier to sleep.” Another important part of aging well is planning for retirement. You make financial plans. When you retire, you need to plan to retire to life, and not just to the couch. “People who just sit and watch TV and 24-hour news don’t tend to do well,” Duxbury said. “Instead of waiting for your blood pressure to go up and anxiety and depression to set in, limit your news to half an hour a day. Then get up and get involved in living.” Social interaction is an essential part of healthy aging that are is too often lacking. “We evolved to be part of a tribe,” Duxbury said. “Until recently, we lived in extended families and everyone had a role to play. Now family may be spread across the country. If you no longer see friends from work as often, you need other friends. Stay active.” As you age, plan the life you want to live. If that means pursuing new hobbies, volunteering, going back to school, or even moving to a community where there are more people your age, go for it. It could not only add more years to your life. It could add more life to your years.

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DECEMBER 2018 • 11


WELLNESS

Sleep As a Window to Wellness By Laura Freeman It’s resolution time again, and as usual, getting in shape and losing weight are likely to be near the top of most lists. However, one often overlooked health habit could make many of the others easier to achieve, and could have a positive influence on health for a lifetime. Sleeping well and getting enough sleep time on a consistent basis has protective effects on both body and mind. A lack of sleep and poor sleep quality can contribute to health problems now, and may play a role in developing problems as we age. During sleep, the brain does its housekeeping and maintenance. Cells shrink slightly, allowing fluids to wash away the debris of the day, including amyloid molecules that might otherwise form plaques and tangles. Research has suggested this might account for one way that sleep could influence the progression of neurological diseases like Alzheimer’s. In Parkinson’s Disease, sleep disturbances can be both an early symptom and a continuing problem that impairs function. UAB neurology researcher Amy Amara MD, PhD, studies sleep disorders in patients with Parkinson’s and other neurodegenerative disorders.

“Parkinson’s affects sleep, and poor sleep affects how Parkinson’s patients are functioning during the day,” Amara said. “Sleep fragmentation is often a major problem. Patients tend Amy Amara, MD, to wake frequently PhD through the night, and that makes getting enough deep sleep and REM sleep difficult. With muscle control problems, turning over to get comfortable isn’t easy. Changes in the nervous system increase the frequency of waking to go to the bathroom, which also increases the risk for falls.” A study Amara has just completed looks at how exercise could be used to help Parkinson’s patients sleep better. “We compared two randomized groups of Parkinson’s patients,” she said. “The control group learned about sleep hygiene. The second group participated in high intensity exercises, moving from one exercise to the next without resting in between. We are still compiling data, but over the 16-week study, we found that exercise did make a difference in helping participants sleep better than the control group.” Past studies have suggested exercise

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might have a protective effect against Parkinson’s Disease or the progression of its symptoms, but how and what type of exercise works best for which patients are areas that needs more investigation. “We can’t be sure yet how much to attribute to exercise, or whether people who are developing movement disorders tend to exercise less because of them,” Amara said. “However, exercise does help with strength and balance, and quality sleep helps people feel better overall.” The lack of sleep also has an impact on health in earlier years. Studies have shown that sleep disruption for several days can create metabolic disturbances that mimic diabetes, with insulin and blood sugar changes. It takes a toll on blood pressure, the cardiovascular system and immune system. Serious accidents are more likely as nervous system responses and judgment are impaired. ADHD, depression, mania, dementia and other cognitive symptoms that aren’t yet clinically significant can increase to the point of needing treatment. On the plus side, studies at UC Berkley, Harvard and other research centers have shown that good sleep is essential to learning and memory. During sleep, the brain sorts, downloads and consolidates the meaningful memories of the day. In the sorting, sleep brings ideas together and can stimulate creativity. All the body’s essential systems take advantage of the circadian down time to reboot, repair and renew. Some sleep difficulties stem from physical disorders that may need evaluation. Apnea and narcolepsy may require medical intervention. REM sleep behavior disorder, which sometimes occurs in people who later develop neurological conditions such as Parkinson’s, turns off protective sleep paralysis so that dreamers begin to act out their dreams, which can be disconcerting and even dangerous for both the sleeper and anyone sharing a bedroom. However, most sleep problems today seem to be a byproduct of modern life. Before electric lights, people slept up to 10 hours a night. In 1942, Americans slept an average of 7.9 hours. Now it’s closer to 6.5 hours. In addition to living in the

stresses of a 24-hour news cycle in a 7-daya-week world, taking work home with us and television give us reasons to stay up. When we do go to bed, it is often with the blue screen of a smart phone disrupting melatonin production. An estimated 50 to 70 million Americans have chronic difficulty sleeping, which can range from sleep onset insomnia to sleep maintenance insomnia that leaves them wakeful in the middle of the night. Knowing how essential sleep is to health, how do we take a proactive wellness approach and change habits to get enough of the quality sleep time our bodies so desperately need? Sleep experts recommend gearing down toward sleep as part of a daily routine. Wake and go to bed at about the same time every day. Stop consumption of caffeine in early afternoon, and time eating so you won’t be too full or too empty at bedtime. Then turn down the lights— particularly blue light from electronic screens—about an hour before bedtime to give melatonin levels time to rise. Some studies have suggested that even one second of looking at a 100-watt bulb can stop melatonin production. “Creating an environment for sleep is important,” Amara said. “You need a dark, quiet, calm place your brain associates with sleep, so don’t work, watch TV or play games on your phone in bed. If you can’t sleep, get up. You don’t want to create an association with your bed and not sleeping. Get up and go somewhere else and do something that isn’t too stimulating. If you read, choose something a little boring and not a page turner. It also helps if the room is a couple of degrees on the cool side. As your body cools down, it helps you go into a sleep cycle.” Sleep has been called the third pillar of wellness, following nutrition and exercise. It might be more apt to think of it as the foundation of wellness, supporting the other healthy behaviors that make wellness possible. When considering the health goals we resolve to aim for this year, there are good reasons the sleeping well should be near the top of the list.

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Birmingham Medical News

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Holiday Season


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WELLNESS

Moving beyond Wellness to Well-Being By CINDY SANDERS

For healthcare providers, the traditional focus has been on physical health and wellness. With value-based models and an emphasis on holistic care, however, attention has increasingly turned to an individual’s overall well-being. For the past decade, Gallup and Sharecare have harnessed powerful information from more than 150,000 annual surveys – with a cumulative database now in excess of 2.5 million surveys – to capture individual perspectives on daily life and assess the state of well-being in America. The “2017 State Well-Being Rankings,” released in 2018, showed last year was a challenging year for Americans’ well-being. While Alabama moved up from a ranking of 44 in 2016 to 38 in 2017, Dan Witters, who is research director for the Gallup-Sharecare Well-Being Index, noted the jump was less about improvement in Alabama and more about declines in other states. Alabama’s index score dropped very slightly from 61 in 2016 to 60.8 last year. However, there were significant declines in well-being in 21 other states. “It was easily the worst year-over-year change at the state level we’ve had over 10 years,” Witters said of the 2017 rankings. As a nation, the overall index score dropped from 62.1 in 2016 to 61.5 in 2017. In the report, Sharecare CEO and Founder Jeff Arnold noted, “The stark difference in our country’s well-being today versus just a year ago underscores the need to understand, assess Jeff Arnold

and nurture the health of our populations comprehensively and continuously.” Witters noted, “Physical health is one of the five elements of well-being, but it goes well beyond that.” He said the other drivers of overall well-being are social, purpose, financial and community elements. “Social well-being is the love you have in your life,” said Witters, adding it’s the energy you derive from supportive relationships. “Purpose well-being is an (CONTINUED ON PAGE 19)

Added Insights And for more insights on population health, download the 2017 Diabetes State and Community Rankings, which was released Nov. 13, 2018. Alaska, Colorado and Montana – each considered ‘well-being elite’ states based on overall well-being trends and rankings –measured the lowest prevalence of diabetes in the nation with less than 9 percent of their adult population being diagnosed with the disease in 2016-17. Conversely, West Virginia, which came in last in the 2017 WellBeing Index, had the highest rates of diabetes with 17.9 percent of adult residents reporting a diabetes diagnosis in 2016-17. Seven other states – all located in the South – reported diabetes diagnoses of at least 14 percent. Those states were South Carolina, Mississippi, Kentucky, Louisiana, Arkansas, Tennessee, and Alabama. The full report is available for download at WellBeingIndex. Sharecare.com.

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DECEMBER 2018 • 13


2018 Alabama Health Care Year in Review By Howard Bogard

I have written this top ten list for years and each time I “try� to write an introduction that is funny or which contains a quote that is uplifting and appropriate for the current year. This time I have nothing. All I can think about is how divisive this country has become with protests and counter-protests, mass shootings and Twitter rants...but then something occurs to me. Physician practices may compete for patients and hospitals may try to outmaneuver competitors for market share, but at the end of the day it is all about the patients. That is what unites Alabama healthcare providers. I was reminded of this recently when working with a client facing very significant financial and operational issues. It would be easy (and maybe prudent) for the client to stop taking Medicaid patients, cut back on staff and essentially turn people away, but that was not the decision because patient care came first. I am reminded of this when I read about the citizens of Sumter and Chilton Counties who passed a sales tax to keep their rural hospitals open. I am reminded of this through the various efforts of UAB to “partner� with rural and small community hospitals in order to help them recruit physicians and to provide specialty, back-

up services. I am reminded of this through the efforts of nursing home providers throughout the state who have banded together to provide expanded and costeffective healthcare options for Medicaid long-term care recipients. So I guess I don’t need to say anything uplifting to describe this past year. The Alabama healthcare providers have already done that for me. Thank you! Now, onto the list. 10. HIPAA / Cybersecurity -Yes, everyone is tired of hearing about HIPAA, but it remains an important topic with increased enforcement actions in 2018. With essentially all protected health information stored electronically, and medical records having a high value on the black market, the healthcare industry is ripe for cyberattacks. This year, MD Anderson Cancer Center was required to pay $4.3 million in civil penalties for HIPAA violations related to the organization’s encryption policies. The violations include three data breaches in 2012 and 2013, which exposed health information of more than 33,500 people. In October, Anthem, Inc. agreed to pay $16 million in penalties after a series of cyberattacks led to the largest U.S. health data breach in history and exposed the health information of almost 79 million people. Ransomware attacks are also on the rise. When electronic protected health information is

encrypted as the result of a ransomware attack, a HIPAA breach has occurred. Unless the covered entity or business associate can demonstrate that there is a â€œâ€Ślow probability that the PHI has been compromised,â€? a breach report is required. 9. Alabama Data Breach Notification Act -- On March 28, 2018, Alabama adopted a data privacy law, the Alabama Data Breach Notification Act of 2018. The Act applies to any “person, sole proprietorship, partnership, government entity, corporation, nonprofit, trust, estate, cooperative association, or other business entityâ€? that acquires, has possession of, or uses sensitive personally identifying information. The stated objective of the Act is protecting the data of Alabama residents, and it defines a breach as the “unauthorized acquisition of data in electronic form containing sensitive personally identifying information.â€? Sensitive personally identifying information is defined to include an Alabama resident’s first name or initial and last name in combination with one or more pieces of information, including as examples, social security numbers, driver’s license numbers, banking account numbers, health insurance numbers, email address or physical addresses. 8. UAB Medical West Replacement Hospital -- Officials with UAB

announced that Medical West Hospital will relocate from Bessemer to McCalla to serve the residents of west Jefferson County. The replacement hospital will be built on land already purchased by UAB at Exit 1 off of Interstate 459 in McCalla. The City of Hoover was in discussions with UAB to relocate the hospital to Hoover and the Hoover Mayor proposed a $20 million incentive package, but the idea lacked support from the Hoover City Council. 7. Telemedicine -- The proposed 2019 Medicare Physician Fee Schedule published in July 2018 (the final Fee Schedule will be published in November after this article is written) contains several amendments designed to promote telehealth programs through improved reimbursement. Currently, Medicare telehealth reimbursement codes are limited in terms of qualifying providers, site and location. In the Fee Schedule, CMS proposes to cover asynchronous telemedicine (e.g., a recorded video and/or image captured by a patient is later evaluated by a clinician), which is a significant step in the promotion of telemedicine. If adopted, these codes will not require the use of interactive AV technology nor require a patient be located in a rural area or a specific qualifying originating site. (CONTINUED ON PAGE 18)

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Birmingham Medical News

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New Bill Advances Care for Adults with Complex Needs By Ann B. DeBellis

A new law enacted by Congress as part of the Bipartisan Budget Act of 2018 was created for the purpose of advancing care for adults with complex needs. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, passed and signed on February 9th, makes significant policy changes to advance the goals of integrated person-centered care for Medicare Advantage beneficiaries and for those who are dually eligible for Medicaid and Medicare. It also expands supplemental benefits to meet the needs of chronically ill Medicare Advantage enrollees. “The intent of the CHRONIC Care Act (CCA) is to better integrate care between Medicare and Medicaid,” says James Henry, an attorney with Cabaniss, Johnston, Gardner, Dumas & O’Neal in Birmingham. “It’s a movement to make health care and health insurance plans more tailored to individual patient needs instead of population statistics. We have talked about Attorney James patient-centered care F. Henry for a long time, but this is a law that can move us in that direction.” The CCA addresses three aspects of care for Medicare and dually eligible beneficiaries. One aspect encourages the use of flexible new tools to manage care for people with complex needs. Henry says it encourages home-centered care, particularly for people with multiple chronic conditions. The benefits include Telehealth use in certain circumstances and may cover house calls. It is part of what is called the Independence at Home demonstration. A demonstration is a temporary program put in place for evaluation by the Centers for Medicare and Medicaid Services. It also includes coverage for certain nonmedical benefits like grab bars, wheelchair ramps and other things that aren’t necessarily thought of as medical equipment. “That coverage is helpful because it allows people with chronic conditions to remain in their homes longer,” Henry says. “Formerly, in order to be covered, supplemental benefits had to prevent, cure or diminish an illness or injury. That standard has been changed. Supplemental benefits now can provide for things that have a reasonable expectation of improving or maintaining the health of a chronically ill patient.” Henry adds that the CCA also expands Telehealth services, currently a big movement to provide better access for

people in rural areas and for chronically ill patients. “Patients with conditions like kidney disease are susceptible to other sources of infection and could be compromised by sitting in a doctor’s office waiting room. Providing services via Telehealth could provide not only convenience for these people, but also better outcomes,” Henry says. A second part of the CCA protects and builds on key programs that serve individuals with complex care needs. The law permanently authorizes Medicare Advantage plans to create three Special Needs Plans (SNPs), one for those who are eligible for both Medicare and Medicaid; one for chronic, severe or disabling conditions, such as HIV-AIDS, end-stage renal disease or chronic and disabling mental illness; and a third for people who are in institutions. “Traditionally, Medicare plans have had to provide the same benefits for everyone within the plan, but under these SNPs, Medicare Advantage can create plans that are tailored more to individual patient needs,” Henry says. “It also extends and expands a demonstration where physicians serve high-need Medicare beneficiaries in their homes to avoid institutional care.” A third aspect of the CCA indicates that care coordination is an essential purpose of the SNPs. This law requires SNPs to integrate care by creating unified plans for dual eligible individuals as well as providing a single pathway for grievances and appeals. “Medicare and Medicaid each have their own coverage and appeal provisions. If beneficiaries are denied coverage for a service, they will no longer have two separate tracks to go down if they are eligible for Medicare and Medicaid,” Henry says. “This is part of an effort to coordinate care so it is less confusing and easier to navigate.” “I believe the new law will be wellreceived. This act has bipartisan support in Congress. I’m sure there is a lot to be learned in the implementation phases of these new programs. From what we know about the law so far, it seems to be a positive piece of legislation.”

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DECEMBER 2018 • 15


CMS Changes Durable Medical Equipment Regs by Jane

Ehrhardt

Starting January 1st, Medicare will put the competitive bidding program (CBP) on durable medical equipment on hiatus. For patients and businesses alike, this opens the door to easier access and a larger market in Birmingham for the sales and rentals of anything from nebulizers to prosthetics to home hospital beds. For the past eight years, Birmingham has been under the strictures of the CBP, which began with a test model in Clearwater, Florida in 2008. CMS was aiming to lower expenses as mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). They implemented a bidding process among companies to vie for the durable medical equipment (DME) market in that one city. “There were approximately 40 medical suppliers there, but after they began the bid process, it went down to three,” says David Mayes, RRT, respiratory therapist at AccuRX pharmacy and infusion center in Birmingham. David Mayes, RRT Any Medicare patient in the area who needed equipment,

from canes to oxygen, had to purchase from one of those three companies. “By instituting the competitive bid, the theory was to provide highvolume, low-margin business to a few providers to save money. It’s the Walmart philosophy,” says David Bush, RPh, nuclear pharmacist and founder of AccuRX. After several David Bush, RPh years, CMS deemed the test successful and, in 2011, expanded it to specific cities nationwide. In Alabama, Birmingham was deemed one of those areas, qualifying as a large enough Medicare market. Five providers were chosen for metroBirmingham. “It was all calculated based on the census,” Mayes says. “There could be a hundred providers in Huntsville, but in Birmingham, because we fell under competitive bid, there was only those five.” Things began to unravel years later when companies began denying patients or going out of business. “The model proved they could save money, but when it went national, the companies got these low, low reimbursements, and it drove them out of business,” Mayes says, explaining that the companies could not support the additional vehicles, staff, and ongoing

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Birmingham Medical News

the program, which they expect to last until December 31, 2020. “I don’t believe you’ll see a surge of new providers on January 1st,” Mayes says. “The ones still providing to patients of private insurers, like Blue Cross, will likely come back to the Medicare market. So from the five we now have in business from competitive bids, we’ll see maybe five more come back.” Because the reimbursements will remain at the competitive bid rates, Birmingham’s MDE market may never regain the provider numbers from ten years ago. “But I think we’re going to see some strategic moves in the market as far as specialty providers in critical care, like for oxygen, where the reimbursement is significantly more,” Mayes says. “New patients won’t notice any difference, but existing patients will see that their physician can now offer them a choice,” Bush says. “It will never be like it was before, though, because with the reimbursements chopped, no provider will likely ever deliver things on the same day.” However, both physicians and patients may once again find that MDE providers will be supplying clinical expertise, through nurses, therapists and pharmacists, and will follow-up, even on something as simple as a nebulizer. “Many times under competitive bidding, the patient had to go and pick up the nebulizer and the medication at a different location,” Bush says. “Now one place can provide the machine and the medication, instruct the patient on its use, and follow up with them to keep that patient out of the ER. I think the healthcare in Birmingham will increase tenfold.”

UAB Comprehensive Cancer Center, continued from page 5

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overhead needed to serve the larger patient base. Some pulled back on their services and others went bankrupt, leaving patients stranded. The solution was not as simple as switching companies. If a piece of medical equipment was close to the end of its lease, other companies would refuse the patient, because Medicare only pays the rental fee on equipment for a certain length of time. “After that, CMS considers the equipment paid for,” Mayes says. “If a new provider picked up that patient late in the lease, they would get little or no reimbursement. “It became an absolute mess. Thankfully the problem wasn’t as bad in Birmingham as in some other parts of the country.” The other downfall of the program centered around a lack of service with the equipment. The DME companies scaled down to the bare bones, alleviating nurses and respiratory therapists. “So now there was no true clinic followup, and patients went without, and doctors didn’t have clinical eyes within the home,” Mayes says. “That is where it really started to turn.” Patients ended up back in the emergency room. “CMS may have saved money on durable medical equipment, but it increased their costs on readmission and hospital fees,” Bush says. The result was a return to the open market. “CMS announced that in January 2019, it was going to open back up the normal standards of the market, so anybody who has a Medicare number can now accept Medicare patients,” Mayes says. Since it’s mandated as part of federal law, CMS is calling it a temporary gap in

higher cervical cancer rates and are more likely to die from the disease than Caucasian women. To help find ways to increase women’s participation in cervical cancer screening, the UAB Comprehensive Cancer Center is leading a randomized trial in the Mississippi Delta, funded by the American Cancer Society, that offers the option of self-collection for women who have not been screened for cervical cancer for four or more years. “This new technology allows women to collect their own sample for HPV testing at home. They don’t have to have a pelvic exam, they just collect the sample on a paper card and smear it. It changes colors and they put it in an envelope,” Scarinci says. “The sample is numbered so the person is not identified.” The goal of the study is to test whether un-screened or under-screened African American women who are given a choice between self-sampling and having a Pap test at the local health department are more likely to engage in cervical cancer screening than women who are given only the option of going to the local health department for a Pap test. Investigators at the UAB Comprehen-

sive Cancer Center aren’t limiting their work to our home turf. They have started an initiative called Globalization and Cancer. No other cancer center in the United States has taken that approach. “The word globalization is used on purpose,” Scarinci says. “We are not going to other countries just to help them. We learn from them. We bring back lessons learned to our underserved populations here. Of course, we bring our experiences to those countries as well. It is a two-way street.” For their first study in Brazil, the UAB group worked with Brazilian Community Health Workers on the self-collection issue. “Adherence to self-collection for HPV testing in Brazil was 100 percent,” Scarinci says. “As a result of working with them, we can use what we have done there in our Mississippi Delta initiative.” Scarinci says that the UAB Comprehensive Cancer Center is putting Birmingham on the map with its innovative approach to cancer control. “It’s how we work locally, and it takes a village to do it,” she says. “Social mobilization requires physicians, parents, and civic organizations to deliver a consistent message, so it’s not just in the hands of the cancer center anymore. It’s in the hands of everyone.”


The Literary Examiner BY TERRI SCHLICHENMEYER

The Mystery of the Exploding Teeth and Other Curiosities from the History of Medicine By Thomas Morris c.2018, Dutton; $26.00; 353 pages Grandma knows best. For every sore throat, broken bone, and cough, she had a remedy. It might not have been pure medical science, but she swore by it. It might have tasted terrible and worked only half the time, but it could’ve been worse, as you’ll see in The Mystery of the Exploding Teeth by Thomas Morris. Not long ago, in a library far away, Thomas Morris was doing research on heart disease and found something much more interesting: old medical journals from the days when doctors believed that leeches and laxatives were perfect cures for what ailed their patients. Morris was fascinated and could not stop reading. The entries he found were horrifying but also intriguing. Here, he presents the best of the worst, starting at the bottom, literally, with items that were delicately removed from places they never should have been. That includes cutlery which, if you’ve ever be-

lieved that eighteenth-century folks were stuffy, will make you re-think your stance. In many cases, diseases that we’ve conquered or can easily treat today were perceived as complete unknowns two centuries ago. Life was harder then. There was no anesthesia for any kind of surgery, kidney stones were far more prevalent, childbirth was a dicey thing, and being healthy depended on a balance of humors, which has nothing to do with laughter. Even so, some “cures” are downright hilarious, given what we know now. In the late 1700s, for example, the acid from a crow’s stomach was used in ointment to relieve pain. Pigeon butts were popular in nineteenth-century pediatrics. Arsenic and mercury were common medicines and were often smoked. And if you had a tapeworm, no problem: there’s a trap for that. And yet – we survived, as a species. People lost limbs and lived. They had things driven into their skulls, and walked

away. They got really, really bad advice and didn’t die. And, sometimes, you have to wonder how. The first thing you’ll need to know when you find The Mystery of the Exploding Teeth is that it’s not a mystery in the sense that you’re used to. No, author Thomas Morris tells, up-front, about every crushed limb, every dynamite burp and pigeon butt in wince-worthy, laughable detail. But even though these things are humorous from today’s vantage point, Morris pokes fun in a respectful manner that isn’t mean-spirited. It’s more on the playful side, pulling old medical reports from the dust, explaining where needed, and cringing along with readers. Even bet-

ter, these accounts go beyond the usual leeches-and-mercury tales. Instead, most of what Morris presents hasn’t had a good exam in decades. Despite their age – and many are 200plus years old – these articles seem fresh. While Morris says that this book consists mostly of stories written by doctors, for doctors, there’s certainly no reason why it can’t be enjoyed by anyone who has interest in medicine, history, or humor. Even Grandma would agree: if boredom is what ails you, The Mystery of the Exploding Teeth is an excellent remedy. Terri Schlichenmeyer is a professional book reviewer who has been reading since she was 3 years old and she never goes anywhere without a book.

Picture a world where underserved populations get the health care they need. At Wexford Health, we are always striving to achieve that world. As a leading provider of correctional care services, we understand the importance of proper medical and mental health treatment and how it can impact the health status of our patients. Making a difference in the lives of these patients is what our dedicated employees do every day. And you can do the same. We are now offering fulfilling opportunities for physicians and nurse practitioners across the State of Alabama. If you chose medicine because you want to help people change for the better, join our Wexford Health team today and grow with an industry leader where we are raising the standard of correctional medicine.

Khris Robinson, Physician Recruitment Consultant Phone: 205-605-7444 ext. 213 Email: khris.robinson@wexfordhealth.com jobs.wexfordhealth.com

Raising the Standard of Correctional Health Care. Birmingham Medical News

DECEMBER 2018 • 17


2018 Alabama Health Care Year in Review, continued from page 14 6. Increased Claims of Sexual Harassment -- It should be no surprise that the healthcare industry is not immune to the #MeToo women’s movement. While recent data is limited, according to the news website FiveThirtyEight, during the 2016 fiscal year the federal Equal Employment Opportunity Commission (“EEOC”) received more than 27,000 complaints of sex-based discrimination. The industries involved were not recorded in about 60% of the cases, but of the industries recorded, health care topped the list with 14% of complaints. Anecdotally, in 2018 my firm has seen a marked increase in EEOC complaints filed by women across all segments of the healthcare industry.

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5. Democrats Take Control of Congress -- With Democrats in control of the House, any further attempts to repeal or replace the Affordable Care Act are over (at least for the next two years). Drug pricing legislation could be a source of bipartisan agreement between Democrats and Republicans, but the pharmaceutical lobby is strong and President Trump’s position on the issue is unclear. 4. Rural Hospital Closures -According to an August 2018 report from the National Rural Health Association, 87 rural hospitals have closed nationwide since 2010. In that same time period, at least five rural hospitals have closed in Alabama. The alarming facts are reflected in a two year old Alabama Hospital Association survey of hospital CEOs. Among the findings, 88 percent of rural hospitals did not receive enough patient care revenue to cover the cost of operations. The problem is multi-faceted, but two concerns dominate. First, Alabama’s rural hospitals receive among the lowest Medicaid reimbursement in the country. Second, the Governor has refused to expand Medicaid, which if adopted would provide a significant source of additional revenue for Alabama’s failing rural hospitals. (See item 2 below). 3. Alabama Integrated Care Network -- On September 12, 2018, CMS approved Alabama’s Integrated Care Network (“ICN”) program. The ICN offers additional care options for

Medicaid long-term care recipients who live in a nursing facility or receive services in their homes through Medicaid’s Elderly and Disabled waiver or the Alabama Community Transition waiver. The ICN contract was awarded to Alabama Select Network, LLC, which will receive a per member per month payment to administer the ICN. Alabama Select will provide enhanced case management, education and outreach services. This is a positive development for the state and is expected to provide significant benefits, both in the provision of healthcare and cost savings, for Alabama’s Medicaid population and program. 2. Alabama’s Continuing Failure to Expand Medicaid -- In the midterm elections, voters in three red states that overwhelmingly supported Donald Trump approved ballot initiatives to expand Medicaid under the Affordable Care Act. This brings the total to 36 states plus the District of Columbia that have expanded Medicaid coverage. Meanwhile, voters in Kansas, Wisconsin and Maine elected governors who favor Medicaid expansion. Estimates vary, but it is projected that 235,000 to 300,000 people in Alabama would gain access to Medicaid if Alabama were to accept federal funding to expand the program. In 2018, the federal government pays 94 percent of the cost of Medicaid expansion, and that will number drop to 90 percent by 2020. A 2012 UAB study estimated that Medicaid expansion

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cspire.com/business 18 • DECEMBER 2018

Birmingham Medical News

could generate $2.2 to $4.6 billion of new economic activity in the state annually and between $12 and $26 million in new tax revenue each year. 1. Opioid Crisis -- According to the CDC, Alabama has the highest rate of opioid prescribing in the country, with Alabama physicians writing 5.8 million prescriptions for opioids in 2015. (To put this in context, Alabama’s total 2018 population is estimated to be 4.89 million people.) In 2016, 741 overdose deaths were reported, representing a rate of 15.3 persons per 100,000. Recently, BlueCross BlueShield of Alabama, the largest insurer in the state, announced it will no longer cover the standard formulation of OxyContin in order to limit prescriptions for the opioid. Several states, including Alabama, have sued drug manufacturers seeking to hold them responsible for overselling painkillers. Recently, Florida sued Walgreens and CVS for failing to take precautions to stop illegal sales. Reports suggest that the fight against opioid abuse may be working, but there is a long way to go. May all of you have a happy and healthy 2019! Howard Bogard is a partner and officer with Burr Forman where he specialized in healthcare law.


Moving beyond Wellness, continued from page 13 important one,” continued the principal for Gallup. He added it’s about having the right vocation – which Witters said might be a job but could also entail being a student or stay-at-home parent or volunteer. “It means liking what you do every day. You’re doing things that come natural to you and that you naturally like,” he explained. “The fourth element is financial wellbeing. It’s less about wealth and more about how good a saver you are … how much debt you carry,” Witters pointed out. He added that money certainly isn’t irrelevant to financial well-being but noted it’s possible to have a high income and poor financial well-being. “People who live within their means and save for the future have high financial wellbeing,” he said. “We find plenty of those people even in lower income brackets.” Witters continued, “The last one is community well-being. It’s how proud you are of the place you live. It’s how safe you feel, and it’s how much you give back to it … impactful voluntarism.” These five elements of well-being, he noted, are what comprise the annual index. “Physical well-being is better than nothing at all, but holistic well-being – having high well-being across the categories – is better than physical wellness alone,” Witters stated. He added the extensive GallupSharecare database allows their researchers and analysts to follow trends over time

beginning with a baseline score and control for numerous factors including race, ethnicity, education, income level, age, and more. The findings are clear that those who have higher overall well-being fare better when it comes to disease burden. “Those high well-being people are much less likely to attain new onset disease burden than their lower well-being counterparts,” Witters pointed out. He added that even as they age, those with higher well-being have a slower rate of developing conditions with age-related risks including high blood pressure, heart disease and diabetes. “High well-being individuals are healthier at baseline and more likely to stay healthier,” he said in comparison to those who rank lower on the well-being scale. Interestingly, Witters noted the physical well-being portion of the latest rankings weren’t the real red flags. While obesity, diabetes, smoking and physical activity continue to be issues across the country, he said there were slight improvements in most of those areas and noted smoking rates have dropped to their lowest level. “The problem in 2017 versus 2016 was the emotional, mental and psychological aspects of well-being,” he said. Witters said, “Clinical diagnoses of depression went up over a point to the highest rate it’s ever been.” He added daily worry and stress were also up. “Well-being came down even as the

economy continued to improve,” he noted. Considering the impact on overall health and disease burden, what can physicians do to address overall well-being? Witters said there are several options providers should consider for both their patients and employees. “We actually have a survey instrument developed that’s quick and provides a well-being score,” he said. Practices and hospitals could make the survey, which only takes three to five minutes, part of the intake process with the resulting assessment being included in the patient’s file. “That can impact instructions on discharge,” Witters said, adding that knowing a patient has low social or financial well-being could prompt sharing information on transportation or medication assistance programs. “High well-being patients have a substantially lower probability of medical adherence failure and 30-day readmit rates,” he pointed out of the benefit of intervention for those with lower well-being. As employers and community leaders, he said physicians and healthcare executives could sponsor Blue Zones Projects® in their communities. National Geographic Fellow Dan Buettner discovered five longevity hotspots in the world – dubbed Blue Zones – where people enjoyed the longest, healthiest lives. His best-selling book that shared the common characteristics from those communities

has now morphed into a community model in conjunction with municipal governments, large employers, health insurers and providers to turn those lessons into action by making the healthy choice the easy choice. For more information on Blue Zones, go online to BlueZonesProject.com and BlueZones.com.

Well-Being Index Methodology The current Gallup-Sharecare WellBeing Index results were based on telephone interviews conducted from Jan. 2-Dec. 30, 2017 with a random sample of 160,498 adults (aged 18 and older) living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error for the Well-Being Index score is ±0.15 points at the 95 percent confidence level. The margin of sampling error for most states is about ±0.6 points (with slightly higher margins of error for the smallest population states including North Dakota, Hawaii, and Delaware). For more information, go online to WellBeingIndex.Sharecare.com.

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happy holiday and a healthy new year.

Thank you for all of your continued support and referrals. We are always here for you.

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GRAND ROUNDS

New 3D Mammography at DCH Regional and Northport Medical The latest in 3D Mammography is available at DCH Regional Medical Center and Northport Medical Center. Both hospitals are equipped with Genius™ 3D Mammography™ devices developed by Hologic. The technology is proven to increase the detection of breast cancers while decreasing the number of women who are asked to return for additional testing, according to Jim Smith, director of imaging services for the DCH Health System. In a conventional mammogram, two X-ray images are taken of the breast, from top-to-bottom and from angled side-to-side, while the breast is compressed between a clear plastic paddle and an imaging detector. The

problem is the compression may cause overlapping of breast tissue, which can hide abnormal tissue or make normal tissue appear abnormal. The new Genius 3D Mammogram exam provides a three-dimensional method of imaging that can reduce the tissue overlap effect. A Genius exam includes both 2D images and tomosynthesis scans. During the tomosynthesis portion of the exam, an X-ray arm sweeps in a slight arc over the breast, taking multiple images. Then a computer converts the images into a stack of thin layers, which allows the radiologist to review the breast tissue one layer at a time.

Ted Hosp Joins Blue Cross and Blue Shield of Alabama Ted Hosp has been named Executive Director of Blue Cross and Blue

Shield of Alabama Governmental Affairs division. Hosp comes to Blue Cross from Maynard, Cooper and Gale law, where he most recently Ted Hosp chaired the firm’s Governmental and Regulatory Affairs practice group. He is a graduate of Brown University and received his law degree from Fordham University. Hosp currently chairs the Alabama Access to Justice Commission, established by the Alabama Supreme Court in 2007. Additionally, he serves on the Alabama State Bar Committee on Volunteer Lawyers Programs and on the board of the Middle District of Alabama Federal Defender’s Program. Hosp has also served on the boards of the Bir-

is pleased to have Nurse Practitioners working with our Physicians.

They play a vital role as physician extenders in the care of our patients. We are grateful to have them as part of our team.

SKYE VISE, CRNP

JENNIFER COTHRON, CRNP

Skye joined our group in November. She previously practiced in a rural clinic setting. Her nursing career consisted of orthopedic and cardiac care. She will be working primarily with Dr. Russell Beaty assisting him in the care of his patients.

Prior to joining us in 2016, Jenn practiced in a long-term acute care setting. During her nursing career, she worked as a trauma flight nurse for 9 years and in cardiac intensive care for 6 years. Her passion is caring for ill patients, disease prevention, and patient/family education.

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Birmingham Medical News

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mingham Volunteer Lawyers Program and the Montgomery Bar Volunteer Lawyers Program.

Children’s of Alabama Maintains Level I Trauma Designation

Children’s of Alabama was re-designated as a Level 1 Trauma Center for the State of Alabama by the Alabama Department of Public Health. Children’s has held this designation continually since 2013. A Level 1 Trauma Center has resources to provide the highest level of surgical care for trauma patients. Children’s treats about 400 trauma patients per year and is one of just four trauma centers in Alabama with the highest level of designation. Others are UAB, South Alabama and Huntsville Hospital. The Children’s Trauma Services team provides specialized care to patients who meet established criteria for Trauma Team activation or patients referred to Children’s for pediatric trauma care. The Trauma Center at Children’s of Alabama also provides care ranging from initial assessment in the Trauma Room, the Emergency Department and/or one of the Critical Care Units through the Rehabilitation phase of inpatient care, and continuing through outpatient clinic follow-up.

Erwin Receives Distinguished Service Award Paul Erwin, MD, dean of the School of Public Health at UAB, has received the Doris Spain Award for Distinguished Service from the Tennessee Public Health Association. The award is especially meaningful to Erwin due to his relation- Paul Erwin, MD ship with Spain. “Doris Spain was my boss when I worked in the Tennessee Department of Health, and has been a mentor and friend,” Erwin said. “She has devoted her career to the valuable work of the Tennessee Public Health Association, creating one of the strongest state affiliates of the American Public Health Association across the country.” Erwin has been a member of TPHA since 1991 and served as president from 2016 to 2017. Before joining UAB as the dean of the School of Public Health, Erwin was a professor and the head of the University of Tennessee-Knoxville Department of Public Health, College of Education, Health and Human Sciences. Since his appointment at UAB, he has joined the Alabama Public Health Association.


GRAND ROUNDS

Campaign for UAB Surpasses One Billion Dollars The future of UAB is now one billion times brighter. Ten years after it kicked off a silent, $one billion fundraising effort and five years after publicly announcing The Campaign for UAB: Give Something, Change Everything — UAB has accomplished the ambitious fundraising goal. The university surpassed $one billion this month, reaching its goal of achieving the milestone by the end of 2018. The overwhelming support for the Campaign resulted in substantial funds for each of the campaign’s priorities — programmatic support, facilities, faculty, research and innovation, athletics, and student support — adding up to a total of $1,002,957,673 to date. “Five years ago, we began the public phase of The Campaign for UAB,” said Ray Watts, president of UAB. “In the five years that have followed, we have received overwhelming support from donors, alumni and friends. We can’t say ‘thank you’ enough.” Ray Watts More than 103,000 donors and alumni contributed to the campaign. All five years of the public phase of The Campaign for UAB set records for philanthropic donations, with more than $100 million given each year

since 2014. Campaign co-chairs Mike Warren, CEO of Children’s of Alabama and Johnny Johns, executive chairman of Protective Life, played a key role in sharing UAB’s story with potential donors. “Reaching this goal was possible because Mike Warren UAB is doing work about which people are passionate,” Johns said. “I have been privileged to meet with many donors who wanted to make a gift that would make a difference.” “As part of this Cam- Johnny Johns paign, UAB asked supporters what was important to them, what they wanted to change in the world, and the university was able to connect those individuals to the people and initiatives at UAB who could make that change happen,” Warren said. The Campaign for UAB has helped fuel achievements that mark some of the most significant in the university’s nearly 50 years of existence, including: • The first named school — the Collat School of Business — thanks to the longtime generosity of Charles Collat and his late wife, Patsy; the new home of that school opened in August. • The new Bill L. Harbert Institute

for Innovation and Entrepreneurship also opened in the new Collat School of Business this summer. • Record contributions to UAB athletics, with more than $50 million in support since 2015. • Three consecutive years of record enrollment. • The creation of novel academic programs to train tomorrow’s leaders in new fields. • 211 new endowed scholarships to attract talented students. • 33 new endowed chairs and 59 new endowed professorships to recruit world leaders in many disciplines. • Recognition as the Top Young University in the nation — and 10th globally — in The Times Higher Education World University Rankings. • Record research funding, which has led to the development of new technologies and therapies, along with commercialization of discoveries. • Patient care that is at the vanguard of precision medicine. • Construction of key new facilities and continued growth as one of the most vibrant, state-of-the-art campuses in the nation. UAB’s previous philanthropic campaign took place between 1999 and 2003 and exceeded its goal of $350 million, which at the time was the largest ever undertaken by an Alabama university. A recent study concluded that UAB

provides an economic impact of $7.15 billion in Alabama and supports more than 64,000 jobs in the state. With 23,000 employees, UAB is Alabama’s largest single employer. “We are a national leader among public urban research universities with academic medical centers because of the people who work and learn here every day, and because of our donors who have demonstrated their belief in our students, faculty and staff by giving so generously throughout this campaign,” Watts said. To learn more about The Campaign for UAB, follow its progress or give, visit uab.edu/campaign.

Susan Bria Named CNO of Shelby Baptist Susan Bria has been named Chief Nursing Officer (CNO) of Shelby Baptist Medical Center. Bria, who has over 30 years of nursing experience, has served as Interim CNO since May of this year while continuing her role as Director of Nursing at Shelby Susan Bria Baptist Medical Center, a position she held since 2013. Prior to her role as Director of Nursing, she served as Manager House Supervisor of Shelby Baptist Medical Center from 2011 to 2013 and Nurse Manager at Princeton Baptist Medical Center from 2005 to 2011.

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Birmingham Medical News

DECEMBER 2018 • 21


GRAND ROUNDS

Megan Drake Named COO of Shelby Baptist Medical Center Megan Drake has been named Chief Operating Officer of Shelby Baptist Medical Center. Drake began her career with Community Health System (CHS) in 2010 as an Administrative Specialist at Northwest Medical Center in Springdale, Arkansas. Margaret Turner, DO She held roles of increasing responsibility during her tenure with CHS before being named Acting Chief Operating Officer and later Assistant Chief Executive Officer of Cedar Park Regional Medical Center in Cedar Park, Texas. In 2015, Drake joined Tenet Healthcare as Market Chief Strategy Officer of Valley Baptist Health System in Harlingen and Brownsville, Texas, and most recently, she joined Prospect Medical Holdings in Los Angeles as Senior Vice President of Business Development of the West Region, based in San Antonio. “Meganhe has a proven track record in strategic development and business and financial acumen that will enable her to make an immediate impact as part of our leadership team,” said Daniel Listi, CEO, Shelby Baptist Medical Center.

James Hill, PhD Joins UAB World-Renowned Expert in Nutrition and Weight Management

James Hill, PhD, an internationally recognized expert in weight management, has been named chair of the UAB Department of Nutrition Sciences and director of the UAB Nutrition Obesity Research Center (NORC). Hill comes to UAB from the University James Hill, PhD of Colorado, where he was director of the Center for Human Nutrition at UC Health Sciences. He also served as director of the UC Anschutz Medical Campus NORC for more than two decades. As a researcher for more than 30 years, Hill has published more than 550 scientific articles and delivered lectures around the world. Hill says a strong nutrition department should do three things well. “Research is the foundation, so we will prioritize research because it provides a credibility that allows us to do everything else,” Hill said. “Education follows, and UAB’s nutrition education is already strong. And we will look at strengthening it so we can be seen as the place for nutrition education at all levels. Finally, we must conduct outreach — we need to take our research

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and education into the community to positively affect the people around Birmingham and beyond.” Hill takes over a UAB NORC that is home to 170 regular, affiliated and mentored member scientists; 37 postdoctoral trainees; and 15 pre-doctoral students. Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, there are only 11 NORC locations in the United States. “I’m thrilled we were able to bring in one of the pre-eminent experts on weight management to build on the success of our nutrition department’s programs,” said Harold Jones, PhD, dean of the UAB School of Health Professions. “Dr. Hill brings nearly 25 years of NORC experience, knowledge and ideas to UAB, and that is sure to propel our center to the next level of research, discoveries and solutions.” Hill is excited about leading UAB’s NORC because he sees it as a strong center that can become even greater. “My passion is helping people achieve lifestyles to prevent and manage chronic disease, and if a major medical center — like the UAB Health System — would engage in this lifestyle medicine area and show you can bring changes that are effective, that would really transform a medical center,” Hill said. “It is very ambitious, but I believe we can accomplish this at UAB. This is a tremendous opportunity to coalesce our resources and make UAB a destination that shows you can use lifestyle to prevent and manage chronic diseases.” From 2008 to 2010, Hill served as president of the American Society for Nutrition. He has also served as president of the North American Association for the Study of Obesity and as vice president of the International Association for the Study of Obesity. He was elected to the National Academy of Medicine in 2014. Hill is co-founder of the America on the Move program, a nonprofit fitness program that works with people to make small lifestyle changes — like adding 2,000 steps or eliminating 100 calories each day — in order to help them improve their health and manage their weight. In 1994, he co-founded the National Weight Control Registry, which today is the largest prospective investigation of long-term successful weightloss maintenance, tracking more than 10,000 people who have lost a significant amount of weight and kept it off for an extended amount of time.

Amy Beard Named CNO at Brookwood

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Birmingham Medical News

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Amy Beard has been named Chief Nursing Officer (CNO) of Brookwood Baptist Medical Center. Beard has served as Interim CNO at Brookwood Baptist since May of this year, and prior to that appointment, she served as the hospital’s Associate CNO. Amy Beard

A nurse executive with more than 22 years’ experience, Beard led the Brookwood Women’s team to achieve the first Joint Commission Perinatal Excellence Designation in the State of Alabama and sixth in the nation in 2015. In her work with Women’s Services, she held several roles of increasing responsibility, including Director, Vice President of Patient Care Services and Market Vice President. Among her many professional affiliations, Beard is recent past President of the Birmingham Region of Nurses Leaders; Board Member of the March of Dimes Central Alabama Division; a member of the Alabama Department of Public Health Women’s Advisory Steering Committee; and a former member of the Samford University Ida V. Mofett School of Nursing Advisory Board, among others.

EDITOR & PUBLISHER Steve Spencer VICE PRESIDENT OF OPERATIONS Jason Irvin CREATIVE DIRECTOR Susan Graham STAFF PHOTOGRAPHER April May CONTRIBUTING WRITERS Cara Clark, Ann DeBellis, Jane Ehrhardt, Laura Freeman, Cindy Sanders, Marty Slay GRAND ROUNDS CORRESPONDENT Frank Sinatra Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 • FAX 205.437.1193 Ad Sales: 205.978.5127 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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GRAND ROUNDS

Turner Joins St. Vincent’s Primary Care Margaret Turner, DO has joined the St. Vincent’s Primary Care network where she is practicing with Mayfair Internal Medicine in Homewood. Turner is an Internal Medicine physician with more than 15 years of experience. She has special interests in the Margaret Turner, DO treatment of hypertension and providing preventive medicine for her patients. Turner graduated with honors from the Texas College of Osteopathic Medicine and completed her residency at Caraway Methodist Medical Center.

Kenneth Sigman MD Joins Southeast Gastro Kenneth Sigman MD has joined Southeast Gastro. Sigman serves as the Chief of the Division of Gastroenterology at Grandview Medical Center where he performs Endoscopic Ultrasound, Endoscopic Retrograde Kenneth Sigman MD Cholangiopancreatography, Double Balloon Endoscopy, and endoscopic stent placement of the GI tract. A native of Ohio, Sigman attended Miami University for undergraduate education and obtained his medical de-

gree from Ohio State University. He also completed his medicine residency and Gastroenterology Fellowship at Ohio State University. He went on to practice in North Carolina before UAB recruited him to Birmingham to help build their Pancreatic-biliary program. Sigman has now practiced for 27 years in Birmingham where he has hosted multiple conferences with nationally recognized faculty in advanced endoscopy and is a frequent speaker at GI conferences as an expert in Biliary and Pancreatic endoscopy. Sigman is a member of the American Gastroenterology Association, the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, the American College of Physicians, the American Pancreatic Association, and is Vice President of the Alabama Gastroenterology Society.

Cassandra Frieson, DNP honored by UAH Cassandra Warner Frieson, DNP is the recipient of the 2018 University of Alabama Huntsville (UAH) Alumni of Achievement Award. Frieson has established an innovative nursing practice in Birmingham that is focused on fall prevention for geriatrics. Before opening Fall Injury Prevention and Rehabilitation Services in 2014, she worked as a Family Nurse Practitioner in Cullman. She was also employed as an adjunct faculty member in the UAH

Graduate Nursing Program. A professional speaker, Frieson has addressed local and international meetings concerning the care of older Cassandra adults. In addition, Frie- Friesonm DNP son is a member of the UAH College of Nursing Advisory Board. A prolific writer and editor, she also serves as editor-in-chief and editor for The Journal of Perioperative & Critical Intensive Care Nursing, Gerontology & Geriatrics: Research, and is a guest associate editor for Frontiers in Public Health.

BCBS Alabama Updates Opioid Management Strategy In a continued effort to help battle the opioid epidemic, Blue Cross and Blue Shield of Alabama is updating its opioid management strategy. Beginning January 1, 2019, the following changes to Blue Cross’ Opioid Management Strategy for commercial members will be implemented: • Roxybond, the new instant release oxycodone formulation that is considered abuse deterrent by the FDA, will be covered. • Lucemyra (lofexidine), the first non-opioid approved drug to treat the symptoms of opioid withdrawal, will be covered. • OxyContin, and its generic (oxy-

codone ER), will no longer be covered. Xtampza ER (oxycodone ER) will be available to all members at a non-preferred brand cost share. • Letters have been mailed to members receiving OxyContin or oxycodone ER notifying them of the change and recommending that they follow up with their doctor to discuss potential alternatives. Providers have also been notified with a list of covered alternatives. • Several alternatives will be covered at the lowest copay for members who need a long-acting opioid for around the clock pain management: Morphine ER, Tramadol ER, Fentanyl ER, and Methadone will be covered. Blue Cross will continue to adopt actionable policies that promote safe prescribing of opioid medication and appropriate access to treatment for opioid use disorder.

Princeton Baptist Doubles Cardiac MRI Throughput with New MRI Princeton Baptist Medical Center has added a new 1.5 magnetic resonance imaging (MRI) machine to its roster. In addition to standard features, this machine has a cardiac MRI package, which doubles Princeton’s cardiac MRI throughput and further enhances the hospital’s well-rounded portfolio as a leading cardiac care facility.

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EVERY CANCER PATIENT IS UNIQUE. AND AT OUR NEW CENTER, THEIR CARE WILL BE, TOO.

The Grandview Cancer Center is about to open its doors, bringing this community an important new resource for cancer care. A full range of care, from diagnosis through treatment and follow-up, will be available right here. Services will be provided by a team of cancer care specialists using advanced technology and cancer treatment options. Jennifer De Los Santos, M.D., is the Cancer Center Director. She is a renowned radiation oncologist whose research in breast FDQFHUWUHDWPHQWKDVJDLQHGLQWHUQDWLRQDODWWHQWLRQ6KHMRLQVPRUHWKDQERDUGFHUWLÀHGSK\VLFLDQVDQGDGHGLFDWHG staff who will provide our patients with personalized care. To learn more, visit GrandviewCancerCare.com.

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