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FOCUS TOPICS CARDIOLOGY

SERVING A 24 COUNTY AREA, INCLUDING BIRMINGHAM, HUNTSVILLE, MONTGOMERY & TUSCALOOSA

HEALTHCARE SPOTLIGHT PAGE 3

Jack Hasson, MD ON ROUNDS

Malpractice Premiums Trend Low A historic run of low medical malpractice premiums continues across the U.S., including in Alabama. “Of the companies that have rates filed in Alabama, I haven’t seen a change in rates in five to six years, but premiums include certain credits or adjustments that will vary by carrier” says Douglas Hughes ... 4

Local Cardiologists Evaluate Hypertension-Control Device in National Trial By ann B. deBeLLis

(CONTINUED ON PAGE 10)

A new device for use in children with early-onset scoliosis is decreasing the need for repeated surgical procedures to lengthen the spine as they grow. The Magnetic Expansion Control (MAGEC™) spinal bracing and distraction system involves fewer invasive surgeries and can reduce complications related to surgery ... 11 FOLLOW US

CARDIOLOGY

Uncontrolled hypertension is a dangerous condition that can lead to heart attack, stroke and even death. According to the Centers for Disease Control, more than 75 million Americans have high blood pressure and only half of them have the condition under control. Cardiologists in the Brookwood Baptist Health System are participating in a study to evaluate the safety and effectiveness of the ROX Coupler, a new device developed by ROX Medical that may help patients with uncontrolled hypertension. The CONTROL HTN-2 study is a multi-center, blinded trial that will include up to 30 study sites in the U.S. The first procedure was performed at Princ-

Magnetic Spinal Growth Rods Are ‘Magic’ for Young Patients

FEBRUARY 2018 / $5

Baptist Princeton has trained about 100 Chinese cardiologists over the past decade through its Chinese Physician Fellowship Training Program. Dr. Farrell Mendelsohn, second from right, is pictured with one of the training groups.

The Providers Role in the New Medicare ID Transition By Jane

ehrhardt

“The one thing doctors should be doing is making sure their patients have their address correct with Medicare,” says Phillip Allen, billing service manager with MediSYS. “The patient won’t get a new card if their address is not correct.” This simple reminder could diminish ongoing problems for providers in the massive transition underway to distribute new Medicare ID numbers. Since its inception in 1965, Medicare has used social security numbers to identify individuals. That will change this April. Due to a legislative mandate in MACRA (Medicare Access and CHIP Reauthorization Act) passed in 2015, a new randomly generated Medicare Beneficiary Identifier (MBI) will be assigned to all 58 million Medicare recipients.

“It is a big change,” Allen says. “MACRA requires that social security numbers be removed to protect beneficiaries from social security number theft, identity theft, and illegal use of benefits.” Which is why the gender and signature line will not be printed on the new Medicare cards either. The cards will start arriving in recipients’ mailboxes this April. Centers for Medicare and Medicaid (CMS) is shipping the cards out in phases based on geographical location over an entire year. “They are withholding details on purpose to guard against identity theft even in the transition,” Allen says. “They’re not specifying which regions they’re sending to on which dates.” The MBI replaces the Health Insurance Claim Number (HICN) (CONTINUED ON PAGE 16)

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Birmingham Medical News

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HEALTHCARE SPOTLIGHT

Always on the Move By Lori Quiller

Hasson has run 130 marathons.

April 13, 2013, is a day Americans will never forget. 40,000 runners from around the world gathered for the Boston Marathon. At 2:49 p.m., two bombs exploded about a mile away from the finish line nearly three hours after the winner crossed over. There were still more than 5,700 runners left in the race. Birmingham pulmonary specialist Jack Hasson, MD had yet to cross that finish line. “At first, I didn’t know there was anything wrong,” Hasson said. “You always hear ambulance sirens during a race, and you get used to it. I was coming over Heartbreak Hill when I heard more and more sirens. I didn’t have any idea what was going on until we were stopped about a mile away from the finish line where they told us about the bombing. That was a horrible feeling. My brain wanted to slip into doctor-mode, but there was nothing I could do to help.” Hasson first began running the Boston Marathon in the late 1970s when participants numbered around 5,000. In those days, his wife would meet him at the finish line. But on this particular day, he was relieved that she wasn’t waiting

for him. “My wife was safe back at the hotel, thank goodness,” Hasson said. In the 5,000-runner days, she could find him at the finish line, but now with 40,000 runners, it was best to wait elsewhere. With the sun setting and no cell service, Hasson had to navigate his way through the chaos of a city under siege to find his way back to his hotel and his wife. It was a long 45 minutes. “Considering where they placed the bombs on the route, it is a miracle that more people weren’t killed or injured,” he said. “It could have been much worse, and I consider myself very lucky not to have been any closer. “These days, we live with the threat of mass shootings, but you can’t allow these things to affect how you live. You can’t stop doing what you enjoy.” After participating in 130 marathons in his life, Hasson has shortened routes. He now runs about nine half-marathons each year. And running isn’t his only outside activity. He became interested in art as a teenager, but he didn’t practice it regularly. He took formal lessons for the first time when he was stationed with the Air Force in Warner Robins, Georgia. What

began as a once-a-week class eventually turned into a passion of putting brush to canvas. “About 15 years ago I decided if I was ever really going to do this, I had better get started,” Hasson said. “So I started taking lessons at the Birmingham Museum of Art. I took drawing lessons first, working with live models, which helped me learn to look at something with a different light. You learn to break things down. Green is not green on a tree, but yellows, reds, browns. You get more perceptive of colors, light and dark, shadows. I look at a scene completely different now than I ever used to.” As motivation to continue painting, Hasson joined the Watercolor Society of Alabama, which has given him the opportunity to exhibit his work, and he is now a Bronze Signature Member. “Now I have motivation to continue to improve because I get to exhibit with real artists,” he said. “I enter my work into these exhibits now. I take photos in different angles and light — something I’d want to paint later. Being able to take photos and paint has given me a fresh look on the things in front of me. The challenge is to be able to capture it again.”

CONFERENCE AGENDA – Saturday, March 17, 2018

www.urologycentersalabama.com

7:00 – 7:50

Registration, Breakfast, visit Vendors

7:50 – 8:00

Welcome: Taylor Bragg, MD

8:00 – 8:05

CME Objectives/Business: Brian Christine, MD

8:05 – 8:35

Toto, we’re not in Kansas anymore: New, Cutting Edge Minimally Invasive Therapies • Rezum – Mell Duggan, MD • Bladder Botox – Paula Rookis. MD • Tibial Nerve Stimulation – Mark DeGuenther, MD

8:35 – 9:35

How did I get here, and how do I get home… A Patient’s Journey Through UCA’s Comprehensive Prostate Cancer Center: Brian Larson, MD, Joelle Hamilton, MD, Bryant Poole, MD, Scott Tully, MD and Ashley Martin, C-PA

9:35 – 9:55

Break, visit Vendors

9:55 – 10:25

Panel I: WHAT…Urologists Treat Women?!? Paula Rookis, MD, Nicole Massie, MD, and Rupa Kitchens, MD

10:25 – 10:55 It’s a bird… it’s a plane… it’s Superman? Nope, Just a Guy on Testosterone: UCA’s Men’s Hormone Replacement Clinic – Eric Westerlund, CRNP

Urology Fundamentals: There’s more to Urology than just Catheters! March 17, 2018

Grand Bohemian Hotel Mountain Brook Birmingham, Alabama

10:55 – 11:25 My sperm counts have fallen, and they can’t get up! Male Infertility 2018 – Austin Lutz, MD 11:25 – 12:10 Lunch 12:10 – 12:40 Checkpoint Inhibitors aren’t just for border crossings Fighting cancers with immunotherapy. – Joelle Hamilton, MD 12:40 – 1:10

Panel II: Ask the Urologist : Eddie Bugg, MD, Michael Bivins, MD, and Tyler Poston, MD

1:10 – 1:40

Angels of Mercy: The UCA Erectile Dysfunction Clinic and What REAL Expertise Can Do For Your Patients. Laura Anderson, RN, Stayce Pilkington, RN and Erynn Lord, RN

1:40 – 2:00

Break, visit Vendors

2:00 – 4:00

ProAssurance Seminar

4:00 – 4:15

Wrap Up: Taylor Bragg, MD

* 2 additional hours of CME will be offered by ProAssurance *

The Medical Foundation of Alabama designates this live activity for a maximum of 4.50 AMA PRA Category 1 Credit(s)TM.

To complete your registration online go to: https://urologycentersofalabamacme2018.eventbrite.com

Proassurance Indemnity designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

ProAssurance Indemnity is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Birmingham Medical News

FEBRUARY 2018 • 3


Malpractice Premiums Trend Low By Jane Ehrhardt

respectively, while Florida, Georgia, and South Carolina increased by around one percent. Only the Northeast showed inA historic run of low medical malcreased average rates. practice premiums continues across the Industry experts point to multiple U.S., including in Alabama. “Of the changes in the healthcompanies that have care field for the onrates filed in Alabama, going trend. Hospital I haven’t seen a change systems and large in rates in five to six group practices now years, but premiums tend to self-insure, include certain credits which pressures caror adjustments that will riers to reduce their vary by carrier” says rates to compete for a Douglas Hughes, JD, shrinking pool of inand COO of Inspirien, dependent physicians, a medical professional cushioned by their liability company covample cash reserves. ering Alabama. Hospitals seekAccording to the ing coverage through 2017 Medical Liability liability companies Monitor (MLM) Annual have also raised their Rate Survey, the medical Douglas Hughes, JD deductibles to garner malpractice insurance lower rates. It is no industry’s collective longer uncommon for a hospital or large mature, base-rate premiums fell nationally practice to buy a $1,000,000 per claim by an overall average of 1.1 percent from coverage policy with a $ $100,000 or the previous year. There was little differ250,000 deductible. “We have we seen ence among the three medical specialties movement in that direction across the surveyed. Premiums decreased one percent board. I’ve seen the deductibles go to for obstetricians/gynecologists and general $750,000 per claim,” Hughes says, addsurgeons and 1.1 percent for internists. ing that more hospitals are selecting the Geographically, the survey revealed quarter-million-dollar option. “We didn’t some slight variance. In the south, Texas see that ten years ago. Then, they purand Virginia reported the greatest dechased first dollar coverage.” clines of three percent and 3.6 percent,

The large, six-figure deductibles partially stem from fewer claims. “Hospitals have worked hard on risk management and quality of care, and you do get a spillover effect of fewer claims,” Hughes says. “That gives hospitals a higher degree of confidence that they are going to have fewer problems.” That translates into feeling comfortable with the risk of higher deductibles in order to pay less to a carrier. Data reported by Becker’s Hospital Review using National Practitioner Data Bank information on 2015 claims, found Alabama ranked 10th for highest number of malpractice claims per 100,000 residents with a notable decrease of 56 percent from the year before. “We have seen a decrease in claims, but not this year,” Hughes says, referring to 2017. For the two prior years, claims dropped around 10 percent, but the projections point to a rise of five to seven percent for 2017. However, the lower number of malpractice claims across the U.S. has not necessarily been reflected in lower payouts. “Claims have been at a low frequency for several years, but when a claim makes it through the process of a trial and there is a plaintiff’s verdict, the verdicts have been more severe.” According to the MLM survey, 14 percent of medical malpractice insurers surveyed reported an increase in claims topping $1,000,000. That higher payout could take its toll on premiums. “Many

of us deal with Lloyd syndicates for excess coverage at various levels,” Hughes says. “Large verdicts or settlements paid at those higher levels puts pressure on those carriers, and they will tighten their pricing. That increase is going to start working its way down.” Physicians and hospitals will have to wait to see the impact of that trickle down. “Overall, it may flatten out,” Hughes says. “But sooner or later, the severity of the jury awards — even if the frequency stays down — is going to drive prices up.” The immediate future of malpractice premiums looks to remain static. “We’re all still going to be here,” Hughes says. But physicians and hospitals could be making different choices. “Those who practice really good medicine may hang on to more of their earnings and take the risk of higher deductibles.” With the continuing trend of fewer claims, physicians and hospitals will re-analyze their insurance numbers. They may choose to pay a lower premium, investing those savings to cover the higher deductible. Then in 25 years, at the end of their careers, they have what would have been spent on insurance payments in their own bank account instead. “With the squeeze on reimbursements and the increase in quality care, physicians and hospitals are willing to assume a higher level of their own risk because of their confidence level in how they deliver care.”

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Birmingham Medical News


CARDIOLOGY

Big Promise in a Small Patch By Ann B. DeBellis

physician receives a concise and comprehensive report from iRhythm analyzing A small wireless device every heart beat and the pathat detects abnormal and tient’s diagnosis. potentially dangerous heart The Zio has no leads, no arrhythmias may replace batteries, and it weighs just a the Holter monitor as the few ounces for a comfortable preferred method for trackand unobtrusive patient expeing electrical heart activity rience. A survey found that 81 in ambulatory patients. The percent of study participants Food and Drug Administrapreferred wearing the Zio tion-approved ZIO patch is patch over the Holter monicompact, low-profile and wator, and 76 percent said the ter-resistant. It can be worn Holter monitor affected their throughout normal activities. daily living activities. Cardiac arrhythmias are Sanjeev S. Hasabnis, common, but diagnosis can DO, FACC, FHRS, of Carbe difficult because the ocdiovascular Associates in currences can be sparse and Birmingham was the first fleeting. A variety of clinical physician in Alabama to use studies have demonstrated the patch. “Zio by iRhythm is that the ZIO patch is better an ambulatory cardiac moniat diagnosing arrhythmias toring device that is similar to than the Holter monitor. It being on a hospital cardiac is preferred by patients and Dr. Sanjeev S. Hasabnis was the first physician in Alabama to use the Zio patch for electrical heart monitoring. monitor, but it works continmay be paving a new way for uously while the patient goes ambulatory heart monitoring. about daily activities. The beauty of this Since the 1960s, the gold standard for The Zio cardiac monitor by iRhythm device is that it provides complete monithese diagnoses has been the Holter moniis essentially a 2 × 5-inch stick-on patch toring with no interruption. There are no tor, an ECG-type device with five to seven with an electronic monitor embedded in gaps which helps the diagnostic accuracy,” leads connected to a central processing unit it. When finished with the prescribed three Hasabnis says. that continuously records electrical cardiac to 14 day wear period, during which every One problem with the Holter moniactivity to help diagnose abnormalities heart beat is recorded, the patient simply tor is the electrodes can come loose over an extended period of time. Patients drops the device in a pre-paid envelope to which causes inaccurate recording. “That are asked to wear the Holter monitor for return by mail for analysis, avoiding the doesn’t happen with the Zio patch,” Has24 to 48 hours which can be an annoyance need for a return visit to the doctor’s ofabnis says. “We can also tailor the Zio debecause of its bulk and wires. fice. Within a few days, the prescribing

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vice monitoring period to each patient for anywhere from three to 14 days.” The Zio device has no therapeutic capability. “Its primary goal is continuous cardiac rhythm monitoring and comprehensive rhythm analysis,” Hasabnis says. “It is purely a diagnostic tool that can tell us if a patient needs a pacemaker or an ablation. It also can tell us if the patient needs a medication adjustment or blood thinning medicines.” Hasabnis says that Zio’s ease of use has led to better patient compliance. A nurse attaches the patch on the patient’s upper left chest area above the heart. “The small patch stays on continuously. The patient can shower, exercise and sleep in comfort. Another advantage of the ZIO patch is its absence of acrylic,” he says. “Many patients are allergic to acrylic, which can cause a skin rash.” A heart arrhythmia can result in serious conditions that can lead to heart failure and, subsequently, death.   The Zio patch is indicated for use on patients who may be asymptomatic or who may suffer from transient symptoms such as palpitations, shortness of breath, dizziness, lightheadedness, presyncope, syncope, fatigue, or anxiety. Because of the size of the patch, Hasabnis says the tracing of heart rhythms is much better with the ZIO patch. “Our diagnostic yield is higher, and we get better information. Early studies on this device have been favorable, and we are excited about the possibilities of this new technology.”

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Birmingham Medical News

FEBRUARY 2018 • 5


CARDIOLOGY

Genes And Cardiovascular Disease When Can Testing Be A Tool? Heart disease doesn’t play fair. Lifelong smokers who never exercise may live well into their 80s on fast food, while vegetarian joggers can die suddenly when their hearts give out. Advances in diagnosis, surgical and nonsurgical interventions, preventive medications and healthier lifestyles are saving thousands of lives that would have been lost only a few years ago. Yet a big part of the equation determining who dies of heart disease, who lives and how well is found in the genes we inherit at birth. Now that genomic testing is becoming more affordable, especially for genes in targeted segments associated with specific disorders, clinical practices need to know when it makes sense to look for heart disease in a patient’s genes. How soon will we be able to use genetic testing to detect individual heart health risks and choose the most effective approach to prevention

and treatment? “At this point in our understanding of genetics and heart disease, it all comes down to the potential for making a difference in management and outcome,” researcher and UAB assistant professor or cardiology Pankaj Arora, MD said. “What can genetic testing tell us beyond what we can learn from a family history, clinical examination and the diagnostic tools we already have?” The actionable information we can gather through testing differs with the type of heart disease. In some Pankaj Arora, MD cardiomyopathies and electrical disorders, one gene, if switched on, can have a large effect in determining whether a patient develops the disorder.

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Association studies have already identified genetic links in a number of these disorders. However, the disease processes that lead to most heart attacks come from the cumulative impact of many different combinations of genes with a small effect that can be switched on or off by epigenetic triggers like lifestyle, environment and illness. We haven’t learned enough yet to look at the many variables and reliably predict the risks for a patient. “In screening families with a history of sudden death at an early age, in clarifying the diagnosis for some causes of heart failure to plan the most effective course of treatment, and to identify which medication is likely to be effective in which patient, there are cases where genetic testing can be helpful,” Arora said. In families with a history of rhythm disturbances where a close relative has died suddenly at an early age or been diagnosed with an electrical disorder, screening others who may share the gene is a consideration. This could be particularly important in young people before they participate in high intensity sports or go into the military or another physically demanding or high stress career. Many of the causes of heart failure are idiopathic or difficult to determine. Screening for genes linked to specific types of heart failure may be helpful in choosing the most effective treatment and predicting the likely course of the disease as it progresses. “When a patient needs a blood thinner, a genetic test can tell us which medication should be most effective,” Aurora said. “What we are learning about genes and how they relate to heart disease is also

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Birmingham Medical News

helping us identify pathways and new research targets for medications that could prevent or slow the progression of the disease.” Arora’s current research focuses on natriuretic peptides (NPs), a hormone produced by the heart. “A deficiency in NP signaling seems to promote cardiometabolic disease,” he said. “This could be an important therapeutic target. Learning more about how the NP axis works could lead to medications that could modulate cardiometabolic risks.” How genetic polymorphisms and their variants contribute to the risk for heart disease has been a major target for research around the world. An accumulating body of data from some of these investigations is offering interesting insights that could be helpful as clinical practice moves more and more toward precision medicine. For example, APO E, or apolipoprotein E, which is a polymorphism that has been researched in relation to Alzheimer’s Disease, also seem to have strong links to coronary artery disease. Alleles 2, 3 and 4 show significant differences in how they interact with LDL, fats, sugars, alcohol and even different types of exercise. The most troubling links are to APO E 4/4, where the patient received copies of allele 4 from both parents. This combination is at extremely high risk for Alzheimer’s and high cholesterol that can be difficult to control. Someone with APO E 2/2 would have a low risk for Alzheimer’s, but possible difficulties in how lipids and sugars are handled. An APO E 4/4 patient and an APO E 2/2 patient could have opposite and even counterproductive responses to the standard advice of avoiding fats, exercising and having a glass of red wine. However, DNA is not destiny. A large study at Massachusetts General of people with a high genetic risk for heart disease found that a healthy lifestyle cut the risk of dying from heart disease in half over the next 10 years. Progress is also being made in gene therapies to edit variants that contribute to cardiomyopathies and in using stem cells to regrow damaged heart muscle. As research into the genetic underpinnings of cardiovascular disease makes rapid leaps forward, it is an exciting time full of hope for at last defeating America’s number one killer. A growing understanding of genes and how they work could soon give us the keys to preventing heart disease and helping the body heal itself. REPRINTS: If you would like to order a reprint of a Birmingham Medical News article in a PDF format or request an additional copy of an issue, please email: steve@birminghammedicalnews. com for information.


Birmingham Medical News

FEBRUARY 2018 • 7


CARDIOLOGY

Get with the Guidelines: Blood Pressure Edition ACC, AHA Redefine Hypertension By CINDY SANDERS

This past November, the American College of Cardiology and American Heart Association redefined the way clinicians and the public should think about ‘high’ blood pressure. After nearly three decades of decline, deaths from heart disease have been on the rise over the past couple of years. While there are multiple risk factors for cardiovascular disease, the good news is that a number of those risks are controllable, including decreasing blood pressure. Previously, stage 1 hypertension began at 140/90 mmHg. Now, patients with a blood pressure of 130/80 mmHg are considered to be hypertensive. Lowering the numbers has allowed clinicians to raise the warning flag sooner and institute lifestyle modifications and medication if warranted. “We’re getting aggressive in looking at how we define hypertension and making sure we’re not underselling blood pressure,” explained Walter Clair, MD, MPH, a nationally recognized expert in his field who leads Vanderbilt Heart in Nashville

and holds national and regional committee appointments with the American Heart Association. “We’ve all agreed for years that blood pressure is normal if it is less than 120 over Walter Clair, MD, 80,” he said. HowMPH ever, Clair continued, hypertension experts have anticipated the

guideline change for several years as the science has shown not only cause for increasing concern with a systolic number of 130 and diastolic measurement above 80 but also a benefit from treatment. “Even when we can show a correlation between bad outcomes and hypertension, we still have to show that treatment is going to make a difference,” he said. With the science in place, these new numbers are the first change in blood pressure guidelines since 2003.

Previously, patients with blood pressures between 120 and 139 systolic and/or a diastolic reading between 80-89 would have been classified as having ‘prehypertension.’ Now, anything greater than 120/80 is considered an elevated blood pressure. “It’s not ‘pre’ so we don’t say, ‘We’ll see you in a year,’” Clair said of the new trigger points. Instead, he continued, physicians should be intervening at that point and following up with patients more frequently to monitor improvement and sustainability. “Jumping all over it (hypertension) doesn’t mean you should necessarily start taking a drug for it,” he added in response to one concern some patients and physicians have voiced about the new guidelines. “But we begin to look more aggressively at cardiac risk factors … and you now have one, elevated blood pressure … so we should look at lifestyle, sodium intake, exercise, diet, smoking.” Realistically, Clair continued, lifestyle modification only achieves a decrease of about 11 millimeters of mercury so someone with a blood pressure of 160/90 probably won’t move the needle enough with lifestyle changes alone. However, he pointed out, those defined as having elevated blood pressure and stage 1 hypertension could quite likely get numbers back in the normal range without requiring medication. He was quick to add that doesn’t mean lifestyle modifications aren’t critical for everyone at any stage of hypertension. “Many people think because they are taking these blood pressure medications and controlling their blood pressure, they don’t have to give up that frequent flyer card to McDonald’s … yes, you do,” he stated. “You still have to do all of the other cardiovascular risk modification steps to get the full benefit. We continue to work to get that message out.” In addition to lowering the definition of high blood pressure, Clair said the new guidelines also reemphasized the correct way to take a blood pressure reading – making sure the person is seated correctly, using the proper cuff size, waiting a few minutes after the patient arrives in an exam room. “We kind of got a little lazy about checking blood pressure over the last few years,” he said. Technology, he added, can also be an important tool for getting an accurate read on blood pressure – particularly among a couple of specific groups. Mobile technology, Clair noted, eliminates ‘white coat (CONTINUED ON PAGE 10)

8 • FEBRUARY 2018

Birmingham Medical News


CARDIOLOGY

Radial Caths and Stents By Laura Freeman

“The advantages were clear. When we saw one of our Heart South cardiologists using radial access for caths and stents, we all wanted to learn. Now we do 70 to 75 percent of our caths and stents using the radial approach,” Clifton Vance, MD, of Hearth South said. “The risks for bleeding and other complications are lower, and it saves our patients a lot of discomfort, especially people who have back pain and find it difficult to lie flat for an extended period. With the radial approach, they will soon be sitting up in bed. They will also likely be up walking and ready to go home sooner.” Radial access may also Clifton Vance, MD performs a radial cath. be easier for larger patient with deeper femoral arteries that are difficult to palpate. However, Vance said. “Some people may have poor there are some patients who may do better flow or an unusually twisted structure to with a traditional femoral approach. their arteries that might make threading “We always test blood flow to the the catheter difficult. We usually use the hand to make sure it is adequate so we right wrist since cath labs tend to be laid don’t risk compromising circulation,” out to work from the patient’s right, but

The catheter is inserted in the wrist.

we can access through the left if needed to get around a problem.” Training to use radial access is much like becoming adept in any other procedure, but there is a bit of a learning curve. “We use a different catheter, a different pathway and different medication to prevent artery spasms,” Vance said. “Most of all, it takes a different muscle memory, like learning to tie your shoes, which becomes automatic with practice. Once you have become proficient, the radial approach is

as fast or faster than the femoral approach. The improvement in patient comfort and satisfaction make it a technique that is well worth learning.” Radial access can be used in scheduled procedures or emergencies for diagnostics or to place stents opening up blood flow in and near the heart. Femoral access is still the preferred route for ablations and some of the more complex percutaneous procedures. Heart South cardiologists perform cath and stent procedures at Shelby Baptist Medical Center and prefer to use a radial approach whenever possible. “Radial access has been growing in popularity over the past six or seven years, but unfortunately, it is only being used about 20 percentage of the time in some areas. I’m looking forward to this option being available to everyone who is a good candidate for a radial approach,” Vance said. Response from Heart South patients has been very positive. “A few have heard of going through the wrist for a cath or stent and they specifically ask for this approach, but for many it’s a new idea,” Vance said. “When we explain it, they are usually just glad to hear that they won’t have to be uncomfortable for hours laying on their backs. Our patients who have had these procedures before are especially pleased.”

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FEBRUARY 2018 • 9


Local Cardiologists Evaluate Hypertension-Control Device, continued from page 1 eton Baptist Medical Center in Birmingham by interventional cardiologist Farrell O. Mendelsohn, MD, a physician partner at Cardiology, P.C. “Our entire research team at Cardiology, P.C. is excited about implementing this research study for our patients. The ROX Coupler technology may offer an alternative option to treat the global problem of uncontrolled hypertension,” says Mendelsohn, the principal investigator for the research protocol. Physicians at Cardiovascular Associates (CVA) are also participating in the study. Gary S. Roubin, MD, FACC, Medical Director and an interventional cardiologist at CVA, says he and his associates are excited to be a part of evaluating this new technology. “This is a Food and Drug Administration (FDA) randomized trial, and our patients have the choice of two convenient hospitals in the area and the potential to receive benefits from this trial,” he says.

For the study, half of the participants will receive the ROX Coupler device and the other half will have a procedure to measure important hemodynamics but will not receive the device. “The procedure to insert the ROX coupler is simple and quick and has proven to be safe in the hands of qualified interventional cardiologists,” Roubin says. “Patients will be monitored for six to 12 months, and they will not know whether they received the device. Neither will the physicians who are monitoring their blood pressure, so there will be no bias.” Roubin adds that while the trial participants in the control group won’t have the device, they will receive the most expert care for their blood pressure. “Should the trial prove to be effective and the device receives FDA approval, the control group members will be given the option of receiving the device at that time,” he says. Mendelsohn says the procedure is a novel approach to controlling high blood

pressure. “The procedure involves going into both the iliac artery and vein, which run side by side like a railroad track. In the artery, there is a corkscrew-type wire that serves as a target. We then enter the vein and direct a needle from inside the vein into the artery directed at the target wire,” he says. “Once we’ve gone from the vein to the artery with the needle, we pass the wire through the needle so that a wire serves as a track from the vein into the artery. Once the wire is in position between the vein and artery, we insert the ROX Coupler delivery system into the vein and pass it through into the artery. That creates an arterio-venous anastomosis or passageway.” Mendelsohn likens the shape of the coupler to that of an hour glass. “We position the hour glass-shaped metallic device partly in the arterial side and partly in the venous side. Then we go back in with a four- millimeter angioplasty balloon and open up the middle part of the hourglass

device, which allows high-pressured blood from the iliac artery to go into the lower pressured iliac vein. The procedure takes less than an hour and is performed under local anesthesia.” Both Roubin and Mendelsohn encourage physicians to talk with their hypertensive patients who might be candidates to participate in the trial. Principal investigators in the Brookwood Baptist Health System include: • Cardiology P.C at Princeton Baptist Medical Center (205) 7804330 Dr. Alain Bouchard – Principal Investigator, Hypertension Management Dr. Farrell O. Mendelsohn – Principal Investigator, Interventional Cardiology • Cardiovascular Associates at Brookwood Baptist Medical Center (205) 510-5000 Dr. Andy Miller – Principal Investigator, Hypertension Management Dr. Gary Roubin – Principal Investigator, Interventional Cardiology “This is a fundamental paradigm shift that, I think, can greatly improve the quality of life for patients with difficult-tocontrol blood pressure. We’ve seen that already in the people we have treated,” Mendelsohn says. “We can offer patients with uncontrolled hypertension something that can drop their blood pressures quickly and significantly. We believe this procedure will improve clinical outcomes dramatically.”

Get with the Guidelines, continued from page 8

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hypertension,’ where patients experience a jump in blood pressure simply by being in a medical setting. “We now have the capability to actually look at people’s blood pressure at home to see if they are really normal or not,” he said. “The other group is people who are suspected of having high blood pressure,” Clair continued. “Those people … believe it or not … actually have blood pressures that look pretty good, but it’s labile.” While they test normal at the physician’s office, they actually have elevated numbers at home or work. “We have these two extremes of people – those who might be over-diagnosed and those who might be missed.” The rising death rates underscore just how important it is to properly identify those at increased risk of heart disease. Additionally, Clair said, “We are worried the increase in childhood obesity is a precursor of another surge in cardiovascular disease.” He continued, “For many years in cardiology, we have been striving to be the #2 killer … it’s a credit to our colleagues in oncology that cardiac disease and stroke remain #1 killers of both men and women in the U.S.” Noting that being the leading cause of death isn’t a designation anyone wants, Clair said more aggressively monitoring and treating elevated blood pressure is one important step toward improving heart health.


Magnetic Spinal Growth Rods Are ‘Magic’ for Young Patients By Ann B. DeBellis

A new device for use in children with early-onset scoliosis is decreasing the need for repeated surgical procedures to lengthen the spine as they grow. The Magnetic Expansion Control (MAGEC™) spinal bracing and distraction system involves fewer invasive surgeries and can reduce complications related to surgery. “This treatment is more specific for children age two and older with early onset scoliosis who have a lot of spine growth left and have a curve that can’t be managed well with a brace,â€? says Shawn Gilbert, MD, Chief of the Orthopedic Division at Children’s of Alabama. “If it can be managed with a brace, we want to wait and keep them braced and do spinal fusion surgery closer to the end of their growth because that is a definitive surgery. The MAGEC™ system is a way to keep the curve from getting bigger while driving continued growth.â€? Early-onset scoliosis is a rare condition in children that is defined by a curvature of the spine greater than 10 degrees with onset before 10 years of age. Young children with this condition are at risk for impaired pulmonary function because progressive spine deformity can restrict chest and lung development during criti-

Dr. Shawn Gilbert performs the in-office MAGEC™ procedure on one of his young patients.

cal growth stages. Physicians want to maximize growth of the spine and thorax by controlling the spinal deformity while promoting normal lung development and pulmonary function. “Chest growth is partially dependent on spine growth, and ribs often are affected by the curvature,� Gilbert says. “We are concerned that the chest gets taller and wider so the child has adequate growth of the lungs and breathing continues to be good.�

Prior to the MAGEC™ system, children with curves that continually increased despite bracing would have rods implanted to help maintain spinal alignment. Periodic adjustment of the rods to account for growth would need to be done two to three times per year. Often, a child might undergo as many as 20 spinal surgeries during growth before a definitive spinal fusion could be done around the age of 10 or 12. Each surgery required

general anesthesia and more incisions. A main benefit of the MAGEC™ system is avoidance of repeat surgeries which reduces anesthetic and operative and postoperative risks, including infection. The MAGEC™ system is comprised of two magnetic titanium telescoping growth rods and an external remote control for non-invasive lengthening. The rod includes an actuator portion with a small internal magnet which allows the rod to be lengthened by use of the external controller. “The magnetic controller rotates the magnet inside the rod which enables us to lengthen or shorten the rod inside the body,â€? Gilbert says. “It is an office procedure, and the child is not put to sleep. There is no incision, mild pain, no anesthesia and no surgical dressing. Most children will not need additional surgery until they stop growing and we replace the MAGEC™ rods with permanent rods and a spinal fusion.â€? Patients who may not be candidates for the MAGEC system procedure include: • Those with infections or pathologic conditions of the bone which would impair the ability to securely fix the device (e.g. osteoporosis, osteopenia); (CONTINUED ON PAGE 12)

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FEBRUARY 2018 • 11


Updating Business Associate Agreements: A New Year’s Resolution by

Kelli Carpenter Fleming

Around this time each year, I like to remind healthcare providers about certain matters they can address at the beginning of each year--a New Year’s Resolution perhaps. You know--those matters that you have every intention of addressing throughout the year, but which get pushed to the side as other “more pressing” matters develop. This year, I am focusing on Business Associate Agreements (BAAs). While BAAs are a necessary tool for ensuring HIPAA compliance, healthcare providers oftentimes overlook this area of compliance. However, given the recent focus on business associate relationships and compliance by the Office of Civil Rights, the government agency overseeing HIPAA compliance, moving forward, healthcare providers should not only ensure that a BAA is in place when one is necessary, but also that the BAA reflects the intentions of the parties. Below are my top five provisions that should be reviewed in any BAA and should be negotiated as necessary. Indemnity Provision. The indemnity provision concerns whether or not the business associate will be responsible for any costs you incur as a result of the business associate’s actions. Healthcare providers should always insist on an indemnity from its business associates. If the business associate violates the terms of the BAA and/or HIPAA and such violation results in a fine, penalty, investigation,

etc. against the healthcare provider, the indemnity provision allows the healthcare provider to pursue the business associate and recoup such costs. It holds the party responsible for the incident also responsible for the associated costs, regardless of which party actually incurs the costs. Breach Reporting. Every BAA should address how quickly Breaches of Unsecured PHI, Security Incidents, and other improper uses and disclosures of patient information will be reported to the healthcare provider following discovery by the business associate. Seeing as it involves the information of your patients and seeing as your patients trust you to protect their information, you will want to learn of the breach or incident as soon as reasonably possible. In that regard, I generally recommend no more than a 10day notice period. The BAA should also specify what information will be provided in the notice, how the business associate will work with you to address the incident, and, with regard to a Breach of Unsecured PHI, who will be responsible for the costs of Breach notification and who will provide the Breach notification. Timely Access. Business associates are required to provide healthcare providers with timely access to patient information (or related accounting information) to help facilitate a patient’s request for access, request for amendment, or request for an accounting in accordance with HIPAA. However, BAAs can contractually require that business associates provide such ac-

cess within specified time periods in order to allow the covered entity to provide a timely response to its patients. For example, covered entities must generally provide patients with access to requested health information within 30 days. Thus, the BAA should include that the business associate will provide the healthcare provider with access within at least 30 days, if not sooner. However, some healthcare providers aim to provide patients with access to information within, for example, 15 days. In such instances, the BAA will need to include a shorter timeframe to allow the covered entity adequate time to review the information provided by the business associate, format the information, and deliver the information to the patient within 15 days. De-identification of Data. Deidentified data is technically not protected by HIPAA. Thus, if business associates are allowed to de-identify the patient data provided by a healthcare provider, they can use the data for any purpose, including a purpose profiting the business associate. For that reason, many healthcare providers disfavor allowing their business associates to de-identify patient data. The idea being that if a healthcare provider is sharing patient information with a business associate in order for that business associate to perform a function or service on behalf of the healthcare provider, a function or service that the business associate is probably getting paid to perform, many healthcare providers have concerns about

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the business associate further using and profiting from their patient information. Thus, many healthcare providers require that business associates only de-identify data upon the healthcare provider’s written consent or only allow the de-identification of data for limited purposes (e.g., data aggregation). Choice of Law. As more and more states develop and expand breach notification requirements and the obligations surrounding the privacy and security of patient information, the choice of law provision in a BAA has become more important. For providers located in Alabama, you should always request Alabama as your choice of law---the location where the patient was treated and the location of the generation of the medical information. BAAs contain additional provisions that may require review and negotiation, but these are my top five provisions to look for when reviewing BAAs. As the New Year gets underway, review your BAAs to make sure that they are up to date and remain in effect. If they need updating or have expired, keep in mind these provisions as you negotiate new documents. Kelli Fleming is a Partner with Burr & Forman LLP and practices exclusively in the firm’s Heath Care Practice Group.

Magnetic Spinal Growth Rods Are ‘Magic’ for Young Patients, continued from page 11 • Patients with metal allergies and sensitivities to the implant materials (e.g. titanium); • Patients with a pacemaker or other active, electronic devices (e.g. ICD); • Those requiring MRI imaging during the expected period the device will be implanted; • Patients younger than two years or weighing less than 25 pounds; • Patients with stainless steel wires or other implants containing incompatible materials. The MAGEC™ rods have been available for use in the United States for about three years, and Gilbert is seeing promising results in patients. While traditional growing rods may still have a place for severe spinal curves, the MAGEC™ system offers benefits for many patients. “Our hope is that lengthening the spine in smaller increments and having fewer surgeries will avoid risks and unintended spinal fusions in most of these young patients,” Gilbert says.


The Literary Examiner BY TERRI SCHLICHENMEYER

Aging Thoughtfully: Conversations about Retirement, Romance, Wrinkles, & Regret by Martha C. Nussbaum & Saul Levmore; Oxford University Press; $24.95; 264 pages Kicking and screaming. That’s how you’ll go into your twilight years: the calendar might say one thing but you’re not going to pay it any mind. There’s still a lot of pep in your step so shouldn’t, as in the new book Aging Thoughtfully, how you spend your golden years be your decision? Once upon a time in the not-too-distant past, the average life expectancy was around 50 years, while the median retirement age was 74. Back then, retirement didn’t involve Social Security or other government programs. Instead, people worked until they couldn’t. Today, there are more choices, and this book is about these choices. First of all, why retire at all? Says Levmore, there are laws in the U.S. that say you don’t have to but he’s in favor of changing them – especially if businesses institute defined benefit plans, which are often seen in government jobs, but rarely in the private sector. These changes would benefit employers, who could better maintain productivity; younger workers need-

ing jobs, and older workers, if Social Security was tweaked a bit. It would also help with “the people normally labeled as the elderly poor,” since defined benefit

plans would give them more month-tomonth income. But retirement: one can only golf so much – what next? Nussbaum says that retirement allows for a second career, either one that pays or one of volunteerism. For those kinds of choices, she looks at Finland, where retirement is mandatory at a relatively young age. It works because the Finns have excellent health care; they have ample time for better retirement preparation; and because they are treated equally. Statistically speaking, as we age, we rely less on plastic surgery and more on the idea that wrinkles are glamorous - a notion that can absolutely be pushed too far. We tend to live our lives backwards, which is okay. Doing so offers time to deal with negative emotions and unfulfilled regrets. Here, we learn the reasons for those pearl-clutching May-December romances we see in the tabloids. And we get advice on giving while we can still say where our assets should go. I struggled a lot with this book, and

I’m ultimately disinclined to recommend it. Here’s why: though Aging Thoughtfully is a series of conversations about getting older, its basis is really old – as in, ancient philosophy and Shakespeare. While that doesn’t make it a bad book by any means, it does mean that its usefulness is limited. Readers looking for advice will have to look harder because that’s buried in Cicero and King Lear. Those in search of solid research will find it scattered between philosopher John Rawls and Cato the Elder. Yes, there are conversations within these pages and they’re thought-provoking, maybe even comforting, but they’re not very accessible for the average reader. Should you decide to tackle this book, do so with awareness for what you’re in for. Aging Thoughtfully isn’t bad but, for most people, it’s going to make you scream. 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.

Weily Soong, MD Maxcie Sikora, MD John Anderson, MD Sunena Argo, MD William Massey, MD Lorena Wilson, MD Carolyn Comer, MD

ATOPIC DERMATITIS (ECZEMA) THE PROBLEM & TREATMENT

Atopic dermatitis (AD) is a complex disorder caused by the interplay between genetic and environmental factors. The effect is not just an itchy rash, but also secondary effects on the patient’s well-being, particularly disturbed sleep. Worldwide, about 20 percent of children and up to 3 percent of the adults have some form of eczema. Studies have found that a third to nearly two-thirds of children and young people with atopic eczema also had a food allergy. Some of these cases responded to topical treatments, but some did not. For many, treating the underlying food allergy was the most effective course of treatment. A diagnosis of AD is based upon pruritus, typical appearance, chronicity, and history of atopy. Incorrect diagnosis is the most common cause for treatment failure. When correctly diagnosed, a topical medication is often prescribed along with patient education on application technique. Patients who report topical treatment making their AD flare should be referred for patch testing. Patch testing detects delayed cellular hypersensitivity to allergens and is typically performed by a boardcertified allergist. Other triggers for AD are food allergy, contact irritants, and occupational exposure. Intensive education and adherence to therapy, treatment of secondary infections, and treatment and removal of allergens and stressors result in a sustained improvement of AD. If the diagnosis is in doubt due to atypical clinical features or poor response to treatment, a board-certified allergist can help with further specialty care.

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FEBRUARY 2018 • 13


The Battle over 340B

AHA & Partners Continue the Quest to Stop Significant Payment Cuts By CINDY SANDERS

Last fall, the Centers for Medicare & Medicaid Services released the outpatient prospective payment system (OPPS) final rule that dramatically cut 340B drug payments to some hospitals. That decision set in motion a chain of events that led the American Hospital Association (AHA), America’s Essential Hospitals and the Association of American Medical Colleges (AAMC) to file suit against the federal agency.

Background on 340B The 340B program was created by Congress as part of the Public Health Service Act in 1992 and signed into law by President George H.W. Bush to help expand access to life-saving prescription drugs for millions of vulnerable Americans. The program requires pharmaceutical manufacturers to provide front-end discounts on covered outpatient drugs purchased by hospitals that meet specific requirements, including disproportionate share and critical access hospitals, and certain non-hospital covered entities that receive federal funding including federally qualified health centers. Registered participants in the program are eligible to purchase drugs at the average manufacturer price (AMP) minus the unit rebate amount (URA). The URA varies by drug classification, and … as with most federal programs … there are numerous rules and modifiers for specific situations and classes of drugs. However, the

bottom line is that drugs available through the 340B program are significantly lower than normal retail or wholesale pricing. A 2015 Government Accountability Office report estimated 340B program participants save anywhere from 20-50 percent on covered pharmaceuticals. According to the Health Resources and Services Administration (HRSA), which manages the program, the intent of the 340B program “is to allow certain providers to stretch scarce federal resources as far as possible to provide more care to more patients.” The stretching of those resources comes from Medicare Part B paying the same amount for covered drugs to both 340B and non-340B providers even though the 340B providers were able to obtain the drugs at a much lower cost. Any residual revenue generated from the difference in the discounted purchase price and standard reimbursement rate can be used by the covered entity, without restriction, to expand services to low-income patients, invest in capital improvements, expand the scope of services, provide patient transportation, help cover administrative costs … or for any other purpose to help keep these typically cash-strapped facilities afloat.

Filing Suit On Nov. 13, 2017, AHA, America’s Essential Hospitals, the AAMC and three hospitals filed suit against the Department of Health and Human Services in the U.S. District Court for the District of Colum-

Congress Weighs In Shortly after the lawsuit was filed in mid-November, Reps. David McKinley (R-WV) and Mike Thompson (D-CA) introduced H.R. 4392, a bipartisan bill that would prevent a dramatic reduction in Medicare Part B payments for certain hospitals that participate in the 340B Drug Pricing Program. “The AHA thanks Representatives McKinley and Thompson for leading this bipartisan effort to protect patient care by preventing CMS from reducing Medicare Part B payments for some 340B hospitals,” said AHA Executive Vice President Tom Nickels.  However, the AHA opposes H.R. 4710 – the 340B Protecting Access for the Underserved and Safety-Net Entities (PAUSE) Act. In a letter to the bill’s sponsors, Nickels outlined several concerns including overly burdensome reporting requirements, aligning the 340B program eligibility with charity care levels (without regard to underpayment, bad debt attributable to low-income patients, unreimbursed Medicare expenses or the hospital’s subsidization of high-cost essential services such as neonatal or burn units), and a two-year moratorium on adding certain hospitals and child sites to the 340B program. Nickels’ letter is available online at BirminghamMedicalNews.com.

bia.

The CMS final rule reduces Medicare payments to certain public and nonprofit hospitals for drugs purchased under the 340B program by nearly 30 percent, estimated to total $1.6 billion in cuts. While the stated intent of the policy was to curb high drug prices, the lawsuit noted the 340B program makes up less than 3 percent of the $457 billion in annual drug purchases in this country and is paid for by drug manufacturers through discounts at no cost to taxpayers. The plaintiffs argued the final rule is in violation of the Social Security Act “and, therefore, should be set

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aside under the Administrative Procedure Act as unlawful and in excess of the HHS Secretary’s statutory authority.” “From its beginning, the 340B Drug Pricing Program has been critical in helping hospitals stretch scarce federal resources to enhance comprehensive patient services and access to care,” Rick Pollack, president and CEO of the AHA, said upon announcing the lawsuit. “CMS’s decision to cut Medicare payments for so many hospitals for drugs covered under the 340B program will dramatically threaten access to healthcare for many patients, including uninsured and other vulnerable populations.” He added the Rick Pollack goal of the lawsuit was to prevent those significant cuts from moving forward beginning Jan. 1, 2018.

A Legal Setback As 2017 wound down, a federal judge ruled the timing wasn’t right for the AHA lawsuit against CMS. U.S. District Judge Rudolph Contreras ruled CMS could move forward with $1.6 billion in planned cuts to the 340B federal drug discount program and that the plaintiffs should wait until the cuts were actually in effect to launch a legal challenge. Citing the November lawsuit as premature, Contreras said the court concluded the suit lacked subject matter jurisdiction because “plaintiffs have failed to present any claim to the (HHS) Secretary for final decision as required by 42 U.S.C. § 405(g)” and dismissed the case on that basis. It should be noted, AHA officials said, that the judge did not rule on the merits of the plaintiffs’ claim. “We’re disappointed by the court’s decision, but undeterred in our efforts to (CONTINUED ON PAGE 15)


Healthcare Collaboration

Stakeholders Sign On for Sim By CINDY SANDERS

Not every major action takes an act of legislation. Last month, a number of major health associations and payer organizations released a consensus statement to streamline prior authorization and simplify processes to improve timely care while reducing administrative burdens. Recognizing preapprovals play an important role in dispensing evidence-based, cost effective care, the organizations also noted the processes vary considerably and can be unduly burdensome to providers, payers and patients. In an effort to streamline the approval process and enhance transparency and communication, the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA) released a consensus statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care. “America’s hospitals and health systems are committed to delivering the best care for patients in the most efficient manner, goals we share with our partners in the health field,” said Tom Nickels, executive vice president of the AHA. “These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden.” The collaborating organizations have identified five key areas where there are opportunities for improvement and have agreed to work together to encourage or improve the processes related to each area as outlined below: Selective Application of Prior Authorization: reduce the number of healthcare professionals subject to prior authorization requirements based on their performance, adherence to evidence-based

medical practices, or participation in a value-based agreement with the health insurance provider. Prior Authorization Program Review & Volume Adjustment: regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them. Transparency & Communication Regarding Prior Authorization: improve channels of communications between health insurance providers, healthcare professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes. Continuity of Patient Care: protect patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in formulary, coverage, health insurance providers or prior authorization requirements. Automation to Improve Transparency & Efficiency: accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point of care. In January 2017, the AMA and 16 other associations representing physicians, medical groups, hospitals, pharmacists, and patients released a series of principles intended to reduce the administrative burdens associated with prior authorization and to ensure that patients receive timely and medically necessary care and medications. More than 100 other healthcare organizations have since supported those principles, providing the impetus to launch the discussions with the health insurance industry that led to the current consensus statement. “This collaboration among healthcare professionals and health plans represents a good initial step toward reducing prior authorization burdens for all industry stakeholders and ensuring patients have timely access to optimal care and treatment,” said AMA Chair-elect Jack Resneck, Jr., MD.

The Battle over 340B, continued from page 14

protect low-income patients and their essential hospitals,” said Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals, in the aftermath of the judge’s decision. “This terrible policy threatens access to care in our most underserved communities and undermines hospitals on which millions of Americans depend. It must not move forward.” Pollack added, “Making cuts to the program, like those CMS has put forward, will dramatically threaten access to healthcare for many communities with vulnerable patients. We are disappointed in this decision from the court and will continue our efforts in the courts and the Congress

to reverse these significant cuts to the 340B program.”

The Battle Continues True to their word, the six plaintiffs in the 340B lawsuit formally notified the court on Jan. 9 of their intent to appeal the district court’s Dec. 29 decision to dismiss the lawsuit. On Jan. 17, the AHA, AAMC and America’s Essential Hospitals requested the U.S. Court of Appeals for the District of Columbia Circuit establish an expedited schedule for the appeal, ensuring completion of all briefing by no later than the beginning of April and a set date for oral arguments soon thereafter.

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Birmingham Medical News

FEBRUARY 2018 • 15


How Does the New Tax Law Affect You In 2018? By Gerard Kassouf, CPA CFP®

In late December 2017, the president signed the Tax Cut and Jobs Act—the first major change in the income tax code in over 30 years. The changes affect individual taxpayers with new tax rates and tax brackets, an increased standard deduction, the loss of the personal exemption for dependents, an increasing child tax credit and limitations to tax and interest deductions, for example. While many provisions of the Act affect businesses, this article focuses on a few of the provisions that will affect individuals in 2018 through 2025. The tax rates and brackets are based on your filing status—single, married filing jointly, married filing separately and head of household. The new act provides seven tax rates, beginning at 10 percent with several brackets as high as 37 percent. Children who were previously taxed at their parent’s tax bracket will now calculate tax on earned income at single taxpayer rates, and unearned income taxed at estates and trusts rates. The alternative minimum tax has been retained for individuals, now with a higher exemption amount. Significant changes have been made to the rules that affect home ownership. The Act modifies the deductibility of home mortgage interest for primary and second homes purchased on December 15, 2017 or later. (Homes purchased before that date remain subject to the old rules). The new rules reduce the maximum first mortgage loan amount from $1,000,000 down to $750,000 (one-half that amount if married filing separately (MFS)). Tax deductions for property tax, income/sales tax and auto tag tax is now limited to $10,000 ($5,000 MFS). Interest for home equity line of credit debt has been eliminated. If you are affected by the $10,000 limitation on tax deductions, consider utilizing the State of Alabama program – The

Alabama Accountability Act. This Alabama Act provides an opportunity for its taxpayers to make a charitable contribution to a qualified charity for federal purposes and receive a dollar for dollar tax credit on your Alabama tax return. Medical expense rules were changed to allow for a reduced threshold of 7.5 percent for all taxpayers. Charitable contribution deductions, previously limited to a 50 percent limitation for cash contributions to public charities and some private foundations are increased to 60 percent. However, the new law eliminates the opportunity for a charitable tax deduction for a contribution to a college or university for the right to buy tickets to an athletic event. The new law changes the taxation and deduction for alimony and separate maintenance agreements modified after December 31, 2018. Payments made under alimony or separate maintenance agreements executed after 2018 will no longer be considered deductible by the payor or income to the payee spouse. One area of the new law that may affect employees that pay some of their own business expenses is the change in deductibility of miscellaneous expenses. Under the new law, the deduction for any miscellaneous itemized deduction subject to the two percent floor is suspended for tax years after 2017 and before 2026. As a planning opportunity, if you currently have an arrangement with your employer where you pay and deduct these expenses on your form 1040, consider modifying your compensation arrangement with your employer to include having them pay or reimbursing you for them. On a positive note, the loss of itemized deductions if your income level exceeded a threshold has been suspended. With possible exceptions to some military personnel on active duty, the itemized deduction for moving expenses is eliminated. This includes amounts received

The Providers. continued from page 1

directly or indirectly from your employer. Moving expenses paid in connection with a new job greater than 50 miles from the prior place of work to your residence has also been eliminated for most taxpayers. Significant changes have been made to the child care credit for children under the age of 17. The amount of the credit has doubled from $1,000 to $2,000. The phase out income levels have increased from $110,000 for married taxpayers filing a joint return to $400,000. There is also a new credit for non-child dependents such as parents or children over the age of 17 in the amount of $500 per year. The new law eliminates the itemized deduction for casualty and theft losses for individuals. This would include losses arising from fire, wind and theft. However, there is an exception for losses which arise in a federally declared disaster area. The Act modifies the rules for college savings funds (529 plans) allowing distributions to include payments to elementary or secondary institutions for payment up to $10,000 per year. Institutions include public, private and religious operated schools. There are also significant modifications to the estate and gift tax rules effective during the period from 2018 through 2025. The amount of the estate and gift tax exemption doubles this year from approximately $5.5 Million to $11 Million per decedent. Many opportunities for planning early in 2018 exist for taxpayers. Taking time in early 2018 to plan, make changes allowed under the new Act, and prepare for your particular situation will allow for better tax results. Be proactive and plan now. Gerard Kassouf, CPA CFP® is a director in the tax, accounting and advisory firm Kassouf & Co., P.C.

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NEW

used for Medicare transactions like billing, eligibility status, and claim status. Whereas the HICN started with the 10-digit social security number and ended with a letter or two designating a policy type, the 11-digit MBI will contain both letters and numbers throughout, such as 1EG4-TE5-MK73. The change also means secondary beneficiaries, such as admissible spouses, will be issued their own unique number. Under the current HICN system, those individuals share the primary beneficiaries’ social security-based identifier. To accommodate for the display, transmission, and processing of the alphanumeric MBI, providers may need to update any software that references that piece of data, such as their practice management and electronic health record (EHR) systems. “Look anywhere patient demographics are housed and wherever any kind of insurance info is housed or communicated,” Allen says. CMS has built in a lengthy transition period, keeping the current HICN number valid until January 1, 2020. Until then, providers can use either the HICN or the MBI in the same field where they have always put the HICN. But they should not submit both numbers on the same transaction. “You have well over a year and plenty of opportunities to get it changed,” Allen says. “Medicare was smart in this case—a lengthy transition period and a lot of communication.” In addition, beginning October 2018 through the end of the transition period, when a provider uses an HICN to submit a Medicare fee-for-service claim, both the HICN and the MBI will be returned on the remittance advice. The most pervasive problem for providers may simply be the lack of awareness among patients. “People get a lot of things in the mail, so this could be easy to overlook,” Allen says. Providers can also note that if the address on file differs from the address on the electronic eligibility transaction responses, then they should ask the patient to contact Social Security and update their Medicare records. To help providers spread the message about the upcoming new cards, CMS has printed flyers, tear-off cards, and posters about the change for practices to distribute to and display for patients. “I would want to make sure I get the correct MBI info from the beneficiary and communicate that number as much as possible to anybody affected by that change,” Allen says, referring to possible problems relaying information between vendors or doctors if they do not both use the same identifier for a patient. Gathering the new MBI should be notably easier, though, now that physicians have become so used to changes in benefits for their patients. “With Medicare advantage plans and competition in the marketplace, doctors are used to changes in insurance,” Allen says. “So I think they’re a lot more used to getting insurance info at the front end every time the patient comes in.” “The positive aspect of the process is you have well over a year transition period, and you will have plenty of opportunities to make the change without worrying about denials,” Allen says.


Robotic-Arm Assisted Joint Replacement By Marti Slay

The surgeons at Andrews Sports Medicine & Orthopaedic Center are the first in Birmingham to use Stryker’s Mako Robot-Arm Assisted Surgery System in total knee, partial knee and hip replacements. This robotic technology increases accuracy in joint replacement procedures. The initial system was installed at St. Vincents Birmingham in August and has been so successful a second robot is already in use. Surgeons Jeffrey Davis, MD and K. David Moore, MD both give the robot high marks in improving quality of care. “I’ve been doing these operations for 25 years,” Moore said. “And there have certainly been incremental improvements in im- Drs. Jeffrey Davis (left) and K. David Moore with the Mako Robotic-Arm Surgery System. plants and the way we care for patients, but this is the biggest step forward I’ve seen. After using the robot for presently have,” Davis said. “It provides late into better longevity,” he said. a very short period of time, doing it the us an opportunity to get it right nearly 100 Davis said his first cases took 15 to 25 conventional way feels antiquated now. percent of the time. Studies show that acminutes longer with the robot, but his surThis is going to be an important step forcuracy matters.” gery time is coming down as he and the ward in terms of results and -- in all likeliMoore agreed. “We know historically staff become more comfortable with the hood -- in how long these implants last.” when implants are aligned appropriately, new technology. Proponents of the system “From a standpoint of reproducibilthey last longer. To the degree that this alsay the time is neutral. ity and accuracy, this beats anything we lows us to be more precise, it should transIn order to use the robot technology,

patients get a CT scan prior to the operation, which the doctor uses to map out a plan. At the time of surgery, the surgeon uses the CT template to confirm that plan. “That’s what takes a little longer,” said Davis. “You use a probe to touch the bone and tell the navigation system where the bone is relative to the CT scan.” Arrays, or sensors, are placed into the bone so the surgeon can see measurements in real time. “The saw blade then cuts exactly in the plane that was predetermined,” Davis said. “I’m able to watch the screen and the soft tissue and see while I’m cutting the bone. It allows me to follow my preoperative plan within a millimeter. I’m still doing the surgery, pushing the buttons and squeezing the triggers and controlling it. The Mako is keeping me in the exact angle and plane.” Because the technology is still relatively new, there are not yet firm numbers, but early indicators reflect a quicker patient recovery. “We’ve made a lot of strides in the way we take care of total knee patients and manage their pain,” Moore said. “It’s a much better operation for the patient than a few years ago. (CONTINUED ON PAGE 20)

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FEBRUARY 2018 • 17


Cyberattack Response By Beth Pitman, JD, CHPC

The 2017 news was replete with stories announcing ransomware attacks on health IT systems across the country. In January, AllScripts, an EHR company, was the victim of the SamSam variant of ransomware leaving many of its hosted healthcare providers without access to patient records, prescription services and other applications for several days. Cybersecurity specialists anticipate increased and more sophisticated ransomware attacks in the healthcare industry in 2018. Ransomware is a form of malware deployed for the purpose of preventing access to data. Typically, access is restricted through encryption and is reinstated upon payment of Bitcoin. The January 2018 OCR Cybersecurity Newsletter provides guidance in preventing cyber extortion. However, if you are a victim, HIPAA has specific requirements for responding. Time: HIPAA requires notice of breach of more than 500 persons within at least 60 days of discovery. The Office of Civil Rights (“OCR”) considers that the time of discovery begins when the incident is first known, not when the investigation is complete. Document: Maintaining good documentation is critical. Much of this is required by HIPAA and will be needed in the event of OCR investigation.

18 • FEBRUARY 2018

Incident Response Team: Alert the incident response team which may include legal counsel, forensic analysts, cyber-insurer, public relations firm, mass mailer, and credit monitoring services. Be familiar with cyber-insurance coverage requirements. Contingency Plan: Consider time and expense of restoration from a recent backup, if feasible. The plan may include an account holding Bitcoin. It has been reported that Hancock Health, also a

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recent SamSam victim, determined that paying the ransom was more cost-effective and timely than manually restoring the system from back-up. Mitigation: Initiate mitigation efforts locally and verify that Vendor has taken steps to identify, correct and contain or remove the intruder or intruders. Even if evicted by the Vendor, verify that there was no intrusion prior to the ransomware incident during which data may have been destroyed, copied or removed.

This may occur well prior to introduction of the ransomware and was the cause of a breach reported by Peachtree Neurological Clinic in Atlanta. Forensic Investigation: Initiate an independent forensic examination, if necessary; request forensic information from the Vendor. This will also be needed to assess the number of affected persons and the specific PHI at risk. Breach Risk Assessment: Initiate breach risk assessment to determine if there is a low risk to the PHI. OCR considers ransomware an unauthorized access if the ePHI has been encrypted. A Breach is presumed if there is unauthorized access, use or disclosure but notice may not be required if risk to the PHI is determined to be low. Notice: If more than 500 persons are affected, notice must be mailed to the affected persons, made on the OCR Breach Portal and to prominent media outlets in the State or jurisdiction, and possibly posted on your website for 90 days. State Notice Requirements: Assess need and requirements for providing notice under state breach laws. Beth Pitman is of counsel with Waller where she advises hospitals and healthcare systems, physician groups, outpatient services providers and HIT companies on HIPAA compliance, data security and technology licensing matters.


When Should a Couple Seek Help from a Fertility Specialist? By Cecil Long, MD

There is really no right answer as to when a couple should consider seeking help from a fertility specialist after attempting to conceive. Some decide after a matter of months, while others may wait a year or more. Infertility could be due to a single factor, or multiple factors, and fertility treatments vary in complexity. One factor, in particular, has become more prominent these days in couples who are trying to conceive: age, which affects both the husband and wife, has become a threat to fecundity as society pressures couples to start a family later in life. Females are born with a limited supply of eggs (oocytes), and after puberty be-

gins, oocytes are depleted at a rate of 30 to 40 per cycle, regardless if the female is taking oral contraceptives. This causes a gradual depletion of oocyte density within the ovaries beginning around age 27, and there is a critical deficiency of oocyte supply starting around the age of 35. Thus, if the woman is about 35 or older, the couple should seek fertility help immediately. In couples age 30 to 32 who have never conceived, the duration for conception is approximately six months. The duration for conception for couples who were successful in their previous attempts decreases to about three to four months. Therefore, within this age range, it is reasonable to use a four to six month window of trying without conception as a guide to seek fertility help. The status of the reproductive tract is

also considered as a possible cause of infertility in females. An important concept to consider is that oocytes undergo changes in the female due to hormonal changes that occur due to aging. After the age of 35, there is an exponential increase in chromosomal abnormalities due to the age of the oocytes. In most males, age does not tend to affect the viability of sperm cells until after the age of 45 to 50. However, both the husband and wife should undergo diagnostic evaluation. Hormonal imbalances, or genetic disorders, such as cystic fibrosis, are some of causes of male infertility. Also, if a man possesses a genetic trait that causes inadequate sperm development and a higher percentage of abnormally shaped sperm (poor sperm morphology), the likelihood of contraception is drastically low,

as the sperm cell cannot fertilize an egg. If the sperm cells possess abnormal motility, they will have difficulty fertilizing the egg. Low sperm count, abnormal sperm morphology, and abnormal sperm motility are the main causes of male infertility. Many couples are faced with the time constraints of fertility in both males and females. In summary, there is no absolute correct answer for when a couple should start to seek fertility help; logically, the earlier the couple seeks help, the more likely there will be success.

The BEAT Cancer program, based in the Department of Nutrition Sciences, began with six weeks of personal coaching from an exercise specialist. After the six weeks, participants were responsible for maintaining their own exercise regimens at home while checking in with the exercise specialist every two weeks. Participants also attended six discussion group sessions with other program participants. Study measurements were obtained at the three-month and sixmonth marks. This study found participants who received a physical activity program focused on achieving 150 weekly minutes of physical activity — approximately 20 minutes per day — reported better sleep quality, fewer sleep disturbances and less daytime dysfunction related to fatigue. The findings — in which results

came from perceived responses rather than an accelerometer — showed that BEAT Cancer significantly improved global sleep quality due to improvements in several global sleep quality components, including perceived quality of sleep, reduced sleep disturbances and less fatigue during the day. Rogers acknowledged that the inclusion of more current sleep measurement options such as bed sensors and sleep recorders in future studies could overcome some of the limitations of measuring self-report sleep quality. She says additional research is needed to determine how the support provided by research staff and other cancer survivor participants may have influenced the sleep improvements. Nevertheless, Rogers is hopeful about the impact of their findings on

improving cancer survivorship care and third-party financial support of such programming because of the randomized controlled design, multicenter enrollment and high retention rates. “This study reinforces the importance of providing physical activity programming as a fundamental part of the cancer survivor care plan,” Rogers said. “It is currently recommended that cancer survivors engage in at least 150 minutes per week of moderate intensity physical activity, such as walking. This study suggests that doing so can potentially help a breast cancer survivor sleep better. Hence, cancer survivors can add another benefit to the list of reasons to find a physical activity they enjoy and get moving.” This project was supported by the National Cancer Institute.

Cecil Long, MD practices fertility medicine at the American Institute of Reproductive Medicine.

RESEARCH NOTES

Improving Sleep Quality for Breast Cancer Survivors A study by researchers at the UAB School of Health Professions published in Medicine & Science in Sports & Exercise, the official journal of the American College of Sports Medicine, connects aerobic physical activity — like walking — to better sleep for post-primary treatment breast cancer survivors. The study, titled “Physical Activity and Sleep Quality in Breast Cancer Survivors: A Randomized Trial,” is the first large randomized controlled aerobic physical activity study of its kind in breast cancer survivors who had completed primary cancer treatment. This study found participants who received a physical activity program focused on achieving 150 weekly minutes of physical activity — approximately 20 minutes per day — reported better sleep quality, fewer sleep disturbances and less daytime dysfunction related to fatigue. “Nearly one in three breast cancer survivors suffers from poor sleep, and poor sleep is associated with greater breast cancer mortality,” said Laura Q. Rogers, MD, principal investigator of the study and professor at UAB. “So research in this area is critical for survivors and those who care about them. Our findings are significant be- Laura Q. Rogers, MD cause the benefits were of sufficient magnitude to reach and exceed the clinically important threshold.” The study, conducted by UAB, Southern Illinois University School of Medicine and University of Illinois at Urbana-Champaign, included 222 breast cancer survivors. Of those participating, 112 received typical care while 110 went through the Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) program.

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Kassouf Named to Who’s Who in Birmingham Healthcare Gerard J. Kassouf, CPA, Healthcare Services Director at Kassouf & Co., was named one of Birmingham Business Journal’s Who’s Who in Birmingham Healthcare for 2017. Kassouf has been with Kassouf & Co. for over 40 years and Gerard J. Kassouf served as Managing Director of the Firm from 1989 to 2017. He specializes in accounting, tax, and consulting services to small businesses with an emphasis on physician practices and other professional firms. His areas of expertise include contract negotiations, compensation arrangements, entity selection, business operations, revenue cycle management, retirement plan design, insurance and educational fund planning. Kassouf earned a Bachelor of Science degree and a Master of Tax Accounting degree from the University of Alabama and holds several professional certifications. He is a Certified Public Accountant (CPA), AICPA Personal Financial Specialist (PFS), Certified Financial Planner™ (CFP®), and an Accredited Estate Planner (AEP).

He is involved in a number of professional organizations, including the American Institute of CPAs, Alabama Society of CPAs, Medical Group Management Association of Alabama and Birmingham, Affiliated Health Advisors, American Health Lawyers Association, Rotary Club of Birmingham, Estate Planning Council of Birmingham, and the Alabama Institute on Federal Taxation.

Cullman Regional and Physicians in Joint Venture Partnership Cullman Regional Medical Center (CRMC) has completed an agreement with the local physician owners in a joint venture for The Surgery Center of Cullman, LLC. In the purchase agreement, finalized January 15, Cullman Regional begins managing the day-to-day operations of the facility and acquires majority ownership in the facility. The 33 employees of The Surgery Center of Cullman will become employees of Cullman Regional. The Surgery Center of Cullman currently provides approximately 5,118 outpatient procedures annually. The transaction is subject to customary regulatory approvals and reviews by state and federal agencies and has been finalized.

Robotic-Arm Assisted, continued from page 17

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It is early in our experience with the Mako, but in patients where I’ve done one knee with the robot and one without, they have almost universally preferred the robot. Because we are able to take care of some of the ligaments and balance issues almost before we start the surgery, it’s easier on the patient.” Six surgeons at Andrews Sports Medicine have become certified on the Mako system by performing surgery on cadavers, follow by a certification course at another surgical facility. The technology has been so well received that initial scheduling was an issue. The second robot, which was put into use in midNovember, has alleviated the scheduling delays and Dr. K. David Moore utilizing the Mako technology during a total knee enables all their surgeons replacement surgery. to more easily make use of the technology. evaluate new technology before we bring “We have tried to be on the cutting it to our patients, but when something edge of orthopedics, whether it’s sports is as clear an improvement as this is, we medicine or joint replacement, for the certainly want to bring it to our patients history of Andrews Sports Medicine,” said as quickly as possible. Now we’ve got the Moore. “I think the key is to do it in a benefit of experience and technology to careful fashion. We want to appropriately make the best outcome.”


GRAND ROUNDS

Patrician named Booth Endowed Chair

The UAB School of Nursing has named Patricia A. Patrician, PhD the second holder of the school’s Rachel Z. Booth Endowed Chair in Nursing. Patrician is nationally recognized for her leadership in the areas of patient safety, quality Patricia A. care and nursing prac- Patrician, PhD tice environments, and has an ongoing program of funded research focused on improving those areas within our nation’s military hospitals. Since joining the UAB School of Nursing faculty, Patrician has sustained a record of extramural funding of $2.5 million as a principal investigator and has served as co-investigator on an additional 11 grants. Patrician — a retired United States Army Colonel and 26-year veteran of the U.S. Army Nurse Corps — recently received a two-year, $400,000 award from the TriService Nursing Research Program for her study “Impact of Nursing on Readmissions, Failure to Rescue & Mortality in DoD Hospitals.” She is one of two senior scholars for the VA National Quality Scholars Program site at the Birmingham VA Medical Center and one of only six people nationwide to serve on the Strategic Advisory Panel of the national Quality and Safety Education for Nurses Institute.

The Booth Endowed Chair was named in honor of Rachel Z. Booth, Ph.D., the school’s third dean, upon her retirement in 2005.

rics facility in Chapel Hill, North Carolina, and present Pediatric Grand Rounds for both University of North Carolina and Duke University medical schools.

Benton Receives Award

Timothy McGraw, MD Joins Southview Medical Group

Elizabeth (Cason) Benton, MD has received the 2018 Paul V. Miles Fellowship Award from the American Board of Pediatrics, an honor that highlights a pediatrician who is dedicated to improving the quality of health care for children. An associate professor in UAB’s Department of Pediatrics, Benton is Elizabeth Benton, the founding director MD of the Alabama Child Health Improvement Alliance and also sees patients at the UAB Primary Care Clinic located at Children’s of Alabama. Her interest focus is in quality improvement in children, and she has helped lead the development of quality improvement initiatives at UAB and across the state. With the Alabama Child Health Improvement Alliance, Benton has developed and led five quality improvement collaboratives across the state regarding obesity treatment and prevention, screening for developmental delay, autism, social emotional issues, and preventing HPV-related cancers. As the Paul V. Miles fellow, Benton will visit the American Board of Pediat-

Timothy McGraw, MD joined Southview Medical Group in December 2017. McGraw, who is a board-certified Dermatologist originally from Huntsville, graduated magna cum laude from Birmingham-Southern College with a degree in chemistry. He earned a commission in the United States Air Force through the ROTC program at Samford University and obtained his medical deTimothy gree at the Uniformed McGraw, MD Services University of the Health Sciences School of Medicine in Bethesda, MD. His medical internship was at Malcolm Grow Medical Center at Andrews AFB, MD where he also completed a Family Medicine residency and became board-certified in this specialty. McGraw served in the U.S. Air Force for several years as a family physician and flight surgeon including deployments to the Pacific Theater and Afghanistan, as well as a tour at the Pentagon before pursuing his Dermatology residency at the San Antonio Uniformed Services Health Education Consortium. He was presented both first and second-place research awards by the Association of

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Military Dermatologists during his residency and also shared responsibilities as chief resident. After his residency, McGraw served as the Chief of Dermatology Services at the United States Air Force Academy in Colorado Springs and then completed a Laser and Cosmetic Dermatology fellowship in Salt Lake City. McGraw has published multiple articles in dermatology journals, has authored a textbook chapter, and has presented at local and international medical meetings. McGraw performs a wide range of Dermatology services for patients of all ages including skin cancer screenings, evaluation and treatment for rashes, acne, skin cancer, eczema, and psoriasis. He also performs cosmetic services including fillers, Botox injections, and performs and directs laser treatments for multiple skin conditions.

TekLinks Named to Top North American MSP List

CRN has named TekLinks to its 2017 Managed Service Provider (MSP) 500 list in the MSP Elite 150 category. The annual list recognizes North American solution providers with cutting-edge approaches to delivering managed services. “We’re a growing business with an eye toward the future of hybrid IT-solutions. We’re excited to receive CRN’s recognition of our strategic approach to delivering managed services,” says TekLinks CEO Jim Akerhielm.

Brian Larson, MD Radiation Oncologist

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FEBRUARY 2018 • 21


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BCBS Implements New Prior Authorization Program for Autoimmune Drugs

Blue Cross and Blue Shield of Alabama is implementing a new autoimmune biologic drug program, concerning pharmaceuticals treating conditions such as rheumatoid arthritis, plaque psoriasis, and Crohn’s disease. Beginning January 1, 2018, a prior authorization (PA) is required for members who are prescribed biologic medications for autoimmune disorders. Blue Cross is taking extra steps to ensure that the PA process goes smoothly for our members: • There will be no change to members who have a current prescription for an autoimmune drug. They will be able to continue taking their current medication without acquiring a PA and they can change to a preferred drug for their condition without requiring a new PA. • Members who are diagnosed with an autoimmune disease and have claims for prerequisite drugs will automatically receive a PA for preferred drugs. Blue Cross and Blue Shield of Alabama will use data analytics to identify members who meet clinical criteria and proactively provide an authorization for coverage. • Members who are prescribed a non-preferred drug will go through the initial PA process. The PA process will simplify the

administrative process for physician offices. This proactive initiative will help members with an autoimmune condition receive the best treatments without disruption.

Champion Sports Medicine Now Provides Telemedicine

Champion Sports Medicine has entered into a partnership with Healthy Roster that will provide Alabama athletes, parents and coaches with instant access to a Champion Sports Medicine clinician when an athlete is injured playing sports. This mobile injury documentation and communication app provides immediate injury consultation and ongoing dialogue with a licensed Champion Sports Medicine expert via the chat, voice or video function on a mobile device. It is compliant with all federal HIPAA regulations and offers a secure forum for injured athletes to receive a telemedicine evaluation. Alabama residents can download the Healthy Roster free app via the App Store or Google Play. Once they tap the “sign up” button, they type in “champion.”

Laura Crandall Brown Foundation to host its annual Taste of Teal

The Laura Crandall Brown Foundation (LCBF) will host its Taste of Teal

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Gala on Saturday, March 10th at The Wynfrey Hotel. The annual event will feature a seated dinner and cocktails, auctions, and casino games and music. The foundation also bestows its “Legacy of Laura” honors on four members of the community at the gala. The 2018 corporate honoree is Kassouf & Co., a local accounting firm that has served Birmingham for almost 90 years. Kassouf & Co. was featured in 2016 as one of Inside Public Accounting’s Best of the Best Firms. Visit www.thinkoflaura.org/TasteofTeal for more information or to purchase tickets.

MASA Members Visit Washington D.C.

About 90 member physicians of the Medical Association of the State of Alabama attended the Association’s Annual Governmental Affairs Conference in Washington January 29th through the 31st. Attendees met with Alabama’s Congressional Delegation to discuss issues related to healthcare and medical services in Alabama. Richard E. Hawkins, MD, President of the American Board of Medical Specialties, was the guest speaker for the conference.

Austad Receives Grant for Longevity Study

UAB Department of Biology chair Steven Austad, PhD received a fiveyear, $1.5 million grant from the National Institutes of Health to study the differences in males and females that may indicate length and quality of life in mice, which in turn will improve hu- Steven Austad, PhD man health. The grant funds research that will develop a standardized measurement and associated recovery metrics that predict the healthspan impact of assumed health-extending interventions when administered in early to mid-life in mice. Investigators will use the grant to develop a panel of quick, inexpensive tests that can be administered to mice in early to mid-life that predict whether an intervention will extend its healthspan, which could be beneficial in clinical trials. One major limitation of aging research is the time it takes to perform a lifespan study. “In order to speed progress in the field of aging research, it would be invaluable to develop the planned panel of tests,” Austad said. “To help us evaluate whether our test panel is working, we will use sex differences observed in successful mouse longevity interventions to validate how well our resilience panel predicts extended healthspan.” Three interventions will be used, including dietary restriction, which has proven benefits in both sexes; rapamycin, known to be beneficial in expanding life more for females than males; and 17-α-estradiol, which exhibits longetivity benefits in males only.

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