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Birmingham Researcher Releases As-Needed Drug for Anxiety
Witney Tew, MD
By Jane ehrhardt
“This will fill an unmet need in mental health,” says Tom Dooley, PhD, a Birmingham researcher with 13 patents for pharmaceutical and biotech developments to his name. Dooley was issued his latest of two U.S. patents in December to cover novel drug combinations for the fast-acting, as-needed treatment of anxiety disorders. He had previously focused his research on dermatology and oncology, until a family member started experiencing anxiety issues in 2007, which helped stimulate the concept for this invention. Typically, the 40 million people over the age of 18 who suffer from anxiety disorders rely on benzodiazepines, such as Xanax, to quiet the symptoms of acute anxiety and panic attacks. This class of drugs can show effects within a half hour and comes with side effects and FDA warnings of potential for abuse. According to The Royal College of Psychiatrists, about four in every 10 people who take benzodiazepines daily for more than six weeks will become addicted. In the course of watching his family member take benzodiazepine, Dooley became intent on finding an alternative. “I didn’t like seeing the side effects such as drowsiness and impaired cognition,” he says. “And I
A Wellness Approach to Chronic Disease Life should be a joy—not an endurance race. The dissonance between how human bodies evolved to live and how modern life is pushing us to live has created a plague of lifestyle-related chronic illnesses. Diabetes, hypertension, immune disorders, obesity and a whole range of diseases of lifestyle are diminishing both the length and the quality of so many lives ... 5
St Vincent’s Opens Hospital in Chilton County For three years, Chilton County has been without a hospital, which at times, has been challenging for the community. For instance, last year, when a school bus crashed in Clanton, the children had to be driven 30 miles away to Shelby Baptist Medical Center in Alabaster ... 9 FOLLOW US
JANUARY 2017 / $5
Tom Dooley in his lab.
(CONTINUED ON PAGE 6)
Reinventing the State’s Malpractice System By Jane ehrhardt
During last year’s Alabama legislative session, Senator Trip Pittman introduced a proposal to rein in the costs of malpractice suits. Senate Bill 413 would have replaced the trial-based system with a no-blame, administrative one. The Patient Compensation Act sat in committee until the end of the session. But Pittman has continued his efforts to seek an alternative to the current system, which is said to drain Medicaid state funds through higher malpractice insurance and large payouts by juries. “As the General Fund chairman, I’m always looking for potential savings,” Pittman says. “As this was presented to me, it could possibly save Alabama tens of millions of dollars. But you don’t really find out all sides of an issue until you put a piece of legislation out there.” The Medical Association of Alabama surprised Pittman with its opposition. “I didn’t realize that opposition would be as strong,” Pittman says. “But that (CONTINUED ON PAGE 12)
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Birmingham Medical News
Dr. Whitney Tew Goes From Physician to Soldier By Cara Clark
Witney Tew, MD is a firm believer in service over self. It not only drove her decision to become a family medicine physician but also prompted her to follow in her father’s footsteps by joining the Alabama Army National Guard, where she has earned her rank as captain attached to the 135th Sustainment Command in Birmingham. Things have been moving quickly for Tew. She got married two years ago. This July, she graduated from residency, and a month later, while practicing with Grandview Family Medicine at Lee Branch, she received orders to deploy. “It’s one of those things,” she said. “You don’t join the military unless you’re ready and willing to do it. In the meantime, I enjoy developing relationships with my patients. In the short time I’ve been here, I realize this is exactly what brought me into family medicine.” Tew says the Guard’s excellent programs for physicians going into medical school led her to join just after college and before beginning her studies. While in school and during her residency, her status was non-deployable. “I knew I would be called up once I finished medical school,” Tew said. “I just didn’t realize it would be so soon.” The military is a sort of a family business. Her father has been in the service for 35 years. Her sister and brother-in-law serve in the Air National Guard, and her niece is in the Army National Guard. “Service members are protected by law against any ramifications from our employer due to our time away, but we are always a little nervous about telling them about Guard obligations,” Tew said. “I have received nothing but support and gratitude for my service from everyone at Grandview—from our clinic staff up to our chief operating officer. That has been a huge factor in relieving the stress that goes along with a deployment.” When she returns from her 90-day deployment, her practice will be waiting. “It’s a little easier for me since I’m an employed physician and have a partner,” Tew said. “It can be really difficult for people to leave their jobs and families for three months.” Tew is ready for the physical rigors of
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Tew (center) with her mother and father.
deployment, having been fitness-oriented all her life. “When I was young, my dad would get home from work and I would run with him” she said. “I remember trying to do push-ups when I was just seven years old.” Over the past few years Tew has completed two half-ironman triathlons and numerous half-marathons. “I call it a triathlon culture,” Tew said. “It encompasses your whole life, and
I absolutely loved it. I got out of it when I was in residency because it’s difficult to do three-hour bike rides when you’ve got 80 hours a week in residency time. She also exercises with high-intensity interval training in addition to strength training. “I’m in the gym six to seven days a week doing weightlifting and cardio,” Tew said. “I also try to watch my calorie intake. I believe everything is okay in moderation,
but when people talk about having a sweet tooth, I say all of my teeth are sweet.” Tew shares her passion for athleticism with her husband Carlo Schiavoni, who is the director of a soccer club in Vestavia Hills, having played for the Canadian national soccer team and for UAB. Of course, she will miss her husband and family while overseas, but she will be ready for the challenge and enthusiastic to see her patients on return.
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Birmingham Medical News
JANUARY 2017 • 3
Functional Medicine The Power of “Why?” By Laura Freeman
Primary care physicians see it almost every day. Patients come in complaining of fatigue. The exam is normal, labs raise no flags, and questions yield few if any clues. At that point, with the time pressures of a typical office visit, it’s tempting to tell patients to try to get more rest and perhaps write a prescription treating the symptom, hoping they will report an improvement on their next visit. Functional medicine takes a different approach. This growing trend in patient care focuses on digging down to uncover the underlying root causes of symptoms. The results from this approach have been so well received that the Cleveland Clinic’s Functional Medicine program has a two-year waiting list. “We could prescribe an ointment for a rash, but sometimes we can learn more by asking why it’s there. Could it be related to a gut problem that may have broader implications for the patient’s overall health? Is it the first sign of a developing autoimmune disturbance that could be headed off with early intervention?” James McMinn, MD said.
During his years as an ER physician, Mcminn became interested in health from a broader perspective. After seeing benefits in his own life from improving nutrition, becoming more ac- James Mcminn, MD tive and reducing stress, when he opened his practice, he took a more holistic approach to help his patients do the same. At Harvard and now as an assistant professor at UAB, he has been passing on what he has learned to other physicians. “I use traditional medicine when traditional gives my patients the best outcome. But integrative medicine gives me a bigger tool box so I can better personalize treatment to my patients,” McMinn said. “Functional medicine takes this another step forward. Instead of just dealing with the complaint that brought the patient into my office, focusing on underlying root causes helps me identify issues that could be related to broader health concerns and possibly prevent problems that could be developing.” As an example of how he uses functional medicine in everyday practice at
Mcminn Clinic in Homewood, he described a recent case. “The patient came to our office complaining of fatigue,” McMinn said. “She didn’t have the energy to do the things she needed to do, and it was affecting her whole life. Fatigue is one of the most common complaints physicians hear, and it usually has multiple causes, which can make treating it effectively more difficult. “I usually start with a good history, an exam and labs looking at metabolism, blood sugar, and electrolytes. In some cases, I may follow up with genetic or other testing if I suspect a particular problem. “This patient had issues with sleep and nutrition, but what stood out in the labs was a low thyroid level. So, following the functional medicine trail, I asked the next question. Why? Why does this woman have a low thyroid level? I looked at her thyroid antibodies, and they were high. So, why are this patient’s thyroid antibodies high? Digging deeper into her history, I found that she noticed the problem after taking antibiotics,” Mcminn said. “Antibiotics are known to affect the body’s microbiome and kill off helpful
bacteria, which allows harmful opportunistic bacteria and fungi to grow. In turn, this can lead to leaky gut syndrome. The increased permeability of the gut allows particles to enter the blood stream, which hyperactivates the immune system. As it turned out, the patient had three separate autoimmune disorders—thyroiditis, alopecia and PCOS. “Thyroid medication and getting better sleep and nutrition did a lot. What made a big difference in how she felt overall was improving her gut health.” So how does Dr. McMinn help patients improve their gut health? “Gut health goes both ways. Poor sleep and stress can impair gut health by affecting the vagus nerve and reducing motility. Patients with poor motility may need something to help. There are prescription medications that can help, but patients may experience side effects. This is one example of how having a bigger integrative medicine tool box to treat patients can make a difference. I’ve prescribed two different herbal cocktails that I have found to be effective and generally well tolerated by most patients. “A key factor is what patients put in (CONTINUED ON PAGE 8)
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Birmingham Medical News
A Wellness Approach to Chronic Disease By Laura Freeman
Life should be a joy—not an endurance race. The dissonance between how human bodies evolved to live and how modern life is pushing us to live has created a plague of lifestyle-related chronic illnesses. Diabetes, hypertension, immune disorders, obesity and a whole range of diseases of lifestyle are diminishing both the length and the quality of so many lives. Due to their chronic nature, medical interventions tend to be aimed more at managing these diseases and treating their symptoms after they have been diagnosed. But what if, instead of trying to hold back the deluge when it is in full flood mode, you begin interventions upstream where there may still be time to redirect the course of the disease? What if, instead of trying to extinguish an inferno of inflammation with medications alone, you take away the triggers fueling the fire and perhaps add in a few flame retardants to avoid rekindling? In chronic diseases, wellness medicine is particularly suited to work hand in hand with traditional medicine to improve outcomes and the quality of patients’ lives. It also empowers patients to
fight back in what is often a frustrating battle to improve their health. “Lifestyle diseases are the scourge of the modern world,” Farah Sultan, MD, founder of Vitalogy Wellness Center, said. “Desk jobs keep us sedentary, where we can’t use our muscles or burn calories. Time pressures Farah Sultan, MD have us grabbing fast food or packaged foods heavily processed with too much salt, sugar, carbohydrates, and additives. Add to that the stresses of trying to earn a living, raise a family and just get through the frustrations of everyday life, and you have a perfect environment for chronic illnesses to thrive.” Sultan, an internist in Homewood, focuses much of her practice on wellness. She works to help healthy patients avoid preventable diseases and to help those with chronic diseases and other serious conditions improve their health. “We see so many patients whose symptoms haven’t resolved with medications alone, or who have had side effects or can’t take medications because of other conditions,” Sultan said. “Some want to enhance their response to treatment, or
to have us work with their physicians to coordinate supportive care. For example, we have vitamin therapies for patients who have had gastric surgery or who want to build their immune system during chemotherapy. “For patients with chronic illnesses, we offer an intensive 90-day program to accelerate their progress. After testing and assessment, we begin by improving the quality of their nutrition. The emphasis is on real food—fresh produce, lean protein and healthy fats while avoiding the excessive sugars, salt, transfats and additives in heavily processed foods. “Exercise is also medicine. Even those who can’t manage exercise classes can usually start gently with chair yoga and build their strength step by step till they can do more. Another important part of self-care is stress reduction. We can help patients learn to use stress reduction techniques like meditation and yoga to reduce the physical effects of stress and bring their mind and body into balance.” The fourth element of the program is personalized to each patient based on their diagnosis, lab values, and in some cases, genetic testing. “When nutritional values aren’t where they should be, or when evidencebased research suggests that vitamins,
herbal compounds or other supplements can help alleviate symptoms or help to optimize the patient’s health, we finetune an individually designed program of supplementation,” Sultan said. “For example, many of my patients have very low levels of vitamin D. In those cases, I sometimes do genetic testing that can indicate whether the patient has a receptor defect that requires extra supplementation. “Vitamin D is essential to a healthy immune system, metabolism, muscles and bones, and it is a precursor to hormones. Patients who are taking statins to reduce cholesterol are also likely to need a good quality coenzyme Q-10. It helps to prevent muscle cramps and replaces the body’s supply of the enzyme that statins tend to diminish. For people who can’t take statins due to other health issues, there are botanicals and nutrients that can help reduce cholesterol. Omega 3s, turmeric, and resveratrol are a few of the supplements that show good research results in improving health,” Sultan said. Feeling better, staying healthier and looking better are also part of wellness at Sultan’s Vitalogy clinic. “Chronological age and body age aren’t necessarily the same,” Sultan said. (CONTINUED ON PAGE 8)
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Birmingham Medical News
JANUARY 2017 • 5
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Birmingham Medical News
Birmingham Researcher Releases AsNeeded Drug for Anxiety, continued from page 1 decided somebody had to come up with something better.” The result is PanX. “This is not one drug. This has the potential for being hundreds of drug combinations,” Dooley says. “In sublingual form, it could offer relief within 15 minutes and the active ingredients are non-addictive.” The multitude of medicinal options derives from PanX being a combination of two active ingredients, one pulled from beta blockers and one from antiemetic antimuscarinic agents — two classes of historically-safe and non-addicting active ingredients. In a panic attack, the beta blocker interferes with adrenaline and addresses the cardiovascular symptoms of anxiety, such as increased heart rate and blood pressure. “That stops the racing heart which is the number-one symptom of an acute anxiety episode. I needed some active ingredient to do that,” Dooley says. “And I needed to marry it with something that would help with the anxiousness, fear, avoidance, nausea and sweating.” That turned out to be antiemetic antimuscarinic agents, commonly used to treat motion sickness and nausea. These address the non-cardiovascular and cen-
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tral nervous system symptoms of anxiety. “The combination is designed to suppress the multiple diverse symptoms of panic attacks or acute anxiety episodes,” Dooley says. Because PanX pulls from two classes of medications, it offers the advantage of a wide array of choices in active ingredients to suit patients. “You can combine any active ingredient from one class with any active ingredient from the other,” Dooley says. That can solve many comorbidity dilemmas, such as with anxiety patients who might be prone to asthma and need to avoid certain beta blockers such as propranolol. The flexibility of PanX extends to choosing the potency of the active ingredients as well, and even the taste. “Some drugs just taste bad, but PanX lets you choose ingredients with taste, if you want something sublingual,” Dooley says. “One could envision many different ways to make the products, even for the same patient.” Professor Charles Nemeroff, MD, PhD, Chairman of the Department of Psychiatry at the University of Miami stated in a PanX release, “A number of patients with anxiety symptoms do not respond or cannot tolerate currently available treatments. This novel approach combining two medications with distinct mechanisms of action has the potential to fill an important niche in the management of such patients.” The multitude of combinations categorizes PanX as new class of drugs. “Patents in pharmacology are typically very narrow — usually one active ingredient in a specific route of delivery and specific potency. This patent is extremely broad,” Dooley says. “This is a class of anxiety medications, like opioid painkillers are a class of drugs.” Dooley has already produced a handful of prototypes with the goal of clinical trials once sufficient investment funds are raised, which is currently underway. “We plan to sell products that are FDA approved or even over-the-counter,” he says. “But for now, we can sell PanX for patients, even for pets, as compounded pharmaceuticals, because the active ingredients are off-patent and are historically well known and already present in FDA-approved drugs.” Unlike so many new drugs on the market, Dooley says PanX will remain affordable. “We’re not talking ridiculous prices. Our goal is to have something to cause a calming effect rapidly but affordably,” he says. “And readily handy.” Whereas benzodiazepines are typically prescribed as daily preventive medications, PanX is intended to be put in a pocket for occasional use as needed. “If you know you have an event that will trigger your symptoms, you can take it and have rapid relief of your symptoms,” Dooley says.
Birmingham Medical News
JANUARY 2017 â€¢ 7
Functional Medicine, continued from page 1
Every Monday and Thursday, we’ll feature healthcare professionals discussing important medical topics. BirminghamMedicalNews.com look for BLOG on the right hand sidebar
their gut. If they have food sensitivities or allergies, those can cause continuing irritation until those problems are identified and eliminated. Sugars and simple carbohydrates can be feeding a fungus and harmful bacteria. Patients may need to follow a specific diet and take probiotics. “Physicians should also be mindful in how they prescribe antibiotics and in doing everything possible to protect the patient’s microbiome and get it back to normal when the course of antibiotics has been completed,” McMinn said. McMinn also pointed out that there is a strong connection between gut health and mental health. “There are ten times as many bacteria cells as human cells in the average human body, and some of those bacteria play an essential role in maintaining optimum levels of neurotransmitters and other biochemicals. The microbiome pro-
duces half or more of the serotonin circulating in the blood stream,” Mcminn said. “If the microbiome is damaged, it can have a profound effect on depression, anxiety and other mental health issues. “A mother who was at her wit’s end, fearing that she was going to have to put her daughter in an institution, came to me to see if anything could be done medically. Her daughter was exhibiting symptoms of severe anxiety and depression. When her history showed that the symptoms had developed suddenly after she took a strong antibiotic, I started her on a comprehensive program to improve her gut health. The symptoms disappeared, and she was soon back to normal.” With January being resolution time, what advice does Dr. McMinn have for people who want to have a healthy year? “Look for opportunities to be active.
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Unstress your mind—try meditation, yoga, prayer—whatever works for you. Outcomes are what is important. Make sure you are getting plenty of vitamin D— and avoid sugars and simple carbs. Those are the roots of all too many problems,” McMinn said.
A Wellness Approach to Chronic Disease, continued from page 5 “Telomeres at the end of our chromosomes are like the ends of shoe laces that keep them from fraying. They protect chromosome stability and the integrity of genes, as well as the number of times cells can divide and how long they can live. “As we get older, telomeres get shorter. Damage can shorten them prematurely. We do telomere testing to determine body age and potential risks to health. If indicated, we can supplement with astragalus root, a telomerase activator that may be helpful,” Sultan said. When patients are feeling better and are getting into shape, they may also want to look better. The clinic also offers a range of facial and skin care services. For those who have “get healthy” on their resolution list for 2017, Sultan has this advice. “Don’t make it hard. Start with baby steps and simple things you can easily do like keeping water near you so it’s easy to drink more; looking for ways to walk more like parking farther away. At the grocery store, do most of your shopping on the outer aisles, where you find real foods—fresh produce, meats and dairy. Stay away from the middle aisle and the shelves of processed packaged foods full of all the things you want to avoid. Go to the farmer’s market and get reacquainted with real food. Get it fresh from the people who grew it,” Sultan said. “Most of all, realize that health isn’t a resolution to be dusted off every January and forgotten before spring. You need to make a year-round commitment to your health and keep on track. You are the person with the power to make this life the best life possible. Be kind to your body.”
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St Vincent’s Opens Hospital in Chilton County By Jane Ehrhardt
For three years, Chilton County has been without a hospital, which at times, has been challenging for the community. For instance, last year, when a school bus crashed in Clanton, the children had to be driven 30 miles away to Shelby Baptist Medical Center in Alabaster. Fortunately, none of the injuries were life-threatening. That all changes with a new $40 million hospital constructed in Clanton off Highway 145 and Interstate 65, right up the road from the defunct Chilton Medical Center. “When the state health officer pulled their license, we looked into buying that building,” says Sibley Reynolds, secretary of the Chilton County Health Care Authority. But the renovation costs were expected to hit $11 million, so they decided against it. Instead, the citizendriven task force brokered a deal with St. Vincent’s Healthcare System to operate a new 30-bed hospital. “We are Neeysa Biddle excited to be a part of bringing a hospital back to Chilton County,” says Neeysa Biddle, Senior Vice President of Ascension Health and President and CEO of St. Vincent’s Health System. “This agreement represents a true partnership with the community. We are thankful to be expanding our presence in Alabama, as we continue to provide outstanding care to more patients throughout the state.” The facility, however, will be owned and built with the help of county monies. That funding derives from a temporary one-cent sales tax increase passed in a 2014 referendum. The tax stays in effect only long enough to pay for the construction of the hospital and to build up a fund for the maintenance of the property. Then the tax expires. St. Vincent’s has some experience with public/private partnerships. The 40-bed St. Vincent’s St. Clair Hospital in Pell City was also built with public funds. Opened in December 2011, that $30 million hospital stands on 165-acres owned the St. Clair Economic Development Council. The successful project was a partnership between the St. Clair County Health Care Authority, St. Clair County Commission, Pell City, the St. Clair County Economic Development Council, and St. Vincent’s Health System. For Chilton County, the hospital creates more than 140 jobs and $13 million a year in payroll. “As a part of Ascension, we bring the resources of the nation’s largest not-for-profit and largest Catholic health system to Chilton County,” Biddle
says. “St. Vincent’s Chilton not only has St. Vincent’s Health System as a partner, but all of Ascension – 141 hospitals, 160,000 associates and many physicians and others.” Called St. Vincent’s Chilton, the technologies incorporated in the facility make it one of the most energy-efficient hospitals in the country. “Members of the Chilton County Health Care Authority had a vision for making sure St. Vincent’s Chilton was designed in such a way that taxpayers’ funds would be spent wisely,” says Suzannah Campbell, the hospital’s administrator. High-tech elements within
the facility will conserve energy, limit long-term maintenance costs, and incorporate new temperature and air-quality technologies that also address infection control. “Generations of residents will benefit from that vision, as the technology in this facility lowers operating costs and the building’s environmental impact. St. Vincent’s is privileged to work with area leaders demonstrating such stewardship.” A full-service hospital, St. Vincent’s Chilton will provide 24/7 emergency services with seven emergency rooms and two trauma bays, along with quality surgical services from complex to minimally
invasive surgeries. Orthopedic surgeons will also be available to perform same-day surgeries, including laparoscopic joint repairs and carpal tunnel fixes. The diagnostics capabilities include an MRI scanner, a 64slice CT scanner to view threedimensional images of the body, nuclear medicine, digital mammography, ultrasound, x-rays and fluoroscopy. Their new lab will end the delay in sending blood or other testing outside of the area for analysis. Specialties will cover the expected full spectrum of typical needs from cardiac rehabilitation, respiratory care, and neurological services to the full array of therapy, including physical, occupational, and speech. A few of the more focused specialists will also be on-site, such as sports medicine, arthritis treatment, and pain management. Gastroenterologists will offer colonoscopies. Podiatrists will provide foot diagnostics and treatments, and ophthalmologists will address cataracts and other vision issues. St. Vincent’s is contracted to operate the new hospital for the next 29 years. Already, plans are being finalized for a medical office building to be built adjacent to St. Vincent’s Chilton. It is slated to open in 2017.
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Birmingham Medical News
JANUARY 2017 • 9
Care at a Distance
UAB First in the Nation to Use Telemedicine for Dialysis Visits By Dale Short
“How are you feeling today?” the doctor asks the dialysis patient. “Everything’s going good,” she says. “Are you having any belly pain? Shortness of breath?” She answers no, and the doctor proceeds with a stethoscope exam, inspects her legs for swelling and her catheter site for any signs of drainage or infection. Then a nurse draws her blood for lab work. It’s a routine medical visit for UAB nephrologist Eric Wallace, MD with one exception: the patient is 100 miles away. The stethoscope at the distant exam site is Bluetooth-enabled, and the visual check is done with a handheld video-cam connected online. The pilot program in which Wallace partici- Eric Wallace, MD pates is thought to be the first in the country to replace an in-person dialysis visit with its telemedicine equivalent. “Our aim is to bridge the subspecialty care available at UAB to areas that may not have it,” Wallace says. “Alabama has one of the highest incidences of end-stage
renal disease in the U.S., and it’s a rural state so there are many patients who have little or no access to subspecialty care like nephrology and dialysis.” His patients have adjusted well to the new long-distance setups. One older lady told Wallace that her son, a NASA engineer, would be amazed by this. The new program has been years in the making. “The only way it could have occurred was through the constellation of events that allowed me to meet up with Michael Smith, who is in charge of distance learning at the Alabama Department of Public Health (ADPH),” Wallace says. “They were already increasing their telemedicine network, and it evolved from there. “If we did it with dialysis only it would probably be cost prohibitive, but ADPH developed a network that other programs can join. The more programs that use it, the lower the cost per visit becomes.” The Department started out with six telemedicine equipment carts at its facilities around the state, and has since added 15 more. “My goal,” Wallace says, “is to have some traditional clinical exams in my office, and then connect to ‘be in’ several county health departments seeing other patients with telehealth. I could be in multiple places within a normal half day
of clinic.” Wallace says that it’s a simple process to set up a new location with a telehealth cart. “I drive to that county, meet all the nurses, and familiarize them with the equipment. After that, it’s easy to catch on to. ADPH has access to a phenomenal group of nurses, and they’ve been nothing but supportive of this.” He looks forward to more counties joining the network, and says that nephrology is only one aspect of the impact telemedicine can have. “If I can provide a fully comprehensive telehealth visit for a home dialysis visit--which is one of the most complicated visits to do--then we can do this for any patient and any disease. There are many clinics here that deliver subspecialty care that can only be available in a university setting, such as rare diseases. Now that can be extended to every corner of Alabama and thus increase the quality of patient care. The gaps in care and education that telehealth can bridge are tremendous.” Will Ferniany, CEO of the UAB Health System, agrees. “With UAB and the ADPH, you have two of the largest health care providers in the state working together for one common goal, to improve the health of the residents of Alabama,” he says. “The examples of what telehealth
can achieve for Alabamians are limitless. The real question is how we organize it so that it can be successful.” Wallace envisions a wide range of refinements in the future. “There are companies whose customer service departments let you leave a phone number and a person calls you when they’re ready. There’s no reason that couldn’t work. You’re at home and when it’s your turn for a clinic appointment somebody calls you. The point is to maximize care and minimize the time patients spend in receiving this care. “Life is changing so much due to technology, and medicine has been relatively slow in catching up, so it’s time. And so much more is possible. We can have a telehealth network to service both the adult and pediatric populations to help ease the burden on patients and their families. I hope this is just the beginning of telehealth in our state.”
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End in Sight for Medicare ALJ Backlog? by
As providers who are currently undergoing a Medicare claims appeal know, there is a lengthy delay to having an appeal actually heard by an Administrative Law Judge (ALJ). Some estimates indicate that it will currently take over 10 years to have an appeal heard. Due to a recent Court Order, that delay may be shortening over the years to come, which brings much needed relief to providers awaiting an ALJ hearing. Before discussing the recent Court Order, a brief review of the Medicare claims appeal process is in order. When a provider receives notice that a Medicare claim has been improperly paid and that an overpayment exists, the provider has the right to appeal that decision. The first level of appeal is called a Redetermination. Under the Redetermination phase, the appeal is heard by the provider’s Medicare Administrative Contractor (MAC) based on written submission. While the provider has 120 days to file a Request for Redetermination review, if the request is filed within 30 days, the filing stays the recoupment of funds. In other words, the appeal filing prevents the MAC from offsetting the alleged overpayment with current or future amounts owed to the provider. This stay is a huge benefit for providers who disagree with the overpayment find-
ing and are pursuing an appeal. Following the Redetermination review, if the decision remains unfavorable to the provider, the provider may file a second level of appeal called a Reconsideration. Under the Reconsideration phase, the appeal is heard by a Qualified Independent Contractor based on written submission. While the provider has 180 days to file a Request for Reconsideration review, if the request is filed within 60 days, the filing once again stays the recoupment of funds by the MAC. Following the Reconsideration review, if the decision remains unfavorable to the provider, the provider may file a third level of appeal with the Office of Medicare Hearings and Appeals (OMHA). This appeal is heard by an ALJ and is the first opportunity the provider has to a live hearing—as opposed to review based solely on written submission. While the provider has 60 days to file the request for an ALJ hearing, there is no opportunity at this level to delay recoupment. In other words, despite the fact that an appeal has been filed, the MAC may offset Medicare funds. Arguably to counter-balance this downside to the provider, the OMHA is legally required to grant the provider a hearing and a decision within 90 days of the appeal request. However, in recent years, due to the large number of appeals being filed, the
OMHA has not been able to meet its 90day deadline. In fact, the delay to obtain an ALJ hearing has grown exponentially and the latest report from the OMHA indicates that it will take approximately 10 years for the OMHA to process its backlog of appeals. All the while, Medicare may offset Medicare funds to recoup the disputed overpayment. As you can imagine, depending on the size of the alleged overpayment, this delay combined with the offset of Medicare funds can be devastating for a provider, and, in some instances, drive a provider out of business. In response to this delay and the detrimental impact on providers, the American Hospital Association filed suit against The Department of Health and Human Services (HHS) for its failure to meet the legally required deadline and in an attempt to push for a resolution of the backlog. After a lengthy court proceeding, the United States District Court for the District of Columbia recently issued its Order in favor of the American Hospital Association. The Court ordered HHS to resolve the current backlog of ALJ appeals by meeting the following reductions in current case volume: • 30% reduction by December 31, 2017; • 60% reduction by December 31, 2018; • 90% reduction by December 31,
2019; and • 100% reduction by December 31, 2020. In addition, HHS must file status reports with the Court every 90 days. What remains to be seen is how HHS will achieve this reduction with its current budget restraints. While several proposals were discussed among the parties in the course of the legal proceeding, the Court refused to place specific procedural limitations on the federal agency, leaving HHS with discretion in how best to achieve the Order’s targets. If the decision stands (at the time of writing this article, an appeal had not been filed by HHS), it will provide some much needed relief to providers currently awaiting an ALJ hearing. While providers will still not receive a hearing within the 90day period, instead of having to wait the perceived 10 years for an ALJ hearing, as predicted, current appeals will be heard sometime within the next four years. Stay tuned to see if an appeal is filed by HHS or how HHS will meet the Court-ordered reduction in case volume. Kelli Fleming is a Partner with Burr & Forman LLP practicing within the firm’s Birmingham office. Fleming practices exclusively within the firm’s Health Care Industry Practice Group.
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Reinventing the State’s Malpractice System, continued from page 1 doesn’t mean you don’t continue to work through it.” “We did not support it last session, and I do not anticipate we would support it in 2017,” says Mark Jackson, executive director of MASA. “This whole concept is a very unproven liability system that we’re not aware of in this form anywhere else in the country.” The same or a similar proposal has been inMark Jackson troduced in several other states, including Florida, Georgia, Ohio and Tennesse, but has yet to pass. “These bills don’t seem to get anywhere. Close examination shoots them down,” says Frank O’Neil with ProAssurance Corporation, the third largest malpractice firm in the country and the
primary insurer in Alabama. The bill would have established a new system under the Alabama Department of Public Health. Patients seeking redress for a medical injury would submit an application. The Office of Medical Review, created by the new system, would determine whether evidence supported the patient’s claim. The healthcare practitioner cited in the claim would then support or oppose the application. Contested applications move on to an Independent Medical Review Panel. If found valid, the patient receives compensation based on a predetermined schedule of payouts set by a panel of physicians and medical experts. An appeal of final determinations could be made to the circuit court. The government’s involvement and the complexity of the system raises criticisms. “Government is not the place you
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look to for efficiencies,” Jackson says. “It becomes a bureaucratic quagmire.” The financial end of the system adds more government layers. A Patient Compensation Board would govern the system and approve the compensation schedule. The monies would come from an annual contribution made by healthcare practitioners based on their type of practice. The Office of Compensation, also created by the new system, would oversee the fund. The pre-set compensation schedule should mean a major decrease in total payouts on claims. However, Mark Jackson disagrees. “That appears to be true,” he says, “until you realize the number of claims will increase exponentially because all you will have to do to put a claim in the system is to call an 800 number and say, ‘hey, I didn’t like what happened with my doctor’.” Proponents of the bill state the new process would dampen physicians’ need to practice defensive medicine to cover any vulnerability to malpractice claims. They estimate the extra tests and labs that physicians request will cost Alabama $1.3 billion in Medicaid over the next decade and $106 million in state health insurance plans in 2015. “If it could produce that change in the culture of medicine, it would be years in the making,” Jackson says. Physicians would still have to defend their cases under this system. Only time would tell if defensive medicine strategies would still play a viable part in their defense. “We feel like the liability system we have in place now, while not perfect, is much more preferable than this proposed system that has no proven track record,”
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Jackson says. The Act that malpractice works under today was passed in 1987 and amended in 1992. O’Neil agrees. “Alabama has a carefully constructed, evolved system that includes safeguards for plaintiffs and patients that works well,” he says. “Insurance rates are based on losses. If losses go up, rates go up. Rates have been steady in Alabama for over 15 years.” Another unseen vulnerability for physicians lies with the National Practitioner Data Bank (NPDB), a confidential information clearinghouse, created by Congress, that tracks malpractice claims and settlements against physicians and other healthcare entities. Going through the courts, malpractice claims get stripped down to the ones meriting court appearances. “Under this system, every time someone called in, that goes into this databank which is not fair,” Jackson says. Pittman agrees that multiple areas of the plan need more scrutiny, including the payouts. “When you create a pool of money, you create a whole new ballgame,” he says. There is also the question of what to do if the pool of money runs out or leaves a surplus. And there is Tripp Pittman uncertainty about how payments to the fund would be handled in the physician’s taxes. “When you first hear about this proposal, it sounds great,” Jackson says. “However, as we dig into it, we find that it doesn’t live up to its objectives. It’s unproven, so a lot of this is speculation.” Jackson says there may be isolated cases where a physician who would have lost a case in court might fare better through this system. “But in general, it does not benefit physicians,” he says. “It takes away the jury of their peers and the provisions and precedents of the medical liability act that created the level playing field in Alabama.” “There are a lot of details that make this more complex than laymen like myself would realize,” Pittman says. “But as a businessman, I understand putting deals together.” Hoping to still find a new solution to malpractice costs, the Senator brought proponents, including Ted Hosp with Maynard Cooper, and opponents, like MASA, together at a meeting in December. “The meeting certainly was vigorous with a lot of passion on both sides, but not a lot of consensus,” Pittman says. As of the end of the year, the proponents are redrafting the proposal to address concerns. “Then we’ll see if there’s something to discuss,” Pittman says. “When you think you’re moving toward something better, it’s not always as straightforward as you would hope.”
A Year of Uncertainty … and Opportunity By CINDY SANDERS
Last month, PwC Health Research Institute released its annual report highlighting the forces anticipated to have the greatest impact on healthcare in the coming year. “Top Health Industry Issues of 2017” outlined 10 areas ranging from healthcare plans under a new administration and the move to ramp up value-based payments … to public health concerns over infectious disease and a public outcry for more transparency in drug pricing. “The report enumerates 10 items, but I think there are some themes,” said Nick Walker, a partner with PwC’s Health Industry Practice. “The fate of the Affordable Care Act dominates the day, and uncertainty is the theme of the day.” He added, “Until the fate of the ACA comes into focus, there is a sense of unrest.” However, Walker continued, “The driving force in healthcare hasn’t really changed, and that’s the move towards value.” Moving to a value-based system is a bipartisan priority … although the path to get there could look very different once President-elect Donald Trump takes office. Walker noted that as a candidate, Trump’s healthcare policy raised more questions than answers with a lack of specificity. Since the election, Trump has moderated his stance, moving from ‘repeal’ to ‘repeal and replace’ to ‘repeal, replace a lot, but keep some.’ Walker noted, “I think the new administration is beginning to understand how disruptive a full repeal of the ACA might be.” He pointed out to simply repeal the law would mean 20 million Americans would lose insurance coverage … and the health systems that serve them would lose reimbursement. “You would see massive uncompensated care in the system, and that’s a big problem. Frankly, it’s almost impossible to do a full repeal,” Walker said. “Also,” he continued, “the Trump Administration thinks there are some attractive parts of the law,” Walker said Trump has notably supported guaranteed issue so that those with pre-existing conditions could still have access to coverage and keeping adult children on a parent’s policy until the age of 26. “There’s a recognition that some parts of the program are useful.” While providers, health systems, and industry suppliers wait for direction on how to proceed, Walker said there are measures that could … and should … be undertaken including scenario planning, investing in education and advocacy, and rethinking historic M&A agreements to create new collaborative arrangements.
Scenario Planning Walker stressed the importance of scenario planning, particularly in uncertain times. Health systems, he noted, particularly need to think about what might happen, how that could impact business, and
what the response should be. What if 20 million lose coverage? What if they don’t, but premiums are higher? What does that do to your system and how does it impact non-urgent procedures? Walker said thinking through various scenarios and possible reactions helps providers remain nimble in the face of uncertainty. “You feel comfortable with health systems who say they don’t know what will happen, but they know how they might pivot depending on how things play out,” Walker noted.
Education & Advocacy “High performance organizations will invest in education and advocacy,” Walker said. This is particularly important in light of a new president with a strong business foundation but little healthcare or policy background. Walker pointed out it isn’t necessarily intuitive to recognize there is an interplay between guaranteed issue and premiums. Instead, a crash course in healthcare requires the disparate parts of the industry to explain the complex intertwining that causes a ripple effect with each decision. “Sharp organizations are pushing the envelope here,” he said. Innovative Collaborations “Historically, you’ve seen mega mergers. I think what you’re going to see in this new economy is more partnership strategies,” Walker said. He added those strategies might be in the form of joint ventures or other collaborations. Already, the industry is seeing more partnerships between for-profit companies and not-for-profit health systems and collaborations based on specialized expertise or geographic reach where partners work together but maintain autonomy. Opportunity from Adversity Walker said a question that should be on the mind of every innovator is: “When the dust settles, what’s going to be up for grabs and how can I take a shot at it?” Nationally, he noted, several big payers pulled out of exchanges. “That left 1.6 million folks, which translates into $8 billion in premiums, up for grabs,” he said. Walker was quick to add there was a reason those large insurers opted out of specific markets, but he said it still leaves an opportunity to look at technology, collaborations, and other innovations to transform that void into a value proposition. As America enters this new era in healthcare reform, Walker said, “Those who will do best are organizations that have demonstrated the ability to adapt … organizations that have demonstrated the ability to innovate … and organizations that know how to build for value.” For additional insights and information, go online to pwc.com, click on industries and then select health industries.
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Addressing Childhood Obesity By CINDY SANDERS
Six years ago, the U.S. Preventive Services Task Force (USPSTF) released evidence-based recommendations for screening and treating obesity in children ages six and older. Last month, a diverse group of 43 stakeholders published a consensus report showing those recommendations are still not being implemented with consistency. A number of barriers to optimal care and potential solutions were highlighted in “Improving Access and Systems of Care for Evidence-based Childhood Obesity Treatment: Conference Key Findings and Next Steps.” The paper, which published online Dec. 7 in the scientific journal Obesity, was led by the American Academy of Pediatrics (AAP) and The Obesity Society (TOS), with funding support from the Agency for
Healthcare Research and Quality (AHRQ) and the AAP, to address what has become a national epidemic. “With nearly one in three children in the United States with overweight or obesity, there is an urgent need to help these children get access to the evidence-based care they need to get healthy,” said Denise E. Wilfley, PhD, lead author, professor at Washington University School of Medicine, and a TOS Fellow. “The consensus group was successful in identifying several barriers to care that impede widespread implementation of the USPSTF recommendation, including lack of health insurance coverage for treatment.” Co-author Stephen Cook, MD, FAAP, FTOS, an associate professor of Pediatrics with the University of Rochester Medical Center and Golisano Children’s Hospital in New York, said the process began in
July 2015 with a multidisciplinary conference. “We were able to bring together a lot of stakeholders from across the spectrum,” noted Cook, who served as the meeting’s co-leader with Wilfley. In addition to researchers and clinicians, he said attendees included representatives of state and federal policy organizations, professional societies, state Medicaid offices, private payers and large employer groups. At the center of the USPSTF recommendations was a call for at least 26 hours of moderate to high intensity behavioral modification interventions. Cook, who is also the associate director of the AAP Institute for Healthy Childhood Weight, said getting kids into such programs and having those interventions be fully covered remains an issue. Screening, he added, has come a long way. “When we asked physicians if they
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were screening (for obesity) in 2006, it was around 50 percent. That’s become more consistent.” In fact, he noted, with automatic plotting of height and weight, most physicians would almost have to disable computer programming not to see where a child falls on the growth curve. The Centers for Disease Control and Prevention defines childhood obesity as a BMI at or above the 95th percentile for children and teens of the same age and sex. “So the question becomes when the doctor sees it, how comfortable do they feel in starting the conversation and do they feel empowered to do so,” Cook asked. Finding and paying for a multidisciplinary program remains a key concern. “‘I don’t have anywhere to send them. Internally, I’m not trained in behavioral modification, and I have nowhere to refer,’” Cook said is a familiar refrain. “Now that healthcare is evolving, there are more options,” Cook said. However, he noted, reimbursement remains an issue. In making the recommendations, the USPSTF hit on 26 hours as an average. “But the problem is there aren’t really any studies or interventions that specifically say or deliver 26 hours, and there aren’t really any protocols or studies for 26 hours. It’s usually 35-50 (hours) in moderate-intensity studies or interventions,” Cook explained. That difference in the evidence-based behavioral modification protocols being used and what most insurers are willing to reimburse based on the recommendation leads to a payment gap, and Cook said that out-of-pocket difference is a very real barrier for many families. Another issue is in how childhood obesity programs are crafted. While an individual provider can deliver the protocol, Cook said the setup of the program must take a multidisciplinary approach, incorporate the family, and include strategies to not only implement change but to sustain those changes. Recently, the USPSTF did another review of the evidence to see if interventions were indicated for younger children or those with less severe weight concerns. Although the group concluded there wasn’t enough evidence to expand their recommendations, they reaffirmed the original findings. “The current evidence is still true, and the higher the intensity, the better the benefit,” Cook noted. “The fact is that the U.S. Preventive Services has reviewed the data twice and found the evidence for the intervention is there. The hope is that pediatricians and clinicians through advocacy channels – whether through professional organizations, state societies or their health systems – advocate both for offering the evidencebased strategies and, at a state level, for reimbursement,” he continued. “Obesity is the most stigmatized disease in this country,” Cook said. Yet, he concluded, not intervening appropriately during childhood means this chronic condition will continue to take a toll on individual health and the larger health system for decades to come.
Through the Looking Glass/Medicare Under a New Trump Administration By Philip M. Sprinkle II
What will be next for health care in the United States? While there have been some successes associated with the Affordable Care Act (“ACA”) such as health insurance coverage available for some Americans that had previously not had such access and increased emphasis on core quality standards such as avoidance of hospital acquired infections1, there are more critics than proponents. Arguments regarding the propriety of, for example, uncapped increases in annual insurance premiums or individual components of ACA such as the efficacy of for-profit auditors of the Medicare Integrity Program that cannot be attacked and are compensated on a cost plus basis with percentage kickback bonuses despite losing over 50 percent of rejected claims could fill volumes. And, ACA appears to have delivered health care to American poor while making health care access financially impossible for the middle class. What cannot be disputed is that ACA and its regulatory progeny have not been able to reduce the extraordinary economic pressures on the American health care system. The 2016 Trustees Report of the Medicare Program confirm, among other statistics, that the Medicare hospital trust fund (the core of Medicare) has been
operating at a deficit since 2008 and will be completely spent by 2028. The hospital trust funds meet neither short nor long term criteria for viability. The health care crisis has not been cured. It has, for now, been delayed, magnified and complicated. Into this regulatory and financial maelstrom, President-elect Trump must plunge. To assist him with this process, President-elect Trump has selected Representative Tom Price, MD (R/Ga.) as his yet-to-be-confirmed appointment as Secretary of Health and Human Services. Representative Price has been a stalwart opponent of ACA. Although the wholesale repeal of ACA may be impossible and, as noted below, imprudent, providers should be attuned to the following concepts that have been repeatedly touted by Representative Price: Emphasis on Patient Choice and Financial Independence. As a physician, Representative Price supports patient choice for providers and patient independence in financial matters. Accordingly, Price supports expanded use of and funding for Health Savings Accounts, patient/taxpayer options to accept tax credits for independent financial planning and to make Medicare itself an optional choice. State Block Grants. Price prefers the dilution of federal control over health care and suggests, as an alternative, grants to
individual states for the purpose of developing state-specific risk insurance pools for high-risk individuals and reinsurance. Relaxation of Antitrust Rules to Permit Interstate Insurance Competition. Consistent with the goal of permitting the consumer to exercise his/her own options, Representative Price suggests that antitrust laws should be relaxed to permit small employers to negotiate collectively with insurers and encourages the elimination of state barriers to insurance so that consumers may have the greatest flexibility in negotiating for insurance rates. Restrictions on Malpractice Claims. As part of an overall program to reduce health care costs, Price has suggested significant changes to malpractice claims. For example, he has proposed pre-trial Administrative Health Care Tribunals for each state compelling potential plaintiffs to complete extensive pre-trial reviews before claims may be asserted and even changes to the burden of proof for litigants depending on whether care was provided according to nationally-approved clinical guidelines developed by physician panels. In addition, Price has outlined new legislation to forbid lump-sum payments to plaintiffs. All of these concepts should be anticipated from a Trump Administration. In addition, a number of current ACA components should be anticipated to continue.
For example, tax assessments for 2017 should be anticipated for taxes already due and owing under the current ACA and its regulations. It is unlikely that earned but not yet collected tax revenues will be forgiven as part of any new iteration of ACA or any other federal health care law. Likewise, continued enforcement activity by the Office of Inspector General (OIG) should be taken as a given as the federal government continues, as the OIG reported earlier this year, to recoup $7 for every $1 in enforcement expenditures. As Presidentelect Trump might observe, “That’s just good business.” Under the new Trump Administration with Representative Price at the helm of HHS, rapid and significant changes in ACA should be anticipated. A review of H.R. 2300 introduced unsuccessfully by Representative Price would be appropriate reading for all health care providers as the likelihood of successful implementation by Secretary Price is high. Arguably, the correction of deficiencies that should not have existed in the first place may not be labeled a success. 1
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Advances in Genetic Testing Improve Diagnosis Capability By Bruce Korf, MD, PhD
Birmingham pediatricians now have expanded options for easily accessing genetic expertise and testing, with the recent opening of a genetics clinic at Children’s of Alabama. It’s important for physicians to consider when to refer a patient for genetic evaluation, especially for those patients who were unsuccessfully evaluated in the past. Most pediatricians have experience in recognizing children with congenital malformations, intellectual disability or developmental delay that may have a genetic component. When those patients receive a diagnosis, parents have at least a minimum understanding of what is happening with their child, how best to manage that child, and whether it may occur in their other children. Unfortunately, in the past a large percentage of patients went undiagnosed, even with an evaluation, putting the parents of young children on a seemingly endless quest to decide how best to manage their child’s medical conditions. A great deal has changed recently, however, and new tools, including microarray and genome sequencing, are available, which means we have the ability to achieve diagnoses that were not available to us before. So if you have been following a patient with medical issues that you suspect are genetic in origin, and that patient has not had genomic sequencing, it is likely time to refer them to a clinic for retesting. One of the new tools available to us is microarray testing, which gives us the ability to make a definitive diagnosis at much
higher rates than we could expect just a few years ago. Older tools would enable us to see the big picture, much like a satellite picture of the earth. Today’s tools are more like the Google Earth app, allowing us to zoom down to street level, so we can see detail on the genome that was previously impossible. Genome sequencing is another tool that has improved our ability to diagnose. The cost for the test is dropping dramatically. Once costing $100 million per run, the test and analysis are now in the $6,000 to $7,000 range. While that is still a lot of money, compared to the cost of other medical tests it is actually fairly reasonable. Microarray can be expected to pick up the genetic cause of 15 to 20 percent of autism spectrum disorder cases. Genome sequencing can pinpoint a diagnosis in about 30 percent of cases of children with intellectual disability, autism spectrum disorder, or congenital anomalies. Putting the two tests together means we can expect a definitive diagnosis in 50 percent of the cases presented to us. Considering that just five years ago we could only expect to diag-
nose about five percent, that’s a tremendous step forward in a very short time. At one time, a genetic diagnosis relied on the physician’s ability to predetermine the underlying problem in order to test for that particular disorder. Today, we are able to diagnose based on the tests, even finding conditions so rare that no physician would have considered testing for them in the past. And when a diagnosis still eludes us initially, we can now share results and experience with other geneticists around the world, enabling us to establish a diagnosis we may not have been able to make alone. In short, the tools we have at our disposal now have never been more powerful, so if you are a pediatrician following a patient and have been unsuccessful getting a diagnosis in the past, it is worth taking a second look now. Of course, putting a name to a disorder is only part of the battle. The next step is knowing how to treat a patient’s condition, and we have made progress in that area as well. Certainly, we can’t say we are able to treat every condition we see, but once we figure out which gene underlies the condition, we then begin to ask why the change in the gene causes the problems it does. And we are gradually figuring that out and identifying drugs that improve quality of life. With such dramatic and rapid developments in the field of genetics, there are many implications to be considered as we move forward. There is increasing discussion that perhaps everyone should have their genome sequenced, as the cost goes down and the feasibility of the testing goes up. This emerging area will have
to be addressed carefully. Between one to three percent of people whose genes are sequenced will discover a condition they did not realize they had or were at risk for, and virtually everyone can learn how their body manages specific medications or can become aware of risk factors for common diseases. But there are also questions about what options exist to manage these risks once they are known. We will have to proceed carefully in light of our increasing technological abilities. For patients with known medical problems that can be addressed with genetic evaluation, however, there are ample reasons to make referrals and try to determine a diagnosis that can improve quality of life for the patient and their family. In addition to the new genetics clinic at Children’s, we have a prenatal diagnosis program through OB/GYN and maternal fetal medicine at UAB, and our newest clinic at Kirklin Clinic for adults. If you have questions about referring a patient to one of our Birmingham area clinics, please call (205) 934-4983 to discuss. Bruce Korf, MD, PhD is a professor at UAB and the chair of the UAB Department of Genetics
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New Software Platform Potentially Generates More Revenue By Jane Ehrhardt
ARCpoint Health has unveiled a new software tool to enable primary care physicians to garner greater reimbursements and better manage labs. Developed by ErgoSum Health, the software platform is a web portal that offers pinpoint wellness exam guidance, triggers lab options and reminders, and coalesces all the reports in one web-based portal or meshes with the practice’s electronic medical records (EMR). The software tool is aimed at supporting the physician’s ability to keep up with some of the everchanging requirements of Medicare, the Affordable Care Act (ACA), and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). “This is designed by health care attorneys, some of whom worked on ACA legislation,” says Terry Pouncey, president of ARCpoint Labs of Birmingham at Greystone. “So it’s optimized to handle all the idiosyncrasies and legalities of that legislation, and also designed to be compatible with MACRA and Meaningful Use.” ARCpoint Health helps physicians not only meet those requirements, but potentially generate additional revenue. “A lot of reimbursements are now based on outcomes, so this platform increases reim-
Sherry and Terry Pouncey, owners of ARCpoint Labs of Birmingham.
bursements through compliance with the regulations,” Pouncey says. “And all the diagnostic tools are at your fingerprints.” For instance, Medicare pays $110 reimbursement for the annual wellness visit. “Statistics say only 10 percent of patients who are eligible actually get this exam each year,” Pouncey says. “Physicians may even be doing an annual exam but not following the regimen required by Medicare or incorrectly coding to qualify for the reimbursement. This platform helps solves that.” ARCpoint Health walks the physician
through the required questions for compliance and alerts the physician to additional assessments and lab tests covered under that exam that could enhance the diagnosis, such as the neurocognitive assessment. “Not a lot of neurocognitive tests give you a quantitative report off an assessment, but ARCpoint Health does,” Pouncey says, adding that the ancillary exams can lead to separate reimbursements. The software platform offers over thirty Behavioral Mental Health (BMHE) assessments, including for alcohol and substance abuse. “MACRA has specific guidelines for behavioral and mental health exams,” Pouncey says. “And these are MACRA-ready.” ACA also allows for yearly screening with several BMHE assessments. Some are self-assessments, allowing the patient to perform them on a tablet at the physician’s office. “The results are instant so the physician can have them prior to meeting with the patient,” Pouncey says. At the end of the wellness visit, ARCpoint Health also generates a seven-page patient care plan document required to be compliant. “Physicians may not be doing that, but they’re supposed to, and this software platform will give you the patient care plan that they can walk out the door
with,” Pouncey says. Through the ARCpoint Health’s web portal, physicians can access all the results at any time. Or they can utilize the EMR interface. “If they want the results also stored with their EMR and potentially order labs and view results through their EMR, they can do that,” Pouncey says. The aggregating of lab testing forms the other component of the software, including blood, genetic, blood allergy, pharmacogenetic, and toxicity for up to 30 different drugs at once. “The software has a prequalification engine that matches the patient’s diagnosis and medical conditions with medical criteria of that patient’s insurance to ensure proper diagnostic lab utilizations,” Pouncey says. It also matches the patient’s personal and family history and medications with the medical criteria of the patient’s insurance for genetic testing. Pouncey says ARCpoint Health takes the work out of finding labs for different testing. “They may have been using Lab A for basic blood tests, Lab B for genetics, and Lab C for allergy testing. But this allows you from a single platform to order all these tests, and the results come back into their EMR,” he says. “It’s a single point of order for all their lab work, and (CONTINUED ON PAGE 18)
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The Brookwood Baptist Health designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Brookwood Baptist Health and the CVA Medical Education Foundation. The Brookwood Baptist Health is accredited by the Medical Association of the State of Alabama to provide continuing medical education for physicians.
10/6/16 4:44 PM
Birmingham Medical News
JANUARY 2017 • 17
Why do Women Live Longer than Men? Women live longer than men. This simple statement holds a riddle that Steven Austad, PhD and Kathleen Fischer PhD of UAB explore in a piece published in Cell Metabolism. “Humans are the only species in which one sex is known to have a ubiquitous survival advantage,” the researchers wrote. Though other species show lifespan differences that may favor one sex in certain studies, contradictory studies with different diets or environmental conditions often flip that advantage to the other sex. With humans, however, it appears to be all females all the time. “We don’t know why women live longer,” Austad said. “It’s amazing that it hasn’t become a stronger focus of research.” Evidence of the longer lifespans for women includes: • The Human Mortality Database, which has complete lifespan tables for men and women from 38 countries that go back as far as 1751 for Sweden and 1816 for France. For every year in the database, female life expectancy at birth exceeds male life expectancy. • A lifelong advantage. Longer female survival expectancy is seen across the lifespan. It is also seen at the end of life, where data show that women make up 90 percent of the supercentenarians, those who live to 110 years or longer.
• The birth cohorts from the mid-1800s to the early 1900s for Iceland. This small, genetically homogenous country — which was beset by catastrophes such as famine, flooding, and disease epidemics — provides a vivid example of female survival. Over that time, “life expectancy at birth fell to as low as 21 years during catastrophes and rose to as high as 69 years during good times,” Austad and Fischer write. “Yet in every year, regardless of food availability or pestilence, women at the beginning of life and near its end survived better than men.” • Resistance to most of the major causes of death. “Of the 15 top causes of death in the U.S. in 2013, women died at a lower age-adjusted rate of 13 of them, including all of the top six causes,” they write. “For one cause, stroke, there was no sex bias, and for one other, Alzheimer’s, women were more at risk.” Although lab models like the roundworm C. elegans, the fruit fly Drosophila melanogaster and the mouse Mus musculus are intensively used in scientific studies, people in those fields are not very aware of how longevity patterns by sex can vary according to genetic backgrounds, or by differences in diet or mating conditions, Austad says. Those uncontrolled variables lead to different results in longevity research. A survey of 118 studies of laboratory mice by Austad and colleagues found that 65 stud-
ies reported that males outlived females, 51 found that females outlived males, and two showed no sex difference. But if variables are controlled, mice may prove to be a useful model to study sex differences in the physiology of aging. This understanding will be helpful as researchers start to develop drugs for human use that affect aging. “We may be able to develop better approaches,” Austad said. Differences may be due to hormones, perhaps the surge in testosterone during male sexual differentiation in the uterus. Longevity may also relate to immune system differences, responses to oxidative stress, mitochondrial fitness or even the fact that men
have one X chromosome (and one Y), while women have two X chromosomes. But the female advantage has a thorn. “One of the most puzzling aspects of human sex difference biology,” write Austad and Fischer, “something that has no known equivalent in other species, is that for all their robustness relative to men in terms of survival, women on average appear to be in poorer health than men through adult life.” This higher prevalence of physical limitations in later life is seen not only in Western societies, but also for women in Bangladesh, China, Egypt, Guatemala, India, Indonesia, Jamaica, Malaysia, Mexico, the Philippines, Thailand and Tunisia.
New Software Platform, continued from page 17 the labs themselves are in-network, all vetted out and approved for the platform.” Physicians choose the labs they want to use from the menu of options when they set up the platform. It also simplifies access to and ordering tests that may only occasionally be needed, like genetics. “This is targeted at primary care physicians who may do some cancer screening and allergy testing, but not do it every day, all day long,” Pouncey says. “This gives them access to some panels that are predefined, like ordering off a menu.” Pouncey says practices do not buy
ARCpoint Health. There is a per exam charge if any exams are used, but the lab platform service is free. “It’s no different than ordering a lab test now, you’re just using this platform to do it,” he says. Besides the ease of handling lab testing, Pouncey says the value in using ARCpoint Health comes from the underutilization of these Medicare exams. “This platform enables that option for physicians in a precise and compliant manner, so you don’t have to worry so much about claims rejections. You’re not having to chase reimbursements anymore.”
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18 • JANUARY 2017
Birmingham Medical News
Wide Awake Hand Surgery By Michael D. Smith, MD
Wouldn’t it be nice to have the option of undergoing anesthesia or being offered the choice of a “wide awake” alternative similar to when you have a dental procedure? As a new hand and upper extremity surgeon, I often meet patients who, for one reason or another, would like to have surgery to correct their problem but don’t want to undergo anesthesia. Some patients have difficulty arranging a ride to pick them up after they had undergone the sedation or others believe they are too high-risk to undergo anesthesia secondary to a significant cardiac or pulmonary co-morbidity. For these patients, I have begun to offer the possibility to have their surgery done under Wide Awake, Local Anesthesia with No Tourniquet or WALANT as it’s known within the hand surgery community. This technique can be used for a variety of hand surgeries such as carpal tunnel syndrome, trigger finger and excisions of mucous cysts. WALANT utilizes one percent lidocaine with 1:100,000 epinephrine buffered with 8.4 percent sodium bicarbonate to provide both local anesthesia to the hand or digit and to also provide hemostasis. This allows the surgeon to avoid using a tourniquet, which is often the most painful aspect of the surgery for patients who are having a procedure done under light sedation. For years, medical students have been taught to never inject lidocaine with epinephrine into the fingers for fear of causing irreversible ischemia and digit necrosis. The familiar adage of no epinephrine into “fingers, nose, penis and toes” was well-
ingrained into my head by the time I had graduated from medical school in 2010. However, Dr. Don Lalonde, a hand surgeon from New Brunswick, Canada, has published his results of over 2000 cases using epinephrine in the finger and has been at the forefront of debunking this commonly held myth. Dr. Lalonde has also published his research into the myth itself, and has found evidence that origin of the myth stems from the use of procaine (Novocaine) in the early 1900’s before the introduction of lidocaine in 1948. Procaine started with a pH of 3.6 and became more acidic as it sat on the shelf. It is likely the reports of digit necrosis after “epinephrine” injection in the early 1900’s were actually cases of highly acidic procaine causing the digit necrosis. Dr. Lalonde has a new adage, “If the
tourniquet. In my practice, patients are sometimes nervous about being awake during their surgery, but they often find that their worry is worse than the reality. In truth, I find the opportunity to talk with my patients during their surgery is a great avenue to build my relationship with the patient, but also to reiterate the post-operative protocol I would like for them to follow. I think most of my patients who have undergone WALANT would agree that it made their surgical experience simpler and more enjoyable. Michael D. Smith, MD practices hand and upper extremity surgery with Southlake Orthopaedics Sports Medicine and Spine Center.
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UAB Ranked Near Top in Federally Funded Research New data from the National Science Foundation shows UAB ranked No.18 nationally among public universities and No. 34 overall in federally financed research in 2015, with more than $328.5 million in expenditures. UAB’s total research expenditures exceeded $516 million in 2015, ranking the institution No. 25 among public universities and No. 41 overall nationally. Federally funded research expenditures at UAB have risen from $290.1 million in 2013 to $328.5 million in 2015. UAB President Ray Watts says the increase comes from targeted initiatives of the institution’s aggressive strategic planning process. “As we change the world for the better, it is critical to grow a research enterprise that supports every area of our mission from education to patient care, community service and economic development,” Watts said. At No. 34 in federal research expenditures, UAB ranks sixth among Southeastern universities, behind only North Carolina (8), Duke (10), Georgia Tech (11), Vanderbilt (24) and Emory (27). UAB ranked No. 22 overall in Life Sciences, as well as No. 22 overall in funding from Health and Human Services and No. 10 nationally among public universities.
fingertip is pink before the lidocaine with epinephrine, it will be pink after the lidocaine with epinephrine.” In addition, there is a reversal agent, phentolamine, that can reverse the hemostatic effects of epinephrine injections within an hour or two. Some of the advantages of WALANT hand surgery include: • Little to no pre-operative testing, as the only two medications being administered are lidocaine and epinephrine. • Patients are able to drive themselves home, as they have had no sedation or anesthesia. • Patients do not need to fast or change medication schedules before the procedure; which is especially helpful in my diabetic patients. • Patients do not need to endure a
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HealthSouth CEO Jay Grinney Retires
UAB Names Vice President of Research After National Search
CEO Jay Grinney retired from HealthSouth at the end of 2016. Executive Vice President and COO Mark Tarr has succeeded Grinney. Leo Higdon Jr., Chairman of HealthSouth’s Board said that Grinney “joined HealthSouth as Jay Grinney CEO at a critical time in the Company’s history and led HealthSouth through a successful turnaround and eventual repositioning as one of the nation’s leading providers of post-acute serMark Tarr vices.” Grinney oversaw the divestitures of non-core businesses, created a strong and flexible balance sheet, and developed a capital allocation strategy that included investments in growing the Company, the initiation of a quarterly dividend and the opportunistic repurchases of the Company’s common stock. He also created a robust development pipeline and led many successful transactions, including the acquisitions of Encompass Home Health and Hospice, Reliant Hospital Partners, and CareSouth, successfully expanding the HealthSouth network to 34 states.
Christopher S. Brown, PhD, former vice president of Research for the University of North Carolina System, has been named vice president of Research at the University of Alabama at Birmingham. Brown comes to UAB from North Carolina State University where he is a Christopher S. Brown, PhD professor of plant and microbial biology and works to develop largescale research teams. He is the director of the NASA/North Carolina Space Grant, as well as chair of the 50-state National Space Grant Alliance. Brown has more than 26 years of experience in research, teaching, research program management, and university/government/industry collaboration. “UAB recently vaulted 36 spots in U.S. News & World Report’s Best Global Universities, due in large part to our growing world impact in research,” said UAB President Ray Watts. “I am confident that Dr. Brown is the right leader to capitalize on that momentum.” From 2012-2016, Brown served as the vice president of Research at the University of North Carolina System, with its 16 public universities, $1.35 billion in research awards in 2015 and 225,000 students. New awards for UNC System research grew by $125 million during his time as vice president.
“I am honored President Watts selected me,” Brown said. “What stood out to me as I pursued this position is the opportunity to aggressively expand UAB’s already impressive and impactful research portfolio to drive discovery and economic development.” Since 1996 as a faculty member and research scientist, Brown has received more than $22 million in grants for research, education and commercial development projects from federal and state sources.
Medical Association Applauds Tom Price, MD for HHS Secretary The Medical Association of the State of Alabama applauds the nomination of U.S. Rep. Tom Price for secretary of the U.S. Department of Health and Human Services. “Congressman Price is a strong advocate for preserving the patient-physician relationship, which inTom Price cludes fighting for patients’ rights as well as preserving physician autonomy,” said Medical Association President David Herrick, MD. “Dr. Price has worked with our Medical Association leadership for many years on the national level to deregulate medicine and ease the administrative burdens placed on physicians. We feel that as a physician, Dr. Price understands firsthand what the health care system needs
to get back on track so our physicians can focus more on treating their patients and less on red tape.” For nearly 20 years, Dr. Price worked in private practice as an orthopaedic surgeon. Before coming to Washington he returned to Emory University School of Medicine as an Assistant Professor and Medical Director of the Orthopedic Clinic at Grady Memorial Hospital in Atlanta, teaching resident doctors in training. He received his Bachelor and Doctor of Medicine degrees from the University of Michigan and completed his Orthopaedic Surgery residency at Emory University. Should Dr. Price be confirmed as secretary of the U.S. Department of Health and Human Services, he would be the first physician to serve in that position since 1989 and the third physician in the 63-year history of the department. The Medical Association strongly feels physician leadership of HHS and in the President’s Cabinet would provide the necessary perspective that has been lacking in the health care decisions of our country.
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Dermatology • Endocrinology • Maternal Fetal Medicine Gastroenterology • Infectious Disease • Oncology Neurology • OB/GYN • Occupational Medicine • Pediatrics Vein • Pulmonology • Rheumatology • Sleep Medicine Orthopedics • Urology • Wound Care • ENT • Cardiology
20 • JANUARY 2017
Birmingham Medical News
Jimmie Dotson, Jr., MD Joins Grandview
Jimmie Dotson, Jr., MD, FACC has joined the Grandview Medical staff. Dotson, who specializes in Interventional Cardiology, has joined Alabama Cardiovascular Group. He is Board Certified in Cardiology. Dotson received his medical degree from the Jimmie Dotson, University of Tennessee Jr., MD College of Medicine in Memphis and completed his residency with the University of Tennessee Internal Medicine Residency program. He also completed a general cardiology fellowship at the University of Mississippi Medical Center and an interventional cardiology fellowship at Detroit Medical Center/ Wayne State University. Dotson is a member of the American Medical Association, American College of Physicians, American College of Cardiology and the Association of Black Cardiologists.
Andrew Miller, MD Selected Chair of American College of Cardiology
Andrew Miller, MD, FACC has been selected as the next Chair of the American College of Cardiology Board of Governors. With a mission to transform cardiovascular care and improve heart health, the American College of Cardiology has over 52,000 members from Andrew Miller, MD, FACC around the world. Miller received his undergraduate degree from Miami University in Ohio and his medical degree with honors from Indiana University School of Medicine. He did an internal medicine residency and a cardiology fellowship, serving as Chief Cardiology Fellow, at UAB where he also was a postdoctoral trainee in the vascular biology and hypertension program. He has received the C. Glenn Cobbs Award for Excellence and the Merck New Investigator Award. From 2010 to the present, he has been listed in the Best Doctors in America.
DCH using Bronchoscopy with Endobronchial Ultrasound
DCH Regional Medical Center has a new, less invasive procedure for diagnosing lung cancer and other lung conditions. Bronchoscopy with Endobronchial Ultrasound (EBUS) is a new way to remove a tissue sample from lymph nodes around the lung to diagnose cancer, lymphoma or sarcoidosis. During EBUS, an endoscope fitted with ultrasound and a small needle to obtain tissue specimens is inserted down the patient’s wind pipe while the patient is under anesthesia. The physician can see live ultrasound images of the surface of airways, blood vessels, lungs and lymph nodes. The improved images allow the physician to view difficult-to-reach areas, which can lead to a better diagnosis. The procedure can in some cases replace mediastinoscopy.
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Birmingham Medical News
JANUARY 2017 • 21
Gupta Joins CVA Himanshu Gupta, MD, FACC has joined Cardiovascular Associates. Gupta, who specializes in cardiac imaging, completed his medical degree at the University of Delhi in New Delhi, India. He is board certified by the ABIM in Cardiology and is also certified by the Board of Nuclear Cardi- Himanshu Gupta, MD ology and the National Board of Echocardiography. Gupta has served as a scientist for the UAB Research and Training Center, as well as the Comprehensive Cardiovascular Center. He has held hospital appointments at UAB Hospital, Kirklin Clinic, UAB Highlands, and The VA Medical Center. He most recently served as the Co-Director of Cardiovascular Magnetic Resonance at UAB. Gupta joins CVA with vast expertise in multi-modality cardiovascular imaging for clinical and research applications, and has been consistently funded in his research and program development by the NIH.
TekLinks Acquires Guidant Partners TekLinks has acquired Nashville-based Guidant Partners, an IT planning and management firm that provides IT infrastructure service. TekLinks’ Nashville presence will grow nearly 50 percent due to the acquisition. The company now has about 350 team
members throughout Alabama, Mississippi, Tennessee, and the Gulf Coast. Based in Birmingham, TekLinks is a national leader in cloud computing, managed services, engineering services, and value-added resale. “Guidant is our most respected competitor in the Nashville market,” says TekLinks CEO Jim AkerJim Akerhielm hielm. “We’re looking forward to a bright future together.”
BHC Vein Center is Named Center of Excellence for Venaseal In addition to being the first and only practice in Alabama to use Venaseal technology, Birmingham Heart Clinic (BHC’)’s Vein Center was recently named a Center of Excellence for the closure system. BHC is now being utilized as a training site for professionals from several states. The VenaSeal™ closure system reduces discomfort and recovery time for patients. The VenaSeal™ closure system is a cyanoacrylate-based medical adhesive for the closure of greater and lesser saphenous veins in the legs. This is the only non-tumescent, non-thermal, and nonsclerosant procedure where adhesive is delivered endovenously to close the vein, which eliminates the risk of nerve injury when treating the small saphenous vein. The procedure is administered without the
N ORTHBANK NORTHBANK O F F I C E PA R K O F F I C E PA R K
use of tumescent anesthesia, meaning only one needle stick is needed to numb the area. It also eliminates the need for postprocedure compression stockings, and reduces post-procedure pain and bruising. “This is a unique procedure that is much more comfortable for patients than traditional treatment methods for venous disease,” Robert Foster, MD said. Robert Foster, MD The VenaSeal procedure is done under ultrasound guidance with the patient draped in the usual sterile fashion like the radiofrequency ablation procedure, except it is non-thermal and non-tumescent. There is one access needle stick site in the lower leg. Once access is achieved, the introducer/dilator and catheter is advanced toward the saphenofemoral junction, compression is applied to the area, and the physician injects the VenaSeal directly into the vein.
Austin Lutz, MD has joined Urology Centers of Alabama. Lutz received his B.S. from Rhodes College in Memphis followed by his M.D. at UAB. He interned at OchsnerLouisiana State University in New Orleans. He practiced at Associated Urologists of Nashville before moving to Austin Lutz, MD Birmingham to join Urology Centers. His special interests of care include comprehensive urological care; robotic and laparoscopic surgery; erectile dysfunction; penile prosthesis; male/female incontinence; medical and surgical management of kidney stones; laser treatment for BPH; male infertility; and microsurgery.
Walker Baptist Medical Center has introduced a new solution for prostate cancer detection with advanced MR/Ultrasound Fusion Biopsies. Termed as UroNav, this new technology offers an alternative prostate screening option for patients with elevated and/or rising PSA levels, which can improve the detection of prostate cancer and remove a patient’s uncertain state of diagnosis after a prostate exam. UrnoNav’s technology combines prebiopsy MR images of the prostate with ultrasound-guided biopsy images in real time for excellent delineation of the prostate and suspicious lesions. “Bringing this system to the Jasper area will allow us to better serve our community and help those who have prostate issues, such as cancer,” said urologist Brian Stone, MD.
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St. Vincent’s Health System is now the first and only health system in the nation to hold the highest Society of Cardiovascular Patient Care accreditations in all three of its areas. The accreditation is based on meeting and exceeding stringent quality and outcome cardiovascular measures. St. Vincent’s holds accreditations in: • AFib with EPS: St. Vincent’s Birmingham, St. Vincent’s East • Heart Failure: St. Vincent’s Birmingham, St. Vincent’s East • Chest Pain: • Chest Pain Center with Primary PCI and Resuscitation: St. Vincent’s Birmingham, St. Vincent’s East • Chest Pain Center: St. Vincent’s Blount, St. Vincent’s St. Clair
Lutz Joins Urology Centers
Walker Baptist Makes New Advances in Prostate Cancer Detection
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St. Vincent’s is Only Health Center in Nation to Hold Highest SCPC Accreditations in All Three Areas
EDITOR & PUBLISHER Steve Spencer VICE PRESIDENT OF OPERATIONS Jason Irvin CREATIVE DIRECTOR Susan Graham STAFF PHOTOGRAPHER April May CONTRIBUTING WRITERS Ann DeBellis, Jane Ehrhardt, Laura Freeman, Lynne Jeter, June Mathews, Cindy Sanders GRAND ROUNDS CORRESPONDENT Frank Sinatra Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110 • FAX 205.437.1193 Ad Sales: 205.978.5127 All editorial submissions should be mailed to: Birmingham Medical News 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: firstname.lastname@example.org —————————————————— All Subscription requests or address changes should be mailed to: Birmingham Medical News Attn: Subscription Department 270 Doug Baker Boulevard, Suite 700-400 Birmingham, AL 35242 or e-mailed to: email@example.com Birmingham Medical News is published monthly by Steve Spencer ©2017 Birmingham Medical News, all rights reserved. Reproduction in whole or in part without written permission is prohibited. Birmingham Medial News will assume no reponsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes. ——————————————————
Birmingham Medical News
JANUARY 2017 â€¢ 23
THE 42ND ANNUAL
BRUCE A. HARRIS SYMPOSIUM
Progress in OB/GYN 2017 for Physicians and Nurses Presented by UAB faculty with guest faculty Larry C. Kilgore, MD - Professor and Chairman, Department of Obstetrics and Gynecology, Director, Division of Gynecologic Oncology, University of Tennessee Medical Center Cancer Institute, Knoxville, TN Jeanne S. Sheffield, MD - Professor, Department of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Baltimore, MD Kelly Hoskins Tyler, MD - Practitioner, Ohio Women’s Health Partners, Chief Resident, Ohio State University, Division of Dermatology, Columbus, OH RN Program - Patricia A. Detzel, MSN, CNM - Assistant Professor, Clinical Obstetrics and Gynecology, Vanderbilt University, School of Medicine, Nashville, TN
Learn about the most recent advances in OB/GYN, including gynecologic oncology, reproductive endocrinology, gynecology and obstetrics from outstanding course faculty. The Bruce A. Harris Symposium offers educational sessions, opportunities for networking, posters detailing research in various topics of OB/GYN and the ever-popular “Stump the Professor” luncheon.
Up to 14.25 AMA PRA Category 1 Credits™ Maximum of 18 CEUs / 3 Pharmacological Contact Hours
FEBRUARY 9-10, 2017 Hyatt Regency - The Wynfrey Hotel Riverchase Galleria Birmingham, Alabama
UAB Department of OB/GYN Alumni Reception Thursday, February 9, 2017 5:00–7:00 p.m. RSVP by February 6th to (205) 934-5631 or firstname.lastname@example.org The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Alabama School of Medicine designates this educational activity for a maximum of 14.25 AMA PRA Category 1 Credits™. Physicians should only claim the credit commensurate with the extent of their participation in the activity. Alabama Board of Nursing continuing education credit for this activity has been approved for a maximum of 18 CEUs and 3 pharmacological contact hours total if attending both days and lunches.
Complete agenda, course registration, accreditation, continuing education credit information, and hotel registration information are available at uab.edu/medicine/obgyn/progress-in-obgyn. Please call (205) 934-5631 or email email@example.com with questions. Sponsored by the UAB Department of OB/GYN, Division of Continuing Medical Education. The University of Alabama at Birmingham is an equal opportunity/affirmative action institution.