Wednesday, December 7, 2016

Limb Sparing Procedure Saves Patient’s Leg


By: Kevin Glandon, patient of Christopher Huff, M.D.

Two winters ago, Kevin Glandon faced a prognosis of an amputation of his left leg due to poor circulation from peripheral artery disease. Kevin is married with three children and works in the nuclear power industry as a principal engineer. This role requires routine travel to the plant sites and walking in the field. “A good part of my jobs requires me to be mobile,” he says.

Arterial disease also affects Kevin’s heart. At the age of 48, stents were placed in his heart arteries because of severe cholesterol build up. Unfortunately, his stents did not remain open, and over a 4 year period he underwent multiple stenting procedures to improve the blood flow to his heart. Ultimately, at age 52, Kevin required bypass surgery.

Concurrently, Kevin was suffering from leg pain as the cholesterol build up in his legs progressed. “In my late thirties, I started having cramps in my left calf,” says Kevin. “Over the years, exercise became a significant challenge because of the poor circulation in my legs.” Similar to what took place in his heart, multiple stents were placed in the arteries of his legs, but these stents failed to stay open. He thus underwent bypass surgery on his left leg to improve the blood flow to his lower leg and foot. It lasted seven months. Doctors then attempted a second bypass, but it only lasted four days. He was then told there was no other option to improve the flow to his left leg, and he would likely need an amputation.

In a final effort to save Kevin’s leg, his primary Cardiologist consulted Christopher Huff, M.D., an Interventional Cardiologist at CVA and Brookwood Baptist Medical Center who specializes in complex peripheral arterial disease and amputation prevention. Dr. Huff reviewed Kevin’s medical record and scheduled a procedure with Kevin for the following day. “Dr. Huff worked for six hours cleaning out the blockage,” says Kevin. “I was awake the whole time and was just in awe of him. He stuck in there with me and worked tirelessly until he and his team restored blood flow back to my natural artery in my lower leg and foot.”

“Without Dr. Huff, I would have lost my leg and it would have been an incredible impact to me and my family,” says Kevin. “I’m blown away by his dedication to my care and the knowledge he brought to the table.” Since the procedure, Kevin sees Dr. Huff for periodic assessments to see how impacted the blood flow is and if needed, Dr. Huff goes into the artery to clean it back out. “I don’t have muscle cramping now and I’m able to walk,” he says.

Kevin is so grateful for what Dr. Huff has done for him and he wants to share his story with others that might be going through the same situation as he did two years ago. “Dr. Huff has said there are so many amputations happening because of PAD and it could have been me,” he says. “Listen to your body. Prevention is the key for something like this. Dr. Huff could help save limbs for people in a situation like mine.

“I can’t say enough about his skills, capability and dedication for his craft,” says Kevin. “Talk about a blessing, Dr. Huff is mine.”

Medical Association Applauds U.S. Rep. Tom Price, M.D., for HHS Secretary




























MONTGOMERY – 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 includes fighting for patients’ rights as well as preserving physician autonomy,” said Medical Association President David Herrick, M.D. “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.

Tuesday, December 6, 2016

Advances in genetic testing result in more effective diagnoses



By: Bruce Korf, M.D., Ph.D.
UAB Professor and Chair, Department of Genetics

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.

For physicians, it’s important 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 relatively 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 even five years ago we could only expect to diagnose about 5 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 1 to 3 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.

We have a new clinic integrated into Children’s, with access to parking and other specialists, making genetic evaluation more convenient for parents than ever before. In addition to our Children’s clinic, 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.

Wednesday, November 30, 2016

Quality and Cost Adjustments May Hit Your Bottom Line in 2017














by: Tammie Lunceford, CPC with Warren Averett LLC

Although the most talked about topic in healthcare in the last few months has been MACRA, another topic is starting to gain much attention—the Value Based Modifier (VBM). The VBM went into effect in 2014 to affect payment in 2016 for practices with 10 or more providers. Eligible professionals are classified as physicians, mid-level providers and certain therapists. Prior to 2014, a group’s only adjustments related to a lack of PQRS participation. It is important to understand the Value Based Modifier is calculated at the tax identification level. Even if a group reports quality as individuals, they will be identified as a group by the number of eligible providers associated with their tax identification number through Medicare enrollment with PECOS.

The Center for Medicare and Medicaid Services (CMS) reports the results of the quality and cost through Quality and Resource Use Reports (QRURs). These reports are released in April as a mid-year QRUR and September for the final year QRUR. The annual QRUR report shows PQRS reported quality information along with CMS calculated outcomes and cost measures to calculate two composite scores: a quality composite and a cost composite. CMS classifies each score into high, average or low based on whether the score is at least one standard deviation above/below the national mean score. This process identifies statistically significant outliers. The outliers are then assigned to the respective quality and cost tier. The CMS quality and cost tiering analysis determines whether the score will earn the medical practice a bonus, penalty or no adjustment to their reimbursement based on performance in these categories.

Most of us understand the quality portion of the VBM, but there are many questions related to cost analysis. The cost portion of the VBM is based on six cost measures to calculate your TIN’s Cost Composite score.

1. Per Capita Costs for All Attributed Beneficiaries

2. Per Capita Costs for Beneficiaries with Diabetes

3. Per Capita Costs for Beneficiaries with COPD

4. Per Capita Costs for Beneficiaries with Coronary Artery Disease

5. Per Capita Costs for Beneficiaries with Heart Failure

6. Medicare Spending per Beneficiary (even providers not in your TIN)


In 2017, all practices will be impacted by the VBM, even solo physicians. We have been afforded flexibility in 2017 for the implementation of MACRA, but since the new Merit Based Incentive Program has a portion that represents quality reporting, it is important for quality reporting to be improved each year. To access your QRUR reports, you must have an account with Enterprise Identity Management to select an administrator. We encourage administrators to obtain the 2015 QRUR reports immediately to assess performance. All practices have until November 30, 2016 to dispute results of the 2015 QRUR report.

While some practices have reported no adjustments after reviewing their QRUR reports, others have reported negative adjustments. Specialty practices with a payer mix of more than 40 percent Medicare can lose large amounts of reimbursement with a 2 percent negative adjustment.


         Quality/Cost                 Low Cost                     Average Cost                 High Cost

High Quality
               + 4%
                 +2%
No payment change
Average Quality
               +2%
No payment change
                -2%
Low Quality
 No payment change
                -2%
                -4%
        

The better performing groups have aligned themselves with a progressive EHR and a practice management system that allows them to track performance by provider. Many of these systems are registered to allow direct reporting of quality to CMS via the EHR web reporting mechanism. Many better performing groups have joined Qualified Clinical Data Registries to increase the number of domains and gain support from other practices in their specialty. Claims-based reporting has proved to be problematic and is not considered the best option for reporting quality data. It is best for large groups to register and report as a group as opposed to individual reporting in most cases. Monitoring individual performance can be difficult, and a single provider’s lack of performance could affect the entire group. Group registration will open early in 2017 and last through June 30. Consider this option if your practice has between 2-99 providers.

We have discussed the 2015 QRUR reports and how they will affect 2017 reimbursement, however, 2016 is almost over. The 2016 performance year affects the 2018 reimbursement for all providers. Be sure to assess your performance and make changes now to improve your scores. Contact your academy or governing board for your specialty to assure you are using the resources available to you. Create a team or committee to focus on VBM workflow; improvement in reporting involves physicians, clinical operations, coders, and a close relationship with your EHR vendor.

Key Areas to Address Now:

• Set up an account with EIDM

• Obtain your QRUR reports

• Contact your academy or vendor for resources

• Evaluate your reporting options

• Evaluate how you collect data in your EHR; are your providers providing actionable data?

• Hire a consultant to assist you in improving quality performance and cost reduction

Healthcare continues to change, and it is highly important to remain engaged and to monitor your success.

Friday, November 18, 2016

Ran•som•ware



By: Curtis Woods
President at Integrated Solutions, LLC

noun: ransomware;


1. a type of malicious malware/software designed to block access to a computer system until a sum of money is paid.

How much will ransomware cost me?

The demanded costs to unlock your files can vary greatly. The prices can range from $25 up to $1000 or more. It is also important to note that paying the ransom does not guarantee that you will ever get your files back.

How does ransomware infect my system?

Ransomware usually infects a system in one of two ways:

1. Your system may become infected by visiting malicious or unsecured websites.

2. Ransomware infections also come through email attachments or links from untrusted emails or emails that have been hacked.

Traditional advice to prevent ransomware

1. Have and maintain a firewall. - Your first line of defense is a strong and well maintained firewall.

2. Use Anti-virus software. - While no Anti-virus protection is good enough to catch everything….the combination of firewall and AV protection is your best combination for protection.

3. Make sure your pop-up blocker is enabled and working. - Many ransomware infections come in the form of a pop-ups that end users click on, thereby unknowingly downloading a virus.

4. Only go to trusted websites. - Make sure everyone in the office is aware of this policy and state clearly what types of websites are not to be visited under company policy.

5. Only open links and attachments from trusted senders. - If there is any question about the authenticity of the sender, call them to verify that the email is legitimate.

6. Make sure your backups have “multiple restore points.” - One of the most important tips is to make sure your backups can be restored from multiple restore points. Some of the most common backup solutions can only restore to the last known backup. For example, if you leave work today at 5:00pm and at 7:00pm your system is infected with Ransomware and your backups run at 10:00pm….you now have a backup of your data, but unfortunately the backup is of corrupted data.

Advanced options for preventing ransomware

• Deep Packet Inspection Devices – These are typically hardware devices that “review” all of the inbound and outbound network traffic and block anything detected as malicious.

• End point security software – This is software specifically directed at malware (Ransomware is malware, not a virus). Security software companies are starting to release applications that are specifically directed at Ransomware.

• Security awareness training – Products like Knowbe4 offer security awareness training and testing for your employees. They offer self-phishing campaigns to help companies properly train employees to not gullibly click on unsafe email attachments and links.

What should I do if I become infected?

• Shut down your computer immediately. This may prevent the Ransomware from spreading.

• You MUST report it to DHS if ePHI has been compromised.

• Call your trusted IT professionals at Integrated Solutions.

Thursday, November 17, 2016

The Value of a Year End Meeting



By: Chase Campbell, CPA
Pearce, Bevill, Leesburg, Moore, P.C.

It’s my favorite season: football championships, holiday parties, and year-end meetings. After several years in public accounting, I am still surprised at how many business owners do not schedule a formal year-end planning session with their trusted advisors, including their CPA. Many people presume the best time to meet with their CPA is when their mailbox fills up with those dreaded tax documents starting in January of each New Year. This is unfortunate because you could be missing out on valuable tax saving opportunities through proper planning prior to December 31st.

The following are a few examples of tax related issues that should be addressed prior to December 31st:

Fixed asset purchases: Assets must be placed in service prior to 12/31 in order to qualify for Sec. 179 and 50% bonus depreciation deductions. Should we purchase new or used assets? Will the purchase be in cash or with debt?

Compensation: Is compensation fair and reasonable based on projected results and practice’s methodology? Have the business owners paid in the appropriate amount of tax? Ensure bonus checks will be issued prior to 12/31.

Retirement plan funding: What is our projected current year minimum and maximum funding? How much funding remains? Will cash flow allow funding prior to the tax return due date?

In addition to mapping out your tax strategy, a year-end meeting with your CPA is a wonderful time to assess other business needs. Contrary to popular belief we understand business related issues other than just taxes! In my experience, clients generally want to discuss the following three non-tax related matters:

Revenue Cycle Management: These discussions would include a review of the practice’s financial key performance indicators, as well as talking through issues affecting the revenue cycle, such as current and upcoming regulatory changes, technology and software needs, payer mix, collection issues, etc.

Identifying New Revenue Streams: With healthcare practices, we need to analyze the profitability of procedures. Should they be outsourced, kept in house, or vice versa to improve the bottom line? Are there additional services or treatments that could be offered? This is also a time to discuss your practice’s marketing efforts and referral sources regarding these revenue streams.

Human Resources Matters: Physician employment, compensation arrangements, clinical and administrative staffing levels, benefits, succession planning, and retirement plan structure.

In closing, I hope you can see that a year-end meeting can encompass more than just tax savings. This is the last opportunity each year to analyze where we’ve been, where we are going, and how we are going to get there.

Wednesday, November 16, 2016

Splash Down in Haiti and Saving Lives

Physicians Giving Back with Richard McGlaughlin, M.D.
Splash Down in Haiti and Saving Lives

By: Lori M. Quiller, APR Director, Communications and Social Media Medical Association of the State of Alabama

It was his love of flying and his intrinsic need to help others that originally led Richard McGlaughlin, M.D., to Haiti in 2010. In January 2010, the small Caribbean country of Haiti had been rocked by a devastating earthquake, and the task of getting supplies to the recovering nation was proving more than just difficult.

Transportation of what life-saving supplies to Haiti by cargo ship was nearly impossible because the ships were unable to get to Port-au-Prince. Dr. McGlaughlin, who owned a small, single-engine aircraft read about the situation on a member’s-forum for the Cirrus Owners & Pilots Association. Bahamas Habitat was asking for volunteers to fly missions to Haiti to transport supplies, so Dr. McGlaughlin loaded up his aircraft with medical supplies for a trip “that has changed my life.”

That was almost seven years ago, and Dr. McGlaughlin has continued making trips to Haiti every year since…including one trip that nearly took his life and that of his daughter.

Dr. McGlaughlin, a gastroenterologist in Birmingham, wasn’t sure what to expect when he first arrived at the makeshift medical camps in Haiti. The one thing he knew for certain was that he was there for a reason.

“It started out as an airplane adventure just bringing in the supplies that were needed. But, the needs of the Haitians were so great, I just couldn’t turn my back,” Dr. McGlaughlin said. “I felt I could make a difference here. I wanted to make a difference.”

For Dr. McGlaughlin, the key wasn’t just to volunteer once in a while. His theory is a little different. He believes that to make a difference, a constant presence is necessary.

“If you apply continual force on a single point more than once, not just over a weekend or two, it can open eyes. Even that wasn’t enough to help the Haitians. We would give them medicine and treat their wounds, but medicine runs out and sometimes wounds don’t heal, so visiting just once in a while wasn’t working the way we wanted it to. We knew the Haitians needed more,” Dr. McGlaughlin said.

When a cholera outbreak began to ravage the residents, Dr. McGlaughlin, whose background is in cholera research and treatment, found himself more useful than ever. He began working with St. Luke’s Hospital to not only treat the Haitians infected with cholera, but also help train other aid workers in the treatment protocols.

Soon Dr. McGlaughlin met a very charismatic Catholic priest named Father Rick Frechette, CP, D.O. Father Rick has worked in Haiti through St. Luke’s Hospital for more than 30 years, and when the two met, Dr. McGlaughlin was amazed by just what Father Rick had managed to do so much with so little.

“Father Rick is the type of person who makes you want to be a better person,” Dr. McGlaughlin said. “He finds these resources, these people that need work, and the people at the camp need certain things, and Father Rick just finds ways to put them together. He’s built a community through connections, given work and jobs to those who need it…it’s amazing to be part of that,” Dr. McGlaughlin said.

When Dr. McGlaughlin first started working with St. Luke’s, he likened the atmosphere to a smaller version of the United Nations with volunteers from many nations pooling their resources together. Everyone lived in tents, ate together, and unfortunately worked in less-than-the-best medical circumstances.

Eventually, the need for more permanent facilities became apparent, but without funding, because this is a charity operation, the permanent facilities would most likely take a while. So, Father Rick did what he did best and used the resources he had at hand – cargo containers.

After the earthquake in 2010, supplies had been shipped in to Haiti by cargo ships and housed in large, metal cargo containers. When the containers were emptied, they had served their purpose, for the moment. When Dr. McGlaughlin told Father Rick more permanent facilities were necessary for the more complicated and urgent cases needing some semblance of a sterile environment until a proper facility could be built, Father Rick produced a solution.

“We built a container hospital,” Dr. McGlaughlin laughed! “And, it worked for what we needed at the time. You use what you have, and that’s what we had.”

Dr. McGlaughlin continues to fly to Haiti, lending his medical skills and his flying expertise to the people of Haiti he has come to know and love. One flight stands out more than any other. In January 2012, he and his daughter, Elaine, were about to leave the Miami airport when he suggested she purchase a camera. This would be her first trip to Haiti with him, and he knew she would want to document the occasion. When she returned with a small, disposable camera, Dr. McGlaughlin laughed and suggested she try again with a better camera.

“It was a beautiful day for a flight,” he laughed. “You couldn’t have asked for more perfect conditions for flying…until I noticed the oil pressure was dropping. I didn’t want to alarm Elaine. She wasn’t paying much attention to me. She was studying the book for her new camera, but she finally looked at me when she noticed my voice changed.”

Dr. McGlaughlin said they didn’t have much time once the oil pressure sharply dropped, seizing the engine, and freezing the propeller. His plane was equipped with a parachute, which is now standard on all Cirrus models. With the parachute engaged, the pair had enough time to get out of the aircraft before it was too late. As they sat in the life raft, they watched the medicine and equipment floating to the surface, but they were safe. Then the disposable – waterproof – camera floated up. It wasn’t what they expected, but they made good use of it.

“It happened, and it could have been so much worse. So much worse,” Dr. McGlaughlin said shaking his head. “But, it wasn’t. Elaine and I flew back to Haiti together and finished the trip. I’ve even lectured on behalf of the use of the plane’s parachute. Some pilots won’t use it. It’s there…use it. I’m here today because I did.”

Father Rick, Dr. McGlaughlin and the battalion of volunteers attached to St. Luke’s Hospital in Haiti continue to work in Haiti by building schools and rendering medical aid to residents day in and day out. Dr. McGlaughlin’s next scheduled visit will be in January 2017, and he plans to take as many donated items as his plane will hold.

However, St. Luke’s Hospital is in great need of donations. The physicians and other volunteers donate of their time and skills, but monetary donations can move mountains. If you would like to donate and be a part of the St. Luke’s Hospital movement in Haiti, visit St. Luke’s Foundation for Haiti at www.stlukehaiti.org