Thursday, March 31, 2016
By: Dr. Marian Northington with Shelby Dermatology
One of the most important concerns for patients interested in facial rejuvenation is the aging jawline and neck. We now have more tools to improve the aging neck ranging from injectables to surgical options. When selecting which treatment is best for your patient, it is important to identify if texture and dyschromias are an issue or if it is skin laxity, excess adipose tissue or a combination. It is also important to identify patient expectations, concerns and what their tolerance is for social downtime. The most effective way of improving skin laxity is a surgical lift. However, some patients do not want the risk or downtime associated with surgery. It is exciting that we have nonsurgical effective options for these patients.
One subtle and easy way to improve the neck with little to no downtime is with botulinum toxin. Botulinum toxins can soften platysmal bands and relax the downward pull of the platysma by injecting along the platysmal muscle. This is known as the Nefertiti lift. Additionally, soft tissue fillers are effective in adding volume and recreating a defined jawline by injecting along the mandibular angle and along the jawline and chin.
Energy devices are another tool we have to improve the appearance of the aging neck. Lasers can be used to improve the discoloration of the neck as well as texture. A variety of lasers are available to address these issues. Noninvasive tightening devices include radiofrequency devices such as thermage or microfocused ultrasound such as ultherapy. It is important to emphasize that these devices will not eliminate skin laxity or remove excess fat like surgery, but they will improve skin laxity and give a natural improvement which improves over time due to wound healing processes. These are excellent options for people who do not want the downtime or risk of surgery. I recommend noninvasive tightening procedures to be done on an annual basis for maintenance and for preventative purposes and like these as an adjunctive treatment to other procedures like liposuction. I also advise patients to start treatments with early signs of laxity to attempt to prevent laxity as much as possible. Cyrolipolysis is another device which induces apoptosis of the fat cells with cold temperatures. A new neck applicator is available to eliminate unwanted neck fat and improve laxity through the wound healing process. The treated fat cells are permanently destroyed. Kybella is another permanent removal of unwanted fat and is an injection of deoxycholic acid in the submental area. Again, the fat cells are permanently destroyed and laxity improves over the next few months. This treatment does have some downtime such as swelling for a week and possibly temporary numbness in the treated area.
Neck liposuction with the tumescent technique is my favorite procedure for neck rejuvenation. The tumecscent technique takes away the risks of general anesthesia. Patients are awake and comfortable. The adipose tissue is anesthetized with a dilute form of lidocaine. It is the most predictable procedure for fat removal and tissue tightening occurs as the area heals. Downtime with this procedure includes bruising, swelling, tenderness, and patients wear a neck strap/garmet for a week. Many patients wonder if they should lose weight before the procedure, but neck fat is not an area that responds well to weight loss and so is not necessary. first. Neck rejuvenation is important part of improving an aging appearance. It is exciting that there are so many options available for our patients.
Wednesday, March 30, 2016
Doctors’ Day in Alabama, a project sponsored by the Medical Association of the State of Alabama and the Alabama Department of Public Health, will be held in conjunction with National Doctors’ Day to celebrate physicians of all specialties serving in our communities.
“The practice of medicine is a special calling,” said Mark Jackson, executive director of the Medical Association. “Physicians study and train for many years, work long and unpredictable hours, and cope with often conflicting demands of work and family life to serve the needs of their communities.”
Although they are healers first, Alabama’s physicians not only contribute to patient health but also the state’s economy. According to a study by the American Medical Association, each Alabama physician supports an average of 10 jobs – contributing to 83,095 jobs statewide – for an average of $1.3 million in positive economic input and a total of $11.2 billion in economic impact statewide.
“Physicians often lead patients and families through some of life’s most challenging moments,” Jackson said. “We wanted to have one day to thank our physicians for the work they do each day to make the health of our residents and our state better. If you see your physician on March 30, help us celebrate Doctors’ Day in Alabama by telling your doctor how much he or she means to you.”
For more information about Doctors’ Day in Alabama, contact Lori M. Quiller, APR, at (334) 954-2580 or firstname.lastname@example.org.
Thursday, March 24, 2016
By: Saritha Uppala, M.D. Internal Medicine Grandview Medical Group
Common chronic diseases include Diabetes, stroke, cancer, heart disease & Osteoporosis. Cancer and cardiovascular disease is the major cause for morbidity and mortality worldwide, with cancer expected to results in 571,950 deaths per year in US. Most common leading cause of cancer continues to be related to tobacco use. Evidence shows that obese men and women are at greater risk of developing cancer and worsening of chronic conditions than non-obese.
Obesity is defined as body mass index (BMI > 30Kg/m2) or greater. In the past 30 years, its prevalence increased worldwide, more than 35% of adults and 20% of children are currently obese in United States. Majority of these obese individuals meet the criteria for metabolic dysfunction characterized by increased waist circumference, insulin resistance, hyperglycemia, hypertension and hypertriglyceridemia.
Which cancers link to obesity, diet or physical activity?
In 2007 AICR (American Institute of Cancer Research) expert report examined the evidence linking various lifestyle factors including diet, physical activity and body weight to cancer at 17 body sites using systematic literature review. There is strong evidence lifestyle linked to more than 12 cancers in men and women, including colon, rectal, pancreatic, gallbladder, renal, malignant melanoma, breast, endometrial cancer, non-Hodgkin’s lymphoma, esophageal, leukemia, multiple myeloma, thyroid cancer, liver prostrate etc. Another comprehensive report complimented to these findings is meta-analysis ( Dobbins et al )of 98 studies done 18 countries from 1985 to 2011 -revealed 8 tumor sites in men and 5 in women has strong association between obesity and cancer . Another 16 year prospective study done in 900, 000 US population done from 1982 till 1998, revealed risk of mortality from these cancers high in men and women with BMI higher than 35. In individuals with colon cancer , BMI greater than 40 has higher risk of mortality than others
Higher the BMI, higher the risk of colon and rectal cancer in men and colon cancer in women. It was shown a risk association of 9% increase in colon cancer for every 5 Units of BMI increase as compared to individuals with normal BMI , similar impact was seen in pancreatic cancer and increased abdominal fat and waist circumference .
Are there possible mechanisms linking obesity and cancer?
Excess body weight can elevate insulin levels, high triglycerides leading increased levels of metabolic hormones like IGF -1 , leptin and adiponectin. Especially in insulin resistance , disrupted glucose metabolism leading to enhancements in chronic, low grade inflammatory state may contribute to growth signaling , vascular signal , cell enrichment for cancer susceptibility , tumor initiation and invasion and metastasis , poor prognosis. These inflammatory markers include interleukin-1beta, IL -6, TNF –alfa, MCP -1. PAI -1 , a serine protease inhibitor is also produced by visceral adipose tissue , increase levels commonly found in obese people associated with risk of atherogenesis, CVD risk and caner.
The magnitude of the association between cancer and obesity risk is noteworthy and could be avoided with reduction in obesity.
Does weight loss improve outcomes?
Weight loss itself has been shown to decrease cancer risk and when we add other life style modifications including exercise has beneficial affect -by altering metabolism thereby slowed tumor growth.
In 2001 International Agency for Cancer Research Committee reports looked at levels of evidence and physical activity and their data supports physically active life style lowers colon cancer risk and also substantial evidence in decrease in breast cancer up to 20 -40% in most active women compared to sedentary women.
Up to 12% decrease in colorectal cancer in individuals who did 30 minutes of recreational physical activity which is equivalent to brisk walking. Increase in physical activity reduces insulin resistance , chronic inflammatory state and also releases circulatory myokines which are anticancer (SPARC and calprotectin)
Patient who achieved weight loss demonstrated significant improvement in a variety of metabolic conditions such as hypertriglyceridemia, Diabetes, HDL 40% decrease in longterm mortality from any cause.
Tuesday, March 22, 2016
By: Jeremy Beck, Director of Sales and Business Development at Integrated Solutions
1. a type of malicious malware/software designed to block access to a computer system until a sum of money is paid.
The Tewksbury, Mass. police department was taken over by CryptoLocker. Their most recent back-up on an external hard drive was also corrupted, and their most recent non-corrupted back-up was 18 months old.
The Tewksbury P.D. enlisted the help of the FBI, the Department of Homeland Security, the Massachusetts State Police, and private info-security firms — all to no avail. After nearly five days of unsuccessful attempts to decrypt the locked systems, they decided to pay the attackers roughly $500 in Bitcoin.
Tewksbury Police Chief Timothy Sheehan told the Tewksbury Town Crier, “It was an eye-opening experience, I can tell you right now. It made you feel that you lost control of everything. Paying the Bitcoin ransom was the last resort.”
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.
What can I do 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.
What should I do if I become infected?
1. Shut down your computer and disconnect it from the internet immediately.
2. Call the authorities.
3. Call your trusted IT professionals, Integrated Solutions.
Monday, March 14, 2016
By: Susan (Zeisler) Pretnar President at KeySys Health LLC
When the focus of HIPAA Risk Management efforts by healthcare entities is simply to comply with documentation requirements to assuage a judgment of ‘willful neglect’ or ‘non-compliance’ in an audit, the spirit of HIPAA is completely lost. In the absence of HIPAA police or the experience of a breach, many fail to see the distinction between compliance and security, or the value of either one.
In truth, almost no routine HIPAA compliance audits have been completed. A few audits were instigated because of major breaches and a small number of covered entities were audited as a pilot several years ago. Those audits only exposed the lack of commitment to both HIPAA compliance and security. Sadly, the only bellwether we have is the thousands of Meaningful Use desk audits that reinforce the notion that you should be guided by compliance, not security, when it comes to managing protected health information. MU audits demand only the evidence of a risk assessment, and sometimes a plan, based on the findings. Never mind actually implementing anything in the plan.
Security, specifically cyber security, is all the rage, yet there is minimal commitment to investing resources to secure electronic protected health information, including using encryption or something so simple as training. ePHI that is not securely created, stored and transmitted in the vast healthcare ecosystem exposes practices to the risk of breach for lax management of digital information. Hackers are having as much success with phishing emails and phone calls to employees who have not been trained to recognize bogus requests for information and dangerous links.
A thorough risk assessment should indicate how vulnerable the practice will be if HIPAA required or addressable safeguards are not in place. Every practice is different. Recommended controls are irrelevant for some (we don’t’ have a wireless network) and a game changer for others (we allow everyone to use their personal mobile devices). No practice is without risk and no technology is stagnant. Unless you conduct a baseline risk analysis, and reassess routinely, it will be difficult to determine which risks you can accept and which risks should be mitigated quickly, ie. those that will improve your security posture.
Glaring lapses in clinical risk management can result in physical harm to the patient. Foregoing or ignoring administrative, technical and physical controls that are basic safeguards for patient data can expose the patient to financial harm or mental distress. Patients, not HIPAA, should be motivating practices to concentrate on security not just compliance.
There are myriad solutions to technical weaknesses in IT infrastructure that can thwart the casual hacker and make it difficult for the professionals. Neglecting staff training that reinforces security policies and procedures and arms employees with knowledge to stop social engineering phishing schemes only compounds vulnerability from technical weaknesses. That’s not rocket science: it’s basic business sense.
Friday, March 11, 2016
By: Samuel R. Goldstein, M.D. with Andrews Sports Medicine and Orthopaedic Center
With spring upon on us, many of us are becoming more active, spending considerable time outside enjoying the warmer weather.
Unfortunately, when it comes to physical activity, many of us “Weekend Warriors” jump right into “too much, too fast, too far” mode.
We feel committed to a sport or activity, but, based on life, work and family demands, find ourselves with limited time to participate. We try to squeeze in rigorous physical activity on our off days – usually the weekend – and all too often this results in aches, pains and even more serious injuries.
As an orthopaedic surgeon, I see a lot of serious Weekend Warrior injuries to the knee. The knee is at high risk for injury because of its complexity and the enormous amount of force it absorbs and stress it takes. Knee injuries often result from a blow to the knee, twisting or turning or an improper landing.
COMMON KNEE INJURIES
The most common knee injuries I treat are intra-articular (inside the knee), including meniscal tears and ligament tears.
The meniscus is a “C” shaped cartilage cushion, which is like a wedge within the knee. There are two in each knee which cushion, support, and aid movement. Injury to the meniscus is very common and is one of the most frequently occurring cartilage injuries of the knee. Menicus tears can occur from wear and tear over time or from a sudden twist, turn, or even slowing down when running. As we age, our meniscus gets worn. This can make it tear more easily. Like a lot of knee injuries, a meniscus tear can be painful and debilitating.
• Pain in knee
• Swelling and stiffness
• Fluid build-up inside on top of knee
• Sensation that knee is getting stuck or locking
The majority of stabilization in the knee comes from the ligaments. The cruciate ligaments are made up of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which cross to form an “x” shape inside the knee. The collateral ligaments provide additional stability on the inside of the knee through the medial collateral ligament (MCL) and outside the knee through the lateral collateral ligament (LCL).
Ligament injuries in the knee - such as an anterior cruciate ligament (ACL) -- are dreaded by pro and amateur athletes alike. They can be painful and debilitating. They can even permanently change our lifestyles. But there's good news. While an ACL injury or other ligament damage once ended the career of many an athlete, treatment has become much more successful for all of us.
• Pain, often sudden and severe
• A loud pop or snap during the injury
• A feeling of looseness in the joint
• Inability to put weight on the point without pain
The form of treatment used for both meniscal & ligament tears will be dependent on the severity of the injury.
1. Physical Therapy – We work closely with physical therapists to create an individualized program to maximize healing and restore function, strength and mobility.
2. Supports - A variety of supports such as a brace, crutches or other advanced support can help restrict movement and allow the cartilage to begin the healing process.
Meniscus - When conservative treatment fails, and the knee continues to be painful and locks in place, arthroscopic surgery may be recommended to repair, trim or remove the damaged meniscal cartilage.
Ligament - Depending on the severity and type of ligament injury, surgery may be recommended.
• For ACL injuries, arthroscopic or open surgery is done using a graft to replace the damaged ligament.
• For certain PCL cases where the ligament is no longer attached properly to the shinbone, surgery is considered.
• For MCL injuries when the ligament is completely torn, surgery can help to repair it.
The risk of injury does not mean we shouldn’t be active, but avoiding these injuries requires some common-sense prevention.
1. If we don’t exercise on a regular basis and are not conditioned for a particular sport or activity, we put yourselves at greater risk for injury.
2. Regular exercise helps maintain our muscle strength to help prevent arthritis and keep our joints flexible and better protect them from damage.
• Warm-up and stretch.
• Gradually increase our activity level – and intensity level – on a week-to-week basis.
• Use proper technique.
• Use proper gear and safety equipment.
• Listen to our bodies. The “no pain, no gain” theory is not a good mantra.
Samuel R. Goldstein, M.D. is an orthopaedic surgeon and sports medicine specialist at Andrews Sports Medicine and Orthopaedic Center. Dr. Goldstein specializes in sports medicine, arthroscopy of the knee and shoulder, knee joint replacement and general orthopedic surgery. He has been practicing medicine in Birmingham since 1989 and provides sports medicine coverage to various high school athletic programs in the Greater Birmingham area.
For more information, contact Andrews Sports Medicine and Orthopaedic Center at 205.939.3699 or visit www.AndrewsSportsMedicine.com
Tuesday, March 1, 2016
By: Chad Sizemore, Managing Partner, ICS Medtech
“Our attorneys have validated our policies, our accounting firm produced our procedures, and our IT vendor installed our network and systems integration to be HIPAA compliant. So we are covered and have nothing to worry about…….”
This is a small subset of the discussions we have with practice managers, security administrators, IT staff, CFO’s, and even doctors with various size practices in regard to HIPAA compliance.
Are you sure? And can you prove it?
By definition, HIPAA is a U.S. law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals, and other health care providers. It was developed by the Department of Health and Human services as a standard to provide patients with access to their medical records and more control over how their personal health information is used and disclosed.
We have all read the rule/law, but what does it really mean?
HIPAA is the basis for privacy standards, but it is cumbersome and hard to understand. And it is very important to remember, it is the baseline for protecting patient data, and we should all treat it as an evolving means to protect all data as if it were our own. We continue to see news reports of large organizations being exposed to data breaches. If large organizations are affected by a breach, it could happen to organizations of all sizes. These large organizations spend millions each year to secure data in their infrastructure, yet we are still seeing examples of exposure. To be HIPAA compliant, you must have third party verification of your policies and procedures, the technology they were designed to administer, and you must be able to show that all internal standards are met. All policies must be followed, and demonstrated to have sufficient documentation to meet the guidelines set forth by the HIPAA/HITECH acts.
Recently the U.S. Department of Health and Human Services’ (“HHS”), Office for Civil Rights (“OCR”), and the Federal Trade Commission (“FTC”) levied fines over $500,000 for HIPAA violations and misrepresentation of encryption levels of services offered by a software provider. OCR has the authority to levy fines from $50,000 to 1.5 million depending on the severity of the case, as well as seek criminal charges against the violators. Vendors and system integrators continue to sell their products as secure. We are living in a time where cyber-attacks are increasing and many organizations believe they have been sold a compliant solution.
There is an increasing gap between IT professionals and executives when it comes to HIPAA compliance. A majority of executives believe they are HIPAA compliant, while few understand what that means or what it provides them. If your organization received government funding for Meaningful Use, you stand a 1 in 20 risk of being audited. To be compliant you must address process and procedure requirements, technology standards, and show that they are consistently monitored and improved if needed. Beyond the potential for fines and legal fees, we must make sure we as a society are diligent in our ability to safeguard all data and maintain compliance in policy, procedure, and technology.
So this means we must spend a ton of money to maintain compliance right?
Compliance should be standardized process and should be priced at a standard cost based on the size of the practice. The total cost should be stated up front for the annual assessment and for ongoing documentation management. The cost should reflect the full effort to address all of the OCR published audit protocol points and to manage the process for continuous audit readiness. No one wants to be audited, but if you apply the principals and proof that a legitimate compliance vendor can provide, the audit process becomes much easier. That vendor should supply the customer with a standardized, automated, and complete process to guide the organization through the compliance process that requires minimal input from the organizations staff. The service should include all the required analysis, evidence, documents, training certifications, and network verifications in a HIPAA compliant offsite storage facility. All organizations should have the option to purchase a monitoring service that alerts them to potential attack at a reasonable cost.
Our process makes it easy on the practice manager, helps you gain or maintain compliance, provides a needed service at an affordable upfront cost, documents checks and balances to keep you audit ready all the time, and allows you to get something for your money. With this process, you can truly answer “Oh, we’re covered” when asked about HIPAA.
About the Author: Chad Sizemore is the Managing Partner of ICS Medtech, LLC. A subsidiary of ICS Inc. a technology systems integrator since 2006 in Birmingham, Alabama. ICS Medtech combines the technology expertise as well as federal and state regulatory audit experience to provide healthcare clients reliable professional services. Contact ICS Medtech at 205-423-6958 or email Chad at email@example.com for additional information.
By: Tammie Lunceford, CPC with Warren Averett
The implementation of the Affordable Care Act has enabled many Americans to acquire health coverage for the first time in their lives. Even those who have enjoyed long term coverage have seen changes in deductibles and co-pays over the last few years. It has always been difficult for the patient to understand their coverage but now it is even more difficult due to the vast number of plans.
Any medical entity providing service to commercially covered patients or physicians who serve the uninsured are challenged when trying to effectively collect from the patient. When working with practice managers, I often find outdated practice management systems still in place with no electronic eligibility or limited eligibility. The front office is trying to answer the phone, greet the patient, and perform various other tasks unrelated to collecting balances and co-pays. The front office staff are the most important people in the office related to efficient account set up and collection of the co-pay and balance. The ability to interpret the eligibility file and confidently educate the patient on their responsibility is very important. Physicians should realize the importance of providing the best practice management systems with best practice workflows in collection activity.
Many patients want to pay but they need options to make reasonable payments. Credit card on file or CCOF is a great option to collect efficiently, reduce statements and staff time by reducing collection calls and the generation of collection letters. Patients like credit card on file because it is paperless and it is no different than paying a bill using online banking. The practice must assure the patient the data is stored securely and their policies are effective in processing the recurring payment.
Tips to Improve Patient Collections:
▪ Prepare efficient registration process and financial policies
▪ Update and verify patient information at every encounter
▪ Perform batch and real-time electronic eligibility
▪ Track staff performance for 95% co-pay collection rate, % of balances collected
▪ Obtain benefits prior to procedure/surgery scheduling…set arrangement using CCOF
▪ Send statements twice monthly
▪ Use two collection agencies, a soft collection agency beginning at 65 days
▪ Use a financing option to transfer patient debt prior to surgery or procedures
▪ Be consistent and educate the patient regarding your policies
Medical entities can improve patient collections by assuring every step of the process is working well. It is important for the billing staff to communicate reasons for a shift to patient responsibility by reviewing the remittances and communicating with front office staff. The use of alerts or flags in the account can prepare a workflow aimed at improving patient collections.
By: John G. Touliatos, MD with Advanced Surgeons, P.C.
There is a medical device for patients 21 years and older who have been diagnosed with GERD called LINX. When patients continue to have heartburn or regurgitation despite taking medication to treat GERD, LINX can be used.
What exactly is GERD? It occurs when the sphincter (valve) between the stomach and the esophagus is weak or opens improperly and allows stomach acid (juices) to reflux into the esophagus and may cause injury to the esophagus and result in heartburn or regurgitation
The LINX system is designed to help the sphincter stay closed to stop the reflux. It uses a small, flexible band of beads. Each bead has a magnet inside. When placed around the outside of the esophagus, the magnet attraction between the beads helps the sphincter stay closed to prevent reflux. Swallowing food will overcome the magnetic attraction and allow the beds to separate, allowing food and liquid to pass normally into the stomach.
Why doctors choose to use this method? This is another option to surgery for GERD, for those whom the Nissen fundoplication seems too invasive. The LINX system does not involve significant alterations to the anatomy that may limit future treatment options. With the Nissen fundoplication, the top part of the stomach is wrapped around the lower esophagus to improve the reflux barrier.
If needed, the LINX system can be removed laparoscopically similar to the way the implant procedure is performed (<1%). Removal of the device generally leaves the esophagus the same as before the implant. After surgery, patients usually go home the same day or the next day. Patients are able to eat a normal soft diet after surgery, and it is well-tolerated by patients. If you have the Nissen fundoplication, patients are restricted to a liquid diet for 3- 4 days that is slowly advanced over weeks to normal food.
Contraindications for the provider are patients who are allergic to titanium, stainless steel, nickel, or ferrous materials. Another consideration is people who need or expect to need an MRI. The newer devices are safe, but it is still may affect the durability or effectiveness of the device. There is no risk of injury to the patient if the MRI is done. It is recommended that anyone implanted with the LINX system register the device with the MedicAlert Foundation.