Monday, March 20, 2017

New Discoveries in Ovarian Cancer



in photo: Rebecca C. Arend, MD
(a GYN oncologist and ovarian cancer researcher at UAB)

The Laura Crandall Brown Foundation (LCBF), a local gynecologic (GYN) cancer foundation, encourages patients to be educated about their treatment options. LCBF’s CanSurvive Support Group meets monthly to help GYN cancer patients and their caregivers have a place to be around others on the same journey. At a recent meeting, Dr. Rebecca Arend, a GYN oncologist and ovarian cancer researcher at UAB, recently spoke with the group to share some of the results and information from her research on utilizing targeted agents to treat GYN cancers. Below is an excerpt from Dr. Arend’s presentation:

Since 2014, the FDA has approved 3 “targeted drugs” for ovarian cancer: Bevacizumab (an anti-angiogenesis agent) and 2 PARP inhibitors specifically for patients with BRCA germline mutations and tumors with somatic BRCA mutations.

“Additional research is being done and we are continuing to make new discoveries about the genes and pathways that suppress and promote cancer cell growth,” said Dr. Arend. Researchers are trying to identify therapies that can disrupt specific pathways and develop more targeted agents.

Improved and expanded genetic sequencing of tumors is enabling researchers to understand what is driving cancer metastasis and recurrence. In ovarian cancer, frequently the tumor suppressor gene TP53 is mutated and therefore, does not function as it should. In addition, about 15% of patients with ovarian cancer have a germline BRCA (or inherited) mutation. As tumors themselves have been genetically profiled, researchers have found that there are additional patients that have developed acquired BRCA mutations in the cancer cells specifically, even though the person does not have a germline mutation. Studies have shown that up to 50% of ovarian tumors have mutations in the same pathway as BRCA, called the Homologous Recombination Pathway and are thus considered to have Homologous Recombination Deficiency. Currently, PARP inhibitors are only approved for patients with germline and somatic BRCA mutations, but they could also be effective against other tumors with Homologous Recombination Deficiency. Trials are ongoing to investigate this.

UAB has started a Personalized Medicine Initiative (PMI) in the Gynecologic Oncology Division. Patients with recurrent ovarian cancer can consent to have their archival tumors undergo genetic sequencing and provide a blood sample to further investigate if tumor mutations can be detected in the blood. Since March of 2016, the Next Generation Sequencing Platform that has been used on the tumor is a 315 gene panel. The results are provided to the treating physician and are also added to the Ovarian Cancer PMI database. The patient’s physician then makes the clinical decision as to either recommend a targeted drug if one is available, a clinical trial, or a currently approved drug. The outcomes of the patients are being prospectively collected in order to provide additional information for current and future patients.



Thursday, March 16, 2017

Enforcement Trends: Five Lessons from recent OCR Resolution Agreements and other enforcement risks





















By: Beth Pittman, CHPC with Waller

Since January 2017, the Department of Health and Human Services Office of Civil Rights (OCR) has entered into two Resolution Agreements  for HIPAA violations, one Resolution Agreement for failure to timely report a breach, and one of only three Civil Money Penalties (CMP) imposed for HIPAA violations since 2009.  In 2016, OCR entered into 12 Resolution Agreements. That was at least double the number in prior years.

Lesson One:  If you are investigated by OCR for a HIPAA violation, be responsive.

Failure to timely respond to OCR notices may result in full imposition of CMP. Children’s Medical Center of Dallas was unable to reach a resolution with HHS and delayed requesting a hearing before an ALJ on the proposed CMP. The organization was required to pay the full of the CMP, or  appeal the CMP. Resolution Agreements are CMP and could not assert affirmative defenses, arguments for waiver or reduction substantially less than the full CMP which is based on a fine assessed for each day of the violation. For a violation classified as “reasonable cause” (as opposed to “willful”), the minimum fine is $1000 per day with a calendar year cap of $1,500,000. OCR does not limit violations to the breach, but typically finds additional violations; some stretching over several years. In settlement discussions, OCR considers the financial condition of the organization; an important mitigating factor for small or distressed facilities. This is not considered in assessing CMPs.

Lesson Two: Conduct a comprehensive security risk analysis and implement corrections.

Overwhelmingly, the top violation found by OCR was failure to complete an accurate and comprehensive enterprise wide security risk analysis (“SRA”), implement an enterprise wide security risk management process and corrections to identified risks and vulnerabilities. Absence of a SRA was a factor considered by OCR in proposing the settlement amount and corrective action plan reached in many Resolution Agreements. In the Resolution Agreement with Memorial Healthcare System, OCR noted violations that extended into the organized health care association (OHCA) when an affiliated physician group’s former employee login was used for over a year to access PHI to commit fraud. OCR recognized that the absence of a SRA, including all affiliated organizations within the OHCA, was a significant omission. Inadequate system audits and access controls would have been identified and could have prevented the breach. 

Lesson Four:  Encryption and device tracking.

More than half of the 2016-2017 Resolution Agreements addressed the failure to encrypt and then track mobile and portable devices on which ePHI is stored. If encryption is not implemented, then you must document the reason, and the alternative equivalent used. Monitoring movement of mobile and portable devices is a critical safeguard.  In each instance, the loss or theft of the device occurred because it was left in an insecure or unmonitored location. 

Lesson Five:  Business Associate identification and management is critical.

One of the largest settlements to date, $5.5 million reached with Advocate Health, was based in part on failure to have a business associate agreement with a billing company service provider. A covered entity, as well as its business associates, is liable for the HIPAA violation of the business associate. It is important not only to enter into business associate agreements but to also monitor and verify a business associate’s HIPAA compliance.   

Other Enforcement Risks:  False Claims Act and overpayment risks are associated with HITECH meaningful use attestation of HIPAA compliance.


Not only may failures in HIPAA compliance result in an investigation by the OCR, you may also be at risk in audits by the Department of Health and Human Services Office of Inspector General (OIG), False Claims Act actions or for Medicare Overpayments initiated by the government or whistleblowers. Payment of an incentive under the HITECH EHR Incentive program is conditioned on certification of compliance with specific HIPAA technical security requirements, including performing a security risk analysis. This may also be a material factor going forward in the amount of reimbursement paid by CMS. The OIG 2017 Work Plan specifically targets audits of EHR incentive recipients “to determine whether they adequately protect electronic health information.”  

Beth Pittman serves as Counsel to the Waller Health Law practice in the Birmingham office.

It’s a Bird, It’s a Plane…… Nope, Just a Man on Testosterone



By: Dr. Brian Christine

You see it on television. You hear it on the radio. You read about it in men’s and sports magazines. I’m talking about men and hypogonadism or, as it’s more commonly referred to, “Low T.” There is no shortage of popular media concerning hypogonadism in men. Unfortunately, the information available to our patients is often incomplete or downright incorrect. Let’s look at the issue of low testosterone in the male population.

Testosterone is produced by the Leydig cells in the testes. Stimulated by luteinizing hormone (LH), the Leydig cells secrete testosterone, and that mechanism has profound effects upon men. Under the influence of testosterone, an embryo will become male. Because of testosterone, men generally have greater muscle mass, a deeper voice, and more body hair than women. Testosterone is also directly linked to a man’s libido, his desire for sexual activity.

Testosterone levels are highest during adolescence and early adulthood. After a man’s 20’s, his levels fall each year. As a man’s testosterone levels fall, he experiences progressive difficulty maintaining lean muscle mass, he may have less energy, and his libido decreases. Small wonder that pharma has seen a huge opportunity to market testosterone replacement products to a progressively aging population, and small wonder that men who see and hear commercials pushing treatment for “low T” as a panacea to restore desire, muscle, vigor, and youth flock to doctors expecting miracles. However, it’s not simply a matter of giving every guy who shows up at your office testosterone. There is a right way, and there is a wrong way.

At Urology Centers of Alabama, we have realized that many patients are not adequately educated about the potential benefits of testosterone, the risks of testosterone replacement therapy, and have not been given realistic expectations. In an effort to improve our screening of men who seek testosterone therapy and our management of men with true hypogonadism, we have established our Men’s Hormone Replacement Clinic. This clinic, focused exclusively on our male patients who are experiencing suboptimal serum testosterone levels, is managed on a day-to-day basis by Nurse Practitioner Eric Westerlund and supervised by me, Dr. Brian Christine.

We perform a complete history, pertinent physical exam, and obtain a detailed laboratory evaluation based on recommendations from the Sexual Medicine Society of North America and the American Urologic Association. We discuss a spectrum of treatment options, including oral clomiphene, topical testosterone gels, intramuscular testosterone injections, and subcutaneous testosterone pellet insertion, and we absolutely discuss potential complications. In the Men’s Hormone Replacement Clinic, periodic monitoring is required every 6 months. Perhaps most importantly, we tell men what testosterone cannot do: testosterone is not a time machine; it cannot turn back the clock and make a 50-year-old feel like a 20-year-old; it cannot magically turn fat to muscle, and it will not make a man with erectile dysfunction potent again.

Testosterone can truly help men feel and perform their best at their age. Careful evaluation and management are a must. Setting expectations is vital. Within these provisos, testosterone replacement therapy is a worthwhile undertaking and one that we as physicians are increasingly asked to perform. No, we cannot produce supermen, but we can benefit our male patients.


To learn more visit www.urologycentersalabama.com


Brian S. Christine, MD
Director of Erectile Restoration and Prosthetic Urology, Urology Centers of Alabama
Director of the Urology Centers of Alabama Fellowship in Prosthetic Urology and Men’s Sexual Health
Member of:
The Sexual Medicine Society of North America
The Society of Prosthetic Urologic Surgeons
The International Continence Society
The European Association of Urology


Wednesday, March 15, 2017

Why Real Estate?



By: Jerry L. Kitchens, Jr. M.D., PC.

I have been asked many times recently, “Why did you get your real estate license and what are you doing with it?” That’s a great question with a complicated answer. The simple response would be, “Well, a surgeon who no longer operates needs something to do”. But to be honest, it was an evolution.

I first met my broker years ago when I was president of a six-man group looking for an office in Homewood. Rich Campbell was honest and very helpful as we worked through the options. In the end, we did not buy the building he showed us but our relationship continued.

 Over time, he started Veritas Medical Real Estate Advisors to represent physicians as they tried to navigate the confusing world of office space and buildings. Fortunately, he asked me to consult with him during the formative days. I will be the first to admit that the hectic schedule of a surgeon left little time to truly help him. He was polite enough, however, to indulge me. As time went by, I got more involved and realized how much I liked it. After my days in the OR were done, I decided to get my license and help Rich as much as I could to engage and assist physicians in negotiating leases and/or purchases. While I am still a “new boy”, I have an excellent teacher.

 I think I should mention that this isn’t the only hat I wear. I work part time in administration at St Vincent's Health System and run a spice business on the side. I’m involved with a physician owned med mal company and do some things with my dad, as well as try to keep up with my wife and 5 kids. So, I am not at Veritas every day, but I must admit they make me feel at home anyway and the satisfaction of a job well done for former colleagues is worth the trip. Come see us!

jkitchens@veritasmre.com

rich@veritasmre.com


Tuesday, March 14, 2017

It’s all about Timing with Dyrc Sibrans, M.D.



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


Dyrc Sibrans, M.D., still greets patients with a firm handshake and a friendly smile. His laughter is infectious and easily fills the room as he reminisces about what he’s accomplished during his career. Already retired once from his own thriving medical practice in Decatur in 2000, he originally prepared to spend more time with his wife at a fishing cabin they purchased in Montana, but something just wasn’t quite right. It was all about timing.

“The personal relationships you build with your patients is what’s so special to me,” Dr. Sibrans said. “I thought that it was probably time for me to get out. We bought the place in Montana in 1998, and went out there after I retired in 2001. I had a stack of books on one side of my chair that kept me in that chair until I had read them all and moved them from that side of the chair to the other side! I never had time before to read just for fun until I retired.”

The allure of Big Sky country was more than just reading for Dr. Sibrans. He’s an avid fly fisherman, and with miles and miles of streams awaiting him, the Alabama rheumatologist actually felt right at home…for a little while. But, as with most who answer a calling in their lives, the first retirement never quite sticks. So, when he was asked to review a few charts for a small community free clinic back home, he happily obliged. It wasn’t long before those few chart reviews became to mean much more to him and to the Community Free Clinic of Decatur-Morgan County. Today, Dr. Sibrans serves as the clinic’s medical director.

The Community Free Clinic of Decatur-Morgan County opened in 2004 and provides free medical care, dental care and prescription medication for low-income residents of Morgan County. Staffed by a handful of full-time employees, the medical staff are all volunteers and has expanded to care for more than 3,000 patients annually.

“I did some chart reviews here when the clinic first started, and they needed a physician to help review the charts that the nurse practitioners had done during the day. We had about three or four of us doing that in the beginning. We average about 20 patients a night, and we do clinic two days a week. That’s a lot. Occasionally we have about three or four doctors that will come in after they have closed their practice, and we’ll finish up the night together. We get here about 4 p.m., and we go until we get finished, but we aren’t the ones who have the long days. The ladies in the office have the long days. They stay a lot longer than we do because they have to do all the paperwork,” Dr. Sibrans explained. The difficult part is to continue to recruit physicians willing to volunteer. The clinic does not take walk-in patients, and there is a screening process. Patients are seen at times when most working physicians have just closed their practices for the day, this makes it difficult for some physicians to come to the Clinic and work three additional hours.

“I do interviews mainly to get some more doctors to come in and volunteer. I think it is a privilege as medical professionals to volunteer. I think it is our responsibility to the community to, in some way, give back to the people who gave so much to us,” Dr. Sibrans said. “When the clinic first opened, they had a lot of physicians who would come in and volunteer. But, over the years, they began to drift away and things got worse. I was doing the chart reviews and noticed there were just a few people doing a lot of the work. Pretty soon I was asked to be fully on board.”

Early on in Dr. Sibrans’ career, he made a critical choice about his career…a choice which could have landed him far outside the path of medicine.

“I have some questions about some of the things I have done in my life, but becoming a physician is definitely not one of them. I truly enjoy it. I knew when I was in high school that I was either going to be a priest or a doctor. I went to the seminary and realized that maybe the celibate life maybe wasn’t the life for me!” Dr. Sibrans laughed. “So, I answered a different calling, and I do consider medicine my true vocation. I had already made up my mind that medicine was what I was going to do. I was a late bloomer. I didn’t really get going in academics until my senior year in high school. Most kids now have to start making great grades in high school. I was very lucky. I got into medicine long before the control by the federal government and insurance companies. The demands that you have to be automated now, it just takes too much time to do what you need to do, and that’s to simply treat your patient. The practice of medicine has become way too difficult these days.”

As a battalion surgeon with the 173rd Airborne Brigade, Dr. Sibrans was part of the Battle of Dak To at the beginning of the Tet Offensive, a nasty battle lasting 19 days and killing 376 U.S. soldiers. He was wounded himself during this battle. Even though he spent much of his time mending his fellow soldiers after battle, Dr. Sibrans found time to render aid to a Montagnard hospital in the highlands not far from his camp.

“Later, we were at a relatively benign base doing protection services. At that time, I was just doing sick call that could mostly be taken care of with antibiotics or cough syrup. I asked for permission to go to that hospital to help out. They were operating on anyone who came in. I saw stuff there that I hadn’t seen since Tropical Medicine in medical school. It was fascinating! All sorts of stuff that I had only read about and never seen again. One day a leper came in, and he was sent on to the leper colony a few miles away that was run by French nuns. I’d never seen anything like that, so I went to volunteer any way I could. I only went twice. Apparently some Viet Cong came into the colony looking for someone. I don’t think they were looking for me. I think they were looking for a Montagnard chief, but our intelligence people found out, and I couldn’t go back. I contacted my wife stateside who got in touch with some drug companies who donated some medicine back to the colony several times. That was such an eye-opening experience. I don’t know that I did that much good, but I know I learned a lot. I tell you what, the training I had at the University of Alabama, and the time I spent at the ER and in the VA, I felt like there wasn’t much I couldn’t handle for at least a little while,” Dr. Sibrans said.

With a lifetime of medicine and volunteerism under his belt, Dr. Sibrans is getting ready to retire…again…at the end of the year. There will be more time for family, reading, fly fishing and his many other hobbies, but when he talks about retiring there’s a bit of a twinkle in his eye.

“It took me a long time to decide to retire. It’s like an old saying I heard a long time ago in medical school that if you’re thinking about doing a tracheostomy, then you should have already done it. So, if I was thinking about retiring, I probably should have already retired!” Dr. Sibrans laughed.

For more information about the Community Free Clinic of Decatur-Morgan County or to become a volunteer, please contact Executive Director Jessica Payne at (256) 309-2491.


Monday, March 13, 2017

Sleep: A Preventative Measure



By: Amita Chhabra M.D
Brookwood Baptist Health, Primary Care - Hoover

At one point or another, everyone has had a two cup coffee day. What makes you reach for that second cup? Perhaps it’s the belief that the extra caffeine may jolt us into having a more productive and efficient day. That may just be a tale some live by. However for most, night time has become a cycle of sleep deprivation and poor sleep patterns. Unfortunately, there is no amount of caffeine that will be able to compensate. In the outpatient setting, we see patients that would like to address complaints of fatigue, anxiety, obesity, hypertension and the list goes on in our every day practice. Oftentimes we preform extensive workups of thyroid, mood, and other organic causes to explain causes of ongoing fatigue. We could avoid testing by asking a simple question: How is your sleep?

The CDC recommends adults get between seven to eight hours of continuous sleep. In some cases, that is just not possible. If you’re anything like me, I’m happy to have four continuous hours of sleep after the birth of our daughter. However, there are some glorious nights when a full night’s sleep changes your entire day. It has been studied 40% of adults report falling asleep during the day, without realizing it, at least once a month. This is called microsleep. It typically occurs when a person will momentarily fall asleep in a conversation, while listening to a lecture, or even while driving. Microsleep is different than narcolepsy. It is typically characterized by not understanding an explanation, or having to repeat phrases, or even “zoning out” while driving. A person who does not have restorative sleep falls victim to a continuous sleep deprivation. They can experience these episodes of microsleep without carrying the diagnosis of narcolepsy. The same person, that experiences an episode of microsleep, may not have those symptoms the next day after a full night’s rest.

Poor sleep is linked to many chronic health conditions. Patients can be evaluated by asking a few simple questions to aide in their overall health. What time do you go to bed? Do you wake up feeling refreshed? How many times is your sleep interrupted during the night? Have you been told that you snore? These key questions that can lead to the diagnosis of sleep deprivation or sleep deficiency without invasive testing.

 If patients aren’t getting the required amount of sleep, providers should introduce recommendations regarding sleep hygiene. Put simply, sleep hygiene prepares the brain for sleep. Sleep hygiene consists of having a routine at bedtime that should be consistent on the weekday and weekends. Avoid screen time, strenuous exercise, and heavy meals at least one hour before bed. It’s important to note that alcohol, nicotine, and caffeine are stimulants that work against the winding down of the brain and body. These kinds of stimulants should be strictly avoided before bed. It is no secret that cardiovascular disease, diabetes, obesity, and depression can all be exacerbated when sleep is compromised. A sufficient amount of sleep may just be a preventative measure for many patients.

Friday, March 3, 2017

Are you sleepy?



By: Stuart J. Padove, M.D. with Medical West Sleep Medicine

Are you sleepy? We would like to introduce you to our Sleep Center here at Medical West!

Have you ever said?:

• I have been told that I snore

• I suddenly wake up gasping for air during the night

• I have been told that I stop breathing while sleeping

• I feel tired during the day even though I slept all night

• I have high blood pressure

• I’m tired during the day no matter how much sleep I get

• I have leg pains at night

• I kick my legs during the night

What do we treat? There are about 88 kinds of sleep disorders, but typically we most commonly see individuals with symptoms of:

• insomnia

• sleep apnea

• narcolepsy

• restless legs syndrome and/or periodic limb movements.

About one-third of the population has some form of insomnia at any given time, and 10% of that group has chronic insomnia. According to the National Sleep Foundation, a large majority (75%) of Americans say they've had at least one symptom of a sleep problem a few nights a week or more within the past year.

If your doctor suggests you undergo a sleep study, or polysomnography, you may be wondering what is involved in this test and what to expect. First, a sleep specialist will meet with you to discuss and review your symptoms. If a sleep study is determined to be needed it will then be scheduled. Sleep studies help doctors diagnose sleep disorders such as sleep apnea, periodic limb movement disorder, narcolepsy, restless legs syndrome, insomnia, and nighttime behaviors like sleepwalking and REM sleep behavior disorder.

A sleep study is a non-invasive, overnight exam that allows doctors to monitor you while you sleep to see what's happening in your brain and body. For this test, you will go to a sleep lab that is set up for overnight stays—usually in a hospital or sleep center. While you sleep, an EEG monitors your sleep stages and the cycles of REM and nonREM or NREM sleep you go through during the night, to identify possible disruptions in the pattern of your sleep.

A sleep study will also measure things such as eye movements, oxygen levels in your blood (through a sensor—there are no needles involved), heart and breathing rates, snoring, and body movements. A sleep study is done in a room that is made to be comfortable and dark for sleeping. You'll be asked to arrive roughly two hours before bedtime. You can bring personal items related to sleep, and you can sleep in your own pajamas. Before you go to bed in the exam room, a technologist will place sensors, or electrodes, on your head and body, but you'll still have plenty of room to move and get comfortable.

If you have symptoms of a sleep disorder, such as the ones above, we are here to help! For more information, please see our website at: http://www.medicalwesthospital.org/sleep-center.php

Tuesday, February 28, 2017

Communicating With Aphasic Patients after Stroke



By: Shelia Carlisle, Speech Pathologist, HealthSouth Lakeshore Rehabilitation Hospital

 A common diagnosis patients present at HealthSouth Lakeshore Rehabilitation Hospital is stroke. One of the many deficits a stroke patient may incur is aphasia, a speech and language disorder that causes difficulty using or comprehending words during listening, speaking, reading and writing. Although symptoms may vary from patient to patient, the difficulties and frustrations people with aphasia and their families encounter are consistent.

Aphasia changes the way healthcare providers communicate with these patients. When communicating with an aphasic patient, consider the following tips:

1) Make sure you have the patient’s full attention before communicating.

2) Eliminate background noise or distractions such as televisions, radios, phones or staff/visitors.

3) Speak to the patient as an adult, using appropriate tone, volume and pitch. Do not talk down to the patient.

4) Keep your instructions simple. Speak at a slow rate and emphasize key words.

5) Do not pretend to understand the patient if you do not.

6) Encourage and use all modes of communication including speech, writing, gestures, drawing, facial expressions, eye contact, pointing, choices and yes/no responses.

7) When asking the patient a question, ask questions that can be answered with a “yes” or “no”. Visual cues are very helpful (i.e., head nods and/or written choices).

8) Give the patient adequate time to respond to questions. Sometimes this can be longer than you expect.

9) Resist the urge to finish the patient’s sentences or offer words.

10) Be ENCOURAGING and PATIENT!

Involve family members in the patient’s care as much as possible especially during communication attempts. Encourage independence and allow the patient to do so much as he or she can for themselves. It may help a person with aphasia, as well as their caregivers and families, to have a book or page with pictures and/or words about everyday topics so the patient can communicate more easily. The inpatient and outpatient speech therapy departments at HealthSouth Lakeshore have many of these tools available for patients and staff use and can assist in educating family members about aphasia and the most effective way in which to communicate with the patient (i.e., gestures, writing, verbal, etc.).

HealthSouth Lakeshore is certified for Disease-Specific Care in stroke rehabilitation. The Joint Commission’s Gold Seal of Approval™ was awarded to the hospital for its compliance with the organization’s national standards for healthcare quality and safety for stroke rehabilitation.

Studies indicate 60 percent of stroke survivors can benefit from comprehensive rehabilitation. Eighty percent of patients receiving this level of therapy return to their homes, work, schools or active retirement, according to the National Rehabilitation Caucus. The Joint Commission’s acknowledgement of HealthSouth Lakeshore’s continuum of care for stroke offers patients and families peace of mind in knowing they are getting quality stroke care for maximized results.


About HealthSouth Lakeshore Rehabilitation Hospital

HealthSouth Lakeshore Rehabilitation Hospital is a 100-bed inpatient rehabilitation hospital that offers comprehensive inpatient and outpatient rehabilitation services. Serving patients throughout north central and central Alabama, the hospital is located at 3800 Ridgeway Drive in Homewood and on the Web at www.healthsouthlakeshorerehab.com .

Monday, February 27, 2017

Technological advances in the hands of a gifted team result in saved lives



By: Yung Lau, M.D.
UAB Professor and Director, Division of Pediatric Cardiology

Thanks to improved technology, pediatric cardiologists at Children’s of Alabama are seeing improved survival rates in children with hypoplastic left heart syndrome and other critical heart conditions.

Hypoplastic left heart syndrome, or the condition of babies born with only one ventricle, is a condition requiring surgery at birth, at 4 to 6 months, and again at 3 to 5 years of age. We discovered that a certain percentage of babies between the first two surgeries could be expected to die suddenly at home.

As a result, Children’s launched Hearts at Home, a program intended to help parents and physicians work together using remote technology to improve that percentage of inter-stage mortality.

With software by Vivify Health, physicians can monitor a child’s condition through a HIPAA-compliant secure system. Parents are provided with a tablet and Vivify’s proprietary software that enables them to enter information such as weight, weight gain and oxygen saturation. That information, along with graphs and trends, is uploaded to physicians. The camera on the tablet even allows practitioners to view the child when a parent is concerned in order to assess whether he needs to come to the hospital.

Another technology, AirStrip ONE, allows us to monitor patients in the hospital from anywhere in the world and consult more effectively with colleagues. With AirStrip ONE, physicians use the Internet and a simple app on their phone to see results from a hospital bedside monitor within five to 10 seconds. We can check on patients periodically, and when needed, we can enlist the support of colleagues for a consult, even when every participant is in a different location. Several eyes almost always mean improved care, as each team member looks at a different aspect of the data. For instance, when a cardiology intensivist recognizes that a particular incident may have been significant, she can ask a pediatric electrophysiologist to look at the rhythm at a particular point in time. The technology allows us to look at trends remotely and adjust our course of care accordingly. Thanks to AirStrip, we have been able to improve and save lives.

Of course, even the best technology is limited by the people who apply it, and the team at Children’s works together in impressive ways to apply these technological advances to make a difference in the lives of our patients. We are part of an organization, Children’s of Alabama, that is dedicated to the care of children. Supporting professionals from therapists to social workers to child life specialists to pharmacists on our team are all focused on forming a cohesive, multi-disciplinary team.

The results have been impressive. Nationally, the average mortality rate for all pediatric cardiac patients is 3.5 percent. Our Birmingham group’s mortality rate in 2015 was 1.6 percent, and that improved to .7 percent in 2016. In addition, while the national mortality rate for hypoplastic left heart syndrome is 8 percent, thanks to Hearts at Home and our team of surgeons, intensivists, cardiologists, anesthesiologists and supporting professionals, we had no deaths due to that condition in 2016.

That’s a result we can all live with.


Monday, February 20, 2017

Got Millennials?



By: Tammie Lunceford, CPC Healthcare Consultant with Warren Averett LLC

As we meet with clients and evaluate the trends affecting the day to day growth of the practice, it is evident that technology is an important consideration. In the past, physicians relied on referrals from other physicians to keep new patients entering the practice. Once the millennial leaves the pediatric physician, the process they utilize to seek treatment may now be vastly different than it was a few years ago.

Smart phones have allowed millennials to utilize the web in seeking medical treatment based on convenience rather than a valued relationship. Your website must be sleek, mobile-friendly, and allow users to get location maps and contact information. If your website is outdated and a mobile phone can’t be utilized to find information in 30 seconds, they’ll move to another website. Millennials are more likely to engage with applications such as Facebook, Twitter and Pinterest than emails and blogs.

Millennials are interested in health and wellness, and they are looking for value and a healthcare organization they can relate to—a genuine brand that is doing something to make a difference. Communication is key. A phone system that directs a patient to a voicemail box will drive patients away from a practice. A patient portal is a vital tool to enable secure messaging, appointment scheduling and live chats. A patient kiosk is helpful in expediting check-in, even better is an app which allows patients to check-in and pay a co-pay before leaving home.

Access to care is essential in capturing a millennial as a patient. Conveniences such as, drive through windows, remote controls and the internet have allowed us to get almost anything quickly. There is tremendous competition in access to care with the growth of urgent care on every corner and the rapid evolution of telemedicine. Practices must be able to offer immediate access instead of expecting that the patient fit into the strict schedule of the practice. Extending practice hours, expanding service, and making your practice accessible to potential patients through the use of mobile technology is part of the formula for keeping your practice healthy with new patients.

Thursday, February 16, 2017

Moving a medical practice can be a daunting task



By: Blake Perry, Chief Technology Officer, Keep IT Simple.

Keep IT Simple has participated in 150+ moves, in-place relocations, new office constructions, and renovations.

Moving a medical practice can be a daunting task. A medical office move can be a result of needing a bigger space, physician retirement, or practice acquisition. While making patients aware of a major change is most certainly a priority, it is equally important to make sure their documents and all office data and service equipment survives the move as well.

What are some things to consider when moving a medical practice? Why is this important?

Whether a medical practice is renovating, moving upstairs, or across town, it is very important to consider how the computers and network equipment will be affected. Are you going to use a new internet provider or a new phone service? Who will be responsible for transporting your computers and network equipment? Who will set it all up again? When will your practice be able to see patients again or take payments?

When planning for a major move, consider having a technology company perform additional backups before the transfer, transport your equipment, and set it back up again. Using a technology company is important because traditional moving companies are not equipped to handle medical technology equipment properly. In most cases, servers and workstations house all patient information and must be transported safely by a professional familiar with using information-sensitive software.

If your medical practice is still using paper charts, it is critical to have your moving company sign a business associate agreement. When a company will be responsible for transporting medical records, they will have exclusive access, even momentarily, to patient information.

In most cases, your office will need to stop seeing patients for equipment to be taken down, backed up, and packed up for a move. Aside from the physical move of your equipment, it is equally important to consider how long it will take to move your equipment. During the hiatus, you can adjust your schedule accordingly, and let patients know when you’ll be available for appointments.

Additional things to take into consideration are:

• the location of computer equipment, and

• what services will be used in the new space.

It is important to know where the computer equipment will be located in your new space so that power plugs, network plugs, phone plugs, and counter-top holes are accessible and the equipment can be properly set up. Most services, like internet, TV, and phone, can be moved to a new location with advanced notice. Sometimes, you will want to take this opportunity to change internet providers, add additional TVs, or upgrade your phone system. These are things that a good technology consultant can help you prepare for so that you don’t have any surprises.

Moving technology equipment is best left to the original installers. Is it common practice for IT companies?

Best case scenario is that the original installers are involved in taking down and setting back up the technology equipment for the new office. The original installers are experienced with all the nuances of your technology and have the best knowledge of how it all fits together. It is very difficult for a technology company, or even the practice owner, who is not very familiar with what all the equipment is, how it is setup, and how it all works together, to come in and take it down properly and put it all back together to work again in the new space.

If a medical practice operates from more than one location, it may be necessary to install new networking equipment so that there is a secure and HIPAA compliant connection between the two or more offices so that data can flow between them in a secure way. This is much easier to coordinate with a good technology consultant that can guide you through purchasing the right equipment, getting the correct services from your internet provider, and successfully setting up the connection.

Most technology companies, like moving companies, will charge for services that include transporting and setting up your technology equipment. Considering that “technology equipment” in most cases is inclusive of all your patient information, this is most certainly worth the investment. Since most moving companies do not operate with proper knowledge of how medical technology works, expensive equipment can get thrown in a truck, damaged, exposed to high or low temperatures that will affect its performance, dropped, or mishandled in such a way that affects your ability to see patients.

What about other moves that aren’t physical, such as acquired practices?

Acquiring practices will require sometimes tricky situations. If the practice that is being acquired has technology, it may require an upgrade or additions to become part of your practice. If the practice is also acquiring the patient data, decisions will need to be made on how you that data will be accessed. Are you going to convert it and import it into your own data? Are you going to setup access to be able to see both systems side by side? These are important questions to ask.

Advice for medical practices making a move.

Reach out to your IT support company early on to find out if they offer services to help during your move. They can properly help your plan. One of the biggest mistakes a medical practice can make is to not include IT support early enough. This can affect how long your system is down, where you can locate your equipment, and how the equipment will perform when it is ready to use in your new space.

Keep IT Simple can help you as early as the blueprint planning stage to be sure that you are building out exactly what you want, for exactly what you need, so that it works and looks great. We have the experience and knowledge to work with your architect, contractors, cabinet installers, electricians, and low-voltage installers. We work with your staff to help provide an easy transition that is safe for your patients’ valuable information.

Tuesday, February 7, 2017

Keeping Promises with Irene Bailey, M.D.




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

Physicians Giving Back Keeping Promises with Irene Bailey, M.D.

Irene Bailey, M.D., is a woman who believes in the power of faith, family and medicine. Running two practices, one in Tallassee and a new extended-hour family medicine/urgent care facility that recently opened in Montgomery, can take its toll. But for Dr. Bailey and her husband, Shaikh Wahid, M.D., there’s always time in the day to enjoy a cup of tea and a piece of chocolate.

Born and raised in Bangladesh, Dr. Bailey’s dream of being a physician began when she was a young girl with a promise made to her father.

“I lost my baby brother when I was 10 years old and he was three months old. That was the first dead body I had ever seen and I was shocked. Now I’m the baby in the family. My parents were devastated,” Dr. Bailey explained. “But, that’s when my father told me, ‘Be a pediatrician and help these kids.’ It was my dream, too. I wanted to help even though I was so young.”

She went to medical school and after just one internship moved to New York with her husband and two-year-old son in 1993. While her husband looked for his residency program, she worked as a nursing school instructor. In 2001, she discovered the UAB School of Medicine Montgomery Regional Medical Campus.

“Through the Family Medicine Residency Program, I realized that I could see everybody. I knew I wouldn’t be bored. Today I see everyone from grandbabies to grandladies. We touch every part of every life, and I love it! I enjoy every day because I’m so blessed!” Dr. Bailey said.

Before long, Dr. Bailey found herself in a unique situation when she became the only full-time physician working with The Learning Tree in Tallassee. The Learning Tree is a nonprofit organization providing educational, residential and support services for children and adolescents with developmental disabilities, including autism. As a statewide organization, The Learning Tree serves more than 600 children and adolescents in 30 Alabama counties, but in Tallassee, the residential school also services Jacksonville and Mobile for about 100 children.

“Treatment can pose a challenge,” Dr. Bailey said. “Sometimes I visit them there at The Learning Tree, but sometimes the children will need to come here. My other patients have always been very understanding, and we make every accommodation we can to get these patients in and seen quickly. But, sometimes I’ve had to go outside to the van to see them because there are just too many distractions here in the office.”

Dr. Bailey said that as her relationship with the administration and staff of The Learning Tree has grown over the past four years, so has the willingness of other specialty physicians to lend a hand when necessary. In fact, Dr. Bailey said, some of these patients who are not part of the residency program in Tallassee travel as long as five hours to see her.

“Autism presents special circumstances, but we all try to rise to that occasion so the children are as comfortable as we can make them,” she said. “I could have said no when this opportunity presented itself, but I’m so blessed. I’m happy that I have this opportunity with these children. If I can help them just a little bit, it’s not them – I’m the one who’s blessed.”

With her work in the Tallassee community and The Learning Tree, and the success of two medical practices, one has to wonder about that promise she made so many years ago.

“My mother and father have both been able to visit and seen me practice medicine. They were so proud! I was also blessed to have had so much support from my father-in-law, who was also a physician. Although it was a promise to my father when I was a child that I become a physician, this has been for me, too,” Dr. Bailey said.

Friday, February 3, 2017

Ribbon Cutting VenaSeal _ BHC Vein Center has recently been named a Center of Excellence for the VenaSeal™


Birmingham Heart Clinic’s Vein Center has recently been named a Center of Excellence for the VenaSeal™ closure system to treat venous disease. In addition to being the first and only practice in Alabama to use this technology, this means that BHC is now being utilized as a training site of this device for professionals from several surrounding states.

The VenaSeal™ closure system is a medical adhesive for the closure of greater and lesser saphenous veins in the legs. Overall, it reduces discomfort and recovery time for patients, and is designed to allow patients to return more quickly to normal activities. This unique approach eliminates the risk of nerve injury when treating the small saphenous vein. The procedure is administered without the use of tumescent anesthesia, and only one needle stick is needed to numb the area. It also eliminates the need for post-procedure compression stockings, and reduces post-procedure pain and bruising.

"This is a unique, almost painless procedure performed in our clinic that is much more comfortable for our patients than traditional treatment methods for venous disease,” explained Dr. Foster. “VenaSeal technology is currently the most advanced vein treatment available, with less discomfort and faster recovery for patients. In fact, patients undergoing this procedure can return immediately to normal activities and exercise.”

Symptoms of venous disease include painful, heavy or swollen legs, as well as dry skin, cramps, ulcers and itchy skin.

BHC also held a ribbon cutting for its fifth practice downtown at St. Vincent’s Birmingham Cardiology Clinic located at 2700 Tenth Avenue South, POB 2, Suite 305. Drs. Monica Hunter, James Towery, and Richard Vest provide high-quality cardiovascular care for patients at this location. Services include diagnostic testing, interventional treatments and procedures, and the management of pacemakers, arrhythmia and Coumadin.

In addition to the downtown location, BHC sees patients at four other clinics: the main campus at 100 Pilot Medical Drive across from St. Vincent’s East in Trussville, at Northside Medical Associates campus in Pell City, St. Vincent’s Blount in Oneonta, and in Gardendale.

The Women of CVA – Heart Health Tailored for Women



Cardiovascular Associates of the Southeast opened its doors in Birmingham, AL in 1946. The private cardiology group is comprised of over thirty physicians who specialize in an array of diagnosis and treatment options with a balance of nationally recognized experts, as well as recently trained cardiologists, in order to maintain our position at the forefront of cardiovascular care.

CVA is unique because they employ the most female cardiologists in private practice in the metro Birmingham area. These women are dynamic and each as passionate as the next about providing their communities with comprehensive women’s cardiology services.

One of the longest standing partners at CVA is Elizabeth Branscomb, MD, FACC. “I came here in the 80’s because the best people in my medical class were here,” says Branscomb. “At that point, CVA had been around for 60 years and Echocardiography was in its infancy. It was an opportunity for me to join a great team to develop new noninvasive procedures.”

Branscomb, the female cardiology trailblazer, helped develop nuclear cardiology and Positron Emission Tomography (PET) stress testing, a noninvasive form of testing. “We were one of the first places in the world to do high volume PET stress testing which can be better for women as they are less likely to have false positives,” says Branscomb. Coupling that with a high volume availability of stress echo which has no radiation, the cardiologists are able to either completely avoid radiation exposure or greatly minimize it in female patients under fifty or of childbearing age in whom ionizing radiation is associated with an increased risk of breast cancer. “Women often get unnecessary testing and procedures,” says Dr. Anuradha Rao. “We offer a thoughtful approach to women’s cardiac care.”

Anuradha Rao, MD, FACC, heads up the CVA Women’s Cardiology. “We are unique in our community because we have a dedicated focus on women’s cardiac issues,” says Rao. Before joining CVA, Rao developed and ran the Women’s Cardiology Program at Tulane. “When I interviewed with my future CVA partners and I met with the women’s specialty groups at Brookwood Baptist Medical Center, there was an overall sense of support,” she says. “A lot of hospitals claim to be women’s hospitals, but Brookwood offers services that go beyond reproductive health from bone health, to cardiac, to mental health services. It’s truly a comprehensive women’s hospital that offers holistic health for women.”

Rao was able to bring her expertise for pregnant women with cardiac issues. “Traditionally, there is no formal training for physicians treating pregnant women with heart problems,” says Branscomb. “Those patients need someone who has experience treating pregnant women and can identify the slight differences in their care.” Rao worked alongside high risk obstetricians while at Tulane to develop that expertise.

Community outreach is important to the practice because often women don’t recognize heart disease and don’t seek proper care. Saema Mirza, MD, FACC, works with the CVA outreach program. “Normally, patients don’t have access to female cardiologists in outreach programs,” says Mirza. “We are able to give them the choice to have a woman and our patient’s gain access to the world class expertise of the CVA group”

Joyce R. Koppang, MD, FACC, has been with CVA for twelve years and also works with some of the group’s outreach communities. “Some of our patients are in areas where they can’t get into town for the care they need,” says Koppang. “We have so many locations for convenience of expertise and we have plenty of options to help provide services that would be totally unavailable to them. We maintain our patients because they have so many places to go.”

The women of CVA don’t feel the need to compete; they work together as a team. “Cardiology has gotten so subspecialized. We don’t hesitate to tap our colleagues for their expertise because as a collective group we have greater knowledge to provide the highest quality of care to our community,” says Rao. “It’s a pleasure being here and on any given day because we have such positive comradery.”

“We are on the forefront of women’s health,” says Branscomb. “Not only do our partners at CVA care about women, they are open to women’s health and would not feel complete without a women’s cardiology program.”

Monday, January 30, 2017

40,000 annual breast cancer deaths in the U.S. alone



By: Damon Stiff, VP Engineering at Capital X-Ray, Inc.

You’ve probably known for a while that breast cancer is one of the leading causes of death in women, with 40,000 annual breast cancer deaths in the U.S. alone. But did you also know that almost 50 percent of women in the U.S. are diagnosed with dense breast tissue and that this higher density has a direct relation to their risk of breast cancer?

For a woman with dense breasts, there may be cases where they receive a negative mammogram, only to later be diagnosed with breast cancer. Dense breast tissue and cancer both appear white on mammograms, sometimes making it difficult to distinguish between the two. This can lead to false negatives or delayed diagnoses.

Tailored to dense breast tissue, Capital X-Ray offers LumaGEM Molecular Breast Imaging (MBI), which is a groundbreaking method that significantly improves early diagnosis of breast cancer in women with dense breast tissue. The compression required for MBI is also lighter and far more comfortable than a mammogram.

Recent studies have confirmed that MBI highlights metabolic activity in breast tumors not visible on mammograms due to tissue density, leading to earlier diagnosis. Clinical research also shows use of LumaGEM reduces biopsies – often painful and costly – by 50 percent. A breakthrough retrospective study, involving over 1,700 women with dense breast tissue over a three-year period, was published in the American Journal of Roentgenology’s August issue confirming LumaGEM’s high incremental cancer detection rate of 7.7 cancers per thousand (7.7/1,000). This compares with published data for primary mammography screening alone of 3/1,000. The study also concluded that when MBI was used as a secondary screening modality, the total number of cancers found was approximately 12/1,000. Approximately 85 percent of these cancers were also confirmed as “node negative,” indicating they were detected at an early stage and therefore presented a better prognosis.

To educate women this year about the importance of MBI and breast density, Gamma Medica launched the “Be Certain” campaign, which aims to give physicians and women access to the most accurate clinical information on breast density and breast cancer detection. In addition to education, Gamma Medica and Capital X-Ray are committed to increasing the number of accurate early breast cancer screenings through installations at major facilities. Every woman deserves to “Be Certain” about her breast health and access to the latest diagnostic tools to help reduce late diagnosis and improve patient clinical outcomes.

LumaGEM is a registered trademark and Digital Direct Conversion Gamma Imaging and DDCGI are trademarks of Gamma Medica, Inc. To learn more about MBI, contact your local Capital X-Ray sales representative at 1-800-239-9729.


About Capital X-Ray, Inc.

Founded in 1987 and headquartered in central Alabama with a branch office in Atlanta, GA, Capital X-Ray has evolved into the largest independent radiology equipment, supply, and service company in the Southeastern United States. With a service and sales force that spans across Mississippi, Tennessee, Alabama, Georgia, and the Florida panhandle, Capital X-Ray has consistently developed its market area while striving to provide customers with a “start-to-finish” solution.

From “ground-up” radiology suite planning, room design/lead shielding plans, feasibility studies & return-on-investment calculations, as well as installation & applications training; Capital X-Ray is able to walk customers through the entire setup and development of their imaging environment. Utilizing Capital’s extensive product line – DR, CR, PACS, MRI, MBI, and analog equipment – customers can rest assured that they are receiving top-notch equipment as well as unbeatable service.


Tuesday, January 24, 2017

Taste of Teal Gala honors UAB GYN Oncology Nurse Practitioner



The Laura Crandall Brown Foundation (LCBF) will honor Nurse Practitioner, Ann George, as the 2017 Legacy of Laura Healthcare Hero Honoree at the Taste of Teal Gala.

The Legacy of Laura awards celebrate those who have volunteered their time and service to our community. These people have made the lives of GYN cancers patients better with their hearts and talents.

“The HealthCare Hero Honoree is someone that consistently demonstrates excellence through serving as a model practitioner in their field, exhibits a consistently compassionate and caring demeanor while communicating with empathy and making a significant impact on patients,” shares the Foundation’s Special Events Coordinator, Lindsay Giadrosich.

This year’s LOL Healthcare Hero Honoree, Ann George, is a Nurse Practitioner in the Division of Gynecologic Oncology at the University of Alabama at Birmingham. Ann George has been practicing Gynecologic Oncology as a Nurse Practitioner for almost 44 years and was one of the very first NPs in the State of Alabama.

She was nominated by Warner Huh and he states, “This is the best recipient of this award because she has set the nursing care standard in Gynecologic Oncology in our state. She has taken care of literally thousands of women diagnosed with GYN cancers. Moreover, she has trained countless nurses, other NPs, medical students, residents, fellows and faculty. Ann has set a very high bar of dedication and work ethic.”

Huh explains that she has been centrally involved in the care of thousands of gynecologic oncology patients and she is arguably the most experienced provider in this specialty in the entire Southeast region.

Ann George will be honored at the 2017 Taste of Teal Gala on March 11th at 6pm at the Hyatt Regency Birmingham The Wynfrey Hotel. In addition to the awards celebration the Taste of Teal Gala includes dinner, drinks, casino games, music, and silent and live auctions. Other honorees include VIVA Health, Corporate Honoree, Shea Bourland, Caregiver and Cheryl Bourn, Survivor. For more information or to purchase your tickets visit www.thinkoflaura.org/tasteofteal

The Laura Crandall Brown Foundation was founded in 2009 to honor the life and memory of Laura Crandall Brown, who died at the age of 25 from ovarian cancer. Laura constantly expressed her desire to be able to help others who might face her same battle, and her loving and courageous spirit inspired her friends and family to create the Laura Crandall Brown Foundation to honor her life, memory, and vision of helping others. Our mission is offering hope through research for early detection of ovarian cancer, empowering communities through gynecologic cancer awareness, and enriching lives through patient support.

Monday, January 23, 2017

Update to Substance Abuse Treatment Records Regulations



By: Adjunct Professor in the Master of Science in Health Law and Policy Program at Cumberland School of Law

On January 13, 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued its Final Rule to update and modernize the Confidentiality of Alcohol and Drug Abuse Patient Records regulations (42 CFR Part 2), often referred to as “Part 2”.

It has been nearly 30 years since Part 2 was last updated. In that time, the provision of healthcare has drastically changed and the substance abuse treatment records regulations were past due for an overhaul. Under the existing Part 2, substance use disorder programs generally may only release patient identifying information related to substance use disorder diagnosis, treatment, or referral for treatment with an individual’s express consent. Even disclosures related to payment, treatment, or health care operations, which are permissible under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) without patient authorization, require express consent.

According to SAMHSA, the Final Rule will further enhance health services research, integrated treatment, quality assurance and health information exchange activities while at the same time safeguarding the essential privacy rights of people seeking treatment for substance use disorders.

Following issuance of the Final Rule, Part 2 continues to apply to any substance use disorder program that receives federal financial assistance, including reimbursements from Medicare, Medicaid, and other government programs, and holds itself out as providing, and provides, substance use disorder diagnosis, treatment, or referral for treatment (Part 2 Program). Patient records subject to Part 2, however, now include substance use disorder records maintained by Part 2 Programs, as well as those records in the possession of “other lawful holders of patient identifying information” (e.g., individual or entities who receive such records pursuant to a Part 2-compliant patient consent).

Major provisions of the Final Rule effective February 17, 2017, include the following:

• Permits a patient, in certain circumstances, to include a general designation in the “To Whom” section of the consent form (e.g., “my treating providers”), in conjunction with requirements that the consent form include an explicit description of the amount and kind of substance use disorder treatment information that may be disclosed.

• Permits electronic signatures to the extent that they are not prohibited by any applicable law.

• Adds a requirement that, upon request, patients who have included a general designation in the “To Whom” section of their consent form must be provided a list of entities (referred to as a List of Disclosures) to which their information has been disclosed pursuant to the general designation.

• Requires both Part 2 Programs and other lawful holders of patient identifying information to have in place formal policies and procedures addressing security, including sanitization of associated media, for both paper and electronic records.

• Regulations related to the disposition of records by discontinued Part 2 Programs now address both paper and electronic records, and adds requirements for sanitizing associated media.

• Clarifies that the required written summary of federal law and regulations to be provided to patients may now be in either paper or electronic format.

• Clarifies that the prohibition on re-disclosure only applies to information that would identify, directly or indirectly, an individual as having been diagnosed, treated, or referred for treatment for a substance use disorder, such as indicated through standard medical codes, descriptive language, or both, and allows other health-related information shared by the Part 2 Program to be re-disclosed, if permissible under other applicable laws.

• Permits data protected by Part 2 to be disclosed to qualified personnel for the purpose of conducting scientific research by a Part 2 Program or any other individual or entity that is in lawful possession of Part 2 data if the researcher provides documentation of meeting certain requirements related to other existing protections for human research.

• Modernizes the audit and evaluation requirements to include provisions governing both paper and electronic patient records.

• Permits an audit or evaluation necessary to meet the requirements of a CMS-regulated accountable care organization or similar CMS-regulated organizations, under certain conditions.

Here are links to the Final Rule and the SAMHSA news release.

Many health care organizations have expressed concerns that the SAMHSA Final Rule does not go far enough. The Partnership to Amend 42 CFR Part 2, a coalition of over 20 health care organizations including the American Hospital Association and the National Association of State Mental Health Program Directors, was formed in an effort to align Part 2 with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to allow appropriate access to patient information that is essential for providing whole-person care. In a press release issued January 13, 2017, the Chair for the Partnership to Amend 42 CFR Part 2 states:

While the final rule is a step in the right direction, it fails to adequately ensure that persons with substance use disorder receive the effective coordinated care they deserve. Particularly in light of our country’s opioid crisis, it is imperative that Part 2 requirements are aligned fully with the HIPAA requirements that allow the use and disclosure of patient information for treatment, payment, and health care operations. Failure to integrate care that addresses all of a patient’s health needs can lead to unintended risks and dangers to individuals.

In addition to the Final Rule, SAMHSA also issued a supplemental proposed rule seeking public input on the role of contractors, subcontractors and legal representatives in the health care system with respect to payment and health care operations. Comments on the proposed rule must be submitted by February 17, 2017.

SAMHSA will monitor implementation of the Final Rule and work to develop additional sub-regulatory guidance and materials on many of the finalized provisions. It is unclear how the incoming Trump administration will feel about these “midnight regulations”.

Friday, January 20, 2017

CVA Welcomes New Cardiovascular Physician to Team



BIRMINGHAM, AL. – Cardiovascular Associates of the Southeast is excited to announce that Himanshu Gupta, MD, FACC a cardiovascular physician, specializing in cardiovascular imaging and general cardiology has joined the group as of (December 19, 2016).

Before joining CVA, Dr. Gupta was a tenured faculty member at UAB Medicine and Radiology and served as a scientist for the UAB Comprehensive Cardiovascular Center, Heart Failure Research Center and Diabetes Research and Training Center. He also served as the Co-Director of Cardiovascular Magnetic Resonance at UAB and held hospital appointments at UAB Hospital, Kirklin Clinic, UAB Highlands, and The VA Medical Center.

Dr. Gupta completed his medical degree at the University of Delhi, New Delhi, India followed by internal medicine residency at Wayne State University, Detroit, MI. Afterwards, he did his four year combined fellowship in cardiovascular medicine and imaging at The University of Alabama at Birmingham, AL where he served as a chief fellow.

He is board certified by the ABIM in Cardiovascular Medicine and is a Diplomate of the Certification Board of Cardiovascular Computed Tomography (CBCCT) and the Certification Board of Nuclear Cardiology (CBNC). He is also a Testamur of the National Board of Echocardiography and has highest-level training in cardiovascular MRI.

He has conducted original research in preventive cardiology, valvular heart disease, pulmonary hypertension and diastolic heart failure with numerous original publications in high impact journals and has been consistently funded in his research and program development by the National Institute of Health (NIH).

Dr. Gupta joins CVA with vast expertise in multi-modality cardiovascular imaging for clinical and research applications. He is married with two young children and participates in various community activities including serving as immediate past president of American Association of Physicians of Indian Origin- Birmingham/ Central Alabama Chapter.

Dr. Gupta will be offering the following at CVA and Brookwood Baptist Medical Center:

• Cardiovascular Consultations

• Acute Cardiovascular Care

• Expert Cardiovascular Imaging and Reading

• Cardiovascular Clinic Office Visits

• Non-Invasive Cardiovascular Procedures


For more information on Dr. Gupta and the services available at Cardiovascular Associates contact us at (205-510-5000) or visit http://www.cvapc.com/

Wednesday, January 4, 2017

From the Treatment Room to the Classroom with Wick Many, M.D.



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


Physicians Giving Back

From the Treatment Room to the Classroom with Wick Many, M.D.

MONTGOMERY – He jokes about it now, but Wick Many, M.D., said he was a sickly child who spent a lot of time in his pediatrician’s office. For those times when he was too sick, his doctor would make house calls…an experience he did not look forward to.

“Back then, in the 1950s, pediatricians would come out to your house at the end of the day. They would spend all day in their clinics seeing children, but then for those who were really sick, they would make house calls. I was scared to death!”

Dr. Many laughed. “The doctor would come in with his big brown doctor’s bag, and that usually meant I was going to get a shot of something. That was my first recollection of medicine.” Dr. Many grew up around medicine. A native of New Orleans, his mother was the paging operator at what was then the Southern Baptist Hospital of New Orleans. Because she worked night or evening shifts and couldn’t come home for dinner, family dinners were often taken on the ER ramp.

“No one in my family had a medical background, but at some point in high school, I decided this was what I wanted to do. I didn’t have an A-HA moment or an epiphany, it’s just what I knew I wanted to do,” Dr. Many said.

Although he went to LSU for his undergraduate degree, he intended to stay close to home for medical school until a friend who was accepted to UAB talked him into joining him in Birmingham. Once convinced of UAB’s credibility as a medical school, he had to convince his colleagues back home in Louisiana.

“This was the late 1960s, and my colleagues who were at LSU just didn’t understand,” Dr. Many explained. “Alabama? Birmingham? What? They just didn’t get it. I stayed at UAB for the rest of my time except for a year when I went to Dallas. I’ve been affiliated with UAB in some way, shape or form since 1980.”

Although trained in infectious disease, there came a time when Dr. Many’s marketing skills were put to the test when he was approached with an opportunity to step into the spotlight and bring some publicity to the UAB School of Medicine Montgomery Regional Medical Campus.

WSFA-12 had run a syndicated medical segment for years with Houston’s Dr. James “Red” Duke, Jr. When that syndication ended, Dr. Many stepped in, not only to provide helpful medical information to viewers but also for the sake of the Montgomery UAB campus.

“Even to this day – TO THIS DAY – there are a lot of people who do not know there is a residency program and a branch campus here in Montgomery,” Dr. Many said. “I can still go to the bank or the post office and folks will ask me if I drive down from Birmingham every day, and I have to tell them no, no, no. UAB has been in Montgomery since 1978, but the majority of the people here in the region still don’t know that. We haven’t done a lot of advertising or marketing because we haven’t had the funding for it.”

As dean of medicine for the UAB School of Medicine Montgomery Regional Medical Campus, Dr. Many is responsible for about 40 medical students, roughly 20 third year and 20 fourth year students. There’s still much room to grow, but Dr. Many said the Montgomery campus is unique considering the resources he and his staff utilize to give the students a well-rounded medical education. For example, in the eight weeks students spend working in the family medicine “block,” four of those weeks are spent in Montgomery with another four in Selma. Part of the time spent in Selma is then spent in Marion with the idea that each step further removes the students from what they have become accustomed to in medical school.

“The purpose of that is to give them an appreciation of not only the opportunities of practicing in a rural setting but also the challenges so that in the future if they decide not to do that they have a better appreciation for what family physicians in that position actually do. I call it ‘intellectual isolation.’ Everyone likes to share stories. If you’re a solo practitioner in a very small town, and you have a patient that comes to you with something weird that you haven’t seen since medical school, who do you talk to? Physicians in more metropolitan areas are fortunate because we have grand rounds, lectures, and of course the Internet has made a difference, but in the most rural of our communities, we don’t have these things,” Dr. Many said.

The Montgomery campus also utilizes resources unique to Montgomery for special teaching opportunities. Representatives from the Medical Association of the State of Alabama, the Alabama Board of Medical Examiners, the Alabama Department of Public Health, the state forensics lab, military physicians and representatives from the Montgomery Police Department all have a special take on medicine that can’t be taught in the classroom but aspects of medicine that new physicians need to understand.

Considering all his contributions to the medical landscape in the River Region and to UAB, it’s difficult to picture medicine without Dr. Many. But in his junior year in college, he also took a different path.

“I came very close to changing my major to history my junior year in college,” Dr. Many said. “If I wasn’t a physician, I’d be a college history professor. I love to read, but I don’t read fiction. I read biographies of our presidents and historical figures. My favorite book is the biography of Alexander Hamilton. He has to this day had an impact on our country. He created the financial system of the United States yet he had so many flaws. Fascinating!”