Friday, December 16, 2016

Pasta Primavera

By: Chef John Hall with Post Office Pies

• 1 pint cooked angel hair pasta

• ¼ cup small diced yellow squash

• ¼ cup small dice zucchini

• 4 cherry tomatoes, quartered

• 2 tbsp capers, drained and rinsed

• 1 tbsp fresh chopped Italian parsley

• 2 cloves minced garlic

• 1 tbsp canola oil

• 1 tbsp EVOO

• 1/8 cup shredded pecorino romano

• Kosher salt and fresh cracked pepper to taste

1. In a sautee pan, cook garlic in canola oil over medium-high heat until golden brown

2. Add squash and zucchini, cook until squash softens but still has slight crunch

3. Add tomatoes, capers , pasta, and parsley. Toss in sautee pan until hot throughout pasta

4. Season with salt and pepper

5. Pour pasta dish into bowl, drizzle with EVOO, and garnish with pecorino romano

Thursday, December 15, 2016

Wide Awake Hand Surgery

By: Michael D. Smith, MD

Would it be nice to have the option of undergoing anesthesia or being offered the “wide awake” alternative similar to when you are having a dental procedure? As a new hand and upper extremity surgeon, I often meet patients that for one reason or another would like to have surgery to correct their problem but are nervous about or don’t want to undergo anesthesia. Some patients have difficulty in arranging for a ride to pick them up after they had undergone the sedation or others believe they are too “high risk” to undergo anesthesia secondary to a significant cardiac or pulmonary co-morbidity. For these patients, I have begun to offer the possibility to have their surgery done under Wide Awake, Local Anesthesia with No Tourniquet or WALANT as it’s known within the hand surgery community. This technique can be used for a variety of hand surgeries such as carpal tunnel syndrome, trigger finger and excisions of mucous cysts.

WALANT utilizes 1% lidocaine with 1:100,000 epinephrine buffered with 8.4% sodium bicarbonate to provide both local anesthesia to the hand or digit and to also provide hemostasis. This allows the surgeon to avoid using a tourniquet, which is often the most painful aspect of the surgery for patients that are having a procedure done under light sedation.

For years, medical students have been taught to never inject lidocaine with epinephrine into the fingers for fear of causing irreversible ischemia and digit necrosis. The familiar adage of no epinephrine into “fingers, nose, penis and toes” was well ingrained into my head by the time I had graduated from medical school in 2010. Dr. Don Lalonde, a hand surgeon from New Brunswick, Canada, has published his results of over 2000 cases using epinephrine in the finger and has been at the forefront of debunking this commonly held myth. Dr. Lalonde has also published his research into the myth and there is evidence that origin of the myth stems from the use of procaine (Novocaine) in the early 1900’s before the introduction of lidocaine in 1948. Procaine started with a pH of 3.6 and became more acidic as it sat on the shelf. It is highly likely the reports of digit necrosis after “epinephrine” injection in the early 1900’s were actually cases of highly acidic procaine causing the digit necrosis.

Dr. Lalonde has a new adage, “If the fingertip is pink before the lidocaine with epinephrine, it will be pink after the lidocaine with epinephrine.” In addition, there is a reversal agent, phentolamine that can reverse the hemostatic effects of epinephrine injections within an hour or two.

Some of the advantages of WALANT hand surgery include:

●Little to no pre-operative testing, as the only two medications being administered are lidocaine and epinephrine.

●Patients are able to drive themselves home, as they have had no sedation or anesthesia.

●Patients do not need to fast or change medication schedules before the procedure; which is especially helpful in my diabetic patients.

●Patients do not need to endure a tourniquet, even for five minutes.

In my practice, patients are sometimes nervous about being awake during their surgery, but oftentimes they find that the worry about “being awake” is much worse than the reality. In truth, I find the opportunity to talk with my patients during their surgery is a great avenue to build my relationship with the patient, but also to reiterate the post-operative protocol I would like for them to follow. I think most of my patients that have undergone WALANT would agree that it made their surgical experience simpler and more enjoyable.

Michael D. Smith, MD

Hand and Upper Extremity Surgeon
Southlake Orthopaedics Sports Medicine and Spine Center, PC

Friday, December 9, 2016

All in the Family with the Smiths

Physicians Giving Back: All in the Family with the Smiths
By: Lori M. Quiller Communications Director, Medical Association of the State of Alabama

LINEVILLE – The City of Lineville is a small, rural community of about 2,500 residents in Clay County. At the heart of the community lies Lineville Clinic, home of the Smith family medical practice.

Patriarch George Smith Sr., M.D., graduated from Howard College with a Bachelor’s degree in Pharmacy and worked for three years with Eli Lilly as a pharmaceutical representative, but something was missing.

“I felt like I could do more than I was doing as a pharmaceutical rep, so I applied to medical school,” Dr. Smith said. “My wife and I really wanted to come back to Lineville, but I wanted to come back here as a doctor. I’m a fourth generation Smith. My great grandfather helped settle the area. This is home.”

In 1966, Dr. Smith came back to Lineville and bought his practice from a physician who wanted to focus more on nursing homes than private medicine. His first day in his new practice was July 1, 1966 – the first day of Medicare.

“I got this survey asking what my office fee was, and I answered truthfully. It was $4, and that stuck with me for another 10 or 12 years because they wouldn’t let me change it. When I first started out it was $2. Can you imagine if I hadn’t changed it?” Dr. Smith laughed.

Since then, Dr. Smith has seen not only his community grow, but also his practice. In 1986, his son, Buddy Smith, M.D., joined the practice.

“I grew up going on house calls with Daddy, carrying his doctor’s bag. He did a lot of house calls in the 60s and 70s, and I was impressed with how people treated my father, how he was respected by his patients and the community. There’s a reason why he’s Dr. Smith and I’m Dr. Buddy. There’s only one Dr. Smith. He’s a legend,” Dr. Buddy said.

Dr. Buddy said one of the things that has contributed to the longevity of the practice, given that it is not affiliated with a large hospital or company, is its reputation largely due to his father. With patients willing to drive up to 50 miles to visit the clinic, and some patients who have been with the clinic since the beginning, there’s something to be said for small town reputations.

“In a small town, everyone knows you,” Dr. Buddy said, “so it’s important to remember why we’re here. We have patients who come a long way to see us because of our reputation. The patients are the reason why we’ve been in practice here for so long. We never forget why we’re here.”

And, that’s just one of the reasons why Dr. Buddy’s daughter, Ashley Smith Lane, M.D., joined the practice in October 2016. Dr. Smith’s Lineville Clinic officially became a family affair with three generations of physicians practicing under the same roof.

“I grew up here and already knew a lot of the people,” Dr. Lane said. “This is a great, established practice, and having these two, amazing mentors during a time when medicine is changing so quickly definitely makes being a young practicing physician a bit easier.”

Dr. Lane said she was prepared for a bit of inconvenience after finishing her residency in Huntsville, where tapping into the medical pool for specialty consults was as easy as picking up a phone. But, her heart was calling her back to Lineville…back to her home.

“Being a young doctor today is already complicated by all the changing rules and regulations, but add in being in a rural setting makes it more complicated because we don’t have the ease of getting our patients to the proper specialists as quickly as we would like,” Dr. Lane explained. “Coming from my residency in Huntsville where all the specialists were pretty much right there at our fingertips to a rural situation that allowed me to be a more well-rounded family doctor…it’s fulfilling and challenging all at the same time. I knew in residency I wanted to come back home, and I knew I would need these skills when I came back here. I loved my time in Huntsville, but this is home.”

Part of what Dr. Lane said she loves about practicing with her father and grandfather is the true partnership she has in the practice.

“It’s been a lot of fun working with both my father and grandfather – it’s actually pretty cool! Of course I’m learning a lot from them, but they also let me do my own thing and be myself. That means a lot, too, to allow me to be myself in the practice as a partner,” she said.

Together, the trio face the challenges of medicine together.

“We have to balance the demands of a health care system with a rural small business. And, everything is more difficult when you’re in a rural setting from communication to referrals to transportation…it’s all challenging,” Dr. Buddy explained. “The biggest challenge is to incorporate all the changes in medicine, such as MACRA, MIPS, advanced payment models, quality incentives, into an independent practice in a rural setting when none of them necessarily translate to my situation. These new rules are written for large practices with large IT departments, not small practices or independent practices like ours. It’s a huge challenge to try to meet these guidelines when you don’t have these resources. It takes more and more of my time away from patient care to do these other things. I would say now it’s 50/50 split between sitting at a computer and sitting with a patient. It’s about equal when we should be caring for our patients more than working computers.”

Another change? Alabama’s prescription drug abuse problem. It’s an issue Dr. Buddy was willing to tackle as one of the architects of the Medical Association’s Opioid Prescribing education course.

“We could see the need was growing because of the lack of prescribing education among our physicians. It was a need that had to be addressed, so we created the Opioid Prescribing Course,” Dr. Buddy said. “Doctors were closing their doors and quitting their practices because of what they were seeing happen in their communities. We needed to find a way to educate our doctors so they could keep their doors open and understand how to prescribe these medications effectively and efficiently. I think we have been successful in educating physicians about the dangers of opioids, but I’m not so sure if we’ve been as successful about continuing to practice pain management. It’s scary out there, but it’s rewarding if done correctly.”

With all the changes in medicine throughout the years, from Medicare to electronic records, Dr. Smith said looking back, he would not have done things any differently.

“I’ve been so happy to do what I do for all these years. It was never about the money. It was always about our patients. I’m sure I could have done better somewhere else, but that’s not why we do what we do, is it? It’s been very rewarding. You know you’ve done some good, and that’s the main thing. I’ve done what I call ‘rounds at the Pig’ at the local Piggly Wiggly where someone might stop me and ask about this or that. I still enjoy stopping to chat,” he laughed.

When Dr. Smith opened the doors of the clinic in 1966, he never expected having three generations of his family practicing medicine under the same shingle, but he can’t hide the smile when you mention his son and granddaughter.

“It’s special,” he said. “I know how rare this kind of thing is, especially for two physicians to choose family medicine and to come back home to a rural practice in a small town…that’s very special.”

Wednesday, December 7, 2016

Limb Sparing Procedure Saves Patient’s Leg

Limb Sparing Procedure Saves Patient’s Leg
Kevin Glandon, patient of Christopher Huff, M.D.  

By: Lindsesy Allumbaugh

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

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

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

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

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

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

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

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

MONTGOMERY – The Medical Association of the State of Alabama applauds the nomination of U.S. Rep. Tom Price for secretary of the U.S. Department of Health and Human Services.

“Congressman Price is a strong advocate for preserving the patient-physician relationship, which includes fighting for patients’ rights as well as preserving physician autonomy,” said Medical Association President David Herrick, M.D. “Dr. Price has worked with our Medical Association leadership for many years on the national level to deregulate medicine and ease the administrative burdens placed on physicians. We feel that as a physician, Dr. Price understands firsthand what the health care system needs to get back on track so our physicians can focus more on treating their patients and less on red tape.”

For nearly 20 years, Dr. Price worked in private practice as an orthopaedic surgeon. Before coming to Washington he returned to Emory University School of Medicine as an Assistant Professor and Medical Director of the Orthopedic Clinic at Grady Memorial Hospital in Atlanta, teaching resident doctors in training. He received his Bachelor and Doctor of Medicine degrees from the University of Michigan and completed his Orthopaedic Surgery residency at Emory University.

Should Dr. Price be confirmed as secretary of the U.S. Department of Health and Human Services, he would be the first physician to serve in that position since 1989 and the third physician in the 63-year history of the department. The Medical Association strongly feels physician leadership of HHS and in the President’s Cabinet would provide the necessary perspective that has been lacking in the health care decisions of our country.

Tuesday, December 6, 2016

Advances in genetic testing result in more effective diagnoses

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

Birmingham pediatricians now have expanded options for easily accessing genetic expertise and testing, with the recent opening of a genetics clinic at Children’s of Alabama.

For physicians, it’s important to consider when to refer a patient for genetic evaluation, especially for those patients who were unsuccessfully evaluated in the past.

Most pediatricians have experience in recognizing children with congenital malformations, intellectual disability or developmental delay that may have a genetic component. When those patients receive a diagnosis, parents have at least a minimum understanding of what is happening with their child, how best to manage that child, and whether it may occur in their other children.

Unfortunately, in the past a large percentage of patients went undiagnosed, even with an evaluation, putting the parents of young children on a seemingly endless quest to decide how best to manage their child’s medical conditions.

A great deal has changed relatively recently, however, and new tools, including microarray and genome sequencing, are available, which means we have the ability to achieve diagnoses that were not available to us before. So if you have been following a patient with medical issues that you suspect are genetic in origin, and that patient has not had genomic sequencing, it is likely time to refer them to a clinic for retesting.

One of the new tools available to us is microarray testing, which gives us the ability to make a definitive diagnosis at much higher rates than we could expect just a few years ago. Older tools would enable us to see the big picture, much like a satellite picture of the earth. Today’s tools are more like the Google Earth app, allowing us to zoom down to street level, so we can see detail on the genome that was previously impossible.

Genome sequencing is another tool that has improved our ability to diagnose. The cost for the test is dropping dramatically. Once costing $100 million per run, the test and analysis are now in the $6,000 to $7,000 range. While that is still a lot of money, compared to the cost of other medical tests it is actually fairly reasonable.

Microarray can be expected to pick up the genetic cause of 15 to 20 percent of autism spectrum disorder cases. Genome sequencing can pinpoint a diagnosis in about 30 percent of cases of children with intellectual disability, autism spectrum disorder, or congenital anomalies. Putting the two tests together means we can expect a definitive diagnosis in 50 percent of the cases presented to us. Considering that even five years ago we could only expect to diagnose about 5 percent, that’s a tremendous step forward in a very short time.

At one time, a genetic diagnosis relied on the physician’s ability to predetermine the underlying problem in order to test for that particular disorder. Today, we are able to diagnose based on the tests, even finding conditions so rare that no physician would have considered testing for them in the past.

And when a diagnosis still eludes us initially, we can now share results and experience with other geneticists around the world, enabling us to establish a diagnosis we may not have been able to make alone. In short, the tools we have at our disposal now have never been more powerful, so if you are a pediatrician following a patient and have been unsuccessful getting a diagnosis in the past, it is worth taking a second look now. Of course, putting a name to a disorder is only part of the battle. The next step is knowing how to treat a patient’s condition, and we have made progress in that area as well. Certainly, we can’t say we are able to treat every condition we see, but once we figure out which gene underlies the condition, we then begin to ask why the change in the gene causes the problems it does. And we are gradually figuring that out and identifying drugs that improve quality of life.

With such dramatic and rapid developments in the field of genetics, there are many implications to be considered as we move forward. There is increasing discussion that perhaps everyone should have their genome sequenced, as the cost goes down and the feasibility of the testing goes up. This emerging area will have to be addressed carefully. Between 1 to 3 percent of people whose genes are sequenced will discover a condition they did not realize they had or were at risk for, and virtually everyone can learn how their body manages specific medications or can become aware of risk factors for common diseases. But there are also questions about what options exist to manage these risks once they are known. We will have to proceed carefully in light of our increasing technological abilities.

For patients with known medical problems that can be addressed with genetic evaluation, however, there are ample reasons to make referrals and try to determine a diagnosis that can improve quality of life for the patient and their family.

We have a new clinic integrated into Children’s, with access to parking and other specialists, making genetic evaluation more convenient for parents than ever before. In addition to our Children’s clinic, we have a prenatal diagnosis program through OB/GYN and maternal fetal medicine at UAB, and our newest clinic at Kirklin Clinic for adults.

If you have questions about referring a patient to one of our Birmingham area clinics, please call (205) 934-4983 to discuss.

Wednesday, November 30, 2016

Quality and Cost Adjustments May Hit Your Bottom Line in 2017

by: Tammie Lunceford, CPC with Warren Averett LLC

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

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

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

1. Per Capita Costs for All Attributed Beneficiaries

2. Per Capita Costs for Beneficiaries with Diabetes

3. Per Capita Costs for Beneficiaries with COPD

4. Per Capita Costs for Beneficiaries with Coronary Artery Disease

5. Per Capita Costs for Beneficiaries with Heart Failure

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

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

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

         Quality/Cost                 Low Cost                     Average Cost                 High Cost

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

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

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

Key Areas to Address Now:

• Set up an account with EIDM

• Obtain your QRUR reports

• Contact your academy or vendor for resources

• Evaluate your reporting options

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

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

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

Friday, November 18, 2016


By: Curtis Woods
President at Integrated Solutions, LLC

noun: ransomware;

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

How much will ransomware cost me?

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

How does ransomware infect my system?

Ransomware usually infects a system in one of two ways:

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

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

Traditional advice to prevent ransomware

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

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

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

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

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

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

Advanced options for preventing ransomware

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

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

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

What should I do if I become infected?

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

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

• Call your trusted IT professionals at Integrated Solutions.

Thursday, November 17, 2016

The Value of a Year End Meeting

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

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

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

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

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

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

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

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

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

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

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

Wednesday, November 16, 2016

Splash Down in Haiti and Saving Lives

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



Monday, November 7, 2016

When You Run, You Are Going to Sweat

Susan Pretnar
President at KeySys Health LLC

Why aren’t more things this simple? When it comes to today’s healthcare environment, the people responsible for managing provider practices and clinics seem to be running pretty hard and sweating more than ever, but not the satisfying sweat of accomplishment. They are sweating how they are going to be responsive to patients and keep them healthy, how to care for their employees and make them productive, how to keep the lights on and stay in compliance with rules and regulations that affect the business. That is, they are sweating running a business.

The title phrase hit me as I was listening to a commentator express the obvious about a topic under discussion. The running analogy is most poignant when applied to managing information technology in the healthcare world:

When you buy technology, you are going to have to invest in it

It doesn’t matter what business you are in: it can’t be said any more plainly. Based on current average IT expenditures and the number of breaches experienced by healthcare businesses, that fact still seems to be ignored or simply not believed. Invest in ‘what’ you might ask: invest in, maximize and support current technologies (including upgrading the basic EMR you bought a few years ago); invest in greater communication capability; invest in education and training; invest in a strategy for adding future technologies.

In truth, investment is only necessary if you are not really going to act on the threat to abandon your patients and your business in 2017. In spite of statistics about impending provider shortages, where IT infrastructure is concerned, healthcare entities are still expected to manage their practices like every other business, or cease to operate. Pressure to add technological capability is escalating, on the one hand because of incentives, penalties or regulations, but even more so because patients are becoming ‘consumers of healthcare’; expecting to interface with their healthcare providers like they do other services.

Accepting the idea that patients want to compare prices for treatment, want to communication with you like they do their bank, want to be assured you can protect the privacy of their information, and want to question why you are recommending a certain treatment plan when Google suggests otherwise, is still being resisted in healthcare. In truth, the people and technology needed to succeed in this present and future operating reality will cost any healthcare business more time and money than they are accustomed to investing.

The not so simple solution is ‘when you buy technology, consciously plan to invest your time and financial support to maximize its use’. Celebrate every successful implementation and learn from inevitable mistakes.

Wednesday, November 2, 2016

New Report Reveals Serious Security Risks within Healthcare Industry

By: TekLinks staff 

A new report reveals the healthcare industry is lacking in basic security awareness among its staff, which can jeopardize entire medical infrastructures.

The healthcare cybersecurity report was released by SecurityScorecard, a security rating and continuous risk monitoring platform.

The 2016 Healthcare Industry Cybersecurity Report found that network security, IP reputation, and patching cadence are healthcare's biggest struggles.

The study also exposes a risk of attacks through social engineering. "Security breaches in this industry pose devastating consequences because they can render an entire system or network inoperable, creating a life or death situation that needs immediate attention," reports

"The low social engineering scores (15th out of 18) among a multitude of healthcare organizations show that security awareness and employee training are likely not sufficient," says Alex Heid, Chief Research Officer at SecurityScorecard. "Security is only as strong as the weakest link, and employees are often the lowest-hanging fruit when it comes to phishing, spear phishing, and other Social Engineering attacks. For a hacker, it only takes one piece of information such as learning the email structure of an organization to exploit an employee into divulging sensitive information or providing an access point into that organization's network."

Among the report's key findings are:

• Over 75% of the entire healthcare industry has been infected with malware over the last year

• 96% of all ransomware targeted medical treatment centers

• Healthcare manufacturing nearly reaches a 90% malware infection rate

• 63% of the 27 Biggest US Hospitals have a C or lower in Patching Cadence, which measures an organization's ability to implement security software patches in a timely fashion

• Healthcare has the 5th highest count of ransomware among all industries

• Over 50% of the Healthcare industry has a network security score of a C or lower

Healthcare providers who are serious about securing their practices can download TekLinks' free Ultimate Guide to Data Security or contact TekLinks at . Our IT experts support clinical systems that collectively serve more than 1 million patients each year.


WHO IS TEKLINKS? A national leader in cloud computing, managed services, engineering services, and value-added resale. We’re a team of expert techies and business professionals who are passionate about building valuable relationships and getting things done right. Simply put: We make IT work for business.

Tuesday, October 25, 2016

Total Hip Replacements

By: K. David Moore, M.D.
Andrews Sports Medicine & Orthopaedic Center

Making the decision to have a total joint replacement is a life-changing decision for all involved. In the past 40 years, millions of people have suffered from arthritic hip pain and experienced relief and restored mobility through total hip replacement. Most patients report that pain experienced after surgery pales in comparison to the pain they were living with on a daily basis.

What advice do you have for those considering a hip replacement?

At Andrews Sports Medicine & Orthopaedic Center, our philosophy is to partner with our patients to help them claim victory over their condition or injury. The first step when making the decision about a hip replacement is for the patient to schedule an appointment with us to see if they are a candidate for total hip arthroplasty (THA). During the initial visit, we take the patient’s medical history, perform a physical examination, and x-ray the hip.

Even if the pain is significant and the x-rays show advanced arthritis of the joint, the first line of treatment is nearly always non-operative. This may include weight loss if appropriate, modifying certain activities, medication, or injections. If the symptoms persist despite these measures, then I recommend that the patient consider a total hip replacement.

The decision to move forward with surgery is not always straight forward and usually involves a thoughtful conversation between me, the patient, and their loved ones. The final decision rests with the patient based on how limited they are by hip pain. I often tell patients that when they have tried non-operative measures, but continue to have to order their loves around what their hip pain will allow them to do, it is time to consider hip replacement.

After having a hip replacement, how many years can a patient expect it to last?

On average, a total joint replacement lasts approximately 15-20 years. However, a more accurate way to think about longevity is via the annual failure rates. Most current data suggests hip replacements have an annual failure rate between 0.5-1.0%. This means that if a patient has a total joint replaced today, they have at least a 90-95% chance that joint will last 10 years, and a better than 80-85% that it will last 20 years.

With continual improvements in technology, these numbers will likely improve. Despite such improvement, I communicate to all my total hip replacement replacements that it is important for them to maintain long-term follow-up with me to assure their replacement is functioning appropriately.

Have hip replacement trends changed in recent years?

I believe that it’s important that we first consider what has not changed about hip replacement. Hip replacement has been an excellent operation for decades. It is an operation that very reliably alleviates pain and restores function. When people have studied everything that we do as physicians in terms of quality of life restored per dollar spent, nothing surpasses hip replacement.

That said, we have continued to improve our techniques and the quality of the implants over the past several decades. The surgery in now done through much more muscle sparing approaches. The Direct Superior approach is the latest of these and may be more muscle sparing than the direct anterior approach that became popular again a few years ago. We have also refined our physical therapy protocols and the way we manage post-operative pain. All of these measures allow patients to get back on their feet and back to the activities that they enjoy more quickly.

Our patient population has changes as well over the past few decades. There has been a definite shift towards a younger patient population considering the procedure. In the past patients often put off hip replacement surgeries until they reached their 60’s & 70’s for a myriad of reasons – surgery, hospitalization, post-surgical pain, extensive recovery time.

As hip replacement technology and recovery times have improved, we have seen a trend of younger patients seeking our attention for hip related problems.

Today’s patients are generally more invested in their health and more motivated to maintain an active lifestyle. Total hip replacement is an excellent option to help them achieve those goals.

K. David Moore, M.D. is an orthopaedic surgeon, specializing in total hip and knee replacements. Prior to joining Andrews Sports Medicine & Orthopaedic Center in June of 2016, Dr. Moore was Director of the Center for Joint Replacement at the University of Alabama at Birmingham. He joined the faculty at UAB in 2001, after serving as Chief of Adult Reconstruction for the United States Air Force at Wilford Hall Medical Center in San Antonio, Texas.

For more information, contact Andrews Sports Medicine & Orthopaedic Center at (205) 939-3699 or visit

Wednesday, October 19, 2016

What Clinicians Need to Know About 2017 Reporting under the New Medicare Quality Payment Program

Elizabeth N. Pitman

Waller, Lansden Dortch & Davis, LLP

On October 15, 2016, the Department of Health and Human Services (HHS) released the final rule outlining its implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP). The QPP applies to clinicians or groups with more than $30,000 in Medicare Part B allowed charges and more than 100 Medicare patients. Clinicians or groups under either threshold or who are participating in Medicare for the first time in 2017 are exempted.

 The QPP rewards value and outcomes via two tracks: Merit-based Incentive Payment Systems (MIPS) or Advanced Alternative Payment Models (Advanced APMs).

MIPS consolidates several existing programs that will be retired. Under MIPS, clinician performance will be measured on a 100 point scale in one or more of the following performance categories:

• Quality (50 points) – replaces the Physician Quality Reporting System (PQRS)

• Clinical Practice Improvement Activities (15 points) – a new category

• Advanced Care Information (25 points) – replaces Meaningful Use

• Cost (10 points) (0 points required in 2017) – replaces the Value-Based modifier Clinicians scoring above a designated threshold may receive higher Medicare payments and those below the minimum threshold will experience a reduction in Medicare payments.

Clinicians qualifying for services delivered through an Advanced APM are exempt from MIPS, will avoid payment penalties and will receive increased Medicare payments. The final list of qualifying Advanced APMs will be published by January 1, 2017.

 Transition Options for 2017

Depending on their level of participation in 2017, MIPS eligible clinicians will be subject to negative or positive payment adjustments beginning January 1, 2019. Clinicians have until March 31, 2018 to submit data collected. The possibilities for clinicians are as follows:

No MIPS or Advanced APM Participation

MIPS eligible clinicians who do not report any data for 2017 and do not participate in an Advanced APM will be subject to a negative 4% payment adjustment. Minimum MIPS Participation To avoid a negative payment adjustment, clinicians must report one of the following for at least a full 90-day period in 2017: (1) one measure in the quality category, (2) one activity in the improvement activities category, or (3) the required measures of the advancing care information category.

Greater MIPS Participation

Clinicians who chose to report more than the minimum data will be eligible for a positive payment adjustment. Clinicians who are exceptional performers in MIPS (ideally reporting data in all three categories for the entire year and achieving a score of 70 or higher) are eligible for an additional positive payment adjustment for the first six years of the program.

Advanced APM Participation

Qualified Providers (QPs) are Clinicians who receive 25% of Medicare payments or see 20% of Medicare patients through an Advanced APM. QPs are excluded from MIPS and qualify for a 5% bonus incentive payment in 2019. Clinicians participating in an Advanced APM must submit the quality data as required by the Advanced APM. The Final Rule offers the potential for additional Advanced APMs and services provided at certain CAHs, RHCs, and FQHCs may be included in determining the threshold under the patient count method.

Small and Rural Practices

Clinicians practicing in small (≤ 15 clinicians) or in rural shortage areas have a reduced reporting burden and will receive increased technical assistance from HHS. Clinicians or groups with a low Medicare volume (≤ $30,000 or 100 Medicare patients) are excluded from the MIPS payment adjustment. HHS is also examining financial risk sharing options to better support small and rural practices. Special rules for the medical home Advanced APM apply. In addition, HHS has committed $20 million annually for the next 5 years to provide training and assistance specific to small and rural clinicians.

For 2017 MACRA reporting, HHS has provided clinicians with greater flexibility in meeting the reporting requirements by lowering the minimum reporting threshold, reducing the number of measures and permitting a 90-day reporting period for 2017. HHS has also accelerated the time-line for assessing whether clinicians meet the Advanced Alternative Payment Model (Advance APM) prior to the end of the MIPS reporting period. HHS expects that this transitional period should give clinicians the opportunity to develop a plan for moving toward accountable care models or revising care delivery practices enabling clinicians to generate higher Medicare payments in future years.

Additional Resources:

Executive Summary of the Final Rule

Quality Payment Program Website

Quality Payment Program Overview Fact Sheet

Thank you to Keith Maune, Belmont University College of Law, for his assistance in preparing this article.

Physicians Giving Back with Marsha Raulerson, M.D.

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

 in photo: Marsha Raulerson, M.D.

Reading Gives You Wings

BREWTON — According to Dr. Seuss in I Can Read with My Eyes Shut!, “The more that you read, the more things you will know. The more you learn, the more places you’ll go.” That’s a philosophy Brewton pediatrician Marsha Raulerson can easily get behind.

For more than 30 years, Dr. Raulerson has celebrated her young patients and encouraged their sense of adventure through reading by providing them with new books during their visits to her clinic. What began as the STARS program, or Steps to Achieve Reading Success, has for the past 20 years been affiliated with the National Reach Out and Read Program. Ten years ago, Dr. Raulerson, working with Polly McClure, launched the Alabama Chapter, American Academy of Pediatrics’ Reach Out and Read Alabama, that gives young children a foundation for success by incorporating books into pediatric care and encouraging families to read aloud together.

“We’ve given out truckloads of books to our patients,” Dr. Raulerson said. “I give a book to every child for every visit, no matter what the age of the child. My community probably contributes about $10,000 a year so we can buy new books because every patient can have a new book.”

In fact, no child who visits Dr. Raulerson’s clinic leaves empty handed. The books she chooses for her patients are not only age appropriate, but also story appropriate to each patient’s particular situation. The majority of her patients have special needs, and each book is intended to give her patients hope.

“I was a reading specialist before I went to medical school, and I would give books to my patients when I was a resident at the University of Florida. I’ve been giving books away since 1978, so my whole career, really. My feeling is that if you can read, you can do anything. I tell my patients that I majored in English in college, not science or math. But, when I went to medical school and had to take biology and chemistry, I could never have done that without the ability to read. If you can read, you can do anything you want!”

Dr. Raulerson laughed when she first realized how long she had been practicing in Brewton, and how many patients had come through her clinic. She shook her head and smiled an easy smile when she admitted that it didn’t initially dawn on her just how many generations of patients she had treated. “I have grand-patients!” she laughed!

“I have a lot of families of three generations of patients, and I remember them all. All my patients are so special to me, and they’ve all received so many books from the clinic. Now, when they tell me that those books helped to create a special bond with their children and grandchildren, that’s heartwarming.”

Given her years of advocacy for children, it’s difficult to imagine the landscape of medicine in Alabama without Dr. Raulerson, but she in fact very nearly did not get accepted into medical school. A native of Jacksonville, Fla., she took her qualifying exams for her doctorate when she ultimately settled on medical school. While she said she felt she was always meant to be a medical doctor, one person sealed the deal for her. Her name was Robbie.

Dr. Raulerson taught school to help put her husband through medical school, and then her husband was drafted and sent to Vietnam. While there, the Raulersons decided to adopt a Vietnamese child. When her husband found the youngest female child in the nursery of an orphanage, he knew this was their child. She was only a few weeks old. The Catholic priest agreed to the adoption to the Baptist couple, and Dr. Raulerson flew to Tokyo to meet her daughter, Robbie.

When Dr. Raulerson got home with Robbie, she was 5 months old and weighed only 8 lbs., was malnourished and very ill. She knew exactly what to do to take care of her daughter, but if any doubt was left as to whether she could be a physician, she wouldn’t doubt much longer. Dr. Raulerson said when she began applying to medical school, she knew the odds would not be in her favor. It was a time when there were not many women in the medical field, and she had a family. Every school she applied to turned her down, except one.

“I was accepted at Emory because of Robbie. They had a different way of interviewing at Emory. They would interview three applicants sitting at a long table. Each applicant was asked what was an event in your life that was really important. There was a football player at the end of the table that talked about being a quarterback. The other girl at the table talked about being homecoming queen. Then they asked me,” Dr. Raulerson paused. The story hanging in her throat fighting to get free. “I told them about when I saw my daughter for the first time. And, I got a telegram that night admitting me to Emory.”

Ironically, Dr. Raulerson transferred to one of the schools that initially rejected her application. Dr. Raulerson’s husband was already a standout fellow at the University of Florida, and his department petitioned the admissions committee to consider an applicant from Emory. She still laughs when she tells the story of being admitted to a school that initially rejected her because she had a family.

Many in Alabama haven’t had the pleasure of meeting this woman who loves to laugh and read to her patients. But after her work with the #IAmMedicaid social media campaign this spring, more people in the state definitely know her name. She estimates between 70 and 80 percent of her patients are Alabama Medicaid recipients, and many of the children in the campaign are her patients. In the end, BP oil money was partially used to reinstate the physician cut that was implemented on Aug. 1 and to shore up the embattled Medicaid budget. Still, according to Dr. Raulerson, it won’t be enough.

“That campaign had to work. It had no choice BUT to work,” she said. “Many of my patients’ families can’t pay their bills. We don’t have enough doctors now, so what happens when we can’t fund the ones who choose to stay? The system is broken.” During the Regular and Special Legislative Sessions, Dr. Raulerson’s editorials about the importance of fully funding Alabama Medicaid appeared in many of the state’s newspapers.

Although the Alabama Legislature is not in session today, there is still work that can, and should, be done, according to Dr. Raulerson.

Perhaps it’s because of her and her husband’s early struggles with starting their own family, or seeing so many of their patients live below the poverty level in Escambia County. Either way, as long as Dr. Raulerson can string together her outspoken words, the children of Alabama will always have another advocate.

“I’m doing a lot more writing now,” she explained. “I feel like I have to. An article I wrote in 1997 about the importance of fully funding Medicaid is just as important today as it was 20 years ago. Nothing has really changed in all that time other than the number of our patients on Medicaid. Something has to change. We have to change. We have to choose to support our kids.”

Dr. Raulerson is a past president of the Medical Association of the State of Alabama, the Alabama Chapter, American Academy of Pediatrics, and VOICES for Alabama’s Children. She is a board member of The Children’s First Foundation.

Tuesday, October 18, 2016

Do You Know The Vitals Of Your Healthcare Practice?

By: Lisa Kianoff, CPA.CITP, CGMA
Vice President of Warren Averett Technology Group

You know them as vitals. You keep up with vitals on all your patients.

So, by the time you see your first patient of the day, you usually have a history of what might also be called their Key Performance Indicators. These KPIs, along with the latest information, enables you to uncover health patterns, determine the questions to ask and start to advise.

Now put your healthcare practice on the exam table. Can you answer these 10 Questions about the vitals of your healthcare practice?

1. What are the earnings of individual profit centers?

2. How are physician extenders (nurse practitioners/PA’s) contributing to profitability each month?

3. What is the contribution to profit by each physician?

4. How do profit centers compare, month to month? Year to year?

5. What are overhead allocations at each profit center, each month?

6. What profit centers do best for the practice?

7. How do you reduce costs, manage risks and streamline financial processes?

8. How do you know when it is the right time to add a new specialist?

9. What are labor costs per patient visit?

10. Where are you bleeding the most?

Fortunately, if you’re like most healthcare organizations, the 2 primary systems you already have in place may contain most all you need to answer those questions: 

Practice Management (PM) is your go-to system for the practice: medical records, patient information, scheduling and medical billing. These systems provide revenue numbers and metrics vital to your ability to analyze your data. Look to these systems for metrics such as employee count, patient visits, square footage, number of providers and other types of non-financial data. 

Accounting / ERP System is your core foundational system for all financial related activities. It includes accounts payable, labor and other cost components that details your financial picture. And detail from Payroll – in-house or outsourced – should be pulled into your ERP along with revenue and other non-financial metric information.

The revenue centric view healthcare organizations get from their Practice Management system is not enough. You need the ability to analyze revenue in combination with related costs to understand profitability by relevant business segments such as location, specialty, doctor, procedure or department.

Your accounting / ERP system is the most logical place to connect all this information. You bring in non-financial data such as employee counts, patient visits, square footage, number of providers and revenue data from your PM system and combine it with the revenue and expense information in your ERP and now you have data to analyze in new ways in dashboards and on financials. Calculations like expenses per square foot, revenue per professional, expenses per employee, and revenue per patient visit can now be incorporated into financials, dashboards and general reporting. Insist on reports that empower you to analyze your financials. And for the metrics you always want front and center, build it into your executive or user dashboards or knowledgebase.

What unlocks all this is your foundation, a chart of accounts designed to produce/view financial information for each multi-faceted component of your practice. Drill into General Ledger Detail for reports on GL Segments or Dimensions that can track:

• Physician Extenders (Nurse/PA)

• Specialties / Ancillaries

• Clinic or location

• Procedures

• Department/Specialty

• Patient Type

• Entities / Companies

• Physician

• Your choice

Financial Reports

To understand profitability by relevant business segments you must be able to analyze revenue with related costs. What diagnosis would you stand behind without metrics at these multiple levels?

Practice Managers, Controllers and Physicians need financial reports that are accurate and comprehensive so they have visibility to see what impacts financial performance – positively and negatively.

Upper management need big picture views, with the ability to slice data as needed. For managers, make it personally relevant with specific reports that focus on revenue and expense only for each one’s selected areas of responsibility.

Focus On Your Health

So how do you feel about the vitals on your healthcare organization? You will have more confidence when your team members have access to the KPIs to help them continually improve your practice focused where they have some control and/or responsibility.

You will improve your service and your bottom line through seeing and understanding the metrics and financials of your entire healthcare organization.

Like the patient who regularly gets their vitals checked, a healthcare organization has to regularly monitor its vitals. Take these 10 questions along with you the next time you visit with the professionals you use to help and guide you with questions on business or finance. Having confidence in the answers means you have what you need to know to be healthy.

Lisa Kianoff, CPA.CITP, CGMA, is Vice President of Warren Averett Technology Group. She was founder and President of L. Kianoff & Associates, Inc. which merged with Warren Averett in 2015. Contact:

Monday, October 17, 2016

3rd annual “Get Busy Fighting!” Golf Tournament presented by VIVA Health

The Laura Crandall Brown Foundation will host the 3rd Annual “Get Busy Fighting” golf tournament, presented by Viva Health, on November 4th at Oxmoor Valley Golf Course. The event honors local gynecologic (GYN) cancer survivor and advocate, Ginny Bourland. Ginny was diagnosed with Stage IV ovarian cancer in the summer of 2011. With no prior medical conditions and leading an otherwise healthy lifestyle, Bourland took particular notice when her sudden weight gain was unresponsive to increased exercise and diet changes. She persisted in finding an answer despite both her general practitioner and gynecologist attributing the symptoms to decreased metabolism and stress. “I knew that none of those explanations really sufficed,” said Ginny. “This was not normal for me.” That persistence led her to the ER, where Bourland said she was determined to find answers. Indeed, after a CT scan, Bourland was told she likely had a type of abdominal cancer. Within 24 hours, an oncologist confirmed it instead as ovarian cancer. Since 2011 she has had three recurrences and become an active fundraiser and advocate in the community for gynecologic cancer research and awareness efforts. She is married to husband Shea and stays busy raising their two beautiful children, Will and Bella, and at her job as an actuary at VIVA Health, which is the tournament’s presenting sponsor for the third year in a row. “Ginny is a fantastic co-worker, and an even better person,” said Tony Ceasar, Director of Marketing & Communications at VIVA Health.

 “We are proud to serve as the presenting sponsor for this event, and to honor Ginny and her impact on the community in this way.” “We are excited to partner with the Bourlands on this 3rd annual event,” said Mary Anne King, Executive Director of the Laura Crandall Brown Foundation. “Ginny touches everyone she meets in a positive way, whether it’s with her story or her wonderful personality. She is a daily example of how personal strife can be channeled into an opportunity to give hope and help others. That idea is something Laura (Crandall Brown) also personified, and is the reason the foundation exists today.”

The tournament will feature a four person scramble format, with prizes for 1st, 2nd and 3rd place teams. Online Registration is available at Entry fees are $125/golfer or $500/team and include greens fee, cart, drink tickets, and entry to the awards lunch. Sponsorships are still available. For more information, contact Proceeds from the golf tournament will benefit the Laura Crandall Brown Foundation’s mission of early detection of ovarian cancer, GYN cancer awareness, and patient support.

About GYN Cancers and the Laura Crandall Brown Foundation’s Impact:

There is no reliable early detection test for ovarian cancer. Currently 85% of cases are detected in late stages, and over half of women diagnosed will die within five years. Furthermore, all GYN cancers together (ovarian, cervical, uterine, vulvar, and vaginal) affect more than 90,000 women in the U.S., and cervical cancer is the only GYN cancer that can be prevented with the use of screening tests. Without early detection and screening tests, awareness is key. The Laura Crandall Brown Foundation is a 501(c)(3) nonprofit that was established in 2009 by family and friends of Laura Crandall Brown, who died of ovarian cancer at the age of 25. 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.

For more information For more information contact Lindsay Giadrosich, Special Events & Awareness Coordinator (205) 427-0256