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Physician Compensation Models in Light of Recent Stark Law Changes

Physician Compensation Models in Light of Recent Stark Law Changes

by Kelli C. Fleming, Burr Forman

On December 2, 2020, the Centers for Medicare and Medicaid Services (“CMS”) finalized sweeping changes to the federal Physician Self-Referral Law, commonly known as the Stark Law. At least one such change may materially impact how physician group practices allocate profits from Stark Law designated health services (“DHS”).

Under the Stark Law, a medical practice with at least two physicians must qualify as a “group practice” in order to take advantage of the Stark Law in-office ancillary services exception, which is the exception often used to allow a physician owner or physician employee to order DHS from his or her own medical practice. As part of the group practice requirements, DHS profits must be distributed to all physicians in the group, or to a pool of five or more physicians in the group, in a manner that does not directly take into account the volume or value of a physician’s referrals for DHS.

Currently, many physician group practices, especially large or multi-specialty practices, allocate DHS profits to its physicians based on DHS categories. For example, profits from one DHS category (e.g., imaging services) may be allocated to certain physicians in the group practice while profits from a second DHS category (e.g., physical therapy) may be allocated to a different (or possibly overlapping) subset of physicians in the group practice.

However, under the new Stark Law rules, CMS has clarified that DHS profits can no longer be allocated based on DHS category. Instead, profits from all DHS categories for all physicians in the group practice (or a component of at least five physicians in the group practice) must be aggregated and then distributed to all physicians in the group practice (or a component of at least five physicians in the group practice) in a manner that does not directly take into account the volume or value of referrals. Using the example above, under this new clarification, DHS profits from both imaging services and physical therapy services ordered by physicians in the group practice (or a component of at least five physicians in the group practice) must be aggregated and then the total aggregated profits distributed to such physicians in a manner that does not take into account the volume or value of referrals.

CMS also clarified that if a physician practice has more than one pool of five physicians, each pool does not have to be treated in an identical manner. For example, one pool may utilize one distribution methodology and a second pool may utilize another distribution methodology, as long as the methodologies used are Stark Law compliant (i.e., not based on the volume or value of referrals).

CMS recognizes that its prior regulatory guidance on the distribution of DHS profits has led to confusion by industry participants. While the other recent changes to the Stark Law take effect on January 19, 2021, the changes with regard to the distribution of DHS profits take effect on January 1, 2022.

Kelli Fleming is a Partner at Burr & Forman LLP and practices exclusively in the firm’s Health Care Practice Group.

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CMS and OIG Issue Historic Revisions to the Federal Anti-Kickback Statute and Stark Law

CMS and OIG Issue Historic Revisions to the Federal Anti-Kickback Statute and Stark Law

By: Anthony Romano with Burr Forman

On November 20, 2020, the Centers for Medicare & Medicaid Services and the Office of Inspector General of the Department of Health and Human Services issued two significant final rules to reform the Anti-Kickback Statute and Stark Law in an aim to reduce regulatory barriers to coordination of patient care, and to accelerate the transformation of the health care system to value-based care (a value-driven health care system that pays for health and outcomes, as opposed to the traditional fee-for-service payment system which rewards providers for the volume of care provided).

The 1,000-page Anti-Kickback Statute final rule does this by implementing seven new safe harbors, modifying four existing safe harbors, and codifying one new exception under the Civil Monetary Penalty Law.  As you are probably aware, the Federal Anti-Kickback Statute provides for criminal penalties for whoever knowingly and willfully offers, pays, solicits, or receives remuneration to induce or reward, among other things, the referral of business reimbursable under any of the Federal health care programs, including Medicare and Medicaid. Health care providers and others may voluntarily seek to comply with statutory and regulatory safe harbors so that they have the assurance that their business practices will not be subject to sanctions under the Anti-Kickback Statute. To receive safe harbor protection, an arrangement must squarely meet each requirement of an applicable safe harbor. However, failure to fit in a safe harbor does not mean that an arrangement violates the Federal Anti-Kickback Statute. Arrangements that do not fit in a safe harbor are analyzed on a case-by-case basis, including whether the parties had the requisite intent. Congress intended the safe harbor regulations to be updated periodically to reflect changing business practices and technologies in the health care industry, and the new final Anti-Kickback Statute regulations accomplish this by, among other things, removing potential barriers to more effective coordination and management of patient care, and by removing potential barriers to the delivery of value-based care.   

The 627-page Stark Law final rule creates new exceptions for value-based arrangements, provides additional guidance to make it easier for physicians and other health care providers to comply with the Stark Law, and provides protection for non-abusive, beneficial arrangements. Unless otherwise specified in the rules, the new provisions go into effect January 19, 2021.  When the Stark Law was enacted in 1989, healthcare was paid for primarily on a fee-for-service basis and the Stark Law recognized that a profit motive could influence some physicians to order services based on their financial self-interest rather than the good of the patient. For this reason, the Stark Law prohibits a physician from making referrals for certain healthcare services payable by Medicare or Medicaid if the physician (or an immediate family member of the physician) has a financial relationship with the entity performing the service. There are statutory and regulatory exceptions, but in short, a physician cannot refer a patient to any entity with which he or she has a financial relationship unless an exception is satisfied.  The Stark Law also prohibits the entity from filing claims with Medicare or Medicaid for services resulting from a prohibited referral, and Medicare or Medicaid cannot pay if the claims are submitted. Although the regulations that interpret the Stark Law have been updated several times, the Stark Law has not been significantly updated since it was enacted in 1989, and all previous changes left in place a framework that is tailored to a fee-for-service environment.  The new Stark Law final rule includes a comprehensive package of reforms to modernize the regulations that interpret the Stark Law while continuing to protect the Medicare program and patients from bad actors.

Overall, these new rules will have a significant, and expected positive, impact on healthcare providers by easing burdensome regulatory restrictions.  With over 1,600 pages of new rules to digest, be on the lookout for more detailed and specific analysis in the near future.  In the meantime, please do not hesitate to contact us if you have specific questions regarding the impact of the new Anti-kickback Statute or Stark Law final rules on you or your practice. 

Anthony Romano practices with Burr & Forman LLP in the firm’s Health Care Industry Group. Anthony may be reached at or (205) 458-5210.

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The Effect Differing Medical Opinions Have On Falsity and Scienter in False Claims Act Lawsuits

The Effect Differing Medical Opinions Have On Falsity and Scienter in False Claims Act Lawsuits

By: Jim Hoover with Burr Forman, LLP

There is currently a circuit split among the Federal Circuit Courts of Appeals regarding the effect differing medical opinions have on the elements of falsity and scienter in False Claims Act lawsuits.  

Earlier this year the Third Circuit Court of Appeals ruled that conflicting medical opinions can create a genuine dispute of material fact on “falsity” in a False Claims Act action. The case is United States v. Care Alternatives. This holding directly conflicts with the Eleventh Circuit’s September 2019 decision in United States v. AseraCare, which held that a mere difference in medical opinion between physicians regarding a patient’s prognosis was not enough to establish falsity under the FCA. In Care Alternatives, the Third Circuit rejected AseraCare and found that conflicting physician testimony about the validity of physician’s certifications was sufficient to raise a dispute of material fact regarding the element of “falsity.” The Third Circuit sought to make clear that in its Circuit, findings of falsity and scienter must be independent from one another for purposes of FCA liability. According to the Third Circuit, the scienter element helps limit the possibility that providers will be exposed to liability under the FCA any time the Government or relator can find an expert who disagreed with the certifying physician’s medical prognosis.

Former employees of Care Alternatives filed a qui tam action against the hospice provider, alleging the hospice had improperly admitted patients who were not eligible for Medicare’s hospice benefit and directed employees to falsify Medicare certifications in order to meet the eligibility requirements. The relators’ physician opined that in 35% of the sample cases he reviewed a reasonable physician would not have certified the patient as terminally ill with a prognosis of six months or less based on the accompanying documentation. Reviewing the same sample set, Care Alternatives’ physician disagreed, finding that a reasonable physician could reasonably certify each case. Thus, there was a disagreement among the parties’ experts. The United States District Court for the District of New Jersey agreed with AseraCare by adopting and applying AseraCare’s holding that an “objective falsehood,” something more than a retrospective difference of opinion, was required to create a genuine dispute of fact.

On appeal, the Third Circuit Court of Appeals disagreed and reversed and remand the case for consideration of the other elements of FCA liability, particularly the element of scienter. The Third Circuit noted it is well-established that subjective opinions can be false, and applied this reasoning to the FCA’s falsity element. The Third Circuit opined that AseraCare’s “objective falsity” standard improperly conflated falsity with scienter, i.e., that the whistleblower prove a certifying physician was making a knowingly false certification. The Third Circuit held that these elements must be considered separately, and the purpose of the scienter requirement is to limit the possibility that a provider could be found to violate the FCA any time the Government or a relator could find an expert who may establish falsity simply by disagreeing with a physician’s prognosis.

Thus, in the Third Circuit a determination that a claim was false does not immediately trigger FCA liability. Relators must still establish that the provider knew the claim was false when the claims was submitted. Unfortunately, however, one of the big problems for False Claims Act defendants is credibility determinations are typically reserved for the jury thus almost forcing the False Claims Act case to trial.  

Because of the circuit court split, a United States Supreme Court opinion is needed to resolve the differing circuits’ approaches. In the meantime, the key takeaway for health care providers across the country is these differing standards will be fought in FCA cases where defendants have made reasonable subjective judgments.  The arguments should focus on both the falsity element and the scienter element.  

Jim Hoover is a partner at Burr & Forman LLP and works exclusively within the firm’s Health Care Practice Group and predominantly handles healthcare litigation.

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Lights, Camera, Action…No!

Lights, Camera, Action…No!

By: Kelli Carpenter Fleming, Esq.

The Office for Civil Rights (“OCR”), the entity responsible for HIPAA compliance and enforcement, has issued a series of guidance documents regarding the interplay of HIPAA and the COVID-19 pandemic. The most recent guidance serves as a reminder to health care providers to follow the requirements of HIPAA when speaking with the media or allowing filming within the office or facility. This has even greater importance due to the increased amount of media attention on healthcare providers and the facilities treating COVID-19 patients. 

The recent guidance reminds health care providers that the HIPAA Privacy Rule is not altered during the COVID-19 public health emergency. HIPAA does not permit a health care provider to give media and film crews access to facilities where patients’ protected health information (“PHI”) will be accessible without the patients’ prior authorization. Even during the current COVID-19 public health emergency, health care providers are still required to obtain a valid HIPAA authorization from each patient whose PHI will be accessible to the media. Consistent with past guidance, OCR reminds providers that masking or obscuring patients’ faces or identifying information before broadcasting a recording of a patient is not sufficient. According to the guidance, by way of an example, “a covered hospital may not allow media personnel access to the emergency department where patients are receiving treatment for COVID-19, without first obtaining each patient’s authorization for such filming.”

We have seen at least two (2) previous OCR investigations regarding inappropriate disclosure of PHI to film crews (in 2016 and 2018), both of which were resolved with corrective action plans and monetary settlements. I would not be surprised if we see additional future OCR enforcement actions in this regard in light of the increased media coverage surrounding COVID-19. 

The recent guidance may be found here.

Kelli Fleming is a partner at Burr & Forman, LLP practicing exclusively in the firm’s Health Care Industry Group.

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Physician Burnout

Physician Burnout


While employees in many professions report burnout, physicians appear uniquely susceptible and the consequences can be detrimental. Physicians are fifteen times more likely to suffer burnout than other professions and statistics indicate that at a given time nearly a third of physicians are experiencing symptoms of burnout.[1] Throughout the course of a career nearly one in two physicians are likely to suffer from burnout, and depending on specialty, it can range from 30 to 65% of physicians. Physicians in the mid-point of their career are the most likely sufferers, but the rates and trends across age groups continue to worsen.[2]  Indicated in a Mayo Clinic study, about 50% of physicians will experience symptoms of burnout at some point in his or her career.[3]


Various theories are offered as to why the problem is reaching epidemic proportions for physicians. One commonly identified contributing factor is that physicians feel increasingly overworked. One study identified the lack of control over a physician’s daily schedule as a primary driver for experiencing burnout.[4] Technology is also recognized as a culprit and studies show doctors are increasingly spending time on the computer instead of interacting with patients.[5] Yet another modern contributor to physician stress can be negative online reviews.[6] Physicians may be feeling increasingly judged and scrutinized by the patients they are dedicated to helping. Outside technology, a decrease in healthy eating habits or exercise is also shown to lead to or exacerbate the problem.[7] This decrease in quality of life is likely driving physicians from the practice of medicine, which further increases stress on the health care system already facing a looming physician shortage as baby boomers retire.[8]

The impact of physician burnout can be enormous. On an individual level, it is destroying quality of life for physicians to the point that many leave the practice of medicine or even turn to suicide. Rates for physician suicide are double that of other professions, with female physicians three times as likely.[9] Increased suicide rates are not only high throughout a physician’s career, but are also evident in medical students with 9.4% of students reporting suicidal thoughts.[10] Physician burnout has also been associated with significant decreases in patient care and safety.[11]


While there are no simple or obvious solutions to physician burnout, there are multiple approaches to consider. For starters, physicians and the greater medical community cannot afford to ignore the impact burnout is having on both individual physicians and the practice of medicine.  The impact of burnout continues to worsen and may be approaching epidemic proportions. One component physicians should recognize is that shouldering the burden themselves is not enough; to paraphrase a classic literary character, you can’t just work harder.[12]  Physicians may need to change the way they practice medicine; by recognizing limitations and learning to say “no.”

Other studies point to promoting lifestyle decisions as a way to combat burnout. Specifically, physicians should find ways to maintain a healthy lifestyle. This can involve eating a healthy diet, sleeping 7-9 hours regularly, and exercising appropriate amounts.[13] Besides physical health, physicians should be encouraged to have creative outlets such as hobbies, sports, leisure activities, and vacations.


ProAssurance is also seeking ways to support physicians and the medical community regarding burnout and the implications it may have on patient care.  In September 2017, ProAssurance established a $1.5 million gift to the University of Alabama at Birmingham (UAB) School of Medicine to endow a chair to support physician wellness.  This endowment was to support research and efforts addressing the issues and challenges related to physician burnout. UAB combined the endowed chair with the existing Chief Wellness Officer position, which was filled by David Rogers, MD, MHPE in January 2018.

In a recent interview with Dr. Rogers, he stated, “Many people talk about burnout as though you’re burned out or you’re not.  But it isn’t that simple. There are degrees of burnout or being engaged. Month by month tracking lets you see a pattern and reevaluate before things spiral in a negative way.”

The use of month to month well-being assessments such as the Mayo Clinic Well-Being Index[14] may help identify and track individual physicians’ well-being.   Hospitals may utilize this assessment to identify certain departments where stress and/or engagement are particularly high. These results could customize resilience training for these groups.

Accomplishing goals to reduce burnout in the medical community means that there must be a systemic and cultural shift. Physicians need to be free from judgment in seeking solutions to this crisis. From his experience, Dr. Rogers would also like to focus on training for frontline leaders in the medical industry. Leaders often set the tone for their employees, so teaching them to identify and mitigate stress is essential. Dr. Rogers believes the medical community is at a crucial point and must start having conversations about physician burnout. “There has to be a change in culture,” he concludes. “It’s hard, but critical to think about what happened to the industry, what we can do to correct it, and what lessons we can learn for the future.”

As professional liability insurers, ProAssurance recognizes the increasing danger of physician burnout and the potential harm to our insured physicians and organizations. Although we have identified the increasing seriousness of this problem, but still struggle with how to identify or prevent it.  We are committed to finding ways to discover the problem before it manifests in professional liability claims, and we encourage our physicians to reach out for solutions if they are feeling overwhelmed or at risk for burnout.

Physicians insured by ProAssurance may contact our Risk Resource department for prompt answers to liability questions by calling 844.223.9648 or via e-mail at

[1] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, accessed September 29, 2017.

[2] Staff, “Medical specialties with the highest burnout rates,” AMA Wire, Jan 15, 2016. accessed September 29, 2017.

[3] Tait D. Shanafelt, M.D. et al,  “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014,” Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 – 1613  accessed September 29, 2017.

[4] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, accessed September 29, 2017.

[5] Paige Minemyer, “Study: Docs spend more time with computers than patients,” Jan 31, 2017, accessed September 29, 2017.


[7] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, accessed September 29, 2017.

[8] “Physician Supply and Demand Through 2025: Key Findings,” AAMC

Accessed September 29, 2017.

[9] Pranay Sinha, “Why Do Doctors Commit Suicide?,” New York Times, Sept 4, 2014,  Accessed September 29, 2017.

[10] Louise B Andrew, MD, JD, “Physician Suicide,” Medscape, June 12, 2017. accessed September 29, 2017.

[11] Megan Brooks, “Provider Burnout Tied to Lower Levels of Patient Safety, Care,” MedScape, accessed September 29, 2017.


[13] Dr. Elaine Cox, M.D., “Doctor Burnout, Stress and Depression: Not an Easy Fix,” April 12, 2016, accessed September 29, 2017.

[14]  Accessed December 20, 2018.

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Summer’s Not Over…Hit the Road with these Safe Travel Tips from Medjet Assist!

Summer’s Not Over…Hit the Road with these Safe Travel Tips from Medjet Assist!

There’s nothing more American than packing up the car and taking a family summer road trip. Whether you’re headed down the road to grandma’s house, across state lines to the nearest beach, or all the way across the country, making sure you get your family there safely is top of mind. By following these summer road trip tips, you’ll help ensure you’ve thought of everything to keep your family safe while you’re on the road.

Tune up the car

Before leaving on your road trip, take your car for a tune-up. Make sure all oil and fluid levels are topped off and that the tires are properly inflated. Consider that your car may soon be under stress it’s not used to, like driving up and down mountain passes, so make sure your brakes are working properly as well.

If you do experience some minor glitch while driving, it helps to know simple car maintenance techniques like how to use jumper cables, how to refill your wiper fluid, how to check the air pressure in your tires and how to change a flat tire—so brush up on your maintenance skills before you leave. Clean your headlights, taillights, signal lights and the inside and outside of your windshield.

Many newer cars come with their own roadside assistance.  Familiarize yourself with the coverage and make sure the emergency numbers are handy.  If you don’t have this coverage, consider joining a roadside assistance service like American Automobile Association (AAA). As a member, AAA will come to your rescue should you lock your keys in the car, get a flat tire, or break down.

Bring a map

You may plan to use GPS to navigate to your destination, but you never know when you may lose signal, cell phone service or your GPS might fail. Good, old-fashioned maps won’t lose power and are reliable no matter what goes wrong, so be sure to bring one along.

Consider the weather

We’re all aware of the dangers of driving in inclement weather. Severe summer weather can often produce heavy downpours, tornados and flash floods. If the weather looks threatening, tune in to a local radio station for updates and keep your ears peeled for storm sirens. It’s always good advice to stay on main roads and highways if possible and try to avoid backcountry roads when you can—especially if you’re driving in unfamiliar areas that may have the threat of flash floods.

If you find yourself in storm conditions that force you to stop driving, make sure you pull all the way off of the highway and turn on your hazard lights. If you are stranded and have to run your vehicle for any reason, do so for 10 minutes every hour and make sure windows are open slightly to prevent carbon monoxide buildup. If you find you’ll be spending the night in your car, illuminating the interior lights will not use as much battery as your exterior light, but still provide a visual indicator to rescuers.

Have a travel safety kit

You should always have a safety kit in your car, but make sure your kit is well stocked before leaving for your summer road trip. Your kit should include warm blankets, water and first aid items, a small flashlight, flares, a battery-operated radio and an emergency contact card. It’s also a good idea to keep a car safety hammer near the driver’s seat. If you happen to be in an accident or your car is submerged in water, the car safety hammer can be used to break the window and create a path to safety.

If you are prescribed important medication, keep it in the car with you and not in the trunk in the event that your trunk becomes inaccessible.

Make sure car seats and boosters are properly installed

The annual family road trip time is a good time to make sure that car and booster seats are properly installed and appropriately fitted to your child. In most cities, local hospitals or fire stations provide free car seat fittings and instillations. Schedule an appointment before you hit the road and travel with peace of mind.

Leave your phone on for cell location

Should your family experience an emergency in a rural environment where communication with the outside world is not possible, remember that cell phone location technologies are extremely helpful in locating missing people. If you’re stranded in your car, keeping your cell phone on will help rescuers pinpoint your location. However, when your phone is out of power it will no longer be helpful in locating you. Keep portable phone chargers and power cords in your car so you’re not stuck with a drained battery in an emergency. Just (And) don’t forget to charge them in advance!

If you’re tired, stop driving

It seems like an obvious tip, but according to the CDC there are 72,000 crashes and nearly 6,000 fatal crashes due to drowsy driving each year. A study by AAA found that the risks of fatigued driving are comparable to drunk driving. We know it can be tempting to push through to your destination, even when you begin to feel tired, but the risks aren’t worth it. If you begin to feel fatigued, get your family to a hotel and resume your drive in the morning.

Let someone know your destination and when you plan to arrive

Communicating your travel plans with someone back home is a crucial piece of your safety plan. Designate a friend or family member to share your itinerary with. If plans change, let them know. When you’ve stopped for the night, check in and share your location as well as your travel plans for the following day. These mundane details could be crucial in locating your family should you suddenly drop off the radar.

Be prepared in a worst-case scenario

It’s hard to think about, but if your family was involved in an auto accident with injuries, what is the long-term plan for returning back home? With an air-medical transport membership like MedjetAssist, members who are hospitalized 150 miles or more from home can arrange medical transport back to their hometown hospital for free, after the cost of the annual membership (sounds expensive but it’s incredibly affordable). Medjet will arrange air medical transfer to a home hospital of choice, regardless of whether it’s deemed “medically necessary.” Your health insurance will only get you to the nearest “acceptable” medical facility (which may not be “acceptable” to you).  The cost for other family members to remain nearby for any extended period of time may also break the bank, so it’s worthwhile coverage to explore.

It can be stressful and overwhelming to think about what danger could befall your family while on the road. Hopefully, you’ll never find a need for this information, but following these safety tips will give you the confidence to handle a crisis, and a sense of comfort knowing that you are prepared for the unexpected.


Article contributed by MedjetAssist, an official partner with the Medical Association. With MedjetAssist, you travel prepared. The safer you feel, the more you can focus on the moment. Especially when you travel. MedjetAssist empowers our members to feel safer and more prepared for travel’s many possibilities.

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Burnout Proof – Healing the Healers with Debbie Booher Kolb, M.D.

Burnout Proof – Healing the Healers with Debbie Booher Kolb, M.D.

MADISON — According to a recent study by the Cleveland Clinic, more than one-third of physicians are in a silent battle with professional burnout. Physicians dealing with mental, emotional and physical exhaustion become less able to provide quality care to their patients and find themselves leaving the medical profession altogether…or worse. It’s the “or worse” scenario that worries Dr. Debbie Kolb of Madison.

As president of the Madison County Medical Society, Dr. Kolb wanted to make a difference in the lives of her colleagues. Together with a wellness committee she chairs, they began to formulate a plan to help physicians in the area who felt overwhelmed in their medical practice and achieve a better work-life balance. They had no idea the vast support they would have for the Physicians Resource Network Wellness Program.

“My father is a retired radiologist,” Dr. Kolb explained. “I remember being in school and hearing about a friend of my fathers who changed careers. I was mystified by that. I didn’t know that was even an option. I’d never heard of a physician changing careers. It’s not even on your radar once you’re in the medical profession. If you do change careers, it’s to go into pharmaceuticals, medical directorships, or to be a life coach. For physicians, it’s truly a business decision once you leave the profession. It’s sad really to think you could burn out so badly that you leave the profession you loved so much completely behind you.”

But, it’s happening more and more to physicians. With the added pressures of government regulations, such as MACRA, electronic health records, ICD-10, and Medicaid funding, the practice of medicine has become even more complicated today than it was just a decade ago. Unfortunately, these pressures have caused physicians to burnout and not only voluntarily leave the profession of medicine, lose their medical license for inappropriate behavior, or commit suicide.

Dr. Kolb’s mission is to help her colleagues prevent burnout by learning how to cope with its symptoms and find a better work-life balance. Her mission began in 2014 at the annual meeting of the American Academy of Family Physicians where she first met Dr. Dike Drummond, better known as The Happy MD, and discovered his book, Stop Physician Burnout.

“This book transcends medicine, and his website is great, too. I was so impressed with his actionable advice. What he gives you to do is really good nuts-and-bolts that made me want to bring him to Huntsville so my colleagues could hear him locally. We’ve had three physician suicides in two and a half years in Madison County alone. So it really became more and more apparent that we needed to do something. This is heartbreaking and preventable. All of this coalesced to really be something that we could all get behind.”

As Dr. Kolb and her colleagues admit, everything begins with a discussion. But, little did they know just how many lives they were about to touch when they rolled out the first component of their burnout program. The first step was an evening event with Dr. Drummond, which sold out 200 seats and had a waiting list for attendees.

“Burnout transcends specialties, and that’s why our physicians have been so appreciative of this program. After the event with Dr. Drummond, we had people commenting and sharing their stories on social media. That’s what we’re trying to do — effect a paradigm shift in the culture of medicine. We really want to let our colleagues know that this is more common than they may realize because physicians just don’t talk about it. We want to start talking about it,” Dr. Kolb said.

Learn more about Madison County’s Physician Wellness program.

*Thanks to the following physicians, committee, Madison County Medical Alliance members, as well as our sponsors whose generosity in time and funding helped make this program a reality:

Wellness committee volunteers include: Board of Trustee members Drs. Aruna Arora, Greg Bouska, James Gilbert, Dawn Mancuso, Paul Tabereaux, Sherrie Squyres and Tarak Vasavada; therapist Dr. Violet Gilbert; Madison County Medical Alliance President Christina Tabereaux; and MCMS Executive Director Laura Moss. While not a committee member, MCMS Past President Dr. Amit Arora has also been instrumental in supporting this mission.

Burnout Proof LIVE was made possible by the generous donations of Huntsville Hospital, ProAssurance, the Madison County Medical Alliance, Blue Cross Blue Shield of Alabama, ServisFirst Bank, Fyzical Therapy and Balance Centers, Crestwood Medical Center, Dr. Hayes Whiteside and the Medical Association of the State of Alabama.

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How is Tax Reform Impacting Physician Practices?

How is Tax Reform Impacting Physician Practices?

The biggest U.S. tax reform since 1986 consists of major tax law changes that will affect everyone. The most significant change for corporations is a move from the graduated corporate tax rate structure to a flat rate. Although President Trump was originally fighting for the corporate rate to be reduced to 15 percent, lawmakers settled by reducing the rate from 35 percent to 21 percent. Other aspects of the tax law are more complex, and many businesses are wondering how this new law will affect their particular industries.

Let’s dive a little deeper into how tax reform is affecting physician practices.

A significant amount of attention has been focused on the 20 percent pass-through income deduction (also known as the qualified business income “QBI” deduction). Unfortunately, physician practices are specifically excluded from QBI deduction eligibility. However, an exception is made for physicians with taxable income under $415,000 for joint filers and $207,500 for single filers. Physicians with taxable income below these thresholds may be eligible for the 20 percent QBI deduction. The QBI deduction calculation is complex and should be considered in conjunction with physician group compensation models and reasonable compensation guidelines.

Entertainment expenses need to be evaluated and minimized. Under the new law, deductions for business-related entertainment expenses are disallowed. Meal expenses incurred while traveling on business will remain 50 percent deductible. The 50 percent disallowance will now also apply to meals provided at an on-premises cafeteria or otherwise on the employer’s premises for the convenience of the employer. After 2025, the cost of meals provided through an on-premises cafeteria or otherwise on the employer’s premises will be nondeductible.

Physicians should also take into account the tax reform changes for individuals by evaluating their personal mortgage interest structure to maximize the interest deduction. This can be achieved by turning a home equity line of credit (HELOC) into a traditional mortgage, if applicable. The home mortgage interest deduction has been modified to reduce the limit on acquisition indebtedness to $750,000 for married filing jointly (MFJ), down from $1,000,000 under previous law. However, if the acquisition indebtedness occurred before Dec. 15, 2017, the limit remains $1,000,000.

Finally, tax reform limits the Federal tax deduction for state and local taxes to $10,000, beginning in 2018. Many physicians will far exceed the $10,000 state and local tax deduction cap. The limitation on state and local tax deduction encompasses both income taxes, sales tax and property taxes. Physicians can potentially minimize tax liabilities by strategically planning the payment of their individual state taxes and utilizing any state scholarship granting organizations, such as an Alabama Scholarship Granting Organization (SGO) or Georgia Student Scholarship Organization (SSO). These programs allow taxpayers to receive a state tax credit in return for an eligible contribution. This contribution qualifies as a charitable contribution on a federal return. This turns a state tax payment into a charitable deduction for federal purposes, increasing itemized deductions.


Article contributed by Warren Averett CPAs and AdvisorsWarren Averett CPAs and Advisors is an official Gold Partner with the Medical Association.

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Cyber Security:  Five Common Phish Attack Schemes

Cyber Security:  Five Common Phish Attack Schemes

Hackers only need you, that’s right just you. They are sneaky and know the general population is busy and doesn’t pay close attention to the emails they receive. Hackers know people are comfortable in their daily habits. They exploit this behavior by creating email scenarios designed to encourage a click. They need just one person to click just one time to infect their computer with malware that grants them access to the information they need to launch a more sinister attack.

“Phishing attacks are by far the most common cyber attack today, and these attacks continue to get more and more sophisticated.  Gone are the days of the ‘dear sir’ attack-now we have to worry if an email appearing to be directly from a co-worker is actually from them,” said Steven Hines, president of Threat Advice.

Because hackers are continually changing their tactics, clicking on a nefarious email or link leading to a cyber attack can happen to anyone. Recognizing the threat before it turns into a disaster is just one way we each can be more prepared. The following are five ways hackers are currently trying to access your business and personal information:

  1. Look but don’t click. If the email address or the attachment name seems “phishy,” it probably is. Are there spelling or grammatical mistakes? Companies with professional staff are not going to make these types of mistakes.
  2. Analyze the salutation and signature closely. Most legitimate businesses will use your name rather than a generic greeting like “Dear customer.” The business should provide ways to contact them in the signature. If that’s not provided, it could be a phishing attempt.
  3. Know your brands. Hackers will spoof your favorite brands and make their emails look enough like the actual brand to fool you. Is the logo color wrong? Are there additional words in the brand name? Did you sign up to receive emails from them? Don’t click any links before you examine the email to confirm the sender.
  4. Urgent or Threating – No one likes a bully. A common phishing technique is to use harassing or threating language in the subject line or email content or to create a sense of urgency to handle a fake problem. Most legitimate banks, utilities/municipalities and businesses will not ask you to provide your private information via email nor threaten you in an email.
  5. What grandma said…“If it’s too good to be true, it probably is!” Hackers will continue to send phishing emails promising riches and prosperity if you only send your social security and bank information. Why? Because unfortunately, people still take the bait.

Article contributed by Cobbs Allen. Cobbs Allen is an official Gold Partner with the Medical Association. For more information about cyber liability insurance and how it protects your business, contact Margaret Ann Pyburn.

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Medical Association Chooses PCIHIPAA to Help Benefit and Protect Its Members

Medical Association Chooses PCIHIPAA to Help Benefit and Protect Its Members

MONTGOMERY – The Medical Association of the State of Alabama has partnered with PCIHIPAA to help protect its members from the onslaught of ransomware attacks, HIPAA violations and data breaches impacting Alabama physicians. Under HIPAA’s Security and Privacy Rules, health care providers are required to take proactive steps to protect sensitive patient information.

“The Medical Association services more than 7,000 Alabama physicians. It’s critical that our members understand the risks surrounding HIPAA compliance and patient data privacy and security laws. We vetted many HIPAA compliance providers and believe PCIHIPAA’s OfficeSafe Compliance Program is the right solution for Alabama physicians. PCIHIPAA’s compliance program is robust and easy to implement. I’m confident our partnership will provide a necessary, value-added program for our members.” said Association President Jerry Harrison M.D.

The partnership comes on the heels of an important announcement surrounding HIPAA compliance regulation. The Director of U.S. Department of Health and Human Services’ Office for Civil Rights recently stated, “Just because you are a small medical or dental practice doesn’t mean we’re not looking and that you are safe if you are violating the law. You won’t be.” In addition, in 2017 hacking and employee errors led to data breaches at Alabama-based Surgical Dermatology Group, UAB Viral Hepatitis Clinic and The University of Alabama, supporting the importance of HIPAA compliance and patient data protection.

According to the U.S. Department of Health and Human Services, OCR has received over 150,000 HIPAA complaints following the issuance of the Privacy Rule in April 2003. A rising number of claims filed under HIPAA in recent years have led many patients to question whether or not their personal payment and health information is safe. As the government has become more aggressive in HIPAA enforcement, large settlements have become widespread and rising penalties for HIPAA non-compliance are a reality.

According to, the types of HIPAA violations most often identified are:

  1. Impermissible uses and disclosures of protected health information (PHI)
  2. Lack of technology safeguards of PHI
  3. Lack of adequate contingency planning in case of a data breach or ransomware attack
  4. Lack of administrative safeguards of PHI
  5. Lack of a mandatory HIPAA risk assessment
  6. Lack of executed Business Associate Agreements
  7. Lack of employee training and updated policies and procedures

“We are honored to be partnering with The Medical Association of The State of Alabama. They have a 140-year track record of helping Alabama physicians thrive. PCIHIPAA’s mission is to help physicians easily and affordably navigate HIPAA requirements and provide the solutions they need to protect their practices. We find that many practices don’t have the resources to navigate HIPAA law, and are unaware of common vulnerabilities. We encourage all association members to take a complimentary risk assessment to quickly assess their HIPAA compliance and risk levels. To get started go to Start Risk Assessment.” said Jeff Broudy, CEO of PCIHIPAA.





PCIHIPAA is an industry leader in PCI and HIPAA compliance providing turnkey, convenient solutions for its clients. Delivering primary security products to mitigate the liabilities facing dentists and doctors, PCIHIPAA removes the complexities of financial and legal compliance to PCI and HIPAA regulations to ensure that health and dental practices are educated about what HIPAA laws require and how to remain in full compliance. Learn more at and

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