March 2017 - Medical Association of the State of Alabama

Archive for March, 2017

Medical Association Celebrates Second Annual Doctors’ Day in Alabama

Posted by admin on March 27, 2017

MONTGOMERY – On March 29, Gov. Robert Bentley signed a proclamation declaring March 30, 2017, the Second Annual Doctors’ Day in Alabama formally recognizing Alabama’s nearly 17,000 licensed physicians serving millions of residents through private practice, in hospitals, in research, and in other health care facilities.

Doctors’ Day in Alabama, a project sponsored by the Medical Association of the State of Alabama and the Alabama Department of Public Health, is held in conjunction with National Doctors’ Day to celebrate physicians of all specialties serving in our communities.

“Physicians often lead patients and families through some of life’s most challenging moments,” said Mark Jackson, executive director of the Medical Association. “We wanted to have one day to thank our physicians for the work they do each day to make the health of our residents and our state better. The practice of medicine is a special calling, and we wanted to recognize that,” he said.

Montgomery radiologist Mark LeQuire had the opportunity to explain a more about the path to becoming a physician to a Today in Alabama morning news crew.

“Most people probably don’t realize the length of training that it takes to become a doctor. After four years of college, four years of medical school, five to seven years of training after that, and then the lifelong experience of training to become a good physician. But, it can be so much more. The concept I try to use in my practice is that of a physician-priest — to heal the body and soul of our patients and our communities as well. We are involved not only in the physical health of our patients but also in the wellness and well-being of our communities. You see that a lot more now with wellness centers in our communities. It’s more about the entire person and not just a body part,” radiologist Dr. LeQuire explained to WSFA-12 on March 31 as he toured the crew through his workspace at Baptist South in Montgomery.

How Do Physicians Contribute to Alabama’s Economy?

Alabama’s physicians fulfill a vital role in the state’s economy by supporting 83,095 jobs and generating $11.2 billion in economic activity, according to a joint report by the Medical Association and the American Medical Association.Alabama’s physicians are major economic engines in their communities. Urban or rural, large group or solo practitioner, Alabama physicians can improve both patient health and the economy.

Alabama’s physicians are major economic engines in their communities. Urban or rural, large group or solo practitioner, Alabama physicians can improve both patient health and the economy.With the changing

With the changing health care environment, it is increasingly important to quantify the economic impact physicians have on our society. To provide lawmakers, regulators and policymakers with reliable information, the report measured the economic impact of Alabama’s physicians according to four key economic barometers. The overall findings in Alabama include:

Jobs: Each physician supports an average of 9.5 jobs, including his/her own, and contributed to a total of 83,095 jobs statewide.Output: Each physician supports an average of $1.3 million in economic output and contributed to a total of $11.2 billion in economic output statewide.
Output: Each physician supports an average of $1.3 million in economic output and contributed to a total of $11.2 billion in economic output statewide.Wages and Benefits: Each physician supports an average of $758,744 in total wages and benefits and contributed to a total of $6.7 billion in wages and benefits statewide.
Wages and Benefits: Each physician supports an average of $758,744 in total wages and benefits and contributed to a total of $6.7 billion in wages and benefits statewide.Tax Revenues: Each physician supports $46,148 in local and state tax revenues and contributes to a total of $404.9 million in local and state tax revenues statewide.
Tax Revenues: Each physician supports $46,148 in local and state tax revenues and contributes to a total of $404.9 million in local and state tax revenues statewide.The study found, in comparison to other industries, patient care physicians contribute as much or more to the state economy than higher education, home health care, legal services, nursing and residential care.

The study found, in comparison to other industries, patient care physicians contribute as much or more to the state economy than higher education, home health care, legal services, nursing and residential care.

Watch Dr. Mark LeQuire’s interview with WSFA-12 on March 31, 2017.

Tags: doctor's day

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Diabetes Alert Day Focuses on Risk Factors of Prediabetes and Diabetes

Posted by admin on March 24, 2017

In 2014, diabetes was the seventh-leading cause of death both in Alabama and the nation at large. According to statistics from the Alabama Department of Public Health, 13.5 percent of Alabama adults have diabetes. As part of the American Diabetes Association’s (ADA) Alert Day^® on Tuesday, March 28, make sure you know the dangers of diabetes.

“On March 28, we will make a concerted effort through our social media accounts on Facebook and Twitter about the dangers and risks associated with prediabetes and diabetes, and how you can protect yourself against developing these diseases,” said ADPH Diabetes Program Director Brandi B. Pouncey.

According to the ADA, Alert Day^® is a time to “sound the alarm about the prevalence of type 2 diabetes in American adults.” The ADA states that nine out of 10 Americans most at risk for type 2 diabetes aren’t aware of it. To help combat this lack of awareness, the ADA has developed a quick test for participants to see if they’re at risk for developing these diseases. For those at risk, the ADA has developed some tips to use when speaking with a health care provider about what they can do to lower their risks. These resources, along with many others, are available on ADPH’s Diabetes Program website.

For more information from ADPH regarding diabetes, go to adph.org/diabetes, facebook.com/DiabetesInAlabama or twitter.com/DiabetesInAL.

Tags: diabetes, health

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Medical Association Urges CMS to Reduce EHR and MU Burden on Physicians

Posted by admin on March 24, 2017

The Medical Association has joined forces with the American Medical Association, Medical Group Management Association and 85 other medical groups to urge Centers for Medicare & Medicaid Services to reduce electronic health record and meaningful use requirements on physicians.

In a letter to new CMS Administrator Seema Verma, the groups first welcomed the new administration’s emphasis on reducing regulatory burdens on the house of medicine by acknowledging that the passage of the Medicare Access and CHIP Reauthorization Act, or MACRA, and the existing value-based purchasing programs affecting physicians, such as Meaningful Use, Physician Quality Reporting System and Value-based Payment Modifier needing streamlining and alignment. However, the administration was urged to take steps to address these same challenges in MU, PQRS and VM prior to their replacement by MACRA and minimize the penalties assessed for physicians who tried to participate in these programs.

“Eligible providers should not be penalized for focusing on providing quality patient care rather than the arbitrary ‘check the box’ requirements of MU. Creating an administrative burden hardship exemption would provide immediate relief for those impacted by the programs that predate MACRA,” the letter stated. “As indicated in the MACRA law and final regulations, policymakers in Congress and the Administration clearly understand that fair and accurate measurement of physicians’ performance will not be possible until better tools become available. We also believe the steps we have outlined are in keeping with President Trump’s efforts to reduce regulatory burden.”

Tags: CHIP, CMS, MACRA, MU, PQRS

Posted in: Advocacy

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House Cancels ACA Repeal/Replace Vote Today

Posted by admin on March 24, 2017

UPDATED Friday, March 24 at 3 p.m.: House Republicans have stopped the vote today on the legislation to repeal and replace the Affordable Care Act amid speculation the bill did not have the 215 votes needed to pass. The decision to pull the vote came after House Speaker Paul Ryan met with President Trump at the White House. While a new vote on the legislation has not yet been announced, House leadership have indicated it could come early next week.

Friday, March 24 at 11:22 a.m.: Legislation that would repeal Obamacare and replace it with a more limited health care program for the uninsured was cleared for debate and votes on Friday in the U.S. House of Representatives by the House Rules Committee. The House voted to begin debate on the GOP’s health care plan Friday, paving the way for a cliffhanger vote late in the afternoon. The Medical Association is closely monitoring the legislation.

House Republican leaders yesterday postponed the vote to repeal and replace the Affordable Care Act fearing the lack of votes to pass the new legislation. Members of the House Freedom Caucus said they needed more changes in the bill to reduce health plan premiums or else they would vote against it.

As of Thursday afternoon, 37 House Republicans, mostly Freedom Caucus members, declared their opposition to the bill, the Washington Post reported. A handful of more moderate GOP members announced their opposition, spurred by proposed revisions that likely would further reduce Medicaid spending and coverage.

Any delay in the House vote would set back GOP plans to pass the bill in both the House and Senate before the Easter recess begins April 7. GOP leaders fear that their members will come under strong pressure to oppose the bill when they return to their districts and face constituents upset about the prospect of losing their ACA coverage.

At least a dozen Senate Republicans have expressed doubts about whether they could support the House bill in its current form. There are big uncertainties about whether provisions to change the ACA’s insurance market regulations would comply with the Senate’s budget reconciliation rules allowing legislation to pass with 51 votes.

Late Thursday the Congressional Budget Office reported that the amended version of the legislation would achieve less than half the budgetary savings of the original bill over a decade, with the same coverage losses. Federal Medicaid spending reductions would dip from $880 billion over 10 years in the original version of the proposed American Health Care Act to $839 billion. But the CBO estimated the revised bill still would result in a similar sharp decline in the number of Americans with health insurance – 14 million more uninsured in 2018 and 24 million more uninsured by 2026.

The Medical Association has been looking at the American Health Care Act from the beginning with an Alabama perspective to determine the impact of the bill on our citizens. Because of that, we have had concerns with the legislation as it was introduced. We would like to encourage more discussions by all parties to move this legislation forward.

U.S. House to Consider Medical Liability Reform Bill

Pending the outcome of the vote on AHCA, the House may consider the Medical Liability Reform Bill. The House Judiciary Committee approved H.R. 1215, the “Protecting Access to Care Act (PACA)” on Feb. 28 by a vote of 18-17. This bill is based on the California medical liability reform law and would limit noneconomic damages to a cap of $250,000, while providing unlimited economic damages. It would also give states the flexibility to increase the cap on noneconomic damages and has language protecting existing state liability reforms.

The AMA has policy in favor of limiting noneconomic damages and supports the bill. House Republican leadership considers this measure to be part of its health care reform efforts. The full House is expected to consider H.R. 1215 during the week of March 27.

Tags: obamacare, repeal, replace, trumpcare

Posted in: Advocacy

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Are Tax Cuts Coming for the Small Business Owner?

Posted by admin on March 24, 2017

While physician practices have many specialized health care compliance issues, most are, in essence, small businesses that face the same challenges as any small business. Taxes and regulations are among those challenges affecting all small businesses. And many owners are now eagerly awaiting alleviation of those challenges.

According to the National Federation of Independent Business, small business optimism is at its highest rate since 2004. Small business owners are hopeful that President Trump’s promises of regulatory reform and lower taxes will become a reality, and small businesses will reap the rewards. With Republicans controlling both Houses, that hope appears to be well-founded.

President Trump and the Republican Congress have promised that a repeal of the Affordable Care Act will lower insurance requirements for small businesses, that the deconstruction of the banking regulations of the Dodd-Frank Act will give small businesses more access to credit, and that tax reform will provide small businesses with tax savings. Let’s take a look at some of the specific tax plans President Trump has proposed that have small business owners excited.

Small business owners are hopeful that President Trump’s promises or regulatory reform and lower taxes will become a reality and small businesses will reap the rewards. Small business owners should rightly expect to see tax cuts in the near future.

The new administration has proposed cutting the highest corporate tax rate from 35 percent to 15 percent. S corporations and other pass-through entities may also see a reduced tax rate, as President Trump has proposed a maximum rate of 15 percent on business income that is reinvested into the company. This proposal provides some relief to the business owner on his “phantom income” tax bill. Comparatively, the House GOP tax plan reduces the corporate rate to 20 percent and the pass-through rate to 25 percent.

Of course, small business owners are also individual taxpayers, and President Trump’s tax plan contains several facets to benefit the individual taxpayer. President Trump’s proposal is to reduce the number of personal income tax brackets from seven to three. For joint filers, the proposed marginal rates on taxable income are 12 percent for up to $75,000, 25 percent for $75,000 to $225,000, and 33 percent for more than $225,000. (Dollar amounts for single filers are half of these amounts.) Here, the House GOP tax plan aligns with President Trump’s proposal, save a slight variation in the dollar amounts.

Of particular interest to many high-income earners is the Net Investment Income Tax (“NIIT”). The NIIT was enacted within the Affordable Care Act (“ACA”) and imposes a tax of 3.8 percent on investment income, such as interest, dividends, short-term and long-term capital gains, rental income, royalty income, and passive activity income. It applies only to investment income that exceeds a threshold of $200,000 of adjusted gross income for single filers and $250,000 of adjusted gross income for joint filers. President Trump, however, has proposed to repeal that tax. And because the NIIT is part of the ACA, which is first and foremost on the Republican Congress’s list of laws to repeal, this 3.8 percent tax may be the first tax to go.

President Trump’s tax plan also includes more than doubling the standard deduction, eliminating the estate tax, and providing revised childcare deductions and rebates. Additionally, he has proposed providing for the establishment of Dependent Care Savings Accounts with a government matching program.

It is worth noting, though, that President Trump has a stated goal of tax simplification. To that end, he has proposed to eliminate the reduced capital gains tax rate for carried interest, eliminate personal exemptions, eliminate the head-of-household status, and impose a cap on itemized deductions. As such, not all of President Trump’s proposed tax plan will provide a benefit to the taxpayer’s bottom line.

Even so, small business owners should be energized by the lower rates and simplification. A reduction of tax compliance expenditures could be significant for the small business. Piggyback that on the expected repeal of the Affordable Care Act, and small business owners can anticipate spending less time and effort on the compliance side and more on the business side.

Although portions of the House Republicans’ tax plan are not as aggressive as President Trump’s, the plans set forth similar reductions to the individual and business tax rates. Consequently, small business owners should rightly expect to see tax cuts in the near future.

Article contributed by Leslie H. Pitman, an attorney at Gilpin Givhan. Gilpin Givan is a Bronze Partner with the Medical Association.

Tags: business, Insurance, management, regulate, tax

Posted in: Management

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Close Patient Care/Diagnosis Gaps with New Informational Claim Process

Posted by admin on March 16, 2017

Blue Cross and Blue Shield of Alabama now offers a new informational claim process in which you have the option to submit an informational claim through ProviderAccesseClaims to report previously closed patient care/diagnosis gaps. The informational claim is for reporting purposes only.

Effective March 6, 2017, the option to dispute an item on a patient’s Patient Health Snapshot (PHS) has been removed and replaced with the “Guide to Closing Patient Gaps” and “Blue Advantage Guide to Closing Patient Gaps” to assist with closing patient gaps. These documents provide you with an in-depth look at scenarios that may apply to your patients when addressing gaps and submitting an informational claim.

These documents are located on our provider website, AlabamaBlue.com/providers. Log in and type “Guide to Closing Patient Gaps” in the search box. It will populate both versions of the guide for you.

Note: The absence of an appropriate “history of code for a resolved condition” is the only scenario in which a dispute can still be filed. This option is available for Blue Advantage patients only. Refer to the “Blue Advantage Guide to Closing Patient Gaps” for more details.

Tags: claim, gap, report

Posted in: Blue Cross Blue Shield of Alabama

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Is a Physician Leaving Your Practice? Here are Your “Must Have” Employment Agreement Provisions (Part I)

Posted by admin on March 16, 2017

The following is the first installment of a three-part series discussing important provisions in physician employment agreements.

When a physician leaves a medical practice, especially if the physician stays in the area to compete against his/her former employer, the situation can become stressful and acrimonious. During the final weeks of employment, the departing physician can start to focus more on his/her new practice to the detriment of the current employer, and disputes often arise regarding access to medical records, soliciting patients and employees and when to schedule procedures – before or after termination. We have seen both medical practices and departing physicians engage in questionable conduct in order to keep as many patients as possible. Lawyers are often engaged to negotiate the terms of separation or, in a worse-case scenario, to file or defend a lawsuit.

Over the years, we have counseled hundreds of physician practices on how to successfully navigate the various issues that arise when a physician departs, regardless of whether the physician is an employee or an owner. Careful planning on the front end through a comprehensive employment agreement is the most important element in an amicable and fair separation. More often than not, we have found that disputes and subsequent litigation can arise when the employment agreement is not properly drafted or does not adequately address the specific terms of separation.

This three-part series provides a summary of the key provisions (with sample language) that can be incorporated into a physician employment agreement to help mitigate problems when a physician leaves your practice. Since each medical practice is unique, please consult with your own attorney before using any of the provided sample provisions in a physician employment agreement.

Setting Expectations. Unless there is an immediate termination due to a breach of the employment agreement or other significant event, such as loss of license, oftentimes a physician’s employment is terminated by either party “without cause” upon thirty (30) to ninety (90) days prior written notice. In that situation, the physician continues to work for the medical practice during the notice period. This can be a very stressful time for both the practice and the departing physician, as the practice often feels that the physician’s loyalties have shifted. Even though the physician remains employed (and receives compensation), the physician may not be acting in the best interest of the soon-to-be former employer. As such, it is helpful to set expectations of conduct in the employment agreement during this transition period.

Following any notice of termination of Physician’s employment with the Employer which does not immediately terminate Physician’s employment, Physician shall continue to conduct himself/herself in accordance with the terms of this Employment Agreement, and specifically shall not: (a) copy (or instruct Employer personnel to copy) medical charts of patients for Physician’s use after termination of employment with the Employer, (b) compile (or instruct Employer personnel to compile) lists containing patient data, including patient names, addresses and/or telephone numbers of Employer’s patients for Physician’s use after termination of employment with the Employer, (c) schedule (or instruct Employer personnel to schedule) medical appointments, procedures and/or surgeries between Physician and Employer’s patients subsequent to the termination date of Physician’s employment with the Employer, (d) take vacation or continuing medical education time-off that is inconsistent with Physician’s normal vacation and continuing medical education time-off, or (e) otherwise diminish or lessen Physician’s services for the Employer.

In addition, upon termination of employment the departing physician should be required to complete certain obligations.

Notwithstanding the termination of Physician’s employment with Employer, Physician shall be required to: (a) cooperate with Employer on any malpractice or other actions or suits related to Physician, (b) immediately upon termination complete all medical records and return all property belonging to Employer, including, without limitation, patient and client lists, fee schedules, compensation information, medical records and all confidential information of the Employer, and (c) otherwise fulfill all responsibilities hereunder reasonably determined by Employer to relate to the services rendered by Physician prior to termination.

Patient Notices. One of the most contentious issues surrounding the departure of a physician involves notifying patients the physician is leaving. Under Alabama licensure law, the departing physician is obligated to notify his/her “Active” patients of the date the physician is leaving and his/her new contact information. The purpose behind the notification is to provide patients the freedom of choice to remain with the practice or follow the departing physician, and to minimize potential patient abandonment issues. The term “Active” patients is not defined under licensure law, but in our experience notice should be sent to those patients treated by the departing physician within the last twelve (12) months immediately prior to termination. Physicians who practice in a specialty that might require longer follow-up care, such as oncology or cardiology, would likely need to notify patients treated in the eighteen (18) to twenty-four (24) months immediately prior to termination.

Sometimes, the medical practice will provide the departing physician a list of his/her patients with addresses so the physician can send the required notice. Oftentimes, however, the medical practice does not want to provide a patient list and arguments arise over the proper way to notify patients and the timing of such notice. Specifying in the employment agreement the form of such notice, how costs are to be allocated and the timing of the notice will help avoid arguments.

Upon termination of this Employment Agreement, Physician shall not have any right to receive a list of patients treated by Physician while an employee of Employer. Any notice required by law to be sent to Physician’s patients upon Physician’s departure from the Employer shall be sent by the Employer on behalf of Physician and the parties hereby agree that such notice shall only be sent to those patients for whom the Physician served as the primary physician within _________ (_____) months immediately preceding the date of termination of this Employment Agreement (e.g., Active Patients). The Physician and Employer shall each pay one-half of the costs associated with the notice, to include applicable postage. The form of notice shall reference both Employer (and its physicians) and the Physician and shall be agreed upon by the parties in good faith. The Physician and Employer will work together in good faith to send out the notice at least thirty (30) days prior to the Physician’s last day of employment, if feasible.

Medical Records. The patient medical records, whether paper or electronic, belong to the medical practice. However, certain situations may arise when the practice should make medical records available to the departing physician after termination, including, for example, to address medical malpractice claims or government investigations. Further, patients have the right of access to their records and can direct that the practice make copies of their records available to the departing physician. Oftentimes, we will include in the patient notice a HIPAA Authorization form for the patient to sign if he/she intends to continue under the care of the departing physician and wants the medical practice to send copies of records to the physician.

Physician shall prepare in a timely and complete manner medical records relating to his/her provision of professional services in such form and containing such information as customarily maintained by Physician and as required by applicable federal and state law, third-party payer agreements and Employer. All patient records, case histories, films, and personal and regular files concerning the patients consulted, interviewed, treated or cared for by Physician pursuant to this Employment Agreement shall belong to and remain the property of Employer. Upon termination of this Employment Agreement, Physician shall have the right, in accordance with state and federal law, including the Health Insurance Portability and Accountability Act of 1996, and its corresponding regulations, as may be amended from time to time, to obtain copies at Physician’s sole cost and expense of any patient record of Employer; provided, however, that Physician was involved in the applicable patient’s care and further that Physician’s right to copy such patient records shall be subject to: (a) Employer receiving a written authorization signed by the patient authorizing Employer to release such copies to Physician, (b) Physician requiring access to certain patient records to defend or prepare to defend any alleged or threatened professional liability claims relating to such patient records, or (c) Physician requiring access to certain patient records with respect to governmental or third party payer audits or reviews of claims for reimbursement relating to such patient records.

While it may take more work on the front-end, having a well-thought out and comprehensive physician employment agreement will save significant time, effort and potentially money when a physician leaves your medical practice. Stay tuned for Part II of this three-part series which will discuss protecting other employees, compensation, and continuing malpractice insurance.

Read the full series:

A Physician is Leaving Your Practice – “Must Have” Employment Agreement Provisions (Part II)

A Physician is Leaving Your Practice – “Must Have” Employment Agreement Provisions (Part III)

Howard Bogard is a Partner with Burr & Forman LLP and serves as the Chair of the firm’s Health Care Industry Group. Kelli Fleming is a Partner with Burr & Forman LLP practicing in the firm’s Health Care Industry Group. Burr & Forman, LLP, is an official Bronze Partner with the Medical Association.

Tags: agree, employ, law, leave

Posted in: Legal Watch

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Four Types of Identity Fraud on the Upswing

Posted by admin on March 8, 2017

If you thought that the promising (albeit modest) drop in the total dollars stolen by identity thieves in 2015 was a harbinger of things to come, think again.

According to the just released 2017 Identity Fraud Study from Javelin Research, the number of victims of this crime—in all its permutations—climbed to a record high of 15.4 million last year. And, despite the fact that the average amount per fraud went down, the total cost topped $16 billion, also an all-time high. What does that say about efforts to rein in identity thieves?

“We’ve gotten pretty good at closing the door once the horse has left the barn,” says Al Pascual, Javelin senior vice president and head of fraud and security. But we need work when it comes to “barring the door” to begin with.

The research, funded by LifeLock, also made clear that even if you don’t maintain a large online presence, taking steps to protect your identity is a smart move. Offline consumers are less likely to experience fraud, Pascual explains. But when it happens it’s worse, because it takes more time to detect. On the other hand, if you’re highly connected, your risk is much higher than average. But you’re also likely to detect—and shut down—attempts at fraud more quickly. How do you protect yourself? “If you’re not digitally inclined, sign-up for a credit protection service,” Pascual says. “If you are, don’t use the same passwords even across retailers.”

The study, now in its 14th consecutive year, highlights a number of specific places identity fraud and theft are on the rise or particularly troubling. Here’s a look at what they are and how to protect yourself:

Card Not Present Fraud

What you need to know: Incidences of this type of fraud, where a thief uses your card number without having the actual card, rose 40 percent last year. Pascual expects those gains to continue. “We’ve gone digital because it’s convenient,” he says. “So have criminals.”

How to guard against it: Take advantage if your credit card offers ways to obscure your payment details, advises Dr. Stephen Coggeshall, Chief Analytics and Science Officer of ID Analytics. Some credit card issuers and fraud protection services will send you alerts if a charge is made and your card is not present. Do that as well. And pay attention to your credit card statements, watching, in particular, for charges you don’t understand.

New Account Fraud

What you need to know: This form of fraud, where a thief steals enough of your identifying information to open an account in your name, is on the upswing. Incidents nearly doubled from 2014 to 2015, and this year showed “almost the same degree of growth,” Pascual said. Importantly, the new accounts being opened are not just at traditional lenders, but also at alternative ones, including payday lenders and peer-to-peer lenders. Those are tougher to track.

How to guard against it: Monitoring your credit, by either taking a very consistent look at your own reports or having a service do it for you, is the key here. One advantage of some services, notes Pascual, is that they look beyond the item on your credit reports to checking and savings accounts and alternative lenders. Also, it sounds run of the mill, but open every piece of mail you get from a financial institution—even those you don’t patronize. Often, you’ll receive notice when an account is opened in your name, giving you a chance to shut it down and alert the credit bureaus.

Account Takeover Fraud

What you need to know: This type of fraud is distinguished by the fact that a criminal is essentially trying to usurp control for a pre-existing account that you’ve set up. Signs that it might be happening include receiving change of password or change of address notices that aren’t prompted by your actions. “These cases result in the highest average loss amount, and sometimes a consumer can be stuck for more of the bill,” says Pascual, explaining that it can be difficult to prove that you didn’t take the actions involving your account, such as removing or spending funds.

How to guard against it: Don’t reuse passwords across sites—particularly across financial ones. Criminals will take the password list from one breach and try those passwords at every major bank across the country to see if they can be used. Tell your financial institutions you want multiple notifications—by both text and email—if actions are taken on your account. “The idea is to make it harder for communication to be severed between you and the institutions,” says Pascual. And if two-factor authentication is available for entry to any of your financial sites, use it.

Sophisticated Phishing

What you need to know: The phishers have gotten better at their game. “We’re used to seeing phishing with poor misspelling, bad grammar, and poor formatting,” says Coggeshall. Criminals have moved beyond that. Today, corporate emails are being spoofed and employees are being sent letters from the CEO or finance department that look legitimate. In some cases, hackers take the time to learn things about you specifically, then target you with a specially crafted phish.

How to guard against it: If someone contacts you that you’re not used to hearing from and asks for any sort of financial or identifying information, a bell should go off in your head. Don’t click on the email. Don’t give out information by phone or text. Instead, back away and—if you believe it might be real—initiate the communication yourself to figure out if the need is legitimate.

LifeLock is a partner with the Medical Association, and physician members receive discounted rates on LifeLock memberships.

Tags: fraud, identity, lifelock, phish

Posted in: MVP

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The Changing Face of Medicine

Posted by admin on March 8, 2017

Although women continue to break boundaries in politics, business and medicine, barriers still remain, which mean trailblazers will always be there to forge ahead.

In fact, Alabama’s first female medical trailblazer passed the Alabama State Medical Examination in 1891 catching the attention of The New York Times. Halle Tanner Dillon Johnson became not only the first woman to pass the 10-day written exam, but she was the first woman of any race to officially practice medicine in the State of Alabama. Dr. Johnson’s actions 126 years ago set the stage for female physicians in Alabama.

Today’s face of health care is changing. One would have been hard-pressed to find many women in medicine just a generation ago where now female applicants to medical schools make up about 50 percent of the total applicant pool. Nationally about one-third of American physicians are women, and with more female physicians come a few more, well…complications.

Women are wives and mothers, jobs which in their own right bring with them their own set of rules to be addressed, such as child care and maternity leave. Factor in the everyday stresses of being a physician, and it becomes complicated.

According to a 2014 study by the Association of American Medical Colleges:

The proportion of applicants to medical school who are women has continued to drop since it peaked in 2003-2004 at 51 percent.
Research indicates that many women who take part-time positions do so on account of dependent children, while most men take part-time positions due to holding other professional positions.
Amongst full-time faculty, the only rank at which women account for more faculty than men is at the instructor level.
While women residents increasingly enter specialties where they have been historically underrepresented, large gender disparities remain.
The top 10 specialties for women residents in 2013-14 were OB-GYN, pediatrics, family medicine, psychiatry, pathology, internal medicine, emergency medicine, surgery, anesthesiology and internal medicine subspecialties.

The long working hours and dedication to delivering a high quality of health care to their patients take its toll on female physicians who are constantly striving to balance their work and home lives. According to a study by the Mayo Clinic and published in the Journal of General Internal Medicine in
2013, this struggle for a work/life balance is felt especially by those whose life partners also work, or by female physicians, younger doctors
and physicians at academic medical centers and manifests as burnout, depression and lower levels of satisfaction about their quality of life.

Finding that balance can be difficult but still possible, according to Irene Bailey, M.D., a family physician in Tallassee. Dr. Bailey and her husband are in the process are opening a new urgent and primary care facility in Montgomery that will be open seven days a week with extended hours.

“I always say, when you work, don’t work long hours that will sacrifice your family life. Budget your time. A lot of medical students and residents feel they have to work very long hours and have no personal life to be successful. But, that’s not true,” Dr. Bailey said. “I learned this rule from my attending, and I’m still living it today: Come to work at least 15 minutes early. You’ll have time to get a cup of tea or coffee and get your paperwork started. That 15 minutes is your head start on your day so you don’t rush before you see your first patient.”

Jennifer Dollar, M.D., a pediatric anesthesiologist in Birmingham, agreed with Dr. Bailey that going the extra step to plan out your schedule, especially for female physicians with busy schedules and families, is a necessary key to success.

“When I’m in the operating room, I may not have that ability to take the time out of the day that I would like to slow down a little. You have to be pretty wise about how you plan out your day. It’s the little things like bringing your lunch and thinking about the things you need to prepare yourself with for what your day may bring. Planning ahead is very important because you’ll still get pulled in a lot of different directions. Your patients need you, your staff, your family, and if you have administrative roles outside your practice…these are all things you juggle throughout the day that pull you in different directions,” Dr. Dollar explained. “I try to map out my week. I even try to map out my month in the very beginning just so I have some kind of idea of where I’m supposed to be and when and what kind of preparation I need before I get there. Then, when I toss in what my kids need, it gets really tricky. It’s a challenge of how do we get all of these moving pieces moving in the right direction to get everything accomplished.”

Unfortunately, in creating a balance between work and home, more importantly making time for their family, can cause some cracks in a female physician’s professional world. The decision then becomes how to speak up to make the situation better.

Lee Sharma, M.D., an OB-GYN in Auburn, found herself with that decision 16 years ago after working as a partner in an all-male practice in which she was the first female partner.

“I don’t think my partners were really prepared to have a female physician, much less a working mother, in the practice because it really is a different consideration when you have a child. My husband and I were already working our call schedules so we were never on call at the same time,” Dr. Sharma said.

Dr. Sharma admitted that when she joined the practice, she never thought of having a conversation with her partners about what would happen when she and her husband decided to have a family. But, when she became pregnant and took maternity leave, she said it was something not only she and
her husband had to adjust to, but her partners as well.

“I had to explain to them that I’m not like you. I do what you do and what your wife does on a daily basis. Because of that, there’s some other things that I have to have,” Dr. Sharma said.

She worked long, crazy hours for four years trying to make the best of being a partner in her practice, being a physician to her patients, and being a wife and mother at home. But, it was an early morning page from her husband that made Dr. Sharma realize just what she was giving up.

“I was on call at the hospital and my husband paged me at about 7 a.m., and he never did that unless it was an emergency. He told me that our youngest woke up around 2 a.m. and wanted to know where I was. He told her I was at the hospital taking care of the babies. She got the phone and asked him to ‘call Mommy.’ I was heartbroken. That was it. I could not have my children miss me like that again,” Dr. Sharma said. Shortly after, she resigned her partnership and opened her own practice.

Nina Nelson-Garrett, M.D., of Montgomery, chose a very male-dominated specialty when she opted for gastroenterology, but it was her passion. Although now she said she’s beginning to see more women enter the specialty, she’s worried for the profession as a whole.

“I’m finding that physicians are leaving medicine altogether. Some of it might be because of the changes in health care. I mean I’ve seen surgeons who are retiring early because of all these mandates,” Dr. Nelson-Garrett suggested. “For women, I think it’s a question of can I can continue at this pace and in this role?”

As an African-American female physician, Dr. Nelson-Garrett has faced different challenges, which she said she has looked at as changing the image of what a physician is to her patient – one patient at a time. From having patients expecting to see a male physician to coming face-to-face with a patient who admitted upfront that he was a racist. But, Dr. Nelson-Garrett’s personal motto, “one person at a time,” has bolstered her during some trying situations.

“I’ve had quite a few instances of being overlooked, ignored and downright mistreated, but I’ve had to just push through,” Dr. Nelson-Garrett explained. “I try to look at a challenging situation as an advantage, like what can I offer in this situation. Then, I want to change the image of what a physician is to our patients. You have to do that one patient at a time.”

Dr. Nelson-Garrett said that because she’s in a specialty where most of the physicians are men, it’s not uncommon for a patient automatically assume that because of her hyphenated last name, that Nelson is her first name and Garrett her last, the patient will often expect a male physician.

“I’ve even gotten nurse,” Dr. Nelson-Garrett chuckled. “Once in medical school during morning rounds huddle where I was the only female in the group, someone thought I was housekeeping. A patient’s family member walked up to me and asked me for a mop and asked if I could help clean up a room. I was shocked! My male colleagues spoke up very quickly and asked why that family member would ask that question. We were all together, with our white coats, and it was just strange. My colleagues were very supportive, but sometimes people assume incorrectly. I think it may be our history because for so long medicine was dominated by men. Somehow it’s become ingrained in patients to expect their physicians to be men.”

For Dr. Nelson-Garrett being a female physician may have its challenges, but she said she feels some of the challenges she’s had in her career have been framed by her race as well.

“In my life, I have never been able to untwine those two unchangeable parts of me,” she explained. “Patients want to know that you care about them, that you are listening to them, and that you are going to try to do something to help them. “When I was living in Arkansas I was taking care of a young man who told me he was racist. I told him my purpose was to take care of him that day. He had fairly significant liver disease, and it took a good bit to get his health under control. When I was getting ready to leave Arkansas, he came to my office and gave me a gift that I still have on my desk. It’s a stone that reads, ‘Nothing is ever etched in stone,’ because he wanted me to come back to Arkansas. No matter who we are, we want to know that someone cares about us.”

Here in Montgomery, Dr. Nelson-Garrett is chief of staff with Baptist East, and she said she has been extremely impressed with the administration’s willingness and respectfulness to have women in leadership positions.

Although each of these physicians have had their own personal struggles in medicine, they agree on one thing in particular for women in medicine today: Speak up.

Dr. Bailey, who’s now operating in two offices, is a firm believer in the power of teamwork. However, she admits it’s very easy for a woman’s nurturing tendencies to take over in the health care system and try to do everything herself.

“Be a team player from your front desk throughout the office. Your learning experience extends to your nurses. We are a team, and we work as a team. It’s important not to hold the burden of the day on our shoulders alone. We have to rely on each other to be successful for the practice and our patients,” Dr. Bailey said.

For Dr. Dollar, who’s the immediate past president of the Alabama State Society of Anesthesiologists, she said she never felt limited as a woman in medicine or excluded from activities by her male colleagues or administrators. But she really didn’t know what she was truly missing in her career until she was introduced to organized medicine.

“You go through medical school and residency to become the best physician that you can be, and your goal is always to take the best care of your patients that you possibly can. But, what I’ve also learned through organized medicine is that it’s not enough to get up every day to take excellent care of your patients. It’s just not enough. That makes you a great physician for the people that you interact with, but your patients also need you to speak up about policy issues that are going to affect them. Your patients don’t have a way to speak up or to understand the complicated issues affecting medicine or everything that goes into practicing medicine today. You have to be an advocate for your specialty. You have to be an advocate for your patients and their excellent care. There are a whole lot of people who have an interest in health care and in medicine who don’t understand how the rules are made or who those rules affect every day,” Dr. Dollar explained.

Dr. Nelson-Garrett’s personal mantra of ‘one person at a time’ extends far beyond the treatment room. Having a voice in the legislation of medicine is just as important as the practice of medicine, and for Dr. Nelson-Garrett, she believes that voice is as much of a physician’s job as treating a patient.

“When you’re part of a group, your voice is heard much louder. With all the changes in health care, a lot of people might feel that we didn’t have a real voice in how the change was made, and that’s where all the angst has come in,” Dr. Nelson-Garrett said.

Dr. Sharma, who found her voice while trying to reconcile a difficult situation, went so far as to get her Master’s degree in conflict resolution and was one foot out of the practice of medicine when she realized that it wasn’t medicine after all that was the problem.

“I started with the AMA when I was a med student. One of the things I’m most grateful for is to be able to serve on Graduate Medical Education Advisory Committee, and I was the only one speaking for the residents in that room. They were making changes to the residency training requirements, and I was the only one speaking up for the residents. What a lot of physicians don’t realize is that if they don’t speak for or against something, nobody will. Then, you can’t be surprised or upset when legislation gets passed that has anything to do with your patients. If you didn’t speak beforehand, you’ve got no right to complain. Doctors think it’s hard to get involved, but it’s not. All you have to do is to be willing to help. Doctors may not realize all that legislation we don’t want to deal with now will pass, and you’ll have to deal with it later,” Dr. Sharma said.

Article by Lori M. Quiller, APR, Director of Communications and Social Media

Tags: bailey, dollar, female, garrett, sharma, women

Posted in: Members

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New American Health Care Act Comes Under Fire

Posted by admin on March 8, 2017

Earlier this week, members of the House Energy and Commerce Committee released legislation as part of the House Republicans’ efforts to repeal and replace Obamacare. Although the legislation cleared its first hurdle with a lengthy, contentious markup session that began Wednesday, the House Ways and Means Committee approved the American Health Care Act. The House Energy and Commerce Committee continued debating the legislation well into Thursday. Many health care organizations are speaking out against the legislation.

In brief, the 123-page legislation proposes to:

Eliminate the Obamacare taxes on job creators, increased premium costs, and limited options for patients and health care providers.
Eliminate the individual and employer mandate penalties.
Prohibit health insurers from denying coverage or charging more to patients based on pre-existing conditions.
Help young adults access health insurance and stabilize the marketplace by allowing dependents to continue staying on their parents’ plan until they are 26.
Establish a Patient and State Stability Fund, which provides states with $100 billion to design programs that meet the unique needs of their patient populations and help low-income Americans afford health care.
Modernize and strengthen Medicaid by transitioning to a “per capita allotment” so states can better serve the patients most in need.
Empower individuals and families to spend their health care dollars the way they want and need by enhancing and expanding Health Savings Accounts (HSAs).
Help Americans access affordable, quality health care by providing a monthly tax credit for low- and middle-income individuals and families who don’t receive insurance through work or a government program.

Although Democrats and Republicans are beginning to speak against the bill, perhaps most critical of the legislation has been the American Medical Association, which issued a letter to congressional leaders stating that it cannot support the bill.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” it said.

AMA President Dr. Andrew Gurman introduced the letter on the AMA’s website by stating: “We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.”

Similarly, the American Nurses Association and the American Hospital Association have expressed strong opposition to the proposed American Health Care Act citing fundamental changes in Medicare and Medicaid, which the groups argue could limit access to care while “in no way improving care.”

“It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations,” wrote Richard Pollack, CEO and president of the American Hospital Association, in his letter to members of Congress.

The legislation does not yet have a score from the Congressional Budget Office, which could provide an estimate of the bill’s cost and impact on coverage levels. However, White House representatives have indicated a score will soon be released.

Other medical groups are expressing concern about the speed at which the bill appears to be moving.

“We are concerned that by rushing to a mark-up … in the Energy and Commerce and Ways and Means Committees, there will be insufficient time to obtain non-partisan estimates of this legislation’s impact by the Congressional Budget Office, or for medical organizations like ours and other key stakeholders in the health care community to offer substantive input on the bill,” the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists: and the American Osteopathic Association said in a joint statement.

Click here for a look at what the American Health Care Act would keep, change and/or repeal versus the ACA.