May 2018 - Medical Association of the State of Alabama

Archive for May, 2018

In Memoriam: Former Board Member Dr. Ronnie Lewis, 1957-2018

Posted by admin on May 31, 2018

Former Medical Association Board Vice President Ronnie Lewis, M.D., of Fyffe, passed away on Tuesday, May 29, at Vanderbilt University Medical Center following a battle with cancer. Funeral services were held on Friday, June 1, 2018, at 2 p.m. at Rainsville Community Church. Burial followed in Green’s Chapel Cemetery with Rainsville Funeral Home, Inc. directing.

Dr. Lewis was a member of the Medical Association and the DeKalb County Medical Society since 1986.

Dr. Lewis is survived by his two brothers, Jackie Lewis of Fyffe, and Tony Lewis and wife Susan of Fyffe, AL; his two sisters, Peggy Croft and husband Bobby of Dawson, AL, and Kathy Bell of Fyffe, AL; his aunt, Elva Blackwell of Fyffe, AL; an honorary son, Bradley Bell and wife Dawn of Pisgah, AL; and three honorary grandchildren, McKenzie Bell, Rhylee Bell and Xander Bell all of Pisgah, AL.

Dr. Lewis was a member, the pianist and song director of Lee’s Chapel in Henagar, AL.

It was the sincere request of Dr. Lewis, that in lieu of flowers, donations be made to the Alabama School of Gospel Music at P.O. Box 199 Fyffe, AL 35971. If you would like more information, click here to go to the Rainsville Funeral Home website.

Tags: memoriam, Ronnie Lewis

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Lead From Where You Are

Posted by admin on May 31, 2018

After mastering self-leadership, the next step is to lead your physician partners and your office staff. Contrary to common belief, some aspects of this role should be filled by all physicians in the group. Yes, there may be a designated single leader for the practice, but that should not enable the others in the group to abdicate their leadership responsibilities. It is a common error to think “I will wait until I am the senior partner, or I will wait until I am the highest producing partner before I begin to lead our group.” Lead well from where you are, and the group will be better for it.

The respect the practice receives is not necessarily driven by how well your group is led, but a dysfunctional medical practice will impair the regard in which you are held by those outside your practice. As a physician, you wield great influence, and that opportunity is enhanced by a perception that all the physicians in your group are positive examples of excellence in patient care and of decorum. Your employees are also ambassadors for your group as a manifestation of the leadership they receive from you.

There are two aspects of leadership and one of them is often neglected in medical practices. First, there is your directed leadership. This is the willingness to make decisions about strategic or tactical matters. Some issues should be handled by your practice administrator and some must be discussed with the full physician group, but many decisions should be made by the physician leader. The issues which the administrator should defer to you from day-to-day matters, will depend on the experience of, and your trust in, your administrator. In today’s complex world of medical practice management, hire a capable person to manage the group, and let them do the job without any micromanagement. Spending too much M.D. time making or reviewing every management decision is unwise. For the bigger issues, the physician leader must make the call. Even if you prefer to seek group buy in, make the decision first and deliver it as a recommendation to the group. Letting a physician group deliberate until a decision is reached is a recipe for the paralysis of analysis. Do not give any physician a veto power about decisions unless your group is very small or it is a decision of major magnitude, like selling or merging your practice.

The second aspect of leadership, and most often overlooked, is your permissive leadership. These are matters which happen because you encouraged or permitted them to occur. Permissive leadership is a hands-off approach and works wonderfully when all members of your group share a common clinical, behavioral and ethical work philosophy. At Warren Averett, when our team is assisting clients in the recruitment of a new physician or in a merger of medical groups, we always steer the discussion away from the monetary issues until we feel that the physicians involved have a compatible clinical mindset.

Clinical compatibility could be perfect, but there must also be a behavioral agreement among the physicians. Are the staff deserving of courtesy and appreciation for their patient support efforts, or are they paid to do a job and that is all the thanks they should expect? Is profanity acceptable in the medical practice? How casually may a doctor cancel clinic in order to engage in last-minute recreational or travel pursuits? Are the practice policies regarding social media, taking vacations when other physicians are already off and fraternization with select members of the staff, hard rules which must be followed, or are they only suggestions? We have been involved in mediating physician disagreements on every item listed here, so we believe it is crucial to discuss these issues before physician employment.

If all in the group are clinically and behaviorally in synch, the remaining issues center on work ethic and most of those can be handled through the physician compensation plan. Physician start time, end time, pace in the work day, use of office talent, ancillary procedures performed, payer mix and procedure mix all impact revenue. In a production-driven physician compensation formula, differences in these factors will make great differences in resulting compensation. There must be some similarity in work habits and ethic, as well as agreement that differences merit variances in compensation.

Where clinical, behavioral and ethical consistency exists among all physicians, and one doctor has the group authority to make decisions, there is harmony, productivity and profitability. We see it time and time again.

Article contributed by James A. Stroud, CPA, D. Maddox Casey, CPA, and Sae Evans, CPA, with Warren Averett CPAs and Advisors. Warren Averett CPAs and Advisors is an official preferred partner with the Medical Association.

Tags: leadership

Posted in: Leadership

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President Trump Signs Right-to-Try Act

Posted by admin on May 31, 2018

On Wednesday, May 30, 2018, Pres. Donald Trump signed the Right-to-Try Act, which allows terminally ill patients the ability to try drugs in preliminary testing but not-yet-approved by the Food and Drug Administration. The aim is to make it easier for those patients suffering from fatal illness who have exhausted all other resources to access drugs unapproved by the FDA, which may provide them some relief from their illnesses.

The Right-to-Try Act is also intended to create a more open and competitive market for drugs still seeking FDA approval, therefore, lowering the cost of the drugs since insurance companies do not cover them. Supporters of the legislation say it gives hope to those who are out of options, while opponents argue the legislation gives a false hope to many who are already in a vulnerable and fragile state.

While the intent is to allow patients to try drugs not otherwise available to them, many point out the FDA already allows patients access to these drugs through an expanded access program. This program allows terminally ill patients access to drugs not FDA approved, ensures the drug is administered correctly and certifies those receiving the medication are adequately informed. Additionally, the approval rate of patients completing the application requesting these drugs since 2006 is 99 percent.

Supporters of the Right-to-Try Act argue these numbers do not reflect the hundreds of patients neglected by the application process through incomplete applications and other factors. Now, the Right-to-Try Act takes the FDA out of the equation and leaves the power with patients and their physicians to work with drug companies directly to access unapproved drugs.

Despite its potential for success, the Right-to-Try Act comes with a significant downside. Since the only requirement for the drugs are that they have passed Phase I testing with the FDA stating they are safe on humans, there is no real understanding of possible side effects these drugs may have on patients. The uncertainty and margin of error around medications not approved by the FDA leave physicians concerned for the health and safety of the patients who choose to use them.

Tags: drug, FDA, medication

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You Can Avoid a HIPAA Fine. Here’s What You Need to Know.

Posted by admin on May 23, 2018

Did you know the government has strengthened its ability to enforce HIPAA law, which now includes fines reaching up to $50,000 per violation with a maximum of $1.5 million in annual penalties? With the increasing rates of cyberattacks and patient data breaches specifically targeting the health care industry, could you afford to pay a penalty if your practice was hit with one or more of these penalties? What about your patients’ records? If your practice incurred a breach, could you guarantee the safety of those medical records?

Without the proper safeguards in place, your patient information can easily fall into the wrong hands, exposing your practice to large governmental fines and risk to your reputation. The Medical Association recently partnered with PCIHIPAA to help our member physician practices take the precautions necessary to ensure their HIPAA compliance.

As a member of the Medical Association, you will receive from PCIHIPAA:

A complimentary 2018 HIPAA Risk Assessment, which is now mandatory under federal law. Take the assessment online at pcihipaa.com/Alabama
A 23-page Risk Analysis Report
A free 30-minute HIPAA Risk Consultation
One year of free Identity Restoration Protection through PCIHIPAA’s OfficeSafe program
A free HIPAA Checklist at http://pcihipaa.com/checklist/alabama

Following the review of your Risk Assessment, PCIHIPAA will demonstrate its comprehensive HIPAA compliance program, which includes a $250,000 data breach and network security policy.

There is no obligation to take the Risk Assessment, online review or to receive the free year of identity restoration protection. However, the Risk Assessment is mandatory by federal law, and not having one on file is a violation of HIPAA. Take the 2018 HIPAA Risk Assessment.

Want to know more about PCIHIPAA? Call (800) 588-0254 and mention you are a member of the Medical Association of the State of Alabama to receive a discounted rate.

PCIHIPAA is a preferred partner of the Medical Association. Learn more about PCIHIPAA.

Tags: HIPAA, pcihipaa

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Demand for Non-Physician Providers Rose to Make Up for Physician Shortage

Posted by admin on May 23, 2018

The Medical Group Management Association has released its 2018 MGMA DataDive Provider Compensation Survey revealing primary care physicians’ compensation rose by more than 10 percent over the past five years. This increase, which is nearly double that of specialty physicians’ compensation over the same period, is further evidence of the worsening primary care physician shortage in the American health care system.

A closer look at this data shows this rise in compensation is not necessarily tied to an increase in productivity. When broken down by primary care focus, family medicine physicians saw a 12 percent rise in total compensation over the past five years, while their median number of work relative value units (wRVUs) remained flat, increasing by less than one percent. Practices offered more benefits to attract and retain physicians, including higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.

“MGMA’s latest survey has put strong data behind a concerning trend we’ve seen in the American healthcare system for some time—we are experiencing a real shortage of primary care physicians,” said Dr. Halee Fischer-Wright, President and Chief Executive Officer at MGMA. “Many factors contribute to this problem, chief among them being an increasingly aging population that’s outpacing the supply of chronic care they require. And with a nearly two-fold rise in median compensation for primary care physicians over their specialist counterparts and increased additional incentives, we can now see the premium organizations are placing on primary care physicians’ skills to combat this shortage.”

Further supporting this trend, the new survey identified meaningful growth in compensation for non-physician providers over the past 10 years. Nurse practitioners saw the largest increase over this period with almost 30 percent growth in total compensation. Primary care physician assistants saw the second-largest median rise in total compensation with a 25 percent increase.

“In many communities that we visit, nurse practitioners and other advanced practice providers provide immediate care and same day access. These providers play an important role in today’s health care system. It’s more efficient and less expensive than visiting the emergency room,” said Nick Fabrizio, Principal Consultant at MGMA.

Based on comparative data from over 136,000 providers in over 5,800 organizations, the 2018 MGMA DataDive Provider Compensation is the most comprehensive sample of any physician compensation survey in the United States. The survey represents a variety of practice types including physician-owned, hospital-owned, academic practices, as well as providers from across the nation at small and large practices.

Other highlights from the survey include:

Over the past five years, rises in median compensation varied greatly by state. In two states, median total compensation actually decreased for primary care physicians: Alabama (-9 percent) and New York (-3 percent). Many states saw much larger increases in median total compensation compared to the national rate, the top five being Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent).
Current median total compensation for primary care physicians also varies greatly by state. The District of Columbia is the lowest paying with $205,776 in median total compensation. Nevada is the highest paying state with $309,431 in median total compensation.
Over the last five years, looking beyond just nurse practitioners, overall non-physician provider compensation has increased at a rate of 8 percent. Looking at the changes over the past 10 years, that rate has doubled to 17 percent. As non-physician providers have increasingly become patients’ primary care providers over the past 10 years, combined with a subsequent shortage of non-physician providers, compensation rates continue to grow for nurse practitioners and primary care physician assistants.
The difference in compensation between the highest-paid state compared to the lowest ranges between $100,000 and almost $270,000 for physicians depending on specialties, and $65,000 for non-physician providers.

The 2018 MGMA DataDive Provider Compensation is the most trusted compensation survey in the U.S., undergoing a rigorous evaluation and inspection. Learn more at www.mgma.com/data.

Tags: care, nurse, physician, practitioner, primary, provider

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MOC Update: Two Certification Programs Transition from Pilot to Permanent

Posted by admin on May 23, 2018

Last year, the Medical Association worked to bring together physicians, medical organizations, state medical societies, hospitals, health systems, patients and the American Board of Medical Specialties to investigate the future of board certification. The first in-person meeting in March produced testimony on continuing certification from stakeholders who provided their perspectives and experiences with continuing certification, the challenges they currently face, and their thoughts about opportunities about the future. Now, the pilot certification programs for two medical specialty organizations has become permanent.

In May, the American Board of Obstetrics and Gynecology and the American Board of Anesthesiology each received notification from the ABMS that their respective Maintenance of Certification pilot programs have been made permanent options for specific members of their groups who reach specific standards.

American Board of Obstetrics and Gynecology

The MOC pilot program is now a permanent option for ABOG Diplomates. If Diplomates meet the high-performance threshold determined by ABOG on the Part II: Lifelong Learning and Self-Assessment component in Years 1-6 of the MOC cycle, they can receive credit for meeting the MOC external assessment requirement. Diplomates must also continue to meet other MOC standards, including the annual MOC Professionalism and Professional Standing requirements. Upon entering Year 6, Diplomates will receive notification they qualify for the new pathway on their personal page in the ABOG physician portal if they have met all requirements. Diplomates that do not meet the eligibility requirements will continue to meet the external assessment standard by passing the MOC examination.

ABOG members can read the full statement here.

American Board of Anesthesiology, Inc.

The American Board of Anesthesiology’s MOCA Minute pilot is now a permanent component of the Maintenance of Certification in Anesthesiology™ (MOCA®) program. MOCA Minute launched in 2014 as a web-based tool that was expanded in 2016 to include most Diplomates. In 2017 those maintaining subspecialty certificates began participating as well. Diplomates answer 30 multiple-choice questions online each calendar quarter (120 per year) at their convenience. Their questions are customized based on which certificate(s) physicians are maintaining and their practice profile, which they fill out indicating the focus of the clinical practice. Upon answering questions, they learn immediately if their answers are correct and see the rationale, a critique and links to learning resources related to the questions.

ABA members can read the full statement here.

Tags: ABMS, anesthesia, anesthesiology, GYN, MOC, OB

Posted in: Education

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New Alabama Mothers Encouraged to Complete PRAMS Survey

Posted by admin on May 23, 2018

Why are some babies born healthy while others are not? The Pregnancy Risk Assessment Monitoring System (PRAMS) surveys new mothers about their pregnancy, delivery and their infant to find answers.

PRAMS is a joint research project between the Centers for Disease Control and Prevention and the Alabama Department of Public Health. Mothers who receive surveys are randomly selected from reported Alabama births. Alabama is one of 47 states currently participating in PRAMS.

“If you receive a survey booklet, please complete it,” Alabama PRAMS Data Manager Victoria Brady said. “The information collected is used in developing health care programs and policies, and the results help doctors and nurses improve health care while making better use of health resources.”

The types of questions asked include:

Attitudes and feelings about the most recent pregnancy
Content and source of prenatal care
Mother’s alcohol and tobacco use
Any physical abuse before and during pregnancy
Infant health care
Contraceptive use
Health care coverage
Mother’s socioeconomic situation
Postpartum depression
Knowledge of pregnancy-related health issues such as nutrition, the benefits of folic acid, infant safe sleep practices, oral health during pregnancy, and the risks of STDs and HIV

Answers will be used for research purposes only and grouped with those of other women. Surveys take about 20 minutes to complete, are available in English and Spanish, and can be mailed back postage-free or completed over the telephone. Mothers may not want to answer a particular question, and that is okay. There is no penalty for not answering all questions.

Mothers who complete a survey may choose from among three complimentary items—disposable diapers, an insulated cooler, or a manicure set—mailed to them in appreciation for their participation.

“Every pregnancy is different, as is every birth,” Ms. Brady said. “Your experience may have a profound effect in bringing about a successful pregnancy and delivery for another mom or even for yourself with a subsequent pregnancy. You can play an active role in improving the health and well-being of Alabama women and babies.”

Download Help Alabama SHINE Poster

Download PRAMS Fact Sheet

Tags: PRAMS

Posted in: Health

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Trump Administration Releases Drug Pricing Blueprint

Posted by admin on May 18, 2018

On May 11, The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs, along with a request for information. The Blueprint was framed as advancing four specific goals:

Reducing list prices;
Improving government’s ability to negotiate better prices;
Encouraging competition through rapid entry to market of generics and biosimilars; and
Lowering patient out-of-pocket expenses.

The Blueprint proposes a broad number of changes to prescription drug programs in several federal health care programs – such as Medicare, Medicaid and other safety net programs – as well as Food and Drug Administration policies that should impact commercial and federal health care program access to affordable prescription drugs.

While some of these proposals can be undertaken through immediate regulatory or subregulatory actions, others are still on the drawing boards at the U.S. Department of Health and Human Services and some will require congressional action to implement. The Blueprint proposes a select number of programmatic and design changes, yet the Administration is seeking feedback for a large number of lingering questions.

Initial review appears to show an increased access to lower-cost alternative generics. But closer review is needed on proposed changes to the Medicare Part D Prescription Drug Benefit Program and the Part B drug reimbursement methods to alleviate concerns the changes may limit patient access to medically necessary alternative brand or specialty treatments and result in additional administrative burdens on physicians and patients. The proposal may also eliminate the requirement that Part D plans include a minimum of two drugs proven to be effective in each therapeutic category or pharmacologic class, if available.

The Medical Association will be closely monitoring the Administration’s “American Patients First” Blueprint and will keep our members updated on any new developments as they become available.

Tags: benefit, biosimilar, blueprint, drug, FDA, generic, Medicare, medication, prescription

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What’s the Future for Physicians without Net Neutrality?

Posted by admin on May 17, 2018

Net neutrality has changed the digital landscape for millions of Americans, specifically physicians and health care professionals, but that could all change on June 11. In December, the Federal Communications Commission voted to repeal the net neutrality rules set in place by the Obama Administration, and on June 11 the repeal of net neutrality is set to take effect. Many professionals are unaware of the positive impact net neutrality has had in areas of the health care profession, such as telemedicine and technology education since it passed in 2015. Despite these technological advancements, many doctors still do not understand net neutrality, or the potential effect the repeal will have on their practice.

What is net neutrality?

Net neutrality is the concept that Internet Service Providers (ISPs) like Verizon, Comcast and Spectrum are required to handle all data equally. Meaning ISPs cannot slow down some websites and speed up others. Net neutrality operates all websites loading at equal speeds and treats all content online fairly. Also, it protects the consumer from paying more money for slower internet speeds. Net neutrality keeps everyone on a level playing field with everyone having the same rights to the equally fast internet, and all websites are available at the same speed and quality.

Life without net neutrality

Without net neutrality, non-profit and educational websites and databases run the risk of being de-prioritized for commercial websites, meaning the importance of educational materials and research is left up to the internet service providers. Allowing ISPs the ability to decide the importance of internet content leaves the potential for the medical and academic community to suffer. Additionally, we can expect slower internet speeds affecting the ability to live-stream, upload and download promptly. Overall, a divide will be created between those who can afford faster internet service and those who are stuck with the slower bandwidth.

What does this mean for physicians?

For physicians and health care professionals, the repeal of net neutrality could be detrimental. First, professionals run the risk of paying significantly more for high-speed internet capable of downloading, uploading, sending and receiving digital medical records. Also, all the advancements made in telemedicine recently could become stagnant. Despite the recent advancements, the future of telemedicine remains uncertain because even if the doctor can afford the high-speed internet to treat patients, many patients may not be able to afford the high-speed internet capable of live-streaming with their doctor.

Likewise, the education of doctors will be impacted significantly. For medical students, there is potential for an increase in tuition since it will cost more for high-speed internet capable of downloading and uploading medical books and research vital to their education. For doctors, it will become harder to stay up-to-date on the most recent research and studies in their field. Educational and non-profit websites will be overshadowed by commercial websites paying ISPs, making it harder to access scholarly research. Finally, the competition created between commercial websites and educational and non-profit websites will hinder and slow-down research. Overall, net neutrality has created a level playing field on the World Wide Web. It has made possible technological advancements that empower physicians with the education and tools they need to best care for their patients.

How can you make a difference?

On Wednesday, May 17, 2018, the Senate voted to reinstate the net neutrality rules repealed in December. The legislation is currently in the House where it is given little hope of advancing. Contact your district’s representative and express your concerns over the end of net neutrality and the effects it will have on physicians and healthcare professionals.

Tags: internet, legislation, neutral, speed

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AMASA Scholarships Help Students Achieve a Dream

Posted by admin on May 17, 2018

Pictured from left in the photo are Michael Brisson, Masheika James, Stephanie Arana and James Coley.

The winners of the 2018 AMASA Medical Student Scholarships have been announced. The AMASA Medical Student Scholarship Fund was established in 2012 by the Alliance to the Medical Association of the State of Alabama in partnership with the Medical Foundation of Alabama to assist rising senior medical students with the financial responsibilities that inevitably accompany their senior year of medical school. Through fundraising events and memorial contributions, AMASA is able to present multiple awards ranging from $1,000 to $10,000 at the annual meeting of the Medical Foundation of Alabama in April of each year.

It is with great pride that we awarded the following four candidates the 2018 AMASA Medical Student Scholarships, and we wish them all the best with the hope this monetary award helps them accomplish their goals:

Stephanie Arana, Alabama College of Osteopathic Medicine

Stephanie, a native of Madison, is a child of first-generation immigrants. At a young age, her mother instilled in her the value of education, hard work, and striving for excellence, which led her on her path to the medical field. After completing her first year of medical school, Stephanie realized she was lacking in essential areas needed for the field of medicine: understanding others, empathetic nature, and passion. She used this realization to motivate her to serve the underserved population of Chicago to regain the concepts she was lacking. Participating in this opportunity helped Stephanie to learn how to balance her world of endless knowledge and her world of sacrifice, dedication and humility.

Stephanie is currently a student at the Alabama College of Osteopathic Medicine where she has served in many capacities, including ACOM Ambassador, National Medical Scholarships Peer Mentor, and ACOM Student D.O. of the Year. She plans to use the scholarship assistance to obtain audition rotations throughout the State of Alabama in hopes of solidifying a residency opportunity in state.

Michael Brisson, Edward Via College of Osteopathic Medicine

Michael, a native of Enterprise, sees the unique relationship that primary care medicine has with the United States military and the osteopathic field. He has had the opportunity to work closely with primary care physicians during his career as an Aeromedical Evacuation Officer in the Alabama Army National Guard. The level of expertise and compassion these physicians bring to the National Guard and the rural communities they serve inspired Michael to pursue a career in primary care medicine.

Michael is currently at the Edward Via College of Osteopathic Medicine in Auburn, and he resides in Enterprise with his wife and two children. Michael believes his medical school is preparing him to fill the critical need for physicians practicing in rural areas, and he plans to use his experiences as an active duty and National Guard medical officer, combat MEDEVAC pilot, and seasoned critical care paramedic to commit himself to the field of primary care in rural Alabama.

James Coley, Edward Via College of Osteopathic Medicine

James, a native of Montgomery, realized his dream of pursuing medicine in high school. His dream became a reality after observing, shadowing and learning from Oncologists and other team members at the Montgomery Cancer Center. During his time pursuing his undergraduate degree at the University of South Alabama, James participated in several leadership positions and programs focused on health and the medical field. Not only did his time at USA reinforce his desire to pursue a medical career, it also allowed him the opportunity to meet his wife.

James is currently a student at VCOM in Auburn. J. Danielle McCullough, Assistant Professor at VCOM, said of him, “While keenly invested in his own career development, James also continues to concentrate his efforts and prioritize the needs of others, especially those less fortunate that he…his altruistic efforts demonstrate his commitment to the VCOM mission of preparing community-focused physicians to meet the needs of underserved populations.”

Masheika James, University of South Alabama College of Medicine

Masheika, a native of Birmingham, defied the odds of her childhood by pursuing a second doctorate degree after graduating from a poverty-stricken high school in Birmingham with limited role models. After becoming a parent at the age of 18 and raising her daughter as a single mother, Masheika became even more motivated to prepare a better future for her daughter and become a professor in pediatrics.

A colleague from the University of Alabama at Birmingham said of Masheika, “She is very resilient and has overcome many challenges and adverse circumstances in her personal life and early educational background that would have crumbled the resolve of many other individuals.”

Masheika is currently at the University of South Alabama College of Medicine in Mobile. Throughout her college experiences, Masheika encountered very few minority professors, let alone women, in the sciences. This revelation urged her to pursue a career in higher education to serve as a role model for future minority high school students as well as minority college undergraduates.

Donations to the Scholarship Program can be sent to AMASA Treasurer Mary Beth Lloyd, 5949 Crestwood Circle, Birmingham, AL 35212. Donations may now be made directly to the AMASA Scholarship Fund from retirement accounts.

Tags: AMASA, scholarship, student

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