March 2019 - Medical Association of the State of Alabama

Archive for March, 2019

Think Your Practice Management Software Makes You HIPAA Compliant?

Posted by admin on March 29, 2019

Complying with HIPAA security standards is a complex matter that demands a comprehensive solution. As a busy healthcare provider, it’s easy and convenient to trust that your practice management software satisfies the necessary HIPAA requirements to keep your electronic medical records safe. But the truth is, in most cases, it doesn’t.

A False Sense of Security

It is a common misnomer that electronic health record (EHR) systems make your practice HIPAA compliant. Companies claim they provide tools that support compliance for technical safeguards. A good thing, but technical safeguards are only one component needed to protect electronic public health information. The HIPAA Security Rule requires two other components: administrative safeguards and physical safeguards. Administrative safeguards include policies and procedures that HIPAA requires and critically important business associate agreements. Physical safeguards protect your data from breaches and unauthorized access. The platform you use to manage your practice might tout that their cloud-based system provides encryption and protection from ransomware. Great, but the question is: do they have all of the crucial aspects needed for HIPAA compliance? Read this next sentence twice. Using practice management software that purports to be HIPAA compliant does not make your practice compliant.

Unfortunately, when it comes to HIPAA compliance, a false sense of security can be dangerous. The violation fines for not following the guidelines enforced by the Department of Health and Human Services’ Office for Civil Rights are costly and can irreparably damage your practice’s reputation. In 2018 alone, HIPAA fines topped $28 million. By not properly protecting your electronic health records, you increase the likelihood of a cyberattack. Being hacked might strike you as a random, unlikely occurrence, but statistics tell a different story. According to a 2016 Lloyd’s Report, 92% of businesses experienced a data breach within a five-year period.

CALCULATE YOUR HIPAA RISK

A Complete HIPAA Solution

PCIHIPAA is an industry leader in HIPAA compliance and data breach protection. We alleviate the angst and uncertainties associated with HIPAA compliancy with a powerful tool called OfficeSafe. Here’s how our software solution fully protects HIPAA electronic medical records:

Comprehensive Risk Assessment – A risk assessment is an annual audit required under the HIPAA Security Rule. Our audit of your practice’s protected health information produces a 22-page report, identifying the potential risks and vulnerabilities to your practice.
Easy Creation of Policies and Procedures – HIPAA regulatory standards mandate that covered entities and business associates develop policies and procedures. OfficeSafe makes regularly updating your policies and procedures easy, ensuring that your staff is informed on important issues such as governing access to electronic public health information and identifying malicious software attacks.
Online Employee Training – Improperly trained employees can lead to reckless handling of electronic public health information and costly HIPAA fines. We take this time-consuming task off of your plate and ensure that your staff understands exactly what is required by HIPAA law.
Crucial Business Associate Agreements – Every vendor and individual you share protected health information with must have a business associate agreement. OfficeSafe makes creating and securely executing these agreements simple and convenient.
$500,000 Cyber Insurance Coverage – Our guaranteed expense reimbursement policy for HIPAA violations covers a range of first and third party exposures, including both physical and non-physical risks. In the event of a HIPAA fine, data breach, or cyberattack, we’ll protect your practice from lost revenue and prevent an interruption to your business.
Email Encryption and Encrypted Cloud-Based Data Backup – At PCIHIPAA, keeping your data secure is our top priority. Our data backup solution is HIPAA compliant with 256-bit encryption and SQL database restoration capabilities. It enables you to distribute confidential protected health information without worry of ransomware or an unexpected incident.
Incident Response Management – Do you have a plan in place in the event of a hurricane, fire, or ransomware attack? Proper preparation—including a data backup plan, a data restoration plan, and an emergency mode operations plan—is a necessity. With OfficeSafe, once you report an incident we’ll work with your IT provider to mitigate the damage and get your business back on track.
PCI Certification – PCI is part of our company name for a good reason. As part of our compliance program, we help you complete the Payment Card Industry (PCI) requirements. Our PCI Compliance program also includes quarterly scans of your network.

The dark web is getting smarter. The risk of not fully and properly securing and maintain your patient’s medical records is a mistake your business can’t afford to make. The good news is peace of mind for your practice and your patients is a click away. Take a complimentary HIPAA Assessment right now, and be on your way toward total HIPAA compliance.

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Tags: assessment, HIPAA, officesafe, pcihipaa, risk, solution

Posted in: HIPAA

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Alabama Medicaid Cumulative MME Edit Coming Early 2019

Posted by admin on March 29, 2019

UPDATE April 26, 2019: Effective May 1, 2019 the Alabama Medicaid Agency will begin implementing cumulative daily MME edits for opioid experienced recipients.

Higher doses of opioids are associated with higher risk of overdose and death – even relatively low dosages (20-50 MME per day) may increase risk.¹ Therefore, Alabama Medicaid will limit the amount of cumulative MME allowed per day on opioid claims. The edit will begin at 250 cumulative MME per day and will gradually decrease over time. The final cumulative MME target is scheduled to be 90 MME per day. This edit is different, and in addition to, the short-acting opioid naïve edit implemented on November 1, 2018.

Phase-In Period:
Beginning May 1, 2019, Alabama Medicaid will begin with a “phase-in” period for 3 months. Claims that exceed the cumulative daily MME limit of 250 MME will be denied at the pharmacy Point of Sale (POS). The dispensing pharmacist will be provided a universal prior authorization (PA) number on the rejection screen and may enter this universal PA number on the claim to allow it to be paid. Pharmacists are urged to notify the affected patient/prescriber to develop a plan to decrease the patient’s total daily MME.

Hard Edit Implementation:
Beginning August 1, 2019, opioid claims that exceed the cumulative MME edit of 250 MME/day will be denied. The universal PA will no longer be valid to bypass the 250 MME edit. Pharmacy override requests for quantities exceeding the MME limit may be submitted to Health Information Designs (HID) and will be reviewed for medical necessity. See link below for override form.

Edit Details:

The universal PA number to override the 250 MME edit will be 0009996321
The universal PA number will be provided on each cumulative MME rejection screen for the pharmacist convenience
Additional edits such as therapeutic duplication, maximum quantity limitations, early refill, non-preferred edits will still apply
Claims prescribed by oncologists will bypass the edit
Long term care and hospice recipients are excluded
Children are included in the edit
A Recipient Information Sheet for prescribers and pharmacists to provide to recipients can be found at http://www.medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME.aspx.

Anticipated Phase Down:
The Agency anticipates gradually decreasing the daily cumulative MME limit every 4 months. The first decrease to 200 MME/day will be implemented on December 1, 2019. Prior to each decrease, a new universal PA number will be assigned to override claims that exceed the new threshold. Providers will be notified via an ALERT prior to each decrease. Again, pharmacists are urged to notify the affected patient/prescriber to develop a plan to decrease the patient’s total daily MME.

Examples of MME calculations/day include:

10 tablets per day of hydrocodone/acetaminophen 5/325 = 50 MME/day
6 tablets per day of hydrocodone/acetaminophen 7.5/325 = 45 MME/day
5 tablets per day of hydrocodone/acetaminophen 10/325 = 50 MME/day
2 tablets per day of oxycodone 15 mg = 45 MME/day
3 tablets per day of oxycodone 10 mg = 45 MME/day
10 tablets per day of tramadol 50 mg = 50 MME/day
1 patch per 3 days of fentanyl 25mcg/hr = 60 MME/day

A link with more information regarding MME calculations is https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf.

IMPORTANT: Only if the override is denied, then the excess quantity above the maximum unit limit is deemed a non-covered service, and the recipient can be charged as a cash recipient for that amount in excess of the limit. A prescriber must not write separate prescriptions, one to be paid by Medicaid and one to be paid as cash, to circumvent the override process. FAILURE TO ABIDE BY MEDICAID POLICY MAY RESULT IN RECOUPMENTS AND/OR ADMINISTRATIVE SANCTIONS. Source: Provider Billing Manual 27.2.3

¹ https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Override Requests:
Once the hard edit is implemented, the MME Override Request Form will be used by the prescriber when requesting an override. The form will be found at: http://medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Forms.aspx.

Any policy questions concerning this provider ALERT should be directed to the Pharmacy Program at (334) 242-5050.

The Agency has developed a consumer-friendly handout to explain the new edit to recipients. A copy is attached to this email and may also be found at http://www.medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Services/9.4.13_Opioid_Edit_Recipient_Handout.pdf

ORIGINAL ARTICLE April 2019: In addition to the opioid naïve 5 and 7-day limits, the Alabama Medicaid Agency is working toward implementing cumulative Morphine Milligram Equivalent (MME) edits in early 2019.

Higher doses of opioids are associated with a higher risk of overdose and death; even relatively low dosages (20-50 MME per day) may increase risk.1 Alabama has led the nation for the past six years in the opioid prescribing rate per 100 population (121 in 2016; 107.2 in 2017) and had nearly three times more opioid prescriptions per 100 population than New York.2

The Alabama Medicaid Agency previously executed many programs to address opioid use such as monthly maximum unit limits, therapeutic duplication edits, Drug Utilization Review (DUR) letters, academic detailing report cards and face to face visits, prior authorization, and other educational efforts. Most recently, Medicaid implemented limits for opioid naïve patients to limit first-time use to five days for children and seven days for adults, limiting daily use to 50 MME. Overrides are available for medical necessity.

In an effort to continue combating the opioid crisis, beginning May 1, 2019*, Alabama Medicaid will limit the amount of cumulative MMEs allowed per day on claims for opioid experienced recipients. The edit will begin at 250 cumulative MME per day and will gradually decrease over time. The final MME target is 90 MME per day.

Claims for opioids that exceed the maximum daily cumulative MME limit will be denied. Claims prescribed by oncologists will be excluded from the edit. Long term care and hospice patients will also be excluded; however, children will be included. Overrides for quantities exceeding the MME limit for medical necessity may be submitted to Health Information Designs (HID). Information regarding override requirements and MME examples will be made available on the Alabama Medicaid Agency website closer to the implementation of the new limitations.

The Agency will implement a robust educational program to include academic detailing visits to the prescribers and pharmacies of the first round of affected patients, extensive training, and notifications to the impacted providers through a provider ALERT closer to implementation. Please check the Alabama Medicaid Pharmacy webpage for additional information: http://www.medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME.aspx

*At the time of article submission, the implementation date is May 1, 2019, for a ‘phase in’ for 250MME/day. During the phase-in period, a universal prior authorization number will be provided on the pharmacy claim rejection, with an explanation to notify the affected patient/prescriber. Hard stops/edits will begin after the phase-in period.

“Calculating Total Daily Dose of Opioids for Safer Dosage”. CDC. https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf. Accessed 2/1/2019.
“Understanding the Epidemic”. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 2/1/2019.

Tags: mme, opioid

Posted in: Medicaid

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What Does 2019 Hold for Telehealth and Related Services?

Posted by admin on March 29, 2019

Historically, payment for Medicare “telehealth services” has been constrained by a number of geographic and other limitations, but there are several new reimbursement opportunities for physicians and other health care practitioners beginning this year. Here we explore the expansion of traditional Medicare “telehealth services” under the Bipartisan Budget Act of 2018 (“BBA 2018”)1 and the SUPPORT for Patients and Communities Act (the “SUPPORT Act”)2, certain newly recognized and separately payable communication technology-based services (which look like telemedicine3 but do not constitute Medicare “telehealth services”), and how Blue Cross and Blue Shield of Alabama (“BCBSAL”) telemedicine policies stack up against Medicare’s new policies for 2019.

Medicare “Telehealth Service” Limitations; Expansion Under BBA 2018 and the SUPPORT Act

Medicare recognizes payment for certain “telehealth services” provided through interactive audio and video communications in certain situations where the service would otherwise ordinarily be furnished in-person (e.g., an evaluation and management or “E/M” visit). Medicare “telehealth services” are limited to beneficiaries located in rural areas, must be performed from certain originating sites (physician/practitioner office, hospital, skilled nursing facility, rural health clinic, etc.4), and may only be performed by certain practitioners (physicians, physician assistants, nurse practitioners, clinical psychologists, etc.5). The pervasiveness of conditions such as acute stroke and substance use disorders and the suitability of treating such conditions through telemedicine recently led to a statutory reduction of many restrictions on the provision of Medicare “telehealth services” in an effort to better control these health conditions at lower costs. Several of these changes resulted from the BBA 2018 and the SUPPORT Act.

The BBA 2018 expanded the availability of reimbursement for telehealth services, especially for end-stage renal disease (“ESRD”) and stroke patients. Specifically, ESRD patients may now receive monthly ESRD-related clinical assessments via telehealth, provided they receive a face-to-face (non-telehealth) visit/assessment at least monthly during the initial three months of home dialysis treatment and at least once every three months thereafter. The BBA 2018 also includes non-hospital-related renal dialysis facilities, and the patient’s home as eligible originating sites and removes the geographic location (i.e., rural area) requirements for monthly ESRD-related clinical assessments provided via telehealth services at the foregoing originating sites.

Medicare “telehealth services” provided “for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke” (“acute stroke telehealth services”) are now subject to special (and less restrictive) rules implemented pursuant to the BBA 2018. CMS added mobile stroke units to the list of eligible originating sites for providing acute stroke telehealth services and removed geographic limitation (i.e., rural area) for acute stroke telehealth services.6 Similarly, under the SUPPORT Act, the geographic limitation (i.e., rural area) is removed and the patient’s home is added as an eligible originating site for purposes of treating individuals diagnosed with a substance use disorder or a co-occurring mental health disorder.

For any of the foregoing Medicare “telehealth services,” it should be noted that no facility fee will be paid where the patient’s home is the originating site. In addition, practitioners will be limited to providing services, which are on the approved list of Medicare “telehealth services,” and must decide whether it is clinically appropriate to treat the underlying condition via “telehealth services.” However, the Centers for Medicare and Medicaid Services (“CMS”) has also expanded opportunities for some services that look like telemedicine but are not classified as Medicare “telehealth services.”

New Communication Technology-Based Services

In the 2019 Physician Fee Schedule Final Rule7, CMS defined a new set of separately reimbursable communication technology-based services, including virtual check-ins, remote evaluation of pre-recorded patient information, and interprofessional internet consultations. CMS does not consider these services to be Medicare “telehealth services” because the services typically would not otherwise be performed at an in-person visit, and therefore, they are not subject to the same geographic, provider-type, and originating site requirements for Medicare “telehealth services.”

Virtual Check-Ins. Until this year, CMS considered any routine non-face-to-face communication that occurs before or after an in-person visit to be bundled into the payment for the visit itself. Starting in 2019, CMS will separately reimburse for “virtual check-ins” (new HCPCS code G2012) used to determine whether an office visit or other service is warranted for an established patient.8 A virtual check-in should include five to 10 minutes of medical discussion and must be provided by a physician or other practitioner who could bill for an E/M service.9 The virtual check-in may be provided by audio-only telephone encounters10, but there must be real-time interaction with the patient. CMS emphasized the importance of obtaining patient consent for virtual check-in services and noted patients are expected to initiate virtual check-ins. Patient consent may be verbal but must be documented in the medical record for each billed service. Practitioners must document the virtual check-in is medically reasonable and necessary, but otherwise, CMS is not imposing any service-specific documentation requirements for the virtual check-in service. CMS is not limiting the frequency with which practitioners may provide and bill for virtual check-in services. However, virtual check-ins that result from a related E/M service in the previous seven days or that lead to an E/M service by the same practitioner or other qualified health care professional in the next 24 hours will be bundled in with the related service instead of being reimbursed separately.

Remote Evaluation of Pre-Recorded Patient Information. CMS has also provided separate reimbursement, starting in 2019, when a physician uses pre-recorded video or images11 captured by a patient to evaluate an established patient’s condition and determine whether an office visit or other service is necessary (new HCPCS code G2010). It is expected the practitioner will review the video or images and follow up with the patient within 24 business hours (verbally via phone call or audio/video communication, or through secure text messaging, email, or secure patient portal). However, if the video or images are of insufficient quality for the practitioner to assess whether an office visit or service is necessary, the practitioner could not bill for the service. Similar to the virtual check-in, if the remote evaluation results from a related service in the previous seven days or leads to an E/M service in the next 24 hours, it will be considered bundled with the related service and will not be reimbursed separately.

Interprofessional Internet Consultation. CMS will also begin to reimburse for interprofessional internet consultations, represented by six newly-recognized CPT codes (99446, 99447, 99448, 99449, 99551 and 99452). The new consult codes recognize reimbursement for both the work of the treating/requesting physician in initiating the consult and the services of the consulting physician in providing consultative services and a verbal and/or written report (generally corresponding to the length of medical consultative discussion). The patient must first give verbal consent to the consultative services, which must include a discussion of applicable cost-sharing requirements, and the consent must be documented in the medical record. Allowing these interprofessional internet consultations should streamline patient care because a patient can receive consultative services without having to set up a separate appointment with the consulting physician, and the reimbursement also recognizes the services provided by both treating/referring physician and the consulting physician.

BCBSAL Telemedicine Policies

The telemedicine policies for BCBSAL are less restrictive than Medicare’s in some respects, but the policies have not been expanded to include the new types of communication technology-based services for which Medicare will provide reimbursement beginning this year. For instance, BCBSAL does not appear to limit telemedicine services to particular originating sites located in rural areas. However, it does require telemedicine services be provided via “two-way, real-time (synchronous), interactive, secured and HIPAA compliant, electronic audio and video telecommunications systems,” and the patient’s home is only approved as an originating site for behavioral health services.12 Practitioners must also obtain patient consent, including all information that pertains to routine office visits and a description of the potential risks, consequences, and benefits of telemedicine.

BCBSAL specifically notes a number of services not considered appropriate for telemedicine, including telephone conversations, video cell phone interactions, provider-to-provider consultations when the patient is not present, appointment scheduling, brief follow-up of a medical procedure to
confirm the stability of the patient’s condition, brief discussion to confirm the stability of the patient’s chronic condition, services that would not be charged during a regular office visit, requests for a referral, and information exchange leading to a subsequent face-to-face visit within 24 hours. As evidenced by this list (which is illustrative rather than exhaustive), BCBSAL arguably would not reimburse for the new communication technology-based services for which Medicare will now make payment, such as virtual check-in, remote evaluation of pre-recorded patient information, and interprofessional internet consult. As has been the case in the past, BCBSAL may follow Medicare reimbursement policies on these communication technology-based services – or something relatively similar – upon a study of how they are implemented in the Medicare program. However, for now, practitioners must continue to maintain and follow two separate policies (at least for billing and reimbursement purposes) for telemedicine services provided to Medicare and BCBSAL beneficiaries.

Conclusion

There are a number of new opportunities to provide patient care services through telemedicine and related means that will be reimbursable under the Medicare program. However, practitioners should note this new menu of services will be scrutinized by CMS in the coming years to ensure services are reasonable and necessary and are not being overutilized. It should also be noted other payors (e.g., BCBSAL) will not necessarily adopt similar payment policies. Practitioners should have policies and procedures to ensure proper use of these services for each applicable payor. If you have additional questions about the scope of telemedicine services reimbursable in your practice, please contact your counsel for assistance.

Article contributed by Christopher L. Richard with Gilpin Givhan, P.C. Gilpin Givhan, P.C., is an official partner with the Medical Association.

References

Pub. L. 115-123 (Feb. 9, 2018).
Pub. L. 115-271 (Oct. 24, 2018).
It is important to note the difference between the general conception of telemedicine and the narrower subset of telemedicine services which constitute Medicare “telehealth services” and are subject to more extensive restrictions.
The full list of eligible originating sites includes: physician/practitioner office, critical access hospital (“CAH”), rural health clinic, Federally qualified health center, hospital, hospital-based or CAH-based renal dialysis center, skilled nursing facility, and community mental health center. Social Security Act, Section 1834(m)(4)(C)(ii) (42 U.S.C. § 1395m(m)(4)(C)(ii)).
The full list of practitioners who may provide Medicare “telehealth services” includes: physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, clinical social workers, clinical psychologists, and registered dieticians or nutrition professionals. Social Security Act, Section 1834(m) (42 U.S.C. § 1395m(m)).
CMS will require practitioners to bill a new modifier to indicate that the services provided are acute stroke telehealth services.
83 Fed. Reg. 59452 (Nov. 23, 2018), available at https://www.govinfo.gov/content/pkg/FR-2018-11-23/pdf/2018-24170.pdf.
CMS determined it would not allow payment for a virtual check-in for a new patient. An established patient is one who has received professional services from the health care practitioner or another health care practitioner in the exact same specialty or subspecialty who belongs to the same group practice, within the past three years.
CMS specifically noted a virtual check-in could not be billed if performed by clinical or billing staff only (and did not involve a physician or other health care practitioner who can bill for E/M services).
Communications technology involving both audio and video components can be used as well, but the payment rate will not vary based on the additional video component.
CMS specifically excluded evaluation of other types of patient-generated information, such as information from heart rate monitors or other devices, because these services could potentially be reported with CPT codes describing remote patient monitoring.
BlueCross BlueShield of Alabama, Telemedicine Policy (last updated Nov. 2018).

Tags: telehealth, telemedicine

Posted in: Legal Watch

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MOC UPDATE: A Progress Report

Posted by admin on March 22, 2019

March 22, 2019: The Medical Association is continuing to work with various stakeholders to make improvements in the MOC process, and we would like to offer a progress report from the American Board of Medical Specialties and its Continuing Board Certification: Vision for the Future Commission. The final report is out, and member boards are beginning to implement Commission recommendations.

Perspectives on the Vision Commission Process

Sometimes You Just Don’t Know by Donald Palmisano describes his experience as a member of the Commission and thoughts on the Commission’s final report.

ABMS Member Board innovative assessments gain momentum in 2019

ABMS Member Boards’ Innovative Assessments Gain Momentum in 2019 describes progress by several ABMS Member Boards towards transitioning from traditional exams to longitudinal assessment programs.

Specific ABMS Member Boards mentioned include those representing anesthesiology, family medicine, ophthalmology, orthopaedic surgery, ob/gyn, pediatrics, psychiatry and neurology, radiology, and the seven boards participating in ABMS’ CertLink program – colon and rectal surgery, dermatology, medical genetics and genomics, nuclear medicine, otolaryngology-head and neck surgery, pathology, and physical medicine and rehabilitation.

For those of you wondering, “what’s longitudinal assessment?” – Longitudinal assessment approaches involve shorter assessments of specific content repeatedly over a period of time and often online, combining principles of adult learning with modern technology to promote learning, retention, and transfer of information. (For example, the ABA MOCA Minute includes 30 questions per calendar quarter, delivered through email, portal, or app.) Through this process, concepts and information are reinforced so that knowledge is retained and accumulated gradually. Overall, these programs allow physicians to assess their knowledge, fill knowledge gaps, and demonstrate their proficiency. They may offer both time and cost savings to board-certified physicians by reducing or eliminating the need for study courses, travel to exam centers, and time away from practice.

Tags: MOC

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National Health Survey Underway in Marengo County

Posted by admin on March 21, 2019

The National Health and Nutrition Examination Survey (NHANES), the most comprehensive survey of the health and nutritional status of the U.S. population, is underway in Marengo County through April 20. This is an “invitation-only opportunity” in which randomly selected participants will receive a free and comprehensive health and nutrition evaluation. Respondents will be compensated for their time, travel and other expenses of up to $125.

“We encourage every eligible resident who has been selected for the survey to agree to participate,” said Alabama Department of Public Health’s Southwestern District Administrator Chad Kent. “All information collected is confidential, as required by law. If you are chosen, you will have been contacted by letter.”

A team of health professionals, nutritionists and health technicians ask respondents to first participate in a health interview in the respondent’s home followed by a health exam in the NHANES mobile examination center. Professionals will have a photo ID badge from the Centers for Disease Control and Prevention. While no medical care is provided directly, a report on physical findings is given to each participant along with an explanation from survey medical staff. All information collected in the survey is kept confidential and privacy is protected.

“NHANES serves as the nation’s ‘health check-up,’ by going into communities to collect health information throughout the country. The survey provides a wealth of important data about many of the major health and nutritional issues affecting the country,” according to the National Center for Health Statistics (NCHS) Director Jennifer H. Madans.

All counties in the United States have a chance to be selected for the NHANES, and Marengo County was one of the 15 counties chosen to be part of this initiative. NHANES provides important data on public health problems from a national perspective. Each year, 5,000 residents across the nation have the chance to participate in the latest NHANES, conducted by the NCHS, part of the Centers for Disease Control and Prevention.

“For the most part, people are very receptive,” George Dixon, study manager, said. “We may ask for some demographic information to determine if any people in the household are selected. We assist participants with transportation and even babysitting if needed.”

NHANES has had a prominent role in improving the health of all people living in the U.S. for the past 55 years. Public health officials, legislators and physicians use the information gathered by NHANES to develop sound health policies, direct and design health programs and services, and expand the health knowledge for the nation. NHANES findings provide critical health-related information on a number of issues such as obesity, diabetes and cardiovascular disease. In addition, NHANES data are used to produce national references and are used to create standardized growth charts for pediatricians across the country.

The comprehensive data collected by NHANES impact the everyday lives of the population of all ages, on everything from air quality to the vaccinations given by doctors, to the low fat and “light” foods now routinely offered in grocery stores.

Tags: health, marengo, nation, survey

Posted in: Health

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STUDY: HPV-Related Cancer Rates Affect Vaccine Uptake in Alabama

Posted by admin on March 21, 2019

MOBILE (March 19, 2019) — USA Health researchers studying HPV vaccination rates in Alabama have made a surprising discovery: Counties with higher rates of HPV-related cancers also showed higher HPV vaccination rates, according to research presented recently at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.

“It was exactly the opposite of what we expected,” said Dr. Jennifer Young Pierce, who heads Cancer Control and Prevention at USA Health Mitchell Cancer Institute. “We found that the higher the rate of cancer in the county, the higher the rate of vaccination.”

The research was one of 12 studies accepted for oral or poster presentations at the national meeting.

The study sought to explore the reasons why vaccination rates for human papillomavirus (HPV) vary so widely among counties in Alabama, from 33 percent to 66 percent. Researchers expected to find lower vaccination rates in rural counties with fewer physicians and in counties with low incomes, which would have been consistent with national reports from the U.S. Centers for Disease Control and Prevention.

However, the data showed little difference in HPV vaccine uptake between urban and rural counties, and between affluent and poor ones. The seven counties with the highest HPV vaccination rates were both rural and low income, Pierce said. “The main takeaway is that perception of high cancer risk overcomes traditional disparities that can affect HPV vaccine uptake.”

Meanwhile, the study also found higher HPV vaccination rates among residents who receive government-funded health care and the highest HPV rates in some counties that have no pediatricians.

The HPV vaccine protects against a variety of cancers in men and women, including cervical, vulvar, vaginal, penile, anal and head and neck. The vaccine is recommended for boys and girls ages 11-12, with catch-up to age 26.

About Mitchell Cancer Institute

As the region’s only academic cancer center, USA Health Mitchell Cancer Institute combines NIH-funded scientific research with comprehensive cancer care serving communities across southern Alabama, southeast Mississippi and portions of northwest Florida. With three locations, more than 50 clinical trials, and five support groups, the Mitchell Cancer Institute guides patients and their families from the moment of diagnosis through survivorship.

Tags: HPV, vaccine

Posted in: Education

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Caring for Alabama: Celebrating the Fourth Annual Doctors’ Day in Alabama

Posted by admin on March 21, 2019

MONTGOMERY, Ala. – On Wednesday, March 27, Gov. Kay Ivey signed a proclamation declaring March 30, 2019, the Fourth Annual Doctors’ Day in Alabama. Doctors’ Day in Alabama formally recognizes Alabama’s nearly 17,000 licensed physicians serving millions of residents through private practice, in hospitals, in research, and in other health care facilities while performing their roles as military service members, parents, volunteers, and community activists.

Doctors’ Day in Alabama, a project sponsored by the Medical Association of the State of Alabama, the Alabama Department of Public Health and the Alabama Hospital Association will be held in conjunction with the 86th Anniversary of National Doctors’ Day to celebrate physicians of all specialties serving in our communities.

“The practice of medicine is a special calling,” said Mark Jackson, executive director of the Medical Association. “Physicians study and train for many years, work long and unpredictable hours, and cope with often conflicting demands of work and family life to serve the needs of their communities. They often lead patients and families through some of life’s most challenging moments,” Jackson said. “While they deserve appreciation every day, we wanted to have one day to show deep gratitude to our physicians for the work they do each day to make the health of our residents and our state better.”

While first contributing to the overall health of their patients through healing, Alabama’s physicians also contribute to the overall health of the state through economic factors. According to a study by the American Medical Association, each Alabama physician supports an average of 11.7 jobs – contributing to 101,770 jobs statewide – for an average of $1.9 million in positive economic input and a total of $16.7 billion in economic impact statewide.

“Alabama’s hospitals are honored to partner with dedicated physicians who provide strong and essential leadership in hospitals to assure patients receive high-quality care,” said Donald E. Williamson, M.D., president of the Alabama Hospital Association. “These men and women are committed to practicing the latest evidence-based care to deliver the best possible outcomes for patients. We are delighted to celebrate them on Doctor’s Day.”

For more information about Doctors’ Day in Alabama, contact Lori M. Quiller, APR, at (334) 538-0235, (334) 954-2580 or lquiller@alamedical.org.

Tags: doctor's day

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What Happens When Physicians Become Patients?

Posted by admin on March 21, 2019

Physicians are not supposed to get sick. We want to believe they are steely-eyed superheroes who never get a cold, never get broken bones, never need the same treatment for ailments as their patients. Physicians are unwavering in their dedication to their patients and the art of medicine…sometimes sacrificing the one thing they have that can keep them moving along in the profession. Their health. So, what happens when physicians become patients?

According to a study by The Mayo Foundation for Medical Education and Research and published by Pew Charitable Trusts, more than one in 10 physicians become addicted to drugs or alcohol, a slightly higher rate than in the general population. Burnout, a recognized problem in the medical professions, and the easy availability of drugs likely make addiction more common among doctors.

Dr. Sandra Frazier

“Physicians are not above the human condition. We are susceptible to the same illnesses as our patients. Yet we are often reluctant to ask for help,” said Sandra Frazier, M.D., medical director of the Alabama Physician Health Program. “The APHP is designed to encourage physicians to get the help they need without fear of disciplinary action against their medical licenses. By keeping our physicians well, we keep our patients safe.”

What is the Alabama Physician Health Program?

Nationwide, physician health programs are designed to make it easier for those in the medical profession to seek help. Here in Alabama, the Alabama Physician Health Program, or APHP, is the program physicians, physician assistants, residents and medical students can turn to for confidential help as a first-line resource for potentially impairing conditions or illnesses.

In 1988 the Alabama Legislature passed legislation to create the Impaired Physicians Committee through the State Board of Medical Examiners to promote the early identification, intervention, treatment and rehabilitation of physicians who may be impaired by “inebriation, excessive use of drugs, narcotics, alcohol, chemicals or other substances or as a result of any physical or mental condition.”

Times have changed, and APHP and the Alabama Physician Wellness Committee have evolved. In 1991 APHP hired its first medical director and created more structure and balance to the program. The mission became one of advocating on behalf of the physicians, which is what the staff of the APHP continues to do today for those under contract.

“The biggest misconception about what we do at APHP is that the physicians we work with are going to get into trouble with the Board of Medical Examiners, and we’re going to take their medical license,” said Rob Hunt, D.Min., director of APHP. “That’s simply not the case. We are a strong advocate on behalf of our physicians who come to us for help. We do not diagnose or treat physicians, but we advocate for them while they are in treatment, monitor them, let them know they are not alone during the process. And, it is a process.”

APHP provides a variety of services, such as case management for support and accountability to toxicology testing; peer monitoring; workplace monitoring; and advocacy services such as reports at the physician’s request to outside sources like hospital credentialing committees, other state PHPs, malpractice carriers, drug courts, etc. APHP also monitors specific conditions, including:

Substance use and addictive disorders
Psychiatric illness, including mood disorders, depression, anxiety, psychosis, etc.
Boundary violations, including inappropriate relationships with patients and sexual harassment
Mental/physical disorders that impair professional practice
Cognitive impairment
Disruptive behavior

For physicians to remain sober after they return to high-stress jobs with access to controlled substances, there has to be a big payoff. For physicians, the reward is huge — keeping a medical license that costs hundreds of thousands of dollars and years to obtain. APHP has a high success rate, and the staff attributes that success to a myriad of reasons but mostly to the level of monitoring and what’s at stake for a medical professional.

“Health care professionals who are monitored through Physician Health Programs have recovery rates greater than other segments of the population in part due to the accountability provided by monitoring as well as their strong desire to continue to practice medicine. We definitely have more success stories than not,” Dr. Frazier explained.

Who Needs Help?

Staff with APHP say the majority of their clients self-report to the program, often at the prompting of others, but it is not unusual for a friend, family member, or colleague to make a report on a physician. Signs a physician may be in trouble include:

Not taking care of oneself
Becoming inattentive
Behavioral changes, such as increased anger and irritability
Loss of interest in activities or becoming withdrawn
Excessive ordering of prescription drugs by mail or local pharmacies
Frequently late for work and/or meetings
Any other behavior that is out of character

Taking the First Step

APHP staff from left Robert C. Hunt, D.Min, director; Fay McDonnell, case manager; and Caro Louise Jehle, program coordinator

Physicians who contract with APHP are sent for evaluation and treatment. There are a number of APHP-approved facilities for medical professionals to receive their evaluation and treatment before their return to the program for monitoring.

“It’s important to know the APHP team does not evaluate, diagnose, or treat physicians,” Dr. Frazier explained. “Instead we refer our physicians to approved evaluators for recommendations and a treatment plan. We then try to ensure those we monitor are compliant with the recommended course of treatment.”

Referrals are confidential. Alabama law requires physicians to report any other physician who may be unable to practice medicine with skill and safety to patients by reason of illness, drugs or mental or physical condition. Reporting to the APHP fulfills this requirement.

A Personal Journey

Lee* is a recently retired surgeon who is a physician-patient of the APHP. This is his story in his own words. Lee is not his real name.

“I entered the Alabama Physicians Health Program with complete terror after a very successful 16-year career as a general surgeon in a very busy private and teaching practice. Though I ‘self-reported’ to the APHP, it was under considerable duress in that I knew at the time if I did not turn myself in I would soon be turned in by another person. There is always some come-apart that tips the balance. The call was incredibly hard to make, but I was greeted by a completely calm, supportive, fellow physician, and I could feel right away I was doing the best thing for myself. I was offered a variety of options but would be required to pick an approved facility for a three-to-five day evaluation. I selected Bradford and opted to remain for the recommended three-month in-patient treatment.

“The hallmark of addiction is denial, a defense so deeply rooted I was incredibly blind myself to the extent and consequences of my addictions, as well as denying it all to others. This is a classic problem to overcome with addicts. Over the course of treatment, I was able to open up to others about my problems and to see the situation from their standpoints. I had grown up in a time and context where getting high on a variety of substances was the norm, and I took to it like a duck to water. I felt I was in the best position to make my own decisions and to play by my own rules. It was ‘work hard, play hard’ for me. Fortunately, I was pretty much able to keep the drugs and alcohol out of my work life, though I came to see in treatment that my behavior did, in fact, have very many negative consequences on myself and others and also the risks I took were enormous. I minimized all of this and somehow felt since I was practicing successfully and what I somehow thought was responsible, that it was all okay.

“On entering treatment I decided to tell it all, to submit myself to evaluation and take the consequences. I had no idea if I would ever be allowed to practice medicine or surgery again. After extensive evaluation and treatment, and with constant support from APHP, I was allowed to retain full prescribing, surgical and medical privileges and was eased back into practice while receiving individual and marital therapy, and group support through APHP and other approved organizations.

“The recovery process entails taking stock of our own problems and making amends to those we have harmed. I got our office staff together and explained to them all the issues I had and asked for their forgiveness and support. I did the same with partners, family, friends and enemies, as well as the hospital administration. I committed to them and to myself to be completely honest in the future. Honesty is the heart of true change. Living in addiction necessarily entails living in a series of lies to others. It was completely remarkable the amount of support I received and the change I could feel coming about in myself. I had come clean with everyone and was completely supported by them all. The relief was enormous, really unbelievable. It turns out virtually everyone has experienced the effects of addiction closely, in their family, their close friends, or in themselves, and they tend to be understanding, appreciative of the honesty, and most supportive of someone trying to face up to it and make a change in their lives.

“I was required by the Board of Medical Licensure to continue meeting all the requirements of the APHP and to continue quarterly drug screening as long as I maintained my medical license. Over the next 13 years of active practice, APHP remained incredibly supportive and does so to this day even in my retirement. I carried on through the embarrassment of receiving drug screens from a number of my patients, colleagues, and nurses I had worked closely with and have honestly never had a negative reaction from any of them. In fact, many subsequently came to me or sent their family in for further surgery. And now, about 14 years sober, my life is so much richer, and there really are no words to express it or to express my appreciation to APHP and to all those who have been so helpful to me in this remarkable journey.”

How Can You or Someone You Know to Get Help?

The staff of the Alabama Physician Health Program is available to advocate for any physician, resident, medical student or physician assistant with an Alabama license. However, those physicians who are members of the Medical Association receive discounted rates. For more information call (800) 239-6272 or email staff@alabamaphp.org. All information is confidential.

Tags: account, addiction, APHP, BME, health, impair, monitor, patient, physician, stress, support, wellness

Posted in: Health

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Legislation Introduced to Tackle Doctor Shortages

Posted by admin on March 15, 2019

WASHINGTON, D.C. – U.S. Reps. Terri Sewell (D-AL) and John Katko (R-NY) have introduced legislation that would take critical steps towards reducing nationwide physician shortages by boosting the number of Medicare-supported residency positions. The Resident Physician Shortage Act (H.R. 1763) would support an additional 3,000 positions each year for the next five years, for a total of 15,000 residency positions.

“This week, medical students across the country will celebrate their match into physician residency programs, but many of their peers will be left without a residency due to the gap between students applying and the number of funded positions. At the same time, the United States faces a projected shortage of up to 120,000 physicians by 2030. We need to act now to train more qualified doctors,” Sewell said. “Increasing the number of Medicare-supported residency positions means increasing the number of trained doctors to meet growing demand. It also means giving hospitals and health centers the tools they need to increase access, lower wait times for patients and create a pipeline of qualified medical professionals to serve Americans’ health needs.”

To become a practicing doctor in the U.S., medical school graduates must complete a residency program. However, for the past two decades, an artificial cap on the number of residents funded by Medicare – which is the primary source of payment for residents – has limited the expansion of training programs and the number of trainees.

According to the Association of American Medical Colleges, the United States will face a physician shortage of between 42,600 and 121,300 physicians by 2030. As the American population grows older, the demand for physicians and other medical professionals will increase.

Earlier this year, the Medical Association empaneled the Manpower Shortage Task Force to develop and restore adequate health care manpower in all geographic areas in order to provide quality local health care for all Alabama citizens. Members of the task force have discussed a number of issues including fully funding the Board of Medical Scholarship Awards, scope of practice, physician pipeline programs, education and the possibility of GME expansion, recruitment and retention of physicians through meaningful tax credits and rural community support, and start-up business models.

“Naturally, there are a lot of concerns about health care shortages in rural areas, but our goal with the task force is a long-term solution,” said Medical Association Executive Director Mark Jackson. “The task force and the resolution stand as a reminder that Alabama ranks in the last five of 50 states in health status categories, and while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is causing an escalation in need for primary care physicians. The Association would like to thank Rep. Sewell for introducing the bill and will work closely with her and her staff to help ensure its passage.”

Read the Resident Physician Shortage Act

Tags: physician, shortage

Posted in: Advocacy

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MOC Update: ABMS Plans Implementation of Board Certification Recommendations

Posted by admin on March 14, 2019

March 12, 2019 CHICAGO – The American Board of Medical Specialties (ABMS) Board of Directors plans to address the recommendations shared in the Continuing Board Certification: Vision for the Future Commission’s final report. Presented to the ABMS Board in mid-February, the Commission’s final report is the culmination of research, testimony and public feedback from stakeholders throughout the Boards and greater health care communities. The Commission took all of this input into consideration, developing a set of recommendations to help continuing certification evolve into a meaningful and relevant program bringing value to a physician’s practice and meeting the highest standard of quality patient care.

The ABMS Board reviewed the Commission’s final report in detail during its February meeting, assessing how best to address the recommendations outlined. The Board agreed to the following as necessary first steps in implementing the Commission’s findings:

Establishment of the “Achieving the Vision for Continuing Board Certification” Oversight Committee charged with directing the implementation strategy. This committee will seek guidance from the ABMS’ new Stakeholder Council and various stakeholders in the continuing certification process throughout the implementation.
Creation of the following four Collaborative Task Forces that will include representatives from professional and state societies and other external stakeholders, focusing on the following areas identified in the Commission’s report:

o Remediation pathways
o Professionalism
o Advancing Practice
o Information and Data Sharing

Agreement of all 24 ABMS Member Boards to commit to longitudinal or other formative assessment strategies and offer alternatives to the highly-secure, point-in-time examinations of knowledge.
Commitment by ABMS to develop new, integrated standards for continuing certification programs by 2020. The standards will address the Commission recommendations for flexibility in knowledge assessment and advancing practice, feedback to diplomates and consistency.
Establishment of a meeting of the ABMS/Council of Medical Specialty Societies joint Board Leadership to ensure full specialty society engagement in building the road map defined by the Commission report especially with regard to the role of continuing certification in advancing clinical practice.

The Commission’s report affirmed that it is the role of the Boards to make summative decisions about continuing the certification of a physician based on a portfolio of information. However, the Commission called for the Boards to create formative processes that offer opportunities for learning and improvement as well as remediation when necessary before summative decisions are made. And, while the report itself didn’t comment directly on the work the Boards have already undertaken to enhance their programs, many of the Commission’s recommendations affirmed those actions, most notably those referencing alternative formative assessment strategies and improving communications with key stakeholders and diplomates.

The Medical Association has been active on the MOC issue, through both its MOC Study Committee and advocacy at the national and state levels. Below is the official statement on the “Vision Initiative” from MOC Study Committee Chairman Dr. Greg Ayers:

“The Medical Association of the State of Alabama’s MOC Study Committee supports a voluntary process for board certification in medical specialties and a departure from the sometimes punitive approach toward certification taken by some American Board of Medical Specialties’ specialty boards. This process must maintain high standards for professionalism and encourage lifelong learning that is clinically relevant to patient care within physicians’ individual practices. The MOC Study Committee believes the ABMS various specialty boards should continue efforts to improve upon and ensure inexpensive, accessible options for increasing the breadth and scope of physicians’ skills and knowledge so they may best serve their patients; however, those efforts should never, of themselves, hinder, obstruct nor supersede the actual provision of care. The ABMS Boards should collaborate to pursue implementation of reciprocal, longitudinal pathways for multi-specialty diplomates. The continuing physician specialty certification process of the future should not include the current high-stakes examination and burdensome, duplicative components of Maintenance of Certification. Given physicians’ support for self-regulation, the MOC Study Committee calls upon the ABMS Boards to fulfill its duty to administer specialty board certification in a manner that assists physicians in continuing to improve the quality of care patients receive.”