Archive for March, 2019

VCOM-Auburn Provides Care and Supplies to Lee County Tornado Victims

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VCOM-Auburn Provides Care and Supplies to Lee County Tornado Victims

BEAUREGARD – Faculty, students and staff at the Edward Via College of Osteopathic Medicine Auburn campus have been working to provide free medical care and supplies to neighboring Beauregard, Alabama area tornado victims. Following the devastating tornado outbreak on Sunday, March 3, VCOM-Auburn administrators worked quickly with community partners to devise a plan to try to assist storm victims. A supply drive was held, which saw donations of bottled water, sports drinks, personal care items, baby care supplies, non-perishable food, first-aid supplies and more.

“What VCOM is doing for the local community is exactly what we strive to do as future physicians — giving our time and knowledge for those in need,” said Tram-Anh Huynh, a second-year student at VCOM-Auburn. “I am really proud to be part of a community that jumped in without hesitation to help the Lee County tornado victims.”

On Monday morning, a tent was erected at Beauregard Drugs and Dr. Martin Roach’s Beauregard Clinic to provide free-of-charge, non-life-threatening medical care to storm victims and rescue and recovery personnel. A pull-type RV trailer was loaned to the effort, which has offered welcome shelter from the cold wind and a place to store relief supplies for distribution. Physicians and students from VCOM have staffed the tent each day from morning until evening.

On Wednesday, March 6, Piedmont Columbus Regional Hospital joined the effort by arriving on scene with a mobile triage unit. This unit, essentially an RV-type vehicle, offers two patient care rooms in a spacious, climate-controlled environment. Medical professionals from Piedmont Columbus Regional have committed to be on site at least through the weekend.

“We are extremely grateful for the cooperation and partnership with Beauregard Drugs, Beauregard Medical Clinic, the Piedmont Columbus Regional mobile unit and Providence Baptist Church,” said J.J. White, D.O., PhD, VCOM-Auburn’s associate dean for simulation and technology, discipline chair for emergency medicine and the College’s disaster response leader for this effort. “We are amazed by the outpouring of support by the entire community and hope to be flexible, adaptable and productive with our relief efforts.”

On Thursday, March 7, the Piedmont Columbus Regional mobile unit, along with the VCOM relief tent and trailer, moved 1.5 miles to Providence Baptist Church at the request of the incident commander. This new location has become the focus of the volunteer efforts for the community. VCOM physicians and students plan to remain at this new location through the weekend.

“Our involvement with relief efforts began the night of the storms treating patients in the emergency department at East Alabama Medical Center,” said VCOM-Auburn fourth-year student Gunnar Magnuson. “Consistently, we have been very encouraged at the overwhelming number of individuals and local health institutions like VCOM-Auburn and its partners looking to help their neighbors in any way they can.”

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Medical Association Successfully Lobbies for PDMP Changes

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Medical Association Successfully Lobbies for PDMP Changes

MONTGOMERY — Registered users of the Alabama Prescription Drug Monitoring Program (PDMP) should have noticed a different format earlier this year. The new platform, called NarxCare™, provides enhanced analytics and risk scores with features including prescription information displayed in easy-to-understand graphic representations and allowing the users to obtain prescription information by clicking on the graphics.

Prescribers using the PDMP have often complained accessing the program is cumbersome, time-consuming and complicated, which discourages use of the tool unless it is specifically required by Alabama Board of Medical Examiners rules.

In 2017, Gov. Kay Ivey established the Alabama Opioid Overdose and Addiction Council, which would in part look into options for prevention, treatment, recovery-support and other behavioral health services for substance-use disorders lacking in our state. Leadership from the Medical Association argued a massive upgrade to the PDMP would need to be part of the mission of the Governor’s Opioid Council.

“The Medical Association has been at the forefront of the opioid crisis for many years looking for new ways to identify better options for treatment of patients with substance use disorder and find more intuitive training and tools for our prescribers. The addition of NarxCare is a great first step in streamlining the PDMP and hopefully encouraging more prescribers to use this diagnostic tool in their practice,” said Association Executive Director Mark Jackson.

On Jan. 15, the Alabama Department of Public Health launched the first phase of that upgrade with the NarxCare™ platform to aid prescribers in clinical decision making and provide support to help prevent or manage substance use disorder.

The new format when prescribers search a patient’s history in the PDMP has now changed:

  • There are two short tutorials available to walk PMDP users through the new system. Prescribers are strongly encouraged to view the NarxCare™ tutorials.
  • In the new NarxCare™ format, the patient’s name and information are listed on the upper right of the screen.
  • Each patient will have Narx Scores for narcotics, sedatives and stimulants.
  • An Overdose Risk Score (0-999) is also displayed for the patient. The higher the number, the more at-risk the patient is for an overdose.
  • The prescriptions are displayed as color-coded, interactive blocks on a bar graph. For example, opioid prescriptions are represented by red blocks. Clicking on a block displays the patient’s prescription information.
  • Full prescription information is listed at the bottom of the page in the traditional format seen in Aware.
  • Medication Assisted Therapy (MAT) and CDC resources are available by clicking the Resources tab.

The Narx Report

The Narx Report includes a patient’s NarxScores, Predictive Risk Scores, Red Flags, Rx Graph and PDMP Data, as well as access to Resources and Care Team Communications all in a single, easy-to-use interface.

The NarxScores. Every Narx Report includes type-specific use scores for narcotics, sedatives and stimulants. These scores are based on a complex algorithm factoring in numbers of prescribers, morphine milligram equivalents (MME), pharmacies and overlapping prescriptions. Scores are quantified representations of the data in the PDMP and range from 000-999 with higher scores equating to higher risk and misuse, and the last digit always represents the number of active prescriptions.

The Predictive Risk Scores. These composite risk scores incorporate relevant data (PDMP and non-PDMP) into advanced and customized predictive models to calculate a patient’s risk of a host of outcomes, including overdose and addiction. Non-PDMP data sets may include medical claims data, electronic health records, EMS data and criminal justice data.

The Red Flags. There are multiple customizable PDMP- and non-PDMP based red flags. A red flag(s) may contribute to the risk of unintentional overdose or other adverse events.

The Rx Graph. The Rx Graph is simple, clear and comparative. The interactive display allows you to view all the information you need, analyze data, and click into specific data points to see more detail. You can easily visualize and understand patterns in prescribing and usage behaviors, as well as identify overlapping prescriptions.

The PDMP Data. The PDMP Report is for controlled substance data. The PDMP Report aggregates two years of historical prescription data from providers and pharmacies, including quantities and active prescriptions.

For information about the PDMP or NarxCare™, contact the Alabama Department of Public Health’s Pharmacy Division at (877) 703-9869.

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Practice Culture is a Reflection of Leadership

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Practice Culture is a Reflection of Leadership

This article is a continuation of the leadership series started by Jim Stroud in 2018. As many of you may know, Jim retired from Warren Averett in December 2018, after serving for many years as an advisor in our health care division. Practice administrators and physicians would seek his advice related to dissension among the physicians, leadership struggles or resistance to change in a changing environment, and more. Jim would communicate the issue, engage our team to assess the details, and resolve the crisis. We often provided ongoing advisory services to foster physician leadership or assist the administrator in facilitating change.

At times, the problems had resulted from governance issues within the practice. A small practice usually relies upon a physician owner to set the practice goals. The practice can only grow and evolve if he or she stays abreast of changes. Every group practice started small and grew over time due to the consistency of the leadership and a clear vision. Most groups employ an administrator to handle most of the day-to-day decisions and lead the practice through strategic goals. Occasionally, we see a practice that grew through the addition of physicians, but there is still no strategic plan for the future.

Communication Is Key

The practice culture is a result of key behaviors of the leadership. Better performing practices have a clear vision statement and review it during all strategic decisions. These practices hold regular physician meetings and keep the practice moving in a strategic fashion. They communicate clearly and practice transparency in setting goals. Better performers value advisors to assist in key decisions and advise through strategic planning. The culture trickles down to how effectively the administrator communicates goals and engages the staff.

A positive culture fosters teamwork through effective communication. Think about how you want the staff and your patients to view your practice. The staff will showcase your culture through the performance of their jobs.  I worked with a practice last year whose physician leader had fostered loyalty and success in the staff through “morning huddles.” The staff worked well as a team and supported each other as problems occurred each day. The culture should evolve by hiring staff that understands the goals of the practice and how their job is important to the success of the practice. A physician/administrator team that communicates vision, trains and engages their staff will grow leaders in every area of the practice.

Our practices will continue to face challenges; the regulatory changes alone will keep a practice on their toes. As technology evolves, our practices have many opportunities to serve patients through new platforms and initiatives. Leadership begins with the physicians. If they effectively communicate their vision, they build a practice that attracts new physicians and loyal staff.

Article contributed by Tammie Lunceford, Healthcare and Dental Consultant, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

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Medical Association Signs on to Letter Targeting PA Requirements

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Medical Association Signs on to Letter Targeting PA Requirements

The Medical Association recently joined the American Medical Association and 85 other national medical groups and state medical associations in sending a letter to the Centers for Medicare & Medicaid  Services to urge CMS to provide guidance to Medicare Advantage plans on prior authorization processes through its 2020 Call Letter. In the jointly signed letter, the groups call upon CMS to require MA plans to selectively apply PA requirements and provide examples of criteria to be used for programs such as ordering/prescribing patterns that align with evidence-based guidelines and historically high PA approval rates. Citing the CMS Patients Over Paperwork initiative, the letter stresses this new guidance will promote safe, timely and affordable access to care for patients; enhance efficiency; and reduce administrative burden on physician practices.

The letter further explains how the prior authorization process has been found to be burdensome for health care providers, health plans and even patients and that physicians and insurers have agreed that these policy changes to eliminate PAs on those services for which there is low variation in care can promote greater transparency regarding services subject to PAs and protect patients to ensure PAs do not impact the continuity of care.

PA programs can create significant treatment barriers by delaying the start or continuation of necessary treatment, which may in turn adversely affect patient health outcomes. According to a 2018 AMA survey of 1,000 practicing physicians, 91 percent of physicians said PAs can delay a patient’s access to necessary care. These delays may have serious implications for patients and their health, as 75 percent of physicians reported that PA can lead to treatment abandonment, and 91 percent indicated that PA can have a negative impact on patient clinical outcomes. Most alarmingly, 28 percent of physicians indicated that PA has led to a serious adverse event (e.g., death, hospitalization, disability/permanent bodily damage) for a patient in their care.

Read the letter in its entirety

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In Memoriam: John Higginbotham, M.D.

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In Memoriam: John Higginbotham, M.D.

John Higginbotham, M.D., a longtime member of the Medical Association and Madison County Medical Society, passed away earlier this week. Dr. Higginbotham was a retired orthopaedic surgeon and who was instrumental in the formation of the North Alabama Medical Reserve Corps. In 2014 he received the Association’s highest award, the Samuel Buford Word Award, which is given in recognition of service to humanity beyond the usual scope of medical practice and often rendered at some personal sacrifice.

He served as medical director of the Metropolitan Medical Response System and as county disaster liaison for the Madison County Medical Society (MCMS) and was a member of the Alabama Department of Public Health’s Advisory Council on Emergency Preparedness. Despite retirement, Dr. Higginbotham continued to serve on the boards of MCMS and NAMRC.

Dr. Higginbotham was 75 when he died Tuesday. A celebration of his life will be held Saturday from 4-8 p.m. at Laughlin Service Funeral Home in Huntsville and March 15 at 11 a.m. at the Episcopal Church of the Epiphany in Guntersville.

Surgeon and Christmas Star: Remembering Dr. John Higginbotham

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It’s Not Just About the Medicine with George Koulianos, M.D.

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It’s Not Just About the Medicine with George Koulianos, M.D.

MOBILE – The main hallway of The Center for Reproductive Medicine in Mobile is lined with photos of smiling babies. The large collages are softly lit by recessed lighting in the ceiling above each frame, and as you walk down the hallway, it’s impossible not to smile at what the physicians and staff affectionately refer to as “our angels.”

This is a place filled with dreams, hope and love, and that’s just how founder and medical director George Koulianos, M.D., likes it. With his easy smile and affable demeanor, he lights up a room whenever he walks in. This is a man whose professional accomplishments in the field of reproductive medicine have made The Center for Reproductive Medicine one of the most successful medical practices of its kind in the country.

The son of an immigrant family, Dr. Koulianos is no stranger to hard work. His father barely escaped the Greek Islands for America during World War II following 52 days and nights of constant bombings by German forces.

“I grew up working with my hands. I grew up pumping gas and fixing cars. My father wanted to make sure I hated it so much that I would study hard to make a life for myself. There’s no way I could ever begin to thank my father for the lessons that he taught me about life,” Dr. Koulianos said.

His father passed away when he was in medical school, but he would certainly be proud of his son. Dr. Koulianos isn’t just a successful physician. A few years ago he embarked on a new venture that began as a bit of a hobby for him and a summer job for his son and daughter. Little did he know just how successful or how much fun he would have being a farmer.

“I love it!” Dr. Koulianos exclaimed. “It’s amazing how many people don’t know where their food comes from. I think it’s, there’s something very spiritual about the whole thing. When you look at that little tomato seedling and think what in the world is this? Then it turns into this beautiful plant that brings forth this wonderful fruit. For me, it’s like how can you not believe in God after you see that and if you live that for a growing season. So I think it’s kind of a miracle personally.”

With more grocery stores and restaurants participating in Buy Local campaigns, small organic farms such as Dr. Koulianos’ are becoming more popular on a much larger scale, plus it means more to residents to know that their produce was grown within just a few miles of their community.

“We’ve had more people approach us about putting our products on their shelves and on their menus…at times it’s been more than we can. We’ve grown so much from what began as land for Dove hunting and hay to now supplying two of the best chefs in Mobile County and new customers in Baldwin County with our produce,” Dr. Koulianos explained.

As much fun as he was having farming with his son and daughter, Dr. Koulianos realized his little patch of heaven had a different purpose. He was already using it as a way to teach his children responsibility and life lessons about their future, but this lesson was more for him.

“I began to realize I was promoting health through nutrition…and isn’t that what a doctor is supposed to do?” Dr. Koulianos questioned. “There was major research beginning to come out about endocrine disruptors and reproduction. These endocrine disruptors that are in synthetic pesticides are really bad for us. So as the farm progressed, the literature got even stronger about the negative effects of endocrine disruptors for a whole slew of areas in health, not just reproduction, but diabetes, heart disease, and on and on. The European Union calculated the cost of endocrine disruptors on the health system in the billions of dollars. Wow! It’s become a way for me as a physician to interact with my patients in a different way. As people get more food conscious and realize what they put into their bodies, it determines what happens to their bodies. I can tell you we’ve had patients who have come to us from other fertility clinics who’ve done IVF and had terrible outcomes. We’ve told them before that if we do your IVF, this is what you’re going to do – you’re going to drop 10 or 20 pounds, you’re going to change the way you eat, you’re going to get all these carbs out of your diet, you’re going to eat these types of foods, you’re going to take certain supplements that help with fertility, you’re going to take the supplements, and then three months from now we’re going to do your IVF cycle. Nutrition really makes a difference, and they make beautiful embryos! Our patients have gotten pregnant in our program where they couldn’t get pregnant elsewhere.”

What began as a small hobby then a family tradition of passing on life lessons from father to son and finally an extension of his chosen profession, Dr. Koulianos said working his land gives him a sense of peace and is a profound experience that’s “good for the soul.” While his son and daughter have moved on, the farm continues to prosper in more ways than one.

“I think one of the great lessons we need to teach our young doctors is that you really are practicing something very special. Medicine might be science, it might be curative, but ultimately, more than anything else, it has to be healing. I really believe in the calling of medicine and in its own way, it’s its own unique ministry. My medical license is very special to me. It means I have a moral obligation to put the needs of the citizens of this state before mine. That’s what a license to practice medicine means. So a farm fits beautifully with the practice of medicine because I’m helping my patients in a different way,” Dr. Koulianos said.

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Record Year for HIPAA Enforcement

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Record Year for HIPAA Enforcement

In the current environment of regulation reduction, it is notable that the Department of Health and Human Services (HHS) received a record $28.6 million dollars in publicized settlements and judgments for HIPAA violations in 2018.  These numbers surpass previous years with the closest year on record being 2016 in which HHS collected $23.5 million dollars. These numbers reflect that HIPAA enforcement actions are on the rise.

There are several factors that are leading to this increase in fines:

  1. A lack of understanding about what encompasses an adequate HIPAA Risk Assessment;
  2. Failure to attain Business Associate Agreements when applicable;
  3. Failure to comply with physical, technical and administrative safeguards to secure protected health information (PHI); and
  4. Failure to implement encryption solutions or alternative adequate measures.

It is important to note that this record-setting total does not encompass all of the enforcement action taken by HHS against covered entities in 2018.  These numbers simply represent larger, more notable settlements and judgments.  In fact, HHS took corrective action against countless health care providers, health plans and business associates last year and it does not appear that these numbers will decrease in 2019.  As of February 22, 2019, HHS has officially begun investigating over 50 entities for large scale breaches.  For more information on these investigations of breaches of 500 individuals or more, visit the Wall of Shame on the HHS website. Pursuant to the HITECH Act of 2009, the Secretary of HHS is required to post information about entities who breach the PHI of 500 people or more to demonstrate transparency to health care consumers.

Health care providers can take action to reduce their risk by doing the following:

  1. Performing annual Risk Assessments;
  2. Identifying Business Associates and entering into adequate Business Associate Agreements;
  3. Creating and updating HIPAA policies and procedures;
  4. Ensuring that employees and staff members receive up-to-date training; and
  5. Proactive monitoring of electronic systems containing PHI.

This uptick in penalties illustrates that HHS is serious about their mandate to protect the privacy and security of PHI.  Their record demonstrates that they can be successful at attaining multi-million dollar settlements with health care entities and health plans that don’t comply with HIPAA regulations.  This is a good time for health care providers and HIPAA Business Associates to review their compliance programs to ensure that they are meeting the requirements. In HIPAA compliance, the lack of a specific strategy to secure PHI is an actionable failure that could result in a large fine and a loss of goodwill with the entity’s customers, its patients.  If you are unsure about whether your HIPAA compliance program is adequate or if you know that it is time to update your policies, procedures and training, consult a health care compliance expert.

Article contributed by Samarria Dunson, J.D., CHC, CHPC, attorney/principal of The Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Ala.  Attorney Dunson is also Of Counsel with the law firm of Balch & Bingham, LLP.  The Dunson Group, LLC, is an official partner with the Medical Association.

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SAME Act Could Give Alabama Second Chance at Medicaid Expansion

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SAME Act Could Give Alabama Second Chance at Medicaid Expansion

Alabama Sen. Doug Jones introduced legislation this week to give a second chance to expand Medicaid to those states that have not yet expanded their programs. The States Achieve Medicaid Expansion (SAME) Act would also give these states another opportunity to receive the same levels of federal funding that was offered in 2010.

“Alabama made a mistake by not expanding Medicaid. If I can give them an opportunity to rectify that, I’d like to do it,” Jones said in an interview with the Montgomery Advertiser. “I think it’s important for us to expand Medicaid in the state to help save our rural hospitals, get better health outcomes in those rural areas and to provide an economic boost in the state. Let’s finish this job and move forward, instead of languishing and letting our Medicaid dollars that we already pay go to other states.”

Originally in 2010, there would have been federal funds to cover the full cost of expansion for three years for those states that expanded their Medicaid program, at which time federal coverage would drop to 90 percent and states would cover the rest. Should the SAME Act pass, full funding would be offered for three years before decreasing to 95 percent funding in the fourth year, 94 percent in the fifth and 93 percent in the sixth. Federal coverage would stand at 90 percent every year thereafter.

The Medical Association remains an advocate for not only fully funding Alabama’s Medicaid program but also agrees with expansion of the program. Medicaid is a state-run program providing health coverage for about 23,000 low-income residents. To qualify for current Medicaid coverage, families with children must have a household income at or below 18 percent of the poverty level. Expanding the program would take that threshold up to 138 of percent the poverty level, offering access to as many as 325,000 Alabamians.

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