Archive for May, 2019

Pregnancy-Related Deaths Happen Before, During, and Up to a Year After Delivery

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Pregnancy-Related Deaths Happen Before, During, and Up to a Year After Delivery

3-in-5 pregnancy-related deaths could be prevented, no matter when they occur.

Pregnancy-related deaths can occur up to a year after a woman gives birth – but whenever they occur, most of these deaths are preventable, according to a new CDC Vital Signs report.

Of the 700 pregnancy-related deaths that happen each year in the United States, nearly 31 percent happen during pregnancy, 36 percent happen during delivery or the week after, and 33 percent happen one week to one year after delivery.

Overall, heart disease and stroke caused more than 1 in 3 (34 percent) pregnancy-related deaths. Other leading causes included infections and severe bleeding. The leading causes of death varied by the timing of the pregnancy-related death.

The findings are the result of a CDC analysis of 2011-2015 national data on pregnancy mortality and of 2013-2017 detailed data from 13 state maternal mortality review committees. CDC defines pregnancy-related death as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

The data confirm persistent racial disparities: Black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women. However, the new analysis also found that most deaths were preventable, regardless of race or ethnicity.

“Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our Nation’s highest priorities,” said CDC Director Robert R. Redfield, M.D. “Though most pregnancies progress safely, I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventative care that can and does save lives.”

Every pregnancy-related death reflects a web of missed opportunities

The CDC Vital Signs report provides the most current data available from CDC’s Pregnancy Mortality Surveillance System. It also summarizes potential prevention strategies from 13 state maternal mortality review committees (MMRCs). MMRCs are multidisciplinary groups of experts that review maternal deaths to better understand how to prevent future deaths.

The committees determined that each pregnancy-related death was associated with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. MMRC data suggest that the majority of deaths – regardless of when they occurred – could have been prevented by addressing these factors at multiple levels.

Key findings

  • From 2011-2015, of pregnancy-related deaths:
    • Nearly 1/3 (31 percent) happened during pregnancy.
    • Just over 1/3 (36 percent) happened at delivery or in the week after.
    • Exactly 1/3 (33 percent) happened 1 week to 1 year postpartum.
  • Leading causes of death differed throughout pregnancy and after delivery.
    • Heart disease and stroke caused more than 1 in 3 deaths overall.
    • Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), caused most deaths at delivery.
    • In the week after delivery, severe bleeding, high blood pressure, and infection were most common.
    • Cardiomyopathy (weakened heart muscle) caused most deaths 1 week to 1 year after delivery.

Working together to prevent maternal deaths

MMRC data demonstrate the need to address multiple contributing factors to prevent deaths during pregnancy, at labor and delivery, and in the postpartum period:

  • Providers can help patients manage chronic conditions and have ongoing conversations about the warning signs of complications.
  • Hospitals and health systems can play an important coordination role, encouraging cross-communication and collaboration among healthcare providers. They can also work to improve the delivery of quality care before, during, and after pregnancy and standardize approaches for responding to obstetric emergencies.
  • States and communities can address social determinants of health, including providing access to housing and transportation. They can develop policies to ensure high-risk women are delivered at hospitals with specialized health care providers and equipment — a concept called “risk-appropriate care.” And they can support MMRCs to review the causes behind every maternal death and identify actions to prevent future deaths.
  • Women and their families can know and communicate about the warning symptoms of complications and note their recent pregnancy history any time they receive medical care in the year after delivery.

CDC is prioritizing the lives of America’s mothers to prevent pregnancy-related death

To read the entire Vital Signs report, visit: www.cdc.gov/vitalsigns/maternal-deaths. For more information about CDC’s work on maternal mortality, please visit: www.cdc.gov/reproductivehealth.

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You Can Help Improve Transparency in the Certified Health IT Market

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You Can Help Improve Transparency in the Certified Health IT Market

Visit Open Forums in May to Inform a New Comparison Tool

Stop by to provide input at an upcoming open forum on the new EHR Reporting Program, which will provide publicly-available, no-cost, comparative information on certified health IT available on the market.

We are also providing a link for regional stakeholders to participate in the open forums virtually.  Please note that the open forums are scheduled for two hours, but feel free to drop-in when you’re available.

In the 21st Century Cures Act of 2016, Congress directed the US Department of Health and Human Services (HHS) to establish a new EHR Reporting Program, which the Office of the National Coordinator for Health IT (ONC) is currently developing. The goal of this program is to provide publicly-available, comparative information about certified health IT features related to security, usability, interoperability, conformance to certification testing, and other areas in order to improve the transparency of the market.

ONC has contracted with the Urban Institute and its subcontractor, HealthTech Solutions, to obtain stakeholder input on how to develop the EHR Reporting Program through public open forums across the country. Input from people like you will help determine:

  • What information should developers of certified health IT report? What information from users could be made available?
  • How that information is collected
  • How this information will be disseminated to the public (for example, would you prefer a product comparison website, data in a spreadsheet, or something else?)

Upcoming Open Forums

Public Health/AL Medicaid/AL Health Information Exchange
Monday, May 20, 2019
9 AM – 11 AM CDT
Montgomery County Health Department
3060 Mobile Highway
Montgomery, AL 36108
https://healthtechsolutions.zoom.us/j/155156076

AL Primary Healthcare Assn (FQHC)/ Rural Health
Monday, May 20, 2019
1 PM – 3 PM CDT
Montgomery County Health Department
3060 Mobile Highway
Montgomery, AL 36108
https://healthtechsolutions.zoom.us/j/432907928

AL Academy of Pediatrics/Primary Care
Monday, May 20, 2019
5 PM – 7 PM CDT
Renaissance Montgomery Hotel & Spa
201 Tallapoosa St
Montgomery, AL 36104
https://healthtechsolutions.zoom.us/j/505593044

Health Systems/Hospitals
Tuesday, May 21, 2019
9 AM – 11 AM CDT
Montgomery County Health Department
3060 Mobile Highway
Montgomery, AL 36108
https://healthtechsolutions.zoom.us/j/824124145

General Public Open Forum
Tuesday, May 21, 2019
1 PM – 3 PM CDT
Montgomery County Health Department
3060 Mobile Highway
Montgomery, AL 36108
https://healthtechsolutions.zoom.us/j/806771227

General Public Open Forum
Tuesday, May 21, 2019
5 PM – 7 PM CDT
Renaissance Montgomery Hotel & Spa
201 Tallapoosa St
Montgomery, AL 36104
https://healthtechsolutions.zoom.us/j/675043250

Can’t make any of these events? Watch for more events where stakeholders can make suggestions at: https://healthtechsolutions.com/EHR-reporting-program.

If you have any questions regarding the  Open Forum, please contact Pam Zemaitis of HealthTech Solutions at Pam.Zemaitis@HealthTechSolutions.com.

 

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For the First Time, Employed Physicians Outnumber Self-Employed

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For the First Time, Employed Physicians Outnumber Self-Employed

CHICAGO — For the first time in the United States, employed physicians outnumber self-employed physicians, according to a newly updated study on physician practice arrangements by the American Medical Association. This milestone marks the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.

Employed physicians were 47.4 percent of all patient care physicians in 2018, up 6 percent points since 2012. In contrast, self-employed physicians were 45.9 percent of all patient care physicians in 2018, down 7 percentage points since 2012. Changes of this magnitude are not unprecedented. Older AMA surveys show the share of self-employed physicians fell 14 percentage points during a six-year span between 1988 and 1994.

Given the rate of change in the early 1990s, it appeared a point was imminent when employed physicians would outnumber self-employed physicians, but the shift took much longer than anticipated. The AMA’s research notes this example and suggests “caution should be taken in assuming current trends will continue indefinitely.”

The majority of patient care physicians (54.0 percent) worked in physician-owned practices in 2018 either as an owner, employee, or contractor. Although this share fell from 60.1 percent in 2012, the trend away from physician-owned practice appears to be slowing since more than half of the shift occurred between 2012 and 2014.

Concurrently, there was an increase in the share of physicians working directly for a hospital or in a practice at least partly owned by a hospital. Physicians working directly for a hospital were 8.0 percent of all patient care physicians, an increase from 5.6 percent in 2012. Physicians in hospital-owned practices were 26.7 percent of all patient care physicians, an increase from 23.4 percent in 2012. In the aggregate, 34.7 percent of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29.0 percent in 2012.

Younger physicians and women physicians are more likely to be employed. Nearly 70 percent of physicians under age 40 were employees in 2018, compared to 38.2 percent of physicians age 55 and over. Among female physicians, more were employees than practice owners (57.6 percent vs. 34.3 percent). The reverse is true for male physicians, more were practice owners than employees (52.1 percent vs. 41.9 percent).

“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” said AMA President Barbara L. McAneny, M.D. “Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment. The AMA stands ready to assist with valuable resources that can help physicians navigate their choice of practice options and offers innovative strategies and resources to ensure physicians in all practice sizes and settings can thrive in the changing health environment.”

As in past AMA studies, physicians’ employment status varied widely across medical specialties in 2018. The surgical subspecialties had the highest share of owners (64.5 percent) followed by obstetrics/gynecology (53.8 percent) and internal medicine subspecialties (51.7 percent). Emergency medicine had the lowest share of owners (26.2 percent) and the highest share of independent contractors (27.3 percent). Family practice was the specialty with the highest share of employed physicians (57.4 percent).

Despite challenges posed by a dynamic change in the health care landscape, most physicians still work in small practices. This share has fallen slowly but steadily since 2012. In 2018, 56.5 percent of physicians worked in practices with 10 or fewer physicians compared to 61.4 percent in 2012. This change has been predominantly driven by the shift away from very small practices, especially solo practices, in favor of very large practices of 50 or more physicians.

The new study is the latest addition to the AMA’s Policy Research Perspective series that examines long term changes in practice arrangements and payment methodologies. The new AMA study, as well as previous studies in the Policy Research Perspective series, is available to download from AMA website.

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Meet Our New Board Members

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Meet Our New Board Members

Alexis T. Mason, M.D.
Secretary-Treasurer

Alexis T. Mason, M.D., is a native of Town Creek, Ala., and was elected Secretary-Treasurer during the Association’s Annual Meeting in April. It was a lawnmower accident when she was just 3 years old, which nearly took a limb and ended her life, that led her to her life’s calling of practicing medicine.

A graduate of Alabama A&M University, Dr. Mason went on to the Rural Medical Scholars Program at the University of Alabama where she received her Masters in Human and Environmental Science in 2008, which propelled her into the University of Alabama School of Medicine where she received her medical degree in 2012. She completed her residency at the University of Tennessee Family Medicine program in Jackson, Tenn., and her fellowship in Behavioral Medicine at the University of Alabama.

She is now practicing in Gordo, AL with Whatley Health Services as well as assisting with the SMART Clinic in Aliceville, Ala. After only two years in rural practice, she has become a favored preceptor for students entering the rural medicine pipeline and active in the AAFP.

 

Jane A. Weida, M.D., FAAFP
7th District Censor

Dr. Jane Weida is an associate professor in the Department of Family Medicine and associate director of the College’s Family Medicine Residency. She received her medical degree from Jefferson Medical College and completed her family medicine residency at Chestnut Hill Hospital in Philadelphia. After 13 years in private practice in Blue Bell, Pa., she spent six years as faculty at Penn State College of Medicine before joining an affiliated community-based family medicine residency in West Reading, Pa. There, she taught residents and medical students and served as the medical director, clerkship director and co-director of the residency’s Global Health Track.

Dr. Weida is active in several professional organizations. She is the immediate past president of the American Academy of Family Physicians Foundation, where she developed the organization’s signature humanitarian program in Haiti. She is committed to residency education, medical student interest in family medicine, and global health and has traveled extensively to provide family medicine education in Haiti and many former Soviet Republics in Asia and Europe.

 

Jay Suggs, M.D.
Place No. 5 Representative

When Alabama native, W. Jay Suggs, M.D., FACS, FASMBS, returned home after his general surgery training at the Mayo Clinic and bariatric surgery fellowship at Princeton, NJ, he started his first bariatric surgery Center of Excellence in Decatur. He also practices in Huntsville and Madison. Dr. Suggs is a board-certified surgeon and is also a Fellow of the American College of Surgeons and a fellow of the American Society for Metabolic and Bariatric Surgery. He has degrees in Biology and Chemistry from Emory University and his medical degree from UAB. Dr. Suggs, together with his wife and three daughters, live in Decatur where they are an active part of their community.

Dr. Suggs has special interests in medical education and research, serving as an associate professor of surgery at the UAB Huntsville Regional Campus, as well as the director for the Huntsville campus of the ACOM and VCOM-Auburn medical schools. He has been involved in the leadership of multiple professional organizations and hospitals.

 

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How Are HIPAA Breaches Impacting Alabama?

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How Are HIPAA Breaches Impacting Alabama?

HIPAA enforcement reached an all-time high in 2018, with financial settlements ranging from $100,000 to $16,000,000.  The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) is responsible for providing oversight and ensuring HIPAA compliance. Last year alone, OCR resolved a total of 25,089 complaints of HIPAA violations and required at least 632 entities to adhere to Corrective Action Plans which document how those entities will attain and maintain compliance with all applicable components of the HIPAA regulations. While last year’s numbers set records and gained significant attention, those numbers are only expected to increase.

As compliance professionals and media outlets focus on the latest hacking incident or security breach, some may wonder how breaches of health care data are impacting the great state of Alabama. While Alabama has a population of fewer than 5 million people, it is no stranger to OCR investigations.  In fact, a look back at the last 15 years of OCR HIPAA enforcement data reflects that the same vulnerabilities that plague states with much larger populations align with issues that burden Alabama covered entities, as well.  Alabama, Florida, Minnesota, New Jersey and Ohio are identical with regard to OCR complaint resolution percentages. In these states, OCR concluded that 28% of the complaints received required corrective action on behalf of the HIPAA covered entity. Only 6 percent of complaints in these states were determined not to be violations and 66 percent of complaints were resolved after the intake and review process.

Several breaches impacting the PHI of 500+ individuals have been reported within the state of Alabama. The most recent was the 2018 breach of FastHealth Corporation, a HIPAA Business Associate which contracted with covered entities to perform website and operational services. An unauthorized third party accessed FastHealth’s web server and acquired information from their databases, impacting 1,345 Alabamians. This breach followed a previous breach by the same organization occurring in June 2017 that likewise involved their network server and affected 9,289 individuals.

While large breaches generally receive the most publicity and attention, smaller breaches can be equally as devastating. For instance, breaches involving mental health or communicable disease information can be harmful to the patient whose information was breached, even if it is just one individual. Pursuant to state statutes, breaching this type of information can open an entity up to civil liability, even if numerous individuals are not affected.

Alabama Breach Notification Statute – A Wake-Up Call  

When Alabama passed the Alabama Data Breach Notification Act of 2018, many health care providers were pleased to note that there was a specific exemption for entities that were required to adhere to HIPAA. However, a careful review of the exemption language is warranted. Pursuant to Section 11, an entity that is subject to HIPAA regulations and complies with those standards are exempt so long as they do the following:

  1. Maintain procedures pursuant to those laws, rules, regulations, procedures, or guidance.
  2. Provide notice to affected individuals pursuant to those laws, rules, regulations, procedures, or guidance.
  3. Timely provide a copy of the notice to the Attorney General when the number of individuals the entity notified exceeds 1,000.

Thus, to be exempt from the Alabama statute, HIPAA covered entities must do more than simply assert exemption status due to HIPAA regulations.  The entity must also demonstrate that it is in compliance with HIPAA.

New Day for Breach Notification Rule Adherence

According to Linda Sanches, Senior Advisor for HIT & Privacy at OCR, it is going to be tougher for entities to conceal breaches. It has come to the attention of OCR that there are HIPAA covered entities who do not report their breaches and have found success staying “under the radar of HIPAA enforcement.” However, Ms. Sanchez announced at the 2019 Health Care Compliance Conference that OCR was not only considering more severe action against entities that did not follow the regulations but that in the future OCR would be observing news reports, interviewing past and disgruntled employees and placing more resources towards seeking out entities that disregarded the regulations.

Alabama covered entities face the same federal regulatory authority as any other state, regardless of size, population or economy.  Thus, it is important for health care providers to understand the requirements and ensure that their entity and their workforce is aware of the regulations and how those regulation impact their organization. The most recent national trends on the location and type of breaches from 2018 can be reviewed in the charts below.

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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First Presumptive Positive Measles Case in Alabama for 2019

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First Presumptive Positive Measles Case in Alabama for 2019

The Alabama Department of Public Health received notification of a case of presumptive positive measles the morning of May 2 in an infant in St. Clair County. Currently, this is the only presumptive measles case under investigation in Alabama.

The infant was considered contagious from April 23, 2019, through May 1, 2019. ADPH is working to confirm the diagnosis and to contact those exposed. The child is not in daycare and has had no out-of-state travel. So far in 2019, ADPH has conducted 174 investigations, including 32 open investigations, but this is the first presumptive positive case.

Measles (rubeola) is a notifiable disease in Alabama. The ADPH Immunization Division investigates reports of suspected measles. ADPH urges that all persons know their measles vaccine status. If never vaccinated and born after 1956, persons are strongly encouraged to obtain an MMR (measles, mumps, rubella vaccine) from their physician, healthcare provider or pharmacy. ADPH vaccine efforts primarily focus on children under 19 years of age. Free MMR vaccine is only available for children participating in the Vaccines for Children (VFC) Program and for persons who may qualify based upon local health department fee schedules.

ADPH has a very limited supply of MMR vaccine for adults and urges those with insurance and other coverage such as Medicaid to be vaccinated at their pharmacy or provider. About 95 percent or more of unvaccinated people exposed to a single case of measles will contract the disease.

For every single case of measles disease, 12-18 additional cases can be expected. The complication rate from measles is about 20-30 percent, especially in infants, children less than 5 years of age, and persons 20 years and older. Complications can range from ear infections and pneumonia to deadly encephalitis. For every 1,000 people with measles, one to two people will die.

Signs and symptoms of measles that occur before the rash are as follows:

  • Patients develop fever, sometimes as high as 105 degrees, followed by cough, runny nose, and red eyes (conjunctivitis).
  • Anywhere from 1-7 days after these symptoms begin, the rash develops.
  • The rash starts on the face and spreads across the body.
  • Patients may also have small white spots on the inside of the mouth on the cheek which may occur from two days before and up to two days after the rash.

From the time that a person is exposed to measles, it can take seven to 21 days for signs and symptoms to occur with an average of 10-14 days. People are contagious from four days before the rash develops until four days after.

For additional information, go to http://alabamapublichealth.gov/immunization/index.html

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CDC Clarifies Opioid Prescribing Guidelines

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CDC Clarifies Opioid Prescribing Guidelines

Since the Centers for Disease Control and Prevention released its Guidelines for Prescribing Opioids for Chronic Pain in 2016, physicians have relied on the document for recommendations when prescribing pain medication to their patients. However, because the CDC did not specifically clarify the guidelines in the original release, many physicians’ groups have been concerned the guidelines were misapplied to the detriment of pain patients.

The CDC issued the guideline in March 2016 in an attempt to curb widespread opioid abuse, which claimed more than 20,000 U.S. lives in the previous year along. The guideline was intended for primary care clinicians and advised them to prescribe treatments other than opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care.

Three years later, more than 300 health care professionals wrote to the CDC urging clarification of the guideline and suggesting the possibility it is being misapplied by physicians and insurers, and even harming patients. The letter was signed by prominent medical experts, including three former White House “drug czars” who served in the Obama, Clinton and Nixon administrations. The University of Alabama at Birmingham School of Medicine’s Professor Stefan G. Kertesz, M.D., is also one of the signees of the letter.

“We urge the CDC to issue a bold clarification about the 2016 guideline — what it says and what it does not say, particularly on the matters of opioid taper and discontinuation,” the group wrote in the letter, which was also sent to leaders of the House Committee on Energy and Commerce and the Senate Committee on Health Education Labor and Pensions.

In a letter released publicly in April, the CDC said the guidelines were not intended to deny chronic pain patients relief from opioids and encouraged physicians to use their “clinical judgment” in prescribing the medications, which can be addictive. The letter also spoke specifically to the use of opioids in the treatment of cancer and sickle cell patients, making it clear the guideline was not meant to limit access to pain management for patients with these conditions.

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Drug Overdoses in Young People on the Rise

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Drug Overdoses in Young People on the Rise

PISCATAWAY, NJ – In American adolescents and young adults, death rates from drug poisoning, particularly from opioids, have sharply increased over the last 10 years, according to new research in the Journal of Studies on Alcohol and Drugs.

In 2006, the death rate from drug poisoning from any type of legal or illicit drug was 8.1 deaths for every 100,000 people in the population ages 15 to 24. This rose to 9.7 per 100,000 by 2015, mainly fueled by deaths from opioid use. In this age group, death rates from opioids — both prescription opioids and illicit opioids such as heroin — rose 4.8 percent on average annually from 2006 to 2015, with an even steeper incline of 15.4 percent a year between 2013 and 2015.

“The surge in drug poisoning deaths . . . among adolescents and young adults reflects the ease of access to pharmaceutical drugs, especially prescription opioids . . . and later transition to more potent opioids,” the authors write. Many young people are introduced to opioids through prescription drugs, such as Vicodin or OxyContin. They often misuse these drugs with motivations to relieve pain, relax, feel good, or get high.

“[W]hen people addicted to prescription opioids face difficulty accessing these drugs because of tighter controls, they often turn to increasingly available and cheaper heroin,” the authors continue. Those who switch from prescription drugs to heroin are at high risk for drug overdose because these individuals are “accustomed to titrated prescription drugs and do not realize that heroin varies in potency and can be cut or mixed with dangerous and potentially deadly substances,” such as fentanyl.

To conduct their study, researchers led by Bina Ali, Ph.D., of the Pacific Institute for Research and Evaluation in Maryland, analyzed mortality data from the National Center for Health Statistics from 2006 through 2015. In addition to examining average annual rate changes in drug poisoning death rates for adolescents (ages 15-19) and young adults (ages 20-24), Ali and her colleagues estimated the costs to society associated with these deaths. This included the costs of medical interventions (emergency transport; treatment in hospitals, nursing homes, and hospices; and autopsies), work loss (loss of earnings and household work that young people would have made over the remainder of an average life), and quality-of-life loss (the monetary value of intangible losses such as pain and suffering).

The investigators found that drug poisoning death rates in adolescents and young adults were higher for Whites (11.9 for every 100,000 people) and American Indian/Alaskan Natives (10.0) compared with Blacks (2.6), Asian/Pacific Islanders (2.3), and Hispanics (4.0). Over time, the rates significantly increased for Whites (1.7 percent per year from 2006 to 2015), Asian/Pacific Islanders (4.3 percent per year from 2006 to 2015), and Blacks (11.8 percent per year from 2009 to 2015).

Drug poisoning death rates in adolescents and young adults vary by state. For example, the rate in West Virginia was approximately 5 times higher than the rate in Nebraska (15.1 vs. 3.1 per 100,000). When looking at changes between 2006 and 2015, New York had the highest increase in drug poisoning death rate, with a 9.4 percent increase each year. This was followed by Ohio, Massachusetts and New Jersey (with 9.1 percent, 9.0 percent and 8.7 percent increases annually, respectively).

The estimated costs of drug poisoning deaths among young people in the United States were $27.1 million in medical costs, $8.5 billion in work loss costs, and $26.5 billion for quality-of-life loss in 2015.

“The burden of drug poisoning deaths among adolescents and young adults is substantial,” Ali and her colleagues conclude. “With the burden of drug poisoning deaths among adolescents and young adults estimated at $35.1 billion nationally, targeted state-specific efforts are warranted.”

Evidence-based and promising strategies exist, such as knowledge and skills development for physicians, young people, and their parents; expansion of prescription drug monitoring programs, prescription drug disposal methods, and naloxone distribution programs; and medication-assisted treatment that combines medications with counseling and behavioral therapies. Interventions that are tailored for high-risk populations and directed at multiple levels (individuals, communities, and public health systems) are needed to reduce premature deaths from drug overdoses, according to Ali.

###

Ali, B., Fisher, D. A., Miller, T. R., Lawrence, B. A., Spicer, R. S., Swedler, D. I., & Allison, J. (2019). Trends in drug poisoning deaths among adolescents and young adults in the United States, 2006-2015. Journal of Studies on Alcohol and Drugs, 80, 201-210. doi:10.15288/jsad.2019.80.201

The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-related journal published in the United States.

To learn about education and training opportunities for addiction counselors and others at the Rutgers Center of Alcohol Studies, please visit https://education.alcoholstudies.rutgers.edu.

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HHS Lowers Annual Limits of Penalties for HIPAA Violations

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HHS Lowers Annual Limits of Penalties for HIPAA Violations

Published in the Federal Register on April 30, 2019, the Department of Health and Human Services (“HHS“) issued a notification to inform the public that HHS is exercising its discretion in how it applies regulations concerning the assessment of civil money penalties (“CMPs“) under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA“), as such provision was amended by the Health Information Technology for Economic Clinical Health Act (the “HITECH Act“).

In February 2009, Congress enacted the HITECH Act which, among other things, strengthened HIPAA enforcement by increasing minimum and maximum potential CMPs for HIPAA violations. Section 13410(d) of the HITECH Act established four categories for HIPAA violations, with increasing penalty tiers based on the level of culpability associated with the violation:

  1. the person did not know (and, by exercising reasonable diligence, would not have known) that the person violated the provision;
  2. the violation was due to reasonable cause, and not willful neglect;
  3. the violation was due to willful neglect that is timely corrected; and
  4. the violation was due to willful neglect that is not timely corrected.

Although the HITECH Act set forth different annual penalty caps for each tier (for all violations of an identical requirement or prohibition in a single year), HHS determined that the language of the penalty provisions was conflicting and allegedly referenced two levels of penalties for three of the four tiers. As a result, HHS concluded that the most logical reading of the law was to apply the highest annual cap of $1.5 million to each tier of violation and that such interpretation was consistent with Congress’ intent to strengthen enforcement.

On January 25, 2013, HHS adopted a final rule that applied the annual limit of $1.5 million to all tiers of violation types, as shown in the chart below:

Upon further review by the HHS Office of the General Counsel, HHS has now determined that the better reading of the HITECH Act is to apply annual limits as shown in the chart below:

HHS is expected to engage in future rulemaking to revise the penalty tiers to better reflect the text of the HITECH Act. Until further notice, HHS stated that it will use the new tier structure shown in the chart immediately above, as adjusted for inflation.

Article contributed by Anthony Romano, a partner with Burr & Forman LLP practicing in the firm’s Health Care Industry Group. Burr & Forman LLP is an official partner with the Medical Association. 

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How Can You Ensure Your Email is Safe and HIPAA Compliant?

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How Can You Ensure Your Email is Safe and HIPAA Compliant?

Using free email providers like Gmail, Yahoo, and MSN are expedient and easy to set up. It’s the reason why some healthcare providers rely on them. While you could stretch to make the argument that these email services can be configured to be “HIPAA capable,” none in the eyes of security experts are HIPAA compliant. And not complying with the safeguards required by HIPAA law can lead to unnecessary violations and costly fines.

What Makes Email Vulnerable?

We all send countless emails every day without thinking about it. But from a technological and safety perspective, there are several links in the chain, which make email vulnerable to malicious interference. Once an email is sent it moves from your workstation to your email server…then onto your recipient’s email server…from there your recipient’s workstation pulls the message from their server. Along the way, there’s a copy of the email stored on each workstation and server.

To satisfy HIPAA requirements, protected health information must be secure both at rest and in transit. This entails having your email messages protected while resting on workstations and servers, but also being secure until they reach the intended recipient’s inbox. There are paid services, like Google’s G Suite, that claim to be HIPAA compliant, but they don’t encrypt your email all the way to the recipient’s inbox. If your email is not secure while in transit, it is susceptible to theft.

The Business Associate Aspect

A big issue with using free email providers is the lack of business associate agreements. As a responsible health care provider, you must have signed agreements with any third-party vendor that handles your protected health information. This means your email and file sharing service needs to sign a business associate agreement in order for them to be HIPAA compliant. Unfortunately, this isn’t possible with free email providers and taking a chance on using one could have costly and disastrous consequences.

Phoenix Cardiac Surgery found this out the hard way in 2012. That’s when they were forced to pay the Department of Health and Human Services $100,000 for HIPAA violations. One of the company’s abuses— as uncovered by the Office for Civil Rights’ investigation—was transmitting electronically protected health information to its employees’ private email accounts using an internet-based email service and posting sensitive data on a publicly accessible, Internet-based calendar service. Phoenix Cardiac Surgery did not have a business associate agreement in place with these vendors, which is a violation of the HIPAA Security Rule.

The Best Way To Secure Your Email

At PCIHIPAA, we offer an email add-on that encrypts your emails and integrates with Outlook, Gmail, and other popular email providers. It’s easy to use, as it allows you to send messages as you normally would. Your recipients are able to view your messages without any software on any browser. With our HIPAA-compliant email solution, you can track and verify that your email has been received by the intended patient. We utilize military-grade end-to-end encryption which ensures that cybercriminals aren’t able to intercept your sensitive data and disrupt your business.

We’ve all heard horror stories about protected health information being compromised via email. It’s simply not worth risking HIPAA violations and fines to use an unsecured email provider.

Call us today at 800-588-0254 and let us know you’re a Medical Association of the State of Alabama member to find out how we can set up an email solution that gives your practice peace of mind and 100% assurance of being HIPAA compliant.

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