Archive for August, 2020

Physicians Perspective: Dr. Chris Adams Talks Telemedicine

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Physicians Perspective: Dr. Chris Adams Talks Telemedicine

Adversity and necessity mandate invention. 

During the COVID-19 pandemic, telemedicine has been transformed almost overnight into a necessary medical tool for remaining connected to our patients.  Without warning, physicians suddenly found themselves in the position of adding communication technologies, learning regulatory requirements, and adapting to an entirely new way of interacting with patients, sometimes reinventing their standard clinic procedures.  Similarly, government and private health care had to modify longstanding obstacles and prohibitions by allowing interstate practice and revising reimbursement policies.

I doubt there is a physician in our state who believes they could have managed their patients through this pandemic without the benefit of telemedicine.  Having said that, telemedicine is not a panacea. 

Practicing in a rural environment, we have discovered that bandwidth challenges are a huge issue.  Older patients also have vision and hearing challenges that make telemedicine less effective than face-to-face visits.  There is still an enormous amount of paperwork involved in conducting a telemedicine visit, it is not simply a matter of “picking up the phone and chatting.”  That is one reason why it is so important to have parity for video and telephone encounters. 

Despite these challenges, most clinicians would like to maintain the availability of this tool as we continue our social and medical confrontation with coronavirus.  At the same time, we also recognize inherent limitations that telemedicine imposes (I just cannot do a good knee exam over the telephone).  The challenge we now face is to define and refine best practices for employing telemedicine.  Part of this effort will require continued advocacy and encouragement of health delivery systems to support telemedicine.  Some of this will also necessitate new legal safe guards for practitioners employing this tool.

As you reflect on how this pandemic has changed your practice, please consider how you can support and contribute to the future of medicine in our state by advocating for your patients and your practice.  It is up to us as clinicians to help mold the future of healthcare delivery.

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Discussions with Decisionmakers: Senator Dan Roberts

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Discussions with Decisionmakers: Senator Dan Roberts

1. Please tell us a little bit about yourself – Primary occupation? Interests? Hobbies?

Growing up, my family moved around a good bit, and we lived as far north as Buffalo, New York, and as far south as Mobile, Alabama. That said, I finished high school in Birmingham and went on to Auburn University where I obtained a degree in Building Science Construction. Following undergrad, I worked in construction for Blount International and worked in South Korea and Saudi Arabia.

I returned to the U.S. to obtain a Masters Degree in Real Estate Development and Urban Affairs from Georgia State. In graduate school, I started our own company doing international trading in South Korea and Pacific Rim countries. I started a real estate sales and development firm based in Birmingham, which I continue to do today.

As far as hobbies go, our seven grandchildren (from our three sons) take up most of our free time my wife and I might have. We enjoy hunting, fishing, and farming, and are blessed to have developed a Treasure Forest and tree farm in central Alabama.

2. What first prompted you to consider running for your Senate District seat and how do you believe your background and experiences help you serve in the legislature?

From an early age I have had an interest in politics and policy. From serving on the Student Government Association in both high school and at Auburn, as well as holding positions in organizations like Fellowship of Christian Athletes and Campus Outreach Brazil, I have a passion for being involved.

In addition to my background in real estate development and international trade, I have also invested in various companies and served on various boards across Alabama. All of these experiences have given me a unique outlook on cultures and markets and, in turn, a unique outlook on legislative policy.

3. During the last legislative session, you were a leading voice in bringing awareness to the need for expanding access and funding for telemedicine in Alabama.  Tell us a little about why this issue is so important to you. 

I’ve been fascinated with the field of medicine nearly my entire life. Not only does healthcare play a major role in my district, I also have many friends and family who work in the healthcare sector.

As far as telemedicine goes, I really was not aware on the impact this type of technology plays (and can play) in healthcare until I was elected to the Alabama Senate. While telemedicine has always been out there, I had never thought of it as a legislative opportunity to help address healthcare needs and disparities.

4. This pandemic has led to the rapid expansion and adoption of telemedicine both statewide and nationally. How do you believe it’s impacted Alabama patients and do you foresee these changes become permanent?

The rapid expansion of telemedicine has given physicians another tool in their tool chest to provide quality care to patients throughout the state. Still, we must ensure that the strides made during this pandemic – both for telemedicine and healthcare in general – do not diminish. To do this, we must ensure that physicians are adequately reimbursed for telemedicine visits if we are going to see this adoption remain and grow. We must also expand our broadband connectivity access to all areas of the state.

We are at the infancy of Telemedicine in our country. I believe that with the right vision and adoption we will see explosive growth in technology, patient adoption, Physician and patient benefits which will result in better patient health, cost savings, a more efficient health care delivery system. We will all be amazed in 2030 with what we have accomplished in Telemedicine.

5. If you could change one thing about our state’s health care system, what would it be?

Overall, we as a state need to be in better physical shape whether it be related to obesity, smoking, exercise, etc. It’s no secret that we’re not the healthiest state in the country. I know it’s a broad answer, but I would change how we think about and address personal health. 

6. How can the Medical Association – and physicians statewide – help better address Alabama’s health challenges?

A big role the Medical Association can play right now is continuing to push for increased telemedicine access and appropriate provider reimbursement. The Association can help us by ensuring future policy positively impacts physicians in all specialties, in all practice types and sizes, and all areas of the state.

While we’ve made progress, our progress will not become permanent without the input and advocacy from physicians. Physicians’ voices are heard through the Medical Association and that needs to continue.

7. What’s the one thing you would like to say to physicians in your district?

First of all, thank you for the untold hours you have spent in and out of hospitals and your offices. I know there are no scheduled hours for physicians, and those “hey doc” calls come
at all times.

To those on the front lines of this fight – whether it’s battling COVID-19 in the hospital or seeing patients in your office – thank you for your commitment to the profession and your patients. Many of you have put work over family, constantly risking your health so that others may have healthcare. Then leaving work trying to not take COVID 19 home with you.

We will get through this pandemic, and hopefully, we will be better able to address situations in the future. We will be better off for having fought this season, but we still have challenges and we must work together to be successful in the future.

For now, I would simply like to convey a heartfelt ‘Thank You’ to all the physicians and healthcare workers. You are inspirational to us all. Thank you.

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Op-Ed: Alabama Medical Practices Hit Hard by COVID-19, Survey Finds

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Op-Ed: Alabama Medical Practices Hit Hard by COVID-19, Survey Finds

By:          John S. Meigs, Jr., MD, President Medical Association of the State of Alabama

In a span of just a few months, the coronavirus pandemic has changed the way we function as a society and has fundamentally altered our healthcare delivery system. It has exacerbated weaknesses in the infrastructure of health care and exposed limitations in current policies at a time when costs are rising and access to care is dwindling.

In an effort to understand these changes and their effects, the Medical Association of the State of Alabama released a survey summary detailing the impact of the novel coronavirus (COVID-19) on medical practices and care delivery.  The survey identified several key findings:

  • Public Health Concerns: Survey data shows that patient volume is down considerably and there are concerns that Alabamians are not going to their physician for routine care, including childhood and adult vaccinations, which will have long term public health consequences.
  • Financial Impact: More than 70% of respondents said COVID-19 has had a severe impact on practice finances, causing layoffs and furloughs and limiting access to care
  • Patient Volume: Nearly 60% said patient volume reductions cut revenues by at least 50%, underscoring the extent to which patients are delaying or skipping necessary care
  • Telemedicine Increase: More than 71% said they’re likely to continue providing telemedicine so long as insurers continue covering the services for patients
  • Liability Concerns: More than 71% are concerned about the potential liability from lack of PPE and patients canceling or delaying procedures and other medical care

In addition, a similar study[1] found that Alabama is ranked sixth in the country in the number of patients that are delaying care. While COVID-19 may change how you receive care, it’s still important to look after yourself by getting the time-sensitive medical care you need to stay healthy.

In light of the findings of the survey, the Medical Association recommends several public policy proposals to combat COVID-19’s effects on physician practices and care delivery:

  1. Allocate state stimulus funds to reimburse practices for COVID-19 related expenses
  2. Expansion of testing, PPE, and cleaning supply availability
  3. Continued coverage of telemedicine by insurers at existing rates
  4. Enactment of “safe harbor” legislation to provide liability protections to health care providers

This pandemic has made telehealth more important than ever, enabling access to care to patients whose needs can be met remotely. Telemedicine has saved lives, helped reduce the spread of the virus, and enabled physicians to care for patients in a time when they might have otherwise been unable to. However, it is not a “silver bullet” and should not be viewed as a total replacement for in-person care.

Whether in a hospital, surgery center, or in a clinic, COVID-19 has drastically changed the care we as physicians provide for our patients. We cannot allow this virus to decimate our already strained healthcare system. Supporting those who care for us is needed now more than ever.

View the Survey Report

View the complete survey summary by clicking the button above or by using this link: https://masa.informz.net/masa/data/images/2020-Survey-Graphic_Summary-FINAL.pdf

John S. Meigs, Jr., MD, President Medical Association of the State of Alabama

[1] Bean, M., 2020. States Ranked By Percentage Of Americans Delaying Care: Nationwide, 40 Percent Of Americans Are Still Delaying Care, According To A Survey From The U.S. Census Bureau.. [online] Beckershospitalreview.com. Available at: <https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-percentage-of-americans-delaying-care.html> [Accessed 26 August 2020].

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Underwood Minority Scholarship Awarded

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Underwood Minority Scholarship Awarded

The Underwood Minority Scholarship Award is named for long-time Montgomery physician and the Medical Association’s 152nd President Jefferson Underwood III, M.D. Dr. Underwood became the first African-American male to serve as President of the Association in 2018-2019. The Underwood Minority Scholarship Award is for African-American individuals underrepresented in Alabama’s medical schools and the state’s physician workforce.

It is with great pride that we award the following candidate the 2020 Underwood Minority Scholarship Award, and we wish her all the best and hope this monetary award helps her accomplish her goals:

Alicia Williams, University of Alabama at Birmingham School of Medicine

A Fort Payne native, Alicia is headed for a career in general pediatrics where she will combine her leadership, clinical skills, knowledge of sports medicine and passion for providing care in rural underserved areas of Alabama. She has had the opportunity to work with teenage youth in Birmingham through Girlz Talk, an organization that teaches professionalism, safety and reproductive education. Alicia has also presented research to Governor Kay Ivey’s team and has collaborated with Secretary Jenna Ross and the Department of Early Childhood Education.

David Bramm, MD, Director of the Rural Medicine Program at UAB states, “Alicia is a breath of fresh air. She is strong without being overbearing, confident without being cocky, devoted to her patients and utterly reliable. I have been privileged to have been a preceptor for several medical schools since 1982 and fully believe Alicia is one of the best I have ever taught. I can recommend her without reservation for the Underwood scholarship.”

Alicia graduated from Mercer University with a 4.0 GPA and a Bachelor’s degree in biology. Currently, she attends UAB School of Medicine and is expected to graduate in 2021. Alicia’s personal interests including writing music, singing and playing basketball.

“I am very grateful to be the first recipient of a scholarship that honors such a respected and esteemed physician as Dr. Underwood,” Alicia states. “This scholarship serves great purpose towards my goals as a future physician, and Dr. Underwood’s leadership and service is a great example for me and other aspiring physicians like me.”

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The Effect Differing Medical Opinions Have On Falsity and Scienter in False Claims Act Lawsuits

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The Effect Differing Medical Opinions Have On Falsity and Scienter in False Claims Act Lawsuits

By: Jim Hoover with Burr Forman, LLP

There is currently a circuit split among the Federal Circuit Courts of Appeals regarding the effect differing medical opinions have on the elements of falsity and scienter in False Claims Act lawsuits.  

Earlier this year the Third Circuit Court of Appeals ruled that conflicting medical opinions can create a genuine dispute of material fact on “falsity” in a False Claims Act action. The case is United States v. Care Alternatives. This holding directly conflicts with the Eleventh Circuit’s September 2019 decision in United States v. AseraCare, which held that a mere difference in medical opinion between physicians regarding a patient’s prognosis was not enough to establish falsity under the FCA. In Care Alternatives, the Third Circuit rejected AseraCare and found that conflicting physician testimony about the validity of physician’s certifications was sufficient to raise a dispute of material fact regarding the element of “falsity.” The Third Circuit sought to make clear that in its Circuit, findings of falsity and scienter must be independent from one another for purposes of FCA liability. According to the Third Circuit, the scienter element helps limit the possibility that providers will be exposed to liability under the FCA any time the Government or relator can find an expert who disagreed with the certifying physician’s medical prognosis.

Former employees of Care Alternatives filed a qui tam action against the hospice provider, alleging the hospice had improperly admitted patients who were not eligible for Medicare’s hospice benefit and directed employees to falsify Medicare certifications in order to meet the eligibility requirements. The relators’ physician opined that in 35% of the sample cases he reviewed a reasonable physician would not have certified the patient as terminally ill with a prognosis of six months or less based on the accompanying documentation. Reviewing the same sample set, Care Alternatives’ physician disagreed, finding that a reasonable physician could reasonably certify each case. Thus, there was a disagreement among the parties’ experts. The United States District Court for the District of New Jersey agreed with AseraCare by adopting and applying AseraCare’s holding that an “objective falsehood,” something more than a retrospective difference of opinion, was required to create a genuine dispute of fact.

On appeal, the Third Circuit Court of Appeals disagreed and reversed and remand the case for consideration of the other elements of FCA liability, particularly the element of scienter. The Third Circuit noted it is well-established that subjective opinions can be false, and applied this reasoning to the FCA’s falsity element. The Third Circuit opined that AseraCare’s “objective falsity” standard improperly conflated falsity with scienter, i.e., that the whistleblower prove a certifying physician was making a knowingly false certification. The Third Circuit held that these elements must be considered separately, and the purpose of the scienter requirement is to limit the possibility that a provider could be found to violate the FCA any time the Government or a relator could find an expert who may establish falsity simply by disagreeing with a physician’s prognosis.

Thus, in the Third Circuit a determination that a claim was false does not immediately trigger FCA liability. Relators must still establish that the provider knew the claim was false when the claims was submitted. Unfortunately, however, one of the big problems for False Claims Act defendants is credibility determinations are typically reserved for the jury thus almost forcing the False Claims Act case to trial.  

Because of the circuit court split, a United States Supreme Court opinion is needed to resolve the differing circuits’ approaches. In the meantime, the key takeaway for health care providers across the country is these differing standards will be fought in FCA cases where defendants have made reasonable subjective judgments.  The arguments should focus on both the falsity element and the scienter element.  

Jim Hoover is a partner at Burr & Forman LLP and works exclusively within the firm’s Health Care Practice Group and predominantly handles healthcare litigation.

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