Posts Tagged health

Diabetes Alert Day Focuses on Risk Factors of Prediabetes and Diabetes

Diabetes Alert Day Focuses on Risk Factors of Prediabetes and Diabetes

In 2014, diabetes was the seventh-leading cause of death both in Alabama and the nation at large. According to statistics from the Alabama Department of Public Health, 13.5 percent of Alabama adults have diabetes. As part of the American Diabetes Association’s (ADA) Alert Day® on Tuesday, March 28, make sure you know the dangers of diabetes.

“On March 28, we will make a concerted effort through our social media accounts on Facebook and Twitter about the dangers and risks associated with prediabetes and diabetes, and how you can protect yourself against developing these diseases,” said ADPH Diabetes Program Director Brandi B. Pouncey.

According to the ADA, Alert Day® is a time to “sound the alarm about the prevalence of type 2 diabetes in American adults.” The ADA states that nine out of 10 Americans most at risk for type 2 diabetes aren’t aware of it. To help combat this lack of awareness, the ADA has developed a quick test for participants to see if they’re at risk for developing these diseases. For those at risk, the ADA has developed some tips to use when speaking with a health care provider about what they can do to lower their risks. These resources, along with many others, are available on ADPH’s Diabetes Program website.

For more information from ADPH regarding diabetes, go to, or

Posted in: Health

Leave a Comment (0) →

What is a Business Associate Agreement, and Why Should You Care?

What is a Business Associate Agreement, and Why Should You Care?

Health care providers are primarily concerned with the treatment and wellbeing of their patients. They gather and maintain tremendous amounts of protected health information[1]  (PHI) throughout the treatment process and commonly share that PHI with third parties who assist them with carrying out their work. This process of sharing PHI with a third party, non-workforce member, may create a business associate relationship. With the passage of the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, medical practices are now required to identify business associate relationships and enter into Business Associate Agreements (BAAs). Failure to comply can led to heavy fines imposed by the Department of Health and Human Services.

A common challenge to compliance with this regulation is assessing whether an individual or entity falls within the definition of a Business Associate.  To make this determination, medical practices are required to identify third parties who create, receive, maintain, or transmit PHI on behalf of the covered entity, including subcontractors. After documenting this process, an appropriate BAA must be executed to govern the relationship and to protect any PHI.

BAAs are contracts that dictate how a Business Associate must use, disclose and safeguard PHI, as well as the covered entity’s responsibilities to the Business Associate. At a minimum, the BAA must include the following provisions:

  • Establish the permitted and required uses and disclosures of PHI by the Business Associate;
  • Provide that the Business Associate will not use or further disclose the information other than as permitted or required by the contract or as required by law;
  • Require the Business Associate to implement appropriate safeguards to prevent unauthorized use or disclosure of the information, including implementing requirements of the HIPAA Security Rule with regard to electronic PHI;
  • Require the Business Associate to report to the covered entity any use or disclosure of the information not provided for by its contract, including incidents that constitute breaches of unsecured PHI;
  • Require the Business Associate to disclose PHI as specified in its contract to satisfy a covered entity’s obligation with respect to individuals’ requests for copies of their PHI, as well as make available PHI for amendments (and incorporate any amendments, if required) and accountings;
  • To the extent the Business Associate is to carry out a covered entity’s obligation under the Privacy Rule, require the Business Associate to comply with the requirements applicable to the obligation;
  • Require the Business Associate to make available to HHS its internal practices, books, and records relating to the use and disclosure of PHI received from, created, or received by the Business Associate on behalf of the covered entity for purposes of HHS determining the covered entity’s compliance with the HIPAA Privacy Rule;
  • At termination of the contract, if feasible, require the Business Associate to return or destroy all PHI received from, or created or received by the Business Associate on behalf of, the covered entity;
  • Require the Business Associate to ensure that any subcontractors it may engage on its behalf that will have access to PHI agree to the same restrictions and conditions that apply to the Business Associate with respect to such information; and
  • Authorize termination of the contract by the covered entity if the Business Associate violates a material term of the contract. Contracts between Business Associates and their subcontractors are subject to these same requirements.[2] (DHHS, 2013)

Don’t Think This Applies to You? Think Again!

Business Associate relationships are voluminous in medical practices.  More often than not, the modern medical practice will have multiple relationships that require a BAA. A few examples may include:

  • Tech support for an Electronic Health Record (EHR)
  • Data storage services
  • Repair services for copiers with hard drives
  • Data destruction
  • Cloud hosting
  • CPA firms that provide accounting services
  • Independent medical transcription services
  • Claims processing

Business Associates May Face Penalties as Well

In June of 2016, Catholic Health Services of the Archdiocese of Philadelphia settled with HHS for $650,000 when it was discovered that they may have violated the HIPAA Security Rule. CHCS provided management and information technology services to the nursing home company creating a Business Associate relationship. HHS alleged that the theft of a CHCS iPhone without password protection compromised the PHI of numerous nursing home residents.

“Business associates must implement the protections of the HIPAA Security Rule for the electronic protected health information they create, receive, maintain, or transmit from covered entities,” said U.S. Department of Health and Human Services Office for Civil Rights (OCR) Director Jocelyn Samuels. “This includes an enterprise-wide risk analysis and corresponding risk management plan, which are the cornerstones of the HIPAA Security Rule.”

Medical practices should be eager to institute BAAs where appropriate as they shift liability to the Business Associate for the inappropriate conduct of the Business Associate. Medical practices should not allow any relationship with contractors to exist without first analyzing the need for a Business Associate Agreement. If not, the medical practice could be required to perform breach notification or pay litigation costs for the actions of the Business Associate. It is paramount that your medical practice attain BAAs when necessary and have a system in place to track them. A proper tracking system will notify you when BAAs expire. Additionally, a proper tracking system will ensure that nothing slips through the cracks.  Understand that if during an audit it is determined that your medical practice lacks the necessary BAAs, has expired BAAs or that they don’t have the required provisions, your entity could be fined for non-compliance with the HITECH Act.

It is important to note that there are a number of exceptions to the Business Associate Agreement requirement that may apply. Some exceptions include conduits, workforce members and janitors. To protect your practice, you should have a qualified professional perform a risk analysis to determine if a BAA is necessary and to fashion a BAA to the specific relationship.

Samarria Dunson, J.D., CHC, CHPC is attorney/principal of Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Alabama.

[1] PHI includes many common identifiers, like a patient’s name, date of birth, address, social security number, full-face photo or any other personal identifiers.

[2] Department of Health and Human Services. (2013) Business Associate Agreement Contracts. Retrieved from

Posted in: Liability

Leave a Comment (0) →

Scale Back Alabama Kicks Off 11th Year

Scale Back Alabama Kicks Off 11th Year

A new year is the perfect time to shed those extra pounds, and the state’s largest weight loss and physical activity competition can help you do that.

Scale Back Alabama is an 8-week statewide program that encourages Alabamians to eat healthier, exercise, and have fun while doing it. Cash prize drawings are held for teams and individuals that lose at least 10 pounds, and participants receive weekly tips on ways they can improve their health.

This year’s contest began with a kickoff today in Montgomery and a challenge from the city of Montgomery. Michael Briddell, director of public information and external affairs for the city, called out fellow city administrators and mayors to join Montgomery in participating in the contest.

“In Montgomery, we are not only concerned about roads and buildings, but also about the health of our citizens,” said Briddell. “We have participated in this exciting program for many years; it’s a fun way to develop some healthy habits, and the results have been amazing. I urge all cities to encourage their staff and their citizens to participate.”

The contest that began with a challenge from American Idol winner Ruben Studdard in 2006 has continued to be a staple in many companies, hospitals, health departments and other organizations, with millions of pounds lost over the 11-year history.

Last year, 10,826 teams of two participated, a total of 21,652 people. More than 1,000 of those teams had each team member lose 10 pounds, and there was a total of 76,485 pounds lost.

The program is free, and two-member teams can register to participate at Participants must be 18 years of age, live or work in Alabama, and must weigh in during the week of January 11–18 at an official weigh-in site. Public weigh-in sites are listed on the Scale Back Alabama website.

Posted in: Health

Leave a Comment (0) →

New CDC Study: Changes in Breast Cancer Death Rates by Age Group

New CDC Study: Changes in Breast Cancer Death Rates by Age Group

Breast cancer death rates among women decreased during 2010-2014, but racial differences persisted, according to a new study by the Centers for Disease Control and Prevention. The findings show changes for death rates from breast cancer by age group for black and white women, the groups with the highest death rates in the United States.

“Our latest data suggest some improvement for black women when it comes to disparities,” said Lisa Richardson, MD, Director of CDC’s Division of Cancer Prevention and Control. “First, the decline in deaths suggests that white and black women under 50 are benefiting equally from cancer treatments. Second, we’re hopeful the lack of difference in death rates between black and white women under 50 will start to be seen in older women.”

Data Highlights

  • There was a faster decrease in breast cancer death rates for white women (1.9% per year) than black women (1.5 percent per year) between 2010 and 2014.
  • Among women under age 50, breast cancer death rates decreased at the same pace for black and white women.
  • The largest difference by race was among women ages 60-69 years: breast cancer death rates dropped 2.0 percent per year among white women, compared with 1.0 percent per year among black women.

The authors noted that the drop in death rates among women may be due to improved education about the importance of appropriate breast cancer screening and treatment, as well as women having access to personalized and cutting-edge treatment.

“The good news is that overall rates of breast cancer are decreasing among black women. However, when compared with white women, the likelihood that a black woman will die after a breast cancer diagnosis is still considerably higher,” said Jacqueline Miller, M.D., and medical director of CDC’s National Breast and Cervical Cancer Early Detection Program.

What Can be Done to Reduce Breast Cancer Risk

Personalized medical treatments combined with community-based cancer control efforts that ensure adequate follow-up and treatment after a cancer diagnosis could help decrease breast cancer death rates faster and reduce differences among black and white women.

Women can take steps to help reduce their breast cancer risk by knowing their family history of cancer, being physically active, eating a healthy diet, maintaining a healthy weight, and getting recommended cancer screenings.

CDC’s National Breast and Cervical Cancer Early Detection Program provides access to timely breast and cervical cancer screening and diagnostic services for low-income, uninsured, and underserved women. It is the largest organized cancer screening program in the U.S. and offers free or low-cost mammograms to women who qualify.

CDC’s Bring Your Brave campaign provides information about breast cancer to women younger than age 45 by sharing real stories about young women whose lives have been affected by breast cancer.

The United States Cancer Statistics web-based report contains the official federal statistics on newly diagnosed cancer cases. CDC and the National Cancer Institute have combined their cancer incidence data sources to produce these statistics. Mortality data are from CDC’s National Vital Statistics System. CDC provides support for states and territories to maintain registries that provide high-quality data through the National Program of Cancer Registries.

Posted in: Health

Leave a Comment (0) →

Health Care Personnel Need Flu Shots, Too

Health Care Personnel Need Flu Shots, Too

The Alabama Department of Public Health, the Medical Association of the State of Alabama and the Alabama Hospital Association have issued a joint statement emphasizing the importance of health care personnel receiving influenza vaccinations, urging this simple but significant infection prevention measure to protect patients.

Influenza is a serious illness that can lead to hospitalization and sometimes death. It is especially dangerous for those at high risk, including the very young, the elderly, and those with other chronic health conditions and compromised immune systems.

It has been documented that health care workers can receive and transmit the flu virus to and from their patients and that annual vaccination of health care personnel is important in preventing the spread of the virus and thus ensuring a safe environment for patients.

Many of these hospitalizations and deaths can be prevented by the widespread use of influenza vaccine, essentially “cocooning” patients from potential flu transmission by health care workers. The CDC estimates that 200,000 Americans are hospitalized each year with the flu and that deaths due to flu have ranged from 3,000 to 49,000 deaths annually.

All health care personnel should receive the flu vaccination annually as soon as vaccine is available. This includes full and part-time employees, staff and licensed independent practitioners, and individuals involved in direct patient care.

For more information, contact Karen Landers, M.D., F.A.A.P., (256) 246-1714 (Alabama Department of Public Health); Rosemary Blackmon, 800-489-2542 (Alabama Hospital Association); or Lori M. Quiller, APR, (334) 954-2580 (Medical Association of the State of Alabama)

Posted in: Health

Leave a Comment (0) →

Flu Shots Recommended for Those 6 Months of Age and Older

Flu Shots Recommended for Those 6 Months of Age and Older

The Alabama Department of Public Health encourages annual vaccination of all persons 6 months of age and older against influenza. One major change for the 2016-2017 season is that children and adults should receive a flu shot instead of nasal spray vaccine. This national recommendation was made because the nasal spray vaccine did not work well for the past three flu seasons.

“It is important for parents to protect their children and themselves by taking flu shots. My advice as a physician is to immunize all eligible family members,” Assistant State Health Officer Dr. Karen Landers said. “The consequences of influenza are worse in certain age groups, both young and old. An annual flu vaccine is the first and most important step in protecting individuals and the community against this serious disease.”

Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During recent flu seasons, between 80 and 90 percent of flu-related deaths have occurred in people 65 years and older.

“Flu season” in the United States can begin as early as October and end as late as May. During this time, flu viruses are circulating at higher rates. A person with the flu may have some or all of these symptoms: fever, cough, sore throat, runny or stuffy nose, headache, muscle aches and often extreme fatigue.

An annual seasonal flu vaccine is the best way to reduce the chances of getting flu and spreading it to others. Vaccination can reduce the risk of influenza-associated hospitalizations for children and adults. It is also associated with a lowered risk of hospitalizations for people with chronic health conditions including heart disease, diabetes and chronic lung disease. Vaccination also helps protect women during and after pregnancy.

In addition to immunization, the public is reminded to follow basic infection control measures to help prevent the spread of the flu. These include covering the mouth and nose with a tissue or cloth when coughing and sneezing, washing hands frequently, and staying at home when sick.

Contact your private physician or your local county health department for a flu clinic schedule. For more information, contact the ADPH Immunization Division at (334) 206-5023 or toll-free at 800-469-4599.

Posted in: Health

Leave a Comment (0) →

Rural Medicine at a Crossroads


Editor’s Note: This article was originally published in the Fall 2015 issue of Alabama Medicine magazine

Part 1 – Feeling the Physician Shortage Pinch

Living in a small town means everyone knows everyone, a tip of the hat speaks volumes, and the nearest neighbor may be a mile down the road. Physicians in these communities are often called upon for a variety of reasons from treating flu and pneumonia, to setting broken bones, to delivering babies. Oftentimes, today’s rural physician is a jack of all trades.

There are many challenges to living in an area that may only have one grocery store or gas station. But, when it comes to the health of Alabama’s residents, many rural counties are further struggling with access to proper health care. As older physicians retire, they leave behind shoes that are tough to fill as fewer young doctors are willing to practice medicine in rural areas.

With Alabama’s rural health care at a crossroads, where do we go next?

Alabama’s 5 million residents routinely struggle with some form of access to health care. Whether it’s finding a specialist or one in primary care, there simply are not enough physicians in Alabama, especially in rural areas…and the shortage is projected to only get worse.

“Already having a relative shortage of physicians compared to urban areas, the trend, which is more pronounced in rural areas, of an increasing proportion of the population who are elderly, has increased the need for rural physicians,” said John Wheat, M.D., professor of community and rural medicine at the University of Alabama’s College of Community Health Sciences and School of Medicine and director of the Rural Medical Scholars Program at the University of Alabama School of Medicine.

Sixty-two of Alabama’s 67 counties have been designated as whole or partial health professions shortage areas, or HPSAs, in which there are not enough physicians to meet the needs of the population. Eight counties have seen their hospitals close, and others are fighting to keep their doors open.

In addition to an older population as compared to urban areas, Medicaid is the primary source of insurance in these rural areas. One-in-four rural residents is eligible for Medicaid benefits, about 10 percent higher than in urban areas. There are many uninsured Alabamians in rural areas who, despite their lack of insurance, still have health care needs.

The shortage of physicians is compounded by the number of older doctors who will retire in the next few years with relatively few young physicians in the pipeline to take their place. This was one of the main reasons the Medical Association worked to pass the Interstate Medical Licensure Compact earlier this year.

“The Compact will allow board-certified doctors with clean records a much faster path to medical licensure in Alabama,” said Buddy Smith, M.D., president of the Medical Association, and a family physician from Lineville. “We want to be able to recruit and attract quality physicians and have them begin treating patients immediately.”

Part 2 – Life in a Small Town

The waiting rooms were packed with nearly every seat occupied on this day as most days for David Arnold, M.D., and Dale Mitchum, M.D. Dr. Arnold, a family physician, and Dr. Mitchum, a general surgeon, work in Geneva County where the population is around 27,000. Dr. Arnold is one of a handful of family physicians in the county, but Dr. Mitchum is the only general surgeon.

Life here moves at a slower pace, with shopping and dining opportunities limited. The challenges of a rural lifestyle require Drs. Arnold and Mitchum to approach their patients and practices in unique ways.

As a family physician of more than 30 years, there’s not much Dr. Arnold hasn’t seen, so he and his staff make sure there is time in their busy schedule during the day for unexpected events that “pop up,” such as cases of sick children or elderly patients or even broken bones.

“Most of my staff have been with me for at least 15 years. We’ve learned to anticipate each other, so our teamwork is exceptional. We wouldn’t be able to see as many patients as we do if we didn’t work so well together,” Dr. Arnold said.

For Dr. Mitchum as the county’s only surgeon, the physician shortage isn’t unique to Alabama. He also treats patients in nearby Bonifay, Fla., and sees how a shortage of physicians anywhere can strain a community’s health care system. As many physicians that have come from his home county of Geneva, he’s seen them leave for a host of reasons to practice elsewhere. Those who stay tend to do so because of family connections.

“It’s hard work,” Dr. Mitchum said. “If you have a relative who is going into medicine who can look to you as a mentor, they can acclimate to the situation. It’s really a nice place to live, but you have to acclimate to the day-to-day slower style of living. It can be culture shock if you’re not used to it.”

Dr. Mitchum understands firsthand about coming back home to take over the family practice. His father, O.D. Mitchum, M.D., was a long-time family physician in Geneva when his son worked as an orderly in the local hospital. After medical school and residency, he came home to stay and eventually practiced with his father for about 20 years before the elder Mitchum retired.

For Dr. Arnold, it was his intention all along to practice rural medicine. The pull of small-town life and the close relationships that often develop between rural physicians and their patients was enough to bring Dr. Arnold to the City of Geneva.

“Now I’m seeing the children I delivered back in the day that have grown up and have children of their own,” Dr. Arnold said. “In these rural counties, the patients are so spread out. Staying in touch with our patients presents its own challenges. I can’t say that we don’t have our own special challenges.”

It’s those “special challenges” and a shrinking number of physicians dealing with them that makes provision of rural health care so different. This is especially true in primary care, where there are fewer students in medical schools across the country choosing primary care as a focus or willing to practice in areas that are designated health profession shortage areas, or HPSAs.

Another challenge for the rural physician, Dr. Mitchum said, comes when a patient needs a specialist. According to him, rural physicians have to deal with all types of problems out of necessity.

“I’m not saying rural physicians are any better at those jobs than physicians in other places, but we deal with those types of things every day. A family physician in a rural setting requires more expertise than one that might practice in an urban setting because we have to be a little bit of all things at all times and do more with less.”

As Dr. Arnold explained, one of his biggest concerns may be access to care, but that’s just the tip of the iceberg. Geneva County has a hospital that’s connected to a nursing home, and he and Dr. Mitchum see patients at both facilities. In addition to the special challenges rural medicine faces, these physicians also have the same burdens of federal regulations to deal with, such as ICD-10, electronic health records, Meaningful Use, etc.

“After seeing patients all day, the next biggest challenge for me is keeping the chart gods happy,” Dr. Arnold said. “Making sure the charting is complete is a huge part of my time when the software required by government regulations will only do so much. The rest is up to me to make sure what goes into the chart is correct.”

Both Drs. Arnold and Mitchum own their practices, and they bear the burden of financing these federal mandates on their own. While these are certainly not easily absorbed by any practice, solo practitioners have an even more difficult time with such expenses. With the current transition to ICD-10, questions remain about reimbursement, delays in payment, and other mandates yet to come.

All three physicians agreed the outlook for rural medicine could be and needs to be improved. The belief that it’s cheaper to practice in a small town is a misconception, they said.

Steven P. Furr, M.D., former president of the Medical Association, and a family practitioner from Jackson, Ala., agreed the regulatory burdens on rural physicians make it more difficult to sustain a medical practice. In fact, Dr. Furr argues the time physicians take to satisfy these federal regulations from Meaningful Use to maintenance of certification to ICD-10, as well as the quality initiatives by insurance companies, negatively affect patient care by overwhelming the physician and staff.

“All physicians are facing these problems, but in rural areas there’s often the lack of staff and training resources to help them migrate through these minefields,” Dr. Furr said.

Physicians enduring the “normal” challenges of practicing medicine and also the special challenges of providing rural care are tremendous assets to the communities they serve.

Dr. Smith stressed that physicians are uniquely situated to help improve both health and the economy, but for rural communities in particular, attracting and keeping them is key.

“When you realize the economic footprint of just one physician is more than $1 million, that’s huge for a small town,” Dr. Smith said. “If you can attract one or two doctors to a rural area, the health and financial benefits to the surrounding area are tremendous.”

Part 3 – From School to Practice…The Making of a Rural Physician

The shortage of physicians is a national problem, and Alabama’s rural communities are certainly feeling the pinch.

According to Allen Perkins, M.D., MPH, professor and chair, Department of Family Medicine, University of South Alabama, one contributing factor for the physician shortage in Alabama could be that medical schools cannot keep up with the health care needs of the state.

“It is clear the overwhelming majority of the medical students come from the urban counties yet the average age of our rural physicians is over age 55. We have an acute lack of mental health services in rural Alabama and yet not training professionals in rural settings,” Dr. Perkins explained.

While not a cure-all for Alabama’s rural health crisis, more physicians is a good thing, and programs to increase the number of physicians in rural areas like the Rural Medical Scholars Program (RMSP) at the University of Alabama’s College of Community Health Sciences and the Board of Medical Scholarship Awards (BMSA) are part of the solution.

RMSP is a highly selective pre-med and medical education program allowing 10 qualified students annually to take graduate level courses, participate in farm field trips, shadow rural physicians, conduct or assist with health fairs and screenings or other community service projects and attend lectures and workshops pertaining to rural community health topics. RMSP is one of several rural health care pipelines in Alabama working to put family physicians into rural areas.

Of the nearly 200 rural Alabama students that entered the RMSP during the past 20 years, about 70 percent entered family medicine and almost 60 percent went on to practice in a rural area. More than 90 percent of RMSP graduates remain in Alabama, yet not all remain in primary care, Dr. Wheat said, as some have gone on to other medical specialties.

Drs. Wheat and Perkins also agree the need for greater funding of the BMSA is key to not only attracting young medical students to the field but keeping them on track for a career in family medicine in Alabama.

The BMSA began in the 1960s as a state-funded incentive program to increase the supply of family practice, internal medicine, and pediatric physicians, and encourages practice in Alabama’s rural medically underserved communities. Several hundred loans have been awarded since the BMSA was created. Students who receive the loans agree to return to a pre-approved medically, underserved community to practice primary care.

“The scholarship board needs to be fully funded,” Dr. Perkins said. “Support for the scholarships that place physicians in rural communities is necessary here.”

Dr. Wheat said he feels the medical schools do their part to train the students, but the scholarships also go a long way to getting the students into the schools. He said the Medical Association’s work to keep and increase the amount of scholarship money available each year helps students decide to stay and practice in rural Alabama.

“More than 90 percent of the first 30 RMSs who chose rural practice were recipients of this [BMSA] award,” Dr. Wheat said. “We see this playing out to the benefit of communities. With a bit more effort on the parts of each of our partners, even the most persistently underserved rural areas of the state will see positive results.”

Family physician Terry James, M.D., said the RMS program was invaluable to him. “I might have had to make different arrangements early on in my career,” Dr. James said. “If not for the RMS, I don’t know if we would be addressing the health care shortage in rural areas at all. I think it goes a long way to fill that void.”

Outside of the state’s two allopathic schools – The University of Alabama School of Medicine and The University of South Alabama College of Medicine – the state has two new osteopathic schools, the Alabama College of Osteopathic Medicine (ACOM) in Dothan, and the Edward Via College of Osteopathic Medicine (VCOM) in Auburn.

“For a state the size of Alabama to have four medical schools is a very big deal,” Dr. Smith said. “Graduating more medical students is a piece of the puzzle and we are very glad to have these two new osteopathic schools here in Alabama.”

Osteopathic medicine is fast-growing with the number of D.O.s having increased more than 200 percent in the past 25 years. Estimates indicate there are more than 92,000 D.O.s practicing in the United States and 540 are in Alabama.

ACOM’s first graduating class will be May 2017, and according to Dean and Senior Vice President Craig J. Lenz, D.O., FAODME, expectations are high for these third-year students who are just now finishing their clinical experiences. According to Dr. Lenz, the real test will be to see how many ACOM graduates come back to their rural beginnings.

“Dothan may not seem like a rural area, but from a medical care point of view, we are. It’s primary care; it’s family medicine; it’s general internal medicine…those are the defined specialties where the need here is the greatest,” Dr. Lenz said.

VCOM-Auburn is also getting its footing and hopes are equally high for the school’s first crop of students. VCOM is a private college that is part of the Edward Via College of Osteopathic Medicine system of campuses across the South.

Gary Hill, D.O., VCOM-Auburn’s Associate Dean for Clinical Affairs, believes more D.O.s entering rural medicine can help solve Alabama’s physician shortage.

“Much misconception about osteopathic medicine is a result of lack of exposure to the osteopathic profession and physicians,” Dr. Hill said. “Many of the old arguments have vanished as osteopathic physicians now have complete practice rights in every state and are fully recognized and accepted in the U.S. armed forces.”

Dr. Mitchum said while the need for more physicians in rural areas is immediate, the solutions may take more time.

“We have a real need here,” Dr. Mitchum said. “More funding for scholarships and gearing residency programs for rural health care should be a priority. We require more expertise than one that might practice in an urban setting because we have to be a little bit of all things at all times. To do that properly, young physicians need extra training, which means we need better funding for scholarships and opportunities. That begins in the schools.”

Part 4 – Rural Medicine…Medical Association Seeks Solutions

Not just sustaining rural medicine in Alabama but actually moving it forward will require the support and buy-in of multiple entities, including the state’s medical schools, state lawmakers and even the communities where the need for medical care is greatest. Training and residency programs must encourage and prepare those willing to serve rural patients to do so, and state-sponsored scholarship programs that help defray the expense of a medical education are a significant part of that. But there’s another very big piece to the rural medical puzzle.

In many counties lacking significant industry or large employers, Medicaid is the most common form of insurance. As Medicaid reimbursements barely cover or don’t at all cover the cost of providing that care, rural practices’ ability to keep their doors open seems under constant threat. just sustaining rural medicine in Alabama but actually moving it forward will require the support and buy-in of multiple entities, including the state’s medical schools, state lawmakers and even the communities where the need for medical care is greatest. Training and residency programs must encourage and prepare those willing to serve rural patients to do so, and state-sponsored scholarship programs that help defray the expense of a medical education are a significant part of that. But there’s another very big piece to the rural medical puzzle.

Alabama has historically offered some of the most meager benefits yet highest qualification thresholds in the nation for its Medicaid program. This leaves many individuals who would otherwise qualify for Medicaid in another state unable to under Alabama’s plan, driving up the rate of uninsured residents, estimated to be close to 750,000 people statewide. But lack of insurance doesn’t stop many rural physicians like Dr. Mitchum from treating a patient even though he must absorb the cost of that treatment entirely, further burdening his practice.

“Every time I hear where we have people without health care, I cringe,” he said. “We do a lot of charity care because we don’t turn away someone in need.”

With higher numbers of uninsured and Medicaid patients in rural areas and with practice visits increasing, Dr. Smith said as far as the Medical Association is concerned, two things the Governor and Legislature could do to improve the outlook for rural medicine are increasing all physicians’ Medicaid payments to Medicare levels and providing Medicaid coverage to the working poor.

“Raising payments rates for Medicaid will cost the state some funds in the short term but should save considerably more over the long term as the anticipated increased access to medical care allows patients’ health to be better managed,” Dr. Smith said. “Untold Medicaid dollars could be saved by preventing costly hospitalizations and long-term care stays whenever possible, in fact that is one of the chief goals of Alabama’s fledgling Regional Care Organization program. The RCOs need enough doctors of all specialties participating so the frequency of those types of costly stays can be mitigated.”

Dr. Smith said the sooner state officials act to address the issue of insurance coverage for the working poor the better.

“Without health insurance, not only are some of these individuals who would qualify for Medicaid suffering but the cost of care provided is borne by the entire health care community,” Dr. Smith said. “It is my hope the Governor and Legislature would work swiftly to tackle this issue.”

While additional funding for scholarships and training, recruiting and attracting more physicians willing to locate in rural areas can go a long way, these alone cannot solve Alabama’s rural health challenges. Dr. Furr said he still believes other incentives are needed to retain physicians in rural areas.

“Whether that is debt service, some type of reduction in income taxes, not just for those who initially come out to practice, but also for those who continue to stay, or perhaps some kind of protection against medical liability for those who practice in underserved areas,” he said.

Delivery of rural medicine is about the ensuring the viability of the people who make up rural communities, Dr. Smith says, mentioning that large employers and economic developers often review an area’s education and health care systems in determining where to next locate a project.

The physicians who call these communities home are vital to rural Alabama’s future, he believes.

“Rural medicine is indeed at a crossroads, but rural communities themselves are as well,” Dr. Smith said.

“What happens in the next several years will determine the fate of ‘country doctors’ and – I think you can say – their patients, too. It’s my sincere hope that we’ll look back in a decade and see the present as just another mile marker, not the end of the road.”

Article by Lori M. Quiller, APR, director of communications and social media

Posted in: Uncategorized

Leave a Comment (0) →
Page 4 of 4 1234