BMN Blog

“The Only Constant in Life Is Change.”- Heraclitus

As a healthcare administration professor with the recent global healthcare-related events in mind, I often think about the future of our healthcare industry.

Overview

There is no doubt that technology has brought improvements to almost every professional field, including healthcare. While the medical field has been slower to adopt technology and software improvements, we are seeing the use of web-based software increase in place of using paper, which is due in part to mobile and tablet devices that have become commonplace. We should now focus on utilizing the technologies that we’ve created to set a new standard of secure but, accessible provider and patient data.

The Alabama Pediatric and Congenital Heart Center at Children’s of Alabama continues to achieve unsurpassed results and bring the latest technology and procedures to children and adults with congenital heart disease in Alabama and throughout the Southeast. Despite the challenges of the COVID pandemic, the volume of patients has remained steady, demanding adaptability among the 300 members of the Heart Center.

The 21^st Century Cures Act is a landmark bipartisan healthcare innovation law that went into effect on April 5, 2021. Cures includes provisions to promote health information interoperability and prohibit information blocking by “Actors,” which include health information networks, HIEs, health information technology developers of certified health IT, and health care providers.

Diabetes is the epitome of “an ounce of prevention is worth a pound of cure.” That was the driving force behind our division’s advocacy efforts that led to a change in Medicaid coverage requirements for continuous glucose monitors (CGM) for children with type 1 diabetes.

Through ongoing advancements in healthcare technology, healthcare providers and patients can now access broader communication applications thanks to advances in data storage. These advancements have improved collaboration, increased communication outlets and have transformed the way data is stored and shared.

Hernia is a problem which has plagued humankind since the beginning of written history. From the Greek word “hernios” meaning “bud” or “offshoot”, it was originally thought to be a problem that was created and exacerbated by coughing. Treatments originally consisted of stooping and bending, which were erroneously thought to reduce the bulging and improve the symptoms. Surgical fixation was poorly understood and attempts to perform surgery were messy affairs that were frequently fatal.

When the Birmingham Medical News asked me to write a blog, they told me I could write about anything. Anything? Anything. 

As we all know, 2020 was a difficult year in the healthcare due to the COVID pandemic. Now, with a large number of people vaccinated, there is hope that things will stabilize.

It took a trip to a textile store… yes, a textile store. It was late 1940s, and Michael DeBakey (who would later become the most innovative and most distinguished cardiovascular surgeon in the world) was thinking how to address a major clinical need for a deadly disease – ruptured aortic aneurysm.

Albert Einstein just died of one, with echoes of his sudden death reverberating in the world and in the medical community. Einstein consulted doctors, including DeBakey, but no treatment options existed at that time.

It is the most complex cardiothoracic surgery performed in newborns, one in which surgeons literally construct a new, larger aorta for babies born with hypoplastic left heart syndrome (HLHS). Called the Norwood procedure, it must be done within the infant’s first week of life, followed by a second surgery when the baby is three to six months, and a third at age four or five.

Many practices are currently leveraging Microsoft Office 365 for e-mail, file storage, and internal collaboration. Unsurprisingly, the number of threats targeting this information (phishing attacks, compromised credentials, etc.) continues to grow at a rapid rate.

In this day and age of advanced technology, physicians have access to abundant clinical information at their fingertips. Electronic medical record (EMR) systems can provide physicians with the data they need to care for their patients at virtually any time or place (whether or not these systems are user-friendly is another story).

Eric Wallace, M.D., the medical director of UAB eMedicine, and Curt Carver Jr., Ph.D., vice president for Information Technology, both at the University of Alabama at Birmingham, were appointed by Governor Kay Ivey to serve on the Broadband Working Group to provide input and guidance on how to allocate funding from the federal Coronavirus Aid, Relief and Economic Security Act. 

Heart South Vascular Institute at Heart South Cardiovascular Group, has successfully performed its first radial to peripheral intervention, and is one of the earliest adopters of this new technology in the area.

The COVID-19 pandemic has challenged virtually every aspect of life, and for many of us, sleep has been severely affected.

The National Institute of Standards and Technology has published a bulletin that provides several key reminders for people who have had to shift to working remotely as a response to COVID-19. The guidance, which can be found in full at the link below, summarizes previous NIST guidelines for working safely when out of the office.

On March 19, the Alabama Department of Public Health (ADPH) issued mandatory health orders to medical practices statewide to delay all elective medical and dental procedures until April 6^th. On March 28, the order was amended such that non-emergency procedures are postponed further notice. Under these guidelines, Medical and dental practices have had to reduce office hours and/or close their office.

Each year, the landscape for physician practices has experienced seismic shifts in the areas of reimbursement, regulatory requirements, technology, and competition. Meeting the challenges of such a shifting landscape is a formidable task for even the most sophisticated of physician practices. Doing so requires a keen eye on what’s ahead and careful planning. So, let’s look at a couple of trends that should be considered in the planning process for 2020.

We live in a three-dimensional world, where many physicians and surgeons diagnose, treat and operate on patients using flat images, but that is not the case at Children’s of Alabama. Seven years ago, I helped open Children’s first 3-D laboratory, which provides cutting-edge technology through advanced visualization. We help our medical staff provide a clearer, less invasive and more realistic view of joints and organs. With this type of information, doctors can also give patient families a clearer vision and understanding of their child’s condition.

With more healthcare organizations moving to VoIP (Voice-over-Internet Protocol) for their phone and communication needs, it’s important to understand the technology and how to make it work for your business needs. So let’s start with the basics.

The effects of a stroke are unique to each patient and everyone’s path to recovery will look different. However, there are inherent truths to stroke treatment that should guide clinical decisions on the best care for patients.

According to the Medical Group Management Association (MGMA), the fourth most challenging issue in practice management is collecting from self-pay and high deductible patients. With patient payments representing a growing portion of practice revenue, re-engineering how patient collections are approached is crucial to practice success.

Transcatheter aortic valve replacement, or TAVR, is a minimally invasive alternative to open heart surgery for patients who require replacement of their aortic valve due to severe aortic stenosis. Although previously available only to patients at high or intermediate surgical risk, in August the Food and Drug Administration approved both of the latest-generation TAVR valves for use in patients at low surgical risk. This is a large group of patients who are typically younger and/or more active than those at higher risk. Until now these patients' only option was open heart surgery.

Information Technology now dominates almost every part of our daily lives and in most cases, we do not have to think or worry the outcomes. We trust that what we input on our phones, keyboards and tablets will result in the right answer. With these repetitive motions it has allowed our business to grow and flourish. But what happens when those items break?

VoIP is a game-changer for the healthcare industry’s communication landscape, allowing for quicker, more reliable communication. However, it also brings with it a multitude of HIPAA concerns that can be confusing to navigate.

Yesterday, I received a text from my eye doctor informing me that I have not scheduled my yearly exam and need to make an appointment. The notification was an electronic version of the Annual Patient Postcard reminders. But unlike the old postcards, the text included links to automatically call the office or direct me to visit self-scheduling. Booking that appointment has been on my to-do list for weeks, but I seem to only remember to do it after the office has closed. Yet, with one click and about two minutes of my time, the mission was accomplished. That’s when it dawned on me – healthcare is going “Amazon.”

The “just right” theme repeated in the classic fairy tale of Goldilocks and the Three Bears hits close to home at Children’s of Alabama’s Pediatric Imaging Center (PIC), where services are tailored especially for kids. Every inch of the PIC, located at Children’s South Pediatric Outpatient Center in Birmingham, is designed with children in mind to ensure their experience is “just right.”

Sound processes are essential to the success of any business. This is even more important in healthcare, where the ever-changing environment makes process improvement vital in order for a practice to prosper.

Millions of patients around the world wear contact lenses to correct their vision.¹In fact, research suggests that contact lenses provide patients with benefits such as better perceived cosmetic appearance, better social acceptance, and a better ability to play sports compared to glasses.^2-4While most contact lens wearers use soft contact lenses for cosmetic reasons, some patients wear specialty hard contact lenses because they are the only way that they can achieve functional vision without undergoing surgery to correct a visually debilitating eye disease like keratoconus (a degenerative disease that results in an irregularly shaped cornea).⁵In other cases, patients who suffer from moderate to severe dry eyes wear specialty contact lenses because they have the ability to make their eyes comfortable enough to effectively function.⁶While there is more than one type of specialty contact lens that can help patients with these conditions, scleral lenses have emerged over the past few years as the contact lens treatment of choice for these difficult-to-treat patients.⁷

As our society transitioned to mobile phones, a frequently overheard question and related advertising theme was “Can you hear me now?”

In 2016 Forrester Research analysts focused their attention on emerging social phenomenon in consumer behavior. They identified several key social trends that are impacting our industry’s ability to adapt to changing policy, market trends and patient needs. One trend they observed was the rapid adoption of new solutions and the abandonment of solutions that didn’t immediately provide value. This trend was seen across all industries.

At this point, nearly every American has heard about the opioid crisis. With increasing scrutiny from governing bodies regarding opioids, pain physicians are tested in treating patients in the challenging chronic pain population. While non-opioid medications, therapy and procedures have their place in treating chronic pain, what are physicians to do when patients fail all of these options? One treatment to consider is spinal cord and peripheral nerve stimulation.

Two years ago, the Children’s of Alabama Community Healthcare Education Simulation Program, or COACHES, launched with a mission of improving pediatric care in community hospitals throughout Alabama.

During my 30 years in healthcare consulting, I have seen several reform initiatives come and go.

In many cases, the initiatives have enhanced the ability of consumers to access insurance coverage and ultimately healthcare. In 1993, President Clinton proposed legislation that led to growth in Health Maintenance Organizations (HMOs) and also the HIPAA privacy standards which are still in place today. In the 2000s, President George Bush proposed changes to the Medicare program that led to the implementation of Medicare Part D coverage.

A look at the calendar tells us that we only have a short time left in 2018. That means many practices will be looking to complete their Security Risk Assessments in order to either qualify for the 2018 Merit-based Incentive Payment System (MIPS) or to simply fulfill their obligations to comply with the HIPAA Security Rule.

National Cybersecurity Awareness Month was created in 2004 by the Department of Homeland Security and the National Cyber Security Alliance to remind us that each we all have the power to make the Internet safer.

Peripheral angioplasty is a minimally invasive procedure that can be performed now in an outpatient setting under local anesthesia for the treatment of peripheral artery disease (PAD). Medical technology has played a significant role in furthering this trend. PAD is a common circulatory problem in which the narrowed arteries reduce blood flow in the legs causing leg pain, numbness and/or discoloration.

As the summer months are a time when many people take vacations, it is a good time to get veins treated. So, today, we are decoding the facts about one of the latest minimally invasive technology offerings at the Alabama Vein Center: VenaSeal™ closure system.

One of the most frustrating things PC users can experience is slow performance or freezing while using their normal programs. It can make even the simplest tasks take several times longer and greatly slow down your work day, which impacts patient care as well. While it will sometimes mean there could be hardware issues and your PC needs an upgrade, there are several steps that you and your IT support can take to speed up the performance of your PC through cleanup tools, anti-virus and anti-malware scans, or optimizing settings.

Dr Beth Malizia and Alabama Fertility Specialists are thrilled to announce the first pregnancy in the state of Alabama from a new technology that allows for the intra-vaginal culture of embryos. This new technique using a device (INVOcell) cultures embryos within a patient’s vagina rather than utilizing the complex incubators of an IVF laboratory.

One of the greatest challenges facing the healthcare industry isn’t a political issue, it’s a geographic issue. What if I told you that approximately 50 million Americans (17 percent of the total population of the US) have limited access to high quality healthcare because they live in rural communities? Rural healthcare has a unique set of challenges including not only geographic but also economic and lifestyle factors.

Over 10 million people in the Unites States and over 200 million worldwide have peripheral arterial disease (PAD).¹ Critical limb ischemia (CLI), defined as ischemic rest pain or tissue loss resulting from arterial insufficiency, affects approximately 1% of the adult population, or 10% of patients with PAD.² Further increasing the impact of CLI is the poor prognosis it carries. Major amputation occurs in 33-67% of patients with ischemic tissue loss at 4 years.^3,4 Mortality at 2 years in CLI patients is as high as 40%, and appears to be even higher in those with tissue loss. The vast majority of these deaths are due to cardiac events, cardiovascular disease, and cancer, rather than PAD.^4,5

Other than skin cancer, prostate cancer is the most common cancer in American men. Although it is common, it is still one of the least well-known cancers and a diagnosis can cause confusion about treatment, symptoms, and potential side effects. In search of a minimally-invasive treatment for your prostate cancer? Through our partnership with Vituro Health, Urology Centers of Alabama is the first and only in the state to offer High Intensity Focused Ultrasound, or HIFU treatment.

Malware are created with the intent to damage or disable our mobile devices, computers or servers. These attempts can include disrupting computing or communication operations, trying to steal sensitive data, accessing our private networks, or hijacking our systems to exploit their resources. With the tremendous growth in email and internet use over the last couple of decades, we have seen a corresponding explosion of growth in malware

I recently visited a specialty practice at a major health system. As I approached the registration desk a posted sign directed me to a standing kiosk to sign in. The family member I accompanied to the visit was unable to stand at the kiosk, so I provided the needed information and signed her in.  Although it was a quick and seamless process, I was concerned because if I needed assistance, there were no employees to ask.  Many practices have implemented kiosk sign-ins and have someone to assist a patient with the process if needed.  Practice administrators have made the decision to implement kiosk to assure verification of the current insurance policy and prompt the patient to pay any out of pocket expense before they see the doctor.  Many of the kiosk solutions allow a pre-registration via email to allow the patient to populate data and upload information from their own device at their convenience.  Benefits of Kiosk Sign-ins include: reduction in the staffing at the front desk, decrease in patient wait time, and most impressively is the increase of time of service collections.

One of the greatest challenges healthcare organizations face today is clinical application interoperability – the communication between computer systems, applications, or software to allow them to work in conjunction with one another.

It is especially important for smaller practices to be mindful of Electronic Protected Health Information (ePHI) security regulations – a breach of ePHI can lead to costly notification requirements and potential monetary penalties under the HITECH Act.[1]  Managing physicians of small independent practices hold many responsibilities, including the duty to comply with the Security Rule within HIPAA regulations.  This article provides a brief overview of federal ePHI compliance safeguards required in a practice.  While not meant to be a comprehensive discussion of all requirements, it highlights legal considerations and safeguards a practice must implement to comply with HIPAA ePHI regulations.  The federal Security Rule under HIPAA requires a health care provider (typically known as a Covered Entity[2]) to have the minimum ePHI safeguards, listed below.

 Mitral valve regurgitation has been described as a very common cardiac valvular abnormality which is under recognized and under treated even in industrialized countries

As today’s healthcare drive pushes practices even further down the path of pay for performance versus the older models of pay for volume, administrators and executives throughout healthcare are researching and implementing ideas to provide an overall better experience for patients.

In 2012, I read this article that made me question much of what I thought I knew about my profession of serving clients as a guide for their financial decisions. The designation following my name for which I had worked so hard at obtaining? Good, but not enough. The incredible technology –from complex financial forecasting to automated investment management?  Lacking. 

According to the Ponemon Institute – www.ponemon.org  - the average cost of a data breach was $3.62 million dollars. This breaks down to $141 dollars per stolen record. International Data Corporation – www.idc.com – estimates that globally data storage will grow ten-fold by 2025 total of 163 zettabytes (a trillion gigabytes) by 2025. Data is stored in a vast range of devices including your smart phone, laptops, notebooks, workstations, tablets and even on your smart TV. Most businesses focus on the technical aspects of how to avoid data breaches (firewalls, anti-virus, security patches, etc.) and often how physical technical assets are destroyed at the end of their life are often overlooked or do not have a set process in place.

Almost everyone has seen the ads for the new anticoagulants at this point. However, many Americans still remain in the dark regarding what atrial fibrillation (Afib) is and it’s potentially devastating consequences. Despite increasing efforts to improve the awareness for atrial fibrillation, many still do not know it’s signs and symptoms or that it is a progressive disease. Afib is the most common arrhythmia in the world affecting 3-6 million Americans with projections of up to 16 million by the year 2050.

A rare cancer of the eye known as uveal melanoma has affected a specific demographic, mainly women, who attended Auburn University in the late 1980’s and early 1990’s. Uveal melanoma is the most common cancer in the eye, but overall its incidence is extremely low, known to affect only 4.3 per 1 million people in the US.  While these cancers are uncommon, they can lead to unfortunate outcomes including total removal of the eye, and even aggressive cancers spreading throughout the body, making it crucial to catch them early.

In the past few years, when we discussed patient satisfaction it pertained only to patient surveys and results. Some managers believe surveys are utilized by specialties, such as, plastic surgery who primarily practice on a cash basis.  Consumerism is here to stay! Cost and quality will create a level playing field in healthcare.  When working with a practice, I love to sit in the waiting room to see operations from the patient’s point of view.  I also search the specialty online to review the competition and the effectiveness of the practice’s website; I may also see online reviews.

In a world of rapidly accelerating technology, our lives have become a 24hr sprint of endless tasks to be completed within a certain timeframe. Doctor offices are inundated with patients many young in age presenting symptoms such as high blood pressure, racing heartbeat, headaches, chest pain, random sweats, insomnia, and gastrointestinal problems. With the increased volume of patients and the demanding time constraints experienced in physician offices, these physical symptoms are often treated individually. The physician may prescribe medication, make recommendations on possible lifestyle changes, yet the symptoms remain. Effective treatment has to go deeper. These patients could be simply suffering from stress or they could be dealing with a more problematic subset of mood disorders: Anxiety Disorders.

Over the last year or so, cryptocurrencies and blockchain technology have grabbed the attention of global markets and its participants.

Most companies assume their cyber security is pretty good… until a breach happens and then you find out where the holes were. We often find that apathy and a lack of being proactive may cost you lots of money. An annual security audit is a necessity for all medical practices and companies in todays ever changing world of technology. It is a vital part of protecting your digital assets and cyber security plan for your organization. It’s not just about discovering any vulnerabilities or shortcomings, rather it’s about opportunities to strengthen your network security.

We all recognize that healthcare is evolving at a rapid pace. With this evolution, the need to share patient information to positively impact quality care, provide a seamless patient experience, plus save time for your staff to coordinate care is of critical importance.  By making the most of new technology, today’s office equipment can easily and securely, help you do just that. 

Every year, new hearing aid technology is introduced to the market. New technology in hearing aids boasts updates and changes in directional microphones,  sound processing algorithms, noise reduction features, amplitude and frequency compression, and audio data transfer between hearing aids, just to mention a few.  What is often forgotten however, is that the primary objective of a traditional hearing aid fitting is to ensure that the patient is receiving the appropriate amount of amplification for their hearing loss at each frequency.

Approximately 12 million Americans suffer from peripheral artery disease (PAD), yet general awareness of the disease is at 25%. Patients over the age of 50 with a history of smoking, high cholesterol, diabetes, hypertension, and heart disease are at the greatest risk.  A staggering 50% of PAD patients have unrecognized symptoms that may progress directly to severe disease.

Robotic assisted surgery has seen an explosion since it was first introduced about 20 years ago with over 4 million procedures performed. Although minimally invasive laparoscopic surgery has been around longer, certain limitations existed within this field. Laparoscopic surgical instruments lack wristed movement, essentially forcing surgeons to operate with chop sticks. The effect was difficulty performing certain procedures and working at difficult angles. Robotic surgery allows wristed action of the instruments, better optics (depth perception), surgeon control of the camera, and better ergonomics. While there is not any significant change in long term outcomes, there are studies suggesting decreased pain and shorter hospital stays.

The state’s first spine procedure using the Mazor Robotic System in conjunction with intraoperative imaging was performed by neurosurgeons with Neurosurgical Associates, PC at St. Vincent’s Birmingham.

Did you know a single patient health record can earn cybercriminals 10 times the price of a stolen credit card number on the black market?

The Office of Civil Rights is auditing small and large healthcare providers alike, imposing multi-million dollar fines in some cases. Meanwhile, the same electronic storage, mobile devices, and cloud-based applications that patients, doctors, and healthcare staff want to use often compromise a practice’s ability to keep that patient data safe.

It has now been two years since the implementation of ICD-10, everyone survived! While denials have been minimal, the goal of implementing ICD 10 to acquire more specificity and a complete picture of health has not been fully achieved.  Physicians and managers have created a new set of shortcuts to assure payment of claims, relying on paper superbills or inappropriate conversions from ICD 9 to ICD 10.

Every caregiver strives to expand the services they provide to their patients, while also improving quality of care and safety. These are certainly our goals at the Children’s of Alabama orthopedic clinic.

Albert Einstein once said, “Life is like riding a bicycle. To keep your balance, you must keep moving.” Moving is one thing the City of Opelika is determined to do…even on two wheels.

Tumor Treating Fields or TTF as it is more commonly known is a recently developed method by which malignant brain tumor cells are prevented from reproducing. Shelby Baptist Medical Center and Generations Radiotherapy & Oncology PC has begun therapy on its first patient using this entirely new approach in the treatment of malignant brain tumors with the Optune TTF system.

Prostate cancer is the second most common cancer diagnosed in American men and the second leading cause of cancer death. While a majority of men will be diagnosed after the age of 65, younger men do need to consider screening for prostate cancer, especially if risk factors are present such as African American heritage or a family history of prostate cancer.

Most all medical practices are preparing a MACRA project this summer. Our healthcare team has had the opportunity to speak to many physicians and managers regarding preparation for the transition from volume to value based medicine and reimbursement.  A large project can be overwhelming for any practice but this is more than a project, it is a culture change!

For years now, I have seen patient after patient frustrated with stubborn fat in areas that do not respond well (or quickly) to diet and exercise. Their concerns are very common, and certainly not something of which to be ashamed. Patients also frequently ask me for my recommendations on non-invasive cosmetic treatments designed to address these issues, like CoolSculpting®, Sculpsure®, Vanquish™ or Zerona™.

When choosing an IT company, you’re selecting a partner that will be yoked to your business. As such, it is not always the traditional, technology-related questions that reveal the most helpful insight into a potential partner.

In the last 10-15 years, the use of mid-level providers has increased to expand the base of patients in many practices.  The Nurse Practitioner scope of practice is more flexible and there are specialty designations available to foster expertise in certain areas.  The insurance companies have expanded the number of plans covering a mid-level provider’s services.

Moving a medical practice can be a daunting task. A medical office move can be a result of needing a bigger space, physician retirement, or practice acquisition. While making patients aware of a major change is most certainly a priority, it is equally important to make sure their documents and all office data and service equipment survives the move as well.