Focus Topic: BIOTECH • CARDIOLOGY

MARCH 2011 / $5

Se r v i n g a n 18 Co u n t y Ar e a , In c l u d i n g Bi r m i n g h a m , Hu n t s v i l l e , Mo n t g o m e r y & Tu sc a l o o s a On Rounds BIOTECH

How Do You Mend A Broken Heart? UAB Graduate Program With Robots And Radio Waves, Lasers And Cold “Stasis” Produces Talented It reads like science fiction, but real life advances in the Biotech Work Force treatment of heart disease have taken By An n B. DeBe l l i s a quantum leap for- ward in recent years. A new master’s degree program in Biotechnology at UAB is producing a Now we are poised on qualified local workforce that could benefit Birmingham’s growing biotechnol- the horizon of another ogy industry. Experts expect the program to attract top talent to the area and wave of interventions to entice venture capitalists to invest in firms launched by graduates. that could mean life Program Director Kathy Nugent, PhD, says the degree program – the for patients who in the past might first of its kind in the south and one of only a few in the U.S. – is essential have been considered too fragile for serving the needs of so many new biotechnology companies. “Because it takes 15 to 20 years for a biotech product to go from discovery to a marketable to survive traditional procedures ... product, the biotech industry has been in adolescence since the mid 1970s,” page 4 she says. “Now, biotechnology is evolving and there are hundreds of companies out there with products. In addition, the biotechnology sector has become a discovery arm for pharmaceutical companies. All of this has created a need for specialty training in biotechnology.” Students in the UAB graduate program in Biotechnology often use facilities Continued on page 12 in the Shelby Interdisciplinary Biomedical Research Building What Happened At OSA?

By St e v e Sp e n c e r

Orthopaedic Specialists of Alabama was founded over 50 years ago. In the NuTech Takes On The World intervening years, OSA grew from a group of three physicians practicing in a small office in Trussville to one of the largest medical practices in Alabama, an organiza- Homegrown Global Leader in Biotech tion with 30 physicians seeing patients in eight full-time offices and eight outreach Don’t feel left out if you don’t im- clinics, each office fully staffed with nurses, PAs, and physical therapy departments, mediately know NuTech. For those along with state-of-the-art equipment that included an imaging center. It’s safe to of us not inside the orthopedic or say that OSA was the Vulcan of Birmingham healthcare, a steadfast institution that would certainly be here forever. spinal surgery worlds, it isn’t exactly Which proves, of course, that nothing is ever really certain. In recent weeks, a a household name. Not yet, anyway. tornado of rumors has ripped through the city. OSA was finished. Dissolved. Gone. But NuTech is getting ready to change Is this true or not? That depends on who you talk to. all that... page 13 Scott Morris, MD Scott Morris, MD, the son of John Morris, MD, one of the OSA founders, Scott Morris, MD repaired the bunions on his daughter’s feet. Continued on page 10 Read Birmingham Medical News online at www.birminghammedicalnews.com

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STD T PRSR Accountable Care Organizations: Making a Mythical Creature Real

By Je n n i f e r H. Cl a r k ability Act (ACA) sets a national agenda of the health care needs of a minimum ACO: for improved access to care, improved of 5,000 Medicare beneficiaries for at • Physicians and other professionals Do you know what a unicorn looks healthcare quality, and lower costs. ACA least three years. The ACO contracts in group practices; like? That is a question almost every focuses particular attention on ACOs as with payers to be accountable for the • Physicians and other professionals person can answer affirmatively with a key reform strategy that will transform entire continuum of care provided to a in networks of practices; ease. Now, have you ever seen a unicorn? the business model of healthcare from defined population. If the cost of care • Partnerships or joint venture While an equally easy question, the an- one based on fee for service and units of provided is less than targeted amounts arrangements between hospitals and swer is likely no. Much like the unicorn, service to one where payments will be agreed to by the payer and the ACO, and physicians/professionals; a mythical creature that we can picture bundled for a group of providers and certain quality measures are achieved, • Hospitals and the physicians/ in our minds but have never seen with will be tied to the quality and value of the ACO and the payer will share the professionals they employ; and our eyes, an Accountable Care Organiza- the care provided. Section 3022 of ACA savings generated. • Other groups of providers that tion presents the same enigma. directs the Secretary of the U.S. Depart- ACOs are the foundation of the the Secretary of the U.S. Department This was the analogy offered by ment of Health and Human Services Medicare Shared Savings Program. Sec- of Health and Human Services deems from California Healthcare Foundation (HHS) to implement an integrated care tion 322 of ACA calls for the Centers for appropriate. President and CEO Mark Smith, when delivery model in Medicare - the Medi- Medicare and Medicaid Services (CMS) he said: care Shared Savings Program - using to enter into contracts with organiza- What are the requirements of an “The accountable care organization ACOs. HHS is expected to issue regu- tions that agree to be accountable for ACO? is like a unicorn, a fantastic creature that lations for the Shared Savings Program the cost, quality, and overall care of a ACA has dictated initial require- is vested with mythical powers. But no at some point in 2011, but, in order population of Medicare beneficiaries ments that an ACO must meet in order one has actually seen one.” to avoid the risk of being left behind, assigned to ACOs. For ACO purposes, to participate. An ACO must have a Accountable Care Organizations providers should begin preparing for the “assigned” means those beneficiaries for legal structure allowing it to receive (ACOs) are a hot topic for discussion transition to accountable care now. whom the professionals in an ACO pro- and distribute shared savings, and a this year and will likely remain in the vide the bulk of primary care services. leadership and management structure forefront of medical news for years to What is an ACO? However, a beneficiary may continue that includes clinical and administrative come. Essentially, an ACO is a network of to seek services from physicians and systems. ACOs must also have sufficient doctors and hospitals in a local delivery providers outside the ACO. primary care physicians participating Patient Protection and system that shares responsibility for to provide care to assigned beneficiaries Affordability Act’s Focus on ACOs providing care to patients. Under the Who can form an ACO? (at least 5,000 Medicare fee-for-service The Patient Protection and Afford- new law, ACOs must agree to manage all Any of the following may form an Continued on page 20 Your business requires attention to detail Rodney L. Dennis, M.D. A. Scott Tully, M.D. Mark S. DeGuenther, M.D. When it comes to your business, we focus on the Thomas E. Moody, M.D. important details – without losing sight of the big Nicole DeSouza Massie, M.D. picture. Vincent Michael Bivins, M.D. Charles E. Bugg, Jr., M.D. Kassouf & Co., P.C., is an established part of the Brian S. Christine, M.D. local community with access to national and Lee N. Hammontree, M.D. international expertise through affiliation with Rupa Kitchens, M.D. (800) 452-1464 CPAmerica International. Whether you’re currently Brain J. Larson, M.D. (205) 930-0920 Bryant E. Poole, M.D. facing challenges or preparing to expand your www. urologycentersalabama.com company into new areas, we offer the carefully Thomas D. Holley, M.D. George W. 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Birmingham Medical News MARCH 2011 • 11 Barriers to Care, continued from page 19 care possible to their patients,” Skochelak in this environment?’” Pryor observed. concluded. “It’s a constant grind to figure out how Whereas re-entry poses problems in to balance all of this, and it has left a last- terms of skill sets, recruitment comes with ing legacy on the physician recruitment myriad issues tied to regulatory mandates. industry.” Stark regulations and anti-kickback laws Fear of regulatory miscue has changed have been tweaked and refined to a point the way facilities now approach recruit- where a great deal of complexity and ment. “We have seen a dramatic shift confusion exists. Entire seminars have almost to the point where the decision- been given on how to define geographic making process has shifted from the Belk & Associates, Inc. service areas and exemptions to the rule administrative area to the legal areas of a “Your Resource for Medical Staffi ng” for hospitals attempting to recruit physi- hospital,” Pryor said. “More often than cians and establish remuneration plans not, we know the gateway to making a that satisfy federal statutes. deal is through the attorney’s office. I Locum Tenens Opportunities For Physicians Curtis Pryor, CEO of national physi- do think there are many cases where the Family Medicine cian recruiting firm Arthur/Miller, Inc., pendulum has swung so far that hospitals noted the intent behind the regulations have gone too far the other way. Instead Emergency Medicine governing recruiting practices was to of doing things that are reasonable and Internal Medicine certify that the interest of patients in a customary, they have offloaded the pro- General Medicine geographic population were being served cess to their legal team, which ultimately Pediatrics first … over and above the interests of the inhibits their ability to be competitive.” Occupational Medicine hospital or physician. However, he con- He added this trend does not bode well tinued, the rules have become so complex for a large swath of American communities Urgent Care that patients are done a disservice when when considering the current physician Karen M. Belk, MBA Hospitalist PRESIDENT the right doctor cannot be placed in the shortage, which is projected to worsen. Al- right location. though Pryor doesn’t have any easy answers, “Through the years, you’ve seen hos- he does hope to see balance return to the Competitive remuneration, mileage, lodging pitals and clinics grapple with, ‘how do system where decisions are made based on and malpractice insurance provided you deal with this … how do you recruit what is truly best for patients. 1.888.892.4DRS www.BelkStaffi ng.com New Discovery, continued from page 14 Fax CV to 256-389-9000 KBelk@BelkStaffi ng.com constitute the scaffold to intertwine and medical field for re-engineered tissue, so accumulate without becoming too tightly we want to move forward with different packed,” says Tambralli, currently a stu- applications as quickly as possible,” Jun dent in the UAB School of Medicine. says. “High density is the problem with flat, Jun likens the revolutionary impact two-dimensional scaffolds.” of this technology on the medical field Scanning electron microcopy showed to the effect of the 3D movie Avatar has that the cotton ball-like scaffold consisted had on the film industry. “We are in the of electro spun nanofibers with a similar beginning stages of this discovery, but I Your Spine diameter but larger pores and a less dense can see great potential for this technology structure compared to the traditional in regenerative medicine,” he says. electro spun scaffolds. Deserves the Best. “In addition, laser confocal micros- our surgeons have over 80 combined copy demonstrated an open porosity and Accountable, years of experience in neurosurgery loosely packed structure throughout the continued from page 11 depth of the cotton ball scaffold, un- and are Board certified by the American beneficiaries), meet patient-centeredness like the superficially porous and tightly Board of neurological Surgery. each criteria, and have processes to: packed structure of the traditional 1. Promote evidence-based medi- surgeon’s extensive training includes at ones,” Jun says. cine; least 6 years devoted to complex and Blakeney compares the discovery 2. Report necessary data to evaluate minimally invasive spine surgery. Your process to trying to put a ship in a bottle. quality and cost measures; and He put the material from a syringe into spine is our expertise. 3. Coordinate care. a bottle first to see how it would work. “That didn’t have a good result, but it Conclusion allowed us to see how it might work,” he While the healthcare industry is says. Blakeney then started trying to cre- devoting significant attention to ACOs, ate structures using funnels, prongs and the concept is still broad in concept and other objects in different arrangements. short on details. Lawmakers left it to “The bowl structure came from different regulators to figure out how to put the iterations of the process and evolved into Your SPIne SPecIALIStS provisions into practice. Until the Cen- what we have now,” he says. ters for Medicare and Medicaid Services Samuel R. Bowen II, MD; E. Carter Morris, III, MD; While they were creating the process, (CMS) issues rules in the coming weeks William C. Woodall, III, MD; Benjamin Banks Fulmer, MD Blakeney says they had no idea of the and months outlining how ACOs will possible ramifications. “It didn’t seem too work in practice, ACOs will remain a Homewood Plaza amazing at the time, but when we sat back mythical creature. 3125 Independence Dr, Ste 200 and looked at the broader applications, we Birmingham, AL 35209 realized it is a big deal,” he says. www.bnspc.com Jennifer H. Clark is an associate in Balch 205-986-5200, toll-free 866-227-7463 The patents for the technology have & Bingham, LLP’s Health Care Law been transferred to start-up company Practice Group. With satellite clinics at St. Vincent’s St. Clair, St. Vincent’s Blount, St. Vincent’s One Nineteen, and Coosa Valley Medical Center. Endomimetics, LLC for further devel- opment. “There are huge needs in the

20 • MARCH 2011 Birmingham Medical News