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William Brannick, MDRadiology2006 Franklin St Ste 200256-539-0457

Joseph Brigance, MDOtolaryngology201 Whitesport Dr SW256-881-5353

Stacey Chavez, MDPediatrics301 Governors Dr SW256-551-4579

Charles Hagen, MDPain Management600 Whitesport Cir256-881-7246

Janet Lawley, MDPediatrics701 Will Halsey Way256-461-7440

Carolyn Taylor-Morns, MDFamily Medicine401 Lowell Dr Ste 22256-539-6900

Roshen Mathew, MDPulmonology725 St Clair Ave256-883-2112

Eleanor Murray, MDObstetrics/Gynecology910 Adams St. Ste 300256-533-7420

Smitha Persaud, MDNeurology1425 Weatherly Rd SE256-881-5570

Jeri Plaxco, DORadiology2006 Franklin St Ste 200256-539-0457

Allison Warren, MDObstetrics/Gynecology910 Adams St Ste 200256-265-6512

MCMS Quarterly Newsletter

elcomeW resident’s

MessageP“Knowing what you know now, would you recommend Medicine to a high school or

college student?” Patients routinely ask this question -- most often they have a relative

interested in becoming a physician. The next question is trickier, “Do you ever rethink your

own decision to become a doctor?”

My answers -- “Yes... and yes (most days).”

There are days, mostly the longer days, that these questions become more difficult questions. It is difficult because of the increased paperwork and EMR requirements. It is difficult because of the changing landscape of even lower reimbursements in the setting of higher insurance expectations. And it is difficult because of the time away from family to pursue a “higher calling” that at times does not appear to be “higher” and a “calling” we often want to leave unanswered.

Yet we must encourage the next generation to go into Medicine because of our good days. These good days outnumber our bad ones and contain moments of meaningful interactions. While it is clear that these conversations, treatments, and surgeries can significantly impact our patients and their families, I wonder if this positive impact is lost in all the minutiae.

These longer days are the days I have to remind myself to both be grateful and practice gratitude. This is hard some days, especially when faced with a stack of never-ending paperwork that always seems to grow when I’m busy taking care of patients. Maybe filling out this paperwork is someone’s idea of taking care of patients-I’m not sure.

Most of us went into Medicine to help people live healthier and better lives. I think we actually tend to do this on our good days for sure and maybe even our bad days.

So, yes, I would recommend Medicine as a career. And yes, I would do all this again. I hope I remember these answers the next time I’m asked...

THE

Spring 2016

Amit Arora, MD

The Madison County Medical Society has been organized to serve its mem-bers as an advocate for the physician/patient relationship, and to promote and preserve the highest standards of professional, educational, and moral conduct.

Our Mission

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Name:Sherrie SquyresSpecialty: Emergency Medicine

Practice Name: HH Emergency Medicine Group

Member Spotlight

2Governmental Affairs Conference

32016 State & Federal Legislature Agenda

5Spring Allergy

8 Upcoming Events

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2016 Executive Board

PRESIDENT: Amit Arora, MD VICE PRESIDENT: James Gilbert, MDSECRETARY: Debbie Kolb, MD TREASURER: W. Scott Lynn, MD

Board of TrusteesGreg Bouska, MD / William Brix, MD / James Byrd, MD

Michael Conrad, MD / Deason Dunagan, MD / Daniel Fox, MD Sharon Gardepe, MD / Akram Haggag, MD / Heather Haley, DO Matthew Hunt, MD / Dawn Mancuso, MD / Alan McCrory, MD

Libby Nord, MD / Brad Rice, MD / Sherrie Squyres, MD Paul Tabereaux, MD / Alex Talalight, MD / Tarak Vasavada, MD

Ex OfficiosPAST PRESIDENT: Jeremy Russell, MD

COUNTY DISASTER LIAISON: John Higginbotham, MD / Norman Sabio, MD MASA FIFTH DISTRICT CENSOR: Brad Rice, MD / MASA PLACE 2 CENSOR: Tim Stewart, MD

REDSTONE ARSENAL LIAISON: David Cole, MD IM RESIDENT REP: Ashley Jackson, MD / FP RESIDENT REP: Tate Hinkle, MD

MEDICAL STUDENT REP: Matthew Carlisle / NAMRC DIRECTOR: Brooke Rawlins

Board of CensorsJeremy Russell, MD / Irma de Leon, MD / Amit Arora, MD / James Gilbert, MD / Debbie Kolb, MD

MCMS Administrative StaffEXECUTIVE DIRECTOR: Laura Moss / ADMIN ASSISTANT/ MEMBERSHIP: Amy McDonald

What do you like best about your current practice?I am an Emergency Physician. My patients are interesting and unpredictable. Just when I think that I have seen it all, I learn something new! I see people who struggle with illness, injury, and situations that I cannot imagine surviving. In Huntsville Hospital’s ER I get to work with an amazing team to do great things. I also serve as HEMSI’s Medical Director and appreciate the tremendous impact that pre-hospital care has on my patients.

What advice would you give to someone just entering the profession of medicine?Go in with your eyes open. I firmly believe that earning admission to medical school is a gift that comes with responsibility. You work hard, but will have a career that is rewarding. Choose where and what you practice with a vision of your life at least 25 years out, and be appreciative of the opportunities you have. It is important to be involved in your community and medical organizations, and to be an advocate for your patients.

Who or what has had the most influence on your professional career?Unlike many physicians, I did not consider a career in medicine from the time I took my first steps. No one in my family had ever even been to college. My parents were hard-working owners of a struggling small business. They were adamant that I get an education, but my father died when I was in high school. My mother and brothers sacrificed to help me through. One particular high school teacher urged me to consider becoming a physician, telling me that I was as capable as any of my male peers and advising me not to limit myself. Then I had an inspiring pre-med advisor, Dr. Joyce Fan, at Houston Baptist University, who convinced me that I could do this. I am eternally grateful. Her favorite saying was “Chance favors a prepared mind!”.

Tell us about yourself- anything you’d like to share…I am lucky to have a supportive husband and two great daughters. Sarah lights up the room, and is an incredible woman. Carolyn is a young adult with autism. She is involved in Special Olympics, and works at Merrimack Hall and Huntsville Hospital. She and her friends are inspirations, and have taught me that everyone has something to offer and needs to be valued. Thank you for the opportunity to share.

nside LookI

Membership Spotlight

our BoardY

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In the cold, early days of February, members of the Medical Association of the State of Alabama (MASA), includ-ing several physicians and family members of Madison County Medical Society, attended the 2016 Governmental Affairs Conference in Washington, D.C. There was an excellent turnout for the meeting with many eager to repre-sent Alabama and their respective communities to their elected officials.

Issues noted that are on the forefront included increasing Medicaid payments, supporting Medicare reform, combating the opioid epidemic, improving electronic health records, reducing physician burnout, supporting the AMA’s Save GME campaign, and advancing telemedicine as well as innovative projects coming from the Center for Medicare and Medicaid Services.

Special activities consisted of an extraordinary tour of Capitol Hill led by Representative Mo Brooks (R – District 5) including being present in the House Chamber for a vote with regards to the Affordable Care Act – a delight for the young children who actually got to sit on the Chamber floor with him. Several attendees were also treated to an exceptional tour of the White House, whose exterior landscape was blanketed with pristine white snow. Lastly, our ProAssurance sponsor representatives took several MCMS members to an outstanding supper, where the importance of professional liability coverage was discussed.

A highlight of the trip occurred during an exchange between Senator Jeff Sessions and an oncologist working with mainly indigent patients in Jefferson County, whereby the willingness to listen to opposing views while stand-ing up for what one believes in was on display. It seemed a true reflection for all those in the room on how to exact changes we are firmly seeking for the betterment of our patients.

Patients depend on us to stay abreast of the issues that will directly affect them so we can do our best to treat the whole person. There is an undeniable important and lasting impact of physician advocacy on Capitol Hill to our communities and practices. With compassionate commitment to engaging our elected officials concerning the welfare of both our patients and fellow physicians alike, a sustained hope exists that this ongoing relationship will produce better health for us all.

MCMS goes to Washington!

Article by: ~Ashley E. Jackson, MD, MS, MBA

MCMS Board Member, AMA RFS Delegate

Back row:Britt GayJulia Boothe, MDDeason Dunagan, MDRao Thotokura, MDClaude SnoddyMiddle row:Ashley Jackson, MDBeverly Jordan, MDAruna Arora, MDAmit Arora, MDKanakadurga ThotokuraElena SuggsCarolyn SnoddySherrie Squyres, MDBottom row:Ashi & Avi AroraEmilia, Sasha & Ana SuggsJay Suggs, MDCongressman Mo Brooks

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2016 FEDERAL AGENDA In 2016, the Medical Association will support:•True reform of the nation’s civil justice system that levels the playing field, discour-ages frivolous lawsuits and does not diminish those protections currently afforded physicians under Alabama law•Relief from meaningful use and EHR-related administrative hassles resulting from unilateral determinations by CMS, to include a new framework for EHR usability to drive EHR improvements that advance the delivery of high-quality, affordable care and a reversal of the current one-size-fits all approach to meaningful use•Relief from the growing burden of administrative and regulatory requirements on physicians, which take time away from patient care and which have shown no improvement in health outcomes•Reform of the Medicare physician payment system that fairly pays physicians for the critical services they provide America’s seniors without tying reimbursement to unrealistic benchmarks•Further expanding all veterans’ access to non-VA physicians so our veterans can receive the care they deserve and need in a timely manner•Repeal of the ACA’s non-discrimination clause (Section 2706) preventing insur-ance plans from offering different payments for services provided by physicians and non-physicians because significant differences in quality can exist•Repeal of ACA’s Independent Payment Advisory Board (IPAB), the 15-member presidentially appointed board with the power to make unilateral decisions regard-ing care delivered to Medicare patients and whose decisions – without formal Con-gressional disapproval – are binding on Medicare•Overhaul of CMS’s fraud and abuse programs, which aim to limit the dishonest activities of a small percentage but which in reality penalize the majority who are honest, hardworking physicians•A streamlining of CMS’s recovery audit contractors (RAC) program, more than 60 percent of whose determinations are overturned when appealed but whose ap-peals process currently has a multi-year backlog•Prescription drug abuse awareness initiatives focusing on education, prevention and treatmentIn 2016, the Medical Association will monitor:•Changes to regulations rescheduling any controlled substance or limiting the sup-ply of a drug that can be written at one time to ensure that patients with chronic pain are still able to get their medication•The flawed concept of CMS’s posting Physician Quality Reporting System data to the Physician Compare website, which includes limited data on physician groups participating in various Medicare quality initiatives, as patients could draw inac-curate conclusions on their physician(s) depending on which information is publicly releasedIn 2016, the Medical Association will oppose:•Creation of a national medical license that could lower standards for delivery of medical care and allow plaintiff trial lawyers to expand their ability to sue doctors in federal law which could supersede Alabama’s medical liability laws•Nationalizing the medical licensure process specifically for Medicare that tele-health companies are pushing in order to boost their business at the likely expense of quality and to the benefit of personal injury lawyers•Lawmakers or bureaucrats in Washington from establishing or setting medical standards into law or regulation, which unlike evidenced-based standards decided by the profession, are onerous, unnecessary and can slow delivery of care while increasing liability•The release of physician payment data because CMS’s methodology provides no context for interpretation, potentially leading patients to make poorly-informed decisions about their physician(s)•Any initiative aimed at reducing prescription drug abuse that singles out or ad-versely negatively impacts law-abiding physician pain management practices and the chronic-pain patients they treat in the overall effort to reduced drug abuse epi-demic.

2016 STATE AGENDAIn 2016, the Medical Association will actively pursue:•Increasing Medicaid payments for all services provided by physicians of all spe-cialties for all Medicaid patients in an effort to expand access to care across Ala-bama for low- or no-income families and individuals•Increasing state monies available for medical scholarship loans to help recruit and retain more physicians to rural and underserved areas of Alabama•Virtual credit card legislation requiring insurers disclose there are fees associated with acceptance of virtual credit cards (a payment method requiring processing fees of the medical practice and rewarding insurers with cash-back or other incen-tives as well as rewarding banks and/or credit card companies)•Prescription drug abuse awareness initiatives focusing on education, prevention and treatmentIn 2016, the Medical Association will support:•Changes to the chemical endangerment of children statute to ensure that a woman with valid prescription for a medication whose newborn tests positive for the substance at birth cannot be charged with chemically endangering the child’s life and no reporting to law enforcement or any governmental entity is required of attending physicians•Eliminating the gap in health insurance coverage for the working poor•Standardizing DNR processes and portability in Alabama•Ensuring payment adequacy for care provided to patients•Reducing administrative burdens on medical practices so physicians can spend more time interacting with patients and less time interacting with computers•Prohibitions on “all products clauses” and rental networks in insurance contracts•Meaningful tort reforms that create a level playing field within the civil justice system, discourage frivolous lawsuits and remove financial incentives for plaintiff lawyers to file non-meritorious claims with the hope of settlement in mind•Preserving the right of patients and their doctors to make medical decisions•Transparency efforts to help patients better understand the level of training or credentials of those providing their care•Tobacco product user fee increases with funds allocated to the state’s Medicaid program and smoking cessation•Emerging practice models allowing physicians greater flexibility, more time with patients and relief from insurer-imposed administrative burdens•Efforts to increase accuracy within the Prescription Drug Monitoring ProgramIn 2016, the Medical Association will monitor:•Changes to Alabama Medicaid’s RCO statute•Medical marijuana and any drug-related legislation•Telemedicine initiatives to ensure the same quality and professional standards apply to all physicians regardless of practice setting or type and also that encour-ages a level playing field•Legislation affecting medical licensure in Alabama•Legislation regulating biosimilarsIn 2016, the Medical Association will oppose:•Legislation increasing physicians’ exposure to liability•Scope of practice expansions for non-physicians that endanger patients•Lawmakers or bureaucrats establishing or setting medical standards into law, which unlike evidenced-based standards decided by the profession, are onerous, unnecessary and can slow delivery of care while increasing liability•Legislation detrimentally affecting the treatment of injured workers in Alabama, granting carriers a statutory advantage in contracting with physicians or allowing non-physicians (like carriers and plaintiff lawyers) to make treatment decisions•Occupational or other tax increases disproportionately affecting physicians•Legislation or regulations preventing physicians from compounding, dispensing, administering or supplying drugs for their patients•Any requirement that physicians perform unreasonable checks of the Prescrip-tion Drug Monitoring Program prior to issuing prescriptions•Granting law enforcement entities unrestricted access to the prescription drug re-cords of patients and physicians within the Prescription Drug Monitoring Program•The sale of any Prescription Drug Monitoring Program data

2016 State and Federal AgendasThe Medical Association Board of Censors has met and approved the Association’s 2016 State and Federal Agendas. These agendas were developed with guidance from the House of Delegates and input from individual physicians throughout the year. As both the Alabama Legislature and Congress begin their work for 2016, there will almost certainly be items added to this list as new issues affecting physicians, medical practices and patient safety arise.

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Spring is in the air, and so are billions of tiny pollens that trigger allergy symptoms in millions of people. This is seasonal allergic rhinitis, commonly referred to as hay fever. It is called Rodney Dangerfield of diseases because it does not get any “respect”. Allergic rhinitis has significant effect on quality of life. It can lead to sinus infections, can disrupt sleep and affect ability to learn at school or be productive at work. The risk of developing allergic rhinitis is much higher in people with asthma or atopic dermatitis and in people with family history of asthma or rhinitis. The allergic reaction is characterized by activation of mast cells and basophils. These cells produce inflammatory substances, such as histamine, leukotrienes and others which cause nasal congestion, itching, sneezing, runny nose and red/itchy/watery eyes. Over several hours, they activate inflammatory cells such as eosinophils that can cause persistent symptoms. 20% of US population suffers from allergic rhinitis. Trees pollinate during early spring and grasses during late spring. Cedar is the earliest tree that starts pollinating in Huntsville. This is quickly followed by Maple, Box-elder, Oak, Elm, Cottonwood and Pine. Yellow dusting seen during spring is due to pine pollen but it is not a strong allergen and is not airborne long to cause problems. Grass pollens peak during April and May. The treatment of allergic rhinitis includes reducing exposure to allergens, medication therapy and allergy shots. In most people, these measures effectively control the symptoms. To reduce exposure Keep windows closed at all times. Use air conditioning, Minimize outdoor activity when pollen counts are high. Peak pollen times are usually between 5am and 10 am. Keep car windows closed, Take a shower after spending time outside, and don’t hang sheets or clothing outside to dry. Up-to-date pollen information is available from the National Allergy Bureau http://aaaai.org/nab/index.cfm. Medication treatment: Start medications a week prior to and use it during the season. Medications treat the symptoms but not the underlying cause of allergies. As soon as you stop the medication symptoms will return. Available OTC medications include non-steroidal nose spray Nasalcrom, less-sedating antihistamines such as Allegra, Claritin and Zyrtec and Nasal steroids Nasacort AQ, Flonase and Rhinocort aqua. Prescription medications include nasal antihistamines Astelin, Astepro, Patanase, Oral antihistamine Xyzal, Oral leukotriene antagonist Singulair and Nasal steroids Nasonex, Nasarel, Omnaris, Veramyst, Qnasl and Zetonna, Dymista, a combination of Flonase and Astelin. Among these the Nasal steroids and Dymista are most effective especially when used regularly. Allergen immunotherapy: Allergy shots are the most natural treatment available. The nature’s proteins are extracted from pollens and standardized. This treatment is used for those with moderate to severe allergies who are not controlled on medications. Allergy shots reduce the need for medications and provide long-term benefit after 3-5 years of treatment. Research has shown that allergy shots prevent the development of persistent asthma and reduce the development of allergy to new things. The allergy shot program consists of a “buildup phase” where individuals start with a small amount of allergenic extract and progress on a weekly basis to reach a “maintenance dose”. This is the dose that gives clinical benefit. Once a patient reaches this dose, he/she can get shots once every 2-4 weeks during the “maintenance phase”. It generally takes 5-10 months to reach the maintenance dose. Rush Immunotherapy or desensitization is a procedure that permits a more rapid build-up. It involves repeated injections over a 6-hour period. Pre-treatment, with medications prior to the procedure reduces the chances of allergic reaction. The advantages of Rush Immunotherapy include quicker clinical benefit for patients and savings of time. “Sublingual immunotherapy” or SLIT is a form of immunotherapy that is given as a daily pill that dissolves under the tongue. It is given daily starting several months before the season and through the season. The first dose is given in the clinician’s office, but after that, patients can take it at home. This type of treatment does not involve getting shots and is only available for those who are allergic to grasses and ragweed. Allergy-Immunologist can help identify the cause and formulate a specific treatment program for your difficult to control patients with seasonal allergic rhinitis.Alabama Asthma Allergy and Immunology Center www.huntsvilleallergy.com

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Madison County Medical Society3330 L&N Drive, Suite IHuntsville, AL 35801

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