Provider Reimbursement Disputes Go Back to 1984 Following Supreme Court’s Regulatory Reset
By
Onecould forgive the healthcare industry for thinking someone drove Doc Brown’s DeLorean time machine through One First Street when it awoke on Friday, June 28, to a blast from the past.
regulatory framework.
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No, Ronald Reagan is not the President; Bruce Springsteen’s Born in the U.S.A. album is not this summer’s biggest musical hit; and we have all known for some time who we are going to call when a poltergeist marauds through town. But on June 28, 2024, the United States Supreme Court sent the healthcare industry and its chief regulator, the Department of Health and Human Services (“HHS”) and its Centers for Medicare and Medicaid Services (“CMS”), back to 1984 when it decided in Loper Bright Enters. v. Raimondo and Relentless, Inc. v. Department of Commerce and overruled Chevron U.S.A. Inc. v. Nat. Res. Def. Council, Inc., in a 6–3 decision.
The Supreme Court’s decision clarifies one thing – that courts, not agencies, have the ultimate authority to interpret Congressional statutes. The new Loper Bright framework poses many questions to the reimbursement landscape and is likely to result in increased provider challenges to agency action, and more success for providers in those challenges. Below are some provider considerations in key reimbursement areas given the new
How Can Providers Use this Change for Medicare Reimbursement and Appeals?
1. Contractor overpayment demands. There may be new opportunities for providers to limit the Medicare contractors’ ability to use statistical extrapolations or statistically valid random sampling (“SVRS”) to recover substantial alleged overpayments from providers. For some providers, these overpayments spell a death-knell on their business. Providers may now challenge the government’s use of extrapolation, including the methodologies that contractors will implement under the Medicare Program Integrity Manual and other Medicare guidance, to argue that such extrapolation, as implemented, overinflates a provider’s payment error, is unreliable or statistically invalid, or is otherwise problematic. These challenges may lead to courts developing their own criteria for when and how extrapolation should be used.
2. Settlement potential. Medicare contractors may now be willing
to utilize the settlement authority conferred upon them by federal law to resolve overpayment demands rather than risk losing during the appeal process. Although many providers have found CMS’ settlement conference facilitation initiative to be an unhelpful alternative dispute resolution process following an overpayment demand appeal, particularly given they only apply when the overpayment is not based on a statistically valid sample, the government may become more willing to offer such settlements if providers succeed in restricting CMS’ ability to utilize extrapolated overpayments.
3. Self-audits and potential refunds. CMS’ requirements that providers review and refund potential overpayments may now be subject to heightened scrutiny and new interpretation, including the timeliness of identifying and returning such overpayments and what constitutes an overpayment. Notably, the statute granting CMS
Evan Schrode, J.D.
Ross Burris, J.D. Polsinelli, PC
Rural Cancer Patients and Health Care Providers Face Challenges See pg. 9
Seton Expands
Oncology Research
The Importance of Well-Woman Visits for Gynecologic Cancer Prevention
RBy Tiffany Redfern M.D., FACOG, Texas Oncology–South Austin
egular well-woman visits are important for maintaining overall health and early detection of potential issues, including gynecologic cancers. These appointments offer comprehensive care that goes beyond reproductive health, providing an opportunity to address lifestyle, preventive measures, and risk management. Well-woman visits can be appropriate for teen girls, adult women, and transgender or non-binary people who have a female reproductive system.
Despite busy schedules, skipping these appointments can lead to missed opportunities for early detection and intervention for gynecologic cancers, especially since many are initially
asymptomatic and early treatment is critical for the best outcomes.
What does a well-woman visit consist of?
A well-woman visit is a routine check-up that includes a thorough evaluation of one’s health, screening for potential issues, and counseling on maintaining a healthy lifestyle. These visits are tailored to one’s age, health history, and risk factors, ensuring a personalized treatment approach. Well-woman exams can include breast and pelvic exams, screenings for sexually transmitted infections (STIs), and discussions about contraception and sexual health.
Early detection of gynecologic cancers
Gynecologic cancers, which include cervical, ovarian, uterine, vaginal, and vulvar cancers, can pose significant health risks but are often more treatable when detected early.
According to the American Cancer Society, in 2024, over
SHOULDN’T YOU BENEFIT
116,000 women in the United States are expected to be diagnosed with gynecologic cancer, and more than 30,000 will die from these diseases. In the state of Texas in 2024, 7,800 women will be diagnosed with cervical, ovarian, or uterine (endometrial) cancer.
• Cervical Cancer: Approximately 13,820 new cases of cervical cancer will be diagnosed in the U.S., with over 4,300 deaths. Most frequently found in women between the ages of 35 and 44, cervical cancer is rarely found in women younger than 20. Routine Pap smears and HPV (human papillomavirus)
tests during well-woman visits can detect precancerous changes in cervical cells, allowing for early treatment. HPV, the most common sexually transmitted infection in the United States, is a virus that causes more than 90% of all cervical cancers, and risk can be significantly reduced with appropriate vaccinations.
• Ovarian Cancer: Ovarian cancer is difficult to detect early. This cancer mainly develops in older women, with about half of the
see Oncology ...page 14
Females’ Osteoarthritis Risk Should Be Addressed Early in Life
UTSW Researchers Explore Clinical Data Showing Sex Differences in The Knee, Propose Laying Early Groundwork
Sex-specific differences in the knee joint should be considered as early as childhood to help prevent higher incidence and severity of knee osteoarthritis (OA) in women later in life, UT Southwestern Medical Center researchers propose in a review of clinical data. Their findings, published in Osteoarthritis and Cartilage, investigate knee anatomy and biology, metabolic factors, and youth sports injuries that can contribute to a higher risk of OA.
Osteoarthritis is the most common form of arthritis, with an estimated 33 million Americans living with the degenerative disease, according to the Centers for Disease Control and Prevention. Knee and hand joints have the highest prevalence of OA worldwide. Although decades of
research have established sex-specific variation in OA, the biological drivers of higher knee OA risk in females are not fully understood. As the frequency of knee injuries early in life increases OA risk, the need to identify prevention strategies becomes greater – particularly for women.
“The frequency and severity of sports-related injuries are on the rise, as it’s more common to see youths engaged in specialized sports with high demand at an early age,” said lead author Paula Hernandez, Ph.D., Instructor of Orthopaedic Surgery and Biomedical Engineering at UT Southwestern. “Young female athletes have a higher risk of ACL (anterior cruciate ligament) injuries compared to young male athletes, and we know these types of injuries can likely
develop into OA later in life.”
By reviewing clinical data from multiple tissues within the knee joint, UTSW researchers revealed key factors behind sex differences from three perspectives: human anatomy, physical activity and response to injury, and metabolic signatures.
Data included mostly young but also older populations grouped into the categories of childhood (0-11 years), adolescence (12-18), early adulthood (19-49, premenopause), and late adulthood (50 and older, postmenopause) to compare across see Osteoarthritis ...page 13
Lead author Paula Hernandez, Ph.D., is Instructor of Orthopaedic Surgery and Biomedical Engineering at UT Southwestern.
Mental Health A Novel and Unique Neural Signature for Depression Revealed
By Baylor College of Medicine
As parents, teachers and pet owners can attest, rewards play a huge role in shaping behaviors in humans and animals. Rewards –whether as edible treats, gifts, words of appreciation or praise, fame or monetary benefits – act as positive reinforcement for the associated behavior. While this correlation between reward and future choice has been used as a well-established paradigm in neuroscience research for well over a century, not much is known about the neural process underlying it, namely how the brain encodes, remembers and translates reward cues to desired behaviors in the future.
A recent study led by Dr. Sameer Sheth, professor and vice chair of research in the Department of Neurosurgery at Baylor College of Medicine, director of the Gordon and Mary Cain Pediatric Neurology Research Foundation Laboratories
and investigator at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital, identified beta frequency neural activity in the anterior cingulate cortex (ACC) of the brain’s frontal lobe as the key neural signature underlying processes associated with recognizing rewards and determining subsequent choices and, thus, shaping future behaviors.
Furthermore, the study, published in Nature Communications, reports this neural signature is altered in patients with depression, opening an exciting possibility of using these neural signals as a new biomarker and a potential innovative avenue for therapy.
Anhedonia is a cardinal symptom of depression and other psychiatric conditions
Human beings derive pleasure through various physical or mental activities, sensory experiences and interactions with family and
friends. However, individuals with depression often experience feelings of hopelessness, sadness or despair for prolonged periods due to disengagement and anhedonia – a medical term meaning loss of the ability to feel joy or contentment in activities and things that they once found pleasurable, all of which has a profound negative impact on their quality of life.
Anhedonia is also associated with other psychiatric and neurological disorders such as schizophrenia and bipolar disorder, substance abuse disorder, anxiety and Parkinson’s disease. Traditional antidepressants and standard treatments often
fail to adequately address this symptom in individuals with severe treatment-resistant depression and other conditions. A better understanding of anhedonia can guide the development of targeted and more effective treatments for depression and related conditions.
Reward bias response is regulated by beta activity in the frontal lobe
To identify the underlying neural basis for anhedonia, Sheth and team recorded and analyzed neural activity from four brain regions of 15 patients see Mental Health ...page 13
FEEL GOOD AGAIN
Healthy Heart
School’s Out, and the Kids Are Bored That’s Not Necessarily a Bad Thing
By Genaro C. Armas American Heart Association
It’ssummertime and the kids are home from school when one day they walk into the kitchen and say, “I’m bored!”
For parents, the first inclination might be to find something for the children to do. But, experts say, don’t underestimate the value of just letting kids figure out how to occupy the time on their own.
“Let them feel bored. And let them try out ways to reduce it, because that’s how we learn to manage any of our emotions, including boredom,” said Dr. Erin Westgate, an assistant professor of psychology at the University of Florida in Gainesville and director of its Florida Social Cognition and Emotion Lab.
A 2023 Frontiers in Sociology study defined boredom as a “state of mind characterized by a lack of
a component for the well-being of people who have, or are at risk for, cardiovascular disease.
Boredom is different from relaxation. Something that one finds relaxing often involves an activity that still stimulates the mind, like riding a bike or gardening, said Dr. Michael Rich, director and founder of the Digital Wellness Lab at Boston Children’s Hospital and an associate professor of pediatrics at Harvard Medical School.
Boredom may still have a couple physical benefits. Rich said, someone who is bored at night may find it easier to go to sleep and get more sleep. The benefits of adequate sleep include improved heart health and a lower risk of chronic conditions, like heart disease and high blood pressure, according to the Centers for Disease Control and Prevention.
Rich is especially enthusiastic
interest, stimulation, or challenge. It is a subjective experience that can manifest in a variety of ways, including restlessness, apathy, and disinterest.”
Boredom can affect mental health, cognition and behavior, and has links to depression, anxiety, impulsiveness and increased risk-taking.
How people experience boredom can manifest in different ways and differ by situation, Westgate said, just like how some people may express other feelings differently.
about the benefits that moments of boredom present for kids from a developmental perspective, and the potential to spark creativity and free play. Such play can provide children with moments to figure out problems or think creatively – skills that become essential as they grow older, said Rich, who recently wrote a book about raising kids in the digital age.
Play is essential to development because it “contributes to the cognitive, physical, social and emotional well-being of children and youth,” while also offering opportunities for parents
In general, an interconnection exists between the mind, body and heart, according to a 2021 American Heart Association report, which cited the importance of mental health as see Healthy Heart...page 13
Join 250,000+ professionals who get free Continuing Medical Education (CME) with Texas Health Steps Online Provider Education. Choose from over 50 CME courses developed by trusted Texas experts, for experts like you. Quick courses and case studies on topics such as Medicaid guidelines, ethics and mental health, and more are all available 24/7.
Hospital News
Ascension Seton Hospitals Achieve 5-Star Rating On 2024 CMS Overall Hospital Star Ratings
A 5-Star Rating Is the Highest Possible Score, Indicating the Best Quality Care For Patients
TwoAscension Seton is proud to announce that Ascension Seton Northwest, Ascension Seton Hays and Ascension Seton Williamson have received 5-star ratings from the Centers for Medicare & Medicaid Services (CMS) 2024 Overall Hospital Quality Star Ratings, released on July 31. These ratings, which assess quality of care, patient safety, and patient experience, are essential for patients and families making informed healthcare decisions.
The CMS Overall Hospital Quality Star Ratings are derived
from 46 publicly reported quality measures, categorized into Mortality, Patient Experience, Readmission, Safety of Care, and Timely & Effective Care. These measures are summarized into a single star rating, with five stars indicating the highest level of hospital performance. Hospitals participating in CMS programs must collect data for these measures, which are reported on Care Compare.
In 2024, based on data from 2,847 hospitals, the national average star rating declined from
Two Years Since Launch of Dial 988 Then Press 1, Veterans Crisis Line Is Supporting More Veterans Than Ever
Since 988 Launch, The Veterans Crisis Line Has Had a 22.7% Increase in Calls, With More Than Two Million Calls, Texts, and Chats Answered In Last Two Years
Twoyears ago, the launch of Dial 988 then Press 1 made it easier than ever for Veterans and their loved ones to access lifesaving support via the U.S. Department of Veterans Affairs’ Veterans Crisis Line. In these past two years, VCL has answered more than 1,638,138 calls, representing a 22.7% increase in calls per day since the launch. This means that more Veterans than ever are getting the support they need from caring, qualified responders during times of crisis.
Dial 988 then Press 1 provides an easy-to-remember number to quickly connect Veterans, service members, and
their loved ones to the Veterans Crisis Line’s lifesaving services. Since the launch of the shortened number, VCL has maintained an average speed to answer of 9.17 seconds. In addition to the increase in calls answered, VCL has also received a 76.7% increase in texts and 27.5% increase in chats per day over the same two years.
“Our Veterans Crisis Line has been providing Veteran-centered support for nearly two decades, and two years ago we made it even easier for Veterans in crisis and their loved ones to reach out for help by launching Dial 988 then Press 1,” said VA Secretary Denis
3.19 stars in 2023 to 3.13 stars. However, Ascension hospitals not only surpassed their all-time performance but also exceeded the national average, improving their average star rating to 3.48 stars in 2024, up from 3.27 in 2023. This significant improvement underscores the enhanced quality of care provided by Ascension.
“It’s an honor for CMS to have rated three of our care facilities among the highest performing, 5-star rated hospitals in the U.S.,” said Andy Davis, president and CEO of Ascension Texas. “Our
McDonough. “One Veteran lost to suicide is one too many. We’re supporting more Veterans than ever through the 988 initiative and will not rest in our continued efforts to spread the word that this resource is available and saves lives.”
The two-year anniversary of the 988 Suicide and Crisis Lifeline marks a major milestone for President Biden’s Unity Agenda and efforts to prevent suicide deaths for Veterans and all Americans by ensuring they have access to free, confidential support in times of crisis. Since launching in July 2022, more than ten million total calls, texts, and chats to 988 have been answered, including 1,179,129 calls answered by VCL via Dial 988 then Press 1.
This year, the two-year anniversary of Dial 988 then Press 1 coincides with the 2024 VA/DOD Suicide Prevention Conference in Portland, Oregon. This biannual event — a major platform for advancing the Biden-Harris Administration’s Reducing Military and Veteran Suicide public health strategy —
5-star performance on the CMS star ratings is a testament to the commitment of our caregivers and associates who deliver high quality and compassionate care for the patients and communities we serve every day.”
Patients, families, and communities can view the star ratings for acute care hospitals on the Care Compare website, a useful tool that can help with making informed healthcare choices.
will bring together over 2,000 VA and DOD care team members, leaders, allies and subject matter experts from across the country to share leading-edge research, evidence-based clinical and community approaches, and improved data methods.
Ensuring every Veteran and their loved ones know how to reach VCL in their time of need, as well as continuing to advance broader efforts to prevent Veteran suicide, are top VA priorities. Today, more than 1,000 responders — many of whom are Veterans themselves — ensure that every Veteran has somebody to call for support in time of crisis.
If you’re a Veteran in crisis or concerned about one, contact the Veterans Crisis Line to receive 24/7 confidential support. You don’t have to be enrolled in VA benefits or health care to connect. To reach responders, Dial 988 then Press 1, chat online at VeteransCrisisLine.net/Chat, or text 838255
Rural Cancer Patients and Health Care Providers Face Challenges Beyond Access and Distance
By Ann Kellett
Rural Americans have higher rates of lung, colorectal and cervical cancers and higher cancer death rates overall compared to their metropolitan counterparts. They also have lower access to cancer screening, treatment and specialty care, are less likely to have access to reliable transportation and health insurance and have higher prevalence of cancer risk factors, like smoking and obesity.
Although much is known about rural patients’ cancer risk factors and barriers to care, little research to date has focused on rural health care providers’ views regarding cancer screening and prevention.
To fill this gap, Alee Lockman, PhD, assistant professor of health policy and management at the Texas A&M University School of Public Health, along with two colleagues from Harvard University and two from St. Francis Medical Center in Illinois,
asked rural health care providers at a regional health system about their perceptions of cancer control in rural communities.
“We wanted to understand how health care providers view the factors— at both the individual and system level—that limit rural patients’ access to care and how these perspectives affect cancer screening and prevention efforts,” Lockman said.
For the study, conducted over six months in 2021, the researchers led semi-structured interviews with 23 primary care providers, nurse navigators and community health workers affiliated with a regional health system that primarily serves rural communities. The providers were asked for their opinions on three issues: barriers that limit rural patients’ access to cancer screenings and preventative behaviors, how health care providers and systems acquire accurate information about these barriers and how providers use this information to
make recommendations about cancer screenings and preventative behaviors.
A thematic analysis of the data identified three primary domains influencing the relationship between providers and rural patients: provider beliefs and assumptions about rural patients; factors affecting information-gathering and care coordination; and providers’ approach to care coordination, including decisionmaking, communication style and trust-building.
“Our main finding is that trust is crucial to the relationship between
rural patients and health care providers, and it’s a two-way street,” Lockman said. “The level of patient-provider trust influences how much rural patients are willing to believe their providers, to follow providers’ health care recommendations, and to provide information that helps providers make appropriate health care decisions.”
Those surveyed stated that many rural patients preferred to manage health conditions on their own or trusted family and friends more than
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Most rural cancer patients prefer to receive treatment close to home
Ascension Seton Expands Neurocritical Care Unit at Dell Seton Medical Center at The University of Texas
Expansion Increases Capacity for Patients with A Range of Neurological Conditions
Ascension Seton is pleased to announce the expansion of its neurocritical care unit at Dell Seton Medical Center at The University of Texas. The first of its kind in Central Texas, the unit provides advanced, multidisciplinary, and compassionate care for patients with a range of neurological conditions. The expansion of the unit will increase patient capacity with an additional 15 beds, for a total of 30 beds, and allow for the treatment of a greater spectrum of neurological conditions, ranging from low acuity, to the most complex and highly acute cases.
The neurocritical care unit expands access to Ascension Seton’s comprehensive neuroscience services in
Central Texas, including neurosurgery and spine surgery, stroke care, and treatments for other complex neurological disorders. The unit will be led by Dr. Shahed Toossi, medical director of the neurocritical care unit, and a team of highly trained neurosurgery, neuro-interventional, and neurovascular specialists, as well as advanced practice providers and neuro-focused nurses, who will provide care around the clock.
“The benefits of a neurocritical care unit in our community are significant,” said Dr. Toossi. “The expansion of this unit allows us to compassionately care for even more patients with a range of neurological conditions.”
According to various studies such as those by Kramer et al. (Neurocrit Care 2011), Varelas et al. (Crit Care Med 2004), and Busl et al (JAMA Neurology 2019), patients who receive specialized neurocritical care have better outcomes including improved survival rates and reduced disability. Patients also have shorter hospital stays, are less likely to need long-term care, and are more likely to return to their normal daily activities.
The 30-bed unit will be staffed by a highly specialized team of boardcertified neurocritical care providers,
feature cutting-edge technology and provide comprehensive treatment for patients in need of neuroscience services, including:
• Acute ischemic stroke
• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Seizures
• Brain or spinal tumors
• Brain or spinal surgery
• Acute brain injury
• Complex neurological disorders of autoimmune, infectious, or see Neurocritical Care...page 12
Hurricanes, Extreme Weather Can Cause Post-Traumatic Symptoms or Other Mental Health Concerns
By Leila Lopez Marks
The Hurricane Beryl is long gone, but powerful emotions rage in its wake. Stress, anger, fear, depressioncoupled with triple digit temperatures and no A/C for thousands - can trigger psychological symptoms.
S torm and weather-induced post-traumatic symptoms can be real and are something to be prepared for, especially with the active hurricane season predicted, said Dr. Namrata Vasquez, a psychologist at Houston Methodist.
Even if you don’t meet criteria for PTSD (post-traumatic stress disorder) or a formal psychiatric disorder, a lot of folks after natural disasters report higher levels of psychological distress, hypervigilance, anxiety and depressive symptoms,” Vasquez said. “You can imagine a lot of people feel less control
over their lives and that can result in depressive symptoms including hopelessness or helplessness.”
A study following Hurricane Harvey in 2017 showed that people displaced from their homes, or otherwise limited in resources (AC, food, water) exhibited higher levels of distress and PTSD symptoms. Furthermore, more than 25% of participants in the study reported clinically significant symptoms of PTSD.
Some strategies to cope with potential stressors or protect your mental health during the season may include:
• Follow national and local preparation guidelines. Be prepared ahead of time. Have an emergency evacuation plan, have an emergency supply of non-perishable food and plenty
Age Well, Live Well
Get Regular Vaccinations to Stay Healthy, Avoid Complications
By Chelsea Couch HHS Aging Texas Well Coordinator
Routinely getting vaccinations can reduce your chances of getting sick and can help older adults avoid complications from viruses like the seasonal flu and
shingles.
According to the National Center for Health Statistics, flu and pneumonia are the 12th-leading cause of death in the United States. Vaccines can reduce the risk of catching these and other viruses, and can prevent or lower your risk
of drinking water. If possible, purchase a backup power source such as a generator to power essentials such as the refrigerator.
• Have a communication plan in place with your loved ones, knowing how to contact one another or meet up safely if needed.
• Reach out to people you trust for additional social support (family, health care providers, friends and community leaders).
Although natural disasters have long existed, the research examining the psychological effects of weather-related trauma has grown notably in the last
of developing serious symptoms that may require hospitalization or can even lead to death.
A s we age, our immune system often doesn’t work as effectively, and any previous immunity to a virus can weaken. That is why getting vaccinated is especially important for older adults.
T he National Institute of Health and the Centers for Disease Control and Prevention (CDC) recommend the following vaccines
several years and will continue to be relevant. Learning how to prepare before potential events, develop and practice effective methods of coping, establish strong sources of social support, and maintain good mental and physical health are imperative to getting through large-scale weather events like Hurricane Beryl. If you are struggling with psychological symptoms following Hurricane Beryl, consider reaching out a mental health provider (therapist, counselor, social worker).
for older adults:
• Seasonal flu: Anyone 6 months or older should receive a yearly flu vaccine. Older adults should get the high-dose flu vaccine specifically designed for people 65 and older.
• Pneumococcal: Pneumonia is often a secondary condition caused by the flu, COVID-19 and other viruses. Experts
see Age Well, Live Well...page 12
New Breakthrough in Alzheimer’s Research: UTMB Researchers Develop Nasal Spray Treatment for Alzheimer’s Disease
Researchers at the University of Texas Medical Branch recently discovered a significant advancement in the fight against neurodegenerative diseases such as Alzheimer’s disease and dementia. The study, published today in Science Translational Medicine, introduces an innovative nasal spray treatment that has shown promising results in clearing harmful tau protein build-up and improving cognitive functions in aged mice models with neurodegenerative diseases.
“This nasal spray approach opens new avenues for non-invasive delivery of tau therapeutic antibodies directly to the brain, and it holds promise for many neurodegenerative diseases.” said Dr. Rakez Kayed, lead author and professor at the Department of Neurology at UTMB.
Tau is a microtubule-associated protein found in human brains that helps stabilize microtubules, part of the framework that gives the cell its
shape and helps it stay organized, in neurons. In healthy brains, tau proteins help keep things in order. But in neurodegenerative diseases, they can become abnormally twisted and form tangles that disrupt neuronal function and lead to cognitive decline. Current tau immunotherapies have struggled with efficacy due to their limited ability to penetrate intracellular compartments where these tau buildups reside.
Kayed and his team developed a specific type of antibody, TTCM2, which selectively recognizes and targets toxic tau buildup. The antibody was packaged in particles to enhance its delivery to the brain via the nasal route. This method bypasses the blood-brain barrier, a significant hurdle in neurodegenerative disease treatment, ensuring rapid and effective delivery of the therapy.
“Our research highlights the potential of nasal tau immunotherapy to effectively target intracellular
Age Well, Live Well
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recommend getting this vaccine if you have a chronic disease, have a weakened immune system or are 65 or older.
• Shingles (herpes zoster): When children get chickenpox, the virus can become active again as they get older and lead to shingles, which is a painful skin rash. To prevent this, experts recommend people 50 or older to get the two-dose vaccine.
• Tetanus, diphtheria and pertussis (TDAP): The TDAP vaccination is recommended for everyone and especially for people who are regularly around babies or young children. The vaccination helps prevent contracting whooping cough, tetanus, pertussis and diphtheria.
• COVID-19: Vaccines and boosters for COVID-19 are important for preventing or
Neurocritical Care
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neuromuscular etiology
The expansion of the neurocritical care unit is part of a broader $280 million expansion of Dell Seton Medical Center at The University of Texas to provide additional healthcare services to
tau aggregates– a primary driver of neurodegeneration and cognitive decline in diseases like Alzheimer’s and other tauopathies,” added Kayed. “This method not only improves the delivery of therapeutic antibodies but also enhances their efficacy in clearing tau aggregates and improving cognitive functions”.
An essential aspect of this approach is that it involves TRIM21, an intracellular receptor for antibodies and E3 ligase, known for mediating the clearance of antibody bound pathogens like viruses. In the study, TRIM21 facilitated the clearance of antibody bound intracellular tau aggregates, thereby enhancing the therapeutic effect and cognitive improvements in the mice model.
“ This advancement could
significantly impact the treatment strategies for Alzheimer’s and related tauopathies, offering new hope for millions of patients suffering from these debilitating conditions,” said Sagar Gaikwad, first author of the study and postdoctoral fellow at UTMB. This study highlights the potential impact on future treatments for neurodegenerative diseases. Researchers at UTMB plan to advance this research by conducting further preclinical trials and exploring the potential of TTCM2-ms in human clinical trials. The goal is to translate these promising results into a viable treatment option for patients suffering from Alzheimer’s disease and other tau-related disorders.
address the needs of the increasing population of Central Texas. Dell Seton Medical Center stroke recognitions
Increased access to high quality care continues to be a primary focus for Ascension Seton. Dell Seton
reducing serious symptoms. They help your immune system build better protection against the virus and its variants.
To learn more about how often you should receive vaccines, view the Centers for Disease Control and Prevention Adult Immunization Schedule. Medicare, Medicaid and private health insurance plans typically cover the cost of getting many of these vaccines. If you don’t have insurance, you might be eligible for assistance. To learn more or find a vaccine provider, visit the Texas Department of State Health Services Adult Safety Net Program website or call 800-252-9152.
Medical Center is one of the only comprehensive stroke centers in Austin. Earlier this month, Dell Seton Medical Center was named a ‘High Performing’ hospital for stroke by U.S. News & World Report.
The neurocritical care unit
For more information about programs and services for older adults, visit the Health and Human Services Age Well Live Well webpage or call 2-1-1.
expansion is located across the hallway from the original unit, and will officially be open to patients July 30, 2024. Dell Seton Medical Center is located at 1500 Red River St, Austin, TX 78701.
Osteoarthritis
Continued from page 4
developmental stages.
Researchers found that differences between males and females in articular cartilage, meniscus, and ACL arise before puberty and can’t be explained solely by sex hormones. Although sex hormones such as estrogen and testosterone play a significant role, studies suggest sex
Mental Health
Continued from page 5
with medication-resistant epilepsy who were undergoing invasive monitoring to localize the zone from where their seizures originated.
As their brain activity was being monitored, these patients performed a perceptual discrimination task called the probabilistic reward task (PRT), a well-validated behavioral task that objectively measures anhedonia by observing subtle changes in behavior related to reward.
“We found that the unequal assignment of reward between two correct responses in this task produced a response bias toward the more frequently rewarded stimulus,” said lead author Dr. Jiayang Xiao, who conducted this study as a graduate student in the Sheth lab. “We found that based on feedback, most individuals modified their subsequent responses to make choices that were likely to get rewarded,
Healthy Heart
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to fully engage with their children, according to a 2007 report from the American Academy of Pediatrics.
People should embrace moments
Rural Cancer Patients
Continued from page 9
health care providers for health advice, often because of patients’ religious beliefs, views on quality-of-life issues and reluctance to discuss their financial struggles and health behaviors.
The providers emphasized the importance of building trust and gathering information through
chromosomes are also a driving factor. Understanding the distinct roles of hormones and chromosomes may help clinicians regulate hormonal effects on OA risk.
T he review also revealed intriguing variation between males and females in the abundance of amino acids and other metabolites, suggesting differences at the metabolic level.
T he anatomic and metabolic
irrespective of the accuracy of their answers.”
Moreover, they found a specific signal – neural oscillations in the beta frequency range – originating from the anterior cingulate cortex (ACC) in the frontal lobe of the brain, showed a consistently strong and positive correlation with the reward bias behavior and tracked closely with the receipt of rewards and their value. Further, they found that this specific brain region was engaged in evaluating both reward stimuli and outcomes, potentially acting as a critical node with a common mechanism for reward assessment.
“Our study has addressed a longstanding fundamental question in neuroscience – which specific brain region and signal regulates the classic reward bias response, a famous example of which is the Pavlovian conditioning where dogs learned to associate the sound of a ringing bell to food,” said co-senior author Dr. Benjamin Hayden, professor of neurosurgery at Baylor.
of boredom “as a gift of not having to do anything else right now,” Rich said, “and use that gift … in ways that enrich us, even if it’s daydreaming or just being silly.”
One strategy for parents or caregivers is to talk with kids ahead of time about activities they might
in-person conversations, during which they could observe patients’ demeanor, social support and body language, and adjust health care recommendations according to the patient’s likely compliance.
The ability to have in-person consultations, however, is hampered by factors on the provider side, such as limited appointment times and problems with electronic health record systems. On the patient side, lack of transportation was identified as a
distinctions between males and females revealed by the review – as well as social components in which gender affects lifestyle – play key roles in the likelihood of physical activity and injury early in life. In the case of knee OA, these differences increase risk for women.
Findings from this review and related research from Dr. Hernandez’s lab are expanding the field’s understanding of how OA is
Reward bias response is altered in patients with treatment-resistant depression
Next, Sheth and his team conducted the PRT in four individuals with severe treatment-resistant depression. They found that reward processing in the ACC was altered in this group. These individuals did not exhibit the typical behavioral response of favoring choices that are more frequently rewarded. This observation suggests a lack of reward-oriented anticipation and that their choices were less driven by reward feedback. Consistent with this change in reward bias behavior, beta activity in the ACC region was reduced and delayed in these individuals.
“In this study, we identified beta activity in the ACC as a potential biomarker for anhedonia,” said Sheth, also a McNair Scholar and Cullen Foundation Endowed Chair at Baylor. “Such a biomarker could have many potential benefits, including improving diagnosis and monitoring symptoms
enjoy in moments of boredom. It’s an opportunity to teach children how to self-regulate their own emotions, similar to how parents may teach kids to soothe themselves back to sleep when they wake up in the middle of the night.
“Boredom isn’t bad. It’s just feedback. And like pain, it’s not
major factor. Most rural communities lack public transportation, which makes in-person medical appointments difficult for elderly patients who do not drive, patients from single-car households and those lacking social support that might provide transportation. In addition, the providers stated that many of their rural patients are hesitant to get specialty health care in urban areas, given the long distance, expense and inconvenience and a desire to receive
influenced by biological sex, laying groundwork that can be used for developing sex-specific exercises and wellness curriculum for students.
“We hope that by showing evidence that sex disparities are not limited to menopausal age, but rather commence early in life, we can create awareness for other researchers to start this practice,” Dr. Hernandez said..
of patients with severe depression and other anhedonia-related psychiatric conditions. Moreover, our findings present an exciting possibility that modulation of the ACC beta activity might be effective treatment anhedonia, a hypothesis we plan to test in future clinical trials.”
The neurotechnology advancements of this research have advanced at a pace not previously possible due in part to funding by the National Institutes of Health Brain Research Through Advancing Innovative Neurotechnologies Initiative, or the BRAIN Initiative.
“This study exemplifies how BRAIN-funded research is already having an impact in the clinic today,” said Dr. John Ngai, director of the NIH BRAIN Initiative. “The innovations in data collection and individualized deep brain stimulation demonstrated in this study may enable a new generation of precision treatments.”
necessarily enjoyable, pleasant feedback,” Westgate said. “But it’s still really important, useful information that gives us sort of a tool to act on that tells us, ‘Hey, this is wrong, and this is an opportunity to fix it and feel better.’”
care closer to home.
“Most solutions intended to reduce barriers to cancer screenings for rural patients focus on structural and institutional barriers, such as reducing administrative challenges and adding telehealth options and mobile clinics,” Lockman said. “We believe that our research on the role of patient-provider communication and trust-building can inform additional solutions addressing the unique challenges of rural communities.”
Disputes
Continued from page 1
1. this authority – Section 1128J(d) of the Social Security Act – is silent on the circumstances under which an overpayment becomes identified, while CMS purports to supplement the statute with its own interpretations for what the identification of an overpayment entails. Under Loper Bright, providers have more leeway to challenge the reasonableness of CMS’ independent requirements not found under the statute.
2. Overpayment appeals. Many CMS overpayment demands are founded upon alleged noncompliance with subregulatory guidance, which does not undergo the formal rulemaking process under the APA. Therefore, courts were not required to defer to CMS when adjudicating the validity of these overpayments. Notwithstanding, providers often have colorable arguments they have complied with
Oncology
Continued from page 3
• women diagnosed aged 63 years or older. Regular pelvic exams and awareness of family history or high risk hereditary conditions such as a BRCA mutation can help identify women at higher risk, prompting more specific diagnostic tests like transvaginal ultrasounds (TVUS) or CA-125 blood tests.
• Uterine (Endometrial) Cancer:
The most common gynecologic cancer in the U.S., with about 67,880 new cases estimated to be diagnosed in 2024, uterine (or endometrial) cancer primarily affects postmenopausal women. However, it can also occur in younger women, particularly those with risk factors such as obesity or a family history of the disease. Currently, there are no screening tests or exams to find endometrial cancer early in women who are at average risk and have no symptoms. Regular well-woman visits can help monitor symptoms such as abnormal bleeding and
the medical necessity requirements for the services under the statute(s) notwithstanding compliance with subregulatory guidance expanding upon the same. Loper Bright provides a stronger basis for providers to push back on these overpayments through the Medicare overpayment appeal process, and Administrative Law Judges (“ALJs”), the Medicare Appeals Council, and the district courts reviewing such agency actions and appeals should be even less inclined to defer to CMS’ overpayment determinations when they are founded on alleged noncompliance with subregulatory guidance standing alone, and providers may expect greater success with their appeals. While it remains to be seen to what extent Loper Bright ultimately affects provider reimbursement day-to-day and long-term, providers
should consult with their outside legal counsel to address past, present, and potential reimbursement issues to determine how Loper Bright presents them with new opportunities and tools to challenge contractor overpayments, conduct self-audits, determine whether voluntary overpayment refunds are warranted, and more – including challenging CMS’ regulations under the APA.
prompt timely intervention. Screening and preventive care
Well-woman visits include important screenings based on age and risk factors. Regular check-ups during these formative years help to establish healthy habits and open lines of communication about sexual health.
For teenagers and young women, these appointments may include administration of the HPV vaccine, which is recommended to start at ages 11-12, but can be given up to age 26 (and in some cases, older).
For adult women, these visits become even more vital. Annual screenings ensure that any changes in health or risk factors are promptly addressed. For example, cervical cancer screenings should begin at age 25, and women aged 21-65 should have a Pap smear every three years, or a combined Pap smear and HPV test every five years if previous results have been normal.
Starting the school year healthy
For girls, tweens, teens, and young adults, scheduling an annual physical exam with a primary care
provider before the school year begins is a proactive step toward maintaining health. These appointments can address issues related to puberty, menstrual health, and sexual education, providing a solid foundation for lifelong well-being. It is also an ideal opportunity for education and counseling. Physicians can provide guidance on diet, exercise, and other lifestyle factors that reduce the risk of gynecologic and other types of cancer.
Don’t let a busy schedule or lack of symptoms be the reason to skip annual well-woman visits. From comprehensive health assessments and vital screenings to preventive care that prevents gynecologic cancer, regular well-woman visits should be a non-negotiable part of every woman’s healthcare routine.
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Dementia CME for Primary Care Providers
Help your patient and their family make the best-informed decisions.
Earn free online Continuing Medical Education (CME) credits developed by the Texas Department of State Health Services and physician experts on Alzheimer’s disease and related dementias. These courses will keep you up to date on the latest validated assessment and screening tools, help you direct patients to community resources, and reinforce your role in helping patients and their families manage symptoms throughout the disease process.
Courses coming soon at dshs.texas.gov/alzheimers-disease/provider