July Edition 2021
Inside This Issue
COVID-19, Telepsychiatry and the Future of Behavioral Health Jobs By Linda Beattie
T Improving Telehealth Services For Medicaid Users See pg. 12
INDEX Legal Matters....................... pg.3 Oncology Research......... pg.4 Mental Health...................... pg.6 Healthy Heart....................... pg.8 Hospital News.................... pg.10
Ascension celebrating opening of new Austin-based Pharmacy Services See pg. 13
he COVID-19 pandemic has created a tsunami of problems across the United States, affecting the public’s mental health in addition to the numerous physical casualties. Fears of the disease, grief for those lost, social separation and economic hardships have created new cases of anxiety and depression, while exacerbating existing mental illnesses. A new poll by the American Psychiatric Association (APA), conducted March 26 to April 5, 2021 among a sample of 1,000 adults, found that: • 41% are more anxious than last year when the pandemic began • 43% said the pandemic has had a serious impact on their mental health (up from 37% in September 2020) • 53% of parents are concerned about the mental state of their children • 48% of parents reported the pandemic has caused mental health problems for one or more of their children, with 26% seeking professional help During this same period when Americans have
developed a greater need for mental health services, psychiatrists have had to make drastic cuts to in-person visits and dive into telepsychiatry. “There is a huge global shortage of behavioral health physicians, and the market is unfortunately dictating a
providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.” While telepsychiatry usually involves direct psychiatrist and patient interaction, it may also include psychiatrists supporting primary care providers through professional consultations. It can be delivered via live, interactive communication or involve recorded information. Rumbles of change before COVID “In the three or four years before COVID hit, psychiatrists had been asking about telepsychiatry,” said Mike Belkin, divisional vice president for Merritt Hawkins. “They were interested in doing virtual visits, asking about working from home, but the market was very slow to respond. Some clients agreed to allow some of these visits, but most did not. They were worried that patient care would be sacrificed. Reimbursement was also an issue.” “Some areas that found recruitment challenging decided to try it,” he continued. “We had some clients that were starting to incorporate one to two days of telepsychiatry visits to help attract those candidates who wanted
The COVID-19 pandemic has created a tsunami of problems... Fears of the disease, grief for those lost, social separation and economic hardships have created new cases of anxiety and depression, while exacerbating existing mental illnesses. greater need. Then with the pandemic shutting down some services, we saw a major transition to telehealth platforms,” said Gabriel Bishop, director of recruiting for the diversified specialties group at Merritt Hawkins. What is telepsychiatry? The APA defines telepsychiatry as a subset of telemedicine, which is “the process of providing health care from a distance through technology, often using videoconferencing.” They add that telepsychiatry “can involve
see Telepsychiatry...page 14
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Legal Matters EEOC Issues Guidance to Employers on COVID-19 Vaccine Incentives By Lindsay Ryan, JD Polsinelli, PC
T
he Equal Employment Opportunity Commission (“EEOC”) recently provided some long-awaited clarification on an employer’s ability to offer incentives to their employees for receiving COVID-19 vaccinations. This new guidance provides welcomed direction to those businesses looking to encourage workers to get vaccinated rather than adopting a mandatory vaccine policy. This article provides a summary of the EEOC’s guidance on vaccine incentives, as well as other new updates to the EEOC’s previous vaccine-related guidance. Vaccine Incentives The EEOC identifies the following options for employers to offer their workers incentives for vaccination under the Americans with Disabilities Act (“ADA”): »» Employers can offer incentives
to employees to voluntarily provide documentation or other confirmation of vaccination received from an independent third party (e.g., pharmacy, personal health care provider or public clinic). However, any information or documentation collected should be maintained confidentially under the ADA. »» Employers can also offer incentives to employees for voluntarily receiving a vaccine administered by the employer or its agent, so long as the incentive is “not so substantial as to be coercive.” Although the EEOC does not go so far as to define “substantial,” it explains that “a very large incentive could make employees feel pressured to disclose protected medical information” when responding to the employer’s pre-vaccination medical screening questions. Although employers can offer an employee’s family member an opportunity to be vaccinated if certain conditions are satisfied, employers cannot require family members to be vaccinated and should not offer employees incentives for family member vaccination.
Confidential Medical Information In its updated guidance, the EEOC instructs that the ADA requires an employer to maintain the confidentiality of employee medical information, including documentation or other confirmation of COVID-19 vaccination, regardless of where the employee gets vaccinated. Accordingly, while employers can require employees provide proof of vaccination (i.e., doing so is not a “disability-related inquiry”), this information must be maintained confidentially and separate and apart from the employee’s personnel file. Reasonable Accommodations The EEOC reiterated that if an employee cannot get vaccinated because of a disability or religious belief, the employer cannot require compliance
with a mandatory vaccine policy unless it can demonstrate that the individual would pose a “direct threat” to the health and safety of the employee or others in the workplace. This determination should be based on consideration of four factors previously-identified by the EEOC, and “should be based on a reasonable medical judgment that relies on the most current medical knowledge about COVID-19,” including the level of community spread, statements from the CDC and/or statements from the employee’s health care provider. The employer must also take into account the employee’s specific work environment. If the employer determines that the see Legal Matters...page 13
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Oncology Research How Innovation is Driving Transformation in Cancer Treatment
FEEL GOOD AGAIN
By Nilesh Verma, M.D. Texas Oncology– Austin Midtown
F
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July 2021
rom new drug therapies to advancements in radiation therapy and promising clinical trials, medical breakthroughs are transforming the way cancer is treated, helping patients live longer, fuller lives. With a growing number of FDA-approved drugs emerging in recent years, this flourish of innovation is creating greater hope for positive outcomes in patients. That’s a big deal in Texas, where more than 131,000 new cases of cancer are expected to be diagnosed in 2021. Immunotherapies: Using the body as the ultimate defense I m m u n o t h e r a p y, which uses the body’s own immune system to fight cancer, is an example of a highly precise and advanced form of cancer treatment. It is becoming increasingly more common and can be used alone or in combination with other treatment, such as chemotherapy, radiation therapy, or surgery. While chemotherapy works by killing cancer cells, it cannot tell the difference between cancer cells and normal cells. Immunotherapy uses certain parts of a person’s immune system to attack cancer cells to stop or slow their growth or limit the cancer’s ability to spread. Chimeric Antigen Receptor T cell (CAR-T) therapy, a type of immunotherapy, is considered one of the most promising cancer breakthroughs in recent years. It’s a personalized therapy that involves engineering a patient’s own immune system’s blood cells to attack cancer cells. During the complex procedure, doctors remove some of the patient’s T cells, a type of white blood cell, which are then genetically reprogrammed to identify and attack cancer. Weeks later, doctors then infuse the re-engineered cells back into the patient’s body. Checkpoint inhibitors: Breaking barriers Another advancement associated
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with immunotherapies is checkpoint inhibitors. Think of the human body as having molecules that serve as checkpoints. These checkpoints can determine whether the surrounding cells are healthy or cancerous, fighting those that are deemed cancerous. Over time, however, cancer cells have found ways to “dupe” the system, so to speak, by hiding behind the checkpoints. Researchers developed drugs with the power to eliminate these molecular checkpoints so the body’s immune system can identify and destroy hiding cancer cells, leaving the healthy cells alone. The evolving landscape of cancer care Amazing advancements abound in many facets of cancer care. Evidence-based cancer care goes far beyond providing drug therapies
to patients. Exciting research developments that are unrelated to cancer medicines are improving patients’ outcomes and quality of life, such as technology to improve cancer screening, ways to minimize the side effects of cancer treatment, and tools to determine best approaches for treatment. Examples include cooling caps that help prevent hair loss during treatment, greater use of oral chemotherapy (vs. intravenous), and new blood tests on the horizon that will detect cancer. Recently developed blood tests are being used to detect cancer cells in the bloodstream. Blood testing as a wide-spread method of testing for cancer is still in development but continues to hold great promise. These new approaches are solving previously vexing problems for oncologists and patients. Alongside the quickening pace of progress comes greater optimism and hope for everyone impacted by cancer. research.
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Mental Health How To Handle Anxiety About Returning to The Office After COVID-19 By Lindsey Hendrix
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July 2021
accines are widely available, mask mandates are lifting, fans are returning to sporting events, businesses are opening back up—our 2020 dreams are coming true! Except, many of us are feeling oddly anxious about it. This time last year, we wrote about how to deal with feelings of isolation and how to balance working from home while homeschooling our kids. Now, after a year of adjusting to this new way of life, we’re once again faced with a change. And it’s admittedly scary. “It’s a lot like kids returning to school after summer break, but it’s intensified because many people have been at home for almost a year and a half,” said Kelly Sopchak, PhD, a psychologist with the Texas A&M Health Telebehavioral Care Program. As employees transition back to working in offices and students return to schools, stress and anxiety levels will be elevated. The good news is, there are ways to navigate the change in stride. Ease back into the swing of things If you have the option, try to transition back to in-person work and school, rather than going back 100 percent all at once. “To go from working from home five days a week to working in the office five days a week is a big jump,” Sopchak said. “Try to go back just one day a week for a while to ease back into it. This is especially helpful for kids who have school refusal, or school anxiety. We will have them go back just two hours a day and build it up from there.” Adults can start by returning to the office one day a week. For children, it’s best to start with a couple hours a day every day of the week. “That way, they don’t have six days to dread about going back to school,” Sopchak said. For people who have been extremely isolated, she suggests easing back out into the world before returning to the office. Go to the park, go shopping and just be around people more in ways that you feel are safe. Simply getting dressed every day is another way to prepare. “Getting into the practice of getting up and getting ready is critical,” Sopchak said. “Getting ready to work on Zoom and getting ready to go to the office are two different things; you’ve got to be prepared.” It’s the same thing parents have done with kids for years: in that week or two before school starts back after summer break, parents start setting
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their kids’ bedtime and lay out their clothes for the next day. Adults can also do this for themselves, to help get back into a routine. “If you feel prepared for something, the anxiety decreases,” Sopchak said. “Setting a bedtime, picking out your clothes the night before and setting an alarm are all ways to prepare for the next day.” Embrace the awkward Our social skills might be a little rusty after being cooped up at home for more than a year, but the awkwardness should wear off after being back out in the world for a little while. This is also
true for children who have missed out on peer socialization over the past year. “We know children and adolescents bounce back quickly,” Sopchak said. “They typically have a lot of resiliency and they learn quickly in social situations. It might take them some time, they might seem a little bit immature at first, and that’s okay. It’s a transition.” For adults, returning to the office will involve navigating invitations to non-work social events, which could be a new skill for people who are normally very social. “Different people will have different comfort levels engaging in social activities,” Sopchak said. “Know your boundaries and don’t be afraid to communicate them. If you’re going to do something and then feel anxious about it for the next two weeks, you probably shouldn’t do it. On the flip side, if you invite someone out for lunch and they say no, just know it has nothing to do with you. It has to do with how comfortable they are going out in that situation.” Confront stress and anxiety It’s your first day back at the office. You’ve been easing yourself back to a regular schedule and you have your morning routine down. You were energized by your favorite podcast on the drive in and you’re really enjoying catching back up with your co-workers. Then, out of nowhere, you feel like you can’t catch your breath. “Pay attention to your body,” Sopchak said. “If you are feeling see Mental Health...page 8
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The American Heart Association suggests gardening as a fun way to boost mental health and physical activity along with nutrition.
Cucumbers
Okra
Eggplant
Beans
Sweet Potatoes
Melons
Summer Squash
Tomatoes
Pumpkins
Peppers
Stress hormones can lead to inflammation, which raises the risk of developing chronic diseases, such as heart disease. Activities that prioritize physical and mental health are a way to help children grow to their full potential. Get to digging, mulching, trimming, watering, and removing those pesky weeds to relieve some stress and anxiety.
Visit heart.org for healthy lifestyle tips, recipes and more. ©2021, American Heart Association. 5/10DS3675
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Healthy Heart
MARINE MILITARY ACADEMY
10 Vegetables To Plant With Your Kids This Summer By The American Heart Association
REPARE FOR COLLEGE
The American Heart Association suggests gardening as a fun way to boost mental health and physical activity along
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ven with temperatures rising across the country, it’s not too late to plant a summer garden. Planting one with your kids can offer health benefits beyond nutrition and provide some affordable summer fun. “Don’t let the heat stop you from the fun of a summer garden,” says Kim Aman, volunteer gardening advisor for the American Heart Association’s Teaching Garden Network. “In the hot summer months, pay extra attention to water. Mulching the top of the soil helps to keep the soil cool and retain moisture. Organic amendments of fish emulsion, worm castings or dried molasses are helpful to provide nutrients.” In addition to basil and other herbs, Aman’s recommendation for heat-friendly summer planting include:
1. Cucumbers 2. Okra 3. Eggplant 4. Beans 5. Sweet potatoes 6. Melons 7. Summer squash 8. Tomatoes 9. Pumpkins 10. Peppers As you dig, mulch, trim, water, and remove those pesky weeds, you may relieve some stress and anxiety, too. According to the American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, getting kids active and outdoors can offer mental health benefits. “Creating a home garden is an activity to get the entire family involved while increasing physical activity to improve mental health and reduce anxiety and depression,” said Lharissa Jacobs, M.Ed, MBA, Vice President of Health Strategies for the American Heart Association Houston. According to the CDC, childhood obesity accelerates during July 2021
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the summer while children are out of school. Children who experience high stress levels are at increased risk for smoking, being overweight or having disrupted sleep – all of which can lead to serious health problems. Stress hormones can lead to inflammation, which raises the risk of developing chronic diseases, such as heart disease. Activities that prioritize physical and mental health can help children grow to their full potential. Healthy eating habits are created during childhood. That’s why the American Heart Association encourages kids to adopt healthy behaviors early in life. Locally in Houston, AHA is working with community partners to help kids make healthy food choices. Over the past year, these initiatives include establishing distribution networks for Texas Farm Fresh boxes through The Common Market, mobile markets in the Third Ward and a farmers’ market in Acres Homes. Planting a summer garden is a great opportunity for kids to learn what it means to be healthy and how fruits and vegetables contribute to a balanced diet. It can also be an opening to discuss the concept of nutrition security and ways to care for our neighbors. Take it one step further with a family volunteer day at a local food pantry or hunger relief organization. Not only does it reduce summer screen time but volunteering also contributes to an overall sense of gratitude and well-being. It’s no secret that a nutrient-rich diet and physical activity are key ingredients to a healthy lifestyle. Mental health is a critical third component. Planting a summer garden might help you flourish in more ways than one. Get more well-being tips at heart.org/ HealthyForGood
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Hospital News St. David’s CareNow Urgent Care teams with American Airlines to offer COVID-19 rapid testing for travelers
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t. David’s CareNow® Urgent Care is now offering convenient pre-flight COVID-19 rapid testing to American Airlines guests traveling to 13 international destinations throughout Central America and the Caribbean, as well as domestic destinations, including Hawaii. The partnership provides convenient COVID-19 testing to the carrier’s guests at 15 CareNow clinics across Central Texas. St. David’s CareNow Urgent Care locations in Central Texas are offering COVID-19 pre-travel testing for American
Airlines passengers traveling to: • Aruba • Bogota, Colombia • Belize • Guatemala • Hawaii, United States • London, England • Montego Bay, Jamaica • Nassau, Bahamas • Roatan, Honduras • San Salvador, El Salvador • San Pedro Sula, Honduras • Santiago, Chile • St. Thomas, U.S. Virgin Islands
VA’s Rapid Naloxone Initiative Recognized in Fight Against Opioid Overdose Deaths
A
life-saving initiative developed by the Department of Veterans Affairs is recognized as the 2020 recipient of the John M. Eisenberg National Level Innovation in Patient Safety and Quality Award by The Joint Commission and the National Quality Forum. The award acknowledges the
national impact of VA’s advancements in preventing opioid overdose deaths and improving the quality and safety of care that patients receive. The VA Rapid Naloxone Initiative provides free Opioid Overdose Education and Naloxone Distribution to Veteran patients at risk for opioid overdose. This also includes stocking
Age Well, Live Well Support for Older Adult Survivors of Abuse By Shelby Enman, Texas Health & Human Services Commission
D
omestic violence (DV) is a widespread issue that can impact anyone. DV includes the use of emotional, physical, financial or sexual violence by a person to gain control of an intimate partner, family member or other loved one. In Texas, 37.7% of women and 26.8% of men experience DV over the course of their lifetime. Older adults can be abused as well. According to the National Council on Aging, about one in 10 adults ages 60 and older nationwide have experienced abuse. Elder abuse is defined as any intentional or neglectful act that causes harm or risk of harm, including self-neglect. This type of violence can include elements of DV but is specific
July 2021
to abuse of vulnerable adults. A vulnerable adult is defined as any adult who has a disability or who is age 65 or older. Adult Protective Services (APS) investigates allegations of abuse that vulnerable adults experience. Everyone 18 and older in Texas is required by law to report suspicions of elder abuse to APS. If you suspect that an older adult you know might be experiencing abuse, call APS at 1-800-252-5400 or visit txabusehotline.org. Many older adults in Texas seek help from their local family violence program. The Texas Health and Human Services Commission (HHSC) Family Violence Program oversees crisis centers and domestic violence programs across Texas that support people who have experienced abuse.
St. David’s CareNow Urgent Care locations can administer on-site rapid tests or polymerase chain reaction (PCR) lab send-out tests. Rapid test results are ready in less than 15 minutes. Travelers can visit any Central Texas location for COVID-19 tests prior to their trip to ensure results will be delivered within the travel destination’s required timeline. The cost for testing is $139. Travelers may schedule an appointment by utilizing Web Check-In at CareNow.com and selecting one of three options: • American Airlines Rapid Test (Hawaii) specifically for Hawaii passengers due to state-specific form requirements • American Airlines Rapid (International) for approved
destinations that allow a rapid COVID-19 test • American Airlines PCR lab send out (International) for approved destinations that require a laboratory send-out COVID-19 test After completing a rapid test, patients will receive a physical and electronic copy of their test results before leaving the clinic. Patients taking a PCR lab send-out test will receive an electronic-only copy of results. Travelers should provide proof of their test during check-in or via the VeriFLY app to show travel readiness based on completed COVID-19 requirements. Visit AA.com for more information on local COVID-19 requirements and destinations served by American Airlines. For more information about COVID-19 testing and other CareNow services, visit CareNow.com.
Automated External Defibrillator cabinets in high risk areas with naloxone and VA Police having speedy access to it for administering when necessary. “Naloxone is used to reverse opioid overdose and its timely administration during an overdose saves lives,” said, VA National Opioid Overdose Education and Naloxone Distribution Coordinator Elizabeth M. Oliva, Ph.D. “VA is at the forefront of this fight, changing lives every day through the Rapid Naloxone Initiative, the Opioid Safety Initiative, Substance Use Disorder Treatment and our Whole Health approach to improving overall well-being.”
VA established the first national Opioid Overdose Education and Naloxone Distribution program in May 2014. Based on a Diffusion of Excellence Promising Practice from the VA Boston Healthcare system, VA formally launched the Rapid Naloxone Initiative in September 2018. This concerted approach has equipped 291,841 VA patients, 3,552 VA police officers, and 1,095 AED cabinets with naloxone. VA’s efforts have resulted in more than 1,950 opioid overdose reversals, with 136 additional opioid overdose reversals facilitated by VA Police and 10 with AED cabinet naloxone.
Of the 64,623 people served by an HHSC-funded family violence program in 2020, about 9% identified themselves as age 50 and older and 785 identified as age 65 and older. “Family violence programs understand the complex issues that survivors of domestic violence face,” said Cody Rothschild, program and policy specialist with the HHSC Family Violence Program. “They offer trauma-informed support services to help people create safety plans and gain access to resources to help them
live lives free of abuse. Any survivor of domestic violence can access these services for free.” Although DV and elder abuse are serious, widespread issues, there are resources and services available to help survivors. If you or someone you know are experiencing abuse, please connect with the following resources below to find support. National Domestic Violence Hotline: call 900-799-SAFE or chat online at thehotline.org
• Tegucigalpa, Honduras
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Austin Medical Times
Improving Telehealth Services for Medicaid Users Researchers At Texas A&M Evaluate the Impact of Telehealth Services On Medicaid Patients’ Health Care Use And Spending To Help Officials Make Critical Decisions
By Callie Rainosek
S
ince 2012, Texas Medicaid users have had access to telehealth services, allowing them to receive health care from a distance. As part of a Texas Senate bill, Texas Health and Human Services submits a biannual Medicaid teleservices report to state officials, who then use this report to improve telehealth services for Medicaid users. This year’s report included a cost-savings analysis that evaluated the impact of telehealth services on patients’ health care use and spending for the years 2012 through 2018. The analysis was a collaborative effort primarily among three Texas A&M University professors within the Population Informatics lab: Hye-Chung Kum, PhD, professor at the Texas A&M School of Public Health and director of the Population
Informatics lab, Benjamin Ukert, PhD, assistant professor at the Texas A&M School of Public Health, and Mark Lawley, PhD, professor at the Texas A&M College of Engineering. Researchers identified two risk groups among Medicaid users that are primarily affected by teleservices: children and the blind/disabled. For children, study results indicated that access to teleservices provides more needed medication and hospital care, which diminishes the need for emergency department visits in the present and over time. For the blind/ disabled, study results suggest that teleservices are meeting a previously unmet need for behavioral and mental health care. The study results also indicated that telemonitoring of patients may lead to quicker response to changes in therapy needs, resulting in less inpatient use.
Although the study began before the COVID-19 outbreak, the pandemic did change the way the researchers worked and how government officials evaluated the study’s results. “More information was needed quicker and, in more detail, because decisions had to be made faster,” Kum said. “Officials needed this information to make better, more informed decisions that properly reflected Medicaid users’ health care needs.” Doing research in such a way that it impacts everyday life is one of the most important research goals for the Population Informatics lab. “I think one of the best ways to help government agencies make better and more informed decisions is by having collaborations with academic institutions,” Kum said. “I think it’s important for researchers at academic institutions to help provide the information and skills necessary for our government leaders so that they can better serve populations.” The report has since been shared with the Texas Office of the Governor and the Office of Lieutenant Governor, the Speaker of the House, Chair of the Senate Health and Human Services Committee, Chair of
the House Public Health Committee, Chair of the House Human Services Committee, and the Legislative Budget Board. “This project required multidisciplinary skills and a lot of teamwork and collaboration,” Kum said. “Time was also of the essence. It was an incredible opportunity to contribute to a project that could positively impact the lives of Medicaid users.” Sulki Park, a graduate student in the College of Engineering and a member of the lab also played a vital role in the study. Additionally, collaborators from the Texas A&M Engineering Experiment Station and the Center for Remote Health Technologies and Systems were involved in the project.
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Ascension To Cut Ribbon Celebrating Opening of New Austin-Based Pharmacy Services Center Connecting Its System-Wide Pharmacy Operations The 30,000-Square-Foot Facility Serves as a Specialty Pharmacy and Distribution Center for The National Health System’s Pharmacy Arm, Ascension Rx By Lauren Rouse
A
scension Rx hosted a special ribbon-cutting ceremony for its new Austin, Texas-based Pharmacy Services Center. Ascension Rx is the pharmacy arm of Ascension, the nation’s largest Catholic health system. Leaders from Ascension, Ascension Rx and the City of Austin will be on hand to celebrate the new facility and the better connected care it offers patients across the country. The Ascension Rx Pharmacy Services Center is a new, multifaceted, 30,000-square-foot facility that serves as a specialty pharmacy, distribution center and patient engagement hub for Ascension Rx sites across the U.S. This new home base expands and centralizes Ascension Rx specialty pharmacy operations, enables high-volume home delivery and creates efficiencies in processing and patient support. “The compassion of our associates and clinicians is the heart of Ascension Rx,” said Lynn Eschenbacher, PharmD, MBA, Chief Pharmacy Officer, Ascension and Ascension Rx. “The work of our Ascension Rx care teams across our national healthcare system combined with the special capabilities within this facility will help to improve coordination so we can better serve
Lynn Eschenbacher, PharmD, MBA, associates and clinicians at ribbon-cutting ceremony
patients and communities with comprehensive pharmacy care.” Ascension Rx: A new model of pharmacy care Ascension Rx provides patients with a comprehensive pharmacy solution and a compassionate, personalized approach. In October 2020, Ascension launched Ascension Rx to connect physicians, nurses and
pharmacists, creating a unified patient and caregiver experience that improves coordination, safety and quality of care. Ascension Rx functions as a high-touch clinical model centered on the patient-clinician relationship, offering specialty medication services, delivery, infusion therapy, and medication management. In response to the complexity and fragmentation that healthcare
consumers often experience when trying to get their prescriptions filled, Ascension Rx offers a seamless and coordinated experience that helps patients receive convenient access to the medicines they need, when and where they need them – whether at a nearby healthcare delivery site or at home.
the extent of employee contact with non-employees (whose vaccination status may be unknown). Pregnancy The EEOC’s guidance also clarifies that employees who are not vaccinated because of pregnancy may also be entitled to certain accommodations under Title VII if the employer makes modifications or exceptions for other employees “who are similar in their ability or inability to work.” These modifications may be the same as the accommodations identified above for employees based on a disability or religious belief. Emergency Use Authorization The EEOC declined to offer any insight on the legal implications of the Emergency Use Authorization for the three available COVID-19 vaccines to
date in the United States, indicating that “[t]he EEOC’s jurisdiction is limited to the federal EEO laws . . . .” The EEOC reinforced, however, that federal EEO laws do not prevent an employer from requiring employees to be vaccinated as a condition of entering the workplace, subject to the reasonable accommodation requirements under Title VII and the ADA (and other EEO considerations discussed in its guidance). Updated CDC Mask Guidance The EEOC acknowledged the recently updated guidance from the Centers for Disease Control and Prevention (“CDC”) exempting fully vaccinated individuals from masking requirements, and indicated that the EEOC is considering the impact of this CDC guidance on the EEOC’s
own COVID-19 guidance provided to date. Accordingly, employers may see further updates to the EEOC’s technical assistance soon. As more and more businesses return to physical workplaces and evaluate their COVID-19-related workplace policies, they should continue to monitor for updated guidance from the EEOC on matters related to employee screening, testing, vaccines and accommodations, as well as guidance from the CDC, the Occupational Safety and Health Administration (“OSHA”) and other public health authorities.
Legal Matters
Continued from page 3 individual would pose a direct threat, it must then consider whether a reasonable accommodation would reduce or eliminate that threat, unless doing so would present an “undue hardship” to the employer. The EEOC provides specific examples of potential accommodations, including wearing a face mask, social distancing, working a modified shift, making changes in the work environment (e.g., increasing ventilation, limiting contact with others), teleworking, or, as a last resort, reassigning to a vacant position in a different workspace. Finally, the EEOC cautions that employers should consider all options before denying an accommodation request, and that the “undue hardship” consideration may be impacted by the vaccination rate of the workforce and
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Telepsychiatry
Continued from page 1 greater flexibility.” “Now with the pandemic creating the need for so many virtual visits, candidates are seeing that they can serve the patient population digitally, but many clients are still slow to engage.” The overall demand for psychiatrists has increased during the pandemic, noted Belkin. “We are receiving a number of requests for psychiatrists, which reflects the reports of more behavioral health issues during this crisis. The needs have spanned adult as well as child and adolescent psychiatry.” “But the hospitals and practices requesting child and adolescent practitioners are generally not looking for telepsychiatry; they are seeking psychiatrists who are willing to move,” he added. “And the nation’s limited supply of child and adolescent psychiatrists makes these candidate searches even more challenging.” The current state of uncertainty “So many physicians would love a telepsychiatry position, but clients continue to worry about patient care, loss of continuity, reimbursements, etc,” said Belkin. “With the current state of emergency, televisits are reimbursed for now, but we’re not sure what is going to happen in the long run. There has been a lot of lobbying to extend those or make them permanent. But healthcare clients still have their doubts,” he explained, adding that their hesitancy may also relate to questions of liability if an adverse outcome occurs following a televisit. “Yet those working in the field are telling us that, in terms of patient care, it doesn’t seem that patients have less care or worse outcomes. Our mental health providers report their level of service is just as good,” he said. Healthcare employers that have tried telepsychiatry have also enjoyed some success, Belkin noted, including one of the firm’s clients in Wisconsin that was having trouble filling a permanent position. Once they opened it up to telepsychiatry, it took just 45 days to secure a qualified psychiatrist. Both client and physician have become fans of the arrangement ever since. Questions of access to mental health
Mental Health
Continued from page 6 increased stress and anxiety, there are different things you can do to cope.” Deep breathing works for some people, or mindfulness exercises may help. Sopchak keeps a mindfulness July 2021
Austin Medical Times services Belkin noted that the convenience of virtual visits and avoiding crowded waiting rooms has been attractive for many patients. “One caveat to the telemedicine trend, however, is that some don’t have good internet connection, or it fades in and out, which can be a problem,” he said. While telepsychiatry can create greater access for some clients living in remote areas, public health experts have voiced concerns about inequities that may leave some unable to receive care in a virtual environment. “A lot of organizations are trying to meet the needs of psychiatrists and their clients, but patients may not have the technology resources to be able to see these professionals remotely because they don’t have a smartphone or laptop or reliable internet,” said Bishop. Limitations of telepsychiatry Despite their attraction for psychiatrists, Bishop explained that there are some limitations to telepsychiatry visits. “Body language is very important to be able to see when visiting with a patient, and a psychiatrist or psychologist can’t necessarily see that during telehealth visit; they may not see what the person is doing with hands, feet, etc.,” she said. Some mental health conditions are also less conducive to teletherapy. “If you are treating depression or anxiety that needs to be addressed, a telehealth visit can work. But if a patient has schizophrenia, or other more acute cases or comorbidities, those may need to be seen in person,” said Bishop. Even the same patient may need different support at different times, she explained. “A lot of it may be medication management, so that one-month checkup online may make sense. You can easily do that virtually.” Another thing candidates might need to consider is the compensation rate for telepsychiatry. “Some clients are open to offering full-time, remote positions but the compensation is going to be less,” said Bishop. “Telehealth may not be as high paying.” Psychiatry recruiting impacted by virtual practice and workforce shortages “Behavioral health clinicians have decided that they can practice virtually from home, making it more difficult to have people consider a traditional, onsite
job,” reported Bishop. “Going forward, I think more organizations need to be open to having some flexibility in their work schedules, like three days on site and two days working remotely--some kind of nontraditional schedule.” “I can’t think of one candidate who has had a negative experience practicing in the virtual environment; most would prefer to work from home, or not have to relocate,” Belkin added. “There are so many opportunities for behavioral health jobs, but not everyone wants to move.” “We need to figure out a solution in psychiatry, as the workforce demographics aren’t promising. More than 80 percent of psychiatrists are over the age of 45, and 60 percent are 55 or older,” he continued. “Psychiatrists do practice longer than their medical colleagues, and their average retirement age is older since they don’t usually encounter physical limitations. But supply issues are still a challenge.” A limited capacity to train new practitioners is part of the issue, according to Belkin, who noted that there are less than 2,000 psychiatry residency slots each year. Without a robust pipeline of new physicians, the workforce shortage is expected to become an even larger crisis. Telemedicine and the future of psychiatry jobs “We expect the demand for psychiatrists will continue to climb,” said Bishop. “There could be a trickle effect for years to come from the pandemic, due to people who experienced traumatic losses, extended seclusion, situational depression or social anxiety. It could take years before we know how it affected younger kids especially.” Virtual visits are also expected to remain popular, though the percentage of mental health services provided remotely vs. in-person will vary depending on location, compensation and other factors. “The availability of reimbursement funding will have a huge impact on whether an organization will start offering telepsychiatry as an ongoing piece of their business,” said Belkin. “If candidates are patient, we believe there will be more dedicated telepsychiatry positions down the line,” he concluded.
app on her phone so when she’s feeling stressed, overwhelmed or anxious about something, she can listen to a guided meditation and bring it down to a level she can manage. You can also try these mindfulness practice videos from the Telebehavioral Care Program. For some people, these strategies may not be effective. In that case,
consider seeking professional help. “This is a big transition. Give yourself grace and say, ‘Look, it’s okay that I’m struggling with this, because this is big,’” Sopchak said. “Our lives were uprooted and changed, and now our lives are going to be uprooted and changed again.”
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