Hospital News

St. David’s CareNow Urgent Care teams with American Airlines to offer COVID-19 rapid testing for travelers

St. 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 • Tegucigalpa, Honduras 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.

VA’s Rapid Naloxone Initiative Recognized in Fight Against Opioid Overdose Deaths

Alife-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 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.

Age Well, Live Well

Support for Older Adult Survivors of Abuse

By Shelby Enman, Texas Health & Human Services Commission

Domestic 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 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. 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 

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

Since 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

Ascension 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 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

Lynn Eschenbacher, PharmD, MBA, associates and clinicians at ribbon-cutting ceremony

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. 

Legal Matters

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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 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. 

Telepsychiatry

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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 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.

Mental Health

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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 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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