Artificial Intelligence: Emerging Issues in Healthcare and Insurance Public Policy
By Remi Stone, JD Director, Government Relations The Doctors Company
The use of artificial intelligence (AI) in the healthcare setting and its effects on professional liability insurance are rapidly evolving. As AI technology advances and becomes more integrated into healthcare, the legislative and regulatory framework is just starting to catch up — as is always the case with new and emerging technologies.
Across the nation, public policymakers are attempting to balance the integration of AI in the healthcare environment with safeguarding positive patient outcomes.
In addition, matters relating to liability remain unsettled. The distribution of liability will likely shift as device manufacturers, algorithm developers, facility leaders, and other parties involved in healthcare choose to integrate AI into more diagnostic and treatment tools.
Causes of action involving professional, vicarious, and product liabilities may become more common in the court systems, and while we have not yet seen legislation enacted that specifically assigns AI liability or targets professional liability tort statutes, we anticipate the future will bring a deluge of bills that attempt to add clarity to this unsettled legal and public policy topic.
Nevertheless, legislation addressing traditional liability concerns increasingly touches on AI issues. AI-related proposals have addressed matters that include patient informed consent, scope of practice, admission decisions, and care plan development, as well as those focusing on more common issues involving data and patient privacy.
Some state legislatures have
put forward ideas, such as banning healthcare insurers from using AI to discriminate on the basis of a patient’s race, gender, national origin, age, or disability. Other states are attempting to regulate the use of AI in diagnosing and treating patients.
For example, patient consent and scope of practice are central to legislation pending before the Illinois legislature (HB1002). One proposal would require that patients be informed and provide consent before a diagnostic algorithm is used, with patients having the option of being diagnosed without it. Any algorithm used must be certified by the state’s Departments of Public Health and Innovation and Technology and known to achieve results as accurate or more accurate than other diagnostic means. In addition, lawmakers are considering legislation (HB 3338) that touches on scope of practice by proposing that healthcare facilities be prohibited from substituting health information technologies or algorithms for a nurse’s human judgment.
The public policy discussion at the federal level is also accelerating. Last October, President Biden issued Executive Order 14110 to promote
responsible development of AI in the healthcare arena. The executive order and subsequently announced public-private partnerships with providers and payers focus on the “safe, secure, and trustworthy use and purchase and use of AI in healthcare.”1
In February 2024, lawmakers formed the Congressional Digital Health Caucus with the goals of educating policymakers about the rapid changes in digital health innovation, showing its potential effects on patients and the healthcare system, and ensuring that all Americans benefit from advancements.
On the international front, the European Union (EU) Parliament adopted the Artificial Intelligence Act in March 2024. The act—the first of its kind in the world—covers the 27 member EU countries with a comprehensive approach to regulating AI, including its use in healthcare. This comes on the heels of the 2022 EU report, Artificial Intelligence in Healthcare, which discussed the clinical, social, and ethical risks posed by AI in healthcare.2 The report is
Oncology Research
Not All Cancers Have Tumors: More Than 4,000 Texans Diagnosed With This Blood Cancer Each Year
By Preethi Ramachandran, M.D., MBBS, MRCP, FRCPath (Hematology) Texas Oncology–Harker Heights, Round Rock North
For most people, the word cancer implies that there’s a tumor or mass growing somewhere in the body. However, contrary to popular belief, not all cancers form tumors.
While many cancer patients are likely to hear the word tumor when they are diagnosed, that might not be the case for the more than 4,700 Texans expected to be diagnosed with leukemia this year.
What is leukemia?
Unlike most cancers, which occur when abnormal cells multiply to form masses, leukemia occurs when abnormal blood cells are generated
within the bone marrow, multiply, and spread throughout the body, crowding out platelets and healthy white and red blood cells. These abnormal cells make it difficult for normal blood cells and platelets to function properly within the body, making a person prone to infection, anemia, bruising, and bleeding.
The four most common leukemia subtypes are:
• Acute lymphocytic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Chronic lymphocytic leukemia (CLL)
• Chronic myeloid leukemia (CML)
Acute leukemia is characterized by rapidly growing cells and quickly diminishes a person’s health, and chronic leukemia develops and progresses slowly over time. How is leukemia staged? For most cancer types, the stage
SHOULDN’T YOU BENEFIT
of the cancer is based on the size and spread of the primary tumor. However, leukemia staging is determined based on blood cell counts and the accumulation of leukemia cells in organs like the liver and spleen. First, the leukemia subtype is determined using cytologic (cellular) tests, flow cytometry, or other lab tests. Then, each leukemia subtype is staged using a specific system which may include molecular testing results for determining the level of risk:
• ALL looks at the type of lymphocyte and the maturity of the cells.
• AML considers the number of healthy blood cells, size and
number of the leukemia cells, changes in the chromosomes of the leukemia cells, and other genetic abnormalities.
• CLL uses the number of lymphocytes in the blood; the degree of lymph node, spleen, or liver enlargement; and the presence of anemia or thrombocytopenia.
• CML measures the number of diseased cells found in blood and bone marrow tests.
see Oncology ...page 14
Legal Matters FSMB Vs. Skynet: 5 Rules for Keeping AI in Check in Medicine
TBy Alexis Angell, J.D. Polsinelli, PC
here has been a significant development that may impact healthcare providers using artificial intelligence (AI) in their practice. The Federation of State Medical Boards (FSMB) has recently released a report providing essential guidance to state regulators on the responsibilities of physicians when incorporating AI into patient care.
5 Key Take-Aways from the FSMB’s New Guidance:
» Emphasis on Education and Proficiency: Physicians must be well-informed about the AI tools they use, understanding both their capabilities and underlying
technologies. This includes being aware of the data on which AI tools are trained and their operational methodologies.
» Accountability and Ethical Use:
The guidance reinforces that physicians hold ultimate responsibility for AI-facilitated decisions in patient care. This involves ensuring that AI tools augment, but do not replace, professional medical judgment and maintaining a rationale for AI-recommended treatments.
» Informed Consent and Transparency: Clear communication with patients about the use of AI in their care is mandatory. This includes discussing how AI impacts treatment decisions and ensuring patients are fully informed about their care options.
» Data Privacy and Security: Physicians must ensure that patient
data used by AI tools are handled with strict privacy measures and comply with all relevant laws and regulations.
» Regulatory Considerations: While state medical boards do not directly regulate AI as a healthcare device, they are empowered to oversee physicians using AI. The report suggests setting up standards that keep pace with the evolution of AI technologies without stifling innovation.
Why It Matters & What’s Next
As AI continues to integrate into healthcare settings, understanding the legal and ethical implications becomes
increasingly vital. The American Medical Association and other stakeholders are actively discussing the balance between embracing AI advancements and protecting both patients and healthcare providers from potential pitfalls associated with AI. Potential pitfalls include bias and inaccuracy, over-reliance on technology, and privacy concerns. States are beginning to evaluate the role of medical boards in regulating AI use within medical practice, with some states starting to enact comprehensive AI statutes that
see Legal Matters ...page 13
Mental Health Excessive Heat and Its Impact on Mental Health
By Baylor College of Medicine
Extreme heat this summer is affecting people across the country – mentally as well as physically. While heat can make anyone irritable, the impact can go beyond that, especially for people with mental health conditions. A Baylor College of Medicine psychiatrist explains how heat affects mental health.
Excessive heat causes changes in emotions and behavior that can result in feelings of anger, irritability, aggression, discomfort, stress and fatigue. Heat alters those behaviors because of its impact on serotonin, the primary neurotransmitter that regulates your mood, leading to decreased levels of happiness or joy and increased levels of stress and fatigue.
The most vulnerable groups affected by heat and mental health include people with preexisting conditions and people who use substances like alcohol. People who
already suffer from stress, anger or anxiety will experience increased serotonin. If people use substances, especially alcohol, they need to be more hydrated. Combining substance use with heat requires even more hydration.
“All mental illnesses increase with heat because it results in more fatigue, irritability and anxiety, and it can exacerbate depressive episodes,” said Dr. Asim Shah, professor and executive vice chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor.
Signs of heat impairing mental health start with irritability, decreased motivation, aggressive behavior and sometimes mental fogging. In worse cases, it can cause confusion and disorientation. While avoiding the heat may not be possible, Shah recommends hydrating with electrolytes and keeping your head covered when going outside. In addition, pour some water on your head to cool down and try doing things
in the shade. If you normally go for walks outside, move them inside by walking in the mall or a large space with air conditioning.
If you take medications, consult with your provider before mixing your dose with excessive heat.
Some medications for mental health, such as lithium for bipolar patients, might not pair well with heat. Lithium goes through the kidney, so if you sweat more, levels of lithium fluctuate.
“If you are out in the heat and using lithium, levels may fluctuate. In that scenario, we have to be very careful and either adjust the dosage of lithium or avoid heat,” he said.
Climate changes, including droughts and extreme changes in temperature, can cause negative effects by increasing pollutants and allergens and worsening air quality. These worsen mental health issues like depression, anxiety or PTSD. Some studies show that exposure to any
natural climate disaster can increase the risk of depression by more than 30%, anxiety by 70% and both by over 87%.
“Children are a vulnerable population due to their physical and cognitive immaturity. They are exposed to more pollutants and allergens as they spend more time outdoors,” Shah said.
Previous studies on emergency room visits explore hospital visits due to heat and mental health. A study in JAMA Psychiatry reported about an 8% increase in emergency visits due to the effects of heat on mental health. If you feel affected by severe heat, speak with your primary care provider or mental health specialist.
FEEL GOOD AGAIN
Healthy Heart
Knowing You Have a Brain Aneurysm May Raise Anxiety Risk, Other Mental Health Conditions
Even If the Risk Is Small, The Potential of a Debilitating Brain Vessel Rupture May Be a Psychological Burden, Finds New Study In The Stroke Journal
By American Heart Association
Among people who had aneurysms (weakened areas in brain blood vessels), the risk of developing a mental health condition was higher than among peers without an aneurysm. The highest risk was seen in patients younger than age 40, according to research published today in Stroke, the peer-reviewed scientific journal of the American Stroke Association, a division of the American Heart Association.
An unruptured intracranial aneurysm occurs when the wall of a blood vessel in the brain becomes weak and bulges out, posing a potential risk of future rupture and life-threatening bleeding in the brain.
in Seoul, South Korea.
”This study did not specifically target brain aneurysms that were small enough not to require treatment and had a low probability of rupture. We included all diagnosed, untreated brain aneurysms that were being followed,” Yang said. “The reason for not treating and only following up may be that the aneurysm is small and unlikely to rupture, making treatment unnecessary. However, the decision is likely based on various circumstances, including the patient’s overall condition, and such specific reasons were not captured in this study group.”
While other studies have observed patterns of stress and anxiety in patients living with an aneurysm diagnosis, the
researchers said this is one of the first large studies to estimate the risk of a mental health condition after aneurysm diagnosis.
In this study, researchers examined data from the National Health Information Database in South Korea, which includes over 20 years (2004 to 2024) of health data for more than 85,000 people who received care from hospitals, clinics and pharmacies throughout the country. It is one of the world’s largest and most comprehensive health information databases. More than six months after diagnosis with
“As a neurosurgeon who treats cerebral aneurysms, I often see people who do not undergo surgery yet feel fear and/or anxiety about their condition before each imaging or screening test to monitor their condition. Even when it is medically judged and explained that follow-up observation is the best course for their aneurysm rather than surgery, they still worry about the very slim chance of developing a fatal brain bleed,” said study co-author Na-Rae Yang, M.D., Ph.D., an assistant professor of neurosurgery in the department of neurosurgery at Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine 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 Texas names John Thresher Chief Strategy Officer
AscensionTexas has announced John Tresher as its new Chief Strategy Officer (CSO). In his role as CSO of Ascension Texas, John will lead the development and implementation of the overall strategy for the market, including identifying and developing high-priority strategic opportunities and partnerships. He will also lead service-line and business development, positioning for growth across the Texas market portfolio.
Prior to his new role as CSO, John most recently served as Chief Development Officer for a large health system
St. David’s Round Rock Medical Center Names New Chief Executive Officer
St.
David’s Round Rock Medical Center has named JW Newman as the facility’s new chief executive officer. Newman, who recently served as chief operating officer at TriStar Centennial Medical Center in Nashville, will transition to his new role on Aug. 12.
“JW brings extensive expertise leading highly ranked institutions,” David Huffstutler, president and chief executive officer of St. David’s HealthCare, said. “I look forward to the
contributions he will make in advancing St. David’s Round Rock Medical Center’s legacy of providing exceptional care to the Round Rock community.”
During his time at TriStar Centennial Medical Center, Newman was responsible for the daily operations and business development of the 741-bed facility. As part of his role, Newman developed a $125-million capital project to support the growth of the hospital, improved patient and staff satisfaction, led efforts
in Texas. He brings over two decades of executive experience in business development, strategy and operations across multiple healthcare sectors.
“We are thrilled to welcome John to Ascension Texas as we continue to focus on strategic growth, building nationally-ranked clinical programs and developing partnerships across our network,” said Andy Davis, president and CEO of Ascension Texas.
John is a graduate of the U.S. Military Academy at West Point with a bachelor’s degree in engineering management. Additionally, John is also a distinguished honor graduate of
the U.S. Army Flight School. He served as a senior Army aviator and instructor pilot, earning several military awards, including a Bronze Star.
to expand cardiac and surgical services, and helped secure a new freestanding emergency room. Additionally, Newman provided oversight for a variety of service lines, including surgical, radiology/imaging, cardiovascular, endoscopy, laboratory, patient transport, respiratory therapy, rehab and wound care.
Prior to his role at TriStar Centennial Medical Center, Newman served as the COO of Medical City Fort Worth. He received his master of science in
healthcare administration from Trinity University in San Antonio and a bachelor of business administration in managerial finance from the University of Mississippi.
John Tresher
Diabetes Drug Metformin May Protect Against Radiation Exposure
Findings From UTSW Study Offer Potential Applications in Cancer Treatment, Nuclear Accidents, And Space Exploration
By UT Southwestern
Metformin, a well-tolerated diabetes drug prescribed to as many as 150 million people worldwide, may also protect cells from radiation damage, UT Southwestern Medical Center researchers report. The findings, published in PLOS ONE, could have broad implications for cancer patients, nuclear accident response teams, and even astronauts traveling in deep space.
“While metformin is primarily known as a safe drug to treat Type 2 diabetes, this report demonstrated that it is also a potent radiation countermeasure,” said the study’s Principal Investigator, Jerry Shay, Ph.D., Professor of Cell Biology and a member of the Harold C. Simmons
Comprehensive Cancer Center at UT Southwestern.
In order to understand the protective mechanism, researchers examined the effects of metformin on human cells in vitro in relation to the production of a potent antioxidant, SOD1, in the cell nucleus. SOD1 performs DNA repair by removing superoxide free radicals that are produced as the result of radiation. Researchers found that when cells were treated with metformin, production of SOD1 increased in the cell nucleus of human fibroblasts.
To examine the effects of metformin in vivo, researchers injected mice with metformin for three days before exposing them to whole-body radiation. They then checked the
rate of micronuclei development – a marker of genotoxicity – in the bone marrow. Mice treated with metformin showed reduced formation of micronuclei.
The researchers also studied the drug’s effects after exposure to galactic cosmic radiation (GCR), which occurs during space travel. A round-trip mission to Mars, for example, would expose astronauts to an unsafe level of GCR, so there is broad interest in possible solutions.
The team used a GCR simulator at the NASA Space Radiation Laboratory in collaboration with Brookhaven National Laboratory. Mice that did or did not receive metformin orally over three days received a dose of simulated GCR equal to a Mars mission. GCR caused significantly more genotoxicity, as indicated by formation of micronuclei, in mice that did not receive metformin than in those that did.
“This study advances the field to indicate that metformin may be a safe radioprotector for first responders to nuclear accidents and for protecting astronauts from the cancer risk and side effects of exposure to space radiation,” Dr. Shay said. “This study also suggests that metformin may be useful for treating patients with radiotherapy for cancer to reduce potential side effects.”
Jerry Shay, Ph.D., is Professor of Cell Biology and a member of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. Dr. Shay, a Distinguished Teaching Professor, holds The Southland Financial Corporation Distinguished Chair in Geriatrics.
Take Charge Of Your Health Journey: Be Your Own Advocate
By Andrew Gerber, M.D., Internal Medicine
M aintaining your health is a lifelong commitment. Addressing evolving priorities becomes increasingly important as we age, and we need to know how to best approach these evolving needs and more frequent visits with your doctor.
Appointments addressing specific health concerns with your doctor can be overwhelming. New, complex information and stress can cause patients to miss important information. How can you manage this complexity and be an effective advocate for your health?
Before your visit:
• Gather and bring all your medications to your appointment.
• Bring your medical records, such as notes and recommendations from specialists and details of recent hospitalizations. Your doctor may have access to some of these records, but systems do not always
communicate with one another effectively.
• Write down a list of questions and concerns that you would like to talk about. It is easy to forget issues during a clinic visit. If there is not enough time to cover all topics effectively, make a follow-up appointment to address everything you wanted to cover.
During your visit, you may not always feel as though you have a lot of time to get through all the important issues. So how can you make your visit with your provider as productive as possible?
• Stay focused on the priorities. Keeping the conversation on track ensures that you can cover as many items on your list as possible and that your doctor can discuss and manage the issues they identify as being critical for your health, such as disease prevention.
• Take notes during your appointment. There may be many things to discuss during
your appointment. Taking notes is useful to ensure no details are lost. Often, your doctor can provide or recommend resources for further education.
• Review after your appointment. Review your notes, educational materials, and updated medication list if needed, and contact your doctor if you have any questions. Schedule a follow-up appointment to review any other questions not addressed at the appointment.
• Consider bringing a friend or family member, especially if an appointment is likely to involve learning new information, such as management of a newly diagnosed
condition, learning the results from a recent test or screening, or building a new nutrition or physical fitness routine. Having someone you trust with you can help you remember details and decisions and provide reinforcement and accountability to the management recommendations.
Facing new diagnoses or tests: Learning about a new health condition, test, or screening can be stressful. When your doctor recommends a test based on age, health conditions, family history, or other factors, ask questions to gain a
see Take Charge...page 13
Warm cookies, delivered.
Experts Call for More Clinical Trials on Alcohol Use, Liver Disease
International Task Force Issues
Recommendations to Guide Research Into Alcohol Use Disorder And To Address Stigma
Moreclinical research is needed to investigate how reducing alcohol consumption in patients with alcohol-related liver disease (ALD) may slow disease progression and improve outcomes, according to an international task force of experts from more than two dozen institutions including UT Southwestern Medical Center.
In a consensus statement published in Nature Reviews, the group, commissioned by the National Institute on Alcohol Abuse and
Alcoholism (NIAAA), issued a set of 28 recommendations to guide the design of future clinical trials addressing alcohol use disorder (AUD) and ALD. The recommendations call for multidisciplinary teams, including experts from hepatology and addiction medicine, and the need to address the stigma of alcoholism.
“Physicians know anecdotally that reducing or eliminating heavy drinking after diagnosis can extend and improve life for patients with
Age Well, Live Well
Falls Prevention Awareness Week
By Stephanie Taylor HHSC Research Specialist
FallsPrevention Awareness Week begins the first day of the fall season on Sept. 23 to raise national awareness on preventing falls and helping older adults live without fear of falling.
Falls are the leading cause of injury for adults 65 and older. According to a 2020 study by the Centers for Disease Control and Prevention, over 14 million older adults in the U.S. — or one out of four — reported falling within the past year.
Many falls can be prevented by exercising, managing medications, having vision checks and making home safety modifications.
Exercise
Staying physically active is important. The Centers for Disease Control and Prevention recommends exercises that improve balance and make your legs stronger to lower your chances of falling. Being active also helps you feel better and more confident.
Regular exercise keeps your joints, tendons and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that weakens bones.
Consider participating in yoga, Pilates and Tai Chi — all of which have been shown to improve balance and muscle strength. Lifting weights
ALD, but research on the subject has been limited,” said Mack Mitchell, M.D., Professor of Internal Medicine in the Division of Digestive and Liver Diseases and Vice President for Medical Affairs at UT Southwestern, who co-chaired the task force and is the lead author on the article. “Our hope is that well-designed clinical trials focused on alcohol use and ALD could lead to effective changes in clinical practice.”
Deaths linked to excessive alcohol use have increased over the past two decades, including a surge during the COVID-19 pandemic. Alcohol consumption is a primary
or using resistance bands can also help build strength.
Speak with your health care provider about the best type of exercise program for you. Texercise, an initiative by the Texas Health and Human Services Commission (HHSC), provides additional resources and programs to assist older adults with engaging in regular physical activity at home.
Managing medications
Some medications can increase a person’s risk of falling through side effects such as dizziness or confusion. Certain medications, as well as combinations of over-the-counter and prescribed drugs, can also increase the risk of a fall.
Having a health care provider review all the medicines you take can make you aware of their side effects and potentially find less risky alternatives. It is also valuable to check with your provider about taking vitamin D
cause of death from liver-related diseases, accounting for more than half of all cirrhosis-related deaths in the U.S. in 2022 and 46% of all liver disease deaths, according to NIAAA. While abstinence has been associated with improved life expectancy for ALD patients, few clinical trials have been conducted to investigate how interventions to reduce or eliminate heavy drinking will affect disease progression.
The task force included hepatologists, addiction medicine specialists, clinical trialists, and
supplements to improve bone, muscle and nerve health.
Vision checks
Visual impairment is prevalent among older adults and a frequent risk factor for falls, according to the National Library of Medicine. Schedule an examination with your eye doctor once a year to check for glaucoma, cataracts or declines in vision, and update your eyeglasses if needed. To learn more about vision loss in older adults and available resources, visit the HHSC Vision Loss in Older Adults page.
Home modifications
Thousands of older adults fall at home each year due to common household hazards, according to the National Council on Aging.
Some of the ways you can make your home safer are:
• Removing throw rugs or use
Alcohol Use ...page 14 see Age Well, Live Well...page 12
Mack Mitchell, M.D., (left) Professor of Internal Medicine in the Division of Digestive and Liver Diseases and Vice President for Medical Affairs at UT Southwestern, holds the Nancy S. and Jeremy L. Halbreich Professorship in Gastroenterology. He is a leading expert on research related to alcohol-related liver disease and alcohol use disorder. Thomas Cotter, M.D., M.S.C.P., is Assistant Professor of Internal Medicine in the Division of Digestive and Liver Diseases at UT Southwestern.
IFinancial Forecast
The Pros and Cons of a Cash Out Refinance
By Grace S. Yung, CFP
f you’re looking for extra cash to pay off or consolidate debt, fund home improvement projects, or start a business, you may have considered tapping into your home’s equity using a cash out refinance. This involves replacing your existing home mortgage with a new loan for a larger amount, in turn, allowing you to pay off your existing loan and access additional funds.
Refinancing your home mortgage is a major financial decision, though, so it is important to understand the pros and cons, and how doing so could impact other areas of your financial plan.
Advantages and Drawbacks of a Cash Out Refinance
There are advantages and drawbacks to doing a cash out refinance. On the plus side, this strategy allows you access to money at a potentially lower interest rate compared to taking
out a personal loan or borrowing cash from a credit card. In addition, if you itemize deductions on your tax return, the interest on the refinanced home loan may be tax deductible.
If you refinanced to a new loan with a fixed interest rate, you would also have predictable monthly payments, which can make budgeting easier. This is not necessarily the case with other cash out alternatives like a home equity line of credit that oftentimes carries a variable interest rate.
There are other potential positives, too, with a cash out refinance, such as a possible increase in your credit score, especially if you used the funds from the refinance to consolidate higher interest debts.
Yet, even given all the benefits of a cash out refinance, there are possible drawbacks to consider. For example, doing so can increase your debt obligations, while also decreasing the equity you have in your home.
Further, “starting over” with a new home loan can mean that you’ll be paying your mortgage for a longer period of time. So, you should consider your budget before moving forward, particularly if you are approaching
Age Well, Live Well
Continued from page 11
double-sided tape to keep them from causing you to slip or trip.
• Making sure all rooms and
hallways have good lighting with easily accessible switches or motion sensor lights.
retirement and trying to reduce your monthly expenses.
Considerations for Cash Out Refinance in Texas
While cash out refinancing is allowed in Texas, the state imposes some different rules than in other states, such as:
The new loan amount may not exceed 80% of your home’s value.
Closing costs may not exceed 2% of the new loan amount.
All liens on the home, such as a second mortgage, must be paid off before moving forward with a cash out refinance.
Home equity loans or home equity lines of credit are not allowed if you already have a cash out refinance loan in place.
There is a six month waiting period after purchasing your home before you can implement a cash out refinance.
− Cash out refinanced loans are not backed by the federal government. Minimum credit score and maximum debt-to-income ratio.
It is important to note that the Texas-specific cash out refinance rules only apply to your primary residence, and not to second homes or investment property.
Should You Consider a Cash Out Refinance?
There are many factors to consider before you move forward with a cash out refinance, including: Interest rate
New payment amount
Tax deductions
Cash out refinance alternatives
Because everyone’s financial needs and objectives are different, a cash out refinance may or may not be right for you. Therefore, you should discuss your short and long-term plans with a CERTIFIED FINANCIAL PLANNER professional who can help you look at all of the angles and determine whether you should move forward.
• Installing handrails on stairs and grab bars in bathrooms and showers.
Foot checks
Have your health care provider check your feet at least once a year. Discuss proper footwear and ask whether seeing a foot specialist is advised.
To learn more about preventing falls at home, visit the National Institute on Aging.
Legal Matters
Continued from page 4
directly and indirectly regulate the use of AI in health care. For example, in May of this year Colorado enacted a comprehensive state AI law that will go into effect on February 1, 2026, and which places certain limits and obligations on developers and entities that deploy AI including for use in health care services. Similarly, the Utah Department of Commerce’s Office of Artificial Intelligence Policy has proposed regulations governing the use of AI chatbots and interactions by mental health care providers that is likely to be taken up by the Utah legislature later this year. Decisions and further regulatory frameworks are expected in the upcoming months, which could set precedents for how AI is integrated into healthcare nationally.
Healthy Heart
Continued from page 6
an aneurysm, researchers compared how many people developed a mental health condition, such as anxiety, stress, depression, bipolar and eating disorders, insomnia and alcohol or drug misuse. They then compared them to the rate of mental health condition diagnoses among similar adults without aneurysm who received care for an upper respiratory infection.
The analysis took place over a 10-year period and found, when compared to people without an aneurysm:
• people with an aneurysm were 10%
Take Charge
Continued from page 10
more complete understanding of your health, risk factors, and test benefits. Asking questions can help you be more confident in actively managing your own health.
Questions to ask about screening tests:
• Why do you recommend this test for me specifically?
• What is the cost of this test? Is it covered by my insurance?
• What should I know about the test itself?
Speaking of AI . . . Use of AI in Recording Privileged and Confidential Peer Review Meetings:
While not discussed in the FSMB’s report, considering the growing integration of AI tools in healthcare settings, it is important to address AI use in sensitive areas such as privileged and confidential peer review meetings. For example, if a practitioner relies on AI as opposed to exercising their professional medical judgment and this action jeopardizes patient care, peer review in healthcare settings should be triggered. Further, using AI for recording and transcribing peer review meetings poses specific challenges and risks beyond a typical business meeting. Without carefully crafted protocols, there is a risk of breaching the confidentiality that is foundational to the peer review process, as AI generated meeting minutes or summaries may
more likely to be diagnosed with a mental health condition;
• the risk of a mental health condition was particularly pronounced in people with an aneurysm under the age of 40; and
• in cases where a mental health condition was diagnosed by a psychiatrist, the difference was even greater, showing a three-fold increased risk.
“Our finding of a higher rate of a severe mental health condition in younger adults with aneurysm underscores the significant psychological burden for this group of patients who may already be dealing with other life stressors, such as building their career and/or raising a family,” Yang said. “This
• What should I do ahead of time to prepare? For example, some medical tests require you to fast ahead of time.
• Are there risks or side effects? How would they be managed?
• How long will it take to get the results? What are our next steps after receiving them?
If your results show you have or are at risk for a medical condition, there are questions you may want to ask:
• What may have caused or contributed to this new condition?
• Is the condition permanent? How is it treated?
not be considered privileged material. Such breaches could undermine the legal protections typically afforded to these activities and potentially expose healthcare providers to legal liabilities. It is vital for healthcare institutions to establish and enforce strict guidelines that govern the use of AI in these sensitive settings, if AI is to be allowed at all, to maintain the integrity and confidentiality of the discussions. As hospitals consider and develop AI policies and protocols we recommend they consider the following:
• Announce at the beginning of any meeting in which AI is being used to record and summarize the meeting, that AI will be used to do so, and that no other recordings of the meeting are authorized;
• Require that any AI assisted documents will be marked
elevated rate of mental health conditions suggests that younger people might be particularly vulnerable, highlighting the need for targeted mental health support and interventions for this age group. This includes providing clear explanations and tailoring treatment decisions for each person,” Yang said.
An aneurysm may be diagnosed when a person has imaging (such as a CT scan or MRI) to evaluate neurological symptoms (such as a headache or vision changes), or it can be discovered by chance if imaging is done for an unrelated issue.
Study limitations include that the analysis was based on diagnostic and prescription codes in a national database, which may be imprecise and
• Does the treatment itself carry the potential for side effects? Your doctor is an ally who is there for you to help with sensitive and social issues that can affect your health – such as social isolation, risk of falling, and urinary incontinence. While these issues may seem difficult to talk about, they all can become more prominent as we age. Your doctor is also focused on prevention through helping you manage unhealthy habits and promoting positive health habits. They may seem uncomfortable or embarrassing to talk about, but doctors are eager to talk about these issues and help you feel comfortable about
accordingly and require review prior to being adopted as an official medical staff record;
• Prohibit AI from being used to make decisions, and require that any decisions remain in the sole discretion of the medical staff based on independent verified information;
• Require that all recordings are erased as a matter of routine within 30 days after the meeting; and
• If AI may be used to draft letters and memos, then require careful personal review of the AI generated document to ensure accuracy before being finalized. Any AI generated or assisted draft letter or draft memo must be marked accordingly.
may not reflect the nuances of individual patient care and mental health status. In addition, the specific size and location of aneurysms were not considered. This study design highlights a possible association but cannot establish a cause-and-effect relationship between an aneurysm diagnosis and later mental health status. This study population was from South Korea, so the findings may not be consistent with populations in other countries.
solutions. They can guide you toward positive, healthy outcomes. You have enough to worry about when you go to see the doctor. As we age, there are many things that we cannot control. It is important to remember that there are many aspects of our health, healthcare, and behaviors that we can control. Taking a proactive approach to your own care will go a long way to reducing your stress and improving your health for years to come.
AI
Continued from page 1
expected to serve as a roadmap for regulating AI in healthcare as the EU builds out the Artificial Intelligence Act’s regulatory framework.
Closer to home, the American Medical Association (AMA) provides a succinct view on physician liability, patient safety, and risk management in Principles for Augmented Intelligence Development, Deployment, and Use.
As the AMA writes, “The question of physician liability for use of AI-enabled technologies presents novel and complex legal questions and potentially poses risks to the successful clinical integration of AI-enabled technologies.”3 The AMA further outlines an approach to addressing liability concerns raised by the deployment of AI in the healthcare
Oncology
Continued from page 3
What treatment options are available for leukemia?
Treatment for leukemia varies depending on the type and stage of leukemia, as well as the patient’s age, medical history, general health, and treatment goals. However, patients with acute leukemia must start treatment immediately due to the rapid progression of the disease. Treatment options for leukemia can include:
• Blood and bone marrow transplant
• CAR-T therapy
• Chemotherapy
• Immunotherapy
• Monoclonal antibodies
• Palliative medicine
Alcohol Use
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members of regulatory agencies. Among its recommendations are definitions for disease categories, criteria for trial participants, treatment considerations, and safety and regulatory concerns.
The article notes that diseases related to alcohol use are among the most stigmatized, resulting in stereotypes that create barriers to
arena:
Current AMA policy states that liability and incentives should be aligned so that the individual(s) or entity(ies) best positioned to know the AI system risks and best positioned to avert or mitigate harm do so through design, development, validation, and implementation.
Where a mandated use of AI systems prevents mitigation of risk and harm, the individual or entity issuing the mandate must be assigned all applicable liability.
Developers of autonomous AI systems with clinical applications (screening, diagnosis, treatment) are in the best position to manage issues of liability arising directly from system failure or misdiagnosis and must accept this liability with measures such as maintaining appropriate medical liability insurance and in their agreements with users.
• Radiation therapy
• Surgery
• Surveillance
• Targeted therapy
What else should I know about leukemia?
Although leukemia is the most common childhood cancer, most cases are in adults over 55. It is also slightly more common in men than women, but everyone should be aware of the signs and symptoms associated with this cancer type, which include swollen lymph nodes, frequent fevers or night sweats, weakness, shortness of breath, and reoccurring infections, among other symptoms.
Thanks to ongoing research and clinical trials, medical advancements have improved survival rates for many types of leukemia. For example, the
treatment, such as ineligibility for liver transplantation. The group proposed that researchers discuss ways to reduce those negative beliefs among all team members in trials for AUD and ALD and, when possible, involve patient representatives and other stakeholders in trial design.
Thomas Cotter, M.D., M.S.C.P., Assistant Professor of Internal Medicine in the Division of Digestive and Liver Diseases at UT Southwestern, also participated in the consensus statement.
Health care AI systems that are subject to non-disclosure agreements concerning flaws, malfunctions, or patient harm (referred to as gag clauses) must not be covered or paid and the party initiating or enforcing the gag clause assumes liability for any harm.
When physicians do not know or have reason to know that there are concerns about the quality and safety of an AI-enabled technology, they should not be held liable for the performance of the technology in question.3
The Doctors Company, like the AMA, will continue to advocate to limit healthcare practitioner liability in the AI space and ensure that it follows the established legal framework for medical malpractice litigation. We will also continue to monitor this important issue and work to protect healthcare practitioners as AI gains momentum.
survival rate for chronic myelogenous leukemia is now 70% — three times higher than it was in the 1970s.
September is Blood Cancer Awareness Month, and while leukemia accounts for only 3.2% of new cancer diagnoses nationally, for the more than 62,770 people who will be diagnosed this year, understanding the potential risk factors, symptoms, and unique characteristics of this disease is crucially important.
“The field of alcohol-associated liver disease lacks well-designed clinical trials integrating alcohol use disorder treatment, a pivotal component in order to optimize patient outcomes. These recommendations will serve as an important blueprint to help guide the field going forward,” Dr. Cotter said.
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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