Austin Medical Times by Rick Delarosa

January Issue 2019

Inside This Issue

Are Primary Care Physicians Going Out of Style? By Phillip Miller Merritt Hawkins

St. David’s Round Rock Medical Center Announces New Chief Operating Officer See pg. 10

INDEX Financial Forecast............. pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.6 New Technology................ pg.8

he Health Care Cost Institute (HCCI) recently released a report that quantifies how the traditional physician office-based model of primary care is changing. According to the report office visits to U.S. primary care physicians declined by 18% from 2012 to 2016. Are Americans getting healthier or have they for some reason become disinclined to see primary care physicians? Not even close. The real answer is that there are simply not enough primary care physicians to go around. The study cites the physician shortage as a key reason for the decline. According to Amanda Frost, Ph.D, senior researcher at HCCI and lead author of the report, “Patients may increasingly see nurse practitioners and physician assistants as a substitute

for primary care physicians, especially in areas with PCP shortages where scheduling an office visit to a PCP is more difficult.” The report notes that while visits to primary care physicians dropped, office visits with NPs and PAs increased by 129% from 2012 to 2016.

You might think these two divergent trends would result in primary care physicians being less busy than they once were, but statistics from the Survey of America’s Physicians suggest otherwise. This national physician survey, which Merritt see Merritt Hawkins... page 12

On Dec 7 2018 Heart Hospital Of Austin Marked Its 20 Year Anniversary New Discoveries Predict Ability to Forecast Dementia See pg. 5

eart Hospital of Austin, is part of St. David’s HealthCare, is a 58-bed hospital and one of the highest performing cardiovascular facilities in the nation, specializing in the diagnosis and treatment of cardiovascular disease. It features a comprehensive 24-hour emergency department; an advanced Executive Wellness Program; five operating rooms (ORs), including two hybrid ORs; three catheterization labs; and two electrophysiology labs. It is home to one of the largest non-academic cardiovascular research programs in the world.

L-R David Laird, chief executive officer; Michael Lopez, chief nursing officer; Lizzette Runnels, vice president of human resources; Missi Johnson, vice president of operations; Seth Herrick, chief financial officer; Mark Gorham, assistant administrator.

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Financial Outlook Make Your Practice Meetings More Efficient to Accomplish More By Reed Tinsley, CPA CVA, CFP, CHBC

t’s easy to blame your staff for unproductive meetings, but the reality is that your leadership role makes you accountable for using your meeting time wisely. If you don’t capture the attention of your staff during the first 10 minutes of a meeting, they’ll lose interest or become disengaged, and you’ll accomplish little. Anyone who manages people needs to understand that meetings are critical to an organization. A bad meeting, in most cases, is a function of its leader. If you’re concerned about whether your meetings accomplish all they should or benefit your practice, ask yourself the following questions: • Do staff question the usefulness of meetings or complain about having to attend? • Do meetings end without resolving critical issues? • Do staff seem disengaged during meetings?

If you answered yes to any of these questions, you may need to rethink your meeting topics or strategies. For a more thorough assessment, take the quiz below, “How does your practice measure up?”. Focus factors Many important organizational decisions are made during meetings, so if staff and executives are nodding off or waiting for the meeting to end, there’s a good chance the decisions being made are bad ones. To avoid negative outcomes, make sure you include the following components in your meetings: 1. Drama. Follow the lead of Hollywood screenwriters: Engage your audience by presenting plenty of conflict early on. Without high drama right away, the audience loses interest. You need to give people something to care about, something worth engaging in conflict over. You need to make them aware of what could happen if they don’t engage, and you need to raise the issues at the beginning of the

meeting, before the audience checks out. For example, patients at your practice complain about being seen long after their scheduled appointments. Ignoring the complaints will result in patients leaving the practice, which could force you to fire employees. Coordinate a meeting and set the problem-solving wheels in motion. Explain the seriousness of the problem and start a discussion on possible solutions. Be careful not to create too much drama. You don’t want your staff thinking you’re bringing up conflict for conflict’s sake. Your goal is to let them know why they should be involved in creating solutions to your practice’s

problems. 2. Context and purpose. If you don’t help staff understand why you’re conducting a meeting and how you expect them to participate, they won’t buy into the process. In many organizations, too much time during meetings is spent discussing topics not critical to the short- or long-term success of the business. All too often, the most important issues never get put on the table. When staff understand your reason for holding a meeting, they are motivated to focus on the topic at hand. They will also know when it’s appropriate to broach certain topics. see Financial Outlook...page 14

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Legal Matters CMS’ 2019 PFS Payment Policies for Telehealth Services By Mark S. Armstrong, J.D.

he Centers for Medicare and Medicaid Services (“CMS”) recently published its final rule regarding payment policies under the Physician Fee Schedule (“PFS”). CMS’ final rule approves and pays under the PFS for a discrete set of new patient services that are provided via remote communication technology and increases access for Medicare beneficiaries to physicians by recognizing the following services that involve the use of communication technology. 1. Brief Communication TechnologyBased Service, e.g. Virtual Check-In . Beginning January 1, 2019, CMS will pay physicians for a newly defined type of service furnished using communication technology. This

service is billable when a physician or other qualified health care professional has a brief non-face-to-face check-in with a patient via communication technology, to assess whether the patient’s condition necessitates an office visit. CMS’ final rule approves payment for virtual check-ins under the following circumstances: • Utilizes real-time audio-only telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission. (Telephone calls that involve only clinical staff cannot be billed under code be billed using HCPCS code G2012 since the code explicitly describes (and requires) direct interaction between the patient and the billing practitioner.) • If the service originates from a related E/M services provided within the previous 7 days by the same physician or other qualified health care professional the service is considered bundled into the previous service. • Verbal consent is noted in the

patient’s medical record for each billed service. • The service is limited to established patients. (CPT defines an established patient as one who has received professional services from the physician or qualified health care professional or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.) • There are no frequency limits on the use of the code. • There are no specific documentation requirements for this service; however, the services must be medically reasonable and necessary. 2. Remote Evaluation of Pre-Recorded Patient Information. Beginning January 1, 2019, CMS will also pay physicians for the remote professional evaluation of patient transmitted information conducted via pre-recorded “store and forward” video or image technology, provided, however, that the service is not separately billable if there is no resulting E/M office visit and there is no related E/M office visit within the

previous 7 days of the remote service being furnished. CMS’ final rule approves separate payment for remote evaluation of recorded video and/or images submitted by the patient under code G2010 under the following conditions: • The service is limited to established patients. • Beneficiary consent that could be verbal or written, including electronic confirmation that is note in the patient’s medical record for each billed service. • Practitioner follow-up may take place by phone call, audio/video communication, secure texting messaging, email or patient portal communication, but must be compliant see Legal Matters...page 14

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New Discoveries Predict Ability to Forecast Dementia from Single Molecule Team Joins National Network Focused on Neurodegenerative Disorders By James Beltran

cientists who recently identified the molecular start of Alzheimer’s disease have used that finding to determine that it should be possible to forecast which type of dementia will develop over time – a form of personalized medicine for neurodegenerative diseases. A new study from UT Southwestern shows that single toxic tau proteins that stick together and spread degeneration across the brains of dementia patients have different shapes. The folds of these molecules hold information that could help diagnose – and perhaps one day treat – neurodegeneration in its earliest stages. The finding comes from a team of scientists appointed this month to a newly created network of international collaborators focused on improving treatment of neurodegenerative disorders. Funded

by the Chan Zuckerberg Initiative, the UT Southwestern group is tasked with using its recent discoveries of the tau protein to develop clinical diagnostic tools. “Our expanded understanding of the tau protein structure changes how we think about detecting and treating Alzheimer’s disease and related dementias,” said Dr. Marc Diamond, Director of UT Southwestern’s Center for Alzheimer’s and Neurodegenerative Diseases. “The next step is to translate this knowledge into simple clinical tests that doctors will use to diagnose and eventually stop the neurodegeneration process at its earliest stages.” Dr. Diamond’s new study expands on research published in July from his lab that documented a structural “genesis” of Alzheimer’s disease – the basis of how a healthy tau protein changes shape and is then capable of assembling with other tau

molecules to kill brain cells. The latest study published in eLife shows that harmful single tau molecules take different shapes that each correlates to a distinct type of larger assembly that will form and self-replicate across the brain. Dr. Diamond’s lab already established in a 2016 study that the structure of larger tau assemblies determines which type of dementia will occur – which regions of the brain will be affected and how quickly the disease will spread. But it was unknown what specified these larger structures. The new research reveals how a single tau molecule that changes shape at the beginning of the disease process contains the information that determines the configuration of the larger, toxic assemblies. This finding

suggests that characterization of the conformation of single tau molecules could predict what incipient disease is occurring – Alzheimer’s or other types of dementia. Scientists made these discoveries by extracting tau protein from cultured cells and human brains, isolating them as single molecules and determining what types of pathological assemblies they would subsequently produce in cells and mice. They determined that contrary to prior ideas, a single tau molecule, rather than being without definable structure, in fact has multiple, stable structures that each determine what type of subsequent pathological assembly it will form. see Dementia...page 11

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Oncology Research Finding Balance: 7 Life Hacks If Your Loved One Has Cancer By Andrew Shaw, M.D. Texas Oncology Cedar Park

aregivers are the unsung heroes of cancer care. They stand with patients to provide critical emotional and physical support and care that enables cancer patients to complete their treatments. The role of caregiver can be overwhelming at times, but by taking a few practical steps it’s possible to find balance. Below are seven tips – or “life hacks” – to help simplify and create balance and efficiency for caregivers. 1. Start a schedule. This can eliminate some of the stress caregivers feel because it provides a sense of control and order. Start by listing your caregiving-related tasks and ordering

cancer patients. Pack a bag with your loved one’s favorite things to offer a sense of comfort during long treatment days. It’ll help the hours go by a little more quickly for you, too. Books, magazines, tablets, adult coloring books, playing cards, and comfort items like blankets, and socks are great items to include. Have water, juice, or ginger ale, snacks, hard candies, and nausea relief medication at the ready. Bring along the caregiver’s binder so you can note upcoming appointments and special instructions you receive from the care team. 4. Check the pantry. During cancer, certain smells can cause nausea. Remove foods that may trigger sickness and replace them with foods you know your loved one can eat to help ease the taste changes that often accompany cancer. 5. Meal prep for yourself and your loved one. Preparing meals in advance for both you and your loved one can help bring a sense of balance and

THE STRENGTH TO HEAL and get back to what I love about family medicine Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference.

them by importance. List the names and availability of family and friends willing to help and the tasks with which they can assist. 2. Create a “caregiver’s” binder. Stay organized by keeping information in one place. Include contact information for healthcare providers, insurance cards, and a list of ongoing needs. Create an appointment tracker that includes details about past and upcoming visits, a list of prescriptions and dosing information, dietary restrictions, and a symptom tracker. Texas Oncology’s Care Guide provides a great foundation. 3. Pack a bag. Treatment and the days following can be grueling for

To learn more about the Army or Army Reserve, call MAJ Tamela Mitchenor at 210-692-7376, or tamela.l.mitchenor.mil@mail.mil

January 2019

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reduce stress for those busy days when there’s little time to cook a homemade meal. Set aside time to choose recipes together, then find a day for healthy meal planning and preparation. 6. Create a private social media group. Your loved one may have numerous people anxiously awaiting health updates. Some social media platforms, provide a central location for interaction with family, friends, and the community to receive updates and show support and love – either through open or closed groups. This also eliminates the overwhelming feeling

see Oncology...page 12

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Cullen Trust For Higher Education Driving Shift to Health Care Value with $5 Million Gift to Dell Medical School

he Houston-based Cullen Trust for Higher Education, part of the Cullen Foundation, has pledged $5 million to Dell Medical School at The University of Texas at Austin to help accelerate the transformation to high-value health care delivery. The gift will support the work of the Value Institute for Health and Care, a joint venture between Dell Med and UT Austin’s McCombs School of Business. The Value Institute works to redefine health care by accelerating adoption of high-value health care in practice, enabling measurement of meaningful health outcomes for individuals and families, and creating distinctive educational programs in value-based care delivery and strategy. Specifically, the gift will help to launch the Value Institute’s new, one-year Master of Science in Health Transformation program, which

is jointly offered by the two schools and is currently accepting applications. It also creates the Cullen Trust for Higher Education Distinguished University Chair in Value-Based Care for Dell Medical School, which will be held by Elizabeth Teisberg, Ph.D., executive director of the institute. Teisberg is an internationally recognized expert in transformational innovation and the implementation of high-value health care, and her groundbreaking book “Redefining Health Care,” co-authored in 2006 with Harvard Business School’s Michael Porter, introduced the concept of value to health care delivery. “The challenges for transforming health care are huge, yet the goal is simple,” Teisberg said. “The purpose of health care is improving health: capability, comfort and calm in the lives of the individuals and families we

serve. This generous support is critical to redefining health care delivery for this fundamental purpose.” Value-based health care, a core focus of Dell Med, represents a shift from the current volume-based, fee-for-service system that defines success by the number of procedures, tests and visits, to a value-based model that defines success as improving health outcomes for individuals and families, and thus improving health care value. “Our current health care system’s business model is backward: it rewards medical providers for the process, not the results,” said Clay Johnston,

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M.D., Ph.D., inaugural Dell Med dean. “The goal of health care should not be more treatment; the goal should be better health. This critical support acknowledges that only by linking business and medicine can we create new models to realign health care with society’s interests.” “UT’s Dell Med and McCombs School of Business are uniquely qualified to initiate a patient care delivery and payment system that provides better outcomes,” said Corbin Robertson Jr., chair of the Cullen see Dell Medical...page 14

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New Technology

the ability to schedule appointments online, to request prescription refills online, and other features that make access to health care services more timely and frictionless. Electronic Health Records (EHR) Evolve

2019 Health Care Technology Outlook By Mark Johnson President, Xtrii

ith the beginning of a new year, letâ&#x20AC;&#x2122;s look at the key technologies that will most influence health care this year. Paper charts are out, and digital is in. Technology is changing at an incredible rate and there are many opportunities for applying technology to improve health care. The following topics are some of the top technologies that will have an impact: Artificial Intelligence

Some people may think of

Artificial Intelligence as something that just exists in Sci-Fi movies. But today, Artificial Intelligence is being applied across many industry and business types, and health care could be one of the biggest beneficiaries. Traditionally, care providers relied on their training, experiences, ongoing studies and local peers for reference information. With that approach, how much relevant information can a single human brain digest, and properly recall at the time of a critical decision? With the application of Artificial Intelligence, the reference sources are vastly increased, the symptoms, factors, treatment options, and outcomes can be quickly compared against millions of others, and the insight that is provided to the care provider is greatly enhanced. Electronic Medical Records Provide More Value In the early adoption stages of Electronic Medical Records (EMRs), while value was being derived overall within the health care organization,

doctors and other care providers often felt like they were receiving very little benefits to justify their additional, required efforts. Early versions of EMRs typically only provided rudimentary information for care providers. Now with ongoing improvements that provide more timely insight, electronic orders, potential interactions, and an ever-growing depth of insight from better Artificial Intelligence, EMRs now provide tremendous new value for the care providers. This increase in value has helped improve EMR adoption and sentiment. Improved Patient Access: Many health care organizations are now expanding and improving their EMRs to provide patients secure access to their medical information,

While the terms EMR and EHR are often used interchangeably, they are different. Electronic Medical Record (EMR) contains the clinical data collected by the medical provider, and an Electronic HEALTH Record (EHR) provides a broader view of the overall health of the patient by including information with other health care providers, such as laboratories, therapists, care takers and specialists. Leveraging Blockchain technology for a better EHR/ EMR: Often people ask why their service history for their car, their home appliances and other items can be easily accessed by service providers nationwide, yet their personal medical history is still trapped within the see New Technology...page 12

Want to Connect with Austinâ&#x20AC;&#x2122;s Top Docs? Some of the nationâ&#x20AC;&#x2122;s finest doctors can be found right here in Greater Austin. Even better? The Austin Medical Times is their Primary Choice for local Healthcare News. Reserve your ad space today Call: 512.203.3987

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Austin Medical Times

Healthy Heart

surrounding community.

Resolving to Join the Mission For Healthier Lives in the New Year By Joel Rice American Heart Association

n the New Year, we at the AHA are grateful to you and looking for the new ways we can all continue the American Heart Association’s mission to be a relentless force for a world of longer, healthier lives. We resolve to you to continue the work in the Austin and surrounding communities toward this mission. Did you know that recent studies have shown that one way to lower stress is to become active in the community and volunteer or work for a dedicated mission? The American Heart Association benefits so much from volunteers including those important contributions from sponsors year-round. Our mission would not be

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able to thrive if we did not have the community support. There are many ways to get involved with the Austin American Heart Association. Participating in one of our annual awareness and fundraising events – the Heart Ball, the Heart Walk, and Go Red For Women® luncheon. Getting your school, company, or church participating in our programs is a great way to contribute to a heart-healthier community. In Austin, our efforts to build a healthier community have included partnering with top companies, school districts, local hospital systems, EMS providers, community organizations, and hundreds of incredible dedicated and passionate volunteers and supporters. We hope you might resolve to join us in our mission by participating in our events for 2019. All of these events help raise funds to provide more dollars for local research and funds our programs in the Austin and

National Wear Red Day – Feb. 1st, 2019 The first Friday of February is National Wear Red Day, a day to raise awareness of heart disease in women. Awareness is key to transforming women’s lives and helping them mitigate their risk factors. All women – and the family and friends who love them – are invited to participate in National Wear Red Day on Friday, February 1st, by wearing red and sharing on social media with the hashtag #AustinGoRed to amplify this lifesaving message. We’d love to get pictures of you and your fellow Red-wearers across our Instagram pages! Go Red For Women - March 1st, 2019 The American Heart Association’s annual Go Red for Women luncheon in Austin highlights the fight against the No. 1 killer of women— heart disease. Go Red for Women is the American Heart Association’s national movement to

end heart disease and stroke in women. This year’s luncheon will be held at JW Marriott Austin, TX on Friday, March 1st, 2019. The annual event is designed to raise awareness of the leading cause of death in women: cardiovascular disease. The event is chaired by Elizabeth Christian of Elizabeth Christian Public Relations and The Austin Go Red for Women Luncheon is sponsored nationally by CVS Health and our local presenting sponsor is St. David’s HealthCare. see Healty Heart...page 12

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St. David’s Round Rock Medical Center Announces New Chief Operating Officer

t. David’s Round Rock Medical Center has named Katie Lattanzi as its new chief operating officer, effective December 3. Before joining St. David’s Round Rock Medical Center, a Level II Trauma Center, Lattanzi served in a number of roles at St. David’s HealthCare, including associate chief operating officer of St. David’s South Austin Medical Center, which received Level II Trauma verification in May. “Katie has proven her ability to maximize hospital operations in a competitive healthcare landscape, increase employee engagement, and promote a culture of warmth, friendliness and personal pride that fosters exceptional patient care,” Jeremy Barclay, chief executive officer of

St. David’s Round Rock Medical Center, said. “I look forward to working alongside her as we address our community’s growing healthcare needs.” At St. David’s South Austin Medical Center, Lattanzi managed several significant growth projects, including the south tower and emergency department expansion, as well as the development of St. David’s Emergency Center in Buda. Lattanzi also spent four years at Heart Hospital of Austin and oversaw strategic planning efforts, renovation projects and the expansion of services offered at the hospital’s Heart Valve Clinic. Lattanzi earned her master’s degree in healthcare administration and a bachelor’s

degree in finance and marketing from Trinity University in San Antonio. She is a fellow of the American College of Healthcare Executives. 

Katie Lattanzi, COO St. David’s Round Rock Medical

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Austin Medical Times

Dell Med, Community Partners Tackling Critical Health Needs for Austin’s Homeless Through Innovative Mobile Care Team

f the more than 7,000 people who experience homelessness in Travis County each year, many have complex health problems as diverse as heart disease and asthma. To help address these persistent challenges, Dell Medical School at The University of Texas at Austin, CommUnityCare Health Centers and Integral Care, Travis County’s mental health authority, are joining forces to launch an innovative, federally-funded mobile care team that serves homeless individuals where they are. The collaboration, which is funded by a five-year, $2.3 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), will support homeless men and women who have a chronic medical condition along with serious mental illness and/or substance use disorder. The mobile, multidisciplinary team will be staffed by qualified health care providers who integrate comprehensive primary care, mental health care, substance use treatment, intensive case management, and wraparound services such as housing assistance and social programs enrollment into a continuum of care with one single team. “Homeless Austinites living with multiple complex medical problems are among the most vulnerable and difficult to reach members of our community, but we believe that our innovative approach can work,” said Dell Med’s Tim Mercer, M.D., MPH, assistant professor in the departments of Population Health and Internal Medicine, who is the project director for this grant. Efforts to effectively treat this population require careful coordination among advocates and organizations working in Austin’s health ecosystem, he said. “Our goal is to fill gaps in care by leveraging the existing strengths

Dementia

Continued from page 5 Dr. Diamond’s team is trying to translate these findings into clinical tests that examine a patient’s blood or spinal fluid to detect the first biological signs of the abnormal tau, before the

and infrastructure of the three collaborating organizations in a whole new way,” Mercer said. It’s also essential to coordinate efforts with other local organizations, such as the Ending Community Homelessness Coalition (ECHO), he added. A 2017 Point-in-Time Count performed by ECHO found that 2,036 Austin residents experience homelessness on any given night, of whom 553 are chronically homeless, 345 have a substance use disorder and 519 experience serious mental illness. It also found that 61 percent of people experiencing homelessness access health care through an emergency room or not at all. Meeting People Where They Are One key design feature of the mobile model is that it allows the team to bring care to patients where they live, unlike the traditional model of requiring patients to seek services in clinics or hospitals to address their health needs. “Normally the burden is entirely on the patient — they have to make appointments, figure out how to get a ride, go to the pharmacy, get their labs processed — they are constantly forced to jump through hoops,” said Audrey Kuang, M.D., clinical director of the homeless health care program at CommUnityCare and assistant professor in the departments of Internal Medicine and Population Health at Dell Med. “It’s tough enough for the average person, but for someone struggling with mental illness or chronically sick or worrying about their next meal, those hoops can be insurmountable obstacles,” she says. Equipped with mobile medical supplies, laptops to access medical records on site, and well-honed “street medicine” engagement tactics, the team remains unfettered by the need symptoms of memory loss and cognitive decline become apparent. His lab is also working to develop treatments to stabilize shape-shifting tau molecules, prevent them from assembling, or promote their clearance from the brain. A diagnostic test will be especially important once effective treatments are established to treat various forms of dementia, he said.

for a building or an exam room to care for patients. “We can meet with clients on the street, a park bench, under a bridge — wherever we need to be to serve them best,” says Kuang. When more complex care is needed, the mobile team can also see patients in one of CommUnityCare’s 24 clinics or Integral Care’s four integrated mental and primary care clinics in Travis County. The community-based mobile care team will consist of at least six health professionals, including: • A primary care physician or nurse practitioner • A mental health care psychiatrist or nurse practitioner • A licensed chemical dependency counselor • A nurse case manager • A qualified mental health professional case manager • A peer navigator An important part of this community-based program is that it relies on the complementary strengths of the organizations involved. Integral Care has been providing outreach and recovery services to people experiencing co-occurring homelessness, mental illness and substance use disorder for over 20 years. Integral Care also partners with the Austin Police Department and Austin-Travis County EMS to connect individuals living on the street to housing, mental and primary health care and alcohol and drug treatment as part of the Homelessness Outreach Street Team. CommUnityCare, part of Central Health’s enterprise, provides primary care and standard case management services to the homeless as well. Dell Med’s population health experts will augment these existing resources through direct care, coordination “It’s probably too late once the effects of neurodegeneration are manifest,” said Dr. Diamond, a leading dementia expert credited with determining that tau acts like a prion – an infectious protein that can self-replicate. “We need to be able to diagnose the process early and know the specific type of neurodegeneration that is occurring, because that is the

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among the partners, and research and evaluation efforts. “We are excited to expand our partnership with Dell Med and CommUnityCare to further support our city’s homeless community,” said Darilynn Cardona-Beiler, director of adult behavioral health systems at Integral Care. “This grant allows us to bring our expertise together and innovate in a unique and effective way. Together, we’re meeting people where they are in the community — providing integrated primary care, mental health care and much needed substance use treatment on the streets of Austin.” Measuring Success In addition to serving as orchestrator of the project, researchers from Dell Med’s Department of Population Health will work to measure the success of the effort. Its data integration division will coordinate information from Integral Care’s and CommUnityCare’s electronic health systems and directly from patients to evaluate effectiveness and identify opportunities for improving and expanding this care model. “By incorporating research into this project, we will be able to understand if this approach to caring for our city’s homeless works and can pay for itself, by reducing hospital and ER visits, for example, and if it can be scaled and replicated to improve the health of communities across the nation,” said William Tierney, M.D., professor and chair of Dell Med’s Department of Population Health.

best chance we have to intervene with a personalized treatment. This is very analogous to how we currently use tumor genotyping to best diagnose and treat cancer.”

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Merritt Hawkins

Continued from page 1 Hawkins conducts every other year for The Physicians Foundation, asks doctors to describe their activity levels. In 2012, 75.5% of physicians said they were either at capacity or overextended and unable to see more patients. In 2018, the number increased to 79.5%

Oncology

Continued from page 6 to respond to multiple calls and text messages. 7. Take care of yourself. When you are giving so much in caring for

(80% for primary care physicians), despite the growth in NP and PA visits. Moreover, in 2018, family medicine was Merritt Hawkins’ number one most requested type of search for the 12th year in a row, with internal medicine close behind at number three. When combined, NPs and PAs were our third most requested type of recruiting assignment, though they were not in our top 20 six or seven years ago.

Demand for primar y care services is so strong that primary care physicians, NPs and PAs are all the targets of aggressive recruiting by hospitals and a growing number of settings that provide “convenient care,” including outpatient clinics, urgent care centers, retail clinics and Federally Qualified Health Centers (FQHCs). Changing delivery models that emphasize team-based care and

population health management also drive the need for more primary care physicians, NPs and PAs. When it comes to primary care physicians and advanced practice professionals such as NPs and PAs, it’s not a question of “either/or” in today’s market….it’s both.

your loved one, it’s important to take time for yourself. Get in the habit of setting aside time for yourself each day. When possible, find someone else who can step in to help you, if only briefly. Whether it’s taking a long walk, relaxing quietly with a book, or a

weekend trip away, your care is equally important as that of your loved one. The role of the caregiver is critical in helping a loved one navigate cancer treatment. At Texas Oncology, caregivers are an essential part of the treatment team. Whether caregiving is

a new role or something you have done for many years, I hope these suggestions help you find the balance you need to care of yourself so that you care for your loved one.

New Technology

Continued from page 8 walls of each health care provider. Fortunately, we are now seeing regional groups of care providers sharing a common EMR system, which at least provides a unified EMR among your local providers within that organization. Since it is unlikely that all health care providers worldwide will ever use the same EMR/EHR system, most likely the solution will require technologies that can improve the connections and ability to share data between disparate systems. Blockchain technology and/or its underlying concepts may finally provide the solution. It would allow the health care provider to maintain control over their portion of the medical record and provide a secure, easy method to share with other authorized constituents. Other challenges, including business, political and non-technical barriers exist that will also have to be addressed. Therefore, widescale adoption may still be many years away. Virtual Reality (VR) Augmented Reality (AR)

and

Healthy Heart

Continued from page 9 The luncheon features keynote speakers, inspiring survivor stories and a survivor fashion show. To purchase tickets and for sponsor information to support this event, please contact Emily Franke at Emily.Franke@heart.org. 2019 Austin Heart Ball – May 11, 2019 Last year’s event raised over $1.1 million dollars and this year, we hope January 2019

Virtual reality (VR) and Augmented Reality (AR) are two technologies that are changing lives of patients and physicians. VR can be used to take training and education to a new level. By adding such a life-like experience, VR is a powerful tool.

Leaders will transform health care, but unfortunately many traditional health care organizations are not prepared for this major industry change. Health care organizations that fail to engage the right expertise and laggards that fail to execute a timely transformation will be replaced.

Health care consumers are alarmed by the ongoing, extreme increases in health care costs and are searching for better options. Technology is creating a more connected and informed health care consumer who is more empowered to Augmented Reality (AR) select the best care and best overall differs from VR in two key respects. value. The AR user does not lose touch with reality, and AR puts information into Digital transformation will touch all eyesight to augment the view versus areas of health care and greatly improve replacing the view like VR. Imagine services such as: New health care access points: a surgeon using AR to have reference care will be delivered in new information displayed directly onto locations and new approaches that the procedure area. The surgeon still will improve the convenience, sees the area being treated, and the quality and costs for consumers. AR overlays helpful information to improve the outcome. Telemedicine: while

Digital Transformation is reshaping every industry, including health care. Digital Transformation

Telemedicine has existed for many years, recent improvements will now bring it into the mainstream. For those that are unable to travel to a provider, they can have the

to raise even more toward the fight against heart disease and stroke. The annual Austin Heart Ball attracts over 700 of the city’s top community and business leaders. Heart Ball supporters help us to connect, innovate, influence and invest in advancing our efforts to change health outcomes as they relate to heart disease and stroke. This year’s event is chaired by Bobby Dillard of Cielo Property Group and will be held at the JW Marriott in Austin and our local presenting sponsor is St. David’s HealthCare. To purchase tickets and

for sponsor information to support this event, please contact Lauren Holcomb at Lauren.Holcomb@heart.org . 2019 Austin Heart and Stroke Walk – October 19, 2019 The Heart Walk is the American Heart Association’s premier event for raising funds to save lives from this country’s No. 1 and No. 5 killers - heart disease and stroke. Last year’s event raised over $1.5 million dollars and we’re already well into planning this year’s event. For more information on how you or your company team

Digital Transformation Reshapes Health care

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health care brought to them. Health care Internet of Things (IoT): Remote monitoring, wearables, smarter sensors, medical device integration, and the everexpanding list of connected health care technology. The IoT will “connect the connected” for better insight and care. We are living in exciting times for health care, and technology will play a key role in transforming and improving your health care. Mark Johnson is a global technology leader that has helped some of the world’s top health care organizations achieve success. He currently serves as President of Xtrii, www.Xtrii.com. For additional information on health care technology and to see more of Mark’s technology tips and insights, visit www.Xtrii. com.

can participate or be a sponsor, please contact Heidi Gerber at Heidi.Gerber@ heart.org . This year’s event is chaired by Doug Losey of Harvey-Cleary Builders, and our local presenting Healthy For Good Sponsors are Ascension Seton, Harvey Cleary Builders, and Texas Mutual Insurance Company. Happy New Year. We are grateful to all of you, who join us in our mission and we hope that more of you will become a part of our work in this new year.

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January 2019

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Austin Medical Times

Financial Outlook Continued from page 3

shore because of time constraints? 9. Is your team reluctant to go off-site more than once a year to review the state of your organization and business? 10. Do team members seem disengaged during meetings?

Use a four-pronged approach that includes a daily check-in meeting, a weekly tactical meeting, a monthly strategic meeting, and a quarterly off-site review. Too often, leaders throw every possible conversation into one long staff meeting. This creates frustration among team members, who struggle to shift back and forth between tactical and strategic conversations, with little or no resolution. By conducting the four types of meetings, you can avoid some of the confusion. In addition, when you run a well-organized meeting, more is accomplished and staff leave with a sense of satisfaction. Dull and uninspiring meetings indicate poor meeting management, which inevitably leads to suboptimal decisions. With the right topics and the right context, can be engaging.

The QUIZ: How Does Your Physician Practice Measure Up? Answer the following questions to find out where your organization stands on meetings. 1. Are your meetings dull and uninspiring? 2. Do team members question the usefulness of meetings? 3. Are critical issues avoided or overlooked during meetings? 4. Do you wonder whether team members are holding back during meetings? 5. Do team members complain about being required to attend meetings? 6. Do meetings end without resolution of critical issues? 7. Do you discuss administrative, tactical, and strategic topics during the same meeting? 8. Are important discussions cut

Legal Matters

advice of a consulting physician or qualified healthcare professional with specific specialty expertise to assist with the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consulting physician or qualified healthcare professional. CMS is requiring the treating practitioner to obtain verbal beneficiary consent in advance of these services, which consent must be documented in the patient’s medical record. In adopting these six codes, CMS is adapting to new trends involving comprehensive patient-centered care management, which particularly

impacts patients with chronic conditions including heart disease, diabetes, respiratory disease, breast cancer, allergies, Alzheimer’s Disease, and factors associated with obesity. CMS’ final rule recognizes that virtual care may improve beneficiary access to high-quality services while lowering the cost of healthcare. By adopting these rules, CMS hopes to support innovation and provide a telehealth benefit without regard to certain geographic limitations.

for value-based care,” said McCombs Dean Jay Hartzell. “The launch of a one-of-a-kind master’s degree program is a perfect example of that, and something we expect will have great impact on the industry.” The M.S. in Health Care Transformation is designed for working health professionals, such as practicing physicians and other clinicians, as well as up-and-coming leaders across the health care sector. Dell Med students also can complete the yearlong master’s degree during their third year of medical school. Beyond the new master’s program, support from the Cullen Trust for Higher Education will be used to: • expand an executive education curriculum that emphasizes how to implement and scale high-value

health care strategies; • develop innovation insights to drive high-value care at UT Health Austin, Dell Med’s clinical practice; • accelerate research on organizations implementing high-value care; and • produce new knowledge about how teams and organizations measure outcomes ad successfully transition to value¬-based care. The Cullen Trust for Higher Education is one of three trusts that are part of the larger Cullen Foundation, which has distributed more than $500 million in grants since being established in 1947. The Cullen Trust for Higher Education has pledged more than $14 million to UT Austin since 1983, with gifts to date totaling nearly $10 million. 

Continued from page 4 with HIPAA. 3. Interprofessional Internet Consultation. CMS’ final rule approved six new CPT codes (99451, 99452, 99446, 99447, 99448 and 99449) that describe assessment and management services conducted through telephone, internet, or electronic health record consultations furnished when a patient’s treating physician or other qualified healthcare professional requests the opinion and/or treatment

Dell Medical

Continued from page 7 Trust for Higher Education. “The antiquated U.S. payment system is the highest cost in the world and yet it does not provide better outcomes. We are proud of Dr. Teisberg, Dean Hartzell, and Dean Johnston’s efforts to deliver value to their patients’ good health,” said Robertson, a UT Austin Distinguished Alumnus who earned his undergraduate degree in business in 1969. A New Hub for Innovation in Value-Based Health Care “The Value Institute for Health and Care is an ideal bridge between the schools of business and medicine, and Dr. Teisberg and her team are positioning UT Austin as a new hub January 2019

If you answered no to all of these questions, congratulations! You have a rare team that has mastered the art of meetings. If you answered yes to four or fewer of these questions, you could probably improve your practice’s decision-making and overall effectiveness by adjusting the structure and content of your meetings. If you answered yes to five or more, your meetings likely cause you to waste considerable human and financial resources and create confusion within your organization. Consider significantly changing the content and structure of your meetings.

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Published by Texas Healthcare Media Group Inc. Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Brad Jander Accounting Liz Thachar Writers Jorge Augusto Borin Scutti, PhD Denise Hernandez MS,RD,LD Office: 512-203-3987 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com

Austin Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Austin Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Austin Medical Times are considered property and are to distribute for publication and copyright purposes. Austin Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430

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January 2019

Austin Medical Times

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