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Volume 10 | Issue 9
Inside This Issue
September Edition 2020
CMS “Hospitals Without Walls” Flexibilities – New Opportunities and Risks Neal D. Shah, JD, Polsinelli, PC
New Sleep Medicine Service Offers Insight into Link Between Sleep Quality and Well-Being See pg. 7
INDEX Oncology Research......... pg.5 Healthy Heart....................... pg.8 Financial Forecast............ pg.10 The Framework.................. pg.12
Telehealth’s Risks to Physicians and Patients See pg. 13
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ne of the most frightening risks of the COVID-19 pandemic is the potential for health systems to become overwhelmed. Houston, like many other regions of the country has seen rapid, often unpredictable increases of cases requiring intensive care and extended hospitalization, prompting serious concerns about bed capacity. In an effort to allow hospitals to maximize capacity and create more effective physical separation between COVID and non-COVID patients, CMS has authorized new regulatory flexibility to support “hospitals without walls” models. In theory, these models will allow hospitals to provide hospital-level care for patients in non-traditional settings including their homes. However, in practice hospitals should be aware of a number of open issues and regulatory complexities involved
with delivering care in such locations. In an interim final rule (CMS-5531-IFC, published at 85 Fed Reg 27550 on May 8, 2020) CMS used its special Pubic Health Emergency waiver authority under Section 1135(b) of the Social Security Act to authorize hospitals to provide care in “temporary expansion sites.” First, CMS waived a number of the hospital “conditions of participation” (or CoPs) including provisions on the “physical
environment” hospitals must maintain. Any location still must be consistent with a state’s emergency preparedness or pandemic response plan. Second, CMS used its waiver authority to create a number of changes to the rules on providerbased hospital locations. Last year, CMS finalized rules allowing temporary relocation of provider based sites during traditional, see CMS... page 14
Rice University Ventilation Unit Gets FDA Emergency Approval
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n enhanced version of the Emergency Use Authorization (EUA) by ApolloBVM designed by Rice the U.S. Food and Drug Administration University engineers has received as an emergency resuscitator for use during the COVID-19 pandemic. The device, as further developed by the Houston manufacturer Stewart & Stevenson Healthcare Technologies LLC, a subsidiary of Kirby Corporation, is designed to deliver air to the lungs of adult patients who require ventilation while they await the availability of a full ventilator. The manufactured version, dubbed Apollo ABVM, is a sturdy and
portable system the company believes can be rapidly deployed in emergencies during the EUA period. Open-source plans for Rice’s ApolloBVM remain online and available to the maker community. The plans have been downloaded by nearly 3,000 registered participants in 115 countries. “The COVID-19 pandemic pushed staff, students and clinical partners to complete a novel design for the ApolloBVM in the weeks following the see Ventilation Unit ... page 14
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Preliminary Study Of 300+ Covid-19 Patients Suggests Convalescent Plasma Therapy Effective American Journal of Pathology Publishes Efficacy Results From Houston Methodist Clinical Trial
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preliminary analysis of an ongoing study of more than 300 COVID-19 patients treated with convalescent plasma therapy at Houston Methodist suggests the treatment is safe and effective. The results, which appear now in The American Journal of Pathology, represents one of the first peer-reviewed publications in the country assessing efficacy of convalescent plasma. From March 28, when Houston Methodist became the first academic medical center in the nation to infuse critically ill COVID-19 patients with plasma donated from recovered patients, research physicians have used the treatment on 350 patients. The study tracked severely ill COVID-19 patients admitted to Houston Methodist’s system of eight hospitals
from March 28 through July 6. These latest results from Houston Methodist that now measured medical effectiveness offer valuable scientific evidence that transfusing critically ill COVID-19 patients with high antibody plasma early in their illness – within 72 hours after hospitalization proving most effective – reduced the mortality rate. The study, titled “Treatment of COVID-19 Patients with Convalescent Plasma Reveals a Signal of Significantly Decreased Mortality,” was led by principal investigator Eric Salazar, M.D., Ph.D., assistant professor of Pathology and Genomic Medicine with the Houston Methodist Hospital and Research Institute and corresponding author James M. Musser,
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M.D., Ph.D., chair of the Department of Pathology and Genomic Medicine at Houston Methodist. “Our studies to date show the treatment is safe and, in a promising number of patients, effective,” Musser said. “While convalescent plasma Principal investigator (right) Eric Salazar, M.D., Ph.D., oversees work being therapy remains done in the convalescent plasma research lab. experimental and we have more research to do and data to of plasma transfusion were excluded. collect, we now have more evidence The patients were tracked for than ever that this century-old plasma 28 days after plasma transfusion and therapy has merit, is safe and can help compared to a control group of similar reduce the death rate from this virus.” COVID-19 patients who did not receive The research team found that convalescent plasma. An observational those treated early in their illness with propensity score-matched analysis was donated plasma that has the highest used to balance the characteristics of concentration of anti-COVID-19 participants and allow for an objective antibodies are more likely to survive interpretation of the results at this and recover than similar patients who stage. were not treated with convalescent Several studies have measured plasma. Patients with a history of safety, showing that the more than severe reactions to blood transfusions, 34,000 COVID-19 patients in the U.S. those with underlying uncompensated who have received plasma transfusions and untreatable end-stage disease and for COVID-19 experienced minimal patients with fluid overload or other adverse effects. conditions that would increase the risk
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A Tale of Two Viruses COVID-19 And Flu: What You Need to Know This Fall By Dipali Pathak
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n old foe and the new kid on the block – influenza and SARS-CoV-2 are two potentially deadly viruses that may circulate concurrently this fall and winter. A Baylor College of Medicine expert outlines the precautions to take to prevent contracting and spreading them. According to Dr. Pedro Piedra, professor of molecular virology and microbiology and of pediatrics at Baylor, it is too early to know what this year’s flu season will be like, but we know that a lot of respiratory viruses that usually circulate during the spring and summer months have quieted down due to social distancing and masking precautions. He said that currently we are not seeing a lot of respiratory activity other than SARS-CoV-2.
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But that may change as children and young adults head back into the classroom and college environment. School-aged children have historically played a significant role in the transmission of influenza virus within the household and community, and now we know that SARS-CoV-2 can be efficiently transmitted by children to others in a school-like environment, he said. In addition to influenza and COVID-19, another virus that could be circulating toward the end of this year and into next is respiratory syncytial virus, or RSV, which has similar symptoms to influenza and SARS-CoV-2, but often does not cause a fever. It’s even possible for someone to contract two viruses at the same time, although this might not be the biggest issue. “If we see these viruses circulating
when SARS-CoV-2 is circulating, my primary concern is that it will be difficult clinically to distinguish one from the other at the beginning of illness until the individual is tested,” Piedra said. “It’s likely going to impact the amount of testing done and the utilization of healthcare. It’s going to complicate matters more.” The long-term consequences from influenza and RSV can make individuals, especially older adults and those with underlying disease, more susceptible to severe complications if they are subsequently infected with SARS-CoV-2. This is why staying in good health and taking preventative measures against other viruses is so important, Piedra said. The best preventative measure against flu would be getting vaccinated against influenza. This year, trivalent
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and quadrivalent formulations of the vaccine are available: • Quadrivalent vaccine: contains four strains of the virus, including two influenza B lineages (Yamagata and Victoria) and two influenza A lineages (H1N1 and H3N2) • Trivalent vaccine: contains three strains of the virus, including one influenza B lineage (Victoria) and two influenza A lineages (H1N1 and H3N2) Adults over the age of 65 should get either the higher dosage or adjuvanted vaccine as they are more likely to develop an immune response with one of these vaccines. Children under 8 years of age who have never been vaccinated against the flu will need two vaccine doses see Two Viruses...page 13
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Oncology Research Covid-19 And Cancer Screenings: Should I Be Screened This Year? By Meghana Bhandari, M.D., Texas Oncology– Sugar Land
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any questions are swirling right now about COVID-19. How can I safely go grocery shopping? How can I best protect myself and my family? And one particularly important question: Should I cancel my cancer screening to avoid the doctor’s office? The answer may surprise you. While some elective surgeries have been delayed, don’t assume screenings, including mammograms, Pap tests, and colonoscopies, are off the table. Pandemic or not, screenings are the most effective way to identify cancers in their earliest stages – often before you experience symptoms. According to the World Health Organization, 30% to 50% of all cancers may be preventable. Delaying cancer screenings may lead to detecting
cancer at a later stage, requiring a more aggressive and lengthy treatment. Listen to what your body is telling you, understand your personal risk for cancer, and contact your doctor to best navigate cancer screenings during COVID-19. Be aware of new or unusual symptoms. Symptoms of concern may include, but are not limited to, unexplained weight loss, changes in bowel and bladder habits, sores that don’t heal, unusual bleeding, and/or a lump. Make an appointment with your doctor immediately if you have noticed these or other symptoms that are unusual to you. And remember that self-exams for breast, skin, and testicular cancers can be done at home. If you find something concerning, immediately alert your doctor, who will direct you to next steps. Know if you are at heightened risk for cancer. You can’t inherit cancer, but you can inherit a higher risk for developing it. Factors that determine if a person has a higher risk of developing certain types of cancer include pre-existing
conditions, personal health history, and family medical history. For example, hereditary breast and ovarian cancer risk factors include male breast cancer at any age, breast cancer at age 45 or younger, or a relative with a BRCA-1 or BRCA-2 mutation. Talk to your doctor about the best time for you to be screened. It’s a simple yet important step to take. According to the American Cancer Society, how long it’s been since you were last screened, how prevalent COVID-19 is in your community, your risk of getting a certain type of cancer, your age, and overall health are all factors your doctor may consider when evaluating the risks and benefits for you to be screened sooner rather than later. What makes sense for you may not make sense for someone else. Your doctor can assess your medical history and individual circumstances to make
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an informed decision about the best time for you to be screened. What’s more, the ease with which patients can schedule virtual appointments through telemedicine means there is no reason not to reach out. Remember, the purpose of preventative cancer screenings is to diagnose and treat cancer early. Skipping preventive screenings can adversely affect your long-term health. Don’t let fear of COVID-19 stand in the way of these essential preventative health screenings. Texas Oncology is taking extensive precautions to keep patients safe, as are medical facilities and hospitals across the state. Should a cancer screening lead to a diagnosis, rest assured it can be treated safely using a combination of in-person appointments and telemedicine – because cancer care can’t wait.
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Implementation of Social Distancing Policies Correlates with Significant Reduction In SARS-Cov-2 Transmission
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ccording to researchers from The University of Texas MD Anderson Cancer Center, the implementation of social distancing policies corresponded with significant reductions in transmission of the SARS-CoV-2 virus and reduced community mobility, both in the U.S. and globally, providing evidence that social distancing is a useful tool in preventing further spread of COVID-19. The study, published in PLOS ONE, estimates that social distancing policies enacted nationally in 46 countries prevented an estimated 1.57 million cases of COVID-19 over a two-week period, representing a 65% reduction in new cases. The researchers suggest these data emphasize the significant benefits that can be achieved by individuals practicing social distancing measures. “At MD Anderson, we are focused on caring for patients with cancer, and we know that our patients
are highly vulnerable to COVID-19,” said senior author Raghu Kalluri, M.D., Ph.D., professor and chair of Cancer Biology. “Therefore, we felt it important to conduct an unbiased analysis of safety measures that could benefit our patients as well as society at large. From our data-driven analysis, it became clear that practicing social distancing can have a huge impact on transmission rates.” Impact of social distancing policies in the U.S. To determine the effectiveness of social distancing policies in the U.S., the researchers analyzed COVID-19 spread across each of the 50 states. Recognizing that many factors contribute to disease spread, they analyzed new cases before and after states enacted social distancing policies. Three states did not implement such policies, providing an opportunity for comparisons. These were analyzed over similar time periods relative to
other states. “We found that states observed significant reductions in transmission rates following the implementation of social distancing policies, compared to states without such policies,” said lead author Daniel McGrail, Ph.D., postdoctoral fellow in Systems Biology. “In fact, two of the smallest reductions in spread were seen in states without social distancing policies.” The 47 states with social distancing policies also saw greater reductions in average community mobility compared to states without policies, which measures the movement trends of residents across residential, workplace, retail and other locations.
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States without social distancing policies also saw decreased mobility, although the change was significantly smaller than states with distancing policies. Impact of social distancing policies globally Understanding that the U.S. analysis was limited by a small number of states without social distancing policies, the researchers analyzed the effects of social distancing policies globally. They were able to obtain sufficient data for 46 countries with national social distancing policies, 74 nations without such policies and 14 with regional policies. see Social Distancing ...page 13
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New Sleep Medicine Service Offers Insight into Link Between Sleep Quality and Well-Being
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uality of sleep for many has endured some collateral damage during the COVID-19 pandemic. A new study from the University of Basel in Switzerland shows people are sleeping more, but the quality of sleep is worse due to the COVID-19 outbreak, and now more than ever, there’s a need for better sleep quality. The Menninger Clinic has launched a Sleep Medicine Service with a focus on mental health and wellness. The team is led by psychiatrist Chester Wu, MD, who completed a sleep medicine fellowship at Stanford University following finishing a psychiatry residency at Baylor College of Medicine. Individuals, ages 3 and up, can get new and chronic sleep issues evaluated and treated to get their health back on track. The medical impacts of poor sleep have been well established, ranging from increased risk of high blood pressure, heart attacks, stroke
and weight gain. Research has shown that sleep affects not only our physical health, but our mental health as well. “Poor sleep impacts our memory, attention, mood, overall quality of life and has even been associated with suicide,” says Wu, director of Sleep Medicine at Menninger. “The relationship between sleep and its effect on the mind run deep.” “When our lifestyle and stress level changes, our sleep habits follow,” Wu said, noting that sleep patterns may shift affecting health and leading to chronic insomnia. “Our service focuses on treating all disorders related to sleep including insomnia, sleep apnea, nightmares, and narcolepsy. We recognize the impact that sleep has on our mental and physical health, and vice versa.” The first step to tackling a sleep issue should be a comprehensive evaluation and potentially a sleep study to rule out if other sleep disorders
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or psychiatric issues may be at play,” says Menninger Psychologist Mary Rose, PsyD, DBSM, CBSM, who has specialized in sleep for over 20 years. If individuals continue to struggle to fall or stay asleep, the gold standard treatment for insomnia has been repeatedly shown to be cognitive behavioral therapy specifically for insomnia (CBT-I) to get to the root of the problem.” “Our team is also active in research to develop a greater understanding of sleep and to use research to guide patient care,” says Michelle Patriquin, PhD, ABPP, director of Research at Menninger. “Menninger published a study last year that found that individuals with untreated nighttime sleep problems have significantly worse mental health,
including higher anxiety, lower quality of life and functioning, and suicidal thoughts compared to individuals who responded to treatment and had improved nighttime sleep.” Treatment and evaluation of sleep disorders is available to people in the Greater Houston area as well as to clients at Menninger. For children, common issues include restless sleep, bed time refusal, or bed-wetting. A parent may accompany their child for an overnight sleep study. Adults more commonly struggle with insomnia, sleep apnea, or excessive sleepiness during the day. Comprehensive testing is provided in a private, overnight sleep lab with an experienced technician. In some cases, at-home sleep testing may suit the situation.
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Healthy Heart Exercise Caution Outdoors in The Summer Heat By The American Heart Association
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he higher the red line creeps up the thermometer gauge, the more red flags for outdoor exercise. Summer temperatures shouldn’t stop you from jogging, hiking, or playing sports outside – but they should alert you to the danger of heat illnesses brought on by exertion. “Think of the heat like you think of a steep hill: Walking is good, but walking up a steep hill is much harder, so scale back the intensity and use more common sense to exercise safely,” said Dr. Clifton Callaway, a professor and executive vice chair of emergency medicine at the University of Pittsburgh. More than 600 people die every year in the U.S. from preventable heat-related illnesses, according to the Centers for Disease Control and Prevention. An estimated 65,000 Americans visit an emergency room for acute heat illness each summer. With global warming, those statistics could get dramatically worse. By 2099, annual heat-related
deaths will increase by “thousands to tens of thousands” in the U.S. alone, according to the federal U.S. Global Change Research project. Whether running a marathon or doing yard work, exercisers should be aware of the possibility of heat cramps, heat exhaustion, and heat stroke. Heat cramps are muscle spasms or pains, often in the legs, which can occur during intense exercise. If you get heat cramps, stop physical activity, move to a cool place, and sip water or a sports drink. Get medical help if the cramps last for more than an hour, or you have heart problems or you’re on a low-sodium diet. With heat exhaustion, signs include heavy sweating, weakness, dizziness, nausea, a fast and weak pulse, and fainting. Seek medical help if you’re vomiting, or if your symptoms last longer than an hour. The most serious heat illness is heat stroke, a condition where the body’s temperature rises to 104 degrees or higher. Other signs can include a fast, strong pulse; confusion; and possibly losing consciousness. Call 911
right away. “(Heat stroke) is a truly life-threatening situation,” Callaway said. “Fortunately, it’s rare.” Prevention is the key to exercising safely in the heat. Callaway recommended drinking plenty of fluids before, during and after exercising – but not alcohol, which dehydrates the body. Avoid exercising between 10 a.m. and 5 pm if it is hot or humid outside. People who have a normal routine of exercising outdoors at lunch should change their plan. Certain people need to be especially careful about exercising in the heat, including people who are
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older or have diabetes, cardiovascular disease, or other medical concerns. The more often you exercise in the heat, the more the body acclimates, especially if you’re physically fit, Callaway said. Still, he said, the general rule for everyone is to pace yourself. McGovern Medical School Sports Cardiologist Dr. John Higgins says, “When it’s hot outside, think HEAT: Hydrate well and frequently (water or sports drinks), Early or late in day exercise (avoid midday workouts!), Attire: breathable workout clothes will keep you cool and dry, & Take it down a notch: cut back on the time or intensity of exercise.”
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Financial Forecast
From all of us at the
Is Your Retirement Plan as Healthy as It Should Be? Why Everyone Needs a Regular “Financial Physical”
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By Grace S. Yung, CFP can implement over time. Just like Midtown Financial attaining optimum physical health, if Group, LLC you want to run a marathon, you don’t start out running the whole 26 miles on Day 1. Rather, you build up to it by going shorter distances and then increasing them over time. Preparing for Your Financial here are seven pillars of good Physical health – and they go way beyond In order to develop a plan that just eating right and exercising. In fact, is based on your specific needs and true health involves integrating all goals, it is important that you are seven of these components – physical, well-prepared for your meeting with a emotional, relationship to self, social, financial professional. Prior to your spiritual, habits/actions, and financial. appointment, it would be a good idea All of these pillars support each to do the following: other. So, even if just one of them is off, • Make a list of your current it can have an impact on everything expenses and income generators else. That being said, is your retirement (and distinguish between which plan as healthy as it should be? If not, expenses are needs versus wants) you may require a financial physical. • Discuss your current and future
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The Benefits of a Healthy Financial Plan Getting a good baseline of where your financial plan is right now can help point you in the right direction in terms of meeting your future objectives. Without taking a financial physical, though, you may not receive the right type of care. In addition to giving you a definitive direction, a financial plan can provide you with other benefits, too, such as: • Protecting assets from various risks • Reducing your future out-of-pocket healthcare and long-term care expenses • Uncovering any shortfalls that you may have between your anticipated future expenses and income sources • Allowing for more efficient tax strategies • Creating an income stream that can continue to flow in for as long as you need it Although setting up a complete financial plan may seem a bit overwhelming, the reality is, once you get a plan / roadmap in place, you
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financial objectives with your spouse or partner to make sure that you’re both on the same page It is also recommended that you gather some important documents and bring these to the meeting so that your planner can review them. These should include your: • Most recent tax returns • 401(k) and/or other retirement plan statement(s) • Statement(s) from any personal savings and/or investments • Pay stubs • Mortgage and/or other debt statements • Insurance statements Once your plan is in place, similar to recommended health and wellness check-ups, you should ideally review your plan once per year to make sure it is still on track. If you experience any major life changes, such as marriage or divorce, the birth or adoption of a child, death of a spouse or partner and/or buying or selling a business or medical practice see Financial Forecast ...page 13
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The Framework First-to-Market Private Health Management Concept Debuts in Houston
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n a city known for big ideas, Houston’s intimate Sydenham Clinic is rethinking healthcare to optimize life and longevity. The just-opened family office for health – set against the treetops of the storied River Oaks neighborhood – is a first of its kind concept that meshes the best of cutting-edge executive health and premier concierge medicine with curated wellness and lifestyle management. Sydenham Clinic aims to fill a gap in health and medical care with customized solutions and support systems unavailable through traditional insurance-based health systems. Whether it be acute care at the clinic, after hours home visits, rapid turnaround lab work, infusion therapy, Covid testing or global emergency care coordination, Sydenham creates personalized solutions that minimize disruptions to clients while taking preventative approaches to help members have stronger immunity development, cognitive health and overall productivity. Not only does the clinic manage the health of prominent Houston residents, but the firm also
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represents high profile national and international patients seeking to work with the top specialists in the Texas Medical Center. As an independent firm, the clinic is able to refer to specialists from all the major health systems and independent providers thereby collaborating with the most progressive minds in medicine and provide members priority access to the most renowned specialists and medical institutions in Houston and the world – including Mayo Clinic, Johns Hopkins, HSS and Cleveland Clinic. Looking to the past for the future, the clinic honors Thomas Sydenham, the father of English medicine who emphasized the value and importance of detailed observations, meticulous medical record-keeping and proactive physician-patient partnerships. It was founded by CEO Aanchal Bhatia – President of Texas Medical Concierge, psychologist, author and philanthropist. Bhatia’s business partner and Co-Founder Shaheed Kajani is global real estate and hospitality private equity veteran. Joining Bhatia and Kajani on Sydenham Clinic’s founding board is
Despo Papafote Caldwell, an e nt r e p r e ne u r and a successful investor in the medical industry. The team has also brought on Dr. Terry Rice, who brings more than 30 years of experience as a physician and educator to her role as the Medical Director. A specialist in internal medicine, Dr. Rice’s career includes past leadership roles as Medical Director and Associate Professor at MD Anderson Emergency Center, Deputy Director of Ben Taub General Hospital Emergency Department and Delta Airlines’ Medical Director of Concourse Health. With a cap of less than 1,000 members, Sydenham Clinic is launching with two program offerings. The Omnia Program is an elevated version of the executive physical with comparable baseline and diagnostic testing offered at Houston’s major hospital systems but goes beyond the conventional by also incorporating genomics, hormonal evaluation, sleep monitoring, nutrigenomics, environmental toxic exposure,
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cognition matrix and physiological fitness evaluation. The Concierge Program is the signature offering where Sydenham serves as your medical attaché with benefits that, in addition to Omnia, include 24/7 primary care, access and coordination to a network of the world’s most renowned medical specialists, the consolidation and management of medical records plus a personal integrative nutritionist. The physician-patient relationship is the cornerstone of a proactive partnership in the health and wellness journey of each member. The team dedicates hours of time getting to know each member and researching recommendations of medicine, supplements, foods, therapies and lifestyle advice based on their unique genome, hormonal, nutritional and lifestyle matrix.
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Telehealth’s Risks to Physicians and Patients Examined in New White Paper
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elemedicine use skyrocketed during COVID-19—by the end of April, visits in the U.S. had risen to nearly one million per week. While telemedicine can provide sweeping benefits, healthcare providers must also be aware of existing and emerging risks to protect themselves and their patients. The Doctors Company addresses these risks and how to mitigate them in a new white paper, Your Patient Is Logging on Now: The Risks and Benefits of Telehealth in the Future of Healthcare. Whilemedicalmalpracticeclaims involving telemedicine have been minimal in the past, these claims may increase as telehealth—which includes telemedicine, remote monitoring, asynchronous data collection, and a variety of other incorporations of technology into nonclinical patient and professional health-related areas— continues to gain popularity. The white paper examines foreseeable future risks
such as: • Missed diagnoses, particularly of cancer. • Increased cyberattacks. • Breaches to patients’ privacy. • Decreased access to care for some patients without access to internet, with language barriers, or a lack of technological savvy. • Uncertainty around the future of reimbursement. • Lack of proper licensure as physicians perform state-to-state care. “This white paper reflects our mission to advance the practice of good medicine and our commitment to serve healthcare providers so they can help others during the pandemic,” said David L. Feldman, MD, MBA, FACS, chief medical officer of The Doctors Company Group. “For example, during the pandemic, telemedicine patients may refuse to come into the medical practice for further evaluation.
We advise physicians on how to be prepared for such incidences so they can focus on caring for those who need it the most.” “We also invited experts to contribute advice on reducing risks so providers and patients can take advantage of telehealth’s many benefits such as increased access to care for most patients, enhanced ability to manage chronic conditions, and reduction of infection risks,” Dr. Feldman added. The paper includes commentary from Til Jolly, MD, FACEP, chief medical officer of Aveshka and senior consultant for emergency care to
the assistant secretary for preparedness and response at the Department of Health and Human Services; Michael Leitman, MD, dean for graduate medical education, designated institutional official, professor of surgery, and professor of medical education, Icahn School of Medicine at Mount Sinai, New York, New York; Ashish Atreja, MD, MPH, chief innovation officer of medicine and head of Mount Sinai’s AppLab; and Milton Chen, PhD, who has worked with many small practices and large systems to implement telehealth and telemedicine services.
masking and social distancing can mitigate the risk of being infected with SARS-CoV-2. He suggests scheduling a time with the doctor’s office or pharmacist to reduce the risk of exposure to others. Since there is overlap of symptoms between viruses, knowing which viruses are circulating in their community can
help individuals determine which one they might have. If an individual tests positive for influenza and is still within 48 hours of the onset of illness, then antivirals can be prescribed to help lessen the severity of the influenza virus. Antivirals are not used in treating SARS-CoV-2. “The verdict is out as to what
type of season we are going to have for influenza. If we have good social distancing and if more schools are virtual, then that’s one less virus we have to worry about,” Piedra said. “But because we don’t know what the future holds, it’s important to still be vaccinated against the flu.”
There was a strong correlation between decreased mobility and decreased transmission of the virus, highlighting the importance of individuals practicing social distancing to effectively prevent transmission of the virus. “This is clear evidence that social distancing measures can collectively have tremendous impacts on reducing
transmission of SARS-CoV-2, and we encourage individuals to practice social distancing to help control spread of infections,” said Kalluri. “We believe these data will provide useful evidence for public health officials and policy makers when considering future measures to reduce the spread of COVID-19 in their communities.”
Just like putting together an optimum health plan, everyone’s needs can differ with financial and retirement planning. So, it is important to discuss your specific goals and objectives
with a CERTIFIED FINANCIAL PLANNER TM who can review your current financial situation, and then make recommendations for you.
Two Viruses
Continued from page 4 four weeks apart. The nasal spray vaccine also is available this year for healthy individuals 2 to 49 years old. Remember, it takes two weeks to be protected after all doses of vaccination have been administered. For those who are nervous to visit the doctor’s office or pharmacy during the pandemic, Piedra reassures that
Social Distancing Continued from page 6
Following a similar analysis, the data indicate that significantly greater reductions in transmission were seen in countries after implementing a national social distancing policy compared to those with regional policies or a matched time frame in countries without policies. No significant difference was
observed between countries with regional policies and those without social distancing policies. Countries with any social distancing policies had significantly reduced community mobility relative to nations without policies, and those with national policies saw greater decreases than countries with regional policies.
Financial Forecast Continued from page 10 – your plan should be reviewed more immediately. That way, it can be revised to reflect any updated goals in light of a changed environment. It can also help to ensure that
you don’t unintentionally leave anyone out, or alternatively, to avoid situations like keeping an ex-spouse on as the beneficiary of your life insurance and/or retirement plan(s).
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September 2020
Page 14
Houston Medical Times
CMS
HOUSTON
Continued from page 1 time-limited emergencies (such as hurricanes). A hospital could apply to its CMS Regional Office (“RO”) for permission to temporarily relocate a provider-based location, although the RO had discretion to approve or deny such a request. For purposes of COVID-19, CMS builds on this flexibility to allow a broad expansion of hospital locations. Relocations of departments that are able to bill a facility fee (an on-campus or “excepted” provider based department) must still be approved by the RO, but a hospital may relocate an “unexcepted” provider-based department without additional approval by CMS. CMS also stated that inpatient departments can take advantage of this flexibility, although the agency was silent on any notice obligation. Further, a single department may now be split between multiple locations, so that a hospital could theoretically extend the enrollment of one of its hospital outpatient departments to cover multiple temporary expansion locations. These flexibilities raise the exciting possibility of providing hospital-level care in patients’ own homes, potentially reducing infection risk, preserving hospital capacity
for the highest-acuity patients, and improving patient satisfaction. However, a number of legal and operational risks continue to exist in this model. The appropriateness of care provided at home will depend on the clinical needs of each patient – patient acuity, co-morbidities, or the nature of required services may make in-home care inappropriate for some patients. As with any departure from traditional practices, a hospital’s decision to provide care in a patient’s home or other non-traditional location will likely be scrutinized in any future medical malpractice action. CMS’s waiver authority also does not affect state law and, in fact, the waivers are expressly conditioned on compliance with state law. Hospitals should carefully review their state licensing rules and other standards to determine whether these rules (including any special Executive Orders or emergency regulations applicable during the pandemic) allow in-home care. Many state laws remain silent on this possibility, but state officials may be willing to work with hospitals to align rules with CMS standards. Further, hospitals should be aware that CMS has only waived some – not all – of the CoPs. Medicare still requires hospitals to comply with important rules including requirements
around providing 24-hour nursing care and discharge to a “safe environment.” The applicability of certain CoPs may depend on the nature of the services to be provided in patients’ homes, and a hospital may need to work with CMS to obtain additional clarity on the specific rules applicable to their desired use case. Finally, the “hospitals without walls” rules are built on the Public Health Emergency waivers, and CMS has not suggested it may extend these rules further. These regulatory considerations will also guide a number of operational considerations. Hospitals may be required to revise staffing obligations, invest in additional technology (particularly telehealth technology) and amend supply agreements to serve a variety of new locations. While the “hospitals without walls” model may be attractive for certain locations and some kinds of patients, hospitals should be aware of the significant policy, legal, and operational considerations necessary to operate such a model. Working with competent legal counsel will be essential to implementing this kind of structure successfully.
Ventilation Unit
Continued from page 1 initial local cases,” said Maria Oden, a teaching professor of bioengineering at Rice and director of the OEDK. “We are thrilled that the device has received FDA Emergency Use Authorization.” Development began in 2018 when a Houston emergency physician, Rohith Malya, brought his idea for a bag valve mask automation device to students at the Oshman Engineering Design Kitchen (OEDK) at Rice’s Brown School of Engineering. The students designed and built a device that would squeeze a standard bag for hours on end, potentially saving the lives of people like those in Thailand, where Malya serves as a hospital’s director of emergency services and where he watched patients needlessly die for lack of sustained ventilation. A video produced by Rice as the students neared graduation in 2019 caught the attention of health professionals around the world last March, spurring a Rice team of staff September 2020
An enhanced version of the bag valve mask-based ventilator designed by Rice University engineers has won federal approval as an emergency resuscitator for use during the COVID-19 pandemic. Photo courtesy of Stewart & Stevenson
engineers and one student, along with Malya, to revisit the “Take A Breather” device. Working around the clock for weeks, the small team, alone in the OEDK during the initial pandemic lockdown, toughened the device and added safety features for use in a medical setting, a process continued by Stewart & Stevenson, which licensed
ApolloBVM in April. Reniers said several manufacturing sites supported the effort, including manufacturing plants in Oklahoma City and Houston. “It is a testimony to the flexibility of our people and our manufacturing facilities that we are able to readily utilize operations to support COVID-19 related needs,” he said.
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Houston Medical Times
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Page 15
September 2020
Houston Medical Times
HEAT STROKE vs STROKE What and Why
Heat stroke is when your body overheats and core body temperature rises to more than
Stroke is when a blood vessel to the brain bursts or is blocked by a clot. Brain cells die from the lack of blood and oxygen.
Risk Factors UP TO
Some people may be at higher risk due to: • • • • •
Age Certain medications Exertion in hot weather Lack of air conditioning Medical conditions
• Spending time outside in excessive heat • Sudden exposure to hot weather • Weight
80%
OF STROKES MAY BE PREVENTED
Factors you may be able Cigarette smoking to treat and Diabetes control: Heart disease
High blood pressure High cholesterol Obesity Poor Diet
Factors you cannot control:
Family history Medical history
Age Race
Signs Body temperature of 104° F or higher is the main sign. Other signs include: • Confusion • Headache • Hot and dry skin (when not exercising) • Fast pulse or racing heart
• • • • •
Flushed or red skin Loss of cousciousness Nausea Rapid, shallow breathing Vomiting
Other signs of stroke include sudden trouble seeing, dizziness, confusion, severe headache, or weakness on one side of the body.
What to do While waiting for emergency care, move the person into shade or indoors, remove excess clothing and try to cool them with water, fans, ice packs or cold, wet towels.
CALL 911 or your local emergency services number ASAP
stroke.org
Unauthorized use prohibited. DS16285 6/20
September 2020
Get to the hospital as quickly as possible by ambulance to improve chance of surviving and having a full recovery.
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