The Framework

The Framework First-to-Market Private Health Management Concept Debuts in Houston

In 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 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 ent repreneu 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,

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.

WHAT WE OFFER:

• Integrating the Montessori method into the public school curriculum • Currently offering Pre-K thru 8th • Open enrollment until positions fill

• Comprehension Stem Program • Character & Leadership Development • High Tech – 7 computers per classroom

Telehealth’s Risks to Physicians and Patients Examined in New White Paper

Telemedicine 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. While medical malpractice claims 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

Two Viruses

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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 – 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 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.

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

Social Distancing Continued from page 6

observed between countries with 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). Following a similar analysis, the regional policies and those without data indicate that significantly greater social distancing policies. reductions in transmission were seen in Countries with any social countries after implementing a national distancing policies had significantly social distancing policy compared to reduced community mobility relative to those with regional policies or a matched nations without policies, and those with time frame in countries without national policies saw greater decreases policies. No significant difference was than countries with regional policies. 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

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

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 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 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.

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.” 

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 COVID-19 in their communities.”

Financial Forecast

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future measures to reduce the spread of with a CERTIFIED FINANCIAL PLANNER TM who can review your current financial situation, and then make recommendations for you. 

CMS

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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 Ventilation Unit 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 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

Stewart & Stevenson

engineers and one student, along with Malya, to revisit the “Take A Breather” device. 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 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

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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

Working around the clock for structure successfully.  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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