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Volume 11 | Issue 7
Inside This Issue
July Edition 2021
COVID-19, Telepsychiatry and the Future of Behavioral Health Jobs By Linda Beattie
T Does Zinc Inhibit or Promote Growth of Kidney Stones? See pg. 8
INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Financial Forecast............ pg.10 Healthy Heart......................pg.11
Men’s Infection Risk Plunges under Prostate-Biopsy Method Adopted by Baylor St. Luke’s Medical Group See pg. 13
he COVID-19 pandemic has created a tsunami of problems across the United States, affecting the public’s mental health in addition to the numerous physical casualties. Fears of the disease, grief for those lost, social separation and economic hardships have created new cases of anxiety and depression, while exacerbating existing mental illnesses. A new poll by the American Psychiatric Association (APA), conducted March 26 to April 5, 2021 among a sample of 1,000 adults, found that: • 41% are more anxious than last year when the pandemic began • 43% said the pandemic has had a serious impact on their mental health (up from 37% in September 2020) • 53% of parents are concerned about the mental state of their children • 48% of parents reported the pandemic has caused mental health problems for one or more of their children, with 26% seeking professional help During this same period when Americans have developed a greater need for mental health services, psychiatrists have had to make drastic cuts to in-person visits and dive into telepsychiatry. “There is a huge global shortage of behavioral health physicians, and the market is unfortunately dictating a greater need. Then with the pandemic shutting down some services, we
saw a major transition to telehealth platforms,” said Gabriel Bishop, director of recruiting for the diversified specialties group at Merritt Hawkins. What is telepsychiatry? The APA defines telepsychiatry as a subset of telemedicine, which is “the process of providing health care from a distance through technology, often using videoconferencing.” They add that telepsychiatry “can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.” While telepsychiatry usually involves direct psychiatrist and patient interaction, it may also include psychiatrists supporting primary care providers through professional consultations. It can be delivered via live, interactive communication or involve recorded information. Rumbles of change before COVID “In the three or four years before COVID hit, psychiatrists had been asking about telepsychiatry,” said Mike Belkin, divisional vice president for Merritt Hawkins. “They were interested in doing virtual visits, asking about working from home, but the market was very slow to respond. Some clients agreed to allow some of these visits,
but most did not. They were worried that patient care would be sacrificed. Reimbursement was also an issue.” “Some areas that found recruitment challenging decided to try it,” he continued. “We had some clients that were starting to incorporate one to two days of telepsychiatry visits to help attract those candidates who wanted greater flexibility.” “Now with the pandemic creating the need for so many virtual visits, candidates are seeing that they can serve the patient population digitally, but many clients are still slow to engage.” The overall demand for psychiatrists has increased during the pandemic, noted Belkin. “We are receiving a number of requests for psychiatrists, which reflects the reports of more behavioral health issues during this crisis. The needs have spanned adult as well as child and adolescent psychiatry.” “But the hospitals and practices requesting child and adolescent practitioners are generally not looking for telepsychiatry; they are seeking psychiatrists who are willing to move,” he added. “And the nation’s limited supply of child and adolescent psychiatrists makes these candidate searches even more challenging.” see Telepsychiatry...page 14
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Legal Matters EEOC Issues Guidance to Employers on COVID-19 Vaccine Incentives By Lindsay Ryan, JD Polsinelli, PC
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he Equal Employment Opportunity Commission (“EEOC”) recently provided some long-awaited clarification on an employer’s ability to offer incentives to their employees for receiving COVID-19 vaccinations. This new guidance provides welcomed direction to those businesses looking to encourage workers to get vaccinated rather than adopting a mandatory vaccine policy. This article provides a summary of the EEOC’s guidance on vaccine incentives, as well as other new updates to the EEOC’s previous vaccine-related guidance. Vaccine Incentives The EEOC identifies the following options for employers to offer their workers incentives for vaccination under the Americans with Disabilities Act (“ADA”): »» Employers can offer incentives
to employees to voluntarily provide documentation or other confirmation of vaccination received from an independent third party (e.g., pharmacy, personal health care provider or public clinic). However, any information or documentation collected should be maintained confidentially under the ADA. »» Employers can also offer incentives to employees for voluntarily receiving a vaccine administered by the employer or its agent, so long as the incentive is “not so substantial as to be coercive.” Although the EEOC does not go so far as to define “substantial,” it explains that “a very large incentive could make employees feel pressured to disclose protected medical information” when responding to the employer’s pre-vaccination medical screening questions. Although employers can offer an employee’s family member an opportunity to be vaccinated if certain conditions are satisfied, employers cannot require family members to be vaccinated and should not offer employees incentives for family member vaccination.
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Confidential Medical Information In its updated guidance, the EEOC instructs that the ADA requires an employer to maintain the confidentiality of employee medical information, including documentation or other confirmation of COVID-19 vaccination, regardless of where the employee gets vaccinated. Accordingly, while employers can require employees provide proof of vaccination (i.e., doing so is not a “disability-related inquiry”), this information must be maintained confidentially and separate and apart from the employee’s personnel file. Reasonable Accommodations The EEOC reiterated that if an employee cannot get vaccinated because of a disability or religious belief, the employer cannot require compliance with a mandatory vaccine policy unless it can demonstrate that the individual would pose a “direct threat” to the health and safety of the employee or others in the workplace. This determination should be based on consideration of four factors previously-identified by the EEOC, and “should be based on a reasonable medical judgment that relies
on the most current medical knowledge about COVID-19,” including the level of community spread, statements from the CDC and/or statements from the employee’s health care provider. The employer must also take into account the employee’s specific work environment. If the employer determines that the individual would pose a direct threat, it must then consider whether a reasonable accommodation would reduce or eliminate that threat, unless doing so would present an “undue hardship” to the employer. The EEOC provides specific examples of potential accommodations, including wearing a face mask, social distancing, working a modified shift, making changes in the work environment (e.g., increasing ventilation, limiting contact with others), teleworking, or, as a last resort, reassigning to a vacant see Legal Matters...page 13
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Built Around You July 2021
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New Findings Offer Improved Therapy of Early-Stage, BRCA Mutation-Associated Breast Cancer Houston Methodist Expert Who Led U.S. Component of Trial Available To Address Eagerly Anticipated Olympia Trial Results By Vanessa Astros
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esults were released this week on a new treatment with the potential to improve the outcomes for patients with hereditary BRCA mutations and high-risk, early-stage breast cancer. These results represent the first time a drug that blocks cancer cells from repairing their DNA (called a PARP inhibitor) has been shown to significantly reduce the risk of breast cancer returning in high-risk patients following completion of standard chemotherapy, surgery and radiation therapy. Titled “Adjuvant Olaparib for Patients with BRCA1 or BRCA2 Mutated Breast Cancer,” the paper appears in the June 3 issue of the New England Journal of Medicine and will be presented June 6 as the first abstract during the plenary session at the 2021 American Association of Clinical Oncology (ASCO) Annual Meeting.
July 2021
Lead author and the OlympiA trial steering committee chair Andrew Tutt, M.D., Ph.D., of The Institute of Cancer Research and King’s College London was principal investigator on the portion of study conducted in patients outside the U.S. and will present the results at ASCO. Led by top experts in BRCA-associated breast cancer from around the world, the OlympiA trial’s co-chairs were Charles E. Geyer, Jr., M.D., a breast medical oncologist and deputy director of the Houston Methodist Cancer Center, Judy E. Garber, M.D., M.P.H., of the Dana-Farber Cancer Institute, and Bella Kaufman, M.D., of the Sheba Medical Center in Israel. Geyer was the principal investigator on the NCI-sponsored portion of the study conducted in the U.S. “OlympiA represents a successful global collaboration among leading international academic breast cancer
research groups, cancer genetics experts, the National Cancer Institute and pharmaceutical industry partners to evaluate the efficacy and safety of olaparib to address the unmet need for improved therapy for individuals with high-risk, BRCA mutation-associated early breast cancer,” said Geyer, who also is a professor of medicine in oncology with the Houston Methodist Research Institute and has provided scientific leadership on the trial since 2013. The OlympiA trial was a tremendous effort recruiting 1,836 patients from 420 centers across 23 countries. A randomized double-blind phase 3 trial, OlympiA was designed to test the efficacy of the Poly(ADPribose)-polymerase (PARP) inhibitor drug olaparib and showed that it significantly improved invasive and distant disease-free survival when given for 52 weeks following the completion of such standard therapies as
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chemotherapy, surger y a nd radiation. Pa t i e n t s were recruited from June 2014 through May 2019, and patients who consented Charles E. Geyer, Jr., M.D to participate were randomly assigned to receive olaparib or a placebo. After three years following initiation of treatment with olaparib, 85.9% of patients were alive and free of recurrent, invasive breast cancer and new second cancers, compared with 77.1% of patients who received a placebo. During this same timeframe, 87.5% of patients receiving olaparib were alive and free of distant metastatic disease, compared to 80.4% on the placebo. While olaparib was also associated with 27 fewer deaths than those on placebo, researchers say longer blinded follow up is required to assess the impact of this therapy on overall survival. What is certain, say researchers, is that germline BRCA1 and BRCA2 sequencing is becoming an important biomarker for the selection of systemic therapy in early breast cancer.
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Oncology Research How Innovation is Driving Transformation in Cancer Treatment By Gurjyot Gury K. Doshi, M.D., Texas Oncology
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rom new drug therapies to advancements in radiation therapy and promising clinical trials, medical breakthroughs are transforming the way cancer is treated, helping patients live longer, fuller lives. With a growing number of FDA-approved drugs emerging in recent years, this flourish of innovation is creating greater hope for positive outcomes in patients. That’s a big deal in Texas, where more than 131,000 new cases of cancer are expected to be diagnosed in 2021. Immunotherapies: Using the body as the ultimate defense Immunotherapy, which uses the body’s own immune system to fight cancer, is an example of a highly precise and advanced form of cancer treatment. It is becoming increasingly more
common and can be used alone or in combination with other treatment, such as chemotherapy, radiation therapy, or surgery. While chemotherapy works by killing cancer cells, it cannot tell the difference between cancer cells and normal cells. Immunotherapy uses certain parts of a person’s immune system to attack cancer cells to stop or slow their growth or limit the cancer’s ability to spread. Chimeric Antigen Receptor T cell (CAR-T) therapy, a type of immunotherapy, is considered one of the most promising cancer breakthroughs in recent years. It’s a personalized therapy that involves engineering a patient’s own immune system’s blood cells to attack cancer cells. During the complex procedure, doctors remove some of the patient’s T cells, a type of white blood cell, which are then genetically reprogrammed to identify and attack cancer. Weeks later, doctors then infuse the re-engineered cells back into the patient’s body. Checkpoint inhibitors: Breaking barriers
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Another advancement associated with immunotherapies is checkpoint inhibitors. Think of the human body as having molecules that serve as checkpoints. These checkpoints can determine whether the surrounding cells are healthy or cancerous, fighting those that are deemed cancerous. Over time, however, cancer cells have found ways to “dupe” the system, so to speak, by hiding behind the checkpoints. Researchers developed drugs with the power to eliminate these molecular checkpoints so the body’s immune system can identify and destroy hiding cancer cells, leaving the healthy cells alone. The evolving landscape of cancer care Amazing advancements abound in many facets of cancer care. Evidence-based cancer care goes far beyond providing drug therapies to patients. Exciting research developments that are unrelated to cancer medicines are improving patients’ outcomes and quality of life, such as technology to improve cancer screening, ways to minimize the side effects of cancer treatment, and tools
to determine best approaches for treatment. Examples include cooling caps that help prevent hair loss during treatment, greater use of oral chemotherapy (vs. intravenous), and new blood tests on the horizon that will detect cancer. Recently developed blood tests are being used to detect cancer cells in the bloodstream. Blood testing as a wide-spread method of testing for cancer is still in development but continues to hold great promise. These new approaches are solving previously vexing problems for oncologists and patients. Alongside the quickening pace of progress comes greater optimism and hope for everyone impacted by cancer. research.
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Mental Health How To Handle Anxiety About Returning to The Office After COVID-19 By Lindsey Hendrix
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or Vaccines are widely available, mask mandates are lifting, fans are returning to sporting events, businesses are opening back up—our 2020 dreams are coming true! Except, many of us are feeling oddly anxious about it. This time last year, we wrote about how to deal with feelings of isolation and how to balance working from home while homeschooling our kids. Now, after a year of adjusting to this new way of life, we’re once again faced with a change. And it’s admittedly scary. “It’s a lot like kids returning to school after summer break, but it’s intensified because many people have been at home for almost a year and a half,” said Kelly Sopchak, PhD, a psychologist with the Texas A&M Health Telebehavioral Care Program. As employees transition back to working in offices and students return to schools, stress and anxiety levels will be elevated. The good news is, there are ways to navigate the change in stride. Ease back into the swing of things
July 2021
If you have the option, try to transition back to in-person work and school, rather than going back 100 percent all at once. “To go from working from home five days a week to working in the office five days a week is a big jump,” Sopchak said. “Try to go back just one day a week for a while to ease back into it. This is especially helpful for kids who have school refusal, or school anxiety. We will have them go back just two hours a day and build it up from there.” Adults can start by returning to the office one day a week. For children, it’s best to start with a couple hours a day every day of the week. “That way, they don’t have six days to dread about going back to school,” Sopchak said. For people who have been extremely isolated, she suggests easing back out into the world before returning to the office. Go to the park, go shopping and just be around people more in ways that you feel are safe. Simply getting dressed every day is another way to prepare. “Getting into the practice of getting up and getting ready is critical,”
Sopchak said. “Getting ready to work on Zoom and getting ready to go to the office are two different things; you’ve got to be prepared.” It’s the same thing parents have done with kids for years: in that week or two before school starts back after summer break, parents start setting their kids’ bedtime and lay out their clothes for the next day. Adults can also do this for themselves, to help get back into a routine. “If you feel prepared for something, the anxiety decreases,” Sopchak said. “Setting a bedtime, picking out your clothes the night before and setting an alarm are all ways to prepare for the next day.” Embrace the awkward Our social skills might be a little rusty after being cooped up at home for more than a year, but the awkwardness should wear off after being back out in the world for a little while. This is also true for children who have missed out on peer socialization over the past year. “We know children and adolescents bounce back quickly,” Sopchak said. “They typically have a lot of resiliency and they learn quickly in social situations. It might take them some time, they might seem a little bit immature at first, and that’s okay. It’s a transition.” For adults, returning to the office
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will involve navigating invitations to non-work social events, which could be a new skill for people who are normally very social. “Different people will have different comfort levels engaging in social activities,” Sopchak said. “Know your boundaries and don’t be afraid to communicate them. If you’re going to do something and then feel anxious about it for the next two weeks, you probably shouldn’t do it. On the flip side, if you invite someone out for lunch and they say no, just know it has nothing to do with you. It has to do with how comfortable they are going out in that situation.” Confront stress and anxiety It’s your first day back at the office. You’ve been easing yourself back to a regular schedule and you have your morning routine down. You were energized by your favorite podcast on the drive in and you’re really enjoying catching back up with your co-workers. Then, out of nowhere, you feel like you see Mental Health...page 8
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Does Zinc Inhibit or Promote Growth of Kidney Stones? Well, Both. to offer some resolution to the differing hypotheses. “What we see with zinc is something we haven’t seen before. It does slow down calcium oxalate crystal growth and at the same time it changes the surface of the crystals, causing defects in the form of intergrowths. These abnormalities create centers for new crystals to nucleate and grow,” reports Rimer, who refers to the effect as a double-edged sword. The formation of kidney stones is a pathological condition that has increased in frequency among patients, leading to an increased amount of suffering and steep rise in medical costs. Though calcium oxalate crystals
are found everywhere, the most naturally abundant form of these crystals are calcium oxalate monohydrates (COM), the kind found in human kidney stone disease. Along with COM, kidney stones are composed of various hard deposits of inorganic salts and organic compounds (e.g., proteins) crystallizing or sticking together in concentrated urine. They can be severely painful to pass through the urinary tract. In this study, Rimer and his team used a combination of in vitro experiments and computational modeling to decode the effects of zinc on COM crystal growth. “The techniques we’re using in our lab to investigate these systems enable us to get a better picture and to deconstruct these complex systems as a means of identifying new ways to prevent kidney stone formation,” said Rimer. “These are enabling tools that allow us to understand at an almost molecular level how various species in urine can regulate crystal growth.”
different things you can do to cope.” Deep breathing works for some people, or mindfulness exercises may help. Sopchak keeps a mindfulness app on her phone so when she’s feeling stressed, overwhelmed or anxious about something, she can listen to a guided
meditation and bring it down to a level she can manage. You can also try these mindfulness practice videos from the Telebehavioral Care Program. For some people, these strategies may not be effective. In that case, consider seeking professional help.
First Study to Validate Conflicting Theories By Laurie Fickman
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funny thing happened on the way to discovering how zinc impacts kidney stones - two different theories emerged, each contradicting the other. One: Zinc stops the growth of the calcium oxalate crystals that make up the stones; and two: It alters the surfaces of crystals which encourages further growth. Now it can be told – both theories are correct as reported in the America Chemical Society journal Crystal Growth & Design by Jeffrey Rimer, Abraham E. Dukler Professor of Chemical and Biomolecular Engineering at the University of Houston, who conducted the first study
Mental Health
Continued from page 6 can’t catch your breath. “Pay attention to your body,” Sopchak said. “If you are feeling increased stress and anxiety, there are
July 2021
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Rimer’s findings on the dual role of zinc on COM was confirmed by atomic force microscopy measurements showing a unique ability of zinc ions to alter the termination of crystal surfaces. The team compared the impact of zinc on COM, with similar ions like magnesium. “We wondered what would happen if we used alternative ions commonly found in urine, such as magnesium, and the answer was nothing. It had little to no effect, whereas zinc had a major effect. This is an excellent demonstration of how subtle differences in the nature of various species impacts their interaction with crystal surfaces,” said Rimer.
“This is a big transition. Give yourself grace and say, ‘Look, it’s okay that I’m struggling with this, because this is big,’” Sopchak said. “Our lives were uprooted and changed, and now our lives are going to be uprooted and changed again.”
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Financial Forecast Reducing the Risk of Identity Theft and Cyber Crime
PlAN WISElY. YOU
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A successful retirement in the future can often depend on having a solid plan now. If your money isn't working as hard as you are, it may be time to act-there are no do overs in retirement planning. Now is the time to consider developing a strategy that can help you work toward your financial goals. I specialize in providing comprehensive, objective financial guidance with the goal of maximizing every remaining moment of the retirement countdown.
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ver the years, the prevalence and frequency of identity theft and cyber-crime has increased exponentially – impacting both individuals and businesses. Many cyber criminals focus on acquiring the personal information of their victims so they can open credit cards, make purchases, and/or sell such details as Social Security numbers to other thieves. If you are impacted by this type of crime, it could be detrimental to your financial well-being – and depending on the particular situation, it could even change your life as you struggle to restore your credit, your medical records, and possibly even your personal reputation. The good news is that as this type of crime has grown, so have the ways that you can go about protecting yourself – and putting some precautions in place could make a world of difference in your personal and financial life. Common Online Threats to Look Out For It is estimated that consumers lost $56 billion to identity theft fraud in 2020, with roughly 49 million people falling victim. Approximately $13 billion in losses were due to “traditional” identity fraud, which consists of criminals stealing personal information and then using it for their own gains. But, while many people are aware of identity theft and unauthorized use of credit cards, these are just two of many different types of online threats that could occur with your personal and/or business information. Some of the more common online threats include: • Falsified Tax Returns – Tax-related identity theft occurs when someone uses a victim’s stolen personal information – including their Social Security number – to file a tax return and claim a fraudulent refund. • Medical Identity Theft – Identity thieves could use someone else’s personal information, as well as
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their medical records to obtain healthcare – and because the victim’s medical history would include information about the criminal, too, it could become life-threatening if the victim later needs medical care and is given the wrong treatment and/or medication. • House Stealing / Deed Theft – This type of crime involves a criminal stealing the victim’s identity and then forging deed or title documents in order to “sell” the home to unsuspecting buyers or to borrow against the equity in it. If you become a victim of ID theft or other type of cybercrime, it can affect you in a number of ways. For example, in addition to the time and effort it can take to restore your credit and finances (and there is no guarantee that you will ever be able to get back to square one), this type of situation can impact you mentally and emotionally. For many victims of identity theft,
missed workdays are also common, and in turn, your income (and possibly even your job) could suffer as a result of the time you must set aside to recover lost funds, rectify your credit report, and ensure that your information is in-tact going forward. Taking Steps to Help Protect Against Cyber Crimes Although there is no guarantee that you will never become a victim of identity theft or a cyberattack, there are some steps that you can take for reducing the odds. Protecting yourself from a cyberattack can take some time and it can be well worth it if it reduces the chances of becoming a victim. To learn more about how to keep your investment and retirement accounts safer, talk with a CERTIFIED FINANCIAL PLANNER professional who can work with you on taking these types of precautions.
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Healthy Heart 10 Vegetables To Plant With Your Kids This Summer By The American Heart Association The American Heart Association suggests gardening as a fun way to boost mental health and physical activity along with nutrition.
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ven with temperatures rising across the country, it’s not too late to plant a summer garden. Planting one with your kids can offer health benefits beyond nutrition and provide some affordable summer fun. “Don’t let the heat stop you from the fun of a summer garden,” says Kim Aman, volunteer gardening advisor for the American Heart Association’s Teaching Garden Network. “In the hot summer months, pay extra attention to water. Mulching the top of the soil helps to keep the soil cool and retain moisture. Organic amendments of fish emulsion, worm castings or dried molasses are helpful to provide nutrients.” In addition to basil and other herbs, Aman’s recommendation for heat-friendly summer planting include:
1. Cucumbers 2. Okra 3. Eggplant 4. Beans 5. Sweet potatoes 6. Melons 7. Summer squash 8. Tomatoes 9. Pumpkins 10. Peppers As you dig, mulch, trim, water, and remove those pesky weeds, you may relieve some stress and anxiety, too. According to the American Heart Association, the world’s leading nonprofit organization focused on heart and brain health for all, getting kids active and outdoors can offer mental health benefits. “Creating a home garden is an activity to get the entire family involved while increasing physical activity to improve mental health and reduce anxiety and depression,” said Lharissa Jacobs, M.Ed, MBA, Vice President of Health Strategies for the American Heart Association Houston. According to the CDC, childhood obesity accelerates during
the summer while children are out of school. Children who experience high stress levels are at increased risk for smoking, being overweight or having disrupted sleep – all of which can lead to serious health problems. Stress hormones can lead to inflammation, which raises the risk of developing chronic diseases, such as heart disease. Activities that prioritize physical and mental health can help children grow to their full potential. Healthy eating habits are created during childhood. That’s why the American Heart Association encourages kids to adopt healthy behaviors early in life. Locally in Houston, AHA is working with community partners to help kids make healthy food choices. Over the past year, these initiatives include establishing distribution networks for Texas Farm Fresh boxes through The Common Market, mobile markets in the Third Ward and a farmers’ market in Acres Homes. Planting a summer garden is a great opportunity for kids to learn what it means to be healthy and how fruits and vegetables contribute to a balanced diet. It can also be an opening to discuss the concept of nutrition security and ways to care for our neighbors. Take it one step further with a family volunteer day at a local food pantry or hunger relief organization. Not only does it reduce summer screen time but volunteering also contributes to an overall sense of gratitude and well-being. It’s no secret that a nutrient-rich diet and physical activity are key ingredients to a healthy lifestyle. Mental health is a critical third component. Planting a summer garden might help you flourish in more ways than one. Get more well-being tips at heart.org/ HealthyForGood
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Supporting The Shift Toward Value-Based Health Care Study Shows That When Health Care Providers Spend More Time with Home Health Care Patients, Risk Of Hospital Readmission Decreases
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he United States spends roughly $3.6 trillion on health care each year, equivalent to nearly 18 percent of the gross domestic product. However, the United States does no better in population health outcomes compared to other high-income countries that spend half as much money on health care. Thus, in recent years there has been a shift toward value-based health care, in which health care providers are paid based on the management and health outcomes of their patients, rather than the number of patients they see. Value-based health care could help stimulate better quality care for patients, saving individuals and the government more money in the long run. One such area of value-based
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health care is home health care, which is often initiated after a hospitalization and provides a way for patients to receive continued care within the comfort of their homes. The goal of home health care is to help homebound patients recover post-discharge and ultimately avoid unnecessary readmissions to the hospital, saving the patient and hospital time and money. However, even while transitioning to value-based care, home health agencies are still rewarded for seeing more patients per day rather than for the value of their services. With the health care industry shifting to value based care, it is important to understand how the delivery of care in the home
could be better designed to improve the quality of care for patients and reduce inefficiencies, such as hospital readmissions. Elena Andreyeva, PhD, assistant professor at the Texas A&M University School of Public Health, recently explored whether and how the amount of time that a provider spends during a home health visit with a recently discharged patient impacts the likelihood of hospital readmission. The study, published in the journal Management Science, used a rich data set to characterize patients and their home health visits, and determine the average amount of time health care providers
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spend with their patient (nearly 44 minutes). The data on time spent with patients was adjusted for patient demographics and condition-related characteristics, such as if the patient was sicker than average. The study suggests that on average, an extra minute during a home health visit is associated with a 1.39 percent decrease in the likelihood of readmission to the hospital following that visit. To put this finding into perspective, if health care providers spend about an extra five minutes with see Health Care...page 14
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Hospital News Men’s Infection Risk Plunges under Prostate-Biopsy Method Adopted by Baylor St. Luke’s Medical Group in The Woodlands By Vanessa Astros
U
rologists at Baylor St. Luke’s Medical Group in The Woodlands completed their first prostate biopsy using the PrecisionPoint™ Transperineal Access System (PPTAS), a new approach that virtually eliminates transrectal-induced bacteria and optimizes cancer detection. With the conventional method to biopsy the prostate, physicians pass the biopsy needle through the rectal wall to reach the prostate, which increases the risk of infectious complications, such as urinary tract infection (UTI), prostatitis, epididymitis, orchitis, bacteremia, and sepsis. The new approach represents major progress in eliminating the risk of infection caused by multiple needle sticks passing through the rectum as
the biopsy needle is inserted in the perineum, the area of skin that lies just below the scrotum. “About 2 to 6 percent of traditional prostate biopsies can lead to infection, with as many as 4 percent of patients enduring severe, whole-body infections that require hospitalization,” said Dr. Christopher Kosarek, a Baylor St. Luke’s Medical Group urologist leading the PrecisionPoint™ rollout for the health system. “The PPTAS drops that risk to near zero, research shows.” False-negative cancer diagnosis is also a major concern seen with the traditional transrectal biopsy method. “Samples gathered through this revolutionary approach have been shown to have a higher cancer-detection rate in those patients who actually have cancer,” said Dr. Kosarek. “Sometimes
Baylor College of Medicine Recruiting Participants for Throat Cancer Screening Study
W
hile smoking-related head and neck cancers are declining in the U.S., human papillomavirus (HPV)-related oropharyngeal, or throat, cancer is on the rise. In fact, oropharyngeal cancer has passed cervical cancer as the leading HPV-related cancer in the country. Baylor College of Medicine is recruiting participants for a screening trial aimed at early detection of HPV-related throat cancer, with the goal of improving the likelihood of cure. More than 80% of oropharyngeal
Legal Matters
Continued from page 3 position in a different workspace. Finally, the EEOC cautions that employers should consider all options before denying an accommodation request, and that the “undue hardship” consideration may be impacted by the vaccination rate of the workforce and the extent of employee contact with non-employees (whose vaccination status may be unknown). Pregnancy The EEOC’s guidance also clarifies that employees who are not vaccinated
the conventional biopsies miss cancers, specifically those hard to reach in the anterior portion of the prostate gland, which is inaccessible with the other approach. This can be up to 15 percent of cancers.” Few health providers in the Houston area have adopted PPTAS, which can be performed in the office setting under local anesthesia. Baylor St. Luke’s Medical Group urologists, Drs. Salim Cheriyan and Christopher Kosarek, are the only medical providers in North Houston offering the novel biopsy method, which revolutionizes the logistics of retrieving prostate tissue samples. The Woodlands Medical Group’s first prostate biopsy employing the transperineal system was successfully performed on June 11, 2021. “It’s clear why Perineologic won
PrecisionPoint Transperineal Access System (PPTAS)
a Medical Design Excellence Award for this new system,” Dr. Kosarek added, noting that it eliminates the need for preventive antibiotics and reduces the number of punctures needed to complete a biopsy. “This is a game-changer for men and can put their minds at ease. Our tireless urology team is excited to provide high-value care utilizing this new technology.” Maryland-based medical device company Perineologic developed and refined PPTAS over four years, committed to reducing infection risks and missed cancers as active surveillance in prostate-cancer patients gains wider acceptance in the medical community.
cancer patients have metastatic cancer by the time they are diagnosed and require advanced treatment. The combination of surgery, radiation and chemotherapy can leave patients with significant side effects like pain, dry mouth, altered taste and difficulty swallowing. Early detection has the potential to reduce treatment toxicity and improve chances of achieving a cure. The TRINITY (Throat and other HPV-Related cancers IN men: Identifying Them earlY) screening
trial is being conducted at Baylor College of Medicine in Houston and the University of Texas Southwestern Medical Center in Dallas. The trial will enroll 1,500 men, ages 50 to 64, without a history of head and neck cancer or HPV-related cancer. Participants will be screened for HPV biomarkers through a blood test and oral rinse. Selected individuals will receive in-person throat examinations, including oropharyngeal swab tests and ultrasound imaging. If the participant tests positive, he will be given the opportunity to be screened for oropharynx, anal and/or penile cancer. “The Pap smear revolutionized the role of OB/GYN physicians in cervical cancer prevention,” said Dr. Erich Sturgis, professor and vice chair of clinical affairs in the Bobby R. Alford Department of Otolaryngology
– Head and Neck Surgery and Brown Foundation Endowed Chair at Baylor. “A routine early detection test for HPV-related oropharyngeal cancer, or at least a biomarker to identify those at high risk, could revolutionize our specialty and disrupt worrisome trends in cancer incidence and mortality, as well as the devastating effects of cancer treatment on this growing population.” Sturgis is also director of the Head, Neck and Thyroid Cancer Multidisciplinary Program at the Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center. The TRINITY trial is funded in part by the Cancer Prevention and Research Institute of Texas (CPRIT). For more information on the trial and how to join, contact Hannah Smith at 713-798-4224 or Hannah.smith@bcm.edu.
because of pregnancy may also be entitled to certain accommodations under Title VII if the employer makes modifications or exceptions for other employees “who are similar in their ability or inability to work.” These modifications may be the same as the accommodations identified above for employees based on a disability or religious belief. Emergency Use Authorization The EEOC declined to offer any insight on the legal implications of the Emergency Use Authorization for the three available COVID-19 vaccines to date in the United States, indicating that “[t]he EEOC’s jurisdiction is limited to the federal EEO laws . . . .” The EEOC
reinforced, however, that federal EEO laws do not prevent an employer from requiring employees to be vaccinated as a condition of entering the workplace, subject to the reasonable accommodation requirements under Title VII and the ADA (and other EEO considerations discussed in its guidance). Updated CDC Mask Guidance The EEOC acknowledged the recently updated guidance from the Centers for Disease Control and Prevention (“CDC”) exempting fully vaccinated individuals from masking requirements, and indicated that the EEOC is considering the impact of this CDC guidance on the EEOC’s
own COVID-19 guidance provided to date. Accordingly, employers may see further updates to the EEOC’s technical assistance soon. As more and more businesses return to physical workplaces and evaluate their COVID-19-related workplace policies, they should continue to monitor for updated guidance from the EEOC on matters related to employee screening, testing, vaccines and accommodations, as well as guidance from the CDC, the Occupational Safety and Health Administration (“OSHA”) and other public health authorities.
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Telepsychiatry
Continued from page 1 The current state of uncertainty “So many physicians would love a telepsychiatry position, but clients continue to worry about patient care, loss of continuity, reimbursements, etc,” said Belkin. “With the current state of emergency, televisits are reimbursed for now, but we’re not sure what is going to happen in the long run. There has been a lot of lobbying to extend those or make them permanent. But healthcare clients still have their doubts,” he explained, adding that their hesitancy may also relate to questions of liability if an adverse outcome occurs following a televisit. “Yet those working in the field are telling us that, in terms of patient care, it doesn’t seem that patients have less care or worse outcomes. Our mental health providers report their level of service is just as good,” he said. Healthcare employers that have tried telepsychiatry have also enjoyed some success, Belkin noted, including one of the firm’s clients in Wisconsin that was having trouble filling a permanent position. Once they opened it up to telepsychiatry, it took just 45 days to secure a qualified psychiatrist. Both client and physician have become fans of the arrangement ever since. Questions of access to mental health services Belkin noted that the convenience of virtual visits and avoiding crowded waiting rooms has been attractive for many patients. “One caveat to the telemedicine trend, however, is that some don’t have good internet connection, or it fades in and out, which can be a problem,” he said. While telepsychiatry can create greater access for some clients living in remote areas, public health experts have voiced concerns about inequities that may leave some unable to receive care in
Health Care
Continued from page 12 their patient during a home health visit (an increase from 44 to 49 minutes), they could decrease the likelihood of their patient being readmitted to the hospital by 6 percent. These findings are significant, especially for Medicare patients who have a hospital readmission rate of about 20 percent, Andreyeva said. “I think these results confirmed our hypothesis that if you spend more time with a patient during a home health visit, you might uncover potential health issues before the patient’s health July 2021
Houston Medical Times
a virtual environment. “A lot of organizations are trying to meet the needs of psychiatrists and their clients, but patients may not have the technology resources to be able to see these professionals remotely because they don’t have a smartphone or laptop or reliable internet,” said Bishop. Limitations of telepsychiatry Despite their attraction for psychiatrists, Bishop explained that there are some limitations to telepsychiatry visits. “Body language is very important to be able to see when visiting with a patient, and a psychiatrist or psychologist can’t necessarily see that during telehealth visit; they may not see what the person is doing with hands, feet, etc.,” she said. Some mental health conditions are also less conducive to teletherapy. “If you are treating depression or anxiety that needs to be addressed, a telehealth visit can work. But if a patient has schizophrenia, or other more acute cases or comorbidities, those may need to be seen in person,” said Bishop. Even the same patient may need different support at different times, she explained. “A lot of it may be medication management, so that one-month checkup online may make sense. You can easily do that virtually.” Another thing candidates might need to consider is the compensation rate for telepsychiatry. “Some clients are open to offering full-time, remote positions but the compensation is going to be less,” said Bishop. “Telehealth may not be as high paying.” Psychiatry recruiting impacted by virtual practice and workforce shortages “Behavioral health clinicians have decided that they can practice virtually from home, making it more difficult to have people consider a traditional, onsite job,” reported Bishop. “Going forward, I think more organizations need to be open to having some flexibility in their work schedules, like three days on site and two days working remotely--some
kind of nontraditional schedule.” “I can’t think of one candidate who has had a negative experience practicing in the virtual environment; most would prefer to work from home, or not have to relocate,” Belkin added. “There are so many opportunities for behavioral health jobs, but not everyone wants to move.” “We need to figure out a solution in psychiatry, as the workforce demographics aren’t promising. More than 80 percent of psychiatrists are over the age of 45, and 60 percent are 55 or older,” he continued. “Psychiatrists do practice longer than their medical colleagues, and their average retirement age is older since they don’t usually encounter physical limitations. But supply issues are still a challenge.” A limited capacity to train new practitioners is part of the issue, according to Belkin, who noted that there are less than 2,000 psychiatry residency slots each year. Without a robust pipeline of new physicians, the workforce shortage is expected to become an even larger crisis. Telemedicine and the future of psychiatry jobs “We expect the demand for psychiatrists will continue to climb,” said Bishop. “There could be a trickle effect for years to come from the pandemic, due to people who experienced traumatic losses, extended seclusion, situational depression or social anxiety. It could take years before we know how it affected younger kids especially.” Virtual visits are also expected to remain popular, though the percentage of mental health services provided remotely vs. in-person will vary depending on location, compensation and other factors. “The availability of reimbursement funding will have a huge impact on whether an organization will start offering telepsychiatry as an ongoing piece of their business,” said Belkin. “If candidates are patient, we believe there will be more dedicated telepsychiatry positions down the line,” he concluded.
gets worse and requires a hospital readmission,” Andreyeva explained. “Given that home health agency services are typically a lot less expensive than hospital stays, it makes sense to invest more into home health infrastructure, such as hiring more personnel, if that helps patients remain healthier.” Further, a cost–benefit analysis that used the study’s findings, general trends in home health costs, and the cost of hospital readmissions, suggested that investing in home health services would save money due to projected fewer hospitalizations. The results of the study and cost-benefit analysis support the shift toward value-based health care. However, there
is still more to explore. “One limitation of our study is that we do not know what went on during these longer home health visits that led to a decrease in the likelihood of hospital readmission,” Andreyeva said. “Did the nurse talk longer with the patient and uncover a potential issue? Or was the visit longer because the nurse had important health care steps to take with the patient? It is extremely important to understand which aspects of a home health visit are the most important in preventing hospital readmission. This way, we could tell home health agencies not just that the visits might need to be longer, but what a provider should do to limit the risk of hospital readmission.”
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The American Heart Association suggests gardening as a fun way to boost mental health and physical activity along with nutrition.
Cucumbers
Okra
Eggplant
Beans
Sweet Potatoes
Melons
Summer Squash
Tomatoes
Pumpkins
Peppers
Stress hormones can lead to inflammation, which raises the risk of developing chronic diseases, such as heart disease. Activities that prioritize physical and mental health are a way to help children grow to their full potential. Get to digging, mulching, trimming, watering, and removing those pesky weeds to relieve some stress and anxiety.
Visit heart.org for healthy lifestyle tips, recipes and more. ©2021, American Heart Association. 5/10DS3675
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