Serving Harris, Galveston, Brazoria, Fort Bend and Montgomery Counties
HOUSTON
March 2019
Volume 9 | Issue 3
Inside This Issue
Time for a Manhattan Project on Alzheimer’s By Dr. Marc Diamond
I
Physician Trends to Watch in 2019 See pg. 10
INDEX Mental Health...................... pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.5 Healthy Heart....................... pg.9 Financial Forecast............ pg.12
Charitable Giving Directly Benefits the Texas Medical Center See pg. 14
magine if Alzheimer’s was treated like other common diseases. Instead of worrying about the prospect of slowly losing your memory, you might get a series of shots during middle age to prevent the onset of this neurological nightmare, just as we do to reduce the risk of flu. Or you could take a daily pill as many do to control their cholesterol or blood pressure. That may sound improbable, given the long string of Alzheimer’s drugs that have failed to work in clinical trials, but I remain optimistic. As a physician-scientist leading research into the causes of neurodegenerative diseases, I believe that we are making significant progress on uncovering the roots of Alzheimer’s. Alzheimer’s is a neurodegenerative disease that has stymied researchers for years. The disease develops when two proteins - A-beta and tau - accumulate in the brain. A-beta builds up outside of nerve cells, and tau inside them. Decades of study suggests that A-beta somehow leads to the accumulation of tau, which is what causes nerve cells to die. This may explain why early treatments focusing exclusively on A-beta failed. These ideas have led to new diagnostic criteria that take into account these two proteins to make the definitive diagnosis. Mechanistic studies take time but pay off As a scientist, I have always been fascinated by the molecular basis of disease, and as a physician I am committed to helping patients. In my lab at the University of Texas Southwestern Medical Center in Dallas, our group is focused on identifying structural changes in the tau protein that enable it to aggregate and cause disease. Our work suggests that neurodegeneration begins with a shape shift in the tau protein, which then forms toxic assemblies, or clumps, in the
brain. These assemblies are mobile, and appear to transmit pathology between different groups of neurons causing disease progression. As tau appears to play the central role in destroying brain cells, and because lost neurons cannot be replaced, our researchers are working to develop tools to pick up the earliest signs of toxic tau. This may occur years before cognitive symptoms become apparent. If physicians can detect the disease-causing forms of tau, they will be able to diagnose the underlying disease before permanent loss of brain cells occurs, perhaps even before individuals know they have a problem. This requires that we develop better, more sensitive biomarkers that may facilitate this process, much like we now use hemoglobin A1C to diagnose incipient diabetes. To do this we’ve pulled together an unconventional team with expertise in structural biology, biochemistry, cell biology, neurology and neuropathology to work side by side in our Center for Alzheimer’s and Neurodegenerative Diseases (CAND). Studies from my lab have already contributed to the development of an anti-tau antibody that is in clinical trials. This antibody
binds tau, and may facilitate its clearance from the brain. Full disclosure: I receive royalties through my former employer, Washington University in St. Louis, for my role in discovering this drug. This approach at CAND is much like the diverse group of engineers and physicists who were brought together during World War II for the Manhattan Project - the secret effort to create the first atomic bomb. Our multidisciplinary team marries discovery and engineering with the goal of developing diagnostic tools and personalized therapies that can stem the progression of Alzheimer’s and other neurodegenerative disorders. The role of philanthropy Major philanthropists have realized the value of integrated research efforts to solve specific problems in science. They are pouring tens of millions of dollars into Alzheimer’s research. Our team at UT Southwestern was recently the recipient of a $1 million award from the Chan Zuckerberg Initiative, set up by Facebook founder Mark Zuckerberg and his wife, Priscilla Chan. In all, the Chan Zuckerberg Initiative awarded more than $50 million to see Manhattan Project... page 18
PRSRT STD US POSTAGE PAID PERMIT NO 1 HOUSTON TX
Page 2
March 2019
Houston Medical Times
medicaltimesnews.com
Houston Medical Times
Page 3
Mental Health State Approves Funds for UTHealth Continuum of Care Campus
T
he With the first $6 million in state funds approved by the Legislative Budget Board and the governor to the Texas Health and Human Services Commission (HHSC), The University of Texas Health Science Center at Houston (UTHealth) will oversee construction of a continuum of care campus for behavioral health that addresses a critical need in Texas. T he 30 4-b e d U T He a lt h Continuum of Care Campus for Behavioral Health is planned to be built adjacent to the 274-bed UTHealth Harris County Psychiatric Center (HCPC) and will include acute, subacute, and residential treatment. The combined facility would create the largest academic behavioral health hospital in the country. During the 85th Legislative Session, the Texas Legislature approved $300 million to expand and significantly repair the state’s hospital system during the 2018-2019 biennium, with the intent to appropriate more funds to HHSC in the following biennia. HHSC recommended
allocating more than one-third of the funding to the UTHealth project. “Our state leaders in the Legislature and in the Health and Human Services Commission have shown incredible dedication to help those suffering from behavioral health illnesses in Texas. UTHealth is honored to partner with them to develop innovative programs and provide the highest level of care for this vulnerable population,” said Giuseppe N. Colasurdo, M.D., UTHealth president and Alkek-Williams Distinguished Chair. “This funding is a giant step toward addressing a critical health care need.” McGovern Medical School at UTHealth operates and staffs UTHealth HCPC, which is jointly owned by the State of Texas and Harris County. It is the second-largest academic behavioral health care hospital in the country and was recently recognized by the Joint Commission as a Top Performer on Key Quality Measures. Additionally, UTHealth HCPC demonstrates the value of academic and healthcare
The park-like green space at UTHealth Harris County Psychiatric Center will be shared by patients and staff as part of the new UTHealth Continuum of Care Campus for Behavioral Health. Photo by Nash Baker)
partnerships underscored by the Texas Legislature and HHSC in the new projects. More than 500 medical school students, residents and fellows – as well as more than 1,500 students in fields including nursing, pharmacology, and social work– annually train at UTHealth HCPC. U T H e a l t h HCPC has approximately 45 people waiting to be admitted at all times, and even though Houston is one of the most populous
regions in the nation, the closest state psychiatric hospital is more than three hours away. “This funding will allow us to build a transformative model of care that will go to the very core of treating behavioral health illnesses. It will help us make a vital difference for these patients and their loved ones,” said Jair Soares, M.D., Ph.D., professor and Pat R. Rutherford, Jr., Chair in Psychiatry see Mental Health... page 17
Do you have a true financial partner, or just another bank? As your true financial partner, Trustmark offers a $0 Down Payment mortgage program designed for both new and established physicians.** Visit trustmark.com/physicianmortgage to find out more.
MEMBER FDIC
$0
945 Bunker Hill Road, Suite 200 | Houston, TX 77024 | 713.827.4240
down FIXED-RATE MORTGAGE*
NO PMI REQUIRED
medicaltimesnews.com
*Primary residence purchase or refinance. 15-year fixed; 5/1, 7/1 and 10/1 ARM with 30-year amortization. ** Some restrictions apply.
March 2019
Houston Medical Times
Page 4
Legal Matters Out-Of-Network Providers Rejoice: The 8th Circuit Condemns the Practice of Cross-Plan Offsetting By Ebad Khan, JD
Polsinelli, PC
A
fter over a year of waiting, the Eight Circuit Court of Appeals aligned itself with the Department of Labor by concurring that the practice of Cross-Plan Offsetting orchestrated by many commercial health insurance companies, and in this case United Healthcare, to recover erroneously overpaid claims from out-of-network health care providers is not only a violation of the terms of a self-funded benefit plan, but may also trigger additional liabilities for commercial health insurers and plan sponsors and administrators of self-funded benefit plans under ERISA. Though the practice is shrouded
in complexities, generally speaking, Cross-Plan Offsetting is a practice commercial payors employ to recover overpayments made to out-of-network providers by withholding the overpaid amount from subsequent payments to be made to the same out-of-network provider. This is done by commercial payors regardless of the fact that the overpayment may have been made by one plan and the offset is taken from a payment to be made by a completely different plan. In Peterson v. UnitedHealth Group, Inc., the Eight Circuit determined that: (i) nothing in a self-funded plan’s plan documents even comes close to authorizing United Healthcare to engage in Cross-Plan Offsetting; (ii) even the broad authority granted to United Healthcare to administer a self-funded benefit plan does not permit it to engage in this practice; (iii) Cross-Plan Offsetting is in tension with the fiduciary duties of a commercial health insurer acting
as a third-party claims administrator (TPA) of a self-funded benefit plan and the fiduciary duties of a plan sponsor because it may amount to failing to pay a benefit owed to a beneficiary under one plan in order to recover money for the benefit of another plan; and (iv) Cross-Plan Offsetting may constitute a transfer of money from one plan to another in violation of ERISA’s “exclusive purpose” requirement. Though this practice is likely permitted between providers who are contracted with commercial payors, those providers who are not contracted with commercial payors (i.e. out-of-network providers) that have overpayments made to them, erroneous or otherwise, that are offset against future payments owed to them, likely have recourse as a result of the Eight Circuit’s ruling. Commercial payors have been orchestrating this practice for many years, and for some, as long as a decade. This translates to many out-of-network providers losing out on a substantial amount of money that should have otherwise been paid to them. As a result of this ruling, the Eight Circuit has now opened the door to out-of-network providers to take
action against commercial payors in hopes to collect money that may have been unlawfully offset against them. Furthermore, if commercial payers are currently still offsetting overpayments against out-of-network providers, this case provides an avenue to those providers to put a stop to this harmful practice against them. Although the Eight Circuit’s decision is not controlling precedent in the Fifth Circuit, the Circuit in which Texas is located, this case may likely be considered as persuasive authority by courts and fact-finders in Texas and nationwide. By taking action against commercial payers to collect offset money or, at the very least, to put a stop to this practice, providers can not only take better control of their patient accounts but make commercial payers think twice about the ramifications of potentially engaging in any suspect practices in the future.
NOW LE ASING LUXURY APARTMENT HOMES Med Center Living with Exclusive Shuttle Unique 1 & 2 bedrooms floor plans Walking distance to Hermann Park & The Museum District Immediate freeway access
5755 Almeda Rd. Hou., TX 77004 www.5755HermannPark.com 281.310.5755 March 2019
medicaltimesnews.com
Houston Medical Times
Oncology Research Three Ways to Cut Your Cancer Risk and Take Back Your Health By Michelina Cairo, M.D., Texas Oncology– Houston Memorial City
E
very year we see advancements and promising trends in diagnosing and treating cancer. Already this year, we learned that the death rate from cancer in the U.S. declined steadily over the past 25 years – 27 percent from 1991 to 2016 – according to the reporting from the American Cancer Society (ACS). It’s a hopeful development attributed largely to reductions in smoking, advances in early detection, and treatment breakthroughs. While we can’t control everything about our health, the World Health Organization reports that 30 to 50 percent of all cancers may be preventable. That means there are steps you can take to improve your overall health – and to beat cancer before you have it.
•Be mindful of nutrition and diet and exercise. While cancer deaths overall are declining, obesity-related cancer deaths are on the rise and Texas is leading the way. According to the new ACS data, Texas has the highest rate of cancers due to excess body weight (EBW), with at least one of every 17 cancers in the U.S. attributable to EBW. Managing your weight, eating a balanced diet, and maintaining regular physical activity are all factors in protecting your body. A lifestyle that includes a well-balanced diet full of nutrients that lower the risk of disease is also important for overall well-being and critical to both preventing and fighting cancer. •Eliminate smoking and tobacco use. In its 2019 report, the ACS cites lung cancer as a major cancer type and one of the top three cancers diagnosed in both men and women. Research consistently shows that smoking cessation is paramount to lung health, and smokers who quit are more likely to live a healthier and longer life, while greatly decreasing lung cancer risk.
Page 5
Smok i n g-rel ate d deaths represent 80 percent of lung cancer mortalities. Options for reducing and eliminating tobacco use include nicotine replacements such as patches, gum, inhalers, sprays, and lozenges – as well as resources and tips for starting your cessation journey. Talk to your primary care physician about how to quit, or contact the Quitline, a hotline supported by the Texas Department of State Health Services, by calling 1-877937-7848. •Limit alcohol consumption. While the link between smoking and cancer is common knowledge, patients are sometimes surprised to hear that limiting alcohol consumption also is a significant factor in preventing the disease. Alcohol use is linked to mouth, throat, larynx, pharynx, esophagus, liver, colon, rectum, and breast cancers. Alcohol affects the body’s ability to absorb nutrients, damages body tissue, raises levels of estrogen, which can lead to breast cancer, and contributes to weight gain. When combined with
other factors, such as smoking, the risk of cancer is significantly higher. To decrease this risk, it is recommended that men should limit intake to two drinks per day, and women to one drink a day. As a society, we’re making huge strides in the fight against cancer, but there is much work to be done. While the medical community continues to focus on diagnosis and treatment, you can do your part one small step at a time by taking charge of your own prevention strategy. It’s about making progress, not perfection, and I am encouraged by the recent statistics that show how far we’ve come in reducing cancer-related deaths. Across the Texas Oncology network, we’re proud to celebrate these victories.
ELEGANCE.OPULENCE. ALESSANDR A 1070 Dallas St.
|
Reservations: 866.842.0100
|
hotelalessandra-houston.com
Hotel Alessandra, Downtown Houston’s Newest Luxury Boutique Hotel
Indulging the Senses 223 elegantly appointed rooms and suites Custom Valencia Bed with luxurious lines Complimentary wireless high-speed internet access in all guest rooms and public areas Spa & outdoor swimming pool Fitness Center Ballroom and Meeting Space Complimentary Maserati Car Service within the downtown area, based on availability Lucienne Restaurant, ranked as one of Houston’s top restaurants Bardot Bar
medicaltimesnews.com
March 2019
Houston Medical Times
Page 6
New Technology Your Advantage in a Changing Health Care Market By Mark Johnson President, Xtrii
T
changes, Digital Transformation is occurring in every market, including healthcare, and will create major shifts in the health care industry. Even with these huge changes in motion, some traditional health care organizations will continue to stick their head in the sand and continue with their old ways and the status quo. By the time these market laggards realize the massive impact, if will be too late and they will struggle to survive. Digital Transformation leaders will reshape healthcare and become the new market leaders. We have already seen this transformation in the retail industry, with malls and storefronts being closed, previously dominant brands like Sears, JCPenney, Kmart and others are now struggling to survive, and more innovative players like Amazon are dominating. The same transformation will occur in the health care industry.
he competitive forces in health care continue to grow. Physicians continue to feel the squeeze of lower reimbursements as their operations costs and complexities increase. Entrepreneurial companies have moved into key service areas, such as radiology, lab services, outpatient surgery centers, and other areas that were historically prime revenue sources for hospitals and large health care organizations. National health care organizations are expanding and moving into new markets and threatening local providers. Innovative companies such as Amazon and Google that have an challenges into impressive track record of transforming Turning industries, have stated their plans to opportunities: • A better customer experience: enter the health care market. Rethink the old practices and In addition to those market
create a more frictionless customer experience. Eliminate the paper nightmare, make it easier for patients to get a timely appointment, provide secure, easy access to the patient’s health information, improve patient engagement, and look for innovative ways to stand out by providing a better experience. Properly rethinking your processes and applying the right technology can provide the solution. • Better leverage the experts: Practitioners and smaller organizations can’t afford to hire employees for every need. Leverage the growing trend of hiring seasoned experts to provide that niche expertise as needed. For example, you know you need
the right technology guidance for key decisions but can’t afford to a hire a full-time Chief Technology Officer. Instead, engage a highlyaccomplished, health care technology expert on an as needed basis. You get a better fit, a higher caliber of expertise, and typically the savings is more than $100,000 a year. • David vs. Goliath: How do small organizations compete with the massive organizations? Too many health care organizations tend to be slow moving market-laggards that often get bogged down in a series of committee meetings and internal politics. Be more strategic, see New Technology...page 18
Postdoctoral Certificate in
Neuropsychology Expand your practice through this unique program designed for licensed psychologists who want to extend the scope of their assessment practices and treatment interventions to include neuropsychology. Study with renowned neuropsychologists: Dr. Elkhonon Goldberg, New York, NY Dr. Arnold Purisch, Orange County, CA
CHANGE THE WORLD. START WITH YOURS.
www.Fielding.edu/Neuro March 2019
medicaltimesnews.com
Dr. Elkhonon Goldberg New York, NY
Houston Medical Times
medicaltimesnews.com
Page 7
March 2019
Houston Medical Times
Page 8
Texas A&M Simulates Disaster to Train Students in Emergency Response By Mary Leigh Meyer
T
HOST YOUR NEXT
CONFERENCE
WITH US!
BOOK NOW:
he Texas A&M University Health Science Center conducted Disaster Day, the largest student-led interprofessional emergency response simulation in the country today. Started by the Texas A&M College of Nursing and now in its 11th year, the event is designed to give future health care and public health professionals experience working together in a disaster scenario. The one-day event, which is
disaster management and simulation oversight at Disaster City’s Emergency Operations Training Center. The students had to react to mass “injuries,” with volunteers in makeup portraying victims with various degrees of wounds, from cuts to compound fractures. The volunteers mimicked panicked patients as they screamed, cried and pleaded for help. At the end of each exercise, instructors and other
(281) 334-1000
PLAN YOUR EVENT • Corporate meetings | Training Sessions • Experienced meeting planners • On-Site catering and banquet services • 25,000 square feet of flexible state-of-the-art meeting space
2500 South Shore Blvd. League City, TX 77573
Located halfway between Houston and Galveston, one mile from Kemah Boardwalk
Students seen here in emergency response scenario.
carefully planned and executed by Texas A&M Health Science Center students, with oversight from a faculty and staff steering committee, provides students with critical life-saving skills required in disaster situations. Not only are participants better prepared to respond in real-life emergencies, but they also learn vital skills to practice collaboratively. The event is held at Texas A&M Engineering Extension Service’s (TEEX) Brayton Fire Training Field and Disaster City, a 52-acre mock city that serves as a training facility for our nation’s emergency responders. A new scenario is selected each year and kept secret until event day to provide the realism of an unexpected situation. Last year’s event was a train crash, and this year’s event simulated a chemical explosion and building collapse where nearly 600 students from the Texas A&M College of Medicine, College of Nursing, Irma Lerma Rangel College of Pharmacy, School of Public Health and the College of Veterinary Medicine & Biomedical Sciences engaged in triage at the disaster site, patient care at a mock field hospital and March 2019
medicaltimesnews.com
observers critiqued student teams on their strategy and communication to help improve their skills for a real-life disaster. “Disaster Day is one of the most transformational interprofessional education exercises at Texas A&M, where students from the Health Science Center and College of Veterinary Medicine and Biomedical Sciences—and for the first time this year, the Corps of Cadets—come together for effective management of an emergency situation,” said Carrie L. Byington ’85, MD, vice chancellor for health services at The Texas A&M University System, senior vice president of the Health Science Center and dean of the College of Medicine. “We are grateful to our system partner TEEX for providing this premier facility for our students to learn in a realistic, hands-on environment, where emergency response professionals from across the nation regularly train.” During the simulation, students either act as providers or emergency see Emergency Response...page 17
Houston Medical Times
Healthy Heart Houston Strive to Revive Conference to Provide Latest Resuscitation Science and Guidelines By American Heart Association and Keith Ozenberger
K
eith Ozenberger, Assistant Training Manager at University of Texas Medical Branch (UTMB), spends his days training first responders. He has helped many people achieve their goals in becoming chief officers and leaders in the fire and emergency medical services (EMS) world. But Keith also knows the value of his investment in this work first hand. In July of 2017, Keith and his son went to the National Boy Scout Jamboree in West Virginia. Keith served as an adventure crew leader for this once-every-four-years gathering of Boy Scouts across the country to put their skills to the test with adventure and camaraderie. A few days into their trip, Keith collapsed in cardiac arrest at their campsite. The Jamboree medical teams responded immediately to start resuscitation. Once Keith’s pulse was restored, they transported him to the hospital by helicopter. There, Keith went into cardiac arrest for a second
time, and later a third. He was in cardiogenic shock, supported by several medicines, placed on a ventilator, and had a balloon pump helping his heart work. About a week later, Keith woke up. He had no recollection of his cardiac event or what happened since. Keith’s recovery included relearning basic functions like walking and eating. Just two weeks after collapsing
at the campsite, Keith was discharged from the ICU and dubbed the “miracle man.” When Keith and his family landed in Houston, they were greeted by their second family – the volunteer fire department. Now, Keith can look back and see the role that preparedness played in his survival. He didn’t have to wait
Celebrating
Page 9
on transportation to the hospital for a trained professional to revive him because CPR happened right at the campsite. “Be prepared” may be the Boy Scout’s motto, but the American Heart Association (AHA) encourages every individual to take on the preparedness mindset. Beyond providing extensive Hands-Only CPR training to individuals across the country, the AHA invests in frequent training and updated guidelines for healthcare professionals. Next month, Houston will host the Strive to Revive Conference: Doubling Survival for In- and Out-of-Hospital Cardiac Arrest. Strive to Revive is a professional education workshop that supports r e s u s cit a t i o n efforts and shares the latest knowledge of resuscitation science. The conference will help hospital professionals and EMS partners address process-related gaps in care and learn about the most current resuscitation practices. When medical professionals apply the most up-to-date
evidence-based treatment guidelines, patient outcomes improve. That’s the simple truth behind the AHA’s drive for continuous quality improvement. Our goal is to save more lives by preventing in-hospital cardiac arrest and optimizing outcomes through benchmarking, quality improvement, knowledge translation and research. If you are a physician, nurse, nurse practitioner, respiratory therapist, resuscitation and code team member, EMT, paramedic, quality improvement staff, administrator or other hospital-based staff that interfaces with emergency response, join us at the Strive for Revive Conference on April 12. The conference will be held at the Denton A. Cooley, M.D. & Ralph C. Cooley, D.D.S. University Life Center at 7440 Cambridge St. Houston, TX 77030 from 7:00 a.m. to 4:30 p.m. Keith Ozenberger will share his full story, bringing a face to the importance of our work. Register online now at https:// learn.heart.org/activity/6691480/detail. aspx. The cost is $30 and parking at the event is $10. Upon completion of the event, 7.25 continuing medical education hours will be awarded. We hope to see you there!
Over 30 Years in Texas!
Featured Home 3619 Somerset York Lane in Somerset Green 713-465-4205 4 Stories n 3 Bed 3.5 Bath n 3,185 sqft Reduced Price: $889,000
98% Customer Recommended Flexible Floor Plans
n n
Nationally Recognized Energy Program 10 Year Structural Warranty
Build On Your Lot Program
New homes from the low $200s
Built Around You
Prices and availability subject to change without notice.
medicaltimesnews.com
March 2019
Houston Medical Times
Page 10
Physician Trends to Watch in 2019 By Jennifer Larson Merritt Hawkins
N
o one can say definitively what’s going to happen with the practice of medicine this year. Yet industry experts expect some ongoing trends and other phenomena have the potential to affect how healthcare is provided both now and in the future. They will also affect how individual physicians go about their jobs. Check out these healthcare trends, technology advances and disruptions that may change the way you work in 2019 and beyond. 8 healthcare trends to watch this year 1. Burnout will continue to be a problem. Not surprisingly, experts forecast physician burnout as an ongoing problem in 2019. In fact, a new report from the Massachusetts Medical Society, the Massachusetts Health & Hospital Association, and the Harvard T.H. Chan School of Public Health calls it a “public health crisis.” The 2018 Survey of America’s Physicians, conducted by Merritt Hawkins on behalf of The Physicians Foundation, found that 78 percent of physicians sometimes, often or always have feelings of burnout. The burnout rate
is higher for female physicians than for males; 84.8 percent vs. 74.1 percent. Burnout and job dissatisfaction can cause physicians to cut back on hours or get out of direct patient care altogether, which affects patient access and puts additional strain on clinicians who remain. 2. Doctors will join start-ups. Looking for something new—really new? This could be the year you join some of your colleagues in finding a start-up that could use your skills and education. Preventive medicine physician Sylvie Stacy, MD, MPH, has been watching as job postings for physicians with start-ups have grown, often in the digital health arena. “Since many of the technologies are so closely intertwined with healthcare delivery and disease management, there will be an increasing need for physicians,” she predicted. 3. More states will join the Interstate Medical Licensure Compact. It just got easier to practice medicine in multiple states. Michigan became the 25th state to enact the Interstate Medical Licensure Compact (IMLC) on December 31, when the state’s governor signed the legislation. The District of Columbia and Guam
Call 713-600-9500 for a free assessment, 24/7.
also participate in the compact, bringing the total participants to 27. That number could grow again in 2019, as the Federation of State Medical Boards reports that Kentucky, New Mexico, and South Carolina are considering an initiative to join the compact. 4. Consolidations will continue. A growing number of physician practices have been sold to larger healthcare systems in recent years, and consolidations, mergers and acquisitions will continue in 2019. When this happens, some physicians may feel relieved to relinquish the burden of practice management, while others are less excited about losing their independence. “We are seeing many venture capital firms purchasing physician groups along with larger health systems,” said
Shawn Yates, director of healthcare product management for Ontario Systems. “This will drive out the smaller physician groups and force them to change their focus and develop partnerships.” 5. More emphasis will be placed on interprofessional collaboration. Team-based care models aren’t going away. “With greater emphasis on holistic care known as patient-centered care for the last few years, it will be paramount going forward,” predicted Ankita Sagar, MD, MPH, a primary care physician with Northwell Health. (RELATED: 5 Things Doctors Can Learn from Nurses) 6. We’ll feel the Amazon and Apple effect. Keep an eye out for changes that may develop from
Your provider of choice
Behavioral health and substance use treatment We offer: • Services for Adolescents, Adults and Seniors • Exclusively women program • Detoxification • Outpatient services for adults - Intensive Outpatient Program - Partial Hospitalization Program
Physicians are on the medical staff of Behavioral Hospital of Bellaire but, with limited exceptions, are independent practitioners who are not employees or agents of Behavioral Hospital of Bellaire. The facility shall not be liable for actions or treatments provided by physicians. Model representations of real patients are shown. Actual patients cannot be divulged due to HIPAA regulations. 162038 6/16
March 2019
see Physician Trends... page 17
medicaltimesnews.com
Houston Medical Times
medicaltimesnews.com
Page 11
March 2019
Houston Medical Times
Page 12
Financial Forecast Financial Independence Starts with a Solid Income Stability Ratio By Grace S. Yung CFP Managing Director Midtown Financial Group
R
egardless of how long you’ve been investing, it’s likely that you have been focusing on returns. Throughout the years, investors have been “trained” by financial “experts” to equate asset accumulation to climbing a mountain, and that getting to the top (i.e., meeting your savings goal) is the end of the journey. But in reality, getting to the top is only half way there, because when you’ve reached retirement, you’ll need a secure income to last the rest of your life. Keeping the Three Legged Stool in Balance Years ago, many retirees counted on income from three primary sources: pensions, Social Security, and personal savings. These are oftentimes referred to as the “three legged stool.” With a defined benefit pension,
retirees could rely on a set amount of income, typically for the remainder of their lifetime. (And sometimes, that income continued for a surviving spouse). Social Security was another source of income. When this program was started in 1935, there were over 40 workers paying into the system for every one retiree collecting benefits.1 This isn’t so anymore. In the past, income that was generated from personal savings was oftentimes just icing on the cake. Plus, because life expectancy was shorter several decades ago, these income sources didn’t have to last very long.
But today it’s a different story.
Defined benefit plans have all but disappeared. And Social Security is facing dire challenges. So today, it’s more important than ever to have enough personal savings and investments to get you through. Generating Future Income You Need There are many methods of generating income in retirement. These include interest and dividends,
annuities, and rental real estate. But just like with your savings plan, ensuring you have enough, for as long as you need it, requires planning. For instance, you must have income you can count on, no matter how long you live. In addition, you need to ensure that your principal is protected, and that you are able to be tax-efficient. Financial advisors who specialize in income planning may initially determine your income stability ratio. This is a proprietary calculation from financial planning software 2 that measures the percentage of retirement income being generated from known or guaranteed sources, versus the percentage of income that is dependent on market performance. As an example, if you need $10,000 per month to spend in retirement, and you have an 80% income stability ratio, that means 80% of your monthly income – or $8,000 – is guaranteed, and 20% of your income
is dependent on other sources that may be volatile or uncertain. So, if a market downturn is experienced, you can still count on 80% of your income. Here, the higher your income stability ratio is, the more guarantee you’ll have with regard to income – and that can equate into a more stress-free financial future. Taking the Next Step Unfortunately, those who aren’t familiar with how to protect and guarantee their incomes are oftentimes the ones who end up taking the most risk with their savings, and in turn, putting the most pressure on their see Financial Forecast...page 18
& LIVE. WALK. SHOP. DINE.
HANOVER SOUTHAMPTON
HANOVER RICE VILLAGE
Two of Hanover Company’s Finest Luxury Apartments in the Heart of Rice Village March 2019
HanoverRiceVillage.com HanoverSouthampton.com
medicaltimesnews.com
888.788.9843
Houston Medical Times
Page 13
MOTHER. SISTER. FRIEND. It’s time to stand together. Up to 80 percent of cardiac events can be prevented, and together we can save the lives of the mothers, sisters and friends we love. Join us as at a Houston-area Go Red for Women Luncheon near you.
NORTHWEST HARRIS COUNTY Friday, May 3
HOUSTON Friday, May 17
medicaltimesnews.com
MONTGOMERY COUNTY Friday, May 23
March 2019
Page 14
Houston Medical Times
Charitable Giving Directly Benefits the Texas Medical Center By Elizabeth Biar
B
y the year 2024, it is expected that 3.1 Million nurses will be needed in the U.S. That is a 16% increase according to the Bureau of Labor Statistics. In Texas, the demand will be even higher, with an expectation that we will need 50% more nurses in 2030. The good news is that there are schools and programs available to help fulfill this need. One such organization is the Good Samaritan Foundation. Founded in 1951, the Foundation has been one of the largest providers of grants and scholarships to nursing students in the state of Texas. The organization has a long history with the Texas Medical Center, and in 1961, it was a driving force behind the creation of Texas Woman’s University College of Nursing, the first nursing school in Houston. Today, the organization continues to be a leader in the nursing field providing over $450,000 in scholarships, grants and awards annually. Nursing students can use the scholarship money toward books and living expenses, not just tuition. The Foundation strives to cut out the overhead costs and middlemen by directly giving the scholarships to the students. With only one full-time staff member at the Good Samaritan Foundation, approximately 85% of donations go directly to student scholarships and nursing school grants. If you are interested in contributing to the Good Samaritan Foundation, or any philanthropic organization, here are some tips.
March 2019
medicaltimesnews.com
First, when considering donating to charity, identify what needs are most important to you and focus on a few organizations that fulfill those needs. There are many charities within the Houston area that provide valuable services and satisfy the varied needs of our community. Do your research to see which non-profit organizations will accomplish your desired goals. Once you have decided where to contribute your money, determine which financial route is best for you. There are several ways in which to contribute f i n a n c i a l l y. The first way is through a one-time contribution via cash, check, or credit card. The donation may be given through an annual capital campaign, or simply a cash contribution given at any time. By contributing to a qualified organization, you may be able to deduct that amount from your federal income tax, if you itemize deductions. The contribution is deductible in the same year it is made. For a 2019 deduction, the gift must be made by the end of this year and can be either by check or credit card. Check with your tax professional for specific guidance. Another way to contribute to a non-profit organization is through your Will as a bequest or through a life insurance policy naming the charity as the beneficiary. You may be able to receive an estate tax charitable deduction for that portion of the benefit going to the charity. You may also set up a charitable trust. Work with your financial advisor and a tax professional to determine the best option for you. Whether donating to a charity located in Houston such as the Good Samaritan Foundation, or an organization with a larger national presence, there are numerous options for charitable giving. Do your research so you may make a difference in the lives of others. ď ľ
Houston Medical Times
Page 15
There is no wrong way to take a CME ethics course. FEATURED COURSES
ADDRESSING ACEs: Learn how to identify, treat and reduce the effects of trauma and toxic stress and reinforce resiliency in young patients. Earn ethics CME.
INTERPERSONAL YOUTH VIOLENCE: Implement proven strategies to identify, intervene in and prevent behaviors such as bullying, self-injury and suicide, dating violence and sexting.
Join more than 100,000 medical professionals who get free CME with Texas Health Steps Online Provider Education. Choose from a wide range of courses relevant to your practice, including short tutorials and podcasts on topics like Medicaid guidelines, ethics and mental health — all available 24/7. Learn more at TXHealthSteps.com.
PRECONCEPTION AND PRENATAL HEALTH: Integrate best practices for preconception health care and counseling into preventive medical checkups.
Content on Texas Health Steps Online Provider Education website has been accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council for Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy of Nutrition and Dietetics, Texas Academy of Audiology, and the International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for some online content.
medicaltimesnews.com
March 2019
Houston Medical Times
Page 16
Time for a Talk About Vaping? By Patrick Wascovich
W Dear Doctors and Staff, Let us take the guesswork out of fracture referrals. No more waiting for appointments! We at the Orthopedic Care Center wish to offer your patients and staff easy scheduling of patients. Our office has extended office hours on Fridays to accommodate patients with fractures. On behalf of the Orthopedic Care Center
Lubor Jarolimek M.D.
ORTHOPEDIC CARE CENTER 2121 OAKDALE HOUSTON, TX 77004
Call us today! OCC_FractureFridaysFA3_Outlined.indd 1
5/29/2013 7:20:41 PM
FITNESS. CONFIDENCE.
MOTIVATION.
At Marine Military Academy, we work hard ... and play hard! Make the most of your son’s summer and send him to our four-week summer camp. Every day, he’ll participate in challenging but exciting military activities and sports that build his fitness, confidence and drive! Boys from across the nation and around the world line up for MMA Summer Camp! Space is limited, but your son is NOT. Register him today!
MMA 2019 SUMMER CAMP FOR BOYS 11-18 »» JUNE 29 – JULY 27 MMA-TX.ORG/SUMMERCAMP »» 956.423.6006 MMA »» A College-Prep Boarding School for Boys in Grades 7-12 »» 320 Iwo Jima Blvd. »» Harlingen, TX 78550 March 2019
ith new findings that show an unprecedented jump in nicotine-containing electronic cigarette usage among teens, many parents wonder how best to approach the topic. “The important thing is to have a nonemotional action that has consequence for the using adolescent,” says psychiatrist Dr. David Atkinson, an addiction specialist at UT Southwestern Medical Center. “Action is more important than explanation, and emotion can actually be counterproductive. Parents should destroy the device the teen is vaping with, flush all of the nicotine that they have, and let their child know that will be their action in the future should it recur.” Dr. Atkinson says that discovering bad behavior by your teen calls for an educative and strategic tact. First, concerned parents need to educate themselves about vaping devices, which are easier to hide and can resemble computer flash drives. “Parents should familiarize themselves with the packaging from pods and other nicotine tanks, and I believe that a teen’s cash flow should be watched carefully,” Dr. Atkinson says. “There’s also send-out tests for metabolites that detect whether they are vaping or smoking combustible [regular] cigarettes.” New data from Centers for
Disease Control and Prevention found that more than 1 in 4 high school students and about 1 in 14 middle school students in 2018 had used a tobacco product in the past 30 days. This was a considerable increase from 2017, which was driven by an increase in e-cigarette use. E-cigarette use increased from 11.7 to 20.8 percent among high school students and from 3.3 to 4.9 percent among middle school students from 2017 to 2018. A National Institutes of Health-supported study found that twice as many high school students used e-cigarettes last year compared with 2017, and 1 in every 5 participating seniors reported having vaped nicotine at least once in the previous month – the largest single-year increase in the University of Michigan-based survey’s 44-year history, surpassing a mid-1970s surge in marijuana smoking. The same report found that marijuana usage has largely remained level over the past few years and that more teens are saying “No” to many other illegal and harmful substances, including alcohol, cigarettes, cocaine, LSD, ecstasy, heroin, and opioid pills.
TAILOR YOUR CAREER WITH THIS UNIQUE PROGRAM!
BIOSCIENCE AND HEALTH POLICY
FALL ENROLLMENT STILL OPEN
profms.rice.edu RICE UNIVERSITY | HOUSTON, TEXAS
medicaltimesnews.com
Houston Medical Times
Mental Health
Continued from page 3 and executive director of UTHealth HCPC. With a focus on reducing rapid readmissions (those within 30 days) and improving outcomes for super users (those with four or more stays per year), this new campus should reduce the pressure on hospital emergency centers and the Harris County Jail, which has become the
Emergency Response
Continued from page 8 management officials. As each team is interprofessional, students can gain a greater perspective on how different health professions collaborate. In collaboration with all of the people and groups required to make an event of this scale happen, the Health Science Center’s Office of Interprofessional Education & Research leads the committee that guides the production of Disaster Day, as its function is to promote and support collaboration across health disciplines. “Although part of our students’ education occurs in the same room and the same simulated experience as students in other professions, what we really want to do is change the way our graduates think about team medicine and how they approach and embrace the concept of the team approach,” said Regina Bentley, EdD, MSN, RN, CNE, assistant vice chancellor for health services at The Texas A&M University System and clinical associate professor at the College of Nursing. “When health sciences students train along side each other, they directly see the value that each discipline is bringing to the table,” added Christine Kaunas, MPH, executive director
Physician Trends Continued from page 10
Amazon’s entrance into the healthcare arena, Yates added. Amazon has already purchased an internet pharmacy, launched its own private label brand of OTC healthcare products called Basic Care, and collaborated with J.P. Morgan and Berkshire Hathaway to establish an employer health coalition. And watch for more innovations in mobile fitness apps and chronic disease
Page 17
de facto regional behavioral health care provider, currently housing more psychiatric patients than all of the state hospitals combined. Harris County Judge Ed Emmett, the Harris County commissioners, Houston Mayor Sylvester Turner, and Houston City Council members strongly supported funding for this needed infrastructure. “The continuum model will be designed to address not only different levels of care but also to integrate the different types of care individuals need, including psychiatric, substance abuse,
and medical care. The continuum will allow the Department of Psychiatry and Behavioral Sciences to continue its research into the causes and treatment of behavioral health issues and to expand its training of the next generation of healers,” Soares said. The new Continuum of Care Campus building, which will be constructed on what is now a parking lot adjacent to UTHealth HCPC, will incorporate the latest design concepts for a behavioral health facility. “Bringing together experts in
neuroscience and architecture, the building will be specifically designed and finely tuned to the unique needs of our patient population,” said Steve Glazier, COO of UTHealth HCPC. “Our intention is to create an environment that promotes safety for both patients and staff, helps to reduce stress and anxiety, and enables patients to maintain their privacy and dignity.”
of interprofessional education and research. “We see that team-based, emergency response training provides for better and safer health outcomes.” These students act as first responders during emergency situations across the country after they graduate, which makes the training provided by Disaster Day irreplaceable. “Training for emergency situations is imperative,” said Corey Authement, College of Nursing student and training director for this year’s Disaster Day. “When you have multiple groups responding to an incident, the interprofessional aspect really comes into play. This interprofessional training is important to be able to respond appropriately in the future.” Nicole Mancuso, a graduate of the College of Nursing, can attest to this. She was working in a Las Vegas emergency room during the mass shooting on the Las Vegas strip in October 2017. “It was probably the worst thing I have ever seen in my life, and I hope I never have to see it again,” Mancuso said. She credits her training of the College of Nursing, can attest to this. She was working in a Las Vegas emergency room during the mass shooting on the Las Vegas strip in October 2017. “It was probably the worst thing I have ever seen in my life, and I hope I never have to see it again,” Mancuso said. She credits her training
at the college and involvement in Disaster Day for teaching her how to appropriately triage and treat patients in mass casualty scenarios. “Having the knowledge of triaging really helped to know who needs more time from me and who is okay in comparison. What I learned at the college built my initial skills to become an emergency room nurse.” This year, emergency response professionals from both Germany and England traveled to observe the scenario and gain insight into how they could bring some of the concepts back to their countries. Members of the Texas State Guard also participated, training members of the Texas A&M Corps of Cadets in extraction procedures for the “injured.” H-E-B’s director of emergency preparedness, Justen Noakes, led a team from their headquarters in San Antonio. His staff served breakfast and lunch to simulation participants from their mobile cooking facility, one of the several H-E-B deploys during real disasters such as Hurricane Harvey. “Disaster Day is a unique opportunity for students to gain firsthand experience in emergency response, conducting duties that are usually entrusted to health care and emergency officials,” Kaunas added. “With interprofessional collaboration, hundreds of students understand how
they can conduct disaster response when lives are at stake while building critical thinking and teamwork abilities.” “Often health care providers compartamentalize themselves— they identify as nurses, as physicians as pharmacists as public health professionals—and do not communicate with each other,” added Charles Borrego, College of Nursing student and incident commander of this year’s Disaster Day. “So starting an interprofessional education early in the learning process helps to break down the compartments and open lines of communication.” Creating an event of this magnitude necessitates a great amount of support. Generous sponsors for the one-day mock disaster included the colleges of medicine, nursing, pharmacy and public health, the Association of Former Students and H-E-B. “I am so proud of all the students, faculty and staff who plan and execute these extraordinary scenarios each year with the goal of providing transformational education to our health students,” Texas A&M University President Michael K. Young said. “It is experiences like this that ensure our graduates who go on to careers in the health field are well prepared for its many challenges and rewards.”
management; Apple has hired about 50 physicians in recent months as the tech giant expands their reach into healthcare, too.
the care of millions of people around the country due to lack of protection for pre-existing conditions, coverage for basic healthcare and screening needs, and decreased funding for Medicaid plans,” said Sagar. “This would be practice-changing because as a physician caring for patients with Medicaid and complex illnesses, I see many patients requiring these protections.”
to its list of Medicare-approved telehealth services for reimbursement. (Learn more about the five new Current Procedural Terminology (CPT) codes and other information included in the final version of the 2019 Physician Fee Schedule and Quality Payment Program.) CMS could do that again in 2019, which would enable providers to receive reimbursement for services using virtual technology. It’s easier to provide services via telemedicine if you’re getting paid to offer them.
7. The ACA’s future hangs in the balance. In December 2018, a federal judge in Texas ruled that the Affordable Care Act was unconstitutional. But a group of attorneys general appealed the ruling, which could eventually send the landmark healthcare legislation to the Supreme Court again. The Texas judge has allowed the law to remain in effect while under appeal. “If the ACA loses its appeal, this could affect
8. Telemedicine opportunities will expand. Last year, the Centers for Medicare and Medicaid Services (CMS) proposed adding more services
medicaltimesnews.com
March 2019
Page 18
Manhattan Project
Continued from page 1 17 investigators and nine scientific teams to launch a Neurodegenerative Challenge Network. This brings together scientists from diverse fields biochemistry, genetics, neuropathology and computational science - who are taking a broad view of the disease by exploring multiple underlying causes of neurodegenerative diseases, even while researchers at CAND focus primarily on tau. The challenge is growing more urgent. Alzheimer’s is a defining medical problem of our generation. More than five million Americans are now afflicted, and that number is expected to reach nearly 14 million by 2050 – threatening to overwhelm an already stressed health care system. With support from the Chan Zuckerberg Initiative, we have integrated research across multiple different labs to try to develop a logical system to classify the various subtypes of neurodegenerative diseases linked to tau. This system is rooted in linking the three-dimensional structure of a single tau protein to its cellular effects,
New Technology
Continued from page 6 nimble, decisive, and timely than your competitors, and fully leverage technology opportunities and digital transformation to your advantage. Keys to success: Take the right actions now. The lost time and expenses incurred for the wrong plan of action can be devasting. Taking no action will be even more devasting. Success starts with tapping the right expertise and leadership. Know your
Financial Forecast
Continued from page 12 portfolios…and themselves! Because not everyone has the same retirement income needs, it’s important that you work with a financial advisor who can guide you through the process of protecting your March 2019
Houston Medical Times
and correlating specific structures with particular patterns of pathology. One day we hope to extract tiny amounts of critical proteins from blood, or spinal fluid that bathes the brain, to predict the onset of specific diseases, and then intervene with a personalized treatment before damage is done. We seek a “personalized” approach to diagnosis based on protein structure. This is analogous to how genetic information is now used to classify cancer. We hope to use this framework to identify patients at risk, so that we can monitor their responses to treatment, and ultimately, to decide who will benefit most from specific interventions. This ambitious plan will require sophisticated new tools to study protein structure, to analyze brain tissues, and to facilitate translation of these ideas to the clinic, all in close collaboration across very disparate scientific disciplines. We must continue to fund basic research While we think targeting tau aggregation and its spread through the brain is the best way to treat disease, it is unlikely to be the only effective one. New therapies are now making their way through clinical trials. These include drugs that turn off the tau gene
strengths and engage the right subject matter expert to guide you through these changing times and augment your business. While you may be the top medical expert in your field, don’t go it alone and make the mistake of trying to be the expert for everything. Missteps can very costly, and it’s vital to know when you should tap a local technology expert, a marketing expert or other professionals to ensure you are making the right investments and are executing the optimal plan.
and block the protein’s production. Multiple trials are using the body’s immune system to attack A-beta and tau proteins, and new biological information about how tau and A-beta cause pathology within cells may lead to complementary strategies. Vigorous efforts such as the Chan Zuckerberg Initiative are providing a critical boost at a time when some pharmaceutical companies have scaled back research into brain disorders. This means that support from the federal government remains indispensable. The National Institutes of Health has tripled its annual budget for research into Alzheimer’s and related dementias since 2014, reaching $1.9 billion in the last fiscal year. I can’t predict when we will have a treatment for Alzheimer’s. But I am confident that when it happens it will be based on discoveries made in academic research laboratories, just as scientists in previous generations produced vaccines for polio and effective drugs for HIV and hepatitis C. A vaccine for Alzheimer’s? Gene editing seemed like science fiction 25 years ago, but now it’s being used to save lives. By shifting the paradigm on Alzheimer’s research, treatments for neurodegenerative diseases can also become reality.
impact to increase. Be a transformation leader and take the right, decisive actions to turn these changes into your advantage. Mark Johnson is a global technology leader that has advised and led the top healthcare organizations for more than 30 years. He currently serves as President of Xtrii, www.Xtrii.com. To see more of Mark’s technology tips and insights, visit www.Xtrii.com.
Health care is going through a time of significant change, and digital transformation will cause the pace and
savings and converting an appropriate Table IV.B2. www.ssa.gov percentage into a stable income stream. 2. RetireUp Pro software. Grace S. Yung, CFP® Managing Director & Wealth Advisor Midtown Financial Group, LLC Securities and advisory services offered through LPL Financial, a Registered Investment Advisor. Member FINRA / SIPC.
The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.
Sources 1. 2012 OASDI Trustee Report, medicaltimesnews.com
HOUSTON
Published by Texas Healthcare Media Group Inc. Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Robert Cox Accounting Liz Thachar Office: 713-885-3808 Fax: 281-316-9403 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com
Houston Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Houston Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Houston Medical Times are considered property and are to distribute for publication and copyright purposes. Houston Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430
Houston Medical Times
Page 19
Looking to avoid risk?
WE CAN SHOW YOU THE WAY. We’re taking the mal out of malpractice insurance. Thanks to our national scope, regional experts, and data-driven insights, we’re uniquely positioned to spot trends early. We shine a light on risks that others can’t see, letting you focus on caring for patients instead of defending your practice. It’s a stronger vision that creates malpractice insurance without the mal. Join us at thedoctors.com
5771_TX_HoustonMedTimes_ORM_Nov2016_f.indd 1
medicaltimesnews.com
10/19/16 12:25 PM
March 2019
Houston Medical Times
cookiedelivery.com
Warm cookies, baked-to-order, delivered to your door. cookiedelivery.com
medicaltimesnews.com