Houston Medical Times

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Legal Matters pg.3

Oncology Research pg.5

Mental Health pg.6

Healthy Heart pg.9

Financial Forecast pg.11

Mental Health Providers: Balancing Privacy with Public Welfare

By

As reported by the national media on an almost daily basis, a large sector of the population has experienced heightened tensions related to disruptions in employment, personal finances, health, family turmoil, and a plethora of other significant concerns caused by the pandemic. These tensions have adversely affected our already overburdened mental health resources and resulted in unexpected consequences for healthcare providers.

Since the spring of 2020, therapists have been faced with addressing uncommon clinical presentations and managing critical situations that go well beyond treating routine, isolated issues. With increasing frequency, patients report ideation of harm, including self-harm, “suicide by cop,” community violence involving serial or mass killings, and random acts of assault or homicide.

These types of encounters create a perilous moral dilemma for mental health providers: how to maintain provider-patient privilege, consistent with their ethical duties to patients and federal and state privacy laws, while adhering to legal reporting obligations that require healthcare providers to reveal certain confidential circumstances to law enforcement to protect the public welfare.

Protection and Release of Health Information

Congress passed HIPAA in 1996. One of its stated goals is to help

protect the privacy and security of patient health information in a variety of categories. The federal government has enacted comprehensive rules governing the use, access, and release

patient confidentiality. Ordinarily, third-party access to PHI requires patient authorization or a court order. Exceptions include government agencies with oversight duties, coroners’ offices, circumstances involving imminent danger to public health or welfare, and other specified outliers.

of protected health information (PHI), including exceptions and significant monetary and administrative penalties for statutory violations. The Office for Civil Rights is responsible for investigating data breaches and enforcing HIPAA’s privacy and security rules.

Subsequently, state legislatures have followed suit and enacted similar—and often more restrictive— regulatory measures designed to protect

The HIPAA FAQs for Professionals states: “The HIPAA Privacy Rule permits a covered entity [such as a mental health provider] to disclose PHI, including psychotherapy notes, when the covered entity [such as the mental health provider] has a good faith belief that the disclosure: (1) is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others and (2) is to a person(s) reasonably able to prevent or lessen the threat.” It may include disclosure to law enforcement, members of the family, or even the target of the threat, depending on the circumstances presented and consistent with applicable law and the

Richard F. Cahill, JD, Vice President and Associate General Counsel, and Robert Morton, MAS, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management The Doctors Company

With increasing frequency, patients report ideation of harm, including self-harm, “suicide by cop,” community violence involving serial or mass killings, and random acts of assault or homicide.

American Heart Association® Heart Challenge

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The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity each week. You can knock that out in just 30 minutes a day, 5 days a week. Too much sitting and other sedentary activities can increase your risk of heart disease and stroke. Plus, regular activity can help you to think, feel and sleep better and perform daily tasks more easily.

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Legal Matters

Avoiding Beneficiary Inducement Trouble When Providing Self-Monitoring Technology to Patients

By Stephen M. Angelette, J.D. Shelby D. Zumwalt, J.D. Polsinelli, PC

More and more patients are taking advantage of wearable devices to allow their healthcare providers in gaining insight on their care, whether monitoring heart rate, glucose, stress, or weight. Some providers would like to provide patients with this wearable technology for no charge to assist in their care. But this approach has historically been limited by federal regulations related to beneficiary inducement.

any person who offers or transfers any remuneration to a Medicare or Medicaid beneficiary that the person knows or should know is likely to influence the beneficiary’s selection of a provider, or supplier of any item or service reimbursed by Medicare or Medicaid. The BIP defines “remuneration” to include any transfer of value, including items or services for free or less than fair market value. In the Affordable Care Act (“ACA”), Congress created several exceptions to the BIP. Relevant here, the ACA created an exception that permits remuneration to a beneficiary if the remuneration meets two elements: the remuneration (1) promotes access to care and (2) poses low risk of harm to patients or to Federal health care programs. This exception is commonly referred to as the “Access to Care Exception.”

In 2016, the OIG issued a regulation interpreting the Access to Care Exception and its elements. In

to require that the remuneration “promotes” access to care by “improving a particular beneficiary’s… ability to obtain items and services payable by Medicare or a State health care program.” This includes providing patients with tools to remove socioeconomic, educational, geographic, mobility, or other barriers to accessing care. The OIG specifically noted that “[S]martphone apps or low-cost fitness trackers could, depending on the circumstances, promote access to care.” The OIG also explained that permissible remuneration “removes an impediment or otherwise facilitates compliance

interpreted the “poses low risk of harm” element to require that the remuneration (1) be unlikely interfere with, or skew, clinical decision making; (2) be unlikely to increase costs to Federal health care programs or beneficiaries through overutilization or inappropriate utilization; and (3) not raise patient-safety or quality-of-care concerns. Regarding overutilization and increased costs, the OIG explained there may be an increase in costs due to an increased access to care, but the concern is where remuneration would increase cost through overutilization or inappropriate utilization such as access to a higher level of care than necessary.

By Amy McCraig

More than 6 million Americans are living with Alzheimer’s disease, for which there is no cure. Early detection is critical to managing symptoms.

A new research project led by Rice University cognitive neuroscientist Stephanie Leal will focus on improving early detection methods through the use of highly sensitive memory tasks and brain imaging — which someday may even lead to a cure.

“Rather than treating the symptoms of Alzheimer’s disease, at which point the damage done to the brain may be irreversible, we are hoping

to understand the earliest cognitive and brain changes, which should get us closer to determining the cause of the disease,” Leal said.

Researchers have begun to zero in on which regions of the brain should be examined for possible signs of Alzheimer’s decades before symptom onset. However, Leal said research has not previously used memory tasks sensitive enough to detect the earliest changes in memory that could be a symptom.

“Even in cognitively normal older adults that don’t have clinical symptoms of Alzheimer’s disease, we can still pick up on these memory deficits that are happening and may

just seem like normal aging to the individual or their family and friends,” Leal said.

Highly sensitive neuroimaging ( MRI and PET scans) is used to examine extremely small regions of the brain that are critical to memory and are impacted before symptoms develop. The technology has only recently evolved to the point that viewing these regions is possible, Leal said, and

pairing it with the sensitive memory tasks could provide warning of future onset of Alzheimer’s early enough to improve long-term outcomes.

The research is funded by a grant from the BrightFocus Foundation. More information is available online at https://science.brightfocus.org/ alzheimers-disease-research/grant/ more-sensitive-measures-towards-earlydetection-alzheimers.

Oncology Research

By Vipal Pratin Durkal, M.D., Texas Oncology–Houston Medical Center

answer is YES!

The importance of healthy eating when fighting cancer

Proper nutrition plays a vital role during cancer treatment. What you eat before, during, and after treatment is important to maintain strength, lower the risk of infection, and allow the body to repair itself.

The holiday season is quickly approaching and food is often at the center of celebrations. While many look forward to tables covered in extravagant main courses, sweet desserts, and festive drinks, these gatherings can be challenging for those who are fighting cancer.

With so many rich and calorie-filled foods at the table, is it possible for cancer patients to prioritize their nutritional health needs while also enjoying their favorite holiday food traditions? Is it possible to provide a bountiful table that accommodates the needs of all our loved ones? The

Dietary recommendations for patients undergoing treatment include:

• Eat plenty of lean proteins and calories to help the body repair tissue.

• Incorporate “good fats,” such as those found in vegetable oils and seafood, which help the body protect tissue and carry vitamins through the bloodstream.

• Consume nutrient-rich carbohydrates, such as fruits, vegetables, and whole grains, which supply energy and promote organ health.

• Drink plenty of water to keep the body hydrated for proper cell function.

Following a healthy eating plan is not always easy when going through treatment. Some patients have difficulty eating or digesting foods, or experience other obstacles such as appetite loss, dry mouth, changes in the taste or smell of foods, sore mouth and throat, nausea, diarrhea or constipation. How to maintain balanced nutrition during the holidays

While the holidays present more opportunities to veer away from a healthy diet, it is still feasible to include balance into holiday cooking and dining. Whether you are a cancer patient or hosting a loved one undergoing treatment, here are ways to optimize seasonal dishes to support

proper nutrition:

• Include fresh rather than processed foods. Salads with seasonal ingredients, fresh vegetable and fruit trays are a great option; one important exception is if you have been asked to follow neutropenic precautions.

• Consume whole grain breads instead of processed rolls or biscuits.

• Choose lean proteins, such as chicken or fish, rather than red meats, like steak or pork.

• Limit or avoid alcohol intake; alternate at least one serving

Mental Health Early Alcohol Use Predicts College Students’ Polysubstance Use Findings Support Individualized Approach to Intervention Programs for College Students

By Dorian Martin

recently published in the Journal of American College Health found college students who were introduced to alcohol before the age of 14 were more likely to use multiple substances—such as alcohol, cannabis, opioids, stimulants or other illicit drugs—at the same time. Texas A&M University School of Public Health’s Benjamin Montemayor, PhD, and Adam Barry, PhD, co-authored the study.

Astudy

College students and their peers between 18-22 years of age use substances at some of the highest rates of all populations—and polysubstance use, which involves using multiple substances such as alcohol and stimulants at the same time, can be especially dangerous

due to their oppositional effects. Depending on the substances taken in unison, drugs used recreationally do not usually cancel each other out but rather amplify the other substances effects. Alcohol, a central nervous system depressant, mixed with a stimulant, a substance that increases activity in central nervous system, can cause some to drink more than they normally would.

“You’re asking your body to adapt to not just alcohol, but alcohol and another psychoactive substance, such as a stimulant or narcotic,” said Montemayor, a visiting assistant professor in the Department of Health Behavior. “By using stimulants, you bypass functions in the body that naturally let your body know it’s time to slow down because that stimulant may be telling your body that you can

continue to drink.”

Predictors of polysubstance use

The Texas A&M researchers worked with Melody Noland, PhD, of the University of Kentucky to analyze data from 822 students who violated their university’s alcohol policy between October 2019 and July 2021. This study was designed as a baseline assessment to facilitate better understanding of alcohol, drug and polysubstance use before developing appropriate intervention programs.

The researchers initially looked at predictors of these college students’

alcohol use and found that a top predictor was age-of-onset, which is the age at which the student first consumed alcohol. The study also identified four additional predictors of a student’s alcohol use: being male, being white, being affiliated with a Greek organization on campus, and having an inflated perception that more people are using alcohol than really are.

The researchers then analyzed the data for polysubstance use. They

Study Finds Grandmaternal High-fat Diet can Impair Social Behavior in Descendants

Hospital What a grandmother ate can affect a grandchild’s brain development according to a new study performed on mice.

New research from investigators at the University of Texas Medical Branch finds that adverse effects of maternal high-fat diet on brain development and related disorders, including autism spectrum disorder, could carry over to a second generation of descendants. In essence, grandmaternal diets could impact brain development and behavior in their grandchildren. The study was published today in Cell Reports.

“Our study focused on the impact of high-fat diet exposure in the maternal lineage on behavioral outcomes associated with

the grandmaternal mice were fed either a control or high-fat diet. Diet-driven loss of microbial richness observed in the grandmaternal females, and their first-generation offspring was partially recovered by the second descendant generation, yet social deficits akin to those in the first descendant generation remained evident in the second.

“These data suggested that disruption of the maternal gut microbiome, instead of that of the juvenile offspring, could be the culprit underlying abnormal social behavior in the descendant generations,” said study co-first author and recent UTMB Neuroscience Graduate Program doctoral graduate, Claudia Di Gesù.

“This study identifies a

neurodevelopmental disorders in descendant generations,” said Shelly A. Buffington, assistant professor in the Department of Neurobiology and faculty in the Sealy Center for Microbiome Research at UTMB. “Remarkably, we found that a high fat grandmaternal diet has the potential to impact neurodevelopment and long-term behavioral outcomes across multiple descendant generations.”

This new study builds on findings from Buffington’s previous study demonstrating the effects of maternal high-fat diet on offspring brain plasticity and social behavior published in Cell in 2016.

In the current study, researchers compared gut microbial richness across three generations of mice in which only

critical link between grandmaternal high-fat diet, stability of descendant microbial communities in response to environmental pressures, and maladaptive behaviors, with profound implications for both host disease susceptibility and therapeutic targeting of the gut microbiome,” said Buffington. “The discovery highlights the potential for therapeutic targeting of the maternal gut microbiome to improve brain development and long-term behavioral outcomes across multiple generations of descendants.

In addition, Di Gesù suggests that preconception, prenatal, and postnatal supplementation with probiotics could one day be incorporated into a

Healthy Heart Diet Change May Make Biggest Impact on Reducing Heart Risk In People with Hypertension

By The American Heart Association

study presented at an American Heart Association’s Hypertension meeting suggests the DASH diet vs. other lifestyle adjustments may be most effective to reduce the risk of heart attack and stroke among people with high blood pressure

Among several lifestyle changes that may reduce cardiovascular disease, adopting the DASH (Dietary Approaches to Stop Hypertension) diet may have the greatest impact for young and middle-aged adults with stage 1 hypertension, according to new research presented at the American Heart Association’s Hypertension Scientific Sessions 2022, held Sept. 7-10, 2022, in San Diego. The meeting is the premier scientific exchange focused on recent advances in basic and clinical research on high blood pressure and

its relationship to cardiac and kidney disease, stroke, obesity and genetics.

According to the 2017 joint American Heart Association and American College of Cardiology High Blood Pressure Guideline, stage 1 hypertension is defined as having a systolic (top number) level of 130-139 mm Hg or having a diastolic (bottom number) measure of 80-89 mm Hg.

The researchers estimate widespread adoption of lifestyle changes, such as limiting heavy alcohol consumption and exercising regularly, may prevent thousands of deaths and save more than one billion dollars in health care costs over the next 10 years. Their analysis found that adoption of the DASH diet could have the greatest benefit, with an estimated 15,000 heart disease events prevented among men and 11,000 event among women.

The DASH eating plan is specifically designed to help manage

blood pressure. The diet emphasizes foods including fruits, vegetables, lean meat sources, nut, seeds and grains and limiting consumption of red meat, sodium, sugars and sugar-sweetened beverages.

The research team estimated that 8.8 million U.S. adults, ages 35-64, have untreated stage 1 hypertension and would be recommended lifestyle changes, such as physical activity, sustained weight loss, moderating alcohol intake and adoption of the DASH diet.

The researchers found that making recommended lifestyle changes to control blood pressure to below 130 mm Hg systolic or 90 mm

Hg diastolic may have substantial health and economic benefits.

In May, the Association published a policy statement, Strengthening U.S. Food Policies and Programs to Promote Equity in Nutrition Security, which recommends expanding and improving U.S. nutrition policies and programs to ensure all American can access nutritious food. In 2020, the Association launched the National Hypertensive Control Initiative, a collaborative initiative with the U.S. Department of Health and Human Services that aims to improve blood pressure control among the most

UTSW Ear Experts Recommend Exams Before Buying OTC Hearing Aids

Adultswith mild to moderate hearing loss who are considering buying hearing aids when they become available over the counter (OTC) later this month should first be examined by an audiologist and physician to determine if the devices will help them, UT Southwestern hearing specialists suggest.

Earlier this year, the Food and Drug Administration issued regulations for a new category of hearing aids that will allow those 18 and older whose hearing issues are not severe to buy the devices through manufacturers or retail outlets. Federal legislation

chronic ear infection, multiple sclerosis, otosclerosis, acoustic neuroma, and inner ear conditions such as Meniere’s disease.

Drs. Even and Newcomer stressed that only those with mild to moderate hearing loss will benefit from the OTC devices and that access to hearing aids will remain difficult for those who suffer from more significant problems. Hearing loss has been linked to other major medical issues such as dementia, depression, falls, and isolation, and the doctors said patients may see additional benefits from the OTC aids.

“OTC is an exciting development

enacted in 2017 after a proposal by the National Academies of Sciences, Engineering, and Medicine authorized the FDA to develop OTC hearing aid specifications, including maximum output levels and insertion depth limits.

William Even, Au.D., an Audiologist and Clinical Assistant Professor in the Department of Otolaryngology – Head and Neck Surgery at UT Southwestern, and Mark Newcomer, M.D., an Ear, Nose, and Throat Physician and Clinical Assistant Professor in the Department of Otolaryngology – Head and Neck Surgery, said a thorough exam can rule out serious medical issues that can cause hearing loss. Those include

in the world of hearing care. As hearing professionals, we welcome any technology that can address the huge need that exists for additional hearing aid interventions, provided that it is applied in a safe and effective manner,” they said.

Hearing loss is widespread among the U.S. population. According to Dr. Even and Dr. Newcomer, only about 20% of the estimated 40 million Americans who could benefit from hearing aids use them.

Patients interested in purchasing OTC hearing aids should also be familiar with smartphone technology and apps that may be needed for rudimentary self-programming.

These existing hearing aids are roughly representative of what the new OTC devices should look like UT Southwestern’s Dr. William Even, Au.D.

Financial Forecast

Are Medical Bills Affecting Your Financial Health?

By Grace S. Yung, CFP Midtown Financial Group, LLC

If you’ve had any medical issues – even those that aren’t considered “serious” – you may have racked up a considerable amount of debt. Unfortunately, even with seemingly minor ailments, it may not take long for it to spiral out of control. This is why medical debt is the leading cause of bankruptcy in the U.S. today.

Could Your Medical Debt Lead You into Bankruptcy?

Even a small amount of medical

expenses. These strategies include:

Obtaining health insurance coverage

Starting or adding to an emergency fund

Closely reviewing your medical bills

One of the best ways to avoid high healthcare expenses is to have health insurance coverage. If you (and/ or your spouse) work for an employer that provides this benefit, it is well worth it to participate in the plan.

Some companies include Health Savings Accounts in their benefit package. This type of account allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. These could include uninsured

debt could negatively impact your current and future finances. In fact, the more money you have going towards paying down these bills, the less you’ll have available to spend, save, or invest.

Studies show that nearly 1 in 5 Americans have medical debt in collections, meaning that millions of consumers are (or have been) unable to pay for various types of care. In addition, more than half of debtors have medical expenses as a part of their bankruptcy filings.

Prescriptions for Reducing or Eliminating High Healthcare Debt

There are ways you could plan ahead for potential healthcare costs in the future. While some of these may require an up-front “cost,” it may be well worth it if you’re able to reduce or eliminate future healthcare-related

medical services, and even the cost of your health insurance deductibles and copayments that you would otherwise have to pay out-of-pocket.

The same is true if you are an independent contractor or self-employed. One place to start is the health insurance marketplace. There are multiple plans offered – many with low premiums and deductibles. You can access this website by going to: https://healthcare.gov.

Another option for helping to cushion the blow of high medical costs is to have an emergency fund. This refers to money that you put in a savings account or other “safe” financial vehicles that you can easily access if or when you need it.

Age Well, Live Well Planning for Long-term Care

By Olivia Burns, HHS Age Well Live Well

Long-term care describes a spectrum of services and supports that help meet a person’s health or personal care needs. Research suggests that about half of the people age 65 and older will need long-term care at some point in their lives.

Long-term Services and Supports (LTSS) are provided in a variety of settings, including the home, the community and residential facilities.

LTSS can include assistance with personal care, such as bathing and dressing, and assistance with health care, such as medical services ordered by a physician. LTSS can also help with other needs, including home-delivered and congregate meals, transportation and group social activities.

LTSS can also be provided in residential facilities, such as nursing homes and assisted living facilities. Nursing homes provide health and personal care in clinical setting, while assisted living facilities provide personal

care in a more home-like setting. It’s important to start planning for any future long-term care that you may need. Steps to take include:

• Learn what services are available and determine what might fit your needs. Given the variety of LTSS, it is helpful to have a good understanding of what services and resources are available before you may need them. Planning also provides options should you need a higher or lower level of care than you initially expected. Visit the Eldercare Locator webpage or call 800-677-1116 for more information. You can also compare different types of LTSS providers on the Medicare webpage..

• Identify how you will pay for care. Unfortunately, long-term care can be expensive. There are free and low-cost LTSS options, but many are limited or have specific eligibility requirements. Medicare

and private insurance plans will cover certain services and some people offset costs by purchasing long-term care insurance. A benefits counselor at your local area agency on aging (AAA) can help you understand your benefits options. Call 800-252-9240 to reach your local AAA and speak with a benefits counselor.

• Make sure your care preferences are understood. Planning for your long-term care is a great way to share with your loved ones your health care preferences. The Texas

Talks campaign helps make these conversations more comfortable. Access the campaign’s information and guided worksheets to help start the conversation.

Planning now for your future long-term care needs can help you learn what is available, determine how you will pay for services and make sure your loved ones know your wishes. This printable resource has comprehensive information on Texas’ long-term care services and provides space to add personal information all in one place to help in your planning.

Mental Health

found that among this group of college students, those who had early onset alcohol use were twice as likely to engage in polysubstance use, while those who had a Greek affiliation were one-and-a-half times more likely. Students registered in their second year and beyond, as well as students who had inflated norms about others’ alcohol use, were also more likely to engage in polysubstance abuse.

Revising intervention programs

Most universities have a zero-tolerance policy for alcohol and cannabis use, particularly for underage students. However, Montemayor noted that cannabis, stimulant and narcotic misuse is harder to notice due to medical prescriptions and the covert way in which they are used. However, colleges frown on use of these drugs without a prescription, and policies nationwide regarding cannabis use are mixed.

Violations of campus alcohol and drug policies are the most frequent reason that students

Healthy Heart

Continued from page 9

vulnerable populations, including racial and ethnic minorities.

“Members of many disadvantaged communities face barriers to healthy food and regular

High-fat Diet

Continued from page 8

comprehensive regimen. A regimen including micronutrient, folic acid, and vitamin D dietary supplementation, physical activity, and cognitive behavior approaches to help improve long-term health outcomes in both the

receive disciplinary referrals. These infractions happen in a variety of ways, including drinking at a tailgate, getting drunk at a party and then coming back to their residence hall, or being drunk and getting caught somewhere on campus.

Because of limited funding or staffing, some colleges and universities take a one-size-fits-all approach where all students are required to attend the same intervention program. However, Montemayor believes this approach doesn’t benefit students, especially those who need more individualized approaches.

Instead, he is advocating for a stepped care and tailored approach. “Ultimately, what I want to do is create a stepped approach to intervention programming for college students,” he said. “Essentially, if you violate a university substance use policy but you’re at a potentially low risk level of being diagnosed with a substance use disorder and it’s a one-off event, you might benefit from an online

program that focuses on education and changing your actions. However, that’s not the case for everyone. There may be a case that those who are moderate or intense users could benefit from a stepped approach that includes transitions to group-based or one-on-one counseling services.”

He also believes developing a screening tool of evidence-based risk factors will help administrators select the best level of support for each individual student. For example, knowing that a student began drinking before the age of 14 and may be more susceptible to polysubstance use, administrators and college health and wellness professionals can try a personalized approach to intervention programming and screen to see if the student has underlying tendencies indicative of a substance use disorder.

The researchers also are conducting additional studies that look at topics such as binge drinking as well as cultural and social characteristics of alcohol use—such

as family’s alcohol usage, and football tailgating or other sociocultural norms—that may predict substance or polysubstance misuse. Montemayor recently received a grant from Texas A&M Health to assess the scope of substance use and those who meet the criteria for a substance use disorder among students at Texas A&M University.

“We may be able to look at some of these predictor factors and see how we can create intervention programs that help mitigate the risk associated with binge drinking, polysubstance use, cannabis use, or having inflated perceived norms and assumptions that some substances are less risky than others,” Montemayor said. “The implications here are not just theoretical; they’re practical where we want to implement intervention programs that can help these students.” 

health care access,” said Kendra D. Sims, Ph.D., M.P.H., a postdoctoral fellow at the University of California, San Francisco and co-lead researcher of this study. “This means they

will not be able to benefit from a counseling from a doctor. Future research should investigate the big picture: social conditions granting people the time and resources to

make healthy lifestyle choices. Only with this information can we develop policies for the prevention of heart disease, especially for vulnerable adults.”

mother and her child, and, potentially, her children’s children.

Other UTMB co-authors include former Buffington Lab postdoctoral scholar Robert Fultz and research associate Ian Bolding. Researchers from

Financial Forecast

Continued from page 11

By having an emergency fund in place, you could avoid the need to dip into other savings and/or use high-interest credit to pay for your healthcare-related costs. You should ideally have the equivalent of 6 months living expenses in an emergency account. However, having any amount in an emergency fund is better than

nothing at all.

You could also find that there are errors on medical bills that you receive. These may include being double-billed or having charges for items that are supposed to be covered by your insurance. Therefore, make sure you check your healthcare bills closely before you make any payments.

Baylor College of Medicine and the University of Palermo also contributed to this study.

The work was supported by funding from the National Institutes of Health, the Brain & Behavior

Research Foundation, the Scott-Gentle Foundation, the Gulf Coast Center for Precision Environmental Health, and the UTMB Institute for Human Infections and Immunity.

If you already have a sizeable amount of medical debt, you may be able to reduce the total balance that you owe, or even have it forgiven. Some of the best strategies for doing this can include:

Medical bill negotiation

− Debt consolidation or personal loan

− Borrowing from your retirement

plan

Being saddled with high amounts of medical and healthcare-related debt can be challenging. So, it can also help if you talk over your situation with a CERTIFIED FINANCIAL PLANNER™ who can assist you with moving forward and becoming debt-free. 

HOUSTON

Public Welfare

Continued from page 1

prevailing standards of ethical conduct. Who Can You Call?

Here are examples of clinical scenarios and courses of action for mental health providers:

• A patient is a potential risk to self. Who can you call? Under HIPAA, healthcare providers may disclose the necessary PHI to anyone who is in a position to prevent or lessen the threatened harm—including family, friends, caregivers, and law enforcement—without a patient’s permission. Consider calling the patient’s emergency contact or adult protective services for a wellness check.

• A patient says he is going to commit suicide by cop. Who can

Legal Matters

Continued from page 3

It appears clear that this self-monitoring technology does not interfere with clinical decision making, nor does it raise patient-safety or qualify-of-care concerns. But the question that the OIG focused on is whether the provision of technology (smartphones specifically) increase healthcare costs through overutilization. The OIG specifically noted during its approval of the arrangement in an advisory opinion that “if the smartphone… could relieve a patient from the burden of purchasing a smartphone or paying for a smartphone contract, then our conclusion likely would be different.” In other words, if the provision of the technology, especially if it has functionality beyond

you call? Consider calling the patient’s emergency contact and law enforcement if, in your good faith judgment, disclosure of the threat is necessary to prevent or lessen the threat and each contact is reasonably able to prevent or lessen the threat.

• A patient says he is going to kill his spouse or another identified individual. Who can you call? Consider calling the spouse or the target of the threat, and law enforcement if, in your good faith judgment, disclosure of the threat is necessary to prevent or lessen the threat and each contact is reasonably able to prevent or lessen the threat.

• A patient expresses the intent to commit mass harm or random act(s) of assault. Who can you call? Consider calling law enforcement if, in your good faith judgment, disclosure of the threat is necessary to prevent or lessen the threat and law enforcement is reasonably able to prevent or lessen the threat.

• A patient needs to be admitted involuntarily due to being a threat to self or others and will not cooperate. Who do you call? Call local law enforcement and follow the law in your state for involuntary commitment.

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the specific patient treatment benefits (like the ability to access the internet or take pictures), gives the patient a product they have a desire to utilize independent of the treatment, the OIG will be skeptical of the benefit.

Providers wishing to provide patients technology to assist with their care should implement safeguards to limit the OIG’s concerns related to overutilization. First, the technology’s functionality should be limited to the features required for treatment. For instance, if a patient does not need take pictures for treatment purposes, the device given to the patient should have the camera disabled. Second, the provision of technology should not be advertised or promoted to the patient

Oncology Research

Continued from page 5

of water or other nonalcoholic beverage for each serving of alcohol.

• Love mashed potatoes? Try a mix of half potatoes and half mashed cauliflower or turnips, and swap the heavy cream for tangy, non-fat Greek yogurt.

• Seasonal vegetables, including squash or sweet potatoes, are already sweet and taste delicious cubed and roasted with olive oil, salt, and rosemary or your favorite herbs.

• Cook with “good fats,” such as vegetable or olive oil, instead of butter or animal fats, which are

high in saturated or trans fats.

• Substitute applesauce for oil, margarine, or butter in baked goods.

• For limited appetite or difficulty swallowing, arrange to have your favorite foods in smaller portions spread out over the course of the day.

• Ensure all foods are properly washed, prepared, and cooked, and store leftovers properly, as cancer patients may have impaired immune systems and be more susceptible to food-borne illnesses.

• Practice the “plate method.”

Fill one half of the plate with

when the treatment regimen is being described. Third, providers should grant patients temporary use of the device that is limited to the duration of their treatment and either require that the wearable be returned or disabled when that time period elapses.

In conclusion, providing patients technology with no safeguards fails to meet the requirements of the Access to Care Exception. However, particularly with devices that do not have significant ancillary functionalities, healthcare providers can make technology available to their patients with fairly minimal limitations to the patient’s usage in compliance with federal law. 

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non-starchy vegetables such as salad, one fourth with lean protein, and the remaining fourth with a nutritious and filling carbohydrate such as whole grain bread, sweet potato, or beans.

• As always, respect the nutritional choices of others, so all may feel welcome.

While the holiday season can be stressful as a cancer patient or as host to a loved one with cancer, it is possible to enjoy and/or provide both healthy and emotionally satisfying meals for holiday celebrations, with just a bit of planning and foresight.

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