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Volume 9 | Issue 12
Inside This Issue
December Edition 2019
A Shortage of Orthopedic Surgeons is Looming By Phillip Miller VP Merritt Hawkins
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Researchers Investigate Impact of Actual and Virtual Nature on Cancer Patients See pg. 7
INDEX Legal Matters........................ pg.3 Oncology Research......... pg.6 The Framework.................... pg.8 Heathy Heart.......................pg.11
The One Nutrition Tip You Need this Holiday Season See pg. 12
ccording to the Centers for Disease Control and Prevention (CDC), the number of hip replacements among people 45 and over increased from 138,700 to 310,800 over the opening decade of this century, while the rate of these procedures increased from 142 per 100,000 people to 257 per 100,000. These numbers tell you all you need to know regarding why demand for orthopedic surgeons is rising. Population aging is driving the need for a wide range of specialists who treat conditions common to older citizens, including orthopedic surgeons. The Association of American Medical Colleges (AAMC) projects a shortage up of to 122,000 physicians by 2032. Of these, up to 55,000 will be primary care physicians, while an even larger number (up to 67,000) will be specialists. The AAMC projects a shortage of up to 23,000 surgeons. The supply of orthopedic surgeons is limited due to the relatively small number who complete residency each year – a number that is inhibited by the 1997 cap Congress placed on funding for physician graduate medical education (GME). Supply also will be increasingly limited by retirements in the specialty. Close to 60% of orthopedic surgeons in active practice are 55 years old or older, and a “retirement cliff” in the specialty
is looming. As a result, the Health Resources and Services Administration (HRSA) projects a shortage of 5,080 orthopedic surgeons by 2025. Given the current limited supply
the specific geographic location they prefer. Many orthopedic surgeons are electing to complete fellowships such as Sports Medicine and wish to focus their practice exclusively on their subspecialty in (typically) a suburban location. Prior to this trend, most candidates often would complete their general orthopedic surgery training and then specialize through experience rather than a fellowship. Many of these physicians would be willing to practice general orthopedics with a subspecialty emphasis. Today, they wish to concentrate exclusively on their subspecialty, and not all opportunities can offer this option. Offer a Competitive Practice Environment It is important to structure the practice opportunity to be as attractive as possible. Not all candidates are seeking the same thing, but in general a positive practice opportunity for many orthopedic surgeons might include an existing practice in which a physician is about to retire, so that the new physician will have an established
Close to 60% of orthopedic surgeons in active practice are 55 years old or older, and a “retirement cliff” in the specialty is looming... HRSA projects a shortage of 5,080 orthopedic surgeons by 2025. of orthopedic surgeons and the strong demand, hospitals, medical groups and others seeking physicians in this special should consider incorporating a variety of best practices to enhance their recruiting success. Some of these are reviewed below. More Sub-specialization A first factor to consider is that it is becoming increasingly difficult to recruit orthopedic surgeons because candidates are becoming more and more specific on the style of practice they are seeking and more committed to practicing in
see Orthopedic Shortage .. page 14
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December 2019
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Legal Matters Are Medicare Conditions of Participation Now Material to Payment? because the “act of submitting a claim for reimbursement itself implies compliance.”1Nevertheless, there was little risk of FCA liability due to a failure to comply with a Condition of Participation, whereas such liability was more likely due to non-compliance By Ann McCullough, Jd and with a Condition of Payment. Ryan Mcateer, Jd Following Escobar, assessment Polsinelli, PC of FCA liability has shifted to determination of whether rior to the 2016 United States a non-compliance with applicable Supreme Court decision in Universal Health Services v. United statutes, regulations, and contract States ex rel. Escobar, False Claims requirements would be material to the Act (FCA) liability could largely be government’s payment decision, as assessed by determining whether opposed to whether non-compliance there was an underlying violation of a related to a Condition of Participation Medicare Condition of Participation or Condition of Payment. This is to or Condition of Payment related to a say that the non-compliance would payment in connection with Federal be material if the government agency health care programs. Under the would not have paid the claim had it implied certification theory, a provider known of non-compliance. However, could be liable under the FCA if although the implied certification it submitted a claim to the federal theory for FCA liability remains government that implicitly certified post-Escobar, the Supreme Court compliance with applicable statutes, described the materiality standard as Hou_Med_times_ad_11_2019.pdf 1 11/20/19 3:44 PM regulations, and contract requirements, “rigorous” and “demanding,” ensuring
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that the FCA does not become “an all-purpose antifraud statute or a vehicle for punishing garden-variety breaches of contract.” So, should providers review applicable statutes and regulations, particularly the Conditions of Payment and Conditions of Participation, to determine the specific basis for non-compliance and associated FCA liability? Or, should providers instead focus on the likelihood that the government agency would have paid a claim even if it had knowledge of the specific instance of non-compliance (i.e., the non-compliance was insubstantial and not material)? The answer is both. When evaluating materiality under the FCA, a statute or regulation expressly identifying a condition of payment
is relevant, but not automatically dispositive. Proof of materiality can include evidence that the government agency consistently refuses to pay claims based on non-compliance with a particular statutory, regulatory or contractual requirement. Conversely, if the government agency regularly pays a particular claim in full despite its actual knowledge that certain requirements were violated, such certain Conditions of Participation, it is likely such requirements were not material. The ruling in Escobar likely will result in new and different bases for FCA violations due to the ambiguity of the implied certification theory. Therefore, providers must be diligent in identifying and immediately addressing non-compliance in order to avoid or limit FCA liability.
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Hospital Disinfectants Struggling to Kill C. Diff Bacteria Colonies Clorox Comes Close, But None Completely Eliminates Superbug
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he deadly and notoriously stubborn superbug, Clostridioides difficile (C. diff), is putting up a winning fight against hospital-grade disinfectants meant to kill it, according to results of a new study published in the Antimicrobial Agents and Chemotherapy journal of the American Society for Microbiology. The C. diff bacterium causes inflammation of the colon with symptoms ranging from diarrhea to life-threatening sepsis and is most common among the elderly in hospitals or other health care facilities.” “We found no disinfectant was able to completely eliminate C. difficile embedded within biofilms, although we did note differences among disinfectants,” reports Kevin Garey, professor of pharmacy practice
at the University of Houston and chair of the College of Pharmacy Department of Pharmacy Practice and Translational Research. Garey was the project’s principal investigator. The paper was the doctoral thesis of first author, Tasnuva Rashid, of the University of Texas School of Public Health. Overall, Clorox, Cidex OPA, and Virex were most effective at killing C. diff spores. Clorox and OPA were also effective at killing total vegetative cell growth, the cellular stage responsible for causing infections. Virex was found to be ineffective against vegetative cell growth in biofilms. Clorox and Virex were most effective in reducing biomass followed by Nixall, Cidex OPA and Vital oxide. No previous studies have
investigated chemical disinfection of C. diff spores embedded in biofilms. For the project, five unique C. diff strains, embedded in three different biofilm types grown for 72 or 120 hours, were exposed to seven different hospital disinfectants. Bacteria can grow on almost any surface and forms a complex biofilm, like a “suit of armor,” as Garey
described it, where it can survive and thrive – think of slime inside an old garden hose or plaque on your teeth – biofilms both. More devastating biofilms form on medical devices like catheters or injection ports, giving bacteria direct access to a patient. In the center of a biofilm, a spot see Superbug...page 14
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When A Freestanding Emergency Department Comes to Town, Costs Go Up, Rice Study Says
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ather than functioning as substitutes for hospital-based emergency departments, freestanding emergency departments have increased local market spending on emergency care in three of four states’ markets where they have entered, according to a new paper by experts at Rice University. State policymakers and researchers should carefully track spending and use of emergency care as freestanding emergency departments disseminate, to better understand their potential health benefits and cost implications for patients, the researchers said. The study appears in the journal Academic Emergency Medicine. Freestanding emergency departments deliver emergency care in a facility that is physically separate from an acute care hospital. They are commonly found in strip malls in urban parts of Texas. “Proponents of freestanding
emergency departments claim that these facilities can relieve the burden of overcrowded waiting rooms in hospital-based emergency departments,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “We sought to test whether these facilities increase spending, because they might serve as supplements to traditional emergency departments rather than substitutes.” There have been numerous stories in the media of patients seeking care in these facilities, who were shocked when they later received bills totaling thousands of dollars. “Consumers mistakenly thought that freestandings would be low-cost
because they look so much like a neighborhood clinic, and facility staff often told patients that their care would be covered by their health insurance, when in fact it wasn’t,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. The researchers found that entry of an additional freestanding emergency department in a local market was associated with a 3.6 percentage point increase in emergency provider reimbursement per insured beneficiary in Texas, Florida and North Carolina. There was no change in spending associated with a freestanding emergency department’s entry in Arizona. Entry of an additional freestanding emergency department was associated with an increase in emergency department utilization in Texas, Florida and Arizona, but not in North Carolina. The implied increases in utilization varied between roughly 3 and 5%. The estimated out-of-pocket
payments for emergency care increased 3.6% with the entry of a freestanding emergency department in Texas, Florida and Arizona, but declined by 15.3 percentage points in North Carolina. “Health care continues to account for an increasing share of the U.S. economy, and emergency care spending as a share total health care costs is also rising,” Ho said. “Therefore it is troubling that in three of four states, entry of freestanding emergency departments results in higher spending, which may not yield significant health benefits. Given that previous studies suggest that much care provided by freestanding emergency departments could be delivered in lower-cost settings, policy makers should carefully regulate entry of these providers as well as their billing practices.”
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Oncology Research When it Comes to Cancer, It’s a Family Affair By Susan Escudier, M.D., FACP, Texas Oncology– Houston Medical Center
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or all the many ways that cancer patients engage with healthcare providers, the reality is that patients walk most of the miles of their cancer journey alongside family members – outside of the clinic or hospital. Parodies poking fun at the family dysfunction that rears its head around the holidays make us laugh as well as perhaps sting with a bit of truth. Indeed, for better or worse, family dynamics shape how we approach life and life’s big challenges like cancer. When it comes to cancer, there is a reverberating effect that is seen, heard, and felt in families. More than 1.76 million new cases of cancer are expected to be diagnosed in the United States in 2019 – and more than 124,000 of those will be in Texas, according to the American Cancer Society and the
Texas Cancer Registry. For every new case, countless family members and loved ones are impacted. Whether you are a patient, caregiver, or love someone with cancer, it’s important to remember that you can cultivate an environment of care and support within your family. Communicate as openly and honestly as you are comfortable. Often while patients are coming to terms with their cancer diagnoses, their family members also are struggling with their feelings. With everyone grappling with emotions ranging from fear and devastation to determination, communication is critical. It’s normal to feel fear, loss of control, disbelief, and guilt. Be as open as you are comfortable and set boundaries if you need to. Recognize that people often have diverse reactions to a diagnosis. Keep in mind that negative reactions are often focused on the diagnosis, not loved ones. Discuss expectations early and often. A patient’s expectations and wellbeing should be at the forefront. Adult children who don’t agree
about their parent’s treatment plan, family members who live far away and don’t know how they can help, unanticipated changes to younger children’s daily activities that they don’t understand – the opportunities for unmet expectations abound when not adequately addressed. This friction can last well beyond the initial diagnosis. Talk to a patient navigator or physician about the benefits of advance care planning to better understand the patient’s wishes and to ensure they’re followed throughout the cancer journey. Take time to connect as a family. The American Cancer Society reports that three out of four families have at least one member who is a
cancer survivor. Beyond daily activities, cancer impacts relationships, shifts family roles, impacts finances, and sometimes living arrangements. As everyone adjusts to the circumstances, spend quality time together doing something enjoyable – where cancer is not the topic of the conversation. Ask for – and be willing to accept – support. Supporting a family member with cancer comes with a lot of responsibility that at times may feel overwhelming. The American Society of Clinical Oncologists (ASCO) defines “informal caregivers” as family see Oncology Research...page 14
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Researchers Investigate Impact of Actual and Virtual Nature on Cancer Patients Clinical Trial Tests Virtual Reality, Live Garden and Art To Reduce Pain and Distress
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he University of Texas MD Anderson Cancer Center today opened its newest free-standing facility in The Woodlands. Serving patients in The Woodlands, Spring, Conroe and communities north of Houston, MD Anderson Cancer Center The Woodlands offers local, convenient access to the nation’s top-ranked comprehensive cancer care. To keep pace with population growth, MD Anderson relocated its previous facility in The Woodlands to a larger building designed for the best possible experience for patients and care providers. The new building, located at the corner of College Park (TX242) and Fellowship Drive, is four times the size of the former location, and it incorporates all services in The Woodlands into one single, easy-to-navigate facility with
free parking. Patients will continue to receive the same high-quality, multidisciplinary care provided at the original location, as well as an expanded Ambulatory Treatment Center and diagnostic imaging center. The new location also provides support services including clinical nutrition, social work and cancer pain management. In the winter, additional interventional radiology, endoscopy, bronchoscopy and procedural services will be available, with plans to add a women’s imaging center in the future. “MD Anderson is committed to expanding access to our expert subspecialty cancer care in the greater Houston area,” said Peter WT Pisters, M.D., president of MD Anderson. “This new facility provides a new level of services that
Celebrating
Live garden and mural designed to calm, relax patients and visitors
will significantly enhance cancer care and the overall experience for patients in The Woodlands and surrounding areas.” MD Anderson The Woodlands offers numerous wellness resources, including Salus, an area for wellness, connection, learning and support, where patients may attend classes and support groups. It also houses a marketplace where patients and visitors may buy coffee, snacks and refreshments. “This expansion allows the MD Anderson team to offer its full range of expert care – from cancer screenings and treatment to survivorship support – to patients
throughout the north Houston area,” said Kent Postma, vice president of Ambulatory Operations at MD Anderson. “We look forward to experiencing this new facility with our patients we previously served in The Woodlands and to maximizing the care and patient experience opportunities for all patients.” MD Anderson The Woodlands is the institution’s third outpatient campus to open this year. MD Anderson’s five campuses aim to improve local community access to subspecialized cancer care and innovative clinical trials.
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The Framework Memorial Hermann The Woodlands Announces $250 Million Campus Expansion Project
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emorial Hermann The Woodlands Medical Center has steadily increased its footprint and services in order to meet the healthcare needs of a growing population since it opened as the area’s first hospital in 1985. That trend will continue well into the future as the hospital today announced a $250 million expansion project, approved by the Memorial Hermann Health System Board, that will add nearly a half-million square feet of new and renovated service areas and 288 new parking spaces to the campus by early 2022. “Our staff and affiliated physicians are extremely proud of providing excellent care to the people who need us,” said Sr. Vice President and CEO of Memorial Hermann The Woodlands and Memorial Hermann Northeast Josh Urban. “With more than a half-million people projected to live within a 10-mile radius of our hospital within the next few years, it became increasingly evident we would
need to grow to continue providing the level of care, service and access the hospital has established over the last three-plus decades.” Memorial Hermann The Woodlands currently treats more than 92,000 patients each year through Emergency Center visits and inpatient admissions. Its current capacity of 397 licensed beds could increase to as many as 535 licensed beds and 30 observation beds upon completion of the project. Parking on the campus, which currently has 2,375 parking spaces for guests, visitors, staff and physicians, will grow to 2,663 free parking spaces when construction is finished. The centerpiece of the expansion will be the new 332,510-square-foot, eight-floor South Tower, which will include new registration, waiting and observation areas; six additional operating rooms; endoscopy services; a post-acute care unit; a conference center; cardiopulmonary and catheterization labs; a 36-bed patient care unit; an
intensive care unit; and three shelled floors for future patient bed growth. It will also include four additional catheterization labs and interventional suites. The hospital’s main entrance, which currently faces Pinecroft Drive to the west as part of the original facility design, will be housed in the new South Tower and face south toward Medical Plaza Drive. A 7,416 squarefoot bridge will connect the new tower to an adjacent parking garage, which will have an additional two levels constructed upon it, providing 332 free parking spaces. The new South Tower will allow for renovation and expansion of 144,120 square-feet in other areas of the hospital, including food services; imaging; surgery
support; pharmacy services; TIRR Memorial Hermann The Woodlands; orthopedic services; and inpatient care areas. “We are extremely excited at how this will enhance the patient experience, which begins the moment someone enters our facility,” Urban said. “What’s more exciting is all the additional lives we will impact through the care that will be delivered in the new structure.” With more than 2,600 employees, Memorial Hermann The Woodlands is currently the third-largest nonretail employer and largest healthcare employer in Montgomery County, according to The Woodlands Area Economic Development Partnership. It is also the fourth-largest employer in North Houston.
Bridgemoor Transitional Care in Webster Earns Accreditation And Certification
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ridgemoor Transitional Care in Webster became the first skilled nursing facility in Harris County to earn accreditation and certification by The Joint Commission for continuous compliance with the commission’s performance standard. The Webster site is the fourth of Bridgemoor’s skilled nursing facilities in Texas to receive this distinction. “We’re incredibly proud to be the first skilled nursing facility in Webster to have earned the Gold Seal of Approval for Nursing Care Center Accreditation and Post-Acute Care Certification,” Mark Fritz, president of Bridgemoor Transitional Care, said. “With this honor, we’re proud to also announce that all of our facilities are now Joint Commission accredited and certified.” The nonprofit Joint Commission is the nation’s oldest
December 2019
and largest accrediting body in health care, awarding accreditation for three years and certification for two years. To earn accreditation and certification from The Joint Commission for Nursing Care Center Accreditation and Post-Acute Care Certification, Bridgemoor Transitional Care in Webster underwent a rigorous on-site review in July. Expert surveyors evaluated compliance with nursing care center standards related to several areas, including assistance with activities of daily living, coordination of care, as well as staff education and training. Surveyors also conducted on-site observations and interviews with the center’s leaders and staff. “By receiving accreditation and certification from The Joint Commission, Bridgemoor Transitional Care in Webster has proved its commitment to provide high quality
post-acute care,” Gina Zimmermann, executive director of the Nursing Care Center Accreditation Program for The Joint Commission, said. “We commend Bridgemoor for holding such high standards and making patient safety and quality of care important priorities.” Bridgemoor’s innovative model of care serves as the transition between the hospital and home, helping to reduce the likelihood of a patient returning to the hospital. This practice can reduce total costs as the patient recovers under the care of a physician-led team.
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“We’re grateful to the physicians, nurses and staff who provide the highest quality care to our patients and make this recognition possible,” Fritz said. The health care provider’s locations in Round Rock and San Antonio last year earned the Gold Seal of Approval—a symbol of quality that reflects a health care organization’s commitment to providing safe and quality patient care. Bridgemoor’s Fort Worth location earned the honor in July.
Houston Medical Times
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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.
MEDICAL TRANSPORTATION PROGRAM TUTORIAL: Help reduce missed appointments by guiding eligible patients to free transportation. This tutorial is an essential resource for medical and dental office staff.
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Financial Forecast Keeping Your Medical Practice Alive… Even When You’re Ready to Move On By Grace S. Yung, CFP Midtown Financial Group, LLC
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elling your medical practice is a big decision. You’ve likely spent many years building up your book of patients, as well as your associates and assistants. So, in addition to the sale of your practice having a financial impact, there may also be an emotional factor. The sale of your practice could take several different forms. It can also raise a number of tax, legal, and financial planning issues that you will have to consider prior to moving forward. With that in mind, it is important that you have a good exit strategy in place. How much is Your Practice Worth? The first step is determining the valuation of your medical practice.
Three common business valuation approaches are measuring value by income, by market comparison, or by cost. It is a good idea to get more than one opinion, as these numbers could vary. It is also recommended that you use a business broker to help you – particularly one who has experience in selling medical practices. In addition to marketing for buyers, a broker may already have clients who are interested purchasers, as well as lenders available who can arrange the financing. In any case, don’t try to sell your business on your own. What you think you might save can cost you more in the long-run if you don’t structure your deal properly. How Will You Be Compensated? Depending on the size and value of your medical practice, one primary element of selling it is determining how you will be compensated. While most business owners sell for a lump sum and walk away, others prefer to receive a series
of payments and/ or phase out of the business over a certain period of time. Other possible types of compen sation could include: • Cash for the sale of the stock shares. • Cash for the sale of the assets. • Exchanging stock in the practice for shares of another medical practice or company. • Selling the assets of the practice in exchange for stock in the new purchaser’s practice or company (if applicable). • Converting your practice to a publicly-traded company. Other Considerations There may be other items to consider, too, such as whether or not you want to help the new buyer transition. For instance, you could stay on for the next year or two on salary or act as a consultant to the practice.
These arrangements could benefit you and the buyer. As an example, the purchaser can rely on your expertise, and you can continue earning an income, as well as possibly continue coverage through the group benefits plan (a particularly enticing option if you are under 65 and not yet eligible yet for Medicare). If you own the building where your practice is located, you could retain ownership of it and collect rent from the new owner of the business. Have an Exit Strategy Having an exit strategy in see Financial Forecast...page 12
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Healthy Heart Addressing Social Determinants Like Education Impacts Overall Health By American Heart Association
he end of the year brings holiday cheer, hustle and bustle and time with family. It brings thoughtful reflection on the past year and hopeful planning for the next year to come. For many, December also means making your annual year-end gift to a favorite organization. Here in Houston, the American Heart Association is making extraordinary efforts to improve the overall health of our community. This includes addressing the growing disparities brought about by social determinants of health - factors that influence where and how people live, learn, work and play. These social determinants of health provide context to a person’s life and can play just as big of a role in affecting health as medications and physical lifestyle changes. Some of the American Heart Association’s recent efforts include
behavioral or environmental. In order to work as a relentless force for longer, healthier lives, the American Heart Association’s work has continuously evolved to address overall health. One of the social determinants of health that demands action is education. How long people stay in school may play a significant role in predicting how well those with coronary heart disease will fare, according to new research that linked lower levels of school completion with a higher risk of heart attack and death. Education level has been known to influence people’s risk of developing cardiovascular disease. The new study examines just how much of a factor it plays among people with established coronary artery disease, which is caused by a buildup of cholesterol and fatty plaque deposits in the heart’s arteries. People with elementary or middle school education had a 52%
placing blood pressure kiosks in hightraffic areas like University of Houston and the Houston Food Bank. These strategic placements make it easier for members of our community who could be at risk of hypertension to check their blood pressure quickly and conveniently. The accessible and innovative kiosks can help users learn more about their overall health and whether they should seek further medical attention to make changes to their daily routines. The American Heart Association recognizes that social determinants of health play a large factor in cardiovascular health. In fact, only about 20% of cardiovascular risk is genetics. The other 80% is either
higher risk of dying from any cause during the study compared to someone who attained a graduate degree. People who completed high school had a 43% increased risk. College graduates had a 26% higher risk compared to people with graduate degrees. These findings should make us all more aware of how social context plays a role in health and the responsibility we have in addressing these issues. As we celebrate the most wonderful time of the year, please consider making a difference to your neighbors and giving back to our community through a lifesaving, tax-deductible gift to the American Heart Association. Donate today at houstonheartwalk.org.
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The One Nutrition Tip You Need this Holiday Season
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are overscheduled or stressed, you may ignore the subtle hunger cues leading you to skip meals. Skipping meals allows your primal hunger to take over once you’ve slowed down or your hunger cues become too strong to ignore. By this time you are ravenous eading over my social media and will overeat whatever is in front accounts and online articles has of you. Honor your hunger by adhering brought about a revelation: there is an overload of tips being shared on how to your usual eating patterns and to prevent holiday weight gain. The times. If my day looks like it’s going holidays are indeed a time of the year to be hectic, I set alarms on my Apple where most people overindulge in watch to remind me to eat. I know it
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high-calorie, high-fat, and high-sugar foods. Physical activity may also take a backseat to holiday events, parties, and travel. The one tip I will offer is to honor your hunger. What does that mean? Honoring hunger is a principle of mindful eating. It means that you should aim to stay nourished throughout the day. The chaos that arises from the holidays may lead you to overschedule yourself. When you
sounds silly to have to remind yourself to eat but I can’t stress how it’s saved me countless times. Pack healthy snacks that you can keep in your purse or in your car, such as portion-packed nuts. And whatever you do, don’t make the mistake of trying to compensate for holiday treats by skipping lunch or dinner. This practice will only backfire causing you to overindulge in those holiday treats.
Financial Forecast Continued from page 10
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December 2019
place before you put your medical practice up for sale can mean the difference between a smooth transaction into retirement and potential bumps along the road. Due to the many intricacies that are involved, it is recommended that you work in conjunction with the medicaltimesnews.com
professionals who can help you. These should include a financial advisor, a business broker, an attorney, and a CPA. Having these partners on your side can help you work towards a deal that makes sense for you.
Houston Medical Times
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Precise Robotic Knee Surgery Fast-Tracks Recovery By Maureen Dyman
N
ew robotic technology at the Michael E. DeBakey VA Medical Center in Houston is ensuring Veterans undergoing knee replacement surgeries experience less pain and recover faster. Last week, David M. Green, M.D., M.S. and Melvyn A. Harrington, Jr., M.D., orthopedic surgeons at the Houston VA, performed the VA’s first total knee replacement using the Mako Robotic-Arm Assisted technology. The patient, a 73-year-old Navy Veteran, is recovering nicely. “We do more than 400 knee replacements at the Houston VA every year,” said Green, who is also board certified by the American Board of Orthopedic Surgery. “This new technology will allow us to perform these surgeries with even more precision. It allows for more precise bone preparation, less soft tissue injury and potentially a less
painful and speedier recovery for our Veterans.” The new technology creates a 3-D virtual model of each patient’s bone anatomy, allowing surgeons to map out the procedure beforehand and size the implant perfectly by using the Veteran’s computed tomography (CT) scan. Surgeons use the virtual model to practice placing the implants or artificial joints in precisely the right location, making adjustments as necessary. The technology provides a personalized surgical plan for each Veteran, based on their unique anatomy. “The 3-D model simulates how a knee will move and act once an implant is in place,” said Harrington, who is also an associate professor of Orthopedic Surgery at Baylor College of Medicine. “Once the virtual model is complete, we use the robotic arm to perform the
Houston VA doctors are thrilled to be able to use this state-of-the-art technology to improve recovery time for Veterans with limited mobility who are often in a great deal of pain.
bone cuts so the implant can be precisely placed.” The most common cause of knee pain in older adults is osteoarthritis, a degenerative joint disease that causes the deterioration of joint cartilage and surrounding bones in the knees. When osteoarthritis of the knees becomes severe, normal activities like walking or going up stairs can become painful or nearly impossible. Knee replacement surgeries can offer Veterans a solution to this pain
and improve their quality of life. Houston VA doctors are thrilled to be able to use this state-of-the-art technology to improve recovery time for Veterans with limited mobility who are often in a great deal of pain. “We are committed to offering our Veterans the best care along with the latest technology,” said Green. “They deserve nothing but the best, and we are proud to give it to them.”
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Orthopedic Shortage
HOUSTON
Continued from page 1
referral network and patient base. Many orthopedic surgeons would prefer to join a private group in which they can receive ancillary revenue from an ambulatory surgery center (ASC). Like other physicians, orthopedic surgeons prefer a controllable lifestyle, and a call schedule of 1:4 or better is preferred by most. Few candidates are seeking a solo practice. They prefer to have at least four or five colleagues for call and for comradery. ORS trauma call is a
major negative for many candidates, particularly if they are focusing on a subspecialty. For example, a foot and ankle orthopedic surgeon usually does not want to have to be called into the ED for a fractured hip on an 80 year old. The compensation must be competitive, with the majority of candidates seeking a potential of $750,000 annually, and often considerably more if they are fellowship trained in total joints, spine, surgery, etc. The other reality is that
location makes a significant difference to today’s candidates. Because there are a lot of options in a competitive market, and because orthopedic surgeons earn high incomes regardless of location, it may be difficult to attract candidates to traditionally challenging locations with just a high income potential. It therefore is important to make all other aspects of the practice as positive as possible.
Continued from page 4 omnipresent and self-propagate in the environment,” said Garey. The survival of C. diff in hospitals and nursing homes is especially hazardous. The Centers for Disease Control and Prevention report that within a month of diagnosis, one in 11 people over age 65 died of a health care-associated C. diff infection. Garey reports that approximately 1% of all people over age 80, whether sick or not,
will die of a C. diff infection. Garey said future research could include improving existing cleansers. “Clorox is the best we have but is still quite caustic to the environment. There is likely a future where we could improve upon it to make an even more superior disinfectant to fight deadly superbugs.”
Oncology Research
Continued from page 6 members who play an important role in the management of cancer and perform tasks that may be physically, emotionally, and socially demanding. Asking for help isn’t a sign of weakness – it’s a sign of strength. Family members can reach out for support to other family members, friends, or even community or church groups. If you’re a patient receiving care from a loved one, encourage them to find support and rest. Families play an integral role in cancer care whether it’s helping patients get to appointments, ensuring medications are taken as directed, or providing a needed meal or hug. At Texas Oncology, we recognize families as essential members of the care team, joining with us in their loved one’s fight against cancer.
December 2019
Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Robert Cox
Superbug
exists without oxygen, an attractive locale for the anaerobic C. diff spore, which dies when it touches oxygen. Rashid was able to get a spore to germinate and replicate itself within a biofilm while exposed to an oxygen-rich environment. “This study helps explain why C. diff is so hard to eradicate from the environment and demonstrates the ability of these spores to be so
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