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April Issue 2015 MD ANDERSON STUDY PREDICTS NEW HEPATITIS C Inside This Issue DRUGS WILL PLACE A DRAMATIC FINANCIAL STRAIN ON THE HEALTH CARE SYSTEM The cost of treating people infected with the hepatitis C virus (HCV) with newly approved therapies will likely place a tremendous economic burden on the country’s health care system. The prediction comes from a cost-effectiveness analysis led by How to avoid travel germs See pg. 14 researchers at The University of Texas MD Anderson Cancer Center. INDEX The findings, reported in the March 17 issue of the Annals of Internal Legal Health...... pg.3 Medicine, predict that the cost of Mental Health...... pg.5 providing patients their daily regimens Healthy Heart...... pg.6 could total $136 billion over five years Money Matters...... pg.8 – 10 percent of the country’s annual prescription drug spending. Marketing Essentials...... pg.9 Jagpreet Chhatwal, Ph.D., study In recent years, management of the used a simulation model to fully Age Well Live Well...... pg.12 lead and assistant professor of Health disease has come to a crossroads. evaluate the cost-effectiveness and The Framework...... pg.18 Services Research at MD Anderson, In 2012, the Centers for Disease budget impacts of sofosbuvir and reported a combination of two drugs Control and Prevention and the U.S. ledipasvir treatment. Their model – sofosbuvir and ledipasvir – recently Preventive Services Task Force both conducted a cost analysis involving recommended a one-time hepatitis C approved by the U.S. Food and Drug patients with four major HCV Administration to treat hepatitis C is screening for baby boomers – people genotypes. cost-effective as opposed to the old born between the years 1946 and standard of care. The budget needed to 1964. Two years later, the Food and The researchers found the treat all diagnosed patients, however, Drug Administration approved the new therapies would reduce the medications sofosbuvir and ledipasvir is unsustainable. clinical burden of the disease. They for disease management. Yet, while determined that the newer, more Ashley Mcclellan named More than two million people the drugs lead to improved outcomes, expensive medications would be most the Woman’s Hospital of Texas CEO are infected with HCV, a virus the cost of the newly approved oral See pg. 16 found in the liver. It is transmitted regimen comes at a staggering price to beneficial for select groups of patients: through blood-to-blood contact. payers – as much as $1,125 per day. those with advanced disease, have the HCV genotype 1, or are younger. “We have millions of people who need treatment for hepatitis The results show that using C and payers obviously don’t have new therapies is cost-effective in the the budget to cover this tremendous majority of patients. However, the expense,” says Chhatwal. As a result, budget required to treat all eligible physicians have to prioritize the new patients would be $136 billion over

drugs to the sickest of patients, and the next five years. Compared with the

HOUSTON TX HOUSTON PERMIT NO 1 NO PERMIT several payers have added restrictions old drugs, new therapies would cost

PAID that only those with the most

US POSTAGE US an additional $65 billion, whereas the PRSRT STD PRSRT advanced disease receive treatment. ” cost offsets would be only $16 billion. For the study, Chhatwal and his team see New Hepatitis C Drugs page 19 Serving Harris, Galveston, Brazoria and Fort Bend Counties

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© 2015 Bank of Texas, a division of BOKF, NA. Member FDIC. Equal Housing Lender. Private Bank at Bank of Texas provides products and services through BOKF, NA and its various affiliates and subsidiaries. Investments and insurance are not insured by the FDIC; are not deposits or other obligations of, and are not guaranteed by, any bank or bank affiliate. All investments are subject to risks, including possible loss of principal. Page 3 Houston Medical Times

impediments to the assumption of a Legal Health higher level of risk. CMS anticipates “Next-Generation ACO” Model Is CMS’s Newest Effort to making 15 to 20 three-year NGAM Encourage More ACO Risk awards incorporating these new features: (“NGAM”) joins the Innovation 1. a prospectively set benchmark Center’s Pioneer ACO Model and the Medicare Shared Savings Program that will be established prior to the start of each performance (“MSSP”) as an additional option for Medicare providers to organize together year, unlike the end-of-the-year to provide coordinated, high-quality benchmark used under the care at lower cost, with the potential MSSP and Pioneer Model By S. Lawrence Kocot and Philo D. Hall impact of outlier patients, Epstein Becker & Green, P.C. to earn higher compensation. 2. two risk arrangements that will be offered to participating individual beneficiary An ACO That Looks More Like “ ACOs, each of which includes expenditures will be capped On March 10, 2015, the Centers Medicare Advantage ” a higher sharing rate than the at the 99th percentile of for Medicare & Medicaid Services’ In announcing the program, MSSP and Pioneer Model expenditures (“CMS’s”) Center for Medicare and CMS states that the NGAM will (one arrangement offers an 80 Medicaid Innovation (“Innovation 4. an option for Next Generation allow providers “to assume higher percent sharing rate, moving Center”) announced a demonstration ACOs to participate in levels of financial risk and reward to 85 percent in the fourth project incorporating new risk models a capitation payment than are available under the Pioneer and fifth years, and the second for reimbursement of accountable mechanism in the second Model and [MSSP].” ACOs currently arrangement offers 100 care organizations (“ACOs”) serving performance year of the Medicare beneficiaries. participating in the Pioneer Model percent full performance risk) or MSSP may apply to participate in program Fresh on the heels of CMS’s the NGAM. Recognizing that there 3. for each risk arrangement, a 5. a new long-term benchmarking recently announced goal of tying 50 has been very little participation 15 percent cap on aggregate methodology that moves percent of Medicare fee-for-service to date in Medicare two-sided risk savings and losses, offering payment away from a base payments to value-based payment models, CMS included in NGAM a protection against substantial in historical expenditures in methodologies by the end of 2018, number of modifications to address costs by outliers; to protect order to ease the difficulty that the Next Generation ACO Model what providers have found to be against the extreme financial see Legal Health page 19

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April 2015 medicaltimesnews.com Houston Medical Times Page 4

UTMB scientists use immunotherapy to reduce memory problems with Alzheimer’s Disease

Texas – A new study from the to as an oligomer. When this happens, University of Texas Medical Branch molecular nutrients can no longer move at Galveston has revealed that a single to where they are needed and the brain dose of an immunotherapy reverses cells eventually die. memory problems in an animal model of Scientists from UTMB have Alzheimer’s disease. The article appears previously shown their anti-tau oligomer in the March 25 issue of the Journal of immunotherapy reduced levels of tau Neuroscience. oligomers and reversed memory deficits Researchers have been working for in an animal model of Alzheimer’s. In decades to map out how Alzheimer’s the current study, it came as a surprise that the immunotherapy also reduced disease wields its devastating effects. What sets Kayed's therapy apart from Marcos Guerrero-Munoz, Urmi amyloid beta oligomer levels, suggesting Although it’s known that two molecules other tau immunotherapy drugs is that Sengupta, Caterina Hernandez, Alan that the detrimental effects of amyloid – tau and amyloid beta – are considered his targets only the toxic oligomer form Barrett and Kelly Dineley. beta are dependent on the presence of responsible for the disease’s progression, of tau and leaves the normal tau alone toxic forms of tau. This paper was supported by the the relationship between these two and able to carry out its typical functions. proteins and resulting memory problems Cullen Trust, the Alzheimer’s Drug “Our findings with this Discovery Foundation, the UTMB has remained unclear. These findings provide strong immunotherapy study indicate a link Mitchell Center for Neurodegenerative between tau oligomers and amyloid beta, evidence of the benefits of targeting Brain cells depend on tau protein ” Disease, the UTMB Sealy Center said lead author and associate professor tau oligomers with immunotherapeutic to form highways for the cell to get for Vaccine Development and these of neurology, Rakez Kayed. Because of approaches as an Alzheimer’s disease nutrients and get rid of waste. In some “ studies were completed as part of an this relationship, removing tau oligomers treatment. neurodegenerative diseases such as interdisciplinary research team funded with our immunotherapy may also Alzheimer s disease, the tau protein by The Moody Project for Translational ’ decrease the harmful effects amyloid The other authors of this paper include changes into a more toxic form referred UTMB s Diana Castillo-Carranza, Traumatic Brain Injury. beta and mitigate memory deficits.” ’

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Mental Health “Ah Bah!” he said. Infant and Early Childhood Development “Ah Bah!” said Mrs. S without thinking. By Ira Glovinsky, going to have to learn their language.” Surprised, Martin turned towards Ph.D., Co-leader, IECD her and said it again: “Ah Bah!” Program “How will I do that?” Mrs. S asked. Mrs. S smiled and repeated the “You’ll have to follow what the sounds. creatures do,” I replied. “Cuf!” said Martin. Stanley Greenspan called Floortime. Turning towards Martin, she The method was one component of picked up a square red block and held “Cuf!” said Mother.” his Developmentally-Based, Individual Mrs. S sat in a small child s chair ’ it in front of him. Difference, Relationship-Based model, next to her son Martin. Her face was Martin turned towards her, and she held out a block to him. He took known as the DIR model. This is the sad and teary. “Five years old and we’ve “Woops, that’s an earthling thing,” the block and put it on top of another, model that we teach students in our never played together,” she wept, patting I said. “He doesn’t understand.” then looked up at her. She handed doctoral program at Fielding Graduate her son’s head. Martin did not respond She gave me a puzzled look, then him another block, and they got into University, based in Santa Barbara, to her touch and instead fingered some California. Our program is a doctorate turned back to her son and said, “Do a building game accompanied by colored blocks. He had been diagnosed in Infant and Early Childhood you want to pl . . .” vocalizations repeated back and forth. with autism and had delayed language Development, with an emphasis on mental health and developmental skills, did not make eye contact, and “Creatures on Martin don’t Finally, Mrs. S turned to me and disabilities. ignored social overtures. understand English!” I interrupted. began to cry. “He’s never done anything like that! she said. I explained that this “I want you to try something,” I “So what do I do?” she asked. ” At present, almost 60 students was Martins idea of play. Her definition said. Mrs. S looked at me expectantly. ’ are learning this pioneering, “I guess you’ll have to follow him,” of play had been very different, but You re going to pretend that you have multidisciplinary model for working “ ’ I said. now she had succeeded in connecting been commissioned by NASA to fly to with families of children with special with Martin. planet Martin. But you have a problem. “But I don’t know how!” she needs. Doctoral students from the The creatures on this planet have never snapped. fields of mental health, education, My approach in this session was occupational therapy, physical therapy, seen an earthling, so no matter what Just then, Martin picked up a block. based on a method developed by Dr. you do, they won’t understand it. You’re see Mental Health page 20

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April 2015 medicaltimesnews.com Houston Medical Times Page 6

Healthy Heart Eating and Drinking for Fitness By: The American Heart Association

blood from your muscles. Your body is your engine, and you can keep it running smoothly by ∙∙ If you only have 5 or 10 Award Winning Restaurant fueling up your tank with healthy foods minutes before you exercise, Where Southern charm meets Texas Heritage. and your radiator with healthy fluids. eat a piece of fruit such as an apple or banana. What you put in your body (nutrition) is as important as what you do with During: Make a Pit Stop your body (exercise). Both are crucial to keeping your engine performing at ∙∙ Whether you’re a serious athlete its best. who trains for hours or you have a low- to moderate-intensity Before: Fuel Up! workout routine, keep your body hydrated with small, Not fueling up before you work out frequent sips of water. is like driving a car on empty. You may ∙∙ You don’t need to eat during a not have enough energy to maximize workout that’s an hour or less. From Sunset to San Felipe your workout and you ll limit your ’ During longer, high-intensity, One of the few Original Houston Eateries ability to burn calories. vigorous workouts, refuel Celebrating 42 years of Tradition

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Ideally, fuel up two hours before every half hour or so with you exercise: healthy carbohydrates such as a banana. ∙∙ Hydrate with water. Drinking water before your workout After: Refuel Your Tank is important to prevent ∙∙ Fluids. Drink plenty of water, dehydration. of course. Instead of sugary ∙∙ Eat healthy, easily digested sports drinks, try flavoring your water with 100% juice carbohydrates such as fruits such as orange juice, which and vegetables, whole-grain provides carbohydrates. cereals (with low-fat or skim milk), whole-wheat toast (with ∙∙ Carbohydrates. You burn a little bit of almond or peanut carbohydrates — the main fuel houstonmuseumdistrict.org butter), oatmeal, low-fat or for your muscles — when you fat-free yogurt, whole-grain exercise. In the 20-60 minutes Asia Society Texas Center • Buffalo Soldiers National Museum • Children’s Museum of Houston after your workout, your Contemporary Arts Museum Houston • Czech Center Museum Houston • The Health Museum pasta, or brown rice. Holocaust Museum Houston • Houston Center for Contemporary Craft • Houston Center for Photography muscles can store carbohydrates Houston Museum of African American Culture • Houston Museum of Natural Science • Houston Zoo as energy and help in recovery. The John C. Freeman Weather Museum • The Jung Center of Houston • Lawndale Art Center ∙∙ Avoid saturated fats and The Menil Collection • The Museum of Fine Arts, Houston • Rice University Art Gallery • Rothko Chapel Opt for fruits, vegetables and protein — these digest slower @HoustonMuseum HoustonMuseumDistrict in your stomach and take away oxygen and energy-delivering see Health Heart page 22

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Money Matters Alternative Investments: The Rx for True Portfolio Diversification

By Clark Edlund, entire portfolio? Beyond the obvious CAIA caveat of a positive expected return over Senior Investment time, the most relevant statistic to take We are hiring Advisor into consideration in terms of the impact ZTWealth it will have on your existing portfolio is ‘correlation’. The lower/negative the correlation (which ranges from -1 to 1) of the investment being considered, the better the impact. For example, it would be advantageous to plug-in assets It’s no secret that medical professionals that zig when the remainder of the have always had an insatiable appetite for “ ” portfolio “zags.” Hedge funds, private exotic investments, real estate deals or equity and real estate are just a few asset businesses outside of their own practice. More than just a job. Get a career with classes that attempt to provide this exact In some doctor’s cases, beyond supporting benefit. These alternatives are highly meaning at the their families, it’s almost as if they practice sought after because their return profiles City of Houston medicine as a means to fund other typically aren’t dependent upon the investments and simply enjoy trying their general direction of the stock market, hand as business men more than being Opportunities meaning they have the potential to earn The City of Houston’s Health and Human Services medical professionals. Although the Department provides traditional public health positive returns in both up and down Full Time medical community has historically been services and seeks to use innovative methods to markets. meet the community’s present and future needs. Chief Nurse, RN enamored with “alternative investments,” Our mission is to work in partnership with the I’m still often asked, “What exactly IS Of course, it can’t really be this community to promote and protect the health and Part Time an alternative investment?” simple, can it? Unfortunately, there are social well-being of all Houstonians and we are now ER Physician many pitfalls and hurdles that must be looking for you to join our amazing team! Physician, MD Is it the method or strategy you addressed prior to making an allocation to implement that makes an investment alternative investments, riding off into the an alternative? Or is it the instrument sunset and retiring on the beach. Access, or structure that meets the requisite? suitability, liquidity and transparency are COH Careers COH Careers City of Houston The simple answer is, sure. The just a few variables that need to be taken

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Dear Doctors and Staff, Let us take the guesswork out of fracture referrals. No more waiting for appointments! “alternative” label is vague and could into consideration before scratching a big We at the Orthopedic Care Center loosely be defined as anything other check to the latest and greatest hedge wish to offer your patients and staff than owning only equities, bonds or fund, business opportunity or real estate easy scheduling of patients. cash. More importantly, we should be deal. Before making any investment asking ourselves why and what are decisions, I would offer the following: Our office has extended office hours on “ ” “ the benefits” for investing in alternatives? Do your homework first (not after things Fridays to accommodate patients with fractures. The primary goal or purpose for making get messy). This means you need to look On behalf of the Orthopedic Care Center an investment outside the spectrum of a into the backgrounds of the people you traditional equity/bond portfolio is no decide to give money to and hopefully different than the same reason we choose they have deep experience in allocating to own many stocks, as opposed to just money to alternatives. Make sure they Lubor Jarolimek M.D. one, or both equities AND bonds, not have skin in the game themselves if all just one or the other. The mission is possible. Secondly, when it comes to simple, incorporate assets that increase exotic investments, never invest more ORTHOPEDIC diversification within the portfolio such than you can afford to lose and make that it will have better returns and/or sure you’re comfortable with the lack CARE CENTER lower volatility (less bumps in the road) of liquidity. Next, invest in what you than it would otherwise. understand. If you cannot understand 2121 OAKDALE the general concept of how the investment Now that we’ve covered the “why” works, find a new investment. Lastly, HOUSTON, TX 77004 portion of the test, let’s move on to the manage your expectations and trust your “how.” More specifically, how does gut. Like your parents probably told you one make an investment that reduces growing up, if something sounds too Call us today! volatility and increases return for the good to be true, then it probably is.

OCC_FractureFridaysFA3_Outlined.indd 1 5/29/2013 7:20:41 PM medicaltimesnews.com April 2015 Page 9 Houston Medical Times

Marketing Essentials Mobile Search: Get Listed Above the Competition…or Disappear

By Stewart than any 300-page YP directory. Gandolf, MBA CEO & Co-Founder First, smartphones and other mobile HealthCare Success devices are close by and immediately Strategies available at a time of need, urgent or otherwise. They are nearly always the consumer’s pocket or hand. (Try that Mr. 50-pound Big Book Directory.) A dermatologist and I were talking And more than 50 percent of Internet the other day about online search and users access it from a mobile device, Google search results in particular. according to Google. His pragmatic view is that Google has the screen, a smartphone user enables seen ahead of your competition—then become the new phone book. It’s where Secondly, the smaller screen of a quick decision, makes an immediate you and your medical practice simply consumers—prospective patients— a mobile device draws the visitor s ’ phone call, and displays a map and don’t exist. turn first to search for and to find a attention to the first listings on the driving directions. Although these same “dermatologist in [community].” page—the listings that are seen first capabilities are available with second The first page of Google’s search draw the most response. But regardless page listings, the consumer has already results is highly prized real estate. What’s more, he feels that if a of the screen size, most people (75 left the building. There’s no fee attached to appearing medical practice isn’t prominently percent) never scroll beyond the first among these organic search results, visible high on the list of results, then page, which gets better than 90 percent So… Do you want to be above but there is professional investment they simply don’t exist for today’s of search traffic activity. (On page two, your competitors on Google? in putting together the right blend of patient. And he’s correct. Online search traffic drops to less than five percent Answer: Definitely yes; otherwise relevance to search terms and other is the new YP directory or Thomas is kindly referred to as a marketing you disappear. Our friend the Search Engine Optimization (SEO) considerations. Guide map of today. In fact, it’s far dead zone.) dermatologist would say that if you more prolific, available and convenient Third, with a few additional taps on aren’t listed high on the first page—and

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knowing that there is an interpreter A Sign of the Times for Hearing Impaired available to them at any moment,” says Dr. Kalpalatha Guntupalli, chief, Medicine Patients ICU, Ben Taub Hospital, and associate professor, Baylor College of Medicine. “In outpatient surgery, I can get the Harris Health System is now using portable device and in a minute turn sign language video technology to better it on to communicate directly with the communicate with its hearing-impaired interpreter who provides face-to-face and hard-of-hearing patients. Connecting service between me and my patient,” patients with physicians and nurses in adds Marcy Balderas, RN, clinical nurse, a timely and convenient manner is one Surgery Clinic, Harris Health Outpatient of the driving forces behind the new Center at Lyndon B. Johnson Hospital. portable interpretation service. The iPad® carts, Language You New iPad®-equipped wheeled carts See (L-UC), operate using the hospital’s (similar to rolling blood-pressure stands) Wi-Fi service and charge on a per minute act as in-person translators of American basis with no minimum requirements for Sign Language for patients and staff at a interpretations. The service is available moment’s notice. The program has four 24 hours a day/seven days a week. While such carts complete with speakers and Graciela Zozaya convenience and providing patients with audio enhancement capability at Harris timely medical care are essential, the new Health’s Ben Taub, Quentin Mease and requested urgently, during off-business devices also are expected to provide Harris Lyndon B. Johnson hospitals. hours or on weekends. All requests were Health a significant cost savings (about 37 New iPad®-equipped wheeled carts charged a minimum of two hours. percent) for sign language interpretations. “One of the greatest advantages of Services serves about 20,000-30,000 using this new technology in clinical Sign language interpreter costs can be “Being able to embrace technology, we requests for Spanish interpretations a settings is its on-demand availability,” quite expensive, especially for hospitalized are better able to serve our hearing-impaired month, plus requests for more than 80 says Graciela Zozaya, manager, Harris patients needing round-the-clock patients by providing them an important other languages. Sign language requests Health Interpretation Services. “This interpretation. Zozaya recalls the case means of communication,” says David are relatively few, but a necessary means less waiting time for patients and of a hearing-impaired patient needing Riddle, administrative director, Harris addition to the more than 200 languages better time management efficiency for intensive care hospitalization. The cost for Health Patient Experience. “The process available for interpretation. Harris providers and staff.” interpretation was about $12,000 because to connect to the service is simple, fast Health. Interpretation Services provides an interpreter was needed throughout and effective, and our patients get their assistance through a dedicated call center, In the past, Harris Health used the patient’s stay. care in a timely manner to provide them in-person interpreters, two-way telephone a service that provided in-person with the best possible health outcomes.” connection and now video connections. interpreters at a cost up to $105 an hour. “In hospitalized patient settings, it Spanish and Vietnamese interpretations TheTW and higher Heights cost Medical was Timesassessed ad_Layout for calls 1 10/27/14 provides 9:38 AM the Page patient 1 with peace of mind Harris Health’s Interpretation are the most requested languages. Live Life Well

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April 2015 medicaltimesnews.com Houston Medical Times Page 12

Age Well Live Well Texercise Materials Available in Spanish

Jeff Carmack, rates of obesity, hypertension and high Managing Editor, cholesterol, which lead to make heart Texas Department of disease, as leading problems among the Aging and Disability Hispanic population. And the American Heart Association says that Hispanics in the United States are disproportionately affected by diabetes.

Fortunately, it doesn’t have to be Americans are living longer but that this way. Heart disease and diabetes, doesn't necessarily mean we’re staying as well as other “lifestyle” diseases, can Buckner’s Solid Reputation. healthy in those later years. Just look at be minimized or prevented by regular Parkway’s Dynamic Programs. the facts: physical activity and a healthy diet. Houston’s Smartest Choice. ∙∙ In Texas, cardiovascular diseases Texercise, a statewide health are among the 10 most frequent promotions program provided by causes of hospitalization of the Texas Department of Aging and The Assurance of Continuing Care. people 45 years and older Disability Services (DADS), can help Whether it’s independent or assisted living, (preventdisease.com). Texans address some of these common health ailments. Texercise equips people memory care or skilled nursing, you’re ∙∙ Preventable illnesses make up assured of the lifestyle that suits your to adopt healthy habits, including good approximately 80 percent of nutrition and regular exercise. needs. Why not learn even more? the burden of illness and 90 Call Susan at 281.677.5912 today, or visit bucknerparkwayplace.org.

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Regular exercise: percent of all U.S. health care costs (Texas Department of ∙∙ Promotes healthy muscles, State Health Services). bones and joints. ∙∙ More than 1 million Texans have ∙∙ Improves balance and been diagnosed with diabetes coordination. and another half-million are believed to have undiagnosed ∙∙ Increases stamina. diabetes (Texas Department of State Health Services.) ∙∙ Reduces the cost of medical care. These numbers apply broadly to our diverse population, but demographers Texercise materials, including a haver also studied individual ethnic manual, activity logs and hints for groups, including Hispanics. healthy eating are available in English and Spanish at www.Texercise.com. The United States Department of Health and Human Services cites high

medicaltimesnews.com April 2015 Page 13 Houston Medical Times

Study Looks to Confirm Antivenom Has “Bite” Against Copperhead Snakes

Dr. Spencer Greene wants to make sure the standard treatment for copperhead snake bites, the most common venomous snake in greater Houston and southeast Texas, works, and if it doesn’t, he wants to stop its use.

As director of medical toxicology for Harris Health System’s Ben Taub Hospital and assistant professor of medicine and pediatrics at Baylor College of Medicine, and the only board-certified medical toxicologist in the Texas Medical Center, Greene also is principal investigator of an antivenom study for the dangerous reptile. Dr. Spencer Greene “Right now, the optimal management of copperhead bites is uncertain. Some eligible copperhead snake bite victims people swear by antivenom (CroFab), now through the fall. Participants in some people swear that it’s not helpful the national study must be 14 years or and possibly harmful,” he says. “There’s older, verify that they were bitten by a good evidence that antivenom is not copperhead within 24 hours and not harmful and my experience tells me that have been administered any antivenom it is probably helpful for copperhead bites, prior to enrolling in the study. but we don’t yet know that for a fact.” Presently, copperhead bites are treated The research is being coordinated at with CroFab, a treatment tested and 18 healthcare sites across the country— proven for cottonmouth and rattlesnake Ben Taub is one of five in Texas. bites. Copperheads, also part of the pit “My suspicion is that it does work, viper family along with cottonmouths and but we want to do the study to know rattlesnakes, have no tested treatment.

for sure,” Greene says. “Does it help with copperhead bites? If it does, we’ll The treatment of CroFab costs about encourage greater use of it. And, if it turns $2,300 a vial, and many snake bite out it’s not helpful, we’ll stop using it.” victims can require up to 18 vials for a full treatment. With the start of spring and warmer temperatures in the forecast, snakes will Greene says copperheads account be more active, and unfortunately, that for more than 50 percent of all bites in usually translates to more victims of snake greater suburban Houston. Some bite bites. The snake usually strikes its target victims do fine without any treatment and most often reacts out of fear when and suffer no permanent tissue damage disrupted. Its muted colors of grays and or systemic toxicity. However, others do. browns make it difficult to see before it In 2012, 60 people nationwide suffered strikes. permanent tissue loss, disfigurement or disability because of a copperhead bite. Greene and his team are looking for

April 2015 medicaltimesnews.com Houston Medical Times Page 14

Airplane or giant germ-mobile: How to avoid travel germs

By Elizabeth Grimm avoid catching anything in-flight. Texas A & M Health Science Center “While airplanes seem like they’re the surest way to catch a cold or something Traveling can be a hassle and a nastier, research suggests that the hazard – especially during cold and flu perceived risk is greater than the actual season – but there are some ways you risk,” Columbus commented. “But it’s can avoid picking up any unwanted always helpful to take some preventative passengers in-flight. measures, especially when the flu or another communicable disease is going Many of us have experienced it: The around.” woman next to you on the plane just the door and turning faucets on and off. If a passenger looks to be contagious, a sneezed without covering her mouth, flight attendant can request that they wear Be aware of your personal space Columbus also suggests bringing a the man behind you is coughing a surgical mask to reduce the chance of small, travel-sized bottle of alcohol-based uncontrollably and you can practically spreading the illness. The flight attendant “Many of the germs you will come hand sanitizer for before and after you eat feel the germs closing in on you as you may also be able to relocate the sick across will be on the armrest or the tray or drink on the plane. The Transportation sit in your cramped seat on what appears traveler away from other passengers if table in front of you,” Columbus said. Security Administration (TSA) allows to be a giant germ deathtrap. Traveling extra seating is available. “You can bring a few sanitary wipes in passengers to bring 3.4 ounces of liquids isn’t always fun, especially during cold and your carry-on and eliminate much of per container in their carry-on bags, as “It’s an awkward social position flu season, but sometimes it’s necessary. your risk there.” long as they are kept in a quart-sized to find yourself in, but if you feel like plastic bag and separate from other items. the person might be contagious, it’s in While a plastic bubble and a personal For areas like the bathroom, follow everyone’s best interest to take precautions. supply of oxygen may seem like the only the Centers for Disease Control and A flight attendant requesting they put on way to keep those germs away, Cristie Preventions (CDC) guidelines for Ask the flight attendant for assistance ’ a mask might make your neighbor realize Columbus, M.D., vice dean of the Texas washing hands: use plenty of soap and If the person next to you can’t stop they’re affecting the people around them,” A&M Health Science Center College water and wash your hands for at least 20 coughing and refuses to cover their of Medicine in Dallas and an infectious seconds. You can avoid touching surfaces mouth, you can quietly excuse yourself disease specialist, offers some tactics to by using paper towels to open and close and enlist the help of a flight attendant. see Avoid Travel Germs page 22

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physician partnerships will continue to the first Baby-Friendly Hospital in ASHLEY MCCLELLAN NAMED THE position TWHT as an industry leader the area. Under Linda’s leadership, WOMAN’S HOSPITAL OF TEXAS CHIEF in the Houston market.” the hospital has continued to deliver more babies than any other hospital in EXECUTIVE OFFICER Ashley is a Fellow in the American Harris County with more than 10,000 College of Healthcare Executives and births a year. earned her BBA in Finance from HCA Gulf Coast Division Southern Methodist University’s Linda was recognized as the President Maura Walsh announced Cox School of Business, and both Houston Business Journal’s 2009 today that Ashley McClellan has been her MBA and MHA from Texas Healthcare Hero Administrator of named the Chief Executive Officer Woman’s University. In 2010, Ashley the Year and the March of Dimes (CEO) of The Woman's Hospital of was honored in the Dallas Business Texas Chapter’s 2007 Outstanding Texas (TWHT). Previously, Ashley Journal’s annual 40 Under Forty issue Volunteer Fundraiser. Governor served as the CEO of Medical Center and was presented the 2011 Young Rick Perry appointed Linda to the of Lewisville in HCA’s North Texas Healthcare Executive of the Year award Judicial Compensation Commission. Division. She began her career with from the Dallas/Fort Worth Hospital Linda has also served on the March HCA in the Chief Operating Officer Council. of Dimes Board of Directors and (COO) development program as the Ashley will be relocating to Executive Board as well as their Associate Administrator at Overland Houston with her husband, Brett, and State Executive Committee, and the Park Medical Center in HCA’s their two sons, Brooks and Spencer, Board of Directors for the Gulf Coast Midwest Division in Kansas. Ashley and will begin her new role on May Regional Blood Center. was promoted to COO at Medical 12th. “Through Linda’s trusted Center of Lewisville, and served in partnerships with employees, that role until 2011 when she was Linda Russell, TWHT’s current physicians, patients and the promoted to CEO. CEO, is retiring after 21 years of community, she has made TWHT a service. Linda began providing “Ashley is an outstanding leader market leader in women’s services.” excellent leadership at TWHT in who has been integral in improving Ashley McClellan said Walsh. “Linda has dedicated her employee engagement and expanding 1994 and has led three major hospital career to ensuring TWHT provides hospital services at Medical Center HCA Gulf Coast Division President. expansions. Most recently, TWHT superior patient care, and we are expanded its services with a new of Lewisville,” said Maura Walsh, “Her focus on quality patient care and committed to continuing her vision.” Pediatric Center and was designated

medicaltimesnews.com April 2015 Page 17 Houston Medical Times

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The Framework TIRR Memorial Hermann Offers New Dining Experience to Patients and Families

went one step further and dropped the There’s nothing typical about the counter tops to 30 inches. Cumbersome care patients receive at TIRR Memorial doors to drink coolers have been replaced Hermann and now there’s nothing typical with doors that slide open and stay open. about their dining experience. The world- renowned rehabilitation hospital has “We tried to think of everything. We recently re-opened its café with the needs even contacted one fast-food corporation of patients and their families in mind. about a proprietary trash can design,” says Jeff Whitaker, director of Food and The fresh look is what you’d expect at Nutrition Services. “We want to create as a new neighborhood restaurant or café not independent an eating experience as we Cafe Before at a hospital. The café’s design features and can for our patients and to that end we special touches are unique and second to spare no effort.” none. Whether its tilted menu monitors or drinks that dispense with a touch of a button, everything is set up to provide “From a design standpoint we’ve patients more independence. made a huge leap forward,” says Jerry Ashworth, FACHE, director of Hospital Operations at TIRR Memorial Hermann. “We see ourselves as a leader in “The café is inviting and much more our field,” says Carl Josehart, Sr. Vice accessible to our patients and if you’re President and CEO of TIRR Memorial here on Thursdays you have to try the Hermann. “In line with the Americans chicken Santa Fe salad it’s unbelievable,” with Disabilities Act (ADA) guidelines adds Ashworth. we built our café in such a way that is better for our patients and their families. ” The new café also offers a self-service The ADA recommends countertops area open 24 hours a day. Patients and be no higher than 34 inches from the their families can purchase fresh food and ground to provide easier access for those in drinks through a kiosk, also designed to wheelchairs. TIRR Memorial Hermann provide access to everyone. Cafe Opening Day

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New Hepatitis C Drugs Continued from page 1 treatments will save health care money explains. “Considering the law also using the drug discounts given in prohibits Medicare from negotiating 2014,” said Chhatwal. “However, drug pricing, the new treatment cost competition from AbbVie has recently could strain the budget of Centers brought down drug costs, which may for Medicare and Medicaid Services.” change the outlook.” “Economics need to play an “While most developed countries important part of improving the health factor in treatment cost before care system,” said Chhatwal. Hepatitis Jagpreet Chhatwal, Ph.D approving a drug, U.S. law prohibits C presents an unusual case where we sufficient. Both the government and [See note to media above.] considering such costs. have cost effective therapeutic options private insurers will need additional Our analysis clearly does not Therefore, patients almost always that our health care system cannot resources to effectively manage this support an assertion that the new end up paying more for the drugs that afford,” Chhatwal continued. “While epidemic.” were developed in the U.S.,” Chhatwal lower drug prices will help, that’s not

Legal Health Continued from page 3

ACOs have had in earning more heavily weighting and skilled nursing facilities; deliver some of the benefit savings every year (in the attainment”) incentive payments for enhancements described optional fourth and fifth receiving ACO services; and above (Preferred Providers extension years under the 6. the ability to engage a process to voluntarily opt must be Medicare-enrolled program, CMS may use “this beneficiaries through benefit into an ACO providers/suppliers but need alternate methodology, which enhancement, such as greater not be ACO participating focus[es] on de-emphasizing access to post-discharge home 7. the option to utilize historical expenditures and visits, telehealth services, “Preferred Providers” to see Legal Health page 20

April 2015 medicaltimesnews.com Houston Medical Times Page 20

Legal Health Investment Management For Continued from page 19 providers/suppliers) Medicare Advantage for a provider Individuals & Institutions organization.” This model also follows CMS’s WRWCO, LLC December 1, 2014, MSSP proposed Between the NGAM and the A Registered Investment Advisor rule, in which CMS proposed a proposed changes to the MSSP, new two-sided shared savings and Medicare ACOs may look very loss model and sought guidance different within two years, as they must to continue to attract and retain We are investment managers. from stakeholders regarding the most appropriate benchmarking ACO participants. CMS, no doubt, We build & manage investments that operate like methodology. After five years of believes that the NAGM program endowments. We emphasize investments that pay implementing and overseeing ACOs, will provide a transition from current regular, predictable, & increasing income in addition CMS recognizes the need for a new incentive models that rely primarily on improvements to earn enhanced to generating capital appreciation & gains. model that “sets more predictable financial targets, enables providers payments to models that reward a We invest in Stocks, Bonds, & other publicly and beneficiaries greater opportunities more stable state of high-quality/ traded securities. We are a “fee-only” firm & do to coordinate care, and aims to attain low-cost service delivery. not charge commissions. Our principal investment the highest quality of care. Under ” Deadlines and Further existing program parameters, only five managers are a Father-Son team with combined Information 50 plus years investment experience. of 405 MSSP ACOs have embraced the two-sided risk model. The Program information, including Bill Williams, President enhanced flexibility in the Pioneer Letters of Intent, application standards Model has proved more successful and procedures, and FAQs may be (713) 681-9305 in generating savings and quality, but found at the CMS Innovation Center (877) 681-9305 (Toll Free) that program is limited to only 19 website (http://innovation.cms.gov/ participating ACOs. initiatives/Next-Generation-ACO- www.wrwcollc.com (website) Model/). Organizations interested [email protected] (email) In discussing the NAGM, Dr. in applying for the first of two rounds Patrick Conway, the CMS Deputy of three-year awards must submit a Administrator for Innovation and Letter of Intent by 11:59 p.m. (ET) Quality, said the industry “need[s] on May 1, 2015, and an application something that looks more like by 11:59 p.m. (ET) on June 1, 2015.

Mental Health Continued from page 5 neuroscience, and nursing are learning area was a cutting-edge accomplishment to assess and treat families using a that is still in its infancy. However, multidisciplinary lens. This lens enables research on his model has already us to see children holistically, to focus shown promising results with children on development, biologically-based on the autism spectrum, and students individual differences, and relationships, in our program, who have their own and to study the micro-system of the professional careers, are beginning to family relationships, the meso-system disseminate the model through their of other environments that touch the own practices while touching families’ child directly such as the neighborhood lives in whole new ways. In this and the school, and variables that innovative, creative work, the child and affect the child indirectly, such as the parent jointly attend and communicate parents’ work schedules, and to look in a back-and-forth, co-regulating way at all of this cross-culturally. This is in which neither partner dominates currently the only doctoral program in the other. The child and the parent, the world that offers a Ph.D. in the area to use Dr. Greenspan’s words, “share of infant and early child development the gleam in one another’s eyes!” It is with an emphasis on mental health this gleam that we are aiming for with and developmental disabilities. our doctoral students, and we hope that their dissertation research lights Dr. Greenspan was a pioneer in up each of the disciplines in which our the field of infant mental health. His students are involved. synthesis of different disciplines in this

medicaltimesnews.com April 2015 Page 21 Houston Medical Times

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Healthy Heart HOUSTON Continued from page 6

whole grains. exercise intensity and duration. the point of developing heat Published by Texas Healthcare exhaustion. Media Group Inc. ∙∙ Protein. Protein can help repair ∙∙ A person who perspires heavily and build muscle. Choose will need to drink more than For most people, water is the Editor healthy protein foods such someone who doesn’t. best thing to drink to stay hydrated. Sharon Pennington as fish, skinless chicken, lean Sports drinks with electrolytes may be meats, fat-free and low-fat milk ∙∙ Certain medical conditions, useful for people doing high intensity, Director of Media Sales and dairy products, beans, and such as diabetes or heart disease, vigorous exercise in very hot weather, Richard W DeLaRosa vegetarian alternatives. may also mean you need to but they tend to be high in added sugars drink more water. People with and calories. Sugary drinks like soda Creative Director Staying Hydrated high concentrations of sodium can be hard on your stomach if you’re Lorenzo Morales in their sweat need to be careful dehydrated, and it’s best to avoid drinks Keeping the body hydrated helps the to avoid dehydration. And containing caffeine, which acts as a Distribution Director heart more easily pump blood through some medications can act as diuretic and causes you to lose more Angelo Rose the blood vessels to the muscles. And, diuretics, causing the body to fluids. Many fruits and vegetables it helps the muscles work efficiently. If lose more fluid. also contain a high percentage of Accounting you’re well-hydrated, your heart doesn’t water, making them an ideal pre- or Liz Thachar have to work as hard. ∙∙ Thirst isn’t the best indicator post-workout snack! that you need to drink. If Dehydration can be a serious you get thirsty, you’re already Office: 713-885-3808 condition that can lead to problems The American Heart Association dehydrated. The easiest thing to Fax: 281-316-9403 ranging from swollen feet or has great resources available online do is pay attention to the color that can provide more information on a headache to life-threatening of your urine. Pale and clear For Advertising illnesses such as heat stroke setting diet goals, heart-smart shopping, means you’re well-hydrated. If advertising@medicaltimesnews. healthy cooking, dining out, and free it’s dark, drink more fluids. com How much water do you need? recipes. Visit our Nutrition Center at www.heart.org/Nutrition. Be sure to ∙∙ Not sweating during vigorous Editor ∙∙ The amount of water a person physical activity can be a red join the conversation online on Twitter [email protected] at @ahahouston #houstoniswhy. needs depends on climate flag that you’re dehydrated to conditions, clothing, and

Avoid Travel Germs Continued from page 14 Columbus said. Houston Medical Times is Published by Texas Healthcare However, it’s important to remember Media Group, Inc. All content respiratory etiquette when the shoe is on in this publication is copyrighted the other foot. If you are feeling sick or by Texas Healthcare Media have a cough, remember to cough and Group, and should not be sneeze into the crook of your elbow and away from others. Wash your hands with reproduced in part or at whole soap and water or use hand sanitizer without written consent from frequently. the Editor. Houston Medical “I would suggest trying to avoid flying Times reserves the right to edit if you’re feeling ill, especially if you think all submissions and assumes you’re contagious, but if you can’t, be no responsibility for solicited considerate of your fellow passengers and or unsolicited manuscripts. All do your best to contain your illness,” Columbus advised. submissions sent to Houston Medical Times are considered Bolster your own immune system every couple of hours to avoid blood clots. all communicable diseases are airborne. property and are to distribute pre-flight If you have a cold or sinus infection, the Being cognizant of the prevention for publication and copyright Ultimately, your best defense against change in cabin pressure might aggravate techniques for different diseases will purposes. Houston Medical sickness is your immune system. Try to symptoms, so Columbus suggests taking reduce your risk of contraction; for more Times is published every month get plenty of sleep and drink water before decongestants and ibuprofen (as long as information about in-flight transmission of communicable diseases and how to your flight to help your immune system there are no potential interactions) to P.O. Box 57430 be at its best. If you are on a long or help alleviate symptoms, before the flight. prevent them, visit the CDC’s website transatlantic flight, stay hydrated and on travelers’ health. Webster, TX 77598-7430 remember to move your legs or stand up It’s important to remember that not

medicaltimesnews.com April 2015 Page 23 Houston Medical Times

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