Houston Medical Times

Serving Harris, Galveston, Brazoria and Fort Bend Counties

November Issue 2014

HOUSTON

PRSRT STDUS POSTAGE

PAIDPERMIT NO 1HOUSTON TX

Janet Barker could write a book about being a caregiver. Barker spent 13 years taking care of her mother, evolving from tracking her mother’s medications to living with her in a senior housing setting. Along with a sister, she now helps care for her 95-year-old aunt.

People like Barker who provide unpaid voluntary care and assistance for family members are sometimes called “family caregivers.” By helping with daily activities such as meal preparation, bathing and dressing, medication, transportation, shopping, and more, they provide much of the support that lets people stay in their homes and out of institutions.

There are an 2.7 million caregivers in Texas. “The value of care given by unpaid – or family – caregivers in Texas is estimated at $34 billion a year,” said Joyce Pohlman, grants coordinator at the Texas Department of Aging and Disability Services (DADS). “Their work is estimated to save the state $3.2 billion to $12.6 billion in Medicare and institutional spending a year.”

Pohlman said that about 50 percent of caregivers are reported to have clinically

significant symptoms of depression, and that women – who make up the bulk of the caregiver cohort – tend to have higher rates of depression and anxiety and lower levels of well-being and life satisfaction than do male caregivers. More than one-fifth of all caregivers report being exhausted when they go to bed at night.

One in 10 caregivers reports that caregiving has caused their physical health to suffer. Additionally, caregivers are known for neglecting themselves by not addressing their needs, leading to chronic health conditions such as heart disease, heart attacks and cancer at twice the rate of non-caregivers. Seventy percent of caregivers who also work outside the home say that their caregiving duties negatively affect their work, forcing them to juggle work hours or take leave to deal with their caregiving responsibilities.

Fortunately, there is help for caregivers in the form of respite care -- short-term help that provides temporary relief to caregivers

“Research shows that respite and other supports have a positive effect on mental and physical health,” Pohlman said.

Caregivers have respite options, Pohlman said. Most DADS waiver programs offer respite as part of their services, and the National Family Caregiver Support Program -- operated by the area agencies on aging -- provides respite information for caregivers. The AAAs and aging and disability resource centers also use the “train the trainer” model to equip caregivers to take care of themselves, and manage their lives better.

Another resource assembled by DADS and the Texas Respite Coordination Center is the Take Time Texas (TTT) website. The centerpiece of TTT is a searchable database with a list of more than 1,000 respite care providers. Users can filter searches by county, type of provider, age of recipient and the type of respite they provide.

The Texas Lifespan Respite Care Program is a state-funded program that pays for respite care. People who are not qualified to get respite services through other programs can sometimes receive them through this program, Pohlman said.

If you provide care for a family member and need a break, respite can help. www.dads.state.tx.us/taketimetexas.

By Jeff CarmackManaging EditorTexas Department of Aging and Disability

RESPITE CARE: CARING FOR THE CAREGIVERSInside This Issue

Cheaper Medications may be CounterfeitSee pg. 10

INDEX

Legal Health .................pg.3

Money Matters .............pg.4

Mental Health...............pg.5

Healthy Heart ...............pg.7

Marketing Essentials ......pg.9

What you don’t know about Hospice Care

could hurt youSee pg. 15

Houston Medical TimesPage 2

November 2014 medicaltimesnews.com

Jeanne and Peter KinnearCommunity Honorees

FMC TechnologiesCorporate Honoree

Dr. Daniel PennyTexas Children’s Hospital

Medical Honoree

Brenda and Marc WattsHeart Ball Chairs

Judy and Russ Labrasca Amanda and Jeff Malone

Auction Co-Chairs

Liz and Robert RigneyOpen Your Heart Chairs

Katie Pryor at 713.610.5072 or [email protected]

Jason FewChairman of the Houston

Board of Directors

Dianna M. Milewicz, M.D., Ph.D.President of the Houston

Board of Directors

C

M

Y

CM

MY

CY

CMY

K

AD_9.5x12.375_HB-2.pdf 1 10/24/2014 3:46:59 PM

Houston Medical Times Page 3

November 2014medicaltimesnews.com

existing, patients. If the concept of a transportation safe harbor is, as the OIG states, to promote “legitimate financial and patient care interests in the provision of local transportation to patients” then the safe harbor should not universally exclude from protection a whole segment of the industry who may be legitimately offering transportation services. There are many legitimate reasons why these entities may provide transportation services. Potentially excluding transportation services to referral sources unnecessarily limits the applicability of the safe harbor, and its beneficial effect on patient access because health care organizations and professionals are typically part of a community of intertwined referral networks. In addition, limiting the transportation safe harbor to existing patients means that new patients with

health care services and the alignment of financial incentives among health providers. The Proposed Rule also attempts to further assist patients in being able to access health care in situations in which these laws have impeded health care providers and suppliers from offering services free of charge or at reduced amounts.

The various proposed new safe harbors that are included in the Proposed Rule relate to the following issues:

1. Part D Cost Sharing Waivers by Pharmacies

2. Cost Sharing Waivers for Emergency Ambulance Services

3. Federal Qualified Health Centers and Medicare Advantage Organizations

4. Medicare Coverage Gap Discount Program

5. Local Transportation

1. Background

On October 3, 2014, the Department of Health and Human Services’ Office of Inspector General (the “OIG”) published a Proposed Rule to add new safe harbors to the federal health care program anti-kickback statute (the “Anti-Kickback Statute” or “AKS”).

It is the first time in seven years that the OIG has either issued any significant changes to or proposed any new safe harbors under the Anti-Kickback Statute. The Proposed Rule sets forth a number of provisions that codify certain exceptions and modifications to laws that Congress has adopted over the last decade. In addition, the Proposed Rule addresses changes regarding payment for

By Daniel E. Gospin, J.D. EPSTEINBECKERGREEN

Legal HealthOIG Proposes New Safe Harbors to the Anti-Kickback

Statute

see Legal Health page 18

2. Public Comments

The OIG has asked the public to provide comments on a number of significant issues addressed in the Proposed Rule. While the Proposed Rule addresses a number of important topics, it falls short of providing full flexibility to health care organizations to accomplish the access and cost-efficiency goals the Affordable Care Act amendments were designed to address, and is otherwise unnecessarily narrow. In some instances, additional clarity is necessary in order to aid providers in determining how best to comply with the proposed new safe harbor provisions. Below are two examples where comments to the OIG are critical:

a. Local Transportation

The proposed safe harbor protecting free or discounted local transportation services to federal health care program beneficiaries is unduly narrow. The OIG proposes limiting the safe harbor to only local transportation (anything within 25 miles). The OIG also proposes to exclude transportation by certain entities (e.g., suppliers or pharmaceutical manufacturers) to certain providers (e.g. referral sources of the transportation provider) and to new, as opposed to

Official Airline of Houston Ballet

Purchase online at

houstonballet.org or call 713.227.2787

The Nutcrackern November 28 – December 28, 2014

Save money at discounted performances Thanksgiving weekend, Nov. 28 – 30!

STANTON WELCH l ARTISTIC DIRECTOR

Shell Oil Company



ways; first an employer contribution

and second an interest credit, which

is guaranteed rather than dependent

on the plan’s investment performance.

This type of plan is an employer-only

contribution plan and the employer

contribution is determined by a formula

specified in the plan document. It can

be a percentage of pay or a flat dollar

amount and can be offered in addition

to 401(k) Profit Sharing plans or other

plans the employer offers. In fact, in

most cases, a 401(k) Profit Sharing plan

in conjunction with a Cash Balance

Plan is necessary to produce the desired

owner and employee contributions.

Like any other qualified plan, a Cash Balance Plan is subject to non-discrimination testing. Employers can anticipate contributions in the range of 5% to 7.5% of pay for rank in file if the owners or partners receive the maximum Cash Balance contribution. The exact percentage required for employees depends on the number of employees included in the plan and the results of non-discrimination testing.

Cash Balance plans can be amended periodically to permit different contribution levels; additionally, a plan

Money MattersHow to Solve Your Retirement Funding Dilemma

Most physicians have a limited understanding of how much they need to save in order to fund 25 to 30 years of retirement. With annual 401(k) and profit-sharing contributions capped at $57,000, options seem limited, especially for older physicians who need to save aggressively. Early in their careers, many physicians have priorities centered on school tuition and mortgage payments. Even later in their careers when physicians focused on their retirement, they found that there was no easy way to “catch-up”to accumulate an adequate nest egg without having to continue to work. The bottom line is it will require having $2 million in conservatively managed assets to generate approximately

$80,000 a year in retirement income to avoid outliving one’s assets.

Is a Cash Balance Retirement Plan for You?

Physicians and Physician Groups who are looking for larger tax deductions and accelerated retirement savings may find that a Cash Balance Plan may be the perfect solution for them. Adding a cash balance plan to the existing 401(k) plan can squeeze 20 years of savings into just 5 or 10 years.

A Cash Balance Plan is a type of IRS-qualified retirement plan known as a “hybrid,” since it combines the high contribution limits of a defined benefit plan with the flexibility and portability of a 401(k) plan. This type of plan can be an ideal retirement vehicle because physicians can accelerate their savings, yet there is a fair amount of flexibility; not everyone in a group has to receive the same contribution. Each participant has accounts that grows annually in two

TREAT YOUYOU

Greenway Plaza (832) 232-5200 | Texas Medical Center (832) 232-9300 | Midtown (713) 343-1400 | Westchase (713) 360-5100

cookiedelivery.com

Warm cookies, made from scratch,

baked to order, delivered right to your door.

©2014 Tiff’s Treats

Warm cookies, made from scratch,

baked to order, delivered right to your door.

see Money Matters page 18

By Margaret Sucré-VailSucré-Vail Wealth Advisors



Paid Advertorial

Mental HealthALCOHOL – SPECIAL AND DEADLY

Alcohol is special, albeit arbitrarily. Alcohol is certainly not the most benign drug human beings abuse, but since it’s been around the longest, it has simply had more time to ingratiate itself into our psyche.

After thousands of years, alcohol has managed to become enmeshed in our cultural DNA. It is a necessary component of many religious rituals. Indeed, even under Prohibition, Jewish people were given special permission to purchase and possess wine. Every Sunday, wine is consumed in many Churches across the country, and who could fault the Irish for drinking at wakes – funerals are painful! Birthdays, Anniversaries, New Year’s Eve, and St. Patrick’s Day are but a few other examples of alcohol’s prominence. Even on other lesser-known holidays, such as Arbor Day or Friday, alcohol is simply ubiquitous.

Whether or not we drink the stuff, most of us at least recognize that alcohol is a sacred ingredient of holidays, celebrations, and even religious ceremonies. Of course, it feels pretty good as well. Alcohol is fully legal (only at 21 years of age) and alcohol drug dealers are still allowed to advertise on television, unlike nicotine drug dealers. Who could deny the ‘special-ness’ of booze?

Alcohol is special - it’s the most commonly used mind-altering drug in the United States. But this popularity comes at a high price. Nearly 20 million Americans suffer with an alcohol abuse disorder. Millions more engage in high-risk drinking that very well could lead to alcoholism. Alcohol stands alone as the largest contributor to preventable causes of death in the U.S. - alcohol abuse disorders eliminate nearly 3 million years of potential life each year, or approximately 30 years of potential life lost for each death. Furthermore, alcohol costs us north of $185 billion annually in lost productivity, healthcare

By Jason Powers MD, MAPPChief Medical Offi cerRight Step & Spirit Lodge

costs, and criminal justice costs.

Alcohol is special, but it’s not unique. To be sure, alcohol is a mind-altering abusable drug like cocaine and heroin. Ethanol, the active intoxicating ingredient is a central nervous system depressant drug. Like all drugs of abuse, alcohol mainly exerts its effects and causes dysfunction in the mesolimbic dopamine system (aka “the addiction center”). Additionally, the signs and symptoms of alcohol addiction…scratch that, alcoholism, are just as predictable and generally identical to every other drug of abuse.

Amongst all the drugs of abuse, alcohol addiction generally takes the longest to develop. That is, people can and do drink for decades before alcohol addiction sets in whereas crack or methamphetamine addiction has a very short gestation period. Alcohol is over-imbibed for so long in fact that it's the only addiction which has a “high functioning” qualifier. I would bet dollars to donuts you've never heard anyone refer to himself or herself as a functional heroin addict.

The only reason why people are allowed to abuse alcohol instead of other drugs, even while maintaining respectable lives (often in marriages with a home and kids) is that alcohol is legal, sacred, and in a word: special. But its not unique – alcohol addiction is just as wretched as heroin addiction.

So-called “high-functioning alcoholics” seem to maintain enough of a normal life semblance that their alcohol-related boo-boos are excused or overlooked. From my perspective, using “high functioning” to describe a chronic progressive and fatal illness is not only misleading, it’s negligent. The risks we take in accepting and permitting alcoholism to progress are too grave to ignore. As someone who sees more than a fair share of the bad stuff, early signs of alcoholism are more than cute red

see Mental Health page 18



and even multiply in the presence of antibiotics, making treatment against them nearly impossible.

But now, after decades of using the same basic ingredients for antibiotics, a new way to treat bacterial infection is

finally on the horizon. Carolyn Cannon, M.D., Ph.D., and her team at Texas A&M Health Science Center have discovered that a new set of compounds synthesized by medicinal chemist Lászlo Kürti, Ph.D., with the University of

antimicrobials was originally isolated by researchers more than a decade ago from a bacterium that originates from the ocean. Then, only tiny amounts could be extracted from cultures of the bacteria with great effort. Fast forward to present day, and the current team now has developed a simple method to synthesize the molecule and tweak it.

“The beauty of the discovery is that these compounds can now be synthesized in one pot in 30 minutes. It’s a very scalable procedure that can easily yield large quantities,” Cannon said. “We have been able to take the new compounds into the lab to study their activity, and have found that they

Texas Southwestern Medical Center in Dallas, have the potential to kill MDROs. Specifically, the researchers have their sights set on methicillin-resis-tant Staphylococcus aureus(MRSA) – a bacterial infection caused by a strain of staph bacteria that’s become resistant to commonly used antibiotics, making it so hard to treat, it’s been deemed a “super bug.” This discovery is predicted to yield an entirely new class of treatments for a multitude of drug resistant infections.

“Microorganisms have been battling each other for millennia, so they have a whole armamentarium of ways to kill each other,” said Cannon, who is a pediatric pulmonologist and associate professor at the Texas A&M College of Medicine. “It’s just a matter of us noticing and isolating those weapons and then synthesizing them for use as treatments against pathogens, the bad guys.”

Penicillin and cephalosporin – the bases for the most commonly used modern antibiotics – were first isolated from fungi. Most new FDA-approved antibiotics are simply tweaks of those original molecules. The first molecule of Cannon and Kürti’s new class of

Wielding Nature’s Sword: Researchers at Texas A&M discover new treatments

against drug-resistant infections

Since World War II, antibiotics have saved countless lives by killing disease-causing bacteria. To this day, traditional antibiotics remain the

only treatment against such illnesses, but overuse and misuse have caused some bacteria to develop resistance to commonly used antibiotics. These bacteria, known as multi-drug resistant organisms (MDROs), are able to survive

PetFriendly

4620 Bellaire Boulevard • Bellaire, TX 77401713-665-3888www.GardensOfBellaire.comSNF #000233 • ALF #000579©2014 Five Star Quality Care, Inc.

Job#: GB141002

Size: 10x6.486

Publication:

Client: The Gardens of Bellaire

De: mdk

Ae: sd

Date: 10.28.2014

Rnd~Ver: r05•vA

Colors

C M Y K

NA NA NA NA

Notes:

1017 TURNPIKE STREET, CANTON, MA 02021 • (P) 781.828.9290 • (F) 781.828.9419 • WWW.TRIADADVERTISING.COM

Call 713-665-3888 to schedule your personal tour.

We’re in the Neighborhood!Celebrating

23 YEARS OF

SERVICE!

Our gated community is nestled on lovely landscaped grounds in an upscale neighborhood in the city of Bellaire. We areconvenient to the fabulous Galleria, the world renowned Texas Medical Center, churches of all faiths, the famous Museum Districtand a variety of dining venues. We have proudly served Bellaire, Meyerland, River Oaks, City of West University Place and thesurrounding communities for 23 years!

WE INVITE YOU TO ENJOY:

• Assisted Living with Personalized Care Plan to MaximizeIndependence

• Healthcare Center for Skilled Nursing & Rehabilitation• Five Star Rehab & Wellness for Physical, Speech and

Occupational Therapy• Restaurant-style dining with menu choices

• A full calendar of social, wellness, recreational and spiritualprograms; plus outings to local attractions

• Scheduled local transportation, laundry and housekeepingservices

• A community rich in Hospitality & Friendship• And so much more!

By Lindsey HendrixTexas A&M Health Science Center

Carolyn Cannon, M.D., Ph.D., pediatric pulmonologist and associate professor at the Texas A&M College of Medicine

see Wielding Nature’s Sword page 20



Healthy HeartHealthy Choices, Smart Eating: How to End the ‘Eat Your

Vegetables’ Fight Only NEW Homes from Beazer give you More:

From the $160s to $500s

Personalization Mortgage Choices Energy Efficiency

$1,000 Decorator Allowance for Nurses & Doctors!*

beazer.com281-214-0450

*Offer good on contracts written and signed by buyer(s) from 1/1/14-01/30/15. $1,000 savings comes in the form of a decorator allowance to use towards design center options. Pricing, features and availability subject to change without notice. Not available with any other offer. Additional restrictions may apply. See New Home Counselor for complete details. © 2014 Beazer Homes. 10/14 120837

GET MORE WITH HOMEOWNERSHIP

With the change in seasons fast approaching, now is a great time to focus on taking active steps to incorporate heart-healthy eating as part of your daily life. A healthier lifestyle starts with making smarter choices regarding food. Adopting a better dietary habits and choosing a varied combination of healthy foods is your first step towards better nutrition. A long life of heart health is about taking small steps each day to change how you eat and live. As those small steps add up, you’ll change

your life for the better. Heart disease and stroke affect everyone in this country —you, your neighbors and your loved ones.

Keep It Simple!

Eating more fruits and vegetables is a good goal with the holiday season right around the corner. Most adults are a long way from getting the recommended 4 to 5 daily servings each of fruits and vegetables. Start shifting your eating habits with small, sustainable changes. The best approach is to take it one day at a time. Choose 1-2 areas in your diet to modify as a beginning, such as focusing on eating more fruits and vegetables with each meal and drink more water instead of sugary drinks. Grab a piece of fruit instead of a bag of chips for your mid-afternoon snack. Eat a salad before dinner. Add chopped veggies to your morning omelet. Those little daily

choices can add up to a big difference in your long-term health. Here are a few easy ways to incorporate some of these changes into your daily routine:

∙ Track what you eat. Keep a food diary or use technology to figure out what you’re eating and why. Identify opportunities to swap out sugary or salty snacks with fruits and veggies. Do you grab a bag of chips from the vending machine around 4 p.m. each day? Try bringing an apple or some veggie sticks with hummus to satisfy your craving.

∙ Start with foods you like. Not a huge fan of salads? Try working vegetables into foods you do

like. For example, add frozen peas or broccoli to rice when it’s almost done cooking.

∙ Eat more soup. Have a bowl of vegetable soup for lunch instead of your usual sandwich. Make it from scratch or check the label to avoid getting too much sodium. Add extra frozen veggies while heating.

∙ Aim for half your plate. Fill up half your plate with fruits and veggies. It’ll keep you from eating too many calories or filling up on empty calories.

∙ Think fiber. Fiber-rich foods like fruits and vegetables are an important part of a healthy

see Healthy Heart page 21

By Apiyo ObalaDirector ofCommunications,American Heart Association



serve as a model for other cities across the state and nation.

“Just as ExxonMobil has made a significant economic impact on the economy of the greater Houston area, so will it now have a powerful impact on its residents’ health and well-being,” said Ron DePinho, M.D., president of MD Anderson. “With this leadership gift we have the opportunity to make the vision of a healthy Texas a reality. We’re grateful for ExxonMobil’s generosity to MD Anderson, its commitment to our community and its partnership in our mission to end cancer.”

As the situation regarding Ebola cases in Texas continues to develop, state officials are asking the University of Texas Medical Branch at Galveston to take a leadership role on several fronts to help combat the infectious disease.

If necessary, UTMB is ready to provide clinical care for Ebola patients and to dispose of medical waste, said Dr. David L. Callender, president of UTMB.

State officials have been discussing how UTMB, which has some of the world’s top Ebola researchers and is helping to develop a possible vaccine, can also lend its clinical expertise to combat the disease.

“UTMB is uniquely positioned to help Texas deal with the Ebola situation,” said Callender

∙ UTMB safely has conducted Biosafety Level 4 research for 10 years, with no infections among those who work in its high-containment labs.

∙ UTMB is home to the National Biocontainment Training Center where scientists train to safely work in high-containment research laboratories all over the globe. The training center also lends its expertise to UTMB’s clinical staff, making sure that all safety protocols are in place.

∙ UTMB runs a Level I Trauma Center, capable of handling the most complex health emergencies.

∙ UTMB has been providing specialized training to its health

care worker well before the first Ebola case was diagnosed in Texas.

∙ UTMB is experienced in safely destroying medical waste.

UTMB does not have any patients who have Ebola and has not been asked to accept such patients from elsewhere.

“But should we have a patient

suspected of having the virus, we are well prepared to provide quality care in a way that protects our employees and the community,” Callender said.

He added that only UTMB health care workers who have received specialized training would be involved in caring for Ebola patients, if that became necessary.

CHI St. Luke’s Health (CHI St. Luke’s) announced a new, multi-year agreement that will ensure continued in-network access to all CHI St. Luke’s hospitals and facilities for patients with Aetna health insurance, effective immediately.

Details of the new agreement have not been disclosed; however, both CHI St. Luke’s and Aetna have stressed the importance of having a strong partnership to best meet

patient needs. The agreement also is expected to help ongoing efforts at CHI St. Luke’s to improve care qualit y, while reducing overall healthcare costs.

“On behalf of CHI St. Luke’s we’re very pleased to announce our new contract with Aetna that will ultimately benefit thousands of patients’ access to care,” said Deborah Lee-Eddie, Interim Chief Operating Officer, CHI St. Luke’s.

“Healthy partnerships with insurance companies have become even more essential in not only protecting patient access, but also in building and maintaining high-quality patient care. This partnership with Aetna will better support our mission to continually improve our healthcare offerings to the Houston community.”

With a new agreement in place, patients with Aetna insurance can continue to see their physicians at

CHI St. Luke’s hospitals and facilities as they have, without any disruptions. The agreement comes well before the original deadline for negotiations.

To confirm in-network benefits, CHI St. Luke’s recommends that patients call the phone number for customer service on the back of their Aetna insurance card. For more information and a full list of locations, visit stlukestexas.com.

UTMB prepared to help Texas fight Ebola

ExxonMobil announced a $10 million grant to The University of Texas MD Anderson Cancer Center’s Moon Shots Program, an unprecedented, comprehensive initiative to significantly reduce deaths from cancer.

Exxon Mobil Corporation Chairman and CEO Rex W. Tillerson shared the news at a press conference preceding the Greater Houston Partnership’s State of Energy luncheon at the Hyatt Regency downtown. He also announced $8 million in additional health grants to two other Texas Medical Center institutions: $3 million to Texas

Children’s Hospital and $5 million to the Texas Heart Institute.

“These world-renowned institutions are helping improve the health and lives of families in the Greater Houston area and that of other patients around the world, and we’re proud to support their important mission,” said Tillerson. “The grants will bolster their lifesaving medical research, prevention programs and patient care.”

The MD Anderson grant supports the Healthy Community Initiative, developed by leaders of the Moon Shots Program’s cancer prevention and

control platform to encourage policies, education, behaviors and services that promote health and prevent cancer.

MD Anderson will designate a targeted population in the Houston area and collaborate with schools, workplaces, clinics, social service agencies, faith-based organizations and neighborhood centers. Its purpose is to implement strategies that promote healthy behaviors, improve health and prevent disease by reaching children and families with information, activities and services that reduce their risk of developing cancer and other chronic diseases. It’s hoped that the project will

CHI St. Luke’s Health and Aetna Reach Agreement, Sign Multi-Year Contract

New contract secures access to high-quality care for Aetna patients in Houston

ExxonMobil commits $10 million to MD Anderson’s cancer prevention and control initiative

Gift to help Houston-area community reduce risk of cancer and other chronic diseases



for many, at their workplace.

A widely circulated article from the Associate Press reports: “The nation’s biggest drugstores and other retailers are grabbing larger chunks of the immunization market, giving customers options outside the doctor’s office to protect themselves against the flu, pneumonia and other illnesses. Nearly half of all flu vaccines provided to adults are now administered in non-medical settings like drugstores or worksite clinics.” [TwinCities.com HEALTH]

By the way, it’s not just fl u shots. Competition from non-medical settings—particularly the nation’s largest pharmacy chains—includes ongoing promotional

messages about vaccinations including:

∙ Chicken Pox

∙ Hepatitis A and Hepatitis B

∙ HPV (Human papillomavirus)

∙ Meningitis /Meningococcal

∙ Pneumonia (Pneumococcal)

∙ Shingles (Herpes zoster)

∙ Whooping Cough (Pertussis)

What you’re up against….

Unlike doctor’s offices, pharmacies and others don’t require an appointment, and in fact, sometimes the flu shot decision is an “impulse buy” that is born out of convience in non-medical settings. It’s usually quick and it’s often paid for by insurance. What’s more, “needle-free”options—such as patches and nasal spray appeal—are appealing to many individuals.

From a marketing perspective, nearly everyone needs a flu shot and potential market is still underserved. And if that’s the marketing opportunity “good news,”the other news is that doctors and other providers are up against tough and growing competition. www.healthcaresuccess.com

Marketing EssentialsFlu Shots Are a Marketing Opportunity (But Competition is

Tough for Doctors)

Perhaps the idea of promoting “flu shots” isn’t particularly “glamorous” in healthcare marketing. Some doctor’s offices, healthcare providers (and marketing professionals) consider vaccinations and immunizations as ordinary and routine as remembering to turning off the lights at night. Nobody gives it much thought.

Preventative care and patient wellbeing

are at the top of the list, but in addition, here are some new reasons to rethink the importance of “flu shots” as a healthcare marketing opportunity. It seems like everyone wants a slice of the pie.

Most people—particularly those who should—don’t get fl u shots. Professionals understand the health risks, and despite ongoing efforts to inform the public, the Centers for Disease Control and Prevention (CDC) reports that only 46 percent of Americans got flu shots last year. Vaccination rates are even worse in certain age categories, according to this detailed article in USA Today.

In their published report, USA Today observes: “At a time when many people are preoccupied with the dangers of Ebola and a rare respiratory virus striking children, [the CDC] announced that fewer than half of Americans are being vaccinated against the flu, which kills an average of more than 30,000 people a year.”

Competition from non-doctors’ offices has skyrocketed (and is still climbing). Virtually every pharmacy in the neighborhood now provides vaccinations, and these and other “non-doctor-office”options are devouring market share. Convenience alone is a big sell-point for consumers who can easily find flu shots available inside supermarkets, big-box retailers, drug stores, shopping malls and,

By Lonnie HirschCo-founder, HealthCareSuccess Strategies



that patients can establish a baseline of the medicine’s characteristics, including appearance, taste, texture, reactions, and packaging.

medicines online and discuss with them the risks and challenges of buying medications over the Internet.

∙ Dispense free samples of brand name drugs so

In the past few years, a number of developments have occurred, including drug shortages and patients having trouble affording their prescriptions, that might seem to justify importing medications from overseas. The world outside of U.S. borders appears to offer a ready supply of cheaper medications easily obtained through unlicensed distributors, trips across the border, or online pharmacies.

The laws that prohibit importing non-FDA-approved medicines are designed to ensure that patients receive medications that meet the FDA’s requirements for safety, purity, and potency. Under the Federal Food, Drug, and Cosmetic Act, it is illegal to import unapproved, misbranded, adulterated, or foreign versions of U.S.-approved medications into the country.

The law also applies to medical devices such as intrauterine devices, which, along with oncology drugs and cosmetic injectables, are commonly involved in legal actions against physicians concerning counterfeit items.

Every healthcare professional who purchases medications is familiar with daily price-list faxes from persistent direct sales companies. Regardless of the supplier, purchasing or using non-FDA-approved drug products exposes the physician to criminal and civil liability. Medical malpractice insurance may not cover any errors in this area—making physicians personally liable for claims that they provided counterfeit drugs.

The medication doesn’t even have to be counterfeit for the physician to suffer legal consequences: Medications that have the correct ingredients but haven’t

If the Cost of a Medication Is Too Good to Be True, the Drug May Be Counterfeit

By Thomas T. Kubic, Treasurer, Partnership for Safe Medicines, and Susan Shepard, MSN, RN, Director, Patient Safety Education, The Doctors Company

been FDA-approved are still illegal to use.

Physicians and their office staff may inadvertently order counterfeit drugs or devices. Follow these tips to protect yourself and your patients from the risks of illegal medications and devices:

∙ Require training for everyone involved in purchasing medications.

∙ Be wary of fax or e-mail blast offers from an unauthorized distributor selling “discounted” foreign medications or devices.

∙ Have clear policies that dictate how to verify the license of a wholesaler providing medications. For example, require that your staff verify all vendors by checking wholesaler accreditation and licensing at http://safedr.ug/VAWDaccredited and http://safedr.ug/fdalicense.

∙ Obtain medications only from secure sources.

∙ Know the warning signs that a product may be counterfeit:

∙ Are prices or deals too good to be true?

∙ Was the fax/e-mail offer unsolicited and from an unknown seller?

∙ Is the labeling in a foreign language when it’s normally in English?

∙ Is the package damaged or soiled?

∙ Are all tamper seals present and intact?

∙ If in doubt, call the manufacturer to check if the lot number is still valid and matches the expiration date.

∙ Educate patients about avoiding counterfeit drugs with free resources like the S.A.F.E.D.R.U.G. checklist at www.safemedicines.org/safedrugs.html.

∙ Identify at-risk patients who may be purchasing



PROTECTIONPROTECTIONPROTECTIONPROTECTION

UNCOMPROMISINGUNCOMPROMISINGUNCOMPROMISINGUNCOMPROMISING

IN TEXAS, WE PROTECT OUR MEMBERS WITH THE BEST

OF BOTH WORLDS: NATIONAL RESOURCES AND LOCAL CLOUT

TEXAS,TEXAS,TEXAS,

NATIONAL NATIONAL NATIONAL NATIONAL RESOURCES RESOURCES RESOURCES LOCAL CLOUTLOCAL CLOUTLOCAL CLOUT

As the nation’s largest physician-owned medical malpractice insurer, with

75,000 members, we constantly monitor emerging trends and quickly

respond with innovative solutions. And our long-standing relationships with

the state’s leading attorneys and expert witnesses provide unsurpassed

protection to our nearly 5,000 Texas members. When these members face

claims, they get unmatched litigation training tailored to the Texas legal

environment, so they enter the courtroom ready to fi ght—and win.

Join your colleagues—become a member of The Doctors Company.

CALL OUR AUSTIN OFFICE AT 800.686.2734 OR VISIT WWW.THEDOCTORS.COM

A4692_HoustonMed_UP_101514_v2.indd 1 10/15/14 5:43 PM



New Aff ordable Care Act tools and payment models deliver $372 million in

savings, improve care

patient experience this year. (Please see the accompanying fact sheet for additional details.)

“We all have a stake in improving the quality of care we receive, while spending our dollars more wisely,”Health and Human Services Secretary Sylvia M. Burwell said. “It’s good for businesses, for our middle class, and for our country's global competitiveness. That’s why at HHS we are committed to partnering across sectors to make progress.”

Memorial Hermann Accountable Care Organization is eligible to share in savings. “A collaborative program like this is second nature to Memorial Hermann,” said Chris Lloyd, CEO

of Memorial Hermann ACO. “Our Clinically Integrated network, which we launched in 2007, was focused on bringing together high quality physicians who collaborate to provide the best clinical outcomes to our patients. When the ACO model was announced, we were already ahead of the game. We had an established group of physicians with access to innovative technology working together to ensure high quality outcomes at the lowest cost possible.”

Since passage of the Affordable Care Act, more than 360 Medicare ACOs have been established in 47 states, serving over 5.6 million Americans with Medicare. Medicare ACOs are groups of providers and suppliers of services that work together to coordinate care for the Medicare fee-for-service (FFS) beneficiaries they serve and achieve program goals.

Centers for Medicare & Medicaid Services (CMS) issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have improved patient care and produced hundreds of millions of dollars in savings for the program.

In addition to providing more Americans with access to quality, affordable health care, the Affordable Care Act encourages doctors, hospitals and other health care providers to work together to better coordinate care and keep people healthy rather than treat them when they are sick, which also helps to reduce health care costs. ACOs are one example of the

innovative ways to improve care and reduce costs. In an ACO, providers who join these groups become eligible to share savings with Medicare when they deliver that care more efficiently.

ACOs in the Medicare Shared Savings Program (Shared Savings Program) and Pioneer ACO Model generated over $372 million in total program savings for Medicare ACOs. The encouraging news comes from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs, and final results from the first year of performance for 220 Shared Savings Program ACOs.

Meanwhi le , t he ACOs outperformed published benchmarks for quality and patient experience last year and improved significantly on almost all measures of quality and

Prices, plans, programs and specifi cations are subject to change without notice. Void where prohibited by law.

Conservatory at Alden Bridge6203 Alden Bridge Drive, The Woodlands, TX 77382 • 832-482-4344

Conservatory at Champion Forest 8215 Cypresswood Drive, Spring, TX 77379 • 281-378-6069

www.ConservatorySeniorLiving.com

InspiredInspiredInspiredSENIOR LIVINGInspiredInspiredLUXURY

InspiredInspiredInspiredInspiredBY

©2014 Discovery Senior Living. Managed and operated by

■ Grande Clubhouse with Resort-Style Amenities■ Chef-Prepared Gourmet Meals■ Recreational and Social Activities■ Professional Team Available 24/7■ Maintenance-Free, All-Inclusive Living

Discover the affordable, all-inclusive luxury of a life well-lived. Come tour our Grande Clubhouse and experience our carefree, fun lifestyle. Call today and have your rent locked-in for three years – guaranteed!

Call for FREE lunch and a tour today!

Houston HospiceLife Matters





that the treatment involves elimination of abnormal veins. Interestingly, eliminating the abnormal veins actually improves the circulation. The principals for treatment haven’t changed, but what have changed are the techniques involved in eliminating the abnormal veins. Procedures which once required an operate room with a general anesthetic, are now performed in an office setting utilizing local anesthesia. The procedures are staged and subsequent procedures are only performed if necessary. This results in fewer incisions. The Saphenous vein, which was previously stripped, is now closed with a laser. The technique of the procedure involves using ultrasound guidance to insert the laser fiber into the vein, advancing it up the leg, and verifying the proper position of the laser fiber. Ultrasound is then used to direct injection of local anesthesia along the vein intended for closure. The laser is then activated and slowly withdrawn.

see Vein Disease page 22

Treatment of vein disease in 2014

In recent years, there has been a transition from traditional surgical procedures, which involved making standard incisions to perform the operations, to minimally invasive surgical procedures, which involve smaller incisions, and quicker return to normal activity. No place is this transition more than apparent in treatment varicose veins and venous insufficiency. This is fortunate, because the number of Americans affected by varicose veins has been estimated at about 25 million.

Proper treatment begins with proper diagnosis. Thus, the biggest advance in treating vein problems has been the increased use of venous ultrasound the office setting. Even radiologists have acknowledged that 94 % of the ultrasounds that are performed in the hospital have not been performed properly. This is not surprising, because even though vascular surgeons developed vascular ultrasound, when venous ultrasound is performed in the hospital setting, the studies are performed in the radiology department, and most radiologists lack the Registered Physician in Vascular Interpretation (RVPI) credential. Also, the technician performing the exam may not have their vascular certification. (RVT).

For vascular surgeons the venous ultrasound has become an extension of the physical exam, and most of vascular surgeons who treat patients with vein problems, perform the ultrasound study themselves. Vascular surgeons like Dr. Bardwil are credentialed to perform the ultrasound, because not only have the RVPI credential, to interpret the vascular ultrasound, but they are also credential as registered vascular techs, (RVT).

The diagnosis of venous insufficiency is made by patient history, and the physical exam, and confirmed by ultrasound. Rarely are other studies or tests required. Venous insufficiency is usually not difficult for an experienced vascular surgeon to diagnosis.

Regarding the treatment of venous disease, it has long been established,

By MichaelBardwil, M.D.Texas Vein &CosmeticSpecialists

Bulging Varicose Veins

Varicose Veins with Leg Swelling

Starting a healthy lifestyle is easy and it doesn’t have to be expensive. Texercise is here to help you on your path to a fit and healthier life. Call 1-800-889-8595 or visit www.texercise.com.

Get fit for the health of it!



What You Don’t Know About Hospice Care Could Hurt You

The truth is, most people don’t think about hospice at all until it becomes a necessity. The concept of hospice is relatively new in the United States. However, as the number of hospice providers grows, with varying degrees of quality, it’s important to be informed. Hospice places its emphasis on quality of life with care that’s tailored to the unique needs

of each individual and their support network. When curative treatments cease to help, the relief of palliative care can bring a new form of hope for terminally ill patients and their families, as hospice services help them make the most of their time together. In 2007, research published in the Journal of Pain and Symptom Management reported that hospice patients lived an average 29 days longer than similar patients who did not have hospice care.

When it came to the United States from England in the 1970s, the hospice movement began as a grass-roots campaign to address the unmet needs of patients with terminal illnesses. The benefits of this care were quickly recognized by the medical establishment. In a 1978 report, a U.S. Department of

Health, Education, and Welfare task force noted both the altruistic and practical advantages of government support for hospice care: “The hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs. As such, it is the proper subject of federal support.” In 1982, Congress included a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act.

With hospice services covered

by Medicare, what started as a purely charitable movement became a probable source of revenue. As a result, the number of for-profit agencies entering into the business of hospice has grown exponentially, with alarming results. An article published by the Washington Post on May 3, 2014 entitled “Terminal neglect: How some hospices treat dying patients” reported that the quality of care provided by hospices varies widely. A Washington Post investigation analyzed Medicare billing records for over 2,500 hospices, obtained an internal Medicare tally of nursing care in patients near death and reviewed complaint records at hundreds of hospices. At many hospices, they discovered that little care was provided for patients most in need. The investigation ascribed this absence of care to skimping on

Dear Doctors and Staff,

Let us take the guesswork out of fracture referrals.

No more waiting for appointments!

We at the Orthopedic Care Center wish to offer your patients and staff easy scheduling of patients.

Our office has extended office hours on Fridays to accommodate patients with fractures. On behalf of the Orthopedic Care Center

Lubor Jarolimek M.D.

ORTHOPEDICCARE CENTER2121 OAKDALEHOUSTON, TX 77004

Call us today! Call us today! OCC_FractureFridaysFA3_Outlined.indd 1 5/29/2013 7:20:41 PM

By Karla GoolsbyHouston HospiceCommunications

see Hospice Care page 22



with a registered nurse.

∙ Locate a nearby clinic or low-cost health care provider with extended hours of operation.

∙ Find some much-needed peace of mind.

The free Nurse Health Line features bilingual staff and language interpreters who are a valuable source of reliable and caring health information, education, and support.

All calls to the Nurse Health Line are confidential and answered

by a staff of professionals who are experienced in assessment of clinical situations. To help patients who call, nurses use their training, experience, evidence-based decision-support tools, and peer-reviewed materials to conduct their assessments.

While manned by staff from Memorial Hermann Health System, the Nurse Health Line is funded through the Center for Medicare and Medicaid Services and Texas Health and Human Services Commission and open to everyone.

It is not designed to assist with life-threatening conditions or emergencies. People with life-threatening conditions and emergencies should immediately call 911.

BRAND NEW

LUXURY APARTMENT HOMES

FOLLOW US!GABLES.COM/RIVEROAKS

866-573-1071

GABLES RIVER OAKS | 2724 KIPLING STREET | HOUSTON, TX 77098

DISCOVER THE NEWEST ADDITION TO HOUSTON'S FINEST LANDMARK TODAY!

Anyone, with or without insurance, can now talk directly with a registered nurse, 24-hours-a-day, seven-days-a-week by calling the new Nurse Health Line at toll-free 855-577-7979 or 713-338-7979.

If you live in Houston or one of the surrounding counties, you may call night or day, weekday or weekend, and reach an experienced registered nurse who will carefully evaluate your health needs and advise you on the best course of treatment for your illness or injury.

From diaper rash to migraine headache, this free service is available

regardless if you have insurance or a primary care provider. When your child has a fever of 102 degrees or you have a nagging cough at 2 a.m., the free Nurse Health Line helps you to:

∙ Get help with both kid and adult medical complaints.

∙ Decide when and where to go for treatment.

∙ Get help after your doctor’s office has closed.

∙ Find a better way to get medical care than sitting for hours in an emergency room.

∙ Figure out options to treat a sick child.

∙ Talk over your health concerns

New, Free Nurse Health Line Helps You Get Medical Answers When You Need

Th emService is available and free for everyone – with or without

insurance, with or without a primary care provider.





a governmental authority.

3. Conclusion

The OIG will be accepting comments on the Proposed Rule until 5:00 pm on December 2, 2014. Stakeholders are encouraged to provide public comment to the OIG regarding these proposals. Comments should address significant challenges related to implementation of the Proposed Rule and provide detailed suggestions based on experience with similar requirements.

no means of transportation to a health care provider will never be able to obtain the necessary transportation to develop a relationship.

b. Cost Sharing for Emergency Ambulance Services

Over the years, the OIG has issued numerous advisory opinions on the issue of the reduction or waiver of coinsurance or deductible amounts owed for emergency ambulance services. The OIG now proposes to establish a

new safe harbor for cost sharing waivers as long as certain conditions are met, including but not limited to, that the ambulance provider or supplier must be owned and operated by a state, a political subdivision of a state or a federally recognized Indian Tribe. The proposed safe harbor does not address either for-profit or not-for-profit (but not government operated) ambulance providers offering such waivers, even if the other conditions of the safe harbor are satisfied, and even if the ambulance

provider is operated pursuant to a federal, state or municipal contract. This is an issue for which non-government ambulance providers should consider submitting comments. The OIG has recognized that emergency ambulance services have inherent safeguards that warrant special treatment in a number of Advisory Opinions, and these safeguards exist irrespective of whether the ambulance supplier is operated by

Legal HealthContinued from page 3

can also be frozen or terminated. As with other retirement plan distributions, any vested account in a Cash Balance Plan can be paid as a lump-sum distribution or annuity. A lump sum distribution can also be rolled over to an IRA or another qualified retirement plan.

Although it may appear that Cash Balance Plans are more expensive to set up and maintain than 401(k) Profit Sharing plans, Cash Balance Plans are typically more cost-effective. Because of the legal contribution limits imposed on

401(k) Profit Sharing Plans combined with hidden fees to cover the high cost of plan administration, 401(k) plans are a more costly way to deliver retirement savings. Cash Balance Plans ultimately help employers and participants save more with significantly higher tax-deferred contribution limits and major tax deductions.

Tax deferral is one of the many advantages of a cash balance plan. All contributions are tax deferred, reducing both ordinary income and adjusted gross income (AGI). Account balances

grow tax-free until distribution. Contributions are age-weighted, with higher contributions for those closer to retirement. Additionally Qualified Retirement Plans remain a premier asset protection vehicle.

Any entit y can sponsor a Cash Balance Plan which includes individuals and partnerships. Get additional information from your tax professional on the tax deductions and allocations of plan contributions for partnerships made on behalf of

non-partner employees and partners.

A report from 2014 National Cash Balance Research done by Kravitz shows growth in these plans have soared by 22%; the most recent rise in taxes is certainly driven part of this growth. The research has also shown California and New York have the most plans, while the fastest growth is in Texas and Florida. Medical and dental groups account for 39% of all Cash Balance Plans nationally. It would be prudent to have an expert complete a study for your medical practice or group.

Money MattersContinued from page 4

flags or signs of occasional excess - they are downright frightening. Alcoholism is a deadly disease. Period.

On a larger scale, Einstein commented that humankind wouldn’t perish at the hands who do evil deeds, but by those who stay silent. High functioning alcoholics, like despots, can trudge along for a long time. Alcoholism is progressive, which means sooner or later something horrible happens. Eventually, alcohol abuse will cause one or major crises, such as a driving under the influence arrest, loss of employment, or divorce.

Sooner or later, one or more persons cannot remain silent. The pain of watching a loved one suffer is horrible. At that point, the lucky one’s become people of interest…to the police, their partners, or their friends. The others, those who aren’t so fortunate, end up

in jail or dead.

I joined one of the lucky ones when, on June 8, 2003, my friends and family staged an intervention just like you see on TV. I fell so far down the rabbit hole that had they remained silent, I would be dead.

On many levels, I was a very “high-functioning” alcoholic. I was not only employed, I had a boutique private practice with quite a few A-list patients. But in terms of well-being, I was extremely low functioning. Like so many others with addiction, I suffered unspeakably agony.

Approximately half of all alcoholics are “high-functioning”…but only on the outside. The hidden agony happens inside, where no one can see. Being out of integrity with oneself is bad enough without the pain of isolation,

but addiction has no mercy. Addiction robs its host of volition and suffocates authentic inter- and intra-personal connections.

Alcoholism is not a disease that cares about your socioeconomic position, either – it can and does affect anyone. Several high-profile “high-functioning” alcoholics who have publicly acknowledged having alcohol abuse disorders include Robert Downey, Jr., Betty Ford, and former President George W. Bush. As healthcare workers, we may not interact regularly with the likes of Downey, but we do see more alcoholism than most people, even if we don’t know what we are seeing.

Healthcare professionals have a higher risk of developing alcoholism than the general population. The trouble is, like pilots, alcoholic healthcare workers put other people’s lives in grave danger.

Surgeons have been known to operate even though they smell like booze and shake.

Admittedly, it’s difficult to notice and intervene on people who have powerful positions such as pilots or surgeons because they aren’t closely monitored and there is always a fear of repercussions. “What can I do?” you may ask. The answer is this: a lot.

Most importantly, if you witness alcoholism and remain silent, you are essentially aiding and abetting the deadly disease of alcoholism. Just as alcoholics avoid seeking help because they fear the repercussions, people who witness alcohol abuse and do not speak up, may be killing with their silence.

While “high-functioning” alcoholics may not be physically addicted to alcohol, abstaining for long periods of time without

Mental HealthContinued from page 5

see Mental Health page 20



Looking for Pediatric CME? We Don’t Kid Around.

Accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council of Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy of Nutrition and Dietetics, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for these events.

txhealthsteps.com

Now you can choose the time and place to take the courses you need and want.• AvailableandFREEtoanyphysician• Online,24/7access• Short,time-savingtutorials• DevelopedbytheTexasDepartmentof

StateHealthServicesandtheTexasHealthandHumanServicesCommission

More than 40 CME courses approved by 9 accrediting bodies include:•ChildrenwithDiabetes•ChildrenwithAsthma•ManagementofOverweightand

ObesityinChildrenandAdolescents•IntroductiontotheMedicalHome•BehavioralHealth:Screening

andIntervention•PediatricDepression•InjuryPrevention

Ethics CME available for these courses:•TeenConsentandConfidentiality•CulturallyEffectiveHealthCare•Recognizing,Reporting,andPreventing

ChildAbuse•MotivationalInterviewing•TransitionServicesforChildrenand

YouthwithSpecialHealth-CareNeeds•IntroductiontoScreening,Brief

Intervention,andReferraltoTreatment(SBIRT):Tutorial



experiencing withdrawal symptoms, they are nonetheless psychologically dependent. This psychological piece often provides clues they’re headed for a crisis, such as blackouts, elaborate excuses for their drinking and behaviors, or frequent severe hangovers. Some signs are obvious, but many are subtle. For example, if you’re worried about someone’s drinking, ask yourself if he or she is willing to attend functions where alcohol is served but reluctant to go anywhere if there isn’t any,

Alcoholism is characterized by a combination of hard to define subjective and objective criteria; and science cannot measure the point at which overuse or even abuse turns into alcohol addiction. How much, how often, and even how long you drink are not as important as what happens 1) when you drink, 2) after you drink, and 3) in your head.

Thoughts and actions matter most. Alcoholism includes craving - a tenacious and powerful urge to drink; tolerance - the need to drink more in order to achieve the same desired effects (get buzzed or wasted); loss of control - inability to stop

or limit drinking once its started and the inability to predict what happens once you start drinking; substantial impairment in life arenas (relationship, occupational, educational, physical, and leisure); and physical dependence - reflected by withdrawal symptoms when one-to-three days pass in between drinks (i.e., shakiness, irritability, nausea, sweating, and anxiety).

Alcohol is not de facto bad. Like my wife who can take it or leave it, most people who drink aren’t alcoholics and never will be. However, many of us aren’t as fortunate - millions of Americans are at risk of losing themselves to booze. Early identification and intervention (instead of waiting until its too late) prevents the unnecessary pain and suffering of irreversible complications, such as brain damage, liver disease, legal problems, divorce, unemployment, and death.

The beauty of expressing your concerns is that it shows them you care. Don’t stay silent if you even suspect someone is headed down the rabbit hole. You’re words are more powerful than you imagine.

Mental HealthContinued from page 20

are more active against MRSA than the gold-standard treatment, vancomycin. Plus, we have found compounds with better activity than the compound made by the bacterium from the ocean.”These constitute a completely new class of antimicrobial molecules that don’t look like anything else currently used in medicine.

While modern-day antibiotics readily go into solutions that can be injected, inhaled or ingested, these new molecules are not water soluble. That factor may seem like a major barrier, but thanks to new nanoparticle technologies, what was once an obstacle has become a momentous opportunity that Cannon’s group, as part of a National Institute of Health’s Program of Excellence in Nanotechnology, has the expertise to seize.

Nanoparticles are simply particles that exist on the nanometer scale (anything up to 100 nanometers is considered a nanoparticle). As a comparison, most

bacteria are on the micrometer scale, averaging about a micron or two long. Even the largest nanoparticle – one that is 100 nanometers – is merely a tenth of a micron. Because they are so small, these nanoparticles contain some very useful properties. For instance, they can be designed to slip through sticky mucus and penetrate into biofilms. They can be synthesized from polymers, large molecules composed of many repeated subunits, designed to be broken down in the body.

“Think of a microscopic baseball with a rubber center covered by yarn, then cowhide. Our otherwise insoluble antibiotic contained in the ‘rubber center’ is shielded by a water-loving hydrophilic surface, the ‘yarn,’ which renders the nanoparticle compatible with suspension in a solution. You can decorate the outside, the ‘cowhide,’ with molecules that specifically bind to the surface of bacteria to allow accumulation

Wielding Nature’s SwordContinued from page 6

see Wielding Nature’s Sword page 21



OFF

ICE S

PAC

E A

VAIL

AB

LE

1315 St Joseph PkySuite 800 | Houston, TX 77002

SUBLEASE

Suite 800 8,510 R.S.F.

Featuresn 8,510 RSF Availablen $13.00/RSF Full Servicen 18 Floorsn 4.69:1000 RSF, RSVD @ $55/Space/Monthn Sublease Term Through January 31, 2017Amenitiesn First floor retail includes Subway and Walgreensn Coffee Shop and Luby’s Deli on-siten All-around views of Downtown

Great Floorplan!

John Luck [email protected] James [email protected]

For more information please contact

No warranty or representation, expressed or implied, is made as to the accuracy of the information contained herein and same is submitted subject to errors, omissions, change of prices, rental or other conditions.

713.499.4100 | 3040 Post Oak Blvd, Ste 1150 | Houston, TX 77056

of the drug at the site of the infection. This nanoparticle delivery is much more targeted than traditional antibiotics,”Cannon said.

Targeting in this precise manner allows for a dramatic drop in the amount of medication that a patient needs in order to kill infection. Further, targeting may spare beneficial bacteria that are often killed secondarily by traditional delivery of antibiotics that are dispensed throughout the body. What’s more, targeting may allow for the use of more potent drugs, since the drugs would merely affect the site of infection and

not the entire body.

The next step for Cannon’s team is to test nanoparticles containing the antimicrobial molecules in animal models, which, she says, is very close to happening.

“This really is a game changer in the battle against these enemies we can’t see with the naked eye,” Cannon said. “Now, we have a weapon that is even more precise than those of their natural enemies that have been killing them for eons. We can zero in on and eliminate them with almost no collateral damage, which is huge.”

Wielding Nature’s SwordContinued from page 20

diet. Not only do they help you feel full and sustain energy between meals, they can also help prevent stroke.

∙ Make it veggie. Go meatless once a week. Try using hearty portobello mushrooms instead of meat for a burger or other favorites such as spaghetti and lasagna.

∙ Think toppings. Slip a handful of vitamin-rich spinach into a sandwich. Add dried or fresh fruit to your cereal or yogurt.

Healthy eating is a family aff air!

When you get home from a long day at work, the last thing you want to do is wage war over broccoli at the dinner table. That’s why it’s so easy to fall into the trap of making mac-n-cheese or ordering pizza. It keeps you out of an “eat your vegetables” fight. The good news is, eat a nutritious meal doesn’t have to be a battle. Don’t be afraid to include your kids in the prep work. By being involved in grocery shopping and food preparation, your kids will have more ‘buy-in.’ if they feel some ownership over the meal, they may be more likely to eat it. It may take some effort and creativity to get kids to choose fruits and vegetables instead of the sweet and salty processed snacks they see advertised. Just remember that developing good eating habits young helps set the stage for lifelong heart health. Help your family

get on the healthy eating bandwagon with these tips:

Make it easy to grab. After you buy groceries, prepare a week’s worth of veggie sticks or cut up a melon in bite-size chunks. Put them in clear containers so they’re easy to spot in the fridge when you’re making lunches or your kids are looking for snacks.

Give yourself shortcuts. Weeknight dinners can be hectic with work, school and kids’ activities. Give yourself a break by buying frozen or canned vegetables you can toss in the microwave. Fresh, frozen and canned can all be healthy choices. Compare food labels and choose items without sauces and too much sodium.

Make fruit and vegetable shopping fun. Visit your local farmers’ market or grocery store with your kids. Show them how to select ripe fruits and fresh vegetables. Let them pick out new ones to try.

Be a role model. Try to eat together as a family. If you’re eating (and enjoying!) a wide range of fruits and vegetables, they’ll be more likely to try them.

Offer healthy options. Instead of asking “What would you like to eat?” offer healthy choices. Let them choose between a banana, strawberries with cereal, or ask them if they want carrots

Healthy HeartContinued from page 7

see Healthy Heart page 22



HOUSTON

Published by Texas Healthcare Media Group Inc.

EditorSharon Pennington

Director of Media SalesRichard W DeLaRosa

Creative DirectorLorenzo Morales

Account ExecutivesJessica Frantz

Distribution DirectorAngelo Rose

AccountingLiz Th achar

Offi ce: 713-885-3808Fax: 281-316-9403

For Advertisingadvertising@medicaltimesnews.

com

[email protected]

Houston Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Houston Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Houston Medical Times are considered property and are to distribute for publication and copyright purposes. Houston Medical Times is published every month

P.O. Box 57430

Webster, TX 77598-7430

or broccoli with dinner.

Have fun. Spear some fruit chunks on a kabob or create fun shapes with cookie cutters.

Sneak it in. Fortify your family’s favorite recipes with fruits or vegetables. Add grated or pureed carrots or zucchini to muffins, pasta and pizza sauces, and

casseroles.

Be patient. Kids’ tastes change over time. Keep offering fruits and vegetables and don’t give up! Many kids need to see and taste a new food a dozen times before they know whether they truly like it.

National Eating Healthy Day is

on Wednesday, November 5. The American Heart Association has great resources available online that can provide more information on setting diet goals, heart-smart shopping, healthy cooking, dining out, and recipes. Visit us online at: www.heart.org/NationalE-atingHealthyDay. Join the conversation online and tag us in your discussion with #houstoniswhy #NEHD.

Healthy HeartContinued from page 21

The heat closes the abnormal vein. The patient is awake during the procedure, and walks immediately following the procedure. Number and size of incisions is greatly reduced. This procedure has the same effect as stripping the saphenous vein, but is less traumatic.

After a short period, the patient’s legs are re-examined. Visible varicose veins will have shrunk. If there are any residual bulging varicose veins, they are eliminated either by making 2-3 mm-sized incisions and removing, or by injecting them with solutions to shrink them. All of this is performed in the office.

This technique, for treating veins,

has been used for over ten years and has an established record of success. However, the quest for improvement is unending. The latest development in the treatment of vein disease has been the introduction of Varithena, which was approved by the FDA, for use in the United States in February 2014, and released in August. BTG, the manufacturer of Varithena, has chosen to initially restrict access of this product, only those physicians, with the most experience in treatment of vein disease. Because of his reputation for treating veins, Dr. Bardwil was asked to be one the first vascular surgeons in the United states to use Varithena. On September 22, Dr. Bardwil performed the first Varithena treatments in Houston. Both

of the treated patients were pleased with the ease of the procedure, and the results.

Varithena is a prescription medication, which is injected directly into the abnormal veins, by using the ultrasound to direct placement. It works to chemically destroy the abnormal vein. The advantage to Varithena is that no anesthesia, not even local anesthesia is required. Not all patients are candidates to have their veins treated with Varithena, The long-term results aren’t known yet, but the early results are promising. At this time, Dr. Bardwil sees Varithena as an additional tool in the treatment of vein disease. http://txvein.com/

Vein DiseaseContinued from page 14

nurses, and to the failure of these hospices to have access to a facility where continuous crisis care could be provided. The investigation found that about 18 percent of U.S. hospices did not provide a single day of crisis care.

The investigation noted that the absence of crisis care at those hospices stands in stark contrast to most others, where such care is common. Medicare payment rates and their unintended financial incentives may be responsible. Providing routine care such as semiweekly nursing visits can be very lucrative. However, symptom management that requires continuous nursing care or inpatient care can be financially draining and logistically problematic, especially for smaller

agencies.

An area of great concern is the burgeoning growth of home health care businesses that offer hospice. "For-profit home care agencies are bleeding Medicare; they raise costs by $3.3 billion each year and lower the quality of care for frail seniors," said Dr. Steffie Woolhandler, professor of public health at CUNY's Hunter College, lecturer at Harvard Medical School. "Letting for-profit companies into Medicare was a huge mistake that Congress needs to correct."

William Cabin, assistant professor of social work at Temple University and lead author of a nationwide study published in the August 2014 issue of the journal Health Affairs said, "While our study is the first to

show that profit-making has trumped patient care in Medicare's home health program, that's no surprise. A large body of research on hospitals, nursing homes, dialysis facilities, and HMOs has shown that for-profits deliver inferior care at inflated prices."

Researchers believe that most hospices are providing quality care and many nurses in the field consider palliative medicine as much a calling as a job. When the hospice movement took root in the United States, hospice practitioners were typically part of religious groups, or were community-supported like the Texas Medical Center’s Houston Hospice. However, since for-profit businesses have come to dominate the industry, early planning and investigation of hospice care options is a necessity.

Hospice CareContinued from page 15



AllegianceBankT E X A S

www.AllegianceBankTexas.com/Med

3.95%We pledge

Equipment Loans as low as

to help build your business.

We’re dedicated to boosting your bottom line. So now until December 31st, 2014, we’re offering

tremendous f inancing rates for the medical equipment you need to keep things moving onward and upward.

3.95% fixed rate for new equipment for up to 60 months. Used equipment eligible for 4.95% fixed rate for up to 48 months. Some restrictions may apply based upon the make and model of equipment purchased.Subject to credit approval. Rates and financing are limited to equipment model years 2007 or newer and are subject to change without notice.

60Months

up to

*

*

281.517.8700

281.517.8720

281.517.8740

281.517.8730

281.517.8780

281.517.8770

281.517.8760

281.517.8710

281.517.8790

281.517.8715

281.517.8750

M A K I N G A D I F F E R E N C E ,

T O G E T H E R .

ABTCO-007 HoustonMedicalTimes Ad Revision 11.25x14 MECH.pdf 1 8/8/14 9:10 AM

Houston Medical Times

medicaltimesnews.com

F o r t y

F a s c i n a t i n g

s t o r i e s

ommanding Views

deal Location

rban Lifestyle

esor t style amenities

xquisite Details

conic architecture

From inception to finish, 2929 is Houston’s new� icon that is truly your address to the w�orld.

Schedule your tour today.

713.572.2929 | 2929Weslayan.com2929 WesLayan street | HoUston, teXas 77027

Documents

Houston Medical Times