Houston Medical Times

Serving Harris, Galveston, Brazoria and Fort Bend Counties

September Issue 2014

HOUSTON

PRSRT STDUS POSTAGE

PAIDPERMIT NO 1HOUSTON TX

Community hospitals long have been important pillars in towns across the country, providing trusted health care services and often ranking as one of the largest employers in their respective communities. In addition, they are engaged in numerous activities critical to quality of life in so many small communities—providing community rooms for civic meetings and activities, supporting health educational functions and charitable events and providing free or low-cost school physicals and emergency services at school athletic events and community functions. However, health care as we know it is quickly changing, and due to a broad convergence of factors, many community hospitals—and the communities they serve—are at risk.

Although the Patient Protection & Affordable Care Act (ACA) may have accelerated some industry trends, reimbursement rates likely would have continued to decline and costs for advanced IT capabilities, clinician talent attraction and compliance likely would have continued to increase regardless of the ACA. Compounding these challenges, community hospitals often

are unable to negotiate at the level of their larger competitors for the highest payor rates, best capital costs and structures or lowest vendor prices. In addition, tightening market share and developing narrow networks are making health systems and hospitals more adversarial, straining even long-standing alliances and putting the survival of many community hospitals in doubt.

In this challenging environment, community hospitals and their boards are faced with myriad difficult, strategic choices. The questions many should be asking include:

∙ Are we prepared for a critical transition from volume to value-based care?

∙ Should we invest in new models of care and new services out of reserves?

∙ Shou ld we e l iminat e unprofitable services that are community-backed and desired?

∙ Should we acquire local physician practices?

∙ Should we redesign our physician compensat ion strategy?

∙ Should we renovate or replace our outdated facility?

∙ Should we pursue outpatient

services at the expense of inpatient services?

∙ Should we continue to provide inpatient care?

∙ Should we pursue an affiliation?

∙ Should we stay independent?

Unfortunately, there are few easy answers to these difficult questions. However, the broader challenges facing community hospitals and their boards do not have easy, off-the-shelf solutions.

With few easy solutions available, it’s imperative for many community hospital boards to undertake an assessment of the strategic position of their hospitals. The strategic readiness assessment is not the same as assembling a multiyear strategic plan or conducting an annual board retreat. This assessment should more heavily focus on near-term survival and success based on the environmental and organizational challenges facing community hospitals.

Based on the needs of the board and the hospital, a strategic assessment can take on numerous forms. Some boards may pursue an internal process, leaning heavily on a strong administrative team, while other boards may decide to supplement their administrative team

By Wyatt Jenkins Managing Financial AnalystBKD Partner

see Strategic Challenges page 20

COMMUNITY HOSPITALS FACE STRATEGICCHALLENGESInside This Issue

Baylor College of MedicineAccepts ALS ice Bucket

ChallengeSee pg. 17

INDEX

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

Mental Health...............pg.4

Healthy Heart ...............pg.5

The Framework .............pg.6

Marketing Essentials ......pg.7

Study predicts hepatitis C will become a rare disease

in 22 yearsSee pg. 18

Houston Medical TimesPage 2

September 2014 medicaltimesnews.com

MONTGOMERY COUNTY HEART WALKAon Hewitt Campus • The Woodlands

BAY AREA HEART WALKKemah Boardwalk

GREATER LAKE HOUSTON HEART WALKLone Star College-Kingwood

HOUSTON HEART & STROKE WALKNRG Park (Formerly Reliant Park)

NORTHWEST HARRIS COUNTY HEART WALKLone Star College-CyFair

SATURDAY • NOV. 1, 2014

For more information,please visit www.heartwalk.org

or call 713-610-5000


MONTGOMERY COUNTY HEART WALKMONTGOMERY COUNTY HEART WALKMONTGOMERY COUNTY HEART WALKAon Hewitt Campus • The Woodlands

SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014SATURDAY • NOV. 1, 2014

please visit www.heartwalk.orgplease visit www.heartwalk.org

NORTHWEST HARRIS COUNTY HEART WALK


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Houston Medical Times Page 3

September 2014medicaltimesnews.com

Legal HealthNEW GUIDANCE ON H-1B ELIGIBILITY FOR NURSES

classification to include other types of RN roles that traditionally may not have been considered H-1B eligible in the past. In light of this updated guidance, health care organizations interested in using foreign nationals to fill their RN staffing needs should now consider the H-1B nonimmigrant classification and, if the sponsored position appears to meet the new guidance in the PM, be prepared to provide the USCIS with the types of evidence that the PM indicates will qualify as an H-1B specialty occupation.

4 ANCC certification recognizes organizations that promote and institute policies to promote advances and high standards in nursing. Information on how to secure ANCC certification status can be found at: http://www.nursecredentialing.org/FunctionalCategory/FAQs/DEO-FAQ.html

things, a specialized baccalaureate or higher degree (or its equivalent) as the minimum requirement for entry into the particular position. Traditionally, RN positions have not been considered H-1B eligible by the U.S. Citizenship and Immigration Services (“USCIS”) because they do not normally require at least a bachelor’s degree in a specialized field or its equivalent.

However, on July 21, 2014, the USCIS released a policy memorandum (“PM”), dated July 11, 2014, which provided the first new guidance on H-1B eligibility for nurses in 12 years and provided some further clarification on what type of RN roles may meet the H-1B professional threshold.

The PM acknowledged a shift in employers’ preference “for more highly educated nurses” and recognized that more specialized RN roles now may qualify as specialty occupations. Examples include addiction nurses, cardiovascular nurses, and emergency room nurses. The PM also reiterated the USCIS position that Advanced Practice Registered Nurses (“APRN”),

such as a Certified Nurse-Midwife, Certified Clinical Nurse Specialist, and Certified Nurse Practitioner, continue to be H-1B eligible because they require the necessary advanced level of education and training. Finally, the PM indicated that, if a state requires at least a bachelor’s degree to obtain a nursing license, an RN position in that state would be considered a specialty occupation. Currently, however, no state has such a requirement.

In adjudicating H-1B petitions for RNs, the USCIS asks the sponsoring health care facility to demonstrate, by a preponderance of the evidence, that the sponsored position satisfies the requirements for a “specialty” occupation. When assessing whether an RN position meets this standard, the USCIS takes into account several factors, including the nature of the employer’s business, industry practices, duties to be performed, certification requirements, American Nurses Credentialing Center (“ANCC”) Magnet Recognition status salary paid in relation to other nurses, and clinical experience requirements.

Although the PM does not provide an immediate solution for the hiring of staff RNs, it does expand the H-1B

With the onset of the Affordable Care Act, health care facilities have a greater impetus to ensure that their nursing staff is sufficiently robust to serve an increasing patient population. However, the immigration options for hiring foreign nurses are limited and often may not provide the necessary immigration pathways for health care organizations to hire foreign registered nurses (“RNs”) to fill their staffing needs. Currently, the only available visa classification to hire most foreign RNs is the H-1B nonimmigrant classification, which is reserved for positions that the government considers as “specialty”occupations, which are professional in nature. Here lies the immigration roadblock.

Current U.S. immigration law defines a “specialty occupation as a position that requires, among other

By: Robert S. Groban, Jr.and Catherine F. SilieEpstein Becker Green



devastating disease.

Incorporating the newest medical approaches along with proven treatment models and methodologies, PaRC is Houston's premier drug and alcohol rehabilitation center. Services include detox, residential treatment, intensive outpatient programs, an adolescent treatment program, family services, aftercare, 12-step meetings,

abuse; but, there are a lot of positive stories out there as well,” said PaRC Director of Business Development Jane Barnes, a motorcyclist and one of the Ride for Recovery founders. “Houston has a huge community of people who have turned their lives around and we want to let the world know there is hope!”

Motorcycle enthusiasts, families, friends, supporters, and community members are invited to join the festivities taking place at the PaRC, located near Memorial City at 3033 Gessner Rd.

In 1989, the federal Substance Abuse and Mental Health Services Administration designated September as “National Addiction and Drug Abuse Recovery Month” to foster education, celebrate recovery, and reduce the stigma attached to this

Mental HealthMemorial Hermann Prevention and Recovery Center

Celebrates National Recovery Month with Motorcycle Ride and Barbeque

The Memorial Hermann Prevention and Recovery Center (PaRC) hosts its 9th Annual Ride for Recovery, a 100-mile motorcycle ride, to raise awareness of substance addiction and embrace recovery on Sunday, Sep. 21.

A first of its kind in the Houston area, the event, coordinated by the PaRC Alumni Association, offers an opportunity for people to get together, celebrate recovery, and let those suffering from addiction know “there is a solution.” Starting at 8 a.m., the motorcycle ride meanders through northwest Harris, Montgomery, and Waller counties and culminates with a barbeque cookout, music, and testimonies from people who have been set free from addiction.

“We often hear the negative stories about alcoholism and drug

and an alumni association.

For more information or to register, visit www.rideforrecovery.com or call the PaRC at (713) 329-7272. All proceeds from the event are donated to the Men’s Center and The New Hope Women’s Center, two community organizations supporting individuals suffering with alcoholism and addiction.

Last year’s Ride for Recovery at the Memorial Hermann Prevention and Recovery Center (PaRC) attracted almost 100 motorcycle enthusiasts from through out Texas.Photo: PaRC Alumni Association



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Healthy HeartREADY TO HELP YOUR FAMILY GET HEALTHY? TAKE

THE EMPOWERMENT CHALLENGE!

By now children are back in school and lunches are being packed daily to send them off. In recognition of Childhood Obesity Awareness month, American Heart Association wants to remind parents that it’s important for children to make the healthy choice, the default choice.

Sadly, childhood obesity continues to cloud the nation burdening one in every three children or teens. The time for action is now before the problem arises. As busy adults, we must recognize that a healthy lifestyle begins with decisions we make. To jump start a healthy lifestyle at home, the AHA is launching the EmpowerMEnt Challenge to empower families to take control of their health by pursuing a different goal every week. Each goal is fun, simple, won’t break the bank and can be done as a family. By the end of the month, you’ll all be better equipped to live a heart-healthy life.

Taking the challenge is easy. Complimentary templates and activities are easily accessible on www.heart.org/healthierkids and are broken down into

By Shelly Millwee and Nancy Gutierrez, American Heart Association

themed weeks. To help keep you on track and accountable during the challenge, you can share your family’s progress on the new Life is Why Facebook group.

∙ Week 1: Empower your Cart. See how much you can boost your fruit and vegetable intake this week. You might be surprised by how many will fit into your grocery cart. Try a scavenger hunt in the store. See how many fruits and veggies your kids can find in 15 minutes.

∙ Week 2: Empower your Glass. This week is about reducing sugar-sweetened beverages. Did you know sodas are one of the leading contributors to obesity? Help your kids start a healthy habit early by reaching for water first (and see if your grocery bill drops!).

∙ Week 3: Empower your Taste. This week is about sodium reduction. That’s important because most people have more than double the amount of sodium (or salt) their bodies need – which increases chances

of high blood pressure, stroke, heart disease and other problems. You can reduce the sodium you eat by comparing labels of similar products and choosing the one with less sodium, and using herbs, spices, citrus juices, and vinegars instead of salt to add flavor to foods.

∙ Week 4: Empower your Movement. This week’s challenge is simple: Get moving! You don’t need to put on a perfect gym outfit and drive all the way across town. Just turn off the TV, grab the kids and get active.

Activities for each week include a grocery store scavenger hunt, ideas for a “Great Lunchbox Switch” challenge, tips on how to “Shelve the Shaker” and fun activities for the “Screens Down, Laces Up” challenge.

During Childhood Obesit y Awareness month, set goals, enforce these healthy habits, and encourage your kids to live a healthier lifestyle. You children will come out healthier, stronger, and with the sense of accomplishment that no one will be able to take away from them. During the adolescent stage, they survive from positive reinforcement and encouraging feedback. Parents, you will always be your children’s number one fan and motivator. As a family, spread the awareness on child obesity, break those unhealthy habits and finish the

Empowerment Challenge strong and healthy!

To help children develop health habits long after the challenge is over, consider leading by example:

∙ Be a good role model

∙ Keep things positive

∙ Get the whole family moving

∙ Limit TV, video game and computer time

∙ Encourage physical activities that they’ll really enjoy

∙ Make dinnertime a family time

∙ Make a game of reading food labels

∙ Stay involved with your kids and help encourage them to make healthy choices

Tickets start at $20!

A Midsummer Night’s DreamChoreography by John Neumeier

n September 4 – 14, 2014

STANTON WELCH l ARTISTIC DIRECTOR

Official Airline of Houston Ballet

Purchase online at

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This production is made possible in part through a gift made by Phoebe and Bobby Tudor

IMAGE: Artists of Hamburg Ballet in A Midsummer Night’s Dream, PHOTO: Holger Badekow.

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Th e FrameworkMD Anderson Opens Diagnostic Imaging Center in West

HoustonFacility Brings Full Complement of Services, Onsite

Radiologists Closer to Patients

Committed to bringing its cancer care services, clinical trials and standard of care closer to patients, The University of Texas MD Anderson Cancer Center opened a full-service diagnostic imaging center in West Houston on Sept. 2.

MD Anderson Diagnostic Imaging in West Houston occupies the first floor of a midrise building located at 15021 Katy Freeway, near the intersection of I-10 and Highway 6, and offers a full

array of cancer imaging and lab services.

The facility, which houses a separate women’s imaging center, is available to patients who have a confirmed diagnosis of cancer or whose primary care physician suspects cancer. Women who would like to have their screening mammograms performed and read at the new location may call directly to make an appointment.

MD Anderson Diagnostic Imaging Center in West Houston has the most advanced technologies available, some of which have software applications and hardware features not yet available elsewhere in Houston.

General imaging services available at the center include Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Positron Emission Tomography

(PET), general and Doppler ultrasound for diagnostics and biopsies, and digital X-ray.

Located in the women’s imaging center are ultrasound, 3-D digital breast tomosynthesis, ultrasound-guided biopsies and other technologies that will allow MD Anderson radiologists and staff to return a same-day diagnosis to women with concerning lumps or to their primary care physicians who referred them. Digital mammography for screening and diagnostics also is available.

MD Anderson radiologists will be on site to review and interpret all of the images, and also

consult with physicians who referred their patients for tests. The radiologists all are MD Anderson faculty subspecialized and fellowship-trained in oncologic radiology. Because of new digital technologies, the MD Anderson radiologists in West Houston can securely share images with colleagues at the Texas Medical Center campus for additional opinions on especially rare or unusual cancers or tumors.

“The first step in identifying the right cancer treatment and achieving the best possible outcome is making the most accurate and precise diagnosis,”said Marshall Hicks, M.D., professor and head of the Division of Diagnostic Imaging at MD Anderson. “Quality

see Th e Framework page 21

By Julie PenneTh e University of TexasMD Anderson Cancer Center

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Marketing EssentialsSocial Media Patient Rants: Defense Lessons from Big Biz

Maybe it was just a coincidence, but two insightful marketing object lessons popped up this week.

The subject matter in common was customer service via social media, but in these two stories the outcomes were different. Both illustrations—one good and one not—are pages from big business, and they hold excellent take-away lessons for hospital and healthcare marketing.

The first mini-drama is a British

Airways blunder last Fall, recounted in a Wall Street Journal blog post by Ryan Holmes. He wrote:

“Several pieces of luggage were lost on a Chicago-Paris flight, hardly an unusual occurrence. But when reaching out for help via formal customer service channels got no results, disgruntled businessman Hasan Syed turned to Twitter.

“Syed paid an estimated $1,000 to send a promoted tweet. His message was brutally direct: “Don’t f ly @BritishAirways. Their customer service is horrendous.” As a promoted tweet, his warning was blasted out not only to his followers but to thousands of other users on the network—an audience that can be strategically targeted by geography, keywords, interests and even gender.

“Incredibly, it took British Airways more than 10 hours to notice and address the complaint. By that time, it

had been retweeted thousands of times and picked up by popular tech news websites. After just a few days, several thousand Twitter users saw Syed’s rant and stories on it ran everywhere from the BBC to Fox News.” [See Business Insider.]

And (just by coincidence), KLM Royal Dutch Airlines published a notice reminding previous passengers of their “24/7 Social Media Servicing.” Their broadcast email read in part:

“A very Happy New Year or ‘Gelukkig Nieuwjaar’ as the Dutch say!

“Did you know that for any service related question you can reach us 24/7 in 10 languages on Facebook, Twitter and soon on Google+ as well? If you ask your question via Facebook or Twitter,

our goal is to respond within one hour. On the klm.us customer support page, you can now see a live response time to know exactly when to expect your answer.”

Useful take-aways from the corporate world…

Most healthcare and hospital marketing doesn’t operate on the grand scale of global airlines, but it’s not a stretch to transfer some valuable service concepts from big biz. After all, there is a constant ebb and flow of patients, often at all hours of the day and night.

And, regardless of the scale, (a) customer service (patient experience and satisfaction) is no less important, and (b) US consumers use social media as a potentially wide-reaching “word-of-mouth” channel for questions, complaints…and even angry rants.

As the Journal article observes:

see Marketing Essentials page 21

By Stewart Gandolf, MBACEO Healthcare SuccessStrategies



On August 24th 230 new medical school students at the University of Texas Medical Branch took part in a symbolic ceremony marking a significant step toward becoming a physician.

The entering class of 2018 at the UTMB School of Medicine, the state’s first medical school, will have their names called, step onto the stage at Moody Gardens Convention Center and be helped into a brand-new, physician’s white coat.

The white coat ceremony, while relatively new, has become a staple at medical schools across America.

“It’s a milestone in a person’s life,” said Dr. Danny O. Jacobs, executive vice president and provost and dean of

the School of Medicine. “The ceremony reinforces our students’ connection with the history of medicine, and reflects their commitment to becoming outstanding physicians.”

“Sometimes you can see a person’s face change as they put on the coat; a realization that they are on their way toward becoming a doctor,” Jacobs said.

The keynote address will be delivered by Dr. Matt Dacso, a UTMB alum of the class of 2016. Dacso, an assistant professor, is director of UTMB’s Center for Global Health Education. His topic is “Being humanitas: The key to success, satisfaction and sanity.”

The white coat ceremony as known today got started in 1993 at Columbia University’s College of Physicians and

Surgeons. The first white coat ceremony at UTMB was in 1996.

CHI St. Luke’s Health (CHI St. Luke’s) and Cigna today announced a new, multi-year agreement that enables Cigna's Houston-area customers to continue to receive covered care at CHI St. Luke’s Health hospitals and facilities on an in-network basis. Terms of the agreement were not disclosed.

CHI St. Luke’s Health and Cigna emphasized their continued strong collaboration and positive working relationship that they believe will help improve overall quality and reduce healthcare costs. Both organizations say they

are pleased that an agreement was reached quickly and in the spirit of partnership.

“We are entering a new era where balanced partnerships between healthcare providers and payers are more important than ever to move the system forward,” said Deborah Lee-Eddie, interim COO of CHI St. Luke’s Health. “Fundamentally, these partnerships are part of our overall effort to fulfill our promise of improving community health through high-quality, cost-effective care. We constantly strive to be good stewards of healthcare resources, and strong partnerships with companies, like Cigna, are an important part of this

effort. This new contract assures Cigna patients in the Houston area that they will have continued access to quality care at CHI St. Luke’s Health.”

“Cigna strives to be a partner of choice for healthcare professionals in Houston, and our long-standing relationship and history of collaboration with CHI St. Luke’s Health enables us to work together to provide better service and more value to our shared customers,” said Mike Koehler, president for Cigna in South Texas. “Together we are changing the healthcare system to focus on building a healthy community

and improving health outcomes, customer experience and affordability.”

To confirm in-network benefits, CHI St. Luke’s Health and Cigna recommend that area Cigna customers contact Cigna by calling the number on the back of their insurance cards. Cigna's customer service representatives are available 24 hours a day, seven days a week for assistance. Individuals covered under a Cigna health plan should continue their care and schedule appointments as they would normally with their physicians and at their CHI St. Luke’s Health hospital of choice.

CHI St. Luke’s Health and Cigna Reach Agreement on a New, Multi-Year ContractContract Extends Collaboration, Provides Access to Quality Care for Cigna Customers in Houston

Memorial Hermann Health System and The University of Texas MD Anderson Cancer Center today announced a new partnership to provide a new level of specialized breast screening at a network of community breast care centers in the greater Houston area.

Starting in late November, MD Anderson will become the exclusive provider of professional breast radiology services for five of Memorial Hermann’s 10 breast care centers, located in Memorial City, The Woodlands, Northeast, Southwest and Sugar Land.

Over time, the network will expand to Memorial Hermann’s locations in Katy, Pearland, Pasadena, Upper Kirby and Northwest. In addition, expansion

planning is underway for centers in Cypress, South Katy and Spring.

Under the agreement, the breast screening network will offer screening and diagnostic services, utilizing existing Memorial Hermann facilities and technical resources, including equipment and staff. MD Anderson‘s fellowship trained, subspecialized breast radiologists will interpret the screening or diagnostic images, perform biopsies if needed and consult with patients and physicians.

The University of Texas Board of Regents approved the agreement Aug. 21 at its regular meeting.

“Memorial Hermann and MD Anderson share a commitment to provide high quality cancer care to communities

across our region,” said Dan Wolterman, president and CEO of Memorial Hermann Health System. “Our partnership will combine the convenience and advanced technologies of Memorial Hermann’s breast imaging centers with interpretation and consultation from the world renowned cancer expertise of MD Anderson, enabling our institutions to provide patients with unparalleled access to specialized breast imaging services close to home.”

The Memorial Hermann and MD Anderson partnership is designed to expand access to high quality screening, specialty breast care and research into a community setting, while giving patients the flexibility and convenience of staying close to home through the expansive Memorial Hermann

network.

“We’re excited to join with Memorial Hermann, one of the nation’s leading health care organizations, to deliver high quality, collaborative breast care to women across the Houston area,” said MD Anderson President Ronald A. DePinho, M.D. “Prevention, early detection, risk reduction, education and outreach are key components of our mission. This collaboration allows us to take our screening expertise to more women, who can take comfort in knowing their imaging will be provided by radiologists who have dedicated their careers to caring for patients with cancer.”

To make an appointment at a Memorial Hermann Breast Care Center, visit memorialhermann.org/ScheduleNow or call 877.70.MAMMO.

Memorial Hermann, MD Anderson join forces to provide enhanced breast imaging services through out the Greater Houston Region

More than 200 UTMB medical students to take part in symbolic white coat ceremony

Event marks entry into medical profession



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Patients with mild to moderate Alzheimer’s disease currently have no treatment options to slow brain cell deterioration. Researchers at Houston Methodist’s Nantz National Alzheimer Center are studying an investigational drug that proposes to do just that.

T-817MA focuses on preventing brain cell loss and slowing disease progression, whereas current treatment options including Donepezil (Aricept®), Rivastigmine (Exelon®), and Memantine (Namenda™) merely treat the symptoms of mild to moderate Alzheimer’s. The researchers want to know whether the investigational therapy using T-817MA can prevent brain cell loss,

slowing disease progression in a more fundamental way.

Houston Methodist is the only study location in Texas to offer this randomized, double-blind, placebo-controlled study. Approximately two-thirds of study participants will receive active study drug, but neither the patient nor the study personnel will know whether patients received the active study drug or placebo until the patients' participation in the study is complete. This is a Phase II clinical trial, an early study assessing the efficacy of a drug that has been tested on relatively few research subjects.

“Previous studies in mice have shown this investigational drug may work by protecting brain cells, which would result in improved memory and cognition,” said Joseph C. Masdeu, M.D., Ph.D., principal investigator of this study at Houston Methodist and director

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Of the more than five million Americans living with Alzheimer's disease, almost two-thirds are women. American women are twice as likely to die of Alzheimer’s disease as they are from breast cancer. According to the Alzheimer’s Association, someone develops Alzheimer’s every 67 seconds. In 2013, 15.5 million caregivers provided an estimated 17.7 billion hours of unpaid care valued at more than $220 billion.

People already diagnosed with

mild to moderate Alzheimer’s may be eligible for this study if they are women or men aged 55-85; they have taken donepezil (Aricept) treatment for at least six months; live in the community, not in a nursing home or assisted-living facility; and have a study partner who has regular contact with the patient (at least 10 hours per week) and can attend study visits.

This study is sponsored by Toyama Chemical Co., Ltd., and is being conducted by the Alzheimer’s Disease Cooperative Study (ADCS), the largest Alzheimer’s disease therapeutic research consortium in the United States and supported by the National Institute on Aging. Approximately 50 clinical sites nationwide will offer the study to 450 patients with mild to moderate Alzheimer’s disease. Houston Methodist expects to enroll approximately 20 patients. For study questions, call 281.222.9983.

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Part of a Fitness ProgramYou don’t have a run a marathon

or lift weights to get the benefits of regular exercise. If you’re not already active, walking is a great way to get on the road to being active. Work toward a goal of 6,000-10,000 steps a day. It may sound daunting but it's easier than you think. By adding simple activities — taking the stairs when you can and parking your car far from the entrance of your work building or a shopping mall — you can increase the number of steps you take each day.

You Can Find Time for Exercise, If You Look

Exercise seems to be the last thing many of us make time for, but you can make time to exercise in several ways. Exercise during your lunch hour, take walks during your

breaks or incorporate activities such as vacuuming, gardening, walking your dog or washing your car by hand in to your daily routine. Even 10 minutes a day can make a difference.

Texercise is perfect for the beginner. “It’s is a well-organized program and it’s easy to follow,” she said. “I encourage my students to keep the handbook with them at all times, because there’s always something you can do. We’re surrounded by opportunities to exercise, so we have no excuse not to exercise.”

Healthy Eating Made Easy

Proper nutrition includes plenty of vegetables, fruits, whole grain products, protein-rich foods, low-fat or nonfat dairy products, and foods with plenty of calcium, vitamin D

Age Well Live WellLook Better, Feel Better, Keep Healthy With Texercise

Aging and illness are sometimes thought of as two sides of the same coin; we get old, we get sick, and that’s just the way it goes.

While there is no denying that illness often accompanies aging, its onset and its severity are to a great extent determined by our habits -- in particular our diets and the amount of exercise we get.

Today, there is no doubt that a healthy diet and the right amount of exercise can stave off (and in some cases prevent) many illnesses, keep us active longer, and make us look and feel better at the same time.

Texercise

Texercise is a statewide fitness program to educate and involve Texans their families and their communities in physical activities and proper nutrition.

Rusty Cribbs, 77, is a retired schoolteacher in Austin and a Texercise instructor. She spends about 10 hours a week exercising. Her regimen includes walking at her local mall, hiking, and table tennis. Her apartment complex has a pool and a fitness center, so she also does water aerobics, walks on the treadmill and the Stairmaster, and also rides a stationary bike. “And I also enjoy dancing,” she said.

Cribbs is a firm believer in the merits of exercise and diet. Texercise “has added so much to my overall health,” she said.

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By Jeff Carmack, Managing Editor,Texas Department of Aging and Disability

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located at 4400 Palm Royale Blvd., in Sugar Land, Texas. Tickets are $200 per player or $700 a foursome, including 18-hole play, cart rental, lunch, and cash bar cart service. At the end of the tournament, Dr. Dan Kelly, an infectious disease spec ia l ist and co -founder of Wellbody Alliance, will present a live update ‘From the Frontlines’ of the fight against Ebola. All proceeds from the event will benefit Wellbody Alliance (www.wellbodyalliance.org - “Wellbodi” means “good health” in local Krio language) and tickets, donations, and hole sponsorships at $500, $1,000, $2,500 and $5,000 are available by (mailed) check or online at www.worldmissionspos-

sible.org

ABOUT WORLD MISSIONS POSSIBLE

World Missions Possible is a “Best in America” & Proud Member of 2012 & 2013 U.S. Combined Federal Campaign “Charities Under 5% Overhead.” Since 2001, WMP has provided medical and aid outreach in hard-to-reach, overlooked, and underserved rural areas in 16 developing nations (including Ghana, India, Nicaragua, Mexico, Sierra Leone, South Africa, Swaziland, USA, Viet Nam, and Zambia). To date, WMP has provided approximately 590 surgeries, 5,560 medical exams and care, 6,000 eye exams, and distributed over 7,750 free pairs of eyeglasses – all free of charge to the patients. The organization has been recognized as “Best in America” by Independent Charities of America. Operating as an audited 501(c)3 organization, World Missions Possible averages 3%-5% administrative costs, as it has no hired staff and has always relied 100% on volunteer support and donors. WMP is a proud member of Combined Federal Campaign “Charities Under 5% Overhead” (2012 & 2013). More information is available at: http://www.worldmissionspossible.org

Houston-based nonprofit World Missions Possible is no stranger to West Africa – leading eight volunteer teams of Houston-based doctors and nurses to bring medical care to over 4,200 patients in remote and rural West African villages. But now one of its partners, Wellbodi Alliance in Sierra Leone, is fighting a rare, but fatal, enemy: The Ebola virus.

“We are in phone contact with the doctors and nurses there and worry every day for their health and welfare. These healthcare providers are the real heroes. They

are risking their own lives to care for the medical needs of others,” said World Missions Possible President Roxane Richter, EMT, “Houstonians can help us to get this clinic protective gear, supplies, and supportive medications they need to stop the spread of this terrible disease.”

HCA Clear Lake Regional Medical Center Emergency Physician Dr. Thomas Flowers, and Elite Care Emergency Physician Dr. Jason Gukhool, led two WMP medical

teams to Kono, Sierra Leone, and provided training in pediatr ic resuscitat ion and life suppor t (abridged Advanced Trauma and Cardiac Life Support), Ultrasound, CPR, sterilization, infection control, and eye care in regional healthcare provider training and EMS capacity building in 2011 and 2012.

The 2012 WMP team assisted with the rampant Cholera epidemic – the worst in 15 years that claimed hundreds of lives and af fected 12,000 people – as well as endemic t yphoid, malaria, and parasit ic

diseases. In 2013 World Missions Possible sent a 20-foot container with over $100,000 worth of medical supplies including an ultrasound, defibrillators, 220 spinal anesthesia surgical sets, and the region’s only operational x-ray unit.

To aid Wellbody Alliance in the current Ebola epidemic, a “Boot Out Ebola” charity scramble golf tournament will be held from 1 p.m. - 6p.m. on Monday, Sept. 22, 2014, at Sweetwater Country Club,

Local Nonprofit, World Missions Possible, Invites Houstonians to Help “BOOT OUT EBOLA” in Sierra Leone

Nonprofit to Provide Supplies and Support to Wellbodi Clinic in West Africa

Pictured are: (L to R) back row: Wellbody Alliance Co-founder, Houston native Dr. Dan Kelly, three clinic staff, WMP Medical Director Dr. Thomas Flowers, and (front row, centered) Wellbody Co-Founder Dr. Bailor Barrie, and WMP President Roxane Richter, EMT, with entire Wellbody Alliance Amputee Clinic staff in Sierra Leone.

The local Houstonian health care providers (as pictured above) in Sierra Leone and their specialties: WMP Medical Director Dr. Thomas Flowers (ACLS & ATLS instructor); WMP President Roxane Richter, EMT (vision screening & triage); Dr. Jason Gukhool (ultrasound training); Joanne Fisher, RN (sterilization & infection control), and Brad Starkey, Flight Paramedic-C (trauma & pediatric). In 2013, World Missions Possible donated a mobile x-ray unit, ultrasound, 2 defibrillators, and a 20-foot container worth over $100,000 in supplies and medications to Wellbody Alliance.



Adolescents most at risk with e-cigarettes, yet teen usage soars

Teenagers are among the fastest growing groups of electronic cigarette consumers in the U.S., with usage among middle and high school students more than doubling from 2011 to 2012, according to data from theCenters for Disease Control and Prevention (CDC). Making this information even more troubling are recent studies showing that teens may also be the most vulnerable to the devices’ physical and psychological side effects.

Even though e-cigarettes don’t contain tobacco, the battery-powered devices do deliver nicotine in aerosol form. “Nicotine’s addictive properties are a risk for any age group, but with adolescents, the stakes are even higher,” says Dr. K. Vendrell Rankin, a professor and associate chair in public health sciences who

is director of Texas A&M University Baylor College of Dentistry’s Tobacco Treatment Services.

For teens, mental health as well as key emotional and cognitive systems are at stake.

“Major cognitive functions and attention performance are still in

the process of developing during adolescence,” Rankin says. “Nicotine increases the risk of developing psychiatric disorders and lasting cognitive impairment and is associated with disturbances in working memory and attention. Reliance on nicotine to manage negative emotions and

situations impairs the development of coping skills.”

In addition to affecting the emotional and cognitive development of teens, nicotine is highly addictive. In fact, the younger a person is when

they begin using nicotine, the more likely they are to become addicted and the stronger the addiction may become. According to the American Lung Association, of adults who smoke, 68 percent began smoking at age 18 or younger.

Nicotine use very quickly escalates into addiction, even when dealing with tobacco-free, odorless “vaping”associated with e-cigarettes. That’s because nicotine in any form triggers the release of neurotransmitters such as adrenaline and dopamine, which dramatically impacts a number of body systems. Dopamine floods the brain, and nicotine cravings increase.

“Everybody has a certain amount of nicotine receptors in the brain,” Rankin says. “When you start smoking, vaping or supplying nicotine to them, they multiply. If you stop smoking or vaping, the receptors don’t go away.”

In other words, the younger users are when they try or start using nicotine, the more receptors they will

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glucose levels that result from defects in insulin secretion, or its action, or both. Insulin is a hormone that helps glucose get into the cells to give them energy. Without insulin, too much glucose stays in your blood.

According to the U.S. Department of Health and Human Services, an estimated 23.6 million people in the United States or 7.8 percent of the population have diabetes, a serious, lifelong condition. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.

Moments later, when Teresa called back to check on Currier, an emergency medical services crew was loading her into an ambulance to rush her to Memorial Hermann Northeast.

The American Diabetes Association says a normal reading after fasting ranges from 70 to 130 mg/dl. In Memorial Hermann Northeast’s Emergency Center, Currier’s glucose was found to be 1,015 mg/dL, a dire emergency situation.

DKA, a life-threatening problem, occurs when the body cannot use glucose as a fuel source because there is no insulin or not enough insulin. Possible complications include fluid buildup in the brain (cerebral edema), heart attack and death of bowel tissue due to low blood pressure, and kidney failure.

Currier spent two days in the Intensive Care Unit at Memorial Hermann Northeast where Theresa was a frequent visitor.

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With a river tubing vacation in New Braunfels, the 4th of July holiday, and her 17th wedding anniversary, stay-at-home mom Betty Currier was having a great summer with family and friends, but she was putting her health on the backburner.

Not eating right and skipping blood sugar level checks quickly caught up to the 43-year-old diabetic from Huffman, Texas. The morning of July 8, Currier was not feeling well when she answered the phone.

“It was Memorial Hermann Northeast Hospital calling to schedule a procedure,” said Currier. “But, I felt so nauseated and sick I couldn’t concentrate on what she was saying or what I was saying.”

Just seconds into the phone

call, Memorial Hermann Northeast Mammography and Ultrasound Nurse Navigator Theresa Huckabay, L.V.N. knew something was not right.

“She sounded very confused and scared,” said Huckabay. “I knew immediately something wasn’t right, so I told her to hang up and call 911. I called 911, too, because I knew she was at home by herself.”

Huckabay’s instincts were right. Currier was suffering diabetic ketoacidosis (DKA).

Most of the food people eat is broken down into glucose (sugar in the blood), the main source of fuel for the body. Diabetes is a metabolic disease in which the body is unable to properly use and store glucose. It is characterized by high

“Th eresa is my angel,” said Betty Currier (left ) with Th eresa Huckabay, L.V.N. “I don’t want to think what would have happened if she hadn’t taken the time to listen to me and care about me. I trust the staff at Memorial Hermann Northeast Hospital - they’re like family.”



Philanthropy and Alumni Relations were also on hand to help accept donations to not only the ALS Association but also the ALS program at Baylor.

ALS is a prog ressive neurodegenerative disease that affects the nerve cells in the brain and spinal cord slowly limiting the ability of the brain to initiate and control muscle movement through out the body. In later stages the body becomes completely immobile while cognition remains unaffected. It eventually leads to death. The illness is also known as “Lou Gehrig's disease," after the famed New York Yankee’s player who was diagnosed in 1939.

There is no cure for ALS but there are treatments that slow the disease. There are current research projects at Baylor looking to determine which genes are responsible for the disease and eventually find a cause and cure.

event among students.

Dr. Yadollah Harati, professor of neurology, and director of the ALS Clinic at Baylor, the only ALS Association Certified Center of Excellence in Houston, brought along his clinic team to take part in honor of the many people they treat and support daily.

Members of the Office of

funds for those who live with ALS, amyotrophic lateral sclerosis.

Second-year medical student Timothy Dunn and graduate school student Adrianne Stone helped spread the word and organize the

Dr. Paul Klotman, President, CEO, and Executive Dean of Baylor College of Medicine was challenged by Mark Wallace, CEO of Texas Children’s Hospital to take part in the Ice Bucket Challenge for ALS. He responded with a full Baylor team effort. Dr. Yadollah

Dr. Paul Klotman, president, CEO and executive dean of Baylor College of Medicine, took part in the ALS Ice Bucket Challenge today, along with more than 200 other members of the Baylor community including students, faculty and staff.

He accepted the challenge by Mark Wallace, CEO of Texas Children’s Hospital, but took it one step further by inviting other Baylor folks to take part. It was a team effort to show support, raise awareness and

Baylor College of Medicine accepts ALS Ice Bucket Challenge

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Study predicts hepatitis C will become a rare disease in 22 years

Computer simulation forecasts favorable trends in eradicating hepatitis C

Effective new drugs and screening would make hepatitis C a rare disease by 2036, according to a computer simulation conducted by The University of Texas MD Anderson Cancer Center and the University of Pittsburgh Graduate School of Public Health. The results of the simulation are reported in the August 5 edition of the journal Annals of Internal Medicine.

“Hepatitis C (HCV) is the leading cause of liver cancer and accounts for more than 15,000 deaths in the U.S. each year,” said Jagpreet Chhatwal, Ph.D., assistant professor of Health

Services Research at MD Anderson, and corresponding author on the study.

“If we can improve access to treatment and incorporate more aggressive screening guidelines, we can reduce the number of chronic HCV cases, prevent more cases of liver cancer and reduce liver-related deaths,”Chhatwal said.

HCV – a virus transmitted through the blood – is spread by sharing of needles, the use of contaminated medical equipment, and by tattoo and piercing equipment that has not been fully sterilized. Those at the highest risk for exposure are baby boomers –people born between 1945 and 1965. Widespread screening of the U.S. blood

supply for hepatitis C began in 1992. A majority of people were infected through blood transfusions or organ transplants before 1992.

Baby boomers account for 75 percent of the estimated 2.7 to 3.9 million people infected in the United States. Half of people with the virus are not aware they are infected. The Centers for Disease Control and Prevention, and the U.S. Preventive Services Task Force now recommend a one-time HCV screening for this population group.

In this study, Chhatwal and his collaborators used a mathematical model with information from several sources including more than 30 clinical trials to predict the impact of new therapies

called “direct-acting antivirals” and the use of screening for chronic HCV cases.

Researchers developed a computer model to analyze and predict disease trends from 2001 to 2050. The model was validated with historical data including a recently published national survey on HCV prevalence. Researchers predicted with new screening guidelines and therapies, HCV will only affect one in 1,500 people in the U.S. by 2036.

The model predicts one-time HCV screening of baby boomers would help identify 487,000 cases over the next 10 years.

“Though impactful, the new

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deliver higher-quality, lower-cost health care. Thus, it is critical for a strategic assessment to look at operations from a global perspective with a focus on delivering high-quality, low-cost health care, now and in the future.

Building on the foundation provided by the financial and operational components, the environmental portion of the strategic assessment considers a wide range of environmental factors that could affect the hospital. These might include the hospital’s competitive position, community demographics, community health status, market share and degree of differentiation from competitors, along with health care reform-driven changes at the state, regional and national level. In addition, a critical component of the strategic assessment’s environmental portion should be an assessment of competitors in the hospital’s primary and secondary service area and their respective affiliation strategies.

Including an analysis of the competitors in the hospital’s market and an assessment of their affiliation strategy should not be viewed as a predestination of the outcome of the strategic assessment process. Rather, the competitive environment in the hospital’s service area should be a critical component of the environmental analysis, potentially highlighting opportunities or threats that may need to be addressed. The shift to a new model of care will require a broad range of collaborations and affiliations, but that does not mean the loss of financial or governmental independence is a foregone conclusion of a strategic assessment that considers competitors and affiliations.

After the strategic assessment is complete, the findings should be followed by action. While the process of the strategic assessment may be beneficial, the assessment brings little value to the hospital if its observations and recommendations are not pursued. The board and administrative team should challenge the entire organization to rapidly accept and implement the changes needed for survival in the current environment. There is no doubt that addressing the challenges facing the hospital can be painful, but carefully considered strategic decisions supporting long-term health care in the community are far more preferable to closing the hospital’s doors for good.

with external advisors. Depending on the makeup of the board, the entire board may or may not be involved in the entire process. Some of the discussions in a strategic assessment may be difficult to fully explore in a large group or public setting. Often, a task force of the hospital’s most informed and engaged board members, medical staff and administrative team members may successfully collaborate on a strategic assessment process, keeping the full board and other stakeholders informed of the project’s progress. Although the mechanics may differ, the best course of action is to establish stakeholder involvement that drives strong support for the final outcomes.

Regardless of the format chosen, a strategic assessment should at least include financial, operational and environmental components. These three areas lay a strong foundation for decision making and build a structure that will support other areas that may necessitate additional evaluation during the assessment process.

A financial analysis is typically the foundation of a strategic assessment. This financial analysis should include realistic projections of the hospital’s profitability and capital capacity. The projections should include the known impact of rate cuts, site of service challenges, Medicaid expansion and other quantifiable events. Other less quantifiable events should be closely considered in the financial analysis as well; these events could include the hospital’s exclusion from a developing narrow network, the loss of Critical Access Hospital status or the movement of a large portion of the hospital’s patients from commercial insurance products to exchange insurance products. Projections should be candid about the financial future of the hospital; unrealistic scenarios with suspect assumptions may lead the board to delay necessary strategic decisions.

From an operational prospective, the strategic assessment should consider a broad range of factors, including quality scores, recruiting high-quality providers, service line profitability and desirability and information technology requirements. While it may not have directly impacted all community hospitals, the move to value-based purchasing and population health management will require hospitals to leverage efficient operations to

Stragetic ChallengesContinued from page 1



imaging and expert reading are critical to properly diagnosing and staging cancer and monitoring how a patient is progressing with treatment.

“To bring this facility to patients, residents and physicians in West Houston and surrounding areas is a key part of our mission,” he continued. “We want our patients to be comfortable not only with the knowledge that they are getting the highest quality images read by MD Anderson radiologists, but we also want them to feel at home with our inviting, private and relaxed environment away from the bustling Texas Medical Center.”

Center Medical Director Monica Huang, M.D., who grew up in Alief, completed two years of specialized radiology training both in breast and full-body imaging beyond her five years of radiology residency training. She and a team of MD Anderson radiologists, imaging nurses, technologists and administrative employees will staff the new center that covers 35,000 square feet.

“Like our colleagues in the Texas Medical Center, we intend to give patients who come to the MD Anderson Diagnostic Center in West Houston the

highest quality care. The circumstances surrounding imaging, whether diagnosing a cancer or determining if there is a recurrence, can be stressful,”said Huang. “Because we are MD Anderson, we understand these fears and are committed to minimizing them through prompt image interpretation and consultation with community physicians and open communication with each patient.”

Imaging for women’s cancers is located in an adjacent area with its own entrance and waiting and changing areas. In addition to breast imaging services, the center provides pelvic ultrasound and MRI, and sonohysterography.

Also available at the center are lab and cytopathology services that provide information to detect and stage cancers. The cytology lab processes a variety of samples and offers immediate assessments, including results from fine needle biopsies performed on site.

MD Anderson Diagnostic Imaging in West Houston is available to all cancer patients, regardless of where they receive their treatment or where they may prefer to have treatment, if cancer is detected.

Th e FrameworkContinued from page 6

“Rather than having to obediently wait on help lines or for email support, consumers can now shout on social channels and be heard by a mass audience, instantly.” With a tip of the hat to British Airways, KLM and Ryan Holmes, consider these useful tips:

Recognize the complaint channel of choice. A majority of US consumers use social media for service questions and complaints, according to a recent Nielson study.

Tomorrow is too late. The immediacy of social media has trained the consumer to expect a quick response. Eight out of 10 Twitter users look for a same-day answer, according to a report form Oracle.

Cast a wide and inclusive net. “Customer service in the age of social media,” Ryan Holmes advises, “needs

to be everyone’s job, [and] customer service in the social media era needs to be radically decentralized…it’s essential that all employees become the eyes and ears of an organization on social media.”

The downside is well understood, and it’s primarily lost revenue. For physicians, medical facilities and providers it also threatens (sometimes damages) professional reputation. On the other hand, surveys tell us that online comments and reviews of doctors by patients are largely positive.

Nevertheless, social media has become a large—and potentially loud—megaphone for consumers in general, and patients in particular, to shout about their questions and concerns. As such, it’s more important than ever to monitor social media vigilantly and to respond quickly. www.healthcaresuccess.com

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Marketing EssentialsContinued from page 7



provide a great opportunity to tackle the hepatitis C epidemic. “But we need to ensure that we provide timely and affordable access to treatment to achieve the potential benefits.”

“The new treatment that costs $1,000 a day has been a subject of debate and can become a barrier to timely access to all patients,” Chhatwal said.

“Although recent screening recommendations are helpful in decreasing the chronic HCV infection rates, more aggressive screening recommendations and ongoing therapeutic advances are essential to reducing the burden, preventing liver-related deaths and eventually eradicating HCV,” Chhatwal said.

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screening guideline does not identity the large number of HCV patients who would progress to advanced disease stages without treatment and could die,” Chhatwal said.

“Making hepatitis C a rare disease would be a tremendous, life-saving accomplishment,” said lead author Mina Kabiri, a doctoral student at the University of Pittsburgh Graduate School of Public Health. “However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening.”

In this study, researchers predicted

a one-time universal screening could identify 933,700 HCV cases. Chhatwal and his colleagues also predict the universal screening and timely treatment can make HCV a rare disease in the next 12 years. Such screening can further prevent:

• 161,500 liver related deaths,

• 13,900 liver transplants and

• 96,300 cases of hepatocellular carcinoma – the most common type of liver cancer.

Chhatwal, whose current research focuses on evaluations of cancer prevention strategies using quantitative methods, says the availability of highly effective therapies and screening updates

Hepatitis CContinued from page 18

have and the more they may struggle with nicotine cravings through out their lives. It’s concerning news for the 1.78 million teens who tried e-cigarettes in 2012, according to the CDC.

E-cigarette companies currently advertise their products to a broad audience that includes 24 million youths, and proposed U.S. Food and Drug Administration regulations would not limit e-cigarette marketing. Bold marketing tactics, celebrity endorsements, endless flavor choices and a plethora of online videos

instructing users on how to mix their own e-cigarette liquid, or “e-juice,” have only added fuel to the fire. There currently are no federal laws in place to restrict minors from purchasing e-cigarettes.

There is a glimmer of hope on the horizon. In April, the FDA released the details of a proposal to extend its tobacco authority to e-cigarettes, including minimum age and identification restrictions intended to prevent sales to minors. A final ruling is slated for summer

2015.

In the meantime, many Texas cities have set their own regulations and ordinances banning the sale of e-cigarettes to minors. Any e-cigarette regulation in Texas will have to occur city by city, Rankin says, since the state doesn’t have comprehensive smoke-free laws.

“I don’t think e-cigarettes are going to drop off,” Rankin says. “It’s the newest — or most popular — kid on the block right now.”

Teens at RiskContinued from page 15

and vitamin B-12. Eating right boosts energy and lowers the risk for many chronic diseases.

Cribs said, “As part of my classes, we always take time to have a healthy snack. And the Texercise book has lots of good information about proper nutrition. It also helps you eat smarter when you’re eating out, and during the holidays.”

Time to Trade In Your Old

Eating Habits

For ideas on healthy eating habits, nutritional plans, a food guidance system and a healthy eating index, visit the U.S. Department of Agriculture’s www.choosemyplate.gov. The changes you make are important and can improve your health and your everyday life. Pretty soon, it will be a habit to eat well. The Texercise website and handbook

www.texercise.com also include nutrition information.

“It’s a new way of life, and eating correctly and exercising regularly can help us have a long healthy life to look forward to,” Cribbs said.

To download a free copy of the Texercise handbook, go here www.texercise.com .

Age Well Live WellContinued from page 12



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