of the Dallas County Medical Society
THE VALUE OF BEING A MEMBER
Jon R. Roth, MS,
EDITORIAL
EDITOR,
Lauren S. Williams
DESIGNED BY Morganne Stewart
ADVERTISING
Strategic Partnerships Manager Janet Fyock
COMMUNICATIONS COMMITTEE
Michelle Caraballo, MD, Chair
Drew Alexander, MD
Ravindra Bharadwaj, MD
Joy Chen, MD
Ann Leitch, MD
Ravina Linenfelser, DO
David Miller, MD
Sina Najafi, DO
Erin Roe, MD, MBA
BOARD OF DIRECTORS
Deborah Fuller, MD, President
Shaina Drummond, MD, President-Elect
Gates Colbert, MD, Secretary/Treasurer
Donna Casey, MD, Immediate Past President
Neerja Bhardwaj, MD
Sheila Chhutani, MD
Philip Huang, MD, MPH
Anil Tibrewal, MD
Rajeev Jain, MD
Raghu Krishnamurthy, MD
Aekta Malhotra, MD
Marcial Oquendo-Rincon, MD
2024: A Year in Review
Deborah Fuller, MD
AS WE CLOSE OUT THE YEAR, WE’RE GRATEFUL FOR THE JOY, CHALLENGES, AND GROWTH THAT 2024 HAS BROUGHT TO DALLAS COUNTY MEDICAL SOCIETY.
Serving as president of our Medical Society for 2024 has been the pinnacle of my professional career in organized medicine. We at DCMS are thankful for the trust and support you have given us throughout the year.
Dallas County Medical Society was founded in1876, making it one of the oldest county medical societies in Texas. With over 9,000 physician members and medical students, we are now the second-largest medical society in Texas and in the US.
We serve to fulfill our mission statement: To promote the highest standards of ethical and medical practice, to advocate for physicians, and to enhance the quality of healthcare in Dallas County.
DCMS has had a highly active year with many fun and educational programs involving physicians, medical students, and their families.
2024 DCMS Activities
• Installation Dinner and Awards Ceremony: January 2024
• Active Shooter Response Training and Panel Discussion (part 1 of a 3-part series): February 2024; 80 participants
• DCMS Afternoon with the Mavericks: February 2024; 195 participants
• DCMS Women in Medicine Afternoon Tea: April 2024; 34 participants
• DCMS Risk Assessment and Verbal De-escalation Training: April 2024; 261 participants
• Wellness and Lifestyle Medicine Symposium: May 2024
• DCMS Member Roundup at the Dallas Zoo: May 2024; 308 participants
• Insperity HR and Gardenuity; Present Your Own Herb Garden: June 2024; 12 participants
• DCMS Day with the Texas Rangers: June 2024; 156 participants
• DCMS Workplace Violence Series: Risk Management: June 2024; 62 participants
• Shakespeare in the Park: Twelfth Night: July 2024; 52 participants
• 2024 DCMS Physician and Student Mixer: August 2024; 247 participants
• DCMS Young Physicians and Medical Students Night at the State Fair of Texas: October 2024; 14 participants
• Autumn at the Arboretum: October 2024; 125 participants
• Women in Medicine: The Art of Beauty: November 2024; 44 participants
• DCMS Holiday Social: The Nutcracker at the Texas Ballet; 65 participants and counting
• TMA Top Ten: What Physicians Need to Know: December 2024; participants to be determined
• DCMS Headquarters Open House: December 2024; participants to be determined
DCMS Staff
No organization is complete without excellent staff at the helm and behind the scenes helping to keep DCMS running smoothly. Please know, each one of you, from myself and all our DCMS membership, that we wouldn’t be a leading, well-respected medical society without each of you supporting and caring for the physicians and the patients of Dallas County.
Jon Roth MS, CAE: Executive Vice President/CEO
Gaby Uquillas : Chief Financial Officer
Ruby Blum: Vice President, Policy and Legislative Affairs
Alyce Eyer: Program and Administrative Manager
Nishi Badhwar: Member Engagement Manager
Lauren Williams: Assistant Vice President, Publications and Digital Communications/Editor, Dallas Medical Journal
Sarah Donahue: Vice President, Events and Fundraising
Deanna Wooten: Senior Vice President, Membership/Operations and Information Technology
DCMS Board of Directors for 2024
Thanks to all physicians, medical students, and families who took part in all these educational and fun-filled activities!
I also want to thank all those who took the time from their busy work schedules to serve on our DCMS Board of Directors for 2024:
Donna Casey MD: Immediate Past President
Shaina Drummond MD: President-Elect
Gates Colbert MD: Secretary/Treasurer
Neerja Bhardwaj MD: Member
Sheila Chhutani MD: Member
Philip Huang MD: Member
Anil Tibrewal MD: Member
Rajeev Jain MD: Member
Raghu Krishnamurthy MD: Member
Aekta Malhotra MD: Member
Marcial Oquendo-rincon MD: Member
Joy Chen MD: Chair, Board of Censors
As 2024 draws to a close, I am profoundly thankful for the privilege of serving as president of Dallas County Medical Society. It has been an incredible honor to work alongside such dedicated and compassionate physicians and staff who strive daily to improve the lives of our patients and the health of our community. Together, we have faced challenges, celebrated successes, and reaffirmed our commitment to the highest standards of medical care and advocacy. We look forward to our Open House in our new DCMS headquarters and sharing it with each of our DCMS members. Thank you all for entrusting me with this opportunity. It has been a year I will always treasure.
Wishing you warmth and joy and a hopeful start to the New Year! DMJ
NEW DCMS HEADQUARTERS IN THE HEART OF UPTOWN
CAMPAIGN FOR THE FUTURE
Fasten Your Seatbelts for a Wild Legislative Ride
Jon R. Roth, MS, CAE
AS WE CATCH OUR BREATH FROM THE INTENSE AND DRAMA-FILLED 2024 ELECTION SEASON, it’s time to gear up for the real work ahead. The Texas Legislature’s 89th Regular Session is set to run from January 14, 2025, to June 2, 2025. This 140-day session will be packed with discussions and decisions on legislation that will shape the future of our state. And who knows, we might even see special sessions called to tackle lingering policy issues.
The 2024 state election cycle for Texas House and Senate members was a spectacle of intraparty politics like never before. Republicans managed to pick up three seats—two in the House and one in the Senate. But the real story was the unprecedented number of incumbents ousted by new candidates within their own party during the primaries. A total of 14 incumbent Republicans lost their seats to new Republican challengers, largely due to backlash over votes on school vouchers and the impeachment attempt of the attorney general.
So, what does this mean for the physician community? The answer is both opportunities and challeng-
es. With 14 new legislators, nine of whom have never held elected office before, there’s a significant learning curve ahead. The Dallas County Medical Society (DCMS), Texas Medical Association (TMA), and our physicians will need to invest considerable time and effort in educating these newcomers on the critical issues facing medicine. We must ensure they understand the complexities and potential pitfalls of seemingly good ideas that could have adverse effects on healthcare.
Advocacy groups that have previously been stymied by the medical community on issues like scope of practice, tort reform, and prior authorization are likely to see these new legislators as fertile ground for advancing their agendas. Without the necessary background and education, these legislators might not ask the tough questions needed to protect the interests of Texans and Texas physicians.
However, this influx of new faces also presents a unique opportunity. By proactively educating these legislators, we can build relationships that may help advance our priorities. While freshman legislators may not have the clout to carry major policy bills, they can still be influential allies as legislation moves through committees and chambers.
A significant part of this educational process begins at home. Physicians should meet with their elected officials and offer their expertise before the session starts. As the saying goes, all politics is local. DCMS can assist with these meetings and provide necessary talking points and background materials. Another crucial way to engage is through the TMA First Tuesday legislative visits at the Capitol in Austin. These visits are vital for legislators to hear directly from their physician, medical student, and alliance constituents about how proposed legislation could impact medical practice in Texas.
Mark your calendars for the 2025 First Tuesdays at the Capitol on February 4, March 4, April 1, and May 6. If you’re new to advocacy, don’t worry—DCMS is here to support you. We will schedule visits, assign physicians to small groups, and work with TMA to provide all the briefing materials. For more information on First Tuesdays, visit TexMed.org.
Let’s make sure we’re prepared for this wild legislative ride and ready to advocate for the future of medicine in Texas.
Jon R. Roth, MS, CAE DCMS EVP/CEO
ADMINISTRATIVE/HEALTH LAW RAC AUDIT DEFENSE CYBER LIABILITY
MEDICAL MALPRACTICE DEFENSE
PEER REVIEW EVIDENTIARY HEARING
INTELLECTUAL PROPERTY RIGHTS
REGULATORY COMPLIANCE CONTRACTS
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GOVERNMENTALENTITIES PRODUCT
But whenauditorsorregulatorsthreatenyou, it'snolaughing matter. You needaggressiveinterventionbya teamofbattletestedspecialists* torebut the government'slegions oflawyers, coders, auditorsand forensicexperts.
"Those are the nine most terrifying words in the English language" President Ronald Reagan once quipped. When facing "help" from the government, put Shaw Wair in your corner. (Phone) 214-217-8357 (Fax) 214-217-828 (Email) info@dkshaw.com Visit usonlinewww.dkshaw.com Shaw & Associatesisa proud memberof *NotcertifiedbytheTexas Boardof
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New AMA Series on Proper Coding and Billing
* torebut the government'slegions oflawyers coders auditorsand forensicexperts
"Those are the nine most terrifying words in the English language" President Ronald Reagan once quipped. When facing "help" from the government put Shaw Wair in your corner (Phone) 214-217-8357 (Fax) 214-217-828 (Email) info@dkshaw com
by Shaw & Wiar, Attorneys at Law Sponsored
With Helping Medical Professionals
REFERENCES
1. https://www.ama-assn.org/practice-management/sustainability/ myth-or-fact-only-those-providing-care-can-enter-billing-codes
IF YOU ARE A PHYSICIAN OR SIMPLY WORK IN AN ADMINISTRATIVE CAPACITY
AT A MEDICAL FACILITY, it would be useful to review the AMA’s recent article “Myth or fact? Only those providing care can enter billing codes.” If you can stomach the “Joy of Medicine™” HR speak, it provides a good overview of who should be entering billing codes. In it, you’ll find, “An AMA review of current guidelines shows that physicians and other qualified health care professionals must ensure that the correct diagnosis and CPT codes, as well as modifiers, if applicable, are used. However, other authorized, appropriate individuals are allowed to physically enter or change the code. If the person entering or changing the code is not the physician, they should consult with the physician to ensure that any update that is made properly reflects the service provided.”
Remember, though, that if you’re the physician, if someone bills incorrectly, it is your responsibility. Make sure that whomever you have billing knows exactly what services you provided, which CPT codes to use, and is regularly checking for updated CPT codes and changes from insurers.
All Local and National Coverage Determinations and insurers’ educational materials including the outrageously cumbersome CMS manual are replete with documentation requirements necessary to comply with basic insurer “reviews” or “audits.” It’s important to keep up with as much education as you can to ensure documentary compliance with your area of specialty or most used CPT codes.
If you’d like to learn more, you can review the AMA’s series on “Debunking Regulatory Myths” for CME credits, or you can read the AMA STEPS Forward® “Reducing Regulatory Burden Playbook,”1 which would be just for education, as you’d receive no CME credit. DMJ
HOUSE CALL
The Value of Being a Member of the Dallas County Medical Society
THE DALLAS COUNTY MEDICAL SOCIETY (DCMS) REPRESENTS NEARLY 150 YEARS OF EXCELLENCE, advocacy, and community in the medical profession. As one of the nation’s largest and most active county medical societies, DCMS is not just an organization— it’s a vibrant hub where physicians connect, grow, and lead. Joining DCMS unlocks opportunities that extend beyond professional development to include personal growth and a sense of belonging.
Building Connections and Networks
At the heart of DCMS is a commitment to fostering
relationships. With the DCMS Directory, which is going digital in 2025, members can easily connect with peers for referrals and collaboration. The Physician Finder and DCMS Career Center offer resources like job boards, career coaching, and recruitment tools, making career advancement seamless. Networking doesn’t stop there; members enjoy access to a variety of DCMS events that blend family fun, entertainment, and professional engagement.
Enhancing Your Practice
DCMS is an ally in helping members manage the complexities of running a medical practice. The TMA Knowledge Center, valued at over $1,000 per user, offers free access to research, journals, and databases. Members also benefit from the Physician Payment Resource Center, a valuable service for resolving payer and reimbursement issues. The Practice Help Program connects members with experts in coding and reimbursement, ensuring the business side of medicine doesn’t hinder patient care.
Unparalleled Resources
Practicing medicine involves both caring for patients and running a successful business. Many factors contribute to your business, and DCMS is your best resource for that information. Legislative actions, private payor trends, compliance issues, reimbursement discrepancies, and the economic climate in the North Texas healthcare arena all influence the success of
your business. The Dallas County Medical Society tracks each of these factors and will keep you informed and up to date through this Business of Medicine section.
The Dallas County Medical Society is pleased to offer the DCMS Partners Program – a resource to assist member physicians in running their practices. The DCMS Partners Program consists of medicine-related businesses that serve Dallas-area physicians. These businesses include, but are not limited to, real estate professionals, practice management services, banking institutions, and legal entities.
Professional Growth Through Education and Advocacy
Members gain access to over 140 CME programs, including TMB-mandated courses, completely free through the TMA Insurance Trust. Beyond education, DCMS ensures physicians’ voices are heard. Advocacy programs like First Tuesdays at the Capitol bring members face-to-face with legislators, strengthening the profession’s influence on public policy. Whether it’s connecting with local officials or supporting medicinefriendly candidates through the DCMS PAC and TEXPAC, members shape the future of healthcare.
Count on the Dallas Medical Society and the Texas Medical Association to advocate for physicians as legislation and administrative actions that impact physicians are deliberated. There is strength in numbers when it comes to advocacy, and when you are a member of organized medicine in Texas, you will never go it alone. The show of a collective effort of DCMS physicians is extremely important. Members provide a powerful common voice protecting patients, physicians, and their relationship, while serving as thought leaders and conveners to model positive change. DCMS physicians are involved in influencing legislation as it pertains to the quality of care delivered to patients.
The Texas Legislature meets every odd-numbered year for 140 consecutive days and will convene again January 14, 2025. Legislators need to hear from you –their physician, medical student, and alliance constituents – during the session to understand how proposed legislation can potentially impact the practice of medicine in Texas. Mark your calendar for 2025 First Tuesdays at the Capitol: February 4, March 4 (TMA Alliance and Young Physician Month), April 1 (TMA Medical Student and Resident Month), and May 6.
Prioritizing Wellness and Leadership
DCMS recognizes the demanding nature of medicine
HOUSE CALL
and prioritizes physician well-being. Programs like the Emotional PPE Project and Wellness First provide confidential mental health resources, while the DCMS Physician Recovery Committee offers structured support for substance use or behavioral health challenges. For those looking to lead, the TMA Leadership College and the UT Dallas Physician Leadership Certificate Program can equip members with tools to navigate and influence the ever-evolving healthcare landscape.
Staying Informed
With a robust communications platform, DCMS keeps its members updated on crucial topics. Members receive the monthly Dallas Medical Journal, science-based articles for ongoing learning, digital communications like the DMJ Weekly Newsletter and TMA’s Texas Medicine Today, offering timely updates on healthcare issues statewide, plus many ways to connect on social media.
Serving the Community
DCMS isn’t just about serving members—it’s also about giving back. From the Dallas County Medical Reserve Corps to disaster volunteer programs, DCMS creates avenues for physicians to make meaningful impacts locally and beyond.
The Dallas County Medical Society coordinates with the Dallas County Health and Human Services Department and other local response organizations during public health emergencies to meet the volunteer needs for medical support. Physicians who volunteer must be members in good standing with Dallas County Medical Society and maintain a current license to practice medicine from the Texas Medical Board.
Physicians who have volunteered in the past have been given assignments such as seeing patients who evacuated from Hurricanes Katrina, Rita, Gustav, and Ike, and providing vaccinations during the initial roll out of the COVID-19 vaccines. For medical sheltering operations, the need for pediatrics, emergency medicine, primary care, and infectious disease physicians is the highest.
Additionally, with the move of the Dallas County Medical Society headquarters into the heart of Uptown Dallas, we are excited to begin the process of creating programs where school children can interact with DCMS physician volunteers to discover the possibilities of medicine as a professional opportunity. Our vision is to provide interactive exhibits to spur young children’s interest in medicine as a profession, create physician-led interactive STEAM programs, foster partnerships with schools and other learning centers, all while cultivating the next generation of Dallas physicians.
Membership in the Dallas County Medical Society is more than a professional commitment; it’s an investment in your career, your community, and your future. With unparalleled resources, a thriving network, and opportunities for leadership and service, DCMS provides an environment where physicians are valued and supported through every phase of their career. Whether you’re seeking professional growth, advocacy support, or a chance to make a difference, DCMS welcomes you to join a legacy of excellence. DMJ
Vaccine and Toxin Injuries to Look for as a Physician
by Shaw & Wiar, Attorneys at Law
IN AN ARTICLE BY THE NEW YORK TIMES ENTITLED “Thousands Believe Covid Vaccines Harmed Them. Is Anyone Listening?”2 Apoorva Mandavilli shares the stories of several people claiming to have been injured by the COVID-19 vaccine. Mandavilli writes about Michelle Zimmerman, 37, a PhD in neuroscience, who claims that after her COVID-19 vaccination, she became extremely sensitive to light and had difficulty remembering simple facts, and now “over three years later, she lives with her parents and has been diagnosed with brain damage, unable to work, drive, or stand for long periods of time.”
Mandavilli also includes the story of Shaun Barcavage, a nurse practitioner in New York City who worked on clinical trials for HIV and COVID-19, who said ever since his first COVID-19 shot, standing up caused his heart to race, a symptom that suggests postural orthostatic tachycardia. He said he also experienced stinging pain in his eyes, mouth, and genitals, which has gone away, as well as tinnitus, which Gregory Poland, the editor-in-chief of the journal Vaccine, claims he, too, developed, as did Buddy Creech, who led multiple COVID-19 vaccine trials at Vanderbilt University.
Mandavilli notes that the COVID-19 vaccine has caused facial paralysis called Bell’s palsy,3 might have caused shingles, and that “CDC has linked mRNA vaccines made by PfizerBioNTech and Moderna to heart inflammation, or myocarditis, especially in boys and young men. CDC has also warned of anaphylaxis, which could occur after any vaccination. Meanwhile, the European Medicines Agency (EMA) has linked both the Pfizer and Moderna vaccines to facial paralysis, tingling sensations, and numbness. EMA also considers tinnitus a side
effect of the J&J vaccine, though American health agencies don’t.” Officially, the CDC recognizes Guillain-Barré syndrome, which is a known side effect of other vaccines, and a blood-clotting disorder, both from the J&J vaccine.
In the last few years, a large contingent, or even a majority, of Americans have become more open about vaccine and toxin injuries, which were previously taboo topics of discussion. Some would be surprised to learn that these issues have actually been litigated for decades. Many would also be surprised to discover that well-known carcinogens like asbestos have not been banned in the United States. According to a ProPublica publication, “unlike dozens of other countries that banned the potent carcinogen outright, the United States never did. To this day, the U.S. allows hundreds of tons of asbestos to flow in each year from Brazil, primarily for the benefit of two major chemical companies, OxyChem and Olin Corp.” These companies use it to make chlorine.4 Everyone is now aware that asbestos causes mesothelioma or asbestosis, yet many in the medical industry forget, or often refuse, to consider that a toxin or vaccine might be causing their patients’ health issues. The effects of ignoring asbestos concerns are catastrophic for patients but lucrative for both doctors and lawyers. In fact, while asbestos is not outright banned in the US, there are entire law firms that only take asbestos-related injury cases.
In an article entitled “Why the U.S. Is Losing the Fight to Ban Toxic Chemicals,” the authors lay out the legal hurdles faced in the US when trying to ban a toxic substance.5 They tell the story of a young girl named Emma Grace who developed cancer as a result of a chemical called TCE:
“[T]he EPA never banned [TCE] in workplaces and industrial factories… In 2014, Kari Rhinehart, a nurse from Franklin, Indiana, was at work when she got a call about her daughter, Emma Grace Findley. Doctors had found signs of swelling during the 13-yearold’s annual eye exam and said she needed further testing…a week before Christmas, Emma Grace died at home in her mother’s arms.” The article continues, saying a local news station “discovered that many children in the community were developing abnormal cancers, [and] Rhinehart learned that sites near her home were polluted with TCE.”
Incidents like this and many others—often welldocumented or litigated, and many anecdotal—remind doctors and lawyers alike to be open as to the cause of a problem. Indeed, besides official reports of COVID-19 vaccine injuries,6 there were, and remain, many unofficial reports of health issues that could be related to the vaccine; however, data from DHHS, the FDA, and CDC remains sorely lacking.7 There is also a concern of incorrect data due to conflicted interests, such as a quite favorable study from The Lancet funded by the FDA.8
As noted, it is difficult to legally ban toxins or examine vaccines in large part because of the relationships that exist between lawmakers, regulators, and the businesses that use toxins or manufacture vaccines. The letter of the law has hamstrung these pursuits for decades, but fortunately, significant progress has been made.
The Toxic Substances Control Act of 1976 allowed the EPA to ban toxic substances but only in the way that was “least burdensome” to the companies that used these chemicals. As anticipated, the law didn’t have any power. Indeed, when the EPA tried to ban asbestos in 1991, the courts ruled against it using the “least burdensome” test, and Congress didn’t eliminate the test until 2016.
Similarly, the National Childhood Vaccine Injury Act of 1986 was passed by Congress “in response to mounting pressure from vaccine makers who claimed they could not afford to continue compensating for the excessive amount of injuries and deaths caused
HEALTH ALLIES
by their products. The law granted pharmaceutical companies complete immunity from liability for any vaccine recommended on the CDC’s childhood schedule. Pharma ramped up development once there was no longer a threat of being sued for adverse outcomes, and a vaccine gold rush ensued, with revenues skyrocketing from $750 million in 1986 to $89 billion in 2021.”9
Many will again be surprised that while the US government makes it almost impossible to sue vaccine manufacturers, it doesn’t deny the reality of vaccine injury, but provides two programs, the National Vaccine Injury Compensation Program for all vaccines besides the COVID-19 vaccine and the Countermeasures Injury Compensation Program for the COVID-19 vaccine in order to compensate those who have been injured by vaccines.10, 11
Sadly also, many toxins are made to look fun specifically for children, but according to the Cleveland Clinic, “[c]urrently, the U.S. doesn’t ban any artificial food dyes.” It then writes that Red 40, a ubiquitous food dye used in many treats for its red color, may cause:
“Hyperactivity, including ADHD, Behavioral changes like irritability and depression, Allergic reaction, Hives and asthma, Sneezing, Watery eyes, Skin irritation, Migraines.
Red dye 40 contains benzene, a known cancer-causing substance.”12
All in all, there is a lot of legal work that needs to be done to correct the toxic stream of chemicals known to cause serious health issues, but progress has been made. By good lawyers partnering with good doctors, many toxic substances that the vast majority of people can agree should be banned will be.
As for doctors and health systems, it is a good idea to consider that your patients could be suffering from a vaccine or toxin injury, both for the patients’ sake and to avoid litigation. Keep an open mind about what might be causing your patients’ health issues. These topics are no longer taboo; rather, they are now topics openly taken seriously by lawyers and doctors alike. DMJ
REFERENCES
2. https://www.nytimes.com/2024/05/03/health/covid-vaccines-side-effects.html
3. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2804297
4. https://www.propublica.org/article/asbestos-poisoning-chemical-plant-niagara-falls
5. https://www.propublica.org/article/toxic-chemicals-epa-regulation-failures#:~:text=The%20 Toxic%20Substances%20Control%20Act,lawmakers%20and%20the%20chemical%20industry.
6. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-andyour-health/coronavirus-vaccine-your-questions-answered/myocarditis-and-covid-19-vaccines-should-you-be-worried
7. https://nypost.com/2024/11/21/us-news/wisconsin-sen-ron-johnson-threatens-legal-action-toget-covid-19-vaccine-data/
8. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00388-2/fulltext
9. https://childrenshealthdefense.org/vaccine-curriculum/
10. https://www.hrsa.gov/vaccine-compensation
11. https://childrenshealthdefense.org/defender/covid-vaccine-injury-largest-payout-claimspending-cicp/
12. https://health.clevelandclinic.org/red-dye-40
Burden of Respiratory Syncytial Virus
Associated Hospitalizations in US Adults, October 2016 to September 2023
by Fiona P. Havers, MD, MHS; Michael Whitaker, MPH; Michael Melgar, MD; Huong Pham, MPH; Shua J. Chai, MD, MPH; Elizabeth Austin, MPH; James Meek, MPH; Kyle P. Openo, DrPH; Patricia A. Ryan, MS; Chloe Brown, MPH; Kathryn Como-Sabetti, MPH; Daniel M. Sosin, MD, MPH; Grant Barney, MPH; Brenda L. Tesini, MD; Melissa Sutton, MD, MPH; H. Keipp Talbot, MD, MPH; Ryan Chatelain, MPH; Pam Daily Kirley, MPH; Isaac Armistead, MD, MPH; Kimberly Yousey-Hindes, MPH; Maya L. Monroe, MPH; Val Tellez Nunez, MPH; Ruth Lynfield, MD; Chelsea L. Esquibel, MSc; Kerianne Engesser, MPH; Kevin Popham, MPH; Arilene Novak, MPH; William Schaffner, MD; Tiffanie M. Markus, PhD; Ashley Swain, BS; Monica E. Patton, MD; Lindsay Kim, MD, MPH
Abstract
IMPORTANCE Respiratory syncytial virus (RSV) infection can cause severe illness in adults. However, there is considerable uncertainty in the burden of RSV-associated hospitalizations among adults prior to RSV vaccine introduction.
OBJECTIVE To describe the demographic characteristics of adults hospitalized with laboratory- confirmed RSV and to estimate annual rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.
DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the RSV Hospitalization
Surveillance Network (RSV-NET), a population-based surveillance platform that captures RSV-associated hospitalizations in 58 counties in 12 states, covering approximately 8% of the US population. The study period spanned 7 surveillance seasons from 2016-2017 through 2022- 2023. Included cases from RSV-NET were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area and with a positive RSV test result.
EXPOSURE Laboratory-confirmed RSV-associated hospitalization, defined as a positive RSV test result within 14 days before or during hospitalization.
MAIN OUTCOMES AND MEASURES Hospitalization rates per 100,000 adult population, stratified by age group. After adjust-
ing for test sensitivity and undertesting for RSV in adults hospitalized with acute respiratory illnesses, rates were extrapolated to the US population to estimate annual numbers of RSV-associated hospitalizations. Clinical outcome data were used to estimate RSV-associated ICU admissions and in-hospital deaths.
RESULTS From the 2016 to 2017 through the 2022 to 2023 RSV seasons, there were 16 575 RSV-associated hospitalizations in adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]).
Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when the COVID-19 pandemic affected RSV circulation, hospitalization rates ranged from 48.9 (95% CI, 33.4-91.5) per 10,000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100,000 adults in 2017 to 2018. Rates were lowest among adults aged 18 to 49 years (8.6 [95% CI, 5.7-16.8] per 100,000 adults in 2016-2017 to 13.1 [95% CI, 11.0-16.1] per 100,000 adults in 2022-2023) and highest among adults 75 years or older (244.7 [95% CI, 207.9-297.3] per 100,000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per 100,000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84,000-230,000) in 2016 to 2017 to 193 000 (95% CI, 140,000-311,000) in 2017 to 2018. Annual ICU admission estimates ranged from 24,400 (95% CI, 16,700-44,800) to
Proportion of Adults With Respiratory Syncytial Virus
34,900 (95% CI, 25,500- 55,600) for the same seasons. Estimated annual in-hospital deaths ranged from 4,680 (95% CI, 3,570-6,820) in 2018 to 2019 to 8,620 (95% CI, 6,220-14,090) in 2017 to 2018. Adults 75 years or older accounted for 45.6% (range, 43.1%-48.8%) of all RSV-associated hospitalizations, 38.6% (range, 36.7%41.0%) of all ICU admissions, and 58.7% (range, 51.9%67.1%) of all in-hospital deaths.
CONCLUSIONS AND RELEVANCE In this cross-sectional study of adults hospitalized with RSV before the 2023 introduction of RSV vaccines, RSV was associated with substantial burden of hospitalizations, ICU admissions, and in-hospital deaths in adults, with the highest rates occurring in adults 75 years or older. Increasing RSV vaccination of older adults has the potential to reduce associated hospitalizations and severe clinical outcomes.
Introduction
Respiratory syncytial virus (RSV) plays an important role in mortality and morbidity in US adults 60 years or older, although there is considerable uncertainty about the overall burden of RSVassociated hospitalizations in this population.1-6 As of May 2024, the US Food and Drug Administration had approved 3 vaccines for prevention of RSV lower respiratory tract disease in adults.7-9 In June 2023, the Centers for Disease Control and Prevention (CDC) recommended a single dose of RSV vaccine in adults aged 60 years or older using shared clinical decision-making10; the recommendations were updated in June 2024 to recommend a single dose of RSV vaccine for all adults aged 75 years or older and for those aged 60 to 74 years who are at increased risk for severe RSV disease.11 To assess vaccine impact, it is essential to clearly define the prevaccine burden of RSV disease in this population.
Clinicians often do not test for RSV in hospitalized adults with respiratory illness12 because an RSV diagnosis does not generally change disease management and because of limited awareness of RSV as an important pathogen affecting adults. Evidence also
suggests that standard RSV detection assays in hospitalized adults might have lower sensitivity than previously believed.13-16 Furthermore, potential changes in respiratory virus testing, including during the COVID-19 pandemic, increase uncertainty in estimates of RSV hospitalizations in older adults.1-6 This analysis used 2016 to 2023 data from the population-based RSV Hospitalization Surveillance Network (RSV-NET) to describe the demographic characteristics of adults 18 years or older hospitalized with laboratory-confirmed RSV and to estimate rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.
Methods
The Respiratory Virus Hospitalization Surveillance Network (RESP-NET) conducts population-based surveillance for US hospitalizations associated with laboratory-confirmed RSV (recorded in RSV-NET), COVID-19 (recorded in COVID-19 Hospitalization Surveillance Network [COVID-NET]), and influenza (recorded in Influenza Hospitalization Surveillance Network [FluSurvNET]). During the 2022 to 2023 surveillance season, RSV-NET captured laboratory-confirmed RSV-associated hospitalizations in 58 counties in 12 states (California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Tennessee, and Utah) covering approximately 27 million persons (approximately 8% of the US population), although the catchment area changed over time.17 This study was reviewed by the Centers for Disease Control and Prevention (CDC), deemed not research, and conducted consistent with applicable federal law and CDC policy (45 CFR part 46.102(l)(2), 21 CFR part 56; 42 USC §241(d); 5 USC §552a; 44 USC §3501 et seq). We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
Included RSV-NET cases were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area with a positive molecular or rapid antigen RSV test result during hospitalization or within 14 days before admission. Laboratory testing was ordered at the discretion of clinicians or through hospital screening procedures. Demographic information, including age, sex, race, and Hispanic or La-
tino ethnicity; hospital admission date; positive RSV test result; and clinical outcomes (ICU admission status and in-hospital deaths) were collected on all patients, allowing calculation of population-based incidence. To characterize the demographic characteristics of adults hospitalized with RSV, race and ethnicity (Hispanic or Latino and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, White, or other [including multiracial and unknown]) were abstracted from the medical record.
From 2016 to 2019, prospective surveillance was conducted annually during the typical RSV season, defined as October to April. Beginning in October 2020, surveillance was conducted year- round, and the RSV season was defined as October to September. Incidence was calculated using National Center for Health Statistics vintage 2020 bridged-race postcensal population estimates (2019 to September 2020 and before October 2020) or US Census Bureau vintage unbridged-race postcensal population estimates (October 2020 to September 2023) for surveillance-area counties or county equivalents.18
Adults hospitalized with RSV were captured in RSV-NET only if they were tested for RSV and if the test accurately detected RSV. Because RSV testing is often not performed in hospitalized adults and RSV diagnostic testing practices have changed over time, rates of RSV-associated hospitalizations in RSV-NET were adjusted for underdetection of RSV infection due to testing practices and test sensitivity using a multiplier approach, as previously described for
FluSurv-NET.19-21 Briefly, each RSV-NET site identified all adults hospitalized with acute respiratory illness (ARI), using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes, in select hospitals and ascertained the proportion of patients tested for RSV and the type of RSV detection test used among a stratified random sample. Adjustment multipliers, the inverse of the frequency multiplied by the mean sensitivity of the assays, were estimated for each season using testing data from hospitalizations in each age group.22 Unadjusted rates were estimated by dividing the number of laboratory-confirmed hospitalizations detected within the RSV-NET catchment area by the catchment area population estimate. Adjusted rates were estimated by multiplying the unadjusted rates by the adjustment multipliers and then presented with 95% CIs to account for uncertainty in adjustment multipliers. Rates of RSV-associated ICU admissions and in-hospital deaths were estimated by multiplying age-specific hospitalization rates by the proportion of patients in each age group who were admitted to the ICU (ICU to hospitalization
ratio) or who died in the hospital.19 Overall numbers of RSV-associated hospitalizations, ICU admissions, and in-hospital deaths in the US were estimated by multiplying adjusted age-specific rates of hospitalization, ICU admission, and in-hospital death by estimated US populations for each age group.18 Starting with the 2020 to 2021 surveillance season, the COVID-19 pandemic affected both RSV circulation and respiratory virus testing practices, affecting RSV-associated hospitalization timing and rates. Demographic characteristics, clinical outcomes, and burden estimates of hospitalizations, ICU admissions, and in-hospital deaths for all seasons; 2020 to 2021 and 2021 to 2022 seasons were excluded from these ranges given atypical RSV circulation. Adjustment multipliers for burden estimates accounted for test sensitivity. Recent studies, including a systematic review and meta-analysis, indicated that adding specimen types, such as paired serological testing or sputum to nasopharyngeal or nasal swab reverse transcriptase– polymerase chain reaction (RTPCR) testing, increased RSV detection by 50% to 66%,16 demonstrating that molecular assays with reportedly high sensitivity might underdetect RSV in adults.13-15 To account for presumed lower sensitivity of PCR testing as performed previously in similar analyses,2 we multiplied rate estimates by 1.5, which assumed a PCR testing sensitivity of 66%. We performed a sensitivity analysis using more conservative estimates that did not include the 1.5 multiplier and that presumed a baseline sensitivity of 92%16 for molecular assays (PCR) and 29%23 for antigen assays.
Statistical Analysis
Rates were presented per 100 000 adults aged 18 years or older; differences in age group–specific rates were compared using χ2 tests. A 2-tailed P < .05 was considered to be statistically significant. Data analyses were conducted using SAS, version 9.4 (SAS Institute Inc).
Results
From the 2016 to 2017 through 2022 to 2023 RSV seasons, 16,575 laboratory-confirmed RSV-associated hospitalizations in adults aged 18 years or older were identified; 98.7% of tests used to detect RSV were RT-PCR. Among hospitalized patients, 9,641 were females (58.2%) and 6,934 were males (41.8%), with a median (IQR) age of 70 (58-81) years; specifically, 62.6% were 65 years or older and 39.7% were 75 years or older. A total of 1,429 patients (8.6%) were Hispanic or Latino, and non-Hispanic patients included 87 American Indian or Alaska Native (0.5%), 985 Asian or Pacific Islander (5.9%), 3,234 Black (19.5%), and 10,187 White (61.5%) individuals, with 653 (3.9%) having other or unknown race
and ethnicity. Hospitalization rates peaked each January during 2016 to 2017 through 2019 to 2020, showed reduced and atypical circulation in 2020 to 2021 and 2021 to 2022, and showed increased circulation and an earlier peak in 2022 to 2023. Across all RSV seasons, 19.1% of patients (2,844 of 14,896) were admitted to the ICU, including 21.0% (425 of 2027) of those aged 18 to 49 years; 4.3% (706 of 16,506) died in the hospital, with in-hospital deaths highest among those 75 years or older (5.8% [378 of 6546]).
Generally, the proportions of adults hospitalized with ARI who were tested for RSV increased over time and were similar across age groups. Across all seasons, 43.5% of hospitalized adults with an ARI were tested for RSV (range, 30.0%-60.7%). In 2016 to 2017, 30.4% of those aged 18 to 49 years, 33.1% of those aged 50 to 64 years, 31.5% of those aged 65 to 74 years, and 27.7% of those 75 years or older were tested. In 2022 to 2023, testing increased to 56.1%, 61.2%, 62.3%, and 61.6% in the same age groups, respectively,. Unadjusted overall rates of laboratory- confirmed hospitalizations within the RSV-NET catchment area ranged from 8.8 per 100,000 adults in 2016 to 2017 to 21.2 per 100,000 adults in 2022 to 2023. Using adjustment multipliers to account for the proportion tested and test sensitivity (range of 3.2-5.4, by season and age group), seasonal hospitalization rates for adults 18 years or older ranged from 48.9 (95% CI, 33.4-91.5) per 100,000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 10,000 adults in 2017 to 2018. Results from the sensitivity analysis where a higher RT-PCR sensitivity (92%) was assumed (ie, without the 1.5 × adjustment multiplier).
Hospitalization rates increased with increasing age. Adjusted rates were lowest in those aged 18 to 49 years, varying from 8.6 (95% CI, 5.7-16.8) per 100,000 adults in 2016 to 2017 to 13.1 (95% CI, 11.0-16.1) per 100,000 adults in 2022 to 2023. Adjusted rates were highest among those aged 75 years or older, varying from 244.7 (95% CI, 207.9-297.3) per 100,000 adults in 2022 to 2023 to 411.4 (95% CI, 292.1-695.4) per 100,000 adults in 2017 to 2018.
Extrapolating adjusted rates to the US adult population, estimated numbers of annual RSV-associated hospitalizations in adults aged 18 years or older ranged from 123 000 (95% CI, 84,000-230,000) in 2016 to 2017 to 193 000 (95% CI, 140,000-311,000) in 2017 to
2018, while annual ICU admission estimates ranged from 24,400 (95% CI, 16,700-44,800) to 34,900 (95% CI, 25,500-55,600) for the same seasons. Estimated annual in-hospital deaths ranged from 4,680 (95% CI, 3,570-6,820) in 2018 to 2019 to 8620 (95% CI, 6,22014,090) in 2017 to 2018. Averaging across seasons, most adult disease burden occurred in adults aged 65 years or older, including 68.2% (range, 65.9%-70.4%) of all hospitalizations, 63.1% (range, 62.5%-64.2%) of ICU admissions, and 81.1% (range, 76.9%-83.0%) of in-hospital deaths. Estimated numbers of hospitalizations in adults 65 years or older ranged from 85,000 (95% CI, 57 000-163 000) in 2016 to 2017 to 136 000 (95% CI, 97 000-228 000) in 2017 to 2018. Averaging across seasons, adults aged 75 years or older accounted for 45.6% (range, 43.1%-48.8%) of all hospitalizations, 38.6% (range, 36.7%-41.0%) of all ICU admissions, and 58.7% (range, 51.9%-67.1%) of all in-hospital deaths.
Discussion
Analysis of data on 16,575 laboratory-confirmed RSVassociated hospitalizations in US adults across multiple seasons obtained from RSV-NET, a large, population-based, geographically diverse surveillance platform, showed estimated RSV-associated hospitalization rates of 48.9 to 76.2 per 100,000 adults per season. These rates suggest a high burden of severe RSV disease, with an estimated 123,000 to 193,000 hospitalizations, 24,400 to 34,900 ICU admissions, and 4,680 to 8,620 in-hospital deaths occurring annually among US adults, although there was a considerable amount of uncertainty surrounding these estimates. Almost half of all hospitalizations and most deaths occurred in adults aged 75 years or older. RSV-associated hospitalizations resulted in considerable morbidity and mortality; nearly 20% of hospitalized patients were admitted to the ICU, and approximately 1 in 25 died in the hospital.
These findings validated RSV as a substantial contributor to respiratory illness and hospitalization among adults, especially older adults, with up to 136,000 estimated annual hospitalizations among those 65 years or older. The burden of RSV-associated hospitalizations in older adults was comparable to the burden of influenza-associated hospitalizations during milder influenza seasons; notwithstanding re-
Demographic Characteristics and Clinical Outcomes of Adults Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Infection
2016 to 2017 Through 2022 to 2023
Characteristic
d
Demographics a Age group, y
ductions in influenza disease achieved through vaccination, 87,000 to 523,000 hospitalizations in adults 65 years or older20 were estimated to occur annually based on data from FluSurvNET, an RESP-NET network with methods and catchment area nearly identical to those of RSV-NET. Similarly, RSV disease severity among hospitalized adults appeared to be comparable to or possibly more than the severity of influenza and SARS-CoV-2 in hospitalized adults.5,24-27 In the present analysis, 19.1% of adults hospitalized with RSV were admitted to the ICU and 4.3% died in the hospital, comparable to study of an RESP-NET analysis of adults hospitalized in 2021 to 2022 that found among those with laboratory-confirmed SARS-CoV-2, 15.5% were admitted to the ICU and 4.6% died; for influenza, those proportions were 13.3% and 4.6%, respectively.25 These proportions of patients with RSV who were admitted to the ICU and died in the hospital were comparable to those in other studies of RSV,4,26,28-30 including the 7.1% in-hospital case-fatality proportion estimated for adults aged 60 years or older in a systematic review and meta-analysis of data from high-income countries.31 Even among patients aged 18 to 49 years who were hospitalized with RSV, clinical outcomes were severe; in the present study, 21.0% were admitted to the ICU, likely reflecting the high proportion of younger adult patients hospitalized with RSV who were immunocompromised or had underlying medical conditions that made them vulnerable to severe disease.32 In-hospital deaths occurred in over 4.0% of adults aged 18 years or older in our analysis, which was likely an underestimation of RSV mortality given that a substantial proportion of deaths may occur after hospital discharge.29,33
The wide CIs for estimated hospitalization rates based on RSV-
NET data reflect considerable uncertainty in estimating the true burden of RSV-associated hospitalizations in the US. This uncertainty is exacerbated by the suboptimal sensitivity of available RSV detection tests and lack of testing for RSV in adults hospitalized with respiratory illnesses, as demonstrated by less than half of adults hospitalized with ARI in participating RSV-NET hospitals being tested for RSV. Despite the uncertainty in these estimates, RSV-NET–based hospitalization rate and burden estimates are comparable to other burden estimates, including an industry-sponsored meta-analysis and systematic review estimating that RSV was associated with 108,834 hospitalizations and 7,763 deaths in 2019 in adults 60 years or older.31 Another industry-sponsored systematic review and meta-analysis, which similarly adjusted for underdetection of RSV by nasopharyngeal or nasal RT-PCR alone (eg, applied the RSV detection multiplier of 1.5) and used pooled estimates of hospitalization rates from prospective1,4-6,34 and modeling studies,35-38 estimated that 17 700, 42 060, and 159 247 RSV-associated hospitalizations occurred annually in adults aged 18 to 49 years, 50 to 64 years, and 65 years or older, respectively,2 which were higher than RSV-NET–based estimates but were within estimated CIs for most seasons. Five prospective studies were the source of the estimates, although several studies were limited to a single season4 or a restricted geographic area,1,4-6,34 which might have affected rate estimates. Unlike these studies, RSV-NET uses population-based surveillance in multiple sites in geographically diverse areas.
Although RSV is now a vaccine-preventable disease,39 its role in acute respiratory disease continues to be underrecognized by clinicians specializing in adult care.40 In the present analysis, less than half of the patients hospitalized with ARI were tested for RSV, consistent with other literature,12 although the proportion of patients who were tested for RSV increased from 2016 to 2017 through 2022 to 2023 in all age groups. The availability of vaccines and the increased use of multiplex respiratory virus testing might increase clinicians’ and patients’ aware-
ness of RSV as a cause of illness in adults. This analysis also highlighted the potential public health impact of RSV vaccination among older adults. RSV particularly affects adults aged 75 years or older, a finding consistently reported by studies estimating RSV-associated hospitalization disease burden.1,2,31 RSV vaccination is effective in preventing hospitalization in adults aged 60 years or older41 and is recommended in the US for adults aged 75 years or older and those aged 60 to 74 years who are at an increased risk for severe RSV disease.11 Early vaccination coverage estimates indicated that in the US, less than 20% of adults aged 60 years or older and less than 10% of nursing home residents had received RSV vaccination by December 2023.42-44 Reducing barriers to vaccination and increasing clinician awareness of the disease burden associated with RSV are needed to increase use of RSV vaccines. Additional population-based epidemiologic analyses are planned to examine risk factors beyond patient age, such as underlying medical conditions, race and ethnicity, rural residence, and social determinants of health, that identify individuals at greatest risk for severe clinical outcomes.
The data we collected and analyzed also demonstrated how the COVID-19 pandemic disrupted the consistent prepandemic seasonality of RSV-associated hospitalizations, with 2 years of atypical seasonality and lower circulation, followed by a surge of RSVassociated hospitalizations in the fall of 2022 with an earlier peak than in prepandemic seasons. This disruption of RSV circulation has been well documented in other studies,45-47 likely because of nonpharmaceutical interventions such as mask wearing, school closure, and social distancing. These data, along with data from FluSurv-NET and COVID-NET, demonstrate the importance of ongoing, robust, population-based hospital surveillance to track major changes in the burden and epidemiologic pattern of seasonal respiratory viruses.
Limitations
There are multiple limitations to this analysis. First, decisions about RSV testing were made at the discretion of the treating clinician. Estimates of RSV burden based only on laboratory-confirmed hospitalizations underestimate the true burden of disease
in adults. Second, although adjustments for underdetection of RSV were made related to testing practices and test sensitivity, assumptions underlying adjustment multipliers may not be correct. These assumptions included that poor test sensitivity was random and that patients hospitalized with ARI who were not tested for RSV were as likely to have RSV as patients who were tested; if untested patients were less likely to have RSV infection, then these methods may overestimate the burden of disease. In contrast, these adjustments did not account for hospitalization of adults with nonrespiratory complications of RSV (eg, heart failure exacerbation)48 who were not tested for RSV and who may not have an assigned ICD-10 diagnosis code for ARI, potentially leading to an underestimation of RSV-attributable hospitalizations.
Third, this study did not evaluate reasons for admission, and RSV may not be the primary reason for hospitalization. However, previous RSV-NET–based analyses have shown that most hospitalized adults with an RSV diagnosis experience substantial respiratory illness, suggesting that mild or asymptomatic RSV infections make up only a small percentage of detected RSV-associated hospitalizations.48,49 Fourth, patients with more severe illness might have been more likely to be tested for RSV, resulting in a potential overestimation of the proportion of patients with RSV-associated hospitalizations who were admitted to the ICU or who died. Fifth, the demographic characteristics of people in the RSV-NET surveillance area were generally similar to those of the US population. However, RSV-NET data might not be generalizable to the entire country, and the methods in this study might not adequately account for the uncertainty in extrapolating RSV-NET data nationally.
Conclusions
This cross-sectional study of adults hospitalized with laboratory-confirmed RSV demonstrated that prior to the availability of vaccines in 2023, RSV was associated with a substantial burden of disease in adults, particularly older adults. In the US, effective RSV vaccines27 have become available and vaccination is now recommended for all adults aged 75 years or older and for those aged 60 to 74 years who are at an increased risk for severe RSV disease. The study found that most hospitalizations occurred among older adults, with the highest hospitalization rates in those aged 75 years or older. Given the large numbers of potentially vaccine-preventable hospitalizations and deaths associated with RSV, increasing vaccine coverage among adults at highest risk could reduce associated hospitalizations and severe clinical outcomes. DMJ
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55. Havers FP, Whitaker M, Melgar M, et al; RSV-NET Surveillance Team. Characteristics and outcomes among adults aged >60 years hospitalized with laboratory-confirmed respiratory syncytial virus—RSV-NET, 12 states, July 2022-June 2023. MMWR Morb Mortal Wkly Rep. 2023;72(40):1075-1082. doi:10.15585/mmwr.mm7240a1
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Sarah Blumenschein, MD
October 25, 2024 DCMS member for 45 years
Robert Bossard, MD
May 10, 2024 DCMS member for 38 years
Charles Cain, MD
June 26, 2024 DCMS member for 63 years
Doyle Carson, MD
May 25, 2024 DCMS member for 63 years
Gordon Dalton, MD
August 7, 2024 DCMS member for 42 years
W.L. Jack Edwards, MD
April 7, 2024
DCMS member for 74 years
Francis Gilbert, MD
May 27, 2024
DCMS member for 65 years
Mark Hardin, MD
October 3, 2024
DCMS member for 36 years
2024 In Memoriam
Wallace Ingram, DO
February 21, 2024 DCMS member for 38 years
Harwin Jamison, MD
June 26, 2024 DCMS member for 65 years
Masashi Kawasaki, MD
April 29, 2024 DCMS member for 55 years
Martin Lazar, MD
April 18, 2024 DCMS member for 50 years
Mark Marshall, MD
December 28, 2023 DCMS member for 60 years
Robert Middendorf, MD
March 29, 2024
DCMS member for 53 years
Stephen Neece, MD
July 12, 2024
DCMS member for 42 years
Robert Perrin, MD
April 29, 2024
DCMS member for 68 years
Peter Polatin, MD
August 17, 2024
DCMS member for 38 years
Rush Steelman, MD
May 8, 2024
DCMS member for 44 years
Herbert Steinbach, Jr., MD
June 20, 2024
DCMS member for 56 years
James Sweatt, III, MD
July 23, 2024
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Charles Tandy, MD
September 11, 2024
DCMS member for 71 years
Dave Tobolowsky, MD
January 29, 2024
DCMS member for 74 years
Agnes Whitley, MD
April 7, 2024
DCMS member for 55 years
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Vanessa Bludau, MSN, APRN, FNP-C
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Philip Lieu, MD, FASRS
Diseases and Surgery of the Retina and Vitreous
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Premium Cataract Surgery Glaucoma Treatment Cornea Disease Diabetic Eye Exams Optical Shop Multifocal Cataract Implants
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10740 N. Central Expy. Ste. 100 Dallas, TX 75231 (214) 361-6700
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W.Z. Burkhead Jr., MD
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Daniel A. Worrel, MD
Kurt J. Kitziger, MD
Andrew L. Clavenna, MD
Holt S. Cutler, MD
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Todd C. Moen, MD
J. Carr Vineyard, MD
M. Michael Khair, MD
William R. Hotchkiss, MD
J. Field Scovell III, MD
Jason S. Klein, MD
Brian P. Gladnick, MD
Bradford S. Waddell, MD
William A. Robinson, MD
Tyler R. Youngman, MD
9301 N. Central Expy., Ste. 500, Dallas, TX 75231 3800 Gaylord Pkwy., Ste. 710, Frisco, TX 75034 Phone: (214) 466-1446 Fax: (214) 953-1210
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A Tailored Approach to Real Estate for Healthcare Professionals
Healthcare professionals give so much to their communities—shouldn’t their homes offer them the sanctuary they deserve? After an 18-year career in healthcare leadership and strategic supply chain management, I witnessed firsthand the immense pressures faced by those in the medical field, especially during the COVID-19 pandemic. These experiences inspired me to transition into real estate and, in 2024, establish Dr. Healthy Homes. Dr. Healthy Homes is a unique real estate initiative created to help healthcare professionals find spaces that promote balance, wellness, and a sense of sanctuary. My mission is to deliver a seamless, tailored experience that supports your personal and professional needs.
The Monument Realty Advantage
To bring Dr. Healthy Homes to life, I partnered with Monument Realty, a brokerage renowned for its innovative approach, exceptional agents, and industry-leading success. Based in Frisco, Texas, Monument Realty is a market leader with over 800 agents and eight offices across Texas. Exclusive partnerships with the Dallas Cowboys, Texas Rangers, and PGA of America give clients unmatched marketing advantages, ensuring
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your real estate goals are met with precision and professionalism.
Streamlined Solutions with the Health Link Program
The Health Link Program was designed to meet the unique needs of Dallas County physicians and healthcare professionals, simplifying and enhancing the real estate experience. As a concierge-level realtor, I go above and beyond to meet your needs by recording home walkthroughs, hosting virtual meetings via Zoom, Teams etc., and providing expert guidance to streamline your home search or sale. I take the time to understand your unique lifestyle and goals, ensuring each step of the process is stressfree and customized to fit your needs. From personalized mortgage solutions and utility setup assistance to post-move support, I handle every detail so you can focus on your patients and practices while we take care of the rest. Contact us today to find a home that promotes your wellness and supports your demanding lifestyle.
Dr. Bri Huedepohl D.H.Sc. R.T (R) REALTOR ® Brihuedepohl@monumentstar.com Cell: 612-202-3519
Information for Authors
Dallas medical professionals look to the Dallas Medical Journal and its community of peer contributors as a valued resource for Dallas County medical information. Our goal is to provide insights on various topics, including patient advocacy, legislative issues, current industry standards, practice management, physician wellness, and more.
The Dallas Medical Journal selectively accepts articles from industry professionals that meet our editorial guidelines. We always seek original, informative articles that ultimately will be a useful source to give our professional readers a broad yet unique reading experience.
If you are interested in submitting an article for consideration, or have additional submission questions, please email Lauren Williams at lauren@dallas-cms.org.
Dr. Bri Huedepohl D.H.Sc. R.T (R)
We Help Members Improve Their Health Insurance Coverage and Control Costs Health Insurance Open Enrollment
Hundreds of medical groups and thousands of physicians, their dependents and employees across Texas have improved their health insurance coverage and controlled costs by working with TMA Insurance Trust. We helped them secure more comprehensive coverage or find a more budgetfriendly option. Many times, it’s both. How? We are group specialists and have uncovered special options available only during Open Enrollment that help owners and independents access group PPO insurance for their employees, or just for themselves - even when they do not have employees. And this is all backed by a higher level of service and care our dedicated members deserve.
Here are some of the ways we help owners and independents get better coverage:
• Practice owners with group coverage for their practice: There are opportunities to help control the cost to your practice and be able to offer your employees health insurance – with a mix of group PPO and HMO plans.
• Practice owners with staff on their own health coverage: A spouse’s plan or that of another provider) you may be able to get group PPO coverage just for yourself and your family.
• Partners with no W-2 employees: You may be eligible for group coverage only for yourself. You’ll need to provide partnership documentation and the company’s SS4 or recent K-1 (Form 1065).
• Physicians who own a business with their spouse, or their spouse is a W-2 employee: You may qualify for group coverage even without partnership documentation.
• Establish a Health Savings Account (HSA): If you select a high deductible health plan to manage costs better, you can open an HSA. These accounts offer tax advantages, spending flexibility and ongoing saving and investment opportunities.
• Starting your own practice: TMA Insurance Trust can help you set up a customized group plan that aligns with your practice’s needs.
To improve your health insurance situation, contact a TMA Insurance Trust health insurance advisor. They can be contacted at 800-880-8181, Monday to Friday 8:00 to 5:00 CST, or by visiting us online at tmait.org.
Dementia CME for Primary Care Providers
Help your patient and their family make the best-informed decisions.
Earn free online Continuing Medical Education (CME) credits developed by the Texas Department of State Health Services and physician experts on Alzheimer’s disease and related dementias. These courses will keep you up to date on the latest validated assessment and screening tools, help you direct patients to community resources, and reinforce your role in helping patients and their families manage symptoms throughout the disease process.
Learn more at dshs.texas.gov/alzheimers-disease/provider