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Serving Harris, Galveston, Brazoria and Fort Bend Counties

HOUSTON

January Issue 2014

Inside This Issue

AVOID BEING PUT ON THE RAC: BE PREPARED FOR A RECOVERY AUDIT CONTRACTOR AUDIT By Kathleen Stillwell, MPA/ HSA, RN, CPHRM, Patient Safety Risk Manager II, The Doctors Company

Americans Pay it Forward Through Historic Cancer Research Study See pg . . . . 10

INDEX Mental Health...............pg.3 Money Matters..............pg.4 Marketing Essentials.......pg.5 The Framework..............pg.6 Live Well Age Well..........pg.8 Healthy Heart................pg.9

What is a RAC Audit? Any medical practice submitting claims to a government program, such as Medicare, may contend with a Recovery Audit Contractor (RAC). RAC audits are not one-time or intermittent reviews; they are a systematic and concurrent operating process for ensuring compliance with Medicare’s clinical payment criteria, documentation, and billing requirements. The RAC program was signed into law by the Medicare Prescription Drug Improvement and Modernization Act

of 2003 and made permanent by the Tax Relief and Health Care Act of 2006. Its purpose is to identify improper Medicare payments—both overpayments and underpayments. The RACs use proprietary software programs to identify potential payment errors in such areas as

duplicate payments, fiscal intermediaries’ mistakes, medical necessity, and coding. RACs also conduct medical record reviews. In fiscal years 2010 and 2011, RACs identified half of all claims they reviewed as having resulted in improper see RAC Audit page 18

Physicians at Memorial Hermann Texas Trauma Institute Develop Award-Winning Innovative New Tourniquet for Combat and Civilian Use US Strokes Deaths Decline Due to Prevention See pg.18

In the fall of 2010, 3rd Battalion 5th Marines, known as 3/5, deployed to the Sangin Valley in the Helmand province of Afghanistan. The valley, dubbed a death trap for the number of lives its battles have claimed, is surrounded by steep inclines covered in lush green

poppy plants. Infamous for their use in the production of heroin, the plants served a second, more strategic purpose in the region – abundant coverage for burying large containers full of powerful homemade bombs, known as improvised explosive devices or IEDs. Memorial Hermann-Texas Medical Center Emergency Medicine physician and United States Navy Reserve Lt. Keith Gates, M.D., who was serving as a Battalion Surgeon there at the time, describes these IEDs as a new breed of explosives that were “designed to hit higher, all the way up to the pelvis, rendering a traditional tourniquet useless. Those who were hit would often bleed to death in the field within minutes.” Gates, who

Keith S Gates M.D. and John B Holcomb M.D.

is an assistant professor with The University of Texas Health Science Center (UTHealth) Medical School, recognized a gap in medical care of IED injuries and began sketching a new, more versatile tourniquet while still in the field. His vision became the Junctional Emergency Treatment Tool, or JETT, which was recently selected as see Memorial Herman Trauma page 20

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Houston Medical Times

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MEDICAL OFFICE SPACE FOR LEASE

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Houston Medical Times

Page 3

Mental Health

in Applied Positive Psychology from UPENN. There we studied optimal I Hope I Don’t Make Me Sick human functioning, individual and dyadic flourishing, strengths, and hard to break, while character virtues using the same rigorous By Jason Powers, M.D. Chief Medical scientific method that we apply in Officer The Right good habits are so hard to form but medical research. Coincidentally, habit Step was no insignificant area of inquiry. so easy to break! That’s not great news, especially since most of us are hard-wired not to do the right things all the time. For example, we’re made to crave high fat, sugar, and salty foods, not exercise enough, and revert to energy-saving automatic brain and body processes, our evolutionary version of automatic pilot, that makes this paradigm unfortunately true.

This time of year, whenever I see anything entitled ‘new year’s...such and such,’ I get a bit green around the gills. For someone who has lost (and gained) hundreds of pounds (so far), and has made more goals than he has attained, I’ve grown weary of resolutions... especially the new year’s varieties - they are the most bilious-genic resolutions Aristotle said that ‘we are what we that exist. repeatedly do. Excellence, then, is not the result of singular heroic deeds, but Judging from the data on the subject, I’m HABIT.‘ Likewise, William James, who not alone. Nearly half of all Americans lived before X-Rays were invented and make New Year’s resolutions. But less was freakishly smart, even in his own than 8% of us actually achieve them! family of genius, accurately qualified Why do we talk the talk but can’t walk Aristotle’s maxim. James predicted the walk? Wise people, such as Aristotle what now we call ‘neuroplasticity,’ with and William James, have known this such precision that even Nostradamus to be true for years: couldn’t help but admire. bad habits are so easy to form but so

As it turns out, the most effective way to pursue happiness is by intentionally directing attention and behaviors in the formation of positive habits (which subsequently also forges one’s character and legacy). While this little bit of wisdom is not exactly revolutionary, neuropsychology research may be just what the doctor ordered. Functional brain studies teach us that James is right. Habit happens automatically. You see, whatever you do becomes part of you. It’s basically what we call neuroplasticity, and it describes the structural changes that occur in the human body (brain included) secondary to behavior.

in meaningful activities, and strengthen social bonds, then you’re doing better than most. Resolutions are easy to make - anyone can say what their tomorrow self will do. But talk is cheap. It’s easy to imagine that we will do the right thing tomorrow. You see, our “future selves” are always acting in the right ways. When we make (new year’s) resolutions, we are announcing that our “tomorrow self” will accomplish whatever is necessary. Psychology Professor Dan Ariely explains that our tomorrow selves are always doing the right things: our tomorrow self is never late, always eats only the very healthiest foods, and gives generously to others.

Our today self assuredly sets an alarm Operationally, you’re developing habits clock the night before, knowing that right now, and if you are acting in the our tomorrow self is going to dutifully ways that promote personal growth, awaken and exercise at the gym...but Recently I completed a Masters program develop your character strengths, engage see Mental Health page 21

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Houston Medical Times

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Money Matters

Benefiting from being an Informed Taxpayer By Margaret SucréVail Sucré-Vail Wealth Advisors

There are two types of tax payers the informed and the uninformed; some taxes are voluntary and with proper planning can be avoided. Let me take you through with some ideas that would enable you to be familiar with the current tax rates so you can be a more informed and proactive tax payer.

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taxpayers filing jointly) will be subject to a 2.35 %( 1.45%+ .09) total Medicare tax. ) Employers must withhold the additional Medicare tax from wages in excess of $200,000 regardless of filing status or other income. Self-employed individuals with the above mentioned wages are also subject to this additional Medicare tax 3.8% (2.9%+.09) Caution the 3.8% surtax: It is in addition to payroll taxes, capital gains and alternative minimum taxes (AMT) over the given income thresholds, which means if your investment advisor is including muni bonds in your portfolio; make certain that they are AMT neutral.

Individual Tax Rate in 2014-39.6% Tax Bracket: This is the highest marginal tax bracket on ordinary income over Proactive planning a priority: This is the $400,000 for single filers and $450,000 number-one new challenge for physicians as well as the most important benefit a for married filing jointly. wealth advisor can bring to clients. It Qualified Dividends and Capital is safe to say with American Taxpayer Gains: Qualified dividends and long- Relief Act 2012 (ATRA); many highterm capital gains for taxpayers that income taxpayers will have sticker shock fall in the 39.6% tax bracket will be when they file their 2013 tax returns. taxed at 20%. The 0%/15% tax rates The ATRA brings many changes, and on dividends and capital gains in lower each change is implemented above a defined threshold, but the thresholds tax brackets. are not uniform. Also, whereas tax brackets and phase-out thresholds are 3.8% surtax: The complicated 3.8% inflation adjusted, the thresholds for Medicare tax on unearned income of the Medicare contribution tax are not high-income individuals, estates and inflation adjusted. trusts. The Medicare surtax is imposed on net investment income(NII) including Taking advantage of deductions/losses interest, dividends, capital gains, royalties, sooner and recognizing income later: This rents and passive income (income that concept is back in vogue: It is imperative is not from an active trade or business). that your portfolio managers pay close This tax applies to taxpayers with attention to asset location rather than modified AGI above these thresholds: asset allocation for efficiency in keeping $250,000 for married taxpayers filing more of what you earn in portfolios, jointly; $125,000 for married taxpayers mitigating the impact of capital gains. filing separately; and $200,000 for single Beware of happy brokers trading in and head of household taxpayers. The your portfolios without regard to tax tax applies to the lesser of the taxpayer's efficient management. Traditionally loss NII or amount of modified AGI over harvesting in your portfolio is done at the threshold amount. For an estate or the end of the year, it will now serve trust, the surtax applies at the highest you better to have it done throughout marginal tax bracket in excess $12,150 the year for the most efficient results. NII in 2014. This tax does not apply to distributions from qualified retirement Comprehensive Advisors: Can actively plans. However, distributions from a manage clients’ assets to protect against charitable remainder trust could be NII market downturns while also managing to the recipient/ beneficiary. taxes. While finding advisors that offer both are rare, it is well worth the added 0.9% Additional Medicare Tax: due diligence. High-income individuals also face an additional 0.9% Medicare tax on Retirement Plans: Take full advantage wages. Wages in excess of $200,000 of deferring as much income in company for an individual ($250,000 for married sponsored retirement plans. If you are see Money Matters page 21

January 2014

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Houston Medical Times

Marketing Essentials

your

The Paradox of Disappearing Patients By Stewart Gandolf, MBA Healthcare Success Strategies

The surprising reason why patients leave and the impact to your bottom line. Most say nothing at all…they just don’t return. Patient satisfaction is the cornerstone of patient retention. It’s difficult to detect, but It is a perception of indifference that causes most people to quit coming back. And the financial loss to your business is nothing to take lightly.

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Changing for good medicine...

The biggest reason that people take their business elsewhere is they perceive an attitude of indifference–meaning how they felt about the experience. “Indifference” wins by a staggering 68%…that’s nearly 7 out of 10. And the categories aren’t even close: Why customers stop buying: Die

1%

Move Away

3%

Formed other relationships 5% For competitive reasons 9%

Due to product/service The perplexing thing about dissatisfaction 14% “disappearing patients” is that they’re not around to ask why they aren’t patients any more. Patients leaving a business rarely complain to you (less than 4%). And 68% Quit because of an attitude Most say nothing at all…they just don’t of indifference by one or more return. With charts packed to the rafters, you may not even know which ones have disappeared. It’s next to impossible to tell which individuals are still “bonded” to your organization (and likely to return), and which charts are ready for the recycled paper bin. You can guess some of the reasons… perhaps they were attracted by the competition; they acted on a trusted referral; they have no current need; they moved, they died…or maybe their sonin-law went into practice. Intuitive or obvious, all these are just the minor issues.

persons representing the business. Although not specifically about healthcare, the results of this wellrespected business survey1 have been validated in many service areas including healthcare, hospital and patient satisfaction surveys. (Other surveys say as much as 80 %.) “That’s not my organization!” Healthcare is a caring profession–and in our experience, service is delivered by caring professionals and staff. But feeling an “attitude of indifference” is not the same as quality of care or even cost.

Now—right here in Texas—you have access to an even stronger source of medical professional liability protection and service. API ProAssurance has increased its strength, combining forces with ProAssurance companies to become the fourth largest writer of medical professional liability insurance in the U.S. You receive unparalleled support, with enhanced risk management and claims resources. We are committed to treating you fairly, helping you to: • protect your important identity • lessen the uncertainty you face • increase the control you experience API ProAssurance From our base in Austin, YOU are our focus.

In the total patient experience, indifference could come from how the phone is answered, enduring delays in the office schedule, or even the cost and convenience of parking. The process of building and maintaining rapport and achieving satisfaction is all in how they were treated. Even more challenging is what the business does not do–such as no friendly greeting, a lack of appointment reminders, after-care calls or other routines to keep in touch with patients. Often it’s the small things that make a

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January 2014


Page 6

Houston Medical Times

The Framework

AMD Global Announces Pre-Lease Opportunity in Multi-Specialty Office Space AMD Global recently announced availability, via pre-lease, of Class-A medical office building space in their Pearland Shadow Creek Professional Plaza development that will also function as a surgery center with multi-specialty offices.

and take care of patients at the HCA Pearland Medical Center and Memorial Hermann Medical Campus,” Patel said. The synergies of multi-specialty offices create close working relationships among physicians allows immediate exchange of patient information and physician patient referrals to colleagues.

Located on Business Center and Discovery Bay Drives between the Patients are then able to receive the upcoming HCA Pearland Medical same care more promptly by eliminating Center and Memorial Hermann the travel time to see specialists located Medical Campus developments, the in different areas of town. $20 + million, 110,000 square-foot SCR Professional Plaza is expected to The SCR Professional Plaza will bring in local physicians who want their own

be completed the third quarter of 2014.

independent practices.

Dharmesh Patel, M.D., CEO of AMD Global and local physician, anticipates that the independence given to physicians practicing in the multi-specialty offices will provide a better avenue to cater to their patient’s needs, and will allow them to serve both the HCA and Memorial Hermann Campus.

“This development will be a good addition to South 288 corridor. With all the growth we see in the community we need office space for businesses needing to relocate,” Matt Buchanan, President of the Economic Committee of Pearland said.

“Rather than be shackled to a specific hospital group where a physician may be restricted or prohibited from certain practices, this independent facility will give physicians the freedom to serve January 2014

medicaltimesnews.com

As Pearland is home to the most Texas Medical Center employees than any other zip code in the area, the center gives physicians the opportunity to have a satellite office giving them access to the benefits of a multi-specialty practice.


Houston Medical Times

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Why choose between national resources and local clout? In Texas, The Doctors Company protects its members with both. With 74,000 member physicians nationwide, we constantly monitor emerging trends and quickly respond with innovative solutions, like incorporating coverage for privacy breach and Medicare reviews into our core medical liability coverage. Our over 5,300 Texas members also benefit from significant local clout provided by long-standing relationships with the state’s leading attorneys and expert witnesses, plus litigation training tailored to Texas’s legal environment. This uncompromising approach, combined with our Tribute® Plan that has already earmarked over $10 million to Texas physicians, has made us the nation’s largest physician-owned medical malpractice insurer. To learn more, call our Austin office at (800) 686-2734 or visit www.thedoctors.com.

We relentlessly defend, protect, and reward the practice of good medicine.

Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

www.thedoctors.com Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

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January 2014


Houston Medical Times

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Age Well Live Well

Get fit for the health of it! By Holly Riley Age Well Live Well Program Coordinator TX Department of Aging and Disability Services

Americans are living longer than ever before. A study by the National Institute on Aging found that people are living longer, in less poverty and often experience lower rates of disability than previously recorded. Life expectancy nearly doubled during the 20th century with a 10-fold increase in the number of Americans age 65 or older. Today, there are approximately 35 million Americans age 65 or older, and this number is expected to double in the next 25 years.

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

The aging of Texas’ population is one of the most important demographic trends affecting our state. Over the next twenty years, the 65 and older population is projected to grow 184 percent. The “boom” of the older adult population, coupled with long life expectancy, means that Texans of all ages need to engage in regular healthy habits now, to ensure their future is healthy. A person’s ability to “age well” is heavily influenced by their engagement in healthy habits, awareness of aging issues and available resources, and by staying socially engaged and connected with others. To help Texans prepare in these key areas, the Texas Department of Aging and Disability Services (DADS) developed the Age Well Live Well program. Through regional Age Well Live Well collaboratives, DADS and local organizations work together to provide Texans with information and programs to help meet the challenges of aging. Age Well Live Well focuses on: ∙

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Improving the physical health of older adults, people with disabilities, their families, and the community;

the aging and disability network. Age Well Live Well collaboratives provide their residents with information about the programs and resources to help them live and age well. These collaboratives also work to develop locally supported Age Well Live Well programs that are free or low cost for the participants. Some of these programs and resources include: ∙

Texercise, a health promotions program of DADS, that educates people about the importance of adopting healthy habits and motivates them to engage in healthy behaviors. www.Texercise.com

You’ll be Amazed, a volunteer campaign of DADS, that educates Texans about the value volunteers provide for the aging and disability population and access to volunteer opportunities. www.dads.state. tx.us/volunteer/volunteering/ index.html

DADS Resource Sheet provides contact information on some of the most popular federal and state programs for older adults and people with disabilities. www.dads. state.tx.us/volunteer/partners/ resourcesheet.pdf

So now what? Regardless of your age, Providing opportunities for begin implementing Age Well Live Well residents to stay engaged in the elements into your life to ensure you live community through volunteer a long, happy, healthy one! activities; and 1. Eat healthy, and engage in regular Creating awareness of aging issues physical activity – Texercise can and resources offered through Age help. Well Live Well collaboratives and see Live Well Age Well page 22

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Houston Medical Times

Healthy Heart

CELEBRATE GO RED FOR WOMEN’S 10TH YEAR ON NATIONAL WEAR RED DAY AND THROUGHOUT FEBRUARY DURING AMERICAN HEART MONTH By Brooklyn Adelman and Shelly Millwee, American Heart Association

"When you look at the media today there is so much emphasis in our culture on making money, rather than on taking care of our health and our families," said Clavon. "I would love to see more young women prioritize health and get involved in helping their communities through causes like Go Red For Women." Nefertiti aims to inspire other women to make a difference in the fight against heart disease through a simple gesture: volunteering.

Cardiovascular diseases cause one in three women’s deaths each year, killing approximately one woman every minute. Yet only 1 in 5 American women believe that heart disease is their greatest health threat and therefore are less likely to call 9-1-1 when experiencing symptoms of heart disease. The American Heart Association’s Go Red For Women is asking all women to Go Red by wearing red, living a healthy lifestyle In addition to volunteering many and speaking red. women join the Go Red for Women movement by spreading awareness that Many women including Nefertiti early detection of heart diseases can save Clavon, 22, Houston, TX Macy’s lives. Heart disease is the No. 1 killer Multicultural Scholarship recipient, are of women – killing more women than working together to spread the message all forms of cancer combined. Most that heart disease is killing our mothers, women don’t notice the symptoms of daughters, sisters and friends. Several heart disease until it’s too late, which is in Clavon’s family have been affected by why heart disease has been called the diabetes and stroke. This family history– silent killer. combined with her work toward a degree in health education and promotion– Anyone can spread awareness by opened her eyes to the challenges facing sharing What it means to Go Red: many Americans, especially those in underserved communities. ∙ Get Your Numbers: Ask your

Page 9

doctor to check your blood pressure and cholesterol. ∙

Own Your Lifestyle: Stop smoking, lose weight, exercise and eat healthy.

Realize Your Risk: We think it won’t happen to us, but heart disease kills 1 in 3 women.

Educate Your Family: Make healthy food choices for you and your family. Teach your kids the importance of staying active.

Don’t be silent: Tell every woman you know that heart disease is our No. 1 killer. Raise your voice at GoRedForWomen.org.

This February, celebrate National Wear Red Day by going red in bigger & bolder ways! Join Clavon and other Houston women by raising your voice and sharing how you or your loved ones have overcome heart disease. Go Red For Women is encouraging all women who have been impacted by heart disease to speak red by telling their personal stories of diagnosis, treatment and survival against women’s No. 1 killer.

Go Red by making a donation to fund critical, women-related research and education. Go Red by speaking red and sharing information about heart disease prevalence, symptoms and prevention with your friends and family.

When you join Go Red and share your story today, more lives will be saved tomorrow. Become part of the Go Red by wearing RED on National movement by joining Go Red For Wear Red Day, Friday, February 7, 2014. Women. Visit GoRedForWomen.org to learn how you can get involved.

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Page 10

Houston Medical Times

Americans Pay it Forward through Historic Cancer Research Study

American Cancer Society’s Cancer Prevention Study-3 Enrolls over 300,000 People to Help Finish the Fight against Cancer

more, this study gives ordinary Americans the chance to be part of this extraordinary study, as together we save more lives from cancer,” said John Seffrin, PhD., CEO of the American Cancer Society.

“The findings from CPS-3 studies to build on that legacy, helping us are not just scientific- they also One hundred years ago, the learn more about the causes of provide the evidence we rely on American Cancer Society began cancer so we can better prevent, to help shape health advice for the fight of a lifetime – the fight against cancer. Now, approximately 2,896 people in Houston and over 300,000 people from across the country have joined that fight by enrolling in the American Cancer Society’s Cancer Prevention Study-3 (CPS-3). The American Cancer Society began a full scale national enrollment for CPS-3 in 2010 and reached its goal for participants in December. The study would not have been possible without the commitment and passion of over a quarter million volunteers nationwide.

contribute to our advocacy efforts to change policies,” said Alpa Patel, Ph.D., American Cancer Society strategic director of the CPS-3 study. During the past 50 years, more than 2 million volunteer participants have joined American Cancer Society Cancer Prevention Studies and have been making a difference simply by giving a little time to fill out surveys and share information about their behaviors, lifestyle, family and personal medical history. Today, a new generation has done the same by joining CPS-3.

Results from previous American Cancer Society long-term followup studies have demonstrated the link between cigarette smoking and lung cancer, the significant impact of being overweight or obese on risk of cancer occurrence and death and the relationship between of a wide range of other “The American Cancer Society the public, develop nutrition and factors such as physical inactivity, has a long history of saving lives detect, treat, and help cure it, for physical activity guidelines and alcohol, nutrition, and medications through cancer research. Cancer generations to come. And what’s cancer prevention programs, and like aspirin on cancer risk. Prevention Study-3 will do so much ©2013 Tiff’s Treats

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Houston Medical Times

Page 12

Discoveries in How Memories Form Could Help Treat Dementia

Brain Research by UH Biologists Provides New Clues to Pavlovian Conditioning Do fruit f lies hold the key to treating dementia? Researchers at the University of Houston (UH) have taken a significant step forward in unraveling the mechanisms of Pavlovian conditioning. Their work will help them understand how memories form and, ultimately, provide better treatments to improve changed how these cells responded to odors by developing a modification memory in all ages. in gamma lobe neuron activit y, known as a memory trace,” he said. Gregg Roman, an associate professor “Interestingly, we found that training of biology and biochemistry at UH, caused the gamma lobe neurons to and Shixing Zhang, his postdoctoral be more weakly activated by odors associate, describe their findings in a that were not paired with an electric paper titled “Presynaptic Inhibition of shock, while the odors paired with Gamma Lobe Neurons Is Required for electric shock maintained a strong Olfactory Learning in Drosophila,” activation of these neurons. Thus, appearing Nov. 27 in Current the gamma lobe neurons responded Biology, a scientific bimonthly journal more strongly to the trained odor published by Cell Press. than to the untrained odor.” “Memory is essential to our daily function and is also central to our sense of self,” Roman said. “To a large degree, we are the sum of our experiences. When memories can no longer be retrieved or we have difficulty in forming new memories, the effects are frequently tragic. In the future, our work will enable us to have a better understanding of how human memories form.”

The team also showed that a specific protein – the heterotrimeric G(o) protein – is naturally involved in inhibiting gamma lobe neurons. Roman says removing the activity of this protein only within the gamma lobe neurons resulted in a loss of the memory trace and, thus, poor learning. Therefore, inhibiting the release of neurotransmitters from these neurons through the actions of the G(o) protein is key to forming Roman and Zhang set about to the memory trace and associative unravel some of these mysteries by memories. studying the brains of fruit f lies (Drosophila). Within the fly brain, The significance of using fruit flies Roman says, there are nerve cells is that while their brain structure is that play a role in olfactory learning much simpler with far fewer neurons, and memory. Olfactory learning, the mushroom body is analogous he says, is an example of classical to the perirhinal cortex in humans, conditioning first described by Pavlov which serves the same function of in his experiment with dogs. In sensory integration and learning. their study, the flies were trained to This simplicity allows scientists to associate a weak electric shock with an gain insights into how memories are odor. After training, the flies avoided acquired, stored and retrieved. that odor.

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“Drosophila represents the Goldilocks principle of neural research, with sufficient behavioral complexity, while maintaining a huge advantage in neural simplicity,” Roman said. “The complex behaviors allow us to see Dementia page 22


Houston Medical Times

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2013 COACH OF THE YEAR FINALISTS

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January 2014


Houston Medical Times

Page 14

HCA Gulf Coast Division Names Matt Dixon Chief Executive Officer of Pearland Medical Center HCA Gulf Coast Division President, Maura Walsh, announced today that Matt Dixon has been named Chief Executive Officer for the new HCA Affiliated Pearland Medical Center that opens in the fall of 2014.

Dixon earned h is Ma st er of Business Administration from the Stephen M. Ross School of Previously, Dixon was the Chief Business at the Operating Officer at St. Mark's Hospital University of  in Salt Lake City, a 317-bed facility in Michigan and  HCA's Mountain Star Division. His received his responsibilities included overseeing Bachelor of Arts from Brigham Young  a staff of 650 physicians and 1500 University. He is also a fellow with  employees, a role he has held since the American College of Healthcare Executives. 2006.  About Pearland Medical Center   Prior to his leadership role at St. Mark's Hospital, Dixon was the Pearland Medical Center, expected  Associate Administrator at Lakeview to open in the fall of 2014, is a new  patient-centered hospital that expands Hospital in Bountiful, Utah. 



“I am pleased to welcome Matt to the HCA Gulf Coast Division team as Pearland Medical Center's Chief Executive Officer,” Walsh said. “Matt's strong background in operational leadership makes him particularly well suited for this role. We look forward to him developing a high-quality, clinically excellent medical staff and building a team of talented and committed leaders.” “I am honored to join the new Pearland Medical Center, a dynamic facility that emphasizes HCA's commitment to providing convenient, high-quality healthcare close to home,” Dixon said. “Pearland is one of the fastest-growing communities in the Houston area, and I am excited about Pearland Medical Center meeting the diverse healthcare needs of Pearland and its surrounding communities.”

January 2014

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HCA Gulf Coast’s long-standing commitment to provide high-quality healthcare close to home. The 144,000 square-foot facility will feature surgical suites, cesarean-section rooms, a general nursery, digital mammography, and a 24-hour emergency department. Imaging services will include magnetic resonance imaging, computerized tomography, a catheterization lab, echocardiogram testing, and nuclear medicine modalities. As an HCA affiliated hospital, Pearland Medical Center joins a continuum of nine other Houston-area medical centers, ambulatory surgery centers, diagnostic imaging facilities, off-campus emergency centers and a regional transfer center that provides ground and air transportation to and from any HCA Gulf Coast Division Affiliated Hospital. Visit www.pearlandmc.com for updates and more information.


Houston Medical Times

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January 2014


Page 16

Houston Medical Times

Baylor College of Medicine names Dr. Alicia Monroe as first senior dean Baylor College of Medicine has named Dr. Alicia D. H. Monroe as senior dean of education and senior vice president of academic affairs and faculty development, a new leadership position overarching all four schools of the College. Monroe currently is the chief academic officer and vice dean of educational affairs at University of South Florida Morsani College of Medicine and is a professor of family medicine. Monroe’s position at BCM will become effective therapy program and the master’s February 2014. program in graduate studies. She has focused on reengineering “As a health sciences university medical education to enhance with schools of medicine, biomedical student readiness for postgraduate sciences, allied health sciences and training and medical practice. tropical medicine, it is important to have a senior dean to forge In partnership with the Lehigh collaboration among the programs Valley Health Network in Allentown, and provide additional assistance to Pa., she developed the SELECT strengthen each of them, said Dr. (Scholarly Excellence, Leadership Paul E. Klotman, BCM president Ex per iences, Collabor at ive and CEO. “Investing in programs Training) MD Program. She is that support our faculty is a high the principal investigator of a priority for Baylor. Dr. Monroe is new Professional Project jointly a recognized leader in mentoring, sponsored by the Institute on professionalism and development Medicine as a Profession and the of academic medical leadership Josiah Macy Jr. Foundation. The programs making her an excellent project supports the development of choice to also lead academic affairs new initiatives and training around and faculty development.” patient-centered care.

Victoria’s family is grateful to blood donors for helping save her life. Gulf Coast Regional Blood Center is encouraging individuals to Commit for Life. It takes three simple steps: • Donate once per quarter; • Allow us to contact you; and • Spread the word. More than 1,000 blood donations are needed every day. There is no substitute for blood, and it’s the blood on the shelf that saves lives today. Commit for Life and save up to three lives with one donation at any of Gulf Coast Regional Blood Center’s Neighborhood Donor Centers. To schedule your donation or to find a convenient location near you, visit www.giveblood.org or call 1(888) 482-5663.

January 2014

“Baylor College of Medicine is an outstanding institution with an exceptional portfolio of strengths and achievements. I am honored to join the team and look forward to collaborating with senior leaders, faculty, administrators and students to advance the BCM vision and mission,” said Monroe.

She previously served in leadership roles at the Warren Alpert Medical School of Brown University. At Brown, she was the associate dean for diversity on the Division of Biology and Medicine and a member of the Executive Leadership Council. She served as associate dean of medicine for minority affairs at the University At the Universit y of South of Massachusetts Medical School Florida, Monroe has held several from 1996 to 2007. leadership positions and has been instrumental in coordinating Monroe has written and lectured education programs. She joined extensively on curricula and faculty USF Health in 2008. At USF, she development topics. oversees undergraduate medical education programs, the physical

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Houston Medical Times

medicaltimesnews.com

Page 17

January 2014


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Houston Medical Times

U.S. Stroke Deaths Declining Due to Improved Prevention, Treatment American Heart Association/American Stroke Association Scientific Statement Stroke deaths in the United States have declined dramatically in recent decades due to improved treatment and prevention, according to a scientific statement published in the American Heart Association journal Stroke. The American Stroke Association commissioned this paper to discuss the reasons that stroke dropped from the third to fourth leading cause of death. “The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, Dr. P.H., chair of the statement writing committee and professor of epidemiology at the

RAC Audit

Continued from page 1 payments.

The program’s mission is to detect and correct past improper payments so that ∙∙ Region D R AC Auditors: the Center for Medicare and Medicaid saved.” HealthDataInsights, Inc. Las Vegas, Services (CMS) can implement actions Nevada, and subcontractor, PRGthat will prevent future improper Schultz USA, Inc. “For the public, the effort you put into payments: lowering your blood pressure, stopping What Does the RAC Review? smoking, controlling your cholesterol and Providers can avoid submitting ∙ ∙ diabetes, exercising and eating less salt claims that do not comply with has paid off with a lower risk of stroke.” The recovery audit looks back three years Medicare rules. from the date the clam was paid. RACs Stroke deaths dropped in men and are required to employ a staff consisting women of all racial/ethnic groups and ∙∙ CMA can lower its error rate. of nurses, therapists, certified coders, and ages, he said. a physician. ∙∙ Taxpayers and future Medicare “Although all groups showed beneficiaries are protected. The RAC reviews claims on a postimprovement, there are still great racial and geographic disparities with stroke payment basis. There are three types of risks as well many people having strokes Who Is Subject to a RAC Audit? review: at young ages,” Lackland said. “We need to keep doing what works and to better ∙∙ Hospitals. ∙∙ Automated—no medical record needed. ∙∙ Physician practice. ∙∙ Nursing homes. ∙∙ Home health agencies. ∙∙ Durable medical equipment suppliers.

Medical University of South Carolina, target these programs to groups at higher in Charleston, S.C. “The decline is real, risk.” not a statistical fluke or the result of more people dying of lung disease, the third MORE leading cause of death.” Co-authors are Edward J. Roccella, Public health efforts including lowering Ph.D., M.P.JN., committee chair; Anne F. blood pressure and hypertension control Deutsch, R.N., Ph.D.; Myriam Fornage, that started in the 1970s have contributed Ph.D.; Mary G. George, M.D., M.S.P.H.; greatly to the change, Lackland said. George Howard, Dr. P.H.; Brett M. Kissela, M.D., M.S.; Steven J. Kittner, Smoking cessation programs, improved M.D., M.P.H.; Judith H. Lichtman, Ph.D., control of diabetes and abnormal M.P.H.; Lynda D. Lisabeth, Ph.D, M.P.H.; cholesterol levels, and better, faster Lee H. Schwamm, M.D.; Eric E. Smith, treatment have also prevented strokes. M.D., M.P.H.; and Amytis Towfighi, Improvement in acute stroke care and M.D., on behalf of the American Heart treatment is associated with lower death Association Stroke Council, Council on Cardiovascular and Stroke Nursing, rates. Council on Quality of Care and “We can’t attribute these positive Outcomes Research, and Council on changes to any one or two specific actions Functional Genomics and Translational or factors as many different prevention Biology. and treatment strategies had a positive impact,” Lackland said. “Policymakers For the latest heart and stroke news, now have evidence that the money spent follow us on Twitter: @HeartNews. on stroke research and programs aimed For updates and new science from at stroke prevention and treatment have Circulation, follow @CircAHA. been spent wisely and lives have been January 2014

Consulting Associates, Inc., and subcontractor, Viant Payment Systems, Inc.

∙∙ Semi-automated—claims review using data and potential human review of a medical record or other documentation. ∙∙ Complex—medical record required. What Can You Do to Prepare for a RAC Audit?

∙∙ Any provider or supplier that submits claims to Medicare.

Assess your risk for billing issues by performing a risk analysis of your billing practices. Assign a knowledgeable Who is the RAC Auditor? member of your staff to review your billing processes and to develop a billing CMS has contracted with RAC auditors compliance plan. Consider hiring a for each region in the United States. It is contractor for this task. Identify billing important to know who the RAC auditor issues, keep track of denied claims, and is in your region. Never ignore a letter look for patterns and determine what from one of these organizations. The corrective actions you need to take to United States is divided into four regions. avoid improper payments. Common Each region has a designated recovery billing errors include: audit contractor. Texas is in Region C. ∙∙ Region A RAC Auditors: Performant Recovery, Inc., and subcontractor, PRG-Schultz USA, Inc. ∙∙ Region B RAC Auditors: CGI Technologies and Solutions, Inc., and subcontractor, PRG-Schultz USA, Inc. ∙∙ Region C RAC Auditors: Connolly

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∙∙ Inadequately trained staff. ∙∙ Lack of time. ∙∙ Did not follow recommendations in Federal Register bulletins. ∙∙ Did not consult Health and Human Service bulletins. see RAC Audit page 20


Houston Medical Times

Page 19

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January 2014


Page 20

Houston Medical Times

RAC Audit

Continued from page 18 billing through automatically generated detailed patient histories, cloning (when you cut and paste the same examination ∙∙ New staff/New billing company. findings), and templates filled in to reflect a more thorough or complex The person responsible for implementing examination/visit. Review these issues the billing compliance plan should with your EMR company and determine regularly monitor RAC progress in if your EMR program has the potential your region. Each RAC must maintain to automatically upcode billing based on a website with information on new audit EMR documentation. focus areas and the status of a provider’s Fundamentals for Compliance audits. Areas to include in your assessment and monitoring plan include: Establish compliance and practice standards and conduct internal ∙∙ Review denied claims categories by monitoring and auditing to evaluate RAC audit. compliance. Conduct appropriate training and education for staff and respond to ∙∙ Keep abreast of notifications on deficiencies identified during internal CMS website. audits. Establish corrective action plans and enforce disciplinary standards when ∙∙ Review annual Office of Inspector necessary. General (OIG) work plan to identify audit areas. Medical billing is complex. Billers ∙∙ Misinterpretation of rules.

and coders must be knowledgeable about many areas pertaining to billing/ reimbursement. Be sure your billing staff understands local medical review ∙∙ Perform audit of your billing policies and is knowledgeable of practice practices. jurisdictions. Billing personnel must staff stay current on coding requirements Potential Issues with Electronic Medical and keep up with industry changes, Records understand denial and appeal processes, and be able to identify resources for The OIG is studying the link between support. electronic medical record (EMR) systems and coding for billing. There is a concern What to Do if You Are Audited that some EMR systems may upcode ∙∙ Monitor RAC progress at regional RAC (their web postings).

Do not ignore a letter from the RAC auditor. It is recommended you have an attorney assist you with your response to a RAC audit. Check with your insurance company to determine if you can get help with the audit. The Doctors Company, for example, provides RAC audit legal assistance for all members as part of its MediGuard® coverage. Before you send records to the auditor, be sure to review them in a “self-review.” Are there common themes? Are you coding with the correct documentation? Make copies of everything you send to the RAC auditor and be sure to keep a copy of all documentation. Send medical records via certified mail.

you may pay by check within 30 days with no appeal, allow recoupment from future payments, or request or apply for an extended payment plan. There is an appeal process if you do not agree with the audit findings.

Do not confuse the RAC Discussion Period with the appeals process. If you disagree with the RAC determination, do not stop with sending the discussion letter detailing why you disagree with the findings. File an appeal before the 120th day after the demand letter. Send correspondence to RAC via certified mail. It is recommended you have legal representation to advise you in the response to a recoupment demand, to determine if you should appeal, and to Staying on top of the RAC audit process ensure you meet the required regulatory is important as there are multiple policies requirements of the appeal process. and procedures governing RAC audits. The RAC can request a maximum of Where to Get More Information on 10 medical records from a provider in a Government Audits 45-day period. The time period that may be reviewed has changed from four years More information on the growing risk to three years. of government investigations and audits Responses are time-sensitive, and significant penalties may result if they are not handled properly. RACs are paid on a contingency basis for overpayments and underpayments. If you agree with the RAC demand letter you have the choice of paying by check or recoupment from future payments, or you may request an extended payment plan.

can be obtained through five short videos featuring tips from Kevin R. Warren, Esq., of Michelman & Robinson LLP's Healthcare Practice at http://ow.ly/rP02n. The videos address how to create an effective compliance program, why it's important to train staff to avoid improper and exaggerated coding, what steps to take if your practice receives a subpoena, and how to properly protect electronically stored information.

If a recoupment demand is issued,

Memorial Herman Trauma Continued from page 1

one of the Top 20 Innovative Products for 2013 by the EMS World Training Conference. UTHealth owns the intellectual property rights to the JETT.

from the femoral arteries of either or both lower limbs, depending on the injury. It is designed to allow for patient movement without dislodging or reducing pressure, which makes it ideal for use in a hostile or pre-hospital environment. Even more, it is compact, lightweight and durable – all necessary components for a device intended to be carried into combat.

chief of the division of Acute Care Surgery at the UTHealth Medical School to create the prototype. He worked with Andrew R. Burgess, M.D., chief of Orthopaedic Trauma Services at the UTHealth Medical School, to help recreate the injuries on cadavers and test the device. A short 18 months after Gates first sent his sketches from Afghanistan, the JETT was officially FDA approved.

Applied circumferentially around the body like a belt, the JETT can be tightened around the pelvic region to compress fractures in place and apply inward pressure to the area without impeding respiration. The device also includes two pressure pads that can Gates collaborated with Col. John be positioned directly over the vessels B. Holcomb, M.D., director of the “It was a testament to how well the supplying the lower extremity, which Texas Trauma Institute at Memorial device worked – and how badly it was can be tightened to block blood flow Hermann-Texas Medical Center and needed,” Dr. Holcomb said. January 2014

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The JETT holds incredible promise in the business of saving lives. Already a limited number have been deployed in combat in Afghanistan, and it is now carried on all Memorial Hermann Life Flight helicopters. In June, Life Flight nurse-paramedic Rudy Cabrera, R.N., B.S.N., C.F.R.N., E.M.T.-P. applied the JETT on its first civilian patient and it is “without a doubt” according to his doctors, the reason one local Houston man is alive today.


Houston Medical Times

Houston Pain Center Participates in a Research Clinical Trial to Stop Chronic Lower Limb Pain in its Tracks By Allen W. Burton, MD

It’s no secret that chronic pain is a growing health issue in the U.S. today. I see chronic pain patients everyday in my practice at Houston Pain Center. Defined as pain lasting longer than six months after an injury has healed, it is estimated that more than 100 million Americans suffer from chronic pain annually. Chronic pain can impact a sufferer’s ability to lead a productive working, social and family life. Many patients undergo years of testing and doctors’ visits without a long-term solution. Neuropathic pain is induced by an injury or disease of the nervous system. A common cause of neuropathic pain is post-surgical nerve damage, which occurs in up to 35

Neurostimulator System is the only spinal cord stimulation system that targets a branch of spinal cord called the dorsal root ganglion (DRG). The Dorsal Root Ganglion (DRG) plays a critical role in the development and maintenance of chronic pain , as it processes pain signals as they travel to the brain. By stimulating the DRG, the Axium System interrupts pain signals before they travel to the brain. Recently published European data from a non-randomized study found that 78 percent of patients experienced pain relief in the lower limbs. Houston Pain Center is now enrolling patients for the ACCURATE study, a prospective, randomized, multi-center, controlled trial to determine the safety and efficacy of the Axium™ Neurostimulator System for chronic neuropathic pain affecting their lower limbs (such as the leg, foot, or groin). To qualify for the ACCURATE study, patients must fit the following inclusion/exclusion criteria: ∙∙ Male or Female between the ages of 22 and 75

Page 21

Mental Health

Continued from page 3 when the alarm goes off it’s our today self who is actually the actor...and the today self hits the snooze button. Fortunately, we have several effective strategies to help us shrink the divide between our today and tomorrow selves. The following top ten list I present is not exhaustive, but I’m not getting paid by the word count. 1. Commit to change - habit starts in the mind, but you can’t think your way to a better way of feeling. You must act your way top a better way of feeling & thinking. 2. Have ‘Little Blue Engine’ thoughts - “whether you think you can or can’t, you’re right,” as Henry Ford said...incidentally he never made trains, as far as I know. 3. Journal - writing down goals helps us organize our thoughts and desires, motivates us to persist, and journaling can boost your overall well-being. 4. Be smart - have SMART Goals, that is. SMART goals helps people think clearly and define their goals, and helps goal achievement. S - Specific, stretch, and significant M - Meaningful, measurable, and motivating A - Acceptable and achievable R - Realistic and relevant to a mission

percent of patients who undergo hernia surgery and 50 to 85 percent of patients who undergo amputations. Other causes include nerve damage caused by trauma or diseases such as Complex Regional Pain Syndrome (CRPS). Neuropathic pain is difficult to treat. Strong medications like opioids can provide relief, but may not always be an effective long-term treatment option. For many years, neurostimulation has been a well-accepted, effective, and safe method to treat neuropathic pain. Most popular is stimulation of the spinal cord. Leads (small wires) are implanted in the epidural space, an area around the spinal cord. A neurostimulator sends pulses to the leads. It is implanted in the abdominal wall or buttock, and is controlled via an external remote control. My practice in Houston is participating in a national study along with nearly two dozen sites across the country to evaluate a potential new therapy for chronic lower limb pain. The investigational Axium™

∙∙ Have had chronic pain affecting lower limbs for at least six months ∙∙ Have not seen lasting success with other treatments and

T - Timed 5. Be smarter - the best goals are “learning” goals, which are of the ‘path’ not ‘destination ilk. Focusing

∙∙ Have not previously used spinal cord stimulation for chronic pain.

6. Approach - select goals in the GO (positive) direction. For example, instead of “avoiding cake and cookies,” make your goal “consume 5 servings of fresh fruits and veggies daily.” (BTW - doing so will boost your mood, too.) 7. Divide and conquer - subdivide your long-term goals into short term subgoals. 8. Recall - remind yourself about your past successes, especially when flummoxed. 9. Substitute - there are more pathways to achieve a goal than there are obstacles. So, don’t be stubborn with using just one approach. 10. Hope - goals are useful, but what happens when you still lack motivation? Hope is the answer. In a nutshell, hope research teaches us that people change when:they learn better ways at doing things, discover that they can make the change happen, and start thinking in terms of goals. In addition, people with high amounts of hope prefer to stretch themselves and aim for more challenging goals. So, I hope you and all those you love have an awesome 2014. And, may you effectively forge good habits on the path to forging your legacy.

Money Matters

Continued from page 4

For more information, or to see if you qualify for the ACCURATE study, please self-employed Physician with fewer visit www.ACCURATEstudy.com or call than 10 employees, consider a Defined 888-978-8397. Benefit (DB) Plan; even with the Dr. Burton is a Board Certified Pain employee contributions costs, it can be Management Specialist practicing at of much tax benefit. Moreover, you put Houston Pain Center with locations in away hundreds of thousands of dollars, and around Houston, Texas. reduce taxes, and fund retirement all in CAUTION: The Axium Neurostimulator one vehicle. It can also serve as assetSystem is an investigational device and is protection. (Annual contributions in DB limited by United States law to investigational Plans are not flexible and are mandatory use. unlike 401K/PSP that are flexible and medicaltimesnews.com

on doing the best you can during the process is far more effective in the long run than focusing solely on performance.

are subjected to limited contributions.) Roth IRA Conversions: With these higher tax rates, do not attempt conversions until either you retire or your income along with the amount of the conversion is below the threshold. As you plan your charitable giving: Consideration should be given to using see Money Matters page 22 January 2014


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Houston Medical Times

Money Matters

HOUSTON

Continued from page 21 low basis assets instead of cash which The bottom line :It is critical to have would allow you to avoid the capital an understanding of not only what taxgains on the growth and get a tax credit saving measures are available to help for the current value of the asset as a gift. cash flow, but also to understand the

future tax implications of investments and planning structures on the decisions you make today.

Editor Sharon Pennington

Marketing Essentials

Associate Editor Lorraine McColley

Continued from page 5

big difference. The loss of one patient is large and far-reaching. Of course, every patient is important… but avoiding the disappearance of even one patient is financially significant to the business. High patient satisfaction is a primary ingredient in patient loyalty or bonding with the organization. Here are six basic business reasons to make patient retention a high priority. ∙∙ Lost future patient care opportunity. In the retail world it’s called “repeat business,” and when a patient leaves the practice or organization they’re likely to be lost forever. ∙∙ Lost patient referrals. Even satisfied patients may leave your organization, but devoted patients will refer to

you. In most organizations patient referrals produce a high Return-onInvestment.

∙∙ Replacement costs are higher than retention costs. It is far more costly to attract a (replacement) patient– anywhere from 4 to 100 times more expensive.

∙∙ Risk to reputation. Dissatisfied individuals not only don’t make referrals, they may tell others about Patient satisfaction. Patient retention. their concerns (even when they are minor.) This negative word- Most patients are not medically trained of-mouth can influence others, and have little or no clinical basis to and potentially reach professional evaluate a professional or the quality referral sources as well. of care. Their value system is usually personal–how they felt about it all–the ∙∙ Possible loss to the competition. total “patient experience.” Patients that are strongly bonded to you tend to ignore competitive The key to retention is satisfaction. Clearly high quality medical care comes marketing messages. first, but cultivating a positive and caring ∙∙ Lost acquisition investment. personal relationship with patients is Attracting patients typically also critical. It is good business sense requires an initial marketing to build, preserve and protect against investment. When they leave the the loss of patients. It can be relatively long-term value of that patient is easy and inexpensive to keep satisfaction high. cut short.

Age Well Live Well when this information will be gov. helpful to you and a loved one. For more information about Age Well To find out about your local Age Well Live Well, or to find out how to make Live Well collaborative and the available your community an Age Well Live 3. Learn about the programs and programs, contact Beverly Brownlow Well collaborative, go to: www.dads. services available to you and older with the Harris County Area Agency on state.tx.us/volunteer/agewell/index. adults – there will come a time Aging at: Beverly.Brownlow@houstontx. html#become. 2. Volunteer with something that has meaning to you. You WILL be amazed at the benefits!

Dementia

Continued from page 12

January 2014

dissecting the logic of the neural circuits that allow for changes in behavior to occur.” The pair says all their experience to date suggests the molecules and logic will translate to most animals, including humans, leading to a more complete understanding of how memories form in humans, both at the level of molecules and through

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Office: 281-338-6560 Fax: 281-316-9403 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com

Continued from page 8

examine many behavioral processes like learning, attention, aggression and addiction-like behaviors, while the simplicity allows us to dissect the crucial neural activities down to single cells. Additionally, Drosophila has the most powerful genetic toolkit available for behavioral experimentation. In using these tools, we are genetically identifying the molecules necessary to perform these behaviors and

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the activity of neural circuits. Initially funded by a Norman Hackerman Advanced Research Program award from the state of Texas, a Major Research Instrumentation Program grant from the National Science Foundation was also critical, supplying the microscope necessary for measuring neural activity.

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