Houston Medical Times

Serving Harris, Galveston, Brazoria and Fort Bend Counties

HOUSTON

July Issue 2016

Inside This Issue

RESEARCH SHOWS SHIFT WORK UNWINDS BODY CLOCKS, LEADS TO MORE SEVERE STROKES

By Holly Shive

Memorial Hermann Trauma Institute Renamed to Honor Dr. James “Red”Duke See pg. 10

INDEX Mental Health...............pg.3 Legal Health..................pg.4 Oncology Research......pg.6 Age Well Live Well........pg.12

Statistics show that some 15 million Americans don’t work the typical nine-to-five. These employees (or shift workers), who punch in for graveyard or rotating shifts, are more prone to numerous health hazards, from heart attacks to obesity, and now, new research, published in Endocrinology, shows shift work may also have serious implications for the brain.

“The body is synchronized to night and day by circadian rhythms—24-hour cycles controlled by internal biological clocks that tell our bodies when to sleep, when to eat and when to perform numerous physiological processes,” said David Earnest, Ph.D., professor in the Department of Neuroscience

and Experimental Therapeutics at the rotating shifts, challenges, or confuses, Texas A&M Health Science Center their internal body clocks by having College of Medicine. “A person on irregular sleep-wake patterns or meal see Shift Workers page 17 a shift work schedule, especially on

Children’s Memorial Hermann Hospital Extends Special ‘Thank You’ to Former Houston Texan Chris Myers & Wife Jenny

Largest Texas Health Insurer Requests to Raise Premiums See pg. 14

Children’s Memorial Hermann Hospital recently held a special event to thank and acknowledge recently retired Houston Texans player Chris Myers and his wife, Jenny, for their longtime contributions. The Myers family has generously supported Children’s Memorial Hermann Hospital’s Pediatric Plastic and Reconstructive Surgery Program for several years with volunteer efforts and financial support through the Dreambuilders

Foundation.

Over three years ago, Chris and Jenny’s son, Keane, was born with a cleft lip and palate. Without surgeries, Keane would have had trouble eating and speaking. He was treated

by Children’s Memorial Hermann Hospital’s pediatric plastic surgery L to R: Susie Distefano, Dr. John Teichgraeber, team.

“When we decided to raise money through the Dreambuilders Foundation, we had no doubt that we wanted these funds to go to the pediatric plastic surgery program at Children’s Memorial Hermann Hospital,” said Jenny Myers. “We wanted other families to share the incredible experience that the outstanding team provided for our son, Keane. The opportunity to assist families in easing the financial burden that comes along with cleft surgeries is extremely humbling.”

Chris Myers, Jenny Myers and Dr. Matthew Greives.

Guests at the event were asked to make a contribution to the Pediatric Plastic and Reconstructive Surgery Program in lieu of a going away present for the Myers, who are moving to Philadelphia this summer. As a gift to the Myers, patients from Children’s Memorial Hermann Hospital painted a keepsake plate, which reads “thank you” and shows a decorated landscape.

“The Myers’ generosity has assisted a number of families who see Former Houston Texan page 17

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Mental Health

What Can You Do About Stress?

By Margaret Jordan, PhD Clinical Psychologist

stress levels? First, let’s look at what people say they do to try to deal with stress. Not surprisingly, there are differences between what women and men turn to for stress reduction. Women are more likely to read or do activities that connect them with other people. They are more likely to say they have eaten too much or consumed unhealthy foods because of stress. They are also less likely to exercise than men. When asked why, many say they are just too tired. Men are more likely to play sports or listen to music to manage stress, but they are also more likely to do nothing for stress.

Much has been written and said about the problem of stress and techniques for reducing it, yet stress levels continue to rise for many people. Stress causes emotional distress, muscular problems, stomach and bowel problems, cardiovascular symptoms, and negative effects on relationships.

Chronic stress can be fatal through suicide, violence, heart attack, or Both men and women say stroke. they need more willpower in

order to change, but women are more likely to say lack of willpower keeps them from making lifestyle changes recommended by health care professionals. These lifestyle changes may include increasing exercise; improving nutrition by eating a more healthful diet or reducing calories; reducing or eliminating alcohol, tobacco, or other drug use; getting 7-8 hours of sleep per night; or adding meditation to their regular practices. These are well-known recommendations for health in general, and all are useful for feeling less stress. But making With all of this stress affecting changes in these behaviors is often so many people, why has there not more easily said than done. been more progress in reducing see Mental Health page 17 Money and work are reported to be the top two sources of significant stress, according to the American Psychological Association, with family responsibilities as the third most common stressor. Adults in urban areas have higher levels of stress, and women report higher stress than men. Hispanic adults report the highest stress levels, compared to those in other racial or ethnic groups. The groups most likely to report extreme stress are adults with disabilities and those who are LGBT.

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Page 4

Legal Health

The Road to Physician Payment Reform: Key Considerations for MIPS and APM Participation patient outcomes through the “Quality Payment Program” (“QPP”). Over the next few months, CMS will be sorting through submitted public comments, including some expressing concerns that the QPP is too complex and its implementation is proposed to happen

By Helaine Fingold, J.D and Lesley Yeung, J.D. too quickly, to determine how it will Epstein Becker & Green, P.C. finalize the initial implementation In April 2015, Congress rules for the QPP. However, clinicians established a new framework for should not wait for the final rule to Medicare Part B physician payments be published this Fall, but should act through the passage of the Medicare now to determine their best options Access and CHIP Reauthorization for participating in the various payment Act of 2015 (“MACRA”). After pathways established in MACRA. consultations with and outreach to Background on MACRA’s clinicians and other stakeholders, in Physician Payment Framework May 2016 the Centers for Medicare & MACRA allows Medicare Part B Medicaid Services (“CMS”) published a proposed rule on implementing clinicians to take part in the QPP in one MACRA’s physician payment reforms. of two ways: through the Merit-Based The proposed rule defines how CMS Incentive Payment System (“MIPS”) or would shift fee-for-service payments Alternative Payment Models (“APMs”). that reward physicians for the volume MIPS modifies and consolidates of services delivered to payments that key components of several existing reward physicians based on value and Medicare quality programs: the

Physician Quality Reporting System, the Value-Based Payment Modifier Program, and the Medicare Electronic Health Record (“EHR”) Incentive Program. MIPS combines these into a single program that assesses performance across four categories: Quality, Resource Use, Clinical Practice Improvement Activities, and Advancing Care Information (related to the electronic exchange of interoperable health information).

Beginning in 2019, MIPS-eligible clinicians will receive a positive, neutral, or negative payment adjustment based on how their performance on

MIPS-reported measures and activities compares to a baseline performance threshold. Importantly, these payment adjustments will be based on clinician performance data beginning with 2017.

An APM is an approach to paying for medical care that incentivizes quality and value through care coordination.

Accountable care organizations, patient-centered medical homes, and bundled payment models are examples of APMs that are currently being tested

by CMS. Beginning in 2019 through 2024, Medicare will offer a 5 percent see Legal Health page 18

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Oncology Research

Cancer mutations and the perspectives to create vacines.

By Jorge Augusto Borin Scutti, PhD Houston Medical Times

Cancer is among the leading causes of death worldwide. In 2012 there were 14 million new cases and 8.2 million cancer-related deaths worldwide. Unfortunately the number of new cancer will rise to 22 million within the next two decades. Susan Sontag in one of hers works titled “ Illness as metaphor” defines illness as a night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship,

often in this column. Therapeutic strategies against cancer has been challenging for many researchers mainly due their biological capabilities in the field of both celular and molecular environment: sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, and activating invasion and metastasis. Cancer vaccines became a gold rush among laboratories, pharmaceutical industries and researchers. As discussed here previously, more than a light on the horizon the immunotherapy ceased to be a promise to become a strategy. But, how does it happen,

in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. According to National Cancer Institute in 2016 an estimated 1,685,210 new cases of cancer will be diagnosed in the United States and 595,690 people will die from the disease. To have an idea of the growth of the national expenditures for cancer care in the United States totaled nearly $125 billion in 2010 and could reach $156 billion in 2020. The fight for a cure for cancer is always in the world spotlight and cancer therapy has been discussed

I mean, how are the specific cancer antigens produced? First we have must accept that as an absolute truth – cancer is an evolutionary process.

Second, there are accumulations of mutations – at random. Not even all mutations are responsible for causing cancer. According to Leonid Mirny, biophysicist and Associate Professor at Harvard “the normal cells are sitting and waiting for the right mutation, so they are getting random mutations. And they are generally getting a little bit sick of this random mutations. These mutations are collectively called ‘passengers’. So those mutations that drive cancer progression are called ‘drivers’ and others are called ‘passengers’. It is

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UH School of Nursing Part of Initiative to Teach Safe Prescribing for Opioids Future Nurse Practitioners will Learn CDC Best Practices for Treating Chronic Pain

By Lisa Merkl University of Houston

to make sure our students have the appropriate knowledge and are taught very specifically about how to prescribe these medications. The updated CDC guidelines will augment existing requirements we already have in place for advanced education on prescribing opioids and using best practices to prevent opioid abuse and overdose.”

As part of academic nursing’s ongoing efforts to address prescription drug and opioid misuse across the U.S., the University of Houston School of Nursing will be incorporating into its curriculum new Centers for Disease Control and Prevention (CDC) guidelines for More than 2.1 million people in prescribing opioid medications for the U.S. are struggling with substance chronic pain. abuse related to opioid pain medicine.

According to the CDC, overdose From 1999 to 2014, the most recent deaths involving prescription opioids statistics available, more than 165,000 have quadrupled since 1999, and new recommendations were recently people have died in the U.S. from issued for prescribing these types overdoses related to prescription of medications. The UH School of opioids, making up at least half of all Nursing is one of 191 nursing schools U.S. opioid overdose deaths. The new

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with advanced practice registered nursing (APRN) programs, joining an American Association of Colleges of Nursing (AACN) initiative, pledging to educate future nurse practitioners on these new CDC guidelines for safely prescribing opioids.

“We recognize that opioid abuse is a pressing public health issue, and it is critical that our family nurse practitioner students receive education on current standards,” said the UH nursing school’s dean, Dr. Kathryn Tart. “Dr. Kathleen Reeve leads the family nurse practitioner program at UH, where nursing students are taught how to write prescriptions.

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guidelines were established to address this issue.

“Pain management is a very complex issue. There are many factors that contribute to opioid overuse and misuse other than prescribing habits,” said Kay Reeve, the clinical professor in charge of this area and teaching the associated classes. “Our faculty will continue to educate students on the issues surrounding opioid abuse, as well as both the non-pharmacological and pharmacological methodologies for the management of acute and chronic pain across the lifespan, in accordance with all regulations and national guidelines.”

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Baylor St. Luke’s Reaches Milestone in Specialized Single-Site Robotic Gynecologic Surgery

CHI St. Luke’s Health–Baylor St. Luke’s Medical Center (Baylor St. Luke’s) announced that more than 100 single-site surgeries for advanced benign gynecologic conditions have successfully been performed using the da Vinci® Si Surgical System.

Baylor St. Luke’s is the first and only hospital in Houston to specialize in using this technology to treat complex gynecologic cases, such as hysterectomy, sacrocolpopexy (pelvic organ prolapse

With single-site, a 3-D camera and other miniaturized surgical instruments are inserted via a single 2-cm incision through the navel. Patients who might otherwise have required open or traditional laparoscopic surgery can now opt to have a virtually scarless procedure, resulting in shorter hospital stays, faster recovery, reduced risk of infection, and more cosmetically appealing results.

NOW LEASING PHASE II

Dr.Guan seen here with the da Vinci® Si Surgical System

Dr. Guan is one of only a handful of surgeons across the country who has received training to perform complex “This is a significant milestone gynecologic procedures using the da for us in the Houston medical Vinci Surgical System. He recently community,” said Xiaoming Guan, completed his 106th single-site robotic MD, PhD, Associate Professor, gynecologic surgery.

Fellowship Director of Minimally “Baylor St. Luke’s is dedicated Invasive Gynecologic Surgery, Baylor College of Medicine, and Minimally to advancing the field of minimally Invasive Gynecologist at Baylor invasive surgery through the use St. Luke’s. “Baylor St. Luke’s is of innovative approaches like uniquely positioned to offer women robotic-assisted surgery,” said Dr. a state-of-the-art surgical option Guan. “Our success in this area proves that is safe, less invasive, and most that this intricate method is the fastest, importantly results in high patient most effective way to provide surgical satisfaction.” care for a gynecologic condition.” repair), myomectomy (fibroid removal), and advanced endometriosis.

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Memorial Hermann Texas Trauma Institute Renamed to Honor Dr. James H. “Red” Duke

Lead the Way in Healthcare “The MBA program at the University of St. Thomas gave me the tools to understand all facets of business, from finance to operations to management, which allowed me to move into a senior management position.”

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rename its renowned trauma Institute after my father is a recognition that I know he would be tremendously humbled by,” said Sara Duke, Ph.D., daughter of Dr. Duke. “He was a good father, but his passion was serving humanity through his surgical skills and his desire to teach and mentor. He cared so much for both the Memorial Hermann and UTHealth family, the Houston community, Texas, and The renaming was officially announced Saturday evening, May the world at large. His passion for 7, at the System’s annual Circle of improving trauma care was driven by

In honor of the late James H. “Red” Duke, Jr., M.D., Memorial Hermann Health System has renamed the Memorial Hermann Texas Trauma Institute. Now named the Memorial Hermann Red Duke Trauma Institute, the System is proud to honor the legendary surgeon who is known for transforming trauma care for not just the city of Houston, but for the entire country.

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Life gala which honored Memorial Hermann Life Flight®, trauma care and Dr. Duke. The gala, along with the approaching 40th anniversary of Life Flight in August, created the perfect backdrop to announce the Institute’s new name.

“Renaming our trauma program in honor of Dr. Duke is a testament of our appreciation for the man who revolutionized trauma care,” said Craig Cordola, Senior Vice President and Regional President for the Central/ West Region for Memorial Hermann.

“Dr. Duke was a mentor, teacher and friend to so many, and we are privileged to work with the Duke family to continue his legacy.”

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his unending focus on the big picture and at the same time every patient being the most important individual in the room. Our entire family is grateful that his legacy lives on through the Memorial Hermann Red Duke Trauma Institute.”

Dr. Duke was a founding member of the American Trauma Society and played a critical role in the development of the EMS and trauma system in the state of Texas. He was well-known within Memorial Hermann, the greater Houston community, Texas and beyond for his commitment to educating the public about health issues and accident prevention, while Dr. Duke, who was the John B. providing extraordinary patient care Holmes Professor of Clinical Sciences and training of EMS, paramedics, at McGovern Medical School at medical students and surgeons.

UTHealth, was instrumental in The Institute is one of only two creating Life Flight in 1976, the first life-saving air ambulance service in Level I trauma centers in the Greater Texas, and served as the medical Houston area treating adult and director of the program for nearly pediatric patients under one roof and four decades. He spent many years brings together a world-class team of dedicated to discovering new ways to clinicians, researchers and educators better care for patients and enhance armed with the latest in research and the trauma center overall. technology to deliver comprehensive, “Having Memorial Hermann life-saving services. medicaltimesnews.com

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Age Well Live Well

Older Americans Act: A Celebration of Aging

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

other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregivers support. OAA services help seniors avoid hospitalization and nursing home care. Aging in place is not only desirable to many seniors and their caregivers, it can also save money that otherwise would be spent on institutional care.

According to George Burns, “You can’t help getting older, but you don’t have to get old.” The Older Americans Act (OAA), landmark legislation that helps seniors remain “Getting old can be a time of as independent as possible in their great joy,” Fielder said. “It can be homes and communities, has helped a time of great comfort, a time that change the face of aging you really get to spend with friends Sue Fielder, director of DADS and family.” The OAA supports Area Agencies on Aging section, preventive health by providing said the OAA is important because opportunities to have a healthy, it keeps issues related to aging— nutritious meal and opportunities wellness, nutrition, transportation, for people who may not have anyone medications, benefits (Medicare and in their lives to go to senior centers,

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Jennifer Scott, director of the Capitol Area Council of Governments, said the OAA “helps seniors age gracefully, successfully and safely in their own homes for as long as possible.

“Most seniors and their caregivers want to stay in their home “The philosophy behind OAA and get services there, and the OAA was civic engagement,” she said. helps make that possible.”

The OAA provides seniors— “Medicare was to provide medical support, Medicaid was to provide and especially rural low-income insurance to people with low seniors—the short-term services income, but the Older Americans they need in the areas of nutrition, Act was all about keeping seniors transportation, socialization, engaged in their communities,” she caregiver respite and more. said.

“OAA supports a state of mind,” Among other things, OAA Fielder said. “It’s a celebration of helps fund Meals on Wheels and aging.”

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LARGEST TEXAS HEALTH INSURER REQUESTS TO RAISE PREMIUMS ON INDIVIDUAL POLICIES

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Blue Cross Blue Shield of Texas (BCBS), which insures approximately 603,000 individual Texas policyholders, announced a proposal to raise premiums on three popular Health Maintenance Organization (HMO) plans by almost 60 percent. The rate hike follows a report by BCBS citing substantial financial losses in the second year of the Affordable Care Act (ACA) exchanges.

The Affordable Care Act, established marketplaces—or exchanges—where people without other health insurance can buy coverage. Filings from healthcare.gov show BCBS is seeking increases between 57.3 percent and 59.3 percent for two

have substantially higher use of health services than BCBS anticipated. “As a consequence, they have proposed substantially higher premiums,” Morrisey said.

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of its Blue Advantage Plus Plans. A 58.6 percent hike has been requested for the Blue Advantage Health Maintenance Organization Plan.

“It’s clear that adverse selection has been a substantial problem in the Texas exchange and in most states,” said Michael Morrisey, Ph.D., professor and head of the Department of Health Policy and Management at the Texas A&M Health Science Center School of Public Health.

“Fewer healthy low utilizers of health care have joined the plans than expected, and, initially, insurers like Texas BCBS only had claims data from other populations—those with employer sponsored coverage or those who had purchases coverage in the era prior to the ACA,” he continued. In essence, more sick folks joined the exchanges than expected, generating losses.

According to Morrisey, BCBS actuaries now have data on actual exchange enrollees in the first two years of the exchange’s operation. It would appear that the exchange enrollees

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“HMOs tend to have smaller panels of hospitals and physicians participating in the plan,” Morissey said. “Typically, the more limited set of providers are willing to accept lower prices for health care services in exchange for a greater volume of patients. It would seem that BCBS discovered the lower provider prices have not been enough to offset the effects of higher utilization of services.”

Preliminary Texas research suggests that after the first year of exchange operation, other carriers have been more aggressive in lowering their premiums relative to BCBS—particularly in the HMO segment of coverage.

“Carrier and plan specific enrollment data are not publicly available, so we don’t know how successful these actions have been in drawing enrollment away from BCBS,” Morrisey said. “However, if other carriers are less aggressive in raising their premiums, 2017 could be a year in which there is a large shifting of coverage from BCBS to other carriers, at least in urban Texas markets where the other carriers offer coverage.”

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Page 15

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Houston Medical Times Special Promotion

LUXURY SENIOR LIVING COMING SOON TO RIVER OAKS The Village of River Oaks a luxury senior housing community is currently under construction at 1015 S. Shepherd. The community is a Joint Venture between Houston-based Owner/ Developer Jim Gray of Bridgewood Property Co. and Harrison Street Real Estate Capital.

The Village of River Oaks will have eight floors of apartment homes with three levels of garage parking. The luxury community is expected to be completed in Spring 2017 bringing independent living, assisted living and memory care options .

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“It’s unique to have a senior’s site in the densely populated urban core, particularly within a well-known area minutes from established retail, medical services and religious institutions,” said Mr. Gray. “When we looked at

the five-mile radius around the site, it was clear that this long-established Houston submarket in close proximity to Houston’s Fine Arts, Theater District and one of the top Medical Centers in the U.S. was very much underserved in quality senior living options.”

The Village of River Oaks amenities will include an indoor heated pool, a fitness center, a movie theater and outdoor terrace. “ “We are pleased to announce that our Information Office is now open and located in the BBVA/Compass Bank Building at 2001 Kirby Drive, Ste. 370, on the corner of San Felipe and Kirby.

Priority Reservations are now being taken so future Residents can select a premium home and lock-in special pre-opening pricing”.

“Baby Boomers are now turning 65 at a rate of more than 10,000 per day,” Integra Realty Resources said in July 2016

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its 2016 Seniors Housing Outlook.

“This ‘graying of America’ will lead to significant demand over the next few decades.” The report stated that 49,000 units — independent living, assisted living, memory care and skilled nursing — were in the construction pipeline in the top 100 U.S. markets as of the fourth quarter of 2015.

This current wave in design of independent living facilities reflect consumers’ changing tastes, the report said. “In an effort to lure Baby Boomers, many projects boast modern architecture with larger units featuring premium finishes such as granite countertops, stainless steel appliances, and upgraded flooring. Another emerging trend is that many new projects are being built in infill locations, where residents have the ability to walk to restaurants, shops, and cultural

attractions.”

Both trends apply to the planned Village of River Oaks. Most units will have designer kitchens with granite counters and stainless steel appliances, plus balconies and floor-to- ceiling glass windows.

Other amenities will include an indoor heated pool, a fitness center, a movie theater, an arts and crafts studio, a salon, library, Town Hall, Bistro/Lounge and numerous additional living areas to encourage socialization and active living.

The location will put residents close to shops and restaurants on W. Gray and the River Oaks area as well as nearby walking trails, the Theater & Museum districts, Houston Medical Center and other services.

To learn more please contact The Village of River Oaks Information Office at 713-952-7600.

Houston Medical Times

Page 17

Shift Workers

Continued from page 1 Neuroscience Program, found that According to Earnest, it’s not the subjects on shift work schedules had longer hours—or the weird hours— more severe stroke outcomes, in terms necessarily that is the problem. Instead, of both brain damage and loss of it is the change in the timing of waking, sensation and limb movement than sleeping and eating every few days controls on regular 24-hour cycles of that “unwinds” our body clocks and day and night.

Of interest, their study—supported makes it difficult for them to maintain their natural, 24-hour cycle. When by the American Heart Association— body clocks are disrupted, as they are found that males and females show when people go to bed and get up at major differences in the degree to radically different times every few days, which the stroke was exacerbated there can be a major impact on health. by circadian rhythm disruption; in Earnest and his colleagues have found males, the gravity of stroke outcomes that shift work can lead to more severe in response to shift work schedules was ischemic strokes, the leading cause of much worse than in females. disability in the United States, which “These sex differences might be occur when blood flow is cut off to part related to reproductive hormones. of the brain.

Young women are less likely to suffer times.”

However, older women approaching menopause show increasing incidence of ischemic stroke and poor prognosis for recovery, compared with men at the same age.

odd schedules, but probably extends to many of us who keep schedules that differ greatly from day-to-day, especially from weekdays to weekends,” Earnest added. “These irregular schedules can produce what is known as ‘social jet lag,’ which similarly unwinds our body clocks so they no longer keep accurate time, and thus can lead to the same effects on human health as shift work.”

Some of Earnest’s previous work has shown that a high-fat diet can also alter the timing of internal body clocks, as well as dramatically increase inflammatory responses that can be a problem in cardio- and cerebrovascular An immediate impact of these disease (conditions caused by problems studies on human health is that that affect the blood supply to the individuals in shift work-type brain—which includes stroke). professions should be monitored “Next we would like to explore more closely and more frequently for whether inflammation is a key link cardio- and cerebrovascular disease and between circadian rhythm disruption risk factors such as hypertension and and increased stroke severity,” Earnest obesity. said. “With this information, we In the meantime, Earnest suggests Using an animal model, Earnest strokes, as compared with men of a may be able to identify therapeutic that those with irregular sleeping and his team, including colleague similar age, and when they do, the interventions that limit damage after patterns should at least try to maintain Farida Sohrabji, Ph.D., also a professor stroke outcomes are likely to be less a stroke in patients with a history of regular mealtimes, in addition to avoiding the usual cardiovascular risk in the Department of Neuroscience severe. In females, estrogen is thought shift work.”

“This research has clear factors like a high-fat diet, inactivity and and Experimental Therapeutics and to be responsible for this greater degree implications for shift workers with tobacco use. director of the Women’s Health in of neuroprotection,” Sohrabji said.

Former Houston Texan Continued from page 1

otherwise might not have had access to the procedures needed to help their children,” said Matthew Greives, M.D., craniofacial and pediatric plastic surgeon affiliated with Children’s Memorial Hermann Hospital and assistant professor in the Division of

Pediatric Plastic Surgery at McGovern Medical School at UTHealth. “Our department operates like a family, and the Myers have been an integral part of that family for many years now.

We wish them all the best in their upcoming move. Their compassionate

hearts will be missed.”

of the Texas Cleft-Craniofacial Clinic

Also in attendance at the event were Susie Distefano, Senior Vice President and CEO of Children’s Memorial Hermann Hospital, and John Teichgraeber, M.D., Co-Director

at Children’s Memorial Hermann Hospital and professor in the Division of Pediatric Plastic Surgery at McGovern Medical School.

Mental Health

Continued from page 3 The idea that more willpower is needed seems to make logical sense. The problem with that notion, though, is that it does not take into account all that is involved in how human beings feel motivation, develop habits, and try to deal with making changes on their own. In addition, these health recommendations do not include factors related to choices individuals and society as a whole have made regarding how people live. Your occupation, your mate, how many children you have, where you live, how well you are connected to a social support network, your income, and factors beyond your

your need to compete with others.

Often deep-seated feelings about authority figures bring up stressful emotions in adults in relationships of all types, but especially at work and with intimate partners. This list only begins to scratch the surface of what might make it difficult to make logical changes in habits of living to Other factors that affect your reduce stress.

So what does help with such experience of stress include things that you may not be fully aware of, difficult issues? We know from such as your level of self-confidence, research that when people try to your ability to regulate your make lifestyle changes in close emotions, the expectations that connection with a health care were instilled in you as your grew up, provider or a group of others your ability to set firm limits, and working toward similar goals, there is control, such as having a disabled family member or the national economy, all play a part in your level of stress. You may have some choice about some of these things (and perhaps more choice than you realize at times), but your options can be limited in changing these aspects of life.

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a greater chance of success. This has been shown to be the case for weight reduction efforts and for dealing with substance abuse. By focusing on developing more healthful ways of living, and by examining choices of living, such as your job, commute, or social connections, you may be able to reduce your stress in a meaningful way. When you encounter obstacles that keep you from making the changes you want to make, it can be very useful to see a licensed mental health professional who can help you identify and address the challenges you face for a less stressful life.

July 2016

Page 18

Houston Medical Times

Legal Health

HOUSTON

Continued from page 4 bonus payment to clinicians reaching set thresholds for revenues derived from APMs that qualify as “Advanced APMs” – generally, ones that include more than nominal downside risk, require the use of certified EHR technology, and determine payments based on quality measures comparable to those included in the Quality performance category under MIPS. Clinicians eligible for the bonus payment will be exempt from MIPS payment adjustments and, beginning in 2026, will receive a higher annual payment update under the Medicare Physician Fee Schedule than clinicians not participating in an Advanced APM. CMS expects that roughly 5 to 10 percent of clinicians will meet the criteria for the bonus payment.

yield gains in quality of care, resulting in lower morbidity and mortality, and in cost savings. However, clinicians must understand the economics associated with focusing their practice improvement efforts on areas that could achieve better value over increasing the volume of services furnished. Further, clinicians should consider how all of the things that they are doing, including their efforts with other payers, can help achieve better performance results that will impact their Medicare fee-for-service payments.

CMS has worked to streamline and align quality measures to simplify MIPS reporting, though it is still complex. Clinicians must understand that, under MIPS, they will be competing for a limited pool of funds.

They should, therefore, assess their Next Steps for QPP Preparation current performance under existing Stakeholders should keep several quality reporting programs, identify the things in mind as they prepare quality measures and activities that are for MIPS and APM participation. available under MIPS, and understand Changes in clinician behavior under the scoring methodology in order to this new framework are expected to determine how best to optimize MIPS

performance.

Finally, CMS has set a high bar for achievement of a bonus payment for participation in Advanced APMs. Clinicians should weigh the financial benefits of Advanced APM participation versus the associated costs and financial risks. Also, of note, CMS has included some significant scoring benefits under MIPS for APM participants who do not achieve Advanced APM status. In the early years, clinicians who perform well under MIPS may be paid as well or better in Medicare fee-for-service while avoiding the risk of loss that accompanies participation in Advanced APMs. However, in later years, clinicians participating in Advanced APMs receive higher annual payment updates than clinicians subject to MIPS. The cumulative nature of those higher updates over time will lead to a significant difference in payment rates, meaning that clinicians will eventually want to be in Advanced APMs.

Oncology Research

July 2016

the TAA and neoantigens have been identified as the targets of tumor reactive cells. Since normal tissues don’t hold these somatic mutations, neoantigens seem to represent ideal targets for cancer immunotherapy. In melanoma cancer, for example, some neoantigens could be discovered using molecular strategies as cDNA library. Among them we can list: CD4, MUM1, CTNNB1, CDC27, TRAPPC1, TP1, ASCC3, HHAT, FN1, OS-9, PTPRK, CDKN2A, GAS7, SIRT2, CLPP and PPP1R3B. Probably these neoantigens have been found in melanoma due to the high mutation rate in this particular cancer type. Currently, our knowledge allows us to use neoantigens to stimulate a specific immune response against a cancer type. However, many unresolved questions remain unanswered.

One major concern is about the heterogeneity of tumor (tumor microenvironment). According to Robert D. Schreiber, Alumni

Editor Sharon Pennington Director of Media Sales Richard W DeLaRosa Creative Director Lorenzo Morales Distribution Robert Cox Guillermo Mendez Accounting Liz Thachar Writers Jorge Augusto Borin Scutti, PhD Denise Hernandez MS,RD,LD Office: 713-885-3808 Fax: 281-316-9403 For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com

Continued from page 6

generally believed that passengers are neutral, they play no role in cancer. Because drivers are usually the same in different patients, but passengers are all different. So in every patient passengers are going to be different from passengers mutations in another patient”. How can we marry mutations and cancer biomarkers? Immune system is based on self-nonself judgment. As opposed to pathogens that contains molecular signatures that can be identify by the host, in cancer these signature are not generally expressed by tumor cells, making them more difficult to be distinguished from normal cells. However, T cells can recognize two classes of antigens: I) a class of tumor antigens, expressed in some normal tissue at low levels and high-expressed in cancer cells called tumor-associated antigens (TAA) and II) tumor-specific neoantigens, which arise from somatic mutations that alter amino acid coding sequences. Several of

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Endowed Professor of Pathology and Immunology at Washington University School of Medicine “it is plausible that neoantigen-specific T cell reactivity forms a major active ingredient of successful cancer immunotherapies, in other words, the genetic damage that on the one hand leads to oncogenic outgrowth can also targeted by the immune system”. Looking forward, a coordinate struggle to evaluate the usefulness of both genetic and nongenetic biomarkers that addresses distinctive aspects of the cancer immune response will permit to incorporate information on individual aspects of tumor-immune interaction. The capacity to personalize cancer immunotherapy will contribute significantly to enhance and to use the immune system to make cancer a controllable and curable disease.

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