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September Edition 2019

Inside This Issue

Bold Goals in the Fight against Metastatic Breast Cancer By Suzanne Stone Executive Director of Susan G. Komen Greater Central and East Texas

Redevelopment of Downtown Health District Property Will Fund Local Health Care Needs See pg. 10

INDEX Legal Matters....................... pg.3 Oncology Research......... pg.4 Healthy Heart....................... pg.6 Financial Forecast............. pg.8

St. David’s Georgetown Hospital Names New Chief Operating Officer See pg. 13

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his year, more than 40,000 women and men in the U.S. (2,980 of those in Texas) will die from breast cancer, most of those from metastatic breast cancer (MBC). That’s one death every 13 minutes. While our focus remains ensuring every person, regardless of income or geographic location, has access to the breast health care they need, we are also passionately pursuing ways to change the outcome for those patients whose cancer has metastasized outside the breast. Komen currently funds more than 540 research teams in 39 states and 10 countries to end breast cancer. Since our organization’s founding in 1982, we have awarded nearly $1 billion in research grants, making Komen the largest nonprofit funder of breast cancer research outside the U.S. government. MBC research initiatives Our current MBC research teams are working at every level from genetics to big data. Komen-funded researcher Nikhil Wagle, M.D., leads the Metastatic Breast Cancer Project (mbcproject.org), a patient-driven initiative that asks MBC patients to share their cancer experiences, medical records, and tumor tissues to accelerate research discoveries. The project released the first publicly accessible data set into cBioPortal, with more to come, and will soon be sharing raw data in the Genomic Data Commons (GDC). The goal of this growing data set is to allow as many researchers as possible to make discoveries that accelerate our understanding of MBC. The detection of circulating

tumor DNA (ctDNA) is a promising way to potentially monitor treatment response and to predict metastatic progression. In a recent NPJ Breast Cancer publication, Komen-funded investigator Gaorav Gupta, M.D., Komen Scientific Advisory Board member Lisa Carey, M.D., and colleagues developed a new blood test that can monitor changes in tumor mutations over time. This test may be used to predict response to therapy in estrogen receptor-positive (ER+) metastatic breast cancer, and it could help guide treatment decisions for patients. Some tumor cells can spread to distant parts of the body where they lie dormant. These disseminated tumor cells (DTCs) are difficult to eliminate and can eventually develop into metastatic tumors. In a Nature Cell Biology publication, Komen-funded investigator Candice Grzelak, Ph.D., Cyrus Ghajar, Ph.D., and colleagues show that DTCs residing near blood vessels are protected from the killing effects of chemotherapy. They demonstrate that targeting the area around blood vessels can sensitize

breast DTCs to chemotherapy and stop the development of metastatic tumors arising from DTCs. Advocacy successes and goals Our pursuit of solutions to MBC isn’t limited to the lab; we are also advocating at all levels of government for policy change that will positively impact care. Thanks in part to our lobbying efforts, the Texas Legislature passed Senate Bill 680 during the 2019 session. This bill would prohibit insurance companies from requiring step therapy. Often step therapy requires that the most affordable therapy or drug be utilized before a newer, more expensive—and perhaps more effective—treatment will be authorized by an insurance company, even when a physician believes the newer form of treatment will be the most effective. MBC patients typically don’t have this kind of time. Texas is now one of 25 states to prohibit the use of step therapy protocols for advanced stage-four cancer or metastatic cancer. We aren’t stopping there. Among our current legislative priorities see Breast Cancer... page 14

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Legal Matters 340b Payment Reductions and Remedies

By Kyle Vasquez, J.D. Lidia M. Niecko-Najjum, J.D. JD Polsinelli, PC

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ecently, the Centers for Medicare and Medicaid Services (CMS) released several highly-anticipated proposed Medicare payment rules: the CY 2020 Medicare Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule, the Medicare Physician Fee Schedule (PFS) CY 2020 Proposed Rule, and the End Stage Renal Disease (ESRD) and Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) CY 2020 Proposed Rule. While the rules contain a variety of proposed payment changes for CY 2020, below are key updates affecting 340B Program covered entities. Part B 340B Drug Payment Rates

for Urban Hospitals According to the 2020 OPPS proposed rule, CMS’s payment policies for 340B drugs and biosimilars would remain unchanged: 1. Continue to pay average sales price (ASP) minus 22.5% for all separately payable, non-pass-through 340B drugs and nonpass-through biosimilar biological products (biosimilars); and 2. Continue to make all biosimilars eligible to apply for temporary pass-through payment at ASP plus 6% of the reference product’s ASP. CMS’s Average Sales Price (ASP) minus 22.5% payment rate is a continuation of a reduced payment rate CMS established in its CY 2018 OPPS Final Rule and expanded in its CY 2019 OPPS Final Rule. Following a challenge from a group of hospital associations and nonprofit hospitals, the D.C. District Court ultimately held that the reimbursement cuts to Part B 340B drugs in 2018 and 2019 were both unlawful. Although the Court granted an injunction, it refused to vacate the

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rules and remanded the issue back to CMS to take the first crack at crafting appropriate remedial measures. The case is now on appeal before the D.C. Circuit Court of Appeals. In the meantime, CMS continues to reimburse applicable covered entities at ASP minus 22.5% and require reporting of applicable modifiers. The Good News and Potential Comment Areas While CMS continues to propose the same reimbursement methodology for 340B drugs that was previously held unlawful by a D.C. District Court on two occasions, the 2020 OPPS Proposed Rule indicates that CMS is actively considering its options should CMS ultimately lose on appeal: 1. Appropriate payment rate. CMS is soliciting comments on whether a rate of ASP plus 3% could be an appropriate remedy for underpaid CY 2018 and 2019 claims, and an alternative to the proposes CY 2020 payment rate of ASP minus 22.5%.. Notably, CMS cited to the District Court’s December

27, 2018 opinion supporting the proposition that a payment reduction of between 0.2-2.9% is “not significant enough” to fall outside the Secretary’s authority to “adjust” ASP. 2. Structuring the remedy. CMS is requesting comments on (i) whether such a remedy should be retrospective in nature (e.g., made on a claim-by-claim basis), (ii) whether such a remedy could be prospective in nature (e.g., an upward adjustment to 340B claims in the future to account for past underpayments) or (iii) whether there is a different mechanism that could produce equitable results while respecting budget neutrality. see Legal Matters...page 14

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Oncology Research Fresh, Seasonal, and Local: Three Ways Eating with the Harvest Improves Your Health By Michelle Ashworth, M.D., Texas Oncology– Round Rock

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omatoes, peppers, peaches, and strawberries. It wouldn’t be summer in Texas without our popular fresh fruits and vegetables. But the joy – and the results – of gardening, along with major nutritional benefits can be experienced in all seasons. Think butternut squash and pumpkins in the fall. Lettuce, spinach, and broccoli in colder weather. Eating with the seasons means different things to different people. Locally fresh and available produce can vary based on whether you reside in a rural area or a city, and the region in which you live. Your local climate will also impact the types of produce available to you.

But whether you’re hitting up your local farmer’s market, scanning the aisles of the grocery store, or growing a garden in your backyard, choosing fresh, in-season produce offers health benefits at any age and stage of life. Here are three things you should know about eating with the seasonal harvest. Fresh produce contributes to lower cancer risk as part of a plant-forward diet. The connection between diet and cancer risk is an important topic we often hear about in the news and from our physicians. What and how much we eat matters. The World Cancer Research Fund has estimated that roughly 20 percent of all cancers diagnosed in the United States are related to poor nutrition, excess body weight, and physical inactivity. Nutritionists recommend eating more cruciferous vegetables such as cauliflower, broccoli, and Brussels sprouts, along with berries, and leafy green vegetables, all of which rate high

in essential vitamins and nutrients. A diet rich in seasonal produce can transform the way we think about food. A well-balanced diet full of nutrients that lower the risk of disease is important to overall well-being and critical to preventing and fighting cancer. “Eating the rainbow” refers to eating a colorful diet rich in fruits and vegetables. Guidelines from the American Institute for Cancer Research (AICR) help make it easy to remember. Its recommendation includes the “two-thirds” rule, meaning two-thirds or more of your plate should comprise vegetables, fruits, beans, or

whole grains, and one-third or less of the plate can be a small portion of protein. Eating fruits and vegetables may help you regain strength after cancer treatment. Our dietary needs change at different stages in life, and this is also true for those with cancer. During cancer treatment, the cancerous cells are killed but sometimes healthy cells are damaged too. This can cause side effects that lead to eating problems, according to the National Institutes of Health (NIH). While going through see Oncology Research...page 14

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September 2019


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Healthy Heart High-Intensity Step Training Boosts Stroke Survivors’ Walking Skills By American Heart Association

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igh-intensity step training that mimics real-world conditions may better improve walking ability in stroke survivors compared to traditional, lowimpact training, according to new research published in the American Heart Association’s journal Stroke. The recent research is vital for residents of Houston, a city that is part of the Stroke Belt, a medical nickname given to describe an 8-state region with high stroke mortality across the southeastern United States. The suggestion of the research is that stroke patients can perform higher intensity walking exercises and more difficult tasks than previously thought possible. The idea is for patients to move beyond traditional, lowintensity rehabilitation to challenge the nervous and cardiovascular systems so patients can improve function and perform better in the real world. “People who suffer strokes often have difficulty walking and impaired

balance. Rehabilitation after a stroke traditionally focuses on patients practicing low-intensity walking, usually only in a forward direction, which does not provide enough of a challenge to the nervous system to enable patients to negotiate real-world situations, such as uneven surfaces, stairs or changing direction,” said study author T. George Hornby, Ph.D., professor of physical medicine and rehabilitation at Indiana University School of Medicine in Indianapolis. Participants received training of either high-intensity stepping performing variable, difficult tasks; high-intensity stepping performing only forward walking; or low-intensity stepping of variable tasks. Variable tasks included walking on uneven surfaces, up inclines and stairs, over randomly placed obstacles on a treadmill and across a balance beam. Researchers evaluated 90 people, 18- to 85-years-old with weakness on one side of the body who had survived a stroke at least six

months prior. The study was small compared to larger, multicenter clinical trials. Hornby said the next step would be to test high-intensity, variable step training in larger patient populations in a large, multicenter clinical trial. This is what the researchers found: • Survivors in both the highintensity, variable training and high-intensity, forward walking groups walked faster and farther than the low-intensity, variable training group. • For all walking outcomes, 57% to

80% of participants in the highintensity groups had important clinical gains, while only 9% to 31% of participants did so following low-intensity training. • High-intensity variable training also resulted in improved dynamic balance while walking and improved balance confidence. Ultimately, the goal is to incorporate high-intensity variable step training into regular clinical rehabilitation protocols.

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September 2019


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Financial Forecast What You Need to Know for Retirement By Margo Geddie Senior Vice President & Financial Advisor Morgan Stanley

Many employers, including hospitals and physician practices, offer 401(k) plans, allowing employees to save for retirement before taxes are re you planning for your taken out of their paycheck. If your retirement? It is never too early or company offers a 401(k) plan, you may too late but starting as soon as possible wish to enroll and contribute. In 2019, gives you the gift of time and more the IRS allows you to contribute up to control over what kind of lifestyle $19,000, and for those 50 and over, you you will have during your retirement may contribute $25,000. While 401(k) years. Consider this: less than half s have many benefits, there are some of Americans have calculated how restrictions. For example, make sure much money they will need to have in you are vested in the system before retirement. Additionally, the average you move on or you may lose your person will spend a whopping 20 employer’s matching contributions. To years in retirement. This data means ensure you understand your employer’s you need to be proactive in your plan, consult the plan administrator or retirement planning. your financial advisor. Know Your Retirement Needs In addition to 401(k)s, IRAs Experts project that the average are another smart way to save for American will need 70 – 90 percent retirement. These accounts are of their pre-retirement income to controlled by you, not your employer. continue to live in their current You may choose a Roth IRA or a standard of living. If you have not Traditional IRA. The difference already thought about what your between the two varies on issues such retirement days will look like, now as age restrictions, income limits, and is the time. How much is needed in tax breaks. For an IRA in 2019, you savings is different for each person. may contribute $6,000 per person, or Some questions to ask yourself $7,000 for those 50 and over. Similar include what exactly do you want to 401(k)s, IRAs can be set up by

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automatic deduction if you so choose. Plan for Unexpected Costs As you plan for retirement, you will probably consider costs such as housing, utilities, travel, and home maintenance. Do not forget other items that might eat away at your savings, such as inflation and taxes. As a professional in the healthcare industry, you may be aware of health care costs. Keep in mind insurance premiums and the cost of long-term care. With careful planning, retirement can be a wonderful time to celebrate life and enjoy your family and hobbies. Take the time now to plan accordingly. 


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Demolition, Redevelopment of Downtown Health District Property Will Fund Local Health Care Needs By Hannah F. Pietsch

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emolition will begin soon of a vacant professional office building near the former University Medical Center Brackenridge — a major milestone in the long-term redevelopment of Central Health’s downtown property that will leverage a partnership with The University of Texas at Austin to create new revenue for local health care needs. The 2033 Higher Education Development Foundation, a local nonprofit created to benefit UT Austin, is Central Health’s first developer to advance a redevelopment project. The foundation’s 99-year ground lease with Central Health for Blocks 164 and 167 will generate revenue to fund health care for people with low incomes in Travis County — and help pay to expand services to

underserved. Central Health will receive more than $460 million over the life of the ground lease for Blocks 164 and 167; the first payment for Block 164 was made in March. The ground lease provides for annual escalations as well as market rate adjustments throughout the term of the lease. “This redevelopment effort is part of a health care transformation taking place in Austin based on an unprecedented partnership between a local health district, a research university and a hospital system,” said UT Austin President Gregory L. Fenves. “It’s unlike anything else taking place across the nation, and today is a milestone for our partnership.” The work includes demolition on Block 164, a 1.2-acre site along Red River Street where an existing three-story building will be replaced

Photo rendering of the forthcoming office building on a site near the former University Medical Center Brackenridge

by a new 17-story office building. It will be the flagship of Austin’s emerging Innovation District by Capital City Innovation, an initiative of Central Health, UT Austin and Ascension Seton, with support from the Downtown Austin Alliance and Opportunity Austin. Companies, nonprofits and community groups will

combine in the district with the goal of improving health care and creating access to jobs. The new structure is expected to be completed by the beginning of 2022. In addition to providing a home for transformative health care efforts, this project includes the proposed see Redevelopment...page 14

HELP US BUILD A HEALTHIER AUSTIN

Access to nutritious food is essential for a healthy, thriving community. Learn about how we’re leading the fight against hunger at centraltexasfoodbank.org. September 2019

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Study Proves Hepatitis C Drugs Reduce Liver-Related Deaths by Nearly Half By Patrick McGee

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new study from the UT Southwestern Simmons Comprehensive Cancer Center demonstrates that antiviral drugs for hepatitis C reduce liver-related deaths by nearly 50% in patients with a history of liver cancer. The finding builds on a December 2018 study by the same researchers who found that antiviral drugs do not increase the risk of liver cancer recurrence, as was previously feared. Dr. Amit Singal’s study was published in the journal Gastroenterology on July 30. Dr. Singal is an Associate Professor of Internal Medicine, Medical Director of the UT Southwestern Liver Tumor Program, and Clinical Chief of Hepatology. He collaborated on these studies with Dr. Caitlin Murphy, Assistant Professor of Population and Data Sciences and Internal Medicine. They are both members of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. Their studies overturn prior misconceptions that made doctors reluctant to prescribe direct-acting antivirals to treat hepatitis C in patients

with a history of liver cancer. Many doctors previously believed that hepatitis C, for all its harmfulness, activates the immune system when it infects the liver, and the immune system kept liver cancer recurrence at bay. But this notion appears to be false. Drs. Singal and Murphy studied nearly 800 patients from 31 medical centers across the country and found that the drugs are not only safe, they decrease death from cirrhosis and liver cancer by 46%. “Not only are these drugs safe in this patient population, but we have now demonstrated that they are helpful,” Dr. Singal said. “Our study changes the paradigm from you could treat a patient’s hepatitis C to you should treat it.” Dr. Carlos L. Arteaga, Director of the Simmons Cancer Center, said the study’s scope and impact are something that can only be produced by a National Cancer Institute-designated Comprehensive Cancer Center. “Dr. Singal had more patients involved in the study than any other participating site. As an epidemiologist, Dr. Murphy brought rigor to the data that removes prior doubt on this issue,” he said.

Live Well Age Well Adult Protective Services Safeguards Our Most Vulnerable Texans By Will Armstrong Texas Health and Human Services

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he Texas Department of Family and Protective Services is charged with “protecting the unprotected.” Twenty-four hours a day, 365 days a year, DFPS employees work to protect children, adults who have disabilities, and adults who are 65 or older from abuse, neglect and exploitation.

September 2019

“Adult Protective Services investigates all suspected victims of abuse, neglect or financial exploitation of the elderly population or adults with disabilities throughout the state of Texas, and our goal is to alleviate or prevent future maltreatment,” said Dirk Sheridan, community engagement lead for APS. APS received approximately 116,000 reports of allegations of

Dr. Murphy said previous studies compounded the misunderstandings of direct-acting antiviral therapy because they, among other things, failed to account for the timing of therapy relative to liver cancer diagnosis, did not include a comparison group, or did not properly consider clinical differences among patients. The new study is a significant contribution because it clears the path to beneficial drug treatment. “Hepatitis C therapy is so important because it provides a cure,” Dr. Singal said. “You take oral medications for two or three months, with minimal to no side effects, and you’re done. You’re cured of hepatitis C. There’s less than a 1% chance of relapse if you’re cured of hepatitis C.” Defeating hepatitis C is an important step because infection can otherwise lead to cirrhosis – scarring of the liver – which can be deadly. Cirrhosis can increase the risk for liver cancer, which also may be fatal. Curing hepatitis C with antivirals breaks the first link in a deadly chain of events and can lead to improvement in liver function among those who have previously developed cirrhosis. The disease can lie dormant for 25 to 30 years and resurface as a lifethreatening specter years after someone

abuse, neglect or exploitation from across the state last year. APS uses the following definitions to define abuse, neglect and exploitation. Abuse: The negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain by a caretaker, family member, or other individual who has an ongoing relationship with the person. Abuse includes sexual assault, verbal, psychological and physical abuse. Obvious symptoms are scratches, cuts, bruises, burns and broken bones. Neglect: The failure to provide for one’s self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain, or the failure of a caretaker to provide such

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has stopped using drugs and turned to a healthy lifestyle. Hepatologists saw an alarming spike in cirrhosis as baby boomers aged. By 2017, The New York Times called hepatitis C “an enormous public health problem.” In 2018, the Centers for Disease Control and Prevention announced there were nearly 2.4 million people living with hepatitis C in the U.S. “Dr. Singal’s and Dr. Murphy’s study reports a welcome, fact-based way to oppose the adverse effects of hepatitis C infection in various demographic groups,” Dr. Arteaga said. “Their findings will have a global, lifesaving impact on how hepatitis C is treated. It is particularly important to Texas because the liver cancer incidence rate in Texas is the highest in the nation.” Dr. Arteaga said the study is also important because liver cancer is highest among the Hispanic population in Texas, and research-based advances in reducing cancer in underserved groups are a Simmons Cancer Center priority.

goods or services. Neglect can result in starvation, dehydration, over or under-medication, unsanitary living conditions, or lack of heat, running water, electricity, medical care or personal hygiene. Exploitation: The misuse of resources of an elderly or disabled person for personal or monetary benefit. This includes taking Social Security or Supplemental Security Income checks, abusing a joint checking account, and taking property or other resources that doesn’t belong to them. “Adult Protective Services clients have the right to refuse certain services if they have capacity and they are not in harm’s way,” Sheridan said. “Adult Protective Services can only investigate suspected victims of abuse, neglect or financial exploitation of individuals who have an ongoing relationship with our clients. We do not investigate telephone scams, home improvement frauds, mail scams, etc. … The alleged see Live Well...page 14


Austin Medical Times

What Is West Nile Virus?

St. David’s Georgetown Hospital Names New Chief Operating Officer

As Cases of West Nile Virus Emerge Around The Country, Here’s What You Should Know By Lindsey Hendrix

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ummer comes to an official close next month, but a hallmark summer pest will remain active in some parts of Texas through Halloween— which is fitting because they want to suck your blood. Mosquito bites are certainly unpleasant, but every now and then, they can go from bothersome to life-threatening if they transfer West Nile virus (WNV).

The first case of West Nile virus this year in Texas was recently confirmed in El Paso County, so we spoke with an infectious disease expert, Cristie Columbus, MD, associate dean for the Texas A&M College of Medicine, to learn more about the disease. What is the West Nile virus? The West Nile virus is a mosquito-borne virus that can cause encephalitis (inflammation of the brain) and meningitis (inflammation of the lining of the brain and spinal cord) and can even be fatal in severe cases. The virus has been detected in 36 states this year, and cases have occurred every summer since 1999, when it first made an appearance in the United States. How is it contracted? Because most people are infected through mosquito bites, the virus is most prevalent during the summer months (from June to September), when mosquitoes are more likely to breed. Mosquitoes contract the disease by feeding on infected birds. WNV is not contagious through normal person-to-person

contact. In rare cases, the virus can be transmitted via blood transfusion, organ transplant or from mother to baby during pregnancy, delivery and breastfeeding. The people most at risk for contracting the virus are those who work outdoors or participate in outdoor activities. However, anyone living in an area where WNV is present in mosquitoes is at risk. What are the symptoms of WNV? According to the Centers for Disease Control and Prevention (CDC), 70 to 80 percent of people infected with WNV show no symptoms at all. The remaining 20 percent may develop symptoms two days to two weeks after being bitten by an infected mosquito. Symptomatic patients are most likely to develop a flu-like illness with fever. In addition to fever, symptoms may include: • Headache • Body aches and joint pains • Nausea or vomiting • Diarrhea • Rash Most people who develop these symptoms make a complete recovery, but weakness and fatigue can last for weeks or months after infection. In rare but extreme cases (less than 1 percent of the time), people develop a serious neurological illness such as encephalitis or meningitis. These illnesses can cause symptoms such as: • Headache • High fever • Neck stiffness • Disorientation • Coma • Tremors • Seizures • Paralysis These neurological effects may take several weeks or months to recover from and, in some cases, can be permanent. Approximately 10 percent of people who develop a neurological illness from WNV will die. Can it be treated?

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t. David’s Georgetown Hospital has selected Christina Roscoe as its new chief operating officer, effective Aug. 1. In this role, Roscoe will oversee multiple departments, including dietary services, engineering, environmental services, laboratory, radiology and surgery. She will also serve as the hospital’s ethics and compliance officer. “Christina brings valuable operational experience, overseeing multiple departments and major expansion projects in her previous roles,” Hugh Brown, chief executive officer of St. David’s Georgetown Hospital, said. “As we continue to grow and the number of patients we serve increases, this depth of knowledge will be paramount to our continued focus on meeting the evolving needs of our patients and community.” Most recently, Roscoe served as assistant chief operating officer in two Dallas-area suburban hospitals— Medical City Plano, a 493-bed acute care hospital, and Medical City Frisco, a 54-bed acute care hospital. She assisted in managing multiple

Unfortunately, there are no vaccines or medications to treat WNV. For people who develop symptoms, over-the-counter pain relievers and fever reducers can be used to relieve some symptoms. People with mild symptoms usually recover on their own, but symptoms may last for several weeks after onset. In more severe cases, patients may need to be hospitalized to receive supportive treatment for neurological symptoms. If you suspect that you or a family member has the virus, consult a health care provider to undergo an exam and further testing. Tests using blood samples or spinal fluid may be used to detect antibodies the immune system creates to fight infection that is present in the body. Other types of tests are available through state public health laboratories or the CDC. Are there any actions you can take to prevent the disease? Since there is currently no

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Christina Roscoe

projects, including a $107-million patient tower expansion at Medical City Plano and a $21.6-million women’s expansion at Medical City Frisco. Roscoe was responsible for the robotics and bariatrics service lines, and she also led efforts to increase efficiencies in surgical services and orthopedics. Roscoe earned a bachelor’s degree in human development and family sciences from The University of Texas at Austin. She holds a master’s degree in healthcare administration from Trinity University in San Antonio.

vaccine, the best method of protection is to prevent mosquito bites. People can do this by applying insect repellant whenever they go outdoors. Repellants using DEET, picaridin, IR3535 and some oil of lemon eucalyptus and para-menthane-diol products typically provide longer-lasting protection. In addition to repellant, wear long sleeves and pants, especially during dawn and dusk, when mosquitoes are most active. Installing or repairing window and door screens can help limit the number of mosquitoes that enter indoors, as can using air conditioning when you can. Reduce the number of mosquitoes around your house by draining any nearby standing water. Empty out water-filled containers such as flowerpots, gutters, buckets, pool covers, pet water dishes and birdbaths to help limit the number of mosquitoes that breed nearby. September 2019


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Breast Cancer

Continued from page 1 are expanding federal funding for biomedical research through the National Institutes for Health and Department of Defense, increasing

Legal Matters

Continued from page 3 1. Beneficiary cost-sharing responsibilities. CMS is also interested in public comments on the most appropriate way to address the issue of Medicare beneficiary cost-sharing responsibilities (20% of the total Medicare payment rate) under any proposed remedy. CMS’s continuation of its current payment methodology is disappointing to covered entities, but its proposal of ASP plus 3% may be a sign of things to come. If the D.C. Circuit Court of Appeals affirms the lower court’s

Oncology Research

Continued from page 4 cancer treatment, some patients will experience loss of appetite, nausea, a sore throat, or trouble swallowing, among other side effects. Others will be instructed by their oncologist to

Redevelopment

Continued from page 10 straightening of Red River Street through the downtown property and will increase public access to Waller Creek. The building will house some of UT’s Dell Medical School operations as well as future strategic partners, who will team up with faculty members and students to rethink health and health care.

Live Well

Continued from page 12 perpetrator must have an ongoing relationship with our clients for APS to get involved or investigate.” Sheridan urges people to call and make a report with the Texas Abuse Hotline if they suspect anything. The APS campaign, It’s

September 2019

Austin Medical Times federal funding and clinical trials for MBC, and keeping therapies affordable for all breast cancer patients. Your expertise and support are critical to the success of these efforts. Apply for a Komen grant at komen. org/ResearchGrants. Contact me at sstone@komengreatercetx.org to

discuss how you can be a part of the Komen family. Our largest fundraiser of the year, the MORE THAN PINK WalkTM, will be held at the Palmer Events Center on September 29. You can register and fundraise to support breast cancer research and treatment at komenwalk.org.

decision in favor of covered entities, CMS may will likely push to reimburse applicable 340B drugs at ASP plus 3% barely meeting the range laid out by the D.C. Circuit Court. Covered entities should submit comments to CMS and quantify the impact of CMS’s ASP plus 3% proposal versus the statutory requirement of ASP plus 6%. Unless stakeholders suggest alternatives to CMS and offer support for those alternatives, CMS would likely finalize its ASP plus 3% proposal, or even a lower payment amount. Key takeaways for 340B Program covered entities:

• Submit comments on the proposed rule regarding an appropriate 340B drug payment rate and remedy structure. Comments must be submitted by 5 p.m. EST on September 27, 2019. • Continue to report JG/TB 340B drug modifiers and expect ASP minus 22.5% for CY 2020 until the Court of Appeals rules on HHS’s appeal. • Continue to preserve rights on underpayments of individual Part B 340B drug claims by filing appeals with your Medicare Administrative Contractors (MACs).

maintain a low-fiber diet instead of high-fiber fruits and vegetables. The NIH also reports that cancer patients may need extra protein and calories. Treatment can affect the body’s ability to absorb nutrients. When treatment ends, boosting the immune system is important – and adding seasonal produce back into the diet can help. Another benefit of eating seasonally? Teaching our communities and families where our food comes

from can help form healthy habits early, preparing younger generations to make healthier decisions. From cancer prevention to nutrition counseling before, during, or after cancer treatment, Texas Oncology is proud to support a healthier lifestyle that reduces disease risk and improves overall wellbeing. 

“It’s exciting to see activity on Central Health’s property because it means we’ll soon be generating even more lease revenue,” said Guadalupe Zamora, M.D., a long-time Austin physician and Central Health board chairperson. “We’re redeveloping this property with the sole purpose of funding our mission of caring for people with low income. We’re grateful to have partners like the 2033 Fund, Dell Med and UT Austin to make this happen.”

Central Health, Travis County’s health care district, owns the 14.3-acre property that was the former University Medical Center Brackenridge. That facility closed in 2017 when Ascension Seton, another strategic partner in improving local health care, moved hospital operations across the street to the Dell Seton Medical Center at The University of Texas, which is adjacent to the medical school. 

Everyone’s Business, urges all Texans to pay attention and help older neighbors and people with disabilities who might be a victim of abuse, neglect or exploitation. “Always pick up the telephone and call 800-252-5400 if you suspect anyone who may be a victim of abuse, neglect or financial exploitation,” Sheridan said. “We have trained

staff answering the telephones 24/7 to assist all callers in reaching the correct services for the suspected or possible victim.” To report abuse, neglect or exploitation, call 800-252-5400. To learn more about APS and how you can get involved, visit dfps. state.tx.us/Everyones_Business. 

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The Offices at Gateway to Falconhead PROFESSIONAL & MEDICAL OFFICE CONDOS - FOR SALE OR FOR LEASE

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