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May Issue 2019

Inside This Issue

The State of Obesity: Our Role as Medical Professionals in the Obesity Epidemic By Wendy Scinta, MD, MS, FOMA, FAAFP

New Interactive Map First to Show Life Expectancy of Texans See pg. 9

INDEX Financial Forecast............. pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.6 Live Well Age Well........... pg.12

Connection between Air Pollution and Alzheimer’s Disease See pg. 11


he obesity epidemic has reached crisis levels. That isn’t fear mongering; it’s an assertion based in fact — the statistics paint an alarming portrait of Americans’ overall health. Adults with obesity in the United States has increased more than 200 percent over the past 40 years, resulting in 70 percent of the population measuring obese or overweight. Further, more than three-quarters of people with obesity do not receive optimal care and support. Addressing obesity with patients isn’t an easy dialogue, but is absolutely essential to tackling the epidemic, especially in light of the fact that nearly half of all people with the disease are not diagnosed with it. T h e vast majority of people with obesity do not actively seek out medical help because t h ey believe weight loss to be their own responsibility, or because they have tried to discuss it wit h t heir provider s, but were confronted with bias and stigma. As medical professionals, we must do better! We must start treating obesity as the disease that it is, and not a character flaw. As we sit on the frontlines of the obesity epidemic, we are well-positioned to make a significant impact in reversing the trends listed above, but we must

approach it armed with the appropriate knowledge of the disease, and we must deliver our advice with grace and compassion. It may seem insignificant, but even a shift in the way that we talk about

...obesity is associated with as many as 236 documented medical conditions. Patients with obesity are at an increased risk of developing diabetes, hypertension, fatty liver disease, cardiovascular issues, stroke, sleep apnea, and many cancers. obesity can go a long way towards preserving the dignity of patients in our care and increasing the likelihood that they will continue with follow-up care. Utilizing patient-first language that describes these individuals as “patients with obesity” rather than

“obese patients” frames obesity as a medical condition that can be addressed without making our patients feel uncomfortable or powerless. We know that obesity is associated with as many as 236 documented medical conditions. Patients with obesity are at an increased risk of developing diabetes, hypertension, fatty liver disease, cardiovascular issues, stroke, sleep apnea, and many cancers. Lack of time during appointments is the most frequently cited reason by healthcare professionals as to why they are not discussing weight management with their patients with obesity. But given that many of these obesity-related conditions can be eliminated through just a five to ten percent decrease in body weight, it is well worth the time investment to make the diagnosis and start the dialogue with our patients. Certainly, much work needs to be done in the study of obesity and in the advocacy of public policies aimed at addressing an epidemic that costs the country upwards of $300 billion annually in medical treatments. Its rising costs combined with an increasing gap between what insurers see Obesity ... page 14


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Financial Forecast Are You Nearing Retirement? By Reed Tinsley, CPA CVA, CFP, CHBC


any people nearing retirement do not confront the financial issues until it’s too late in the game. The bad news is… financial planning is a process that is better when prepared with more time and planning. The good news is… it can start at any time in a person’s life – but the later you start, the more compromises and adjustments you might have to make. You need to attack your financial planning aggressively and intelligently. Following are some things to consider doing: Get rid of debt – especially from credit cards. Next, try to pay down mortgages that have interest rates higher than what you can earn on your investments. Reduce spending. Current life styles need to be adjusted to accomplish longer term goals which should include being secure financially. Look at every area of spending including housing, insurance, clothing, medical costs, gifts to children and vacations. An

alternative is to work longer. Invest in a more tax-efficient manner. Buy bonds and bank CDs in your tax deferred accounts and stocks in your own name. The interest will then be free from current taxation and the dividends and eventual capital gains will be taxed at reduced rates.3. Invest in a more tax-efficient manner. Buy bonds and bank CDs in your tax deferred accounts and stocks in your own name. The interest will then be free from current taxation and the dividends and eventual capital gains will be taxed at reduced rates. Invest in a more tax-efficient manner. Buy bonds and bank CDs in your tax deferred accounts and stocks in your own name. The interest will then be free from current taxation and the dividends and eventual capital gains will be taxed at reduced rates. Lower investing costs by using discount brokers; and buying index and exchange traded funds rather than individual stocks and actively managed mutual funds. The costs do count and hold down your overall yields and

growth. Buy longer-term bonds instead of CDs to increase your yields. Consider setting up a ten or twenty-year bond ladder. A ladder has equal portions of your bond investments coming due annually allowing reinvestments at the then current rates, permitting you to change your investments, or have the funds available for other purposes. Understand what you are really investing in. For example, a bond mutual fund is not a “safe” investment. Once made, you can only get back an amount that the market deems appropriate based on the current interest yields. As market yields increase the value of the bond fund

will decrease. Of course, the opposite is true if rates drop, the fund’s value will increase, assuming there isn’t excessive leverage within the fund or a major management misjudgment. Long-term investment plans should not ignore stocks. A married couple, both at age 70, would have at least one of them living twenty-five or more years – that is long term. The planning should not be to outlive your money. Someone at age 92 can possibly ignore future effects of inflation and plan on spending down principal; but not someone age 70. Review your asset allocation a see Financial 12

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Legal Matters 340b Program Key Developments appeal of a recent decision by the District of Columbia (“D.C.”) District Court to enjoin enforcement of CMS’s nearly 30% payment cut to Part B payments for 340B drugs. HHS filed its notice of appeal on February 22, 2019 and sent a clear signal that the Administration intends to defend its actions that are estimated to save the Medicare program roughly $1.6 billion.

By Kyle A. Vasquez William D. Galvin, III JD Polsinelli, PC


his article offers a brief recap of key recent federal and state developments pertaining to the 340B Program, along with practical next steps that covered entity leaders need to quickly consider given the potential economic and policy implications of the issues described below. HHS Prolongs Medicare Reimbursement Cuts for 340B Drugs by Filing Appeal The Medicare / 340B payment reduction saga continues as the Department of Health and Human Services (“HHS”) filed a notice of

In its 2018 OPPS Final Rule, HHS reduced reimbursement for such drugs from Average Sales Price (“ASP”) plus 6%, to ASP minus 22.5% in 2018, resulting in a nearly 30% reduction in reimbursement. Following challenges from a group of hospital associations and nonprofit hospitals, the D.C. District Court held that the Secretary of HHS had overstepped his authority when he made such a significant change to reimbursement in light of the clear statutory mandate to reimburse covered entities at ASP plus 6% absent availability of acquisition cost survey data. However, the court stopped short of vacating the 2018 rule due to the

potential for widespread disruption to Medicare’s Part B payment system. With litigation ongoing, covered entities are essentially left in limbo. It is critical that all impacted covered entities preserve their rights relative to underpaid claims for 340B drugs by appealing such claims with to the relevant Medicare Administrative Contractor (“MAC”). This case may take years to make its way through the judicial system, so covered entities need to consider the relatively low expense to preserve their rights versus the significant lost opportunity by taking a wait-and-see approach. HRSA Enhances Scrutiny of 340B Eligibility Documentation

The Health Resources & Services Administration (“HRSA”) recently announced that as of April 1, 2019, it will begin conducting additional program integrity reviews of covered entity eligibility under the 340B Program, and may require additional supporting documentation of hospital classification upon registration. HRSA has historically relied on covered entities self-policing and, more recently, random audits to validate compliance with the hospital classification requirements. HRSA’s April 1, 2019 announcement reflects its intent to more proactively test compliance on a much wider scale. see Legal 14


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May 2019

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Oncology Research Advance Care Planning: Three Tips for Making Personal Health Decisions support. It’s also important to work with professionals who are trained to guide patients through the trajectory of their healthcare journey. They answer questions, initiate important conversations, help you set goals, and provide counseling. They also ensure your wishes are implemented into very day we are faced with decisions your treatment plan. This support – 35,000 of them, according to spans all aspects of care, including researchers at Cornell University. treatment choice, palliative care Some decisions are subconscious, and, in many cases, hospice meaning we don’t even realize our and end-of-life care. It’s also an brains are making them for us. Other opportunity for those closest to you decisions are as simple as what to eat to consider their own health-related for lunch or what shirt to wear, while decisions. others are much more complex, require • Share what’s important to you. deep consideration, and significantly Our values and beliefs reflect who impact our lives. we are. Medical diagnosis and Health-related decisions fall into health issues can change a lot, but that category. While we can do our that doesn’t change the core of best to make the right decisions, no who a person is. Personal values, one truly knows what the future holds. perspectives, and cultural and Advance care planning is the process religious beliefs give us strength of learning about the choices you have in times of weakness – they’re for your future medical care, and how also invaluable when it comes to you want to be treated if you are unable By Quan Dang, M.D., Texas Oncology– Round Rock


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advance care planning. Ensuring to speak for yourself. It empowers us to a patient’s values and beliefs are make decisions for the future of our incorporated into healthcare health and plan for the unknown. decisions gives medical teams, Discussions around advance care families and caregivers confidence planning are different for everyone, that the actions and choices about and may also depend on your current care that are made along the way health. These serious conversations are are respectful of their patient’s or made easier in an environment where loved one’s wishes– now and in the an informed patient is supported and future. encouraged. your options. As you consider advance • Explore Advance care planning is care planning, here are three tips not a one-size-fits-all solution. for fostering conversations that are The decisions are as unique productive, meaningful, and put to each patient as part of their you in the driver’s seat of your future individualized treatment plan. healthcare: They’re decisions about your life • Remember you’re not alone. and your health, and exploring all While advance care planning is options can help guide your decision highly personal, it’s not something making. Ultimately, having open a patient should take on alone. dialogue about medical directives Family and friends, who know you well and care about you, see Oncology 14 can offer invaluable emotional

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New Research Identifies Potential PTSD Treatment Improvement


esearchers may have found a way to improve a common treatment for post-traumatic stress disorder (PTSD) by changing how the brain learns to respond less severely to fearful conditions, according to research published in Journal of Neuroscience. The study by researchers at The University of Texas at Austin Dell Medical School suggests a potential improvement to exposure therapy — the current gold standard for PTSD treatment and anxiety reduction — which helps people gradually approach their trauma-related memories and feelings by confronting those memories in a safe setting, away from actual threat. In a study of 46 healthy adults, researchers compared participants’ emotional reactions to replacing an unpleasant electric shock on the wrist with a surprise neutral tone, instead of simply turning off the shocks. Omitting the feared shocks is the current norm in exposure therapy. The participants’ brain activity was

measured by functional magnetic resonance imaging (fMRI). Their emotional reactions were measured by how much they were sweating from their hands. Compared with simply turning off the shocks, replacing the feared shocks with a neutral tone was associated with stronger activity in the ventromedial prefrontal cortex — an area critical for learning safety and inhibiting fear. Replacing the feared shock with a simple tone also lowered participants’ emotional reactions to pictures that previously had been associated with the electric shock when participants were tested the next day. “This simple treatment of replacing an expected threat with an innocuous sound resulted in a long-lasting memory of safety, which suggests that the brain may be able to better control its fear response by means of a pretty straightforward, nonpharmaceutical intervention,” says lead study author Joseph Dunsmoor, Ph.D., an assistant professor in the

Department of Psychiatry at Dell Medical School. In the study, Dunsmoor’s team randomly divided participants to two groups — those who had the shock turned off and those who had the shock replaced by a neutral tone. Both groups were exposed to a picture of a face paired with an electric shock on the wrist on day one of the study. The groups were then exposed to the pictures with the shock turned off, or with the shock replaced by the surprising tone. Both groups returned the next day to measure brain activity and emotional reactions to the fear-conditioned pictures.

The researchers measured participants’ brain activity to the fear-conditioned pictures using fMRI scans. They also measured participants’ emotional responses to the threat of receiving an electric shock based on the amount of sweat recorded from a hand. “It is well-known that the brain learns by surprise,” says Dunsmoor. “Our study suggests that replacing expected aversive events with neutral and unexpected events, even a simple tone, is one way to capture attention so that the brain can learn to regulate fear more effectively.” 

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First-of-Its-Kind Health Social Work Department at Dell Medical School Means Better Whole-Person Care for All


ocial work to be woven into the med school’s pillars of education, clinical care, research and community impact Dell Medical School and Steve Hicks School of Social Work at The University of Texas at Austin are advancing the role of social work as an agent of health care transformation through the creation of the new Department of Health Social Work within the medical school, the first of its kind in the nation. Pending final approval by University of Texas System and the Texas Higher Education Coordinating Board, the Department of Health Social Work is jointly operated by both schools and creates a formalized structure of collaboration to support the schools’ shared interprofessional missions. Clinical and nonclinical social workers at the medical school now have an academic home within

the institution, as well as a bridge to the Steve Hicks School, through which to receive support for professional development, research and educational opportunities. “Having a department of health social work embedded in Dell Med ensures that the health care we provide takes into account the whole person, including their family and their community,” said Barbara Jones, Ph.D., MSW, inaugural chair of the Department of Health Social Work. “We are taking an important step toward including every voice and valuing everyone’s expertise within the fields of health care. This is a real boon for our profession,” said Jones, who will continue to serve as associate dean of health affairs and professor at the Steve Hicks School in addition to her new role at the medical school. Social work is critical to health care transformation, especially in the

face of economic inequality and health disparities existing in our current health system,” said Clay Johnston, M.D., Ph.D., dean of the medical school. “A social worker starts where the person is and helps identify what matters most to each person. That’s essential in building a health system that places value on better health outcomes based on each individual’s needs.” Currently, Dell Med is home to more than 20 social workers, about half of whom provide direct services to

patients as part of UT Health Austin, the clinical practice of Dell Med. Within UT Health Austin’s clinics, social workers are a critical component of team-based care, working alongside physicians, nurses, dieticians, pharmacists, physical therapists and other skilled care providers to ensure that all aspects of a patient’s well-being are addressed through personalized care. The addition of a health see 12

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New Interactive Map First to Show Life Expectancy Of Texans By ZIP Code, Race, And Gender T Southwestern Medical Center scientists for the first time have calculated and mapped life expectancy by gender and race/ethnicity down to the ZIP code and county levels in Texas. The new analysis and interactive mapping tool, which uses data from the Texas Department of State Health Services (DSHS) Center for Health Statistics 2005-2014 death records, reveal dramatic variation by gender, race/ethnicity, and geography.


study was really striking, down to the ZIP code level,” said Dr. Sandi Pruitt, lead investigator of the new study and Assistant Professor in the Department of Population and Data Sciences at UT Southwestern. Life expectancy at birth is the average number of years that a newborn can expect to live assuming mortality patterns at the time of birth remain constant in the future. Overall life expectancy in Texas is 78.5 years, which means that on average a child

Highlights from the study:

born in Texas on Jan. 1, 2019, can expect to live until spring 2097. Overall life average expectancy for women is 81.1 years compared with 75.9 for men. Life expectancy is 81.2 years for Hispanics, 78.1 years for whites, and 75.3 years for blacks. “This study sheds important new light on the issue of health disparities,” said Dr. David Lakey, Vice Chancellor for Health Affairs for The University of Texas System. “Overall disparities by gender or racial groups are significant, but to truly impact health we need to understand where the disparities are most severe, and to recognize that there is immense geographic variation even within groups.”

• Life expectancy was longest – 97.0 years – in the 78634 ZIP code in Hutto, Texas (near Austin) and was shortest – 66.7 years – in the 76104 ZIP code in Fort Worth. • Overall, life expectancy in Texas varied as much as 30 years between ZIP codes. • Women’s overall life expectancy was 5.2 years longer than men’s. • Hispanic, black, and white women had longer life expectancies than their male counterparts. • Hispanic life expectancy was 3 years longer than white life expectancy and 5.9 years longer than black life expectancy. • Life expectancy was strongly associated with poverty: Those living in ZIP codes with less than 5 percent poverty lived an average of 82.4 years, whereas those living in ZIP codes with more than 20 percent poverty lived an average of 76.4 years. “We knew that where you live is predictive of health, but the degree of variation that we observed in this

Average life expectancy across gender and racial groups include: • Hispanic women – 83.9 years; Hispanic men – 78.28 • White women – 80.6; White men – 75.6 • Black women – 78.0; Black men – 72.4

see Life 12



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May 2019

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Healthy Heart May is American Stroke Month. Here’s why it matters… By Joel Rice Executive Director American Heart Association


e admit, at the American Heart Association, we’re obsessed with ending stroke. Why? Because up to 80 percent of strokes may be preventable. This month, learn how and spread the word. Is heart disease or stroke in your family? If so, your risk may be higher. Did your father have a stroke? Did your mother have a heart attack? Did any of your grandparents have heart disease? Those might seem like random questions, but they’re very important factors when it comes to understanding your risk for these diseases. Knowing your family’s health history can help you avoid both heart disease and stroke – the No. 1 and No. 5 causes of death

in America. “Both the risk of heart disease and risk factors for heart disease are strongly linked to family history,” said William Kraus, M.D., a preventive cardiologist and research scientist at Duke University “If you have a stroke in your family, you are more likely to have one.” How much family history do you need to know? Dr. Kraus, who is also a volunteer for the American Heart Association, said you should share your family history with your healthcare provider as soon as possible. If you don’t know the full history, start with your immediate family. Find out if your brothers, sisters, parents or grandparents had heart disease or stroke and how old they were when they developed these diseases. Your family history provides a picture of the environment and genetics in place when these diseases occurred. “You

can’t counteract your genetics,” Dr. Kraus said, and so if you have a history you must do what you can to change your environment. You can lower your risk factors by changing behaviors that can increase your chances of getting heart disease or stroke. “It’s good, healthy living – the more that can be ingrained in your family, the more impact it has,” Dr. Kraus said. “A patient should encourage better eating habits, physical activity and eliminating smoking.” Even if your family has a clean bill of health, you should be aware of other genetic factors that can increase your family’s risk. For example, see Healthy 14


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May 2019

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Connection Between Air Pollution and Alzheimer’s Disease 2.4 Million, Multi-University NIH Study on Air Pollution’s Impact On Alzheimer’s and Dementia-Related Diseases By Rae Lynn Mitchell


ew study will examine the emerging evidence that the air we breathe over our lifetimes impacts our brain health when we age. Xiaohui Xu, PhD, associate professor and department head at the Texas A&M School of Public Health, is the Texas A&M site principal investigator on a study that will examine this evidence. Researchers from Texas A&M University, George Washington University and the University of North Carolina at Chapel Hill have been awarded $2.4 million by the National Institute of Environmental Health Sciences and the National Institute of Aging, both part of the National Institutes of Health (NIH),

to study the effects of air pollution exposure on brain health, based on the Atherosclerosis Risk in Communities study (ARIC). A total of 15,792 middle-aged (45–64 years) men and women from four U.S. communities participated in the ARIC study, which included extensive examinations, information on demographics, medical history, medication use and health behaviors. Xu and Texas A&M researchers Qi Ying, PhD, and Eun Sug Park, PhD, will develop air pollution modelling, generate air quality data to assess exposure, manage data and develop statistical approaches for analysis. The research group will focus on studying midlife to later life air pollution

exposure. An advance modeling approach will be used to generate monthly estimates of ambient pollutants to better understand the pollution levels during a person’s lifetime along with the ARIC study. In order to recommend or develop interventions to reduce the dementia burden through reducing ambient air pollution exposure, the researchers must determine whether there is a link between specific pollutants and

Alzheimer’s and dementia-related diseases, and what groups are most affected. “The overall goal of the research is to find prevention methods for Alzheimer’s disease and other forms of dementia,” Xu said. “Delaying the onset of dementia even by just one year would have a significant impact for the patient, their family and society, making this an issue of public health.” 

in all age groups. “This is pretty convincing evidence that presence of the laws has some beneficial implications,” Ferdinand said. The researchers studied 16 states in the country, comparing them to themselves and to Arizona, which served as the control state because it didn’t have a texting ban during the study period. They were also able to model how many crash-related emergency department visits were averted due to the bans while taking into account other factors that might affect crash rates, such as gasoline prices. The findings indicated that states with a primary ban on all drivers saw reductions in motor vehicle-related emergency department visits in all age groups. The average 8 percent

reduction seen in states with a primary texting ban translates to 3,264 fewer visits per year. When looking at various age groups specifically, on average, states with a primary texting ban saw 778 fewer visits among those 15–21 years old, 1378 among those 22–33 years old, and 507 among those 34–45 years old each year following the implementation of the ban. Ferdinand cautioned that because the research team only looked at 16 states, they can’t be sure the trends they saw would hold for the entire country. “We also can’t measure how well these laws are being enforced on the ground,” she said. “However, it’s exciting when research can demonstrate that the law can be a useful public health intervention.”

Laws Against Texting While Driving Prevent Emergency Room Visits New Research Shows That Primary Bans on Texting While Driving Prevent Motor Vehicle Crash-Related Visits to Emergency Departments By Christina Sumners


ew evidence from Texas A&M School of Public Health indicates that texting-while-driving laws may avert the need for emergency treatment following a motor vehicle crash. Researchers found that states with a primary texting ban on all drivers on average saw an 8 percent reduction in emergency department visits resulting from a motor vehicle crash. The research, led by Alva O. Ferdinand, DrPH, JD, assistant professor at the School of Public Health, was published today by the American Journal of Public Health. Approximately 39 million Americans visit emergency departments every year due to all types of injuries, but many of them motor vehicle crashes, according to the Centers for Disease Control and Prevention.

A primary texting ban means that police officers can stop someone they see texting while driving. With a secondary ban, on the other hand, police officers can only cite someone for texting while driving if they pull the driver over for another reason, like speeding or running a red light. Some of Ferdinand’s previous research showed that texting bans do reduce the number of crash-related deaths and hospitalizations, but in this study, she wanted to determine if they also reduce the number of minor injuries typically treated in an emergency department setting. “What I’m most interested in studying is whether laws—even ones we think of as punitive—benefit population health,” Ferdinand said. Ferdinand’s current research found that primary bans reduced crash-related emergency room visits

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Live Well Age Well

discharges, one of the biggest problems people face is losing their spot in their nursing home when they have to go to the hospital. This practice, known as “patient dumping,” is among the top five frequent complaints Ducayet’s office sees. The long-term ombudsman will make sure you know your rights, including your right to appeal and return to your nursing home after a hospital stay and can represent you during that appeal. While telling your nursing home’s management is often the best and quickest way to make sure your complaint is addressed,

HHSC stands by ready to help if needed. “An ombudsman can help bring the resident’s concerns to management and offer ideas to address the concern,” Ducayet said. “An ombudsman can give everyone information about the nursing facility’s requirements about residents’ rights and will tell the resident about the option to report a complaint to HHSC Long-Term Care Regulatory services.” To reach your long-term care ombudsman, call 800-252-2412 or email ltc.ombudsman@hhsc.state.

not portfolio yields which is where the cash flow comes from. Also, many of the traditional rules do not apply anymore. Consider putting a portion of your assets in immediate annuities to increase your cash flow to guarantee

some cash flow for the rest of your life. The downside is that the funds are no longer available to be used for anything else and disappear upon your death. You need to balance wanting a secure cash flow with leaving a “legacy” to your heirs.

Know your safety nets. If you continue to spend down your assets to maintain “yesterday’s” life style you can always get a reverse mortgage if you own a house.

medical school. This move is expected to enhance efforts such as the existing interprofessional curriculum and the Center for Health Interprofessional Practice and Education, as well as support nonclinical social workers already working within the medical school in disciplines ranging from

population health and surgery to oncology and pediatrics. “Together, Dell Med and the Steve Hicks School will help achieve the goal of transforming health care and interprofessional education by providing social workers a space to learn and exchange knowledge on

state-of-the-art practices in social work, and collectively enhancing their contribution to UT Austin’s vision of revolutionizing personal and public health,” says Luis Zayas, Ph.D., dean of the Steve Hicks School of Social Work and professor of mental health and social policy.

area), county-level life expectancy was 82.0 but ZIP code-level life expectancy ranged from 75.2 (78721) to 87.5 years (78754). • Within Harris County (Houston area), county-level life expectancy was 78.9 but ZIP code-level life expectancy ranged from 69.8 (77026) to 89.7 years (77073). • Within El Paso County, county-level life expectancy was 79.8, but ZIP code-level life expectancy ranged from 75.6

(79901) to 90.4 years (79928). • Within Bexar County (San Antonio area), county-level life expectancy was 79.1, but ZIP code-level life expectancy ranged from 67.6 (78208) to 89.2 years (78254). • Within Tarrant County (Fort Worth area), county-level life expectancy was 78.7, but ZIP code-level life expectancy ranged from 66.7 (76104) to 87.2 years (76002).

A variety of groups may find the data mining capabilities valuable, including social services, government agencies, nonprofits, and even homeowners. The researchers examined 1.6 million death records to compile the database, focusing on the state’s three largest racial groups: non-Hispanic (NH) whites, blacks (regardless of ethnicity), and Hispanics. The database includes information on 992 ZIP codes in Texas.

Long-Term Care Ombudsman Helps Nursing Home Residents with Rights By Michael Wright Texas Health and Human Services


o Living in a nursing home doesn’t mean giving up your freedom. If you feel someone is violating your rights, the Texas Health and Human Services Commission’s long-term care ombudsman can help. Nursing home residents have the same rights and protections of their health, safety and welfare that we all share. For nursing home residents these rights include the right to vote, voice complaints, exercise personal choice, the opportunity to make medical and social decisions as well as visit with anyone you wish and to be lawfully discharged and leave the facility. The long-term care ombudsman’s webpage has more information at https://apps.hhs. rights.html. “The right to visitors and

the right to be lawfully discharged are too often overlooked,” said Patty Ducayet, Texas long-term care ombudsman. “This includes 24-hour access to family members and access to other visitors if you consent to their visit.” It’s not unusual for family disputes about someone’s care to lead to friction over who can visit. If your family can’t work visitation out, Ducayet’s office can help keep the focus where it should be. “Our job is to help the resident’s voice lead the decision-making,” Ducayet said. “We remind all parties the person living in the nursing home is the one who decides who gets to visit.” W h e n it comes to

Financial Forecast Continued from page 3

minimum of once a year, and don’t automatically rebalance. Traditional rebalancing refers to asset values and


Continued from page 8 social work department also ensures further integration of social work into the education, research and community impact pillars of the

Life Expectancy

Continued from page 9 The online maps illustrate the variation in life expectancy occurring across geographic areas: • Within Dallas County, for example, county-level life expectancy was 78.3 but ZIP code-level life expectancy ranged from 67.6 (75215) to 90.3 years (75204). • Within Travis County (Austin May 2019

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On Saturday, May 11, 2019, the American Heart Association will host the 22ND Annual Heart Ball, the most exclusive and elegant evening in Austin. Join us for an evening of passion and fun that includes a hosted cocktail reception followed by dinner, live auction and a live musical performance. Presenting Sponsor

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May 2019

Austin Medical Times

Page 14


effectively diagnose and treat this devastating disease. Ending the obesity epidemic demands the cooperation of several key stakeholders including government officials, insurers, the food industry, employers and individuals struggling with the condition, as well as medical professionals. We play a critical role in this mission because patients cannot receive clinically sound, evidence-based treatments when they don’t know that they have a treatable medical condition. Proper diagnosis can make a life-saving difference in patient outcomes, help to profoundly lower medical costs and improve our country’s overall health. Consider your patients and whether you have taken the time to address their weight-related

issues. Now is the time to begin that dialogue, and if you’re having trouble getting started, there are more resources than ever to help with facilitating these vital conversations. Together, we can make a significant impact on the country’s biggest health challenge, and end obesity once and for all. Dr. Wendy Scinta is a nationally recognized expert on adult and childhood obesity treatment. She is the President of the Obesity Medicine Association and is the founder of BOUNCE, an internationally renowned program that has been presented at multiple scientific assemblies and organizational meetings throughout the U.S. Learn more about Dr. Scinta.

California Governor’s Medicaid Drug Pricing Executive Order Could Have Significant 340B Implications

of California Gavin Newsom signed an executive order to carve out prescription drug benefits from Medi-Cal managed care plans. The executive order requires the California Department of Health Care Services to transition all pharmacy benefits for the State’s Medicaid managed care plans to a fee-for-service (“FFS”) plan by January 2021. Aimed at curbing the State’s spending on prescription drugs, the Governor’s executive order would significantly reduce covered entity savings by applying Medi-Cal’s actual acquisition cost payment scheme to 340B drugs that were historically reimbursed under Medi-Cal managed care plans.

dubbed Medi-Cal, currently provides prescription drug coverage directly to beneficiaries on a FFS basis, however, managed care organizations (“MCOs”) provide prescription drug coverage for those beneficiaries enrolled in managed care. Medi-Cal FFS reimburses 340B drugs on an actual cost basis, essentially negating any net financial benefit for covered entities. In contrast, MCOs typically operate like traditional commercial health insurance plans, negotiating rates for 340B drugs with covered entities. Covered entities should remain cognizant of state initiatives regarding prescription drug spending and the potential for impacts on the 340B Program.

On January 7, 2019, Governor


Continued from page 1 cover and what patients can afford to pay only exacerbates the crisis. The good news is that we now know more than ever about obesity, including weight-set points, genetics, epigenetics (how the environment affects our DNA) and the intersecting influences of mental and physical health. And while medical schools do not currently have objective, measurable standards in obesity training, that will soon change with the introduction of new competencies which will ensure that future and current medical professionals are armed with the relevant knowledge necessary to

Legal Matters

Continued from page 4 HRSA requires all covered entities to maintain the necessary documentation verifying that they meet all statutorily required eligibility criteria. Covered entities must be prepared to provide HRSA with auditable eligibility documentation upon registration or request and do so under short timelines or face termination from the 340B program.

Healthy Heart Continued from page 10

statistics show that African-Americans face higher risks for high blood pressure, diabetes and stroke. Statistics also indicate that about 1 in 3 Hispanics will have high blood pressure, and nearly half will battle high blood cholesterol. Just because your family has a history of cardiovascular disease, does

Oncology Research

Continued from page 6 allows patients to have control of decisions regardless of the outcome

May 2019



not mean that you will certainly have the same diseases, it just means that you are more likely to have them. Disease is not imminent, and your health can be managed by making healthier lifestyle changes like those included in the Life’s Simple 7™. If you want to start living a healthier life, look no further than Life’s Simple 7™. My Life Check was designed by the American Heart Association with the goal of improved health by educating the public on how best to live. These measures have one

unique thing in common: any person can make these changes; the steps are not expensive to take, and even modest improvements to your health will make a big difference. Start with one or two. This simple, seven step list has been developed to deliver on the hope we all have--to live a long, productive healthy life. To see the full list go here - https:// healthy-living/ healthy-lifestyle/my-life-check--lifessimple-7 .

and may offer peace of mind for caregivers and loved ones. As oncologists and medical professionals, we always hope for the best with cancer treatment. We also want our patients to have a plan for everything, including their future medical care and how they want to live the rest of their life. At Texas

Oncology, I’m proud to work with advance care planning professionals who are dedicated to helping patients make decisions that will be respected throughout the cancer journey.

Published by Texas Healthcare Media Group Inc. Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Brad Jander Accounting Liz Thachar Office: 512-203-3987 For Advertising advertising@ Editor

Austin Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Austin Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Austin Medical Times are considered property and are to distribute for publication and copyright purposes. Austin Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430

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May 2019

Austin Medical Times

Advancing the practice of good medicine.


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