Page 1

March Edition 2021

Inside This Issue

Telemedicine for Medical Practices During COVID-19 By David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management; Devin O’Brien, Esq., Deputy General Counsel, VP Doctors Company

I What You Need To Know After Getting The COVID-19 Vaccine See pg. 12

INDEX Legal Matters....................... pg.3 Oncology Research......... pg.4 Mental Health...................... pg.6 Healthy Heart....................... pg.8

VA Offers Millions in Grant Funding for Adaptive Sports to Support Disabled Veterans See pg. 12

f your practice is among those seeking to ramp up telemedicine visits for patients during the coronavirus pandemic, there’s good news — you’re covered for liability and we can point you to resources to get you started. As the outbreak spreads, many practices are grappling with declines in patient visits. Virtual visits may give patients and practices alike peace of mind from the worry of the spread of infection. For example, phone use can reduce viral exposure during office visits. Some practices are creating cell-phone waiting areas, instead of gathering patients in their waiting rooms. After patients check in, they wait in their cars with their phones, ready to receive a call saying their provider is ready for them. While not true telehealth, cell-phone waiting shows how practices can use existing technologies to reduce COVID-19 exposure. While telemedicine has a spectrum of uses, there are two critical channels in which it can play a critical role during the current crisis: • It can be an essential tool both in keeping your patients at home, and in reducing the traffic and potential contagion in your offices. Many typical office visits—such as explaining test results and follow-up visits, can be accomplished via telehealth rather than in-person office visits.

• It can be an invaluable tool in screening potential coronavirus patients, especially with the current limited access to testing. If patients

Some practices may not think they are using telemedicine when in fact they already are. Telemedicine encompasses a range of care options, from remote presence technologies that allow specialists to serve patients in rural locations, to simply using a smartphone or landline to talk to a patient. Some states consider phone consultations to be telemedicine. If a practice is not prepared to implement new technology, it can consider making greater use of phone consultations—especially for established patients—during this time. Whether or not a phone consultation is reimbursable depends entirely on the payer. Generally speaking, visits that involve both audio and video are more likely to be reimbursed. In situations where audio-only visits are reimbursed, physicians should be aware that reimbursements often are higher if both audio and video are used.

Many typical office v isits — such as explaining test results and follow-up visits, can be accomplished via telehealth rather than in-person office visits. fear they have the virus, you can guide them in a video call through a symptom check—if they are not currently displaying symptoms you can schedule for another video call. If they are exhibiting symptoms and you want to see them in-person, you can schedule them to come at times designated for sick visits and better separate them from patients who need to come in for well visits.


Page 2

March 2021

Austin Medical Times


Austin Medical Times

Page 3

Legal Matters Five Emerging Trends In Value-Based Care

By Lori A. Oliver, J.D. Kathleen Snow Sutton, J.D. Polsinelli, PC


he pace and pressure to embrace value-based care are picking up. The COVID-19 pandemic exposed the risks and limitations of reliance on fee-for-service reimbursement and, combined with the groundbreaking changes in health care delivery models and regulatory flexibility, indicate a renewed focus on value-based care. This article outlines five of the top trends to watch for in value-based care for 2021. 1. Leaning In to Value-Based Care. One of the lessons from 2020 is that reliance on fee-for-service can leave providers vulnerable to volatility and

changes in demand. As utilization plummeted during the COVID-19 pandemic, providers who had invested heavily in value-based care have been better able to weather the pandemic and the economic downturn by having a consistent source of revenue despite low utilization. The rapid changes in health care driven by the pandemic only further emphasized the need for providers to lean into value-based care. Beyond the allure of steady revenue streams, new regulatory flexibilities and care delivery innovation creates an opportunity for providers to realize a more rapid rate of return on their investment in value-based care by increasing the portion of their business with value-based care reimbursement. 2. Continued Innovation and Disruption. While value-based care has always been an area ripe for innovation, 2021 presents a unique set of circumstances that point to a surge of innovation and disruption in both payment and care delivery models. Value-based care had been a priority for the

Centers for Medicare and Medicaid Services (“CMS”) under the Trump administration, but there is no reason to expect a change of course away from value-based care. In fact, the Biden administration’s health care goals will likely require an increased emphasis on cost savings, which may result in an even greater push towards value-based care. Commercial payors also continue to push towards innovative payment and care models as COVID-19 has highlighted the inequities in the health care delivery system and challenges for providers. 3. Capitalizing on COVID-19 Infrastructure.

The COVID-19 pandemic prompted transformational changes to the health care system that portend continued opportunities to manage patient care and provide quality care in lower cost settings. As a result of the pandemic, both the federal and state governments threw open the doors to allow providers to furnish services via telemedicine and other digital health modalities during the COVID-19 public health emergency. Many of the telehealth waivers have been made permanent. Providers who have embraced digital see Legal Matters...page 14

Hello, Spring!

Celebrate this season and every day with us.

5011 Burnet Road. Austin 512-451-9292


March 2021

Austin Medical Times

Page 4

Oncology Research Colorectal Cancer and the Danger of Putting Your Health on Hold By Shubhada Shrikhande, While these statistics are M.D., Texas Oncology– concerning, there’s no better time to Austin reverse the trend and prioritize your


hat’s on your “to do” list that you have been putting off during the pandemic? Yoga classes? Dentist appointment? Getting the car washed? One-year since some of the first COVID-19 shelter-in-place orders it seems easier to justify procrastinating and postponing some activities or chores. But a recommended colonoscopy should not be one of them. According to the Health Care Cost Institute, colonoscopies fell almost 90% early in the pandemic and were still down 11% last fall. What’s more, data from the National Cancer Institute (NCI) projects as many as 10,000 additional deaths during the next 10 years from colorectal and breast cancer alone as a direct result of failure to get screened during the pandemic.

health. March is Colorectal Cancer Awareness Month. Don’t let fear of COVID-19 stand in the way of your health. Doctors’ offices and medical providers are taking extra precautions to ensure healthcare facilities are safe for patient appointments and screenings. Make a plan to protect yourself against colorectal cancer through awareness, education, and prevention. Know your risk. More than 90% of colorectal cancer cases are diagnosed in people age 50 and older; however, recent research indicates the disease is on the rise in younger adults. According to NCI, people born around 1990 have two times the risk of colon cancer and four times the risk of rectal cancer compared to people born around 1950. Additionally, cases are more likely to be diagnosed at a later stage in adults younger than 50 compared to older adults. Your physician can help determine your personal cancer

risk and when to start screenings. Smarten up about screenings. Being vigilant and on guard when it comes to colorectal cancer is key. The disease typically lacks symptoms in its early stages – when treatment is the most effective. Screenings also provide the opportunity to find and remove polyps before they develop into colorectal cancer. Speak with your physician about which of the several available tests is right for you. The American Cancer Society (ACS) recommends patients start with a colonoscopy at the age of 45; however, a family history of colorectal cancer or polyps suggests beginning screenings earlier than age 45. Take care of your body. Maintaining a healthy weight through regular exercise and a nutritious diet can reduce your risk of several cancer types, including colorectal cancer. According to American Association for Cancer Research, up to 16% of colorectal cancers are associated with physical inactivity. Whether you walk, bike, or

practice yoga, make time to get moving every day. To give your body the fuel it needs, limit your intake of red and processed meats – which can increase risk for colorectal cancer – and eat plenty of fruits, vegetables, and whole grains. Colorectal cancer is the second leading cause of cancer deaths among men and women combined in the U.S. In Texas, the ACS predicts 11,280 Texans will be diagnosed with colorectal cancer this year, with 4,030 estimated deaths. Let’s reverse the trend this Colorectal Cancer Awareness Month – take action to move taking care of your gastrointestinal health from your “to-do” list to your “done” list. You won’t regret the decision.

Postdoctoral Certificate in

Neuropsychology Expand your practice through this unique program designed for licensed psychologists who want to extend the scope of their assessment practices and treatment interventions to include neuropsychology. Study with renowned neuropsychologists: Dr. Elkhonon Goldberg, New York, NY Dr. Arnold Purisch, Orange County, CA


www.Fielding.edu/Neuro March 2021


Dr. Elkhonon Goldberg New York, NY

Austin Medical Times

Page 5

Expert advice for difficult conversations. F EATURED CO URSES

ADOLESCENT SUBSTANCE ABUSE: 1.00 AMA PRA Category 1 Credit(s)™ Ethics Accredited

TEEN CONSENT AND CONFIDENTIALITY: 1.25 AMA PRA Category 1 Credit(s)™ Ethics Accredited

GENETIC SCREENING: 1.00 AMA PRA Category 1 Credit(s)™ Ethics Accredited

Join more than 100,000 medical professionals who get free CME with Texas Health Steps Online Provider Education. Choose from a wide range of courses relevant to your practice, including short tutorials and quick courses on topics like Medicaid guidelines, ethics and mental health—available 24/7. Learn more at TXHealthSteps.com.

Content on the Texas Health Steps Online Provider Education website has been accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council for Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy of Nutrition and Dietetics, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for some online content.


March 2021

Austin Medical Times

Page 6

Mental Health Empathy-Focused Phone Calls Alleviate Loneliness, Depression, Anxiety During COVID-19 Pandemic By Maninder “Mini” Kahlon, Ph.D.


ocial isolation arising from COVID-19 has sparked significant mental health issues, resulting in a jump from 1 in 10 adults reporting anxiety or depressive disorder symptoms before the pandemic to 1 in 3 adults more recently. But new research published today in JAMA Psychiatry shows that loneliness, depression, anxiety and overall mental health among older people can be improved through an empathy-focused telephone program. Known as “Sunshine Calls,” the four-week program was conducted as a randomized controlled trial of 240 mostly homebound, older adults. Lay callers engaged in telephone conversations with program participants; about half lived alone, and all reported having at least one chronic health condition. Compared with those who didn’t receive calls,

“We found that people feel meaningfully better when someone connects with them on their terms, consistently and authentically,” said lead study author Maninder “Mini” Kahlon, Ph.D., associate professor of population health and executive director of Factor Health at Dell Med. “In a time of overwhelming need for mental health services across America, this approach offers rapid improvements in loneliness, depression and anxiety. Better still, it’s scalable because it’s delivered by people who are not mental health professionals,” said Kahlon. The study adds to a growing body of evidence on the connection between loneliness and health, as well as on how mental health conditions can be meaningfully improved through new kinds of programs relying on everyday people, when clinicians aren’t necessary.

THE STRENGTH TO HEAL and get back to what I love about family medicine Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference.

To learn more about the Army or Army Reserve, call MAJ Tamela Mitchenor at 210-692-7376, or tamela.l.mitchenor.mil@mail.mil

©2010. Paid for by the United States Army. All rights reserved.

March 2021

recipients reported an average improvement of more than 1 point out of a 7-point standard scale in their feelings of loneliness, equaling a 16% difference. The number of adults who were at least mildly anxious at the outset dropped by 37% by the end of the program, and the number who were at least mildly depressed at baseline dropped by 25%, according to study authors. The Sunshine Calls program was developed by Factor Health, an initiative of Dell Medical School at The University of Texas at Austin and the Episcopal Health Foundation, in collaboration with Meals on Wheels Central Texas. Factor Health tests and builds programs at scale to deliver health outside of traditional settings, such as clinics and hospitals.


Callers, ages 17-23 years old, underwent a 1-hour video training to help them prioritize empathetic listening and eliciting conversation during the calls. Each caller supported six to nine participants during the pilot. Call recipients dictated the frequency and time of day for when they wanted to receive the calls, which usually lasted on average about 10 minutes. Researchers tracked participants’ loneliness, anxiety, depression and overall mental health using several widely accepted measurement tools that were administered as questionnaires, answered before and after the pilot program. Participants were largely women, mostly single, with 39% see Mental Health...page 14

Austin Medical Times

Page 7

Equals make

THE BEST PARTNERS. We’re taking the mal out of malpractice insurance. As a company founded and led by doctors, we know what keeps you up at night. It’s why we partner with practices of all sizes to help manage the complexities of today’s healthcare environment and reward the practice of good medicine. Because when you have a partner who’s also a peer, you have malpractice insurance without the mal. Join us at thedoctors.com

7588_TX_HoustonMedTimes_BP_Oct2020_0920_v1.indd 1


9/17/20 1:45 PM

March 2021

Austin Medical Times

Page 8

Healthy Heart


Federal Dietary Guidelines Emphasize Healthy Eating Habits but Fall Short On Added Sugars


meats, sugar-sweetened foods and beverages and refined grains. The guidelines are consistent with the American Heart Association’s dietary recommendations, and they show that a high-quality diet at every life stage can promote health and reduce the risk of diet-related chronic disease. This is even more a topic of discussion during March, which is National Nutrition Month. “But we are disappointed that USDA and HHS did not accept all of the Dietary Guidelines Advisory Committee’s science-based recommendations in the final guidelines for 2020, including the recommendation to lower added sugars consumption to less than 6% of

reducing cardiovascular disease risk. In the Greater Houston area, the American Heart Association is working with community partners, like TOMAGWA HealthCare Ministries, to educate people about the importance of good nutrition and making heart-healthy food choices. “I’m really excited about our partnership with the American Heart Association. Our patients will be able to see their provider and then receive a prescription for the specific food box that they need that will come with educational material as well as recipes so that they can continue to stay healthy,” said Timika Simmons, Chief Executive Officer at TOMAGWA HealthCare Ministries.


CONQUER LIFE! At Marine Military Academy, challenge leads to growth, and growth leads to success. By providing a college-preparatory curriculum in a structured, disciplined and focused setting, our cadets rise to new heights as scholars and leaders. No other school can unlock a boy’s potential like MMA.


MMA-TX.ORG »» 956.423.6006 ADMISSIONS@MMA-TX.ORG MMA »» A College-Prep Boarding School for Boys in Grades 7-12 MMA »» 320 Iwo Jima Blvd. »» Harlingen, TX 78550

March 2021

he American Heart Association, the world’s leading voluntary organization focused on heart and brain health, responded to the 2020-2025 Dietary Guidelines for Americans (DGA) released by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS). “The new federal dietary guidelines emphasize the importance of healthy eating and encourage Americans to ‘make every bite count,’” said Mitchell S. V. Elkind, M.D., MS, FAHA, FAAN, president of the American Heart Association. The new guidelines, like earlier versions, stress the importance of adopting a healthy dietary pattern that is rich in fruits, vegetables and legumes and includes whole grains, low-or non-fat dairy, seafood, nuts, and unsaturated vegetable oils, and low in consumption of red and processed

calories,” Elkind said. Added sugars can include refined fruit juices, corn syrup and other added refined sugars. The largest single source of added sugars in the US diet is sugary drinks, which contain excessive calories and no additional nutrients, and contribute to weight gain and diabetes. Many adults and children have little room in their diet for empty calories and need to go lower than 10% to have a healthy dietary pattern and meet their essential nutrient needs. The guidelines also recommend reducing saturated fat intake and replacing it with unsaturated fats, particularly polyunsaturated fats. A lower intake of saturated fat and a higher intake of unsaturated fat can lower incidence of cardiovascular disease for individuals. Sodium is another key area of interest to the American Heart Association. Reducing excessive sodium intake, of which 70 percent comes from processed, prepackaged and restaurant foods, is critical to

By Suzanne Hanshaw


Austin Medical Times

Three Longtime Antibiotics Could Offer Alternative to Addictive Opioid Pain Relievers


hree decades-old antibiotics administered together can block a type of pain triggered by nerve damage in an animal model, UT Southwestern researchers report. The finding, published online today in PNAS, could offer an alternative to opioid-based painkillers, addictive prescription medications that are responsible for an epidemic of abuse in the U.S. Over 100 million Americans are affected by chronic pain, and a quarter of these experience pain on a daily basis, a burden that costs an estimated $600 billion in lost wages and medical expenses each year. For many of these patients – those with cancer, diabetes, or trauma, for example – their pain is neuropathic, meaning it’s caused by damage to pain-sensing nerves. To treat chronic pain, prescriptions for opioid painkillers have increased exponentially since the late 1990s, leading to a rise in abuse and overdoses. Despite the desperate need for safer

pain medications, development of a new prescription drug typically takes over a decade and more than $2 billion according to a study by the Tufts Center for the Study of Drug Development, explains study leader Enas S. Kandil, M.D., associate professor of anesthesiology and pain management at UTSW. Seeking an alternative to opioids, Kandil and her UT Southwestern colleagues – including Hesham A. Sadek, M.D., Ph.D., professor of internal medicine, molecular biology, and biophysics; Mark Henkemeyer, Ph.D., professor of neuroscience; Mahmoud Ahmed, Ph.D., instructor of internal medicine; and Ping Wang, Ph.D., a postdoctoral researcher – explored the potential of drugs already approved by the Food and Drug Administration (FDA). The team focused on EphB1, a protein found on the surface of nerve cells, which Henkemeyer and

his colleagues discovered during his postdoctoral training nearly three decades ago. Research has shown that this protein is key for producing neuropathic pain. Mice genetically altered to remove all EphB1 don’t feel neuropathic pain, he explains. Even mice with half the usual amount of this protein are resistant to neuropathic pain, suggesting EphB1’s promise as a target for pain-relieving drugs. Unfortunately, no known drugs inactivate EphB1. Exploring this angle further, Ahmed used computer modeling to scan a library of FDA-approved drugs, testing if their molecular structures had the right shape and chemistry to bind to EphB1. Their search turned up three tetracyclines, members of a family of antibiotics used since the 1970s. These drugs – demeclocycline, chlortetracycline, and minocycline – have a long history of safe use and minimal side effects, Ahmed says. To investigate whether these

Page 9

drugs could bind to and inactivate EphB1, the team combined the protein and these drugs in petri dishes and measured EphB1’s activity. Sure enough, each of these drugs inhibited the protein at relatively low doses. Using X-ray crystallography, Wang imaged the structure of EphB1 with chlortetracycline, showing that the drug fits neatly into a pocket in the protein’s catalytic domain, a key portion necessary for EphB1 to function. In three different mouse models of neuropathic pain, injections of these three drugs in combination significantly blunted reactions to painful stimuli such as heat or pressure, see Opioid Pain...page 14


cookie d


cookie d

Warm cookies, delivered.


March 2021

Austin Medical Times

Page 10

Urban Americans More Likely to Follow Covid-19 Prevention Behaviors Than Rural Americans First National Study Found Key Differences in The Rates at Which Rural And Urban Americans Wear Face Coverings in Public and Work From Home By Rae Lynn Mitchell


imothy Callaghan, PhD, and Alva Ferdinand, DrPH, JD, from the Southwest Rural Health Research Center at Texas A&M University School of Public Health, joined colleagues in the first national study of how often people in urban and rural areas in the United States follow COVID-19 guidelines. These include public health best practices like wearing masks in public, sanitizing homes and work areas, maintaining physical distancing, working from home and avoiding dining in restaurants or bars. The research team used a survey of 5,009 U.S. adults that closely matched the makeup of the country’s population as a whole. The survey asked how

often participants followed COVID-19 prevention recommendations and collected data on political ideology, perceived risk of getting COVID-19, whether participants had been tested for the disease, and how trusting of medical experts subjects were. They also collected data on demographic factors like age, gender, race, education, income and religiosity and used respondent ZIP code to determine whether they lived in a rural or urban area. The research team found rural Americans were less likely than their urban counterparts to report following most of the recommended prevention behaviors. The two most notable differences were in wearing face coverings in public and in working from home. They also found smaller

but significant differences in avoiding restaurants, changing travel plans and disinfecting homes and work areas, with rural residents again being less likely to follow recommendations. Other measures like social distancing, hand washing and canceling social engagements showed no significant differences between rural and urban-dwelling Americans. When including political ideology and social factors in their analysis, the researchers found that some factors were associated with the likelihood of following recommendations. Older respondents and people who were more concerned about COVID-19 were more likely to follow at least some of the recommendations, as were those with greater educational attainment and higher income. People with a more conservative political ideology were less likely to follow prevention guidelines and women were more likely to follow them than men. However, living in a rural area remained a strong

influence on following public health recommendations. Given the limited access to high quality medical care in rural areas, these behaviors could lead to negative, yet avoidable, health outcomes in rural America. Finding ways to improve the adoption of COVID-19 prevention behaviors in rural areas is therefore critical, “something that targeted messaging might help to achieve,” Callaghan said. “Public health efforts that consider factors like trust of medical experts and political ideology when reaching out to different groups could be key.”


Access to nutritious food is essential for a healthy, thriving community. Learn about how we’re leading the fight against hunger at centraltexasfoodbank.org. March 2021


Austin Medical Times

Page 11

A team in healthcare law that’s the


Driving business, practicing law.

100 Congress Avenue, Suite 1800, Austin, TX 78701 Fletcher Brown: 512-685-6400



March 2021

Page 12

Austin Medical Times

What You Need to Know After Getting The COVID-19 Vaccine


s the long-awaited COVID-19 vaccine rollout begins across the country and everyone is eager to get back to normal life, it can be confusing to understand what you can and cannot do once you and those around you are vaccinated. A Baylor College of Medicine vaccine expert weighs in on why we still need to be cautious of spreading the virus in the community. First, it is important to get both doses of the vaccine for full protection. “Once we have our first dose of the vaccine, there is a degree of protection that starts to kick in,” said Dr. Hana El Sahly, associate professor of molecular virology and microbiology and of medicine – infectious diseases at Baylor. “But the information and data we have about the effectiveness of the vaccines are really about two doses. So everyone should make sure to get their second dose for full protection as we know it from these clinical trials that we just conducted.” The efficacy data that has been reported on the vaccines is based on data from 14 days after the second dose of the vaccine was administered in the

Moderna trial and seven days after the second dose in the Pfizer trial. As vaccines becomes more widely available and more data are generated about long-term efficacy of the Pfizer and Moderna vaccines as well as newer vaccines in the pipelines, El Sahly hopes that we can vaccinate a large fraction of the community and have more comfort in easing social distancing measures and resuming life as we knew it before COVID-19. However, even after receiving the second dose, El Sahly said to keep in mind that much of the data is short term and does not tell us what the vaccines do for our ability to transmit the virus to others. “It is possible that if we are vaccinated we are much less likely to come down with COVID symptoms but we do not know that we are not having asymptomatic infection that could be spread to others,” she said. Until the vaccine coverage in the community is high, it is very important to maintain the preventive measures of social distancing and mask wearing. El Sahly also cautioned that the

available data only provides information about the two-month period post-vaccination and little is known about the vaccine efficacy for a longer time period. “Longer term data will be generated soon, but we all need to keep in mind that for now, all the data we have on protection is short term,” she said. Once you are fully vaccinated and are deciding whether you should spend time with other fully vaccinated individuals indoors or without masks, El Sahly recommends looking at the risk versus the benefit, especially if one

or more of the individuals is in a higher risk category or if it’s been more than two months since everyone received the second dose of the vaccine. At this time, she also recommends not gathering in large groups indoors. If you are considering flying after the second dose of the vaccine, keep in mind there are other people on the airplane that you can unknowingly spread the virus to and that there’s still a small chance that you can get the virus. It’s important to keep your mask on and take all other safety precautions if you are traveling.

Subscribe to Our Digital Issue Now you can get the Austin Medical Times delivered straight to your inbox. Never miss an Issue of Austin’s Leading Local Healthcare News Online.

austinmedtimes.com March 2021


Austin Medical Times

Page 13

VA Offers Millions in Grant Funding For Adaptive Sports to Support Disabled Veterans Community Organizations May Now Apply Online


he Department of Veterans Affairs (VA) is accepting applications from community organizations through March 31 — for up to $16 million in grant funding — to provide adaptive sports and therapeutic recreational opportunities for disabled Veterans and members of the armed forces. VA research and clinical experience shows that physical activity is important to maintaining good health and improving overall quality of life. VA awards grants to qualifying organizations to plan, develop, manage and implement a variety of sports and activities for Veterans, including cycling,

kayaking, archery and skiing. To be eligible for a grant, an organization must be a non-federal entity with significant experience in managing a large-scale adaptive sports program. “Through these grants, VA is extending its reach to assist organizations that help Veterans in their communities to engage in sports and recreation,” said VA Director of the National Veterans Sports Programs and Special Events Leif Nelson. “Veterans will have more opportunities to learn new skills related to their sport of choice and embrace the positive influence and benefits of adaptive sports and equine activities.”

AI Tool Helps Patients, Doctors Make Better Surgery Decisions Together By Adria Johnson


steoarthritis of the knee is one of the most common forms of arthritis, affecting more than 30 million Americans. Treatments range from physical therapy to joint injections to total knee replacement surgery. In a new study published in JAMA Network Open, a team from UT Health Austin’s Musculoskeletal Institute found that a decision aid powered by artificial

intelligence (AI) can help patients and their doctors determine which course of treatment is most appropriate, and improve health outcomes. The team at UT Health Austin, the clinical practice of Dell Medical School at The University of Texas at Austin, developed the decision aid in collaboration with a digital health company. The aid uses AI to enhance shared decision making around treatment options. It works by

In fiscal year 2020, VA awarded nearly $15 million in adaptive sports grants to 116 organizations headquartered in 37 states, the District of Columbia and Puerto Rico. Programs funded through these grants are estimated to serve more than 13,000 Veterans and service members across the country. Of the total awarded, $1.5 million was used to assist organizations that offer equine-assisted therapy to support mental health. Applications must be submitted online by March 31, at 3 p.m. EST. VA

combining a patient’s clinical data with patient-reported outcome measurements — surveys completed by patients that include detailed information about how knee arthritis affects their everyday lives. “The AI software processes an array of data and calculates a personalized score for an individual patient that predicts their outcomes if they chose to undergo knee surgery,” said lead study author Prakash Jayakumar, M.D., assistant professor of Surgery and Perioperative Care at Dell Med. “And it’s all done before the patient and doctor even meet for their initial consultation. It’s a powerful tool providing insights that we’ve never had before—a true game-changer.” In the study, Jayakumar and his


will announce award decisions this fall based on a competitive selection. Details of the Notice of Funding Opportunity, including frequently asked questions and additional information can be viewed under the “Grant Program” tab online at VA Adaptive Sports Grant Program.

colleagues used a randomized controlled trial to compare outcomes between two patient groups: One used the AI-enabled decision aid, combined with education materials and preference-setting tasks. Patients in the other group made their treatment decision after receiving only the education materials. The group using the AI technology, education and preference-setting tasks showed: • Higher levels of decision quality and shared decision-making; • Increased patient satisfaction; • And better functional outcomes, compared to patients who only received educational materials. “We also found that the decision aid produces positive outcomes from patients of all backgrounds, regardless of employment status or type of insurance— including those who traditionally feel less empowered to make informed decisions,” said Jayakumar. “Patients who used the aid fared better physically, as well. We think that’s because it promotes patient engagement, making them equal partners in their health care team and the decision-making process.” For clinicians, the high-tech tool can clarify a patient’s fears and preferences around surgery, and help them better-manage patient expectations. “This demonstrates the benefits of a personalized, data-driven approach to shared-decision making for patients considering total knee replacement—a benefit which could have far-reaching consequences for populations suffering from knee osteoarthritis,” said Jayakumar.

March 2021

Page 14

Austin Medical Times

Legal Matters

Continued from page 3 health as a way to weather the pandemic will also have the opportunity to capitalize on this investment as a way to manage patient care and see a return on investment for services that are typically not reimbursable under fee-for-service arrangements. Providers who have invested in these types of programs similarly provide an opportunity to provide quality care in lower cost environments, which will benefit providers who are fully engaged in value-based care. 4. New Opportunities for Provider Alignment. Recent changes to federal law aim to lower barriers to value-based care. In particular, CMS and the Office of Inspector General (“OIG”) created new flexibility under the Stark Law and Anti-Kickback Statute for value-based arrangements to allow providers to enter into value-based care arrangements that previously may have been prohibited. While

the new exceptions and safe harbors still require that arrangements be carefully crafted, they provide new opportunities to align with providers and to incentivize activities that promote value-based goals that were previously unavailable. Additionally, the sweeping interoperability and information blocking rules aim to ensure that patients and providers are able to access health information, further reducing structural barriers to value-based care. 5. Emphasis on Social Determinants of Health. Finally, players in the value-based care space — particularly in Medicaid managed care programs — are placing greater emphasis on addressing social determinants of health. Providers and payors are beginning to recognize the crucial role that nonmedical factors play in patient health. By solving for these issues — such as transportation, food, housing, language services, etc.

— providers and payors are able to realize significant benefits in improving patient health and outcomes while keeping medical costs relatively low. The focus on social determinants of health is an emerging trend in value-based care that is likely to grow as players seek creative ways to manage patient care through value-based arrangements. As providers and payors emerge from the upheaval of the pandemic and the resulting revolutionary changes in health care, we can expect renewed interest in value-based care. Opportunities abound to capitalize on the changes wrought by the pandemic, as well as emerging prospects, by fully investing in value-based care.

Web Development Lorenzo Morales Distribution Brad Jander Accounting Liz Thachar

Editor editor@medicaltimesnews.com

our dedicated volunteers who safely deliver their meals. Sunshine Calls fill that void with caring conversations that make a world of difference in the lives of homebound seniors.” Factor Health experts are available to support similar existing telephone outreach programs to help maximize program effectiveness. Researchers are currently seeking funding to maximize reach, measure impact, and demonstrate effectiveness

at scale. Factor Health is also seeking health insurers, self-insured employers and other potential partners to test methods to pay for outcomes that enable health systems to create effective programs.

these drugs might be able to blunt pain in humans too, the next stage for this research, says Kandil. “Unless we find alternatives to opioids for chronic pain, we will continue to see a spiral in the opioid epidemic,” she says. “This study shows what can happen if you bring together

scientists and physicians with different experience from different backgrounds. We’re opening the window to something new.”

Opioid Pain

Continued from page 9

March 2021

Senior Designer Jamie Farquhar-Rizzo

For Advertising advertising@ medicaltimesnews.com

Continued from page 6

with the triplet achieving a greater effect at lower doses than each drug individually. When the researchers examined the brains and spinal cords of these animals, they confirmed that EphB1 on the cells of these tissues had been inactivated, the probable cause for their pain resistance. A combination of

Director of Media Sales Richard W DeLaRosa

Office: 512-203-3987

Mental Health

self-reporting as Black or African American and 22% as Hispanic or Latino. “Loneliness, depression and feelings of isolation are ‘viruses’ that can negatively affect the health of the vulnerable homebound older Central Texans we serve,” says Adam Hauser, president and CEO of Meals on Wheels Central Texas. “During the pandemic, our clients are receiving few — if any — visitors other than

Published by Texas Healthcare Media Group Inc.


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

Austin Medical Times

Page 15


The Nutrition Facts label can help you make healthier choices. Use it! Here’s what to look for:

Start with serving information. This will tell you the size of a single serving and how many servings are in the package.

Check total calories. Do the math to know how many calories you’re really getting if you eat the whole package.

Limit certain nutrients. Compare labels when possible and choose options with lower amounts of added sugars, sodium and saturated fat and no trans fat.

Get enough of Eat foods with nutrients your body needs, and Vitamin D.

Understand % Daily Value. •

The % Daily Value (DV) tells you the percentage of each nutrient in a single serving in terms of the daily recommended amount.

To consume less of a nutrient (such as saturated fat or sodium), choose foods with a lower % DV (5% or less).

To consume more of a nutrient (such as higher % DV (20% or more).

For more tips and tricks on eating smart, visit heart.org/HealthyForGood EAT SMART


©American Heart Association 2020 DS15662 2/20


March 2021

Austin Medical Times




ade In M


Profile for Rick Delarosa

Austin Medical Times