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Volume 10 | Issue 12
Inside This Issue
December Edition 2020
Smartphones, Texts, and HIPAA: Strategies to Protect Patient Privacy By Kim Hathaway, MSN, CPHRM Patient Safety Healthcare Quality & Risk Management Consultant The Doctors Company
P 5 Ways to Keep Diabetes Under Control See pg. 8
INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart....................... pg.8
5-Way Kidney Swap At Houston Methodist Hospital See pg. 11
hysicians have embraced smartphone technology, with the vast majority using phones to communicate via text messages and access medical information. The attraction is obvious: Smartphone applications place libraries full of information at users’ fingertips— including drug alerts (such as PDR. net) that are literally a click away. Texting via secure messaging systems is instantaneous, convenient, and direct. It reduces the time waiting for colleagues to call back and it can expedite patient care by facilitating the exchange of critical lab results and other necessary patient data. Smartphone technology is not just for peer-to-peer use: To manage their own healthcare needs, empowered patients are requesting more access to their physicians and medical records. Patients are also investing in mobile health technologies that provide continuous vital sign monitoring and generate health data that can be sent to their physicians. (For more information
on this topic, see our articles “Wearables Offer Wealth of Data During COVID-19, but Liability Risks Remain” and “Remote Patient Monitoring.”) Technology is becoming essential to the patient experience and increasingly important to younger, technology-savvy patients. Safeguard Against HIPAA Violations The very convenience that makes using smartphone technologies so inviting may also create privacy and security violations if messages containing protected health information (PHI) are not properly safeguarded. It is important that physicians and their teams understand that communications
between patients or other providers have the potential to lead to violations of the Health Insurance Portability and Accountability Act (HIPAA). Physicians and other team members must not communicate with patients using their personal text messaging systems. Before communicating with patients through electronic technologies, a practice must have in place a secure HIPAA-compliant messaging platform that interfaces with the electronic health record (EHR) and strong administrative procedures. HIPAA compliance is paramount to the physician’s ability to communicate safely see HIPAA... page 14
Throughput at Freestanding and Hospital-Based Emergency Rooms
H
ealthcare experts are striving emergency rooms based on different to learn about emergency care measures of quality care and throughput. at freestanding and hospital-based A Baylor College of Medicine expert conducted a study on this to investigate how much time patients spend in freestanding emergency rooms compared to hospital-based emergency rooms. The findings were published in the Journal of the American College of Emergency Physicians Open. Researchers used the Emergency Department Benchmarking Alliance, a preexisting database containing information from hundreds of emergency rooms across the United States. They
pulled information from a combined 500 freestanding and low-volume hospital-based emergency rooms and compared metrics on length of stay, door-to-doctor time and how likely one is to be admitted to the hospital. Findings showed that if a see ER ... page 12
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Legal Matters Gaps in Payment for Covid-19 Laboratory Testing Plague Providers and Patients
By Colleen Faddick, J.D. Sara Iams, J.D. Polsinelli, PC
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he federal government declared a Public Health Emergency (“PHE”) in response to the COVID-19 pandemic effective January 27, 2020. While the health care industry has been continually adapting to new clinical information and regulatory challenges, the need for rapid and reliable COVID-19 laboratory testing has stayed constant. At the outset, both providers and patients were led to believe that all testing would be free or paid for by insurance. Much of it is. But the ongoing nature of the pandemic has exposed gaps in this payment structure, leading to uncertainty by providers and
patients. The goal of this article is to identify the key payment sources and to highlight ongoing issue areas. I. Payment for COVID-19 Laboratory Services Rather than a national payment resource for COVID-19 testing, a patchwork of coverage and payment has developed through federal statutes, state and local health departments, and employers. The key sources are: • Commercial Payers and Federal Health Care Programs. New federal laws require most commercial health insurance plans, Medicare, Medicare Advantage, and Medicaid to cover COVID-19 testing at no charge to the beneficiary when determined to be medically appropriate by a health care provider. This includes out-of-network commercial plans that, by law, must pay a provider’s posted cash price for COVID-19 tests. It generally does not include non-
diagnostic testing for surveillance. • H R S A Program for the Uninsured. The federal Health Resources and Services Administration (“HRSA”) also administers a reimbursement p r o g r a m through which providers can submit claims and receive Medicare rates for testing uninsured individuals for COVID-19. • State and Local Health Departments. State and local health departments have also established free COVID-19 testing sites, typically funded by relief funds from the federal or state government and operated by the government or providers under contract. • Employers. As employers have encouraged or mandated employees to return to work, they have sought testing solutions
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to ensure a safe workplace. Per EEOC guidelines, employers are financially responsible for the cost of testing. II. Unexpected Gaps and Regulatory Hurdles Despite these funding sources, several gaps and regulatory hurdles have made obtaining consistent payment more difficult. Authorization and Infrastructure to Bill Payers. Almost all provider types have been asked to join in the testing effort. As a practical matter, though, some providers—like pharmacies—did not have the enrollments, contracts, or see Legal Matters...page 12
December 2020
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Houston Medical Times
Texas Children’s Fetal Center Teaches Its Innovative Fetoscopic Spina Bifida Repair Technique Using Telemedicine to International Colleagues During COVID-19 Pandemic
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s the COVID-19 pandemic continues to have a global impact, surgeons at Texas Children’s Fetal Center® have turned to technology to continue teaching their innovative, minimally-invasive technique for repairing spina bifida in-utero to fetal surgeons worldwide. Pioneered by a team at Texas Children’s in 2014 led by Dr. Michael Belfort, obstetrician-in-chief at Texas Children’s Pavilion for Women and chairman of the Department of Obstetrics and Gynecology at Baylor College of Medicine, the paradigm-shifting technique allows surgeons to access the fetal spine in a minimally-invasive way to repair neural tube defects. This world-first fetoscopic approach involves placing two very small ports (4 mm) into the
December 2020
uterus to allow the use of a fetoscope and tiny surgical instruments to repair the fetal spine. Texas Children’s has shown the benefits to the baby with this approach are the same as those obtained by teams using the large-scar approach, but, in contrast, after a fetoscopic spina bifida repair, the risk of preterm birth is significantly reduced. In fact, the average gestational age at birth of patients at Texas Children’s is 37-38 weeks compared with 34-35 weeks with the large-scar approach. Additionally, mothers can deliver vaginally since in the more than 90 cases done at Texas Children’s, there were no signs of harm to the uterus. Texas Children’s has done the most fetoscopic spina bifida repairs in the world, with 93 patients having
undergone the procedure. Major fetal surgery innovations, first researched and developed at Texas Children’s are now used worldwide by teams performing fetoscopic spina bifida repairs. Fetal surgeons at Texas Children’s have proctored and mentored many international fetal surgery teams and performed their fetoscopic technique in a number of countries including Israel, South Africa, Argentina, Belgium, Mexico, Colombia and Iran. In December 2019, the hospital held its first simulation training course for fetoscopic spina bifida repair, with 12 international teams of fetal surgeons attending from virtually every continent to learn how to perform the technique. Recently, a team of fetal
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surgeons from Giesen/Marburg in Germany reached out to Texas Children’s to request training in the hospital’s fetoscopic approach. Several options were considered and a telemedicine approach was developed. In partnership with Storz, a multinational endoscope manufacturer, a secure real-time video connection was established between the operating room at Texas Children’s Pavilion for Women in Houston and a conference room in Germany. A sophisticated Storz robot with four separate cameras allowed full visual and verbal communication between the team performing the surgery and the team in Germany. A split screen showed real-time see Texas Children’s...page 14
Houston Medical Times
Oncology Research When Your Cancer Spreads: Three Things to Know About Metastatic Cancer By Nikesh Jasani, M.D., Texas Oncology
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cancer cannot be eliminated from a patient’s body. Learning that you or a loved one has metastatic cancer can be devastating, but treatment options are available. For patients with metastatic or advanced cancer, treatment may not make the cancer go away, but it can help in other ways such as slowing the growth of a cancerous tumor, relieving symptoms, improving quality of life as well as prolonging life. The future of treatment for metastatic cancer is promising. Scientists, oncologists, and cancer researchers are focused on finding new and innovative ways to treat cancer and improve the lives of patients. This includes exploring the evolution of cancerous tumors and mutations from a primary cancer to metastatic cancer and working to better understand types of tumor growth and metastases. With better understanding of what drives tumor growth, spread, and resistance we develop more successful treatment. For example, metastatic and recurrent cancer are generally treated with systemic therapy – any treatment directed at
destroying cancer cells throughout the body – such as chemotherapy, radiation, immunotherapy, or a combination of several modalities. Some types of immunotherapies can target and attack certain cells in the body, enhancing the immune system’s ability to fight cancer. Some targeted therapies impair the growth process triggers that may be unique to some cancers. Having cancer that spreads is understandably difficult to accept and to discuss. Your physician and care team should always serve as your best resources when you have questions or concerns about your health. At Texas Oncology, we want patients to feel empowered to make informed decisions about their care – and walk beside them every step of the way.
RELAX
ancer is life-altering at any stage, and the subsequent cancer journey has the power to impact the physical, mental, and emotional health of patients and often those who love them. This is particularly true for patients who learn their cancer has metastasized or spread from the primary cancer location into other organs or areas of the body, which may indicate the disease will be a chronic condition. Sometimes called stage IV or advanced cancer, metastatic cancer can travel through the bloodstream or lymph system and develop a tumor in a new location. While cancer can spread to many areas of the body, it most commonly spreads from the primary cancer site to the bone, liver, or lungs, as well as the lymph nodes, according to the National Cancer Institute.
When it comes to cancer – or any serious illness – it’s important to understand what a diagnosis means for your current and long-term health. Here are considerations if you or someone you know is diagnosed with metastatic cancer. Recurrent cancer and metastatic cancer are not the same thing. Cancer recurrence is when cancer returns after treatment and after a period of time when no cancer was detected, whereas metastatic cancer means a primary cancer has spread to other parts of the body. Recurrent cancer may return where it previously occurred or in another part of the body. Recurrence can happen if cancer cells were resistant and survived the original treatment, developing into detectable tumors over time. Always ask your physician if you have questions about words used to describe your diagnosis. Metastatic cancer may be managed as a chronic illness. Metastatic cancer impacts patients differently based on their individual disease and risk factors. According to the American Cancer Society, many types of metastatic
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In the Heart of the Medical Center December 2020
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Mental Health How to Cope with Pandemic Loneliness This Holiday Season
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he holiday season can be a joyous, but many suffer from depression during this time of year. A number of factors can contribute to the “blues” during the holidays, including social isolation, grief and financial strain. This year, you may also experience feelings of depression and loneliness due to the pandemic. “People are grieving for similar reasons: loss of family members, jobs, relationships, friendships and physical touch. Everyone is suffering,” said Dr. Asim Shah, professor and executive vice chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. “Holiday blues will affect a lot of people this year, including those who haven’t suffered from it before.” Develop new traditions The key to handling loneliness? Stop using the phrase “social distancing,” as it can make others feel more depressed during this time.
Instead, practice “physical distancing” by socializing outdoors with a small group of loved ones to create new holiday traditions. Follow guidelines and socialize by keeping your distance in open spaces. Social and digital media has played a large role in the pandemic in terms of connection, as well as helping reduce loneliness. Many families won’t have the chance to visit each other this year, so Shah suggests socializing in the backyard with a few people while video chatting with family members in another city. Shah also stresses the importance of having a positive circle around you to defeat loneliness. The circle should be made up of loved ones outside of your immediate family members who live with you to create a safe, friendly environment. “That safe environment will be your crutch and your help, and you will be their help. Everyone needs socialization,” Shah said.
Celebrating
Know the signs Symptoms of holiday depression include feeling withdrawn or disconnected, not enjoying things you used to enjoy, lack of motivation, problems with sleeping, lack of appetite, difficulty concentrating, feeling irritable, fatigue or trouble making decisions. If isolation or loneliness leads to depression, seek help immediately. Connect with professionals with telehealth opportunities and join self-help groups. Social support is key, and a lot of these feelings can be eased by connecting with your social circle. If you’re aware that someone near you is suffering from holiday depression, lead them to professional help. “Don’t be judgmental. Give your loved ones options and be supportive. Be a good listener and guide them through this time,” Shah said. Survivor’s guilt Many are also experiencing
survivor’s guilt with the loss of loved ones to COVID-19. They feel guilty for surviving tragedy while family or friends suffered from the illness. Shah shares these tips to cope with survivor’s guilt this holiday season: • Practice mindfulness: focus on breathing techniques and meditation • Practice self-care: read, listen to music, exercise • Be optimistic and help others: Volunteer, help your elderly neighbors, help others financially if possible, donate blood and educate people on how to wear a mask
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Healthy Heart In Light of Pandemic, Flu Vaccinations More Important Than Ever for People at Highest Risk By Suzanne Hanshaw American Heart Association
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he American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives, is helping to keep families and communities safe from the flu by providing facts, resources and encouraging people to get a flu vaccine. “Getting the flu vaccine is especially important this year. If you get it, you may need to be hospitalized, in this time of COVID-19, in an already overwhelmed healthcare system,” said Eduardo Sanchez, M.D., M.P.H., FAAFP, American Heart Association chief medical officer for prevention and former commissioner of health for the state of Texas. “In a normal year, the flu is serious and can even cause death. While it is important for almost everyone six months and older to get a flu vaccine, it’s especially important
for those at highest risk: • Seniors and people with underlying risk factors such as heart disease, stroke, and diabetes, among others. According to the Centers for Disease Control (CDC), those 50 years-old and older, living with one or more chronic conditions, are at high risk for the flu. Those who aren’t vaccinated are six times more likely to experience a heart attack • Children, especially those who are under 5 years-old and those who are back in school. Children who are vaccinated are 74% less likely to be hospitalized due to the flu. • Pregnant women – those who are vaccinated are 40% less likely to be hospitalized due to the flu. • According to the CDC, people who are Black or Latinx may be at increased risk for the flu and are least likely to get the flu shot.
S o m e people have misinformation and concerns about the flu vaccine, causing them to skip it altogether. Here are some facts: The vaccine does not cause the flu. It may cause very mild side effects. The most common are soreness, swelling or redness on your arm near the site of the shot that might last only 1 or 2 days. However, the mild symptoms you might experience from the vaccine are much less severe than the flu itself. It is safe and effective and easy to access. The flu vaccine is safe and effective for places that are taking extra safety measures like your doctor’s office, pharmacies, and some employers that are providing drive-thru vaccinations. It is accessible even without insurance. Many community pop-up vaccination sites, federally funded programs, local health departments, community health centers, and some
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places like churches and community centers offer the vaccination at no cost for those who qualify. It is not too late to get vaccinated. Flu season typically peaks between December and February, so getting the vaccine now is better than waiting. You need at least two weeks for your body to develop antibodies to the virus. However, being vaccinated anytime during flu season is better than not at all. “No one wants the flu. The best way to keep your family and yourself safe from the flu is by getting the flu vaccine and as with COVID-19 prevention, wearing a mask, washing your hands often, and social distancing helps,” said Dr. Sanchez. “Don’t forget to take your mask when you go for your flu vaccine.”
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Houston Medical Times
5 Ways to Keep Diabetes Under Control Controlling Your Diabetes is More Important Than Ever During the COVID-19 Pandemic and Flu Season By Gracie Blackwell
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iabetes is a disease that plagues around 10.5 percent of the U.S. population and is the seventh-leading cause of death in the U.S. Now, more than ever, it is important for people, especially those with diabetes, to watch over their health, especially due to the simultaneous occurrence of the COVID-19 pandemic and flu season. Diabetes occurs when the amount of blood glucose—the main form of energy your body uses, which comes from food—in your body is too high. A hormone made by the pancreas, called insulin, helps the glucose from the food be used for energy. Diabetes occurs when the body does not make enough insulin (in type 1 diabetes) or does not use the insulin efficiently (type 2 diabetes). Jason R. McKnight, MD, MS, FAAFP, clinical assistant professor in the Department of Primary Care and Population Health at the Texas A&M University College of Medicine, provides five ways that people can keep their diabetes—more specifically their type 2 diabetes—under control. Maintain a healthy weight According to McKnight, the majority of people with type 2 diabetes are overweight. This is because excess fat in the body predisposes an individual to the insulin-resistant state that leads to type 2 diabetes. “If you’re overweight, you are almost certainly at risk for developing type 2 diabetes at some point in time, so maintaining a healthy weight is very important to help prevent the onset of type 2 diabetes,” McKnight said. To identify which weight category you are in, McKnight recommends using the Body Mass Index (BMI) method, which uses your height and weight to measure your body fat. Although it is not perfect, it is the best objective way doctors use to categorize weight, according to McKnight. Eat a well-balanced diet The foods you eat can make a huge difference in how well you manage your diabetes. A healthy diet that incorporates a variety of the main food groups can help control your blood sugar, help you maintain a healthy weight and give you more energy throughout the day. According to the National Institute of Diabetes and Digestive and Kidney Diseases, people with diabetes should eat from the main food groups but limit the amount of foods high in saturated and trans-fat, sodium, sweets
December 2020
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and beverages with added sugar. You may talk to your doctor or health care provider about setting up a healthy meal plan that is right for you. “It is recommended that your diet not be heavily reliant on fats and carbohydrates,” McKnight said. “Even if you’re able to maintain a healthy weight, long term ingestion of a high level of carbohydrates causes your body’s blood sugar to spike up, which can lead to an insulin-resistant state and can cause type 2 diabetes.” Exercise regularly Exercise is the best method to decrease insulin resistance, according to McKnight. “There are lots of medications out there for type 2 diabetes, but nothing really works as well as what exercise does,” McKnight said. “When you exercise and work out, your body is burning more blood sugar and as your muscles get bigger, they actually have more insulin receptors on them, so sometimes we can actually get rid of that insulin-resistant state and either prevent or basically treat type 2 diabetes.” The Centers for Disease Control and Prevention (CDC) recommends that adults get at least 150 minutes of moderate-intensity aerobic activity per week and participate in a musclestrengthening activity at least twice per week. Moderate-intensity aerobic activity can be anything that gets your heart beating faster, which can include brisk walking, pushing a lawn mower or riding a bike. Muscle-strengthening activities include lifting weights, doing pushups or sit-ups or heavy gardening. Although these are the recommendations, McKnight says that any amount of exercise that you can do is better than none. Take all medications as prescribed If you have type 2 diabetes, you must work with your doctor or health care provider to keep blood sugar levels down. Your provider will prescribe certain medications tailored to fit your needs. It is important to take your medications in the right way and on time because long-standing, untreated diabetes or blood sugar that is higher than usual for see Diabetes...page 11
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Will Social Security Become Less Secure in 2021?
f you’re currently collecting Social Security retirement income benefits – or you soon will be – it is important that you have a good understanding of how the program works, as well as methods for maximizing this incoming cash flow. Similar to most other retirement and healthcare-related programs, changes to Social Security (and Medicare) usually occur on a regular basis – and at the end of every year, the Social Security Administration (SSA) announces any of the updates that will take effect the following January. Going into 2021, there are several revisions to be mindful of, whether you
to a set annual amount. For 2021, this Social Security earnings test limit will be $18,960, which is up from $18,240 in 2020. 3. Increased Medicare Part B premiums. For those who are covered by Medicare, the premiums for Part B (which covers doctors’ services, some outpatient procedures, and medical supplies and equipment) are deducted directly from Social Security income each month. In 2020, it was anticipated that the COVID-19 crisis would lead to significantly higher Medicare Part B premiums. However, that turned out not to be the case. And, even though these premiums will go up, the amount will not be as high as initially expected.
have actually started receiving Social Security benefits, or you are still paying into the system as a worker: 1. Cost-of-Living Adjustment (COLA). As the prices of goods and services go up, it is important to generate additional income in order to keep pace with your lifestyle. According to the SSA, an average retired worker in 2020 receives $1,520 per month, and an average retired couple brings in, on average, $2,563. Typically (but not always), Social Security recipients will receive a cost-of-living adjustment, or COLA. For 2021, these benefits will increase by 1.3%. This equates to $20 per month more for individuals, and $33 added for the average retired couple. The maximum monthly Social Security benefit amount for recipients who are at full retirement age will also go up in January (2021) from $3,011 to $3,148. 2. Higher earnings test limits. If you collect Social Security income benefits prior to reaching your full retirement age and you are still working, you could be subject to the Social Security “earnings test” and have some of your benefits reduced by $1 for every $2 that you earn up
Social Security 2021 Updates for Current Workers In order to qualify for Social Security retirement income benefits, you need a total of 40 “work credits.” These are based on a set dollar figure of earnings, and you can accumulate up to four of these credits each year. If you’re still working and paying taxes into the Social Security program, the amount of each work credit will increase in 2021 from $1,410 to $1,470. This means that if you earn at least $5,880 in 2021, you will add four Social Security work credits to your tally. How to Maximize Your Retirement Income from Social Security With multiple strategies and time frames available for collecting Social Security retirement income, narrowing down the best method for you could seem a bit overwhelming – especially if you want these benefits to coordinate with other sources of retirement income you’re eligible for, such as a pension, annuity, and/or interest and dividends from personal savings and investments. Consider working with a CERTIFIED FINANCIAL PLANNER TM practitioner who is also well-versed in Social Security so she or he can help you look at the whole picture.
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Good Samaritan’s Gift Starts 5-Way Kidney Swap at Houston Methodist Hospital On a warm October morning in Houston, seven months into the COVID-19 pandemic, a young man from Lake Charles was surprised to learn his kidney donor was a woman in her 50s whose husband was severely ill with kidney disease. He had never met her until that morning—and now he is forever grateful to her for this second chance at life.
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his heartfelt encounter was repeated four more times, as recipients of a rare 5-way kidney swap met their donors a few days after their lifesaving surgeries at Houston Methodist Hospital. A husband and wife, a mother and son, two cousins, two sisters, and a boss and her employee were part of a transplant swap, which is a way to save patients who need a kidney but who have incompatible donors. By agreeing to a swap, the donors provide kidneys to different recipients, usually strangers, and these surgeries happen in quick succession. Five-way swaps are rare because they take great medical expertise and resources, and agreement from 10 transplant patients. The Houston Methodist chain began on Oct. 20 with Tara Berliski of Magnolia, Texas. Tara was a match for her husband John “HB” Berliski, who had both his kidneys removed in July after a 20-year battle with Polycystic Kidney Disease. However, when Houston Methodist informed Tara that she had also matched with a young “hard to match” patient, the couple chose to be a part of the swap that ultimately saved four additional lives. “The decision was a no-brainer,” said Tara. “I was taught to help those in need. It’s just how I was raised.” She matched with Justin Barrow—the
Diabetes
Continued from page 8 patients can lead to many complications. Keeping a list of all your current medications, filling your prescription immediately after your appointment and creating a daily routine for tracking your medications are all important measures in order to take your medicine as prescribed, according to the Association of Diabetes Care & Education Specialists. Control other chronic health problems There are certain other medical problems that can increase someone’s
patient from Lakes Charles—who was considered a hard-to-match recipient due to his high antibody count. Justin was diagnosed with a rare disease called nephropathic cystinosis when he was 18-months old. “A five-way swap is a very complex logistical task, even more so during the COVID-19 pandemic, but seeing the new hope from patients is what makes it all worthwhile,” said Osama Gaber, M.D, Director of J.C. Walter Jr. Transplant Center and lead surgeon for the swap. “I am continually amazed by people’s generosity. Good Samaritan donors, like Tara, restore my faith in humanity.” More than 80 health care professionals were involved in the care for the donors and recipients, from preparing them for the operating rooms to maintaining a safe environment during the pandemic. Kidney swaps are of growing importance as there continues to be long waits on kidney organ lists. In the past six years, the number of living donor kidney transplants in the U.S. has increased at least 24%, according to UNOS. The average wait for a person on the kidney list is three to five years. Swaps make it easier and faster for a patient to get a life-saving organ.
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risk of diabetes or increase the risk of complications from diabetes. McKnight says it is important to monitor these other chronic health problems to prevent further complications. For instance, people with untreated or undertreated hypothyroidism puts them at risk for developing type 2 diabetes, or if they already have diabetes, it makes it more difficult to keep their blood sugar under control. According to the CDC, the best ways to control your chronic health problems include visiting your doctor regularly to get screened, avoiding drinking too much alcohol, getting enough sleep and quitting smoking. medicaltimesnews.com
December 2020
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Legal Matters
Continued from page 3 claims processing infrastructure to shift from billing drugs or other services to billing for laboratory services. While Medicare fast-tracked enrollment processes to enable payment, other payers did not, and the administrative burden of adapting to new codes and billing processes has been a significant hurdle. Non-Covered Testing. Payers may also deny payment for testing. For example, although federal statute mandates payment in many cases, there is concern about payment for testing asymptomatic patients with no known
ER
Continued from page 1 patient was treated and released, their emergency department stay was about nine minutes shorter at a freestanding emergency room compared to a hospital-based emergency department. If the patient was admitted to the hospital, they waited about 44 minutes longer at freestanding
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exposure and about whether payers will adopt frequency limitations for repeat testing. In addition, the federal government has said that payers are not required to pay for screening tests for general workplace safety, for public health surveillance, or for “any other purpose” not intended for diagnosis or treatment of COVID-19. Thus, providers offering tests are well-served to develop protocols for testing that follow federal guidelines. Mandatory Testing. CMS recently instituted mandatory testing for staff and residents of certified long-term care facilities, but offered no options for reimbursement (except coverage otherwise available through insurance). Some states have offered
payment for a baseline test, but not recurring tests, and others have offered payment on an invoice basis, but only after the facility seeks payment from all possible payers. All in all, there is the potential for facilities to incur tremendous costs for an indefinite period, and both state and federal governments may need to act to resolve the payment uncertainty around payment. Patient-Directed or Self-Pay Testing. Laboratories are also confronting challenges associated with patients seeking COVID-19 testing without a practitioner order and with self-pay testing. The lack of a physician order can present issues under FDA Emergency Use Authorizations, which
typically call for testing to be done upon the order of a qualified person, and under state laws, which may not permit so-called “direct access testing.” In other scenarios, the lab may want to offer (or the patient may seek) a test on a self-pay basis to avoid the uncertainty around payer coverage. In such cases, although patients may agree to pay out-of-pocket, Medicare and Medicaidparticipating providers (in particular) must grapple with mandatory claim submission provisions, which require claim submission for all covered services. Whether these regulatory hurdles come into play depends on the facts, but they are nonetheless potential barriers to payment.
emergency departments compared to hospital-based departments. “If you wind up going to the ER and leaving, it’s more efficient from the standpoint of the patient to do so at a freestanding ER,” said Dr. Cedric Dark, assistant professor of emergency medicine at Baylor and principle investigator of the study. “However, if your condition is sick enough to warrant hospital admission, you will wind up staying in the ER for a bit
longer at a freestanding department, because the hospital beds aren’t immediately upstairs. Doctors will have to call hospitals that are open for care and then transfer you from the freestanding ER, which takes up time that otherwise could be spent in your room in a hospital bed.” Previous research by researchers at Baylor and Rice University determined that freestanding and
hospital emergency departments were similar in cost in Texas. According to Dark, further research needs to be conducted to understand more about the quality of care at freestanding emergency rooms.
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HIPAA
Continued from page 1 and send appointment reminders, alerts, and other follow-up reminders. Text messages among colleagues should also be encrypted and exchanged in a closed, secure network designed specifically to protect PHI, not on personal messaging systems. A secure messaging platform allows for the encrypted flow of information and storage in the medical record. Many EHR products now interface with secure messaging systems or the secure systems are integrated into the EHR product. Implementing a secure messaging platform must include establishing electronic communication policies regarding the proper and improper uses of texting—which means specifying what types of information may or may not be texted. Patients must also be educated on how the practice uses electronic communications and/or texting and be given the option of consenting or opting out of those communications. In addition to using a secure messaging platform, other minimal protections include automatic screen locking settings and remote wiping programs. An automatic screen locking setting secures a device when it is inactive, requiring a password to unlock it. Timing can be changed to shorten the interval before locking the screen. Remote wiping programs can erase data, texts, and email. Both safeguards provide additional protection in the event a device is lost or stolen. The government website HealthIT.gov provides tips and information for individuals and organizations related to securing mobile devices. Compliance is a challenge when the technology options and HIPAA security rules are not known or they are misunderstood. We have found that some clinicians are still using unsecured personal messaging systems and consumer apps to text images and send files containing PHI. With penalties up to $50,000 per HIPAA violation, safeguarding communications should be of the utmost priority. Texting Orders In December 2017, the Centers for
Texas Children’s
Continued from page 4 ultrasound images, an overall view of the operating room, an overhead view of the surgeon’s hands and the view from the endoscope inside the mother’s uterus. This was the first international broadcast of a fetoscopic spina bifida repair. The surgeons in Marburg were able to take notes, ask questions during December 2020
Houston Medical Times
Medicare and Medicaid Services issued a clarification regarding texting patient information among healthcare providers. The recommendations include the following: • Texting patient information among members of the healthcare team is permissible if accomplished through a secure platform. • Computerized provider order entry is the preferred method for submitting orders. • The current prohibition on secure text messaging of patient care orders is continued. Ensure Accuracy to Avoid Liability Concerns Shorthand and abbreviations are commonly used in text messaging. The informal nature of text messages can increase the chances of miscommunication. It is important to ensure accuracy and use standardized and approved abbreviations, particularly when patient information is exchanged over text. Texting cannot substitute for a dialogue with a colleague concerning a patient. If the matter is critical or you have any doubt about the communication, it is best to speak directly with your colleague. Discoverability Just as phone records are discoverable during litigation, so are the text messages on personal and work-designated smartphones. When changes occur in the patient’s condition or a serious event takes place, limit texting to messages over a secure messaging platform, and ensure that message content is appropriate for the medical record. Do not use personal messaging systems for any messages containing PHI or that are not compliant with the HIPAA Security Rule. For example, if you don’t have access to a secure messaging system and need to use your personal phone, text a generic message such as “please call urgently.” Communication about patient care information should be made in person or by person-to-person phone call and documented in the medical record. If texting is the only way to communicate, keep texts brief, professional, and to the point. If you would not document the communication in the medical record, do not say it in a text message. Avoid
expressing your opinion in a text about the care others have provided, unexpected events, or possible errors. Instead, communicate your understanding of events using an appropriate format, such as in an incident report or during a postevent investigation. Text messages from medical device representatives and other vendors who are present during patient care are also discoverable. Text messages should not contain discussions, opinions, or comments that would not be included in the medical record. Take Steps to Protect Your Practice Consider the following strategies for safeguarding your practice: • Conduct a risk assessment to evaluate the risks of texting—including message content and security measures that have been taken. • Use a secure messaging platform to send communications, not a personal or unsecure messaging system. • Enable encryption on your mobile device. • Set screens to lock automatically if inactive, and use the remote wiping function to prevent lost devices from becoming data breaches. • Ensure that your system has a secure method for verifying provider authorization. • Have a texting policy that outlines the acceptable types of text communications and specifies situations in which a phone call is warranted. Specify any applications that would be used in conjunction with texting. • Know your recipient and double check the “To” field to prevent sending confidential information to the wrong person. • Minimize identifying patient details in texts. • Assume that your text can be viewed by anyone in close proximity to you, and always maintain physical control of your device. • Ensure that the metadata retention policy of the device is consistent with the medical record retention policy and/or that it is in accordance with a legal preservation order. • Report to the practice’s privacy officer and your malpractice carrier any incidents of lost devices or data breaches.
and after the surgery, and were able to fully understand the procedure itself, as well as the team dynamic required. The team in Germany will continue their training on simulation models with virtual help from Texas Children’s as they progress toward their first case. “Our mission has always been focused on providing the best possible outcomes to our patients and we are privileged to share our innovative
techniques worldwide, so more children have a better chance at living with less complications from spina bifida,” Belfort said. “During a time where teams cannot travel to us, we continue to find ways to use technology to share our expertise with fetal surgeons nationally and internationally, so progress isn’t halted and more babies worldwide can have better outcomes.”
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