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Serving Harris, Brazoria, Fort Bend, Montgomery and Galveston Counties


Volume 11 | Issue 3

Inside This Issue

March Edition 2021

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 Nexus Health Systems Launches Neurospecialty Rehabilitation Unit See pg. 10

INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart......................pg.11 Financial Forecast............ pg.12

VA Offers Millions In Grant Funding For Adaptive Sports To Support Disabled Veterans See pg. 13

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 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. Some practices may not think they are using telemedicine when in fact they already are. Telemedicine encompasses a range of care options, see Telemedicine ..page 14

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


s the long-awaited COVID-19 back to normal life, it can be vaccine rollout begins across the confusing to understand what country and everyone is eager to get 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 see Vaccine ... page 14


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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 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. see Legal Matters...page 14

March 2021

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Houston Methodist Expert Notes Covid-19 Precautions Lead to Historic Drop in Flu Cases Masking, Handwashing, Social Distancing Work to Curb Respiratory Infections Across The Board


ouston, we’re doing something right. And, it seems, so is the rest of America. A silver lining is emerging amid the COVID-19 pandemic. Influenza numbers are way down – 98 percent down, according to the CDC. Locally, during flu season last year, Houston Methodist’s system of eight hospitals saw 250 to 450 flu cases per week. This year? The hospital system has seen only 2 to 5 flu cases per week so far. The numbers tell a striking story. Handwashing, masking and social distancing work. That also translates to a possible 20,000 lives saved and potentially keeping nearly 400,000 hospital beds open, according to CDC estimates of deaths and hospitalizations for last year’s flu season. This is especially important now, given the unprecedented strain COVID-19 has put on hospitals across the country. “Influenza A and B are down

this year across the United States in a really historic way,” said S. Wesley Long, M.D., Ph.D., medical director of diagnostic microbiology at Houston Methodist. “This was also seen in the southern hemisphere flu season that precedes and is a big influence on ours.” And it’s not just the flu. Long said there have been very low rates of RSV, short for respiratory syncytial virus, which is common in children, as well as a very low rate of rhinovirus and enterovirus – the common cold viruses – during the March and April lockdown last year. He noted the drop in all of our respiratory viruses was very rapid when the lockdown was initiated in March 2020, and rhinovirus and enterovirus numbers only began to slowly increase when restrictions started to ease in April and May. “We were on the upswing for a

couple of respiratory viruses in early 2020,” Long said. “But they dropped to nothing extremely quickly when the rodeo was canceled and we went on lockdown in Houston.” Influenza and RSV, however, have remained very low, even into the usual respiratory virus season that began in the fall. This could be due to the October and more recent surges in COVID-19 cases prompting people to double down their precautionary efforts of good hand hygiene, wearing masks, social distancing and getting their flu shots in anticipation of a feared “twindemic” of flu and COVID-19, a prediction that, thankfully, has not happened. “It shows the power of the intervention measures brought about by COVID-19, coupled with lockdowns, really do work. It’s really striking that when we started to ease up on stay-at-home orders, we

S. Wesley Long, M.D., Ph.D., is the medical director of diagnostic microbiology at Houston Methodist

saw some of them, like rhinovirus and enterovirus, slowly come back,” Long said. “I can’t stress enough the overriding factor reducing the spread of respiratory viruses is most likely the precautions many individuals are now accustomed to taking of masking, handwashing and social distancing, as well as an increase in people getting the flu vaccination. I think this gives us hope that we can get COVID-19 under control as we roll out vaccines to pair with these public health interventions.”

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Houston Medical Times

Oncology Research Colorectal Cancer and the Danger of Putting Your Health on Hold By Susan Escudier, M.D., FACP, Texas Oncology– Houston Medical Center


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.

While these statistics are concerning, there’s no better time to reverse the trend and prioritize your 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

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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.


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Mental Health Pandemic Increases Substance Abuse, Mental Health Issues for Those Struggling with Obesity


he COVID-19 pandemic is having a detrimental impact on substance use, mental health, and weight-related health behaviors among people with obesity, according to a new study by researchers at UT Southwestern and the UTHealth School of Public Health. The study, published in the journal Clinical Obesity, surveyed 589 patients with obesity who are enrolled in the UT Southwestern Weight Wellness Program, a multidisciplinary weight management and post-bariatric care clinic. Nearly half of the group reported using recreational drugs and alcohol, and 10 percent reported increased use since the start of the pandemic. Seventeen of the patients have tested positive for COVID-19. Almost a quarter (24.3 percent) of the patients reported using opioids in the 30 days preceding the survey, 9.5 percent sedatives or tranquilizers, 3.6 percent marijuana, and 1 percent

March 2021

stimulants. Patients were surveyed from June 1, 2020, to Sept. 30, 2020, after COVID-19 stay-at-home orders had been lifted in North Texas. “Many patients with obesity are also challenged by mental health conditions. Those who reported anxiety, depression, and trouble sleeping were two to four times more likely to increase their use of substances. For those who reported stress eating, there was a sixfold increase in substance use,” says study author Jaime Almandoz, M.D., MBA, medical director of the Weight Wellness Program and assistant professor of internal medicine at UT Southwestern. According to the Centers for Disease Control and Prevention, more than 42 percent of American adults are obese. Obesity-related health conditions include heart disease, stroke, Type 2 diabetes, and certain types of cancer that are some of the leading causes of preventable,

premature death. Nearly 70 percent of the patients reported that it was more difficult to achieve their weight loss goals during the pandemic, with about half spending less time on exercise. These findings were similar to another paper authored by Almandoz last spring, which was one of the first studies to show the impact of shelter-in-place orders on health behaviors in people with obesity. “This study demonstrates that adults with obesity continued to engage in the same behaviors and struggled with mental health challenges, even after lockdown orders were lifted. We need to develop interventions targeting these vulnerable groups, such as telehealth options and outreach efforts,” says senior author Sarah Messiah, Ph.D., M.P.H., an adjunct professor in the UTSW department of population and data sciences and a professor in the department of epidemiology, human genetics, and environmental sciences at the UTHealth School of Public Health. The researchers noted that the


patients surveyed were predominantly white, college-educated individuals with middle- to high-income levels. Thus, the survey results may not be generalizable to other populations, and may not accurately assess the burden of the pandemic on obesity-related health behaviors in lower socioeconomic status and/ or ethnic minority populations disproportionately affected more by obesity and COVID-19. The survey participants were established weight management patients with health insurance – not representative of the average American challenged with obesity, in which less than 2 percent receive anti-obesity medications and fewer than 1 percent undergo bariatric surgery.

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Memorial Hermann and UTHealth Researching Emergency Treatment of Patients with Intracerebral Hemorrhage


emorial Hermann-Texas Medical Center and The University of Texas Health Science Center at Houston (UTHealth) recently joined more than 100 hospitals and mobile stroke units across the United States and in other countries to investigate a new emergency treatment for patients with intracerebral hemorrhage (ICH), or a “bleeding stroke.” The name of the study is the rFVIIa (Recombinant Factor VIIa) for Acute hemorrhagic Stroke Administered at Earliest Time (FASTEST) Trial. The study will determine if Recombinant Factor VIIa, a medicine used to treat and prevent bleeding, may improve outcomes after a stroke caused by bleeding in the brain if the medicine can be given within the first two hours after the stroke starts. For this study, physicians are seeking community input about the proposed clinical trial that will assess the efficacy of Recombinant Factor

VIIa in treating brain bleeds. As part of this trial, patients with brain bleeding who cannot communicate whether or not they want to take part in the trial can be included with an “exception from informed consent” with consent being obtained later. The exception to consent is only allowed in life threatening circumstances when it is not possible to get consent from the patient or the patients’ families or representatives before the study needs to begin, where the best strategy is unknown and when there is a potential benefit to participants. “Our goal for consulting the community for this study is to ensure that communities have the opportunity to provide input before the study starts and to make sure they understand the proposed investigation and its risks and benefits,” said study consultant Elizabeth Noser, MD, Director of Community Engagement

for the UTHealth Institute for Stroke and Cerebrovascular Disease at UTHealth. According to the American Stroke Association, someone in the United States has a stroke every 40 seconds and more than 20,000 people die each year from ICH. An intracerebral hemorrhage occurs because a weakened blood vessel in the brain breaks and within a few hours of the onset of symptoms, bleeding accumulates in the brain. “Although ICH makes up only 15 percent to 20 percent of all strokes, it is a particularly lethal form of this potentially disabling condition,” said James Grotta, MD, Director of Stroke Research, Clinical Institute for Research and Innovation at Memorial Hermann-Texas Medical Center (TMC) and a member of the Stroke Institute. “The brain injury from ICH is usually very severe and over 40 percent of people with ICH

are dead within a month and only 20 percent can independently care for themselves at six months.” According to Grotta, there is currently no treatment for ICH that is scientifically proven to improve outcome. “Black people have an increased risk of ICH at younger ages compared to white people, and the risk of ICH at 45 years of age is five times higher for blacks than whites,” added see Bleeding Stroke...page 13

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Nexus Health Systems Launches Neurospecialty Inpatient Rehabilitation Unit



□□ -OVER.


he new unit at Nexus Specialty Hospital offers another phase of the Nexus Neurocontinuum, setting individuals up for greatest level of success post-brain injury or neurologic disorder. Nexus Health Systems officially opened their new 16-bed inpatient rehabilitation unit (IRU) at Nexus Specialty Hospital during a virtual grand opening at the end of January. Fully equipped to care for higher acuity, neuro-specialty patients, the IRU is the ideal setting for individuals who are slower to recover and Neuro-trained and experienced therapists at Nexus Specialty Hospital would benefit from daily help a patient stand for the first time since his brain injury. rehabilitation. “The focus of our IRU is needs, challenge them to continue improving neurofunction,” explained progressing and support the greatest IRU Medical Director Dr. Zoraya level of independence.” As the latest phase, the IRU adds Parrilla. “Our therapy team works with patients daily to help them grow another layer of care for individuals stronger and become more independent. who seek to successfully return home With the unit situated within Nexus or residential rehabilitation, possibly at Specialty Hospital, patients also Nexus Neurorecovery Center. Those benefit from onsite medical specialists recovering from a brain injury or and higher levels of care to manage any neurologic disorder benefit from daily physical, occupational and speech continuing medical complications.” Individuals can admit to the IRU therapy, as the focus shifts from medical two ways: from another facility or as an stability to improving neurofunction inpatient at Nexus Specialty Hospital, and becoming stronger. neuro-trained and once medically stabilized and ready “Our for rehabilitation. In fact, 97% of IRU experienced therapists specialize in patients transfer from another unit the evaluation and treatment of our within the hospital. This continuation specific patient population,” explained of care was strategically developed and Trianna Warkentin, Board-Certified is the newest phase within the Nexus Specialist in Neurologic Physical Therapy. “That is crucial to helping Neurocontinuum. As the only complete patients function at the highest level neurocontinuum in the country, and improve their overall quality of life Nexus Health Systems provides physically, mentally and emotionally.” Patients in the IRU with deficits individuals with a patient-focused, and causes for abnormal movements tiered approach to care. Offering a variety of services and settings, from due to a disease or injury of the nervous a neurologic ICU environment to system have different needs than other community-based rehabilitation, patients. Multiple body systems are the Nexus Neurocontinuum helps affected which impacts vision and individuals function at the highest perception, senses, motor skills and cognition. Every patient presents possible level. “We utilize our care environments differently, which is why Nexus as a tool to advance patient outcomes,” believes in individualized treatment explained Dr. John Cassidy, Founder, plans tailored to the person’s specific CEO and CMO of Nexus Health and unique needs and goals. These Systems. “Our Nexus Neurocontinuum therapy plans challenge and actively spans multiple facilities and programs engage patients to cause permanent so our patients can receive care in improvement in their systems. environments that meet their current

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

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

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.

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Financial Forecast Choosing an Advisor to Aid in Your Financial Health By Grace S. Yung, CFP® , Managing Director Midtown Financial Group, LLC.


hoosing a financial planner is one of the most important decisions you will make in your life. That is because you are engaging someone who you will build a long-term relationship with over time to help you work towards your life goals and in turn, your financial security. But while many people in the industry may offer you “advice,” the reality is that not all financial advisors are created equally. They do not all have the proper training, skills, time-tested processes or competency. Additionally, they do not necessarily maintain suitable ongoing continuing education requirements to assist them in providing sound or up-to-date advice. That’s why choosing to work with a CERTIFIED FINANCIAL PLANNERTM, should be considered before you move forward. Why work with a CFP? Why work with a CFP? There are several reasons to do so, but one


main reason is that you will know the individual you choose, elected to take the time to further develop their knowledge base and skills by taking it upon themselves to go the extra mile to earn the CFP marks. This will give you, the consumer the confidence in knowing the individual(s) you chose is competent to serve you. CFP Experience & Education Requirements A CFP practitioner has to meet minimum educational requirements and must have a number of years of industry experience, as well as classroom prerequisites. This experience-related requirement can help to give you comfort in knowing that the advisor is proficient in diverse areas of financial planning and management, versus simply possessing “textbook” knowledge and process without actually working with clients and putting the strategies into action. CFP candidates are also required to pass a rigorous six-hour CFP Certification Examination which

tests both financial planning knowledge and ability, and it includes measurements in the areas of critical thinking and problem-solving ability (using real-life case studies / situations). An advisor must also possess at a minimum, a bachelor’s degree (or higher level of education from a college or university). Once a financial advisor has earned the CFP designation, they are required to complete regular continuing education (CE) courses. Many CFPs take it a step further and develop special areas of focus. For example, they may specialize in working with medical practice owners on personal planning, as well as business succession strategies or proactive care planning for individuals. CFP Ethical Requirements In addition to training on financial concepts and tools, a CFP must commit to high ethical and professional standards – both for the purpose of becoming a CFP and for maintaining the designation over time. This includes satisfying the CFP Board’s Fitness Standards, as well as committing to its “Code of Ethics and Standards of Conduct,” which set

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forth the ethical responsibilities that the advisor must use when working with consumers, as well as with their employer(s). A primary aspect of this Code is the CERTIFIED FINANCIAL PLANNERTM practitioner’s obligation to act as a fiduciary, which refers to acting in the best interest of the client at all times when offering financial advice and strategies. Choosing the Right Financial Professional Before hiring someone to help you with your financial goals, it would be a good idea to review their background, licenses, and experience, as well as determine the type of planning in which they may specialize. For more information, go to letsmakeaplan.org to learn more about CERTIFIED FINANCIAL PLANNERTM practitioners near you. 

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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,

Bleeding Stroke

Continued from page 8 Grotta, who is also Director of the Mobile Stroke Unit Consortium and a

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.”

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 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.

neurologist with Memorial Hermann Medical Group. The study will enroll patients that are picked up on the UTHealth Mobile Stroke Unit and brought to Memorial

Hermann -TMC and other hospitals in the Houston area. Participants in this study will receive either the medication or a placebo that contains no active medication. The research is funded by

the National Institutes of Health and is scheduled to begin in early 2021.


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Houston Medical Times



Continued from page 1 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.

Web Development Lorenzo Morales

Continued from page 1 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.

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.

Legal Matters

Continued from page 3 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, March 2021

Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo


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

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