BY MARY M. BEARDEN AND ALLISON SHELTON, BROWN & FORTUNATO, P.C. On March 26, 2013, the Office of Inspector General (OIG) issued a Special Fraud Alert regarding physician- owned entities. The Fraud Alert highlights the potential for abuse when a physician has an opportunity to earn a profit through an investment in an entity for which the physician can generate business. In the Fraud Alert, the OIG (1) outlines suspect features of physician-owned entities; (2) discusses policy concerns associated with such entities; (3) indicates that, under certain circumstances, hospitals that enter arrangements with physician-owned entities may violate the Medicare/Medicaid anti- kickback statute (AKS); and (4) highlights the risks associated with physician-owned distributorships. Repeatedly throughout the Fraud Alert, the OIG emphasizes that: “Longstanding OIG guidance makes clear that the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute.” According to the OIG’s interpretation of the AKS, if only one purpose of remuneration is to induce referrals, then the arrangement violates the AKS. To determine whether one purpose of an arrangement with a physician-owned entity is to generate illegal referrals, the OIG will look at the totality of the facts and circumstances, including operational safeguards, the details of an entity’s legal structure, and the conduct of all investors and other parties involved in the arrangement. With all physician-owned entities, the OIG has four general concerns. First, the physician’s ability to maximize a profit INSIDE ▼ The Leading Source for Healthcare Business News April 2013 • Volume 10, Issue 1 • $3.50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . INDEX ▼ Financial Perspectives.......3 THA...............................4 Technology.......................6 Special Feature..................8 Breaking Ground............ 10 Integrative Medicine........ 12 . . . . . . . . . . . . Financial Perspectives: Exceptional customer service: How to do it, see page 3 Huntsville Memorial Hospital Opens New Emergency and Imaging Center see page 10 PRSRT STD US POSTAGE PAID HOUSTON TX PERMIT NO 13187 SuperFoods Rx For Pregnancy see page 12 BY PETER ANDREW SACCO PH.D., AUTHOR, RIGHT NOW ENOUGH IS ENOUGH When individuals engage in substance abuse (alcohol, drugs, etc.) and they are unable to quit usage on their own even though they have tried repeatedly, but succumb to using again, they might be said to possess an addiction. Addictions are multi-faceted whereby they affect individuals in one or more ways; biologically, psychologically or socially. When the body develops withdrawal symptoms after the individual discontinues use, they are said to possess a physical tolerance (body needs it). The substance is in their blood stream and they need it to physically function in order to remove the side- effects of withdrawal. Conversely, when an individual craves a substance that leads them to suffer emotionally and/ or impedes their rational functioning without it, they are said to possess a psychological addiction. When prescribing drugs to patients it is important to understand that certain individuals possess addictive personalities, that have the potential to get addicted to certain types of drugs! Addiction and substance dependence is a slow, insidious process which develops over time through repeated use and eventual abuse of the drug of choice. When most addicts began using their substance of choice and using moderately, they were in control. When prescribed by a physician, they believe that the physician has their best intentions in mind. Since physicians practice “beneficence”, doing what is best for the patient, most patients Addiction: Overcoming addictions and bad habits...now! Please see ADDICTION page 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physician-owned distributorships remain on the Fed’s radar Please see LEGAL AFFAIRS page 13
Transcript
BY MarY M. Bearden and allison shelton,Brown & Fortunato, P.C.
On March 26, 2013, the Office of Inspector General (OIG) issued a Special Fraud Alert regarding physician-owned entities. The Fraud Alert highlights the potential for abuse when a physician has an opportunity to earn a profit through an investment in an entity for which the
physician can generate business. In the Fraud Alert, the OIG (1) outlines suspect features of physician-owned entities; (2) discusses policy concerns associated with such entities; (3) indicates that, under certain circumstances, hospitals that enter arrangements with physician-owned entities may violate the Medicare/Medicaid anti-kickback statute (AKS); and (4) highlights the risks associated with physician-owned distributorships.
Repeatedly throughout the Fraud Alert, the
OIG emphasizes that: “Longstanding OIG guidance makes clear that the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute.” According to the OIG’s interpretation of the AKS, if only one purpose of remuneration is to induce referrals, then the arrangement violates the AKS. To determine whether one purpose of an arrangement with a
physician-owned entity is to generate illegal referrals, the OIG will look at the totality of the facts and circumstances, including operational safeguards, the details of an entity’s legal structure, and the conduct of all investors and other parties involved in the arrangement.
With all physician-owned entities, the OIG has four general concerns. First, the physician’s ability to maximize a profit
INSIDE▼
The Leading Source for Healthcare Business NewsApril 2013 • Volume 10, Issue 1 • $3.50
Financial Perspectives: Exceptional customer service: How to do it, see page 3
huntsville Memorial hospital opens new
emergency and imaging Center
see page 10
PRSRT STDUS POSTAGE
PAIDHOUSTON TX
PERMIT NO 13187
superFoods rx For Pregnancysee page 12
BY Peter andrew saCCo Ph.d., author, right now enough is enough
When individuals engage in substance abuse (alcohol, drugs, etc.) and they are unable to quit usage on their own even though they have tried repeatedly, but succumb to using again, they might be said to possess an addiction. Addictions are multi-faceted whereby they affect individuals in one or more ways; biologically, psychologically or socially. When the body develops withdrawal symptoms after the individual
discontinues use, they are said to possess a physical tolerance (body needs it). The substance is in their blood stream and they need it to physically function in order to remove the side-effects of withdrawal. Conversely, when an individual craves a substance that leads them to suffer emotionally and/or impedes their rational functioning without it, they are said to possess a psychological addiction. When prescribing drugs to patients it is important to understand that certain individuals possess addictive personalities, that have the
potential to get addicted to certain types of drugs!
A d d i c t i o n and substance dependence is a slow, insidious process which develops over time through repeated use and eventual abuse of the drug of choice. When most addicts began using their substance of choice and using moderately, they were in control. When prescribed by a physician, they believe that the physician has their best intentions in mind. Since physicians practice “beneficence”, doing what is best for the patient, most patients
Addiction: Overcoming addictions and bad habits...now!
Why should you strive to give exceptional customer service to your patients? Why not just good? The answer is that most patients often have a
hard time differentiating between similar services offered by different physician medical practices, but they can readily differentiate between different levels of service.
One reason for this is because exceptional service – that is, service that exceeds their expectations and exceeds what they have received elsewhere – elicits an emotional reaction, and emotions imprint in our memories.
Patients have very good and very long memories with respect to customer service, and this is what makes a practice “referable.” If you are not getting a lot of new patient referrals from patients (depending on the specialty of course), then there may be
a problem with customer service in your office. So here are some ideas for elevating your patient customer service from good to exceptional:
It starts at the front deskThis is a new patient’s first contact with the office and how established patients continue to interact with the office, we all know this. These interactions include telephone and in-person contacts. Are these interactions friendly? Do these interactions make it easy for a patient (ex. Scheduling an appointment, registration, etc.). Finally, what about your waiting room? If a patient has to sit there for a while waiting to get in to see the doctor, how is their experience? Is there a flat screen TV in the waiting area? Do you offer free Wi-Fi? You get the point.
Spruce up that websiteI can always tell how progressive a physician practice is just be looking at its website. In this day and age, websites that really interact with patients is a must in my opinion. The following are some of the most “modern” features I have found on physician websites, all being HIPAA compliant:• Secure online bill pay.• Appointment reminders and lab results
messages.• Patient registration, demographic and
health history completion online.• Completion of a history of present
illness prior to the visit.
• Shared patient communication between practices. Practices that refer patients to a specialty practice can make that referral electronically and can follow-up on the patient’s progress via the portal.
• “Chat with a Biller” or “Chat with a Collector” function.
• Appointment requests and requests for prescription refills.
• Credit card payments without the use of a credit card machine; online payment plans that automatically drafts the patient’s credit or debit card monthly.
• Patient refunds via the web portal.
View patient complaints as giftsOne of the most valuable gifts your patients can give you is a complaint – even if it isn’t the most pleasant gift to receive. That’s because when patients complain they’re telling you what you need to do to keep them as a patient. Patients who complain are trying to work with you to resolve any issues between you.
Practice active listening When you receive a complaint – or just a suggestion – from a patient, stop everything and listen carefully. Show the patient that you are listening with words like I see … yes … okay and nonverbal cues such as nodding and eye contact. Ask questions as needed for clarification and to get more information. Take notes as appropriate.Partner with your patient to find a solution
to the problem. Make sure your employees are using language that says we are in this together. For example:• Let’s see what we can do to fix this.• I know you’re upset, but I will work
with you to solve this.• We have options. Here are some of
them.
Train your employees to use solution-oriented language that suggests that a solution exists, and you will find it for them or with them. For example:• I will take care of this for you.• I can assure you this will be resolved.• I will keep you posted as soon as I learn
something.
Always focus on the positive. For example:• Instead of saying Our policy is … say
This is what we can do • Instead of saying I don’t know say I’ll
find out for you. • Instead of saying You need to talk to
say Let me get someone who can help.
Employees, management, and all providers should always thank patients for their input and tell them how helpful it will be for improving the situation in the future. So always remember this - Once a new or established patient makes an appointment with your office, be sure you keep them coming back by wowing them with your office’s great customer service. t
FinanCial PersPeCtiVes
. . . . . . . . . . . . . . . Exceptional customer service: how to do it
discussion on texas solution meaningful opportunity for texas
special to Medical Journal – houston BY dan stultz, M.d., FaCP, FaChe, President/Ceo, texas hospital association
Texas legislators this month began turning up the volume on the issue of Medicaid expansion, which could flow more than $65.6 billion in federal funds to Texas over the next 10 years while requiring about $18.6 billion from the state.
Texas hospitals appreciate state leaders for their willingness to consider innovative, flexible solutions to serving the Medicaid population. As proposed in other states, a variety of options exist for Texas to create its own unique Texas Medicaid solution. We also believe the federal Affordable Care Act provides a more expeditious pathway to reform short of waiting on the federal government to approve a state block grant of the entire program.
The need is significant.
Currently, a quarter of our state’s residents are uninsured, putting pressure on employers and their employees to cover uncompensated care costs through higher health insurance premiums. Expanding coverage reduces pressure on Texas business owners in a variety of other ways as well. The most important is its ability to decrease $448 million in penalties from “shared responsibility” payments employers will face for not offering health insurance benefits to employees. We also know that employees with health coverage have better access to primary and preventive services, which improves health and reduces medical expenses. Covered employees also have improved health outcomes, which leads to lower absenteeism and increased productivity.
Taking this step to reform Medicaid would get more Texans the preventive care they need before an emergency arises while helping to relieve the stress on emergency rooms that often are faced with patients in
need of routine care. In addition, it would help get workers back on their feet faster as their access to quality care improves.
Although Texas hospitals recognize concerns with the current Medicaid program, Texas is a national leader for its work with the state to move most of the acute care program into a private-market managed care model. This ensures access to primary care services and better care management. Additionally, the Medicaid 1115 Transformation Waiver provides incentives for hospitals to invest in primary care and mental health capacity in their communities that will improve access to quality care and divert costly inappropriate emergency room utilization.
Medicaid expansion equals coverage expansion, and the funding will --- no doubt --- help Texas hospitals. In the broader view, though, Medicaid expansion is the right thing to do for Texas, and a growing chorus of Texans is speaking up. A recent survey of Texas voters shows a strong majority of Texans in favor Medicaid expansion.
Additionally, the current opportunity to work with the federal government to create a Texas solution using Medicaid expansion funding will create greater access to health care for working Texans, many of whom are gainfully employed but cannot afford health care coverage in the private market.
We believe there is a path to Medicaid expansion.
It’s a path to shared responsibility. ... to put a Texas solution in place that works with federal programs.
... to place safeguards that ensure the federal government maintains its commitments.
... and to include patient accountability.
Texas hospitals urge Gov. Perry and other Texas leaders to allow this dialogue, to seriously research what could be allowed by CMS to expand coverage in Texas. It’s the right way to ensure coverage to reduce uncompensated care ... but at the end of the day, it’s the right thing for everyone.. t
23510 Kingsland, Phase I of the development, is centrally located on the northwest corner of Kingsland Boulevard and Cobia Drive. The site was selected based on its close proximity to five major hospital systems, great accessibility to Grand Parkway and Interstate 10 as well as its position within a high growth suburban area.
telesleep at houston Va: a new source of support for veterans The Michael E. DeBakey VA Medical Center (MEDVAMC) is providing care to Veterans with sleep related breathing disorders in its rural areas with telemedicine technologies. Telesleep provides Veterans at the MEDVAMC community outpatient clinics in Lufkin, Beaumont, Conroe, Richmond, Lake Jackson, Galveston and Texas City with faster diagnosis and treatment options for sleep related breathing disorders such as obstructive sleep apnea.
Obstructive sleep apnea (OSA) is one of the most common types of sleep disorders. It occurs when the upper airway becomes narrow as the upper airway muscles relax naturally during sleep. In OSA, breathing stops or becomes very shallow. This type of event may happen hundreds of times each and every night. This reduces oxygen in the blood and causes arousal from sleep. The low oxygen is the main reason for other medical problems such as heart diseases.
A major symptom is extremely loud snoring, sometimes so loud that bed partners find it intolerable. Other indications that sleep apnea may be present are obesity, persistent daytime sleepiness, bouts of awakening out of breath during the night, and frequently waking in the morning with a dry mouth or a headache. A patient with OSA usually wakes up feeling un-refreshed and tired. Only a sleep study in a sleep laboratory or
home sleep testing can show definitively that sleep apnea is present and determine its severity.
Veterans who are identified by their primary care physicians as candidates for a sleep study are scheduled for a group diagnostic session at their respective clinic. The session is conducted through video conferencing with a sleep physician and a health technician at MEDVAMC. Each Veteran is assigned a home sleep testing kit and trained on how to properly use it for a period of sleep of at least 4-6 hours. The device is returned to the health care provider as soon as possible, and the data is extracted from the device and sent to the sleep physician for evaluation and diagnosis.
Upon diagnosis of OSA, if the patient’s OSA is not complicated by other illnesses, the Veteran returns to the clinic to receive their Positive Airway Pressure (PAP) machine. PAP is administered at night during sleep through a nasal or facial mask held in place by Velcro straps around the patient’s head. The mask is connected by a tube to a small fan-generated air flow machine about the size of a shoe box. The PAP machine increases air pressure in the throat so that the airway does not collapse when one breathes in. The air pressure is adjusted as needed after evaluation by the sleep physician.
“Untreated, OSA is associated with high blood pressure, heart failure and other cardiovascular diseases, stroke, memory problems, weight gain, impotence, and headaches. Fortunately, sleep apnea can
teChnologY
. . . . . . . . . . . . . . .
Please see TECHNOLOGY page 15
DIAGNOSIS DEFINED
IHC
Flow Cytometry
Cytogenetics
FISH
Molecular Genetics
CTC
For more information callApplied Diagnostics at 713-271-4133or visit www.applieddiagnostics.com
1140 Business Center Drive, Houston TX 77043
Applied Diagnostics is a fully integrated laboratory specializing in hematologicalmalignancies and molecular diagnostics.
By performing all critical testing in its Houstonfacility, Applied Diagnostics ensures better:
Specimen integrityTurnaround times, andConsultative support
√
√
√
Bayside Surgical and Medical Center4001 Preston Avenue, Pasadena, Texas 77505
respiratory therapist, st. hilaire saint Firmin, rrt, demonstrates the proper fitting for the Positive airway Pressure (PaP) machine to Veterans at the outpatient clinics
THe area’S Premier DeveLOPer, Johnson Development briNgS yOU...
free aDmiSSiON • WeeKeNDS iN aPriL ONLy!johnsondevelopment.comfind more info at Homes from the $150s -1 Millions+
Creating environments that celebrate life.
7 cOmmUNiTieS . 84 mODeL HOmeS . 327 avaiLabLe HOmeS . 20,001 DecOraTiNg iDeaS
Build your dream in Sienna Plantation. Just a 5 minute drive to Fort Bend Parkway,22 minutes to the Texas Medical Center. New sections are now open, featuring homes from the $550’s.For more information please contact: Jeff Lombardo at 281.778.1996.Visit our new model in the heightS at Sienna Plantation.
Dream BIG.SiennaPlantation.com l PartnersinBuilding.com
68 Tall Trail . 4317 Sq. Ft. . $697,900March/april Move in
7119 Sentinel Falls . 4037 Sq. Ft. . $724,900March/april Move in
Whether you prefer local beers, imports, or hard-to- find brews, Spec’s selection is huge!
From cans to kegs, you’ll find what you’re looking for are your on-the-way, less-to-pay for
everyday store! CHEERS TO SAVINGS!®
DECISIONS,DECISIONS,
Lower Prices, Bigger Selection!
LOCATIONS ALL OVER THE HOUSTON AREA specsonline.com • TEXAS SUPERSTORESm (888) 526-8787
®
®
sPeCialFeature
. . . . . . . . . . . . . . .
When do I start Stage 2 of meaningful use?
BY dr. daVid nilasena, Chief Medical officer, Centers for Medicare and Medicaid services’, southwest region On Aug. 23, 2012, the Centers for Medicare & Medicaid Services published the final rule for Stage 2 of the Medicare and Medicaid electronic health record incentive programs. The rule provides new criteria that eligible professionals, eligible hospitals and critical access hospitals must meet to participate in the incentive programs. Stage 2 Timeline In the Stage 1 meaningful use regulations, CMS established a timeline that required providers to progress to Stage 2 criteria following two program years under the Stage 1 criteria. This original timeline would have required Medicare providers who first demonstrated meaningful use in 2011 to meet Stage 2 criteria in 2013. However, CMS delayed the onset of Stage 2
requirements. Now, the earliest that Stage 2 will be effective is fiscal year 2014 for eligible hospitals and critical access hospitals or calendar year 2014 for eligible professionals.
The table below illustrates the progression of meaningful use stages based on the year a Medicare provider begins participation in the program. Note that providers who were
early demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in 2014. All other providers would meet two
years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year.
Resources For more information on Stage 2, please visit the CMS website at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html If you have not participated in the Medicare or Medicaid electronic health record incentive programs, or if you have never achieved meaningful use under the Stage 1 criteria, please visit the CMS website at www.cms.gov/EHRIncentivePrograms for more information about how to take part in the program. t ………………… As the chief medical officer of the Centers for Medicare & Medicaid Services’ Southwest region, Dr. David Nilasena, MD, MSPH, MS, has helped a broad range of health care provider groups understand the requirements of the electronic health record incentive programs since their inception in 2011.
The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with
patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical
malpractice insurer. And, local physician advisory boards across the country. Why do we go this far?
Because sometimes the best way to look out for the doctor is to start with the patient. To learn more about
our medical malpractice insurance program, call (800) 686-2734 or visit www.thedoctors.com.
Donald J. Palmisano, MD, JD, FACSBoard of Governors, The Doctors CompanyFormer President, American Medical Association
We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company.
huntsville Memorial hospital opens new emergency and imaging center in Madisonville
Huntsville Memorial Hospital is excited to announce that the doors for their new Emergency and Imaging Center in Madisonville, Texas are officially open.
“Huntsville Memorial Hospital is committed to providing high quality, accessible services throughout the Huntsville and Madisonville area. The new Emergency and Imaging Center will offer area residents convenient access to emergent care in areas where such services were not immediately available,” says Shannon Brown, Chief Executive
Officer of Huntsville Memorial Hospital. “This new facility will offer a full range of round-the-clock emergency services to adults and children in the Madisonville area. This endeavor is consistent with our 86-year tradition of providing high quality patient centered care and accessible health services.”
Huntsville Memorial Hospital, a Joint Commission-accredited, not-for-profit acute care community hospital, is partnering with TeamHealth to staff the new facility with highly trained emergency room physicians. TeamHealth also staffs Huntsville Memorial Hospital’s main emergency department, which should assist with provider availability in times of high volume. “This Emergency Center will operate just as an emergency room in a hospital facility, complying with all of the same requirements for hospital-based emergency departments,” said Tracy Campos, Director of Emergency Services for HMH.
The Madisonville Emergency Center will be open 365 days a year, 24 hours per day and handle all types of emergencies from chest pain to stroke symptoms and high blood pressure to general children’s emergencies. Patients requiring inpatient hospital care will be transferred to Huntsville Memorial Hospital. The facility’s staff of highly trained emergency physicians, nursing, and clinical staff have been preparing for the grand opening sine HMH broke ground in August of 2012. This Center is fully equipped just like any hospital emergency department, including comprehensive imaging services. “Outpatient imaging and laboratory services are available as well,” said Jason Loftin, Director of Imaging Services for HMH. “We will have pre-scheduled and
walk-in appointments available for our Imaging Center side of the facility every weekday from 8 am to 5 pm. Our state-of-the-art diagnostic technology includes a CT scanner, ultrasound, and digital x-ray,” said Loftin.
“We anticipate this facility will fulfill a need for an emergency room close to home,” Brown said. “Our quality physicians and nursing staff are committed to consistently exceeding patient expectations. We would like to thank the local community for their support thus far and thank them for trusting Huntsville Memorial Hospital for their healthcare needs.”
Huntsville Memorial Hospital’s new Emergency and Imaging Center is located at 3301 East Main Street in Madisonville, across from Bucees. HMH is committed to providing an alternative to today’s overburdened hospital emergency department with the highest standard of care and customer service. t
From US-59 in Sugar Land take Hwy 6 south 3 miles . 281.499.8700
Ft. B
end
Pkw
y
8
Will
iam
s Tr
ace
59 Universit y Blvd.
90
6
showcase near university blvd and lJ Parkway
In compliance with the Internal Revenue Code sections 6113 and 6710 and related rules and regulations, all advertising and promotional materials for the Show House will include express and conspicuous statement that “Contributions or gifts to the Texas Gulf Coast Chapter of the American Society of Interior Designers and/or the 2013 ASID TGCC Show House are not tax deductible.”
Tickets are $12 in advance or $15 at the door . Online at ASIDtgcc.org
BY ViCtor s. sierPina, Md, aBFP, aBihM, distinguished teaching Professor, Family and integrative Medicine, utMB health
If you as a health professional are concerned about increasing rates of infertility, premature birth, children with neurological conditions such as autism spectrum and attention deficient disorders, obesity, and diabetes, you are not alone. Many scientists have determined these problems have been increasing rapidly over the last decade and longer.
No single causative agent has been found. However, factors such as brain injury, genetics, behavioral, environmental, and social problems all play a likely role.
A root to some these problems is likely to be traced to pregnancy, when our next generation is most vulnerable. For example, insecticides are essentially neurotoxins. Once they enter the food supply, and their
mother’s bodies, it seems likely that their neurotoxicity may be a risk to a developing human nervous system, so much more complex than that of an arthropod. Studies of cord blood in newborns have shown over 200 xenobiotics and chemicals, and new to nature molecules that bathe the emerging infant. Do we really understand the impact of these on growth, development, and fertility?
Helping us to sort this out and promote healthier babies is a new book by the best-selling author of SuperFoods Rx, Dr. Steven Pratt. An ophthalmologist by training and current practice, Dr. Pratt has made an intense study of the benefits of lifestyle and healthy eating published in several popular books.
His latest work, SuperFoods Rx for Pregnancy: The Right Choices for a Healthy, Smart, Super Baby may seem a long stretch for an eye specialist but it is filled with practical and well-researched suggestions. Among these are the not so radical ideas that problems in the ability to conceive, to have a healthy pregnancy, and a healthy baby are primarily linked by several common causes: nutrition, lifestyle, and environment.
To put it elementally, we are living very different lives than our ancestors whose diet was mainly whole, home-cooked foods,
without the chemicals that are part of our contemporary environment. Meat and fish was farmed locally or hunted from the wild. Vegetables were gathered or raised in a less chemicalized setting. In the past, babies were all breast-fed and obesity in adults or children was rare. Parents and children were more physically active. Daily stress levels were very different.
Our environment has changed radically. Foods are now highly processed, pesticides and insecticides in them are common, chemicals from plastics disrupt vital hormonal pathways, and nutrient deficiencies alter expression of genes and increase birth defects.
Commonly used chemicals to manufacture omnipresent plastic products include BPA, PCB, and phthalates interrupt hormonal signals, essential to fertility and healthy babies. Some of these chemicals banned for decades, like PCB and insecticides like DDT, or heavy metal like lead remain in our environment as potent neurotoxins and endocrine disruptors.
So let me walk you through this book so you get a sense of the topics. Part 1, Before You Get Pregnant, has four chapters dedicated to help improving fertility, improving the newborn’s environment even before conceiving, preparing your body for baby and a robust, pre-pregnancy
nutrition program. These chapters are heavy on lifestyle, healthy superfoods, and detoxifying the environment, including the uterine environment.
Part 2, While Baby Is in Your Belly further explores proper diet and lifestyle choices while pregnant and eating for two. This section has in depth nutritional advice including nutrient content of common foods, specific brand names for healthier and organic food choices, and excellent detail on environmental toxins, drugs, prescriptions medications, alcohol and their impact on the fetal environment.
Part 3 is cleverly called the The Fourth Trimester and supports the well-known benefits of breast feeding for both baby and mom. Sleep, post-partum depression, stress, and physical activity are all covered in a welcome and refreshing fashion.
As in the preceding sections, excellent coverage is given to physiology and scientific research while keeping it accessible to the lay audience. Still, it is great refresher for physicians, nurses, midwives, and others that work with pregnancy and offers the kind of language and specific suggestions that anyone interested in conceiving and raising a healthy child will appreciate.
through referrals to an entity in which the physician has an ownership interest may corrupt the physician’s medical judgment. The OIG is concerned that this potential for monetary gain may lead a physician to order products and services that are not medically necessary. Likewise, such arrangements that do not contain sufficient safeguards can result in overutilization and increased costs to patients and federal health care programs. Finally, the OIG is concerned that such arrangements lead to unfair competition.
Many states, including Texas, attempt to reduce the likelihood of fraud and abuse by enacting statutes that require a physician, when referring a patient, to disclose to the patient the physician’s interest in the entity receiving the referral. The OIG emphasized that such disclosures do not sufficiently reduce the risk of fraud and abuse, however. According to the OIG, such disclosures can be manipulated to serve as a promotion of the physician-owned entity and its products and services. For example, a physician may disclose an interest by saying, “As an owner of this company, I know the quality of the products.” Such disclosures cause a patient to trust the physician’s referral rather than question whether the physician is acting in the patient’s best interest.
In the Fraud Alert, the OIG highlights a certain type of physician-owned entity—i.e., a physician-owned distributorship (POD). PODs are entities that sell, distribute, and/or manufacture medical devices that are implanted through surgical procedures. Over the past few years, the number of PODs throughout the United States has grown substantially. According to the OIG, such entities “are inherently suspect under the anti-kickback statute” because: (1) the risks associated with investing in PODs are generally low; (2) physician owners can realize a high rate of return; and (3) a physician has a significant amount of discretion over the implantable device used when the physician performs a surgery in a hospital.
Since 2006, PODs were on the federal government’s radar. On October 6, 2006, Vicki Robinson, Chief for the Industry Guidance Branch of the OIG, issued a letter regarding PODs. In the letter, she indicated that the OIG’s 1989 Special Fraud Alert regarding joint ventures applied to PODs. She also stated that such entities should be closely scrutinized because they present a “strong potential for improper inducements between and among the physician investors, the entities, device vendors, and device purchasers.” Two years later, on February 27, 2008, OIG representative, Gregory Demske, testified before a special committee of the Senate that PODs “raise substantial concerns that a physician’s return on investment from the venture may influence the physician’s choice of device.”
On June 9, 2011, the Senate Finance Committee released a report concerning PODs. The Ranking Member Orin Hatch
(R-UT) was quoted in the report’s press release as saying: “The financial incentives created by these entities set a dangerous precedent that, as indicated in this report, can lead to serious overutilization and force unnecessary, invasive procedures for patients.” On the day the report was released, five senators from the Committees on Finance, Aging, and Judiciary issued a letter to the OIG. In the letter, the senators indicated that the OIG’s guidance on the topic of PODs “is not sufficient.” They also stated “that guidance alone, in the absence of any visible enforcement proceedings, may be insufficient to stop the growth of those entities that do not appear to be structured with the appropriate safeguards.”
On September 13, 2011, the OIG issued a letter responding to the senators’ concerns. In the letter, the OIG emphasized its commitment to enforcement actions and promised a report analyzing the impact of PODs on the health care industry. The OIG also explained that, because the AKS is an intent-based statute that depends on the facts and circumstances of a particular case, a one-size-fits-all rule pertinent to every form of POD is difficult to develop.
True to its word, the OIG indicated in its Work Plan for FY 2013 that the OIG will issue a report concerning PODs that provide spinal implants to hospitals. Also,
the recent Fraud Alert expands upon the suspect characteristics identified in the 1989 Special Fraud Alert to highlight certain questionable factors relating to PODs. The questionable factors listed by the OIG include: (1) the size of the investment offered to a physician depends upon the volume or value of referrals the physician is expected to generate for the POD; (2) profit distributions are not proportional to the physician’s ownership interest; (3) investors pay different prices for the identical ownership interests; (4) physician-owners of PODs overtly or covertly condition referrals to hospitals on the purchase of the POD’s
Patients and families at HealthSouth Rehabilitation Hospitals hear a lot about a higher level of care. What does this mean to
you? Our rehabilitation teams work with patients and their families, providing superior care with quality outcomes to return patients to maximum independence at home and in the community.
To a patient recovering from an illness, injury or surgery, a higher level of care means:
• Personalized goals for a faster return home• Comprehensive team approach to rehabilitative care• Advanced technologies for the latest treatments• Physician visits every day• Three hours of therapy over a day, five days a week• 24-hour certified rehabilitation nursing care
For a higher level of care, choose a rehabilitation leader that makes a difference for patients and families. Choose HealthSouth Rehabilitation Hospitals.
The final section, Part 4 is very practical with shopping lists, recipes, and information about supplements.
The book is coming out in April or May from Wiley Press and can be preordered at http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118129547.html.
In the meantime, here are some key points from SuperFoods Rx for Pregnancy to improve fertility, to have a healthier pregnancy, and a healthier baby for you, your family, or your patients:
Eat more SuperFoods (and their related food friends) for optimal health before, during, and after pregnancy. This applies to both mothers and fathers. Buy organic and local when you can. Avoid environmental toxins that could have a negative impact on your baby’s health in the womb including heavy metals, BPA, BPS, PCB, phthalates, pesticides, insecticides. Eat organic foods whenever you can and detox your home environment.
Look up the “Dirty Dozen” and the “Clean Fifteen” of foods with higher or lower levels of environmental toxins. Use house plants to detoxify your home and use non-toxic cleaning supplies.
Maintain a healthy weight, “exercise any day that you eat,” avoid giving alcohol to underage children such as your fetus, and don’t smoke (anything).
Following these common-sense principles will result in an increased chance that you, your kids, or your patients can conceive, bear, and raise a healthy child and will personally live long and well enough to enjoy the grandchildren. I heartily recommend it to anyone in their childbearing years. t
NOTE: Portions of this article were previously published in the Galveston County Daily News.
products; (5) physician-owners are pressured to arrange for the purchase of the POD’s products; (6) the POD will repurchase an owner’s interest in the event the physician does not generate sufficient business for the POD; (7) the POD is a shell entity; (8) the POD does not actively oversee all distribution functions; (9) physician-owners do not disclose their interest in PODs to hospitals; (10) the POD exclusively serves the physician-owners’ patients; (11) the POD has a small number of investors
which enables a physician-owner’s return on investment to strongly correlate with the physician’s referrals; and (11) physician-owners alter their medical practices around the time that they invest in a POD.
At the end of the Fraud Alert, the OIG indicated that “because the anti-kickback statute ascribes criminal liability to parties on both sides of an impermissible ‘kickback’ transaction, hospitals . . . that enter into arrangements with PODs also may be at risk under the statute.” When the OIG considers an arrangement between a POD and a hospital, the OIG will look for any evidence that the hospital purchased products from the POD in order to “maintain or secure
referrals from the POD’s physician-owners.”
Physicians often request that hospitals purchase items or services from entities owned by the physicians. To ensure that hospitals are not involved in an impermissible transaction, hospitals should adopt and enforce policies that require physicians to disclose any financial interests that could potentially create a conflict of interest. Also, hospitals should adopt and implement procedures designed to ensure that the hospital’s decision to enter into an arrangement with a physician-owned entity is a commercially reasonable, good faith decision based on concerns for high quality health care and patient safety. t
believe that using the drugs they are prescribed is “good”! They do not worry about getting addicted to the script!
Physicians need to be aware or at the very least inquire about a patient’s lifestyle and substance usage, especially if they are prescribing pain killers, stimulants or depressants to their clients. As patients use their drugs with frequency, even having increased doses of the substance, their ability to moderately manage their intake and control over the use of the substance diminishes when they possess an addictive personality. Furthermore, some studies show that when someone engages in drugs or substance use for 21 days, they have the propensity to turn it into a lifestyle and continue use, even when they do not need it for medicinal reasons. When they get to this point they may not control their substance use any longer. Instead, the withdrawal symptoms and cravings took control over their daily lives.
In my new book Right Now Enough Is Enough, I tackle the underlying issues which keep so many people “addicted” or habituated to their bad habits. I use a process
derived from 10 years of research working with those in recovery, still suffering from addictions, mental health professionals and addiction professionals that literally hits home and gets people onto prospective roads to recovery...fast! it’s all about getting at the root of bitter resistance!
Whenever an individual chooses to quit using their substance of choice either by going “cold turkey” (quitting immediately) or going into a detoxification program they are often likely to develop symptoms of withdrawal. When the body has developed a tolerance to a substance, the individual is physiologically addicted to the substance. Individuals experience unpleasant, even violent symptoms in their bodies due to quitting. If you are prescribing drugs to help patients get off of the “withdrawal” symptoms, you need to moderate what your patients are doing with this lately drug. They may use it as a substitute and get hooked on it.
When an individual is able to quit with minimal or no disruptive bodily sensations, rather experience intense or violent changes in their moods, they are most likely addicted to their substance of choice at a psychological/mental level. The ability to eliminate the toxicity and need from their bodies is more easily achieved than those with physiological addictions. Individuals
with physiological addictions may slip and use their substance of choice again because they feel the need to alleviate a physical symptom. Conversely, individuals with psychological addictions to substances may use again after a “slip” as a form of escapism, instant gratification “high”, or to cope mentally with psychological stress. Note that some patients will use their pain killers for physical problems to numb/mask their psychological discomforts. Through repeated use, they learn that this works. What you may have prescribed for pain management/moderation now becomes the drug of choice for abuse and addiction!
The best means of treating one’s addiction is to encompass all aspects of the individual’s being, bio-psycho-social, so no area is left out. By focusing on all areas, you provide the best optimal treatment plan and focus on the individual as a symmetrical being. Doctors need to start recognizing patients are more than just bodies and bring into recognition the mind-body connection in the healing process. It is also important to identify individuals to begin using medications designed to treat the body whom abuse it to “treat the mind”!
To learn more about RIGHT NOW ENOUGH IS ENOUGH! and take the addictions and/or co-dependency tests, visit www.rightnowenoughisenough.com t
be diagnosed and treated,” said Amir Sharafkhaneh, M.D., Ph.D., medical director of the MEDVAMC Sleep Disorder Center. “Telesleep allows the Veterans the ability to be evaluated in the comfort of their own home in a more timely and efficient manner. Being able to provide this service in the community clinics is just another example of taking the care to where the Veteran lives,” said Sharafkhaneh.”
huntsville Memorial hospital adopts new strategy for revenue cycle management
In an effort to meet the financial demands of an ever-changing healthcare environment, Huntsville Memorial Hospital has announced that they have entered into a five year agreement with Parallon Business Solutions; a leading provider of healthcare business and operational services. Through the agreement, Parallon is providing Huntsville Memorial Hospital with patient access oversight and complete back-office functions, including: billing, collections and cash posting, support services and payment compliance and denials management. Parallon operates the largest and most advanced revenue cycle shared services model in the industry, offering full-service
solutions from patient registration through account resolution for facilities in 24 states.“One of the key drivers in working with Parallon is its expertise in creating a sustainable operational model that will help us advance our mission to care for our community,” said Shannon Brown, chief executive officer at Huntsville Memorial Hospital. “We are confident that Parallon’s scale, full suite of services and proven best practices will help us identify significant improvement opportunities to net revenue and reductions in cost to collect.”
One key component of a hospital’s robust finance team is the Director of Patient Financial Services. This position is crucial to providing one-on-one consultations with any patient regarding questions or concerns with billing. Today, Brown announced that they are “promoting from within to fill this position” and proudly stated that Chyrel Evans, the current hospital registration manager is “HMH’s top candidate and the person for the job”.
st. luke’s sugar land hospital goes “3-d” in Fight against Breast Cancer
St. Luke’s Sugar Land Hospital (SLSL) recently announced that its advancing early diagnosis and detection of breast cancer with a new 3-D digital mammography unit, which provides an extremely precise, clear picture of small, often undetected tumors.“By offering the latest technology in mammography, St. Luke’s Sugar Land is
committed to increasing the number of women in our area who will receive routine breast cancer screenings,” said Rob Heifner, Chief Executive Officer, SLSL. “With statistics showing that one in eight women will develop breast cancer sometime in her lifetime, early detection plays a crucial role in improving a woman’s chance of survival.” This particular 3-D digital mammography system is available in only 100 sites in the United States, including two St. Luke’s hospitals in Sugar Land and The Woodlands. It applies breast tomosynthesis, an advanced technology for radiologists to identify and characterize individual breast structures. During a tomosynthesis exam, multiple images of the breast are acquired at different angles. These images are then used to produce a series of one-millimeter thick slices that can be viewed as a 3-D reconstruction of the breast.
texas physician breaks ground in robotic cervical surgery
Performing surgery on a pregnant patient is a delicate matter. Risks to both mother and baby must be carefully weighed in every decision a surgeon makes. Recently, at the University of Texas Medical Branch at Galveston, a surgeon performed a groundbreaking robotic laparoscopic procedure on a 35-year-old pregnant patient whose cervix was too short to sustain a pregnancy.
Dr. Sami Kilic, chief of minimally invasive
gynecology and research at UTMB, is the first surgeon in the world reported to have used robotically assisted, ultrasound-guided laparoscopic surgery to successfully tighten a pregnant patient’s incompetent cervix. The procedure is explained in a new paper now online in the Journal of Minimally Invasive Gynecology. When performed traditionally, abdominal cerclage surgery requires a large incision and a long period of recovery. Kilic’s new procedure left the patient with only three tiny abdominal scars.
Stitches to the cervix during surgery must be precise; a suture placed a hair’s breadth the wrong way can puncture either the amniotic sac or a major blood vessel in the mother. With the dual visualization screen of the da Vinci Si robotic surgical system, Kilic was able to view a real-time ultrasound image on one screen and the operative field via scope camera on another screen, side by side; at the same time he performed the surgery. This two-screen system offers unsurpassed visualization in a laparoscopic surgical situation.
The surgery lasted two hours, and the patient was discharged after a one-night stay in the hospital. An ultrasound performed two weeks later confirmed the cerclage had been placed properly. The patient proceeded to have an otherwise uncomplicated pregnancy, going into labor at 36 weeks. Other authors of the paper include UTMB Drs. Teresa M. Walsh, Mostafa A. Borahay and Karin A. Fox. t
We continually push the boundaries of neuroscience.At the Mischer Neuroscience Institute at Memorial Hermann–Texas Medical Center, we have a reputation for innovation. We were selected to participate in the nation’s first multi-center trial to study the use of hypothermia following head injury. We established one of the first dedicated stroke programs in the world. We orchestrate more clinical trials for new multiple sclerosis therapies than anyone in Texas. And we are leaders in performing complex spine surgeries and reconstructions. All of this is enabled by our groundbreaking affiliation with The University of Texas Health Science Center at Houston (UTHealth) Medical School. Together, we make more neuroscience breakthroughs every day. Learn more at neuro.memorialhermann.org.
