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1 Legal Affairs: Federal courts find no need to recognize a peer review privilege, see page The Leading Source for Healthcare Business News June 2012 Volume 9, Issue 3 $3.50 INSIDE UH students develop prototype device that translates sign language see page 10 INDEX Breaking Ground...3 Financial Perspectives...4 Legal Affairs...5 Healthcare Properties...6 Technology...10 Integrative Medicine...11 THA Patient centered medical home see page 11 PRSRT STD US POSTAGE PAID HOUSTON TX PERMIT NO With so many current issues and changes with healthcare reform, how do you keep your system focused on preparing for the future? Ronald A. DePinho, MD The University of Texas MD Anderson Cancer Center MD Anderson has been focused on its mission to eliminate cancer for more than seven decades, and we will not waiver from that commitment. We keep it in mind every time we ask ourselves: What s a better way of providing care, and how do we prove it s better? MD Anderson s culture always has been focused on the future with its outstanding clinical research and basic science programs. But looking ahead to a future of reduced reimbursements, tougher competition, rising costs and a mandate for enhanced public transparency, we ve added Please see ADMINISTRATOR SURVEY page 8

2 Medical Journal - Houston Page 2 June

3 Medical Journal - Houston Page 3 June BREAKING GROUND HCHD opens newest pediatric clinic in Bear Creek off Highway 6 The Harris County Hospital District recently opened its newest pediatric facility Pediatric and Adolescent Health Center- Bear Creek. The new location marks the hospital district s farthest expansion into western Harris County. More than 70 people attended a ribboncutting ceremony. Among the featured speakers included Harris County Commissioner Jack Cagle and HCHD President and CEO David S. Lopez. The new 7,000-square-foot facility has 12 exam rooms and is expected to treat about 10,000 patient visits annually. Among the services available to children up to the age of 18 are: Sports physicals Health education The center located at 5860 Highway 6, Suite 108, Houston, Texas, 77084, operates 8 a.m. 4:30 p.m. Monday through Friday. To accommodate all children needs, all forms of insurance including CHIP (children s state-subsidized insurance) and Medicaid are accepted. For appointments, call Skanska USA and Harris County Hospital District celebrate topping off of Westlands Ambulatory Care Center Skanska USA joined with Harris County Hospital District (HCHD) to celebrate the topping off of the new Westlands Woodchase Bldg II MeDIcaL OFFIce BuILDInG SurGery center MeDIcaL SuIteS available Cutting the Ribbon at the New Pediatric and Adolescent Health Center-Bear Creek, Celebrating the dedication of the Harris County Hospital District s newest pediatric facility Pediatric and Adolescent Health Center-Bear Creek are, from left, Harris County Commissioner Jack Cagle; Jackie Ryan, nurse manager, Pediatrics-Ambulatory Care Services, HCHD; Dr. Elizabeth Bosquez, medical director, Pediatric and Adolescent Health Center-Bear Creek, HCHD; Ken Janda, president and CEO, Community Health Choice; Ileana Perez, program manager, School-Based Clinics, HCHD; Christina Mintner, administrative director, Pediatrics, Ambulatory Care Services, HCHD; David S. Lopez, president and CEO, Harris County Hospital District; Linda DeClouette, project manager, Facilities Planning, HCHD. Behavioral health and psychiatry Well-child care Sick-child care Chronic disease management Newborn follow-up Immunization and vaccinations Laboratory Ambulatory Care Center and Garage at the LBJ General Hospital campus. The Westlands Ambulatory Care Center has been a fantastic partnership between Skanska and HCHD, said Charles Griffiths, Skanska project manager. Please see BREAKING GROUND page S Gessner Physicians Endoscopy Center (PEC) Surgery Center Amenities: Covered parking available Building signage available After hour HVAC Card key access Griff Jaggard Gjaggard@moodyrambinint.com (P) (C) For Leasing Information: Derek Beck Dbeck@moodyrambinint.com (P) (C)

4 Medical Journal - Houston Page 4 June FINANCIAL PERSPECTIVES When was the last time you reviewed your personnel manual from a legal standpoint? BY REED TINSLEY, CPA, CVA, CFP, CHBC While not intended as a legal document, did you know your personnel manual may have the force of an employment contract? If you haven t done so in a while, or not at all, review it to be sure it won t cause unintended problems. Like many other physician contracts, personnel manuals often do not get an annual review; they get stuck in a drawer never to be looked at again until an employee leaves the practice and a problem arises. Perhaps you think your personnel manual as some sort of low-key presentation booklet that describes policies and benefits for your staff. Unfortunately, it s often loaded with dynamite. A variety of court decisions have made this apparent. Be careful, for instance, how your manual describes the employment relationship. Nothing in it should imply that the staff member s role is permanent. I ve seen some manuals where it actually states that after an initial three months probationary employment, the position would become permanent; it s much safer to describe the employment relationship as becoming regular. As another means of assuring that you can fire an employee if dissatisfied with performance, have your manual specifically state that each staffer s employment is at will. The following helps make the point: The Practice retains its right to terminate employment with or without good cause; by the same token, you have the right to leave with or without good cause. Watch out, too, if your manual sets out a pre-firing procedure like a set of progressive disciplinary steps. Courts have held employers liable for wrongful discharge when those steps were not followed. In the same vein, language saying that discharge will only be for certain types of behavior ( for cause, for example) may make a termination illegal if you do not or cannot document that behavior. Statements of an employee s benefits can be held against you even if you had changed those arrangements. I recall a practice whose manual promised all regular employees term life insurance of one times salary. The doctors dropped the group s term life insurance contract, but the promise lived on in the manual much to their financial risk. Some attorney s I talk to suggest deleting from manuals all specific description of benefits. Instead, the manual should simply refer employees to the actual benefit plan documents. If you prefer describing benefits, here is a common protective statement I see including in manuals along these lines: The material in this manual represents our informal summary of benefits at the time of publication. Those benefits are under continuing review, and they are fully described in our formal summary plan descriptions and/or insurance subscription agreements. Refer to those sources for a full description of each plan s benefits and limits. If any provisions are inconsistent with this manual, the formal plan documents are controlling. We reserve the right to change or terminate any benefit plan at any time in accordance with the formal plan documents. As you can see, be sure to draft your personnel manual with real care. Be aware, too, that the law varies significantly from state to state on the entire subject of employee manuals and rights thereunder. I have seen offices hire a practice administrator from another state and that administrator then proceeds to revise the current manual based on where he or she came from. If you haven t reviewed your manual recently, I strongly suggest having it reviewed by your legal counsel - make sure it s legally correct, comprehensive, clear and relatively bulletproof. As I mentioned before, many manuals in existence today are ticking time bombs waiting to go off. You certainly don t want to create any undue problems for yourself and your medical practice. This issue not only applies to medical practices, but any healthcare organization that issues an employee manual to its workforce. Protecting your practice and your personal assets: 4 steps for savvy physicians BY JIM E. SLOAN,, President/ Founder, Jim Sloan & Associates Physicians who own and manage their own practice face a unique set of financial challenges throughout their working and retirement years. Acting as both business owner and employee, physicians must plan for business finances while still managing and planning personal assets. Please see FINANCIAL PERSPECTIVES page 13

5 Medical Journal - Houston Page 5 June LEGAL AFFAIRS Federal courts find no need to recognize a peer review privilege BY MARY M. BEARDEN and ALLISON D. SHELTON, BROWN & FORTUNATO, P.C. Peer review committees play an essential role in the improvement of the quality of patient care. Generally, peer review committees (1) evaluate a physician during credentialing to determine whether the physician should receive privileges at a health care entity; (2) address issues and complaints that arise when staff members fail to fulfill the responsibilities of their positions; and (3) analyze and respond to concerns regarding the quality of care provided to patients. To be effective, committees must have members who are willing to freely express their expert opinions on issues and hold the members of the medical staff to high professional standards. Unfortunately, medical malpractice suits tend to hinder the free exchange required for effective peer review. Recognizing that the medical profession is best suited to effectively regulate and police itself, state legislatures have established court privileges to protect and promote the peer review process. All fifty states and the District of Columbia extend privileges to peer review committees so that the members of such committees may freely engage in candid and frank discussions to improve the quality of patient care. The Texas Occupations Code establishes the peer review privilege for committees that evaluate quality of care or the competence of physicians. Other medical committees can also claim a statutory privilege under the Texas Health and Safety Code as long as the bylaws for the health care entity establish and regulate such committees. These privileges operate to maintain the confidentiality of communications and documents generated by the committee, its members, and any other person or group serving the committee. As a result, such documents and communications are not subject to disclosure in a court of law. Thus, when a malpractice claim is brought against a physician, the plaintiff may not obtain the peer review records from the physician, the committee, or the health care entity. Some limitations apply to the scope of the statutory privileges in Texas. First, the Texas Medical Board and the Department of State Health Services may access the records of committees. Next, a plaintiff in a lawsuit may use committee records obtained from some source other than the committee. Also, the privileges do not apply to documents and records maintained in the ordinary course of business, including patient charts. Finally, the privileges do not apply when federal law will determine the outcome of a case. When a privilege is not established by the Constitution, federal statute, or the Supreme Court, federal courts may find the existence of a privilege based on their reasonable interpretation of federal common law. Even though all fifty states have determined that peer review communications should be privileged, HealthSouth Offers a Higher Level of Care. here s how. the federal courts have not found the establishment of such a right for federal questions. The opinion in Adkins v. Christie provides a thorough explanation of the analysis federal courts apply to determine whether Please see LEGAL AFFAIRS page 14 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. HealthSouth Rehabilitation Hospital of Cypress Wortham Center Dr Cypress, TX HealthSouth Rehabilitation Hospital of Humble McKay Drive Humble, TX A Higher Level of Care healthsouth.com HealthSouth Sugar Land Rehabilitation Hospital 1325 Highway 6 Sugar Land, TX HealthSouth Rehabilitation Hospital The Woodlands IH 45 South Conroe, TX :healthsouth Corporation:

6 Medical Journal - Houston Page 6 June HEALTHCARE PROPERTIES The Woodlands medical office building market BY HENRY HAGENDORF, CCIM, LEED AP and BETH YOUNG, CCIM, LEED AP, Hagendorf- Young Commercial Property Services In all aspects of city and community lifestyles, The Woodlands is a beautiful, vibrant and upscale master planned residential and business community. The city covers over 28,000 acres with a growing to analyze advantages to this proximity. While the results are not surprising they do reflect and confirm a MOB rental market space that has solid underpinning with a strong foundation and sustainable future. The twelve subject properties total 740,599 square feet and average an impressive 94.5% occupancy without the two properties under construction. The market is so strong that tenants occasionally will take more or less space than they had planned on leasing because of the lack of available space. Tenant representatives and leasing agents that specialize in The Woodlands state that it is clearly a landlord s market resulting in fewer incentives being offered by the landlords and allowing the Landlords to population of slightly over 100,000 and a very impressive median household income of $91, Its healthcare community includes some of Houston s finest hospital providers including St. Luke s and Memorial Hermann. Some of these hospital s are architectural masterpieces and appear more in keeping with an upscale vacation spot with lakeside views, than the traditional plain and uninviting hospital environment of years past. In keeping with the success of the overall community The Woodlands boast a healthy medical office building (MOB) inventory of approximately 1.2 million square feet of Class A and B properties including at least two buildings under construction and being preleased. A recent survey was conducted to evaluate the health of the upper class category of the MOB market. Twelve buildings were selected based on quality, location, ownership and management. Some of the study group was located on or adjacent to a hospital choose tenants with stronger financial statements, demand higher rental rates and negotiate beneficial lease terms. Rental rates in this market are quoted in two ways which allocate the operating expenses differently. The base rental rate that is net of operating expenses is categorized as a triple net or NNN rental rate. The term triple net refers to a rental rate that does not include operating expenses that are incurred in a commercial property, but are passed through separately to the tenants on a pro-rata basis. These operating expenses include property taxes and insurance, utilities (in most cases unless directly metered to the tenant), maintenance and management services. The base rent that is quoted inclusive of these operating expenses is categorized as a gross rental rate. The majority of the leasing agents in The Woodlands quoted NNN rental rates ranging from $18.50 to Please see HEALTHCARE PROPERTIES page 15

7 Medical Journal - Houston Page 7 June Free CME credits. Available 24/7. Now you can choose the time and place to take the courses you need and want. We ve made it easy to take free CME courses online. We offer 24/7 access to more than 40 courses, including when to refer to a pediatric specialist. And even when you re not taking a course, you can access the latest references and resources you need. The CME courses were developed by the Texas Department of State Health Services and the Texas Health and Human Services Commission. All courses are comprehensive and accredited. * *Accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council of Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Dietetic Association, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for these events. Taking New Steps To view courses online, visit CME Courses Include: When to Refer to a Geneticist Children with Diabetes Children with Asthma Newborn Screening Case Management Developmental Screening Many others Referral Guidelines Pediatric Depression High Blood Pressures in the Office Atopic Dermatitis Gastroesophageal Reflux in Infants Exercise-Induced Dyspnea Referral Guidelines Overview STEPS-0379_HoustonMedJrnl_10n5x12n75.indd 1 3/30/12 2:19 PM

8 Medical Journal - Houston Page 8 June HOSPITAL ADMINISTRATOR SURVEY continued from page 1 a new dimension of research. For a number of years now, we ve had teams looking at the science of improvement, which will help define the value of MD Anderson care. Leading this research are our Institute for Cancer Care Excellence and the Department of Process Improvement and Quality Education, which bring together our faculty and staff to look at ways to streamline processes, cut waste, quantify quality care and reduce costs. While these are issues that may drive responses to health care reforms, they also are opportunities to enhance the patient experience and improve the outcomes of their disease. David J. Fine St. Luke s Episcopal Health System The current challenge faced by healthcare organizations is to continue to operate effectively under the current delivery model while actively preparing for a radically different system of care and reimbursement. It is critical that neither area be neglected. In order to keep employees attention on the most important areas, St. Luke s focuses on five core pillars: people, finance, quality, service and growth. These pillars are the foundation for setting organizational goals and direction at St. Luke s Maura Walsh HCA Gulf Coast Division One of the advantages of being part of a large healthcare company is the opportunity to leverage its many resources and relationships to access the most up-to-date information on healthcare reform and other initiatives straight from the nation s experts. Thus, we are able to positively impact the care we provide to patients directly and in real-time. Information and initiatives are shared throughout the Gulf Coast Division hospitals in Houston, Corpus Christi and South Texas. By maintaining a keen, patient-centered focus in the quality of care throughout our Gulf Coast Division facilities, we are able to provide safe, quality care now and in the future regardless of the external environment. Adam C. Walmus Michael E. DeBakey VA Medical Center The Michael E. DeBakey VA Medical Center does not provide free health care. The care we provide has been paid for a thousand times over by our Nation s Veterans and by the sacrifices they have made to keep our Nation free. What we do here at the VA, and the only reason for our existence, is pay back a portion of the debt this Nation owes to these heroes. The price of freedom is visible when you walk into each clinic and on each unit. This is what makes our mission and our medical center special. Our patients are not just simply patients. They are military Veterans and our Nation cares for its Veterans like no other country on earth. What is your vision for your institution? Ronald A. DePinho, MD The University of Texas MD Anderson Cancer Center I see MD Anderson as the epicenter for changing the human condition. With the people, resources and drive at this institution, combined with new technologies, rapidly expanding scientific knowledge and improved methods for discovery, MD Anderson can make cancer a disease of the past. I m confident of it. Adam C. Walmus Michael E. DeBakey VA Medical Center Please see ADMINISTRATOR SURVEY page 9

9 Medical Journal - Houston Page 9 June HOSPITAL ADMINISTRATOR SURVEY continued from page 8 My goal is to continue providing the best health care anywhere to Veterans and serving as a research and educational facility for the next generation of health care providers, while using taxpayer funds in the most effective manner possible. In addition, I believe we must demonstrate integrity, transparency, and openness with all of our stakeholders: Veterans, family members, employees, volunteers, our affiliates, elected officials, and the community. What is the number one item on your agenda in 2012 and how are you addressing it? Ronald A. DePinho, MD The University of Texas MD Anderson Cancer Center MD Anderson has the will, collaborations and brainpower to conquer cancer, and many of my priorities in the coming year will focus on that objective. We will be developing aggressive plans for curing several major cancers and putting into practice new models of discovery and patient care, taking full advantage of many new technologies, advanced knowledge and innovative thinking. Adam C. Walmus Michael E. DeBakey VA Medical Center We have many challenges to overcome, including the growing number of returning Veterans from the conflicts in Iraq and Afghanistan and the increasing percentage of women Veterans in the Armed Forces; each group with its own unique health concerns and issues. With this in mind, we also must ensure we reach out to all Veterans, regardless of their backgrounds and service eras. Dr. DeBakey s expectations and unwillingness to compromise are always with us. He would be proud of the compassionate, high quality, excellent care we provide, and will continue to provide, to American s heroes, our Nation s Veterans. t 2012 HOSPITAL ADMINISTRATOR s y s t e m s u r v e y

10 Medical Journal - Houston Page 10 June TECHNOLOGY DIAGNOSIS DEFINED Applied Diagnostics is a fully integrated laboratory specializing in hematological malignancies and molecular diagnostics. By performing all critical testing in its Houston facility, Applied Diagnostics ensures better: IHC Flow Cytometry Cytogenetics FISH Molecular Genetics CTC Specimen integrity Turnaround times, and Consultative support UH students develop prototype device that translates sign language Too often, communication barriers exist between those who can hear and those who cannot. Sign language has helped bridge such gaps, but many people are still not fluent in its motions and hand shapes. Thanks to a group of University of Houston students, the hearing impaired may soon have an easier time communicating with those who do not understand sign language. During the past semester, students in UH s engineering technology and industrial design programs teamed up to develop the concept and prototype for MyVoice, a device that reads sign language and translates its motions into audible words. Recently, MyVoice earned first place among student projects at the American Society projected on its monitor. The industrial designers researched the application of MyVoice by reaching out to the deaf community to understand the challenges associated with others not understanding sign language. They then designed MyVoice, while the engineering technology students had the arduous task of programming the device to translate motion into sound. The biggest difficulty was sampling together a databases of images of the sign languages. It involved images per sign, Seto said. The team was ecstatic when the prototype came together. From its conceptual stage, MyVoice evolved into a prototype that could translate a single phrase: A good job, Cougars. For more information call Applied Diagnostics at or visit Business Center Drive, Houston TX FREE RENT Louetta Professional Plaza 9316 Louetta Road, Spring, Texas Space Available: 4,800 SF - can be subdivided Prominent tenant signage Over 6 parking spaces per 1,000 rsf Separately metered electricity Private entries Prominent medical/dental tenant roster For more information, please contact us at (713) todd@groenrealtypartners.com of Engineering Education (ASEE) - Gulf Southwest Annual Conference. The development of MyVoice was through a collaborative senior capstone project for engineering technology students (Anthony Tran, Jeffrey Seto, Omar Gonzalez and Alan Tran) and industrial design students (Rick Salinas, Sergio Aleman and Ya-Han Chen). Overseeing the student teams were Farrokh Attarzadeh, associate professor of engineering technology, and EunSook Kwon, director of UH s industrial design program. MyVoice s concept focuses on a handheld tool with a built-in microphone, speaker, soundboard, video camera and monitor. It would be placed on a hard surface where it reads a user s sign language movements. Once MyVoice processes the motions, it then translates sign language into space through an electronic voice. Likewise, it would capture a person s voice and can translate words into sign language, which is This wasn t just a project we did for a grade, said Aleman, who just graduated from UH. While designing and developing it, it turned into something very personal. When we got to know members of the deaf community and really understood their challenges, it made this MyVoice very important to all of us. Since MyVoice s creation and first place prize at the ASEE conference, all of the team members have graduated. Still, Aleman said that the project is not history. We got it to work, but we hope to work with someone to implement this as a product, Aleman said. We want to prove to the community that this will work for the hearing impaired. We are proud of such a contribution to society through MyVoice, which breaks the barrier between deaf community and common society, added Attarzadeh. t

11 Medical Journal - Houston Page 11 June INTEGRATIVE MEDICINE LIve Here Lounge open daily 5925 almeda rd., suite d Houston, tx sales: Leasing: Momentum towards the patient centered medical home BY KYU JANA, MD Assistant Professor, UTMB Family Medicine The current health care system in United States is unsustainable. Healthcare expenditures are 2 ½ times higher than in other developed countries and projected to increase steeply in the next 10 years. Forty five million US citizens - over 15% of the population - remain uninsured or have limited access to healthcare. Diseases are now more expensive to treat as there is proliferation of medical technologies and treatment which are increasingly complex. Hence the status quo is increasingly unacceptable. A solution requires transformation of health care in United States. The patient centered medical home (PCMH), featured in the Affordable Care Act, has been endorsed as the foundation for healthcare t r a n s f o r m a t i o n. Patient Centered Medical Home was first developed in 1967 by American Academy of Pediatrics and more recently adopted by primary care organizations including American Academy of Family Physicians, American College of Physicians, and American Osteopathic Association in PCMH provides care that is accessible, continuous, comprehensive, and coordinated and delivered in the context of family and community. Currently physicians are compensated for acute, episodic and procedure-based care. They generally see large number of patients for short office visits. The clinic is centered around the physician to allow him or her to see the maximum number of patients. In this system, primary care physicians are often unable to provide all the preventive health and chronic care services the patient needs. Furthermore non face-to-face care such as communication with patients and coordination of care is not reimbursed in our current fee for service system. Also quality of care provided and outcomes are not routinely measured and collected in most contemporary medical practices. In the PCMH model, a team of professionals is led by the primary care physician and addresses all the needs of patients registered with it. The team consists of physicians, nurses, nurse practitioners, pharmacists, dieticians, social workers, office staff, and others involved in providing care. At the core of the PMCH model is the patient s personal, long-term relationship with the primary care physician (PCP). The PCP proactively determines the health needs with or without patient visits. It is expected that the PCP utilizes evidence based guidelines, coordinates all aspects of patients care, tracks tests, consultations and ensures follow up. In turn the PCMH is appropriately reimbursed for non-face-to-face time spent by the physician and other team members. It is believed that this patient-centric approach and whole person orientation will improve quality and safety, enhance access and lower health care expenditures. A set of common goals for the PCMH can be found in the Joint Principles issued by the AAFP, AAP, ACP, and AOA in February 2007 and endorsed by American Medical Association: 1) continuing relationship with a primary care physician, 2) care which has a whole person orientation, 3) personal physician-led team of individuals who collectively take responsibility, 4) coordinated and integrated care, 5) quality and safety are measured and collected, 6) enhanced access to care, and 7) payment structure to appropriately reimburse PCP s for adopting PCMH principles. For patients, a PCMH is where they get the right care, at the right place, at the right time. It is personal, as the patients has an ongoing relationship with their own PCP. And care is integrated - their doctors talk to each other. Patients can actively participate in their own care and provide feedback. In general patients can expect better access to their PCP through systems such as open scheduling, expanded hours, group and new options for communication between patients, their personal physicians, and practice staff. For the PCP s and their teams, PCMH means continually improving the care patients receive. Practices undergo a voluntary recognition process by a non- Please see INTEGRATIVE MEDICINE page 15 I LIve at MosaIc and I Love It THANK YOU HOUSTON, for making US #1 in condo SAleS. NOw, we HAve A gift for YOU. Receive up to 3% in buyer incentives to use any way you like. * Apply to price, closing costs or HOA dues. Call or come in today for details. great FInancIng options available 18 Homes closed last month! the Medical center is minutes away, there s a world-class gym downstairs, and the pool deck reads like a five-star hotel. It s my home base for everything. discover your MosaIc today visit the Live Here Lounge or go to MosaicHouston.com Buy one bedrooms from the $160s two bedrooms from the $300s Penthouses available Lease one bedroom lease from $1600/mo two bedroom lease from $2400/mo Penthouses available *For acceptable contracts written from 5/3/12-7/15/12. 3% in buyer incentives for homes in stacks 3,9,11 & 13 of North Tower. 2% in buyer incentives for all other homes in North Tower. Oral representations cannot be relied upon as correctly stating representations of the seller. For correct representations, reference should be made to the Purchase Agreement, the Condominium Information Statement and documents required by Code Section of the Texas Uniform Condominium Act to be furnished by the seller to a buyer.

12 Medical Journal - Houston Page 12 June THA Social media affecting the way hospitals can communicate with patients Bayside Surgical and Medical Center 4001 Preston Avenue, Pasadena, Texas Total Space Available:12,790 SF Multiple entrances for patient s convenience and physician privacy Concrete parking greater than 5/1,000 Fire sprinkler/alarm system For more information, please contact us at (713) todd@groenrealtypartners.com Special to Medical Journal Houston By Dan Stultz, M.D., President/CEO, Texas Hospital Association We teach every hospital employee the importance of evolving with changing technology to advance the care we provide. The importance of encouraging these employees to personally invest time in their own continuing education is a key strength to ensure growth and quality of an organization. As health care leaders, now is the time for a little of our own medicine in one key growth area: social media. Social media offers significant opportunities for our organizations. Certainly, the social media revolution is underway, and while the train has left the station, it is still possible to get onboard. According to a Pew Research Center survey, adults ages increased use of social media 400 percent over the last four years, and 48 percent of adults use social networking sites like Facebook, LinkedIn and Google Plus every day. According to Ad Age, 91 percent of baby boomers who are now caregivers use Facebook daily. Even more striking is that their use measures at 150 minutes per month, and they view 70 percent more pages than the average internet user. To top it off, 70 percent of this population are female key health care decision-makers. Let s be clear. The social media role of the hospital or physician is not to diagnose patients in a virtual environment. A patient who is complaining of a condition online is very different from a patient who is presenting to an ER, and providing very good care requires thorough analysis of patient needs. In the simplest terms, we can say that hospitals and physicians should be engaging proactive audiences who are looking for information on health needs. While we can qualify many forms of internet activity as social, we can also loosen the reigns in terms of how we engage patients online while also staying in compliance and mitigating risk in terms of patient privacy. Tying physicians to mobile devices for diagnosing or prescribing is certainly an aspect of changing the way we use technology, but arming the staff with hardware is akin to giving a chef a spatula and asking him to serve a seven-course dinner. Hospitals also have to take what social media has accomplished as a principle to determine ways to engage patients about their care. This involves investment in development in new applications, which are likely already being considering by hospital information technology staff. With the increasing embrace on changing care models, we can work within HIPAA, and use practices from social media to remind patients about follow-up appointments or medication reminders. We also have to consider ways to help patients who are seeking information about their health situation. Certainly, some hospitals are already on their way, embracing social media at a rapid pace. According to a study by AMN Healthcare, 1,229 hospitals used social media in 2011, compared with 391 in Last year, hospitals accounted for more than 3,170 accounts on YouTube, Facebook, Twitter, LinkedIn and blogs. But we can do more. We can ensure that best practice models are in place to ensure patients get the care they are seeking and needing. The Texas Hospital Association is working to become a frontline leader to help hospitals develop best practice models for engaging patients in the realm of social media. On August 9-10, THA will host the 2012 Health Care Social Media Summit at the Four Seasons Hotel in Austin to take a step beyond the entry-level engagement that hospitals need in order to move in a progressive direction. The growth in technology-based communications on the social level has reared its head into health care over the last several years, and despite the effort by many to avoid its many attributes, it is clear that social media usage can pave the way to higher patient volume, higher patient satisfaction, and reduced readmissions. t

13 Medical Journal - Houston Page 13 June FINANCIAL PERSPECTIVES continued from page 4 Special consideration must be taken in striking the right balance between business and personal finances. Here are four important aspects that physicians should consider in managing money now and planning for the future. Financial Planning Developing a comprehensive plan is the vital first step in establishing a strong financial foundation. Despite its importance, many overlook instituting a financial plan. Oftentimes, doctors work diligently throughout their working years and assume that their earnings and accumulating assets will result in ultimate financial success; unfortunately, that is not always the case. In today s world, many successful physicians find themselves with the challenge of trying to balance ever expanding responsibilities. Concerns over business, family, social and personal lives can crowd out efforts to develop an effective financial plan. Instead of developing a strong unified approach to their finances, many people adopt a scattered piece-meal approach. A unified approach to financial planning begins with an accurate analysis of your present financial position. After a review of your short and long-term goals, a plan must be developed to help you realize those goals. Lastly, and perhaps the most important step, is to commit yourself to ongoing review of the plan so that it can be adjusted to reflect changes that occur in your life. Investment Management In developing a financial plan, you will set short and long-range goals. In order to meet these goals, you will likely be exposed to various investment vehicles. Any investor participating in the financial markets must actively monitor holdings. Today s financial landscape is rapidly evolving and volatility is here to stay, which requires time and attention to effectively manage a portfolio. Many investors seek advice from professionals as they navigate the markets and design, implement and monitor an investment plan. Asset Protect Planning After financial and investment plans have been designed and as assets are beginning to accumulate, it is important to take strides to protect those assets. As a business owner, your practice itself is a significant asset. Physicians must work to protect the practice and individual assets from potential threats. One example of a potential threat to both the business and personal assets is legal action. Due to the nature of their work, physicians are frequently targeted with lawsuits that could place assets and their practices at risk. A 2011 study from the New England Journal of Medicine found that between , 7.4% of all physicians had a malpractice claim filed against them and 1.6% of those resulted in a payment. It is impossible to know whether or not you will face legal action during your career; however it should be a high priority, to protect assets through malpractice insurance and other asset protection strategies. The optimal goal would be to provide a strategy to protect financial and retirement plans from a physical or legal hazard. There are various asset protection strategies that are available to physicians that would allow you to keep control of your assets now, while providing the asset protection that is needed for your financial future, including gifting techniques, various types of trusts and insurance strategies, among others. Step 4: Retirement Planning For many physicians, a secure and fulfilled retirement is the ultimate goal. Developing a financial plan, actively managing investments, and implementing asset protection strategies are all steps on the road to retirement. Retirement planning involves implementing a strategy to effectively transition from the accumulation stage to the distribution stage. Oftentimes, individuals seek assistance from a financial professional to design a lifetime income plan that identifies income needs in retirement, while accounting for risk tolerance, tax concerns and investment options. Though there is no one-size-fits-all approach to financial and retirement planning, following a few basic steps can help achieve true financial success for physicians navigating business and personal financial management. To accomplish this, a review of your entire financial picture would be necessary, to include financial planning, investment management, asset protection planning, and retirement planning. Investment Advisory Services offered through Global Financial Private Capital, LLC, an SEC Registered Investment Advisor. The opinions expressed herein are those of Jim Sloan as of the date of the recording or interview and may not reflect the views of Global Financial Private Capital, LLC. This material is for informational purposes only and is not a recommendation, offer or solicitation to Please see FINANCIAL PERSPECTIVES page 14 Your Time is Valuable. Don t Spend It on Your Commute! Join the other medical professionals who have already chosen to live in a spectacular single-family home community by Toll Brothers America s Luxury Home Builder Ask about our Doctor Loan program! 7 Communities Within Close Proximity to Major Medical Facilities! The Woodlands I-45 & Woodlands Pkwy. Timarron at Creekside Park Single-Family Homes Priced from the mid-$300s (281) Paloma Pines at Creekside Park Single-Family Homes Priced from the mid-$400s (281) Player Vista at Sterling Ridge Final Opportunity! 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14 Medical Journal - Houston Page 14 June BREAKING GROUND continued from page 3 Skanska is committed to constructing state-of-the-art healthcare facilities and we are proud to be closely associated with HCHD. We look forward to our continued work with them. Skanska USA and Harris County Hospital District celebrated the topping off with a beam-signing ceremony which was followed by lunch and remarks from project manager Charles Griffiths of Skanska USA as well as Harris County Hospital District (HCHD) president and CEO David Lopez and HCHD Board of Managers chairman Stephen DonCarlos. Scheduled to be complete in early 2013, the new Ambulatory Care Center on the LBJ campus will feature a three-story, 72,000- SF clinic, 19,000-SF connector and threestory parking garage. The new construction will allow the 332-bed teaching hospital to relocate the specialty clinics currently housed in the hospital to the new space and convert the old space to inpatient use. The project is located at 5656 Kelley Street, Houston, Texas FINANCIAL PERSPECTIVES continued from page 13 buy or sell any securities. Any comments regarding safe and secure investments, and guaranteed income streams refer only to fixed insurance products. They do not refer, in any way to securities or investment advisory products. Insurance and annuity product guarantees are subject to the claimspaying ability of the issuing company, and are not offered by Global Financial LEGAL AFFAIRS continued from page 5 a privilege is established under common law. In 2007, Dr. Russell Adkins filed suit against the Houston Medical Center (HMC) in Georgia for discrimination. During discovery, Dr. Adkins sought documents from various peer review actions at HMC so that he could compare how the committee treated him versus other physicians. Claiming that the state s peer review privilege applied, HMC refused to produce the documents. In Adkins, the Eleventh Circuit Court of Appeals addressed whether the peer review privilege applied in the federal civil rights suit. The court weighed the public s interest in the promotion of the peer review privilege for vigorous and critical analysis of the medical profession against the need to uncover evidence of discrimination. Explaining that the peer review privilege will not promote a TOPS Surgical Specialty Hospital grand opening TOPS Surgical Specialty Hospital recently opened its newly renovated wing including the addition of state-of-the-art operating rooms, pre- and postoperative areas as well as remodeled inpatient rooms which provide a spacious, patient-friendly atmosphere. TOPS has provided elite-level patient care to the north Houston community for over 32 years. The medical staff at TOPS includes physicians specializing in orthopaedic Private Capital, LLC. Investment Advisory Services offered through Global Financial Private Capital, LLC, an SEC Registered Investment Advisor. Investment Advisory Services offered through Global Financial Private Capital, LLC, an SEC Registered Investment Advisor. The opinions expressed herein are those of Jim Sloan as of the date of the recording or interview and may not reflect the views of Global Financial Private Capital, LLC. This material is for informational purposes only and is not a greater good in civil rights suits as it does in malpractice cases, the Eleventh Circuit joined the Fourth and Seventh Circuits in holding that the privilege does not apply in federal civil rights and antitrust cases. Two years later, in Guzman v. Memorial Hermann Hospital System, the District Court for the Southern District of Texas reviewed decisions in various federal cases and found that no peer review privilege exists under federal common law. In Guzman, the plaintiff brought a federal claim under EMTALA as well as a state law claim of negligence against a hospital. When the plaintiff sought production of peer review documents, the hospital asserted the statutory privilege and refused. The court determined that if the peer review documents were pertinent to both the EMTALA and the state law claims, then federal common law would apply and the documents would not be privileged. After reviewing the documents in camera, however, the court found that they were TOPS Surgical Specialty Hospital surgery, hand surgery, gastroenterology, general surgery, gynecology, ophthalmology, oral and maxillofacial, otolaryngology (ENT), pain management, podiatry, spine surgery, urology, plastic/reconstructive surgery and 24-hour emergency care. TOPS was recently ranked #23 out of 307 Texas Hospitals by Consumer Reports Magazine and is the first in Houston to offer 3D Tomosynthesis Mammography at all four TOPS Breast Center locations. TOPS is located at Red Oak Drive, Houston, TX t recommendation, offer or solicitation to buy or sell any securities. Any comments regarding safe and secure investments, and guaranteed income streams refer only to fixed insurance products. They do not refer, in any way to securities or investment advisory products. Insurance and annuity product guarantees are subject to the claimspaying ability of the issuing company, and are not offered by Global Financial Private Capital, LLC. Investment Advisory Services offered through Global Financial Private Capital, LLC, an SEC Registered Investment Advisor. t only significant to the state law negligence claim. As a result, the state s peer review privilege applied, and the hospital was not required to disclose the documents. Even when the statutory privilege does not apply in federal litigation, courts have other tools to protect the confidentiality of the material, including protective orders and confidentiality agreements. Physicians and health care entities in Texas should not allow the limitations of the peer review privilege to inhibit candid and critical analysis during peer review activities. As long as the peer review activity and analysis is done in good faith for the betterment of patient care, then the privilege will adequately protect the actions of the committee and the individuals involved. Further, health care entities should take caution to ensure that their committees operate in conformance with bylaws, as this is a prerequisite to the application of the statutory privilege. t Publisher & Editor Mindi Szumanski mindi@mjhnews.com Advertising Director Tascha Turnley tascha@mjhnews.com Business Manager & Circulation Tom Turnley tom@mjhnews.com Business Development Manager Denise Ronquille-Bell denise@mjhnews.com Director of Marketing Jeanie McHugh jeanie@mjhnews.com Phone Medical Journal - Houston is published monthly by STT Enterprises, Inc. Entire editorial content of this publication copyrighted by STT Enterprises, Inc. and must not be reproduced whole or in part without special permission. Medical Journal - Houston will assume no responsibility for unsolicited manuscripts. All letters and correspondence sent to Medical Journal - Houston are considered property of Medical Journal - Houston and are unconditionally assigned to it for publication and copyright purposes. Medical Journal - Houston reserves the right to refuse any advertising. Only publication of an advertisement shall constitute final acceptance of the advertiser's insertion order. Subscriptions are $35 per year. Subscription information or changes to addresses for existing subscriptions should be ed to tom@mjhnews.com or mailed to the address below. P.O. Box 686 Dickinson, Texas

15 Medical Journal - Houston Page 15 June HEALTHCARE PROPERTIES continued from page 6 $24.00 per square foot per year. To evaluate a tenant s full rent you have to combine the base NNN rent with the tenant s pro-rata share of operating expenses. Operating expenses quoted in the market ranged from a low of $9.00 to almost $13.00 per square foot per year. When the operating expenses are combined with the NNN rates, the resulting rental rates for this submarket range from $27.50 to $33.00 per square foot per year. The quoted gross rental rates (inclusive of operating expenses) were $23.00 to $ Regardless of the methodology used, NNN or gross rates, the end result should be very close. Typically a landlord is willing to offer a tenant an allowance to pay for all or part of the improvements needed in the space for the tenant s occupancy. In the MOB environment this is very expensive because of the construction characteristics needed for the practicing physicians. These construction contributions must be covered for the landlord in the rental structure over the term of the lease. The cost of construction for a medical office practice can range from $30.00 to over $60.00 per square foot depending on the condition of the space. For a medical office that is 5,000 square feet, the cost for interior improvements could range from $150,000 to $300,000. It is important to remember that the contribution made by the landlord for these improvements will be incurred up front before the tenant moves in. The landlord then recovers these expenses over the term of the lease. The Woodlands survey clearly indicates that the various landlords are very willing to invest in the tenants that office in their buildings. The survey indicated that the quoted tenant improvement allowance quoted by the landlords ranges from $5.00 per square foot for space that requires very little renovation because of a previous tenant s occupancy, to $60.00 per square foot for spaces in buildings under construction. The average quote for tenant improvements ranged from $10.00 to $20.00 per square foot for a five year lease to $30.00 to $40.00 per square foot for longer - seven to ten year leases. The MOB market in The Woodlands can be summarized as follows: Occupancies are high, in the mid-90% range The market favors the Landlord who can be stubborn and aggressive Rental rates will remain high with upward pressure Tenants need to understand how the expenses are factored into the rent Tenants may have to contribute to the build out of the space they lease Anyway you look at it, The Woodlands is a very desirable place to live and work. And these conditions confirm it. t INTEGRATIVE MEDICINE continued from page 11 governmental entity to demonstrate that they are able to provide patient centered services consistent with PCMH principles. Practices are appropriately compensated for non-face-to-face time and receive financial incentives for supporting medical home features including payments for achieving measureable and continuous quality improvements and cost savings. For the public and private payer of health care, the PCMH model of primary care delivery is a way of reducing costs without sacrificing quality. In fact Medical Home demonstration projects have cut health care costs while improving care quality. For example, the Veteran Affairs Midwest PCMH project lowered the mortality rate of their COPD patients enrolled in a medical home from 13.8/100 patient years to 10.1 with overall cost savings. Group Health demonstration project estimated that for every $1 invested in Medical Home, there was a return of $1.50 in medical expenditures. They can also expect cost savings from decreased emergency department visits and hospital admissions. It is not surprising that large integrated health care systems such as the Veterans Affairs are undergoing transformation into Patient Centered Medical Homes. In certain parts of the country, private and public payers such as BCBS, Humana and Medicaid have begun supporting PCMH through payments models such as care coordination payments and performancebased incentives. More than 24,000 physicians and 4,170 practices have become recognized as Patient Centered Medical Homes in the last five years and the number is increasing. In Houston, nearly 300 PCP s like physicians in Harris County Hospital District clinics care for patients in Medical Homes. Some concerns remain, and the PCMH model has not been uniformly adopted. Incentive structure remains murky except in select demonstration projects. Adoption of PCMH model has significant up-front costs, up to $23,000 to 90,000 per physician. In addition, the actions of Center for Medicare and Medicaid Services supplanting its Medical Home Demonstration Project with Accountable Care Organization (ACO) programs are raising more questions. Nevertheless, it is to be noted that the ACO s are based on PCMH principles. While founding principles of patient centered medical homes are sound - improving quality and reducing costs, execution of PCMH has challenges. But, it is expected that these transformative principles are here to stay. Physicians and practices should consider incorporating these principles, namely enhance access, coordinate care, and start measuring quality. t siennaplantation.com facebook.com/siennaplantation Sienna Parkway at Hwy Friends & Family Live Where Your Friends and Family Live. Beautiful affordable homes. 3 Waterparks. Bike and Hike. Sports Fields. Peaceful parks. 5 FBISD schools. And more! Come to our HomeFinder Center for maps and more information about Sienna. We will be looking for you. Ashton Woods. Avanti. Coventry. Custom Classics. Darling Homes. D. R. Horton. Fairmont Custom Homes. Meritage Monterey Custom Homes. Newmark. Partners in Building. Perry. Plantation. Pulte. Regan Custom Homes Ryland. Sterling Classic Custom Homes. Trendmaker. Triumph. Westport Sienna builders are offering homes from the $170s to the millions. from $170s-Millions Galleria Greenway Med Center Fort Bend Parkway Downtown

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