Arkansas Legislative Session In Full Swing!! AATherkrkaansnsaass FFaamilmilyy PPhysicihysiciaann Volume 19 • Number 2

2015 Arkansas 68th Annual Scientific Assembly, June 10-13 Doubletree Hotel, Little Rock, Arkansas pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • [email protected] For Advertising info contact Tom Kennedy • 1-800-561-4686 [email protected] The Arkansas Family Physician The Arkansas Family Physician is the official magazine of the Arkansas Academy of Family Physicians Dear Academy Member, Managing Editor Carla Coleman As this publication goes to press, House Bill 1160 is scheduled for a special order of business Thursday, February 26 before Officers Daniel Knight, M.D. the House Public Health Committee. So the outcome of Little Rock – President that bill will be known before this Journal reaches you. We J. Drew Dawson, M.D. strongly oppose this bill which would open the entire Schedule Pocahontas – President Elect Tommy Wagner, M.D. II prescribing to APNs allowing them to practice independent Manila – Vice President of physician supervision in all but two counties in Arkansas E. Andy Gresham, M.D. and provide for reimbursement equivalent to physicians. Contact has been made with Crossett – Secretary/Treasurer members whose legislators on the Public Health Committee reside in their areas. Delegates Should this bill get out of the Public Health Committee, we will be making contact with Julea Garner, M.D., Hardy Richard Hayes, M.D., Jacksonville the entire membership to contact your legislators to oppose this bill.

Alternate Delegates th Lonnie Robinson, M.D., Mountain Home Included in this issue is a preview of the Academy’s 68 Annual Scientific Assembly Dennis Yelvington, M.D., Stuttgart which will be held Thursday, June 11 through Noon on Saturday, June 13. As soon as all of the information is received from speakers, we will go to press and hopefully have Directors Hunter Carrington, M.D., Hot Springs the program with hotel and registration information to you in late March. There will James Chambliss, M.D., Magnolia be a Pre Assembly program on Wednesday, June 10 on “Team Based Care and What Amy Daniel, M.D., Augusta you Need to Know about ICD 10”. This will provide additional CME hours and will be at Scott Dickson, M.D., Jonesboro a separate registration fee. Your office staff is encouraged to attend this pre assembly Angela Driskill, M.D., Alexander Rebecca Floyd, M.D., Van Buren program. Eddy Hord, M.D., Stuttgart C. Len Kemp, M.D., Paragould The slate of officers and directors will be in the next Journal. This issue includes Jason Lofton, M.D., DeQueen changes to the ByLaws which will be presented to those in attendance at the Annual Leslye McGrath, M.D., Paragould Matthew Nix, M.D., Texarkana Meeting for a vote. Philip Pounders, M.D., Little Rock Please pay your dues for the 2015 year and if you need hours for re-election for the Tasha Starks, M.D., Jonesboro period ending 12/31/14 please report them as soon as possible or call us and we will – Resident Director be happy to help you! Brian Bowlin, Medical Student, UAMS – Student Representative We urge you to get involved in the Academy, there are many areas we need your input. Academy Staff Just give us a call or email us at [email protected] and we will put you to work! Carla Coleman Executive Vice President Sincerely, Michelle Hegwood Administrative Assistant

Correspondence, articles, or inquiries should be directed to: ArAFP, 500 Pleasant Valley Drive, Building D, Suite 102 Little Rock, Arkansas 72227 Phone: 501-223-2272 Carla Coleman Instate Toll-Free: 1-800-592-1093 Fax: 501-223-2280 E-mail: [email protected] Executive Vice President Edition 71

On the cover: pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President • [email protected] Arkansas State For Advertising info contact Tom Kennedy • 1-800-561-4686 [email protected] capital in Little Rock.

3

President’s Message Daniel Knight, M.D., President

Daniel Knight, M.D.

My presidency started out with pure medical homes. The Board has been find the gestalt of what all of the other chaos. Unfortunately, I booked a vacation actively involved in this project including board members believe and develop it prior to knowing when the inauguration providing housing in our office for the into a plan that represents what our for AR AFP President was. When I found Arkansas Community Cares program members want and support. While I have out, I had nearly overbooked myself, that provides training and personnel been a leader in other positions, this one leaving one-half day to arrive home from for offices that need care managers. has the widest and most diverse group China and make it to the ceremony. As This has provided some income to our of constituents that I have been involved luck and our plane service to Arkansas organization as they have moved in with with. It takes quite a bit of listening and would have it, my flight was canceled and us which has allowed us to help shape discerning to know what is the right path moved to the next day. I made it home this project to support family physicians. and how to get there. one and a half hours before the time for As we have proceeded into the The annual AAFP Congress of my installation, jet-lagged from a country legislative period, we have had usual Delegates was a new experience for me. a world-away and a great lack of sleep and unusual challenges in bills that While I knew we had representatives on the way home. All’s well that ends have been presented. We have had the to the Congress from our chapter, I well! We had a wonderful luncheon and ubiquitous scope of practice issues, didn’t know what amount of work our a meaningful ceremony, starting my year this year involving APN’s practicing delegates put into this. I found that as president off right! independently without supervision and we have 2 delegates and 2 alternates The remainder of last year and the being paid at a rate of a physician. There that attend yearly and can serve up to beginning of this year has followed a have been more unusual bills such as 6 years. Prior to becoming a delegate, similar plan. As Arkansas decided to allowing newly graduated, non-licensed they must serve as an alternate delegate. enter Medicaid expansion with a new physicians to practice without a license Therefore, these members put in a plan-the Private Option, it has caused under a licensed physician’s supervision commitment of up to 12 years to become lots of chaos in the medical world. We until they are able to progress in their an AAFP delegate. That is an amazing have been accepting many new patients training. APN’s and PA’s have asked amount of hard work and dedication that are newly insured and have a myriad to be able to write schedule II drug to help make Family Medicine better. of poorly controlled medical problems. prescriptions. This has brought up much They read a library full of bills on While we want to care for these patients discussion among our members. everything from Coca-Cola support to and improve their health, it has been Personally, it has been a year of euthanasia. They must decide whether challenging to get their needs met. As growth for me. Carla Coleman is an to pass them, kill them or make them we are proceeding into this expansion, excellent teacher and leader and has something worthwhile. I really admire uncertainty reared its head concerning given me the guidance to know where the dedication of our members to this the Medicaid expansion with an election I was going and how to get there. We endeavor. of a new governor and a changed began the year by attending ALF (Annual I look forward to the remainder of Arkansas legislature. For a moment, Leadership Forum) in Kansas City where my year as president with your support. we were unsure whether the Medicaid I interacted with many other wonderful I believe we have an excellent group of expansion would remain in place. leaders throughout Family Medicine. board members who give a lot of their Fortunately, our governor has developed It was an exhilarating experience that busy lives to serve. We are also gifted a plan to continue the expansion while gave me confidence to proceed to the with an excellent Chapter Executive we re-evaluate the needs and abilities presidency. After that, we have had a in Carla Coleman who knows her way of the state. While it is an exciting couple of board meetings, discussing around and makes my job easy! So, have a time, there have been many changes both controversial and exciting plans great new year. It promises to be exciting! including Medicaid’s plan to develop a for the board to act on. It is a new payment system for patient-centered experience for me to lead while trying to Dan Knight

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At the membership meeting above purposes and to Section 7. All members of those Ar AFP members represent the needs of its of the Board are expected in attendance at the Annual members. to attend all regularly Scientific Assembly, several bylaw scheduled meetings of the amendments will be presented to 2. Chapter VII Section 4 Board and shall attend be more aligned with the AAFP “Dues for Active members the Annual Scientific bylaws and to also correct some shall not exceed the sum Assembly annually. If bylaw requirements that are no of $300. unless approved a Director misses two longer effective as follows: (bolded by ¾ of the membership meetings in a year they areas are changes to the bylaws or attending the Annual are “presumed to have additions to the bylaws) Scientific Assembly resigned.” Shall an Officer or Director fail 1. Chapter III Section 1 The (please note it currently to attend the Annual mission of the Arkansas says $250. This does not Scientific Assembly, Chapter is to promote mean we are increasing they shall be subject to excellence in healthcare dues – in fact our state dismissal from the board. and the betterment of dues have not increased for Should a director health of the American over 12 years but it allows or officer fail to be people. To Provide in future years a dues in attendance for responsible advocacy increase if needed) installation as an officer for and education of or director, they will be patients and the public 3. Chapter VII Section 5. subject to dismissal from in all health related Dues for Supporting the board depending members: To preserve members shall not exceed on the reason for non and promote quality cost the sum of $300., unless attendance. effective health care; to approved by ¾ of the promote the science of membership attending Chapter XV. Section 2: art of Family Medicine the Annual Scientific The order of business at the and to ensure an optimal Assembly. Organizational Meeting of supply of well trained the Board during the Annual Family Physicians; To (please note it is currently Scientific Assembly shall promote and maintain $250. This category of include an orientation high standards among membership’s dues have session for new members physicians who practice not increased in over 12 and all members of the Family Medicine; To years – same as Active but Board who wish to vote preserve the right of allows for in future years if shall be required to Family Physicians to needed). complete a Conflict of engage in any medical Interest Statement. and surgical procedures Chapter IX – Board of for which they are Directors If anyone desires a qualified by training and Section 2. The Board complete copy of the experience; To provide of Directors shall meet current bylaws, please advocacy, representation at least four times contact the AR AFP office and leadership for the per year including the and a copy will be emailed specialty of Family Organizational meeting of or mailed upon request! Medicine and To the Board. (the current maintain and provide an bylaws state “excluding” organization with high the Organizational standards to fulfill the meeting)

6 Across Arkansas. Charles Nabholz Board Member - CHI St. Vincent Across Chairman Emeritus - The Nabholz Group America.

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7 ARcare Accepting Applications for Primary Care Doctors!! AR Care is accepting applications for a and ability to relate with consideration and The Staff Physician works as part board certified Physician. Must have current effectiveness to patients and staff of ArCare. of a medical provider team providing licensure in the State of Arkansas; Must Openings exist in Hazen, Augusta, Wynne, medical services to the patients of be Certified with prescriptive authority Cabot West, Conway and Lonoke. ArCare. In addition, Staff Physicians unless specifically exempted by the Chief Medical Officer and Medical Director, shall be qualified to serve on the active Medical Staff of a local hospital, provide inpatient care services, assume “on call” after hours responsibilities and supervise community health center PAs or NPs as Leading the Way appropriate. The Staff Physician also has the responsibility to coordinate and monitor all aspects of patient care Did you know that one in four adults services in accordance with the Patient experiences mental illness in a given year? Centered Medical Home model of care. It’s true. Yet because behavioral health issues For more information, contact Terry are difficult to treat, you may have doubts as Hill at [email protected] or call to when someone you know is in need of 870-919-1315 behavioral healthcare. In order to safely care for others, you may need assistance in managing the behavioral, emotional or addictive issues. Let The BridgeWay lead Full Time the way towards quality care. Faculty Member The BridgeWay is available 24 hours a day and seven days a week to assess the mental health issues experienced by children, adolescents and adults. In addition, we can provide a mobile assessor at no charge. Our mobile assessors are licensed Needed!!! clinical professionals who are experienced in determining the mental health needs of people of all ages and arranging for the appropriate level of care. Let The BridgeWay lead the way towards clarity.

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8 9 Getting Paid Notes on Coding and Reimbursement Five issues to watch in 2015

Family physicians spent much of 2014 staff to help the physician retain as much stands to make it harder for physicians to wrestling with the seismic changes affecting focus on the patients as possible. make the best clinical decisions and calls medicine across the United States and in for policymakers, providers, and payers to their practices. That won’t slow down in 3. ICD-10 finally arrives. build a more straightforward cost of care 2015. “The coming year will again be one Physicians were given a one-year structure. of major transition for the U.S. healthcare reprieve when the Centers for Medicare system,” said Lou Goodman, PhD, president & Medicaid Services (CMS) postponed 5. Patient access to care. of The Physicians Foundation and chief the implementation date for the new ICD- As more people are gaining access to executive officer of the Texas Medical 10 coding structure to Oct. 1, 2015. But health insurance through the Affordable Association, in a statement announcing the extra time likely won’t improve many Care Act and demanding health care the Foundation’s “Physician Watch List for physicians’ outlook or support. According to services, the overall number of physicians 2013.” The list, based on the Foundation’s the Foundation’s survey, half of respondents is declining or reducing the amount of time own research, policy papers, and physician expected ICD-10 to cause severe available to see patients. According to the surveys, identifies the five issues most likely administrative problems in their practices Foundation, 44 percent of respondents in to affect physicians and their patients this and three-quarters said it will unnecessarily its survey said they were planning to reduce year. complicate coding. Still, it’s highly unlikely access to their services, such as shrinking CMS will delay ICD-10 again, so practices their panels, retiring, going to part-time 1. Accelerating consolidation. need to make the necessary investment of work, or taking non-clinical jobs. This could Hospitals and health systems are time and money to be ready for the change. reduce patient access to care by tens of buying up small practices and absorbing thousands of full-time equivalents (FTEs) in solo physicians at a faster pace. Besides 4. Patients demanding the true cost of the future. The Foundation, along with the affecting local competition, costs, and care. University of North Carolina-Chapel Hill, patient choice, the trend has physicians Medical costs were once a hidden has developed a tool to help analysts and worried about clinical autonomy. The algebra to the public, deciphered only by lawmakers to better gauge future shortages Foundation’s 2014 Biennial Physician payers and health care administrators. of physicians. Goodman said the list shows Survey found that 69 percent of those But media focus in recent years on the the continued threat to small medical participating said they had concerns about lack of transparency in billing practices, practices and that policymakers must autonomy and being able to make the best as well as higher out-of-pocket costs “bring physicians into the fold to ensure decisions for their patients. It said that as for patients, has the public much more the policies they implement are designed the consolidation isn’t expected to slow frustrated. The seeming arbitrariness of to advance the quality of care for America’s down, hospitals and physicians must work what certain procedures actually cost patients in 2015 and beyond.” together to prevent bureaucracy or other organizational factors from influencing medical decision-making.

2. The physician-patient relationship is stressed. The increased documentation of value-based reimbursement systems and perceived interference of health care employers are considered key external pressures on the relationship between patients and their physicians. In particular, physicians have told the Foundation that these factors are eating into their face-to- face interactions with patients while also limiting their choices of practice types and requiring more time spent negotiating with payers and vendors. These pressures will call for more reliance on practice support

10 11 or low-cost health centers in Arkansas, including charity clinics and FQHCs. The safety net clinics in Arkansas have long served as the sole avenue through which Arkansans without health insurance could receive care outside of the emergency room, including access to basic primary care, dental care, and some pharmacy services. These providers generally offer care in areas that The Impact offace Expanded a shortage of health Coverage care services, regardlesson of insurance coverage. Arkansas’s HealthAccording Care to the SafetyUniform Data Net System Clinics of the Health Resources and Services Administration (HRSA), in 2013, 51 percent of patients served by FQHCs nationwide were between the ages of 25 and 64.5 This included 94 CHCA sites located around the state. In addition to CHCA sites, many smaller operations, which are mostly faith-based, are scattered in both urban and rural Arkansas’s safety net clinics are responding to a major change in the health care environment. In 2014, approximately 250,000 low income Arkansans gained access to health care throughareas. newly These available in coveragedependent options clinics in the are Arkansas often Health part of a larger, community-based operation partnered

Insurance Marketplace and the Arkansas Health Care Independencewith Program. food 1banks,As a result, churches, the number or seniorof uninsured centers. has dropped precipitously. Prior to 2014, safety net providers in the state were unsure exactly how this shift in the health care coverage landscape would impact them, their business models, andSeveral their clientele. programs, A year includinglater, safety federal net clinics grants, across suppthe ort these clinics because they successfully state have had an array of experiences, and now face new and differentprovide challenges. necessary This issue primary brief willand provide acute background care, often costing far less than alternatives. Additionally, information on the Arkansas health care safety net and a samplingmany of experiences of these in clinicsthis changing have environment. benefitted from the HRSA 340B Drug Pricing Program.6 This program allows specific types of health care facilities to receive and utilize prescription medications at a much-reduced cost.7 National Trends FigureFigure 1: 1: 2013 2013 Arkansas Health Center Community Data Nationally, the number of uninsured individuals Health Center Data has decreased, but many safety net clinics still Introduction strength in a more expect to serve uninsured clients. These may There are both national and expansive, private include undocumented individuals, as well as statewide efforts to increase the market? Third individuals who do not qualify for subsidized number of people with access to To assess Party: 20% affordable health care coverage, the experiences private coverage through the health insurance Uninsured: 8 which is expected to lead to better related to coverage Medicare: marketplace or traditional Medicaid. Until the 2 40% health outcomes. Arkansas’s expansion, the 13% efforts have been more successful Arkansas Center changing health insurance market reaches a

than most,3 thanks to bipartisan for Health steady state, questions will remain about the leadership, innovative programs, Improvement viability of safety net clinics. Once the market is and comprehensive, system-wide (ACHI) identified Medicaid/ more stable, clinics may need to examine transformation strategies. As a safety net clinics SCHIP: result, providers in Arkansas are with guidance 27% whether and how they can change their seeing an infusion of previously from the Arkansas business models to adjust to the new market. uninsured patients who now have Department Patient characteristics of those seen in 12 federally qualified To date, at least one free clinic in Arkansas has the ability to pay for health care of Health and health centers in Arkansas Source: “2013 Health Center Data.” Accessed on January 16, 2015 closed, attributing its closure to the increased services. the Community at http://bphc.hrsa.gov/uds/datacenter.aspx?year=2013&state=AR Clinics that have focused on Health Centers of health coverage and lack of need for their providing care to uninsured and Arkansas (CHCA). services,9 which has been noted by other clinics as described in the following section, Arkansas underinsured individuals—safety CHCA supports communityExperiences health . ClinicSafety responses Net Clinic toBackground reduced demand for services have varied from a business net clinics—are adapting in this center sites, which are Federally The health care safety net dynamic environment. Will these Qualified Health Centersperspective, (FQHCs). butrefers several to providers clinics notedthat deliver that theya were glad their patients would now have better new coverage programs continue ACHI then reached outaccess to a to comprehensivesignificant level care. of health care to in the current political conditions? sample of clinics across the state, uninsured, Medicaid, and vulnerable

Will newly insured clients continue covering a range of geographic populations,4 many of which—either to seek care in safety net clinics and socioeconomic areas.ARKANSAS ACHI byEX mandatePERIENCES or adopted mission— now that they have a payment conducted key informantIn Arkansas, interviews thereoffer are care many to patients different without types of safety net clinics. Likewise, there have been a A source? Will safety net clinics with managers of twovariety FQHCs andof experiences regard to since coverage. the increasePresently, of the insured population. No two clinics have identical retain access to reduced drug five charitable clinics. This brief pricing, and if not, will it affect provides descriptive informationmissions or business models; therefore, no two clinics have been impacted identically. However, a their budgets? Will safety net clinics about the preliminaryfew impact themes of have emergedA Although .rural The health faith -clinics and mission-based clinics are facing a period of internal have a disproportionate increase expanded coverage inreflection Arkansas asto determine(RHCs) are if thenot surveyedneeds ofin theirthis brief, patien ts would be better addressed through new in uninsured patients? How will relayed by clinic managers. many RHCs serve as part of the safety net clinics gain negotiating avenues. One clinic,safety netthe in Charitable Arkansas’s ruralChristian areas. Medical Clinic of Hot Springs, redirected its model of care to provide additional ancillary services, such as community education. Several others have managed to continue despite a smaller patient load, and are waiting to learn if those newly insured 12 Copyright © 2015 by the Arkansas Center for Health Improvement. All rights reserved. The Impact of Expanded Coverage on Arkansas’s Health Care Safety Net Clinics Page 2 there are well over 100 free or low- health insurance marketplace or examine whether and how they can cost health centers in Arkansas, traditional Medicaid.8 Until the change their business models to including charity clinics and FQHCs. Schanging health insurance market adjust to the new market. To date, The safety net clinics in Arkansas reaches a steady state, questions at least one free clinic in Arkansas have long served as the sole avenue will remain about the viability of through which Arkansans without safety net clinics. Once the market health insurance could receive care is more stable, clinics may need to continued on page 14 outside of the emergency room, including access to basic primary care, dental care, and some pharmacy services. These providers generally offer care in areas that Baptist Health face a shortage of health care services, regardless of insurance welcomes coverage. According to the Uniform Data Neurointerventional System of the Health Resources and Services Administration Radiologist, (HRSA), in 2013, 51 percent of patients served by FQHCs Dr. Eren Erdem who nationwide were between the ages of 25 and 64.5 This included 94 joins Neurosurgery CHCA sites located around the state. In addition to CHCA sites, Arkansas. many smaller operations, which are mostly faith-based, are scattered in both urban and rural areas. Specializing in: Dr. Erdem received his Doctor of These independent clinics are often part of a larger, community-based • Carotid and Intra Cranial Medicine degree from Istanbul operation partnered with food Stents University in Turkey. He went on to banks, churches, or senior centers. • Cerebral Aneurysm Coiling receive specialty degrees in the area of Several programs, including • AVM Embolization federal grants, support these Diagnostic Radiology, Neuroradiology clinics because they successfully • Kyphoplasty, Vertebroplasty and Neurointerventional Radiology provide necessary primary and • Sacroplasty at Long Island College Hospital in acute care, often costing far less • Head and Neck Tumor than alternatives. Additionally, New York, Children’s Hospital of Embolization many of these clinics have Philadelphia and Lahey Clinic in Boston. benefitted from the HRSA 340B • Acute Stroke Intervention

Drug Pricing Program.6 This • Spine Tumor Ablation Dr. Erdem has been serving as program allows specific types of health care facilities to receive and • SI Joint Fusion Associate Professor of Radiology at utilize prescription medications at • Minimally Invasive Spine the University of Arkansas for Medical a much-reduced cost.7 Decompression Sciences as section chief and is • Minimally Invasive Disc excited about joining Drs. Tim Burson, National Trends Herniation Treatment Nationally, the number David E. Connor and David Reding with of uninsured individuals has • Spine Pain Management Neurosurgery Arkansas. decreased, but many safety net clinics still expect to serve uninsured clients. These may For more information or to schedule include undocumented individuals, as well as individuals who an appointment call 501-224-0200. do not qualify for subsidized private coverage through the 9601 Baptist Health Drive, Suite 310

13 will continue to have coverage after 2015, in order to determine if they should follow suit. CHCA sites have seen less of a decrease in demand, but must adjust to shifts in revenue sources. For example, some have anticipated billing less through Medicaid and more through private insurance carriers. Community Healthcontinued Center from spage 13 Centers’ (otherwise referred to as Figure 2: Arkansas Safety Net Site Examples Since 1985, CHCA has provided programmatic FQHCs)support interests and has closed, attributing its closure in areas that advocated for Communityto the increased Health health Centers coverage’ (otherwiseotherwise would referred to as FQHCs)and lack interests of need for in their areas services, that9 otherwiselack adequate would which has been noted by other health care lack adequate healthclinics care as describedservices. in theThere following are currentlyservices. There are twelve CHCA Centerssection, around Arkansas the Experiences. state, and eachcurrently manages twelve a Clinic responses to reduced demand CHCA Centers number of CHCA clinifor servicesc sites have, totaling varied from 103 a. As FQHCs,around the the state, CHCA sites are requiredbusiness toperspective, serve an but underserved several and area,each manages10 and clinics noted that they were glad a number of are often the sole healththeir patients care would provider now have in a communityCHCA clinic. While sites, they are required tobetter provide access care to comprehensive regardless of thetotaling ability 103. toAs care. FQHCs, the CHCA pay, they have traditionally accepted payment fromsites area variety required Arkansas Experiences to serve an of sources, including private coverage, Medicare, Medicaid, In Arkansas, there are many underserved area,10 and a sliding fee scaledifferent for types those of safety without net clinics. insurance. and are often the Likewise, there have been a variety sole health care Community Clinicof experiences since the increase provider in a Community Clinic, ofa thehealth insured care population. ministry No twoof St. Franciscommunity. House While clinics have identical missions or they are required NWA Inc., has servedbusiness the models; low-income therefore, population no to provideof Wa careshington and Benton counties since 1996, and became FQHCtwo qualified clinics have in been2004. impacted They operateregardless twelve of the locations ability to pay, throughout they The Rogers, first issue is the increased identically. However, a few themes have traditionally11 accepted payment competition for the newly insured Springdale, Siloamhave Springs emerged. and The the faith- surrounding and from areas a variety. Like of sources, all FQHCs, including Communitypopulation, mainly Clinic with hospital- historically acceptedmission-based Medicaid clinics patients, are facing and offeredprivate services coverage, Medicare,to the uninsured facilitated on a sliding clinics. Thefee second issue a period of internal reflection to Medicaid, and a sliding fee scale for is that the uninsured population scale. In 2013, Communitydetermine if Clinic the needs saw of their just over those27,000 without individuals, insurance. 39 percentcontinues of whom to face were educational, uninsured. With thepatients expansion would be of better insurance addressed coverage, Community Clinic anticipatcultural,ed and that linguistic rate barriers that through new avenues. One clinic, Community Clinic prohibit them from accessing care would drop to nearthe 25 Charitable percent Christian in 2014 Medical. Three -quartersCommunity through Clinic, 2014,a health theircare uninsuredat traditional rate clinics. was It is likely a closer to 31 percentClinic, which of Hot they Springs, credit redirecteded to severalministry factors of St. Francis. House NWA combination of these factors that its model of care to provide Inc., has served the low-income contribute to the uninsured rate The first issue is theadditional increase ancillaryd competition services, such for thepopulation newly of insured Washington population, and stayingmainly relatively with hospital high, potentially- as community education. Several Benton counties since 1996, and straying from projected budgets. facilitated clinics. Theothers second have managed issue to is continue that the uninsuredbecame FQHC population qualified in 2004. continues Anotherto face contributing educational, factor despite a smaller patient load, They operate twelve locations is that the clinic serves a higher cultural, and linguisticand arebarriers waiting thatto learn prohibit if those themthroughout from accessing Rogers, Springdale, care at traditionalrepresentation clinics of .the It ismedically likely a combination of thesenewly insuredfactors will that continue contribute to have toSiloam the uninsured Springs and therate surrounding staying relativelyfrail population. high, The Health Care

coverage after 2015, in order to areas.11 Like all FQHCs, Community Independence Program (HCIP) was potentially strayingdetermine from projected if they should budgets. follow Clinic historically accepted Medicaid designed to keep eligible individuals suit. CHCA sites have seen less of patients, and offered services to the having exceptional health care Another contributinga decrease factor inis demand,that the but clinic must servesuninsured a higher on a slidingrepresentation fee scale. In ofneeds the medicallyin traditional frailMedicaid population. The Healthadjust Careto shifts Independence in revenue sources. Program 2013, Community (HCIP) Clinicwas sawdesigned just tocoverage, keep elexpectingigible that amount to For example, some have anticipated over 27,000 individuals, 39 percent be about 10 percent of individuals individuals having exceptionalbilling less through health Medicaid care and needs of inwhom traditional were uninsured. Medicaid With the coverage, deemed eligibleexpecting for the that Private amount to be aboutmore 10 throughpercent private of individuals insurance deemedexpansion eligible of insurance for coverage,the Private Option.Option. To date,To date, Community Clinic carriers. Community Clinic anticipated that has found that 13 percent of those Community Clinic has found that 13 percent of thoserate would newly drop toeligible near 25 havepercent been newly designated eligible have asbeen designated having exceptionalCommunity health care Health needs Centers (i.e., medicallyin 2014. frail Three-quarters). Since thethrough clinic hasas havingtraditionally exceptional served health care Since 1985, CHCA has provided 2014, their uninsured rate was those without insuranceprogrammatic who alsosupport lack and adequatecloser care to coordination, 31 percent, which it they stands to reason that their advocated for Community Health credited to several factors. medically frail patient panel would be slightly higher. continued on page 18 CABUN Rural Health Services CABUN Rural Health14 Services Inc. manages six clinic sites in and near Hampton, Arkansas. The Center traditionally served patients in Calhoun, Bradley, and Union Counties, giving them their unique name. Over the past year, CABUN has not seen a significant change in the overall number of patients, but there has been a change in the makeup of their patient panel. The clinic has seen up to 25 percent of its previously uninsured patient population gain coverage through newly available options. As the opportunity to enroll approached in late 2014, they hoped to continue Copyright © 2015 by the Arkansas Center for Health Improvement. All rights reserved. The Impact of Expanded Coverage on Arkansas’s Health Care Safety Net Clinics Page 3

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Pinnacle Pointe Behavioral Healthcare System All major Insurances, ® 1501 Financial Centre Parkway TRICARE and Little Rock, Arkansas 72211 Medicaid Accepted.

“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved. 15 Explanation of Practice Transformation and Care Coordination

Practices that contract with coordinating patient care as Arkansas Community Cares will a member of the primary care be provided boots on the ground provider’s health care team. and care direct patient outreach - In larger practices Practice transformation helps coordination for their complex patients. care coordinators may practices develop the systems and Working directly with practices be embedded within workflows to better manage your and complex patients in managing the practice population, while care coordination their health care needs ensures the actually touches those patients that following occurs: are complex and high risk. The - At a minimum care two efforts are synergistic and not coordinators will duplicative and the maximum benefit Assessing the needs of the spend time in each occurs when you have the systems and patient – performing an initial practice weekly processes in place at the practice to comprehensive assessment. manage your patient population and Coaching patients on self- o Implementing a patient- o then have skilled care coordinators to centered care plan in the management of chronic work as a part of the health care team practices electronic medical conditions. intervening on those patients that will record. benefit the most. o Performing Medication Outreaching, educating and management and home visits o where appropriate

o Developing ongoing population health processes and procedures (work flows) for NOW their patient populations. Chenal Promenade Area LEASING AVAILABLE SUMMER 2015 West Little Rock o Supporting and assisting to establish a “medical neighborhood” environment AMENITIES with community based

◗ Population 74,000± (5 mile radius) collaborations and knowledge ◗ Easily Accessible WLR Location of available resources. ◗ Class A Medical O ce o Assuring that all Arkansas ◗ Free Parking Community Cares care ◗ Professional Management coordinators are continually and consistently trained in 37 ACRE MEDICAL CAMPUS evidence based practices which allows for the Make the move to West Little Rock. identification and spread of This state-of-the-art medical o ce building is part of a best practice. planned 37-acre medical campus that will serve as a destination for health care services in West Little Rock. Perfect for a satellite o ce, expanding practice, or new Practices that are ready to begin medical o ce. irwinpartners.com intensive outreach and population management may contact Arkansas CONTACT CALL EMAIL Community Cares to discuss in more GREG JOSLIN 501.225.5700 [email protected] detail. Susan Beasley, Program Director @ 919.236.9957 or sbeasley@ ARcommunitycares.com.

16 2015 Arkansas 68th Annual Scientific Assembly June 10-13, 2015 Doubletree Hotel, Little Rock, Arkansas Preview Although the program has been finalized for the Academy’s 68th Annual Scientific Assembly, we are “tweaking the times and making sure all of the information is correct before going to press!” The official program will be in your offices by the end of March complete with registration and hotel reservation information! We will also post it on our website arkansasafp. org

The Pre Assembly begins on Wednesday morning with a program by State Volunteer Mutual Insurance (they will do their own registration, etc. and promotions).

We will provide a combined session beginning at 1:15 pm for our Pre Assembly program entitled, “Team Based Care and ICD 10 Preparedness”. This session will end at approximately 4:15 pm.

On Thursday, June 11 our Annual Assembly kicks off with our first keynote of the week being Arkansas Surgeon General Gregory Bledsoe, M.D. followed by a 40 minute session by Doctor Joe Tollison of the American Board of Family Medicine who will be available to answer questions afterwards about anything pertaining to the boards and certification.

Thursday’s program continues with a presentation by Dr. Richard Fry on “Diagnosis of Autism” followed by “Anticoagulants” by Dr. Randy Minton. A lunch meeting will be held that day presented by State Volunteer Mutual Insurance on “Managed Care and Payment Reform”.

The afternoon session on Thursday will kick off with a “New Drug Update” by Dosha Cummins, Pharm.D., of Jonesboro followed by “ENT Potpourri” by Dr. Graves Hearnsberger of Little Rock. The last lecture of the day will be “Diabetes – Making the Right Choice in a Sea of Treatment Options” by Dr. Louis Kuritzky of Gainesville, Florida.

Concluding the Thursday program will be something new for us as we offer 75 minutes of Roundtable Interractive Sessions on: “Diabetes” led by Dr. Louis Kuritzky:: “CPCI” by Dr. Julea Garner and Rachel Wallis: “Women’s Health” by Dr. Leslye McGrath: “New Drugs Update” by Dosha Cummins, Pharm.D., “PCMH” by Dr. Lonnie Robinson: “Rural Medicine” by Dr. Amy Daniel and “Insulin” by Dr. Jeff Mayfield and “Resident/Student Involvement” by Dr. Tasha Starks and Dr. Scott Dickson.

Friday will begin with a breakfast meeting hosted by Arkansas Foundation for Medical Care with their Medical Director Dr. Beth Milligan presenting, “Practice Transformation.”

Our second keynote address will be provided that morning by President elect of the AAFP, Dr. Wanda Filer on “An Update from the American Academy of Family Physicians” followed by a presentation by Dr. Shane Speights and Dr. Joe Stallings on “Disaster Planning for your Practice.” The final lecture before the Installation of Officers Luncheon will be Dr. Harvey Makedon on “Overview of GLBT Issues.”

The afternoon session begins with “End of Life Issues” by Dr. Sara Beth Harrington followed by “Thyroid Nodules” by Dr. Brendan Stacks and “Update in Pediatric Infectious Disease” by Dr. Gary Wheeler.

Saturday’s program will begin with a breakfast meeting by Legacy Neuro on “How to Diagnose and Treat Disorders of Pain, Numbness or Weakness” by Doctor Scott Schlesinger and Dr. David Rubin; Doctor Mark Jansen will present “Nailing the Problem – Primary Disorders of the Nails and Secondary Changes due to Systemic Disease States.” An overwhelming request for “Direct Pay Patient Models” will be presented by Doctor Randall Oates of Fayetteville followed by our final presentation by Doctor Lonnie Robinson on “Family Docs on a Mission”.

Please be looking for the program the end of March with hotel and registration information! There is a room block at the hotel for our group offering a discounted rate that we will post in the official program. We hope you will join us for a great CME event!!!

17 continued from page 14 around the state to learn about their operational costs for direct their experiences since the state care have greatly dropped with a expanded health coverage. Many of drop in patient volume, they still needs (i.e., medically frail). Since these clinics have grown from faith- face issues arranging care for those the clinic has traditionally served based responses to unmet needs without insurance. those without insurance who also demonstrated by the uninsured. Another major change has been lack adequate care coordination, These responses supported by local the new hours during which CCMC it stands to reason that their charitable giving provide some is open for care. Previously, the medically frail patient panel would immediate access to health care clinic was open three days per week be slightly higher. services but do not remove the from 8:00 a.m.–5:00 p.m., as well financial barrier to a comprehensive as two evenings each month. Now, CABUN Rural Health Services set of primary care, specialty and with the drop in uninsured patients CABUN Rural Health Services pharmaceutical needs. With the seeking care from them, they are Inc. manages six clinic sites in availability of comprehensive health open just half a day each week and and near Hampton, Arkansas. care coverage the role of charitable one evening per month. The Center traditionally served clinics in eliminating financial patients in Calhoun, Bradley, and barriers to care is expected to Christian Health Center of Union Counties, giving them their change. Camden unique name. Over the past year, The Christian Health Center of CABUN has not seen a significant Charitable Christian Medical Camden (CHCC), located in Camden, change in the overall number of Clinic Arkansas, has been in operation patients, but there has been a In downtown Hot Springs, since 1997. It seeks to provide change in the makeup of their Arkansas, the Charitable Christian care to the uninsured of Ouachita patient panel. The clinic has seen Medical Clinic has operated for County and serve as a resource for up to 25 percent of its previously 17 years as the primary health other community needs. Like many uninsured patient population gain service location for the uninsured charitable clinics, CHCC provides coverage through newly available of Garland County. The mission of services on a sliding scale. Since options. As the opportunity to enroll the organization has always been to the implementation of the Private approached in late 2014, they provide services for those who lack Option, CHCC has seen its patient hoped to continue assisting patients access to care. In early 2014, the load drop by 60 percent as local in gaining coverage. There are still organization decided that it needed residents are now able to receive a significant number of uninsured to alter the services provided in care from traditional providers. individuals seeking care there, order to fully carry out its mission in CHCC often partners with the and the clinic expects the need to the future. As of late 2013, the clinic Delta Alliance for Healthcare—a continue to exist. was managing and delivering care to non-profit organization aimed at The largest issue CABUN sees about 1,000 uninsured individuals. stopping generational poverty in the for its patient population is the A year later, that number is just Delta region—to combine resources gap in knowledge about available 150. Operating under a new name, to improve care. programs and how these programs Cooperative Christian Ministries While access to insurance can benefit them. There seems to and Clinic (CCMC), they recognized coverage has improved, access to be a great deal of confusion among that their new strategy should be health care providers continues to the public, patients, and even some to help enroll patients into newly be an issue for many Arkansans, providers about the details of what available insurance options, provide especially those in the Delta region. is being offered. CABUN is trying ancillary services, and refer patients CHCC encourages patients to work to alleviate this issue by using two to traditional primary care providers with an identified primary care federally funded full-time Assistors in the community. physician but continues to see the to hold education events and assist CCMC continues to provide same patients while they struggle people with enrollment through a direct care for those who remain to get appointments. Some patients variety of methods. ineligible for insurance—mainly the have historically faced 30-60 day undocumented population in West appointment delays, so CHCC Independent Clinics Central Arkansas. A new challenge provides for them in the interim to In addition to two CHCA has surfaced; many of the programs help prevent care gaps. The clinic Centers, ACHI had conversations and grants that funded CCMC accepts and then distributes other with representatives from five operations in the past do not cover goods that their patients may have independent safety net clinics from the undocumented population. While trouble acquiring. For example,

18 they collect used crutches and cease to exist in a year’s time but volunteers to meet the needs of this wheelchairs which are distributed they are working on plans to expand growing demand. to new patients in need. Because of their other service lines. These cost and access issues related to services are often not provided in Harmony Health Center medical equipment, these donation standard health insurance plans While Little Rock, Arkansas is services are likely to continue to be and are therefore cost prohibitive home to a wide array of primary in high demand. for low-income populations. In care, public health, and specialty response, SHC offers the entire clinics, those without health Samaritan Community Center spectrum of dental services from insurance in central Arkansas can In Rogers, Arkansas, the cleanings, screenings, and X-rays, still face barriers receiving care Samaritan Community Center to extractions and emergency dental outside of emergency services. has been in operation since 1989 care. SHC has continued to see the serving as a food pantry and demand for these services increase clothing ministry. Over time they and is constantly seeking more continued on page 20 realized the lack of health care access for the uninsured in their community was a large barrier for their constituents. They began offering a weekly medical clinic, called the Samaritan Health Center (SHC), in the evening hours for the uninsured, hoping to provide opportunities for locals to Get Back to Life seek health care. The SHC served approximately 30-35 people each month who otherwise did not have access to a physician. Since the beginning of 2014, they have seen a steady decline in patient numbers. With fewer patients requesting appointments, they then began operating clinic hours on a biweekly basis. The patients who continue to seek care are largely in need of ancillary services such as care coordination or help navigating the health care system. SHC works with their local CHCA Center to provide coverage information and help enroll people into newly available insurance options. SHC encourages already established clients to connect with a local primary care physician and is often actively involved in scheduling appointments as well as helping with medication reconciliation. While SHC’s medical operations Get Back to Life are on the decline, the clinic Get Back to Life continues to see a need for dental, vision, and behavioral health services. The SHC director mentioned the medical clinic may

19 14-Mocek Physican Referral Ad PR.indd 1 12/11/14 9:33 AM continued from page 19 open five days per week offering the horizon, causing the clinics preventive and acute services to question whether to expect to the uninsured population a sudden increase in demand in Jonesboro, Arkansas. JCHC after having changed operations. In 2005, a group of citizens continuously saw an increase in Those clinics that now accept concerned with this underserved the number of patients served, different insurance carriers population came together to create reaching capacity with 5,463 face the challenge of decreased the Harmony Health Clinic (HHC). individuals in 2013. The center demand for primary care services Located a few miles from downtown operates mainly through the and an increased demand for Little Rock, HHC provides services Arkansas Department of Health specialty care such as behavioral

for the uninsured, transient, Charitable Clinics Grant Program,12 health, dentistry, and vision care. undocumented, and homeless a large annual fundraiser, and An interesting facet of these groups directly and through all several individual and faith- based challenges is that the mission of local shelters. donations. They also traditionally these clinics is to serve those in Since the implementation of charged a flat $15 office visit greatest need and most clinics are the Health Care Independence fee to help ensure patients kept not disappointed to see the need Act, HHC has seen a 50 percent appointments. met by more comprehensive and decrease in its patient population. Since the beginning of 2014, integrated providers. Unlike other clinics, they continue JCHC has seen approximately The majority of charitable to operate the same amount of 100 fewer patients each month. clinics who shared experiences clinic hours but now require the This has caused a decrease in reported a dramatic decrease in services of only one physician revenue for the clinic that they the number of uninsured walking instead of two. They also continue are temporarily managing through through their doors seeking care. to offer two full time, in-person reserves. JCHC will look to its This has mainly affected demand, Assistors to educate those now Board of Directors to determine but also revenue, as programs eligible for insurance. While their if any operational changes are aimed to benefit the uninsured are patient numbers have decreased needed should this decreasing being eliminated. Yet the attitude dramatically, HHC is confident trend continue. The patients of several operational managers is that their services will continue to that are still seen at JCHC have positive; they are glad to be losing be needed. They know that people reported a mixture of issues such patients if that means patients are will continue to experience gaps as not being eligible for new receiving more comprehensive care in the health care system. This insurance programs, or the plans elsewhere. They know that their includes some individuals who will offered still being too expensive. previous patients are better served go through periods of transition Access to primary care physicians by a traditional primary care between insurance carriers and in the local area is another large setting and are grateful so many some who require care outside of issue; many patients have returned of them now have access to health traditional settings. to JCHC saying that their new coverage, and through that, direct Patients who have become insurance was not accepted, or access to care. eligible for the Private Option often they could not get an appointment It is unlikely that safety net want to continue their relationship without an extended waiting time, providers will completely cease with HHC despite now having often causing care gaps for very ill to be in demand due to the needs insurance coverage. HHC continues patients. of undocumented, transient, and to act as a care connector and economically sensitive populations, educator instead of direct care Conclusion even if the HCIP continues. The provider. Conversely, the demand A year after Arkansas efforts to increase the number for other services provided by HHC experienced an increase in its of Arkansans who are covered by continues to grow. The demand number of covered lives, many of affordable health insurance have for their dental care exceeds the state’s community and faith- been successful in many ways, their supply of trained volunteers, based clinics have adjusted to as demonstrated by the decrease creating a desire to be able to decreases in demand. However, seen in many strictly charitable expand those services. a new challenge for these groups clinics. More work is needed to may be just around the corner. strengthen the network of providers Jonesboro Church Health Center The potential for the Arkansas in disparate areas as well as to Since 1992, Jonesboro Church Health Care Independence Act to educate the newly eligible about Health Center (JCHC) has been be repealed or unfunded looms on the options available to them. In

20 order for safety net providers to 1, 2014; http://www.hrsa.gov/opa/ arkansas- clinic-closing-because- continue to be successful, they will update.html. obamacare-enrollment. need to identify funding streams for the changing services that are 7 “340B Drug Pricing Program.” 10 “What are Federally qualified being demanded of them. Health Resources and Services health centers (FQHCs)?” Administration, Accessed on June Health Resources and Services References 1, 2014 at http://www.hrsa.gov/ Administration, Accessed on 1 Health Care Independence Act opa/. January 28, 2015 at http:// of 2013, Act 1497, Act 1498. www.hrsa.gov/healthit/toolbox/

8 Kane A; for The Denver Post. RuralHealthITtoolbox/Introduction/

2 Andrulis, DP. “Access “Colorado Clinics Scramble to qualified.html to Care is the Centerpiece Find Place in new Health Care in the Elimination of Environment.” Denver and the 11 “Locations.” Community Socioeconomic Disparities in West; The Denver Post, March Health Centers of Arkansas, Inc. Health.” Annals of Internal 2014; http://www.denverpost. Accessed January 29, 2015 http:// Medicine, 1998;129(5):412-6. com/news/ci_25672493/colorado- www.chc-ar.org/locations. doi:10.7326/0003-4819-129-5- clinics-scramble-find-place-new- 211217A01 199809010-00012 health- care. 12 “Arkansas Department of Health: Arkansas Charitable

3 Witters D; Gallup Well-Being. 9 Mac Neal C; TPM Livewire. Clinics Grant Program.” Arkansas “Arkansas, Kentucky Report “Arkansas Free Clinic Closing, Department of Health. Accessed Sharpest Drops in Uninsured Citing More Insured Through on January 28, 2015 at http:// Rate: Medicaid Expansion, State Obamacare.” TPM Medial www.healthy.arkansas.gov/ Exchanges Linked to Faster LLC., April 10, 2014. http:// programsServices/hometownHealth/ Reduction in Uninsured Rate.” talkingpointsmemo.com/livewire/ ORHPC/Pages/Programs.aspx. Washington, DC: Gallup, Inc., August 5, 2014. Accessed online at http://www.gallup.com/ poll/174290/arkansas-kentucky- report-sharpest-drops-uninsured- rate.aspx.

4 Institute of Medicine. “America’s Health Care Safety Net: Intact But Endangered.” National Academy of Sciences, WHAT TOOK YOU A LIFETIME 2000. Accessed online at http:// iom.edu/~/media/Files/Report%20 TO LEARN CAN BE LOST IN MINUTES. Files/2000/Americas-Health- Care-Safety- Net/Insurance%20 Safety%20Net%202000%20%20 report%20brief.pdf

5 “2013 Health Center Data.” Health Resources and Services Administration; Accessed on January 16, 2015 at http://bphc.hrsa.gov/ WITH A STROKE, TIME LOST IS BRAIN LOST. healthcenterdatastatistics/index. html. Learn the warning signs at StrokeAssociation.org or 1-888-4-STROKE. 6 “340B Drug Pricing Program: Important Benefit, Significant

Responsibility.” Health Resources ©2004 American Heart Association and Services Administration, June Made possible in part by a generous grant from The Bugher Foundation.

21 NOTE TO PUB: DO NOT PRINT INFO BELOW, FOR ID ONLY. NO ALTERING OF AD COUNCIL PSAs. American Stroke Association - Magazine - (4 5/8 x 4 7/8) B&W - ASNYR2-N-01065-U “Lifetime” 110 line screen digital files at Schawk: (212) 689-8585 Ref#: 211217 SVMIC Declares Arkansas Membership $10.0 M Dividend ARKANSAS MEDICAL Statistics SOCIETY EXCLUSIVELY ENDORSES SVMIC

BRENTWOOD, Tenn. – The Arkansas During the week of February 9, The average age of an Arkansas Medical Society has selected State the American Academy processed Chapter member is between 40 and Volunteer Mutual Insurance Company (SVMIC) as their exclusively endorsed members due for re-election on 44 years of age. carrier for Medical Professional December 31, 2014 who have Other membership categories Liability/Malpractice (MPL) coverage reported sufficient CME for are: Resident members – 92: effective January 2015. SVMIC has been re-election for the three year Student Members – 86: Supporting insuring physicians in Arkansas for 25 years, making it the largest and longest period January 1, 2012 through members – 1: Life members – 88 continual writer of MPL coverage in the December 31, 2014. and Inactive members – 3 for a state. Regretfully, 46 Arkansas AFP total membership of the Arkansas “SVMIC and the Arkansas Medical members have yet to fulfill the chapter of 1280. Society share a deep commitment to the physicians of our state. SVMIC provides CME requirements for continued Membership dues are being paid Arkansas physicians with a proven membership and will be dropped for the 2015 year ahead of schedule partner who has the integrity and from the membership roles in May as compared to last year. Dues financial strength to support their long if the CME requirements are not statements went out in October, term promise to Arkansas policyholders,” said David Wroten, Executive President of reported by March 31. 2014. As of this date, February the Arkansas Medical Society. Requirements for continued 13 , we have received a total of Further, John H. Mize, SVMIC’s President membership in the AAFP are a $115,791. for Arkansas member and CEO, adds, “We are proud to have minimum of 150 hours of CME dues!!! been selected by the Arkansas Medical Society as their exclusive endorsed MPL as acceptable to the AAFP of Congratulations to our new carrier and look forward to continuing to which one half (75 hours) must be members as follows: work with the AMS as we bring our Prescribed Credit or formal course unique, powerful combination of physician-focused MPL coverage and credits. Twenty five of these hours Andrew Christopher DeClerk, broad risk management resources to bear must be “live” ( or not by online Student in the interest of Arkansas physicians.” courses). Elective hours make up SVMIC and AMS both recognize the the remainder which are enrichment Barrett Burger, Student value of physician involvement in governance; SVMIC’s Arkansas Advisory type activities such as courses not Committee is composed of 9 physicians approved by the AAFP: hospital Morgan Drake, Student from various specialties throughout staff meetings , etc. If you are Arkansas. In fact, says Dr. Dennis one of the 46 members who have Heather Collier, Student Yelvington, Chair of the Board of Trustees of the Arkansas Medical Society, “SVMIC not reported sufficient hours for has a local presence to support us continued membership – please James Mitchell, Student including 3 local representatives living in contact us and see if we can assist Arkansas, as well as a fully staffed office in reporting your hours. Precepting Jake McMillion, Student in nearby Memphis. Further, we feel as though Arkansas physicians are well a nurse, a medical student or other represented in the leadership of the health professional can be reported Jim Awar, Student SVMIC Board of Directors and are proud for up to 20 Prescribed Hours per that an Arkansas physician, Dr. John Lytle year. We can be reached at 501 Anthony Rooney, Student of Pine Bluff, has been elected as the next Vice-Chair of SVMIC’s Board. This 223 2272 or [email protected]. structure gives me great confidence that Demographic characteristics David Blackburn, Student SVMIC will continue to be in close touch of the Arkansas Chapter as of with the issues faced by Arkansas 1/31/15 show 855 Active members Lonna Bufford, Resident – physicians.” of which 617 are male and 238 Texarkana SVMIC was founded by physicians in are female. 152 of this number 1976 and provides MPL coverage in are an AAFP Fellow: 715 are U.S. Jonna Michelle Dyer, M.D., Tennessee, Arkansas, Virginia, Kentucky, Medical School graduates and 810 Fayetteville – Active Member Georgia, Alabama and Mississippi. SVMIC has maintained an “A” (Excellent) are graduates of a family medicine transfer from Missouri or better rating from A.M. Best Company residency program. for more than 30 years.

22 Arkansas Legislative Session In Full Swing!!

There are several bills that have been filed of interest to Family Doctors described below. Emails will be sent out as we obtain information on when they will be heard. It is possible by the time this Journal reaches you, the bills will have been heard. The bills are as follows:

SB 133 (Bledsoe) - Telemedicine - Establishes the licensure requirements for physicians and others utilizing telemedicine, requires the “in person” standard as the basis for patient relationships in order to utilitize telemedicine and establishes coverage and payment requirements for insurance carriers. SUPPORT

HB 1136 - (Magie) - A bill allowing APRN’s and Pas to continue writing hydrocodone combination products that were reclassified as Schedule II. Requires specific authorization from the collaborating physician and requires the Board of Nursing to adopt rules for treatment of chronic, non-malignant pain that are as stringent as those of the State Medical Board. SUPPORT

HB 1160 – (Hammer) – APRN SCOPE OF PRACTICE - Another effort by the APRNs to practice medicine. APRNs who practice in “medically underserved areas (73 of 75 counties) may obtain a permit from the Nursing Board that would allow them to prescribe ALL Schedule II drugs, serve as the equivalent of a Primary Care Physician, head of the Patient Centered Medical Home and receive reimbursement equal to a physician. After two years under a Collaborative Practice Agreement, they can request from the Nursing Board an exemption to allow full practice without collaboration. STRONGLY OPPOSED

HB 1165 (Gonzales) - Full Schedule II Drugs. This bill allows APRNs and PAs to write “ALL” Schedule II drugs. STRONGLY OPPOSED

Members of the Senate Public Health Committee: Members of the House Public Health Committee: Chair – Senator Cecile Bledsoe Chair – Representative Kelley Linck Vice Chair – Senator Stephanie Flowers Vice Chair – Representative Deborah Ferguson Senator John Cooper Representative Mary Bentley Senator Scott Flippo Representative Justin Boyd Senator Keith Ingram Representative Ken Bragg Senator Missy Irvin Representative David Branscum Senator David Sanders Representative Charlene Fite Senator Gary Stubblefield Representative Kim Hammer Representative Ken Henderson Representative Fredrick Love Representative Robin Lundstrum Representative Stephen Magie Representative David Meeks Representative Josh Miller Representative Betty Overbey Representative John Payton Representative Chris Richey Representative Dan Sullivan Representative Jeff Wardlaw Representative Richard Womack Health Literacy: Challenges and Strategies

By Lynda Beth Milligan, MD, FAAFP, CPE, CHCQM

Health literacy is a more serious American adults read on an eighth-grade people with a compromised health problem than many health care level, but most medical information status.6 professionals realize, and it affects the is written on a twelfth-grade level.3 No one can determine health literacy majority of your patients. Public health After a doctor’s office visit, patients levels by observation alone. Low- leaders are shifting the health literacy misunderstood instructions more than 60 literacy adults have learned to hide focus from hospitals to the community to percent of the time. their inadequacy with excuses such as, improve how people understand and use Low health literacy has a direct “I forgot my glasses,” or “I’ll wait to health information in their lives. and negative impact on compliance, decide this until I can talk to my family Health literacy means having outcomes and cost. Some studies have about it.” Most are too embarrassed to the ability to obtain, process, and placed the cost of health illiteracy at ask questions or fear asking a “stupid” understand basic health information and more than $236 billion per year.7 The question. Other clues include not being services needed to make appropriate health care costs of low-literacy-level able to explain their medical or health health decisions and follow treatment Medicare beneficiaries are four times concerns, what their medications are for, instructions.1 Only 12 percent of higher than costs for beneficiaries with a or how to take them. They don’t follow American adults meet this standard of high level of literacy.2 People with limited through with tests and appointments, health literacy and less than half have health literacy are much more likely to and are non-compliant with medications any health literacy skills, according avoid important preventive measures and treatments. to the National Institutes of Health. such as mammograms, Pap smears and It is the primary responsibility of Adequate health literacy also includes flu shots.4 They are more likely to have public health professionals and the the ability to provide informed consent, chronic conditions and are less able healthcare and public health systems to understand preventive treatments, to manage them effectively. They have to increase patients’ understanding of and possess math skills sufficient to more preventable hospital visits and health care instructions, treatments and understand dosages and calculate admissions.5 background information. The following premiums, copays and deductibles. Low Populations most likely to experience are tips to start using with your patients: health literacy has multiple causes, low health literacy are older adults, including the fact that more than 90 racial and ethnic minorities, people with million American adults have limited less than a high school degree or GED literacy skills.3 Less than 60 percent certificate, people with low-incomes, have English as their first language. Most non-native speakers of English, and continued on page 26

24 WHEN IT COMES TO YOUR PATIENTS’ HEALTH CARE, YOU HELP CALL THE PLAYS Encourage Blood pressure check your patients to Flu shot schedule important Cholesterol screening preventive care: Colorectal cancer screening Mammogram Cervical cancer screening

Preventive care can detect problems early and help keep

your patients healthy. THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MP2-AMS.PREVHLTH.AD,4-12/14 25 continued from page 24 SAMUEL A. MOORE, D.O. condition rather than disease References: • Use plain language, free of pathophysiology. 1. U.S. Dept of Health and Human medical jargon. Slow down Services 2000. Healthy people Orthopedics & Sports Medicine the pace of your speech. Avoid • Train all staff in your organization 2010. Washington, D.C: U.S. vague terms. “Take on an empty to recognize and respond Government Printing Office. stomach” may be confusing, but appropriately to patients with Originally developed for Ratzan SC, “Take one hour before you eat literacy and language needs. Parker RM. 2000. Introduction. breakfast” leaves less room for In National Library of Medicine n misinterpretation. Listen to the • Ask patients to “teach back” Current Bibliographies in Medicine: Total joint replacement patient and use the same terms he what they have been told. After Health Literacy. Sheldon CR, Zorn of the hip & knee or she uses. explaining a new concept, new M, Ratzan SC, Parker RM, Editors. n Arthoscopy of the hip, medication or treatment plan, NLM Pub. No. CBM 2000-1. knee, shoulder • Keep instructions short and ask the patient to repeat what Bethesda, MD National Institutes of simple. Only tell them what they you said, in his or her own Health, U.S. Department of Health n Rotator cuff repair need to know unless they ask words. The patient’s response and Human Services. n specific questions. Reinforce and will tell you far more about the ACL reconstruction repeat instructions. level of understanding. Continue 2. Literacy of older adults in America. n Fracture treatment to reassess comprehension and 1996. Washington, DC: National n • Focus on one to three key adjust your response until the Center for Education Statistics, US PRP & Stem Cell Therapies messages, and repeat and patient has a full understanding. Dept. of Ed. reinforce that information in “Teach back” is one of the top Accepting new patients in different ways. Use pictures, 11 patient safety practices for 3. U.S. Dept. of Health and Human Little Rock, North Little Rock, concrete and specific examples, reducing medical errors.7 Services. What is health literacy? Conway and Beebe offices and verbal illustrations. Oct. 2014. Washington, DC. These links provide free National Institutes of Health. Call 501-663-6455 • Ask patients to list one to downloadable tools to help physicians three of their top concerns or improve communication with low- 4. Scott TL, Gazmararian JA, Williams or 1-800-336-2412 questions. Patients are more health-literacy patients: MV, Baker DW. 2002. Health for an appointment likely to retain the answers to literacy and preventive health care their own questions. Combine • http://www.cms.gov/Outreach- use among Medicare enrollees patients’ concerns with your key and-Education/Outreach/ in managed care organization. messages to simplify and focus WrittenMaterialsToolkit/ Medical Care. 40 (5): 395-404. your instructions to a manageable downloads/ amount of information. ToolkitPart05Chapter06.pdf 5. Baker DW, Parker RM, Williams MV, Clark WS. 1997. The • Focus instructions on what you • ahrq.gov/professionals/quality- relationship of patient reading want the patient to do. Explain patient-safety/pharmhealthlit/ ability to self-reported health specific behaviors and personalize pharmlit.pdf and use of health services. Amer your instructions. Journal of Public Health. 87 (6): 1027-1030. • Develop short and simple The communications gap between explanations for common side patients’ understanding and the skills 6. National Center for Education effects and frequently encountered required to comprehend typical health Statistics 2006. The Health medical conditions. Test these care information must be narrowed. Literacy of America’s Adults: with patients and revise your Putting the burden of effective Results From the 2003 National words until all patients can teach communication and understanding Assessment of Adult Literacy. it back to you without hesitation. on yourself, makes patients more at Washington, DC: U.S. Dept. of ease and willing to make an effort to Education Scan the QR code with your smart phone or search • Instructions and educational comprehend. background materials should be 7. Iowa Healthcare Collaborative. Samuel Moore, D.O. - Orthopedic Surgeon explained verbally and include Dr. Milligan is vice president, June 2013.Teach back basics. written and pictorial versions. corporate medical director with the www.ihconline.org/aspx/general/ www.drsamuelmoore.com Handouts should focus on the Arkansas Foundation for Medical Care. page.aspx?pid=107 www.facebook.com/DrSamuelMoore patient’s experience with a THE BEST SURGEONS. THE BEST TREATMENT. orthosurgeons.com 26 ALL FOCUSED ON YOU. SAMUEL A. MOORE, D.O. Orthopedics & Sports Medicine

n Total joint replacement of the hip & knee n Arthoscopy of the hip, knee, shoulder n Rotator cuff repair n ACL reconstruction n Fracture treatment n PRP & Stem Cell Therapies

Accepting new patients in Little Rock, North Little Rock, Conway and Beebe offices Call 501-663-6455 or 1-800-336-2412 for an appointment

Scan the QR code with your smart phone or search Samuel Moore, D.O. - Orthopedic Surgeon

www.drsamuelmoore.com www.facebook.com/DrSamuelMoore

THE BEST SURGEONS. THE BEST TREATMENT. orthosurgeons.com ALL FOCUSED ON YOU. 27 of the early success stories in terms a Health Alert Network Advisory of expanded access and increase in about the measles outbreak that primary care received. The Oregon included recommendations for From Coordinated Care Organizations health care professionals to use reported a 19 percent reduction in in their practices. One of those AAFP emergency department spending recommendations is to consider and a 17 percent reduction in measles in the differential diagnosis NEWS emergency room visits during 2013. of anyone with a febrile rash illness One Oklahoma initiative the Sooner and clinically compatible symptoms NOW: Care program, reported it avoided who has traveled abroad recently 61,000 ER visits from 2009 to 2013 or who has come in contact with for a cost savings of $21 million. someone who also has a febrile New Report Highlights More than 90 percent of children rash illness. Savings Achieved by and adolescents in the plan had Given that it’s the middle of flu Medical Homes access to a primary care physician season, measles should be added to in 2013. the list of possible causes of febrile Between 2009 and 2013, PCMHs Evidence suggests that trends rash. supported by payment incentives continue to be positive for practices Immunization Schedules: had increased in number from 26 that are able to fully implement the http://www.aafp.org/patient-care/ to 114, patients served (5 million PCMH model of care. The longer immunizations/schedules.html) to 21 million) and a number of a PCMH practice has implemented states embracing medical home the model, the more impressive the transformation (18 to 44) according results. CDC, AAFP and Others to the PCPCC report which reviewed Offer Flu Treatment PCMH initiatives in several states. For a complete copy of this Tips In all the report combined findings article, it can be viewed on the from seven state reports, seven AAFP website under AAFP News Even though the 2014-15 vaccine insurance reports and 14 peer 2/9/15 has proven to be only 23 percent reviewed studies. effective against H3N2 viruses, According to Rajul Rajkumar, a the CDC continues to recommend primary care physician and acting Measles Outbreak the vaccine for all eligible patients deputy director of CMS’s Center for Offers Discussions for because it provides at least some Medicare and Medicaid innovation, Immunizations protection against the H3N2 strain states three elements are essential and protects against two or three for the medical home to be The number of cases reported in other virus strains that could effective: January alone of Measles was more possibly circulate later in the • The physician should receive than the total seen in a typical year. season. incentives such as shared According to widespread reports, The CDC and several medical savings in the second or third most of the cases have been traced organizations are urging physicians year of the initiative to DisneyLand in Orange County, and other health care professionals • The care team needs training California. AAFP President Robert to help protect children under 2 to handle multiple tasks to Wergin observes that the elevated and adults 65 and older by using preserve the physician’s time media exposure of this outbreak antiviral drugs promptly when • All participating institutions offers a perfect opportunity for influenza is suspected. They note need access to patient family physicians to identify that flu activity is still high and information at a specified time unimmunized patients in their likely will continue for weeks practices and reach out to them to pointing out that influenza A Typically, studies have shown explain the importance of getting viruses remain the most commonly evaluations of medical homes put the measles, mumps and rubella circulating strains to date with too much emphasis on cost savings (MMR) vaccine. more hospitalizations and deaths often ahead of other considerations From January 1 to January occurring in these two high risk such as access to care. 30, 102 people in 14 states were patient populations during seasons Each initiative that researchers reported as having measles: when H3N2 viruses predominate. studied was measured based on Last year the CDC received the The CDC recommends three cost and utilization, preventive most measles case reports the influenza antiviral drugs: health service offerings, C C agency had seen in 20 years oseltamivir (Tamiflu), zanamivir xprimary care access and patient - more than 600: On January (Relenza) and the IV drug peramivir satisfaction. Oregon has been one 23 of this year, the CDC issued (Rapivab).

28 SeasonalGetaways

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29

Happy Holiday Season to You and Yours! The As Amily hysiciAn ArkAns F P Volume 19 • Number 1 AN OUNCE OF PREVENTION

WHERE HEALTH IS PRIMARY.

Patients with access to primary care are more likely to receive preventive services and timely care before their medical conditions become serious – and more costly to treat. Family doctors work with their patients to keep them healthy. We want to ensure that all patients have access to and use regular preventive care.

Let’s make health primary in America. Learn more at healthisprimary.org .

#MakeHealthPrimary The AAFP Launches National Campaign “HEALTH IS PRIMARY” (See Page 25)

For Advertising Information

contact Tom Kennedy Publishing Concepts, Inc. by phone at 501/221-9986 ext. 104 or by email at [email protected]

We’re a knowledgeable connector of people, physicians and health care places.

One way we keep physicians and patients connected is through a Personal Health Record (PHR), available for each Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas member. A PHR is a confidential, Web-based, electronic record that combines information provided by the patient and information available from their claims data.

A PHR can help physicians by providing valuable information in both every day and emergency situations.

To request access, contact PHR Customer Support at 501-378-3253 or [email protected] or contact your Network Development Representative.

arkansasbluecross.com MPI 2003 11/13

30 The Core Content Review of Family Medicine

Why Choose Core Content Review?

• CD and Online Versions available for under $250! • Cost Effective CME • For Family Physicians by Family Physicians • Print Subscription also available • Discount for AAFP members • Money back guarantee if you don’t pass the Board exam • Provides non-dues revenue for your State Chapter

North America’s most widely-recognized program for: • Family Medicine CME • ABFM Board Preparation • Self-Evaluation

• Visit www.CoreContent.com • Call 888-343-CORE (2673) • Email [email protected]

31 Arkansas Academy of Family Physicians Presorted Standard 500 Pleasant Valley Drive, Building D, Suite 102 U.S. Postage Paid Little Rock, Arkansas 72227 Little Rock, AR Permit No. 2437

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Claims handled by SVMIC Consecutive years SVMIC has 2, 560 attorneys from inception 31 maintained an “A” (Excellent) or in Arkansas to date; better financial rating from A.M. unmatched claims expertise working with local Best; industry-leading financial stability defense counsel in Arkansas helps defend your means we will be here when you need us. personal and professional reputation if the time comes.

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