Reducing Readmissions Slowing the Revolving Door

+($/7+&$5(-2851$/ NOVEMBER / DECEMBER 2014 I healthcarejournallr.com I $8 of Little Rock Reducing Readmissions Slowing the Revolving Door

One on One Mark White, CEO Arkansas Blue Cross and Blue Shield

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Smart, in-depth, award-winning healthcare reporting +/5 November/December 2014

Chief Editor Smith W. Hartley [email protected]

Managing Editor Karen tatum [email protected]

Editor/Writer Philip Gatto [email protected]

Contributors A. D. Lively John Mitchell

Correspondents Rhonda Finnie, dnp, aprn, agacnp-bc, rnfa Ray Hanley Nathaniel Smith, MD, MPH Joseph W. Thompson, MD, MPH

Art Director Liz Smith [email protected]

Sponsorship Director Dianne Hartley [email protected]

Photographer Zoie Clift

2014 Healthcare Journal of Little Rock Advisory Board

Sara B. Bradley, CPA Vice President- Finance Mercy Health System-Hot Springs

Scott Davis, MD, FACC Interventional Cardiologist Arkansas Cardiology

Ray Hanley President, Chief Executive Officer Arkansas Foundation for Medical Care

Lynda M. Johnson Partner Friday, Eldredge & Clark, LLP

M. Corey Little Chief Executive Officer Arkansas Mutual Each issue of HENRI ROCA, MD Healthcare Journal of Chief, Integrative Medicine, Central Arkansas Veterans Healthcare System Little Rock provides important articles, Assistant Professor, University of Arkansas Medical School features, and information for health- Hayden W. Shurgar Attorney care professionals. Also included are a Wright, Lindsey & Jennings LLP

“One on One” with the Chief Editor, Roxane A. Townsend, MD Vice Chancellor of Clinical Programs and CEO, University Medical Center Local Correspondents, Hospital University of Arkansas for Medical Sciences

Rounds, Healthcare Briefs, and more. Michele R. Wright, PhD Pathology Partners, LLC

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November / December 2014 I Vol. 2, No. 1 page 12

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On the Cover reducing readmissions Revolving door has financial repercussions +/5 page 28

page 34 Features 18 Buying Time A quarter-century of Departments innovation in the battle against Myeloma Editor’s Desk...... 10 Healthcare Briefs...... 41 24 PAs in Arkansas Hospital Rounds...... 57 An update from ARAPA Advertiser Index...... 66 28 Why SHARE Matters Correspondents Health information exchange in Arkansas Director’s Desk...... 48 Policy...... 50 34 One on One with Quality...... 52 Mark White Nursing...... 54 President and CEO, Arkansas BCBS editor’s desk

“We spend our time searching for security and hate it when we get it.” — john steinbeck, america and americans

Every so often we experience a defining moment in life. The recent appearance of the Ebola virus within the United States has created a heightened awareness of our approach towards public health and our resolve towards protecting the health of healthcare workers. The CDC and its director, Thomas Frieden, MD, have been starkly criticized for the agency’s apathetic response towards its containment policies and its view towards the responsibility of healthcare workers and their compliance with procedures. The CDC has been charged with the responsibility from the federal level to detect and respond to new and emerging health threats. The response is coming. About 10 years ago I worked for Thomas Frieden at New York City’s Department of Health and Mental Hygiene. My general impression was Dr. Frieden was a straight-up guy who takes public health very seriously. During that time, under Frieden’s leadership, New York City instituted smoking bans throughout the City which appeared to many New Yorkers as an overreach of government’s involvement in public health. The smoking ban model was later replicated by many cities and communities. So, my opinion is, change is coming. Public health is usually taken for granted until these types of situations arise. Then, we bring our focus to the public health possibilities which range in reactions from possible concern to outright panic. The mission of public health is to best gauge the truest possibilities and act on that likelihood with reasonableness. We want enough protective measures without overshooting the mark with needless bureaucracy and infringement of freedoms. This is a tough balancing act. Healthcare organizations all across the country are reevaluating their infectious control protocols to account for new and emerging threats such as Ebola. There aren’t many priorities for healthcare organizations more important than protecting the health of healthcare workers. Many healthcare organizations generally have held a “patients first” mantra. Healthcare workers have always functioned with a controlled risk when dealing with patients. This will continue with a heightened awareness towards threats of injury or infection. No place is perfect. But, we all know we can and should do better. The new mantra will be “people first.” There’s never a dull moment in healthcare. New and changing types of injury and illness inspire new and changing treatments and policies. We are getting close to 20% of the GDP dedicated to healthcare. That means much of the population is focused on improving the health of others. It’s not an easy task. And, considering the risks, changes, and complexity of providing healthcare, I hope caregivers who are technically skilled and care for our well-being understand the gratitude we have for the work they do.

Smith Hartley Chief Editor [email protected] readmissions For the past two years, hospitals nationwide have adapted to a new Affordable Care Act rule that exacts penalties if a Medicare patient is readmitted within 30 days of discharge. The Medicare Readmission Reduction Act was adopted to take a bite out of the annual $26 billion it costs the government when Medicare patients return to the hospital. e reducing readmissions Revolving door has financial repercussions

By John Mitchell readmissions

The third year results, which will reduce maximum three percent. In Arkansas, no hospital payments in the newly started fed- hospital was at the three percent maximum, eral fiscal year for all Medicare patients (not but 47 percent * of the state’s hospitals were just for readmitted patients), were recently assessed a penalty, just below the national announced. In total 2,610 hospitals will for- average of 49 percent. feit up to three percent of their Medicare Nationally, the penalties will amount to payments, with 39 hospitals penalized the $428 million in the 2015 fiscal year. This focus on readmissions represents one of the biggest paradigm shifts in recent hospital management memory. “The old mindset was that every patient – even a readmission - was a good patient,” said Doug Weeks, Executive Vice President & Chief Operating Officer at Baptist Health, referring to the financial metrics hospitals must consider to operate. He stressed we need so patients don’t this attitude has changed, unnecessarily return,” with a bit of a “juggling Weeks added. act” to meet admission cri- Week’s assessment is teria that both satisfies length echoed by Dr. Stephen Jencks, of stay protocol and properly pre- one of the first researchers to iden- pares the patient for discharge to avoid read- tify the high rate of readmission in America. ** mission. “Physicians are doing the best they “This really modest step (of penalties) can to do the right thing by the patient. We’re persuaded a lot of hospitals to talk in ways working with our medical and hospital staff they were simply not talking 10 years ago,” to hone in on what kind of case management he was quoted as saying in a Kaiser Health News report about readmissions. Hospital leaders know this readmission campaign has wider ramifications. Commer- TOP Doug Weeks, Executive Vice President & COO, Baptist Health. cial payers often adopt Medicare practices as BOTTOM Nicholas Lang, MD, Chief well, so the future could see all payers apply- Medical Officer, UAMS Medical Center. ing the readmission penalty model. Nicholas Lang, MD, Chief Medical Officer

14 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK at UAMS Medical Center describes the emer- been historically readmitted,” she explained. for example, has deployed advance prac- gence of the readmission standards as a “But we’ve been able to lower our readmis- tice nurses to conduct health checks on fundamental redefinition of the meaning of sion from 18 percent (the national average) discharged patients. The trauma physi- healthcare. to 10 percent.” cians now act as the attending doctor with “We’ve been focused on the hospital and According to a hospital-by-hospital data such specialists as orthopedic surgeons act- the clinic. But now we have to step back and report released by Medicare,*** UAMS is ing as consulting physicians. The hospital’s look at the rest of the system, such as how one of only a few hospitals in Arkansas ENT surgeons, which include Dr. Lang, have the patient gets meds and home health deliv- with three straight year-to-year declines in launched a length of stay initiative to ensure ery. We now have to consider just as much readmission penalties. Most hospitals saw that patients meet the appropriate length of about what happens when the patient leaves an increase from year two to year three as stay for their case. Townsend added that they the hospital. There are a lot of social barri- two new standards – readmission for elec- have a dedicated group of nurse case managers that can inhibit recovery,” said Dr. Lang. tive hip and knee replacements and lung ers whose main focus is to look at discharge “Readmissions will never get to zero,” ailments, such as chronic bronchitis – were needs, including home health and medica- said Roxanne Townsend, CEO of UAMS. added to the original three conditions of tion needs. “However the challenge is that to improve acute myocardial infarction, heart failure, “It’s a more holistic approach,” she said. the numbers you have to develop a plan and pneumonia. “We have to ask the patient questions such that works with 100 percent of our patients, Townsend cites several initiatives in play as, ‘Can you go to the bathroom by yourself? even though only about 20 percent have at UAMS. The hospital’s trauma department, Do you have food?’ and if not, how will these

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 15 readmissions

things be fixed?” 18,000 clients a year. This includes working with CareLink. The Baptist’s Weeks said finding such com- local, nonprofit agency, which was founded munity partners is strongly correlated with in 1979, provides resources for older people decreasing readmission rates. He said the to help them remain independent in their hospital tracks readmission rates from rehab homes. CareLink currently helps about and long term care facilities. “We want to be sure that we are sending our patients to post discharge facilities (SNF, rehab, and nursing facilities) that care about the same things we do, such as making sure scrips get filled and the patients go to their post discharge appointments with their primary care physician,” he said. He also said they have restructured their case management across the Baptist system to remove departmental silos that can interfere with optimal post discharge care. “Our total readmission penalty University Medical is small,” he explained. “But we’ve Center, Beth Israel Med- got room for improvement.” ical Center, Tufts Medical Some of the biggest hospital names in the Center, and satellite hospitals in country are feeling the bite. Hospitals sched- the Mayo Clinic and Geisinger Health System. uled to lose one percent of Medicare pay- “Every time they add conditions, the pen- ments in the upcoming year include Rush alties go up,” said Nancy Foster, a quality expert at the American Hospital Associa- tion in the Kaiser report. At Saline Memorial, Sherry Jensen, MSN, Director of Quality, Risk, and Compliance, TOP Roxanne Townsend, MD, a registered nurse who worked her way up CEO, UAMS. BOTTOM Sherry Jensen, MSN, from the floor to supervisor and then to Director of Quality, Risk, and manager, offers a unique perspective to the Compliance, Saline Memorial. challenge of readmission. “When the readmission rates were first

16 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK unfair. “There was anger at first, followed by “We have an outreach program for rehab acceptance. It was a lot for people to get their and nursing home facilities through our minds around.” regional HEN group, which brings in speak- As with the other hospitals, Saline ers and gives us a chance to share best prac- recruited their Home Health Department to tices,” she said. The area HEN – Healthcare create pathways for reducing readmissions. Engagement Network – is one of 26 such They also called on their hospital volunteers, regional groups sponsored by CMS, which who raise money for hospital grants. Jensen administers Medicare and Medicaid. said they realized that many patients did not These relationships are important. Jensen have a scale, critical for measuring fluid build recalled a patient who was readmitted from a up in CHF patients. The volunteers agreed to nursing home for CHF. During discharge dis- fund the purchase of scales designed with cussions between the hospitalist, patient, and large numbers to make it easier for older nurse from the long term care facility (LTCF), patients to see the read-out. it was discovered that patient’s diet – in fact She said the hospital’s IT department also all the patients’ diets at the LTCF – was at a helped. Jensen worked with IT to develop much higher sodium level than was advis- a daily report that showed readmission by able for a population at risk for CHF. This dis- department. cussion led to new protocols for all LTCFs “That really opened our eyes, even though to reduce readmissions, including weighing at first it was overwhelming. We didn’t real- patients every day, monitoring labs, changing ize that almost every day we had at least one diets, and adjusting Lasix dosages to control readmit coming through our doors,” Jensen fluid retention. said. “We use this report and determine what “This collaboration with the long term care disease processes and what patient popu- facilities is clicking; you can just feel it hap- lations we need to focus on. Now we can pening,” said Jensen. She also credits a cul- see days between a readmission and con- ture at Saline where change is encouraged. sider that a win.” She said this knowledge “For the past few years we’ve had have a enabled her department to work with the CEO who is very proactive about quality hospital’s case management staff to develop improvement. We haven’t always had that an assessment to screen for patients at risk and it makes a big difference.” for readmission. Hospitals, Jensen reminds, are for sick peo- introduced, we had to do a lot of education Jensen said they saw a decline in readmis- ple. “It’s not like the old days when your doc- with staff, doctors, and administrators too,” sions from year one to year two. As with half tor might put you in for a few days to get some she recalled. The standard that if a patient the hospitals in the state, Saline’s third year rest. Readmission is another trip to the hospi- discharged with CHF returned with a broken numbers have climbed and they are work- tal and it stresses the body. It’s just better for a leg was still a readmission seemed patently ing on additional strategies. patient’s quality of life to recover at home as soon as they can and provide the resources needed to keep them there,” she said. n

* http://www.kaiserhealthnews.org/ Stories/2014/October/02/Medicare- readmissions-penalties-by-state.aspx ** http://www.kaiserhealthnews.org/ Stories/2014/October/02/Medicare- readmissions-penalties-2015.aspx *** http://capsules.kaiserhealthnews.org/ wp-content/uploads/2014/10/Readmissions- Year-3.pdf

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 17 myeloma institute Buying

Time I By A.D. Lively A Quarter-Century of Innovation in the Battle against Myeloma This fall, the Myeloma Institute at the University of Arkansas for Medical Sciences (UAMS) celebrated 25 years of an ongoing crusade to improve the length and quality of life for people diagnosed with myeloma and similar cancers.

A cancer of the plasma cells in the blood, death sentence. Even patients fortunate myeloma is, like all cancers, a result of enough to receive state-of-the-art treat- genetic mutations of a patient’s own cells. ment like stem cell transplants could only These mutations cause the cells to change realistically expect 2-3 more years of life. in detrimental ways, and the more rapidly Over the last two and a half decades, they are able to reproduce and gain a foot- however, the efforts of the institute’s hold inside the body, the more aggressive researchers, clinicians, and clinical trial (and often dangerous) the cancer. volunteers have transformed the medical When UAMS professor of medicine and establishment’s view of myeloma; what pathology Bart Barlogie, MD, PhD, founded once was perceived as an almost univer- the Myeloma Institute in 1989, a diagno- sally fatal cancer is now, for many patients, sis of multiple myeloma was essentially a a manageable condition. myeloma institute

Pressing back against a any other ther- progressive disease apy available at Barlogie’s research vision for the insti- the time: of the tute was a clinical trial-based approach to 231 patients who myeloma he called Total Therapy. Rather participated in than focusing treatment efforts on the pur- Total Therapy 1 Total Therapy is the suit of any single methodology, Total Ther- for myeloma, 20 biomedical version apy clinical trials are designed to combine percent are still and maximize proven treatments while alive to celebrate of a “full court press,” simultaneously exploring new avenues of the 25th anniver- designed to create attack through basic research sary of the Insti- Bart Barlogie, MD, In many ways, Barlogie’s all-encompass- tute. By any med- and exploit every PhD opportunity available ing strategy was similar to the proactive ical standard, this “40 Minutes of Hell” defense that Coach was a huge success. to stop myeloma’s Nolan Richardson and the soon-to-be Final Total Therapy became the gold standard progress in the body. Four Razorback basketball team were per- treatment, the best chance for survival fecting up the road in Fayetteville in 1989; against a disease previously considered to Total Therapy is the biomedical version of be 100 percent fatal, and established the a “full court press,” designed to create and institute as an important hub of myeloma exploit every opportunity available to stop treatment and research. Now in its sixth myeloma’s progress in the body. iteration, Total Therapy has evolved in Barlogie’s first version of Total Therapy order to incorporate and evaluate new introduced the practice of tandem stem cell methodologies and therapies, many of transplants to myeloma treatment. In stem which have been discovered in the insti- cell transplants, chemotherapy is used to tute’s laboratories and tested in clinical kill the cells in the bone marrow, including trials in partnership with the more than the cancer cells, in order to make way for 11,000 patients who have been treated the transplant of new, healthy cells capable there since 1989. of producing cancer-free blood. The Total Therapy 1 study built on this treatment by New leadership, same intensity using tandem transplants, consecu- While Barlogie will continue to treat patients tive transplants done weeks or and conduct research, this anniversary months apart. And it proved also marks his transfer of the institute’s to be more effective than directorship to Gareth Morgan, MD, PhD.

Gareth Morgan, MD, PhD PET scans of a myeloma patient’s liver. Photo at left shows a tumor in the upper left side. The photo at A self-described “laboratory nerd” who is are people [from the Total Therapy 1 pro- right shows the tumor has also a practicing clinician, Morgan says two tocol] who have been coming to Arkansas disappeared after starting of the things he is enjoying most in his new for treatment and helping us study the dis- therapy with Trametinib. home are the friendly people and plentiful ease for twenty-five years. And for a disease sunshine. where you are meant to be dead in two-and- “I am a native of Wales in the UK, where it’s a-half years, that’s a very big deal.” frequently grey and cold. I think I might have With approximately 450 new patients had rickets for the first 20 years of my life,” annually, the institute sees more cases of Morgan, an internationally known clinician- he jokes. “But Arkansas is beautiful, with so multiple myeloma and related diseases than scientist with a strong track record in molec- many opportunities for outdoor activities.” any other facility in the world, and each new ular genetics and drug development, arrived Morgan also cites Myeloma Institute’s patient is offered the opportunity for gene at UAMS from the Myeloma UK Research “huge patient base” and continuity as major array analysis, which allows researchers to Centre at the Institute of Cancer Research in advantages. “In clinical studies, the ability categorize their myelomas into very specific, London this July and so far shows no signs to observe patients longitudinally is a huge stratified subtypes known to respond best to of slowing the scope or the pace of discovery advantage to further study. And the continu- certain types of chemotherapies. “We look at established by his predecessor. ity of the patients here is astounding. There all of the genes expressed in the cancer and

Researchers at the Myeloma Institute have used global gene expression profiling (GEP) of purified myeloma cells to discover that myeloma is not one disease, but rather seven different subtypes of disease caused by seven distinct molecular defects. This discovery helps explain why some patients respond well to current therapies while others do not. Of more than 54,000 gene probes tested, researchers identified 700 (100 for each subtype) whose differential expression is visible in the unique over (red) or under (green) “staircase” appearance of the figure [above]. This figure, known as a “heatmap,” represents the expression level of these 700 genes in purified myeloma cells from 351 newly diagnosed patients. The color red indicates the gene is expressed at high levels, while green indicates low levels. A computer algorithm developed by Myeloma Institute researchers uses these gene expression levels, in conjunction with other tests, to provide a more accurate and specific diagnosis of the disease that enables physicians to create more personalized, targeted treatment plans for each individual myeloma patient.

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 21 myeloma institute

these microenvironments and making them unfriendly places for tumors to grow.”

Advancing with technology The Myeloma Institute is currently leverag- ing advancements in technology to create a bioinformatics infrastructure to support the large-scale data storage, sharing, access, and analysis necessary for the Institute’s ongoing global collaborations. These types of technological developments all contribute to making the institute’s signature personalized genomic treatment faster, more accurate, and less expensive to execute. “Anything that helps us identify the most effective treatments and shortens the amount of time between when patients are make dense information bands into differ- and to damage or minimize any helpful cells diagnosed and treated is going to help,” says ent groups. That is one level of technology- that might serve as threats. Morgan. “And I actually believe we are not based personalized medicine that nobody “Not only does this disease mutate your too far from being able to take someone’s else is really doing, and it allows us to make own plasma cells and turn them against DNA and doing their genomic sequencing better decisions about treatment choices,” you, but it also teaches the mutated cells in 24-48 hours, with the results coming back says Morgan. how to make a more comfortable growing on a desktop machine.” environment for themselves,” Morgan says. The most significant development facil- More opportunities for pressure “Now we believe it’s possible to find a way to itating personalized molecular medicine at The expected five-year survival rate for a switch off the cancer cells just by targeting the institute has been the radical drop in newly diagnosed myeloma patient treated cost of genomic sequencing. According to at the Myeloma Institute is now 74 percent, the National Institutes of Health’s National versus 43 percent for a comparable patient Human Genome Research Institute, sequenc- population in the National Cancer Institute ing of the first human genome cost $100 mil- database. And newly-diagnosed patients lion; five years later, it was still a daunting with genomically defined low-risk disease $10 million to sequence the genome of any can expect a median survival exceeding ten given individual. In the last few years, how- years. ever, widespread demand has brought down One of the next challenges for the Insti- the price to a manageable $5000 per genome, tute, however, is to improve the clinical making it an affordable option for each indi- outcome of the 15 percent of patients with vidual myeloma patient. genomically defined high-risk myeloma, a subtype with a current median sur- Killing your own cancer vival rate of about three years. Work is The next generation of clinical tri- already in progress to find the best treat- als in the pipeline at the institute ment combination that targets high-risk builds on the previous work of mutations. Another opportunity for better myeloma drug targeting might actually be found in the environment around tumors. As myeloma cells multiply in the body, they begin to affect the area around them in ways designed to further support their growth

22 NOV / DEC 2014 I Healthcare Journal of little rock Graphic shows how the drug Trametinib can inhibit an A B C abnormally activated MAPK pathway.

A) Normal MAPK kinase pathway – physiological signaling through the MAPK pathway after binding of a ligand to the rRTK. B) MAPK pathway activation due to an activating mutation of KRAS in the absence of ligand binding. C) The drug Trametinib can inhibit abnormally activated MAPK pathway.

both the London and Arkansas research without sickness, and with a much lower risk patients are diagnosed and treated, the bet- teams, with the added innovation of using of infection. It’s nontoxic—you are just using ter the outcomes—longer survival rates and antibody treatment in addition to, or pos- your own immune system. So it’s not like kill- less suffering from pain, dehydration, and sibly even in lieu of, molecularly targeted ing your normal cells; most people don’t have the other negative symptoms associated chemotherapies. any reaction to it at all. It’s a good solution with the disease. “Now that we can split people up into to cancer.” Morgan urges community physicians, different subtypes of myeloma, we want to who are often the first to hear about the ap- add antibody treatment into it, and see if that Early detection = better outcome pearance of myeloma symptoms, to always improves our outcomes,” says Morgan. “So The next quarter-century may bring not just keep the disease in mind as a possible di- we are starting off with a big push to get a better treatments and cures for myeloma; agnosis when patients exhibit pain and fe- new, FDA-received antibody into patients. there may also be ways to prevent the can- ver. He also encourages them to go beyond Maybe we can use antibodies to fix the cer before it starts by identifying precursor “old-fashioned” tests like erythrocyte sedi- immune system.” conditions to myeloma and creating inter- mentation rate (ESR), in which abnormal The hope of these trials is that at least one ventions that prevent cell mutations. For results can also be indicators of infections version of the myeloma-specific antibody, example, all myeloma starts as a condition and diseases besides myeloma. He rec- called antiCD(sp)38, can make cancer cells called MGUS (monoclonal gammopathy of ommends, instead, exploring some of the visible to the patient’s own immune system undetermined significance) that can be rec- newer and more accurate tests available, again. Because myeloma mutates plasma ognized with tests to help physicians iden- like Free light chain assays (Freelite), which cells, which are the source of the antibodies tify patients who need to be monitored for screen for tiny amounts of paraproteins. that would normally be the body’s primary further disease development. And another “So the best thing I can think of to tell the defenders against infection, it effectively recently developed test can recognize in- people of Arkansas,” says Morgan, “is if you hijacks the body’s entire immune system. As dividuals belonging to a high-risk subset get back pain, leg pain, and/or fever, consid- the number of dysfunctional antibodies pro- of patients diagnosed with a disease called er the possibility of multiple myeloma and duced by myeloma-mutated cells increase, smoldering myeloma who are most likely to make sure you request that your physician patients are increasingly vulnerable to infec- develop full-blown cancer. does a screen for it. And if the screen does tion, pain, systemic damage to the kidneys Currently, there is a built-in 3-6 month unfortunately indicate myeloma then we and bones, and ultimately death. “diagnosis delay” for patients with my- are here for you, right here in Little Rock. “Patients are currently in the hospital eloma, where they present with symptoms We will use the latest technology to learn as undergoing treatment for four to six months, that seem minor at first but then present much as we can about the best mode of at- or even longer. With antibody treatment, you with a higher number of myeloma cells and tack for your particular cancer, and then we could do this as an outpatient, without nausea, far more acute symptoms. The earlier these will go at it with everything we have.” n

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 23 Physician Assistants

PAs in Arkansas An update from Kendall Key, PA-C President, Arkansas Academy of Physician Assistants

The purpose of ARAPA is to act as a written summary report of the year’s a representative of the PA profession, activities as well as recommendations for as well as enhancing the advance- the upcoming year. As president, I also cor- ment of the profession through- respond with AAPA (American Academy out the state of Arkansas. ARAPA of Physician Assistants) regarding yearly also provides assistance and sup- paperwork needed by their organization port to PAs, health professionals, and attend AAPA meetings as applicable. and health services by organizing I also am responsible for keeping mem- health information into forums and bers abreast of changes within the con- programs that concern the delivery and stituent organization and strive to monitor quality of healthcare services in Arkansas. the goals and objectives of our organization. These are just a few examples of my What is your role with the Arkansas responsibilities. Academy of Physician Assistants? A. There are multiple responsibilities that What is the duration? come with my position as president of Is this a one year position? ARAPA. One is to coordinate the agenda A. You are first elected as a president elect for our Board of Directors meetings, pre- and hold that position for one year under side over all business meetings, and provide the current president at that time. Once that

24 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK one year duration is over, you hold the posi- A. One thing we are trying to get changed is need medical care and to educate the people tion as current president which is also a one just our basic scope of practice—changes in of Arkansas about our role as PAs. year term. Finally, there is a one year term in what we can do daily at our job. For example, We are always working to make positive the position as past president. All in all, this right now we are currently licensed to only changes to the profession of PAs in our state position is a three year term on the ARAPA write for certain categories of medication— through various rules and regulations that board of directors. category III, IV, and V. We are always try- affect our daily practice. ing to push to be able to write for a broader As an association how many members scope of medication to not only be able to Is it ever an inconvenience to have to do you have as a percentage of PAs in provide for our patients, but to also be able go to the supervising physician? Arkansas? to do that for our supervising providers. For A. The PA physician relationship is imper- A. There are currently 295 licensed phy- instance, right now if I had a patient come in ative to provide the most attentive quality sician assistants in the state of Arkansas. and they were in extreme pain, there is only medical care to our patients. A good rela- At this time, we have 150 members in our a certain type of medication that I would be tionship is built on trust and reliability. PAs organization. able to prescribe them. Anything more than are trained to examine, diagnose, and treat that I would have to go through my super- patients alone, however there are instances What are some of the big issues for vising provider and have them write for that when a supervising physician is directly physician assistants in Arkansas? medication. involved. Supervising physicians are reach- What are some of the things that you We are continually striving to bring qual- able by phone or direct involvement and are are trying to get changed? ity healthcare to those areas in Arkansas who always involved in the PA physician team.

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 25 physician assistants

What specifically within the scope of practice are you looking for? A. Our purpose is to provide patients access to quality medical care. There are a few issues that may limit that healthcare such as the inability to prescribe certain medica- providers. This, along with local senators, currently have two PA training programs tions, and reimbursement issues by insur- legislators, and lobbyists who we work with, in the state, Harding University PA program ance companies. We work closely with our ensures we can keep promoting the PA pro- and UAMS PA program. Training of PAs for governing bodies to ensure proper treatment fession and providing quality medical care. the state of Arkansas is growing, which will for our patients, and have the interest of all hopefully lead to an increase in the number PAs in mind when striving to make changes How would you say your scope of of PAs in the state. to our rules and regulations. practice authority compares to the rest of the country? What is your hot issue right now? Is it the Arkansas Medical Board that A. The practice authority of Arkansas is com- What’s the one thing you want to get makes these decisions? parable to other states, however we have accomplished? A. Yes, PAs are licensed by the Arkansas State fewer PAs in our state, than in others. We A. One of the most important issues for our Medical Board.

Do you also use the state legislative process to make changes? “One thing we are trying to get A. Yes, many of the issues regarding practicing changed is just our basic scope as a medical provider are legislatively driven. ARAPA has a Governmental Affairs Com- of practice—changes in what mittee, along with our parent organization, we can do daily at our job.” American Academy of Physician Assistants, who watch the legislative affairs of medical

26 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK PA Specialties in Arkansas

organization will always be trying to improve variety of practitioners for students, new recognition and reimbursement by insurance and/or experienced PAs, and physicians to companies for our services. learn from.

What are some things that you agree What are the educational with in terms of what physician requirements for PAs? assistants shouldn’t be doing? A. As per the Arkansas State Medical Board, A. PAs are trained as a part of the medical the educational requirements for PAs include healthcare team working directly with a graduating from a physician assistant or sur- supervising physician. We are not seeking geon assistant program accredited by the autonomy, but to promote excellent health- American Medical Association’s Committee s 37.8% Primary Care* care as part of a team of medical providers. on Allied Health Education and Accredita- s tion or the Commission on Accreditation of 2.2% Internal Medicine Subspecialties Can you clarify the supervisory Allied Health Education Programs. Another s requirements? educational requirement includes passing 24.4% Surgical Subspecialties A. s There are numerous supervisory require- the certifying examination administered by 11.1% Emergency Medicine ments for PAs in Arkansas. The Arkansas the National Commission on Certification of s 24.4% Other Specialties State Medical Board section 17-105-109 Physician Assistants. states the following: *Primary Care includes Family Medicine (with and without Urgent Care), General Internal A) Supervision of PAs shall be continuous Does your push for expanded scope Medicine, General Pediatrics and OB/GYN. but not be construed as necessarily requir- of practice affect the relationship of ing the physical presence of the supervising PAs and providers? Do they recognize PA Settings physician at the time and place that services the need for more providers and your in Arkansas are rendered. ability to fill that niche or are they B) The physician/PA team must ensure watching you carefully to make sure that: you are not invading their space? 1) the PA’s scope of practice is identified A. As stated before, PAs want to extend care 2) the delegation of medical tasks is appro- to those who do not have adequate health- priate for the PA’s level of competence. care. There are areas of Arkansas in need of 3) the relationship and access to the more healthcare providers. PAs in the state supervising physician is defined of Arkansas seek to work with physicians 4) a process for evaluating the PA’s per- and other members of the healthcare team formance is established to extend this care to rural Arkansas. C) The PA and supervising physician may The average PA in Arkansas sees 71-80 designate back-up physicians who are agree- patients a week, 15.5% are uninsured, 26.5% able to supervise the PA during the absence are Medicaid patients, and about 35% are of the supervising physician Medicare patients. There are some prac- s 35.5% Hospital Settings* tices that may not see that type of patient, s What is the role of the academy don’t accept Medicaid or Medicare, so those 44.5% Physician Group and Solo Practice as regards education? PAs are filling that niche. PAs also work and s A. As part of our licensure and certification live in rural areas so they are seeing those 4.4% Certified Rural Health Clinic PAs must have 100 hours of CME every 2 patients who live out in rural areas where

s years. ARAPA holds an annual continuing the closest clinic may be two hours away. So 15.4% Other Settings medical education meeting offering 10-15 a PA may be able to work at a clinic that is *Hospital Settings include Hospital Emergency hours of education. Students and all medi- supervised by a physician in a small commu- Department, Inpatient Unit, Operating Room, Intensive/Critical Care Unit, Outpatient Unit and cal professionals are invited to participate in nity and help those patients closer to home. n Other Units of Hospitals. our CME conference. During our annual con- Resources: ference, we have PAs and physicians from all www.arkansaspa.org SOURCE: 2013 AAPA ANNUAL SURVEY different specialties as speakers. This gives www.aapa.org PERCENTAGES MAY NOT TOTAL 100% DUE a great insight into the daily practices of a www.armedicalboard.org TO A SMALL NUMBER OF NONRESPONSES.

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 27 share

Why SHARE Matters

Health Information Exchange in Arkansas By The Arkansas Office of Health Information Technology clinical information, including test results Across the nation, emerging Health and doctors’ notes from the referring care Information Exchange (HIE) facility. Using SHARE will also allow for the health information to be accessible prior to technology is opening up new a patient’s arrival so that a treatment plan can be established and put into action more avenues of securely exchanging quickly. SHARE’s mission is to give providers private health data with other access to a more complete picture of their patients’ health, when and where they need members of a patient’s healthcare it most—at the point of care. With SHARE fully implemented, a connected provider is team. In Arkansas, the state’s HIE able to access, in the exam room, the current is SHARE (State Health Alliance electronic health information for that patient from all other SHARE-connected facilities for Records Exchange), operated where that patient has received treatment. The value of SHARE increases for every par- by the State’s Office of Health ticipant with every new practice or hospital that joins the exchange. Information Technology (OHIT). SHARE’s benefits to providers include saving time, reducing errors, reducing duplicate testing, offering more robust clinical information at the point of care, expediting referrals and follow-ups, and facilitat- n ever-harried clinic offices, as medical pro- ing cost-saving initiatives like the Arkansas viders try to give and record the best care Medicaid Patient-Centered Medical Home possible, coordination of care is one of the Initiative and Accountable Care Organiza- easiest things to slip through the cracks. tion savings models. In addition, SHARE can When access to the patient’s medical history help providers meet their Meaningful Use Imeans a physician’s office must make sepa- requirements. For patients, benefits include rate calls and faxes for each patient to that better-informed care which should lead to patient’s other physicians, therapists, labo- fewer errors, fewer duplicate tests and pro- ratories, pharmacies, and other members of cedures, and ideally, better outcomes. that patient’s healthcare team, healthcare Greg Wolverton, Chief Information Offi- providers often duplicate tests unnecessarily. cer of ARcare, has implemented SHARE in Historically, medical providers treat 23 rural ARcare clinics. He reports ARcare patients using all the information they have has found value in SHARE saying, “We are available. What’s changing with SHARE is now receiving hospital discharge summa- how much more robust clinical informa- ries for our patients into our EMR and best tion is now available, instantly, at the point yet, it is automatic and we do not spend of care. Medical professionals can now elec- countless hours of manpower tracking tronically access complete and up-to-date discharges.” share

SHARE & Patient-Centered Medical Homes One of the driving factors for SHARE this year has been Arkansas Medicaid’s Patient- Centered Medical Home initiative. In Janu- ary, Arkansas DHS, Division of Medical Ser- vices announced that joining SHARE would be necessary within 12 months for anyone enrolled in PCMH. An integral part of the patient-centered medical home concept is coordinating care among the entire healthcare team, and using technology to facilitate that increased flow of information. SHARE fulfills that function for Arkansas, connecting a patient’s providers no matter where in the state they are located. Growth of SHARE care and the ability to submit patient infor- The PCMH benefit comes in the form of SHARE officially launched its first hospi- mation such as immunizations to public event notifications. As a practice’s patients tal, North Arkansas Regional Medical Cen- health registries. are admitted to or discharged from the hos- ter, in December 2012. Since that time, it has SHARE currently supports many types pital, the provider receives an instant noti- vastly grown in functionality and added of data that can be exchanged, including fication and link to their record through more than 275 other participants in the referrals, clinical care summaries, discharge SHARE. This makes timely follow-up care, exchange, including over two dozen hospi- summaries, lab results, allergies, medication another important provision of PCMH, as tals across the state. Both the University of histories, CCD exchange, ADTs, transcribed well as a proven way to decrease hospital Arkansas for Medical Sciences and Arkansas documents, radiology reports, immuniza- readmission rates, much easier for the prac- Children’s Hospital, are pushing patient data tions, and diagnoses. tice’s staff to flag and follow. through SHARE, as are 12 other hospitals, with more than a dozen others signed on to participate soon.

SHARE & Meaningful Use Without The Medicare and Medicaid Electronic SHARE Healthcare Record (EHR) Incentive Pro- gram provides incentive payments to eligible hospitals and providers as they adopt, implement, upgrade or demonstrate meaningful use (MU) of certified EHR technology. These MU standards play into the growth of SHARE. As organizations across the state attest to the Centers for Medicare & Medicaid Services (CMS) that they are using their new EHR technology in meaningful ways that positively affect patient outcomes, SHARE can facilitate Meaning- ful Use Standards. There are a number of menu items, objectives, and requirements that SHARE can address, including most notably those surrounding transitions of

30 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK Fragmented care how the others are treating me, which means should not be on the patient.” Arkansas Health Information Technology that I must keep each physician informed of Statistics show that the average person Coordinator Ray Scott often tells groups of my full medical history, which as many of us sees at least 18 doctors in their lifetime, his own experience with a cardiologist at St. know, is more challenging than it seems. The says Scott who adds that, despite this fact, Vincent, an endocrinologist at UAMS, and burden of providing accurate medical his- most medical offices are set up as though an eye doctor at Baptist. “None is aware of tory, prescription dosages, and test results they are providing the only medical care a patient receives. Even when they do take the progressive, proactive step to implement an electronic medical records system for their physicians to use, all too often, these only With can communicate with other clinics using SHARE the same EMR system.

EHR Vendor v. Vendor There are more than 600 competing Elec- tronic Health Record (EHR) vendors now operating in the United States, including at least 50 in Arkansas. SHARE is built to be what is called in the tech world “vendor- agnostic.” Systems A and B may not be able to talk with each other, but they and all the other certified systems should be able to communicate with SHARE. Scott says OHIT has the considerable challenge and expense of building interfaces with each vendor used by a member of the SHARE network, so that they literally can share information with each other about

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 31 share

iFive T ps for Smooth HIT Implementations Making IT Work Whether you are joining SHARE or implementing new software in the office, these five best practices can make a big difference in how pain-free the change is for your office.

Ask for help, because it is there for you. For HIT newcomers, it can be a big, intimidating world of vendors and technologies and methodologies and quality improvement initiatives. It’s easy to get overwhelmed and feel paralyzed by the huge- ness of the task ahead. You don’t have to go through this alone, and you don’t have to be the explorer cutting through the jungle with a machete. Several Arkansas organizations have already built the paths, and are available to help you select and implement a new EHR, or a new SHARE connection. Reach out to the Regional Extension Center for “Consumer Reports” help selecting a vendor for your specific practice’s needs. Arkansas Foundation for Medical Care and Arkansas Center for Healthcare Improvement staff can be of enormous use here as well. OHIT’s SHARE tech and operational teams will also help you understand each step of the way. SHARE is built to be Assign a Project Champion. what is called in the Projects flounder when no one owns them. It’s easy to predict that there will be resentment or occa- tech world “vendor- sionally outright hostility within your staff to major changes. Make sure there is at least an equal agnostic.” Systems amount of enthusiasm to counteract that negativity, people who fully buy into the benefits of the A and B may not be able to talk with each change and want the best for the patients. You need a single person designated as Project Champion other, but they and to own the project and manage the implementation from an operational standpoint. HIE is a tool, but all the other certified your team has to have a leader to demonstrate its potential to make care better and work life easier. systems should be able to communicate Plan around workflow and staff adoption, not around tech implementation. with SHARE. The first day a technology comes online is not the first day your staff should hear about it or be expected to adopt it. Implementing any sort of change to the workflow means introducing it to your staff at a pace they can follow and with real use cases they can understand. The technology is just the tool, and its effectiveness is only as good as the skill of those who know how to use it. Give them ample time to expect it, accept it, and grow better using it.

Communicate the why. Joining and participating in SHARE is going to affect those it touches, including staff and patients. Communicate clearly both internally and externally what you are doing, what possible problems it will help solve or prevent, what other benefits is expected to come from it, and how it affects them. Too much information is conveyed without ever communicating the very basics—why it matters.

Be patient and open to the future. Real, systemic change does not arrive overnight. Realize that functionality and familiarity will continue to grow, and that progress is never “done.” It’s a process, and one that will increasingly help your patients receive better and better care. Offer constructive feedback so your voice can be included when the next iteration of SHARE or a new technology is designed.

32 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK •Full HIE Integration incorporates the Secure Messaging and the VHR, with additional functionality enabled. SHARE has set up and tested interfaces with the Arkansas Department of Health so that hospitals and practices with full SHARE integration can easily transmit immunizations, electronic lab results, and syndromic surveillance to public health registries. SHARE charges a fee ($50-$75/month) to Ray Scott, Arkansas Health practices to connect to Secure Messaging Information and the Virtual Health Record. Costs increase Technology for full HIE integration, as do the benefits Corrdinator practices can expect to reap. Monthly fees for hospitals are on a sliding scale, based on the hospital’s average daily census. The first step is getting the majority of Affordability has been a factor for many hospitals and practices to participate in HIE providers and hospitals, even with SHARE’s locally. Next steps involve communicating relatively low monthly rates. There is no with patients about their rights and privacy limit or standard for how much a related to HIE.” vendor can charge to connect The HIT Coordinator says he envisions to SHARE. Whenever possi- a day when SHARE will be able to offer a ble, OHIT negotiates with the patient portal where patients will be able vendor to offer discounted to view their complete records in meaning- patients they have in fees for the vendor’s cus- ful ways. More networking is also to come. common. tomers throughout the state. Scott sees SHARE connecting to more kinds The SHARE net- SHARE has saved Arkansas of providers, including behavioral health, work acts as the conduit providers many thousands of school nurses’ offices, and community sup- for patient health infor- dollars through negotiated dis- port services, and finding responsible ways mation traveling between counts for eClinicalWorks, Greenway, to aggregate clinical data being exchanged providers, not as a data warehouse. GE Centricity, e-MDs, and Allscripts, and has through HIE for use in public health or It does so securely and privately, in compli- built interfaces with many more vendors. further integration with digital health and ance with the highest HIPAA and health This fall, SHARE began offering hospi- telemedicine. information security standards. SHARE tals a way to connect to a “lite” version of Scott says, “HIE is a tool for building our operates in real time so the patient’s record SHARE called SimpleSHARE, which allows healthcare future; no telling what kind of via SHARE is always current and available at a hospital’s existing Health Information Ser- innovation will come next.” n the point of care. No more waiting for faxes. vice Provider (HISP) to communicate with SHARE as a HISP. This basic connection 3 ways to SHARE, (starting at $100/month) allows the hospi- different price points tal to interact more easily with providers in SHARE offers three tiered ways that provid- the SHARE network, but does not open up ers and hospitals can join the bidirectional the suite of benefits that a full HIE integra- Learn More network, depending on needs, their vention brings with it. Go online to http:// dors’ technological capabilities, and their www.sharearkansas. resources: The future com/ •Secure Messaging offers secure, “The future for HIE is to get as close as pos- encrypted email exchange through the sible to interoperability not only at the state Email info@ Direct 2.0 network. level, but nationally,” says Ray Scott who sharearkansas.com •A Virtual Health Record (VHR) enables adds that “programs are already underway Call 501-410-1999 providers to view the updated patient’s to build the technological infrastructure to SHARE record via a secure web portal. support a national HIE.

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 33 dialogue

Mark White began his career with Arkansas Blue Cross and Blue Shield in 1970 as a staff accountant and worked in several roles within the Provider Audit and Finance areas before being named manager of Pro- vider Reimbursement. White left the Plan for a short time and returned in 1984 as controller of the Life Insurance Company of Arkan- sas, currently known as USAble Life. In 1986, he assumed the duties of vice president of Finance for the Plan, was later promoted to senior vice president of Finance and subsequently promoted to executive vice president, chief financial officer and treasurer. In 1993 he one was named president and chief executive officer of USAble Corporation. White became president of Arkansas Blue Cross in January of 2009. He is the former chairman of the Arkansas on Life and Disability Insurance Guaranty Association and the former vice chairman of the Arkansas Comprehensive Health Insurance Pool. one White serves on the boards of Arkan- with Mark White sas Blue Cross and Blue Shield, USAble President and CEO Corporation, HMO Partners, Inc., Life and Specialty Ventures, LLC, Blue Arkansas Blue Cross Cross and Blue Shield Association, BCS and Blue Shield Financial Corporation, Plans’ Liability Insurance Company, National Insti- tute for Health Care Management, Lit- tle Rock Branch of the Federal Reserve Bank of St. Louis, Little Rock Chamber of Commerce, Arkansas State Chamber of Commerce and Fifty for the Future. one on one dialogue

Chief Editor Smith W. Hartley Has the role of the health insurance business changed since the Affordable Care Act? Has it become more like a public utility or how would you char- acterize the industry as a whole?

Mark White Yes it has changed. I wouldn’t call us a public utility. Certainly segments of our business you could draw that parallel, particularly with the influence of the ACA and the exchange business. And really, particularly in our market, the private option, which is our unique approach to expanding Medicaid in Arkansas. Whether “public utility” is a good way to describe that, I don’t know, but it is highly regulated, we’ve certainly got more regulatory hurdles to leap. We will eventu- ally have a lot more requirements around compliance although from a regulatory perspective, I consider our industry fairly highly regulated to start with. Compliance requirements are going to continue to increase over time. I draw a parallel to Medicare Advantage or Medicare Part D. I don’t know if you are familiar with what plans are required to do there, but I see the same requirements being layered on the ACA business.

Editor Does that mean increased reporting? Increased documentation?

Mark White Increased reporting. A little more new competitor come into the market and I Editor Why is Blue Cross the significant attention paid to detail like down to the types anticipate after things kind of stabilize over insurer here? of communication we have with members or a couple of years that we’ll see maybe a cou- prospective members or policyholders. The ple more national competitors in that market Mark White I think it’s because we have been elements that are included in those commu- than are present today. Right now there are here for 66 years, we are organized as a nications, all that. three carriers in that business. mutual insurance company, we view our- On the commercial health side we have a selves as a not-for-profit mutual, which to Editor Arkansas Blue Cross and Blue Shield lot of competition and we still have the larg- me means we don’t have to worry about has a significant market share. Can you talk est share of that market as well. shareholders or exporting capital out of state about that and maybe some of your com- to pay dividends, and we’re just focused on petitive goals? Editor Can you say roughly what your mar- the Arkansas market. While I say that, we ket share is? also provide benefit administration for sev- Mark White We probably have the largest eral national accounts that are headquar- market share of any of our competitors in Mark White It depends on how you define tered in Arkansas. So by that affiliation we our state. So from the standpoint of hav- “share” but I think with number of members in do provide administrative services outside ing to focus on increasing our market share state it would be somewhere close to between the borders of our state, but our insured that might be a little bit of a challenge. We 800,000 and a million, with not replicating products are all within Arkansas and that’s certainly want the customers we don’t have any, because some of them have health prod- the only place we are really licensed to sell and work hard to attract those customers, uct or dental product or some other affiliation insurance. but I think with the ACA we’ve seen one with the company. But in that range.

36 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK so much by us; it’s the state medical board Back in the old days when I first came to that is really the level of review there. work here every claim was a piece of paper Our challenge though in Arkansas is and you handled each one, and you had a you can find areas of the state where pri- control number that went on it and it went to mary care is a shortage. If you go to Eastern an individual who would fill out an 80-col- Arkansas and the delta and extreme South- umn card on a keypunch machine and it was ern Arkansas there are shortages, not only of entered into the system that way. Now virtu- primary care, but specialty care. When you ally all of our claims are electronic and we are talking about the more urban areas with use a proprietary system that we developed specialty care coverage there aren’t any sig- in partnership with a technology vendor a nificant gaps. long time ago, what we call AHIN, Advanced But our network is pretty open. I would Health Information Network. It allows pro- say max 98% physicians are in and I think all viders to check for eligibility, file claims, to of the hospitals are in. There are a few behav- do maybe a first review of a claim so if it’s ioral health facilities that don’t contract with missing information, you can kick it back to us, but all the acute care hospitals do. the business staff at the physician’s office or the hospital so they can make a correction Editor I guess that’s the advantage of having and push it on through. most of the members. So it’s really changed. At one time our ratio of claims examiners to customer ser- Mark White Well it helps. We had a more selec- vice reps was probably 8:1, maybe more. Now tive network arrangement until AWP came it’s a pretty equal number. So where we’re along. That’s when we first rolled out PPOs investing is having more customer service and what we were doing then is we reps who can answer questions and resolve would try to choose, in multi- issues and fewer claims examiners because but our hospital towns, one as our of that technology. network is contracted provider. After The other thing we do is we capture so AWP we had to collapse much more information now than we did a pretty open. I all that. And that’s work- decade ago from the standpoint of that being would say max ing okay for us. It’s not a a feed for our case management and disease 98% physicians critical issue that we’re management initiatives. Editor In terms of your are in and i think wanting to stir the water provider network are all of the over at this time. Editor Are providers still making common there areas of Arkan- hospitals mistakes when they are filing? sas that are a little more are in Editor Can you talk about challenging to get certain the importance of technology Mark White You still have a certain amount specialties? in claims management? How has of that, but I would say it’s not extensive. It’s technology changed to your advantage? what I would consider a normal rate. What Mark White We have an “any willing pro- Has it helped with your staffing model? Has we would do if we had a particular office that vider” statute in Arkansas, which basically is helped with expediting claims? was having difficulty there, we would have says that any provider who is willing to con- our network development reps go out and tract with us based on our terms and condi- Mark White Yes. As far as technology, we have meet with them and find out what the issue tions, we have to allow them to participate in invested significantly in technology during is and do some onsite training. It’s to their our network. So we have a fairly broad net- my 34-plus year career here. And the change benefit and our benefit, so everyone wins. work. Almost everyone is in. Not everyone, I think we’ve seen more recently is that we because for some reason some physicians now use systems that have what we call Editor Do health insurance companies like choose not to contract with us, or for some first pass rate on claims. So when claims hit Blue Cross have a role with the overall reason we may have to remove a physician our system quite often if they meet all the improvement of health? What can they do? from the network. We sometimes have to screens they’ll pass through the system and decredentialize a physician who didn’t meet be adjudicated without intervention of an Mark White Our historical role was we really the standards. But those are really not driven individual. focused on our members and how to relate to

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 37 dialogue

them as far as care gaps. How do we ensure that they get the right care when they need it and from the best qualified providers of care? We’ve kind of expanded our view on that, and this is more of a statewide view, that we’re interested in participating wherever we can to improve the health of Arkansans. Arkansas doesn’t have the poorest health in the nation, but real close to it. I think we are ranked 49th now. If we look at that and we think about anything that we can do to improve the health status of all Arkansans, that’s what we should be about. Not only will it help our members, it will help economic development in the state if we have a healthier workforce or healthier children that can go to school and learn and be productive citizens in the future. That’s our broader focus, but we really focus on our members as far as being able to relate to them. For some customers we have a system where if the individual calls in for customer service and the system can Editor Can you talk a little bit about the The first line would be our own physician identify them perhaps as someone who is process of looking at different healthcare staff and then some external third party as diabetic or pre-diabetic, it will connect them modalities, medical technologies? There well. It’s independent and if they come back with a case manager and they can do some are so many things out there that aren’t tra- and say we ought to do this, we do it. outreach on their management of their dis- ditional. What’s the process you would use ease. We have a number of different custom- when considering them? Editor As far as the ACOs everybody is talking ers that use that technology. about building and moving towards, what is Mark White With anything nontraditional your role with that? Is this something Blue Editor Is it preventive type services that you we have on staff about 13 or 14 physicians Cross is mandated to do? provide? Incentives? led by Bob Griffin, our Chief Medical Offi- cer, and a retired Army General Surgeon. I Mark White Well if you’ve seen one account- Mark White We’re doing some of that, work- think our group is very disciplined in looking able care organization you’ve seen one ing with larger employers, and we do it here at any kind of a new technology, a new way accountable care organization. They all vary for our workforce as well. Basically it’s struc- to deliver care, as far as going through our from market to market and community to tured so that we do a health risk assessment screens and determining does it fit medical community. We are working with a number and then some will do what we call biomet- policy or not? Currently I would say we are of hospitals in the state in developing what ric screening in conjunction with that and conservative in that regard meaning until it’s we consider an ACO or a version of an ACO. actually take blood pressure, BMI, and some tested, new technology or new pharmacol- This is around defining a population with an basic labs. We’ve been doing that for three ogy, we will not add it to medical policy. integrated health system and attributing that years for our workforce now. population to them and really making them And then what we do is if an individual has Editor And the committee is made up of all responsible for the total care delivery to that risk factors or indicators, if they are trying to medical doctors? group. We have three that will be hopefully manage those, with diet, exercise, manag- ready for the first of the year and possibly ing their blood sugar, taking their meds for Mark White Physicians and some nurses, but one more next year. These are in different hypertension when they should, then there’s all clinicians. This group is responsible, too, if communities. a carrot attached to that. The stick is if they there is a member that says I want to be pro- ignore these risk factors and don’t see any vided some experimental treatment and we Editor And I guess that would change your progress improvement, then their share of deny it because it is experimental. There is a payment methodology? the healthcare premium goes up. process we go through for evaluation of that.

38 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK Mark White The movement here is moving and he says, “Go see Dr. X or Y, and tell him getting them comfortable with having a fam- away from fee for service to what we can you need a new knee.” And that’s as far as it ily doctor or a medical home and then work- term fee for value, episodic-based payments, goes. We view the new augmented transpar- ing with those medical homes to manage that but what we would like to do is to incent the ency as a good thing. patient population and provide proper reim- medical system that if they provide better bursement and incentives to move the needle care that is more efficient and saves them Editor Do you think that is the future? That on that population health risk. money then they get to share in those sav- people will be able to make their health pro- ings. Because if you just say we want you to vider choices based on cost and quality? Editor Do you see value in members choosing do all of those things and we are going to take their physician or hospitals by price? Would it away by reducing what you are paid, you Mark White I think so, particularly for specialty it change competition? Would there be value are not going to have a lot of uptake on that. reimbursement. The focus is probably going in providers sharing their fee schedules? to be more on the individual because if we Editor Have you found any success with these see an expansion of the enrollment of the Mark White I think price alone is just one mea- models yet? ACA, someday that may be the market, where sure. Absolutely it would affect competition. there’s not much group commercial market But if you’ve worked in a physician practice Mark White The episodic based payment sys- remaining. Then our outreach to individuals you know that showing fee schedules prob- tems that we’ve rolled out seem to be work- is going to have to be providing good value ably isn’t very meaningful. I think that peo- ing, yes. We started with hips and knees, and service and communication. I really think ple would be better attuned and could say, “I COPD, appendectomy, T&A, colonoscopy, that will be an integral part of that—the kind need to have my tonsils out and this is what it those are the new ones coming up. Basically of information they can use to say, “What do costs here with this physician, here’s what it we started off looking at knees for instance. I need to do, where do I need to go, who do I costs across town or in the next community.” There’s a real disparity between the prices need to see?” It’s a difficult decision for most I think you have to get it down to that level. we pay for a knee replacement. They vary individuals because they are not medically based on physician and at which institu- literate and they don’t know who to ask other Editor Do you think that’s coming? tion the actual procedure was performed. than their primary care physician. Being able to normalize that and share that The other phenomenon that’s going on is Mark White Oh yeah. It’s back to transpar- information back with the physicians and pretty rapid expansion of the medical home. ency. We are working within the Blues on with the lead physician, which we term the We’re going to be attributing more and more what we call our national consumer cost principal, accountable physician, has really of our members to a medical home so if they transparency model and basically that’s changed some practice patterns around here. don’t have a primary care relationship today, a mechanism to capture a certain level of Now they are asking questions about “Why they’ll have one in the future. One of the that off of claims data so an individual who is my cost higher?” Certainly the status of issues of the 190,000 to 200,000 that signed is a member can go in there and if they are the patient matters, but we have a way to up on the private option, most of those indi- medically literate and technologically lit- normalize that so that is making an impact. viduals haven’t had insurance, haven’t had a erate they can go through there and make relationship with a physician. They receive some of those decisions. We’re not seeing a Editor So you’ve noticed it’s less costly and their care in the ER largely. So it’s really a lot of uptake on it, though. Yet. We’re going you are getting better outcomes? process of communicating with them and to expand it from about 400 procedures to

Mark White I think we are seeing some quality improvement and we’ve seen a net lower cost. It’s not substantial, but it’s a move in the right direction. You talked about technology and we are capturing a lot more granular information around care than we ever have. At some point in time, we’ll have the means and the mechanism and the will to share this more broadly to an individual and you can really from that make your own decisions about where you want to go for care. You will be able to look at the cost/quality matrix and see where the best value is. Typically now, most people see their primary care physician

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 39 dialogue

You also have a segment in a lot of areas, and we have some in Arkansas, that don’t want to have anything to do with any kind of insurance or government program and they’ll stay away. So the growth is probably going to be in small businesses that decide they are not going to have group coverage anymore and their employees would go into the individual exchange. And we may see some of the large accounts post 2017. The more membership that is in there you about 1600 procedures. So we are going to discussions. We are sharing everything we would assume the more oversight regulation have an expanded base there nationally. So know. we will be exposed to and thinner margins that may be a little more meaningful. So my forecast for the future is this: on the business. growth in the ACA is going to be slow, par- Some states are trying to do away with the Editor Are there any big initiatives coming ticularly if we see the individual mandate go federal subsidies. If that happens I think the that we should know about? away and I think that’s a potential that’s out only people who will enroll in the exchanges ‘‘Mark White Well our focus of course is on there. are those with catastrophic health risk. And if the ACO environment and the relationships that’s the case how will we underwrite that? with health systems on episodes, on medi- Editor Why would they take away the cal homes; those are the big three I guess. mandate? Editor How has the health insurance industry changed over the past ten or twenty years? Editor What are some of the challenges asso- Mark White I think this gets into politics, but ciated with that new landscape? I think the Republican leadership would Mark White For us a big change has proba- probably say, “We don’t like mandates in bly been product design during that period Mark White The challenge we face is it’s new a general context so let’s take that away.” I from the standpoint of going from comp for us, but it’s also new for the provider com- think that wouldn’t necessarily be viewed as major med to an HMO and PPO or POS munity and they’re cautious from the stand- a negative from the Democratic side. So if style products. The other big change has point of wanting to be sure they understand they want to make some tweaks to the ACA been how we go about servicing our mem- the level of risk that they may be taking on I think that would be one of the first ones we bers and improvements we’ve made based with all these arrangements and how they see. To me that indicates slow growth of the on technology that we talked about earlier can mitigate or afford that risk. We’re accus- non-Medicaid expansion market, the regu- and how we use that technology to provide tomed to taking risk on individuals and on lar exchange market. There was an article higher level, more accurate service. Those their health and we’ve done that for a long in the paper the other day where they were are the big things. time, whereas on the provider side that’s not anticipating 50,000 enrollees by 2017, and Influences on the other hand are regula- their forte. So the process we go through there we have 43,000 today. So that’s not much tory, legislative, and I think we look at all the is a lot of back and forth, a lot of meetings, try- growth and that’s with the mandate in place. challenges we are facing to retrofit this orga- ing to find a way to neutralize that and allow nization to fit the environment for the next them to participate in these initiatives with- Editor But the mandate doesn’t have any 35 years under the ACA. We look back at say out maybe taking a full bite right at the onset. real teeth. 2000, Y2K was a big deal, and now we look So maybe some upside potential without too back at that as the good old days. I tell our much downside potential initially and then Mark White Well it increases. But if you take staff that in five years they are going to look normalizing that risk over a longer period. someone who is young, too old to still be on at 2014 as the good old days. It’s just your per- their parents’ insurance, and healthy, they’ll spective changes. We’ve become more com- Editor I would imagine some of them bring in make a decision about, “Do I want to pay a plex, our business requirements are going to contractors or advisors on all that. premium or do I want to use that money for certainly increase. I think our workforce is living expenses or whatever?” That rationale going to be more and more knowledge-based Mark White Some do, but we are trying to is out there because young people are gen- than they have been. This is progression that’s work with providers that are wanting to erally fairly confident about their health and been going on for three decades. We’ve fortu- work with us so there’s an openness about that nothing bad is going to happen to them. nately got a lot of good, bright, smart people that. We’re not hiding anything in these So they are going to stay out of the market. here that can move us forward. n

40 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK healthcare Newsbriefs I People I Information

CARTI Construction Milestone More than 100 guests gathered to witness the raising of the final beam to be installed in the new CARTI Cancer Center as part of what building professionals refer to as a “topping off” ceremony on the site of the largest construction project in Arkansas. For details see page 43

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 41 will also modify its Safety Baby Showers to include State increased focus on safe sleep environment and the needs and preferences of teen mothers. Arkansas Department of Health Monitors Ebola Outbreak D eputy Director Leaving for National Nonprofit Arkansas Department of Human Services (DHS) Deputy Director Janie Huddleston left the agency in October, marking the end of a 16-year career in which she led efforts to overhaul the state’s child welfare and behavioral health systems. Huddleston began working at DHS in September 1998 as the Director of the Division of Child Care and Early Childhood Education and was tapped to be one of the agency’s two deputy directors in May 2004. She was responsible for the divisions While Ebola poses a very low risk to Arkansans, the Arkansas Depart- of Behavioral Health Services, Children and Family ment of Health (ADH) announced it is keeping a close watch on the Services, County Operations, Developmental Dis- Ebola outbreak in West Africa to ensure the safety of Arkansas citizens. abilities and Medical Services (Medicaid). ADH is working with hospitals, emergency medical service providers, Huddleston left her position to serve as Proj- ect Director for the Quality Improvement Center faith-based organizations, the State Chamber of Commerce, and the for Research-Based Infant-Toddler Court Teams Departments of Education and Higher Education to ensure they have at ZERO TO THREE, a nonprofit organization that appropriate protocols in place to screen and monitor individuals who provides parents, professionals, and policymakers may have traveled to Arkansas from the affected West African countries the knowledge and the know-how to nurture early (Guinea, Sierra Leone, Liberia, and Nigeria). development. Arkansas has no active or suspected cases of Ebola, and the risk is Arkansas Awarded Suicide very low for the general public. Ebola only spreads from those who are Prevention Grant infected AND are experiencing symptoms, such as fever or bleeding. T he Arkansas Department of Health (ADH) has Ebola is spread from person-to-person through direct contact with received notice that the state is one of twenty-six states and tribes awarded a Garrett Lee Smith State bodily fluids such as blood, urine, vomit, diarrhea, sweat, semen, and and Tribal Suicide Prevention Grant. The grant is breast milk or by exposure to objects contaminated with bodily fluids, managed by the Suicide Prevention Branch within such as needles. Ebola does not spread through air, food or water. the Center for Mental Health Services in the Sub- ADH will continue to closely monitor the Ebola outbreak and provide stance Abuse and Mental Health Services Adminis- tration. The funding is expected to total $3,680,000 additional information and guidance as needed. Current information over five years. can be found at www.healthy.arkansas.gov or www.cdc.gov/ebola. This is the first time Arkansas has been awarded the Garrett Lee Smith Memorial Youth Suicide Pre- Grant Will Help Educate Teen Mothers infants of teen mothers, identified as a high-risk pop- vention Grant. These dollars will fund a population- Teen mothers in selected Arkansas counties will ulation. It will allow the research team at Arkansas focused Arkansas Youth Suicide Prevention Proj- receive training on creating a safe sleep environ- Children’s Hospital Research Institute (ACHRI) and ect. The funding will be used to increase the number ment for their babies thanks to a $2.3 million grant the ACH Injury Prevention Center to offer training to of youth-serving suicide prevention organizations, from the National Institutes of Health, Eunice Ken- teen mothers in Pulaski, Jefferson, and Lonoke coun- increase clinical service providers, and improve fol- nedy Shriver National Institute of Child Health and ties on infant safety, including the sleep practices low-up care of suicidal youth. The funds will also Human Development. The grant recipient is Mary recommended by the American Academy of Pedi- help increase awareness and use of the National Aitken, MD, MPH, director of the Arkansas Chil- atrics (AAP). That includes placing babies on their Suicide Prevention Lifeline. dren’s Hospital Injury Prevention Center, professor back to sleep and creating a safe sleep environment. of Pediatrics and chief of the Center for Applied As part of the grant, the ACH Injury Prevention Premiums Projected to Drop Research and Evaluation (CARE) at the University Center will rigorously test the Generations in Fam- Two Percent in 2015 of Arkansas for Medical Sciences (UAMS). ilies Talking Safe Sleep (GIFTSS) intervention in T he Arkansas Insurance Department is projecting The goal of the five-year grant is to reduce inci- the subpopulation of teen mothers and will draw that insurance policies sold through the Arkan- dences of Sudden Infant Death Syndrome (SIDS) upon its experience in successfully implementing sas Health Insurance Marketplace will see a net and other causes of sleep-related deaths among educational interventions in Arkansas. The Center decrease of two percent in premium costs for

42 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

DHS Names Stehle Medicaid Director DBHS Director. Green has worked for the Depart- T he Arkansas Department of Human Services ment of Human Services for more than 15 years (DHS) has tapped Dawn (Zekis) Stehle to serve as and has served as Director/Commissioner of DDS the state’s Medicaid director following a national since 2003. search to fill the position. Stehle, who has been Jim Brader, the DDS Assistant Director for Compli- interim director since June 1, previously oversaw ance, will serve as Interim DDS Director in Green’s Medicaid’s effort to transform Arkansas’s health absence. care payment system. Stehle replaces Dr. Andy Allison. local Stehle began her career with DHS in August 2006 as a fellow working in Medicaid before landing a per- OfficialsC elebrate CARTI manent position with the agency as a policy ana- Construction Milestone lyst in January 2007. She quickly rose through the More than 100 guests gathered to witness the rais- Dawn Stehle ranks of the agency, becoming the DHS Policy and ing of the final beam to be installed in the new CARTI Planning director in April 2008. Four years later, Cancer Center as part of what building profession- she was named Medicaid’s Director of Health Care als refer to as a “topping off” ceremony on the site 2015. This calculation includes the policies offered Innovation. In that position, she led the nationally- of the largest construction project in Arkansas. through the Arkansas Private Option, which will acclaimed Arkansas Health Care Payment Improve- Jan Burford, CARTI president and chief execu- notice a small decrease in premiums, but will essen- ment Initiative. The initiative aims to create a more tive officer, drew a comparison to the construction tially remain flat in comparison to 2014. This is an efficient and effective statewide healthcare system. process for those present, who were also invited to aggregate projection, meaning that some individual place their signatures on the final steel beam prior consumers will see a small increase in premiums, UAMS, Dept. of Veterans to its raising and placement. and others will see their costs drop more than two Affairs Expand Affiliation Targeted to open in Fall 2015, the CARTI Cancer percent. Nationwide, insurance costs historically Gov. Mike Beebe recently joined officials from Center will be a multi-specialty, patient-focused can- rise by six-to-ten percent annually. UAMS and the Arkansas Department of Veter- cer treatment center offering medical, surgical and Final rates will be released once the plans are cer- ans Affairs at UAMS Northwest in Fayetteville to radiation oncology and diagnostic radiology with tified by the U.S. Department of Health and Human announce a plan to provide residents in the Arkan- clinics dedicated to imaging, infusion, research, Services. This will happen before open enrollment sas State Veterans Home on the regional campus pharmacy and support programs. The center will for 2015 begins on November 15. improved care. serve as the hub of the statewide network of satel- The plan will allow interprofessional teams of lite clinics which sees an estimated 20,000 cancer Electronic Cigarette Use U AMS students to participate in and observe care patients per year. among Youth Concerning delivered to residents. UAMS resident physicians Greg Williams, chief executive officer of Nabholz In 2013, 263,000 youth who had never smoked a also will be involved in providing care. Construction services and leader of the CARTI Can- cigarette used an electronic cigarette (e-cigarette) The agreement, dubbed “Welcome Home,” cer Center construction team, shared some notes according to the Centers for Disease Control and expands on an education affiliation with the 108- of interest, including: Prevention (CDC). The data, from the National bed skilled nursing facility located in space leased •The first piece of steel installed as part of the Youth Tobacco survey of middle and high school on the UAMS Northwest campus. CARTI Cancer Center was placed on May 15, 2014. students, also showed that youth who had never Students in UAMS Northwest nursing, medical, Upon completion, the construction team will have smoked conventional cigarettes but who used e-cig- pharmacy, and other programs will visit the resi- essentially built one 4,800 square foot house per arettes were twice as likely to smoke conventional dents of the veterans facility as part of their overall week. cigarettes as those who had never used e-cigarettes. care given by the home’s staff. The agreement will •Approximately 50,000 cubic yards – the equiva- In Arkansas, 24.9 percent of youth in grades nine likely expand again to include additional services to lent of 15 Olympic-sized swimming pools - of dirt through 12 currently use tobacco. This ranks Arkan- the residents when the new physical therapy pro- have been removed or redistributed from the site sas at 40th in the youth smoking rate, when com- gram at UAMS Northwest begins in 2015. of the cancer center. pared to other states. •More than 2,000 tons – or 4 million pounds – of There is evidence that nicotine’s adverse effects on DBHS Director to Leave steel will be placed in the completed building. adolescent brain development could result in last- T he Arkansas Department of Human Services •More than 400 miles of electrical cable, electrical ing deficits in cognitive function. Nicotine is highly (DHS) director of the Division of Behavioral Health circuitry, and plumbing/HVAC pipes will be installed addictive. Three out of every four teen smokers Services (DBHS) Joy Figarsky resigned in October in the building. According to Williams, if laid end- become an adult smoker. E-cigarettes also produce to return to work in the private sector. Figarsky, who to-end, this would stretch from Little Rock to New carcinogens and small particles that irritate lungs. has nearly 30 years of experience working in the Orleans. Arkansas was one of the first states to create a behavioral health field, joined DHS in June 2013. •More than 13,000 cubic yards of concrete – the law prohibiting the sale of e-cigarette products to Dr. Charlie Green, previously Director/Commis- equivalent of 50 million pounds – will be placed minors. However, the law does not have any penal- sioner of the DHS Division of Developmental Dis- in foundations, slabs and sidewalks as part of the ties for those who choose to sell to minors. abilities Services (DDS), has stepped in as Interim center.

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 43 Claudia Barone, EdD, APRN

Barone Named to FDA Legislative Update Lawmakers Dismang, Chesterfield, and Davis are addressed by UAMS Medical Panel on Tobacco Center CEO Roxane Townsend, MD, during a panel discussion. Claudia Barone, EdD, APRN, a professor in the Col- lege of Nursing at the University of Arkansas for Medical Sciences (UAMS), has become the first Arkansas private option and its impact on health Michael Mancino, MD, an associate professor in nurse appointed to the Tobacco Products Scien- statewide. the UAMS Department of Psychiatry, is the princi- tific Advisory Committee of the U.S. Department of The law, summarized by the legislators them- pal investigator on the first of the two-year studies, Health and Human Services, Food and Drug Admin- selves, uses public funds, mostly from the fed- while Alison Oliveto, PhD, a professor in the UAMS istration (FDA). eral government, to buy private insurance for Department of Psychiatry, is the principal investiga- Barone is a nationally known expert in tobacco low-income individuals in lieu of enrolling them in tor on the other, both funded by the National Insti- cessation. She has trained as a Tobacco Treat- Medicaid. tute on Drug Abuse. ment Specialist at the University of Massachu- The legislators said the voice of the medical com- In the first trial, reportedly the only one of its kind setts Medical School’s Center for Tobacco Treat- munity will be welcomed in the upcoming session in the United States, subjects will receive the med- ment Research and Training. Her research interest when securing continued funding for the private ication lisdexamfetamine, known commercially as in tobacco cessation includes grant-supported work option will undoubtedly be a point of much debate. Vyvanse, during a one-week stay at a residential studying clinic-based cessation techniques. While the Legislature doesn’t have to pass a new facility. The participants will then receive the drug The 12-member FDA committee is selected from law to continue the private option, it does have to on an outpatient basis for six weeks and continue to among those knowledgeable in the fields of medi- pass a spending resolution allowing the state to be followed on an outpatient basis for eight weeks cine, medical ethics, science, or technology involv- fund it. Doing that requires approval from 75 per- after discharge from the residential facility. ing the manufacture, evaluation or use of tobacco cent of both houses in the Legislature. In the second trial, subjects will be given the drug products. The panel advises on issues related to the Invited by panel moderator Cherry Duckett, UAMS atomoxetine, known commercially as Strattera, for regulation of tobacco products. vice chancellor for governmental affairs, to address two weeks while residing at a residential facility, and The committee reviews and evaluates safety, the law’s impact on UAMS, Roxane Townsend, MD, then continue to receive the drug for eight weeks dependence, and health issues relating to tobacco vice chancellor for clinical programs and CEO of as outpatients. products and provides appropriate advice, informa- UAMS Medical Center, noted the dramatic decline Participants will also take part in weekly cog- tion and recommendations. in uninsured patients – from about 11 percent in nitive behavioral therapy sessions to help them January to less than 4 percent by June. develop strategies to cope with their addiction to C ouncil Hosts Fall Legislative Update She praised the private option as a “brilliant solu- methamphetamine. A trio of state legislators visited the University of tion” by the Legislature for meeting the mandates “We’re looking at these two drugs as treatment Arkansas for Medical Sciences (UAMS) campus this of the federal Affordable Care Act. options to not only help addicts address their drug fall for the third installment of Legislative Update, a problem but as a way to prevent them from relaps- semiannual panel discussion open to all students Study Using ADHD Drugs ing,” said Oliveto. “Methamphetamine affects the and employees hosted by the Image Council of the to Treat Addiction user’s decision-making process, which explains why Professional Nursing Organization. A team of University of Arkansas for Medical Sci- so many people continue to use the drug despite State Sen. Jonathan Dismang, State Sen. Linda ences (UAMS) researchers are studying the poten- its consequences. We hope by improving their con- Chesterfield, and State Rep. Andy Davis partici- tial of two drugs used to treat Attention Deficit centration levels that we can directly impact their pated in the hour-long discussion, most of which Hyperactivity Disorder (ADHD) in helping addicts addiction.” focused on the passage and implementation of the overcome their dependence on methamphetamine. Individuals interested in participating in the

44 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

studies may call (501) 526-7969 or visit www. methresearch.com.The studies are both clinical trials using drugs approved by the Food and Drug Administration for the treatment of ADHD.

Arkansas Hospice & Arkansas Hospice Foundation Elect 2015 Boards Arkansas Hospice and the Arkansas Hospice Foun- dation have elected new officers and members for their 2015 Boards of Directors. Arkansas Hospice Board officers include: Sheila Campbell, chair; Tim Osterholm, chair-elect; Donna Baas, vice chair; Mike Miller, treasurer; Doug Was- son, secretary; and Brooke Bumpers, chair emeri- Sheila Campbell Kenniann Summerell tus. Board members include: Christopher Cooper; Sharon Davis; Frank Funk; Dr. Margarita Garcia; Dr. Mariann Harrington; Beth Ingram; Stephen Lan- professor in the Department of Pediatrics in the announced awards to six researchers totaling about caster; John Lile; Don Munro; Dr. David Reding; U AMS College of Medicine. $300,000 for pilot studies. Scotty Shively; Kenniann Summerell; JoAnne Wil- The EoE findings, which included genomic and The annual awards of about $50,000 each are son; and Rebecca Winburn. protein analyses of 736 patients who participated made to studies with the strongest likelihood of Arkansas Hospice Foundation Board officers in the research, give researchers a better under- developing into larger research programs that lead include: Kenniann Summerell, chair; Vivian Trickey standing of why people develop EoE disorders and to improved health and healthcare. Smith, chair-elect; Walker Sloan, vice chair; Lindsey allergies in general. The UAMS researchers and their project titles are: Baker, treasurer; Rob Anderson, secretary; and Sha- • Paul Gottschall, PhD, College of Medicine, ron Heflin, chair emeritus. Board members include: Laser Device Offers Hope for Department of Pharmacology and Toxicology: Tar- Sharon Aureli; Sheila Campbell; Greg Hale; James Early Cancer Detection geting lecticans to enhance synaptic plasticity in Herden; Kimberly Pruitt; Debbie Scrivner; Anne Ted- Researchers at the University of Arkansas for Medi- Alzheimer’s disease ford; Judy Waller-Breece; and Jessica Worman. Hon- cal Sciences (UAMS) have developed a laser-based • Gur Kaushal, PhD, College of Medicine, Depart- orary Board members are Gail Arnold and Bishop device with wide-ranging implications for cancer ment of Internal Medicine: Antifibrotic therapy by Kenneth Hicks. research, diagnosis, and treatment. upregulation of autophagy to reverse renal fibrosis Conceived by Vladimir Zharov, PhD, DSc, direc- in chronic kidney disease Researchers Discover Genetic tor of the Arkansas Nanomedicine Center at UAMS • Dennis Kuo, MD, College of Medicine, Depart- Key to Food Allergy and a professor in the Department of Otolaryngol- ment of Pediatrics: Barriers and facilitators to health A recent breakthrough in understanding the cause ogy, College of Medicine, the device can spot cancer care transition from pediatric to adult healthcare of a rare, hard-to-treat allergic disorder has been cells as they speed through the bloodstream, label • Lee Ann Macmillan-Crow, PhD, College of Medi- made by a group of research institutions that them for tracking, and even kill them. The technol- cine, Department of Pharmacology and Toxicology: include the University of Arkansas for Medical Sci- ogy has also demonstrated that it could become a Novel therapy to reduce injury to human donor kid- ences (UAMS) and the Arkansas Children’s Hospital platform for unraveling the mysteries of metastasis. neys prior to transplant Research Institute (ACHRI). This National Institutes of Health (NIH)-funded • Mark Mennemeier, PhD, College of Medicine, The discovery, reported online in Nature Genet- research includes a UAMS Translational Research Department of Neurobiology & Developmental ics, could lead to new targeted therapies for eosino- Institute pilot award that aided Zharov’s devel- Sciences: A joint CTSA (Clinical and Translational philic eophagitis (EoE). The allergic/immune condi- opment of the clinical prototype device for trials Science Award) project with Washington University tion causes inflammation of the esophagus, usually involving melanoma and breast cancer patients. School of Medicine (St. Louis) leading to a Phase II from consuming foods such as dairy products, eggs, Zharov hopes that someday the same device he clinical trial for tinnitus soy, and wheat. is using to identify and label CTCs in humans can • Steven Post, PhD, College of Medicine, Depart- Existing treatments for EoE are limited to pre- be recalibrated to kill the cells, making his device ment of Pathology: Pathological features that pre- scribing long-term restrictive diets and steroid a “theranostic” instrument. “Theranostic” refers to dict clinical outcome in vulvar squamous cell car- sprays to swallow. agents with combined diagnostic and therapeutic cinoma patients. The study found that EoE is triggered by the inter- capabilities. The UAMS Translational Research Institute’s mis- action between epithelial cells, which help form the sion is to help accelerate research that will improve lining of the esophagus, and a gene called CAPN14. Translational Research Institute the health and healthcare of people in Arkansas and It also identified a marker that can be used to mea- Funds Pilot Studies across the country. It was established with major sure the activity of the disease, said UAMS’ Robert The University of Arkansas for Medical Sciences funding from the National Institutes of Health (NIH) Pesek, MD, an author on the study and an assistant (UAMS) Translational Research Institute recently in 2009 as a Clinical and Translational Science

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 45 Nursing license number and a Social Security Num- access to opportunities for chronic disease pre- ber belonging to another person to obtain employ- vention and risk reduction and increasing access ment as a school nurse in Searcy, from the 2007-08 to environments with healthy food options, among school year through the 2011-12 school year. other objectives.” Boyce was indicted by a federal grand jury on Sep- Chronic disease prevention, Kohler noted, not tember 5, 2012. The seven-count indictment charged only improves patients’ quality of life but provides her with wire fraud, aggravated identity theft, and economic benefits as well. According to projections misuse of a social security number. On February 26, by the Milken Institute, chronic disease cost Arkan- 2014, Boyce pleaded guilty to one count of wire fraud, sas’ economy approximately $25 billion last year, one count of aggravated identity theft, and one count including treatment and lost productivity. That cost of misuse of a Social Security Number. is projected to rise to $42 billion annually within The matter was investigated by Special Agent a decade without better prevention and manage- Jeffrey Hannah of the Office of the Inspector Gen- ment education. eral for the U.S. Department of Health and Human In 2013, UAMS Northwest appointed Pearl Services and Special Agent Mark McElrath of the McElfish the director of research to begin building Bray Gourmet will be the on-site restaurant at the new CARTI Cancer Center. Office of the Inspector General of the Social Secu- a research and community-based program infra- rity Administration. Assistant United States Attor- structure with the goal of addressing health dispari- ney Alexander Morgan prosecuted the case for the ties, including high incidences of chronic disease Award (CTSA) recipient. The institute’s funding United States. in underserved populations. In less than two years, from NIH flows through the National Center for the community-based program has established six Advancing Translational Sciences (NCATS). St. John Joins Hot Springs active projects that have been awarded $5.1 mil- Cardiology Associates lion in funding. Bray Gourmet Selected for Interventional Cardiologist, Dr. Greg St. John, is now While northwest Arkansas continues to enjoy eco- New CARTI Cancer Center caring for patients alongside Drs. Jeffrey Tauth, Eric nomic growth and counts itself a statewide leader Bray Gourmet, the Little Rock-based delicatessen Bowen, and Victor Castro at Hot Springs Cardiol- in health outcomes, there are communities that are and catering company, will be the on-site restau- ogy Associates. He brings more than 18-years of left out of that prosperity and excluded from equi- rant at the new CARTI Cancer Center, according to cardiology experience to their office located at 130 table healthcare, said McElfish. a recent announcement by officials with the state- Medical Park Place. wide network of cancer care providers. Dr. St. John is board certified in internal medicine Med Student Receives “Having a restaurant on-site that is mindful of the and cardiovascular diseases, and a Fellow of the Hamilton Scholarship nutritional needs and challenges of cancer patients American College of Cardiology. A native Arkansan, Jesse Wray, a first-year medical student from Craw- is sure to be a valuable resource as they undergo Dr. St. John attended medical school at UAMS in fordsville, has been awarded the Ralph B. Hamil- treatment at CARTI,” said Jan Burford, CARTI presi- Little Rock, where he also completed his internship, ton, MD, Endowed Scholarship at the University of dent and chief executive officer. residency, and fellowship. He is on staff at National Arkansas for Medical Sciences (UAMS) College of Serving downtown Little Rock since opening Park Medical Center, and will continue to provide Medicine. in July 2012, Bray Gourmet is known for its fresh, interventional cardiology services to Hot Springs Wray received his undergraduate degree in biol- homemade sandwiches, wraps, soups, salads and and the surrounding communities. ogy at the University of Arkansas in Fayetteville in breakfast. May. While there, he was active in the Alpha Epsi- While the majority of the downtown menu will be UAMS Receives Grant to lon Delta premedical honors society, the Order available at the CARTI location, a few minor changes Address Health Disparities of Omega Greek leadership honors society and are expected, including the addition of fresh, fruit The University of Arkansas for Medical Sciences Lambda Chi Alpha fraternity. Wray participated in smoothies and daily specials. (UAMS) has been awarded a three-year, $2.99 mil- undergraduate research in the field of astrobiology. lion grant from the Centers for Disease Control and Wray’s volunteer activities during college included Fake Nurse Sentenced To Prevention (CDC) to address health disparities in work with Big Brothers Big Sisters of Northwest 4-Year Prison Term the Hispanic and Marshallese communities in Ben- Arkansas and the Volunteer Action Center Literacy Christopher R. Thyer, United States Attorney for ton and Washington counties. Program. the Eastern District of Arkansas, announced that “Northwest Arkansas is an area with the largest The Ralph Hamilton, MD, Scholarship Fund United States District Judge Brian S. Miller sen- number of Marshallese and Hispanic residents in was founded in Crittenden County almost 25 tenced Susan Elaine Boyce, 60, formerly of Pleas- the state. These populations are rapidly increasing years ago to help local students in their quest ant Plains, Arkansas, to four years in prison to be and have significant health disparities,” said UAMS to become doctors. UAMS began adminis- followed by three years of supervised release for Northwest Vice Chancellor Peter Kohler, MD, a dis- tering the scholarship this year. Hamilton fraudulently portraying herself as a nurse. Judge tinguished professor in the College of Medicine and was a family physician and the first chief Miller also ordered Boyce to pay $175,099.24 in res- co-principle investigator for the CDC grant. “This of staff at Crittenden Memorial Hospital titution to the Searcy Special School District. grant will fund efforts to drive down chronic dis- in West Memphis. He graduated from Boyce used an Arkansas State Board of ease problems and costs in the region by increasing U AMS in 1934 and, following a medical

46 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

internship in New Jersey, established his practice in West Memphis in 1936. Hamilton was widely known for his compassion and dedication to his patients and community during his 57 years in practice. He died in 1991.

Jorden Named Vice Chancellor IT and CIO Rhonda Jorden, a 27-year veteran of information technology, has been named vice chancellor for information technology and chief information officer for the University of Arkansas for Medical Sci- ences (UAMS). Jorden earned a bachelor’s in computer informa- Rhonda Jorden Barbara G. Williams tion systems from Arkansas State University (ASU) and worked as a contract programmer for five years before earning a Master of Business Administration activities, and a special tribute to those who have against the intrauterine wall and makes internal from ASU in 1992 and joining UAMS. Her career at experienced or are experiencing Alzheimer’s. pressure rise. That pushes the air inside the Koala the university has included roles in management of To start or join a team today, visit the Alzheim- Toco and produces a signal. The signal is transmit- patient systems, software development, clinical sys- er’s Association alz.org/walk. To learn more about ted through an attached cable that also is plugged tems operations, and serving as interim chief infor- the disease and available resources, call the into a fetal heart rate monitor. mation officer for 14 months ending in 2011. For the Alzheimer’s Association 24/7, toll-free Helpline at In 2002, UAMS established BioVentures and its past 12 years she has been the director of technical 800-272-3900. Technology Licensing Office to facilitate the startup operations and chief technology officer. of new business enterprises, based on UAMS tech- Contraction Monitoring nology. The university is interested in translating its Alzheimer’s Walk to Raise Device Goes to Market research endeavors such as Koala Toco technology Critically Needed Funds An inexpensive, disposable external medical device into products that benefit human health. The Alzheimer’s Association is inviting Central created and developed by University of Arkansas for Arkansas residents to unite in a movement to Medical Sciences (UAMS) and University of Arkan- Williams Receives AHA reclaim the future for millions by participating in the sas at Little Rock (UALR) professors can now be Chairman’s Award Alzheimer’s Association Walk to End Alzheimer’s®. bought and used by clinicians to monitor contrac- Barbara G. Williams, department chairperson of Walk to End Alzheimer’s will take place on Novem- tions in pregnant women. the University of Central Arkansas Department of ber 8, 2014 at the Clinton Library in Little Rock. The tocodynamometer, marketed as Koala Toco, Nursing received the 2014 Arkansas Hospital Asso- Walk to End Alzheimer’s is more than a walk. It is was approved in May by the Food and Drug Admin- ciation (AHA) Chairman’s Award during the AHA’s an opportunity for participants in Central Arkan- istration. Koala Toco, manufactured and marketed annual Awards Dinner in October. sas to learn about Alzheimer’s disease and how to by Murray, Utah-based Clinical Innovations, is com- Dr. Williams will complete both her term as presi- get involved with this critical cause, from advocacy patible and works with existing equipment like fetal dent of the Arkansas Association of Hospital Trust- opportunities and clinical trial enrollment to sup- heart rate monitors. ees (AAHT) and as trustee delegate to the AHA port programs and services. Walk participants will Work on developing the device started about four board in October. During her two-year tenure, Dr. also join in a meaningful ceremony to honor those years ago by Curtis Lowery, MD, chairman of the Williams has been a mentor for hospital trustees affected by Alzheimer’s disease. College of Medicine’s Department of Obstetrics in the state and has represented trustees both in In addition to the short walk, par- and Gynecology, Hari Eswaran, PhD, a professor in Arkansas and nationally at regional policy board ticipants will enjoy Craig the same department, and James D. Wilson, MS, meetings of the American Hospital Association in O’Neill as the emcee along assistant director of research at the UALR Gradu- discussions about important healthcare issues and with food, music, kids’ ate Institute of Technology. the value of governance education. Tocodynamometers are electronic devices for Dr. Williams is a member of Conway Regional monitoring and recording uterine contractions dur- Health System’s Board of Trustees. As AAHT chair- ing labor. They are applied to the lower part of the man, she was instrumental in helping design and uterus using a belt. administer a 2014 survey aimed both at trustees Older tocodynamometers can cost hundreds of and at CEOs to determine exactly what trustees dollars, are completely electronic, and have to expected and needed from the AHA and AAHT. The be cleaned following their use. Koala Toco is a survey results will play a large role in how the organi- small plastic disk with air inside that rests on zation advocates for and educates hospital trustees the abdomen of a pregnant woman. When in coming years. n the uterus contracts, it pushes

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 47 We Must Work Together to Increase the Number of Arkansans Immunized Against The influenza vaccine for 2014-2015 will Influenza and Save Lives cover the same strains covered by the 2013- 2014 vaccine. These strains include two In- fluenza A strains (one H1N1 and one H3N2) and one or two Influenza B strains, depend- Last year was a very bad The 2013-2014 flu season produced the ing on whether the vaccine is a trivalent or year in Arkansas for the flu. highest number of flu deaths reported in a quadrivalent formulation. Arkansas in the last three decades. To our There are several formulations that will The predominant circulating knowledge, none of those who died this past be available. strain of influenza virus was season had been immunized against the flu, Inactivated influenza vaccine, which is H1N1, and it was particularly with the exception of a young child, who was given as a shot, is available in either trivalent only partially immunized—having received or quadrivalent standard-dose formulations. deadly for young adults. one rather than two doses of influenza vac- There is also a high-dose trivalent formula- During the 2013-2014 flu cine, as recommended for children aged six tion for adults aged 65 years and older. season 76 people died from month through eight years during their first Recombinant trivalent influenza vaccine, the flu. The majority were season of influenza immunization. Ironically, also given as a shot, is available for people the strains covered in the vaccine last year who are egg allergic. between the ages of 25-64 were well-matched to the circulating strains. Live attenuated influenza vaccine, which is years. The high death rate The best way to decrease the number of given as a nose spray, is available for children among younger adults was Arkansans who die from the flu is to immu- and adults aged 2 through 49 years. A new nize the population of our state. Therefore, unusual. Typically most flu- the Arkansas Department of Health is seeking related deaths occur among to partner with schools, communities, and very young children and health care providers to promote flu shots and immunize as many people as possible, older adults. Flu activity as soon as the flu vaccine is available. usually begins in October of Influenza immunization is recommended each year, peaks in January by the CDC Advisory Committee on Immu- or February of the following nization Practices (ACIP) for all people aged 6 months and older, who have no contrain- calendar year, and runs until dications to receiving the vaccine. Contra- April or May. indications include severe allergy to any of the vaccine components, including severe allergy to egg protein. It is estimated that 49.7 percent of people in Arkansas were vaccinated against the flu during the 2013-2014 flu season, which is higher than the national flu vaccination rate of 46.2 percent (see the graph at right).

48 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK Nathaniel Smith, MD, MPH Director and State Health Officer, Arkansas Department of Health

the efficacy of influenza vaccination begins to wane about six months after the shot is given, especially among older adults. There- fore, there’s a balancing act for vaccination timing, as delaying vaccination may permit great immunity later in the season, but result in missed opportunities to vaccinate, and possible difficulty immunizing the population quickly if flu season peaks early. In October, the Department of Health will begin publishing weekly flu status reports for Arkansas. Health care providers who would like to view these reports can go on the Ar- kansas Department of Health’s website under the Flu section. Health care providers can help the Health Department track flu deaths by reporting all influenza-related deaths to the Health Department’s Communicable Dis- ease Section at 501-537-8969 or fax to 501- 661-2428. Death due to influenza (regardless of age) became a required reportable condition September 1, 2014. There are several Healthy People 2020 Ob- jectives related to increasing influenza immunizations. There are two that are worth mentioning here. Increase the percentage of children aged 6 months through 17 years who are vaccinated annually against seasonal influenza to 70.0 percent. Increase the percentage of adults aged 18 and older who are vaccinated annually ACIP recommendation for this year is that not be delayed to obtain the live attenuated against seasonal influenza to 70.0 percent. healthy children aged 2 through 8 years who vaccine. This recommendation is based on With the progress we have made in the have no contraindications should receive the the superior efficacy of the live attenuated past few years, these two Healthy People live attenuated vaccine, when it is immedi- vaccine in this age range. 2020 Objectives are realistically achievable ately available. When it is not immediately The CDC recommends that in general in- in Arkansas. It will take a coordinated effort available, vaccination with the inactivated fluenza immunization should begin as soon across the state to turn them into reality, but vaccine should be given. Vaccination should as vaccine is available. It is recognized that it is quite doable. n

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 49 E-Cigarettes and Vaping: History Repeating Itself

Remember back a few decades when magazine ads, TV commercials, billboards, and the like made us think smoking was cool? The result—an overwhelming burden of disease and death; the U.S. Surgeon General’s warning ignored by too many because of an addiction they could not overcome; a staggering hit to health care budgets; law suits against the tobacco companies; and enforced restrictions on advertising and sale to minors. After years of battling for tobacco cessation, we were finally winning with significant declines in use, especially among children. Tobacco was no longer cool.

Just as we thought we could take a deep, non-users. Bystanders can absorb nicotine, clean breath in relief, along came a new threat propylene glycol, and tobacco-related con- that is as insidious as tobacco. That threat is taminants such as formaldehyde, acetalde- e-cigarettes. As Dr. Nate Smith, State Health hyde, and acrolein. Blood levels of nicotine Officer and Director of the Arkansas Depart- in non-smoking people exposed to ENDS ment of Health, warned recently in this jour- vapor have been documented.” Dr. Smith also nal (HJLR July/August 2014), e-cigarettes wrote that ENDS vapor has been reported and other vapor products are nicotine de- to condense in the environment ultimately livery systems and can have serious health creating a toxic dust. consequences. Misleading promotion of ENDS as a safe He wrote, “Electronic nicotine delivery alternative to smoking has caused an ex- systems (ENDS) are re-normalizing smok- plosion of use among youths, on college ing behaviors and threaten to reverse clean campuses, and in enclosed areas otherwise indoor air gains. Further, secondhand vapor protected by the Clean Indoor Air Act. While contains chemicals that can be inhaled by we wait for regulations to catch up with this

50 NOV / DEC 2014 I Healthcare Journal of little rock Joseph W. Thompson, MD, MPH Arkansas Surgeon General and Director, Arkansas Center for Health Improvement

new development, I strongly urge businesses brain development could result in lasting def- and institutions to voluntarily ban the in- icits in cognitive function. Further, an article door and on-campus use of e-cigarettes and published recently in the New England Jour- other vapor products. Our citizens deserve nal of Medicine reports that “epidemiologic the same protection against the ill-effects of studies have shown that nicotine use is a ENDS that they have enjoyed against second- gateway to the use of marijuana and cocaine hand smoke. in human populations.” Arkansas was one of the first states to cre- I see history repeating itself, and hope that ate a law prohibiting the sale of e-cigarette as a society we will not let another genera- products to minors. This law was passed in tion fall victim to the life-altering harms of 2013, along with a law prohibiting the use nicotine. of e-cigarettes on public school property. There are currently 466 brands of ENDS, However, penalties are limited to a maxi- and many are specifically marketed towards mum fine of $100 and enforcement has not young people. They are sold in iridescent col- been rigorous. ors and fruit and candy flavors. And, they are The Arkansas Department of Health re- advertised unfettered, following the same ported that data from the National Youth successful formula employed by the tobacco Tobacco survey of middle and high school industry before we wised up and implement- students showed that youth who had never ed restrictions to protect our kids against a smoked conventional cigarettes but who deliberate campaign to get them addicted. used e-cigarettes were twice as likely to In Arkansas, independent vapor shops are smoke conventional cigarettes as those who growing in number with at least 68 currently had never used e-cigarettes. Further, survey known to be in operation. Vapor shops sell results published by the CDC show that the ENDS products completely unregulated and number of middle and high school students free to promote in any misleading way they “I strongly urge using e-cigarettes, or “vaping,” tripled over chose. A situation they are exploiting to ad- three years, from 79,000 in 2011 to more than vance their own agenda. The goal—to create a businesses and a quarter million in 2013. new generation of nicotine addicts dependent institutions to Ask any teenager and you will hear that on their products. voluntarily ban “vaping” has become mainstream, with most History also shows us that we are likely in users and their parents thinking it is harm- for another mighty battle with the tobacco the indoor and less, unaware of the dangers of nicotine ad- industry sparing no expense to counter the on-campus use diction presented by e-cigarettes. In fact, a efforts of advocacy groups and policymak- Journal of American Medicine Pediatrics study ers as they rally to enact restrictions. In the of e-cigarettes of 40,000 middle and high school students meantime, it is up to us as health care pro- and other vapor indicated adolescents consider e-cigarettes fessionals to speak out and work to educate as high-tech, accessible, and convenient, es- children and their parents. They need to know products.” pecially in places where smoking cigarettes what we know: e-cigarettes are dangerous is not allowed. and not cool! n We have known for a long time that nicotine is highly addictive, and there is evidence that nicotine’s adverse effects on adolescent

Healthcare Journal of little rock I NOV / DEC 2014 51 You Help Patients; AFMC Helps You Navigating the Challenges of PCMH

Health care providers in In Arkansas, the PCMH program is one as- Arkansas are adapting well pect of the Arkansas Payment Improvement Initiative (APII), designed to improve the to the rapidly changing quality of health care, reduce costs, and en- landscape of quality gage the patient in his or her own health and improvement initiatives, new health care. APII provides financial rewards Care’s (AFMC) provider relations represen- for high-quality, coordinated, and efficient tatives and PCMH Quality Assurance (PCMH technology opportunities, care. The PCMH shared-savings program QA) staff can help practices understand the and cost-saving and profit- has set a 2014 medium cost per-beneficiary PCMH program and the required activities sharing efforts. Changes and threshold of $2,032. Practices are eligible to and metrics to earn shared savings. Con- challenges will continue for receive 50 percent of the difference between tact these skilled folks at 501-212-8600 or the threshold and the practice’s average cost. at [email protected]. the immediate future. Let’s Arkansas PCMH began Jan. 1, and its sec- take a minute to remind ond performance period begins Jan. 1, 2015. Episodes of Care The PCMH model com- ourselves why and how we’re Enrollment (required annually) for the second plements the work already begun with ep- period began Sept. 1 and will close Nov. 17. The isodes of care (EOC). The EOC initiative being asked to make these initial goal of getting 40 percent of Arkansas’ shares the PCMH model’s goal of rewarding changes, and review the Medicaid beneficiaries assigned to a PCMH high-quality, coordinated, and efficient care. challenges and benefits that has been exceeded and now more than 70 per- The EOC initiative focuses on improving care, cent of beneficiaries are in a PCMH. The num- as well as protecting the physician’s discre- are on the horizon. ber of participating physicians has expanded tion in clinical decision-making. to more than 900 statewide. An EOC is a collection of health care ser- Within the Arkansas PCMH initiative, the vices that are provided to a patient based on a Patient-Centered Medical Home The pa- biggest challenge facing most practices is the diagnosis, intervention or condition, and dur- tient-centered medical home (PCMH) is a time and commitment needed to improve ing a given length of time. Providers continue team-based approach to health care deliv- processes and outcomes. A majority of the to file claims and will be reimbursed according ery that facilitates a partnership between a clinics participating in the PCMH initiative to each payer’s fee schedule. When providers patient, the patient’s family, and the patient’s are small, rural practices with limited staff can perform with his or her average cost in the physicians. Led by primary care physicians, and resources and may be involved in mul- commendable range and meet quality metrics PCMH strives to comprehensively manage tiple initiatives/incentive programs. One goal for an episode, they will receive a gain share and coordinate a patient’s health needs. Prac- of the Arkansas PCMH initiative is to support at the end of the performance period. tices will shift their time from reactive care to those clinics by providing additional resourc- Eleven EOCs have been established, and proactive care to provide more control over es through education, outreach, and identi- providers have already received a gain/risk daily workflow and help improve practice ef- fying best practices. share for the first five episodes that have com- ficiencies while improving patient outcomes. The Arkansas Foundation for Medical pleted a full performance period.

52 NOV / 2014 I Healthcare Journal of little rock Ray Hanley President and CEO, Arkansas Foundation for Medical Care

both the quality and cost effectiveness of es- you’re not using SHARE or have a closed EHR tablished EOCs. system, then exchanging patient information Visit www.paymentinitiative.org for more may not be possible. information, to access webinars, and sign- Ongoing assessment of the EHR to make up for Alerts. AFMC’s provider representa- sure that software is current ensures that tives are always available to help with your practices can continue to meet practice EOC needs. transformation requirements. AFMC was awarded a federal contract that has enabled Electronic Health Records It may be dif- us to provide individualized technical assis- ficult to imagine the cost savings that elec- tance to more than 1,500 health care provid- tronic health records (EHR) prom- ers. Services include best practices for EHR ise when you are writing the optimization, resolution of software issues, check for an EHR system ongoing education, HIPAA security assess- and learning how to nav- ments and on-site detailing visits. AFMC can igate it. Implementation tailor additional technical assistance to meet of this technology has a practice’s specific needs. been difficult for many A critical component in the coordination Challenges that practices. However, of patient care is EHR systems interoper- providers face with EHRs are the essential ability. Effective and efficient care coordi- EOCs include diag- foundation for most of nation would be extremely hard to achieve nosing more appro- the health care transfor- without interoperability because it supports priately, identifying mation initiatives under- the transport of patient health information clinic and provider pat- way, including PCMH. EHR between disparate EHR systems or through terns, ensuring quality, and technology equips health care a health information exchange. This allows controlling costs. AFMC’s provid- professionals with the ability to eas- health information to get to the right provider er outreach team can help providers identify ily analyze patient panels, monitor trends, at the right time. Having access to a patient’s cost drivers by reviewing EOC reports and and track high-risk patients. complete medical record gives providers the educating providers on the quality metrics An EHR maintains an individual patient’s opportunity to bring the patient in for an infor each episode. These highly experienced electronic medical record and facilitates tervention before problems escalate into ex- teams understand different practice work- that information being shared with other pensive hospitalizations. flows and can demonstrate how to change health care providers. By having access to A final challenge, and one that is increas- practice patterns to maximize quality and a patient’s family history, physicians’ case ing in importance, is privacy and security. minimize costs. Providers who find them- notes, immunization status, medications, “Hacking” and HIPAA breaches continue to selves in the non-acceptable cost range and allergies, past surgeries, hospitalizations, capture headlines. AFMC can advise clinics owe money back as a risk share have an op- and insurance information in one readily and hospitals on how to bridge security gaps. portunity to decrease that risk. By careful- accessible place, EHRs enable providers to AFMC has created industry-leading tools to ly reviewing quarterly performance reports increase practice efficiencies and cost sav- help conduct annual security risk analyses. with your provider outreach team, changes ings, improve patient care and coordination, More than a health information technol- can be identified that will control costs and and improve the accuracy of diagnoses and ogy intervention, PCMH requires a funda- increase quality. The outreach team often health outcomes. mental change to a practice’s organizational finds that small changes, such as diagnosing It is important to note that a health infor- culture. The “home” in patient-centered med- more appropriately, can have a big impact. mation exchange (HIE) mechanism is nec- ical home is not a place, but it is the team that EOCs were established to stabilize the essary for practices to share electronic data takes responsibility and accepts accountabil- long-term economic growth of Arkansas’ with other providers and with the patient. ity for the patient’s health. PCMHs focus on health care system. So far, the savings have Arkansas’ State Health Alliance for Records care coordination, prevention, and manag- been impressive and providers are sending in Exchange (SHARE) is one way to provide se- ing chronic diseases to reduce costs and im- valuable feedback that continues to improve cure transmission of health information. If prove quality and the patient experience. n

Healthcare Journal of little rock I NOV / DEC 2014 53 Maximizing Potential May Increase Momentum

Jim Collin’s book, Good to Great, describes transformation as Change, Advancing Health, recommends a large heavy flywheel inching forward requiring great effort that nurses practice to the fullest extent of their education and training. This means that at first.A s consistent energy is applied, the flywheel gains a barriers to practice, whether they are organi- momentum of its own through the synergy of each previous zational, regulatory, or statutory, prevent the push and the visible results from the effort. Ultimately, the largest group of healthcare providers from making the contribution they are educated to flywheel may take off, prompting the question, “What was the make. This is true of all nurses, particularly one event that gave it such momentum?” (Collins, 2001) As advanced practice registered nurses. Collins’ researchers asked this question to successful business Advanced Practice Registered Nurses (APRNs) are Registered Nurses who have a leaders whose companies outperformed their counterparts, Master’s or Doctoral degree in Nursing and they were shocked when they discovered that there was no have taken a national certification exam as miracle moment. The “great” companies demonstrated a a Certified Nurse Practitioner, Clinical Nurse Specialist, CertifiedN urse Midwife, or Certi- deliberate process of determining the best actions to take to fied Registered Nurse Anesthetist. Each cat- accomplish their vision and simply did them. egory has distinct characteristics which support its role as a provider of evidence-based, patient centered care. The CNP is the largest Much has been written of healthcare group of APRNs in Arkansas. reform and initiatives designed to improve CertifiedN urse Practitioners (CNP) are access and quality while simultaneously educated and credentialed (e.g., boarded) reducing the cost. The health professions according to a specific population (e.g., adult/ have responded by stepping forward to edu- gerontology, family/across lifespan, women’s cate the public and legislators on scopes of health/gender related, neonatal, pediatrics, practice and advocating for practicing to the psychiatric/mental health). Eighteen states level of the profession’s education, training, and the District of Columbia have full prac- and license. The report from the Institute of tice authority for CNPs which means that Medicine, The Future of Nursing: Leading they are able to practice to the fullest extent

54 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK Rhonda Finnie DNP, APRN, AGACNP-BC, RNFA President, Arkansas Nurses Association

of them may write prescriptions (Arkansas designation of leaders of Patient Centered State Board of Nursing, 2013). Medical Homes, are addressed within the In Arkansas, CNPs may only prescribe DEA national context of an increasing knowledge Schedules III-V. On October 6, hydrocodone- base on patient-centered, high quality out- containing products transitioned to a Sched- comes with lowered cost. ule II narcotic based on a change in DEA reg- Although nursing represents the largest ulations. Although this medication was within healthcare workforce in the U.S., it is part of the scope of practice previously, the change a larger system, a system with complex, mov- means that the medication requires a written ing, interlocking parts. Each piece reinforces prescription from a treating physician. This other parts to create an integrated whole will be a tremendous barrier to care, particu- which is stronger and self-reinforcing. This larly in the areas served by CNP clinics, in the is why every healthcare profession should hospital setting in which CNPs are responsi- practice to its fullest potential, producing ble for transferring and discharging patients a push on the flywheel, creating momen- and in my own practice in a neurosurgical tum toward the common goals of increased clinic as I see patients with acute and post- access, high quality, and reduced cost. n operative pain. Currently, there are opportunities to move SOURCES forward at the federal level by allowing CNPs Center to Champion Nursing In America. (2010). Access to care and Advanced Practice to order durable medical equipment and sign Nurses: A review of Southern U.S. practice laws. home health or hospice orders (Home Health Retrieved from http://www.rwjf.org/en/research- Care Improvement Act of 2013). If quality and publications/find-rwjf-research/2010/01/ access-to-care-and-advanced-practice-nurses. access are goals, doesn’t it make sense to html allow the actual practitioner to provide a signature for the equipment or services needed? American Association of Nurse Practitioners. (2014). 2014 Nurse Practitioner state practice It is not only nurses who are advocating for environment. Retrieved from http://www. a healthcare system that embraces the pro- aanp.org/images/documents/state-leg-reg/ fession’s strengths as they have evolved over stateregulatorymap.pdf time. TheA merican Association of Retired Arkansas State Board of Nursing. (2013). Annual Persons (AARP) and the Robert Wood John- Report. Retrieved from http://www.arsbn. son Foundation (2010) as well as the National arkansas.gov/forms/Documents/Annual%20 Report2013.pdf Governor’s Association (2012) have published of their education and licensure under the reports on the role that CNPs, particularly Collins, J. (2001). Good to great: Why some state’s board of nursing. This is the model those in primary care, can play in achieving companies make the leap...and others don’t. New York: Harper Collins Publishers. endorsed by the Institute of Medicine and the national and state goals of access and quality National Council of State Boards of Nursing with lower cost. This is particularly important National Governors Association. (2012). The role (American Association of Nurse Practitioners, in a rural state like Arkansas with well doc- of nurse practitioners in meeting the demand in primary care. Retrieved from http://www.nga. 2014). In the state of Arkansas, CNPs have umented health disparities, shortages, and org/cms/home/nga-center-for-best-practices/ a collaborative agreement with a physician. mal-distribution of primary care provid- center-publications/page-health-publications/ They are able to diagnose and treat patients ers. This requires thatA PRNs who are edu- col2-content/main-content-list/the-role-of- nurse-practitioners.html as well as order and interpret diagnostic tests. cated to provide primary care services actu- They can also prescribe medications under ally function in that role. It also requires that the collaborative agreement. Of the 1,308 issues, such as reimbursement parity, pri- Arkansas residents licensed as CNPs, 1,244 mary care provider status, and appropriate

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 55

hospital Roundshospital news & Information

Gala for Life Raises Close to a Million About 900 guests attended the 2014 UAMS Winthrop P. Rockefeller Cancer Institute’s Gala for Life event, which raised more than $915,000 for the UAMS Cancer Institute. A portion of the proceeds benefited research programs at the Bone and Soft Tissue Tumor Center at the Cancer Institute and Arkansas Children’s Hospital ( ACH), an affiliate of UAMS. 5-year-old Asher Ray reportedly stole the show. Diagnosed two years ago with Ewing sarcoma, Asher, along with her mom and grandmother, were special guests at the black-tie dinner at Little Rock’s Statehouse

Convention Center. Ewing sarcoma is a rare bone cancer Kimo Stine, MD, (left) and that primarily affects children and adolescents. Richard Nicholas, MD, greet 5-year-old Asher Ray and For details see page 60 her mom, Susan, upon their arrival at the Gala for Life.

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 57 Physicians’ Specialty Hospital Earns Women’s Choice Award® Physicians’ Specialty Hospital has received the Arkansas Children’s Hospital Joins SHARE 2014 Women’s Choice Award for being voted one of America’s Best Hospitals for Patient Experience Physicians and providers all by women for a third consecutive year. This distinc- over the state can now access tion is the only award that identifies the country’s immediately and securely best healthcare institutions based on robust crite- ria that consider female patient satisfaction and exchange current, updated what women say they want from a hospital includ- electronic health records ing quality physician communications, responsive- (EHRs) for thousands of Arkan- ness of nurses and support staff, cleanliness, and sas children, thanks to the con- trusted referrals from other women. Being named and recognized as a hospital of tributions of Arkansas Chil- choice among women represents an important dren’s Hospital (ACH), which consumer message in today’s healthcare market- is now pushing data through place considering that women account for 90% of SHARE, the Statewide Health all healthcare decisions for themselves and their Information Exchange. families (American Academy of Family Physicians). SHARE enables providers at Baptist Health Foundation different medical facilities across Arkansas to exchange medical Announces USTA Tournament records for patients they have in common. Using SHARE, a pedia- Baptist Health Foundation announced the addition trician can connect to a patient’s most current and comprehensive of Bolo Bash Tennis to its legendary Bolo Bash fun- draising events during a news conference held at health information, including that patient’s health data from other Pleasant Valley Country Club, where the event will facilities connected to SHARE. be held in spring 2015. From a hospital’s perspective, if a child arrives in the Emergency “Bolo Bash Tennis is a new partnership between Room for the first time after a car wreck, the ER staff is now able to Baptist Health and the United States Tennis Asso- pull up his record in SHARE, see his current medical condition and ciation (USTA),” said Troy Wells, president and CEO of Baptist Health. “Baptist Health is thrilled to con- medications, and make better-informed decisions about his care tinue this prestigious event bringing some of the on the spot. country’s top tennis players to Little Rock as well A CH is one of 26 hospitals signed on to participate in SHARE. as raising money for our heart transplant program Arkansas Health Information Technology Coordinator Ray Scott said at Baptist Health.” The USTA Men’s Pro Circuit event to be held in A CH’s participation marks a turning point for SHARE. “Every time April is a pathway to the US Open and tour-level a new practice or hospital in the state joins SHARE, the network is competition for aspiring tennis players. This tourna- that much more useful to its participants. Arkansas Children’s Hos- ment has hosted players such as the 2014 US Open pital is the one that other providers in SHARE have been clamoring Finalist Kei Nishikori who turned pro in 2007. The 10 for—being able to access electronic records and communicate more days of Bolo Bash Tennis will include play by aspiring professional tennis players, a wildcard tournament easily with ACH makes SHARE significantly more powerful and rele- for local tennis players, social events, kids’ day, and vant to all hospitals, physicians, therapists, and parents,” Scott said. the legendary Bollettieri Tennis Academy for all ages. Scott said that research shows that patients whose health records The monies raised from this tournament will ben- are available via a secure health information exchange with their efit Baptist Health’s Heart Transplant Institute, specifically the purchase of Centrimag, a device to tem- other physicians receive better care and have fewer duplicate tests porarily support the right or left side of the heart. and procedures ordered by the different physicians. Sponsorship opportunities are available to be a part of the tennis tournament and meet the pros. There are various sponsorship levels available now to support this event. For more information contact Rebecca Scaife with the Baptist Health Foun- dation at [email protected] or 501-202-1207.

58 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

UAMS Opens Adult Spina Bifida Clinic The University of Arkansas for Medical Sciences (UAMS) has opened an adult Spina Bifida Clinic, the first multidisciplinary clinic available to adult patients in Arkansas. Spina bifida is a developmental disorder caused by the incomplete closing of the embryonic neural tube before a baby is born. The UAMS clinic will help coordinate the patients’ complex care needs with different UAMS specialists and with their primary care physicians. The clinic includes physicians and staff from urology, wound care nurses, and medical social workers who will coordinate with other UAMS medical services including physical medicine and rehabilitation, plas- Lee Archer, MD Peter Banko tic and reconstructive surgery, general surgery, neurosurgery, and orthopedics. recognition for outpatient satisfaction, physician To receive the recognition, Archer had to be board Baptist Health Brings EMR satisfaction, growth, and financial stability. certified and have extensive training and educa- to Hot Spring County tional experience in MS care. His team also had Baptist Health is improving the quality, safety, and CHI St. Vincent Reports to be a comprehensive care team focused solely efficiency of patient care in Hot Spring County. Significant Growth on the disease and include social workers, speech Patient charts at Baptist Health Medical Center-Hot CHI St. Vincent health system – with hospitals in Hot pathologists, physical therapists as well as nurse Spring County (BHMC-HSC) became electronic in Springs, Little Rock, Sherwood, and Morrilton; an practitioners devoted to helping MS patients. October, utilizing Epic, the leading vendor of health- integrated medical group of more than 250 physi- care software. cians; and other associated health care entities like CHI Names Banko SVP, Baptist Health-HSC has used a partial electronic CHI St. Vincent West – generated more than $650 Group Executive Officer medical record for the last several years. The new million in net patient revenue from July 1, 2013 to June Catholic Health Initiatives has named longtime Epic system will be a comprehensive system that 30, 2014. The operating earnings for the health sys- healthcare industry executive Peter Banko as senior will virtually replace the paper record leaving only tem (before interest, depreciation, amortization, and vice president and group executive officer of the a few items on paper that will be scanned into the restructuring) for fiscal year 2014 was $45.6 million. organization’s east/southeast division as well as system after the patient’s discharge. The Epic sys- “This represents a significant turnaround from chief integration officer. tem is private, safe, and secure. FY13 when our implementation of a comprehensive Banko, currently president and chief executive Baptist Health has utilized a team of specialists to electronic medical record and business office tran- officer of CHI St. Vincent in Little Rock, will over- work with the staff in Malvern and has been meeting sition greatly impacted our financial performance,” see CHI St. Vincent; CHI Memorial in Chattanooga, weekly since April in order to make a smooth and said Peter D. Banko, President & CEO of CHI St. Vin- Tenn.; CHI St. Joseph Health in Reading, Penn.; and successful change. cent.“ Our simple strategy of focusing on the qual- Saint Clare’s Health System, Denville, N.J. ity, experience, and safety of our patient care, on Banko also will direct the transition process for NPMC Receives Top strong physician relationships, and being low cost Memorial Health System of East Texas, which will Performance Award provider in the market led to this remarkable finan- become part of Houston-based CHI St. Luke’s National Park Medical Center managers recently cial rebound.” Health over the next several months; and will attended the annual conference for Capella Health- assume responsibility for the CHI national inte- care facilities in Franklin, Tennessee, where NPMC U AMS Physician, Staff Named gration team. He began his new role Sept. 22, and was awarded the Capella Healthcare Star of Excel- ‘Partner in MS Care’ replaces M. Elizabeth “Beth” Obrien, who left CHI lence Award for being the company’s top perform- University of Arkansas for Medical Sciences last month for an executive position with Peace- ing hospital for the year of 2013. (UAMS) neurologist Lee Archer, MD, and the team Health in Washington. The star of excellence is the highest level achieve- he leads in the clinical care of multiple sclerosis Before being named the top executive at St. ment for Capella hospitals, and 2013 marks the patients recently became the first group of medical Vincent in 2007, Banko, who has more than three fourth year that NPMC has received the award, out professionals in Arkansas designated as a Partner in decades of experience in healthcare, served for four of the 5 years of eligibility. The award is based upon MS Care by the National Multiple Sclerosis Society. years as chief operating officer and vice president a composite scoring system representing patient The Partner in MS Care designation recognizes of CHRISTUS Spohn Health System, Corpus Christi, satisfaction, growth, physician satisfaction, quality Archer and his clinical care team as a high-quality Texas. He also served for three years as senior vice measurements, employee satisfaction, and finan- multiple sclerosis (MS) care organization offering president for PhyAmerica Physician Group, Dur- cial stability. comprehensive care for MS patients and having a ham, N.C., a privately held, $1.5 billion healthcare In addition to the overall Star Award, NPMC strong collaborative relationship with the national organization that included a large primary care phy- received several individual awards including organization. sician group and the nation’s largest emergency

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 59 medicine revenue cycle company. Earlier, he held multiple leadership positions at Saint Clare’s Health System in Denville, N.J.

Otter Creek Clinic Adds New APRN, Extends Hours Baptist Health Family Clinic-Otter Creek (BHFC- Otter Creek) has welcomed Advance Practice Reg- istered Nurse (APRN) Matt Sharpe as a second provider to meet the healthcare needs of southwest Little Rock, Bryant, and surrounding communities. With the addition of Sharpe, the clinic is now offering new extended office hours on Mondays, Tues- days and Thursdays from 7:30 a.m. to 7:30 p.m. David Wassell, MD Matt Sharpe, APRN

Expansion at CHI St. Vincent West CHI St. Vincent has announced the next phase of completed his residency at the University of Arkan- reportedly stole the show. Diagnosed two years ago growth and development at its outpatient, ambula- sas Medical Sciences in Little Rock. He previously with Ewing sarcoma, Asher, along with her mom and tory care campus in west Little Rock – CHI St. Vin- worked for OrthoArkansas until moving to his solo grandmother, were special guests at the black-tie cent West – with the groundbreaking of a new medi- practice in Stuttgart. dinner Sept. 26 at Little Rock’s Statehouse Con- cal office building. The 44,000 square foot facility vention Center. Ewing sarcoma is a rare bone can- will be located on the 37-acre site owned by CHI St. Saline Memorial Receives cer that primarily affects children and adolescents. Vincent adjacent to Promenade Shopping Center Governor’s Quality Award The Gala for Life was chaired by Denise and Her- in Chenal. Saline Memorial Hospital (SMH) was recently pre- shey Garner, MD, JD, of Fayetteville. Hershey Gar- The first floor of the state-of-the-art facility will sented their seventh Arkansas Governor’s Quality ner is a radiation oncologist at Highlands Oncology house a full complement of outpatient imaging ser- Award (GQA) by Governor Mike Beebe at the Annual Group, which works collaboratively with the UAMS vices, including MRI, CT and ultrasound, Michael GQA Awards Celebration on September 15th at the Cancer Institute to offer clinical trials and compre- Pohlkamp DDS Family Dentistry, and Cornerstone Marriott Hotel in Little Rock. More than 400 busi- hensive cancer treatment to Arkansans in north- Pharmacy. Additional space will be used to expand ness and civic leaders from throughout Arkansas west Arkansas. KTHV news anchor Craig O’Neill was the CHI St. Vincent Breast Center and other wom- attended the celebration. master of ceremonies. en’s services. Only 26,000 square feet remain for The awards ceremony includes four award levels lease in this phase of the campus build out. of Performance Excellence (in descending order of Building completion is scheduled for summer qualifications): the Governor’s Award, the Achieve- 2015. Current services at CHI St. Vincent West ment Award, the Commitment Award, and the Chal- include primary care, urgent care, geriatric, and lenge Award. As well as the recognition, recipients sleep services. receive an in-depth evaluation of their management systems and a written feedback report citing Baptist Health Opens New strengths and areas for improvement. Orthopedic Clinic in Stuttgart SMH received the Achievement Award which is Baptist Health and Dr. David Wassell have part- intended for organizations that have demonstrated nered to provide Stuttgart residents with high- systematic and notable processes through their quality orthopedic services in a more convenient commitment and practice of quality principles to location that’s closer to home with the open- achieve performance excellence. ing of Baptist Health Orthopedic Clinic-Stuttgart (BHOC-Stuttgart). Gala for Life Raises Close to a Million Some of the services provided at BHOC-Stuttgart About 900 guests attended the 2014 UAMS Win- include care for shoulder and elbow pain, hand and throp P. Rockefeller Cancer Institute’s Gala for Life wrist injuries, pain management, rheumatology, hip event, which raised more than $915,000 for the and knee replacement, foot and ankle issues, osteo- UAMS Cancer Institute. A portion of the proceeds porosis, and more. benefited research programs at the Bone and Soft Wassell earned a Bachelor of Science degree Tissue Tumor Center at the Cancer Institute and from the United States Air Force Academy in Colo- Arkansas Children’s Hospital (ACH), an affiliate of rado Springs. He then served as an Air Force Cap- UAMS. Gov. Mike Beebe accepts the Pat and Willard tain and F-16 fighter pilot. After completing his mili- Arkansas Gov. Mike and first lady Ginger Beebe Walker Tribute Award, which was presented to tary service, Wassell earned his medical degree and were the official honorees, but 5-year-old Asher Ray him and First lady Ginger Beebe.

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James Carver Walker, MD Taylor Moore, MD Anna Strong, MPH, MPS

Gala for Life founding sponsor is the Willard and and/or rising PSA levels. U AMS Family Medical Pat Walker Charitable Foundation. Donations made “This new technology is poised to become the Centers Earn Level III by guests that evening totaled $296,000, which standard in prostate care,” said Dr. Tim Langford, Three University of Arkansas for Medical Sciences included matching gifts by Gene Joyce, MD, and with Arkansas Urology and chief of staff at Bap- (U AMS) family medical centers recently earned family and Marge and Tom Schueck. tist Health Medical Center-Little Rock. “This gives national recognition as Level III patient-centered urologists and radiologists the ability to offer our medical homes, completing the goal of achieving Moore Joins Baptist Health patients a more refined, rational, and individualized L evel III status for all eight UAMS family medical & Arkansas Urology approach on whether to biopsy, observe or treat centers statewide. Level III patient-centered medi- Dr. Taylor Moore will soon belong to the Baptist their disease.” cal home is the highest recognition given by the Health family of specialists when he joins Drs. Edwin After a patient has undergone a prostate National Committee for Quality Assurance (NCQA). Diaz and Ron Kuhn in the North Little Rock office of MRI, physicians utilize DynaCAD for Prostate to Family medical centers at UAMS regional centers Arkansas Urology. quickly visualize and evaluate suspicious lesions. in Magnolia, Springdale, and Texarkana attained Moore, who earned his medical degree and com- The UroNav fusion biopsy system uses this criti- L evel III status in late August. UAMS family medi- pleted his residency from the University of Arkansas cal diagnosis information to provide urologists cal centers in Jonesboro, Fayetteville and Pine Bluff for Medical Sciences, is a member of the American with a targeted approach to prostate biopsy. earned the recognition in June. The UAMS family Urologic Association and American Medical Asso- medical center in Fort Smith received the status ciation. He will become the 14th physician practic- A CH Names Exec. Dir. of Child in 2013 and the center in Little Rock attained the ing with Arkansas Urology, which has eight locations Advocacy & Public Health designation in 2010. across Arkansas. Anna Strong, MPH, MPS, has joined Arkansas Chil- Nationally, about a quarter of the primary care dren’s Hospital (ACH) in the newly created position practices have adopted the patient-centered medi- Walker Seeing Patients at of executive director of Child Advocacy and Pub- cal home model. CHI St. Vincent Clinic lic Health. In the new role Strong is responsible for James Carver Walker, MD is now seeing patients at leading development and implementation of com- Baptist Health Boosts CHI St. Vincent General & Colorectal Surgery Clinic munity health initiatives, and will also oversee and Services in Greenbrier at 701 N. University, Suite 203 in Little Rock. track the hospital’s community engagement goals. Greenbrier Family Clinic (a Baptist Health affiliate) Walker earned his medical degree and completed Before joining ACH last month, Strong had a long- began seeing patients at its new state-of-the-art his general surgery internship and residency at the established connection to the hospital and the Natu- facility this fall. On the same day it opened, the new University of Arkansas for Medical Sciences. He is ral Wonders partnership, in which ACH plays a major Baptist Health Therapy Center-Greenbrier, located a member of the American College of Surgeons and role. She previously served as health care policy direc- adjacent to the family clinic, opened as well. the American Medical Association. tor at Arkansas Advocates for Children and Families, Drs. Gary Bowman and Charles Clifton, who are where she authored the 2014 and 2011 editions of long-time residents of the area, will continue to be High Tech Prostate Imaging Natural Wonders: The State of Children’s Health in the providers with a third provider being added in and Biopsy Arrives in AR Arkansas, and planned and conducted the 2012 January 2015. The doctors have known each other Baptist Health, in partnership with Arkansas Urol- Community Health Needs Assessment for ACH. She since their residencies in 1990 and have practiced ogy, is now offering a powerful new solution for served as president of the ACH Foundation’s Commit- together since 2002. analysis, planning, and targeted biopsy of the pros- tee for the Future group and as a Child Life volunteer. Greenbrier Family Clinic will offer a wide range of tate. This complete clinical solution for the prostate P rior to Strong’s service for Arkansas Advocates comprehensive family medical care including basic combines MRI with ultrasound technology offering for Children and Families, she was senior policy ana- laboratory testing, consultations with specialists, a new biopsy option for many patients with elevated lyst for the UAMS Center for Rural Health. drug screenings, routine and complex exams, and

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 61 Conway Regional Achieves (BHCMC) located at 5315 West 12th Street in Little Governor’s Quality Award Rock. Before joining the practice at BHCMC, Stew- Governor Mike Beebe presented the Governor’s art was employed at Arkansas Heart Hospital for Award for Performance Excellence to Conway the past nine years. Regional Health System during the 20th annual Awards Celebration for the Governor’s Quality Connor Joins Baptist Health Award. & Neurosurgery Arkansas In all, 28 organizations from throughout the state Neurosurgeon Dr. David E. Connor, Jr. is now part of were presented quality awards during the celebra- the Baptist Health family of specialists since joining tion at the Marriott Hotel in downtown Little Rock. Neurosurgery Arkansas this summer. More than 400 business and civic leaders from Connor earned his medical degree from the Lake throughout Arkansas also attended the celebration. Erie College of Osteopathic Medicine in Pennsylva- Conway Regional was the only healthcare orga- nia and completed his internship and residency at Heather Grigsby, APRN nization achieving the Governor’s Award, which is Louisiana State University-Health Sciences Cen- the highest award bestowed by the quality awards ter in Shreveport. He is a member of the American program. Conway Regional is also the first organi- Association of Neurological Surgeons. zation from its five-county market area (Faulkner, As one of the three surgeons at Neurosurgery Perry, Van Buren, Cleburne and Conway counties) Arkansas, Connor will provide his expertise to to achieve this prestigious award. Conway Regional patients along with Drs. Tim Burson and David Red- was awarded the Achievement Award, the second ing. Some of the services Neurosurgery Arkansas highest level, last year in its first year to apply. offers include surgery for carpal tunnel syndrome, trigeminal neuralgia, brain tumors, cervical and lum- Malvern Family Clinic bar spine disorders, craniosynostosis, Chiari malfor- Welcomes New APRN mation, and carotid endarterectomy. Baptist Health Family Clinic-Malvern (BHFC-Mal- vern) recently welcomed Advance Practice Regis- CHI St. Vincent and Cornerstone tered Nurse (APRN) Heather Grigsby as a third pro- Plan LTACH Expansion vider to meet the healthcare needs of Malvern and CHI St. Vincent and Cornerstone Hospital of North Jeffrey Stewart, MD the surrounding communities. Little Rock (CHG) are finalizing agreement terms Grigsby, who is a native of Malvern, received her to expand the presence of CHG, a long term acute Bachelor of Science degree in Nursing from the Uni- care hospital (LTACH), to CHI St. Vincent Infirmary versity of Central Arkansas and has been a nurse at in Little Rock and CHI St. Vincent North in Sher- Baptist Health Medical Center-Hot Spring County wood. CHG, which currently has 40 licensed beds at for the past nine years. She recently completed her North Metro Medical Center in Jacksonville, intends Master of Science in Nursing at the University of to lease space to operate additional LTACH beds in Arkansas for Medical Sciences. the greater Little Rock area. LTACHs offer an important transition for patients Stewart Joins Baptist between short-term acute care hospitals and post- Health Heart Institute acute care providers, such as rehabilitation, skilled Dr. Jeffrey Stewart will soon be a part of the Baptist nursing, and home health. LTACHs furnish care to H ealth Heart Institute. The heart institute offers a patients with chronic critical illness and other com- full range of cardiovascular services including edu- plex medical conditions that need hospital-level, cation and prevention, diagnostics, emergency care, acute care for extended periods of time. David E. Connor, Jr., MD transplantation, and cardiac rehabilitation pro- CHG is staffed with critical care nurses and spe- grams by partnering with some of the most experi- cialized clinical staff such as respiratory therapists, enced heart physicians. certified wound care nurses, and physical and occu- school physicals. Stewart, who earned his medical degree from Lou- pational therapists who work alongside internists The new satellite therapy center, located at 49 isiana State University School of Medicine in New and other physician specialists like pulmonologists South Broadway, Suite 2, in Greenbrier, will be Orleans, completed his residency at Madigan Army and cardiologists. open Monday through Friday from 8 a.m. to 5 p.m. Medical Center in 1997 and a Cardiology Fellowship An agreement between CHI St. Vincent and CHG offering the latest services for physical and occu- at Walter Reed Army Medical Center in 2000. will result in approximately seventy-five additional pational therapy. The staff will include Karmen Specializing in internal medicine, cardiovascu- jobs for highly qualified critical care and medical Lawson, physical therapist; Mandy Petty, business lar disease, and interventional cardiology, Stewart surgical registered nurses, as well as licensed voca- manager; and Margaret Standridge, occupational is joining Drs. Anthony Fletcher and Joe Hargrove tional nurses to care for the anticipated increase therapist and clinic manager. with the Baptist Health Cardiology & Medicine Clinic in patients. Additional medical staff, including

62 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

pulmonologists and hospitalists, will be necessary to provide physician services. In addition, an agreement between CHI St. Vin- cent and CHG will provide more than a fifty percent increase in coverage for those likely to need long term acute care. While CHG serves the complex medical needs of adults of all ages, those aged 65 and older represent the largest share of patients. In the next 10 years, the population of adults aged 65 and older in Arkansas is projected to increase by nearly thirty percent. With a final agreement in place, CHG operating in CHI St. Vincent North would begin to accept patients in late 2014. CHG operating in CHI St. Vincent Infirmary would begin serving patients in early 2015.

Delta Dental Awards Grant to 12th Street Wellness Center A $15,000 grant presented by the Delta Dental of Arkansas Foundation to the student-led 12th Street Health and Wellness Center of the Univer- ROC Kid Jakiah Collins tries out a hands-on display about tornados at the Museum of Discovery sity of Arkansas for Medical Sciences (UAMS) will during the ROC Star Kids event. Jakiah was diagnosed with kidney cancer at age 3 and is now fund equipment for expanding oral health screen- cancer free. ROC Doctors UAMS Radiation Oncology Center (ROC) physicians (l-r) Jose Pengaricano, Vaneerat Ratanatharathorn, and Matthew Hardee, attended the event celebrating ings and services available to residents of the Little childhood cancer survivors who were treated at ROC. Rock neighborhood. Purchased with the grant funding were equipment and materials to allow dental hygiene and dental The third annual ROC Star Kids event was held Baptist Health Opens students to provide oral screenings and basic den- at the Museum of Discovery in Little Rock’s River New Sleep Center tal care under supervision of licensed dentists. In Market District. Families were invited to enjoy the Baptist Health Medical Center-Hot Spring County addition to cleanings, the services can now include museum’s exhibits, a special science show, and (BHMC-HSC) recently held a ribbon cutting for simple fillings and extractions. lunch. The event was hosted by the UAMS Cancer the newly updated Sleep Center. The BHMC-HSC The interprofessional 12th Street Center opened Institute Auxiliary and the UAMS ROC, which is the Foundation generously provided $100,000 toward in 2013. There, students from all of the UAMS col- only facility in Arkansas to offer specialized radia- equipment and renovations making the Sleep Cen- leges provide health and wellness services, includ- tion therapy for children. ter possible. The BHMC-HSC Foundation was rec- ing disease and medication management, den- E ach ROC Star Kid in attendance received a ognized with a plaque that will hang in the Sleep tal screenings, health screenings, education, and T-shirt, glow stick bracelet, and star-shaped bead Center. immunizations for the community. for their Beads of Courage necklace. Beads of Cour- Baptist Health Sleep Center at BHMC-HSC pro- The equipment purchased with the grant money age is a program through which children with seri- vides testing that can lead to diagnosis and treat- includes a battery-operated, handheld intraoral ous illnesses receive beads to represent milestones ment for patients who are unable to sleep or are X-ray unit that produces high-quality radiographic in their treatment. chronically sleepy. images, an autoclave for sterilization of instruments TO he R C Star Kids program began with the and handpieces, and a variety of dental and dental encouragement and support of Arkansas’ first lady Robinson to Head Children’s hygiene instruments. Ginger Beebe, who attended this year’s event. Bee- Specialty Services be’s granddaughter, Alexandria, was diagnosed at 11 Catherine Robinson, MHA, FACHE, has been pro- ROC Star Kids Enjoy weeks old with a tumor encircling her spinal column moted to the role of executive director of Children’s Science, Food and Fun and was treated successfully at ACH. Specialty Services for Arkansas Children’s Hospital A Saturday of fun and play may be commonplace Volunteers at the event included the Angels of (ACH). She began her responsibilities in the new for many kids. But for those who have been diag- Hope, a group of high school juniors sponsored by position in September. nosed with cancer, even the simple moments take the 20th Century Club whose mission is to teach Reporting to ACH Senior Vice President and Chief on special meaning. That’s why, for the past three cancer awareness, encourage volunteerism, and Operating Officer David Berry, Robinson is respon- years, the University of Arkansas for Medical Sci- inspire leadership among teenage girls. The 20th sible for providing administrative leadership and ences (UAMS) has hosted a day of fun and cele- Century Club’s Lodge provides free housing for can- coordination to programs that function in and bration for pediatric cancer patients treated at its cer patients receiving treatment at UAMS and other around the ACH campus but are not fully integrated Radiation Oncology Center (ROC). facilities throughout Little Rock. into the leadership structure. She will be working

Healthcare Journal of LITTLE ROCK I NOV / DEC 2014 63 Catherine Robinson, MHA, FACHE

UAMS wins first place in pink glove competition UAMS Medical Center CEO Roxane Townsend listens with members of the Toad Suck Queens as Winthrop P. Rockefeller Cancer Institute Executive Director Peter Emanuel thanks participants in the winning UAMS entry in the Medline Pink Glove Dance video competition.

with the leaders of UAMS programs including Child Health Sciences College of Osteopathic Medicine Psychiatry, Child Maltreatment, Family Treatment in Tulsa, recently completed his Fellowship in Car- Program, and the Child Advocacy Center, all of diovascular Disease at the University of Arizona which will reside in the new ACH Children’s House. Medical Center in Tucson. Joe Hackler, MD Additional programs and services including Psy- One of 17 physicians at Arkansas Cardiology, chology and the Dennis Developmental Center will Hackler specializes in clinical cardiology, non-inva- be included in her areas of responsibility. sive imaging, diagnostic catheterization, and physi- Robinson joined ACH in 2009 as an administrative ologic assessment of heart disease. place in the non-health care organization category, fellow, completing her fellowship in 2010. She was which included universities. named policy office director in the same year. This U AMS Wins First Place in The 90-second winning video featured a comic past winter, Robinson was promoted to Administra- Pink Glove Competition book-style theme with faculty, staff, and patients tive Services director, where she was responsible Thanks to the support of nearly 21,000 online acting as superheroes in the fight against breast for management and oversight of the Playaway Gift votes, the University of Arkansas for Medical Sci- cancer. Online voting took place during two weeks Shop and Administrative Support Services. ences (UAMS) was named first-place winner in the in September, with almost 500,000 total votes cast Robinson holds a master of health administration national Medline Pink Glove Dance video competition. for all entries. and bachelor’s in biology from Texas A&M Univer- The $10,000 prize was presented to UAMS Medical UAMS also raised more than $2,000 for the sity. She completed the administrative fellowship at Center CEO Roxane Townsend, MD, and 20th Century Arkansas Chapter of Susan G. Komen for the Cure A CH in 2010 and served as the Policy Office director Club president Sandy Byrd by Medline representative as part of its participation in the contest. before accepting her most recent role. Dave Woody at a news conference held at the UAMS Sponsored by Medline — the manufacturer of medi- Winthrop P. Rockefeller Cancer Institute. cal supplies and services including pink exam gloves Baptist Health Welcomes As part of the contest, the prize is donated to a and creator of the YouTube sensation Pink Glove Hackler to Heart Institute cancer charity chosen by UAMS—the 20th Century Dance — the national competition has had nearly Dr. Joe Hackler has joined the Baptist Health Heart Club’s Lodge. Located near UAMS, the lodge pro- 200,000 people dance in videos worldwide. Medline Institute. The heart institute offers a full range of car- vides free housing to cancer patients who have to donates a portion of each sale of its pink exam gloves diovascular services including education and preven- leave their hometown for treatment. to the National Breast Cancer Foundation to help save tion, diagnostics, emergency care, transplantation, UAMS partnered with Metropolitan Emergency lives through early detection and to provide mam- and cardiac rehabilitation programs by partnering Medical Services (MEMS) to produce the breast mograms and support services for those in need. n with some of the most experienced heart physicians. cancer awareness video that featured more than Hackler, who earned his undergraduate degree at 200 employees and patients wearing pink surgical the University of Oklahoma and his medical degree gloves and dancing to Pharrell Williams’ “Happy.” from the Oklahoma State University Center for With 20,760 online votes, the video received first

64 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK advertiser index

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66 NOV / DEC 2014 I Healthcare Journal of LITTLE ROCK