Dan Riley CFO, UAMS Medical Center

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One on One Dan Riley CFO, UAMS Medical Center

T he Cost of the Charge

Shifting Course/Moving Target

Drug and Device Makers Find Receptive Audience

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+/5 September / October 2016

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Advertising [email protected] F eedback Visit HealthcareJournalLR.com [email protected] We would love to hear from you. and sign up for weekly eNews. Contents September / October 2016 I Vol. 3, No. 6 10

20 Election 2016: Where do they stand on + /5 Healthcare? 30

features

One on One with 32 Daniel J. Riley...... 10 CFO, UAMS Medical Center

Shifting Course/ Moving Target...... 20 Hospitals change paradigms even as ACA faces uncertainty

Drugs and Device Makers...... 26 Find receptive audience at for-profit, southern hospitals

Election 2016...... 30 Where do they stand on healthcare?

The Cost of the Charge...... 32 Health consequences of energy choices

Departments

Editor’s Desk...... 8 Healthcare Briefs...... 39 Hospital Rounds...... 57 26 Books...... 65

Correspondents

Director’s Desk...... 48 Policy...... 50 Quality...... 52 Medicaid...... 54 Editor’s Desk

Choose your government — for real

It’s political season. One thing’s similar interests and desires. If you are discontent with your gov- for certain. We all don’t want the same ernment, change is easy. With this plan, excuses for discontent- things. What’s interesting is why are we ment dissipate. Or perhaps you choose to live in a land of people all so committed to saying we all are one who like to be discontent. Many actually do. people? We aren’t all the same. We don’t There will be a wide spectrum of choices. I’m sure people want to be governed the same. There from across the globe would be glad to participate. Imagine was a time when Louisiana was Loui- choosing to live in New Orleans, South Carolina, or Sweden siana and California was California. because their unique style of government suited you. This is One world government doesn’t work. the future. Administering over 300 million people in the United States Since we’re the Healthcare Journal, let’s use healthcare as an in the same manner doesn’t work. Everyone is feeling the dis- example. Some lands will be highly regulated and pharmaco- contentment. But our discontentment doesn’t have to lead to logical based. Some lands will have no insurance, or financial fruitless anger. Let’s be smart. Let’s design the future. regulations, and your visit with a provider will be an economic Here’s what the future will look like. There are lines in the agreement simply between patient and provider. Some lands sand with entirely different governments. But, here’s the big will attempt natural, holistic health and only use medicine as a difference – transferability. Everyone should be able to choose last resort. Money does not exist—many choices, many systems. their type of government. Then, be able to easily make it happen. S o while many are wrangling between the choices of Don- Imagine, in one land you can be a risk taker. The rules are lim- ald Trump and Hillary Clinton, let’s consider other options. ited. Social, economic, and regulatory controls are minimal to Don’t we say the definition of insanity is doing the same thing none. You can express your heart’s desire and take chances, live and expecting different results? Let’s step back, reconsider, be free, risk death; it’s your choice. In a nearby land, your choices smart, and fix it. We all want different things. That’s not only are limited. Administration is tight. But, you will be very safe. okay, it’s good. A long life is likely. Safety is the focus. And of course, there will be blends – a government for your taste. Some will offer 100% income taxation, some 50%, some 0; all with a variety of choices on social issues. Religious can be with religious, others can be with others. When lands innovate to compete for people, people win. S mith Hartley In order to make this work, we must allow the ability to trans- Chief Editor fer easily into your preferred government. This is ideal. When [email protected] someone in a risk-taking land decides they want more safety with tight rules, they can transfer. Transportation is easy and accessible. We should avoid thinking most of us are bad people; we just all have different ideas of how we want to be governed. Let’s make it easily available. We are not talking about two different lands. We are talking about 100 different lands. Lands will compete for each other by offering varieties of hope, beauty, or opportunity. Lands will compete for people by offering a version of an ideal government. Can you imagine choosing from a brochure of 100 entirely different forms of government? Freedom to transfer is the key. You and your friends with similar interests will be united with those of

8 SEPT / OCT 2016 I Healthcare Journal of Little rock

One on One with Daniel J. Riley CFO, UAMS Medical Center

photos of mr. Riley by Johnpaul Jones/UAMS Additional renderings/images courtesy of UAMS dialogue

Dan Riley has been Chief Financial Officer at Systems Inc. where he managed a network of UAMS Medical Center since joining the University more than 120 physicians at 35 sites throughout of Arkansas for Medical Sciences (UAMS) in 2000. the greater Houston area. After that, he worked He has more than 30 years of experience in health- as chief financial officer for North American Med- care financial operations and management. ical Management Inc. in Houston before joining Riley graduated in 1981 from the University of Columbia/HCA Hospital as chief financial officer New Orleans with a bachelor’s degree in account- of Tulane University Hospital & Clinic. ing and became a Certified Public Accountant. Riley has been active in the Arkansas and Amer- He was a financial audit and consulting profes- ican Hospital Association, the University Health sional with Deloitte & Touche for 10 years before System Consortium, American Association of moving into healthcare as director of contracting Medical Colleges, the Healthcare Financial Man- and internal audit with Hermann Hospital in agers Association, and America’s Essential Hos- Houston. pitals. He is the past president of the National He then was chief financial officer for Peak Kidney Foundation of Southeast Texas.

12 SEPT / OCT 2016 I Healthcare Journal of little rock Chief Editor Smith W. Hartley UAMS has a all the campuses, not just UAMS Medical rather than volume-based. And they seem separate CFO for the University and for Center. So there’s an allocation methodol- to be well on that way although I would say the Medical Center, can you talk a little ogy for that. that includes a lot of the demonstration bit about that delineation as well as the projects, the ACO projects you might have crossover? E ditor Can you talk about the transition in heard about. I’d say here in Arkansas and at Dan Riley Certainly we work very closely healthcare from volume to value and what UAMS that percentage isn’t nearly that high. together. As an academic medical cen- that means for hospitals and for UAMS in But it is coming. ter we have a lot of matrices and intrinsic particular? The next part of that stated goal is to have accountabilities. My direct line of report Riley I think that is probably the biggest 50% of those payments moved into some is to the CEO of the integrated clinical top of mind subject, not only for us finan- value-based pay-for-performance type of enterprise here, Dr. Roxane Townsend. Dr. cial officers, but for all healthcare executives mechanism by the end of 2018. So it’s cer- Townsend, in that capacity, reports directly and administrators as we look to the future. tainly here, it’s on the horizon, it has affected to the Chancellor. So basically we all work CMS, as part of the origination, and really it almost every internal meeting we have. Our for the Chancellor. But also I have a line of preceded the Affordable Care Act, but that orientation is around all the things that accountability in reporting to the campus just kind of stuck the gas pedal on all this, these pay-for-performance mechanisms CFO Bill Bowes. Bill has responsibility for all has expressed its goal to move the major- are intended to do in that it is essentially the aspects of the campus, all the academic ity of its payments away from where it has driven by the Triple Aim of the Institute for medical centers or the academic pieces; the historically been based. It has been volume- Healthcare Improvement. That is essentially colleges, pharmacy, nursing, public health, based—you do something you pay for it—to to improve the patient experience, which all fall underneath that umbrella. Of course a value-based proposition, which is more you might translate into increasing patient the UAMS medical center is a fairly large, based on things that are maybe de-linked satisfaction; they want to improve the health in terms of the clinical division, piece of the from just activities. So I think their goal is, of populations, so rather than have epi- UAMS campus as a whole. And that’s my by the end of 2016, to have 30% of their total sodic care, where the patient has something responsibility as CFO over that domain. payments in some payment models that are wrong and you remediate it, let’s get into based more on value, pay-for-performance improving health and so moving more into E ditor In terms of cost allocation, is there a lot of crossover? Riley I think we have a pretty good account- ing of our costs. Certainly because we have to do cost reporting for the governmental pay- “Our orientation is around ers, Medicare and Medicaid, we have to keep our books aligned. Medicare and Medicaid all the things that these pay- don’t want to pay for educating nursing stu- for-performance mechanisms dents or things like that so we have to keep our costs fairly aligned and ledgered. So even are intended to do in that it is though we are all one tax ID and one entity, we do have a sort of subdivided set of ledgers essentially driven by the that our books are divided into. We have our direct costs aligned that way. Triple Aim of the Institute for The rub comes in those areas where we know we have overhead areas that span the Healthcare Improvement. ” entirety of the umbrella of the UAMS campus. We have a pretty good methodology for allocating what I would call those overhead areas and the medical center would get its share of that overhead—things like the Chancellor’s office and human resources and so forth all have to eventually support

Healthcare Journal of little rock I SEPT / OCT 2016 13 dialogue

managing populations and managing pre- The other piece supporting that is we’ve patient experience. She has a lot of advisory ventive care. And the third aim is obviously created a chief medical quality officer posi- committees in each of these initiatives, most to try to bend the cost curve to achieve all tion. If you look three years back we didn’t of them are populated significantly by actual that at a lower cost per capita basis. have that. We are basically keying this up to patients that have volunteered to spend As that triple aim was articulated and be all physician-driven because the physi- their time and effort and advice and feed- these objectives were expressed by CMS, cians and the caregivers are the key to the back on those things that we’re doing. So I organizations like UAMS have quickly started success of all this. Dr. Chris Cargile heads think that’s been a big piece of what we’re mobilizing and we’ve done just that. We’ve that office up. We are investing heavily in doing with regard to this value-based world done many different things, under the lead- quality initiatives that again, three years that’s on the horizon. ership of both the chancellor and our CEO of ago weren’t even on the map. We have Now, the question is what does the the integrated clinical enterprise, as well as realigned and reorganized our medical future hold? We don’t know and that’s part the dean of the medical school here. We are board to be supportive of the new service of the challenge for us. I have been in the moving our structure towards an administra- line structure and there are several com- healthcare industry a while now so I am tive structure that will be directed more to be mittees that are dedicated towards improv- dating myself, but when Medicare changed able to react and key some of these things. ing the quality, improving the health. So the payment mechanism from a fee-for- What I mean by that is, we’ve changed our organizing ourselves around all these service mechanism, and I am talking about clinical enterprise to really integrate the phy- objectives has been sort of the big change hospitals here, to a prospective payment sician component into the hospital delivery element that I am talking about. system, that was done in 1983. That’s when of care. We’ve integrated those around clini- The other significant area besides the we went from getting paid retroactively cal service lines and those service lines were quality office is we created a patient- and based on our cost to a prospective pay- developed based on the types of patients we family-centered care department and the ment based on the type of patient you are have and the care we deliver here at UAMS. focus there is on the patient experience seeing. So the concept of diagnostic related The concept is to do that all around a patient- aspect of that Triple Aim. We have always groups, DRGs came in vogue. So you are centered perspective. The idea is what’s best done a great job here at UAMS of trying to going to get one payment for that type of for the patient? Usually if we can figure that accommodate patients needs and so forth, patient regardless of whether you kept that out and make changes where necessary to but what we’ve found is, in a disjointed fash- patient in the hospital five days or three achieve that objective, the cost component is ion, doing it department by department it days and so forth. There was a lot of angst, improved and certainly the patient satisfac- wasn’t a very coordinated and well-orches- a lot of fear, a lot of hysteria about the issue tion component is improved. And generally trated activity. By creating the office, and back then. But in some ways it was easier if we are doing what’s right for the patient, this is an associate vice chancellor position because pretty much you knew what the the health goals are improved. So we rear- that is now led by Julie Moretz, we are really ground rules were. Now what we have is ranged that and we started July 1st of this investing in the activities directed toward a stated goal, but we don’t actually know past year. We just finished our first fiscal year improving the patient experience at UAMS. how those mechanisms are really going operating under clinical service lines here at She has a team that aligns around many dif- to be played out and what is going to be the medical center. ferent fronts, but it’s all topics related to the that pay-for-performance mechanism

“The concept is to do that all around a patient-centered perspective. The idea is what’s best for the patient? Usually if we can figure that out and make changes where necessary to achieve that objective, the cost component is improved and certainly the patient satisfaction component is improved. And generally if we are doing what’s right for the patient, the health goals are improved.”

14 SEPT / OCT 2016 I Healthcare Journal of little rock that CMS plays by. The reason is, they Riley I am going to speak from the UAMS which UAMS is. So over the years we have themselves are trying to figure out what perspective because Medicaid is probably received some reimbursements that are just is the best mechanism so they are doing a different for us than a lot of others, prob- not available to other institutions, but give lot of demonstration projects, a lot of tri- ably magnitude wise and everything else. recognition to our cost structure, our mis- als, innovation grants, and things like that. Medicaid represents just shy of a fifth of our sion as teachers of healthcare providers, So while the goal is to move 50% of pay- patient population, so about 20 percent of and so forth. So we’ve gotten some reim- ments into pay-for-performance by 2018 our business is Medicaid. Obviously Medic- bursements we didn’t use to have and others the actual vehicle in which they take it aid is a very important and impactful payer unfortunately can’t access, but for us it has there is still being decided. So some of the to us as some of the other payers are. I will come at a cost. We’ve met by the match nec- angst is trying to figure out where is all this say that we, at UAMS, have always had a essary to pull those dollars down in most of going to land? We don’t know that answer very good working relationship with Med- those instances and while that was the best any better or worse than any of our peers icaid and, unlike some of the other payers, sort of thing to do at the time it has been an across the country. So what we do is, we are who are strictly payers, we view Medicaid area where if we could maybe get the state investing in doing the things we know we as a sister agency to UAMS because we are to help us a little bit with the match—I want should be doing to try and move quality, both in the business of trying to improve the to be careful here because this has been improve patient satisfaction, and improve healthcare of Arkansans. We have worked debated very much by our chancellor with the patient experience, and hopefully those with them quite well over the years on the governor’s office, and they have helped activities will help position us for whatever things that are programmatic in terms of the us over the years, as much as they can, but mechanism we ultimately land in. needs of the Medicaid patient population, the reality is there are not many dollars at but also we have worked with them to try the state level either. E ditor So what is the impact of Medicaid and structure reimbursements that the fed- As far as adequacy of payment could we to your hospital in terms of adequacy and eral government had designed that are par- use more? You are not going to have any timeliness of payment? ticular to state-operated teaching hospitals, hospital CFO say no, we wouldn’t like to

Healthcare Journal of little rock I SEPT / OCT 2016 15 dialogue

have a better rate. But overall as a payer they relax that. So I think they are working E ditor Can you describe the impact of bad and a partner I cannot complain about with us and working with payers in the state. debt to hospitals? that right now. We do have a little bit of an Unfortunately we, like many other provid- Riley That’s one of those mixed bag answers. inventory of claims that are unpaid and it’s ers in our state, are just kind of wearing that First of all bad debt is obviously always associated with issues around their eligibil- inventory right now. impactful to hospitals. Whereas before, in ity application processing vendor and their the good old days, bad debt might have system with which they have had problems E ditor So is Medicare much different for been more easily absorbed by what payer throughout this past year. I think they con- you than Medicaid? rates you got, and may not have been quite tinue to have problems and we wear some R iley One thing about Medicare is they have as impactful on your overall bottom line of that—we do have some claims that we a lot of billing rules and so forth, but if you because there’s ability to costshift that bad would like to have liquidated and paid, but follow their billing rules and you basically debt ahold to what you were getting paid we are working with them and I think they comply with their stated processes and through rates by your payers. That ability have been very transparent about what they you can get a good clean claim out, they to costshift is diminishing as we speak. Now are doing ultimately to remedy that and so will pay you pretty quickly. So we get paid bad debt is becoming an item where you that’s just something we will work with fairly quickly by Medicare. The issue is, are have to try to manage it to the best you can them to try to see through. They have actu- the payments adequate? We think the Medi- achieve and eke out the margins in order to ally tried to work on getting some forbear- care rates need to go up, but you won’t hear keep reinvesting yourselves and stay in the ance from CMS to relax some of the timely another hospital CFO say any different. As healthcare game. filing issues because some of these claims far as a payer, once you’ve got a claim keyed Having said that, bad debt overall for are coming up on Medicaid’s timely filing. up and ready to go, they do pay quickly and UAMS has improved dramatically and that’s If they don’t quickly get that fixed and they we have generally been pretty satisfied with quite frankly primarily due to the Afford- realize they are not going to get that fixed, their performance. able Care Act and expansion of Medicaid.

16 SEPT / OCT 2016 I Healthcare Journal of little rock E ditor How are you managing the increasing costs of staff, supplies, etc.? Riley That’s the game we continually play. As pharmaceuticals go up, as the supplies, the implantables go up how do we try to keep that spend curve at least consistent with what our revenues are showing? And that’s a challenge because right now, the folks who sit at the top of the food chain, and the way I view it in healthcare, that’s big pharma and the medical device manufacturers. You might have seen in the news about the Medicare drug costs that have ballooned way above expectations and mostly all driven by these very high cost drugs. And they are primarily centered around cancer, hepatitis, things like that. And reimburse- one thing ment mechanisms are just not geared to reflect those kinds of cost increases con- for sure is temporaneously. Usually there is a delay institutions and there is also a question whether you like ours will ultimately get total reimbursement, plus be around they bake those kinds of costs into their fee schedules. So we have a lot of organization around our supply chain, not only in pharmacy, in terms of the pharmacy and thera- peutics committee, but also medical device Certainly you can easily see why that would insurance plans that are outlined on the and other medical supplies. We have value be. Whereas before there was the irony of health insurance exchange as being colored analysis teams that are directed towards dif- hospitals who would seek to try and get paid silver, blue, gold, etc. Usually that is dictated ferent areas whether it be surgical implants from those folks who could least afford to by not only what you cover, but the amount or latex gloves or sutures, and we continu- pay us. That was usually called self pay. But of out of pocket expenses the patient or ally make sure that we are participating in when they couldn’t pay us or didn’t pay us enrollee is expected to pay on their health- group purchasing organization. We work that would turn into a bad debt. So obvi- care. For some of those plans the load the with Vizient, a success organization. They do ously with the expansion of Medicaid and patient is expected to pick up is pretty sig- a lot of work with us in the supply chain and people getting insurance, our self pay per- nificant and we’ve seen sort of an increase in we are constantly looking for ways to save centage has improved dramatically over the that these last couple of years. As the reality five cents on a length of rope and a piece of expansion years. So our bad debt has basi- of healthcare costs come to roost and this pipe around here. cally been cut in half. all starts settling out, large employer plans It’s a continual process because just as Now that’s the good news. The not so are starting to recalibrate their plans and you get a win here then a new item comes good news is as you view the entire insured increasing that load. So that piece, even on the market and kind of takes those sav- population of folks getting healthcare, and though the population as a whole is mov- ings and now you are investing in the bigger I am kind of harking that back to not only ing to more and more getting insured, we and better mousetrap that everyone wants. insurers, but a lot of large employer health do have our eye on and have some concerns Sometimes those bigger and better mouse- plans and even smaller employer health about ultimately bad debt that may come to traps are the exact right thing for patient plans, the idea of trying to push more and us in the form of these higher out of pocket care, for quality, for efficacy, and so that’s more responsibility into the enrollee’s expectations that people either can’t afford to what our value analysis teams are directed pocket in terms of out of pocket participa- pay or choose not to pay. So we are certainly towards doing and making sure the technol- tion in healthcare. You have heard of the mindful of that and are concerned about it. ogy makes sense and making sure we can

Healthcare Journal of little rock I SEPT / OCT 2016 17 dialogue

get into it at the best price we can. Then we pocket responsibilities are, and be sure they only about a third of their sticker prices. try to manage it over time. understand that. We are working primarily So if you look at gross charges last year on our estimation processes to make sure we collected 29.29 percent of the sticker E ditor What is the methodology for pricing we are giving patients as good information prices. There is no other industry in the and price transparency? as possible. country, in the industrialized world, that Riley Where the pricing comes in to play The second part is those pieces that gross prices for their services are to be col- is with this out of pocket piece as much as insurance doesn’t cover and all of a sud- lected at a rate that is basically less than a anything. And that comes in two different den the patient becomes responsible for, third of that sticker price. So in that regard sorts of perspectives. The first perspective that’s where they become much more inter- sticker prices have lost a lot of meaning. is the ten percent copay, or the deductible ested in our prices per se. We try to educate And that 29% compares to just 15 years ago based on the insurance plan design—most of them. An example of that would be some- in 2001, when that number was like 44.4%. those are usually calculated based on what one who wants a dermatologic procedure Even back then it was still less than half. the allowable rates are that the insurer will that’s really not necessary; it’s purely cos- You don’t have to go but a few years prior pay. So in that regard our pricing doesn’t metic. We have some plastic procedures to 2001 to the point where as an indus- really impact that much; it’s just a matter that are not usually covered by insurance. try we were actually collecting more than of the benefit plan design and the amount So pricing becomes much more important 50%, but that’s the trend that we’ve seen of out of pocket participation the patient when it comes to those kinds of things. We in healthcare. Prices have been continu- is expected to pay. In that regard we try to try to give patients as good estimates as ally increased in order to chase that ever make sure that we verify a patient’s insur- we can and explain what those prices are diminishing book of business that is price ance, communicate with them what they based on, but our problem as an indus- sensitive. It has really become a problem are expected to pay and what their out of try as a whole, hospitals’ real revenue is for us as an industry because there is a lot

18 SEPT / OCT 2016 I Healthcare Journal of little rock “So the first part of that question is I feel good about the future. It has to work. But making it work in an environment of uncertainty as to what the future holds in terms of these revenue streams is a challenge. We need to make sure how to figure out how we reinvest in our people and our nurses and our physicians so that these folks are engaged and feel good about being part of the healthcare delivery system.”

of focus on what gets “billed” but that’s not the rates are and so we have some reserves the government can devise. One thing for the reimbursement. We are generally lower as an institution, but they are meager when sure is institutions like ours will be around. than most of our peers across the coun- you look at what you really want to have The issue will be how do we stay abreast try, but that still doesn’t help explain when as an academic medical institution and I of all the changes that are being made and someone comes in and says, “You charged am speaking from a campus perspective. the pace of those changes. Like I said, the me this for an MRI on my bill, but my insur- We certainly have some concerns because gas pedal has been stepped on here these ance company paid you this.” And the “this” we have some infrastructure that needs last few years and I think it is going to con- is about a third of what the charge is. That’s to be attended to in terms of some of the tinue to be stepped on. How can we adapt an unfortunate reality of what we deal with non-hospital related physical assets of and change so that we’re in the best posi- here. So education is a constant battle; try- the campus. While I would probably defer tion to work with our partners in this state ing to make people understand the unex- to Bill on those discussions, I am part of to provide those services in a manner that plainable is difficult. those discussions and I can say that we are we can continue to stay in business, reinvest an organization that only can service any in ourselves, and reinvest in the resources E ditor What are some hospital strategies debt, whether its hospital related or cam- that make this place work? That’s our peo- for funding capital improvements? pus related or a mixture of both, from the ple. Making that math work is what keeps revenues we enjoy and right now those rev- me up at night. Riley Other than hope and a prayer, which enues are significantly skewed and driven So the first part of that question is I feel is not a strategy as our Chancellor likes to by the clinical enterprise. good about the future. It has to work. But remind us…the thing about funding capital making it work in an environment of uncer- improvements, other than our last major, E ditor Is there anything that you are par- tainty as to what the future holds in terms major capital improvement (when we did ticularly optimistic about? of these revenue streams is a challenge. We the new replacement bed tower here in Riley I am optimistic in this regard. When need to make sure how to figure out how 2009) we fund our capital reinvestment you look at healthcare as an industry and we reinvest in our people and our nurses essentially internally. The issue for health- a percentage of the GNP it’s a sizeable and and our physicians so that these folks are care—right now rates are as low as they necessary part of the U.S. economy and it’s engaged and feel good about being part of have ever been and access to capital is still a sizeable and necessary part of what we the healthcare delivery system. My biggest there if you were to do a major project—so need as a society. In that regard, the aca- thing that keeps me up at night is how to it’s not so much the current environment demic medical institutions are a big part of reconcile all the factors in the future not or the cost of capital, it’s looking to the that delivery system—someone has to teach knowing what’s coming. Right now some future and the ability to service the debt the future caregivers of the future genera- of the defining drivers of those things have you take on. We don’t want to take on debt tions getting care and getting that care paid yet to be decided upon. n that we can’t service. No matter how good for in whatever mechanisms that payers and

Healthcare Journal of little rock I SEPT / OCT 2016 19 healthcare delivery

Shifting Course/ Moving Target Hospitals change paradigms even as ACA faces uncertainty

By John Mitchell

Recently, President Obama published a piece about the future of the 2010 Patient Protection and Affordable Care Act (ACA) in the prestigious Journal of the American Medical Association (JAMA).1 According to industry sources 2, it marks the first time that a sitting president has had a scholarly article published in JAMA. Shifting Course/ Controversial is not a big enough word to He explained that strategic action trans- describe the ACA. Its most politically con- lates to two goals. It includes both figur- tentious element is the requirement that all ing out how to keep their patients healthy Americans must obtain health insurance or and out of the hospital, as well as entering pay a tax penalty that escalates every year. into risk-based contracts (in general, a set To achieve these reform ends, the govern- payment, per patient, over time). Hospitals ment has gone big time into the business which become adept at population wellness of health insurance, creating insurance management to achieve risk-based success exchanges and offering tax subsidies. also stand to earn enhanced reimburse- we could get doing it the old way when a However, most Americans are unaware ments in support of their operating bud- patient might only have their blood pres- of an even bigger impact of the law: that gets. Thomas cited their large and growing sure measured (with a cuff) once a month the ACA is transforming how healthcare is Medicare Advantage at-risk program as an or once a quarter,” Thomas said. The watch delivered in America. In a concept known as example. will also remind patients to take their meds a shift from fee-for-service to value-based New applications of technology more and to control high blood pressure. payments, physicians and hospitals are rein- more are also playing a big part of fulfill- “We can get into peoples’ homes now to venting the way we all receive care. Doctors ing the ACA mandate. For example, Och- manage their health, which helps patients and hospitals are now more and more get- sner was one of the first health systems in who may have trouble leaving their homes ting paid on how good a job they do to keep the U.S. last year to partner with Apple to (for medical or social reasons).” He added people in their communities healthier from deploy its Apple watch to monitor patient that building telemedicine platforms for chronic diseases and out of the hospital. blood pressures to improve hypertension. two-way communication between clinicians Because the results of the upcoming pres- Ochsner was a beta tester and succeeded in and patients in their homes is also a valuable idential election could either expand or con- importing patient data from the Apple watch strategy for the redesign effort. tract the ACA, we thought it was a good time into its electronic health record system. Getting doctors – the gatekeepers of to check in with some regional hospitals to “We get more readings in a day now then America’s health system – to buy-in is see how the ACA is going. Warner Thomas, President and CEO at Ochsner Health System, which serves several Louisiana locations, cites data and “...most Americans are unaware of technology as two of the biggest drivers in an even bigger impact of the law: meeting the wellness, quality, and payment that the ACA is transforming how reforms of the ACA. “To be a center of excellence for chronic healthcare is delivered in America.” disease, we have to have the right data on patients to develop strategy,” he said. healthcare delivery

“The changes are viewed in our system favorably. I see a lot more engagement – a sense that we’re all in this together.”

Warner Thomas, President and CEO, Ochsner Health System

has the rare opportunity to help reinvent 2017. He said the talks among pediatricians children’s health delivery in an entire state. across Arkansas are focused on agreeing to “Arkansas is fairly rural – there are only the definition of population wellness and 3.5 million residents and 710,000 children how providers will be held accountable. in the entire state,” Steele explained. “That’s “We’re nine weeks into this process. We a number you can wrap your arms around.” want to have agreement on these points Dr. Steele is a board-certified pediatrician because I don’t want to throw a state-wide who was recruited to ACH about two years party that no one attends,” he said with a ago after learning the workings of negotiat- laugh. The payers are also very interested in ing risk-based contracts in a multi-specialty the initiative; they have presented about 30 practice in Missouri. He said their goal is metrics to help the network make decisions. to improve children’s wellness throughout “We’re going to need to make these Arkansas, which he said ranks near the bot- changes and be flexible,” Dr. Steele con- tom (25th percentile5) nationwide for chil- cluded. “Our efforts need to implement vital to the reinvention goals under the dren’s health. He said the state’s decision value-based reimbursement, but I don’t ACA. According to a recent study by Aetna three years ago to expand Medicaid cover- think we can go whole hog on a risk-basis Health3 on its Epocrates app, low physician age under the ACA has been a positive step for an entire population across the state. Our engagement to ACA changes is still preva- forward. network has to be sustainable.” lent. However, the study indicates the results “Spending on pediatrics represents only Down the street at University of Arkansas are certainly improved over another survey 10 percent of healthcare dollars spent. But for Medical Sciences (UAMS) in Little Rock, conducted in 2012 (two years after the ACA for payers they have to pay attention to that the teaching and training hospital has been was enacted). That study found that out of 10 percent to get a 100 percent coverage net- among early adopters of many of the tenets of ten doctors none were unwilling to recom- work,” said Dr. Steele. the ACA quality and cost redesigns. For exam- mend the profession.4 Thomas said that He also noted that while there have been ple, UAMS was designated an AHEC (Area improvements in quality outcomes and flat- some risk-based adult contracts in support Health Education Center) by the Centers for tening of costs seems to be improving the of ACA goals, value-based contracting does working partnership. not yet appear to be wide-spread in Arkan- “I think the provider community is very sas. However, according to Dr. Steele, there engaged in new payment models and is has been expansion of risk value-based trying to drive the change,” he said, “The contracts under the medical home model changes are viewed in our system favor- as part of the Medicaid expansion. Medical ably. I see a lot more engagement – a sense homes are designed to coordinate a patient’s that we’re all in this together.” care between multiple providers. This helps For those who take care of kids, the ACA achieve both population wellness manage- is more of a blank slate with an emphasis on ment goals and deliver care with lower costs. Medicaid (primarily children— and to a lesser To accomplish this goal, Dr. Steele is extent, low-income adults), as opposed to working to put together a statewide network Medicare (primarily older adults). At Arkan- of providers across the state. This initiative, sas Children’s Hospital (ACH) in Little Rock, called the Arkansas Children’s Care Network, Rob Steele, MD, MBA, Chief Strategy Officer, is scheduled to formally kick-off in May of

22 SEPT / OCT 2016 I Healthcare Journal of little rock “We’re nine weeks into this process. We want to have agreement on these points because I don’t want to throw a state-wide party that no one attends.”

Rob Steele, MD, MBA, Chief Strategy Officer, ACH

of physician quality-based payments under – patients are receiving outside the UAMS Rob Steele, MD, MBA the 2015, bi-partisan Medicare Access and system. CHIP Reauthorization Act. This all adds to more cost efficiency, All this is to say that UAMS has jumped especially given the Medicaid expansion in deep into the ACA swimming pool. Which Arkansas. Dr. Townsend noted that many at- is fine with Dan Rahn, MD, Chancellor at risk patients were able to get health insur- UAMS, because he believes change was ance under the ACA expansion. She said that necessary. because of this expanded coverage, for the “Regardless of the model, we should and first time UAMS was able to turn back in will be producing better results for patients,” some of the Disproportionate Share (DSH) said Dr. Rahn. He added that the long time payments traditionally paid to safety net fee-for-service model “is not in the best hospitals. But with DSH payments nation- interest of society and it’s not sustainable.” wide scheduled to be cut $43 billion between As with all the hospitals interviewed, both 2018 to 20247, savings in healthcare deliv- Dr. Rahn and Roxane Townsend, MD, CEO ery are supposed to make the difference. Dr. Rachel Verville at UAMS, cited the benefit of converting to Townsend thinks this may be a stretch. a high-functioning patient health record to “Right now we’ve got one foot on the boat Medicare and Medicaid (CMS) under the cur- meet ACA quality and efficiency goals. The and one foot on the dock,” she explained. “It rent designation cycle for its ability in primary consensus is that data is knowledge. CMS (the redesign of healthcare delivery) will be care physician training and service lines. It has has been advocating for a nationwide medi- easier once we’re all in the boat. In the end, also been successful in establishing primary cal electronic health record since before the we have to generate enough margin to take care homes for its patient population. In the ACA was passed6 and has continued with care of people, while reinvesting in people, next round of CMS demonstration projects, various funding provisions under the ACA. equipment, and technology. This holds true UAMS believes it will be approved for value- “We had 35 separate software systems no matter what the payment model.” based purchasing/payments and the redesign that didn’t talk to each other,” said Dr. Back in Louisiana, LCMC Health in New Townsend. “We now have a seamless sys- Orleans – the rapidly growing system that tem from inpatient to outpatient care that includes five hospitals, including the man- gives us a broad view of patient care.” She agement of the new state University Medical said that Medicare claims data can now also Center – has been born under the shadow tell them what care – including prescriptions of the ACA. Theirs is a rare opportunity

“We serve many disadvantaged and fragile patients. We are now in a better position to get them the help they need.”

Rachel Verville, Vice President of Revenue Cycle, LCMC

Healthcare Journal of little rock I SEPT / OCT 2016 23 healthcare delivery

“ Regardless of the model, we should and will be producing better results for patients.”

Dan Rahn, MD, Chancellor, UAMS

to reinvent healthcare while they invent themselves. “We’re a new and emerging health system,” said Rachel Verville, Vice President of Revenue Cycle for LCMC. The New England native was recruited after her experience in managing population wellness in two other states that expanded Medicaid expansion. Louisiana has added 250,000 people to its Medicaid rolls since the expansion that went into effect on July 1.8 “What a tremendous benefit for the community, it’s really inspiring to see the poten- qualify for coverage under the Medicaid 1- http://jama.jamanetwork.com/article. aspx?articleid=2533698# tial impact,” she added. “We serve many dis- expansion,” she said. “Before the expansion, 2 - http://medcitynews.com/2016/07/ advantaged and fragile patients. We are now it was a real challenge for them to afford jama-obama-public-option/ 3 - http://www.forbes.com/sites/ in a better position to get them the help they health insurance.” davechase/2016/07/12/study-shows-doctor- need.” This strategy is a remedy to the decades engagement-critical-for-obama-to-reach- his-health-reform-goals/#6cfea62c702f As with Arkansas Children’s Hospital, old challenge of underserved patients get- 4 - https://www.linkedin.com/pulse/square- LCMC’s mission is unique. Their teaching ting primary care in hospital emergency deal-clinicians-quadruple-aim-dave-chase 5 - http://www.commonwealthfund.org/ hospital is a main safety net provider of departments (ED), which is the most expen- publications/press-releases/2011/jan/ child-health-release healthcare service in New Orleans. Verville sive point of entry into the healthcare sys- 6 - https://www.cms.gov/Regulations- said that they have a triple aim to succeed tem. Verville noted that many of their ED and-Guidance/Legislation/ EHRIncentivePrograms/index. under the ACA. This includes: to create a top physicians and staff are great advocates for html?redirect=/ehrincentiveprograms tier patient experience; improve the health the city’s homeless population, with a keen 7 - http://www.governing.com/topics/health- human-services/gov-medicare-deal-delays- of their patients; and reduce costs. interest in overcoming service barriers. With hospital-cuts.html 8 She also said they are working closely the Medicaid expansion and the ACA, this - http://www.theadvocate.com/baton_ rouge/news/politics/article_d753c856- with the federally qualified health clinic challenge has become more doable. 4ad8-11e6-a5bc-a32039638363.html (FQHC) 504 Healthnet to achieve these ACA “We are very excited about what the goals. FQHCs by design focus on providing Affordable Care Act can continue to do,” primary care services to help underserved she concluded. “It will take all of us, includ- patients stay healthy and out of the hospi- ing patients, to come together to get every- tal. She said that patients who have never thing out of it. Any conversation we can have sought the care they need are now coming about what we need to do manage popu- in because they have coverage. lation health can only be a good thing.” n “In New Orleans we have a large population of hospitality service workers, as well as musicians and artists who are self- employed, working more than one job, who have never had coverage. But now they

24 SEPT / OCT 2016 I Healthcare Journal of little rock We’re a little bit different ... and we’re okay with that.

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+($/7+&$5( -2851$/ healthcarejournallr.com of Little Rock propublica

Drug and Device Makers Find Receptive Audience at For-profit, Southern Hospitals

By Charles Ornstein and Ryann Grochowski Jones, ProPublica, June 29, 2016 This story was co-published with multiple media outlets. propublica

Where a hospital is located and who medical breakthroughs. ProPublica matched data on company owns it make a big difference in how many And we recently found an associa- payments to physicians in 2014 with data of its doctors take meals, consulting, and tion between payments and higher rates kept by Medicare on the hospitals with promotional payments from pharmaceu- of brand-name prescribing, on average. which physicians were affiliated at the tical and medical device companies, a new A ccepting even one inexpensive meal from time. We only looked at each doctor’s pri- ProPublica analysis shows. a company was associated with a higher rate mary hospital affiliation and only at doctors A higher percentage of doctors affiliated of prescribing the product to which the meal eligible to receive payments in the 100 most with hospitals in the South have received was linked, another study showed. common medical specialties. The payments such payments than doctors in other regions This analysis shows profound differences included speaking, consulting, meals, travel, of the country, our analysis found. And a among hospitals, but it’s uncertain why that gifts and royalties, but not research. greater share of doctors at for-profit hos- is. It could be that hospitals play a role in To be sure, the data is not perfect. Com- pitals have taken them than at nonprofit and shaping affiliated doctors’ acceptance of panies must report their payments to the government facilities. payments or that like-minded physicians federal government, and some doctors have Doctors in New Jersey, home to many of congregate at particular hospitals. found errors in what’s been attributed to the largest drug companies, led the coun- Those who support limits on such pay- them. Companies can face fines for errors, try in industry interactions: Nearly eight in ments say patients may want to know how and doctors have a chance each year to con- 10 doctors working at New Jersey hospitals prevalent industry money is at a hospital test information reported about them. Also, took payments in 2014, the most recent year before choosing it for care. “Maybe they’re Medicare’s physician data may not capture for which data is available. Nationally, the prescribing or treating you as a patient not doctors who do not participate in the pro- rate was 66 percent. (Look up your hospital based on evidence, but rather based on mar- gram and it may not accurately reflect the using our new tool at https://projects.pro- kets or industry gain or personal gain,” said status of doctors who have moved. (Read publica.org/graphics/d4d-hospital-lookup) Dr. Kelly Thibert, president of theA merican more about how we conducted our analy- For the past six years, ProPublica has Medical Student Association, which grades sis at https://www.propublica.org/article/ tracked industry payments to doctors, find- medical schools and teaching hospitals on how-we-compiled-the-dollars-for-docs- ing that some earn hundreds of thousands their conflict-of-interest policies.P atients, hospital-data.) of dollars or more each year working with she said, “need to be aware that this could As might be expected, hospitals with drug and device companies. We’ve reported potentially be an issue and they need to tougher rules, such as banning industry how the drugs most aggressively promoted speak up for themselves and their loved reps from walking their halls and bringing to doctors typically aren’t cures or even big ones who may be in those hospitals.” lunch, tended to have lower payments rates. propublica

A labama had rates above 76 percent. At the other end of the spectrum, Vermont had the Where a hospital is located makes lowest rate of industry interactions (19 per- a big difference in how many of its doctors cent), followed by Minnesota (30 percent). take payments from drug and medical device Maine, Wisconsin and Massachusetts had companies. See how your state compares. rates below 46 percent. Some of these states had laws requiring public disclosure of payments to doctors that predated the federal Doctors Taking Payments (%) government’s. < Lower Higher Percentage > In Minnesota, just over 30% of In Vermont, less than There were also major differences hospital-affiliated doctors take 20% of hospital-affiliated payments, the second lowest doctors take payments, the between hospitals based upon who owned rate in the country. lowest in the country. them. For-profit hospitals had the highest rate of payments to doctors, 75 percent, followed by nonprofit hospitals at 66 percent. Federally owned hospitals had the lowest rates at 29 percent, followed by other gov-

In New Jersey, ernment hospitals at 61 percent. Hospitals nearly 79% of operated by the U.S. Department of Veterans hospital-affiliated doctors take A ffairs were not included in our analysis. payments, the Among hospitals with at least 50 affiliated highest in the country. doctors, the one with the highest proportion of doctors taking payments was St. Francis Hospital-Bartlett, a relatively small hospital outside Memphis that is owned by Tenet Healthcare Corp. Fifty-nine of the 62 doctors for which Medicare listed St. Francis as their Five of the six states with the primary affiliation took payments in 2014, a highest rates of hospital-affiliated doctors taking payments are in rate of 95 percent. the South: Louisiana, Mississippi, Florida, South Carolina and In a statement, the hospital said it sup- Alabama - all above 76%. ported disclosure and transparency: “Patients should have the ability to access informa- Sources: ProPublica analysis; Information on physicians’ primary hospital affiliations comes from tion about any relationship that might exist the Centers for Medicare and Medicaid Services’s 2014 Physician Compare data. Information on medical industry payments comes from the federal government’s Open Payments data. between their doctor and the companies that Information on hospital ownership is from the American Hospital Association Annual Survey. make the products that might be recom- mended for their care, so that they can dis- For example, at Kaiser Permanente, a giant doesn’t make anything happen. There’s a fair cuss that information directly with their phy- California-based health insurer that runs 38 amount of surround-sound in the organi- sician.” Spokesman Derek Venckus declined hospitals, fewer than three in 10 doctors took zation around reminding people about this to answer other questions about the hospital’s a payment in 2014. Since 2004, the system and reminding them why we took this step.” rate or its policies. has banned staff from taking anything of Levine said she believes many of the pay- Overall, our analysis showed, the percent- value from a vendor. ments attributed to Kaiser doctors were for age of doctors taking payments at a given “Our intent was to disrupt the strategy meals and snacks at professional meetings, hospital wasn’t correlated with the share of of using what industry calls ‘food, friend- even if they didn’t eat them. its doctors receiving larger payments, those ship, and flattery’ to develop relationships ProPublica’s analysis found distinct totaling $5,000 or more. (In part that may with prescribers and influence the choice of regional differences in comparing where be because so few doctors received more drugs, the choice of devices, implants, things industry payments were most concentrated. than $5,000.) like that,” said Dr. Sharon Levine, an execu- After New Jersey, the states with the high- Some hospitals had a relatively low pro- tive vice president of the Permanente Fed- est rates of hospital-affiliated doctors taking portion of doctors taking payments but a eration, which represents the doctor arm of payments were all in the South: Louisiana, relatively high share of doctors taking sub- Kaiser Permanente. “Passing a policy alone Mississippi, Florida, South Carolina, and stantial amounts of money. In these cases,

28 SEPT / OCT 2016 I Healthcare Journal of little rock experts say, the hospitals are probably percent of doctors took a payment, com- including Massachusetts General Hospital banning meals and gifts while permitting pared to 48 percent at “B” hospitals, 58 and Stanford Hospital, limit interactions or encouraging deeper relationships, often percent at “C” hospitals and 63 percent between doctors and pharmaceutical rep- with oversight. at hospitals rated as incomplete because resentatives and monitor doctor interactions At Karmanos Cancer Center in Detroit, their policies were “insufficient for evalu- with industry closely, officials said. Some more than a quarter of doctors took more ation.” By comparison, 69 percent of doc- post details of their doctors’ commercial than $5,000 from industry in 2014, the high- tors at unrated hospitals took payments. Of relationships on their websites. est rate in the nation. Spokeswoman Patri- the 204 hospitals graded, about 150 were in In interviews, some said they double- cia Ellis said in an email that the hospital ProPublica’s data (hospitals run by the U.S. checked their physicians’ disclosures against has conflict-of-interest policies in place Department of Veterans Affairs were not). the data reported by the companies. and is comfortable with its level of physi- “I think that’s significant,” said Thibert, the “It’s like stop signs. Everybody knows cian interactions. group’s president. “That’s still a lot of docs they’re supposed to stop at stop signs but “Our cancer experts are committed to receiving money unfortunately. That’s some- as you and I both know, people seem to providing exceptional care and work tire- thing we’re continuing to work on.” cruise through them from time to time,” lessly to find/discover/advance innovative The University of Iowa Hospitals and said Dr. Harry Greenberg, senior asso- treatments that can help patients survive Clinics received an A on the scorecard. Its ciate dean for research at Stanford Uni- their cancer,” she wrote. “I lost both my par- rate of doctors taking payments, less than versity School of Medicine. “That’s just ents and several other loved ones to cancer. 27 percent, is among the lowest in the coun- human nature. We have a system we try …I know our experts at Karmanos Cancer try. Less than 3 percent of its doctors took to pick it up and do corrective action.” n Institute are doing everything they can to payments worth at least $5,000, also below help other cancer patients have more time average. Its policy, in place since 2009, bans Deputy data editor Olga Pierce contributed with their loved ones. And they’re doing that drug company from providing gifts and to this report. with the highest integrity and commitment.” meals in almost all circumstances, bans Many cancer hospitals and specialty hos- doctors from giving promotional talks, and About Our Partners pitals, including heart and orthopedic facili- requires consulting arrangements be signed This story was published in collaboration ties, had among the highest rates of doctors off on by officials. with news organizations across the country, receiving high-dollar payments. “We really have had great success in get- including NPR, The Boston Globe, the Researchers as well as officials at the ting [physicians] to comply with it,” said Tampa Bay Times, The Tennesseean, The A ssociation of American Medical Colleges, Denise Krutzfeldt, manager of the health Philadelphia Inquirer, inewsource, New a trade group for medical schools and teach- system’s conflict of interest office. England Public Radio, KPCC, The Arizona ing hospitals, said they had not analyzed the Other hospitals with below-average rates, Republic and the USA Today Network. data the way ProPublica has. But officials said members do track payments made to doctors at their own institutions. A cross the country, hospital and medical At For-Profit Hospitals, Doctors More school leaders are divided about what con- Likely To Take Pharma Payments stitutes an appropriate payment. “There is A hospital’s ownership makes a difference in what proportion of its doctors a range of opinions between those people take payments from pharmaceutical and medical device companies. who believe that industry payments should be cut out vs. those who believe that there’s Ownership a way to carefully monitor them,” said Dr. Investor-Owned (For-Profit) 74.7% Janis Orlowski, the association’s chief health Nonprofit 65.5% care officer. Government (Nonfederal) 61.4% ProPublica found differences in the payment rates at teaching hospitals based on Government (Federal) 29% the grades assigned to them by the Amer- ican Medical Student Association, which Source: ProPublica analysis; American Hospital Association; Centers for Medicare and medicaid Services. Notes: 115 out of 4,815 hospitals had an unknown ownership type; hospitals operated by the U.S. Department of Veterans reviewed their conflict-of-interest policies Affairs are not included in the federal tally. in 2014. A t the “A” hospitals we analyzed, 46

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 29 election 2016: where do they stand on healthcare? price transparency Donald Trump’s Healthcare Platform

x Completely repeal Obamacare. Our x Require price transparency from all healthcare pro- elected representatives must eliminate the viders, especially doctors and healthcare organizations individual mandate. No person should be like clinics and hospitals. Individuals should be able to shop required to buy insurance unless he or she to find the best prices for procedures, exams or any other medical-related procedure. wants to. x Block-grant Medicaid to the states. Nearly every state already offers benefits beyond x Modify existing law that inhibits the what is required in the current Medicaid structure. The state governments know their peo- sale of health insurance across state lines. ple best and can manage the administration of Medicaid far better without federal over- As long as the plan purchased complies with head. States will have the incentives to seek out and eliminate fraud, waste, and abuse to state requirements, any vendor ought to be preserve our precious resources. able to offer insurance in any state. By allowing full competition in this market, insurance x Remove barriers to entry into free markets for drug providers that offer safe, reliable costs will go down and consumer satisfac- and cheaper products. Congress will need the courage to step away from the special inter- tion will go up. ests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, x Allow individuals to fully deduct health safe and dependable drugs from overseas will bring more options to consumers. insurance premium payments from their tax returns under the current tax system. Busi- The reforms outlined above will lower healthcare costs for all Americans. There are other nesses are allowed to take these deductions reforms that might be considered if they serve to lower costs, remove uncertainty, and so why wouldn’t Congress allow individu- provide financial security for all Americans. And we must also take actions in other pol- als the same exemptions? As we allow the icy areas to lower healthcare costs and burdens. Enforcing immigration laws, eliminating free market to provide insurance coverage fraud and waste, and energizing our economy will relieve the economic pressures felt by opportunities to companies and individuals, every American. It is the moral responsibility of a nation’s government to do what is best we must also make sure that no one slips for the people and what is in the interest of securing the future of the nation. through the cracks simply because they cannot afford insurance. We must review basic Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were s

options for Medicaid and work with states to simply enforce the current immigration laws and restrict the unbridled granting of visas on mm o to ensure that those who want healthcare to this country, we could relieve healthcare cost pressures on state and local governments. C edia

coverage can have it. m

To reduce the number of individuals needing access to programs like Medicaid and Chil- ia Wiki v x Allow individuals to use Health Savings dren’s Health Insurance Program we will need to install programs that grow the economy a/2.0)], s - y

Accounts (HSAs). Contributions into HSAs and bring capital and jobs back to America. The best social program has always been a job b / s e should be tax-free and should be allowed to – and taking care of our economy will go a long way towards reducing our dependence s accumulate. These accounts would become on public health programs. .org/licen

part of the estate of the individual and could s on

be passed on to heirs without fear of any Finally, we need to reform our mental health programs and institutions in this country. mm eco death penalty. These plans should be par- Families, without the ability to get the information needed to help those who are ailing, are v ticularly attractive to young people who are too often not given the tools to help their loved ones. There are promising reforms being healthy and can afford high-deductible insur- developed in Congress that should receive bi-partisan support.

ance plans. These funds can be used by any 2.0 (http://creati A -S Y

member of a family without penalty. The flex- B CC ibility and security provided by HSAs will be of great benefit to all who participate.

Excerpted from: https://www.donaldjtrump.com/positions/healthcare-reform photo By Michael Vadon [ Michael Vadon By photo

30 SEPT / OCT 2016 I Healthcare Journal of little rock Hillary Clinton’s Healthcare Platform

x Defend the Affordable Care Act and build enrollment campaign to ensure more people enroll in these on it to slow the growth of out-of-pocket costs. extremely affordable options.

x Crack down on rising prescription drug x Expand access to affordable healthcare to families regardless of immigration status. Hill- prices and hold drug companies accountable ary sponsored the Immigrant Children’s Health Improvement Act in the Senate, which later so they get ahead by investing in research, not became law and allows immigrant children and pregnant women to obtain Medicaid and jacking up costs. CHIP. She believes we should let families—regardless of immigration status—buy into the Affordable Care Act exchanges. x Protect women’s access to reproductive healthcare, including contraception and safe, x Continue to support a “public option”—and work to build on the Affordable Care Act to legal abortion. make it possible. Hillary supports a “public option” to reduce costs and broaden the choices of insurance coverage for every American. To make immediate progress toward that goal, Hill- x Make premiums more affordable and ary will work with interested governors, using current flexibility under the Affordable Care lessen out-of-pocket expenses for con- Act, to empower states to establish a public option choice. sumers purchasing health insurance on the Obamacare exchanges. Her plan will provide x Defend the Affordable Care Act. Hillary will continue to defend the Affordable Care Act enhanced relief for people on the exchanges, (ACA) against Republican efforts to repeal it. She’ll build on it to expand affordable coverage, and provide a tax credit of up to $5,000 per slow the growth of overall healthcare costs (including prescription drugs), and make it pos- family to offset a portion of excessive out-of- sible for providers to deliver the very best care to patients. pocket and premium costs above 5% of their income. She will enhance the premium tax x Lower out-of-pocket costs like copays and deductibles. The average deductible for employer- credits and ensure that all families purchasing sponsored health plans rose from $1,240 in 2002 to about $2,500 in 2013. Hillary believes that s on the exchange will not spend more than 8.5 workers should share in slower growth of national healthcare spending through lower costs. on mm o percent of their income for premiums. Finally, C

edia she will fix the “family glitch” so that families x Reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 m can access coverage when their employer’s percent in 2013 to 12.6 percent in 2014. Hillary believes we need to demand lower drug costs ia Wiki v family plan premium is too expensive. for hardworking families and seniors. ain], m lic do x Support new incentives to encourage all x Transform our healthcare system to reward value and quality. Hillary is committed to Pub states to expand Medicaid. Hillary will fol- building on delivery system reforms in the Affordable Care Act that improve value and qual- low President Obama’s proposal to allow any ity care for Americans. state that signs up for the Medicaid expan-

ent of State page) [ page) ent of State sion to receive a 100 percent match for the Hillary will also work to expand access to rural Americans, who often have difficulty find- m first three years, and she will continue to look ing quality, affordable healthcare. She will explore cost-effective ways to broaden the scope epart D for other ways to incentivize states to expand of healthcare providers eligible for telehealth reimbursement under Medicare and other pro-

hoto at at hoto Medicaid to meet the health needs of their grams, including federally qualified health centers and rural health clinics. She will also call P most vulnerable residents. for states to support efforts to streamline licensing for telemedicine and examine ways to fficial O expand the types of services that qualify for reimbursement. x Invest in navigators, advertising, and As president, she will continue defending Planned Parenthood, which provides critical

ent of State ( ent of State other outreach activities to make enroll- health services including breast exams and cancer screenings to 2.7 million women a year. m ment easier. Hillary will ensure anyone who And she will work to ensure that all women have access to preventive care, affordable con- epart D

s wants to enroll can understand their options traception, and safe, legal abortion—not just in principle, but in practice, by ending restric- and do so easily, by dedicating more funding tions like the Hyde Amendment. for outreach and enrollment efforts. She will invest $500 million per year in an aggressive Excerpted from: https://www.hillaryclinton.com/issues/health-care/ photo By United State By photo

Healthcare Journal of little rock I SEPT / OCT 2016 31 The Cost of the How’s this for a surprise? Gregg Butler, professor of science in sustainable development at the University of Manchester in the U.K., says he would be happy to have a nuclear waste storage facility in his backyard. Wait...he said...what?? Yes, it’s true, but it’s not just because of the safety of properly disposed radioactive waste—it’s the comparison with the alternative. All things considered, the health consequences of nuclear waste and accidents combined may pale in comparison to the enormity of the consequences of our current largest source of energy—fossil fuels.

The Cost of the Charge Health consequences of energy choices

By Claudia S. Copeland, PhD energy

For many, the idea of nuclear energy brings with it fear and distrust. The symptoms of radiation sickness are horrific, and the potential impact of accidents is tremendous, and terrifying. The Chernobyl meltdown, with radiation fallout as far as Western Europe, and the Fukushima Daiichi nuclear disaster, which displaced 160,000 people, are alone enough to win nuclear power the crown for scariest source of energy. Add to this the fact that, for all practical purposes, nuclear waste lasts forever, and it certainly seems that nuclear energy must be the worst way to power our lives, in terms of human health.

In reality, though, major failures of civil- Falls, that killed three operators. In con- ian nuclear power plants are few and far trast, deadly disasters in coal mining have between: the Fukushima disaster in 2011, been a steady constant throughout its his- the Chernobyl disaster in 1986, the Three tory, with more than 100,000 miners killed in Mile Island partial meltdown in 1979, which the past century in the U.S. alone, and almost resulted in no deaths and no significant double that number killed in China. Globally, increases in cancer afterwards, and the 1961 an estimated 12,000 coal miners die every explosion and meltdown of SL-1, a remote year from accidents, according to the BBC. army nuclear power reactor near Idaho But accidents in the coal mine are only the

“...accidents in the coal mine are only the beginning. The current number of Chinese pneumoconiosis (black lung) cases exceeds 700,000, according to China Daily, and U.S. black lung cases are on the rise in Appalachia as well, according to a January report in Environmental Health Perspectives.” a Commons i med i k i a W i Image v Image

there is no such solution for the waste gen- erated by fossil fuels. It enters our air, water, and soil. Filters can help, as can increases in fuel efficiency through technology, but the fact remains that pollution from fossil fuels is a huge health issue. In the U.S. alone, each year sees over 16,000 hospital admissions for asthma, pneumonia, and cardiovascular conditions linked to pollution from fossil-fuel power plants. In addition, such pollution is implicated in more than 7,000 emergency room visits for asthma, more than 18,000 cases of chronic bronchitis and 59,000 cases of acute bronchitis, more than 1 million lower and upper respiratory infections, and more than 30,000 premature deaths. Annual lost work days due to air pollution number over 5 million. Outside the developed world, with fewer

e regulations and weaker enforcement, air pol- Fukushima lution from fossil fuels is far worse, as any Daiichi nuclear disaster traveler to big cities in Latin America, south- Radiation hotspot east Asia, or Africa can tell you. Africa not only in Kashiwa. hosts the world’s most air-polluted city (in Nigeria), but also suffers from widespread oil- related water pollution that affects drinking water and fishing, a staple source of food and income for villagers. A United Nations Envi- ronmental Programme report documented extensive oil-related contamination of soil and water in the Niger Delta region; in the most serious case, they found an 8-cm thick beginning. The current number of Chinese measured. According to a regression analysis layer of refined oil floating on the groundwa- pneumoconiosis (black lung) cases exceeds reported in PNAS in 2013, the impact of the ter serving the community wells. In one com- 700,000, according to China Daily, and U.S. increased total suspended particles (TSPs) munity, drinking water in wells was contami- black lung cases are on the rise in Appala- translated into a decreased life expectancy nated with levels of benzene over 900 times chia as well, according to a January report of 5.5 years among northerners due to car- the WHO upper limit. in Environmental Health Perspectives. diorespiratory diseases associated with the Latin America also suffers from oil-related Burning coal affects health almost as dra- higher use of coal. Of course, oil and natural environmental health problems. A 2004 Pan- matically as mining it. An unintended de facto gas are cleaner than coal, but also generate American Health Organization report on the experiment in China, in which officials gave substantial pollution, as well as accidents. oil industry in the Amazon basin of Ecuador free coal for heating to northern regions, Whereas radioactive waste from nuclear documented a range of toxicological effects but not southern ones, allowed the con- power plants can be vitrified into glass, coated associated with oil exposure. Spontaneous sequences of increased coal burning to be in concrete, and buried deep underground, abortions were 2.5 times higher in women

Healthcare Journal of little rock I SEPT / OCT 2016 35

energy

living near oil fields, and the rates of several to tens of thousands of additional deaths forms of cancer were elevated: cancers of the each year by the end of the century during stomach, rectum, skin melanoma, soft tissue, summer months. Rising temperatures also and kidney in men, cancers of the cervix and adversely affect air quality, which increases lymph nodes in women, and hematopoietic asthma and other respiratory illnesses. cancers in children. In China, outdoor air pol- Among the most problematic predicted air lution contributes to 1.6 million deaths per quality issues linked to climate change is year, according to a 2015 study by Berkeley an increase in the amount of ground-level scientists Rohde and Muller, reported in PLoS; ozone, which can damage lung tissue and this number represents 17% of all the deaths inflame airways, aggravating asthma and in China. other respiratory conditions. According to the US Global Change Research Program Climate Change (USGCRP), by 2030, ground-level ozone- Beyond the effects of pollution looms the related illnesses and premature deaths potential global catastrophe of climate due to climate change could number in the change. Excessive and rising carbon diox- thousands if no mitigating air quality policy ide in the atmosphere from fossil fuels emis- changes are put in place. sions is predicted to lead to global warming, Rising temperatures can also adversely acidification of the ocean, changes in rainfall, affect water quality, through increased run- sea level rise, and increases in the frequency off leading to pollution of recreational and In addition to waterborne diseases, cli- or severity of extreme weather effects. How drinking water sources, and through infec- mate change is also predicted to affect vec- might this affect our health locally? tious disease. Disease-causing microbes tor-borne diseases. The activity of ticks Hot temperatures can lead to heat stroke, expected to increase with rising temper- that transmit Lyme disease, for example, is dehydration, and increased cardiovascular, atures include Vibrio bacteria and other restricted by climate. As temperatures rise, cerebrovascular, and respiratory disease. pathogenic bacteria, toxin-producing algal these ticks are likely to become active ear- According to the EPA, heat-related deaths in blooms, and waterborne parasites like Cryp- lier, and their geographic range is expected the United States could reach the thousands tosporidium and Giardia. to expand. Mosquitoes transmit a great

Reasons and Effects of air pollution

• Carbon dioxide from exhausts and energy production • Methane from cattle breeding • Sulfur oxides from exhausts and industry • CFCs from refrigerants and propellants • Nitrogen oxides from exhausts and industry • Ozone from air with high oxygen level, catalysed by nitrogen oxides • Soot and particulate from exhausts and industry 1. Greenhouse effect by keeping sun warmth and light from reflecting back into space 2. Particulate contamination affecting respiratory systems 3. Raised UV radiation levels by destruction of the ozone layer 4. Acid rain leads to acidification and forest dieback 5. Increased ozone levels affecting respiratory systems 6. Contamination by nitrogen oxides affecting respiratory systems

image By chris [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

36 SEPT / OCT 2016 I Healthcare Journal of little rock e Hydroelectric power is a relatively clean energy source, and it is not highly accident-prone.

security, including the processing, storage, low to be consciously heard), ground cur- transportation, and consumption of food.” rent, and shadow flicker. Shadow flicker is One effect of particular concern to Gulf the phenomenon of the moving shadow of Coast residents is a predicted increase in the blade of a wind turbine creating a slow extreme weather events. Storm-related flickering light effect as the shadow moves damage to roads and communication infra- over windows, akin to someone continuously structure disrupts access to healthcare ser- switching a light switch off and on every cou- vices, especially impacting the elderly and ple of seconds. people with disabilities. Carbon monoxide In spite of the large number of com- poisoning due to improper use of genera- plaints, valid studies have revealed no sci- tors increases during storm-related outages, entific evidence for a direct link to human and mental health effects such as depression health. So, what is causing the symptoms? or PTSD increase following storm-related One explanation is a “nocebo” effect. Akin trauma or loss. to a placebo effect, which improves people’s health through purely psychological effects, Alternatives nocebos are phenomena that lead to adverse Clearly, the health effects caused by fossil health symptoms due to the psychologi- number of diseases, many deadly. Cur- fuels are dramatic and far-reaching, even cal effect of the belief that they are harm- rently, mosquito-transmitted viruses like here in the U.S. Other than nuclear energy, ful. Some have asserted that wind turbine Dengue and Zika are not seen in temper- though (which many still do not feel com- health complaints are correlated not with ate and northern climates because the mos- fortable with), how else can we power our wind turbines, but with media attention to quitoes that transmit them cannot survive modern world? Hydroelectric power is a rela- adverse effects, and accusations have even the northern winter, curtailing the infec- tively clean energy source, and it is not highly been made that fossil fuel industry propo- tion cycle. The more warming, the greater accident-prone. However, when accidents do nents have fanned the flames of Wind Tur- the range of these mosquitoes, potentially happen, they are extremely deadly: for exam- bine Syndrome. affecting large numbers of people. Glob- ple, in 1975, a single typhoon destroyed 62 A critical review published in late 2015 ally, temperature increases of 2-3ºC would poorly constructed dams in the Banqiao Res- in the Journal of Occupational and Envi- increase the number of people who are at ervoir in China, killing 171,000 people and ronmental Medicine found no evidence of risk of malaria by several hundred million, leaving 11 million more homeless. Dams direct harm by wind turbine noise and no according to the World Health Organization. can also lead to increases in waterborne correlation of complaints with objective Beyond infectious diseases, climate diseases, such as schistosomiasis, change may affect general health through a parasitic infection second only impacts on food quality. This can be through to malaria in terms of morbidity and toxins—higher sea temperatures are expected mortality. to lead to an increase in mercury in seafood— Considered even cleaner than hydroelec- or pathogens; for example, food poisoning tric power, wind energy, in addition to being caused by Salmonella increases with heat. low in mortality due to accidents, emits no In addition, nutrition can be affected by an water, ground, or air pollution. However, since increase in carbon dioxide, with lowered wind energy is so clean, turbines have been levels of proteins and essential minerals in built very close to residences to take advan- crops such as wheat, rice, and potatoes. The tage of power infrastructure, and a strange relationships between climate change and syndrome of health complaints has emerged. agriculture are well-documented, accord- The complaints include sleep disturbance, ing to the USDA, with risks to food security headache, anxiety, depression, dizziness, increasing with higher concentrations of and cognitive dysfunction. Researchers are greenhouse gases and extending “beyond not sure what exactly is causing these symp- agricultural production to other elements of toms, but speculated causes include audible Wind energy global food systems that are critical for food noise, infrasound (sound at frequencies too turbines

Healthcare Journal of little rock I SEPT / OCT 2016 37

energy e Another clean energy source, well-suited to our sunny climate is solar energy.

All things considered, solar energy and wind energy appear to be the clear winners in terms of human health—except for one additional source: the human body itself! Little Rock has an ideal climate for bike riding. While riding a bike in traffic can lead to morbidity due to accidents, if you can find a route that is free of traffic hazards, using the energy your own body generates from food calories is not only clean, but can provide a net increase in wellness due to the health benefits of exercise. Getting the benefits of exercise together with human-pow- measures of sound pressure. Instead, indi- energy. Solar has the lowest impact in terms ered clean energy aren’t confined to bikes, rect harm appeared to stem from stress due of accidents per kilowatt hour produced, after either: Adam Gilmore of the University of to annoyance, and this was significantly cor- nuclear energy (which is low due to the high Guelph in Canada found that harnessing related with factors such as residents’ opin- amount of energy produced, not to a low total electricity produced by people working out ions of the aesthetics of the wind turbines in number of accident-associated deaths), and in a fitness center could recover 7.9% of the the surrounding scenery. A similar scenario operation of solar panels does not produce facility’s energy demand. (It was not eco- is seen with shadow flicker; the frequency pollution. However, the production of solar nomically feasible, considering the cost of of shadow flicker brought about by com- panels does involve potentially hazardous fitting pedal devices to electricity generators, mercial wind turbines is too slow to cause materials, including lead, arsenic, copper, but decreases in the cost of the technology epileptic seizures, but it does cause annoy- and a number of other toxic chemicals, and or rising fuel prices could tip the scales at ance. Studies of quality of life (QOL) using improper disposal can lead to health haz- some point in the future.) physical and mental health scales found ards—about the same as those associated Researchers Suhalka et al., from Jaipur, contradictory results. One small study (38 with the general microelectronic industry. India, and Romanian researchers Mocanu participants living within 2 km of a wind Recycling can mitigate much of the impact et al. have designed bicycle-powered gener- turbine) found lower QOL in residents liv- of solar cell components, and as the com- ators, capable of providing light or power- ing near wind turbines, while another, large ponents are valuable, companies are moti- ing other small devices—quite useful in off- study (853 residents living within 1.5 km of vated to recycle them. (Of course, it is impor- the-grid villages. Of course, if you’ve ever a wind turbine) found significantly higher tant that conditions in recycling plants are watched a playground full of kids, you may QOL levels in those living closer to a turbine. protective of workers’ health.) As technol- have marveled at “how much energy” they All in all, wind energy appears to be a healthy ogy improves, these issues are also steadily all have. Well, Tulane electrical engineering energy source, but in light of the number improving. The Australian independent think professor S. R. Pandian has developed a sys- of complaints—regardless of whether they tank TAI, in a report on the costs and benefits tem for harnessing all that playground energy represent a nocebo effect— wind turbines of solar energy, quantified the health impacts using pneumatic cylinders. Low-cost systems should best not be positioned in close prox- as 0.5 cents/kWh vs. 1.9 cents/kWh for natu- like this have lower energy harvesting effi- imity to residences. ral gas, the healthiest of the fossil fuels. Some ciency, but in the case of playground energy, This brings us to another clean energy concern has been expressed about electro- efficiency is not as important, since kids want source, one that’s well-suited for our sunny magnetic fields associated with solar panels, to play regardless! After the low installation climate here in Little Rock and ideal for posi- but these fears are not supported by any valid cost, it’s free energy, free fitness, and free fun. tioning close to the people using it—solar scientific studies. Now, how’s that for healthy?! n

“All things considered, solar energy and wind energy appear to be the clear winners in terms of human health—except for one additional source: the human body itself!”

38 SEPT / OCT 2016 I Healthcare Journal of little rock healthcarebriefs News I People I Information

ACRI, UAMS Scientists Investigating What Makes AR an Obese State

Scientists at Arkansas Children’s Research Institute (ACRI) and the University of Arkansas for Medical Sciences (UAMS) have received a $1.4 million grant from the USDA to find out why obesity rates in Arkansas are among the worst in the nation.

See story on page 46

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 39 HealthcareBriefs

Anderson Named AFMC Associate Medical Director The Arkansas Foundation for Medical Care (AFMC) recently announced that Jennifer Ander- son, PharmD, MD, has been appointed to the position of associate medical director. She is responsible for performing prescription drug and other specialized clinical reviews for Arkan- sas Medicaid. Prior to joining AFMC, Anderson was chief of surgery for the Central Arkansas Veterans Health- care System and an ophthalmologist at Arkansas Jennifer Anderson, PharmD, MD Adam Grant, MD Ophthalmology Associates. Anderson plans to continue her practice while at AFMC. Anderson, who is also a pharmacist, received where and when residents and professionals of Deshundra Thomas, 27, of Wilmar, turned her- her medical degree from Eastern Virginia Medi- the downtown area need it most, said Baptist self in to the Warren Police Department on one cal School in Norfolk, Va., in 2004 and her Doctor Health. Offering walk-in and express appointment count of failure to report adult or long-term care of Pharmacy from the University of Arkansas for convenience, Baptist Health Downtown Care can facility resident maltreatment, a Class B misde- Medical Sciences in 1999. She is board certified be used as a person’s primary care physician’s meanor. She observed another employee abuse by the American Board of Ophthalmology. office or only when needed for urgent care mat- a resident and failed to report it to the facility. ters like unexpected illnesses or minor injuries. Thomas was released after posting bond and is Walmart Foundation Awards Dr. Adam Grant will be the primary care pro- waiting on a court date to be set in Drew County Funds for Diversity Programs vider. Grant received his Doctor of Osteopathic District Court. The Walmart Foundation has given $56,000 Medicine from the Des Moines University and T o report Medicaid fraud or abuse or neglect to the University of Arkansas for Medical Sci- completed his residency at St. John’s Episco- in residential care facilities, contact the Attorney ences (UAMS) for its Center for Diversity Affairs pal Hospital in Far Rockaway, New York. Grant General’s Medicaid fraud hotline at (866) 810-0016 Programs. The summer enrichment programs is trained in a more holistic approach to medi- or [email protected]. encourage students throughout the state to con- cine, which means he considers a patient’s envi- sider careers in healthcare. ronment, nutrition, and body system as a whole New Senior Arkansas Hall of The Center for Diversity Affairs summer enrich- when diagnosing and treating medical conditions. Fame Inductees Recognized ment programs are designed to strengthen sci- Baptist Health Downtown Care offers a variety The Division of Aging and Adult Services (DAAS) ence, math, literacy, and test-taking skills. In addi- of comprehensive services for acute health needs of the Arkansas Department of Human Services, tion, the programs give students an introduction such as lab work and X-rays, as well as primary care in partnership with the Arkansas Area Agencies to the many health career options at UAMS and needs such as annual exams, preventative care on Aging, has announced the 2016 nominees for include mentored research, the Summer Sci- and management of ongoing medical conditions. the Senior Arkansans Hall of Fame and inducted ence Discovery Program, Bridging the Gap, ACT Located at 401 West Capitol Avenue, Suite 101B, three. Preparation, and Undergraduate Summer Science in Little Rock, Baptist Health Downtown Care is Keith Laverne Hamm of Berryville, Phil McBee Enrichment Program I and II. This summer, more open Monday through Friday from 7 a.m. to 4 p.m. of Pine Bluff and Harriet Raley of Searcy were rec- than 180 students were exposed to health careers ognized at a luncheon during the 20th Biennial in the UAMS colleges of Health Professions, Med- Two Women Arrested by Silver Haired Legislative Session at the Wyndham icine, Nursing, Pharmacy, Public Health, and the Medicaid Fraud Control Unit Riverfront Hotel in North Little Rock. The nomi- Graduate School. Arkansas Attorney General Leslie Rutledge nees included Charlie Baxter, Georgia Childers, The Walmart Foundation supports initiatives announced the arrest of an Izard County woman and Dan Trevathan. focused on creating career opportunities and and a Bradley County woman by the Attorney Each year, DAAS recognizes senior Arkansans strengthening communities, in an effort to enable General’s Medicaid Fraud Control Unit. who have been nominated by other citizens for sustainable impact. The foundation meets the Anna Moore, 59, of Melbourne, turned her- serving their communities and enhancing the needs of the underserved by directing charita- self in to the Izard County Sheriff’s Office on one lives of fellow seniors. They must be citizens of ble giving toward its core areas of opportunity, count of Medicaid fraud. She is accused of mar- the State of Arkansas, at least 60 years or older sustainability, and community. rying the Medicaid recipient she was providing and have performed outstanding contributions services to and continuing to submit billing docu- or services. Prior to today, there were 70 seniors Baptist Health Downtown ments for her services, totaling more than $10,000 in the Hall of Fame. Care Opens for services she was not eligible to provide, a Presentations were made by Craig Cloud, direc- A cross between an urgent care walk-in clinic Class B felony. Moore was released after post- tor of DAAS, and Brad Nye, assistant director of and an appointment-based family physician’s ing bond and is scheduled to appear in Pulaski DAAS. The new inductees received a plaque and office, the new Baptist Health Downtown Care County District Court in September. will have their names added to a plaque in the clinic offers quick, convenient service especially This case was referred to the Attorney Gener- governor’s office. for those who live and work in the downtown area. al’s office by the Office of the Medicaid Inspec- Delegates serve as legislators during the two- It’s an all-new way to see a trusted physician tor General. day session by writing, debating, and voting on

40 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

bills addressing issues critical to older Arkan- obesity,” said Dr. Weber, who will serve as director who also directs the Physical Activity, Energetics, sans. Prior to the session, the elected delegates of the ACRI Center for Childhood Obesity Pre- and Metabolism Lab at Arkansas Children’s Nutri- received training on topics such as the legisla- vention. She is also a professor of Pediatrics in the tion Center (ACNC) and is an associate professor tive process, how to write bills, and how a bill College of Medicine at the University of Arkansas of Pediatrics at UAMS. ACRI investigator Mario becomes a law. for Medical Sciences (UAMS). “This center will be Cleves, PhD, director and section chief of Pedi- Delegates traveled to the Arkansas State Capi- a prime example of how research translates into atric Biostatistics and a professor of Pediatrics at tol for committee meetings in the following areas: interventions, creating a brighter future for kids UAMS, will direct the biostatistics core. •Legal/Revenue and Tax right here in Arkansas and around the nation.” Unique to the center is the direct involvement •Aging Issues The award marks the third major childhood of the Arkansas Department of Health. Joy Rock- •Service Rates/Funding obesity initiative this year to receive substantial enbach, Act 1220 coordinator for the Arkansas •Senior Centers government backing on the ACRI campus. It will Department of Health, will serve as the deputy The Silver Haired Legislative Session has been enable Dr. Weber and her colleagues to better director of the center to help guide its scientists to conducted biennially since its institution by a 1977 understand the origins of pediatric obesity and closely align their work with public health initiatives. General Assembly resolution sponsored by Rep. lead to the development of interventions focused Dr. Weber and the mentoring teams expect B. G. Hendrix and the late Rep. W. F. “Bill” Foster. both on prevention and reducing associated the junior investigators to become independent It is one of at least 28 such sessions held through- complications such as hypertension and diabetes. within two years of support, after which new junior out the country to give senior citizens a chance to This work will directly contribute to the Arkansas investigators will replace them to establish their participate in the legislative process. Children’s mission to make children better today own childhood obesity research projects. This will Older Arkansans interested in becoming a del- and healthier tomorrow. enable continued growth of the program. Fol- egate in future sessions should contact the Area In establishing the center, Dr. Weber and her lowing the initial five-year award period, COBRE Agency on Aging in their county or the Division of research team will work to prevent the rise in grants can be renewed for an additional two five- Aging and Adult Services. County candidates will Arkansas’ childhood overweight and obesity year periods. need to circulate qualifying petitions and submit rates, which now stand at 39 percent for all chil- In addition to ACRI, key institutional and state them to their Area Agency on Aging. dren, according to the Arkansas Center for Health partners include the Arkansas Department of Improvement (Year 12 Report; www.achi.net). The Health, the Arkansas Children’s Nutrition Center, ACRI Receives NIH Award for goal is to reduce this rate significantly over the the Arkansas Center for Health Improvement, the Childhood Obesity Prevention next five to 10 years. UAMS CTSA Translational Research Institute, the The Arkansas Children’s Research Institute (ACRI) In its first five years, a COBRE focuses on devel- UAMS Department of Pediatrics, the UAMS Col- announced that it is creating a center for the study oping research infrastructure and providing junior lege of Public Health, the University of Arkansas of childhood obesity with a $9.4 million grant investigators with formal mentoring and research at Fayetteville, and the University of Arkansas funded by an Institutional Development Award project funding to help them acquire preliminary Cooperative Extension Service. Other state and (IDeA) from the National Institutes of Health. The data to successfully compete for independent federal institutions and programs, nonprofit orga- center will be integral to Arkansas Children’s Hos- research grant support. nizations, and the public and private business pital’s plans to build a statewide network of care, “A COBRE award of this magnitude makes a community statewide are also partners, includ- while addressing one of the state’s most daunting substantial difference in our ability to tackle a ing the Arkansas Coalition for Obesity Preven- public health crises. problem as complex and difficult as childhood tion, the Child Health Advisory Committee, and The award creates the ACRI Center for Child- obesity,” said Pope L. Moseley, MD, executive the School Nurses Association. hood Obesity Prevention, established as an vice chancellor of UAMS and dean of the Col- IDeA Center of Biomedical Research Excellence lege of Medicine. “The mentoring and training CARTI Receives CVS Health (COBRE) – the first of its kind to be located at programs it supports will boost Arkansas’ scien- Community Grant ACRI. The IDeA program builds research capaci- tific capacity in this area for decades to come.” CARTI recently announced it has received a ties in states that historically have had low levels ACRI Center for Childhood Obesity Prevention $10,000 CVS Health Community Grant to create of NIH funding by supporting basic, clinical and junior investigators will examine topics such as an eight week Smoking Cessation program for translational research, faculty development, and how interventions during pregnancy can reduce smokers. The Community Grants Program was infrastructure improvements. Funding will sup- the risk of childhood obesity, how preschool created by CVS Health as part of its commitment port the center’s creation and operations for the educators can influence obesity prevention, how to helping people achieve their best health by next five years. developmental and environmental influences providing financial assistance to programs that Led by Judith Weber, PhD, RD, the multidisci- affect obesity and educational well-being, and are focused on smoking cessation and prevention. plinary Center for Childhood Obesity Prevention how to better inform policies addressing child- The support from CVS Health will help CARTI will strengthen ACRI’s obesity research capacity hood obesity. provide smoking cessation classes to negate the and create mentoring pathways for emerging sci- The center’s junior investigators will have guid- effect tobacco has on cancer patients, smokers, entists who will focus on pediatric obesity. This ance from experienced research mentors to com- and their families. new center at ACRI will also serve as an anchor for plete these projects and to obtain funding inde- “The need for smoking cessation classes in the development of a comprehensive pediatric pendent of the center. Further, the COBRE award Arkansas is compelling,” said Carolyn Garrett, obesity program at Arkansas Children’s. provides two core research units, one in biosta- CARTI Patient Resource Center Coordinator. “We envision a future where parents don’t have tistics and another in metabolism, to support the “Arkansas has an adult smoking rate of 25.9%, the to worry about their child developing any of the investigators. Leading the metabolism core will second highest in the country, with the national countless complications children face because of be ACRI Investigator Elisabet Borsheim, PhD, rate at 16.8% and an estimated 5,800 adults in

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 41 HealthcareBriefs

our state die each year from smoking. This has a for nearly six years by filing patent infringement direct link to Arkansas’ high mortality rate for lung lawsuits against all potential generic competitors. and bronchial cancer.” Cephalon subsequently settled those lawsuits in “Because we are committed to serving the 2005 and early 2006 by paying the generic com- patient as a whole, we want to offer them, their petitors to delay sale of their generic versions family members and other smokers in the com- of Provigil until at least April 2012. Because of munity help with quitting,” Garrett continued. “In that delayed entry, consumers, states, and others order to do so, we have to certify our trainers paid hundreds of millions more for Provigil than through the American Lung Association, and this they would have had generic versions of the drug grant from CVS Health is allowing us to do that launched by early 2006, as expected. and then offer ongoing Freedom From Smoking This settlement was facilitated by litigation Cessation Classes.” brought against Cephalon by the Federal Trade Mark Kenneday CARTI was selected to receive a grant through Commission (FTC). In May 2015, the FTC set- the CVS Health Community Grants 2016 appli- tled its suit against Cephalon for injunctive relief cation process. This year, grants were specifically and $1.2 billion, which was paid into an escrow awarded to smoking cessation programs offered account. The FTC settlement allowed for those Society of Healthcare Engineering as a key source in a community setting that are helping people escrow funds to be distributed for settlement of of professional development, industry informa- lead tobacco-free lives and are reducing the prev- certain related cases and government investigation, and advocacy, including representation on alence of smoking. tions, such as those of the 48 states. key issues that affect their work in the physical The Freedom From Smoking Classes will be T he settlement is subject to court review, healthcare environment. held for eight weeks at 6 p.m. every Thursday including providing consumers with notice and through October 13. The classes are free, but an opportunity to participate in, object to or opt CARTI Foundation Names registration is required. To register, call 501-660- out of the settlement. The states expect court New Board Members, Chair 7610 or email [email protected]. review will be provided by Judge Mitchell Gold- Six new members have been named to the CARTI berg of the Eastern District of Pennsylvania, who Foundation Board of Directors and will each serve Rutledge Reaches Settlement is currently overseeing other litigation concerning three-year terms leading the fundraising arm of with Cephalon Provigil against Cephalon and others. the statewide network of cancer care providers. Arkansas Attorney General Leslie Rutledge has New CARTI Foundation board members include: reached a settlement, along with 47 other states, UAMS Vice Chancellor Recognized • Representative Fred Allen, of Little Rock; with Cephalon and affiliated companies. The set- for Lifetime Achievement • Ann Freely, of Maumelle; tlement ends a multistate investigation into anti- Mark Kenneday, University of Arkansas for Medi- • Steve Jonsson, of Little Rock; competitive conduct by Cephalon to protect its cal Sciences (UAMS) vice chancellor of operations, • Charles Nabholz, of Conway; monopoly on the drug market, bringing in major recently received the Crystal Eagle award from • Mary Ellen Thompson, of Little Rock; profits for its landmark wakefulness drug, Provigil. the American Society for Healthcare Engineering. • Jan Zimmerman, of Little Rock. Due to its conduct, Cephalon delayed generic, Recognizing his lifetime achievement in health- Serving as CARTI Foundation board chair for cheaper versions of Provigil from entering the care engineering, the Crystal Eagle was pre- the 2016-2017 term is Phyllis Rogers, of Sherwood. market for several years. sented to Kenneday at the society’s 53rd annual Rogers is a senior vice president and chief finan- “ Arkansans deserve the benefits of a free mar- Conference and Technical Exhibition in Denver. cial officer at Delta Dental of Arkansas. ketplace, but unlawful actions like those of Ceph- The society is a membership group of the Ameri- The CARTI Foundation was incorporated in alon deceitfully keep prices high and harm con- can Hospital Association. 1983 as a non-profit organization to assist CARTI sumers,” said Attorney General Rutledge. “This Kenneday, a former president of the society, in meeting the current and future needs of Arkan- agreement holds Cephalon accountable and pro- has contributed to the field in multiple ways. He sas cancer patients and their families. vides important relief to consumers who overpaid authored the national “Health Facility Commis- for drugs as a result of Cephalon’s corruption.” sioning Guidelines” and has worked for better Cowan Invested in Linda T he settlement includes $35 million for distri- codes and standards regulating hospitals. Ken- C. Hodges Dean’s Chair bution to consumers who bought Provigil with neday also has inspired and mentored many facil- Patricia A. Cowan, PhD, RN, dean of the Univer- $673,734.84 going to Arkansas consumers. The ity professionals and has helped promote facility sity of Arkansas for Medical Sciences (UAMS) Col- State’s total recovery will be $502,779.05 consist- leaders into executive leadership. lege of Nursing, was invested Aug. 4 in the Linda ing of $235,928.25 to compensate for State pro- Kenneday earned a master’s degree in business C. Hodges Dean’s Chair. prietary claims and $266,850.78 for Arkansas’s administration and a bachelor’s degree in civil Cowan succeeds Lorraine Frazier, who left share of disgorgement and costs. engineering technology and construction man- UAMS last year, as both the chair and dean. As patent and regulatory barriers prevented agement, both from the University of Houston. As Cowan began at UAMS on Nov. 9, 2015. She generic competition to Provigil neared expiration, vice chancellor since 2008, he is responsible for came from the University of Tennessee Health Cephalon intentionally defrauded the U.S. Patent several hundred employees and oversees all cam- Science Center in Memphis where she served as and Trademark Office to secure an additional pat- pus facilities, engineering, construction, mainte- professor and associate dean for academic and ent, which a court subsequently deemed invalid nance, housekeeping, police department, and student affairs in the College of Nursing. and unenforceable. Before that court finding, occupational safety activities. An endowed chair is the highest academic Cephalon was able to delay generic competition More than 11,000 members count the American honor a university can bestow on its faculty. A

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chair can honor the memory of a loved one or may honor a person’s accomplishments. It is supported with donations of $1 million, with the chair holder using the interest proceeds for research, teaching or service activities. UAMS Chancellor Dan Rahn, MD, and UAMS Provost Stephanie Gardner, PharmD, EdD, presented Cowan with the chair medallion. Jean C. McSweeney, PhD, the college’s associate dean for research, said she felt certain UAMS would remain a leader in nursing education under Cowan’s leadership. Mikaila Wilson Calcagni Ryan E. Hall, MD Donna K. Hathaway, PhD, RN, Cowan’s mentor and a distinguished professor at the University of Tennessee Health Science Center, said her underlying passion for teaching and preparing the next Association, American Nurses Association, South- funds to establish a professorship to recognize generation of nurses would serve UAMS well. ern Nursing Research Society, and Sigma Theta Hodges’ leadership in the College of Nursing. It Cowan earned her Bachelor of Science in Nurs- Tau International. was later elevated to an endowed chair. ing at the University of Missouri and her Master Linda C. Hodges, EdD, RN, served as dean and of Science in Nursing at the University of Kansas. professor of the College of Nursing from 1989 Arkansas Mutual Awards She earned a doctorate in nursing science at the to 2006. During her tenure, the college greatly Scholarship to UAMS University of Tennessee. expanded its academic programs to include the Medical Student She has more than 30 years of experience in all state’s first online higher education academic Mikaila Wilson Calcagni, of Fayetteville, has been areas of nursing including academics, clinical prac- degree program, numerous master’s specialty awarded the Arkansas Mutual Medical Student tice and research. Her research interests include tracks, including the first nurse practitioner pro- Award, a scholarship for third-year medical stu- lifestyle interventions in overweight youth and gram in Arkansas, and the state’s only PhD in dents at the University of Arkansas for Medical adults and cardiovascular and metabolic outcomes. nursing program. Sciences (UAMS), who want to practice primary She participates in a multi-professional research In 2000, Daphine D. Doster, a pioneer in nursing care in rural Arkansas. team and is interested in translational research. education in Arkansas who was active in establish- The scholarship is funded by the Arkansas Cowan is a member of the American Heart ing the state’s first nursing school, bequeathed Mutual Insurance Co. in partnership with the UAMS College of Medicine to encourage more medical students to enter primary care fields such as family practice, general internal medicine, and pediatrics and to practice in rural Arkansas where Cowan Invested in Linda C. Hodges access to physicians is limited. Dean’s Chair Corey Little, CEO of Arkansas Mutual Insurance Co., the only medical liability insurance provider headquartered in Arkansas, said the company is deeply committed to improving rural healthcare in the state. More than two-thirds of Arkansas’ counties include federally designated Primary Care Health Professional Shortage Areas. Primary care physician shortages are projected to increase sub- stantially as the state’s population continues to age and require more medical care, and as more Arkansans, now insured as a result of health system reform, seek primary care services.

Hall Joins CARTI as Hematologist/Oncologist R yan E. Hall, MD, has joined the CARTI medical staff as a hematologist/oncologist, according to Jan Burford, CARTI president and chief executive officer. Prior to arriving at CARTI, Hall completed his fellowship in hematology/oncology at Wake Forest Baptist Medical Center in Winston-Salem, NC. HealthcareBriefs

A magnum cum laude graduate of the Uni- versity of Arkansas with a Bachelor of Science in Chemistry, Hall received his medical degree at the University of Arkansas for Medical Sciences in 2010. Hall performed his internship and residency at the University of Kentucky in Lexington where he also served as chief resident. Certified by the American Board of Internal Medicine and the Arkansas State Medical Board, Hall currently holds memberships in the Ameri- can Society for Clinical Oncology, the American S ociety of Hematology, and the American Col- Jerad M. Gardner, MD S ue T. Griffin, PhD lege of Physicians.

Gardner Named Deputy Editor-in-Chief Soft Tissue Pathology, International Society of Charles W. Smith, MD, director of Primary Care Jerad M. Gardner, MD, an assistant professor in Dermatopathology, and the United States and Services at UAMS, said the clinic offers the same the University of Arkansas for Medical Sciences Canadian Academy of Pathology. level of service and access to health profession- (UAMS) College of Medicine’s departments als as any UAMS primary care location, with addi- of pathology and dermatology, was recently Clarksville Woman Sentenced tional flexibility for walk-in patients. appointed as a deputy editor-in-chief of the for Medicaid Fraud The clinic will be led by Jennifer Dukes Casey, Archives of Pathology & Laboratory Medicine. Arkansas Attorney General Leslie Rutledge MD, who has most recently been practicing fam- He is the youngest in the journal’s 90-year his- announced the conviction of a Johnson County ily medicine at the UAMS clinic on Financial Cen- tory to receive the appointment. The Archives woman for Medicaid fraud. Sherry Wommack tre Parkway in West Little Rock. She graduated of Pathology & Laboratory Medicine, published pleaded guilty in Pulaski County Circuit Court. from UAMS with her medical degree in 2007. She monthly by the College of American Pathologists, Wommack was sentenced to three years’ proba- completed her residency at UAMS South Cen- is the most widely read pathology journal in the tion and ordered to pay a fine of $600. As part tral in Pine Bluff, serving as chief resident from world. of the sentencing agreement, she paid $5,606.75 2009-2010. “The lives of most practicing pathologists have in restitution to the Arkansas Medicaid Program been touched by Dr. Gardner directly or indirectly, Trust Fund. Two Join Baptist Health whether they know it or not,” said Philip T. Cagle, Wommack, 46, of Clarksville pleaded guilty Malvern Clinic MD, the journal’s editor-in-chief. “Dr. Gardner has to Medicaid fraud, a Class C felony. Wommack The husband and wife duo, Drs. Richard Chastain been the premier champion and visionary for the billed the Arkansas Medicaid Program for ser- and Laura Lester, have recently joined the medi- application of social media, mobile devices, and vices that were not rendered. cal team at Baptist Health Family Clinic-Malvern. other new technologies to diagnostic pathology The case was initiated by a referral from the Chastain, a Malvern native, received his bach- practice, professional and lay public education, Office of the Medicaid Inspector General and was elor’s degree in biology from Henderson State academic collaboration, professional society out- prosecuted in coordination with the 6th Judicial University and a bachelor’s degree in medical reach, patient support groups, and more.” District Prosecuting Attorney Larry Jegley. technology from the University of Arkansas for Gardner, a board-certified pathologist special- T o report Medicaid fraud or abuse or neglect Medical Sciences. He earned his medical degree izing in dermatopathology and bone/soft tissue in residential care facilities, contact the Attorney from the American University of the Caribbean sarcoma pathology, oversees social media strat- General’s Medicaid fraud hotline at (866) 810-0016 School of Medicine in St. Maarten, Netherlands egy and account management for the journal. He or [email protected]. Antilles. came to UAMS in 2012 and serves as program L ester, who grew up in Texarkana, Texas, and director of the dermatopathology fellowship pro- UAMS Neighborhood Clinic later moved to Lowell, Arkansas, attended the gram and clinical co-director of the musculoskel- Opens at Capitol Mall University of Arkansas in Fayetteville where she etal/skin block for the College of Medicine. The University of Arkansas for Medical Sciences completed a bachelor’s degree in biology. After Gardner’s research interests include bone and (UAMS) has opened a new UAMS Neighborhood medical school at Ross University School of Medi- soft tissue tumors and skin disease. He has lec- Clinic at Capitol Mall offering scheduled appoint- cine in Dominica, West Indies, she returned to tured internationally on the topics, as well as ments and walk-in friendly, high-quality primary Arkansas for her residency. speaking to healthcare professionals locally and care services in downtown Little Rock. Both Lester and Chastain completed their fam- across the country on how to use Facebook, Twit- The clinic, 1401 W. Capitol Ave. Plaza E (in the ily medicine residency at UAMS Northwest in Fay- ter and Instagram professionally. He’s published Victory Building), is open from 8 a.m. to 5 p.m. etteville and both physicians are members of the multiple peer-reviewed articles and authored 30 Monday through Friday and offers primary care American Academy of Family Physicians. textbook chapters. for patients of all ages, including: He is a member of the American Society of Der- • Treatment for mild or severe illnesses that Griffin Honored with Lifetime matopathology, Arkansas Dermatological Society, arise unexpectedly Achievement Award Arkansas Medical Society, College of American • Annual exams and preventive care University of Arkansas for Medical Sciences Pathologists, International Society of Bone and • Management of ongoing medical conditions. (UAMS) researcher Sue T. Griffin, PhD, recently

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received the Lifetime Achievement Award from improving quality of life. Motwani will oversee the the Alzheimer’s Association at its International hematology fellows who will see patients in clinic Conference in Toronto. each week. Griffin has made groundbreaking contributions Davis received her medical degree from the in the study of Alzheimer’s disease and other neu- University of Oklahoma College of Medicine in rodegenerative conditions. She is the Alexa and Oklahoma City. She completed residency in inter- William T. Dillard professor in geriatric research, nal medicine and pediatrics in 2014 and fellow- director of research at the Donald W. Reynolds ship in hospice and palliative medicine this year, Institute on Aging at the University of Arkansas for both at UAMS. Medical Sciences and the founding chief editor Motwani received her medical degree from of the Journal of Neuroinflammation. Grant Medical College in Mumbai, India. She Robin Devan, MD Her pioneering work included the discovery of completed residency in internal medicine at a type of inflammation in the brains of Alzheim- Mount Sinai School of Medicine’s Bronx Program er’s patients. Griffin went on to show how this in New York City and a fellowship in hematology inflammation contributes to formation of amyloid and medical oncology through Tufts University plaques, neurofibrillary tangles, and Lewy bod- School of Medicine at Baystate Medical Center ies in Alzheimer and Parkinson brains as well as in Springfield, Massachusetts. its connections to genetic differences that confer greater risk of the disease in certain individuals. Jones Installed as AAHP President Her current work is building toward therapy Kendrea Jones, PharmD, of Little Rock, was with a team-oriented exploration of novel drugs installed as President of the Arkansas Pharmacists to combat these molecular and biochemical Association’s (APA) Arkansas Association of Health- processes. System Pharmacists (AAHP) Academy at its 134th Griffin’s perseverance has been an asset. In Annual Convention. She is a clinical pharmacist at 1986 when she joined UAMS, Griffin was hav- Arkansas Children’s Hospital and an associate pro- ing a hard time attracting interest in her theory fessor at UAMS College of Pharmacy. Pooja Motwani, MD about Alzheimer’s disease. In 1989, she published Jones is a member of APA, the American Soci- a landmark study describing how neuroinflamma- ety of Health-System Pharmacists (ASHP), the tion provokes an out-of-control immune response. American Association of Colleges of Pharmacy, Many scientists have since confirmed her findings, the Society of Critical Care Medicine, and the and today most in the field accept her theory, and American College of Clinical Pharmacy the Alzheimer’s program at UAMS has earned She received her doctor of pharmacy from NIH grant awards continuously since 1991. the University of Arkansas for Medical Sciences (UAMS) and has completed a Pharmacy Prac- Devan Joins Arkansas Hospice tice Residency at Methodist University Hospital Dr. Robin Devan of Little Rock has joined Arkan- in Memphis and a Critical Care Specialty Resi- sas Hospice as a physician for the central Arkan- dency at Texas Tech University Health Sciences sas area. Devan graduated from the University of School of Pharmacy. Arkansas for Medical Sciences in 2008. She completed her residency in internal medicine in 2011 Guhman to Step in Temporarily to and a fellowship in hospice and palliative Care Oversee Division of Youth Services Megan Davis, MD in 2012. The Arkansas Department of Human Services She was an assistant professor of palliative care (DHS) announced that Betty Guhman will serve at the Winthrop P. Rockefeller Cancer Institute as the Interim Director of the DHS Division of and University of Arkansas at Medical Sciences Youth Services while the agency searches for a hospital, and the director of the UAMS Adult permanent director. Guhman, a native Arkansan, Sickle Cell Clinical Program before joining Arkan- has served as a senior advisor to Governor Asa sas Hospice. Hutchinson since 2014 with a particular focus on the Department of Human Services in general Motwani, Davis Named Co- and child welfare. Directors of Sickle Cell Program Guhman began her career as a protective ser- Pooja Motwani, MD, and Megan Davis, MD, have vice worker for what is now the DHS Division of been named co-directors of the Adult Sickle Cell Children and Family Services in 1973. In 1977, she Clinical Program at the University of Arkansas for was named Deputy Commissioner of the newly Medical Sciences (UAMS). formed Division of Youth Services. These positions Kendrea Jones, PharmD In addition to overseeing the program as co- were the beginning of a long career in public ser- directors, Davis will lead the palliative care part vice, including time as a tenured professor at the of the clinic, focusing on relieving symptoms and University of Arkansas’s Department of Sociology,

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 45 HealthcareBriefs

Criminal Justice and Social Work and the Director W e’re going to look at those environmental and an August 23 presentation. of the Fullbright School of Public Affairs. She also behavioral factors and then delve more into the The check was presented by Donnie Cook, served as a Chief of Staff when Hutchinson was metabolic and physiological aspects.” Arkansas state president and Little Rock mar- a Congressman and as Chief of Staff and advisor Based on what they learn from the existing data, ket president for Bank of America, to Stephanie when he served as first Undersecretary of the U.S. the researchers will then build an in-depth survey Gardner, PharmD, EdD, UAMS provost and chief Department of Homeland Security. to administer to parents of 200 children between academic officer, and Billy Thomas, MD, vice Guhman is a graduate of Springdale High the ages of 7 and 10. chancellor for diversity and inclusion. School, has a Bachelor’s in Social Work from the The children will also undergo fitness and activ- Braylon Camper, a sophomore at the University University of Arkansas and a Master’s of Social ity testing in the Physical Activity and Energy of California, Los Angeles, first became involved Work Administration from the University of Arkan- Metabolism Lab at ACRI and Arkansas Children’s with the Center for Diversity Affairs in eighth sas at Little Rock. Nutrition Center (ACNC), led by Elisabet Bor- grade, via its Bridging the Gap program. This sheim, PhD, study co-investigator and an associ- summer, he worked alongside Parimal Chowd- West Memphis Woman ate professor of Pediatrics in the UAMS College hury, PhD, professor in the Department of Phys- Sentenced for Medicaid Fraud of Medicine. iology and Biophysics in the UAMS College of Arkansas Attorney General Leslie Rutledge The children in the study will wear accelerom- Medicine, studying cell culturing and the effects announced the conviction of a Crittenden eters for a week to assess their free activity and of microgravity on rats. County woman for Medicaid fraud. Lacasha their sleep patterns. Researchers will also study A small portion of the gift is designated for the Perry pleaded guilty in Pulaski County District their responses to strength and treadmill tests, UAMS Chancellor’s Circle. The Chancellor’s Circle Court. Perry will pay a fine of $2,916. She was also gauging the children’s metabolic health in rela- is UAMS’ premier annual giving society that pres- ordered to pay $972 in restitution to the Arkansas tion to their activity and overall fitness. ents grants each year to areas of greatest need. Medicaid Program Trust Fund. Weber and Borsheim believe the study will Thirteen grants were awarded this year. Perry, 36, of West Memphis was arrested by reveal the conditions specific to Arkansas that can “Investing in a diverse workforce is just one of agents of the Attorney General’s office in March. be changed to reduce obesity rates and improve the ways we’re addressing issues fundamentally She pleaded guilty to Medicaid fraud, a Class A overall child health. connected to economic mobility,” Cook said. misdemeanor. Perry billed the Arkansas Medic- “You can’t change genetics, but you can change “Through this grant, we look forward to helping aid Program for services that were not rendered. behaviors,” Weber said. “We want to see if liv- UAMS Center for Diversity Affairs promote the The case was initiated by a referral from the ing in a rural environment is really more of a risk diversity of workforce in health professions.” Office of the Medicaid Inspector General and was factor, and if these families had better access to Other Bank of America guests at the presenta- prosecuted in coordination with the 6th Judicial sidewalks, parks or school gymnasiums, if it would tion included John Dominick, senior vice presi- District Prosecuting Attorney Larry Jegley. make them healthier and more physically fit.” dent; Heather Albright, vice president-small busi- Until now, there has been little background or ness banking; and Karil Greason, assistant vice ACRI, UAMS Scientists foundational research conducted on the specific president. Investigating What Makes characteristics of the state that influence obe- Bank of America has given nearly $400,000 to AR an Obese State sity rates. UAMS in recent years and has supported the S cientists at Arkansas Children’s Research Institute The study closely aligns with Gov. Asa Hutchin- Center for Diversity Affairs for the past five years (ACRI) and the University of Arkansas for Medical son’s Healthy Active Arkansas plan, and will inform for recruitment, retention and graduation of stu- Sciences (UAMS) have received a $1.4 million grant strategies to address child obesity statewide, rang- dents, particularly economically disadvantaged from the USDA to find out why obesity rates in ing from creating denser and more livable commu- students, to meet the future medical needs of Arkansas are among the worst in the nation. nities to ensuring schools offer ample opportuni- the state. T he “Arkansas Active Kids!” study, funded ties for physical activity throughout the day. This gift supports the center’s summer enrich- through the USDA’s Agricultural Research Ser- “The most important part of this research ment programs, which benefit students through- vice, will include two phases over four years. First, will be the interventions it leads to,” Borsheim out Arkansas. These programs are designed to researchers will analyze existing datasets from added. “We are purposefully trying to connect strengthen science, math, literacy, and test-taking the National Survey of Children’s Health and The the behavioral and physiological aspects of the skills. In addition, the programs give students an Youth Risk Behavior Surveillance System to see study to create healthier tomorrows for all the introduction to the many health career options what environmental factors predispose Arkansans children of Arkansas.” at UAMS and include mentored research, the to obesity and suggest how those can be modi- Preliminary work to support the project was Summer Science Discovery Program, Bridging fied. They’ll be looking for sociodemographic and funded by USDA-ARS Project 6026-51000-010- the Gap, ACT Preparation, and Undergraduate environmental characteristics that affect children’s 05 and by the Arkansas Biosciences Institute, the S ummer Science Enrichment Program I and II. activity and fitness levels. major research component of the Tobacco Settle- This summer, more than 180 students have been “We want to know, when we look at Arkansas ment Proceeds Act of 2000. exposed to health careers in the UAMS colleges alone, or when we look at the Delta region of the of Health Professions, Medicine, Nursing, Phar- U.S. alone, does that picture look different from Bank of America Supports macy, Public Health and the Graduate School. the national picture?” said the study’s principal UAMS Diversity Programs Bank of America has also given support for pro- investigator, Judith Weber, RD, PhD, director of Bank of America continued its support for the grams that serve low-to-moderate income popu- ACRI’s Childhood Obesity Prevention Research University of Arkansas for Medical Sciences lations at the UAMS Donald W. Reynolds Institute Program and a professor of Pediatrics at UAMS. (UAMS) with a $24,500 corporate foundation gift on Aging and Department of Family and Preven- “Is there something unique about Arkansas? given to the UAMS Center for Diversity Affairs at tive Medicine.

46 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

Arkansas Hospice traumatic events, and the new knowledge from Names New CMO the fast emerging sciences of resilience and brain Brian Bell, MD, has joined Arkansas Hospice as development/ neuroplasticity. We can, and need vice president and chief medical officer. He is a to, establish a focus on better preparing individu- native of Little Rock and a graduate of the Uni- als, the family unit and communities, to face chal- versity of Arkansas for Medical Sciences. He is lenges to their emotional and mental wellness,” board certified in family medicine and hospice said NDBH President Jan Kasofsky, Ph.D. and palliative medicine, and has worked in hos- NDBH conference participants will hear from pice since 2006. and interact with national experts to explore and Bell was previously the palliative care medical identify new preventive approaches to mental director for Spartanburg Regional Medical Center wellness and resilience. Speakers will focus on in Spartanburg, South Carolina. He also started Brian Bell, MD understanding the biological and behavioral the first palliative medicine fellowship program in responses to trauma and discuss how to pre- South Carolina and served as its program director. emptively implement normalized interventions. expertise and skills in implementation science, The pre-conference program begins Sunday, NIH Awards Early Career Grants child and community nutrition, and community October 23, 9:30 a.m.-3:30 p.m. and explores the to Two UAMS Researchers engagement. To help achieve her goals, she will science and literature of personal, family, and com- University of Arkansas for Medical Sciences take part in a comprehensive plan of mentored munity resilience and looks at the practical appli- (UAMS) early career researchers Joshua Kennedy, research, didactic education, cross-disciplinary cations of specific techniques to strengthen both MD, and Taren Swindle, PhD, are recipients of collaborations, and structured field studies. individuals and communities. A morning panel dis- National Institutes of Health (NIH) grants that will Kennedy and Swindle said their awards were cussion on October 24 will feature a presentation support their work over the next several years. made possible by two years of research support on the underlying neurobiological, genetic adapta- In May, Kennedy, whose laboratory is at Arkan- and training they received through the UAMS tions, and the research-based therapeutic interven- sas Children’s Hospital Research Institute (ACHRI) Translational Research Institute’s KL2 Mentored tions for trauma and stress that can be exploited on the Arkansas Children’s Hospital campus, R esearch Career Development Scholar Award for interventions to promote mental wellness and received notice of a five-year $877,000 NIH Program. Kennedy and Swindle were selected resilience. The afternoon session will focus on how National Institute of Allergy and Infectious Dis- for the competitive KL2 program in 2013 and resilience involves more than just “bouncing back” eases K08 Award. He is an assistant professor of 2014, respectively. and includes the ability to cope with unanticipated internal medicine and pediatrics, UAMS College T he KL2 has provided Swindle with training shocks and disasters. Some strategies include: risk of Medicine Department of Pediatrics, Division of experiences in nutrition, grant writing, and quali- analysis, integrated and holistic approaches, part- Allergy and Immunology. tative methods that were critical to her concep- nerships, knowledge management, and a social Swindle, an assistant professor in the College tualization of the K01 grant and strengthening capital focus. of Medicine Department of Family and Preven- her qualifications as a K01 candidate, she said. On October 25, the goal of the morning session tive Medicine, was recently notified that she will is to understand how resilience can be promoted receive a four-year, $442,583 NIH National Insti- National Behavioral Health at different stages of life, from early childhood tute of Diabetes and Digestive and Kidney Dis- Conference Scheduled through old age. The afternoon session will share ease K01 Award. in New Orleans approaches that can be used to build commu- Kennedy’s grant provides salary and laboratory The 2016 National Dialogues on Behavioral nity resilience including social cognitive theory support for his investigation into how allergies Health’s (NDBH) 57th annual conference will be approaches such as self-efficacy and self/human and rhinovirus infections (common colds) work in held in New Orleans at the Renaissance Arts Hotel agency as they pertain to resilience. There will tandem to create life-threatening symptoms for in New Orleans from October 23 through 26. The be additional presentations on the use of tech- people with asthma. He will work with patients conference theme is “Promoting Individual, Family nology related to the ability to identify hot spots who experience critical asthma symptoms as a and Community Mental Wellness and Resilience.” for focusing efforts to build community resilience. result of rhinovirus infections and allergies, and he The focus of the conference is to identify short- Presenters will also explore the use of existing will conduct laboratory experiments on donated and long-term solutions to maintaining mental and emerging technologies that are supporting lung tissue. wellness by applying research-based approaches initiatives related to personal and community The K08 Award program is an intensive, super- for communities and across the lifespan of indi- resiliency including GIS systems, analytics, and vised research career development experience, viduals and their families. Early registration is smart phone applications. preparing clinical researchers such as Kennedy encouraged. The program will conclude with a morning dis- for careers that have a significant impact on the “Mental health experts are frequently called cussion of social and mass media campaigns health-related research needs of the country. upon at the time of a crisis to diagnose and addressing critical factors targeting individual and Swindle’s research involves the study of a child- treat a problem, but rarely are they preemptively community resilience. Specific examples will be care-based nutrition intervention and develop- sought out to use their knowledge to “inoculate” shared along with available outcome data from ment of a strategy for implementing the inter- individuals, families, and communities, to pro- these efforts. vention. She will pilot test the implementation tect and preserve community safety and men- Conference registration and a more detailed strategy and the intervention’s effect on child tal wellness. It is time to change this illness/dis- listing of topics and presenters, including health outcomes. ease-based approach by pre-emptively applying national speakers, is available at www.national- The K01 award is designed to advance Swindle’s therapeutic interventions commonly used after dialoguesbh.org. n

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 47 dialogue

column Director’s Desk

of those attempting suicide. TheCDC began researching the phenomenon of suicide clusters as far back as 1987. Clusters appear to be especially frequent in adolescents and young adults, which is why efforts are now Suicide underway to educate those who work with youth on how to properly address the issue.

Prevention First Comes Awareness of the Problem ADH is taking the public health approach by In 2013 suicide became the leading cause first making the public aware of the problem. The department is providing data and of violent death in Arkansas, and in 2014 informational resources to a variety of me- there were 503 Arkansans recorded as dia outlets to alert the public to the large number of suicides in the state. As the public dying by suicide, according to data from becomes more aware of the issue, so too do they become more willing to seek knowl- the Office of Vital Statistics at theA rkansas edge on preventative measures. Awareness also helps to remove some of the stigma Department of Health. By comparison, in associated with suicide and mental illness the same year 206 were reported to have and encourages the public to seek assistance. Another important step in raising awareness died by homicide. On a national level, the is making sure that Arkansans know they have a National Lifeline at their disposal CDC reports that Arkansas ranks 15th in 24/7 with 1-800-273-TALK. This number in- the nation in our suicide death rate. sures that Arkansans always have someone to listen in times of crisis.

We Must Next Provide Prevention Education Suicide among youth and young adults those between the ages of 10 and 24. The next step for addressing suicide as a is a special concern because they have a The plan for utilizing this grant will in- public health issue is providing education higher rate of suicidal ideation as compared clude increasing awareness of the prob- on prevention to mental health profes- to those over the age of 25. To better as- lem of suicide, introducing the public to sionals, educators, and the general public. sist in addressing this issue, Arkansas was the National Lifeline (1-800-273-TALK), We want to make sure people realize that awarded the Garrett Lee Smith Memorial helping to destigmatize those who are in suicide prevention can be done by anyone, Suicide Prevention Grant from the Sub- crisis and seek assistance, and providing regardless of occupation or level of educa- stance Abuse and Mental Health Services educational opportunities for both clini- tion. We are developing programs that will Administration (SAMHSA) in 2014. This cians and laypeople who are interested in teach suicide prevention to youth, adults in grant provides $3.6 million over a period of learning about suicide prevention. Treat- educational professions, first responders, five years to address the needs ofA rkansans ing suicide as a public health problem has mental health professionals, and anyone for suicide prevention, particularly among helped other states to decrease the numbers who has an interest in suicide prevention.

48 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK Nathaniel Smith, MD, MPH Director and State Health Officer, Arkansas Department of Health

Education will be presented in both digital and in-person formats to reach a greater audience. Topics will include not only how to recognize the signs and risk factors for suicide, but also how to intervene in times of crisis, how to seek appropriate help, and what to do after an attempt occurs. Pro- tocols for safety planning and models for suicide prevention policies for schools and facilities are already available for those who are prepared to implement strategies to prevent suicide. The programs being implemented byADH are evidence based, which means they have been demonstrated to decrease suicides and suicidal behaviors in those engaged by the programs. Although Arkansas has seen an increase in suicides in recent years, with the implementation of these new programs and the connections that ADH is building with the community, we are hopeful that we will begin to see these numbers decline. Below is a list of groups we are connect- ing with: National • VA of Arkansas—working on planning the veterans’ mental health summit, educating lifeline their community action boards (CABs) on 1-800-273-talk suicide prevention • Mental Health Council of Arkansas— working together on the first ever suicide prevention camp at Camp Aldersgate this year • Governor’s Suicide Prevention Council “Clusters appear to be especially • Arkansas Suicide Prevention Network (ASPN) frequent in adolescents and • Arkansas EMS Association young adults, which is why efforts • Arkansas Department of Education—collaborating on model policies and providing are now underway to educate trainings those who work with youth on how • ADH Hometown Health Improvement— to properly address the issue.” collaborating on injury prevention trainings • Arkansas Minority Health Commission— sponsoring a conference. n

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 49 column policy

Today eight people will be killed by an avoidable tragedy. They will be killed by distracted drivers, and sadly they will become a statistic. Personally, I can think of two times that I unintentionally ran a red light. Both of these times I was using my cell phone, both of these times I was distracted, and both times I could have contributed to these statistics. Keep Your Eyes on The Road: the High Stakes of Distracted Driving

In Arkansas and across the United into three categories: visual (removing eyes (as little as five seconds), you have traveled States, there has been a lot of progress made from the road), manual (removing hands the length of a football field. The margin for over the years to combat drunk driving, pro- from the steering wheel), and cognitive error is simply too great for you to take your mote proper use of car seats, and remind (thinking about things besides driving). These eyes off the road. the public to always wear a seatbelt. How- distractions can arise from a number of ev- While nearly every driver has been guilty ever, the growing safety issue of distracted eryday actions, including use of cell phones, of distracted driving at some point, research driving is often overlooked. According to personal grooming, interaction with naviga- from Distraction.gov shows that ten percent a report by the National Highway Traffic tion systems, talking to passengers, smoking, Safety Administration (NHTSA), 3,179 people and even hunting Pokémon. were killed and an estimated 431,000 were The National Occupant Protection Use injured in motor vehicle crashes involving Survey (NOPUS) reports that at any given distracted drivers in 2014. Locally, the Bryant moment across America, approximately Police Department reports over 20 percent 660,000 drivers are using cell phones or of their 500 plus accidents were caused by manipulating electronic devices while distracted driving. driving; this number has held steady since The NHTSA defines distracted driving as 2010. Texting is the most dangerous form happening when drivers divert their attention of distracted driving as it involves physi- from driving and focus on another activity. cal, visual and mental distractions. Consider The Centers for Disease Control (CDC) goes this from the CDC: when traveling at a rate even further and breaks these distractions of 55 MPH, in the time it takes you to text

50 SEPT / OCT 2016 I Healthcare Journal of little rock Joseph W. Thompson, MD, MPH Director, Arkansas Center for Health Improvement

“...when traveling at a rate of 55 MPH, in the time it takes you to text (as little as five seconds), you have traveled the length of a football field.”

school zones and highway work zones and school bus drivers from cell phone activity at any time. These are considered “primary offenses,” which means a state trooper, police officer or sheriff’s deputy can initiate a traffic stop without observing any other traffic violation, regardless of the driver’s age. In addition, Arkansas’s graduated driver’s license prohibits any driver under the age of 18 from all cell phone activity and drivers aged 18-20 must use a hands-free device. The best way to end distracted driving is to educate all Americans about the danger it poses. Make a pledge to lead by example and of all drivers aged 15 to 19 years old involved mistakes while operating a vehicle. refrain from texting or talking on the phone in fatal crashes were reported as distracted Distracted driving has become a key is- while driving. Consider making a family at the time. This goes up for drivers in their sue for policymakers at both the state and pledge or setting up a contract with your chil- 20s where 27 percent of drivers involved national level. The U.S. Department of Trans- dren to motivate them to follow safety rules. in fatal crashes were distracted. Distracted portation has launched Distraction.gov to Explain to minors that driving is a privilege drivers also endanger pedestrians and cy- bring attention to this issue, including a na- that will be taken away if rules are not fol- clists. There were 520 nonoccupants killed tional campaign directed at texting while lowed. Distraction.gov has an online pledge in distraction-affected crashes in 2014. driving called “U Drive. U Text. U Pay.” Due that you and your family members may sign Even proficient drivers with years of ex- to the potential dangers of distracted driv- to pledge against distracted driving. perience behind the wheel are in danger, ing, laws have been put into place across Most importantly, speak up if you find particularly with the rise in technology the country that result in punishments in- yourself as a passenger in the car of a dis- and its use in personal vehicles. People of cluding fines and license suspensions. Forty tracted driver and commit to telling oth- all ages are using a variety of hand-held de- six states have banned texting while driving ers about the dangers of distracted driving. vices, such as cell phones and navigation for all drivers, and 14 states have prohibited Drunk driving and seatbelt use are com- devices, when they are behind the wheel. hand-held phone use by all drivers. monly discussed; let’s make distracted However, hands-free devices may provide a Arkansas law prohibits the use of a hand- driving as high of a priority. Drive safely false sense of safety. Although these devices held cell phone for texting, typing, email or and keep yourself alive—no distractions, do not involve a visual or physical distrac- accessing the internet while driving, regard- cell phones, texting, reading, grooming, tion, the cognitive interruption can easily be less of the driver’s age. Arkansas prohibits or passenger disruptions! The fight to end enough to result in drivers making crucial all drivers from using hand-held phones in distracted driving starts with each of us. n

Healthcare Journal of little rock I SEPT / OCT 2016 51 dialogue

column quality

I’m happy to say that there is great interest in this topic here in Arkansas. On June 21, a capacity crowd gathered at the Embassy Curbing the Suites in Little Rock to attend the 2016 Gov- ernor’s Quality Award Health Care Seminar, of Costs Produces which the Arkansas Foundation for Medical Care (AFMC) is an overall sponsor. This year’s theme was “From Genetic Codes to Zip Codes: Linking Quality Health Care and Healthy En- Better vironments.” Organized by Sue Weatter at the State Chamber of Commerce, the conference showcased what organizations inside and out- Population side the health care industry are doing to address population health. Jayme Mayo, wellness director at Nabholz Construction Company in Conway, gave the Health most impressive presentation of the day. She talked about the company’s highly successful Finding ways to curb rising health care costs employee wellness program that has saved the company millions in health insurance costs. seems to be in the forefront of everyone’s mind But success didn’t happen overnight. Mayo and the executives at Nabholz learned through these days, and more attention is being paid to trial and error that hosting 5K runs and cook- population health as a result. Researchers, public ing classes weren’t the key to lowering choles- terol and blood pressure numbers, or even get- health officials and health care providers are ting employees to participate in the program. becoming more aware that programs and policies Educating employees on how to make healthier choices wasn’t enough. outside of the exam room and the hospital ward are Once the wellness program’s focus shifted from outputs to outcomes and leaders found key to making people healthier and turning the tide the right incentives for their employees (an- on the nation’s high rates of obesity and chronic nual bonuses, retaining company-paid insurance premiums), they saw participation sky- disease. Better health behaviors lead to better rocket and health indicators improve. It was outcomes and reduce demand on the health care the combination of education, care coordination, and incentives that brought about real system. But to accomplish change on a wide scale, improvement. The effort is even more impressive when we must address the social and economic barriers you think about the fact that the majority of to good health. their employees are burly construction men who may not be the most receptive to change. Nabholz’s success in getting their employees healthier should be a model for all employers.

52 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK Ray Hanley President and CEO, Arkansas Foundation for Medical Care

Taking a hard look at neighborhoods Rock were worse than in Little Rock. As part of his presentation, Kruse relat- Trent Haywood, MD, JD, and chief medi- Viewing health status data through this ed his experiences as a former hospital ad- cal officer of the Blue Cross Blue Shield As- lens brings existing health disparities and ministrator in St. Joseph and how the com- sociation (BCBSA), gave an eye-opening their causes into sharp focus, and can help munity was able to come together to create presentation about social determinants of policy makers and providers tailor interven- innovative programs to address barriers to health. We’re all aware of the annual state tions to the specific needs within that zip health care access. It’s a good lesson on how and county health rankings that various or- code. Simply requiring people to maintain former competitors can learn to collaborate ganizations release in regard to obesity and a healthy lifestyle without recognizing and and improve access in a fairly rural com- other indicators. Haywood’s presentation, lowering the barriers beyond an individual’s munity with a lot of challenges, including a “Zip Code Patterns: Geographic Traits or control is setting them up for failure. large number of people with low socio-eco- Geographic Behaviors?” showed that there Effectively addressing these disparities nomic status. The presentation also illus- are wide variances in health status even is vital. The cost to the entire health care trates how health care providers can unite within a city, and that environmental, eco- system and society should be recognized with businesses to improve health care ac- nomic, and social factors have a far-reach- and dealt with, and programs like Arkan- cess and community resources. ing influence on health. sas Works is one key element. Having af- Other seminar presenters included a panel Haywood and BCBSA have developed fordable health insurance coverage is one on affecting population health in Arkansas. a web-based mapping program that uses way to help close health disparities. Alan Nichols, CEO of Mainline Health Sys- publicly available data along with BCBSA tems in Dermott, discussed ways the feder- claims data to show how factors such as Coming together for change ally qualified health center addressed the access to transportation, grocery stores The conference closed with a presentation physical, social, and mental health needs of and primary care providers correlate to a by Lowell C. Kruse, former president and its rural population. Shanda Guenther, chief population’s health status within a zip code. chief executive officer of Heartland Health quality officer of Northwest Medical System One example Haywood gave was to com- in St. Joseph, Mo. Kruse is also the current in Fayetteville, talked about increasing ac- pare the number of primary care providers chairman of the board for Communities of cess for Hispanic and Marshallese popula- within a half-mile radius of bus stops in Lit- Excellence 2026, a nonprofit organization tions. Denny Ledford, administrator of Shiloh tle Rock and North Little Rock. In the Little developing the adoption of Baldrige Award Nursing and Rehab in Springdale, described Rock example, the number of providers was principles for communities interested in the facility’s efforts to change its culture to be around 200. At one North Little Rock stop, building the civic infrastructure to tackle more resident-centered and to prevent hos- there were zero. Not surprisingly, the health social, economic, and environmental bar- pital readmissions. In a separate presenta- status indicators in that area of North Little riers to health. tion, Marisha DiCarlo, PhD, MPH, and director of the Office ofH ealth Communications for the Arkansas Department of Health, gave an overview of Healthy Active Arkansas and “Simply requiring people to how seminar attendees could get involved with the statewide effort. maintain a healthy lifestyle While moving the needle on population without recognizing and health may seem like an insurmountable lowering the barriers beyond task, given the great obstacles we face as policymakers and health care providers, this an individual’s control is year’s seminar showed that there are tools setting them up for failure.” and resources available, as well as a variety of best practices. Our challenge now is to make the best use of them. n

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 53 dialogue

column medicaid

Over the last few years, Arkansas has been at the forefront of national efforts to create better payment mechanisms for primary care. We were one of seven regions to be selected for a national multi-payer Patient Centered Medical Home (PCMH) demonstration sponsored by Medicare. Subsequently, Arkansas payers, including Medicaid, expanded this concept to all primary care sites in the state, including pediatrics. This summer, the Center for Medicare & Medicaid Services selected Arkansas as one of 14 regions for the next phase of its primary care payment reform efforts, Comprehensive Primary Care Plus (CPC+).

New payment models, CPC+ live voice access so that patients can discuss set the stage for a acute issues with a health professional by phone at night and on weekends rather than going to the emergency department. It also requires practices to identify high-risk pa- Primary Care tients and create care plans for coordinated management of these patients with multiple medical issues and social challenges. TheA r- Renaissance kansas PCMH program now has nearly 900 physicians and few practice sites have been removed from the program due to failure to meet expectations of this transformation process. It is no secret that primary care of the least compensated specialties in the On top of this new infrastructure support, has struggled to sustain its workforce, espe- medical profession. It is no wonder then that Arkansas PCMH offers shared savings bo- cially in rural and social-economically chal- new students look elsewhere for profession- nuses for practices that offer comprehensive lenged neighborhoods. Overhead costs con- al goals and practice aspirations. care that also reduces expected healthcare sume more than half of a practice’s revenue, We have perhaps reached a tipping point inflation. Judicious use of radiology, con- and many practices survive by high-volume, in rethinking primary care. The PCMH in- sultation and prescriptions as well as good quick visits that often neglect chronic dis- creases prospective per-member, per-month follow-up to reduce use of the emergency ease management and preventive services. payments to support overhead in the busy departments and hospital days can result in Burnout amongst physicians and profes- primary care clinic. These new dollars do lower risk-adjusted total costs for a prac- sional support staff in primary care is not not represent extra compensation, per se tice panel and substantial bonus payments in uncommon. Many healthcare professionals but rather are an investment in transform- shared savings year-over-year. Last year, the find that the practice environment of pri- ing infrastructure to move practices from Arkansas Medicaid PCMH program awarded mary care does not support the ideals and dependence on quick, acute-care visits to nearly $8 million in shared savings bonus concepts that they learned in training and more comprehensive, longitudinal care. For payments while the program reduced ex- desired to implement in day-to-day prac- example, the Arkansas PCMH program re- pected healthcare cost growth to more than tice. Furthermore, primary care remains one quires practice sites to offer round-the-clock cover these extra dollars to practice sites.

54 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK William Golden, MD Arkansas Medicaid Medical Director

to managing high-volume patient flows to achieve revenue targets. Many are cau- tiously optimistic that these new payment approaches can reduce administrative burden by greater use of prospective payments that reduces documentation needs for every visit while the same time creating better patient centered care that results in better outcomes at a lower cost with greater patient satisfaction. We are still in the early stages of payment reform in healthcare. There are many emerging models for payment and in practice organization. Many physicians have given up independent practice and become salaried professionals within healthcare systems. The distribution of financial incentives within a healthcare system is still a work in progress. E lectronic medical records still function “For example, the Arkansas PCMH program mostly as billing systems and not tools for requires practice sites to offer round-the-clock effective panel management for population health oriented clinicians. Nevertheless, the live voice access so that patients can discuss uptake in Arkansas for these new approaches acute issues with a health professional by is strong and promising for a renaissance in phone at night and on weekends rather than primary care. As our state’s experience has been watched closely throughout the United going to the emergency department.” States, we are a laboratory for new ways of structuring primary care to our communities. It is clear that the old framework has failed CPC+ will expand upon these concepts to be little interest in doing the work to health professionals and patients and there when it starts up in 2017. This new multi- transform their daily operational routine is a growing communal sense of looking for payer Medicare program will offer two to a more comprehensive, longitudinal ap- and developing a new way for the future. n tracks with shared savings paid upfront for proach. This avoidance of new frameworks expected utilization metrics. New prospec- could well prove to be detrimental to those tive Medicare dollars are substantial, and practice sites. Increasingly, these payment Bill Golden, MD, Professor of Medicine at UAMS, holds a secondary appointment in the COPH De- practices in Arkansas are able to apply for reforms will give a significant financial ad- partment of Health Policy and Management and has this five-year program until mid-September vantage to participating primary care clinics. been appointed to serve as a member of the guid- ing committee for the national Health Care Payment 2016. TheA rkansas payer community will be CPC+, in fact, exempts participating practic- Learning and Action Network. The network, which is working to offer coaching support as well as es from the new MACRA requirements that under the federal Centers for Medicare & Medicaid Services (CMS), was convened to identify payment common metrics to reduce administrative are perplexing many physicians who care models and reforms that will lead to better care at burden to practice sites. Interest appears to for Medicare patients. Transformation has lower costs – primarily by tying health care payments not to services but to value and quality of patient be strong. frequently led to greater professional sat- outcomes. Dr. Golden, who has been a leader in state There are a few practices that are resist- isfaction by a site’s physicians, nurses, and and national efforts to move towards payment mod- ing the opportunity to sign up for these other support staff as they work as a team els that emphasize value over volume, also serves as Medicaid Medical Director for the Arkansas Depart- new payment approaches. There appears to meet the needs of patients, as opposed ment of Human Services.

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 55

hospitalrounds hospital news and information

Nancy Embry, RN, and Barbara Malott, Conway Nurses RN, of Conway, both lactation specialists Achieve in the Conway Regional Women’s & Infants’ Department, recently earned their International International Board Certified Lactation Lactation Consultant credentials (IBCLC). Credentials Story continued on page 58

ABOVE Lactation consultants Barbara Malott, RN (left) and Nancy Embry, RN, (right) celebrate their newly-acquired International Lactation Consultant Certifications. They are shown with Mary Salazar, RN, Director of Conway Regional’s Women’s and Infant’s Services.

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 57 HospitalRounds

Steely Opens Conway Clinic Baptist Health Selected to Join Donald E. Steely, MD, of Conway, an inter- Baby-Friendly Hospital Initiative ventional cardiologist on the staff of Conway Baptist Health Medical Center-Little Rock has Regional Health System, has opened a new been selected to be among the first hospi- clinic, named the Conway Regional Cardiovas- tals in the nation to join the EMPower Initia- cular Clinic. tive to enhance maternity care practices and Dr. Steely, who has practiced in Conway since work toward achieving the Baby-Friendly USA© 1998, has opened the new clinic at Suite 202 at designation. 525 Western Ave within Conway Regional Medical EMPower is a three-year hospital-based qual- Center. Effective Aug 1, Dr. Steely became a part- ity improvement initiative focusing on maternity ner with Conway Regional and the Jack Stephens practices leading to Baby-Friendly designation. Donald E. Steely, MD Heart Institute at CHI St. Vincent. Funded by the Centers for Disease Control and He formerly practiced at Conway Heart Clinic, Prevention, EMPower is aimed at increasing which is also located at Conway Regional Medi- breastfeeding rates throughout the United States cal Center. and promoting and supporting optimal breast- “Our patients will receive the same level of feeding practices toward the ultimate goal of excellent care as they have had in the past, pro- improving the public’s health. vided by the same physician and same nursing “We’re in stage three of the four stages of the team that they have come to rely upon for their initiative,” said Brenda Goodhart, Women’s Cen- cardiovascular care,” Dr. Steely said. “The benefit ter director. “The third stage includes the educa- for them will be this new relationship that inte- tion of all staff and physicians working on post- grates my expertise along with the cardiology ser- partum and in labor and delivery.” vices of Conway Regional and CHI-St. Vincent’s As part of this effort, Baptist Health Medical Jack Stephens Heart Institute. This will expand Center-Little Rock will receive ongoing support and enhance the cardiovascular services offered in breastfeeding practices from experienced to our community and our patients.” coaches, as well as training and resource sup- Win Rockefeller Jr. Conway Regional’s Chief Operating Officer Alan port in lactation education. The effort supports Finley said, “The cardiovascular clinic is a first for evidence-based practices for prenatal and mater- us, but still part of our ongoing efforts to form a nity settings known as the Ten Steps to Success- stronger affiliation with our physicians. The clinic ful Breastfeeding and the Baby-Friendly Hospital Economic Development Commission provides a vehicle for us to work together closely.” Initiative, an effort to encourage and recognize •Mandy Macke, of Fayetteville, associate direc- He added, “We are always looking for oppor- hospitals and birthing centers that complete the tor of the Willard and Pat Walker Charitable tunities to help physicians deal with all the head- Ten Steps. The Baby-Friendly Hospital Initiative, Foundation aches of practice management, giving them more launched in the United States in 1996, desig- •Carol Rodgers, of Little Rock time and energy to focus on patient care. We nates as “Baby-Friendly” hospitals that meet the •Trip Strauss, of Little Rock, senior vice president will manage the business side of the practice so criteria for women to initiate and continue with – investments at Merrill Lynch Dr. Steely can focus on patient care both in the breastfeeding. Horakova and Strauss, a married couple, hold clinic and the hospital. It also gives us a vehicle for The hospital’s efforts toward receiving the Baby- one board seat. Win Rockefeller Jr. is the 2016- growing cardiology services. When you have car- Friendly designation also support Governor Asa 2017 board chair. Members are elected for three- diologists interested in being in clinics that have Hutchinson’s Healthy Active Arkansas plan. Bap- year terms and may serve up to three terms total. a relationship with a larger entity, it helps us in tist Health is part of the consortium to oversee recruitment, developing new services, and just the implementation of the plan. Conway Nurses Achieve being more tightly affiliated with the physicians. International Lactation Credentials It gives us an opportunity to bring more services UAMS Winthrop P. Rockefeller Nancy Embry, RN, and Barbara Malott, RN, of to the community.” Cancer Institute Foundation Conway, both lactation specialists in the Con- Dr. Steely has more than 24 years of experience Elects New Board Members way Regional Women’s & Infants’ Department, as a physician and holds a medical degree from The Winthrop P. Rockefeller Cancer Institute recently earned their International Board Certi- the University of Arkansas for Medical Sciences. Foundation at the University of Arkansas for Med- fied Lactation Consultant credentials (IBCLC). He completed a residency in Internal Medicine ical Sciences (UAMS) announces the election of The International Board of Lactation Consultant and Pediatrics followed by a fellowship in Cardi- its new board members: Examiners provides an international certification ology at UAMS and Arkansas Children’s Hospital. •Remmel T. Dickinson, of Little Rock, producer board with more than 28,100 certified consultants He is certified in Interventional Cardiology, Gen- with Big Rock Productions, LLC in 102 countries. At the beginning of 2016 there eral Cardiology, and Internal Medicine. •Lloyd Garrison, of Little Rock, president and were approximately 15,144 IBCLCs in the United Dr. Steely is team cardiologist for the University CEO of CDI Contractors States with 85 of these lactation consultants resid- of Central Arkansas athletics program and team •Barbara Hoover, of Little Rock ing in Arkansas. physician for Conway Christian School. He is a •Lenka Horakova, of Little Rock, director of The path to acquiring IBCLC certification is graduate of Hendrix College. business development – Europe at the Arkansas long and in-depth requiring formal education, 90

58 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

hours, in specified health science subjects, human focus is to protect, promote, and support breast- services across the state. lactation, and breastfeeding along with at least feeding to benefit women, children, and families A dedication ceremony was held for the center, 1,000 hours of clinical practice and experience in worldwide. which is a 36,438-square-foot facility on the Arkan- providing care to breastfeeding families. Candi- sas Children’s Hospital campus that will house the dates then must pass an in depth examination on Arkansas Children’s Hospital Rebecca and Robert Rice Medical Clinic, Chil- a variety of lactation and breastfeeding topics in Opens Center for Safe dren’s Protection Center, Family Treatment Pro- order to be recognized as an IBCLC. & Healthy Children gram, and the Child Study Center. Conway Regional’s Lactation Services currently When the David M. Clark Center for Safe & The center has been entirely funded by philan- employs two full-time Lactation Consultants and Healthy Children opens on the campus of Arkan- thropy, demonstrating tremendous community one pool Lactation Consultant who provide both sas Children’s Hospital, it will be the state’s first support for a single, safe place for children who inpatient and outpatient lactation support ser- comprehensive program to address child abuse have been abused and neglected. Donors have vices to our patients and families. This team also and maltreatment. It will be a single, safe place provided more than $14 million to fund the center, operates the Conway Regional Lactation Store for children who have been abused and mis- which is designated in honor of the late David M. and breast pump rental service in addition to treated to receive all the services they need Clark through a gift provided by the Clark Fam- coordinating the Great Start Lactation Club, a – medical, advocacy, and mental health care ily Foundation. free monthly breastfeeding support group. among them. The center is part of Arkansas Chil- According to the Arkansas Department of The IBCLC credential identifies essential mem- dren’s plan to transform the health of children Human Services, there were 9,543 confirmed bers of the maternal-health care team whose in Arkansas by expanding access to pediatric cases of child abuse or neglect, while 33,683

Supporters and leaders marked the dedication of the Clark Center for Safe & Healthy Children on the Arkansas Children’s Hospital campus recently.

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 59 HospitalRounds

reports of child maltreatment were received by Baptist Health-Conway the Arkansas Child Abuse Hotline in 2015. The Introduces Smart Beds CDC estimates that for every case confirmed, two “A patient’s hospital bed can be looked at as a more go unreported. place for a patient to rest or it can be a device that actually helps in the patient’s treatment,” New OB/Gyn Joins said Joanie White-Wagoner, vice president and Conway Regional Staff administrator for Baptist Health Medical Center- Lauren Nolen, MD, an obstetrician/gynecologist, Conway. “Every patient room at our Conway hos- has joined the medical staff of Conway Regional pital has a smart bed. These beds are integrated Health System. with our clinical documentation system making Lauren Nolen, MD Dr. Nolen is accepting new patients at Conway it a high tech tool for caregivers. By collecting O B/Gyn Clinic and is in practice with Drs. Andrew data independently, the beds also increase con- Cole, Phillip Gullic, Keitha Holland, Carole Jack- venience for the patient.” information such as if the patient is a fall risk. son, Spencer Johnson, and Paul McChristian. The smart beds have many practical features Finally, patients who would like to have infor- Conway OB Gyn Clinic also includes Tracy Lamey, that will make it easier for caregivers to monitor mation about their health condition and hospital an advanced practice registered nurse. Dr. Nolen conditions and accomplish tasks like weighing stay can do so through a program called MyChart is in practice at the 2519 College Avenue location. patients without moving them to a scale. Record- Bedside accessed on an electronic tablet that will Dr. Nolen completed a four-year residency in ing and monitoring weight, for example, is critical be provided to them. MyChart offers secure, free obstetrics and gynecology from the University for patients with conditions such as congestive access to key aspects of a patient’s medical infor- of Arkansas for Medical Sciences in Little Rock heart failure who must have their weight con- mation, such as lists of medications ordered and and also holds a medical degree from there. She stantly monitored to determine if fluid is build- tests and treatments scheduled for each day. In graduated from UCA with a Bachelor of Science ing up in the body. addition, patients can get to know their care team in Biology. What makes smart beds so smart is that all the better by reviewing photos and bios of each per- She is a native of Perryville and is the daugh- medical data monitored by the bed is automati- son. Not only that, but patients will also be able ter of Dr. James Nolen of Morrilton. Her mother, cally uploaded into Epic the electronic medical to make non-emergent requests from the staff Jan Nolen, is a nurse with the Arkansas Depart- records system. This helps nurses to see trends through the tablet. Those requests could be any- ment of Health. Her interest in medicine started in a patient’s weight, blood pressure, and tem- thing from wanting some ice to needing a blan- at any early age and she was drawn to obstetrics perature, which may mean adjusting medications. ket. Of course, patients can play games or listen and gynecology during medical school because The patient can also control the room’s thermo- to music on the tablets as well to help pass the of the day-to-day variation between clinic time stat, lighting, and TV as well as order room service time or relax. with her patients and the operating room during or call the nurse all from his or her bed. Charg- labor and delivery. ing stations for personal electronic devices are a UAMS Named Most Wired Dr. Nolen is a member of the American College convenient amenity too. Hospital for 2016 of Obstetrics and Gynecology and the Ameri- In addition to the high tech beds, each patient UAMS Medical Center recently won the Most can Medical Society. While at UAMS, she was room will have an electronic message board Wired Award for the second year in a row from awarded the Barton Scholarship for 4.0 GPA and on the exterior to identify who is in the room the American Hospital Association Health Forum. was a member of the AOA Honor Medical Society. as well as indicate for the caregivers important The hospital, part of the University of Arkan- sas for Medical Sciences (UAMS), has won the distinction nine times. It is one of only two hospitals in Arkansas to earn the honor for 2016. Stone County Medical Center in Mountain View Baptist Health- received the award for Most Wired – Small and Conway Introduces Rural. Smart Beds The survey included 680 participants represent- ing an estimated 2,146 hospitals — more than 34 percent of all hospitals in the United States. “In the past year, UAMS has focused on enhancing patient- and family-centered care,” said Rhonda Jorden, UAMS chief information officer. “This is supported with the transition of our clinical organization to Service Lines and by optimizing our clinical computer systems.” Projects include: •Piloting e-visits through the patient portal. •Moving to a single patient bill. •Enhancing cybersecurity defenses. •Enhancing mobile functions so busy clinicians

60 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK It’s in our DNA...

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can be more productive. the Sportsmetrics ACL program. •Introducing Service Line Balanced Scorecards Turner works to rehabilitate orthopedic patients, to measure patient- and family-centered care particularly athletes. The most common diagno- improvements. ses he treats are low back pain, ACL rehab, rota- Roxane Townsend, MD, UAMS Medical Center tor cuff repair, upper back and neck pain, and CEO, said staff and patients alike benefit when a general weakness. hospital is wired. Eric Burgener, PT, DPT, OCS, earned a bache- “Real-time communication is extremely impor- lor’s degree in Health Sciences from the University tant to our staff, our patients and their families,” of Central Arkansas and went on to complete the Townsend said. “I’m convinced that as health Physical Therapy Doctoral program there as well. care becomes more complex and our treatment He is also certified in worker’s comp rehabilitation. Eric Burgener options more varied, the key to efficient, quality He uses core stabilization techniques designed to care is going to be ongoing improvement in our promote spinal stability, and encourage pain free ability to communicate and use health informa- mobility for maximal function. tion effectively.” The most common diagnoses he treats are: spi- According to the survey, conducted between nal stenosis, sciatica, degenerative disc disease, January and March 2016, Most Wired hospitals postural dysfunction, and a variety of orthopedic are using telehealth to fill gaps in care; provide lower extremity diagnoses including patellofemo- services 24 hours a day, seven days a week; and ral disorders, ACL rehab, and joint replacement expand access to medical specialists. In redefin- rehabilitation. ing the way that they provide care in their com- More than 10,000 therapists have achieved the munities, Most Wired hospitals are using tech- certification nationally since the orthopaedics nology to build patient engagement with the specialty exam was first given in 1989. individual’s lifestyle in mind, which includes electronic access to their care team. Arkansas Children’s Launches Most Wired hospitals are utilizing population Campaign for Northwest Hospital Turner Sibley health management tools and partnering with Arkansas Children’s leadership, alongside lead other healthcare providers to share critical clini- investors and patient families, launched a $70 mil- cal information used in analyzing interventions lion campaign to transform children’s health in the aimed at key patient groups, such as those with region. CARE CLOSE TO HOME: The Campaign diabetes. To get patients the right care, hospitals for Arkansas Children’s Northwest will fund con- are using predictive modeling to eliminate pre- struction of a freestanding children’s hospital in ventable problems. As they build out new capa- Northwest Arkansas. bilities, hospitals are also taking strong actions to “Care close to home means providing pediat- ensure health data is secure. ric care to the region’s 200,000 children – emer- HealthCare’s Most Wired® survey is published gency care, pediatric surgery, cancer treatments, annually by Health & Hospitals Networks (H&HN). a robust offering of subspecialty pediatric ser- For a full list of winners, visit www.hhnmag.com. vices, and a direct link to Angel One,” said Marcy Doderer, president and CEO of Arkansas Conway Regional Therapists Children’s. “We are humbled and grateful to our Achieve Orthopaedics Certification friends and investors who have stepped forward Bernard Gojer, MD Eric Burgener and Turner Sibley, two Therapy & with transformational support to improve chil- Rehab Solutions’ physical therapists who treat dren’s health in Northwest Arkansas.” patients at Conway Regional Therapy Center- When it opens in January 2018, the 233,613 Scherman Heights, have been awarded Board square-foot hospital will be the region’s first and Certification in Orthopaedics through the Ameri- only comprehensive pediatric healthcare center can Board of Physical Therapy Specialties. and will include: According to the Board’s online directory, only •24 inpatient beds to care for children requiring 17 physical therapists in Arkansas hold this highly- overnight stays specialized certification. •24-hour pediatric Emergency Department Burgener is from Hattieville and Sibley is from •Pediatric surgery unit with 5 operating rooms Helena. Both currently live in Conway. •An outpatient clinic with 30 exam rooms sup- Turner Sibley, PT, DPT, OCS, earned a Doctorate porting more than 20 subspecialty areas and a of Physical Therapy from Tennessee State Univer- general pediatric clinic sity in Nashville, Tenn., in 2013. He is a graduate •A full range of ancillary and diagnostic services, Ernesto Ruiz-Rodriguez, MD of the Exercise Science program at the University child life and pastoral care of Arkansas in Fayetteville, and he is certified in •Outdoor gardens, nature trails, and interactive

62 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK go online for eNews updates HealthcareJournalLR.com

features designed for children committees pledged $5 million to be given to nuclear cardiology, echocardiography, cardiovas- •A helipad and refueling station supporting the project over the next five years through their cular CT, and vascular medicine and holds five Angel One, one of the nation’s leading pediatric annual fundraisers. board certifications. His expertise includes inter- intensive care transport services with more than Additional members of the Caring Community ventional and general cardiology, peripheral vas- 2,000 transports annually. – Terri and Chuck Erwin, Cynthia and Kirk Dupps, cular disease, nuclear cardiology, transthoracic Arkansas Children’s Northwest is being built on Premier Concepts, Karen and Darren Horton, echo and trans-esophageal echo, vascular ultra- 37 acres of land. This $7.5 million gift was donated Johnelle Hunt, the Willard & Pat Walker Chari- sound, arrhythmia/pace maker/defibrillator man- by Robin and Gary George, Cathy and David table Foundation, Inc., the Fadil Bayyari Family, agement, congestive heart failure management, Evans and their families. The campus is centrally and the estate of Mildred and Jarrell Gray—were lipid management and preventive cardiology, and located on I-49 between Don Tyson Parkway and recognized from the stage for their generosity, CT calcium scoring and coronary CT angiography. Highway 412, across from Arvest Ballpark. The leadership and commitment to the Care Close Gojer joined Arkansas Cardiology in July and is project is expected to cost $427.7 million in con- to Home campaign. seeing patients in Conway. struction, technology, equipment, and operating “Arkansas Children’s Northwest has experi- Ruiz-Rodriguez completed his residency in expenses over the next five years, and will create enced fantastic support since this project was internal medicine at the Cleveland Clinic Founda- 250 new jobs. announced a year ago. Support has come from tion and then went on to complete three fellow- “Arkansas Children’s Northwest reflects 10 years businesses and individuals across Northwest ships: Cardiovascular Disease at the University of of planning and collaboration. Once open, we Arkansas with commitments exceeding $53 mil- Kentucky; Interventional Cardiology and Periph- fully expect that the scope of facilities and pro- lion as of today,” said Gary George. “We are eral Interventions at the University of Arkansas grams will evolve and expand,” said Fred Scar- hopeful that every business, every organization, for Medical Sciences; and Structural Heart Dis- borough, president and chief development offi- and every family throughout the region will con- ease and Advanced Interventional Cardiology at cer of Arkansas Children’s Foundation. “The sider supporting this project for the children of the University of Minnesota. He is the only fel- campus is being designed to meet the needs this part of the state.” lowship-trained cardiologist in structural heart of children. Our plan is rooted in an evidence- Doug McMillon, president and CEO of Wal- disease that performs transcatheter aortic valve based approach to pediatric care with quality Mart Stores, Inc., delivered the keynote address at and flexibility as key elements of the design. As Friday evening’s Color of Hope Gala. Highlighting demand for services in the region increases, we the need for a children’s hospital in the commu- will respond and grow accordingly. This children’s nity, he noted, “Let’s work together to bring hope hospital belongs to the region.” to all of those who need expert pediatric care advertiser index Marking significant progress towards the cam- close to home. If we continue to work together, I paign’s $70 million goal, Doderer announced that believe we can make Arkansas Children’s North- insurance-dental lead investors have pledged $53 million in com- west something to be proud of for generations Delta Dental of Arkansas • 2 mitments to date. Arkansas Children’s Caring to come.” 1513 Country Club Rd. Community, a core group of corporations, foun- Arkansas Children’s Northwest is being Sherwood, AR 72120 dations and individuals who are leading the fun- designed by Polk Stanley Wilcox Architects of 501.835.3400 www.deltadentalar.com draising efforts for Arkansas Children’s Northwest, Fayetteville and Little Rock, Ark., and FKP Archi- were celebrated on stage at the annual Color of tects of Houston, Texas. Nabholz Construction is insurance-professional Hope Gala. overseeing construction. The hospital is sched- The Doctors Company • 18 Those recognized included: uled to open in January 2018. The campus is an 8315 Cantrell Rd., Suite 300 •The Tyson Family and Tyson Foods, Inc. integral part of Arkansas Children’s Hospital’s plan Little Rock, AR 72227 donated $15 million, the largest single gift in to transform the health of children in Arkansas 501.614.1134 www.thedoctors.com Arkansas Children’s history. The gift established by expanding access to pediatric services across the Tyson Family Tower on the hospital’s campus. the region. State Volunteer Mutual Insurance • 68 •Robin and Gary George and David and Cathy 101 Westpark Drive, Suite 300 Brentwood, TN 37027 Evans and their families donated $7.5 million dol- Baptist Health Welcomes New 800.342.2239 lars of land in Springdale. Robin and Gary George Physicians To Heart Institute www.SVMIC.com made an additional $1 million gift providing for Baptist Health has welcomed Drs. Bernard Gojer real estate the Robin George Chapel. and Ernesto Ruiz-Rodriguez, new physicians at •Walmart and Walmart Foundation announced Arkansas Cardiology, to the Baptist Health Heart Chenal Properties • 67 a historic gift of $8 million to the project, one of Institute. 7 Chenal Club Blvd. Little Rock, AR 72223 their largest gifts to healthcare. The company has The heart institute offers a full range of cardio- 501.821.5555 a longstanding relationship with Arkansas Chil- vascular services including education and pre- www.chenal.com dren’s through the Children’s Miracle Network vention, diagnostics, emergency care, transplan- Urologists Hospitals. tation, and cardiac rehabilitation programs by •J.B. Hunt Transport Services, Inc., longtime partnering with some of the most experienced Arkansas Urology • 3 partner of Arkansas Children’s, committed $5 heart physicians. 1300 Centerview Dr. Little Rock, AR 72211 million to the construction. Gojer has more than 20 years of experience 501.219.8900 •Will Golf for Kids and Color of Hope practicing interventional and general cardiology, www.arkansasurology.com HospitalRounds

replacement (TAVR), a minimally invasive alter- care, creating systems where they don’t currently native to traditional valve replacement, in cen- exist, and providing innovative tools and mea- tral Arkansas. His other clinical interests include sures to improve the speed and quality of care by complex percutaneous coronary and peripheral enabling EMS, referring hospitals (non-PCI) and endovascular interventions. receiving hospitals (PCI-capable) to work together In addition, Ruiz-Rodriguez is board certified seamlessly and accelerate the decision making in internal medicine, cardiovascular disease, and process while treating high-risk patients. interventional cardiology. He joined the Little Rock offices of Arkansas Cardiology in August. Fellowship-Trained Palliative Care Physician Joins UAMS CHI St. Vincent Receives Fellowship-trained palliative care physician Clark L. Smith, MD Mission: Lifeline Award Clark L. Smith, MD, has joined the University of The CHI St. Vincent Infirmary in Little Rock has Arkansas for Medical Sciences (UAMS). He sees been honored with the Mission: Lifeline award for patients at the UAMS Winthrop P. Rockefeller UAMS. He was fellowship trained in the UAMS invoking specific quality improvement measures Cancer Institute and is an assistant professor in Fellowship in Hospice and Palliative Care. Smith for the treatment of severe heart attack patients the UAMS College of Medicine Department of previously served as medical director at Arkan- as outlined by the American Heart Association. Internal Medicine. sas Hospice. The goal of Mission: Lifeline from AHA is to Smith earned his medical degree from the He is certified by the American Board of Family improve patient outcomes overall and save lives. UAMS College of Medicine and completed his Medicine with a certificate of added qualification This is accomplished through addressing gaps in residency in family and preventive medicine at in hospice and palliative care. n

a long history of investing in the future of Springdale and Northwest Arkansas,” said Mr. Tyson Gives Tyson. “We’re proud to continue that legacy with this gift to Arkansas Children’s Northwest.” $15 Million This gift represents the largest single contribution in Arkansas Children’s history. It estab- lishes the Tyson Family Tower at Arkansas Children’s Northwest. The tower will anchor the to Arkansas new facility, which will include 233,613 square feet of inpatient beds, emergency care, diagnostic services, and clinical space. Children’s “This gift will transform healthcare for children in the region and create a wellness des- Northwest tination for families for generations to come,” said Marcy Doderer, President and CEO of Arkansas Children’s. “To have the Tyson name attached to this project demonstrates what The Tyson Family and Tyson Foods, Inc. an impact this facility will have on the area. It’s a testament to the outstanding legacy of are making another significant investment this remarkable family and company.” in the Northwest Arkansas region. John H. With this gift, the Northwest Arkansas community has now pledged $45.5 million for the Tyson, Chairman of the Board, Tyson Foods; construction of Arkansas Children’s Northwest. The total cost of the project is estimated to Barbara Tyson; and Donnie Smith, CEO of be $427.7 million over the next five years. The campus is being designed by Polk Stanley Tyson Foods, announced a gift of $15 mil- Wilcox Architects of Fayetteville and FKP Architects of Houston, Texas. Nabholz Construc- lion for the construction of Arkansas Chil- tion is overseeing construction. The hospital is scheduled to open in January 2018. The dren’s Northwest. campus is an integral part of Arkansas Children’s plan to transform the health of children “The Tyson Family and Tyson Foods have in Arkansas by expanding access to pediatric services across the region. Reviews by the bookworm

You have a job, go to work, and there are things you expect for it. A paycheck, first of all; that’s the big one. You might expect a job title, too, maybe a company car, and you expect regular hours. But, as in “Counting the Days While My Mind Slips Away” by Ben Utecht with Mark Tabb, you don’t expect work to make your life disappear.

One of the earliest recollections Ben Utecht cherishes is that of playing football with his father, a preacher with a good arm. In that memory, Utecht, suited up in tiny protective gear, was four years old and eager to learn the game. They were Minnesota Vikings fans then; growing up, Utecht re- calls trips to training camps and following his teams. Meanwhile, he matured physically and mentally and excelled at high school football which, at sixteen, paid off: he was offered a college scholarship, and a chance to play with the Min- nesota Gophers. But the college career Utecht dreamed of hav- it was ing didn’t happen: he was injured, injured, and common, he injured again. He played football, but not as says, for much or as well as he needed to play and when players to get By Ben Utecht with Mark Tabb it was time for the NFL drafts, he wasn’t picked. their “bell c.2016, Howard Books Throughout this, Utecht struggled with his rung.” relationship with God, but a shared-faith connec- tion with Indianapolis Colts coach Tony Dungy saved Utecht’s career. Keeping a promise made at a speaking event, Dungy called Utecht’s agent in the days following the draft and a the Days While My Mind Slips Away” is really quite a nice surprise. deal was brokered. In this book that’s supposedly not about football, author Utecht But, says Utecht, this isn’t a book about football. (with Mark Tabb) writes mostly about football. That’s not unex- Five times throughout his career, Utecht suffered concussions. pected, but how it’s approached is: though the game’s a large part It was common, he says, for players to get their “bell rung.” When of this story, the authors seem to treat it as just another small layer that happened, they’d usually be quickly examined, deemed fit to Utecht’s life. There’s some name-dropping, yes, play-by-plays, to play, and sent back to the field – but for Utecht, the damage and a light touch of proper bragging, but it all strongly supports seemed to build. Playing with pain is normal in football, but he had the rest of this faith-based, love-filled tale of trust (justified and terrible headaches, his body didn’t always respond to his brain, otherwise), and family. important memories went missing, and his personality changed. Readers interested in the seamy side of football or the aftermath He started to understand that the old Ben Utecht wasn’t coming of injuries will find this book to be eye-opening but if you’re not back… a fan, don’t let its sports-centricity scare you off. Even someone Though it’s a little on the rough side, and though it’s filled with with the tiniest pigskin familiarity will find “Counting the Days obviously recreated conversations presented as truth, “Counting While My Mind Slips Away” to be payday. n

Healthcare Journal of LITTLE ROCK I SEPT / OCT 2016 65 Reviews by the bookworm

We blurt it out without thinking; it’s a common question when someone has died unexpectedly. What happened, where did it happen, why, how…? Knowing the answer can help make sense of the senselessness of death. And in the new book “Morgue: A Life in Death” by Dr. Vincent DiMaio and Ron Franscell, knowing what happened could lead to a conviction.

Even as a little boy, Vincent DiMaio “assumed” he would become a doctor. It was “not a conscious decision,” he says, but many family members had taken that route so he entered medical school, which he “detested.” When it was time to finally choose a specialty, he re- membered how his father (also a physician) had “dragged” him to various New York City morgues on his rounds. DiMaio was comfortable with and fascinated by death and corpses. He chose pathology, too. “Pathologists,” says DiMaio, “are doctors’ doc- The work tors” but the science itself is imperfect. “Most “isn’t nearly coroner systems” don’t produce quality work, as By Dr. Vincent DiMaio and Ron Franscell he claims but yet, they’ve solved many, many glamorous c.2016, St. Martin’s Press crimes. The work “isn’t nearly as glamorous as TV makes it,” but pathology has answered all kinds as TV makes of questions about death. it...” That doesn’t mean that it doesn’t affect its practitioners. DiMaio says that pathologists learn not to let violence bother them. “You can’t live expecting everyone to be… a psychopath,” he “In matters of death and life, that’s our only moral standard.” says, and he learned early that “What I have on the tray [during an There was one mistake I made with “Morgue”: I had it by my autopsy] is not a person but a body….The person, the soul, is gone.” bedside. In his long career, DiMaio has seen his share of dead bodies, and Not only did authors Vincent DiMaio and Ron Franscell keep me he’s solved a lot of crimes – some of them, decades old. up reading way past my bedtime, but they also kept me awake with In Maryland, he weighed in on the deaths of multiple infants real-life gruesomeness and tales of murder and mayhem solved. Yes, by their mother. “I am angry,” he says, “that I still don’t know her there are times when a strong stomach is required to proceed, but true death toll.” there’s also an element of can’t-look-away, too. DiMaio’s stories are He was involved in the solving of a Civil-Rights-Era bombing. well-told and true crime fans may recognize them; if so, you’ll also He was there at the last exhumation of Lee Harvey Oswald, and enjoy knowing how those cases were closed and buried. he consulted on the Phil Spector trial. He solved a few “secrets and Sensitive readers, know that this is probably not a book for you. puzzles.” He even saved a man from capital punishment. Nope, but CSI lovers and true crime fans will be overjoyed with it, Overall, he says, when looking at forensic evidence, it’s all about so get your hands on “Morgue.” Miss it, and you’ll forever wonder reasonable doubt. what happened… n

66 SEPT / OCT 2016 I Healthcare Journal of LITTLE ROCK