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Q&A with

Doug Ross, MD

CMO, CHI St. Vincent Hospitals: Operating Through Financial Pressures Hospital Accreditation International Medicine A Larger role for midwives

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March / April 2018

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Contents March / April 2018 I Vol. 5, No. 3

24

30 22

+ /5

fe atures Hospitals: Operating Through Financial Pressures.............................10 Doug Ross, MD CMO, CHI St. Vincent......... 18 Hospital Inspections Reports Secret, Feds Decide......................... 22 International Medicine Q&A with Heidi Chumley, MD, MBA............................... 24 A Larger Role for Midwives...............................30 Depa rt m ent s Editor’s Desk.............................................................8 Healthcare Briefs............................................... 33

18

Hospital Rounds..................................................57 Ad Index................................................................... 66

Corr es po nd ent s Director’s Desk.................................................... 44 Policy.......................................................................... 46

10

Mental Health....................................................... 48 Orthopedics........................................................... 50 Medicaid................................................................... 52 Wealth Management....................................... 54 Acupuncture.......................................................... 56

Editor’s Desk

It’s time for herbalism to be magnified in our conscious discussions. Nature produces the herbs to significantly benefit our health. It’s almost astounding that we really don’t have a thorough understanding of the opportunities we have to treat ourselves with regards to the impact herbalism can play in our well-being. Part of the challenge is the information. There are studies and other viable sources to explain the impact nature’s plants can have on our chemical design. A larger challenge is being able to adequately prescribe an ideal herbal treatment plan. When I go to a health food store and look at all the herbal propositions, I’m basically overwhelmed. Does this really help? How much of this is just marketing? And, yes, all the outcomes such as better sleep, increased energy, reduced pain, stamina, better skin, better hair, better mood, etc., all sound great. Do I take everything? But most of the challenge seems to be that herbalism is not significant in our modern culture. There is an opportunity in the world of health to become an expert in all things herbalism. There are experts, but surprisingly, they are rarely sought out. Much of it has to do with our culture. The concept of natural prevention is usually pressed towards the back of the discussion. We have a culture. We like our culture. It would be important, however, to bring a mindfulness to the possibilities of herbal health to the forefront. Nature gives us what we need; I’m just not sure we are paying attention. Some examples that I’m told are effective include: d Circulatory system: Hawthorne berries, Yarrow, Lime Blossom, and Arnica d Musculoskeletal system: Willow and Meadowsweet

Also, there are thousands of specific herbal treatment modules such as treatment for anti-inflammatory issues, for example, which include Calendula, Turmeric, Arnica, Licorice, and Wild Yam. There are literally thousands of options and treatment possibilities with herbs. Obviously, too many to list here, but information is available. Prior to our modern industrial revolution, cultures throughout the world became experts in many of these treatment techniques. Many still use them today. It seems as if it would be a nice balance to our modern system. Not all products are as proclaimed. Being a sophisticated herbalist will take many years of practice and trial and error. There are side effects to herbs. The proper coordination of dosage and interaction is an art and science. I think our culture is almost ready. By slowing down and observing the health possibilities, we can find enhanced treatment modalities, new opportunities for farming and business, and an awareness of life options we have not yet given proper mindfulness.

d Respiratory system: Licorice, White Horehound, Goldenseal, and Coltsfoot d Digestive system: Slippery Elm, Chamomile, Peppermint, Fennel, Agrimony, Oak Bark, and Ginger d Skin: Chickweed, Arnica, Plantain, and St. John’s Wort

Smith Hartley

d Urinary System: Corn Silk, Couchgrass, Bearberry, and Horsetail

Chief Editor

d Nervous System: Slippery Elm, Hops, Mugwort

8 MAR / APR 2018 I Healthcare Journal of little rock

[email protected]

Hospitals: Operating Through Financial Pressures By William T. Marshall, CPA (Inactive), MBA, JD

This article will focus on the financial performance of general acute care hospitals located in the Little Rock Service Area. One of these hospitals is owned by a multi-hospital organization having financial difficulties that may have resulted, or may result in having a negative impact on the Little Rock hospital it owns. Before discussing the financial performance of Little Rock general acute care hospitals, a brief discussion of the financial decline in U.S. hospitals will give some insight as to why most of the Little Rock general acute care hospitals are having financial difficulties in recent years.

Healthcare Journal of little rock I MAR / APR 2018 11

Hospital Finances

“According to CHI’s Annual Report as of the fiscal year ended June 30, 2017, CHI’s loss from operations was approximately $585 million.”

U.S. Hospital Financial Performance HCA The largest for-profit multi-hospital organization is HCA Healthcare, Inc. (HCA), which is the first company that I worked for after completing my education in 1975 in their corporate headquarters in Nashville, Tennessee. According to its Form 10-K filed

the year ended December 31, 2017, of $18,398

largest Catholic healthcare systems, serving

on February 23, 2018, HCA reported reve-

million compared to $21,275 million for the

more than four million people each year in 17

nues before provision for doubtful accounts

year ended December 31, 2016. CHS reported

states through operations and facilities that

for the year ended, December 31, 2017, of

a net loss of $ 2,459 million, up from the

span the continuum of care, including103

$47,653 million compared to $44,747 mil-

year ended December 31, 2016, of a net loss

hospitals, 3 academic medical centers, and

lion for the year ended December 31, 2016,

of $ 1,721 million. CHS owns the following

29 critical access facilities; physician prac-

while net income for the year ended Decem-

eight hospitals in Arkansas: (i) Medical Cen-

tices; long-term care facilities; assisted living

ber 31, 2017, decreased to $2,216 million

ter of South Arkansas, El Dorado, Arkansas;

and residential-living facilities; community-

compared to $2,890 million for the year

(ii) Northwest Medical Center, Springdale,

based health services; home care, research

ended December 31, 2016.

Arkansas; (iii) Northwest Health Physi-

and development; medical and nursing edu-

cians’ Specialty Hospital, Fayetteville, Arkan-

cation; reference laboratory services; virtual

sas; (iv) Siloam Springs Regional Hospital,

health services; managed care programs;

The second largest for-profit multi-hos-

Siloam Springs, Arkansas; (v) Willow Creek

and clinically integrated networks. As of Sep-

pital organization is Tenet Healthcare Corp.

Women’s Hospital, Johnson, Arkansas; (vi)

tember 15, 2017, CHI has operations with a

(Tenet). According to its Form 10-K filed

Northwest Medical Center-Bentonville, Ben-

service area that covers approximately 54

on February 26, 2018, for the year ended

tonville, Arkansas; (vii) Sparks Medical Cen-

million people, or approximately 17% of the

December 31, 2017, Tenet reported reve-

ter – Van Buren, Arkansas; and (viii) Sparks

U.S. population.

nue before doubtful accounts for the year

Regional Medical Center, Fort Smith Arkan-

According to CHI’s Annual Report as of

ended December 31, 2017, of $20,613 mil-

sas. According to a November 14, 2017, article

the fiscal year ended June 30, 2017, CHI’s

lion compared to $21,070 million for the year

written by Ayla Ellison for Becker Hospital

loss from operations was approximately

ended December, 31, 2016. Tenet reported

Review in August of 2017, CHS extended its

$585 million. When adjusted for nonoper-

a net loss for the year ended December

divestiture plan. The company said it would

ating gains of $714 million, the CHI Annual

31, 2017, of $704 million, up from the year

sell a group of hospitals with combined rev-

Report showed an excess of revenue over

ended December 31, 2016, of a net loss of

enue of $1.5 billion in addition to the 30 hos-

expenses of $129 million. The CHI Quarterly

$ 192 million. In a presentation to inves-

pitals already announced. After complet-

Report for the three months ended Septem-

tors at the J.P. Morgan Healthcare Confer-

ing the its original 30-hospital divestiture

ber 30, 2017, showed loss from operations of

ence in San Francisco in January 8, 2018,

plan in November of 2017, CHS once again

approximately $78 million. When adjusted

the new CEO of Tenet, Ronald Rittenmeyer,

expanded its divestiture plan and on Janu-

for nonoperating gains of $213 million, this

said 2,000 jobs would be eliminated under

ary 16, 2018 it announced it would sell addi-

CHI Quarterly Report showed an excess

the $250 million cost-cutting plan. That is

tional hospitals with combined revenue of

of revenue over expenses of $135 million.

up from 1,300 jobs that were initially going

$2 billion.

According to CHI’s Quarterly Report as of

TENET

to be eliminated. Tenet no longer owns any hospitals in Arkansas.

September 30, 2017, a letter of intent for the

CHI

sale of QualChoice Health, Inc.’s Medicare

Catholic Health Initiatives (CHI) which

Advantage health insurance operations has

began operation on July 1, 1996, is a tax-

been received, with an anticipated sale in

The third largest for-profit multi-hospi-

exempt Colorado corporation and has been

fiscal year 2018. This Quarterly report also

tal organization is Community Health Sys-

granted an exemption from federal income

states that although there has been a sig-

tems, Inc. (CHS). According to its Form 8-K,

tax under Section 501(c)(3) of the Internal

nificant interest in the QualChoice Health

filed on February 27, 2018, for the year ended

Revenue Code. Colorado-based CHI is a

commercial operations, the uncertainty sur-

December 31, 2017, CHS reported revenue

group of non-profit and for- profit organi-

rounding the Affordable Care Act and cur-

before provision for doubtful accounts for

zations that comprises one of the nation’s

rent political environment has delayed the

CHS


anticipated sale of this operation to a time-

healthcare systems, is a 22-state network

by the Health Care and Education Recon-

line outside of CHI’s control. CHI remains

of more than 9,000 physicians and other

ciliation Act of 2010 (Affordable Care Act or

committed to selling or otherwise disposing

advanced practiced clinicians and 63,000

ACA). In addition, slumping Medicare mar-

of the QualChoice Health commercial oper-

employees. The organization was formed in

gins put hospitals on precarious cliff. In the

ations while it continues to actively market

1996 when two congregations of the Sisters

November 27, 2017, Modern Healthcare, in

these operations.

of Mercy joined their 10 hospitals together

an Article entitled “Slumping Medicare mar-

At the 36th Annual J.P. Morgan Health-

to form Catholic Healthcare West, which

gins put hospitals on precarious cliff”, Vir-

care Conference, CHI made a presentation

now includes over 400 care centers includ-

gil Dickson indicated that “[w]hile extended

wherein it described a proposed merger

ing hospitals, urgent and occupational care,

coverage in a net positive, hospital leaders

with Dignity Health. A non-binding letter

imaging centers, home health, and primary

still complain that the government payment

of intent was signed on October 24, 2016,

care clinics under the name Dignity Care,

programs do not cover costs. In regard to

and a Definitive Agreement was signed in

headquartered in San Francisco. According

Medicare, hospitals received 88 cents for

December 2017, to create a new, nonprofit

to the November 15, 2017, Deloitte Indepen-

every dollar spent caring for beneficiaries

health system. The combination would bring

dent Auditor’s Review Report to the Board

in 2015 and 90 cents for Medicaid patients,

together two leading health systems with

of Directors of Dignity Health and its Sub-

according to the American Hospital Asso-

facilities in 28 states. The new health sys-

ordinate Corporations as of the fiscal year

ciation.” According to this Modern Health-

tem will include more than 700 care sites

ended June 30, 2017, excess of revenues

care article , Medicare margins are in a free

and 139 hospitals, offering people and com-

over expenses attributable to Dignity Health

fall. In 2015, aggregate margins hit a negative

munities access to quality care delivered by

totaled an excess of $384 million compared

7.1% across hospitals. According to the Medi-

approximately 159,000 employees and more

to a deficit of revenues over expenses of

care Payment Advisory Commission, mar-

than 25,000 physicians and other advanced

$238 million as of the fiscal year ended June

gins are expected to sink to a negative 10%

practiced clinicians. The governing board

30, 2016.

this year. According to the American Hospi-

of the new organization-Board of Stew-

Why are General Acute Care Hospitals

tal Association (AHA), hospitals and health

ardship Trustees-will include six members

Experiencing Financial Challenge? The

systems in the U.S. are facing an unparal-

from each legacy board and the two CEOs to

healthcare industry in general, and the

leled force to change. Industry experts have

establish its corporate headquarters in Chi-

acute care hospital business in particu-

projected that multiple, intersecting pres-

cago and operate under a new name that will

lar, are experiencing significant regulatory

sures will drive the transformation of health-

be chosen in the second half of 2018. Local

uncertainty based, in large part, on legisla-

care delivery and financing from volume-

facilities will continue operating under their

tive efforts to significantly modify or repeal

to-value payments over the next decade. In

current names.

and potentially replace the Patient Protec-

the current regulatory and economic envi-

tion and Affordable Care Act, as amended

ronment, hospitals must focus their efforts

Dignity Health, one of the nation’s largest

on performative initiatives that are essential in the short term and that will also remain critical for long-term success. The inaugural report of the AHA Committee on Per-

“The healthcare industry in general, and the acute care hospital business in particular, are experiencing significant regulatory uncertainty based in large part on legislative efforts to significantly modifyor repeal and potentially replace the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act or ACA).”

formance Improvement details “Hospital and Care Systems of the Future”. The team conducted exploratory interviews and analyzed the results to identify must-do, priority strategies and core organizational competencies that organizations should establish to remain successful in this time of sweeping change. One of these “Must-Do” strategies to succeed in the future was improving efficiency through productivity and financial management. These 10 “Must-Do Strategies to Succeed in the Future” are available for review on the AHA web site. At the U.S. News

& World Report’s Healthcare of Tomorrow Conference which took place in Washington,

Hospital Finances

Source: MedPac

D.C., on November 14-16, 2017, it was con-

Privacy and security

$ 569,471

cash flow due in part to further swelling of

cluded that the healthcare of tomorrow will

Fraud and abuse

$ 339,471

staff and technology expenses” (Modern

move away from hospitals. At the J.P. Mor-

Program integrity

$ 337,379

Healthcare, February 5, 2018) and based on

gan Healthcare Conference which took place

New models of care

$ 121,774

projections that operating cash flow will

in January, it was reported that the direc-

Total cost

$7, 585,752

contract by 2% to 4% over the next 12 to 18

tion that hospitals are heading in is actu-

Source: American Hospital Association

ally pretty clear and consistent. One of the

months, that revenue growth will slow amid “very low” payment increases, that there will

consistent themes was that all hospitals are

According to Navigant’s 2017 CEO Forum,

be an ongoing shift in payment mix to gov-

experiencing margin compression and that

“Hospitals and health systems faced a tre-

ernment payers, and there will be contin-

hospitals must manage cost and margins.

mendous uncertainty in 2017, a trend that

ued shift to high-deductible health plans”.

According to the American Hospital Asso-

will continue throughout 2018. According

(Hospital Financial Management Magazine,

ciation, combined underpayments from the

to Rulon F. Stacey, PhD., FACHE, Managing

February 2018)

government programs were $57.8 billion in

Director, Navigant Transformation Institute,

Last year, a study by McKesson Corp.

2015. This includes a shortfall of $41.6 bil-

“I’ve seen firsthand how uncertainty can

found that only 26% of hospitals were meet-

lion for Medicare and $16.2 billion for Med-

affect delivery. Instead of waiting or waver-

ing goals to lower healthcare costs under the

icaid, the association reported. Attempts to

ing, providers must maintain their focus on

new pay models, and just 30% were meeting

move Medicare from a fee-for-service sys-

efforts that improve safety, quality, satisfac-

care-coordination goals. The slow progress

tem to a value-based model poses perhaps

tion, eliminate disparity of care, and reduce

is occurring despite significant implementa-

the most serious challenge to hospitals and

cost. But achieving these care delivery goals

tion of cost incurred by hospitals. On aver-

health systems struggling with low Medi-

is increasingly proving a challenge. Accord-

age, hospitals have five full-time employees,

care programs.

ing to a Navigant analysis of 2000 hospital,

including clinical staff, tracking and report-

from 2015-2017, average operating margins

ing quality measures under value-based

Total Cost

dropped from 5.6% to 3.6%, a 35% decrease.

models, according to the American Hospital

Hospital condition of participation $3,108,052

These trends are forecasted to continue, if

Association. They are also spending approx-

Billing and coverage

$1,641,046

not worsen. Moody’s downgraded not-for-

imately $709,000 annually on the admin-

Meaningful use

$ 759,689

profit healthcare from stable to negative in

istrative aspects of quality reporting. The

Quality reporting

$ 708,692

2018, predicting further decline in operating

American Hospital Association estimated

Regulatory Area


that health systems, hospitals and post-

year beginning July 1, 2015, and ending June

Arkansas, a tertiary care referral center with

acute providers spend $39 billion annually

30, 2016, showed a negative $9,690,123, up

522 acute care beds in use at June 30, 2017;

complying with the regulatory mandates.

from a negative $7,919,546 from prior year.

(iii) regional programs, including Tele-edu-

That equates $7.6 million for an average-

According to CHI’s Annual Report as of

cation, Rural Hospital Program, and eight

sized community hospital (161 beds).

the fiscal year ended June 30, 2017, CHI’s

Area Health Education Centers (AHECs)

More broadly, the American Hospital

loss from operations was approximately

located throughout the state; (iv) the Win-

Association suggested that the average com-

$585,247,000. Dignity Health’s Form 990

throp P. Rockefeller Cancer Center Institute;

munity hospital spends $7.6 million annu-

for the tax year beginning July 1, 2015, and

(v) Harvey and Bernice Jones Eye Institute;

ally on administrative costs to meet a subset

ending June 30, 2016, showed Revenue less

(vi) Donald W. Reynolds Institute on Aging;

of federal mandates that cut across quality

Expenses of a positive $31,219,525, but down

(vii) Myeloma Institute for Research and

reporting, record-keeping and meaningful

from the prior year of positive $494,850,341.

Therapy; (vii) Psychiatric Research Insti-

use compliance.

tute; (viii) Jackson T. Stephens Spine Neu-

Baptist Health, Little Rock

Little Rock, Arkansas General-Acute Care Hospital Performance St. Vincent Infirmary, Little Rock

rosciences Institute and (ix) Transitional

Baptist Health, Little Rock, is not a sub-

Research Institute. Therefore, its revenue

sidiary of a multi-hospital organization. Its

less expenses cannot be compared to CHI

Form 990 for the tax year beginning Janu-

St. Vincent Infirmary, Little Rock, or Bap-

ary 1, 2015 and ending December 31, 2015,

tist Health.

showed revenue less expenses of approxi-

According to the UAMS Audited Finan-

St. Vincent Infirmary Medical Center,

mately positive $49 million, up from prior

cial Statement the tax year beginning July 1,

d/b/a CHI St. Vincent Infirmary, in Little

year of a positive $42 million. According

2016, and ending June 30, 2017, showed an

Rock, Arkansas, and CHI St. Vincent North

to it Medicare Cost Report, Baptist Health

operating loss of approximately a negative

are owned by Catholic Health Initiatives

showed a positive net income of about $33

$86 million, up from the operating loss in

(CHI).

million with 843 licensed beds and an Occu-

2016 of approximately a negative $5 million.

pancy Rate of 52%.

After adding back nonoperating revenues

According to the 2005 IRS Form 990, Return of Organization Exempt from Income Tax (Income Tax Return), for the

of State Appropriations of about $31mil-

UAMS Medical Center

lion, Gifts of about $20 million, Investment

tax year beginning July 1, 2015, and ending

The UAMS is a state-assisted academic

Income of about $24 million, a deduction for

June 30, 2016, CHI St. Vincent Infirmary, Lit-

health center composed of (i) the Colleges

Interest on Debt of approximately 11 million

tle Rock, showed revenue less expenses of

of Medicine, Pharmacy, Nursing, Health

and Gain on Disposable Assets of $133 thou-

a negative $18,088,329, up from prior year

Professionals, Public Health, Graduate

sand, the net income for the fiscal year ended

negative $13,015,256. In addition, St. Vin-

School, and Northwest Arkansas Satel-

June 30, 2017, was approximately a negative

cent Medical Group’s Form 990 for the tax

lite Campus; (ii) the University Hospital of

$20 million down from a positive net income


Hospital Finances

for the fiscal year ended, June 30, 2016, of a

Shared Savings Programs (MSSP). UAMS

one-half of the fiscal year end left to make

positive $19 million. The Audited Financial

and Baptist Health will share in any sav-

up the $32 million gap, keep the deficit at $39

Statement, which was prepared by KPMG,

ings generated for the treatment of Medicare

million and come up with a deficit-free bud-

indicated while a 1.3% increase in operat-

patients attributed to the ACO, but will also

get for fiscal year, 2019, it was reported on

ing revenue was experienced in 2017, UAMS

share in any losses if costs exceed current

January 10, 2018, that during the weekend of

incurred higher operating expenses during

baseline amounts. Members of the Legisla-

January 6, 2018, it reduced its work force by

the year. The leading increase in operating

ture’s Joint Performance Review Commit-

600 positions, including 258 layoffs. UAMS

expenses were compensation and benefits

tee have questioned the UAMS’s contract for

expects that the job cuts will save UAMS

expenses, which increased by approxi-

emergency room and orthopedic services

between $26 million to $30 million this year

mately $59 million, or 6.4%. This increase

at Baptist Health Medical Center-Conway.

and up to $60 million in fiscal year 2019. In

was primarily due to the staffing required

The Committee wants UAMS to appear on

addition, on January 10, 2018, it has been

to support higher inpatient and outpatient

January 25 and “answer questions about

reported that UAMS will have new reduc-

volumes. Also, supplies and other services

the nature of the contract,” said Represen-

tions which shall come on top of the 600

increased by approximately $42 million, or

tative Mark Lowery, R-Maumelle, who is a

positions, including the 258 layoffs. It has

9.5%, largely for medical supplies, primarily

co-chair of the committee. Certain aspects

been reported that the 258 layoffs, includ-

for surgeries, and drugs and medicines for

of the UAMS/Baptist Health affiliation have

ing faculty, took place on Monday, January

both inpatient and outpatient care.

been criticized by Conway Regional Medical

8, 2018. It has also been reported on Janu-

According to the Economic Outlook Sec-

Center System’s President and CEO, Mat-

ary 10, 2018, that more staff reductions are

tion of the Audit’s Management’s Discussion

thew Troup, who has said that he thought

to come at UAMS, including tenured or ten-

and Analysis, looking ahead, UAMS antic-

the arrangement between UAMS and Baptist

ure-track faculty of as many as 45 such fac-

ipates a further decline in net position of

Health Medical Center-Conway was unfair

ulty members, once UAMS lawyers work out

$39 million, based on fiscal year 2018 bud-

competition.

the terms under which they may be let go.

get projections. UAMS, in collaboration with

UAMS’s 2018 budget projections of a defi-

These notifications could come in two-to-

Baptist Health, is forming an accountable

cit of $39 million was approved by the UA

four weeks and could be followed by fur-

care organization (ACO) under the rules

System Board of Trustees, a figure that could

ther reduction in work force in the new year.

established by the Centers of Medicare

reach approximately $72 million by the end

UAMS has contracted with Huron Consult-

and Medicaid Services (CMS) for Medicare

of this fiscal year. Since there is only about

ing of Chicago to look at such changes. n



Q & A with

Doug Ross, MD

CMO, CHI ST. VINCENT

C

HI St. Vincent recently announced the promotion of Dr. Doug Ross to Senior Vice President and Chief Medical Officer. Dr. Ross, of Hot Springs, previously was vice president of medical affairs for CHI St. Vincent Hot Springs. In his new position, he will oversee medical services throughout the CHI St. Vincent system. Ross has played a key role in helping CHI St. Vincent develop an integrated emergency medical group covering all four CHI St. Vincent hospitals in central Arkansas and Conway Regional Medical Center. He has also played an essential role in quality improvements at CHI St. Vincent Hot Springs. Ross joined what was then Mercy Hot Springs in 2003 as an emergency medicine physician. He has also served as chief of staff, medical director of informatics and medical director of the emergency department. He is board certified in emergency medicine and he completed his residency in emergency medicine at the University of South Carolina. He is a graduate of the University of Arkansas for Medical Sciences.

dialogue

Chief Editor Smith W. Hartley With such a

large system as CHI St. Vincent, what is the role of Chief Medical Officer?

Dr. Doug Ross My role as Chief Medical Offi-

cer is to make sure that every patient that enters our doors achieves the highest clinical quality and best outcomes. We want our patients to understand our focus on patient safety as our number one priority. In addition, I want every patient at any of our campuses across Arkansas to feel the care and compassion of our coworkers and physicians. I believe a Chief Medical Officer must be innovative and create new and efficient processes to accomplish these goals. Editor As the newly appointed Chief Med-

ical Officer of CHI St. Vincent, what are some of your first priorities?

Dr. Ross I think my first priority as the new

Chief Medical Officer at CHI St. Vincent is to develop relationships. We have an outstanding team and infrastructure here at CHI St. Vincent. We have standardized state

“I think my first priority as the new Chief Medical Officer at CHI St. Vincent is to develop relationships.”

of the art processes to achieve the best clinical outcomes. However, those best practices and those processes will go nowhere unless we focus on the people that are actually on the front lines helping care for our patients. Developing relationships and rapport and fostering engagement from our coworkers and physicians is key to achieving our goals. Editor From a leadership position, how can

one encourage attention and focus to quality initiatives?

Dr. Ross I think keeping focus on high qual-

ity in healthcare all boils down to our staff remembering that the quality and safety issues that are our focus all directly impact the health and well being of people. When we launch a quality or safety initiative, it is that emphasis on the patient that helps align everyone’s vision and engagement to see that project through to completion. We have


tremendous community leaders that sit on our hospital board to help hold our team accountable to nothing less than excellence in the quality of care we provide. In addition, I think at CHI St. Vincent we also have

“I believe my role as Chief Medical Officer is to serve the patients of this ministry and that focuses my work every day.”

the benefit of the focus of our mission and ministry here in Arkansas. As we further

people. We have nurses, physicians, and

patient in the hospital, and transitioning that

expand the healing ministry of Jesus, this

staff that truly believe in our core values of

patient into the post-acute environment, the

helps motivate and align our team for the

reverence, integrity, compassion, and excel-

individuals in each of those areas have to

best possible outcomes.

lence as we deliver care to the people of

work seamlessly as a team for that patient

Arkansas. We have developed cutting edge

to have the best results. This is our focus at

Editor What are some ways medical staff

treatment modalities in Cardiac Care with

CHI St. Vincent.

can be mindful of cost issues as they prac-

our CHI St. Vincent Heart Institute. We have

tice care?

world-renowned neurosurgical techniques

Editor How does a CMO assess and improve

within our Arkansas Neurosciences Insti-

patient safety issues?

Dr. Ross A focus on evidence-based

tute. We are very excited about the expan-

best practices from our providers is key

sion of this team to our St. Vincent North

Dr. Ross The most important aspect a CMO

here. Prior to healthcare, I studied engi-

campus in Sherwood to create a neuro-

can instill in the healthcare setting is a cul-

neering in college. Engineers take evidence-

science center of excellence. One area we

ture of safety. Safety is the number one

based practice and design robust processes

would like to focus on is the growth of our

priority for all of our coworkers. We want

to implement these practices to achieve

primary care base across Arkansas. As we

every patient that walks through our doors

the highest quality at the lowest possible

transition to not only caring for individuals

to know that their safety is at the top of our

cost. As you look across the country, there

but placing a focus on caring for popula-

minds at all times. Creating this culture of

is a great degree of variability in delivering

tions, the primary care doctor will play an

safety occurs through effective leadership

healthcare. As Chief Medical Officer, one of

even larger role in creating healthier com-

in creating an atmosphere of comfort and

my roles is to make sure our physicians and

munities than they do today.

transparency, as well as a non-punitive

providers are kept up to date on the new-

atmosphere in bringing potential safety

est evidence and best practices and to then

Editor There are many leadership styles;

issues to light. Once these issues are iden-

design processes to efficiently bring these

describe your style?

tified we can then have our teams develop

best practices to the bedside to benefit our

robust processes to mitigate these safety

patients. This robust process design allows

Dr. Ross I strongly believe in being a servant

us to deliver care much more efficiently and

leader. I believe my role as Chief Medical

effectively, while reducing cost in the pro-

Officer is to serve the patients of this min-

Editor Can you describe your vision for

cess. I also think it’s important to have our

istry and that focuses my work every day. I

CHI St. Vincent in the future, and your role

providers understand resource utilization

enjoy directly working with our nurses and

in this vision?

to make sure that each patient is receiving

physicians at the bedside with our patients. I

the appropriate level of care in the appro-

always have an open door policy and work

Dr. Ross To start, I am very blessed to be

priate setting. There are times that certain

to create an atmosphere of collegiality and

given the opportunity to help lead at CHI

tests should be done in the hospital, while

teamwork. I also believe in doing these

St. Vincent. The core values of the CHI St.

there are other tests that can be performed

things in a spirit of humility and integrity.

Vincent ministry match my own personal

in the ambulatory setting, generally at a lower cost. Editor Where specifically are some of the

risks.

values and I very much believe that my

Editor Do you encourage a team approach

work is part of a ministry. My goal for CHI

to care?

St. Vincent is to grow and continue to bring

state-of-the-art healthcare to the citizens

medical strengths at CHI St. Vincent; where

Dr. Ross Healthcare cannot be successful

of Arkansas and surrounding states. We

would you like to specifically improve

without a focus on the team. One part of

will accomplish this goal in a very turbulent

immediately?

the team is not any more important than

and ever-changing healthcare landscape by

the next. As we transition to more of a global

being innovative with our focus on quality,

Dr. Ross I think one of the strengths of

view of healthcare, taking into account pre-

safety, and patient experience. n

CHI St. Vincent across Arkansas is our

ventative medicine, acute care for the sick

Healthcare Journal of LITTLE ROCK I MAR / APR 2018 21

Accreditors Can Keep Their Hospital Inspection Reports Secret, Feds Decide By Charles Ornstein, Propublica

Reversing course, federal health officials withdrew a proposal that would have required private accrediting organizations to publicly release reports of problems they found in health care facilities. Accreditors and hospitals panned the idea; consumer advocates and business groups supported it.

Federal health officials have backed down from a controversial proposal that would require private accreditors to publicly release reports about errors, mishaps, and mix-ups in the nation’s hospitals and health care facilities. The Centers for Medicare and Medicaid Services proposed in April that accreditors publicly detail prob-

The government’s proposal to make accreditors’ reports public was strongly protested by accreditors and the hospitals that pay them for their services.

lems they find during inspections of hospitals and other medical facilities, as well

noted that its reviews in fiscal year 2015

and a group representing health care jour-

as the steps being taken to fix them. Nearly

found that accrediting organizations often

nalists were supportive, saying consumers

nine in 10 hospitals are directly overseen by

missed serious deficiencies found soon after

deserve more information about the quality

these accreditors, not the government. But

by state inspectors.

of hospitals. The Medicare Payment Advi-

in a notice released Wednesday afternoon,

Leah Binder, president and CEO of The

sory Commission, an independent agency

the government withdrew the proposal. CMS

Leapfrog Group, a coalition of employers

that advises Congress on Medicare pol-

said that federal law prohibits the agency

that advocates for quality and transparency

icy, urged CMS to implement the require-

from disclosing the results of inspections

in health care, criticized the CMS decision

ment as soon as possible, saying it would

performed by the accrediting organizations

to back down. “This is disgraceful, unfair

enable Medicare beneficiaries to make more

and that the proposal, though it required

to patients as well as employers and other

informed decisions about where to seek

accreditors, not the agency, to release the

purchasers of health care,” she said in an

health care.

reports may appear as if CMS was attempt-

email. “The public deserves full transparency

Consumer Reports and its publisher, Con-

ing to circumvent the law. “CMS is commit-

on how the health care industry performs.

sumers Union, likewise supported the pro-

ted to ensuring that patients have the ability

Instead, transparency has been sacrificed to

posal. “Such survey [inspection] results pro-

to review the findings used to determine that

accommodate special interests that lobby to

vide insight into hospital quality that is not

a facility meets the health and safety stan-

avoid disclosing embarrassing information

now transparent. Consumers have a right to

dards required for Medicare participation,”

about health care quality.”

know this critical information that is used to

the agency said in a fact sheet. “However, we

The government’s proposal to make

determine if facilities are in compliance with

believe further review, consideration, and

accreditors’ reports public was strongly

health and safety requirements for Medicare

refinement of this proposal is necessary to

protested by accreditors and the hospitals

patients, and thus, all patients.”

ensure that CMS establishes requirements,

that pay them for their services. Some ques-

Though accreditors have to be approved

consistent with our statutory authority, that

tioned its legality; all challenged its wisdom.

by the secretary of Health and Human Ser-

will inform patients and continue to support

The Joint Commission, for instance, said the

vices, they rarely take punitive action against

high quality care.” The government’s pro-

proposal would increase costs and decrease

the organizations they oversee. Of the 4,010

posal, and subsequent about face, comes

patient safety. “The provision will adversely

hospitals listed on The Joint Commission’s

as federal officials have grown increasingly

affect the collaborative efforts of accredit-

website, more than 99 percent have full

concerned that private accreditors aren’t

ing bodies and healthcare organizations to

accreditation and only eight are on track to

picking up on serious problems at health

improve patient safety and engage in contin-

lose their gold seal of approval.

facilities.

uous quality improvement,” the commission

On its website, The Joint Commission

Health care facilities that receive federal

said in a June letter. “Ultimately, there will be

allows users to check the accreditation sta-

funding are required to comply with Medi-

increased patient harm and lower quality.”

tus of hospitals but provides scant infor-

care’s requirements and thus are subject to

Another accreditor, the Center for

mation on inspection findings, even when

government oversight. But the law allows

Improvement in Healthcare Quality, raised

hospitals are described as receiving a pre-

hospitals, ambulatory surgery centers, home

similar concerns. “Knowing that survey

liminary denial of accreditation. For one

health agencies and hospices to pay private,

[inspection] reports are public knowledge

hospital, the explanation is, “Existence at

national accrediting organizations for such

will only incentivize hospitals and other

time of survey of a condition, which in The

oversight instead.

healthcare entities to go back to the days of

Joint Commission’s view, poses a threat to

Every year CMS and state health agen-

‘hiding’ quality of care issues from accredi-

patients or other individuals served.” The

cies inspect a sample of hospitals and other

tors, rather than working with us to improve

threat itself is not specified. Other smaller

health care facilities accredited by private

the quality and safety of care rendered to

accrediting organizations provide even less

organizations in order to validate the work

patients.”

information. n

of the groups. In a report to Congress CMS

But consumer groups, business alliances, Healthcare Journal of LITTLE ROCK I MAR / APR 2018 23

International Medicine: Q & A with Heidi Chumley MD, MBA Executive Dean, American University of the Caribbean School of Medicine

Dr. Heidi Chumley was named Executive Dean of the American University of the Caribbean School of Medicine in 2013 and is responsible for the development of a strategic vision for academic excellence and career outcomes. She also acts as the head of Adtalem Global Education’s Academic Council. Dr. Chumley joined AUC following an eight-year career at the University of Kansas School of Medicine where she most recently served as Associate Vice Chancellor for educational resources and inter-professional education. Her responsibilities included fostering a vibrant learning environment supported by technology and other academic resources, as well as developing a center for inter-professional education and simulation. She also served for nearly four years as Senior Associate Dean for medical education, responsible for admissions, curriculum, and student affairs. Dr. Chumley also led initiatives in rural health and cultural enhancement and diversity.

“…international schools have for the last 40 years played a really important role in providing physicians for the U.S. healthcare system.”

She has been recognized with national awards for teaching, leadership, and scholarship, including the President’s Award from the Society of Teachers of Family Medicine for leading the task force that created the national Family Medicine Clerkship Curriculum. She is an editor of the textbooks Color Atlas in Family Medicine, Color Atlas in Internal Medicine, and Color Atlas for Pediatrics. Dr. Chumley earned her medical degree from the University of Texas Health Science Center in San Antonio, where she also completed her residency in family medicine and a fellowship in academic leadership. She recently completed an executive MBA at the University of Miami with an emphasis on Latin America and the Caribbean. She received her bachelor’s degree in biochemistry from Abilene Christian University.

international medicine

Chief Editor Smith W. Hartley Why are inter-

over two-thirds of them again in primary

the world: Dominican Republic, Vietnam,

national medical students filling residency

care. In 2017, four graduates went into resi-

Russia, Uganda, and Zimbabwe—places

positions in the United States?

dency in Arkansas, two in family medicine,

where they get to see and do a number of

one in radiology, and one in anesthesiology.

things that you typically don't get to do in

Dr. Heidi Chumley Many international medi-

The one in anesthesiology is at University of

the U.S. during clinical rotations.

cal students are actually U.S. citizens who

Arkansas at Little Rock.

plan to practice back at home in the U.S., so

Editor Is the curriculum designed for a

they would naturally seek a residency here

Editor Are medical schools outside the

in the U.S. At AUC for example, about 90% of

U.S. different at all in regards to curricu-

our enrolled students are American citizens

lum, training, etc.?

or permanent residents who plan to come

specific region of the world? Chumley No. Most of our students are U.S.

or Canadian citizens, about 90% U.S. and

back to the U.S. and look at U.S. residency

Chumley They're really very similar because

8% Canadian, who plan to return to the U.S.

positions. From the residency program side,

even the schools outside of the U.S., if they

or Canada to practice, so we're really set up

you know they are seeking to fill their posi-

are modeled after U.S. schools like AUC is,

to help people be ready for that. But, being

tions with the best candidates available. Best

take the same set of licensing exams as stu-

located in another country does broaden

means different things to different people

dents who attend U.S. medical schools. The

your worldview. America is a place of many

and often, best to a residency program

curriculum is designed to prepare students

different cultures and backgrounds, and

means people who are from your area. So, if

for residency training in the U.S. and to pass

when you take people to another country

we have in our school people who are from

those licensing exams, so they're really very

and expose them to different cultures and

a certain town in America that needs doc-

similar. At AUC the first approximately two

backgrounds, they begin to learn how you

tors and also has a residency program, then

years of study are what we call the basic sci-

integrate that type of information into care

that residency program can be really inter-

ences or medical sciences. This is very simi-

of patients.

ested in those students. About one in four of

lar to U.S. schools. The last two years are

all first-year residency positions that are in

called the clinical years, and that is when

The Match are filled by international grads.

students complete different clinical rota-

shortage in the United States, and if so,

For residency positions in primary care, it's

tions at teaching hospitals. One difference

why?

even higher, up to a third of first year posi-

at AUC is that students have the opportu-

tions, that are filled by international grads.

nity to complete clinical rotations at many

Chumley Yes, there is a physician short-

places in the world. Many return to the U.S.

age. We think there will probably be close

Editor Can you give us an example of resi-

to do their clinical training. Many go to the

to a shortage of about 90,000 positions by

dencies being filled in Arkansas?

U.K., which has a very different healthcare

2025. Several reasons for that. I think the

system, providing a very interesting learning

most important reason is that there are not

Chumley Since 2000, 49 AUC graduates

experience. There are elective opportunities

enough U.S. medical school slots to support

have gone into residency in Arkansas, and

for our students in many different parts of

the number of physicians that are needed in

Editor And overall, is there a physician

the U.S. with population growth and aging. The number of people in their later years,

“America is a place of many different cultures and backgrounds, and when you take people to another country and expose them to different cultures and backgrounds, they begin to learn how you integrate that type of information into care of patients.”

people living longer, and living longer with chronic disease—all of those things increase the number of positions that are needed, particularly around primary care. While there are probably places in the U.S. that don't have a shortage of physicians overall, there are primary care shortages, particularly in rural and inner city underserved areas, spread throughout the country, and those will face the brunt of increasing shortages as the number of physicians produced by the U.S. medical school system cannot keep pace with the number of physicians needed to treat the population.


Editor Are international medical students

treated differently at all in the U.S. residency program? Chumley There is a stigma attached to being

an international medical student but once graduates get into the residency program that stigma generally goes away. It is challenging for students. They face other obsta-

“In general, most people stay within a hundred miles of where they do their residency program and that includes international medical graduates.”

cles in doing some of their clinical rotations in the elective years or even in the primary clinical year, which is the third year, as many people believe that an international medi-

their residency program and that includes

Editor By doing an international medi-

cal graduate's education is inferior, which of

international medical graduates. There are

cal program, what other opportunities

course, I don't believe.

really three factors. People like to go back

exist for international medical students

to where they're from; they like to go close

when they don't do the traditional U.S.

Editor Do international medical students

to where they did their clinical training,

residency?

typically stay in the regions of their resi-

and they like to go to where they did their

dency programs?

residency training. So, if they come from a

Chumley An international medical grad-

place and return there for clinical training

uate or a graduate from a U.S. medical

Chumley In general, most people stay

and residency, they're incredibly likely to

school cannot be licensed to practice med-

within a hundred miles of where they do

stay there.

icine in the U.S. without doing a residency. Healthcare Journal of little rock I MAR / APR 2018 27

Whether you graduate from a U.S. school or an international medical school, if you don't do

International medical students filling residency positions in the U.S.

a residency, you have to look at a pathway besides clinical medicine. So, people use their MD degree, which is still a valuable degree, to go into research, business, the pharmaceutical industry, public health, health policy, or any number of areas. But, in general, people go to medical school to practice medicine, and that's where they want to be. Editor Finally, can you tell us

what your opinion is on the future of international programs? Do you see this as a

• Many international medical students are U.S. citizens who plan to practice back home in the U.S. At AUC approximately 90% of enrolled students are American, 8% are Canadian, and 2% are international. • IMGs were 24% of all first-year residency positions filled this year in the NRMP match. Among primary care positions, they represented 34% of new residents. • IMGs comprise a major pipeline of new physicians entering the U.S. healthcare system and make up 24% of all active physicians in the U.S. (as high as 38% in some states). • According to a report by the Association of American Medical Colleges, there could be a shortage of up to 88,000 doctors by 2025. • The primary care sector faces the brunt of that shortage with up to 35,600 more primary care physicians needed by 2025. • In 2017, IMGs were 34% of all first-year primary care residency positions. They are filling positions in family medicine, internal medicine, and pediatrics, and going into rural and underserved areas of the country.

growing trend and something U.S. medical students should try and create more capacity for, or do you think you’ll see growth

Total Positions Filled Filled by US-IMG Filled by Non-US IMG Filled by IMG

in enrollment? Chumley Yes,

international

schools have for the last 40 years played a really important role in providing physicians for the U.S. healthcare system. Even as the U.S. schools expand, and we see a few new U.S. medical schools and a few new DO schools come

All Residency 27,688 Positions

2,777 3,814 6,591 (10%) (14%) (24%)

Internal Medicine 7,101

1,030 (14.5%)

Family Medicine 3,215

658 337 995 (20.5%) (10.5%) (31%)

2,003 (28%)

3,033 (42.7%)

Pediatrics 2,693 204 253 457 (7.5%) (9.4%) (17%) All Primary Care 13,009

1,892 2,593 4,455 (14.5%) (20%) (34%)

on board, there are still more qualified applicants than there is capacity for in U.S. MD and

Since 2000, 201 AUC graduates earned residencies in the state of Louisiana. Most of those

DO schools. There are still more

placements (75%) are in primary care specialties. Of those graduates, about half (100) were in

residency positions that can be

New Orleans or Baton Rouge. And of those, 50 were originally from the state.

filled by graduates of U.S. MD or U.S. DO schools. So yes, there are a number of people who want to be physicians, who go to inter-

• Historically, the most popular residency programs for AUC graduates have been Baton Rouge General Medical Center’s family practice program, Baton Rouge General Medical Center’s internal medicine program, LSU’s emergency medicine program, and LSUHSC’s family practice program.

national schools, and there are opportunities for them to return

In 2017, eight graduates earned residencies in Louisiana, including:

to the U.S. I think in the future,

• Three in family medicine: Baton Rouge General Medical Center (2) and LSU (1)

international schools are going to continue to be a really impor-

• Four in internal medicine: Baton Rouge General Medical Center (2), Ochsner Health System, and LSU Shreveport (2)

tant part of the U.S. physician

• One in emergency medicine/family medicine: LSU Shreveport

workforce. n

Healthcare Journal of Little Rock I MAR / APR 2018 29

A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies By Nina Martin, Propublica

According to a new study, states that give midwives a greater role in patient care achieve better results on key measures of maternal and neonatal health.

In Great Britain, midwives deliver half of all babies, including Kate Middleton’s first two children, Prince George and Princess Charlotte. In Sweden, Norway and France, midwives oversee most expectant and new mothers, enabling obstetricians to concentrate on highrisk births. In Canada and New Zealand, midwives are so highly valued that they’re brought in to manage complex cases that need special attention. All of those countries have much lower rates of maternal and infant mortality than the U.S. Here, severe maternal complications have more than doubled in the past 20 years. Shortages of maternity care have reached critical levels: Nearly half of U.S. counties don’t have a single practicing obstetrician-gynecologist, and in rural areas, the number of hospitals offering obstetric services has fallen more than 16 percent since 2004. Nevertheless, thanks in part to opposition from doctors and hospitals, midwives are far less prevalent in the U.S. than in other affluent countries, attending around 10 percent of births, and the extent to which they can legally participate in patient care varies widely from one state to the next.

Now a groundbreaking study, the first

mitigates the impact of any systemic racial

He said licensed midwives could be used to

systematic look at what midwives can

bias. You listen. You’re compassionate.

solve shortages of maternity care that dis-

and can’t do in the states where they prac-

There’s such a depth of racism that’s inter-

proportionately affect rural and low-income

tice, offers new evidence that empower-

mingled with [medical] systems. If you’re

mothers, many of them women of color.

ing them could significantly boost mater-

practicing in [the midwifery] model you’re

“Growing our workforce, including both

nal and infant health. The five-year effort

mitigating this without even realizing it.”

midwives and obstetricians, and then ensur-

by researchers in Canada and the U.S., pub-

The study, published in the peer-reviewed

ing we have a regulatory environment that

lished Wednesday, found that states that

journal PLOS ONE, analyzes hundreds of

facilitates integrated, team-based care are

have done the most to integrate midwives

laws and regulations in 50 states and the

key parts of the solution,” he said.

into their health care systems, including

District of Columbia — things like the set-

To be sure, many other factors influ-

Washington, New Mexico and Oregon, have

tings where midwives are allowed to work,

ence maternal and infant outcomes in the

some of the best outcomes for mothers and

whether they can provide the full scope of

states, including access to preventive care

babies. Conversely, states with some of the

pregnancy- and childbirth-related care, how

and Medicaid; rates of chronic disease such

most restrictive midwife laws and practices

much autonomy they have to make deci-

as diabetes and high blood pressure; and

— including Alabama, Ohio and Mississippi

sions without a doctor’s supervision, and

prevalence of opioid addiction. And the

— tend to do significantly worse on key indi-

whether they can prescribe medication,

study doesn’t conclude that more access to

cators of maternal and neonatal well-being.

receive insurance reimbursement or obtain

midwives directly leads to better outcomes,

“We have been able to establish that

hospital privileges. Then researchers over-

or vice versa. Indeed, South Dakota, which

midwifery care is strongly associated with

laid state data on nine maternal and infant

ranks third from the bottom in terms of mid-

lower interventions, cost-effectiveness and

health indicators, including rates of cesar-

wife-friendliness, scores well on such key

improved outcomes,” said lead researcher

ean sections, premature births, breastfeed-

indicators as C-sections and preterm births.

Saraswathi Vedam, an associate professor of

ing and neonatal deaths. (Maternal deaths

Even North Carolina is average on C-section

midwifery who heads the Birth Place Lab at

and severe complications were not included

rates, breastfeeding and prematurity.

the University of British Columbia.

because data is unreliable.)

The findings are unlikely to quell the

Many of the states characterized by poor

The differences between state laws can

controversies over home births, which are

health outcomes and hostility to midwives

be stark. In Washington, which has some of

almost always handled by midwives and

also have large black populations, raising

the highest rankings on measures such as

comprise a tiny but growing percentage of

the possibility that greater use of midwives

C-sections, premature births, infant mortal-

deliveries in the U.S., or fears among doc-

could reduce racial disparities in maternity

ity and breastfeeding, midwives don’t need

tors and hospitals that closer collaborations

care. Black mothers are three to four times

nursing degrees to be licensed. They often

with midwives will raise malpractice insur-

more likely to die in pregnancy or childbirth

collaborate closely with OB-GYNs, and can

ance rates. In fact, said Ann Geisler, who runs

than their white counterparts; black babies

generally transfer care to hospitals smoothly

the Florida-based Southern Cross Insur-

are 49 percent more likely to be born pre-

when risks to the mother or baby emerge.

ance Solutions, which specializes in insur-

maturely and twice as likely to perish before

They sit on the state’s perinatal advisory

ing midwives, her clients’ premiums tend to

their first birthdays.

committee, are actively involved in shap-

be just one-tenth of premiums for an OB-

ing health policy and receive Medicaid reim-

GYN because their model of care eschews

bursement even for home births.

unnecessary interventions or technology.

“In communities that are most at risk for adverse outcomes, increased access to midwives who can work as part of the health

At the other end of the spectrum, North

Far from being medical renegades, the vast

care system may improve both outcomes

Carolina not only requires midwives to be

majority of midwives want to be integrated

and the mothers’ experience,” Vedam said.

registered nurses, but it also requires them

into the medical system, she said.

That’s because of the midwifery model,

to have a physician sign off on their appli-

Generally, licensed midwives only treat

which emphasizes community-based care,

cation to the state for approval to practice.

low-risk women, Geisler said. If the patients

close relationships between providers and

North Carolina scores considerably worse

become higher risk, midwives are supposed

patients, prenatal and postpartum wellness,

than Washington on indices such as low-

to transfer them to a doctor’s care. Since

and avoiding unnecessary interventions that

birthweight babies and neonatal deaths.

many OB-GYNs only see midwife patients

can spiral into dangerous complications,

Neel Shah, an assistant professor at Har-

when a problem emerges, they may develop

said Jennie Joseph, a British-trained mid-

vard Medical School and a leader in the

negative views of midwives’ skills, she said.

wife who runs Commonsense Childbirth, a

movement to reduce unnecessary C-sec-

The benefits of midwifery come as no sur-

Florida birthing center and maternal care

tions, praised the study as “a remarkable

prise to maternal health advocates. In 2014,

nonprofit. “It’s a model that somewhat

paper — novel, ambitious, and provocative.”

the medical journal Lancet concluded that

Healthcare Journal of little Rock I MAR / APR 2018 31

maternal care

integrating midwives into health care sys-

the possibility of delivering at home. Of

reflecting attitudes that wiped out the state’s

tems could prevent more than 80 percent

the more than 15,000 midwives now certi-

once-rich tradition of black birth attendants.

of maternal and newborn deaths world-

fied in the U.S., the vast majority are certi-

“Here they associate us with granny mid-

wide — in low-resource countries that lack

fied nurse-midwives, or CNMs — registered

wives — someone with absolutely no medical

doctors and hospitals, by filling dangerous

nurses with an additional graduate degree

background,” said Sheila Lopez, one of just

gaps in obstetric services; in high-resource

who are trained to provide the full range of

13 CNMs currently licensed to practice in

countries, by preventing overuse of med-

reproductive and maternity care, including

the state. Alabama has no midwifery educa-

ical technologies such as unnecessary

delivering babies in hospital settings. After

tion programs, so Lopez had to get her train-

C-sections that can lead to severe compli-

that, the definitions get fuzzy, said Ginger

ing in Atlanta while working as a full-time

cations. A review by the Cochrane group,

Breedlove, a Kansas-based CNM and con-

labor and delivery nurse in Birmingham,

an international consortium that examines

sultant who is a past president of the Amer-

two and a half hours away. Once she grad-

research to establish best practices in med-

ican College of Nurse-Midwives (ACNM).

uated with her CNM degree in 2012, it took

ical care, found that midwives are associ-

There are “direct-entry midwives,” “certified

her three years to find a midwifery job near

ated with lower rates of episiotomies, births

professional midwives” and “lay midwives,”

her home. Alabama law requires that CNMs

involving instruments such as forceps and

all of which are primarily associated with

have a “collaborative physician” who is will-

miscarriages.

home births but who have different types

ing to oversee their practices. “It’s really kind

While widely accepted in Europe, mid-

of training and may or may not be licensed

of just a harsh work environment,” Lopez

wives in the U.S. have been at the center of a

and regulated by a state. “It’s very confus-

said. “The doctors don’t understand what the

long-running culture war that encompasses

ing,” Breedlove said. “The title ‘midwife’ has

role of the midwife is. So they don’t go out

gender, race, class, economic competition,

multiple meanings” — which does not help

seeking it. And if they don’t know, then they

professional and personal autonomy, risk

efforts to promote the profession.

won’t back us up.”

versus safety, and philosophical differences about birth itself.

In recent years, national groups such as

Carole Campbell of Gadsden, the only

the American Congress of Obstetricians and

black nurse-midwife in current practice

Midwives were valued members of

Gynecologists have become much more

listed on the Alabama Board of Nursing

their communities until the late 19th cen-

welcoming to nurse-midwives and more

website, has even more impressive creden-

tury, when medicine became profession-

open to home births by licensed midwives.

tials than Lopez does: a doctorate in nursing

alized and doctors’ groups began pushing

But many individual doctors remain wary,

practice as well as a CNM, plus five years of

for a monopoly over obstetric care. Physi-

acknowledged Dartmouth University’s Tim-

teaching experience at a community college.

cians argued that birth was a “pathologic”

othy Fisher, who teaches OB-GYN and is the

“I’m at the top of my practice,” she said, but

process that required scientific knowledge

medical director of the Northern New Eng-

because no local OB-GYN group has been

and hospital equipment, and they vilified

land Perinatal Quality Improvement Net-

willing or able to enter into a collaborative

midwives — who were mostly immigrants

work. One main reason “is the lack of expo-

arrangement with her, she isn’t allowed to

or, in the South, blacks commonly known

sure to midwife care during our training as

provide any prenatal or postpartum care,

as “grannies”— as dangerously uneducated

OBs. Things that are foreign are scary, and

much less deliver babies. “Would I like to

for insisting that birth was a natural (“physi-

we view them with skepticism,” Fisher said.

be doing that? Absolutely.”

ological”) function. In 1915, Joseph DeLee of

In North Carolina, requirements that

Alabama lawmakers recently passed a

Chicago, the most influential OB-GYN of his

CNMs have permission from doctors to

bill that would legalize certified professional

day, called midwives “relics of barbarism”

practice means that they are unable to work

midwives — the type who attend home births

and “a drag upon the science and the art of

in the 31 counties in the state that have no

— though the process of integrating them

obstetrics,” while one North Carolina doctor

obstetrical care provider, said Suzanne Wert-

into the maternal care system is likely to be

dismissed black midwives as having “fingers

man, president of the ACNM’s North Car-

long and uncertain. Meanwhile, only 18 out

full of dirt” and “brains full of arrogance and

olina affiliate. Midwives are “just an after-

of 54 rural counties in the state have hospi-

superstition.” By the 1950s, the vast majority

thought here … sort of like a bonus. The idea

tals that offer obstetrical services. Courtney

of women gave birth in hospitals, attended

of one profession overseeing another pro-

Sirmon, a doula, or birth helper, who heads

by doctors.

fession — it’s problematic and it doesn’t serve

the Alabama Birth Coalition, recalls a rural

the consumer well.”

client who recently gave birth while on the

Midwifery began to make a comeback in the 1970s and 80s, embraced by mid-

In Alabama, the state with the worst infant

way to the nearest hospital, in Birmingham.

dle-class white women who wanted more

mortality rate in the country, midwifery

“They were going over 100 miles per hour

of a voice in their maternity care, including

restrictions have been almost as tough,

when she delivered in the back seat.” n

32 MAR / APR 2018 I Healthcare Journal of Little Rock

N e w s / p e o p l e / i n f o r m at i o n

Healthcare Briefs

Arkansas Lifeline Call Center Opens

Story next page


Healthcare Briefs and service at all locations,” according to Arkansas Hospice COO Robin Hayes. The move was effective Oct. 15. A 26-year veteran of nursing with more than 20 years in hospice care, Deal joined Arkansas Hospice as a PRN RN in 2009 at the Conway area office, and has held multiple positions within the company, most recently serving as the Program Director over the Central, Conway, Searcy, and Batesville Area Offices, as well as the Little Rock Inpatient Center.

UAMS’ Sponsors Science Café on ‘Farming in the 21st Century’ Science Café Little Rock, co-sponsored by the University of Arkansas for Medical Sciences (UAMS), recently held a public forum entitled “Farming in the 21st Century.” Panelists contrasted farming operations, large and small, and discussed the challenges of modern farming, crop choices, methods, and costs. This month’s panel will included Chris Hiryak, Arkansas Department of Health’s Lifeline Call Center

director of Little Rock Urban Farming; Christine Hernandez, livestock entrepreneur with Heifer

Arkansas Department of Health Opens Arkansas Lifeline Call Center The Arkansas Department of Health (ADH) has officially opened the Arkansas Lifeline Call Cen-

International; and Andrew Grobmyer, Executive Suicide is the leading cause of violent death in Arkansas. In 2016, there were 546 suicide deaths,

Director and Vice President of the Agricultural Council of Arkansas.

which is more than double the amount of homi-

Dorothy Graves, associate director for adminis-

cides that year. Sixty-seven of those deaths were

tration of the UAMS Winthrop P. Rockefeller Can-

youth ages 10-24.

cer Institute, moderated the event.

ter, which is now answering calls made in Arkan-

Veterans can access the Veteran Crisis Line by

Science Café includes a corresponding live

sas to the National Suicide Prevention Lifeline at

calling the national line at (800) 273-8255 and

radio call-in program, “Science Café Little Rock,”

(800) 273-8255.

pressing 1. Anyone can also text the crisis line by

on National Public Radio-affiliate station KUAR

sending TALK to 741741, or chat online at https://

FM89. The science talk show, featuring one

suicidepreventionlifeline.org/chat/.

speaker from the monthly panel of scientists and

The opening of the call center was mandated by Act 811 of the 2017 legislative session. This is the first call center for the national line to be

The ADH Injury and Violence Prevention Sec-

experts, is aired just prior (6:05-6:30 p.m.) to the

operated by a state health department in the

tion works to prevent suicides through education,

live Science Café event. Hiryak served as the radio

nation. Previously, Arkansas was one of two states

resources, and awareness. To learn more about

guest.

without an in-state call center, which meant that

the trainings and resources that are available for

Science Café events are held on the fourth

calls were being answered out of the state.

your group, business, or school, visit http://www.

Tuesday of the month, except for July, August,

healthy.arkansas.gov/programs-services/topics/

and December. Check out the website for more

suicide-prevention.

information on monthly speakers and topics at

“We are pleased to offer this important in-state service for Arkansans,” said Dr. Nathaniel Smith, ADH Director and State Health Officer. “Callers in crisis will be able to speak to someone here in Arkansas who has a strong understanding of the resources available in the state. This number

Arkansas Hospice Names Anita Deal as Senior Director of Clinical Services

www.sciencecafelr.com.

White to Rejoin DHS as Deputy Director for Aging, Adult, and Behavioral Health Programs

is available for many reasons - whether a person

Arkansas Hospice announced the promotion of

is contemplating suicide or is having feelings of

Anita Deal to the new position of Senior Direc-

The Arkansas Department Human Services

anxiousness, depression, hopelessness, or they

tor of Clinical Services. In the new position, Deal

(DHS) announced Tuesday that Mark White will

just want to talk.”

will serve as clinical lead “to enhance our care

serve as the new Deputy Director of the Division


For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com

Mark White

for Aging, Adult, and Behavioral Health (DAABH).

Terry Angtuaco, MD

Jeff Mayfield, MD

how DHS works in this arena,” said Cloud.

UAMS, we are fortunate to recruit outstanding

White has nearly 15 years of experience in state

Following this transition, White will oversee

women to our training programs each year, and

government, with about five of those as a senior

Adult Protective Services and aging programs

women lead more than half of our divisions and

executive. He was named DHS chief counsel in

previously handled by the Divisions of Aging

sections. This is in significant measure due to the

March of 2013 and was then promoted to Dep-

and Adult Services and Behavioral Health Ser-

role model of excellence in clinical care, educa-

uty Director of DHS in 2015. As Deputy Director

vices, including the ARChoices program and

tion, and scholarship Dr. Angtuaco has provided

of DHS, he oversaw more than half of the depart-

DHS’s work with Community Mental Health Cen-

through the years.”

ment, including all of the Medicaid, health, and

ters. Adult Protective Services investigates reports

Angtuaco came to UAMS in 1980 as an instruc-

community programs. Since September of 2016,

of maltreatment and neglect of older Arkansans.

tor in the Department of Radiology. She was

White has served as the Director of Legal Ser-

The ARChoices program offers personal care and

promoted to assistant professor a year later. She

vices for the nonprofit Arkansas Public School

assistance to adults with physical disabilities so

holds faculty positions in five departments across

Resource Center.

that they can remain in their homes rather than

the colleges of Medicine, Health Professions, and

receiving care in an institution.

Public Health.

UAMS’ Terry Angtuaco, MD, Inducted as Inaugural Fellow to American Association for Women Radiologists

reviewed articles and lectured internationally.

White has a long history of state service outside of DHS, as well. He has served as a lawyer for the Arkansas Department of Education, an Administrative Law Judge with the Arkansas Workers Compensation Commission, and as former Governor Mike Huckabee’s Policy Advisor for Regulatory Affairs.

Terry Angtuaco, MD, a professor in the Col-

She’s authored or co-authored several peer-

Baptist Health’s Jeff Mayfield, MD, Appointed to Special Commission of AAFP

“Mark has extensive knowledge of this area

lege of Medicine’s Department of Radiology at

Dr. Jeff Mayfield, a family physician at Baptist

of DHS. He is a steady, capable leader who is

the University of Arkansas for Medical Sciences

Health Family Clinic-Bryant, an Arkansas Health

highly respected in this agency and across the

(UAMS), was one of 18 recently inducted into the

Group clinic, was recently appointed to the com-

state. There was no doubt that he was the right

inaugural fellowship class of the American Asso-

mission on Continuing Professional Development

choice for this new position,” said DHS Director

ciation for Women Radiologists.

of the American Academy of Family Physicians.

Cindy Gillespie. White will begin in his new DHS role on Feb. 19. In this role, White will work with Craig Cloud,

The class was recognized at the 2017 Radiolog-

He, along with his fellow commissioners, will

ical Society of North America annual meeting in

meet three times a year, and report directly to the

Chicago in November.

AAFP Board of Directors. One of the main duties

Director of the Division of Provider Services and

The American Association for Women Radi-

of the CPD commission is to assign how much

Quality Assurance, and DAABH Director Jay Hill

ologists was founded in 1981 to address issues

continuing medical education credit will be given

to transition and integrate programs that benefit

unique to women in radiology and related

to every CME activity available to AAFP members

aging Arkansans into the new division. Act 913 of

professions.

and to assign what each activity is valued.

the 2017 legislative session created the DAABH

“Dr. Angtuaco’s success in achieving the goals

Mayfield’s term of office began in December of

division, which combines the services of two pre-

of the AAWR can be readily seen in our own

2017 and ends Dec. 14, 2021. He was nominated

viously distinct divisions within DHS--Aging and

department,” said James E. McDonald, MD, chair

by the Arkansas Chapter of the AAFP Board of

Adult Services and Behavioral Health.

of the UAMS Department of Radiology. “While

Directors. Mayfield has served the AAFP Arkansas

“I look forward to working with Mark and Jay

the need for improvement in gender diversity in

chapter for more than 20 years, having served in

as we transition to the new divisions and reshape

radiology is a topic of discussion nationally, at

every elective office including president (2011-’12)


Healthcare Briefs

Jo Ellen Ford

Lee Ronnel

John Shock, MD

Kent Westbrook, MD

and currently serving as alternate delegate to the

Award. The award recognizes current or former

Ronnel, along with his wife Dale and their

AAFP Congress of Delegates and the executive

employees for their ability to envision, promote,

extended family, has been a dedicated and pas-

and nominating committee.

and utilize philanthropy to transform the land-

sionate supporter of UAMS for more than four

scape and constitution of UAMS.

decades. Ronnel is a member and former chair of

The AAFP is the nation’s second largest medical specialty organization with more than 129,000

Ward, UAMS chancellor from 1979-2000, is

the University of Arkansas Foundation, Inc. Board

members nationwide. There are chapters in every

remembered as a “giant” in the history of health-

of Directors, and a former member and chair of

state, as well as in Uniformed Services, the Virgin

care and higher education in Arkansas. He led

the UAMS Foundation Fund Board. The Ronnels,

Islands, Guam, and Puerto Rico, with the mission

UAMS’ transformation from a small medical

members of the Society of the Double Helix, have

to improve the health of patients, families, and

school with a charity hospital into a health sci-

given millions to UAMS over their long history

communities by serving the needs of members

ences university and research leader.

with the institution and have begun a scholarship

with professionalism and creativity. The AAFP

“Today, we honor our volunteer and employee

Arkansas Chapter has more than 1,350 members.

leaders who have, through generous donations

“It’s indeed an honor to receive the P.O. Hooper

of their time and talent, made a better future for

Volunteer Leadership Award,” Ronnel said. “It

healthcare in Arkansas,” said William Clark, chair

has been both an honor and a pleasure to have

of the UAMS Foundation Fund Board.

served as chairman of the UAMS Foundation

UAMS Foundation Fund Board Honors Four for Lifetime Achievement

program for the College of Medicine.

“Congratulations to Dr. Shock, Dr. Westbrook,

Fund Board as that board’s representative to the

The UAMS Foundation Fund Board has recog-

Lee Ronnel, Jo Ellen Ford – we not only commend

University of Arkansas Foundation. I will treasure

nized four honorees with lifetime achievement

you, but are in awe of your extraordinary impact

the Hooper Award, and I thank you for making

awards in gratitude for their decades of service

and impressive legacies,” said Lance Burchett,

me one of the first recipients.”

and philanthropy to UAMS.

vice chancellor for Institutional Advancement.

The awards were presented Feb. 1 at UAMS’ annual All Boards Luncheon.

Shock joined the College of Medicine as chair

Ford, along with her husband Joe, is a mem-

of the Department of Ophthalmology in 1979,

ber of the Society of the Double Helix and had

when there was only one other full-time faculty

Jo Ellen Ford and Lee Ronnel, both of Little

an instrumental role in creating both the Donald

member in that department. He significantly

Rock, were named the inaugural recipients of the

W. Reynolds Institute on Aging and the Winthrop

expanded the department’s faculty and increased

P.O. Hooper, MD, Volunteer Leadership Award. In

P. Rockefeller Cancer Institute Auxiliary. She is a

patient visits from about 6,000 annually to almost

1879, Hooper, along with seven other Little Rock

lifetime member and a former chair of the Foun-

20,000. Shock was one of the first to develop the

physicians, helped to found what is now UAMS.

dation Fund Board, the Donald W. Reynolds Insti-

ultrasonic cataract machine, and established the

The award recognizes UAMS donors for their

tute on Aging Community Advisory Board, and

Jones Eye Institute. He was interim dean of the

exceptional support of the institution’s mission

the Winthrop P. Rockefeller Cancer Institute Foun-

College of Medicine from 2000 to 2002 and was

through volunteerism, leadership, and philan-

dation Fund Board.

UAMS executive vice chancellor from 2002 to

thropy. Like Hooper, they inspire, lead, and moti-

“I’m very grateful for this award,” Ford said. “I

vate others to shape the future of the institution.

want to say thank you to my husband, who has

“I would like to thank the UAMS Foundation

John Shock, MD, founding director of the Har-

always encouraged me to do whatever I felt led

Fund Board for naming me a recipient of the

vey & Bernice Jones Eye Institute, and Kent West-

to do, whether it was Bible study fellowship or

Harry P. Ward Lifetime Achievement Award,”

brook, MD, distinguished professor in the Col-

working at the university hospital in the cancer

Shock said. “Dr. Ward was a master builder, and

lege of Medicine, were named as the inaugural

center and the aging center. It’s been a wonder-

set the stage for enormous campus expansion

recipients of the Harry P. Ward, MD, Visionary

ful blessing to me to be able to help in this area.”

that occurred during his tenure. He did this by


2009.


giving people like Kent Westbrook and myself the opportunity and encouragement to build programs which he thought contributed to the whole. He also openly welcomed individuals who were like-minded, that shared his vision to build a campus of which we all can be very proud.” Westbrook, a 1965 College of Medicine graduate, worked with colleagues throughout much of the 1970s and 1980s to develop comprehensive, multidisciplinary cancer programs at UAMS, culminating in the 1984 formation of the Arkansas Cancer Research Center, the predecessor of the Winthrop P. Rockefeller Cancer Institute. He served as its director for 14 years and was chief of the Division of Surgical Oncology from 1992 to 2003. Westbrook served as interim chair of the Department of Surgery from 1999 to 2002 and as interim vice chancellor for UAMS Development and Alumni Affairs, now the Division of Institutional Advancement, in 2011. He has been an associate dean and a member of the Chancellor’s Cabinet. “It’s really thrilling to me to receive this Harry P. Ward Visionary Award,” Westbrook said. “It’s a great honor. When my wife and I came to this

Simmons Bank’s Cathy Brazeale (left) and Laura Parrish (right) present a $436,000 check to Pedro Delgado, MD, Director of the UAMS Psychiatric Research Institute, on behalf of the Caroline T. Briggs Charitable Trust.

campus 56 years ago, I had no concept of winning an award like this. This award came about because James Suen and I had a dream of a can-

of the Department of Psychiatry in the UAMS Col-

cer center, and I really thank all of the people who

lege of Medicine.

were involved in the development of the Winthrop P. Rockefeller Cancer Institute.”

According to the National Institutes of Health, about one in 100 people in the United States have

“We are very grateful for this gift, which I think will go a long way toward making a difference

schizophrenia, which affects how a person thinks, feels, and behaves.

Each honoree received a plaque with their

in the lives of people with schizophrenia,” said

name and engraved portrait. Copies of the

Delgado, pictured center. “This will allow us

plaques will be displayed on a commemorative

to develop a program that focuses on an area

wall outside the Chancellor’s Suite in the Central

where, until now, we’ve had a gap in our research

Building on the main UAMS campus.

portfolio. We will be able to bring in some new

CHI St. Vincent Health at Home’s services in

researchers in the field as well as involve some

Hot Springs and in Morrilton have been ranked

of our younger faculty members to grow this

among the “HomeCare Elite” as two of the top-

program.”

performing home health agencies in the United

Briggs Trust Donates $436,000 to UAMS for Schizophrenia Research

Briggs, a native of Pine Bluff, passed away in

CHI St. Vincent Health At Home Services in Hot Springs, Morrilton Earn ‘Elite’ Status

States.

A gift of $436,000 will allow the Psychiatric

2016 at the age of 92. The trust is overseen by

The annual rankings developed by the Ability

Research Institute at the University of Arkansas

Simmons Bank. The bank’s Cathy Brazeale, a Vice

Network identify the top 25 percent of Medicare-

for Medical Sciences (UAMS) to fund additional

President and Trust Officer, and Laura Parrish, a

certified home health agencies in the country. The

research into schizophrenia, a serious mental dis-

Trust Officer, represented the Briggs trust during

2017 list marked CHI St. Vincent Health at Home

order that can cause hallucinations, delusions,

the presentation. Brazeale, pictured left, and Par-

Morrilton’s 12th year being recognized as “Elite”

and a loss of touch with reality.

rish, pictured right, later toured the institute to

and CHI St. Vincent Health at Home Hot Springs’

The donation from the Caroline T. Briggs Chari-

learn more about its research efforts. Among the

eighth time for the recognition.

table Trust was delivered Dec. 19 by representa-

sites they visited were the transcranial magnetic

“At CHI St. Vincent Health at Home, we’re hon-

tives of the trust and Simmons Bank to Pedro Del-

stimulation suite, the Walker Family Clinic, and

ored to be recognized for the positive impact

gado, MD, director of the institute and chairman

the Brain Imaging Research Center.

we make on our industry,” said Scott Love, area


Healthcare Briefs director of operations for CHI St. Vincent Health

of the Blue & You Foundation. “After a success-

at Home. “Our teams in Hot Springs and Mor-

ful first year of training in southeast Arkansas, this

rilton strive every day to provide excellent and

second grant will take the training to five addi-

compassionate care to our patients who are

tional hospitals in central and north Arkansas.”

recovering in the comfort of their own home.

SOAPS was created in 2016 when the Blue &

This recognition reflects our commitment to our

You Foundation awarded UAMS $110,752 for a

patients and to improving the quality of care we

one-year simulation education outreach pilot

provide in our communities.”

project. Using web-based learning modules and

HomeCare Elite agencies are determined by an

hands-on simulation training, health providers in

analysis of performance measures in quality out-

Chicot and Helena-West Helena were taught bet-

comes, best practices implementation, patient

ter methods for identifying sepsis, with the goal

experience, quality improvement and consistency,

of providing training across multiple hospitals in

and financial health. In order to be considered for

the Arkansas Delta.

Frits van Rhee, MD, PhD

the recognition, an agency must be Medicare-

The project coincided with the 2017 creation

certified. CHI St. Vincent Health at Home in Mor-

of the statewide Sepsis Collaborative, a joint ini-

the health of Arkansans. In its 16 years of oper-

rilton and Hot Springs are in the top 25 percent

tiative of UAMS, the Arkansas Hospital Associa-

ation, the Blue & You Foundation has awarded

of among more than 9,000 agencies considered.

tion, the Arkansas Department of Health, and the

more than $30 million to 1,319 health improve-

Arkansas Foundation for Medical Care.

ment programs in Arkansas. For more informa-

Blue & You Foundation Gives UAMS $104,269 for Simulation Education to Reduce Infection

This latest gift from the Blue & You Foundation will enable UAMS, in collaboration with the Arkansas Hospital Association and the Arkansas

The Blue & You Foundation for a Healthier

Department of Health, to guide participating hos-

Arkansas has awarded $104,169 to the Univer-

pitals through an examination of organizational

sity of Arkansas for Medical Sciences (UAMS) to

policies, procedures, and hospital equipment to

expand an education program using simulation to

ensure that they are in compliance with current

reduce sepsis, a life-threatening condition caused

evidence-based guidelines for best practice.

tion, visit www.BlueAndYouFoundationArkansas.org.

International Expert at UAMS Myeloma Institute Releases First Book on Castleman Disease Castleman disease, a rare disorder of the lymph nodes and related tissues, was identified and

Gregory Snead, MD, UAMS associate profes-

named more than a half-century ago but, until

The gift goes to fund the Simulation Outreach

sor of emergency medicine, and the Simulation

recently, no one had written a book exclusively

to Address Patient Safety (SOAPS) program,

Outreach team will provide training to 250 med-

about it.

which began two years ago and which served

ical professionals at Conway Regional Medical

Frits van Rhee, MD, PhD, professor of medicine

as a catalyst for a statewide initiative to improve

Center, Baptist Health Medical Center – North

and director of developmental and translational

patient safety in Arkansas. The program will be

Little Rock, Five Rivers Medical Center in Poca-

medicine at the Myeloma Institute at the Univer-

expanded to five hospitals in Arkansas.

hontas, White River Medical Center in Batesville,

sity of Arkansas for Medical Sciences (UAMS), has

“Patient safety is one of UAMS’ core values, and

and River Valley Medical Center in Dardanelle.

changed that.

we’re pleased to receive continued support from

Additional funding from the Arkansas Hospital

His new 163-page hardback book, Castleman

the Blue & You Foundation in this endeavor,”

Association may enable an additional 150 to 200

Disease, was released recently as part of the

said UAMS Interim Chancellor Stephanie Gard-

medical professionals to be trained.

Hematology/Oncology Clinics of North Amer-

by infection.

ner, PharmD, EdD. “With the success of programs

Each hospital will benefit from the same web-

ica series of clinics review articles published

like SOAPS, we can significantly reduce the risk of

based learning modules, lecture, and hands-on

bimonthly by Elsevier Inc. The book features

hospital-acquired infections.”

simulation training as those in the pilot. SOAPS

13 chapters by 26 international physicians and

Sepsis is a life-threatening condition caused

team members will work with clinical care pro-

researchers who specialize in the disease.

by the body’s response to infection. Without

viders, infection prevention personnel, and qual-

“A lot of progress has been made in the treat-

timely treatment, sepsis can rapidly cause tissue

ity improvement officers on ways to continually

ment of this disease and a lot of new information

damage, organ failure, and death. It is the most

track their rates of infection.

is available,” said van Rhee, considered an international expert on Castleman disease.

expensive condition treated in United States hos-

Arkansas Blue Cross and Blue Shield estab-

pitals, and the estimated annual cost of treating

lished the Blue & You Foundation in 2001 as a

He developed the idea for the book. He also

sepsis in Arkansas is $200 million.

charitable foundation to promote better health

wrote one of its chapters, and co-authored the

“This is our second year of funding this impor-

in Arkansas. The Blue & You Foundation awards

preface and the book with Nikhil C. Munshi, MD,

tant program to reduce serious infection in Arkan-

grants annually to nonprofit or governmental

associate director of the Jerome Lipper Myeloma

sas,” said Patrick O’Sullivan, Executive Director

organizations and programs that positively affect

Center at Dana-Farber Cancer Institute in Boston.


Healthcare Briefs Munshi was previously with UAMS. The book will also be published online by chapters. Castleman disease occurs when an abnormal overgrowth of cells occurs in the lymph system, which serves as the main part of the body’s immune system. The disease, affecting 5,000 to 6,000 patients across the nation, was identified by Benjamin Castleman, MD, in 1954.


contributed chapters to other books, including

perspective to advance the national conversation

those on myeloma and bone marrow transplan-

about how important clear health communication

tation, positron emission tomography (PET) scan-

and health literacy are to creating a patient-cen-

ning, and radiation therapy in treating myeloma.

tered health system,” said Trudeau, the first law-

Arkansas ‘Stop the Bleed’ Program to Provide Medical Kits to Arkansas Schools The Arkansas Department of Health presented

yer to serve on this roundtable. Health literacy is the degree to which individuals can obtain, communicate, process, and understand the basic health information and services needed to make appropriate health decisions.

“The average oncologist may only see one

“Stop the Bleed” medical kits to the Arkan-

Trudeau joined the UAMS Center for Health

patient with Castleman disease in his career,” said

sas Department of Education, a partner in the

Literacy in 2017, providing teaching, consulting,

van Rhee. “So it is hard for community doctors to

Arkansas “Stop the Bleed” program. “Stop the

and program work. He was one of seven from

be well-informed and a lot of patients don’t get

Bleed” trains bystanders to be immediate volun-

the academic world recently chosen to join the

the correct treatment.”

teer responders and to act quickly in the event

roundtable. Others on the roundtable are from

of a trauma to save lives until professional emer-

government agencies, nonprofit organizations

gency responders can arrive on the scene.

and industry.

Unicentric Castleman disease is localized, affecting only a single lymph node region, and can often be successfully treated by surgically

Trauma is the number one cause of death for

Trudeau is also an associate professor of law

removing the affected area. Multicentric Castle-

Arkansans between the age of one and 45. The

at the University of Arkansas at Little Rock Wil-

man disease affects multiple lymph node areas

first five minutes after a trauma are crucial. Imme-

liam H. Bowen School of Law. He received his

and can give rise to night sweats, fevers, weight

diate volunteer responders who are trained in

law degree in 2002 from Western Michigan Uni-

loss, anemia, and, in severe cases, organ failure

“Stop the Bleed” techniques can make a life or

versity Thomas M. Cooley Law School and served

and death. Van Rhee was previously the princi-

death difference to a person who is injured. They

as a professor there for 13 years before coming

pal investigator on a worldwide trial with a new

are able to provide basic trauma care before pro-

to UAMS and UALR.

monoclonal antibody, siltuximab. This trial led to

fessional responders arrive on the scene.

the first FDA-approved treatment for multicen-

Arkansas is leading the nation in the training of

tric Castleman Disease. The encouraging results

law enforcement and school personnel in these

of the trial also led to the approval of the drug by

techniques. Through a grant from ADH, Arkan-

the European Medicine Agency

Arkansas Department of Health Offering Free Flu Shots in Local Health Units

sas’s “Stop the Bleed” Program will provide wall-

The Arkansas Department of Health (ADH)

The cause in many patients is unknown, or idio-

mounted public access trauma kits to more than

is offering free flu shots in all local health units

pathic, and the disease has now been termed

300 schools that have participated in the training

(LHUs). There will be no out of pocket cost for

idiopathic Castleman disease (iMCD). “That is

across Arkansas.

patients, regardless of their insurance status. The

one of the main areas of focus in this book,” said van Rhee, who addresses the topic in “Treatment of Idiopathic Castleman Disease,” the chapter he wrote with research associate Amy Greenway and lab director Katie Stone at the UAMS Myeloma

UAMS’ Christopher Trudeau Tapped for National Health Literacy Roundtable Christopher Trudeau, JD, an associate profes-

state continues to see a high number of flu cases and flu-related deaths this season. Any Arkansan who has not yet received a flu shot can go to the LHU near them. LHUs are listed on the ADH website at www.healthy.arkansas.gov/health-units.

sor in the College of Medicine at the University of

ADH is reporting 125 flu-related deaths so far

Van Rhee felt a sense of urgency to create the

Arkansas for Medical Sciences (UAMS), has been

this season. Three of those deaths were children.

book after co-founding the international Castle-

selected for a three-year term on the Roundtable

It is not too late to get a flu shot this flu season.

man Disease Collaborative Network in 2012 with

on Health Literacy with the National Academies

Even in years where the flu shot is not perfect,

his patient David Fajgenbaum, MD, then in med-

of Science, Engineering, and Medicine.

it is still the best protection from the flu that is

Institute.

ical school and now a physician at the University

The private, nonprofit institution provides

available. Other important ways to help prevent

independent, objective analysis and advice and

the spread of flu include washing hands, avoid-

“The timing seemed right, under this umbrella

informs public policy decisions related to sci-

ing people who are sick, coughing into the elbow,

organization where physicians and researchers

ence, technology, and medicine. The 30-member

avoiding touching the face and eyes, and staying

from around the world meet each other and

Roundtable on Health Literacy meets in Wash-

home when sick.

exchange ideas,” said van Rhee.

ington, DC three times a year to develop, imple-

Flu symptoms include fever, chills, cough, sore

ment, and share health literacy practices in the

throat, muscle or body aches, fatigue, and a

healthcare community.

headache. Symptoms may also include vomit-

of Pennsylvania.

While this is van Rhee’s first time to compile and edit a book, the physician, who trained in the Netherlands and United Kingdom, previously

“I look forward to contributing my legal

ing and diarrhea in children. Influenza antiviral


Healthcare Briefs


prescription drugs, like Tamiflu, can be used to

heart disease. Foods that have whole grains and

want to eliminate the guesswork and connect

prevent or treat influenza if started soon after

protein and are low in calories and low in satu-

families with trustworthy resources,” said Jayne

symptoms begin.

rated fat can help lower blood pressure.

Bellando, PhD, CoBALT co-director and associate

People who are at a higher risk for complica-

Often there are no symptoms of high blood

professor of pediatric psychology in the UAMS

tions from the flu include:

pressure, even though it is one of the biggest rea-

College of Medicine’s Department of Pediatrics.

• Children aged two years old and younger

sons people suffer from heart attack and stroke.

CoBALT is a project of the James L. Dennis

• Adults aged 65 years and older

Arkansas leads the nation for the highest heart

Developmental Center, a part of the Department

• Pregnant women, or women up to two weeks

attack death rates and is number five in the nation

of Pediatrics that conducts diagnostic evaluations

for the highest stroke death rates.

on children. CoBALT is funded by the Arkan-

after delivering a child • People with a suppressed immune system

“By changing the definition of high blood pres-

sas Department of Human Services’ Division of

• People with chronic health problems, like

sure, the guidelines recommend earlier steps for

Developmental Disabilities Services’ Title V Chil-

asthma, diabetes, cancer and heart disease

care to prevent the illness and death that can

dren with Special Healthcare Needs Program.

• Residents of nursing homes or other chronic

occur as a result of uncontrolled hypertension,”

While in search of a diagnosis, families often

care facilities

said Dr. Appathurai Balamurugan, ADH State

face long wait times and travel distances. In

It is recommended that everyone aged

Chronic Disease Director. “People should know

search of a way to better serve families, Depart-

six months and older get the flu shot every year.

their blood pressure numbers, and make impor-

ment of Pediatrics faculty partnered with the

It is especially important for pregnant women

tant lifestyle choices, like quitting smoking, get-

Title V program about eight years ago to form

and others at high risk for complications. The flu

ting physically active, and eating a healthy diet

CoBALT.

shot is available in local health units, located in

that will help lower blood pressure.”

Education is CoBALT’s primary mission. It aims

every county, and in many doctor’s offices. Phar-

The new guidelines redefine high blood pres-

to train teams of healthcare providers across the

macies also have flu shots available but do not

sure, treatment thresholds, goals, and medi-

state with the knowledge and the confidence to

give flu shots to children younger than seven

cations in the management of hypertension in

screen children for developmental disorders. It

years of age.

adults. This is the first update to the United States

also focuses on reducing wait times and travel

guidelines on blood pressure detection and treat-

distances for families – all with the goal of improv-

ment since 2003. These changes mean that high

ing outcomes for patients.

Healthy Lifestyle More Important than Ever in the Fight Against High Blood Pressure

blood pressure is now defined as readings of 130

Today, there are CoBALT teams in Lowell, Fort

and higher for the systolic blood pressure mea-

Smith, Clinton, Forrest City, El Dorado and Little Rock.


surement (top number), or readings of 80 and

and other healthcare providers are adopting

higher for the diastolic measurement (bottom

“The ultimate goal of empowering families with

new hypertension (high blood pressure) guide-

number). That is a change from the old defini-

information and training more healthcare profes-

lines developed by the American Heart Associa-

tion of 140/90 and higher, and reflects the health

sionals to screen for developmental disorders is

tion, American College of Cardiology, and nine

impact that can occur at those lower numbers.

to help families get quicker access to specialized

other health professional organizations. These guidelines mean that some patients who were not thought to have high blood pressure may now be considered hypertensive. Hypertension leads to illness and death, but it can be prevented.

UAMS CoBALT Website Connects Families, Providers with Trusted Autism Resources

developmental screening, which may result in quicker services,” Bellando said. “Quicker services often lead to better outcomes, because when you’re dealing with children and develop-

A new website developed by the University of

mental disorders, each passing week can mean

Important lifestyle changes can help people

Arkansas for Medical Sciences (UAMS) connects

another missed milestone. It’s important to start

who have high blood pressure reduce their risk

families and healthcare professionals with infor-

services quickly.”

of a heart attack or stroke. These include quitting

mation and resources about autism and other

smoking, moving more, and eating healthy foods.

developmental disorders.

The newly launched CoBALT website is the latest step in this ongoing effort.

Smoking increases a person’s risk for heart dis-

The endeavor is a result of the Community-

“For families and providers alike, it’s OK to have

ease because it raises a person’s blood pressure.

based Autism Liaison and Treatment Project

questions. We intentionally worked to make the

By quitting smoking, people can lower their

(CoBALT). The new site – www.CoBALTAR.org –

website as clear and accessible as possible,” said

blood pressure and reduce their risk of heart dis-

aims to be a “one-stop shop” for families and

Eldon G. Schulz, MD, CoBALT co-director and

ease. Arkansans can get help quitting by contact-

providers.

professor in the Department of Pediatrics. “There

ing the Arkansas Tobacco Quitline at 1-800-QUIT-

“If you are a parent who suspects your child

are videos, frequently asked questions, and links

NOW. Physical activity and a healthy diet that is

might have autism or another developmental

to reputable outside sources, in addition to the

low in red meat and full of a variety of fruits and

disorder, it can be overwhelming to try to find

text we’ve provided. The site may be accessed at

vegetables are important in the fight against

reliable, evidence-based information online. We

www.CoBALTAR.org.



Medicaid Distributes SFY 2018 UPL Calculations

associate professor in the Department of Pathol-

• Adults aged 65 years and older

ogy and Department of Dermatology at UAMS;

• Pregnant women, or women up to two weeks after delivering a child

Arkansas Medicaid officials notified hospitals on

Sandra McGrew, director of content marketing

Dec. 14 about the estimated upper payment limit

for Ghidotti Communications in Little Rock; and

• People with a suppressed immune system

(UPL) calculations which will apply to the state’s

Sebastian Montes of the FBI Little Rock Field

• People with chronic health problems, like

Hospital Assessment Program for state fiscal year

Office Cyber Division.

asthma, diabetes, cancer and heart disease

(SFY) 2018, which began July 1, 2017. The cal-

Dorothy Graves, associate director for adminis-

culations provide hospital specific amounts for

tration of the Winthrop P. Rockefeller Cancer Insti-

care facilities

the assessment fees that will be charged to the

tute, moderated the event.

It is recommended that everyone aged six

• Residents of nursing homes or other chronic

hospitals and the supplemental payments which

Science Café includes a corresponding live

months and older get the flu shot every year. It

they will receive during the 12-month period end-

radio call-in program, “Science Café Little Rock,”

is especially important for pregnant women and

ing June 30, 2018. The notifications triggered the

on National Public Radio-affiliate station KUAR

others at high risk for complications. The flu shot

start of a legally mandated 30-day period dur-

FM89. The science talk show, featuring one

is available in Local Health Units located in every

ing which hospitals may review the numbers and

speaker from the monthly panel of scientists and

county and many doctor’s offices. Pharmacies also

make a case for changes, if any are needed.

experts, is aired just prior (6:05-6:30 p.m.) to the

have flu shots available, but do not give flu shots

live Science Café event. Gardner served as the

to children younger than seven years of age.

Typically, the initial quarterly UPL payments generated through the program for any given SFY

radio guest.

UAMS Relationship Enrichment Series Aimed at Helping Couples

have been distributed prior to Christmas. How-

Science Café events are held on the fourth

ever, a delay in completing the necessary calcu-

Tuesday of the month, except for July, August,

lations for SFY 2018, coupled with the 30-day

and December. Check out the website for more

The University of Arkansas for Medical Sci-

review period, made that target impossible for

information on monthly speakers and topics at

ences (UAMS) Couples Center hosted a four-

this year.

www.sciencecafelr.com.

week relationship enrichment series, designed

Therefore, the payments covering the first quarter of SFY 2018 (July 1-September 30) will be the same as quarterly amounts paid during SFY 2017. Those payments should have been made by Christmas. Once the SFY 2018 calculations are final, they

to help couples make their bond stronger, hap-

Got the Flu? Prevent its Spread by Staying Home

pier, and healthier. The sessions were led by Chelsea Wakefield,


PhD, LCSW, director of the Couples Center and

urges Arkansans to stay home if they have a fever

nationally recognized psychotherapist and author,

or other symptoms that could be flu-related.

who is extensively trained in helping with prob-

will govern the assessment fees and supplemen-

Going to work or to school while contagious

tal payments for the second and third quarters of

could spread the flu. People are generally conta-

lems related to relationships. The topics of the sessions were “The Dance of

SFY 2018. The final SFY 2018 payments will reflect

gious one to two days before symptoms start and

Two – Relationship as a Path of Personal Growth,”

a true-up amount to reconcile the payment for

five to seven days after symptoms start.

“How to Communicate Needs and Desires in

the first quarter. Any hospital paid too little in that

“A good rule of thumb is to not go anywhere

Ways that Engage Rather than Alienate,” “Work-

initial payment will have the shortage included

until you have been fever-free for 24 hours without

ing Through Sexual Difficulties – Exploring the

in the final quarterly payment. Likewise, any first

the help of medication,” said Dr. Gary Wheeler,

Mystery of Desire,” and “Meaningful Connection

quarter overpayments will be recovered in the

ADH Chief Medical Officer. “You could spread the

– How to Get There and Stay here.”

final quarter of the fiscal year.

flu to someone who is at risk of complications like

For questions, contact Josh Hooten at (501)

hospitalization or even death.”

“This series is designed to help all couples, no matter what age or stage they are at in their rela-

Flu symptoms include fever, chills, cough, sore

tionship,” said Wakefield. “The Couples Center

throat, muscle or body aches, fatigue, and a

is devoted to providing good information, and

headache. Symptoms may also include vomiting

teaching people the skills and tools that will help

and diarrhea in children. Influenza antiviral pre-

couples get through rough patches in their rela-

Science Café Little Rock, co-sponsored by

scription drugs, like Tamiflu, can be used to treat

tionship or enrich an already good relationship.”


or prevent influenza if started soon after symp-

(UAMS), recently held a program focused on “The

toms begin.

396-6004 or email [email protected].

UAMS’ Science Café Focuses on ‘The Science of Social Media’

Arkansas Public Health Association Hosts 70th Annual Conference

Science of Social Media.” Panelists discussed

There have already been eight flu-related

the positives and negatives of social media as a

deaths this flu season in Arkansas, all in people

widely used global communications and employ-

aged 65 or older. People who are at a higher risk

ment recruiting tool.

for complications from the flu include:

hold its 70th annual conference May 9-11 at the

• Children aged two years old and younger

Crowne Plaza in Little Rock.

The panel will included Jerad Gardner, MD,

The Arkansas Public Health Association will


Healthcare Briefs The theme of the event will be “Pathways to

at the University of Arkansas for Medical Sciences

Oral Health Clinic and General Practice Residency

Health Equity: A Glance at the Social Determi-

(UAMS) has received an $118,000 grant from the

Program and an assistant professor in the Center

nants of Health, Health Policy, and Advocacy.”

Delta Dental of Arkansas Foundation to create an

for Dental Education; Gene Jines, D.D.S., director

The objectives of the annual meeting are:

oral health and dental education curriculum avail-

of the Center for Dental Education; Mitzi Efurd,

able to all students.

Ed.D., associate professor and chairman of the

• To provide practical skills and comprehensive information for public health professionals from across the state. • To stimulate the exchange of innovative programs and partnerships with hospitals/clinics,

The oral health component will be incorpo-

Department of Dental Hygiene in the College

rated into the current IPE curriculum. Students

of Health Professions; and Wendy Ward, Ph.D.,

in all degree programs at UAMS are required to

director of interprofessional faculty development

take IPE courses.

in the Office of Interprofessional Education.

Kathryn Neill, PharmD, director of Interprofes-

The Delta Dental of Arkansas Foundation

ties to create a healthy future for those at risk

sional Administrative and Curricular Affairs in the

is committed to improving the oral health of

• To enhance multidisciplinary interaction and

UAMS Office of Interprofessional Education, said

Arkansans.

team development among public health

the curriculum will help students be better able

professionals.

to address the significant oral health needs of

schools, businesses, worksites and communi-

• To provide innovative approaches/consider-

Arkansans.

UAMS Sets March Adult Computer Classes

“Integrating medical and dental health care is

One computer class — Computer Basics —

populations.

one way to ensure that preventative oral health

and seven computer workshops — One-on-One

ations for minority and medically underserved The meeting offers attendees the opportu-

services can begin even before age one,” said

Computer Support, Computer Maintenance,

nity to learn from the latest research and prac-

Weldon Johnson, Executive Director of the Delta

Online Shopping and Banking, Texting and Typ-

tice, conduct hands-on assessments on the latest

Dental of Arkansas Foundation. “Combining the

ing on Your iPhone, File Management, Free Work-

tools and service, network with industry experts

delivery of oral health and primary care services

shop, and Google Photos — will be taught in

and colleagues, and expand their professional

offers a comprehensive health system that is effi-

March for adults at the University of Arkansas for

horizons. Attendees will be able to choose from

cient, patient-centered and has the potential to

Medical Sciences (UAMS) Donald W. Reynolds

multiple education sessions, enabling them to

provide affordable, quality health care to families

Institute on Aging.

customize their schedule to best fit their public

throughout the state.”

health interest.

According to 2010 data published by the Arkan-

The courses will be presented by the Little Rock Digital Learning Center, a nonprofit volunteer

CEUs will be requested for nurses, dietitians,

sas Center for Health Improvement, 64 percent of

group. Courses begin Feb. 1. The schedule is:

environmental health specialists, and health edu-

children and adolescents had evidence of current

• One-on-One Computer Support, March 1-30;

cators.To register, go to http://tiny.cc/APHA18.

or past cavities, and 29 percent had untreated

UAMS Offers Free Estate Planning Assistance for Cancer Patients Cancer patients and survivors were recently

cavities. Among older adults, 23.3 percent of adults 65 and older in Arkansas reported that they had lost all of their permanent teeth — compared with 16.9 percent nationwide.

invited to receive free legal assistance on impor-

“The knowledge our students will gain from

tant personal documents 24 at the University of

this curriculum will help ensure that even when

Arkansas for Medical Sciences (UAMS).

Arkansans are unable to see a dentist, other

Call for appointment. • Texting and Typing on Your iPhone, March 1, 1-3 p.m. • Computer Basics, Mondays and Wednesdays, March 5-21, 10 a.m. to noon. • File Management, March 6 and 8, 1:30-3 p.m. • Computer Maintenance, March 12 or 14, 1-3 p.m. • Google Photos, March 13 and 15, 1:30-3 p.m.

The estate planning clinic was be held at the

health care providers will be able to look out for

UAMS Winthrop P. Rockefeller Cancer Insti-

their oral health needs, which is vitally important

• Free Workshop, March 16, 1-3 p.m.

tute as a free service by local attorneys. It was

because oral health affects much more than just

• Online Shopping and Banking, March 26 and

open to anyone in cancer treatment or who has

the mouth,” said Neill, noting that research sug-

28, 1-3 p.m.

completed treatment, based on financial need.

gests poor oral health is linked to heart disease

The course fee for three- and four-week classes

Attendees met individually with licensed attor-

and stroke.

is $60, including a manual. Additional courses

neys to prepare wills, living wills, and powers of

The curriculum will include training modules,

range from $20 to $35 for workshops, depend-

attorney, and left with notarized copies of their

live lectures and simulation activities, as well as

ing on the number of sessions and whether a

documents.

screening events that will support preventive

manual is included. Classes are in Room 2156

measures and identify patients in need of further

at the UAMS Institute on Aging, 629 Jack Ste-

intervention.

phens Drive.

Delta Dental of Arkansas Foundation Awards UAMS $118K for Dental Education The Office of Interprofessional Education (IPE)

The course is being developed by an inter-

For more information and to register for classes,

professional team of faculty composed of Neill,

call (501) 603-1262, email [email protected], or

Ashley McMillan, D.M.D., assistant director of the

visit http://www.littlerockdlc.org. n


dialogue

column

Director’s Desk

Reducing Accidental Infant Deaths Through Safe Sleep Practices

There are few events that are as tragic as the sudden loss of an infant’s life, and the ripple effects extend beyond immediate family to our broader community. Sadly, there are many Arkansans who experience such loss every year due to infant sleep related death. The Arkansas Department of Health and our partners are working together to reduce the number of infants who die unexpectedly due to sleep related deaths. All healthcare providers and caregivers should know the ABC’s of safe sleep: the baby should sleep Alone, on his or her Back and in a Crib.

Nationally, over 3,500 infant deaths

and strangulation in bed. According to the

similar safe sleep surface by themselves;

were considered sudden unexplained in-

National Center for Health Statistics, SIDS

however, many families still share beds or sleeping locations and may not have access

fant deaths (SUIDs) in 2014. In Arkansas, 61

is the leading cause of death in infants from

infants died of SUIDs, ranking us among the

one month to one year of age in the United

to safe sleep surfaces such as cribs. The pro-

highest in the nation for SUID rates. SUID is

States.1 SUIDs affects everyone; however,

motion and practice of safe sleep can help

a term used to describe the sudden and un-

there are significant disparities in SUID

reduce infant mortality rates due to SUID in

expected death of a baby less than 1 year of

rates across race, ethnicity, and community. Arkansas.

age with no immediately obvious cause that

Native American and non-Hispanic black

often happens during sleep or in the baby’s

populations suffer SUIDs at a higher rate

dated 2016 safe sleep recommendations for

sleep area. There are a variety of causes

than most in the United States.

infants to reduce the risk of all sleep-related

for SUIDs, and often the cause of death is

There are some key factors that can make

The American Academy of Pediatrics up-

death. In addition to recommendations to al-

discovered during an autopsy or death in-

a difference in sleep safety to reduce the risk

ways put the baby on his or her back to sleep

vestigation. Sudden Infant Death Syndrome,

of SUIDs, and these include position of the

at night and for naps, use a safety-approved

or SIDS, is defined as the sudden death of

baby for sleep, sleep location and feeding

crib or bassinet with a firm surface, and share

an infant that remains unexplained after

practices. Babies should be laid to sleep on

the room with the baby but not the bed, the

a thorough investigation, including death

their backs. Unfortunately, data from the

update included additional best practices.

scene investigation, autopsy, and review of

Arkansas 2013 Pregnancy Risk Assessment

These are: do not expose the baby to smoke,

the infant’s clinical history. The three most

Monitoring Survey indicated that more than

alcohol, or illicit drugs, breastfeed the baby

commonly reported types of SUIDs are SIDS,

30% of infants were not laid to sleep on their

for six months or longer, and make sure the

unknown reasons, and accidental suffocation

back. Babies should also sleep in a crib or

baby receives routine immunizations.

44 MAR / APR 2018 I Healthcare Journal of LITTLE ROCK

Nathaniel Smith, MD, MPH Director and State Health Officer, Arkansas Department of Health

One way in which the Arkansas Depart-

sleep. Through COIIN partner efforts, 34

ment of Health and others are addressing

Arkansas hospitals are now providing such

as Healthy Active Arkansas and the Arkansas Breastfeeding Coalition. Breastfeeding

SUIDs is through the Safe Sleep Collabora-

training to staff and new parents.

helps protect against a wide variety of dis-

tive Improvement and Innovation Network

Another way the Arkansas Department of

eases and conditions, including SIDS. The

(CoIIN). This effort includes the Arkansas

Health is addressing safe sleep is by the ad-

promotion and support of breastfeeding is

March of Dimes, Zeta Phi Beta Sorority, Inc.,

dition of safe sleep education to the Women,

an important component to help improve

Arkansas Hospital Association, Arkansas

Infants, and Children (WIC) program’s policy

overall infant health.

Children’s Hospital, and the University of

manual so the training can be included as a

Arkansas for Medical Sciences. CoIIN has

WIC class. Safe sleep education is also pro-

SUIDs by sharing information with family

developed and is distributing Safe Sleep

vided in WIC program participants’ welcome

and friends about safe sleep practices and

Toolkits to hospitals across the state and

backpack. Additionally, partnerships with

making sure new families have a safe sleep

is helping birthing hospitals work toward

volunteer, civic and community groups,

environment for their newborn. Healthcare

becoming safe sleep certified through the

such as the Stork’s Nest and Sisters/Broth-

professionals should provide education on

Everyone can play a part to help reduce

Cribs for Kids certification program. CoIIN

ers United, have engaged many commu-

safe sleep practices to families that are ex-

works to train birthing hospitals across the

nity volunteers who help to educate others

pecting. Hospitals can model the ABCs of

state in safe sleep best practices. When the

around safe sleep practices.

safe sleep practices with newborns in their

Finally, ADH is very active in promoting

nurseries, giving parents a chance to prac-

ing formal training to staff members and

breastfeeding and providing breastfeed-

tice. We can all can play a role to prevent

seven were educating parents about safe

ing support through collaboratives such

these accidental deaths. n

effort began, three hospitals were provid-


column policy

If you follow this column, you’ve likely noticed that I focus a lot on obesity in this space. And for good reason. Arkansas is ranked among the states with the highest rates of obesity and most inactive residents. It’s a major problem here and throughout the United States—where even the healthiest states have higher obesity rates than many developed countries (according to the 2017 America’s Health Rankings Annual Report by the United Health Foundation). But this is not another column about obesity in Arkansas. I want to spotlight another vicious killer: tobacco.

Kicking the Habit:

It’s Time We Deal with Arkansas’ Tobacco Problem Leading by Example

46 JAN / FEB 2018 I Healthcare Journal of little rock

Joseph W. Thompson, MD, MPH Director, Arkansas Center for Health Improvement

Where do we go from here?

In the past few months, two reports

smoking regular cigarettes. Among adults

have painted a grim picture regarding to-

18 to 30 it reported that 47.7 percent of e-

Arkansas still has loopholes through ex-

bacco use and control in Arkansas.

cigarette users started smoking traditional

emptions to its smoke-free law to protect

The 2018 scorecard from the American

cigarettes versus only 10.2 percent of non-

workers and the public in some workplaces,

Lung Association’s “State of Tobacco Con-

users. The study by Brian Primack and col-

restaurants, and bars. Strengthening state

trol” report graded Arkansas with an “F” for

leagues, “Initiation of Traditional Cigarette

law to protect Arkansans in all public spaces

tobacco prevention and cessation funding,

Smoking After Electronic Cigarette Use

and workplaces should be a top priority.

tobacco taxes, access to cessation services,

Among Tobacco-naive U.S. Young Adults,”

Another powerful weapon in the fight to

and Tobacco 21 (a movement to raise the

was published in the American Journal of

curb tobacco use is implementing stricter

minimum tobacco-purchasing age to 21).

Medicine in December.

age requirements, as the community of

Arkansas received a “C” grade for smoke-

Additionally, a report from the National

Helena-West Helena has already done by

free air because of restrictions to public and

Academies of Sciences, Engineering and

unanimously voting to restrict sales to those

workplace smoking already in place.

Medicine released in January concluded

under 21 years of age. Expanding minimum

The adverse effects of tobacco are well

that using e-cigarettes containing nicotine

buying ages statewide could go a long way

known. Smoking and other tobacco use

can be addictive and may put young peo-

toward reducing tobacco uptake and sub-

causes cancer, stroke, birth defects, heart

ple at greater risk of picking up traditional

sequent addiction among young people.

disease, respiratory problems, and lung dis-

smoking habits.

The U.S. Department of Health and Hu-

ease. The list goes on. We also know that secondhand smoke is a silent killer and there

man Services has reported evidence that

We’ve made some progress

demonstrates the effectiveness of raising

is no safe level of exposure. According to the

Arkansas has admittedly taken some en-

taxes to reduce tobacco consumption, espe-

CDC nearly 6,000 adults die each year in

couraging steps toward stamping out the

cially among young adults and low-income

Arkansas from illnesses related to smoking.

tobacco problem, although without going

tobacco users. The Tobacco Nation report

Despite this knowledge and awareness

far enough. In 2006 Governor Mike Hucka-

puts Arkansas among the states with some

tobacco use in a group of states including

bee signed bills making most workplaces

of the lowest tobacco taxes. An analysis

Arkansas more closely resembles that of

smoke-free and banning smoking in vehi-

published last year in the official journal of

a developing nation, according to a Truth

cles with children under 6 years old. In 2011 a

the Society for Research on Nicotine and

Initiative report published shortly before

bill signed by Gov. Mike Beebe strengthened

Tobacco found that tobacco consumption

the ALA report card. In fact, the report dubs

that law, increasing that age restriction to

could be reduced by 8 to 46 percent, de-

these 12 contiguous states with the high-

minors under the age of 14.

pending on the amount of the tax hike.

est rates of tobacco prevalence, “Tobacco Nation.” We have some work to do.

What about e-cigarettes?

Local communities have led the way on

These are just a few of the measures that

tobacco-free policies for parks, schools, and

could be employed. If we come together

businesses. Every college campus in the

around this issue Arkansas can take dra-

state has banned smoking, including e-cig-

matic steps forward. We’ve done it before.

arettes. The Arkansas Clean Indoor Air Act

In the past few years—after committee

Use of electronic cigarettes has grown

of 2006 protects workers from secondhand

meetings, planning sessions, and summits—

dramatically in the past 10-15 years, espe-

smoke in the workplace and public places.

local and state leaders, including our gov-

cially among youth and young adults. Fre-

Since 2012 the CDC has worked to educate

ernor, have coalesced and committed to a

quently marketed as a safe alternative to to-

tobacco users on the dangers of smoking,

comprehensive plan to fight obesity through

bacco, e-cigarettes still remain insufficiently

while connecting them with helpful—and

the Healthy Active Arkansas initiative. It’s

studied for their long-term effects on the

free—resources in their home state through

true that there is more work to be done but

lungs and other organs, or their health im-

a quitline (1-800-QUIT-NOW).

there are clear steps being taken to reach

pact when used during pregnancy. One recent study among young adults who had never smoked found that e-cig-

Despite these efforts tobacco use remains the leading cause of preventable death in Arkansas and throughout the region.

positive outcomes. It is time to do the same regarding tobacco and help our citizens kick the habit. n

arette use may function as a gateway to Healthcare Journal of little rock I MAR / APR 2018 47

column Mental Health

the opioid crisis: So What Are We Going to Do About It? Life is challenging, isn’t it? We spend almost every minute of our day doing something; we are working, taking care of family, paying bills, grabbing a bite on the run, and squeezing in some sleep. Sometimes, even when we try our hardest, we encounter pain in our bodies.

48 MAR / APR 2018 I Healthcare Journal of LITTLE ROCK

JASON MILLER, CEO The BridgeWay

Pain is an awful thing. Yes, it is our body’s way of telling us that we are injured and need medical attention, but it never feels good, and we never see it as a positive. Once, when my daughter was a baby, she had a fever and wanted to rest. Her mother and I didn’t mind too much because she was a non-stop runner, even at 18-months old (we needed the rest). However, she was feeling so poorly that we decided to give her pain reliever/fever reducer to help her feel better. Within an hour, she was bouncing off the walls again, even though her body was still battling an infection. After the medicine wore off, she was in pain with mild fever again. This time, as hard as it was to watch her ache, we

“We are hurting, and we have trained ourselves as a society to reach for the quickest and most available adversary to pain—pain relievers such as opioids.”

let her body heal itself without pain medications. She was fine. We all struggle with pain in different ways, and most all of us do not like it or want it. In- most all industrialized nations combined.

for pain. Meditation, stretching, light exer-

tense pain (i.e. pain that rates 7 or above on

We are, as a country, addicted to reducing

cise, acupuncture, physical therapy, better

the Pain Scale) is where many of us struggle

pain. We are, as a country, addicted to market

diet, and good sleep are all potential ways

the most to function. We are hurting, and we

forces that tell us we can be better with more

to pinpoint and reduce pain. In most cases,

have trained ourselves as a society to reach

chemicals in our bodies. We are, as a nation,

our body knows how to heal itself. Pain is

for the quickest and most available adversary

addicted to a crisis.

sometimes a natural defense to allow our

to pain—pain relievers such as opioids. Opioids are everywhere. Aside from a

bodies to repair or fight.

So what are we going to do about it?

Seek Out Treatment. If you or someone

powerful (and effective) marketing strategy

I think we owe it to ourselves to look at

you know is addicted to pain medications, do not take it lightly. Yes, pain is unpleas-

from the pharmaceutical companies, opioids

ourselves. Are we (or those we love) taking

are prescribed (and now over-prescribed)

pain medications far beyond the recom- ant, but addiction is almost always far, far

by physicians all over the nation. Many of

mended dose? Has it become necessary to

us just have them in our medicine cabinet

keep narcotics/opioids in our vehicles or

ing hospitals, have detox and/or rehab pro-

from a previous toothache or surgery. Il- purse so that it is always available if we need

grams that can help. Newer therapies, such

worse in the end. Dozens of facilities, includ-

licit drugs like Heroin (opiates) are making

it? Have we asked someone else for medi- as treatment with buprenorphine, may be an

a comeback because prescription drugs are

cations to help fight pain because we were

finally being regulated and limited, and now

out of pills? Have we ignored symptoms in

Help Fight the Fight. Advocate right. Do

the treatments for them are everywhere too.

someone we love or enabled their addiction

not enable someone to seek out drugs to help

answer as well.

At my hospital, we rarely go a day where we

by buying pills or hiding their addiction from

their problems. Participate in efforts to re-

do not encounter someone addicted to pain

someone else? Have we called a treatment

duce the use of opiates. Tell your doctor to

medications or heroin.

center and asked for help? Have we done all

find an alternative, and work to do your part

we can to advocate for our friends, our family,

to fight this battle with opioid addiction. We

Yet the saddest part of the story is that something created to make us feel better is

and ourselves?

have to ask ourselves, what are we going to

actually killing people every single day. As

Look for Alternatives. Pain is a terrible

a country, the U.S. uses more opioids than

thing, but there are alternative treatments

do about it? My best. n


column Orthopedics

Jimmy Tucker, MD Arkansas Specialty Orthopaedics

merger expertise as a special help. And, we reviewed the importance of arriving

GETTING ESTABLISHED: Legal to do list

at mutual strategic goals, operational and financial principles, leadership and governance structures that solve past problems and formalize organizational practices. Our third article examined issues related to “going public” with the merger, such as anti-trust issues and the reactions other may have as we make our plans known. Overall, our goal in “going public” was to get some level of buy-in, understanding and even endorsement by the health

This is the fourth of six articles detailing the merger of our two groups, OrthoArkansas Orthopedics & Sports Medicine and Arkansas Specialty Orthopedics. Our goal is to share, from a physician leader’s perspective, the issues and industry trends that lead to a merger decision, the strategic, legal and cultural process of merging, our candid experiences along the way and our results. In this article, we discuss the legal process of merging and its various components.

care partners of our future merged group. This step is not about publicity or marketing but about assuring acceptance of the merger process by parties with a stake in its outcome. This is the beginning, not the end, of communication about the merger and signals that it really is going to happen and will be a good thing for all involved. Now, for more legal work. Most physician leaders are not attorneys. Yet, our work and practice lives are

In our first article we discussed our

nity and state led us to consider the notion

governed and directed in many ways by le-

desire to bring the golden age of medi-

that we should combine our groups and

gal documents we must understand, even

cine—that time when we can help our pa-

meet these challenges together.

more so as we structure a merger. What

tients improve their health and function

In the second article, we reviewed the

follows is, in broad terms, a sample of legal

more than any time before—to our patients

categories of issues key to the cultural,

documents devised to establish and gov-

and partners. We believe that golden age

operational and legal decision to merge.

ern a new organization, transition from a

of medicine can be now if it is steered by

We reviewed the needed financial and

previous one, and employ those principal-

those closest to the patients: physician

legal advisors, some of whom may have

ly involved.

leaders who want their organizations to be essential partners to patients, other providers and society in general. As our groups forecasted our futures with that in mind, a combination of the national, local and group factors created an inflection point that demanded a response. Issues like health care consolidation, costs and accountability, EMR and IT infrastructure, Value-based Healthcare Purchasing and the needs of our commu-


“It’s crucial that all physician leaders fully understand this set of documents and can translate them into lay language.”

Tad Pruitt, MD OrthoArkansas Orthopedics & Sports Medicine

Current Legal Documents One thing to remember as the merger takes place is that each merging entity is

tomized. It’s crucial that all physician leaders fully understand this set of documents and can translate them into lay language.

majority. In our case, we had two roughly equal groups and wanted to be sure that we

still directed legally by its current docu-

Big ideas (devised and articulated in

institutionalized an appropriate mix of

ments. Current By-Laws and Employment

doctor-talk) get put by lawyers into legal-

time-specific fair representation by and

Agreements in particular will often govern

ly binding paperwork that said docs must

protection of both legacy groups while still

how key decisions about the merger can

then live by; so, each physician leader has

building in what we believed were optimal

be executed and must be considered. Rel-

to make sure that the legal paperwork says

“new merged group” dynamics and de-

evant State Law also comes into play here.

what you want it to say and what you think

cision-making for the future. We arrived

For instance, there are provisions in the

it says.

at these principles in our merger negotia-

Law to protect a dissenting Shareholder during the merger process. Not following

Typical Merger Documents likely in-

tions and the Bylaws were where we made them happen.

clude:

Shareholder Agreement

the Law can result in exposure, delays and

Plan of Merger

costs for all parties later on.

The Plan of Merger is the legal frame-

This fairly standard agreement states

work to establish that the legacy entities

the qualifications for becoming a Share-

are going to merge, that previous entities

holder and how shares are established,

Broadly speaking, there are two cate-

will no longer exist, that appropriate es-

purchased, sold and devolved.

gories of documents for a merger. First,

tablishment documents will be executed,

there are documents that legally establish

that stock will be exchanged or similar, and

the merged entity. These are usually fair-

noting a date for the merger to take effect.

Scope of Legal Documents

Employment Agreement and Deferred Compensation Agreement These documents have both standard

Articles of Incorporation

and more customized features to estab-

that make sure the organization exists in

Articles of Incorporation formally cre-

lish the flow and distribution of both work

the eyes of the Law and are mandatory.

ate and legally establish the entity in the

responsibilities and resources among the

Second, there are documents that put into

eyes of the Law. Most of the content is

Shareholders and other employees. Pro-

legal terms and practice the governance,

based on statute but certain items, like the

fessional services, fees and compensation,

operations, and finances of the merged

name of the entity, are determined legally

benefits and income distribution, current

entity and its Shareholder and employees.

in the Articles of Incorporation.

and delayed, are all part of these agree-

ly standard, non-controversial provisions

These are much more variable and cus-

Bylaws

ments. Also, duties, responsibilities and

Bylaws are all about governance. Meet-

obligations of both the Corporation and

ings, votes, delegation of powers, direc-

Employee are devised here in detail.

tors, officers and key employees are all

Mastering a serviceable level of under-

described and determined in the Bylaws.

standing of all the various legal documents

Of particular concern for physicians and

can be daunting. But, it is a leadership

leaders are the details of how various lev-

chore that physician leaders must take on

els of decisions can be made and by whom.

as they shepherd their colleagues towards

In our case, we established certain respon-

the new entity. Taking the time to get doc-

sibilities for a leadership subset of share-

uments right and to be clear on them will

holders and how that group would be de-

help establish a secure (and legal!) group.

vised from the legacy groups initially. We

The decision-making process and the

also reserved certain powers to the overall

means devised for governance, responsi-

ownership group. And of those decisions,

bilities and resource allocation will ulti-

some were determined to be simple major-

mately found the group’s collective culture

ity decisions while other required a super-

for years to come. n


dialogue

column medicaid

We make hypertension too complicated. That is a shame since it is foundational for long term personal and community health. Despite all that is written about this common condition, no more than 60 percent of patients with elevated blood pressure are at treatment goals. With new guidelines released late last year, this is a good time to clarify our thinking and focus on core concepts.

Blood Pressure for

Dummies Rising blood pressure is part of aging Many patients reject the notion of being hypertensive and taking inexpensive, low dose medication. Over half the population has elevated blood pressure after age 55. We should regard this physiologic change more like the need for reading glasses as we get older. Think risk rather than disease Too many people view hypertension as a chronic disease that implies ill health. It is more appropriate to view blood pressure as a health risk. As one’s numbers go up, so do the long term chances for stroke, heart attack, and kidney problems. Lowering blood pressure should be as ingrained as brushing one’s teeth. Most people prefer to avoid the dentist and spend 15-30 minutes a week on oral hygiene…. Why not a morning pill?

William Golden, MD Arkansas Medicaid Medical Director

“Too many medical offices measure blood pressure casually and apart from recommended techniques.”

If the inflatable portion of the cuff does not go

Diabetes and blood pressure

around 2/3 of the arm, falsely high numbers

Around 10 percent of adults are now di-

can result. Taking pressures over bulky cloth-

abetic and that percentage may well grow.

ing will distort values. Poor patient position-

Many patients are challenged to maintain

ing or on patients who have not been quietly

target blood sugars. Nevertheless, manag-

sitting for a bit can also change values. Then

ing blood pressure and cholesterol is almost

there is the issue of white coat hypertension.

most as effective as tight control of blood

Good automated cuffs are available in most

sugar in reducing long term risks of compli-

stores these days for under $30. Collecting

cations in Type 2 diabetes and often easier to

multiple readings at home and in the office

achieve therapeutic treatment goals. Achiev-

is probably the best way to insure greater

ing the easy items go a long way to managing

accuracy. We spend money on lots of odd

a complex chronic challenge.

gadgets for the home: an automated blood What is risky?

pressure machine is probably one of the bet-

Is hypertension really

ter “toys” one can own.

this simple?

Lifestyle vs genetics

are comorbidities, occasional side effects,

The 2017 guidelines are really a revision on risk reduction strategies. The old notion

Nothing is ever completely easy. Yes, there

of 140/90 as the boundary line for normal

Most personal blood pressure readings

medication interactions that pop up. But 85

vs a hypertensive cardiovascular condition

likely reflects genetics. On the other hand,

percent of blood pressure issues in the of-

inadvertently reinforced the concept of high

there are a couple of items that can tweak

fice are pretty straightforward. The miscel-

blood pressure as a disease. The new guide-

pressure higher. Drinking several servings

laneous complexities of clinical care are not

lines view blood pressure as a continuum of

of alcohol, a day, including beer, often raises

sufficient to explain the continued preva-

risk which increases by different factors as

values significantly. High use of salt in pro-

lence of elevated blood pressure contributing

the numbers climb. In many ways, lower is

cessed foods or at the dinner table will ad-

to avoidable long term cardiovascular risk.

better until one gets side effects. The setting

versely change readings. Stress and street

Let’s embrace 130/80 to be a fundamental

of the ideal target will generate theoretical

drugs have their impact as well. Using medi-

platform of healthy aging and view it as an

arguments forever into the future, but that

cation to remedy avoidable personal habits

achievable component of daily life like wear-

discussion should be ignored by most of us.

is never an ideal strategy.

ing a seat belt or a bike helmet. It is time to

The new documents focus on 130/80 as a compromise target for personal health. Num-

cut out the confusions and casual indifferAversion to medication

ence. Individual patients, communities, and

bers higher or lower should reflect discus-

Too many patients grimace about start-

sions with a health professional and how one

ing medication for blood pressure. There

responds to simple interventions. Clinicians

are patients who avoid effective prescrip-

should avoid labels such as prehypertension

tion medication but take unproven vitamins

et al and concentrate on reducing long term

from health food shelves. Gone is the day

cardiovascular risk with the least burden-

that everyone starts on a “water pill”. Most

some efforts.

patients now take a once daily “ACE inhibitor” or calcium blocker. A 90 day supply of

Is blood pressure

Lisinopril, if paid out of pocket and without

measurement accurate?

insurance, can be bought for under $5. A once

Sadly, accuracy is less than ideal. Too many

a day risk reduction agent, usually well tol-

medical offices measure blood pressure ca-

erated for five cents is one of the last great

sually and apart from recommended tech-

bargains in our medical economy. Risk reduc-

niques. As Americans have gotten bigger, so

tion takes adherence and persistence – and

too is the need for larger blood pressure cuffs.

acceptance of a natural life process.

our health care system would all benefit from this focus. n

Bill Golden, MD, Professor of Medicine at UAMS, holds a secondary appointment in the COPH Department of Health Policy and Management and has been appointed to serve as a member of the guiding committee for the national Health Care Payment Learning and Action Network. The network, which is under the federal Centers for Medicare & Medicaid Services (CMS), was convened to identify payment models and reforms that will lead to better care at lower costs – primarily by tying health care payments not to services but to value and quality of patient outcomes. Dr. Golden, who has been a leader in state and national efforts to move towards payment models that emphasize value over volume, also serves as Medicaid Medical Director for the Arkansas Department of Human Services.


column Wealth

How to Roll Over Your 401k for Any Reason at Any Time

Without Penalty

The primary savings vehicle for millions of Americans is the typical 401(k), 403(b), and other tax-deferred plans. These plans, governed by ERISA, which stands for the Employee Retirement Income Security Act, are subject to many restrictions. A significant drawback of 401(k)’s, 403(b)’s, and similar plans is the 10% government imposed penalty you are subjected to if you wish to access your own money anytime before you hit the magical age of 59 and a half. There are a handful of “Qualifying Events,” or ERISA approved “Interruptions” that would allow you to avoid this government-imposed penalty. These include retirement, getting a divorce, changing jobs, or becoming disabled.

Unfortunately, you may find yourself

in 2008 the average target-date mutual

restrained by the limited investment op-

fund lost 30 percent or more of its value.

tions offered within your company-spon-

People at or near retirement who experi-

sored retirement plan. Studies show that

enced losses like that were forced to work

75% or more of plan participants have no

several more years in an attempt to regain

idea what fees they are paying within their

the lost money. Can you imagine being on

retirement plan. The vast majority of those

the cusp of retirement and six months out

I’ve talked to will admit they aren’t even

you lose 30% of the value of your 401(k)?

sure what investments they own in their

Something called sequence of returns risk

employer-sponsored retirement plan. Nu-

can create serious challenges. For younger

merous fund options have horrible per-

workers who are several decades from re-

formance histories and high fees. Many

tirement this isn’t a concern.

of the default investments within today’s retirement plans consist of target-date mutual funds. The idea behind a target date mutual fund is that as you get closer to your “Target Date” of retirement, your holdings shift towards more conservative investment holdings. The problem is that


What do you do if you find yourself stuck with investments that don’t meet your investment objectives? Some retirement plans do offer something called an in-service distribution, which allows you to rollover a portion, or all of your retirement funds to an in-

David Lukas David Lukas Financial

have access to true fiduciary. This doesn’t make people feel comfortable, especially when they’re dealing with what is perhaps their most significant asset. For many, dealing with a financial advisor one on one gives them a certain level of comfort. If I trust you as my financial advisor you’re the person I want to call, especially when making financial decisions. Just like I would call my attorney for legal advice, or my doctor to address a medical issue, I want to be able to speak directly with my financial advisor for financial matters. vestment of your choice even before you

place since the 1980’s. Thousands of peo-

separate from your current employment.

ple who previously thought they could not

Regrettably many plans forbid moving

access their retirement accounts have suc-

any of your retirement funds until after

cessfully rolled over their 401k plans using

you turn fifty-nine and a half or leave your

this well-established process. Completing

job. People incorrectly believe or worse,

an ISAR does not prevent you from future

are told by their financial advisor that they

contributions or continuing to receive

have no options but to wait until one of the

your employer match. The ISAR is afford-

aforementioned events occur. Remember

ed to plan participants based on well-es-

ERISA, the law that passed in 1974 that

tablished ERISA laws and is in no way a

governs those qualified plans? The Re-

loophole in the law. The ISAR process is

tirement Equity act of 1984 (REA) allowed

outlined in ERISA code and is a wholly

for an additional ERISA approved inter-

compliant application of federal pension

ruption. This change in the law provides

laws. There is no 10% penalty or tax-con-

for what is called an in-service alternative

sequence for completing an ISAR rollover.

rollover (ISAR). If you haven’t heard of this

You may be thinking to yourself that your

before you are not alone. The vast majori-

plan documents do not allow for this. Once

ty of those in my industry are not familiar

your plan administrator understands this

with, nor have experience in facilitating an

is fully allowable under the ERISA law they

in-service alternative rollover. There are

should sign off on your in-service alterna-

a few stipulations involved. To be eligible

tive roll over.

for an ISAR your plan must be governed by the ERISA law, which means it is a qualified plan. The second requirement is that you must be married. The ISAR process is a legal procedure, which does require the involvement of attorney experienced in this area of the law. ISAR’s have been taking

Number two: Another benefit is that you can choose any asset or assets you desire. It diversifies what they can do. You now have the entire world of investment options available at your disposal, giving you a more active role in constructing and allocating your retirement funds. Number three: For the first time you will have control of perhaps your most significant asset. The ISAR process does not cause you to lose your 401K contributions. Your employer can and should continue contributing to your retirement in your 401K. Your 401K plan stays in place and your employer match continues with ongoing participation. Number four: You can typically roll out up to 100% of your vested retirement funds. You might have heard that around age 50 to 55 years old you can roll over a portion of your 401K into an IRA. With an ISAR the limitation isn’t there. You can

The reasons one might consider an ISAR are many. First, many people are looking for a fidu-

usually roll 100% of your vested funds over at any age. That’s a big deal for a lot of people.

ciary advisor they can meet with in person.

An ISAR isn’t for everyone. When con-

Often a plan participant ends up calling an

sidering this process it is essential to make

800 number and speaking to a represen-

sure you are working with someone who

tative or outsourced company. They don’t

has experience in this area. n


column Acupuncture

Martin Eisele, LAc Evergreen Acupuncture

Long before America was founded as a nation China had a full system of medicine to treat every malady. While we are most familiar with acupuncture as an important part of that system, there are a number of other aspects still commonly used today. These include the physical therapy techniques of cupping (suction cups), guasha (skin/fascia scraping), tuina (medical massage), and moxibustion (heat). Herbal medicine was the most predominant. Teas, soups, and poultices were made from roots, leaves, bark, flowers, insects, animal parts, and minerals. Many of these same herbs are used today in both traditional formulas that have been used for centuries, and modern combinations of these same herbs.

letes like swimmer Michael Phelps. The technique is opposite that of a massage in that it pulls instead of pushes and is used to restore or increase blood flow, loosen stiff muscles and fascia, improve athletic performance, and decrease pain. It is also used to treat the onset of colds and flu, respiratory, and digestive issues. It is an effective technique, and has been incorporated by PT’s and massage therapists (who call it “massage cupping”).

What’s Old is New Again:

Modern Medicine Incorporates Asian Medicine’s Techniques

Another technique directly incorporated from Chinese medicine by PT’s is Guasha, an ancient method of scraping the skin with a utensil. Guasha is used to treat soft tissue. The skin over an area of muscle, tendon, or ligament is scraped to release restrictions, and increase blood flow. It too can produce intense bruising, but it is very effective. A PT named David Graston “invented” the same technique, named it after himself, trademarked it, and sells devices for $1000-$2000 and beyond. However,

Some people balk at using herbs for a

Chinese herbs just because they are me-

people have literally been doing the exact

number of reasons, not the least of which

dicinal without first consulting someone

same thing using a Chinese soup spoon or

is because they are associated with a for-

who is trained.

other cheap, handy utensil for centuries.

eign country. The herbs sold in the U.S.

Chinese herbs can be very effective.

A practice called moxibustion is used to

are produced under Good Manufacturing

Modern research and testing shows the

heat areas of the body. In Chinese medi-

Practices (GMP), which is a system for en-

clinical effectiveness and chemical anal-

cine, if the problem is caused by cold, then

suring that products are consistently pro-

ysis isolates the specific chemical com-

use heat to treat. It’s only logical. Moxa

duced and controlled according to quality

pounds. Western medicine tends to do the

is using the herb artimesia (mugwort)

standards. I use herbs from a company run

latter and produce effective drugs (think of

burned like a coal to heat specific areas.

by a (Western) medical doctor/pharma-

the willow bark and aspirin connection).

Usually it is in a cigar shaped form held

cologist/Chinese medicine practitioner.

Many modern medicines come directly

over the skin, or the Japanese method of

While many people have reservations

from isolated plant compounds or deriva-

tiny rice-sized grains burned directly onto

about using these herbs, they are com-

tives. So while there may be a hesitation to

the skin. It is very effective and I use it for

pletely safe when recommended by a Li-

use Chinese herbs, the study of their effec-

neuropathies, osteoarthritis, and muscu-

censed Acupuncturist who has training in

tiveness and compounds can complement

lo-skeletal issues. Heat has been used as a

the applications, contraindications, and

and advance modern medicine.

medical treatment for centuries; think PT hot packs or hot stone massage.

pharmaceutical interactions. There are

One of the more prominent techniques

certainly times when herbs should not

associated with Asian medicine is cupping,

Lastly, Chinese bonesetters were the

be recommended. For instance, I never

which is suction cups used for a variety

original chiropractors. PT’s are now doing

recommend herbs to a pregnant wom-

of reasons. While this technique seems

acupuncture but calling it “dry needling”.

an, although Chinese medicine has been

archaic and is indeed seen in Egyptian hi-

Chinese medicine may seem archaic, but

treating pregnant women with herbs for

eroglyphics, most people familiar with it

many of the techniques are still in use to-

centuries. Patients should never buy or use

have seen it used recently on Olympic ath-

day. n


H o s p i ta l n e w s a n d i n f o r m at i o n

Hospital Rounds

Jacob Mauterstock Receives Surgery at UAMS to Prepare for Robotic Arm Story next page Healthcare Journal of Little rock I MAR / APR 2018 57

Hospital Rounds First Arkansan Receives Surgery at UAMS to Prepare for Robotic Arm Jacob Mauterstock is in the gym every day. He demonstrates yoga poses at the drop of a hat. “It’s a lifestyle thing,” said Mauterstock, 41, of Conway.

Mauterstock was using an auger as part of a

has been fitted with a temporary prototype of the

home improvement project with his fiancé when

robotic arm, and he is helping “train” the software

the sleeve of his shirt got caught. His arm was

that will allow his nerves and his future robotic arm

badly damaged, and he was rushed to UAMS,

to communicate.

where Bracey and Tait performed an emergency amputation of his arm above the elbow.

The prototype he has now is heavier than the robotic arm, which will be made of carbon. Also,

Despite the extent of the injury, it is the philoso-

it is powered by his body movements, rather than

That approach to life remains steadfast, even

phy of Bracey and Tait’s department – the Depart-

his thoughts. For example, if he wants to bend

though Mauterstock lost his left arm in Decem-

ment of Orthopaedic Surgery in the UAMS Col-

his elbow, he shrugs his shoulder in a certain way.

ber of 2016. Despite this setback, Mauterstock was

lege of Medicine – to help their patients live their

the first person in Arkansas to undergo a surgery

best lives.

that will allow him to use a robotic arm controlled

He has attachments for the “hand” part of the arm that allow him to work out, hold on to bicycle

So when they talked to Mauterstock after sur-

handlebar,s and do yoga. Even though he has only

gery, they told him about the procedure—a tar-

had the prototype arm for a month, he is already

UAMS is one of the few hospitals in the nation

geted muscle reinnervation-—which would pre-

adept at controlling its movements. As he strolls

where the surgery is being performed. Mauter-

pare him for the robotic arm, a myoelectric

across the gym room floor, his movements look

stock’s surgeons, John Bracey, MD and Mark Tait,

prosthetic. They moved some of Mauterstock’s

natural and totally under his control.

MD, have advanced training in upper extremity

nerves to remaining muscles on his arm. When the

“I try to learn something new every day,”

surgeries.

robotic arm is fitted in place, it will connect with

Mauterstock said. “Upon returning to work after

those muscles and nerves to pick up electrical sig-

my accident, I also started going back to the

nals from his brain about movement.

gym.”

by his thoughts.

“We were lucky that this surgery was part of our fellowship training,” Bracey said. “When we learned how to do it, we did so knowing that this

The technology has been in use among military

The prototype arm allows him to work out both

was something that we wanted to bring back to

amputees for about 10 years and only recently has

sides of his body, which he is eager to do in order

Arkansas. Even though we did Jacob’s surgery

become available for civilians.

to maintain – and rebuild – muscle mass on his left

soon after the accident, that isn’t necessary. For

Eleven months later, Mauterstock is taking all

arm. In addition, Mauterstock is all about taking

other upper body amputees, we can do this sur-

the necessary steps to be prepared to receive

those daily, incremental steps that will pay divi-

gery up to 10 years after the amputation.”

his robotic arm, which will likely occur in 2018. He

dends in the future. “Thanks to my stubborn attitude, support from others, outstanding care and leading-edge technology at UAMS, I’m not going to let this accident change how I live my life,” Mauterstock said. “Jacob is a perfect candidate for this surgery, and his outcome so far has been encouraging,” Bracey said. “That’s one of the great things about practicing medicine in an academic medical center setting – the chance to take part in cuttingedge advances like this.”

CHI St. Vincent Heart Institute LVAD Program Achieves Center of Excellence Certification The CHI St. Vincent Heart Institute has been recognized as a Joint Commission Certified Center of Excellence for its Left Ventricular Assist Device (LVAD) Program. An LVAD is a surgically implanted mechanical pump that is attached to the heart and is used to treat advanced heart failure. Physicians with the CHI St. Vincent Heart Institute performed the institute’s first LVAD surgery earlier this year. The Joint Commission recently conducted a



two-day review of the LVAD Program with an on-

selected by the IQI advisory committee, which is

Tobacco use remains the leading preventable

site visit to CHI St. Vincent Infirmary. The Joint

comprised of staff from hospitals, Arkansas Med-

cause of premature disease and death in the

Commission reviewed standards for clinical prac-

icaid, AFMC, and the Arkansas Hospital Asso-

United States. “We have added this tobacco

tice and held performance meetings with physi-

ciation (AHA). Hospitals participating in IQI are

screening to our admission assessment, so

cians and clinicians who lead the LVAD program.

required to collect and submit data on quality

unless a patient gets through without an assess-

The Center of Excellence achievement rec-

measures; data is independently verified. Hospi-

ment being completed, we should be screening

ognizes CHI St. Vincent as an organization that

tals must meet specific quality goals for at least

meets rigorous standards to support adults with

80 percent of eligible measures to receive bonus

• Patients identified as tobacco product users are

heart failure. The requirements are based on the

payments, which are adjusted annually to contin-

offered or provided practical counseling to quit

Centers for Medicare and Medicaid Services

ually improve quality.

and FDA-approved cessation medications. Jen-

everyone,” said Jensen.

(CMS) requirements for patient eligibility; care

“The outstanding dedication of a growing num-

sen said that Saline Memorial provides coun-

coordination; physician and staff licensing, edu-

ber of Arkansas hospitals to improve their quality

seling and medications to all users unless they

cation, and training; and post-surgical and fol-

of care not only helps Medicaid patients, but also

refuse treatment.

low-up care.

saves public dollars,” said Dr. William E. Golden,

A total of more than $3.3 million in performance

“As a Center of Excellence, the CHI St. Vin-

medical director of Arkansas Medicaid. “Arkan-

bonus payments were made to 15 Arkansas hospi-

cent LVAD program mission is to improve the

sas continues to be a national leader in quality

tals for the 2017 IQI program, based on their suc-

health of the people and the communities we

improvement.”

cessful performance in improving the quality of

serve through advanced heart failure therapies

Throughout this year, the pay-for-performance

health care and patient outcomes that align with

and research,” said Dr. Thurston Bauer, cardio-

program focused on quality measures that

Arkansas Medicaid’s clinical priorities. Arkansas

thoracic surgeon and surgical director of the LVAD

resulted in the following:

Medicaid has awarded more than $43 million dur-

program. “We’re honored to be recognized for

• Elective deliveries of babies before 39 weeks’

ing the IQI program’s 11-year history.

our dedication to continued excellence. Our

gestation have declined among Medicaid ben-

Arkansas Medicaid, AHA, and AFMC worked

team provides patient-centered care with the lat-

eficiaries more than 97 percent since the base-

together to develop the IQI, which has earned

est research and the best technologies through a

line data collections in the fall of 2009. Jensen

national attention for its innovative involvement

multidisciplinary team approach.”

reported that Saline Memorial had only one

with the healt care community. IQI reflects a grow-

early elective delivery during this pay-for-per-

ing movement toward rewarding hospitals for

formance reporting time.

commitment to quality and providing evidence-

To learn more about the LVAD program and the CHI St. Vincent Heart Institute, visit CHIStVincent. com/heart.

Saline Memorial Hospital Receives Award from Inpatient Quality Incentive Program

• Exclusive breast milk feeding at hospital discharge has increased 31 percent since the initial baseline measurement in 2011; Medicaid beneficiaries now have a rate of 33.35 percent. Jensen said, “Our exclusive breastfeeding rate for

based care to their patients. For more information on Saline Memorial Hospital, visit http://www.salinememorial.org/.

Dr. Doug Ross Promoted to Chief Medical Officer for CHI St. Vincent

Saline Memorial Hospital in Benton received

the reporting period was 58 percent, the high-

a performance bonus payment from Arkansas

est we have ever experienced. This is due to

Medicaid and Arkansas Foundation for Medical

the education that is started in the OB clinics

CHI St. Vincent announced that Dr. Doug Ross

Care (AFMC) as part of the annual Inpatient Qual-

and carried forward through to the post-par-

has been promoted to the position of Senior Vice

ity Incentive (IQI) program. The award – based

tum unit. Everyone plays a part in the success

President and Chief Medical Officer.

on Saline Memorial’s successful performance in

of the mother and baby, experiencing this spe-

Dr. Ross, of Hot Springs, previously was vice

improving the quality of health care and patient

cial bond that is both emotionally and physically

president of medical affairs for CHI St. Vincent

rewarding for the child and mother.”

Hot Springs. In his new position, he will oversee

outcomes that align with Arkansas Medicaid’s clin-

medical services throughout the CHI St. Vincent

ical priorities – was presented during the annual

• Low-risk Caesarian sections among first-time

Arkansas Medicaid Educational Conference on

mothers have declined 21 percent statewide

Dec. 6 at Embassy Suites in Little Rock.

with a current Medicaid beneficiary rate of 22.36

Ross has played a key role in helping CHI St.

“Saline Memorial is committed to improving the

percent. This rate is below the national Healthy

Vincent develop an integrated emergency med-

health of our community, and we are pleased that

People 2020 benchmark for a third year. “Our

ical group covering all four CHI St. Vincent hos-

our goals and results align with those of Arkan-

rate continues to be below the statewide rate –

pitals in central Arkansas and Conway Regional

sas Medicaid and AFMC,” said Sherry Jensen,

at 20 percent – during that reporting period,”

Medical Center. He has also played an essential

director of Quality and Risk Management at Saline

said Jensen.

role in quality improvements at CHI St. Vincent

Memorial. Nationally standardized quality measures are

• Screening hospital in-patients for tobacco use now occurs about 99 percent of the time.

system.

Hot Springs. Ross joined what was then Mercy Hot Springs


Hospital Rounds

Tyler McDonald, RN

Marcus Elliott

in 2003 as an emergency medicine physician. He

and processes are thoroughly vetted for both effi-

has also served as chief of staff, medical director

ciency and effectiveness,” said McDonald.

of informatics, and medical director of the emergency department. He is board-certified in emergency medicine and he completed his residency in emergency

spent eight years in leadership positions at CHI-

forward to helping form dynamic partnerships

St. Vincent, including Market Director of Nursing

with corporate leaders to improve the health of

Operations for the health system.

the community. I’m also excited about telling the

a graduate of the University of Arkansas for Medi-

in Nursing from the University of Central Arkan-

cal Sciences

sas and a Master’s Degree in Health Administra-

director of Surgical Services for Conway Regional Health System. “We are excited to have Tyler leading our sur-

“It is my honor to represent Conway Regional to the business community,” said Elliott. “I look

McDonald holds a Bachelor of Science degree

Tyler McDonald, RN, of Springhill is the new

president of retail sales.

Prior to joining Conway Regional, McDonald

medicine at the University of South Carolina. He is

Tyler McDonald, RN, Named Conway Regional’s Director of Surgical Services

Crystal Bohannan

tion from Ohio University.

story of a creative, caring, and committed Conway Regional staff.” Elliott is a licensed minister and is founder of a nondenominational ministry known as “Church

A native of El Dorado, McDonald and his wife,

228.” In addition, he has served as campus pas-

Kami, have lived in the Conway area since 2004.

tor for the New Life Church at the downtown Lit-

They have three children.

tle Rock campus.

Marcus Elliott Joins Conway Regional as Director of Corporate Health Services

for the Arkansas Razorbacks, for which he served

Elliott is a former all-conference football player as captain of the ’84 team. A graduate of the University of Arkansas at Fayetteville, Elliott stays con-

gical services department,” said Angie Longing,

Marcus Elliott has joined Conway Regional

nected to sports and the Hogs through regular

RN, Chief Nursing Officer at Conway Regional.

Health System as the Director of Corporate Health

appearances on “Drive time Sports Talk,” a pop-

“Tyler is known for his commitment to advancing

Services.

ular radio show carried statewide on 103.7 The

relationships with physicians and co-workers, and

In this position, Elliott will serve as the health

has a personal interest in co-worker engagement

systems’ representative to community employers

as a catalyst to the advancement of quality and

and will have oversight over Conway Regional’s

safety for the patient.”

athletic training area as well as the Diabetes Self-

The position requires expertise in clinical and

Management Education program.

Buzz. Marcus and his wife, Ramona, have three adult children.

Crystal Bohannan Named VP of Operations for CHI St. Vincent Hot Springs

business operations of a surgery department that

“As we continue to focus on being successful in

includes eight inpatient operating suites, outpa-

a dynamic market, Marcus will be critical in helping

tient surgical services, preoperative, postopera-

to identify community health needs and ensuring

CHI St. Vincent Hot Springs has named Crystal

tive and sterile services. Overall, he oversees the

that Conway Regional is meeting those needs,”

Bohannan as vice president of operations. In her

work of 104 employees.

said Rebekah Fincher, Corporate Director of Busi-

new position, Bohannan will be responsible for

ness Development and Physician Relations.

overseeing finance and revenue for CHI St. Vin-

McDonald is also responsible for working with physicians to improve surgical processes

Elliott has more than 12 years combined experi-

and ensure a safe patient environment for sur-

ence as an executive sales representative and ter-

gical procedures. “I am passionate about pro-

ritory manager with Eli Lilly Pharmaceuticals and

Bohannan joined CHI St. Vincent Hot Springs in

cess improvement and co-worker engagement. I

Medtronic Diabetes medical devices, as well as

2014 as market director for operational finance.

believe that the safest patient environment is one

eight years with Alltel Communications, serving

She earned her bachelor’s degree from South-

in which clinicians have autonomy in their practice,

five years in sales as the manager and then vice

ern Arkansas University and Master of Business


cent’s locations in Hot Springs, which include a hospital and multiple clinics.


Springs over the past four years,” said Anthony Houston, president of CHI St. Vincent Hot Springs. “We are confident she will continue to thrive and enrich the hospital in her new role so our team can continue to provide the highest quality patient care available.”

UAMS Surgeons Team Up to Remove Pituitary Gland Tumor Analiz Rodriguez, MD, PhD

Alissa Kanaan, MD

Carolyn Pry said members of her church congregation were surprised to see her in Sunday worship just days after she’d had brain surgery. The 69-year-old retired school teacher from

Administration degree from Mississippi State

environmental services, and nutrition services. She

Emerson no longer has headaches or feels dizzy

University.

will continue her responsibilities in health informa-

after two UAMS surgeons removed a tumor using

tion management, patient access, IT, and materi-

a multidisciplinary, non-invasive approach.

In her new role, Bohannan will assume leadership in a variety of operational sectors at CHI

als management.

Pry’s problems began when her local primary

St. Vincent Hot Springs, including prevention

“Crystal has played a vital role in the man-

care physician discovered the pituitary macroad-

services, volunteer services, senior services,

agement and operations of CHI St. Vincent Hot

enoma following a minor stroke in April. After a

Hospital Rounds Baptist Health, Arkansas Blood Institute Start ‘Thank You’ Program Baptist Health and Arkansas Blood Institute have partnered on an innovative program called “Thank the Donor” that provides a way for blood recipients to thank the person who donated their blood. The process maintains confidentiality for both individuals, which is imperative for healthcare privacy protections. “Thank the Donor” makes it possible for patients to send a note or photo to their blood donors by visiting the website at ThankTheDonor.org. Step-by-step instructions make the process easy to follow. “Baptist Health is proud to implement ‘Thank the Donor,’” said Troy Wells, president and CEO of Baptist Health. “Patients and families will have the opportunity to personally thank the blood donor, and in turn, the blood donors will know their donation went to help someone in need and will be encouraged to continue making a difference in the lives of patients.” Heart-shaped tags with the words “Thank the Donor” are attached to the units of donated blood that make their way to the recipient’s hospital room. Special bar codes, instead of names, are used to match the donor and also ensure anonymity. The program will begin on Feb. 1 at Baptist Health Medical Center-Little Rock and will expand over the coming weeks to Baptist Health’s other facilities utilizing blood products. “Not many patients ever get the chance to thank their blood donors,” said John Armitage, MD, president and CEO of Arkansas Blood Institute. “‘Thank the Donor’ breaks the communication barriers and offers a new and different way to share a thank you. We know this personal connection will inspire our wonderful donors to keep saving lives.”

referral to a specialist, Pry ultimately called UAMS

to remove the growth. Once she cleared the way,

the way joint replacement surgery is performed,

for another opinion. Neurosurgeon Analiz Rodri-

Rodriguez retrieved the tumor in small pieces.

enabling surgeons to have a more predictable sur-

guez, MD, PhD, who specializes in primary and

After the surgery, Kanaan took out any debris

secondary brain tumors and endoscopy, was able

that blocked air passages. And both doctors

Baptist Health medical centers in Little Rock and

to schedule her for the following week.

scheduled post-operation monitoring for the

North Little Rock now each have a Mako robot for

patient.

orthopedic cases.

The pituitary macroadenoma is a tumor that

gical experience with increased accuracy.

forms on the pituitary gland, a pea-sized struc-

Pry said Kanaan, Rodriguez, and their staffs are

“With Mako, we can provide each patient with

ture located at the base of the brain, just behind

very compassionate and accommodating. On

a personalized surgical experience based on

the bridge of the nose.

the day of her operation, each came by regularly

their specific diagnosis and anatomy,” said Dr.

“To access the tumor, we had to go through the

to make sure her family was comfortable as they

Richard Nix, an orthopedic surgeon with Baptist

nose,” Rodriguez said. “Ideally, a neurosurgeon

waited. And since Pry lives more than three hours

Health Medical Center-Little Rock. “Using a vir-

works with an otolaryngologist during this type of

away from UAMS, the physicians coordinated

tual 3D model, Mako allows surgeons to create

surgery because it results in a better outcome for

scheduling to make it more convenient for Pry.

each patient’s surgical plan pre-operatively before

the patient--less pain and faster healing.”

“They made me feel like I’m the only patient

entering the operating room.”

“I felt very good about Dr. Rodriguez from

they have,” she said. “I could not have asked for

“During surgery, we can validate that plan and

the moment I met her,” Pry said. “She and Dr.

better doctors or facilities. I highly recommend

make any necessary adjustments while guiding

Kanaan both worked very well with me. They’re

UAMS to anyone.”

the robotic arm to execute that plan,” said Dr.

a godsend.” Alissa Kanaan, MD, director of the Rhinology Division in the Department of Otolaryngology, worked alongside Rodriguez in the surgery.

Baptist Health Offering Robotic Technology for Joint Replacement Baptist Health is the first, and only, medical

Martin Siems, an orthopedic surgeon with Baptist Health Medical Center-North Little Rock. “It’s exciting how this technology is changing the way joint procedures are done.”

Kanaan began the surgery by cutting through

center in central Arkansas to offer robotic arm-

The demand for joint replacements is expected

the nasal cavity to create an opening through the

assisted total knee, partial knee, and total hip

to rise in the next decade. Total knee replace-

sinuses to reach the skull base where the tumor

replacement with Stryker’s Mako System. This

ments in the United States are estimated to

is located. She prepared a wide enough passage

highly advanced robotic technology transforms

increase by 673 percent over the next 10 years,



while primary hip replacements are estimated to

Accelerate PhenoTM at UAMS Significantly Reduces Time for Identification of Pathogens, Treatment

increase by 174 percent. The Mako Total Knee application is a knee replacement treatment option designed to relieve the pain caused by joint degeneration due to osteoarthritis. Through CT-based 3D modeling of bone anatomy, surgeons can use

A new technology at the University of Arkansas

the Mako System to create a specific surgical

for Medical Sciences (UAMS) reduces from days

plan and identify the implant size, orientation,

to hours the time it takes to identify patho-

and alignment based on each patient’s unique

gens associated with life-threatening blood-

anatomy. The Mako System also enables sur-

borne infections.

geons to virtually modify the surgical plan intra-

The FDA-approved Accelerate Pheno sys-

operatively and assists the surgeon in executing

tem also quickly identifies which antibiotic

bone resections.

would be most effective on a case-by-case

With the Mako Partial Knee application, follow-

basis. It is the latest addition to the Clinical

ing the personalized pre-operative plan, the sur-

Microbiology Laboratory’s array of industry-

geon guides the robotic arm during bone prep-

redefining technologies for the identification and treatment of infectious diseases.

aration to execute the pre-determined surgical plan and position of the implant. By selectively tar-

“We are one of the first in the world introducing this technology,” said Eric Rosenbaum, MD,

geting only the part of the knee that is damaged,

MPH, medical director of the Clinical Microbiology Laboratory. “The way it works is nothing short

surgeons can resurface the diseased portion of

of revolutionary – part of a wider renaissance in clinical microbiology we are experiencing. But

the knee, while helping to spare the healthy bone

more importantly, it provides our clinicians and patients life-saving results at speeds never before

and ligaments surrounding the knee joint.

possible.”

The Mako Total Hip application is a treatment

Conventional methodology takes at least two days to identify a pathogen and about three days

option for adults who suffer from degenerative

for the antibiotic results. The Accelerate Pheno can identify a pathogen in one hour and identify

joint disease of the hip. During surgery, the sur-

a treatment in a matter of several hours.

geon guides the robotic arm during bone preparation to prepare the hip socket and position the implant according to the pre-determined surgical plan.

CHI St. Vincent Hot Springs, ARCOM Partner to Expand Medical Education Opportunities CHI St. Vincent Hot Springs announced a new

“For critically ill patients with blood infections, hours compared to days can save lives – this marks a major change in the way UAMS now approaches these complex illnesses,” Rosenbaum said. “Our faculty physicians are dedicated to generating and advancing new biomedical knowledge that improves health, since new knowledge drives clinical care,” said Pope L. Moseley, MD, executive vice chancellor of UAMS and dean of the College of Medicine. “Dr. Rosenbaum’s progressive and innovative approach to clinical pathology will result in additional life-saving care for many Arkansans.” Most significant is the ability of the Accelerate Pheno to test a pathogen’s susceptibility to various antibiotics and provide a score indicating which antibiotic would be most effective.

partnership with the Arkansas College of Osteo-

“This feature is new and unique,” Rosenbaum said. “It means we are getting patients on the

pathic Medicine (ARCOM) in Fort Smith to

most appropriate antibiotic days faster, off more-expensive and sometimes toxic broad spectrum

develop new Undergraduate Medical Education

antibiotics, and on the road to recovery.”

(UME) and Graduate Medical Education (GME) training opportunities for ARCOM students and graduates. CHI St. Vincent Hot Springs anticipates launching GME residencies in both family practice and

The Accelerate Pheno is an example of how innovators and tech-minded individuals are changing the world of medicine. Previously, the method of testing samples had remained essentially unchanged since its inception decades ago. It involved putting a sample from the patient in a dish, allowing it to grow, and then identifying the pathogen using relatively prolonged biochemical testing.

internal medicine beginning in 2020. The part-

Instead, the Accelerate Pheno uses a technology called morphokinetic cellular analysis. Video

nership will strive to improve the overall quality

of a pathogen’s growth is recorded and computer algorithms compare it to an archive of growth

of healthcare in the Arkansas.

pattern information – a first-ever application of this technique in clinical microbiology.

According to U.S. News and World Report,

The Accelerate Pheno is just one of several technologies at the Clinical Microbiology Labora-

Arkansas currently ranks 50th in overall health-

tory that improve identification of diseases, including tuberculosis, meningitis, drug-resistant infec-

care. Studies show that having a personal primary

tions, influenza, and others.

care provider is associated with a higher likelihood


Hospital Rounds

Jevin Smith, MD

Brad Lindsey, MD

Jonathan Lee, MD

of appropriate care, and a usual source of care is

greater good of healthcare through the training

physician partnership is a natural fit for us and will

associated with better health outcomes.

of our state’s future physician workforce.”

serve as a vehicle for Conway Regional to con-

“The health of individuals and communities

Houston added, “The partnership with ARCOM

tinue focusing on growing and expanding pain

often greatly depends on access to quality health-

fits squarely within the core mission of CHI St. Vin-

management services to meet the needs of our

care,” said Anthony Houston, president of CHI

cent to create healthier communities and com-

community.”

St. Vincent Hot Springs. “CHI St. Vincent’s com-

pliments the existing nursing partnerships with

“We are excited for this partnership with Drs.

mitment to expand partnerships that will gener-

Henderson State University and National Park

Lindsey, Lee, and Smith.” said Rebekah Fincher,

ate greater access to quality healthcare through

College.”

Corporate Director of Physician Relations and

educational and research based collaborations

Crystal Bohannan, vice president of operations

Business Development. “This partnership ensures

becomes an essential tool to fulfill our institu-

at CHI St. Vincent Hot Springs, who has respon-

the community has the needed and qualified pro-

tional mission and implement mechanisms that

sibility for leading the efforts to launch the medi-

viders to evaluate and treat for pain management,

ultimately help alleviate existing health dispari-

cal education programs, added, “CHI St. Vincent

and gives the physicians the ability to focus pri-

ties and increase the quality of life for all that we

has poised itself to become a leader in health-

marily on patient care, while we focus on manag-

serve.”

care education emphasizing care coordination

ing the business side of the practice.”

Dr. Ray Stowers, provost and dean of ARCOM,

and communication among training healthcare

The center opened on Jan. 8 in Suite 304 of the

said, “Research has shown that residents tend

professionals to transform primary care that pro-

Conway Regional Medical Tower, located off the

to establish their practices near their residency

motes overall health and quality of life measures.”

East Lobby of Conway Regional Medical Center.

training. The training of our students and residents occurring at an institution like CHI St. Vincent Hot Springs exponentially increases their opportunity to recruit and retain our graduates.” In an effort to help mitigate a projected primary

Anesthesiologists Join Conway Regional to Form Conway Regional Pain Management Center

Office hours are Monday through Thursday, 8 a.m. to 5 p.m., closing from 12 to 1 p.m. Hours on Friday are 8 a.m. to 12 p.m. Drs. Lindsey, Smith, and Lee formerly practiced pain management as Conway Pain Clinic. They

care physician shortage in Arkansas, ARCOM cre-

Anesthesiologists Jevin Smith, MD, Brad Lind-

evaluate, diagnose, and provide interventional

ated a mission to educate and train compassion-

sey, MD, and Jonathan Lee, MD, have partnered

treatment for a wide range of disorders including

ate osteopathic physicians, skilled in the science

with Conway Regional Health System to form the

acute pain, chronic pain, and cancer pain. Drs. Lee

of patient-centered osteopathic medical care and

Conway Regional Advanced Pain Management

and Smith will also remain in practice alongside

focused on service to the underserved. “This mis-

Center.

Drs. Carol Angel and Jennifer Bishop with Con-

sion will ultimately be accomplished at the under-

”We are thankful to have the support of Con-

graduate and graduate medical education levels

way Regional in managing the business side of

through excellence in teaching, research, service,

our pain management practice,” said Jonathan

and scholarly activity as demonstrated within the

Lee, MD. “This will allow us to focus strictly on our

stellar reputation of the CHI St. Vincent system,”

patients and provide Conway with full-time pain

said Kyle Parker, president and CEO of the Arkan-

management care.”

way Anesthesiology Consultants.

Dale M. Carter, MD, Joins UAMS as Headache Specialist Dale M. Carter, MD, has joined the University of Arkansas for Medical Sciences (UAMS) as a neu-

sas Colleges of Health Education, ARCOM’s par-

“Drs. Smith, Lindsey, and Lee have been a part

ent institution. “Our institutional mission perfectly

of our medical staff for years, providing excep-

She sees patients in the Jackson T. Stephens

aligns with CHI St. Vincent, and we look forward

tional care to our community,” said Matt Troup,

Spine & Neurosciences Institute’s Neurology

to working hand-in-hand to further advance the

Conway Regional President and CEO. “This

Clinic.


rologist specializing in headaches.


Dr. Dylan Thaxton is a family practice specialist in Malvern. He attended and graduated from the University of Arkansas College of Medicine in 2005. Thaxton has more than 12 years of diverse experience, especially in family practice. Dr. Bruce K. Burton is an internal medicine specialist in Malvern. He attended and graduated from the University of Arkansas College of Medicine in 1978. Burton has more than 39 Dale M. Carter, MD

years of diverse experience, especially in inter-

Sarah Bradley

nal medicine. Arkansas Heart Hospital Clinic-Malvern Diagnostic Clinic is located at 2223 Grant St. For appoint-

She also serves an educational role as an assistant professor in the UAMS College of Medicine’s Department of Neurology.

became CHI St. Vincent Hot Springs in 2014. Bradley will primarily provide financial operations support to CHI St. Vincent Infirmary in Little Rock, CHI St. Vincent North in Sherwood, and

ments or for more information, call (501) 337-9031.

Winrock, Arkansas Heart Hospital, UAMS Team Up for Healthcare Accelerator

“Headaches affect many people and can have a

CHI St. Vincent Morrilton. She is a CPA, and she

serious impact on quality of life. Dr. Carter brings

earned her undergraduate degree from Ouachita

Winrock International, Arkansas Heart Hospital,

many years of experience working with a wide

Baptist University in Arkadelphia. She is currently


variety of patients. We are happy to offer her

a Master of Business Administration candidate.

(UAMS), and BioVentures announced that they are

expertise to the public through our Neurology

Bradley brings to CHI St. Vincent a rich knowl-

collaborating to extend and expand Health Inno-

Clinic, and she will be a valuable teacher for our

edge of acute care and health system financial

vatAR, a program that supports and accelerates

neurology residents,” said Robert L. “Lee” Archer,

operations and she has extensive experience in

the development of new startup companies with

MD, professor and chairman of the Department

financial reporting and analysis, revenue cycle

innovative solutions to improve healthcare deliv-

of Neurology.

management, and strategic planning.

ery in Arkansas.

Arkansas Heart Hospital Acquires Malvern Diagnostic Clinic

leader in bringing new medical technologies to

Carter earned an MA in counseling psychology in 1976 at Ball State University in Muncie, Indiana. She obtained her medical degree in 1984 from

“Arkansas Heart Hospital has long been the our state, and we now welcome the opportunity

Albany Medical College in Albany, New York,

Arkansas Heart Hospital recently added the Mal-

to partner with innovation leaders by opening our

where she received the Frederick Hesser Award

vern Diagnostic Clinic to its network of commu-

doors, letting startups and clinical science grow

for Academic Excellence in Neurology. She com-

nity clinics. Arkansas Heart Hospital Clinic-Mal-

together within our walls,” said Dr. Bruce Mur-

pleted her neurology residency at Albany Medi-

vern Diagnostic Clinic will continue to serve as a

phy, CEO of Arkansas Heart Hospital. “Health

cal Center.

primary-care clinic and will now add cardiology to

InnovatAR and Arkansas Heart Hospital will work

its list of service lines.

together to help healthcare startups have the very

Carter is board-certified and holds memberships in the American Academy of Neurology and the

Arkansas Heart Hospital physicians will lead

American Medical Association. Before joining the

the Arkansas Heart Hospital Clinic-Malvern Diag-

“BioVentures is dedicated to creating a state-

neurology team at UAMS, Carter lived in Portland,

nostic Clinic, along with Drs. Dylan Thaxton and

wide infrastructure to support a growing biomed-

Oregon, where she had a private practice special-

Bruce K. Burton, and Amy Miller, APN. The clinic

ical research capacity in Arkansas,” said Nancy

izing in headaches.

will offer cardiac care, including early heart screen-

Gray, PhD, President of BioVentures, LLC. “We

ings, heart disease testing, vein and vascular care,

believe Health InnovatAR is an important part of

and more.

building the ecosystem that supports the biomed-

CHI St. Vincent Names Sara Bradley as Vice President of Finance

“Arkansas Heart Hospital is committed to pro-

best chance at success.”

ical industry.”

viding convenient, quality cardiac care throughout

The Arkansas Economic Development Commis-

Sarah Bradley joined CHI St. Vincent in late 2017,

the state,” said Dr. Bruce Murphy, CEO and presi-

sion awarded Winrock $250,000 for Health Inno-

having previously worked for Mercy Health Sys-

dent of Arkansas Heart Hospital. “The merger of

vateAR and will support the healthcare accelera-

tem. She served as the Chief Financial Officer for

Arkansas Heart Hospital Clinic-Malvern Diagnos-

tor through a new program designed to increase

Oklahoma State University Medical Trust in Tulsa,

tic Clinic will provide the Malvern community with

acceleration activities in targeted industries in the

Okla. Before that, she worked as vice president

access to our internationally renowned cardiolo-

state.

and CFO for Mercy Hospital Hot Springs, which

gists without having to travel far for the best care.”

“AEDC is excited to support Health InnovatAR,”


Hospital Rounds said Executive Director Mike Preston. “These

participate by donating personal hygiene items,

Monetary donations also can be contributed so

startup companies and their research will play

clothes, and other necessities to the Methodist

that specific items can be purchased to meet

vital roles in changing the landscape of the health-

Counseling Clinic in their community.

the needs of the children at MFH. Contributions

care industry in the state, the nation, and all over

“We often think of Lent as a time to give up or

can be delivered to the Methodist Family Health

the globe. Getting in front of the game now will

fast from something in our lives, but it also can be

Counseling Clinic serving the community closest

help our economic climate for years to come and

a time to take on something that renews our spirit

to the contributor after April 1. Drop-off locations

place Arkansas in the forefront of those working

and connection to our neighbor,” said Kelli Reep,

include:

in health care innovation.”

director of communications at Methodist Family

• Alma: 1209 Hwy 71N, Suite B; (479) 632-1022

The program will take place over six months.

Health. “Get Up & Give is an easy project to take

• Batesville: 500 E. Main St., Suite 310; (870) 569-4890

Each company will receive seed investment as well

on and makes a tremendous impact on the chil-

• Fayetteville: 74 W. Sunbridge Dr.; (479) 582-5565

as intense mentorship and assistance as they rap-

dren and families we serve. Many of our kids are

• Heber Springs: 407 S. 7th St.; (501) 365-3022

idly proceed from concept to product develop-

in the foster care system or have families with few

• Hot Springs: 100 Ridgeway, Suite 5; (501) 318-6066

ment and customer acquisition. Initial seed invest-

monetary resources. Providing them things like

• Jonesboro: 2239 S. Caraway, Suite M; (870) 910-3757

ments into the companies will be $50,000, and the

new underwear, soap, their own school supplies –

• Little Rock: 1600 Aldersgate Road, Suite 100B;

companies may also receive additional back-end

even books and toys – demonstrates to them that

(501) 537-3991

investments.

someone they have never even met cares about

For more information, visit https://www.method-

Health InnovatAR is a new and expanded iter-

their well-being.”

ation of a previous accelerator program known

Methodist Family Health asks that all items

as HubX—LifeSciences, the first-ever privately-

contributed through Get Up & Give are new.

istfamily.org/get-up-give/ or contact Kelli Reep at [email protected] or (501) 906-4210. n

funded and industry-specific business accelerator program in Arkansas. The 2016 program featured startups from around the nation and the world with innovative products for the healthcare

advertiser index

industry. Each company spent three months testing their patented technologies and perfecting their business strategies. Participating companies collectively raised more than $2 million in private equity funding. Health InnovatAR will be managed by Jeff Stinson of the Innovate Arkansas team at Winrock International. Stinson is also the executive director of the Fund for Arkansas’ Future. “We’ve built a powerful team around a successful model,” said Stinson. We’re honored and excited to have Arkansas Heart Hospital, UAMS, and BioVentures joining us as partners.” More information about Health InnovatAR, including an online application, can be found at HealthInnovatAR.com.

Methodist Family Health Sponsors Collection for Families Served Methodist Family Health has a way for Arkansans to honor the Lenten season by contributing to Arkansas children and families managing psychiatric, emotional, behavioral, and spiritual issues. The 9th Annual Get Up & Give collection project will be held during the entire 40 days of Lent,

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through Mar. 29. Both children and adults can


Arkansas Urology • 9