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PAIDuS healthcare

journals

SCan TO SuBSCRiBE

with Chad AduddellCEO, CHI St. Vincent

Mission Impossible The Eyes Have ItMedicaid Compliance in AR: A Q&AStalking the Superbug

Chief editor

Smith W. Hartley [email protected]

managing editor

Karen Tatum [email protected]

editor/writer

Philip Gatto [email protected]

ContributorsA.D. LivelyJohn W. MitchellDelanna Padilla

Correspondents

Rhonda Finnie, DnP, APRn, AGAcnP-bc, RnFAWilliam Golden, MDRay Hanleynathaniel Smith, MD, MPHJoseph W. Thompson, MD, MPH

sponsorship direCtor

Dianne Hartley [email protected]

aCCount exeCutive

Rebekah Hardin [email protected]

art direCtor

Liz Smith [email protected]

photographer

Zoie clift

2015 HealtHcare Journal of little rock advisory Board

Sara b. bradley, cPAVice President- Finance, Mercy Health System-Hot Springs

Scott Davis, MD, FAccInterventional Cardiologist, Arkansas Cardiology

Ray HanleyPresident, Chief Executive Officer, Arkansas Foundation for Medical Care

Lynda M. JohnsonPartner, Friday, Eldredge & Clark, LLP

M. corey LittleChief Executive Officer, Arkansas Mutual

Henri Roca, MDChief, Integrative Medicine, Central Arkansas Veterans Healthcare SystemAssistant Professor, University of Arkansas Medical School

Hayden W. ShurgarAttorney, Wright, Lindsey & Jennings LLP

Roxane A. Townsend, MDVice Chancellor of Clinical Programs and CEO, University Medical CenterUniversity of Arkansas for Medical Sciences

Michele R. Wright, PhDPathology Partners, LLC

september / october 2015

Each issue of Healthcare Journal of Little Rock provides important

articles, features, and information for healthcare professionals. Also included

are Local Correspondents, Hospital Rounds, Healthcare Briefs, and more.

Smart, In-depth,Award-winning

Healthcare Reporting

HealthcareJournallr.com Your source for local news, information, and analysis

Copyright© 2015 Healthcare Journal of Little Rock The information contained within has been obtained by Healthcare Journal of Little Rock from sources believed to be reliable. However, because of the possibility of human or mechanical error, Healthcare Journal of Little Rock does not guarantee the accuracy or completeness of any information and is not responsible for any errors or omissions or for the results obtained from use of such information. The editor reserves the right to censor, revise, edit, reject or cancel any materials not meeting the standards of Healthcare Journal of Little Rock.

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ContentsSeptember / October 2015 I Vol. 2, No. 6

10

3218

24

departMents

Editor’s Desk ............................................................8

Healthcare Briefs ...............................................41

Hospital Rounds .................................................59

correspondents

Director’s Desk....................................................50

Policy .........................................................................52

Medicaid ..................................................................54

Quality ......................................................................56

features

One on One .....................................10with Chad Aduddell, CEO, CHI St. Vincent

Mission Impossible .................. 18Cardiac surgeon volunteers in Kenyan mission hospital

The Eyes Have It ..........................24Unique treatment aids PTSD sufferers

Setting Things Straight ..................................................28A Q&A with Elizabeth Thomas Smith, Arkansas Medicaid Inspector General

Stalking the Superbug ............................................. 32Hospitals adopt strategies to reduce antibiotic resistant infections

24

28

editor’s desk

One Of the mOst encOuraging aspects Of

health is that much of it boils down to simple choices.

in spite of genetic and accidental circumstances, life

is a series of choices. The wonderful news is gratitude

is a simple choice that can be made by anyone. The

results are proven and remarkable.

studies have shown that choosing to be grateful

results in reduction of stress and an improvement

of the immune system. a society of grateful people means a lowering of

healthcare costs, a more productive environment, and a better and more

pleasant way to live for all.

so why do people choose ungratefulness. first of all, most don’t con-

sider it a choice. most believe that they are subject to their own minds and

bodies rather than the master of their own thoughts. however, ingratitude

usually comes from a spirit of pride. The humble are grateful. When we

choose humility, gratefulness is a natural fruit.

also, externally we are bombarded with images intended to incite in-

gratitude. politicians want to get elected. They will try to convince us of

why we need them to be happy. Businesses will hope to convince us our

happiness will come through them. But mostly, we can surround ourselves

with ungrateful speech. morose doom and gloom talk is contagious. But,

so is pleasant uplifting talk. Be aware.

gratitude offers many benefits such as better sleep, more attractive-

ness, more creativity, confidence, better energy, better emotional well-

being, and improved relaxation. Overall, gratitude leads to better health

and well-being.

so how can we lead our patients to gratitude for improved health? it

begins with a discussion. some other ideas to consider are:

smith hartley chief [email protected]

• Create a journal. List 5 things to be thank-

ful for every day.

• Be aware that gratitude is a state of mind. It’s

a choice. pain is many times not a choice. But

misery and gratitude are a choice.

• Look at the external environment. Identify

images intended to create dissatisfaction and

understand the motive. Don’t follow the crowd.

• Look at your thought processes. Explore im-

proving your thought patterns.

• Be part of the solution and not the problem.

Don’t be so anxious to create misery in the world.

extend kindness when it doesn’t seem natural.

You may change the world for the good.

• Don’t expect everybody to be on board. Some

people enjoy being in a state of misery. They may

come around to a different decision later.

• Finally, lighten up the perspective. We’ll prob-

ably be okay.

i hope this thought helps someone.

A Timeline of Fad DietsUnless they’ve been blessed with a mighty metabolism, wondrous willpower, or endless energy, the average person, at some point in his/her life has witnessed the sneaky accumulation of unwanted pounds. The seemingly endless quest to eliminate excess weight (preferably with as little effort possible) has led to a long tradition of diet plans and methods. From the fairly sensible to the supremely silly, these fad diets have mostly come and gone, but a few have really pulled their weight.

Please enjoy our fat free, sugar free, gluten free, low-carb listing.e

Gratitude is powerful for Good health.Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. I melody beattIe

dialogue

CEO, CHI St. VInCEnt

One on One with Chad Aduddell

On March 16, 2015, Chad S. Aduddell assumed the

position of Interim Market Chief Executive Officer

(CEO) for CHI St. Vincent. As CEO, Aduddell has

accountability for CHI St. Vincent, which includes all of

Catholic Health Initiatives’ (CHI) organizations and

operations in the state of Arkansas. He reports jointly to

the Board of Directors of CHI St. Vincent and to Peter D.

Banko who took on the expanded role of Senior Vice

President of Operations and Chief Integration Officer

for Catholic Health Initiatives in September 2014.

“We are answering a call to respond to physical,

mental, spiritual, and social needs of the community.”

dialogue

12 SEPT / OCT 2015 I HealtHcare Journal of little rock

Chief Editor Smith W. Hartley To get

started, can you describe the demograph-

ics of your patient base?

Chad Aduddell CHI St. Vincent has grown

into one of the largest healthcare systems

in the state of Arkansas. We’re looking at

about 4500 coworkers. We have facilities,

obviously here, the infirmary in Little Rock,

our facility in Sherwood, a facility in Morril-

ton, the facility in Hot Springs, and now, the

ambulatory campus out in West Little Rock,

and the partnership with Conway Regional.

So we serve patients from all across the

state. We have patients from every county.

We’ve had patients come from out of state,

specifically for our neurosurgical program.

Patients have come from out of the country

for that program as well. So we view our-

selves as serving the entire state.

We’re a Catholic, not-for-profit ministry

and so if you look at who we are and what

we’re about, a significant part of who we are

is serving the poor and vulnerable. So that’s

a specific demographic that’s important to

us It’s part of our heritage that goes back to

1888 and it’s part of who we are today. If you

look at our strategic priorities the top pri-

ority on the list is to continue to serve that

demographic. So we serve everybody, but

again as part of our Catholic mission and

ministry, we have a specific desire to serve

the underserved.

Editor What does it mean to specifically

be a Catholic facility other than serv-

ing the underserved? How is it different

operationally?

For Almost three yeArs, Aduddell has served as executive Vice President and Chief operating officer of ChI st. Vincent and President of ChI st. Vincent Infirmary. he came to ChI st. Vincent from st. Anthony hospital (sponsored by ssm health Care, the first health care recipient of the malcolm Baldridge National Quality Award) in oklahoma City, oklahoma in 2012. At st. Anthony, Aduddell served as the President of the Bone & Joint hospital, and the Chair & Administrator of the saints Cardiovascular Institute.

Aduddell has prior experience in hospital operations and the physician enterprise with ChrIstUs spohn health system in Corpus Christi, texas, and in the phy-sician enterprise and physician residency program management with ssm health Care in oklahoma City. he has a bachelor of science with honors from the University of tulsa and a master of business adminis-tration in health care administration from oklahoma City University’s meinders school of Business. e

123 1087 1727

India’s Caraka Samhita recommends a moderate diet high in fiber and carbohydrates to prevent diabetes.

Liquid William the Conqueror, King of England, may have thought of the first fad diet. In a vain attempt to lose weight so he could ride his horse, the king embarks on an all-liquid diet. The bump in his fairly sound plan is that the liquid is alcohol.

Swamp People Thomas Short derives the strange notion that living near swamps makes people fat (perhaps after visiting Louisiana). Need to lose weight? Simply step away from the swamp.

HealtHcare Journal of little rock I SEPT / OCT 2015 13

Aduddell It’s everything. It’s who you are.

Our mission, and I am paraphrasing, is to

extend the healing ministry of Jesus Christ

and the Catholic Church. So if you look back

127 years ago, the Sisters that came to this

community with limited resources, just

came to answer a calling and I would say

that we have that same approach today. We

are answering a call to respond to physi-

cal, mental, spiritual, and social needs of

the community and so being a Catholic

ministry I think differentiates itself when

you look at that mental, spiritual, and

social component of the healing that we

are concerned about. It goes beyond just

the medical, technical diagnosis and the

physical treatment.

Now operationally, to give you an exam-

ple, we pray before every meeting, give a

prayer or reflection, so there is an attitude

or spirit in the organization that wants that

mission to be borne out in everything we do.

Editor Operationally, on the issue of qual-

ity, could you talk a little bit about some of

your internal initiatives and how you mea-

sure quality at CHI St. Vincent?

Aduddell I talked about our top priority

being serving the poor and vulanerable, but

if you continue to look through our strategic

plan and where our focus is, quality, safety,

and the patient experience, those three

things, to us, all go together. There is an over-

lap between them and they are interrelated.

There are many different metrics that

in healthcare we utilize to look at quality.

Some of those are mandated to us by the

government. Some of those are just best

practices, evidence-based medicine that

has been clinically proven over time. So

for us, it’s taking those metrics, those goals,

and working with our providers, our lead-

ers, and our caregivers to say, “Where are

our areas for improvement?” Where we are

doing well, we want to maintain that and

where we have areas for improvement, we

have a process improvement mechanism in

place to sit down and look at any gaps that

we may have so the patients benefit from a

continuous process improvement.

Editor There is always a lot of discus-

sion about reducing hospital readmis-

sions. What are some of CHI St. Vincent’s

strategies?

Chad Aduddell One of the initiatives that

we worked on with our providers and our

leadership team was specifically around

reducing readmissions for joint replace-

ment patients. So we participated in a bun-

dled payment initiative. The goals of that

program were to improve the quality of

care and at the same time reduce the cost

to deliver that care. A global challenge that

we face in healthcare today is to improve

1820 1830 1863

Vinegar Lord Byron waxes poetic about the cleansing and weight loss powers of mixing water with apple cider vinegar.

Crackers A high-fiber diet of vegetables and abstinence from sex are the key ingredients in a diet plan touted by Sylvester Graham, the eventual creator of Graham crackers. Hmmm.

Banting In what may well have been the first attempt at a low carb diet, Englishman William Banting loses 50 pounds simply by cutting out bread, butter, milk, and potatoes and eating more meat. For a while, “banting” actually becomes slang for dieting.

e

dialogue


quality, improve access, improve safety,

improve the patient experience, and at the

same time reduce the cost of care. As part of

this bundled payment initiative we set out

and looked at where there were opportuni-

ties for us to improve our quality for our

patients and yet at the same time reduce the

cost to provide that care.

To your question one of the areas that

we looked at was readmissions. The patient

would come in and have a joint replacement,

would go home, and at some time later, if

there was a complication, may be readmit-

ted. So we very specifically wanted to stay

engaged with the patient, not just during

their surgery, and after their surgery, and

after their discharge, but keep in touch with

them in the months after that, making phone

calls to them, checking in with them, and

seeing how their healing was progressing.

And if there were any issues or complica-

tions, to be able to address those rather than

the old approach of when they discharged

and you didn’t know how things were going

and you may not hear from them and then

they may be readmitted, potentially even

to another facility. Especially patients that

live two or three hours away, may admit to

another facility. Well that’s still a readmis-

sion, an unexpected outcome, from the pro-

cedure, so between having our orthopedic

surgeons on call, and being available if there

was a complication, we were able to also

proactively make post-discharge calls and

check on these patients and see how they

were doing. We were able to reduce the read-

mission rate by more than 50%.

That’s a long-winded story, but it was a

specific example of a very intentional ini-

tiative where we looked at a process and

said, “How can we do this better?” And took

the process even beyond the patient/hos-

pital stay and followed them at home for

months after the surgery, again to improve

that quality, and to help avoid a readmis-

sion. Not only did that improve outcomes

for the patients, but a byproduct of that is it

reduced unintended costs as well.

Editor Can you talk about the importance

of technology from a medical perspective

and perhaps also from an information sys-

tems perspective?

Aduddell As a general comment, technology

has lagged behind in the healthcare industry

compared to other industries. However, there

are instances where technology is making

improvements in patient care. So there’s defi-

nitely advances in the operating room, where

technology is helping us. There are advances

in imaging where technology is improving

our ability to diagnose. So there are definitely

examples in healthcare where you can point

to an investment that has been made in tech-

nology that improves quality.

There’s also, and this is what I was getting

at when I mentioned some of the challenges,

maybe other industries have been further

ahead, but now we’re beginning to try things

in healthcare that maybe in the past weren’t

explored.

For instance, we have recently piloted

a program in our rural hospital in Morril-

ton where our hospitalist interacts with the

patients through telemedicine. So there’s

literally a patient in a bed in Morrilton and

we have piloted the hospitalist interacting

with that patient and the hospitalist is sit-

ting here at the hospital in Little Rock. Yet

they are engaging the patient and the nurse

in the hospital room in Morrilton. So technol-

ogy has enabled us to do that in a way that

the patient feels like the doctor’s right there

with them. So, that’s an opportunity for us

to use technology in some areas where we


looked at that same situation, so we sat down

together and said, “Okay, we are all facing an

unsustainable financial situation. How can

we work together and preserve the good

things, the things that are important to us

as individual organizations, and yet work

together with the common goal to improve

quality, improve safety, improve our commu-

nities’ experience with healthcare, and at the

same time reduce the cost to deliver that?”

So that’s what we’re trying to do together

with Conway; we have a goal to develop a

statewide network. That’s what we aspire to

do with other like-minded facilities around

the state. So again, as a Catholic ministry,

we have our name, our identity, our mis-

sion, our heritage, that we want to preserve

and Conway Regional, as an independent

community hospital, has their identity and

the things that they want to preserve. So

this partnership is just a way for us to work

together to do those things I mentioned and

improve access to care for Arkansans, and

at the same time work to reduce the cost to

deliver that. It’s all about us continuing to

may have a shortage of providers and yet

still be able to extend healthcare and give

people access to specialists and some of the

best providers available, even though there

may be a significant distance. That’s just one

example.

Editor CHI Vincent and Conway Regional

recently announced a partnership agree-

ment. Can you talk a little bit about the

benefits of this agreement to both parties?

Aduddell I think you have to back up and

look at the big picture of what’s going on in

healthcare today. If we look at the healthcare

industry consuming 18% of the overall U.S.

economy, and the cost to provide health-

care is continuing to rise, unfortunately for

what we are spending, our outcomes aren’t

as good as some other countries that are not

spending as much. And so we are reaching

an unsustainable growth curve. We now see

reimbursement to hospitals and providers

declining and yet our expenses, the supplies

that we utilize, the technology that we uti-

lize, the workforce that we employ, those

costs are going up. When you do the math,

that doesn’t work. That’s not sustainable.

So as a health system we look at that sit-

uation and we’ve talked to other indepen-

dent hospitals across the state and they’ve

“...a significant part of who we are is serving the poor and

vulnerable. So that’s a specific demographic that’s important to us. It’s part of our heritage

that goes back to 1888 and it’s part of who we are today.”

1902 1903 1917

Hay Thankfully the Hay Diet does not involve eating hay, but rather is named for William Hay who introduces the notion of avoiding “foods that fight”—combinations that cause imbalance in our bodies.

Masticate On the advice of British PM William Gladstone, Horace Fletcher suggests that chewing each bite of food a minimum of 32 times can aid digestion and weight loss, especially if you spit the food out before swallowing.

Every Bit Counts Perhaps the first to suggest counting calories, Los Angeles physician Lulu Hunt Peters also holds “Watch Your Weight Anti-Kaiser” classes for wartime food conservation.

e

dialogue


improve quality for Arkansans and yet make

the financial platform more sustainable.

Editor Did Baptist Hospital’s moving into

that area accelerate the discussions?

Aduddell I am not going to talk about Bap-

tist. We are a ministry with a goal to have a

statewide presence and to work with facili-

ties all across the state to achieve the things

I mentioned. So we’re doing that and we’re

not thinking about competitors when it

comes to those partnerships. We really are

looking at how to improve quality, how to

reduce the cost of care, how to make it more

sustainable for Arkansans. For us that’s not

about competition.

Editor Can you describe then some of the

specifics of the partnership? Is CHI St. Vin-

cent taking over the management of the

hospital?

Aduddell I won’t get into a lot of detail, but

yes, as part of the partnership, the Con-

way Regional Board did ask CHI to man-

age the operations of Conway Regional.

So that’s what we’ve agreed to do and that

gives both organizations the opportunity to

work together, to learn from one another,

to find out where we are doing things well,

that they can learn from, and find out from

them the things they are doing well, that

we can learn from. And at the same time, to

look at our costs to provide that care and

see where there are opportunities to bring

those costs down.

Editor And is this through the Arkansas

Health Alliance?

Aduddell That’s something different. The

Arkansas Health Alliance goes back to that

statewide vision where we think, beyond

Conway, just in conversations we’ve had

with other facilities around the state, that

those same challenges exist. Everybody is

experiencing decreased reimbursement,

significant decrease in reimbursement

from Medicare. Everybody is seeing finan-

cial challenges, increasing costs—supplies,

technology, maintaining your facilities,

increasing salaries and benefits for your

coworkers. Those are part of every inde-

pendent community hospital around the

state. The Health Alliance is a mechanism or

vehicle for us to go out and talk to and find

common ground with those other facilities

and again, try to work together for us all to

be able to continue to provide high quality

care and yet remain financially sustainable.

Editor You may not be ready to announce

anything, but are there some other hospi-

tals you are in discussions with?

Aduddell There’s nothing specific. Every-

body is feeling the same pressures. Some

more acutely than others. But this is a mac-

roeconomic challenge that is facing the

entire healthcare industry and so it applies

to all of those facilities across the state.

Some are in different financial condition

than others, but we’re out there just talking

to different facilities all over the state and

seeing if there’s an interest in trying to work

together. So no specifics, but just as a gen-

eral comment, that’s what we are attempt-

ing to do.

Editor I understand CHI St. Vincent is

also growing some presence in West Lit-

tle Rock. What does that entail?

Aduddell In West Little Rock we have 40

acres and two pavilions at this point. One

just opened this summer. We have primary

care providers, pediatrics, urgent care, sleep

medicine, geriatric care in our first pavil-

ion. In our second pavilion we just opened

a state-of-the-art outpatient imaging cen-

ter, a retail pharmacy, there’s an indepen-

dent dentist that is in the building, and then

we also have a satellite of our breast center


with 3-D mammography as a partnership

between CHI St Vincent and ARAPA (Arkan-

sas Academy of Physician Assistants).

The whole point of this being that we

believe that healthcare is going to be less

about the hospitals and more about well-

ness as we move forward. So we’re invest-

ing resources in our outpatient strategy,

whereas in the past, more resources were

invested in the hospitals. We are trying to

balance that now. Yes, there are still dollars

that need to be spent in your hospital, but

we want to also invest in wellness, popula-

tion health, and provide more access points

so that people don’t have to come to the

hospital for an x-ray, an MRI, a CT scan.

Our urgent care provides more access

by having extended hours. So we’re try-

ing to help the community, the population

shift from maybe utilizing an emergency

department to an urgent care. So maybe

for something that’s not emergent, but they

don’t want to wait to get in for a scheduled

clinic, the urgent care fills that gap. That’s

just another area where we are trying to

provide increased access and physically,

another accent point.

Editor You are coming into a new role as

the CEO. What are some of the areas you

have focused on that might have been a

little different from the past?

Aduddell We’ve already touched on some

of my areas of focus. I think one of the dif-

ferences as a Chief Operating Officer my

role was to daily be focused on the opera-

tions of our ministry. Now I sit in a more

strategic, more big picture role and spend

some of my time with what we refer to as

“heads up time” where I am thinking about

the ministry and where it is headed and

talking to other leaders in our organization,

community leaders outside of our organiza-

tion, board members, about the direction of

our ministry and talking about what part-

nerships we should be pursuing and who

we can work with and how we can meet our

first objective of being a ministry that serves

the underserved and then, too, how do we

continue to improve that quality and safety

that we talked about.

I’ve also spent time thinking about our

workforce and how do we create a safe envi-

ronment that helps our coworkers have an

engaged place to work, that is also think-

ing about their personal wellness and their

families’ wellness? There’s a lot of time in

my role that we spend looking at those ini-

tiatives and things we can do to make CHI

St. Vincent a better place to work. And then

finally, a lot of time around strategic part-

nerships like we talked about with Conway

Regional.

Editor Anything else you are working on?

Final thoughts?

Aduddell You know you asked about qual-

ity and we’re obviously proud of some of

the things that we’ve done. I’ve been very

impressed with the work in nursing and

we’ve invested in and continue to invest

heavily in nursing and nursing education

and nursing development, nursing research,

and it’s that investment that helped us to be

recognized as a Magnet facility for nursing.

This was the third year in a row that we’ve

been named by U.S. News and World Report here at St. Vincent Infirmary as the top hos-

pital in Arkansas. And at the same time it’s

not about that for us.

Those are recognitions, but we’re commit-

ted every day to the things that we’ve talked

about and that’s where I spend my time and

energy—making sure that this ministry is

focused on serving the community, serv-

ing the underserved, improving the quality

and safety, creating a better place to work for

our coworkers, and then looking out there

across the state at how we can make health-

care better, more accessible, and more finan-

cially sustainable for Arkansans and work

with those independent community hospi-

tals that have that same goal. n

“...and that’s where I spend my time and energy—making sure that this ministry is focused on serving the

community, serving the underserved, improving the quality and safety,

creating a better place to work for our coworkers, and then looking out

there across the state at how we can make healthcare better...”

1920s 1928 1930s

Grapefruit Later known as the Hollywood Diet, eating grapefruit with (or in some cases for) every meal is meant to promote weight loss. Indeed grapefruit has been shown to have some appetite suppressing capabilities.

Light ‘em Up In fairness, this was before the Surgeon General’s warning, but smoking is recognized and promoted as a way to curb one’s appetite. In 1925 The Lucky Strike cigarette brand launches the “Reach for a Lucky instead of a sweet” campaign.

Are You Inuit? Tougher than most to follow due to lack of availability (and palatability) of ingredients—the Inuit Diet consists of all the caribou meat, raw fish, and whale blubber you want.

e

Mission Doctor

Mission ImpossibleCardiaC Surgeon VolunteerS in Kenyan MiSSion HoSpital I By A.D. Lively

When CHI St. Vincent cardiothoracic surgeon S. Thomas Rayburn, III, MD, boarded the first of the three planes that would take him to Nairobi, Kenya for a mission trip in March of 2015, he realized that he was entirely alone.

“It was my first visit,” he says, “and I didn’t know anyone there.” He also didn’t speak Swahili, the native language, which meant he would be reliant upon an interpreter for communications throughout his visit.

After 17 hours in the air, followed by a four-hour drive across Kenya to the mission hospital in rural Bomet, Rayburn soon found himself operating on a very small patient.

“They had set up some chest surgery for me—the first one was ten months old,” he says. “It’s been many years since I’ve operated on somebody that young.”

And then, without warning, the electricity went off, plunging the operating room into darkness and forcing the surgeon to finish his work by the light of a battery-operated headlamp.

“So it was a little intimidating,” Rayburn says, with typical understatement. “But luckily we had a good experience.” e

Mission Doctor


“It’s not just that the surgery itself is so

complicated,” he says. “But to do it and to do

it well—you have anesthesia, specialized anes-

thesia, perfusionists, a number of surgical

assistants, a person that is responsible for all

of the instruments and all of the equipment.

“You just have to have such a big team

working at a high level,” he continues.

“Because if you don’t, it won’t work.”

Rayburn spent “a couple years” looking

for the right place and opportunity. Finally,

based on the recommendation of a former

classmate from the University of Mississippi

School of Medicine, he discovered Tenwek,

a nondenominational Christian hospital in

Bomet, Kenya.

Founded in 1937 by missionaries from

World Gospel Mission, Tenwek is one of

the largest and most specialized hospitals

in the area. Their motto of “We Treat, Jesus

Heals” is the focal point of their mission,

Finding TenwekRayburn, a native of Greenville, Mississippi,

has been in practice for 16 years now, the last

two at CHI St. Vincent in Little Rock. While

long interested in doing mission work overseas,

he was looking for a hospital that would

support his specialty, cardiothoracic surgery,

“and that’s really kind of difficult to find.”

S. Thomas Rayburn, III, MD

1934 1950s 1950s

Bananas! And skim milk are promoted as a weight loss combo by the United Fruit Co.

Cabbage Soup It is unknown how long anyone is able to stick to this diet, which consists of eating very little and consuming cabbage soup daily.

Tapeworms Swallowing a tapeworm in a pill to lose weight seems beyond imagination, but rumors run rampant about opera singer Maria Callas and others doing just that. Gruesome and deadly side effects lead to a ban on the sale of “tapeworm pills.”


which includes training for medical interns

and residents; nursing students; medical

chaplains; and dental, laboratory, and phar-

maceutical technicians. They also “provide

advanced training for doctors in family prac-

tice and surgery. (www.tenwekhospital.org)

“It’s in a rural area, but it’s a 300-plus bed

hospital,” says Rayburn. “It was told to me

that it was the most advanced mission hos-

pital in Africa, and I can see why.”

He has nothing but praise for the Ten-

wek staff and trainees and is grateful, he

says modestly, that he was able to “kind of

help out” with procedures that “we do more

commonly than they do.”

Providing Access to CareRayburn is full of praise for Tenwek’s abil-

ity to care for challenging (and potentially

epidemic) illnesses like cholera and tubercu-

losis and “all of the things that we just don’t

really see much of.”

“They take care of such difficult, sick

patients,” he says. “I mean, I’ve never seen

a cholera patient. And there’s a whole ward

up there.”

He did about 15 surgeries while he was

there—about the same number he would

have done in a comparable amount of time

here in Arkansas—with people coming from

as far away as Nairobi to benefit from his

expertise.

He was struck by “just how appreciative”

people were to receive treatment in the face

of such “late presentations of neglect and

[lack of access to] basic care and those

types of things.” He describes one tumor he

removed at Tenwek that was the size of a

small volleyball, “just because it was so late-

presenting.” He estimates that, in a similar

patient in Little Rock, “we would see [it at]

a tenth of the size.”

Rayburn is perhaps best known for min-

imally invasive heart and lung surgeries,

which avoid large incisions and rely heav-

ily on thoracoscopy, or the use of tiny cam-

eras that enable the surgeon to view the

chest cavity.

“They had enough imaging equipment

that I was able to do a little bit of that while I

was there,” he says, citing patients with bad

pneumonias that had caused a buildup of

infected fluid between the lung and chest

wall.

A Life-Threatening Emergency“What I did was mostly confined to chest

and heart procedures,” he says. However,

“I did fix one ruptured [abdominal aortic]

aneurysm.”

The outcome for an abdominal aortic

aneurysm (AAA) is usually positive “if you

have surgery to repair the aneurysm before

Rayburn spent “a couple years” looking for the right place and opportunity. Finally, based on the recommendation of a former classmate from the University of Mississippi School of Medicine, he discovered Tenwek, a nondenominational Christian hospital in Bomet, Kenya.

1957 1960 1961

Shot in the Dark Would be weight losers receive injections of human chorionic gonadotropin derived from the urine of pregnant women, rabbits or mares.

Zen The first appearance of the macrobiotic diet in the western world goes heavy on the grains.

Calories-Don’t-Count Oh if only this were true! In 1961, Brooklyn doctor Herman Taller invents the CDC diet after losing 65 pounds in eight months. He avoids carbs and sugar but packs in the meat three times a day. The FDA eventually rules this practice as unsafe.

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Mission Doctor


it ruptures,” according to MedLine Plus, a

web publication of the National Institutes of

Health’s National Library of Medicine. How-

ever, if an AAA ruptures or tears, it becomes

a life-threatening emergency that fewer than

one in five patients will survive.

“She was clinically dead when we took her

to surgery, and she survived,” he says of the

Tenwek patient. “I think that was the case

that they were probably the most apprecia-

tive that I was there for.”

In addition to “the usual congenital

heart disease issues that would happen

everywhere,” says Rayburn, he also noted a

much higher incidence of heart valve dam-

age from rheumatic heart disease, which

can be avoided by treating rheumatic

fever with antibiotics.

“It is just very uncommon [in

the U.S.] these days.” he says,

although “I’ll occasionally see

folks that are in their 70s or 80s

that will have had it back then,

pre-antibiotic.”

“And again, it’s from lack of access

to care,” he continues. “A lot of them are

pretty rural.”

Unexpected ChallengesThe extent of what Tenwek Hospital can

do, and of the level of care it provides, “is

just a real testament,” says Rayburn. How-

ever, being in a different—and differently

equipped—environment was sometimes

challenging.

For example, “the blood bank there is

pretty rudimentary,” he says, and mak-

ing sure a blood match was available for

a surgical patient could

sometimes cause delays.

And other supplies, like basic

instruments and sutures—“things that you

take for granted”—were not always available.

Another challenge was the frequent and

continual recurrence of the electricity outage

that had surprised Rayburn during his first

surgery. Two or three times a day, he says,

inconsistently and with no warning, “the

electricity would stay off for 15-30 minutes.”

While the anesthesia machines did

thankfully have “some sort of backup sys-

tem,” unlike hospitals in the US, which

are designed with a system of emergency

generators that make blackouts unlikely, the

lights would just go out.

“It was an eye-opening experience,”

quipped Rayburn.

Hopes for a Recurring MissionRayburn’s full schedule did not leave much

room for tourism, although he enjoyed the

small amount of time he was able to spend

exploring. “One of the things they talked me

into doing was going on safari at the end of

my trip,” he says, in an area about fifty miles

away from the Tenwek compound. “That was

really just fascinating.”

The ultimate goal of his trip, however, was

it waS an eye-opening experienCe.

1963 1964 1970

Weight Watchers It may be a little unfair to include this diet, which was founded by Jean Nidetch, a self-described “overweight housewife obsessed with cookies” as a fad, as it is still going strong today.

I’ll drink to that Hearkening back to William the Conqueror, the Drinking Man’s Diet is more about drinking than diet and is eventually dubbed “unhealthful” by the Harvard School of Public Health.

Sleeping Beauty This dubious diet is actually nothing more than extended unconsciousness aided by sedatives. Elvis is said to have tried this one.

e

to establish the basis for a long-term rela-

tionship with Tenwek. “I feel good that we

set up the foundation for having a recurring

mission to go there,” he says.

“Even though this was a working trip, in

a lot of ways it was also a fact-finding trip”

to find out what was needed, says Rayburn,

who is hoping to return in 2016.

He also learned what he didn’t need. “I’d

say three quarters of what I packed was

worthless.”

Next time, he’ll bring fewer personal

“I can’t say enough about the people over there. I came away very impressed in all aspects of what they’re doing with what they have, and what an unbelievable ministry that they are able to bring to the table.”

A New PerspectiveRayburn’s CHI St. Vincent name tag proved

to be a universal conversation starter: peo-

ple would see it and ask “where I was from

and what I was doing and what I did every

day—everybody was very interested in those

kinds of things.”

He is particularly grateful to CHI St. Vin-

cent’s for giving him the time off to extend

their own mission of healing, education, and

research “halfway around the world” into

Kenya. “I got a lot of encouragement and

appreciation,” he says. “To the best of my

knowledge, nobody in Arkansas has ever

done this for heart surgery.”

Rayburn, who continues to exchange

emails with his Tenwek colleagues, has

developed a whole new set of friends and

relationships. “I can’t say enough about the

people over there,” he says. “I came away

very impressed in all aspects of what they’re

doing with what they have, and what an

unbelievable ministry that they are able to

bring to the table.”

“It really is one of those things that

changes your perspective on a lot of stuff,

and broadens and deepens your respect for

what’s going on,” he continues. “You realize

all that you have access to, and what your

life is, and you count your blessings.” n

effects and more equipment and supplies:

“basic sutures, basic instrument pans, things

like that. I’ll take one of the battery-operated

headlights that we used when the electric-

ity went down.”

But what he would most like to bring are

more skilled volunteers—“more of a team,”

he says. He is also talking to other doctors

about going at different times “kind of in

conjunction with us, so that we can con-

tinue to support [Tenwek] and extend their

mission.”

Cli

niC

al

pho

tos

Co

ur

te

sy s

am

ar

ita

n’s

pu

rse

emdr

By Karen Tatum

Post Traumatic Stress Disorder (PTSD) is nothing

new, but in recent years, especially with a steady

number of returning veterans suffering its effects,

both our understanding and options for treatment

of the disorder have grown. One such treatment,

Eye Movement Desensitization and Reprocessing

or EMDR, is increasingly being used after multiple

randomized studies have confirmed its benefits. In

fact, according to the EMDR Institute (www.emdr.

com) founded by Dr. Francine Shapiro, EMDR is

now recommended as an effective treatment for

trauma in the Practice Guidelines of the American

Psychiatric Association, and those of the

departments of Defense and Veterans Affairs.

UniqUe TreaTmenT aids PTsd sUfferers

ThEeyes hAVE IT!

PRAcTITIOnERS OF EMDR like chanda

camden, LcSW, in Little Rock, admit the

therapy can seem weird. But to borrow a

phrase from a recent, popular advertising

campaign, “It’s only weird if it doesn’t work.”

The eye movement that lends its name

to this 8-phase form of integrative therapy

consists of a patient engaging both the right

and left sides of his/her brain by following a

series of lights or the fingers of the therapist

or alternatively engaging in bilateral tapping

or sound stimulation. This of course is just

one part of a more complex set of steps in

the integrative therapy first developed by Dr.

Shapiro in 1990.

According to camden, EMDR uses com-

ponents of several different gold standard

therapy modalities. “It kind of pulls the best

parts of each out and combines them in a

way in which all of the effects are enhanced,”

she explains. And in fact, eye movement is

not always necessary in EMDR as long as

there is some form of bilateral stimula-

tion. “What Dr. Shapiro discovered is that

although she began her work with the eye

movements you can also do tactile and

sound as well. It’s not always eyes.” So ther-

apists sometimes use hand held tappers that

vibrate back and forth or sounds on head-

phones. “The idea behind that component

is that it’s bilateral stimulus and the theory

is that it is activating both hemispheres of

the brain at the same time so you get differ-

ent kinds of processing going on at once,”

says camden.

camden notes that one of the things Dr.

Shapiro studied was REM state in sleep. “She

was looking at the connection between rapid

eye movement during the sleep state and

stages of sleep; that stage of sleep that’s

memory consolidation where you take all of

your experiences from the day and integrate

them and file them away into your under-

standing of the world. Traumatic memories

don’t consolidate in that way.” According to

camden, Shapiro also noticed that when

people process information during the day

they move their eyes back and forth and she

wondered about that. “She developed theo-

ries that suggested when you are processing

information you are never only processing

right or left; it’s always a combination. But

“...the theory is that it is activating both hemispheres of the

brain at the same time so you get different kinds of processing

going on at once.”

1975 1977 1978

Cookies Sanford Siegal, a south Florida doctor, creates weight loss cookies from a mixture of amino acids. Patients consume six cookies a day in addition to a 300-calorie dinner. Something tells me it wasn’t the cookies.

Slim-Fast Another one with some staying power, dieters can still have “a shake for breakfast, a shake for lunch, then a sensible dinner” today.

Scarsdale Perhaps remembered more for the scandal that ensued after Dr. Herman Tarnower was shot by his girlfriend, “The Complete Scarsdale Medical Diet” gained some notoriety.

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emdr


when you are asleep right is more in con-

trol. When you are awake left is more in con-

trol,” explains camden. “The trick is how to

get those two to engage in a synergistic way

and process information while you are fully

awake.”

That synergistic processing is the goal of

EMDR based on the theory that PTSD stems

from traumatic memories or experiences

that are not processed correctly by the brain.

Because they are not filed away like regu-

lar memories, triggering those traumatic

memories can produce an intense, often

physical response…a very real reliving of

the traumatic event.

That potentially intense response requires

several steps before the eye movement

part of the treatment. It is important to first

ensure that memory can be safely triggered

and that the patient has the tools to cope

with it. If not, then those coping skills need

to be developed first.

Like most forms of therapy, the first phase

of EMDR is an intense history taking ses-

sion. The therapist determines if the patient

is a candidate for EMDR and identifies the

traumatic memories that may be targeted

by the treatment. This may be one simple

traumatic event or fear, or it may be a collec-

tion of traumatic experiences or memories.

As mentioned above, the second phase

involves ensuring the patient has the coping

skills and support system to handle the emo-

tions that may be triggered by the therapy.

The therapist can help the patient improve

or enhance those skills and learn techniques

to reduce stress.

Phases three through six involve using

EMDR to treat the targets identified in phase

one. According to the EMDR Institute this

involves “the client identifying the most

vivid visual image related to the memory

(if available), a negative belief about self,

related emotions, and body sensations.

The client also identifies a preferred posi-

tive belief. The validity of the positive belief

A light display on a computer screen or a therapeutic tapping device can produce similar bilateral processing results in lieu of the light bar traditionally used in EMDR.

1979 1980s 1980s

Dexatrim For those looking for an easy way out, diet pills become popular and Dexatrim is a household name. When the key ingredient, phenylpropanolamine (PPA), is linked to an increased risk of stroke in 2000, the formula is changed and dieters become more wary.

Cabbage Soup Repeats Well you knew that already, but this diet returns as a seven- day plan consisting of as much cabbage soup as the dieter wants along with additional foods such as fruit or raw veggies on selected days. Also known as the “Dolly Parton diet.”

Timing is Everything Ayds, an appetite-suppressing candy gains some popularity, but the name becomes an issue when the AIDS crisis hits. It soon disappears from the market.

e


is rated, as is the intensity of the negative

emotions.”

During the therapy the patient focuses on

that most intense image, negative thought,

and body sensations while simultaneously

engaging in the bilateral stimulation. The

patient is told to just notice what happens

and then to let their mind go blank and

pay attention to the thoughts, feelings or

images that appear. “They might be images

or thoughts or pictures that the person asks,

‘Why did I think of that?’ Kind of like when

you wake up from a dream. Maybe later in

the session it will make sense,” says camden

The process is repeated, sometimes

working through multiple focuses of atten-

tion until the patient reports no distress trig-

gered by those memories. They are then told

to focus on the pre-approved positive image,

thought or belief while again engaging in the

eye movements. Any re-emerging negative

reactions are addressed in the same way as

the positive beliefs are reinforced.

Phase seven involves closure and journal-

ing as well as reinforcing self-calming skills

learned during the therapy and the final

phase is a re-evaluation and status check.

camden notes that for some clients with

a single, simple trauma, all eight phases may

be achieved in one or two sessions, but for

others with more complex traumas, the

treatment could last several months. The

standard for EMDR therapy is 8-12 sessions,

says camden, but “a lot of times it will be

longer than that if you have complex issues,

multiple traumas.” Sometimes those aren’t

immediately apparent. “They might say ‘I

am terrified to drive because I was in a car

accident,’ but you may not start with the car

accident,” she explained. “You might find

during the thorough history that when that

person was five they were in a car accident

with their mother and that’s where you need

to start. These experiences are cumulative

and can act with each other.”

Many people suffering through a trauma

will avoid seeking therapy because the idea

of “diving in there and dealing with it is so

terrifying,” says camden. A common thread

in all forms of trauma is loss of control. “So

in treating someone for trauma you want to

give them a sense of being in control. You

don’t want to take control away from them.

EMDR is wonderful, being built in a way that

there’s a lot of sensitivity to that. The per-

son is in control. I am the facilitator. If they

are anxious when I make a suggestion to

focus on something, we don’t. no pushing.

My objective is not to re-traumatize.”

While the treatment was originally devel-

oped for the treatment of PTSD and is now

considered one of the top treatments for

the disorder, EMDR has also been used with

some success to treat phobias, anxiety dis-

orders, even depression, said camden. how-

ever most of the research on its efficacy thus

far has been focused on PTSD.

“It is not appropriate for every issue that

every person comes in with,” says camden,

“But I use it as much as I can. I believe it’s

considered a brief therapy in comparison

with other therapies that might take years

and years.”

Although the fact that EMDR can be rel-

atively fast-acting is a plus, it is not some-

thing that is emphasized or promised in the

sessions. “That might be unnerving,” said

camden. “You can imagine if you come in

and say, ‘My brother was shot and killed a

month ago and I am having nightmares and

I am a wreck, and I really can’t deal with it.’

If you sit down in two or three sessions and

you are really feeling fine, that might trig-

ger guilt issues. ‘Why am I not still having

nightmares? Why am I not still a wreck?’”

She emphasizes that getting past the trauma

doesn’t make you a bad person or mean that

you didn’t care. “We just removed barriers to

normal processing then allowed the psyche

to process in a really organic way.”

When used for PTSD EMDR is typically

covered by insurance, says camden. When

used for other issues like anxiety orders, for

example, it would depend on what types

of therapies are combined as to whether

it would be covered. “I don’t think your

insurance would pay for it if it’s not clini-

cally causing problems in your life.”

camden notes that there is now an EMDR

International Association (www.emdria.org)

that manages and trains a network of thera-

pists all over the world “It is definitely grow-

ing because it works. It’s such a strange ther-

apy. It’s weird, but it works.” n

Chanda Camden, LCSW

“While the treatment was originally developed for the treatment of PTSD and

is now considered one of the top treatments for the disorder, EMDR has also been

used with some success to treat phobias, anxiety disorders, even depression.”

Q & A

Setting Things Straight

In June, Governor Asa Hutchinson announced that

Elizabeth Thomas Smith, previously the administration’s

chief legal counsel, would become the state’s next

Medicaid Inspector General. Smith has more than two

decades of experience practicing law, including more than

15 years combined as a prosecutor and later as associate

general counsel for the University of Arkansas for Medical

Sciences. Smith served as deputy prosecuting attorney

under Larry Jegley for the 6th Judicial District. She also

served as an assistant attorney general of Arkansas under

Mike Beebe and with the firm of Mitchell Williams Selig

Gates and Woodyard, specializing in healthcare.

By Delanna Padilla

A Q&A with Elizabeth Thomas Smith, Arkansas Medicaid Inspector General

1981 1982 1985

Beverly Hills This diet focuses on food combinations or lack thereof. For example, fruit should be consumed alone and Champagne is neutral. Cheers!

The F-Plan Audrey Eaton suggests restricting daily calories to 1000 and choosing foods with a high fiber content.

Fit for Life This diet plan, published by Harvey and Marilyn Diamond, prohibits consuming complex carbs and protein in the same meal.

Pho

to b

y Zo

ie C

lift

As you have been recently appointed to the position of Medicaid Inspector General, have you had an opportunity to set any particular goals that you wish to accomplish in this position?A. The statutory creation of this office

(Office of Medicaid Inspector General

“OMIG”) provides for a separate set of eyes

to work as an independent entity to review

the expense of Medicaid Funds and com-

pliance with Medicaid requirements. The

office’s powers and duties are to: prevent,

detect, and investigate fraud and abuse

within the medical assistance program;

refer appropriate cases for criminal prose-

cution; and to recover improperly expended

medical assistance funds.

Governor Hutchinson wanted a trusted

advisor, someone who understood both

enforcement and provider perspectives,

and someone familiar with his overall

health care reform efforts. With Medicaid

reform at the forefront of legislative policy

issues, the OMIG is in a position to play

an important role in our overall approach.

My agency is utilizing multiple sources

and implementing tools to identify issues

with use of Medicaid funds. This includes

the use of analytical tools that place an

emphasis on data analytics to pinpoint

specific areas of concern in the Medicaid

program. Often outliers in billing are iden-

tified through data mining. My plan is to

utilize the resources rather than to sim-

ply rely upon complaints. These analytical

1985 1987 1988

Paleo This modern diet fad marks a return to food as found in nature. References to “eating like a caveman” encourage embarrassing consumption of large amounts of meat and sometimes even grunting.

Star Power Actress Elizabeth Taylor publishes a book, “Elizabeth Takes Off,” in which she advocates eating veggies and dip daily at 3 p.m. Methinks the other meals might be the problem.

O My! Oprah loses 67 pounds on a liquid diet. She appears on TV pulling a wagonload of fat to demonstrate her weight loss. Ewww, that is 3% gross.

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Q & A


‘‘resources are provided by state contrac-

tors as well as federal contractors, which

will assist in identifying billing outside of

the normal range.

We are also working with DHS to but-

tress their efforts to ensure proper utiliza-

tion of state and federal Medicaid funds. Of

course my role is to identify fraud, waste,

and abuse, but I also want to be a resource

to correct issues in the Medicaid system as

a whole to ensure Medicaid funds are being

spent as intended. I have open lines of com-

munication with DHS and other agencies

and together we plan to strategically focus

on some areas of highest need/reward/

return on investment.

The mission will not be just to identify

fraudulent providers, which has been the

focus in the past, but also to identify ben-

eficiary fraud. Beneficiaries as well as pro-

viders are subject to review. Cases where

beneficiaries and providers are working

together to exploit the Medicaid program

have been identified. In this data driven

world, our mission should be to identify all

types of fraud, waste, and abuse and avoid

improper spending of taxpayer money.

Tell us about your qualifications to be Medicaid Inspector General.

A. When Governor Hutchinson asked me to

move from my position as his Chief Counsel

to Medicaid Inspector General, he focused

on my experience working both sides of the

issue. For ten years, I represented health-

care providers. The majority of that time I

spent on campus as associate general coun-

sel for one of the state’s largest healthcare

providers advising their compliance depart-

ments regarding billing practices. I under-

stand how difficult proper billing can be.

I have represented providers before state

agencies and in civil lawsuits. Prior to rep-

resenting providers, I prosecuted fraud, as

well as all types of criminal offenses, as a

deputy prosecuting attorney for Pulaski

County. Additionally, my father is a physi-

cian and so I have seen how the system has

changed over the years.

In reviewing the OMIG records, have you seen any patterns emerge as to cer-tain types of violators, types of practice, or in particular areas of the state?A. The statutes, laws, and regulations

require my office to identify fraud, waste,

and abuse across the state to maximize

recovery of improper Medicaid payments.

We see potential fraud, waste, and abuse

across the provider spectrum and all areas

of the state. OMIG has recently begun using

more progressive analytical tools to identify

outliers and potential abusers. OMIG has

subpoena power and this office has sub-

poenaed beneficiaries to determine whether

services allegedly provided were provided

or were not provided. We can pursue civil

and administrative enforcement actions

against individuals or an entity engag-

ing in fraud, abuse, illegal, or improper

acts within the program. State law allows

OMIG to review provider records for up to

3 years. However, if a credible allegation of

fraud exists or OMIG has reason to believe

fraud occurred, we are authorized to look

back 5 years.

Do you have sufficient resources to handle an increased caseload of investigations?A. There are a number of hurdles associated

with starting a new state agency. The posi-

tion and the agency were created in 2013; it

is the first new agency in the state in many

years. During the first few weeks in this

position I began reviewing the duties, roles,

and responsibilities, as well as the staffing

within the office and other resources avail-

able to aid in detection of fraud, waste, and

abuse. I have been analyzing the resources

“Of course my role is to identify fraud, waste, and abuse, but I also want to be a resource to correct issues in the Medicaid system as a whole to ensure Medicaid funds are being spent as intended.”

1990s Undetermined 1992

Mediterranean Another old way of eating is recognized for its health benefits and the Mediterranean Diet becomes the latest fad.

Feeling Blue It has been long believed that the color blue is a natural appetite suppressant, perhaps because of the dearth of blue foods in nature. Blue plates, linens, even tinted eyewear is said to help reduce the amount of food you consume.

Atkins There are few Americans of a certain age that haven’t tried some version of this low carb diet created by Dr. Robert C. Atkins. The promise of copious amounts of protein and fat soothes the sting of giving up sugar.

e


‘‘ Often smaller offices do not have staff dedicated

to compliance; the person submitting the billing should

receive training on proper coding and billing practices. Reviewing billing to ensure

proper signatures are present prior to submission is an easy fix for a provider,

because without them, that’s a potential violation.

to determine how best to fulfil our mis-

sion. Governor Hutchinson wants to ensure

OMIG has the resources that are necessary

and appropriate to carry out the important

duties of Medicaid oversight.

I’m sure that providers are curious as to what triggers an audit by the OMIG. Can you tell us?A. Audits start in various ways: complaints

to the hotline or via email, reports from

other providers or state and federal agen-

cies, referrals from boards, and information

obtained through data analytics, as well as

in verifying self-reporting by providers. We

work closely with many other state agencies

as well as law enforcement. Additionally, we

have computer analytics that provide data

mining tools which run algorithms on pro-

vider billings. Outliers are identified and we

review those to determine if fraud, waste, or

abuse is occurring.

What preventative measures can provid-ers take to ensure that they are comply-ing with Medicaid billing requirements?A. Training and staff education on com-

pliance with the Medicaid Manual are key

components to prevent issues with Medic-

aid billing. Providers can and should review

claims before submission to ensure there is

documentation to support the claims. Many

large providers have compliance depart-

ments. Often smaller offices do not have

staff dedicated to compliance; the person

submitting the billing should receive train-

ing on proper coding and billing practices.

Reviewing billing to ensure proper signa-

tures are present prior to submission is

an easy fix for a provider, because without

them, that’s a potential violation. OMIG is

also working closely with the DHS agencies,

as well as providers, to make sure providers

understand rules and regulations regarding

billing, allowable costs, etc.

What would you like to tell providers about the OMIG?A. I am excited about the opportunity to

bring a new perspective to the Office. While

I am focused on enforcement, I am also

looking forward to supporting providers

who may be confused or lack understand-

ing of compliance issues. I should point out

that self-reporting is highly recommended.

We even have a self-report protocol on our

website. Providers are always welcome

to call us and discuss their concerns and

questions.

OMIG has made a concerted effort to rec-

ognize and provide guidance to providers

who find problems within their own orga-

nizations and self-disclose those issues or

irregularities in their dealings with the Med-

icaid Program. This approach was devel-

oped to encourage and offer incentives for

providers to investigate and report matters

that involve possible fraud, waste, abuse or

inappropriate payment of funds, whether

intentional or unintentional.

Developing this partnership between

providers and OMIG enhances OMIG’s

overall efforts to eliminate fraud, waste, and

abuse while simultaneously offering pro-

viders an avenue to reduce their legal and

financial exposure. By statute, OMIG is pro-

vided the ability to mitigate when providers

self-report. We want to work with provid-

ers to ensure Medicaid funds are properly

utilized. Training on the Medicaid regula-

tions is a must and proper billing is key. n

antibiotic resistance

By John W. Mitchell

Hospitals adopt strategies to reduce antibiotic resistant infections

Superbug

Stalking the

“Antibiotic drug resistant infections put

patients in a position where we may not be

able to treat them.”



In August, the Centers for Disease Control & Prevention

(CDC) made the sobering announcement* that drug

resistant infections, often dubbed “superbugs”, cause

more than two million illnesses a year, resulting in 23,000

deaths. This comes on the heels of the National Action

Plan for Combating Antibiotic-Resistant Bacteria **

(NAPCARB) initiative released by the White House in

March, setting specific goals for hospitals to reduce such

drug resistant infections.

HosPItAls HAve PRoveN to be remark-

ably adept at rising to such challenges. The

Centers for Medicare and Medicaid (CMs)

has over the past decade held hospitals

accountable for such quality and outcome

measures as reducing surgical infections,

early deliveries, and central line infections.

This latest NAPCARB initiative is wide

reaching, setting goals for antibiotic use in

agriculture (the food supply), edu-

cating patients about their roles

in requesting and using antibi-

otics, creating a high function-

ing stat testing network in

the U.s., and other

measures. The plan

is also designed to

mesh with World

Health organiza-

tion initiatives at the

international level.

Hospitals and physicians, as usual, are

leading the way in combating this public

health problem. Under NAPCARB, hospi-

tals are required to achieve a “reduction of

inappropriate antibiotic use by 50 percent

in outpatient settings and by 20 percent in

inpatient settings.”

“We’re paying attention to this because

it’s a threat internationally and globally,”

said vicki Allen, MsN, a clinical spokesper-

son for the Association for Professionals in

Infection Control and epidemiology (APIC).

Allen is also an Infection Control Director

who oversees a clinical staff of five at Car-

oMont Regional Medical Center, a 435-bed

hospital in Gastonia, NC. “Antibiotic drug

resistant infections put patients in a posi-

tion where we may not be able to treat them,”

she explains. APIC, which helped the White

1994 1995 1995

Labels Not a diet, but an important development for dieters. The Guide to Nutrition Labeling and Education Act requires food companies to include nutritional info on nearly all packaging.

The Zone Recognizing that too much of anything can be a bad thing, the Zone Diet rethinks low carb by proscribing a ratio of 40-30-30 for carbs, fat, and protein at each meal.

Sugarbusters The latest incarnation of the Atkins low-carb trend.


House shape the NAPCARB initiative, works

with both hospitals and patients to educate

about superbugs.

“We’ve been focusing on reducing all

hospital acquired infections,” said todd

Burstain, MD, Chief Medical officer at

tulane University Hospitals. He said tulane

uses a multidisciplinary team solution to

reduce infection rates. This solution has, for

example, reduced the rate of Foley cathe-

ter patient days by half, which has resulted

in a corresponding reduction in catheter

related infections to less than one percent.

This improvement was made with a major

and minor tweak instructive for all infection

reduction efforts.

“We developed and instituted a new

protocol that allowed registered nurses to

remove catheters within 24 hours without a

doctor’s order,” said Dr. Burstain. “But we had

to change the name from “nurse driven” pro-

tocol to a “sepsis reduction” protocol. some

doctors feel it is their responsibility to make

these decisions and this judgment should

not be unduly shifted to nurses. once we

changed the name, everyone was fine with it.”

one of the reasons hospitals are being

charged with a 50 percent reduction in

the inappropriate use of antibiotics is that

more and more hospitals – not just academic

organizations such as tulane – are employ-

ing physicians. Dr. Burstain’s colleague Jef-

frey Percak, MD, an Assistant Professor of

Clinical Medicine and an infectious disease

specialist, said they have thought a lot about

the best way to communicate with prescrib-

ers in such settings as the eR and primary

care clinics, as well as with the hospital-

ists, ICU intensivists, residents, and other

specialists who take care of patients in the

hospital.

“We’re paying attention to this because it’s a threat internationally and globally.”–Vicki Allen

50/20%Under NAPCARB, hospitals are required to achieve a “reduction of inappropriate antibiotic use by 50 percent in outpatient settings and by 20 percent in inpatient settings.”

1996 2000s 2000s

What’s Your Type? This diet, created by Peter J. D’Adamo suggests that diet should be determined by blood type.

Cotton-Balls So the thinking goes “I need more fiber and fewer calories and I want to feel full…” and that’s where they lose me. Sure, cotton balls (how does one even swallow one?) fit the bill, but their complete lack of nutritional value, taste, or any other food-like quality make this idea a little too fluffy.

Juicy Juicing, the art of creating healthy cleanses or dietary supplements by combining various vegetables, leafy greens, and sometimes fruit, takes off. Experts warn that a liquid only diet should not exceed 5 days.

e



“The solution to these kinds of challenges

is sometimes just as much about human

connections as technological issues,” said Dr.

Percak. “I oversee bringing people together

from the different departments to help them

make better prescribing decisions.” Not that

technology isn’t important. Dr. Percak cited

several recent advances in testing technol-

ogy that now greatly aids doctors in decid-

ing quickly if a patient has a viral or bacte-

rial infection. This is key, as in the past it was

often the clinical practice to prescribe anti-

biotics first and get the lab results second.

“We’ve been using the same Gram stains

and Petri dish methods for the past 50 years,”

Dr. Percak explained. “These are still needed,

but these are also old tools. Just as there have

been technological advances in imaging and

cardiac testing, thanks to technology, doc-

tors get excited when they see that we can

get c-diff (clostridium difficile) bacterial test

results back now as quickly as 45 minutes

and results for tuberculosis, which is highly

contagious in hospitals, in two hours or less.”

one of the stated outcomes of NAPCARB

is the “the establishment of state Antibi-

otic Resistance Prevention Programs in

all 50 states to monitor regionally impor-

tant multi-drug resistant organisms and

provide feedback and technical assistance

to health care facilities.” such data collec-

tion and sharing has been in place at Baton

Rouge General Medical Center.

“We started an antimicrobial steward-

ship program five years ago and have

already reduced inappropriate use of anti-

biotics by 60 percent. We’ve been data shar-

ing with the CDC for a while and are now in

the early stages – two months – of infor-

mation sharing with other city-wide hospi-

tals,” said Kenny Cole, MD, Clinical trans-

formation officer at Baton Rouge General.

“The only way to decrease antibiotic resis-

tant infections is for all hospitals in a com-

munity to work together. It doesn’t work for

just one hospital to make changes.” He said

that otherwise, the drug-resistant strains can

re-emerge in other facilities.

Dr. Cole said the NAPCARB goals are rea-

sonable for any hospital to achieve. He said

that in 2008 Baton Rouge General adopted

the six sigma lean process improvement

program hospital-wide to make the reduc-

tion of inappropriate antibiotic use and

other quality improvements part of a cul-

tural change. As at tulane, Baton Rouge

General adopted a protocol that allowed

nurses to participate in the initiative, adopt-

ing a similar catheter removal policy. He also

said that physician engagement, including

working with medical residents, was a criti-

cal in achieving their improvement.

“This effort has been part of the trans-

formation to value-based purchasing under

the Affordable Care Act. We got buy-in by

sharing evidence-based medicine to change

practice patterns of use of broad spec-

trum antibiotics on the inpatient side and

by working with eR and the primary care

physicians in the outpatient clinics,” Dr. Cole

explained.

He also said that use of broad-spectrum

antibiotics, as opposed to narrow-spectrum

antibiotics, is a prescribing practice that has

promoted resistance. Broad-spectrum anti-

biotics kill both good and bad bacteria in our

“We developed and instituted a new protocol that allowed registered nurses to remove catheters within 24 hours without a doctor’s order.”–Todd Burstain, MD, Chief Medical Officer at Tulane University Hospitals

“...doctors get excited when they see that we can get c-diff (clostridium

difficile) bacterial test results back now as quickly as 45 minutes and results for tuberculosis, which is highly contagious

in hospitals, in two hours or less.”–Jeffrey Percak, MD, Assistant Professor of Clinical Medicine

Todd Burstain, MD

Jeffrey Percak, MD


body. Repeated over time, this can cause bad

bacteria to rise up to recolonize space occu-

pied by good bacteria. These “bad” players

can then become resistant to the antibiotics.

“We’ve had very good success in getting

our medical staff to change this practice pat-

tern. We strive to speak the language of good

patient care and create a team approach

between nurses and doctors in everything

we do. Reducing inappropriate antibiotic use

is good patient care,” said Dr. Cole.

Another contributing factor to antibi-

otic resistant bacteria as identified in NAP-

CARB is that there are not many promising

new antibiotics being developed. The plan

lays out actions to address this reality. Ryan

Bariola, MD, Associate Professor of Infec-

tious Diseases and Director of

the Antimicrobial

stewardship Pro-

gram at University of

Arkansas for Medi-

cal sciences (UAMs),

said there is not much incentive under the

current healthcare financing structure for

pharmaceutical companies to develop new

varieties.

“The reality is it’s expensive to develop

drugs and antibiotics are not a long term

use medicine that generates extended rev-

enue for pharmaceutical companies,” said

Dr. Bariola. “I think it is good that we have

a federal initiative rather than each hospital

trying to figure this out individually.”

He added that the rate of antibacterial

resistant infections in Arkansas is lower than

other parts of the country and that the rate

of antibiotic resistance has declined over the

One of the stated outcomes of NAPCARB is the “the establishment of State Antibiotic Resistance Prevention Programs in all 50 states

to monitor regionally important multi-drug resistant organisms and provide feedback and technical assistance to health care facilities.”

“We started an antimicrobial stewardship program five years ago and have already reduced inappropriate use

of antibiotics by 60 percent.”–Kenny Cole, MD, Clinical Transformation Officer, Baton Rouge General

50 States

Kenny Cole, MD

2000 2000 2003

Macrobiotic A restrictive Japanese diet based on whole grains and veggies creates a brief buzz.

Raw Another siren call away from the joys and dangers of processed food, the Raw Food Diet has some traction.

South Beach A less drastic low-carb diet than Atkins, Dr. Arthur Agatston’s South Beach Diet is an instant hit.

e



last four years at UAMs, which is the only

academic medical center in Arkansas. Dr.

Bariola stressed that antibiotics are strong

tools in curing patients, so it’s a matter of

keeping perspective.

“We’re not trying to stop antibacterial

use. It’s all about giving the right antibi-

otic in the right dose at the right time,” he

said. “Antibiotic resistance creates expen-

sive medical problems, but this is not mainly

about money. It’s about doing what’s right

for patients.”

As with many programs, real time inter-

vention is an effective strategy, which means

reviewing prescriptions as they come into

the pharmacy. For Gretchen Blondeau,

PharmD, BCPs, an infectious disease phar-

macist at slidell Memorial Hospital out-

side of New orleans, antibacterial resistant

strains have redefined her role in healthcare.

“The practice of pharmacy has changed

since I started in 1984,” said Dr. Blondeau.

“It’s gone from dispensing medications to

helping the physicians protect the patients,”

she said. “Reducing these cases is a focus for

us at slidell Memorial. We’ve hired a second

clinical pharmacist to expand our efforts.”

As in Baton Rouge, she said the hospital is

working with two other hospitals in the area

within a 30 mile radius – st. tammany Par-

ish Hospital and lakeview Regional Medi-

cal Center – to share information on patho-

gens and to work on initiatives with doctors,

many who practice at two or more of the

hospitals. she works with an infectious dis-

ease doctor to review charts, orders, and put

new strategies into place, such as switch-

ing patients to narrow-spectrum antibiot-

ics. The result has been about a 50 percent

reduction in inappropriate antibiotic use at

slidell Memorial Hospital.

All sources agreed that patient expecta-

tion is a big part of the superbug problem.

Patients often expect to be given a prescrip-

tion, whether for themselves or a child, even

when it has been explained their illness is

viral, not bacterial.

“Patients need to understand that just

because they are sick, it doesn’t mean they

must have a prescription,” said Dr. Blondeau,

a point all the clinicians interviewed also

stressed. Doctors often feel under pres-

sure from patients who have been condi-

tioned of think of a prescription as a value-

added component of their office or eR visit.

All sources agreed that patient expectation is a big part of the superbug problem. Patients often expect to be given a prescription, whether for themselves or a child, even when it has been explained their illness is viral, not bacterial.

2004 2006 2007

Heart Unhealthy The FDA bans the sale of diet drugs and supplements containing ephedra after it’s linked to heart attacks.

Master Cleanse This concoction of hot water, lemon juice, maple syrup, and cayenne pepper, promises quick results. I think we can work out how.

Alli The latest thing since Dexatrim, this nonprescription diet supplement keeps your body from absorbing some of the food you eat, with some rather disturbing side effects.


Changing these attitudes is part of the goal

of the NAPCARB plan. APIC offers patient

education tools on their website about inap-

propriate antibiotic use that can be adopted

by hospitals. An APIC post *** also broaches

other related topics, such as not using anti-

biotics prescribed for someone else, as well

as not insisting on antibiotics if the doctor

says the illness is viral and medicine is not

required.

“Patients should always ask questions

about any prescription. They need to under-

stand why they are taking a medicine plus

how long they need to take it. This helps

patients keep themselves safe,” added Dr.

Bariola at UAMs.

Now that both the CMs and the White

references* http://www.cdc.gov/media/releases/2015/p0804-hai-modeling.html** https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant*** http://consumers.site.apic.org/healthcare-settings/ask-questions-about-your-medications/

“We’re not trying to stop antibacterial use. It’s all about giving the right antibiotic in the right dose at the right time.”

“The practice of pharmacy has changed since I started in 1984. It’s gone from

dispensing medications to helping the physicians protect the patients.”

– Gretchen Blondeau, PharmD, BCPS, infectious disease pharmacist at Slidell Memorial Hospital

House have elevated the issue of antibiotic

resistance as another in a long line of qual-

ity metrics, hospitals can expect to see the

accountability ratchet up.

“In the circles I travel in, most hospitals

are in process or have started working on

this metric,” said vickie Allen with APIC. “I

think that most likely we will see this mea-

sure emerge as a penalty metric with CMs

in the near future.” n

Gretchen Blondeau, PharmD, BCPS

Ryan Bariola, MD– Ryan Bariola, MD, Associate Professor of Infectious Diseases and Director of the Antimicrobial Stewardship Program at University of Arkansas for Medical Sciences (UAMS)

2010 2010 2011

Weight What? Perennial favorite Weight Watchers gets a big plug when singer/actress Jennifer Hudson loses 80 pounds on the plan.

Paleo Part II The “caveman diet” has a resurgence of popularity and related publications.

HCG If you want underweight triplets, the HCG diet is for you. This weird fad combines a fertility drug with a 500- to 800-calorie-a-day regimen.

*For sources and attributions of timeline images see page 65

healthcare


briefsN e w s I P e o P l e I I N f o r m at I o N

led by martIN Hauer-JeNseN, md, Phd, a team of university of arkansas for medical sciences (uams) researchers has secured a $10.5 million grant to establish a center to study side effects of radiation therapy and other types of cancer therapy.

the Center for studies of Host response to Cancer therapy will be the first research center of its type in the united states. the grant, part of the Centers for biomedical research excellence (Cobre) program of the National Institute of General medical sciences, will be given out over five years with a possible renewal for two additional five-year periods.

the center’s primary objectives are to create a self-sustaining, multidisciplinary research center at uams that examines the mechanisms of and prevention strategies for cancer-therapy-induced toxicity and side effects. another important goal is to help junior scientific investigators who have a common research focus in this area to establish themselves as independent scientists.

Hauer-Jensen will serve as director of the center. uams researchers daohong Zhou, md, a promi-nent stem cell and molecular biologist, and marjan boerma, Phd, a radiation biologist with exten-sive experience in irradiation techniques, will be part of the center’s leadership team and direct core facilities. Hauer-Jensen, Zhou and boerma all are faculty in the division of radiation Health in the uams College of Pharmacy department of Pharmaceutical sciences. Hauer-Jensen also serves as director of the division.

Martin Hauer-Jensen, MD, PhD, center, looks at some lab data on a transparency along with Daohong Zhou, MD, left, and Marjan Boerma, PhD, right.

Grant Will Fund Study oF CanCer-therapy toxiCity


healthcareBriefs

was transported to the Pulaski County Jail where

bond was set at $250,000.

arkansas children at higher risk for DrowningChildren in arkansas are at an increased risk for

drowning, according to research conducted by the

arkansas Infant and Child death review Program

at arkansas Children’s Hospital (aCH). arkansas

ranks 7th in the u.s. for drowning-related deaths

among children under 17, and the state’s drowning

rate is 60 percent higher than the national average.

since 2010, the arkansas Infant and Child

death review Program has reviewed cases of

unexpected deaths of children ages birth to 17.

local review teams found that of all the drowning

cases reviewed, over 5 percent involved children

(uams) College of medicine, has been awarded

a two-year grant of more than $400,000 by the

National Institutes of Health to study the genetics

of borrelia burgdorferi, the bacterium that causes

lyme disease.

the goal of the research is to identify specific

genes required by b. burgdorferi to live in a mam-

mal or a tick. through genetic manipulation, cer-

tain genes believed to help the bacteria adapt,

especially during infection and transmission, can

be mutated to inactivate individual genes. If the

mutated bacterium then either fails to grow or

cause infection, this gene is likely very important

to the bacterium. Knowing the identities of these

essential bacterial genes could give scientists a

better understanding of how to prevent infection

or treat lyme disease.

chicot county Woman arrested for Medicaid Fraudarkansas attorney General leslie rutledge

announced the arrest of tabitha woods of der-

mott by the attorney General’s medicaid fraud

Control unit on one charge of medicaid fraud, a

Class b felony.

woods, 43, was arrested in dermott. she is

accused of billing medicaid for providing ser-

vices for her mother while she was clocked in and

working as a contract employee at the arkansas

department of Correction delta regional unit.

woods also billed medicaid while her mother

was admitted to a long-term care facility. woods

Baptist health aPrN Wins State awardadvance Practice registered Nurse (aPrN) Karen

J. richardson with baptist Health family Clinic-

warren was presented with the 2015 Nursing

Compassion award.

richardson was one of more than 50 nurses

nominated from across the state for the award,

which is given by the state board of Nursing in

conjunction with Publishing Concepts, Inc. Nomi-

nations for the award were submitted by patients,

their family members, and/or peers. richardson

was chosen the winner and the most outstand-

ing nurse in arkansas based on her compassion,

care, and empathy.

cartI earns Komen for the cure GrantCartI has been named the recipient of a $35,000

grant from the susan G. Komen for the Cure

arkansas affiliate to fund a resource program

designed to benefit low-income CartI breast

cancer patients throughout arkansas.

Currently celebrating its 21st annual presenta-

tion of financial support to arkansas programs

and organizations dedicated to the fight against

breast cancer, the CartI gift is one of a total of 21

individual grants awarded by the Komen affiliate

this year collectively valued at more than $900,000.

olivia wyatt, CartI counseling and resources

coordinator, said the Komen grant will be used

to fund “access to treatment—overcoming bar-

riers,” a program designed to assist low-income

breast cancer patients throughout arkansas with

necessary travel and housing expenses related to

daily cancer treatment.

researcher awarded Grant to Study lyme DiseaseJon blevins, Phd, an assistant professor in the

department of microbiology and Immunology in

the university of arkansas for medical sciences

uaMS MediCal Student earnS arkanSaS Mutual aWard Corey little, Ceo of arkansas mutual Insurance Co.; Kristin mitchell, third-year uams medical student; and Pope moseley, md, dean of the uams College of medicine.

Karen J. richardson, aPrN


go online for eNews updatesHealtHCareJourNallr.Com

act 900 of 2015 places basic protections in law

for retail pharmacies in arkansas. by ensuring that

pharmacies are not reimbursed below their costs,

it ensures patient access to the retail pharmacy of

their choice throughout arkansas, pharmacists say.

UaMS recruiting adolescent Girls for trauma Studya team of researchers at the university of arkan-

sas for medical sciences (uams) is recruiting girls

ages 11-17 for a study of how child abuse can

change brain function and increase the likelihood

of adults developing mental health disorders.

the study, at the uams brain Imaging research

Center, is hoping to uncover the effects early life

trauma can have on the brain. It will involve partici-

pants undergoing functional magnetic resonance

imaging (fmrI) while they perform different deci-

sion-making tasks. to learn more about how to

participate, call (501) 526-4880.

OhIt awarded hIe Funds from ONcthe department of Health and Human ser-

vices’ (HHs), office of the National Coordinator

for Health Information technology (oNC) has

announced that the arkansas office of Health

Information technology (oHIt) was one of twelve

awardees for the advance Interoperable Health

Information technology services to support

Health Information exchange funding opportu-

nity and will receive $2.6 million under a two-year

cooperative agreement program.

this award will help build on the work oHIt

has done to date to improve care delivery and

share information more broadly to support bet-

ter healthcare decisions while maintaining privacy.

the funding will be used to expand the adoption

of health information exchange technology to

behavioral health and long-term and post-acute

care providers. this will enable oHIt to facilitate

between the ages of 1 and 4 who drowned in

either a bathtub or bucket of water.

older children were more likely to drown in open

bodies of water or swimming pools. the arkan-

sas review teams found most recreational drown-

ings occurred among young people ages 10 to 17.

UaMS Medical Student earns arkansas Mutual awardKristin mitchell of North little rock has been

awarded the arkansas mutual medical student

award, a scholarship for third-year medical stu-

dents at the university of arkansas for medical

sciences (uams) who want to practice primary

care in rural arkansas.

the $10,000 scholarship was funded by the

arkansas mutual Insurance Co. in partnership

with the uams College of medicine to encourage

more medical students to enter primary care fields

such as family practice, general internal medicine,

and pediatrics and to practice in rural arkansas

where access to physicians is limited.

lobbying Group Sues State of arkansasthe federal lobbying group for the prescription

drug middlemen, known as pharmacy benefit

managers (Pbms), has filed a lawsuit against the

state of arkansas in united states district Court for

the eastern district of arkansas. the lawsuit chal-

lenges the constitutionality, among other claims,

of arkansas act 900 of 2015.

act 900 of 2015 establishes appeals standards for

arkansas pharmacies when the Pbms set the reim-

bursement rates for generic medications below

the drug acquisition cost of the pharmacies. a

recent survey of the pharmacy owner membership

of the arkansas Pharmacists association indicated

during the past year 11% of all of their generic

prescriptions processed by Pbms were paid below

their acquisition cost of the drug product.

health information exchange to improve health

care via information sharing that will advance

healthcare on many fronts, including quality, cost,

and safety.

laboratory Supervisor Joins arkansas Urologystephanie evans of little rock has joined arkan-

sas urology as laboratory supervisor. In this role,

evans will oversee daily activities in the laboratory,

such as analyzing specimens, resolving complex

clinical problems, and ensuring quality control.

evans brings more than 15 years of clinical care

experience to arkansas urology. she holds a bach-

elor’s degree in medical technology from the uni-

versity of arkansas for medical sciences.

Governor Directs DhS to end Planned Parenthood contractGovernor asa Hutchinson has directed the depart-

ment of Human services to terminate its existing

agreements with Planned Parenthood of arkansas

and eastern oklahoma. termination was effective

thirty days from the date of the letter from dHs to

Planned Parenthood.

Governor Hutchinson released the following

statement:

“It is apparent that after the recent revelations

on the actions of Planned Parenthood, that this

organization does not represent the values of the

people of our state and arkansas is better served

by terminating any and all existing contracts with

them. this includes their affiliated organization,

Planned Parenthood of arkansas and eastern

oklahoma.”

Knight Named aaFP Fellow daniel Knight, md, chair of and associate profes-

sor in the department of family and Preventive

medicine in the university of arkansas for medical

sciences (uams) College of medicine, has been

named a fellow of the american academy of fam-

ily Physicians (aafP).

Knight is board certified in family practice. He

is a board member of the american association

of medical Colleges Council of faculty and aca-

demic societies and president of the arkansas

academy of family Physicians from 2014-2015. He

also is chair of uams College of medicine Coun-

cil of department Chairs and a member of the

arkansas state medicaid Patient-Centered medi-

cal Home advisory Committee and the arkansas

blue Cross/ blue shield Primary Care advisory

Committee.

daniel Knight, mdstephanie evans


HealthcareBriefs

craighead county Man arrested for Medicaid Fraud arkansas attorney General leslie rutledge

announced the arrest of a Craighead County

man by the attorney General’s medicaid fraud

Control unit.

emmitt Paul milam, 45, of Jonesboro was

arrested on one count of medicaid fraud. milam

was booked into the Pulaski County Jail where

he posted bond and was released. He is accused

of billing the arkansas medicaid Program more

than $55,000 for services that were not rendered,

a Class b felony.

holy Grounds Program launched in churchesthe Center for Healing Hearts and spirits has

joined state and local partners to assist 20

churches in implementing tobacco-free Grounds

policies through their wCaaa tobacco-free Coali-

tion Program. the purpose of the program is to

educate people about the dangers of tobacco

use anywhere on their grounds, inside and out.

the churches are aCt Church (Nlr and Conway),

bethel ame Church little rock, Church of deliv-

erance, first baptist Church, first baptist Church,

Gener8tion Church, Greater 3-4 missionary bap-

tist Church, Greater New Hope baptist Church,

Greater rose of sharon, lebanon missionary bap-

tist Church, st. augustine Church, st. bartholomew,

st. Paul missionary baptist Church, and the Infin-

ity Church.

the Center for Healing Hearts and spirits

and wCaaa tobacco-free Coalition encour-

age arkansans who currently smoke to kick the

habit as smoking can lead to heart disease. Call

1-800-QuIt-Now.

aG announces Settlement with accredo Pharmacyarkansas attorney General leslie rutledge

announced that a settlement has been reached

to resolve kickback allegations against accredo

Health Group Inc. the agreement resolves claims

that accredo recommended the drug exjade to

medicaid patients in exchange for kickbacks from

Novartis Pharmaceuticals Corp., which markets the

drug.

under the terms of the settlement, accredo

has agreed to pay $60 million to the federal gov-

ernment and over $40 million to states. arkansas

has received $141,202.35 under the settlement,

deposited into the medicaid Program trust fund.

UaMS to host annual Family Medicine UpdatePrimary care physicians will have the opportunity

to earn nearly 15 hours of continuing education

oct. 9-10 at the university of arkansas for medi-

cal sciences’ (uams) 19th annual family medi-

cine update.

the two-day conference, hosted by the Con-

tinuing medical education (Cme) division of the

uams department of family and Preventive medi-

cine, will feature a day of musculoskeletal topics

ranging from pre-sports physicals to the knee and

foot. topics and conditions family physicians see

regularly in their practice, including chronic kid-

ney disease, menopause, obesity, diabetes and

polypharmacy, will also be covered.

Call (501) 526-5439 or visit cme.uams.edu to

register. Groups of three or more who register

at the same time will receive a 25-percent dis-

count. Groups must register by phone to receive

discount.

cartI Foundation Board Names New Member, Officersdiane wilder, md, of little rock, has been named

to the CartI foundation board of directors and

will serve a three-year term helping to lead the

fundraising arm of the statewide network of can-

cer care providers.

a medical oncologist with CartI since 2002,

wilder is board-certified in both internal medi-

cine and medical oncology.

barry simon, of little rock, has been re-elected

to a second term as CartI foundation board

president for 2015-2016. simon is the president

and owner of datamax Inc. Phyllis rogers, of sher-

wood, also returns for a second term as vice chair

of the CartI foundation board. rogers is a senior

vice president and chief financial officer at delta

dental of arkansas.

arkansas Made Incorrect ehr Incentive Payments the Centers for medicare and medicaid (Cms)

has determined that arkansas made incorrect

medicaid electronic health record (eHr) incen-

tive payments to hospitals totaling $1.2 million

over nearly 2 years. Incorrect payments included

both overpayments and underpayments, for a net

overpayment of $79,428.

as an incentive for using eHrs, the federal

government is making payments to providers

that attest to the “meaningful use” of eHrs. the

Government accountability office has identified

improper incentive payments as the primary risk

to the eHr incentive programs. these programs

may be at greater risk of improper payments than

other programs because they are new and have

complex requirements.

from November 1, 2011, through June 30, 2013,

the state agency paid $53,782,323 for medicaid

eHr incentive payments. oIG (1) reconciled both

professional and hospital incentive payments

reported on the state’s form Cms-64, Quarterly

medicaid assistance expenditures for the medical

assistance Program, with the Nlr and (2) selected

for further review 20 hospitals paid the highest

total dollars of incentive payments. the state

agency paid the 20 hospitals $19,125,371, which

is 65 percent of the total paid during the audit

period. this amount included second-year pay-

ments for 9 of the 20 hospitals, totaling $3,504,223.

the state agency made additional incentive pay-

ments to 18 of the 20 hospitals, totaling $6,417,265

as of september 30, 2014.

oIG found that adH made incorrect eHr incen-

tive payments to 14 hospitals.

In written comments on the draft report, adH

concurred with four of the six recommendations

made by oIG . the state agency did not concur

with the recommendation to refund the net over-

payment of $79,428, but stated that the incentive

Keith m. olsen, Pharmd

diane wilder, md

go online for eNews updatesHealtHcareJournallr.com

payments for 8 of the 13 hospitals had already

been adjusted in accordance with the findings.

the state agency also stated that it expected the

incentive payments for the other five hospitals to

be adjusted in accordance with the report.

adH also did not concur with the recommenda-

tion to work with the one hospital for which the

total incentive amount was set aside to recalcu-

late the incentive payment using the June 2009

cost report data. the state agency said that, on

the basis of communications between oIG and

the hospital, it concluded that oIG agreed that

the use of the 2010 cost report was appropriate.

Olsen Named Dean of UaMS college of PharmacyKeith m. olsen, Pharmd, has been named dean

of the university of arkansas for medical sciences

(uams) College of Pharmacy and will begin his

role at uams on or before Nov. 1. as dean, olsen

will oversee all aspects of the uams College of

Pharmacy.

olsen succeeds stephanie Gardner, Pharmd,

edd, who on July 1 became the uams provost

and chief academic officer. Kathryn Neill, Pharmd,

assistant dean and associate professor in the Col-

lege of Pharmacy, will serve as interim dean of the

College until olsen takes his new post at uams.

since 2007, olsen has been chair of the depart-

ment of Pharmacy Practice at the university of

Nebraska medical Center (uNmC) College of

Pharmacy in omaha, Nebraska. He also serves as

manager of education and research in the depart-

ment of Pharmaceutical and Nutrition Care at the

Nebraska medical Center in omaha. He specializes

in critical care and infectious diseases, teaching and

serving as the Infectious disease section coordina-

tor for pharmacotherapy II and is a preceptor for

the critical care and infectious diseases clerkships.

olsen was a member of the uams College

of Pharmacy faculty from 1989 to 1993, serving

as associate professor and director of the Clini-

cal Pharmacokinetic laboratory and monitoring

service.

Workshops Offered on Farm-to-School Program the Childhood obesity Prevention research Pro-

gram at arkansas Children’s Hospital research

Institute (aCHrI) will host a series of usda

regional farm-to-school workshops in october

and November to educate school personnel, farm-

ers, and community partners of the advantages of

participating in a farm-to-school program.

the workshop will take place on the following

dates:

•Oct. 15 at Southwest Research and Extension

in Hope

•Oct. 29 at University of Arkansas at Monticello

•Nov. 5 at Arkansas State University in Jonesboro

•Nov. 12 at North Arkansas College in Harrison

•Nov. 19 at UA Cooperative Extension in Little

rock

each workshop will host up to 50 participants,

and 10 travel scholarships are available to support

participant attendance at each session. the events

are sponsored by the usda farm-to-school Grant

Program, arkansas Cooperative extension office,

arkansas GardenCorps, arkansas farmers’ mar-

ket association, Krebs brothers restaurant store,

and berries by bill.

workshop participants will learn:

•How to menu, procure, market, and prepare

local foods in schools

•Hands-on culinary skills training for school caf-

eteria staff

•Business and production planning for farmers

•Food safety for farmers and schools

registration for the workshops can be found

by visiting archildrens.org/farmtoschool. for

questions, please contact Jenna rhodes at

501-364-3360.

Pharmacy Students earn National award uams College of Pharmacy students have

achieved a three-peat, winning the national organ

donation Challenge award yet again, and in this

year’s competition, surpassing 11 rival colleges of

pharmacy.

In 2013 and 2014, the students also won the chal-

lenge from the american society of transplanta-

tion by raising public awareness of the need for

more organ donors.

according to the u.s. department of Health

and Human services, 123,851 people in 2014 were

on waiting lists for organ donations and 29,532

received them. the gap has widened every year

since.

seth Heldenbrand, Pharmd, associate professor

in the College of Pharmacy, advised the college’s

students who volunteered for the awareness effort

and organized the organ donation awareness

workgroup. some members of the work group

also met with representatives of the arkansas

regional organ recovery agency

In 2015, the students won the national contest

of pharmacy students through educational pre-

sentations at events organized by arora and at

public schools and the uams 12th street Health &

wellness Clinic. other awareness events included

a partnership with Piro brick oven and barroom

to distribute flyers; participating in a live television

interview on tHV 11 on wear blue and Green day

for organ donation awareness; participating in sev-

eral health fairs; organizing a donor and recipient

family day at the little rock Zoo; and promoting

and participating in wear blue and Green day.

UaMS Pilot Studies earn awards the university of arkansas for medical sciences

(uams) translational research Institute recently

announced awards to seven researchers totaling

about $350,000 for pilot studies.

the annual awards of about $50,000 each are

made to studies with the strongest likelihood of

leading to improved health and healthcare. for

a uams College of Pharmacy student staffs an informational table at the 12th street

Health & wellness Center to raise awareness of the need for increased organ donations.



HealthcareBriefs

the first time this year, pilot awards were also

offered for studies that address common barri-

ers to research, such as the recruitment of research

participants and regulatory issues.

also a first this year, the institute invited com-

munity and business stakeholders to participate

in the evaluation of the pilot studies alongside

scientific reviewers. the practice is in keeping with

the translational research goal of ensuring that

studies are relevant to communities.

the uams researchers and their project titles

are:

•Laura Hutchins, MD, College of Medicine,

department of Internal medicine, Hematology:

development and implementation of video

assisted process for the uams tissue bioreposi-

tory and procurement service

•Magomed Khaidakov, MD, PhD, College of

medicine, department of Internal medicine, Gas-

troenterology: sessile serrated adenomas/polyps

– search for biomarkers of malignant potential

•Il-Young Kim, PhD, College of Medicine,

department of Geriatrics: role of dietary protein

intake on whole body protein in the elderly

•Tamara Perry, MD, College of Medicine, Depart-

ment of Pediatrics: exploring the effects of sleep

patterns and physical activity on asthma in ado-

lescents with wrist-worn smart devices

•Ronald Salomon, MD, College of Medicine,

department of Psychiatry: Ketamine effects on

dorsal raphé function in depression

•Scott Warmack, PharMD, College of Pharmacy,

uams Northwest Campus: Participant preferred

dissemination methods

•Vladimir Zharov, PhD, DSc, College of Medi-

cine, department of otolaryngology: Photoacous-

tic diagnosis of circulating clots in cancer patients

Scott chosen as Public health Nurse leaderPatricia Neel scott, dNP, rN the director for the

Center for Health advancement at the arkansas

department of Health is one of just 25 nurses

from across the country to be selected as a Pub-

lic Health Nurse leader (PHNl) by the robert

wood Johnson foundation (rwJf). she will par-

ticipate in a two-year leadership development

program designed to strengthen the capacity of

senior public health nurses to improve popula-

tion health, address social determinants of health,

respond to emerging trends in health and health-

care, influence policy, and lead collaboration in

their communities.

scott has worked for four years at the arkan-

sas department of Health, starting in Newborn

screening and school Health programs and now

is director for the Center of Health advancement.

Prior to returning to her home state, she was on

faculty for 15 years at Vanderbilt university school

of Nursing in Nashville, tenn., where she helped

start the first three elementary school-based

health centers in Nashville.

resources Offered for IcD-10 Prepas of oct. 1, 2015, all providers billing arkansas

medicaid will be required by the united states

department of Health and Human services (HHs)

to use billing codes outlined in the International

Classification of diseases, 10th edition (known as

ICd–10). the federal mandate requires all health

plans, clearinghouses, and healthcare providers

to use ICd-10 diagnosis and procedure codes.

Claims submitted without ICd-10 Codes for dates

of service on or after 10/1/15 will not be paid.

the arkansas dms announced that the Con-

tent-based testing (Cbt) tool is again available

for use. the testing environment allows providers

and vendors to test their ability to submit claims

to arkansas medicaid prior to the ICd-10 compli-

ance date of october 1, 2015. the tool provides

over 150 clinical scenarios that cover a wide range

of practice specialties.

Providers are highly encouraged to take advan-

tage of this testing opportunity and continue test-

ing ICd-10 coding skills by registering at http://

icd10cbt.com/moodle/.

UaMS Names Vice chancellor for regional Programstim Hill has been named university of arkansas

for medical sciences (uams) vice chancellor for

regional Programs effective aug. 1. Hill, of mau-

melle, succeeds mark mengel, md, who retired

in may. Hill has served in the position in an interim

appointment since then.

regional Programs, originally called the area

Health education Centers (aHeCs), was started in

1973 through the efforts of then-Gov. dale bum-

pers, the arkansas legislature and uams to train

medical residents and provide clinical care and

health education services around the state.

Previously, Hill was director of the uams Center

for Healthcare enhancement and development

since october 2013 and for more than two years

before that, he was director of the uams Center

for rural Health. from 1998 to 2009, Hill served

as president and Ceo of the North arkansas

regional medical Center in Harrison.

Professional counselor arrested for Medicaid Fraudarkansas attorney General leslie rutledge

announced the arrest of al Greggory dodds, lPC,

of Camden, by the attorney General’s medicaid

fraud Control unit on one charge of medicaid

coalition for Obesity Prevention recognizedthe arkansas Coalition for obesity Prevention (arCoP) has

been selected as a 2015 President’s Council on fitness, sports

& Nutrition Community leadership award recipient. this award

is given annually to individuals or organizations who improve the

lives of others within their community by providing or enhanc-

ing opportunities to engage in sports, physical activities, fitness or

nutrition-related programs.

arCoP’s goal is to increase the percentage of arkansans of all ages who have access

to healthy and affordable food and who engage in regular physical activity. Growing

Healthy Communities, the Coalition’s primary project, brings together individuals,

companies, and organizations across sector lines to recognize that a healthy com-

munity is a better community on virtually every measure of success. since 2009, more

than 50 communities across the state have worked with arCoP’s Growing Healthy

Communities project at varying levels.

the Coalition’s primary funding source is through grants from organizations includ-

ing the blue & you foundation for a Healthier arkansas, the arkansas department

of Health, and the university of alabama at birmingham midsouth transdisciplinary

Collaborative Center for Health disparities research.

to learn more about the arkansas Coalition for obesity Prevention, visit www.

arkansasobesity.org.



fraud, a Class b felony. dodds, 55, was arrested

in little rock.

on July 21, 2015, the medicaid fraud Control

unit served a search warrant on dodds’ office in

Camden, and he admitted to purposely billing

the arkansas medicaid Program in a fraudulent

manner for the last six months and estimated his

own fraudulent billings to be between $70,000

and $80,000.

the medicaid fraud Control unit and the office

of the medicaid Inspector General (omIG) are

working together to audit the past three years

of dodds’ billings, and initial reviews indicate

the amount of the fraud will well exceed dodds’

estimates.

on June 30, 2015, the medicaid fraud Control

unit received a referral from the omIG regard-

ing an allegation that dodds fraudulently double-

billed the arkansas medicaid Program. an omIG

audit found dodds overbilled medicaid $8,133.77

for January 2015.

consortium awarded National Science Foundation Grantthe university of arkansas for medical sciences

(uams) is part of a consortium of arkansas institu-

tions that has been awarded a five-year, $20 mil-

lion grant from the National science foundation

(Nsf) to support research and development of

novel, functional surfaces produced using inno-

vative materials and having nano-sized structures

and features.

the funding is part of the National science

foundation’s experimental Program to stimulate

Competitive research (ePsCor), which promotes

scientific progress nationwide by establishing part-

nerships with government, higher education and

industry.

the other nine participants are the university

of arkansas at fayetteville, university of Central

arkansas, university of arkansas at little rock,

ouachita baptist university, southern arkansas

university, Philander smith College, arkansas

state university, university of arkansas at Pine

bluff, and the university of arkansas at monticello.

obtaining this ePsCor grant was the result

of cooperative strategic planning and strong

research collaborations involving all the participat-

ing arkansas institutions and the grant will make

collaborative research among all of these arkansas

institutions stronger and more productive.

Governor Names Senior health Policy advisorGovernor asa Hutchinson has announced John

martin as his new senior Health Policy advisor.

martin was previously the deputy legislative

director for senator tom Cotton (r-ar), where

he has served as primary advisor to the senator on

domestic policy including healthcare, agriculture,

and other issues concerning arkansas for the last

two and a half years.

Prior to joining then-representative Cotton in

2013, martin worked for former Health and Human

services secretary tommy thompson, managing

the statewide grassroots operation for his 2012

u.s. senate campaign in wisconsin. He previously

worked as a consultant for deloitte.

cowan Named Dean of UaMS college of Nursing Patricia a. Cowan, Phd, rN, has been named

dean of the College of Nursing at the university

of arkansas for medical sciences (uams) and will

begin at uams on or before dec. 1.

Cowan succeeds lorraine frazier, who left uams

in January. Jean mcsweeney, Phd, rN, associate

dean for research and director of the uams Col-

lege of Nursing’s doctoral program and a nation-

ally recognized researcher and educator, has been

serving as interim dean since January and will con-

tinue until Cowan officially begins as dean.

Cowan currently serves as professor and

associate dean for academic and student affairs

in the College of Nursing at the university of ten-

nessee Health sciences Center in memphis. she

has more than 30 years of experience in all areas

of nursing including academics, clinical practice,

and research.

Cowan’s research interests include lifestyle inter-

ventions in overweight youth and adults and car-

diovascular and metabolic outcomes. she partici-

pates in a multi-professional research team and is

interested in translational research.

In-home Services to transition to Private Sectordr. Nate smith, director of the arkansas depart-

ment of Health, announced recently that the

department’s In-Home services office will be tran-

sitioned to a private sector provider. this process

is expected to take at least six months and comes

in the wake of financial constraints and competi-

tion from the private sector over the last five years.

the department does not intend to wind down

the business and cease operating, but instead

will market the program to private providers with

the capacity to manage the size and scope of the

operations, including employees and patients.

In-Home services has suffered a 28 percent

decline in patients, an 18 percent decline in rev-

enues, and a 19 percent decline in the number of

employees over the last five years. Had this deci-

sion not been made now, an immediate reduction

of employees would have been necessary.

aG announces Medicaid Fraud arrest, convictionsarkansas attorney General leslie rutledge has

announced the arrest of a mississippi County

woman by the attorney General’s medicaid fraud

Control unit. lenisha Nicole daniels, 31, of bly-

theville, was arrested on one count of medicaid

fraud. she turned herself into the Pulaski County

Jail where she posted bond and was released.

daniels is accused of billing the arkansas med-

icaid Program $1,900 for medicaid services she

did not perform. Plea and arraignment hearings

will be set in Pulaski County district Court at a

later date.

rutledge also announced the convictions of

a Jefferson County woman and a mississippi

County woman for medicaid fraud. the two

women pleaded guilty in unrelated cases in the

Pulaski County Courts. each will serve a period

of probation and pay restitution to the arkansas

medicaid Program and fines totaling over $7,000.

additionally, the medicaid fraud convictions will

tim Hill

Patricia a. Cowan, Phd, rN


HealthcareBriefs

be reported to federal authorities and may result

in the defendants being excluded from participa-

tion as providers in the medicaid and medicare

program for a period of up to 10 years.

lucy blackmon, 34, of Pine bluff pleaded guilty

to medicaid fraud, a Class a misdemeanor. black-

mon billed the arkansas medicaid Program for

home health services while the patient was in the

hospital. she was ordered to pay restitution of

$233.28 and fines totaling $1,199.84.

linda Hunt, 55, of blytheville pleaded guilty to

medicaid fraud, a Class C felony. Hunt billed the

arkansas medicaid Program for services she did

not provide. she was sentenced to three years of

probation and ordered to pay $5,318.25 in restitu-

tion and $918.75 in fines. she paid $5,000 of the

restitution to the arkansas medicaid trust fund

at the time of sentencing.

Office Supervisor joins arkansas UrologyCheryl mcfalls of benton has joined arkansas

urology as the business office supervisor. In this

role, mcfalls will oversee the daily operations of

the clinic’s business office to include billing/collec-

tions, accounts management, and customer service.

mcfalls brings more than 20 years of manage-

rial experience to the clinic and has an extensive

background in customer service, human resources,

and office administration.

UaMS college of Nursing Gets hrSa Grant a $1.9 million grant from the u.s. department of

Health and Human services will enable the univer-

sity of arkansas for medical sciences’ (uams) Col-

lege of Nursing to train more nurse practitioners

to provide healthcare for aging adults in arkansas.

uams was one of 21 institutions to receive fund-

ing from the department’s Health resources and

services administration’s (Hrsa) advanced Nursing

education program. the funds will foster the Geri-

atric advanced Practice program through a part-

nership between the John a. Hartford Center for

Geriatric Nursing and five of the arkansas aging Ini-

tiatives’ (aaI) partner hospitals. aaI is a program of

the uams donald w. reynolds Institute on aging

that partners with the uams regional centers, local

hospitals, colleges, universities and communities to

provide health care to aging adults.

Claudia beverly, Phd, rN, principal investigator of

the grant and director of the John a. Hartford Cen-

ter for Gerontological Nursing excellence (HCGNe)

and the Geriatric advanced Practice project, said

the goal is to provide training for an additional 50

to 60 nurse practitioners with the funding through

the College of Nursing’s master of Nursing science

specialty degree in adult gerontology primary care.

the degree program has 16 students in its current

class and expects to attract 15 to 20 students in

each class moving forward.

the grant will also support a partnership

between the College of Nursing and the uams

antenatal and Neonatal Guidelines, education

and learning system (aNGels) to work with

patients with congestive heart failure through

telemedicine, in addition to further interprofes-

sional education training for students.

Co-principal investigators of the grant are

leanne lefler, Phd, associate professor; bill buron,

Phd, assistant dean for nursing; and melodee Har-

ris, Phd, assistant professor, all in the College of

Nursing.

hardee Joins cartI Medical Staff matthew e. Hardee, md, has joined the CartI

medical staff as a radiation oncologist. Prior to

arriving at CartI, Hardee was a radiation oncolo-

gist with the university of arkansas for medical

sciences radiation oncology Center in little rock.

Certified by the american board of radiology,

the arkansas state medical board and the New

york state board for medicine, Hardee currently

holds memberships in the arkansas medical soci-

ety, the american association for Cancer research,

and the american society for therapeutic radiol-

ogy and oncology.

Neonatal hypoglycemia May affect School-age academics Newborns with transient low blood sugar may

have lower literacy and math achievement test

scores in fourth grade, according to researchers

from the university of arkansas for medical sci-

ences (uams) and baylor College of medicine in

Houston in a report published online in the journal

JAMA Pediatrics.

the uams and baylor researchers were able

to make the association of early transient hypo-

glycemia with decreased proficiency on literacy

and mathematics tests, after controlling for ges-

tational age, race, gender, socioeconomic status

and maternal education.

“with the findings of this study, we have shown

some evidence of the impact of early transient

newborn hypoglycemia,” said Nahed o. elHassan,

md, mPH, associate professor in the neonatology

section of the uams department of Pediatrics.

elHassan emphasized that the study was prelimi-

nary and the findings will have to be validated by

other researchers before any changes to screen-

ing or management of newborn hypoglycemia

are considered.

Co-authors of the study include elHassan and

shasha bai, Phd, assistant professor in the biosta-

tistics division of the uams College of medicine’s

department of Pediatrics. Jeffrey r. Kaiser, md, a

former uams College of medicine faculty mem-

ber, is the study’s principal investigator.

WIc receives USDa award for Breastfeeding Promotion the arkansas women, Infants and Children (wIC)

program is the recipient of the u.s. department

of agriculture, food and Nutrition service, spe-

cial supplemental Nutrition Program for women,

Infants and Children’s loving support Gold award

of excellence.

this award recognizes agencies that are in vary-

ing stages of demonstrating exemplary breast-

feeding promotion and support practices. the

intent of the award is to provide models and moti-

vate other local agencies and clinics to strengthen

their breastfeeding promotion and support activi-

ties, and ultimately increase breastfeeding initia-

tion and duration rates among wIC participants. n

Cheryl mcfalls

matthew e. Hardee, md

and we’re okay with that.Mailed directly to local healthcare leadership including physicians, administrators, insurers, and ancillary providers, as well as distributed at local healthcare organizations.

The most comprehensive and cost-effective way possible to reach your local healthcare industry.

of Little Rock

We’re a litt le bit different ...

healthcarejournallr.com

50 SEPT / OCT 2015 I HealtHcare Journal of lIttle rocK

as kissing bugs). Chagas disease is endemic

throughout much of Mexico, Central Amer-

ica, and South America, where an estimated

8 million people are infected.

The triatomine bug thrives in poor hous-

ing conditions. The kissing bug enters a

home by crawling through cracks and

holes – or by clinging to a pet or a person’s

clothes. Infection occurs when the bite site

of a triatomine bug is contaminated by a

parasite called Trypanosoma cruzi found

in the insect’s feces. The parasite enters the

body through the wound or through mu-

cous membranes. Infection can also occur

from mother to baby and through contami-

nated blood products, organs, lab exposure,

and rarely, food or drink.

Chagas disease has both an acute and

chronic phase, and if left untreated infec-

tion may be life-long. Acute disease occurs

a few weeks after infection. There may be

fever or swelling where the parasite entered

into the skin or mucous membrane. Dur-

ing the chronic phase, most people expe-

rience a prolonged asymptomatic form of

disease during which few-to-no parasites

are found in the blood. Many people may

remain asymptomatic for life, although 20

- 30 percent of those infected do develop

debilitating and sometimes life-threaten-

ing medical problems. Complications of

chronic Chagas disease may include heart

Emerging Pathogens

ExponEnTIAl worlDwIDE popula-

tion growth, and longer life due to better

nutrition and medical advances, has led to

expanding urbanization and human en-

croachment on wilderness habitats. These

wilderness habitats are reservoirs for in-

sects and animals that harbor infectious

agents. Increased travel of people, animals,

and food products have made the world

more connected. As a culture, many of us

have gone from eating foods grown in our

own back yards to eating foods from sever-

al countries every week. This international

expansion of the agricultural system allows

for emerging diseases to rapidly distribute

around the world.

Some of the most concerning emerging

pathogens in the U.S. and Arkansas include

Chagas Disease, Chikungunya virus, Den-

gue virus, and Zika virus.

Chagas disease is caused by the para-

site Trypanosoma cruzi, carried by blood-

sucking insects called triatomines (known

columnDirector’s Desk

why does it seem that there are more emerging diseases today than ever

before? Infectious diseases have been emerging and re-emerging for

thousands of years, causing pandemics. Improvements in worldwide

surveillance allow us to characterize disease emergence more frequently

than ever before. Most emerging pathogens originate in animals, and it is

important to better understand why we are seeing an increase.

HealtHcare Journal of lIttle rocK I SEPT / OCT 2015 51

lymphopenia, thrombocytopenia, elevat-

ed creatinine, and elevated hepatic trans-

aminases. Fatalities related to chikungu-

nya are rare.

Dengue virus has emerged as a world-

wide problem since the 1950s and is a lead-

ing cause of illness and death in the trop-

ics and subtropics. As many as 400 mil-

lion people are infected per year. Dengue

is transmitted between people by mosqui-

toes found throughout the world, including

Arkansas. The U.S. population has no im-

munity, and so it is theorized that the lack

of dengue transmission in the continental

U.S. is primarily because contact between

people and the vectors is too infrequent to

sustain transmission.

There are not yet any vaccines to prevent

dengue. The most effective protective mea-

sures are those that prevent mosquito bites.

Early recognition of infection and prompt

supportive treatment can substantially

Nathaniel Smith, MD, MPHDirector and State Health officer,

Arkansas Department of Health

rhythm abnormalities that can cause sud-

den death, a dilated heart that doesn’t pump

blood well, or a dilated esophagus or colon.

Arkansas has one species of triato-

mine, some of which carry the Trypano-

soma parasite. Although Chagas disease

remains rare in Arkansas, it is thought to

be under-recognized.

Chikungunya virus was first identified

in Tanzania in 1952. In the Kimakonde lan-

guage of Mozambique, chikungunya trans-

lates to “that which bends over” – a clear

reference to the stooped posture often ex-

hibited by patients who develop the dis-

ease’s classic manifestation of severe joint

pain. Since 2013, local transmission has

been identified in 44 countries or territories

in the western Hemisphere, including the

U.S., with more than 1.2 million suspected

cases reported to the pan American Health

organization from affected areas.

Chikungunya virus is transmitted by the

bites of infected female mosquitoes. These

mosquitoes can be found biting outside or

inside and throughout daylight hours, with

peaks of activity in the early morning and

late afternoon. Two of the mosquito species

that live in Arkansas have been shown to

successfully transmit the virus to humans,

but currently the virus is not endemic to

Arkansas.

Chikungunya can cause a debilitating

illness, most often characterized by fever,

headache, fatigue, nausea, vomiting, mus-

cle pain, rash, and joint pain. Acute chikun-

gunya fever typically lasts 7-10 days, but

as with dengue, west nile Virus, and other

arboviral fevers, some patients have pro-

longed fatigue lasting several weeks. Addi-

tionally, some patients have reported debil-

itating joint pain or arthritis which may last

from months to years. Chikungunya infec-

tion is thought to confer life-long immuni-

ty. Clinical laboratory findings can include

is more likely to cause high fever, severe ar-

thralgia, arthritis, rash, and lymphopenia,

while dengue is more likely to cause neu-

tropenia, thrombocytopenia, hemorrhage,

shock, and death. It is important to rule

out dengue because proper clinical man-

agement of dengue can improve outcomes.

Another emerging virus in the Americas

is the Zika virus. Zika is related to Yellow

Fever, Dengue, and west nile. It is spread

to people through mosquito bites. The most

common symptoms of Zika are fever, rash,

joint pain, and conjunctivitis. The illness is

usually mild, and symptoms last from sev-

eral days to a week. Severe disease requir-

ing hospitalization is uncommon.

outbreaks of Zika have occurred in Af-

rica, Southeast Asia, and the pacific Is-

lands. Because the species of mosquitoes

that spread Zika are found throughout the

world, it is likely that outbreaks will spread

to new countries. Zika is not currently

Contributing Authors: Sue Weinstein, DVM, MPH, State Public Health Veterinarian and Dirk Haselow, MD, PhD, State Epidemiologist

Some of the most concerning emerging pathogens in the U.S. and Arkansas

include Chagas Disease, Chikungunya virus, Dengue virus, and Zika virus.

lower the risk of medical complications

and death.

Symptoms of infection usually begin 4

- 7 days after the mosquito bite and typi-

cally last 3-10 days. Although dengue can

be transmitted through blood, organs, and

from mother to baby, in the vast majority of

infections, a mosquito bite is responsible.

It is important to note that both dengue

and chikungunya are transmitted by the

same mosquitoes and have similar clinical

features. The two viruses can circulate in

the same area and can cause occasional co-

infections in the same patient. Chikungunya

found in the United States; however, cas-

es of Zika have been reported in return-

ing travelers. recent outbreaks in the pa-

cific Islands and Brazil will likely increase

the number of Zika cases among travelers

visiting or returning to the United States.

These imported cases could result in lo-

cal spread of the virus in some areas of the

United States. There is no vaccine to prevent

or medicine to treat Zika. n


the flavor and texture of baked goods and

sweets and provides more stability in deep

frying at high temperatures than natural

polyunsaturated or monounsaturated fats.

A few years later (1911) Procter & Gam-

ble introduced Crisco vegetable shorten-

ing as the first manufactured food product

to contain trans fat. It was promoted as an

economical alternative to animal fats and

butter and over the years became a pantry

staple in homes across the country.

During World War II the fed-

eral government began ration-

ing butter in an effort to con-

trol supply and demand while

manufacturing plants were be-

ing used to support the war ef-

fort. As a result margarine, which

contains trans fat, became a popular

substitute for butter, driving trans fat even

deeper into everyday use.

This was followed by a movement, which

began in the 1980s, to limit fat in our diets.

Advocacy groups targeted fast-food chains

to remove saturated fat. The fast-food in-

dustry responded by increasing the use of

partially hydrogenated oils containing trans

fat. Despite the fact that, unlike other fats,

trans fats are neither required nor beneficial

for health, they were believed at the time to

HoW DID sometHInG so

bAD for our health become

so deeply ensconced in our

food supply? trans fat was

born for the sake of conve-

nience and in the name of

progress. The history of the

rise and fall of trans fat in the

American diet provides valuable insight

into unintended consequences and the need

for a shift in how we make policy decisions.

In 1903 scientist Wilhelm normann re-

ceived a patent for the process of convert-

ing unsaturated fatty acids into saturated

compounds. This chemical process changes

the molecular structure of fatty acids, in-

creasing product shelf life and decreasing

refrigeration requirements. The semi-solid

substance can be customized to enhance

We have known for some time that trans fat contributes to cardiovascular

disease. Research has shown that the main source of trans fat—partially

hydrogenated oils—is not as safe as we once thought. The Food and Drug

Administration (FDA) recently classified trans fat as a food additive and ruled

against its inclusion in our food supply. on June 18, 2018, following a three-

year compliance period, the era of trans fat will come to an end.

columnpolicy

The Era of Trans Fat ComEs To a ClosE and

ProvidEs a lEsson For FuTurE HEalTH PoliCy


be a healthier option to saturated fat.

During the 1990s several scientific stud-

ies revealed a new picture of trans fat. The

human body generally cannot metabolize

trans fat efficiently and the consumption of

trans fat was shown to raise LDL (bad) cho-

lesterol and lower HDL (good) cholesterol,

increasing the risk of coronary heart disease.

on a per-calorie basis, trans fats appear to

increase the risk of coronary heart disease

more than any other fat and pose a substan-

tially increased risk even in small amounts

(1 to 3 percent of total energy intake). In a

review article in the New England Journal of Medicine, researchers stated, “The evidence

and the magnitude of adverse health effects

of trans fatty acids are in fact far stronger on

average than those of food contaminants or

pesticide residues.”

In 2005 the U.s. Department of Agricul-

ture made a limited intake of trans fatty ac-

ids (below 1 percent of total energy intake)

a key recommendation of the new food-

pyramid guidelines and, in 2006, the Food

and Drug Administration implemented a

rule requiring manufacturers to list trans

fat content on nutrition labels. In 2007 new

York became the first city to ban the use of

partially hydrogenated vegetable oils and

spreads in restaurants, encouraging food

Joseph W. Thompson, MD, MPHDirector, Arkansas center for Health Improvement

trans fat consumption.

From a policy perspective we have had a

tendency, as in the case of trans fat, to accept

things as safe until they are proven harmful,

often ignoring future health consequences

altogether.

The obesity epidemic is a prime example.

The dramatic rise in obesity over the past

few decades is the unintended consequence

of societal change. our food is processed

for convenience and new technology de-

veloped in the name of progress has taken

over our leisure time. The result is higher

caloric intake and reduced physical activ-

ity. neighborhoods have been developed

without sidewalks, schools have been built

away from populations centers, communi-

ties have become unhealthy food deserts

and junk food oases.

Creating environments that promote

health instead of inadvertently encourag-

ing obesity requires that we stop and think

about the potential health effects of a plan,

project or policy before it is built or imple-

mented. The Public Health Institute and the

American Public Health Association have

termed this “Health in All Policies” and de-

veloped a guide for state and local govern-

ments in response to growing interest in us-

ing collaborative approaches to improve the

health of all people by incorporating health

considerations into decision making across

sectors and policy areas.

trans fat became deeply ensconced in

our food supply but once science caught

up with progress the alarm was sounded.

As a nation we found a way to intentionally

wean trans fat out of our diets. The alarm

has been ringing on the dire impact of obe-

sity on health. As a nation we must be as

intentional in solving the obesity epidemic

as we have been in bringing an end to the

era of trans fat. n

companies across the country to remove

trans fat from their products.

since the alarm was raised on trans fat,

American consumers have decreased their

trans fat intake from 4.6 grams per day in

2003 to about a gram a day in 2012. many

non-hydrogenated vegetable oils have be-

come available that have life spans exceed-

ing that of the trans fat-laden frying short-

enings. Alternatives include trans fat-free

vegetable oils such as olive, canola, soy,

corn, sunflower, safflower, and oils made

from other grains, nuts, and seeds. several

reformulated trans fat-free margarines and

shortenings are also now available, and food

manufacturers nationwide have reformu-

lated their products to contain less trans fats.

However, until the end of the three-year

compliance period, trans fat may still be

found in some foods. The most likely to in-

clude trans fat are products like frostings,

coffee creamers, microwave popcorn, pack-

aged pies, canned biscuits, frozen pizzas, and

some stick margarines. It’s a good idea to

check the nutrition facts label on the pack-

age to avoid the health risk associated with

“The most likely to include trans fat are products like

frostings, coffee creamers, microwave popcorn,

packaged pies, canned biscuits, frozen pizzas, and

some stick margarines.”


U.S. health care system. In order to achieve

this, we need to improve our payment struc-

ture by incentivizing quality and value over

volume, which requires the participation

of the entire health care community. This

spring, the Obama administration an-

nounced a commitment to increase value-

based purchasing nationwide to at least 30

percent by 2016 and 50 percent by 2018. This

effort was announced at the White House

and at Health and Human Services head-

quarters in Washington D.C. with Arkansas

representatives in attendance. Last month,

Medicare announced a new episode of care

for hip and knee surgery modeled largely on

the episode of care initiated by the Arkan-

sas payment improvement initiative. This

CMS program will share savings in costs

with hospitals in 75 counties throughout

the country on the total cost of providing

lowered joint arthroplasty surgery for the

preoperative, operative, and postoperative

Arkansas: On the forefront of APM innovation for public, private sectors

ArkAnSAS HAS been At tHe fOrefrOnt

of payment reform in the United States. Its

multi-payer payment improvement initia-

tive has been led by Medicaid, Arkansas blue

Cross blue Shield, and QualChoice over the

last four years. This effort received one of

the first State Innovation Model grants from

the federal government and has garnered

national attention for its successful bringing

to scale of innovative payment models such

as episodes of care and the patient centered

medical home (PCMH).

We want a better, smarter, and healthier

columnmedicaid

The latest estimates predict that health care spending will soon

approach 20 percent of the U.S. gross national product. This increasing

expenditure puts stresses on the entire economy as premiums, co-pays,

and taxes can barely provide sufficient revenue to cover service demand.

Most observers believe that payment systems need to evolve away

from a fee-for-service framework and move toward incentivizing better

outcomes and efficient care delivery through alternative payments

models (APMs). The end goal is to have providers assume greater

accountability for total cost of care in the process of providing services

and thus broaden the stewardship of health system resources to involve

providers, payers, and patients in the effort to bend the cost curve.


time periods of the patient journey.

In concert with these evolving payment

concepts, CMS has recruited payers, provid-

ers, and stakeholders throughout the coun-

try to work together to create, implement,

and expand the use of value purchasing

incentives into the healthcare marketplace

by establishing the Health Care Payment

Learning and Action network.

Some 4,000 entities have signed up to

participate in this learning action network,

including individual patients, insurers, pro-

viders, states, consumer groups, employers,

and other partners. This multi-stakeholder

effort will be led by a guiding committee

selected by CMS and its contractor Mitre.

Chaired by brookings Institution Direc-

tor Mark McClellan and former California

Healthcare foundation CeO Mark Smith,

the 24-person Guiding Committee is com-

prised of diverse healthcare leaders with

extensive experience in payment reform and

health system dynamics.

A LAn Partner is an organization that has

committed to specific targets that match or

exceed the established goals for accelerat-

ing APM adoption. A Partner also agrees to

work with the LAn and to measure and re-

port progress towards the goals it has set

for transitioning to a system that advances

quality and value over volume.

Over the next few years, this dynamic and

growing network of engaged stakeholders

will identify core concepts for dissemina-

tion and adoption by payers, providers, and

patients. It will support small work groups

to identify promising interventions and

frameworks for a sustainable health care

system. The groups will develop practical,

actionable, and operationally meaningful

recommendations that will address critical

barriers, and therefore align payers and ac-

celerate the adoption of APMs.

The first work group launched in July,

William Golden, MDArkansas medicaid medical Director

focused on developing common payment

reform terms and operational definitions,

which will lay the foundation for the LAn’s

work going forward. Additionally, the group

will develop an approach for measuring

progress toward achieving the LAn goals.

two more groups are expected to launch

this fall.

The guiding committee will meet monthly

in person or by phone to review progress by

the workgroups and national contractor and

recommend strategies for dissemination and

timely implementation of effective models

of reform. The LAn website – https://pub-

lish.mitre.org/hcplan/ – and a planned col-

laboration panel will provide relevant and

timely information, along with opportunities

for participants to contribute to and com-

ment on the work produced by the LAn.

I look forward to aiding in the transfor-

mation of health care in Arkansas and across

the nation and sharing that here. n

e

In concert with these evolving payment concepts, CMS has recruited payers, providers, and stakeholders throughout the country to work together to create, implement, and expand the use of value purchasing incentives into the healthcare marketplace by establishing the Health care Payment Learning and action Network.

Arkansas Medicaid Medical Director Dr. William Golden recently began working with CMS and a small group of national leaders to identify payment models and reforms that will lead to better care at lower costs, something Arkansas has been on the forefront of accomplishing.

In the coming months, this 24-member guiding committee – comprised of providers, purchasers/employers, consumers/patients and government representatives – will identify priorities for the Health Care Payment Learning and Action Network and begin laying out a strategy to modernize state and national programs.


The push to get everyone ready for ICD-10

implementation by Oct. 1 has been manag-

er of provider relations Amelia Rich-Elam’s

priority throughout the summer and fall at

town hall meetings and training opportuni-

ties across the state.

Much of AFMC’s outreach targets prac-

tice transformation, led by Rhelinda McFad-

den. One aspect of practice transformation,

patient-centered medical homes (PCMH),

is a team-based, care-delivery model, led

by primary care physicians who compre-

hensively manage Medicaid patients’ health

needs. This year, our provider reps, work-

ing in every county in Arkansas, established

95 PCMH agreements, covering 120 loca-

tions. These include 500 physicians who

are treating 200,000 Medicaid beneficiaries.

That’s 67 percent of total Arkansas Medicaid

beneficiaries.

PCMH, along with the episodes of care

(EOC) initiative are part of Arkansas’ Health

Care Payment Improvement Initiative (APII).

APII and practice transformation demon-

strate the new direction in U.S. health care

and Arkansas has become a national leader

in these efforts. Medicare is now showing in-

terest in paying for EOCs. Additionally, four

health insurance companies are now paying

PCMH practices an additional per beneficiary,

per month amount.

AFMC uses a variety of outreach methods

because every Arkansas medical practice is

different. Outreach includes face-to-face site

visits, conference calls, e-blast campaigns,

conferences, exhibits, town hall meetings,

participation in stakeholders’ events and

committees, mail and email, Internet por-

tals, virtual office visits, collaborative on-site

networking, surveys, advertising, blogs, and

other social media posts.

It is AFMC’s credibility and the personal

touch our staff adds to outreach that makes

the difference. Providers have come to rely

on AFMC to provide timely updates, train

them on industry best practices, and supply

cutting-edge technical assistance and data

analysis.

These examples illustrate the range of

AFMC’s outreach efforts:

n Individualized provider relationsThe majority of AFMC’s outreach respon-

sibilities to the Medicaid population flow

through our provider relations department.

columnquality

AFMC Reaches Out to Improve

Health Care

If I had only one word to describe the work of the Arkansas Foundation

for Medical Care (AFMC), it would be outreach. Sustained and wide-

ranging outreach over many years has made AFMC a leader in improving

health care and improving the lives of all Arkansans.


incentive program now qualify for services.

Medicaid-eligible professionals include MDs,

Doctors of Osteopathy, specialists, dentists,

nurse practitioners, certified nurse midwives,

and physician assistants, as defined by the

Centers for Medicare & Medicaid Services.

AFMC HealthIT services include:

• Education on MU and EHR incentives

• Vendor selection and management

• Project management and workflow

design

• Functional interoperability and health

information exchange training

• HIPAA security risk analysis

• Patient engagement and patient portal

implementation strategies

The state of Arkansas has contracted with

AFMC to provide Medicaid-eligible profes-

sionals with the technical assistance needed

to achieve and sustain MU of their certified

EHR technology and providing strategies for

increased patient and family engagement in

their health care. This work supports Arkan-

sas’ ongoing transformation efforts. By suc-

cessfully achieving MU, providers can use

data from their certified EHR technology to

participate in practice transformation ini-

tiatives and prepare for value-based pay-

ment models, identify and treat patients with

chronic diseases and incorporate preventive

measures for high-risk patients. AFMC Heal-

thIT will also provide MU attestation assis-

tance and HIPAA security risk analyses for

up to 25 critical access and rural hospitals.

AFMC HealthIT also provides MU techni-

cal assistance under consulting agreements

to Arkansas’ Medicare-eligible profession-

als and eligible professionals in Mississippi.

The Arkansas Department of Health funds

our chronic disease initiative with 15 prac-

tices to reduce hypertension and prevent

type 2 diabetes.

Funded by a private partnership with

Aledade, AFMC HealthIT’s outreach helps

Ray HanleyPresident and cEo,

Arkansas Foundation for medical care

practices in both Arkansas and Mississippi

participate in ACOs.

n Continuing quality improvementAFMC’s strong reputation for quality im-

provement continues as part of a quality

improvement network (QIN) under the re-

gional umbrella of TMF Qin-QIO. Under the

11th Scope of Work, we are focusing on im-

proving care for the Medicare population in

these areas:

• Improving cardiac health and reducing

cardiac disparities

• Reducing disparities in diabetes care

• Improving prevention coordination

through MU

• Reducing healthcare-associated infec-

tions in hospitals

• Reducing healthcare-acquired condi-

tions in nursing homes

• Coordination of care, medication safety

and preventing adverse drug events

Under the value-based payment, quality

reporting, and the physician feedback report-

ing program:

• Improving Medicare beneficiary immu-

nization rates

• Identifying depression and alcohol use

disorder in primary care and care transitions

for behavioral health

Much of this work requires direct technical

assistance to providers, physician practices,

home health agencies, nursing homes, hospi-

tals, and community stakeholders. Training,

n Health information technologyAFMC’s HealthIT department, directed by

Marq Walker, focuses its outreach in four

areas:

• Achieving and sustaining Meaningful

Use (MU)

• Recruiting providers for the no-cost

Medicaid MU technical assistance contract

• Educating providers and patients to bet-

ter manage chronic diseases

• Increasing participation in Medicare’s

shared-savings programs through affiliation

with Aledade, a national accountable care

organization (ACO)

Since 2010, the team has helped Medicare

and Medicaid-eligible physicians achieve

and sustain MU. This work has helped cre-

ate the infrastructure needed for health

care data exchange, outcomes analysis, and

quality improvement. MU defines the mini-

mum standards for using electronic health

records (EHR) and for exchanging patient

clinical data between providers, insurers,

and patients.

Additionally, Medicaid-eligible health care

professionals who previously did not qualify

to receive subsidized services under the EHR

“Providers have come to rely on AFMC to

provide timely updates, train them on industry

best practices, and supply cutting-edge technical assistance and data analysis.”


columnquality

including peer educators, and learning and

action networks, is also a key part of the suc-

cess of our quality improvement outreach.

n Quality of hospital careThe Inpatient Quality Incentive (IQI) pro-

gram is a voluntary Arkansas Medicaid pro-

gram offering performance bonus payments

to hospitals that improve the quality of pa-

tient care according to Arkansas Medicaid’s

clinical priorities. More than $30 million has

been paid to Arkansas acute care hospitals

since the IQI program began.

Our quality improvement team works with

all acute care hospitals, with the exception

of pediatric, rehabilitative, inpatient psychi-

atric, critical access, and teaching hospitals.

We are especially proud of the progress our

outreach work has produced over the past

five years in these areas:

• 92 percent reduction in early elective

delivery

• Increased number of new mothers who

breastfeed

• Decreased premature births

• 130 percent increase in hospital-provid-

ed smoking cessation treatment.

The Medicaid Quality Improvement (MQI)

outreach team provides evidence-based edu-

cation on specific quality improvement proj-

ects that help prevent illness, injury, disability,

and death for Arkansas Medicaid beneficia-

ries. Methods include face-to-face academ-

ic detailing for clinics, hospitals, physicians,

healthcare providers, helping them imple-

ment quality improvement projects into their

practice. Some of our successes include:

• Increased breastfeeding rates by 7 per-

cent over the past three years

• Decreased premature births

• Decreased opioid prescribing for non-

malignant pain by an average of nearly 20

percent

• Decreased radiation exposure by de-

creasing unnecessary abdominal CT scans

center. NET is a Medicaid waiver program

that provides Medicaid beneficiaries with

non-emergency transportation to medical

services.

The NET team’s outreach starts with ei-

ther the NET Helpline or Beneficiary Griev-

ance Hotline. Most callers just need the NET

Helpline, which provides information about

how they’ll get to and from their medical ap-

pointments. The Beneficiary Grievance Hot-

line, which serves all Medicaid beneficiaries,

works to resolve beneficiaries’ problems and

includes information about the appeals and

fair hearing processes.

We are especially proud of our new cus-

tomer service center for Medicaid benefi-

ciaries. The center includes both a toll-free

line for assistance and a separate line for

complaints. The assistance line is limited to

beneficiaries on the private option or origi-

nal Medicaid, but the complaint line is for

all beneficiaries.

The center’s 10 customer service repre-

sentatives can also act as a liaison between

the DHS county offices and the beneficiary.

Funded by Medicaid, the center’s staff field

an average of 3,200 calls per month, escalat-

ing to more than 5,000 calls per week during

open enrollment. A strong working relation-

ship with stakeholders at the DHS Division of

County Operations, the Arkansas Insurance

Department, Hewlett-Packard, DHS Division

of Medical Services, and ConnectCare is an

important factor in the center’s success. n

• Increased provider participation in the

Prescription Monitoring Program

• All projects include evidence-based

medicine, recommended guidelines, strat-

egies for success, resources, tools and free

materials that can be ordered by any orga-

nization, clinic or hospital.

n Long-term careThe phenomenal success of AFMC’s popular

Arkansas Innovative Performance Program

(AIPP) is due to the quality and individual

nature of its outreach. Designed to enhance

the quality of care and quality of life for nurs-

ing home residents, the AIPP team provides

more than 1,000 onsite consultations a year.

They offer training and/or assistance to staff

and administrators in all 226 Arkansas nurs-

ing homes on the long-term care industry’s

best practices, and federal and state regu-

lations. AIPP staff develops and monitors

the implementation of specific solutions to

deficiencies that are identified during state

surveys conducted by the Arkansas Depart-

ment of Human Services’ (DHS) Office of

Long Term Care.

AIPP hosts frequent networking opportu-

nities, and sponsors conferences and training

opportunities to share best practice solutions.

These opportunities draw staff from all areas

of long-term care – nursing homes, assisted

living facilities, home health care, human de-

velopment centers, and hospital staff.

Funded by Medicaid, all AIPP services

are voluntary, confidential, and provided at

no cost to nursing homes. The 12-member

AIPP team includes registered nurses, CNAs,

long-term care administrators, and statis-

ticians, all of whom have direct long-term

care experience.

n Beneficiary outreachTwo of our outreach programs work with

Medicaid beneficiaries: Non-emergency

transportation (NET) and the customer care

hospital


roundsh o s p i ta l n e w s & i n f o r m at i o n

From adding an on-campus farmers market to revamping cafeteria menus to include

leaner choices with lower prices, Baptist Health is putting its weight behind many

new programs to help its employees and visitors lead healthier lifestyles.

“We seek to be an organization that’s about health and not just health care,” said

Troy Wells, Baptist Health president and CEO. See story on page 62

BapTisT HEalTH Tips sCalEs FOr HEalTHiEr liFEsTylEs

local chef Donnie Ferneau

gives a demonstration on preparing healthy menu

options.

HospitalRounds

Baptist health holds topping-out Ceremony Baptist health held a topping-out ceremony this

summer on the 37-acre site in Conway to mark the

completion of the main steel structure for Baptist

health medical Center-Conway. Baptist health

president and Ceo troy wells, civic leaders, com-

munity members, local physicians, and Baptist

health employees celebrated this milestone for

the 111-bed hospital located on the west side of

interstate 40 in Conway.

since construction began, the hospital has

already increased in size to 264,000-square-foot

and is now 111-beds after the expansion of the

women’s Center added labor and delivery. the

medical center is still on track to open in the

spring of 2016 with eight operating rooms and a

level iii trauma-center emergency room.

Baptist health collaborated with some 30 Con-

way-based physicians to design and develop the

new medical center.

employees throughout the Baptist health sys-

tem as well as the community had an opportunity

to personally sign their names on the beam that

was used in the topping-out ceremony.

the construction project has generated more

than 250 jobs and currently Baptist is working to

hire the 425 healthcare professionals and staff that

will work in the Conway medical center.

the estimated cost of the entire project is now

at $170 million. Gsr andrade is providing archi-

tectural design services and CDi is the General

Contractor.

FaRE Names aCh as Center of Excellence food allergy research & education (fare), the

leading nonprofit organization working on behalf

of the 15 million americans with food allergies,

has announced the establishment of the fare

Clinical network. the network is an initiative that

aims to accelerate the development of drugs for

patients with food allergies as well as improve the

quality of care for this serious illness. fare will

initially fund 22 centers of excellence, including

arkansas Children’s hospital, with an investment

of over $2 million dollars annually.

Under fare’s leadership and coordination,

fare Clinical network members will serve as

sites for clinical trials for the development of new

therapeutics and will develop best practices for

the care of patients with food allergies. the fare

Clinical network will serve as a powerful driver of

collaboration to advance the field of food allergy,

with member centers contributing to the devel-

opment of a national food allergy patient registry

and biorepositories.

arkansas Children’s hospital research institute

will participate as a clinical network site. stacie

Jones, mD, chief of allergy and immunology at

aCh, will serve as the site director.

NpMC announces 2015 Junior Volunteersnational park medical Center’s annual junior vol-

unteer summer service program welcomed 24

area teens as the program kicked off this summer.

the junior volunteer program, which ran through

august 7, is designed to help area students learn

more about the healthcare industry and to give

them real-life workplace experience.

this year’s junior volunteers were hannah

reeves, whitney Caldwell, ashleigh andres, trin-

ity Dooley, malena mcCoy, Deshala Golden, syd-

ney lee, Brittany Dooley. second row: sydney

Couch, ayania hicks, Kajal Bharany, riddhi modi,

Carissa Crumpton, mallory Burgess, savanah mat-

thews, autumn Donley, Caroline tankersley, evan

morgan, amy singleton, Clayton threadgill, Kevin

Kowalkowski, alexis smith, and Colton Guill.

the volunteers worked in various hospital

departments, both medical and non-medical in

nature. tasks include support services for both

patients and employees.

healthsouth, Chi st. Vincent partner on Rehab hospital healthsouth Corporation and Chi st. Vincent

hot springs, a Catholic health initiatives’ hospi-

tal, have signed an agreement to jointly own and

operate a 40-bed inpatient physical rehabilitation

hospital in hot springs, arkansas.

initially, the joint venture will own and oper-

ate the 20-bed inpatient rehabilitation unit cur-

rently located on the campus of Chi st. Vincent

hot springs at 300 werner street. the unit will

be immediately expanded to 27 beds and will

continue to serve patients with needs for intense

physical rehabilitation. the unit will be named Chi

st. Vincent hot springs rehabilitation hospital, an

Baptist HealtH Holds topping-out Ceremony



affiliate of healthsouth.

the joint venture partners expect to relocate

the inpatient rehabilitation unit to a new 40-bed

hospital located at 1636 higdon ferry road in hot

springs in the second quarter of 2016. the new

state-of-the-art hospital will provide comprehen-

sive, inpatient physical rehabilitation to patients

who have experienced stroke, trauma, brain injury,

complex orthopedic conditions, as well as other

major illnesses or injuries.

North Metro Medical Center Joins aR saVEsnorth metro medical Center in Jacksonville has

partnered with the University of arkansas for med-

ical sciences (Uams) to provide life-saving emer-

gency care for stroke patients in the region.

Called ar saVes (arkansas stroke assistance

through Virtual emergency support), the program

uses a high-speed video communications system

to help provide immediate, life-saving treatments

to stroke patients 24 hours a day. the real-time

video communication enables a stroke neurolo-

gist to evaluate whether emergency room physi-

cians should use a powerful blood-clot dissolving

agent within the critical three-hour period follow-

ing the first signs of stroke.

the ar saVes program is a partnership

between the Uams Center for Distance health,

the state Department of human services, north

metro medical Center and 47 other arkansas

hospitals.

since the program began nov. 1, 2008, more

than 2,791 patients have received stroke consults

through ar saVes and 751 patients have received

the blood-clot dissolving agent.

forty-seven other arkansas hospitals are partici-

pating in the ar saVes program. the ar saVes

program will continue adding hospitals across

arkansas in the coming months, said Curtis low-

ery, mD, director of the Uams Center for Distance

health.

Chi st. Vincent health at home Expandspetit Jean home Care in morrilton and Visiting

nurse association of arkansas in little rock are

now Chi st. Vincent health at home. as part of

the Chi st. Vincent family, this alignment will cre-

ate a stronger, more unified structure as Chi st.

Vincent continues to care for patients and build

healthier communities throughout arkansas.

in november 2014, the Chi st. Vincent health

at home brand was launched with the opening of

Chi st. Vincent hot springs. Chi st. Vincent is com-

mitted to move beyond exceptional medicine to

exceptional health. this alignment of home health

services will allow for greater coordination of home

care services across the entire healthcare system.

Chi st. Vincent health at home has three loca-

tions, serving all of central arkansas at 220 mcau-

ley Ct. in hot springs; 1 executive Center Court in

little rock; and 2110 helicopter lane in morrilton.

Cardiologist Joins Chi st. Vincent heart Clinic arkansasYalcin hacioglu, mD, cardiologist, is currently

accepting appointments at Chi st. Vincent heart

Clinic arkansas at 10100 Kanis rd. in little rock. his

specialties are interventional and nuclear cardiology.

hacioglu is a graduate of the University of

arkansas for medical sciences where he earned

a fellowship in cardiology. he also earned a fellow-

ship in cardiac Ct at harbor-UCla medical Cen-

ter in torrance, Calif. hacioglu holds Diplomate

Certification in nuclear cardiology, echocardiogra-

phy, echocardiography in adult transthoracic plus

stress echocardiography, cardiovascular disease,

and cardiovascular Ct.

he is a member of the american College of

Cardiology, american society of echocardiogra-

phy and the society of Cardiovascular Computed

tomography.

UaMs Receives 2015 Most Wired awardthe University of arkansas for medical sciences

(Uams) medical Center recently became the only

arkansas hospital to earn the 2015 most wired

award from the american hospital association

health forum and the College of healthcare infor-

mation management executives (Chime).

roxane townsend, mD, Uams medical Center

Ceo, said healthcare teams are using improved

access to accurate data to identify areas to improve

care and measure the success of medical interven-

tions. “in addition, the online patient portal has

been enthusiastically embraced by our patients

and families to access information and communi-

cate with their care team,” townsend said.

NpMC offers New treatment for paDnational park medical Center is the first hospital

in the hot springs region, and one of only two

hospitals in the state of arkansas to offer a new

minimally-invasive procedure to treat peripheral

artery disease (paD) in the upper leg. Drug-coated

balloons are a new type of medical device used to

treat paD in the upper legs once medical manage-

ment has failed. the first procedure at national

park medical Center was performed by interven-

tional radiologist, Dr. lonnie wright, in June.

Drug-coated balloons are designed to help

restore blood flow by reopening blocked arter-

ies and delivering a medication to the artery wall

that clinical studies have shown helps keep the

artery open longer than other available therapies.

npmC has chosen to use the in.paCt admiral

drug-coated balloon by medtronic because it has

demonstrated excellent results in the treatment

of paD in the upper legs.

Chi st. Vincent Celebrates opening of West pavilion iithe grand opening of Chi st. Vincent west pavil-

ion ii was held in July at 16115 st. Vincent way,

little rock. this second pavilion, at the intersec-

tion of Chenal parkway and st. Vincent way in

little rock, is home to new 3D mammography.

Chi st. Vincent west pavilion ii also includes a

full-service outpatient imaging center with mri,

Ct, Ultrasound and X-ray, family dentistry, and a

pharmacy.

Expansion Means New Namea celebration was held this summer in honor of

Baptist health schools’ advancement and new

name. the community, Baptist health employ-

ees, current students, and alumni attended the

celebration at the newly named Baptist health

College little rock.

along with the expansion of its student body

and academic offerings, the school has been tran-

sitioning from a diploma-granting institute to a

degree-conferring college over the last few years.

on July 1 that transition was complete when Bap-

tist health schools little rock officially became

Yalcin hacioglu, mD


HospitalRounds

Baptist health College little rock.

initially, degrees will be offered in the school of

nursing to about 600 students. those graduating

will now receive an associate degree instead of a

diploma.

students can choose from nine programs of study

including practical nursing and registered nursing

and the allied health fields of histotechnology, med-

ical laboratory science, nuclear medicine technol-

ogy, radiography, occupational therapy assistant,

sleep technology, and surgical technology.

hematologist/oncologist Joins UaMsa. naidu sasapu, mD, a fellowship-trained hema-

tologist/oncologist, has joined the winthrop p.

rockefeller Cancer institute at the University of

arkansas for medical sciences (Uams). he sees

patients in the medical oncology Clinic and spe-

cializes in treating lymphomas, leukemias, and

other hematological disorders, including bone

marrow transplantation.

sasapu is an assistant professor in the Uams

College of medicine Division of hematology/

oncology and a graduate of the three-year Uams

hematology/oncology fellowship program.

sasapu is certified by the american Board of

internal medicine and is a member of the ameri-

can College of physicians, american medical

association, american society of Clinical oncol-

ogy, and american society of hematology.

tucker Joins surgery specialists of hot springssurgery specialists of hot springs has welcomed

general surgeon, Dr. James “J.J.” tucker, to the

practice at 1900 malvern avenue in hot springs.

Dr. tucker joins Drs. Breving, latham, and martin.

Dr. tucker is practicing a full scope of general

surgeries, including advanced laparoscopic gas-

trointestinal surgeries, Bariatric surgeries, colorec-

tal surgery, breast surgery, endocrine surgery, liver

resection, fistula and port placement, reflux, acha-

lasia and upper Gi surgery, esophageal surgery,

and endoscopy.

Chi st. Vincent acquires Conway interfaith Clinic the sharing of similar visions, to care for the poor

and vulnerable, has led to a change of ownership

at Conway interfaith Clinic. the clinic is now Chi

st. Vincent interfaith Clinic. the transfer was com-

pleted July 6, 2015.

the Conway clinic has experienced a steady

decline in the number of patients who need free

healthcare. “the affordable Care act now pro-

vides health insurance to the previously uninsured

who once received free care at the clinic,” said

David foster, president Chi st. Vincent medical

Group. services will still be available to those who

now have medicare, medicaid, other health insur-

ance or no health insurance.

Conway Cafeteria offering arkansas Grown Foodsthe Conway regional medical Center Cafeteria

has begun offering arkansas grown produce to

visitors and staff.

the produce, which is available on the salad bar

and on other food lines, is identified by a label

that says “arkansas Grown” and also indicates

where the farm is located. so far, produce has

been received from farms in wynne, monticello,

and tupelo.

“our produce vendor, Us foods, is contracting

with farmers in state to provide the produce,” said

scott whitehurst, director of nutritional services.

“it’s a great way to support arkansas farmers while

eating nutritious food.”

produce that is available will depend on the

growing cycle.

hip and Knee surgeon Joins UaMs orthopaedics hip and knee surgeon simon C. mears, mD, phD,

has joined the University of arkansas for medi-

cal sciences (Uams), and will see patients at the

Uams orthopaedic Clinic at #2 shackleford west

Boulevard.

mears is also a professor in the Department of

orthopaedics in the Uams College of medicine.

he is a board-certified orthopaedic surgeon with

special interests in total hip and knee replace-

ment, hip fracture care, and geriatric orthopae-

dics. mears has won the prestigious Jahnigen

award in geriatric medicine.

he comes to Uams from the total Joint Cen-

ter at Baylor regional medical Center at plano,

texas, where he served as clinical professor in the

Department of surgery at the health sciences

Center in the texas a&m University’s College of

medicine. previously, he practiced at Johns hop-

kins University in Baltimore for 10 years as an assis-

tant and associate professor. he served as chair-

man of orthopaedic surgery at the Johns hopkins

Bayview medical Center. mears was also founder

and co-director of the hip fracture service at the

Bayview medical Center from 1998-2013, and

medical director of the wenz orthopaedic Unit

from 2005-2013.

Williams selected to social Worker leadership academyJulie williams, social worker at national park med-

ical Center’s senior Care unit, has been selected

by the arkansas chapter of the national associa-

tion of social workers (nasw) to participate in the

inaugural nasw arkansas leadership academy.

the nasw, which is the largest membership

organization of professional social workers in the

world, works to enhance the professional growth

and development of its members, to create and

maintain professional standards, and to advance

sound social policies. the arkansas chapter’s lead-

ership academy aims to identify and develop lead-

ers who will act as positive change agents for the

field of social work and their respective agencies.

Baptist health tips scales for healthier lifestyles from adding an on-campus farmers market to

revamping cafeteria menus to include leaner

choices with lower prices, Baptist health is put-

ting its weight behind many new programs to help

its employees and visitors lead healthier lifestyles.

“we seek to be an organization that’s about

a. naidu sasapu, mD

simon C. mears, mD, phD



health and not just health care,” said troy wells,

Baptist health president and Ceo.

as part of Baptist health’s participation in the

national healthier hospital initiative (hhi) and

the implementation of its Bhealthy campaign,

the healthcare system has started several unique

programs and opportunities for its employees

and visitors.

the first opportunity began about two years ago

when Baptist health partnered with heifer Usa

and nearby st. Joseph farm to use local produce

in the little rock cafeteria. the relationship with

heifer expanded this year to include participation

in heifer Usa’s Community supported agriculture

(Csa) project. through Csa, employees pay a rea-

sonable fee and in return receive about 6 to 10

pounds of arkansas grown produce each week

for 18-weeks. items have included everything from

fresh fruits and vegetables to harvested nuts and

honey. through the Csa program, employees not

only enjoy wholesome fresh staples, but they also

support small, local farmers by participating.

in addition to the weekly produce deliveries,

the healthcare system has organized and now

holds a farmers market on the little rock campus.

about eight to 10 farmers from central arkansas

come each tuesday from 7 a.m. to 1 p.m. to sell

loads of tomatoes, okra, peppers, squash, water-

melons, cantaloupes, peaches, eggs, and more.

the Bhealthy farmers market, which is open to

employees, hospital visitors and the commu-

nity, will continue through october. the market

expanded to Baptist health medical Center-north

little rock in July.

But even with the availability of nutritious fruits

and vegetables, sometimes people need help

learning how to prepare healthy meals. Baptist

health chef len thompson and local chef Donnie

ferneau use the produce from the Csa program

and the farmers market to illustrate to others how

easy it is to prepare healthier meals for themselves

and their families.

in addition, if employees want to eat healthier,

but are not thrilled about cooking for themselves,

they can now purchase prepackaged single-serve

to-go meals from Good food by ferneau. Deliv-

ered weekly to the little rock campus, the deli-

cious meals include locally grown vegetables and

meats all prepared in a healthy way by ferneau.

as the healthier choices and eat-local move-

ment continues to gain momentum throughout

the healthcare system, employees and guests will

start seeing differences in all the Baptist health

cafeterias. as part of the Bhealthy campaign,

cafeterias will be adding educational signage and

materials, introducing a new pricing strategy that

benefits those who choose healthier food items

and incorporating whole grains, all trans-fat free

products and the use of some free-range and anti-

biotic-free meats.

hhi is the brainchild of health Care without

harm (hCwh), the Center for health Design and

practice Greenhealth, commissioned by more

than 490 hospitals from 12 of the largest health-

care systems across the nation. hospitals partici-

pating in hhi have committed to reach certain

leadership goals; encourage better eating prac-

tices and food choices; become sustainability

stewards through recycling, waste reduction, and

food waste reduction; and identify resources to

achieve these goals.

Conway Regional, Chi st. Vincent announce partnershipthis summer, the boards of directors of Conway

regional health system (Conway regional) and

Chi st. Vincent announced that the two health

systems have signed an agreement whereby Con-

way regional enters into a five-year management

agreement with Chi st. Vincent. Under the agree-

ment, effective august 17, each health system will

retain its name, governance, and autonomy. this

agreement comes after months of discussions

between the two organizations, the final phase

of a process that began in late 2013 when Con-

way regional’s board announced they were seek-

ing a strategic affiliation partner to ensure that

Conway regional will be well positioned to con-

tinue providing access to high quality healthcare

Baptist HealtH tips sCales for HealtHier lifestyles


hospitalRounds

services for faulkner County and the north central

arkansas area.

as a result of these discussions, the two com-

panies also announced the formation of a new

corporate entity called the arkansas health alli-

ance. Jim lambert, president and Ceo of Conway

regional, will become president of the arkansas

health alliance. the alliance will be the only orga-

nization of its kind in arkansas designed to help

independent community hospitals and health-

care systems lower their costs while achieving a

level of clinical integration and coordination of

care to promote more accessible, higher quality

and lower cost care for the communities served

by alliance members.

Esteva Joins Chi st. Vincent Family Clinic Universityirina esteva, mD, is currently accepting new

patients at Chi st. Vincent family Clinic University

at 4202 s. University ave., little rock. her specialty

is family medicine.

esteva completed her residency at the Univer-

sity of arkansas for medical sciences southwest

regional Center, texarkana.

aCh announces New hospital in springdalearkansas Children’s hospital plans to build a new

hospital campus in springdale. the campus will

be built on 37 acres donated by David and Cathy

(George) evans, Gary and robin George, and their

families. this gift represents a historic investment

in the future of pediatric healthcare in arkansas.

the springdale campus is part of aCh’s broader

plan to expand pediatric services across arkan-

sas. the first step in improving access to care

was marked by the arrival of two new angel one

helicopters earlier this summer. the second step

in developing the new aCh statewide system is

the planning of a 24-bed pediatric hospital on the

campus in springdale, arkansas. aCh will detail

additional plans for expanded services across

arkansas throughout the coming months.

the state-of-the-art hospital will sit on a 37-acre

campus located on i-49 between Don tyson park-

way and highway 412, bordered by s. 56th street

and watkins avenue across the street from arvest

Ballpark.

the proposed 225,000-square-foot facility will

include:

•24 inpatient beds

•Emergency Department/Urgent Care Center

with 21 exam rooms

•30 Clinic exam rooms

•Five Operating rooms

•Imaging capabilities (MRI, CT and routine x-ray)

•Diagnostic services (infusion, PFT, EEG, echo,

neurophysiology, audiology, rehabilitation)

•Helipad with refueling station

with the proposed site location, 70% of north-

west arkansas residents will be able to reach

aCh’s services within 30 minutes or less.

Conway Regional therapist achieves Board Certification sarah Conley, pt, Dpt, of Conway recently

became board-certified as a women’s health

Clinical specialist (wCs) through the american

physical therapy association (apta). she is one

of the only treating therapists in arkansas certified

to attain this prestigious specialization.

Conley is the managing supervisor and treating

physical therapist at Conway regional therapy

Center-specialty Clinic in Conway. the specialty

Clinic specializes in the rehabilitation of the pel-

vic floor muscles and other women’s health issues

such as pain during sexual intercourse, pain after

episiotomy/laceration, post mastectomy and

breast surgery, and scar tissue management.

Conley will be recognized by the apta at an

awards ceremony in anaheim, California in feb-

ruary, 2016.

More than 200 Complete Residency at UaMsmore than 200 physicians recently completed their

medical residencies at the University of arkansas

for medical sciences (Uams), with more than 100

choosing to practice in state and alleviate the

growing physician shortage.

Uams has historically kept a high number of

physicians in state after completing their resi-

dencies. according to the latest figures from the

american association of medical Colleges, from

2004 to 2013, only seven other states had higher

retention rates.

on June 30, 214 medical residents completed

training at Uams’s main campus and its regional

centers in their chosen medical specialties with

more than 50 different specialties represented.

of the 214, 56 are family medicine residents,

with 33 of those remaining in arkansas. seven of

those stayed in small towns.

physician retention is a goal of the Uams Col-

lege of medicine when it selects residents for

training.

about 80 percent of College of medicine

students are in-state. some graduates who leave

the state for fellowships after their residencies

return to arkansas within five years, said James

Clardy, mD, the college’s associate dean for Grad-

uate medical education.

irina esteva, mD

Zac henley, mD

mark Viegas, mD

matt troup


more than half the family physicians in arkansas

were trained through Uams residencies in little

rock and its regional centers throughout the state.

Currently 758 family practice physicians trained

by Uams are practicing in 69 of the state’s 75

counties.

pediatrician Joins Chi st. Vincent hot springsZac henley, mD, is currently accepting patients

at Chi st. Vincent pediatric Clinic at 225 mcauley

Court, hot springs. henley completed his resi-

dency and internship in pediatrics at the University

of arkansas for medical sciences.

he is board certified in pediatrics by the ameri-

can Board of pediatrics. he is a member of the

american academy of pediatrics and the ameri-

can medical association.

troup Named president Conway Regional health systemmatt troup, former Vice president of ancillary and

support services for Chi st. Vincent in little rock,

is now president & Ceo Conway regional health

system in Conway. troup joined Conway regional

as part of a five-year management agreement

between the two health systems to insure that

Conway regional will be well positioned to con-

tinue providing access to high quality healthcare

services. it services faulkner county and north

central arkansas.

prior to his role as Vice president, ancillary ser-

vices at Chi st. Vincent, troup was Chief oper-

ating officer (Coo) and site administrator at

holmes regional medical Center in melbourne,

fla. providing strategic and operations oversight

for the hospital and trauma center.

troup’s 20-year healthcare career includes serv-

ing as Coo at hillcrest medical Center, tulsa,

okla. he served in multiple roles at texas health

resources in Dallas; was president of texas health

presbyterian of winnsboro; Vice president of

operations for texas health presbyterian in Dal-

las; and Vice president for methodist health sys-

tem, Dallas.

UaMs Welcomes First Dental Residentsthe University of arkansas for medical sciences

(Uams) welcomed in July its first two resident

dentists, who will provide dental care to patients

as part of a yearlong postgraduate dental resi-

dency program.

ashley mcmillan, DDs, a little rock native, and

michael Dienberg, DDs, of racine, wisconsin,

were selected for the residency program hosted

by the Center for Dental education in the Uams

College of health professions. residents will

receive 12 months of advanced education from

faculty dentists while providing dental care at

Uams, arkansas Children’s hospital, the student-

led Uams 12th street health and wellness Cen-

ter, and the harmony health Clinic in little rock.

in the Uams clinic, dental residents will join

clinic staff that includes faculty dentists, registered

dental hygienists, and registered dental assistants.

highlighting the interprofessional aspect of the

residency, the dental residents attended Uams

orientation alongside medical residents.

the dental residents also will complete two-

week rotations in medical programs including

anesthesiology, emergency medicine, internal

medicine, and otolaryngology along with a four-

week rotation at arkansas Children’s hospital.

the rotations are in addition to seeing patients

in a hospital operating room who cannot be seen

in the oral health clinic, typically due to medical

reasons.

the program will expand to six resident dentists

per year after the first year.

Viegas Joins Chi st. Vincent Clinic Midtownemark Viegas, mD, is currently accepting new

patients at Chi st. Vincent medical Clinic mid-

towne at 1100 north University, suite 1, little rock.

Viegas is a graduate of the University of arkan-

sas for medical sciences in little rock, where he

earned his medical degree and completed his

residency. his specialty is family medicine.

arkansas Children’s hospital Earns stage 6 Recognitionarkansas Children’s hospital has achieved stage 6

of the himss analytics electronic medical record

(emr) adoption modelsm (emram). stage 7 is

the highest level attainable. Currently, 1,297 hos-

pitals (23.6 percent) in the United states, includ-

ing aCh, carry a stage 6 designation, higher than

3,972 other hospitals in the nation and Canada.

the recognition was announced by aCh Vice

president of information technology applications

mike hart, Bsn, ms, rn-BC.

himss analytics developed the emr adoption

model in 2005 as a methodology for evaluating

the progress and impact of electronic medical

record systems for hospitals in the himss ana-

lytics™ Database. tracking their progress in

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timeline resources

SourceS:Lesley rotchford, Diets through history: The good, the bad and the scary, Health.com, updated February 8, 2013, http://www.cnn.com/2013/02/08/health/diets-through-history/index.htmlrene Lynch, A brief timeline shows how we’re gluttons for diet fads, LA Times Health & Fitness, February 28, 2015, http://www.latimes.com/health/la-he-diet-timeline-20150228-story.htmlThe Weirdest, craziest Fad Diets of All Time, refinery 29, http://www.refinery29.com/fad-diets#slide-1Vanessa rodriguez, eleven Weirdest Diets in History, Active.com, http://www.active.com/nutrition/Articles/11-Weirdest-Diets-in-HistoryDietary Timeline, Social Issues research centre, http://www.sirc.org/timeline/timeline.shtml

ImAgeS:By Lucky Strike [Public domain], via Wiki-media commons


HospitalRounds

completing eight stages (0-7), hospitals can review

the implementation and utilization of information

technology applications with the intent of reach-

ing stage 7, which represents an advanced elec-

tronic patient record environment.

according to himss, for a hospital to achieve

the stage 6 designation it must:

•Have made significant executive commitments

and investments to reach this stage;

•Appear to have a significant advantage over

competitors for patient safety, clinician support,

clinician recruitment, and competitive marketing

for both consumers and nurse recruitment;

•Have almost fully automated/paperless medi-

cal records when they have implemented their

it applications across most of the inpatient care

settings;

•Be starting to evaluate their data for care deliv-

ery process improvements or have already doc-

umented significant improvements in this area;

•Have made investments that are within reach of

most hospitals and recognize the strategic value

of improving patient care with the ehr;

•Have begun to create strategic alignments with

their medical staff to effectively utilize information

technology to improve the patient safety environ-

ment; and

•Be well positioned to provide data to key

stakeholders, such as payers, the government,

physicians, consumers, and employers, to sup-

port electronic health record environments and

health information exchanges.

aCh & lRsD to offer athletic training support arkansas Children’s hospital (aCh) and the lit-

tle rock school District (lrsD) are partnering to

offer the athletic training services provided by the

aCh sports medicine department at all middle

school and high school football games and prac-

tices starting this fall.

aCh sports medicine athletic trainers will be on

the field for all football games to provide injury

prevention and treatment support to all lrsD

football players. they’ll also provide support for

all basketball games and other home events like

wrestling, soccer, and baseball games. athletes —

from cheerleaders and short stops to goalies and

dancers — will also have access to aCh athletic

trainers during their practices and school days

throughout the week.

hospitalist Joins Chi st. Vincent infirmary matthew law, mD has joined the hospitalist group

at Chi st. Vincent infirmary in little rock.

law recently completed his internal medicine

residency at tulane University health sciences

Center in new orleans. he earned his medical

degree at the University of arkansas for medical

sciences – College of medicine; a master of sci-

ence in Cell & molecular Biology at tulane Uni-

versity and a Bachelor of science in Biochemistry

& molecular Biology at rhodes College in mem-

phis, tenn.

saline Memorial hospital launches oRBERa saline memorial hospital (smh) has partnered

with apollo endosurgery to offer the incision-less,

non-surgical orBera™ intragastric Balloon pro-

cedure to patients living with moderate obesity.

orBera™ is a soft balloon that occupies space

in the stomach. in a non-surgical (endoscopic) pro-

cedure done under a mild sedative, the deflated

orBera™ balloon is placed into the stomach

(only taking 15 minutes to implant), and then filled

with saline until reaching approximately the size

of a grapefruit. the balloon remains in place for a

period of six months, aiding in portion control and

ultimately assisting in sustainable weight loss at a

rate of 3.1 times those who engaged in diet and

exercise alone. there’s no cutting and no incisions.

Bumpass Joins UaMs orthopaedics Departmentorthopaedic spine surgeon David B. Bumpass,

mD, has joined the Department of orthopaedics

at the University of arkansas for medical sciences

(Uams). he is also an assistant professor in the

Department of orthopaedics in the Uams Col-

lege of medicine.

Bumpass completed a fellowship in 2014 at

washington University, in adult and pediatric spine

surgery. he remained at washington University

for an additional year to gain further experience

in complex spinal deformity surgery, one of only

four surgeons in the United states to complete

this training.

Bumpass has received grant funding for multiple

projects and has authored several peer-reviewed

articles. he is a member of the american acad-

emy of orthopaedic surgeons, the missouri state

orthopaedic association, and the north american

spine society.

in his position, Bumpass will split his time

between Uams and arkansas Children’s hospital.

Village Walk for Cancer Research Benefits UaMs CenterGrab your walking shoes and head to the 14th

annual Village walk for Cancer research on sept.

26 in hot springs Village. one hundred percent of

net proceeds from the walk will benefit the win-

throp p. rockefeller Cancer institute at the Uni-

versity of arkansas for medical sciences (Uams).

Cost to participate is $35. participants may

register on the day of the event or in advance

at www.walkforcancerresearch.org. walkers are

invited to participate in memory or honor of a

loved one.

participants will gather at Cortez pavilion and

may walk any distance they desire along the her-

nando trail. in addition to the walk, the event will

feature door prizes, a silent auction, lunch and

live music.

since it began 14 years ago, the Village walk

for Cancer research has raised almost $500,000

for cancer research programs at the Uams Can-

cer institute. as arkansas’ only academic cancer

center, the Uams Cancer institute offers research-

driven care and clinical trials unavailable else-

where in the state. n

matthew law, mD

David B. Bumpass, mD

($/7+&$5( 2851$/ · of Little Rock +($/7+&$5( -2851$/ SEPTEMBER / OCTOBER 2015 I healthcarejournallr.com I $8 OneOn One P r S r t S t D u S P o S ta G e PA ID u S h ea lthcare j o

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