FOCUS TOPICS WOMEN’S HEALTH PRIMARY CARE PRACTICE MANAGEMENT
May/June 2014 December 2009 >> $5
PHYSICIAN SPOTLIGHT PAGE 3
Michael Cassat, MD
SAMA Healthcare in El Dorado Makes Waves Nationally for its Innovative Primary Care Reform
ON ROUNDS
BY BECKY GILLETTE
Reform of Preferred Network Pharmacy Program in Medicare Part D Blocked by Congress Two pharmacies in Eureka Springs were recently left out of a list of preferred networks for Medicare Part D SilverScript, a supplemental drug insurance program by the private insurance company, CVS ... 4
Answering Patients Who Question the Value of Mammograms Mammograms to detect breast cancer have become a very controversial issue with a recent 25-year Canadian study that showed having yearly mammograms didn’t reduce breast cancer deaths in women ... 5
Leslie Collins MLT, is shown working in the laboratory at SAMA Healthcare Services.
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ICD-10 Implementation Expected to Make It Even Harder For Providers to Get Paid BY BECKY GILLETTE
The new medical coding, ICD-10, has been delayed several times. It was scheduled to go into effect Oct. 1, 2014. But at the same time in early April that the Arkansas Medical Group Management Association (MGMA) annual convention in Hot Springs was focusing on this challenge, word came that Congress had voted to delay implementation until Oct. 1, 2015. The delay is a relief to many since preparing for it has been extremely challenging. (CONTINUED ON PAGE 12) COURTESY OF UAMS/TIM TAYLOR
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EL DORADO – SAMA Healthcare Service is in the national spotlight for innovations designed to improve patient care in a state with high poverty levels that ranks next to last in the nation for the health status of its residents. “SAMA is a picture of what primary care could and should be,” said an article by Geoffrey Cowley, “One State’s Healthcare Revolution,” published in March on MSNBC. “The clinic’s four teams, sporting color-coded scrubs, work as units to ensure that each of their patients gets enough care, support and follow-up to stay well and avoid hospitalization. …At a glance, we see that 40 percent of SAMA’s diabetic patients got potentially limb-saving foot exams last year—compared to 10 percent nationally—and that the clinic’s on-site services
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PhysicianSpotlight
Michael Cassat, MD
Sports Medicine physician, Arkansas Specialty Orthopedics “After years of struggling in
BY LYNNE JETER
closer to our family.”
college to find a career, I found
Cassat has also served as a team phy-
What do you get when you
a love of medicine through my
sician for various high school, college, and
mix a chemist dad and RN mom?
time of service,” he explained.
professional athletic teams. He rotates be-
Three sons, all healthcare provid-
“After serving in the military, I
tween the practice’s Sherwood, and Little
ers. Leading the charge: first-born
returned to college to pursue a
Rock locations.
Michael Cassat, MD, a sports
degree in microbiology, and ul-
“As we learn more about hip pathol-
medicine physician at Arkansas
timately entered medical school.”
ogy, research has shown that many of
Specialty Orthopedics, specializ-
After earning a medical
the conditions we see are the likely early
ing in the non-surgical treatment
cause of hip arthritis,” he said. “The ul-
of musculoskeletal injuries.
timate goal is to determine how to better
“My main area of interest is
“
I worked under one of the pioneers of minimally invasive hip surgery in Vail, Colorado, and am excited to continue this work in Arkansas.
in the evaluation of complex hip disorders, and hip preservation surgery,” said Cassat. Cassat frequently collaborates with James Tucker, MD, at
”
Arkansas Specialty Orthopedics to evaluate and treat patients of all ages with hip pain. “We commonly see patients
recognize these injuries early while they’re minimally symptomatic and treatable. Through early recognition of these disorders, we hope to dramatically reduce the overall incidence of hip arthritis. “My personal goal is to continue to refine examination and imaging techniques to improve the quality of
with tears of the acetabular labrum, with
process is critical for excellent outcomes.”
degree from UAMS, Cassat completed
hip impingement, or with hip dyspla-
Over the next year, the number of hip
a family medicine residency at the Area
A native Arkansan and former col-
sia,” he said. “I function in this role for
arthroscopy cases is expected to double in
Health Education Center Northwest in
legiate soccer player, Cassat is the son of
the clinic through careful examination,
the United States.
Fayetteville.
Richard and Susan Cassat. His younger
outcomes after arthroscopic surgery.”
interpretation of imaging, coordination
“Dr. Tucker and I already have years of
“I was always drawn to the care of
brothers are Jeffrey Cassat, RN, an oper-
of physical therapy, and imaging guided
expertise in these complex evaluations and
musculoskeletal conditions in my private
ating room circulator, and James Cassat,
therapeutic and diagnostic injections.
procedures, and reflect the highest level of
practice office,” he said. “In 2011, I had
MD, a pediatric infectious disease special-
Ultimately, if surgical intervention is re-
expertise in the state of Arkansas,” he said.
the opportunity to train in sports medi-
ist. Cassat and his wife, Jennifer have two
quired, Dr. Tucker and I work together as
Even though medicine seemed a
cine under a group of the top orthopedic
children a freshman in college and a son
a team to optimize outcomes. Minimally
natural calling for Cassat, it wasn’t until
doctors in the country at The Steadman
serving in the military. In his spare time,
invasive arthroscopic techniques now
he served in the U.S. Navy as a hospital
Clinic in Vail, Colorado. After spending
the energetic sports medicine physician
allow for repair of many causes of hip
corpsman, providing medical care to ac-
several years in Colorado, I had the op-
enjoys duck and deer hunting, fishing, and
pain, but careful evaluation of the disease
tive duty sailors, before it became his goal.
portunity to return to Arkansas and be
training for triathlons.
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Reform of Preferred Network Pharmacy Program in Medicare Part D Blocked by Congress “In the past, we had always been in the SilTwo pharmacies in verScript’s preferred Eureka Springs were network and were recently left out of a able to serve our list of preferred netcustomers with zero works for Medicare co-pay for generic Part D SilverScript, drugs,” said Danny a supplemental Smith, pharmadrug insurance procist, Smith Drug ... gram by the private Company, Eureka insurance company, Springs. “This year, — Robert Woolsey, pharmacist CVS. The Eureka cuswe weren’t allowed to.” tomers now have to travel “It looks like Silver13 miles to Walmart or EconScript just wants people to go omy Drug in Berryville if they want to a chain,” said Beth McCullough, to get their prescriptions from a preferred owner of Medical Park Pharmacy, Eunetwork pharmacy where costs are lower. reka Springs. “They want them to go to The Eureka pharmacies don’t think Walmart. For people who come to my drug that is fair. They feel the deal benefits the store, their co-pay is no longer going to be largest retailer in the world and other sezero. It is wrong. It is not fair. It discrimilected pharmacies at the expense of small, nates against local pharmacies.” locally owned pharmacies and the people Interestingly enough, Economy Drug – some who can no longer drive or don’t in Berryville is also a locally owned, indehave reliable transportation – who rely on pendent pharmacy, and it is on the Silverthem for medications. Script’s list. But Economy Drug doesn’t like BY BECKY GILLETTE
“
Driving business to one store or another using Medicaid dollars should not be allowed
”
HELP PATIENTS QUIT. Refer your patients to the American Lung Association for smoking cessation options. For questions or more information, contact Laura Frick at 314.645.5505 x1014 or lfrick@breathehealthy.org.
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the preferred network program, either. “We think preferred networks in general are bad for the American public, and they typically only benefit big box stores,” said Gabe Roy, one of the pharmacists at Economy Drug. “The American people should be free to go where they want and get the same co pay. These networks are out there, and we realize they are unfair. But if we don’t affiliate with any Gabe Roy networks, we won’t have any business.” Economy Drug was recently left out of another closed-door preferred network deal involving Walmart and Harps in Green Forest. Economy Drug is now no longer a preferred network pharmacy for the insurance program for Tyson’s, which is the largest private employer in the county. “The whole network system is a farce,” said Robert Woolsey, a pharmacist with Medi-Quik, Ozark. “It is definitely not fair to my customers, nor myself. It is just a tactic by big business to drive the customer population to their pharmacy. It has nothing to do with what is good for the patient or the healthcare system. All independent pharmacists are asking for is a level playing field. We are not asking for more reimbursement. We are not asking for any more payments than a preferred pharmacy.” Woolsey said at some point this inequity will be exposed and when it is, it will be a national news story. “Driving business to one store or another using Medicare dollars should not be allowed,” he said. “It is not fair. It is an attempt to stifle competition. If customers are given a level playing field, they will choose their local pharmacist every time over mail order or chain pharmacies. Study after study shows they will go to where they get better service. Let the consumer make the decision about who wins and loses business.” Preferred networks are a big problem all over the country, said Mark Riley, PharmD, president of the National Community Pharmacists Association (NCPA) and executive vice president and CEO of Arkansas Pharmacists Association. It is a particular issue in rural states like Arkansas. Arkansas is Mark Riley one of only a handful of states that have more independent pharmacies than chain stores. “In my opinion, preferred networks are wrong,” said Riley, “It creates an unlevel playing field not only for pharmacies, but for patients who are locked out of going to their local drug store. I personally feel it is a violation of Medicare’s own policies
regarding not allowing any inducements to move a person from one provider to another. It is inconsistent with its policy.” The Center for Medicare & Medicaid Services (CMS) had determined that the government is not saving any money with the preferred network programs, and had proposed doing away with it. But heavy lobbying in Congress earlier this year overturned that proposed reform. “What is particularly disturbing right now is CMS has finally come to understand preferred networks are not providing the savings they thought,” Riley said. “We worked three years on educating them, and they were going to do away with the preferred networking allowing any pharmacy in the network if it met the terms of payment. “It is disturbing that CMS got it, put out a notice about a rule change eliminating the networks, and there was a fire storm against it in Congress pushed by the big drug store companies and brand name drug manufacturers. The heat got to be too much for CMS.” Riley said large chain pharmacies want preferred networks because they are usually the ones chosen. He said it is frustrating that CMS had the gumption to make the changes, and got politically slammed. NCPA has written a letter to lawmakers asking the Senate and House Small Business Committees to hold a hearing looking into the unintended consequences for patients and independent community pharmacies that have resulted from Medicare Part D “preferred pharmacy” prescription drug plans. NCPA said a patient choice proposal received support from dozens of members of Congress from both parties, but was set aside by CMS March 10 largely as a result of political opposition to other, unrelated provisions contained in the agency’s broader proposed rule. “Over the last several years we have heard increasing concern from our small business owner members in regards to being excluded from participating in Medicare Part D preferred pharmacy networks,” NCPA CEO B. Douglas Hoey, RPh, MBA wrote in the letter. “Many of our members are suffering due to unintended consequences. Small business community pharmacies across the country are losing patients due to their inadvertent exclusion from these preferred networks.” CVS Caremark spokeswoman Christine Kramer said SilverScript meets all of the CMS access standards for Medicare Part D. She said CVS Caremart referred pharmacies are pharmacies in their network where they have negotiated lower cost sharing on covered prescription drugs for members of the plan. Walmart did not respond to requests for comment. medicalnewsofarkansas
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Answering Patients Who Question the Value of Mammograms BY BECKY GILLETTE
Mammograms to detect breast cancer have become a very controversial issue with a recent 25-year Canadian study that showed having yearly mammograms didn’t reduce breast cancer deaths in women from ages 40 to 59. Another study, “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence,” published in the New England Journal of Medicine in November, 2013, concluded that breast cancer was overdiagnosed (tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million U.S. women in the past 30 years. “Screening is having, at best, only a small effect on the rate of death from breast cancer,” said study co-author H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. Gilbert said false alarms are exceedingly high. “Among a thousand 50-year-old American women screened annually for a decade, how many will have at least one false alarm?” Welch asks. “Our estimate ranges from 490 to 670. The data come from the mammographers themselves.” With those studies getting a lot of press, healthcare providers may be getting questions from patients about whether mammography is really worth it. Arkansas experts said the studies should be taken in light of numerous other studies that do show mortality benefits. Another point is that the mammograDr. Issam phy screening equipment Makhoul used today is superior to that used for the women considered in the two studies above. “I can hear both sides of the story,” said Issam Makhoul, MD, a breast oncologist who is an assistant professor at the University of Arkansas for Medical Sciences (UAMS). “Our obligation to the patients is to tell them the good, the bad and the in between. The imaging techniques used 25 to 30 years ago are obsolete. Some studies using these techniques showed benefits to mammography and some didn’t. With better technology, it is likely that we can detect cancer better now and protect patients from dying. We have data from very well-balanced mammography studies showing there can be a 23 percent decrease of the risk of dying from breast cancer.” While mammography can save lives, it can cause harm indirectly, as well. “All of us are walking around with baby cancers that will never become a problem,” Makhoul said. “This is what was found with prostate cancer that it was being overdiagnosed and surgery was commonly being done on cancer that medicalnewsofarkansas
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would never harm anyone.” Makhoul said false alarms can be expensive too, especially if they require a biopsy, and can cause tremendous anxiety. “But we cannot know if these cancers would have stayed quiet or progressed to a full blown disease,” Makhoul said. “Mammography has its limitations, too, as some patients may be diagnosed with cancer in the interval between two tests.” Those skeptical of the benefits of the mammograms argue that if they were effective, you would expect the incidence of advanced stages (3 and 4) breast cancer to have declined. Yet, that hasn’t occurred. Still, Makhoul said there is no question in his mind that mammograms help save Dr. Appathurai many lives and should be Balamurugan considered by all women after certain age. The studies referred to above that showed little mortality benefit were done on women under the age of 50, yet women over 50 are more likely to have breast cancer. “Cancer is a disease of older women,” he said. “Screening is more likely to save lives if the patients are older. You have to remember the lifetime risk is one in eight women get breast cancer, 12 percent. The risk is greater as a woman ages.” Appathurai Balamurugan, MD,
MPH, medical director, Chronic Disease Prevention and Control Branch, Arkansas Department of Health, recommends that healthcare providers faced with questions from women about the benefits of mammography discuss with them the fact that mammograms are still recommended by the National Cancer Institute and the Centers for Disease Control and Prevention. “The U.S. Preventive Services Task Force compiles all these studies and makes universal recommendations,” Balamurugan said. “For example, there is another study from Sweden that shows a 31 percent reduction in mortality from biennial screening mammography. Mammography has shown to provide a 15 percent reduction in mortality for a long time now. Breast cancer deaths can be prevented.” The U.S. Preventive Services Task Force recommends that women ages 40 to 49 discuss with their physicians the pros and cons of screening. After age 50, women need biennial mammography until age 74. As a physician himself, Balamurugan has seen that news about mammogram studies that show no benefit are confusing to women with no medical background, and make them apprehensive. “I always recommend women talk to their physicians about mammography,” Balamurugan said. “Talk about the risks and benefits. It is not one shoe fits all. Other factors that need to be taken into account are a personal or family history of
breast cancer, menopause at a later age, a menstrual cycle that began early, no children, no breast feeding, and a history of being on hormone replacement therapy. Those are some of the factors physicians would assess regarding recommending screening. Empower women by giving them good information, and let them have shared decision-making in screening.” Makhoul said there is no reason to recommend mammograms as mandatory for women at a certain age. In addition to the risk factors mentioned above, he recommends looking at a detailed family history of cancer. Women with a family history of other cancers including colorectal cancer might be predisposed to breast cancer. “I would make it more of a choice from ages 40 to 50,” he said. “At age 50, I would tell a patient to consider it every two years. At 60, I would be more forceful recommending a yearly mammogram.” Tailor the recommendation to the age of patient and the amount of risk. It is important to tell patients about the risk of false positives, over diagnosis and interval cancers. “If we find something, we have to pursue it,” Makhoul said. “This generates a lot of anxiety that sometimes lasts many months if you tell them to come back to be tested again in three or six months. In the majority of cases, it will be false positives, and the patient will have been anxious all this time. Most of the time, it ends up being nothing.”
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When you need it.
Identity as a Risk Factor Heart disease and the feminine mystique BY CINDY SANDERS
Medical professional liability insurance specialists providing a single-source solution ProAssurance.com
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Despite the fact that heart disease is the number one killer of women in America and stroke the leading cause of disability, women often don’t identify with the very real dangers the disease holds for their gender, according to Robert Wood Johnson Foundation Clinical Scholar Lisa Rosenbaum, MD. Dr. Lisa “We all know men Rosenbaum drop dead of heart attacks … we don’t think of women dropping dead of a heart attack,” the University of Pennsylvania cardiologist noted of the masculine attributes often attached to heart disease. Furthermore, women tend to fear other diseases, notably breast cancer, more than heart disease. The HealthyWomen 2010 survey, in partnership with the National Stroke Association and the American College of Emergency Physicians, found that women believe breast cancer is five times more prevalent than stroke, and 40 percent of those surveyed were ‘only somewhat’ or ‘not at all’ concerned about experiencing a stroke. Yet, stroke is significantly more prevalent in women than in men, and stroke kills twice as many women as breast cancer each year. “There’s a certain sort of female solidarity around breast cancer,” Rosenbaum stated. In a perspective piece published earlier this year in the New England Journal of Medicine, Rosenbaum wrote about an encounter with a middle-age woman with high blood pressure and hyperlipidemia. When Rosenbaum asked the new patient what was the number one killer for women, she noted the patient “answered in a way that sticks with me: ‘I know the right answer is heart disease,’ she said, eyeing me as if facing an irresistible temptation, ‘but I’m still going to say breast cancer.’” Rosenbaum is quick to say breast cancer is a valid concern, but the emotions linked to the disease go beyond just the facts. She pointed to the controversy surrounding mammography as a clash between data and identity at the social level. Despite a recommendation from the U.S. Preventive Services Task Force to decrease mammography frequency for most women under age 50 based on decades of data, Rosenbaum wrote, “So intense was the outrage over these evidence-based recommendations that a provision was added to the Affordable Care Act specifying that insurers were to base coverage decisions on the previous screening guidelines.” No matter where you stand on mammography, most healthcare professionals
are united in agreeing lifestyle modifications and appropriate use of medications have been proven to prevent heart disease and save lives. However, Rosenbaum contends that facts alone aren’t enough. Instead, she said the healthcare community needs to find a way to tap into the emotional aspects of heart disease as successfully as has been done with breast cancer. In the her perspective piece, Rosenbaum wrote that although the first decade of educational campaigns such as Go Red for Women “led to a near doubling of women’s knowledge about heart disease, in the past few years, such efforts have failed to reap further gains.” She told Medical News, “Our default in medicine is to give people facts, and then we don’t know what to do when we hit the wall. We know how to disseminate facts … we don’t know how to change feelings.” Complicating the issue with heart disease is that in so many cases it is preventable, and therefore comes with builtin guilt. Risk factors, which have been well publicized, include smoking, obesity, high blood pressure, high cholesterol, and sedentary lifestyle. “All of these are embedded with a sense of not taking care of yourself,” Rosenbaum said. “You should have done something differently.” Conversely, breast cancer is imbued with a sense of having a terrible disease visited upon a victim, which is true. Also, because breast cancer kills more women at a younger age than heart disease, there are multiple media images of beautiful, strong heroines fighting and surviving … or succumbing … to a disease that attacks a body part that is so uniquely feminine. Rosenbaum pointed out Angelina Jolie’s message about breast cancer resonated with women across the nation who saw the actress as a lovely, brave, fierce role model. Again, she stated, it isn’t ‘bad’ that breast cancer has pushed its way to the front of female consciousness. It’s smart … and perhaps it’s the type of message the field of cardiology should consider to reach more women. However, Rosenbaum said it isn’t fair to ask healthcare providers to try to change identity beliefs in a brief office visit. Instead, she said the subject requires research regarding social values and group identity. Ultimately, Rosenbaum added, cultural messaging will likely come from a variety of sources including media outlets. Today, she said, “Our biggest challenge is translating what we know into better health of our population. The next phase of evidence based-medicine should be as much about figuring out how to communicate that evidence to our patients … to do that we have much to learn from the methodological approaches of (CONTINUED ON PAGE 8)
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Better Operations from Better Compliance BY ANGELA MILLER, CHC, CMC
The OIG has had compliance program guidance since the early 1990’s for Physician Group Practices and other types of providers such as hospital, DME. With the Healthcare Reform Act and Patient Protection Affordable Care Act, a Compliance Program is required since 2013. The required compliance program should follow the OIG Compliance Guidance for your physician practices. An effective compliance program will develop a risk assessment and audit protocol to monitor the business’ activity to prevent fraud and abusive activities. The program will also ensure contracts and relationships comply with federal Stark Law and Anti-kickback Statute. Keep in mind a physician practice has to maintain compliance for several areas such as HIPAA Privacy (2003) and HITECH security (2009) which also includes the Omnibus Rule (2013), OSHA standards, Human Resource Processes, licensing requirements and more. Each program has very specific elements that must be implemented to be “effective and active,” including a program manager(s), support from the top down, standards of conduct, policies and procedures, training, monitoring and more. As you can see there are many pitfalls that are possible. Without compliance the business operations will suffer one way or the other. HITECH Security is beyond your billing system. It looks to whether or not someone can hack open ports in your server, what employees are saving on their PCs and mobile devices and are the devices encrypted, who has access to PHI and e-PHI, are staff emailing PHI and more. This is a very intensive process of examining the IT infrastructure and does require knowledge and understanding of HIPAA and HITECH rules. The Office for Civil Rights (OCR) as well as the Office of Inspector General (OIG) will be auditing to ensure compliance with the HIPAA and HITECH provisions. Security audits include wrongfully attesting to Meaningful Use or not maintaining meaningful use guidelines for the money a provider was paid for their Electronic Medical Records system and are prosecuted under the Federal False Claims Act which includes a treble damages penalty. HIPAA Audits are increasing mainly due to the number of breaches being reported and the penalties are steep considering the cost of monitoring in a proactive manner. A breach can be anything where PHI ends up in the wrong hands such as but not limited to stolen or lost mobile devices containing PHI. Omnibus Rules expands all the privacy and security rules to Business Associates. A business associate is anyone who may have potential access or need to see protected health information such as consultant, attorney, billing companies, etc. Providers must have a business associate agreement updated in 2013 with the new medicalnewsofarkansas
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rules. Providers must keep a log of all business associates, date, and purpose at a minimum. OSHA rules for work place safety, signs as appropriate for your business must be maintained and training performed with staff. Human Resource Compliance ensures that you perform all verification prior to hiring, complete all the necessary forms, completed your new hire process and checklists, employee evaluations are performed, employees disciplined accord-
ingly, consistency, and all must comply with federal and state laws. All the programs require the need for monitoring the processes to ensure they start and stay compliant. This auditing process will include reviewing billing revenue reports, selecting a sample of claims to ensure the documentation is sufficient to warrant the evaluation and management code billed and services provided, patient records for privacy acknowledgement and appropriate consent or authorization, if applicable, IT network and devices audit
at least annually, meaningful use compliance, inspection of the OSHA items that are appropriate for your office, employee records to verify they have been checked against the sanction provider databases, and all employee training has been completed. Keep in mind, if the audit results in problem areas that need to be corrected, ensure those issues are corrected and documented education is provided. Using compliance to improve your business operations is essential and will (CONTINUED ON PAGE 8)
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Brain & Behavior, an Odd Couple: News from the Outskirts of Psychiatry, Epidemiology and Neurosciences. Older fathers and the risk of psychiatric disorders in their offspring By ERICK MESSIAS, MD, PhD For many decades, the most wellknown association between parental age and offspring outcome was the relationship between advanced maternal age and the risk of Down syndrome in the youth. Over the last decade, since the pioneer work of Dolores Malaspina in the early 2000’s, there has been an increasing awareness of the relationship of advanced paternal age and the risk for a variety of mental health diagnoses, most commonly schizophrenia. This fact should not be surprising as in mammals the vast majority of new mutations into the gene pool are actually introduced by the males, due to their constantly dividing spermatogonia accumulating mutations as we age. In an average male, by the age of 40 the germ cell precursors will have undergone 660 divisions, while the number of such divisions in females is usually 24, all but the last occurring during fetal period. These new mutations, introduced by males as they age, has been associated with a number of diagnoses, such as achondroplasia, Apert syndrome, and progeria. With schizophrenia being considered a complex brain disorder, how could we study such an association? It turns out that a number of small epidemiological studies, in the 1950s and ’60s, had called attention to the fact that patients with schizophrenia seemed to have later paternal age. That finding was then forgotten until the late 1990s when Malaspina and her collaborators decided to take a second look at that association in a large population-based birth cohort in Israel, the Jerusalem Perinatal Study. They linked the data from that study to the national registry of psychiatric illness maintained by the State of Israel. Looking at this detailed, comprehensive, and reliable source they calculated the incidence of schizophrenia stratified by parental age. They found that fathers in the youngest category (those under 25 years of age) had the lowest incidence of schizophrenia diagnosis in their offspring (2.5/1000) and
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that that incidence increased progressively as they looked at older fathers by 5-year increments, to 3.5 per 1000, 3.7 per 1000, 4.4 per 1000, 4.6 per 1000, and 5.0 per 1000, reaching 11.4 per 1000 in the offspring of fathers 50 years or older. They also looked at maternal age and did not find any such risk. Since that initial report, published in 2001, there have been over 20 studies looking at the relationship between advanced paternal age and schizophrenia. In 2011, we were able to summarize data from 12 such epidemiological studies – both cohorts and case-controls – into a meta-analysis examining schizophrenia risk and paternal age. Looking at all these studies combined, we found a consistent increased risk for offspring schizophrenia as paternal age increased until the maximum risk category which included fathers fifty years of age or older. The increased risk appeared significant as early as 30 years of age with the highest risk being for those with fathers over 50 years of age. Also in 2011, another meta-analysis was published supporting the hypothesis that advanced paternal age is also a risk factor for autism in the offspring. In reviewing all the autism data the authors estimated that offspring of men over the age of 50 had more than double the risk of autism (a relative risk of 2.2 in statistical/epide-
miological terms) compared to children of men younger than 30; these estimates were controlled for maternal age and other know autism risk factors. All these findings lead to a more recent, and thought provoking, study recently published in JAMA Psychiatry. In that study, John McGrath – an Australian epidemiologist expert in schizophrenia risk factors – and a team from Denmark used the magnificent national registry of that Scandinavian country. Data on over 2.8 million people, born in Denmark between 1955 and 2006, were included. Since they had complete data on parents age as well the medical history of each individual, the effects of parental age – both parents – was analyzed and the risk estimated, not only for schizophrenia but for a broad range of psychiatric diagnosis. At first look it seemed that those born from both younger and older parents, compared to parents between ages 25 and 29, were at higher risk for a psychiatric diagnosis. However, at closer examination, a more nuanced, and interesting, picture emerged. First, not all psychiatric disorders are linked to early or advanced parental age as diagnoses such as schizoaffective disorders, eating disorders, and bipolar disorder, showed negligible or no such association. Second, fathers with advanced age seemed in deed to have a higher risk of having off-
Better Operations, continued from page 7 improve efficiency, cash flow, and keep your business “between the ditches.” Effective compliance programs will also ensure the company is meeting all federal and state laws, the coverage criteria for the services you provide which will reduce risk for overpayments in audits, reduce the provider’s risk for criminal charges and help keep penalties to a minimum. You can use the compliance program as a marketing point to referral sources because providers do not want to risk referral business to a company that is unethical or not compliant which may cause the “Badges” to show up at their office as a secondary investigation or even for questions. As a former compliance officer, I developed a compliance program that reflected the personality of the company and the executive team. This saved the company when we disclosed we had a rouge employee who violated federal law. I also focused on working closely with billing to ensure we all stayed current on education and changes with payers. Have you started on your compliance programs? The programs are required and upon audit or investigation, especially,
the government is not giving lenience for not having put programs into place. Failing to have compliance programs in place could result in the government pursuing criminal charges, which sounds as painful and expensive as it really is unfortunately. Here is the good news, if you pull the OIG Compliance Guidance and work plan for 2014, this will help you outline a program if you need to do the program yourself. Office for Civil Rights has sample Privacy Notices and other forms. A consultant or your healthcare attorney can review what you have done as part of the independent audits of these programs to give you an assessment of your program. This will help your compliance or regulatory officer develop changes and improve the efficiency of the program. An efficiency and effective set of compliance programs will improve the company’s operations and reduce risk. Don’t look at compliance programs as “cost centers but rather “reward programs” for your company! Angela Miller, CMC, CHC, is president of Medical Auditing Solutions LLC. Contact her at www. MedicalAuditingSolutions.com
spring with schizophrenia or autism – in their study advanced paternal age was defined as 45 years of age. Third, children of younger mothers seemed to have an increased risk of hyperkinetic disorders, like attention-deficit disorder, as well as behavioral and emotional disorders with onset in childhood and adolescence. Fourth, children of younger parents – both father and mother – are at increased risk of psychiatric problems associated with the use of alcohol and other psychoactive substances. These observations coming from large epidemiological studies confirm the impression that we have a lot to learn by observing populations as they live their lives. Results like the ones described above can link to genetic mechanism – like the hypothesis that de novo mutations that may be emerging in the male germline – as well as the difficulties and tribulation of teen pregnancy, with all its social, cultural, and economic determinants. We have to be aware of these associations, think about the complexity of our human existence, and hope we can help each other and become a better society for all. Erick Messias, MD, PhD, is the medical director of the Walker Family Clinic in the University of Arkansas for Medical Sciences’ Psychiatric Research Institute and an associate professor in the UAMS Department of Psychiatry.
Identity as a Risk Factor, continued from page 6 the social sciences.” Rosenbaum added the starting point to address women’s perceptions of heart disease should be to conduct focus groups to evaluate where emotional beliefs currently stand and assess the impact of framing messaging in different ways. “This is decades worth of work,” she stressed, “to ultimately understand not just how they feel and where those feelings come from, but to evaluate whether there are appropriate interventions that help women adopt more heart-healthy behaviors.” While heart disease might have a decidedly masculine feel, there’s no reason why research can’t point to ways to soften the message and appeal on an emotional level to women, as well. After all, women are often identified with their capacity to love … the trick will be finding the right words to help a woman celebrate her big heart while being cognizant of the dangers that come with having an enlarged one.
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Success.
After beating liver cancer, UAMS has Carroll Martindale back in the swing of things.
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n 2010, Carroll Martindale should have been waiting for a tee time at his favorite golf course. Instead, he was waiting for something entirely more important: a new liver. After being diagnosed with liver cancer, Carroll was told he was a candidate for a transplant. While waiting for a donor, he underwent life-prolonging chemotherapy and radiation treatment at the UAMS Winthrop P. Rockefeller Cancer Institute, Arkansas’ official cancer research and treatment facility. Three years later, the call came and Carroll returned to UAMS for a successful liver transplant. Today, he is healthy, back on the course and thankful that the best things in life are worth waiting for.
Visit cancer.uams.edu or call: 501-526-2272
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SAMA Healthcare in El Dorado Makes Waves Nationally, continued from page 1 prevented 880 emergency room visits, saving the system a quick $2.6 million.” SAMA has also been profiled twice in Comprehensive Primary Care (CPC), an Initiative of the Center for Medicare & Medicaid Innovation. “Sometimes Arkansas feels like it’s five years behind everyone else,” Gary Bevill, MD, a SAMA physician partner, said in the CPC newsletter. “But not us. Our partnership has always pushed the envelope, and we see this as the cutting edge of where medicine is going.” The program has already seen a far greater payback than the initial $500,000 grant received from Medicaid\Medicare for the patient-centered medical home model initiative. The program makes patient care a team approach with a focus on making sure there are good transitions between a hospital or nursing home and home, and that patients receive the preventative healthcare they need. “We are part of the CPC Initiative being piloted in three or four states,” said SAMA Practice Administrator Pete Atkinson. “In addition to working with Medicare and Medicaid, Blue Cross Blue Shield of Arkansas and QualChoice are participants in the project. We are transitioning from a reactive healthcare system to a proactive healthcare system. The physician fo- Pete Atkinson cuses on what the patient is there for, and the care coordinator is able
Team Bevill at SAMA Healthcare includes (l to r) Amanda Garcia, LPN, LoToyia Pickett, LPN, Gary Bevill MD, Leanne Glidewell, APRN, Lorrie Rapp LPN, and Candy Cates LPN (Care Coordinator).
The four different teams at SAMA Healthcare wear different colors of uniform to help patients identify the team they are seeing. Shown above are care coordinators Yolanda Moody, LPN, Team Callaway (purple); Amelia Dolden, LPN, Team Hatley (red); Candy Cates, LPN, Team Bevill, orange; and Britni Jones, LPN, Team Sheppard (blue)
to focus on preventative care.” One of the biggest changes with the new initiative was hiring of four care coordinators who help handle transitions and educate people about when it is appropriate to go to the emergency room (ER).
That effort has been highly successful. It can be difficult to say exactly how much it might save to catch a cancer early when it is easier to treat as opposed to an advanced cancer. But it is certain it prolongs lives and reduces suffering.
Coming Soon! Register online at
“It has not just reduced costs, but perhaps has saved lives,” Atkinson said. “We have already found several cases of colon and breast cancer very early. If you are a woman who is 45 and hasn’t had a mammogram, they are going to make sure that happens. Colorectal screening is a big one, as well.” One of the first things SAMA did was create teams. Teams are made up of a doctor, a nurse practitioner, three LPNs and a care coordinator. Each team wears a different color uniform. “Patients are actually associating with their team,” Atkinson said. “It is working the way it is supposed to. It is almost like a sports team with patients cheering on their team. The team helps with continuity of care. When a doctor goes on vacation, patients will still see that same team. Each team knows their patients rather than bouncing patients around from practitioner to practitioner. With the teams, we feel like we can do a better job of knowing patients when they walk in the door.” Nancy New, clinical informatics coordinator, is responsible for running reports to check SAMA’s quality measures to see how well they are taking care of patients including getting them in for preventative services. “I’ve been in healthcare for 20 years,” New said. “I think it is pretty exciting. There is no one else in our area that is doing anything like this. Patients like being able to talk to the same person each time they come in. We certainly wouldn’t be able to do it without our EMRs (electronic medical records), which we’ve been on for 12 years. We were one of the first ones in the state to have EMRs. That tool in itself is huge in being able to provide quality care and continuity of care for the patients. All of our quality measures are run from that system, which helps us track our progress and how we are taking care of our patients.” SAMA uses the EMR Allscripts, which includes a risk stratification feature that allows nurses to mark records and the physician confirm the stratification during the patient visit. Nurses review records for the next day’s appointments to risk stratify patients and make sure preventive care screenings are current. Allscripts has a clinical decision support feature that notifies the staff of needed screening or diagnostic tests. If screenings are needed, patients can visit the in-house lab at SAMA prior to the appointment. The four physicians at SAMA and a staff of about 45 take care of about 19,000 patients. SAMA has been recognized by the Arkansas Surgeon General Joe Thompson for its innovative approach to healthcare.
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Compliance Affordability a Sticking Point BY LYNNE JETER
A conversation several years ago about the delayed but still looming ICD10 conversion and other billing and coding challenges prompted Mike Sacopulos, JD, to create affordable compliance plans for small to midsize physician practices. “ICD-10 is a game changer,” said Sacopulos, founder and president of the Medical Risk Institute (MRI), based in Terre Haute, Ind. “As Mike practices struggle to adapt Sacopulos, JD to ICD-10 standards, we should anticipate mistakes and difficulties will arise. A coding and billing compliance plan will assist the practice in this time of transition. Compliance education and selfevaluation through software analysis will also reduce exposure to the practice.” Sacopulos became intrigued with putting together a coding and billing compliance package with a reasonable price tag after talking with a colleague, Karen Zupko of KarenZupko & Associates, a nationwide consulting firm that works with hundreds of practices on proper coding procedures. “We noticed that many practices needed compliance plans, but there wasn’t a cost-effective solution on the market,” he
said. “Larger practices and hospitals have the infrastructure to establish compliance plans and proper training. But those tasks are far more difficult for small to medium size practices. Also, the Office of Inspector General’s stepping up enforcement efforts – a record number of claims were brought by the OIG for coding and billing fraud and failures to comply with applicable standards in 2013 – provided a good base. To me, the need and the timing seemed to merge to call for an affordable solution.” The process starts with a practice completing a questionnaire geared toward determining its compliance needs. From this, a coding and billing compliance plan is tailored to meet the practice’s needs. Next, training is offered to staff on compliance issues. The package also makes use of a software tool that helps the practice see how its coding compares to other practice of the same specialty located in the same state. Additionally, the package includes ongoing support and education for a year, said Sacopulos. “The idea is to provide a turnkey compliance service to practices,” he emphasized. Various companies, such as Medical Compliance Plus and Practice Support Resources Inc., offer compliance documents in template form. “We differ from this approach in that we fit the compliance plan to the prac-
tice,” he explained. “In my opinion, a 180-plus page book full of template documents is the legal equivalent of playing Go Fish. Practices are busy; this is a complex topic. That’s why (we) tailor documents and supplies ongoing support via a telephone hotline. On the other end of the spectrum are specialty consulting or legal firms that can custom design documents and supply individualized auditing services. Some of these firms are top notch, such as Horne LLP, but they’re often beyond the financial reach of smaller practices. We try to balance the need for individual attention with economic reality.” Around the same time the Office of Civil Rights (OCR) announced it was resuming random HIPAA audits, it dispatched 1,200 notices following a pilot program that revealed nearly 90 percent of surveyed practices, hospitals and other covered entities weren’t HIPAA-compliant. “We should expect heavy fines to be levied,” said Sacopulos. “The OCR claims to collect $8 to $9 for every dollar they spend/invest on enforcement. That alone should make us want to hide under our beds.” Prior to 2012, there were no random HIPAA audits. The system was complaint and notice driven. In 2012, with the help of an outside consulting firm, OCR launched a pilot program of random audits of medical practices and other covered
entities. Approximately 130 entities were audited, noted Sacopulos. “That’s a small numerator when compared to the enormous denominator of all the medical practices, hospitals … around the country,” he said. “We’re now seeing the expansion of the random audit program initially by a factor of about 10. We should expect these audits to become far more routine in the future.” Outside the random audit program, MRI is seeing a significant interest in the enforcement of HIPAA regulations at both the state and federal level. “OCR has trained every state’s Attorney General’s Office on enforcement,” said Sacopulos. “Recently, we’ve seen the Federal Trade Commission bring action against a medical provider for failure to safeguard patient information. If that wasn’t enough, plaintiff law firms are now filing private civil actions patterned from failures to meet HIPAA standards. Practices need to place the review their HIPAA compliance effort towards the top of the to-do list.” Sacopulos described ICD-10 conversion preparation and increased activities of the Office of Inspector General (OIG) as “mixing to create a perfect storm.” “In large part, this is why we believe it’s never been more important to have a current and comprehensive approach to compliance,” he said.
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ICD-10 Implementation, continued from page 1
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“Medical coding has long been one of the biggest challenges we face when running a medical practice,” said Kelley Suskie, MHSA, FACMPE, administrator, Department of Pathology, University of Arkansas for Medical Sciences, who is the current president of the Arkansas MGMA. “Receiving payment from an insurance company hinges on stringent rules Kelley Suskie set by each payer. Now with this new code set, that challenge is amplified and the timing of its implementation has only made it worse. With many medical practices implementing new electronic medical record (EMR) systems while trying to get reimbursed by the government for using the EMR system meaningfully, ICD-10 training has not been the only administrative challenge healthcare workers are facing.” When ICD-10 comes in to replace ICD-9, it will create 55,000 additional codes to choose from. Right now there are 14,000 codes; with ICD-10, there are going to be 69,000 codes. The greater detail in the new coding will be a huge challenge, Suskie said, because not only are there new codes to choose from, but also new questions to ask the patient with more detailed documentation in the patient’s chart. “If you have an issue with a patient’s arm, it won’t just be the left arm, but the upper left arm,” Suskie said. “So it is going to create greater detail. We have to bring everybody up to speed as far as training them how to look up these codes and be in concert with the health insurance companies and Medicare\Medicaid to make sure they are accepting what we are sending them as far as all the digits.” Currently ICD-9 uses three to five digits. IDC-10 goes from three to seven digits. Suskie said there are significant implementation costs for the coding program required by the Centers for Medicaid & Medicare Services (CMS) that is also used by insurance companies. “There is a good bit of concern from our members about ICD-10,” Suskie said. “It is much more complicated and prone to errors. We also have to make sure our systems are in line to accept the codes. This is just going to magnify all the issues we have now with providers getting paid. Smaller practices don’t have as many resources to comply with ICD-10. They have one coder and that coder has to figure it out by himself/herself. But it is an issue across the board, no matter what size the practice is. This is an issue that doesn’t discriminate.”” One of the additional costs is due to providers having to pay for Certified Coding Certification for their employee(s). People who assign the codes have to sit for a test to be certified. Suskie said with ICD-10, it is important to have a good software vendor. “Now most of us have gone to EMRs,” she said. “Part of HIPAA was we transitioned to EMRs. That is an-
other item that we discussed at our annual conference in April in Hot Springs. With HIPAA, computer security is critical. You just don’t realize how fast it can get out of hand. Your systems have to be intelligent enough that, if there is a breach, you can go back and document everywhere that patient’s record has been.” Another practice management issue that impacts physicians is value-based purchasing, which is part of the Patient Protection and Affordable Care Act. Suskie said because it is imperative to economize on rapidly skyrocketing medical costs, there is a major effort to change the way healthcare is delivered. Those include pay-for-performance models where payers are interested in not just getting patients well, but keeping them well. “There is greater use of the patientcentered medical home model, taking care of the patient overall, and not just their current disease,” Suskie said. Rarely have so many changes been made in American healthcare at such a rapid rate. In Arkansas, more than 100,000 people were added to the Medicaid private option expansion earlier this year, and many others in the state transitioned to different healthcare plans. It has created a lot of additional paperwork. “If all the parts are not in place, if you don’t send them the exact information or credentialing falls out, there can be issues with delayed payments,” Suskie said. “With all the changeover, lots of things happen. It created a cash flow issue. You weren’t getting paid on time. Patients come in and are confused. They are not sure what to do to sign up. A lot of practices have had to help educate patients on the new options available to them. The new private option in Arkansas has generated some confusion.” Hospitals and physicians are paid for the services provided on separate fee schedules. Hospitals get paid a DRG (diagnosis related group) rate based on a set amount for a specific illness. “On the physician side, there is still a fee for service, but that is something that is probably going to be changing with the new healthcare law,” Suskie said. “That is unnerving, but we know that the healthcare system can’t sustain itself with the current level of spending. We understand that, but it is a challenge to understand how it is going to work with the new payment models.” The Arkansas MGMA is an affiliate with the national MGMA that is 25,000 strong. In Arkansas, there are about 200 members across the state, the majority of which are small group practices in private offices.
To Learn More: Go online to http://www.arkansasmgma.com/ http://www.cms.gov/ Medicare/Coding/ICD10/index. html?redirect=/icd10
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GrandRounds Public, Private Collaboration Announced for UAMS Northwest A public and private collaboration was announced to help fund a physical therapy academic program, an internal medicine residency and related programs at the University of Arkansas for Medical Sciences (UAMS) Northwest campus in Fayetteville. UAMS officials were joined at its regional campus by supporters and state legislators to celebrate more than $2 million total in gifts from individuals and foundations as well as economic development grants supported by area legislators. The funding is being used for renovation and construction of facilities as well as program support. The grants were awarded to UAMS by the Northwest Arkansas Economic Development District and the Western Arkansas Planning and Development District from surplus state funds allocated to the districts this year by the state Legislature. A physical therapy clinic, to open in late 2014, is being built at UAMS Northwest, where faculty therapists will provide care for patients and eventually offer hands-on clinical experiences for UAMS physical therapy students in the Doctor of Physical Therapy program. The program expects to welcome its first 24 students in 2015. It is part of the UAMS College of Health Professions and is the first UAMS academic program to be housed solely on its Fayetteville campus. The three-year postgraduate internal medicine residency program at UAMS Northwest will increase the number of new physicians starting their careers in the state. The program, now working toward accreditation, hopes to admit its first group of eight physicians in July 2015. The internal medicine residency program will have 24 total residents — admitting eight per year — who will serve in five hospital systems across the region. They will join UAMS family medicine, pharmacy and psychiatry residents already completing their training in northwest Arkansas. In addition, some of the grant funding will be used to create a sports medicine fellowship at UAMS Northwest to give physicians specialized training in physical fitness, treatment and prevention of injuries related to sports and exercise. About 10,000 square feet on the UAMS Northwest campus is being renovated for teaching and administrative space for the physical therapy program. Students will take advantage of existing UAMS Northwest resources, such as the simulation lab for exercises involving simulated patients. The students also will participate in team-based multi-disciplinary opportunities where they will learn alongside students from the other programs at UAMS Northwest. Once the three-year physical therapy program is at full enrollment, 72 students in 2018, annual revenue from tuition and the faculty-run clinic is expected to cover operational expenses. medicalnewsofarkansas
.com
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GrandRounds NARMC Welcomes New Director of Cardiac Rehabilitation North Arkansas Regional Medical Center proudly announces that Jean Marie Mulloy, APRN has accepted the position of Director of Cardiac Rehabilitation. Mrs. Mulloy comes to NARMC from Baptist Health Rural Health Clinic Jean Marie in Clarendon/Stuttgart, Mulloy AR. She was also previously employed at Hospice Home Care of AR and XL Health in Baltimore, MD. Mrs. Mulloy has a Masters in Science of Nursing and is a Board Certified Family Nurse Practitioner. Mrs. Mulloy’s associations and accomplishments include; Alumni Association of University of Central Arkansas (UCA), American Association of Nurse Practitioner, Sigma Theta Tau Honor Society of Nursing, Cum Laude Undergraduate (UCA), and Program Scholar in the Family Nurse Practitioner Program at Arkansas State University.
Arkansas Mutual Insurance Company Funds Annual Award At UAMS An annual $10,000 award has been created by Arkansas Mutual Insurance Company and the University of Arkansas for Medical Sciences (UAMS) to be given to a third-year medical student with an interest in rural primary care. The award, called the Arkansas Mutual Medical Student Award, will first be awarded this summer. The award will go to a third-year medical student with financial need that was born, raised or otherwise considered to be “from” Arkansas. The student will have expressed an interest in rural medicine and primary care, and also will have demonstrated an ability to excel in patient communication and patient- and family-centered care. The recipient of the award will be selected in compliance with the policies of UAMS and the College of Medicine. Arkansas Mutual Insurance Company, a nonprofit organization, is the only medical liability insurance provider that is headquartered in Arkansas and dedicated to serving only Arkansas-based medical professionals. Founded in 2008, Arkansas Mutual is owned and governed by its physician policyholders. For more information go to www.arkansasmutual. com.
One in 65 Arkansas Children Has Autism Spectrum Disorder One in 65 Arkansas children has been identified as having Autism Spectrum Disorder (ASD), according to a new report by the Arkansas Autism and Developmental Disabilities Monitoring (AR ADDM) Program of the University of Arkansas for Medical Sciences (UAMS). The new Arkansas numbers are the
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first since a 2002 count and are part of national data released today by the Centers for Disease Control and Prevention that was gathered from the national ADDM network. The 2002 count estimated that one in 145 Arkansas children were identified with autism. The new state estimate is based on information collected from health and special education records of children who were 8 years old and living in Arkansas in 2010. The Arkansas monitoring program, in collaboration with the Arkansas Department of Health, is one of only two sites in the ADDM Network to track autism in an entire state and the only site that continues to do so. The AR ADDM data found that boys are four times more likely to be identified with autism than girls. Also, white children are more likely to be identified with ASD than black or Hispanic children, and 23 percent of children identified with autism had not yet been classified as having it by a community health care or education provider. UAMS pediatricians treat children with ASD at the UAMS Dennis Developmental Center. Based on the data, Arkansas already is taking action to allocate increased funding for autism services, reviewing curriculum changes to meet the needs of students with autism, offering a graduate level autism curriculum for students seeking a master’s degree in special education and certification in behavioral analysis. The state also is engaged in initiatives to improve screening for autism and support for parents, educators, law enforcement and mental health professionals. AR ADDM relies on close collaboration with more than 250 education and health care providers throughout Arkansas to obtain complete and accurate data. The statewide monitoring program covers the second-largest population base and the largest geographic area in the national network. Research team members in some cases must travel more than 500 miles to visit data sources.
UAMS First in State with Ultra-Rapid Diagnostic Device and Automation Tool The University of Arkansas for Medical Sciences (UAMS) recently became the first hospital in Arkansas to acquire a breakthrough device that can identify microorganisms in a fraction of the time and cost of conventional diagnostic methods. The recent purchase of a matrix-assisted laser desorption/ionization timeof-flight mass spectrometer, or MALDITOF, is making obsolete some age-old clinical microbiology lab techniques at UAMS, said Eric Rosenbaum, M.D., M.P.H., medical director of the UAMS Clinical Microbiology Laboratory. UAMS is also the first in Arkansas to purchase a companion to the MALDITOF, called the PreviIsola, Rosenbaum said. This new tool introduces lab auto-
mation into UAMS’ microbiology laboratory, an area that has been difficult to automate. The MALDI-TOF can identify 192 bacterial colonies within minutes. That compares to hours and often days using conventional analytic methods that are standard in the majority of laboratories around the world. MALDI-TOF is a nearly instantaneous one-step process that eliminates the time-consuming tasks of tracking how bacteria colonies metabolize various sugars or how well a bacteria colony grows on different types of media. The new device allows a laboratory analyst to simply gather a small amount of a bacterial colony, place it on a slide, and cover the colony with a protective matrix compound. After the slide is loaded into the MALDI-TOF instrument, a laser is fired at the sample, releasing a plume of ionized particles from the specimen that travels through a time-offlight (TOF) chamber until the particles reach a sensor. Each bacterium, yeast, and fungus analyzed produces a unique spectral “fingerprint” on the sensor that is matched to a database. The result is instant identification. In addition to helping UAMS, the MALDI-TOF device will be offered as a diagnostic service and resource for other Arkansas hospitals, serving as an alternative to the large commercial laboratories in other states.
Dr. Angela Green Promoted to Vice President/ Performance Improvement at ACH Angela Green, PhD, APRN, NNPBC, has been promoted to vice president of Performance Improvement at Arkansas Children’s Hospital (ACH), according to ACH Senior Vice President and Chief Medical Officer Dr. Jay Deshpande. Dr. Angela Green joined ACH Green in 1998 as an advanced nurse practitioner in the cardiovascular intensive care unit (CVICU). Recently, she served as interim senior vice president/ chief nursing officer. Prior to the interim CNO position, she served as director of Professional Practice, where she provided leadership for professional nursing practice, including clinical education, nursing research, and evidence-based practice. Green holds the John Boyd Family Endowed Chair in Pediatric Nursing. A native of Daphne, Ala., Green received her bachelor of science in nursing from Auburn University, master of science in nursing from the University of South Alabama, and doctor of philosophy from the University of Arkansas for Medical Sciences. She is nationally certified as a neonatal nurse practitioner (NNP-BC).
PUBLISHED BY: SouthComm, Inc. CHIEF EXECUTIVE OFFICER Chris Ferrell ASSOCIATE PUBLISHER Rebekah Hardin rhardin@medicalnewsofarkansas.com Ad Sales: 501.580.8903 NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR Becky Gillette bgillette@medicalnewsofarkansas.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS
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Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Operating Officer Ron Jiranek Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director Of Digital Sales & Marketing David Walker Director Of Accounting Todd Patton Creative Director Heather Pierce Director Of Online Content/Development Patrick Rains Medical News of Arkansas is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2014 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.
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ARKANSAS MUTUAL Industry Experience
38 years
6 years
Arkansas Experience
25 years
6 years
A.M. Best Rating
A (Excellent)
Not rated
A.M. Best Rating History
A (Excellent) or better for 30 consecutive years
None
Operations
Managed 100% in-house with some of the lowest expenses in the country
Managed pursuant to a contractual agreement with an affiliated entity that is partially owned by management of Arkansas Mutual and outside investors
Percentage of premium spent on operating expenses
17%
66%
Surplus as regards policyholders
$496.7M
$2.8M
Total dividends returned to Arkansas physicians
$13.5M
$0
Dividends returned to Arkansas physicians in the last five years
$8.6M
$0
Dividends returned to Arkansas physicians in the last five years as a percentage of premium
9%
0%
This chart contains information extracted from the December 31, 2013 Statutory Annual Statements of each company and from other publicly available sources.
Who would you trust to be there when you need to defend your professional reputation? Looking at the numbers, there is no comparison. When it comes to your medical professional liability insurance, it pays to do your homework.
Mutual Interests. Mutually Insured. Contact Sharon Theriot at sharon.theriot@svmic.com or call 1-800-342-2239. Follow us on Twitter @SVMIC
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Good medicine deserves the best defense We know good medicine when we see it, and we’re determined to defend it. MagMutual’s Claims Committees consist of physicians just like you. They review cases with the same care they’d wish for their own. We hire the top local attorneys who are guided by our local expert claims specialists. And we won’t settle a claim without your consent. What else would you expect of a physician-owned, physician-led company?
Medical malpractice insurance for Arkansas physicians These agents are experts on the products and services MagMutual offers in Arkansas: Ken Bennett MagMutual 888-892-5211 kbennett@MagMutual.com
Judy Englehart Regions Insurance, Inc. 479-785-5222 | Regions.com
MagMutual.com
Insurance products and services are issued and underwritten by MAG Mutual Insurance Company and its affiliates.
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